The burden of occupational cancer in Great Britain · 2019. 12. 5. · Great Britain • to produce...

Health and Safety Executive

The burden of occupational cancer in Great Britain Overview report

Prepared by the Health and Safety Laboratory, the Institute of Environment and Health, the Institute of Occupational Medicine and Imperial College London for the Health and Safety Executive 2012

RR931 Research Report



Lesley Rushton Sanjeev Bagga Ruth Bevan Terry Brown John Cherrie Phil Holmes Lea Fortunato Sally Hutchings Rebecca Slack Martie Van Tongeren Charlotte Young Gareth S Evans

This project aimed to estimate of the current burden of cancer for Great Britain due to occupational exposure to carcinogenic agents/ exposure circumstances. The measure of the burden of cancer used was the attributable fraction (AF) i.e. the proportion of cases that would not have occurred in the absence of exposure. Data were obtained on the risk of the cancer for each exposure, accounting for confounding factors, and the proportion of the population exposed over the relevant exposure period. Carcinogenic agents/exposure circumstances, classified by the International Agency for Research on Cancer as definite (Group 1) or probable (Group 2A) human carcinogens were considered. Overall estimates are presented for cancer registration (incidence) data in 2004, and mortality data in 2005.

The estimated total (male and female) AF and deaths related to overall occupational exposure is 5.3%, giving 8010 attributable deaths (men: 8.2% (6355); women 2.3% (1655)). The estimated total (male and female) AF and registrations related to overall occupational exposure is 4.0%, giving 13598 attributable registrations (men: 5.7% (9988); women 2.1% (1655)).

Occupational AFs are over 2% for the following cancers: bladder, breast, larynx, lung, mesothelioma, nasopharynx, non-melanoma skin cancer, oesophagus, sinonasal, and soft tissue sarcoma. Asbestos, shift work, mineral oils, solar radiation, silica, diesel engine exhaust, polycyclic aromatic hydrocarbons from coal tars and pitches, occupation as a painter or welder, dioxins, environmental tobacco smoke (non-smokers), workplace exposure to radon, tetrachloroethylene, arsenic and strong inorganic mists each contribute 100+ registrations.

This report and the work it describes were funded by the Health and Safety Executive (HSE). Its contents, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy.

HSE Books

© Crown copyright 2012

First published 2012

You may reuse this information (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view the licence visit www.nationalarchives.gov.uk/doc/open-government-licence/, write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email [email protected].

Some images and illustrations may not be owned by the Crown so cannot be reproduced without permission of the copyright owner. Enquiries should be sent to [email protected].

ACKNOWLEDGEMENTS

Funding was obtained from the Health and Safety Executive (HSE). Andrew Darnton from the HSE was responsible for the work on mesothelioma. The contributions to the project and advice received from many other HSE and Health and Safety Laboratory staff is gratefully acknowledged. Two workshops were held during the project bringing together experts from the UK and around the world. We would like to thank all those who participated and have continued to give advice and comment on the project. We would also like to thank Helen Pedersen and Gareth Evans for their help in editing and formatting the reports.

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EXECUTIVE SUMMARY

INTRODUCTION HSE wishes to develop appropriate practical measures to reduce the incidence of occupational cancer in Great Britain; they currently rely on estimates of the effects of occupation on cancer mortality in the US made by Doll & Peto in 1981 (4% of all US cancer deaths with an uncertainty range of 2% to 8%). The overall aims of this project were:

• to produce an updated estimate of the current burden of occupational cancer specifically for Great Britain

• to produce an estimate of the future occupational cancer burden in Great Britain based on recent and current exposures, together with the method for updating this in future

• where the data are sufficiently detailed, to break down any headline estimates into exposure-cancer combinations

This report presents an overview of the results of the current burden of cancer due to occupational carcinogens and circumstances in Great Britain (GB) together with a summary of the methodology developed and the data used.

METHODOLOGY The primary measure of the burden of cancer used in this project was the attributable fraction (AF) i.e. the proportion of cases that would not have occurred in the absence of exposure; this was then used to estimate the attributable numbers. The AF requires the risk of the disease due to the exposure of interest and the proportion of the target population exposed. Estimation was carried out for 2005 for mortality and 2004 for cancer incidence for occupational exposures and for agents classified by the International Agency for Research on Cancer (IARC) as group 1 (established) and 2A carcinogens (probable). . Risk estimates, adjusted where appropriate for confounders, were obtained from key studies, meta-analyses or pooled studies, taking into account study quality. Dose-response risk estimates were generally not available in the epidemiological literature nor were proportions of those exposed at different levels of exposure over time available for the working population in GB. However, where possible risk estimates were obtained for an overall ‘lower’ level and an overall ‘higher’ level of exposure to the agents of concern and matched appropriately to the exposure scenario in question. The risk estimates for occupational exposure to ionising radiation were derived using generalized linear dose response models of excess relative risk per unit of cumulative radiation dose from the United Nations Scientific Committee on the Effects of Atomic Radiation.

The period during which exposure occurred that was relevant to the development of the cancer in the target year 2005 was defined as the risk exposure period (REP). For solid tumours a latency of 10-50 years was assumed giving a REP of 1956-1995; for haematopoietic neoplasms 0-20 year’s latency was assumed giving a REP of 1986-2005. The proportion of the population ever exposed to each carcinogenic agent or occupation in the REP was obtained from the ratio of the numbers ever exposed to the carcinogens of interest in each relevant industry/occupation within GB over the total number of people ever employed. National data were used to obtain these. Account was taken of changes in numbers employed in the primary and manufacturing industry and service

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sectors in GB over the REP and adjustment was made where appropriate for employment turnover over the period.

RESULTS The overall burden in GB attributable to the occupational carcinogens was 5.3% (based on deaths (8.2% for men and 2.3% in women). Numbers of attributable deaths are 8010 overall (6355 for men, 1655 for women) and numbers of attributable cancer registrations are 13598 overall (9988 for men, 3611 for women). The AFs by cancer site range from less than 0.01% to 95% overall, the most important cancer sites for occupational attribution being, for men, mesothelioma (97%), sinonasal (43.3%), lung (21.1%), nasopharynx (10.8%), bladder (7.1%) and NMSC (6.9%), and for women mesothelioma (82.5%) sinonasal (19.8%), lung (5.3%), breast (4.6%) and nasopharynx (2.4%). Occupation also contributes 2% or more overall to cancers of the larynx, oesophagus and soft tissue sarcoma (STS), with in addition for men melanoma of the eye (due to welding), non-Hodgkin’s lymphoma (NHL), and stomach. Lung cancer contributes the largest number of attributable deaths for both men and women followed, for men, by mesothelioma, bladder, oesophageal and stomach cancers, and for women, by breast cancer, mesothelioma, bladder and oesophageal cancers. For attributable numbers of cancer registrations, the patterns differ between men and women; for men, lung cancer contributes the largest numbers of registrations followed by NMSC, mesothelioma, bladder, oesophageal and stomach cancers, nonHodgkin’s lymphomas and sinonasal cancer; for women breast cancer contributes the largest numbers of registrations followed by lung cancer, NMSC, mesothelioma, bladder cancer, nonHodgkin’s lymphoma, ovarian, sinonasal and oesophageal cancers.

Many carcinogenic exposures in the workplace affect multiple cancer sites. Asbestos contributes the most to both total attributable deaths and registrations (larynx, lung, mesothelioma, stomach). Others making a major contribution to attributable deaths and/or registrations include arsenic (lung), diesel engine exhaust (DEE) (bladder, lung), dioxins (lung), environmental tobacco smoke (ETS) encountered at work in non-smokers (lung), mineral oils (bladder, lung, non-melanoma skin cancer (NMSC), sinonasal), polycyclic aromatic hydrocarbons from coal tar and pitches (NMSC), radon from natural exposure in workplaces (lung), shift work, including flight personnel (breast), silica (lung), solar radiation (NMSC), strong inorganic acid mists (larynx, lung), tetrachloroethylene (cervix, non-Hodgkin’s lymphoma, oesophagus), work as a painter (bladder, lung, stomach) and work as a welder (lung, melanoma of the eye due to ultra violet radiation).

Industry sectors contributing substantially to the total burden includes construction, land transport, manufacture of transport equipment, metal workers, mining, painters and decorators in the construction industry, personal and household services (this sector includes repair trades, laundries and dry cleaning, domestic services, hairdressing and beauty), printing and publishing, public administration and defence, roofers and road repairs, shift work, and wholesale and retail trades. The majority of industry sectors involve exposure to several carcinogens (many over 10) with construction and many of the manufacturing sectors involving potential exposure to between 15 and 20 carcinogens. There are several key exposures which give rise to substantial numbers of registrations across multiple industry sectors. Of note is the contribution of exposure to (i) asbestos, DEE, silica and solar radiation in the construction industry; (ii) asbestos, DEE, ETS (non-smokers), soots and tetrachloroethylene in personal and household services; (iii) asbestos and DEE in land transport (railway, road, pipelines); (iv) asbestos, DEE, silica and solar radiation in mining; (v) ETS (non-smokers) and solar radiation in public administration and defence; (vi) asbestos, ETS (non-smokers) and radon in the wholesale and retail trade, restaurants and hotels and (vii) dioxins, non-arsenical insecticides and solar radiation in farming.

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DISCUSSION This project is the first to quantify in detail the burden of cancer due to occupation specifically for GB. The project highlights the impact of occupational exposures, together with the occupational circumstances and industrial areas where exposures to these agents occurred in the past, on population cancer morbidity and mortality. Our methodological approach was developed with advice, discussion and peer review from international experts, including IARC, throughout the project and at two international workshops. It takes account of issues such as latency and the period in which relevant exposure would occur, changes in workforce turnover and employment trends and the potential to be exposed to several carcinogens concurrently and at different levels. These methods have the potential to be adapted for use in other countries and extended to include social and economic impact evaluation.

However, assumptions made in our methodology and uncertainties and inaccuracies in the data may have introduced biases into our estimates. Inclusion of IARC group 2A carcinogens may have inflated our estimates; alternatively exclusion of IARC group 2B (possible) carcinogens and other suspected or unknown carcinogens may have led to an underestimation. Other caveats include inappropriate choice of risk estimates, imprecision in the risk estimates and estimates of proportions exposed, inaccurate assumptions about the risk exposure and latency periods, and in some cases a lack of separate risk (and/or cancer incidence) estimates for women.

Due to the long latent interval of many cancers the estimates of current burden are based on exposures occurring in the past. Many of these would have been considerably higher than today and there is evidence of continuing downward trends in the UK in many exposures. However, it should be noted that for many of the carcinogens a major contribution to the burden was made by a large number of workers exposed at low levels and low risk.

Separate reports present the results for the current burden for each individual cancer site; estimates of Disability-Adjusted Life Years; methods to predict future estimates of the occupational cancers; application of the future burden methods to predict future burden for important hazards; and the results of sensitivity analysis of these estimates to sources of uncertainty and bias.

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CONTENTS 1.0 INTRODUCTION......................................................................................................... 1

2.0 METHODOLOGY........................................................................................................ 2

1.1 Overview of the study design.............................................................................. 2

2.2 Risk estimates .................................................................................................... 2

2.3 Exposed population estimation......................................................................... 11

2.4 Statistical analysis ............................................................................................ 12

3.0 RESULTS ................................................................................................................. 13

3.1 Attributable fractions and numbers by cancer site............................................ 13

3.2 Deaths and registrations by carcinogen and cancer site .................................. 20

3.3 Deaths and registrations by industry sector and carcinogenic agent or occupational circumstance ............................................................................... 35

3.4 Deaths and registrations by industry sector and cancer site ............................ 70

4.0 DISCUSSION............................................................................................................ 82

5.0 BIBLIOGRAPHY....................................................................................................... 86

6.0 STATISTICAL APPENDIX ....................................................................................... 94

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1.0 INTRODUCTION In 1981 in their report to the US Congress, Doll & Peto presented a method of estimating the effects of occupation on cancer mortality in the US (Doll & Peto, 1981). The proportion of cancer they attributed to occupation was about 4% of all US cancer deaths with an uncertainty range of 2% to 8%. More recently they have produced a new estimate of 2% with a range of 1-5% and suggest that less than 1% is known to be avoidable by practicable ways (Doll and Peto, 2005). The Health and Safety Executive (HSE) has relied on the 1981 study to estimate the proportions of cancers in Great Britain (GB) due to occupational exposures, giving an estimate of around 6000 cancer deaths (uncertainty range 3000 to 12000) and 12000 cancer registrations (uncertainty range 6000 to 24000) currently occurring each year in GB. In a later overview of the epidemiology of cancer, Doll & Peto suggested that it is unlikely that occupational hazards account for more than two or three per cent of all fatal cancers in developed countries such as the UK, but they acknowledge that the quantitative evidence is uncertain and the estimate could be out by a factor of two (Doll & Peto, 2003).

HSE wishes to develop appropriate practical measures to reduce the incidence of occupational cancer in Great Britain. These measures could include improved risk assessment, chemical substitution, improved control measures and evidence of their effectiveness. It will be important that these can be employed in small- and medium-sized enterprises as well as larger businesses. Future strategies for deciding where HSE targets its action on workplace carcinogens through policy-making, advice and enforcement activity are dependent on a sound evidence base. This evidence base will also help determine HSE’s priorities for preventing future disease.

It is acknowledged that the estimates of current burden of cancer due to occupational exposures are based on evidence and methodology that is over 25 years old, and that it is now appropriate that the validity of these estimates is reassessed using currently available scientific evidence.

The aims of this project carried out by Imperial College London in collaboration with the Health and Safety Laboratory (HSL), the Institute of Environment and Health (IEH) at Cranfield University and the Institute of Occupational Medicine (IOM) were:

• to produce an updated estimate of the current burden of occupational cancer in Great Britain

• to produce an estimate of the future occupational cancer burden in Great Britain based on recent and current exposures, together with the method for updating this in future

• to the extent that the data will allow, to break any headline estimates down into exposure-cancer combinations

These estimates will inform the HSE’s ongoing deliberations, as part of the cancer project of the Long Latency Disease Programme, on the priorities for intervention on occupational carcinogens.

This report presents an overview of the results of the current burden of cancer due to occupational carcinogens and circumstances in GB together with a summary of the methodology developed and the data used. Separate technical reports for each cancer giving more details of the source data, cancer burden calculations, and statistical methodology will be made available on the HSE website during 2010. Other reports will include methods for predicting the future burden of occupational cancers due to recent exposures, and the application of these methods to priority carcinogens and exposure circumstances. Other measures of burden will be reported such as Years of Life Lost and Disability-Adjusted Life Years, as well as a report summarizing the application of a sensitivity analyses to determine the biases and uncertainties surrounding these estimates of cancer burden.

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2.0 METHODOLOGY

1.1 OVERVIEW OF THE STUDY DESIGN

For each cancer, information on the incidence, mortality and survival trends in GB was obtained and an overview of the aetiology and known and suspected causal factors, including occupationally related factors, was carried out. Estimation was carried out using 2005 data for mortality and 2004 for cancer incidence. Mortality data were obtained from the Office for National Statistics (ONS), and the General Register Office for Scotland. Cancer incidence data were obtained from ONS, Cancer Statistics, Registrations, Series MB1 for England, the Scottish Cancer Registry, and the Welsh Cancer Intelligence and Surveillance Unit.

The attributable fraction (AF) i.e. the proportion of cases that would not have occurred in the absence of an occupational exposure was estimated; this was then used to estimate the attributable numbers. There are several methods for estimating the AF but all depend on knowledge of the risk of the disease due to the exposure of interest and the proportion of the target population exposed (Steenland et al, 2006).

2.2 RISK ESTIMATES

Risk estimates were obtained from key studies, meta-analyses or pooled studies, taking into account quality (including relevance to GB, sample size, extent of control for confounders, adequacy of exposure assessment, and clarity of case definition). Studies could be industry-based cohort studies or population-based case-control studies.

Factors that were considered for the choice of study included:

• Representativeness o Broad based and representative of the occupations or industrial exposures in GB o Included separate evaluations for men and women if relevant

• Study quality o Large sample size o Control for confounders i.e. adjusted analyses carried out o Adequate exposure assessment in the study o Standardised diagnosis of cancer cases o Appropriate comparison or a control population

• Portability, for which there are three key issues: o UK study or similar population, so that the source study and target (GB)

exposures match on types and levels of exposure o Up-to-date study, so that the relevant period of exposure in the source population

is not so long ago that the exposures on which the risk estimates were based no longer match exposures in the target relevant exposure period

o Comparable distribution of known confounders within GB population.

Where possible, risk estimates were selected that were adjusted for important confounders or non-occupational risk factors e.g. smoking for lung cancer, smoking and alcohol use for laryngeal cancer. Where only a narrative review was available giving a range of risk estimates from several relevant studies a combined estimate of the relative risks (RR) was calculated based on a random- (for heterogeneous RRs) or fixed- (for homogeneous RRs) effects model. Formal systematic

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reviews and meta-analyses were carried out to estimate risk estimates for laryngeal and stomach cancers related to asbestos exposure.

Dose-response risk estimates were generally not available in the epidemiological literature nor were proportions of those exposed at different levels of exposure over time available for the working population in GB. However, where possible risk estimates were obtained for an overall ‘lower’ level and an overall ‘higher’ level of exposure to the agents of concern and matched appropriately to the exposure scenario in question.

The risk estimates for occupational exposure to ionising radiation were derived using generalized linear dose response models of excess relative risk per unit of cumulative radiation dose from the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR, 2006). Cumulative lifetime dose was estimated using data from the Central Index of Dose Information (CIDI) (HSE, 1998). For aircrew, who are not covered by CIDI, the mean total lifetime radiation dose per pilot was obtained from a large cohort study of European airline pilots (Langner et al, 2004) and combined with numbers employed obtained from the British Airways Stewards and Stewardesses Union (BASSA, 2008) and the Labour Force Survey.

A substantial proportion of the excess is likely to occur in the large number of workers with low exposures for whom estimates of average risks are inevitably unreliable. Where no risk estimate could be identified for very low/background levels of exposure for a particular carcinogen, a RR was estimated for the ‘lower exposed’ group by (i) taking the harmonic mean of all the available ratios of ‘higher’ to ‘lower’ RR estimates for cancer-exposure pairs for which data were available, (ii) applying this average ratio to the ‘higher’ level estimate for the carcinogen to obtain a ‘lower’ level RR estimate for the carcinogen. If the resulting RR estimate was less than 1, RR was set to one.

A complete list of all the RRs chosen for each level of exposure and the source of these RRs is given in Table 1.

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Table 1: Risk estimates used in the estimation of attributable fractions

High exposure Low exposure

Cancer Exposure

Relative risk (95% confidence

interval)

Relative risk (95% confidence interval)

Relative Risk Source Strength of evidenceh

Bladder Aromatic amines Sorahan et al.(1998) Strong Industrial chemicals/MbOCA manufacture

1.70 (1.05, 2.76)

Rubber products manufacture 1.89 (1.34, 2.66) Plastic products manufacture 1.73 (1.17, 2.55)

Benzidine-based dye manufacture

2.61 (0.98, 7.00)

Laboratory technicians 1.05 (0.60, 1.86)

Medical and nursing 1.62 (1.03, 2.55)

Cable manufacturing 2.46 (1.20, 5.04) Dyestuffs 2.61(0.98, 7.00) Textile printing and dyeing 2.32 (0.98, 5.45) Leather work 2.51(1.44, 4.35)

Diesel 1.24 (1.01, 1.41) 1.03 (0.84, 1.26) High and Low: Boffetta and Silverman (2001)

Suggestive

Hairdressers (males) 1.22 (0.98, 1.51) Czene et al.(2003) Suggestive

Hairdressers (females) 1.09 (0.81, 1.43) Czene et al. (2003) Suggestive Mineral oilsa 1.39 (1.20, 1.61) 1 High:Tolbert 1979 Suggestive

PAH 1.44 (1.20, 1.74) 1 High: Boffetta et al. (1997) Strong

Painters 1.17 (1.11, 1.23) Bosetti et al. (2005) Suggestive Bone Ionising radiationb 1.03 UNSCEAR (2008) Strong

4


Cancer Exposure


interval)



Brain Inorganic leada 1.06(0.8, 1.4) 1 High: Steenland and Bofetta (2000)

Suggestive

Non arsenical insecticides Suggestive Farmers 1.06 (1.02, 1.11) Acquavella et al. (1998) Pesticide manufacture 1.01 (0.75, 1.36) Jones et al. (2008)

Petroleum refining 1.02 (0.83, 1.25) Sorahan (2007) Suggestive Breast Shift work 1.51 (1.36, 1.68) Megdal et al. (2005) Suggestive

Flight personnel 1.44 (1.26, 1.65) Megdal et al. (2005) Suggestive Cervix Tetrachloroethylenec 1.95 (1.00, 3.40) 1.29 (0.18, 3.16) High: Ruder et al. (2001) Suggestive Kidney Trichloroethylene 1.2 (0.8, 1.7) 1 High: Wartenberg et al.

(2000) Low: Morgan et al. (1998)

Suggestive

Larynx Asbestosa 1.37 (1.17, 1.6) 1 High: Fortunato and Rushton (2012)

Suggestive

Rubber manufacture 1.19 (0.82, 1.62) Sorahan et al. (1989) Suggestive Strong inorganic acid mists containing sulphuric acid

4.28 (2.13, 8.58) 1.91 (0.97, 3.78) High: Steenland and Beaumont, 1989 Low: Coggon et al. (1996)

Strong

Leukaemia (Acute non-lymphatic leukaemia only)

Benzene 1.11 (0.3, 2.83) Bloemen et al. (2004) Strong Chemical manufacturing 2.17 (0.9, 5.20) Collins et al. (2003) Land transport 1.32 (0.49, 2.88) Lewis et al. (2000)

Leukaemia (except Chronic lymphatic leukaemia)

Ionising radiationb UNSCEAR (2008) Strong Aircrew 1.04 Other 1.03

All Leukaemia 1,3 butadiene 2.3 (0.6, 8.3) 1.3 (0.4, 4.3) High and Low: Delzell et al. (2001)

Suggestive

Ethylene oxide 1 Teta et al. (1999) Strong Chemical and other manufacture

2.29 (0.64, 6.02) Coggon et al. (2004)

Medical workers 1.08 (0.03, 6.19) Coggon et al. (2004) Formaldehyded Suggestive

5


Cancer Exposure


interval)



Embalmers 1.6 (1.2, 2.0) Collins and Lineker (2004) Health and veterinary

employees, research scientists 1.2 (0.8, 1.8) Collins and Lineker (2004)

Non-arsenical insecticides Suggestive Agricultural workers and farmers

1.1 (1.02, 1.18) Acquavella et al. (1998)

Grain milling 1.07 (0.75, 1.47) Alavanja et al (1990) Pesticide manufacturing 1.08 (0.81, 1.44) Jones et al. (2009)

Liver Ionising radiationb 1.01 UNSCEAR (2008) Strong Trichlolorethylene 1.3 (1.09, 1.55) 1 High: Alexander et al.

(2007) Suggestive

Vinyl chloride monomerc 2.86 (1.83, 4.25) 1.89 (0.32, 3.96) High: Simonato et al. (1991)

Strong

Lung Arsenic 2.05 (1.43, 2.85) 1.74 (0.75, 3.43) High and Low: Lee-Feldstein (1986)

Strong

Asbestose Not applicable Strong Berylliuma 1.12 (0.99, 1.26) 1 High: Ward et al. (1992) Strong Cadmium 1.19 (1.09, 1.29) 1 High: Verougstraete et al.

(2003) Strong

Chromium 1.18 (1.12, 1.25) 1 High: Cole and Rodu (2005) Low: Crump et al. (2003)

Strong

Cobalt 1.93 (1.03, 3.62) 1.3 (1.00, 1.66) High and Low: Moulin et al (1998)

Suggestive

Diesel engine exhaust 1.47 (1.29, 1.67) 1.10 (0.70, 1.80) High: Lipsett and Campleman (1999) Low: Coggon et al, 1984

Suggestive

Environmental tobacco smoke ( males)a

1.29 (0.93, 1.78) 1 High: Zhong et al. (2000) Strong

Environmental tobacco smoke ( females)a

1.15 (1.04, 1.28) 1 High: Zhong et al. (2000) Strong

6


Cancer Exposure


interval)



Ionising radiation (males)b 1.005 UNSCEAR (2008) Strong Ionising radiation (females)b 1.021 UNSCEAR (2008) Strong Inorganic leada 1.14 (1.04, 1.73) 1 High: Steenland and

Boffetta, 2000 Suggestive

Mineral oilsa 1 Strong Printers 1.58 (1.28, 1.95) Tolbert (1997) Other industries 1.08 (1.04, 1.11) Tolbert (1997)

Nickeld Seilkop and Oller (2003) Strong Clydach Refinery 1.39 (0.92, 2.01) Sorahan and Williams

(2005) Other exposed workers 1.03 (0.97, 1.10) Seilkop and Oller (2003)

Painters 1.21 (1.12, 1.31) Chen and Seaton (1998) Strong Polycyclic Aromatic Hydrocarbons

1 Suggestive

Manufacture of industrial chemicals, petroleum and coal products, non-metallic products; iron and steel industry; nonferrous metal industrye

Armstrong et al. (2004)

(50%) <0.01 µg/m3 1 (40%) 0.01- <0.75 µg/m3 1.02 (1.01, 1.03) (5%) 0.75- <2 µg/m3 1.08 (1.04, 1.11) (5%) 2+ µg/m3 1.25 (1.13, 1.38)

Radone NA Strong Silica 1.32 (1.24, 1.41) 1.00 (0.85, 1.30) High: Kurihara and Wada

(2004) Low: Steenland et al. (2001)

Strong

Steel foundry workers 1.46 (1.34, 1.58) Sorahan et al. (1994) Strong Strong inorganic acid mistsa 1.36 (0.97, 1.94) 1 High: Steenland and

Beaumont (1989) Low: Coggon et al. (1996)

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Cancer Exposure


interval)



TCDD (Dioxins) Suggestive Agriculture and farming 1.03 (0.78, 1.04) Kogevinas et al. (1997) Pesticide manufacture 1.22 (1.05, 1.41) Jones et al. (2009) Pulp and paper manufacture 1.04 (0.96, 1.03) McLean et al.(2006) Other industries 1.12 (0.98, 1.28) Kogevinas et al. (1997)

Tin miners 1.83 (1.48, 2.28) Hodgson and Jones (1990) Strong Welders 1.26 (1.20, 1.32) Ambroise et al. (2006) Strong

Lymphohaemato-poietic

1,3 butadiene 2.03 (1.35, 2.93) 1.05 (0.72, 1.46) High and Low: Delzell (2006)

Suggestive

Melanoma of the eye

UV radiation (welders) 2.05 (1.20, 3.51) Shah et al. (2005) Suggestive

Multiple myeloma Non-arsenical insecticides Suggestive Grain milling 1.09 (0.99, 1.19) Alavanja et al (1990) Agriculture and farming 1.01 (0.50, 1.81) Acquavella et al. (1998) Pesticide manufacture 1.26 (0.89, 1.77) Jones et al. (2009)

Nasopharynx Formaldehyded 2.10 (1.78, 9.13) 1 High: Hauptmann et al. (2004)

Suggestive

Wood dust 2.40 (1.10, 4.50) 1 High: Demers et al. (1995) Suggestive

Non-Hodgkin’s Lymphoma

Hairdressers 1.20 (0.84, 1.66) Boffetta et al. (1994) Suggestive Non-arsenical insecticides Suggestive

Grain milling 1.00 (0.64, 1.48) McLean et al. (2006) Agriculture and farming 1.11 (1.05, 1.17) Pesticide manufacture 1.98 (1.45, 2.69) Jones et al. (2009)

TCDD (Dioxins) Suggestive Pesticide manufacture 1.98 (1.45, 2.69) Jones et al. (2009) Paper and pulp manufacture 1.40 (0.60, 2.70) McLean et al. (2006) Other industries 1 Bodner et al. (2003)

Tetrachloroethylenea 1.39 (0.56, 2.86) 1 Ruder et al. (2001) Suggestive Trichloroethylenea 1.29 (1.00, 1.66) 1 Mandel et al. (2006) Suggestive

8


Cancer Exposure


interval)



Non-melanoma skin Mineral oilsad 1.20 (0.67, 2.15) 1 High and Low: Mitropoulos and Norman (2005)

Strong

Polycyclic Aromatic Hydrocarbons (coal tars and pitches)

1.74 (1.07, 2.65) Partanen and Boffetta (1994)

Strong

Solar radiation Freedman et al. (2002) Strong Mixed outdoor and indoor work

1.01 (0.93, 1.09)

Outdoor work 1.30 (1.14, 1.47) Farming 1.15 (1.00, 1.32)

Oesophagus Soots 3.87 (1.93, 6.93) Evanoff et al. (1993) Suggestive Tetrachloroethylenec 2.47 (1.35, 4.14) 1.63 (0.24, 3.85) Ruder et al. (2001) Suggestive

Ovary Hairdressers 1.18 (0.98, 1.40) Boffetta et al. (1994) Suggestive Pancreas Acrylamided 1.85 (0.68, 4.03) 1.22 (0.66, 2.27) High and Low: Marsh et

al. (2007) Suggestive

Sinonasal Chromiumc 5.18 (2.37, 11.30) 3.42 (0.42, 10.52) High: Rosenman and Stanbury (1996)

Suggestive

Formaldehyde (males)d 1.66 (1.27, 2.17) 1 High: Mannetje et al. (1999)

Suggestive

Formaldehyde (females)d 1 1 Suggestive Leather dust 7.41 (3.83, 12.94) Fu et al. (1996) Strong Mineral oilscd 2.8 (1.4, 5.7) 1.85 (0.25, 5.31) Suggestive Nickel 8.7 (1.05, 31.4) Clydach Refinery:

Grimstrud and Peto (2006) Strong

Woodc 3.1 (1.6, 5.6) 2.05 (0.28, 5.21) High: Demers et al. (1995) Strong Soft tissue sarcoma TCDD (dioxins) Suggestive

Agriculture and farming 1.03 (0.90, 1.17) Acquavella et al. (1998) Pesticide manufacture 1.13 (0.75, 1.70) Jones et al. (2009) Paper and pulp manufacture 1.13 (0.59, 1.98) McLean et al. (2006) Other industry 2.03 (0.75, 4.43) Kogevinas et al. (1997)

9


Cancer Exposure


interval)



Stomach Asbestos (males) 1.66 (1.49, 1.86) 1.21 (1.06, 1.38)g High: Harding et al. (2009) Low: Fortunato and Rushton (2012)

Suggestive

Asbestos (females) 1 1 Fortunato and Rushton (2012)

Suggestive

Inorganic leada 1.33 (1.18, 1.49) 1 High: Fu and Boffetta (1995)

Suggestive

Painters 1.27 (1.01, 1.60) Chen and Seaton (1998) Suggestive Rubber industry 1.13 (1.02, 1.25) Sorahan et al. (1989) Suggestive

Thyroid Ionising radiationb 1.09 UNSCEAR (2006) Strong a Insufficient dose-response data; risk estimate for low exposure based on harmonic mean of the high/low ratios across all other cancer-exposure pairs in the overall project where data were available; this was < 1, hence risk estimate for low set to 1. b Confidence Intervals not estimated for cancers attributed to ionizing radiation, as they are not yet available for the excess relative risk models used (UNSCEAR 2008) c Insufficient dose-response data; risk estimate for low exposure based on harmonic mean of the high/low ratios across all other cancer-exposure pairs in the overall project where data were available dIn addition to risk estimates for high and low exposure, a risk estimate of 1 was used for background exposure eAsbestos and radon estimated using different methodology from the standard method, see Hutchings and Rusthton (2011) fHigh exposure subdivided by categories of 8 hour Time Weighted Average (TWA) benzo-a-pyrene (BaP) levels gEstimated from the meta-analysis by Fortunato and Rushton (2012) omitting the study by Harding et al. (2009) h Strength of evidence for carcinogenicity as assessed by Siemiatycki et al. (2004)

10

2.3 EXPOSED POPULATION ESTIMATION

The period during which exposure occurred that was relevant to the development of the cancer in the target year 2005 was defined as the risk exposure period (REP). For solid tumours a latency of 10-50 years was assumed giving a REP of 1956-1995; for haematopoietic neoplasms 0-20 year’s latency was assumed giving a REP of 1986-2005. The proportion of the population ever exposed to each carcinogenic agent or occupation in the REP was obtained from the ratio of the numbers ever exposed to the carcinogens of interest in each relevant industry/occupation within GB over the total number of people ever employed (Equation 4 in the Statistical Appendix).

If the study from which the risk estimates were obtained was population based, an estimate of the proportion of the population exposed was derived directly from the study data, although such studies were rarely available in practice for GB. If the risk estimate was obtained from an industry-based study, national data sources such as the CARcinogen EXposure database (CAREX) (Pannett et al, 1998), the UK Labour Force Survey (LFS) (LFS, 2009) and Census of Employment (ONS, 2009) were used. CAREX was used for estimating the numbers of the GB population ever exposed to a carcinogen by industry sector. As highlighted above data are not available on the levels of exposure in all industry sectors for all the carcinogens considered, nor the numbers exposed at these levels. The industry sectors were thus allocated to ‘higher’ or ‘lower’ exposure categories assuming distributions of exposure and risk that corresponded broadly to those of the studies from which the risk estimates were selected. The initial allocations were based on the judgment of an experienced human exposure scientist; each assessment was then independently peer-reviewed and if necessary, a consensus assessment agreed. Data from CAREX are not differentiated by sex; 1991 Census data by industry and occupation were used to estimate the relative proportions of men and women exposed. The LFS and Census of Employment data were used to estimate numbers ever employed in specific occupations e.g. welder, painter etc., and for specific industries for carcinogens not included in CAREX.

CAREX data for GB relate only to the period 1990-93. For the LFS and CoE an available year was chosen to represent numbers employed about 35 years before the target year of 2005, as this was thought to represent a ’peak’ latency for the solid tumours, and is also close to the mid-point of the REP for estimating numbers ever exposed across the period (for which a linear change in employment levels was implicitly assumed). Where the Census of Employment was used, the data are for 1971. Where the LFS was used, the first year available used was 1979 for solid tumours, and 1991 for short latency cancers.

When CAREX data were used adjustment factors were applied to take account of the change in numbers employed in the primary and manufacturing industry and service sectors in GB over the REP. Adjustment for employment turnover over the period for grouped main industry sectors was also carried out (see equation 3 in the Statistical Appendix). Ideally this requires full national starter and leaver data across the REP for all industry sectors. In the absence of this quality of data, estimating turnover directly using new starters in years within the REPs gives the best approximation for the purpose of estimating those ever exposed. This method estimates starters in the past year as a proportion of the average number employed (Gregg and Wadsworth, 2002). As exposure in occupational epidemiological studies is usually defined as at least one year, we have adapted this to exclude short-term labour turnover. New starters in the past year who are expected to remain employed for at least one year were taken as a proportion of all those expected to be employed for at least 1 year. This was estimated as the number recorded as employed for between 1 and 2 years divided by the total employed for at least one year using LFS data averaged over the REP.

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2.4 STATISTICAL ANALYSIS

The AFs have been calculated on a ‘cancer by cancer’ basis. To estimate the AFs for each cancer/occupational carcinogen Levin’s method was used if risk estimates came from an industry-based study or a review or meta-analysis together with estimates of the proportion of the population exposed from independent national sources of data (Levin, 1953). Miettinen’s method was used if risk estimates and proportion of cases exposed came from a population-based study (Miettinen, 1974) (equations 1 and 2 respectively in the Statistical Appendix). For each AF, a random error confidence interval was calculated using Monte Carlo simulations (Steenland and Armstrong, 2006). The AFs were applied to total numbers of cancer specific deaths (2005) and cancer registrations (2004) for ages that could have been exposed during the REP to give attributable numbers. Where risk estimates were only available from mortality studies AFs derived from these were used for estimation of attributable registrations and vice versa. Similarly if separate AFs for women could not be estimated those for men or for men and women combined were used.

The AF for mesothelioma was derived directly from several UK mesothelioma studies that suggest between 96% and 98% of male mesothelioma cases are due to occupational or paraoccupational (e.g. exposure from living near an asbestos factory or handling clothes contaminated due to occupational exposure) exposure (Yates et al, 1997; Howel et al, 1997; Rake et al, 2009). Combining the results from Rake et al (2009) with those from two studies in which results were reported separately for females (Goldberg et al, 2006; Spirtas et al, 1994) gave estimates of 75%-90% for females. The ratio of asbestos related lung cancer to mesothelioma deaths has been suggested to be between two-thirds and one (Darnton et al, 2006). Rather than using our standard method for the estimation of numbers of lung cancers attributable to asbestos, we therefore used a ratio of 1:1, lung cancer to mesothelioma deaths. This takes into account the impact that past levels of exposure to asbestos are having on the current incidence by the direct link to mesothelioma deaths that are still climbing whereas lung cancer in general is declining due to the reduction in smoking. This assumes, however, that lung cancer has a similar pattern of latency as mesothelioma. The total lung cancers attributable to asbestos were allocated between industries by using estimates of relative risk for ‘higher’ and ‘lower’ level exposed (from Goodman et al, 1999) and proportions ever exposed by industry sector (based on CAREX) combined as weights.

For lung cancer associated with radon exposure from natural sources, estimates of rates of lung cancer due to exposure to radon in domestic buildings (NRPB 2000) were applied to estimates of the time employees spend in workplaces where radon exposure occurs.

AFs for all the relevant carcinogenic agents and occupational circumstances were combined into a single estimate of AF for each separate cancer. To take account of potential multiple exposures, strategies including partitioning exposed numbers between overlapping exposures or estimating only for the ‘dominant’ carcinogen with the highest risk were used. The IARC Monograph process has been taking place over many years and has resulted in overlap between substances evaluated. For lung cancer, for example, there are 32 occupations or carcinogenic agents evaluated by IARC. AFs were estimated for 21 of these; for example, substances such as coal-tars and pitches and processes such as coal gasification and coke production were included within our evaluation of Polycyclic Aromatic Hydrocarbons (PAH). Where exposure to multiple carcinogens remained it was assumed that the exposures were independent of one another and that their joint carcinogenic effects were multiplicative. The AFs were then combined to give an overall AF for that cancer using a product sum (equation 5 in the Statistical Appendix). An overall AF for all cancers was estimated by summing the attributable numbers for each, and dividing by the total number of cancers in GB.

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3.0 RESULTS

The study has quantified for the first time the impact of occupation on the burden of cancer in Britain for all cancer sites and the carcinogens which IARC have classified as having sufficient (group 1) or limited (group 2A) evidence in humans. Estimates of attributable fractions, attributable numbers of deaths (for 2005) and attributable numbers of cancer registrations (for 2004) have been made for:

1. for males and female separately and for the total; 2. for 24 separate cancer sites and the total 3. for 41 separate carcinogens or occupational circumstances 4. for over 60 separate industry sectors.

This report presents summary tables for these results. More detailed results are available in MS Excel tables on the HSE website and will be available in the technical reports for the individual cancer sites.

3.1 ATTRIBUTABLE FRACTIONS AND NUMBERS BY CANCER SITE

The overall burden by cancer site (AFs, attributable numbers (ANs) and 95% confidence intervals) is given in Table 2A together with the International Classification of Disease (ICD) version 10 codes for each cancer site. 8.2% (n = 6355) of cancer deaths in 2005 in men and 2.3% (n = 1655) in women in Britain have been estimated to be due to occupation giving an overall AF of 5.3% (n = 8010). The combined AFs for registrations are 5.7% (n = 9988) for men in 2004 and 2.1% (n = 3611) for women giving an overall AF based on registrations of 4.0% (n = 13598).

If only agents and occupations classified by IARC as group 1 and having strong evidence of carcinogenicity in humans are considered, the overall burden reduces to 3.8% (5986 total deaths, 9590 total registrations) (Table 2B). Only 9 cancer sites are involved (bladder, larynx, leukaemia, liver, lung, mesothelioma, NMSC, sinonasal and thyroid). The dominance of asbestos exposure and mesothelioma, asbestos and the many other group 1 carcinogens affecting lung cancer and solar radiation and NMSC means that the reduction in the AF and attributable numbers for men (6.3%, 5123 deaths, 8277 registrations) is far less than for women (1.0%, 862 deaths, 1313 registrations) for whom shift work is most dominant.

In general, attributable fractions and numbers are higher for men than for women, due mainly to the higher proportions of males exposed to occupational carcinogens. The difference between the numbers of attributable deaths and registrations reflects the varying survival from cancer with mortality and registration numbers being similar for poor survival cancers such as lung cancer and mesothelioma; in contrast the difference is much greater for cancers such as breast cancer where survival is improving and for NMSC, which is rarely fatal.

The AFs by cancer site range from less than 0.01% to 95% overall, the most important cancer sites for occupational attribution being, for men, mesothelioma (97%), sinonasal (43.3%), lung (21.1%), bladder (7.1%) and NMSC (6.9%), and for women mesothelioma (82.5%) sinonasal (19.8%), lung (5.3%), breast (4.6%) and nasopharynx (2.4%). Occupation also contributes 2% or more overall to cancers of the larynx, oesophagus and soft tissue sarcoma (STS), with in addition for men melanoma of the eye (due to welding), non-Hodgkin’s lymphoma (NHL) and stomach.

Lung cancer contributes the largest number of attributable deaths for both men and women followed, for men, by mesothelioma, bladder, oesophageal and stomach cancers, and for women,

13

by breast cancer, mesothelioma, bladder and oesophageal cancers. For attributable numbers of cancer registrations, the patterns differ between men and women; for men, lung cancer contributes the largest numbers of registrations followed by NMSC, mesothelioma, bladder, oesophageal and stomach cancers, non-Hodgkin’s lymphomas and sinonasal cancer; for women breast cancer contributes the largest numbers of registrations followed by lung cancer, NMSC, mesothelioma, bladder cancer, non-Hodgkin’s lymphoma, ovarian, sinonasal and oesophageal cancers.

14

Table 2A Estimated attributable fractions, deaths and registrations by cancer site in 2005 (deaths) and 2004 (registrations)

Cancer Site Attributable Fraction (%) Attributable Numbers

(95% Confidence Interval) (95% Confidence Interval)

Deaths (2005) Registrations (2004)

ICD-10 code

Male Female Total (Based on Deaths)

Male Female Total Male Female Total

Bladder C67 7.1 (4.6, 9.7)

1.9 (1.3, 3.9)

5.3 (3.4, 7.7)

215 (139, 296)

30 (21, 62)

245 (159, 358)

496 (321, 684)

54 (37, 110)

550 (357, 795)

Bone C40-C41 0.04 0.01 0.02 0 0 0 0 0 0 Brain C70-C72 0.5

(0.1, 1.1) 0.1

(0, 0.2) 0.3

(0.0, 0.7) 10

(1, 20) 1

(0, 3) 11

(1, 23) 12

(1, 25) 2

(0, 4) 14

(1, 28) Breast C50 4.6

(3.3, 6.0) 4.6 (3.3, 6.0)

555 (397, 727)

555 (397, 727)

1969 (1407, 2579)

1969 (1407, 2579)

Cervix C53 0.7 (0.0, 2.1)

0.7 (0.0, 2.1)

7 (0, 22)

7 (0, 22)

18 (1, 56)

18 (1, 56)

Kidney C64-C66, C68

0.04 (0, 0.16)

0.04 (0, 0.14)

0.04 (0, 0.15)

1 (0, 3)

1 (0, 2)

1 (0, 5)

2 (0, 7)

1 (0, 4)

3 (0, 10)

Larynx C32 2.9 (1.4, 5.7)

1.6 (0.6, 3.5)

2.6 (1.2, 5.2)

17 (8, 34)

3 (1, 6)

20 (9, 40)

50 (24, 99)

6 (2, 13)

56 (26, 112)

Leukaemiaa C91-C95 0.9 (0.2, 3.5)

0.5 (0.1, 4.5)

0.7 (0.2, 3.9)

18 (4, 71)

5 (1, 49)

23 (5, 120)

30 (7, 118)

9 (1, 80)

38 (8, 198)

Liver C22 0.2 (0.1, 0.3)

0.1 (0.1, 0.2)

0.2 (0.1, 0.3)

4 (2, 6)

2 (1, 2)

5 (3, 8)

4 (2, 6)

1 (1, 2)

5 (3, 8)

Lung C33-C34 21.1 (19.2, 24.7)

5.3 (4.3, 6.9)

14.5 (13.0, 17.2)

4020 (3659, 4696)

725 (592, 946)

4745 (4251, 5643)

4627 (4212, 5406)

815 (666, 1063)

5442 (4877, 6469)

Lymphohaematopoietic

C81-C96 0.004 (0, 0.014)

0.002 (0, 0.007)

0.003 (0, 0.011)

0 (0, 1)

0 (0, 0)

0 (0, 1)

0 (0, 1)

0 (0, 0)

1 (0, 2)

15




ICD-10 code



Melanoma (eye) C69 2.9 (0.6, 6.6)

0.4 (0.1, 1.0)

1.6 (0.3, 3.6)

1 (0, 3)

0 (0, 0)

1 (0, 3)

6 (1, 13)

1 (0, 2)

6 (1, 15)

Mesothelioma C45 97.0 (96.0, 98.0)b

82.5 (75.0, 90.0)b

94.9 (93.0, 96.9)b

1699 (1681, 1717)

238 (216, 260)

1937 (1898, 1976)

1699 (1681, 1717)c

238 (216, 260)c

1937 (1898, 1976)c

Multiple Myeloma

C90 0.4 (0, 1.0)

0.1 (0, 0.3)

0.3 (0, 0.7)

5 (0, 10)

1 (0, 2)

6 (0, 12)

8 (0, 18)

2 (0, 3)

10 (0, 21)

Nasopharynx C11 10.8 (2.3, 47.9)

2.4 (0.6, 6.8)

8.0 (1.8, 34.3)

7 (2, 31)

1 (0, 2)

8 (2, 33)

14 (3, 61)

1 (0, 4)

15 (3, 65)

NHL C82-C85 2.1 (0, 6.9)

1.1 (0.1, 2.9)

1.7 (0, 5.4)

43 (0, 138)

14 (1, 37)

57 (1, 176)

102 (0, 328)

39 (3, 101)

140 (3, 430)

NMSCd C44 6.9 (1.3, 15.0)

1.1 (0.0, 2.9)

4.5 (0.8, 9.9)

20 (4, 44)

2 (0, 6)

23 (4, 50)

2513 (478, 5447)

349 (0, 899)

2862 (478, 6346)

Oesophagus C15 3.3 (1.5, 7.5)

1.1 (0.3, 2.8)

2.5 (1.1, 5.9)

156 (70, 358)

28 (8, 70)

184 (78, 429)

159 (71, 365)

29 (9, 74)

188 (80, 439)

Ovary C56 0.5 (0, 1.2)

0.5 (0, 1.2)

23 (0, 52)

23 (0, 52)

33 (0, 76)

33 (0, 76)

Pancreas C25 0.02 (0, 0.07)

0.01 (0, 0.04)

0.01 (0, 0.05)

1 (0, 2)

0 (0, 1)

1 (0, 4)

1 (0, 2)

0 (0, 1)

1 (0, 4)

Sinonasal C30-C31 43.3 (27.3, 74.0)

19.8 (14.4, 31.6)

32.7 (21.5, 54.8)

27 (17, 47)

10 (8, 16)

38 (25, 63)

95 (60, 162)

31 (23, 50)

126 (83, 212)

STS C49 3.4 (0, 11.4)

1.1 (0, 3.8)

2.4 (0, 8.1)

11 (0, 36)

3 (0, 9)

13 (0, 45)

22 (0, 75)

4 (0, 15)

27 (0, 90)

Stomach C16 3.0 (1.5, 5.1)

0.3 (0.1, 0.5)

1.9 (1.0, 3.4)

101 (52, 176)

6 (3, 11)

108 (55, 187)

149 (77, 258)

9 (4, 15)

157 (81, 274)

16




ICD-10 code



Thyroid C73 0.12 0.02 0.05 0 0 0 0 0 1 Total: C00-C97

Total based on deaths

8.2 (7.2, 9.9)

2.3 (1.7, 3.2)

5.3 (4.6, 6.6)

6,355 (5640, 7690)

1,655 (1249, 2287)

8,010 (6888, 9977)

Total based on registrations

5.7 (4.0, 8.4)

2.1 (1.4, 3.2)

4.0 (2.7, 5.9)

9,988 (6938, 14794)

3,611 (2370, 5412)

13,598 (9308, 20206)

Total cancers in GB in ages 15+ 77,912 72,212 150,124 175,399 168,184 343,583

Abbreviations: ICD = International Classification of Diseases; NHL = non-Hodgkin’s lymphoma; NMSC=non-melanoma skin cancer; STS = soft tissue sarcoma aAF applicable to all leukaemias bIncludes cases described as due to paraoccupational or environmental exposure to asbestos. cTaken as equal to attributable deaths for this short survival cancer. d Based on registrations CIs were not estimated for bone and thyroid cancers and other cancers attributed to ionizing radiation, as CI estimates are not yet available for the excess relative risk models used (UNSCEAR 2006) Totals do not always sum across rows due to rounding error

17

Table 2B Estimated attributable fractions, deaths and registrations by cancer site in 2005 (deaths) and 2004 (registrations) for agents and occupations classified as IARC group 1 with ‘strong’ evidence of carcinogenicity in humans

Cancer Site Attributable Fraction (%) (95% Confidence Interval)

Attributable Numbers (95% Confidence Interval)

Deaths (2005) Registrations (2004) Male Female Total (Based

on Deaths) Male Female Total Male Female Total

Bladder 0.8

(0.7,3.0) 0.6

(0.5,2.9) 0.7

(0.7,3.0) 24

(20, 91) 10

(9, 39) 34 (29, 130)

55 (47, 211)

18 (16, 70)

73 (63, 280)

Bone 0 0 0 0 0 0 0 0 0

Brain 0 0 0 0 0 0 0 0 0

Breast

0

0 0 0 0 0 Cervix 0 0 0 0 0 0 0 0 0

Kidney 0 0 0 0 0 0 0 0 0

Larynx 2.3

(0.8,5.1) 1.5

(0.5, 3.4) 2.1

(0.8, 4.8) 14

(5, 31) 2

(1, 5) 16

(6, 37) 40

(15, 89) 6

(2, 12) 46

(17, 102)

Leukaemia a 0.1

(0, 2.0) 0.2

(0, 3.9) 0.2

(0, 2.6) 3

(0, 40) 2

(0, 36) 5

(1, 75) 5

(1, 70) 4

(0, 55) 8

(1, 124)

Liver 0.1

(0.1,0.3) 0.1

(0, 0.1) 0.1

(0.1, 0.2) 2

(1, 4) 1

(0, 2) 3

(2, 6 ) 2

(1, 4) 1

(0, 2) 3

(2, 6)

Lung 17.6

(15.5, 19.4) 4.4

(3.5, 5.4) 12.0

(10.2, 13.9) 3346

(2945,3687) 599

(527,660) 3945

(3472,4347) 3851

(3390,4244) 673

(592, 742) 4524

(3983, 4985) Lymphohaematopoietic

0 0 0 0 0 0 0 0 0

Melanoma (eye) 0 0 0 0 0 0 0 0 0

Mesothelioma

97.0 (96.0, 98.0)b

82.5 (75.0, 90.0) b

94.9 (93.0, 96.9)

1699 (1681, 1717)

238 (216, 260)

1937 (1898, 1976)

1699 (1681, 1717)c

238 (216, 260) c

1937 (1898, 1976)

c

Multiple Myeloma 0 0 0 0 0 0 0 0 0

Nasopharynx 0 0 0 0 0 0 0 0 0

18

Cancer Site Attributable Fraction (%) (95% Confidence Interval)

Attributable Numbers (95% Confidence Interval)

Deaths (2005) Registrations (2004) Male Female Total (Based

on Deaths) Male Female Total Male Female Total

NHL 0 0 0 0 0 0 0 0 0

NMSCd 6.9

(1.3, 15.0) 1.1

(0.0, 2.9) 4.5

(0.8, 9.9) 20

(4, 44) 2

(0, 6) 23

(4, 50) 2513

(478, 5447) 349

(0,89 9) 2862

(478, 6346)

Oesophagus 0 0 0 0 0 0 0 0 0

Ovary 0 0 0 0 0 0 0 0 0

Pancreas 0 0 0 0 0 0 0 0 0

Sinonasal 21.0

(11.8, 34.7) 13.6

(8.2, 22.5) 17.7 (10.2,

29.2) 13 (7, 22) 7 (4, 12) 20 (11, 34) 46 (26, 76) 22 (12, 36) 68 (38, 112)

STS 0 0 0 0 0 0 0 0 0

Stomach 0 0 0 0 0 0 0 0 0 Thyroid 0.1 0 0 0 0 0 1 0 1 Total Based on deaths 6.6 (6.0, 7.2)

1.2 (1.0, 1.4)

4.0 (3.6, 4.4)

5121 (4665, 5635)

862 (758, 1020)

5983 (5417, 6618)

Total Based on registrations

4.7 (3.2, 6.8)

0.8 (0.5, 1.2)

2.8 (1.9, 4.1)

8212 (5640, 11858)

1310 (840, 2075)

9522 (6480, 13933)

Total cancers in GB in ages 15+ 77912 72212 150124 175399 168184 343583

NHL = Non-Hodgkin’s lymphoma; NMSC = non-melanoma skin cancer; STS = soft tissue sarcoma a AF applicable to all leukaemias b Includes cases described as due to paraoccupational or environmental exposure to asbestos. c Taken as equal to attributable deaths for this short survival cancer. d Based on registrations. Totals do not always sum across rows due to rounding error Confidence Intervals not estimated for cancers attributed to ionizing radiation, as they are not yet available for the excess relative risk models used (UNSCEAR 2006)

19

3.2 ATTRIBUTABLE FRACTIONS, DEATHS AND REGISTRATIONS BY CARCINOGEN AND CANCER SITE

Tables 3, 4 and 5 give attributable fractions, total deaths and total registrations respectively, by cancer site and for each carcinogenic agent or occupational circumstance, together with a ranking by total carcinogenic agent. 95% confidence intervals for these figures, numbers of deaths and registrations for males and females and their 95% confidence intervals are available on the HSE website, together with the attributable fractions and their 95% confidence intervals.

Asbestos contributes the most to the attributable burden from occupational carcinogens with 2.6% of all cancers (based on deaths) in the GB population being attributable to occupational asbestos exposure (Table 3). This is followed by silica (0.53%), diesel engine exhaust (DEE) (0.43%), mineral oils (0.38%), shift work (0.37%), work as a painter (0.22%), environmental tobacco smoke (ETS) (0.17%), TCDD (dioxins) (0.15%), naturally occurring radon (0.12%), work as a welder (0.10%).

The first two results columns of Table 3 give the proportion of the population ever exposed occupationally to the carcinogens over the risk exposure period (REP) with long latency proportions relating to solid tumours and the short latency proportions relating to cancers such as leukaemia, lymphoma etc. 13.7% of the population were ever exposed occupationally to solar radiation followed by mineral oils (up to 15%), TCDD (7.7%), silica (6.9%), naturally occurring radon in the workplace (6.4%), ETS (5.6%), wood dust (5.3%), DEE (5.1%), non-arsenical insecticides (4.3%) and inorganic lead (3%).

Asbestos also contributes the most to total attributable deaths (Table 4) (larynx (3), lung (1937), mesothelioma (1937), stomach (32)), followed by silica (lung (789)), diesel engine exhaust (DEE (605)), mineral oils (bladder (131), lung (410), sinonasal (16)), shift work (breast (552), work as a painter (bladder (31), lung (246), stomach(57)), environmental tobacco smoke (ETS) encountered at work in non-smokers (lung (249)), dioxins (TCDD) (lung (187)), radon exposure from natural exposure in workplaces (lung (184)), and work as a welder (lung (152)).

Fifteen of the carcinogens contributed over 100 total cancer registrations (Table 5), the largest being asbestos exposure (mesothelioma (1937) and lung (1937) larynx (8) and stomach cancers (47)), followed in order by shift work, including flight personnel (breast (1957)), mineral oils (bladder (296), lung (470), NMSC (902), sinonasal (55)), solar radiation (SR) (NMSC (1541)), silica (lung (907)), diesel engine exhaust (DEE) (lung (695), bladder (106)), PAHs from coal tar and pitches (NMSC (475)), occupation as a painter (bladder (71), lung (282), stomach (83)), dioxins (lung (215), NHL (74), STS (27)), ETS (lung (284)), radon (lung (209)), occupation as a welder (lung (175), melanoma of the eye due to UV radiation (6)), tetrachloroethylene (cervix (18), NHL (17), oesophagus (130)), arsenic (lung (129)) and strong inorganic acid mists (larynx (46), lung (76)).

The results in these tables highlight the fact that many carcinogenic exposures in the workplace affect multiple cancer sites.

20

Table 3 Proportion of the population ever exposed and attributable fractions (%) by carcinogenic agent or occupational circumstance and cancer site

Proportion of the population ever

exposed (%)

Cancer Site

Agent Solid tumours

Short latency cancers

Bladder Bone Brain Breast Cervix Kidney Larynx Leukaemia Liver Lung LH Melanoma eye

Mesothelio ma

1,3-Butadiene 0.02 0.01 0.00 Acrylamide 0.04 Aromatic amines 0.48 0.67 Arsenic 0.34 0.34 Asbestos 1.07 0.37 5.91 95.09 Benzene 2.27 0.25 Beryllium 0.15 0.02 Cadmium 0.47 0.02 Chromium VI 1.71, 1.70(1) 0.18 Cobalt 0.48 0.19 Diesel engine exhaust 5.11, 5.09(1) 1.00 1.84 Ethylene oxide 0.02 0.01 ETS 5.65 0.76 Flight personnel 0.03(8) 0.03 Formaldehyde 1.30 0.59 0.20 Hairdressers and barbers 1.80(9) 0.98 0.16

Inorganic lead 3.02, 2.97(1), 3.01 (10) 0.05 0.11

Ionising radiation 0.72(7) 0.40(7) 0.02 0.02 0.01 0.01 Leather Dust 1.49 Mineral oils 14.39 12.11, 2.81 1.25

21


exposed (%)

Cancer Site

Agent Solid tumours



Mesothelio ma

13.23(2)

Nickel 1.17, 0.0004(6) 0.02

Non-arsenical insecticides 4.29 3.27 0.29 0.38

PAHs 1.29, 1.22(1) 0.07 0.003 PAHs - Coal tars and pitches 0.86 Painters 3.09 0.67 0.75 Petroleum refining 0.35 0.01 Radon 6.44 0.56 Rubber industry 0.52 0.12 Shift work 4.84(11) 4.53 Silica 6.88 2.41 Solar radiation 13.66 Soots 0.21 Steel foundry workers 0.14 0.08

Strong inorganic-acid mists containing sulphuric acid 0.61, 0.58(1)

2.13 0.20

TCDD 7.73(3) 2.41,

5.93(4) 0.57

Tetrachloroethylene 1.39(12) 0.81 0.68 Tin miners 0.001(5) 0.00 Trichloroethylene 0.21 0.11 0.04 0.06

22


exposed (%)

Cancer Site

Agent Solid tumours



Mesothelio ma

UV 1.55 1.56 Vinyl chloride 0.06 0.11 Welders 1.55 0.46 Wood dust 5.32 Total AF(%) 5.38 0.02 0.35 4.56 0.68 0.04 2.61 0.74 0.18 14.47 0.00 1.56 95.09

LH= Lymphohaematopoietic; PAH = polycyclic aromatic hydrocarbon; TCDD = 2,3,7,8-Tetrachlorodibenzodioxin; UV = ultra violet (1) ‘Iron and steel basic industries' have been excluded from the CAREX industry sectors for all relevant carcinogens when estimating lung cancer to avoid overlap with the separate estimate for steel foundry workers. (2) For mineral oils different paths of exposure were recognised (dermal and inhalation), and therefore some industries were excluded from the estimates for the different cancer sites. The highest estimate (14.39%) is for NMSC, which is for dermal exposure only; lung (13.23%), bladder and sinonasal cancers (both 12.11%) exclude solely dermal exposure (motor mechanics, office machinery mechanics and aircraft engine maintenance fitters). Printers were included (with a high level relative risk) in the estimates for lung cancer, but excluded for the other cancer sites. (3) For TCDD (long latency) the estimates for lung cancer from LFS 1979 data include farming, forestry and horticulture (4) For TCDD (short latency) the estimates for STS (5.93%) from Census of Employment data are used which include farming, forestry and horticulture; (excluded for NHL, 2.41%) (5) For tin miners the number shown here was for the whole cohort employed from 1941, not a point estimate. (6) For lung cancer from nickel exposure the number shown here for non-ferrous metals basic industries is from CAREX (1.17%). For sinonasal cancer for which only high level exposure was considered to have excess risk, numbers for the Clydach cohort only were used (0.0004%). (7) For Ionising Radiation exposure data were obtained from the Central Index of Dose Information (CIDI, 1998) which excludes air crew, plus data from the LFS for male flight crew and from a cohort of women flight crew from the BA Stewards and Stewardesses Union (BASSA) data. (8) 0.03% is the proportion ever exposed for men and women together; flight personnel as an exposure was estimated for women’s breast cancer only; the proportion of women ever flight personnel is 0.07%, estimated using the BASSA cohort (9)Estimation for hairdresser and ovarian cancer was for women only; the proportion of women ever hairdressers is 3.01% (10) For inorganic lead the estimates for stomach cancer (3.01%) exclude the rubber industry to avoid double counting

23

(11)4.84% is for men and women together. Estimates were made for shift work and women’s breast cancer only; the proportion of women in shift (night) work is 0.093% (12) Estimation for tetrachloroethylene and cervical cancer was for women only; the proportion of women ever exposed to tetrachloroethylene is 0.90%

24

Table 3: Continued: Attributable fraction (%) by carcinogenic agent or occupational circumstance and cancer site Agent MM Nasopharynx NHL NMSC Oesophagus Ovary Pancreas Sinonasal STS Stomach Thyroid Total across all

cancer sites (based on deaths)

Rank

1,3-Butadiene 0.00 40 Acrylamide 0.01 0.00 38 Aromatic amines 0.02 20 Arsenic 0.08 12 Asbestos 0.58 2.6 1 Benzene 0.00 30 Beryllium 0.00 28 Cadmium 0.01 25 Chromium VI 5.69 0.04 14 Cobalt 0.04 15 Diesel engine exhaust 0.43 3 Ethylene oxide 0.00 41 ETS 0.17 7 Flight personnel 0.00 34 Formaldehyde 0.44 0.17 0.00 27 Hairdressers and barbers 0.19 0.54 0.02 19 Inorganic lead 0.28 0.04 17 Ionising radiation 0.05 0.00 36 Leather Dust 8.39 0.01 24 Mineral oils 1.42 13.84 0.38 4 Nickel 0.00 0.01 26 Non-arsenical insecticides 0.03 0.38 0.03 18 PAHs 0.00 32 PAHs - Coal tars and pitches 0.76 0.00 33 Painters 1.03 0.22 6 Petroleum refining 0.00 42 Radon 0.12 9

25

Agent MM Nasopharynx NHL NMSC Oesophagus Ovary Pancreas Sinonasal STS Stomach Thyroid Total across all cancer sites

(based on deaths)

Rank

Rubber industry 0.08 0.00 29 Shift work 0.37 5 Silica 0.53 2 Solar radiation 2.41 0.01 23 Soots 0.81 0.04 16 Steel foundry workers 0.02 21 Strong inorganic-acid mists containing sulfuric acid 0.06 13 TCDD 0.86 2.27 0.15 8 Tetrachloroethylene 0.20 1.74 0.09 11 Tin miners 0.00 39 Trichloroethylene 0.03 0.00 31 UV 0.00 37 Vinyl chloride 0.00 35 Welders 0.10 10 Wood dust 7.62 10.02 0.01 22 Total Attributable fraction (%) 0.03 8.03 1.74 4.50 2.54 0.54 0.01 32.67 2.27 1.95 0.00 5.34

MM = multiple myeloma; NHL = Non-Hodgkin’s lymphoma; NMSC = non-melanoma skin cancer; PAH = polycyclic aromatic hydrocarbon; STS = soft tissue sarcoma; TCDD = 2,3,7,8-Tetrachlorodibenzodioxin; UV = ultra violet

26

Table 4 Total deaths by carcinogenic agent or occupational circumstance and cancer site

Cancer Site Agent

Bladder Bone Brain Breast Cervix Kidney Larynx Leukaemia Liver Lung LH Melanoma eye Mesothelioma

1,3-Butadiene 0 0 Acrylamide Aromatic amines 31 Arsenic 113 Asbestos 3 1937 1937 Benzene 4 Beryllium 6 Cadmium 8 Chromium VI 58 Cobalt 63 Diesel engine exhaust 47 605 Ethylene oxide 0 ETS 249 Flight personnel 4 Formaldehyde 6 Hairdressers and barbers 8 Inorganic lead 2 36 Ionising radiation 0 0 0 2 Leather Dust Mineral oils 131 410 Nickel 8 Non-arsenical insecticides 9 12 PAHs 3 1 PAHs - Coal tars and pitches Painters 31 246

27

Cancer Site Agent

Bladder Bone Brain Breast Cervix Kidney Larynx Leukaemia Liver Lung LH Melanoma eye Mesothelioma

Petroleum refining 0 Radon 184 Rubber industry 1 Shift work 552 Silica 789 Solar radiation Soots Steel foundry workers 25 Strong inorganic-acid mists containing sulphuric acid

16 67

TCDD 187 Tetrachloroethylene 7 Tin miners 1 Trichloroethylene 1 2 UV 1 Vinyl chloride 3

Welders 152

Wood dust Total deaths 245 0 11 555 7 1 20 23 5 4745 0 1 1,937 Total deaths in GB 2005b 4642 233 3215 12182 1036 3499 766 3102 2794 32798 8479 83 2040

LH= Lymphohaematopoietic; PAH = polycyclic aromatic hydrocarbon; TCDD = 2,3,7,8-Tetrachlorodibenzodioxin; UV = ultra violet aBlank cells indicate that attributable cancer deaths were not estimated for this occupational exposure. Zero represents an estimate of less than 0.5. bDeaths aged 25+ for solid tumours, aged 15-84 for haematopoietic neoplasms for men and 15-79 for haematopoietic neoplasms for women

28

Table 4: Continued: deaths by carcinogenic agent or occupational circumstance and cancer site Agent

MM Nasopharynx NHL NMSC Oesophagus Ovary Pancreas Sinonasal NMSC STS Stomach Thyroid Total across all cancer sites Rank

1,3-Butadiene 1 40 Acrylamide 1 1 38 Aromatic amines 31 20 Arsenic 113 12 Asbestos 32 3909 1 Benzene 4 30 Beryllium 6 28 Cadmium 8 25 Chromium VI 7 65 14 Cobalt 63 15 Diesel engine exhaust 652 3 Ethylene oxide 0 41 ETS 249 7 Flight personnel 4 34 Formaldehyde 0 0 7 27 Hairdressers and barbers 5 23 36 19 Inorganic lead 16 53 17 Ionising radiation 0 3 36 Leather Dust 10 10 24 Mineral oils 7 16 7 563 4 Nickel 0 8 26 Non-arsenical insecticides 6 13 40 18 PAHs 4 32 PAHs - Coal tars and pitches 4 4 4 33 Painters 57 334 6

29

Agent

MM Nasopharynx NHL NMSC Oesophagus Ovary Pancreas Sinonasal NMSC STS Stomach Thyroid Total across all cancer sites Rank

Petroleum refining 0 42 Radon 184 9 Rubber industry 4 5 29 Shift work 552 5 Silica 789 2 Solar radiation 12 12 12 23 Soots 59 59 16 Steel foundry workers 25 21 Strong inorganic-acid mists containing sulphuric acid 83 13 TCDD 31 13 231 8 Tetrachloroethylene 7 126 140 11 Tin miners 1 39 Trichloroethylene 1 4 31 UV 1 37 Vinyl chloride 3 35 Welders 152 10 Wood dust 7 11 19 22 Total deaths 6 8 57 23 184 23 1 38 23 13 108 0 8010 Total deaths in GB in 2005b 1769 97 3281 501 7286 4234 7111 115 501 557 5515 337 150124c

MM = multiple myeloma; NHL = Non-Hodgkin’s lymphoma; NMSC = non-melanoma skin cancer; PAH = polycyclic aromatic hydrocarbon; STS = soft tissue sarcoma; TCDD = 2,3,7,8-Tetrachlorodibenzodioxin; UV = ultra violet aBlank cells indicate that attributable cancer deaths were not estimated for this occupational exposure. Zero represents an estimate of less than 0.5. bDeaths aged 25+ for solid tumours, aged 15-84 for haematopoietic neoplasms for men and 15-79 for haematopoietic neoplasms for women cAll malignant neoplasms

30

Table 5 Total cancer registrations by carcinogenic agent or occupational circumstance and cancer site Agent Bladder Bone Brain Breast Cervix Kidney Larynx Leukaemia Liver Lung LH Melanoma

eye Mesothelioma

1,3-Butadiene 0 1 Acrylamide Aromatic amines 66 Arsenic 129 Asbestos 8 2223 1937 Benzene 7 Beryllium 7 Cadmium 9 Chromium VI 67 Cobalt 73 Diesel engine exhaust 106 695 Ethylene oxide 1 ETS 284 Flight personnel 13 Formaldehyde 10 Hairdressers and barbers 15

Inorganic lead 2 41 Ionising radiation 0 1 0 2 Leather Dust Mineral oils 296 470 Nickel 9 Non-arsenical insecticides 11 19

PAHs 7 1 PAHs - Coal tars and pitches Painters 71 282 Petroleum refining 0

31

Agent Bladder Bone Brain Breast Cervix Kidney Larynx Leukaemia Liver Lung LH Melanoma eye

Mesothelioma

Radon 209 Rubber industry 3 Shift work 1957 Silica 907 Solar radiation Soots Steel foundry workers 29 Strong inorganic-acid mists containing sulphuric acid

46 76

TCDD 215 Tetrachloroethylene 18 Tin miners 1 Trichloroethylene 3 2 UV 6 Vinyl chloride 3 Welders 175 Wood dust Total Attributable Registrations 550 0 14 1969 18 3 56 38 5 5442 1 6 1937

Total Registrations in GB, 2004 9878 323 3933 43202 2612 6759 2112 5147 2798 37378 18090 383 2040

LH = lymphohaematopoietic cancers; PAH = polycyclic aromatic hydrocarbon; TCDD = 2,3,7,8-Tetrachlorodibenzodioxin; UV = ultra violet aBlank cells indicate that attributable cancer registrations were not estimated for this occupational exposure. Zero represents an estimate of less than 0.5. bRegistrations aged 25+ for solid tumours, aged 15-84 for haematopoietic neoplasms for men and 15-79 for haematopoietic neoplasms for women; figures for mesothelioma based on deaths.

32

Table 5: Continued: total cancer registrations by carcinogenic agent or occupational circumstance and cancer site

Agent MM Nasopharynx NHL NMSC Oesophagus Ovary Pancreas Sinonasal STS Stomach Thyroid Total across all cancer

sites

Rank

1,3-Butadiene 1 38 Acrylamide 1 1 39 Aromatic amines 66 19 Arsenic 129 14 Asbestos 47 4216 1 Benzene 7 34 Beryllium 7 32 Cadmium 9 28 Chromium VI 22 89 16 Cobalt 73 18 Diesel engine exhaust 801 6 Ethylene oxide 1 41 ETS 284 10 Flight personnel 13 26 Formaldehyde 1 1 12 27 Hairdressers and barbers 14 33 63 21 Inorganic lead 23 65 20 Ionising radiation 1 4 36 Leather Dust 31 31 24 Mineral oils 902 55 1722 3 Nickel 0 9 30 Non-arsenical insecticides 10 33 73 17 PAHs 8 31 PAHs - Coal tars and pitches 475 475 7 Painters 83 437 8 Petroleum refining 0 42

33

Agent MM Nasopharynx NHL NMSC Oesophagus Ovary Pancreas Sinonasal STS Stomach Thyroid Total across all cancer

sites

Rank

Radon 209 11 Rubber industry 6 9 29 Shift work 1957 2 Silica 907 5 Solar radiation 1541 1541 4 Soots 60 60 22 Steel foundry workers 29 25 Strong inorganic-acid mists containing sulphuric acid 122 15

TCDD 74 27 316 9 Tetrachloroethylene 17 130 164 13 Tin miners 1 40 Trichloroethylene 3 7 33 UV 6 35 Vinyl chloride 3 37 Welders 175 12 Wood dust 14 39 54 23 Total Attributable Registrations 10 15 140 2,862 188 33 1 126 27 157 1 13598 Total Registrations in GB 2004b 3006 189 8236 67220 7498 6197 7246 378 1063 7970 1519 343583c

MM = multiple myeloma; NHL = Non-Hodgkin’s lymphoma; NMSC = non-melanoma skin cancer; PAH = polycyclic aromatic hydrocarbon; STS = soft tissue sarcoma; TCDD = 2,3,7,8-Tetrachlorodibenzodioxin; UV = ultra violet aBlank cells indicate that attributable cancer registrations were not estimated for this occupational exposure. Zero represents an estimate of less than 0.5. bRegistrations aged 25+ for solid tumours, aged 15-84 for haematopoietic neoplasms for men and 15-79 for haematopoietic neoplasms for women; figures for mesothelioma based on deaths. cAll malignant neoplasms

34

3.3 DEATHS AND REGISTRATIONS BY INDUSTRY SECTOR AND CARCINOGENIC AGENT OR OCCUPATIONAL CIRCUMSTANCE

Tables 6a,b, 7 and 8 give numbers ever exposed over the risk exposure period (REP), total deaths and total registrations respectively, by industry sector and for each carcinogenic agent or occupational circumstance; a rank based on the total over all carcinogenic agents is given for industry sector. Numbers of deaths and registrations for males, females and the total are available on the HSE website, together with the respective attributable fractions. Based on CAREX data very large numbers are estimated to have been exposed to carcinogens in the construction sector, 2 million to RCS, 1.6 million to solar radiation through outdoor work and nearly 500,000 to diesel engine exhaust (DEE). LFS 1979 data also highlighted the large numbers employed as painters in the construction sector as well as roofers, road builders and paviors who were exposed to coal tars and pitches. In the services sector the highest numbers (over 1 million during the REP) were estimated to have been occupationally exposed to benzene and mineral oils, mainly in personal and household services (including vehicle repair and other repair services), and to diesel engine exhaust mainly in land transport. About 2.3 million service sector workers have been exposed to a risk of NMSC from outdoor work in the sun, 1.8 million are at risk of lung cancer from past exposure to radon and 1.5 million non-smokers are at risk of lung cancer from environmental tobacco smoke (ETS) in the workplace. Very large numbers of women (nearly 2 million) have worked as night shift workers (breast cancer) in occupations associated with health-care, transport, communication, leisure and hospitality sectors, and air transport. About 1.7 million have been exposed to non-arsenical pesticides and dioxins in agriculture, forestry and fishing, and nearly 500,000 to solar radiation. Also amongst the largest numbers exposed are to mineral oils including 4.2 million metal workers, and 1.2 million welders (both estimated from LFS data). The exposure pattern for many of the carcinogens relevant to the short latency cancers (leukaemia, lymphoma etc; REP 1996-2005) is different to that of the long latency cancers with the largest numbers of those ever exposed being in the service industry sectors, followed by manufacturing, agriculture and a relatively small number in construction (Table 6b).

The top ten industry sectors contributing to the total burden differ between deaths and registrations, being for deaths (Table 7): construction, shift work, personal and household services (this sector includes repair trades, laundries and dry cleaning, domestic services, hairdressing and beauty), land transport, metal workers, painters and decorators in the construction industry, printing and publishing, mining, wholesale and retail trades, and manufacture of transport equipment; and for registrations (Table 8): construction, shift work, metal work, personal and household services, land transport, roofers and road repairs, painters and decorators in the construction industry, mining, printing and publishing, and public administration and defence. The difference occurs because of the increased numbers of cancer registrations compared to deaths for longer survival cancers such as breast and NMSC.

Twenty one industry sectors have 100 or more total attributable registrations (Table 8). As can be seen from examination of the columns in both tables 7 and 8, the majority of industry sectors involve exposure to several carcinogens (many over 10) with construction and many of the manufacturing sectors involving potential exposure to between 15 and 20 carcinogens. In addition, the potential occurrence of several exposures in what might be thought as less traditionally exposed sectors e.g. dry cleaning, hairdressing and beauty is highlighted. There are several key exposures which give rise to substantial numbers of registrations across multiple industry sectors. Of note is the contribution of exposure to (i) asbestos, DEE, silica and solar radiation in the construction industry; (ii) asbestos, DEE, ETS (non-smokers), soots

35

and tetrachloroethylene in personal and household services; (iii) asbestos and DEE in land transport (railway, road, pipeline); (iv) asbestos, DEE, silica and solar radiation in mining; (v) ETS (non-smokers) and solar radiation in public administration and defence; (vi) asbestos, ETS (non-smokers) and radon in the wholesale and retail trade, restaurants and hotels and (vii) dioxins, non-arsenical insecticides and solar radiation in farming.

36

Table 6a Total numbers ever exposed over the risk exposure period by industry sector and carcinogenic agent or occupational circumstance: Long latency cancers

Industry Sector/Carcinogenic agent

Acr

ylam

ide

Aro

mat

ic a

min

es

Ars

enic

Asb

esto

s

Ber

ylliu

m

Cad

miu

m

Chr

omiu

m V

I

Cob

alt

Die

sel e

ngin

eex

haus

t

Envi

ronm

enta

lTo

bacc

o Sm

oke

Flig

ht p

erso

nnel

(2)

Farming 7,049 Forestry 487 Horticulture Total agricultural, hunting, fishing and forestry 7,536 Beverage industries 1,504 182 26,540 Crude petroleum and natural gas production 968 6,823 268 42,885 Electricity, gas and steam 1,731 1,470 695 3,542 3,759 831 21,613 26,068 Food manufacturing 68 11,669 12,666 21,983 17,024 General industry Iron and steel basic industries (1) 40,761 3,873 5,450 9,451 Manufacture of electrical machinery, apparatus, appliances and supplies 46 8,258 3,958 6,971 30,999 2,096 6,971 48,664 Manufacture of fabricated metal products, except machinery and equipment 3,337 13,668 119,816 35,982 22,325 36,021 Manufacture of footwear 125 615 Manufacture of furniture and fixture, except primary of metal 8,674 786 25,156 2,870 Manufacture of glass and glass products 7,313 1,669 2,574 3,468 2,905 598 5,332 Manufacture of industrial chemicals 4,340 74 4,585 4,866 171 6,396 17,199 6,572 9,038 13,345 Manufacture of instruments, photographic and optical goods 1,344 7,096 9,403 5,820 877 26,550 Manufacture of leather and products of leather or of its substitutes 17,682 3,155 46 Manufacture of machinery except electrical 46,490 13,253 129,805 17,701 17,974 127,967 Manufacture of miscellaneous products of petroleum and coal 222 Manufacture of other chemical products 1,247 285 5,210 80 9,260 10,650 7,899 21,608 Manufacture of other non-metallic mineral products 1,264 5,969 962 154 66,138 Manufacture of paper and paper products 2,791 10,263 2,113 6,515 8,740

37


Acr

ylam

ide

Aro

mat

ic a

min

es

Ars

enic

Asb

esto

s

Ber

ylliu

m

Cad

miu

m

Chr

omiu

m V

I

Cob

alt

Die

sel e

ngin

eex

haus

t

Envi

ronm

enta

lTo

bacc

o Sm

oke

Flig

ht p

erso

nnel

(2)

Manufacture of plastic products not elsewhere classified 1,150 17,729 19,409 2,358 1,669 7,337 Manufacture of pottery, china and earthenware 2,700 1,424 2,700 25,318 Manufacture of rubber products 626 1,259 23 2,842 5,285 148 6,710 Manufacture of textiles 66,587 103 3,178 18,714 831 5,746 11,235 Manufacture of transport equipment 120 8,668 2,654 4,135 82,478 13,247 14,659 115,452 Manufacture of wearing apparel, except footwear 40 5,764 3,326 6,379 23,354 Manufacture of wood and wood and cork products, except furniture 36,649 159 17,199 7,620 22,872 2,732 Metal Workers Mining 69,088 72,254 Non-ferrous metal basic industries 52,834 34,023 13,486 6,248 15,109 Other manufacturing industries 103 302 6,720 3,531 1,333 1,857 10,977 Painters (not construction) Petroleum refineries 251 2,844 1,048 4,978 74 4,704 5,193 Printing, publishing and allied industries 8,708 20,696 14,306 3,389 65,568 Tobacco manufacture 68 Water works and supply 23,322 Welders Total manufacturing industry, mining, quarrying, electricity, gas, water 6,327 127,615 122,265 94,937 61,411 140,956 556,324 175,332 431,929 614,646 Construction 12,786 209,244 27,671 19,333 12,237 483,589 123,609 Painters and decorators (construction) Roofers, road surfacers, Roadmen, Paviors (Construction) Total Construction 12,786 209,244 27,671 19,333 12,237 483,589 123,609 Air transport 911 3,263 17,831 5,208 27,901 68,310 Business, professional and other organisation 4,718 Communication 25,861 41,707 Education services 7,502 3,829 24,732 Financing, insurance, real estate and business services 202,885

38


Acr

ylam

ide

Aro

mat

ic a

min

es

Ars

enic

Asb

esto

s

Ber

ylliu

m

Cad

miu

m

Chr

omiu

m V

I

Cob

alt

Die

sel e

ngin

eex

haus

t

Envi

ronm

enta

lTo

bacc

o Sm

oke

Flig

ht p

erso

nnel

(2)

Flight Personnel 13,902 Land transport 10,002 6,295 615,665 18,311 Medical, dental, other health and veterinary services 62 1,492 30,127 Personal and household services 52,872 97,038 13,637 85,230 284,099 132,655 Public administration and defence 10,316 121,847 Recreational and cultural services 163 54,516 Research and scientific institutes 1,548 10,016 6,193 Sanitary and similar services 1,635 3,624 3,053 1,846 194 17,423 18,643 Services allied to transport 1,244 305 948 57,390 36,860 Shift work Water transport 4,227 53,531 23,168 Welfare institutions 31,358 Wholesale and retail trade and restaurants and hotels 17,793 55,566 720,607 Total Service industries 9,112 68,208 1,798 128,457 911 21,197 115,735 6,349 1,147,754 1,536,637 13,902 TOTAL 15,439 195,824 136,849 432,638 62,322 189,825 691,392 193,919 2,063,271 2,282,428 13,902

(1) Iron and steel basic industries have been excluded when estimating lung cancer burden due to exposure to Chromium VI and Diesel engine exhaust to avoid overlap with the separate estimate for steel foundry workers; iron and steel basic industries have been included when estimating burden for sinonasal cancer due to Chromium VI exposure and bladder cancer due to Diesel engine exhaust exposure. (2) For flight personnel as an exposure (breast cancer only), flight personnel are women identified in the BA Stewards and Stewardesses Union (BASSA) data cohort only

39

Table 6a continued Total numbers ever exposed over the risk exposure period by industry sector and carcinogenic agent or occupational circumstance: Long latency cancers

Industry Sector/Carcinogenic Agent

Form

alde

hyde

Hai

rdre

sser

s and

barb

ers

Inor

gani

c le

ad

Ioni

sing

rad

iatio

n(2)

Lea

ther

Dus

t

Min

eral

oils

(3)

Nic

kel(4

)

Non

-ars

enic

al

inse

ctic

ides

Poly

cycl

ic A

rom

atic

H

ydro

carb

onss

PAH

s - C

oal t

ars

and

pitc

hes

Pain

ters

Farming 1,268,835 Forestry 31,128 Horticulture 383,354 Total agricultural, hunting, fishing and forestry 1,683,317 Beverage industries 5,017 581 Crude petroleum and natural gas production 3,736 16,328 5,057 Electricity, gas and steam 15,286 154,014 3,468 28,453 Food manufacturing 3,229 7,740 42,308 5,524 General industry 40,969 Iron and steel basic industries (1) 10,650 21,152 129,417 27,981 2,771 Manufacture of electrical machinery, apparatus, appliances and supplies 44,309 5,467 Manufacture of fabricated metal products, except machinery and equipment 3,047 76,623 47,300 157,734 34,786 Manufacture of footwear 426,118 740 Manufacture of furniture and fixture, except primary of metal 226,509 Manufacture of glass and glass products 1,583 19,802 2,688 4,659 Manufacture of industrial chemicals 5,729 10,001 8,019 7,317 5,729 Manufacture of instruments, photographic and optical goods 19,398 448,391 2,984 Manufacture of leather and products of leather or of its substitutes 23 174,829 1,219 Manufacture of machinery except electrical 4,328 136,941 14,301 39,754 142,898 23,384 Manufacture of miscellaneous products of petroleum and coal 495 467 Manufacture of other chemical products 2,050 15,457 177 Manufacture of other non-metallic mineral products 3,332 11,402 11,806 Manufacture of paper and paper products 4,112 2,335 6,413 1,646

40


Form

alde

hyde

Hai

rdre

sser

s and

barb

ers

Inor

gani

c le

ad

Ioni

sing

rad

iatio

n(2)

Lea

ther

Dus

t

Min

eral

oils

(3)

Nic

kel(4

)

Non

-ars

enic

al

inse

ctic

ides

Poly

cycl

ic A

rom

atic

H

ydro

carb

onss

PAH

s - C

oal t

ars

and

pitc

hes

Pain

ters

Manufacture of plastic products not elsewhere classified 11,510 43,204 Manufacture of pottery, china and earthenware 53,934 1,521 7,757 Manufacture of rubber products 4,767 21,915 Manufacture of textiles 26,938 962 Manufacture of transport equipment 85,906 15,475 73,474 52,920 Manufacture of wearing apparel, except footwear 102,468 2,785 48,090 Manufacture of wood and wood and cork products, except furniture 70,791 4,886 2,933 Metal Workers 4,243,91

2 Mining 442 1,445 1,900 1,571 Non-ferrous metal basic industries 7,142 35,310 53,631 9,260 Other manufacturing industries 7,899 1,378 Painters (not construction) 327,246 Petroleum refineries 1,196 3,053 Printing, publishing and allied industries 5,969 451,226 74 598 Tobacco manufacture 68 581 Water works and supply 21,830 Welders Total manufacturing industry, mining, quarrying, electricity, gas, water 488,944 662,520 210,730 600,947

5,375,47 5 469,566 49,626 300,130 2,771 327,246

Construction 20,453 123,951 2,031 20,453 Painters and decorators (construction) 922,197 Roofers, road surfacers, Roadmen, Paviors (Construction) 343,695 Total Construction 20,453 123,951 2,031 20,453 343,695 922,197 Air transport 9,970 70 Business, professional and other organisation Communication 35,045 Education services 528 Financing, insurance, real estate and business services Flight Personnel 69,973

41


Form

alde

hyde

Hai

rdre

sser

s and

barb

ers

Inor

gani

c le

ad

Ioni

sing

rad

iatio

n(2)

Lea

ther

Dus

t

Min

eral

oils

(3)

Nic

kel(4

)

Non

-ars

enic

al

inse

ctic

ides

Poly

cycl

ic A

rom

atic

H

ydro

carb

onss

PAH

s - C

oal t

ars

and

pitc

hes

Pain

ters

Land transport 7,535 735 38,514 Medical, dental, other health and veterinary services 12,095 1,683 Personal and household services

1,100 727,978 328,422 1,011,30

8 100,005 Public administration and defence 1,030 1,030 Recreational and cultural services 320 Research and scientific institutes 761 1,763 Sanitary and similar services 2,917 6,571 38,901 Services allied to transport 3,111 99 2,851 Shift work Water transport 7,581 705 Welfare institutions Wholesale and retail trade and restaurants and hotels 40,005 20,003 Total Service industries

14,804 727,978 435,616 80,725 1,011,30

8 169 202,008 TOTAL

524,201 727,978 1,222,08

7 291,455 600,947 6,386,78

3 471,766 1,732,942 522,591 346,466 1,249,44

3 (1 Iron and steel basic industries have been excluded when estimating lung cancer burden due to exposure to inorganic lead and polycyclic aromatic hydrocarbons to avoid overlap with the separate estimate for steel foundry workers; iron and steel basic industries have been included when estimating burden for bladder cancer due to exposure to polycyclic aromatic hydrocarbons and for liver cancer and stomach cancer due to exposure to inorganic lead. (2) For Ionising Radiation exposure data were obtained from the Central Index of Dose Information (CIDI, 1998) which excludes air crew, plus data from the LFS for male flight crew and from a cohort of women flight crew from the BA Stewards and Stewardesses Union (BASSA) data. (3) For mineral oils different paths of exposure were recognised (dermal and inhalation), and therefore some industries were excluded from the estimates for the different cancer sites. Non-melanoma skin cancer included only dermal exposure; lung, bladder and sinonasal cancers exclude solely dermal exposure (motor mechanics (personal and household services), office machinery mechanics (manufacture of machinery except electrical) and aircraft engine maintenance fitters (manufacture of transport equipment)). Printers were included (with a high level relative risk) in the estimates for lung cancer, but excluded for the other cancer sites. The total given here includes all these exposed groups. (4) For lung cancer from nickel exposure the number shown here for non-ferrous metals basic industries is from CAREX. For sinonasal cancer for which only high level exposure was considered to have excess risk, numbers for the Clydach cohort only were used (not shown in this table).

42

Table 6a continued: Total numbers ever exposed over the risk exposure period by industry sector and carcinogenic agent or occupational circumstance: Long latency cancers


Petr

oleu

m r

efin

ing

Rad

on

Rub

ber

indu

stry

Shift

wor

k

Silic

a

Sola

r ra

diat

ion

Soot

s

Stee

l fou

ndry

w

orke

rs

Stro

ng in

orga

nic-

ac

id m

ists

with

su

lphu

ric

acid

Farming 5,653 470,020 Forestry 109 27,650 Horticulture Total agricultural, hunting, fishing and forestry 5,763 497,669 Beverage industries 15,052 137 Crude petroleum and natural gas production 9,511 8,394 Electricity, gas and steam 18,555 19,261 104,393 Food manufacturing 67,927 2,050 47,202 General industry Iron and steel basic industries (1) 7,353 11,032 57,538 13,968 Manufacture of electrical machinery, apparatus, appliances and supplies 79,334 27,995 Manufacture of fabricated metal products, except machinery and equipment 45,920 45,573 49,941 32,319 Manufacture of footwear 6,624 570 Manufacture of furniture and fixture, except primary of metal 23,681 2,267 Manufacture of glass and glass products 5,849 39,479 36,928 Manufacture of industrial chemicals 19,990 3,520 30,462 Manufacture of instruments, photographic and optical goods 14,688 8,924 Manufacture of leather and products of leather or of its substitutes 2,893 900 4,464 Manufacture of machinery except electrical 105,310 92,564 23,437 Manufacture of miscellaneous products of petroleum and coal 188 1,652 Manufacture of other chemical products 28,111 32,246 36,419 Manufacture of other non-metallic mineral products 9,557 138,997 60,557 Manufacture of paper and paper products 18,105 17,587 Manufacture of plastic products not elsewhere classified 21,289 9,967 Manufacture of pottery, china and earthenware 7,278 123,979 46,382 82 Manufacture of rubber products 9,061 208,326 4,004

43


Petr

oleu

m r

efin

ing

Rad

on

Rub

ber

indu

stry

Shift

wor

k

Silic

a

Sola

r ra

diat

ion

Soot

s

Stee

l fou

ndry

w

orke

rs

Stro

ng in

orga

nic-

ac

id m

ists

with

su

lphu

ric

acid

Manufacture of textiles 31,153 1,925 Manufacture of transport equipment 61,838 36,563 312,256 21,675 Manufacture of wearing apparel, except footwear 31,432 2,813 32,377 Manufacture of wood and wood and cork products, except furniture 17,934 98,453 Metal Workers Mining 947 85,414 57,258 Non-ferrous metal basic industries 12,085 13,703 18,071 25,217 Other manufacturing industries 10,143 7,495 Painters (not construction) Petroleum refineries 139,905 2,176 649 14,397 Printing, publishing and allied industries 51,507 4,306 181,802 Tobacco manufacture 1,714 6 Water works and supply 3,132 51,456 Welders Total manufacturing industry, mining, quarrying, electricity, gas, water 139,905 730,827 208,326 688,473 1,122,505 57,538 228,051 Construction

95,736 2,039,98

9 1,575,241 Painters and decorators (construction) Roofers, road surfacers, Roadmen, Paviors (Construction) Total Construction

95,736 2,039,98

9 1,575,241 Air transport 10,305 2,892 4,660 Business, professional and other organisation 14,646 61,412 Communication 34,523 289,061 Education services 177,151 2,513 Financing, insurance, real estate and business services 337,980 216,118 Flight Personnel Land transport 49,480 21,107 363,730 Medical, dental, other health and veterinary services 181,039 38,252 Personal and household services 80,702 28,447 84,585 Public administration and defence 158,512 449,292

44


Petr

oleu

m r

efin

ing

Rad

on

Rub

ber

indu

stry

Shift

wor

k

Silic

a

Sola

r ra

diat

ion

Soot

s

Stee

l fou

ndry

w

orke

rs

Stro

ng in

orga

nic-

ac

id m

ists

with

su

lphu

ric

acid

Recreational and cultural services 55,379 115,359 Research and scientific institutes 9,912 3,626 31,450 Sanitary and similar services 25,910 15,491 142,019 Services allied to transport 14,987 2,423 163,769 Shift work 1,953,645 Water transport 7,069 4,915 38,252 Welfare institutions 74,319 16,083 Wholesale and retail trade and restaurants and hotels 537,416 368,313 Total Service industries 1,769,331 1,953,645 52,967 2,321,557 84,585 4,660 TOTAL

139,905 2,601,656 208,326 1,953,645 2,781,42

9 5,516,973 84,585 57,538 246,679 (1) Iron and steel basic industries have been excluded when estimating lung cancer burden due to exposure to strong inorganic acid mists to avoid overlap with the separate estimate for steel foundry workers; iron and steel basic industries have been included when estimating burden for laryngeal cancer due to exposure to strong inorganic acid mists.

45

Table 6a continued Total numbers ever exposed over the risk exposure period by industry sector and carcinogenic agent or occupational circumstance: Long latency cancers


TC

DD

(Dio

xins

)(1)

Tet

rach

loro

ethy

lene

Tin

min

ers(2

)

Tri

chlo

roet

hyle

ne

Ultr

a V

iole

t

Vin

yl c

hlor

ide

Wel

ders

Woo

d du

st

Farming 1,268,835 Forestry 31,128 30,567 Horticulture 383,354 Total agricultural, hunting, fishing and forestry 1,683,317 30,567 Beverage industries 1,999 524 51 Crude petroleum and natural gas production 353 387 Electricity, gas and steam 18,071 137 Food manufacturing 12,734 23 2,346 General industry Iron and steel basic industries 240,104 5,365 1,071 Manufacture of electrical machinery, apparatus, appliances and supplies 18,441 10,548 3,896 Manufacture of fabricated metal products, except machinery and equipment 34,183 12,182 11,983 Manufacture of footwear 63 Manufacture of furniture and fixture, except primary of metal 536,465 Manufacture of glass and glass products 228,021 1,310 740 1,173 Manufacture of industrial chemicals 56,972 7,540 3,531 Manufacture of instruments, photographic and optical goods 11 752 Manufacture of leather and products of leather or of its substitutes 649 46 182 Manufacture of machinery except electrical 48,785 17,319 28,129 Manufacture of miscellaneous products of petroleum and coal Manufacture of other chemical products 7,905 6,555 Manufacture of other non-metallic mineral products 104,644 285 11 8,531 Manufacture of paper and paper products 170,219 12,564 24,535 Manufacture of plastic products not elsewhere classified 5,752 2,364

46


TC

DD

(Dio

xins

)(1)

Tet

rach

loro

ethy

lene

Tin

min

ers(2

)

Tri

chlo

roet

hyle

ne

Ultr

a V

iole

t

Vin

yl c

hlor

ide

Wel

ders

Woo

d du

st

Manufacture of pottery, china and earthenware 207,797 171 Manufacture of rubber products 142 Manufacture of textiles 18,122 330 Manufacture of transport equipment 14,956 16,795 41,415 Manufacture of wearing apparel, except footwear 23,504 666 46 285 Manufacture of wood and wood and cork products, except furniture 91,435 318,532 Metal Workers Mining 416 Non-ferrous metal basic industries 300,498 3,844 188 1,481 Other manufacturing industries 11,123 Painters (not construction) Petroleum refineries 23 439 137 Printing, publishing and allied industries 16,095 12,108 Tobacco manufacture 137 228 40 Water works and supply 1,891 Welders 626,978 626,978 Total manufacturing industry, mining, quarrying, electricity, gas, water 1,399,690 233,196 416 59,333 626,978 21,915 626,978 1,017,743 Construction 68,396 1,034,277 Painters and decorators (construction) Roofers, road surfacers, Roadmen, Paviors (Construction) Total Construction 68,396 1,034,277 Air transport 5,459 9 2,299 Business, professional and other organisation Communication 1,401 29 Education services 251 553 539 10,045 Financing, insurance, real estate and business services Flight Personnel Land transport 24,596 21,070 Medical, dental, other health and veterinary services Personal and household services 227,280 24,999 Public administration and defence

47


TC

DD

(Dio

xins

)(1)

Tet

rach

loro

ethy

lene

Tin

min

ers(2

)

Tri

chlo

roet

hyle

ne

Ultr

a V

iole

t

Vin

yl c

hlor

ide

Wel

ders

Woo

d du

st

Recreational and cultural services 335 Research and scientific institutes 363 399 389 Sanitary and similar services 530 17,098 Services allied to transport 1,335 795 15,677 Shift work Water transport 705 261 239 Welfare institutions Wholesale and retail trade and restaurants and hotels 41,007 Total Service industries 41,007 261,389 26,816 1,993 66,456 (1) For TCDD (long latency) the estimates for lung cancer from LFS 1979 data include farming, forestry and horticulture (2) For tin miners the number shown here was for the whole cohort employed from 1941, not a point estimate.

48

Table 6b Total numbers ever exposed over the risk exposure period by industry sector and carcinogenic agent or occupational circumstance: Short latency cancers


1,3-

But

adie

ne

Ben

zene

Eth

ylen

e ox

ide

Form

alde

hyde

Ioni

sing

rad

iatio

n(1)

Non

-ars

enic

al

inse

ctic

ides

TC

DD

(Dio

xins

)(2)

Tet

rach

loro

ethy

lene

Tri

chlo

roet

hyle

ne

Farming 1,053,200 1,259,549 Forestry 43,904 53,799 Horticulture 383,402 308,412 Total agricultural, hunting, fishing and forestry 1,480,506 1,621,760 Beverage industries 5 2,499 996 261 Crude petroleum and natural gas production 1,305 907 1,861 176 Electricity, gas and steam 59,374 9,001 Food manufacturing 249 20,305 6,343 General industry 11,912 Iron and steel basic industries 1,937 5,305 431,232 2,672 Manufacture of electrical machinery, apparatus, appliances and supplies 9,185 5,254 Manufacture of fabricated metal products, except machinery and equipment 1,518 17,026 6,068 Manufacture of footwear Manufacture of furniture and fixture, except primary of metal 112,820 Manufacture of glass and glass products 789 153,873 652 369 Manufacture of industrial chemicals 2,110 3,170 2,854 7,444 25,819 Manufacture of instruments, photographic and optical goods Manufacture of leather and products of leather or of its substitutes 323 23 Manufacture of machinery except electrical 2,156 4,410 24,299 8,626 Manufacture of miscellaneous products of petroleum and coal 113 Manufacture of other chemical products 721 4,301 1,387 1,021 Manufacture of other non-metallic mineral products 1,659 52,602 142 Manufacture of paper and paper products 6 2,048 150,697 6,258 Manufacture of plastic products not elsewhere classified 3,438 3,895 5,733

49


1,3-

But

adie

ne

Ben

zene

Eth

ylen

e ox

ide

Form

alde

hyde

Ioni

sing

rad

iatio

n(1)

Non

-ars

enic

al

inse

ctic

ides

TC

DD

(Dio

xins

)(2)

Tet

rach

loro

ethy

lene

Tri

chlo

roet

hyle

ne

Manufacture of pottery, china and earthenware 130,361 85 Manufacture of rubber products 902 Manufacture of textiles 13,417 9,026 Manufacture of transport equipment 7,449 8,365 Manufacture of wearing apparel, except footwear 51,037 11,707 332 Manufacture of wood and wood and cork products, except furniture 35,260 23,613 Metal Workers Mining 694 Non-ferrous metal basic industries 36 3,557 125,164 1,915 Other manufacturing industries Painters (not construction) Petroleum refineries 335 1,277 11 Printing, publishing and allied industries 8,016 Tobacco manufacture 68 113 Water works and supply 942 Welders Total manufacturing industry, mining, quarrying, electricity, gas, water 7,511 16,039 2,543 243,533 76,390 27,748 1,093,362 116,150 29,552 Construction 14,297 47,808 Painters and decorators (construction) Roofers, road surfacers, Roadmen, Paviors (Construction) Total Construction 14,297 47,808 Air transport 227 4,354 Business, professional and other organisation Communication 1,117 Education services 423 4,319 423 423 200 446 Financing, insurance, real estate and business services Flight Personnel 103,400 Land transport 25,722 291 19,616 Medical, dental, other health and veterinary services 45 6,467 9,701 424 Personal and household services 811,110 874 181,263 20,155

50


1,3-

But

adie

ne

Ben

zene

Eth

ylen

e ox

ide

Form

alde

hyde

Ioni

sing

rad

iatio

n(1)

Non

-ars

enic

al

inse

ctic

ides

TC

DD

(Dio

xins

)(2)

Tet

rach

loro

ethy

lene

Tri

chlo

roet

hyle

ne

Public administration and defence Recreational and cultural services 257 270 Research and scientific institutes 305 1,559 305 611 1,295 289 321 Sanitary and similar services 2,625 2,650 427 Services allied to transport 28 1,065 Shift work Water transport 2,073 562 Welfare institutions Wholesale and retail trade and restaurants and hotels 183,009 18,375 Total Service industries 774 1,030,671 7,196 11,865 108,059 18,375 208,467 21,619 TOTAL 8,285 1,046,710 9,739 269,695 184,449 1,508,254 2,733,496 372,425 51,172

(1) For Ionising Radiation exposure data were obtained from the Central Index of Dose Information (CIDI, 1998) which excludes air crew, plus data from the LFS for male flight crew and from a cohort of women flight crew from the BA Stewards and Stewardesses Union (BASSA) data. (2) For TCDD (short latency) the estimates for Soft tissue sarcoma from Census of Employment data are used which include farming, forestry and horticulture; (excluded for Non-Hodkin’s Lymphoma). The total given here includes all exposed industries.

51

Table 7 Total cancer deaths by industry sector and carcinogenic agent or occupational circumstance Industry Sector/Carcinogenic agent

1,3-

But

adie

ne

Acr

ylam

ide

Aro

mat

ic a

min

es

Ars

enic

Asb

esto

s1

Ben

zene

Ber

ylliu

m

Cad

miu

m

Chr

omiu

m V

I

Cob

alt

Die

sel e

ngin

eex

haus

t

Eth

ylen

e ox

ide

Env

iron

men

tal

Tob

acco

Sm

oke

Flig

ht p

erso

nnel

Farming Forestry Horticulture Total agricultural, hunting, fishing and forestry Beverage industries

0

0 0 2 Crude petroleum and natural gas production

0

0 0 4 0 Electricity, gas and steam 1 18 0 0 0 2 Food manufacturing

0

3 2 0 General industry Iron and steel basic industries 7 0 0 0 Manufacture of electrical machinery, apparatus, appliances and supplies 5

0

1 0 1 1 Manufacture of fabricated metal products, except machinery and equipment

0

20 9 2 Manufacture of footwear

0

Manufacture of furniture and fixture, except primary of metal 7

0

7 0 Manufacture of glass and glass products 6

0

0 1 0 Manufacture of industrial chemicals 0 1 0 3 60 0 1 3 5 1 Manufacture of instruments, photographic and optical goods

0

0 2 0 Manufacture of leather and products of leather or of its substitutes 3 0 0 Manufacture of machinery except electrical

5

22 5 2 Manufacture of miscellaneous products of petroleum and coal

0

0 Manufacture of other chemical products 0 0 0 64 0 2 9 1 0 Manufacture of other non-metallic mineral products 1

0

0 6 Manufacture of paper and paper products 0 34 0 1 1 Manufacture of plastic products not elsewhere classified 0 0

0

0 1 0 Manufacture of pottery, china and earthenware

0

1 Manufacture of rubber products 0 0 0

0

0 Manufacture of textiles 11 0 0 1 Manufacture of transport equipment 0 106 0 14 3 1 Manufacture of wearing apparel, except footwear

0

1 1

52


1,3-

But

adie

ne

Acr

ylam

ide

Aro

mat

ic a

min

es

Ars

enic

Asb

esto

s1

Ben

zene

Ber

ylliu

m

Cad

miu

m

Chr

omiu

m V

I

Cob

alt

Die

sel e

ngin

eex

haus

t

Eth

ylen

e ox

ide

Env

iron

men

tal

Tob

acco

Sm

oke

Flig

ht p

erso

nnel

Manufacture of wood and wood and cork products, except furniture 31 0 2 2 Metal Workers Mining 167 35 Non-ferrous metal basic industries 44 0 6 2 5 1 Other manufacturing industries 0 0

1

0 0 Painters (not construction) Petroleum refineries 0 0 35 0 0 0 0 Printing, publishing and allied industries

0

4 0 Tobacco manufacture

0

Water works and supply

2

Welders Total manufacturing industry, mining, quarrying, electricity, gas, water 0 1 22 99 485 0 6 8 64 58 66 0 Construction 13 2,568 0 4 234 32 Painters and decorators (construction) Roofers, road surfacers, Roadmen, Paviors (Construction)

Total Construction 13 2,568 0 4 234 32 Air transport

0

0 1 2 10 Business, professional and other organisation

1

Communication

2

6 Education services 0 0

0

4 Financing, insurance, real estate and business services 29 Flight Personnel

4

Land transport 123 0 0 284 3 Medical, dental, other health and veterinary services 0 0

0

Personal and household services 9 326 3 1 25 19 Public administration and defence

1

18 Recreational and cultural services 0 8 Research and scientific institutes 0 0 0

0

0 1 Sanitary and similar services 1 12 0 0 0 2 31

53


1,3-

But

adie

ne

Acr

ylam

ide

Aro

mat

ic a

min

es

Ars

enic

Asb

esto

s1

Ben

zene

Ber

ylliu

m

Cad

miu

m

Chr

omiu

m V

I

Cob

alt

Die

sel e

ngin

eex

haus

t

Eth

ylen

e ox

ide

Env

iron

men

tal

Tob

acco

Sm

oke

Flig

ht p

erso

nnel

Services allied to transport

0

0 0 26 5 Shift work Water transport

0

0 5 3 Welfare institutions

5

Wholesale and retail trade and restaurants and hotels 60 1 5 104 Total Service industries 0 0 9 1 521 4 1 2 352 0 218 4 TOTAL1,2 1 1 31 113 3909 4 6 8 65 63 652 0 249 4

1Asbestos related cancers by industry exclude mesotheliomas thought to be para-occupational and environmental in origin, which are included in the total 2Grouped sector subtotals exclude mesotheliomas thought to be para-occupational and environmental in origin, and industry attributable deaths and registrations do not sum to the totals and subtotals due to the method used to combine attributable fractions across exposures

54

Table 7: Continued: total cancer deaths by industry sector and carcinogenic agent or occupational circumstance Industry Sector/Carcinogenic agent

Form

alde

hyde

Hai

rdre

sser

s and

barb

ers

Inor

gani

c le

ad

Ioni

sing

rad

iatio

n

Lea

ther

Dus

t

Min

eral

oils

Nic

kel

Non

-ars

enic

al

inse

ctic

ides

Poly

cycl

ic A

rom

atic

H

ydro

carb

onss

PA

Hs -

Coa

l tar

s and

pi

tche

s

Pain

ters

Petr

oleu

m r

efin

ing

Rad

on

Rub

ber

indu

stry

Farming 28 0 Forestry 1 0 Horticulture 10 Total agricultural, hunting, fishing and forestry 39 0 Beverage industries 1 Crude petroleum and natural gas production 0 Electricity, gas and steam 1 0 1 Food manufacturing 0 0 5 General industry 0 Iron and steel basic industries 0 1 0 2 0 1 Manufacture of electrical machinery, apparatus, appliances and supplies 8 6 Manufacture of fabricated metal products, except machinery and equipment 0 4 0 3 Manufacture of footwear 7 0 0 Manufacture of furniture and fixture, except primary of metal 2 2 Manufacture of glass and glass products 0 0 0 Manufacture of industrial chemicals 0 2

1

0

1

Manufacture of instruments, photographic and optical goods 47 1 Manufacture of leather and products of leather or of its substitutes 3 0 Manufacture of machinery except electrical 0 0 0 8 Manufacture of miscellaneous products of petroleum and coal 0 0 Manufacture of other chemical products 0 3 2 Manufacture of other non-metallic mineral products 0 1 1 Manufacture of paper and paper products 0 1 Manufacture of plastic products not elsewhere classified 0 8 2 Manufacture of pottery, china and earthenware 0 1 Manufacture of rubber products 1 0 1 5 Manufacture of textiles 1 2 Manufacture of transport equipment 2 0 5 Manufacture of wearing apparel, except footwear 3 0 2

55


Form

alde

hyde

Hai

rdre

sser

s and

barb

ers

Inor

gani

c le

ad

Ioni

sing

rad

iatio

n

Lea

ther

Dus

t

Min

eral

oils

Nic

kel

Non

-ars

enic

al

inse

ctic

ides

Poly

cycl

ic A

rom

atic

H

ydro

carb

onss

PA

Hs -

Coa

l tar

s and

pi

tche

s

Pain

ters

Petr

oleu

m r

efin

ing

Rad

on

Rub

ber

indu

stry

Manufacture of wood and wood and cork products, except furniture 1 0 1 Metal Workers 284 Mining 0 0 0 0 0 Non-ferrous metal basic industries 0 6 1 1 1 Other manufacturing industries 1 Painters (not construction) 79 Petroleum refineries 0 0 0 Printing, publishing and allied industries 233 0 4 Tobacco manufacture 0 0 Water works and supply 0 Welders Total manufacturing industry, mining, quarrying, electricity, gas, water 6 28 2 10 563 8 1 4 0 79 0 55 5 Construction 0 25 0 8 Painters and decorators (construction) 254 Roofers, road surfacers, Roadmen, Paviors (Construction) 4 Total Construction 0 25 0 4 254 8 Air transport 1 Business, professional and other organisation 1 Communication 2 Education services 0 12 Financing, insurance, real estate and business services 23 Flight Personnel 1 Land transport 0 0 3 Medical, dental, other health and veterinary services 0 0 12 Personal and household services 0 36 0 0 6 Public administration and defence 0 11 Recreational and cultural services 4 Research and scientific institutes 0 0 1 Sanitary and similar services 0 0 2 Services allied to transport 0 1

56


Form

alde

hyde

Hai

rdre

sser

s and

barb

ers

Inor

gani

c le

ad

Ioni

sing

rad

iatio

n

Lea

ther

Dus

t

Min

eral

oils

Nic

kel

Non

-ars

enic

al

inse

ctic

ides

Poly

cycl

ic A

rom

atic

H

ydro

carb

onss

PA

Hs -

Coa

l tar

s and

pi

tche

s

Pain

ters

Petr

oleu

m r

efin

ing

Rad

on

Rub

ber

indu

stry

Shift work Water transport 0 0 Welfare institutions 5 Wholesale and retail trade and restaurants and hotels 0 37 Total Service industries 0 36 1 0 0 121 TOTAL1 7 36 53 3 10 566 8 40 4 4 334 0 184 5

1Industry attributable deaths and registrations do not sum to these totals and subtotals due to the method used to combine attributable fractions across exposures

57

Table 7: Continued: total cancer deaths by industry sector and carcinogenic agent or occupational circumstance Industry Sector/Carcinogenic Agent

Shift

wor

k

Silic

a

Sola

r ra

diat

ion

Soot

s

Stee

l fou

ndry

w

orke

rs

Stro

ng in

orga

nic-

ac

id m

ists

with

su

lfuri

c ac

id

TC

DD

(Dio

xins

)

Tet

rach

loro

ethy

lene

Tin

min

ers

Tri

chlo

roet

hyle

ne

Ultr

a V

iole

t

Vin

yl c

hlor

ide

Wel

ders

Woo

d du

st

Ove

rall2

Ran

k

Farming 1 35 65 19 Forestry 0 1 0 2 55 Horticulture 11 21 33 Total agricultural, hunting, fishing and forestry 1 47 0 88 Beverage industries 0 0 4 52 Crude petroleum and natural gas production 0 0 0 4 51 Electricity, gas and steam 5 0 2 0 32 30 Food manufacturing 0 2 0 0 12 39 General industry 0 59 Iron and steel basic industries 0 25 1 46 1 0 84 16 Manufacture of electrical machinery, apparatus, appliances and supplies 10 6 1 0 39 27 Manufacture of fabricated metal products, except machinery and equipment

12

0 12 11 1 0 75 18

Manufacture of footwear 0 7 47 Manufacture of furniture and fixture, except primary of metal 5 22 32 Manufacture of glass and glass products

11

0 31 0 0 49 26 Manufacture of industrial chemicals

1

11 8 1 0 99 14 Manufacture of instruments, photographic and optical goods 0 0 49 25 Manufacture of leather and products of leather or of its substitutes 2 0 0 8 46 Manufacture of machinery except electrical

25

9 16 1 0 91 15 Manufacture of miscellaneous products of petroleum and coal

0

1 58 Manufacture of other chemical products

9

14 1 0 103 13 Manufacture of other non-metallic mineral products

37

0 14 0 0 60 21 Manufacture of paper and paper products 7 6 2 0 51 23 Manufacture of plastic products not elsewhere classified 1 0 11 41 Manufacture of pottery, china and earthenware 33 0 0 25 0 60 20 Manufacture of rubber products 0 7 48 Manufacture of textiles 2 0 17 35 Manufacture of transport equipment

10

0 8 5 1 0 155 10 Manufacture of wearing apparel, except footwear 0 3 0 0 0 10 43 Manufacture of wood and wood and cork products, except furniture 0 11 3 50 24 Metal Workers 284 5

58


Shift

wor

k

Silic

a

Sola

r ra

diat

ion

Soot

s

Stee

l fou

ndry

w

orke

rs

Stro

ng in

orga

nic-

ac

id m

ists

with

su

lfuri

c ac

id

TC

DD

(Dio

xins

)

Tet

rach

loro

ethy

lene

Tin

min

ers

Tri

chlo

roet

hyle

ne

Ultr

a V

iole

t

Vin

yl c

hlor

ide

Wel

ders

Woo

d du

st

Ove

rall2

Ran

k

Mining 26 0 1 228 8 Non-ferrous metal basic industries

4

0 9 38 0 0 0 119 12 Other manufacturing industries

2

0 4 51 Painters (not construction) 79 17 Petroleum refineries 0 0 0 0 36 28 Printing, publishing and allied industries 0 2 0 243 7 Tobacco manufacture 0 0 0 60 Water works and supply 0 0 3 54 Welders 1 152 153 11 Total manufacturing industry, mining, quarrying, electricity, gas, water

175 1 25 83 179 52 1 3 1 3 152 8 2200

Construction 614 7 10 10 3457 1 Painters and decorators (construction) 254 6 Roofers, road surfacers, Roadmen, Paviors (Construction) 4 53 Total Construction 614 7 10 10 3694 Air transport 0 1 0 0 15 37 Business, professional and other organisation 0 2 57 Communication 0 0 0 11 42 Education services 0 0 0 16 36 Financing, insurance, real estate and business services 0 52 22 Flight Personnel 4 49 Land transport 0 3 0 416 4 Medical, dental, other health and veterinary services 0 13 38 Personal and household services 0 59 73 1 556 2 Public administration and defence 2 31 31 Recreational and cultural services 0 12 40 Research and scientific institutes 0 0 0 2 56 Sanitary and similar services 0 0 20 34 Services allied to transport 0 0 0 0 33 29 Shift work 552 552 3 Water transport 0 0 0 0 9 45 Welfare institutions 0 10 44 Wholesale and retail trade and restaurants and hotels 0 6 211 9

59


Shift

wor

k

Silic

a

Sola

r ra

diat

ion

Soot

s

Stee

l fou

ndry

w

orke

rs

Stro

ng in

orga

nic-

ac

id m

ists

with

su

lfuri

c ac

id

TC

DD

(Dio

xins

)

Tet

rach

loro

ethy

lene

Tin

min

ers

Tri

chlo

roet

hyle

ne

Ultr

a V

iole

t

Vin

yl c

hlor

ide

Wel

ders

Woo

d du

st

Ove

rall2

Ran

k

Total Service industries 552 3 59 0 6 78 1 0 0 1955 TOTAL1,2 552 789 12 59 25 83 231 140 1 4 1 3 152 19 8010

1Asbestos related cancers by industry exclude mesotheliomas thought to be para-occupational and environmental in origin, which are included in the total 2Grouped sector subtotals exclude mesotheliomas thought to be para-occupational and environmental in origin, and industry attributable deaths and registrations do not sum to the

totals and subtotals due to the method used to combine attributable fractions across exposures

60

Table 8 Total cancer registrations by industry sector and carcinogenic agent or occupational circumstance


1,3-

But

adie

ne

Acr

ylam

ide

Aro

mat

ic a

min

es

Ars

enic

Asb

esto

s1

Ben

zene

Ber

ylliu

m

Cad

miu

m

Chr

omiu

m V

I

Cob

alt

Die

sel E

ngin

eE

xhau

stE

thyl

ene

oxid

e

Env

iron

men

tal

Tob

acco

Sm

oke

Flig

ht p

erso

nnel

Farming Forestry Horticulture Total agricultural, hunting, fishing and forestry Beverage industries 0 0 0 3 Crude petroleum and natural gas production 0 0 0 5 0 Electricity, gas and steam 1 19 0 0 0 2 Food manufacturing 0 4 2 0 General industry Iron and steel basic industries 16 0 0 0 Manufacture of electrical machinery, apparatus, appliances and supplies 6 0 1 1 1 1 Manufacture of fabricated metal products, except machinery and equipment 0 26 11 2 Manufacture of footwear 0 Manufacture of furniture and fixture, except primary of metal 8 0 7 0 Manufacture of glass and glass products 7 0 0 1 0 Manufacture of industrial chemicals 0 1 0 3 64 0 1 4 6 1 Manufacture of instruments, photographic and optical goods 0 0 2 0 Manufacture of leather and products of leather or of its substitutes 8 0 0 Manufacture of machinery except electrical 6 28 5 2 Manufacture of miscellaneous products of petroleum and coal 0 0 Manufacture of other chemical products 0 0 0 69 0 2 10 1 0 Manufacture of other non-metallic mineral products 1 0 0 7 Manufacture of paper and paper products 0 37 0 1 1 Manufacture of plastic products not elsewhere classified 0 0 0 0 1 0 Manufacture of pottery, china and earthenware 0 1 Manufacture of rubber products 1 0 0 0 0 Manufacture of textiles 23 0 0 1 Manufacture of transport equipment 0 115 0 18 4 2 Manufacture of wearing apparel, except footwear 0 1 1

61


1,3-

But

adie

ne

Acr

ylam

ide

Aro

mat

ic a

min

es

Ars

enic

Asb

esto

s1

Ben

zene

Ber

ylliu

m

Cad

miu

m

Chr

omiu

m V

I

Cob

alt

Die

sel E

ngin

eE

xhau

stE

thyl

ene

oxid

e

Env

iron

men

tal

Tob

acco

Sm

oke

Flig

ht p

erso

nnel

Manufacture of wood and wood and cork products, except furniture 35 0 2 2 Metal Workers Mining 192 43 Non-ferrous metal basic industries 50 0 6 3 6 2 Other manufacturing industries 0 0 1 0 0 Painters (not construction) Petroleum refineries 0 0 38 0 0 0 0 Printing, publishing and allied industries 0 4 0 Tobacco manufacture 0 Water works and supply 2 Welders Total manufacturing industry, mining, quarrying, electricity, gas, water 1 1 48 113 535 0 7 9 86 67 80 0 Construction 15 2773 0 4 290 36 Painters and decorators (construction) Roofers, road surfacers, Roadmen, Paviors (Construction)

Total Construction 15 2773 0 4 290 36 Air transport 0 0 2 3 11 Business, professional and other organisation 1 Communication 3 7 Education services 0 0 0 4 Financing, insurance, real estate and business services 33 Flight Personnel 13 Land transport 133 1 0 350 3 Medical, dental, other health and veterinary services 0 0 0 Personal and household services 18 361 5 2 29 22 Public administration and defence 1 20 Recreational and cultural services 0 9 Research and scientific institutes 0 0 0 0 0 1 Sanitary and similar services 1 13 0 0 0 2 3 Services allied to transport 0 0 0 33 6 Shift work

62


1,3-

But

adie

ne

Acr

ylam

ide

Aro

mat

ic a

min

es

Ars

enic

Asb

esto

s1

Ben

zene

Ber

ylliu

m

Cad

miu

m

Chr

omiu

m V

I

Cob

alt

Die

sel E

ngin

eE

xhau

stE

thyl

ene

oxid

e

Env

iron

men

tal

Tob

acco

Sm

oke

Flig

ht p

erso

nnel

Water transport

0 0

6 4 Welfare institutions 5 Wholesale and retail trade and restaurants and hotels 66 1 6 118 Total Service industries 0 0 18 1 573 7 3 2 431 0 248 13 TOTAL1,2 1 1 66 129 4216 7 7 9 89 73 801 1 284 13

1Asbestos related cancers by industry exclude mesotheliomas thought to be para-occupational and environmental in origin, which are included in the total 2Grouped sector subtotals exclude mesotheliomas thought to be para-occupational and environmental in origin, and industry attributable deaths and registrations do not sum to the totals and subtotals due to the method used to combine attributable fractions across exposures

63

Table 8: Continued: total cancer registrations by industry sector and carcinogenic agent or occupational circumstance Industry Sector/Carcinogenic agent

Form

alde

hyde

Hai

rdre

sser

s and

barb

ers

Inor

gani

c le

ad

Ioni

zing

rad

iatio

n

Lea

ther

Dus

t

Min

eral

oils

Nic

kel

Non

-ars

enic

al

pest

icid

esPo

lycy

clic

Aro

mat

ic

Hyd

roca

rcon

s

PAH

s - C

oal t

ars a

nd

pitc

hes

Pain

ters

Petr

oleu

m r

efin

ing

Rad

on

Rub

ber

indu

stry

Farming 51 1 Forestry 2 0 Horticulture 19 Total agricultural, hunting, fishing and forestry 72 1 Beverage industries 1 Crude petroleum and natural gas production 0 Electricity, gas and steam 2 0 2 Food manufacturing 0 0 6 General industry 0 Iron and steel basic industries 0 2 0 3 4 1 Manufacture of electrical machinery, apparatus, appliances and supplies 10 7 Manufacture of fabricated metal products, except machinery and equipment 0 5 0 4 Manufacture of footwear 22 0 1 Manufacture of furniture and fixture, except primary of metal 3 2 Manufacture of glass and glass products 0 0 0 Manufacture of industrial chemicals 0 2 1 1 2 Manufacture of instruments, photographic and optical goods 203 1 Manufacture of leather and products of leather or of its substitutes 10 0 Manufacture of machinery except electrical 0 0 0 9 Manufacture of miscellaneous products of petroleum and coal 0 0 Manufacture of other chemical products 0 3 2 Manufacture of other non-metallic mineral products 0 2 1 Manufacture of paper and paper products 0 2 Manufacture of plastic products not elsewhere classified 0 9 2 Manufacture of pottery, china and earthenware 0 1 Manufacture of rubber products 1 0 1 9 Manufacture of textiles 1 3 Manufacture of transport equipment 2 0 5 Manufacture of wearing apparel, except footwear 5 0 3

64


Form

alde

hyde

Hai

rdre

sser

s and

barb

ers

Inor

gani

c le

ad

Ioni

zing

rad

iatio

n

Lea

ther

Dus

t

Min

eral

oils

Nic

kel

Non

-ars

enic

al

pest

icid

esPo

lycy

clic

Aro

mat

ic

Hyd

roca

rcon

s

PAH

s - C

oal t

ars a

nd

pitc

hes

Pain

ters

Petr

oleu

m r

efin

ing

Rad

on

Rub

ber

indu

stry

Manufacture of wood and wood and cork products, except furniture 1 0 2 Metal Workers 1,252 Mining 0 0 0 0 0 Non-ferrous metal basic industries 0 8

2

1 1 Other manufacturing industries 1 Painters (not construction) 102 Petroleum refineries 0 0 0 Printing, publishing and allied industries 267 0 4 Tobacco manufacture 0 0 Water works and supply 0 Welders Total manufacturing industry, mining, quarrying, electricity, gas, water 11 34 2 31 1722 9 2 8 4 102 0 62 9 Construction 0 31 0 9 Painters and decorators (construction) 334 Roofers, road surfacers, Roadmen, Paviors (Construction) 471 Total Construction 0 31 0 471 334 9 Air transport 1 Business, professional and other organisation 1 Communication 3 Education services 0 14 Financing, insurance, real estate and business services 26 Flight Personnel 1 Land transport 0 0 4 Medical, dental, other health and veterinary services 1 0 14 Personal and household services 0 63 0 0 6 Public administration and defence 0 12 Recreational and cultural services 4 Research and scientific institutes 0 0 1 Sanitary and similar services 0 0 2 Services allied to transport 0 1

65


Form

alde

hyde

Hai

rdre

sser

s and

barb

ers

Inor

gani

c le

ad

Ioni

zing

rad

iatio

n

Lea

ther

Dus

t

Min

eral

oils

Nic

kel

Non

-ars

enic

al

pest

icid

esPo

lycy

clic

Aro

mat

ic

Hyd

roca

rcon

s

PAH

s - C

oal t

ars a

nd

pitc

hes

Pain

ters

Petr

oleu

m r

efin

ing

Rad

on

Rub

ber

indu

stry

Shift work Water transport 0 1 Welfare institutions 6 Wholesale and retail trade and restaurants and hotels 0 42 Total Service industries 1 63 1 0 0 137 TOTAL1 12 63 65 4 31 1722 9 73 8 475 437 0 209 9

1 Industry attributable deaths and registrations do not sum to the totals and subtotals due to the method used to combine attributable fractions across exposures

66

Table 8: Continued: Total cancer registrations by industry sector and carcinogenic agent or occupational circumstance


Shift

wor

k

Silic

a

Sola

r ra

diat

ion

Soot

s

Stee

l fou

ndry

wor

kers

Stro

ng in

orga

nic-

acid

mis

ts w

ith su

lphu

ric

acid

TC

DD

(Dio

xins

)

Tet

rach

loro

ethy

lene

Tin

min

ers

Tri

chlo

roet

hyle

ne

Ultr

a V

iole

t

Vin

yl c

hlor

ide

Wel

ders

Woo

d du

st

Ove

rall2

Ran

k

Farming 128 41 220 12 Forestry 7 1 1 11 50 Horticulture 13 31 36 Total agricultural, hunting, fishing and forestry 135 55 1 263 Beverage industries 0 0 4 55 Crude petroleum and natural gas production 0 0 0 5 53 Electricity, gas and steam 6 53 3 0 88 25 Food manufacturing 1 2 0 0 15 45 General industry 0 59 Iron and steel basic industries 0 29 3 75 1 0 135 17 Manufacture of electrical machinery, apparatus, appliances and supplies 15 7 1 0 49 32 Manufacture of fabricated metal products, except machinery and equipment

14

1 17 13 1 0 94 23 Manufacture of footwear 0 22 39 Manufacture of furniture and fixture, except primary of metal 13 34 35 Manufacture of glass and glass products 12 1 43 0 0 64 29 Manufacture of industrial chemicals 1 16 11 1 0 116 19 Manufacture of instruments, photographic and optical goods 0 0 206 13 Manufacture of leather and products of leather or of its substitutes 2 0 0 20 40 Manufacture of machinery except electrical

28

13 18 1 0 111 20 Manufacture of miscellaneous products of petroleum and coal 1 1 58 Manufacture of other chemical products 10 20 1 0 119 18 Manufacture of other non-metallic mineral products 43 1 19 0 0 73 26 Manufacture of paper and paper products 9 7 2 0 59 31 Manufacture of plastic products not elsewhere classified 1 0 14 46 Manufacture of pottery, china and earthenware 38 23 0 35 0 98 22 Manufacture of rubber products 0 11 49 Manufacture of textiles 3 0 31 37 Manufacture of transport equipment

11

5 12 6 1 0 182 14

67


Shift

wor

k

Silic

a

Sola

r ra

diat

ion

Soot

s

Stee

l fou

ndry

wor

kers

Stro

ng in

orga

nic-

acid

mis

ts w

ith su

lphu

ric

acid

TC

DD

(Dio

xins

)

Tet

rach

loro

ethy

lene

Tin

min

ers

Tri

chlo

roet

hyle

ne

Ultr

a V

iole

t

Vin

yl c

hlor

ide

Wel

ders

Woo

d du

st

Ove

rall2

Ran

k

Manufacture of wearing apparel, except footwear 1 3 0 0 0 13 48 Manufacture of wood and wood and cork products, except furniture 2 14 8 66 28 Metal Workers 1252 3 Mining

29

31 1 296 8 Non-ferrous metal basic industries

4

9 14 50 1 0 0 156 16 Other manufacturing industries 2 0 5 54 Painters (not construction) 102 21 Petroleum refineries 7 0 0 0 46 33 Printing, publishing and allied industries 3 2 0 282 9 Tobacco manufacture 0 0 0 60 Water works and supply 26 0 29 38 Welders 6 175 181 15 Total manufacturing industry, mining, quarrying, electricity, gas, water 200 163 29 122 254 60 1 5 6 3 175 23 3909 Construction 707 841 11 29 4,668 1 Painters and decorators (construction) 334 7 Roofers, road surfacers, Roadmen, Paviors (Construction) 471 6

Total Construction 707 841 11 29 5439 Air transport 0 1 0 0 18 42 Business, professional and other organisation 1 3 56 Communication 5 0 0 17 43 Education services 0 0 0 18 41 Financing, insurance, real estate and business services 3 63 30 Flight Personnel 14 47 Land transport 6 3 0 498 5 Medical, dental, other health and veterinary services 1 16 44 Personal and household services 14 60 89 2 670 4 Public administration and defence 240 273 10 Recreational and cultural services 55 69 27 Research and scientific institutes 1 0 0 3 57

68


Shift

wor

k

Silic

a

Sola

r ra

diat

ion

Soot

s

Stee

l fou

ndry

wor

kers

Stro

ng in

orga

nic-

acid

mis

ts w

ith su

lphu

ric

acid

TC

DD

(Dio

xins

)

Tet

rach

loro

ethy

lene

Tin

min

ers

Tri

chlo

roet

hyle

ne

Ultr

a V

iole

t

Vin

yl c

hlor

ide

Wel

ders

Woo

d du

st

Ove

rall2

Ran

k

Sanitary and similar services 68 0 90 24 Services allied to transport 3 0 0 0 43 34 Shift work 1,957 1957 2 Water transport 1 0 0 0 11 52 Welfare institutions 0 11 51 Wholesale and retail trade and restaurants and hotels 6 7 246 11 Total Service industries 1957 402 60 0 7 94 2 0 1 4007 TOTAL1,2 1957 907 1541 60 29 122 316 164 1 7 6 3 175 54 13598

1Asbestos related cancers by industry exclude mesotheliomas thought to be para-occupational and environmental in origin, which are included in the total 2Grouped sector subtotals exclude mesotheliomas thought to be para-occupational and environmental in origin, and industry attributable deaths and registrations do not sum to these totals and subtotals due to the method used to combine attributable fractions across exposures

69

3.4 DEATHS AND REGISTRATIONS BY INDUSTRY SECTOR AND CANCER SITE

Tables 9 and 10 give total deaths and total registrations respectively, by industry sector and for each cancer site. Numbers of deaths and registrations for males, females and the total are available on the HSE website, together with the respective attributable fractions. The totals and ranking for industry sector for Tables 9 and 10 are the same as in Tables 7 and 8 respectively.

In addition to the contribution of multiple carcinogens in many industry sectors these tables highlight the multiplicity of types of cancer within industry sectors. For example, from Table 10, there are 7 for farming (brain, leukaemia, lung, multiple myeloma, non-Hodgkin’s lymphoma, NMSC, soft tissue sarcoma, (9 for construction (bladder, brain, larynx, lung, mesothelioma, NMSC, oesophagus, sinonasal and stomach), and 12 for personal and household services (bladder, cervix, kidney, leukaemia, lung, mesothelioma, nonHodgkin’s lymphoma, oesophagus, ovary, sinonasal, stomach).

70

Table 9 Total deaths by industry sector and cancer site

Industry Sector/Cancer site

Bla

dder

Bon

e

Bra

in

Bre

ast

Cer

vix

Kid

ney

Lar

ynx

Leu

kaem

ia

Liv

er

Lun

g

LH

Mel

anom

a_ey

e

Mes

othe

liom

a1

Farming 7 8 35 Forestry 0 0 1 Horticulture 2 3 11 Total agricultural, hunting, fishing and forestry 9 11 47 Beverage indu stries 0 0 0 3 Crude petroleum and natural gas production 0 0 0 0 4 Electricity, gas and steam 0 0 0 0 0 0 19 9 Food manufacturing 0 0 0 0 0 10 General industry 0 0 0 0 Iron and steel basic industries 9 0 0 1 0 52 Manufacture of electrical machinery, apparatus, appliances and supplies 0 0 0 0 2 0 28 Manufacture of fabricated metal products, except machinery and equipment 0 1 0 2 0 0 60 Manufacture of footwear 0 Manufacture of furniture and fixture, except primary of metal 0 2 16 Manufacture of glass and glass products 0 0 0 42 Manufacture of industrial chemicals 0 0 2 0 1 61 0 30 Manufacture of instruments, photographic and optical goods 19 0 28 Manufacture of leather and products of leather or of its substitutes 3 0 0 2 Manufacture of machinery except electrical 0 0 1 0 2 0 0 71 Manufacture of miscellaneous products of petroleum and coal 0 0 0 Manufacture of other chemical products 0 0 3 0 1 66 0 32 Manufacture of other non-metallic mineral products 1 0 0 56 Manufacture of paper and paper products 0 0 1 0 31 0 17 Manufacture of plastic products not elsewhere classified 0 0 0 1 8 0 Manufacture of pottery, china and earthenware 0 0 54 Manufacture of rubber products 0 0 1 0 1 0 Manufacture of textiles 11 0 1 3 Manufacture of transport equipment 0 0 0 2 0 92 54 Manufacture of wearing apparel, except footwear 0 0 0 2 0 4 Manufacture of wood and wood and cork products, except furniture 0 1 46 Metal Workers 112 152 Mining 3 0 0 0 0 214 9

71


Bla

dder

Bon

e

Bra

in

Bre

ast

Cer

vix

Kid

ney

Lar

ynx

Leu

kaem

ia

Liv

er

Lun

g

LH

Mel

anom

a_ey

e

Mes

othe

liom

a1

Non-ferrous metal basic industries 1 0 0 2 0 0 108 Other manufacturing industries 0 4 Painters (not construction) 7 59 Petroleum refineries 0 0 0 0 0 18 0 18 Printing, publishing and allied industries 0 0 241 Tobacco manufacture 0 0 0 Water works and supply 0 0 2 Welders 152 1 Total manufacturing industry, mining, quarrying, electricity, gas, water 167 0 1 3 1 17 7 4 1708 0 1 168 Construction 18 1 0 2 0 2085 1292 Painters and decorators (construction) 24 187 Roofers, road surfacers, Roadmen, Paviors (Construction) Total Construction 42 1 0 2 0 2271 1292 Air transport 0 0 0 0 0 9 Business, professional and other organisation 1 Communication 0 0 8 Education services 0 0 0 0 14 0 Financing, insurance, real estate and business services 38 Flight Personnel 0 4 0 0 0 Land transport 21 0 0 0 0 0 327 62 Medical, dental, other health and veterinary services 0 0 0 0 12 0 Personal and household services 17 4 0 3 0 298 65 Public administration and defence 0 21 Recreational and cultural services 8 Research and scientific institutes 0 0 0 0 0 1 0 Sanitary and similar services 0 0 0 0 15 2 Services allied to transport 2 0 0 0 28 Shift work 552 Water transport 0 0 0 0 7 Welfare institutions 7 Wholesale and retail trade and restaurants and hotels 0 1 146 12 Total Service industries 41 0 555 4 0 0 5 1 1049 0 141 TOTAL 245 0 11 555 7 1 20 23 5 4745 0 1 1937

Abbreviations: LH = Lymphohaematopoietic

72

Table 9: Continued. Total deaths by industry sector and cancer site


Mul

tiple

Mye

lom

a

Nas

opha

rynx

NH

L

NM

SC

Oes

opha

gus

Ova

ry

Panc

reas

Sino

nasa

l

STS

Stom

ach

Thy

roid

Ove

rall2

Ran

k

Farming 4 9 1 0 65 19 Forestry 0 0

0

0 0 0 2 55 Horticulture 2 3 0 21 33 Total agricultural, hunting, fishing and forestry 6 0 13 1 0 1 88 Beverage industries 0 0 4 52 Crude petroleum and natural gas production 0 0 4 50 Electricity, gas and steam 0 2 0 0 0 32 30 Food manufacturing 0 0 2 0 12 39 General industry 0 0 59 Iron and steel basic industries 14 0 1 0 6 1 84 16 Manufacture of electrical machinery, apparatus, appliances and supplies 0 5 0 2 39 27 Manufacture of fabricated metal products, except machinery and equipment 1 0 10 1 75 18 Manufacture of footwear 7 7 47 Manufacture of furniture and fixture, except primary of metal 2 3 22 32 Manufacture of glass and glass products 0 5 0 0 0 2 49 26 Manufacture of industrial chemicals 0 2 1 0 0 1 99 14 Manufacture of instruments, photographic and optical goods 1 2 49 25 Manufacture of leather and products of leather or of its substitutes 0 3 8 46 Manufacture of machinery except electrical 1 14 2 0 91 15 Manufacture of miscellaneous products of petroleum and coal 1 58 Manufacture of other chemical products 0 0 1 103 13 Manufacture of other non-metallic mineral products 2 0 0 1 60 21 Manufacture of paper and paper products 2 0 0 0 51 23 Manufacture of plastic products not elsewhere classified 0 2 11 41 Manufacture of pottery, china and earthenware 4 0 0 0 2 60 20 Manufacture of rubber products 0 0 4 7 48 Manufacture of textiles 0 2 0 17 35 Manufacture of transport equipment 0 0 4 1 1 155 10 Manufacture of wearing apparel, except footwear 0 0 0 3 0 10 43 Manufacture of wood and wood and cork products, except furniture 1 1 0 2 0 50 24 Metal Workers 6 14 284 5

73


Mul

tiple

Mye

lom

a

Nas

opha

rynx

NH

L

NM

SC

Oes

opha

gus

Ova

ry

Panc

reas

Sino

nasa

l

STS

Stom

ach

Thy

roid

Ove

rall2

Ran

k

Mining 0 2 0 228 8 Non-ferrous metal basic industries 4 0 0 0 2 2 119 12 Other manufacturing industries 0 4 51 Painters (not construction) 13 79 17 Petroleum refineries 0 0 0 0 36 28 Printing, publishing and allied industries 0 2 0 243 7 Tobacco manufacture 0 0 0 60 Water works and supply 0 0 3 54 Welders 153 11 Total manufacturing industry, mining, quarrying, electricity, gas, water 0 3 33 8 48 1 36 12 31 0 2200 Construction 4 7 10 6 31 3457 1 Painters and decorators (construction) 43 254 6 Roofers, road surfacers, Roadmen, Paviors (Construction) 4 4 53 Total Construction 4 10 10 6 75 3694 Air transport 1 0 15 37 Business, professional and other organisation 0 2 57 Communication 0 0 0 11 42 Education services 0 0 0 16 36 Financing, insurance, real estate and business services 0 52 22 Flight Personnel 0 4 49 Land transport 0 3 0 1 0 416 4 Medical, dental, other health and veterinary services 0 0 0 0 13 38 Personal and household services 0 11 0 122 23 1 1 556 2 Public administration and defence 2 31 31 Recreational and cultural services 0 12 40 Research and scientific institutes 0 0 0 0 0 0 2 56 Sanitary and similar services 0 0 0 0 20 34 Services allied to transport 0 0 0 33 29 Shift work 552 3 Water transport 0 0 0 9 45 Welfare institutions 0 10 44 Wholesale and retail trade and restaurants and hotels 1 0 0 0 211 9

74


Mul

tiple

Mye

lom

a

Nas

opha

rynx

NH

L

NM

SC

Oes

opha

gus

Ova

ry

Panc

reas

Sino

nasa

l

STS

Stom

ach

Thy

roid

Ove

rall2

Ran

k

Total Service industries 0 11 3 126 23 0 1 0 3 0 1955 TOTAL2 6 8 57 23 184 23 1 38 13 108 0 8010

Abbreviations: NHL = Non-Hodgkin’s lymphoma; NMSC = non-melanoma skin cancer; STS = soft tissue sarcoma 1Asbestos related cancers by industry exclude mesotheliomas thought to be para-occupational and environmental in origin, which are included in the total

2Grouped sector subtotals exclude mesotheliomas thought to be para-occupational and environmental in origin, and industry attributable deaths and registrations do not sum to these subtotals due to the method used to combine attributable fractions across exposures

75

Table 10 Total cancer registrations by industry sector and cancer site Industry Sector/Cancer site

Bla

dder

Bon

e

Bra

in

Bre

ast

Cer

vix

Kid

ney

Lar

ynx

Leu

kaem

ia

Liv

er

Lun

g

LH

Mel

anom

a_ey

e

Mes

othe

liom

a1

Farming 8 13 40 Forestry 0 1 1 Horticulture 3 5 12 Total agricultural, hunting, fishing and forestry 11 19 54 Beverage industries 0 0 0 4 Crude petroleum and natural gas production 0 0 0 0 4 Electricity, gas and steam 0 0 0 0 0 0 22 9 Food manufacturing 0 0 0 0 0 12 General industry

0

0 0 0 Iron and steel basic industries 20 0 0 3 0 60 Manufacture of electrical machinery, apparatus, appliances and supplies 0 0 1 0 5 0 32 Manufacture of fabricated metal products, except machinery and equipment 0 1 0 6 0 0 68 Manufacture of footwear 1 Manufacture of furniture and fixture, except primary of metal 0 3 18 Manufacture of glass and glass products 0 0 0 48 Manufacture of industrial chemicals 1 0 6 0 1 70 0 30 Manufacture of instruments, photographic and optical goods 44 0 32 Manufacture of leather and products of leather or of its substitutes 8 0 1 2 Manufacture of machinery except electrical 0 0 2 1 5 0 0 81 Manufacture of miscellaneous products of petroleum and coal 0 0 1 Manufacture of other chemical products 0 0 7 0 1 75 0 32 Manufacture of other non-metallic mineral products 2 0 0 64 Manufacture of paper and paper products 0 0 3 0 35 0 17 Manufacture of plastic products not elsewhere classified 0 0 0 1 9 0 Manufacture of pottery, china and earthenware 0 0 62 Manufacture of rubber products 0 0 3 0 1 0 Manufacture of textiles 23 0 1 3 Manufacture of transport equipment 0 1 1 4 0 106 54

76


Bla

dder

Bon

e

Bra

in

Bre

ast

Cer

vix

Kid

ney

Lar

ynx

Leu

kaem

ia

Liv

er

Lun

g

LH

Mel

anom

a_ey

e

Mes

othe

liom

a1

Manufacture of wearing apparel, except footwear 0 0 0 4 0 4 Manufacture of wood and wood and cork products, except furniture 0 1 52 Metal Workers 252 174 Mining 6 0 0 0 0 246 9 Non-ferrous metal basic industries 1 0 0 5 0 0 124 Other manufacturing industries 0 5 Painters (not construction) 16 67 Petroleum refineries 0 0 0 0 0 20 0 18 Printing, publishing and allied industries 0 0 276 Tobacco manufacture 0 0 0 Water works and supply 0 0 3 Welders 175 6 Total manufacturing industry, mining, quarrying, electricity, gas, water 375 0 1 6 2 49 11 4 1958 1 6 168 Construction 41 1 0 7 0 2399 1292 Painters and decorators (construction) 56 215 Roofers, road surfacers, Roadmen, Paviors (Construction) Total Construction 97 1 0 7 0 2614 1292 Air transport 0 0 0 0 0 11 Business, professional and other organisation 2 Communication 0 0 9 Education services 0 0 0 0 16 0 Financing, insurance, real estate and business services 43 Flight Personnel 0 13 0 0 1 Land transport 48 0 0 0 1 0 375 62 Medical, dental, other health and veterinary services 0 0 1 0 14 0 Personal and household services 36 11 1 5 0 338 65 Public administration and defence 0 23 Recreational and cultural services 9 Research and scientific institutes 0 0 0 0 0 1 0

77


Bla

dder

Bon

e

Bra

in

Bre

ast

Cer

vix

Kid

ney

Lar

ynx

Leu

kaem

ia

Liv

er

Lun

g

LH

Mel

anom

a_ey

e

Mes

othe

liom

a1

Sanitary and similar services 0 0 0 0 17 2 Services allied to transport 4 0 0 0 33 Shift work 1957 Water transport 0 0 0 0 8 Welfare institutions 8 Wholesale and retail trade and restaurants and hotels 0 1 165 12 Total Service industries 90 0 1969 11 1 1 8 1 1195 0 141 TOTAL 550 0 14 1969 18 3 56 38 5 5442 1 6 1937

Abbreviations: LH = Lymphohaematopoietic

78

Table 10 Continued: Total cancer registrations by industry sector and cancer site Industry Sector

Mul

tiple

Mye

lom

a

Nas

opha

rynx

NH

L

NM

SC

Oes

opha

gus

Ova

ry

Panc

reas

Sino

nasa

l

STS

Stom

ach

Thy

roid

O

vera

ll2

Ran

k

Farming 7 22 128 1 220 12 Forestry 0 0 1 7 1 0 11 50 Horticulture 3 8 0 31 36 Total agricultural, hunting, fishing and forestry 10 0 31 135 1 1 263 Beverage industries 0 0 4 55 Crude petroleum and natural gas production 0 0 5 53 Electricity, gas and steam 53 2 0 0 0 88 25 Food manufacturing 0 1 2 0 15 45 General industry 0 0 59 Iron and steel basic industries 34 4 1 1 12 2 135 17 Manufacture of electrical machinery, apparatus, appliances and supplies 1 5 1 3 49 32 Manufacture of fabricated metal products, except machinery and equipment 2 1 10 5 94 23 Manufacture of footwear 22 22 39 Manufacture of furniture and fixture, except primary of metal 4 10 34 35 Manufacture of glass and glass products 0 12 1 0 0 4 64 29 Manufacture of industrial chemicals 0 4 1 1 1 2 116 19 Manufacture of instruments, photographic and optical goods 125 6 206 13 Manufacture of leather and products of leather or of its substitutes 0 10 20 40 Manufacture of machinery except electrical 2 14 5 0 111 20 Manufacture of miscellaneous products of petroleum and coal 1 58 Manufacture of other chemical products 0 0 2 119 18 Manufacture of other non-metallic mineral products 4 1 0 1 73 26 Manufacture of paper and paper products 2 0 0 0 59 31 Manufacture of plastic products not elsewhere classified

0

3 14 46 Manufacture of pottery, china and earthenware 9 23 0 0 3 98 22 Manufacture of rubber products 0 0 6 11 49 Manufacture of textiles 0 2 1 31 37 Manufacture of transport equipment 1 5 4 4 1 182 14 Manufacture of wearing apparel, except footwear 1 0 1 3 1 13 48

79

Industry Sector

Mul

tiple

Mye

lom

a

Nas

opha

rynx

NH

L

NM

SC

Oes

opha

gus

Ova

ry

Panc

reas

Sino

nasa

l

STS

Stom

ach

Thy

roid

O

vera

ll2

Ran

k

Manufacture of wood and wood and cork products, except furniture 2 2 2 6 1 66 28 Metal Workers 778 48 1252 3 Mining 31 4 0 296 8 Non-ferrous metal basic industries 10 9 0 1 3 3 156 16 Other manufacturing industries 0 5 54 Painters (not construction) 19 102 21 Petroleum refineries 7 0 0 0 46 33 Printing, publishing and allied industries 3 2 1 282 9 Tobacco manufacture 0 0 0 60 Water works and supply 26 0 29 38 Welders 181 15 Total manufacturing industry, mining, quarrying, electricity, gas, water 0 7 80 1069 49 1 122 25 45 0 3909 Construction 8 841 10 21 46 4668 1 Painters and decorators (construction) 64 334 7

Roofers, road surfacers, Roadmen, Paviors (Construction) 471 471 6

Total Construction 8 1312 10 21 110 5439 Air transport 1 0 18 42 Business, professional and other organisation 1 3 56 Communication 5 0 0 17 43 Education services 0 0 0 18 41 Financing, insurance, real estate and business services 3 63 30 Flight Personnel 0 14 47 Land transport 6 3 0 2 0 498 5 Medical, dental, other health and veterinary services 0 1 0 0 16 44 Personal and household services 0 28 14 125 33 2 2 670 4 Public administration and defence 240 273 10 Recreational and cultural services 55 69 27 Research and scientific institutes 0 1 0 0 0 0 3 57 Sanitary and similar services 68 0 0 0 90 24 Services allied to transport 3 0 0 43 34

80

Industry Sector

Mul

tiple

Mye

lom

a

Nas

opha

rynx

NH

L

NM

SC

Oes

opha

gus

Ova

ry

Panc

reas

Sino

nasa

l

STS

Stom

ach

Thy

roid

O

vera

ll2

Ran

k

Shift work 1957 2 Water transport 1 0 0 11 52 Welfare institutions 0 11 51 Wholesale and retail trade and restaurants and hotels 2 6 1 0 246 11 Total Service industries 0 29 402 129 33 0 3 1 4 0 4007 TOTAL2 10 15 140 2862 188 33 1 126 27 157 1 13598

Abbreviations: NHL = Non-Hodgkin’s lymphoma; NMSC = non-melanoma skin cancer; STS = soft tissue sarcoma 1Asbestos related cancers by industry exclude mesotheliomas thought to be para-occupational and environmental in origin, which are included in the total

2Grouped sector subtotals exclude mesotheliomas thought to be para-occupational and environmental in origin, and industry attributable deaths and registrations do not sum to these totals and subtotals due to the method used to combine attributable fractions across exposures

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4.0 DISCUSSION

Our estimate of the fraction of current cancer deaths in the UK due to past occupational exposures is the upper limit of the range of 1%-5% suggested by Doll and Peto (2005). Burden estimates from other studies range between 3 and 10% (Dreyer et al, 1997; Driscoll et al, 2005; Steenland et al, 2003; Nurminen and Karjalainen 2001; Vineis and Simonato, 1991; Gustavsson et al, 200; Landrigan and Markowitz 1989; Leigh et al, 1997). This is partly due to differences in the numbers of cancers and carcinogens considered. For example the global estimate of occupational cancer (Driscoll et al, 2005) included only lung cancer, leukaemia and mesothelioma; their estimate for lung cancer included only 8 carcinogens, arsenic, asbestos, beryllium, cadmium, chromium, DEE, nickel and silica. The 13 additional agents in our study contributed 33% of the total attributable registrations from lung cancer. The relative importance of different cancer sites also changes as more cancer sites are included; for example, in this study with leukaemia (included in the global estimate) being less important than other sites including other haematopoietic malignancies such as non-Hodgkin’s lymphoma.

Our methodological approach was developed with advice, discussion and peer review from international experts, including IARC, throughout the project and at two international workshops. It takes account of issues such as latency and the period in which relevant exposure would occur, changes in workforce turnover and employment trends and the potential to be exposed to several carcinogens concurrently and at different levels. These methods have the potential to be adapted for use in other countries and extended to include social and economic impact evaluation. For example, both the methods and results from the study are currently being utilised to inform an EU project to make recommendations (and to assess the socioeconomic impact) for new European Union Occupational Exposure Limits for 25 recognised carcinogens. It is also being used to underpin the on-going update of the World Health Organisation Global Burden of Disease.

However, assumptions made in our methodology and uncertainties and inaccuracies in the data we have used may have introduced biases into our estimates, the impact of which is not fully captured in the confidence intervals presented. Table 11 gives some of these and the direction of the impact of these on the estimation of the burden due to occupation. On-going work is exploring the sensitivity of the estimates to such sources of uncertainty and bias.

Agents classified by IARC by the end of 2008 as Group I and 2A carcinogens were assessed. Other substances, such as IARC group 2B carcinogens, many of which may be treated as if they were human carcinogens in regulatory settings have not yet been evaluated; our estimates could thus be too low. In addition, our estimates do not include evaluation of the results from the review and update by IARC of all group 1 carcinogens carried out in 2009 in which a separate classification was given for all cancer sites that were relevant to specific carcinogens; these classifications could potentially vary between cancer sites for the same substance. For example, asbestos has recently been classified as group 1 for mesothelioma and cancers of the larynx, lung and ovary and as group 2A for colorectal, pharyngeal and stomach cancers (Straif et al, 2009).

Uncertainty or bias may have been introduced in the choice of the study for obtaining data for the risk estimates, for example if the exposures in the source study did not reflect those experienced in GB or distributions of confounders differed between the source population and GB. A major gap in available information was a lack of separate risk estimates for women and/or cancer incidence. The use of risk estimates derived from studies of men for women and mortality risk estimates for incidence may have biased the AFs. Epidemiological studies of occupational groups are often confounded by a ‘healthy worker effect’ i.e. a reduced overall risk estimate compared to the general population. This together with

82

potential misclassification of exposure in epidemiological studies could lead to an underestimation of the true effect and thus an underestimation of the burden.

Table 11: Uncertainties and limitations of the methodology and their potential impact on the estimate of the burden of disease due to occupation.

Source of Uncertainty Potential impact on burden estimate

Exclusion of IARC group 2B and unknown carcinogens ↓

Inappropriate choice of source study for risk estimate ↑↓

Imprecision in source risk estimate ↑↓

Source risk estimate from study of highly exposed workers applied to lower exposed target population

↑

Risk estimate biased down by healthy worker effect, exposure misclassification in both study and reference population

↓

Inaccurate risk exposure period ↑↓

Unknown proportion exposed at different levels of exposure ↑↓

Effect of unmeasured confounders ↑↓

Most of the risk estimates from the published literature were related to some estimate of cumulative exposure. In assigning ‘higher’ and ‘lower’ categories to the CAREX industry groups implicit assumptions were made regarding the similarity of durations and intensities of exposure between the source and target (national) populations. National data are not generally available on the proportions of those exposed at different levels of exposure nor does the UK have a national job exposure matrix such as those developed in Finland and the US (Antilla et al, 1992; Greife et al, 1995). The ideal requirement for obtaining the risk estimates is a large good quality study carried out in Britain with quantitative exposure estimates for each of the cancers and carcinogens to be estimated. Unfortunately, these studies are rarely available. However, we have been careful to use estimates of relative risk from studies that were conducted in populations where exposure levels are representative of the level of risk to which British workers are likely to have been exposed.

Due to the long latent interval of many carcinogens our estimates of current burden are based on exposures occurring in the past. Many of these would have been considerably higher than today and there is evidence of continuing downward trends in the UK in many exposures (Cherrie et al, 2007). A comprehensive analysis of published exposure data, particularly in Western Europe and North America, has shown similar patterns of decreasing exposure patterns across a wide range of industries and substances (Symanski et al, 1998a,b). It should be noted that for many of the carcinogens in our study a major contribution to the burden was made by a large number of workers exposed at low levels and low risk for which our quantitative risk estimates are inevitably uncertain.

Our study has highlighted the fact that many workers may potentially be exposed to several carcinogens and that these may affect multiple cancer sites. Key carcinogens and industry sectors have been identified posing varying challenges for risk reduction strategies. These include, asbestos, DEE, ETS (non-smokers), radon, silica, solar radiation and shift work.

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Substantial exposure to asbestos in Britain until the 1970s has contributed to a continuing rise in asbestos-related deaths from lung cancer and mesothelioma (Hodgson et al, 2005) and asbestos contributes 30% of the occupationally-related cancer registrations and nearly half of the deaths in our study. Exposure in the construction industry is highlighted in our study along with other dusts such as those containing silica. A recent case-control study of UK mesothelioma patients found high risks associated with exposure to asbestos in the construction industry including work as a plumber, electrician, painter or decorator (Rake et al, (2009). The authors suggest that a substantial proportion of the deaths in carpenters would be among those who installed asbestos installation board as fireproofing and the large amount of asbestos that remains in many older buildings may still be a potential hazard to construction workers involved in renovation, maintenance or asbestos removal. The difficulties of managing asbestos exposures arising during industrial maintenance and repair and the problems of health protection of workers worldwide has been discussed (Wagner, 2007).

Exposure to dusts containing silica is also highlighted in several industry sectors in our study, including the construction industry. Measurements of respirable crystalline silica in the UK construction industry have found levels that greatly exceed the current workplace exposure limit (WEL) of 0.1 mg/m3, particularly for work in confined spaces and without water suppression of dust or effective extraction (Chisholm, 1999).

Diesel engines have a wide range of industrial applications including on-road equipment (most heavy and medium duty trucks and buses use diesel engines) and off-road applications in the mining, rail, construction, distribution and farming industries and in the military, including the use of diesel-powered heavy equipment, locomotives, forklift trucks, ships, tractors and generators. In a recent review of the literature the highest levels of elemental carbon were reported for enclosed underground work sites in mining and construction (elemental carbon (EC): 27-658 µg/m3) (Pronk et al, 2009). Intermediate levels were reported for above-ground semi-enclosed areas involving work as a workshop mechanic, dock worker and fire station workers (EC<50 µg/m3), with the lowest levels (EC<25 µg/m3) being reported for enclosed areas separated from the source such as drivers, train crew, parking attendants, vehicle testers and utility service workers.

Cancer in non-smokers due to workplace exposure to ETS may be expected to largely disappear in Britain in future due to the ban now in force; our results demonstrate the impact this exposure may have in countries where no ban is yet enforced. Carcinogens such as naturally occurring radon could also easily be eliminated from workplaces. Our study has extended evaluation of more ‘traditional’ industrial hazards such as asbestos to estimation of the effect of newer and less traditional problems. In 2007 IARC classified shift work, in particular night work, as being group 2A for breast cancer (Straif et al, 2007). The estimate of nearly 2000 breast cancer registrations due to shift work in our study is 54% of all female occupationally-related cancer registrations (1971/3622). The epidemiological evidence evaluated by IARC comes from population-based case-control studies and studies of nurses, marine telephone operators and female flight attendants although in the latter the effect of concomitant exposure to shift work and ionizing radiation is difficult to disentangle. Large studies in other industry groups with collection of good shift pattern data are needed. Denmark recently became the first country to designate breast cancer as an occupational disease for the purpose of receiving compensation (Commentary, 2009). The ramifications of this decision and results such as those in our study could be significant given the large numbers of women working night shifts in Britain and worldwide.

Exposure to solar radiation and mineral oils at work was associated with a large number of registrations from NMSC (21% of all attributable registrations). Mortality from NMSC is low but there may be substantial morbidity from disfigurement as the lesions tend to be on the head and neck and as the

84

prevalence is high they represent a considerable economic burden to health services (Trakatelli et al, 2007; Houseman et al, 2003, Boyle et al, 2004) NMSC is thought to be substantially under-registered; our occupationally related figures are thus likely to be under-estimated.

On-going work and future reports will address (i) estimation of the burden due to occupational exposures using other measures such as years of life lost and Disability-Adjusted Life Years, (ii) the methodology that has been developed for predicting future estimates of the occupational cancers due to more recent exposures and application to important exposures identified from the current burden estimation results (iii) exploration of the sensitivity of the estimates to sources of uncertainty and bias.

Summary This project is the first to quantify in detail the burden of cancer due to occupation specifically for Great Britain. The project highlights the impact of occupational exposures, together with the occupational circumstances and industrial areas where exposures to these agents occurred in the past, on population cancer morbidity and mortality; this can be compared with the impact of other causes of cancer. Prioritisation of risk reduction strategies should focus on those workplaces where such exposures are still occurring.

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6.0 STATISTICAL APPENDIX

Formulae used in the estimation of AF 1. Levin’s equation

AF = Pr(E)*(RR-1)/{1+Pr(E)*(RR-1)} (1) where RR = relative risk, Pr(E) = proportion of the population exposed A common denominator is used across exposure levels and industries for each exposure

2. Miettinen’s equation AF = Pr(E|D)*(RR-1)/RR (2) where Pr(E|D) = proportion of cases exposed (E = exposed, D = case)

3. Turnover equation to estimate numbers ever employed during the REP i=b

Ne(REP) = ∑ l(adj15)i * n0/(R-15)} i=a

k =(age(u )−age(1)) j=d +k

+ ∑ ∑ {l(adj15)j *n0 * TO /(age(u)-age(l)+1)} (3) k =0 j=c+k

Where: Ne(REP) = numbers ever employed in the REP n0 = numbers employed in the exposed job/industry at a mid-point in the REP TO = staff turnover per year R = retirement age (65 for men, 60 for women) l(adj15)i = the proportion of survivors to age i of those alive at age 15 (from GB life tables) a to b = age range achieved by the original cohort members by the target year (2004) (65 to 100 for the solid tumour REP; 35 to 84 (men) and 35-79 (women) for the short latency REP) c to d = age range achieved by the turnover recruited cohort members by the target year (25 to 64 for the solid tumour REP; 15 to 34 for the short latency REP) age(u) and age(l) = upper and lower recruitment age limits (24 and 15)

The equation can be represented as a single factor acting as a multiplier for n0, calculated by setting n0 to 1 in the above equation, so that the factor varies only with TO see Table A1 below.

4. Equation to estimate the proportion of the population exposed

Pr(E) = Ne(REP) / Np(REP) (4) where Np(REP) = numbers ever of working age during the REP from population estimates for the relevant age cohorts in the target year

5. Equation for combining AFs where exposed populations overlap but are independent and risk estimates are assumed to be multiplicative:

AFoverall = 1- Πk(1-AFk) for the k exposures in the set (5)

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Table A1 Employment level adjustment and turnover factors used in the calculation of AF

Main Industry Sector Adjustment

factor for change in employment

levels*

Turnover per year

Men A-B Agriculture, hunting and forestry; fishing 1 7% C-E Mining and quarrying, electricity, gas and

water; manufacturing industry 1.4 9%

F Construction 1 12% G-Q Service industries 0.9 11%

Total 1 10% Women A-B Agriculture, hunting and forestry; fishing 0.75 10%

C-E Mining and quarrying, electricity, gas and water; manufacturing industry

1.5 14%

F Construction 0.67 15% G-Q Service industries 0.8 15%

Total 0.9 14% * Applied to CAREX data for the solid tumour REP only. Exposed numbers are obtained for a mid-point year in the REP where national employment data sources have been used (the LFS or CoE).

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Published by the Health and Safety Executive 06/12



This project aimed to estimate of the current burden of cancer for Great Britain due to occupational exposure to carcinogenic agents/exposure circumstances. The measure of the burden of cancer used was the attributable fraction (AF) ie the proportion of cases that would not have occurred in the absence of exposure. Data were obtained on the risk of the cancer for each exposure, accounting for confounding factors, and the proportion of the population exposed over the relevant exposure period. Carcinogenic agents/ exposure circumstances, classified by the International Agency for Research on Cancer as definite (Group 1) or probable (Group 2A) human carcinogens were considered. Overall estimates are presented for cancer registration (incidence) data in 2004, and mortality data in 2005.

The estimated total (male and female) AF and deaths related to overall occupational exposure is 5.3%, giving 8010 attributable deaths (men: 8.2% (6355); women 2.3% (1655)). The estimated total (male and female) AF and registrations related to overall occupational exposure is 4.0%, giving 13598 attributable registrations (men: 5.7% (9988); women 2.1% (1655)).

Occupational AFs are over 2% for the following cancers: bladder, breast, larynx, lung, mesothelioma, nasopharynx, non-melanoma skin cancer, oesophagus, sinonasal, and soft tissue sarcoma. Asbestos, shift work, mineral oils, solar radiation, silica, diesel engine exhaust, polycyclic aromatic hydrocarbons from coal tars and pitches, occupation as a painter or welder, dioxins, environmental tobacco smoke (non-smokers), workplace exposure to radon, tetrachloroethylene, arsenic and strong inorganic mists each contribute 100+ registrations.

This report and the work it describes were funded by the Health and Safety Executive (HSE). Its contents, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy.

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