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BIG DEBATE 3
Cancer Societies Must Invest More Resources to Reduce Environmental and Occupational Cancer Risk Exposure
No conflict of interest
Lesley Rushton Imperial College London
So what’s the problem? 1. ENVIRONMENTAL CAUSES
Air pollution (traffic + industry)
UV radiation
Particulates, Diesel fumes, Hydrocarcbons
Contaminated water – e.g. arsenic
Skin, bladder, kidney cancers + non-malignant effects
Indoor air
Waste management
EMFs
How much environmentally caused cancer is there?
2015 Global Burden of Disease estimates of deaths due to:
• Unsafe water + sanitation 1,766,000 (all causes) • Air pollution 6,455,000 Ambient air pollution 4,241,000 (283,000 lung cancers) Household air pollution 2,854,000 (149,000 lung cancers)
• Residential radon 64,000 (lung cancer)
So what’s the problem? 2. OCCUPATIONAL CAUSES
ILO mortality estimates
• 2.3 million workers worldwide die from occupational accidents and diseases annually
• Of these there are 666,000 deaths globally from exposure to carcinogens in the workplace.
0
1,000
2,000
3,000
4,000
5,000
Canc
er re
gstr
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Cancer Registrations by Industry in Britain
Agriculture, Forestry and Fishing Manufacturing, Mining and Utilities Construction Service Industries
Construction Banned in Britain ETS at work is a major cancer risk globally
The Cost: Good social and economic reasons to drive occupational cancer down • Social cost to employees, their families and society
loss of life life long injury and illness health and medical care loss of earning impact on the family
• Cost to business remedial work potential insurance increase replacing staff retraining staff reputation and lost business
Recent British figures: £12.3 billion annually (lung £6.8, meso £3.0 breast £1.1) £11.4 billion are ‘human’ costs, borne by individuals
Why should cancer societies invest more resources to reduce environmental and occupational research on cancer?
Family/Genetics
Ethnicity Low penetrance
BRCA etc. Moderate penetrance
Mammographic density
Reproduction/Hormonal Environmental + Occupational
Lifestyle
Endogenous hormones: levels of oestrogen, androgens, etc.
Age at menarche
Nulliparity vs. parity1
Age at 1st birth
Age at menopause
Oral contraceptives
HRT
Pregnancy characteristics
Alcohol
Diet BMI
Physical activity
Socio-economics
EMF
Shift work
Disease & medicine radiation
Ionising radiation
Flight personnel
Geography Various chemical
exposures
Unbalanced knowledge base: e.g. Breast cancer
Funding of occupational/environmental studies:
• Important role in identifying and quantifying risks + understanding the aetiology of disease
• Contribute to: Risk and health impact assessment Setting standards and limits in workplaces and the general
environment Providing evidence for compensation Support decisions on priority actions for risk reduction Contribute to an understanding of health inequalities Reduction of risk in non-malignant disease
Prevention is better than cure
Modern problems: e.g. diesel engine exhaust Cancers: bladder and lung cancers Non-malignant effects including chronic bronchitis and lung function decline
Continuing problems: e.g. asbestos Several cancer types
More support needed to increase knowledge base of occupational/environmental cancer
• Essential baseline data to inform reduction: e.g. exposure data especially in Low and Middle Income Countries
• Epidemiological research to demonstrate risks even including well established carcinogens such as asbestos
• Occupational studies offer value for money and are feasible: range of exposures, tightly controlled re other risk factors e.g. smoking. feasible in practice facilitate extrapolation to lower dose environmental levels
• Multi-country/centre primary intervention studies to demonstrate the effectiveness of reduction strategies and transferability to other countries and circumstances.
Cancer societies need to support prevention of occupational and environmental cancer
To increase • The knowledge base of the risks involved • Awareness among workers and public of the risks of cancer
at work and from the environment • Partnerships between employers, employees and regulators
to develop prevention strategies • Transfer of knowledge between countries and organisations • Support for prevention campaigns
Vote ‘FOR’ To prevent cancers caused by occupation and environment
1. Now
2. In future generations
Thank you
