Occupational Cancer

Based on well-documented associations between occupational exposures and cancer, it is estimated that approximately 20,000 cancer deaths and 40,000 new cases of cancer each year in the U.S. are attributable to occupation.

Millions of U.S. workers are exposed to substances that have tested as carcinogens in animal studies. However, less than 2% of chemicals in commerce have been tested for carcinogenicity.

Cancer is a group of different diseases that have the same feature, the uncontrolled growth and spread of abnormal cells. Each different type of cancer may have its own set of causes. Many factors play a role in the development of cancer. The importance of these factors is different for different types of cancer. A person's risk of developing a particular cancer is influenced by a combination of factors that interact in ways that are not fully understood. Some of the factors include:

• Personal characteristics such as age, sex, and race
• Family history of cancer
• Diet and personal habits such as cigarette smoking and alcohol consumption
• The presence of certain medical conditions
• Exposure to cancer-causing agents in the environment
• Exposure to cancer-causing agents in the workplace

In many cases, these factors may act together or in sequence to cause cancer.

Cancer Clusters

Scenario

Worker pulling a hydraulic cleaner from an open vinyl chloride reactor at Avon Lake, OH in 1974, prior to the exposure controls mandated by the OSHA standard. Vinyl chloride is known to cause angiosarcoma of the liver.

Three members of the staff of an elementary school were diagnosed with cancer in 1997 and 1998; one person each with brain, liver, and ovarian cancer. Since 1998, four cases of breast cancer also were diagnosed. Increased concern among employees regarding the potential association between the workplace and the cancers prompted a request for an investigation.

The information below addresses cancer clusters in general and shows how this type of information would be used to respond to this scenario.

Cancers often appear to occur in clusters, which scientists define as an unusual concentration of cancer cases in a defined area or time. A cluster also occurs when the cancers are found among workers of a different age or sex group than is usual. The cases of cancer may have a common cause or may be the coincidental occurrence of unrelated causes. Although the occurrence of a disease may be random, the distribution of that disease may not be uniform, and clusters of disease may arise by chance alone. When cancer in a workplace is described, it is important to determine the primary site of the cancer.

What do we look for when evaluating a cancer cluster?

1. Because cancer is a common disease, cancer can be found among people at any workplace. In the United States, one in two men and one in three women will develop cancer over the course of their lifetime. These figures show the unfortunate reality that cancer occurs more often than many people realize. Disease or tumor rates are very variable in small populations and rarely match the overall rate for a larger area, such as the state, so that for any given time period some populations have rates above the overall rate and others have rates below the overall rate. So, even when there is an excess, this may be completely consistent with the expected random variability.

   Worker handling amosite asbestos, which is known to cause lung cancer and mesothelioma, at a pipe insulation manufacturing plant in Tyler, TX, in the early 1970s.

   In the scenario above, 95 staff members had worked at the school since it opened in 1992. Breast cancer is the most common type of cancer in women, affecting an estimated one of every eight women. Because the school's workforce was primarily composed of women, it was not unusual to see several cases of breast cancer. Although these breast cancers were diagnosed within a relatively short time frame, this made sense given the age of the staff and the age distribution for breast cancer.

2. Cancer clusters thought to be related to a workplace exposure usually consist of the same types of cancer. When several cases of the same type of cancer occur and that type is not common in the general population, it is more likely that an occupational exposure is involved. When the cluster consists of multiple types of cancer, without one type predominating, an occupational cause of the cluster is less likely.

   In our example, four types of cancer were diagnosed among the elementary school staff.

3. When a known or suspected cancer-causing agent is present and the types of cancer occurring have been linked with these exposures in other settings, we are more likely to make the connection between cancer and a workplace exposure. We also look to see whether cancer is occurring among employees in particular jobs or areas of the workplace. This can help to identify exposures.

   School environments do not typically contain significant hazardous exposures. Asbestos can be a concern in older buildings, but while it is known to cause lung cancer and mesothelioma, it is not known to cause the types of cancer reported among this group of employees.

4. The time between first exposure to a cancer-causing agent and clinical recognition of the disease is called the latency period. Latency periods vary by cancer type, but usually are 15 to 20 years, or longer. Because of this, past exposures are more relevant than current exposures as potential causes of cancers occurring in workers today. Often, these exposures are hard to document.

   The average time from first employment in the school to the diagnosis of cancer among staff members in the elementary school in our example was 5.7 years.

Conclusions for the scenario above

Workers on top of a coke oven. Work on top of coke ovens is known to cause lung and skin cancer, and thought to cause kidney cancer.

The distribution of types of cancer did not appear unusual given the age and gender of the employees. No known biologically significant exposures were identified. The building only became occupied in 1992, therefore, given what we know about latency periods, none of the cancer cases met the latency criterion. Given this information, it was concluded that the cancers reported among these workers were unlikely to be the result of employment at the elementary school.

This scenario illustrates the key questions that are answered in response to cancer cluster inquiries. Historical experience at NIOSH has shown that most reports of cancer clusters indicate the coincidental occurrence of cancer in workforce members. In most situations, particularly in non-industrial work environments, it is not possible to link the cancers to exposures at work.

Carcinogenic Agents

• NIOSH Carcinogen List
• International Agency for Research on Cancer (IARC)
  External link: http://www.iarc.fr/
• National Toxicology Program Annual Report on Carcinogen
  External link: http://ehis.niehs.nih.gov/roc/toc9.html
• NIOSH Pocket Guide
  External link: http://www.cdc.gov/niosh/npg/
  
  

National Academies Evaluation

Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services – Evidence Package

General: Causes, Specific Diseases

• NIOSH: Cancer Research Methods
  Information from the National Occupational Research Agenda (NORA) poster on Cancer Research Methods.
• The Importance of Information Dissemination in the Prevention of Occupational Cancer
  Environmental Health Perspectives (1995; vol. 103, pp. 217-218)
  This paper provides examples of successes and failures of information dissemination.
  External link: http://ehp.niehs.nih.gov/members/1995/Suppl-8/fine-full.html
• Agencies, Organizations, etc.
  • American Cancer Society
    External link: http://www.cancer.org
  • National Cancer Institute (NCI)
    External link: http://www.cancer.gov/
  • University of Pennsylvania Cancer Center
    External link: http://oncolink.org/

Regulation and Policy

• OSHA Standards
  External link: http://www.osha.gov/SLTC/carcinogens/standards.html
  

Surveillance

• Occupational Respiratory Disease Surveillance (ORDS)
  Occupational respiratory disease medical screening and monitoring
• Work-Related Lung Disease Surveillance Report 2002
  DHHS (NIOSH) Publication No. 2003-111 (2002)
  The sixth of a series, the Work-Related Lung Disease (WoRLD) Surveillance Report 2002 provides information on various work-related respiratory diseases and associated exposures in the United States. The WoRLD Surveillance Report 2002 describes where these diseases are occurring (by industry and geographic location), who is affected (by race, gender, age, and occupation), how frequently they occur, and temporal trends.
• Section 13. Lung Cancer
  PDF 115 KB (4 pages)