Occupational Cancer Research Centre (OCRC)

Permanent URI for this collectionhttps://hdl.handle.net/1807/73641

The Occupational Cancer Research Centre (OCRC) is a unique partnership that unites research, healthcare, workplace safety, labour and industry groups. Established in 2009, the OCRC is the first of its kind in Canada. The establishment of the OCRC grew out of the recognized need to re-emphasize research on the causes and prevention of occupation-related cancers after decades of diminished effort in most countries.

The OCRC works to fill the gaps in our knowledge of occupation-related cancers and uses these findings to inform preventive programs to control workplace carcinogenic (cancer-causing) exposures and improve the health of workers.

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Effect modification of the association of cumulative exposure and cancer risk by intensity of exposure and time since exposure cessation: a flexible method applied to cigarette smoking and lung cancer in the SYNERGY Study
(Oxford University Press, 2014-02-01) Vlaanderen, Jelle; Portengen, Lützen; Schüz, Joachim; Olsson, Ann; Pesch, Beate; Kendzia, Benjamin; Stücker, Isabelle; Guida, Florence; Brüske, Irene; Wichmann, Heinz-Erich; Consonni, Dario; Landi, Maria Teresa; Caporaso, Neil; Siemiatycki, Jack; Merletti, Franco; Mirabelli, Dario; Richiardi, Lorenzo; Gustavsson, Per; Plato, Nils; Jöckel, Karl-Heinz; Ahrens, Wolfgang; Pohlabeln, Hermann; Tardón, Adonina; Zaridze, David; Field, John K.; 't Mannetje, Andrea; Pearce, Neil; McLaughlin, John; Demers, Paul; Szeszenia-Dabrowska, Neonila; Lissowska, Jolanta; Rudnai, Peter; Fabianova, Eleonora; Stanescu Dumitru, Rodica; Bencko, Vladimir; Foretova, Lenka; Janout, Vladimir; Boffetta, Paolo; Forastiere, Francesco; Bueno-de-Mesquita, Bas; Peters, Susan; Brüning, Thomas; Kromhout, Hans; Straif, Kurt; Vermeulen, Roel
The indiscriminate use of the cumulative exposure metric (the product of intensity and duration of exposure) might bias reported associations between exposure to hazardous agents and cancer risk. To assess the independent effects of duration and intensity of exposure on cancer risk, we explored effect modification of the association of cumulative exposure and cancer risk by intensity of exposure. We applied a flexible excess odds ratio model that is linear in cumulative exposure but potentially nonlinear in intensity of exposure to 15 case-control studies of cigarette smoking and lung cancer (1985-2009). Our model accommodated modification of the excess odds ratio per pack-year of cigarette smoking by time since smoking cessation among former smokers. We observed negative effect modification of the association of pack-years of cigarette smoking and lung cancer by intensity of cigarette smoke for persons who smoked more than 20-30 cigarettes per day. Patterns of effect modification were similar across individual studies and across major lung cancer subtypes. We observed strong negative effect modification by time since smoking cessation. Application of our method in this example of cigarette smoking and lung cancer demonstrated that reducing a complex exposure history to a metric such as cumulative exposure is too restrictive.
Natural resource-based industries and prostate cancer risk in Northeastern Ontario: a case-control study
(BMJ Publishing Group, 2016-08) Sritharan, Jeavana; Demers, Paul A.; Harris, Shelley A.; Cole, Donald C.; Kreiger, Nancy; Sass-Kortsak, Andrea; Lightfoot, Nancy
Objective: Prostate cancer continues to be the most commonly diagnosed cancer in men, and there is limited knowledge on its preventable risk factors. A number of occupational exposures in natural resource-based industries are suspected to be related to prostate cancer risk. This study investigates associations between employment in these industries and prostate cancer. Methods: Data were from a population-based, case–control study previously conducted in Northeastern Ontario. Incident cases (N=760) aged 45–85 years and diagnosed with prostate cancer between 1995 and 1998 were identified from the Ontario Cancer Registry. Controls (N=1632) were recruited using telephone listings, and were frequency matched to cases by age. Lifetime occupational history was collected for all participants. Logistic regression was used to estimate ORs and their associated 95% CIs. Results: Elevated risks were observed for employment in forestry and logging industries (OR=1.87, 95% CI 1.32 to 2.73) and occupations (OR=1.71, 95% CI 1.24 to 2.35), and these risks increased with duration of employment for ≥10 years. Elevated risks were also found for employment in wood products industries (OR=1.45, 95% CI 1.07 to 1.97), and paper and allied products industries (OR=1.43, 95% CI 1.03 to 2.00), and when duration of employment was ≥10 years. There were also elevated risks in agriculture and mining-related work; however, these findings were not consistent across industry and occupation categories. Conclusions: Prostate cancer risk may be associated with work in several natural resource industries, primarily in the forest industries. To further evaluate observed associations, studies should focus on natural resource-based exposures in larger populations with improved exposure assessment.
Pesticide exposures and the risk of multiple myeloma in men: An analysis of the North American Pooled Project
(Wiley, 2016-10-15) Presutti, Roseanna; Harris, Shelley A.; Kachuri, Linda; Spinelli, John J.; Pahwa, Manisha; Blair, Aaron; Zahm, Shelia Hoar; Cantor, Kenneth P.; Weisenburger, Dennis D.; Pahwa, Punam; McLaughlin, John R.; Dosman, James A.; Freeman, Laura Beane
Multiple myeloma (MM) has been consistently linked with agricultural activities, including farming and pesticide exposures. Three case-control studies in the United States and Canada were pooled to create the North American Pooled Project (NAPP) to investigate associations between pesticide use and haematological cancer risk. This analysis used data from 547 MM cases and 2700 controls. Pesticide use was evaluated as follows: ever/never use; duration of use (years); and cumulative lifetime-days (LD) (days/year handled × years of use). Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression adjusted for age, province/state of residence, use of proxy respondents and selected medical conditions. Increased MM risk was observed for ever use of carbaryl (OR = 2.02, 95% CI = 1.28-3.21), captan (OR = 1.98, 95% CI = 1.04-3.77) and DDT (OR = 1.44, 95% CI = 1.05-1.97). Using the Canadian subset of NAPP data, we observed a more than threefold increase in MM risk (OR = 3.18, 95% CI = 1.40-7.23) for ≤10 cumulative LD of carbaryl use. The association was attenuated but remained significant for >10 LD of carbaryl use (OR = 2.44; 95% CI = 1.05-5.64; ptrend = 0.01). For captan, ≤17.5 LD of exposure was also associated with a more than threefold increase in risk (OR = 3.52, 95% CI = 1.32-9.34), but this association was attenuated in the highest exposure category of >17.5 LD (OR = 2.29, 95% CI = 0.81-6.43; ptrend = 0.01). An increasing trend (ptrend = 0.04) was observed for LD of DDT use (LD > 22; OR = 1.92, 95% CI = 0.95-3.88). In this large North American study of MM and pesticide use, we observed significant increases in MM risk for use of carbaryl, captan and DDT.
Antineoplastic drug contamination on the hands of employees working throughout the hospital medication system
(Oxford University Press, 2014-07) Hon, Chun-Yip; Teschke, Kay; Demers, Paul A.; Venners, Scott
We previously reported that antineoplastic drug contamination is found on various work surfaces situated throughout the hospital medication system (process flow of drug within a facility from initial delivery to waste disposal). The presence of drug residual on surfaces suggests that healthcare workers involved in some capacity with the system may be exposed through dermal contact. The purpose of this paper was to determine the dermal contamination levels of healthcare employees working throughout a hospital and to identify factors that may influence dermal contamination. We selected participants from six hospitals and wiped the front and back of workers' hands. Wipe samples were analyzed for cyclophosphamide (CP), a commonly used antineoplastic drug, using high-performance liquid chromatography-tandem mass spectrometry. Participants were asked about their frequency of handling antineoplastic drugs, known contact with CP on their work shift, gender, job title, and safe drug handling training. In addition, participants were surveyed regarding their glove usage and hand washing practices prior to wipe sample collection. We collected a total of 225 wipe samples. Only 20% (N = 44) were above the limit of detection (LOD) of 0.36ng per wipe. The average concentration was 0.36ng per wipe, the geometric mean < LOD, the geometric standard deviation 1.98, and the range < LOD to 22.8ng per wipe. Hospital employees were classified into eight different job categories and all categories had some dermal contamination levels in excess of the LOD. The job category with the highest proportion of samples greater than the LOD were those workers in the drug administration unit who were not responsible for drug administration (volunteer, oncologist, ward aide, dietician). Of note, the highest recorded concentration was from a worker who had no known contact with CP on their work shift. Our results suggest that a broader range of healthcare workers than previously believed, including those that do not directly handle or administer the drugs (e.g. unit clerks, ward aides, dieticians, and shipper/receivers), are at risk of exposure to antineoplastic drugs. A review of control measures to minimize antineoplastic drug exposure that encompasses a wide array of healthcare workers involved with the hospital medication system is recommended.
Antineoplastic drug contamination in the urine of Canadian healthcare workers
(Springer Verlag, 2015-10) Hon, Chun-Yip; Teschke, Kay; Shen, Hui; Demers, Paul A.; Venners, Scott
Purpose: The purpose of this study was to quantify the urine concentration of non-metabolized cyclophosphamide (CP), a commonly administered antineoplastic drug, among potentially exposed Canadian healthcare workers and to identify factors associated with the drug concentration levels. Methods: Participants were asked to provide two sets of 24-h urine samples (at two different sampling events), and the level of CP was quantified using high-performance liquid chromatography–tandem mass spectrometry. In addition to demographic information, participants were surveyed regarding their frequency of handling of antineoplastic drugs, safe drug handling training, and known contact with CP on their work shift. Descriptive and inferential statistical analyses were performed. A backward stepwise linear mixed effect model was conducted to identify the factors associated with urine concentration levels. Results: We collected 201 urine samples, and 55 % (n = 111) had levels greater than the LOD of 0.05 ng/mL. The mean urinary CP concentration was 0.156 ng/mL, the geometric mean was 0.067 ng/mL, the geometric standard deviation was 3.18, the 75th percentile was 0.129 ng/mL, and the range was
The inclusion of women in studies of occupational cancer: a review of the epidemiologic literature from 1991-2009
(Wiley, 2015-03) Hohenadel, Karin; Raj, Priyanka; Demers, Paul A.; Zahm, Shelia Hoar; Blair, Aaron
Introduction: Since the early 1990s, researchers have been concerned with the low rate at which women are included in epidemiologic studies of occupational cancer. A previous evaluation determined that one-third of articles published between 1970 and 1990 included women. Methods: To assess whether there has been an improvement in recent years, papers on occupational cancer between 1991 and 2009 were reviewed in fifteen journals. Results: The proportion of articles that included men remained stable around 90%, while the proportion of articles that included women increased substantially, from 39% in 1991–1995 to 62% in 2006–2009. Articles that assessed risk among men only or men and women presented a higher number of risk estimates and were more likely to evaluate dose-response relationships than studies including women. Conclusions: Despite advances in the inclusion of women in studies of occupational cancer, disparities remain in the number of studies of occupational cancer and depth of analysis in studies that included women. Am. J. Ind. Med. 58:276–281, 2015. © 2015 Wiley Periodicals, Inc.
A comparison of exposure assessment approaches: lung cancer and occupational asbestos exposure in a population-based case-control study
(BMJ Publishing Group, 2014-04) Hardt, Jill S.; Vermeulen, Roel; Peters, Susan; Kromhout, Hans; McLaughlin, John R.; Demers, Paul A.
Objectives: In attempts to overcome the limitations of self-reported data in occupational health research, job-exposure matrices, which assign exposure by occupation, have emerged as an objective approach for assessing occupational exposures. On the basis of a lung cancer case–control study conducted in the Greater Toronto Area, 1997–2002, assessment of occupational exposure to asbestos was compared using self-reports and a general population job-exposure matrix (DOM-JEM). Methods: Cases and frequency matched controls provided life-time job histories and self-reported exposures to potential lung carcinogens including asbestos through a detailed questionnaire. Exposure to asbestos was also assigned to each job by linking occupational histories with DOM-JEM. Agreement in classification of exposed and unexposed jobs according to self-reports and DOM-JEM was evaluated using Cohen's κ. Risks for lung cancer were estimated using unconditional logistic regression for each exposure assessment approach. Results: The prevalence of occupational asbestos exposure was greater when based on DOM-JEM than when based on self-reports. Agreement in classifying exposure to jobs between the two assessment approaches was poor. The risk of lung cancer was not elevated among workers who self-reported asbestos exposure, whereas workers considered exposed on the basis of DOM-JEM were almost twice as likely as unexposed workers to be diagnosed with lung cancer (OR 1.9, 95% CI 1.3 to 2.7). Conclusions: It is generally assumed by epidemiologists that self-reported exposure assessments result in inflated risk estimates. In this study, self-reports found no association with a well-established risk factor, whereas a high-quality job-exposure matrix revealed relative risk estimates that are more consistent with previous findings.
Exposed! Or Not? The Diminishing Record of Workplace Exposure in Canada
(Canadian Public Health Association, 2014) Hall, Amy L.; Peters, Cheryl E.; Demers, Paul A.; Davies, Hugh W.
The Canadian Workplace Exposure Database (CWED) is the first of its kind in Canada. It was originally developed in 2008 by the Canadian Carcinogen Exposure project (CAREX Canada) to assist in estimating worker exposures to carcinogens across the country. Following the CWED’s establishment, all Canadian federal and provincial agencies responsible for administering occupational health and safety regulation were surveyed to obtain a clearer picture of the quantity and quality of regulatory exposure data available. This revealed troubling reductions in exposure measurement collection, retention, and centralization by these agencies in recent years. Such trends will limit access to workplace exposure measurements for federal and provincial regulatory agencies as well as health researchers. Workplace exposure databases are used around the world for a variety of important purposes, such as identifying hazardous workplaces and workers at risk, assessing temporal–spatial trends, setting priorities for prevention, and informing epidemiological research. Efforts are underway to preserve historical data and promote prospective collection, however future success of the CWED will require collaboration and long-term vision on the part of those responsible for collecting workplace exposure measurements in Canada.
Designing exposure registries for improved tracking of occupational exposure and disease
(Canadian Public Health Association, 2016) Arrandale, Victoria H.; Bornstein, Stephen; King, Andrew; Takaro, Timothy K.; Demers, Paul A.
OBJECTIVES: Registries are one strategy for collecting information on occupational exposure and disease in populations. Recently leaders in the Canadian occupational health and safety community have shown an interest in the use of occupational exposure registries. The primary goal of this study was to review a series of Canadian exposure registries to identify their strengths and weaknesses as a tool for tracking occupational exposure and disease in Canada. A secondary goal was to identify the features of an exposure registry needed to specifically contribute to prevention, including the identification of new exposure–disease relationships. METHODS: A documentary review of five exposure registries from Canada was completed. Strengths and limitations of the registries were compared and key considerations for designing new registries were identified. RESULTS: The goals and structure of the exposure registries varied considerably. Most of the reviewed registries had voluntary registration, which presents challenges for the use of the data for either surveillance or epidemiology. It is recommended that eight key issues be addressed when planning new registries: clear registry goal(s), a definition of exposure, data to be collected (and how it will be used), whether enrolment will be mandatory, as well as ethical, privacy and logistical considerations. CONCLUSIONS: When well constructed, an exposure registry can be a valuable tool for surveillance, epidemiology and ultimately the prevention of occupational disease. However, exposure registries also have a number of actual and potential limitations that need to be considered.
Urinary metal concentrations among female welders
(Oxford University Press, 2015-01) Arrandale, Victoria H.; Beach, Jeremy; Cembrowski, George S.; Cherry, Nicola M.
As part of a Canada-wide study of women entering non-traditional trades [Women's Health in Apprenticeship Trades-Metalworkers and Electricians (WHAT-ME)], we examined spot urine samples from women welders in Alberta to determine whether urinary metal concentrations exceeded those of the general population, to compare levels to previously published urinary concentrations in male welders and to examine the relationship with welding tasks. Women mailed-in urine samples collected close to the time of completing a detailed exposure questionnaire, including welding tasks on their most recent day welding at work. Of 53 welders working in their trade, 45 had urinary creatinine >0.3-≤3.0g l(-1) and were included in analyses. Seven metals were examined for which both population and male welder urinary concentrations were available: cadmium, chromium, cobalt, copper, manganese, nickel, and zinc. Principal component analysis was used to extract three components from natural log transformed creatinine-corrected metal concentrations. Of the 45 women, 17 reported more than one main task. Overall two thirds worked in fabrication, a third on pipe welding, and smaller numbers on repair, in construction or other tasks: manual metal arc welding was reported by 62%, semi-automatic arc welding by 47%, and arc welding with a tungsten electrode by 15%. In multiple regression analyses, little relation was found between urinary metals and task or type of welding, except for cadmium where lower levels were seen in those reporting semi-automatic manual welding (after adjustment for age and smoking). The proportion of women welders exceeding the selected general population 95th percentile was high for manganese (96%) and chromium (29%). Urinary metal concentrations were similar to those reported for male welders with only manganese, with a geometric mean in women of 1.91 µg g(-1) creatinine, and perhaps copper (11.8 µg g(-1) creatinine), consistently lower in male welders. Although not evident from the task analysis reported here, differences in exposure by sex may be explained by type of welding or by other work practices. A closely comparable cohort of male welders would be necessary to examine this hypothesis more fully.
Sun Safety at Work Canada: a multiple case-study protocol to develop sun safety and heat protection programs and policies for outdoor workers
(BioMed Central, 2015-07-10) Kramer, Desre M.; Tenkate, Thomas; Strahlendorf, Peter; Kushner, Rivka; Gardner, Audrey; Holness, D. Linn
Background: CAREX Canada has identified solar ultraviolet radiation (UV) as the second most prominent carcinogenic exposure in Canada, and over 75 % of Canadian outdoor workers fall within the highest exposure category. Heat stress also presents an important public health issue, particularly for outdoor workers. The most serious form of heat stress is heat stroke, which can cause irreversible damage to the heart, lungs, kidneys, and liver. Although the need for sun and heat protection has been identified, there is no Canada-wide heat and sun safety program for outdoor workers. Further, no prevention programs have addressed both skin cancer prevention and heat stress in an integrated approach. The aim of this partnered study is to evaluate whether a multi-implementation, multi-evaluation approach can help develop sustainable workplace-specific programs, policies, and procedures to increase the use of UV safety and heat protection. Methods/design: This 2-year study is a theory-driven, multi-site, non-randomized study design with a cross-case analysis of 13 workplaces across four provinces in Canada. The first phase of the study includes the development of workplace-specific programs with the support of the intensive engagement of knowledge brokers. There will be a three-points-in-time evaluation with process and impact components involving the occupational health and safety (OHS) director, management, and workers with the goal of measuring changes in workplace policies, procedures, and practices. It will use mixed methods involving semi-structured key informant interviews, focus groups, surveys, site observations, and UV dosimetry assessment. Using the findings from phase I, in phase 2, a web-based, interactive, intervention planning tool for workplaces will be developed, as will the intensive engagement of intermediaries such as industry decision-makers to link to policymakers about the importance of heat and sun safety for outdoor workers. Discussion: Solar UV and heat are both health and safety hazards. Using an occupational health and safety risk assessment and control framework, Sun Safety at Work Canada will support workplaces to assess their exposure risks, implement control strategies that build on their existing programs, and embed the controls into their existing occupational health and safety system.
Ontario Uranium Miners Cohort Study Report
(The Occupational Cancer Research Centre and Cancer Care Ontario, 2015-02) Navaranjan, G.; Berriault, C.; Do, M.; Villeneuve, Paul J.; Demers, Paul A.
This study is an updated analysis of mortality and cancer incidence for a cohort of Ontario uranium miners exposed to radon decay products (RDP). The cohort had been created previously using the Ontario Mining Master File (MMF) (1954-1986) and data from the National Dose Registry (NDR) (1954-2004). For this update the mortality follow-up of the cohort between 1954 and 2007 was expanded by linking to records in the Canadian Mortality Database (CMDB). Similarly cancer incidence from 1969 and 2005 was ascertained by linking to the Canadian Cancer Database (CCDB) at Statistics Canada. Annual exposure to radon, in working level months (WLMs), was available for each cohort member.
Prevention System Quality Index (PSQI): An inaugural report evaluating Ontario’s efforts in cancer prevention
(Cancer Care Ontario, 2015) Kalenge, S.; Lewyckyj, W.; Demers, Paul A.; Cancer Care Ontario
The 2015 Prevention System Quality Index (PSQI) report begins Cancer Care Ontario’s (CCO’s) annual monitoring and evaluation of the cancer prevention system in Ontario. The PSQI reports on the effects of system-level policies and programs in Ontario, which encompass all large-scale initiatives taking place across the province. The PSQI identifies achievements, as well as gaps at the system level to encourage system improvement. This focus on system-level policies and programs stems from evidence showing that healthy public policy and community-wide programs facilitating healthier individual choices are more effective in reducing the prevalence of modifiable risk factors at a population level than trying to change behaviours one person at a time. It also recognizes that all levels of government, a range of government ministries and divisions, policy-makers, decision-makers and sectors have a role in influencing cancer prevention.
Tracking occupational diseases: An analysis of approaches for the Canadian context
(WorkSafeBC, 2014) Arrandale, Victoria; Demers, Paul A.; Bornstein, S.; Nies, B.; McLeod, C. B.; Koehoorn, M.
Effective systems for monitoring occupational diseases would be of considerable assistance to Canadian Workers’ Compensation Boards (WCBs) as well as to other policy makers and stakeholders involved with occupational health. Canadian decision makers have recently shown interest in the use of registries in monitoring occupational exposure and disease. This report presents a review of operating exposure registries, outlines several key considerations in the planning of new registries, and provides a brief comparison of registries with other approaches for exposure and disease tracking.
Lung cancer among coal miners, ore miners and quarrymen: smoking-adjusted risk estimates from the synergy pooled analysis of case-control studies
(Nordic Association of Occupational Safety and Health, 2015-09-01) Taeger, Dirk; Pesch, Beate; Kendzia, Benjamin; Behrens, Thomas; Jöckel, Karl-Heinz; Dahmann, Dirk; Siemiatycki, Jack; Kromhout, Hans; Vermeulen, Roel; Peters, Susan; Olsson, Ann; Brüske, Irene; Wichmann, Heinz-Erich; Stücker, Isabelle; Guida, Florence; Tardón, Adonina; Merletti, Franco; Mirabelli, Dario; Richiardi, Lorenzo; Pohlabeln, Hermann; Ahrens, Wolfgang; Landi, Maria Teresa; Caporaso, Neil; Pesatori, Angela Cecilia; Mukeriya, Anush; Szeszenia-Dabrowska, Neonila; Lissowska, Jolanta; Gustavsson, Per; Field, John; Marcus, Michael W.; Fabianova, Eleonora; 't Mannetje, Andrea; Pearce, Neil; Rudnai, Peter; Bencko, Vladimir; Janout, Vladimir; Dumitru, Rodica Stanescu; Foretova, Lenka; Forastiere, Francesco; McLaughlin, John; Paul Demers, Paul Demers; Bueno-de-Mesquita, Bas; Schüz, Joachim; Straif, Kurt; Brüning, Thomas
Objectives: Working in mines and quarries has been associated with an elevated lung cancer risk but with inconsistent results for coal miners. This study aimed to estimate the smoking-adjusted lung cancer risk among coal miners and compare the risk pattern with lung cancer risks among ore miners and quarrymen. Methods: We estimated lung cancer risks of coal and ore miners and quarrymen among 14 251 lung cancer cases and 17 267 controls from the SYNERGY pooled case–control study, controlling for smoking and employment in other at-risk occupations. Results: Ever working as miner or quarryman (690 cases, 436 controls) was associated with an elevated odds ratio (OR) of 1.55 [95% confidence interval (95% CI) 1.34–1.79] for lung cancer. Ore miners (53 cases, 24 controls) had a higher OR (2.34, 95% CI 1.36-4.03) than quarrymen (67 cases, 39 controls; OR 1.92, 95% CI 1.21–3.05) and coal miners (442 cases, 297 controls; OR 1.40, 95% CI 1.18–1.67), but CI overlapped. We did not observe trends by duration of exposure or time since last exposure. Conclusions: This pooled analysis of population-based studies demonstrated an excess lung cancer risk among miners and quarrymen that remained increased after adjustment for detailed smoking history and working in other at-risk occupations. The increase in risk among coal miners were less pronounced than for ore miners or quarrymen.
Identifying potential exposure reduction priorities using regional rankings based on emissions of known and suspected carcinogens to outdoor air in Canada
(BioMed Central, 2015-08-22) Setton, Eleanor M.; Veerman, Basil; Erickson, Anders; Deschenes, Steeve; Cheasley, Roz; Poplawski, Karla; Demers, Paul A.; Keller, C. Peter
Background: Emissions inventories aid in understanding the sources of hazardous air pollutants and how these vary regionally, supporting targeted reduction actions. Integrating information on the relative toxicity of emitted pollutants with respect to cancer in humans helps to further refine reduction actions or recommendations, but few national programs exist in North America that use emissions estimates in this way. The CAREX Canada Emissions Mapping Project provides key regional indicators of emissions (total annual and total annual toxic equivalent, circa 2011) of 21 selected known and suspected carcinogens. Methods: The indicators were calculated from industrial emissions reported to the National Pollutant Release Inventory (NPRI) and estimates of emissions from transportation (airports, trains, and car and truck traffic) and residential heating (oil, gas and wood), in conjunction with human toxicity potential factors. We also include substance-specific annual emissions in toxic equivalent kilograms and annual emissions in kilograms, to allow for ranking substances within any region. Results: For provinces and territories in Canada, the indicators suggest the top five substances contributing to the total toxic equivalent emissions in any region could be prioritized for further investigation. Residents of Quebec and New Brunswick may be more at risk of exposure to industrial emissions than those in other regions, suggesting that a more detailed study of exposure to industrial emissions in these provinces is warranted. Residential wood smoke may be an important emission to control, particularly in the north and eastern regions of Canada. Residential oil and gas heating, along with rail emissions contribute little to regional emissions and therefore may not be an immediate regional priority. Conclusions: The developed indicators support the identification of pollutants and sources for additional investigation when planning exposure reduction actions among Canadian provinces and territories, but have important limitations similar to other emissions inventory-based tools. Additional research is required to evaluate how the Emissions Mapping Project is used by different groups and organizations with respect to informing actions aimed at reducing Canadians’ potential exposure to harmful air pollutants.
Differences in the carcinogenic evaluation of glyphosate between the International Agency for Research on Cancer (IARC) and the European Food Safety Authority (EFSA)
(BMJ Publishing Group, 2016-08) Portier, Christopher J.; Armstrong, Bruce K.; Baguley, Bruce C.; Baur, Xaver; Belyaev, Igor; Bellé, Robert; Belpoggi, Fiorella; Biggeri, Annibale; Bosland, Maarten C.; Bruzzi, Paolo; Budnik, Lygia Therese; Bugge, Merete D.; Burns, Kathleen; Calaf, Gloria M.; Carpenter, David O.; Carpenter, Hillary M.; López-Carrillo, Lizbeth; Clapp, Richard; Cocco, Pierluigi; Consonni, Dario; Comba, Pietro; Craft, Elena; Dalvie, Mohamed Aqiel; Davis, Devra; Demers, Paul A.; De Roos, Anneclaire J.; DeWitt, Jamie; Forastiere, Francesco; Freedman, Jonathan H.; Fritschi, Lin; Gaus, Caroline; Gohlke, Julia M.; Goldberg, Marcel; Greiser, Eberhard; Hansen, Johnni; Hardell, Lennart; Hauptmann, Michael; Huang, Wei; Huff, James; James, Margaret O.; Jameson, C. W.; Kortenkamp, Andreas; Kopp-Schneider, Annette; Kromhout, Hans; Larramendy, Marcelo L.; Landrigan, Philip J.; Lash, Lawrence H.; Leszczynski, Dariusz; Lynch, Charles F.; Magnani, Corrado; Mandrioli, Daniele; Martin, Francis L.; Merler, Enzo; Michelozzi, Paola; Miligi, Lucia; Miller, Anthony B.; Mirabelli, Dario; Mirer, Franklin E.; Naidoo, Saloshni; Perry, Melissa J; Petronio, Maria Grazia; Pirastu, Roberta; Portier, Ralph J.; Ramos, Kenneth S.; Robertson, Larry W.; Rodriguez, Theresa; Röösli, Martin; Ross, Matt K.; Roy, Deodutta; Rusyn, Ivan; Saldiva, Paulo; Sass, Jennifer; Savolainen, Kai; Scheepers, Paul T. J.; Sergi, Consolato; Silbergeld, Ellen K.; Smith, Martyn T.; Stewart, Bernard W.; Sutton, Patrice; Tateo, Fabio; Terracini, Benedetto; Thielmann, Heinz W.; Thomas, David B.; Vainio, Harri; Vena, John E.; Vineis, Paolo; Weiderpass, Elisabete; Weisenburger, Dennis D.; Woodruff, Tracey J.; Yorifuji, Takashi; Yu, Il Je; Zambon, Paola; Zeeb, Hajo; Zhou, Shu-Feng
The International Agency for Research on Cancer (IARC) Monographs Programme identifies chemicals, drugs, mixtures, occupational exposures, lifestyles and personal habits, and physical and biological agents that cause cancer in humans and has evaluated about 1000 agents since 1971. Monographs are written by ad hoc Working Groups (WGs) of international scientific experts over a period of about 12 months ending in an eight-day meeting. The WG evaluates all of the publicly available scientific information on each substance and, through a transparent and rigorous process,1 decides on the degree to which the scientific evidence supports that substance's potential to cause or not cause cancer in humans. For Monograph 112,2 17 expert scientists evaluated the carcinogenic hazard for four insecticides and the herbicide glyphosate.3 The WG concluded that the data for glyphosate meet the criteria for classification as a probable human carcinogen. The European Food Safety Authority (EFSA) is the primary agency of the European Union for risk assessments regarding food safety. In October 2015, EFSA reported4 on their evaluation of the Renewal Assessment Report5 (RAR) for glyphosate that was prepared by the Rapporteur Member State, the German Federal Institute for Risk Assessment (BfR). EFSA concluded that ‘glyphosate is unlikely to pose a carcinogenic hazard to humans and the evidence does not support classification with regard to its carcinogenic potential’. Addendum 1 (the BfR Addendum) of the RAR5 discusses the scientific rationale for differing from the IARC WG conclusion. Serious flaws in the scientific evaluation in the RAR incorrectly characterise the potential for a carcinogenic hazard from exposure to glyphosate. Since the RAR is the basis for the European Food Safety Agency (EFSA) conclusion,4 it is critical that these shortcomings are corrected.
CAREX Canada: an enhanced model for assessing occupational carcinogen exposure
(BMJ Publishing Group, 2015-01) Peters, Cheryl E.; Ge, Calvin B.; Hall, Amy L.; Davies, Hugh W.; Demers, Paul A.
Objectives: To estimate the numbers of workers exposed to known and suspected occupational carcinogens in Canada, building on the methods of CARcinogen EXposure (CAREX) projects in the European Union (EU). Methods: CAREX Canada consists of estimates of the prevalence and level of exposure to occupational carcinogens. CAREX Canada includes occupational agents evaluated by the International Agency for Research on Cancer as known, probable or possible human carcinogens that were present and feasible to assess in Canadian workplaces. A Canadian Workplace Exposure Database was established to identify the potential for exposure in particular industries and occupations, and to create exposure level estimates among priority agents, where possible. CAREX EU data were reviewed for relevance to the Canadian context and the proportion of workers likely to be exposed by industry and occupation in Canada was assigned using expert assessment and agreement by a minimum of two occupational hygienists. These proportions were used to generate prevalence estimates by linkage with the Census of Population for 2006, and these estimates are available by industry, occupation, sex and province. Results: CAREX Canada estimated the number of workers exposed to 44 known, probable and suspected carcinogens. Estimates of levels of exposure were further developed for 18 priority agents. Common exposures included night shift work (1.9 million exposed), solar ultraviolet radiation exposure (1.5 million exposed) and diesel engine exhaust (781 000 exposed). Conclusions: A substantial proportion of Canadian workers are exposed to known and suspected carcinogens at work.
IARC monographs: 40 years of evaluating carcinogenic hazards to humans
(National Institute of Environmental Health Sciences, 2015-06) Pearce, Neil; Blair, Aaron; Vineis, Paolo; Ahrens, Wolfgang; Andersen, Aage; Anto, Josep M.; Armstrong, Bruce K.; Baccarelli, Andrea A.; Beland, Frederick A.; Berrington, Amy; Bertazzi, Pier Alberto; Birnbaum, Linda S.; Brownson, Ross C.; Bucher, John R.; Cantor, Kenneth P.; Cardis, Elisabeth; Cherrie, John W.; Christiani, David C.; Cocco, Pierluigi; Coggon, David; Comba, Pietro; Demers, Paul A.; Dement, John M.; Douwes, Jeroen; Eisen, Ellen A.; Engel, Lawrence S.; Fenske, Richard A.; Fleming, Lora E.; Fletcher, Tony; Fontham, Elizabeth; Forastiere, Francesco; Frentzel-Beyme, Rainer; Fritschi, Lin; Gerin, Michel; Goldberg, Marcel; Grandjean, Philippe; Grimsrud, Tom K.; Gustavsson, Per; Haines, Andy; Hartge, Patricia; Hansen, Johnni; Hauptmann, Michael; Heederik, Dick; Hemminki, Kari; Hemon, Denis; Hertz-Picciotto, Irva; Hoppin, Jane A.; Huff, James; Jarvholm, Bengt; Kang, Daehee; Karagas, Margaret R.; Kjaerheim, Kristina; Kjuus, Helge; Kogevinas, Manolis; Kriebel, David; Kristensen, Petter; Kromhout, Hans; Laden, Francine; Lebailly, Pierre; LeMasters, Grace; Lubin, Jay H.; Lynch, Charles F.; Lynge, Elsebeth; 't Mannetje, Andrea; McMichael, Anthony J.; McLaughlin, John R.; Marrett, Loraine; Martuzzi, Marco; Merchant, James A.; Merler, Enzo; Merletti, Franco; Miller, Anthony; Mirer, Franklin E.; Monson, Richard; Nordby, Karl-Cristian; Olshan, Andrew F.; Parent, Marie-Elise; Perera, Frederica P.; Perry, Melissa J.; Pesatori, Angela Cecilia; Pirastu, Roberta; Porta, Miquel; Pukkala, Eero; Rice, Carol; Richardson, David B.; Ritter, Leonard; Ritz, Beate; Ronckers, Cecile M.; Rushton, Lesley; Rusiecki, Jennifer A.; Rusyn, Ivan; Samet, Jonathan M.; Sandler, Dale P.; de Sanjose, Silvia; Schernhammer, Eva; Costantini, Adele Seniori; Seixas, Noah; Shy, Carl; Siemiatycki, Jack; Silverman, Debra T.; Simonato, Lorenzo; Smith, Allan H.; Smith, Martyn T.; Spinelli, John J.; Spitz, Margaret R.; Stallones, Lorann; Stayner, Leslie T.; Steenland, Kyle; Stenzel, Mark; Stewart, Bernard W.; Stewart, Patricia A.; Symanski, Elaine; Terracini, Benedetto; Tolbert, Paige E.; Vainio, Harri; Vena, John; Vermeulen, Roel; Victora, Cesar G.; Ward, Elizabeth M.; Weinberg, Clarice R.; Weisenburger, Dennis; Wesseling, Catharina; Weiderpass, Elisabete; Zahm, Shelia Hoar
Background: Recently, the International Agency for Research on Cancer (IARC) Programme for the Evaluation of Carcinogenic Risks to Humans has been criticized for several of its evaluations, and also for the approach used to perform these evaluations. Some critics have claimed that failures of IARC Working Groups to recognize study weaknesses and biases of Working Group members have led to inappropriate classification of a number of agents as carcinogenic to humans. Objectives: The authors of this Commentary are scientists from various disciplines relevant to the identification and hazard evaluation of human carcinogens. We examined criticisms of the IARC classification process to determine the validity of these concerns. Here, we present the results of that examination, review the history of IARC evaluations, and describe how the IARC evaluations are performed. Discussion: We concluded that these recent criticisms are unconvincing. The procedures employed by IARC to assemble Working Groups of scientists from the various disciplines and the techniques followed to review the literature and perform hazard assessment of various agents provide a balanced evaluation and an appropriate indication of the weight of the evidence. Some disagreement by individual scientists to some evaluations is not evidence of process failure. The review process has been modified over time and will undoubtedly be altered in the future to improve the process. Any process can in theory be improved, and we would support continued review and improvement of the IARC processes. This does not mean, however, that the current procedures are flawed. Conclusions: The IARC Monographs have made, and continue to make, major contributions to the scientific underpinning for societal actions to improve the public’s health.
Health-related interventions among night shift workers: a critical review of the literature
(Nordic Association of Occupational Safety and Health, 2014-11) Neil-Sztramko, Sarah E.; Pahwa, Manisha; Demers, Paul A.; Gotay, Carolyn C.
Objectives: Associations between shift work and chronic disease have been observed, but relatively little is known about how to mitigate these adverse health effects. This critical review aimed to (i) synthesize interventions that have been implemented among shift workers to reduce the chronic health effects of shift work and (ii) provide an overall evaluation of study quality. Methods: MeSH terms and keywords were created and used to conduct a rigorous search of MEDLINE, CINAHL, and EMBASE for studies published on or before 13 August 2012. Study quality was assessed using a checklist adapted from Downs & Black. Results: Of the 5053 articles retrieved, 44 met the inclusion and exclusion criteria. Over 2354 male and female rotating and permanent night shift workers were included, mostly from the manufacturing, healthcare, and public safety industries. Studies were grouped into four intervention types: (i) shift schedule; (ii) controlled light exposure; (iii) behavioral; and, (iv) pharmacological. Results generally support the benefits of fast-forward rotating shifts; simultaneous use of timed bright light and light-blocking glasses; and physical activity, healthy diet, and health promotion. Mixed results were observed for hypnotics. Study quality varied and numerous deficiencies were identified. Conclusions: Except for hypnotics, several types of interventions reviewed had positive overall effects on chronic disease outcomes. There was substantial heterogeneity among studies with respect to study sample, interventions, and outcomes. There is a need for further high-quality, workplace-based prevention research conducted among shift workers.

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