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Health and Safety Executive

The burden of occupational cancer in Great Britain Technical Annex 2: Sinonasal cancer

Prepared by Imperial College London and the Health and Safety Laboratory for the Health and Safety Executive 2007

RR595 Technical Annex 2



Lesley Rushton & Sally Hutchings Imperial College London Department of Epidemiology and Public Health Faculty of Medicine St Mary’s Campus Norfolk Place London W2 1PG

Terry Brown Health and Safety Laboratory Harpur Hill Buxton SK17 9JN

The aim of this project was to produce an updated estimate of the current burden of occupational cancer specifically for Great Britain. The primary 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 on the risk of the disease due to the exposures of interest, taking into account confounding factors and overlapping exposures, were combined with data on the proportion of the target population exposed over the period in which relevant exposure occurred. Estimation was carried out for carcinogenic agents or exposure circumstances that were classified by the International Agency for Research on Cancer (IARC) as Group 1 or 2A carcinogens with strong or suggestive human evidence. Estimation was carried out for 2004 for mortality and 2003 for cancer incidence for cancer of the bladder, leukaemia, cancer of the lung, mesothelioma, nonmelanoma skin cancer (NMSC), and sinonasal cancer.

The proportion of cancer deaths in 2004 attributable to occupation was estimated to be 8.0% in men and 1.5% in women with an overall estimate of 4.9% for men plus women. Estimated numbers of deaths attributable to occupation were 6,259 for men and 1,058 for women giving a total of 7,317. The total number of cancer registrations in 2003 attributable to occupational causes was 13,338 for men plus women. Asbestos contributed the largest numbers of deaths and registrations (mesothelioma and lung cancer), followed by mineral oils (mainly NMSC), solar radiation (NMSC), silica (lung cancer) and diesel engine exhaust (lung and bladder cancer). Large numbers of workers were potentially exposed to several carcinogenic agents over the risk exposure periods, particularly in the construction industry, as farmers or as other agricultural workers, and as workers in manufacture of machinery and other equipment, manufacture of wood products, land transport, metal working, painting, welding and textiles. There are several sources of uncertainty in the estimates, including exclusion of other potential carcinogenic agents, potentially inaccurate or approximate data and methodological issues. On balance, the estimates are likely to be a conservative estimate of the true risk. Future work will address estimation for the remaining cancers that have yet to be examined, together with development of methodology for predicting future estimates of the occupational cancers due to more recent exposures.

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 2007

First published 2007

All rights reserved. No part of this publication may bereproduced, stored in a retrieval system, or transmitted inany form or by any means (electronic, mechanical,photocopying, recording or otherwise) without the priorwritten permission of the copyright owner.

Applications for reproduction should be made in writing to:Licensing Division, Her Majesty’s Stationery Office,St Clements House, 216 Colegate, Norwich NR3 1BQor by email to hmsolicensing@cabinetoffice.x.gsi.gov.uk

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ACKNOWLEDGEMENTS

Funding was obtained from the Health and Safety Executive (HSE) and managed through the Health and Safety Laboratory. We would like to thank Damien McElvenny for initiating the project and Gareth Evans for his management role. Andy Darnton from the HSE was responsible for the work on mesothelioma. The contributions to the project and advice received from many other HSE and HSL 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.

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CONTENTS

Acknowledgements iii

1. Incidence and Trends 1

2. Overview of Aetiology 3

3. Attributable Fraction Estimation 93.1 General Considerations 93.2 Wood dust 113.3 Formaldehyde 133.4 Boot and Shoe Manufacture and Repair (leather dust) 183.5 Nickel 193.6 Chromium 223.7 Polycyclic aromatic hydrocarbons 243.8 Textile dust 263.9 Mineral oils 27

4. Overall attributable fraction 314.1 Comparison of exposure AFs 314.2 Exposure map 324.3 Overall AF 334.4 Summary of results 354.5 Exposures by industry/job 364.6 High versus low exposures 374.7 Discussion 38

5. References 41

6. Annex 1 46

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1. INCIDENCE AND TRENDS

Cancer of the nose and paranasal sinuses (sinonasal cancer, SNC) (ICD-10 C30/C31; ICD-9 160) is a disease with a racial and geographical distribution. In most parts of the world it is a rare condition but in certain ethnic groups (Southern Chinese, Eskimos and other Arctic natives, inhabitants of South-East Asia) and also the populations of North Africa and Kuwait, this low risk profile alters (IARC, 2002). In the UK about 300 cases are diagnosed each year (Office of National Statistics -ONS MB1 Series1) (Table 1), and fewer than 150 people die from the condition (ONS DH2 Series2) (Table 2). Long-term trends in the incidence of SNC were studied on the basis of notifications of cancer cases in England and Wales over the past 10 years. A total of 2,934 cases of SNC were reported between 1994-2002, giving steady annual incidences of around 0.8 per 100,000 males and 0.5 per 100,000 females. These contrast with the simultaneous increases in risk for cancers of the middle and lower respiratory tract, and indicate that cigarette smoking does not play any significant role in the aetiology of SNC. Since this tumour type has few non-occupational aetiologies, the stable time trends observed indicate that all the major risk factors have been present in work places in a relatively unchanged form for more than ten years. It should be noted however that recent disease rates may relate to quite distant past exposures due to the long latency periods possible for sinonasal cancer.

The five-year relative survival rate for SNC is about 50% (Roush, 1996), but this varies according to the stage and histological type. Patients with well-differentiated squamous cell carcinoma (SCC) had a significantly higher five-year survival rate than patients with poorly differentiated carcinomas (Jakobsen et al., 1997). Cancer mortality to incidence ratios for cancer of the nasal cavity and middle ear (C30) are 0.15 for men and 0.25 for women (ONS, 2005). For cancer of the accessory sinus (C31) the ratio is 0.77 for men and 0.66 for women.

About 60% of sinonasal cancers are squamous cell carcinomas, and adenocarcinomas (ACs) account for 1-2% of sinonasal cancers (Cancer Research UK3).

Table 1: Number of sinonasal cancer registrations in England 1994-2003

Men Women

Year Total Registrations %Total Crude Total Registrations %Total Crude Registrations Rate Registrations Rate

/100,000 /100,000

1994 112145 199 0.18 0.8 112175 143 0.13 0.5

1995 103986 185 0.18 0.8 105151 116 0.11 0.4

1996 104103 188 0.18 0.8 105461 139 0.13 0.6

1997 104335 194 0.19 0.8 107289 133 0.12 0.5

1998 106745 190 0.18 0.8 109957 135 0.12 0.5 1999 108827 181 0.17 0.8 112237 150 0.13 0.6

2000 111543 199 0.18 0.8 112066 153 0.14 0.6

2001 112516 190 0.17 0.8 112134 142 0.13 0.5

2002 112579 179 0.16 0.7 111210 118 0.11 0.5

2003 112732 191 0.17 0.7 114740 143 0.12 0.5 Average 108951 190 0.18 0.78 110242 137 0.12 0.52

http://www.statistics.gov.uk/StatBase/Product.asp?vlnk=8843&Pos=&ColRank=1&Rank=240 2 http://www.statistics.gov.uk/StatBase/Product.asp?vlnk=618 3. http://www.cancerhelp.org.uk/help/default.asp?page=13799

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Table 2: Number of sinonasal cancer deaths in England and Wales 1999-2004.

Men Women

Year Total Deaths

Deaths %Total Crude Rate /100,000

Total Deaths

Deaths %Total Crude Rate /100,000

1999 264299 60 0.02 0.23 291819 34 0.01 0.13

2000 255347 74 0.03 0.28 280117 43 0.02 0.16 2001 252426 68 0.03 0.27 277947 66 0.02 0.25

2002 253144 69 0.03 0.27 280383 44 0.02 0.16

2003 253852 77 0.03 0.30 284402 57 0.02 0.21

2004 244130 63 0.03 0.24 268411 53 0.02 0.20

Average 253866 69 0.03 0.27 280513 50 0.02 0.18

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2. OVERVIEW OF AETIOLOGY

The low absolute risk in the general population has been accompanied by high relative risks for specific chemical exposures and occupational settings, such as nickel refining and woodworking. For these reasons SNC has been designated a ‘sentinel cancer’ that may permit the identification of environmental cancer risk factors (Olsen, 1988; Rutstein et al., 1984).

The Occupational Health Decennial Supplement (Drever, 1995) observed that the risk was greater in the furniture and cabinet making industry, which was reflected by the elevated proportional registration rates (PRRs) and proportional mortality ratios (PMRs) in job groups related to the industry (Table 3). Dust from vegetable-tanned leather has also been shown to cause these cancers and again PRR and PMR were elevated in leather and shoe workers. Other exposures that have been shown to be associated include chromium, nickel, welding, flame cutting and soldering, and lacquers and paints (Hernberg et al., 1983a; Hernberg et al., 1983b).

Table 3: Job codes with significantly high PRRs and PMRs for cancer of the nose and nasal cavities. Men and women aged 20-74 years, England, 1981-87.

Job group

PRR 95%CI PMR 95%CI Observed

SIC code Description Registrations Deaths

Men

068 Leather and shoe workers

257 103-530 - 7

104 Carpenters 138 83-216 - 19 105 Cabinet makers 803 367-1525 568 245-1119 9 8 106 Case and box

makers 554 67-2001 - 2

108 Woodworking machinists

710 341-1307 386 167-761 10 8

109 Other woodworkers 676 220-1580 330 40-1192 5 2 124 Machine tool

operators 146 101-204 - 34

164 Packers and sorters 312 115-681 - 6

Women

060 Other service personnel

153 103-220 - 29

Source: Drever et al. (1995) Occupational Health Decennial Supplement

IARC have assessed the carcinogenicity of a number of chemicals; and those classified as causing SNC or possibly causing SNC are given in Table 4. Other exposures and industries/occupations thought not be associated with an increased risk of SNC include polycyclic aromatic hydrocarbons and the textile manufacturing industry.

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Table 4: Occupational agents, groups of agents, mixtures, and exposure circumstances classified by the IARC Monographs, Vols 1-77 (IARC, 1972-2001), into Groups 1 and 2A, which have the nasal cavity and parasinuses as the target organ.

Agents, Mixture, Circumstance Main industry, Use Evidence of carcinogenicity

in humans

Strength of

evidence

Other target organs

Group 1: Carcinogenic to Humans

Agents, groups of agents

Wood dust Logging & sawmill workers; Sufficient Strong Nasopharyngeal pulp & paper & paperboard industry; woodworking trades (e.g. furniture industries, cabinetmaking, carpentry & construction); used as filler in plastic and linoleum production

Chromium VI Chromate production plants dyes Sufficient Suggestive Lung & pigments; plating and engraving; chromium ferro-alloy production; stainless-steel welding; in wood preservatives; leather tanning; water treatment; inks; photography; lithography; drilling muds; synthetic perfumes; pyrotechnics; corrosion resistance

Nickel compounds Nickel refining and smelting; welding

Sufficient Strong Lung

Mineral oils Production; used as lubricant by Sufficient Suggestive Skin metal workers, machinists, Bladder engineers; printing industry (ink Lung formulation); used in cosmetics, medicinal and pharmaceutical preparations

Exposure circumstances

Boot & shoe manufacture & repair Leather dust; benzene & other Sufficient Strong Bladder solvents Leukaemia

Lung Furniture & cabinet-making Wood dust Sufficient Strong Isopropanol manufacture, strong acid Diisopropyl sulphate; isopropyl Sufficient Strong Larynx process oils; sulphuric acid Lung

Group 2A: Probably Carcinogenic to Humans

Agents & groups of agents

Formaldehyde Production; pathologists; medical Limited Suggestive Nasopharyngeal laboratory technicians; plastics; cancer (NPC) textile industry Leukaemia

Group 2B: Possibly Carcinogenic to Humans


Textile manufacturing industry Textile dust in manufacturing process; dyes and solvents in dyeing and printing operations

Exposures

Wood Dust

Occupational exposure to fine particulate wood dust is a well-known cause of SNC, and has been classified as carcinogenic to humans by the IARC (IARC, 1995). The evidence seems to be strongest

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for exposure to hardwood dust and adenocarcinoma of the nose and sinuses; and fine particulate dust generated by sanding seems to be more carcinogenic than coarse dust generated by sawing. Tobacco smoking and other life-style factors seem to play a minor role, if any, in the aetiology of SNC (Roush, 1996).

SNC has been associated with woodworking in many countries, including England (Acheson, 1976; Acheson et al., 1972; Acheson et al., 1981; Acheson et al., 1982b; Rang & Acheson, 1981), France (Luce et al., 1992), Denmark (Hernberg et al., 1983b; Olsen, 1988), Sweden (Hardell et al., 1982; Hernberg et al., 1983b), Finland (Hernberg et al., 1983b), the Netherlands (Hayes et al., 1986), Italy (Comba et al., 1992a; Comba et al., 1992b; Merler et al., 1986), the USA (Brinton et al., 1984; Robinson et al., 1996; Vaughan & Davis, 1991; Vaughan et al., 2000), Canada (Elwood, 1981) and Australia (Ironside & Matthews, 1975). The mean latent period (time of first exposure to time of cancer incidence) has been estimated to be 43 years (range 27-69) (Roush, 1996), and following termination of exposure the risk of SNC may persist for many years.

The highest exposures have generally been reported in wood furniture and cabinet manufacture, especially during machine sanding and similar operations (with wood dust levels frequently above 5mg/m3). IARC have classified this occupation as a Group 1 carcinogen to humans (IARC, 1987b). Exposure levels above 1mg/m3 have also been measured in the finishing departments of plywood and particleboard mills, where wood is sawn and sanded, and in the workroom air of sawmills and planer mills near chippers, saws and planers. Exposure also occurs among workers in joinery shops, window and door manufacture, wooden boat manufacture, installation and refinishing of wood floors, pattern and model making, pulp and paper manufacture, construction carpentry and logging. However, the latter occupations are not classified as carcinogenic to humans. Measurements are generally available only since the 1970s, and exposures may have been higher in the past because of less efficient (or non-existent) local exhaust ventilation and other measures to control dust.

In the industry, an occupational exposure level (OEL) of 5mg/m3 for total inhalable hardwood dust came into effect in April 1988, which was replaced by a MEL of the same value when CoSHH regulations came into force in October 1989. A MEL of the same value was introduced in January 1997 for softwood.

A recent study, using data stored in the National Exposure Database (NEDB), investigating trends in inhalation exposure of wood dust showed that levels had declined by 8.1% per year, after taking into account the effect of the data source (inspection visit or representation survey) (Creely et al., 2006). The trend was fairly constant across industry sectors (manufacture of furniture and manufacture of wood products, not furniture) and occupations (carpenters, wood machinists, sanders/polishers). These reductions were said to have been brought about by significant changes in equipment and production methods, lower production rates and modification/upgrading capabilities of dust control and extraction equipment. Although this analysis showed a decrease in levels, a survey carried out in 2000 by the HSE noted that wood dust exposure in nearly 30% of 47 small businesses surveyed was in excess of the 5mg/m3 maximum exposure level (MEL), and a written CoSHH assessment was available at only 34% of sites visited (Dilworth, 2000). Circular sawing and sanding were identified as processes giving rise to particularly high exposures. About 5% of samples exceeded the MEL by five times, but no site- or process-specific factors could be identified that could have led to these levels of exposure. Comparison with a similar survey in 1988/9 (HSE, 1990) showed the number of samples exceeding the MEL had been reduced significantly from 40.5% to 27.2%. Similarly, in 1988/9 only 12.2% of sites controlled all exposures to wood dust to below the MEL, whereas in 1999/2000 this figure had increased almost threefold to 34.0%. Nevertheless, the number of premises with at least one exposure in excess of 5mg/m3 MEL was similar.

In the industry, an OEL of 5mg/m3 for total inhalable hardwood dust came into effect in April 1988, which was replaced by a MEL of the same value when COSHH Regulations came into force in October 1989. A MEL of the same value was introduced in January 1997 for softwood.

Within the industries above, exposure to solvents and formaldehyde in glues and surface coatings, phenol, wood preservatives, engine exhausts and fungal spores may occur. According to Acheson et

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al. (1982b), the fact that woodworking machinists (who saw timber) and chain makers (who shape, finish, sand and assemble furniture) experience similar risks makes it unlikely that the tumours are due to a chemical agent applied to the wood at a particular stage of the process, but that they are more probably due to a substance in wood itself.

According to CAREX there were about 430,000 people exposed to wood dust in various industries in Great Britain (GB) in 1990-93, and Section 3.2 gives a break down of these numbers.

Formaldehyde

Formaldehyde is used mainly in the production of phenolics, urea, melamine and polyacetal resins. These have wide uses as adhesives and binders for the wood products, pulp and paper, and synthetic vitreous fibre industries and in the production of plastics and coatings and in textile finishing. It is also used extensively as an intermediate in the manufacture of industrial chemicals, and directly in aqueous solution (formalin) as a disinfectant and preservative in many applications. Occupational exposure occurs in a wide range of occupations and industries, the highest being observed during the varnishing of furniture and wooden floors, in the finishing of textiles, the garment industry, the treatment of fur and in certain jobs within manufactured board mills and foundries. Short-term high exposures have been reported for embalmers, pathologists and paper workers.

Formaldehyde produces SNC in rats exposed to formaldehyde vapour (Albert et al., 1982). The widespread ambient exposures (e.g. via particleboard, MDF and insulation) have led to substantial interest in risk assessment (Acheson, 1985). Studies have suggested associations most commonly with nasopharyngeal cancer rather than SNC (Blair et al., 1987; Blair et al., 1986; Vaughan et al., 1986a; Vaughan et al., 1986b). Exposure to formaldehyde appears to be an independent risk factor for AC of the nasal cavity and sinuses (Luce et al., 1993); and a pooled analysis (Luce et al., 2002) showed an increased risk of AC in men and women thought never to have been exposed to wood dust or leather dust, with an exposure-response trend for an index of cumulative exposure. Two other studies have shown an increased risk (Hansen & Olsen, 1995; Olsen & Asnaes, 1986), whilst larger studies have shown no excesses (Coggon et al., 2003; Hauptmann et al., 2004; Pinkerton et al., 2004). A recent review of the evidence by an IARC working group concluded there is limited evidence that formaldehyde causes SNC in humans (IARC, 2005).

CAREX estimated about 94,000 workers exposed to formaldehyde in GB between 1990 and 1993. Section 3.3 shows the numbers of workers exposed to formaldehyde in the various industries.

Boot and Shoe Manufacture and Repair

In 1980, and again in 1987, IARC concluded that there is an excess risk of cancer among people employed in the boot and shoe manufacturing and repair industry (IARC, 1981; IARC, 1987a). The strongest evidence cited was for excess risks for SNC and leukaemia. Some of the exposures found in these industries (e.g. formaldehyde and tannin) may overlap with those found in woodworking, and it is interesting that the ACs appear to be more strongly related to this type of exposure. Relative risks well in excess of ten-fold have been reported from studies in England and Italy (Acheson et al., 1982a; Merler et al., 1986). People who worked in the dustiest operations were found to be at the greatest risk suggesting a role for exposure to leather dust. A further study of over 500 men in three UK towns showed a significant risk to those in the dustiest operations within the industry (Pippard & Acheson, 1985). However, other PMR and cohort studies have shown no excess of nasal cancer (Decoufle & Walrath, 1983; Garabrant & Wegman, 1984; Paci et al., 1989; Walker et al., 1993; Walrath et al., 1987). Section 3.4 gives numbers of workers within the industry and those possibly exposed to leather dust.

Nickel

Nickel has many uses in industry because of its unique properties. The majority of all nickel is used in alloys, because it imparts such properties as corrosion resistance, heat resistance, hardness, and strength. The main uses are in the production of stainless steel, copper-nickel alloys, and other corrosion-resistant alloys. Pure nickel is used in electroplating, as a chemical catalyst, and in the

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manufacture of alkaline batteries, coins, welding products, magnets, electrical contacts and electrodes, spark plugs, machinery parts, and surgical and dental prostheses. According to CAREX, approximately 85,000 workers are exposed to nickel compounds and Section 3.5 indicates the industries where workers are exposed. Exposure by inhalation, ingestion and skin contact occur via airborne fumes, dusts and mists in nickel and nickel alloy production plants as well as in welding, electroplating, grinding and cutting operations.

Early studies of industrial cohorts suggested that the risk of SNC associated with nickel exposure arose in the course of the nickel refining process (Brinton et al., 1984; Hernberg et al., 1983b; Roush et al., 1980). This has been attributed to exposure to a mixture of oxides and sulphides of nickel, although increased risk has also been found with exposure to oxides of nickel in the absence of sulphides. Most of the observations of elevated risk appear to be in workers exposed to high levels of soluble nickel compounds through processes that have not been used in GB for many years. For example, in the study of the Clydach refinery in South Wales the evidence for an excess risk is weak in refiners first employed after 1950 (based on one case), when the refinery process was modified improving work conditions and reducing occupational dust exposures (Grimsrud & Peto, 2006; Sorahan & Williams, 2005). The MEL for soluble nickel salts is 0.1mg/m3 (as Ni; 8-hr time weighted average (TWA)); for insoluble salts the limit was 3mg/m3 (as Ni; 8-hr TWA), which was reduced to 0.5mg/m3 (as Ni; 8-hr TWA) in 1992. For metallic nickel a limit of 1mg/m3 (as Ni; 8-hr TWA) was set in 1984, which was subsequently reduced to 0.5mg/m3 (as Ni; 8-hr TWA) in 1992.

Chromium

Chromium VI (CrVI) has been widespread in commercial use for over 100 years because of its property as a corrosion inhibitor. Early uses included chrome pigments and tanning liquors. More recently it has been widely used in chromium alloys and chrome plating. The steel industry is the major consumer of chromium. Of the occupational situations in which exposure to chromium occurs, highest exposures to chromium VI may occur during chromate production, welding, chrome pigment manufacture, chrome plating and spray painting; highest exposures to other forms of chromium occur during mining, ferrochromium and steel production, welding and cutting and grinding of chromium alloys. A MEL for all CrVI compounds of 0.05mg/m3 (8-hr TWA) was established in 1992. Section 3.6 shows that approximately 130,000 workers were exposed to the metal in 1990-1993 and gives a breakdown of the numbers by industry.

IARC classified CrVI compounds as a Group 1 carcinogen in 1990 (IARC, 1990a). Only inhalation is considered a concern for occupational exposure, thus the lung is the major site of concern. SNC has been associated with hexavalent chromate in primary studies of chromate production workers in Japan, the UK and the USA, of chromate pigment production workers in Norway and of chromium platers in the UK, although in the latter study the observed excess of SNCs was not considered to be due to chromium exposure.

Mineral Oils

Mineral oils are primarily used as lubricant base oils to produce further refined oil products, which are used in manufacturing, mining, construction and other industries. A single US case-control study using the Connecticut Tumour Registry supports an association between SNC and work entailing machining fluid exposure (Roush et al., 1980). However, in subsequent reviews of occupational exposure to metalworking fluids SNC was not considered (Calvert et al., 1998; Mirer, 2003; NIOSH, 1998)

Polycyclic Aromatic Hydrocarbons

Polycyclic aromatic hydrocarbons (PAHs) are a group of over 100 different chemicals that are formed during the incomplete burning of coal, oil and gas, garbage, or other organic substances like tobacco or charbroiled meat. PAHs are usually found as a mixture containing two or more of these compounds, such as soot. Some PAHs are manufactured, and these pure compounds usually exist as colourless, white, or pale yellow-green solids. PAHs are found in coal tar, crude oil, creosote, and roofing tar, but

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a few are used in medicines or to make dyes, plastics, and pesticides. They are common to three occupational processes associated with SNC:

• Petroleum production (Blot et al., 1977);

• Furnace oven workers and coke production (Acheson et al., 1981; Bruusgaard, 1959); and

• Mineral oil in metal-cutting operations (Roush et al., 1980; Roush et al., 1982); however, risks appear to have been reduced (Roush et al., 1980).

CAREX estimated approximately 106,000 workers were exposed to PAHs in GB between 1990 and 1993 (see Section 3.7). However, the problem with PAHs is non-occupational exposure from the various sources above.

Textile dust

The textiles and clothing industries employ around 189,000 staff in the UK across 10,700 businesses, but increasingly these are small businesses. Textile workers are exposed to textile-related dusts throughout the manufacturing process. During spinning, weaving and knitting operations, exposure to chemicals is generally limited. In dyeing and printing operations, workers are frequently exposed to dyes, optical brighteners, organic solvents and fixatives. Workers in finishing operations are exposed to crease-resistance agents (many of which release formaldehyde), flame-retardants and antimicrobial agents. In dyeing, printing and finishing processes, workers typically have multiple exposures that can vary with time and process.

Several studies have shown an association between textile work and SNC (Acheson et al., 1972; Acheson et al., 1981; Bimbi et al., 1988; Brinton et al., 1985; Comba et al., 1992a; Comba et al., 1992b; Malker et al., 1986; Ng, 1986; Olsen, 1988). Exposure to textile dust was considered a plausible agent, although a possible association with cotton dust was suggested (Acheson et al., 1972; Brinton et al., 1985). IARC (IARC, 1990b) concluded there is limited evidence that working in the textile manufacturing industry entails a carcinogenic risk, and that any risk is due to exposure to dusts from fibres and yarns.

No data exist in CAREX on the number of workers exposed to textile dust, but Section 3.8 gives numbers in employment from the Labour Force Survey (LFS).

Other Exposures

Radiation exposure has been associated with SNC in radium dial painters (Aub et al., 1952; Brues & Kirsh, 1977; Polednak et al., 1978; Rowland, 1975). However, this occupation does not exist anymore and therefore poses no problem.

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3. ATTRIBUTABLE FRACTION ESTIMATION

3.1 General Considerations

Substances and Occupations

The substances considered in the estimation of the attributable fraction (AF) for sinonasal cancer are those outlined in Table 5.

Exposures assigned to the established group for the calculation of overall AF are in IARC group 1 with ‘strong’ evidence of an association with sinonasal cancer (as used by Siemiatycki et al., (2004)). Exposures in the uncertain group are IARC group 1 or 2A (or 2B in the case of textile dust) with ‘suggestive’ evidence of an association with SNC.

Table 5: Substances considered in the estimation of the attributable fraction for nasal cancer

Agents, Mixture, AF Comments Strength Established (E) Circumstance calculation of or Uncertain (U)

evidence

Group 1: Carcinogenic to Humans

Agents, groups of agents

Wood dust Y Strong Established Chromium VI Y Processed changed in the UK in 1958- Suggestive Uncertain

60, so included for pre-1960 exposures only

Nickel compounds Y Strong Established Mineral oils Y Suggestive Uncertain


Boot & shoe manufacture & repair

Considered as leather dust Strong Established

Furniture & cabinet- Considered under wood dust Strong making Isopropanol manufacture N No data Strong Established

Group 2A: Probably Carcinogenic to Humans

Agents & groups of agents

Formaldehyde Y Suggestive Uncertain

PAHs N Not on Siemiatycki’s list for nasal cancer. Awaiting cancer site information from IARCs recent

Suggestive Uncertain

evaluation


Textile manufacturing industry (IARC 2B)

Y Suggestive Uncertain

Latency

A latency of a maximum of 50 years has been assumed for SNC, with a minimum of 10 years.

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Relevant Exposure Period

For estimation of the cancer burden for 2004, the target relevant exposure period (REP) thus extends back to 1955, i.e. exposures in the period 1955 to 1994 are relevant.

Data relevant to the calculation of AF

The two data elements required are an estimate of relative risk (RR), and either (1) an estimate of the proportion of the population exposed (Pr(E)) from independent data for GB, or (2) an estimate of the proportion of cases exposed (Pr(E|D)) from population based study data.

The RR chosen from a ‘best study’ source is described for each exposure, with justification of its suitability.

In the absence of more precise knowledge of cancer latency, it is assumed that exposure at any time between 1955 and 1994 can result in a cancer being recorded in 2004 as a registration or underlying cause of death. For an independent estimate of the proportion of the population exposed, numbers of workers ever exposed during this period were counted using a point estimate of exposed workers taken from the period. If this were from CAREX relating to 1990-93, an adjustment was made to take account of gross changes in employment levels which occurred particularly in manufacturing industry and the service sector across the REP. Otherwise a point estimate that represented numbers employed as close as possible to about 35 years before the target year of 2004 was used, as this is thought to represent a ‘peak’ latency for the solid tumours, and was 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 is implicitly assumed). Where the Census of Employment (CoE) was used, the data was for 1971. Where the LFS was used, the first year available was 1979. A turnover factor was applied to estimate numbers ever exposed during the REP, determined mainly by the estimate of staff turnover per year during the period. For each exposure therefore, if an AF had been based on independent estimates of numbers exposed, the table of results included the point estimate of numbers employed, the adjustment factor for CAREX if applicable, the staff turnover estimate, and the resulting estimate of numbers ever exposed during the REP. Other estimates used in the calculations that remained constant across exposures are given below:

(1) Number of years in REP = 40. (2) Proportion in the workplace ever exposed was set to one, i.e. all were assumed to be exposed,

in the absence of more detailed information. Where sources other than CAREX were used for the point estimate of numbers exposed, such as the LFS or CoE, a precise as possible definition of workers exposed was sought.

(3) The numbers ‘ever’ of working age during the target REP = 19.2 million men and 20.9 million women. This was the denominator for the proportion of the population exposed, and was based on population estimates by age cohort in the target year.

(4) Total deaths from sinonasal cancer in GB for 2004 = 70 for men, 59 for women. (5) Total registrations for sinonasal cancer in GB for 2003 = 218 for men, 167 for women. 2003

was the most recent year for which data was available.

Where data on worker numbers was only available for men and women combined (CAREX data), the percentage of men that had been assumed was included in the tables of numbers exposed for each exposure. The allocation to high and low, and occasionally negligible, exposure level categories, or division into separate exposure scenarios, was also included in these tables.

For an AF calculated using an internal study-based estimate of the numbers exposed, the table of results includes the proportion of the population exposed as estimated from the study controls. This was done for comparison with any independent data estimated for the target REP. The table also includes the numbers of exposed, the total cases, and the proportion of cases exposed from which the AF was calculated. Further comments in the text cover the issues of portability of the ‘study based’ estimates to the GB situation.

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Full details of the derivation of the above factors and the methods of calculating AF are published separately (Estimation of the Burden of Cancer in Great Britain due to Occupation – Technical Report: Methodology). Unless otherwise stated, Levin’s formula is used for estimates using independent estimates of numbers exposed, and Miettinen’s formula is used for study based estimates.

Alternative estimates of AF

Relative risks drawn from industry based cohorts were normally matched to independent Pr(E) estimates, and relative risks from population-based case control studies were normally matched with their own study based estimates of Pr(E|D). However departures from this expectation were acceptable.

Where ‘best study’ sources were available to estimate AF using both and mixed approaches, alternative estimates were presented. A judgement was be made as to which method was preferred for each exposure, and which result will therefore be included in the combined AF for the cancer being examined. However, there was known to be a great deal of uncertainty surrounding these calculations, over and above that reflected in the ‘traditional’ random error only confidence intervals presented for each AF. A full sensitivity analysis and methodology for estimating confidence limits that incorporate this additional uncertainty – ‘credibility limits’ – and examples of their use will be published elsewhere. Offering alternative estimates at this stage serves to illustrate the likely extent of this uncertainty.

3.2 Wood dust

(a) Risk estimate: An excess nasal cancer risk was demonstrated over 30 years ago amongst woodworkers in the furniture industry in England and other countries (Acheson, 1976; Acheson et al., 1968; Acheson et al., 1972; Macbeth, 1965). A study of furniture workers between 1954-1968 observed standard rate ratios (SRRs) in excess of 1,000 (Rang & Acheson, 1981). Since then a number of other studies of wood-related industries have been undertaken and in 1995 two pooled analyses were published by IARC. The first was of five cohorts, results of which were published between 1984 and 1994 (Demers et al., 1995a). This analysis obtained an overall summary standard mortality rate (SMR) of 3.1 (95% CI 1.6-5.6) for SNC, for woodworkers in all industries. However, all deaths occurred amongst furniture workers (SMR = 4.3, 95% CI – 2.2-7.8). There was also a positive dose-response relationship:

• Possible exposure SMR = 0.8, 95% CI 0.0-4.6

• Probable exposure SMR = 1.2, 95% CI 0.0-6.5

• Definite exposure SMR = 8.4, 95% CI 3.9-16.0

The second was an analysis of 12 case-control studies, published between 1982 and 1993 (Demers et al., 1995b). The relative risk for all men in any wood-related job was 2.0 (95%CI 1.6-2.5); for women it was 1.6 (95% CI 0.9-2.8). The RR for workers in sawmills, furniture, carpentry and other wood products was 2.5, 4.5, 2.9 and 2.8, respectively. Again a dose-response relationship was observed (Low <1 mg/m3 8hr TWA, RR=0.8 (95% CI 0.4-1.5); Moderate 1-5 mg/m3, RR=1.2 (0.9-1.6); High >5 mg/m3, RR=5.8 (4.2-8.0) for men,). The low, moderate and high RRs for men and for women were used in the present study for the AF calculation using Levin’s formula and CAREX exposed numbers for the proportion of the population exposed (Pr(E)). The low RR estimate for men, however, is set to 1 in this calculation (as a negative AF, implying a ‘protective’ effect of low level wood dust exposure is not realistic). The RRs used for women were: low 1.6 (95% CI 0.6-4.7); moderate 2.0 (95% CI 0.5-7.8); high 1.0 (95% CI 0.2-4.0). The RRs for any ‘wood-related’ job were used for an alternative calculation of AF using Miettinen’s formula, with a study-based estimate of the proportion of cases exposed (Pr(E|D)).

(b) Numbers exposed: The number of workers exposed to wood in various industries according to CAREX for 1990-93 are given in Table 6. Exposure in construction was allocated to the ‘higher’ category, as it was assumed that these were all carpenters/joiners. In order to split the CAREX exposed numbers between men and women, it was assumed that all occupations were in skilled trades,

11

shop floor and transport operatives (SOC major groups 5, 8 and 9). These data were used to estimate Pr(E) for Levin’s calculation of AF.

Table 6: Numbers of workers exposed to wood dust according to CAREX in 1990-1993.

Industry CAREX Data 1990-1993

Number Number in Exposure Exposed Industry Level

Forestry and logging 10,887 14,500 M Crude petroleum and natural gas production 68 53,300 L Food manufacturing 412 414,150 L Beverage industries 9 88,100 L Tobacco manufacture 7 9,950 L Manufacture of textiles 58 182,000 L Manufacture of wearing apparel, except footwear 50 189,500 L Manufacture of leather and products of leather or of its substitutes 32 16,825 L Manufacture of footwear 11 38,500 L Manufacture of wood and wood and cork products, except furniture 55,930 132,975 H Manufacture of furniture and fixture, except primary of metal 94,196 144,325 H Manufacture of paper and paper products 4,308 119,050 M Printing, publishing and allied industries 2,126 354,750 L Manufacture of industrial chemicals 620 130,000 L Manufacture of other chemical products 1,151 175,175 L Petroleum refineries 24 18,075 L Manufacture of rubber products 25 53,025 L Manufacture of plastic products nec 415 136,900 L Manufacture of glass and glass products 206 43,275 L Manufacture of other non-metallic mineral products 1,498 70,875 L Iron and steel basic industries 188 48,425 L Non-ferrous metal basic industries 260 79,325 L Manufacture of fabricated metal products, except machinery and equipment

2,104 292,200 L

Manufacture of machinery except electrical 4,939 692,275 L Manufacture of electrical machinery, apparatus, appliances and supplies 684 473,750 L Manufacture of transport equipment 7,272 456,900 L Manufacture of instruments, photographic and optical goods 132 8,6225 L Other manufacturing industries 1,953 59,375 L Electricity, gas and steam 24 140,975 L Construction 228,115 1,753,450 H Land transport 5,114 671,050 L Water transport 58 68,175 L Air transport 558 95,700 L Services allied to transport 3,805 180,725 L Communication 7 459,425 L Sanitary and similar services 4,150 274,225 L Education services 2,438 1,455,875 L Total 433,834 9,673,325

Main Industry Sector Male %

Agriculture, hunting and forestry; fishing Moderate 10887 78%

Mining/quarrying, electricity/gas/steam, High 150126 76% manufacturing industry Moderate 4308 76%

12


Number Exposed

Number in Industry

Exposure Level

Low 24268 76% Construction High 228115 99% Service industries Low 16130 65%

(c) AF calculation: The AFs calculated using Levin’s formula were 29% and 0.3% for men and women respectively, and were higher than the AF calculated using Miettinen’s formula for men and lower for women, at 16% (95% CI 11% - 21%) and 3% (0 – 6%) respectively. Estimates for Pr(E) using the CAREX data were lower than would be estimated from the proportion of exposed controls from the study data (10% and 2% from the CAREX data versus 26% and 5% from the study controls). The higher AF estimated for men using Levin’s formula resulted from most of the exposed (91%) being considered ‘high exposed’ and therefore attracting a high RR (=5.8). Our preferred estimate was the one based on Levin’s formula and the independent CAREX data (Table 7).

3.3 Formaldehyde

(a) Risk estimate: A cohort of British chemical workers exposed to formaldehyde was established in the early 1980s (Coggon et al., 2003). Five of the six companies involved produced their own formaldehyde on site and either used it to manufacture resins and adhesives, or exported the product as formalin, paraformaldehyde or alcoforms. The last company imported formalin to produce resins. The cohort comprised 14,014 men who were followed up to 2000. Between 1941 and 2000 the SMR was 0.87 (95% CI 0.11-3.14), with only two cases observed. In a pooled analysis by IARC of 12 case-control studies, a non-significant elevated risk, increasing with level of exposure to formaldehyde, was observed among individuals with no or low exposure to wood dust (Luce et al., 2002). Higher and significant odds ratios (ORs) were observed among those with moderate and high levels of exposure to wood dust. Luce et al., only estimated ORs for adenocarcinomas and for squamous cell carcinomas separately. Mannetje et al., (1999) give ORs from a subset of 8 European studies of Luce’s original 12, for sinonasal cancer as a whole, which were adjusted for the effect of other occupational exposures. The ORs were 1.66 (95% CI 1.27–2.17) for men and 0.83 (0.41-1.69) for women for occupational exposure to formaldehyde. These ORs were used for the AF estimate in this study, for the high level exposure group and for women at all exposure levels (for which it is set to 1, although the CI values are used in the calculation of a confidence interval for the AF). Coggon’s RR was used for the lower and background exposure levels for men, again taken as RR=1, as a negative AF would result from RR<1 which is not realistic (see below).

(b) Numbers exposed: The number of workers exposed to formaldehyde in 1990-1993 according to CAREX is given in Table 8. In order to split the CAREX exposed numbers between men and women, it is assumed that all the exposed occupations in manufacturing and in construction were in skilled trades, shop floor and transport operatives (SOC major groups 5, 8 and 9), and that the exposed occupations in the service sector were in professional, associated professional and technical and personal and protective service occupations (SOC groups 2, 3 and 6). These data were used to estimate Pr(E) for Levin’s calculation of AF, as an alternative to the European population based studies.

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Table 7: Results for Nasal Cancer and Wood Dust Exposure

Occupational exposure Wood dust

'Best study' for RR estimate

Demers et al. (1995) Demers et al. (1995)

Type of study Pooled population-based case-control studies Pooled population-based case-control studies

Sex Male Female

Exposure level TOTAL High Moderate Low TOTAL TOTAL High Moderate Low TOTAL

Independent data:

Industry Sectors C-E F Total A-B C-E Total C-E G-Q Total C-E F Total A-B C-E Total C-E G-Q Total

CAREX numbers 114,096 225,834 339,930 8,492 3,274 11,766 18,444 10,485 28,928 380,624 36,030 2,281 38,311 2,395 1,034 3,429 5,824 5,646 11,470 53,210 exposed

CAREX adjustment factor

1.4 1.0 0.0 1.0 1.4 1.4 0.9 1.5 0.7 0.0 0.8 1.5 1.5 0.8

Annual 0.09 0.13 0.00 0.09 0.09 0.09 0.11 0.14 0.16 0.00 0.10 0.14 0.14 0.15 employment turnover Numbers exposed 551,887 1,106,750 1,658,637 29,340 15,837 45,177 89,213 39,423 128,636 1,832,450 303,110 9,724 312,834 7,365 8,698 16,063 48,998 27,033 76,031 404,929 in the REP (1955 -1994)

Study data Exposed cases 220 18

Total cases 680 250

Proportion of 0.26 0.05 controls exposed

Proportion of the population exposed 0.029 0.058 0.086 0.002 0.007 0.10 0.015 0.000 0.015 0.001 0.004 0.02

Proportion of cases exposed 0.32 0.07

Relative risks 2.00 5.80 5.80 5.80 1.20 1.00 1.60 1.00 1.00 1.00 2.00 1.60

Attributable fraction

Levin's 0.12 0.22 0.29 0.0005 0.00 0.29 0.00 0.00 0.00 0.001 0.002 0.003

‘Random error’ [0.084 - [0.156 - [0.217 - [0.000 - [-0.004 - [-0.012 - [0.000 - [-0.012 - [0.000 - [-0.001 -95% confidence 0.168] 0.287] 0.377] 0.001] 0.003] 0.042] 0.001] 0.043] 0.005] 0.013] interval

Attributable deaths 8 15 21 0 0 21 0 0 0 0 0 0

Attributable registrations 26 47 64 0 0 64 0 0 0 0 0 0

Attributable fraction

Miettinen's 0.16 0.03

‘Random error’ [0.11 - 0.21] [-0.01 -95% confidence 0.06] interval

Attributable deaths 11 2

Attributable registrations 35 5

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Table 8: Numbers of workers exposed to formaldehyde according to CAREX in 1990-1993



Crude petroleum and natural gas production 656 53300 B Beverage industries 881 88100 B Manufacture of textiles 4730 182000 L Manufacture of wearing apparel, except footwear 17992 189500 L Manufacture of wood and wood and cork products, except furniture 12430 132975 L Manufacture of furniture and fixture, except primary of metal 39772 144325 L Manufacture of paper and paper products 722 119050 L Manufacture of industrial chemicals 1006 130000 L Manufacture of other chemical products 360 175175 L Manufacture of plastic products nec 2021 136900 L Manufacture of glass and glass products 278 43275 L Manufacture of other non-metallic mineral products 585 70875 L Iron and steel basic industries 1870 48425 B Non-ferrous metal basic industries 1254 79325 B Manufacture of fabricated metal products, except machinery and equipment

535 292200 L

Manufacture of machinery except electrical 760 692275 B Construction 4511 1753450 B Education services 122 1455875 B Research and scientific institutes 176 91100 H Medical, dental, other health and veterinary services 2796 1435675 H Recreational and cultural services 74 534600 B Personal and household services 276 686750 B Total 93807

Main Industry Sector % Male

Agriculture, hunting and forestry; fishing High 0 Low 0

Mining/quarrying, electricity/gas/steam, Low manufacturing industry Background

80431 5421

76% 76%

Construction Low Background

0 4511 99%

Service industries High Background

2972 472

45% 45%

From the study data (Mannetje et al., 1999), 34% of the study controls reported exposure to formaldehyde. This also provided an estimate of the proportion of the population exposed.

Clothing retail workers may also be exposed to formaldehyde. This category was not included in the CAREX estimates of exposed workers, and clothing retail was not noted as a high risk occupation in the pooled Mannetje study, for which full occupational histories were collected and exposure to formaldehyde was examined using a job-exposure matrix. However the high proportion of study controls recorded as exposed to formaldehyde in this study may include these workers.

(c) AF calculation: The AF was calculated using two alternative approaches. One estimate was obtained from the pooled OR and proportion of cases exposed from the population-based study, using

15

Miettinen’s formula. Using this method, the AF for men was 20% (95% CI 10% - 29%) and for women was 0 (1.5% - 8%). Using Levin’s formula, based on the same RRs but an independent estimate of numbers exposed from GB data (CAREX, undifferentiated by exposure level), the AF for men was only 1.2% (0.5% - 2.0%), and for women 0% (0% - 0.6%) (data not presented). The difference in men was due to the 20-fold difference in the proportion of the population exposed estimated from the two different data sources (34% from the study data, 1.8% from the independent CAREX data). This indicates one or more of three possibilities. (1) Non-portability of the European population-based study estimates of numbers exposed in GB, (2) that a higher estimate of RR would be appropriate for GB due to the fewer number of more highly exposed individuals, or (3) there must be serious uncertainty about the reliability of either estimate, due mainly to the difficulty of separating the effects of this exposure from that of wood, leather and textile dust. In the case of (2), evidence from Coggon et al., in the UK industry suggested a lower rather than higher RR would be appropriate for the UK, as there was no raised risk observed in the industry cohorts.

The approach we have adopted for our preferred estimate is to apply the higher RR=1.66 of Mannetje et al., to the highest exposed group of men, and Coggon’s estimate (set to one) for the lower and background exposed groups. For all women the RR used was one. The resulting estimate of AF was 0.02% (95% CI 0.01%-0.03% based on random error of the Mannetje RR only) for men and zero (0-0.7%) for women.

This exposure falls in the ‘uncertain’ category. The estimate of 20% was retained in the overall estimate for established plus uncertain carcinogens for sinonasal cancer, as an indication of the uncertainty over this result for formaldehyde. It must also be acknowledged that there was no obvious reason why relative risks should be markedly different in men and women exposed to formaldehyde, indicating further uncertainty regarding these results (see Table 9).

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Table 9: Results for nasal cancer and formaldehyde exposure

Occupational exposure Formaldehyde


Reference Mann etje et al. (1999 )

Mannetj e et al (1999)

Coggan et al. (2003) Mannetj e et al. (1999)

Mannetje et al. (1999)

Type of study

Poole d popul ation-

Pooled populati on-based

UK industry cohort Pooled populati on-based

Pooled population-based case-control studies

based case- case-case- control control contr studies studies ol studie s

Sex Male Female

Exposure Higher Lower Higher Lower level + +

Background Background

TOTAL TOTAL Independen t data:

Industry Sectors

TOT AL G-Q C-E F G-Q Total TOTAL G-Q C-E F G-Q Total

CAREX numbers 20,90 exposed 1,337 65,248 4,466 212 69,926 71,263 1,635 20,604 45 260 9 22,544 CAREX adjustment factor 0.9 1.4 1.0 0.9 0.8 1.5 0.7 0.8 Annual employme nt turnover 0.11 0.09 0.13 0.11 0.15 0.14 0.16 0.15 Numbers exposed in the REP (1955 - 174,7 1994) 5,029 315,606 21,886 799 338,291 343,319 7,827 171,228 192 1,243 74 176,209

Study data Exposed cases 229 15

Total cases 451 104 Proportion of controls exposed 0.34 0.17

Proportion of the population exposed 0.0003 0.001 0.018 0.018 0.000 0.000 0.008 0.008

Proportion of cases exposed 0.51 0.14 Relative risks

1.66 1.66 1 1 0.83 1 1 1 1 Attributable fraction

Levin's 0.00017 0 0 0.0002 0 0 0 0 [-

‘Random error’ 95% [0.0001 [0.0001

[0.00 0 -

0.005 -

confidence interval

-0.0003]

[-0.001 -0.002]

[-0.016 -0.036]

-0.0003]

[0.000 -0.000]

0.000 ]

0.006 ]

[-0.005 - 0.006]

Attributable deaths 0 0 0 0 0 0 0 0

Attributable registrations 0 0 0 0 0 0 0 0 Attributable Miettinen' fraction s 0.20 0

‘Random error’ 95% confidence interval

[0.10 -0.29]

[-0.15 -0.08]



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3.4 Boot and Shoe Manufacture and Repair (leather dust)

(a) Risk estimate: An increased risk of nasal cancer in the boot and shoe industry was noted over 30 years ago in Northamptonshire (Acheson et al., 1970a; Acheson et al., 1970b). An Italian study observed an OR of 6.8 (90% CI 1.9-2.5) in those employed in the whole leather industry (Battista et al., 1995); an OR of 8.3 (95% CI 1.9-36.0) was associated with shoemaking, while leather tanners had an OR of 5.0 (95% CI 0.92-28.0). In two cohorts of shoe manufacturers (one in Italy and one in England), an SMR of 7.41 (95% CI 3.83-12.94) was observed among the English cohort (Fu et al., 1996). The SMR for those probably exposed to leather dust was 8.05 (95% CI 4.16-14.10), and in those with a high exposure was 11.7 (95% CI 5.34-22.2). The English cohort RR estimate from Fu et al. was used in the calculation of AF matched to independent GB estimates of the number exposed. An estimate from an IARC pool of population based case control studies in Europe (Mannetje et al., 1999) of OR = 1.92 (95% CI 1.10 – 3.35) for men and 2.71 (0.78 – 9.43) for women was used for an alternative AF estimate using study-based estimates of numbers exposed.

(b) Numbers exposed: Only those exposed to vegetable-tanned leather dust were believed to be at risk (Coggan, 2007, personal communication). No CAREX data exist for leather dust, but the LFS estimated that about 10,500 people worked in leather and related trades, and 19,000 in the manufacture of leather goods (average numbers in employment for 2002 to 2004).

Data from the CoE indicated that about 63,000 men and 68,000 women were employed in the leather and footwear industries in 1971, the point in the relevant exposure period for nasal cancer thought to be responsible for the highest number of these cancers occurring in 2004 (see Table 10). These estimates were used for the calculation of AF based on independent data. There was no more detailed data available on type of leather dust to which workers were exposed, so this must be considered the upper limit estimate.

Table 10:Number of workers possibly exposed to leather dust and/or working in the boot and shoe manufacturing industry, according to Census of Employment in 1971

SIC Code

Job Title Number employed

Men

Number employed

Women

431 Leather (tanning and dressing) 16,449 4,364 432 Leather goods 6,956 12,390 450 Footwear 39,348 51,738

62,753 68,492

(c) AF calculation: The AF for leather dust using the pooled European population based study was 3% (95% CI 0.2% - 5%) for men and 4% (1% - 10%) for women. Based on a lower estimate of proportion of the population exposed from CoE data for GB, but a higher estimate of RR specific to an English shoe manufacturing cohort, the AF for men becomes 7% (3% - 12%) and for women 11% (5% - 18%). This estimate was based on independent (GB) numbers exposed was our preferred estimate of AF (see Table 11).

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Table 11: Results for nasal cancer and leather dust exposure

Occupational exposure Leather dust


Reference Mannetje et al. (1999)

Fu et al. (1996) Mannetje et al. (1999)

Fu et al. (1996)

Type of study Pooled population-based case-control studies

English shoe manufacturing workers cohort

Pooled population-based case-

English shoe manufacturing workers cohort

control studies Sex Male Male Female Female

Exposure level High High

Independent data: Leather and Leather and footware

Industry Sectors TOTAL footware trades TOTAL trades

CoE 1971 numbers exposed 62,753 68,492

Annual employment turnover 0.09 0.14

Numbers exposed in the REP (1955 - 1994) 216,814 384,133 Study data

Exposed cases 26 7

Total cases 451 104

Proportion of controls exposed 0.03 0.03

Proportion of the population exposed 0.01 0.02

Proportion of cases exposed 0.06 0.07 Relative risks

1.92 7.41 2.71 7.41 Attributable fraction

Levin's 0.07 0.11

‘Random error’ 95% confidence interval [0.03 - 0.12] [0.05 - 0.18]


Attributable registrations 15 18 Attributable fraction

Miettinen's 0.03 0.04

‘Random error’ 95% confidence interval [0.002 - 0.052] [-0.01 - 0.10] Attributable deaths

2 3


3.5 Nickel

(a) Risk estimate: Significant excesses of nasal cancer have been observed in studies of nickel-exposed workers (Andersen et al., 1996; Anttila et al., 1998; Grimsrud & Peto, 2006; Jarup et al., 1998; Sorahan & Williams, 2005). However, the only group of workers with any significant exposure to nickel were those employed at the Clydach nickel carbonyl refinery in South Wales (n=812) (Sorahan & Williams, 2005). The most recent study of this cohort published an SMR of 8.7 (95% CI 1.05-31.4), which was based on only two cases, one of which started work after 1930 but before the refining process changed in the early 1950s, and the other after 1950. This is the estimate that will be used in the calculation of AF for the Clydach cohort. No other estimates were available for nickel exposure. For the low exposure group, an RR of half of this (4.85) is therefore assumed. An RR of 1 was assumed for industries judged to have background exposure only.

(b) Numbers exposed: Table 12 gives the numbers of workers exposed to nickel by industry according to CAREX for 1990-1993. For the male/female split all were assumed to be “blue collar” workers in SOC major groups 5, 8 and 9. The number of workers first employed in the period 1953-

19

1992 with at least five years of employment at Clydach was 812, and all were men (Sorahan & Williams, 2005).

Table 12: Numbers of workers exposed to nickel according to CAREX in 1990-1993

Industry CAREX Data 1990-1993 Exposure Level Number Number in

Exposed Industry

Metal ore mining 387 1225 L Food manufacturing 1359 414150 B Manufacture of paper and paper products 1126 119050 B Printing, publishing and allied industries 13 354750 B Manufacture of industrial chemicals 1408 130000 B Manufacture of other chemical products 31 175175 B Manufacture of pottery, china and earthenware 267 54450 B Manufacture of glass and glass products 472 43275 B Iron and steel basic industries 1658 48425 L Non-ferrous metal basic industries 9388 79325 L Manufacture of fabricated metal products, except machinery and equipment 27696 292200 L Manufacture of machinery except electrical 25091 692275 B Manufacture of electrical machinery, apparatus, appliances and supplies 960 473750 B Manufacture of transport equipment 12901 456900 L Manufacture of instruments, photographic and optical goods 524 86225 B Other manufacturing industries 242 59375 B Electricity, gas and steam 609 140975 B Construction 448 1753450 B Air transport 17 95700 B Services allied to transport 24 180725 B Total 84621 5,651,400



Mining/quarrying, electricity/gas/steam, High manufacturing industry Low

Background

0 52030 32102

76% 76%

Construction Background 448 99% Service industries Background 41 65%

(c) AF calculation: For the Clydach factory alone, for exposures which have occurred since 1955, the AF is very small (0.01%), with at most only one registration currently expected to occur over a period of 20 years. Attributable fractions of 4% (95% CI 0 – 14%) and 2% (0 – 7%) are estimated for men and women respectively from the CAREX exposed data for other low-level exposed groups (see Table 13).

The figures for the low exposed group do need to be treated with caution as the RR on which they were based was chosen arbitrarily. Therefore although this is established, this exposure at low levels will be included with the ‘uncertain’ group to reflect our uncertainty that the exposure still presents any risk at all in GB as an occupational hazard.

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Table 13: Results for nasal cancer and exposure to nickel

Occupational exposure Nickel

‘Best study’ for RR estimate Grimsrud and Peto (2006)

Type of study Clydach refinery cohort

Sex Male Female Exposure level Clydach

cohort Low Background Total Low Backgrou

nd Total

Independent data:

Industry Sectors C-E 98% C-E C-E 98% C-E CAREX numbers exposed 812 39,543 24,868 64,410 12,487 7,723 20,211 CAREX adjustment factor 1.4 1.4 1.5 1.5 Annual employment turnover 0.09 0.09 0.14 0.14 Numbers exposed in the REP (1955 – 1994) 164 191,271 120,286 311,721 105,050 64,974 170,024

Proportion of the population exposed 0.00001 0.01 0.01 0.02 0.01 0.00 0.01 Proportion of cases exposed Relative risks 8.70 4.85 1.00 4.85 1.00 Attributable fraction

Levin’s 0.0001 0.04 0 0.04 0.02 0 0.02

‘Random error’ 95% confidence interval

[0.0000 – 0.0003]

[0.0003 – 0.1315]

[0.0001 – 0.07]

[0.0001 – 0.07]

Attributable deaths 0.00 3 3 1 1 Attributable registrations 0.01 8 8 3 3

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3.6 Chromium

(a) Risk estimate: A study at three UK chromate producing factories observed a significant excess of deaths from nasal cancer (4 obs, 0.26 exp; SMR – 15.4; 95% CI – 4.2-39.4), up to 1988 (Davies et al., 1991). However, all of these deaths occurred in men starting work before major plant and process changes were completed during 1958-1960. A study of 1,087 Yorkshire chrome platers employed between 1972 and 1997 also observed an (albeit non-significant) excess risk (SMR – 6.87; 95% CI 0.17-38.3) (Sorahan & Harrington, 2000). However, this was based on only one case, and it is not stated when the subject had first been exposed. A review of epidemiological studies of chrome and cancer mortality was unable to conduct a meta-analysis relating to SNC (Cole & Rodu, 2005). The authors found that the relevant literature consisted almost entirely of case reports.

Another study of a cohort of workers known to have been employed between 1937 and 1971 in four former chromate producing facilities in the US (Rosenman & Stanbury, 1996), found a PMR of 5.18 (95% CI 2.37 – 11.30). This was used for the high exposed group. An RR of 1 was assumed for the low exposed group.

(b) Numbers exposed: Table14a gives numbers working with chrome/chromium (according to the SIC description) from the LFS for 1983 and 2003. The total was about 78,000 workers, in 1983, 44,000 by 2003. HSL estimated that 60,000 welders may have been exposed to CrVI compounds arising from welding fumes, and also 14,875 workers in foundries who were likely to have incurred chrome exposures. They estimated there are up to 500 chrome-electroplating businesses in the UK employing an average of 18 employees per site, with 25% of these potentially exposed. This equates to a maximum of 2,250 potentially exposed workers. This gives a total of about 77,125 workers thought to be currently exposed. Exposures in chrome pigment use are low, as are those in the use of wood preservatives and from cement dust (the main exposure in construction).

Table 14a: Number of workers possibly exposed to chrome/chromium, according to LFS 1983 and 2003.

LFS 1983 LFS 2003 SIC description Other non-ferrous material and 10,879 1,838 Other non-metal Manufacture of chrome alloys; chromium their alloys production production and refining; chromium

manufacture Extraction preparation of metalliferous ore

3,931 1,199 Non-ferrous mine Chrome ore mining and preparation

Heat and surface treatment of 24,596 12,405 Treatment coating of Chrome/chromium plating metals materials Leather and fellmongery 7,390 3,445 Leather tanning

dressing Chromium tanning

Inorganic chemicals 18,997 20,185 Inorganic chemical Chromium compound manufacture, manufacture excluding pigments

Dyestuffs and pigments 12,108 5,276 Dye pigment Manufacture of chromium pigments manufacture

Table 14b gives the numbers of workers exposed to chromium by industry according to CAREX for 1990-1993. The total employed in manufacturing, estimated for 1990-93, was similar to the above 1983 LFS estimate and current HSL estimates. The CAREX data was therefore used. As the processes involved are known to have ceased by 1960, only exposure in the five years from 1955 to 1959 inclusive was counted as contributing to the estimate of AF.

For the male/female split all were assumed to be “blue collar” workers in SOC major groups 5, 8 and 9.

22

Table 14b: Numbers of workers exposed to chromium according to CAREX in 1990-1993.

Industry CAREX Data 1990-1993 Exposure Level Number Number in

Exposed Industry

Forestry and logging Unknown Unknown Crude petroleum and natural gas production 1,198 53,300 L Food manufacturing 2,049 414,150 L Beverage industries 264 88,100 L Manufacture of textiles 3,286 182,000 H Manufacture of wearing apparel, except footwear 1,012 189,500 H Manufacture of leather and products of leather 554 16,825 H Manufacture of footwear 108 38,500 H Manufacture of wood, wood and cork products 3,020 132,975 H Manufacture of furniture and fixtures 138 144,325 H Manufacture of paper and paper products 1,802 119,050 L Printing, publishing and allied industries 3,634 354,750 L Manufacture of industrial chemicals 3,020 130,000 H Manufacture of other chemical products 1,626 175,175 H Petroleum refineries 874 18,075 L Manufacture of rubber products 928 53,025 H Manufacture of plastic products, nec 3,408 136,900 H Manufacture of pottery, china and earthenware 250 54,450 H Manufacture of glass and glass products 609 43,275 H Manufacture of other non-metallic mineral products 169 70,875 H Iron and steel basic industries 680 48,425 H Non-ferrous metal basic industries 2,368 79,325 H Manufacture of fabricated metal products 21,038 292,200 H Manufacture of machinery, except electrical 22,792 692,275 H Manufacture of electrical machinery, apparatus, appliances 5,443 473,750 L Manufacture of transport equipment 14,482 456,900 H Manufacture of instruments, photographic and optical 1,651 86,225 L Other manufacturing industries 620 59,375 H Electricity, gas and steam 660 140,975 H Construction 4,264 1,753,450 H Land transport 1,528 671,050 L Water transport 1,026 68,175 L Air transport 4,328 95,700 L Services allied to transport 74 180,725 L Sanitary and similar services 448 274,225 L Personal and household services 20,687 686,750 L Total 130,038 2,835,200



Mining/quarrying, electricity/gas/steam, High manufacturing industry Low

80768 16915

76% 76%

Construction High 4264 99% Low 0

Service industries High Low

0 28091 65%

23

(c) AF calculation: The AF was estimated as 1% for men (95% CI 0.3% - 2.5%) and 0.5% for women (0.2% - 1.3%) (see Table 15).

Table 15: Results for nasal cancer and exposure to chromium VI

Occupational exposure Chromium VI

'Best study' for RR estimate Rosenbaum and Stanbury (1996) Rosenbaum and Stanbury (1996)

Type of US industry cohort US industry cohort study Sex Male Female

Exposure level

High Low Total High Low Total

Independent data:

Industry Sectors C-E F Total C-E G-Q Total C-E F Total C-E G-Q Total CAREX numbers 12,85 18,25 31,11 19,38 exposed 61,384 4,221 65,605 5 9 5 96,720 4 43 19,427 4,060 9,832 13,891 33,318 CAREX adjustment factor 1.4 1.0 1.4 0.9 1.5 0.7 1.5 0.8 Annual employment turnover 0.09 0.13 0.09 0.11 0.14 0.16 0.14 0.15 Numbers exposed in the REP (1955 - 19,12 26,40 1959) 44,819 2,801 47,620 9,386 9,736 3 66,742 3 28 26,431 5,529 7,467 12,997 39,428

Proportion of the population exposed 0.0001 0.002 0.001 0.003 0.000 0.001 0.001 0.002 Proportion of cases exposed

Relative risks 5.18 5.18 1.00 5.18 5.18 1.00

Attributable fraction 0.001 0.01 0 0.01 0.000 0.005 0 0.005

‘Random error’ 95% [0.0002 [0.003 - [0.002 - [0.002 -confidence - 0.025] [0.003 - [0.000 - 0.013] 0.013] interval 0.0015] 0.025] 0.000]

Attributable deaths 0 1 1 0 0 0

Attributable registrations 0 2 2 0 1 1

3.7 Polycyclic aromatic hydrocarbons

(a) Risk estimate: PAHs have historically been linked with nasal cancer (Acheson et al., 1981; Blot et al., 1977; Roush et al., 1980; Roush et al., 1982). However, it has been noted that the risks appear to have been reduced (Roush et al., 1980), and current exposures may be relatively uncommon so as to prevent detection of elevations in risk for SNC in epidemiological studies (Roush, 1996).

(b) Numbers exposed: Table 16 gives the numbers of workers exposed to PAHs by industry according to CAREX for 1990-1993.

24

Table 16: Numbers of workers exposed to polycyclic aromatic hydrocarbons according to CAREX in 1990-1993



Crude petroleum and natural gas production 888 53,300 H Metal ore mining 103 1,225 H Other mining 217 28,150 H Food manufacturing 970 414,150 H Tobacco manufacture 102 9,950 H Manufacture of wearing apparel, except footwear 8,444 189,500 H Manufacture of leather and products of leather or of its substitutes 214 16,825 H Manufacture of footwear 130 38,500 H Manufacture of wood and wood and cork products, except furniture 515 132,975 H Manufacture of paper and paper products 289 119,050 H Printing, publishing and allied industries 105 354,750 H Manufacture of industrial chemicals 1,006 130,000 H Petroleum refineries 536 18,075 H Manufacture of miscellaneous products of petroleum and coal 82 1,125 H Manufacture of rubber products 3,848 53,025 H Manufacture of pottery, china and earthenware 1,362 54,450 H Manufacture of glass and glass products 818 43,275 H Manufacture of other non-metallic mineral products 2,073 70,875 H Iron and steel basic industries 4,913 48,425 H Non-ferrous metal basic industries 1,626 79,325 H Manufacture of fabricated metal products, except machinery and equipment

6,108 292,200 H

Manufacture of machinery except electrical 4,106 692,275 H Manufacture of transport equipment 9,292 456,900 H Electricity, gas and steam 4,996 140,975 H Construction 4,511 1,753,450 L Wholesale and retail trade and restaurants and hotels 4,855 4,459,525 L Land transport 9,348 671,050 L Water transport 171 68,175 L Services allied to transport 692 180,725 L Public administration and defence 250 1557,875 L Sanitary and similar services 9,442 274,225 L Personal and household services 24,273 686,750 L Total 106285 13,091,075



Mining/quarrying, electricity/gas/steam, High 48232 76% manufacturing industry Low 0

Construction High Low

0 4511 99%

Service industries High Low

0 53542 65%

25

(c) AF calculation: The AF has not been calculated as there was no estimate of RR available.

3.8 Textile dust

(a) Risk estimate: In a review of cancer risk in the textile industry, a relative risk of 1.75 (95% CI 1.07-2.70) was observed based on data from a single US hospital based case-control study (Brinton et al., 1985) in workers exposed to cotton dust (Mastrangelo et al., 2002). No excess was seen in pooled studies of workers exposed to wool or silk and synthetic fibres. Excesses were seen in those employed as spinners and weavers (SMR = 3.03; 95% CI 0.60-8.77) and weavers (SMR = 4.72; 95% CI 2.15-8.96). In a population-based case-control study in France, any exposure to textile dust resulted in an OR for squamous cell carcinomas of 0.90 (95% CI 0.33-2.43) for men and 2.45 (95% CI 0.85-7.06) for women compared to individuals with no exposure (Luce et al., 1997). A dose-response relationship was observed in men and women. In a pooled analysis of 12 population based case-control studies of which this formed a part, a raised risk again for women only was found for adenocarcinomas, of 1.7 (0.4 – 7.9), 3.5 (1.2 – 10.7) and 2.5 (0.7 – 9.0) for the low, medium and high levels of cumulative exposure respectively. The risk estimate used therefore needed to cover both of these histology types plus all exposure levels, which we have estimated at 1.15 (0.82 – 1.61) for men and 1.38 (0.94 – 2.02) for women (inverse-variance weighted averages). As these RRs were drawn from a population-based case-control study, an internal estimate of the proportion of the population exposed was used to estimate the AF. An alternative estimate using numbers exposed in GB, taken from the Census of Employment for 1971, used the RR of Brinton et al., (1985) of 2.13 (95% CI 1.1-4.3) for women and 1.32 (0.8-2.2) for men in workers exposed in the textile or clothing industries.

(b) Numbers exposed: No data exist in CAREX on the number of workers exposed to textile dust, but Table 17 gives numbers employed in industries with possible exposure from the LFS for 2002-2004, and from the Census of Employment for 1971.

Table 17: Number of workers possibly exposed to textile dust in selected industries.

Industry Labour Force Survey

2002-2004 Average

Textile manufacture 118,143 Textile garment and related trades, nec. 7,377 Textile process operatives 19,429

Census of Employment

1971 Men Women

Textiles 309,767 271,405

(c) AF calculation: The AF is 1% (0% - 4%) for men and 7% (0% - 16%) for women using Luce’s estimates of RR and numbers exposed, with Miettinen’s formula for the AF. Using Brinton’s estimate and independent data for Pr(E) (and therefore Levin’s formula for AF) the estimates of AF were 1.8% for men (0% - 6.3%), and 7.6% for women (0.7% - 19.4%) (see Table 18).

However, using Luce’s RR and the independent GB estimate for Pr(E) gave nearly the same estimate of AF of 0.8% (0% - 6%) for men as when using the internal study estimate (1.0%). This indicated that the study-based estimates of population exposed were portable to GB for men (the estimate for Pr(E) from independent GB data is 6%, the Pr(E) estimated from study data controls is 7%). However, the

26

equivalent estimate for women was less than half of the European-based estimate (2.7%, CI 0% - 7%). This was related to the much higher estimate for the proportions of women exposed to textile dust from the pooled studies compared to the GB CoE data (20% versus 7%). Our preferred estimate for AF was therefore the one using the RR of Luce et al., with the independent estimate of Pr(E), rather than the Brinton RR which related to more ‘historic’ exposures (the Brinton paper was published in 1985) and may have overestimated the risk.

Table 18: Results for Nasal Cancer and Textile Dusts Exposure

Occupational exposure Textile dust

'Best study' for RR estimate Luce et al. (2002) Brinton et al. (1985)

Luce et al. (2002) Brinton et al. (1985)

Type of study Pooled population /hospital based case-control studies

Hospital based case-control study

Pooled population /hospital based case-control studies

Hospital based case-control study

Sex Male Female Exposure level Total Total

Independent data:

Industry Sectors C-E C-E C-E C-E CoE 1971 numbers exposed 309,767 309,767 271,405 271,405 Annual employment turnover 0.09 0.09 0.14 0.14 Numbers exposed in the REP (1955 -1994) 1,070,257 1,070,257 1,522,157 1,522,157

Study data Exposed cases 39 33 Total cases 499 128 Proportion of controls exposed 0.07 0.20

Proportion of the population exposed 0.06 0.06 0.07 0.07 Proportion of cases exposed 0.08 0.26 Relative risks 1.15 1.15 1.32 1.38 1.38 2.13 Attributable fraction

Levin's 0.008 0.018 0.027 0.076 ‘Random error’ 95% confidence interval

[-0.006 -0.059]

[-0.011 -0.063]

[-0.004 -0.069]

[0.007 – 0.194]

Attributable deaths 1 1 2 4 Attributable registrations 2 4 4 13 Attributable fraction

Miettinen's 0.01 0.07 ‘Random error’ 95% confidence interval

[-0.02 -0.04]

[-0.03 -0.16]

Attributable deaths 1 4 Attributable registrations 2 12

3.8 Mineral oils

(a) Risk estimate: Tolbert (1997) reviewed the relationship between mineral oil and cancer, covering metal machining, print press operating, and cotton and jute spinning. He suggested that as sinonasal cancer is a rare cancer, case-control studies rather than cohort studies were more useful for estimating RR. He reported a single case-control study using the Connecticut Tumour Registry (Roush et al., 1980) which supported an association of sinonasal cancer with work entailing exposure to machining fluid, with an OR of 2.8 (95% CI: 1.4-5.7). Only men were included in this study, and no smoking data was collected.

27

(b) Numbers exposed: No data exist in CAREX on the number of workers exposed to mineral oils, The numbers of metal machinists potentially exposed to mineral oils (metal working fluids) in GB are shown in Table 19, taken from LFS data for 1979. ‘Low’ (L) and ‘low or no’ (background, B) exposure levels are indicated as such. Exposure level (H) indicated jobs with known exposure to soluble metal working fluid (MWF) as a fine mist spray. Jobs unallocated to H, L or B in Table 19 had dermal exposure only, not relevant to sinonasal cancer. Printers were thought not normally to be exposed to mineral oils, but textile workers may also have been exposed, but were excluded from the calculation of AF for sinonasal cancer to avoid overlap with textile dust exposure.

Table 19: Numbers of workers exposed to mineral oils according to LFS 1979

SIC code Description Male Female Total Exposure Level

LFS 1979 111.1 Foremen of Press and Machine Tool Setters 2164 - 2164 H 111.2 Foremen of other Centre Lathe Turners 736 - 736 H 111.3 Foremen of Machine Ttool Setter Operators 581 - 581 H 111.4 Foremen of Machine Tool Operators 8947 252 9199 H 111.5 Foremen of Press Stamping and Automatic Machine

Operators 1498 - 1498 H

111.6 Foremen of Metal Polishers 265 - 265 B 111.7 Foremen of Fettlers Dressers - - - B 111.8 Foremen of Shot Blasters - - - B 112.1 Press and Machine Tool Setters 64157 740 64897 H 112.2 Other Centre Lathe Turners 49774 - 49774 H 112.3 Machine Tool Setter Operators 10818 232 11050 H 112.4 Machine Tool Operators 335097 50424 385521 H 113.1 Press Stamping and Automatic Machine Operators 34002 18281 52283 H 113.2 Metal Polishers 11112 1425 12537 B 113.3 Fettlers Dressers 12391 1619 14010 B 114.1 Foremen of Toolmakers Tool Fitters Markers-Out 4319 - 4319 H 114.2 Foremen of Precision Instrument Makers and Repairers 969 - 969 L 114.3 Foremen of Watch and Chronometer Makers and Repairers - - - L 114.4 Foremen of Metal Working Production Fitters and

Fitter/Machinists 27544 - 27544 H

114.5 Foremen of Motor Mechanics Auto Engineers 13825 - 13825 -114.6 Foremen of Maintenance Fitters (Aircraft Engines) 522 - 522 -114.7 Foremen of Office Machinery Mechanics - - - -115.0 Toolmakers Tool Fitters Markers-Out 92886 510 93396 H 116.1 Precision Instrument Makers and Repairers 28071 1667 29738 L 116.2 Watch and Chronometer Makers and Repairers 6527 225 6752 L 117.0 Metal Working Production Fitters and Fitter/Machinists 546544 6933 553477 H 118.1 Motor Mechanics Auto Engineers 269925 1271 271196 -118.2 Maintenance Fitters (Aircraft Engines) 3957 - 3957 -119.0 Office Machinery Mechanics 11506 - 11506 -131.8 Shot Blasters 6049 - 6049 B 160.5 Labourers and Other Unskilled Workers in Foundries in

Engineering 15469 567 16036 H

160.6 Labourers and Other Unskilled Workers in Engineering and Allied Trades

21276 259 21535 H

TOTAL 1580931 84405 1665336

28

(c) AF calculation: The AF was 28% (95% CI 8%-51%) for men and 4% (1%-9%) for women when calculated using the LFS estimates of numbers exposed and Levin’s formula. These AFs resulted in 20 and 2 attributable deaths for men and women respectively in 2004, and 62 and 6 attributable registrations (in 2003). The estimated AF using internal study data and Miettinen’s formula was much lower, 6% (95% CI 1%-10%) for men, with no estimate available for women as only men were included in the study. The proportion of the population exposed as estimated from the proportion of exposed controls was much lower (at 3%) than the estimate using the LFS data (23%), which is the reason for the discrepancy. As the study population (Connecticut, USA) was unlikely to match with the distribution of MWF exposure in the GB population, the AF estimate using external GB data was preferred (Table 20).

Table 20: Results for nasal cancer and exposure to mineral oils

Occupational exposure Mineral Oils

'Best study' for RR estimate Roush Roush et al. (1980) Roush et al. (1980) et al. (1980)

Type of study

Single case-control

Single case-control study Single case-control study

study Sex Male Female Exposure Higher Lower and Total Higher Lower & Total level background background

exposure exposure Independent Industry data: Sectors C-E C-E C-E C-E C-E C-E

LFS 1979 numbers exposed 1,215,812 65,384 1,281,196 78,198 4,936 83,134 Annual employment turnover 0.09 0.09 0.14 0.14 Numbers exposed in the REP (1955 -1994) 4,200,677 225,904 4,426,581 438,568 27,683 466,252

Study data Exposed cases 19 Total cases 216 Proportion of controls exposed 0.03

Proportion of the population exposed 0.22 0.01 0.23 0.021 0.001 0.022 Proportion of cases exposed 0.09 Relative risks 2.80 2.80 1 2.80 1 Attributable fraction

Levin's 0.28 0 0.28 0.04 0 0.04 ‘Random error’ 95% confidence interval

[0.08 -0.51]

[0.08 -0.51]

[0.008 -0.090]

[0.008 -0.090]

Attributable deaths 20 0 20 2 0 2 Attributable registrations 62 0 62 6 0 6 Attributable fraction

Miettinen's 0.06

‘Random [0.01 -error’ 95% 0.10]

29

4

confidence interval

Attributable deaths Attributable registrations 12

30

4. OVERALL ATTRIBUTABLE FRACTION

4.1 Comparison of exposure AFs

Figure 4.1a below shows the proportion of each population for each exposure, using independent GB data sources, Figure 4.1b shows the proportion of the population exposed, estimated from the study data controls. These were consistently higher across all exposures for which there was data in the population- based pooled study.

Figure 4.1a Proportion of the population exposed, from independent GB data sources

Sino-nasal cancer: Proportions of the population exposed

0.00 0.05 0.10 0.15 0.20 0.25 0.30 0.35 0.40

Wood dust

Formaldehyde

Leather dust

Nickel - Clydach only

Nickel

Chromium IV

Textile dust

Mineral Oils

Expo

sure

Pr(E)

MaleFemale

Figure 4.1b Proportion of the population exposed, from pooled case-control study data sources

Sino-nasal cancer: Proportions of the population exposed

0.00 0.05 0.10 0.15 0.20 0.25 0.30 0.35 0.40

Wood dust

Formaldehyde

Leather dust

Textile dust

Mineral Oils

Expo

sure

Pr(E)

MaleFemale

Figure 4.2a, shows the attributable fraction estimated for each exposure for men and for women using external GB estimates. The AFs calculated using internal study data estimates and Miettinen’s formula are in Figure 4.2b. As for the estimates of Pr(E), the AFs, with the exception of leather dust, are also higher from the population based studies. The estimate for leather dust is higher using independent data due to a relatively high estimate of RR from a UK cohort study.

31

Figure 4.2a Attributable fractions, estimated using independent GB data sources

Sino-nasal cancer: Occupational attributable fractions

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%

Wood dust

Formaldehyde

Leather dust

Nickel - Clydach only

Nickel

Chromium IV

Textile dust

Mineral Oils

Combined AF

Established exposures only

Established + Uncertain exposures

Expo

sure

AF

Male

Female

Figure 4.2b Attributable fractions, estimated using pooled population based case-control study data sources

Sino-nasal cancer: Occupational attributable fractions

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%

Wood dust

Formaldehyde

Leather dust

Textile dust

Mineral Oils

Expo

sure

AF

Male

Female

4.2 Exposure map

The exposure map (Figure 4.3) gives an indication of how exposures overlapped in the working population. It illustrates the potential for double counting of the exposed population when an overall AF is calculated, and facilitates strategies to avoid this. For a given cancer, the map entries consisted

32

of either an agent (or group of agents such as PAHs), or an exposure scenario (i.e. an industry or occupation in which such exposure occurs). Agents are in plain type, exposure scenarios in italics, from Table 4. Lines joining boxes then indicate where overlap would occur were all the entries in the map simply considered separately – for example, if leather dust and chromium VI were considered separately, overlap would occur in leather tanning (these ‘overlap’ exposure scenarios are indicated in the smaller print, again based on information in Table 4). For substances and occupations shown in dotted boxes a separate AF has not been estimated, as these exposure scenarios are included with another exposure (see Table 5).

The exposure map indicated that all the exposures covered for nasal cancer overlapped in some way in the working population, so no AFs can be summed directly.

Figure 4.3 Nasal cancer exposure map

Textile finishing

Formaldehyde

Chromium VI

Nickel

Wood dust, furniture and cabinet making

Leather dust, boot and shoe manufacture

Mineral oils

PAHs

Isopropanol manufacture

Leather tanning Wood preservatives

Plywood manufacture, varnishing

Metal working industries

Textile dust, textile manufacturing

industry

4.3 Overall AF

If it were assumed that all the exposures act independently and multiplicatively in causing nasal cancer, an overall AF was calculated by taking the complement of the product of complements for each exposure AF. The results of doing this for the established, and established plus uncertain, groups of exposures (see Table 5) were calculated for the AFs using independent estimates of the proportion of the population exposed. The results were an overall attributable fraction of 34% for men and 11% for women for the established occupational carcinogens, increasing to 64% and 18% respectively when the uncertain group were also included. Note that for formaldehyde in the uncertain group the study data based estimate of 20% were used rather than the independent data based estimate of zero for the overall AF – see section 3.3. This reflects a much higher proportion of the population likely to have been exposed than the CAREX based estimate.

33

An alternative approach, if it were thought unlikely that the effect of the exposures on disease causation were independent and multiplicative, was to draw all AF estimates for the cancer from a single population-based study took into account all possible exposures. The pooled case-control studies of Demers, Luce and Mannetje fulfilled this requirement (at least in as far as all the potentially exposed were represented), and Mannetje et al., (1999) estimate an overall AF of 39% (95% CI 18% -92%) for men and 11% (0.1% - 100%) for women based on the European subset of eight of the original 12 studies. These estimates include formaldehyde and textile dust, and therefore represented the established plus uncertain groups of exposures identified for our presentation of these results. Nickel and chromium, and mineral oils, did not feature in these estimates, as there were no nickel- or chromium-exposed cases. Our estimate for overall AF, calculated using only the pooled study RRs for the established occupational carcinogens (wood and leather dust), was 18% for men and 7% for women. Our estimate for the established plus uncertain exposure groups was 39% and 13% for men and women respectively, and differs from Mannetje’s as it was based on all 12 pooled studies for wood dust (Demers et al., 1995b) and textile dust (Luce et al., 2002), rather than Mannetje’s subset of eight European studies. It also included the separate estimate for mineral oils. Mannetje’s estimate was preferred, however, as it was calculated directly from the pooled study OR and the prevalence for ‘ever having worked’ in at least one nasal cancer risk occupation, explicitly avoiding double counting from overlapping exposures and therefore not requiring the assumption of independence / multiplicative. The separate-study based estimate for mineral oils was also thought to be unreliable (see Section 3.8). Other author’s estimates of overall attributable fraction for sinonasal cancer are shown in Table 21.

Table 21: Other estimates of occupational attributable fraction for sinonasal cancer

Reference Location Men Women

Doll and Peto (1981) US 25% 5%

Dreyer et al., (1997) Nordic countries 30% <2%

Kogevinas et al., (1998) Europe 41% 7%

Mannetje et al., (1999) Europe 39% 11%

Nurminen and Karjalainen (2001) Finland 24% 7%

Steenland et al., (2003) US 33% - 46%

34

4.4 Summary of results: Results are summarised in Table 22 (Annex 1) and Table 23.

Table 23: Summary of results

Pr(E) – Attributable Attributable Numbers exposed independent AF and its 95% CI – deaths registrations

Exposure (E/U) (1955-94) data independent Pr(E) (2004) (2003)

M F M F M F M F M F E Wood dust 1,832,450 404,929 0.10 0.02 0.29 0.003 21 0 64 0

U Formaldehyde 343,319 176,209 0.018 0.008 0.0002 (0.0001-0.0003) 0

(0-0.006) 0 0 0 0

E Leather dust 216,814 384,133 0.01 0.02 0.07 (0.03-0.12) 0.11

(0.05-0.18) 5 6 15 18

E Nickel – Clydach 164 0.00001 0.0001 (0-0.0003) 0 0

U Nickel – all 311,721 170,024 0.02 0.01 0.04 0.02 (0.0001-0.07) 3 1 8 3

U Chromium VI 66,742 # 39,428 # 0.003 0.002 0.010 (0.003-0.025) 0.005

(0.002-0.013) 1 0 2 1

U Textile dust 1,070,257 1,522,157 0.06 0.07 0.008 (0-0.059) 0.03

(0-0.069) 1 2 2 4

U Mineral Oils 4,426,581 466,252 0.23 0.002 0.28 (0.08-0.51) 0.04

(0.008-0.090) 20 2 62 6

Combined AF

Established (E) exposures only 0.34 0.11 24 6 74 18 Established + Uncertain (E+U) exposures 0.64* 0.18 45 11 140 31

Pr(E) – study AF – and its 95% CI study-based controls Pr(E|D)

Wood dust 0.26 0.05 0.16 (0.11-0.21) 0.03 (0-0.06) 11 2 35 5

Formaldehyde 0.34 0.17 0.20 (0.10-0.29) 0 (0-0.08) 14 0 44 0

Leather dust 0.03 0.03 0.03 (0.002-0.052) 0.04 (0-0.10) 2 3 6 7

Nickel – Clydach only Nickel Chromium VI Textile dust 0.07 0.20 0.01 (0-0.04) 0.07 (0-0.16) 1 4 2 12

Mineral Oils U 0.03 0.06 (0.01-0.10) 4 12

Combined AF

Established exposures only 0.18 0.07 13 4 40 11 Established + Uncertain exposures 0.39 0.13 27 8 86 22 Mannetje et al.(1999) estimate 0.39 0.11 27 6 85 18

Construction only Established exposures only 0.22 0.0000 15 0 47 0 Established + Uncertain exposures ## 0.22 0.0000 15 0 47 0

# 1955-1959 only * This combined AF included the study-based estimate for formaldehyde of AF = 0.20. Using the independent data estimate of AF = 0 (or AF = 0.01**), the combined AF was 0.55 (or 0.56**), resulting in 439 and 121 male deaths and registrations respectively (see text).

35

** The AF for formaldehyde was 0.01 using Mannetje’s pooled study RR of 1.66 rather than Coggon’s UK cohort RR of 0.87 for the ‘lower and background’ as well as ‘higher’ exposed groups, resulting in one attributable death and three attributable registrations. ## In order to identify construction workers separately in the CAREX data, this estimate used the independent data based AF of 0.02% for men for formaldehyde, rather than the study based estimate of 20% normally used for the combined AF estimate.

The preferred AF estimates for the individual exposures were in most cases those that used the independent GB based estimate of Pr(E). They are highlighted in bold in Table 23. In the case of wood dust, a French study made a substantial impact on the RR estimates used for our AF, contributing 22% of the cases in the pool and high relative risks (Demers et al., 1995). When excluded from the European subset of eight studies (Mannetje et al., 1999), the authors’ estimated AF for wood dust was very substantially reduced (18% to 5%). It is known that different woods are used in the French industry to the UK. Our lower estimate is therefore preferred for wood dust, based on lower risks for two thirds of the ever-exposed population. This proportion of the population exposed, 10% of the GB workforce, is also substantially lower than the pooled study estimate of 26%, based on exposed controls. For leather dust, the GB proportion exposed was a half of the pooled study estimate, and the RR estimate used was from a representative UK cohort. For textile dust, 9% of the female GB workforce was estimated to have had some exposure, versus 20% in the pooled non UK population-based study. This suggested a preference for the independent GB estimate of Pr(E). For formaldehyde the AF estimate was very uncertain (see section 3.3). Using UK data produced an AF of zero. Using the pooled study RR estimated across all exposure levels with a GB estimate of exposed numbers produced an AF of 1% for men; the same RR applied to the very much higher pooled study estimate of numbers exposed (34% versus 2% from the GB CAREX data) resulted in an AF of 20% for men, which was the one used in the combined AF for established plus uncertain carcinogens, to reflect our uncertainty about the result for formaldehyde. All estimates for formaldehyde are 0% for women. For mineral oils, only one RR estimate was available, from a single 1980 US case control study. Applied to the GB (LFS) estimates of numbers exposed to metal working fluids, a high AF resulted from the estimate that 29% of men were exposed. This however was more realistic than the exceptionally low study-based estimate (for which the comparable Pr(E) was 3%).

Our preferred best estimate for a combined AF for the established carcinogens was therefore 34% for men and 11% for women, resulting in an estimated 74 SNC registrations (24 deaths) in men and 18 (6 deaths) in women in 2003 (2004). For the established plus uncertain group, the combined estimate was 64% and 18%, resulting in an estimated 140 SNC registrations in men in 2003 (and 45 deaths in 2004), and 31 registrations for women in 2003 (and 11 deaths in 2004).

4.5 Exposures by industry/job

The industries accounting for the highest numbers of those exposed to a nasal cancer carcinogen (established or uncertain categories) were textiles (from exposure to textile dust), the furniture and wood product industries (through exposures to wood dust, formaldehyde and Chromium VI salts) and construction and the manufacture of machinery and fabricated metal products (through exposures to those three plus nickel). These results largely reflected the numbers employed, historically, in these industries in Great Britain (Figure 4.4).

36

Figure 4.4 Exposures by industry/job in GB in the period1955 – 1994.

Industry /Occupation classes with over 150,000 ever exposed 1955-1994

0 250,000

500,000

750,000

1,000,000

1,250,000

1,500,000

1,750,000

CAREX

Construction

Manufacture of fabricated metal products, except machinery and equipment

Manufacture of machinery except electrical

Manufacture of furniture and fixture, except primary of metal

Manufacture of wood and wood and cork products, except furniture

CoE 1971

Textiles

W,

F,

C, N

W,

F,

C, N

W,

F,

C, N

W,

F, C

W,

F, C

'Te

xtile

dust

Indu

stry

/O

ccup

atio

n cl

ass

Numbers ever exposed 1955-1994 and <85 in 2004

Males

Females

Exposures:W = Wood dustF = FormaldehydeC = Chromium VI (1955-1959 only)N = Nickel

4.6 High versus low exposures

For the established plus uncertain sinonasal cancer carcinogens, about 94% of the attributable registrations in men occur in the 86% of the ‘ever exposed’ who were exposed at the higher level. The figure for women is 88% of nasal cancers in the 85% who were exposed at the higher level. In Table 24, attributable registrations for formaldehyde were based on the higher (20%) estimate of AF used for the overall (combined exposure) nasal cancer AF.

Table 24: Numbers ever exposed to an occupational carcinogen for sinonasal cancer in the period 1955-1994 (and aged under 85 in 2004) and attributable registrations (by level of exposure)

Exposure High Exposures Moderate, low and background exposures

Numbers exposed Attributable Numbers exposed Attributable (1955-94) registrations (1955-94) registrations

M F M F M F M F Wood dust 1,658,637 312,834 64 0 173,812 92,094 0 0 Formaldehyde 5,029 7,827 44 0 338,291 174,774 0 0 Leather dust 216,814 384,133 15 18 - - - -Nickel - Clydach only 164 - 0 - - - - -Nickel - - - - 311,721 170,024 8 3 Chromium VI 47,620 # 26,431 # 3 1 19,123 # 12,997 # 0 0 Textile dust 1,070,257 1,522,157 2 4 - - - -Mineral Oils 4,200,677 438,568 62 6 225,904 27,683 0 0 Combined Exposures: Established exposures only* 74 18 0 1 Established + Uncertain exposures *

137 28 8 4

# 1955-1959 only

* The totals across exposure levels sum to more than the overall total due to overlapping exposures. Figures were rounded to the nearest 500 (combined numbers exposed)

37

4.7 Discussion

Amongst the established occupational carcinogens for nasal cancer, wood and leather dust now account for virtually all current cases, with wood dust causing four times as many cancers as leather dust in men. In women nearly all the occupation attributable sinonasal cancers are due to leather dust exposure.

When the uncertain occupational carcinogens are also considered, mineral oils account for over half the attributable deaths and registrations. Formaldehyde also appears to be responsible for more cases in men than the established dusts combined, but no cases in women. This finding for formaldehyde needs to be treated with some caution as the evidence is contradictory, and it is particularly difficult to separate the effects of this exposure from wood, leather and indeed textile dust with which it is often associated. Overlap of these other exposures with mineral oils is not an issue. The high proportion of the male population exposed to mineral oils, in metal machining occupations, is the reason this AF estimate is so high.

Small numbers of nasal cancers are still probably being caused by long past exposures to chromium VI and nickel. Again this finding needs to be treated with caution, depending as it does on assumptions that exposure to chromium VI was still occurring up to 1960, and that latency may really be as long as up to 50 years. For nickel exposure, only low levels of exposure were assumed, but the exposure was assumed to continue through the whole relevant exposure period up to 1994, so that a large number of workers were affected. In the absence of study data, an arbitrary estimate of RR had to be assumed, half that for the Clydach cohort for exposures from after 1930 to 2000. Historical exposures in the Clydach factory itself were responsible for very few current cases indeed, measurable as between one and five cases over a period of 20 years.

For women, mineral oils and textile dust were second only to leather dust as (possible) causes of nasal cancer, due to the large numbers exposed.

No data was available to estimate the attributable fractions for isopropanol manufacture and PAHs (other than mineral oils), so no estimate of their contributions was possible.

Nasal cancer has well-established occupational causes. Historically, an imbalance between numbers of men and women affected by an otherwise non gender specific cancer has been taken as an indication of a possible occupational link, due to the greater numbers of male workers in historically high-exposure jobs. After subtracting cancers thought to be attributable to occupation, the numbers of ‘non-attributable’ deaths and registrations are broadly similar for men and women when taking account of only the ‘established’ carcinogens, see Table 25. When taking account of the uncertain as well as established occupational exposures, there is an imbalance towards more female than male cases unattributed to occupation. This may be explained by the zero AF estimated for formaldehyde for women, based on an RR of less than 1 from Mannetje’s European study pool, contrasted with RR=1.66 for men from this study, and an indication of raised risk amongst ‘high exposed’ women in Luce’s analysis of all 12 pooled studies which does not feature in Mannetje’s subset. It may also be partially explained if the proportion of men ever exposed to mineral oils is an overestimate. Note however that this would not explain all the observed discrepancy between male and female unattributed numbers. This still appears using the study-based (Pr(E|D)) AF estimate for the established plus uncertain carcinogens, which for mineral oils was based on the very low proportion of controls exposed to mineral oils in the US study. The raised PRR for women classified in the Decennial Supplement as ‘other service personnel’ is interesting in this context (Table 3), based on 29 registrations for sinonasal cancer in women aged 20-74 years from 1981-87.

38

Table 25: Deaths and registrations for sinonasal cancer not attributable to occupation, for men and women

Occupational AF

Non-attributable deaths (2004)

Non-attributable registrations (2003)

Exposure set AF calculation M F M F M F

Established Independent Pr(E) 34% 11% 46 53 144 149

Study based Pr(E|D) 18% 7% 57 55 178 156

Established + uncertain Independent Pr(E) 64% 18% 25 48 78 136

Study based Pr(E|D) 39% 13% 43 51 132 145

39

5 REFERENCES

Acheson, E.D. (1976). Nasal cancer in furniture and boot and shoe manufacturing industries. Preventive Medicine, 5, 295-315.

Acheson, E.D. (1985). Formaldehyde: epidemiological evidence. IARC Scientific Publication, 65, 91-95.

Acheson, E.D., Cowdell, R.H., Hadfield, E. & Macbeth, R.G. (1968). Nasal cancer in woodworkers in the furniture industry. British Medical Journal, 2.

Acheson, E.D., Cowdell, R.H. & Jolles, B. (1970a). Nasal cancer in the Northamptonshire boot and shoe industry. British Medical Journal, 1, 385-393.

Acheson, E.D., Cowdell, R.H. & Jolles, B. (1970b). Nasal cancer in the shoe industry. British Medical Journal, 1, 791.

Acheson, E.D., Cowdell, R.H. & Rang, E.H. (1972). Adenocarcinoma of the nasal cavity and sinuses in England and Wales. British Journal of Industrial Medicine, 29, 21-30.

Acheson, E.D., Cowdell, R.H. & Rang, E.H. (1981). Nasal cancer in England and Wales - an occupational survey. British Journal of Industrial Medicine, 38, 218-224.

Acheson, E.D., Pippard, E.C. & Winter, P. (1982a). Nasal cancer in the Northamptonshire boot and shoe industry - is it declining? British Journal of Cancer, 46, 940-946.

Acheson, E.D., Winter, P., Hadfield, E. & Macbeth, R.G. (1982b). Is nasal adenocarcinoma in the Buckinghamshire furniture industry declining? Nature, 299, 263-265.

Albert, R.E., Sellakumar, A.R., S., L. & al., e. (1982). Gaseous formaldehyde and hydrogen chloride induction of nasal cancer in the rat. Journal of the National Cancer Institute, 68, 597-603.

Andersen, A., Berge, S.R., Engeland, A. & Norseth, T. (1996). Exposure to nickel compounds and smoking in relation to incidence of lung and nasal cancer among nickel refinery workers. Occupational and Environmental Medicine, 53, 708-713.

Anttila, A., Pukkala, E., Aitio, A., Rantanen, T. & Karjalainen, S. (1998). Update of cancer incidence among workers at a copper/nickel smelter and nickel refinery. International Archives of Occupational and Environmental Health, 71, 245-250.

Aub, J.C., Evans, R.D., Hemplemann, L.H. & et al. (1952). The late effects of internally deposited radioactive materials in man. Medicine, 31, 221-329.

Battista, G., Comba, P., Orsi, D., Norpoth, K. & Maier, A. (1995). Nasal cancer in leather workers: an occupational disease. Journal of Cancer Research and Clinical Oncology, 121, 1-6.

Bimbi, G., Battista, G., Belli, S., Bellino, F. & Comba, P. (1988). Nasal cancer and occupational exposures: a case-referent study. In Progress in Occupational Epidemiology., Hogstedt, C. & Reuterwall, C. (eds) pp. 99-102. Elsevier: Amsterdam.

Blair, A., Stewart, P.A., Hoover, R.N. & al., e. (1987). Letter to the Editor: Cancers of the nasopharynx and oropharynx and exposure to formaldehyde. Journal of the National Cancer Institute, 78, 191-193.

Blair, A., Stewart, P.A., O'Berg, M. & al., e. (1986). Mortality among industrial workers exposed to formaldehyde. Journal of the National Cancer Institute, 76, 1071-1084.

Blot, W.J., Brinton, L.A. & Fraumeni Jr, J.F. (1977). Cancer mortality in US counties with petroleum industries. Science, 198.

Brinton, L.A., Blot, W.J., Becker, J.A., Winn, D.M., Browder, J.P., Farmer Jr, J.C. & Fraumeni Jr, J.F. (1984). A case-control study of cancers of the nasal cavity and paranasal sinuses. American Journal of Epidemiology, 119, 896-906.

Brinton, L.A., Blot, W.J. & Fraumeni Jr, J.F. (1985). Nasal cancer in the textile and clothing industries. British Journal of Industrial Medicine, 42, 469-474.

Brues, A.M. & Kirsh, I.E. (1977). The fate of individuals containing radium. Transactions of the American Clinical Climatology Association, 88, 211-218.

Bruusgaard, A. (1959). Occurrence of certain forms of cancer in gas workers. Tidsskr Nor Largeioren, 79, 755-756.

Calvert, G.M., Ward, E., Schnorr, T.M. & Fine, L.J. (1998). Cancer risks among workers exposed to metalworking fluids: a systematic review. American Journal of Industrial Medicine, 33, 282-92.

41

Coggon, D., Harris, E.C., Poole, J. & Palmer, K.T. (2003). Extended follow-up of a cohort of British chemical workers exposed to formaldehyde. Journal of the National Cancer Institute, 95, 1608-1615.

Cole, P. & Rodu, B. (2005). Epidemiologic studies of chrome and cancer mortality: a series of meta-analyses. Regulatory Toxicology and Pharmacology, 43, 225-231.

Comba, P., Barbieri, P.G., Battista, G., Belli, S., Ponterio, F., Zanetti, D. & Axelson, O. (1992a). Cancer of the nose and paranasal sinuses in the metal industry - a case-control study. British Journal of Industrial Medicine, 49, 193-196.

Comba, P., Battista, G., Belli, S., de Capua, B., Merler, E., Orsi, D., Rodella, S., Vindigni, C. & Axelson, O. (1992b). A case-control study of cancer of the nose and paranasal sinuses and occupational exposures. American Journal of Industrial Medicine, 22, 511-520.

Creely, K.S., van Tongeren, M., While, D., Soutar, A.J., Tickner, J., Agostini, M., de Vocht, F., Kromhout, H., Graham, M., Bolton, A., Cowie, H. & Cherrie, J.W. (2006). Trends in Inhalation Exposure: Mid-1980s till Present. Institute of Occupational Medicine.

Davies, J.M., Easton, D.F. & Bidstrup, P.L. (1991). Mortality from respiratory cancer and other causes in United Kingdom chromate production workers. British Journal of Industrial Medicine, 48, 299-313.

Decoufle, P. & Walrath, J. (1983). proportionate mortality among US shoeworkers. American Journal of Industrial Medicine, 4, 523-532.

Demers, P.A., Boffetta, P., Kogevinas, M., Blair, A., Miller, B.A., Robinson, C.F., Roscoe, R.J., Winter, P., Colin, D., Matos, E. & Vainio, H. (1995a). Pooled reanalysis of cancer mortality among 5 cohorts of workers in wood-related industries. Scandinavian Journal of Work and Environmental Health, 21, 179-190.

Demers, P.A., Kogevinas, M., Boffetta, P., Leclerc, A., Luce, D., Gerin, M., Battista, G., Belli, S., Bolm-Audorf, U., Brinton, L.A., Colin, D., Comba, P., Hardell, L., Hayes, R.B., Magnani, C., Merler, E., Morcet, J.-F., Preston-Martin, S., Matos, E., Rodella, S., Vaughan, T.L., Zheng, W. & Vainio, H. (1995b). Wood dust and sino-nasal cancer: pooled reanalysis of twelve case-control studies. American Journal of Industrial Medicine, 28, 151-166.

Dilworth, M. (2000). Wood Dust Survey 1999/2000. Health & Safety Laboratory: Buxton. Drever, F. (1995). Occupational Health Decennial Supplement. Series DS no. 10: The Registrar

General's Decennial Supplement for England and Wales. HMSO: London. Elwood, J.M. (1981). Wood exposure and smoking: Association with cancer of the nasal cavity and

paranasal sinuses in British Columbia. Canadian Medical Association Journal, 124, 1573-1577.

Fu, H., Demers, P.A., Costantini, A.S., Winter, P., Colin, D., Kogevinas, M. & Boffetta, P. (1996). Cancer mortality among shoe manufacturing workers: an analysis of two cohorts. Occupational and Environmental Medicine, 53, 394-398.

Garabrant, D.H. & Wegman, D.H. (1984). Cancer mortality among shoe and leather workers in Massachusetts. American Journal of Industrial Medicine, 5, 303-314.

Grimsrud, T.K. & Peto, J. (2006). Persisting risk of nickel related lung cancer and nasal canceramong Clydach refiners. Occupational and Environmental Medicine, 63, 365-366.

Hansen, J. & Olsen, J.H. (1995). Formaldehyde and cancer morbidity among male employees in Denmark. Cancer Causes and Control, 6, 354-360.

Hardell, L., Johansson, B. & Axelson, O. (1982). Epidemiologic study of nasal and nasopharyngeal cancer and their relation to phenoxy acid or chlorophenol exposure. American Journal of Industrial Medicine, 3, 247-257.

Hauptmann, M., Lubin, J.H., Stewart, P.A., Hayes, R.B. & Blair, A. (2004). Mortality from solid cancers among workers in formaldehyde industries. American Journal of Epidemiology, 159, 1117-1130.

Hayes, R.B., Gerin, M., Raatgever, J.W. & de Bruyn, A. (1986). Wood-related occupations, wood dust exposure, and sinonasal cancer. American Journal of Epidemiology, 124, 569-577.

Hernberg, S., Collan, Y., Degerth, R., Englund, A., Engzell, U., Kuosma, E., Mutanen, P., Nordlinder, H., Hansen, H.S., Schultz-Larsen, K. & al., e. (1983a). Nasal cancer and occupational exposures. Preliminary report of a joint Nordic case-referent study. Scandinavian Journal of Work and Environmental Health, 9, 208-213.

42

Hernberg, S., Westerholm, P., Schultzlarsen, K., Degerth, R., Kuosma, E., Englund, A., Engzell, U., Hansen, H.S. & Mutanen, P. (1983b). Nasal and sinonasal cancer - connection with occupational exposures in Denmark, Finland and Sweden. Scandinavian Journal of Work and Environmental Health, 9, 315-326.

HSE. (1990). HSE Internal Report: Exposure to hardwood dust. In Technical Development Survey Report. Health and Safety executive: Bootle.

IARC. (1981). Wood, Leather and Some Associated Industries. 25. IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans. International Agency for Research on Cancer: Lyon

IARC. (1987a). The Rubber Industry 28 IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans. International Agency for Research on Cancer: Lyon

IARC. (1987b). Overall Evaluations of Carcinogenicity: an updating of IARC monographs Vols 1 to 42. IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans. International Agency for Research on Cancer: Lyon.

IARC. (1990a). Volume 49: Chromium and Chromium Compounds. In IARC Monograph Evaluation Carcinogenic Risk to Humans: Lyon, France.

IARC. (1990b). Volume 48. Monographs on the evaluation of the carcinogenic risk of chemicals to humans. Some flame retardants and textile chemicals and exposures in the textile manufacturing industry. In IARC Monograph Evaluation Carcinogenic Risk to Humans, IARC (ed). IARC: Lyon, France.

IARC. (1995). Wood Dust and Formaldehyde IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume 62: In IARC Monograph Evaluation Carcinogenic Risk to Humans, IARC (ed). IARC: Lyon, France.

IARC (2002). Cancer Incidence in Five Continents, Vol. VIII. IARC Scientific Publication No. 155. Lyon: Internatinal Agency for Research on Cancer

IARC. (2005). Formaldehyde, 2-Butoxyethanol and 1-tert-Butoxy-2-propanol. 88. Ironside, P. & Matthews, J. (1975). Carcinoma of the nose and paranasal sinuses in woodworkers in

the state of Victoria, Australia. Cancer, 36, 1115-1121. Jakobsen, M.H., Larsen, S.K., Kirkegaard, J. & Hansen, H.S. (1997). Cancer of the nasal cavity and

paranasal sinuses. Prognosis and outcome of treatment. Acta Oncologica, 36, 27-31. Jarup, L., Bellander, T., Hogstedt, C. & Spang, G. (1998). Mortality and cancer incidence in Swedish

battery workers exposed to cadmium and nickel. Occupational and Environmental Medicine, 55, 755-759.

Luce, D., Gerin, M., Leclerc, A., Morcet, J.-F., Brugere, J. & Goldberg, M. (1993). Sinonasal cancer and occupational exposure to formaldehyde and other substances. International Journal of Cancer, 53, 224-231.

Luce, D., Gerin, M., Morcet, J.-F. & Leclerc, A. (1997). Sinonasal cancer and occupational exposure to textile dust. American Journal of Industrial Medicine, 32, 205-210.

Luce, D., Leclerc, A., Begin, D., Demers, P.A., Gerin, M., Orlowski, E., Kogevinas, M., Belli, S., Bugel, I., Bolm-Audorf, U., Brinton, L.A., Comba, P., Hardell, L., Hayes, R.B., Magnani, C., Merler, E., Preston-Martin, S., Vaughan, T.L., Zheng, W. & Boffetta, P. (2002). Sinonasal cancer and occupational exposures: a pooled analysis of 12 case-control studies. Cancer Causes and Control, 13, 147-157.

Luce, D., Leclerc, A., Morcet, J.-F., Casallareo, A., Gerin, M., Brugere, J., Haguenoer, M. & Goldberg, M. (1992). Occupational risk factors for sinonasal cancer - a case-control study in France. American Journal of Industrial Medicine, 21, 163-175.

Macbeth, R.G. (1965). Carcinoma of the nasal cavity and accessory sinuses in woodworkers. Journal of Laryngology, 79, 592-612.

Malker, H.S.R., Mclaughlin, J.K., Blot, W.J., Weiner, J.A., Malker, B.K., Ericcson, J.L.E. & Stone, B.J. (1986). Nasal cancer and occupation in Sweden, 1961-1979. American Journal of Industrial Medicine, 9, 477-485.

Mannetje, A., Kogevinas, M., Luce, D., Demers, P.A., Begin, D., Bolm-Audorf, U., Comba, P., Gerin, M., Hardell, L., Hayes, R.B., Leclerc, A., Magnani, C., Merler, E., Tobias, A. & Boffetta, P.

43

(1999). Sinonasal cancer, occupation, and tobacco smoking in European women and men. American Journal of Industrial Medicine, 36, 101-107.

Mastrangelo, G., Fedeli, U., Fadda, E., Milan, G. & Lange, J.H. (2002). Epidemiologic evidence of cancer risk in textile industry workers: a review and update. Toxicology and Industrial Health, 18, 171-181.

Merler, E., Baldasseroni, A., Laria, R., Faravelli, P., Agostini, R., Pisa, R. & Berrino, F. (1986). On the causal association between exposure to leather dust and nasal cancer: further evidence from a case-control study. British Journal of Industrial Medicine, 43, 91-95.

Mirer, F. (2003). Updated epidemiology of workers exposed to metalworking fluids provides sufficient evidence for carcinogenicity. Applied Occupational and Environmenatl Hygiene 18, 902-12.

Ng, T.P. (1986). A case-referent study of cancer of the nasal cavity and sinuses in Hong Kong. International Journal of Epidemiology, 15, 171-175.

NIOSH. (1998). Occupational Exposure to Metalworking Fluids. In Criteria for a Recommended Standard. National Institute for Occupational Safety and Health: Cincinnati, Ohio.

Olsen, J.H. (1988). Occupational risks of sinonasal cancer in Denmark. British Journal of Industrial Medicine, 45, 329-335.

Olsen, J.H. & Asnaes, S. (1986). Formaldehyde and the risk of squamous-cell carcinoma of the sinonasal cavities. British Journal of Industrial Medicine, 43, 769-774.

ONS. (2005). Cancer Statistics, Registrations. Registrations of Cancer Diagnosed in 2003, England. Vol. No. 34. Series MB1. Office for National Statistics: London.

Paci, E., Buiatti, E., Costantini, A.S., Miligi, L., Pucci, N., Scarpelli, A., Petrioli, G., Simonato, L., Winkelmann, R. & Kaldor, J. (1989). Aplastic anemia, leukemia and other cancer mortality in a cohort of shoe workers exposed to benzene. Scandinavian Journal of Work and Environmental Health, 15, 313-318.

Pinkerton, L.E., Hein, M.J. & Stayner, L.T. (2004). Mortality among a cohort of garment workers exposed to formaldehyde: an update. Occupational and Environmental Medicine, 61, 193-200.

Pippard, E.C. & Acheson, E.D. (1985). The mortality of boot and shoe makers, with special reference to cancer. Scandinavian Journal of Work and Environmental Health, 11, 249-255.

Polednak, A.P., Stehney, F. & Rowland, R.E. (1978). Mortality among women first employed before 1930 in the US radium dial-painting industry: A group ascertained from employment lists. American Journal of Epidemiology, 107, 179-195.

Rang, E.H. & Acheson, E.D. (1981). Cancer in furniture workers. International Journal of Epidemiology, 10, 253-261.

Robinson, C.F., Petersen, M., Sieber, W.K., Palu, S. & Halperin, W.E. (1996). Mortality of Carpenters' Union members employed in the U.S. construction or wood products industries, 1987-1990. American Journal of Industrial Medicine, 30, 674-694.

Rosenman, K.D. & Stanbury, M. (1996). Risk of lung cancer among former chromium smelter workers. American Journal of Industrial Medicine, 29, 491-500.

Roush, G.C. (1996). Cancer of the Nasal Cavity and Paranasal Sinuses. In Cancer Epidemiology and Prevention pp. 587-602. Oxford University Press: Oxford.

Roush, G.C., Kelly, J.A., Meigs, J.A. & Flannery, J.T. (1982). Scrotal carcinoma in Conecticut metal-workers; sequel to a study of sinonasal cancer. American Journal of Epidemiology, 116, 76-85.

Roush, G.C., Meigs, J.A., Kelly, J.A., Flannery, J.T. & Burdo, H. (1980). Sinonasal cancer and occupation: a case-control study. American Journal of Epidemiology, 111, 183-193.

Rowland, R.E. (1975). The risk of malignancy from internally deposited radioisotopes. In Radiation Research: Biomedical, Chemical and Physical Perspectives., Nygaard, O.F., Adler, H.I. & Sinclair, W.K. (eds) pp. 146-155. Academic Press: New York.

Rutstein, D.D., Mullan, R.J., Frazier, T.M., Halperin, W.E., Melius, J.M. & Sestito, J.P. (1984). Sentinel health events (occupational) - a basis for physician recognition and public health surveillance. Archives of Environmental Health, 39, 159-168.

Sorahan, T. & Harrington, J.M. (2000). Lung cancer in Yorkshire chrome platers, 1972-97. Occupational and Environmental Medicine, 57, 385-389.

44

Sorahan, T. & Williams, S.P. (2005). Mortality of workers at a nickel carbonyl refinery, 1958-2000. Occupational and Environmental Medicine, 62, 80-85.

Vaughan, T.L. & Davis, S. (1991). Wood dust exposure and squamous cell cancers of the upper respiratory tract. American Journal of Epidemiology, 133, 560-564.

Vaughan, T.L., Stewart, P.A., Teschke, K., Lynch, C.F., Swanson, G.M., Lyon, J.L. & Berwick, M. (2000). Occupational exposure to formaldehyde and wood dust and nasopharyngeal carcinoma. Occupational and Environmental Medicine, 57, 376-384.

Vaughan, T.L., Strader, C., Davis, S. & Daling, J.R. (1986a). Formaldehyde and cancers of the pharunx, sinus and nasal cavity: I Occupational exposures. International Journal of Cancer, 38, 677-683.

Vaughan, T.L., Strader, C., Davis, S. & Daling, J.R. (1986b). Formaldehyde and cancers of the pharynx, sinus and nasal cavity: II. Residential exposures. International Journal of Cancer, 38, 685-688.

Walker, J.T., Bloom, T.F., Stern, F.B., Okun, A.H., Fingerhut, M.A. & Halperin, W.E. (1993). Mortality of workers employed in shoe manufacturing. Scandinavian Journal of Work and Environmental Health, 19, 89-95.

Walrath, J., Decoufle, P. & Thomas, T.L. (1987). Mortality among workers in a shoe manufacturing company. American Journal of Industrial Medicine, 12, 615-23.

45

6. Annex 1:

Table 22: Source data Level of Source Data for the proportion of the exposure study data population exposed

Reference Study type Male/ Femal e

Mortality/ cancer incidence

Exposure scenario RR (95% CI) ~

Source Group ed main

Industry /Occupation classes

Numbers: Male

Numbe rs:

Female

Numbers: Total

indust ry sector

Wood dust High (>5 mg/m3 8hr TWA)

Demers et al. (1995)

Pooled population-based case-control studies

M+F Mortality and cancer incidence

Sawmills,furniture,a nd other wood products, carpentry

5.8 (4.2-8.0) [M] 1.0 (0.2-4.0) [F]

CAREX C-E Manufacture of wood and wood and cork products, except furniture

42,507 13,423 55,930

Manufacture of 71,589 22,607 94,196 furniture and fixture, except primary of metal

F Construction 225,834 2,281 228,115 High Total 339,930 38,311 378,241

Moderate (1-5 Forestry workers, 1.2 (0.9-1.6) A-B Forestry and logging 8,492 2,395 10,887 mg/m3) logging workers and [M] 2.0 (0.5-

pulp and paper 7.8) [F] workers

C-E Manufacture of 3,274 1,034 4,308 paper and paper products Moderate Total 11,766 3,429 15,195

Low (<1 mg/m3 8hr TWA) 0.8 (0.4-1.5) [M -set to C-E Crude petroleum 52 16 68 1] 1.6 (0.6-4.7) and natural gas [F] production

Food manufacturing 313 99 412 Beverage industries 7 2 9 Tobacco 5 2 7 manufacture Manufacture of textiles

44 14 58

Manufacture of wearing apparel,

38 12 50

46

except footwear Manufacture of leather and products of leather or of its substitutes

24 8 32

Manufacture of footwear

8 3 11

Printing, publishing and allied industries

1,616 510 2,126

Manufacture of industrial chemicals

471 149 620

Manufacture of other chemical products

875 276 1,151

Petroleum refineries 18 6 24 Manufacture of rubber products

19 6 25

Manufacture of plastic products nec

315 100 415

Manufacture of glass and glass products

157 49 206

Manufacture of other non-metallic mineral products

1,138 360 1,498

Iron and steel basic industries

143 45 188

Non-ferrous metal basic industries

198 62 260

Manufacture of fabricated metal products, except machinery and equipment

1,599 505 2,104


3,754 1,185 4,939

Manufacture of electrical machinery, apparatus, appliances and

520 164 684

47

supplies Manufacture of 5,527 1,745 7,272 transport equipment Manufacture of 100 32 132 instruments, photographic and optical goods Other 1,484 469 1,953 manufacturing industries Electricity, gas and steam

18 6 24

Sub-total 18,444 5,824 24,268 G-Q Land transport 3,324 1,790 5,114

Water transport 38 20 58 Air transport 363 195 558 Services allied to 2,473 1,332 3,805 transport Communication 5 2 7 Sanitary and similar services

2,698 1,453 4,150

Education services 1,585 853 2,438 Sub-total 10,485 5,646 16,130 Low Total 28,928 11,470 268,513 TOTAL 380,624 53,210 433,834

Formaldehy High Mannetje et al. Pooled M+F Mortality JEM used to 1.66 (1.27- CAREX G-Q Research and 79 97 176 de (1999) population-

based case-control studies

and Cancer incidence

classify occupations 2.17) [M], 0.83 (0.41-1.69) [F]

scientific institutes

Medical, dental, 1,258 1,538 2,796 other health and veterinary services High Total 1,337 1,635 2,972

Low Coggon et al. (2003)

UK industry cohort

M Mortality British chemical workers in six companies producing and/or using formaldehyde for resins and

0.87 (0.11-3.14) [M], 0.83 (0.41-1.69) [F -from Mannetje et al. (1999)] - set to 1

C-E Manufacture of textiles

3,595 1,135 4,730

adhesives or exporting as

48

formalin, paraformaldehyde or alcoforms

Manufacture of 13,674 4,318 17,992 wearing apparel, except footwear Manufacture of 9,447 2,983 12,430 wood and wood and cork products, except furniture Manufacture of 30,227 9,545 39,772 furniture and fixture, except primary of metal Manufacture of 549 173 722 paper and paper products Manufacture of 765 241 1,006 industrial chemicals Manufacture of 274 86 360 other chemical products Manufacture of 1,536 485 2,021 plastic products nec Manufacture of 211 67 278 glass and glass products Manufacture of 445 140 585 other non-metallic mineral products Manufacture of 407 128 535 fabricated metal products, except machinery and equipment Low Total 61,128 19,303 80,431

Backgr 0.87 (0.11-3.14) [M], 0.83 (0.41- Crude petroleum 499 157 656 ound 1.69) [F - from Mannetje et al. and natural gas

(1999)] - set to 1 production Beverage industries 670 211 881 Iron and steel basic 1,421 449 1,870 industries

49


953 301 1,254

Manufacture of 578 182 760 machinery except electrical Sub-total 4,120 1,301 5,421

F Construction 4,466 45 4,511 Education services 55 67 122 Recreational and cultural services

33 41 74

Personal and household services

124 152 276

Sub-total 212 260 472 Background Total 8,798 1,606 10,404 TOTAL 71,263 22,544 93,807

Leather dust

High Fu et al. (1996) English shoe manufacturi

M+F Mortality Shoe manufacturers 7.41 (3.83-12.94)

CoE 1971

Leather (tanning and dressing)

16,449 4,364 20,813

ng workers cohort

Leather goods 6,956 12,390 19,346 Footwear 39,348 51,738 91,086 TOTAL 62,753 68,492 131,245

Nickel Clydac Grimsrud and Clydach M Mortality Clydach nickel 9.8 (1.05- Clydach C-E Clydach nickel 812 812 h Peto (2006) refinery carbonyl factory 31.4) cohort carbonyl factory cohort cohort Low 4.85 (1.03-

16.21)# CAREX C-E Metal ore mining 294 93 387

Iron and steel basic 1,260 398 1,658 industries Non-ferrous metal basic industries

7,135 2,253 9,388

Manufacture of 21,049 6,647 27,696 fabricated metal products, except machinery and equipment Manufacture of 9,805 3,096 12,901 transport equipment Low Total 39,543 12,487 52,030

Backgr ound

1# C-E Food manufacturing 1,033 326 1,359

50

Manufacture of paper and paper products

856 270 1,126


10 3 13


1,070 338 1,408


24 7 31

Manufacture of pottery, china and earthenware

203 64 267


359 113 472


19,069 6,022 25,091

Manufacture of electrical machinery, apparatus, appliances and supplies

730 230 960

Manufacture of instruments, photographic and optical goods

398 126 524

Other manufacturing industries

184 58 242

Electricity, gas and steam

463 146 609

Sub-total 24,398 7,704 32,102 F Construction 444 4 448 G-Q Air transport 11 6 17

Services allied to transport

16 8 24

Sub-total 27 14 41 Background Total 24,868 7,723 32,591 CAREX TOTAL 64,410 20,211 84,621

51

Chromium VI

High Rosenbaum and Stanbury (1996)

US industry cohort

M Mortality Chromate producing facilities

5.18 (2.37-11.30)

CAREX C-E Manufacture of textiles

2,497 789 3,286

Manufacture of wearing apparel, except footwear

769 243 1,012

Manufacture of leather and products of leather or of its substitutes

421 133 554

Manufacture of footwear

82 26 108

Manufacture of wood and wood and cork products, except furniture

2,295 725 3,020

Manufacture of furniture and fixture, except primary of metal

105 33 138


2,295 725 3,020


1,236 390 1,626

Manufacture of rubber products

705 223 928

Manufacture of plastic products, nec

2,590 818 3,408

Manufacture of pottery, china and earthenware

190 60 250


463 146 609

Manufacture of other non-metallic mineral products

128 41 169

Iron and steel basic industries

517 163 680


1,800 568 2,368

Manufacture of 15,989 5,049 21,038

52

fabricated metal products, except machinery and equipment Manufacture of machinery except electrical

17,322 5,470 22,792

Manufacture of transport equipment

11,006 3,476 14,482

Other manufacturing industries

471 149 620

Electricity, gas and steam

502 158 660

Sub-total 61,384 19,384 80,768 F Construction 4,221 43 4,264

High Total 65,605 19,427 85,032 Low 1 # C-E Crude petroleum

and natural gas production

910 288 1,198

Food manufacturing 1,557 492 2,049 Beverage industries 201 63 264 Manufacture of paper and paper products

1,370 432 1,802


2,762 872 3,634

Petroleum refineries 664 210 874 Manufacture of electrical machinery, apparatus, appliances and supplies

4,137 1,306 5,443

Manufacture of instruments, photographic and optical goods

1,255 396 1,651

Sub-total 12,855 4,060 16,915 G-Q Land transport 993 535 1,528

Water transport 667 359 1,026 Air transport 2,813 1,515 4,328

53

Services allied to transport

48 26 74

Sanitary and similar 291 157 448 services Personal and household services

13,447 7,240 20,687

Sub-total 18,259 9,832 28,091 Low Total 31,115 13,891 45,006 TOTAL 96,720 33,318 130,038

Textile dust High Luce et al. (2002) Pooled population /hospital based case-control

M+F Mortality and cancer incidence

Job exposure matrix (JEM) used to classify occupations

1.15 (0.9-2.12) [M] #, 1.38 (0.94-2.02) [F] #

CoE 1971

C-E Textiles 309,767 271,40 5

581,172

studies Mineral High Roush et al. Single case- M Mortality Work entailing 2.8 (1.4-5.7) LFS C-E Foremen of Press 2,164 - 2,164 Oils (1980) control airborne exposure to 1979 and Machine Tool

study cutting oils Setters Foremen of other 736 - 736 Centre Lathe Turners Foremen of 581 - 581 Machine Tool Setter Operators Foremen of 8,947 252 9,199 Machine Tool Operators Foremen of Press 1,498 - 1,498 Stamping and Automatic Machine Operators Press and Machine 64,157 740 64,897 Tool Setters Other Centre Lathe 49,774 - 49,774 Turners Machine Tool Setter Operators

10,818 232 11,050

Machine Tool 335,097 50,424 385,521 Operators Press Stamping and 34,002 18,281 52,283 Automatic Machine Operators

54

Foremen of Toolmakers Tool Fitters Markers-Out

4,319 - 4,319

Foremen of Metal Working Production Fitters and Fitter/Machinists

27,544 - 27,544

Metal Working Production Fitters and Fitter/Machinists

546,544 6,933 553,477

Toolmakers Tool Fitters Markers-Out

92,886 510 93,396

Labourers and Other Unskilled Workers in Foundries in Engineering

15,469 567 16,036

Labourers and Other Unskilled Workers in Engineering and Allied Trades

21,276 259 21,535

High Total 1,215,812 78,198 1,294,010 Foremen of Precision Instrument Makers and Repairers

969 - 969

Foremen of Watch and Chronometer Makers and Repairers

- - -

Precision Instrument Makers and Repairers

28,071 1,667 29,738

Watch and Chronometer Makers and Repairers

6,527 225 6,752

Low Total 35,567 1,892 37,459 Foremen of Metal Polishers

265 - 265

Foremen of Fettlers Dressers

- - -

55

Foremen of Shot Blasters

- - -

Metal Polishers 11,112 1,425 12,537 Fettlers Dressers 12,391 1,619 14,010 Shot Blasters 6,049 - 6,049 Background Total 29,817 3,044 32,861 TOTAL 1,281,196 83,134 1,364,330

~ = Male and female unless otherwise stated [M] = Male [F] = Female TWA = Time weighted average # = Estimated by the study team LFS = Labour Force Survey CoE = Census of Employment Industry sectors: A-B = Agriculture, hunting and forestry; fishing C-E = Mining and quarrying, electricity, gas and water; manufacturing industry F = Construction G-Q = Service industries

56

Published by the Health and Safety Executive 10/07



The aim of this project was to produce an updated estimate of the current burden of occupational cancer specifically for Great Britain. The primary 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 on the risk of the disease due to the exposures of interest, taking into account confounding factors and overlapping exposures, were combined with data on the proportion of the target population exposed over the period in which relevant exposure occurred. Estimation was carried out for carcinogenic agents or exposure circumstances that were classified by the International Agency for Research on Cancer (IARC) as Group 1 or 2A carcinogens with strong or suggestive human evidence. Estimation was carried out for 2004 for mortality and 2003 for cancer incidence for cancer of the bladder, leukaemia, cancer of the lung, mesoth elioma, nonmelanoma skin cancer (NMSC), and sinonasal cancer.

The proportion of cancer deaths in 2004 attributable to occupation was estimated to be 8.0% in men and 1.5% in women with an overall estimate of 4.9% for men plus women. Estimated numbers of deaths attributable to occupation were 6,259 for men and 1,058 for women giving a total of 7,317. The total number of cancer registrations in 2003 attributable to occupational causes was 13,338 for men plus women. Asbestos contributed the largest numbers of deaths and registrations (mesothelioma and lung cancer), followed by mineral oils (mainly NMSC), solar radiation (NMSC), silica (lung cancer) and diesel engine exhaust (lung and bladder cancer). Large numbers of workers were potentially exposed to several carcinogenic agents over the risk exposure periods, particularly in the construction industry, as farmers or as other agricultural workers, and as workers in manufacture of machinery and other equipment, manufacture of wood products, land transport, metal working, painting, welding and textiles. There are several sources of uncertainty in the estimates, including exclusion of other potential carcinogenic agents, potentially inaccurate or approximate data and methodological issues. On balance, the estimates are likely to be a conservative estimate of the true risk. Future work will address estimation for the remaining cancers that have yet to be examined, together with development of methodology for predicting future estimates of the occupational cancers due to more recent exposures.

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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