Environmental and Occupational Causes of Cancer: A Review of Recent Scientifi c Literature ppt

Environmental and Occupational

Causes of Cancer

A Review of Recent Scientifi c Literature

Richard Clapp, D.Sc.

Genevieve Howe, MPH

Molly Jacobs Lefevre, MPH

Prepared by

Boston University School of Public Health

and the Environmental Health Initiative,

University of Massachusetts Lowell

For the

Cancer Working Group of

the Collaborative on Health and

the Environment

September 2005

A Publication

of the Lowell Center

for Sustainable

Production

University of

Massachusetts

Lowell

Acknowledgements

The authors gratefully acknowledge the following organizations and individuals for their contributions to this paper:

o The Cancer Working Group of the Collaborative on Health and the Environment for initiating this project.

o The Mitchell Kapor Foundation for the financial support it provided through the San Francisco Medical

Society Foundation.

o Julia Brody, Theo Colburn, Devra Lee Davis, Nancy Evans, Mandy Hawes, David Kriebel, Michael Lerner,

Lynn Rosenberg, Ted Schettler, Jeanette Swafford, David Wegman, and other members of the Cancer

Working Group of the Collaborative on Health and the Environment for scientific advice and editorial

assistance.

The Lowell Center for Sustainable Production

The Lowell Center for Sustainable Production (LCSP) uses rigorous science, collaborative research, and innovative

strategies to promote communities, workplaces, and products that are healthy, humane, and respectful of natural

systems. The Center is composed of faculty, staff, and graduate students at the University of Massachusetts Lowell

who work collaboratively with citizen groups, workers, businesses, institutions, and government agencies to build

healthy work environments, thriving communities, and viable businesses that support a more sustainable world.

This paper was produced by LCSP’s Environmental Health Initiative, which seeks to better understand relationships

between environmental exposures and human health, to prevent exposures that may be harmful, and to reverse rates

of chronic disease.

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This document is available at www.sustainableproduction.org and www.cheforhealth.org.

©2005 The Lowell Center for Sustainable Production, University of Massachusetts Lowell

TABLE OF CONTENTS

EXECUTIVE SUMMARY..........................................................................................................................................................1

INTRODUCTION .......................................................................................................................................................................3

ESTIMATING ENVIRONMENTAL AND OCCUPATIONAL CONTRIBUTIONS TO CANCER ....................4

A Look at Recent History........................................................................................................................................................4

Causes: Genes or Environment? ............................................................................................................................................6

PERSPECTIVES ON RESEARCH METHODS...................................................................................................................7

Epidemiologic and Animal Studies: Strengths and Limitations.........................................................................................7

Cancer Clusters..........................................................................................................................................................................7

Cancer Incidence and Mortality Data ....................................................................................................................................8

THE STATE OF THE SCIENCE.............................................................................................................................................9

Methodology ..............................................................................................................................................................................9

The State of the Science by Cancer Type..............................................................................................................................12

Bladder Cancer......................................................................................................................................................................12

Bone Cancer..........................................................................................................................................................................12

Brain and other Central Nervous System Cancers..........................................................................................................12

Breast Cancer ........................................................................................................................................................................13

Cervical Cancer.....................................................................................................................................................................14

Colon Cancer ........................................................................................................................................................................15

Esophageal Cancer...............................................................................................................................................................15

Hodgkin’s Disease................................................................................................................................................................15

Kidney Cancer.......................................................................................................................................................................16

Laryngeal Cancer ..................................................................................................................................................................16

Leukemia................................................................................................................................................................................17

Liver and Biliary Cancer ......................................................................................................................................................17

Lung Cancer ..........................................................................................................................................................................18

Mesothelioma........................................................................................................................................................................19

Multiple Myeloma.................................................................................................................................................................20

Nasal and Nasopharynx ......................................................................................................................................................20

Non-Hodgkin’s Lymphoma ...............................................................................................................................................20

Ovarian Cancer.....................................................................................................................................................................21

Pancreatic Cancer .................................................................................................................................................................21

Prostate Cancer.....................................................................................................................................................................22

Rectal Cancer ........................................................................................................................................................................22

Soft Tissue Sarcomas (STS) ................................................................................................................................................23

Skin Cancer............................................................................................................................................................................23

Stomach Cancer....................................................................................................................................................................23

Testicular Cancer..................................................................................................................................................................24

Thyroid Cancer .....................................................................................................................................................................24

COMMENTS AND DISCUSSION ..........................................................................................................................................25

RECOMMENDATIONS ............................................................................................................................................................29

REFERENCES..............................................................................................................................................................................30

APPENDICES...............................................................................................................................................................................37

Appendix 1. Substances and mixtures that have been evaluated by IARC as definite (group 1) human

carcinogens and that are occupational exposures ................................................................................................................37

Appendix 2. Occupations or industries evaluated by IARC as definitely, probably, or possibly entailing excess

risk of cancer among workers. ...............................................................................................................................................39

Appendix 3. Definite or probable occupational carcinogens and carcinogenic circumstances, by site. ....................40

Appendix 4. Mortality rates from cancer and heart disease for ages younger than 85 and 85 and older,

1975-2001. ..................................................................................................................................................................................41

Appendix 5. Incidence rates for all cancer sites by race and sex for ages 64 and under, 1973-2001..........................42

Appendix 6. Incidence rates for all cancer sites by race and sex for ages 65 and over, 1973-2001............................43

Appendix 7. Mortality rates for all cancer sites by race and sex for ages 64 and under, 1969-2001...........................44

Appendix 8. Mortality rates for all cancer sites by race and sex for ages 65 and over, 1969-2001.............................45

Appendix 9. Incidence rates for lung & bronchus cancers by race and sex, 1973-2001. .............................................46

EXECUTIVE SUMMARY

Nearly one in two men and more than one in three

women in the United States will be diagnosed with cancer

at some point in his or her lifetime. Cancer is now the

leading cause of death for individuals under age 85. Even

though tobacco remains the single most significant

preventable cause of cancer, it has been linked neither to

the majority of cancers nor to many of the cancers that

have increased rapidly in recent decades including

melanoma, lymphomas, testicular, brain, and bone marrow

cancers.

This paper summarizes recent scientific evidence of

environmental and occupational links to nearly 30 types of

cancer. It includes a critique of the 25 year-old analysis

by Doll and Peto and subsequent analyses that attribute

an extremely small fraction of cancer deaths to

involuntary environmental and occupational exposures.

The paper presents the state of the evidence on causal

associations between environmental and occupational

exposures and specific cancer types. The discussion of

each cancer type is introduced by highlights of trends in

incidence and mortality rates. Lastly, the paper considers

additional indications that involuntary exposures are

linked to cancers, such as patterns observed in different

geographic areas and among different populations,

including patterns of cancer in children.

The authors cite several notable findings:

• Cancer evolves from a complicated combination of

multiple exposures. Attempting to assign certain

exposures (i.e. diet, smoking, environment, etc.)

certain roles in causing cancer that will total 100% is

inappropriate given that no one exposure single￾handedly produces cancer and many causes of

cancer are still unknown. Comprehensive cancer

prevention programs need to reduce exposures from

all avoidable sources. Cancer prevention programs

focused on tobacco use, diet, and other individual

behaviors disregard the lessons of science.

• Examples of strong causal links between

environmental and occupational exposures and

cancer include:

o Metals such as arsenic and cancers of the

bladder, lung, and skin.

o Chlorination byproducts such as trihalomethanes

and bladder cancer.

o Natural fibers such as asbestos and cancers of

the larynx, lung, mesothelioma, and stomach.

o Petrochemicals and combustion products,

including motor vehicle exhaust and

polycyclic aromatic hydrocarbons, and cancers

of the bladder, lung, and skin.

o Pesticide exposures and cancers of the brain,

Wilms tumor, leukemia, and non-Hodgkin’s

lymphoma.

o Reactive chemicals such as vinyl chloride and

liver cancer and soft tissue sarcoma.

o Metalworking fluids and mineral oils with

cancers of the bladder, larynx, nasal passages,

rectum, skin, and stomach.

o Ionizing radiation and cancers of the bladder,

bone, brain, breast, liver, lung, ovary, skin,

and thyroid, as well as leukemia, multiple

myeloma, and sarcomas.

o Solvents such as benzene and leukemia and non￾Hodgkin’s lymphoma; tetrachloroethylene and

bladder cancer; and trichloroethylene and

Hodgkin’s disease, leukemia, and kidney and liver

cancers.

o Environmental tobacco smoke and cancers of

the breast and lung.

The sum of the evidence regarding environmental

and occupational contributions to cancer justifies urgent

acceleration of policy efforts to prevent carcinogenic

exposures. By implementing precautionary policies,

Europeans are creating a model that can be applied in the

U.S. to protect public health and the environment. To

ignore the scientific evidence is to knowingly permit tens

of thousands of unnecessary illnesses and deaths each

year.

ENVIRONMENTAL & OCCUPATIONAL CAUSES OF CANCER ● Lowell Center for Sustainable Production 1