14. Cancers attributable to occupational exposures in the UK in 2010

When Scientific Knowledge and Ignorance Make It Difficult to Improve Occupational Health: A French and European Perspective

This article analyzes the consequences of the increasing reference to scientific expertise in the decision and implementation process of occupational health policy. Based on examples (exposure limits and attributable fractions) taken from an interdisciplinary seminar conducted in 2014 to 2015 in France, it shows how the measurement or regulation of a problem through biomedicine-based tools produces blind spots. It also uses a case study to show the contradictions between scientific and academic aims and public health intervention. Other indirect implications are also examined, such as the limitation of trade unions' scope for action. Finally, the article suggests launching a broad political debate accessible to nonspecialists about collective occupational health issues-a dialogue made difficult by the rise of the afore-mentioned techno-scientific perspective.

Associations between occupational exposure to benzene, toluene and xylene and risk of lung cancer in Montréal

BACKGROUND

Benzene, toluene and xylene (BTX) are aromatic hydrocarbons with inconclusive evidence of lung carcinogenicity. The aim of this research was to assess the associations between occupational exposures to BTX agents and lung cancer.

METHODS

In a population-based case-control study of lung cancer, occupational histories were obtained and exposures were assessed by experts. Unconditional multivariate logistic regression was used to estimate ORs and 95% CIs, among men, between various metrics of occupational exposure to BTX and lung cancer, while adjusting for established and possible risk factors.

RESULTS

Considerable overlap was found between occupational exposure to BTX, where the majority of exposed participants were exposed to all three chemicals. Lung cancer was associated with exposure to benzene (OR=1.35; 95% CI 0.99 to 1.84), toluene (OR=1.31; 95% CI 0.99 to 1.74) and xylene (OR=1.44; 95% CI 1.03 to 2.01). While these results were adjusted for smoking and other recognised and possible lung cancer risk factors, they were not mutually adjusted among the three BTX agents.

CONCLUSIONS

Our study provides suggestive evidence that occupational exposure to one or more of the BTX agents may be associated with lung cancer.

Associations Between Sexual Orientation and Overall and Site-Specific Diagnosis of Cancer: Evidence From Two National Patient Surveys in England

Purpose To address gaps in evidence on the risk of cancer in people from sexual minorities. Patients and Methods We used data from 796,594 population-based English General Practice Patient Survey responders to explore the prevalence of self-reported diagnoses of cancer in the last 5 years among sexual minorities compared with heterosexual women and men. We analyzed data from 249,010 hospital-based English Cancer Patient Experience Survey responders with sexual orientation as a binary outcome, and International Classification of Diseases, Tenth, Revision, diagnosis as covariate-38 different common and rarer cancers, with breast and prostate cancer as baseline categories for women and men, respectively-to examine whether people from sexual minorities are over- or under-represented among different cancer sites. For both analyses, we used logistic regression, stratified by sex and adjusted for age. Results A diagnosis of cancer in the past 5 years was more commonly reported by male General Practice Patient Survey responders who endorsed gay or bisexual orientation compared with heterosexual men (odds ratio [OR], 1.31; 95% CI, 1.15 to 1.49; P < .001) without evidence of a difference between lesbian or bisexual compared with heterosexual women (OR, 1.14; 95% CI, 0.94 to 1.37; P = .19). For most common and rarer cancer sites (30 of 33 in women, 28 of 32 in men), the odds of specific cancer site diagnosis among Cancer Patient Experience Survey respondents seemed to be independent of sexual orientation; however, there were notable differences in infection-related (HIV and human papillomavirus [HPV]) cancers. Gay or bisexual men were over-represented among men with Kaposi's sarcoma (OR, 48.2; 95% CI, 22.0 to 105.6), anal (OR, 15.5; 95% CI, 11.0 to 21.9), and penile cancer (OR, 1.8; 95% CI, 0.9 to 3.7). Lesbian or bisexual women were over-represented among women with oropharyngeal cancer (OR, 3.2; 95% CI, 1.7 to 6.0). Conclusion Large-scale evidence indicates that the distribution of cancer sites does not vary substantially by sexual orientation, with the exception of some HPV- and HIV-associated cancers. These findings highlight the importance of HPV vaccination in heterosexual and sexual minority populations.

Attitudes towards lung cancer screening in socioeconomically deprived and heavy smoking communities: informing screening communication

BACKGROUND

While discussion continues over the future implementation of lung cancer screening, low participation from higher risk groups could limit the effectiveness of any national screening programme.

OBJECTIVES

To compare smokers' beliefs about lung cancer screening with those of former and never smokers within a low socioeconomic status (SES) sample, to explore the views of lower SES smokers and ex-smokers in-depth, and to provide insights into effective engagement strategies.

DESIGN, SETTING AND PARTICIPANTS

Using proactive, community-based recruitment methods, we surveyed 175 individuals from socioeconomically deprived communities with high smoking prevalence and subsequently interviewed 21 smokers and ex-smokers. Participants were approached in community settings or responded to a mail-out from their housing association.

RESULTS

Interviewees were supportive of screening in principle, but many were doubtful about its ability to deliver long-term survival benefit for their generation of "heavy smokers." Lung cancer was perceived as an uncontrollable disease, and the survey data showed that fatalism, worry and perceived risk of lung cancer were particularly high among smokers compared with non-smokers. Perceived blame and stigma around lung cancer as a self-inflicted smokers' disease were implicated by interviewees as important social deterrents of screening participation. The belief that lungs are not a treatable organ appeared to be a common lay explanation for poor survival and undermined the potential value of screening.

CONCLUSIONS

Attitudes towards screening among this high-risk group are complex. Invitation strategies need to be carefully devised to achieve equitable participation in screening.

Cancer incidence attributable to lifestyle and environmental factors in Alberta in 2012: summary of results

BACKGROUND

Estimates of the proportion of cancer cases that can be attributed to modifiable risk factors are not available for Canada and, more specifically, Alberta. The purpose of this study was to estimate the total proportion of cancer cases in Alberta in 2012 that could be attributed to a set of 24 modifiable lifestyle and environmental risk factors.

METHODS

We estimated summary population attributable risk estimates for 24 risk factors (smoking [both passive and active], overweight and obesity, inadequate physical activity, diet [inadequate fruit and vegetable consumption, inadequate fibre intake, excess red and processed meat consumption, salt consumption, inadequate calcium and vitamin D intake], alcohol, hormones [oral contraceptives and hormone therapy], infections [Epstein-Barr virus, hepatitis B and C viruses, human papillomavirus, Helicobacter pylori], air pollution, natural and artificial ultraviolet radiation, radon and water disinfection by-products) by combining population attributable risk estimates for each of the 24 factors that had been previously estimated. To account for the possibility that individual cancer cases were the result of a combination of multiple risk factors, we subtracted the population attributable risk for the first factor from 100% and then applied the population attributable risk for the second factor to the remaining proportion that was not attributable to the first factor. We repeated this process in sequential order for all relevant exposures.

RESULTS

Overall, an estimated 40.8% of cancer cases in Alberta in 2012 were attributable to modifiable lifestyle and environmental risk factors. The largest proportion of cancers were estimated to be attributable to tobacco smoking, physical inactivity and excess body weight. The summary population attributable risk estimate was slightly higher among women (42.4%) than among men (38.7%).

INTERPRETATION

About 41% of cancer cases in Alberta may be attributable to known modifiable lifestyle and environmental risk factors. Reducing the prevalence of these factors in the Alberta population has the potential to substantially reduce the provincial cancer burden.

A methodologic framework to evaluate the number of cancers attributable to lifestyle and environment in Alberta

BACKGROUND

Previous research to estimate population attributable risks for cancer in Alberta has been limited. Attributable burden estimates are important for planning and implementing population-based cancer prevention strategies. This article describes a methodologic framework to estimate the number of incident cancers attributable to modifiable lifestyle and environmental risk factors in Alberta.

METHODS

We estimated population attributable risks for cancer for exposures to 24 established cancer risk factors including tobacco consumption and environmental tobacco exposure, environmental factors, infectious agents, hormone therapies, dietary intake, obesity and physical inactivity. We used risk estimates to quantify the association between individual exposures and cancer sites as well as prevalence estimates for individual exposures in Alberta to estimate the proportion of cancer in Alberta that could be attributed to each exposure. These estimations were conducted in the context of a theoretical minimum risk principle, whereby exposures corresponding to the lowest levels of population risk were used as the comparisons for alternative exposure levels.

INTE RPRETATION

We outline the main methodologic principles for the protocol used in evaluating population attributable risks for modifiable lifestyle and environmental risk factors for cancer in Alberta. The data produced by this project will provide important information concerning which known cancer risk factors are responsible for the largest proportions of cancer in Alberta and could inform future cancer prevention strategies.

Impact of work-related cancers in Taiwan-Estimation with QALY (quality-adjusted life year) and healthcare costs

This study estimates the annual numbers of eight work-related cancers, total losses of quality-adjusted life years (QALYs), and lifetime healthcare expenditures that possibly could be saved by improving occupational health in Taiwan. Three databases were interlinked: the Taiwan Cancer Registry, the National Mortality Registry, and the National Health Insurance Research Database. Annual numbers of work-related cancers were estimated based on attributable fractions (AFs) abstracted from a literature review. The survival functions for eight cancers were estimated and extrapolated to lifetime using a semi-parametric method. A convenience sample of 8846 measurements of patients' quality of life with EQ-5D was collected for utility values and multiplied by survival functions to estimate quality-adjusted life expectancies (QALEs). The loss-of-QALE was obtained by subtracting the QALE of cancer from age- and sex-matched referents simulated from national vital statistics. The lifetime healthcare expenditures were estimated by multiplying the survival probability with mean monthly costs paid by the National Health Insurance for cancer diagnosis and treatment and summing this for the expected lifetime. A total of 3010 males and 726 females with eight work-related cancers were estimated in 2010. Among them, lung cancer ranked first in terms of QALY loss, with an annual total loss-of-QALE of 28,463 QALYs and total lifetime healthcare expenditures of US$36.6 million. Successful prevention of eight work-related cancers would not only avoid the occurrence of 3736 cases of cancer, but would also save more than US$70 million in healthcare costs and 46,750 QALYs for the Taiwan society in 2010.

•

A practical approach to estimate impact of work-related cancers is demonstrated.

•

3010 male and 726 female cancers were estimated work-related in Taiwan in 2010.

•

The impact included 46,750 QALYs annually, healthcare costs more than US$70 million.

Human papilloma virus attributable head and neck cancer in the sudan assessed by p16INK4A immunostaining

BACKGROUND

The aim of this study was to screen for human papillomavirus (HPV) infections in head and neck squamous cell carcinomas (HNSCCs) using P16 immunostaining.

MATERIALS AND METHODS

A retrospective study was performed on 150 samples from patients diagnosed with HNSCCs. HPV status was determined using p16INK4A.

RESULTS

31 of the 150 (20.7%) HNSCCs were HPV positive.

CONCLUSIONS

A large proportion of HNSCCs in Sudan are associated with HPV infection. The fact that the prevalence of HPV is high among Sudanese patients with head and neck cancers (HNC) has obvious implications for vaccine therapy.

Novel targeted bladder drug-delivery systems: a review

The objective of pharmaceutics is the development of drugs with increased efficacy and reduced side effects. Prolonged exposure of the diseased tissue to the drug is of crucial importance. Drug-delivery systems (DDSs) have been introduced to control rate, time, and place of release. Drugs can easily reach the bladder through a catheter, while systemically administered agents may undergo extensive metabolism. Continuous urine filling and subsequent washout hinder intravesical drug delivery (IDD). Moreover, the low permeability of the urothelium, also described as the bladder permeability barrier, poses a major challenge in the development of the IDD. DDSs increase bioavailability of drugs, therefore improving therapeutic effect and patient compliance. This review focuses on novel DDSs to treat bladder conditions such as overactive bladder, interstitial cystitis, bladder cancer, and recurrent urinary tract infections. The rationale and strategies for both systemic and local delivery methods are discussed, with emphasis on new formulations of well-known drugs (oxybutynin), nanocarriers, polymeric hydrogels, intravesical devices, encapsulated DDSs, and gene therapy. We give an overview of current and future prospects of DDSs for bladder disorders, including nanotechnology and gene therapy.

Association of breast cancer with sleep pattern--a pilot case control study in a regional cancer centre in South Asia

The rising trend of breast cancer both in developed and developing countries is a real threat challenging all efforts to screening, prevention and treatment aspects to reduce its impact. In spite of modern preventive strategies, the upward trend of breast cancer has become a matter of great concern in both developed and developing countries. Chittaranjan National Cancer Institute is a premier regional cancer institute in eastern region of India catering to a large number of cancer patients every year. A pilot case control study of fifty breast cancer patients and 100 matched controls was conducted during 2013 to evaluate the effects of habitual factors like working in night shift, not having adequate sleep, and not sleeping in total darkness on breast cancer of women. The study revealed that not sleeping in total darkness was associated with higher odds of outcome of breast cancer of women. This positive correlation can play a vital role in formulation of preventive strategies through life style modification.

Interaction of chromium(III) with a N,N'-disubstituted hydroxylamine-(diamido) ligand: a combined experimental and theoretical study

Reaction of hydroxylamine hydrochloride with prop-2-enamide in dichloromethane in the presence of triethylamine resulted in the isolation of the N,N'-disubstituted hydroxylamine-(diamido) ligand, 3,3'-(hydroxyazanediyl)dipropanamide (Hhydia). The ligand Hhydia was characterized by multinuclear NMR, high-resolution electrospray ionization mass spectrometry (ESI-MS), and X-ray structure analysis. Interaction of Hhydia with trans-[Cr(III)Cl2(H2O)4]Cl·2H2O in ethanol yields the ionization isomers [Cr(III)(Hhydia)2]Cl3·2H2O(1·2H2O) and cis/trans-[Cr(III)Cl2(Hhydia)2]Cl·2H2O (2·2H2O). The X-ray structure analysis of 1 revealed that the chromium atom in [Cr(III)(Hhydia)2](3+) is bonded to two neutral tridentate O,N,O-Hhydia ligands. The twist angle, θ, in [Cr(III)(Hhydia)2](3+) is 54.5(6)(0), that is, very close to an ideal octahedron. The intramolecular hydrogen bonds developed between the N-OH group of the first ligand and the amidic oxygen atom of the second ligand and vice versa contribute to the overall stability of the cation [Cr(III)(Hhydia)2](3+). The reaction rate constant of the formation of Cr(III) complexes 1·2H2O and 2·2H2O was found to be 8.7(±0.8) × 10(-5) M(-1) s(-1) at 25 °C in methyl alcohol and follows a first-order law kinetics based on the biologically relevant ligand Hhydia. The reaction rate constant is considerably faster in comparison with the corresponding water exchange rate constant for the hydrated chromium(III). The modification of the kinetics is of fundamental importance for the chromium(III) chemistry in biological systems. Ultraviolet-visible and electron paramagnetic resonance studies, both in solution and in the solid state, ESI-MS, and conductivity measurements support the fact that, irrespective of the solvent used in the interaction of Hhydia with trans-[Cr(III)Cl2(H2O)4]Cl·2H2O, the ionization isomers[Cr(III)(Hhydia)2]Cl3·2H2O (1·2H2O) and cis/trans-[Cr(III)Cl2(Hhydia)2]Cl·2H2O (2·2H2O) are produced.The reaction medium affects only the relevant percentage of the isomers in the solid state. The thermodynamic stability of the ionization isomers 1·2H2O and cis/trans-2·2H2O, their molecular structures as well as the vibrational spectra and the energetics of the Cr(III)- Hhydia/hydia(-) were studied by means of density functional theory calculations and found to be in excellent agreement with our experimental observations.

[Cancers of the nasal cavity and paranasal sinuses: clinicopathological, etiological and therapeutic aspects]

Sinonasal cancers are rare and are often associated with occupational exposure that should be researched. Their diagnosis is often delayed. Carcinomas are the most common histological variety. The aim of the present report is to review the main scientific literature about sinonasal cancer to identify their clinicopathological features, and their main causes and treatment modalities. The treatment of these tumors is surgical, usually followed by radiotherapy.

Frequency and genotype of human papillomavirus among Sudanese patients with head and neck tumours

OBJECTIVES

The aim of this study was to determine the frequency and genotype of human papillomavirus (HPV) infections in head and neck squamous cell carcinomas (HNSCCs) and benign head and neck tumours.

METHODOLOGY

A retrospective study was performed on 150 samples of patients diagnosed with HNSCCs and 50 samples obtained from patients diagnosed with benign head and neck tumours. Tumour DNA was amplified using polymerase chain reaction (PCR) with HPV consensus and multiplex primers.

RESULTS

Six of the 150 (4%) HNSCCs were HPV positive. HPV16 was the most prevalent type, with single infections present in 3/6 (50%) cases, whereas HPV18 and HPV33 were detected in 2/6 (33%) and 1/6 (17%), respectively. HPV infections were detected in 3 (50%) cases of oral cavity and 3 (50%) cases of pharynx.

CONCLUSIONS

There was a significant association between HPV infection and HNSCCs (P < 0.05). The present data support the importance of HPV infection in oral and larynx tumours.

Role of solar UVB irradiance and smoking in cancer as inferred from cancer incidence rates by occupation in Nordic countries

A large body of evidence indicates that solar ultraviolet-B (UVB) irradiance and vitamin D reduce the risk of incidence and death for many types of cancer. However, most of that evidence comes from midlatitude regions, where solar UVB doses are generally high in summer. Data on cancer standardized incidence ratios (SIRs) by sex and 54 occupation categories based on 1.4 million male and 1.36 million female cancer cases for 1961–2005 in the five Nordic countries provide the basis for an ecological study of the role of solar UVB in the risk of many types of cancer at high latitudes. Lip cancer SIRs less lung cancer SIRs for men was the best index of solar UVB dose, which was weakly inversely correlated with both melanoma and nonmelanoma skin cancer (NMSC) SIRs. Lung cancer SIRs were used as the index of the effects of smoking. For men, the UVB index was significantly inversely correlated with 14 types of internal cancer—bladder, breast, colon, gallbladder, kidney, laryngeal, liver, lung, oral, pancreatic, pharyngeal, prostate, rectal and small intestine cancer. For women, the same UVB index was inversely correlated with bladder, breast and colon cancer. These results generally agree with findings from other studies. These results provide more support for the UVB-vitamin D-cancer hypothesis and suggest that widespread fear of chronic solar ultraviolet (UV) irradiance may be misplaced.