Rushton L, Hutchings S, Brown T
Imperial College London, Department of Epidemiology and Public Health, Faculty of Medicine, St Mary's Campus, London, UK.
Occup Environ Med. 2008 Dec;65(12):789-800. doi: 10.1136/oem.2007.037002. Epub 2007 Dec 13.
Work-related cancers are largely preventable. The overall aim of this project is to estimate the current burden of cancer in Great Britain attributable to occupational factors, and identify carcinogenic agents, industries and occupations for targeting risk prevention.
Attributable fractions and numbers were estimated for mortality and incidence for bladder, lung, non-melanoma skin, and sinonasal cancers, leukaemia and mesothelioma for agents and occupations classified as International Agency for Research on Cancer (IARC) Group 1 and 2A carcinogens with "strong" or "suggestive" evidence for carcinogenicity at the specific cancer site in humans. Risk estimates were obtained from published literature and national data sources used for estimating proportions exposed.
In 2004, 78,237 men and 71,666 women died from cancer in Great Britain. Of these, 7317 (4.9%) deaths (men: 6259 (8%); women: 1058 (1.5%)) were estimated to be attributable to work-related carcinogens for the six cancers assessed. Incidence estimates were 13,338 (4.0%) registrations (men: 11,284 (6.7%); women 2054 (1.2%)). Asbestos contributed over half the occupational attributable deaths, followed by silica, diesel engine exhaust, radon, work as a painter, mineral oils in metal workers and in the printing industry, environmental tobacco smoke (non-smokers), work as a welder and dioxins. Occupational exposure to solar radiation, mineral oils and coal tars/pitches contributed 2557, 1867 and 550 skin cancer registrations, respectively. Industries/occupations with large numbers of deaths and/or registrations include construction, metal working, personal and household services, mining (not metals), land transport and services allied to transport, roofing, road repair/construction, printing, farming, the Armed Forces, some other service industry sectors and manufacture of transport equipment, fabricated metal products, machinery, non-ferrous metals and metal products, and chemicals.
Estimates for all but leukaemia are greater than those currently used in UK health and safety strategy planning and contrast with small numbers (200-240 annually) from occupational accidents. Sources of uncertainty in the estimates arise principally from approximate data and methodological issues. On balance, the estimates are likely to be a conservative estimate of the true risk. Long latency means that past high exposures will continue to give substantial numbers in the near future. Although levels of many exposures have reduced, recent measurements of others, such as wood dust and respirable quartz, show continuing high levels.
与工作相关的癌症在很大程度上是可以预防的。本项目的总体目标是估计英国目前因职业因素导致的癌症负担，并确定致癌因素、行业和职业，以便针对性地进行风险预防。
对膀胱癌、肺癌、非黑色素瘤皮肤癌、鼻窦癌、白血病和间皮瘤的死亡率和发病率的归因分数及数量进行了估计，这些癌症的致癌因素和职业被国际癌症研究机构（IARC）归类为第1组和2A组致癌物，且在人类特定癌症部位有“充分”或“提示性”致癌证据。风险估计来自已发表的文献和用于估计暴露比例的国家数据源。
2004年，英国有78237名男性和71666名女性死于癌症。其中，估计有7317例（4.9%）死亡（男性：6259例（8%）；女性：1058例（1.5%））可归因于所评估的六种与工作相关的致癌物。发病率估计为13338例（4.0%）登记病例（男性：11284例（6.7%）；女性：2054例（1.2%））。石棉导致的职业归因死亡占一半以上，其次是二氧化硅、柴油机尾气、氡、油漆工工作、金属工人和印刷行业接触的矿物油、环境烟草烟雾（非吸烟者）、焊工工作和二恶英。职业性接触太阳辐射、矿物油和煤焦油/沥青分别导致2557例、1867例和550例皮肤癌登记病例。死亡和/或登记病例数量较多的行业/职业包括建筑业、金属加工业、个人和家庭服务业、采矿业（不包括金属矿）、陆路运输及相关服务业、屋顶修缮、道路维修/建设、印刷业、农业、武装部队、其他一些服务业以及运输设备制造业、金属制品制造业、机械制造业、有色金属和金属制品制造业以及化学工业。
除白血病外，所有癌症的估计数均高于英国目前健康与安全战略规划中使用的数字，与职业事故每年导致的少量死亡（200 - 240例）形成对比。估计数的不确定性主要源于近似数据和方法学问题。总体而言，这些估计数可能是真实风险的保守估计。长时间的潜伏期意味着过去的高暴露水平在不久的将来仍将导致大量病例。尽管许多暴露水平已经降低，但最近对其他一些物质（如木尘和可吸入石英）的测量显示，其水平仍然很高。
