Lombaert Noömi, Gilles Mik, Verougstraete Violaine
International Cadmium Association, 1150 Brussels, Belgium.
International Zinc Association, Reach Cadmium Consortium, 1150 Brussels, Belgium.
Toxics. 2023 Apr 8;11(4):354. doi: 10.3390/toxics11040354.
Inhalation exposure to cadmium at the workplace has been associated with an increased risk of lung cancer and non-cancer respiratory effects. To ensure levels of cadmium remain below effect levels, air quality is monitored and regulations specifying an air limit value are implemented. The EU Carcinogens and Mutagens Directive of 2019 recommended values for the inhalable fraction and the respirable fraction but the latter only for a transitional period. Cadmium exposure has also been associated with systemic effects, following its storage in the kidneys and due to its long half-life. The accumulation of cadmium occurs via different exposure routes and from different sources, including workplace dust and fumes, food, and smoking. Biomonitoring (in blood, urine) has been identified as the most appropriate method to follow up cumulative exposure and total cadmium body burden, as it conveniently reflects intakes by all routes. However, it is not systematically implemented. This paper has a double objective: first, proposing a possible limit value for the respirable fraction, using an approach integrating epidemiological data. Secondly, demonstrating that the implementation of both air and biological limit values is key to protecting workers' health in occupational settings. The paper summarizes the current knowledge on cadmium health effects and how biomarkers reflect those. It presents an approach to derive a respirable value, using recent human data, and describes how the combination of air monitoring and biomonitoring is applied by the EU industry to protect the workforce. While a respirable fraction value helps protect workers against local respiratory adverse health effects, air monitoring alone is not sufficient to protect workers against systemic effects of cadmium. Therefore, complementary biomonitoring and the implementation of a biological limit value is recommended.
在工作场所吸入镉与肺癌风险增加以及非癌症性呼吸道影响有关。为确保镉含量保持在影响水平以下，需对空气质量进行监测，并实施规定空气限值的法规。欧盟2019年的《致癌物和诱变剂指令》推荐了可吸入部分和可呼吸部分的数值，但后者仅适用于过渡期。镉暴露还与全身影响有关，这是由于其在肾脏中的蓄积以及半衰期较长。镉的蓄积通过不同的暴露途径和来源发生，包括工作场所的灰尘和烟雾、食物以及吸烟。生物监测（血液、尿液）已被确定为跟踪累积暴露和体内镉总负担的最合适方法，因为它能方便地反映所有途径的摄入量。然而，它并未得到系统实施。本文有两个目标：第一，使用整合流行病学数据的方法，提出可呼吸部分的可能限值。第二，证明实施空气和生物限值对于在职业环境中保护工人健康至关重要。本文总结了目前关于镉对健康影响的知识以及生物标志物如何反映这些影响。它提出了一种利用最新人体数据得出可呼吸值的方法，并描述了欧盟行业如何应用空气监测和生物监测的组合来保护劳动力。虽然可呼吸部分的值有助于保护工人免受局部呼吸道不良健康影响，但仅靠空气监测不足以保护工人免受镉的全身影响。因此，建议进行补充生物监测并实施生物限值。
