Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Swedish Work Environment Authority, Solna, Sweden.
Crit Rev Toxicol. 2023 Dec;53(3):131-167. doi: 10.1080/10408444.2023.2218887. Epub 2023 Jun 27.
This article addresses issues of importance for occupational exposure limits (OELs) and chemical carcinogens with a focus on non-threshold carcinogens. It comprises scientific as well as regulatory issues. It is an overview, not a comprehensive review. A central topic is mechanistic research and insights, and its implications for cancer risk assessment. Alongside scientific advancements, the approaches of hazard identification and qualitative and quantitative risk assessment have developed over the years. The key steps in a quantitative risk assessment are outlined, with special attention given to the dose-response assessment and the derivation of an OEL using risk calculations or default assessment factors. The work procedures of several bodies performing cancer hazard identifications and quantitative risk assessments, as well as regulatory procedures to derive OELs for non-threshold carcinogens, are presented. Non-threshold carcinogens for which the European Union (EU) introduced binding OELs in 2017-2019 serve as illustrations together with some currently used strategies in the EU and elsewhere. Available knowledge supports the derivation of health-based OELs (Hb-OELs) for non-threshold carcinogens, and the use of a risk-based approach with low-dose linear extrapolation (linear non-threshold, LNT) as the default for non-threshold carcinogens. However, there is a need to develop methods that allow recent years' advances in cancer research to be used for improving risk estimates. It is recommended that defined risk levels (terminology and numerical values) are harmonised, and that both collective and individual risks are considered and clearly communicated. Socioeconomic aspects should be dealt with transparently and separated from the scientific health risk assessment.
本文主要讨论职业接触限值(OEL)和化学致癌物的相关问题,重点是非阈值致癌物。涵盖了科学和监管方面的内容。本文是一篇概述,而非全面综述。其中一个核心主题是机制研究及其对癌症风险评估的启示。除了科学进展外,危害识别以及定性和定量风险评估方法多年来也在不断发展。本文概述了定量风险评估的关键步骤,特别关注剂量-反应评估以及使用风险计算或默认评估因素推导 OEL。本文还介绍了几个进行癌症危害识别和定量风险评估的机构的工作程序,以及为非阈值致癌物推导 OEL 的监管程序。本文以欧盟在 2017-2019 年为非阈值致癌物引入有约束力 OEL 为例,同时介绍了欧盟和其他地区目前使用的一些策略。现有知识支持为非阈值致癌物制定基于健康的 OEL(Hb-OEL),并使用基于风险的方法进行低剂量线性外推(线性非阈值,LNT)作为非阈值致癌物的默认方法。然而,需要开发方法,以便将近年来癌症研究的进展应用于改善风险估计。建议协调定义的风险水平(术语和数值),并考虑和明确传达集体风险和个体风险。应透明地处理社会经济方面的问题,并将其与科学健康风险评估分开。