Priorities for Occupational Cancer Research and Prevention in Canada Paul A. Demers, PhD

OCRC Research Day 2011 March 23rd, 2011 Research Program Priority Areas from the OCRC Strategic Plan • Surveillance of occupational cancers & workplace exposures • Identification of causes of cancer in the workplace • Intervention research to develop and evaluate prevention and exposure reduction strategies What substances and circumstances should be priorities? • ~ 60 definite or probable workplace • Over 100 additional workplace exposures are possible carcinogens • Many other workplace exposures with a suspicion of human carcinogenicity • Even greater number of workplace substances with little formal evaluation Recent Reports Relevant to Setting Priorities • Report of the Advisory Group to Recommend Priorities for IARC Monographs during 2010–2014. IARC, Internal Report 08/001. Lyon, France, 2008 • Ward EM, Schulte PA, Straif K, et al. Research Recommendations for Selected IARC‐Classified Agents. Environmental Health Perspectives 2010:119(10):1355‐1362. • Presidents Cancer Panel. Reducing environmental cancer risks. U.S. National Cancer Institute, April 2010. • Demers PA, Peters CE, Nicol AM. Priority Occupational Carcinogens for Surveillance in Canada: Preliminary Priority List. CAREX Canada, 2008. • Hohenadel K, Marrett L, Pichora E, Brown J, Harris S, Blair A. Occupational Cancer Research Centre Stakeholder Consultation Report. OCRC, November 2009.

All reports are available at: http://occupationalcancer.ca/topics/information‐resources/reports/ IARC Evaluation Priorities 2010‐2014

High Priorities (occupational) Medium priorities (occupational)

Asphalt & bitumen* Atrazine Carbon‐based nanoparticles Metalworking fluids & lubricants Crystalline fibres other than N‐Nitrosamines* Ultrafine particles Polybrominated biphenyls (PBB) Motor vehicle exhaust emissions Polybrominated diphenyl ethers (PBDE) Perfluorinated compounds (e.g. PFOA) Polychlorinated biphenyls (PCB) Radiofrequency electromagnetic fields* DEHP and other phthalates* Sedentary work Styrene Stress Trichloroethylene & other chlorinated Iron & iron oxides solvents Welding

* IARC review already scheduled NIOSH/IARC Top 20 Research Priorities Ultrafine particles Chlorinated solvents Titanium dioxide Trichloroethylene Carbon black Perchloroethylene Diesel Engine Exhaust Methylene chloride Welding fumes Chloroform Metals Other Chemicals Lead & lead compounds Formaldehyde Indium phosphide Styrene & Styrene‐7,8‐Oxide Metallic cobalt Acetaldehyde Pesticides Propylene Oxide Polychlorinated Biphenyls (PCBs) Atrazine Di (2‐ethylhexyl) phthalate (DEHP) Shiftwork Priorities for Etiologic Research versus Prevention? • Both the IARC Monograph Program and the NIOSH priorities focus on contributing to the classification of new carcinogens • Research on established carcinogens? – Some are defined only by job or industry (e.g. painting & welding) and targets for prevention are needed – Some are poorly defined (e.g. wood dust) – Dose‐response often poorly understood OCRC Stakeholder Needs Assessment Survey Most frequently identified exposures Exposure category Examples of commonly listed exposures Frequency Chemicals Formaldehyde, amines, PCB, sulphuric acid mists… 30 Dusts and fibres Asbestos, fibreglass, silica, wood dust, carbon black 27 Radiation Electromagnetic fields, nuclear, cell phone, solar, 24 ionizing radiation, radiofrequency radiation, WIFI… Lifestyle factors Smoking, physical activity, stress, diet, alcohol 18 Shiftwork ‐‐ 16 Pesticides ‐‐ 15 Nanomaterials ‐‐ 14 Exhaust Diesel, gasoline 14 Metals Uranium, chromium, cobalt, gold, , smelter 13 fumes, tungsten, welding fumes, lead Work environment Indoor air, environmental tobacco smoke, mould 12 Solvents Solvents (general), benzene, trichloroethylene… 9 Fossil fuels & oils Metal working fluid, oil mists, , fuel, asphalt 7 Pharmaceuticals Antineoplastic drugs, cytotoxic drugs 4 CAREX Canada Estimated Exposure in Ontario • Over 250,000 exposed: Shift work at night, , solar radiation • 100‐250,000: Other PAHs, crystalline silica, benzene • 50‐100,000 exposed: Lead, wood dust, asbestos, artificial UV • 25‐50,000 exposed: Chromium, chlorophenoxy herbicides • 10‐25,000 exposed: Nickel, cobalt, styrene, ionizing radiation, formaldehyde, cadmium, toluene diisocyanate • 5‐10,000 exposed: Tetrachloroethylene, trichloroethylene, methylene chloride, antineoplastic drugs, • 1‐5,000 : PCBs, refractory ceramic fibres, antimony trioxide, acrylonitrile, acrylamide, napthalene, vanadium pentoxide, pentachlorophenol

http://www.carexcanada.ca/en/carcinogen_profiles_and_estimates/ OCRC Cancer Research Priorities: General Principles • Focus on suspected carcinogens to contribute to the classification of carcinogens • Studies of new and emerging issues (e.g. shiftwork) and under‐studied populations (e.g. women) • Cancer surveillance to identify new groups at increased risk and identify new potential carcinogens • Focus on established carcinogens for exposure surveillance and preventions related research • Consider past, current, and future exposure in Ontario Towards a cancer free workplace http://occupationalcancer.ca