Cancer & the Environment

Cancer & the Environment Overview

Environmental and Internal Factors

Sources of Data
Specific Factors (pathogens; radiation; medications and hormones; occupational; environmental)

Exposure Assessment, Monitoring, and Comparison Groups

Identifying Carcinogens and Risk Assessment

Occupational Studies
Cancer Clusters
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What is the Environment?

Everything

outside of the body that enters and interacts

with it Diet, medications, radiation, sunlight, hormones, viruses, bacteria, smoking, alcohol, chemicals, etc. Traditionally we think of chemicals and other external harmful exposures and not pathogens and lifestyle factors Two-thirds of cancers are linked to some type of environmental factor (including diet and lifestyle factors)

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Avoidable Environmental Factors

Proportion of Cancer Deaths Linked to Avoidable Risk Factors
Tobacco Diet Infections: bacteria, viruses Ionizing and UV light Occupation Pollution: air, water, food 2931 percent 2050 percent 1020 percent 57 percent 24 percent

15 percent

Source: Doll R. (UK data) Recent Results in Cancer Research 1998; 154:3-21.

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Internal Factors
Genetics and family history Gene-environment interactions Immunity and hormone levels Susceptibility and detoxification

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Sources of Data on Environmental Agents

IARC-Comprehensive program for evaluating potential carcinogencity of chemical and physical agents

http://monographs.iarc.fr/ENG/Classification/index. php Decisions based on epidemiology, toxicology, animal studies, and genetics Most up to date information because experts meet regularly to review new information on agents that have incomplete or conflicting information

NIOSH and National Toxicology Program have similar schemes

http://ntp.niehs.nih.gov Publish new list every 2 years but more limited in coverage of agents
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Sources of Data on Environmental Agents

Table 81 International Agency for Research on Cancer (IARC) Assessments of Chemical Carcinogenicity as of 2004 *
Category Carcinogenicity Number of Agents or Exposure Situations 95 66 241 497 1 Number of Agents or Exposure Situations that are Occupational 28 27 113 -

Group 1 Group 2A Group 2B Group 3 Group 4

Carcinogenic to humans Probably carcinogenic to humans Possibly carcinogenic to humans Not Classifiable as to carcinogenicity in Humans Probably not carcinogenic to humans

Total evaluated 900 *Source: Adapted with persmission from J.M. Stellman and S.D. Stellman, Cancer and the Workplace, CA A Cancer Journal for Clinicians, Vol. 46, pp. 70-92, 1996, Lippincott-Raven Publishers. Source: As evaluated in IARC Monographs Volumes 1-88. Source: J. Siemiatycki et al, Listing Occupational Carcinogens, Environmental Health Perspectives, Vol. 112 No. 15, pp. 1447-1459, 2004.

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Pathogens
Viruses

Human papillomavirus Hepatitis B and C Epstein-Barr Human herpesvirus 8

Heliobactor pylori

Bacteria Aflatoxins

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Radiation
Ultraviolet radiation Ionizing radiation
Nuclear materials Radon gas Therapeutic and diagnostic radiation

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Medications and Hormones

Chemotherapeutic and immunosuppressive agents Hormone replacement therapy Oral contraceptives

DES

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Occupational Chemicals
Solvents Benzene, carbon tetrachloride, chloroform Fibers and dust Asbestos Silica Wood Vinyl chloride Dioxins

Polycyclic aromatic hydrocarbons

Benzidine
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Occupational Chemicals: Metals

Metal
Arsenic Beryllium

Cancers
Skin, lung, bladder, kidney, liver Lung

Present in
Wood preservatives, glass, pesticides Nuclear weapons, rocket fuel, ceramics, glass, plastic, fiberoptic products Metal coatings, plastic products, batteries, fungicides Automotive parts, floor covering, paper, cement, asphalt roofing; anti-corrosive metal plating Cotton dyes, metal coating, drier in paints, varnishes and pigment inks, certain plastics, specialty glass Steel, dental fillings, copper and brass, permanent magnets, storage batteries, glazes youngh@gwu.edu

Human Carcinogen?
Yes Yes

Cadmium

Lung

Yes

Chromium

Lung

Yes

Lead

Kidney, brain

Probable carcinogen

Nickel

Nasal cavity, lung

Nickel metal: Probable carcinogen Nickel compounds: Yes 12

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Environmental Chemicals
Solvents Benzene Fibers and dust Asbestos Dioxins Polycyclic aromatic hydrocarbons Arsenic

Chlorine by-products
Air pollution
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Exposure Assessment Issues

Transience of populations

Often based on ecological data so reduced specificity-lack of monitoring data

Mixtures of agents-potential for synergistic effects Dose-response and threshhold Chronic vs. acute exposures

Genetics and susceptibility influence all of these

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Monitoring
Environmental

Biomonitoring

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Comparison Groups
Unexposed

Comparability

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Identifying Carcinogens
Laboratory experiments

Animal studies
Human studies Ecological Case-control Cohort

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Risk Assessment
Potency

Exposure type
Dose-response

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Occupational Studies
Exposures assessment easier Better defined, better measured, higher levels Following populations easier Lack of women or minorities in some industries Size may not be large enough to identify rare cancers or cancers with lower risk

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Occupational Studies
Cancer is leading cause of work-related deaths accounting for 32% of work-related deaths 20% of cancers in male blue collar workers are occupationally related

~48,000 cancers per year are work-related

Only 2% of all chemicals used in industry tested for carcinogenicity

In US, 3 million workers exposed to possible carcinogens

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Occupational Studies
Cancer Lung PAR % 6-13 Examples Asbestos, radon, ETS, diesel, uranium miners, painters, asphalt workers

Bladder Mesothelioma Skin Liver

7-19 85-90 1.5-6 0.4-1.1

Aniline and other types of dyes Asbestos Solar radiation, and PAHs Vinylchloride (higher if consider HBV and HCV in health care workers)

Leukemia Nasophayrngeal

0.8-2.8 33-46

Benzene, ionizing radiation Wood dust, nickel, hexavalent chromium, formaldehyde

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Cancer Clusters

Apparently high concentration of cases in defined time period, geographical or occupational setting, or defined group of people

Do the cases have a related etiology or are they due to chance?

Is the exposure well-defined, high and prolonged? Are the cases the same type of cancer or a mix of cancers and benign disease? Is the type of cancer unusual or age of onset unusual? Are the observed number of cases higher than what would be expected? Can the population at risk be defined? Can exposure be documented or defined and is the latency period adequate?

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Cancer and the Environment

For More Information

Heather A. Young, PhD, MPH Department of Epidemiology and Biostatistics School of Public Health and Health Services
2100W Pennsylvania Street, NW 8th Floor Washington, DC 20037 (202) 994-6518 youngh@gwu.edu http://sphhs.gwu.edu/faculty/index.cfm?empName=%20Heather%20Y oung&employeeID=631

Specializing in environmental and occupational exposures particularly pesticides; cancers and reproductive and perinatal outcomes; cancer disparities; and health of deployed and veteran populations

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