Wednesday, 19 December 2012

Why where you work could influence risk of breast cancer

Workplace plays a pivotal role in influencing cancer risk

WHO statistics show that 19% of all cancers are attributable to the environment including work settings, and result in 1.3 million deaths annually worldwide. In reality, the actual figure could be much higher than this, as an individual’s genetics, physiology, exposure to environmental cancer causing agents (carcinogens) and life style invariably crisscross and therefore it is seldom possible to study environmental exposure and cancer in isolation. One thing is clear, that cumulative exposure to certain environmental agents, could either initiate cancer, or be involved in its progression. Breast cancer is the most common cancer among women in many industrialised nations. Roughly 48,000 women in the UK and 226, 870 women in the US get breast cancer each year.  Hormones, notably estrogen, play an important role in breast cancer progression.  Several studies have shown that environmental agents exist, that interfere with hormones by mimicking them or by disrupting them called endocrine disruptors.  Those that mimic the effects of estrogens are called xenoestrogens. Well known synthetic  xenoestrogens  include Polychlorinated biphenyls (PCBs), BPA (Bisphenol A)and phthalates, which are widely used industrial compounds.

Whilst several laboratory studies implicate a link between environmental exposure and breast cancer, large scale population studies have been inconclusive. This is understandable as the laboratory systems are simplistic and can study factors in question in isolation. In the 1990s, NIEHS and the NCI conducted a large study on the environmental causes of breast cancer, to investigate the increased breast cancer rate in Long Island, New York . In the study, scientists focused their investigation on three widespread pollutants - organochlorine pesticides, polychlorinated biphenyls, and polycyclic aromatic hydrocarbons (PAHs), to which many of the Long Island residents had been exposed. Whilst a small increase in breast cancer risk was due to PAH exposure the researchers were unable to identify any environmental factor that could be responsible for the high incidence of breast cancer area.

Approximately the same time as the Long Island studies, across the border, in Essex and Kent counties of Southern Ontario, Canada, the local cancer hospital staff raised alarm about industrial workers developing breast cancer. This area then became the subject for studies which showed a link between cancer and industrial/agricultural work settings, but the questions explored in the study were not complete. A subsequent study in this region ( recently published) which has a stable population and diverse modern agriculture and industry was used for more thorough investigations and provided interesting observations. Cases were recruited over a six year period from mid 2002 through to  mid 2008 and  the occupations of 1006 women who had breast cancer and 1146 randomly selected women from the community without this disease were analysed . The results showed that women working in environments with risk of high exposure to carcinogens and endocrine disruptors had a high risk of developing breast cancer. Notable sectors with high risk were the agricultural sectors (where pesticides are used), automotive plastics manufacturing sector, food canning industry, metalworking industry and bars/gambling industry (second hand smoke exposure risk). The researchers also found that premenopausal breast risk was highest in those women working in the plastics industry and food canning industry.

The study provides resounding evidence for linking occupational exposure of endocrine disruptors/ carcinogens and breast cancer risk warranting further studies. With people generally spending an average of 8 hours at work, working environments are major influences of cancer risk. Employees  are often not made aware of  their risks of harmful exposures at work and  how they could reduce exposures. Evidently, most of the exposure risks for occupational cancers are preventable.  A clean working environment should be the basic right of a worker. A resolution by the World Health Assembly in 2005 on cancer prevention and control urged countries to develop programmes aimed at reducing cancer incidence and mortality. This resolution advocated for special attention to cancers prevention by avoiding exposure to chemicals at the workplace and in the environment.  Though, it remains to be seen what cancer prevention programmes have been developed or implemented in the workplace, to what extent,  and how it compares between different countries.

Brophy, J., Keith, M., Watterson, A., Park, R., Gilbertson, M., Maticka-Tyndale, E., Beck, M., Abu-Zahra, H., Schneider, K., Reinhartz, A., DeMatteo, R., & Luginaah, I. (2012). Breast cancer risk in relation to occupations with exposure to carcinogens and endocrine disruptors: a Canadian case--control study Environmental Health, 11 (1) DOI: 10.1186/1476-069X-11-87

DeMatteo, R., Keith, M., Brophy, J., Wordsworth, A., Watterson, A., Beck, M., Ford, A., Gilbertson, M., Pharityal, J., Rootham, M., & Scott, D. (2012). Chemical Exposures of Women Workers in the Plastics Industry with Particular Reference to Breast Cancer and Reproductive Hazards NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy, 1 (-1), 427-448 DOI: 10.2190/NS.22.4.d

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