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Growing
awareness about health and increased concern about exposures to occupational
hazards among workers have led to many questions in recent years
about occupational cancers. This information describes cancer and
how the New Jersey Department of Health and Senior Services (NJDHSS)
responds to concerns about cancers at work.
Topics
 What
is cancer?
What
is a cancer cluster?
How
are reports of cancers at work responded to by the NJDHSS?
Initial
information collection
Decision
about the need for additional investigation
Additional
information collection
Statistical
analysis based on the additional information
Industrial
hygiene evaluation of the workplace
What
are the known occupational & non-occupational causes of
cancer?
Contact
us about a cancer concern
WHAT IS CANCER?1-3
[top
of page] Cancer is a diverse group of more than 100 diseases in which abnormal
cells multiply and spread out of control. Cancer is common; in this
country, men have a 45 percent chance and women have a 39 percent chance
of being diagnosed with some form of cancer during their lifetime.
The chances of getting cancer increase with age. However, the survival
rate for many cancers has improved in recent years due to earlier diagnosis
and improved treatment. The most common cancers among U.S. men are
prostate, lung, colon and rectum, urinary bladder, and skin. Among
women in this country, the most common cancers are breast, lung, colon
and rectum, uterine, ovary, and skin. The causes are not known for many cancers, but scientists estimate
that most cancers are due to lifestyle factors such as smoking, drinking
heavily, and a diet with excess calories, high fat, and low fiber.
Other important factors related to cancer are reproductive patterns,
sexual behavior, and sunlight exposure. Factors related to work or
residence, environment, infections, and heredity are thought to be
less common causes of cancer. Ten to thirty years or more may pass
between the initial exposure to the cause of cancer and the diagnosis
of the cancer. 1American Cancer Society, Cancer Facts and Figures - 2003.
2Brownson RC, Reif JS, Alavanja MCR. Cancer. In: Chronic Disease Epidemiology
and Control. Ed. Brownson RC, Remington PL, Davis JR. American Public Health
Association, Washington, D.C., 1993:137-167.
3Ries LAG, Eisner MP, Kosary CL, Hankey BF, Miller BA, Clegg L, Mariotto A, Fay
MP, Feuer EJ, Edwards BK (eds). SEER Cancer Statistics Review, 1975-2000, National
Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2000, 2003. WHAT IS A CANCER CLUSTER?
[top
of page] A cancer cluster is defined as a much greater number of cancer cases
than expected in a group of people, a geographic area, or a period
of time. Most suspected cancer clusters are shown not to be true clusters.4 4Cancer
Clusters. National Cancer Institute, U.S. Department of Health and
Human Services. January 23, 1997. HOW ARE REPORTS OF CANCERS AT WORK RESPONDED TO BY THE NJDHSS?
[top
of page]
A concern about cancer at work may be reported to the NJDHSS by a
worker, a union representative, or an employer. The NJDHSS responds
to a report of concern about cancer at work with the assistance of
the person who reported the cancers. The following steps describe this
process: Initial Information Collection on the Occurrence of Cancer and the
Working Population [top
of page]
The first step in responding to a report of cancer at work is for
the person reporting the cancers to provide as much of the following
information as possible to the NJDHSS staff:
- the number of people with cancer and the time period; for example,
ten people with cancer diagnosed between 1990 and 2002;
- the types of cancer; for example, colon cancer, breast cancer,
lung cancer, Hodgkin disease;
- the date of diagnosis, age, sex, and occupation of each of
the individuals with cancer;
- how many years the persons with cancer worked in their
current jobs or at this workplace;
- the type and size of the work unit; for example, a school
with 20 teachers or a fire department with 40 firefighters;
- if there is or was direct exposure to a specific hazard
at work, especially anything that is known or suspected
to cause
cancer;
for example, workers who have been exposed to arsenic
for the past twenty
years;
- the type of work activities; e.g. welding, mixing
chemicals, office work.
Decision About the Need for Additional Investigation
[top
of page] The above information is then used by the NJDHSS staff to decide if
additional investigation is needed. Some considerations in making this
decision are:
- How many cases of cancer are there? Cancer is common so it is
expected that some people in a workplace will develop cancer.
- Are the reported cancers of many different types? If there are
many different types of cancer, a single occupational cause is
less likely
than if there is one or only a few types.
- Are the workers with cancer concentrated in a particular job
title or location? An
occupational exposure is less likely to be the cause if the
cancer cases are distributed
among different job titles and locations.
- Were the workers with cancer employed in the job or at the worksite
for at least ten years before the diagnosis of cancer? Cancer usually
takes ten to thirty years to develop after first exposure to the cancer-causing
agent.
- Are there any known or suspected occupational causes for the
reported cancers; and if so, were the workers with the cancers
directly exposed
to these causes at work?
Some common cancers such as breast and prostate do not have a known
occupational
cause.
- Have scientific studies found an association between the jobs
(e.g. firefighter, metal worker) or the industry (e.g. production
of benzene
or products containing
benzene) of the affected workers and the types of reported cancers?
Often a decision is made that additional investigation by the NJDHSS
is not necessary. For example, two women with breast cancer among twenty
women in an office probably would not need to be further investigated
because breast cancer is a common cancer in women with no known cause
related to occupation. A situation of two men, one with lung cancer
and another with colon cancer, who both worked less than five years
at their present workplace would not need further investigation. These
cancers are very common among men and would not be very likely due
to exposures that began less than five years ago. If no further investigation
is needed, NJDHSS staff send a letter to the person who contacted us
summarizing our conclusion that no further investigation is needed
and why, along with information about the cancers and exposures of
concern. Additional Information Collection
[top
of page] If a decision is made that additional investigation by the NJDHSS
is appropriate, the person who reported the cancer concern would be
asked to collect more information, using the NJDHSS form, “Report
of Cancers at Work.” This form includes questions about each
person with cancer - name, social security number, address, race, sex,
type of cancer, date of diagnosis, date of birth, date of death if
deceased, job title, and when the person began employment at this workplace,
and the name and address of the physician who diagnosed the cancer.
The form also has questions about the work group including the numbers
of workers by age, sex and year. All of this information must be kept
confidential by the person collecting the information and by the NJDHSS.
The information on the types of cancer and dates of diagnosis is confirmed
through the New Jersey State Cancer Registry, death certificates, or
the physicians who diagnosed the cancers. Statistical Analysis Based on the Additional Information
[top
of page] If the additional information is obtained and there are enough confirmed
cases of cancer, the NJDHSS staff use statistical techniques to determine
if there are more cases of cancer among the work group than expected,
and if so, whether this is likely to be due to chance. The expected
number of cancer cases usually is based on state-wide cancer incidence
rates (number of new cases of cancer per 100,000 people) from the New
Jersey State Cancer Registry and the age and sex distribution of the
work group. The NJDHSS issues a report with the results of the statistical
analysis, any additional information, and recommendations. Industrial Hygiene Evaluation of the Workplace
[top
of page] The NJDHSS staff may recommend an industrial hygiene evaluation of
the workplace at any point in our response to a report of cancers at
the workplace. Examples are:
- The person reporting the cancers describes a situation in which
there appears to be current exposure at work to a cancer-causing
or otherwise hazardous substance.
- The statistical analysis of the reported cancers shows that there
is more cancer than expected in the work group.
The purpose of the industrial hygiene evaluation of the workplace
is to determine if employees are currently exposed to hazards. Recommendations
are made to protect workers from current hazards. Depending on the
situation, a worksite industrial hygiene evaluation may be performed
by:
- NJDHSS industrial hygiene staff, in the case of public
employees;
- a consultant hired by the employer; or
- the employer’s in-house industrial hygiene staff.
WHAT ARE THE KNOWN OCCUPATIONAL AND NON-OCCUPATIONAL CAUSES OF CANCER?
[top
of page] The tables on the following pages, which list the major causes of
cancer, are used to help decide the response to reported cancers at
work. For more information on cancer, contact the Cancer Epidemiology
Services of the NJDHSS at (609) 588-3500. Free information on cancer can also be obtained from:
Information on hazardous exposures in the workplace can be obtained
from:
TABLE 1
KNOWN OCCUPATIONAL CAUSES OF CANCER1
| EXPOSURE |
CANCERS |
TYPES OF WORKERS POTENTIALLY EXPOSED |
| 4-Aminobiphenyl |
Bladder |
Workers in the production of 4-aminobiphenyl |
| Arsenic (inorganic compounds, e.g. arsenic pentoxide, arsenic
trioxide) |
Skin, lung, gastro- intestinal, kidney |
Workers in mining and in copper and other smelting involving
arsenic, in pesticide application, and in wood preservation |
| Asbestos |
Lung, larynx, mesothelioma2, gastrointestinal |
Workers in mining and milling of asbestos, in manufacture
of asbestos products, in ship-building and construction trades, in asbestos
insulation, in building demolition, in asbestos abatement, and in brake
repair and in building maintenance |
| Benzene (and benzene-containing solvents) |
Leukemia |
Workers in the production of benzene and in the use of products
containing benzene; car mechanics; benzene is used extensively as a solvent
in the chemical and drug industries and as a gasoline additive |
| Benzidine and dyes metabolized to benzidine |
Bladder |
Workers in the production of benzidine and benzidine-based
dyes and in the garment, leather, printing, paper and homecraft industries
where benzidine-based dyes are used |
| Beryllium (and beryllium compounds) |
Lung |
Beryllium miners, alloy makers and fabricators; phosphorus
manufacturers; ceramics workers; missile technicians; nuclear reactor workers;
electronic equipment workers; jewelers |
| 1,3-Butadiene |
Lymphatic system, blood-forming system |
Workers in the chemicals and allied products, 1,3-butadiene
manufacturing, and rubber industries |
| Cadmium (and cadmium compounds) |
Lung |
Workers in zinc and lead ore smelting; producing, processing,
& handling cadmium powders; cadmium-coated steel welding; nickel-cadmium
battery manufacture |
| Bis(chloromethyl) ether and technical-grade chloromethyl
methyl ether |
Lung (mainly small-cell type) |
Chemical plant workers, ion exchange resin makers, laboratory
workers, polymer makers |
| Chromium hexavalent compounds |
Lung |
Workers in stainless steel production and welding and the
chromate production, chrome plating, ferrochrome alloys, chrome pigment,
and tanning industries |
| Environmental tobacco smoke |
Lung |
Workers in restaurants, bars, casinos, and offices where
smoking is permitted; workers in airplanes (before smoking was banned) |
| Erionite (a zeolite3) |
Mesothelioma2 |
Workers in mining and production of other natural zeolites
or in the production or use of zeolite-containing products |
| Ethylene oxide |
Lymphatic system, blood-forming system |
Workers in manufacture of ethylene oxide and its derivatives;
manufacture of products where ethylene oxide is used as a sterilant; hospital/healthcare
workers; ethylene oxide is used as a sterilant in the manufacture of medical
devices, healthcare products, pharmaceuticals, and spices. |
| Mustard gas |
Respiratory tract |
Not manufactured or used in the U.S. at present; to date,
workers most likely exposed have been military personnel |
| 2-Naphthylamine |
Bladder |
Laboratory technicians and scientists who use it in research |
| Nickel Compounds |
Lung, nasal |
Workers in mining, smelting, welding, casting, spray painting
and grinding, electroplating, production and use of nickel catalysts, polishing
of nickel-containing alloys, other jobs where nickel compounds are produced
or used |
| Radon |
Lung |
Underground uranium miners, other underground workers and
certain mineral processing workers |
| Silica, crystalline (respirable size) |
Lung |
Workers in quarrying and mining of coal and other minerals;
stone cutting and construction; ceramics; foundry work; sandblasting; polishing
& grinding; manufacture of abrasives, plastics, rubber and paint; production
of cement, scouring soap, tile and clay; boiler scaling; road construction
and repair; insulation production and installation |
| Strong inorganic acid mists containing sulfuric acid |
Lung, laryngeal |
Workers in the chemical manufacture, building and construction,
lead-acid battery, phosphate fertilizers, metal, petroleum and coal products,
oil and gas extraction, printing, paper, and tannery industries |
| 2,3,7,8-Tetrachlo-rodibenzo-r-dioxin (TCDD or "Dioxin") |
Lung, non-Hodgkin lymphoma |
Workers in waste incineration; firefighting; chemical research;
paper bleaching; herbicide production; and production or use of pentachlorophenol
and other chlorinated compounds |
| Thorium dioxide |
Liver |
Ceramic makers, incandescent lamp makers, magnesium alloy
makers, metal refiners, nuclear reactor workers, chemists, vacuum tube makers,
workers in tin, rare-earth metal and phosphate mining and processing industries,
workers in formulation, packaging, preparation or administration of thorium
dioxide as a pharmaceutical |
| Vinyl chloride |
Liver, brain, lung, lymphatic system, blood-forming system |
Workers involved in vinyl chloride polymerization to form
other materials, usually PVC resins, and in the piping to storage or transport
or maintenance of the finished polymer |
| Wood dust |
Nasal |
Workers who use machinery or tools to cut or shape wood,
especially sanders in the transportation equipment and wood cabinet industries,
press operators in the wood products industry, and lathe operators in the
furniture industry |
| Coke oven emissions |
Lung, genitourinary system |
Workers in the production of coke from coal or in using coke
to extract metals from their ores, in the synthesis of calcium carbide,
or in the manufacture of graphite and electrodes |
| Soots |
Lung, skin (particularly of the scrotum) |
Chimney sweeps, heating-unit service workers, brick masons
and helpers, building demolition workers, insulators, firefighters, metallurgical
workers, horticulturalists |
| Coal tars and coal tar pitches |
Skin (including scrotum), lung |
Workers in coke production, coal gasification, aluminum production,
foundries, and wood preservation and in production or use of pavement tar,
roofing tar, coal tar pitch, coal tar paints, coal tar coatings, coal tar
enamels, and refractory bricks |
| Untreated and mildly refined mineral oils |
Skin (particularly of the scrotum), lung |
Workers in the manufacture of automobiles, airplanes and
parts, steel, screws, pipes, precision parts, transformers, in brass products
and aluminum production, and in engine repair, copper mining, and newspaper
and commercial printing |
1National Toxicology Program, U.S.D.H.H.S. Report on Carcinogens, Tenth Edition, 2002.
2Cancer of the lining of the lung or abdomen.
3Zeolites are minerals, common in the western United States. TABLE 2
KNOWN NON-OCCUPATIONAL CAUSES OF CANCER1-9
| CAUSE |
CANCERS |
HOW EXPOSED |
| Cigarettes |
Lung, mouth, pharynx, larynx, esophagus, pancreas, uterine
cervix, bladder, kidney, nasal, stomach, liver, myeloid leukemia |
Smoking cigarettes |
| Smokeless tobacco |
Oral cancers especially cheek, gum |
Use of the plug, leaf, or snuff forms of tobacco, especially
dipping snuff |
| Cigars |
Oral, larynx, esophagus |
Smoking cigars |
| Environmental tobacco smoke10 |
Lung |
Breathing smoke from other people's cigarettes |
| Alcohol |
Mouth, larynx, throat, esophagus, liver, breast |
Heavy drinking of alcoholic beverages |
| Diet |
Colon, rectum, prostate, uterusStomach, lung, esophagus,
colon, rectum |
Eating foods high in fat, especially red meat Low intake
of fruits and vegetables |
| Infections Helicobacter pylori Hepatitis B Virus Hepatitis
C Virus Human Papilloma Virus (certain strains) |
StomachLiver Liver Cervix |
Person-to-person contactContact with infected person's blood,
sexual contact, mother-to-child transmission during pregnancyContact with
infected person's blood, mother-to-child transmission during pregnancySexual
contact |
| Obesity |
Colon, rectum, prostate, uterus, breast (among postmenopausal
women), kidney |
Greater caloric intake than energy output |
| Sunlight10 (ultraviolet radiation) |
Skin (melanoma and non-melanoma) |
Outdoor activities in which the skin is not protected, exposure
to tanning lamps. Severe sunburns during childhood may greatly increase
the risk of melanoma in later life. |
| Radon10 |
Lung |
Radon in the ground, groundwater, or building materials enters
homes in the air, decays, and is breathed in. |
| Reproductive history in women:Young age at first menstruation
or older age at menopauseNever bearing childrenBearing first child after
age 30 Oral contraceptives |
Breast, uterus Breast, uterus, ovaryBreast Small increased
risk for breast cancer, especially long-term use and among recent or current
users Decreased risk for cancers of the ovary and uterus |
Evidence suggests that the longer a woman is exposed to the
hormone estrogen (estrogen made by the body, taken as a drug, or delivered
by a patch), the more likely she is to develop breast cancer. For example,
the risk is somewhat increased among women who began menstruation at an
early age (before age 12), experienced menopause late (after age 55), never
had children, or took hormone replacement therapy for long periods of time.
Each of these factors increases the amount of time a woman's body is exposed
to estrogen. Women who are exposed to estrogen for a longer time also have
a higher risk for cancer of the uterus. Women take oral contraceptives for
birth control purposes. Oral contraceptives used now contain lower dosages
of hormones than in the past. |
| Peri- and post- menopausal hormonal replace-ment therapy,
especially long-term useEarly age at first sexual intercourse, many sexual
partners, having sex with a partner who has had many sexual partners |
Breast, uterus Cervix |
Women use hormone replacement therapy to treat the symptoms
during and after menopause. Women with these risk factors are at increased
risk for infection with human papilloma virus, which may increase the risk
for cancer of the cervix. |
1American Cancer Society. Cancer Facts and Figures - 2003.
2Harras A, editor. Cancer Rates and Risks. USDHHS. 1996.
3International Agency for Research on Cancer. Scientific review meeting
on IARC Handbooks of Cancer Prevention, Volume 8, Fruits and Vegetables,
2003 (Website: http://www.iarc.fr).
4IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume
59, Hepatitis Viruses, 1994.
5IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume
61, Schistosomes, Liver Flukes, and Helicobacter pylori, 1994.
6IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume
64, Human papillomaviruses, 1995.
7IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume
72, Hormonal Contraception and Post-Menopausal Hormonal Therapy, 1999.
8IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume
83, Tobacco Smoke and Involuntary Smoking (in preparation) (Website:
http://www.iarc.fr).
9National Cancer Institute. What You Need To Know About Breast Cancer.
Information about detection, symptoms, diagnosis, and treatment of breast
cancer. NIH Publication No. 00-1556. Posted: 11/20/2000, Updated 06/04/2003.
10Environmental tobacco smoke, radon, and sunlight can also be occupational
hazards.
Revised September 2003
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Cancer Epidemiology Services
