Heather Young, PhD,

MPH
December 8, 2014

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

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)

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.

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

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

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

Number of Agents or
Exposure Situations that are

Occupational

Group 1
Group 2A

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

95
66

28
27

241

113

497

Group 2B
Group 3
Group 4

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.

Pathogens
Viruses

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

Bacteria

Heliobactor pylori

Aflatoxins

Radiation
Ultraviolet radiation
Ionizing radiation

Nuclear materials
Radon gas
Therapeutic and diagnostic radiation

Medications and Hormones

Chemotherapeutic and immunosuppressive
agents
Hormone replacement therapy
Oral contraceptives

DES

10

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

Benzidine

11

Occupational Chemicals: Metals

Metal

Cancers

Arsenic

Skin, lung, bladder,

kidney, liver

Beryllium

Present in

Human Carcinogen?

Wood preservatives
glass, pesticides

Yes

Lung

Nuclear weapons,
rocket fuel, ceramics,
glass, plastic,
fiberoptic products

Yes

Cadmium

Lung

Metal coatings,
plastic products,
batteries, fungicides

Yes

Chromium

Lung

Automotive parts,
floor covering, paper,
cement, asphalt
roofing; anti-corrosive
metal plating

Yes

Lead

Kidney, brain

Cotton dyes, metal

coating, drier in paints,
varnishes and pigment
inks, certain plastics,
specialty glass

Probable carcinogen

Nickel

Nasal cavity, lung

Steel, dental fillings,

copper and brass,
permanent magnets,
storage batteries,glazes

Nickel metal:
Probable carcinogen
Nickel compounds: Yes

12

Environmental Chemicals

Solvents
Benzene

Fibers and dust

Asbestos
Dioxins

Polycyclic aromatic hydrocarbons

Arsenic
Chlorine by-products
Air pollution

13

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

14

Monitoring
Environmental

Biomonitoring

12/10/2012

youngh@gwu.edu

15

Comparison Groups
Unexposed

Comparability

12/10/2012

youngh@gwu.edu

16

Identifying Carcinogens
Laboratory experiments

Animal studies
Human studies
Ecological
Case-control
Cohort

17

Risk Assessment
Potency

Exposure type
Dose-response

18

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

19

Occupational Studies
Cancer is leading cause of work-related
deaths accounting for 32% of work-related
deaths (J Occup Environ Hyg. May 2014; 11(5): 326337. )
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
(Occup Environ Med 2008;65:787-788) (Environ Health Perspect 2003:; 111:112 )

20

Occupational Studies
Cancer

PAR %

Examples

Lung

6-13

Asbestos, radon, ETS, diesel, uranium miners,

painters, asphalt workers

Bladder

7-19

Aniline and other types of dyes

Mesothelioma

85-90

Asbestos

Skin

1.5-6

Solar radiation, and PAHs

Liver

0.4-1.1

Vinylchloride (higher if consider HBV and HCV in

health care workers)

Leukemia

0.8-2.8

Benzene, ionizing radiation

Nasophayrngeal

33-46

Wood dust, nickel, hexavalent chromium,

formaldehyde

21

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?

(CA Cancer J Clin 2004;54:273280)

22

Cancer and the Environment

Young, PhD, MPH

For Heather
MoreA.Information

Department of Epidemiology and Biostatistics

The George Washington University
Milken Institute School of Public Health
950 New Hampshire Ave, NW
5th Floor
Washington, DC 20037
(202) 994-6518
youngh@gwu.edu
http://publichealth.gwu.edu/faculty/?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

23