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      Estimating the burden of lung cancer in Canada attributed to occupational radon exposure using a novel exposure assessment method

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          Abstract

          Objective

          Exposure to radon causes lung cancer. The scope and impact of exposure among Canadian workers have not been assessed. Our study estimated occupational radon exposure in Canada and its associated lung cancer burden.

          Methods

          Exposed workers were identified among the working population during the risk exposure period (1961–2001) using data from the Canadian Census and Labour Force Survey. Exposure levels were assigned based on 12,865 workplace radon measurements for indoor workers and assumed to be 1800 mg/m 3 for underground workers. Lung cancer risks were calculated using the Biological Effects of Ionizing Radiation (BEIR) VI exposure-age-concentration model. Population attributable fractions were calculated with Levin’s equation and applied to 2011 Canadian lung cancer statistics.

          Results

          Approximately 15.5 million Canadian workers were exposed to radon during the risk exposure period. 79% of exposed workers were exposed to radon levels < 50 Bq/m 3 and 4.8% were exposed to levels > 150 Bq/m 3. We estimated that 0.8% of lung cancers in Canada were attributable to occupational radon exposure, corresponding to approximately 188 incident lung cancers in 2011.

          Conclusions

          The lung cancer burden associated with occupational radon exposure in Canada is small, with the greatest burden occurring among those exposed to low levels of radon.

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          Most cited references23

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          Dying for work: The magnitude of US mortality from selected causes of death associated with occupation.

          Deaths due to occupational disease and injury place a heavy burden on society in terms of economic costs and human suffering. We estimate the annual deaths due to selected diseases for which an occupational association is reasonably well established and quantifiable, by calculation of attributable fractions (AFs), with full documentation; the deaths due to occupational injury are then added to derive an estimated number of annual deaths due to occupation. Using 1997 US mortality data, the estimated annual burden of occupational disease mortality resulting from selected respiratory diseases, cancers, cardiovascular disease, chronic renal failure, and hepatitis is 49,000, with a range from 26,000 to 72,000. The Bureau of Labor Statistics estimates there are about 6,200 work-related injury deaths annually. Adding disease and injury data, we estimate that there are a total of 55,200 US deaths annually resulting from occupational disease or injury (range 32,200-78,200). Our estimate is in the range reported by previous investigators, although we have restricted ourselves more than others to only those diseases with well-established occupational etiology, biasing our estimates conservatively. The underlying assumptions and data used to generate the estimates are well documented, so our estimates may be updated as new data emerges on occupational risks and exposed populations, providing an advantage over previous studies. We estimate that occupational deaths are the 8th leading cause of death in the US, after diabetes (64,751) but ahead of suicide (30,575), and greater than the annual number of motor vehicle deaths per year (43,501). Copyright 2003 Wiley-Liss, Inc.
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            CAREX Canada: an enhanced model for assessing occupational carcinogen exposure

            Objectives To estimate the numbers of workers exposed to known and suspected occupational carcinogens in Canada, building on the methods of CARcinogen EXposure (CAREX) projects in the European Union (EU). Methods CAREX Canada consists of estimates of the prevalence and level of exposure to occupational carcinogens. CAREX Canada includes occupational agents evaluated by the International Agency for Research on Cancer as known, probable or possible human carcinogens that were present and feasible to assess in Canadian workplaces. A Canadian Workplace Exposure Database was established to identify the potential for exposure in particular industries and occupations, and to create exposure level estimates among priority agents, where possible. CAREX EU data were reviewed for relevance to the Canadian context and the proportion of workers likely to be exposed by industry and occupation in Canada was assigned using expert assessment and agreement by a minimum of two occupational hygienists. These proportions were used to generate prevalence estimates by linkage with the Census of Population for 2006, and these estimates are available by industry, occupation, sex and province. Results CAREX Canada estimated the number of workers exposed to 44 known, probable and suspected carcinogens. Estimates of levels of exposure were further developed for 18 priority agents. Common exposures included night shift work (1.9 million exposed), solar ultraviolet radiation exposure (1.5 million exposed) and diesel engine exhaust (781 000 exposed). Conclusions A substantial proportion of Canadian workers are exposed to known and suspected carcinogens at work.
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              Radon exposure is rising steadily within the modern North American residential environment, and is increasingly uniform across seasons

              Human-made buildings can artificially concentrate radioactive radon gas of geologic origin, exposing occupants to harmful alpha particle radiation emissions that damage DNA and increase lung cancer risk. We examined how North American residential radon exposure varies by modern environmental design, occupant behaviour and season. 11,727 residential buildings were radon-tested using multiple approaches coupled to geologic, geographic, architectural, seasonal and behavioural data with quality controls. Regional residences contained 108 Bq/m3 geometric mean radon (min < 15 Bq/m3; max 7,199 Bq/m3), with 17.8% ≥ 200 Bq/m3. Pairwise analysis reveals that short term radon tests, despite wide usage, display limited value for establishing dosimetry, with precision being strongly influenced by time of year. Regression analyses indicates that the modern North American Prairie residential environment displays exceptionally high and worsening radon exposure, with more recent construction year, greater square footage, fewer storeys, greater ceiling height, and reduced window opening behaviour all associated with increased radon. Remarkably, multiple test approaches reveal minimal winter-to-summer radon variation in almost half of properties, with the remainder having either higher winter or higher summer radon. This challenges the utility of seasonal correction values for establishing dosimetry in risk estimations, and suggests that radon-attributable cancers are being underestimated.
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                Author and article information

                Contributors
                c.b.ge@uu.nl
                Journal
                Int Arch Occup Environ Health
                Int Arch Occup Environ Health
                International Archives of Occupational and Environmental Health
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0340-0131
                1432-1246
                30 March 2020
                30 March 2020
                2020
                : 93
                : 7
                : 871-876
                Affiliations
                [1 ]GRID grid.5477.1, ISNI 0000000120346234, Institute for Risk Assessment Sciences (IRAS), , Utrecht University, ; Yalelaan 2, 3584 CM Utrecht, Netherlands
                [2 ]GRID grid.61971.38, ISNI 0000 0004 1936 7494, CAREX Canada, Simon Fraser University, ; Burnaby, Canada
                [3 ]GRID grid.419887.b, ISNI 0000 0001 0747 0732, Occupational Cancer Research Centre, , Cancer Care Ontario, ; Toronto, Canada
                [4 ]GRID grid.14709.3b, ISNI 0000 0004 1936 8649, Department of Epidemiology, Biostatistics and Occupational Health, , McGill University, ; Montréal, Canada
                [5 ]GRID grid.416702.6, ISNI 0000 0001 2186 6071, Institut de Recherche Robert-Sauvé en santé Et en sécurité du Travail, ; Montréal, Canada
                [6 ]GRID grid.14848.31, ISNI 0000 0001 2292 3357, Department of Environmental and Occupational Health, School of Public Health, , Université de Montréal, ; Montréal, Canada
                [7 ]GRID grid.413574.0, ISNI 0000 0001 0693 8815, Department of Cancer Epidemiology and Prevention Research, , Alberta Health Services, ; Calgary, Canada
                [8 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Dalla Lana School of Public Health, , University of Toronto, ; Toronto, Canada
                [9 ]GRID grid.22072.35, ISNI 0000 0004 1936 7697, Cumming School of Medicine, , University of Calgary, ; Calgary, Canada
                Article
                1537
                10.1007/s00420-020-01537-2
                7452915
                32232555
                acffb40d-3696-46d1-a725-781a6a2dabf0
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 27 September 2019
                : 16 March 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000521, Canadian Cancer Society;
                Award ID: 701285
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2020

                Occupational & Environmental medicine
                lung cancer,radon,occupational exposure,disease burden
                Occupational & Environmental medicine
                lung cancer, radon, occupational exposure, disease burden

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