The control of occupational carcinogens is based on the critical review of scientific investigations both in humans and in experimental systems. There are several review programmes being undertaken in different countries aimed at controlling occupational exposures which could be carcinogenic to humans. The criteria used in different programmes are not entirely consistent, leading occasionally to differences in the control of agents in different countries. For example, 4,4-methylene-bis-2-chloroaniline (MOCA) was classified as an occupational carcinogen in Denmark in 1976 and in the Netherlands in 1988, but only in 1992 has a notation “suspected human carcinogen” been introduced by the American Conference of Governmental Industrial Hygienists in the United States.
The International Agency for Research on Cancer (IARC) has established, within the framework of its Monographs programme, a set of criteria to evaluate the evidence of the carcinogenicity of specific agents. The IARC Monographs programme represents one of the most comprehensive efforts to review systematically and consistently cancer data, is highly regarded in the scientific community and serves as the basis for the information in this article. It also has an important impact on national and international occupational cancer control activities. The evaluation scheme is given in table 1.
Table 1. Evaluation of evidence of carcinogenicity in the IARC Monographs programme.
1. The evidence for the induction of cancer in humans, which obviously plays an important role in the identification of human carcinogens is considered. Three types of epidemiological studies contribute to an assessment of carcinogenicity in humans: cohort studies, case-control studies and correlation (or ecological) studies. Case reports of cancer in humans may also be reviewed. The evidence relevant to carcinogenicity from studies in humans is classified into one of the following categories:
- Sufficient evidence of carcinogenicity: A causal relationship has been established between exposure to the agent, mixture or exposure circumstance and human cancer. That is, a positive relationship has been observed between the exposure and cancer in studies in which chance, bias and confounding could be ruled out with reasonable confidence.
- Limited evidence of carcinogenicity: A positive association has been observed between exposure to the agent, mixture or exposure circumstance and cancer for which a causal interpretation is considered to be credible, but chance, bias or confounding could not be ruled out with reasonable confidence.
- Inadequate evidence of carcinogenicity: The available studies are of insufficient quality, consistency or statistical power to permit a conclusion regarding the presence or absence of a causal association, or no data on cancer in humans are available.
- Evidence suggesting lack of carcinogenicity: There are several adequate studies covering the full range of levels of exposure that human beings are known to encounter, which are mutually consistent in not showing a positive association between exposure to the agent and the studied cancer at any observed level of exposure.
2. Studies in which experimental animals (mainly rodents) are exposed chronically to potential carcinogens and examined for evidence of cancer are reviewed and the degree of evidence of carcinogenicity is then classified into categories similar to those used for human data.
3. Data on biological effects in humans and experimental animals that are of particular relevance are reviewed. These may include toxicological, kinetic and metabolic considerations and evidence of DNA binding, persistence of DNA lesions or genetic damage in exposed humans. Toxicological information, such as that on cytotoxicity and regeneration, receptor binding and hormonal and immunological effects, and data on structure-activity relationship are used when considered relevant to the possible mechanism of the carcinogenic action of the agent.
4. The body of evidence is considered as a whole, in order to reach an overall evaluation of the carcinogenicity to humans of an agent, mixture or circumstance of exposure (see table 2).
Agents, mixtures and exposure circumstances are evaluated within the IARC Monographs if there is evidence of human exposure and data on carcinogenicity (either in humans or in experimental animals) (for IARC classification groups, see table 2).
Table 2. IARC Monograph programme classification groups.
The agent, mixture or exposure circumstance is described according to the wording of one of the following categories:
|Group 1—||The agent (mixture) is carcinogenic to humans. The exposure circumstance entails exposures that are carcinogenic to humans.|
|Group 2A—||The agent (mixture) is probably carcinogenic to humans. The exposure circumstance entails exposures that are probably carcinogenic to humans.|
|Group 2B—||The agent (mixture) is possibly carcinogenic to humans. The exposure circumstance entails exposures that are possibly carcinogenic to humans.|
|Group 3—||The agent (mixture, exposure circumstance) is not classifiable as to its carcinogenicity to humans.|
|Group 4—||The agent (mixture, exposure circumstance) is probably not carcinogenic to humans.|
Known and Suspected Occupational Carcinogens
At present, there are 22 chemicals, groups of chemicals or mixtures for which exposures are mostly occupational, without considering pesticides and drugs, which are established human carcinogens (table 3). While some agents such as asbestos, benzene and heavy metals are currently widely used in many countries, other agents have mainly an historical interest (e.g., mustard gas and 2-naphthylamine).
Table 3. Chemicals, groups of chemicals or mixtures for which exposures are mostly occupational (excluding pesticides and drugs).
Group 1-Chemicals carcinogenic to humans1
|Exposure2||Human target organ(s)||Main industry/use|
|4-Aminobiphenyl (92-67-1)||Bladder||Rubber manufacture|
|Arsenic (7440-38-2) and arsenic compounds3||Lung, skin||Glass, metals, pesticides|
|Asbestos (1332-21-4)||Lung, pleura, peritoneum||Insulation, filter material, textiles|
|Benzene (71-43-2)||Leukaemia||Solvent, fuel|
|Benzidine (92-87-5)||Bladder||Dye/pigment manufacture, laboratory agent|
|Beryllium (7440-41-7) and beryllium compounds||Lung||Aerospace industry/metals|
|Bis(chloromethyl)ether (542-88-11)||Lung||Chemical intermediate/by-product|
|Chloromethyl methylether (107-30-2) (technical grade)||Lung||Chemical intermediate/by-product|
|Cadmium (7440-43-9) and cadmium compounds||Lung||Dye/pigment manufacture|
|Chromium (VI) compounds||Nasal cavity, lung||Metal plating, dye/pigment manufacture|
|Coal-tar pitches (65996-93-2)||Skin, lung, bladder||Building material, electrodes|
|Coal-tars (8007-45-2)||Skin, lung||Fuel|
|Ethylene oxide (75-21-8)||Leukaemia||Chemical intermediate, sterilant|
|Mineral oils, untreated and mildly treated||Skin||Lubricants|
|Mustard gas (sulphur mustard)
|Pharynx, lung||War gas|
|2-Naphthylamine (91-59-8)||Bladder||Dye/pigment manufacture|
|Nickel compounds||Nasal cavity, lung||Metallurgy, alloys, catalyst|
|Shale-oils (68308-34-9)||Skin||Lubricants, fuels|
|Talc containing asbestiform fibers||Lung||Paper, paints|
|Vinyl chloride (75-01-4)||Liver, lung, blood vessels||Plastics, monomer|
|Wood dust||Nasal cavity||Wood industry|
1 Evaluated in the IARC Monographs, Volumes 1-63 (1972-1995) (excluding pesticides and drugs).
2 CAS Registry Nos. appear between parentheses.
3 This evaluation applies to the group of chemicals as a whole and not necessarily to all individual chemicals within the group.
An additional 20 agents are classified as probably carcinogenic to humans (Group 2A); they are listed in table 4, and include exposures that are currently prevalent in many countries, such as crystalline silica, formaldehyde and 1,3-butadiene. A large number of agents are classified as possible human carcinogens (Group 2B, table 5) - for example, acetaldehyde, dichloromethane and inorganic lead compounds. For the majority of these chemicals the evidence of carcinogenicity comes from studies in experimental animals.
Table 4. Chemicals, groups of chemicals or mixtures for which exposures are mostly occupational (excluding pesticides and drugs).
Group 2A—Probably carcinogenic to humans1
|Exposure2||Suspected human target organ(s)||Main industry/use|
|Acrylonitrile (107-13-1)||Lung, prostate, lymphoma||Plastics, rubber, textiles, monomer|
|Benzidine-based dyes||–||Paper, leather, textile dyes|
|1,3-Butadiene (106-99-0)||Leukaemia, lymphoma||Plastics, rubber, monomer|
|p-Chloro-o-toluidine (95-69-2) and its strong acid salts||Bladder||Dye/pigment manufacture, textiles|
|Creosotes (8001-58-9)||Skin||Wood preservation|
|Diethyl sulphate (64-67-5)||–||Chemical intermediate|
|Dimethylcarbamoyl chloride (79-44-7)||–||Chemical intermediate|
|Dimethyl sulphate (77-78-1)||–||Chemical intermediate|
|Epichlorohydrin (106-89-8)||–||Plastics/resins monomer|
|Ethylene dibromide (106-93-4)||–||Chemical intermediate, fumigant, fuels|
|Formaldehyde (50-0-0)||Nasopharynx||Plastics, textiles, laboratory agent|
|4,4´-Methylene- bis-2-chloroaniline (MOCA)
|Polychlorinated biphenyls (1336-36-3)||Liver, bile ducts, leukaemia, lymphoma||Electrical components|
|Silica (14808-60-7), crystalline||Lung||Stone cutting, mining, glass, paper|
|Styrene oxide (96-09-3)||–||Plastics, chemical intermediate|
|Oesophagus, lymphoma||Solvent, dry cleaning|
|Trichloroethylene (79-01-6)||Liver, lymphoma||Solvent, dry cleaning, metal|
|–||Plastics, textiles, flame retardant|
|Vinyl bromide (593-60-2)||–||Plastics, textiles, monomer|
|Vinyl fluoride (75-02-5)||–||Chemical intermediate|
Table 5. Chemicals, groups of chemicals or mixtures for which exposures are mostly occupational (excluding pesticides and drugs).
Group 2B—Possibly carcinogenic to humans1
|Acetaldehyde (75-07-0)||Plastics manufacture, flavors|
|Acetamide (60-35-5)||Solvent, chemical intermediate|
|Acrylamide (79-06-1)||Plastics, grouting agent|
|p-Aminoazotoluene (60-09-3)||Dye/pigment manufacture|
|o-Aminoazotoluene (97-56-3)||Dyes/pigments, textiles|
|o-Anisidine (90-04-0)||Dye/pigment manufacture|
|Antimony trioxide (1309-64-4)||Flame retardant, glass, pigments|
|Auramine (492-80-8) (technical-grade)||Dyes/pigments|
|Benzyl violet 4B (1694-09-3)||Dyes/pigments|
|Bitumens (8052-42-4), extracts of
steam-refined and air-refined
|Bromodichloromethane (75-27-4)||Chemical intermediate|
|b-Butyrolactone (3068-88-0)||Chemical intermediate|
|Carbon-black extracts||Printing inks|
|Carbon tetrachloride (56-23-5)||Solvent|
|Ceramic fibers||Plastics, textiles, aerospace|
|Chlorendic acid (115-28-6)||Flame retardant|
|Chlorinated paraffins of average carbon chain length C12 and average degree of chlorination approximately 60%||Flame retardant|
|a-Chlorinated toluenes||Dye/pigment manufacture, chemical intermediate|
|p-Chloroaniline (106-47-8)||Dye/pigment manufacture|
|4-Chloro-o-phenylenediamine (95-83-9)||Dyes/pigments, hair dyes|
|CI Acid Red 114 (6459-94-5)||Dyes/pigments, textiles, leather|
|CI Basic Red 9 (569-61-9)||Dyes/pigments, inks|
|CI Direct Blue 15 (2429-74-5)||Dyes/pigments, textiles, paper|
|Cobalt (7440-48-4)and cobalt compounds||Glass, paints, alloys|
|p-Cresidine (120-71-8)||Dye/pigment manufacture|
|N,N´-Diacetylbenzidine (613-35-4)||Dye/pigment manufacture|
|2,4-Diaminoanisole (615-05-4)||Dye/pigment manufacture, hair dyes|
|4,4´-Diaminodiphenyl ether (101-80-4)||Plastics manufacture|
|2,4-Diaminotoluene (95-80-7)||Dye/pigment manufacture, hair dyes|
|p-Dichlorobenzene (106-46-7)||Chemical intermediate|
|3,3´-Dichlorobenzidine (91-94-1)||Dye/pigment manufacture|
|3,3´-Dichloro-4,4´-diaminodiphenyl ether (28434-86-8)||Not used|
|1,2-Dichloroethane (107-06-2)||Solvent, fuels|
|Diesel fuel, marine||Fuel|
|Di(2-ethylhexyl)phthalate (117-81-7)||Plastics, textiles|
|1,2-Diethylhydrazine (1615-80-1)||Laboratory reagent|
|Diglycidyl resorcinol ether (101-90-6)||Plastics/resins|
|Diisopropyl sulphate (29973-10-6)||Contaminant|
|2,6-Dimethylaniline (2,6-Xylidine)(87-62-7)||Chemical intermediate|
|3,3´-Dimethylbenzidine (o-Tolidine)(119-93-7)||Dye/pigment manufacture|
|1,1-Dimethylhydrazine (57-14-7)||Rocket fuel|
|1,2-Dimethylhydrazine (540-73-8)||Research chemical|
|Disperse Blue 1 (2475-45-8)||Dyes/pigments, hair dyes|
|Ethyl acrylate (140-88-5)||Plastics, adhesives, monomer|
|Ethylene thiourea (96-45-7)||Rubber chemical|
|Fuel oils, residual (heavy)||Fuel|
|Furan (110-00-9)||Chemical intermediate|
|Glycidaldehyde (765-34-4)||Textile, leather manufacture|
|HC Blue No. 1 (2784-94-3)||Hair dyes|
|Hexamethylphosphoramide (680-31-9)||Solvent, plastics|
|Hydrazine (302-01-2)||Rocket fuel, chemical intermediate|
|Lead (7439-92-1) and lead compounds, inorganic||Paints, fuels|
|2-Methylaziridine(75-55-8)||Dyes, paper, plastics manufacture|
|4,4’-Methylene-bis-2-methylaniline (838-88-0)||Dye/pigment manufacture|
|4,4’-Methylenedianiline(101-77-9)||Plastics/resins, dye/pigment manufacture|
|Methylmercury compounds||Pesticide manufacture|
|2-Methyl-1-nitroanthraquinone (129-15-7) (uncertain purity)||Dye/pigment manufacture|
|Nickel, metallic (7440-02-0)||Catalyst|
|Nitrilotriacetic acid (139-13-9) and its salts||Chelating agent, detergent|
|5-Nitroacenaphthene (602-87-9)||Dye/pigment manufacture|
|N-Nitrosodiethanolamine (1116-54-7)||Cutting fluids, impurity|
|Oil Orange SS (2646-17-5)||Dyes/pigments|
|Phenyl glycidyl ether (122-60-1)||Plastics/adhesives/resins|
|Polybrominated biphenyls (Firemaster BP-6) (59536-65-1)||Flame retardant|
|Ponceau MX (3761-53-3)||Dyes/pigments, textiles|
|Ponceau 3R (3564-09-8)||Dyes/pigments, textiles|
|1,3-Propane sulphone (1120-71-4)||Dye/pigment manufacture|
|b-Propiolactone (57-57-8)||Chemical intermediate; plastics manufacture|
|Propylene oxide (75-56-9)||Chemical intermediate|
|2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) (1746-01-6)||Contaminant|
|Thioacetamide (62-55-5)||Textile, paper, leather, rubber manufacture|
|4,4’-Thiodianiline (139-65-1)||Dye/pigment manufacture|
|Thiourea (62-56-6)||Textile, rubber ingredient|
|Toluene diisocyanates (26471-62-5)||Plastics|
|o-Toluidine (95-53-4)||Dye/pigment manufacture|
|Trypan blue (72-57-1)||Dyes/pigments|
|Vinyl acetate (108-05-4)||Chemical intermediate|
1 Evaluated in the IARC Monographs, Volumes 1-63 (1972-1995) (excluding pesticides and drugs).
2 CAS Registry Nos. appear between parentheses.
Occupational exposures may also occur during the production and use of some pesticides and drugs. Table 6 presents an evaluation of the carcinogenicity of pesticides; two of them, captafol and ethylene dibromide, are classified as probable human carcinogens, while a total of 20 others, including DDT, atrazine and chlorophenols, are classified as possible human carcinogens.
Table 6. Pesticides evaluated in IARC Monographs, Volumes 1-63(1972-1995)
|2A—Probably carcinogenic to humans||Captafol (2425-06-1) Ethylene dibromide (106-93-4)|
|2B—Possibly carcinogenic to humans||Amitrole (61-82-5) Atrazine (1912-24-9) Chlordane (57-74-9) Chlordecone (Kepone) (143-50-0) Chlorophenols Chlorophenoxy herbicides DDT (50-29-3) 1,2-Dibromo-3-chloropropane (96-12-8) 1,3-Dichloropropene (542-75-6) (technical-grade) Dichlorvos (62-73-7) Heptachlor (76-44-8) Hexachlorobenzene (118-74-1) Hexachlorocyclohexanes (HCH) Mirex (2385-85-5) Nitrofen (1836-75-5), technical-grade Pentachlorophenol (87-86-5) Sodium o-phenylphenate (132-27-4) Sulphallate (95-06-7) Toxaphene (Polychlorinated camphenes) (8001-35-2)|
1 CAS Registry Nos. appear between parentheses.
Several drugs are human carcinogens (table 9): they are mainly alkylating agents and hormones; 12 more drugs, including chloramphenicol, cisplatine and phenacetin, are classified as probable human carcinogens (Group 2A). Occupational exposure to these known or suspected carcinogens, used mainly in chemotherapy, can occur in pharmacies and during their administration by nursing staff.
Table 7. Drugs evaluated in IARC Monographs, Volumes 1-63 (1972-1995).
|IARC GROUP 1—Carcinogenic to humans|
|Analgesic mixtures containing phenacetin||Kidney, bladder|
|Azathioprine (446-86-6)||Lymphoma, hepatobiliary system, skin|
|N,N-Bis(2-chloroethyl)- b-naphthylamine (Chlornaphazine) (494-03-1)||Bladder|
|1,4-Butanediol dimethanesulphonate (Myleran)
|1-(2-Chloroethyl)-3-(4-methylcyclohexyl)-1-nitrosourea (Methyl-CCNU) (13909-09-6)||Leukaemia|
|Cyclosporin (79217-60-0)||Lymphoma, skin|
|Cyclophosphamide (50-18-0) (6055-19-2)||Leukaemia, bladder|
|Diethylstilboestrol (56-53-1)||Cervix, vagina, breast|
|8-Methoxypsoralen (Methoxsalen) (298-81-7) plus ultraviolet A radiation||Skin|
|MOPP and other combined chemotherapy including alkylating agents||Leukaemia|
|Oestrogen replacement therapy||Uterus|
|Oestrogens, nonsteroidal||Cervix, vagina, breast|
|Oral contraceptives, combined||Liver|
|Oral contraceptives, sequential||Uterus|
|IARC GROUP 2A—Probably carcinogenic to humans|
|Androgenic (anabolic) steroids||(Liver)|
|Bischloroethyl nitrosourea (BCNU) (154-93-8)||(Leukaemia)|
|1-(2-Chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) (13010-47-4)||–|
|Nitrogen mustard (51-75-2)||(Skin)|
|Phenacetin (62-44-2)||(Kidney, bladder)|
|Procarbazine hydrochloride (366-70-1)||–|
1 CAS Registry Nos. appear between parentheses.
2 Suspected target organs are given in parentheses.
Several environmental agents are known or suspected causes of cancer in humans and are listed in table 8; although exposure to such agents is not primarily occupational, there are groups of individuals exposed to them because of their work: examples are uranium miners exposed to radon decay products, hospital workers exposed to hepatitis B virus, food processors exposed to aflatoxins from contaminated foods, outdoor workers exposed to ultraviolet radiation or diesel engine exhaust, and bar staff or waiters exposed to environmental tobacco smoke.
The IARC Monograph programme has covered most of the known or suspected causes of cancer; there are, however, some important groups of agents that have not been evaluated by IARC—namely, ionizing radiation and electrical and magnetic fields.
Table 8. Environmental agents/exposures known or suspected to cause cancer in humans.1
|Agent/exposure||Target organ2||Strength of evidence3|
|Polycyclic aromatic hydrocarbons4||(Lung, bladder)||S|
|Nitrate and nitrite||(Oesophagus, stomach)||S|
|Radon and its decay products||Lung||1|
|Other X-irradiation||Leukaemia, breast, thyroid, others||E|
|Ultraviolet radiation A||(Skin)||2A|
|Ultraviolet radiation B||(Skin)||2A|
|Ultraviolet radiation C||(Skin)||2A|
|Use of sunlamps and sunbeds||(Skin)||2A|
|Electric and magnetic fields||(Leukaemia)||S|
|Chronic infection with hepatitis B virus||Liver||1|
|Chronic infection with hepatitis C virus||Liver||1|
|Infection with Helicobacter pylori||Stomach||1|
|Infection with Opistorchis viverrini||Bile ducts||1|
|Infection with Chlonorchis sinensis||(Liver)||2A|
|Human Papilloma virus types 16 and18||Cervix||1|
|Human Papilloma virus types 31 and 33||(Cervix)||2A|
|Human Papilloma virus types other than 16, 18, 31 and 33||(Cervix)||2B|
|Infection with Schistosoma haematobium||Bladder||1|
|Infection with Schistosoma japonicum||(Liver, colon)||2B|
|Tobacco, alcohol and related substances|
|Alcoholic beverages||Mouth, pharynx, oesophagus, liver, larynx||1|
|Tobacco smoke||Lip, mouth, pharynx, oesophagus, pancreas, larynx, lung, kidney, bladder, (others)||1|
|Smokeless tobacco products||Mouth||1|
|Betel quid with tobacco||Mouth||1|
|Toxins derived from Fusarium moniliforme||(Oesophagus)||2B|
|Chinese style salted fish||Nasopharynx||1|
|Pickled vegetables (traditional in Asia)||(Oesophagus, stomach)||2B|
|Fresh fruits and vegetables (protective)||Mouth, oesophagus, stomach, colon, rectum, larynx, lung (others)||E|
|Fat||(Colon, breast, endometrium)||S|
|Fiber (protective)||(Colon, rectum)||S|
|Nitrate and nitrite||(Oesophagus, stomach)||S|
|Vitamin A, b-carotene (protective)||(Mouth, oesophagus, lung, others)||S|
|Vitamin C (protective)||(Oesophagus, stomach)||S|
|IQ||(Stomach, colon, rectum)||2A|
|Reproductive and sexual behavior|
|Late age at first pregnancy||Breast||E|
|Low parity||Breast, ovary, corpus uteri||E|
|Early age at first intercourse||Cervix||E|
|Number of sexual partners||Cervix||E|
1 Agents and exposures, as well as medicines, occurring mainly in the occupational setting are excluded.
2 Suspected target organs are given in parentheses.
3 IARC Monograph evaluation reported wherever available (1: human carcinogen; 2A: probable human carcinogen; 2B: possible human carcinogen); otherwise E: established carcinogen; S: suspected carcinogen.
4 Human exposure to polycyclic aromatic hydrocarbons occurs in mixtures, such as engine emissions, combustion fumes and soots. Several mixtures and individual hydrocarbons have been evaluated by IARC.
Industries and Occupations
Current understanding of the relationship between occupational exposures and cancer is far from complete; in fact, only 22 individual agents are established occupational carcinogens (table 9), and for many more experimental carcinogens no definitive evidence is available based on exposed workers. In many cases, there is considerable evidence of increased risks associated with particular industries and occupations, although no specific agents can be identified as aetiological factors. Table 10 present lists of industries and occupations associated with excess carcinogenic risks, together with the relevant cancer sites and the known (or suspected) causative agent(s).
Table 9. Industries, occupations and exposures recognized as presenting a carcinogenic risk.
|Industry (ISIC code)||Occupation/process||Cancer site/type||Known or suspected causative agent|
|Agriculture, forestry and fishing (1)||Vineyard workers using arsenic insecticides Fishermen||Lung, skin Skin, lip||Arsenic compounds Ultraviolet radiation|
|Mining and quarrying (2)||Arsenic mining Iron ore (haematite) mining Asbestos mining Uranium mining Talc mining and milling||Lung, skin Lung Lung, pleural and peritoneal mesothelioma Lung Lung||Arsenic compounds Radon decay products Asbestos Radon decay products Talc containing asbestiform fibers|
|Chemical (35)||Bis(chloromethyl) ether (BCME) and chloromethyl-methyl ether (CMME) production workers and users Vinyl chloride production Isopropyl alcohol manufacture (strong-acid process) Pigment chromate production Dye manufacturers and users Auramine manufacture p-chloro-o-toluidine production||Lung (oat-cell carcinoma) Liver angiosarcoma Sinonasal Lung, sinonasal Bladder Bladder Bladder||BCME, CMME Vinyl chloride monomer Not identified Chromium (VI) compounds Benzidine, 2-naphthylamine, 4-aminobiphenyl Auramine and other aromatic amines used in the process p-chloro-o-toluidine and its strong acid salts|
|Leather (324)||Boot and shoe manufacture||Sinonasal, leukaemia||Leather dust, benzene|
|Wood and wood products (33)||Furniture and cabinet makers||Sinonasal||Wood dust|
|Pesticides and herbicides production (3512)||Arsenical insecticides production and packaging||Lung||Arsenic compounds|
|Rubber industry (355)||Rubber manufacture Calendering, tyre curing, tyre building Millers, mixers Synthetic latex production, tyre curing, calender operatives, reclaim, cable makers Rubber film production||Leukaemia Bladder Leukaemia Bladder Bladder Leukaemia||Benzene Aromatic amines Benzene Aromatic amines Aromatic amines Benzene|
|Asbestos production (3699)||Insulated material production (pipes, sheeting, textile, clothes, masks, asbestos cement products)||Lung, pleural and peritoneal mesothelioma||Asbestos|
|Metals (37)||Aluminum production Copper smelting Chromate production, chromium plating Iron and steel founding Nickel refining Pickling operations Cadmium production and refining; nickel-cadmium battery manufacture; cadmium pigment manufacture; cadmium alloy production; electroplating; zinc smelters; brazing and polyvinyl chloride compounding Beryllium refining and machining; production of beryllium-containing products||Lung, bladder Lung Lung, sinonasal Lung Sinonasal, lung Larynx, lung Lung Lung||Polycyclic aromatic hydrocarbons, tar Arsenic compounds Chromium (VI) compounds Not identified Nickel compounds Inorganic acid mists containing sulphuric acid Cadmium and cadmium compounds Beryllium and beryllium compounds|
|Shipbuilding, motor vehicle and railroad equipment manufacture (385)||Shipyard and dockyard, motor vehicle and railroad manufacture workers||Lung, pleural and peritoneal mesothelioma||Asbestos|
|Gas (4)||Coke plant workers Gas workers Gas-retort house workers||Lung Lung, bladder, scrotum Bladder||Benzo(a)pyrene Coal carbonization products, 2-naphthylamine Aromatic amines|
|Construction (5)||Insulators and pipe coverers Roofers, asphalt workers||Lung, pleural and peritoneal mesothelioma Lung||Asbestos Polycyclic aromatic hydrocarbons|
|Other||Medical personnel (9331) Painters (construction, automotive industry and other users)||Skin, leukaemia Lung||Ionizing radiation Not identified|
Table 10. Industries, occupations and exposures reported to present a cancer excess but for which the assessment of the carcinogenic risk is not definitive.
|Industry (ISIC code)||Occupation/process||Cancer site/type||Known (or suspected) causative agent|
|Agriculture, forestry and fishing (1)||Farmers, farm workers Herbicide application Insecticide application||Lymphatic and haematopoietic system (leukaemia, lymphoma) Malignant lymphomas, soft-tissue sarcomas Lung, lymphoma||Not identified Chlorophenoxy herbicides, chlorophenols (presumably contaminated with polychlorinated dibenzodioxins) Non-arsenical insecticides|
|Mining and quarrying (2)||Zinc-lead mining Coal Metal mining Asbestos mining||Lung Stomach Lung Gastrointestinal tract||Radon decay products Coal dust Crystalline silica Asbestos|
|Food industry (3111)||Butchers and meat workers||Lung||Viruses, PAH1|
|Beverage industry (3131)||Beer brewers||Upper aero-digestive tract||Alcohol consumption|
|Textile manufacture (321)||Dyers Weavers||Bladder Bladder, sinonasal, mouth||Dyes Dusts from fibers and yarns|
|Leather (323)||Tanners and processors Boot and shoe manufacture and repair||Bladder, pancreas, lung Sinonasal, stomach, bladder||Leather dust, other chemicals, chromium Not identified|
|Wood and wood products (33), pulp and paper industry (341)||Lumbermen and sawmill workers Pulp and papermill workers Carpenters, joiners Woodworkers, unspecified Plywood production, particle-board production||Nasal cavity, Hodgkin lymphoma, skin Lymphopoietic tissue, lung Nasal cavity, Hodgkin lymphoma Lymphomas Nasopharynx, sinonasal||Wood dust, chlorophenols, creosotes Not identified Wood dust, solvents Not identified Formaldehyde|
|Printing (342)||Rotogravure workers, binders, printing pressmen, machine-room workers and other jobs||Lymphocytic and haemopoietic system, oral, lung, kidney||Oil mist, solvents|
|Chemical (35)||1,3-Butadiene production Acrylonitrile production Vinylidene chloride production Isopropyl alcohol manufacture (strong-acid process) Polychloroprene production Dimethylsulphate production Epichlorohydrin production Ethylene oxide production Ethylene dibromide production Formaldehyde production Flame retardant and plasticizer use Benzoyl chloride production||Lymphocytic and haemopoietic system Lung, colon Lung Larynx Lung Lung Lung, lymphatic and haemopoietic system (leukaemia) Lymphatic and haemopoietic system (leukaemia), stomach Digestive system Nasopharynx, sinonasal Skin (melanoma) Lung||1,3-Butadiene Acrylonitrile Vinylidene chloride (mixed exposure with acrylonitrile) Not identified Chloroprene Dimethylsulphate Epichlorohydrin Ethylene oxide Ethylene dibromide Formaldehyde Polychlorinated biphenyls Benzoyl chloride|
|Herbicides production (3512)||Chlorophenoxy herbicide production||Soft-tissue sarcoma||Chlorophenoxy herbicides, chlorophenols (contaminated with polychlorinated dibenzodioxins)|
|Petroleum (353)||Petroleum refining||Skin, leukaemia, brain||Benzene, PAH, untreated and mildly treated mineral oils|
|Rubber (355)||Various occupations in rubber manufacture Styrene-butadiene rubber production||Lymphoma, multiple myeloma, stomach, brain, lung Lymphatic and haematopoietic system||Benzene, MOCA,2 other not identified 1,3-Butadiene|
|Ceramic, glass and refractory brick (36)||Ceramic and pottery workers Glass workers (art glass, container and pressed ware)||Lung Lung||Crystalline silica Arsenic and other metal oxides, silica, PAH|
|Asbestos production (3699)||Insulation material production (pipes, sheeting, textiles, clothes, masks, asbestos cement products)||Larynx, gastrointestinal tract||Asbestos|
|Metals (37, 38)||Lead smelting Cadmium production and refining; nickel-cadmium battery manufacture; cadmium pigment manufacture; cadmium alloy production; electroplating; zinc smelting; brazing and polyvinyl chloride compounding Iron and steel founding||Respiratory and digestive systems Prostate Lung||Lead compounds Cadmium and cadmium compounds Crystalline silica|
|Shipbuilding (384)||Shipyard and dockyard workers||Larynx, digestive system||Asbestos|
|Motor vehicle manufacturing (3843, 9513)||Mechanics, welders, etc.||Lung||PAH, welding fumes, engine exhaust|
|Electricity (4101, 9512)||Generation, production, distribution, repair||Leukaemia, brain tumors Liver, bile ducts||Extremely low frequency magnetic fields PCBs3|
|Construction (5)||Insulators and pipe coverers Roofers, asphalt workers||Larynx, gastrointestinal tract Mouth, pharynx, larynx, oesophagus, stomach||Asbestos PAH, coal tar, pitch|
|Transport (7)||Railroad workers, filling station attendants, bus and truck drivers, operators of excavating machines||Lung, bladder Leukaemia||Diesel engine exhaust Extremely low frequency magnetic fields|
|Other||Service station attendants (6200) Chemists and other laboratory workers (9331) Embalmers, medical personnel (9331) Health workers (9331) Laundry and dry cleaners (9520) Hairdressers (9591) Radium dial workers||Leukaemia and lymphoma Leukaemia and lymphoma, pancreas Sinonasal, nasopharynx Liver Lung, oesophagus, bladder Bladder, leukaemia and lymphoma Breast||Benzene Not identified (viruses, chemicals) Formaldehyde Hepatitis B virus Tri- and tetrachloroethylene and carbon tetrachloride Hair dyes, aromatic amines Radon|
1 PAH, polycyclic aromatic hydrocarbon.
2 MOCA, 4,4’-methylene-bis-2-chloroaniline.
3 PCBs, polychlorinated biphenyls.
Table 9 presents industries, occupations and exposures in which the presence of a carcinogenic risk is considered to be established, whereas Table 10 shows industrial processes, occupations and exposures for which an excess cancer risk has been reported but evidence is not considered to be definitive. Also included in table 10 are some occupations and industries already listed in table 9, for which there is inconclusive evidence of association with cancers other than those mentioned in table 9. For example, the asbestos production industry is included in table 9 in relation to lung cancer and pleural and peritoneal mesothelioma, whereas the same industry is included in table 10 in relation to gastrointestinal neoplasms. A number of industries and occupations listed intables 9 and 10 have also been evaluated under the IARC Monographs programme. For example, “occupational exposure to strong inorganic acid mist containing sulphuric acid” was classified in Group 1 (carcinogenic to humans).
Constructing and interpreting such lists of chemical or physical carcinogenic agents and associating them with specific occupations and industries is complicated by a number of factors: (1) information on industrial processes and exposures is frequently poor, not allowing a complete evaluation of the importance of specific carcinogenic exposures in different occupations or industries; (2) exposures to well-known carcinogenic exposures, such as vinyl chloride and benzene, occur at different intensities in different occupational situations; (3) changes in exposure occur over time in a given occupational situation, either because identified carcinogenic agents are substituted by other agents or (more frequently) because new industrial processes or materials are introduced; (4) any list of occupational exposures can refer only to the relatively small number of chemical exposures which have been investigated with respect to the presence of a carcinogenic risk.
All of the above issues emphasize the most critical limitation of a classification of this type, and in particular its generalization to all areas of the world: the presence of a carcinogen in an occupational situation does not necessarily mean that workers are exposed to it and, in contrast, the absence of identified carcinogens does not exclude the presence of yet unidentified causes of cancer.
A particular problem in developing countries is that much of the industrial activity is fragmented and takes place in local settings. These small industries are often characterized by old machinery, unsafe buildings, employees with limited training and education, and employers with limited financial resources. Protective clothing, respirators, gloves and other safety equipment are seldom available or used. The small companies tend to be geographically scattered and inaccessible to inspections by health and safety enforcement agencies.