Academic journal article Environmental Health Perspectives

Environmental and Occupational Interventions for Primary Prevention of Cancer: A Cross-Sectorial Policy Framework

Academic journal article Environmental Health Perspectives

Environmental and Occupational Interventions for Primary Prevention of Cancer: A Cross-Sectorial Policy Framework

Article excerpt

BACKGROUND: Nearly 13 million new cancer cases and 7.6 million cancer deaths occur worldwide each year; 63% of cancer deaths occur in low- and middle-income countries. A substantial proportion of all cancers are attributable to carcinogenic exposures in the environment and the workplace.

OBJECTIVE: We aimed to develop an evidence-based global vision and strategy for the primary prevention of environmental and occupational cancer.

METHODS: We identified relevant studies through PubMed by using combinations of the search terms "environmental," "occupational," "exposure," "cancer," "primary prevention," and "interventions." To supplement the literature review, we convened an international conference titled "Environmental and Occupational Determinants of Cancer: Interventions for Primary Prevention" under the auspices of the World Health Organization, in Asturias, Spain, on 17-18 March 2011.

DISCUSSION: Many cancers of environmental and occupational origin could be prevented. Prevention is most effectively achieved through primary prevention policies that reduce or eliminate involuntary exposures to proven and probable carcinogens. Such strategies can be implemented in a straightforward and cost-effective way based on current knowledge, and they have the added benefit of synergistically reducing risks for other noncommunicable diseases by reducing exposures to shared risk factors.

CONCLUSIONS: Opportunities exist to revitalize comprehensive global cancer control policies by incorporating primary interventions against environmental and occupational carcinogens.

KEY WORDS: cancer, environmental health, occupational, policy, primary prevention, public health. Environ Health Perspect 121:420-426 (2013). http://dx.doi.org/10.1289/ehp.1205897 [Online 5 February 2013]

Cancer is the second leading cause of death worldwide. In 2008, there were 7.6 million deaths from cancer, and 12.7 million new cancer cases (Ferlay et al. 2010). More than half of all cancers and 63% of cancer deaths occur in low- and middle-income countries.

Estimations show that at least one-third of all cancer cases could be prevented based on current knowledge (Danaei et al. 2005). Although preventable risk factors such as tobacco use, alcohol consumption, unhealthy diet, and physical inactivity play a major role in the development of cancer, a range of environmental factors and occupational exposures also contribute significantly to the global cancer burden (Parkin et al. 2011; President's Cancer Panel 2010; Tomatis et al. 1990). Exposures to environmental and occupational carcinogens are often preventable.

"Environment" is defined by the World Health Organization (WHO) for the purpose of environmental attribution as "all the physical, chemical and biological factors external to the human host, and all related behaviors, but excluding those natural environments that cannot reasonably be modified" (Pruss-Ustun and Corvalan 2006). This definition is limited to those parts of the environment that can, in principle, be modified so as to reduce the impact of the environment on health. It also excludes those behaviors and lifestyles not strictly related to environmental exposures such as alcohol consumption and tobacco use as well as behaviors related to the social and cultural environment, genetics, and parts of the "unmodifiable" natural environment (Pruss-Ustun and Corvalan 2006).

Humans are exposed to numerous carcinogenic agents through inhalation, eating, drinking, and skin contact. Since most people work for nearly two-thirds of their lifetime, they have many, and often prolonged, opportunities for contacts with occupational carcinogens, resulting in the accumulation of exposure over a lifetime. WHO has estimated that a substantial proportion of all cancers are attributable to the environment, including work settings (WHO 2009a). For 2004, it was estimated that occupational lung carcinogens (such as arsenic, asbestos, beryllium, cadmium, and chromium) caused 111,000 lung-cancer deaths, and asbestos alone was estimated to cause 59,000 deaths from mesothelioma. …

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