Workplace exposure to carcinogens in New Zealand (HRC 08/569) Study report for the Department of Labour Andrea ’t Mannetje Centre for Public Health Research Massey University [email protected] 1 Centre for Public Health Research – May 23, 2013 Contract information: Title: Workplace exposure to carcinogens in New Zealand HRC Reference: 08/569 (partnership Programme Research Contract) Steering Committee: Occupational Health Research Strategy Steering Committee Host Institution: Massey University Named Investigators: Andrea ’t Mannetje (CPHR), Neil Pearce (CPHR), Dave McLean (CPHR), Jeroen Douwes (CPHR), Evan Dryson, Chris Walls, Lis Ellison-Loschmann (CPHR, Sunia Foliaki (CPHR), Aaron Blair (US National Cancer Institute), Hans Kromhout (IRAS, University of Utrecht), Tania Slater (CPHR), Paolo Boffetta (International Agency for Research on Cancer) Additional Investigators who worked on this contract: Bill Glass (CPHR), Kerry Cheung (CPHR), Bradley Prezant (CPHR) Contract period: 1 July 2008 – 30 June 2011 (extension to 15 December 2011) 2 Centre for Public Health Research – May 23, 2013 Contents 1. Introduction ........................................................................................................................................ 4 2. Summary of Research ......................................................................................................................... 5 2.1. Background ................................................................................................................................. 5 2.2. Aims ............................................................................................................................................. 5 2.3. Design .......................................................................................................................................... 5 2.4. Subjects ....................................................................................................................................... 5 2.5. Main outcome measures ............................................................................................................ 6 3. Specific outputs of the project ............................................................................................................ 7 3.1. Literature review.......................................................................................................................... 7 3.2. List of occupational carcinogens .................................................................................................. 9 3.3. NZ-CAREX ................................................................................................................................... 10 3.4. NZ-ACEM .................................................................................................................................... 11 3.5. Industry surveys ......................................................................................................................... 16 3.5.1. Joiners and Furniture industry (wood dust and formaldehyde) ......................................... 16 3.5.2. Building industry (asbestos and silica) ................................................................................ 16 3.5.3. Other industries .................................................................................................................. 18 3.6. Other outcomes of the study ..................................................................................................... 18 3.6.1. Stakeholder engagement .................................................................................................... 18 3.6.2. International research partnerships ................................................................................... 19 4. Synthesis of research outcomes / conclusions ................................................................................. 20 4.1. The extent and industrial distribution of workplace carcinogens in New Zealand ................... 20 4.2. The key industries for which intervention would result in marked reductions in occupational cancer ................................................................................................................................................ 20 4.3. The key carcinogens for which intervention would result in marked reductions in occupational cancer ................................................................................................................................................ 21 4.4. Intervention strategies and barriers to the implementation of additional interventions......... 22 4.5. Main conclusions. ...................................................................................................................... 25 Appendix 1: Draft Literature review Appendix 2: List of occupational carcinogens 3 Centre for Public Health Research – May 23, 2013 1. Introduction In 2008 The Centre for Public health Research was awarded a Partnership Programme Research Contract for the project titled “Workplace exposure to carcinogens in New Zealand”, which was submitted in response to a 2007 RFP under the Occupational Health Research Strategy, a joint initiative in Occupational Health Research, funded by the Department of Labour and the Health Research Council of New Zealand. This report summarises the work completed under this contract. 4 Centre for Public Health Research – May 23, 2013 2. Summary of Research The research to be carried out under this contract was summarized in the application as follows: 2.1. Background The National Occupational Health and Safety Committee (NOHSAC) estimates that 237-425 people die each year from occupational cancer in New Zealand. The lack of national data on the extent and industrial distribution of occupational exposure to carcinogens is limiting the prioritisation and implementation of successful prevention strategies. 2.2. Aims (i) To provide a detailed assessment of the extent and industrial distribution of workplace carcinogens in New Zealand; (ii) to identify key industries and key carcinogens for which intervention would result in marked reductions in occupational cancer; and (iii) in selected key industries, to review the intervention strategies currently in place and evaluate the barriers to the implementation of additional interventions. 2.3. Design The project will involve: (i) a literature review of the occupational causes of cancer relevant to New Zealand, and the known solutions for reducing and/or preventing exposures; (ii) the development of a New Zealand specific Information System on Occupational Exposure to Carcinogens (NZ-CAREX); (iii) the development of a New Zealand specific Agricultural Chemicals Exposure Matrix (NZACEM); (iv) a survey in key New Zealand industries, evaluating the work practices regarding occupational carcinogens currently in place, the knowledge and attitudes of employers, employees and health and safety personnel about workplace carcinogens and possible intervention strategies. 2.4. Subjects The survey in key New Zealand industries will involve recruiting employers, employees and health and safety personnel from each selected industry, who will complete a questionnaire on current exposures, work practices, knowledge and attitudes regarding workplace carcinogens and prevention strategies, and perceived barriers of implementation of additional intervention strategies. Where possible, the subjects will be recruited through 5 Centre for Public Health Research – May 23, 2013 contacts from ongoing studies at the Centre for Public Health Research. The findings of the study will be discussed with industry stakeholders. 2.5. Main outcome measures This study will provide an overview of the occupational causes of cancer in New Zealand. In addition, it will provide easily accessible, quantitative, and New Zealand-specific data on the extent and industrial distribution of occupational exposure to carcinogens. This will not only provide estimates of the number of workers exposed to carcinogens, but will also help determine the key exposures and key industries for which intervention would result in marked improvements in occupational health. This study will also provide new knowledge on interventions and their effectiveness and the perceptions and behaviours regarding health and safety in key New Zealand industries. The study’s stakeholder engagement will result in a greater industry awareness of the occupational cancer problem and the potential benefits of interventions. Finally, this study will build international research partnerships and will increase the occupational health research capacity in New Zealand. 6 Centre for Public Health Research – May 23, 2013 3. Specific outputs of the project The project has several concrete outputs, apart from the envisaged scientific publications in peer reviewed journals that will flow from this research. The specific outputs are: (1) Literature review; (2) List of occupational carcinogens; (3) NZ-CAREX and (4) NZ-ACEM. Each is discussed in more detail below. 3.1. Literature review The literature review starts with an introductory chapter on what is currently known about occupational cancer in New Zealand. Background information is given on how occupational exposures are evaluated for carcinogenicity according to the International Agency for Research on Cancer. The question whether occupational cancer is a problem of the past is discussed, followed by estimates of the burden of occupational cancer in the world and in New Zealand specifically. What sources of information are available on exposure to occupational carcinogens are summarised, as well as the most important approaches available for the prevention of occupational cancer. This is followed by a chapter for each industry subdivision (according to the ANZSIC 3-digit classification). The 42 chapter titles are listed in Table 1, along with the number of people in New Zealand employed in these industries, according to the 2006 census. Table 1: The Australian and New Zealand Standard Industry Classification and the number of men and women employed in each subdivision according to the 2006 Census. ANZSIC 3-digit industry subdivision men women total A01 Agriculture A02 Services to Agriculture; Hunting and Trapping A03 Forestry and Logging A04 Commercial Fishing B11 Coal Mining B12 Oil and Gas Extraction B13 Metal Ore Mining B14 Other Mining B15 Services to Mining C21 Food, Beverage and Tobacco C22 Textile, Clothing, Footwear and Leather Manufacturing C23 Wood and Paper Product Manufacturing C24 Printing, Publishing and Recorded Media C25 Petroleum, Coal, Chemical and Associated Product Manuf. C26 Non-Metallic Mineral Product Manufacturing C27 Metal Product Manufacturing C28 Machinery and Equipment Manufacturing C29 Other Manufacturing D36 Electricity and Gas Supply D37 Water Supply, Sewerage and Drainage Services E41 General Construction E42 Construction Trade Services F45 Basic Material Wholesaling 13,311 12,726 6,744 2,238 708 240 384 1,497 807 35,436 7119 19,101 12,111 12,609 5,607 22,503 34,359 10,314 3,075 1,191 57,399 70,797 20,379 10,467 6,180 1,227 627 66 54 54 222 120 19,350 10647 3,876 10,131 5,361 1,239 4,254 8,301 3,882 1,326 504 7,509 11,832 8,190 23,784 18,909 7,974 2,862 771 297 438 1,719 927 54,789 17763 22,980 22,242 17,955 6,822 26,745 42,654 14,193 4,401 1,695 64,908 82,644 28,566 7 Centre for Public Health Research – May 23, 2013 F46 F47 G51 G52 G53 H57 I61 I62 I63 I64 I65 I66 I67 J71 K73 K74 K75 L77 L78 M81 M82 N84 O86 O87 P91 P92 P93 Q95 Q96 Q97 Machinery and Motor Vehicle Wholesaling Personal and Household Good Wholesaling Food Retailing Personal and Household Good Retailing Motor Vehicle Retailing and Services Accommodation, Cafes and Restaurants Road Transport Rail Transport Water Transport Air and Space Transport Other Transport Services to Transport Storage Communication Services Finance Insurance Services to Finance and Insurance Property Services Business Services Government Administration Defence Education Health Services Community Services Motion Picture, Radio and Television Services Libraries, Museums and the Arts Sport and Recreation Personal Services Other Services Private Households Employing Staff 26,295 23,088 33,252 39,807 39,243 34,686 27,261 1,563 1,341 5,502 1,146 12,357 3,588 13,119 15,957 3,993 8,367 27,537 105,156 23,217 7,380 38,028 21,246 7,203 6,105 7,056 12,060 13,050 23,007 9 9,279 20,424 47,772 66,804 11,250 59,904 6,174 291 810 3,441 276 9,924 1584 11,220 22,449 5,046 8,316 24,801 96,255 34,044 2,454 101,097 85,047 47,634 5,043 8,748 12660 21,252 18,729 24 35,577 43,530 81,024 106,596 50,490 94,590 33,432 1,857 2,151 8,949 1,419 22,272 5,172 24,333 38,415 9,039 16,686 52,329 201,414 57,267 9,834 139,134 106,305 54,834 11,151 15,801 24,717 34,299 41,739 33 The numbers are based on the 2006 Census data Each chapter covers the following: 1. Description of the industry 2. Potential for work-related carcinogen exposure 3. Exposure studies 4. Cancer risk 5. Gaps in knowledge 6. Prevention strategies 7. References The description of the industry gives background information on what activities are performed in that industry, the number of people working in that industry, and the main occupational groups within that industry. The paragraph on the potential for work-related carcinogen exposure discusses the tasks and circumstances during which workers can be exposed to carcinogens, and lists these carcinogens. The paragraph on exposure studies, lists whether specific exposure studies have been reported for carcinogens within this industry. The paragraph on cancer risk, summarises whether epidemiological studies have reported any increases in cancer risk for this particular industry or for occupational groups that are prevalent within this particular industry. New Zealand specific studies are discussed separately. The following paragraph briefly points out the main gaps in knowledge regarding exposure to carcinogens and cancer risk for this industry, followed by a review of documents or other information available regarding prevention strategies. 8 Centre for Public Health Research – May 23, 2013 The literature review’s division into industry groups, resonates with the National Action Agenda 2010-2013 (of the Workplace Health and Safety Strategy for New Zealand to 2015) approach of identifying priority industries and developing action plans by industry sector. STATUS: The literature review is currently being edited for publication as a CPHR report (see draft report in Appendix 1). It can be used as a stand-alone information source on the exposure circumstances of occupational carcinogens in New Zealand, but is also an accompanying document to CAREX-NZ. 3.2. List of occupational carcinogens Based on the IARC evaluations and the information stored in CAREX, a list of occupational carcinogens was compiled. This list contains industrial chemicals, fibres and dusts, combustion products, metals, microbial agents, pesticides, hormones, radiation, pharmacological agents and exposure circumstances, which can be present in the workplace and workers can potentially be exposed to as part of their work. Included are IARC Group 1, 2A and 2B carcinogens, with classifications updated to the end of 2011. IARC evaluation (updated to end 2011): Group 1: The agent is carcinogenic to humans. Group 2A: The agent is probably carcinogenic to humans. Group 2B: The agent is possibly carcinogenic to humans. For each carcinogen listed, basic background information is provided. This includes: 1. The IARC evaluation (group 1, 2A or 2B) and the reference to the IARC Monograph in which the compound was evaluated. 2. The CAS number, which is a unique numerical identifier of the agent, published by the Chemical Abstracts Service (CAS) of the American Chemical Society. 3. The exposure category (all agents are categorized into one of the following groups): • Industrial chemicals • Metals • Pesticides • Fibres and dust • Radiation • Pharmacological • Hormones • Microbial agents • Combustion product • Exposure circumstances 4. A short summary of the agent's uses. Information mainly obtained from CAREX, the 11th RoC (Report on Carcinogens of the US National Toxicology Program; http://ntp.niehs.nih.gov/) and HazMap (http://hazmap.nlm.nih.gov/). 9 Centre for Public Health Research – May 23, 2013 5. The New Zealand exposure standard for the compound - if available - obtained from the New Zealand Workplace Exposure Standard, published in 2002 (updates published since 2002 are included). 6. Definition of the agent for the purpose of the CAREX evaluation. Obtained from the original CAREX database. The list currently includes 81 Group 1 carcinogens; 56 Group 2A carcinogens and 118 Group 2B carcinogens. The list of carcinogens is part of the CAREX-NZ ACCESS database, which has the advantage it can be easily updated (e.g. when exposure standards or IARC classifications change), and can be printed out in different ways (e.g. alphabetical; grouped by exposure category; grouped by IARC evaluation, etc.). STATUS: this document is available as a background document for CAREX-NZ, as well as a stand-alone document (See draft report in appendix 2). 3.3. NZ-CAREX NZ-CAREX stands for CArcinogen EXposure New Zealand. It is an ACCESS based information system, listing for each industry the carcinogens that may occur in that industry. The industry classification follows the same classification as applied for the literature review (see 3.1). The carcinogen classification follows the same classification as that applied for the list of occupational carcinogens (see 3.2.). NZ-CAREX provides for each industry an estimate of the fraction of workers within that industry potentially exposed to each carcinogen expected to be present in that industry. These estimates are based on the international CAREX evaluations and local expert assessment (i.e. industrial hygienists and other professionals in the field). By combining the fraction of workers with the total number of men and women working in that industry, the total number of men and women potentially exposed within that industry is automatically calculated within the ACCESS database. This information can be presented in different ways within NZ-CAREX, in the form of automatic ACCESS reports. When information within NZ-CAREX is updated, these reports are automatically updated as well. The reports include: 1. Carcinogens 2. Carcinogens by industry 3. Industries by carcinogen The Carcinogens report lists all carcinogens and the estimated total number of men and women with potential occupational exposure to this carcinogen in New Zealand. The Carcinogens by industry report lists the carcinogens that can occur in each industry, plus the estimated number of men and women potentially exposed to them within that industry. 10 Centre for Public Health Research – May 23, 2013 This report gives a quick overview of the total number of carcinogens within that industry and which carcinogens are the most common within that industry. The Industries by carcinogen report lists the industries in which occupational exposure to a certain carcinogen can occur, together with the total number of men and women potentially exposed to that carcinogen in each industry. This report gives a quick overview of which industries contain the highest number of workers exposed for each particular industry. STATUS: the NZ-CAREX database is ready for use for a wide range of carcinogens and industries, and we will continue to update the database for other carcinogens and industries (not yet included). We propose to present the database at Department of Labour (DoL) at a date/time convenient for the DoL. 3.4. NZ-ACEM Farmers have an increased risk of certain cancers, but which exposures are responsible is not known. Pesticide exposure is likely to be related to this increased risk, but it has been very difficult to associate specific pesticides with the increased risk because of the difficulties in assessing the exposure to specific pesticides. Therefore, as part of this project, a New Zealand specific Agricultural Chemicals Exposure Matrix (NZ-ACEM) was developed. This is supplementary to NZ-CAREX and specifically focuses on pesticide exposure within the agricultural industry. NZ-ACEM was set up separately from NZ-CAREX because: 1. The IARC classification used for NZ-CAREX is not very complete regarding the classification of the carcinogenicity of pesticides 2. The industry classification used for NZ-CAREX is not specific enough to characterize pesticide exposure To illustrate that the IARC classification used for NZ-CAREX is not very complete regarding the classification of the carcinogenicity of pesticides, the pesticides evaluated to be Group 1 or 2A or 2B by the IARC Monographs for their carcinogenicity are listed below. Pesticides (or pesticide groups) evaluated by IARC to be a group 1, 2A or 2B carcinogen Group 1: Arsenical pesticides Group 2A: non-arsenical pesticides (occupational exposure in spraying and application); captafol; ethylene dibromide Group 2B: 1,2-Dibromo-3-chloropropane; aramite; chlordane; chlordecone; chlorphenoxy herbicides; chlorothalonil; DDT; dichlorvos; heptachlor; hexachlorobenzene; lindane; mirex; nitrofen; pentachlorophenol; sodium ortho-phenylphenate; toxaphene For many pesticides the evidence of carcinogenicity has never been evaluated by IARC. In addition, many of the pesticides that were evaluated are no longer used in New Zealand. Also, some evaluations refer to a very broad group of pesticides (e.g. non-arsenical pesticides; chlorophenoxy herbicides) which is not informative regarding potential risk associated with specific pesticides. 11 Centre for Public Health Research – May 23, 2013 Table 2. Active ingredients most commonly used in New Zealand (2004) and their evaluation of human carcinogenicity active ingredient (pesticide group) CAS tonnes active ingredient/yr Evaluation of human carcinogenicity HSNO (NZ) Herbicides EPA (US) IARC (WHO) 2000 MCPA (phenoxy hormones) 94-74-6 447 not likely (2003) glyphosate 344 evidence of noncarcinogenicity (1991) 2,4-D (phenoxy hormones) 94-75-7 282 not classifiable (1997) terbuthylazine (triazines) 5915-41-3 224 not classifiable (1994) mecoprop (phenoxy hormones) 93-65-2 178 MCPB (phenoxy hormones) 94-81-5 174 (phosphonyls) 1071-83-6 not likely (2008) isoproturon (urea derivates) 34123-59-6 73 acetochlor (amides) 34256-82-1 63 suggestive evidence (2007) hexazinone (triazines) 51235-04-2 53 not classifiable (1994) atrazine (triazines) 1912-24-9 49 not likely (2000) triclopyr (other hormones) 55335-06-3 44 alachlor (amides) 15972-60-8 possibly (chlorophenoxy herbicides) (1987) possibly (chlorophenoxy herbicides) (1987) possibly (chlorophenoxy herbicides) (1987) possibly (chlorophenoxy herbicides) (1987) possibly -> not classifiable (1999) not classifiable (1996) 40 suspected propachlor (amides) 1918-16-7 27 suspected trifluralin (dinitroanilines) 1582-09-8 19 possible (1986) linuron (urea derivates) 330-55-2 14 possible (2001) glufosinate-ammonium (phosphonyls) 77182-82-2 12 not likely (1999) picloram (other hormones) 1918-02-1 11 evidence of noncarcinogenicity (1994) not classifiable (1991) probable (1999) (ethylenethiourea) possibly -> not classifiable (2001) fungicides 900 mancozeb (dithiocarbamate) 8018-01-7 442 multiple indicators (1997) likely (1997) not classifiable (1991) sulphur (inorganics) 7704-34-9 99 captan (other fungicides) 133-06-2 47 suspected multiple descriptors (2004) not classifiable (1987) chlorothalonil (other fungicides/organochlorine) 1897-45-6 25 suspected likely (1994) possibly (1999) metalaxyl-m 15 (other fungicides) no CAS metiram (dithiocarbamate) 9006-42-2 15 tolylfluanid (other fungicides) 731-27-1 14 likely (2002) thiram (dithiocarbamate) 137-26-8 11 not likely (2003) not classifiable (1991) suggestive evidence (2003) not classifiable (1991) phosphorous acid (inorganics)13598-36-2 7 ziram (dithiocarbamate) 137-30-4 6 insecticides probable (1999) 200 diazinon (organophosphate) 333-41-5 93 not likely (1997) methamidophos (organophosphate)10265-92-6 19 not likely (1997) chlorpyrifos (organophosphate) 2921-88-2 17 evidence of noncarcinogenicity (1993) carbaryl (carbamate) 63-25-2 16 fenamiphos (organophosphate) 22224-92-6 11 pirimiphos-methyl (organophosphate) 29232-93-7 phorate (organophosphate) 298-02-2 likely (2002) cannot be determined (1998) 6 evidence of noncarcinogenicity (1993) 300 hydrogen cyanamide 420-04-2 216 not classifiable (1987) evidence of noncarcinogenicity (1993) 8 plant growth regulators ammonium thiosulphate 7783-18-8 suspected possible (1993) 45 chlormequat-chloride 999-81-5 19 not likely (2007) mepiquat-chloride 24307-26-4 15 not likely (2003) Other agencies have a more complete list of pesticides evaluated for carcinogenicity, for example, the United States Environmental protection Agency (EPA). Table 2 lists the 12 Centre for Public Health Research – May 23, 2013 pesticide active ingredients most commonly used in New Zealand according to figures published in 2004, the evaluation of human carcinogenicity by IARC and US EPA, and the information regarding carcinogenicity given on these active ingredients under HSNO. This indicates that for several pesticides that are widely used in New Zealand, there is suspicion of carcinogenicity to humans. It also indicates that in some cases the information from different agencies is conflicting. For this reason, NZ-ACEM includes not only pesticides that are suspected to be carcinogenic, but all commonly used pesticides in New Zealand. The list of pesticides was based on ‘Trends in pesticide Use in New Zealand: 2004”, published in 2005 as a report to the Ministry for the Environment by HortResearch. The ANZSIC 5-digit industry classification was used as a starting point for the industry axis of NZ-ACEM. A further subdivision based on specific crops within each industry was made, because pesticide use can vary significantly between crops, and pesticide use is reported for each of these crops in the ‘Trends in pesticide Use in New Zealand: 2004” report. Table 3. The Australian and New Zealand Standard Industry Classification for the agricultural industry and the number of men and women employed in each industry according to the 2006 Census, as well as specific crops within each industry industry A0111 Plant Nurseries A0112 Cut Flower and Flower Seed Growing A0113 Vegetable Growing asparagus carrots cauliflower/cabbage/b.sprouts/broccoli cucumbers/tomatoes/capsicums forage brassicas kumara lettuce onions/garlic peas/beans potatoes pumpkins silverbeet/spinach squash sweetcorn tomatoes - outdoor A0114 Grape Growing A0115 Apple and Pear Growing apples pears/nashi A0116 Stone Fruit Growing apricots cherries peaches/nectarines plums A0117 Kiwi Fruit Growing A011910 Citrus Growing A011920 Berry Fruit Growing blackcurrants blueberries boysenberries/blackberries/raspberries strawberries A011990 Other Fruit Growing nec avocado Men (n) 1677 651 2697 Women (n) 1893 837 2025 Total (n) 3570 1485 4722 2175 2199 1509 1428 3687 3630 189 123 312 1758 210 282 1161 141 345 2919 354 627 1473 1005 2478 13 Centre for Public Health Research – May 23, 2013 feijoas olives passionfruit persimmons tamarillos walnuts/macadamias/chestnuts A0121 Grain Growing barley cereal silage or balage maize-grain maize-silage or balage oats wheat A0122 Grain-Sheep and Grain-Beef Cattle Farming A0123 Sheep-Beef Cattle Farming A0124 Sheep Farming A0125 Beef Cattle Farming A0130 Dairy Cattle Farming A0141 Poultry Farming (Meat) A0142 Poultry Farming (Eggs) A0151 Pig Farming A0152 Horse Farming A0153 Deer Farming A015910 Mixed Livestock A015930 Beekeeping A015990 Livestock Farming nec A016910 Tobacco and Hops Growing A016920 Cultivated Mushroom Growing A016990 Crop and Plant Growing nec A0212 Shearing Services A0213 Aerial Agricultural Services A0219 Services to Agriculture nec A0220 Hunting and Trapping A0301 Forestry A0302 Logging A0303 Services to Forestry 402 159 561 501 6333 12021 6918 21798 504 357 552 600 1020 2046 525 1227 78 189 411 1908 282 10296 240 1800 2934 2010 180 3033 5337 3747 11715 423 324 210 630 501 1011 234 744 27 288 237 1011 60 5058 51 498 318 411 681 9369 17355 10665 33513 927 681 762 1230 1518 3057 759 1971 105 480 648 2919 342 15354 294 2301 3252 2421 The NZ-ACEM database is an ACCESS database listing the pesticides used for each specific crop in New Zealand (for the industries and crops listed above in Table 3). The pesticides are grouped into FAO categories, as specified in Table 4. STATUS: The NZ-ACEM is completed and can be used to assess occupational exposure to specific pesticides in epidemiological studies that collected information on crop. It can also be used as a general information source on the potential pesticide exposure in each agricultural sector. Similar to NZ-CAREX, we propose to present the NZ-ACEM database at Department of Labour at a date/time convenient for the DoL. 14 Centre for Public Health Research – May 23, 2013 Table 4. The grouping of pesticides used in NZ-ACEM agrichemical group FAO Category active ingredients Benzimidazoles Benomyl; carbendazim; fuberidazole; thiabendazole; thiophanate-methyl Botanicals and Biologicals Bacillus subtilis; Ulocladium oudemansii Diazines, Morpholines & other EBIs Dicarboximides Bupirimate; dimethomorph; fenarimol; triforine Dithiocarbamates Mancozeb; metiram; thiram; ziram Inorganics bordeaux mixture; calcium polysulfide; copper ammonium complex; copper ammonium complex (acetate/carbonate); copper hydroxide; copper oxychloride; copper sulphate; cuprous oxide; phosphorous acid; sulphur Azoxystrobin; kresoxim-methyl; trifloxystrobin FUNGICIDES & BACTERICIDES Strobilurins Iprodione; procymidone Other fungicides Bitertanol; cyproconazole; difenoconazole; epoxiconazole; flusilazole; flutriafol; imazalil; myclobutanil; penconazole; prochloraz; propiconazole; tebuconazole; triadimefon; triadimenol 2-hydroxy benzoic acid; captan; carboxin; chlorothalonil; cymoxanil; cyprodinil; dichlofluanid; dicloran; dithianon; dodine; ethylene glycol; fenamidone; fenhexamid; fluazinam; fludioxonil; folpet; fosetyl-aluminium; metalaxyl; metalaxyl-m; pencycuron; propamocarb; pyrazophos; pyrimethanil; quintozene; streptomycin; tolclofos-methyl; tolylfluanid Amides Acetochlor; alachlor; metolachlor; propachlor; propyzamide Bipyridyls Diquat; paraquat; paraquat dichloride Carbamate herbicides Asulam; chlorpropham; phenmedipham Dinitroanilines Pendimethalin; trifluralin FOPs and DIMs Clethodim; clodinafop-propargyl; fenoxaprop-p-ethyl; flamprop isopropyl; fluazifop-p-butyl; haloxyfop; haloxyfop [(r)-isomer]; sethoxydim; tralkoxydim Clopyralid; dicamba; picloram; triclopyr; triclopyr butoxyethyl ester: triclopyr bee Triazoles and Diazoles HERBICIDES Other hormone types Phenoxy hormones Phosphonyls 2,4-D; 2,4-D amine; 2,4-D ester; 2,4-DB; dichlorprop; dichlorprop-p; MCPA; MCPB; mecoprop; mecoprop-p glufosinate-ammonium; glyphosate; glyphosate-trimesium Triazines chlorimuron-ethyl; chlorsulfuron; halosulfuron-methyl; iodosulfuron-methyl-sodium; metsulfuronmethyl; primisulfuron-methyl; thifensulfuron-methyl; tribenuron-methyl Atrazine; hexazinone; metribuzin; prometryn; simazine; terbuthylazine Uracils terbacil Sulfonylureas Urea Derivatives Diuron; isoproturon; linuron; methabenzthiazuron Other herbicides Amitrole; bentazone; bromoxynil; chloridazon; clomazone; dichlobenil; diflufenican; dimethenamid; ethofumesate; fluroxypyr; ioxynil; norfluazon; oxyfluorfen Acaricides Azocyclotin; clofentezine; dicofol; fenbutatin oxide; fenpyroximate; milbemectin; propargite Botanicals and Biologicals Abamectin; Bacilli; Cydia pomonella granulosis virus, mexican strain; pyrethrins; Serratia entomophila; spinosad Carbaryl; furathiocarb; methiocarb; methomyl; oxamyl; pirimicarb; primicarb INSECTICIDES Carbamate insecticides Insect Growth Regulators Buprofezin; diflubenzuron; lufenuron; s-methoprene; tebufenozide Organophosphates Acephate; azinphos-methyl; chlorpyrifos; diazinon; dichlorvos; dimethoate; fenamiphos; maldison; methamidophos; parathion-methyl; phorate; pirimiphos-methyl; prothiofos; terbufos alpha-cypermethrin; bifenthrin; cyfluthrin; cypermethrin; deltamethrin; esfenvalerate; fluvalinate; lambda-cyhalothrin; permethrin; tau-fluvalinate Clothianidin; emamectin benzoate; endosulfan; fipronil; imidacloprid; indoxacarb; indoxycarb; metaldehyde; pymetrozine; thiacloprid; thiamethoxam; thiocloprid Pyrethroids Other insecticides 15 Centre for Public Health Research – May 23, 2013 3.5. Industry surveys As specified in the study proposal, it was not feasible within the time and financial constraints of the study to survey all industries for their exposure to carcinogens and their specific intervention and prevention strategies. Instead we made use of the infrastructure already in place for studies being conducted by CPHR in industries with exposure to key carcinogens (e.g. asbestos, silica and wood dust). The surveys conducted in these selected industries are summarized below. 3.5.1. Joiners and Furniture industry (wood dust and formaldehyde) A study entitled “Exposures to hazardous airborne substances in the wood conversion industry”, which was principally funded by ACC, also included parts particularly relevant for the aims of the current study. In particular, the study included an exposure survey in the New Zealand joinery and furniture industry involving measurements of airborne substances including wood dust and formaldehyde. The study also included an assessment of which strategies have been most effective in reducing exposure in other countries. This study showed that the majority of New Zealand joinery and furniture workers (87% and 63% respectively) are exposed to inhalable wood dust levels in excess of international standards of 1 mg/m3. Formaldehyde exposure levels were very low in both joinery and furniture workers. A review of available wood dust prevention strategies showed that educational intervention measures alone, such as risk education and providing information on good work practice, results in only a modest reduction in (wood) dust exposure. For more effective control measures to be developed – directed at the conditions and tasks that contribute most to these exposures - more detailed information on peak exposures is essential. The results of this study are reported in a CPHR technical report: Cheung K, McLean D, Pearce N, Douwes J. Exposures to hazardous airborne substances in the wood conversion sector. Technical Report No. 33. Wellington: CPHR, 2010. Another study currently being conducted at the Centre for Public Health Research entitled “Workplace interventions to reduce wood dust exposures in joinery and furniture workers” which is funded by the HRC and DoL, focuses specifically on the intervention strategies to reduce wood dust exposure. This study is on-going. 3.5.2. Building industry (asbestos and silica) A study entitled “Asbestos exposure levels in demolition sites”, which was principally funded by DoL, also included parts particularly relevant for the aims of the current study. As part of this study, a variety of asbestos demolition projects across New Zealand were sampled (time-weighted average and short-term) for personal exposure to asbestos fibres using standard methodology (both PCM and TEM). Workers reported variable adherence to the administrative controls portions of the DoL Asbestos Guidelines, with initial training, initial medical evaluation, and the requirement that a supervisor be present consistently achieved, but follow-up exams and implementation of required asbestos work practices, including 16 Centre for Public Health Research – May 23, 2013 proper use of respiratory protection, were poorly achieved. In particular, containment was noted to be in place, but in all but one of the 9 sampled projects, required negative air pressurization was not achieved or even realistically attempted. Air sampling (25 TWA samples, 10 STEL samples) indicated a median exposure for all 9 projects to be well below applicable WES time-weighted average and STEL levels (median TWA 0.03 fibres/cc., median STEL 0.15 fibres/cc.). Eight of the nine sites would be in compliance with applicable WES PCM asbestos exposure requirements (1.0 fibres/cc. TWA), 7 of these 8 with measured levels less than 0.1 fibres/cc. A PCM sample of 0.122 fibres/cc. from one project, on reanalysis by TEM, indicated levels of 3.3 structures/cc., chrysotile. The ninth site (PCM levels exceeding the WES at 0.871 fibres/cc.) involved demolition of a material suspected by the type of facility to contain high asbestos content. TEM levels of 8.3 structures/cc., (amosite and chrysotile present), were measured on reanalysis of this sample. As part of this study a questionnaire assessing perceived risk and safety behaviours regarding asbestos was administered to 91 maintenance workers (86 male, 2 female, 3 unspecified sex) working in older buildings at 2 universities (both located on the North island) and 2 city maintenance divisions (1 North island, 1 South island). Carpenters, electricians, painters, plumbers, fitters, and supervisors were represented. Virtually all respondents claimed to be aware of health risks associated with asbestos, but on average reported only moderate confidence, maybe 40% of the time, in their ability to detect asbestos-containing building materials. About half had received prior training on asbestos safety and health issues. The reported frequency of encountering asbestos-containing materials was infrequent; 16% of respondents (15 of 91) encountered one of 6 building material types likely to contain asbestos more than 1x per month. Over 60% used outside contractors to handle it when identified. When handling it themselves, protective equipment and appropriate work practices were used only about 50% of the time. The report of this study was presented to DoL: Measurement of asbestos exposure levels in a sample of demolition, trade and maintenance work sites. RFP Number 264. The Workplace Group Of The Department Of Labour. FINAL REPORT 3/09/2010. Another small exposure study entitled “Measuring Silica-Containing Dust Exposure in Workers Skill-Sawing Hardie Linea® Weatherboard” was a cooperative study between the Department of Labour (DoL), a Contractor, and the Centre for Public Health Research (CPHR), Massey University, during which an inhalable dust exposure monitor was worn by one worker for about 2 hours while skill sawing linea® board to size. The study showed that even after only two hours of cutting linea® board , there were twenty instances where peak levels reached from 1.68 to 210.01 mg/m3. An 8-hour TWA was calculated to be 7.3 mg/m3. In New Zealand, there is no short term exposure limit (STEL) for silica dust exposure; however, there are time-weighted averages (TWAs) for cristobalite (0.1 mg/m3 respirable dust), quartz (0.2 mg/m3 respirable dust), tridymite (0.1 mg/m3 inhalable dust), Tripoli (0.2 mg/m3 respirable dust of contained respirable quartz), and silica (2 mg/m3 respirable dust). However, in spite of the two hours of sampling, it was evident that the worker and other workers in a close proximity were being exposed to high levels of silica dust. The results of this study are available in a report: Measuring Silica-Containing Dust Exposure in Workers Skill-Sawing Hardie Linea® Weatherboard. July 2011. Kerry Cheung and Gerry Kalogeropoulos. Centre for Public Health Research. Massey University, Wellington. 17 Centre for Public Health Research – May 23, 2013 3.5.3. Other industries Other CPHR studies are currently on-going which will also provide information on occupational exposure to carcinogens and potential prevention strategies. These include studies in the sawmilling industry (Occupational asthma in New Zealand sawmill workers); the spray painting industry (Neurotoxic effects of occupational solvent exposure), the agricultural sector (Occupational exposures in farmers in Australia) and meat industry (Cancer in meat workers: identifying the causal exposures). 3.6. Other outcomes of the study 3.6.1. Stakeholder engagement Over the duration of the study, the regular PROHM meetings (Practitioners and Researcher Occupational Health) have developed into a platform for stakeholder engagement. Since the start of PROHM, a total of 5 meetings have been held (listed below). PROHM meetings 1st PROHM meeting: 21 April 2009 2nd PROHM meeting: 20 November 2009 3rd PROHM meeting: 14 October 2010 4th PROHM meeting: 10 May 2011 5th PROHM meeting: 16 November 2011 The PROHM meetings are full-day meetings organized by CPHR and in first instance attended by CPHR and DoL staff, and are now also attended by ACC staff, employers and occupational health physicians. The discussions during these PROHM meetings often illustrated that better communication between Health and Safety professionals, Health and Safety researchers, DoL and industry will be beneficial for all parties and will ultimately benefit the health and safety of New Zealand workers. The participants of the meeting showed great interest in the specific outputs of this project (in particular, the list of occupational carcinogens and the literature review) and indicated that access to these outputs would be useful to them. In addition to the PROHM meetings, the different studies into a variety of occupational health and safety issues that have been and continue to be conducted at the Centre for Public Health Research are also platforms for stakeholder engagements including DoL, Industry associations and the Unions. Also, Dr Bill Glass has since the start of the project been employed by the Centre for Public health Research, and has been instrumental for establishing contacts with industry stake holders. 18 Centre for Public Health Research – May 23, 2013 3.6.2. International research partnerships Throughout the course of the study international research partnerships in the area of occupational carcinogens have been strengthened. In particular CPHR has strong contacts with the International Agency for Research on Cancer (IARC); the creators of the Finnish and European CAREX as well as the Canadian CAREX. In late 2011, a new initiative started to update the international CAREX database, and add additional countries. This initiative is led by Kurt Straif ([email protected]), of the International Agency for Research on Cancer and is envisaged to develop further in 2012. NZ-CAREX which was developed as part of the here presented project, will also be part of this initiative. 19 Centre for Public Health Research – May 23, 2013 4. Synthesis of research outcomes / conclusions The aims of this study were (i) to provide a detailed assessment of the extent and industrial distribution of workplace carcinogens in New Zealand; (ii) to identify key industries and key carcinogens for which intervention would result in marked reductions in occupational cancer; and (iii) in selected key industries, to review the intervention strategies currently in place and evaluate the barriers to the implementation of additional interventions. The main findings of the study are summarized below. 4.1. The extent and industrial distribution of workplace carcinogens in New Zealand The literature review and NZ-CAREX illustrate that there are very few industries with no known or suspected exposure to carcinogens. Most industries have potential for exposure to several known human carcinogens. There are more than 50 known human carcinogens present in New Zealand workplaces and more than an additional 100 possible or probable human carcinogens present in New Zealand workplaces. 4.2. The key industries for which intervention would result in marked reductions in occupational cancer The following criteria were used to identify those industries for which intervention would result in a marked reduction in occupational cancer, using the information in the literature review and NZ-CAREX. 1. The strength of the evidence of an increased cancer risk for that industry (as summarized in the literature review). 2. The total number workers exposed to carcinogens within that industry (which is the product of the carcinogen exposure prevalence for that industry and size of the industry in New Zealand, as listed in NZ-CAREX). 20 Centre for Public Health Research – May 23, 2013 Table 5. Prioritizing of industries for intervention regarding carcinogen exposure. Medium number exposed High number exposed Not associated with increased cancer risk/ not studied Storage Communication services Property services Government administration Community services Motion picture/radio/tv services Sport and recreation Machinery & motor vehicle wholesaling Personal and household good retailing Occasionally associated with increased cancer risk Commercial fishing Food, beverage Electricity & gas supply Defence Libraries, museums, arts Food retailing Motor vehicle retailing Accommodation, cafes &restaurant education Printing & publishing Petroleum & chemical Repeatedly associated with increased cancer risk Forestry and logging Mining and extraction Textile, clothing, footwear Transport Business services (Includes painting, carpentry, chimney sweeping Personal services (Includes hairdressers) Agriculture Construction Health services Machinery & equipment mfg Metal product mfg Wood & paper product mfg Increasing priority Low number exposed Increasing priority Table 5 categorizes 6 industries as being repeatedly associated with an increased risk of cancer and having a high number of workers potentially exposed to carcinogens (due to the large size of the industry and high exposure prevalence within the industry). These industries with the highest priority for intervention include (in alphabetical order): Agriculture; Construction; Health services; Machinery & equipment manufacturing (mfg); Metal product mfg; and Wood & paper product mfg. It is noteworthy that the here identified industries overlap to a large extent with the five priority sectors specified in the National Action agenda 2010-2013 and Occupational Health Action plane 2011-2013 of the Workplace Health and Safety Strategy for New Zealand 2015 (Agriculture, Construction, Fishing, Forestry, and Manufacturing). 4.3. The key carcinogens for which intervention would result in marked reductions in occupational cancer The following criteria were used to identify key carcinogens for which intervention would result in reductions in occupational cancer, using the information in the literature review and NZ-CAREX. 21 Centre for Public Health Research – May 23, 2013 1. The strength of the evidence on the association between exposure and cancer outcome (based on the IARC classification). 2. The prevalence in the New Zealand working population (from NZ-CAREX). Table 6. Prioritizing of occupational carcinogens for intervention. Low prevalence of exposure Medium prevalence of exposure High prevalence of exposure 2B (possibly carcinogenic to humans) Examples: Acrylonitrile Marine diesel fuel Occup exp in drycleaning Occup exp in printing processes Examples: Bitumens Chlordane Chlorophenoxy herbicides ELF EMF Examples: Chlorinated solvents (Carbon 2A (probably carcinogenic to humans) Examples: PCBs Examples: Ethylene bromide Hairdresser & barber Examples: Diesel engine exhaust 1) Shiftwork Chlorinated solvents (1,2,3-trichloropropane; tetrachloride; methylene chloride) Carpentry and joinery Gasoline engine exhaust Styrene Welding fumes 1 (carcinogenic to humans) Examples: Beryllium acrylamide Examples: Arsenic nickel Ethylene oxide X and gamma radiation High temperature frying (emissions from) Inorganic lead compounds Non-arsenical insecticides Asbestos Benzene Chromium VI compounds Formaldehyde Involuntary smoking Painter – occup exp as Silica Solar radiation Wood dust Increasing priority tertrachloroethylene; trichloroethylene) Increasing priority 1) Since submission of this report, diesel engine exhaust has been classified as a group 1 carcinogen by IARC Table 6 categorizes 9 occupational carcinogens as having high prevalence in the working population (due to the large size of the industries and high exposure prevalence within the industry) and having sufficient evidence of being carcinogenic to humans (IARC group 1 carcinogens). These occupational carcinogens with the highest priority for intervention include (in alphabetical order): Asbestos; Benzene; Chromium VI compounds; Formaldehyde; Involuntary smoking; Painter (occupational exposures as); Silica; Solar radiation; Wood dust. 4.4. Intervention strategies and barriers to the implementation of additional interventions The third aim of this study was, in selected key industries, to review the intervention strategies currently in place and evaluate the barriers to the implementation of additional 22 Centre for Public Health Research – May 23, 2013 interventions. The intervention strategies available are discussed in the literature review. From CPHR’s studies in different industries, the following aspects were identified as barriers to the implementation of additional interventions: 1) Lack of knowledge about carcinogenicity of certain occupational exposures The industry surveys summarized under 3.5 as well as stakeholder engagement during PROHM meetings revealed in some cases a general lack of knowledge about whether certain exposures were carcinogenic to humans or not. This was also the case for some human carcinogens very common in New Zealand workplaces. For example, wood dust is not often regarded as a human carcinogen although it has been classified as such by IARC since 1995. There appears to be very little awareness of the carcinogenicity of crystalline silica which has been classified as a human carcinogen by IARC since 1997. Several commonly used chlorinated solvents are classified as probably carcinogenic to humans by IARC (group 2A), but little awareness of this was noted. This indicates that more awareness of the classifications produced by objective international agencies is required. New Zealand specific reference materials or databases (e.g. the WES or HSNO database) do not provide a complete overview of the carcinogenicity of all exposures present in the workplace. The IARC classifications on the other hand, are not limited to chemical exposures alone and are publicly available, thus giving a broad overview of what chemicals/metals/fibres/dusts/radiation/microbial agents/combustion products/exposure circumstances are carcinogenic to humans. The list of occupational carcinogens produced as part of this project restricts the list of the IARC classifications to only occupational exposures, thus providing a quick reference guide of what occupational exposures are carcinogenic to humans. 2) Lack of awareness of the presence and exposure levels of carcinogens in the workplace The industry surveys as well as stakeholder engagement during PROHM meetings also revealed a general lack of awareness of the presence of certain occupational carcinogens in the workplace. This is directly associated with the lack of regular exposure measurements in the workplace. For example, people are not aware of the presence of silica in the dust (e.g. building industry) if the silica content is never quantified. The literature review which was one of the outputs of this study, will provide a quick reference guide of which carcinogens could potentially be present in each industry and more exposure measurements will also contribute towards a better awareness of the presence (and levels) of carcinogens in the workplace. 3) Lack of awareness of the magnitude of occupational cancer problem in New Zealand The difficulties in quantifying the number of cancer cases that occur each year due to occupational exposures have resulted in a severe under-estimation of the size of the occupational cancer problem in New Zealand and are therefore a barrier to the implementation of interventions. The NOHSAC reports have already highlighted the lack of awareness of the size of the occupational health problem in New Zealand and the estimates of the number of deaths and incident cases of occupational disease (including occupational cancer) published in the first NOHSAC report have resulted in a better awareness of the potential health gain to be made by preventing workers’ exposure to carcinogens. In addition, occupational carcinogens have now been identified as a priority area of focus in 23 Centre for Public Health Research – May 23, 2013 Occupational Health Action Plan 2011-13 of the Workplace Health and Safety Strategy for New Zealand to 2015. The continued assessment of the number of occupational cancer cases and deaths, as has been undertaken by the Centre for Public health Research (project: Indicators for Surveillance of occupational disease) and part of the National Occupational Diseases Framework, will further increase the awareness of the size on the occupational cancer problem in New Zealand. 4) Lack of technical know-how to control exposure The industry surveys as well as stakeholder engagement during PROHM meetings also revealed in some cases a lack of know-how to control exposure and limited access to sources that could provide such information. In addition, even for very obvious carcinogens such as asbestos, methods to control exposures may be in place but may not be functioning properly (see 3.5.2). 5) Lack of knowledge and tools for evaluation of effectiveness of the intervention Following on to the previous point, there is also a need for tools evaluating the effectiveness of interventions. If such tools were available and could demonstrate significant reductions in exposure, this would remove an important barrier for the implementation of control measures. For example, video exposure monitoring can be useful in visualising the effect of control measures, from simple changes in work practices to technical solutions for reducing exposure (as is currently being tested in the joinery and furniture industry). 6) Lack of financial means During the industry surveys and stakeholder engagement during PROHM meetings, the financial costs of implementing control measures were not reported as an important barrier, as it would only be a potential barrier if the other barriers had been removed. However, a lack of motivation to put in the financial means was reported in situations where the effectiveness of the investment is not clear. 24 Centre for Public Health Research – May 23, 2013 4.5. Main conclusions Main conclusions: • • • • • • • • There are more than 50 known human carcinogens commonly present in New Zealand workplaces. The most common of these are: Asbestos; Benzene; Chromium VI compounds; Formaldehyde; Involuntary smoking; occupational exposures as a Painter; Silica; Solar radiation; Wood dust. There are more than an additional 100 possible or probable human carcinogens present in New Zealand workplaces. The industries for which an increased cancer risk has been observed repeatedly in epidemiological studies and have the highest number of potentially exposed workers include: Agriculture; Construction; Health services; Machinery & equipment manufacturing (mfg); Metal product mfg; Wood & paper product mfg. Of the agricultural chemicals currently in use in New Zealand’s agricultural sector, none are known human carcinogens, but numerous are suspected to be carcinogenic to humans. A number of barriers for the implementation of intervention strategies were identified, which could be removed by improving access to knowledge regarding the occurrence of carcinogens in New Zealand workplaces and improving access to control tools and methods to evaluate their effectiveness. The specific outputs of this study (literature review, list of carcinogens, NZ-CAREX, NZACEM) can contribute towards improving access to knowledge regarding the occurrence of carcinogens in New Zealand workplaces. Workplace exposure measurements and video exposure monitoring can also play an integral part in removing barriers for implementation and evaluation the effectiveness of control measures. 25 Centre for Public Health Research – May 23, 2013