Is It Time to Rethink the Way We Assess the Burden of Work-Related Cancer?

Accident and social security benefits granted to cancer patients in Brazil, 2008-2014

This article aims to describe the distribution of cancer among the benefits granted by the General Social Security Registry, from 2008 to 2014, in Brazil. Ecological study using data given by the National Social Security Institute. The proportion of accidental (work-related) and social security (general) benefits granted by cancer in Brazil was determined, among the benefits granted for all causes, and a spatial analysis was conducted to assess the geographical distribution of these proportions, with the states Brazilians as a unit of analysis. Cancer was the reason for granting 533,438 benefits (2.9% of the total benefits granted for all causes), with a predominance of females in social security benefits (53.7%) and males in accidental benefits (71.6 %). The highest proportions of social security benefits for cancer occurred in North and Midwest regions. In 19 of the 26 Brazilian states (including all states in the southern region) and in the Federal District, there was no granting of accident benefits for cancer. The analysis of the occurrences of cancer that generated benefit concessions suggests a disproportionality in granting of social security benefits in relation to accident workers, mainly in North, Northeast and South regions of Brazil.

Accident and social security benefits granted to cancer patients in Brazil, 2008-2014

Abstract This article aims to describe the distribution of cancer among the benefits granted by the General Social Security Registry, from 2008 to 2014, in Brazil. Ecological study using data given by the National Social Security Institute. The proportion of accidental (work-related) and social security (general) benefits granted by cancer in Brazil was determined, among the benefits granted for all causes, and a spatial analysis was conducted to assess the geographical distribution of these proportions, with the states Brazilians as a unit of analysis. Cancer was the reason for granting 533,438 benefits (2.9% of the total benefits granted for all causes), with a predominance of females in social security benefits (53.7%) and males in accidental benefits (71.6 %). The highest proportions of social security benefits for cancer occurred in North and Midwest regions. In 19 of the 26 Brazilian states (including all states in the southern region) and in the Federal District, there was no granting of accident benefits for cancer. The analysis of the occurrences of cancer that generated benefit concessions suggests a disproportionality in granting of social security benefits in relation to accident workers, mainly in North, Northeast and South regions of Brazil.

Contribution of causal factors to disease burden: how to interpret attributable fractions

What proportion of the risk in a given population is attributable to a risk factor? The population attributable fraction (PAF) answers this question. "Attributable to" is understood as "due to", which makes PAFs closely related to the concept of potential impact or potential benefits of reducing the exposure. The PAF is a tool at the border between science and decision making. PAFs are estimated based on strong assumptions and the calculations are data intensive, making them vulnerable to gaps in knowledge and data. Current misconceptions include summing up PAFs to 100% or subtracting a PAF for a factor from 100% to deduce what proportion is left to be explained or prevented by other factors. This error is related to unrecognised multicausality or shared causal responsibility in disease aetiology. Attributable cases only capture cases in excess and should be regarded as a lower bound for aetiological cases, which cannot be estimated based on epidemiological data alone (exposure-induced cases). The population level might not be relevant to discuss prevention priorities based on PAFs, for instance when exposures concentrate in a subgroup of the population, as for occupational lung carcinogens and other workplace hazards. Alternative approaches have been proposed based on absolute rather than relative metrics, such as estimating potential gains in life expectancy that can be expected from a specific policy (prevention) or years of life lost due to a specific exposure that already happened (compensation).

Exposição ocupacional e câncer: uma revisão guarda-chuva

Resumo Objetivo: fornecer uma visão geral das associações entre exposição ocupacional e risco da ocorrência ou morte por câncer. Métodos: esta revisão guarda-chuva da literatura utilizou as bases Medline e Web of Science. A partir de protocolo de busca, foram incluídas metanálises para diversas circunstâncias ocupacionais e cânceres selecionados que possuíssem algum nível de evidência para associação com ocupação. Resultados: foram incluídas 37 metanálises, abrangendo 18 localizações de câncer. Considerando a avaliação da heterogeneidade dos estudos, da qualidade da evidência e da força de associação, obteve-se evidências altamente sugestivas de associações entre exposição a solvente e mieloma múltiplo; amianto e câncer de pulmão; hidrocarbonetos e câncer de trato aerodigestivo superior; e estresse ocupacional e câncer colorretal. Conclusão: há evidências robustas para associar exposições ocupacionais e tipos de câncer não previstos, inicialmente, nas orientações de vigilância do câncer relacionado ao trabalho no Brasil. Permanecem lacunas sobre exposições de grande relevância, que carecem de metanálises mais consistentes, por exemplo, exposição a poeiras inorgânicas e câncer de pulmão e mesotelioma; exposição a solventes e tumores hematológicos. Evidências de câncer em outras regiões anatômicas foram menos robustas, apresentando indícios de incerteza ou viés.

Occupational exposure and cancer: an umbrella review

Abstract Objective: to provide an overview of the associations between occupational exposure and risk of occurrence or death from cancer. Methods: this umbrella review used the Medline and Web of Science databases. Based on the search protocol, meta-analysis was included for several occupational circumstances and selected cancers that had some level of evidence associated with the occupation. Results: 37 meta-analysis were included, covering 18 cancer locations. By assessing the heterogeneity of studies, quality of evidence, and strength of association, results highly indicated associations between solvent exposure and multiple myeloma, asbestos and lung cancer, hydrocarbons and upper aerodigestive tract cancer, occupational stress and colorectal cancer. Conclusion: robust evidence shows an association between occupational exposures and types of cancer not initially foreseen in the guidelines for work-related cancer surveillance in Brazil. Gaps in relevant exposures require further research and more consistent meta-analysis, including: exposure to inorganic dust and lung cancer and mesothelioma; solvents and hematological tumors. Evidence of cancer in other anatomical regions was less robust, showing signs of uncertainty or bias.

When Scientific Knowledge and Ignorance Make It Difficult to Improve Occupational Health: A French and European Perspective

This article analyzes the consequences of the increasing reference to scientific expertise in the decision and implementation process of occupational health policy. Based on examples (exposure limits and attributable fractions) taken from an interdisciplinary seminar conducted in 2014 to 2015 in France, it shows how the measurement or regulation of a problem through biomedicine-based tools produces blind spots. It also uses a case study to show the contradictions between scientific and academic aims and public health intervention. Other indirect implications are also examined, such as the limitation of trade unions' scope for action. Finally, the article suggests launching a broad political debate accessible to nonspecialists about collective occupational health issues-a dialogue made difficult by the rise of the afore-mentioned techno-scientific perspective.