Beata Świątkowska

Effect of Occupational Exposures on Lung Cancer Susceptibility: A Study of Gene–Environment Interaction Analysis

Background: Occupational exposures are known risk factors for lung cancer. Role of genetically determined host factors in occupational exposure–related lung cancer is unclear. Methods: We used genome-wide association (GWA) data from a case–control study conducted in 6 European countries from 1998 to 2002 to identify gene–occupation interactions and related pathways for lung cancer risk. GWA analysis was performed for each exposure using logistic regression and interaction term for genotypes, and exposure was included in this model. Both SNP-based and gene-based interaction P values were calculated. Pathway analysis was performed using three complementary methods, and analyses were adjusted for multiple comparisons. We analyzed 312,605 SNPs and occupational exposure to 70 agents from 1,802 lung cancer cases and 1,725 cancer-free controls. Results: Mean age of study participants was 60.1 ± 9.1 years and 75% were male. Largest number of significant associations (P ≤ 1 × 10−5) at SNP level was demonstrated for nickel, brick dust, concrete dust, and cement dust, and for brick dust and cement dust at the gene-level (P ≤ 1 × 10−4). Approximately 14 occupational exposures showed significant gene–occupation interactions with pathways related to response to environmental information processing via signal transduction (P < 0.001 and FDR < 0.05). Other pathways that showed significant enrichment were related to immune processes and xenobiotic metabolism. Conclusion: Our findings suggest that pathways related to signal transduction, immune process, and xenobiotic metabolism may be involved in occupational exposure–related lung carcinogenesis. Impact: Our study exemplifies an integrative approach using pathway-based analysis to demonstrate the role of genetic variants in occupational exposure–related lung cancer susceptibility. Cancer Epidemiol Biomarkers Prev; 24(3); 570–9. ©2015 AACR.

Asbestos in Poland: occupational health problems.

The presentation addresses current problems of health risk and health effects associated with exposure to asbestos, including data on historical exposure and on currently valid occupational exposure limits. The quantity and types of the raw material used for the production of various asbestos products have also been discussed in relation to the particular types of asbestos-induced occupational diseases. The authors describe the medical care system for former asbestos workers and those currently exposed during removal of asbestos-containing products. The national system for medical certification of occupational asbestos-related diseases and the compensation procedure have been outlined as well. According to the parliamentary Act of 1997, importing, manufacture and sale of asbestos and asbestos-containing materials are prohibited in Poland. Thus, the assessment of asbestos exposure and the monitoring of health conditions of workers at asbestos-processing plants have become irrelevant. However, the delayed health effects attributable to past exposure continue to be the matter of concern for public health. Likewise, the environmental pollution from asbestos waste landfills in the vicinity of asbestos-processing plants (where high levels of asbestos fibre in ambient air have been recorded) will continue to be a serious public health problem. Presently, two programmes aimed at minimising the adverse effects of asbestos on population health are underway. One of them is the governmental programme for “Elimination of asbestos and asbestos-containing products used in Poland, 2002–2032”. The programme was updated in 2009 to cover the workers contracted to perform demolition works and provide protective covers to asbestos waste landfills. This will be the exposed group who need prophylactic health care. The other is a programme of prophylactic examinations for former asbestos workers and is referred to as the AMIANTUS programme. Both programmes have been briefly described.

Environmental asbestos pollution — Situation in Poland

ObjectivesEnvironmental exposure of the general population to asbestos in Poland is mainly due to degradation of very popular asbestos-cement products and the resultant release of the elementary asbestos fibres into the ambient air. Assessments of environmental pollution by asbestos were based on the volume of the raw material used, amount of manufactured asbestos products, and measuring the concentration of fibres in the air.Material and MethodsUnder the governmental program intended to remove asbestos, measurements of the concentration of asbestos fibres were performed in 2004–2010 in all provinces of Poland. Considering that potential sources of asbestos dust emissions were present in residential areas, 1634 sampling sites were designated. From 2 to 4 air samples were collected at each sampling site. A total of 5962 samples were collected during seven years. A single dose of air collected by 25 mm 0.8 μm pore Sartorius filter was 1,300 litres. The fibres were counted using optical microscopy with phase contrast (PCM) on a polarizing microscope (PLM) at a total magnification of 600×.; method was adapted to determine the concentration of asbestos fibres in non-occupational environment.ResultsMean concentration of asbestos fibres was 492 f/m3 (95% CI: 467–518). In 82% of the sampling sites, the mean concentrations did not exceed 800 f/m3. As much as 25.8% of the samples were found to be below the detection limit of the method. Estimated mean concentrations of fibres in different provinces ranged from 146 (95% CI: 106–203) to 709 f/m3 (95% CI: 591–851). In the areas affected by former asbestos-processing plants, mean concentration was 732 f/m3 (95% CI: 527–1016) and was significantly higher than levels recorded in other areas of Poland.ConclusionAsbestos consumption per capita and the recorded moderate levels of asbestos fibres concentration in atmospheric air point to a relatively low level of environmental asbestos pollution in Poland.

Predictors of lung cancer among former asbestos-exposed workers.

OBJECTIVES Despite extensive literature concerning the risk of lung cancer incidence among asbestos workers there is still lack of data specifying the association between the level of exposure and the frequency of cancer occurrence. The aim of the analysis was to assess the influence of smoking and selected factors related to occupational exposure on the risk of the incidence of lung cancer among the workers who were exposed to asbestos dust in the past. MATERIAL AND METHODS The assessment was performed based on the case-control studies carried out within a cohort including 7,374 former workers of asbestos processing plants, examined over the years 2000-2013. Analysis of the material was based on the calculation of the odds ratio (OR) using conditional logistic regression modeling, adjusted for cigarette smoking, cumulative exposure, branch and time since last exposure. RESULTS During the survey period there were 165 cases of lung cancer. Among the individuals who smoked, the relative risk of lung cancer incidence was twice as high in the persons smoking more than 20 pack-years (OR=2.23; 95% CI: 1.45-3.46) than it was in the case of the non-smokers. Analysis revealed that the risk of lung cancer in the group with the highest exposure was two times higher in comparison with the low cumulative asbestos exposure (OR=1.99; 95% CI: 1.22-3.25). The risk continued to increase until 30 years after cessation of asbestos exposure and started to decline many years after the last exposure. Influence of the mentioned above characteristics is particularly visible for tumors located in the lower parts of the lungs. CONCLUSION Our findings confirm the strong evidence that the lung cancer risk is associated with asbestos exposure and it increases along with the increasing exposure. A strategy of smoking cessation among the individuals exposed to asbestos dust would potentially have health promoting effects.

Medical monitoring of asbestos-exposed workers: experience from Poland.

Abstract In Poland, the use of asbestos was banned in 1997 and asbestos plants have been closed since then. Despite their closure, cases of asbestos-related occupational diseases among former asbestos workers are still being recorded in the Central Register of Occupational Diseases. Between 2001 and 2014, there were 2726 asbestos-related illnesses, classified and reported as diseases associated with occupational exposure to asbestos. In 2000, Poland introduced a programme called Amiantus, targeted at former asbestos-processing plant workers. The programme provided periodic medical examinations to workers and free access to medications for treatment of asbestos-related illnesses. Introduction of the programme provided additional data to generate a reliable estimation of the number of asbestos-related occupational diseases, including cancer. The average latency period for asbestosis, lung cancer and mesothelioma is about 40 years so there may still be some health impact to former workers necessitating follow-up. We present the Polish experience of implementing a medical examination programme for asbestos-exposed workers and provide a list of activities to consider when planning for such a programme.

Occupational diseases among farmers in Poland

BACKGROUND The studys objective is to present epidemiological situation concerning the incidence of occupational diseases among farmers in Poland. MATERIAL AND METHODS All 3438 cases of occupational diseases diagnosed among farmers and obligatorily reported to the Central Register of Occupational Diseases (covering all the national territory and all the cases of occupational diseases diagnosed in Poland after 1970) over the years 2000-2014 were subjected to analysis. RESULTS The annual incidence in the analyzed period ranged 5-14 per 100 000 farmers. The analysis showed that about 90% of pathologies were induced by the biological agents. Almost every third pathology due to biological agents had allergic origin. Infectious and parasitic diseases accounted for 62% of the cases. Among them the diseases carried by ticks (93%) - borreliosis (85.8%) and tick-borne encephalitis (7.2%) were the most frequent ones. The age of farmers, in the case of whom bronchial asthma and allergic rhinitis were diagnosed, was significantly higher than the age of remaining employees of the national economy, in which these occupational diseases were recognized. CONCLUSIONS The study indicates the necessity to introduce periodic health examinations programs focusing on agricultural workers to monitor health and well-being and improve working conditions and the working environment. Med Pr 2016;67(2):163-171.

Progression of small, irregular opacities in chest radiographs of former asbestos workers

ObjectivesPulmonary parenchymal changes appear many years after the start of exposure to asbestos and their progression has been observed to continue many years after cessation of the exposure. The aim of the present analysis is to assess the risk of progression of radiological changes in the respiratory system, based on long-term follow-up of groups of workers occupationally exposed to asbestos dust.Materials and MethodsThe analysis included 3144 individuals voluntarily applying for a medical examination in 2000–2010, who had performed at least two radiographs of the chest. Probability of progression in subsequent studies was based on the evaluation of radiographs for the presence of small, irregular type s, t, u opacities in the parenchymal lung tissue with profusion categories as specified in the classification of ILO, 1980. Multistate hidden Markov model was used in the statistical analysis.ResultsIn the group of patients, small irregular opacities with a profusion of 1/1 or higher occurred in 640 (20%) patients in the first examination, and in 918 (29%) patients in the last examination. No parenchymal changes were observed in 1360 (43%) patients in the first examination (opacity profusion category 0/0), and in 645 (20%) patients in the last examination. The risk of progression of radiographic changes in former workers of asbestos processing plants is higher in smokers, from profusion category 0 to 1 — by 30% (HR = 1.30, 95% CI: 1.15–1.47), from profusion category 1 to 2 — by 50% (HR = 1.50, 95% CI: 0.92–2.45). The risk of progression of parenchymal changes decreases in the workers employed in subsequent calendar years: for category changes from 1 to 2, the decrease is nearly 40% for every 10 years of subsequent employment (HR = 0.60, 95% CI: 0.45–0.80). The probability of the progression increases with longer latency period: for change of category from 1 to 2, the increase is about 20% (HR = 1.19, 95% CI: 1.00–1.42) per 10 years of employment for blue collar workers. The risk of the 1 to 2 category progression is significant, nearly 2.5-fold higher in the workers employed in the asbestos-processing textile industry.ConclusionsOur results show that the risk of progression of pulmonary parenchymal fibrotic processes was higher in the smokers, workers employed during the earlier calendar years of the discussed period, those with longer latency period, blue collar workers involved directly in the production processes, and employees of the asbestos cement and/or textile industries.

Modifiable risk factors for the prevention of lung cancer

Summary Background Lung cancer is the most frequent malignant disease worldwide. In 2002, the number of new lung cancer cases was estimated at 1.3 million, which makes over 12.4% of all new cases of neoplasm registered all round the globe. It is also the leading cause of death from cancer. Aim The objective of this paper was to provide a review of some modifiable risk factors for lung cancer. Materials/Methods Data sources were MEDLINE from January 1950 to November 2006, title in the field. Search terms included: lung cancer, tobacco smoke, social class, diet, alcohol consumption and physical activity terms. Book chapters, monographs, relevant news reports, and Web material were also reviewed to find articles. Results The results of the literature review suggest that smoking is a major, unquestionable factor of lung cancer risk. Exposure to environmental tobacco smoke (ETS) and social class could also play a role in the occurrence of the disease. Diet, alcohol consumption and physical activity level are other important but less extended determinants of lung cancer. Conclusions Effective prevention programmes against some of the lifestyle-related factors for lung cancer, especially against smoking, must be developed to minimize potential health risks and prevent the future cost of health.

Occupational diseases among healthcare and social workers in 2009–2016

BACKGROUND The aim of the paper is to present statistical data on the occurrence of occupational diseases among healthcare and social workers in Poland in 2009-2016. MATERIAL AND METHODS All cards certifying that a case of occupational disease had been diagnosed in a patient belonging to this occupational group, received by the Central Register of Occupational Diseases, served as the basis of the study. Data is presented in absolute numbers and incidence rates. In the analysis, disease categories, voivodships and occupations were taken into account. RESULTS In 2009-2016, as many as 1462 cases of occupational diseases were diagnosed for healthcare workers. In 2016, the number of cases was 42.6% lower than in 2009. Mean annual incidence rate in these years was 26.3 cases per 100 thousand workers. The most frequent were: infectious and parasitic diseases (64.8% of cases), peripheral nervous system diseases (9.6%), dermal diseases (8.9%), locomotor (8.3%), and chronic vocal organ disorders (3.2%). Among infectious or parasitic diseases, the most cases were viral hepatitis (56%) and tuberculosis (39%). Almost every second case of occupational disease in healthcare workers was detected in the nurses (47.8%). CONCLUSIONS The incidence of occupational diseases in total and in the most frequent categories continued to decrease. One of the reasons for the decline is the improvement of working conditions resulting from the application of more modern instruments and apparatus as well as greater knowledge of the risks and the use of appropriate procedures. Med Pr 2018;69(5).

Mesothelioma continues to increase even 40 years after exposure – Evidence from long-term epidemiological observation

BACKGROUND Because asbestos dust is considered one of the most dangerous types of dust for peoples health, issues related to the effects of asbestos exposure still remain questions about the role of cessation of exposure. OBJECTIVES The aim of the present study was to determine the importance of temporal patterns, especially the time since the end of exposure in the risk of pleural mesothelioma. METHODS A total of 131 patients with pleural mesothelioma and 655 frequency matched by gender and year of birth controls enrolled in the health surveillance programme for asbestos-related diseases over the years 2000-2014, were included in the analysis. Conditional logistic regression models were applied to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS The results show that the risk of pleural mesothelioma continued to increase even after 40 years since the last exposure. The estimated odds ratio for the subjects who had their last exposure 40 years ago, compared with the odds ratio of those who had their last exposure 5 years ago, was 2.68 (95%CI: 1.16-.621). We also observed that crocidolite exposure was associated with a very high significant mesothelioma risk, 5-fold higher for those working with mixed exposure compared to the subjects who worked only with chrysotile. CONCLUSIONS Dose-response relationships in populations occupationally exposed are critical to the study related to environment asbestos contamination. Our findings confirm the strong evidence that mesothelioma risk increases along with the increasing time since exposure termination.