Occupation and cancer in Brazil: a perennial challenge

a recent study identified 47 occupational agents among the 120 classified as definitively carcinogenic to humans by the International Agency for Research on Cancer. Studies carried out in the last two decades suggested fractions of cancer attributable to occupation, ranging from 1.3% in Brazil to 8% in Finland, although the criteria for measuring exposure in these studies can be questioned. In Brazil, scientific production on occupation and cancer is limited. The Revista Brasileira de Saúde Ocupacional (RBSO) published, between January 2003 to July 2022, six articles on the subject. In the PubMed database, from 2012 to 2022, 14 studies carried out in Brazil were identified.

Conclusion:

expanding research in this subject in Brazil is imperative to obtain more accurate estimates of workers exposed to carcinogens and related malignant tumors, essential to support public health actions and to establish norms on exposure limits or agents banning, reducing the burden of cancer in the Brazilian society.

Keywords:
cancer; work; occupational exposure; occupational health; Brazil

Studies	Nurminen and Karjalainen, 2001²¹21. Nurminen M, Karjalainen A. Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland. Scand J Work Environ Health. 2001;27(3):161-213. (Finland)	Steenland et al., 2003¹⁹19. Steenland K, Burnett C, Lalich N, Ward E, Hurrell J. Dying for work: The magnitude of US mortality from selected causes of death associated with occupation. Am J Ind Med. 2003;43(5):461-82.⁾ (USA)	Rushton et al., 2010²⁰20. Rushton L, Bagga S, Bevan R, Brown TP, Cherrie JW, Holmes P, et al. Occupation and cancer in Britain. Br J Cancer. 2010;102(9):1428-37.⁾ (United Kingdom)	Azevedo and Silva et al., 2016¹⁷17. Azevedo e Silva G, de Moura L, Curado MP, Gomes FS, Otero U, Rezende LFM et al. The fraction of cancer attributable to ways of life, infections, occupation, and environmental agents in Brazil in 2020. PloS One. 2016;11(2):e0148761. (Brazil)
Exposure	1960-1984	1980-1983	1956-1995/1986-2005	2000 Census
Exposure	1960-1984	1980-1983	1956-1995/1986-2005	PNAD 2003
Incidence	No	No	Yes	Yes
Mortality	Yes	Yes	Yes	Yes
Carcinogens	IARC Groups 1 (22 agents) and 2A (22 agents)	IARC Group 1 and 2A	IARC Group 1 and 2A	IARC Group 1
Evaluated cancer types	26 tumors related to occupational exposure	Nine tumors related to occupational exposures	All types of cancer	All types of cancer
Fraction of cancer attributable to occupations	8% (Men: 14%; Women 2%)	From 2.4 to 4.8% (Men: 3.3-7.3%; Women: 0.8-1.0%)	5.3% (Men: 8.2%; Women: 2.3%)	1.3% (Men: 2.3%; Women: 0.3%)
Notes:	• Nearly half of work-related deaths were due to malignant tumors	• Lung cancer contributed to about 75% of all work-related cancer deaths	• More than 8% of cancer deaths in men were due to occupational exposures and above 20% for lung cancer	• Unlike the other studies in the table, this one was not designed specifically for occupational exposure. The fraction attributable to multiple cancer risk factors was examined, which included occupation. Same approach as the classic study by Doll and Peto¹⁵15. Instituto Nacional de Câncer José de Alencar Gomes da Silva. Ambiente, trabalho e câncer: aspectos epidemiológicos, toxicológicos e regulatórios [Internet]. Rio de Janeiro; 2021[citado em 9 set 2022]. Disponível em: https://www.inca.gov.br/sites/ufu.sti.inca.local/files/media/document/ambiente_trabalho_e_cancer_-_aspectos_epidemiologicos_toxicologicos_e_regulatorios.pdf https://www.inca.gov.br/sites/ufu.sti.in... .
	• 54% of occupation-related deaths were due to lung cancer.	• Half of occupation-related lung tumor deaths were attributed to asbestos exposure	• Nearly 70% of occupation-related deaths were due to lung cancer. More than half were due to exposure to asbestos, half of which was due to construction work
	• Of all lung cancer deaths, 24% were attributed to exposure to occupational carcinogens; half of which to asbestos

Author/Year/Study location	Design/Period of study	Exposure	Outcome	Main results
Miranda Filho et al., 2014⁵⁹59. Miranda Filho AL, Koifman RJ, Koifman S, Monteiro GTR. Brain cancer mortality in an agricultural and a metropolitan region of Rio de Janeiro, Brazil: a population-based, age-period-cohort study, 1996-2010. BMC Cancer. 2014;14(1):320. Rio de Janeiro	Ecological Study. 1996 and 2010	Agriculture	Deaths from malignant neoplasm of the brain (ICD-10, C-71)	Serrana Region
				AAPC: 3.8%; 95%CI:0.8;5.6
				RR (75-79 years): 33.63; 95%CI:15.24;74.22
				Metropolitan area
				AAPC: -0.2%; 95%CI:-1.2;0.7
				RR (75-79 years): 23.78; 95%CI:22.55;25.07
Koifman et al., 2014⁶¹61. Koifman S, Malhão TA, Pinto de Oliveira G, de Magalhães Câmara V, Koifman RJ, Meyer A. Cancer mortality among Brazilian dentists. Am J Ind Med. 2014;57(11):1255-64. Brazil	Ecological Study. 1996 and 2004	Dentist (occupation code 063)	Deaths from malignant neoplasms (ICD-10, C00-C97)	MOR (general population)
				Male dentists
				20-49 years old:
				C00-C97: 4.29; 95%CI:3.42;5.47
				C18-21: 3.24; 95%CI:1.30;6.67
				C71: 1.70; 95%CI:0.55;3.96
				C82-C85: 3.71;95%CI: 1.36;8.09
				50-79 years old:
				C00-C97: 1.67;95%CI:1.54;1.81
				C18-21: 2.40; 95%CI:1.81;3.15
				C71: 2.08; 95%CI:1.33;3.10
				C82-C85: 2.54;95%CI:1.55;3.91
				Female dentists:
				20-49 years old:
				C00-C97: 2.26; 95%CI:1.91;2.67
				C18-21: 2.47; 95%CI:1.13;4.69
				C71: 5.56; 95%CI:3.35;8.67
				C82-C85: 3.18; 95%CI:1.03;7.41
				C50: 3.67; 95%CI:2.69;4.89
				50-79 years old:
				C00-C97: 4.22; 95%CI:3.58;4.97
				C18-21: 3.12; 95%CI:1.66;5.34
				C71: 2.73; 95%CI:0.88;6.36
				C82-C85: 6.17; 95%CI:2.47;12.7
				C50: 5.19; 95%CI:3.69;7.09
Algranti et al., 2015⁵⁶56. Algranti E, Saito CA, Carneiro APS, Moreira B, Mendonça EMC, Bussacos MA. The next mesothelioma wave: mortality trends and forecast to 2030 in Brazil. Cancer Epidemiol. 2015;39(5):687-92. Municipalities of São Paulo and other places in Brazil	Ecological Study	Asbestos	Deaths from mesothelioma (ICD-10, C45) and pleural cancer (ICD-10, C38.4)	Crude average crude mortality rate ratio
				C45
				Leme: 11.0
				São Caetano do Sul: 8.4
				Osasco: 5.2
				Brazil: 1
				C38,4
				Leme: 0.0
				São Caetano do Sul: 4.2
				Osasco: 1.7
				Brazil: 1
				C45+C38,4
				Leme: 4.4
				São Caetano do Sul: 5.9
				Osasco: 3.1
				Brazil: 1
				C45
				Trends in numbers of cases
				Brazil: R²= 0.63, p = 0.0012
				São Paulo R²= 0.69, p = 0.0004
				Standardized crude mortality rate
				São Paulo: R²= 0.35, p=0.0344
Segatto et al., 2015 Algranti et al⁶³63. Segatto MM, Bonamigo RR, Hohmann CB, Müller KR, Bakos L, Mastroeni S, et al. Residential and occupational exposure to pesticides may increase risk for cutaneous melanoma: a case-control study conducted in the south of Brazil. Int J Dermatol. 2015;54(12):e527-538. Porto Alegre, state of Rio Grande do Sul, Brazil	Hospital-based case-control April 2012 to September 2013	Pesticides	Cases of cutaneous melanoma	Use of pesticides for > 10 years:
				OR:1.9; 95%CI:1.2;8.2
				Occupational exposure to pesticides:
				OR: 3.2; 95%CI:1.2;6.8
				General use of pesticides
				OR: 2.03; 95%CI:1.03;6.89
				Indoor use of pesticides four or more times a week
				OR: 1.44; 95%CI:1.11;3.49
Boccolini et al., 2016⁶⁵65. Boccolini P de MM, Boccolini CS, Chrisman J de R, Koifman RJ, Meyer A. Non-Hodgkin lymphoma among Brazilian agricultural workers: A death certificate case-control study. Arch Environ Occup Health. 2016;72(3):139-44. Paraná, Santa Catarina, and Rio Grande do Sul	Case-control based on death certificates January 1996 to December 2005	Agricultural workers	Deaths from non-Hodgkin’s lymphoma (ICD-10, C82-C85)	20 - 39 years old:
				Crude OR:1.31; 95%CI:1.05;1.87
				OR adjusted for gender, state of residence, education, and race: 2.06; 95%CI:1.20;3.14
				40 - 69 years old:
				Crude OR: 0.80; 95%CI:0.67;0.95
				OR adjusted for gender, state of residence, education, and race: 0.96; 95%CI:0.75;1.23
Fortes et al., 2016⁶⁴64. Fortes C, Mastroeni S, Segatto MM, Hohmann C, Miligi L, Bakos L, et al. Occupational exposure to pesticides with occupational sun exposure increases the risk for cutaneous melanoma. J Occup Environ Med. 2016;58(4):370-5. Brazil and Italy	Hospital-based case-control (2001 and 2003 for the Italian study and 2007 to 2013 for the Brazilian study)	Exposure to the sun and pesticides	Cases of cutaneous melanoma	Pesticides
				OR: 2.58; 95%CI:1.18;5.65
				Use of pesticides for 10 years or more
				OR: 7.40; 95%CI:1.91;28.7
				Exposure to at least two types of pesticides
				OR: 4.04; 95%CI:1.20;13.6
				Herbicides
				OR: 3.08; 95%CI:1.06;8.97
				Fungicides
				OR: 3.88; 95%CI:1.17;12.9
				Pesticides and occupational sun exposure
				OR: 4.68; 95%CI:1.29;17.0
Azevedo e Silva et al., 2016²¹21. Nurminen M, Karjalainen A. Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland. Scand J Work Environ Health. 2001;27(3):161-213. Brazil	Ecological Study	Formaldehyde, paint, rubber industry, benzene, leather powder, silica, wood powder, nickel, asbestos, benzopyrene, diesel, iron/steel, radon, gamma radiation	Cancer of the esophagus (squamous), nasopharynx, sinonasal, larynx, lung, bladder, breast, ovary, mesothelioma, non-Hodgkin’s lymphoma and leukemia	Fraction of cancer attributable to occupation:
				1.3%
				Men
				2.3%
				Women
				0.3%
Krawczyk et al., 2016⁶⁰60. Krawczyk N, Espíndola Santos AS, Lima J, Meyer A. Revisiting cancer 15 years later: exploring mortality among agricultural and non-agricultural workers in the Serrana Region of Rio de Janeiro. Am J Ind Med. 2016;60(1):77-86. Região Serrana do Rio de Janeiro: Teresópolis, Nova Fribourg, Bom Jardim, Cantagalo, Duas Barras, and Sumidouro	Ecological Study 1999-2013	Agricultural workers	Cancer deaths	Men 30-69 years
				Reference group: non-agricultural workers in the mountainous region of Rio de Janeiro
				Stomach= MOR:1.55; 95%CI:1.13;2.12
				Esophageal cancers= MOR:1.93; 95%CI:1.38;2.7
				Reference group: non-agricultural workers in Rio de Janeiro
				Stomach= MOR: 2.30; 95%CI:1.72;3.08
				Esophageal cancers= MOR: 3.12; 95%CI:2.30;4.24
				Reference group: non-agricultural workers in Porto Alegre
				Stomach= MOR: 2.28 95%CI:1.69;3.08
				Esophageal cancers= MOR:1.72; 95%CI:1.26;2.34
Fernandes et al., 2019⁵⁷57. Fernandes GA, Algranti E, Conceição GM de S, Wünsch Filho V, Toporcov TN. Lung cancer mortality trends in a Brazilian city with a long history of asbestos consumption. Int J Environ Res Public Health. 2019;16(14):2548. Osasco, Sorocaba, and São Paulo State	Ecological Study 1980 to 2016	Asbestos	Deaths from lung cancer (ICD-9, C162) (ICD-10, C33-34)	Men
				Osasco = AAPC: 0.7%; 95%CI:0.1;1.3
				Sorocaba = AAPC: -1.5%; 95%CI:-2.4;-0.6
				São Paulo State = AAPC: -0.1; 95%CI:-0.3;0.1
				Period-age-cohort model from 1996 onward:
				Osasco: increased risk of death
				Sorocaba: reduced risk of death
				São Paulo State: reduced risk of death
Santos et al., 2020⁶²62. Santos ASE, Martins AAF, Simões Gonçalves E, Meyer A. Mortality from selected cancers among Brazilian mechanics. Asian Pac J Cancer Prev, 2020;21(6):1779-86. Southern and Southeastern Brazil	Ecological Study 2006 to 2017	Male mechanics	Deaths from hypopharyngeal ICD-10, C10; nasopharynx ICD-10, C13; larynx ICD-10, C11; ICD-10 lung, C32; and bladder cancers ICD-10, C67; myeloid leukemia ICD-10, C92; and all ICD-10, C91-95 leukemias	Oropharyngeal:MOR:1.84; 95%CI:1.66;2.11
				Hypopharynx: MOR:1.39; 95%CI:1.07;1.81
				Larynx: MOR: 1.45; 95%CI:1.32;1.59
				Lung: MOR: 1.07; 95%CI:1.01;1.12
				Bladder: MOR:1.16; 95%CI:1.02;1.32
				Leukemia: MOR:0.85; 95%CI:0.75;0.96
Fernandes et al., 2021⁶⁸68. Fernandes GA, Algranti E, Wünsch-Filho V, Silva LF, Toporcov TN. Causes of death in former asbestos-cement workers in the state of São Paulo, Brazil. Am J Ind Med. 2021;64(11):952-9. State of São Paulo	Cohort 1995 to 2016	Asbestos	Cancer deaths	Men:
				Overall Mortality = SMR: 1.1; 95%CI:0.98;1.23
				Mesothelioma = SMR: 69.4; 95%CI:22.55;162.1
				Asbestosis = SMR: 975.7; 95%CI:396.4;2031
				Peritoneal cancer = SMR: 5,0; 95%CI:0.13;27.78
				Laryngeal cancer = SMR: 1,4; 95%CI:0.30;4.20
				Lung cancer = SMR: 1,5; 95%CI:0.82;2.64
Saito et al., 2022⁵⁸58. Saito CA, Bussacos MA, Salvi L, Mensi C, Consonni D, Fernandes FT, et al. Sex-specific mortality from asbestos-related diseases, lung and ovarian cancer in municipalities with high asbestos consumption, Brazil, 2000-2017. Int J Environ Res Public Health, 2022;19(6):3656. Five municipalities that mined asbestos and 24 that housed cement-asbestos industry plants in Brazil	Ecological Study 2000 to 2017	Asbestos	Deaths from mesothelioma (ICD-10, C45X), asbestosis (ICD-10, J61), pleural plaques (ICD-10, J92.0), lung cancer (ICD-10, C34), and ovarian cancer (ICD-10, C56)	Men:
				Mesothelioma = SRR: 1.70; 95%CI:1.45;1.99
				Asbestosis= SRR: 6.35; 95%CI:4.86;8.28
				Pleural Plaques = SRR: 5.06; 95%CI:3.69;6.89
				Lung cancer= SRR: 1.33; 95%CI:1.31;1.34
				Women:
				Mesothelioma = SRR: 1.17;95%CI:0.95;1.43
				Asbestosis = SRR: 1.86; 95%CI:0.96;3.39
				Pleural Plaques = SRR: 0.86; 95%CI:0.35;1.79
				Lung cancer = SRR: 1.19; 95%CI:1.17;1.20
				Ovary = SRR: 1.34; 95%CI:1.31;1.37
Áfio et al., 2022⁶⁶66. Áfio NS, Forte ACFMS, Sanzana CES, Aguiar IWO. Trabalho rural associado a cânceres linfohematopoiéticos em hospital público de referência: estudo caso-controle, Ceará, Brasil, 2019-2021. Cad Saúde Pública. 2022;38(7):e00286121. Reference Hospital in the State of Ceará	Hospital-based case-control study 2019 and 2021	Occupations	Lymphohematopoietic cancers, multiple myeloma, leukemias, or non-Hodgkin’s lymphoma	Rural workers
				OR_crude = 5.00; 95%CI:1.91;13.06
				OR_adjusted = 3.38; 95%CI:1.20;9.54
				Commercial workers
				OR_crude = 0.26; 95%CI:0.10;0.70
				OR_adjusted = 0.30; 95%CI:0.10;0.88
Brey et al., 2022⁶⁷67. Brey C, Consonni D, Sarquis LMM, Miranda FMDA. Câncer de pulmão e exposição ocupacional: estudo caso-controle de base hospitalar. Rev Gaúcha Enferm. 2022;43:e20210043. Philanthropic Hospital in Curitiba-PR	Hospital-based case-control study February and October 2019	Known (list A) or suspected (list B) occupations associated with lung cancer	Cases of lung cancer (ICD-10, C34; including its subcategories)	Painters (list A)
	Hospital-based case-control study February and October 2019			OR= 14.3; 95%CI:1.8;116.5

Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho - FUNDACENTRO Rua Capote Valente, 710 , 05409 002 São Paulo/SP Brasil, Tel: (55 11) 3066-6076 - São Paulo - SP - Brazil
E-mail: rbso@fundacentro.gov.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Contact: Gisele Aparecida Fernandes Email: gisele.fernandes@accamargo.org.br