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Background The EU Horizon2020 “safe-by-design for Nano” (SBD4Nano) project aims to develop a tool to assist users in the safe-by-design process and decisions to reduce risk as a result from working with- or using newly developed products containing manufactured nanomaterials (MNs). Therefore, TNO set out to develop an easy-to-use quantitative exposure assessment tool that helps users with different levels of expertise to reduce the exposure from MNs following an integrated Tiered safe-by-design approach. Method Based on previous projects, literature, expert knowledge, a Tiered set of model determinants and corresponding calculations were integrated into a conceptual model. Also, an exposure database based on the EU GRACIOUS template was created containing a large set of exposure measurements collected from diverse literature studies. Machine learning was applied to these exposure measurements to validate and refine the model. Lastly, a safe-by-design module was added to assist users modify their material or process design to reduce exposure. Results An online tool is realized that will be freely available on https://diamonds.tno.nl/#neq. The NEQ offers a Tiered approach by smartly adapting the questions based on the depth of information the user can provide allowing anywhere between a Tier-1 and a Tier-2 approach. After answering questions, the user is presented an exposure estimate including uncertainty of the current design. The user is guided to enter a new design that reduces the exposure and/or its uncertainty.

Introduction The EPHOR project is constructing a mega cohort for pooled analysis of data from multiple European cohort studies of occupation and health. The objective is to provide new evidence of the impact of occupational exposures on the risk of major non-communicable diseases, through systematic and agnostic analyses across the life-course. Materials and Methods Cohorts are registered in an online inventory. Cohort data and occupational information are being harmonised and documented in an online variable catalogue, and will be linked with a newly developed European Job-Exposure Matrix (EuroJEM) characterising multiple: chemical and particle, ergonomic, physical, and psychosocial exposures and precariousness. Cohort information on working time will also be harmonised. Knowledge gaps on occupational exposures in relation to major non-communicable diseases were identified. Both meta-analysis and decentralized analysis approaches will be used, as appropriate. Ethics approval is provided by all relevant committees. Results Currently 29 European cohorts covering a broad range of countries as well as multi-country studies are participating, containing more than 20 million participants. Cohort designs range from smaller scale studies including hundreds to thousands of workers with detailed exposure and/or outcome characterisation, to large-scale general population cohorts including multiple millions of participants with occupational information captured using registry-based methods. Cohorts were largely established and followed-up during the 2000s through the current time, though some were established earlier. Occupational information primarily entails the working lifetime or follow-up period. Outcome information includes disease incidence, disability, and mortality. In some studies, information about genetics, epigenetics, other biomarkers and clinical/functional evaluations is available. Analysis will address knowledge gaps of cancer, respiratory, cardiovascular/metabolic, and neurodegenerative diseases, mental and musculoskeletal disorders, and work participation. Conclusions We expect the mega cohort will be a useful long-term resource to study relationships of occupations, work-related exposures and health in Europe to inform policy and prevention.

Objective Exposure to radon causes lung cancer. The scope and impact of exposure among Canadian workers have not been assessed. Our study estimated occupational radon exposure in Canada and its associated lung cancer burden. Methods Exposed workers were identified among the working population during the risk exposure period (1961–2001) using data from the Canadian Census and Labour Force Survey. Exposure levels were assigned based on 12,865 workplace radon measurements for indoor workers and assumed to be 1800 mg/m3 for underground workers. Lung cancer risks were calculated using the Biological Effects of Ionizing Radiation (BEIR) VI exposure-age-concentration model. Population attributable fractions were calculated with Levin’s equation and applied to 2011 Canadian lung cancer statistics. Results Approximately 15.5 million Canadian workers were exposed to radon during the risk exposure period. 79% of exposed workers were exposed to radon levels 3 and 4.8% were exposed to levels > 150 Bq/m3. We estimated that 0.8% of lung cancers in Canada were attributable to occupational radon exposure, corresponding to approximately 188 incident lung cancers in 2011. Conclusions The lung cancer burden associated with occupational radon exposure in Canada is small, with the greatest burden occurring among those exposed to low levels of radon.

Exposure to occupational carcinogens is often overlooked as a contributor to the burden of cancer. To estimate the proportion of cancer cases attributable to occupational exposure in Canada in 2011, exposure prevalence and levels of 44 carcinogens were informed by data from the Canadian carcinogen exposure surveillance project (CAREX Canada). These were used with Canadian Census (between 1961 and 2011) and Labour Force Survey (annual surveys between 1976 and 2013) data to estimate the number of workers ever exposed to occupational carcinogens. Risk estimates of the association between each carcinogen and cancer site were selected mainly from published literature reviews. Population attributable risks were estimated using Levin's equation and applied to the 2011 cancer statistics from the Canadian Cancer Registry. It is estimated that 15.5 million Canadians alive in 2011 were exposed, during at least one year between 1961 and 2001, to at least one carcinogen in the workplace. Overall, we estimated that in 2011, between 3.9% (95% CI: 3.1%-8.1%) and 4.2% (95% CI: 3.3%-8.7%) of all incident cases of cancer were due to occupational exposure, corresponding to lower and upper numbers of 7700-21,800 cases. Five of the cancer sites - mesothelioma, non-melanoma skin cancer, lung, female breast, and urinary bladder - account for a total of 7600 to 21,200 cancers attributable to occupational exposures such as solar radiation, asbestos, diesel engine exhaust, crystalline silica, and night shift work. Our study highlights cancer sites and occupational exposures that need recognition and efforts by all stakeholders to avoid preventable cancers in the future.

Outdoor workers are exposed daily to solar ultraviolet radiation, an important contributor in the development of non-melanoma skin cancer. This study aimed to quantify the health burden of non-melanoma skin cancers among outdoor workers in Canada. Solar ultraviolet radiation exposure and estimates of exposure levels were applied to employment information from Canada census data to determine the exposed population in the risk exposure period (1961–2001). Risk estimates were drawn from meta-analyses selected based on quality and relevance to the current study. Population-attributable fractions were calculated using Levin’s equation and attributable cases were estimated based on incidence data reported by the Canadian Cancer Society. In 2011, 6.31% (4556 cases) of non-melanoma skin cancer cases were estimated to be attributable to occupational exposure to solar ultraviolet radiation. The majority of these cases occurred in men in the agriculture or construction industries. These estimates of the burden of non-melanoma skin cancer in Canada identify the need for further prevention efforts, particularly in agriculture and construction. Introducing workplace sun safety measures could be an important area for policy development.

Background Only few risk factors have been identified for amyotrophic lateral sclerosis (ALS). Higher risks were reported for various occupations (e.g. farmers, construction workers), but responsible exposures remain largely unknown. We investigated the association between occupational exposure to diesel engine exhaust and sporadic ALS in a population-based study with detailed information on possible confounders. Methods An ongoing ALS case-control study is being conducted in the Netherlands since 2006, and we here present data for 2006–2014. Lifetime occupational histories and lifestyle factors were collected via questionnaires. A general population job-exposure matrix was assigned to estimate exposure to diesel engine exhaust. All exposure variables were estimated up to two years before survey to account for any changes due to disease onset. Odds ratios were estimated by logistic regression models, adjusted for age, sex, smoking and alcohol. Results Data were available for 1040 sporadic ALS cases (63.6% male) and 2050 controls (60.2% male). Ever occupational exposure to diesel engine exhaust was not associated with risk of ALS (OR=1.06, 95% CI 0.87–1.28). No exposure-response relation was observed for either cumulative exposure or exposure duration on a continuous scale. Conclusion Our analysis suggests that exposure to diesel engine exhaust is not associated with an increased risk of ALS.

Objectives To estimate the numbers of workers exposed to known and suspected occupational carcinogens in Canada, building on the methods of CARcinogen EXposure (CAREX) projects in the European Union (EU). Methods CAREX Canada consists of estimates of the prevalence and level of exposure to occupational carcinogens. CAREX Canada includes occupational agents evaluated by the International Agency for Research on Cancer as known, probable or possible human carcinogens that were present and feasible to assess in Canadian workplaces. A Canadian Workplace Exposure Database was established to identify the potential for exposure in particular industries and occupations, and to create exposure level estimates among priority agents, where possible. CAREX EU data were reviewed for relevance to the Canadian context and the proportion of workers likely to be exposed by industry and occupation in Canada was assigned using expert assessment and agreement by a minimum of two occupational hygienists. These proportions were used to generate prevalence estimates by linkage with the Census of Population for 2006, and these estimates are available by industry, occupation, sex and province. Results CAREX Canada estimated the number of workers exposed to 44 known, probable and suspected carcinogens. Estimates of levels of exposure were further developed for 18 priority agents. Common exposures included night shift work (1.9 million exposed), solar ultraviolet radiation exposure (1.5 million exposed) and diesel engine exhaust (781 000 exposed). Conclusions A substantial proportion of Canadian workers are exposed to known and suspected carcinogens at work.

BackgroundRadon is a well-known cause of lung cancer. Our goal was to estimate the prevalence and level of occupational exposure to radon, and to estimate the current lung cancer burden caused by radon exposure in Canadian workplaces.MethodsHighly exposed (i.e. underground) workers were assigned exposure proportions at the national level using CAREX methodology. Exposure for the indoor working population was estimated using province-specific radon measurements from the Canadian federal building survey (n=12 870 samples). The proportion of workers exposed to specific ranges of radon (50–100, 100–150, 150–200, 200–400, 400–800,>800 Bq/m3) were calculated and we assigned the midpoint of the range as the average radon concentration for each exposure group. For the >800 Bq/m3category, the province-specific mean of measurements>800 Bq/m3was assigned. The above exposure assessment was applied to a population model of the historical Canadian labour force and exposures between 1961 and 2001 (the risk exposure period) were considered as contributing to cancer cases in 2011. The BEIR VI exposure-age-concentration model was used to assign relative risks by exposure category. The population attributable fraction was calculated using Levin’s equation.ResultsThere were an estimated 4.4 million indoor workers and 26 000 highly exposed workers exposed to radon during the risk exposure period. Nearly 80% of these workers were exposed below 50 Bq/m3 (half the WHO reference level). Combining the indoor and highly exposed workers, we calculated that 0.80% of lung cancers are attributable to occupational radon exposure; this equates to 188 lung cancer cases per year.ConclusionsOurs was the first study to use a data-driven approach to estimate radon exposure and lung cancer burden for indoor workers. Some of the attributable cases can be prevented by reducing workers’ exposure at workplace.

Objective Cancer is the second-leading cause of death in Latin America and the Caribbean (LAC). Exposure to workplace carcinogens is an important factor, yet there are sparse data about the numbers and types of LAC workers exposed. This project aimed to build capacity for CARcinogen EXposure (CAREX) programs in LAC. Methods The CAREX method, originally developed in the European Union for estimating exposure to occupational carcinogens, has been used and modified in some Central American countries and Canada. Generally, the approach combines labour force data with estimates of the proportions of workers exposed to priority carcinogens in each country. A two-day workshop involving over 20 participants from Canada and 12 LAC countries was held to discuss methodological approaches, issues unique to LAC, and research opportunities. Certain individual countries subsequently developed CAREX programs by holding consultations to identify priority carcinogens and adapting proportion of exposure values from existing CAREX programs. Results CAREX programs in LAC have been established in Costa Rica, Nicaragua, Panama, Guyana, Colombia, Peru, and Chile. Central American CAREX projects included exposure estimates by sex for approximately 30–35 carcinogens that incorporated levels of uncertainty. Both informal and formal workers were covered in exposure estimates, although estimates for these populations are challenging in most countries. In general, agents with the greatest prevalence of exposure in all industries included solar radiation, environmental tobacco smoke, crystalline silica, and pesticides. In Peru, exposure estimates were based on data from LAC and Europe with the involvement of experts from 43 institutions. Preliminary results from Chile have also been produced using a slight variation of this approach. Conclusions This project demonstrates that the CAREX methodology can be readily adapted to different countries, economies, and priority carcinogens. CAREX exposure estimates are integral for informing primary prevention activities and improving estimates of the global occupational cancer burden.

Objectives To enhance access to CAREX Canada’s occupational exposure estimates by creating and demonstrating two electronic tools, eWORK Excel and eWORK Online. Both tools allow users to explore CAREX results by occupation, industry, exposure level, and carcinogen. Results generated by the tools are dynamic, customizable, and tailored to the user’s interest. Method eWORK Excel was developed in Microsoft Excel with the PowerPivot add-on. eWORK Online was developed using a data visualisation software called Tableau Public. Data inputs (prevalence and level of exposure estimates to known and suspected carcinogens) were developed using CAREX methods established in the European Union and enhanced for the Canadian context. Results Two functional tools, eWORK Excel and eWORK Online, are already completed and beta testing is underway. Future deliverables include upgrading the tools with additional data and capabilities, and refining tool features based on testing feedback. Target audiences differ for our two eWORK tools. eWORK Excel is aimed at savvy data users such as researchers in occupational hygiene and epidemiology. eWORK Online is for users who prefer quick, simple, yet high quality statistics on occupational exposures to various carcinogens. Target groups for eWORK Online include physicians, policymakers, occupational health and safety professionals, and labour organisations. Conclusions The overall goal of the CAREX Canada project is to help reduce exposure to carcinogens in Canadian workplaces by providing scientific evidence on exposure patterns and concentrations for policymakers and other important stakeholders. eWORK Excel and eWORK Online are innovate tools which play a key role in effective communication of our research results.

Objectives The CANJEM general population job-exposure matrix summarizes expert evaluations of 31 673 jobs from four population-based case–control studies of cancer conducted in Montreal, Canada. Intensity in each CANJEM cell is represented as relative distributions of the ordinal (low, medium, high) ratings of jobs assigned by the experts. We aimed to apply quantitative concentrations to CANJEM cells using Canadian historical measurements from the Canadian Workplace Exposure Database (CWED), taking exposure to wood dust as an example. Methods We selected 5170 personal and area wood dust measurements from 31 occupations (2011 Canadian National Occupational Classification) with a non-zero exposure probability in CANJEM between 1930 and 2005. The measurements were taken between 1981 and 2003 (median 1989). A Bayesian hierarchical model was applied to the wood dust concentrations with occupations as random effects, and sampling duration, year, sample type (area or personal), province, and the relative proportion of jobs exposed at medium and high intensity in CANJEM cells as fixed effects. Results The estimated geometric mean (GM) concentrations for a CANJEM cell with all jobs exposed at medium or high intensity were respectively 1.3 and 2.4 times higher relative to a cell with all jobs at low intensity. An overall trend of −3%/year in exposure was observed. Applying the model estimates to all 198 cells in CANJEM with some exposure assigned by the experts, the predicted 8-hour, personal wood dust GM concentrations by occupation for 1989 ranged from 0.48 to 1.96 mg m−3. Conclusions The model provided estimates of wood dust concentrations for any CANJEM cell with exposure, applicable for quantitative risk assessment at the population level. This framework can be implemented for other agents represented in both CANJEM and CWED.