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Paul A Demers, Ph.D.

Occupational Cancer Research Centre

Dalla Lana School of Public Health

University of Toronto

Surveillance Strategies for Asbestos-Related Disease and Exposure in Canada

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Systems for Asbestos Surveillance

  • CAREX Canada – population surveillance of exposure
  • Cancer Registries in Canada
  • The Asbestos Workers Registry
  • The Occupational Disease Surveillance System

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https://www.odsp-ocrc.ca/

Although the OCRC was created to focus on cancer, it now includes a wide range of occupational diseases. In 2018, the Occupational Disease Surveillance Program (ODSP) was launched with funding from the province of Ontario Government.

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Cancer Registries in Canada

  • Both health and labour are primarily under provincial jurisdiction in Canada, with some exceptions
  • Cancer registration in Canada in all provinces since 1970 (some provinces earlier)
  • High quality cancer registries (microscopic confirmation for 85-90% of cases and death certificate only identification for only 2-3%)
  • Information collected includes cancer site, histology, diagnosis date, sex, birth date, geographic location at diagnosis, method of confirmation

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Statistics Canada. Table 103-0550 - New cases of primary cancer, by cancer type, age group and sex, Canada, provinces and territories, annual, CANSIM (database) [Internet].

Annual newly diagnosed cases of mesothelioma in Canada

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Age-Adjusted Incidence Rates of Mesothelioma in Ontario

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Mesothelioma Incidence in Ontario by Census Division 1992-2016

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Asbestos Workers Registry (AWR)

  • A Mandatory exposure registry created in 1986 under regulation of asbestos on construction projects and in buildings & repair operations

22. (1) The Provincial Physician, Ministry of Labour, shall establish and maintain an Asbestos Workers Register listing the name of each worker for whom an employer submits an asbestos work report under section 21. 

  • Requires employers to report workers engaged in high and moderate risk work with asbestos containing materials
  • When a worker reaches 2,000 cumulative hours of work (approximately equal to one year’s work) the worker is notified

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AWR Compared to Ontario Rates

​

Construction (n=15,933)

Manufacturing (n=4,680)

​

cases

SIR*

95% CI

cases

SIR*

95% CI

Lung Cancer

299

1.4

(1.3-1.6)

128

0.9

(0.8-1.1)

Mesothelioma

63

10.1

(7.8-13.0)

22

4.6

(2.9-6.9)

COPD

1310

3.1

(2.9-3.3)

505

1.8

(1.6-1.9)

Asbestosis

107

18.1

(14.8-21.9)

29

6.2

(4.2-9.0)

Pulmonary Fibrosis

102

11.6

(9.5-14.1)

53

17.5

(13.1-22.9)

* Standardized Incidence Ratio’s compared to the general population, �adjusted for sex, age, and calendar period.

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Group

Asbestosis

(HR 95% CI)

Mesothelioma

(HR 95% CI)

Construction industry

2.5 (2.1-3.0)

2.0 (1.6-2.3)

General contractors

1.1 (0.8-1.6)

1.5 (1.1-2.0)

Special-trade contractors

3.1 (2.6-3.8)

2.1 (1.7-2.5)

Construction trades occupations

3.6 (3.1-4.3)

2.4 (2.0-2.8)

Construction electricians & repairmen

3.3 (2.4-4.6)

2.1 (1.4-3.2)

Carpenters and related occupations

2.0 (1.4-2.8)

1.7 (1.2-2.5)

Plasterers and related occupations

5.6 (3.4-9.3)

2.3 (1.1-4.9)

Insulators

35.2 (21.7-57.0)

25.8 (15.2-43.8)

Pipefitting and plumbing

8.2 (6.4-10.5)

5.9 (4.5-7.7)

DeBono NL et al, American Journal of Industrial Medicine 2021;64:476-487.

ODSS Results: Mesothelioma & Asbestosis in Construction

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Conclusions

  • We have developed many good systems to identify asbestos related diseases
  • Tracking exposure is much more difficult
    • CAREX Canada can provide good estimates of exposure
    • Identifying workplaces and levels of exposure is difficult
  • The numbers we generate can be powerful tools for change

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Obrigado!��Thank You!