world cancer report - iarc

co-induced disease, including the impact
of environmental tobacco smoke. However,
such limitations do not detract from the
value of initiatives to reduce environmental
pollution. Such measures may reasonably
be presumed to contribute to prevention of
cancer, even in the absence of definitive
data.
Air pollution
Air pollution has decreased in most developed
countries during recent decades. In
some Central and Eastern European countries,
such as Poland, there has been a
significant reduction in emissions of air
pollutants as a result of the implementation
of environmental protection programmes
[10]. However, even when an
increased risk of cancer is attributable to
environmental pollution, appropriate preventive
measures may not be adopted.
People living in villages in Cappadocia,
Central Turkey, where the local stone used
for house construction was contaminated
with the carcinogenic fibre, erionite, were
burdened with a very high incidence of
pleural mesothelioma [11]. Attempts to
relocate exposed individuals away from
contaminated houses were hampered by
economic constraints and there is anecdotal
evidence that migrants from poorer
parts of the country moved into some of
the houses left empty.
Regulation is the primary approach to
preventing pollution-induced cancer.
Improvements in air quality have been
achieved by means of adopting guidelines
and legislation, examples of which include
the WHO Air Quality Guidelines for
Europe, the National Ambient Air Quality
Standards (US Environmental Protection
Agency) and Council Directives on Air
Quality (European Union). The Environmental
Health Criteria series of the
International Programme on Chemical
Safety currently assesses the health risks
of some 120 chemical compounds and
mixtures. Limits have been set on motor
vehicle exhaust emissions in many parts
of the world. The Council of the European
Communities has adopted a phased programme
for the implementation of emission
standards for carbon monoxide,
hydrocarbons and nitrogen oxides from
gasoline and diesel-powered vehicles [12].
One aspect of the control of atmospheric
pollution in relation to cancer concerns
the limiting of ozone depletion. The 1987
Montreal Protocol (mediated by United
Nations Environment Programme and
signed by 150 countries) has resulted in
the cessation of production and consumption
of a significant proportion of all
ozone-depleting substances in industrialized
countries. The worldwide consumption
of ozone-depleting substances
decreased by nearly 75% in the seven
years to 1996. As a result of the subsequent
decline in the rate at which global
ultraviolet radiation is increasing, it has
been estimated that 1.5 million cases of
melanoma may be prevented in the next
60 years [13].
Indoor air pollution is a major public
health challenge, which demands action in
terms of research and policy-making [14].
The greatest burden of disease resulting
from exposure to smoke from cooking
Standard (mg/L) Countries
(concentration and date standard was established, if known)
< 0.01 Australia (0.007, 1996), European Union (1998),
Japan (1993), Jordan (1991), Laos (1999), Mongolia (1999),
Namibia, Syria (1994)
0.01 -0.05 Canada (0.025, 1999)
0.05 United States (considering lowering standard from
0.05, 1986), Mexico (considering lowering standard, 1994)
Operative measure Examples
Bahrain, Bangladesh, Bolivia (1997), China, Egypt (1995),
Indonesia (1990), Oman, Philippines (1978), Saudi Arabia,
Sri Lanka (1983), Viet Nam (1989), Zimbabwe
Table 4.7 Currently accepted national standards for arsenic in drinking water.
Preventing exposure
Use of gloves and face mask Pharmacists handling cytotoxic drugs
Full respirator Specified emergency procedure for spillage of
hazardous material
Controlling exposure
Environmental monitoring Measurement of asbestos fibre level in
breathing zone
Film badge to assess radiation exposure
Assessing uptake and excretion Urinary measurement of metabolite, e.g.
dimethylphosphate in workers exposed to
dichlorvos
Urine analysis for haematuria
Determination of protein adducts and screening
for preneoplastic lesions in MOCA {4,4'methylenebis(2-chloroaniline)}-exposed
workers
Determination of DNA adducts in coke oven
workers exposed to polycyclic aromatic
hydrocarbons
Table 4.8 Means to either prevent or determine the level of exposure to occupational carcinogens.
Reduction of occupational and environmental exposures 139