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Authors Call for Increased Attention to Cancer Risk From Silica

Action could help millions of Americans exposed to silica at work (December 10)

A new review highlights developments in understanding the health effects of silica and calls for action to reduce illness and death from silica exposure at work, including stronger regulations, heightened awareness and prevention, and increased attention to early detection of silicosis and lung cancer using low-dose computed tomography (CT) scanning.

For centuries, silica has been known to cause lung disease (silicosis). Evidence that silica causes lung cancer has been more recent, accumulating over the last several decades. Writing in CA: A Cancer Journal for Clinicians, Kyle Steenland, PhD, at Emory University, and Elizabeth Ward, PhD, of the American Cancer Society, highlight three important developments that have the potential to prevent illness and death from silica exposure at work.

The first development is the publication of recent studies providing detailed exposure-response data, enabling regulations based on quantitative risk assessment. New studies have also shown that silica-exposed workers who do not have silicosis and who do not smoke still have increased rates of lung-related mortality.

Second, a new rule lowering the permissible occupational exposure for the estimated 2.2 million U.S. workers exposed to silica is currently under consideration. Risk assessments estimate that lowering occupational exposure limits from the current to the proposed standard will reduce silicosis and lung cancer mortality to approximately one-half of the rates predicted under the current standard.

Third, low-dose CT scanning has been proved to be an effective screening method for lung cancer. The authors recommend that clinicians ask about the patient’s occupational history to determine whether silica exposure has occurred; and if it has, clinicians should give extra attention to the early detection of silicosis and lung cancer, as well as place extra emphasis on quitting smoking. The authors recommend that individuals with significant occupational exposure to silica be offered screening beginning at age 50 if they also have smoked the equivalent of one pack a day for at least 20 pack-years — what experts call 20 pack-years of smoking.

Source: ACS; December 10, 2013.

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