Establishing National CARcinogen EXposure (CAREX) Programs In Latin America And The Caribbean: Achievements And Future Directions
Julietta RODRIGUEZ GUZMAN, Pan American Health Organization/Americas Regional Office of the World Health Organization, United States
DEMERS P. 2,3,4
, PAHWA M. 2
, PETERS C. 4,5,6
, GE C. 4,7
1 Sustainable Development and Health Equity, Pan American Health Organization/Americas Regional Office of the World Health Organization, Washington DC, USA
2 Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Canada
3 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
4 CAREX Canada, Simon Fraser University, Burnaby, Canada
5 Carleton University, Ottawa, Canada
6 Institut National de la Recherche Scientifique-Institut Armand-Frappier, Universite du Quebec, Montreal, Canada
7 Universiteit Utrecht, Utrecht, the Netherlands
Purpose: 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. The objective of this project was to build capacity for developing CARcinogen EXposure (CAREX) projects in LAC.
Methods: The CAREX method, originally developed in the European Union for estimating exposure to occupational carcinogens, has been used and modified in multiple Central American countries and Canada. The approach generally involves combining 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 as a forum for discussing methodological approaches, issues unique to LAC, and research opportunities.
Results: CAREX programs in LAC have been established in Costa Rica, Nicaragua, Panama, Guyana and Colombia, with projects currently in progress in 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. Stakeholder consultations were held in Peru to identify priority carcinogens. Proportion of exposure values from other CAREX projects were considered for the Peruvian context.
Conclusions: This project demonstrated that the CAREX methodology can be readily adapted to different countries, economies, and priority carcinogens. Exposure estimates generated from CAREX projects are integral for informing primary prevention activities and improving estimates of the global occupational cancer burden.
Funding source: Canadian International Development Research Centre; Pan American Health Organization; National Cancer Institute of Colombia