Western Australian Institute for Medical Research (WAIMR)


http://www.waimr.uwa.edu.au

Epidemiology Group

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The Epidemiology Group

The Epidemiology Group studies the causes and patterns of cancer and other chronic diseases in human populations.

A particular interest is occupational causes of cancer. We study people in particular occupations (particularly heavy industries such as the asbestos industry) and follow them to see if they are at increased risk of cancer. Other types of studies involve comparing the work histories of people with and without cancer. If a particular work exposure causes cancer, we expect to see more people in that job who have cancer than who don't have cancer. We are or have undertaken studies of breast cancer, prostate cancer, colorectal cancer, non-Hodgkin lymphoma and childhood leukaemia and brain cancer. In order to improve the methods used in these types of studies we are developing new tools for assessing work histories using cutting-edge computer technologies (see www.occideas.org).

Migration has been important to the wealth and development of Australia. In the post war period up until the 1960s nearly six million European migrants arrived in Australia, largely to build Australia's manufacturing industries. From the 1970s restrictions were eased on non-European migration as migrants with increased skill and educational levels were sought. Australia is a nation of migrants and migrant workers will continue to feature as a significant group of the Australian workforce. Currently in Australia we know very little about them, but internationally we know that they are likely to work in the worst of jobs and suffer from more work-related accidents and injuries. We are undertaking research to study the working conditions of migrant workers. This information is vital in order to promote and maintain good health in these sub populations in the future.

Senior Research Staff

Lin Fritschi Professor Lin Fritschi

Head, Epidemiology Group

Research: occupational causes of cancer; exposure assessment in epidemiological studies

 Alison Reid A/Professor Alison Reid

Research Associate Professor

Research: the health of migrant workers; asbestos-related disease in women

Major Projects

Breast Cancer, Environment and Employment Study (BCEES)
Funded by NHMRC

Breast cancer is the most common cancer in Australian women, while about 5-10% of breast cancer can be linked to genetic factors, the remaining 90-95% is thought to be linked to environmental and lifestyle factors. There have been a number of recent events which have raised public concern that occupational exposures are contributing to the increasing occurrence of this cancer. The Western Australian Institute for Medical Research (WAIMR) in conjunction with the University of WA are conducting a three year study investigating occupational risk factors for breast cancer in women. In this study, we are investigating occupational causes of breast cancer as well as physical activity, sleep and pesticide exposure. Participants are asked to complete a questionnaire asking about their occupational history and lifestyle. We need 3000 women to participate, 1000 with breast cancer and 2000 without. We will then compare the occupational/lifestyle information of women who have been diagnosed with breast cancer with those who have not, in search of common patterns that may point to factors that cause or prevent cancer.

For more information on the study please visit our website at bcees.org.au.

Collaborators and staff: Lin Fritschi, Jane Heyworth, Deborah Glass, Thomas Erren, Christobel Saunders, Kristan Aronson, Terry Slevin, Terry Boyle, Jennifer Girschik, Sonia el Zaemy, Allyson Thomson, Pierra Rogers, Mai Nguyen.

OccIDEAS
Funded by NHMRC

Occupational exposures to different chemical, biological and physical agents amongst workers are very common. Other than a few carcinogens, we know very little about the thousands of harmful agents present at workplaces. In order to study these agents we need to assess whether people have been exposed to them in the past. Assessing occupational exposure in community-based studies is difficult and complex. OccIDEAS is an online application which automates the process of assessment. OccIDEAS has the potential to make high-quality occupational assessment more efficient and accessible for epidemiological studies. It is currently being used in our BCEES study as well as 5 other Australian studies and one large study in China.

For more information see our website at www.occideas.org.

Collaborators and staff: Lin Fritschi Troy Sadkowsky, Deborah Glass, Geza Benke.

Migrant Workers
Funded by ARC

Use of skills/educational qualifications and mental health

Since the mid 1990s Australia's immigration program has focused on encouraging skilled migration. Other work has suggested that there is underutilization of qualifications among recent migrants. This study is investigating skill usage in migrant workers in three longitudinal studies of migrants to Australia and examine if there is an association with mental health status.

Exposure to physical and psychosocial hazards in the workplace, and risk of fatal and non-fatal work-related accidents and injuries.

The international literature suggests that migrant workers are exposed to more hazards at work than native-born workers and suffer from more work-related accidents and injuries. The evidence base for Australia is patchy despite the fact that Australia has such a large migrant population. This study will address this gap in the evidence by addressing key questions. Do migrants suffer from more workplace accidents, injuries and fatalities than Australian born workers? Do these reduce with longer duration of residence? In addition this study will establish the best methods to address future questions about the workplace conditions of migrants in Australia (in terms of physical and psychosocial hazards); e.g. do they differ from those of Australian-born workers; what hazards are workers in Australia exposed to - what is the prevalence of exposure to known carcinogens (ie asbestos, benzene) or to psychosocial hazards (i.e job strain, unemployment, underemployment); do they differ for males and females and do they improve with longer duration of residence in Australia?

For more information on the study please visit our website at www.waimr.uwa.edu.au/research/iwohs.html.

Collaborators: Alison Reid, Lin Fritschi, Tony LaMontagne, Seeromanie Harding and Erik Lenguerrand.

Wittenoom Cohort Studies
Funded by NHMRC

Mesothelioma risk among different migrant groups at Wittenoom

In Australia's recent past, anecdotal evidence from the blue asbestos mining and milling operation at Wittenoom suggested that Italian migrants were given 'dirtier' jobs than their native-born counterparts. This study will examine the incidence of mesothelioma and lung cancer and deaths from all causes by ethnic group to determine if migrant workers worked in more hazardous jobs at Wittenoom than Australian-born workers.

Psychosocial health following exposure to blue asbestos at Wittenoom

The major impacts on physical health from exposure to blue asbestos at Wittenoom are known. What is not understood is the impact of this exposure on psychosocial health. In our 2007 mailed questionnaire to all surviving former Wittenoom workers and residents traced to an address in Australia, were four questions that sought information on their general sense of control of their lives. The locus of control is a measure of internal versus external control (mastery versus powerlessness) and has no specific relationship with health. In addition we included the Short Form-12 (SF-12) to measure health-related quality of life, and also asked for current or main occupation and highest educational qualification. Work in progress is examining associations between locus of control and SF-12 and asbestos exposure at Wittenoom. This project will examine any associations between locus of control and poor mental health (mental component summary from the SF-12<30) and incidence of asbestos-related disease.

Temporal expression of mesothelioma

Some authors have suggested that the risk of mesothelioma may attenuate after more than 40 years since first exposed to asbestos. Among the Eternit cohort from Casale Monferrato, Italy, the risk of mesothelioma increased up to 40 years since first exposure and plateaued thereafter. Among the women from Wittenoom to date there have been no new cases of mesothelioma among those women first exposed to asbestos more than 52 years ago. However this may change as the median time since first exposure was 37 years (IQR 27 - 44 years) as at the end of 2005. Among female gas mask workers exposed to crocidolite no cases of mesothelioma have arisen more than 51 years after first exposure. Similarly the rate of mesothelioma appears to level off after 50 years since first exposure in the Wittenoom workers.

This project will examine if there is a decrease in risk of mesothelioma (pleural and peritoneal) and exposure-related lung cancer with time since the cessation of exposure (or since first exposure) through an international collaboration. This will involve a pooled analysis of data from several asbestos exposed cohorts; Australia - Wittenoom workers and residents; Italy - asbestos cement factory workers, and other cohorts of amosite exposed railway workers and insulators and England (Nottingham World War II Gas Mask Workers). All of these cohorts have follow up of more than 40 years. This work is important to the understanding of the temporal expression of mesothelioma and lung cancer following exposure to various types of asbestos. It will provide information applicable to understanding the pattern of Australia's current and future mesothelioma burden.

Collaborators: Alison Reid, Bill Musk, Nick de Klerk, Geoffrey Berry, Enzo Merler, Corrado Magnani.

Australian Workplace Exposure Study (AWES)
Funded by NHMRC

About 1.5 million Australians may be currently exposed to carcinogens in their jobs. This estimate is based on European data and we need Australian information in order to direct future Australian research, policy and practice. The project will survey 5000 Australian workers to estimate their exposure to 38 chemical and physical carcinogens found at work. This will provide a sound basis for estimating the occupational risk of cancers for Australian workers and determining how to decrease the number of cancers caused by work.

For more information on the study please visit our website at www.waimr.uwa.edu.au/research/awes.html.

Collaborators and staff: Lin Fritschi, Alison Reid, Deborah Glass, Tim Driscoll, Geza Benke, Renae Fernandez, Renee Carey.

WA Bowel Health Study (WABOHS)
Funded by NHMRC

Bowel cancer is the second most commonly diagnosed cancer in Australians. About 10% of bowel cancers can be linked to a family history or genetics. The remaining 90% are thought to be linked to environmental and lifestyle factors, although it is not clear what factors are most involved. The goal of the WA Bowel Health Study (WABOHS) was to identify the environmental and lifestyle factors that may contribute to the development of cancer in different areas of the large bowel. We were also interested in the interactions between these lifestyle factors and low-risk genes that may lead to cancer in different areas of the large bowel.

Collaborators and staff: Jane Heyworth, Lin Fritschi, Barry Iacopetta, Cameron Platell, Terry Boyle, Sarah McNaughton.

2009 Publications

  1. Rogers C, Kvaskoff M, Disipio T, Youlden D, Whiteman D, Eakin E, Youl PH, Aitken J, Fritschi L. 2009. Prevalence and determinants of sunburn in Queensland. Health Promotion Journal of Australia 20:102-6. [NCBI PubMed Entry]
  2. Fritschi L. 2009. Shiftwork and cancer. (Editorial) British Medical Journal BMJ 339:b2653. [IF 12.827 cited 1]
  3. Karipidis K; Benke G; Sim M; Fritschi L; Vajdic C; Kricker A, Armstrong B. 2009. Non-Hodgkin lymphoma and occupational radiation exposure assessed using local data. Occupational Medicine 59:437-9. [NCBI PubMed Entry] [IF 1.324 cited 1]
  4. Coory M, Thompson B, Baade P, Fritschi L. 2009. Utility of routine data sources for feedback on the quality of cancer care: an assessment based on clinical practice guidelines. BMC Health Services Research 9:84. [NCBI PubMed Entry] [IF 1.680]
  5. Lucas M, Fritschi L, Day L, Shirangi A. 2009. Significant injuries in Australian veterinarians and use of safety precautions. Occupational Medicine 59:327-33. [NCBI PubMed Entry] [IF 1.324]
  6. Friesen MC, Benke G, Del Monaco A, Dennekamp M, Fritschi L, de Klerk N, Hoving JL, MacFarlane E, Sim MR. 2009. Relationship between cardiopulmonary mortality and cancer risk and quantitative exposure to polycyclic aromatic hydrocarbons, fluorides, and dust in two prebake aluminium smelters. Cancer Causes and Control 20:905-916. [NCBI PubMed Entry] [IF 3.690]
  7. Friesen MC, Fritschi L, Del Monaco A, Benke G, Dennekamp M, de Klerk N, Hoving JL, MacFarlane E, Sim MR. 2009. Relationships between alumina and bauxite dust exposure and cancer, respiratory, and circulatory disease. Occupational and Environmental Medicine 66:497-501. [NCBI PubMed Entry] [IF 3.302]
  8. Sim MR, Del Monaco A, Hoving JL, MacFarlane E, McKenzie D, Benke G, de Klerk N, Fritschi L. 2009. Mortality and cancer incidence in workers in two Australian prebake aluminium smelters. Occupational and Environmental Medicine 66:464-70. [NCBI PubMed Entry] [IF 3.302]
  9. Shirangi A, Fritschi L, Holman CD, Bower C. 2009. Birth defects in offspring of female veterinarians. Journal of Occupational and Environmental Medicine 51:525-33. [NCBI PubMed Entry] [IF 2.085]
  10. Shirangi A, Fritschi L, Holman C. 2009. Associations of unscavenged anesthetic gases and long working hours with preterm delivery in female veterinarians. Obstetrics and Gynecology 113:1008-17. [NCBI PubMed Entry] [IF 4.397 cited 1]
  11. Iacopetta B, Heyworth J, Girschik J, Grieu F, Clayforth C, Fritschi L. 2009. The MTHFR C677T and DeltaDNMT3B C-149T polymorphisms confer different risks for right- and left-sided colorectal cancer. International Journal of Cancer 125:84-90. [NCBI PubMed Entry] [IF 4.734]
  12. Fritschi L, Morrison D, Shirangi A, Day L. 2009. Psychological well-being of Australian veterinarians. Australian Veterinary Journal 87:76-81. [NCBI PubMed Entry] [IF 0.801 cited 2]
  13. MacFarlane E, Glass D, Fritschi L. 2009. Is farm-related job title an adequate surrogate for pesticide exposure in occupational cancer epidemiology? Occupational and Environmental Medicine 66:497-501. [NCBI PubMed Entry] [IF 3.302]
  14. Austin R, Thompson B, Coory M, Walpole E, Francis G, Fritschi L. 2009. Histopathology reporting of breast cancer in Queensland: the impact on the quality of reporting as a result of the introduction of recommendations. Pathology 41;361-365. [NCBI PubMed Entry] [IF 2.324]
  15. Lucas M, Day L, Fritschi L. 2009. Injuries to Australian veterinarians working with horses. The Veterinary Record 164:207-9. [NCBI PubMed Entry] [IF 1.240]
  16. Thompson B, Austin R, Coory M, Aitken J, Walpole E, Francis G, Fritschi L. 2009. Completeness of histopathological reporting of melanoma in a high incidence geographical region. Dermatology 218:7-14. [NCBI PubMed Entry] [IF 2.227]
  17. Beadle G, Baade P, Fritschi L. 2009. Acute myeloid leukemia after after breast cancer: a population-based comparison with hematological malignancies and other cancers. Annals of Oncology 20:103-9. [NCBI PubMed Entry] [IF 4.935]
  18. Reid A, Heyworth J, de Klerk NH, Musk AW. 2009. Gestational trophoblastic disease and asbestos exposure: An hypothesis. Cancer Epidemiology Biomarkers & Prevention 18(11):2895-2898. [NCBI PubMed Entry] [IF 4.77]
  19. Reid A, Segal A, Heyworth JS, de Klerk NH, Musk AW. 2009. Gynecologic and breast cancers in women after exposure to blue asbestos at Wittenoom. Cancer Epidemiology Biomarkers & Prevention 18(1):140-7. [NCBI PubMed Entry] [IF 4.77]
  20. Reid A, Berry G, Heyworth J, de Klerk NH, Musk AW. 2009. Predicted mortality from malignant mesothelioma among women exposed to blue asbestos at Wittenoom, Western Australia. Occupational and Environmental Medicine 66:169-174. [NCBI PubMed Entry] [IF 3.30]

2010 Publications

  1. Reid A. Migrant Workers. Invited Opinion Piece - Ethnicity & Health In Press (accepted 21/12/2009, to be published April 2010 issue) [IF 0.94]
  2. Fritschi L, Guenel P, Ahrens W. Breast cancer in priests: follow-up of an observation made 167 years ago. European Journal of Epidemiology In Press (accepted 7/1/2010) [NCBI PubMed Entry]
  3. Abramson M, Benke G, Cui J, de Klerk NH, Del Monaco A, Dennekamp M, Fritschi L, Musk AW, Sim MR. Is potroom asthma due more to sulphur dioxide than fluoride? - an inception cohort study in the Australian aluminium industry. Occupational and Environmental Medicine In Press (accepted 14/12/2009)
  4. Bailey H, Milne E, de Klerk N, Fritschi L, Bower C, Attia J, Armstrong BK. Representativeness of child controls recruited by random digit dialling. Paediatric and Perinatal Epidemiology In Press (accepted 28/9/2009) [IF 1.660 cited]
  5. Milne E, Royle JS, Miller M, Bower CI, de Klerk NH, Bailey HD, van Bocksmeer F, Attia J, Scott RJ, Norris MD, Haber M, Thompson JR, Fritschi L, Marshall G, Armstrong BK. Maternal folate and other vitamin supplementation during pregnancy and risk of acute lymphoblastic leukemia in the offspring. International Journal of Cancer In Press (accepted 25/9/09) [NCBI PubMed Entry] [IF 4.734]
  6. Fritschi L, Friesen MC, Glass D, Benke GP, Girschik J, Sadkowsky T. OccIDEAS: Retrospective occupational exposure assessment in community-based studies made easier. Journal of Environmental and Public Health In Press (accepted 30/8/2009) [NCBI PubMed Entry]
  7. Girschik J, Glass D, Ambrosini G, Fritschi L. An investigation and literature review of mining and prostate cancer: could mining be protective against prostate cancer? Occupational and Environmental Medicine In Press (accepted 19/8/2009) [NCBI PubMed Entry] [IF 3.302]