How to quantitatively assess dermal exposure to volatile organic compounds

Overview of respiratory cancer
Laryngeal cancer
Most laryngeal cancers are squamous in origin and originate in the glottis. Supraglottic and subglottic tumours are rare. This disease is markedly more frequent in men than in women (Rafferty et al, 2001), and there is a large geographical variability in disease frequency. In the United Kingdom in the 1990s, laryngeal cancer accounted for around 1 in 70 diagnosed cases of cancer. Moreover, the disease mainly affects elderly people. On the basis of male patients diagnosed in 2000–2001, the age-standardised 1-year relative survival rate was 84% and after 5 years was 64% (Rachet et al, 2008a), and has improved significantly since the early 1980s. Survival was poorer for women than for men (Quinn et al, 2005).

The main risk factors for cancer of the larynx are tobacco and alcohol, which together have a synergistic effect on the risk of laryngeal cancer (IARC, 2004; Altieri et al, 2005; Pelucchi et al, 2006a). For smoking, the reported effect estimates have been generally strong, consistent and show a pronounced exposure–response relationship (Olshan, 2006). The aetiological role of alcohol is less clear, but evidence suggests both a weaker association and a joint effect with tobacco.

Lung cancer
Lung cancer is the most common malignant neoplasm among men in most countries and is increasing among women, notably in western countries. Lung cancer is rapidly fatal, and thus the trends in incidence and mortality are closely similar. Survival in the United Kingdom in 1986–1990 was very poor, only around 21% after 1 year and 6% after 5 years in both men and women, and has only marginally improved over the last 20 years (Rachet et al, 2008b). In men in England, Wales and Scotland, both incidence and mortality reached a plateau in the early 1970s, and both have since steadily decreased (Quinn et al, 2005). However, in women, increasing trends were seen up to the end of the 1980s, since when rates have been fairly stable. Lung cancer accounted for 23.4% of cancer deaths among men, and 17.9% of such deaths in women in 2005.

The overwhelming determinant of the occurrence of lung cancer is cigarette smoking, which is now estimated to account for ∼90% of the burden in developed countries (Peto et al, 1994), either independently or by synergistic associations with other risk factors. The geographical and temporal patterns are determined chiefly by the consumption of tobacco (Boffetta and Trichopoulos, 2002).

Mesothelioma
Mesothelioma is a rare form of cancer that develops from the mesothelium, the protective lining that covers many of the body’s internal organs. Its most common site is the pleura, but it may also occur in the peritoneum and the pericardium. The number of mesothelioma deaths each year has increased markedly since the late 1960s. In 2005, there were 2046 mesothelioma deaths – >1% of all malignant cancer deaths in Great Britain – compared with 153 in 1968 (HSE, 2010), the first full year for which data are available from the mesothelioma register. This cancer is more common in men who typically account for about 85% of mesothelioma-related deaths each year (McElvenny et al, 2005). The long latency of the disease – typically 30–40 years – also means that most cases occur at older ages, with around two-thirds of cases occurring at ages 60–80 years (HSE, 2010). Survival remains very poor; median survival is <12 months (CRUK, 2011).