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In an editorial in an earlier issue of this journal, Johanson & Tinnerberg (1) expressed serious and well-founded concern over the large number of future occupational cancer cases that will result if exposures for a number of substances are not reduced below the so-called \"binding occupational exposure limit values\" (BOELV) issued by the EU (2). The balance between what is perceived as possible to comply with and the foreseeable health gain when setting BOELV is further discussed in a letter to the Editor by Cherrie (3). This debate raises several important aspects of how to protect workers from cancer as well as other potentially lethal diseases. Herewith, we discuss some of these aspects. One problem in setting OEL is that levels that are considered safe may not be seen as feasible when accounting for technological and societal aspects. The EU has recognized this problem by distinguishing between so-called \"indicative\" (health-based) and legally binding OEL (4). However, a BOELV that does not protect from a high risk for severe health effects is not adequate. Both Johanson & Tinnerberg and Cherrie point to respirable crystalline silica (RCS) as an example: While the EU’s Scientific Committee on Occupational Exposure Limits (SCOEL) recommended an OEL <0.05 (5) in order to protect workers reasonably well against negative health effects, the EU decided on a BOELV of 0.1 mg/m³ for RCS (2). The US Occupational Health and Safety administration (OSHA) has come to a different conclusion and decided on an OEL of 0.05 mg/m³ (6). The EU has presented an extensive risk assessment for RCS developed within the SHEcan project (7). We argue that a BOELV at 0.1 is insufficient and partly may be due to misinterpretations of the SHEcan report. The report estimates the future number of lung cancer cases attributable to occupational exposure to RCS in the EU up to 2069. Four scenarios are discussed: (i) a baseline scenario, essentially predicting future numbers of cases without further regulatory action, (ii) a BOELV of 0.2 mg/m3 with 99% compliance, (iii) a BOELV of 0.1 mg/m³ with 99% compliance, and (iv) a BOELV of 0.05 mg/m³ with 99% compliance. The estimations are based on an assumption of a latency period of 10–50 years from reduction of exposure until cancer risk drops. This assumption, in itself reasonable from present evidence, has the consequence that there is virtually no difference in projected annual future cases between the four scenarios for ≥40 years. The reduction in exposure in scenarios ii–iv comes into effect first only in the year 2050 (see figure 4.1 on p49 in ec.europa.eu/social/BlobServlet?docId=10161&langId=en). An assumption of 99% compliance with the BOELV in scenarios ii–iv has a dramatically stronger effect on the projected number of cases than the OEL itself: Even if the OEL was doubled to 0.2 mg/m³ the number of attributable cancer registrations in 2060 would be reduced by 70% just from the assumption of almost full compliance. The additional number of attributable cancer registrations that are prevented when an OEL of 0.1 (scenario iii) is compared to an OEL of 0.05 (scenario iv) under an assumption of almost full compliance is comparatively small (7, p123). The reason for this strong effect of a 99% compliance is that exposure often will exceed the OEL. The report may lead to the misconception that an OEL of 0.05 mg/m³ has little benefit over an OEL of 0.1 mg/m³, especially if the cases saved are expressed as lives saved per year over the entire 60-year period. For Sweden and other countries where OEL already have legal status, the introduction of BOELV would have no legal implications. The SHEcan report shows that occupational exposure to silica will cause in all 440 000 cancer cases between 2010 and 2069 in the EU if nothing further is done (scenario i). This number must be reduced even if it will take time until preventive measures have full effect. An analogy with asbestos is obvious: it is well known that reductions in the mesothelioma rate were seen first only many decades after asbestos was banned – yet no one would argue that it was not worth reducing asbestos exposure for this reason. The report assumes an annual 7% decrease in silica exposure levels until the period 2020–2029 even if no further regulatory action is taken. This is a very questionable assumption that went unconfirmed in a recent French report (8) that gave no evidence for reduced exposure to RCS in the French construction sector during the last decade. This indicates that even the very high number of 440 000 attributable cancer registrations is underestimated by the report, to which, in addition, should be added the number of chronic obstructive pulmonary disease and kidney disease cases, for which a much shorter latency period until risk drops is likely. The concepts “maximum tolerable risk” and “acceptable risk” have been developed for exposure to genotoxic carcinogens, for which no exposure level could be considered safe. A life-time extra number of four cases per 1000 exposed workers over a 40-year working life has been suggested as a maximum tolerable risk, and four cases per 100 000 exposed workers as an acceptable risk, both in Germany and in the Netherlands (9, 10). These figures can be transformed to the individual life-time risk of contracting cancer from the exposure as 4/1000, corresponding to 0.4% individual risk. While these limits are not absolute and can be discussed, it is of interest to apply them to the case of RCS. The risk associated with an OEL of 0.1 mg/m³ for RCS is associated with risks far higher than “maximum tolerable”, ie, 0,4%. The US OSHA estimated that exposing 1000 workers for 45 years at 0.1 mg/m3 would result in 33 extra lung cancer deaths as life-time risk, corresponding to an individual risk of 3.3% (6), exceeding the maximum tolerable risk nearly 10-fold. Since the EU Directive concerns cancer, the report did not consider other health effects, which is necessary for a general risk assessment. The US OSHA estimated there would be another 85 deaths from non-malignant lung disease (8.5%) and, roughly estimated, 39 deaths from renal disease (3.9%) that should be added to this toll. This adds up to an individual excess death risk of 15%, which by far clearly exceeds what is generally seen as the maximum tolerable risk of 0.4%! Still, this is a conservative estimate, which includes neither excess deaths from myocardial infarction that occur from 0.025 mg/m³ and up (11) nor excess autoimmune disease, eg, rheumatoid arthritis and other autoimmune diseases (12, 13). In support of Johanson & Tinnerberg (1), we argue that the lifetime excess death risk for silica-exposed workers is totally incompatible with fundamental workers’ rights of health and safety. This aspect, which must be safeguarded by the OSH society, will be even more important when working life is prolonged and when exposure conditions may be more diverse, ie, workers with high exposure and excessive risk may be too few to impact the disease burden in society but in that group the burden may still be extreme. In our view, the assumption of 99% compliance is unrealistic and it is necessary to lower the OEL. In addition, leaving the BOELV at 0.1 mg/m3 means this will continue for the future, a silent epidemic that is deeply unethical to ignore. References 1. Johanson G, Tinnerberg H. Binding occupational exposure limits for carcinogens in the EU - good or bad? Scand J Work Environ Health 2019 May;45(3):213–4. https://doi.org/10.5271/sjweh.3825. 2. Directive EU. (EU) 2019/130 of the European parliament and of the council of 16 January 2019. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32019L0130. 3. Cherrie JW. Binding occupational exposure limits for carcinogens in the EU - necessary but not sufficient to reduce risk. Scand J Work Environ Health 2019 Jul;45(4):423–4. https://doi.org/10.5271/sjweh.3836. 4. SCOEL. SCOEL’s involvement in setting Occupational Exposure Limits: Webpage accessed 2019-10-23. Available from: http://ec.europa.eu/social/BlobServlet?docId=3879&langId=en. 5. SCOEL. Recommendation from the Scientific Committee on Occupational Exposure Limits for Silica, Crystalline (respirable dust). SCOEL/SUM/94. November 2003. Available from: http://ec.europa.eu/social/BlobServlet?docId=3803&langId=en. 6. OSHA. Occupational Exposure to Respriable Crystalline Silica. Federal Register/vol 81, no 58/Friday, March 25, 2016/ Rules and Regulations. Occupational Safety and Health, Department of Labour, Administration (Docket No. OSHA-2010-0034) RIN 1218/AB70. OSHA 2016. Available from: https://www.govinfo.gov/content/pkg/FR-2016-03-25/pdf/2016-04800.pdf. 7. Cherrie JW, Gorman Ng M, Searl A, Shafrir A, van Tongeren M et al. Health, socio-economic and environmental aspects of possible amendments to the EU Directive on the protection of workers from the risks related to exposure to carcinogens and mutagens at work. Respirable crystalline silica. IOM Research Project: P937/8, May 2011. Available from: https://ec.europa.eu/social/BlobServlet?docId=10161&langId=en). 8. ANSES. Agence nationale de sécurité sanitaire alimentation, environnement, et du travail (ANSES). Dangers, expositions et risques relatifs à la silice cristalline. Avis de l’Anses Raports d’expertise collective (Saisine no 2015-SA-0236). Avril 2019. Èdition scientifique. ANSES English summary: Available from: https://www.anses.fr/en/content/exposure-crystalline-silica-poses-high-risks-worker-health 9. Federal Institute for Occupational safety and Health. The risk-based concept for carcinogenic substances developed by the Committee for Hazardous Substances. Federal Institute for Occupational safety and Health (BAuA), Dortmund, Germany, 2013. Available from: www.baua.de/dok/3581564 10. Health Council of the Netherlands. Guidelines for the calculation of occupational cancer risk values. Health Council of the Netherlands, 2012. Available from: www

OBJECTIVES: This discussion paper aims to provide recommendations for the development of occupational exposure limits (OEL) for psychosocial hazards. By comparing the characteristics of non-psychosocial and psychosocial hazards at work as well as approaches to derive occupational limit values for both types of hazards, the paper summarizes conceptual requirements and methodological perspectives for OEL in psychosocial risk assessment. METHODS: An interdisciplinary working group comprised of academics, active practitioners in company occupational health management and members of national committees advising policymakers conducted regular face-to-face and online meetings between October 2022 and August 2024 to draft a narrative review and discussion of the current state of research on OEL for psychosocial hazards within the fields of psychology, sociology and medicine. RESULTS: The current field of research is in its early stages, indicated by individual efforts and a lack of joint decision-making. Existing approaches towards OEL focus on disease-level outcomes (eg, burnout, depression), which limits their effectiveness for primary prevention and identifying early warning signs of harm. CONCLUSION: Based on the limited existing literature, we recommend (i) the use of outcome variables that enable detection of early stages of adverse effects aligned with the no-observed adverse effect level (NOAEL) and the lowest-observed-adverse effect level (LOAEL), (ii) standardization and harmonization of hitherto independent assessments of identical hazards, and (iii) policy-level actions to foster collaborative decision-making based on the full spectrum of scientific evidence.

Indoor air quality (IAQ) standards and guidelines for volatile organic compounds (VOCs) have been stipulated by various national and international agencies. The main purpose of this paper is to establish an overview of indoor VOCs regarding their impacts on human health. Herein, 13 VOCs were designated as indoor air pollutants (IAPs) in the IAQ standards and guidelines. They were further grouped into four types: nonchlorinated aromatic compounds, chlorinated aromatic compounds, chlorinated aliphatic compounds and aldehydes. For this purpose, the present study discusses the criteria for designating VOCs, and summarizes their main sources in indoor environments. Because the occupational exposure limit (OEL) in workplaces has often used as a preliminary basis for establishing acceptable health-based IAQ guidelines in buildings and residences, this paper thus reviews the OEL values, especially in the American Conference of Governmental Industrial Hygienists (ACGIH)-threshold limit value (TLV). In addition, this paper also reviews the information about the classification of carcinogenicity in human by the international agencies for these VOCs. It shows that human tissues, including kidney, liver, leukemia, nasal cavity, paranasal sinus, liver and bile duct, could be more involved in the development of cancers or tumors when people are exposed to these VOCs through inhalation route in buildings over a long period of time.

N,N-Dimethylacetamide (DMAC), which is widely used as an industrial solvent, can be absorbed via the respiratory tract and skin of humans exposed to it. Hepatotoxicity is a main health risk of DMAC exposure in humans, and the relevant cases and epidemiological studies are reviewed herein. No hepatotoxicity was identified in workers exposed to ~3 ppm DMAC, and among workers exposed to >9 ppm DMAC the DMAC exposure was not observed to contribute significantly to liver damage. However, a case of liver damage was identified in which the calculated 8-hour weighted average was 12.8 mg/m3 (3.6 ppm). The skin absorption notation for DMAC is indicated based on human volunteer studies. The evidence regarding DMAC’s potential carcinogenicity in humans is not sufficient, and our literature search identified no report of DMAC as a reproductive toxicant in humans. Further case reports and epidemiological studies are necessary to determine the acceptable DMAC exposure limit for workers and thus protect them from DMAC’s toxicity.

[...]the authors cite data for respirable crystalline silica where exposure to 0.1 mg/m3 over a working career of 45-years would result in >1% of those exposed dying from work-related lung cancer, non-malignant respiratory disease, or kidney disease. The SHEcan project also predicted that around 230 000 people will die from lung cancer from workplace exposure to diesel engine exhaust particulate. [...]for diesel exhaust particulate the BOELV might need to be around 0.05 mg/m3 as REC to allow employers to comply, based on typical measurements in industry (7), but this limit would do little to reduce the predicted death toll from occupational exposure to diesel exhaust particulate.

Several recent reports indicate health hazards for workers with below occupational limit exposure to benzene (BZ). Our updated review indicates that such low exposures induced traditional as well as novel toxicity/genotoxicity, e.g., increased mitochondria copy numbers, prolongation of telomeres, impairment of DNA damage repair response (DDRR), perturbations of expression in non-coding RNAs, and epigenetic changes. These abnormalities were associated with alterations of gene expression and cellular signaling pathways which affected hematopoietic cell development, expression of apoptosis, autophagy, etc. The overarching mechanisms for induction of health risk are impaired DDRR, inhibition of tumor suppressor genes, and changes of MDM2–p53 axis activities that contribute to perturbed control for cancer pathways. Evaluation of the unusual dose–responses to BZ exposure indicates cellular over-compensation and reprogramming to overcome toxicity and to promote survival. However, these abnormal mechanisms also promote the induction of leukemia. Further investigations indicate that the current exposure limits for workers to BZ are unacceptable. Based on these studies, the new exposure limits should be less than 0.07 ppm rather than the current 1 ppm. This review also emphasizes the need to conduct appropriate bioassays, and to provide more reliable decisions on health hazards as well as on exposure limits for workers. In addition, it is important to use scientific data to provide significantly improved risk assessment, i.e., shifting from a population- to an individual-based risk assessment.

Exposure to airborne substances such as gases, vapours, and particles remains a relevant health risk in many workplaces. A current topic and cause for discussion is the investigation of the health effects of particles containing zinc oxide (ZnO). Among other data, those collected from our study on human exposure data of ZnO in 2018 prompted the National Research Centre for the Working Environment 2021 to formulate a new, sharply lowered proposed occupational exposure limit (OEL) for zinc in workplaces. Since the publication of the Danish report, further studies have been conducted with ZnO. In the following text, all arguments for deriving this new limit value for zinc from the report are discussed, extended with the more recent data since 2018. It should be noted that especially the application of time extrapolation factors needs further discussion and harmonization between regulatory authorities. From our point of view, the data situation can justify a higher OEL for zinc than that proposed by the Danish National Research Centre for the Working Environment.

The study investigated the exposure of spray painters to organic solvents, toxic metals, and hexavalent chromium over 21 working days in 2017. The results found these concentrations of 12 VOCs to be below the short-term exposure limit (STEL) established by the US Occupational Safety and Health Administration (OSHA). The mass concentration of total particulate matter (PM) exposure to workers was 20.01 ± 10.78 mg/m 3 , which exceeds OSHA’s permissible exposure level of 15 mg/m 3 . The mean concentration of the total metals for all particle sizes was 109.1 ± 12.0 μg/m 3 , and those for lead (496,017.0 ng/m 3 ) and iron (252,123.8 ng/m 3 ) were the highest of metal elements. Significantly, the mean concentrations of Pb and As exceeded OSHA’s permissible exposure limits (PELs) of 0.05 and 0.01 mg/m 3 , respectively. The total hexavalent chromium concentration was 1163.01 ng/m 3 , and the individual particle sizes (PM 1−2.5 , PM 1 , and PM 0.25 ) were strongly and positively correlated with the Cr(VI) concentrations for PM 2.5 . The study determined that approximately 56.14% of the hexavalent chromium inhaled during the spray-painting process was deposited in the upper respiratory system of the head airway region, followed by the alveolar and tracheobronchial regions, with fractions of 11.93 and 0.05%, respectively. Although the mean ratio of hexavalent chromium to total chromium was only 3.6% for all particle sizes, the cancer risk of the total particles in Cr(VI) (1.6 × 10 −3 ) exceeded the acceptable risk value (10 −6 ). The cancer risks of As and Cr(VI) associated with quasi-ultrafine particles, PM 0.5–1 , PM 1–2.5 , and PM > 2.5 , also exceeded 10 −6 . Comparison of the carcinogenicity risk of VOCs and metals suggests that the adverse health effect of inhaled particles on spray-painting workers is more serious than that from VOC exposure.

Approximately 11 million people work as welders worldwide and an additional 110 million are exposed to welding fumes at work (1). Several countries have an occupational exposure limit (OEL) for welding fumes of 5 mg/m3 (1,2) and similar OEL for respirable dust (2). Given the accumulating evidence on serious health effects from welding fumes <5 mg/m3, adequate worker protection including a more stringent health based OEL is an urgent issue. We therefore welcome that the European Commission has assigned the European Chemical Agency (ECHA) to propose an OEL for welding fumes at the EU level, pursuant to the Carcinogens and Mutagens Directive (CAD). It should be noted that welding fumes - besides having a very complex and variable composition - are process generated and do not fall under the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) regulation. In the following, we present some of the key issues when setting an OEL for welding fumes.

This study was aimed to investigate the potential harmful element (PHE) concentrations in coal dust and evaluate the human risk assessment and health effects near coal mining areas. For this purpose, dust samples were collected near various coal mines in Cherat, Pakistan, and analyzed for the PHE concentrations. Determined PHE concentrations were evaluated for the health risk assessment. Results revealed that ingestion was the major pathway as compared to others for PHE exposure. Individual chronic daily intake (CDI) of PHEs was higher than their respective permissible exposure limits set for oral exposure routes by the Agency for Toxic Substances and Disease Registry (ATSDR). Chronic risk or health index (HI) values were observed < 1 for all PHEs and in the order of Pb > Cr > Cd > Ni > Cu > Co > Zn. Higher HI values of Pb, Cr, and Cd could attribute to various chronic health problems as observed during the medical examination survey of this study. Cancer risk (CR) values for this study were observed within the US Environmental Protection Agency (EPA) limits. However, if current practices continued, the PHEs will cross these limits in a near future. Therefore, this study strongly recommends the provision of safety measures, rules, and regulation to avoid health hazards in the future.