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S10-3 Establishing national carcinogen exposure (CAREX) programs in latin america and the caribbean: achievements and future directions
  1. Julieta Rodriguez Guzman1,
  2. Paul A Demers2,3,4,
  3. Manisha Pahwa2,
  4. Cheryl E Peters3,5,6,
  5. Calvin B Ge3,7
  1. 1Sustainable Development and Health Equity, Pan American Health Organisation/Americas Regional Office of the World Health Organisation, Washington, USA
  2. 2Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Canada
  3. 3CAREX Canada, Simon Fraser University, Burnaby, Canada
  4. 4Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
  5. 5Carleton University, Ottawa, Canada
  6. 6Institut National De La Recherche Scientifique-Institut Armand-Frappier, Universite Du Quebec, Montreal, Canada
  7. 7Universiteit Utrecht, Utrecht, The Netherlands


Objective 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. This project aimed to build capacity for CARcinogen EXposure (CAREX) programs in LAC.

Methods The CAREX method, originally developed in the European Union for estimating exposure to occupational carcinogens, has been used and modified in some Central American countries and Canada. Generally, the approach combines 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 to discuss methodological approaches, issues unique to LAC, and research opportunities. Certain individual countries subsequently developed CAREX programs by holding consultations to identify priority carcinogens and adapting proportion of exposure values from existing CAREX programs.

Results CAREX programs in LAC have been established in Costa Rica, Nicaragua, Panama, Guyana, Colombia, 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. In Peru, exposure estimates were based on data from LAC and Europe with the involvement of experts from 43 institutions. Preliminary results from Chile have also been produced using a slight variation of this approach.

Conclusions This project demonstrates that the CAREX methodology can be readily adapted to different countries, economies, and priority carcinogens. CAREX exposure estimates are integral for informing primary prevention activities and improving estimates of the global occupational cancer burden.

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