Annals of Occupational and Environmental Medicine

The Korean Society of Occupational & Environmental Medicine (대한직업환경의학회)
권호 표지

Occupational Cancer Update

직업성 암의 최신 지견

  • An, Yeon-Soon (Department of Occupational Medicine, Dongguk University Ilsan Hospital)
  • 안연순 (동국대학교 일산병원 산업의학과)
  • Published : 2011.09.30
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Abstract

This article reviews newly available knowledge regarding occupational cancer based on an assessment of International Agency for Research on Cancer (IARC) Monograph program from 2006 to 2010. The IARC reviewed the agents to evaluate the carcinogenicity in humans according to their priority. During the last five years, the IARC has reviewed many kinds of agents, including all of the Group 1 carcinogenic agents. Agents belonging to groups other than Group 1 were also reviewed. A few agents, such as shiftwork and firefighting, were reviewed for the first time after introducing the IARC Monograph Program. Most of the reassessed Group 1 agents were reaffirmed, showing that there was sufficient evidence to prove their carcinogenicity to human beings. However, some carcinogens were correlated to the new cancer site, since it was deemed that sufficient evidence was present. For example, larynx and ovary cancer deemed to have sufficient evidence of carciongenicity relating to asbestos exposure, joining lung cancer and mesothelioma. Some agents, such as benzo(a)pyrene, ortho-toluidine, 1,3-butadiene, and others belonging to Group 2A were upgraded to Group 1 based on newly identified epidemiologic findings, along with sufficient animal and mechanistic evidence. Benzo(a)pyrene and benzidine-based dyes were classified as human carcinogens based on sufficient animal and pervasive mechanistic evidence. This new data shows that not only chemical agents but also working conditions, such as stress and shiftwork were found to apply to human carcinogenicity. The IARC listed these agents in order to prioritize their review regarding their carcinogenicity to humans. There is a great need to study these newly emerging agents suspected to relate human carcinogenicity, and deem they are worthy of notice.

이 종설에서는 최근 5년 동안 IARC가 검토한 직업성 발암인자 중 발암성에 대한 분류등급이나 동일 분류등급 이라도 표적장기에 대한 발암성의 증거가 변화된 인자 위주로 변화된 내용을 기술하였다. 또, 일주기 교란을 동반한 교대근무, 소방관, 카본블랙 등 기존에 검토되지 않았던 인자들과 암 발생과의 관계를 소개하였다. 주요 내용은 다음과 같다. 생물학적 인자 중 C형간염은 비호지킨림프종 발생에 충분한 증거가 있고, B형간염은 제한적 증거가 있다고 하였다. 석면의 경우 충분한 발암성의 증거가 있는 암에 후두암과 난소암을 추가하였다. 신발 생산 및 수선 공정을 삭제하고, 대신 원인 인자인 가죽분진이 비강 및 부비강암을 일으키는 충분한 증거가 있다고 하였다. o-toluidine과 벤지딘계 염료를 Group 2A에서 Group 1으로 조정하였는데 벤지딘계 염료는 벤지딘으로 대사되는 염료에 한정하였다. 도장작업의 경우 발암증거가 충분한 표적장기에 방광암을 추가하였고, 도장공 어머니의 주산기 노출이 어린이 백혈병 발생에 제한적인 증거가 있다고 하였다. 비전리 방사선 중 100-400 nm 파장의 자외선(UVA, UVB, UVC)을 Group 1으로 분류하고 발암성이 충분한 표적장기는 피부 흑색종이라고 하였다. 또, 맥락막 흑색종이 발암 증거가 충분한 표적장기인데, 직업적으로 용접공에서 맥락막 흑색종이 증가한다고 하였다. 일주기를 교란시키는 교대근무를 유방암을 일으키는 제한적 증거가 있는 Group 2A로 분류하였다. 소방관을 Group 2B로 분류하고 비호지킨림프종, 고환암, 전립선암에 대한 제한적 증거가 있다고 하였다. 2010-2014년에 새로이 검토해야할 우선순위로 탄소계 나노입자, 라디오주파수 전자기장 등 새로운 산업과 관련된 인자를 선정하였고, 좌식작업, 스트레스 등의 위험요인도 우선순위 검토에 포함하여 머지않아 이들 인자의 발암성에 대한 증거가 정리될 것으로 보인다. 우리나라는 유해물질에 노출되는 전 근로자를 대상으로 하는 특수건강진단, 전 국민 암 감시체계인 중앙 암등록 등의 제도가 있어 직업성 암을 연구하기에 세계적으로도 좋은 환경을 가진 것으로 판단되지만 이 분야의 연구는 매우 일천하다. 향후 직업성 암 관련 연구들이 활성화되어 우리나라 근로자를 대상으로 수행된 연구가 국제적으로 직업성 암의 원인을 밝히고 많은 미제를 해결하는데 기여함과 더불어 업무상 질병 판정의 근거자료로의 활용 등 발암물질 노출 근로자 관리에 활용되어야 할 것이다.

Keywords

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