The Role of IARC in Causation of Occupational Diseases: Case Study of the Carcinogenic Evaluation of Crystalline Silica

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The importance of causation of occupational diseases and the role of the International Agency for Research on Cancer (IARC) are discussed in this chapter. As a case study, the process by which silica dust was judged a known human carcinogen by IARC is reviewed. Silicosis is a chronic occupational lung disease known to be caused by inhaling crystalline silica, and the pulmonary cancer risk after the diagnosis of silicosis is a part of the IARC review of evidence. Laboratory animal evidence and mechanistic findings supporting IARC evaluation are also described. There remains a need to explore the association between silica exposure and other nonlung tumors, especially gastrointestinal cancers. The Occupational Safety and Health Administration (OSHA) developed a new regulatory standard that lowered the permissible exposure to 50ug/m3 in 2016. OSHA labeled silica as a known human carcinogen because of the IARC assessment. Occupational medicine leaders need to address several current silica dust problems such as silicosis/coal workers pneumoconiosis among coal miners, acute silicosis and auto-immune diseases among countertop workers, and intervention programs to lower silico-tuberculosis among South African miners. Future research studies need good silica dust monitoring estimates and high-quality industrial hygiene samples to evaluate the associations between silica exposure and many diverse diseases.