Burden of cancer attributable to six occupational exposures in the Netherlands, 2021: a health impact assessment study

Our plain-English summary of Burden of cancer attributable to six occupational exposures in the Netherlands, 2021: a health impact assessment study, by T.O.E. De Crom, I. Eekhout, E. Lebbink, et al (BMJ Public Health, 2026).

The study

• Authors: T.O.E. De Crom, I. Eekhout, E. Lebbink, C. Lanting, S. Peters, A. Pronk, C. Ge
• Journal: BMJ Public Health
• Published: 2026;4(3):e004797
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Although numerous occupational exposures are known to be carcinogenic, the extent to which they contribute to the cancer burden in the Netherlands remains unclear. We estimated the annual cancer burden attributable to six occupational carcinogens in the Netherlands for 2021.

Methods: We selected occupational exposures and related cancer sites classified as group 1 human carcinogens by the International Agency for Research on Cancer, focusing on the six with the highest cancer burden in a UK study. These exposures include asbestos, respirable crystalline silica, diesel engine exhaust, solar ultraviolet (UV) radiation and painter- and welder-related occupational exposures. Population attributable fractions (PAFs), representing the proportion of cancer cases attributable to these exposures, were calculated using Levin's equation. Input data included the proportion of the population exposed during the relevant exposure period (1971-2011), derived from data from Statistics Netherlands; and relative risks for each exposure-cancer site combination, obtained from existing literature. Cancer incidence data in 2021, obtained from the Netherlands Cancer Registry, were multiplied by the PAFs to estimate the total numbers of attributable cases.

Results: In 2021, an estimated 3932 cancer cases (3.1% of all cases) were attributable to the six occupational exposures, with a greater proportion in men (5.4%) than in women (0.5%). Solar UV radiation contributed to the most cases (1720 squamous cell carcinomas of the skin), followed by asbestos (925 lung cancers, 463 mesotheliomas, 10 ovarian cancers, 9 laryngeal cancers), painter-related exposures (156 lung cancers, 83 bladder cancers), welder-related exposures (201 lung cancers, 11 ocular melanomas), respirable crystalline silica (233 lung cancers) and diesel engine exhaust (187 lung cancers).

Conclusions: Occupational exposures contribute to the cancer burden in the Netherlands, especially among men. Solar UV radiation and asbestos result in the highest numbers of attributable cancers. Targeted exposure control could substantially reduce this preventable cancer burden.

Copyright © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. Published by BMJ Group.

In plain English

This health impact assessment estimated how many cancers diagnosed in the Netherlands in 2021 could be attributed to six workplace exposures, including asbestos. Rather than following individual workers, the authors combined national employment data for 1971 to 2011, job-exposure matrices, relative risks from earlier studies and 2021 cancer registry counts. For mesothelioma, they assigned fixed occupational shares (85% of cases in men, 60% in women) taken from earlier work. Of 12 780 902 people of working age in that period and alive in 2021, 7.7% were estimated to have had occupational asbestos exposure, 1.4% at high levels. Of 126 717 new invasive cancers in 2021, not counting basal cell skin cancer, an estimated 3932 (3.1%) were attributed to the six exposures: 3616 in men (5.4%, though one passage prints 5.5%) and 316 in women (0.5%). Asbestos accounted for an estimated 1406 cases, including 925 lung cancers (6.5% of all lung cancers) and 463 mesotheliomas (81% of all mesotheliomas), plus 10 ovarian and 9 laryngeal cancers. Solar UV radiation accounted for the most cases, 1720. The authors called their total almost certainly an underestimate.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Health impact assessment (modelling study). Population attributable fractions were calculated with Levin's equation from estimated exposure prevalence and relative risks taken from existing literature, then applied to 2021 cancer registry counts. No individuals were followed.
• Who was studied: Residents of the Netherlands who were of working age (15 years or older) at some point during 1971 to 2011 and still alive in 2021, estimated at 12 780 902 people. The 126 717 new cancer cases diagnosed in this population in 2021 came from the Netherlands Cancer Registry.
• Exposure: Six occupational exposures: asbestos, respirable crystalline silica, diesel engine exhaust, solar UV radiation, and painter- and welder-related exposures. Asbestos exposure was assigned to occupations with a job-exposure matrix as none, low or high; no fiber types are named. For mesothelioma, the authors directly assigned the share of cases attributed to occupational exposure: 85% in men and 60% in women.
• Main results:
  • Prevalence: an estimated 7.7% of the population at risk had occupational asbestos exposure, including 1.4% at high levels.
  • All six exposures together: of 126 717 new cancer cases in 2021 (67 093 in men, 59 624 in women), an estimated 3932 (3.1%) were attributable. This total covers all invasive cancers excluding basal cell carcinoma.
  • By sex: an estimated 3616 attributable cases in men (5.4%) and 316 in women (0.5%). The Results section prints 5.5% for men, while the abstract and Discussion give 5.4%, which matches 3616 out of 67 093.
  • Asbestos total: an estimated 1406 attributable cancer cases, a population attributable fraction of 1.1% of all cancers.
  • Asbestos, lung cancer and mesothelioma: an estimated 925 lung cancers (6.5% of all lung cancers) and 463 mesotheliomas (81% of all mesotheliomas).
  • Asbestos, ovarian and laryngeal cancer: an estimated 10 ovarian cancers (0.7% of ovarian cancers) and 9 laryngeal cancers (1.3% of all laryngeal cancers).
  • Solar UV radiation: the most attributable cases, 1720 (1.4% of all cancers), all cutaneous squamous cell carcinomas.
  • Painter-related exposures: an estimated 156 lung cancers (1.1% of all lung cancers) and 83 urinary bladder cancers (1.2%).
  • Welder-related exposures: an estimated 201 lung cancers (1.4% of all lung cancers) and 11 ocular melanomas (5.4% of all ocular melanomas).
  • Respirable crystalline silica and diesel engine exhaust: an estimated 233 and 187 lung cancers respectively, each 0.2% of all cancers.
  • By age: attributable cases and fractions generally rose with age, with the highest burden among people aged 70 to 79.
• The authors' conclusion: The authors concluded that about 3932 cancer cases in the Netherlands in 2021 were attributable to the six occupational exposures. They found the burden higher among men than women, with the largest contributions from solar UV radiation and asbestos.
• Limitations the authors state:
  • The study included only selected IARC group 1 exposure and cancer combinations, so the total occupational cancer burden is almost certainly underestimated.
  • Some double counting of exposed workers may remain despite restricting new hires to those aged 40 or younger who had been in the job for 12 to 24 months.
  • The 10 to 50 year latency window was an assumption; a different window would change the estimates.
  • Job duration was occupation-specific but not time-specific, which may have misclassified cumulative exposure.
  • Converting occupation codes between classification versions required allocating some codes that could map to several categories, which may have introduced misclassification.
  • The solar UV burden is likely underestimated because non-melanoma skin cancers are under-recorded, and melanoma was not included.

Topics

Medical terms in this study, explained in our Lexicon: Occupational Exposure, Carcinogenic, Crystalline, Population Attributable Fraction (PAF), Relative Risk, Cancer Registry, Squamous Cell Carcinoma, Lung Cancer.

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