<b>Bijsluiter</b>. De hyperlink naar het originele document werkt niet meer. Daarom laat Woogle de tekst zien die in dat document stond. Deze tekst kan vreemde foutieve woorden of zinnen bevatten en de opmaak kan verdwenen of veranderd zijn. Dit komt door het zwartlakken van vertrouwelijke informatie of doordat de tekst niet digitaal beschikbaar was en dus ingescand en vervolgens via OCR weer ingelezen is. Voor het originele document, neem contact op met de Woo-contactpersoon van het bestuursorgaan.<br><br>====================================================================== Pagina 1 ======================================================================

<pre>Cadmium and
inorganic cadmium
compounds
Health-based recommendation on occupational exposure limits
To: the State Secretary of Social Affairs en Employment
No. 2019/03, The Hague, March 20, 2019
                                                            2 2
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<pre> Contents                                                         Cadmium and inorganic cadmium compounds | page 2 of 14
 contents
      Samenvatting                                      3 03 Recommendation and conclusion by the Committee 9
                                                             3.1 Health-based recommended occupational exposure limit   9
      Executive summary                                5    3.2 Skin notation                                        10
                                                             3.3 Conclusions                                           11
 01 Scope                                               7
      1.1  Background                                  7    References                                                11
      1.2  Committee and procedure                     7
      1.3  Data                                        7
 02 Previous evaluations                               7
      2.1  Recommendation by the SCOEL (2010)          8
      2.2  Advisory letter of the Health Council (2013) 8
      2.3  Recommendation by the SCOEL (2017)          9
1       Health Council of the Netherlands | No. 2019/03                                    2                             3
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<pre> Samenvatting                                                                                  Cadmium and inorganic cadmium compounds | page 3 of 14
 samenvatting                                                                                           gram (μg) cadmium per gram creatinine in de
                                                                                                        urine.
                                                                                                        Daarnaast adviseerde de SCOEL om specifiek
 In 2013 heeft de Gezondheidsraad een advies          Gezondheidsrisico’s cadmium en                    ter bescherming tegen de nadelige effecten op
 uitgebracht over beroepsmatige blootstelling         anorganische cadmiumverbindingen                  de longen, ook een gezondheidskundige
 aan cadmium en anorganische cadmium-                 Cadmium en anorganische cadmium-                  advieswaarde voor beroepsmatige blootstelling
 verbindingen. In dat advies heeft de Commissie       verbindingen zijn schadelijk voor de gezondheid.  in de lucht in acht te nemen. De SCOEL ging
 Gezondheid en beroepsmatige blootstelling aan        Mensen die op hun werk worden blootgesteld        daarbij uit van de respirabele fractie, dat wil
 stoffen (GBBS) toen aangegeven zich aan te           aan cadmium in de lucht kunnen daar ziek van      zeggen het deel van de in lucht aanwezige
 sluiten bij de aanbevelingen die de Scientific       worden. Na inademing hoopt de stof zich op in     deeltjes cadmium dat na inademing kan
 Committee on Occupational Exposure Limits            het lichaam en beschadigt daar onder andere       doordringen tot in de longblaasjes. De gezond-
 (SCOEL) eerder in 2010 heeft gedaan. In 2017         nieren en botten. Ook het eten van met            heidskundige advieswaarde die de SCOEL
 heeft de SCOEL opnieuw een advieswaarde              cadmium verontreinigd voedsel en roken draagt     daarvoor afleidde is 4 microgram (μg) cadmium
 afgeleid. De Commissie GBBS heeft die nieuwe         bij aan de blootstelling. Daarnaast kan het       per kubieke meter (m3) lucht. Het is de bedoe-
 advieswaarde beoordeeld en komt tot de               inademen van cadmium op de werkplek leiden        ling dat beide advieswaarden in combinatie met
 conclusie dat deze wetenschappelijk                  tot longemfyseem en mogelijk tot longkanker.      elkaar gebruikt worden.
 onvoldoende onderbouwd is. Ze adviseert de                                                             In 2013 publiceerde de Gezondheidsraad een
 staatssecretaris van SZW om uit te blijven gaan      Advieswaarden SCOEL 2010                          advies over beroepsmatige blootstelling aan
 van van de Gezondheidsraad.                          In 2010 stelde de SCOEL voor om een biolo-        cadmium en anorganische cadmium-
                                                      gische limietwaarde te hanteren om te besch-      verbindingen. De Commissie GBBS van de
                                                      ermen tegen nierschade als gevolg van het         Gezondheidsraad concludeerde dat de aanbev-
                                                      cadmium dat mensen binnen kunnen krijgen          olen advieswaarden van de SCOEL weten-
                                                      (zowel beroepsmatig als niet-beroepsmatig). De    schappelijk voldoende onderbouwd zijn.
                                                      SCOEL adviseerde een waarde van 2 micro-
2        Health Council of the Netherlands | No. 2019/03                                                               2                                4
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<pre> Samenvatting                                                                                  Cadmium and inorganic cadmium compounds | page 4 of 14
 Advieswaarde SCOEL 2017                             Zij komt tot de conclusie dat die wetenschap-      commissie zich wel vinden in de conclusie van
 In 2017 heeft de SCOEL opnieuw een advies           pelijk onvoldoende onderbouwd is. De onder-        de SCOEL dat een huidnotatie niet nodig is.
 uitgebracht over cadmium en anorganische            zoeken waar de SCOEL de nieuwe waarde op
 cadmiumverbindingen. In dit advies stelt de         baseert zijn onderling niet goed te vergelijken en Advies aan de staatssecretaris
 SCOEL een gezondheidskundige advieswaarde           kennen methodologische beperkingen. Zo is          De commissie adviseert om het eerdere advies
 voor van 1 μg cadmium per m3 lucht. Die             nierschade op verschillende manieren               van de Gezondheidsraad aan te houden, dat
 waarde geldt voor de inhaleerbare fractie, dat      gedefinieerd, is het in sommige onderzoeken        uitgaat van een biologische advieswaarde in de
 wil zeggen het geheel van het in lucht              niet duidelijk welke stoffractie is gemeten en is  urine van 2 μg cadmium/g creatinine in combi-
 aanwezige cadmium dat kan worden ingeademd          het aantal onderzochte deelnemers erg beperkt.     natie met een gezondheidskundige
 via mond en/of neus. Deze nieuwe waarde             De commissie benadrukt dat het eerdere advies      advieswaarde in de lucht van 4 μg cadmium/m3
 beschermt volgens de SCOEL ook tegen de             luidde om een biologische limietwaarde te          (respirabele fractie).
 nadelige effecten op de nieren en daardoor          gebruiken in combinatie met een advieswaarde
 hoeft deze niet in combinatie met de eerder         voor de concentratie in de lucht. Door die combi-
 voorgestelde biologische advieswaarde te            natie te adviseren wordt er rekening mee
 worden toegepast.                                   gehouden dat mensen ook buiten hun werk
 De SCOEL concludeert daarnaast dat een huid-        blootgesteld kunnen worden. Dit is van belang
 notatie niet nodig is.                              omdat cadmium zich ophoopt in het lichaam.
                                                     Het cadmium waar mensen in hun vrije tijd aan
 Beoordeling Commissie GBBS                          zijn blootgesteld is het lichaam nog niet uit als
 De Commissie GBBS van de Gezondheidsraad            ze weer naar hun werk gaan.
 heeft de nieuwe gezondheidskundige                  Volgens de commissie zijn er geen aanwijzingen
 advieswaarde van de SCOEL voor cadmium en           dat cadmium makkelijk kan worden opgenomen
 anorganische cadmiumverbindingen van 1 μg           via de huid en zo substantieel kan bijdragen aan
 cadmium/m3 (inhaleerbare fractie) beoordeeld.       de totale inwendige bloostelling. Daarom kan de
3       Health Council of the Netherlands | No. 2019/03                                                                2                               5
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<pre> Executive summary                                                                                 Cadmium and inorganic cadmium compounds | page 5 of 14
 executive summary                                                                                          by SCOEL is 4 microgram (μg) cadmium per
                                                                                                            cubic metre (m3) air. Both advisory values
                                                                                                            should be used combined.
 In 2013, the Health Council of the Netherlands         lates in the body and can subsequently damage,      In 2013, the Health Council of the Netherlands
 published an advisory report on occupational           amongst others, kidneys and bones. Also, the        published an advisory letter on occupational
 exposure to cadmium and inorganic cadmium              ingestion of cadmium-contaminated food and          exposure to cadmium and inorganic cadmium
 compounds. In this advisory report, the Dutch          smoking contributes to the exposure. In addition,   compounds. The Committee concluded that the
 Expert Committee on Occupational Safety                inhaling cadmium in the workplace can lead to       advisory values proposed by the SCOEL in 2010
 (DECOS) supported the recommendations that             emphysema and possibly lung cancer.                 were scientifically sufficiently substantiated.
 ware derived by the Scientific Committee on
 Occupational Exposure Limits (SCOEL) in 2010.          Advisory values of SCOEL 2010                       Advisory values of SCOEL 2017
 In 2017, the SCOEL derived a new advisory              The SCOEL recommended in 2010 to maintain           In 2017, the SCOEL again drafted an advisory
 value. The Committee has evaluated this value          a biological limit value to protect against kidney  report on cadmium and its inorganic
 and concludes that it is scientifically insufficiently damage due to exposure to cadmium (both             compounds. In this report, the SCOEL proposed
 substantiated. The Committee therefore recom-          occupational as well as non-occupational). The      a health-based advisory value of 1 μg cadmium
 mends the State Secretary to maintain the              SCOEL recommended a value of 2 microgram            per m3 air. That value relates to the inhalable
 previous advisory values.                              (μg) cadmium per gram creatinine in the urine.      fraction, which is the fraction of the substance in
                                                        In addition, the SCOEL recommended a health-        air that can be inhaled through the nose and/or
 Cadmium and inorganic cadmium                          based advisory value for occupational exposure      mouth. According to the SCOEL, this value
 compounds and health risks                             in air to specifically protect against adverse      protects also against adverse effects on the
 Cadmium and inorganic cadmium compounds                effects of the lung. The SCOEL based this value     kidneys and therefore does not have to be
 are harmful to health. Occupational exposure to        on the respirable fraction, which means the         applied in combination with the earlier proposed
 cadmium in the air can lead to adverse health          fraction of the substance in air that can pene-     biological limit value.
 effects. After inhalation, the substance accumu-       trate into the alveoli. The advisory value derived
4       Health Council of the Netherlands | No. 2019/03                                                                     2                                  6
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<pre> Executive summary                                                                                Cadmium and inorganic cadmium compounds | page 6 of 14
 In addition, the SCOEL concluded that a skin          The Committee notes that there is no indication
 notation is not warranted.                            for a substantial contribution of dermal uptake to
                                                       systemic exposure to cadmium, and therefore
 Evaluation of the DECOS                               supports the conclusion of the SCOEL that a
 The DECOS of the Health Council of the Nether-        skin notation is not warranted.
 lands has evaluated the new SCOEL health-
 based advisory value of 1 μg cadmium/m3 (inhal-       Recommendation to the State Secretary
 able fraction) for cadmium and inorganic              The Committee recommends to maintain the
 cadmium compounds. This Committee                     previous recommendation of the Health Council
 concludes that this value is scientifically insuffi-  of the Netherlands, which consists of a biolog-
 ciently substantiated. The studies used by the        ical limit value in the urine of 2 μg cadmium/g
 SCOEL for derivation are poorly mutually              creatinine combined with a health-based advi-
 comparable and have methodological limita-            sory value in air of 4 μg cadmium/m3 (respirable
 tions. For instance, damage to the kidneys is         fraction).
 defined in different ways, in several studies it is
 not clear which fraction of cadmium in air was
 measured, and the number of individuals exam-
 ined is very limited. The Committee emphasizes
 that the previous recommendation (a biological
 limit value in combination with an advisory value
 in air) takes into account that people can also be
 exposed non-occupationally to cadmium. This is
 important as cadmium accumulates in the body.
5         Health Council of the Netherlands | No. 2019/03                                                                2                             7
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<pre>                                                                                            Cadmium and inorganic cadmium compounds | page 7 of 14
 01 scope                                                                   1.2 Committee and procedure
                                                                            The present document contains the evaluation of the DECOS, hereafter
 1.1 Background                                                             called the Committee. The members of the Committee are listed at the
 At the request of the Minister of Social Affairs and Employment, the Dutch end of this report.
 Expert Committee on Occupational Safety (DECOS), a committee of the        In 2018, the president of the Health Council released a draft of the report
 Health Council of the Netherlands, performs scientific evaluations of the  for public review. No comments were received.
 toxicity and carcinogenicity of substances to which man can be exposed
 in the workplace. The purpose of these evaluations is to recommend on      1.3 Data
 health-based occupational exposure limits. These recommendations serve     The Committee’s recommendations are based on scientific data, which
 as a basis in setting legally binding limit values by the Minister.        are publicly available. The Committee evaluated the SCOEL opinion3
                                                                            adopted in February 2017, taking into account the references used and
 In this advisory report, a recommendation is made for cadmium and inor-    those used in the previous evaluations of the SCOEL (2010)2 and the
 ganic cadmium compounds. The Committee has previously evaluated the        Health Council (2013)1. No additional literature search was performed.
 consequences of exposure to cadmium and inorganic cadmium
 compounds.1 The Committee based that evaluation on an opinion
 published in 2010 by the Scientific Committee on Occupational Exposure     02 previous evaluations
 Limits (SCOEL).2 Recently, the SCOEL published another report on
 cadmium and inorganic cadmium compounds.3 In the present advisory          In this Chapter, the Committee provides a short summary of its previous
 report, the Committee evaluates the most recent SCOEL recommenda-          advisory letter and the previous evaluations of the SCOEL on cadmium
 tion.                                                                      and organic cadmium compounds.1-3 More details can be found in the
                                                                            respective documents.
6        Health Council of the Netherlands | No. 2019/03                                                             2                                  8
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<pre>                                                                                            Cadmium and inorganic cadmium compounds | page 8 of 14
 2.1 Recommendation by the SCOEL (2010)                                     and derived a recommended OEL of 4 μg Cd/m3 (respirable fraction). The
 For its recommendation in 20102, the SCOEL concluded that the kidney is    SCOEL indicated that a health-based OEL of 4 μg cadmium/m3 would also
the organ most susceptible to systemic cadmium toxicity following work-     prevent genotoxicity and potential carcinogenic effects caused by
place exposure. As cadmium has a very long half-life (10-20 years), the     cadmium exposure.
accumulated cadmium body burden rather than the cadmium concentra-          The necessity of a skin notation was not discussed by the SCOEL.
tion in the air determines the development of systemic effects. The
SCOEL considered cadmium levels in the urine (Cd-U) to be the best          2.2 Advisory letter of the Health Council (2013)
parameter for the quantification of the body burden, and the concentration  In an advisory letter1, the Committee has indicated that it supported the
of cadmium in ambient air as a measure for local exposure of the lungs.     approach that was described by the SCOEL in 20102 for deriving health-
The SCOEL used dose-response relationships between body burden and          based advisory values for cadmium and inorganic compounds. The
systemic effects derived from a large number of epidemiological. Based      Committee noted that the kidneys are the most critical target organs for
on these assessments, the SCOEL recommended a biological limit value        cadmium-induced toxicity, that is related to the systemic cadmium burden.
(BLV) of 2 μg cadmium/g creatinine in the urine to protect workers against  After evaluation of the available data, the Committee supported the BLV of
systemic cadmium toxicity, particularly effects on kidneys and bones.       2 μg cadmium/g creatinine in the urine that was recommended by SCOEL.
The SCOEL was of the opinion that this BLV provided insufficient protec-    The Committee also acknowledged that the BLV did not provide sufficient
tion against local toxicity resulting from long-term inhalation of cadmium- protection for local effects after exposure by inhalation, necessitating the
containing dust and vapours, which can lead to local lung effects such as   derivation of an advisory value in air. In line with SCOEL, the Committee
lung emphysema and potentially lung cancer. Therefore, the SCOEL            considered the reported lung function effects as the most suitable starting
recommended an additional occupational exposure limit (OEL) for the         point and concluded that a health-based recommended occupational
cadmium concentration in the ambient air. Existing epidemiological studies  exposure limit (HBROEL) of 4 μg cadmium/m3 was appropriate (Note: the
examining the relationship between cadmium and lung cancer were             Committee did not specify that this value related to the respirable fraction).
considered not suitable for derivation of a recommended OEL. The            The Committee confirmed that this HBROEL would also prevent genotoxic
SCOEL considered a study on factory workers exposed to cadmium and          and potential carcinogenic effects.
the effects on lung function4 suitable for quantitative hazard assessment,
7        Health Council of the Netherlands | No. 2019/03                                                               2                                 9
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<pre>                                                                                             Cadmium and inorganic cadmium compounds | page 9 of 14
 In this advisory letter, the necessity of a skin notation was not discussed In addition, the SCOEL stated that a skin notation is not indicated.
 by the Committee.
 2.3 Recommendation by the SCOEL (2017)                                      03 recommendation and
 In 2017, the European Commission published another recommendation
 by the SCOEL for cadmium and inorganic cadmium compounds.3 In this                    conclusion by the Committee
report, the SCOEL argued that the previously recommended OEL of 4 μg
cadmium/m3 (respirable fraction) does not sufficiently protect against       3.1 Health-based recommended occupational exposure limit
nephrotoxicity. The SCOEL referred to evaluations of the World Health        In 2010, the SCOEL has recommended a BLV in urine of 2 μg cadmium/g
Organisation (WHO)5 and the Bundesanstalt für Arbeitsschutz und Arbeit-      creatinine to protect workers against systemic cadmium toxicity, in combi-
smedizin (BAuA)6, that in turn, referred to a study by Thun et al. (1991)7.  nation with a recommended OEL in the air of 4 μg cadmium/m3 (respirable
 The SCOEL concluded that nephrotoxicity can occur at a cumulative (life-    fraction) to protect against local effects in the lungs.2 The Committee has
 time) lowest-effect exposure of 100-400 μg/m3 x years (which is equivalent  agreed with this recommendation, as was outlined in an advisory letter in
to a daily mean exposure of 2.5-10 μg/m3, for a 40-year working expo-        2013.1 Recently, the SCOEL has recommended an additional OEL in the
sure). The SCOEL also noted that the Ausschuss für Gefahrstoffe (AGS)        air that fundamentally differs from the previous one. This new recommen-
of BAuA6 deduced from the data of Thun et al. (1991)7 that after exposure    dation involves an advisory value of 1 μg cadmium/m3 (inhalable fraction)
 to 4 μg cadmium/m3 for 40 years, nephrotoxicity could arise in about 1% of  to protect against systemic effects, which is to be applied independently of
the exposed workers (the SCOEL does not specify which fraction this          the BLV. For its present recommendation, the Committee has only evalu-
value relates to). The SCOEL subsequently recommended a health-based         ated the most recent evaluation by the SCOEL, involving a value of 1 μg
OEL of 1 μg cadmium/m3 (inhalable fraction), and noted that this value is    cadmium/m3 (inhalable fraction).
 independent from biological monitoring.
                                                                             SCOEL has based its recommended OEL of 1 µg/m3 (inhalable fraction)
                                                                             on a publication of Thun et al. (1991)7, in which publications on adverse
                                                                             health effects after occupational exposure to cadmium are reviewed. With
8        Health Council of the Netherlands | No. 2019/03                                                                 2                               10
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<pre>                                                                                                      Cadmium and inorganic cadmium compounds | page 10 of 14
 respect to the most critical effect (i.e., the induction of kidney dysfunction), cadmium/m3 (respirable fraction) to protect against local effects in the
 Thun et al. (1991)7 summarises data on the prevalence of tubular                 lung. The Committee emphasizes that the previous recommendation
proteinuria and the exposure to cadmium from several occupational                 takes into account that people can also be non-occupationally exposed to
cohorts (Kjellstrom (1977)8; Jarup et al (1988)9; Elinder et al. (1985)10;        cadmium. This is important as cadmium accumulates in the body.
 Falck et al. (1983)11; Thun et al. (1989)12; Mason et al. (1988)13; Ellis et al.
 (1985)14). The recommended OEL of the SCOEL is related to both                   3.2 Skin notation
 cadmium fumes and cadmium dusts (generally with unknown particle size            The SCOEL concludes that for cadmium and its inorganic compounds, a
 distribution), as has been reported in the original publications. Since all      skin notation is not indicated.
 inhaled cadmium is assumed to contribute to the critical effect, the OEL         Limited data on skin absorption of cadmium are available. The only study
 recommended by the SCOEL relates to the inhalable fraction. The                  allowing quantitative assessment is the in vitro percutaneous absorption
 Committee notes that the studies underlying the OEL recommended by               study by Wester et al. (1992), using human skin.15 In this study, 0.5-0.6%
 the SCOEL show methodological differences and have several limitations.          of an environmental dose of 58*10-5 μg/cm2a was absorbed into plasma in
 They vary in the criteria used to define kidney dysfunction, have included       16 hours.
 a limited number of individuals (particularly at exposure levels below 500       The Committee considers a skin notation warranted when exposure of
 µg/m3*year; range 125-34) and prevalence cases (2-3/exposure category),          2,000 cm2 of skin (both hands and forearms) to the substance during one
 and for several studies it is not clear which fraction of cadmium dust was       hour could result in an absorbed amount exceeding 10% of the amount
 measured. The Committee is therefore of the opinion that the study of            that can be absorbed via the lungs, on exposure for eight hours to the
 Thun et al. (1991)7 is not a suitable starting point for deriving an advisory    occupational exposure limit.16 Considering the limited absorption reported
value.                                                                            by Wester et al. 1992)15, and considering the physico-chemical properties
                                                                                  of cadmium, the Committee concludes that a skin notation is not indicated.
The Committee therefore recommends to maintain the previously
recommended values, i.e., a health-based BLV in urine of 2 μg cadmium/g
creatinine to protect workers against systemic cadmium toxicity, in
combination with a health-based advisory value in the air of 4 μg                 a
                                                                                    11.6.10-2 μg/mL (116 ppb) x 5 µL
9        Health Council of the Netherlands | No. 2019/03                                                                      2                              11
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<pre>                                                                                            Cadmium and inorganic cadmium compounds | page 11 of 14
 3.3 Conclusions                                                              5
                                                                                 World Health Organisation. Air quality guidelines for Europe; second
 The Committee recommends the previously proposed a health-based                 edition. 2000; WHO Regional Publications, European Series, No. 91.
 biological limit value in urine of 2 μg cadmium/g creatinine, in combination 6
                                                                                 Ausschuss für Gefahrstoffe. Begründung zu ERB Cadmium in TRGS
 with a health-based advisory value in the air of 4 μg cadmium/m3 (respir-       910. AGS, Dortmund/Berlin, 2014.
 able fraction).                                                              7
                                                                                 Thun MJ, Elinder CG, Friberg L. Scientific basis for an occupational
 The Committee further concludes that a skin notation is not indicated.          standard for cadmium. Am J Ind Med 1991; 20(5): 629-42.
                                                                              8
                                                                                 Kjellstrom T, Evrin PE, Rahnster B. Dose-response analysis of
                                                                                 cadmium-induced tubular proteinuria: a study of urinary beta2-
           references                                                            microglobulin excretion among workers in a battery factory. Environ
                                                                                 Res 1977; 13(2): 303-17.
 1
    Health Council of the Netherlands. Advisory letter Cadmium and            9
                                                                                 Jarup L, Elinder CG, Spang G. Cumulative blood-cadmium and tubular
    inorganic cadmium compounds. The Hague, 2013; Publication no.                proteinuria: a dose-response relationship. Int Arch Occup Environ
    2013/14E.                                                                    Health 1988; 60(3): 223-9.
 2
    Scientific Committee on Occupational Exposure Limits.                     10
                                                                                 Elinder CG, Edling C, Lindberg E, Kagedal B, Vesterberg O. beta
    Recommendation from the Scientific Expert Group on Occupational              2-Microglobulinuria among workers previously exposed to cadmium:
    Exposure Limits for Cd and its inorganic compounds. 2010; SCOEL/             follow-up and dose-response analyses. Am J Ind Med 1985; 8(6):
    SUM/136G.                                                                    553-64.
 3
    Scientific Committee on Occupational Exposure Limits. Cadmium and         11
                                                                                 Falck FY, Jr., Fine LJ, Smith RG, McClatchey KD, Annesley T, England
    its inorganic compounds; Opinion from the Scientific Committee on            B, et al. Occupational cadmium exposure and renal status. Am J Ind
    Occupational Exposure Limits. 2017; SCOEL/OPIN/336.                          Med 1983; 4(4): 541-9.
 4
    Cortona G, Apostoli P, Toffoletto F, Baldasseroni A, Ghezzi I, Goggi E,   12
                                                                                 Thun MJ, Osorio AM, Schober S, Hannon WH, Lewis B, Halperin W.
    et al. Occupational exposure to cadmium and lung function. Editor:           Nephropathy in cadmium workers: assessment of risk from airborne
    Nordberg GF, Herber RFM and Alessio L. Cadmium in the Human                  occupational exposure to cadmium. Br J Ind Med 1989; 46(10): 689-97.
    Environment: Toxicity and Carcinogencity 1992: 205-10.
10        Health Council of the Netherlands | No. 2019/03                                                             2                               12
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<pre>                                                                          Cadmium and inorganic cadmium compounds | page 12 of 14
 13
    Mason HJ, Davison AG, Wright AL, Guthrie CJ, Fayers PM, Venables
    KM, et al. Relations between liver cadmium, cumulative exposure, and
    renal function in cadmium alloy workers. Br J Ind Med 1988; 45(12):
    793-802.
 14
    Ellis KJ, Cohn SH, Smith TJ. Cadmium inhalation exposure estimates:
    their significance with respect to kidney and liver cadmium burden. J
    Toxicol Environ Health 1985; 15(1): 173-87.
 15
    Wester RC, Maibach HI, Sedik L, Melendres J, DiZio S, Wade M. In
    vitro percutaneous absorption of cadmium from water and soil into
    human skin. Fundam Appl Toxicol 1992; 19(1): 1-5.
 16
    European Centre for Ecotoxicology and Toxicology of Chemicals.
    Strategy for assigning a ‘skin notation’. 1993; ECETOC Document No.
    31 (Revised).
11       Health Council of the Netherlands | No. 2019/03                                          2                             13
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<pre>                                                                                                                         Cadmium and inorganic cadmium compounds | page 13 of 14
 The Committee                                                                                         Consulted experts:
 •  F.G.M. Russel, Professor of Pharmacology and Toxicology, Radboud University Medical Center,        •  P.J. Boogaard, Professor of Environmental Health and Human Biomonitoring, Wageningen Univer-
    Nijmegen, chairman                                                                                    sity and Research Centre; and toxicologist, Shell International BV, The Hague
 •  R. Houba, Occupational Hygienist, Netherlands Expertise Centre for Occupational Respiratory        •  H. van Loveren, Professor of Immunotoxicology, Maastricht University, Maastricht
    Disorders, Utrecht                                                                                 •  I.M.C.M. Rietjens, Professor of Toxicology, Wageningen University and Research Centre, Wagen-
 •  E.D. Kroese, Toxicologist, TNO, Zeist                                                                 ingen
 •  C.F. Kuper, Toxicologic Pathologist, Utrecht
 •  G.B.G.J. van Rooy, Occupational Physician/toxicologist, Arbo Unie Expert Centre for Chemical Risk
    Management, and Radboud UMC Outpatient Clinic for Occupational Clinical Toxicology, Nijmegen
 •  L.A. Smit, Epidemiologist, Institute for Risk Assessment Sciences, Utrecht
 •  R.C.H. Vermeulen, Professor of Environmental Epidemiology and Exposome Science, Institute for
    Risk Assessment Sciences, University Utrecht, Utrecht
 •  A.H. Piersma, Professor of Reproductive and Developmental Toxicology, Utrecht University, and
    National Institute for Public Health and the Environment, Bilthoven, structurally consulted expert
 Observers:
 •  H. Stigter, Occupational Physician, Inspectorate SZW, Ministry of Social Affairs and Employment,
    The Hague
 •  D. Theodori, Social and Economic Council, The Hague
 Scientific secretary:
 •  S.R. Vink, Health Council of the Netherlands, The Hague
12         Health Council of the Netherlands | No. 2019/03                                                                                                     2                                        14
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<pre> The Health Council of the Netherlands, established in 1902, is an independent scientific advisory body. Its remit is “to advise the government and
 Parliament on the current level of knowledge with respect to public health issues and health (services) research...” (Section 22, Health Act).
 The Health Council receives most requests for advice from the Ministers of Health, Welfare and Sport, Infrastructure and Water Management, Social
 Affairs and Employment, and Agriculture, Nature and Food Quality. The Council can publish advisory reports on its own initiative. It usually does this in
 order to ask attention for developments or trends that are thought to be relevant to government policy.
 Most Health Council reports are prepared by multidisciplinary committees of Dutch or, sometimes, foreign experts, appointed in a personal capacity.
 The reports are available to the public.
 This publication can be downloaded from www.healthcouncil.nl.
 Preferred citation:
 Health Council of the Netherlands. Cadmium and inorganic cadmium compounds.
 Health-based recommendation on occupational exposure limits.
 The Hague: Health Council of the Netherlands, 2019; publication no. 2019/03.
 All rights reserved
13         Health Council of the Netherlands | No. 2019/03                                                               2
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