Popular media frequently cover cancer, but not from an OHS perspective. Yet occupational cancer tops the International Labour Organisation workplace diseases and accidents table with over 600,000 dying of occupational cancers ever year.
Occupational cancer and Workers’ Memorial Day
Rory O’Neill and Andrew Watterson
Popular media frequently cover cancer: the tragedy for the individual; cancer the challenge for the medical profession; cancer the result of smoking and bad diet. Yet occupational cancer tops the International Labour Organisation workplace diseases and accidents table with over 600,000 dying of occupational cancers ever year. More than 1 in 5 workers face a cancer risk from their work. Between 8 and 16 per cent of all cancers result from occupational exposures. Action is needed in the first instance on carcinogens not on the cancers. However, failures to revise an evidence base no longer fit for purpose on occupationally caused and occupationally related cancer numbers have skewed governmental policy and practice of governments, regulators and enforcement agencies. Inadequate statistics lead to ineffective prevention policies. The diseases primarily but not exclusively affect industrial workers. (1)(2)(3)(4)
Recent studies estimate the work contribution to cancer deaths at up to five times the level reported by Doll and Peto in 1981 (5). WHO in 2006 reported: “estimates of the proportion of cancer deaths in the general population attributable to occupational exposures in developed countries in the range of 4-20 per cent.” (6) . ILO staff estimates in 2007 concluded that the occupational cancer attributable fraction in the working age and above population is approaching 10% and is significantly higher in industrialised countries. Australian researchers estimate approximately 10.8 per cent of cancer cases (excluding non-malignant skin cancers) in males and 2.2 per cent in females are due to occupational exposures (7)(8) . Others consider using the 1981 Doll/Peto estimates for occupational cancer probably underestimates the occupational exposure contribution by a factor of two to four in both the US and the UK (9). These estimates draw on research well beyond the narrow IARC carcinogens list.
|
Occupational cancer cases/year (GB) Based on 2004/5 figures |
HSE/Doll-Peto estimate (5) |
Other estimates (1, 7, 9,12) |
|
% of all cancers |
4% |
12% |
|
Deaths |
6,000 |
18,000 |
|
New cases |
10,800 |
32,000 |
Using European Union CAREX 1990s estimates for workers exposed to group 1 International Agency for Research on Cancer carcinogens – those known to cause cancer in humans - approximately 5 million workers (22 per cent of the employed) were exposed to these agents in Great Britain in 1990-93 (10). Exposures totalled around 7 million. By this estimate, over a fifth of the UK workforce has been exposed to possible human carcinogens and for these workers most of the resultant cancers will only emerge in two decades or more.
While smoking cessation has become a major public health priority and produced an entire prevention industry, no similar campaign has been mounted against the carcinogens encountered by millions at work The UK lags seriously behind countries like Canada and Finland in recognising, publicising and solving the problem. The moribund Health and Safety Executive - whose occupational health staff have almost dwindled away over the last two decades, and who face more major cutbacks including staff and office closures - cannot effectively monitor many small and medium sized enterprises who may be using carcinogens.
Far more UK employees die from occupationally caused and occupationally related cancers each year than from road traffic crashes and murders combined . The media can justify neglecting the significant public health threat posed by occupational cancer partly because they reflect the apathy, indifference and ignorance of health professionals towards the subject. In Canada, there is a specific occupational cancer prevention strategy and much related policy work (11) . In USA, some states have a toxics use reduction institute funded by government and employers to remove or reduce exposures to many carcinogens (9). In the UK, the best the HSE can muster over the last 3 years is two restricted occupational cancer seminars and a fainthearted, long overdue and poorly resourced asbestos campaign. Much remains to be done to cut the UK occupational cancer toll. UK authorities do not acknowledge this.
Occupational cancer is a major and neglected public health issue that affects a specific population group – discrete sections within the working or have-worked populations – that is relatively easily identified and targeted with preventive measures. Globally trade unions recognise this. On April 28th 2007, unions in 100 different countries will mark Workers Memorial Day with cancer prevention seminars, training days, workplace assessments at the start of a major cancer prevention drive (12). Those exposed to occupational cancer risk in the UK should expect support from statutory authorities and the medical profession.
References
(1) Hazards Magazine Burying the evidence. 2005. 92, October-December .
(2) Guo J, Kauppinen T, Kyyronen P, Heikkila P, Lindbohm ML, Pukklala E. Risk of esophageal, ovarian, testicular, kidney and bladder cancers and leukemia among Finnish workers exposed to diesel or gasoline engine exhaust. Int J Cancer 2004;111(2): 286-292
(3) Becher H, Ramroth H, Ahrens W, Risch A, Schmezer P, Dietz A. Occupation, exposure to polycyclic aromatic hydrocarbons and laryngeal cancer risk. Int J Cancer 2005; 116 (3):451-457
(4) Lee WJ, Blair A, Hoppin JA, Lubin JH, Rusiecki JA, Sandler PP et al . Cancer incidence among pesticide applicators exposed to chlorpyrifos in the Agricultural Health Study. J Nat Cancer Inst 2004;1781-1789
(5) Doll R and Peto R. The causes of cancer: Quantitative estimates of avoidable risks of cancer in the United States today. J Natl Cancer Inst 1981;66 (6) :1191-1308
(6) WHO. Prevention of occupational cancer. GOHNET newsletter 2006, number 11.
(7) Hammalainen P, Takala J, Saarela KL. Global estimates of fatal work-related diseases. Am J Ind Med 2007:50:28-41
(8) Fritschi L and Driscoll T. Cancer due to occupation in Australia. Australian and New Zealand J of Pub Health 2006; 30(3):213-219
(9) Clapp RW, Howe, GK, Jacobs M. Environmental and occupational causes of cancer revisited. J Pub Health Policy 2006;27(1):61-76
(10)Finnish Institute of Occupational Health. CAREX web pages
(11) Canadian Strategy for Cancer Control. Prevention of Occupational and Environmental Cancer in Canada. Health Canada. 2005. www.cancercontrol.org
(12) Occupational cancer/Zero Cancer: A union guide to prevention (2007) [pdf]. International Metalworkers’ Federation.
Rory O’Neill (editor@hazards.org) is editor of Hazards magazine; health, safety and environment officer for the International Federation of Journalists and a senior visiting researcher at the Occupational and Environmental Health and Safety Research Group, Stirling University. Professor Andrew Watterson (aew1@stir.ac.uk) is Director of the Occupational and Environmental Health and Safety Research Group, Stirling University, Scotland FK9 4LA