Carcinogens in the workplace - are you safe?

It is estimated that around 1.5 million workers in Australia are potentially exposed to carcinogens at work, according to a Safe Work Australia report released in 2006. This estimate is based on the EU approach (Kogevinas et al, 1998) on percentage of workers exposed to carcinogens in particular industries. As the battle against workplace carcinogens continues, industry experts are calling for a more effective process to identify occupational carcinogens, to inform workers about potential risks and to reduce the use of chemicals in industry.

Occupational cancers reportedly claim 600,000 lives a year - one life every 52 seconds. While work-related cancers are not easily identifiable, it is estimated that around 5000 cancers a year in Australia can be attributed to occupational exposure to carcinogens.

Occupational cancers are not easily identifiable, as they have no unique pathological or clinical features and the lag time between exposure and cancer diagnosis may be decades, said Professor Lin Fritschi, of the Western Australian Institute for Medical Research. There is no unique independent system for collection of data on work-related cancers, and compensation data are of little help because of considerable under claiming. Fritschi and co-authors recently wrote an opinion piece¹ on occupational cancers, in The Medical Journal of Australia, calling for world’s best practices to reduce exposure to cancer-causing agents and cut the toll of work-related cancers.

In Australia, there is limited systematic work aimed at identifying occupational carcinogens, informing users about carcinogenic risks, and reducing the use of chemicals in industry, said Fristchi, noting that there are very good systems internationally which could be considered for use here to help reduce the risk of workplace exposure to carcinogens.

According to a recent report released by Safe Work Australia, occupational skin diseases cost more than $33m to the economy. Safe Work Australia Chair Tom Phillips AM said that skin exposure to chemicals and the causes and occurrence of occupational skin disease are serious workplace health issues that have a large economic impact on the Australian economy each year.

The report - National Hazard Exposure Worker Surveillance: Chemical exposure and the provision of chemical exposure control measures in Australian workplaces - found that 37% of the workers surveyed had skin contact with chemicals in the workplace. Workers most at risk of being diagnosed with occupational skin disease are those exposed to chemicals or wet work in their day-to-day jobs. These include tradespersons, labourers, healthcare workers, hair and beauty workers, and food handlers, states the report.

The main industries impacted by occupational skin disease are health and community services, accommodation, cafes and restaurants, construction, agriculture, forestry and fishing. "Some of these industries have been identified as priority areas for chemical and hazard exposure prevention under the new work health and safety strategy that is due to be released in the second half of 2012," said Phillips.

Wet work, detergents, disinfectants, solvents, bases and alkalis, fuels, rubber accelerators and potassium dichromate in leather and cement are thought to be some of the main causes of occupational skin diseases.

In the opinion piece published in The Medical Journal of Australia, Fritschi and co-authors propose the plan of action² below for work-related cancers in Australia.

Strategic action aimed at reducing the burden of occupational cancer in Australia needs to be concentrated around three aspects: raising the profile of occupational cancer; interventions to reduce exposure to carcinogens, supported by legislative processes; and improving the support for patients with occupation-related cancer.

To prioritise preventive activity, it will be essential to collect data on the number of workers in Australia who are exposed to carcinogens, what industries they are in, and the concentration and frequency of exposures. Several possible sources of data exist. The National Industrial Chemicals Notification and Assessment Scheme is the Australian Government authority responsible for assessing (but not regulating) health and environmental impacts of industrial chemicals. The National Pollutant Inventory publishes data on annual emissions of 93 specific chemicals generated in Australia. In addition, Safe Work Australia publishes some research relating to workplace health and safety and workers compensation. None of these sources contain good estimates of the number of workers exposed to a particular carcinogen. The establishment and resourcing of an effective national database with the appropriate powers to gather and report the appropriate data may be necessary. However, the current multiagency and multijurisdictional approach to the regulation of carcinogens makes such a national approach difficult. Of note, in 2009, the federal government established the Standing Committee on Chemicals - an interdepartmental group that aims to achieve an effective and efficient national system of chemicals and plastics regulation.

It is important that Australia applies the highest standards of worker protection, based on the best international evidence. While workplace health and safety is a state responsibility, it is not appropriate that some states have worse protection for workers than others, or that the implementation and enforcement of the national regulations should vary between states and territories. The Model Work Health and Safety Regulations and model Codes of Practice were developed to harmonise regulations across the country; however, concern exists - first, to ensure that the highest health and safety standards apply in these revised regulations and, second, to ensure they are adopted by all jurisdictions.

Australia should not lag behind global best practice in reducing exposure to carcinogens. Australian authorities should establish effective processes to review international decisions on carcinogens in a timely manner and introduce appropriate changes to the local workplace. We should also investigate the feasibility of introducing initiatives that are known to be successful in reducing carcinogen exposure, such as TURA or the Finnish exposure register.

A potential effect of introducing stricter legislation in Australia may be to move manufacturing and processing offshore to countries with less stringent regulations.
The issue of workplace exposure to carcinogens has the potential for being both under- and overemphasised. Reliable information needs to be easily accessible for workers, employers, consumers and the media. Media coverage about suspected ‘cancer clusters’ without evidence or investigation can promulgate anxiety when there is low (if any) real risk. Cancer Council Australia has developed a position statement on occupational carcinogens.

The Asturias Declaration, developed by the World Health Organization, recommends that all countries develop education campaigns to improve public knowledge of environmental causes of cancer and strategies for prevention. General practitioners and other relevant clinicians need to know how to take a thorough occupational exposure history and to improve their confidence in identifying whether cancers may be occupationally caused. An Australian list of priority carcinogens, with easy availability of reliable information, relevant to clinicians (such as is being produced by CAREX Canada) would be helpful.

Workers and medical staff are not always aware of the potential for compensation and the processes for gaining it. Effective identification of and compensation for cases of work-related cancer would provide necessary support to affected cancer patients and an increased incentive for insurers, government and industry to minimise the occurrence of such cases.

Poor awareness of exposure to occupational carcinogens and lack of attribution of cancer to occupational causes, among both the clinical and general community, limits opportunities to reduce the likelihood and extent of exposure. In addition, potentially legitimate compensation cases are not pursued.

In Australia, the currently limited and fragmented approach to the process of minimising workplace cancer risk is a significant obstacle to collecting and reporting data on exposure to carcinogens, and an even greater challenge to reducing such exposures.

A strategic approach to this task requires the development of partnerships between unions, government and industry, consumers, non-government organisations, cancer clinicians, occupational physicians and the environmental movement. In addition, audits and reviews should be instigated to determine what is being done to introduce best practice to Australia.

[1] The opinion piece, written by Lin Fritschi, MB BS, PhD, FAFPHM, Professor, Western Australian Institute for Medical Research, University of Western Australia, Perth, WA; Renae C Fernandez BHlthSci, BCom, MPH, Research Assistant, Western Australian Institute for Medical Research, University of Western Australia, Perth, WA; Deborah A Vallance MB BS, BMedSci, MPH, National Occupational Health and Safety Coordinator, Australian Manufacturing Workers Union, Melbourne, VIC; Terry J Slevin MPH, FPHAA, Education and Research Director, Cancer Council Western Australia, Perth, WA; Alison Reid PhD, Associate Professor, Western Australian Institute for Medical Research, University of Western Australia, Perth, WA; Timothy R Driscoll MB BS, MOHS, PhD, Associate Professor, Sydney School of Public Health, University of Sydney, Sydney, NSW; Deborah C Glass PhD, Senior Research Fellow, Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, was first published in The Medical Journal of Australia.

[2] Fritschi L et al. Controlling occupational cancers in Australia. Med J Aust 2012; 196(3) 162-164. © Copyright 2012. The Medical Journal of Australia - reproduced with permission.