The worldwide challenge of occupational cancer

Concern was raised at the ICOH conference about the "embarrassing" lack of progress on asbestos and occupational cancer

Underlined by latest figures on fatalities, work-related cancer is one of the critical workplace health issues of our time. It provided the focus of debate at ICOH 2018, the year’s largest gathering of occupational health experts in May, writes Tim Walsh.

ICOH 2018, the triennial international congress, was this year held at the Convention Centre Dublin between 29 April-4 May. It brought together some of the leading authorities on workplace health issues for a global policy forum on occupational cancer.

The ILO (International Labor Organization), WHO (World Health Organization), ISSA (International Social Security Association), EU-OSHA (European Agency for Safety and Health at Work), IARC (International Agency for Research on Cancer), ICOH (International Commission on Occupational Health) and IOSH (Institution of Occupational Safety and Health) were among organisations represented in the 90-minute debate.

The wide-ranging discussion touched on the many and various issues in tackling occupational cancers. This article intends to highlight some of forum’s main talking points:

Scale of the issue

The official figures on deaths from occupational cancers are stark, and yet they are considered conservative.

ICOH president Dr Jukka Takala, chair of the session, said 27% of all work-related deaths were because of cancer, according to the ILO – that’s around 742,000 annually.

By region, the high-income economies have the biggest percentage of deaths from cancer (52%) and the true global figures rise as more is known. “Numbers are going up all of the time – the more you study the more you find,” he said.

Dr Christa Sedlatschek, director of EU-OSHA, said cancer was the second main cause of death in the EU and “carcinogens cause the majority of fatal occupational diseases” in the bloc.

On the scale of existence of potentially cancer-causing substances in the workplace, she added: “Thirty-eight per cent of workplaces have chemical or biological substances present – large enterprises use more than 1,000 different chemical products – and I believe that this total is under-reported. New risks are emerging all the time.”

Knowledge gaps and work cancer registers

Dr Kurt Straif, of IARC, highlighted how little we know about occupational cancer. “There are major knowledge gaps in terms of workplace exposure and cancer risks,” he said.

“Research on prevention is tiny and needs to be increased, particularly the economic aspect – the cost of inaction.”

A shift in funding priorities had seen most of today’s research funding dedicated to genetic and personalised medicine, and basic and clinical medicine, he said.

During the session, delegates were invited to vote on priority topics for discussion and they rated workplace carcinogen registers as number one.

“The global occupational carcinogen register will enable us to document our success – and this is incredibly important in our times,” Dr Straif said.

Challenges in prevention and control

Dr Shengli Niu, a specialist in occupational health at the ILO’s Programme on Safety and Health, outlined the key barriers to progress in the prevention of occupational cancer and control of workplace carcinogens.

“It is difficult to link a specific cancer to a specific exposure – made more difficulty by long latency – sometimes of half a century,” he said.

Most cancers are multi-factorial in etiology and “the prevention of occupational cancers has a much lower profile in the workplace than preventing workplace accidents”.

IOSH chair Dr Bill Gunnyeon highlighted the challenges for No Time to Lose, IOSH’s ground-breaking campaign on occupational cancer. The initiative had now reached workers in 32 countries on five continents. “There is a strong desire to partner with us,” he said.

More difficult, he said, was assessing the changes in behaviour in organisations as a result of such a campaign – the next stage in measuring impact. Because of the latency of many occupational cancers, there was a natural delay in being able to pinpoint success in achieving the ultimate goal – a reduction in the number of people contracting and dying of occupational cancers, said Dr Gunnyeon.

“More people die from occupational cancer than malaria – perhaps we need a Bill Gates for occupational cancer?” he said.

What countries can do

There was plenty countries could do to prevent exposure to workplace carcinogens, said Dr Ivan Ivanov, of the occupational health team at WHO. A range of “core measures” included:

  • Develop regulatory standards and enforce control of the use of known carcinogens in the workplace
  • Avoid introducing known carcinogens in the workplace
  • Include occupational cancer in the national list of occupational diseases
  • Identify workers, workplaces and worksites with exposure to carcinogens

A further set of “desirable measures” included:

  • Develop programmes for cancer prevention and control in the workplace
  • Organise registries of occupational exposures to carcinogens and exposed workers
  • Estimate the national occupational burden of disease from carcinogens

However, national programmes were a struggle for developing countries, delegates heard. For example, professor David Rees, of South Africa’s National Institute for Occupational Health, said: “Given the enormous social and health needs in … low-income countries, is it really possible (to do anything about reducing occupational cancers)?”

He explained that Africans in their communities relied on two things: skilled and experienced workers (“they are essential”) and stable families, for development. Both are affected if someone in the community/village gets occupational cancer.

“Can anything be done – yes, bit by bit”, said Dr Straif. But certain steps were required to improve the situation, including the cessation of transferring hazardous industries to low income countries, and a ban on asbestos mining, production and export.

Lack of progress on asbestos is ‘embarrassing’

A number of contributors to the policy forum turned their attention to asbestos.

Hans-Horst Konkolewsky, secretary-general of ISSA, told ICOH 2018 delegates of a British documentary he had watched at the very beginning of his career, in Denmark in the 1980s. Alice, a fight for life told the story of Alice who was dying after contracting cancer from working in an asbestos factory in West Yorkshire.

Konkolewsky said this powerful film had had a big impact in his native country: “It obliged the Government to prepare an action plan for asbestos in Denmark.”

He added: “This brings me to a strong call to action to make this an asbestos free world … We are so far away from this (goal) that it’s embarrassing.”

Tim Driscoll, of the University of Sydney School of Public Health, highlighted that asbestos was being used extensively 20, 30, 40 years ago in high-income countries such as Australia, North America and the UK. As a result, cancer levels in these countries (from exposure to asbestos) are currently much higher than anywhere else in the world.

However, despite Asia having low occupational cancer rates now, they will rise because many Asian countries are still using asbestos “and so in 20 to 30 years the rates will be much higher”.

“Something needs to be done, we don’t want the same problems being repeated,” said Driscoll.

Consensus on urgency to act now

In his presentation, the ILO’s Dr Niu referenced ILO convention 139, which lays out the most essential principles for prevention and control of workplace carcinogens, including:

  • replacement of carcinogenic substances by less dangerous ones
  • establishment of a list of carcinogens to be prohibited, or made subject to authorisation or to control
  • recording of data concerning exposure and exposed workers
  • medical surveillance
  • information and education

The convention was adopted in 1974 following discussions at two successive sessions of the International Labour Conference, in 1971 and 1973. Its intention was “to lay down general principles for implementation at the national level of the specific and detailed measures required and for the development of adequate control programmes”.

Recognising the difficulties in acting in this field, a year later, the 1975 session of the International Labour Conference adopted a resolution which referred to the “adverse social and economic consequences, both for the workers and for the industry which may follow the implementation of strict preventive and protective measures prescribed by national legislation, and methods of meeting the hardships involved”.

Forty-three years later, the number of known deaths from work-related cancers is rising. Countries continue to mine or import asbestos. In May 2018, many of the world’s foremost workplace health bodies and experts were in consensus on the need for urgent action.

“It’s high time for us all to act together to bring a difference,” said Dr Niu.

“We need to get into prevention – occupational cancer is preventable…. It’s an enormous obligation and a huge task,” added Konkolewsky.

“2.25 million people will have died of occupational cancer between now and the next ICOH gathering in Melbourne in three years’ time,” agreed Dr Gunnyeon.

In conclusion, the global policy forum at ICOH 2018 laid bare the harsh economic, social and political realities that lie in the way of progress in the fight to reduce deaths from occupational cancers.

Tim Walsh is head of communications and media at the Institution of Occupational Safety and Health

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