1
Why
the UK stalled on occupational cancer prevention,
where we stand now internationally and what
Scotland can do about it?
WHO estimate that globally 7-19 of all cancers
are due to toxic environmental exposures. 2009

• Andrew Watterson, Tommy Gorman, Rory ONeill
• Occupational and Environmental Health Research
  Group
• Centre for Public Health and Population Health
  Research
• School of Health Sciences,
• University of Stirling,
• Scotland

• 15,764 people died from cancer in Scotland in
  2013
• If 10 of cancer deaths are work-related, an
  estimated 1576 deaths are work-related cost to
  Scotland of 3,862,200,000 (estimate of 2.45
  million per cancer death DEFRA 2006)
• Estimated 1 in 5 workers exposed to carcinogens

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Occupational cancer prevention?
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Huepers occupational cancers -
some substance and Site Concerns 1942

• Asbestos
• Benzidine
• Diesel
• Dyes, coal tar
• Endocrine disruptors linked to breast cancer
• Metal Dust

• Blood cancers
• Brain cancers
• Breast cancer (endocrine)
• Lung cancers
• Naso-pharyngeal cancers
• Prostate cancer (Oppenheimer 1926 Henry et al
  1931 6 of 46 occupations
• Testicular cancer (Shimkin 1941 stilbestrol)

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Global estimates of fatal work-related-diseases.
Hamalainen et al 2007 AJIM 5028-41 (1)
In 2012, an EU Occupational Health and Safety
workshop looked at occupationally-caused and
related cancers and identified hidden groups
whose occupational exposure to cancer risks and
carcinogenic processes was under-represented in
exposure data and intervention strategies (EASHW
2012). They noted an unrecognised work-related
cancer burden in lower socio-economic classes,
women, migrant workers, the precariat and floated
the concept of socially discriminating cancers
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EU/Global Statistical picture. EASHW 2008
Region Number of all cancer deaths Number of all cancer deaths Attributable fraction related to work Attributable fraction related to work Number of deaths attributable to work Number of deaths attributable to work Work-related cancer
Cancer (total) Men Women Men Women Men Women Total
EU 15 528,953 410,829 13.8 2.2 72,996 9,038 82,034
EU 25 600,508 464,757 13.7 2.2 82,194 10,144 92,338
EU 27 623,709 481,307 13.6 2.1 85,106 10,177 95,581
World 3,872,766 3,062,008 9.6 9.6     665,738
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Table Estimate of the proportion of cancer
deaths that will be found to be attributable to
various factors
  Best Estimate Range
Tobacco 30 25-40
Alcohol 3 2-4
Diet 35 10-70
Food additives lt1 5-2
Sexual behaviour 1 1
Yet to be discovered hormonal analogies of reproductive factors Up to 6 0-12
Occupation 4 2-8
Pollution 2 1-5
Industrial products lt1 lt1-2
Medicines and procedures 1 0.5-3
Geographical factors 3 2-4
Infective processes 10 1-?
UK/ US Cancer Pattern, cited by Peter Boyle,
Source Doll Peto (1981)
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Scotland and some occupational
cancer studies, missed policy opportunities and
developments
1990s Old epidemics and endemics in occupational
health cancers listed 2006 The economic costs
of health service treatments for occupational
cancers. Annals New York Academy Science, 1076
871-881. OEHRG 2006. OEHRG met Scottish Minister
of Public Health to discuss occupational cancer
prevention 2006-2015 OEHRG held workshops and
spoke at seminars on occupational cancer
prevention 2008 OEHRG produced paper on Burying
the Evidence on occupational cancer 2008 OEHRG
held international conference in Stirling on
occupational and environmental cancer
prevention 2008 OEHRG published paper in European
Journal of Oncology on occupational cancer
prevention in Scotland a missing public health
priority. 2014 OEHRG worked for WHO on costs of
occupational cancers 2014 APHA occupational
breast cancer prevention policy initiative based
on OEHRG
1875 The first case of paraffin cancer in GB was
described by Bell in Scottish shale oil plants -
a well known fact among the local physicians
(Hueper 1942156)
Major public health threats in Scotland? Skewing
risk assessment, risk reduction risk
management? (from 2006) Murders
2003 108 Road traffic
fatalities 2004 306 (includes
work link) Suicides
2004 835 Occupational cancer
2004 600 using 4 Doll/Peto estimates
1800
(12 Clapp estimate)

1922. Scott described 19 cases of paraffin cancer
in the Scottish industry. No effective action had
apparently followed Bells report
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Alberta firefighters recognised diseases 14. UK
0?
The top 10 occupational carcinogens and their
related cancers and their prescribed industrial
disease status (HSE 2012 and DWP)
Substance and related Cancers Related cancers Prescribed industrial disease status
Asbestos Mesothelioma Lung Larynx Stomach Yes Yes No rejected in 2008 No
Silica Lung Yes
Shift work Breast No
Welding Lung No
Painting Lung Bladder No No
Diesel exhaust emissions Lung Bladder No No
Solar radiation Non melanoma skin cancer No
Polycyclic aromatic hydrocarbons (PAHs) coal tar and pitches Non melanoma skin cancer Yes
Tetrachlorethylene Cervix, Non-Hodgkins Lymphoma Oesophagus No No No
Radon Lung No
Source Watterson 2015
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Simple solutions? The law on workplace carcinogens
REACH
COSHH and related EU Management directives
EU Carcinogen Directive 2004
ECHA
IARC
protect workers against risks to their health and safety, including the prevention of such risks, arising or likely to arise from exposure to carcinogens or mutagens at work (Art. 1).
CLP Regulations 2010-2015 Hazard category
carcinogen is a substance or mixture that induces
or increases cancer incidence with mechanisms
relevant to humans 1A known human carcinogen
largely human evidence H350 eg-i 1B presumed
human carcinogen largely animal evidence
H351 2. Suspect human carcinogen evidence but
not yet sufficiently strong
CMR,toxicity, respiratory sensitiser
Specific regulations such as Control of
Asbestos Regulations 2012 - Ionising Radiations
Regulations 1999 1 (IRR99) and The Radiation
(Emergency Preparedness and Public Information)
Regulations 20012 (REPPIR)
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Global activity on cancer prevention
Canada 2000s
WHO/IARC and Asturias 2011 PP information -regulat
ion, enforcement and sunsetting
The UK?
French substitution programme 2000s
USA 1990s onwards
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Scottish specific strategies and opportunities
a more Nordic model?

• Scottish Government discussion/ focus, with
  cross-party initiatives, on occupational and
  environmental diseases including cancer and
  using public and community engagement
• Prevention through public health and social and
  environmental justice - linking NHS policy, plans
  and practice with enforcement and regulation by
  HSE and SEPA and in the Scottish Governments
  Better Cancer Care and Action Plans (2008gt)
• Prevention through incentives? Scottish
  Government benefits for enterprises that adopt
  toxics use reduction/sunsetting/green jobs
  strategies on carcinogens?
• Prevention through economic penalties? Scottish
  parliamentary action to recover costs of
  occupational and environmental diseases,
  including occupational cancer, from employers?
• Greater governmental support for victims of
  occupational cancer through better disease
  recognition and recording, welfare rights and
  social services. ?
• Greater support, advice, information and use of
  existing regulation and enforcement where needed
  from HSE/SEPA/EHOs on occupational and
  environmental monitoring of industries and
  workplaces using and emitting carcinogens. ? UK
  ACTS and WATCH vanishing?

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Reductions TURI (1990 - 2005)