Deathwatch - Hazards issue 111 July-September 2010

Hazards issue 111, July-September 2010

US president’s cancer panel exposes UK’s do nothing strategy

Two official studies published in 2010 confirm a long-neglected workplace cancer crisis. But while the US report recommends urgent preventive action, writes Hazards editor Rory O’Neill, the UK report is just another body count.

Death watch
Hazards issue 111, July-September 2010

Top advisers to Barack Obama have recommended policymakers in the US abandon a reactionary approach to regulation of cancer causing chemicals and champion a precautionary approach.

The strongly worded report, released in May 2010 by the President's Cancer Panel, says exposure to carcinogens at work and in the wider environment poses a serious threat to the US population, causing “grievous harm” that government agencies including the Occupational Health and Safety Administration (OSHA) have not adequately addressed. The panel reports directly to the president.

‘Reducing environmental cancer risk: What we can do now’ says the US government has “grossly under-estimated” the problem because of a lack of research. Much of the suffering faced by people diagnosed with toxin-related cancer could have been prevented, according to the 240-page report.

A cover letter to the report co-signed by panel members LaSalle D Leffall Jr and Margaret L Kripke notes “the public is becoming increasingly aware of the unacceptable burden of cancer resulting from environmental and occupational exposures that could have been prevented through appropriate national action... our nation still has much work ahead to identify the many existing but unrecognised environmental carcinogens and eliminate those that are known from our workplaces, schools, and homes.”

Wood dust caused nose cancer
A widow has received compensation after her husband died of a work-related nose cancer. Barry Haw contracted the condition after being exposed to wood dust while working as a craftsman for Robert Thompsons Craftsmen Limited. Mr Haw spent much of his career working with hardwoods such as oak and beech. He became seriously ill in 2006 and died as a result of his cancer in late 2007. Sino-nasal cancer is rare, but studies have shown that exposure to wood dust significantly increases the risk of developing the disease.

Mr Haw’s widow Heather said: “I lost my husband through this awful disease. All that Barry did, just like his father, was go to work in order to provide for his family. From the time he first developed the illness, he endured an awful lot from horrendous surgery to radiotherapy and chemotherapy. I would not want anyone else to go through that.”

Ian Bailey, a specialist in occupational cancers with personal injury law firm Irwin Mitchell, said: “It seems that there are some jobs where the incidence of the disease is relatively high and this includes furniture manufacturers and joiners. The link between the disease and exposure to hardwood dust is particularly strong with exposure to oak, beech and mahogany. Although this is not a widely known cancer it is something that craftsmen working with wood need to be aware of to allow them to take the appropriate precautions to protect their health.”

The report warns that people from disadvantaged populations “are more likely to be employed in occupations with higher levels of exposure (eg. mining, construction, manufacturing, agriculture, certain service sector occupations) and to live in more highly contaminated communities.”

It adds that existing regulations are inadequate and inadequately enforced. “Industry has exploited regulatory weaknesses, such as government’s reactionary (rather than precautionary) approach to regulation,” it says.

The report comes on the heels of a Health and Safety Executive (HSE) commissioned UK study of occupational cancer numbers, which confirms the official estimates cited routinely by both US and UK authorities have greatly under-played the extent of the problem.

The UK report indicates thousands of occupational cancer deaths each year have been missed in official estimates. The study for HSE, the UK’s official workplace safety enforcement agency, puts the number of cancer deaths in 2005 that were attributable to work at 8,023 - which compares to the 6,000 deaths a year HSE defended as a “best available estimate” until two years ago (Hazards 99).

This figure was based on the 30-year-old Doll/Peto report, which forms the basis of estimates of occupational and environmental cancer rates cited by authorities in the US as well as the UK, and criticised in the President’s panel report. The new higher figures, which HSE now concedes “are likely to be a conservative estimate of the total attributable burden”, indicate in Great Britain there were 13,694 cancers caused by work in 2005.

But even this figure is conservative for an embarrassment of reasons, including:

• The study only considered group 1 and 2a carcinogens, discounting possibles in the lower 2b category where there is evidence of risk, but not enough suitable studies to establish the link with certainty.

• HSE's analysis generally relied on large studies, but researchers have pointed out that many smaller workplaces like car repair shops and small scale building work can result in routine and considerable exposures.

• The study uses an HSE estimate of the numbers of lung cancers caused by asbestos exposure, which knocks at least 1,000 cancer deaths a year - and possibly more than 3,000 - off more usually cited figures.

• The occupational risks from certain cancers, for example leukaemia and non-Hodgkin's lymphoma, are virtually dismissed, despite evidence of a significant risk in other countries.

• Rates of certain cancers, for example, work-related cases of prostate cancer, are seriously downplayed.

• Other nations and statutory and health agencies recognise risks from more substances and for cancers at shorter latency periods.

Filling the gaps in the HSE analysis would quickly push the toll into excess of 10,000 deaths a year and probably well above the minimum 12,000 annual occupational cancer death toll estimated by Hazards in 2005 (Hazards 92).

Paralysis by analysis

HSE’s approach on breast cancer risks exemplifies how the watchdog continues to do little more than watch the toll grow. The HSE report concluded nearly 2,000 women contract breast cancer every year in the UK because they work night shifts. The figure, based on 2005 data, attributes 1,969 new cases of breast cancer and 555 deaths from the disease that year to shiftwork. It says: “The estimate of nearly 2,000 breast cancer registrations due to shiftwork in our study is 54 per cent of all female occupationally-related cancer registrations.”

Professor Andrew Watterson, head of occupational health research at Stirling University, urged HSE last year to act on international evidence confirming the link between breast cancer and shifts (Hazards 106).

However, HSE chief medical adviser John Osman responded: “At present HSE does not think the evidence on a cancer risk is compelling enough to require more of employers than is already required of them in respect of protecting the health of employees who do shift work.”

It’s an approach dubbed “paralysis by analysis”. But while HSE does nothing, the body count moves upwards unchecked. And it is an approach HSE is standing by.

Commenting after publication of the latest breast cancer figures in the 2010 report, an HSE spokesperson told Hazards: “In the light of these findings, this is clearly an area which needs more research. We are actively monitoring and assessing this issue.”

Occupational cancer is a neglected burden that is not shared equally across the population.

Olivia Carlton, president of the Society of Occupational Medicine, speaking as the latest HSE figures were presented at the society’s June 2010 annual conference, commented: “There is a social inequality in occupational cancer risk, which is concentrated in manual workers and lower employment grades.” She added: “The missed opportunity is that we know many of the culprits and how to control them.”

The inequalities issue is one also acknowledged in the US president’s panel report, which notes: “The reality of this unequal burden is not just a health issue, but an issue of environmental justice.”

And it calls for an explicit and radical response.

The US report recommends: “A precautionary, prevention-oriented approach should replace current reactionary approaches to environmental contaminants in which human harm must be proven before action is taken to reduce or eliminate exposure,” adding that this new approach “should be the cornerstone of a new national cancer prevention strategy that emphasises primary prevention.”

Busy doing nothing

By contrast, the UK report for HSE shows a complete lack of ambition. “Prioritisation of risk reduction strategies should focus on those workplaces where such exposures are still occurring,” it concludes.

It’s the sort of empty phrase that leaves HSE, an agency without the resources, strategy nor seemingly even the will to either eliminate or control the culprits, spared any difficult questions. This isn't theory. Even where HSE knows there are problems, for example in sectors with notorious cancer risks or where its own surveys identify serious breaches, the watchdog is failing to protect workers.

A 2010 survey by HSE found the microelectronics industry - under investigation for a suspected cancer link in the UK and elsewhere - was neglecting health risks to workers and tampering with crucial safety alarms. HSE, though, prosecuted none of the law-breaking firms [See: HSE observes hi-tech horror show].

HSE's oversight has been similarly lacklustre in the chemical sector. Workers producing rubber goods are not being provided the minimum legally-required protection from cancer risks, a survey by HSE found.

The survey findings, published online in July 2010 but not press released by the agency, revealed that six of 75 rubber fume exposures measured were in excess of the Workplace Exposure Limit (WEL). However, almost all the firms visited in the small study had “significant deficiencies” in their engineering controls and the risk assessments under the Control of Substances Hazardous to Health (COSHH) regulations the study found, were “not suitable and sufficient”. Dermal exposures at rubber compounding “are not adequately controlled”, the report added.

It concluded “although exposures are typically below the WEL, exposures are not being controlled as low as reasonably practicable (ALARP), as is the requirement for carcinogens under the COSHH regulations. Almost all sites visited had significant deficiencies related to the engineering controls used to control rubber fume exposures. Moulding presses without local exhaust ventilation (LEV) fitted were frequently encountered. Where LEV was installed, deficiencies linked to design, use and maintenance were observed. The use of respiratory protective equipment (RPE) to control fume exposures was uncommon.”

The report adds to earlier concerns about poor control of occupational cancer risks in the chemical sector. A December 2007 report from HSE revealed a disastrous failure by chemical firms to control one of the best known workplace carcinogens. HSE assessed occupational exposures to the industrial chemical MbOCA, which can cause bladder cancer and which has been linked to other cancers, and found controls and personal protective equipment (PPE) were inadequate, training was poor and exposure levels were unacceptable.

'About 75 per cent of company risk assessments were insufficient and unsuitable,' it said. Earlier interventions to reduce risks had worked 'but the exposure control measures then implemented by the industry were not sustained,' the study found.

HSE's behaviour amounts to a regulatory deficit now bordering on impotence. HSE is not even allowed to talk a good campaign anymore – the Tory-led coalition government has banned the watchdog from spending any money on campaigns, an activity HSE had maintained was being used to compensate for a catastrophic decline in inspection and enforcement. Firms are now unlikely to receive a visit from HSE more than once in a working lifetime. HSE’s low profile is rapidly descending into virtual invisibility (Hazards 110).

So, while the work cancer count has vaulted by over 2,000 deaths a year and accounts for more than 10 times more victims than murder, there will be no innovative or ambitious HSE prevention measures.

Belatedly discovering more than 2,000 extra dead bodies a year might have prompted an apology from HSE. It should certainly have prompted a rethink.

Workers, cancer victims and bereaved relatives have got neither.

References

Reducing environmental cancer risk: What we can do now, President’s Cancer Panel, 2010 [pdf].
Lesley Rushton and others. Occupational and cancer in Britain, British Journal of Cancer, volume 102, pages 1428–1437, 2010 [abstract].
The burden of occupational cancer in Great Britain, research report 800, HSE, 2010 [pdf]. www.hse.gov.uk/research
While you were sleeping, Hazards magazine, number 106, Summer 2009.
A small survey of exposure to rubber process dust, rubber fume and N-nitrosamines, RR819, HSE, July 2010.
A survey of occupational exposure to MbOCA in the polyurethane elastomer industry in Great Britain 2005-2006, HSE, December 2007.

Pesticides linked to cancer surge

A ‘dramatic’ increase in a range of occupational and childhood cancers has been linked to pesticide exposures.

Public health researchers, writing in a new report for the Chemicals, Health and Environment Monitoring Trust (CHEM Trust), call on the UK government to step up action to ban the most harmful pesticides and to bring in a duty for the public to be informed before spraying takes place. They add that safer alternatives are available and are preferable to attempting to avoid occupational or environmental exposures to inherently dangerous substances.

‘A review of the role pesticides play in some cancers: Children, farmers and pesticide users at risk?’, links exposure prior to conception or during pregnancy to higher rates of childhood cancer and warns that farm workers could also be developing cancers caused by pesticide exposures at work. The report says several studies “strongly suggest” that pesticide exposures are associated with non-Hodgkin’s lymphoma (NHL), leukaemia, prostate cancer and other hormone-related cancers. It adds that environmental factors “must be partly to blame” for massive increases in the incidence of certain cancers since 1975 – because genes in a population do not change that quickly.

Since the mid-1970s, cases of NHL have more than doubled in Britain, prostate cancer has tripled, testicular cancer has doubled and breast cancer in women has increased by two-thirds, and in men has quadrupled, the report notes. In the 35 years up to 1998, childhood cancer in Britain increased by 35 per cent, it adds. Although the increasing numbers may be in part a result of better diagnosis, the report authors believe environmental factors, including pesticides, are a contributory factor.

Stirling University’s Professor Andrew Watterson, a co-author of the report, commented: “Occupational and environmental cancers have been a neglected public health issue in the UK for decades.” He added: “The regulatory response has usually been ‘if in doubt, do continue using pesticides’ when the scientific literature is littered with examples of products that have been cleared in the past emerging as known or suspect human carcinogens. There is a long-overdue and urgent need to mount a cancer prevention campaign on pesticides based on effective precautionary principles.”

A review of the role pesticides play in some cancers: Children, farmers and pesticide users at risk?, Chem Trust, 2 July 2010. Chem Trust news release [pdf] and report [pdf]. Hazards green jobs, safe jobs blog

HSE observes hi-tech horror show

Microelectronics firms in Britain have neglected health risks to workers, tampered with crucial safety alarms and have shown no consideration of the risks faced by entire groups of workers, an official report has found. However, despite its inspectors discovering widespread and potentially deadly breaches of health and safety law, the Health and Safety Executive (HSE) did not prosecute a single firm.

HSE confirmed that despite a lack of “corporate oversight” on health issues, none of the companies had faced the courts, with just four firms targeted with a total of seven HSE improvement notices. “Where there was significant concern, appropriate enforcement action was taken,” an HSE spokesperson told Hazards. The probe involved inspectors visiting 17 companies in the UK involved in making semiconductors.

The HSE investigation uncovered “weaknesses”, “misunderstandings” and poor practices in vital safety procedures across the sector, which is currently under investigation both inside and outside the UK after studies linked work in microelectronics factories to elevated rates of a range of cancers.

Monitoring to ensure compliance with safety rules in high hazard situations “was weak at several sites,” the investigation report noted. “Often, there was no consideration of risks to others arising from maintenance and cleaning, for example from spread of contamination.” Occupational health services for workers had not improved since a 2002 evaluation and were “often poorly targeted,” said the report.

“Few companies had satisfactory auditing and review arrangements for their management system for hazardous substances,” it said. In a few cases companies had been “slow” to investigate abnormal results from monitoring workers, the inspectors found. And in “several” cases, gauges had been tampered with to prevent safety alarms from stopping production.

The report warns: “High level, corporate oversight was often largely concentrated on safety rather than health issues.”

Control and management of hazardous substances in semiconductor manufacturers in Great Britain in 2009, HSE, July 2010 [pdf].