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Hazards 120, October-December 2012
Cancer costs: Work cancers are deadly and costly – so why is so little done?
Occupational cancers cost the economy billions each year. They claim thousands of lives and tear apart families. So why, asks Stirling University’s Professor Andy Watterson, does the Health and Safety Executive continue a ‘sterile debate’ on the risks instead of taking real action to prevent another generation of preventable deaths?

Totting it up, cancers caused by work are a massive drain on the UK economy. Taking UK government cost-per-work-cancer estimates and the Health and Safety Executive’s figure of 8,000 cancer deaths a year, from its ‘The burden of occupational cancer in Great Britain’ reports, the annual cash bill exceeds £2 billion.

But this is just the start of it. Cancer survival rates are improving, but the 13,000 plus new work cancer cases HSE accepts occur each year don’t come cost free, even if they don’t necessarily kill. Care of the sick, lost wages and welfare payments will add hundreds of millions to the bill, minimum.

Even then, we are basing the calculation on HSE’s fantasy burden figures for occupational cancer mortality and morbidity (Hazards 111). These fall short on the number of cancer causes included, the impact of cancer on workers outside the largest, most easily studied industries, and makes assumptions on the numbers of cases attributable to work falling way short of estimates elsewhere.


No prevention dimension

After several years of pressure from Hazards, the issue of occupational cancer has made it at least onto the HSE agenda. Unfortunately, prevention hasn’t. A paper considered at HSE’s 22 August 2012 board meeting, Occupational cancer – priorities for intervention, didn’t include the word. Neither did the action points in the minutes of the discussion.

HSE spends about £7m total on work-related ill-health research each year. Prevent just three cancers and UK plc has paid off this investment. Prevent 1 per cent of the 8,000 cancers deaths even HSE admits occur in the UK each year, and HSE has offset its entire annual budget.

Several countries already recognise that occupational cancer reduction programmes can be highly cost-effective and quickly recover their costs. Killing people needlessly is an expensive business.1  

HSE’s plan, however, makes no mention of either prevention or related inspection, investigation or enforcement activity. Instead, HSE’s board agreed only to “proactively engage with professional bodies to deliver future interventions” and “explore avenues for possible interventions.”

HSE would “continue to develop its partnership work on asbestos, respirable
crystalline silica and welding,” but pointedly avoided any hard commitments to do anything new.

Minutes of the meeting note: “The Board recognised the challenges in working to reduce occupational exposure to agents such as diesel exhaust emission and silica, and were still of the view that improving compliance with current occupational exposure limits would improve the situation.”

Despite a slew of papers and the International Agency for Research on Cancer recognising the shiftwork and breast cancer association (Hazards 119), the HSE board instead “recognised that there was still insufficient evidence, at present, to confirm the link between shift work and breast cancer.”

The watchdog also decided it would “maintain its current low level of activity of tetrachloroethylene and polycyclic aromatic hydrocarbons,” both recognised and commonplace workplace cancer-causers. It would look at throwing another carcinogen, mineral oils, off its priority list.


Worse than nothing

HSE’s cancer burdens research, while flawed, presented indisputable evidence the safety enforcer was failing on occupational cancer and needed to do something different and do it better. It showed HSE had consistently under-estimated the risk, and that exposures at work were a significant and ongoing problem.

But HSE isn’t even doing its own job right, let alone sorting out anyone else’s. The watchdog is supposed by law to ensure there is adequate medical surveillance for those exposed to carcinogens at work. But an organisation that had 120 medical staff 20 years ago now has around 20 serving a much larger workforce (See: Low life: How the government has put a low price on your life). It hasn’t got the hands even if it had the will.

The European carcinogens directive also requires that official safety agencies including HSE ensure that where there is any activity likely to carry the risk of exposure to carcinogens, the nature, degree and duration of workers' exposure are determined on a regular basis and that problems are addressed. The directive adds: “The employer shall supply the authorities responsible at their request with the information used for making the assessment.” HSE has never required this information from employers.

It is clear that HSE is increasingly out of step when it comes to the need for enforcement to play a part of a cancer prevention strategy. A European Agency for Safety and Health at Work (EU-OSHA) workshop on ‘Carcinogens and work-related cancer’ held in Berlin from on 3-4 September 2012 attracted regulators, unions and experts from 23 countries and concluded both advice and enforcement - carrots and sticks – were needed.

HSE instead seem intent on dragging down standards elsewhere. In 2012 an officially convened European Union Working Party on Chemicals (WPC) with representatives  from four member states - France, Finland, Germany and the UK – attempted to agree binding occupational exposure limits (BOELs) for 26 workplace carcinogens. Only the UK, when presented with a choice, openly supported a number of proposals to introduce a less protective BOEL.


There’s no excuse

Why has action in the UK been so slow, halting and often regressive? HSE has been captured and neutralised by a regulation averse business lobby, a problem amplified as the watchdog wrestles with a smaller budget and a government bent on pulling its teeth (See Low life. How the government has put a low price on your life).

Instead, the UK is locked in a sterile debate about attributable fractions – how many cancers are related to work – rather than working out effective strategies for tackling the dozens of known and suspected carcinogens known to be in routine use across tens of thousands of workplaces.

Although economic costs should not of themselves determine action on workplace cancers, they do form part of the picture - especially as a process of cost-shifting means the financial burden is not borne by employers, but by the NHS, government, the victims and their families and communities.

Removing carcinogens and reducing exposures to carcinogens is preferable and possible.2  US states have had some successes using toxics use reduction programmes that cut carcinogen usage. France has an active national occupational cancer prevention strategy that place an emphasis on substitution. 

The World Health Organisation (WHO) sponsored Asturia conference in 2011 identified the key practical steps needed.3  The Asturia declaration called for framework for control of environmental and occupational carcinogens that concentrates on the exposures identified by IARC as proven or probable causes of human cancer. Find alternative, safer substances or alternative, safer ways to do the job.

HSE, though, is sticking with more of the same failed and deadly strategy, just with less resources and fewer staff. Measurable indicators of carcinogen exposure in the UK have been missing for some time. Prevention and efforts to ensure employers comply with the law requiring they minimise exposures to carcinogens are absent too.

And the watchdog has no intention of taking a lead. Its August 2012 cancer strategy document notes: “HSE's role in occupational health issues, as in safety issues, can only be that of a catalyst to bring about improvements, with the primary role resting with others.”

At what stage such inertia translates into acts of ‘wilful ignorance’ on the part of the regulator is not clear, but it must be very close.



1. Orenstein MR, Dall T, Curley P, Chen J, Tamburrini AL, Petersen J. (2010) The economic burden of occupational cancers in Alberta. Alberta Health Services, Calgary, Canada.

2. Christiani D. (2011). Combating the environmental causes of cancer. New England Journal of Medicine, 364: pages 2266-2268.

3. Landrigan PJ, Espina C, and Neira M. (2011). Global prevention of environmental and occupational cancer. Environmental Health Perspectives, volume 119:a280-a281.


Campaigners call for action on cancer

The Alliance for Cancer Prevention has criticised the Health and Safety Executive’s occupational cancer strategy, saying it “fails to acknowledge the actual scale of cancer caused by work.” Commenting on an HSE paper discussed at the safety watchdog’s 22 August 2012 board meeting, the campaign said: “The paper is based on a fairy tale unrealistic view of the world of work today, ignores many known carcinogens, shows little interest in finding unknown exposures, underestimates the numbers of workers exposed and shows no sense of urgency to tackle this massive but preventable workplace epidemic. Because of the lack of action now, more people will develop occupational cancers and die from them in the future.”

The alliance, which involves unions, environmental and women’s health groups, said HSE “has been in denial about work cancer for over three decades,” depending far too heavily on epidemiology which is only capable of seeing widespread, long-established problems in large numbers of workers, employed for long periods of time, in large workplaces such as mines, mills and manufacturing. It said the approach was unsuitable for today’s smaller and fast evolving workplaces with more complex, and diverse exposures. It added it was a method that was incapable of picking up high risk exposures affecting smaller groups of workers.

Alliance spokesperson Helen Lynn said: “The HSE approach to occupational cancer ensures thousands more people will develop the disease through exposures at work. Delaying action on better shift work patterns is just condemning more women to greater risk of breast cancer while there is action that could be taken immediately.' The TUC in 2012 produced a guide for unions on preventing occupational cancer which called for zero tolerance of carcinogens in the workplace (Hazards 117). After pressure from union representatives on HSE’s board, the safety watchdog agreed to organise a March 2013 conference on the prevention of occupational cancers and practical measures to reduce them. HSE was also told to investigate the economic cost of workplace cancers.

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Cancer costs

Occupational cancers cost the economy billions each year. They claim thousands of lives and tear apart families. So why, asks Stirling University’s Professor Andy Watterson, does the Health and Safety Executive continue a ‘sterile debate’ on the risks instead of taking real action to prevent another generation of preventable deaths?


No prevention
Worse than nothing
There’s no excuse

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