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       Hazards, number 163, 2023
DISCOUNTING WOMEN | Work cancers in women go unstudied and unaddressed
Cancer studies have neglected the workplace risks faced by women. Hazards editor Rory O’Neill looks at new evidence of the damaging consequences for prevention, compensation and women’s health.


A rare study of occupational hazards and ovarian cancer has found new evidence that many common jobs undertaken by women are associated with an elevated risk.

The authors of the University of Montreal study, published in the journal Occupational and Environmental Medicine in July 2023, note relatively few studies have evaluated the occupational hazards faced by women.

And those that have, have often failed to account for potentially influential factors, previous employment history, or have included relatively few participants, so limiting the findings, they say. 

To try and avoid these issues, the researchers drew on lifetime employment history from a population-based case-control study, to carry out an exploratory analysis looking at two dimensions of the workplace environment: Employment in a particular role or industry; and specific occupational exposures.

They included participants in the PRevention of OVArian Cancer in Quebec (PROVAQ) study, all of whom were aged 18–79, and who had been recruited from seven Montreal hospitals between 2010 and 2016 after being diagnosed with epithelial ovarian cancer.

In all, 491 of these women meeting the inclusion criteria for the study were matched with 897 women who didn’t have ovarian cancer.

For each job held for at least six months, participants reported the job title; start and end dates; working hours, including shift work; and main tasks performed. 

Real risks

After accounting for other risk factors, calculations using the Canadian job-exposure matrix (CANJEM) confirmed that working for 10 or more years as a hairdresser, barber, beautician and in related roles was associated with a three-fold higher risk, while employment for 10 or more years in accountancy was associated with a doubling in risk, and working in construction with a near tripling in risk. 

Similarly, long term work in the clothing industry, including embroidery, was associated with an 85 per cent heightened risk of developing the disease while working in sales or retail was associated with heightened risks of 45 per cent and 59 per cent respectively. 

Heightened risks of more than 40 per cent were observed for high cumulative exposure (8 or more years) – compared with none – to 18 different agents.

These included talcum powder; ammonia; hydrogen peroxide; hair dust; synthetic fibres; polyester fibres; organic dyes and pigments; cellulose; formaldehyde; propellant gases; naturally occurring chemicals in petrol and bleaches.

TORY TAKEOVER  Women firefighters face exposure to potentially deadly risks including carcinogenic contaminants when fighting fires. Their union FBU says decent maternity pay is essential to protect them when pregnant or nursing. more

Hairdressers, beauticians and related workers were the jobs most frequently exposed to 13 agents, including ammonia, hydrogen peroxide, organic dyes and pigments, and bleaches, and the second most frequent occupation exposed to talcum powder.

The authors of the study conclude their results “suggest that employment in certain occupations and specific occupational exposures may be associated with increased risks of ovarian cancer.”

Drs Melissa Friesen and Laura Beane Freeman of the US National Cancer Institute, in a linked commentary in the journal, note there are wider lessons from the study.

“The limited representation of women in occupational cancer research studies has been recognised for decades,” they write.

“Unfortunately, this remains true today for many cancer sites and workplace exposures despite the fact that in 2021 women made up 40 per cent of the global workforce, with percentages in some countries much higher.”

Problem diagnosed

The UN’s top health and cancer agencies were accused in August 2023 of ‘institutional failure’ and of perpetuating the under-count of occupational cancers in women through “the publication of inaccurate statements about the adverse health effects of exposure to asbestos among females.”

A commentary in the Journal of Scientific Practice and Integrity by authors from universities in Italy, Germany, USA and Canada, notes that the most recent editions of the Classification of Tumours published by the World Health Organisation’s International Agency for Research on Cancer (IARC) state that asbestos is rarely the cause of malignant mesothelioma (MM) – an aggressive and usually deadly cancer linked primarily to asbestos exposure – in females, “when, in fact, the epidemiologic literature shows that the risk of MM in females exposed to asbestos approaches that in males.

“While it is correct that the overall incidence of MM in females is lower than in males, the view that MM in females is not caused by asbestos is unsupported.

“This view results from an inadequate occupational history, the failure to recognise the importance of environmental exposures, and the misrepresentation of published literature by the selection of limited literature and biased bibliographies, often by authors with financial conflicting interests.”

They say despite “several fruitless attempts to correct the record” WHO has refused to amend the classification. They conclude the classification is “inconsistent with the published scientific literature, suggesting deliberate misrepresentation and raising the question of undisclosed COI [conflicts of interest] as a factor. The consequences in this case are dire for the females at risk, for their families, and for the public at large.”

The commentary on the ovarian cancer study notes it “reminds us that while the lack of representation of women in occupational cancer studies – and indeed, even potential strategies to address this issue – have been long recognised, there is still a need for improvement in studying women’s occupational risks.

“By excluding women, we miss the opportunity to identify risk factors for female specific cancers, to evaluate whether sex-specific differences in risk occur, and to study exposures occurring in occupations held primarily by women.”

There is a price to pay. Occupational cancer compensation schemes rarely compensate women.

For others, it is a deadly oversight.



Warning on women’s work health crisis

Women are suffering a greater burden of occupational disease than men and are facing a ‘workplace health crisis’, a new report has warned.

Uncovering the UK’s hidden crisis in women’s workplace health, a report from the British Occupational Hygiene Society (BOHS), highlights the ‘urgent need’ for measures to protect women from getting ill because of work.

It points to an ‘alarming rise, in work-related ill-health in women, citing Health and Safety Executive’s (HSE) 2022 Labour Force Survey findings which estimated 918,000 women suffer from worsened health due to exposures at work, compared to 778,000 men.

BOHS said even these shocking figures “are believed to be under-reported, indicating an alarming gap in monitoring, measuring, and reporting the true scale of the problem.”

“We are witnessing a silent and growing crisis that is significantly damaging women’s health in the workplace,” said BOHS president Alex Wilson.

BOHS says its report aims to initiate a national discussion on this crisis, arguing the impact of the workplace on women’s health should be seen as an indicator of national equality policy, health and safety impact, and social sustainability.



Firefighters’ safety call for better maternity pay

The firefighters’ union FBU has called for 12 months maternity leave on full pay for firefighters, citing research finding that exposure to contaminants while firefighting impacts the health of pregnant firefighters, fetuses, and babies.

In a letter addressed to the Local Government Association, the FBU’s National Women’s Committee reports that many women feel they must return to firefighting duties once their pay is halved as they cannot afford to stay on maternity leave.  

It notes that despite the physically demanding nature of the job and the risk of exposure to fire contaminants, current maternity pay for firefighters provides only 90 per cent pay for an initial six weeks, decreasing to 50 per cent pay for 12 weeks, followed by statutory maternity pay.

FBU says some fire and rescue services have improved their maternity offers, leaving firefighters facing ‘a postcode lottery’.

The FBU demand for 12 months maternity pay has now been raised with fire service employers, who it says “have engaged with the issue and have committed to responding in due course.”

Ben Selby, FBU assistant general secretary said: “Firefighters rightly expect employers to take the threat contaminants pose to mothers’ and babies’ health seriously. Employers should be doing everything in their power to ensure that the material support is there, so that nobody is forced to choose between working as a firefighter and becoming a parent.

“Proper maternity pay is essential for building an equal, supportive fire service which values and protects the health of pregnant staff and new parents."

Robyn Richardson, acting secretary of the FBU National Women’s Committee said:  “No-one should have to choose between protecting their salary and having a baby. Many firefighters struggle to make ends meet on half pay, forcing them to return to work far sooner than they should have to. 

“Firefighter maternity pay is currently a lottery depending on where you work in the country. Stress and financial pressure are the last things you need when caring for a new-born. Women have been raising the need for proper maternity provision for decades: it is vital to building a supportive, inclusive workplace. The fire service can and must do better.”

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Cancer studies have neglected the workplace risks faced by women. Hazards editor Rory O’Neill looks at new evidence of the damaging consequences for prevention, compensation and women’s health.

Real risks
Problem diagnosed

Warning on women’s work health crisis
Firefighters’ safety call for better maternity pay

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