US president’s panel calls for cancer precaution

CATCHING CANCER  Authorities in the US and the UK have both seriously under-estimated the extend of occupational and environmental cancers, new reports show.

CATCHING CANCER Authorities in the US and the UK have both seriously under-estimated the extent of occupational and environmental cancers, new reports show.

Policymakers in the US should abandon a reactionary approach to regulation of cancer causing chemicals and champion a precautionary approach, top advisers to Barack Obama have said. Their report comes on the heels of a UK study of occupational cancer numbers which shows the official estimates cited routinely by both US and UK authorities have greatly under-played the extent of the problem.

This month’s strongly worded report 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 Safety and Health 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.”

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. The reality of this unequal burden is not just a health issue, but an issue of environmental justice.”

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 UK report indicates thousands of occupational cancer deaths each year have been missed in official estimates. The study for the Health and Safety Executive (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. This 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.

The figure is conservative for a host of reasons. The study only considered group 1 and 2a carcinogens, discounting possibles caused by those 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. And 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. In addition, other nations recognise risks from more substances and for cancers at shorter latency periods.

TUC general secretary Brendan Barber commented: ‘This paper confirms that past estimates of the numbers of cancers caused by occupational exposure have been too low. However it also shows that the effect on women has been under-estimated in the past – in particular the relationship between shiftwork and breast cancer.’

He added: ‘We welcome the additional work the HSE is doing in this, but this should not be used as an excuse for delay as there is already sufficient evidence for cancer prevention to be given a much higher priority.’

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.

Unlike the UK report, the US President’s panel report calls for explicit and radical measures to address the problem. The 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.”

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