Controlling occupational cancers in Australia

Work-related cancer attracts considerable public and media attention, but has received limited attention from researchers and policymakers in Australia, particularly in comparison to other cancers, such as those related to tobacco use and sun exposure. During the 1980s, the National Health and Medical Research Council (NHMRC) issued model regulations for the control of carcinogenic substances, and the National Occupational Health and Safety Commission (NOHSC) was formed to coordinate efforts to improve OHS. Policies and strategies on occupational cancer were developed by the NOHSC, and the Australian Mesothelioma Registry was funded. In 2005, the NOHSC was replaced by the Australian Safety and Compensation Council (ASCC).1 In turn, in 2008 the ASCC was replaced by Safe Work Australia, which has the primary responsibility of “improving work health and safety and workers’ compensation arrangements across Australia”.2 Despite these initiatives, little progress has been made on Australia’s regulatory approach to occupational carcinogen exposure.

The number of cancers resulting from occupational exposures is difficult to estimate. Occupational cancers are not easily identifiable, as they have no unique pathological or clinical features and the lag time between exposure and cancer diagnosis may be decades. There is no unique independent system for collection of data on work-related cancers, and compensation data are of little help because of considerable underclaiming. By applying European attributable fraction estimates to Australian employment data, it has been estimated that about 5000 cancers a year are caused by occupational exposures.3 In making this estimate, major assumptions needed to be made regarding the frequency and extent of exposure to occupational carcinogens in Australian industry, since definitive local information is lacking.

In Australia, there is limited systematic work aimed at identifying occupational carcinogens, informing users about carcinogenic risks, and reducing the use of chemicals in industry. Internationally, there are several such initiatives that could be considered for the Australian context.

A number of authoritative independent agencies, such as the International Agency for Research on Cancer, have programs that review evidence regarding potential carcinogens and classify agents according to their carcinogenic potential.4 Other agencies, such as the American Conference of Governmental Industrial Hygienists5 and the United States National Toxicology Program,6 classify agents with respect to carcinogenicity and set occupational and general population exposure standards that are regularly updated and revised. Germany maintains a database of international exposure limits for chemical agents.7 Australian regulations related to carcinogens make use of these international classifications when identifying carcinogenic substances (eg, the Australian Model Work Health and Safety Regulations contain a limited schedule of nine prohibited and 11 restricted carcinogens).8 However, there is no system to regularly update regulations and schedules based on best international knowledge.

The United Nations Globally Harmonized System of Classification and Labelling of Chemicals (GHS) is being adopted internationally.9 The GHS classifies chemicals by type of hazard (including carcinogenicity) and proposes standard labels and safety data sheets containing information on physical hazards and toxicity. The proposed Australian Model Work Health and Safety Regulations implement the GHS for chemical classification and hazard communication requirements.

The European Union (EU) introduced legislation in 2007 for the registration, evaluation, authorisation and restriction of chemicals (REACH).10 The REACH approach is based on the premise of “no data, no use”. That is, toxicological and epidemiological data must be provided for substances manufactured or imported into the EU in excess of 1 tonne. For some substances, derived no-effect levels (DNELs) for workers and the general population must be set. No human health effects are expected if exposure is kept below the relevant DNEL. REACH does not apply outside the EU, but it does apply to all substances on the EU market, including those imported from Australia.

A very successful example of legislation aimed at reducing exposure to toxic agents (including some carcinogens) is the Massachusetts Toxics Use Reduction Act (TURA).11 Under TURA, a list of toxic or hazardous substances (“toxics”) has been created, and any firm that uses, generates or imports any of these must prepare a toxics use reduction plan, report the quantities of toxics they deal with and pay a levy based on the quantity reported. An institute was established to provide resources and tools to support the TURA, including education, community outreach, research into less toxic alternatives, and incentives.12 Between 1990 and 2009, and after adjusting for production decreases, reports to the program showed that emissions decreased by 56% and use of toxic chemicals decreased by 21%.13

Another legislative approach to reducing carcinogen exposure was introduced in Finland in 1979. Companies and institutions are required to report workplace exposures to specific carcinogens to a public register. The aim is to reduce the risk of occupational cancers by improving the identification, assessment and elimination of workplace carcinogens. Between 2000 and 2004, the register received, on average, 25 109 notifications of exposed workers, representing 39 300 exposure events annually.14

Strategic action aimed at reducing the burden of occupational cancer in Australia needs to be concentrated around three aspects: raising the profile of occupational cancer; interventions to reduce exposure to carcinogens, supported by legislative processes; and improving the support for patients with occupation-related cancer.