Unlike workplace accidents, where injuries can be relatively quickly assessed and compensation awarded, it can take years or many decades before work-related cancers are diagnosed.
There is no doubt some exposures in the past have left workers with a cancer diagnosis that would not have otherwise occurred. Sometimes that happened before the link between the exposure and cancer was clearly understood, such as the early asbestos miners.
Since modern occupational health and safety legislation came into play in Australia in the 1970s and early 80s, exposures have included people working in the sun and people working in smokey bars and clubs.
To count the recent cost of cancer at work, we gathered data from Safework Australia spanning the 12 years to 2012. Our report, released today, shows 4,745 Aussies received a compensation payout for a cancer that was, at least in part, caused by an occupational exposure. This totalled A$360 million over the 12 years.
Sun exposure contributing to skin cancer was one of two big-ticket items. More than half (53%) of the claims related to neoplasams (another term for cancer, melanoma and non-melanoma skin cancers) of the skin of one kind or another. People with skin cancers due to outdoor work attracted 15% of the funds paid.
The other was asbestos: about three-quarters of the A$360 million has been paid to people with mesothelioma.
These sound like big numbers until we consider that the best estimates suggest about 5,000 cancer cases each year (about 4,400 of whom are men) occur as a result of some kind of occupational exposure. That means less than 10% of the cancer cases suspected to be linked to work exposures manage to attract compensation.
Why so little compensation?
Some, but not all cancers, have clear causes. Mesothelioma, for instance, is unequivocally linked to asbestos exposure.
Lung cancer can be caused by the individual’s smoking, or in non-smokers, it might be linked to exposures such as second-hand smoke at work, silica, formaldehyde and asbestos (for every mesothelioma case caused by asbestos there are probably two additional lung cancer cases).
However, workers who smoked and had workplace exposure to other cancer-causing agents may not be getting or even seeking compensation.
Some occupational exposures happen outside work too, such as sun exposure. But compensation should be paid if there is some demonstrable “work-related injury” that contributed to the disease.
So the PE teacher – who is also a surf lifesaver and cricketer – can still seek compensation for her squamous cell carcinoma after running school sport for the first 15 years of her career without wearing a hat and sunscreen.
There are, of course, the chemical exposures specific to some industries that most people immediately think of when considering this issue. Benzene, formaldehyde and nitrosamines are known carcinogens and can all be found in some Australian workplaces.
Diesel is another important example. A recent study estimated almost 14% of the Australians workforce had significant exposure to diesel exhaust. And almost 2% had high levels in their current jobs.
The truckie spending 50 hours a week or more in the cabin breathing the exhaust from his own rig and the traffic around him is increasing his lung cancer risk. So too is the underground miner using diesel-driven mine equipment, particularly if in a confined space.
Emission-reduction technology will help. But transport workers of the past need to know they carry their previous exposure as a possible contributor to any future lung cancer. They carry that risk to a far greater extent than any routine commuter.
Painters and plumbers exposed to lead, metal workers and electrical workers exposed to cadmium and farmers and gardeners exposed to glyphosate are all examples where products are still in use and personal protective equipment should be used. But it would be better would be to find other substances to serve the same function.
Preventing work-related cancers
When it comes to prevention, we’ve made some steady progress. Asbestos has been banned for decades and we’ve been banging on about SunSmart for more than 30 years. But in both cases we are not out of the woods.
We still have no clear record of how much asbestos is in public and private buildings and homes in Australia. Those working in construction, maintenance, renovation or refit do not have confidence in identifying asbestos. Nor do they have a clear diagram explaining where they might come across it in the work they do.
And there are still too many employers who have staff regularly working outdoors who do not have clear sun protection policies.
For people who are diagnosed with cancers and who have a work history of being exposed to carcinogens, we need a better mechanism to identify the connection and explore proper compensation.
For the current and future generations of workers, we need to keep improving conditions to cut out as much exposure to cancer-causing agents as is humanly possible. Employers should be aware of the specific risks they have in their industry and either find different ways to tackle the task or, if that’s not viable, ensuring the risk is effectively removed or reduced.
Other groups also have important roles to play. Regulators need to keep on top of the best evidence on cancer-causing agents as they unfold. Doctors diagnosing cancer might also brush up on their work history recording skills.
Finally, workers also need to play their part by following health and safety procedures. The best cancer is the one we prevent.
Terry Slevin receives funding from health and research funding agencies which finance health promotion programs (eg Departments of Health and Health Promotion Foundations) and public health research. He is affiliated with The Cancer Council WA and Cancer Council Australia and a member of the Public Health Association of Australia..