Occupational Cancer Prevention in Scotland: Challenges and Opportunities

1. “Why the UK stalled on occupational cancer prevention, where we stand now internationally and what Scotland can do about it?” Andrew Watterson, Tommy Gorman, Rory O’Neill Occupational and Environmental Health Research Group Centre for Public Health and Population Health Research School of Health Sciences, University of Stirling, Scotland WHO estimate that globally 7-19% of all cancers are due to toxic environmental exposures. 2009 • 15,764 people died from cancer in Scotland in 2013 • If 10% of cancer deaths are work-related, an estimated 1576 deaths are work-related = cost to Scotland of £3,862,200,000 (estimate of £2.45 million per cancer death DEFRA 2006) • Estimated 1 in 5 workers exposed to carcinogens

2. Occupational cancer prevention?

3. Hueper’s occupational cancers - some substance and Site Concerns 1942 • Asbestos • Benzidine • Diesel • Dyes, coal tar • Endocrine disruptors linked to breast cancer • Metal Dust • ‘Blood’ cancers • Brain cancers • Breast cancer (endocrine) • Lung cancers • Naso-pharyngeal cancers • Prostate cancer (Oppenheimer 1926; Henry et al 1931 6 of 46 occupations • Testicular cancer (Shimkin 1941 stilbestrol) Andrew Watterson UoS Holyrood March 2105

4. Global estimates of fatal work-related-diseases. Hamalainen et al 2007 AJIM 50:28-41 (1) In 2012, an EU Occupational Health and Safety workshop looked at occupationally-caused and related cancers and identified ‘hidden’ groups whose occupational exposure to cancer risks and carcinogenic processes was under-represented in exposure data and intervention strategies (EASHW 2012). They noted an unrecognised work-related cancer burden in lower socio-economic classes, women, migrant workers, the precariat and floated the concept of ‘socially discriminating cancers’ Andrew Watterson UoS Holyrood March 2105

5. EU/Global Statistical picture. EASHW 2008 Andrew Watterson UoS Holyrood March 2105

6. Table: Estimate of the proportion of cancer deaths that will be found to be attributable to various factors UK/ US Cancer Pattern, cited by Peter Boyle, Source: Doll & Peto (1981)

7. “Scotland and some occupational cancer studies, missed policy opportunities and developments 1990s: Old epidemics and endemics in occupational health – cancers listed 2006 The economic costs of health service treatments for occupational cancers. Annals New York Academy Science, 1076; 871-881. OEHRG 2006. OEHRG met Scottish Minister of Public Health to discuss occupational cancer prevention 2006-2015 OEHRG held workshops and spoke at seminars on occupational cancer prevention 2008 OEHRG produced paper on ‘Burying the Evidence on occupational cancer’ 2008 OEHRG held international conference in Stirling on occupational and environmental cancer prevention 2008 OEHRG published paper in European Journal of Oncology on “occupational cancer prevention in Scotland: a missing public health priority”. 2014 OEHRG worked for WHO on costs of occupational cancers 2014 APHA occupational breast cancer prevention policy initiative based on OEHRG 1875 The first case of paraffin cancer in GB was described by Bell in Scottish shale oil plants - ‘a well known fact among the local physicians’ (Hueper 1942:156) Major public health threats in Scotland? Skewing risk assessment, risk reduction & risk management? (from 2006) Murders 2003 = 108 Road traffic fatalities 2004 = 306 (includes work link) Suicides 2004 = 835 Occupational cancer 2004 = 600 using 4% Doll/Peto estimates 1800 (12% Clapp estimate) 1922. Scott described 19 cases of paraffin cancer in the Scottish industry. No effective action had apparently followed Bell’s report

8. The ‘top’ 10 occupational carcinogens and their related cancers and their prescribed industrial disease status (HSE 2012 and DWP): Alberta firefighters recognised diseases = 14. UK = 0? Source: Watterson 2015

9. Simple solutions? The law on workplace carcinogens REACH COSHH and related EU Management directives EU Carcinogen Directive 2004 ECHA IARC CLP Regulations 2010-2015 Hazard category – carcinogen is a substance or mixture that induces or increases cancer incidence with mechanisms relevant to humans 1A known human carcinogen – largely human evidence H350 eg-i 1B presumed human carcinogen – largely animal evidence H351 2. Suspect human carcinogen – evidence but not yet sufficiently strong CMR,toxicity, respiratory sensitiser Specific regulations such as: – Control of Asbestos Regulations 2012 - Ionising Radiations Regulations 1999 [1] (IRR99) and The Radiation (Emergency Preparedness and Public Information) Regulations 2001[2] (REPPIR)

10. Global activity on cancer prevention Canada 2000s WHO/IARC and Asturias 2011 PP information -regulation, enforcement and sunsetting The UK? French substitution programme 2000s USA 1990s onwards

11. Scottish specific strategies and opportunities – a more Nordic model? • Scottish Government discussion/ focus, with cross-party initiatives, on occupational and environmental diseases including cancer and using public and community engagement • Prevention through public health and social and environmental justice - linking NHS policy, plans and practice with enforcement and regulation by HSE and SEPA and in the Scottish Government’s Better Cancer Care and Action Plans (2008>) • Prevention through incentives? Scottish Government benefits for enterprises that adopt toxics use reduction/sunsetting/green jobs strategies on carcinogens? • Prevention through economic penalties? Scottish parliamentary action to recover costs of occupational and environmental diseases, including occupational cancer, from employers? • Greater governmental support for victims of occupational cancer through better disease recognition and recording, welfare rights and social services. ? • Greater support, advice, information and use of existing regulation and enforcement where needed from HSE/SEPA/EHOs on occupational and environmental monitoring of industries and workplaces using and emitting carcinogens. ? UK ACTS and WATCH vanishing? Andrew Watterson UoS Holyrood March 2105

12. Reductions TURI (1990 - 2005) Andrew Watterson UoS Holyrood March 2105