Occupational risk factors still ‘largely overlooked,’ says expert
There’s no shortage of pink merchandise that sells a promise that proceeds will go toward breast cancer research.
But what exactly is "breast cancer research?" Where are those proceeds really going?
Not, it would seem, toward research around the prevention of workplace risk factors for breast cancer, said Jim Brophy, occupational health researcher at the University of Windsor in Ontario, adding it’s an area of research that is "woefully neglected."
"We firmly believe that research into preventable causes of breast cancer has to be given a much higher priority than it is getting. Unfortunately, the focus — the scarce research into prevention that is being done — is primarily looking at the individual lifestyle factors such as diet, exercise, smoking and alcohol use — in other words, voluntary factors to which personal responsibility can be assigned," he said.
"But these factors can’t account for the majority of cases. In fact, there is evidence that there are likely multiple interacting factors, including environmental exposures and timing of exposure, that may be significant contributors."
Study highlights hazards
Brophy and his partner and fellow researcher, Margaret Keith, conducted two studies into occupational risk factors for breast cancer. One of the studies, released in 2012, was a large case-control study that took six years to complete.
Published in the journal Environmental Health, it studied 1,006 women with breast cancer and 1,146 randomly selected women from the community who did not have breast cancer.
The central finding?
"A number of occupations were found to increase breast cancer risk," said Brophy, adding that there’s mounting evidence many different occupational factors may substantially increase the risk.
Overall, there was an increase in breast cancer risk of 42 per cent among women across all occupations and industries who were highly exposed to either mammary carcinogens or endocrine disrupters, found the study.
Women who worked in farming had a 36 per cent increase in breast cancer risk, while the risk more than doubled for women working in bars and gambling facilities such as casinos and racetracks, said Brophy.
"A 73 per cent increase in risk was found in the metalworking sector… and the risk more than doubled for women working in the food canning sector, as well as for women working in automotive plastics manufacturing," he added.
There were also some important findings about pre-menopausal women, who generally have a much lower risk for developing breast cancer.
"The risk of developing breast cancer before menopause was more than 400 per cent higher for women who worked in automotive plastics, and the risk was more than 500 per cent higher for those who worked in food canning," said Brophy.
Brophy and Keith also conducted a qualitative study to better understand the exposures workers had in these settings. That research, which took about three years to complete, gathered descriptive information through focus groups with more than 150 individuals who had worked in occupations such as farming, auto manufacturing, health care, dental, metalworking and hairdressing, said Keith.
"We heard from pretty much every occupational group… that they very much feared job loss. And this fear has had a chilling effect on efforts to gain health and safety improvements."
‘It’s never just one thing’
One of the reasons occupational factors that might contribute to breast cancer are often overlooked is because many assume breast cancer is genetic, or due to behavioural factors, said Charlotte Brody, vice-president of health initiatives at the BlueGreen Alliance in Minneapolis, Minn.
"Almost everybody who’s ever talked about breast cancer talks about the breast cancer gene, and (that’s a) tiny fraction of the breast cancer story," she said, as genetics account for only a small proportion of breast cancer causation.
"If you want to talk about preventing breast cancer, you have to talk about what are the factors that add up to breast cancer? And what can we do to minimize those factors?" she said.
"It’s never just one thing that makes you sick — not for breast cancer and really probably for anything else. It’s always a combination of factors that makes you sick."
It can be stress, it can be night shift work, it can be radiation, it can be having benign breast disease and it can be chemicals. And it’s the combination of factors that tips the balance between health and disease, said Brody.
The concept of risk is central to this issue, said Keith.
"It’s generally acknowledged that society tolerates a degree of risk in exchange for economic advantages. However, not all members of society share equally in the risks or advantages."
We need to be asking questions about what level of risk is acceptable, and who makes the decisions about the level of risk workers are exposed to, said Keith.
"(And) what do we do if science is not yet developed enough to determine whether or not there is risk of human harm from exposure, as may be the case with many chemicals?" she said.
"Unfortunately, the setting of occupational exposure limits does not take into account whether a substance has been found to cause breast cancer in test animals, whether it is an endocrine disrupter or what might be the potential effects of mixtures in real-life work environments."
Breast cancer research has had very encouraging results when it comes to treatments and mortality rates, said Brody.
"Fewer and fewer women who have a breast cancer diagnosis die because of that diagnosis. That’s very good news. But we shouldn’t let that good news prevent us from understanding that the incidence of breast cancer is going up," she said.
"If we put money into prevention, we could see good results from that as well."
Lack of funding, lack of awareness
In 2011, consultations took place with Canadian stakeholders including labour and health-care groups, said Brophy. The resulting report identified a number of barriers preventing further research into occupational risk factors for breast cancer, including "lack of funding, poor data regarding exposures, lack of awareness and resistance from employers and industry."
It also identified difficulties associated with using the results from occupational cancer research in the workplace to reduce the risks, said Brophy.
The lack of attention to the issue and employers’ failure to consider safer alternatives to potentially harmful or carcinogenic chemicals is a symptom of a deeper problem, he said.
"This issue lights up what is the ongoing problem for workers, which is the lack of democracy, the lack of power to shape the environment in which they work," he said.
Women often work in precarious employment situations, including in workplaces where they are likely to be exposed to toxic chemicals, said Brophy — and the more vulnerable the position they are in, they more difficult it is to speak up on health and safety issues.
The American Public Health Association released a policy resolution in November 2014 discussing the need for action around breast cancer and potential occupational factors in its development.
"Despite significant scientific evidence about its known or suspected causes, research and prevention measures to identify and eliminate occupational and other environmental hazards and risk factors for breast cancer remain largely overlooked," said the policy.
"Action required starts with making a national priority of promoting and supporting research on occupational and other environmental causes of breast cancer."
There’s also an enormous amount of work that can be done around green procurement, said Brody, adding that Wal-Mart has actually done a very good job of this.
"They’re basically saying to their supply chain, ‘We don’t want carcinogens in our products, we don’t want neurotoxins in our products. So if you want to sell to us — and by the way, you can’t survive without selling to us — here’s our list of priority chemicals. You’ve got three years, and we want them out.’"
