Occupational workplace dangers of bladder cancer continue to swell despite improvements in risk knowledge and materials
Occupational exposure to carcinogens is to blame for the rising rates of bladder cancer in workers. The overall risk of bladder cancer mortality is greater for men than for women, while the incidence seems to be increasing faster in women than in men according to the Oct. 8 JAMA Oncology, Contemporary Occupational Carcinogen Exposure and Bladder Cancer, an online report.
There are approximately 60 to 70 chemicals known to cause cancer that employees in Canadian workplaces are exposed to, said Paul Demers, the director of the Occupational Cancer Research Centre with Cancer Care Ontario. Various types of cancer are caused by various types of chemicals, so it is often difficult to generalize which professions need to be wary of which carcinogens, he explained.
"Groups that are classically at high risk are people in mining, various parts of construction involve exposure to a number of carcinogens as well, but it can impact people in a lot of different professions, people in the printing industry… hairdressers appear to have an increased risk of bladder cancer," said Demers.
According to the report, workers who regularly use tobacco, dye, rubber, and leather in their work have the highest incidence rates of bladder cancer due to the presence of the chemical called aromatic amines. The second chemical prevalent to bladder cancer, is polycyclic aromatic hydrocarbons. Chimney sweeps, nurses, waiters, aluminum workers, seamen, and oil/petroleum workers are shown to have the greatest mortality rate due to its use.
Agricultural sector workers can breathe a sigh of relief because they have the lowest occupational bladder cancer risk, suggested the report.
"The primary concern is usually carcinogens in the air; sometimes there are also things that people get on their skin like soot and some chemicals can pass through the skin and also increase the risk of cancer," said Demers.
There are a number of extremely toxic chemicals that are no longer used in the workplace because they are known to cause bladder cancer, but other contributors such as diesel — which creates cancer-causing exhaust — are still used regularly, Demers explained. "Diesel exhaust is a cause of lung cancer, but we also think it’s a probable cause of bladder cancer and there are hundreds of thousands of people across this country who are exposed to diesel engine exhaust."
Painters also have an increased risk of bladder cancer, but cancer research professionals are not sure what it is about the work that increases the risk, "and that makes it hard to prevent," he said.
Bladder cancer is the sixth most common type of cancer and is less deadly than certain other types of cancer, such as lung cancer. When considering safety policies at the workplace, employers must be aware of a myriad of types of cancer, explained Demers. "Our knowledge of what causes cancer is always increasing and we have to keep up with that."
Understanding causes can take time
While present laws and common sense may guide occupational health and safety-minded employers in decision-making that help keep employees safer, it often takes time to decipher what caused the disease. "Our legislation and protective measures are not always up to date. We have to keep vigilant all the time," said Demers.
Sometimes implementing legislation following a discovery that a chemical is detrimental to a worker’s health can be fast, "but usually it takes some years depending on the nature of the chemical and how important it is," said Demers. "The worst example is probably asbestos."
There has been reliable evidence that the chemical caused cancer since as early as the 1950s, he said, but it wasn’t until the mid-seventies that drastic actions were finally taken to reduce the use of asbestos. "That is the worst case scenario and we’ll be paying the price for that for decades to come," he noted.
Despite the seeming lack of action, there are safeguards in place for Canadian employers and employees. "In order for employees to protect themselves, they should be aware of what their employer obligations are at law" as well as their own, said Nathaniel Marshall, associate at Johnstone & Cowling LLP in Toronto, Ont. "The employee has the ability to refuse unsafe work," he said, "they can raise this complaint with management or, if necessary, with a union representative." There is no set procedure to how this must be done and can be as simple as a worker saying, "Hey I don’t think this is totally safe," explained Marshall. If a relationship with the employer is such as that the employee doesn’t feel safe casually explaining his position, more formal measures can also be taken under the law.
The Occupational Health and Safety Act is the piece of legislation that helps protect employees and employers in the workplace when it comes to occupational health and safety concerns, Marshall said. Naturally employers have onerous obligations under the act and "it is the employer’s responsibility to take all reasonable precautions in the circumstances to protect its workers," he said.
The definition or "reasonable precautions" are fact-specific, explained Marshall, and would depend on the nature of the workplace, the work that is performed, and what safety mechanisms would be required in those circumstances. The act only requires the minimum standard to be applied, "but there is nothing stopping employers from going further than that, so they can always do more than what the act requires," said Marshall.
Soliciting input from employees is key to figuring out potential safety issues at the workplace. Protection from bladder cancer-causing hazardous materials specifically can be done through "diligent inspections of their storage and hygiene facilities, of PPE — personal protective equipment — the engineering controls that are in place, random air quality testing to make sure everything is working properly, and also to identify potential problems, before they actually become a problem," Marshall said.
