Landmark paper sets a seriously flawed occupational cancer benchmark

The 1981 Doll/Peto paper remained the UK Health and Safety Executive’s preferred source for estimates of occupational cancer causes and incidence until 2008, long after the findings has been disputed and described as “discredited”.  Errors in methodology led to a substantial under-estimate of the true incidence. The pro-industry leanings of the lead author was also criticised. Hazards magazine noted in 2007 that basing official policies on Doll/Peto estimates has resulted in a chronic failure to secure either the resources or the priority required for meaningful preventive action.

Doll R and Peto R. The causes of cancer: Quantitative estimates of avoidable risks of cancer in the United States today, Journal of the National Cancer Institute, volume 66, number 6, pages 1191-1308, 1981.

‘Lifestyle’ cancer bias used to absolve real workplace culprits

The major challengers of the estimates made by Doll and Peto from the late 1970s and 1980s. Epstein and Schwartz give greater weight to toxicological and clinical research and challenge the relatively low estimates given by Doll and Peto to work and wider environmental factors. Self-interest of the chemical industry apart, the lifestyle theory of cancer causation is held to reflect misinformation and ‘inactive conservatism’.

Epstein S and JSchwarz. Fallacies of lifestyle cancer theories. Nature, volume 289, pages 127–130, 1991.

US union declares war on workplace cancers

This groundbreaking guide from the US autoworkers’ union UAW, issued in 1980 and reprinted in 1992, gave workers the information to interpret epidemiological studies for themselves, identify their strengths and weaknesses and to identify work-related cancer risks for themselves. The initiative came as the UAW leadership declared “war on workplace cancer” in response to an alarming series of cancer mortality studies conducted among autoworkers by government, company, and union epidemiologists.

These studies revealed an “increased proportion of cancer deaths” among “workers in machining operations, foundry workers, and workers in vehicle assembly plants”; the epidemiologists believed those deaths were related to occupational carcinogen exposure.

The Case of the Workplace Killers: A Manual for Cancer Detectives on the Job, UAW, November 1980. For a review of UAW’s ‘war on workplace cancer’, see: Josiah Rector. Environmental Justice at Work: The UAW, the War on Cancer, and the Right to Equal Protection from Toxic Hazards in Postwar America, Journal of American History, volume 101, number 2, pages 480-502, September 2014. Full text of the article is posted online here.

Pre-Doll papers show much higher risks

Two major US reports published shortly before the 1981 Doll/Peto report – one from US government organisations  and another backed by employers’ organisations – put the occupational cancer contribution at least 20 per cent of all cancers, with the industry-backed report conceding occupational cancer constituted “a public health catastrophe”.

Bridbord K and others. Estimates of the fraction of cancer in the United States related to occupational factors. Bethesda, MD: National Cancer Institute, National Institute of Environmental Health Sciences, and National Institute for Occupational Safety and Health, 1978.

Proctor R. Cancer Wars. New York: Basic Books, 1995 (includes reference to the early industry-backed estimate).

Benzene linked to leukaemia

The study uncovered high rates of leukaemias in a population exposed only to the solvent benzene and where benzene levels were generally below recommended limits. The authors acknowledge that the figures underestimate the scale of the problem. It was  the first cohort study of workers linking benzene exposure directly to leukaemia. Under-reporting remains a problem to the present. The industry was criticised in 2014 after it was revealed it has operated a long-term project to suppress or rebut evidence of this cancer link (see CPI, 2014). A 2004 study confirmed health risks at low level exposure to benzene. Concerns were raised in 2014 about harmful benzene exposure levels in the vicinity of fracking operations (see Macey and others, 2014).

Peter Infante, Robert Rinsky, Joseph Wagoner, and Ronald Young. Leukaemia in benzene workers, Lancet, volume 2(8028), pages 76-78, 9 July 1977.

A continually-updated, annotated bibliography of occupational cancer research produced by Hazards magazine, the Alliance for Cancer Prevention and the International Trade Union Confederation (ITUC).