It’s time we cared for those who care for us

It’s time we cared for those who care for us

Millions of frontline workers across the EU have put themselves at risk of being infected by COVID-19 whilst doing their jobs. Now it's time to protect them against an even older enemy.

Frontline workers, from nurses to firefighters, delivery drivers to cleaners, have worked tirelessly through the pandemic to maintain essential services and keep society moving. But the health of millions of these workers across the European Union has been under threat long before the pandemic, from a very different cause.

Cancer is the leading cause of work-related death in the EU, accounting for an astonishing 100,000 new cases and 80,000 deaths each year. European workers are at risk of developing cancer by being exposed at work to substances they use day in, day out, year on year. Importantly, according to the European Commission, over 40% of cancer cases are preventable.

In the healthcare sector alone, 12.7 million professionals in Europe are occupationally exposed to deadly hazardous drugs, such as cytotoxic drugs, which are vital for the treatment of cancer as they are effective killers of cancerous cells. However, they are also non-selective, meaning that they do not differentiate between malignant cells and normal healthy tissue. This poses a real danger for healthcare professionals who regularly handle cytotoxic drugs as research shows they are three times more likely to develop cancer.

The very same healthcare professionals who have put their lives on the line during COVID-19 are also therefore putting themselves at risk of developing cancer and other diseases when preparing, administering, transporting and disposing of these hazardous carcinogenic drugs. Patients and families are also at risk as studies have shown that public areas in hospitals are often contaminated, and as are people's homes because care is increasingly provided outside of hospitals.

Unfortunately, the real tragedy of work-related cancer is that a workers’ long-term exposure to hazardous substances might not result in the diagnosis of cancer for years, if not decades, later. An ex-firefighter whose career involved regular exposure to the fumes of harmful chemicals, or a cancer nurse soon to retire, may learn too late that they have developed cancer without realizing, at the time, that it was their work which has seriously damaged their health.

Sadly, the health risks associated with exposure to hazardous substances are not limited to an increased chance of developing cancer. Substances such as Glycol ethers, which are commonly used as solvents, or warfarin, which is used as a biocide, are examples of reprotoxins. This means they all adversely affect the ability of men and women to reproduce and can also alter child development during gestation and after birth.

Research on the impact of reproxtoxins was undertaken in Denmark between 1997 and 2013. The study monitored children whose mothers worked in greenhouses and found that the exposure of the workers to pesticides during the first 8 weeks of pregnancy led to numerous health issues in the child once it was born. Studies also show that nurses exposed to cytotoxic drugs are twice as likely to miscarry.

Whether it be exposure to carcinogenic hazardous substances or chemicals which affect reproductive health, the potential impact on a person’s life is long-lasting and life threatening and so everything should be done to stop this from happening - especially in the workplace. We know that prevention is better than cure, and we know that workplace cancer and reproductive problems can be prevented through legislative protection.

The European Commission is rightly prioritising the need for prevention measures in its BEATING CANCER PLAN for 2020, which includes “further legislative and soft measures to reduce exposure to carcinogenic substances in the workplace.” This will help to raise awareness of the issue of work-related cancer, but policymakers need to act now, not talk, to save lives.

The European institutions have attempted to address some of these issues with recent and regular revisions of the Carcinogens and Mutagens Directive (CMD) which is designed to prevent occupational exposure to hazardous substances. The CMD remains the most effective and only current legislation which can protect workers from exposure to hazardous drugs and reprotoxins.

We welcome the recent proposal by the European Commission on a fourth revision of the Directive (CMD4), published on 22 September 2020, introducing binding occupational exposure limit values for three carcinogens. It was, however, a great pity that the Commission did not take the opportunity to include hazardous drugs and reprotoxins in the proposal.

All hope is not lost. The solutions exist. It is simply a matter of political will.

The most effective solution is complex in wording but straightforward in practice. It requires the European Commission and the other EU institutions to accept legislation in the current fourth revision of the Carcinogens and Mutagens Directive (CMD4) to include three groups of hazardous drugs in Appendix I and reprotoxins in the title of the CMD. This should be supported and supplemented by new guidance to ensure that effective prevention measures are put in place and implemented across Europe.

It will be said that there is no need for legislation, that it does not work, or that we need to wait for further research or evidence. The truth is that we have known about these risks for decades and have done very little to address them in practice. We know that legislation works and will work to stop cancer at work.

The time for debate is over, the time for action to protect those who care for us is now.

Stop Cancer at Work campaign is to protect workers across the EU.

Supported by The European Trade Union Confederation (ETUC), European Trade Union Institute (ETUI), European Public Services Union (EPSU) and European Biosafety Network (EBN) – with other partners including the European Federation of Nurses Associations (EFN), Standing Committee of European Doctors (CPME), European Cancer Patient Coalition (ECPC), European Specialist Nurses Organisation (ESNO), and European Association Pharmacy Technicians (EAPT).

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