Last reviewed 31 July 2017

Lung cancer is the UK’s biggest cancer killer and increasingly health and safety campaigners and employers are focusing on this disease in order to tackle the unacceptably high burden of occupational ill health facing the nation’s workers. Marking World Lung Cancer Day on 1 August 2017, Vicky Powell takes a look at the facts about the disease and current efforts to reduce cancer-related respiratory risks to British workers.

Lung cancer at work — the facts

According to the charity Cancer Research UK, it has been estimated that around a fifth of lung cancers in men in the UK (about 21%) and between 4 and 5% of lung cancers in women in the UK are linked to work-related exposures.

Smoking remains the greatest risk factor for lung cancer, with an estimated 86% of lung cancers in the UK linked to tobacco smoking. However, exposure to substances like asbestos, silica and radon, as well as air pollution, also greatly increase the risk of developing the disease.

A number of occupational exposures have been classified by the International Agency for Research on Cancer (IARC) as causes of lung cancer. In the UK, these occupational exposures can be analysed as follows.

  • An estimated 6 to 8% of lung cancer deaths in the UK each year are linked to asbestos exposure. Lung cancer mortality is 77% higher in asbestos-exposed workers, compared with the general population.

  • Silica dust, from sand, stone and concrete, is another leading occupational cause of lung cancer. The risk of lung cancer is 55% higher in men who have worked as bricklayers, compared with men who have never done so, with experts concluding that this is probably due to silica exposure.

  • In professional drivers, lung cancer risk is between 19 and 47% higher than the general population and mechanics are also a higher risk group.

  • Painters represent yet another higher risk group — with a risk of lung cancer between 22 and 57% higher compared with the general population.

  • Dioxins such as TCDD, typically found in metal and pesticide production, are another hazardous substance which has been linked to lung cancer — pesticide production workers face a risk of death from lung cancer which is 22% higher than the average.

  • Welding fumes are classified by IARC as a cause of lung cancer, with the risk of lung cancer 26% higher in welders than in the general population.

  • Other occupational causes include radon, mineral oils, arsenic and inorganic arsenic compounds and rock wool and glass wool. The risk of lung cancer is also higher in iron and steel foundry workers.

Taking action on lung cancer

The sixth annual World Lung Cancer Day takes place on 1 August 2017, as an international grassroots initiative. Supporters of the Day have pointed out that lung cancer was a rare disease in the early 20th Century but its incidence has gradually increased in the last 100 years. However, lung cancer remains a preventable disease, considering the key risk factors of tobacco, industrial products, air pollution and nutritional deficiencies. Indeed, recent research has demonstrated that the critical factor increasing the risk of lung cancer is quite simply the long-term respiration of carcinogenic materials.

Increasingly, health and safety campaigners in the UK are taking a targeted approach in their efforts, focusing initiatives for work-related health on the areas where the greatest impacts can be achieved.

On 28 April 2015, Workers’ Memorial Day, the British Occupational Hygiene Society (BOHS) launched its Breathe Freely initiative, aimed at controlling exposures to prevent occupational lung disease in the construction industry. Subsequently, in 2017, the Chartered Society for Worker Health Protection launched a second campaign, focused on the manufacturing sector, to run in tandem with the Society’s existing construction-based initiative.

Lung cancer is a key focus for both BOHS initiatives.

  • Over 5500 construction workers develop cancer each year and 3500 former construction workers die of the disease, as a result of occupational exposures.

  • However, it must be noted that the majority of the above cases of cancer are caused by breathing in carcinogenic substances: the most significant carcinogens in the construction sector are past exposure to asbestos (69%), followed by silica (17%), painting and diesel engine exhaust fumes (6–7% each).

  • In the manufacturing sector, it is estimated that every year, around 4000 workers in the industry suffer from breathing and lung problems they believed were caused or made worse by their work.

  • Some 2200 deaths from cancer each year are caused by past work in manufacturing industries, with around half of these estimated cases the result of previous exposure to mineral oils (associated with lung and bladder cancer) and asbestos (associated with lung cancer and mesothelioma).

The Health and Safety Executive (HSE) has identified welding as one of the top ten causes of work-related cancer, causing around 152 deaths a year and, with the aim of maximising improvements in respiratory health protection at work, BOHS has confirmed the initial focus of its latest campaign will be on the key area of welding activities in manufacturing.

Another targeted initiative is that launched in November 2014 by the Institution of Occupational Safety and Health (IOSH). The No Time to Lose campaign aims to raise awareness of occupational cancer and to encourage businesses to take steps to prevent the disease. IOSH’s campaign literature points out that:

  • Around 8000 deaths in the UK are due to work-related cancer each year — the equivalent of 17 super jumbos crashing and killing everyone on board.

  • Around half or 4000 of these deaths are due to lung cancer caused by asbestos exposure.

  • The dangers of exposure to asbestos remain to this day — 1.8 million people are still at risk of getting cancer caused by asbestos.

  • Some 800 of the deaths are due to lung cancer caused by silica and more than 600 lung (or bladder cancer) deaths have been caused by exposure to diesel fumes.

  • People are 40% more likely to get lung cancer from diesel fumes than passive smoking.

Managing the risks

As a starting point in preventing and controlling exposure to carcinogens at work, the HSE refers employers to the Control of Substances Hazardous to Health (COSHH) regime. COSHH is the key legislation that requires employers to control all substances that are hazardous to health, including exposure to carcinogens.

In terms of the Health and Safety at Work, etc Act 1974 and the COSHH framework, employers have a duty to undertake a risk assessment and then put in place control measures to reduce employees’ exposures to carcinogens.

In addition to the essential steps of introducing control measures to prevent occupational lung cancer, employers must also provide staff with information about the hazards, risks and control measures, and instruction and training to use the control measures.

The British Lung Foundation (BLF) has pointed out lung cancer is the UK's biggest cancer killer and a third of all people with lung cancer are diagnosed at hospital in an emergency. By this time, they usually have severe symptoms, and the cancer is often advanced, with fewer options for treatment. Only 10% of people survive for at least five years after they find out they have lung cancer, compared with breast and prostate cancer, where 80% of people affected will survive for at least five years.

Because of this, the BLF has launched a campaign to encourage earlier diagnosis of lung cancer, with greater awareness of the signs and symptoms of lung cancer, such as a persistent cough, chest pain and weight loss, so that more people will know when it's time to go see their doctor. Certainly, information about the risk factors and symptoms of lung cancer could usefully be included as topics within workplace wellbeing programmes. Other areas for focus could include employer-sponsored health initiatives, such as smoking cessation programmes, and advice for coping with a co-worker’s cancer.

At a recent event in London in June 2017, IOSH recently showcased the work being done by the 200 supporters of its No Time to Lose campaign in managing exposure to carcinogens in the workplace.

Similarly, in May 2017, the launch of BOHS’s Breathe Freely initiative for the manufacturing sector, attended by the first 70 partners and supporters of the campaign, prompted the Chair of the HSE, Martin Temple, to say, "It is great to see the range of organisations here acting together to improve health and safety.”

Lung cancer statistics — and in particular the survival rates — make for sobering reading but what is encouraging is that increasingly, innovative companies are tackling the issues around lung cancer at work in multifaceted ways, encouraged by campaigns such No Time to Lose and Breathe Freely. And in the process, organisations will not only reduce their workers’ risk of lung cancer, but also improve wider occupational health within the organisation itself, throughout corporate networks and across supply chains.