What is this cancer series about?
There is no comprehensive occupational disease surveillance in South Africa. To gain insight into cancers related to work and work environments locally, we have used the national vital statistics Cause of Death Registry. The main occupation during life is a required field on the death certificate, and when completed, it provides us with exposure information. These analyses allow us to investigate if there are cancers in South Africa that may be related to work exposures.

Why does this matter?
Occupational cancer needs to be prevented, and if not prevented, compensated to encourage prevention and support the workers and their families. Identifying occupations with increased risk of death from cancer provides information for labour inspectors and health and safety professionals about possible carcinogen exposure in specific industries and jobs.

What drew you and the team’s interest to this area of research?
Occupational diseases are often diagnosed after the person has left work, making it difficult to report to employer databases and the relevant government departments. Attribution of a disease to work exposure requires access to occupational medical specialists, which is often unavailable to workers. This surveillance allows us to identify industries or jobs with high death rates and encourage the implementation of controls to reduce disability. The information is critical for guiding policy, workplace programmes, and standards. This work will also hopefully increase access to compensation for workers with work-related cancer.

What was your role in this series?
I played a central role in developing the surveillance concept based on similar work in the USA and UK and developed the analysis methodology. I authored and analysed the investigation into lung cancer and occupation, as well as authored the introduction to the concept of proportional mortality ratios (PMRs) as valid measures of association when better information is lacking.

Why should people read this series?
This series identifies high-risk occupations for the cancers analysed and aims to increase awareness of jobs where employees are at risk of developing cancer. This can motivate people in those jobs to use PPE and controls effectively to protect their health and to report any concerns to their health and safety representatives. This series could be used to encourage people living with cancer to enquire with their medical providers about work attribution and possible compensation.

What impact do you hope the series will have on public health policy and healthcare access?
This series should encourage investment in research into occupational cancer in South Africa, as the PMRs provide an association but not a causal link. More research is needed to establish algorithms for compensation of work-related cancer, allowing other exposures such as smoking to be taken into account. The list of compensable occupational diseases should be updated to reflect this new information and current research findings. This series should also be used to inform inspections into the control of carcinogens in high-risk workplaces to prevent future cancers. The information should inform the development of improved regulations, guidelines, and health and safety programmes in the high-risk sectors.

Dr Kerry Wilson is an epidemiologist in the Epidemiology and Surveillance Section at the National Institute for Occupational Health.

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