Is It Time to Rethink the Way We Assess the Burden of Work-Related Cancer?

Abstract

Population attributable fractions (PAFs) are increasingly used for setting cancer prevention priorities. Our review aims, first, to gather published estimates of the percentage of cancer attributed to causal agents in the workplace and, second, to analyze them from the perspective of their potential effects on population health inequities. The estimates generally ranged from less than 2% to more than 8%, with an average of 4–5%. While most authors acknowledge that exposures concentrate in lower-socioeconomic status and more vulnerable workers, the literature has never considered the occupational group as a source of variation in the calculations. This knowledge gap is linked to the paucity of data describing the occupational patterning of exposures and cancer. More globally, the social gradient in cancer is often interpreted in the light of behavioral factors alone, a tendency linked by historians to the very foundations of modern epidemiology. Yet, there is accumulated evidence that work affects health and the risk of death through different pathways, which are also relevant to cancer. While the epidemiologic literature addressed conceptual and validity issues surrounding PAFs, it seldom questioned their potential impacts. There is in particular a lack of consideration of factors beyond individual behaviors and a paucity of attention to population health inequities. We hence propose to further the discipline’s reflexivity by changing the focus, scope, and metrics in order to assess the burden of work-related cancer in a way that is more meaningful to the most disadvantaged workers.