Imagine if an airplane crashed onto the runway of a European airport every day. After a few weeks, the situation would become politically untenable. With 300 deaths a day, and over 100 000 in a year, it would become an inescapable priority.

I can already hear the objection: this is hypothetical fantasy. Of course it is. Its only purpose is to better understand what is currently happening in Europe in terms of occupational cancers. The link between fiction and reality is unavoidable: over 100 000 deaths a year. For cancer sufferers, there is nothing hypothetical about these deaths. We can sum up in four words why 100 000 work-related cancer deaths are not a political priority: inequality, visibility, power and freedom.

Inequality: the privileged classes fly much more than the rest of the population. If there were 100 000 deaths a year from air disasters, this figure would include a high proportion of shareholders, senior managers, politicians, etc. For the 100 000 deaths from occupational cancer, the opposite is true. Breast cancers affect hairdressers exposed to massive concentrations of dangerous cosmetic substances. Lung cancers affect building workers exposed to crystalline silica and asbestos. This list could go on for several pages. Workers are 10 times more exposed to the risk than managers.

Visibility: an air disaster makes the front page of the newspapers. Deaths from occupational cancer remain invisible. Doctors rarely question their patients about the dangers to which they were exposed throughout their working life. In most cases, they ask just three questions. Do you smoke? Do you drink? Have other members of your family had this type of cancer? Limiting themselves to these three questions perpetuates age-old superstitions that attribute cancer to sin (individual behaviour) or fate (misfortune of having bad genes). Social determinants are ignored. Paradoxically, it is these collective determinants where prevention is most effective.

Power: combating occupational cancer requires measures that come into conflict with corporate profits. It is sometimes suggested that the war on cancer could be won by discovering new treatments or perfecting means of early detection. This naive and technocratic vision masks the struggle over public and social control of production choices.

Freedom: you are free to decide with which airline you want to fly. If there were repeated air disasters, the airlines concerned would soon lose their customers. They would have to make a choice between bankruptcy and effective safety. By contrast, the organisation of work and the choice of processes and substances are imposed on workers by the company’s management.

There are plenty of reasons to be outraged. But if we want to convert this outrage into action, objectives need to be set.

Strong legislation: cancers cost the compa- nies that cause them virtually nothing. The costs are borne by victims, social security and public health systems. Without binding rules, no prevention can reach all workplaces. The current European legislation on prevention of cancer in the workplace needs to be comprehensively revised. Its scope is too limited. The number of substances for which exposure limit values have been set covers fewer than 20% of actual exposure situations. It does not provide for health monitoring extending beyond the period of exposure. Rules are also needed to reduce the quantity of carcinogenic substances produced for the market. This requires the European regulation on chemicals (REACH) to function better, particularly by imposing the authorisation procedure for all carcinogenic substances. The specific legislation on pesticides and cosmetics must be reviewed, because it was drawn up under pressure from industrial lobbies.

Strong inspection: work inspection systems have been weakened throughout Europe. Bosses who expose their staff to the risk of cancer know that they are unlikely to be inspected or sanctioned.

Strong trade union action: within companies, it is the mobilisation of the workers concerned that makes the difference between pretend prevention and real prevention. It ensures a balance of power. The replacement of substances and processes that cause cancer must be accelerated. We must ensure that all dangerous exposures are avoided or reduced as far as possible. We must get involved in the drafting of the risk assessment document and check that effective preventive actions are planned and monitored.

Over the next few months, the European Commission will define an action plan for occupational cancer. Will it settle for a facelift, or will it implement more ambitious legislative reforms? We need to be vigilant: since 2004 it has been the Commission that has deliberately blocked any improvement of the legislation on the protection of workers from occupational cancer. The response will depend on our capacity to convert cancer into a political priority. With over 100 000 deaths a year, there is an urgent need to mobilise•.


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Occupational cancers: from outrage to action