According to the American Cancer Society’s Cancer Statistics 2022, the lifetime probability of a male in the U.S. developing cancer is 1 in 2. For females the probability is 1 in 3. Over 1.9 million people in the U.S. were newly diagnosed with cancer in 2022. About 17 million Americans are now being treated or were treated for cancer. About one of every four deaths annually in the U.S. is from cancer. Within the coming decades, lifetime cancer risk i.e., cancer incidence in the U.S. will increase 50%-70% mainly because of population growth and an aging population.

Occupational cancer – global perspective

Work-related cancer, which includes exposure to occupational carcinogens such as chemicals, wood dust, radiation, viruses, and lighting and persistent night shift work (identified by IARC in 2019), is estimated to cause approximately 80,000 fatalities annually in the EU, twenty times the number caused annually by occupational accidents.  

EU-OSHA is conducting a telephone interview of 3,000 workers each in the countries of Germany, Ireland, Spain, France, Hungary, and Finland about their potential exposure to carcinogens. See “EU-OSHA Project overview: Worker survey on exposure to cancer factors.” EU-OSHA plans to publish the first findings of this survey this year (2023). Findings should generate considerable discussion globally on concerns and management for occupational carcinogens.


The research report “What do people fear about cancer? A systematic review and meta-synthesis of cancer fears in the general population” Vrinten C, McGregor LM, Henrich M, et al. Pyscho-Oncology, 2017;26:1070-1079, found that one-third to one-half of the general population in the United States and United Kingdom say they fear cancer more than any other disease. Five to ten percent (5%-10%) experience extreme worry. Proximity to cancer triggers fear. Fear alters behavior.

4C (foresee)

Curiosity, Concern, Controversy, and Conflict are the progressive behavioral stages of worker response to a new or growing health or safety threat at the workplace. It is management’s responsibility to foresee new or growing health or safety threats. Curiosity is the easiest stage to manage. Conflict is the most difficult. A third-party e.g., OSHA, attorney, union representative, etc. is often necessary to resolve conflict. Each stage becomes progressively more disruptive to normal business. If a behavioral stage is satisfactorily managed rarely will workers feel the need to move to the next stage. 

Cancer risk assessments

Cancer management begins with a risk assessment e.g., what is the proximity to cancer at the workplace? Management should designate a lead person or group to be familiar with major cancer assessment practices such as the latest versions of U.S. EPA Integrated Risk Information System (IRIS), U.S. Department of HHS National Toxicology Program (NTP), and WHO Agency for Research on Cancer (IARC). Both NTP and IARC were established over 50 years ago. NIOSH Current Intelligence Bulletin 68: Chemical Carcinogen Policy should also be understood.

Policy and procedures

Most workplaces should establish a policy on cancer. A policy is simply a destination that workplace management seeks to reach, such as educating workers on cancer prevention e.g., smoking cessation, accommodating people with cancer at the workplace, or implementing risk management for potential occupational carcinogens. Procedures are the roadmap to how management will reach the policy destination. 


Workplaces subject to OSHA Hazard Communication standards (e.g., 1910.1200) should routinely determine through review of Safety Data Sheets and other information if any products may contain a carcinogen, mutagen, or chemical toxic to reproduction (CMRs) as defined in the HCS. Cancer is a genetic disease. Looking for carcinogens or mutagens in products should be readily understood. The reason why employers should look for chemicals toxic to reproduction within the cancer topic requires a greater understanding. Be aware that the European Parliament and Council of the European Union amended EU 2004 Directive on protection of workers from risks related to exposure to carcinogens or mutagens at work to include reprotoxic substances on March 9, 2022 (EU Directive 2022/431). Note that amended Annex III to EU Directive 2022/431 establishes that carbon monoxide will have an EU workplace TWA at 20 ppm because of reprotoxic concerns. Contrast that U.S. federal OSHA has a CO TWA at 50 ppm. 

Cancer clusters

The 2016 Frank Lautenberg Chemical Safety for the 21st Century Act includes a provision called “Trevor’s Law” that addresses cancer clusters. Trevor’s Law requires that the CDC/ATSDR periodically update guidelines for public agencies to conduct investigations for suspected cancer clusters. Be aware that the 2013 guidelines have been updated to “2022 Guidelines for Examining Unusual Patterns of Cancer and Environmental Concerns.” The term “cancer cluster” is now diminished in favor of “unusual patterns of cancer.” Management should be familiar with the 2022 guidelines. IARC’s July 2022 “List of classifications by cancer sites with sufficient or limited evidence in humans, IARC Monographs Volumes 1-132” (14-page document) is particularly beneficial to help validate or refute unusual patterns of cancer.


Management should assign a person or group to be very familiar with all requirements of OSHA standard 29 CFR 1910.1020 Access to employee exposure and medical records. The assigned person or someone within the group should be given the supplementary title “industrial hygienist” to qualify as a “health professional” as defined within the standard. The 1910.1020 standard is designed for epidemiology purposes. For example, under the standard each employee exposure record “shall be preserved and maintained” for at least thirty (30) years. An SDS and any air sampling data, just to mention a couple examples, qualifies as exposure records under the standard. Management should periodically examine all exposure records for cancer potential e.g., does an SDS from 30 years ago identify a recently recognized carcinogen? The record examination should be summarized in a periodic report to management. Management should be alert to who has access to records, such as a representative of a deceased employee. 


People generally fear things the most that they understand the least. The greater that workers are informed and trained, where applicable, about cancer, particularly issues about occupational carcinogens, the better they will be to support cancer management activities.