1. The Politics of a Work Related Cancer Epidemy: Bladder Cancers in the European Union Laurent Vogel ETUI April 2016

2. Global Context: Men

3. Global context: Women

4. Bladder cancers in the EU-27 in 2012 (Source: EUCAN) MenWomenBoth sexes Incidence 96442 26693123135 Mortality 2991410338 40252 Prevalence (5 year) 32178188032409813

5. Bladder Cancer as a result of the lack of prevention at the workplace ● From 1895, work-relatedness has been identified (Rehn’s study in Germany on aniline dye factory) ● From 10 to 15% of incidences and mortality can be attributed to workplace exposures among men ● Occupational Epidemiology of bladder cancer among women is not well developped (as often for female workers in cancer epidemiology)

6. Bladder, ureter and urethra cancers among female workers accorders to the Nordic registers (NOCCA) ● Significative higher prevalence among: ● Administrators, Clerical workers, Sales agents and Shop workers ● Mechanics and Engine operators ● Chemical process workers, Printers, Textile workers ● Beverage workers and tobacco workers ● Waiters ● Hairdressers ● Building caretakers

7. Occupations or industries evaluated by IARC as entailing excess risk of bladder cancer among workers (from EU-OSHA 2014, adapted from Siemiatycki et al., 2004, and Boffetta et al. 2003) Occupation or industrySuspected substanceSites Aluminium productionPitch volatiles; aromatic aminesLungs, bladder Auramine manufacture 2-naphthylamine; auramine; other chemicals; pigments Bladder Boot and shoe manufacture and repair Leather dust; benzene and other solvents Lymphatic and haemopoietic system, nose, paranasal sinuses, bladder Coal gasificationCoal tar; coal tar fumes; PAHs Skin, bladder, lungs Coke productionCoal tar fumes Skin, lungs, bladder, kidneys Gas workers Coal carbonisation products; 2- naphthylamine Lungs, bladder, scrotum Hairdressers and barbers Dyes; solvents; propellants; aerosols Bladder, lungs, lymphatic system, ovaries Magenta manufacture Magenta; ortho-toluidine; 4,4´- methylenebis (2-methylaniline); ortho-nitrotoluene Bladder PaintersNot identifiedLungs, bladder, stomach Petroleum refiningPAHs Bladder, brain, lymphatic and haemopoietic system Pulp and paper mill workersNot identified Lungs, bladder, lymphatic and haemopoietic system Railway workers, filling station attendants, bus and truck drivers, operators of excavating Diesel engine exhaust; extremely low-frequency magnetic fields Bladder, stomach, larynx, lymphatic and haemopoietic system, lungs Rubber industryAromatic amines; solvents Bladder, stomach, larynx, lymphatic and haemopoietic system, lungs Synthetic latex production, tyre curing, calendering operatives, reclaim rubber, cable makers Aromatic aminesBladder Textile manufacturing industry Textile dust, dyes and solventsBladder, sinonasal cavities, mouth

8. Commission’s Policy from 2004 to 2016: we have lost 12 years ● « We don’t want to know »: the CAREX programme was stopped. No data is available about exposure at EU level. ● « We don’t want to act »: Revision of the carcinogens directive was postponed for about 12 years. ● Secondhand exposure to cigarette smoke may also contribute to bladder carcinogenesis: the preparation of a directive on environmental tobacco smoke in the workplace was stopped

9. SCOEL has proposed limit values (OEL) for carcinogens related to bladder cancer ● Among them ● Diesel engine exhaust ● 4,4’-Methylenedianiline (MDA) – also identified as a substance of very high concern under REACH. 1,4 million tonnes produced in the EU, probably up to 4 million workers exposed as downstream users in construction and manufacturing branches ● Benzo(a)pyrene: up to 7 million of workers are exposed ● 4,4’Methylene bis 2-Chloaniline (MOCA) ● O-Toluidine

10. What is on the EU legislative agenda? After more than 10 years of paralysis, the Commission will propose only 13 OELs (probably in May 2016) ● The main exposures causing bladder cancer are still not considered by the Commission proposal

11. What can be done by MEPs ? ● European Parliament should amend the COM proposal and include more OELs + post employment health surveillance ● European Parliament should urge the Commission to implement the hairdressers’ health and safety agreement through a directive

12. More on: ● http://www.etui.org/Publications2/Reports/Carcinogens- that-should-be-subject-to-binding-limits-on-workers- exposure http://www.etui.org/Publications2/Reports/Carcinogens- that-should-be-subject-to-binding-limits-on-workers- exposure ● http://www.etui.org/Publications2/Working- Papers/Eliminating-occupational-cancer-in-Europe-and- globally http://www.etui.org/Publications2/Working- Papers/Eliminating-occupational-cancer-in-Europe-and- globally ● http://www.etui.org/Publications2/Guides/Preventing-work- cancers.-A-workplace-health-priority http://www.etui.org/Publications2/Guides/Preventing-work- cancers.-A-workplace-health-priority