Linking the Assessment of the Burden of Work-Related Cancer to Health Inequities Research

Abstract

TPS 791: Occupational health 1, Exhibition Hall, Ground floor, August 26, 2019, 3:00 PM - 4:30 PM Population attributable fractions (PAFs) are increasingly used for discussing cancer prevention priorities. Although conceptual and validity issues have been widely addressed in the epidemiological literature, there is a paucity of attention on the impact of PAFs in decision-making, and the lack of consideration of factors like work or the environment on population health inequalities. Our aims are, first, to gather published estimates of cancer attributed to causal agents in the workplace over the last decades (past); second, to analyze them from the perspective of their potential effects on population health inequalities research (present); and third, to explore ways by which population health metrics could take occupational inequities into account (future). PAFs of work-related cancer 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 workers, occupational group has never been considered 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, and that may result in what science studies refer to “undone science”. Yet, there is accumulated evidence that work affects health and death through different pathways, which are also relevant to cancer inequalities research and prevention. 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. We empirically illustrate some of these conceptual and methodological issues based on the secondary analysis of a large case-control study on lung cancer conducted in France.