Ultraviolet radiation due to sun exposure is one of the most common causes of work-related cancer in Ontario. About 1,400 cases of work-related non-melanoma skin cancers are diagnosed a year in the province. The most at-risk groups of workers are those working in construction, farming and transportation.
Without additional protective measures, cases among construction workers in Ontario are on track to double by 2060. But according to a new cost-benefit analysis led by Dr. Amir Mofidi, a post-doctoral fellow at the Institute for Work & Health (IWH), 6,034 cases of non-melanoma skin cancers could be averted over 30 years if all Ontario construction workers wore protective clothing such as long sleeves, pants and neck coverings. The averted costs of wearing protective clothing would be $38.0 million (in 2017 Canadian dollars) over 30 years—a saving of $0.49 for every dollar spent over that time period.
The research team also found benefits for another type of preventive measure: the use of shade structures. These structures include portable canopies or pop-up tents that are set up near jobsites for workers to use whenever they need during a work shift. With the use of shade structures, 2,945 cases in Ontario could be averted over 30 years, resulting in averted costs of $20.5 million. For every dollar spent providing workers protective shade structures, a saving of $0.35 would be realized.
The study, published online in May 2021 in the Journal of Occupational and Environmental Hygiene (doi:10.1080/15459624.2021.1910278), used an innovative method that drew on past studies of the societal and economic burden of occupational cancer.
For estimates of solar UV radiation exposure in Ontario’s construction sector, the team relied on work by the Occupational Cancer Research Centre and CAREX Canada. For the cost-benefit analysis, the team used a method developed by IWH Senior Scientist and study lead Dr. Emile Tompa. In recent years, Tompa and Mofidi have used this method to estimate the societal costs of occupational cancers caused by asbestos in Canada (doi:10.1136/oemed-2016-104173), the costs and benefits of silica reduction measures in Ontario’s construction sector (doi:10.1186/s12889-020-8307-7), and the societal costs of work injuries and diseases in five European Union countries (doi:10.1186/s12889-020-10050-7).
In an earlier phase of this study, the research team conducted an economic analysis to estimate the societal costs of work-related non-melanoma skin cancers. This new analysis builds on those findings to estimate the cost-benefit of the two types of protective measures that are most available to workplaces—protective clothing and shade structures.
The new analysis found that, in a scenario where protective clothing is worn by workers and its use offers 100 per cent protection from 2020 onward, the yearly costs and benefits of this intervention would even out by 2046. A similar scenario for shade structures would see yearly costs and benefits even out by 2041. In models where partial use of, or partial compliance with, these measures results in only 60 per cent protection, the break-even dates would be 2051 for protective clothing and 2044 for shade structures.
According to the hierarchy of controls, shade structures are preferred over protective clothing. But in the case of construction, workers in some occupations—such as those working at heights—are less likely to be able to use them, says Mofidi.
Mofidi notes that, as seen in previous economic analyses of work-related cancer-prevention interventions, the costs and benefits are unevenly distributed.
The costs are borne primarily by employers, while the savings resulting from averted cancer cases are realized by the health-care system, and by workers and their families in the form of averted health treatment costs, caregiving costs, loss of income and loss of health-related quality of life, he says.
It would be good to have stakeholders negotiate an acceptable distribution of prevention costs, as the total benefits substantially outweigh the total costs.