Treating occupational cancers in general practice

Farming, mining, construction. Toiling outside and working up a good, hard sweat.
 
These types of occupations are often seen as the backbone of Australia.
 
But some people in these jobs can find themselves exposed to carcinogenic agents in the workplace, which can result in the development of what are known as occupational cancers. And many people may be surprised at how much of a problem this remains, particularly in Australia.
 
‘People think that [issue] has been and gone as we’ve become a well-regulated workforce with unions, workers’ rights and improved working situations,’ Melissa Ledger, Manager of Cancer Smart at the Cancer Council of Australia, told newsGP.
 
‘But, in fact, about 5000 cases of cancer a year in Australia are a result of occupational exposures. So we need still to talk about this and make sure we don’t become complacent.’
 
People can potentially be exposed to more than 165 cancer-causing agents in the work environment – and 38 of these agents are of high priority and specific to Australian workplaces. 
 
Workers who run the greatest risk of exposure include farmers, drivers, miners and transport workers, with men more likely to experience this risk than women.
 
And while asbestos may be the first type of work-related carcinogen that comes to mind for many, it actually no longer makes the list of most the common carcinogens in Australia, which includes solar ultraviolet (UV) radiation, diesel engine exhaust, environmental tobacco (or second-hand smoke), benzene, lead and silica.
 
‘We are so complacent about UV radiation that it drops off the list all the time, but skin cancers are by far away and the most common occupational cancer,’ Ms Ledger said.
 
The other most common occupational cancers in Australia are mesothelioma, bronchus and lung, nose and nasal sinus, leukaemia and bladder cancers.
 
One of the biggest challenges for health professionals in terms of occupational cancers is their long latency period.
 
‘It’s not an immediate, acute response of wheezing or red eyes. It’s 20, 30 and in some cases even 40 years after exposure that you might get a cancer diagnosis,’ Ms Ledger explained.
 
This delayed manifestation contributes to the fact that, despite greater awareness of preventive measures, rates of occupational cancers have not declined.

Dr Helen Wilcox, Cancer Council Western Australia General Practice Advisory Committee Chair, believes the Cancer Council’s module on occupational cancer will be helpful to GPs.
 
‘We are not yet seeing a significant fall in cancer diagnoses, due in part to the latent period between exposure and development of cancer,’ Dr Helen Wilcox, Chair of the Cancer Council Western Australia General Practice Advisory Committee, told newsGP.
 
‘About 40% of workers have had a significant occupational exposure to a carcinogen and around one in 10 cancers are thought to be due to occupational exposures. That’s a lot of general practice patients, now and in the future, who are potentially affected.’
 
These statistics convinced the Cancer Council that it was important to create an educational module about occupational cancers for GPs. The module provides GPs with a mix of information and practical resources.
 
‘Some of these cancers already present frequently in general practice, so GPs are well versed in the relevant screening and diagnostic strategy,’ Dr Wilcox said. ‘Others are less common, meaning GPs may not be as familiar with the appropriate risk assessment and workup.
 
‘This module groups the common and less common cancers together, and also groups them by exposure, so a GP can search the module for guidance for a specific exposure. 
 
‘It also includes templates for exposure history-taking, patient education resources, and case studies which include both clinical data and the compensation process once a potential exposure is recognised.’
 
One of the main things that Ms Ledger would like GPs to take away from the module is that taking the time to investigate a patient’s work history can make a vital difference.
 
‘Many symptoms of common illnesses can also be similar to symptoms of a cancer. So it’s important, when GPs are looking at their patient’s symptoms, they ask a few additional questions around occupation, and not just current occupation, but a historical overview,’ she said.
 
‘That might change their differential diagnosis and perhaps reduce the chance of delay. For example, a GP might decide a patient needs to go straight to a respiratory physician because their occupational history and the symptoms together paint a different picture than just the symptoms alone.’
 
The module is available for free on the Cancer Council website.
 
‘Preventing and managing occupational cancers is a complex task, shared between GPs, our occupational physician colleagues and the many regulatory bodies at state and federal levels,’ Dr Wilcox said.
 
‘GPs need a resource that clearly defines our role in managing these patients, and this module is that resource.’

Cancer Cancer Council GP education occupational cancers QICPD workplace risks