A Workers’ Survey on Exposure to Cancer Risk Factors in Europe: An Innovative Approach to get Comparable and Reliable Data for Prevention and Policy-making Purposes

1. Safety and health at work is everyone’s concern. It’s good for you. It’s good for business.
A Workers’ Survey on Exposure to Cancer Risk Factors in Europe:
An Innovative Approach to get Comparable and Reliable Data
for Prevention and Policy-making Purposes
Irastorza Xabier, Cavet Marine, Cockburn William, Prevention and Resarch Unit, EU-OSHA
©EU-OSHA, Jim Holmes

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Background of the survey
 Cancer: more than half of all work-related deaths in the European Union
https://oshwiki.eu/wiki/Eliminating_occupational_cancer_in_Europe_and_globally
 A need for data on workplace exposures to cancer risk factors
 A lack of harmonised and comparable data in Europe
 A feasibility study was conducted in 2017
https://osha.europa.eu/en/publications/feasibility-study-development-computer-assisted-telephone-survey-
estimate-workers/view
 Aims of the Workers’ exposure survey on cancer risk factors in Europe:
• An accurate and comprehensive picture of current risks related to worker
exposure to a selection of cancer risk factors
• High quality information for both prevention and policy making purposes
• A contribution to the challenge of reducing work-related cancer

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Overview of the methodology
 Following an Australian model based on a web-based application to assess
occupational exposure in epidemiological studies (OccIDEAS), developed by
a team led by Prof Lin Fritschi https://www.occideas.org/
 Comprehensive sample sizes of employed population, contacted by phone
 A selection of countries for the initial survey
 Assessment of several exposures at the
same time, within a range of cancer risk
factors including asbestos, benzene,
chromium VI, diesel exhaust, nickel, silica dust,
UV radiation, wood dust, among others
 Harmonised methodology and standardised
data collection across the six countries
 First findings in 2023
Country Sample size
Finland 2,500
France 5,000
Germany 7,500
Hungary 3,125
Ireland 2,500
Spain 3,750

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Adaptation to the European context
 National expertise:
• One group of minimum six experts in each participating country
• Occupational hygiene generalists with a big network (including specialist for
specific issues)
 Working process:
• National experts give insight on any specificities regarding tasks or working
practices in their country that could have an effect on the determinants of
exposure to cancer risk factors.
• National experts assess all sets of questions (modules) to check if:
−they are complete and adequate for the national context;
−some tasks or exposure situations are relevant to the country but yet not
covered in the questionnaire;
−some tasks or exposure situations are not relevant for Europe.

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Validation of the questionnaire – a crucial step
 One of the pillar to good quality
 A thorough adaptation is required to achieve high quality results
 Coverage of all potential exposure situations to the selected cancer risk
factors – work tasks in all 6 countries should be accurately reflected
 Correct terminology – survey should be relevant to the respondent and
properly understood
 A group of international experts provides additional input on the cancer
risk factors, conditions of use at workplaces and exposure assessment
 High quality data is needed to enable data processing with OccIDEAS tool

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Questionnaire adaptation to different national languages
 EU-OSHA drafted a glossary of technical terms included in the questionnaire
to support national experts, linguists and interviewers
 cApStAn conducted a translatability assessment of the questionnaire and
suggested some alternative wordings
 IPSOS NV piloted a pre-testing of a selection of questions (cognitive interviews)
to ensure that the survey questions are understood correctly and are able to be
answered accurately by respondents
final version of the English master questionnaire
 Next steps:
• Translation into Finnish, French, German, Hungarian and Spanish, following a
complex translation approach, widely used in cross-cultural surveys (TRAPD)
• Adaptation of the English questionnaire for Ireland

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Challenges and limitations
 Identification of European scenarios (cancer risk factors and occupational
safety & health legislations) and differences from Australia, leading to:
• A new set of questions on chemical/pharmaceuticals/plastics industry;
• A new questions on medical devices manufacturing;
• A new questions to address automotive industry, wood processing;
• A new set of questions addressing the nuclear energy sector;
• Additional questions on control measures for tasks involving asbestos removal;
• Changes in exposure levels to benzene for specific work tasks…
 Identification of relevant differences between European countries, and how
to address them
 Adaptation to national languages, simple questions but specific terminology