Last updated: 15-Jan-2007
Effective Assessment
It is useful to note from the start that there will be no effectiveness evaluations provided for the prevention strategies summarized below. Data on outcomes related to interventions are scarce in the literature. While “environmental scans” listing many different programs are commonplace, comparing the relative effectiveness of interventions related to carcinogens has not yet been part of the research agenda.
The International Union Against Cancer (UICC) is the largest non-governmental association related to cancer in the world, comprising 280 cancer-fighting organisations. It published a guide to cancer prevention in 2004[1] which could only find one systematic review on the effects of interventions to control occupational carcinogen risk. That review, though limited to carcinogenic risk in the rubber industry, outlined the complexity encountered in gathering evidence of prevention effectiveness with all forms of workplace cancer:[2]
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as noted above, the long latency period between exposure and disease development, which makes it difficult to identify harmful agents, makes it equally difficult to monitor improvements in morbidity and mortality with any intervention (though the use of biological markers of exposure is helping to offset this problem).
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long-term observational studies are challenging to conduct, especially trying to control confounding influences (and RCTs with an unprotected control group of course would not be ethical).
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the quantitative relationship between exposure and disease is often poorly understood, so that an intervention involving the reduction of exposure is difficult to interpret.
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in the event a carcinogen is eliminated in an occupational setting, the health impact of any substitute product is not always certain.
The UICC report concludes: “this picture shows why it is difficult to obtain evidence of a reduction in cancer risk after the adoption of control measures and why reports of such evidence are rare.”[3]
[1] International Union Against Cancer. Evidence-based Cancer Prevention: Strategies for NGOs - A UICC Handbook for Europe. Available at http://www.uicc.org/index.php?id=976 (accessed December 2004).
[2] Kogevinas M, Sala M, Boffetta P et al. Cancer risk in the rubber industry: a review of the recent epidemiological evidence Occupational & Environmental Medicine 1998; 55(1): 1-12.
[3] International Union Against Cancer. Evidence-based Cancer Prevention: Strategies for NGOs - A UICC Handbook for Europe. Available at http://www.uicc.org/index.php?id=976 (accessed December 2004).