Julia Vanella is a staff writer for Brief Policy Perspectives and a second-year MPP student.

Breast cancer is the most prevalent cancer among women in the United States, making it a top health policy concern. According to the National Institute of Health (NIH), about 12 percent or one in eight women in the United States will develop breast cancer in their lifetime. Cancer stage at diagnosis is a determiner for survival rate and treatment options. If the cancer is caught in the early stages when it is still localized, a person’s 5-year survival rate increases to 99 percent. While the increasing rate of breast cancer is widely known, and scientists have identified many risk factors that increase a woman’s chance of developing breast cancer, they do not yet know what leads normal cells to become cancerous ones.

Occupational Risk of Breast Cancer

According to the US Department of Labor, 53.7 percent of women over the age of sixteen participate in the labor market, and the majority of women work full-time. While the stigma around job status and gender has shifted, leading to an increased presence of women in management and professional fields, women continue to be primarily represented in people-oriented positions and ones that work with inanimate objects and mechanical systems. Women’s occupational health risk is significantly understudied, yet existing research suggests some occupations entail a substantially increased risk of breast cancer.

Exposures to chemical and physical agents can vary significantly within any occupational group, work activity, or work shift pattern. Flight attendants, one of the most extensively studied occupational groups, have been suggested to have a high risk of breast cancer. Flight attendants experience night shift work and circadian rhythm disruption, which can affect one’s sleep and wake cycles and any physical, mental, and behavioral changes that follow a 24-hour cycle. This can reduce the circulation of melatonin levels, which may increase one’s risk for breast cancer. They are also exposed to flame retardants in airplanes, pesticides, and combustion products from jet fuel, which has been suggested to increase one’s risk for breast cancer. A survey conducted in 2014-2015 of 5,366 flight attendants in the United States suggested that 3.4 percent of female flight attendants reported having had breast cancer compared with 2.3 percent of women in the general population group. Flight attendants are also exposed to ionizing radiation, which derives from space and is more intense as one gets higher in the air. Exposure may increase the risk of cancer, and while passengers are also exposed since they spend less time in the air than flight attendants, their exposure is minimal.

Nurses are also commonly referred to as an occupational group with higher risks for breast cancer. Studies suggest that within the nursing profession risk of breast cancer varies depending on the duration and setting of employment. A research study conducted on nurses suggests that after longer periods of rotating night work, there was an elevated risk of breast cancer; women who reported to work more than 20 years of rotating night shift work had a 79% greater  risk of breast cancer compared to those who did not report any rotating night shifts.

Other medical personnel, such as physicians, also have been suggested to have high risks for breast cancer. One study suggests that female orthopedic surgeons exposed to low dose ionizing radiation have a prevalence of cancer that was 85 percent higher than the general female population in the US. Female orthopedic surgeons have been reported to have had a 2.9-fold higher prevalence of breast cancer compared to the general US female population. 

Female production workers have also been reported to be at high risk for breast cancer. A six-year study conducted in Canada suggests that women employed in the automotive plastics industry were about five times as likely to develop breast cancer prior to menopause. This was due to the workers handling a wide array of carcinogenic and endocrine-disrupting chemicals, including heavy metals, flame retardants, and bisphenol A (BPA).

As women continue to make their presence known in the labor market, health policies to lower and prevent occupational breast cancer risk as well as make diagnoses earlier must be implemented to protect half of the workforce.

Policy Implications

Occupational breast cancer is largely preventable through effective policies in the form of legislation or regulations and worker education. Prevention policies must be implemented to prevent the prevalence of disease before it occurs. Studies that attempt to identify and describe workplace agents associated with breast cancer as well as interventions focusing on the use of toxic processes and substances and their regulations are limited. 

The US Occupational Safety and Health Administration (OSHA) has published guidance to employers and workers about transitioning to safer chemicals but they are not enforced by regulations. While OSHA has added protections to flight attendants for ionizing radiation, the regulating and monitoring of this kind of radiation isn’t performed as regularly as it is in the European Union (EU), therefore not tracking or measuring the radiation levels of airline workers, leaving them more exposed than necessary.

Looking Towards the Future

Despite the existing research and knowledge of the causes of cancer, millions of female workers continue to be involuntarily exposed to various kinds of known and suspected harmful carcinogens in the workplace. More research and attention are necessary to address this health disparity within the workplace. Government agencies and foundations should incorporate green chemistry, the design and production of chemical products that reduce or eradicate the use of harmful substances, and use informed substitution principles in their practices to prevent and reduce the rates and risks of breast cancer within the workplace to protect female workers.