Occupational cancers masterclass

Callum R.: My name is Callum. I'm from the Cancer Council Queensland. So, I'm an advisor of cancer prevention there. I'm joined by Carolyn here who's with SafeWork Queensland (Office of Industrial Relations). So obviously, today, we're going to be going over occupational cancers and carcinogens and having a bit of a chat about that. We appreciate everyone coming out here today. We're all for the health side of occupational health and safety. It's all important, but that's really the area that we specialise in.

Callum R.: On the pamphlet, I'm filling in for our manager who decided to resign after agreeing to the presentation. So, I'll be delivering our cancer information today, which is awesome. So yeah, we're going to get going. Any questions, feel free to ask. If I can't answer them, I'll let you know, but I'm happy to look into that for you. Carolyn, I believe, is going to be speaking about occupational carcinogens more so from a regulation point of view. I'm just going to be talking about the main ones that Cancer Council Queensland advocate for and the ones that are pretty well known to actually cause cancer in the workplace. Everyone okay with that? Fantastic, so let's get going.

Callum R.: We get a lot of questions. What is workplace cancer? A lot of people are a little unsure on what that actually refers to. So, within workplaces, there are many different cancer-causing agents, okay? It's not just one. There's actually a whole host of them and at different levels of carcinogenicity, which we'll talk about as well. The thing about occupational cancers is occupation is ... let's say working in mining or construction or something like that. They're often exposed unwillingly to a lot of carcinogens at much higher rates than someone who works in doors in an office would.

Callum R.: That poses a massive public health issue for us, and no one really should have to go to work and be exposed to something which can cause cancer, and that's something that we stand by extremely strongly. The International Agency for Research on Cancer has actually identified a 120 group one carcinogens. What I mean by group one ... getting our research hats on I suppose. Group one refers to that there is convincing evidence that that agent causes cancer in humans. Then you might hear me refer to something as group two. That means it's a probable cause of cancer.

Callum R.: For today's presentation, we're going to be talking about a lot of group one carcinogen. So, there's enough evidence to suggest that through overexposure, over time, those may cause cancer in someone. Of course, that's up to a lot of different other factors, length of exposure, the amount you're exposed to, as well as a host of genetic factors as well when we talk about things like UV or environmental tobacco smoke. But we're going to be going over quite a few today such as diesel, engine exhaust.

Callum R.: We'll have a bit of a chat about Silica being Cancer Council. We also always make sure that we talk about occupational UVR or ultraviolet radiation exposure as well. So, we'll have a chat about a range of things. I understand we may not cover everything that maybe you want some information about. If that's the case, you can always ask us, and we're more than happy to send you any information that you want. We just have some limited time. So without further ado, we'll get going.

Callum R.: A little bit of statistics for you, just to get things going. So approximately 3.6 million Australians are exposed to carcinogens in the workplace, so that's an extremely high percentage of occupational exposures. It's important to note that a lot of the information that I'm going to reference today comes from the Australian workplace exposure study, which was done in 2012. That was a phone-based survey of over 5,000 participants, and it really gave us really good, effective insights into how much people have been exposed to and what they're actually exposed to as well.

Callum R.: So, a lot of the information that I reference today is from that. I recommend if you want any more information, you can always look into that, and a lot of the evidence that's come from that has helped guide us in our recommendations particularly from the Cancer Council in the advocacy work we do in occupational cancers. An occupational cancer is very much an evolving area, I would say. It's getting more and more attention. Has everyone seen a lot in the media lately about glyphosate or silica dust? Yeah, so it's quite a topical area at the moment, and that's because a lot of evidence is continuing to grow, which is great. It's great for us. However, obviously, the evidence is growing, and it's a very negative thing.

Callum R.: 3.6 million Australians are exposed to carcinogens in the workplace. That may be any one or more carcinogens, but 3.6 million Australians are on a frequent basis. So that probably equates to around two and five workers, which is about 57 per cent of men and 22 per cent of women. You'll see throughout the presentation today, men have much higher rates of exposure to certain carcinogens, and that's due to having an over-representation in many occupations like construction and mining, in which a lot of the exposures we're talking about are apparent.

Callum R.: One thing that I've pointed out down the bottom of the presentation there, which I don't think a lot of people are aware of when often when we think of workplace health and safety and deaths that may have occurred. It's often through accidents. Was anyone aware that occupational cancer is the biggest cause of workplace death? No. I actually wasn't aware of that either until just recently. But the biggest killer of people in the occupational setting is cancer, and those cancers are caused by occupational exposures in their job.

Callum R.: That's a pretty strong statistic, isn't it? So, obviously, Cancer Council has a slightly biased on what should be taken seriously. But with a statistic like that, it's very clear to us that more really does need to be done in this area, and many people are dying unwillingly every year, and the thing to remember is that occupational carcinogenic exposure is completely preventable when we're doing the right things at work, both from employer and employee contexts. So, we feel very strongly about that, so I'm going to reference that a lot more throughout the presentation today.

Callum R.: So, the Australian workplace exposure study that was done in 2012, this table here needs a little bit of explanation. What the researchers have done has extrapolated the data that was found in that survey and then applied it for the whole workforce. So what this table here is actually referring to that of all lung cancers that we can expect people will get in their lifetime from 2012. You can see there it's 408,650 for males and 319,700 for females and around 730 lung cancer cases we can expect to see throughout the lifetime of everyone that is working in the workforce in 2012.

Callum R.: That's to be expected. Lung cancer is an extremely prevalent cancer. The thing that is very alarming to us is the excessive amounts of lung cancer due to exposures, okay? The thing about excessive lung cancer due to exposure, it does refer to those exposures as being completely preventable. If you're not being exposed to silica or diesel engine exhaust, your risk of having lung cancer is going to be greatly reduced. So, for males, we know that when the survey was done in 2012, this is lifetime risk applied to the general population. The excessive number of cancers we're going to see is 25,100 due to occupational exposures. That's 25,000 cases of lung cancer that could have been prevented in the workplace.

Callum R.: Then we've got 1,420 female cases of lung cancer as well. Like I said before, throughout the statistics, you'll see that men are very much over-represented and that's mostly due to the occupations in which they often work in. However, women are more and more coming into those occupations as well. So, then you can see an overall future excess fraction of all the lung cancer cases is 6.1 per cent for males and 0.4 per cent for females and a total percentage of 3.6 per cent. 3.6 per cent doesn't sound like that much, but when it's actually over 26,000 cases of lung cancer that people will get in their lifetime through occupational exposures, that's a very significant statistic for us.

Callum R.: So just to point out that the Australian workplace exposure study looked at 13 different carcinogens, which may cause lung cancer. So what this table is referring to is what we found and which was applied to the general population of the workforce. This is looking at the different occupational carcinogens, which are big risk factors for cancer. So, you can see there are ultraviolet radiation, diesel engine exhaust, environmental tobacco, smoke, benzene, silica, wood dust, so on and so forth. No real surprise to a lot of people that solar ultraviolet radiation equates to the biggest occupational exposure, and you can see that's well over 1.5 million workers are exposed to solar ultraviolet radiation.

Callum R.: Ultraviolet radiation is one of those things which is often unavoidable. Queensland is the skin cancer capital of the world. Was anyone aware that skin cancer has the highest rates of skin cancer anywhere in the world? Yep. So, extremely high rates of skin cancer, and a lot of those are due to occupational exposures as well. We've got about 37 per cent of our workforce being exposed to ultraviolet radiation. When the Australian workplace exposure study was done, it also identified the at-risk occupations of exposure. No real surprises here that solar ultra violet radiation is most common in those occupations like farmers, agriculture workers, construction, painters.

Callum R.: Any job that requires outdoor work often has excessive exposure to ultraviolet radiation. We know that sun protective controls aren't always taken as seriously as they really should be. So next we've got diesel engine exhaust. Diesel engine exhaust has become quite topical. A few years ago, we let out a media release outlining that hundreds of lung cancer cases are due to diesel engine exhaust exposure each year. Since then, it's been picked up as a bit more of a topical area. We're going to have a bit of a chat about it.

Callum R.: But you can see there that 29 per cent of the population has been exposed to diesel engine exhaust, which is very bad for us and a very big risk factor for lung cancer. You can see that the occupations are farmers, heavy vehicle drivers and miners. Skipping through a few more. Environmental tobacco smoke. We've made great jumps and bounds in reducing the smoking rate to about 12 per cent in Queensland, but we know that environmental tobacco smoke is still a massive factor in occupational exposure, and that's ... When I say environmental tobacco smoke, it pretty much refers to second-hand smoke exposure to people who don't smoke, and are just trying to get on with their job.

Callum R.: You've got things like benzene, silica, which we'll talk about a lot today, actually. Silica has been very topical. Silica dust is found ubiquitously across many different products, concrete, bricks, stone. When it's worked, it can create silica dust, which is respirable and can cause things like Mesothelioma, lung cancer and silicosis, which we'll talk about today as well. So, you see there over 500,000 people are exposed to silica dust in the workforce, which is a very large amount. Then wood dust down the bottom there with about 500,000 exposures as well, and that's coming across occupations like carpenters, handy persons, those sorts of occupations.

Callum R.: So that was for males. We're looking at females. It's pretty much the same occupational carcinogens as you can see. Just at much lower rates due to the fact that, like I said, women are often underrepresented in a lot of the occupations that have the highest exposures to very carcinogenic materials. Probably one to outline, their solar ultraviolet radiation is still extremely high as well as diesel engine exhaust. So, we're going to be really looking at a few of those today. They pose a very serious health risk particularly in an occupational context.

Callum R.: We really think that it's worth bringing attention to those areas. So, here's another interesting little table for you. These are the future cancers that we will see that statistics will tell us will occur due to those exposures that we saw during the Australian workplace exposure study in 2012. This is for all of our carcinogens that will cause more than 50 cancers in the lifetime. So quite alarmingly, asbestosis is still counting for over three and a half thousand cancers, which is extremely high still for males and only about 20 for females.

Callum R.: In this day and age, you would think asbestos, that is one of the more well-known occupational carcinogens, is controlled enough, but more needs to be done. People are often unwillingly dealing with asbestos containing materials without actually knowing it. That really does bring up the question, "Is there enough education and training out there for people to actually identify those and know how to dispose of them appropriately?"

Callum R.: A few other very big ones, diesel engine exhaust. We can expect to see 4,242 cases of lung cancer in the lifetime of those people that took part in that Australian workplace exposure study. You've then got environmental, tobacco, smoke, nickel, and a few others there. So you can see silica dust down the bottom is actually contributing to the most lung cancer cases due to occupational exposure. So silica dust is very bad. It's something we want to talk about today, but you can see we can expect to see over five and a half thousand cases of lung cancer due to occupational silica exposure in our population that was interviewed in 2012 and then applied to the general population.

Callum R.: Some extreme statistics there. Does anyone have any questions about that? No? Keep going. So, no real surprise again. These are our workers at risk. So, these are our occupations at highest risk of being exposed to a lot of those carcinogens that we have talked about previously. Just remember, I've put down the bottom there, if your occupation that you work in isn't listed on there, that doesn't mean that your staff members or anyone in your workforce isn't exposed to a carcinogen of some description.

Callum R.: These are just the ones that in which we find the largest degree of exposure. That's definitely farmers, heavy transport workers, miners, carpenters, mechanics, particularly diesel mechanics when we think about things like diesel engine exhaust and transport workers. Then on top of that, from all of those exposures, the most common occupational cancers, which we do see, things like mesothelioma, which is a cancer of the outside lining of the lung. Bronchus and lung cancer, nose and nasal sinus cancer, leukaemia, cervical cancer, and bladder cancer.

Callum R.: So, it's not just lung cancer. There's actually a whole host of other cancers that a lot of these occupational exposures do predispose people to, and that's not to mention obviously the other big range of acute and chronic health effects things like silica dust can cause. I'm just talking about cancer because that's our speciality. It's important to remember that things like environmental tobacco smoke will increase the risk of things like heart disease.

Callum R.: Something that we hear quite frequently, unfortunately, is that people are still a little bit unsure on the terminology of carcinogens, and we often hear, "There are no carcinogens in my workplace." That may be correct, but what's often the case is there are no carcinogens that people are aware of in their workplace. So, a big difference there. One of the reasons why I don't think occupational cancer has given the time of the day that it probably deserves is because of cancer latency. Does anyone know what I mean when I say that?

Callum R.: Yep, so what I mean by cancer latency is cancer doesn't just occur after one exposure, okay? You don't get exposure to silica dust and then the next day you wake up with lung cancer. Cancer latency often has a very long gestational period. For example, things like mesothelioma can often take 20 to 40 years to actually turn into cancer following exposure to that carcinogen. So, the issue is, is that those exposures aren't always tangible. When we think about things like accidents in the workplace, if someone hurts their back or something like that, it's immediate. It's immediate. It's tangible.

Callum R.: Things like exposure to silica dust, you often won't have any symptoms, okay? One of the issues with that is a lot of people aren't actually aware that they've been unwillingly exposed to a lot of carcinogens in their workplace for a very long period of time. So, you can imagine when they start getting symptoms, it's often too late. That's one of the big issues that we deal with. Like I said, it's not always an instant impact. There's not always acute health effects associated with these exposures.

Callum R.: The other thing is it's very hard to pinpoint at what point in time someone could have been exposed to something, particularly when it's not well known a lot of the carcinogens that are out there. So, someone who may be even ... It may not even be an occupation. It may be someone who works in DIY. They do a lot of bench cut topping. They've handled asbestos unwillingly and then later on down the life, they have a diagnosis of cancer. That's something that we're really trying to change and make sure that people are actually aware of the carcinogens in their workplace.

Callum R.: If we can be aware of the dangers that are out there, then we can put policies and procedures in place which protect people against those, which can be done very effectively across every carcinogen that I'm going to speak about today. So, like I said, quite a topical area at the moment. Has anyone seen any of these on the board? Did anyone see the Four Corners Monsanto case, glyphosate or Roundup? No one saw that? That was an interesting one because I'm pretty sure probably everyone in this room has something to do with Roundup really. I know in the garden. It's used both occupationally and domestically, so we'll have a bit of a chat about that one.

Callum R.: Probably what's of big interest to us is Greg Hunt actually asked workforce regulators to do an investigation of stone masons into silicosis because actually here in Queensland, a couple of months ago, it was confirmed that there were 35 stone masons that have the potential fatal disease due to their occupational exposures. So, silicosis and silica dust is very topical at the moment. So, we definitely think it's worth talking about. It's good that it is topical. It's bad that it's topical because people are getting disease.

Callum R.: Unfortunately, that's what actually often happens. Things aren't really taken seriously until someone gets a terrible disease or someone dies, and that's something that we're looking to try and avoid. So, it's a very topical area at the moment. Diesel engine exhaust is often one of those areas as well. So here's a table of our priority carcinogens. Like I said, I'm not going to speak about all of these. I don't have enough time. If you have any questions, please let me know, or I can refer you to the right place.

Callum R.: But there are a lot of priority carcinogens in the workforce. Having a look at the board, I'm sure probably most people's occupations will deal with one or more of those things. Some of the things that we're going to talk about is combustion products. So we're going to be talking about engine exhaust. You've got things like inorganic dust like asbestos and silica dust. You've got materials like arsenic and lead and nickel. Then of course you've got things like radiation, both from radiant radiation as well as radiation from things caused from occupations that have a lot of welding and that sort of thing in them as well.

Callum R.: So, we'll through and talk about quite a few. Like I said before, if any of those are of interest, let us know. We're just going to talk about the ones that Cancer Council is really addressing at the current time. So let's have a closer look. First, we're going to have a bit of a chat about silica dust. Silica dust is one of those ones which is just continually coming into the media more and more. Silica dust is such a big issue because it's found so ubiquitously across so many products. Silica dust is a naturally occurring mineral, silica quartz as it's often known, and it's found in stone, rock, gravel, clay, products like bricks, tiles, concrete, artificial stone bench tops, and even some plastic materials.

Callum R.: So, chances are if you work in an occupation like construction or anything like that, you've probably got exposure to silica dust. It's found almost everywhere. Silica isn't ... It's only carcinogenic when it becomes respirable, okay? So you don't have to be worried walking down that you're going to get silica dust exposure due to the concrete you're walking on. It's only when those materials are aggravated, and it forms a fine dust that's then respirable and damages the lungs. That's when we stopped getting things like silicosis and lung cancer later on in life.

Callum R.: So, Silica dust is a big issue for us, and I think people aren't aware very much of how frequently it actually is exposed to people. At our office just up the road, for example, we got new tiles taken out and put in. They were smashing and grinding those tiles, which definitely would have contained silica dust. The people doing that had no respiratory protection at all. So we still find that it's probably something not taken seriously enough. That's obviously just one example. The thing about silica dust is it is very avoidable with the right occupational procedures.

Callum R.: So, silica dust is actually only toxic or it's only damaging to us when we actually inhale it. Other than that, it's okay. You can probably see there that little five cent piece. That's not much silica dust. A lot of people are inhaling a lot more of that throughout their day. If you're inhaling more of that as a tangible example, you're definitely going over the guidelines for exposure to silica dust. Something that I should point out that there actually is no safe level of exposure to silica dust, which means you shouldn't be exposed to any really.

Callum R.: It's often unavoidable. However, you can greatly reduce the amount of exposures you actually have. The issue of silica dust is when it turns into a dust, it's 100 times smaller than a grain of sand. It's minute. Because of the size of it, it's actually able to penetrate deep into the lungs when you inhale it, bypassing the body's natural process of getting rid of it. I think probably one of the big things to point out here is that around one Australian worker every 36 hours is diagnosed with lung cancer caused by exposure to silica dust. Did anyone know about that? That's pretty intense, isn't it?

Callum R.: So you can imagine every almost day in a half, someone who worked in an occupation where they're dealing with a lot of those materials is now being diagnosed with lung cancer because of those exposures. Luckily, more and more information is now occurring, but there wasn't the information there was previously. So that really hits home to us definitely. No one should have to go to work and be exposed to something, which may cause cancer later on down the life.

Callum R.: So Australian workers, so one every 36 hours, and if we think back to that table of that occupational group. In 2012, we can expect in the lifetime of the Australian workforce, over five and a half thousand cases of lung cancer due to silica dust exposure. So, it's something that needs to be taken seriously. In 2011, about 587,000 Australians were exposed to silica dust while working. It's a very significant thing. A lot of exposures. Like I said before, it's very easy to be exposed to silica dust because it's really found in a lot of different building materials.

Callum R.: It's estimated that 5,758 of these workers will develop lung cancer over the course of their lifetime, okay? That's a pretty scary statistic and one which we take extremely seriously, and that's a statistic we would like to see reduced to pretty much nothing. When we're thinking about our occupational carcinogens, and previously I was talking about group one, group two. It doesn't really sound like much, but silica dust falls into the group one carcinogen, which means that there's convincing evidence that it causes cancer in humans.

Callum R.: So silica dust is toxic just like something like cigarette smoke is toxic to humans as well. So, an extremely important thing that we really do need to be taking seriously. This is just a small table that just shows you the different occupational task where in which you may be exposed to silica dust. Probably doesn't come as much as a surprise to many people that things like brick lane, sand casting, sandblasting, demolition, stone masonry particularly. A lot of very ambiguous activities across a lot of occupations will cause silica dust exposure, and a lot of people aren't using the right protective equipment.

Callum R.: And a lot of times, occupations don't have the right administrative controls to actually deal with that occupational dust exposure. So you can see probably up on the board, a lot of people here today, we probably work in occupations in which those do occur. If that's the case, maybe it's actually a good time to identify silica dust exposure in your workplace as well. So, looking at our control measures then, we've talked about it quite a bit. Silica dust definitely can be reduced quite heavily. You'll see a range of things there. You'll keep seeing this upside-down triangle there. That's the hierarchy of control.

Callum R.: In any of our occupational carcinogens, the first thing we obviously want to do is eliminate it. In terms of things like silica, because it's found so frequently in so many different building materials, that can be extremely difficult, and we want to substitute materials for safer materials. Engineering controls, obviously, administrative controls, and then of course personal protective equipment, which is absolutely paramount in terms of silica dust exposure.

Callum R.: So, a few things that are recommended. I'll just go over a few of these quickly just to give you an idea. Ventilation. Ventilation is something extremely important in terms of reducing silica dust exposure such as local exhaust ventilation. Same with on-tool extraction. So if people are doing bench cutting and those sorts of things, very high-power tools create very fine dust. Just remember that. Water suppression where possible. Obviously, water suppression is a great way to reduce any occupational exposure in the atmosphere.

Callum R.: So, things like asbestos and silica dust where possible. We would always recommend that. Personal protective equipment, absolutely paramount, as well as respiratory protective equipment, which abides by Australian Standards is extremely important in terms of reducing the amount of exposure that you're actually having to silica dust. So, there are actually a range of strategies to reduce this, and we always recommend that people should use as many of those tools at their hands as they can.

Callum R.: We're going to have a chat about diesel engine exhaust. I've already brought it up a couple of times, so we definitely think it's worth talking about. Has anyone heard much about diesel engine exhaust previously as a carcinogen? Not really? Oftentimes you probably think diesel engine exhaust in the environment more so than would do actually people's health. But diesel engine exhaust poses a very significant occupational health risk to people.

Callum R.: So what is diesel engine exhaust? Well, diesel engine exhaust is a mixture of soot and a mixture of gases, which are carcinogenic to humans upon respiration. We think this is an extremely important thing. Just like silica dust, diesel engine exhaust is grouped as a grade one carcinogen, so it's known to cause cancer in humans. The thing about diesel engine exhaust, the soot particles absorb a lot of the toxic chemicals, which we then inhale. When we inhale those toxic chemicals into our lungs, that's where the damage is caused, and over time, that may increase one's risk of developing lung cancer. Things like COPD as well when it comes to diesel engine exhaust. Something that really does need to be taken seriously.

Callum R.: Interestingly enough, in Australia, diesel engine exhaust is the second most common carcinogen workers are exposed to. Does anyone want to know what the first one is? Someone have a shot of what the number one carcinogen exposure is. Don't be shy. Shout it out. It's ultraviolet radiation from the sun, okay? That's our number one occupational carcinogen exposure, and number two is actual diesel engine exhaust. So, it poses a very significant health issue in terms of the occupational context, and that's about 1.2 million Australian workers who are exposed to DEE every year.

Callum R.: So, extremely significant. A lot of people being exposed to it at different levels, yes, but we know there's no safe level of exposure to diesel engine exhaust. And again, it is grouped as a grade one carcinogen, meaning it causes cancer. Just to be clear, that doesn't mean that everyone exposed to diesel engine exhaust will get cancer. That's not the case at all, but it very much increases the likelihood of it. All of these carcinogens have a dose response relationship.

Callum R.: Thus, the more you're exposed to, the greater the likelihood that may cause cancer later on in life. The other thing about diesel engine exhaust, it may cause things like bladder cancer as well. So here's a few snippets of a media release that we released in 2016. What this was actually depicting is that there's a lot of deaths due to lung cancer in Australia every year that are due to occupational diesel exhaust exposure. So it poses a very real and significant health risk in terms of our occupations.

Callum R.: If we look at the occupations that are actually most exposed to diesel engine exhaust, probably no surprise here. One of the biggest ones are mechanics. So you can see there in the red, that's high exposure. You've got the orange, which is medium, and then you've got yellow, which is low. No real surprise again that about 37 per cent of male workers are exposed to diesel engine exhaust in their occupation, and about 6 per cent of females. Probably one of the biggest statistics is down the bottom there that 130 lung cancer cases are caused by diesel engine exhaust every year.

PART 1 OF 4 ENDS [00:32:04]

Callum R.: Was anyone aware of that? No. It's really one of those things that a lot of people don't seem to be aware of, which we really should. So, 130 lung cancer cases each year are caused by diesel engine exhaust. You can see it's often in those occupations with high exposure like mechanics, farmers, and miners. Mechanics, obviously, working with engines and that sort of thing on a daily basis have high levels exposure, which means they increase the likelihood of getting lung cancer because of that. I thought this would be interesting to chuck in. These are Australian emission standards. The graph here is showing the implementation of schedule of global national heavy-duty diesel emission standards. So those are non-road diesel emission standards.

Callum R.: Have a bit of a look at that graph there. But you can see in the grey, that's referring to no standard so no diesel engine exhaust standard. The dotted line is showing the time between in which country started to see this as a real health issue and implement changes which we often called tier two or tier four. Then you've even got countries like the U.S. now using new technologies for their drivers, which are completely reducing the amount of diesel engine exhaust people are exposed to. Can anyone see Australia there? Was there so much going on? No, absolutely nothing. There's absolutely no emission standards for heavy-duty diesel emission standards for Australia, which we're a bit perplexed by. Australia is pretty good about getting onto things, generally speaking, in an international context, but we're right there with Russia. Not a lot going on.

Callum R.: That's really alarming to us. That's probably one of the reasons why we still see so many cases of lung cancer every year due to diesel engine exhaust exposure. Talking about the control measures on each of these occupational carcinogens. I always think it's a good idea to also talk about some of the things that we can do in our workplace to reduce exposure. You can probably see there. Again, I'm going to be showing that pyramid time and time again. It's extremely important to take into place. When we think about eliminating a risk in something like diesel engine exhaust, of course, the best thing is going to be engine selection. When that's not appropriate, we need to think about fuel selection, engine refurbishment, enclosed equipment. There are a range of things that can still be done to very much dramatically reduce the amount of diesel engine exhaust people are exposed to.

Callum R.: Maintenance and repairs, ventilation systems are extremely important to reduce exposure to anything that we're inhaling. As you can see, a range of strategies can actually be implemented. If you think that diesel engine exhaust is an issue in your workplace, I'd recommend that you very much get onto that. There are a lot of things that you can actually do. Personal Protective Equipment is obviously always going to be one of the things that's taken seriously, which we really don't see in terms of things like diesel engine exhaust, particularly amongst people like mechanics. You don't often see them wearing respiratory protective equipment or anything like that, when maybe they really should be. There is a lot that can be done there, but we'll keep moving. One of the bread and butters for Cancer Council Queensland specifically is solar ultraviolet radiation. Queensland, unfortunately, is known as the skin cancer capital of the world.

Callum R.: Queensland has the highest rates of melanoma and non-melanoma skin cancers, unfortunately. That's due to having such nice weather, and a lot of people that are being exposed to way too much UV exposure. You can probably see down there, 200 melanomas and 34,000 non-melanoma skin cancers are caused by being exposed to solar UVR at work each year in Australia. 34,000 non-melanoma skin cancers. When I say non-melanoma skin cancer, does anyone know what those two are? It's a basal cell carcinoma or BCC and a squamous cell carcinoma. They're not as deadly as a melanoma, but they can cause a lot of health issues if you don't get onto them. I thought what else would be interesting to put in here is, you can probably see there that graph up there. That's actually workers compensation that was carried out between 2000 and 2012. You can see that compensation for skin cancer is actually extremely significant.

Callum R.: You can probably see that towards the end, it was actually costing $5.1 million in reimbursements because of skin cancer. Not only does it possess extremely significant health issue to people, skin cancer can be absolutely deadly and melanoma kills many people every year, but it's also costing people a lot of money. Very, very significant. Working outdoors. This data comes from the National Hazard Exposure Study. What that actually found that is about one in five workers who worked in direct sunlight undertook their ... Only one in five workers who worked in direct sunlight took their work outside at peak UV hours. What we mean by peak UV? We'll have a look at the UV forecast but UV fluctuates throughout the day with UV peaking in the middle of the day, which is when people are generally speaking at work.

Callum R.: We know that administrative controls are a great way to reduce the overall amount of UV exposure people have, which is maybe changing the way in which work is done outside of those hours. It's not always possible, but we really should be recommending it. Not many people or employees are. Close to one fifth of workers who worked in direct sunlight reported that their employer did nothing to prevent health problems caused by direct sunlight or sunburn. That's anything from encouraging the use of sunscreen, personal protective equipment, hats, sunscreen, and the provision of shade as well. Although, you would think it was done a lot better in somewhere like Queensland, we still continue to see it not really taken as seriously as it should be. That may come back to the idea of latency as well. Skin cancer takes a while to form into things like melanoma and its occupational exposures, which are causing a lot of cancers every year.

Callum R.: Has everyone seen this before? The UV forecast? It's a bit of a bell curve. Very, very important to take into account. I would recommend in any setting in which you have any workers working outdoors, we should always be looking at the UV forecast for the day. You'll find in Queensland, UV levels can get extreme, above 11. Overexposure to UV at extreme levels can occur in four or five minutes to an unprotected individual, which is why personal protective equipment is so important for our outdoor workers. You can see their low is zero to two; moderate three to five. Does anyone know the UV recommendation when sun protection is required? UV levels above?

Speaker 1: Three.

Callum R.: Three or above. We always say if the UV is three or above, sun protection is required because if the ultraviolet index is that high, then that sun exposure can damage your skin and increase the likelihood of skin cancer. Due to a lot of genetic differences in your exposure to ultraviolet radiation, recommendations are just a blanket approach in Queensland, which is sun protection is required all year round. The reason for that is, here's a graph of the Australian capital city average maximum UV levels by month. Could everyone see Brisbane highlighted in yellow there? As you can see, even in June and July, which are our cold months, the UV doesn't drop below three. In fact, it's still getting up to four. We find that people often become quite lackadaisical in winter even though they may be working in the middle of the day because it feels cold outside. One of the very important things to note is that UV and heat are different. When I say UV, it's ultraviolet radiation from the sun.

Callum R.: But was anyone aware that UV and heat a different things? They're not associated. The level of UV that a country or State like we have is through a range of things like how close you are to the equator, how thick the ozone layer is. Queensland happens to be sitting in an area with extremely high UV as well as most of Australia. You can see even Hobart's getting very high down the bottom there. We're really only beaten by Darwin, in the Northern Territory, of course, which is very high all year round. I think that really makes it clear that there's never a time not to protect your skin against UV in Queensland during the day. It doesn't matter if it's summer, spring, autumn or winter, sun protective procedures should be taken extremely seriously. Solar UVR, obviously, the biggest thing in terms of skin cancer is prevention. Protecting yourself from the sun. Although skin cancer is so high, it's also the most preventable, and the most treatable cancer if caught early.

Callum R.: Has anyone ever heard of the A, B, C, D, E of melanoma? No? This is a good tool to use, which actually gives a tangible identification if a mole is getting worse. That refers to things like the asymmetry - is it a weird shape? The border, does it have an irregular border, the colour, the diameter, and is it evolving? Is it changing? One of the biggest recommendations at Cancer Council, and should be in your occupation as well, is people need to be skin-aware. What I mean by that is people need to know their own skin, their own moles. They need to be able to identify when changes are taking place. Pretty much 100 per cent of skin cancers can be treated effectively if they're caught early. The reason why so many people die of melanoma is because it's not caught early enough, and it gives melanoma the time to spread or metastasized throughout the body. Just remember, occupational UV exposure each year, 200 melanomas are caused by that, so very significant, and over 35,000 cases of non-melanoma skin cancer.

Callum R.: We always recommend that, doesn't matter your occupation, but definitely outdoor occupations, involving outdoor work, definitely being skin-aware. Something that everyone's probably very aware of is the slip, slop, slap, seek and slide, glad I got through that, which is ubiquitous blanketed across everyone. I think everyone recognises this, but everyone doesn't take it as seriously as they should. Slip, we're obviously referring to using protective clothing. Now, you're probably seeing more and more a lot of clothes and a lot of work clothes now have a UPF factor. Has everyone seen that? UPF factor is a good way of identifying the ultra violet protective factor of the clothing, how much UV it's going to block. You'll find most clothes are about 50 plus. 50 plus UV means it'll block about 97 per cent of the UV that would have hit your skin otherwise.

Callum R.: We always recommend that if you can't get clothing that has that factor on it, you should be looking for a clothing that is dark in colour and has a tight wave. Dark colours absorb UV, and a tight wave allows less UV to penetrate through the clothing. Sunscreen - does our workplace supply people with sunscreen when they go outdoors? Yeah, so most of us. That's good. We would hope it would be everyone, but it's not always the case. Of course, our recommendations is always sunscreen with an SPF of 30 plus or greater. SPF 30 plus if applied correctly, which a lot of people do not do, gives you about 95 per cent protection. Interestingly enough, SPF 50 plus gives you about 97 per cent protection. They're very similar. We recommend sunscreen 30 plus. There's also the recommendation that you should apply sunscreen 20 minutes before going outside to start your work.

Callum R.: That's not a wives-tale like, I don't know, swimming after you eat or something like that. I missed out on a lot of swimming because of that. Applying sunscreen 20 minutes before you actually go outdoors is extremely important because most sunscreens absorb UV and you need to give it time to soak into your skin. That's actually something very important, 20 minutes before we go outside. Slap on a hat. That one speaks for itself. You need a hat that's covering your ears, your neck, and most of your face, your nose, particularly. Seek shade. Obviously, the best way to avoid UVR exposure is to block it. This, obviously, isn't always going to be practical. In a lot of occupations, we're not always going to have access to shade, but where we can, we should.

Callum R.: We always recommend occupations to be able to provide shade to those workers who are constantly in the sun. Lastly, sunglasses. Sunglasses, something which I don't think is necessarily taken as seriously as sunscreen. You've got to remember that UVR exposure to the eyes can cause things like ocular melanoma as well as cataracts. It has very significant effects on the eyes as well, which needs to be taken into account. Having a look at our control measures, like I said before, slip, slop, slap, seek and slide. But there are other very important things we need to take into account. Some of you may not be aware that UV comes directly from the sun, but it's also scattered when it hits the ground. Things like concrete, bright surfaces actually reflect UV back into you. Thus increasing the UV that you're actually exposed to. Where possible, avoiding that.

Callum R.: Providing shade, window tinting for those people who obviously spending a long time in their cars, delivery, whatever it may be. Rotating work, so administrative controls. If the UV is going to be extreme on a day and we can change our workdays activities to avoid that peak UV period, which we really should be looking into that where practical. Personal protective equipment, we've talked about that. I'm always a very big recommender of the SunSmart UV App. If you go to the Google Store and you look up SunSmart, you'll actually find a UV app. What that actually can give you is a UV alert. When the UV gets high enough that you need to start protecting yourself, it will send you an alert. That's a really good tangible way to keep that in mind. Obviously, the other thing is skin checks. We're always recommending that people speak to their health professional about getting their skin checked, forming a relationship, and being skin-aware.

Callum R.: Like I said before, solar ultraviolet radiation is still the number one exposure. Moving along, we're going to now talk about wood products, which a lot of people don't really know too much about. When I say wood products, what I'm referring to is wood dust and formaldehyde. We've all heard of wood dust and formaldehyde. The issue is, is that both wood dust and formaldehyde are both classified by again by the IARC as a group-one carcinogen. Both are known to cause cancer in humans. A very, very serious thing to take into account. It's estimated that around 16 per cent of cancers of the nose and nasal sinuses in men and 2 per cent in women could be due to exposure to wood dust. This is a very growing area of study, but we know that lots of nasal cancers are caused every year by exposure to wood dust and formaldehyde. You can probably see that table down the bottom there.

Callum R.: Obviously, wood dust has both short and long-term health effects. You can see that things like leukaemia is also associated with exposure to formaldehyde. Does anyone know what products often have formaldehyde in them, or what it's often contained in? Formaldehyde is often used in adhesives, so MDF fibreboard and that sort of thing. When you work with those materials and it generates wood dust, not only do you get the wood dust component, you get the formaldehyde as well that's often in the adhesive that are used. Formaldehyde's used very frequently. In 2010, it was reported that 14 per cent of Australian workers, like machinery, were exposed to wood dust. Again, not as large as something like UVR exposure but extremely significant. 14 per cent of Australian work is still a very large amount.

Callum R.: Not all wood dust is the same. Hardwood dusts definitely pose a much greater threat compared to softwood dust mostly because the hardwood dust can turn into a very fine wood dust, which is respirable a lot easier. Workplace ventilation and those sorts of things is extremely important when it comes to wood dust, which we'll have a chat about now. Looking at our hierarchy of control and our control measures that we should be recommending for wood dust, both personal protective and respiratory protective equipment is very necessary as well as both on tool ventilation systems. If you actually investigate wood dust control for yourself, you'll find there's actually a whole host of different control measures you can implement relatively risk-free, which will greatly reduce the amount of exposure.

Callum R.: Cleaning schedule is often very important for wood dust. You want to make sure that you are cleaning wood dust not with a broom or blowing it away. That's only blowing the particulates into the air. This is something that needs to be vacuumed. Wood dust, I really foresee this has been one of those emerging areas as well which it continues to be, and Cancer Council is continuing to develop resources on wood dust. Any of the resources or topics that you've looked at today that you're interested in, we have a program called kNOw Workplace Cancer spelled kNOw, K-N-O-W. I'd recommend googling that and having a look for yourself if you're looking to reference any materials from today's presentation. At the end of the presentation, I'll show you a couple of useful links.

Callum R.: So environmental tobacco smoke, that's the next one that we're talking about. Again, something that we probably don't take too seriously. I think smoking is one of those areas which Australia is extremely progressive in terms of legislation. Like I said, the smoking rate is down to 12 per cent. That smoking rate, it's not the same everywhere. Blue collar occupations often have a much higher proportion of smokers. Environmental tobacco smoke is actually a combination of mainstream and side stream smoke from someone smoking. It's second-hand smoke exposure. What I mean by side stream smoke, it's the smoke that's released from the top of the cigarette. Interestingly enough about side stream smoke, it can hang around for a very long period of time. When it cools down, it can actually be up to 12 times more toxic than firsthand smoke.

Callum R.: Was anyone aware of that? Second-hand smoke or environmental tobacco smoke, although you may not be getting the same dose as a smoker is, it's actually often more toxic to your health. Environmental tobacco smoke still poses a very significant issue in many occupations. Then, of course, you've got mainstream smoke, which is the smoke exhaled by a smoker, which contains all of those chemicals and carcinogens which the first and smoker is getting themselves. Like I said before, we all know about cigarettes. We know why they're bad. They contain around 7000 chemicals and 69 of those chemicals are known to cause cancer on their own. One of the statements that we've got at Cancer Council is smoking causes 16 different types of cancer, including the butt, which equals as bowel cancer as well.

Callum R.: Smoking remains the single largest modifiable risk factor for cancer compared to anything else. A very serious thing to take into account. We always say just with something like silica dust, there's no safe level of second-hand smoke exposure. A bit more about environmental tobacco smoke. It is still a very serious thing. Between 2004 and 2005, it's estimated that 141 Australian deaths were due to inhaling second-hand smoke. It still poses a very significant health issue in Australia. Particularly from an occupational context, when people who don't smoke, are often exposed to second-hand smoke exposure. Interesting point down there, it's not about occupations, but it really does justify the carcinogenicity of second-hand smoke. Non-smokers exposed to second-hand smoke at home have a 20 to 30 per cent increased risk of developing lung cancer compared to with people who live in a smoke-free home. What that really means is that if you're constantly being exposed to second-hand smoke, your risk of lung cancer later on in life is continuing to increase.

Callum R.: It's something, which we say there is no safe level of. Obviously, the benefits of a smoke-free workplace. I think workplace, health, safety and wellbeing is a very big emerging area. I won't go over these too much, but becoming a smoke-free workplace has a variety of benefits, not just protecting employees, improved employee health, increase productivity, reduce sick leave, decrease the number of staff retiring early due to disease, reduce hazards, create a healthy business image, the list goes on. We're always recommending, in terms of our control measures, the number one thing you can do, like the hierarchy says, is eliminate.

Callum R.: Go, become a smoke-free workplace. When that's not possible, things like a designated smoking area are probably the next best thing in which you can separate so people aren't exposed to second-hand smoke. It's very important to note that smokers shouldn't be stigmatised for their habit. Smoking needs to be recognised as an extremely addictive thing. However, their smoke shouldn't affect someone else. Signage and communication, if there's an inquiry, we get more than anything else at Cancer Council, it's occupations asking us what to do about people who aren't abiding by workplace legislation in terms of smoking. The best thing you can do is signage and communication, and creating a supportive environment. Bearing in mind that quitting smoking is incredibly difficult. We know that the average smoker may take up to 30 different quit attempts before they're successful.

Callum R.: It's not something that you can just go cold turkey. Has anyone heard of Healthier Happier Workplaces, the Workplace Quit Smoking Program? No one's heard of it. A couple of us have. If you've got a lot of smokers at your workplace and you work in a blue-collar industry, I'd very much recommend you look into the Workplace Quit Smoking Program. That's actually by the Queensland Government, through Quitline. What that actually does, it's a Workplace Quit Smoking Program that actually gives workers access to free counselling sessions as well as nicotine replacement therapy to assist them on their quit journey. If you haven't heard about that already and smoking is an issue in your workplace, you work in a blue-collar industry, I'd very much you have a look at Workplace Quit Smoking Program. That's only in Queensland as well. You can register online for that program.

Callum R.: We're very much advocates of that, and Cancer Council frequently facilitate that program as well. The other program. If you want any more materials regarding SunSmart resources, or smoking resources, all of that can be found on Cancer Council Queensland's Quest Program, which is quest.org.au. You can download any of the resources on that website and utilise them in your own workplace, which we're always encouraging occupations do. We'll keep going, a few more to go. Welding is another area that is classified or welding fumes, I should say, are classified as a group one carcinogen. Welding, it causes cancer unfortunately. There's two main types of welding. That's electric arc welding and oxy-fuel welding.

Callum R.: The thing about welding, it's grouped as a grade one carcinogen, both in terms of welding fumes, the fumes that the metal that you're welding produces, and then you inhale as well as the UV exposure, the welding arc actually shoots. It gives you a very high dose of UV exposure. We often find a lot of cataracts and ocular melanomas can be the cause of excessive UV exposure from welding. In 2017, all types of welding fumes were classified as group one carcinogens. Regardless of what we're welding, if it's producing fumes, that's considered a carcinogen and something that may cause cancer. Here's a bit of a diagram here. Welding causes cancer by both contaminants from welding fumes. When we heat metal over boiling point, and then when it cools, it releases fumes which we can then inhale - that's carcinogenic, as well as UV radiation in the arc of the weld.

Callum R.: What you'll also get as bounced back UV. That can cause all sorts of health problems, but what we're really interested in is lung cancer as well as melanoma and cataracts of the eye. Welding actually poses a very serious health issue, if not done correctly. You can probably see there on that table over to the right there. Those are the different types of fumes. Beryllium and that sort of thing is categorised as a grade-one carcinogen. Welding fumes, we definitely need to take that into account as a serious occupational health issue, which I really don't think it is at the moment. This image down here is just depicting the types of welding. I'm not sure if anyone here is from an industry in which welding takes place. Regardless, the lowest fumes, and compared to the highest fumes, come from different types of welding. You can probably see up there arc gouging MMA, flux core, all produce very high levels of fumes.

Callum R.: The higher level of the fume produced, the more exposure someone has and the greater the increased risk of things like lung cancer are. Very important to take into account. Welding control measures. I won't go into these too much, but where possible, surface preparation, making sure the materials that we're welding are clean and free of things like paint, which can, when melted, cause carcinogen through fumes. The welding process and the fumes were using correct welding processes that are going to reduce the amount of fumes that we're producing, such as that outlined on here. PPE, Personal Protective Equipment is absolutely paramount. People seemed to be pretty good wearing masks, but we should also be wearing long sleeves and gloves to reduce exposure to harmful UV from the welding arc, which can actually bounce back. We always say that welding should be done in isolation. Other people may be exposed to the UV from the arc if it's done in close proximity to other people.

Callum R.: Asbestos. In terms of all of our carcinogens that aren't well-known, asbestos is probably the one that's known very well because it's caused so many health issues in Australia because Australia was such a big user of asbestos, unfortunately. Asbestos has been shown to cause cancer of the lung over in larynx as well as mesothelioma. Asbestos, I won't go into it too much. We know it's such a serious thing. You can probably see down in that graph down there, you can see the introduction of asbestos really occurred in the 1960s in Australia. We really started to worry about it in the 1980s. What that graph is showing is the number of cancers caused by exposure to asbestos. As you can see, as we continue to use it, those numbers of lung cancer continue to go up. It still causes a great deal of lung cancer today. One of the issues with asbestos, a lot of people aware of it, but we're not very good at identifying asbestos-containing materials because it is used ubiquitously across many products.

Callum R.: Many Australian homes still have asbestos everywhere as well as materials. Probably, it's good to point out that there's two different types of asbestos. You've got bonded, non-friable; that doesn't seem to produce as much respirable asbestos than you've friable, which is actually the loose-bound stuff. That's really the issue. That's asbestos you can crumble. It's reduced to the atmosphere in which someone can then inhale it and it damages our lungs through mesothelioma, fibrosis or lung cancer later on down in our lives. You can see that Australia was one of the highest users of asbestos per capita, when it was thought to be quite a safe material. That's one of the issues that is so large today that we've got so many materials that still contain asbestos.

Callum R.: One good thing, we've actually produced an e-learning training course on asbestos specifically. The training is more so targeted to renovators, but I would definitely recommend if you're looking to grow accustom and know how to identify asbestos-containing materials and know how to deal with them appropriately in the most safe way, I'd recommend you look at that course. That's www.elearning.cancer.org.au/courses. It's the kNOw Asbestos course. We've had very good feedback from that course. The reason why we produced it is we know that there is a huge gap in knowledge on how to deal with asbestos-containing materials effectively. Please, in your own time, check that out. I would very much recommend it. Looking at our control measures, asbestos removal is one of the areas in which people often frequently exposed.

Callum R.: We really need to be isolating these sorts of things and implementing procedures and practises into our workplace, which we're reducing the risk of exposure to asbestos. Again, I would very much recommend looking into that kNOw Asbestos course. It's a great way of identifying ACMs, or asbestos-containing materials. Finally, although, it's not really considered something that we advocate to heavily for. I definitely thought pesticides would be worthwhile talking about, because they've been quite apparent in the media lately. Particularly things like glyphosate, which we'll talk about. Probably, just to set the record straight to get a bit. Pesticides, herbicides, insecticides, fungicides; there's very limited evidence. With things like welding and silica dust, there's a very large body of emerging evidence of its carcinogenicities in human.

PART 2 OF 4 ENDS [01:04:04]

Callum R.: That's not really the case with herbicides and pesticides, unfortunately. However, you can see down there, arsenic, lindane and ethylene oxide or all categorised as group one carcinogens, meaning they're cancerous to humans as I've continued to stay throughout today. I will say that things like glyphosate or Roundup, which is the most used pesticide, it doesn't fall into the grade one category, which we're going to talk a bit more about.

Callum R.: Recently there was a very large lawsuit, that someone in America did against Monsanto because he was diagnosed with lymphoma, and he thought it was due to the amount of Roundup that he was exposed to and he won that case. There's over 720,000 tonnes of it produced per year. The reason why it's so good, it's broad spectrum it's often cheaper than others, and we find it's used throughout a lot of farms in Australia. So like I said, most widely used herbicide. It's probably good to point out on this graph here. There's sufficient evidence that Roundup is carcinogenic to animals, but limited evidence in human and that's why it's given what's called a grade 2A carcinogenic classification. Okay.

Callum R.: We're not 100 per cent sure on just how bad it is for humans. We're pretty sure that it's quite a safe product to use, particularly for people that are just doing gardening. It's quite a safe product. So like I talked about before, the Sydney Morning Herald, dying cancer patient awarded $395 million in Monsanto Roundup case. Okay. There is evidence to suggest that constant use of glyphosate can potentially cause things like non-Hodgkin's lymphoma.

Callum R.: The big question is glyphosate carcinogenic to humans? So you can see there's evidence to show mixed results. Okay. We're not too sure after, during a hundreds of studies it's probably carcinogenic, but probably at very, very high doses. Like I said before, just to reassure everyone there doesn't really appear to be any risk in the general community or through the food consumption that we have on foods that are sprayed with glyphosate. So I would very much recommend, if you get any questions about that, it's still a very big emerging area. There is evidence to suggest that very high doses of glyphosate can be carcinogenic to humans, particularly through an increased risk of lymphoma. However, to most people it's not a risk at all.

Callum R.: So in the presence of uncertainty, what we always say is where possible, it's always safest to wear protective equipment when spraying, respiratory protection and long sleeve shirts are the best thing you can do in a time of some uncertainty in terms of the carcinogenicity of things like Roundup.

Callum R.: Shift-work. This was interesting. I wasn't aware that shift work was actually classified as a carcinogen, a grade 2A carcinogen. And that's through evidence that actually associated shift-work with a modest increase of breast cancer. Quite an interesting one, definitely one that needs to be looked into further, but you can see that that has the same classification of something as glyphosate does. This is very important. Any of the chemicals or minerals or anything that we've talked about today, I'd recommend getting a bit of background information into them yourself. There's a range of different summary of chemical regulations in Australia. So those are the main bodies where very big users of NICNAS and those sorts of things. So for your own work, I'd very much feel free to look into any of those for some more information. I understand you've only really received a rough preview for today.

Callum R.: Finally, what we like to say is what harm comes from using preventative measures. Okay. You're never going to get sick from using preventative measures across any of these carcinogenic materials, which we've talked about today, and always think about the hierarchy of control. The best thing to do in terms to reduce exposure to a carcinogen is to eliminate it. If you can't do that, you need to look at things that can be done better to reduce the risk of exposure to the occupational workforce.

Callum R.: Like I said, any information about today, some more resources and that sort of thing that you're interested in. Check out kNOw Workplace Cancer. You'll see it's cancer.org.au/workcancer. There'll be more information about most of the topics that I've talked about today. So if you want to hear more about silica, diesel engine exhaust, I'd really recommend that you utilise those resources in your own workplace. Finally, like I've spoken to you about today, Cancer Council Queensland has a healthy workplace program that's Quest. So he can go to quest.org.au and that's where you can find resources for your workplace in terms of SunSmart resources, tobacco, healthy eating and drinking, that sort of thing. And apart from that, that's it. I'm going to hand it over to Carolyn now.

01:09:16

Carolyn Topping: Hi everybody. My name's Carolyn Topping. I'm an occupational hygienist with Workplace Health and safety Queensland. So we're the health and safety regulators for OHS, excluding mining in Queensland. I'm going to just go through with you guys the regulatory framework for health and safety and how it applies to occupational carcinogens. So upfront, I would just like to clarify that the Work Health and Safety laws that we have in Queensland do cover, occupational exposure to carcinogens, and we'll talk through the main provisions that we rely on when we're looking at these types of issues in workplaces. I'm also going to show a video, from the ABC about a scenario. Well, it's not a scenario, it's a real life case and we'll just talk through some of the regulatory provisions and how we have applied them, and would apply them in similar situations. So the most important provisions that apply to all workplace cancer risks is the primary duty of care and the risk management requirements.

Carolyn Topping: I'm sure most of you, if you're working in a health and safety area have heard about the primary duty of care, and that's not to put a workers' health and safety at risk. The duty includes providing a safe work environment, ensuring there is a safe system of work in place, ensuring that substances and plants are used safely, plant as in equipment not plants as in green plants, and it also includes monitoring of worker health. So we'll cover that a little bit later as well. But the primary duty of care it's not a motherhood statement. So it's the number one overarching provision that we rely on as regulators to ensure worker health and safety. So we go to that a lot. So when we do prosecutions or when we take other sort of enforcement action so we're writing a Notice to Improve some controls in a workplace or if we need to prohibit an activity in the workplace, a lot of the time we will refer back to that primary duty of care.

Carolyn Topping: There are penalty provisions that are attached to breaching the primary duty of care as well. And that's where we get prosecutions and fines from. So unless there is a specific Regulation about a matter, the primary duty of care applies so it still applies anyway, but there might be specific regulations about an issue that you would need to comply with as well, but we always can go back to that primary duty of care to protect worker health.

Carolyn Topping: The other main provision that we rely on is the risk management framework and it applies to carcinogens as well, and someone who has a duty to manage a risk must eliminate or minimise that risk so far as reasonably practicable. The standard risk management steps that apply to safety risks also apply to health risks and they also apply to carcinogens as well.

Carolyn Topping: That means identifying hazards, putting controls in place and making sure you review those controls on an ongoing basis to make sure that the controls are working as expected. So for a lot of health issues, the reviewing of the controls is quite important. A lot of the times people will rely on local exhaust ventilation for removing contaminants out of the air. And that's a very important thing that over time you need to keep an eye on that. So workplaces need to make sure that those controls continue to work and give the same level of protection as when they put it in the first place. So the control measures when they're being implemented for occupational cancers, as with anything else, we rely on that hierarchy of control. So Callum addressed that quite well in when he looked at all the different carcinogens that he went through. So, that does apply from the risk management regulations. So, it's reasonable. So I've just got here as an example. Oh, sorry, I skipped ahead of myself.

Carolyn Topping: I think a lot of us are going to be familiar with the hierarchy of control, but so we need to eliminate hazards. We can then go to substitution and engineering control second, and then if there's any remaining risk, you can look at admin controls. So moving people around, and reducing exposure time, that sort of thing. But there is also, personal protective equipment and it's not a mistake that it's at the bottom. It is there to protect workers from residual risk. So when we got the new legislation, probably not so new now, but it quite clearly has covered now that PPE Personal Protective Equipment, while it can be an important part of control measures, it is definitely there for residual risk.

Carolyn Topping: So we want workplaces to be taking the higher order controls first. So as an example of that, if we were to go into a workplace that had some airborne contaminants, we would look at whether they've got some local exhaust ventilation or whether they have some wet methods or depending on what the contaminant is and we would then think about does that remove all the risk if there is still a residual risk, RPE then plays a role in making sure that the worker is, their exposure is minimised so far as reasonably practicable.

Carolyn Topping: So there are some situations where we would look at RPE is sometimes engineering controls or other controls are not going to be available. So it might be the primary control. So say where someone is entering a confined space and there's an oxygen deficient environment. RPE would be the thing that you would go to in terms of some self-contained breathing apparatus or something like that, and also if it's a mobile activity, so someone spraying herbicides on the side of the road, they're not going to have the opportunity for higher order controls. So they might go to wearing PPE to protect them. That's fine in some of those limited situations.

Carolyn Topping: So, this is a good picture to just imagine how controls work and ideally where we want to see controls. So we want to prevent exposure to workers from the source. The first place where you would look at putting controls is at the source. That might be, say we talked about welding fume before, so they are on torches. There is available on tool extraction. So we would look at something like that and suggest that to workplaces to control it at the source. So it's not released into the air born environment where someone can breathe it in.

Carolyn Topping: The next preference would be for, putting in controls along the pathway, so into interfering with that path so that it doesn't get to the workers. So it might come out of a process, but it doesn't get to where the workers are. So an example of that is we can't control the sun. So our UVR examples, so you would put up something in the pathway that would be a shade structure to protect workers. And the receiver would be the last place where you would look. So at the worker protection, so you might, as I just said, we might look at that RPE or respirators might be suitable in some situations to remove residual risk, but it's not the place where we would start looking at putting controls in place. And generally speaking, they would be used in conjunction with other methods. So, in addition to those two main provisions that I've just discussed, there are some chemical carcinogens that have specific regulations which apply to the use. So these are chemical sources, and we'll just have a quick look at those.

Carolyn Topping: We have something, I'm not sure if any workplaces here have them, but there are some prohibited and restricted carcinogens in the Regulations. So they're known or suspected, substances for causing cancer. So they came in with the change to the legislation that started in 2012. So there's 20 of those chemicals that are prohibited and restricted carcinogens and any workplace that uses those, they have to be authorised by Workplace Health and Safety Queensland to do so. So with the prohibited carcinogens, they are to be used for research, so genuine research and analysis purposes. So they're more or less chemicals that have gone out of general industrial use. So people are using them to find contamination in products or in the air or soil. So they're used in laboratory settings generally, or in forming some sort of research at a university. There's also the restricted carcinogen, so they're still being used in industrial processes, and the best example of that is a product called mocker, and I've just got another slide to show about that.

Carolyn Topping: So that's just an indicator or that's a graph of our current authorised carcinogens or how many that we have. We have 70 restricted carcinogens that we've authorised and we have 12 prohibited that we've authorised as well. So, we have granted the most authorisations for a chemical called cyclophosphamide. So if we've got anyone here from healthcare sector or research areas, it's a drug used in treating cancer and some other diseases, and we've got most of those have been used in compounding pharmacies, so they make up the drugs for healthcare professionals to administer to patients, or it's being used in a research fashion.

Carolyn Topping: And the remaining authorisations are for carcinogens used in research and analysis. So they're generally speaking well controlled environments. The only exception to that is this chemical called mocker. And it's used by generally small industrial facilities who are making hard polyurethane products. So, the little wheels you might get on a trolley, you know, that are really hard plastic, mocker goes into, it's part of the curing of those plastics.

Carolyn Topping: Callum also mentioned lead. So, lead is and occupational health risks that has been around for centuries, although the use of lead is slowly being phased out, it is still quite heavily regulated. In the regulations themselves, there are currently 18 led processes listed and these are common work processes where lead exposure can occur.

Carolyn Topping: If lead exposure occurs in one of those processes, I'll go into what controls have to be put in place. But there also might be lead exposure that can occur in processes that aren't inside that list of 18. And if it was a process outside of that 18, we would go back to that primary duty of care to look at whether people are providing a safe work environment there work method is safe, et cetera.

Carolyn Topping: The control measures that need to be put in place for a lead process generally a lot of them are around containing contamination. So a lot would be in relation to lead dust, so it moves with the air. So we want to contain lead contamination. It has to be cleaned up safely, no eating or drinking or smoking when you're touching lead products. So something that people here might do in their part-time in their spare time shooting firearms, that's an avenue for people to be exposed to lead. So, what can actually happen with lead, it's not just what you breathe in, it's also if you get it on your hands or on your face. If you're in a dusty process and you've got, say you're doing some renovations at home and you're grinding the paint off your house and it's an old house, it might have lead, probably does have lead paint on it.

Carolyn Topping: You can get it on your hands and then you can accidentally ingest it. And it sounds like it's a bit strange that people would eat that. And it would affect their exposure, but it is a significant avenue. It's one of the few chemicals that ingestion is a real significant avenue for exposure. So, just to finish off that list, when we're looking at workplaces who do lead processes, they need to ensure that they have adequate washing facilities and that people don't take lead home. Lead is a much higher risk to children and to women of reproductive capacity.

Carolyn Topping: So, the two leading causes of elevated blood lead levels in Queensland workplaces is lead paint removal from domestic dwellings, and they're usually older houses, so built before the 1970s and the older your house is the more lead paint it probably has on it. So lead has been phased out of paints over time. More significantly since the '70s. And as I mentioned, indoor firing ranges, due to the lead, that's mostly in the primer for the bullets. So, we've had recently this year, a prosecution of an indoor firing range for exposing their workers and causing some health effects for a particular worker. So we've successfully prosecuted for that.

Carolyn Topping: In addition to those controls. So those controls we just mentioned or I just mentioned apply to any lead process, but there was also this thing that we called lead risk work and lead risk work is for the higher risk work tasks, so where they're going to probably make more dust that people can breathe in. So if it is something is lead risk work, the employer has to provide health monitoring and blood lead testing. So a lot of people might be familiar with the blood lead testing that people might get for lead. People often get that at home as well if they'd been doing renovations and they're concerned or their neighbour's been doing renovations and blood lead tests is the best way to determine exposure for lead.

Carolyn Topping: Health monitoring is required for a range of chemical carcinogens as well. There are 15 substances that are listed in Schedule 14 of the Regulation. Now 11 of those are cancer causing substances or potentially cancer causing substances. If a chemical is listed in Schedule 14 and there is a significant risk to the health of people using that chemical, then health monitoring has to be provided. So it's a mandatory requirement. There's also other chemicals that are not listed in Schedule 14. A lot of people don't sort of understand schedule where the regulation talks about health monitoring. It talks about sort of two things. It talks about Schedule 14, so silica is listed in Schedule 14.

Carolyn Topping: So if there is significant risk to health, you must do, health monitoring. But there's also another avenue that health monitoring may become mandatory is if it is to another chemical and there is a valid test to detect a health effect. But it can be quite difficult for an employer might have trouble working out sometimes whether there might be a good test that is available. So we always recommend that they talk to an occupational physician if they have something, if you're using something in your workplace that might be a risk.

Carolyn Topping: I just wanted to talk briefly about Workplace Exposure Standards as well. So, standards apply for some carcinogens. So we've talked about silica. It's a very topical is Callum has said, so it is one of those substances that can cause cancer and there is an exposure standard for. There's about 700 workplace exposure standards and there are thousands of chemicals that are used in workplaces. So, there will be a lot of substances that people use in their workplaces or that might be a by-product of an industrial process or a task or activity like cutting, grinding, et cetera.

Carolyn Topping: What I wanted to mention was predominantly is that exposure standards while they are in the regulation and it says that you can't expose a worker over the exposure standard. There is also the primary duty of care, and there's also the risk management provisions that say that the risk to health has to be minimised so far as reasonably practicable. So there is some confusion in industries that an exposure standard gives people that you can expose people up to that level. That's not correct. It is standard occupational hygiene practise, that exposure is minimised, but it can't be more than what is listed in the exposure standard.

Carolyn Topping: So we always, especially where you've got substances, like something that causes cancer. So there's an unpredictable nature. We've got the biological variability in the people being exposed that also influences whether someone's going to get cancer. So we always encourage people to minimise so far as reasonably practicable, and I shouldn't say encourage, I should say that we would take action to make sure that that happens as well.

Carolyn Topping: We've got this video here to go through, what I wanted to ... Some of you might have already seen this on the ABC, so it's from the ABC website and it features two workplaces. A workplace in Melbourne and a workplace in Brisbane. What I wanted you to do was, it's an interesting story. It's a sad story though. But what I would like is for you guys when they're showing some footage of the workplaces is just to have a look at those workplaces and see what you can see that might be concerning in terms of a health risk to those workers and what controls. So they're going to talk about some things, some controls, and so just have a think about those as you're watching the video. Then we'll have a talk about how the regulation would apply in similar scenarios.

Speaker 2: Tahir Ozkul lungs this so badly scarred that even a short trip to the dog park is hard going.

Tahir Ozkul: I can't go somewhere easily. I have to carry all the time, my oxygen. But the air is the short breaths is very bad.

Speaker 2: At just 46, Tahir has accelerated silicosis, an aggressive form of the dust lung disease.

Dr. Ryan Hoy: Somebody will become very disabled as a result of shortness of breath. They'll develop a constant coughing as a result of it, and unfortunately at the moment, the only treatment we have as lung transplantation.

Speaker 2: It's left him with an uncertain future according to his wife, Callista.

Callista Ozkul: For when Tahir and I first moved out together, I remember when we were moving furniture, he carried a fridge on his own down the hallway and into the back of a truck and now you know, he can't even bend down to tie up his shoes without becoming incredibly breathless.

Tahir Ozkul: I'm like small there. Look at this.

Speaker 2: Tahir worked at a small Melbourne factory where he cut engineered stone into kitchen benches that are popular in new houses. It released toxic silica dust.

Tahir Ozkul: When we actually cut, dry cutting. We  got a big fan on the roof. We use that one. Yeah, and it sucked all the dust but still the dust everywhere.

Callista Ozkul: I feel really angry that we didn't know how dangerous it was.

Speaker 2: He's reached a confidential legal settlement with his former employer for breaching the safe limit for silica dust exposure.

Leah O'Kefee: Tahir's workplace was very small. There's only a few people working there at least small businesses are not aware of how serious this health condition is. They're not necessarily aware of their obligations, and they need to be doing more to protect workers.

Speaker 2: Tahir is not alone. There's been a cluster of silicosis cases in Queensland. More than 20 WorkCover claims have been lodged by engineer stone workers just in September.

Grace Grace, Queensland Industrial Relations Minister:   Of these six cases are terminal with a life expectancy of three to five years. Tragically, some of these workers are young.

Speaker 2: It sent shock waves through the industry. Scott Rigney runs his workshop in North Brisbane and has just had his workers lungs tested.

Scott Rigney: We're aware it was a risk. But I don't think we really had a grasp on just how serious it is. You do get told, but I mean, until you start seeing people get sick or I don't think that you really paid as much mind to it is what you do now.

Dr. Graeme Edwards: Thirty percent of workers working with the engineered stone will develop accelerated silicosis.

Speaker 2: Senior occupational physician, Dr. Graham Edwards is conducting urgent health screening of workers and his warning of another spike in cases.

Dr. Graeme E.: I'm expecting another 300 cases in Queensland alone by December.

Speaker 2: Is that outrageous?

Dr. Graeme E.: It's horrendous. It's alarming. 50 per cent of those are going to have progressive massive fibrosis. That's just in Queensland. There is no reason why these numbers will not be replicated. The system in Australia currently only can accommodate about 200 lung transplants a year. We're going to be adding another 130 on the numbers that they'll be given.

Speaker 2: Engineered stone can be so dangerous when it's cut because it's silica content can be up to 90 per cent far more than marble or granite. It's led to a ban on the practise known as dry cutting in Queensland, something Tahir Ozkul wants done everywhere.

Tahir Ozkul: But the problem is the dry cutting. You have to stop dry cutting use the water all the time.

Speaker 2: Dr. Redwoods has also found many tradesmen are wearing masks that offer little protection.

Dr. Redwoods:

PART 3 OF 4 ENDS [01:36:04]

Dr. Redwood: They need to wear a powered air-purified respirator. Very simple device. So we've got a filter, a pump, supplies air to the breathing zone.

Speaker 2: Canberra man, Frank Scott has driven to Cairns, hoping some sunshine will ease the burden on his scarred lungs. He's making the road trip while he's still able.

Frank Scott: Canberra's winters was knocking me around on the lungs a bit too much, so I took the golden opportunity to come for a drive up to this beautiful place.

Speaker 2: For years, Frank Scott was self-employed, sometimes dry cutting engineered stone. He was unaware he had silicosis until one day he couldn't carry stone up a set of stairs.

Frank Scott: Pissed off. Yeah, it's a shocking disease. You're young and fit and strong, you're going alright, but all those tiny little bits of dust add up over the years and will bite you on the bum.

Speaker 2: Frank is only 48 and doctors have advised him he could need a lung transplant.

Frank Scott: I'm holding off on that for as long as possible, because you only get five to seven years after a transplant and that's a pretty short time. If I look after myself I could get another ten years before I have to go for a transplant.

Dr. Ryan Hoy: So, have you been back to The Alfred to the lung transplantation patient team recently?

Speaker 3: Yeah, I'm on the list at the moment, yeah last two months.

Speaker 2: While he waits on the transplant list, [Tehya Ozkul 01:37:58] is seeing specialist Dr Ryan Hoy for an update.

Dr. Ryan Hoy: Unfortunately there's been a lot more progression of the scarring so [crosstalk 01:38:07]

Speaker 2: He's been warning about a silicosis outbreak for years, and is frustrated by the lack of action.

Dr. Ryan Hoy: So this is the largest occupational lung disease crisis we've seen since the peak of asbestos use in the 1960s and the 1970s. I've seen about eight patients in the last 12 months.

Speaker 2: Dr Hoy is calling for silicosis to become a notifiable disease, which means health authorities must be told about new cases.

Dr. Ryan Hoy: That way when a case is identified, there can be a thorough investigation as to why that disease has occurred, and to protect other workers that actually work at that workplace too.

Speaker 2: For now, [Tehya Ozkul 01:38:52] is cherishing these moments with his family, because he knows he has to make them count.

Speaker 3: At the moment I'm focussed on this lung transplant. I want to breathe, you know ...

Speaker 4: We're a couple with a young child who thought that we had our whole future ahead of us. We could lose him and it's just so unfair.

Speaker 5: And yesterday [Tehya 01:39:22] went into hospital for his lung transplant operation. Our best wishes are with him and his family while he's in hospital, and we'll keep you posted on his progress.

Carolyn Topping: So did anybody here see that when it was run on ABC? Yeah, yeah, it's a sad story and it's not good that people have had to get sick to raise awareness about some of the occupational health issues that people face in their workplace ... but, so Callum's already talked about it but respirable crystalline silica is, so that video was all about people getting silicosis and that's what is being seen at the moment. But it is also a cause of lung cancer, so silica exposure is about one and a half times, so for someone who gets exposed to silica as part of their work, because that's where silica exposure occurs, it's not going to generally occur in non-occupational settings, but someone who gets exposed to silica at work is about one and a half time more likely to get lung cancer than someone who's not exposed to silica.

Carolyn Topping: Someone who has silicosis, so they're about 2.5 times more likely to get lung cancer than someone who doesn't have silicosis. So there is an increased risk for people in industries where there is silica exposure.

Carolyn Topping: So I just wanted to go through some of the issues that were raised in the video. There was two workshops that you saw there. One was in Melbourne and one was in Brisbane. So one used dry cutting methods and from what we saw on the video it didn't look like there were any controls in place, so there wasn't controls to prevent it becoming airborne, or there wasn't controls to suppress it out of the air.

Carolyn Topping: We clearly saw dust visible on work surfaces, on floors, on tables, and we also saw a photo of the worker with dust on their face, and you could see where there was sort of a clean space where their respirator was, so in that picture at least we know he was wearing a respirator but there was issues also brought up there from Dr. Edwards about the sufficiency of the respirator that perhaps people have been using.

Carolyn Topping: They talked about the exposure standard and being exposed above the exposure standard. And the family and the worker talked about their lack of understanding of the health risks and the products that they were using, and that was reflected in the Brisbane workshop as well, but when we looked at the workplace in that video there was wet cutting going on. When you're wet cutting, the dust is still being created but it's just being suppressed with water, so there's a couple of issues around that. That the water, so the water that contains silica can then be spun around when you're using power tools, and there's also that wet slurry that's going to be created, can then get onto the floors and then it has to be cleaned up before it dries out.

Carolyn Topping: The worker was wearing a respirator in that second workshop, but it was a different kind of respirator from the guy in the first workshop. Was there anything anybody else wanted to raise, that they saw in that video that they think we could talk about?

Carolyn Topping: No, okay. Well what I thought was really revealing and it's something that we come across a lot as occupational hygienists when we work with workplaces, is just that fundamental lack of understanding and understanding the invisible hazards that people have in their workplace. So, in that first video it wasn't invisible because there was so much dust, but in a lot of other workplaces, it might be invisible because the dust will be really fine, so the dust that is the hazardous part is the really fine dust that is very, very small. And they also don't really take things seriously until someone gets sick and it's too late then so with these long latency diseases it takes such a long time and it's not a like a guarding issue, a machine guarding, where someone might injure themselves or cut off their fingertip, it's very immediate, the effect is very immediate, but with occupational health issues a lot of them take a long time for something to be seen, a health effect to be seen.

Carolyn Topping: Based on the scenarios presented in the video, I just want to go through and have a look at the regulatory provisions that would apply. This information that we're going to talk about is based on how inspectors might apply certain parts of the legislation to get improvements in the workplaces. So the first thing there is providing a safe system of work. So that's going back to that primary duty of care, so we would go back to that primary duty of care, for some aspects of the things that we saw in that video. Dry-cutting without control measures to remove or suppress dust, the slurry that might be allowed to pool on the ground and dry out and then become airborne again, and using cleaning methods that don't generate airborne dust.

Carolyn Topping: Callum touched on it before as well, when we go to workplaces where there is a dust issue we always ensure that if they use brooms to clean up or normal type vacuum cleaners, that that practise ceases, so we want people wet cleaning or we want them using a H-Class vacuum cleaner to clean up.

Carolyn Topping: Yes.

Speaker 6: [inaudible 01:45:43]

Carolyn Topping: What industry do you work in?

Speaker 6: [inaudible 01:45:48]

Carolyn Topping: Okay, yes. So, there has been some issues in terms of construction and direction given about M-Class because of some issues in terms of the generation of keeping up with equipment and that sort of thing and the capacity to cope, but in an industrial situation, so something like this, a workshop, H-Class is the way to go. We would recommend H-Class anyway for something that's going to cause cancer. So when you go to the Australian Standards, so there's Australian Standard on vacuum cleaners and vacuums, and it recommends that H-Class for anything that causes cancer, so that's what we base that on. And a H-Class vacuum cleaner is a ... You can't buy a H-Class from Godfreys or something like that, it's actually a proper industrial vacuum that the whole system is sealed, so that particles, so the very small particles can't escape through the filter or they can't escape through the system through cracks in the casing or inside, internally.

Carolyn Topping: We'd also from that video, look at our plant regulations so that the dust extraction, apart from the vacuum cleaner, any dust extraction meets that H-Class capacity so that they are removing most of the small particles out of the work air. We'd also have a look at the Personal Protective Equipment Regulations. So a respirator is provided so we would want to see in that sort of situation a respirator provided for the residual risk, so even that workplace where, the second workplace where there was the water suppression, there would still be dust, so those aerosols of the water particles would contain silica and then they are being flung around so we would want to see respirators for workers in that situation.

Carolyn Topping: With respirators, I'm not sure, is any people here aware about fit testing requirements for ... Yeah, okay so there are people here who do that. So whenever a respirator is given to a worker to wear, it has to be fit tested for them. So what that means is there is a special test, so there's two tests that can be done, so the person wears their respirator and they work out, there's two processes to work out if there is leakage, too much leakage into a respirator.

Carolyn Topping: Both of the respirators we saw in that video were the half-faced ones and they rely on a seal, so the seal between that ... Of the surface of the respirator and your face to provide the protection. So all respirators have some leakage in that work that way that are negatively pressurised, that work that way, so dust will, very small particles can leak in and in the design in Australian Standards, that's minimised, so when respirators come in different sizes people are different sizes, faces are different shapes, the respirators need to be fit tested to a worker. They need to pass that fit tester for the respirator they're going to wear.

Carolyn Topping: Does that make sense?

Speaker 7: What's the difference between a Class H and a Class M and HEPA?

Carolyn Topping: I'll go with HEPA first. So that's talking about the capacity of the filter, the actual filter medium to filter out the small particles, so 99.97 per cent of particles, I think it's 0.3 microns, are filtered out through the filter medium. When you look at M-Class or H-Class vacuum cleaners, it's the whole system that is tested to a standard so it makes sure that any particles, fine particles are captured and stay within that system.

Carolyn Topping: So the difference between M and H is that H-Class is sort of, the whole system will give you that HEPA rating, so 99.97 per cent. M-Class, I can't remember sorry, off the top of my head but I think it might be about 95 per cent, so its whole efficiency of the system is reduced. So that's, less toxic things are okay with M-Class, more toxic things need the H-Class.

Carolyn Topping: Yes.

Speaker 8: In the recent campaign we noted that in the construction industry has dust that was run because advice that either an H- or an M-Class can be used in that industry as opposed to the stone mason [inaudible 01:51:21] respiratory silica are higher [inaudible 01:51:21] it said that it was H-Class only or ... [inaudible 01:51:23] so the inspectors who have been doing the campaign incorrect?

Carolyn Topping: No, no, so for the engineered stone campaign that we're doing, we are, because it's an industrial situation, we are saying that H-Class is the best level of protection or with a vacuum system so that's what we're recommending there. With the construction, it's sort of a moving feast we're wanting to move that. When that project started there was some issues in terms of, because it's on pieces on equipment, so you've got some equipment that's going to be putting out a very large capacity of dust and there was some issues. I haven't actually worked on the construction dust process, project, I'm on the engineering one, but, on the engineered stone, but my understanding is that the capacity of some of those, the H-Class machines, because they are so good at filtering out and their efficiency is so good, that there were some issues in terms of them being able to cope with the capacity of the dust that was being produced by, say, a grinder or a saw.

Carolyn Topping: But I think now that we've drawn a line in the sand or we're starting to draw lines in the sand about what you can use in terms of, well what we expect is that that is going to move for construction over time as well because it is the same hazard, the engineering benchtops, the exposure levels are probably different in terms of the actual measured result that you might get in the engineered stone compared to construction.

Carolyn Topping: A lot of construction, if it's outside, might be less exposure because of the dilution factors and that sort of thing involved, but I think you will see over time that that might shift. Does that answer your question?

Speaker 8: [inaudible 01:53:23]

Carolyn Topping: We can have a chat later, but I know that may have caused a little bit of confusion but I think over time we will see that, that shift there with construction.

Carolyn Topping: One of the other issues that was raised in that video was about information training and instruction. We do have some provisions about that and what we would expect in that sort of situation is that the harm is explained to workers. So in that situation it's respirable crystalline silica, and that they would explain the control measures that are in place and how a worker would go about using them.

Carolyn Topping: And then the final point that I'd like to draw your attention to is about the health monitoring, and in both of those situations you would expect or we would expect that workers are getting health monitoring. So there would be a significant risk to health of workers in both of those situations, even though in that second one the person was wearing respiratory protection. There's a reason why respirators are so far down the hierarchy of control and that's because a lot of that relies on that facial seal so if you accidentally are sweaty that day, you mightn't get the level of protection that you're expecting from your respirator.

Carolyn Topping: If you put your respirator on in a hurry and it's not quite sealed up that particular day, you won't get the level of protection. So there are issues there, so we would be expecting to see in both of those situations, health monitoring provided to those workers. In the health monitoring provided or the health monitoring in the regulation there, a lot of that is focused on detecting silicosis, and a reason for that is that a lot of the research on the health effects from silica say that if you are protecting people from silica, so if you're keeping your, minimising your exposures and you're keeping it well, well, well below the exposure standard, that you are protecting people from respiratory diseases of all types, so silicosis and lung cancer.

Carolyn Topping: I'm not sure what that says about then people with silicosis. They are at increased risk as we went through before.

Speaker 9: Is the definition of significant risk that which the department [inaudible 01:56:02]

Carolyn Topping: Well, there is some guidance so the Queensland regulations don't cover that, so there is no definition that we have in Queensland regulations. We look to the Safe Work Australia guidance. That says over the 50 per cent mark, so over 50 per cent of the exposure standard is generally the occupational hygiene principle of where-

Speaker 9: [inaudible 01:56:34]

Carolyn Topping: Yeah, yeah. When we've done the, when we're working in this engineering stone space at the moment we are asking people to do health monitoring at half of the half, so a quarter of the exposure standard. There is, Safe Work Australia is currently reviewing the exposure standard for silica, so it is probable, likely, that the exposure standard may be reduced, in the future. And then it might be half of the half is the new half. If that makes sense.

Carolyn Topping: Yeah?

Speaker 10: Just one question or two questions for you. Do you regulate the health monitoring activity and if so is there a breach or non-compliance [inaudible 01:57:23] then my second question is what are the requirements around the health monitoring [inaudible 01:57:33]

Carolyn Topping: There are quite a few duties with health monitoring, so yes we, if an inspector forms a reasonable belief that there is a significant risk to the health of workers due to exposure, that they would enforce the health monitoring procedure or the health monitoring provisions, and as part of the provisions it talks about that you have to have it overseen by, the regulation talks about a registered medical practitioner with experience in health monitoring. So they need to go to someone who knows what occupational exposures and what sort of testing they should be doing.

Carolyn Topping: The Schedule 14, if it's a Schedule 14 substance it tells the employers or it tells the medical professionals what screening is required, what's mandatory, it doesn't mean they can't do other screening, but it tells you about the mandatory screening.

Carolyn Topping: I'm just thinking what else ... They're probably the most important factors, is about that you identify significant risk and you have, you have to, the employer pays for the health monitoring, they give the workers time off work so that's all covered by the employer.

Carolyn Topping: ... A copy of the health monitoring report, so the employer has to provide certain information to the medical practitioner. The medical practitioner then, at the end of, so they will go through their screening tests and consult with the worker, then a report, so they call this a health monitoring report, is then provided back to the employer. It only provides information about the results specific to the risks of exposure at the workplace so it doesn't give private information, health information, but that report comes back to the employer.

Carolyn Topping: If there is an injury, illness or disease that has been identified by the registered medical practitioner, a copy of that report is provided to Workplace Health and Safety Queensland, and as that lady said, about, that is also, a copy of that is also provided to the workers as well.

Carolyn Topping: I should have brought my Reg along and then I'd be able to have a look but, in the Health Monitoring Regulations there's, I think that just about covers them all. Can anybody think of anything else I've missed?

Speaker 11: With regards to the [inaudible 02:00:25] screen [inaudible 02:00:25] workers. Is there [inaudible 02:00:34] across all of the silica exposure industries or is it primarily aimed at that [inaudible 02:00:41]

Carolyn Topping: Yeah. So something that's going on with the engineered benchtop workers is that WorkCover Queensland is providing free health screening to those workers, so as part of that there is processes in place so it ensures that workers who are referred through that free service, that they are getting an adequate x-ray, so by someone taking it who knows that it's going to be for occupational exposure, that it's read by someone who is trained to the ILO standard or the International Labour Organisation Standard.

Carolyn Topping: And then those workers too will get to see an occupational physician and they will also get to see a, depending on what happens during that process and if they've got any possible disease, they might see a respiratory physician as well. The standardised questionnaires and the lung function testing will be done by qualified people. So that's through that WorkCover process.

Carolyn Topping: I think it's raising issues internally in terms of the Health Monitoring Regulations that we have in place and the Safe Work Australia guidance so because we don't have a lot of those details in the legislation themselves we refer to the Safe Work Australia guidance document and Safe Work Australia is actually looking at some of that guidance documentation at the moment.

Carolyn Topping: I would, yeah, there's some policy implications from the things that you're saying that I can't really comment on because I'm an occupational hygienist and I'm down in the technical area, but I think there are issues that have been raised in terms of those things that would see workers being, get the same level of care no matter what industry that they work in.

Carolyn Topping: Yes, there are issues, there are issues that have come up for us internally, in terms of how do we get compliance with good standards for people based on the current regulations that we have in place, so a lot of that we refer to the Safe work Australia guidance but I think that's a space that, more work will be done and yeah. I feed off a lot of what the CWP has sorted out a lot of those issues, yeah.

Carolyn Topping: Is there any other questions? Because that's about me done, I just wanted to sum up with saying that for occupational cancers, the primary duty of care applies to all exposures. The risk management principles applies to all exposures. The hierarchy of control applies to all exposures. So all those standard sort of safety focused, where people in the safety sphere are very confident and comfortable in using those things, they also apply to health risks as well.

Carolyn Topping: It's probably just a lot of that invisible, the invisibleness of health risks that makes it difficult for people to understand, and that latency period. We do have specific regulations on some occupational carcinogens. That's me done, is there any other questions?

Carolyn Topping: Okay, well thanks everybody, it was good to see you all here. Thank you.

PART 4 OF 4 ENDS [02:04:45]