In practice

There are already so many inspiring initiatives in the European Member States. Three of the best examples highlighted below.

Early warning systems


How can we pick up potential risks and assess whether there is a causal link between exposure to a substance and the prevention of cancer? How can we take measures to reduce the risk? ‘Early warning systems are needed!’


Lode Godderis, Professor at the Centre for Environment and Health of the KU Leuven in Belgium, explains why it’s so important to use these systems. “In this case we can’t use deductive thinking because we simply don’t know if a specific cancer case is caused by exposure at work”, explains Godderis. The solution is an inductive way of thinking. “So look at the disease first”, says Godderis “and then look for patterns and (ir)regularities. A hypothesis needs to be formulated which can then help us develop general theories or drawing conclusion.”


Nicole Palmen, a researcher at RIVM in the Netherlands, explains that there are three different types of early warning systems:

1. Clinical watch systems - particularly where physicians report cases of sick employees, and where information on exposure and classification is requested.

2. Databases of information about disease and exposure/work, with which one can do such as epidemiological studies to detect possible links between exposure and health effects.

3. Health surveillance and biological monitoring, in which one verifies whether workers who are exposed have health effects to a particular substance or activity.


Palmen explains that in Europe we have developed already a different number of systems which can be used to investigate relationships between exposure to chemicals and health effects resulting from exposure at work”. But European countries all have their own national based early warning systems. International cooperation is lacking while it is essential to act as quickly as possible. Palmen states: “what we need is an international expert group.  European cooperation on identification, evaluation and control is essential.”


That said, it's time for action. What steps can we take for the future? Some inspiring proposals:

• More advanced knowledge of mode of action, type of cancer, and potency for a given carcinogen is a prerequisite for identifying causality.

• An international database for registration of cases or clusters of diseases occurring in the workplace.

• EU OSHA should take the initiative for a common system and coordinating collaboration and dissemination of information.

• Build trust between workers, management, health practitioners and authorities - share information and experience.

• Do we need a stronger reporting system, for example streamlined parameters?

• Regular doctors are not very aware of the risks. A set of questions could be formulated that should be answered when taking the patient history.

• Oral exposure versus inhalation exposure. Use more proper toxicology methods. New exposures are created in the process and products are used in combination.




Nicole Palmen:

“My goal today? Action! I'm a researcher, but I'm also practical, searching for effect. We can take steps to counter work-related cancer. To put something in motion, you need both researchers and policy-makers. Today these parties are together and we should take advantage of this. We asked the question: 'what steps can we take to work together in putting and keeping early warning systems for carcinogens in place?', and we have received valuable advice, directly from the field. We will examine them and process them in a publication. Hopefully, these recommendations will be discussed at an EU setting. We have put a first step. Great. But if we really want to achieve something, we have to invest.”

'No time to lose'


“As an academic,” says Lesley Rushton, researcher in Occupational Epidemiology at the Imperial College in London, “it's very nice to find that your work actually gets use. It's an honour for me to have an organisation like IOSH use my data, as a background.”


IOSH – the British Institution of Occupational Safety and Health – uses Rushtons data and methodology to substantiate their ‘no time to lose’-campaign. The campaign works to raise awareness of occupational cancer, doing so through the production and distribution of fact sheets, flyers and other resources.

More information can be found here.


Purificación Morán, Researcher at the Union Institute of Work Environment and Health of the Spanish Trade Union, gives a telling, if somewhat shocking, statistic. “In 2014, of the estimated 215.000 newly diagnosed cases of cancer in Spain, some 9.000 are considered to be due to occupational exposure - but only twenty-three cases of work-related cancer were actually reported. Proving the occupational origin of cancer is difficult.” The campaign Cancér Cer en el Trabajo (‘zero cancer at the workplace’) aims to raise workers’ awareness of carcinogens, and to eliminate or reduce the use of carcinogenic substances.

More information can be found here.


Wim van Veelen, policy advisor at the Dutch trade union FNV, explicitly thanks his Spanish colleagues: their ‘zero’-campaigns formed the inspiration for the Dutch Werkplek Kankervrij-campaign (‘no cancer in the workplace’). Like the Spanish original, one main target is to raise awareness, but the trade union also provides workers with the means to develop counter arguments, whenever their employers claim that a target OEL - or Occupational Exposure Level – is to ambitious to be feasible.

More information can be found here.





Jop Groeneweg:

“There are several things that I think make these campaigns outstanding. One of them is that the content is probably okay. There is no doubt about the numbers; there is no doubt about the sense of urgency. Of course, now the question is how to translate those numbers into information that will get people to change their attitude towards these substances. What I really like is the 'zero' in the zero-campaigns. It's a good target, because it's not negotiable. It immediately raises awareness. So if you have to set a goal, make it zero.”

Asbestos Removal


It is difficult to talk about work-related cancer without talking about asbestos. And thus, my presentation is on the biggest asbestos removal project worldwide that my firm has managed. This was the removal of asbestos at the Vienna International Centre between 1999 and 2013. The total gross floor area of these buildings was 340,000 m² and the buildings were used by some 4,500 staff. This project went through several steps: a status report, a pilot study, the planning of the removal of asbestos and then the actual removal of asbestos, which took from 2004-13. The removal of asbestos had to be achieved safely and while maintaining the normal function of the buildings.


One of the most important steps in this project was to undertake a thorough and detailed investigation on asbestos containing materials in the building before starting any work. As such, there is the European standard (EN) which is at the same time also an international standard (ISO) and that has been published in 2014, this means it is nearly brand new.


This standard – EN ISO 16000-32: Investigation of buildings for the occurrence of pollutants – is available in every country of the EU (in the Netherlands as NEN-EN-ISO 16000-32) and has been worked out within an international working group with me as chairman respectively on the basis of an Austrian standard which I have influenced due to the experience of approximately 20 years of working with asbestos. It is necessary to undertake appropriate control and supervising measures during asbestos removal procedures and that monitoring should be realized by SEM (scanning electron microscopy) and not even by PCM (phase contrast microscopy), as it is still done in many countries of the EU.




Heinz kropiunik:

"The removal of asbestos from the VIC buildings was successful, but, we have also realised that workers are also vulnerable to asbestos cement products which have been used in rooves and facades. In the past we didn't realise the danger of these products and we now have to develop strategies for their safe removal. For example, gutters with sediments with high concentrations of asbestos particles need to be removed by workers in adequate safety equipment and have access to mobile cleansing rooms."