The Results Are In: Ontario’s Occupational Cancer Review

After years of pressure from sick workers and their families and advocates, and a year and a half since the province announced a review, the wait is over. The findings of Ontario’s Occupational Cancer Review, headed by Dr. Paul Demers, were made public earlier this month in a report entitled Using scientific evidence and principles to help determine the work-relatedness of cancer.

In January 2019, Demers–an internationally-renowned expert in occupational disease–was tasked with doing an independent review that would answer three questions. How can scientific evidence best be used in determining work-relatedness in occupational cancer claims, particularly in cases with multiple exposures? Are there any best practices in other jurisdictions that Ontario should consider adopting? And what scientific principles should inform the development of occupational disease policy?

The report confirms what workers afflicted by cancer and other occupational illnesses have long believed: that only a fraction of those made sick by their workplace receive compensation through WSIB. Here are some of the key findings of Demers’ report.

Many are left behind

The Occupational Cancer Research Centre estimates that every year, workplace exposure to 16 well-established carcinogens results in thousands of diagnosed cases of cancer in Ontario–but successful WSIB claims don’t reflect that.

“On average, the WSIB has accepted 170 cancer claims per year (130 of which are for asbestos-related cancers). This is only a small fraction of the 3,000 estimated occupational cancers predicted for Ontario (including approximately 800 due to asbestos).” (page v)

To ensure that more cases of occupational cancer are covered by workers compensation, Demers suggests that the WSIB update and expand its list of the cancers that are presumed to be caused by the workplace. He also calls for new policies that set forth how other factors, such as smoking or exposure to multiple carcinogens, are weighted.

Scientific knowledge is not up to date

Around the world, there is a growing body of research on the link between cancer and chemicals, radiation and other factors–but the latest scientific understandings are not reflected in decisions of Ontario’s workers compensation system.

“…the International Agency for Research on Cancer (IARC) … has identified hundreds of known, probable, and possible associations between workplace exposures and cancer. While our knowledge of what causes cancer has greatly increased and continues to do so, the sophistication with which we approach attribution in workers’ compensation has not always kept pace.”  (pages v-vi)

Demers recommends that the WSIB increase its internal scientific capacity by employing more scientists with graduate level training in epidemiology, toxicology and exposure science.

GPs are ill-prepared

While occupational physicians are well-equipped to recognize work-related disease, most people don’t have access to that type of specialist. Instead, they must rely on family doctors for support with WSIB claims.

“Without the recognition by primary care providers, the onus of recognition falls on the patient and fewer workers’ compensation claims are filed. In order to reduce the extent of under-recognition, physicians need better training or tools on the causes of cancer and for collecting a full work history from their patients, which would include where the patient had worked, the dates they were employed, and the hazards present.” (page 20)

Demers acknowledges that it’s a tall order, but recommends that education be increased in order to boost Ontario doctors’ understanding and awareness of occupational cancers.

No one is tracking clusters

Identifying and tracking cancer clusters–for example, a group of workers from a particular industry or employer that has higher rates of disease that in the general population–is vital to learning more about workplace carcinogens. Yet, this critical investigation isn’t happening.

“Unfortunately, there is currently no agency in Ontario with the responsibility to investigate occupational clusters and neither the WSIB nor the MLTSD have the necessary research capacity.” (page 23)

Demers says ideally this should be done by the Ministry of Labour, Training and Skills Development independently of the WSIB, but the work could be shared in partnership with other branches of government.

To read the rest of Demers’ findings and recommendations, see the PDF or this easy-t0-navigate version of the full report.