Long term night shifts linked to doubling of breast cancer risk

Working night shifts for 30 or more years doubles the risk of developing breast cancer, and is not confined to nurses as previous research has indicated, finds a study published online in Occupational and Environmental Medicine.

Shift work has been suggested as a risk factor for breast cancer, but there has been some doubt about the strength of the findings, largely because of issues around the assessment of exposure and the failure to capture the diversity of shift work patterns. Several previous studies have also been confined to nurses rather than the general population.

In this study, the researchers assessed whether night shifts were linked to an increased risk of breast cancer among 1134 women with breast cancer and 1179 women without the disease, but of the same age, in Vancouver, British Columbia, and Kingston, Ontario.

The women, who had done various different jobs, were asked about their shift work patterns over their entire work history; hospital records were used to determine tumour type.

This may be important, say the authors, because risk factors vary according to hormone sensitivity, and the sleep hormone melatonin, disruption to which has been implicated in higher breast cancer risk among night shift workers, may boost oestrogen production.

Around one in three women in both groups had worked night shifts. There was no evidence that those who had worked nights for up to 14 years or between 15 and 29 years had any increased risk of developing breast cancer.

But those who had worked nights for 30 or more years were twice as likely to have developed the disease, after taking account of potentially influential factors, although the numbers in this group were comparatively small.

The associations were similar among those who worked in healthcare and those who did not. Risk was also higher among those whose tumours were sensitive to oestrogen and progesterone.

The suggested link between breast cancer and shift work has been put down to melatonin, but sleep disturbances, upset body rhythms, vitamin D or lifestyle differences may also play their part, say the authors.

“As shift work is necessary for many occupations, understanding which specific shift patterns increase breast cancer risk, and how night shift work influences the pathway to breast cancer, is needed for the development of healthy workplace policy,” conclude the authors.

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Microscopic dust may pose a danger to underground rail workers

Maggie Smith/freedigitalphotos.net

New research from the University of Southampton has found that working in an underground railway system for a sustained period of time could have health implications.

Matt Loxham, PhD student at the University of Southampton, explains: "We studied the ultrafine dust (or particulate matter) found in an underground station in Europe...It was at least as rich in metals as the larger dust particles...These tiny dust particles have the potential to penetrate the lungs and the body more easily, posing a risk to someone's health."

While coarse dust is generally deposited in the conducting airways of the body, for example nasal passages and bronchi; and the fine dust generally can reach the bronchioles (smaller airways), it is almost exclusively the ultrafine dust which is able to reach the deepest areas of the lungs, into the alveoli, where oxygen enters the blood and waste gases leave, to be exhaled. There is evidence that this ultrafine dust may be able to evade the protective barrier lining the airways (the epithelium), and enter underlying tissue and the circulation, meaning that the toxicity of ultrafine particles may not be limited to the airways but may involve the cardiovascular system, liver, brain, and kidneys.

Mr Loxham adds: "Underground rail travel is used by great numbers of people in large cities all over the world, for example, almost 1.2 billion journeys are made per year on the London Underground. The high level of mechanical activity in underground railways, along with very high temperatures is key in the generation of this metal-rich dust, and the number of people likely to be exposed means that more studies into the effects of particulate matter in the underground railway environment are needed, as well as examining how the levels of dust and duration of exposure might translate to effects on health."

Study: Smaller Companies Bearing the Financial Burden of Employees with Cancer

Disability in Workers with Cancer Equals 20 Percent of Healthcare Spending

Each year, more than three million American workers are diagnosed with cancer, leading to high productivity losses that mainly affect smaller companies, reports a study in the December Journal of Occupational and Environmental Medicine. 

Analyzing a national survey of medical spending, the researchers found that cancer in U.S. workers leads to productivity losses of more than 33 million disability days per year, amounting to $7.5 billion in lost productivity. Based on the average wages of the workers surveyed, disability costs due to cancer were equal to 20 percent of total healthcare spending.

Nearly 85 percent of the workers with cancer worked for smaller companies with fewer than 500 employees. These small-business employees had higher rates of other health problems as well, including high blood pressure, depression, and chronic obstructive pulmonary disease. They were also more likely to be uninsured.

Certain types of cancers, including women's cancers and melanoma, were associated with higher burdens of illness. For breast cancer, health care costs and hospitalizations were twice as high and disability days 55 percent higher than for other cancers.

The study is one of the first to document the economic impact of cancer in the U.S. workforce. The true cost in terms of lost productivity is likely even higher than the disability days measured in the study. The authors call for further efforts to reduce the burden of illness associated with cancer and its treatment—perhaps including supportive care interventions to reduce cancer-related disability.

Photo: freedigitalphotos.net

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Sharp Spike in Computer-Related Injuries Predicted for Medical Workers, Find Studies

As U.S. health care goes high tech, spurred by $20 billion in federal stimulus incentives, the widespread adoption of electronic medical records and related digital technologies is predicted to reduce errors and lower costs – but it is also likely to significantly boost musculoskeletal injuries among doctors and nurses, concludes a Cornell University ergonomics professor in two new papers.

The repetitive strain injuries, he said, will stem from poor office layouts and improper use of computer devices.

"Many hospitals are investing heavily in new technology with almost no consideration for principles of ergonomics design for computer workplaces," said Alan Hedge, professor of human factors and ergonomics in Cornell’s College of Human Ecology's Department of Design and Environmental Analysis. "We saw a similar pattern starting in the 1980s when commercial workplaces computerized, and there was an explosion of musculoskeletal injuries for more than a decade afterward."

For a paper published in the Proceedings of the Human Factors and Ergonomics Society 56th Annual Meeting, held Oct. 22-26 in Boston, Hedge and James asked 179 physicians about the frequency and severity of their musculoskeletal discomfort, computer use in their clinic, knowledge of ergonomics and typing skills. The most commonly reported repetitive strain injuries were neck, shoulder and upper and lower back pain -- with a majority of female doctors and more than 40 percent of male doctors reporting such ailments on at least a weekly basis. About 40 percent of women and 30 percent of men reported right wrist injuries at a similar frequency.

"These rates are alarming. When more than 40 percent of employees are complaining about regular problems, that's a sign something needs to be done to address it," said Hedge. "In a lot of hospitals and medical offices, workplace safety focuses on preventing slips, trips and falls and on patient handling, but the effects of computer use on the human body are neglected."

The gender differences, the authors write, appear to be in part because women reported spending about an hour longer on the computer per day than men.

In a second study of 180 physicians and 63 nurse practitioners and physician assistants in the same health system, published in a new volume, "Advances in Human Aspects of Healthcare" (CRC Press), more than 90 percent of respondents reported using a desktop computer at work. On average, they spent more than five hours per day using computers.

Fifty-six percent of doctors and 71 percent of nurse practitioners and physician assistants said their computer use at work had increased in the past year; 22 percent of doctors and 19 percent of nurse practitioners and physician assistants reported less time in face-to-face interactions with patients. Only about 5 percent of participants reported an "expert knowledge" of ergonomics, and more than two-thirds said they had no input in the planning or design of their computer or clinical workstation.

"We can't assume that just because people are doctors or work in health care that they know about ergonomics," Hedge said. "With so many potential negative effects for doctors and patients, it is critical that the implementation of new technology is considered from a design and ergonomics perspective.”