Document QJozxrxLQxkajD19BDKEG1gVv

/ u '%-Xi Ca GfL o n v While thousands of hazardous substances are being used in the workplace with more being introduced every year, OSHA has completed regulatory activity for only 17 In an effort to escape the slow "substance-by-substance" approach to set ting standards, OSHA has proposed a system that would per mit standardized responses, in regulatory terms, for suspected carcinogens. Secretary of Labor Ray Marshall and Assis tant Secretary Eula Bingham, head of the Occupational Safety and Health Administration, have announced the first comprehensive pro posal for regulating cancer-causing substances. The proposed cancer policy will establish a pro cedure for identification, classification, and regu lation of potential carcinogens m American workplaces At the outset, osftv recognizes that 1,500 to 2,000 agents have been identified by NtOsH as being "suspect carcinogens" (hew Pub lication No. (niosh) 77-149N Yet osha has completed regulatory action on only 17. osha recognizes that in regulating occupa tional carcinogens, man> gaps remain in the knowledge of cancer, its causes, prevention, and cure. However, to wait for years to resolve these issues scientifically without some consistent and workable system for the regulation of toxic sub stances, for which there is evidence of carcino genic potential to humans, would be inconsistent with osha's statutory obligations and unaccepta ble to all concerned. The new osii \ proposal and broad rulemaking proceeding which will accompany it arc intended to establish New procedures and regulatory framework for regulating worker exposures to potential oc cupational carcinogens Scientifically-bused policies to identify and classify such substances. Three model standards for use in spcctfic rulemaking involving such substances. Secretary Marshall noted that "this compre hensive cancer policy represents a major break through for osha. Trying to control carcinogenic substances on a case-by-case basis is like try ing to put out a forest fire one tree nt a time. Instead, vve are propostng a systematic way of determining which toxic substances require emergency attention by osha. "This now policy will allow osha to respond to threats to worker health with much greater speed and efficiency. This represents another step in our continuing efforts to make osha a model regulatory agency Eul.i Bingham and her staff arc to be commended for their efforts in developing such an important policy." Dr, Bing ham pointed to the proposed cancer policy as another indication of osha's renewed commit ment to protecting American woikers from health hazards. "The sad fact is that more than 1,000 Ameri cans die every day horn cancer--370,000 a year. Leading cancer researchers have attributed more than 60 percent of these cancer cases to en vironmental factors. "I believe the time has come to implement a comprehensive program to prevent cancer in the workplace." , Dr. Bingham noted that as a result of the proposed rule, osha will develop three model standards, incorporating Osin's views on which protective provisions are generally the most ap propriate for different eategoties of substances. Thus, in a later rulemaking for a specific sub stance, the only major issues to be resolved would be selection of an approptiate exposure limit and determination of whether osha has appropriately classified the substances. Classifying substances In classifying each toxic substance encoun tered, osha will rely on evidence from human epidemiological siudtes, adequately designed and conducted animal studies, or both. The degree of conclusivcncss of such data would determine whether the toxic substance in question should be regulated as a Category I or Category II sub stance. Alternatively, a decimation of Category 111 may be assumed (for a substance requiring Further data development) or Category IV (for substances omiv believes arc not found in Amer ican wotkplaco, but otherwise would be regu lated) . The proposed rules and system would pci nut any "interested person" or osha itself to present 14 DECEMBER 1977 003751ft 7 1712947 jf RSV0033777 information to the Secretary of Labor for the classification of any toxic substance After re ceipt of such information, ihe Secretary would publish a notice for public comment giving the contents and source of such information Gen erally a 30-day public comment period would be provided following which the secretary would, within 30 additional days, publish a notice classifying tltc substance as Category I, II, III or IV, and explaining his decision. osha proposes lo classify as Category I those substances whose carcinogenicity has been estab lished in humans, or in two mammalian species of test animals, or in one species if those results have been replicated Category II substances would be those whose carcinogenicity has been reported but the evidence is only suggestive, or is positive in only one species and not yet repli cated. Classification of a substance in Category I would trigger the immediate issuance of the mo del emergency temporary standard. Tins would be quickly followed by rulemaking--using the model for proposed permanent standards for Category' 1 substances. At the conclusion of the rulemaking, if die Secretary of Labor determines the substance should more correctly have been classified as Category' II, the model for that standard would be followed in issuing the per manent rule Under these procedures, rulemaking would be significantly streamlined and speeded because the issues for rulemaking m dealing with Cate gory I substances would be limited to: whether the Secretary correctly classified the substance as Category 1, whether he was correct in the de termination that the Category I classification should not be rebutted, whether the lowest fea sible exposure level was selected or whether there are suitable less hazardous substitutes, whether the substance has unique properties that make provisions of the model inappropriate, and the environmental impact arising from regulation of the substance Similarly, an initial classification of a toxic substance in Category II would initiate rulemak ing following the model for permanent standards for such substances The three mode! standards to be developed include an emergency temporary standard to be issued, in general, if the toxic subsiancc meets the criteria for a Category I substance, a pro posed permanent standard for such substances, and n proposed permanent standard for those substances that meet the criteria only for a Cate gory II designation In discussing its proposed system for classi fying substances as Category I, II, III, or IV. OSHA noics in lire proposal (which appeared October 4 in the Federal Regina) that there is general agreement among scientific experts on the praciical and cthic.il difficulties in relying on epidemiological studies tn man as the sole basis for establishing thu carcinogenic potential of a substance; the validity of studies in experi mental animals to establish the carcinogenic potential of a substance, the minima! and opti mal experimental conditions for carcinogenic testing, and, the kinds of statistically significant changes in tumor incidence that can be observed in experimental animals and used to characterize carcinogenic potential Areas of agreement In particular, there appears to be general agreement on several major issues on which osha is retying in proposing these regulations: osha relies, in general, only upon results found in testing of mammalian species, especially the rat and mouse, because they arc directly relevant to man m carcinogenicity testing Positive results in any mammalian species will, as a general rule, supersede negative find ings in another species, and positive annual data generally should supersede human data because of frequent defects in human studies Testing of substances at constant high ex posure levels is required to overcome the sta tistical insensitivity of laboratory bioassays conducted with the limited number of animals than can be practicably handled in laboratories. The size of groups of test animals must be sufficiently large to permit statistical evaluation for significance. osha notes that while there is substantial agreement on these five issues which arc key to Osiia's classification system, there are six other areas where scientific experts are less fully in agreement osha hopes the rulemaking will lead to full and conipi chensivc debjtc on all eleven of the classification factors to permit develop ment of a sound classification system. In the re maining six issues, osha proposes: To place as much weight on an expeument m which only benign tumors are observed, as when both benign and malignant tumors arc induced To interpret the results of experiments 0037519 -W- * * i *^#H'i V'MT JOB SAFETY AND HEALTH 1712948 [f 15 RSV0033778 I showing increased incidence of tumors in acute or chronic effects other than carcinogen treated animals as evidence of carcinogcmcitv, icity. Also, where the record indicates that regardless of spontaneous cancer incidence, pro suitable substitute substances exist, osha can vided that the experiments arc sufficiently well- propose to prohibit the use of a Category I sub controlled and an increase in incidence is sta stance. tistically significant Only the model for proposed permanent To consider development of tumors from standards for Category I toxic substances re dermal, inhalation, injection (with tumors at quires establishment of a regulated area (access distant sues) and oral exposures as directly to which must be limited by the employer to relevant to occupational exposure, conversely, "authorized" personnel). tumors at the site of injection or implantation shall generally be regarded as irrelevant to occupational exposure. To place much greater weight on positive results that have been replicated in another Study than on a single unconfirmed result. That in regulating a Category I toxic sub stance, the level of exposure to be set will not be a "healthful," "safe," or "no-cflcct" level, but a feasibility level to be determined by osha. That although the agency is of the view that "no-eflect" levels cannot be set for a carcinogen, there arc some who believe it may be desirable to quantify the degree of risk for the purpose of evaluating the expense and level of control considered feasible. Thus, the agency seeks comments on whether such an estimation should be attempted, and if so, the methods to be employed In discussing the three proposed model stand ards, osha notes its intention that, apart from the unique substance-specific aspects of these In prescrib'ng methods of compliance, the most significant difference between the model emergency rule and the proposed permanent rule for Category I substances is that the emer gency rule would permit greater reliance on respirators to reduce exposures; the permanent rule would require substantial reliance on en gineering and work practice controls to reduce exposures--with respirators permitted only as an interim means of protection. Requirements for protective clothing and equipment would be essentially the same except that the proposed emergency rule would not require clothes-ehaneing rooms Requirements for hygiene facilities and practices aie essentially the same for all tluce model proposals except that tiic emergency rule for any substance not previously regulated by osha would not require compliance with the requirements for lunch rooms, shower rooms, and the like. standards as future lulemahings are undertaken, The three model standards require the use the provisions of the models, ns determined m of signs and Ijbcls with the two models for this rulemaking, will not be an issue. Category I substances requiring the warning of "cancer hazard ' Model comparison Recordkeeping requirements are essentially In the notice of proposed rulemaking, ostiv provides a sidc-bv-side comparison of the three models. Each follows a standard format-, but, to distinguish between emergency rules and pro posed permanent rules for Category I and Cate gory II chemicals, there arc some significant the same except that the mode! emergency rule would prescribe shorter time periods for reten tion and would not require a transfer to momi of mcclrcnl records if the employer ceases to do business. Other sections of the three models which will differences. be essentially the same include those coveiing: Among the differences arc- scope, definitions, exposure monitoring and Permissible exposure limits in the emer measuring, housekeeping, waste disposal, medi gency temporary rule and in the proposed cal surveillance (with substance-specific ptoio- permanent rule fot Category f substances would eols to be filled in for each new substance dealt be set at the lowest level feasible, for Category with), employee information and training, ob II substances, exposure levels would be those servation of p'omtormg, effective dates, and currently prescribed in osiiv's table of peumssi- appendices All three models eall for three blc exposure levels, or Jt lower levels if appia- appendices a substance sffctv data sheet, sub printc, or where no prescribed levels exist, the\ stance technical guidelines, and medical suiveil- would be set at an appropnatc level based on lanee euidelmes . 10 DECEMBER 1977 0037520 PST 1712949H RSV0033779 k- V-. i osha is seeking full discussion of all of the issues raised by the proposed classification sys tem, the agency's rationale for classifying, the model standards, procedures to be followed, and any other relevant issues raised by the proposed regulation Conimems, data, and views of in terested persons are being sought, osha has scheduled a public hearing to begin at 9:30 a m , March 14, 197S, in the Department of Labor Auditorium. Those who wish to present testi mony should submit requests to appear, post marked no later than January30, 1978, to the Osha Division of Consumer Affairs, Room N3633, U.S Department of Labor, Third Si. and Constitution Avc., NVV, Washineton, D.C. 20210. Requests to appear at the hearing must con tain the following: name, address and phone number of each person to appear, the capacity in which the person will appear, approximate time required, specific issue(s) raised by the proposal that will be addressed, a detailed state ment of the position to be taken on each such issue; and whether documentary evidence will be submitted, and if so, a brief summary of mat evidence. Copies of all written submissions and requests lo appear will be avjii.ibie for inspection and Copying in the offices noted above. In addition to the above requirements, any person intending to testify for more than 15 minutes at the public hearing must submit not later than January 30, 1978, four copies of the full text and all documents to the osha Division of Consumer Affairs Such submissions also will be available for inspection and copying, but at the osha Docket Office. The Environmental Protection Agency Earlier this year, Douglas M. Costle, epa Ad ministrator, delineated lus agency s approach to dealing with cancer hazards. The essence of the Toxic Substances Control Act is expressed in three policy statements which appear at the beginning of the Act. Costle said The first statement is that "adequate data should be developed with respect to the ctfect of chem ical substances and mixture' on health and the environment and the development of such data should be the responsibility of those who manu facture and those who process such chemical substances and mixtures " In defining tins policy, Congress placed the buiden for developing loxic substance information squarely upon the pro ducers of chemical products. Congress intended that the manufacturers and producers take cor rective action themselves. It was not written simply to provide a means for tux to obtain data to support regulatory actions, epa, of course, will use information developed by manu facturers to bjek up regulatory actions when necessary "But if epa thought its job was to protect human health and the environment solely through the imposition of a wholesale series of individual regulations applicable to individual chemicals and in individual situations, then the real thrust and meaning of this first policy state ment would ba lost," Costle said. The second policy statement says "adequate authority should exist to regulate chemical sub stances and mixtures winch present an unreason able risk of injury to health or the environment and to take atcion with respect to chemical sub stances and mixtures which are imminent haz ards " The burden is upon epa to use its legal authority aggressively in the protection of health and the environment. However, r.pv should use that authority only after it has evaluated the facts and determined that an "unreasonable risk" exists. To make this decision, the agency has to understand the toxicity of the chemical substance in question, the population exposed to the chem ical, the degree of exposure, and the costs and problems associated with eliminating or limiting that exposure. The third policy says that "authority over chemical substances and mixtures should be exercised in such a manner as not to impede un duly or create unnecessary economic barriers to technological innovation '' Again, the burden is on epa. The Congress intends that epa exercise judgment in the regulation of chemical sub stances. It does not intend for epa to ask for more information than it really needs All of the actions which epa has taken, and will take, arc consistent with the three basic policies set down by Congress. "Wc will sec to it th.it adequate data arc developed with respect to the effect of chemical substances and mix tures on health and the environment. Wc will regulate chenmnl substances and mixtures which picsent an unreasonable risk. And we will exer cise our jutlioritv m a manner so as not to im pede unduly or create unnecessary economic barriers," Costle said. Jim roster u OSffA chief of news medic services 0057521 PST JOB SAFETY AND HEALTH 17 1712950 h RSV0033780 u uTjUlSljD hjvc/Ci-itoU\ic>J V^7GsWj ^ivhiiil LasL/^^'v^S'LlLife? AGENT Wood Leather Iron oxide Nickel Arsenic Chromium ORGAN AFFECTED OCCUPATION Nasal cavity Woodworkers and sinuses Nasal cavi;J and sinuses, urinary blad der Leather and shoe workers Lung; larynx Iron ore miners; metal grindeis and polishers, silver finishers; iron foundry workers Nasal sinuses; Nickel smelters, lung mixers, and roasters; electro lysis workers Skin; lung; liver Miners; smelters; insecticide makers and sprayers; tanners, chemical workers; oil re finers, vintners Nasal cavity and sinuses, lung; larynx Chromium producers, processors, and users; acetylene and aniline workers; bleachers; glass, pottery, and lino leum workers; battery makers IB DECEMBER 1977 Asbestos Lungfplcurnl Miners; millers; and peritoneal textile, insulation, mesothelioma) and shipyard workers Petroleum, petroleum coke, wax, creosote, an thracene, pa raffin, shale, and mineral oils Nasal cavity; larynx, lung, skin;scroium Contact with lubricating, cool ing, paraffin or wax fuel oils or coke; rubber fil lers; retort work ers; textile weavers; drcscl jet testers Mustard gas Larynx, lung; Mustard gas trachea; w orkers bronchi Vinyl chloride Liver; brain Plastic workers Bis-chloromethyl ether, chloromcthyl ether Lung Chemical workers . Isopropyl oil Nasal cavity Isopropyl oil producers Coal soot, Lung, larynx; Gashouse work coal tar, other skin, scrotum; ers, stokers, and products of urinary blad producers; as coal combus der phalt, coal tar, tion and pitch work ers; coke oven workers; miners; still cleaners Benzene Bone marrow Explosives, ben zene, or rubber cement workers; distillers; dye users; painters; shoemakers Auraminc, Urinary blad Dyestuffs manu benzidine, der facturers and alpha-Nnph- users; rubber thylamine, beta-Napththylamine, workers (prcssmen, filtcrmcn, laborers); textile magenta, 4- dyers; paint man- Aminodiphenyl, 4-N'i- ufaclurers trodiphcnyl Source: Nation?) Cancer Institute 0037522 psj 1712951IV RSV0033781 Labor Secretary Ray Marshall were going after the whales instead of the minnows. "We arc today announcing a new policy that I believe will pro\ idc the broad net wc need to catch some of the biggest whales--cancer caus ing substances For too long osha has had to approach each toxic chemical on a substance by substance basis Trying to control carcinogenic substances on a cose by case basis is like trying to put out a foicst fire one tree at a time. "Instead we are proposing a systematic way of determining which ioxic substances require emergency attention by osha I believe this com prehensive cancer policy represents a major j breakthrough for osha--it will allow us to re spond to threats to worker health with much { I greater speed and efficiency. "It was not too long ago that Dr. Bingham and "This represents another step in our continu I announced a redirection of the resources of ing efforts to make osha a model regulatory osha. With limited resources we felt that we had agency. Eula Bingham and her staff are to be to focus on the most serious threats to the health commended for their efforts in developing such and safety of workers. We announced that we an important policy." Dr. Eula Bingham, head of OSHA year. Leading cancer researchers have attributed 5 more than 60 percent of those cancer cases to environmental factors "So the message is clear. I believe the time has come to implement a comprehensive program to prevent cancer in the workplace "Under this new cancer policy, we would clas sify a substance in one of four categories and then take specific action depending on the clas sification. A major purpose of the rulemaking is to settle once and for all, the policy issues that will guide osha in its future regulation of occu pational carcinogens. In the past a great deal of time and energy has been expended in debate over scientific and medical questions about the I extent to which available data could be con sidered as evidence of cancer hazard m man. "It is particularly significant that osha is tak Tins prudent public health policy will end the i ing the lead among go\crnment agencies in at need for such exhaustive debate as we deal tempting to set comprehensive policies to deal with each new substance with the problems of cancer. Ours has been the "Also, in the past we have os an agency ex agency chosen by many as the example of bu pended horrendous amounts of time and energy reaucratic nit-picking But we have pledged our in developing each separate section of the j'ob efforts to attack the more serious hazards. There health standards on a subsiancc-by -substance can be no doubt that cancer is among those basis. Through this rulemaking wc will develop serious hazards Moreover, many of the chem standard foimals and content for the regulations icals which we now regard as cancer-causing needed to deal vviih Category I and II sub have first been recognized from the tragic con stances. So wc are proposing model emergency sequences of cancer in the woikplacc. temporary standards for all subsinnecs Intel "The sad fact is that more than 1,000 Amer classified as C.ucgors I. That model would be icans die every day Irom cancer--370,000 per the selnclc for piomptly issuing an emergency JOB SAFETY AN`0 HEALTH 19 I 0037523 PST A. ( jk c.J, v-v* l > RSV0033782 rale ns soon as the substance involved is classi fied as Category 1 or a confirmed carcinogen "Another model standard would be used in developing a permanent standard for Category I substances and a third model would be used to dcsetop a permanent rule for the Category IT suspect carcinogens. "While there are a number of differences among ihe three models, the most significant arc in the c\tent to which worker exposure must be limited. `The emergency and permanent rules we would issue for Category I substances would reduce worker exposure to the lowest level feasible, C while the Category H exposure level set would be sufficiently low 10 prevent acute or chronic 3 lovic effects in exposed workers g "Our proposed system, then, will cnabl.c us to quickly react to new evidence of carcinogcniciiv. jj to properly classify a substance and deal with it k in an appropriate regulatory fashion with most 'j of the issues involved settled beforehand. This i] will, we are confident, markedly speed up our 3 capability to deal with carcinogens and greatly *1 enhance our ability to protect workers. 1 Grover Wrenn, OSHA haalth standards chief "In general, those substances for which there exists an overwhelming consensus based on human and animal data would be placed in Category I. This would include such substances as arsenic, coke oven emissions, benzene, beryl lium, chiomates, and pesticides such as Dibroniochloropropane and kepone Category II would be for those substances for which there is some "strongly suggestive evidence" like those currently being tested by the National Cancer jj Institute. Tests of Category II substances would if show some positive results that were not conclu- tj sive such as evidence in one species but not in another, or evidence in one sex but not the other. Examples would be recently-tested chlon- tj ated hydrocarbon solvents such as perchloroe- 8 thylenc and trichloroethylene. | "Because this proposal does not, in itself, reg- <] ulate exposure to any specific substance, an eco- *j nomic impact statement would be meaningless. As standards are developed under the new sys- * tern, impact statements will be prepaid This is i, not quite a "fill-m-the-blank" proposal, but it a will reduce discussion to those unique areas that J relate to each substance. This proposal would 4 make a big difference in the time needed for 3 osna to respond to newly-discovcrcd health 1 hazards. It would remove all doubt about the 4 method of OSHA's tesponse. | "A preliminary review of the Kiosii list of sus- pectcd carcinogens indicates about 100 would 3 belong to Category I Another 3-400 would be- j long to Category II, and the remainder would be in Category III or IV, I f-1 ft SKpaaKSjLS :3 By Peter S. Barth G-.i d Lvtd Z'J72lG?Qi ^ J lTl. "TNrr'-S/'-'Ti 7Tsi n * /p^ancer will kill some 370,000 Americans ft this year. While cardiovascular diseases will kill perhaps 2 5 times as many per sons as cancer, the latter appears to inspire far moic fear in the minds of the public Perhaps this can be explained by ihe suddenness with winch cancer may appear m persons of all ages 20 DECEMBER 197? 0037524 PST 1712953V RSV0033783 as compared to the very gradual deterioration ahead to see how the problem will develop in that so frequency precedes dcjlh from cardio occupations where workers are, or have been, vascular illnesses "the fear may also be traced exposed to presently known carcinogens First, to the very high death rates, particularly in ear data on the number of workers exposed to such lier years, in persons diagnosed as having cancer. agents is extremely crude and sketchy. For ex Ultimately, however, the root of the attitude is ample, no distinction is typically made among probably the absolute ignorance of the causes of workers who face occasional or extremely lim the disease Simply put, in the vast majority of ited exposures, and those routinely exposed, or cases the cause of cancer is unknown. Further, others who periodically must face substantial even in those instances where the disease may be doses. Secondly, data arc presented, generally, traced to a specific carcinogen, it is not known as a stock of workers exposed at a point in time, why the agent induces the disease in some per rather than taking into account labor turnover sons and not m others Thus, for example, it re and, therefore, reporting the number of workers mains a mystery why some persons will develop who have been exposed over a time period cancer subsequent to very' limited exposure to Since intcr-induxtry turnover rates vary' substan asbestos, while others necessarily exposed for tially, the problem is especially tricky. Overall, sufficiently prolonged periods to large amounts the task is difficult but until such data arc de of the substance may develop (the potentially veloped vve will not be able to gauge accurately deadly) asbestosis but do not develop cancer. the potential scope of the occupational cancer Occupational or industrial cancer occurs problem. where the cause of the disease is largely to be Finally, it should be noted that our growing found at the workplace. 'If.s definition, regrett ability to treat medically individuals with cancer ably, yields little insight into the magnitude of will partly undermine efforts to identify the ex the problem. Many substances to which one is tent of the problems of the workplace. A large exposed at the workplace may routinely be share of the knowledge linking cancer to specific found in the environment At the extreme, pro occupations, industries and/or hazards is the longed and substantial exposure to sunlight is product of epidemiological research, much of understood to be hazardous, thus impenimg which depends upon fatality data and death workers in outdoors activities (sailors, farmers, records In summary, resolving the issue of the recreation persons) as well as sun-worshippmg extent to which the workplace contributes to non-workers The caicmogens asbestos, nickel, cancer will not be simple, cheap or quick. arsenic, etc. are often found ns air pollutants, Environmental causes jeopardizing workers and others indiscriminately, though the extent of exposure will typically be There appears to be wide agreement that per far higher at workplaces. It is only the rarest of haps 60-90 percent of cancer is environmentally situations such as occurred m the case of vinyl caused. Breaking this down into its components, chloride where a relatively unusual type of can c.g , air pollution, diet, cigarettes, drinking-water cer is found and can be unambiguously traced contaminants, the workplace, etc., yields little lo the workplace. agreement, however That estimates of the extent Since the causes of cancer in most cases have to which work is responsible vary so widely is not been established, the extent to which the due to the pioblcms enumerated above While workplace is responsible for causing the disease it will ceitamlv offend parties on all sides of the cannot be established cuircntly Compounding debate, it seems reasonable to the author to the problems of attributing causality is the tong describe as conservative, an estimate of 1 or 2 latency period of the disease. Thus, persons percent of the cases as caused by the workplace developing the disease today may have been in Using such an estimate, based on the predicted contact with the causal ageutfs) perhaps 20 or total of 370.000 cancer fatalities for 1977, even 30 years ago. Tins phenomenon also con some 3.SOO-7,600 persons will have died from tributes to the enormity of the task of putting occupational cancer The author does not be the responsibility at the workplace in a legal lieve that these numbers represent the "true" proceeding number of cases, but instead arc only a very safe, Not only are there these pi obicms in deter lower estimate on ihe extent of the problem as mining how many cases of cancer are occupa measured In faialitics tional in origin, we cannot even effectively look There exists an enormous disparity between 0037525 PST JOB SAFETY AND HEALTH 1/r RSV0033784 Ihe numbers cited above and the extent to which occupational cancer is seen by state workers' compensation systems. Data have been compiled by the author on the extent to which occupa tional disease claims are paid under state work ers* compensation laws It has been found that a very small number of claims involving occupa tional diseases generally arc seen and processed by state agencies Data from the stales in this area arc incomplete and generally difficult to aggregate Data sources examined included annual rcpoits of state agencies, separate mail and telephone surveys of these agencies, a mail survey of insurers, and data from the National Council on Compensation Insurance, the body that assists insurance earners in setting rates Piecing these all together it appears safe to con clude that perhaps fewer than 100 fatality eases a year due to cancer aie being compensated Since the data on non-fatal claims are even more difficult to sort through, e.g. some skin cancer claims may be identified only as ``skin disorders," it is far more speculative to guess the extent to which such eases arc compensated Nevertheless, it is absolutely certain that as in the case of fatalities, there is a large gap between claims compensated and any "conservative" estimate of the number of new eases of occupationallyrelated cancer each year The disparity between the incidence of occu pational cancer and of cases compensated is likely attributable to a variety of sources Prob ably foremost among these is the problem of ignorance The physician may not know that his patient has been exposed to carcinogens at the workplace, employees may not know even what substances they handle and. moreover, they may not be aware of their potential rights to workers' compensation The personal agony that indi viduals and their families suffer when confronted with such a disease can explain why many seek to avoid the extended controversy that is al most inevitable m compensation proceedings. A second set of problems is that n variety of provisions in various state laws effectively pre clude receiving compens.inon in many eases For example, some stamtes of limitation pro visions that may bar claims based on earlier exposures m.iv be reasonable m cases of most occupational diseases, bm arc not where the latency period is ns long ns in cancer. A thud factor tending to reduce claims is the cnomuty of the task of proving ili.it the disease is work-conuccicd lit workers' compensation 22 DECEMBER 1977 proceedings the burden of proof rests with the claimant who may have been exposed to the carcinogenic agent decades earlier, and possibly while engaged in a diflercnt occupation and/or industry. Simply because a cancer victim has at one time or another been occupationally exposed to sucli a hazard will hardly suffice in most instances to assure that workers' compensation will be paid. Rather, claimants or their survivors must persuade the authorities that the disease was caused by a hazardous exposure that may have occurred years ago. Such issues frequently lead to physicians testifying for either litigant about the possible source of a disease that is still not basically understood. Adversary procedures Another problem that tends to discourage the filing of claims is the very lengthy and conten tious procedure that typically precedes the reso lution of a case involving occupational disease. Where a worker incurs a serious occupational disease, it typically takes well over a year from the time a claim is first filed until a first payment is made--in eases where indemnity benefits are eventually paid. The lengthiness of workers' compensation proceedings together with the adversary process may well discourage some physicians from ever willingly becoming involved in such eases. Con sequently, it is likely that they will not raise the matter of workers' compensation where patients are found to lmvc cancer. The system of workers' compensation in the U.S. is basically adversmi.il, and the resolution of a controversy regarding the source of a person's illness or death can involve substantial sums of money. Nevertheless, it is clear that the fundamental problems are scientific and tech nological If the problem was primarily the way vve adjudicate claims one should expect to find a far larger number of eases involving cancer in other countries that are using very different approaches to workers' compensation. Instead, it appears that ihe volume of chums for occupa tional cancer in most western Euiopean nations is quite small and not far out of hue with the U.S experience In those countries, however, information about occupational cancer increas ingly is being brought to the public's and work ers' attention and a singe in chums may well result. A similar type of development in the United States should also be anticipated. 1712955 . n 0037526 PST RSV0033785