labor First Step Towards the Recognition of Breast Cancer as an Occupational Disease in France
At the beginning of February, a night worker had her breast cancer recognised as an occupational disease for the first time in France. This decision was the result of a large-scale union campaign which made good use of a worker's survey to raise public awareness but also to mobilise around the issue of occupational cancers.
Martine, as is customary in hospitals, has worked many night shifts over the course of her career. Her breast cancer diagnosis forced her to stop working so that she could receive treatment. When she returned to work, her working conditions remained largely unchanged. As a result, she was unable to complete her career and had to choose the option of early retirement. It was only in 2023, after five years of proceedings, that her cancer was recognised as an occupational disease, and judged to create an incapacity for work at 35%.
Several studies show that night work is harmful to workers' health. However, a distinction must be made between proven risks (sleep disorders and metabolic disorders), probable risks (type 2 diabetes, coronary heart disease and carcinogenic risk) and possible risks (high blood pressure and vascular accidents). For women in particular, night work increases the risk of breast cancer by up to 30%. However, night work is essential for the proper functioning of certain sectors, particularly health services - and it is still not recognised as a risk factor for cancer. As a result, there is a certain taboo around the issue: workers accept to work at night without necessarily being aware of the potential consequences for their health, and some employers do not put in place adequate prevention mechanisms.
Martine's situation also touches on another issue: that of returning to work after or during cancer treatment. According to Think Pink, a national breast cancer organisation in Belgium, 55% of cancer diagnoses are received by people who are still working. 60 to 80% of them return to work after their treatment. The organisation thus stresses the importance of putting in place the necessary conditions for a successful return to work. This can take the form of a temporary reduction in working hours, or a modification of the tasks to be performed if they are no longer in line with the worker's abilities. According to a study conducted by LUCAS KU Leuven, 'one third of the respondents are currently experiencing difficulties in their work following breast cancer treatment, and one in three even thinks that they will have to stop working prematurely because of the treatment, mainly because of concentration problems'.
The particular case of Martine highlights the uncertainty surrounding the recognition of the occupational nature of breast cancer. For the moment, night work and shift work are considered 'probable' carcinogens. Consequently, the presumption of causality does not exist and it is up to the victim to prove the existence of a direct and essential link between the pathology (cancer) and their regular work (night work). A task made difficult by the fact that breast cancer is a multifactorial disease. Lifestyle habits, such as alcohol and tobacco consumption, and also certain medical history elements are taken into account. Thus the procedures are often long and particularly trying for workers already physically and psychologically weakened by the disease. In the end, the decision is made by an expert who decides whether or not there is a causal link between the pathology and the working conditions. This is what happened for Martine in April 2022, with a favorable opinion given by the 'departmental' medical council (Conseil médical départemental). This was a victory for the worker, who was ultimately awarded compensation of 35% of her annual salary.
Martine's story is not isolated, but it is the first success of a campaign launched in 2017 by a 'breast cancer collective' created by the Federation of Mines of the CFDT union in Lorraine (France). This collective conducts awareness campaigns but also labour surveys in the healthcare and air transport sectors with a dual objective. The first is to enable trade unions and staff representatives to demand more effective prevention measures in these sectors. The second is the inclusion of breast cancer in the lists of occupational diseases. This would lighten the procedural burden and allow these workers to be better compensated.
At the European level, the fight against occupational cancers focuses mainly on exposure to carcinogens or mutagens, such as benzene or nickel. There is also a Directive on the prevention of risks arising from exposure to ionising radiation (Dir. 2013/59/EURATOM), whose Chapter VI is dedicated to occupational exposure. Although ionising radiation is recognised as a hazard, it is not recognised as a presumed cause of breast cancer. The only European instrument referencing occupational diseases and their causes is non-binding (Recommendation 2003/670/EC). It is therefore up to the Member States to transpose or not this recommendation into national law. Moreover, breast cancer is not mentioned explicitly but indirectly under the heading of 'diseases caused by ionising radiation'. Similarly, night work is not addressed in the legislation to prevent cancer, but in the Working Time Directive (Dir. 2003/88/EC). Therefore, if the CFDT's effort leads to the official recognition of breast cancer as an occupational disease caused by exposure to ionising radiation and/or night work, this could also pave the way for better recognition in other countries, even at the European level.