logo

Female Reproductive Cancers

Background

The participation of women in the labour force has increased over time, including those of reproductive age, but the impact that this may have on reproductive cancers is poorly understood. Women may be exposed to various chemical, physical, and biological factors in work environments that may impact the female reproductive system (e.g., altering sex hormone levels, ovarian dysfunction). This analysis focuses on cervical, uterine (also called endometrial), and ovarian cancers among female workers in Ontario.

Download the Fact Sheet

Risk Factors

The International Agency for Research on Cancer (IARC) has identified various non-occupational agents associated with increased risk of reproductive cancers (1). However, little is known about the relationship between occupational risk factors and female reproductive cancers, such as cervical, ovarian, and uterine cancers. Exposure to asbestos is the only established occupational risk factor for ovarian cancer (1-3). There are no established occupational risk factors for cervical and uterine cancers, although a few studies have suggested links to metalworking fluids and organic solvents, particularly for cervical cancer (4-7).

There is also limited research on the risk of reproductive cancers among female workers in different occupational groups. A few studies have found higher risks of cervical cancer among construction workers, drivers, mechanics, and electricians; higher risks of ovarian cancer among teachers, managerial/administrative workers, accountants, hairdressers, and workers in the printing industry; and higher risks of uterine cancer among teachers and managerial/administrative workers (8-10).

The table below shows selected cancer sites and the known (sufficient evidence) and possible (limited evidence) risk factors associated with these sites, as classified by IARC (1).

Cancer SiteKnown Risk FactorsPossible Risk Factors
Uterus
  • Postmenopausal estrogen therapyEstrogen-progesterone menopausal therapy
  • Tamoxifen
  • Diethylstilbestrol (a nonsteroidal estrogen medication)
Ovaries
  • AsbestosPostmenopausal estrogen therapyTobacco smoking
  • X- and Gamma- radiationTalc-based body powder
Cervix
  • Various types of human papillomavirus (HPV) infectionsHuman immunodeficiency virus (HIV) type 1 infectionTobacco smokingEstrogen-progesterone oral contraceptivesIn-utero exposure to diethylstilbestrol
  • Various types of human papillomavirus (HPV) infections

Occupational Disease Risks

The risk of cervical, uterine, and ovarian cancers was examined among approximately 800,000 female workers in Ontario’s Occupational Disease Surveillance System (ODSS). The tables below display the percent increase in risk of cervical, uterine, ovarian cancers among certain groups of female workers compared to all other female workers in the ODSS (aged 15 to 85 years). Tables shown are based on selected occupation and industry groups.

Managerial and Administrative 
Higher risks of uterine and ovarian cancer were observed among workers in managerial and administrative occupations. It is unclear what is causing this increased risk, although a few studies have suggested that sedentary workplace behaviours, such as reduced occupational physical activity and prolonged sitting may contribute to a higher risk of developing these cancers (11-13). There was no association between managerial occupations and cervical cancer risk in this study.

Occupation

Higher Risk (%)
Uterine CancerOvarian Cancer 
Managerial, administrative

39%*

22%

General managers and other senior officials263%*—
Accountants, auditors and financial officers76%*28%
Other managers and administrators51%*54%*
* Statistically significant (α=0.05)

Construction
Construction workers, specifically electricians, had a higher risk of invasive cervical cancer, although no association was observed for in-situ cervical cancer. Other studies have shown similarly elevated risks among construction workers (9,14). A few studies have proposed that diesel engine exhaust and lead exposure may increase the risk of cervical cancer (15,16). No association was observed for ovarian or uterine cancer risks in this study.

Occupation Higher Risk (%)
Invasive Cervical Cancer
Construction, overall

82%*

Electricians172%*
* Statistically significant (α=0.05)

Teaching
Teachers had a higher risk of developing uterine cancer. Sedentary behaviour and reduced occupational physical activity may contribute to increased uterine cancer risk (11). No association was found between teaching occupations and ovarian or cervical cancer risks in this study.

Occupation Higher Risk (%)
Uterine Cancer
Teaching and related, overall

38%*

Elementary and secondary school teaching35%*
University teaching 67%*
Other teaching and related occupations70%*
* Statistically significant (α=0.05)

Metalworking
Metalworkers had higher risks of developing both invasive and in-situ cervical cancer. There is some evidence linking cervical cancer and exposure to metalworking fluids and trichloroethylene, an organic solvent sometimes used as a metal degreaser (5,7,17). Higher risks of uterine and ovarian cancers were also observed among workers in certain metalworking occupations. The higher risk of ovarian cancer among these workers may be related to trichloroethylene exposure, which has been linked to ovarian cancer in some studies (18).

Occupation / Industry Higher Risk (%)
In-Situ Cervical CancerInvasive Cervical Cancer Uterine CancerOvarian Cancer
Occupation

 

 

Metal product fabricating

20%*

38%*

—

13%

Metal machining59%*—60%*

72%*

Tool and die making——300%

—

Metal shaping and forming44%*34%——
Metal processing44%*——

104%*

Industry

 

 

Primary metal industries

13%117%*—

—

* Statistically significant (α=0.05)  

Product fabricating, assembling, and repairing
Both in-situ and invasive cervical cancer risk were higher among product fabricating occupations in this study. Some product fabricating workers may be exposed to metalworking fluids and trichloroethylene, which may be associated with increased cervical cancer risk (4-6). In-situ cervical cancer risk was higher for workers in rubber and plastic product fabricating in this study. These workers may be exposed to Bisphenol A (BPA), which some studies have found may increase the risk of cervical cancer (19,20). No associations between product fabricating, assembling, and repairing occupations and ovarian and uterine cancers were observed in this study.

Occupation Higher Risk (%)
In-Situ Cervical CancerInvasive Cancer 
Product fabricating, assembling, and repairing

17%*

20%*

Metal products

20%*

38%*

Motor vehicles

37%*

48%*

Rubber, plastic

42%*

—

Other product fabricating, assembling, and repairing 15%64%*
* Statistically significant (α=0.05)

Implications for Prevention

Female reproductive cancers are influenced by a variety of factors, and the role of occupational factors is still not well-understood. Further studies are needed to understand the relationship between female reproductive cancer risk and occupational exposures such as metalworking fluids, diesel engine exhaust, lead, and reduced occupational physical activity.

Improving the understanding of risk factors for reproductive cancers among female workers can provide valuable insights for developing occupational cancer prevention strategies, identifying high risk groups, and improving health outcomes for working women.

Among the general population of Ontario, some prevention strategies are already in place. To prevent HPV infection, the main risk factor for cervical cancer, HPV vaccinations have been offered in Ontario schools since the 2007-08 school year (21,22). Cervical cancer screening was introduced in Ontario in the 1970s and has resulted in a significant decrease in cervical cancer rates (23). Differences in screening participation may impact the observed cervical cancer risk among certain groups. Little is known regarding screening rates by occupation, but women with higher socioeconomic status may be more likely to participate in screening programs (24,25). There are no regular screening programs in place for uterine or ovarian cancer in Ontario (26,27).

Female-Reproductive-Cancers-BulletinDownload

References

  1. International Agency for Research on Cancer. List of classifications by cancer sites with sufficient or limited evidence in humans, IARC Monographs Volumes 1-135 a Cancer site Carcinogenic agents with sufficient evidence in humans. 2023.
  2. Constanza Camargo M, Stayner LT, Straif K, Reina M, Al-Alem U, Demers PA, et al. Occupational exposure to asbestos and ovarian cancer: a meta-analysis. Environ Health Perspect [Internet]. 2011 Sep [cited 2023 Mar 28];119(9):1211–7. Available from: https://pubmed.ncbi.nlm.nih.gov/21642044/
  3. Kang DM, Kim JE, Kim YK, Lee HH, Kim SY. Occupational Burden of Asbestos-Related Diseases in Korea, 1998-2013: Asbestosis, Mesothelioma, Lung Cancer, Laryngeal Cancer, and Ovarian Cancer. J Korean Med Sci [Internet]. 2018 Aug 1 [cited 2023 Mar 28];33(35). Available from: https://pubmed.ncbi.nlm.nih.gov/30140191/
  4. Charbotel B, Massardier-Pilonchery A, Fort E, Dananché B, Févotte J, Confavreux-Romestaing C, et al. Occupational trichloroethylene exposure and cervical pathology: a case-control study. Ann Occup Hyg [Internet]. 2013 Apr [cited 2023 Mar 30];57(3):407–16. Available from: https://pubmed.ncbi.nlm.nih.gov/23091111/
  5. Hansen J, Sallmén M, Seldén AI, Anttila A, Pukkala E, Andersson K, et al. Risk of cancer among workers exposed to trichloroethylene: analysis of three Nordic cohort studies. J Natl Cancer Inst [Internet]. 2013 [cited 2023 Mar 30];105(12):869–77. Available from: https://pubmed.ncbi.nlm.nih.gov/23723420/
  6. Betenia N, Costello S, Eisen EA. Risk of cervical cancer among female autoworkers exposed to metalworking fluids. Scand J Work Environ Health [Internet]. 2012 [cited 2023 Jun 21];38(1):78–83. Available from: https://pubmed.ncbi.nlm.nih.gov/21901243/
  7. Charbotel B, Fervers B, Droz JP. Occupational exposures in rare cancers: A critical review of the literature. Crit Rev Oncol Hematol [Internet]. 2014 [cited 2023 Mar 28];90(2):99–134. Available from: https://pubmed.ncbi.nlm.nih.gov/24387944/
  8. Slack R, Young C, Rushton L. Occupational cancer in Britain. Female cancers: breast, cervix and ovary. Br J Cancer [Internet]. 2012 Jun 19 [cited 2023 Feb 5];107 Suppl 1(Suppl 1):S27–32. Available from: https://pubmed.ncbi.nlm.nih.gov/22710675/
  9. Pukkala E, Martinsen JI, Lynge E, Gunnarsdottir HK, Sparn P, Tryggvadottir L, et al. Occupation and cancer – follow-up of 15 million people in five Nordic countries. Acta Oncol [Internet]. 2009 [cited 2023 Feb 5];48(5):646–790. Available from: https://pubmed.ncbi.nlm.nih.gov/19925375/
  10. Le ND, Leung A, Brooks-Wilson A, Gallagher RP, Swenerton KD, Demers PA, et al. Occupational exposure and ovarian cancer risk. Cancer Causes Control [Internet]. 2014 [cited 2023 Mar 28];25(7):829–41. Available from: https://pubmed.ncbi.nlm.nih.gov/24728670/
  11. Zheng W, Shu XO, McLaughlin WH, Chow WH, Gao YT, Blot WJ. Occupational physical activity and the incidence of cancer of the breast, corpus uteri, and ovary in Shanghai. Cancer [Internet]. 1993 Jun 1 [cited 2023 Mar 28];71(11):3620–4. Available from: https://pubmed.ncbi.nlm.nih.gov/8490910/
  12. Shields T, Gridley G, Moradi T, Adami J, Plato N, Dosemeci M. Occupational exposures and the risk of ovarian cancer in Sweden. Am J Ind Med [Internet]. 2002 Sep [cited 2023 Mar 28];42(3):200–13. Available from: https://pubmed.ncbi.nlm.nih.gov/12210689/
  13. Biller VS, Leitzmann MF, Sedlmeier AM, Berger FF, Ortmann O, Jochem C. Sedentary behaviour in relation to ovarian cancer risk: a systematic review and meta-analysis. Eur J Epidemiol [Internet]. 2021 Aug 1 [cited 2023 Mar 28];36(8):769–80. Available from: https://pubmed.ncbi.nlm.nih.gov/33492550/
  14. Carpenter L, Roman E. Cancer and occupation in women: identifying associations using routinely collected national data. Environ Health Perspect [Internet]. 1999 [cited 2023 Feb 5];107 Suppl 2(Suppl 2):299–303. Available from: https://pubmed.ncbi.nlm.nih.gov/10350514/
  15. Scheurer ME, Danysh HE, Follen M, Lupo PJ. Association of traffic-related hazardous air pollutants and cervical dysplasia in an urban multiethnic population: a cross-sectional study. Environmental Health [Internet]. 2014 Jun 13 [cited 2023 Sep 21];13(1):52. Available from: /pmc/articles/PMC4063240/
  16. Furtak G, Kozłowski M, Kwiatkowski S, Cymbaluk-Płoska A. The Role of Lead and Cadmium in Gynecological Malignancies. Antioxidants [Internet]. 2022 Dec 1 [cited 2023 Sep 21];11(12). Available from: /pmc/articles/PMC9774668/
  17. Charbotel B, Massardier-Pilonchery A, Fort E, Dananché B, Févotte J, Confavreux-Romestaing C, et al. Occupational trichloroethylene exposure and cervical pathology: a case-control study. Ann Occup Hyg [Internet]. 2013 Apr [cited 2023 Mar 30];57(3):407–16. Available from: https://pubmed.ncbi.nlm.nih.gov/23091111/
  18. Mortality of aerospace workers exposed to trichloroethylene – PubMed [Internet]. [cited 2024 Mar 25]. Available from: https://pubmed.ncbi.nlm.nih.gov/9647907/
  19. Khan NG, Correia J, Adiga D, Rai PS, Dsouza HS, Chakrabarty S, et al. A comprehensive review on the carcinogenic potential of bisphenol A: clues and evidence. Environ Sci Pollut Res Int [Internet]. 2021 Apr 1 [cited 2024 Feb 1];28(16):19643. Available from: /pmc/articles/PMC8099816/
  20. Hines CJ, Jackson M V., Deddens JA, Clark JC, Ye X, Christianson AL, et al. Urinary Bisphenol A (BPA) Concentrations among Workers in Industries that Manufacture and Use BPA in the USA. Ann Work Expo Health [Internet]. 2017 Mar 1 [cited 2024 Feb 1];61(2):164–82. Available from: https://dx.doi.org/10.1093/annweh/wxw021
  21. Health Ontario P. Human Papillomavirus (HPV) Vaccine. 2017 [cited 2024 Mar 25]; Available from: www.publichealthontario.ca
  22. Getting the HPV vaccine | ontario.ca [Internet]. [cited 2024 Feb 21]. Available from: https://www.ontario.ca/page/getting-hpv-vaccine
  23. Cervical Screening | Cancer Care Ontario [Internet]. [cited 2024 Feb 21]. Available from: https://www.cancercareontario.ca/en/types-of-cancer/cervical/screening
  24. Broberg G, Wang J, Östberg AL, Adolfsson A, Nemes S, Sparén P, Strander B. Socio-economic and demographic determinants affecting participation in the Swedish cervical screening program: A population-based case-control study. PLoS One. 2018 Jan 10;13(1):e0190171. Doi: 10.1371/journal.pone.0190171. PMID: 29320536; PMCID: PMC5761876.
  25. Ibfelt E, Kjær SK, Johansen C, Høgdall C, Steding-Jessen M, Frederiksen K, Frederiksen BL, Osler M, Dalton SO. Socioeconomic position and stage of cervical cancer in Danish women diagnosed 2005 to 2009. Cancer Epidemiol Biomarkers Prev. 2012 May;21(5):835-42. doi: 10.1158/1055-9965.EPI-11-1159. Epub 2012 Mar 20. PMID: 22434535.
  26. Uterine cancer | Canadian Cancer Society [Internet]. [cited 2024 Feb 21]. Available from: https://cancer.ca/en/cancer-information/cancer-types/uterine
  27. Ovarian cancer | Canadian Cancer Society [Internet]. [cited 2024 Feb 21]. Available from: https://cancer.ca/en/cancer-information/cancer-types/ovarian

The Occupational Disease Surveillance System (ODSS) Surveillance Bulletins provide summaries of occupational exposures and disease risks across different industries and occupational groups detected through occupational disease surveillance. At this time the ODSS includes workers from 1983-2019 and follows their health outcomes until 2020. This bulletin reflects only the diseases currently tracked within the ODSS. The system is updated and expanded on an ongoing basis. 

More information about the ODSS including data sources, methods and the most recent results can be found at https://www.occupationalcancer.ca/odss/ and OccDiseaseStats.ca.

© 2024 Occupational Cancer Research Centre