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).

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.

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.

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.

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).

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.

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).

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.
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