Occupational exposure to carcinogens among health and social care workers in Europe: new insights from worker exposure studies
Cancer remains one of the most pressing public health challenges worldwide, and occupational exposure to carcinogens is recognized as an important and preventable cause. A new study led by the Barcelona Institute for Global Health (ISGlobal) and supported by the La Caixa Foundation sheds new light on the prevalence of cancer-causing risk factors, particularly in the health and social care sector (HeSCare) across Europe. Unlike many previous studies that focused primarily on the industrial and manufacturing sectors, this study outlines exposures encountered within the nursing profession, an area that has historically been overlooked in occupational carcinogen surveillance.
The study, published in the European Journal of Public Health, drew on data from the landmark Worker Exposure Study (WES) conducted in 2022-2023 under the auspices of the European Occupational Safety and Health Agency (EU-OSHA). WES represents an unprecedented effort in Europe to systematically quantify exposure to 24 carcinogens through in-depth, task-focused telephone interviews with more than 24,000 workers across six countries: Finland, France, Germany, Hungary, Ireland, and Spain. Of these, a cohort of 3,041 people working in health and social care professions, representing approximately 11% of the European Union’s workforce, was analysed.
The findings reveal a worrying reality. Nearly 30% of workers in the health and social care sector have experienced exposure to at least one carcinogen during their most recent work week. Even more concerning is that nearly 8% were exposed to multiple carcinogens simultaneously. These statistics highlight the sector’s vulnerability to carcinogenic risks, from chemicals to environmental factors that are often underestimated in clinical and care settings.
Ionizing radiation has emerged as a major risk factor, affecting 7.4% of health and social care workers. This exposure typically occurs from handling radiological equipment, such as diagnostic X-ray machines, and medical isotopes used for diagnosis and treatment. Although the medical community relies heavily on these technologies, occupational safety measures are clearly insufficient or inadequately implemented in certain settings, exposing workers to cancer risks.
An equally pressing issue is exposure to diesel engine exhaust, experienced by 6.2% of workers. The presence of diesel-powered vehicles and equipment in healthcare facilities and social care settings contributes to the inhalation of a complex mixture of carcinogenic particles, both indoors during transportation operations and outdoors during facility maintenance. Diesel exhaust fumes are classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC) and are primarily associated with lung cancer, but also with other malignancies.
The sun’s ultraviolet radiation, a risk factor affecting 6.1% of these workers, poses an interesting dimension to occupational accidents in health and social care. People who work outdoors, such as community health nurses, home care providers, and social workers, face cumulative exposure to ultraviolet radiation, which is a well-established etiologic agent of various skin cancers. This finding extends the traditional view of occupational exposure beyond the hospital setting.
Chemical carcinogens, particularly formaldehyde and benzene, remain significant contributors, with prevalences of 5.2% and 4.8%, respectively. Formaldehyde is commonly found in disinfectants, sterilizers, and some chemical formulations used within medical laboratories and healthcare facilities. Exposure to benzene is less obvious in this field, but can occur through environmental pollution and certain cleaning products and solvents. Both compounds are well known for their genotoxicity and association with blood cancers.
Importantly, this study reveals that high levels of exposure to formaldehyde (2.3%) and ethylene oxide (2.0%) exacerbate cumulative occupational risks. Ethylene oxide is widely used to sterilize medical devices, but it is also a strong alkylating agent that is a known carcinogen. Such high exposure levels require an urgent reassessment of exposure limits and implementation of strict protective measures.
This study goes beyond single drug exposure and draws attention to the complex carcinogen exposures prevalent in this workforce. Exposure to diesel exhaust alongside solar ultraviolet radiation or simultaneous contact with formaldehyde and ethylene oxide compounds complicates these occupational hazards, with synergistic effects potentially increasing cancer risk beyond an additive model.
Notably, gender differences emerged in the patterns of exposure, with the prevalence of carcinogen exposure among male workers being significantly higher (35.7%) compared to women (26.1%). This discrepancy may reflect occupational segregation within the sector, job differences, or differences in compliance with protective procedures and warrants further gender-focused occupational health research.
These facts are forcing a rethink of occupational health policy in health and social care settings. Historically, carcinogenic risks in these settings have been overshadowed by concerns in other industries that are perceived as higher risk. However, this data reflects the workplace realities faced by care workers and advocates tailored prevention strategies aimed at reducing exposure through enhanced engineering controls, administrative policies, and personal protective equipment.
Ultimately, this study serves as an important call to action for regulators, employers, and healthcare professionals alike. Continuous monitoring and proactive intervention of occupational carcinogen exposures can have a significant impact on employee well-being and ultimately the burden of cancer associated with occupational hazards.
Given the complex nature of exposures in health and social care professionals, interdisciplinary collaboration between occupational health professionals, policy makers and scientific researchers is critical to developing effective prevention frameworks. Increased education about occupational carcinogens, combined with strict enforcement of safety standards, can create a safer environment for people dedicated to caring for others.
This pioneering research not only informs evidence-based occupational health practice, but also raises public awareness of the hidden carcinogenic risks that healthcare and social care workers face every day, challenges preconceptions and sparks a paradigm shift in workplace safety priorities across Europe.
Research object: people
Article title: Occupational exposure to cancer risk factors among health and social care workers in Europe: Results of a worker exposure survey
News publication date: April 3, 2026
Web references:
https://doi.org/10.1093/eurpub/ckag056
References:
Khan, MW, Vallbona-Vistós, M., Cavet, M., Vilahur, N., Turner, MC Occupational exposure to cancer risk factors among health and social care workers in Europe: Results of a worker exposure study. European Journal of Public Health, 2026.
Keywords: occupational exposure, cancer risk factors, health and social care workers, carcinogens, ionizing radiation, diesel exhaust, ultraviolet light, formaldehyde, ethylene oxide, occupational safety, Europe, worker exposure research
Tags: Cancer prevention in health workersCancer risks in the social care professionCarcinogens in health and social careOccupational cancer epidemiology in EuropeEuropean Occupational Safety and Health Agency researchExposure to carcinogens in the care sectorHealth and social care worker surveyEurope ISGlobal occupational cancer researchOccupational carcinogen exposure in health workersEuropean occupational health risksOccupational safety in social careWorker exposure studyEurope 2022-2023
