Abc Toowong Case Study

Both investigations into the cancer clusters at ABC Toowong and the National Gallery of Australia (NGA) followed sound principles of studying clusters with similar conclusions. However, the ABC building was abandoned while the NGA remains open. Considering the methodical investigations and the evidence uncovered, I propose that both sites should have remained open.

Cancer cluster investigations should not be undertaken as an exclusively scientific study. Their social element is unmistakable in the media coverage of many clusters. This component was not addressed in the initial investigation performed by Queensland Health on the breast cancer cluster at ABC Toowong. They undertook a standard epidemiological study and, by focussing their interviews

of employees on personal risk factors instead of workplace exposures they damaged their rapport with the staff. Dissatisfied employees, backed by the high media profile of the case, pressured management to commission a second investigation. This time, a better relationship was maintained between the investigators and employees. While the investigators still enquired about personal risk factors, they also considered workplace exposures and communicated the reasons behind the process effectively with the employees.
The investigators calculated cancer rates and examined breast cancer-related exposures.

The rate of breast cancer was found to be much higher (six times higher) than the general population. Initially, the probability of the calculation was found to be 1 in a million but was later adjusted to roughly 1 in 25. However, the statistics used to calculate these probabilities are not foolproof (see Q1). As the use of statistics in cancer clusters is questionable, it is more appropriate to focus on exposures. After a thorough examination, the investigators uncovered no convincing exposures to explain the high rate of breast cancer, both in the workplace or personal risk factors. Although unknown exposures cannot be discounted, it is likely the high rate occurred by chance rather than by a workplace related exposure. To provide further evidence, cancer rates in other ABC workplaces in the country, which would have similar exposure profiles, were calculated and found to be no higher than the general population. Clearly, the evidence uncovered did not suggest a harmful workplace exposure and, therefore, did not warrant the closure of the building. This reaction was probably linked with the initial dissatisfaction of the employees and the media storm and misinformation that accompanied the

investigation.
As with ABC Toowong, the cancer cluster investigation at the NGA was born out of an inadequate initial study and employee dissatisfaction. The second, more comprehensive study, involved improved communication with staff with all interested employees involved and those who brought the issue to attention given particular attention. Again, both cancer rates and exposures were examined, but this time workplace exposures were given priority over personal risk factors. In this example, there was limited evidence of a higher than community cancer rate. There was no change in risk for all cancers combined, an increased risk of lung and bowel cancer that likely occurred by chance, and a specific increase in bowel cancer in security guards but this was probably affected by individual risk factors. This time, however, the investigators identified a number of potential workplace carcinogens but most of these were at levels well below what is considered unsafe. The only exposure of concern was diesel fumes entering from trucks in the loading dock which were at high, but not extreme levels. Even though there was little evidence of high cancer rates, the proactive step to change the loading dock layout to reduce fumes was taken. Beyond this alteration, the NGA did not make any other major changes and the building remains open and active. Considering the limited evidence of high cancer rates and risky workplace exposures, I maintain this was the right action to take.
Even though hazardous workplace exposures were unlikely in both ABC Toowong and the NGA, the best action was taken by investigating the clusters thoroughly; from a workplace relations perspective this was important. Both investigations, eventually, were treated as socio-scientific procedures with the staff adequately consulted. In the ABC cluster, a high rate but no concerning exposures were identified. As other workplaces with similar exposures had community cancer rates, it is likely the high rate at Toowong occurred by chance and therefore, the building should have stayed open. At the NGA, no alarming cancer rates but a concerning exposure was found. Here, they took the right action by staying open but addressing the concerning exposure. Both followed rigorous principles for investigating cancer clusters with very different outcomes.