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Are night shifts bad for you?

The Danish government has just begun compensating women who have developed breast cancer after years of working nights. So how worried should we be, asks Lucy Atkins

 

• 
• • Lucy Atkins
  • The Guardian, Tuesday 17 March 2009
  • Article history

Night workers tend to eat more unhealthily and exercise less. Photograph: Tim O'Hara/Corbis

Could "the graveyard shift" be more than a figure of speech? The Danish government certainly thinks so. It has just begun to award compensation to women who have developed breast cancer after years of working night shifts - such as flight attendants and nurses. So far about 40 women have received pay outs, although not all claims were successful - including women who had a family history of breast cancer.

The Danes acted after the International Agency for Research on Cancer, part of the World Health Organisation, placed shift work along with anabolic steroids, ultraviolet radiation and diesel engine exhaust fumes as a "possible human carcinogen" in 2007. One level up are Category One risks - "known carcinogens" such as asbestos. The agency's conclusion was based on evidence from a wide number of studies of both humans and animals.

Most studies have concentrated on linking breast cancer with what cancer researchers call the "light-at-night" effect on the body's hormones, and they have consistently found that shift-workers have a higher risk of developing breast cancer than women who work regular daytime hours - on average around a 48% higher risk.

Scientists believe that this is because of the effects of shift work on the body's production of the so-called "hormone of darkness", melatonin. If your night time is spent in artificial light (even dim artificial light) your brain stops churning out melatonin. This multitasking hormone keeps your biological clock ticking over, making sure that you are alert during the day and sleepy at night. It also seems to play an important role in cancer protection.

Melatonin lowers levels of the female hormone oestrogen in the blood - oestrogen is known to encourage the growth of certain cancers, notably breast and ovarian cancer. It could also block the growth of cancer cells and boost the body's immune system by killing cell-damaging "free radicals" (killing free radicals also happens to be why antioxidants are so prized) and block cells from dividing. Since the brain produces the most melotonin in the middle of the night when it is dark, night- shift workers - whose bodies are saturated by artificial light - have abnormally low levels.

So how worried should night-workers be? "I think we can say there is a big public health problem here," says Professor Andrew Watterson, an occupational health specialist at Stirling University. We are not just talking about breast cancer (a significant enough problem in its own right), he says, there is also evidence linking the night shift with a raft of other health problems, including prostate or womb cancer. Night shifts might also have detrimental reproductive effects: a Danish study of 40,000 women found that night workers had more chance of having lower-weight babies (and lighter babies have a higher chance of serious health issues, such as respiratory problems or disabilities). These women were also more likely to have pregnancies that lasted longer - raising the risk of stillbirth.

Other studies have suggested a link with bowel cancer and gastric problems - possibly because night workers tend not to eat so healthily and to exercise less. There is also, says Watterson, evidence of a link between shift work and non-Hodgkins lymphoma, possibly because the body's immune system lacks the positive effects of melatonin. "The Danish response to the breast cancer issue is very progressive," he concludes. "The British government should absolutely follow suit."

The government currently has no plans for compensating British women in such a way. And according to Cancer Research UK, any night-shift panic would be premature. "The breast cancer risk has not been conclusively shown," says Dr Kat Arney, senior science information officer at Cancer Research UK. This is because there are so many complicating factors when you try to study the effects of lifestyle on cancer risk. "At the moment we just don't know how other lifestyle factors, such as taking HRT, obesity, having fewer children or drinking alcohol, interact with shift work to increase a woman's risk of breast cancer," says Arney.

All these factors - rather than melatonin - could be the real reasons behind any apparent cancer links. For instance, explains Arney, "we know that breast cancer is more common in inactive women, so if shift workers get less exercise than the general population, this could explain their higher risk."

"We'll know more about the risks to British women from an upcoming Health and Safety Executive study, which is due to be completed by 2011," she says. As for bowel, prostate or womb cancers, only one or two studies have been done for each cancer type, so more research must be done before anyone can say for sure that there is a link. "More research would be good," says Watterson, "but it's obvious that there are major health problems associated with shift work."

If there does turn out to be a "light-at-night" effect, then tackling it could be a major health challenge. For instance, how many shifts per week could you get away with before your risk of related cancers became significant? Watterson says it is probably safe to assume that, "You don't have to be working every night to be at risk. It just has to be part of your shift pattern, something you do periodically, but regularly."

The current studies show that if there is a link then it takes a long time to kick in - you'd need to work regular night shifts over 20 or 30 years to significantly raise your risk of developing breast cancer. Cancer Research UK says that until there is more conclusive evidence, shift workers - like anybody else - should go to the doctor if they notice any abnormalities and keep up with their NHS screening appointments.

Watterson thinks a more organised public health response is called for. "We don't tend to identify the damage being done where shift working is prevalent and I think that's an error," he says. "The damage is there but we don't see it and we don't count it."

The night worker's tale:
'I was a grumpy, spotty hermit'

Working as a journalist at ITN meant regular two-week spells of night shifts. I'd get a sickening sense of dread for the fortnight leading up to them, knowing that I would become a sleep-deprived grumpy, spotty hermit.

At 10pm on night one, instead of my usual wind-down glass of wine, I'd take a wake-up shower and set off to work, where I would struggle to stay alert until 8am.

Night two should get better - but only if you've remembered before going to bed to unplug your landline, turn off your mobile phone and deactivate your doorbell - and your neighbours don't decide to indulge in any DIY.

The office is an eerie place at night. There's no banter and it's hard to stay motivated. And I did no excercise - because I was living every waking moment in darkness, venturing into the outside world for my usual run seemed an impossibility.

By the end of the fortnight, I'd have purple under-eye bags, stomach cramps (my digestive system would get very confused), and emotions so highly charged ("Nobody understands how tired I am!") that I was fit to explode.
Helen Croydon

Blue Dog Jewelley - how much money is too much?

Howard Jacobson: You can never get enough sex, but you can have too much money

Society will always be unjust. The question is how great we can bear the disparity to be

The Independent, Saturday, 31 January 2009

And now Updike. So how many great writers is that who have died these past 12 months? In the meantime, the world's bankers are back with their noses in the bonus trough, their numbers barely depleted, and the titled fogeys of our Upper Chamber go on tottering avariciously into odious old age. Thus do we lose on the swings and lose on the roundabouts.

"Sex is like money," Updike wrote somewhere, "only too much is enough." Good joke. But I have a softer spot, myself, for the too much of sex over the too much of money. So does literature. Casanovas must suffer or repent ultimately, but we enjoy their promiscuity until ultimately comes along. There's something about the pursuit of too much sex that we relish: those who do it raise our spirits. About how many money men can we say that? Yes, the public has a soft spot for Dragons' Dens and Apprentices, but those are just game shows. Capitalism light. Otherwise, amassing just doesn't do for us what its opposite, profligacy, does. What financier singing to his money (or singing away ours) could ever please us the way Don Giovanni wooing Zerlina pleases us?

The weakest argument made for excessive earnings is that only by offering a fortune do you attract the right person. It should always have been obvious that that's a truism which proves its very opposite. If it's only the fortune that makes the job suitable for the man then the man is by definition unsuitable for the job. Even banking – the one place where the rapacity criterion might have applied – has proved that. The greedy, we now know, are not even good at greed. And were it true that we must pay the most to get the best, why do we argue differently when it comes to the jobs we prize above all others? Let teachers or nurses strike for half a day to improve their pittance and they are accused of irresponsibility and greed, of not honouring the sacred codes of selflessness we associate with their professions. Here the very opposite to the avarice principle prevails: we pay the least to get the best.

A sentimental assumption about job satisfaction underlies this double thinking. Teachers and nurses, we say, do what they do because they love to do it; for them the calling is its own remuneration. (An assumption that doesn't look the other way, with our pitying the poor banker for whom the only relief from the grinding unrewardingness of his job is the prospect of a seven-figure bonus.) But however true it is that the best of what we do we do because we choose to, and let money come or let it not, extreme inequalities in pay must create discontent. Society will always be unjust – not only unequal but undiscriminating – in its distribution of rewards. The question is how great we can bear the disparity to be; and when a banker gets more in his Christmas box than the entire annual teaching salary of a failing inner-city comprehensive – though not so failing as the banker's bank – we have passed the point of tolerance. I might have tried to calculate how many undernourished children could be fed with the money the average Premier League footballer earns every time he misses a penalty, but we indulge footballers. Like rock stars and actresses they get us through the grey days of life in an innocent reverie of emulation, which is I suppose preferable to envy.

The last people of whom this can be said are those who, with no visible or valued talents to justify their earnings – and I am not talking about Jonathan Ross – will sell their influence in either chamber of our Parliament. I am, I don't mind admitting, prejudiced against Lord Taylor of Blackburn, the peer alleged to have told the undercover Sunday Times reporter that £120,000 was not only routine but cheap for the sort of help he was prepared to give to change a law. It might be his municipally lean and hungry look I don't like, that air of knowing your way around committees and directorships. It might be that he was a town councillor before he was a lord, and no one loves a town councillor. It might be that it is difficult to understand why he is in the House of Lords at all. Whatever the reasons, I cannot give him a fair hearing in my heart.

It is not, anyway, as though the alleged conversation has uncovered anything we didn't already have a pretty shrewd idea was there. Since the Lords has even more local councillors in it than it has old lags, and since we have little faith in the probity of local councils, we are not likely to be surprised by any accusation of malpractice. So they earn a few quid for bending the ear of the law. Of course they do. It's their profession. What other skills ever justified their peerages?

One hundred and twenty thousand pounds, however, ups the moral ante rather. And not just by its size. And not just for what you have to do to get it. It's the reported boast that's ugly. The unembarrassed pride in it. Why, in these of all times, would a man swank about the money he earns, never mind about the things he does to earn it? OK, the boast belongs to bargaining, but how can a person enjoying public confidence and charged with democratically governing a country not choke on its utterance; whatever the legality, how can it not dismay any Labour peer in his soul to know that with a wink in the right direction, the merest tug at an ermined sleeve, he can pull in more than it takes to keep the families of four Blackburn warehousemen going for a year? And then to call such a sum a bargain!

Cheap at twice the price. Thus, with every allegation, as with each new revelation of the inducements dished out like dog biscuits to bankers, do we measure the difference between having and not having. So who is finally going to say it: that there is such a thing as too much, that while it might be true one never gets enough sex, one can get too much money? In fact excess of both makes you ill at last. Your knees and concentration go after too much sex. Your humanity goes after too much money. But that's between you and your maker. More importantly, the idea of a society for our mutual benefit goes. And then who can blame those who don't have influence to sell, or investors to bemuse, when they resort to cruder measures?

Posted by Shona Lockhart, 31st January 2009

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