As a physician, you may have patients who work as welders. Welding is fundamental to many industrial processes and occurs across a variety of industries. Here we review key chronic health outcomes related to welding and provide information on reporting related workplace exposures and diseases.

Welding and allied processes have shared health hazards, such as ergonomic stressors, noise, welding fumes, irritating gases, fires, ultraviolet and infrared radiation, eye hazards, and electrical shocks. These hazards place welders at risk of certain chronic occupational diseases. These diseases often have gradual onset over several years, which can make diagnosis and assessment of risk factors difficult.

Occupational diseases associated with welding

Respiratory diseases

Long-term exposure to welding fumes is associated with chronic obstructive pulmonary disease (COPD), chronic bronchitis, and occupational asthma, although the degree of risk depends on several factors (e.g., type of metal fumes, workplace controls).[1] Routine spirometry for welders is not required in Canada; however, it is important that the patient is aware of the signs of asthma and bronchitis and sees a physician early for persistent respiratory symptoms. For concerns about asthma or COPD, consider referring your patient for pulmonary function testing. You can search either Pathways or the College of Physicians and Surgeons of BC’s Diagnostic Accreditation Program to find accredited testing facilities where pulmonary function testing is performed.

Illnesses from chemical exposures

Exposures to chemicals like metals and solvents, including agents like chromates, nickel, epoxies, and degreasers, can vary and are highly job dependent. The patient should work with their employer to understand and effectively prevent these exposures. Medical monitoring among asymptomatic individuals is limited under BC’s Occupational Health and Safety Regulation and is typically arranged by the employer.

If the patient develops signs of toxicity from a chemical exposure, laboratory testing may be indicated. The indications and interpretation of these tests can be specific, so ordering family physicians may consider consulting other specialist physicians (e.g., internal medicine or medical subspecialties), calling the BC Drug and Poison Information Centre, or contacting a WorkSafeBC physician via the RACEapp+ to discuss.

Occupational cancers

The International Agency for Research on Cancer has assessed that welding fumes are a confirmed cause of lung cancer, with positive associations with kidney cancer.[2] Ultraviolet radiation from welding has also been determined to cause ocular melanoma.[2] Patients diagnosed with these cancers should have occupational histories that inquire into welding.

Contact dermatitis

Welders have regular contact with dermal sensitizers that can lead to allergic contact dermatitis—notably metal dusts and fumes (e.g., nickel, chromium), epoxies, and resins.[3] Workplace irritants include solvents, petrochemicals, and ultraviolet radiation. Patch testing may be indicated for welders with dermatitis to ensure that allergens are identified and managed.

Noise-induced hearing loss

Welders are often exposed to hazardous noise levels, which can cause noise-induced hearing loss.[4] Employers have legislated responsibilities for noise, including exposure limits, hearing conservation programs, workplace controls, and audiometric surveillance. You may receive referrals to initiate medical investigations, specialist referrals, and clinical management of abnormal audiograms from workplace surveillance programs.

If you suspect occupational risks or exposures

If there are any significant concerns about preventable health risks in a workplace, you or your patient can contact WorkSafeBC’s Prevention Information Line (1 888 621-7233).

Patients who believe they have had exposure to a harmful substance at work but haven’t experienced ill effects can file the exposure through WorkSafeBC’s Exposure Registry Program (https://www.worksafebc.com/en/resources/health-care-providers/forms/exposure-registry-program-form-41m1?lang=en [12]).
—Kieran Steer, MD, FRCPC, MSc
Medical Specialist, Occupational Diseases, Medical Services, WorkSafeBC
—Jeanette Campbell, MSc(A), CIH, ROH
Senior Occupational Hygienist, OHS Science and Technical Service, WorkSafeBC

Additional reading

Canadian Centre for Occupational Health and Safety. Welding – Ergonomics. Last reviewed 12 August 2024. www.ccohs.ca/oshanswers/safety_haz/welding/ergonomics.html [13].

WorkSafeBC. Controlling exposure risks from welding and cutting processes. March 2024. www.worksafebc.com/en/resources/health-safety/books-guides/controlling-exposure-risks-welding-cutting-processes [14].

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This article is the opinion of WorkSafeBC and has not been peer reviewed by the BCMJ Editorial Board.

References

1.    Galarneau J-M, Beach J, Cherry N. Respiratory ill-health and welding exposures: A Canadian cohort study. Am J Ind Med 2024;68:99-111. https://doi.org/10.1002/ajim.23678 [16].

2.    International Agency for Research on Cancer. Welding, molybdenum trioxide, and indium tin oxide. In: IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Vol 118. Lyon, France: International Agency for Research on Cancer; 2018.

3.    Cherry N, Galarneau J-M. Occupational dermatitis in welding: Does nickel exposure account for higher rates in women? Analysis of a Canadian cohort. Ann Work Expo Health 2021;65:183-195. https://doi.org/10.1093/annweh/wxaa049 [17].

4.    Korczynski RE. Occupational health concerns in the welding industry. Appl Occup Environ Hyg 2000;15:936-945. https://doi.org/10.1080/104732200750051175 [18].