Tomaz Levstek

Researchers have obtained a baseline snapshot of working conditions and health concerns of nail salon workers in the first step of studies to determine the health impact of their exposure to potential carcinogens in nail care products.

The baseline survey, conducted by researchers at the Northern California Cancer Center, the School of Medicine and the Stanford Cancer Center, was the beginning of a larger effort to learn whether the women have a higher risk of breast cancer and other diseases, as has been suggested by some smaller studies. It was published online May 14 and will appear in the Journal of Community Health in October.

"This is part of a larger political issue in terms of the absolute lack of regulation in personal care products," said Peggy Reynolds, PhD, consulting professor of health research and policy and senior research scientist at the Northern California Cancer Center. She said that because makers of personal care products—such as those used in nail salons—don't have to report ingredients, nobody knows what chemicals the salon workers are exposed to on a daily basis. Despite the lack of reporting, the products are known to contain benzene and methyl chloride, which can cause breast tumors in animals exposed to the chemical fumes.

California has more than 300,000 people licensed to work in nail salons, and the majority of them are owned and staffed by Vietnamese women. Nail salons are among the fastest-growing industries in the United States. Among Vietnamese women in this country, breast cancer is the leading cause of cancer death.

Given the increasing numbers of women working with possible carcinogens in salons, Reynolds and first author Thu Quach, a graduate student at UC-Berkeley, wanted to establish a baseline for understanding the working conditions. Quach said that although a baseline does not assess actual health risk, it can be an advisable first step to invite goodwill when working with minority populations.

"The funding that we got encourages a pilot project to build partnerships in the community," Quach said. Their work was funded by the state-run California Breast Cancer Research Program as part of a community research collaboration program, which is intended to build relationships between minority communities and researchers.

The team worked with Oakland-based Asian Health Services, which does outreach in the Bay Area Asian communities. That organization has been concerned about the lack of information on the health of nail salon workers, as well as the ability of those women to access health care.

Working with the Asian Health Services, Reynolds and her team were able to talk with 201 workers in 74 salons in Alameda County. "This isn't the kind of study we could easily do without working within the population," said Reynolds, who is also a member of the Stanford Cancer Center.

The group surveyed the size of the salon, whether the salon had ventilation, how long the women had worked in the industry and their access to health care. They learned that among women who were more than 40 years old, 89 percent have been screened for breast cancer. About 45 percent of salons have a ventilation system in place.

Of all the women surveyed, 80 percent said they had concerns about the health effects of working with some chemicals and 62 percent also said they had developed a health problem after they started working in a salon. The concerns they reported included headaches, skin problems, trouble breathing and chronic pain.

The research group has since received follow-up funding to study cancer rates and to monitor air in salons. Workers will wear air-quality sensors that will provide a snapshot of what chemicals the salon workers are exposed to and in what quantities. In another arm of the follow-up study, Reynolds and her team will look at cancer rates in these women compared with the general population to learn if the chemical exposure poses a cancer risk.

In addition to learning the health impact of working in nail salons, Reynolds said she hoped the work draws attention to potential hazards posed by cosmetic manufacturers that are not required to declare ingredients. Many manufacturers already produce alternate versions of products for the European market, where stricter regulations prohibit many chemicals known to act as carcinogens.

"To me, the fact that the same producers are selling a different formulation in Europe is shocking," said Reynolds. If her study reveals clear health effects posed by cosmetic products, it may help push similar regulations in the United States, she said.