• 2,300 women
    women were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2015
  • 86%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2016
  • 71%
    of stage III colon cancer patients received chemotherapy within 60 days of after surgery in 2014
  • 86%
    of all cancer surgery patients received their consult within the recommended wait time in 2016, and 87% received their surgery within the recommend wait time
  • Over 43,000
    patients were discussed at comprehensive multidisciplinary cancer conferences (MCCs) in fiscal year 2016/2017
  • About 13%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following surgery
  • 79%
    of breast cancer patients had a guideline-recommended mammogram in the first follow-up year
  • 74%
    of colorectal cancer patients diagnosed in 2013 had a surveillance colonoscopy within 18 months of surgery
  • Over 100
    patient and family advisors, who vary by their type of cancer and experiences, represent diverse regions and work with Cancer Care Ontario to ensure a person-centred cancer system
  • 383,023
    unique patients were screened for symptom severity using Your Symptoms Matter – General Symptoms (YSM-General) in 2016
Click here to emailClick here to printClick here to share

Environmental Health


Key findings

The number of facilities reporting the use, creation or release of toxic substances under the Ontario Toxics Reduction Act, 2009 (TRA 2009) increased from 841 in 2010 to 1040 in 2015. The number of facilities reporting the use, creation or release of known carcinogens also increased, up from 464 in 2010 to 674 in 2015. Since reporting under TRA 2009 is still in its infancy, it is important to note that the increased number of facilities that are reporting should be perceived as positive. As the TRA is a voluntary program, the increasing number of reporting facilities over the years shows that manufacturing and mining facilities are taking action/looking at ways to ensure toxics use reduction and pollution prevention.

While industrial emissions remain a source of air pollution in Ontario, emission amounts have decreased substantially over the past decade. For example, in 2005, 2,262 facilities reported approximately 975,000 tonnes of total releases in air to the National Pollutant Release Inventory (NPRI). In 2015, that amount had decreased to 1,666 companies reporting approximately 525,000 tonnes.

Environment and health in Ontario

Increasing evidence links environmental exposures to cancer and other health outcomes1,2. A recent global health assessment estimates that from 7% to 19% of cancers are currently attributable to toxic environmental and work-related exposures3–5. Due to the difficulty of directly assessing environmental exposures, we use indirect data on factors influencing "potential" exposure6. In this report, those data are derived from the following:

  1. Use, creation and release of hazardous substances. TRA 2009 collects information on the use, creation and release of hazardous substances. TRA 2009 and Ontario Regulation 455/09 were implemented as a toxic use reduction strategy, with the goal of providing Ontarians better disclosure about the use, creation and release of toxic substances in their communities7. TRA 2009 was modelled after the successful Massachusetts 1989 Toxics Use Reduction Act8, and it requires select13 manufacturing and mining facilities in Ontario that already federally report their industrial releases to (1) track, account and report on their use, creation and release of select toxic substances on an annual basis; (2) plan for the reduction of each toxic substance (implementation of these reduction plans is voluntary); (3) report and submit summary plans and annual reports on progress; and (4) update plans at least every 5 years.
  2. Hazardous substances released into the environment. A publicly accessible national database that annually tracks the toxic chemicals “released and/or transferred into the environment (land, air and water)" from industrial facilities in Canada is available from the NPRI. This is a mandatory pollutant release reporting program that was established in 1993 under the federal Canadian Environmental Protection Act, 1999 (CEPA 1999)9,10. The NPRI was developed under the guidance of a multistakeholder committee and is modelled after the U.S. Toxics Release Inventory (section 313 EPCRA 1986; 40 CFR Part 372)11. It requires all Canadian industrial facilities that employ 10 or more people to report on 346 select toxic substances that are deemed to pose a threat to human life or the environment if the facilities use more than 10,000 kg of each substance annually.
Table 1. Summary of proposed Toxics Reduction Act, 2009 (TRA 2009) indicators, 2010–2015

2010 2011 2012 2013 2014 2015 Expected direction of indicator Actual direction of indicator
Number of facilities reporting 841 840 1,119 1,097 1,065 1,040 Arrow up Arrow up
Number of facilities reporting carcinogens* 464 429 729 712 691 674 Arrow Down Arrow up
Total number of toxic substances* reported 155 150 235 236 233 233 Arrow Down Arrow up
Total number of carcinogens reported (known and suspected) 43 43 59 58 58 58 Arrow Down Arrow up

*by CAS Number (as opposed to by substance name)

Table 2. Ontario total releases (in tonnes) reported to the National Pollutant Release Inventory (NPRI), water and air, 2005–2015
Year Facilities Unique substances reported Releases to water (ON) Releases to air (ON)
2005 2,262 205 56,845 975,061
2006 2,212 204 54,803 876,820
2007 2,072 208 54,555 837,696
2008 1,962 187 58,778 719,185
2009 1,825 179 52,079 466,116
2010 1,760 179 52,823 533,958
2011 1,662 174 57,393 544,969
2012 1,691 238 71,201 537,431
2013 1,698 240 57,919 552,566
2014 1,656 246 58,523 519,395
2015 1,666 230 56,506 525,353

* There have been changes in the NPRI reporting from 1993 to date, especially around the addition, modification and removal of substances. Changes in the thresholds at which different substances should be reported also have been made. Updated information on NPRI releases can be found at Environment and Climate Change Canada.

What do the results show?

Toxics Reduction Act (TRA) 2009

  • In the initial TRA 2009 reports to the Ontario Ministry of the Environment and Climate Change in 2010, 841 facilities reported the use, creation or release of 155 toxic compounds (including known human carcinogens (IARC Group 1) (N=15) and suspected human carcinogens (IARC Group 2A or 2B) (N=28)).
  • Changes in TRA 2009 reporting occurred after 2010, when the Ministry of the Environment and Climate Change changed from a 47 substance priority list (Table A in O. Reg 455/09) to the NPRI toxic substance list. That increased the number of toxic substances reported to 346 (MOECC lists 322 substances under its current prescribed substances list, not 346).
  • In 2015 (Table 1), 1040 facilities reported the use, creation or release of 233 toxic compounds, and of the total substances reported for those years nearly 25% were known or suspected human carcinogens (N=58).
  • The number of facilities that reported the use, creation or release of known or suspected human carcinogens increased from 464 in 2010 to 674 in 2015 (Table 1).
  • Known or suspected human carcinogens are still being used, created or released in Ontario.
  • Future indicators will track the change in the amount of toxic substances reported under TRA 2009, as well as the proportion of companies implementing plans to reduce the use, creation and release of toxic substances in Ontario.

Hazardous substances released into the environment (NPRI)

  • The NPRI reports indicate that air emissions have decreased over the last decade. In 2005, there were 2,262 facilities reporting approximately 975,000 tonnes of pollutants in the air; in 2015, that had decreased to 1,666 facilities releasing approximately 525,000 tonnes. (Table 2).
  • Potential toxicity of the emissions depends on factors like the properties of the compound being released and the medium into which it is released. Weighting factors like benzene-equivalent are typical toxic equivalency potential factors that can be used to take into account differences in toxicity and exposure potential, allowing comparisons of releases on a common scale.

Why is this important to Ontarians?

  • Outdoor air pollution represents a major public health concern, because everyone is exposed to outdoor air pollutants, albeit to different degrees12. Examples of populations that are more susceptible to air pollutants are children, the elderly etc.12.
  • A wide range of toxic chemicals are released from industrial facilities into the air and water, and/or they are transferred off-site for disposal. Many of these chemicals are known to cause cancer, and prolonged exposure to these releases may increase cancer risk2.
  • By undertaking the reporting processes required in TRA 2009, manufacturing and mining facilities may have opportunities to reduce toxics through actions such as substituting toxic substances with safer alternatives, increasing process efficiencies (e.g. using less of the substance or reducing waste generation) and reformulating products so less of the substance is needed.

How does Ontario compare with other jurisdictions?

  • Ontario ranked third highest in environmental carcinogen air release in Canada in 2015 after Alberta and Quebec; several programs and initiatives have been established to reduce the potential health risks associated with chemicals.
  • The Ministry of the Environment and Climate Change has proposed daily and annual standards for carcinogenic environmental contaminants based on toxicology, especially for hexavalent chromium and volatile organic compounds (like benzene and 1,3-butadiene).
  • Ontario has taken a leading role in implementing TRA 2009 as a program that emphasizes industry changes that reduce or eliminate the use of toxic chemicals, the generation of hazardous waste, emissions (to air or land) and by-products per unit of product manufactured.

Find out more

View Notes

  1. Yang M. A current global view of environmental and occupational cancers. J Environ Sci Health C Environ Carcinog Ecotoxicol Rev. 2011; 29:223–249.
  2. Public Health Ontario and Cancer Care Ontario. Environmental Burden of Cancer in Ontario [Internet]; [cited 2015 February 13]. Toronto: Public Health Ontario; 2016. Available at: https://www.publichealthontario.ca/en/eRepository/Environmental_Burden_of_Cancer_
  3. Christiani DC. Combating environmental causes of cancer. New Engl J Med. 2011; 364:791–793.
  4. World Health Organization. Global health risks: mortality and burden of disease attributable to selected major risks [Internet]. Geneva: World Health Organization; 2009. Available from: http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf.
  5. Landrigan PJ, Espina C, Neira M. Global prevention of environmental and occupational cancer. Environ Health Perspect. 2011; 119:a280–a281.
  6. Frumkin H. Environmental health: from global to local. New York: John Wiley & Sons; 2010.
  7. Legislative Assembly of Ontario. Toxics Reduction Act, 2009. Chapter 19 [Internet]; [cited 2015 Mar 10]. Available from: https://www.ontario.ca/laws/statute/09t19.
  8. The Government of Massachusetts [Internet]. Commonwealth of Massachusetts; c2016. Toxics Use Reduction Act; [cited 2015 Mar 10]. Available from: http://www.mass.gov/eea/agencies/massdep/toxics/tur/.
  9. Environment and Climate Change Canada [Internet]. Ottawa: the Government of Canada. Canadian Environmental Protection Act, 1999. Part 3; 2014 Feb 28 [cited 2015 Mar 10]. Available from: http://www.ec.gc.ca/lcpe-cepa/default.asp?lang=En&n=26A03BFA-1.
  10. Environment and Climate Change Canada [Internet]. Ottawa: the Government of Canada. National Pollutant Release Inventory: tracking pollution in Canada; 2016 Jan 4 [cited 2015 Mar 10]. Available from: http://www.ec.gc.ca/inrp-npri/.
  11. EPA.gov [Internet]. The United States of America Environmental Protection Agency; 2016. Toxics release inventory (TRI) program; 2016 Mar 1 [cited 2015 Mar 10]. Available at: http://www2.epa.gov/toxics-release-inventory-tri-program.
  12. Sheehan MC, Lam J, Navas-Acien A et al. Ambient air pollution epidemiology systematic review and meta-analysis: A review of reporting and methods practice. Environ. Int. 2016; 92-93:647-656. http://dx.doi.org/10.1016/j.envint.2016.02.016 Available at: