Occupational risk factors for lung cancer in women: results of a case-control study in Germany

Global prevalence of musculoskeletal disorders among sanitary workers: a systematic review and meta-analysis

Objectives. Sanitary workers are more likely to experience musculoskeletal disorders (MSDs) due to a lack of ergonomics principles and poor job design. Thus, this systematic review and meta-analysis aimed to quantify MSDs among sanitary workers. Methods. The PRISMA and PICOS protocols were used for flow diagrams and review questions, respectively. Articles published between 2000 and 2022 were eligible. The keywords '(Musculoskeletal Disorders) AND (Solid waste collectors *OR Street sweepers *OR Sewage workers *OR health facilities cleaners)' and MeSH terms were utilized. The data were analyzed using STATA version 17 with a 95% confidence interval (CI). Results. A total of 158 papers were qualified, with 26 studies from 17 countries and a total of 6586 sanitary workers. The global prevalence of MSDs among sanitation workers was 40.52% (95% CI [32.47, 48.67]; p < 0.05). It was 43.32% (95% CI [31.98, 54.68]; p < 0.05) in high-income countries and 38.58% (95% CI [26.94, 50.18]; p < 0.05) in low-income countries. By subgroup analysis, it was 45.12% (95% CI [32.57, 57.67]; p < 0.05) for solid waste collectors, which is the highest prevalence among other workers. Conclusion. Current evidence shows that sanitation workers have a higher prevalence of occupationally associated MSDs, which might be lowered by using ergonomic work design principles.

Lung cancer risk in painters: results from the SYNERGY pooled case-control study consortium

OBJECTIVES

We evaluated the risk of lung cancer associated with ever working as a painter, duration of employment and type of painter by histological subtype as well as joint effects with smoking, within the SYNERGY project.

METHODS

Data were pooled from 16 participating case-control studies conducted internationally. Detailed individual occupational and smoking histories were available for 19 369 lung cancer cases (684 ever employed as painters) and 23 674 age-matched and sex-matched controls (532 painters). Multivariable unconditional logistic regression models were adjusted for age, sex, centre, cigarette pack-years, time-since-smoking cessation and lifetime work in other jobs that entailed exposure to lung carcinogens.

RESULTS

Ever having worked as a painter was associated with an increased risk of lung cancer in men (OR 1.30; 95% CI 1.13 to 1.50). The association was strongest for construction and repair painters and the risk was elevated for all histological subtypes, although more evident for small cell and squamous cell lung cancer than for adenocarcinoma and large cell carcinoma. There was evidence of interaction on the additive scale between smoking and employment as a painter (relative excess risk due to interaction >0).

CONCLUSIONS

Our results by type/industry of painter may aid future identification of causative agents or exposure scenarios to develop evidence-based practices for reducing harmful exposures in painters.

Role of occupational exposures in lung cancer risk among women

OBJECTIVES

To explore possible associations between selected occupational agents and lung cancer risk among women.

METHODS

A population-based case-control study on lung cancer was conducted from 1996 to 2001 in Montreal, Canada. Cases were individuals diagnosed with incident lung cancer and population controls were randomly selected from electoral lists and frequency-matched to age and sex distributions of cases. Questionnaires on lifetime occupational history, smoking and demographic characteristics were collected during in-person interviews. As part of a comprehensive exposure assessment protocol, experts reviewed each subject's work history and assessed exposure to many agents. The current analysis, restricted to working women in the study, includes 361 cases and 521 controls. We examined the association between lung cancer and each of 22 occupational exposures, chosen because of their relatively high prevalences among these women. Each exposure was analysed in a separate multivariate logistic regression model, adjusted for smoking and other selected covariates.

RESULTS

There were few elevated OR estimates between lung cancer and any of the agents, and none were statistically significant, although the limited numbers of exposed women engendered wide CIs.

CONCLUSIONS

There was little evidence to suggest that women in this population had experienced excess risks of lung cancer as a result of their work exposures. However, the wide CIs preclude any strong inferences in this regard.

Occupational exposure to wood dust and risk of lung cancer: the ICARE study

OBJECTIVES

In a previous analysis of data from a French population-based case-control study (the Investigation of occupational and environmental CAuses of REspiratory cancers (ICARE) study), 'having ever worked' in wood-related occupations was associated with excess lung cancer risk after adjusting for smoking but not for occupational factors. The present study aimed to investigate the relationship between lung cancer risk and wood dust exposure after adjusting for occupational exposures.

METHODS

Data were obtained from 2276 cases and 2780 controls on smoking habits and lifelong occupational history, using a standardised questionnaire with a job-specific questionnaire for wood dust exposure. Logistic regression models were used to calculate ORs and 95% CIs adjusted for age, area of residence, tobacco smoking, the number of job periods and exposure to silica, asbestos and diesel motor exhaust (DME).

RESULTS

No significant association was found between lung cancer and wood dust exposure after adjustment for smoking, asbestos, silica and DME exposures. The risk of lung cancer was slightly increased among those who were exposed to wood dust more than 10 years, and had over 40 years since the first exposure.

CONCLUSION

Our findings do not provide a strong support to the hypothesis that wood dust exposure is a risk factor for lung cancer. This study showed the importance of taking into account smoking and occupational coexposures in studies on lung cancer and wood dust exposure. Further studies evaluating the level and frequency of exposure during various tasks in woodwork are needed.

Lung cancer risk and occupational exposures in crop farming: results from the AGRIculture and CANcer (AGRICAN) cohort

Objectives

Farmers are considered at lower risk of lung cancer. However, specific tasks can expose them to hazardous air contaminants such as pesticides, diesel exhaust and mineral dust. This study aimed to assess the associations between various crops and related tasks and the risk of lung cancer, overall and by histological subtypes.

Methods

AGRIculture and CANcer is a prospective French cohort of individuals affiliated to the agricultural health insurance scheme. Incident lung cancers (n=897) were identified by cancer registries from enrolment (2005–2007) to 2013. Data on crop and livestock exposure during lifetime were obtained from the enrolment questionnaire. We used a Cox model with attained age as timescale, adjusted for gender, smoking history and exposure to cattle and horses. Effects of duration and surface were assessed and analyses stratified on gender and smoking status were performed.

Results

Winegrowers were at higher risk of adenocarcinoma (HR=1.27 (95% CI 0.94 to 1.72)). We also found an association between pea growing and small cell lung cancer: significant effect of duration (ptrend=0.04) and the suggestion of a surface–effect relationship (ptrend=0.06); increased risk (HR=2.38 (95% CI 1.07 to 5.28)) for pesticide users; and significant effect of duration (ptrend=0.01) for harvesters. The risk of squamous cell carcinoma was increased for sunflower growing (HR=1.59 (95% CI 0.97 to 2.62), fruit-tree pruning (HR=1.44 (95% CI 0.92 to 2.27)) and pesticide use on beets (HR=1.47 (95% CI 0.92 to 2.34)). Corn and/or wheat/barley growers were at lower risk of lung cancer.

Conclusions

Our results suggest associations between lung cancer and several crop-related tasks, even if we cannot rule out some chance findings due to multiple comparisons.

Lung cancer risk among hairdressers: a pooled analysis of case-control studies conducted between 1985 and 2010

Increased lung cancer risks among hairdressers were observed in large registry-based cohort studies from Scandinavia, but these studies could not adjust for smoking. Our objective was to evaluate the lung cancer risk among hairdressers while adjusting for smoking and other confounders in a pooled database of 16 case-control studies conducted in Europe, Canada, China, and New Zealand between 1985 and 2010 (the Pooled Analysis of Case-Control Studies on the Joint Effects of Occupational Carcinogens in the Development of Lung Cancer). Lifetime occupational and smoking information was collected through interviews with 19,369 cases of lung cancer and 23,674 matched population or hospital controls. Overall, 170 cases and 167 controls had ever worked as hairdresser or barber. The odds ratios for lung cancer in women were 1.65 (95% confidence interval (CI): 1.16, 2.35) without adjustment for smoking and 1.12 (95% CI: 0.75, 1.68) with adjustment for smoking; however, women employed before 1954 also experienced an increased lung cancer risk after adjustment for smoking (odds ratio = 2.66, 95% CI: 1.09, 6.47). The odds ratios in male hairdressers/barbers were generally not elevated, except for an increased odds ratio for adenocarcinoma in long-term barbers (odds ratio = 2.20, 95% CI: 1.02, 4.77). Our results suggest that the increased lung cancer risks among hairdressers are due to their smoking behavior; single elevated risk estimates should be interpreted with caution and need replication in other studies.

Population Attributable Risk for Occupational Gancer in Italy

Population studies estimating the proportion of cancer attributable to occupation (PAR) in different geographical areas in Italy are reviewed. Studies using lists of industrial activities and occupations which are known or suspected to entail exposure to lung carcinogens gave lung cancer PARs between 5% and 36%. Those using job-exposure matrices estimated PARs of 3%-53%, with most of the values ranging between 17 and 33%. For bladder cancer, PARs ranged between 4% and 24%. The uses and limitations of calculating population attribultable risk are discussed.

Systematic review with meta-analysis of the epidemiological evidence in the 1900s relating smoking to lung cancer

BACKGROUND

Smoking is a known lung cancer cause, but no detailed quantitative systematic review exists. We summarize evidence for various indices.

METHODS

Papers published before 2000 describing epidemiological studies involving 100+ lung cancer cases were obtained from Medline and other sources. Studies were classified as principal, or subsidiary where cases overlapped with principal studies. Data were extracted on design, exposures, histological types and confounder adjustment. RRs/ORs and 95% CIs were extracted for ever, current and ex smoking of cigarettes, pipes and cigars and indices of cigarette type and dose-response. Meta-analyses and meta-regressions investigated how relationships varied by study and RR characteristics, mainly for outcomes exactly or closely equivalent to all lung cancer, squamous cell carcinoma ("squamous") and adenocarcinoma ("adeno").

RESULTS

287 studies (20 subsidiary) were identified. Although RR estimates were markedly heterogeneous, the meta-analyses demonstrated a relationship of smoking with lung cancer risk, clearly seen for ever smoking (random-effects RR 5.50, CI 5.07-5.96) current smoking (8.43, 7.63-9.31), ex smoking (4.30, 3.93-4.71) and pipe/cigar only smoking (2.92, 2.38-3.57). It was stronger for squamous (current smoking RR 16.91, 13.14-21.76) than adeno (4.21, 3.32-5.34), and evident in both sexes (RRs somewhat higher in males), all continents (RRs highest for North America and lowest for Asia, particularly China), and both study types (RRs higher for prospective studies). Relationships were somewhat stronger in later starting and larger studies. RR estimates were similar in cigarette only and mixed smokers, and similar in smokers of pipes/cigars only, pipes only and cigars only. Exceptionally no increase in adeno risk was seen for pipe/cigar only smokers (0.93, 0.62-1.40). RRs were unrelated to mentholation, and higher for non-filter and handrolled cigarettes. RRs increased with amount smoked, duration, earlier starting age, tar level and fraction smoked and decreased with time quit. Relationships were strongest for small and squamous cell, intermediate for large cell and weakest for adenocarcinoma. Covariate-adjustment little affected RR estimates.

CONCLUSIONS

The association of lung cancer with smoking is strong, evident for all lung cancer types, dose-related and insensitive to covariate-adjustment. This emphasises the causal nature of the relationship. Our results quantify the relationships more precisely than previously.

Risk of lung cancer and occupational history: results of a French population-based case-control study, the ICARE study

OBJECTIVES

To assess the risk of lung cancer associated with occupations and industries.

METHODS

A French population-based case-control study included 2923 cases and 3555 controls. Lifelong occupational history was collected. Two lists of occupations known (A) or suspected (B) to be associated with lung cancer were used. Occupations and industries not included in these lists were also explored.

RESULTS

Among men, the smoking-adjusted odds ratio was 1.97 for list A (attributable fraction: 12.3%), 1.4 for list B (due especially to carpenters/joiners and transport workers). Among unlisted occupations, excess risks were found for welders, plumbers, and several construction crafts. Odds ratios among women were elevated for list A, list B (due especially to launderers/dry cleaners), cleaners and hairdressers.

CONCLUSIONS

These results confirm the role of known occupations and give insight into new occupational risk factors among men and women.

Interaction of occupational and personal risk factors in workforce health and safety

Most diseases, injuries, and other health conditions experienced by working people are multifactorial, especially as the workforce ages. Evidence supporting the role of work and personal risk factors in the health of working people is frequently underused in developing interventions. Achieving a longer, healthy working life requires a comprehensive preventive approach. To help develop such an approach, we evaluated the influence of both occupational and personal risk factors on workforce health. We present 32 examples illustrating 4 combinatorial models of occupational hazards and personal risk factors (genetics, age, gender, chronic disease, obesity, smoking, alcohol use, prescription drug use). Models that address occupational and personal risk factors and their interactions can improve our understanding of health hazards and guide research and interventions.

Lung cancer risk in painters: a meta-analysis

We conducted a meta-analysis to quantitatively compare the association between occupation as a painter and the incidence or mortality from lung cancer. PubMed and the reference lists of pertinent publications were searched and reviewed. For the meta-analysis, we used data from 47 independent cohort, record linkage, and case-control studies (from a total of 74 reports), including > 11,000 incident cases or deaths from lung cancer among painters. Three authors independently abstracted data and assessed study quality. The summary relative risk (meta-RR, random effects) for lung cancer in paint-ers was 1.35 [95% confidence interval (CI), 1.29-1.41; 47 studies] and 1.35 (95% CI, 1.21-1.51; 27 studies) after controlling for smoking. The relative risk was higher in never-smokers (meta-RR = 2.00; 95% CI, 1.09-3.67; 3studies) and persisted when restricted to studies that adjusted for other occupational exposures (meta-RR = 1.57; 95% CI, 1.21-2.04; 5 studies). These results support the conclusion that occupational exposures in painters are causally associated with the risk of lung cancer.

Occupational lung cancer in US women, 1984-1998

BACKGROUND

Lung cancer is the leading cause of cancer death in US women, accounting for 72,130 deaths in 2006. In addition to smoking cessation, further reduction of the burden of lung cancer mortality can be made by preventing exposure to occupational lung carcinogens. Data for occupational exposures and health outcomes of US working women are limited.

METHODS

Population-based mortality data for 4,570,711 women who died between 1984 and 1998 in 27 US States were used to evaluate lung cancer proportionate mortality over time by the usual occupation and industry reported on death certificates. Lung cancer proportionate mortality ratios were adjusted for smoking, using data from the National Health Interview Survey (NHIS) and the American Cancer Society's Cancer Prevention Study II.

RESULTS

Analyses revealed that 194,382 white, 18,225 Black and 1,515 Hispanic women died 1984-1998 with lung cancer reported as the underlying cause of death. Following adjustment for smoking, significant excess proportionate lung cancer mortality was observed among US women working in the US manufacturing; transportation; retail trade; agriculture, forestry, and fishing; and nursing/personal care industries. Women employed in precision production, technical, managerial, professional specialty, and administrative occupations experienced some of the highest significantly excess proportionate lung cancer mortality during 1984-1998.

CONCLUSIONS

The results of our study point to significantly elevated risks for lung cancer after adjustment for smoking among women in several occupations and industries. Because 6-17% of lung cancer in US males is attributable to known exposures to occupational carcinogens, and since synergistic interactions between cigarette smoke and other occupational lung carcinogens have been noted, it is important to continue research into the effects of occupational exposures on working men and women.

Lung cancer and occupation: A New Zealand cancer registry-based case-control study

BACKGROUND

There are many proven and suspected occupational causes of lung cancer, which will become relatively more important over time, as smoking prevalence decreases.

METHODS

We interviewed 457 cases aged 20-75 years notified to the New Zealand Cancer Registry during 2007-2008, and 792 population controls. We collected information on demographic details, potential confounders, and employment history. Associations were estimated using logistic regression adjusted for gender, age, ethnicity, smoking, and socio-economic status.

RESULTS

Among occupations of a priori interest, elevated odds ratios (ORs) were observed for sawmill, wood panel and related wood-processing plant operators (OR 4.63; 95% CI 1.05-20.29), butchers (OR 8.77, 95% CI 1.06-72.55), rubber and plastics products machine operators (4.27; 1.16-15.66), heavy truck drivers (2.24; 1.19-4.21) and workers in petroleum, coal, chemical and associated product manufacturing (1.80; 1.11-2.90); non-significantly elevated risks were also observed for loggers (4.67; 0.81-27.03), welders and flame-cutters (2.50; 0.86-7.25), pressers (5.74; 0.96-34.42), and electric and electronic equipment assemblers (3.61; 0.96-13.57). Several occupations and industries not of a priori interest also showed increased risks, including nursing associate professionals (5.45; 2.29-12.99), enrolled nurses (7.95; 3.10-20.42), care givers (3.47; 1.40-8.59), plant and machine operators and assemblers (1.61; 1.20-2.16), stationary machine operators and assemblers (1.67; 1.22-2.28), food and related products processing machine operators (1.98; 1.23-3.19), laborers and related elementary service workers (1.45; 1.05-2.00), manufacturing (1.34; 1.02-1.77), car retailing (3.08; 1.36-6.94), and road freight transport (3.02; 1.45-6.27).

CONCLUSIONS

Certain occupations and industries have increased lung cancer risks in New Zealand, including wood workers, metal workers, meat workers, textile workers and drivers. Am. J. Ind. Med. 54:89-101, 2011. © 2010 Wiley-Liss, Inc.

Meta-analyses of occupational exposure as a painter and lung and bladder cancer morbidity and mortality 1950-2008

The International Agency for Research on Cancer (IARC) classified occupational painting as a human carcinogen based on lung and bladder cancers; however, no specific exposures were implicated. The authors conducted comprehensive meta-analyses of the epidemiological literature on occupational painting and these cancers. The authors abstracted study results and confounder information, and used quantile plots and regression models to evaluate heterogeneity and publication bias. Summary risk estimates were derived and sensitivity analyses performed to evaluate smoking, socioeconomic status (SES), and exposure variables. Where applicable, a Bayesian approach was used to externally adjust for smoking, a major risk factor for both cancers. For lung cancer cohort mortality studies, publication bias and heterogeneity were seen, and earlier studies reported higher risk estimates than later studies. Overall lung cancer summary risk estimates were 1.29 for case-control and 1.22 and 1.36 for cohort morbidity and mortality studies, respectively, and risk estimates for bladder cancer were 1.28 for case-control and 1.14 and 1.27 for cohort morbidity and mortality studies, respectively (all statistically significant). Risks did not differ between painters and mixed occupations. Nonsignificant summary estimates resulted for lung and bladder cancers when controlling for SES, or externally adjusting for smoking in lung cancer studies. Summary risks varied by control source for case-control studies. Residual confounding by smoking and SES, lack of exposure group effect, and publication bias limit the ability of the meta-analyses to explain associations observed between occupational painting and lung and bladder cancers. Given the long latencies for lung and bladder cancers, these weak associations, if real, may not be elucidated through studies of occupational painting today.

Lung cancer risk in painters: a meta-analysis

OBJECTIVE

We conducted a meta-analysis to quantitatively compare the association between occupation as a painter and the incidence or mortality from lung cancer.

DATA SOURCES

PubMed and the reference lists of pertinent publications were searched and reviewed. For the meta-analysis, we used data from 47 independent cohort, record linkage, and case control studies (from a total of 74 reports), including > 11,000 incident cases or deaths from lung cancer among painters.

DATA EXTRACTION

Three authors independently abstracted data and assessed study quality.

DATA SYNTHESIS

The summary relative risk (meta-RR, random effects) for lung cancer in painters was 1.35 [95% confidence interval (CI), 1.291.41; 47 studies] and 1.35 (95% CI, 1.211.51; 27 studies) after controlling for smoking. The relative risk was higher in never-smokers (meta-RR = 2.00; 95% CI, 1.093.67; 3 studies) and persisted when restricted to studies that adjusted for other occupational exposures (meta-RR = 1.57; 95% CI, 1.212.04; 5 studies). The results remained robust when stratified by study design, sex, and study location and are therefore unlikely due to chance or bias. Furthermore, exposure response analyses suggested that the risk increased with duration of employment.

CONCLUSION

These results support the conclusion that occupational exposures in painters are causally associated with the risk of lung cancer.

Lung cancer and occupation in a population-based case-control study

The authors examined the relation between occupation and lung cancer in the large, population-based Environment And Genetics in Lung cancer Etiology (EAGLE) case-control study. In 2002-2005 in the Lombardy region of northern Italy, 2,100 incident lung cancer cases and 2,120 randomly selected population controls were enrolled. Lifetime occupational histories (industry and job title) were coded by using standard international classifications and were translated into occupations known (list A) or suspected (list B) to be associated with lung cancer. Smoking-adjusted odds ratios and 95% confidence intervals were calculated with logistic regression. For men, an increased risk was found for list A (177 exposed cases and 100 controls; odds ratio = 1.74, 95% confidence interval: 1.27, 2.38) and most occupations therein. No overall excess was found for list B with the exception of filling station attendants and bus and truck drivers (men) and launderers and dry cleaners (women). The authors estimated that 4.9% (95% confidence interval: 2.0, 7.8) of lung cancers in men were attributable to occupation. Among those in other occupations, risk excesses were found for metal workers, barbers and hairdressers, and other motor vehicle drivers. These results indicate that past exposure to occupational carcinogens remains an important determinant of lung cancer occurrence.

Risk factors for lung cancer: a case-control study in Hong Kong women

To identify etiological connections of lung cancer in Chinese women in Hong Kong, who are among the highest in lung cancer incidence and mortality, we conducted a case-control study, in which 279 female lung cancer cases and 322 controls were selected and frequency matched. A variety of information, including dietary habits, occupational history, smoking, domestic environmental exposures, and family history of cancer was collected, and their associations with lung cancer were analyzed with logistic analysis approach. In addition to positive associations with exposures to cooking emissions and to radon at home, smoking and family cancer history, we observed that increasing consumption of meat was linked to a higher risk, whereas consumptions of vegetables had a strong protective effect against lung cancer. Moderate consumption of coffee appeared to be beneficial against the disease. Those never employed and domestic helpers were at a higher risk. The results indicated that environmental exposures, risky personal behaviors, or lifestyle, as well as family cancer aggregation are among important contributors to the high incidence of lung cancer in Hong Kong females.

Endotoxin exposure and lung cancer risk: a systematic review and meta-analysis of the published literature on agriculture and cotton textile workers

Objective

To examine the association between exposure to endotoxins and lung cancer risk by conducting a systematic review and meta-analysis of epidemiologic studies of workers in the cotton textile and agricultural industries; industries known for high exposure levels of endotoxins.

Methods

Risk estimates were extracted from studies published before 2009 that met predefined quality criteria, including 8 cohort, 1 case–cohort, and 2 case–control studies of cotton textile industry workers, and 15 cohort and 2 case–control studies of agricultural workers. Summary risk estimates were calculated using random effects meta-analyses. Potential sources of heterogeneity were explored through subgroup analyses.

Results

The summary risk of lung cancer was 0.72 (95% CI, 0.57–0.90) for textile workers and 0.62 (0.52–0.75) for agricultural workers. The relative risk of lung cancer was below 1.0 for most subgroups defined according to sex, study design, outcome, smoking adjustment, and geographic area. Two studies provided quantitative estimates of endotoxin exposure and both studies tended to support a dose–dependent protective effect of endotoxins on lung cancer risk.

Conclusion

Despite several limitations, this meta-analysis based on high-quality studies adds weight to the hypothesis that occupational exposure to endotoxin in cotton textile production and agriculture is protective against lung cancer.

Occupational risk of lung cancer among lifetime non-smoking women in Shanghai, China

OBJECTIVES

Occupational lung carcinogens have been primarily studied in men. The aim of this study was to investigate occupational lung cancer risk in a cohort of Chinese non-smoking women.

METHODS

In 1996-2000, 71 067 non-smoking women who had held a job outside the home were interviewed for the prospective Shanghai Women's Health Study in China. Exposure to lung carcinogens was assessed by matching occupation and industry titles from lifetime occupational histories with lists of jobs identified by the International Agency for Research on Cancer to have potential exposure to: (1) known (A-list); or (2) suspected (B-list) carcinogens. In addition, similar occupational titles were grouped independent of the a priori defined lists. Relative risks (RRs) were calculated using Cox proportional hazards regression.

RESULTS

During follow-up through 2005, 219 incident lung cancer cases were diagnosed. Jobs on the A-list and B-list were held by 0.8-6.7% and 2.7-9.4% of the cohort, respectively. Overall, ever holding any job on the A-list or B-list was not associated with lung cancer incidence. Indications of excess risk were found for two subgroups: painters (A-list) and rubber workers (B-list) (RR = 2.0 and 1.7, respectively, p<or=0.1). An exploratory analysis of 35 occupational categories independent of the lists showed significantly increased risks for leather products/shoes, wood/paper products and miscellaneous production/transportation. The former two of these categories were similar to subgroups of the B-list, but broader than the specific a priori defined jobs.

CONCLUSIONS

Significantly elevated lung cancer risk was associated with employment in some broad occupational categories that also included jobs with potential exposure to suspected carcinogens (B-list). The results suggest that although similar exposures to those described on the B-list may play a role in this cohort of Chinese women, carcinogenic exposure may not be restricted only to the jobs on the B-list.

Occupation, gender, race, and lung cancer

OBJECTIVE

To examine associations between occupation and lung cancer by gender and race.

METHODS

We used data from the Maryland Lung Cancer Study of nonsmall cell lung carcinoma (NSCLC), a multicenter case control study, to estimate odds ratios (ORs) of NSCLC in different occupations.

RESULTS

After adjusting for smoking, environmental tobacco smoke, and other covariates, NSCLC ORs among women but not men were elevated in clerical-sales, service, and transportation-material handling occupations; ORs were significantly increased in all three categories (OR [95% confidence interval]: 4.07 [1.44 to 11.48]; 5.15 [1.62 to 16.34]; 7.82 [1.08 to 56.25], respectively), among black women, but only in transportation-material handling occupations (OR [95% confidence interval[: 3.43 [1.02 to 11.50]) among white women.

CONCLUSIONS

Women, especially black women, in certain occupations had increased NSCLC ORs.

Socioeconomic differences in lung cancer incidence: a systematic review and meta-analysis

OBJECTIVE

To investigate the associations between various socioeconomic indicators and lung cancer incidence.

METHODS

We searched PubMed and EMBASE databases for studies on socioeconomic position (SEP) and lung cancer incidence published through October 2007. Random-effect model was used to pool the risk estimates from the individual studies. We stratified the analysis by adjustment strategy to investigate the influence of smoking on socioeconomic gradient in lung cancer incidence.

RESULTS

Out of 3,288 citations, we identified 64 studies eligible for inclusion. Compared to the highest SEP level, we observed an overall increased risk in lung cancer incidence among people with low educational SEP (61%), low occupational SEP (48%), and low income-based SEP (37%). The negative social gradient for lung cancer incidence remained for most of the possible sets of pooled estimates obtained in subgroup analyses for occupational and educational SEP with less consistency for SEP based on income in studies adjusted and unadjusted for smoking. No evidence of publication bias was apparent.

CONCLUSION

Lung cancer incidence was associated with low educational, occupational, and income-based SEP. The association, adjusted or unadjusted for smoking, points out the importance of social position to be addressed in all discussions on cancer preventive measures.

Occupations and lung cancer: a population-based case-control study in British Columbia

An investigation based on a large population-based case-control study in British Columbia, Canada, was conducted to identify high-risk occupations for lung cancer by histological subtypes. Subjects were 14,755 male incident cancer cases for whom lifetime occupational histories and information on smoking and relevant covariates were collected. Occupational associations for 2998 lung cancer cases, including histological subtypes, were assessed by logistic regression using other cancer cases, excluding smoking-related cancers, as controls. An excess risk of lung cancer was found among workers in metal processing, bakers, and ship deck crew for all histological subtypes, and construction workers, chefs and cooks, and medical workers for specific histological subtypes. Occupational associations that are unique to histological subtypes of lung cancer were identified. Owing to a scarcity of literature in this area, future research needs to focus on confirming these histological associations, and identifying the risk from key exposures found within these occupations (e.g., medical radiation, electromagnetic fields, and cooking fumes).

Do genetic factors protect for early onset lung cancer? A case control study before the age of 50 years

BACKGROUND

Early onset lung cancer shows some familial aggregation, pointing to a genetic predisposition. This study was set up to investigate the role of candidate genes in the susceptibility to lung cancer patients younger than 51 years at diagnosis.

METHODS

246 patients with a primary, histologically or cytologically confirmed neoplasm, recruited from 2000 to 2003 in major lung clinics across Germany, were matched to 223 unrelated healthy controls. 11 single nucleotide polymorphisms of genes with reported associations to lung cancer have been genotyped.

RESULTS

Genetic associations or gene-smoking interactions was found for GPX1(Pro200Leu) and EPHX1(His113Tyr). Carriers of the Leu-allele of GPX1(Pro200Leu) showed a significant risk reduction of OR = 0.6 (95% CI: 0.4-0.8, p = 0.002) in general and of OR = 0.3 (95% CI:0.1-0.8, p = 0.012) within heavy smokers. We could also find a risk decreasing genetic effect for His-carriers of EPHX1(His113Tyr) for moderate smokers (OR = 0.2, 95% CI:0.1-0.7, p = 0.012). Considered both variants together, a monotone decrease of the OR was found for smokers (OR of 0.20; 95% CI: 0.07-0.60) for each protective allele.

CONCLUSION

Smoking is the most important risk factor for young lung cancer patients. However, this study provides some support for the T-Allel of GPX1(Pro200Leu) and the C-Allele of EPHX1(His113Tyr) to play a protective role in early onset lung cancer susceptibility.

Occupation and risk of lung cancer in Central and Eastern Europe: the IARC multi-center case–control study

OBJECTIVE

We sought to evaluate the role of occupation and industry in lung carcinogenesis in six countries in Central and Eastern Europe.

METHODS

This multi-center case-control study included 2,056 male and 576 female lung cancer incidence cases diagnosed from 1998 to 2001 and 2,144 male and 727 female controls frequency-matched for sex and age. Unconditional regression models were applied to calculate the odds ratios after controlling for potential confounders including age (5-year groups), study center (15 centers), and tobacco pack-years.

RESULTS

Elevated odds ratios (ORs) were found for men employed as production workers (OR 1.45, 95% CI 1.22-1.72), bookkeepers and cashiers (1.81, 1.03-3.24), general farmers (1.67, 1.08-2.60), livestock workers (2.54, 1.09-5.88), miners (2.17, 1.47-3.23), toolmakers and metal patternmakers (2.56, 1.34-4.94), glass formers (2.55, 1.18-5.50), dockworkers, and freight handlers (1.49, 1.04-2.12). Industries with elevated risk among men included mining (1.75, 1.20-2.57), manufacture of cement, lime, or plaster (3.62, 1.11-12.00), casting of metals (2.00, 1.17-3.45), manufacture of electric motors (2.18, 1.24-3.86). For women, elevated ORs were found for medical, dental, veterinary doctors (2.54, 1.01-6.31), librarians and curators (7.03, 1.80-27.80), sewers 3.63 (1.12-10.23).

CONCLUSIONS

This study identifies new areas for further, explanatory analyses, especially in production work, and indicates new possible sources of exposure to cancer risk for women.

Concentrations of polychlorinated dibenzo-p-dioxins in processed ball clay from the United States

Processed ball clays commonly used by the ceramic art industry in the United States were collected from retail suppliers and analyzed for the presence and concentration of the 2,3,7,8-Cl substituted polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDDs/PCDFs). The average PCDD toxic equivalent (TEQ) concentrations of these processed ball clays was approximately 800 pg/g (TEQ-WHO) with characteristic congener profiles and isomer distributions similar to patterns of previously analyzed raw and processed ball clays. The PCDF concentrations were below the average limit of detection (LOD) of 0.5 pg/g. Correlation analyses reveal no significant relationship between total organic carbon (TOC) and either individual, homologues, and total tetra-through octa-chlorinated PCDD congeners, or TEQ concentrations of the processed ball clays. The results are consistent with earlier studies on levels of PCDDs in ball clays. Data from earlier studies indicated that dioxins may be released to the environment during the processing of raw clay or the firing process used in commercial ceramic facilities. The presence of dioxin in the clays also raises concerns about potential occupational exposure for individuals involved in the mining/processing of ball clay, ceramics manufacturing and ceramic artwork.

Occupation and lung cancer mortality in a nationally representative U.S. Cohort: The National Health Interview Survey (NHIS)

OBJECTIVE

The objective of this study was to assess the risk of lung cancer mortality in a nationally representative sample of U.S. workers by occupation.

METHODS

National Death Index linkage identified 1812 lung cancer deaths among 143,863 workers who participated in the 1987, 1988, and 1990-1994 National Health Interview Surveys.

RESULTS

Current and former smoking status was predictive of lung cancer mortality (hazard ratio [HR] = 15.1 and 3.8, respectively). Occupations with significantly higher risk for age- and smoking-adjusted lung cancer mortality included heating/air/refrigeration mechanics (HR = 3.0); not specified mechanics and repairers (HR = 2.8); financial records processing occupations (HR = 1.8); freight, stock, and materials handlers (HR = 1.5); and precision production occupations (HR = 1.4).

CONCLUSION

Although tobacco use continues to be the single most important risk factor for lung cancer mortality, occupational exposure to lung carcinogens should be targeted as well to further reduce the burden of lung cancer.

The impact of psychosocial and organizational working conditions on the mental health of female cleaning personnel in Norway

BACKGROUND

This study examined the association between psychosocial and organizational work conditions and mental health among women employed in the cleaning profession in Norway.

METHODS

Self-report questionnaires were mailed to 661 cleaning staff personnel from seven cleaning organizations in seven different cities across Norway. The response rate was 64%, of which 374 (88%) respondents were women. The questionnaires assessed socio-demographic information and employment history, work organization, and psychosocial working conditions. The Hopkins Symptoms Checklist (HSCL-25) was included to assess mental health.

RESULTS

On average, respondents were 43 years old and reported 10.8 years of experience working in the cleaning industry. The proportion of women scoring a HSCL-25 equal to or above 1.75 was 17.5%, which was higher than the average prevalence of mental health problems among working Norwegian women (8.4%). A factor analysis of the questions specific to the psychosocial work environment identified the following four underlying dimensions: leadership, co-workers, time pressure/control, and information/knowledge. Two of these, poor satisfaction with leadership (OR = 3.6) and poor satisfaction with co-workers (OR = 2.3), were significantly related to mental health. In addition, having contact with colleagues less than once a day (OR = 2.4) and not being ethnically Norwegian (OR = 3.0) increased the risk for mental health problems.

CONCLUSION

Mental health problems are frequent among female cleaning professionals in Norway. Our results indicate that quality of leadership, collaboration with co-workers, and ethnicity were significantly associated with mental health.

The impact of psychosocial and organizational working conditions on the mental health of female cleaning personnel in Norway

Background

This study examined the association between psychosocial and organizational work conditions and mental health among women employed in the cleaning profession in Norway.

Methods

Self-report questionnaires were mailed to 661 cleaning staff personnel from seven cleaning organizations in seven different cities across Norway. The response rate was 64%, of which 374 (88%) respondents were women. The questionnaires assessed socio-demographic information and employment history, work organization, and psychosocial working conditions. The Hopkins Symptoms Checklist (HSCL-25) was included to assess mental health.

Results

On average, respondents were 43 years old and reported 10.8 years of experience working in the cleaning industry. The proportion of women scoring a HSCL-25 equal to or above 1.75 was 17.5%, which was higher than the average prevalence of mental health problems among working Norwegian women (8.4%). A factor analysis of the questions specific to the psychosocial work environment identified the following four underlying dimensions: leadership, co-workers, time pressure/control, and information/knowledge. Two of these, poor satisfaction with leadership (OR = 3.6) and poor satisfaction with co-workers (OR = 2.3), were significantly related to mental health. In addition, having contact with colleagues less than once a day (OR = 2.4) and not being ethnically Norwegian (OR = 3.0) increased the risk for mental health problems.

Conclusion

Mental health problems are frequent among female cleaning professionals in Norway. Our results indicate that quality of leadership, collaboration with co-workers, and ethnicity were significantly associated with mental health.

An international comparison of women's occupational health issues in the Philippines, Thailand, Malaysia, Canada, Hong Kong and Singapore: the CIDA-SEAGEP study

BACKGROUND

An international comparison study of women's occupational health issues was carried out in 2000 for the Philippines, Thailand, Malaysia, Canada, Hong Kong and Singapore. The study was funded by the Canadian International Development Agency's Southeast Asia Gender Equity Program.

AIM

The objective was to compare the issues, risk factors, social determinants, and challenges in women's occupational health, according to the status of economic development as defined by the World Bank.

METHOD

Data were collected through 27 key informant interviews of high-ranking government officials and senior researchers, self-administered questionnaires on country or regional statistics and 16 courtesy calls.

RESULTS

Results indicated that women's occupational health problems common in these countries or regions included women's long hours of work (double workday), shift work and a caring role for family and friends. Problems reported in developing countries but not developed countries included poor access to training and protective equipment, and insufficient legislation to protect women's rights. Problems reported in developed countries but not in developing countries included obesity, smoking and not including women in health research.

CONCLUSION

This paper provides insights into the changing environment in the workplace, such as increasing participation of women in the paid workforce and changes in gender differences due to the changing country economy, for improving women's occupational health.

Women and occupational lung disease: sex differences and gender influences on research and disease outcomes

We have attempted to describe the current state of knowledge regarding occupational lung disease in women. A large section of this article was devoted to describing the methodologic challenges that face researchers when evaluating gender differences in occupational lung disease. The findings of the presented studies are likely limited by many of the methodologic problems that were identified earlier. To accurately identify the true risk of occupational lung disease in women workers, these findings must be replicated in future studies with special attention paid to the various aspects of occupational lung disease research that are susceptible to gender-related bias.

Cancer incidence in the workers cohort of textile manufacturing factory in Alytus, Lithuania

Altogether 14,650 workers employed at least for 1 year a the textile factory in Alytus, Lithuania, were included in the cohort and followed during the period from 1978 to 1997. The standardized incidence ratio (SIR) for men was 1.28. The incidence of esophagus cancer was significant higher (SIR 3.42). It increased only slightly for lung (SIR 1.35). In the women cohort, SIR was 1.05. However, there was a significant increase of the incidence of gallbladder cancer (SIR 3.19). Among textile-processing (spinning and weaving departments) women workers, we found elevated total cancer incidence (SIR 1.35), incidence of breast cancer (SIR 1.49), and cervical cancer (SIR 1.82). In this cohort increased SIR values were observed for more than 10 years since first exposure for all cancer (SIR 1.70) and cervical cancer (SIR 2.44).

Occupational cancer among women: where have we been and where are we going?

Studies of occupational exposures have been a fruitful area of research for identifying carcinogens. Some of the early observations, such as increased risk of breast cancer among nuns and bone cancer among radium dial workers, were made among women. Recent research on cancer among women has shown increased risks of cancer in many industries and occupations. Estimates that 1% of cancer among women is attributable to occupation are based on research conducted mainly in the 1970s among men in developed countries. These studies do not reflect the dramatic changes in the participation of women in the workplace or the patterns of employment of women in developing countries. The proportion of women in the paid workforce, the amounts and types of unpaid labor, the distribution of women by economy sector, the scale of the workplaces, the allowable exposure levels in the workplace, and implementation of controls have changed over time and vary internationally. Occupational cancer researchers need to expand their focus on women, increase activities in developing countries, include newly created industries, use sophisticated exposure assessment methods, and, where appropriate, incorporate molecular epidemiologic techniques to discover new occupational carcinogens and to identify where better control measures are needed.

Occupations and breast cancer risk among Chinese women in urban Shanghai

BACKGROUND

Although, an elevated risk of breast cancer has been suggested for a number of occupations, many earlier studies were limited by selection biases, the incomplete assessment of job histories, and the inability to control for confounding.

METHODS

We examined the relationship between occupational history and breast cancer risk using data from a population-based case-control study of 1,458 cases and 1,556 age-matched controls (90% response rate) conducted in Shanghai, China. Unconditional logistic regression models were used to derive odds ratios (ORs) and 95% confidence intervals (95% CIs) of breast cancer risk associated with occupations and duration of employment adjusting for non-occupational risk factors.

RESULTS

The following occupations were found to be associated with an increased risk of breast cancer: laboratory technicians (OR 9.94, 95% CI 1.20-82.37), telephone and telegraph operators (OR 4.63, 95% CI 1.85-11.59), leather and fur processors (OR 3.25, 95% CI 1.11-9.53), and glass-manufacturing workers (OR 2.08, 95% CI 1.14-3.82). A dose-response pattern for years of employment was observed for leather and fur processors (P = 0.02) and glass-manufacturing workers (P = 0.01). Stratified analyses also revealed dose-response relationships between the risk of breast cancer and years of employment as inspector and product analysts among pre-menopausal women (P = 0.02), and as farmers among post-menopausal women (P = 0.04).

CONCLUSIONS

This study found that several occupations are associated with an increased risk of breast cancer among women. Studies examining various occupational exposures in these high-risk occupations are warranted to identify carcinogens that may play a role in the increased breast cancer risk.

Occupational risks for lung cancer among nonsmokers

We conducted a case-control study in 12 European study centers to evaluate the role of occupational risk factors among nonsmokers. We obtained detailed occupational histories from 650 nonsmoking cases (509 females/141 males) and 1,542 nonsmoking controls (1,011 females/531 males). On the basis of an a priori definition of occupations and industries that are known (list A) or suspected (list B) to be associated with lung carcinogenesis, we calculated odds ratios (ORs) for these occupations, using unconditional logistic regression models and adjusting for sex, age, and center effects. Among nonsmoking men, an excess relative risk was observed among those who had worked in list-A occupations [OR = 1.52; 95% confidence interval (C) = 0.78-2.97] but not in list-B occupations (OR = 1.05; 95%), CI = 0.60-1.83). Among nonsmoking women, there was an elevation of risk for list-A occupations (OR = 1.50; 95% CI = 0.49-4.53), although this estimate was imprecise, given that less than 1% of cases and controls were exposed. Exposure to list-B occupations was associated with an increase in relative risk (OR = 1.69; 95% CI = 1.09-2.63) in females, but not in males. Women who had been laundry workers or dry cleaners had an OR of 1.83 (95% CI = 0.98-3.40). Our findings confirm that certain occupational exposures are associated with an increased risk for lung cancer among both female and male nonsmokers; however, knowledge on occupational lung carcinogens is biased toward agents to which mainly men are exposed.

Lung cancer and exposure to man-made vitreous fibers: results from a pooled case-control study in Germany

BACKGROUND

To investigate the association between lung cancer and occupational exposure to man-made vitreous fibers (MMVF), a pooled analysis of two case-control studies was conducted in the years 1988-1994.

METHODS

The case series consisted of 3498 males who were histologically or cytologically verified primary lung cancer cases. 3541 male population controls were drawn at random from the general population and matched to cases by sex, age, and place of residence. To examine the relationship between MMVF and lung cancer we asked all study subjects who worked for at least 6 months as construction and installation workers whether they ever installed or removed insulations and what kind of insulation material they used.

RESULTS

Some 304 (8.7%) cases and 170 (4.8%) controls reported to have insulated with glass wool or mineral wool mats. Coded as ever/never exposed, the odds ratio was 1.48 (95% CI: 1.17-1.88), adjusted for smoking and asbestos. To be sure to exclude any confounding effect of asbestos, we tried to identify those cases and controls who insulated with glass wool or mineral wool mats only and never reported any asbestos exposure. For this group we calculated an odds ratio of 1.56 (95% CI: 0.92-2.65), after adjustment for smoking. An elevated risk was also estimated on the basis of an expert rating which was done for a subgroup of cases and controls. Ever exposure to MMVF (but not to asbestos) in this subgroup yielded an odds ratio of 1.30 (95% CI: 0.82-2.07).

CONCLUSIONS

Our study provides some indication for an excess risk of man-made vitreous fibers. This result also persists after adjustment for smoking and asbestos.