Sensitivity of the association between increased lung cancer risk and bitumen fume exposure to the assumptions in the assessment of exposure

Assessing occupational styrene exposure in the European and US Glass Reinforced Plastics Industry for the period between 1947 and 2020

BACKGROUND

We aimed to develop a method for assessing occupational styrene exposures for application in epidemiological studies on risks of lymphohematopoietic neoplasms and other malignant and non-malignant diseases in the European and the US glass reinforced plastics industries.

METHOD

We estimated a linear mixed effects model based on individual airborne personal measurements of styrene from the glass reinforced plastics industry in Denmark, Norway, Sweden, UK, and the US. The most suitable model was chosen based on its predictive power as assessed using cross validation with different combinations of predictors; and by comparing their prediction errors.

RESULTS

We created a database containing 21,201 personal and area measurements but a subset of 14,440 personal measurements that spanned a period from 1962 to 2018, were used in the analysis. The selected model included fixed effects for year, sampling duration, measurement reason, product, process and random effects for country and worker. There was strong agreement between the model's predictions and actual exposure values indicating a good fit (Lin's CCC: 0.85 95% CI 0.84, 0.85). There were regional differences in exposure levels, with the UK and the US having comparable exposures that were higher than those in the Nordic countries. Higher exposures were consistent with measurements collected for inspection purposes, the lamination process, and specific products. Styrene exposure levels have decreased annually on average by 7%.

CONCLUSION

Our exposure model and the resulting exposure predictions will enable estimation of lifetime occupational exposure for individual workers in the European and the US glass reinforced plastics industry and possibly related health risks among employees. The approach facilitates understanding of the uncertainty in our prediction model and can inform analysis of the bias that application of our exposure assessment approach can produce in epidemiologic analyses of exposure-response associations. Addressing systematic sources of bias can increase confidence in the conclusions of the epidemiologic analysis.

Cancer Risk Associated With Exposure to Bitumen and Bitumen Fumes: An Updated Systematic Review and Meta-Analysis

OBJECTIVE

To evaluate whether cancer risks are increased among bitumen (asphalt) workers.

METHODS

Systematic review and meta-analysis of cancer risks (lung, upper aerodigestive tract (UADT), esophagus, bladder, kidney, stomach, and skin) and bitumen exposure. Certainty in the epidemiological evidence that bitumen-exposed workers experience increased cancer risks was rated using Grading of Recommendations Assessment, Development and Evaluation criteria.

RESULTS

After excluding lower-quality studies, lung cancer risks were not increased among bitumen-exposed workers (meta-relative risk [RR] 0.94, 95% CI 0.74 to 1.20, eight studies). Increased risks of UADT and stomach cancers were observed (meta-RR 1.31, 95% CI 1.03 to 1.67, 10 studies and meta-RR 1.29, 95% CI 1.03 to 1.62, seven studies, respectively).

CONCLUSIONS

Except for lung cancer, evidence for increased cancer risks among bitumen-exposed workers was judged to be of low certainty, due to inadequate exposure characterization and unmeasured confounders (coal tar exposure, smoking, and alcohol consumption).

Job-exposure matrix for historical exposures to rubber dust, rubber fumes and n-Nitrosamines in the British rubber industry

OBJECTIVES

To develop a quantitative historical job-exposure matrix (JEM) for rubber dust, rubber fumes and n-Nitrosamines in the British rubber industry for 1915-2002 to estimate lifetime cumulative exposure (LCE) for a cohort of workers with 49 years follow-up.

METHODS

Data from the EU-EXASRUB database-rubber dust (n=4157), rubber fumes (n=3803) and n-Nitrosamines (n=10 115) collected between 1977 and 2002-were modelled using linear mixed-effects models. Sample year, stationary/personal measurement, industry sector and measurement source were included as fixed explanatory variables and factory as random intercept. Model estimates and extrapolations were used to construct a JEM covering all departments in both sectors of the rubber manufacturing industries for the years 1915-2002. JEM-estimates were linked to all cohort members to calculate LCE. Sensitivity analyses related to assumptions about extrapolation of time trends were also conducted.

RESULTS

Changes in rubber dust exposures ranged from -6.3 %/year (crude materials/mixing) to -1.0 %/year (curing) and -6.5 %/year (crude materials/mixing) to +0.5 %/year (finishing, assembly and miscellaneous) for rubber fumes. Declines in n-Nitrosamines ranged from -17.9 %/year (curing) to -1.3 %/year (crude materials and mixing). Mean LCEs were 61 mg/m3-years (rubber dust), 15.6 mg/ m3-years (rubber fumes), 2483.2 µg/m3-years (n-Nitrosamines sum score), 18.6 µg/m3-years (N-nitrosodimethylamine) and 15.0 µg/m3-years (N-itrosomorpholine).

CONCLUSIONS

All exposures declined over time. Greatest declines in rubber dust and fumes were found in crude materials and mixing and for n-Nitrosamines in curing/vulcanising and preprocessing. This JEM and estimated LCEs will allow for evaluation of exposure-specific excess cancer risks in the British rubber industry.

A case-control study of lung cancer nested in a cohort of European asphalt workers

BACKGROUND

We conducted a nested case-control study in a cohort of European asphalt workers in which an increase in lung cancer risk has been reported among workers exposed to airborne bitumen fume, although potential bias and confounding were not fully addressed.

OBJECTIVE

We investigated the contribution of exposure to bitumen, other occupational agents, and tobacco smoking to the risk of lung cancer among asphalt workers.

METHODS

Cases were cohort members in Denmark, Finland, France, Germany, the Netherlands, Norway, and Israel who had died of lung cancer between 1980 and the end of follow-up (2002-2005). Controls were individually matched in a 3:1 ratio to cases on year of birth and country. We derived exposure estimates for bitumen fume and condensate, organic vapor, and polycyclic aromatic hydrocarbons, as well as for asbestos, crystalline silica, diesel motor exhaust, and coal tar. Odds ratios (ORs) were calculated for ever-exposure, duration, average exposure, and cumulative exposure after adjusting for tobacco smoking and exposure to coal tar.

RESULTS

A total of 433 cases and 1,253 controls were included in the analysis. The OR was 1.12 [95% confidence interval (CI), 0.84-1.49] for inhalation exposure to bitumen fume and 1.17 (95% CI, 0.88-1.56) for dermal exposure to bitumen condensate. No significant trend was observed between lung cancer risk and duration, average exposure, or cumulative exposure to bitumen fume or condensate.

CONCLUSIONS

We found no consistent evidence of an association between indicators of either inhalation or dermal exposure to bitumen and lung cancer risk. A sizable proportion of the excess mortality from lung cancer relative to the general population observed in the earlier cohort phase is likely attributable to high tobacco consumption and possibly to coal tar exposure, whereas other occupational agents do not appear to play an important role.