Retrospective Evaluation of Occupational Exposures in Cancer Epidemiology: A European Concerted Action of Research

Job exposure matrices for occupational respiratory disease: a narrative review

BACKGROUND

Job exposure matrices (JEMs) are epidemiological tools used to provide estimations of occupational exposures when it is not feasible to complete detailed individual occupational histories.

AIMS

To identify and summarize the characteristics of published general population JEMs (GPJEM) of inhalable occupational exposures applied in studies of respiratory disease.

METHODS

MEDLINE and EMBASE databases were searched using pre-defined search terms, with screening performed by two independent reviewers to identify studies reporting the use of a GPJEM. JEM creation papers were subsequently identified and reviewed for each individual GPJEM, noting its characteristics in terms of occupational classification system and exposure estimates.

RESULTS

From 728 studies identified in initial searches, 33 GPJEMs of inhalable occupational exposures were identified. Versions of the International Standards Classification of Occupations were the most used occupational classification system. Binary, probability and intensity-based exposure estimates were most frequently reported in GPJEMs.

CONCLUSIONS

Selection of a GPJEM to apply in epidemiological research should be based on the exposure(s) of interest, time period of occupations under review, geographical region for intended use, occupation classification system used and the exposure estimate outcome.

Cumulative exposure estimates for polychlorinated biphenyls using a job-exposure matrix

PCB exposure has been associated with increased risk for cancer, neurological disease, and for birth defects in children exposed in utero. Because of the long half-lives of PCB congeners, they remain a public health problem in the United States 30 years after being banned. Workers (n=3569) at an Indiana capacitor manufacturing plant were exposed to polychlorinated biphenyls (PCBs) from 1957 to 1977. The purpose of this work was to develop a period-specific job-exposure matrix (JEM) for a follow-up epidemiologic study investigating the increased risks for cancer previously observed in the cohort.

METHODS

We used eight exposure determinants to estimate PCB exposures systematically. Work history, job description, capacitor production factors, PCB usage trends, and air sample data were used to develop the JEM in four steps: (1) all job titles (n=884) were assessed for exposure determinants, (2) jobs with similar exposure determinants were grouped, (3) for each job exposure category, exposure intensity (high-medium-low-background) and frequency (continuous-intermittent) were qualitatively rated separately for inhalation and dermal exposure, and (4) for each job exposure category, the product of intensity (based on air sampling data) and frequency (fraction of day exposed) was calculated. The JEM was then modified for two eras of different PCB exposure conditions.

RESULTS

The resulting JEM consists of inhalation and dermal exposure values for 19 job exposure categories.

CONCLUSION

The JEM showed an exposure-response trend associated with increased brain cancer mortality in the epidemiologic study.

Assessment of occupational exposures in community-based case-control studies

Assessing occupational exposures in community-based studies is a challenge for investigators because there are no standardized or validated approaches for collecting information regarding occupational history. The strengths and limitations of the methods available for assessing occupational exposures are reviewed. In community-based case-control studies, the prevalence of most chemical agents is low. The common sources of misclassification in these studies are addressed, as are strategies for dealing with misclassification bias. Methods to assess the presence and magnitude of differential reporting by cases and controls are outlined, together with analytic strategies to improve the classification of occupational exposures.

Use of a job-exposure matrix to assess occupational exposures in relation to birth defects

Accurate exposure assessment remains a challenge in occupational epidemiology. We evaluated one approach, use of a job-exposure matrix (JEM), by applying the National Institute for Occupational Safety and Health (NIOSH) JEM to a large case-control birth defects study that included parental occupation information. We investigated the JEM exposure predictions in several ways and found that for a substantial proportion of the parents in the birth defects study, the JEM yielded either no exposure data or nonsense predictions. Among exposure predictions that were plausible, most were of low probability. The high probability exposure predictions were statistically unstable, and neither low nor high probability exposure predictions were reliable. There was considerable discrepancy between the JEM predictions and expert assessments for five exposures of interest. Application of the NIOSH JEM to the birth defects study database (and probably other databases as well) does not provide a useful means of assessing occupational exposures.

Carcinogen DNA and protein adducts as biomarkers of human exposure in environmental cancer epidemiology

Carcinogen DNA and protein adducts promise to provide a more objective measure of human exposure to environmental carcinogens than can be obtained by questionnaire data or environmental measurements. The adducts represent an integration of exposure, absorption, distribution, metabolism, DNA repair, and cell turnover, and thus provide a measure of biologically effective dose; the fact that DNA adducts are involved in the carcinogenic process means such a measure may be more relevant than exposure measures based on ambient levels of a given carcinogen. This approach has been successfully applied to situations where accurate questionnaire data on exposure are difficult to obtain (e.g., for the dietary carcinogens aflatoxins and heterocyclic amines, aromatic amine exposure via environmental tobacco smoke, etc.). Despite the promise of carcinogen DNA and protein adducts, there are a number of issues that must be addressed, including sensitivity, specificity, temporal relationship between exposure and disease, and their mechanistic role in the process of carcinogenesis. This information is a necessary prerequisite to the successful application of these biomarkers into appropriately designed epidemiological studies.