Cancer mortality among women in the Russian printing industry

Our plain-English summary of Cancer mortality among women in the Russian printing industry, by M.A. Bulbulyan, S.A. Ilychova, S.H. Zahm, et al (American Journal of Industrial Medicine, 1999).

The study

• Authors: M.A. Bulbulyan, S.A. Ilychova, S.H. Zahm, S.V. Astashevsky, D.G. Zaridze
• Journal: American Journal of Industrial Medicine
• Published: 1999;36(1):166-71
• Cited by: 38 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: This study evaluates cancer mortality among women employed in two large printing plants in Moscow.

Methods: A total of 3,473 women who were actively employed as of December 31, 1978, with a minimum of 2 years employment were followed from 1 January 1979 to 31 December 1993. There were 47,791 person-years observed, with only 51 women lost to follow-up (1.5%). Standardized mortality ratios (SMRs) were calculated using the population of Moscow to generate expected numbers. Analyses by job (compositors, press operators, and bookbinders), age hired, latency, and duration of employment were conducted.

Results: Among women employed in the two printing plants, there was a significant excess of esophageal cancer, based on seven deaths (expected = 2.7, SMR = 2.7, 95% CI = 1.1-5.4). Four of the seven esophageal cancer deaths occurred among bookbinders (expected = 1.0, SMR = 4.1, 95% CI = 1.1-10.4), all among workers hired before 1957 (expected = 0.6, SMR = 7.1, 95% CI = 1.9-18.3), the last year benzene was used in bookbinding. Ovarian cancer was also significantly elevated among bookbinders (12 observed, 4.2 expected, SMR = 2.9, 95% CI = 1.5-5.0), which, along with one death from mesothelioma of the abdomen, might be related to the use of asbestos-contaminated talc fillers in paper. Press operators had significantly elevated mortality from stomach cancer (observed = 9, expected = 4.1, SMR = 2.2, 95% CI = 1.0-4.2) and, based on two deaths each, melanoma and bladder cancer.

Conclusions: Women in this printing industry cohort experienced excess mortality of cancer of the esophagus and stomach, with suggested increases of melanoma and bladder cancer. Further follow-up of this cohort, which would allow more in-depth analysis of rare cancer sites, latency, and duration of employment, is warranted. Gender comparisons within the cohort should also be conducted to clarify the role of occupational and lifestyle factors in the etiology of cancer among workers in the printing industry.

In plain English

This retrospective cohort study followed 3,473 women from 1979 through 1993. All had been working at the two largest printing plants in Moscow at the end of 1978 and had at least 2 years of employment. Their deaths were compared with the numbers expected from Moscow population death rates. Overall, the women had fewer deaths than expected (SMR 0.8). Esophageal cancer deaths were higher than expected (7 deaths versus 2.7 expected), and four of these were among bookbinders. Among bookbinders, ovarian cancer deaths were also higher than expected (12 versus 4.2 expected; SMR 2.9, 95% CI 1.5 to 5.0), with the higher figure among those employed 15 years or more. One woman in the cohort died of mesothelioma of the abdomen. Asbestos exposure was not measured. The authors wrote that workers probably were exposed because talc used as a paper filler was contaminated with asbestos, and they suggested this possible exposure may explain the ovarian cancer excess. Press operators had more stomach cancer deaths than expected. The authors noted that chance could not be ruled out, especially for findings based on small numbers, and that they lacked detailed exposure information.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective cohort mortality study comparing observed deaths with deaths expected from Moscow general-population rates (standardized mortality ratios, SMRs)
• Who was studied: 3,473 women employed at the two largest printing plants in Moscow (book and magazine production) as of December 31, 1978, each with at least 2 years of employment. They were followed from 1979 to 1993, for 47,791 person-years. Jobs were compositors (423), press operators (524), bookbinders (1,271) and other jobs such as proofreaders (1,255).
• Exposure: Printing-industry work by job. Compositors were exposed to lead dust and fumes. Press operators were exposed to ink mists, paper dust and solvents. Bookbinders were exposed to solvents (including benzene until 1958), adhesives and paper dust. Asbestos exposure was not measured. The authors assumed probable exposure because talc used as a paper filler was contaminated with asbestos. No asbestos fiber type is named.
• Main results:
  • All women in the cohort: 573 deaths observed versus 703.3 expected, SMR 0.8 (95% CI 0.8 to 0.9).
  • All women in the cohort: significant excess of esophageal cancer, 7 deaths versus 2.7 expected, SMR 2.7 (95% CI 1.1 to 5.4).
  • Bookbinders: 4 of the 7 esophageal cancer deaths, versus 1.0 expected, SMR 4.1 (95% CI 1.1 to 10.4). All 4 were among bookbinders hired before 1958, SMR 7.1 (95% CI 1.9 to 18.3).
  • Bookbinders: ovarian cancer significantly elevated, 12 deaths observed versus 4.2 expected, SMR 2.9 (95% CI 1.5 to 5.0).
  • Bookbinders, ovarian cancer by hire date: those hired after 1957 had 5 deaths versus 1.2 expected, SMR 4.8 (95% CI 1.5 to 11.1). Those hired before 1958 had 7 deaths versus 3.7 expected, SMR 1.9 (95% CI 0.8 to 3.9).
  • Bookbinders, ovarian cancer by length of employment: women employed 15 or more years had 7 deaths versus 2.0 expected, SMR 3.5 (95% CI 1.4 to 7.1). Women employed 2 to 14 years had 5 deaths versus 2.7 expected, SMR 1.9 (95% CI 0.6 to 4.3).
  • All printing plant employees combined (Table III): ovarian cancer 13 deaths observed versus 11.3 expected, SMR 1.2 (95% CI 0.6 to 2.0).
  • One death from mesothelioma of the abdomen occurred in the cohort. The woman had worked at the printing plant from age 18 until her death.
  • The authors' interpretation: the ovarian cancer excess may have been due to possible asbestos exposure among printing plant employees.
  • Press operators: significantly elevated stomach cancer mortality, 9 deaths versus 4.1 expected, SMR 2.2 (95% CI 1.0 to 4.2). Press operators also had excesses of melanoma and bladder cancer, based on two deaths each.
• The authors' conclusion: The authors concluded that women in this printing industry cohort had excess mortality from cancer of the esophagus and stomach, with suggested increases in melanoma and bladder cancer. They called for further follow-up of the cohort.
• Limitations the authors state:
  • The study relied on mortality data rather than cancer incidence.
  • Moscow comparison death rates were missing for several cancer sites for many of the study years. For liver, pancreas, melanoma, ovary, bladder, kidney, brain and leukemia, only 1992 rates were available.
  • Detailed exposure information was lacking.
  • Chance cannot be ruled out, particularly for findings based on small numbers.
  • It is not known whether the cohort's alcohol and tobacco use differed from that of the Moscow general population.

Topics

Medical terms in this study, explained in our Lexicon: standardized mortality ratio (SMR), Latency, Esophageal Cancer, Ovarian Cancer, Mesothelioma, Talc, Stomach Cancer, Etiology.

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