Exposure to cement dust, related occupational groups and laryngeal cancer risk: results of a population based case-control study

Our plain-English summary of Exposure to cement dust, related occupational groups and laryngeal cancer risk: results of a population based case-control study, by A. Dietz, H. Ramroth, T. Urban, et al (International Journal of Cancer, 2004).

The study

• Authors: A. Dietz, H. Ramroth, T. Urban, W. Ahrens, H. Becher
• Journal: International Journal of Cancer
• Published: 2004;108(6):907-11
• Cited by: 65 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A population-based case-control study was performed in the Rhein-Neckar region, Germany, to evaluate occupational risk factors for the development of laryngeal cancer ("Rhein-Neckar-Larynx Study"). Between May 1998 and December 2000, 257 patients (236 males, 21 females), aged 37-80, with histologically confirmed laryngeal cancer, as well as 769 population control persons (702 males, 67 females), were included (1:3 frequency matched by age and sex). History of occupational exposures, as well as other risk factors (tobacco, alcohol), was obtained with face-to-face interviews using a detailed standardized questionnaire. The complete individual work history was assessed. A detailed assessment of work conditions was obtained by job-specific questionnaires (JSQs) for selected jobs known to be associated with exposure to potential laryngeal carcinogens. Estimates for total exposure hours by substance were calculated based on JSQs. Published occupational hygiene data were used to infer semiquantitative scores of exposure intensity for specific job tasks. After adjustment for tobacco and alcohol intake, a significant elevated odds ratios (OR) could be demonstrated for persons that were exposed to cement during their work as building and construction workers. An OR of 2.42 was calculated for workers of the high exposed subgroup (95% confidence interval: 1.14-5.15; p < 0.001). Smoking was the main confounding factor because the unadjusted cement OR of 3.20 dropped down to 2.42 after adjustment for tobacco intake. We conclude that there is good evidence for cement dust exposure acting as a tobacco, alcohol and asbestos independent risk factor for laryngeal carcinoma. Our study gives a base for further toxicologic investigations on this topic.

Copyright 2003 Wiley-Liss, Inc.

In plain English

This population-based case-control study in the Rhein-Neckar-Odenwald region of southwest Germany compared 257 laryngeal cancer patients (236 men, 21 women), recruited between May 1998 and December 2000, with 769 population controls. Ever working in building or construction was linked to an odds ratio of 2.2 (95% CI 1.55–3.14) after adjusting for tobacco and alcohol. Job-specific questionnaires found cement dust exposure in 14.8% of male cases and 5.1% of male controls. Adjusted for tobacco, alcohol and socioeconomic status, the odds ratio was 2.04 (95% CI 1.16–3.56). Smoking was the main confounding factor. After socioeconomic adjustment, no dose-response was seen: the highest exposure group (more than 3,000 lifetime working hours) had an odds ratio of 1.87 (95% CI 0.88–4.01). For asbestos, the odds ratio of 2.1 unadjusted fell to 1.3 (95% CI 0.8–2.1, not statistically significant) after tobacco and alcohol adjustment. The authors concluded that their cement dust measure, which merged slaked lime before about 1965 with Portland cement afterwards, showed an elevated laryngeal cancer risk independent of tobacco, alcohol, socioeconomic status and asbestos. They noted their dose-response data were limited.

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: Population-based case-control study (Rhein-Neckar-Larynx Study), with face-to-face interviews and a later telephone validation sub-study of cement exposure
• Who was studied: 257 cases of histologically confirmed squamous cell carcinoma of the larynx (236 men, 21 women) and 769 population controls (702 men, 67 women) drawn from population registries, frequency matched 1:3. Rhein-Neckar-Odenwald region, southwest Germany, May 1998 to December 2000.
• Exposure: Occupational cement dust, assessed by job-specific questionnaires and a list of hazardous substances. Exposure was rated as none, middle (up to 3,000 lifetime working hours) or high (more than 3,000 hours). Asbestos exposure (fiber types not named) was also assessed as a possible confounder, as was employment in building and construction.
• Main results:
  • Ever working as a building or construction worker: 103 (40.1%) cases and 163 (17.7%, as printed) controls. The odds ratio was 2.6 unadjusted and 2.2 (95% CI 1.55–3.14) adjusted for tobacco and alcohol.
  • Cement dust exposure by job-specific questionnaire: 14.8% of male cases and 5.1% of male controls. No female cases were exposed.
  • Ever exposed to cement (job-specific questionnaires): the odds ratio was 3.13 stratified for age and sex only, 2.39 adjusted for tobacco and alcohol, and 2.04 (95% CI 1.16–3.56, p 0.01) also adjusted for socioeconomic status.
  • Smoking was the main confounding factor: the unadjusted cement odds ratio of 3.2 fell to 2.4 after tobacco adjustment.
  • Middle cement exposure (up to 3,000 lifetime working hours; 16 male cases, 17 male controls): odds ratio 2.35 adjusted for tobacco and alcohol, and 2.22 (95% CI 1.02–4.84, p 0.04) with socioeconomic adjustment.
  • High cement exposure (more than 3,000 lifetime working hours; 19 male cases, 19 male controls): odds ratio 2.42 adjusted for tobacco and alcohol, and 1.87 (95% CI 0.88–4.01, p 0.11) with socioeconomic adjustment.
  • Dose-response effects disappeared after adjustment for socioeconomic factors.
  • Cement exposure assessed by the list of hazardous substances: odds ratio 1.18 (95% CI 0.77–1.81, p 0.45) after adjustment for tobacco, alcohol and socioeconomic status.
  • Asbestos: 75.0% of male cases and 85.2% of male controls reported no asbestos exposure.
  • The odds ratio for asbestos exposure was 2.1 unadjusted and 1.3 (95% CI 0.8–2.1, not significant) after adjustment for tobacco and alcohol.
  • Telephone validation re-interview, 2–4 years later, of 15 cases and 80 controls first recorded as cement exposed: all 15 cases confirmed exposure, against 69 of 80 controls (86.3%). The difference was not statistically significant.
• The authors' conclusion: The authors concluded that their cement dust exposure data showed a statistically significant elevated risk for laryngeal carcinoma, independent of tobacco, alcohol and socioeconomic status. That measure merged slaked lime before about 1965 with Portland cement afterwards. They added that this risk was also independent of asbestos and other described risk factors.
• Limitations the authors state:
  • The data on dose-response effects have limited validity.
  • The validation study was small.
  • In earlier decades, lime dust exposure was often lumped together with cement exposure.
  • The lime sub-analysis numbers were too small for definite conclusions.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Throat and laryngeal cancer.

Medical terms in this study, explained in our Lexicon: Laryngeal Cancer, Case-Control Study, Occupational Exposure, Work History, Odds Ratio, confidence interval, Confounding, Carcinoma.

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• Alcohol, smoking, and occupational factors in cancer of the larynx: a case-control study — W. Ahrens, K.H. Jöckel, et al. (1991)
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