Cancer Causes & Control

Our medical research library holds 30 studies published in Cancer Causes & Control (1997–2023). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 30 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: Kluwer Academic Publishers
• Published: 1990 to the present, Netherlands
• Language: English
• ISSN: 0957-5243 (print), 1573-7225 (electronic)
• Its record in the NLM Catalog

2020s

• Do patterns of past asbestos use and production reflect current geographic variations of cancer risk?: mesothelioma in Ontario and British Columbia, Canada. C.E. Slavik, P.A. Demers, L. Tamburic, et al. 2023;34(4):349-360. PubMed · Publisher · Free full text

  Abstract

  Purpose: Canada was a major global asbestos producer and consumer. Geographic patterns of Canadian asbestos use and mesothelioma, a highly fatal cancer linked to asbestos exposure, have not been previously reported. This study summarized key trends in mesothelioma incidence by geography and time in two Canadian provinces, Ontario and British Columbia (BC), and explored how past workforce characteristics and geographic trends in asbestos production and use may shape variations in regional rates of mesothelioma.

  Methods: We report trends in mesothelioma incidence (1993-2016) for Ontario and British Columbia using population-based incidence data that were age-standardized to the 2011 Canadian population. Historical records of asbestos production and use were analyzed to geo-locate industrial point sources of asbestos in Ontario and BC. The prevalence of occupations in regions with the highest and lowest rates of mesothelioma in Ontario and BC were calculated using labor force statistics from the 1981 Canadian Census.

  Results: Regional mesothelioma rates varied in both provinces over time; more census divisions in both Ontario and BC registered mesothelioma rates in the highest quintile of incidences during the period 2009 to 2016 than in any prior period examined. Certain occupations such as construction trades workers were more likely to be overrepresented in regions with high mesothelioma rates.

  Conclusion: This work explored how studying asbestos exposure and mesothelioma incidence at small-scale geographies could direct cancer surveillance and research to more targeted areas. Findings indicated that regional variations in mesothelioma could signal important differences in past occupational and potentially environmental exposures.

  © 2023. Crown.

• Differences in cancer survival by remoteness of residence: an analysis of data from a population-based cancer registry. N. Afshar, D.R. English, J.A. Chamberlain, et al. 2020;31(7):617-629. PubMed · Publisher

  Abstract

  Purpose: Cancer survival is generally lower for rural compared with urban residents, but findings have been inconsistent. We aimed to assess inequalities in cancer survival by remoteness of residence in Victoria, Australia.

  Methods: Incident cancer cases diagnosed in 2001-2015 with 30 cancer types (n = 331,302) were identified through the Victorian Cancer Registry and followed to the end of 2015 through death registries. Five-year net survival was estimated using the Pohar-Perme method and differences assessed by excess mortality rate ratios (EMRRs) using Poisson regression, adjusting for sex, age and year of diagnosis. EMRRs adjusted for socio-economic disadvantage were also estimated.

  Results: People living outside major cities had lower survival for 11 cancers: esophagus, stomach, colorectum, liver, gallbladder/biliary tract, pancreas, lung, connective/soft tissue, ovary, prostate, kidney. No differences in survival were found for cancers of uterus, small intestine and mesothelioma. After adjusting for socio-economic disadvantage, the observed differences in survival decreased for most cancers and disappeared for colorectal cancer, but they remained largely unchanged for cancers of esophagus, stomach, liver, pancreas, lung, connective/soft tissue, ovary and kidney.

  Conclusion: People with cancer residing outside major cities had lower survival from some cancers, which is partly due to the greater socio-economic disadvantage of rural residents.

2010s

• Differences in cancer survival by sex: a population-based study using cancer registry data. N. Afshar, D.R. English, V. Thursfield, et al. 2018;29(11):1059-1069. PubMed · Publisher

  Abstract

  Purpose: Few large-scale studies have investigated sex differences in cancer survival and little is known about their temporal and age-related patterns.

  Methods: We used cancer registry data for first primary cancers diagnosed between 1982 and 2015 in Victoria, Australia. Cases were followed until the end of 2015 through linkage to death registries. Differences in survival were assessed for 25 cancers using the Pohar-Perme estimator of net survival and the excess mortality rate ratio (EMRR) adjusting for age and year of diagnosis.

  Results: Five-year net survival for all cancers combined was lower for men (47.1%; 95% CI 46.9-47.4) than women (52.0%; 95% CI 51.7-52.3); EMRR 1.13 (95% CI 1.12-1.14; p < 0.001). A survival disadvantage for men was observed for 11 cancers: head and neck, esophagus, colorectum, pancreas, lung, bone, melanoma, mesothelioma, kidney, thyroid, and non-Hodgkin lymphoma. In contrast, women had lower survival from cancers of the bladder, renal pelvis, and ureter. For the majority of cancers with survival differences, the EMRR decreased with increasing age at diagnosis; for colorectal, esophageal, and kidney cancer, the EMRR increased with time since diagnosis.

  Conclusion: Identifying the underlying reasons behind sex differences in cancer survival is necessary to address inequalities, which may improve outcomes for men and women.

• Incidence of malignant mesothelioma in Germany 2009-2013. M. Lehnert, K. Kraywinkel, E. Heinze, et al. 2017;28(2):97-105. PubMed · Publisher

  Abstract

  Purpose: The malignant mesothelioma is a rare malignancy and mainly caused by occupational exposure to asbestos. German cancer registries are providing a national database to investigate temporal and regional patterns of mesothelioma incidence. These may be of interest for healthcare planning and for surveillance programs aiming at the formerly exposed workforce.

  Methods: We analyzed population-based incidence data of malignant mesothelioma by site, type, sex, age, as well as district and state of patient's residence. Age-standardized incidence rates (AIRs40+) were calculated according to the European standard population truncated to the age of 40 years and older. We present rates at national, state, and district level and trends of incidence of northern states of Germany.

  Results: In total, 7,547 malignant mesotheliomas were reported to German cancer registries diagnosed between 2009 and 2013-90% located to the pleura. On average, 1,198 men and 312 women were affected each year. We estimated AIR40+ of 4.77 in 100,000 German men and 0.98 in 100,000 German women. Regional clusters were predominantly located to the seaports of West Germany. The highest regional AIR40+ was 20 per 100,000 men. Corresponding rates in northeast Germany were between 2 and 4 per 100,000 men.

  Conclusion: Regional clusters of high incidence indicate districts with former shipyards and steel industry, but predominantly in the western part of Germany. The West-to-East difference corresponds to patterns of mortality. Twenty years after banning asbestos in Germany, Bremen and Hamburg are presenting the highest mesothelioma incidence but show steadily decreasing trends.

• Therapeutic radiation for lymphoma and risk of second primary malignant mesothelioma. E.T. Chang, E.C. Lau, F.S. Mowat, et al. 2017;28(9):971-979. PubMed · Publisher

  Abstract

  Purpose: This large, population-based U.S. study of lymphoma patients followed for up to four decades enables detailed analysis of second primary mesothelioma risk after radiotherapy.

  Methods: U.S. Surveillance, Epidemiology, and End Results data were used to identify second primary mesothelioma among patients diagnosed with Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL) between 1973 and 2014. Standardized incidence ratios (SIRs) were calculated by radiotherapy. Multivariate adjusted associations were examined using competing risks survival analysis.

  Results: Among 47,219 HL patients (19,538 irradiated) and 252,090 NHL patients (52,454 irradiated), second primary mesothelioma developed among 28 lymphoma patients who received radiotherapy and 59 who did not. Mesothelioma risk was increased among HL and NHL patients treated with radiotherapy [SIR = 1.78, 95% confidence interval (CI) 1.18-2.58], but not without radiotherapy. After multivariate adjustment, radiotherapy was associated with increased mesothelioma risk (relative risk = 1.64, 95% CI 1.05-2.57), especially in lymphoma patients diagnosed before 1995 and after a latency of at least 10 years, and apparently with younger age at diagnosis.

  Conclusions: The increase in second primary mesothelioma risk following radiotherapy for lymphoma is independent of several patient and disease characteristics, and is higher with earlier treatment era and longer latency.

• Geographic distribution of incidence of pericardial and paratesticular mesotheliomas in the USA. S.J. Lowry, N.S. Weiss. 2016;27(12):1487-1489. PubMed · Publisher

  Abstract

  Purpose: Exposure to asbestos is thought to cause the large majority of pleural mesotheliomas in the USA. It is unknown whether asbestos exposure plays a role in the etiology of rarer forms of mesothelioma, e.g., those located in the pericardium or in the tunica vaginalis of the testis. In order to address this question, we sought to determine whether geographic patterns of incidence of these mesotheliomas have paralleled those of pleural mesotheliomas.

  Methods: We used age-adjusted incidence data from the nine populations served by the National Cancer Institute's Surveillance, Epidemiology, and End Results program during 1973-2011. Among men ages ≥50 years, we compared the incidence of pericardial and paratesticular mesotheliomas, respectively, with the incidence of pleural mesothelioma across the nine populations.

  Results: The rate of pleural mesothelioma was approximately twice as high in the San Francisco-Oakland (SFO) and Seattle-Puget Sound (SPS) areas compared to the other regions. In contrast, rates of paratesticular and pericardial mesotheliomas were not elevated in SFO (n = 3 paratesticular, 1 pericardial) or SPS (n = 4 paratesticular, 1 pericardial) relative to other regions.

  Conclusions: The results of this ecologic study do not support a role for asbestos exposure in the etiologies of either pericardial or paratesticular mesotheliomas; however, this study was limited by small numbers and was unable to directly ascertain asbestos exposure.

• Exposure to environmental chemicals and heavy metals, and risk of pancreatic cancer. S.O. Antwi, E.C. Eckert, C.V. Sabaque, et al. 2015;26(11):1583-91. PubMed · Publisher · Free full text

  Abstract

  Purpose: Exposure to various chemicals and heavy metals has been associated with risk of different cancers; however, data on whether such exposures may increase the risk of pancreatic cancer (PC) are very limited and inconclusive. We examined PC risk with self-reported exposures to chemicals and heavy metals.

  Methods: The design was a clinic-based, case-control study of data collected from 2000 to 2014 at Mayo Clinic in Rochester, Minnesota, USA. Cases were rapidly ascertained patients diagnosed with pancreatic ductal adenocarcinoma (n = 2,092). Controls were cancer-free patients in primary care clinics (n = 2,353), frequency-matched to cases on age, race, sex, and state/region of residence. Cases and controls completed identical risk factor questionnaires, which included yes/no questions about regular exposure to pesticides, asbestos, benzene, chlorinated hydrocarbons, chromium, and nickel. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) comparing those who affirmed exposure to each of the chemicals/heavy metals to those who reported no regular exposure, adjusting for potential confounders.

  Results: Self-reported regular exposure to pesticides was associated with increased odds of PC (OR 1.21, 95% CI 1.02-1.44). Regular exposure to asbestos (OR 1.54, 95% CI 1.23-1.92), benzene (OR 1.70, 95% CI 1.23-2.35), and chlorinated hydrocarbons (OR 1.63, 95% CI 1.32-2.02) also was associated with higher odds of PC. Chromium and nickel exposures were not significantly associated with PC.

  Conclusions: These findings add to the limited data suggesting that exposure to pesticides, asbestos, benzene, and chlorinated hydrocarbons may increase PC risk. They further support the importance of implementing strategies that reduce exposure to these substances.

• Parental occupational exposure and risk of childhood central nervous system tumors: a pooled analysis of case-control studies from Germany, France, and the UK. C. Huoi, A. Olsson, T. Lightfoot, et al. 2014;25(12):1603-13. PubMed · Publisher

  Abstract

  Purpose: To assess the risk of childhood central nervous system (CNS) tumors associated with parental occupational exposure to polycyclic aromatic hydrocarbons (PAH), diesel motor exhaust (DME), asbestos, crystalline silica, and metals, which are established carcinogens in adults.

  Methods: We pooled data from three population-based case-control studies from Germany, France, and the UK. Cases were children aged up to 15 years and diagnosed with CNS tumor, and controls were frequency-matched by age and sex. Socio-demographic data and parental occupation around conception/pregnancy and at diagnosis were collected using standardized interviews, face-to-face or by telephone. A general population job-exposure matrix was used to assign a level of exposure to each job. Logistic regression models were fitted to compute odds ratios and 95 % confidence intervals.

  Results: Our study included 1,361 cases of CNS tumors and 5,500 controls. Paternal exposure to PAH, asbestos, and metals around conception was associated with an increased moderate risk of CNS tumors, although statistically non-significant. The association with exposure to asbestos around conception and diagnosis was stronger when fathers were exposed to high levels. Paternal exposure to DME and silica, and maternal exposure to PAH, DME, asbestos, silica, and metals, were not associated with an increased risk of CNS tumors.

  Conclusion: Our large pooled study showed weak evidence of a modest association between paternal occupational exposure to PAH and CNS tumor risk. Our findings need further exploration in the future studies.

• Regional variations in German mesothelioma mortality rates: 2000–2010. S.J. Schonfeld, V. McCormack, M.J. Rutherford, et al. 2014;25(5):615-24. PubMed · Publisher

  Abstract

  Purpose: Germany has one of the highest age-adjusted mesothelioma mortality rates worldwide. As mesothelioma occurs ≥ 30 years after asbestos exposure, contemporary rates likely reflect exposures in the 1960-1970s. During this period, political division between West and East Germany led to differences regarding the import and consumption of asbestos. It is unclear whether mesothelioma rates also differ between these formerly separate countries which are now served by similar health and mortality reporting systems, thereby facilitating regional comparisons.

  Methods: We examined regional, temporal, and sex variations in mesothelioma mortality rates in Germany in 2000-2010, collapsing the federal states into West Germany, East Germany, and Berlin. We calculated truncated (≥ 40 years) age-standardized mesothelioma mortality rates (ASRs(40+)) per 100,000 person-years, estimated sex-stratified mortality rate ratios (MRRs) (95 % confidence intervals (CIs)), adjusted for age and calendar year from Poisson models, and fitted age-period-cohort models.

  Results: There were 12,854 mesothelioma deaths at ages ≥ 40 years in Germany during 2000-2010. ASRs(40+) were higher in West (males 4.4; females 0.8) than East (males 1.7; females 0.6) Germany. MRRs for West versus East Germany were 2.68 (95 % CI 2.48-2.88) among males and 1.42 (95 % CI 1.27-1.59) among females. In both regions, mortality rates increased for birth cohorts until the mid 1940s and subsequently declined. The country's peak mesothelioma burden is predicted to occur by 2020.

  Conclusions: Geographical differences in mesothelioma mortality rates are consistent with heterogeneous historical asbestos exposures. Differences may exist for other asbestos-related cancers and should be investigated in analytic studies with individual asbestos exposure information.

• Asbestos: a hidden player behind the cholangiocarcinoma increase? Findings from a case-control analysis. G. Brandi, S. Di Girolamo, A. Farioli, et al. 2013;24(5):911-8. PubMed · Publisher · Free full text

  Abstract

  Purposes: We conducted a case-control analysis to explore the association between occupational exposure to asbestos and cholangiocarcinoma (CC).

  Methods: The study was based on historical data from 155 consecutive patients with CC [69 intrahepatic CC (ICC) and 86 extrahepatic CC (ECC)] referred to Sant'Orsola-Malpighi University Hospital between 2006 and 2010. The cases were individually matched by calendar period of birth, sex, and region of residence to historical hospital and population controls. Occupational exposure to asbestos was retrospectively assessed considering job titles obtained from work histories. Separate conditional logistic regression models were applied for ECC and ICC. Estimates were adjusted for smoking status and socioeconomic class.

  Results: We matched 149 controls (median birth year: 1947; males: 56 %) to 41 cases of ICC (median birth year: 1946; males: 56 %) and 212 controls (median birth year: 1945; males: 48 %) to 59 cases of ECC (median birth year: 1945; males 51 %); 53 cases were not matched due to residence or birth year. We found an increased risk of ICC in workers exposed to asbestos (adjusted OR 4.81, 95 % CI 1.73-13.33); we also observed suggestive evidence that asbestos exposure might be associated with ECC (adjusted OR 2.09, 95 % CI 0.83-5.27). Sensitivity analysis restricted to patients from the Province of Bologna produced confirmatory figures.

  Conclusions: Our findings suggest that ICC could be associated with asbestos exposure; a chronic inflammatory pathway is hypothesized. Exposure to asbestos could be one of the determinants of the progressive rise in the incidence of ICC during the last 30 years.

• Lung cancer risk at low cumulative asbestos exposure: meta-regression of the exposure-response relationship. S. van der Bij, H. Koffijberg, V. Lenters, et al. 2013;24(1):1-12. Meta-analysis · Review PubMed · Publisher

  Abstract

  Purpose: Existing estimated lung cancer risks per unit of asbestos exposure are mainly based on, and applicable to, high exposure levels. To assess the risk at low cumulative asbestos exposure, we provide new evidence by fitting flexible meta-regression models, a notably new and more robust method.

  Methods: Studies were selected if lung cancer risk per cumulative asbestos exposure in at least two exposure categories was reported. From these studies (n = 19), we extracted 104 risk estimates over a cumulative exposure range of 0.11-4,710 f-y/ml. We fitted linear and natural spline meta-regression models to these risk estimates. A natural spline allows risks to vary nonlinearly with exposure, such that estimates at low exposure are less affected by estimates in the upper exposure categories. Associated relative risks (RRs) were calculated for several low cumulative asbestos exposures.

  Results: A natural spline model fitted our data best. With this model, the relative lung cancer risk for cumulative exposure levels of 4 and 40 f-y/ml was estimated between 1.013 and 1.027, and 1.13 and 1.30, respectively. After stratification by fiber type, a non-significant three- to fourfold difference in RRs between chrysotile and amphibole fibers was found for exposures below 40 f-y/ml. Fiber-type-specific risk estimates were strongly influenced by a few studies.

  Conclusions: The natural spline regression model indicates that at lower asbestos exposure levels, the increase in RR of lung cancer due to asbestos exposure may be larger than expected from previous meta-analyses. Observed potency differences between different fiber types are lower than the generally held consensus. Low-exposed industrial or population-based cohorts with quantitative estimates of asbestos exposure a required to substantiate the risk estimates at low exposure levels from our new, flexible meta-regression.

• Risk of mesothelioma following external beam radiotherapy for prostate cancer: a cohort analysis of SEER database. A. Farioli, F.S. Violante, S. Mattioli, et al. 2013;24(8):1535-45. PubMed · Publisher · Free full text

  Abstract

  Purpose: To investigate the association between external beam radiotherapy (EBRT) for prostate cancer and mesothelioma using data from the US Surveillance, Epidemiology, and End Results (SEER) cancer registries.

  Methods: We analyzed data from the SEER database (1973-2009). We compared EBRT versus no radiotherapy. Incidence rate ratios (IRR) and 95 % confidence intervals (95 % CI) of mesothelioma among prostate cancer patients were estimated with multilevel Poisson models adjusted by race, age, and calendar year. Confounding by asbestos was investigated using relative risk of mesothelioma in each case's county of residence as a proxy for asbestos exposure.

  Results: Four hundred and seventy-one mesothelioma cases (93.6 % pleural) occurred in 3,985,991 person-years. The IRR of mesothelioma was increased for subjects exposed to EBRT (1.28; 95 % CI 1.05, 1.55) compared to non-irradiated patients, and a population attributable fraction of 0.49 % (95 % CI 0.11, 0.81) was estimated. The IRR increased with latency period: 0-4 years, IRR 1.08 (95 % CI 0.81, 1.44); 5-9 years, IRR 1.31 (95 % CI 0.93, 1.85); ≥10 years, IRR 1.59 (95 % CI 1.05, 2.42). Despite the fairly strong evidence of association with EBRT, the population attributable rate of mesothelioma was modest-3.3 cases per 100,000 person-years. The cumulative incidence of mesothelioma attributable to EBRT was 4.0/100,000 over 5 years, 24.5/100,000 over 10 years, and 65.0/100,000 over 15 years.

  Conclusions: Our study provides evidence that EBRT for prostate cancer is a small but detectable risk factor for mesothelioma. Patients should be advised of risk of radiation-induced second malignancies.

• Cohort study of workers employed in an Italian tire manufacturing plant, 1962-2004. D. Mirabelli, A.M. Cacciatore, D. Ferrante, et al. 2012;23(12):2023-9. PubMed · Publisher

  Abstract

  Purpose: To investigate mortality and bladder cancer incidence among workers of a tire manufacturing plant where antioxidants severely contaminated by beta-naphthylamine were never used.

  Methods: Mortality follow-up was performed of 9,501 workers first hired between 1962 when the plant started operations and 2000. Person-years of observation from 1962 to 2004, expected deaths, and standardized mortality ratios (SMR) were calculated. Follow-up for bladder cancer incidence from 1988 to 2003 was carried out, and standardized incidence ratios (SIR) were calculated. Multivariable (Poisson) analyses of bladder cancer incidence and mortality by duration of employment (DOE) and time since first employment (TSFE) were performed.

  Results: Among men, SMRs were significantly reduced for all causes, all cancers, lung cancer, cardiovascular, and ischemic heart diseases. Bladder cancer mortality and leukemia mortality were close to expectation but increased with TSFE. Seventy-two incident cases of bladder cancer were observed (SIR = 1.15; 95 % confidence interval 0.90-1.44), and multivariable analysis suggested a possible increase in rate ratios with DOE. Among women, mortality was close to expectation, but the limited number of observed deaths prevented detailed analyses.

  Conclusions: No significant cancer excess was observed. A suggestion of increased risks of bladder cancer and leukemias after extended TSFE was present in men, deserving consideration as exposure to carcinogens possibly occurred early in plant operation. Furthermore, this cohort of workers is still relatively young and less than 10 % have died. There was, thus, limited power to detect small increases in risk at rare cancer sites. Further epidemiological surveillance of this cohort is planned.

2000s

• Ionizing radiation: a risk factor for mesothelioma. J.E. Goodman, M.A. Nascarella, P.A. Valberg. 2009;20(8):1237-54. Review PubMed · Publisher

  Abstract

  In the majority of mesothelioma cases worldwide, asbestos is a likely causal factor, but several alternative factors, such as ionizing radiation, have been recognized. We reviewed ionizing-radiation evidence from epidemiology studies of (1) patients exposed to the diagnostic X-ray contrast medium "Thorotrast," (2) patients undergoing radiation therapy (i.e., to treat cancer), and (3) atomic energy workers chronically exposed to lower levels of radiation. The results from these populations are also supported by case reports of mesothelioma following therapeutic radiation. Statistically significant associations were found in many, but not all, epidemiology studies (particularly those of Thorotrast- and radiation-treated patients). Given the low mesothelioma rate in the general population, the consistently increased risk among these radiation-exposed individuals is noteworthy. Many studies were limited by the lack of a uniform manner in which mesothelioma was reported prior to introduction of a uniform classification system (ICD-10). Future studies that rely on ICD-10 should have greater power to detect an association. While the evidence falls short of a definitive causal link, considering studies in which statistical significance was achieved, the case reports, and the plausible mode of action, we conclude that the evidence is supportive of a causal link between ionizing radiation exposure and mesothelioma risk.

• Lung cancer in chrysotile asbestos workers: analyses based on the two-stage clonal expansion model. D.B. Richardson. 2009;20(6):917-23. PubMed · Publisher

  Abstract

  Objective: To evaluate the magnitude and temporal pattern of lung cancer risk following exposure to chrysotile asbestos.

  Methods: I analyzed data on lung cancer mortality in a cohort of asbestos textile workers who were exposed to almost pure chrysotile. Employment history and industrial hygiene data were used to derive asbestos exposure estimates. These data were analyzed within the framework of the two-stage clonal expansion (TSCE) model and the Cox proportional hazards model.

  Results: Under the TSCE model, the association between chrysotile asbestos and lung cancer mortality was primarily due to an exposure-induced increase in the proliferation of initiated cells. In a setting of protracted exposure to chrysotile asbestos, this model implies that the estimated hazard ratio was at its maximum between ages 40 and 65 years. Cox regression analyses support these conclusions; the estimated excess relative risk per fiber-year/ml was 0.053 (95% CI: 0.023, 0.124) at ages <65 years, while there was minimal evidence of association at older attained ages.

  Conclusions: The TSCE model fits these data well, accommodating the observed departure from the proportional hazards assumption. These analyses suggest that the effect of chrysotile asbestos exposure on lung cancer risk varies with attained age.

• Cancer of the gastrointestinal tract and exposure to asbestos in drinking water among lighthouse keepers (Norway). K. Kjaerheim, B. Ulvestad, J.I. Martinsen, et al. 2005;16(5):593-8. PubMed · Publisher

  Abstract

  Objective: Previous studies of predominantly ecological design have indicated a possible elevation of gastrointestinal cancer risk in population groups exposed to drinking water contaminated with asbestos from natural sources or asbestos-cement containing water pipes. In the present study the possible effect of ingested asbestos fibers on gastrointestinal cancer risk was investigated in an occupational group where a proportion of the employees was exposed to asbestos in their drinking water.

  Method: A cohort of 726 lighthouse keepers first employed between 1917 and 1967 were followed up for cancer incidence from 1960 to 2002. The standardized incidence ratio (SIR) was calculated as the number of new cancer cases divided by the expected number based on five-year age and sex specific incidence rates in the general rural population of Norway. A 95% confidence interval (CI) was calculated for all SIR values assuming a Poisson distribution of the cancer cases.

  Results: Risk of stomach cancer was elevated in the whole cohort (SIR: 1.6, CI: 1.0-2.3), in the subgroup with definite asbestos exposure (SIR: 2.5, CI: 0.9-5.5), and when the group was followed for 20 years and more after first possible exposure (SIR: 1.7, CI: 1.1-2.7). Less consistent results were found for colon cancer; SIR was 1.5 (CI: 0.9-2.2) overall, 0.8 (CI: 0.1-2.9) among the exposed, and 1.6 (CI: 1.0-2.5) twenty years and more after first possible exposure.

  Conclusion: The results support the hypothesis of an association between ingested asbestos and gastrointestinal cancer risk in general and stomach cancer risk specifically.

• Occupational class, occupational mobility and cancer incidence among middle-aged men and women: a prospective study of the French GAZEL cohort*. M. Melchior, M. Goldberg, N. Krieger, et al. 2005;16(5):515-24. PubMed · Publisher

  Abstract

  Objective: To examine the association between occupational class, occupational mobility and cancer incidence in the 1990s.

  Methods: Prospective study of 14,853 men and 5493 women employed by a large French company. Incident cases (any cancer, smoking and alcohol-related, breast) were ascertained through a validated company-based cancer registry (1990-2002). Hazard ratios (HRs) by occupational class and by career-long occupational mobility were calculated adjusting for age, marital status, tobacco and alcohol consumption, weight, diet, asbestos exposure, family history of cancer, and reproductive history.

  Results: 359 male cancers (107 smoking and alcohol-related) and 208 female cases (120 breast cancers) were observed. Male clerks and manual workers were at high risk, particularly of smoking and alcohol-related cancers (compared to managers, age-adjusted HRs: 2.95 95% CI 1.37-6.38 and 2.18 95% CI 1.15-4.11). Adjusting for specific health behaviors and other cancer risk factors reduced this gradient (fully-adjusted HRs respectively 1.95 95% CI 0.89-4.27 and 1.54 95% CI 0.80-2.97). The risk was also associated with occupational mobility. We found no association between women's occupational class and cancer.

  Conclusion: The incidence of smoking and alcohol-related cancers among French men shows a strong socioeconomic gradient. Policies addressing these social disparities are needed.

• Occupational exposures and risk of adenocarcinoma of the lung in Uruguay. E. De Stefani, P. Boffetta, P. Brennan, et al. 2005;16(7):851-6. PubMed · Publisher

  Abstract

  Objectives: To investigate occupational risks of lung adenocarcinoma in Uruguay and to confirm a previously reported increased risk among butchers.

  Methods: We conducted a case-control study among men in four major hospitals in Montevideo, based on interviews to 338 cases of lung adenocarcinoma and 1014 hospital-based controls. We calculated odds ratios (ORs) of lung adenocarcinoma for employment in 22 jobs, after adjustment for tobacco smoking and other potential confounders.

  Results: The OR was increased for employment as farmer, tractor driver, painter and medical worker, but no trend was suggested for duration of employment. Long-term employment as mason, glass worker or textile worker resulted in an increased OR. The OR for employment as butcher was 1.2 (95% confidence interval 0.7-2.1). The OR increased with increasing duration of self-reported exposure to formaldehyde.

  Conclusions: Occupational exposures seem to play a limited role in causing lung adenocarcinoma among men in Uruguay. Employment as butcher was not confirmed as an important risk factor.

• Occupational exposures and risk of esophageal and gastric cardia cancers among male Swedish construction workers. C. Jansson, A.L. Johansson, I.A. Bergdahl, et al. 2005;16(6):755-64. PubMed · Publisher

  Abstract

  Objective: The rising incidence and the strong male predominance among patients with esophageal and gastric cardia adenocarcinoma remain unexplained. We hypothesized that occupational airborne exposures in a traditional male dominated industry might contribute to these observations.

  Methods: A prospective, large cohort study of Swedish construction workers was linked to the Swedish population-based registers of Cancer, Causes of Death and Total Population. 260,052 men were followed from 1971 through 2000. Industrial hygienists assessed specific exposures for 200 job titles, and occupational airborne exposures were analyzed separately and combined. Incidence rate ratios (IRR), with 95% confidence intervals (CI), were estimated in multivariable Cox regression models adjusted for attained age, calendar period, smoking status and body mass.

  Results: We found positive associations between high exposure to asbestos (IRR 4.5 [95% CI 1.4-14.3]) and cement dust (IRR 3.8 [95% CI 1.5-9.6]) and risk of esophageal adenocarcinoma. Associations were seen between high exposure to asphalt fumes (IRR 2.3 [95% CI 1.0-5.3]) and wood dust (IRR 4.8 [95% CI 1.2-19.4]) and risk of cardia adenocarcinoma. No consistent associations regarding esophageal squamous-cell carcinoma were found.

  Conclusions: Exposure to asbestos and cement dust may be risk factors for esophageal adenocarcinoma, and exposure to asphalt fumes and wood dust may increase the risk of cardia adenocarcinoma. However, these associations cannot explain the major sex differences or the increasing incidence trends of these tumors.

• Prior lung disease and risk of lung cancer in a large prospective study. A.J. Littman, M.D. Thornquist, E. White, et al. 2004;15(8):819-27. PubMed · Publisher

  Abstract

  Objectives: While 75-90% of people who develop lung cancer are smokers, only a small proportion of smokers develop lung cancer. Identifying factors that increase a smoker's risk of developing lung cancer may help scientists to better understand the etiology of lung cancer and more effectively target high-risk groups for screening.

  Methods: Information on physician-diagnosed non-malignant lung diseases [asbestosis, asthma, chronic bronchitis or emphysema (CB/E), pneumonia, and tuberculosis] was obtained at baseline from 17,698 men and women involved in CARET, a randomized lung cancer prevention trial of beta-carotene and vitamin A among heavy smokers and asbestos-exposed workers. Hazard ratios for lung cancer were estimated through Cox regression models, after controlling for potential confounding factors, included smoking. Analyses were restricted to former and current smokers.

  Results: During a median follow up of 9.1 years, 1028 cases of lung cancer occurred. Those who developed lung cancer were more likely to report a history of CB/E than controls (adjusted HR = 1.29, 95% CI: 1.09-1.53). In subgroup analyses, the association between a history of CB/E and lung cancer was stronger for those who were younger at diagnosis/reference, men in the heavy smoker cohort, former smokers, and those with squamous cell carcinomas. There was little association between a history of other lung diseases and lung cancer.

  Conclusions: Smokers with a history of CB/E may be at higher risk of developing lung cancer, independent of their smoking history.

• Cancer incidence among marine engineers, a population-based study (Iceland). V. Rafnsson, P. Sulem. 2003;14(1):29-35. PubMed · Publisher

  Abstract

  Objectives: Marine engineers are in their occupation exposed to different chemicals, organic solvents, exhaust gases, oils, and petroleum products, and were formerly exposed to asbestos. The aim was to study the cancer pattern, with particular attention to lung and bladder cancer, in an Icelandic cohort of marine engineers, indirectly controlling for their smoking habits.

  Methods: A cohort of 6603 male marine engineers was followed up from 1955 to 1998, a total of 167,715 person-years. The cohort was record linked by the engineers' personal identification numbers to population-based registers containing the vital and emigration status and cancer diagnosis. Standardized incidence ratios (SIRs) were calculated for all cancers and different cancer sites in relation to different lag time and year of graduation. Information on smoking habits was obtained by administering a questionnaire to a sample of the cohort (n = 1,501).

  Results: In the total cohort 810 cancers were observed, whereas 794 were expected (SIR 1.0, 95% CI 1.0-1.1), and significantly increased risk of stomach cancer (SIR 1.3, 95% CI 1.0-1.5) and lung cancer (SIR 1.2, 95% CI 1.0-1.5) was found. Increased risk of all cancers (SIR 1.2, 95% CI 1.1-1.3), stomach cancer (SIR 1.5, 95% CI 1.1-1.9), lung cancer (SIR 1.4, 95% CI 1.2-1.8), pleural mesothelioma (SIR 4.8, 95% CI 1.3-12.3), and urinary bladder cancer (SIR 1.3, 95% CI 1.0-1.8) were observed when a 40-year lag time was applied. The engineers' smoking habits were similar to those in a sample of the general population. The predictive value for lung cancer was 1.03.

  Conclusions: The increased risk for mesothelioma is possibly attributable to the previous asbestos exposure. The excess of lung cancer could also be related to asbestos exposure. The high incidence of stomach cancer, lung cancer, and bladder cancer may be related to exposure to chemical risk factors, such as oils and petroleum products, as confounding due to smoking seems to be ruled out. In the light of the limited exposure information in the present study the importance of the different occupational exposures needs to be evaluated in further studies.

• Occupation and larynx and hypopharynx cancer: a job-exposure matrix approach in an international case-control study in France, Italy, Spain and Switzerland. F. Berrino, L. Richiardi, P. Boffetta, et al. 2003;14(3):213-23. PubMed · Publisher

  Abstract

  Objective: To investigate the effect of exposure to occupational agents on the risk of hypopharyngeal/laryngeal cancer.

  Methods: Case-control study conducted during 1979-1982 in six centres in South Europe. An occupational history and information on exposure to non-occupational factors were collected for 1010 male cases of hypopharyngeal/ laryngeal cancer as well as for 2176 population controls. The exposure to 10 occupational agents was assessed through a job-exposure matrix. As occupational histories had been collected since 1945 major analyses were restricted to subjects aged less than 55 years (315 cases and 819 controls).

  Results: Significant elevated risks adjusted for non-occupational variables (smoking, alcohol consumption and diet) and other occupational exposures were consistently found for organic solvents (odds ratio (OR) for ever-exposure: 1.7, 95% confidence interval: 1.1-2.5) and asbestos (OR: 1.6, 1.0-2.5). A significant positive trend for both probability of exposure and duration was found for exposure to solvents. A positive association between exposure to formaldehyde and laryngeal cancer was also suggested. No association was found for exposure to arsenic and compounds, chromium and compounds, and polycyclic aromatic hydrocarbons. Analyses restricted to subjects aged 55 or more did not show elevated risks, with the exception of wood dust (OR: 1.8, 1.3-2.7).

  Conclusions: In our study occupational exposure to solvents was associated with an increased risk of hypopharyngeal/laryngeal cancer. Results also provide additional evidence of an excess of risk for exposure to asbestos.

• Pleural mesothelioma incidence in Europe: evidence of some deceleration in the increasing trends. F. Montanaro, F. Bray, V. Gennaro, et al. 2003;14(8):791-803. PubMed · Publisher

  Abstract

  Objective: To summarize the geographical and temporal variations in incidence of pleural mesothelioma in Europe, using the extensive data available from European general cancer registries, and consider these in light of recent trends in asbestos extraction, use and import in European countries.

  Material And Methods: The data were extracted from the European Cancer Incidence and Mortality database (EUROCIM). The inclusion criteria was acceptance in Volume VII of Cancer Incidence in Five Continents. Truncated age-standardized rates per 100,000 for the ages 40-74 were used to summarise recent geographical variations. Standardized rate ratios and 95% confidence intervals for the periods 1986-1990 and 1991-1995 were compared to assess geographical variations in risk. To investigate changes in the magnitude of most recent trends, regression models fitted to the latest available 10-year period (1988-1997) were compared with trends in the previous decade. Fitted rates in younger (40-64) and older adults (65-74) in the most recent period were also compared.

  Results: There was a great deal of geographical variation in the risk of mesothelioma, annual rates ranging from around 8 per 100,000 in Scotland, England and The Netherlands, to lower than 1 per 100,000 in Spain (0.96), Estonia (0.85), Poland (0.85) and Yugoslavia, Vojvodina (0.56) among men. The rank of the rates for women was similar to that observed for men, although rates were considerably lower. Between 1978 and 1987, rates in men significantly increased in all countries (excepting Denmark). In the following 10 years, there was a deceleration in trend, and a significant increase was detectable only in England and France. In addition, the magnitude of recent trends in younger men was generally lower than those estimated for older men, in both national and regional cancer registry settings.

  Conclusions: While mesothelioma incidence rates are still rising in Europe, a deceleration has started in some countries. A decrease may begin in the next few years in certain European populations considering the deceleration of observed trends in mesothelioma and asbestos exposure, as well as the recent ban on its use.

• Sinonasal cancer and occupational exposures: a pooled analysis of 12 case-control studies. D. Luce, A. Leclerc, D. Bégin, et al. 2002;13(2):147-57. PubMed · Publisher

  Abstract

  Objective: In order to examine the associations between sinonasal cancer and occupational exposures other than wood dust and leather dust, the data from 12 case-control studies conducted in seven countries were pooled and reanalyzed.

  Methods: The pooled data set included 195 adenocarcinoma cases (169 men and 26 women), 432 squamous cell carcinomas (330 men and 102 women), and 3136 controls (2349 men and 787 women). Occupational exposures to formaldehyde, silica dust, textile dust, coal dust, flour dust, asbestos, and man-made vitreous fibers were assessed with a job-exposure matrix. Odds ratios (ORs) were adjusted for age, study, wood dust, and leather dust, or other occupational exposures when relevant. 95% confidence intervals (CIs) were estimated by unconditional logistic regression.

  Results: A significantly increased risk of adenocarcinoma was associated with exposure to formaldehyde. The ORs for the highest level of exposure were 3.0 (Cl = 1.5-5.7) among men and 6.2 (CI=2.0-19.7) among women. An elevated risk of squamous cell carcinoma was observed among men (OR=2.5, CI=0.6-10.1) and women (OR = 3.5, CI = 1.2-10.5) with a high probability of exposure to formaldehyde. Exposure to textile dust was associated with non-significantly elevated risk of adenocarcinoma, among women only: the OR for the high level of cumulative exposure was 2.5 (CI = 0.7-9.0). High level of asbestos exposure was associated with a significantly increased risk of squamous cell carcinoma among men (OR = 1.6, CI = 1.1-2.3).

  Conclusions: The results of this pooled analysis support the hypothesis that occupational exposure to formaldehyde increases the risk of sinonasal cancer, particularly of adenocarcinoma. They also indicate an elevated risk of adenocarcinoma among women exposed to textile dust, and suggest that exposure to asbestos may increase the risk of squamous cell carcinoma.

• Kidney cancer and occupational exposure to asbestos: a meta-analysis of occupational cohort studies. D. Sali, P. Boffetta. 2000;11(1):37-47. Meta-analysis PubMed · Publisher

  Abstract

  Objective: To study the risk of kidney cancer following asbestos exposure.

  Methods: We carried out a meta-analysis of the results of cohort studies of workers predominantly exposed to asbestos. We contacted the authors of 70 cohort studies; published results were available from the reports of 10 cohorts; we obtained the relevant information for an additional 27 cohorts.

  Results: The studies included in the analysis comprised a total of 169 kidney cancer deaths and 69 incident cases. The overall pooled standardized mortality ratio (SMR) of kidney cancer was 1.1, with a 95% confidence interval (95% CI) of 0.9-1.3. The pooled SMR was higher for workers with undefined asbestos exposure (SMR 1.2, 95% CI 0.9-1.6) than for workers with either predominant chrysotile (SMR 0.9, 95% CI 0.7-1.3) or some amphibole (SMR 0.96, 95% CI 0.6-1.5) exposure. Studies with published results had higher SMRs than studies for which information was obtained from the authors. Studies with high asbestos exposure and an elevated SMR of lung cancer tended to show an increased risk of kidney cancer.

  Conclusions: It is unlikely that asbestos exposure is responsible for an important increase in kidney cancer risk; however, high asbestos exposure might entail a small increase in risk.

• X-ray evidence of increased asbestos exposure in the US population from NHANES I and NHANES II, 1973-1978. National Health Examination Survey. W.J. Rogan, N.B. Ragan, G.E. Dinse. 2000;11(5):441-9. PubMed · Publisher

  Abstract

  Objectives: Jobs involving heavy asbestos exposure increase risk for lung cancer and mesothelioma substantially, and low-level exposures may carry some risk. At least one indicator of asbestos exposure, mesothelioma, has been increasing in the US for decades. We investigated the prevalence of another indicator, pleural thickening on x-ray, in a defined sample of the US population.

  Methods: Certified physicians read 1060 x-rays from the second National Health and Nutrition Examination Survey (1976-1980) for pleural changes consistent with pneumoconiosis, which are a reasonably specific indicator of asbestos exposure.

  Results: Prevalence estimates, in NHANES II, in the age group 35-74 years, are 6.4% (+/- 0.9%) among males, 1.7% (+/- 0.6%) among females, and 3.9% (+/- 0.6%) overall. These prevalences are approximately twice those estimated from NHANES I data (1971-1975).

  Conclusions: X-ray evidence of asbestos exposure was common in the late 1970s and increasing. The increase may be due to occupational asbestos exposure, but it is so large as to suggest some contribution from environmental, non-occupational asbestos exposure.

1990s

• Cancer in asbestos-exposed occupational cohorts: a meta-analysis. M. Goodman, R.W. Morgan, R. Ray, et al. 1999;10(5):453-65. Meta-analysis PubMed · Publisher

  Abstract

  Objective: To examine existing asbestos-exposed occupational cohorts and apply a meta-analytic technique to determine the magnitude of association between exposure and lung cancer and to investigate other cancer sites that may be related to such an exposure.

  Methods: We summarized the data from 69 asbestos-exposed occupational cohorts reporting on cancer morbidity and mortality. Data were extracted regarding numbers of deaths for each cancer, numbers of mesotheliomas, occupations and latency for respiratory, gastrointestinal, urinary and lymphohematopoietic cancers. For each cancer, we calculated a meta-SMR and examined heterogeneity of results using a chi-square test and by calculating a Z-statistic for each study. To examine the dose-response effect, we divided the studies into tertiles according to the percentage of mesothelioma deaths that served as a proxy estimation of asbestos exposure.

  Results: Lung cancer data demonstrated meta-SMRs of 163 and 148 with and without latency, respectively, with significant heterogeneity of results even after stratification according to occupational groups. Stratification of lung cancer studies according to percentage of mesothelioma deaths showed a dose-response effect. Z-scores ranged from -12.21 to + 29.49. Analysis for laryngeal cancer yielded meta-SMRs of 157 and 133 with and without latency, respectively, demonstrating homogeneous results across studies but accompanied by no evidence of a dose-response effect. Data for gastrointestinal cancers showed no evidence of a significant association and no dose-response effect. Kidney cancer demonstrated statistically non-significant meta-SMRs of 120 (95% CI 88-160) and 111 (95% CI 94-131) with and without latency respectively.

  Conclusions: This meta-analysis demonstrates a wide variability of the association between occupational asbestos and lung cancer. There was a suggestion of an association between asbestos and laryngeal carcinoma and no clear association with other cancers.

• Incidence of cancer among Finnish patients with asbestos-related pulmonary or pleural fibrosis. A. Karjalainen, E. Pukkala, T. Kauppinen, et al. 1999;10(1):51-7. PubMed · Publisher

  Abstract

  Objectives: To study the asbestos-associated risk of lung cancer according to the histological type of cancer, the time of and time since diagnosis of asbestosis, the asbestos-associated risk for cancers other than lung cancer or mesothelioma, and the predictive value of asbestos-related pleural abnormalities as regards the risk of cancer.

  Methods: Finnish patients with asbestosis (n = 1,376) or asbestos-related benign pleural disease (n = 4,887) notified as an occupational disease since 1964 were followed-up through the Finnish Cancer Registry for cancer in 1967-95.

  Results: Compared with the total cancer incidence in Finland, men with asbestosis had a raised risk of lung cancer (standardized incidence ratio [SIR] = 6.7; 95% confidence interval [CI] = 5.6-7.9), mesothelioma (SIR = 32, CI = 14-60) and cancer of the larynx (SIR = 4.2, CI = 1.4-9.8). The risk of lung cancer was similarly raised for all histological types of lung cancer (the highest in insulators) and did not change markedly over time of notification or duration of follow-up. Men with benign pleural disease had a raised risk of mesothelioma (SIR = 5.5, CI = 1.5-14) and a slightly elevated risk of lung cancer (SIR = 1.3, CI = 1.0-1.8). Among women with asbestosis, significant excess was found for lung cancer and mesothelioma.

  Conclusion: Asbestosis and asbestos-related benign pleural disease seem to possess different predictive values as regards the risk of lung cancer.

• Drinking water and cancer. K.P. Cantor. 1997;8(3):292-308. Review PubMed · Publisher

  Abstract

  Epidemiologic evidence on the relation between contaminants in drinking water and cancer is reviewed. The reviewed studies cover exposure to: disinfection byproducts; nitrate; arsenic and other metals; volatiles and contaminants from hazardous waste sites; asbestiform fibers; radionuclides; and fluoride. Most investigations are ecologic, with some confirmation of elevated risk from individual-based studies. In the case of waterborne arsenic, and possibly chlorination byproducts, there is a consistent but small body of epidemiologic evidence of an association with one or more types of cancer. Nitrate in groundwater has increased greatly over the years, and the demonstration of endogenous nitrosation among highly exposed subjects raises concern of elevated cancer risk. However, the epidemiologic data are not yet sufficient to draw a conclusion. There is a diversity of studies among populations exposed to water contaminated with pesticides, volatile organics, or mixtures from hazardous waste sites. Studies of asbestiform fibers and radionuclides in water are not conclusive, but there are suggested elevations of several cancer sites in highly exposed populations. There is no suggestion that fluoride in drinking water is linked with elevated risk of cancer. As topics for epidemiologic evaluation, drinking water contaminants pose methodologic problems common to studies designed to detect relatively small elevations in risk, with the added challenge of assessing exposures for many years in the past. Nevertheless, epidemiologic assessment is valuable and clearly warranted, given the potential public health impact of small risk elevations among very large exposed populations, and the limitations of toxicologic experiments in assessing carcinogenic risk of complex mixtures or of compounds for which appropriate animal models are not available.

• Silica, asbestos, man-made mineral fibers, and cancer. K. Steenland, L. Stayner. 1997;8(3):491-503. Review PubMed · Publisher

  Abstract

  Approximately three million workers in the United States are estimated to be exposed to silica, man-made mineral fibers, and asbestos. The lung is the primary target organ of concern. Each of these substances is composed predominantly of silicon and oxygen; asbestos and silica are crystalline, and asbestos and man-made mineral fibers are fibers. Man-made mineral fibers and asbestos are used as insulating agents, with the former having generally replaced the latter in recent years. Silica is used in foundries, pottery, and brick making, and is encountered by miners. A meta-analysis of 16 of the largest studies with well-documented silica exposure and low probability of confounding by other occupational exposures, indicates a relative risk (RR) of 1.3 (95 percent confidence interval [CI] = 1.2-1.4). Lung cancer risks are highest and most consistent for silicotics, who have received the highest doses (RR = 2.3, CI = 2.2-2.4, across 19 studies). The data for mineral fibers continue to support the International Association for Research on Cancer's 1988 judgment that mineral fibers are a possible human carcinogen (Group 2B). Recent epidemiologic studies provide little evidence for lung carcinogenicity for either glass wool or rock/slag wool. Ceramic fibers, a much less common exposure than glass wool and rock/slag wool, are of concern because of positive animal studies, but there are insufficient human data. Regarding asbestos, its carcinogenicity for the lung and mesothelium is well established. With regard to the controversy over chrysotile and mesothelioma, the data suggest chrysotile does cause mesothelioma, although it may be less potent than amphibole asbestos.

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