Lung cancer risk and workplace exposures in black men and women

Our plain-English summary of Lung cancer risk and workplace exposures in black men and women, by J.E. Muscat, S.D. Stellman, J.P. Richie, et al (Environmental Research, 1998).

The study

• Authors: J.E. Muscat, S.D. Stellman, J.P. Richie, E.L. Wynder
• Journal: Environmental Research
• Published: 1998;76(2):78-84
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

There are little data on workplace exposures and lung cancer risk in blacks. An ongoing case-control study of lung cancer that included 550 black men and women with lung cancer and 386 age-matched controls was examined by reported occupational exposures and job titles. In men, significant associations were observed with reported exposure to asbestos [odds ratio (OR), 1.8; 95% confidence intervals (CI) 1.03-3.1] and coal dust (OR, 2.8; 95% CI 1.1-7.0). Elevated but nonsignificant risks of 1.4 or more were detected for the following occupations: police/security guards, farmers/farm workers, laborers, and motor-vehicle drivers. In women, nonsignificant increased risks were found with reported exposure to paint (OR, 1.8) and gas fumes (OR, 4.9). Women employed as farmers/farm workers and building maintenance workers had elevated but nonsignificant risks.

In plain English

This hospital-based case-control study examined usual jobs and self-reported workplace exposures among black patients in U.S. teaching hospitals from 1978 to 1996. It included 550 people with lung cancer (365 men and 185 women) and 386 age-matched control patients admitted for conditions unrelated to tobacco use. Results were adjusted for age, education and smoking. Among men, the only statistically significant increased associations with lung cancer were reported asbestos/insulation exposure (odds ratio 1.8; 95% CI 1.03 to 3.1) and coal dust (odds ratio 2.8; 95% CI 1.1 to 7.0). Fiber types were not specified. Few women reported workplace exposures. Their odds ratio for asbestos was 1.0 (95% CI 0.2 to 4.6). No job category was significantly linked to lung cancer. Women building maintenance workers had a non-significant odds ratio of 2.5 (95% CI 0.5 to 13.4), which the authors said likely reflected exposure to friable asbestos. The authors concluded that occupational exposures appear to contribute to lung cancer in at least black men. They noted low statistical power, many comparisons, reliance on self-reported exposure and possible recall bias.

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: Hospital-based case-control study (analysis of black subjects within an ongoing multicenter lung cancer case-control study begun in 1978)
• Who was studied: Black patients in U.S. teaching hospitals, 1978 to 1996: 550 newly diagnosed, histologically confirmed lung cancer cases (365 men, 185 women) and 386 age-matched hospital controls admitted for conditions unrelated to tobacco use
• Exposure: Self-reported usual adult occupation and regular exposure (at least 8 hours a week) to items on a list of over 40 occupational exposures, including asbestos/insulation (fiber type not specified), coal dust, wood dust, stone dust, paint, gas fumes, diesel exhaust and pesticides
• Main results:
  • In men, after adjustment for age, education and smoking, reported asbestos/insulation exposure was significantly associated with increased lung cancer risk (OR 1.8; 95% CI 1.03 to 3.1), as was coal dust (OR 2.8; 95% CI 1.1 to 7.0). The text calls these the only significant associations, but Table 2 also shows a significant inverse association for oil in men (OR 0.6; 95% CI 0.4 to 0.9)
  • Among male controls, 10.4% reported asbestos/insulation exposure (Table 2 gives 15.8% of male cases)
  • In women, reported asbestos exposure was 3.2% in cases and 3.7% in controls, with an odds ratio of 1.0 (95% CI 0.2 to 4.6); few women reported occupational exposures overall
  • Among men, asbestos exposure was reported by 13.6% of cases with squamous cell cancer and 16.5% of cases with adenocarcinoma; risk differed little by histologic type
  • No specific job category was significantly associated with lung cancer. Non-significant elevated odds ratios were seen in men for police/security workers (2.0), farmers/farm workers (1.7) and drivers (1.5), and in women for farmers/farm workers (2.0), building maintenance workers (2.5; 95% CI 0.5 to 13.4 per Table 3) and clerical workers (1.5)
  • In this study, 10.4% of black controls reported asbestos exposure compared with 6.3% of white controls interviewed during the same period
• The authors' conclusion: The authors concluded that occupational exposures appear to contribute to lung cancer in at least black men, and that occupational exposure to lung carcinogens may be more common in blacks than in whites. They interpreted the elevated risk in women building maintenance workers as likely reflecting exposure to friable asbestos.
• Limitations the authors state:
  • It was not possible to obtain a control for each case
  • Statistical power for any single occupation was low because jobs were so varied
  • Data were collected over a long period and may not reflect changes in workplace safety standards
  • Many comparisons increased the chance of false-positive findings
  • Hospital controls had illnesses, some of which may be job-related
  • Self-reported exposure may be under-reported, and no workplace industrial hygiene surveys were possible
  • Recall bias is possible

Topics

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

Medical terms in this study, explained in our Lexicon: Lung Cancer, Case-Control Study, Occupational Exposure, Odds Ratio, confidence interval.

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