Mesothelioma and employment in massachusetts: analysis of cancer registry data 1988-2003

Our plain-English summary of Mesothelioma and employment in massachusetts: analysis of cancer registry data 1988-2003, by C.R. Roelofs, G.J. Kernan, L.K. Davis, et al (American Journal of Industrial Medicine, 2013).

The study

• Authors: C.R. Roelofs, G.J. Kernan, L.K. Davis, R.W. Clapp, P.R. Hunt
• Journal: American Journal of Industrial Medicine
• Published: 2013;56(9):985-92
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Cancer registries can be used to monitor mesothelioma cases and to identify occupations and industries previously and newly associated with mesothelioma-causing asbestos exposure by using standard registry data on the "usual" occupation and industry of the case.

Methods: We used the National Institute for Occupational Safety and Health's Standardized Occupational Industry Coding Software to code 564 mesothelioma cases for occupation and 543 for industry of the 1,424 incident mesothelioma in the Massachusetts Cancer Registry from 1988 to 2003. Additionally, we coded the occupation and industry of 80,184 comparison cancer cases (35% of comparison cases in our database). These were used to compute Standardized Morbidity Odds Ratios (SMORs).

Results: Seventeen occupations and 11 industries had statistically significant elevated SMORs for mesothelioma. Occupations and industries historically associated with mesothelioma remained elevated in these results. However, we also found statistically significant elevated SMORs for several occupations and industries for which there was previously weak or no association such as chemical engineers, machine operators, and automobile mechanics and machine manufacturing, railroads, and the U.S. Postal Service.

Conclusions: Incident cases of mesothelioma do not appear to be declining in Massachusetts, as legacy exposures to asbestos continue to produce cases in individuals involved in shipbuilding and construction. Exposures in occupations and industries not previously associated with mesothelioma also contribute cases. Cancer registries, with improved data collection, should continue to be monitored for mesothelioma cases and asbestos exposures.

Copyright © 2013 Wiley Periodicals, Inc.

In plain English

This study used Massachusetts Cancer Registry records to examine which usual occupations and industries were linked to mesothelioma among residents diagnosed from 1988 to 2003. Of 1,424 mesothelioma cases, the authors could code 564 for occupation and 543 for industry. Most records said retired, unknown or disabled and were left out. The cases were compared with 80,184 cases of cancers not associated with asbestos, using standardized morbidity odds ratios (SMORs) adjusted for gender and age. Seventeen occupations and 11 industries had statistically significant elevated SMORs. Insulation workers had an SMOR of 38.4 (95% CI 17.7 to 83.5; 9 cases), and ship and boat building and repairing had 38.2 (95% CI 29.4 to 49.7; 96 cases). Elevations also appeared in groups less often linked to mesothelioma, including chemical engineers, automobile mechanics, railroads and the U.S. Postal Service. The authors could not tell whether exposure happened in the reported usual job or elsewhere, such as military service. They concluded that occupations and industries with historical asbestos exposure continued to be at risk, and recommended continued surveillance and better job data collection.

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: Surveillance analysis of cancer registry data, comparing mesothelioma cases with other cancer cases using standardized morbidity odds ratios (SMORs) calculated by logistic regression
• Who was studied: 1,424 mesothelioma cases among Massachusetts residents reported to the Massachusetts Cancer Registry, 1988 to 2003. Of these, 564 (40%) were coded for occupation and 543 (38%) for industry. The comparison group was 80,184 cases of cancers not associated with asbestos (35% of comparison cases), such as prostate, breast, melanoma, leukemia and lymphoma.
• Exposure: Usual occupation and usual industry as recorded in the registry, coded with NIOSH software. No fiber types or doses were measured.
• Main results:
  • Seventeen occupations had statistically significant elevated SMORs for mesothelioma, and 11 industries had statistically significant elevated SMORs.
  • Insulation workers: 9 cases, SMOR 38.4 (95% CI 17.7 to 83.5). Plumbers, pipefitters and steamfitters: 49 cases, SMOR 9.5 (95% CI 7.0 to 12.8).
  • Ship and boat building and repairing (96 cases) and construction (127 cases) contributed the most cases among the significantly elevated industries. Ship and boat building and repair had the highest SMOR (38.2, 95% CI 29.4 to 49.7). The next highest was miscellaneous repair services (7.3, 95% CI 3.8 to 13.9).
  • Several occupations less commonly identified with mesothelioma had elevated SMORs, including chemical engineers (5 cases, SMOR 5.3, 95% CI 2.1 to 13.1) and automobile mechanics (10 cases, SMOR 2.1, 95% CI 1.1 to 4.0).
  • Industries that were significantly elevated in this study but not in the earlier Massachusetts study were railroads (7 cases, SMOR 3.2, 95% CI 1.4 to 7.3), U.S. Postal Service (19 cases, SMOR 1.7, 95% CI 1.1 to 2.7), machine manufacturing, and the military.
• The authors' conclusion: The authors concluded that industries and occupations with historical asbestos exposure, such as insulation work, ship and boat building and construction, continued to be at risk. They recommended further surveillance and investigation of occupations and industries with elevated SMORs where no risk had previously been shown.
• Limitations the authors state:
  • Fewer than 40% of mesothelioma and comparison cases had enough occupation and industry information to be coded.
  • A validation check found that the coding software correctly coded about 70% of occupations and industries.
  • Some SMORs were based on small numbers of cases, giving wide confidence intervals.
  • Recorded usual occupation and industry is a limited stand-in for a detailed exposure history. The authors could not determine whether exposure happened in the usual occupation or elsewhere (for example, postal workers who may be veterans).
  • The comparison cancer cases could not be checked against Massachusetts population data to see whether they were representative.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Cancer Registry, Asbestos Exposure, Odds Ratio.

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