Nasal and sinonasal cancer. Connection with occupational exposures in Denmark, Finland and Sweden

Our plain-English summary of Nasal and sinonasal cancer. Connection with occupational exposures in Denmark, Finland and Sweden, by S. Hernberg, P. Westerholm, K. Schultz-Larsen, et al (Scandinavian Journal of Work, Environment & Health, 1983).

The study

• Authors: S. Hernberg, P. Westerholm, K. Schultz-Larsen, R. Degerth, E. Kuosma, A. Englund, U. Engzell, H.S. Hansen, P. Mutanen
• Journal: Scandinavian Journal of Work, Environment & Health
• Published: 1983;9(4):315-26
• Cited by: 108 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001747).

Abstract

A joint Danish-Finnish-Swedish case-referent investigation was initiated in 1977 in order to study the connection between nasal and sinonasal cancer and various occupational exposures. All new cases of nasal and sinonasal cancer were collected from the national cancer registers (Finland and Sweden) or from the hospitals (Denmark). Those still alive who agreed to an interview (N = 167) were individually matched for age and sex with patients with colonic or rectal cancer. A detailed telephone interview was made according to standardized forms. Both cases and referents thought that their condition was the one under study. The exposures were coded blindly by an industrial hygienist. The results showed associations between nasal and sinonasal cancer and exposure to (i) hardwood or mixed wood dust (discordant pairs 14: 2), (ii) softwood dust alone (13:4), (iii) chromium (16: 6), (iv) nickel (12: 5, not significant), (v) welding, flame-cutting and soldering (17: 6), and (vi) lacquers and paints (14: 0). The last finding was probably due to confounding from wood dust exposure. Hardwood dust exposure was associated with adenocarcinoma. Softwood dust exposure alone was associated with epidermoid and anaplastic carcinomas. No associations were found for a number of exposures, including agricultural chemicals, textile dust, asbestos, quartz dust, organic solvents and leather work. Possible exposure to formaldehyde was evenly distributed between the cases and referents.

In plain English

This was a case-referent study begun in 1977 in Denmark, Finland and Sweden. It included 167 living patients with newly diagnosed cancer of the nose or sinuses (69 in Denmark, 24 in Finland, 74 in Sweden). Each was matched by country, sex and age with a patient who had colon or rectal cancer. Everyone was interviewed by telephone about their work history, and an industrial hygienist coded exposures without knowing who was a case. Nasal and sinonasal cancer was associated with combined hardwood and softwood dust (odds ratio 12.0, 95% confidence limits 2.4 to 59.2), softwood dust alone (odds ratio 3.3, 1.1 to 9.4), chromium (odds ratio 2.7, 1.1 to 6.6), and welding, flame-cutting and soldering (17 to 6 discordant pairs). The nickel result was not significant. For asbestos, the discordant pairs split 9 to 5, which was not significant. Because some studies link asbestos to colon cancer, the authors said their comparison group was probably inadequate and could hide a raised risk. They drew no conclusions about asbestos.

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: Matched case-referent (case-control) study using telephone interviews; referents were patients with colonic or rectal cancer
• Who was studied: 167 living patients with new primary malignant tumors of the nasal cavity and paranasal sinuses who agreed to be interviewed: 69 in Denmark, 24 in Finland and 74 in Sweden, diagnosed from 1 July 1977 to 31 December 1980. Each was matched by country, sex and age (within 3 years) with a living colon or rectal cancer patient.
• Exposure: Occupational exposures built from data on 26 specific agents or exposures, including hardwood, softwood and mixed wood dust, chromium, nickel, welding, flame-cutting and soldering, lacquers and paints, agricultural chemicals, textile dust, asbestos, quartz dust, organic solvents, leather work and possible formaldehyde. The last 10 years before diagnosis were excluded to allow for latency.
• Main results:
  • Wood dust (discordant pairs, case exposed versus referent exposed): hardwood or mixed wood dust 14:2. Hardwood plus softwood dust 12:1, odds ratio 12.0 (95% confidence limits 2.4-59.2). Softwood dust only 13:4, odds ratio 3.3 (1.1-9.4). Hardwood dust only 2:1, odds ratio 2.0 (0.2-21.0).
  • Metals: chromium 16:6 discordant pairs, odds ratio 2.7 (1.1-6.6). Nickel 12:5, odds ratio 2.4 (0.9-6.6), not statistically significant. Welding, flame-cutting and soldering 17:6.
  • Lacquers and paints showed 14:0 discordant pairs. The authors judged this probably due to confounding from wood dust exposure.
  • By tumor type, hardwood dust exposure was associated with adenocarcinoma. Softwood dust alone was associated with epidermoid and anaplastic carcinomas.
  • Asbestos exposure showed a discordant pair ratio of 9:5, which was not statistically significant.
  • Possible exposure to formaldehyde was evenly distributed between cases and referents.
• The authors' conclusion: The authors considered the association between wood dust and nasal and sinonasal cancer the most important finding. They suggested that exposure to mixed chromium and nickel compounds in welding fumes, flame-cutting and other tasks also causes an increased risk. They refrained from drawing any conclusions about asbestos.
• Limitations the authors state:
  • Colon and rectal cancer referents were probably an inadequate comparison group for asbestos, because some studies link asbestos to colonic cancer. This bias would tend to mask an increased risk of nasal or sinonasal cancer, so the authors drew no conclusions on asbestos.
  • About 40% of identified cases could not be interviewed, which could in principle introduce selection bias.
  • The interviewers were not blinded to case or referent status.
  • Numbers in the tumor-type analyses were small, and chance findings cannot be disregarded.
  • Data on formaldehyde exposure were weak, and the exposure categories were formed after the study began.
  • There were too few exposed women to analyze their data separately.

Topics

Medical terms in this study, explained in our Lexicon: Occupational Exposure, Confounding, Adenocarcinoma, Carcinoma.

Related studies

• Nasal cancer and occupational exposures. Preliminary report of a joint Nordic case-referent study — S. Hernberg, Y. Collan, et al. (1983)
• Sinonasal cancer and occupational exposures: a pooled analysis of 12 case-control studies — D. Luce, A. Leclerc, et al. (2002)
• Risk factors for nasal malignancies in German men: the South-German Nasal cancer study — E.M. Greiser, K.H. Greiser, et al. (2012)
• Solitary fibrous tumour of the nasal cavity and paranasal sinuses — I. Alobid, L. Alós, et al. (2003)
• Asbestos and cancer of head and neck — P.M. Stell, T. McGill (1973)
• Incidence, mortality and survival in malignant pleural mesothelioma before and after asbestos in Denmark, Finland, Norway and Sweden — K. Hemminki, A. Försti, et al. (2021)

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