Nasal cancer and occupational exposures. Preliminary report of a joint Nordic case-referent study

Our plain-English summary of Nasal cancer and occupational exposures. Preliminary report of a joint Nordic case-referent study, by S. Hernberg, Y. Collan, R. Degerth, et al (Scandinavian Journal of Work, Environment & Health, 1983).

The study

• Authors: S. Hernberg, Y. Collan, R. Degerth, A. Englund, U. Engzell, E. Kuosma, P. Mutanen, H. Nordlinder, H.S. Hansen, K. Schultz-Larsen
• Journal: Scandinavian Journal of Work, Environment & Health
• Published: 1983;9(2 Spec No):208-13
• Cited by: 14 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. 001748).

Abstract

Nasal and sinus paranasal cancers have been associated with several occupational exposures, for example, dust from hardwood, nickel and unspecific agents occurring in the boot and shoe industry. A joint Danish-Finnish-Swedish case-referent investigation was initiated in 1977 to study further the connection between nasal and sinus paranasal cancers and various occupational exposures. All new cases of these cancers were collected from the national cancer registers (Finland & Sweden) or from hospitals (Denmark). Those still alive who agreed to the interview (N = 167) were individually matched for age and sex with patients with colonic or rectal cancer. A detailed telephone interview was performed according to a standardized procedure. Both the cases and referents thought that their condition was the one under study. The exposures were coded blindly by an experienced industrial hygienist. The results showed associations between nasal or sinus paranasal cancer and exposure to hardwood or mixed wood dust (discordant pairs 14/2); softwood dust alone (13/4); chromium 16/6); nickel (12/5, not significant); welding, flamecutting, and soldering (17/16); and lacquers and paints (12/0). Hardwood dust exposure showed a connection 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 preliminary report described a Danish, Finnish and Swedish case-referent study of nasal and paranasal sinus cancer. It included 167 living patients diagnosed 1978 to 1980, each matched by country, sex and age with a colon or rectal cancer patient. Patients were interviewed by telephone about past jobs, and an industrial hygienist coded exposures blindly. Nasal cancer was associated with combined hardwood and softwood dust (odds ratio 12.0, 95% confidence limits 2.4 to 59.2) and softwood dust only (3.3, 1.1 to 9.4). It was also associated with welding, flamecutting and soldering (2.8, 1.2 to 6.9) and chromium (2.7, 1.1 to 6.6), categories that often overlapped, and with lacquers and paints (discordant pairs 12/0). The authors could not separate wood dust from paints and lacquers as the cause. Associations for nickel and for asbestos (discordant pairs 9/5) were not statistically significant. The authors noted that colon cancer patients might be an inadequate comparison for asbestos. They concluded the study supported a hardwood dust and adenocarcinoma link and suggested softwood dust as a cause of other nasal cancer types.

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: Case-referent (case-control) study with individually matched pairs; preliminary report
• Who was studied: 167 living patients with primary malignant tumors of the nasal cavity and paranasal sinuses diagnosed in 1978, 1979 and 1980 (Denmark 69, Finland 24, Sweden 74; 110 men and 57 women). Each was matched for country, sex and age at diagnosis (within 3 years) with a living patient with cancer of the colon or rectum.
• Exposure: Occupational exposures from a telephone interview covering each job of more than one year, up to 10 years before diagnosis. Exposures were coded blindly by an industrial hygienist as none, moderate or heavy, from 26 specific agents or exposures. These included hardwood and softwood dust, metals (chromium, nickel), welding, lacquers and paints, asbestos, and formaldehyde.
• Main results:
  • Combined hardwood and softwood dust: discordant pairs 12/1, odds ratio 12.0, 95% confidence limits 2.4 to 59.2. Hardwood dust only: 2/1, odds ratio 2.0, 0.2 to 21.0.
  • Softwood dust only: discordant pairs 13/4, odds ratio 3.3, 95% confidence limits 1.1 to 9.4. All 13 exposed cases had tumor types other than adenocarcinoma, 10 of them epidermoid or anaplastic carcinoma.
  • Hardwood dust exposure was mainly associated with adenocarcinoma.
  • Lacquers and paints: discordant pairs 12/0. However, eight cases and no referents had been exposed to both wood dust and paints and lacquers, so the authors could not separate the two as causes.
  • Welding, flamecutting and soldering: discordant pairs 17/6, odds ratio 2.8, 95% confidence limits 1.2 to 6.9.
  • Chromium: discordant pairs 16/6, odds ratio 2.7, 95% confidence limits 1.1 to 6.6. Many cases fell into two or more of the metal exposure categories.
  • Nickel: discordant pairs 12/5, odds ratio 2.4, not statistically significant.
  • Asbestos exposure: discordant pair ratio 9/5, not statistically significant.
  • Formaldehyde: no indication of an association. In the category 'painting, lacquering and glueing' there were 18 exposed cases and 6 exposed referents, but 15 of those cases had also been exposed to hardwood dust. No conclusions were drawn about formaldehyde.
  • Smokers had higher odds ratios than nonsmokers.
• The authors' conclusion: The authors concluded that the study supported earlier findings linking hardwood dust with adenocarcinoma and suggested softwood dust as a cause of other types of nasal and sinus paranasal cancer. They also concluded that exposure to nickel and chromium in occupations other than their production may cause nasal cancer.
• Limitations the authors state:
  • The comparison group of colon and rectal cancer patients could be considered inadequate for judging asbestos, because some studies had found a connection between asbestos exposure and colonic cancer.
  • Exposures had occurred 10 to 60 years earlier, so they could not be measured and were classified from estimates.
  • Reports linking formaldehyde with nasal cancer in rats appeared after the study was under way, and the protocol could not be changed to explore past formaldehyde exposure in sufficient detail.
  • For some exposures (for example cadmium, arsenic, oil mist, bitumen, leather work) the study was uninformative because the exposures were rare.
  • Chromium and nickel exposures mostly occurred together and could not easily be separated statistically.

Topics

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

Related studies

• Nasal and sinonasal cancer. Connection with occupational exposures in Denmark, Finland and Sweden — S. Hernberg, P. Westerholm, et al. (1983)
• 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)
• Sinonasal cancer and occupational exposures: a pooled analysis of 12 case-control studies — D. Luce, A. Leclerc, et al. (2002)
• Heavy metals, welding fumes, and other occupational exposures, and the risk of kidney cancer: A population-based nested case-control study in three Nordic countries — I.M. Michalek, J.I. Martinsen, et al. (2019)

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