Occupational and environmental exposures and lung cancer in an industrialised area in Italy

Our plain-English summary of Occupational and environmental exposures and lung cancer in an industrialised area in Italy, by V. Fano, P. Michelozzi, C. Ancona, et al (Occupational and Environmental Medicine, 2004).

The study

• Authors: V. Fano, P. Michelozzi, C. Ancona, A. Capon, F. Forastiere, C.A. Perucci
• Journal: Occupational and Environmental Medicine
• Published: 2004;61(9):757-63
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Aims: To investigate the effects of occupational exposures and residence near to industrial sites on lung cancer mortality in an area in Italy.

Methods: 234 cases of lung cancer and 729 controls matched by sex, age, and date of death were enrolled. Environmental exposure was evaluated using historical residence data. A geographical information system was used to compute distances from residence to pollution source (cement factory, power plants, harbour) and an average distance was computed for each subject. Odds ratios (OR) and 95% confidence intervals (CI) in a logistic regression model were used to estimate the relative risk of lung cancer associated with the risk factors (smoking habits and occupational exposure) collected by questionnaire; ORs for distances from pollution sources and from city centre were computed, adjusting for smoking habits, education, and occupation.

Results: Smoking habits (< or =10 cigarettes/day, OR = 2.28; 11-20, OR = 4.64; >20, OR = 6.61) and occupational exposure to asbestos (OR = 3.50) were significantly associated with lung cancer risk. Reported traffic level of area of residence and residence near the four sources were not associated with increased risk of lung cancer. There was a significantly increased risk for those residing outside the city centre, in the southern outskirts (OR = 1.51).

Conclusions: The increased lung cancer risk observed in the area can partly be explained by occupational exposures. The increased risk in the outskirts of the city is consistent with the results of dispersion models that indicate high levels of pollutant deposition in the same area.

In plain English

This case-control study examined lung cancer deaths in Civitavecchia, an industrial Italian town north of Rome with a harbour, a cement factory and power plants. It compared 234 residents who died of lung cancer between 1987 and 1995 with 729 who died of other causes, matched by sex, age and date of death. Relatives answered questions about smoking, jobs and homes. Compared with non-smokers, every smoking level was linked to higher risk, with an odds ratio of 6.61 (95% confidence interval 3.52 to 12.42) for over 20 cigarettes a day. Among men, asbestos workers had a significantly increased risk (odds ratio 3.45, 95% confidence interval 1.68 to 7.07). Other jobs, including seamen and foundrymen, had raised but not statistically significant odds ratios. Living near the pollution sources showed no increased risk, but living in the southern outskirts rather than the city centre did (odds ratio 1.51, 95% confidence interval 1.04 to 2.18). The authors concluded that occupational exposures partly explained the area's excess lung cancer, and noted relatives' information may be inaccurate. The article named no asbestos fiber type.

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: Population-based case-control study of deceased people (mortality study), with three controls per case and information collected by interviewing next of kin
• Who was studied: Male and female residents of the municipality of Civitavecchia (Lazio region, Italy) who died between 1 January 1987 and 31 December 1995. Cases died of lung cancer; controls were matched by sex, age and date of death and excluded deaths from respiratory diseases. The analysis included 963 people: 234 cases and 729 controls. Of these, 201 cases and 626 controls were men.
• Exposure: Smoking habits; work history classified against lists of occupations known or suspected to raise lung cancer risk and an IARC-based checklist of 23 at-risk occupations, which included asbestos work (no fiber type given); reported traffic level; and residential distance from a harbour, a cement factory and power plants
• Main results:
  • Among men, asbestos workers had a significantly increased risk of lung cancer: odds ratio 3.45 (95% CI 1.68 to 7.07). This was adjusted for age, year of death and smoking. Asbestos work was reported for 17 cases (9.2%) and 17 controls (2.8%).
  • Among men, odds ratios were raised but not statistically significant for several other jobs. These were asphalt workers 1.66, welders 1.55, leather workers 1.42, foundrymen 2.00, butchers 1.64 and seamen 1.53 (95% CI 0.99 to 2.38).
  • In all cases and controls, smoking was linked to significantly increased risk in every dose category compared with non-smokers. Odds ratios were 2.28 (1.08 to 4.80) for 10 or fewer cigarettes a day, 4.64 (2.48 to 8.69) for 11 to 20 a day, and 6.61 (3.52 to 12.42) for more than 20 a day.
  • Odds ratios were 1.30 (0.77 to 2.19) for ever working in an occupation 'known' to be at risk for lung cancer and 0.82 (0.51 to 1.32) for an occupation 'suspected' to be at risk.
  • Compared with the city centre, living in the southern outskirts was linked to a significantly increased risk: odds ratio 1.51 (1.04 to 2.18). The northern outskirts had an odds ratio of 1.29 (0.82 to 2.03).
  • Distance from the harbour and from the power plants showed no difference in risk. Risk was significantly greater for people living furthest from the cement factory (more than 1.2 km versus less than 0.6 km): odds ratio 1.81 (1.13 to 2.92). Length of residence and reported traffic level were not linked to increased risk.
• The authors' conclusion: The authors concluded that occupational exposures can partly explain the increased lung cancer risk in the Civitavecchia area. They also concluded that the geographical analysis did not point to a clear role for living near the industrial sites, and that the higher risk in the outskirts is consistent with dispersion models showing heavy pollutant deposition there.
• Limitations the authors state:
  • Smoking and work histories came from next of kin and may be incomplete or inaccurate. The authors said this could cause misclassification and make the occupational results conservative.
  • Distances from the different pollution sources were highly correlated, so the sources likely confounded one another.
  • The authors described the geographical conclusion as only suggestive and a post hoc interpretation.
  • The higher risk in the outskirts might reflect socioeconomic differences, unmeasured exposures such as radon, or migration of people with lower lung cancer risk.
  • Emission dispersion model results were available for only one power plant.
  • The analysis of individual occupations, including asbestos work, covered men only because there were too few women.
  • Because this was a mortality study, controls may have included smoking-related deaths. The authors said this could explain the lower odds ratios for smokers.

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: Environmental Exposure, Lung Cancer, Occupational Exposure, Odds Ratio, confidence interval, Relative Risk, Habit, Deposition.

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