Occupational exposure to textile dust and lung cancer risk: Results from the ICARE Study

Our plain-English summary of Occupational exposure to textile dust and lung cancer risk: Results from the ICARE Study, by S. Ben Khedher, M. Neri, F. Guida, et al (American Journal of Industrial Medicine, 2018).

The study

• Authors: S. Ben Khedher, M. Neri, F. Guida, M. Matrat, S. Cenée, M. Sanchez, L. Radoi, G. Menvielle, E. Marrer, D. Luce, I. Stücker, Icare Study Group
• Journal: American Journal of Industrial Medicine
• Published: 2018;61(3):216-228
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: To investigate the association of lung cancer with occupational exposure to textile dust and specifically to cotton dust in the population-based case-control study ICARE.

Methods: Lifelong occupational history of 2926 cases and 3555 controls was collected using standardized questionnaires, with specific questions for textile dust exposure. Odds ratios (ORs) and 95% confidence intervals (CI) were estimated using unconditional logistic regression models controlling for confounding factors including smoking and asbestos exposure.

Results: An inverse association between textile dust exposure and lung cancer was found among workers exposed ≥5% of their work time (OR = 0.80, 95%CI = 0.58-1.09), more pronounced for distant exposures (40+ years; up to a 56% reduced risk, statistically significant). The OR of lung cancer was significantly decreased among workers exposed to cotton fibers (OR = 0.70, 95%CI = 0.48-0.97).

Conclusions: Our results provide some evidence of a decreased risk of lung cancer associated with exposure to textile dust, particularly cotton.

© 2017 Wiley Periodicals, Inc.

In plain English

This French population-based case-control study, ICARE (2001-2007), compared 2926 people with lung cancer and 3555 controls. It examined work exposure to textile dust, and especially cotton dust, adjusting for smoking and estimated asbestos exposure. An odds ratio below 1 means lower odds of lung cancer. The 220 cases (7.5%) and 300 controls (8.4%) with a textile-dust job had an odds ratio of 0.84 (95% CI 0.67-1.07), which the authors called borderline significant. For those exposed more than 5% of their work time it was 0.8 (95% CI 0.58-1.09). In this group, it was 0.44 for last exposure more than 39 to 47 years before interview (95% CI 0.23-0.84) and more than 47 years before (95% CI 0.21-0.94), both significant. It was 1.7 (95% CI 1.01-2.84) for more than 24 to 39 years. Workers with at least one job exposed to cotton over 5% of work time had 0.70 (95% CI 0.48-0.97). The textile odds ratio was 0.68 (95% CI 0.44-1.07) without asbestos exposure and 0.96 (95% CI 0.72-1.28) with it. Neither of these, nor their interaction, was significant. The authors concluded their results support an inverse association but need replication.

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: Multicenter population-based case-control study (ICARE), using face-to-face interviews and logistic regression adjusted for smoking, asbestos and other factors
• Who was studied: 2926 people with histologically confirmed lung cancer aged 18-75, from departments in France covered by cancer registries, and 3555 controls selected by random digit dialing, studied 2001-2007
• Exposure: Self-reported occupational exposure to textile dust in each job. Those exposed more than 5% of work time received a specific questionnaire on fiber types (cotton, wool, silk, Tergal or polyester, polyamide or nylon, rayon). Asbestos exposure was estimated with task and job exposure matrices and treated as a confounder.
• Main results:
  • 220 cases (7.5%) and 300 controls (8.4%) ever held a job with textile dust exposure. Their OR was 0.84 (95% CI 0.67-1.07), described by the authors as borderline statistically significant.
  • Workers exposed 5% or less of work time had an OR of 1.01 (95% CI 0.72-1.4). Those exposed more than 5% of work time (126 cases and 158 controls) had an OR of 0.8 (95% CI 0.58-1.09), not statistically significant.
  • Among workers exposed more than 5% of work time, those last exposed more than 39 to 47 years before interview had an OR of 0.44 (95% CI 0.23-0.84). Those last exposed more than 47 years before had an OR of 0.44 (95% CI 0.21-0.94). Both were statistically significant.
  • In the same group, those last exposed more than 24 and up to 39 years before interview (59 cases, 40 controls) had an OR of 1.7 (95% CI 1.01-2.84), as shown in Table 2.
  • For duration of exposure, all ORs were below one and not statistically significant, with a statistically significant trend (P = 0.03).
  • Workers who had held at least one job exposed to cotton with a frequency over 5% of work time (97 cases, 137 controls) had an OR of 0.70 (95% CI 0.48-0.97). This was the only fiber type with a statistically significant result. The ORs for wool, linen, nylon, rayon, silk and Tergal were below 1 but not significant, and almost all of those workers were also exposed to cotton.
  • Workers exclusively exposed to cotton (18 cases, 21 controls) had an OR of 0.63 (95% CI 0.28-1.40), not statistically significant.
  • Ever exposure to textile dust gave an OR of 0.68 (95% CI 0.44-1.07) among people never exposed to asbestos and 0.96 (95% CI 0.72-1.28) among asbestos-exposed people. The interaction was not statistically significant (P = 0.52).
  • Subjects who reported using protective masks (19 cases, 15 controls) had an OR of 0.94 (95% CI 0.36-2.41). Non-mask users (107 cases, 143 controls) had an OR of 0.76 (95% CI 0.55-1.07). Both were compared with people never exposed to textile fibers.
  • Analyses by histological subtype of lung cancer showed no statistically significant associations.
• The authors' conclusion: The authors concluded that their results support an inverse association between occupational textile dust exposure and lung cancer risk. They wrote that a decreased risk is suggested for exposures distant in time and for work with cotton fibers, and that further investigations are needed to replicate these results.
• Limitations the authors state:
  • Relatively low numbers of subjects in some subgroups may have reduced statistical power.
  • Few workers described their tasks and the chemicals they used, so these could not be analyzed.
  • The retrospective case-control design carries a risk of differential misclassification of exposure.

Topics

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

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

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• The joint effect of asbestos exposure, tobacco smoking and alcohol drinking on laryngeal cancer risk: evidence from the French population-based case-control study, ICARE — G. Menvielle, A. Fayossé, et al. (2016)

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