Occupational exposures and risk of esophageal and gastric cardia cancers among male Swedish construction workers

Our plain-English summary of Occupational exposures and risk of esophageal and gastric cardia cancers among male Swedish construction workers, by C. Jansson, A.L. Johansson, I.A. Bergdahl, et al (Cancer Causes & Control, 2005).

The study

• Authors: C. Jansson, A.L. Johansson, I.A. Bergdahl, P.W. Dickman, N. Plato, J. Adami, P. Boffetta, J. Lagergren
• Journal: Cancer Causes & Control
• Published: 2005;16(6):755-64
• Cited by: 52 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: The rising incidence and the strong male predominance among patients with esophageal and gastric cardia adenocarcinoma remain unexplained. We hypothesized that occupational airborne exposures in a traditional male dominated industry might contribute to these observations.

Methods: A prospective, large cohort study of Swedish construction workers was linked to the Swedish population-based registers of Cancer, Causes of Death and Total Population. 260,052 men were followed from 1971 through 2000. Industrial hygienists assessed specific exposures for 200 job titles, and occupational airborne exposures were analyzed separately and combined. Incidence rate ratios (IRR), with 95% confidence intervals (CI), were estimated in multivariable Cox regression models adjusted for attained age, calendar period, smoking status and body mass.

Results: We found positive associations between high exposure to asbestos (IRR 4.5 [95% CI 1.4-14.3]) and cement dust (IRR 3.8 [95% CI 1.5-9.6]) and risk of esophageal adenocarcinoma. Associations were seen between high exposure to asphalt fumes (IRR 2.3 [95% CI 1.0-5.3]) and wood dust (IRR 4.8 [95% CI 1.2-19.4]) and risk of cardia adenocarcinoma. No consistent associations regarding esophageal squamous-cell carcinoma were found.

Conclusions: Exposure to asbestos and cement dust may be risk factors for esophageal adenocarcinoma, and exposure to asphalt fumes and wood dust may increase the risk of cardia adenocarcinoma. However, these associations cannot explain the major sex differences or the increasing incidence trends of these tumors.

In plain English

This prospective cohort study followed 260,052 male Swedish construction workers from their first occupational health examination (1971 to 1993) through 2000, using national registers. Exposure to 12 agents, including asbestos, was rated none, moderate or high from each man's job title at his first examination. During follow-up, 64 men developed esophageal adenocarcinoma, 165 gastric cardia adenocarcinoma and 179 esophageal squamous-cell carcinoma. Among men rated highly exposed to asbestos, the risk of esophageal adenocarcinoma was raised (incidence rate ratio, IRR, 4.5, 95% CI 1.4–14.3), based on 3 cases. High cement dust exposure also showed a raised risk (IRR 3.8, 95% CI 1.5–9.6). Asbestos was not significantly associated with the other two cancers. High asphalt fume and wood dust exposure were associated with cardia adenocarcinoma. The authors concluded that asbestos and cement dust may be risk factors for esophageal adenocarcinoma. They noted limited statistical power, about two significant results expected by chance, exposure estimates based on job title only, and no control for alcohol.

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: Prospective cohort study linked to Swedish national cancer, cause-of-death and population registers, analysed with Cox regression
• Who was studied: 260,052 male Swedish construction workers who attended occupational health examinations (Bygghälsan) between 1971 and 1993, followed through December 31, 2000
• Exposure: A job-exposure matrix built by industrial hygienists, using only the job title at each man's first health examination. It rated 12 agents, including asbestos, as no, moderate or high exposure.
• Main results:
  • Case counts during follow-up: 64 esophageal adenocarcinomas, 165 gastric cardia adenocarcinomas and 179 esophageal squamous-cell carcinomas
  • Esophageal adenocarcinoma: among men with high exposure to asbestos the IRR was 4.5 (95% CI 1.4–14.3). Among men with high exposure to cement dust the IRR was 3.8 (95% CI 1.5–9.6).
  • The high asbestos exposure group included 3,572 men. It had 3 esophageal adenocarcinoma cases (IRR 4.5, 1.4–14.3), 1 cardia adenocarcinoma case (IRR 0.6, 0.1–4.2) and 1 esophageal squamous-cell carcinoma case (IRR 0.5, 0.1–3.7).
  • Cardia adenocarcinoma: high exposure to asphalt fumes gave an IRR of 2.3 (95% CI 1.0–5.3). High exposure to wood dust gave an IRR of 4.8 (95% CI 1.2–19.4).
• The authors' conclusion: The authors concluded that asbestos and cement dust exposure may be risk factors for esophageal adenocarcinoma, and that asphalt fumes and wood dust may increase the risk of gastric cardia adenocarcinoma
• Limitations the authors state:
  • Limited statistical power, because the cancers are rare and several agents were uncommon
  • Many comparisons were made, so about two statistically significant results would be expected by chance alone
  • Lifetime job histories were not available; only the job title at the first health examination was used
  • Exposures were partly misclassified because they were based on job titles rather than individual exposure levels
  • A healthy worker effect: cancer incidence in the cohort was lower than in the general Swedish male population
  • Alcohol consumption could not be controlled for
  • Asbestos exposure is likely underestimated in the cohort

Topics

The National Library of Medicine indexes this study under subjects our site covers: Stomach cancer, Throat and laryngeal cancer.

Medical terms in this study, explained in our Lexicon: Occupational Exposure, Adenocarcinoma, Cohort Study, Incidence, confidence interval, Carcinoma.

Related studies

• Occupational asbestos exposure and risk of esophageal, gastric and colorectal cancer in the prospective Netherlands Cohort Study — N.S. Offermans, R. Vermeulen, et al. (2014)
• Airborne exposures and risk of gastric cancer: a prospective cohort study — K. Sjödahl, C. Jansson, et al. (2007)
• Multiple myeloma and diesel and other occupational exposures in swedish construction workers — W.J. Lee, D. Baris, et al. (2003)
• Occupational Exposures and Esophageal Cancer: Prog Study — A. Gressier, G. Gourier, et al. (2022)
• Occupational exposures and risk of oesophageal cancer by histological type: a case-control study in eastern Spain — M. Santibañez, J. Vioque, et al. (2008)
• Smoking, occupational exposures, and idiopathic pulmonary fibrosis among Swedish construction workers — M. Andersson, P.D. Blanc, et al. (2021)

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