Occupational exposures and risk of stomach cancer by histological type

Our plain-English summary of Occupational exposures and risk of stomach cancer by histological type, by M. Santibañez, J. Alguacil, M.G. de la Hera, et al (Occupational and Environmental Medicine, 2012).

The study

• Authors: M. Santibañez, J. Alguacil, M.G. de la Hera, E.M. Navarrete-Muñoz, J. Llorca, N. Aragonés, T. Kauppinen, J. Vioque, PANESOES Study Group
• Journal: Occupational and Environmental Medicine
• Published: 2012;69(4):268-75
• Cited by: 71 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: To explore the relationship between stomach cancer (SC), by histological type, and occupations and occupational exposures.

Methods: The authors conducted a hospital-based case-control study in south-east Spain. Subjects were 399 incident histological confirmed SC cases (241 intestinal and 109 diffuse adenocarcinomas) and 455 controls frequency matched by sex, age and province of residence. Occupation was coded according to the Spanish National Classification of Occupations 1994. Occupational exposures were assessed by the FINJEM Job Exposure Matrix. ORs were estimated by unconditional logistic regression adjusting for matching variables and education, smoking, alcohol and diet.

Results: In men, statistically significant increased risk of the diffuse subtype was found for 'cooks' (OR 8.02), 'wood-processing-plant operators' (OR 8.13) and 'food and related products machine operators' (OR 5.40); for the intestinal subtype, a borderline association was found for 'miners and quarry workers' (OR men 4.22, 95% CI 0.80 to 22.14). Significant increased risk was observed between the diffuse subtype of SC and the highest level of exposure to 'pesticides' (OR(H) both sexes 10.39, 95% CI 2.51 to 43.02, p(trend)=0.02) and between the intestinal subtype and asbestos (OR(H) men 3.71, 95% CI 1.40 to 9.83, p(trend)=0.07). Restricted analyses of exposures of 15 years and longer showed significant associations between the diffuse subtype and the exposure to 'wood dust' (OR men 3.05).

Conclusions: This study supports the relationship previously suggested between SC and occupational exposure to dusty and high temperature environments. Several occupations may also increase the risk of diffuse SC but not the intestinal subtype.

In plain English

This hospital-based case-control study compared 399 histologically confirmed stomach cancer cases (265 men, 134 women) with 455 controls from nine hospitals in Alicante and Valencia, Spain, between 1995 and 1999. The authors coded each person's main occupations and estimated exposure to 27 agents, including asbestos, with a Finnish job exposure matrix. In men, high estimated asbestos exposure (above 0.26 fibers/cm3) was associated with the intestinal subtype of stomach cancer (OR 3.71, 95% CI 1.40 to 9.83; p for trend 0.07). The association remained for exposure lasting at least 15 years (OR 3.21, 95% CI 1.07 to 9.63). In a pooled analysis of men and women, the diffuse subtype was associated with high pesticide exposure (OR 10.39, 95% CI 2.51 to 43.02), though no women had high exposure. In men, this subtype was also associated with work as cooks, wood-processing-plant operators and food machine operators. The authors cautioned that the asbestos finding could reflect the Finnish matrix over-assigning exposure, and that many comparisons could yield chance findings. They concluded the study supports links between stomach cancer and dusty and high-temperature workplaces.

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: Hospital-based case-control study (part of the PANESOES Study), analysed with unconditional logistic regression
• Who was studied: 399 histologically confirmed stomach cancer cases (265 men and 134 women; 241 intestinal and 109 diffuse adenocarcinomas) and 455 controls (285 men and 170 women) with diseases such as hernias and fractures. Participants were aged 30 to 80 and were hospitalised from January 1995 to March 1999 in nine hospitals in Alicante and Valencia, Spain.
• Exposure: Occupations were taken from each person's two main jobs, coded by the Spanish CNO94 classification. Exposure to 21 chemical agents (including asbestos and pesticides), four physical exposures and two ergonomic exposures was estimated with the FINJEM job exposure matrix and classed as high, low or unexposed. For asbestos, high meant above 0.26 fibers/cm3 and low meant at or below 0.26 fibers/cm3. No asbestos fiber type is specified.
• Main results:
  • Men with high estimated asbestos exposure for at least 1 year had an increased risk of intestinal adenocarcinoma: OR 3.71 (95% CI 1.40 to 9.83), p for trend 0.07. There were 14 exposed cases and 7 exposed controls.
  • In men, the asbestos association with intestinal adenocarcinoma remained when restricted to high exposure lasting at least 15 years: OR 3.21 (95% CI 1.07 to 9.63).
  • In men, high asbestos exposure was associated with all histological types of stomach cancer combined: OR 3.31 (95% CI 1.33 to 8.23). It was not significantly associated with the diffuse subtype: OR 1.68 (95% CI 0.30 to 9.46).
  • In an analysis pooling men and women, the diffuse subtype was associated with the highest level of pesticide exposure: OR 10.39 (95% CI 2.51 to 43.02). The table for women shows no women, either cases or controls, in the high-pesticide category, so the high-exposure group consisted of men. The association remained significant in men alone (OR 8.34, 95% CI 2.01 to 34.61).
  • In men, the diffuse subtype was associated with several occupations: cooks (OR 8.02, 95% CI 1.14 to 56.34), wood-processing-plant operators (OR 8.13, 95% CI 1.52 to 43.55) and food and related products machine operators (OR 5.40, 95% CI 1.21 to 24.08).
  • In men, there was a borderline association between the intestinal subtype and miners and quarry workers: OR 4.22 (95% CI 0.80 to 22.14).
  • In men, the diffuse subtype was associated with wood dust exposure longer than 15 years (OR 3.05, 95% CI 1.11 to 8.32) and with low-level low-frequency magnetic field exposure (OR 2.06, 95% CI 1.10 to 3.85).
• The authors' conclusion: The authors concluded that their study, though explorative, supports previously reported relationships between stomach cancer and occupational exposure to dusty and high-temperature environments. They also concluded that, in their study, occupational factors were more related to the diffuse subtype than to the intestinal subtype.
• Limitations the authors state:
  • The high-asbestos cases were mainly carpenters and joiners and miners and quarry workers. The authors said the asbestos association could be due to the Finnish matrix over-assigning asbestos exposure to Spanish workers.
  • Many comparisons were made, so some associations may be spurious or due to chance.
  • Some associations rest on a low number of observations.
  • FINJEM exposure estimates were not adapted to Spanish exposure circumstances.
  • H pylori infection, which was not accounted for, could cause confounding.
  • Only the two main occupations were collected, not a full lifetime job history.
  • Mineral dust exposure was not assessed through FINJEM.
  • Interviewers were not blinded to case or control status.

Topics

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

Medical terms in this study, explained in our Lexicon: Occupational Exposure, Stomach Cancer, Case-Control Study, Adenocarcinoma.

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