Occupational Risk Factors for Laryngeal Cancer in Tunisia: A Case Control Study

Our plain-English summary of Occupational Risk Factors for Laryngeal Cancer in Tunisia: A Case Control Study, by A. Gaddour, A. Brahem, H. Mosbah, et al (La Medicina del Lavoro, 2023).

The study

• Authors: A. Gaddour, A. Brahem, H. Mosbah, C. Sridi, M. Saidane, M. Belakhdher, A. Chouchene, I. Kacem, M. Maoua, H. Kalboussi, O. El Maalel, S. Chatti, W. Kermani, M. Najib
• Journal: La Medicina del Lavoro
• Published: 2023;114(6):e2023047
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Tobacco use and alcohol consumption are the primary risk factors for laryngeal cancer (LC). In most populations, occupational exposures are likely to play a minor role in laryngeal carcinogenesis. We aimed to investigate the association between occupational exposure and laryngeal cancer.

Methods: It is a case-control study that included 140 cases diagnosed between January 2013 and December 2016 and 140 controls matched by sex, age, alcohol consumption, and tobacco consumption.

Results: Significantly increased risks were found amongst workers of the building sector (OR=4.621; 95% CI [1.826-11.693]) and the mechanical industry sector (OR=5.074; 95% CI [1.425-18.072]). Significant association of laryngeal cancer with various carcinogens was observed such as asbestos (p=0.009; OR=3.68; 95% CI [1.29-10.46]), paint vapors (p=0.005; OR=3.35; 95% CI [1.37-8.16]), solvents (p=0.001; OR=3.29: 95% CI [1.61-6.68]) and cement dust (p=0.003; OR=3.19: 95% CI [1.43-7.12]). After binary logistic regression, cement dust was independently correlated with LC (p=0.042; OR=3.93; 95% CI [1.04-14.78]. The administration sector was associated with decreased risk (p=0.001; OR=0.07; 95% CI [0.03-0.15]) as well as the health sector (p=0.001; OR=0.098; 95% CI [0.02-0.43]).

Conclusions: Our results supported the role of occupational factors in developing LC. Further studies enabling an in-depth analysis of occupational exposures are necessary to provide a clearer definition of the etiological associations between single agents and circumstances of exposure and the genesis of LC.

In plain English

This hospital-based case-control study looked at whether work exposures were linked to laryngeal cancer (cancer of the voice box) in Tunisia. It compared 140 patients diagnosed from 2013 to 2016 at a university hospital in Sousse with 140 people without cancer from the same hospital's occupational medicine clinic, matched for age, sex, smoking and drinking. Trained interviewers recorded work histories. Asbestos (fiber type not stated) was reported by 15 cases and 5 controls (odds ratio 3.68, 95% confidence interval 1.29 to 10.46). Cement dust, solvents and paint vapors were also more common among cases. Building and mechanical industry work were associated with higher risk, and administration and health work with lower risk. When factors were analyzed together, cement dust was the only exposure still independently linked to higher risk, and administration work the only factor linked to lower risk. The authors noted that asbestos, cement dust and silica exposures were closely interconnected, and that hospital recruitment could introduce selection bias. They concluded that the substances most incriminated in their study were asbestos, cement dust, solvents and paint vapors.

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 of occupational risk factors
• Who was studied: 140 laryngeal cancer cases diagnosed between January 2013 and December 2016 and treated at University Hospital Farhat Hached, Sousse, Tunisia, and 140 controls without cancer chosen from consultants of the same hospital's Occupational Medicine department, matched by sex, age, alcohol consumption and tobacco consumption
• Exposure: Self-reported occupational sectors and exposures recorded by face-to-face questionnaire, including asbestos (fiber type not specified), cement dust, silica, solvents, paint vapors, pesticides, metals and others. Each was given a semi-quantitative exposure index (work hours times years of exposure times exposure level from 0 to 3).
• Main results:
  • Asbestos exposure was reported by 15 cases (12.1%) and 5 controls (3.6%): p=0.009, OR=3.68, 95% CI 1.29 to 10.46
  • The asbestos exposure index was higher in cases (161.1, plus or minus 99.3) than in controls (36.0, plus or minus 72.0), p=0.027
  • Cement dust was associated with laryngeal cancer in the univariate analysis (p=0.003; OR=3.19; 95% CI 1.43 to 7.12)
  • In the multivariate analysis, cement dust was the only exposure independently associated with increased risk of laryngeal cancer (p=0.042; OR=3.93; 95% CI 1.04 to 14.78)
  • After binary logistic regression, the administration sector was the only protective factor identified (OR=0.15; 95% CI 0.06 to 0.38)
  • Solvents were associated with laryngeal cancer (p=0.001; OR=3.29; 95% CI 1.61 to 6.68)
  • Paint vapors were associated with laryngeal cancer (p=0.005; OR=3.35; 95% CI 1.37 to 8.16)
  • Increased risks were found for workers in the building sector (OR=4.621; 95% CI 1.826 to 11.693) and the mechanical industry sector (OR=5.074)
  • In the univariate analysis, the administration sector was associated with decreased risk (p=0.001; OR=0.07; 95% CI 0.03 to 0.15), as was the health sector (p=0.001; OR=0.098; 95% CI 0.02 to 0.43)
  • No role of silica dust exposure emerged from the study
• The authors' conclusion: The authors concluded that in their study the most incriminated occupational substances were asbestos, cement dust, solvents and paint vapors
• Limitations the authors state:
  • As a hospital-based rather than population-based study, it could be susceptible to selection bias
  • Exposure assessment was semi-quantitative and may not objectively capture exposure variability between jobs
  • Exposures to asbestos, cement dust and silica are strongly interconnected, making it difficult to study the individual effect of each
  • Differences between participants could affect how questions were understood; the authors simplified the questions and checked understanding

Topics

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

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

Related studies

• A case-control study of occupational risk factors for laryngeal cancer — P. Wortley, T.L. Vaughan, et al. (1992)
• Occupational asbestos exposure as a risk factor for laryngeal carcinoma in a population-based case-control study from Germany — H. Ramroth, W. Ahrens, et al. (2011)
• Exposure to cement dust, related occupational groups and laryngeal cancer risk: results of a population based case-control study — A. Dietz, H. Ramroth, et al. (2004)
• Laryngeal and hypopharyngeal cancer and occupational exposure to asbestos and man-made vitreous fibers: results of a case-control study — J.L. Marchand, D. Luce, et al. (2000)
• 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)
• Diet and other risk factors for laryngeal cancer in Shanghai, China — W. Zheng, W.J. Blot, et al. (1992)

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