Occupational risk factors for lung cancer in women: results of a case-control study in Germany

Our plain-English summary of Occupational risk factors for lung cancer in women: results of a case-control study in Germany, by I. Jahn, W. Ahrens, I. Brüske-Hohlfeld, et al (American Journal of Industrial Medicine, 1999).

The study

• Authors: I. Jahn, W. Ahrens, I. Brüske-Hohlfeld, M. Kreuzer, M. Möhner, H. Pohlabeln, H.E. Wichmann, K.H. Jöckel
• Journal: American Journal of Industrial Medicine
• Published: 1999;36(1):90-100
• Cited by: 50 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: To investigate the association between lung cancer and occupational factors in women.

Methods: Six hundred eighty-six women with lung cancer and 712 controls matched for age and region were interviewed to gather occupational histories and information about other risk factors and confounders. Odds ratios (OR) and 95%-confidence intervals (CI) were calculated.

Results: There were 11 cases and 2 controls who reported occupational asbestos exposure. Significantly elevated risks (P < 0.05, smoking-adjusted), were observed in the following industries: chemical, oil (OR 3.7), pottery, glass (OR 2.5), engine, vehicle building (OR 2.2), paper, wood, print (OR 1.9), cleaning service, hairdressing, housekeeping, waste disposal (OR 1.5); and occupations: assemblers, unskilled metal workers (OR 2.5), stock clerks, etc. (OR 1.6), restaurant owners and hoteliers (OR 2.7), as well as waitresses and travel attendants (OR 2.6).

Conclusions: The study provides evidence that both occupations previously observed as hazardous in males, and occupations of particular significance for women only, play a role in the risk of lung cancer in women.

In plain English

This German study compared 686 women with lung cancer and 712 women without it, pooled from two case-control studies run between 1988 and 1996. Women were interviewed about every job held for at least six months and about smoking. Asbestos exposure was assessed with 17 job-specific questionnaires. Thirteen women reported asbestos exposure (11 cases, 2 controls), giving a smoking-adjusted odds ratio of 5.6 (CI 1.07–28.78). Their tasks included work with brake and clutch linings or insulating material containing asbestos, wearing heat protective clothing, and bystander exposure in shipbuilding. After smoking adjustment, statistically significant elevated odds ratios were seen in industries including chemical and oil (3.7) and engine and vehicle building (2.2). They were also seen in jobs including assemblers and unskilled metal workers (2.5), restaurant owners and hoteliers (2.7), and waitresses and travel attendants (2.6). The authors concluded that men and women may face comparable occupational lung cancer risk for exposures both experience, and that some jobs may matter particularly for women. They noted possible selection bias from low control response in one of the two studies.

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: Pooled analysis of two population-based case-control studies (the BIPS study and the GSF study)
• Who was studied: 686 women with newly diagnosed lung cancer and 712 population controls matched for age and region. BIPS study: 165 cases and 165 controls, 1988–1993, Bremen and surroundings and the Frankfurt/Main area. GSF study: 521 cases and 547 controls, 1990–1996, parts of western and eastern Germany.
• Exposure: Lifetime job histories (all jobs held at least six months), coded by occupation and industry. Jobs were compared against lists of known (list A) and suspected (list B) lung cancer risk occupations. Asbestos exposure was assessed with 17 job-specific supplementary questionnaires. No fiber types were named.
• Main results:
  • Women who reported occupational asbestos exposure: 13 women (11 cases and 2 controls); smoking-adjusted odds ratio 5.6, CI 1.07–28.78
  • The asbestos-exposed women's job tasks included production of or work with brake and clutch linings or insulating material containing asbestos (e.g., in a weaving mill, garages, production of car accessories), wearing heat protective clothing, and bystander exposure in shipbuilding
  • Smoking-adjusted odds ratios for women ever employed in these industries were statistically significant: chemical and oil 3.7 (1.44–9.42); pottery and glass 2.5 (1.00–6.08); engine and vehicle building 2.2 (1.10–4.18); paper, wood and print 1.9 (1.12–3.28); cleaning service, hairdressing, housekeeping and waste disposal 1.5 (1.01–2.06)
  • After further adjustment for smoking and asbestos, all of these industries except pottery and glass remained statistically significant
  • Women ever employed as assemblers or unskilled metal workers: smoking-adjusted odds ratio 2.5 (1.16–5.23), based on 33 cases and 13 controls
  • Smoking-adjusted odds ratios were 2.7 (1.14–6.51) for restaurant owners or managers and hoteliers, and 2.6 (1.37–4.87) for waitresses and travel attendants
  • Women ever employed in known high-risk (list A) occupations: 31 cases and 8 controls. Smoking-adjusted odds ratio 3.1 (1.22–7.63); adjusted for smoking and asbestos, 2.7 (1.05–6.92).
  • Housekeeping and restaurant service workers were the only job category where risk rose with longer employment. Their smoking-adjusted odds ratio for more than 10 years employed was 1.8 (1.09–3.11).
• The authors' conclusion: The authors concluded that, for workplace exposures experienced by both sexes, men and women may face comparable risk of occupational lung cancer, and that some industries and occupations may be of particular significance for women only
• Limitations the authors state:
  • Selection bias cannot be completely ruled out because of poor response among controls in the GSF study. The GSF control response was 41%, versus 60% in the BIPS study.
  • People from the lower social class were underrepresented among controls
  • Some of the risks still elevated after smoking adjustment might reflect residual confounding. The authors argued this was unlikely for the hotel and restaurant job findings.

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: Lung Cancer, Case-Control Study, Odds Ratio, confidence interval, Asbestos Exposure.

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