Occupations and industries in France at high risk for pleural mesothelioma: A population-based case-control study (1998-2002)

Our plain-English summary of Occupations and industries in France at high risk for pleural mesothelioma: A population-based case-control study (1998-2002), by P. Rolland, C. Gramond, A. Lacourt, et al (American Journal of Industrial Medicine, 2010).

The study

• Authors: P. Rolland, C. Gramond, A. Lacourt, P. Astoul, S. Chamming's, S. Ducamp, C. Frenay, F. Galateau-Salle, A.G. Ilg, E. Imbernon, N. Le Stang, J.C. Pairon, M. Goldberg, P. Brochard, PNSM Study Group
• Journal: American Journal of Industrial Medicine
• Published: 2010;53(12):1207-19
• Cited by: 41 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Occupational exposure to asbestos, widely used in various industries for decades, is the most important risk factor for pleural mesothelioma. We report here the ranking of occupations and industries in France at high risk for this cancer among men and women.

Methods: A population-based case-control study, conducted from 1998 to 2002, included 462 cases (80.3% men) and 897 controls. Data were collected in face-to-face interviews with a standardized questionnaire. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each occupation and industry; subjects never employed in each category were the reference.

Results: For men, risks were high for several occupations and industries. Besides the expected high risks for non-metallic mineral product makers and manufacturing asbestos products, occupations such as plumbers (OR = 5.57, 95% CI: 2.90-10.69), sheet-metal workers, welders, metal molders, coremakers, and cabinetmakers were also at high risk. Elevated risks were found in the industries of shipbuilding (OR = 9.13, 95% CI: 5.20-16.06) and construction, but also in the manufacturing of metal products, chemicals, and railroad and aircraft equipment. The results for women showed increased but not significant risks in several occupational activities.

Conclusions: This report provides new insight into the epidemiology of mesothelioma, confirming risks for occupational activities reported earlier and pointing out risks in activities never previously reported. It offers guidance to authorities for the compensation of asbestos victims and for prevention in at-risk activities still involving asbestos-containing products.

In plain English

This case–control study examined which jobs and industries were linked to pleural mesothelioma in France. It compared 462 people diagnosed 1998 to 2002 (371 men, 91 women) with 897 matched people without it. It analysed job and industry titles, not measured asbestos exposure. Among men, 11 larger and five smaller occupational groups had significantly raised odds ratios, including plumbers and pipe fitters (OR 5.57, 95% CI 2.90 to 10.69). Among industries with at least 20 subjects, asbestos-product manufacture (OR 11.41, 95% CI 3.80 to 34.30) and shipbuilding and repairing (OR 9.13, 95% CI 5.20 to 16.06) ranked highest; some smaller groups had higher but very imprecise estimates. Motor vehicle repair showed no significantly high risk. Among women, raised odds ratios were not significant except in other financial institutions, a small group the authors found difficult to explain. The authors noted that only about 60% of cases were interviewed, and that low control participation probably overestimated risk among blue-collar men. They concluded the results confirm a strong relation in men between this cancer and work associated with asbestos exposure.

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: Population-based case–control study, with two controls per case drawn from the general population and matched for sex, age and district of residence
• Who was studied: 462 cases (371 men, 91 women) with pleural mesothelioma diagnosed 1998–2002 and 897 controls (732 men, 165 women), living in districts covered by the French National Mesothelioma Surveillance Program (PNSM)
• Exposure: Lifetime occupations and industries (all jobs held at least 6 months), coded by industrial hygienists who did not know whether subjects were cases or controls. Asbestos exposure and fiber types were not measured directly in this analysis.
• Main results:
  • Among men, 11 of the occupations with at least 20 subjects (shown in Figure 2) had a significantly raised odds ratio. The highest was for plumbers and pipe fitters (OR 5.57, 95% CI 2.90 to 10.69).
  • Among men, five further occupations with fewer than 20 subjects also had significantly raised odds ratios: non-metallic mineral (including asbestos) product makers, woodworking machine operators, insulators, metal molders and coremakers, and cabinetmakers.
  • Among men, non-metallic mineral (including asbestos) product makers, a small group of 10 cases and 1 control, had an OR of 20.88 (95% CI 2.64 to 165.00).
  • Among men, insulators (8 cases, 2 controls) had an OR of 6.36 (95% CI 1.32 to 30.56).
  • Among men, among the industries with at least 20 subjects (shown in Figure 3), manufacture of asbestos products had the highest risk (OR 11.41, 95% CI 3.80 to 34.30).
  • Among men, shipbuilding and repairing came next among those industries (OR 9.13, 95% CI 5.20 to 16.06).
  • Among men, smaller industry groups with fewer than 20 subjects also had significantly raised but very imprecise odds ratios. These included manufacture of synthetic resins, plastic materials and man-made fibers except glass (6 cases, 1 control; OR 12.23, 95% CI 1.47 to 102.14).
  • Among men, the smaller industry groups also included food products n.e.c. (6 cases, 1 control; OR 9.68, 95% CI 1.12 to 83.91).
  • Among men, combining high-risk jobs with high-risk industries showed high odds ratios for plumbers and pipe fitters, sheet-metal workers, and welders and flame-cutters in the manufacture of structural metal products.
  • Work involving asbestos friction products (repair of motor vehicles and motorcycles) was not associated with a significantly high risk.
  • Among women, odds ratios were raised for several occupations and industries, but none was statistically significant.
  • Among women, the only significant excess risk was in the small industry group of 'other financial institutions' (7 cases, 4 controls; OR 5.51, 95% CI 1.38 to 22.05).
  • The authors described the financial-institutions result among women as difficult to explain.
• The authors' conclusion: The authors concluded that the results confirm a strong relation in men between pleural mesothelioma and occupational activity associated with asbestos exposure.
• Limitations the authors state:
  • Under-diagnosis of mesothelioma could not be excluded, especially among elderly people.
  • Only about 60% of registered cases were interviewed while alive and included in the study.
  • About 50% of invited controls took part. Male controls included fewer blue-collar workers than the general population, which the authors said probably overestimated the risk among blue-collar men.
  • Each job or industry was analysed without simultaneously accounting for the subjects' other jobs.
  • The analysis did not take into account other factors, such as specific carcinogens from occupational or domestic exposures.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Case-Control Study, Occupational Exposure, Odds Ratio, confidence interval, Epidemiology, Mesothelioma.

Related studies

• Attributable risk in men in two French case-control studies on mesothelioma and asbestos — A. Lacourt, P. Rolland, et al. (2010)
• Compensation of pleural mesothelioma in France: data from the French National Mesothelioma Surveillance Programme — S. Chamming's, B. Clin, et al. (2013)
• Choice of rating method for assessing occupational asbestos exposure: study for compensation purposes in France — C. Gramond, P. Rolland, et al. (2012)
• Occupational and non-occupational attributable risk of asbestos exposure for malignant pleural mesothelioma — A. Lacourt, C. Gramond, et al. (2014)
• Pleural mesothelioma: a descriptive analysis based on a case-control study and mortality data in Ile de France, 1987-1990 — Y. Iwatsubo, J.C. Pairon, et al. (1994)
• Occupational exposure to chlorinated solvents and risk of head and neck cancer in men: a population-based case-control study in France — C. Barul, A. Fayossé, et al. (2017)

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