Risk factors for nasal malignancies in German men: the South-German Nasal cancer study

Our plain-English summary of Risk factors for nasal malignancies in German men: the South-German Nasal cancer study, by E.M. Greiser, K.H. Greiser, W. Ahrens, et al (BMC Cancer, 2012).

The study

• Authors: E.M. Greiser, K.H. Greiser, W. Ahrens, R. Hagen, R. Lazszig, H. Maier, B. Schick, H.P. Zenner
• Journal: BMC Cancer
• Published: 2012;12:506
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: There are few studies of the effects of nasal snuff and environmental factors on the risk of nasal cancer. This study aimed to investigate the impact of using nasal snuff and of other risk factors on the risk of nasal cancer in German men.

Methods: A population-based case-control study was conducted in the German Federal States of Bavaria and Baden-Württemberg. Tumor registries and ear, nose and throat departments provided access to patients born in 1926 or later.

Results: Telephone interviews were conducted with 427 cases (mean age 62.1 years) and 2.401 population-based controls (mean age 60.8 years). Ever-use of nasal snuff was associated with an odds ratio (OR) for nasal cancer of 1.45 (95% confidence interval [CI] 0.88-2.38) in the total study population, whereas OR in smokers was 2.01 (95% CI 1.00-4.02) and in never smokers was 1.10 (95% CI 0.43-2.80). The OR in ever-smokers vs. never-smokers was 1.60 (95% CI 1.24-2.07), with an OR of 1.06 (95% CI 1.05-1.07) per pack-year smoked, and the risk was significantly decreased after quitting smoking. Exposure to hardwood dust for at least 1 year resulted in an OR of 2.33 (95% CI 1.40-3.91) in the total population, which was further increased in never-smokers (OR 4.89, 95% CI 1.92-12.49) in analyses stratified by smoking status. The OR for nasal cancer after exposure to organic solvents for at least 1 year was 1.53 (1.17-2.01). Ever-use of nasal sprays/nasal lavage for at least 1 month rendered an OR of 1.59 (1.04-2.44). The OR after use of insecticides in homes was 1.48 (95% CI 1.04-2.11).

Conclusions: Smoking and exposure to hardwood dust were confirmed as risk factors for nasal carcinoma. There is evidence that exposure to organic solvents, and in-house use of insecticides could represent novel risk factors. Exposure to asbestos and use of nasal snuff were risk factors in smokers only.

In plain English

This population-based case-control study looked for risk factors for cancers of the nasal cavity, paranasal sinuses and nasopharynx in men in Bavaria and Baden-Württemberg, Germany. The authors compared 427 male cases, born after 1925 and diagnosed from 1990 on, with 2,401 men drawn from residency registries, mainly through telephone interviews; some cases had face-to-face pilot interviews or mailed questionnaires. They asked about lifetime jobs and exposures, including asbestos; no fiber type is named. Smoking and at least a year of hardwood dust exposure were each linked to higher risk. Overall, men with at least a year of asbestos exposure did not show a raised risk (odds ratio 0.81, 95% CI 0.47 to 1.39). Among smokers, risk rose with each year of asbestos exposure, reaching an odds ratio of 2.30 (95% CI 1.17 to 4.53) for 14 or more years. Never-smokers showed no statistically significant increase. The authors concluded that asbestos raised risk mostly in past and current smokers. They noted that fewer cases (55%) than controls (62%) took part. Because cases were recruited retrospectively, many had died, and next-of-kin answered for 31% of cases.

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, mainly using computer-assisted telephone interviews, with face-to-face interviews in a pilot phase and mailed questionnaires for some cases
• Who was studied: 427 male cases born after 1925 with histologically confirmed primary cancer of the nasal cavity, paranasal sinuses or nasopharynx (diagnoses from January 1, 1990), identified through tumor registries in Bavaria and ENT departments in Baden-Württemberg, Germany; 2,401 male controls drawn at random from community residency registries
• Exposure: Self-reported lifetime occupational history, with specific exposures including asbestos, solvents, radiation and dusts. Asbestos was analysed as ever-exposure for at least 1 year, per year of exposure, and by tertiles of exposure years. No fiber type is given. Other exposures studied were nasal snuff, smoking, hardwood, softwood and chipboard dust, organic solvents, nasal sprays or lavage, and home insecticides.
• Main results:
  • All participants: asbestos exposure for at least 1 year was not associated with increased risk. The odds ratio was 0.81 (95% CI 0.47 to 1.39), with 67 cases (15.7%) and 296 controls (12.3%) exposed.
  • All participants: there was a marginally significant increase per year of asbestos exposure for cancers of the paranasal sinuses (OR 1.03, 95% CI 1.00 to 1.06).
  • Smokers: the odds ratio per year of asbestos exposure was 1.04 (95% CI 1.01 to 1.06) in the text; Table 5 gives 1.03 (1.01 to 1.06).
  • Smokers exposed to asbestos for 14 years or longer: OR 2.30 (95% CI 1.17 to 4.53), with 24 exposed cases and 54 exposed controls in that tertile.
  • Smokers, per year of asbestos exposure, by tumor site: paranasal sinuses OR 1.06 (95% CI 1.01 to 1.13); nasopharynx OR 1.05 (95% CI 1.01 to 1.10).
  • The highest asbestos risk reported was in the third tertile of exposure years for paranasal sinus cancers (OR 5.37, 95% CI 1.18 to 24.36). This appears in the discussion of results in ever-smokers.
  • Never-smokers: no statistically significant increase in risk with asbestos exposure.
  • All participants: ever-smokers had a 60% higher risk than never-smokers (OR 1.60, 95% CI 1.24 to 2.07).
  • All participants: hardwood dust exposure for at least 1 year was associated with an OR of 2.33 (95% CI 1.40 to 3.91).
• The authors' conclusion: The authors concluded that their results confirm smoking, hardwood dust and asbestos as carcinogens for nasal carcinoma. They concluded that nasal snuff or asbestos dust leads to increased risk mostly in past and current smokers.
• Limitations the authors state:
  • The response rate was lower in cases (55%) than in controls (62%).
  • Cases were recruited retrospectively, which meant many cases had died.
  • Next-of-kin answered for 134 of 427 cases (31%) but only 19 of 2401 controls (0.8%). The authors examined this as a possible source of bias.
  • The never-smoker subgroup (135 cases, 986 controls) may have been too small to detect a risk. The authors raised this in discussing nasal snuff.

Topics

Medical terms in this study, explained in our Lexicon: Case-Control Study, Odds Ratio, confidence interval, Carcinoma.

Related studies

• Asbestos and cancer of head and neck — P.M. Stell, T. McGill (1973)
• Solitary fibrous tumour of the nasal cavity and paranasal sinuses — I. Alobid, L. Alós, et al. (2003)
• Asbestos and man-made vitreous fibers as risk factors for diffuse malignant mesothelioma: results from a German hospital-based case-control study — K. Rödelsperger, K.H. Jöckel, et al. (2001)
• Workplace risk factors for cancer in the German rubber industry: Part 1. Mortality from respiratory cancers — S.K. Weiland, K. Straif, et al. (1998)
• Solitary fibrous tumor of the nasal cavity and orbit — M. Fukunaga, S. Ushigome, et al. (1995)
• Occupational risk factors for chronic respiratory disease in a New Zealand population using lifetime occupational history — A. Hansell, R.E. Ghosh, et al. (2014)

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