Sinonasal cancer and occupational exposures: a pooled analysis of 12 case-control studies

Our plain-English summary of Sinonasal cancer and occupational exposures: a pooled analysis of 12 case-control studies, by D. Luce, A. Leclerc, D. Bégin, et al (Cancer Causes & Control, 2002).

The study

• Authors: D. Luce, A. Leclerc, D. Bégin, P.A. Demers, M. Gérin, E. Orlowski, M. Kogevinas, S. Belli, I. Bugel, U. Bolm-Audorff, L.A. Brinton, P. Comba, L. Hardell, R.B. Hayes, C. Magnani, E. Merler, S. Preston-Martin, T.L. Vaughan, W. Zheng, P. Boffetta
• Journal: Cancer Causes & Control
• Published: 2002;13(2):147-57
• Cited by: 93 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: In order to examine the associations between sinonasal cancer and occupational exposures other than wood dust and leather dust, the data from 12 case-control studies conducted in seven countries were pooled and reanalyzed.

Methods: The pooled data set included 195 adenocarcinoma cases (169 men and 26 women), 432 squamous cell carcinomas (330 men and 102 women), and 3136 controls (2349 men and 787 women). Occupational exposures to formaldehyde, silica dust, textile dust, coal dust, flour dust, asbestos, and man-made vitreous fibers were assessed with a job-exposure matrix. Odds ratios (ORs) were adjusted for age, study, wood dust, and leather dust, or other occupational exposures when relevant. 95% confidence intervals (CIs) were estimated by unconditional logistic regression.

Results: A significantly increased risk of adenocarcinoma was associated with exposure to formaldehyde. The ORs for the highest level of exposure were 3.0 (Cl = 1.5-5.7) among men and 6.2 (CI=2.0-19.7) among women. An elevated risk of squamous cell carcinoma was observed among men (OR=2.5, CI=0.6-10.1) and women (OR = 3.5, CI = 1.2-10.5) with a high probability of exposure to formaldehyde. Exposure to textile dust was associated with non-significantly elevated risk of adenocarcinoma, among women only: the OR for the high level of cumulative exposure was 2.5 (CI = 0.7-9.0). High level of asbestos exposure was associated with a significantly increased risk of squamous cell carcinoma among men (OR = 1.6, CI = 1.1-2.3).

Conclusions: The results of this pooled analysis support the hypothesis that occupational exposure to formaldehyde increases the risk of sinonasal cancer, particularly of adenocarcinoma. They also indicate an elevated risk of adenocarcinoma among women exposed to textile dust, and suggest that exposure to asbestos may increase the risk of squamous cell carcinoma.

In plain English

This study pooled and reanalyzed data from 12 case-control studies of cancer of the nose and sinuses (sinonasal cancer) from seven countries, with cases diagnosed between 1968 and 1990. It included 432 squamous cell carcinomas, 195 adenocarcinomas and 3136 controls. Workplace exposure to formaldehyde, silica, textile dust, coal dust, flour dust, asbestos and man-made vitreous fibers was estimated from job titles using a job-exposure matrix. Among men, a high cumulative level of asbestos exposure was linked to a statistically significant increase in squamous cell carcinoma (odds ratio 1.6, 95% confidence interval 1.1 to 2.3), but the authors saw no obvious dose-response pattern. Formaldehyde was linked to adenocarcinoma. Women exposed to textile dust had elevated risks of adenocarcinoma, statistically significant only at the medium level. Mineral wools were not associated with sinonasal cancer. The authors concluded that the results suggest asbestos exposure may increase the risk of squamous cell carcinoma. They noted that estimates based only on job titles were likely misclassified and that some subgroups were small.

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 (reanalysis) of 12 case-control studies
• Who was studied: 930 sinonasal cancer cases (680 men, 250 women), including 432 squamous cell carcinomas (330 men, 102 women) and 195 adenocarcinomas (169 men, 26 women), plus 3136 controls (2349 men, 787 women), from studies in China, France, Germany, Italy, the Netherlands, Sweden and the USA. Cases were diagnosed between 1968 and 1990.
• Exposure: Occupational exposures to wood dust, leather dust, formaldehyde, textile dust, flour dust, coal dust, crystalline silica, asbestos and four types of man-made vitreous fibers (MMVF). These were estimated from job titles and industries with a job-exposure matrix built for this analysis. For asbestos, the matrix rated fiber concentration and how often exposure occurred.
• Main results:
  • Among men, a high cumulative level of asbestos exposure was associated with a significantly increased risk of squamous cell carcinoma: OR 1.6 (95% CI 1.1–2.3), 75 cases and 437 controls. For low and medium levels the ORs were 1.2 (0.8–1.8) and 1.0 (0.7–1.5).
  • For asbestos there was no obvious dose-response pattern. Men definitely exposed to asbestos (probability above 90%) had an OR for squamous cell carcinoma of 1.9 (CI 0.9–3.9). For adenocarcinoma in men, the highest OR, 2.3 (CI 1.5–3.5), was at the lowest probability of exposure, and ORs decreased as probability increased.
  • For asbestos and squamous cell carcinoma in men, the ORs for high cumulative exposure were above one in nine studies, ranging from 1.4 to 7.2. No association was found in three studies (Brescia, Germany, Los Angeles).
  • Cumulative formaldehyde exposure was associated with a significantly increased risk of adenocarcinoma in both sexes. At the highest level the OR was 3.0 (CI 1.5–5.7) in men (adjusted also for wood and leather dust) and 6.2 (CI 2.0–19.7) in women.
  • Among men, definite formaldehyde exposure gave an OR for squamous cell carcinoma of 2.5 (CI 0.6–10.1). Among women, a probability of exposure above 50% gave an OR of 3.5 (CI 1.2–10.5).
  • Textile dust was associated with adenocarcinoma among women only. The OR was 3.5 (CI 1.2–10.7) at the medium cumulative level and 2.5 (CI 0.7–9.0) at the high level.
  • Mineral wools were not associated with sinonasal cancer. Numbers exposed to the other MMVF types were too small for meaningful results.
  • Among women, a significantly elevated risk of adenocarcinoma was found at the highest cumulative silica exposure, but it was based on only two exposed cases. Silica was not associated with nasal cancer in men.
• The authors' conclusion: The authors concluded that the results are consistent with formaldehyde increasing the risk of sinonasal cancer, particularly adenocarcinoma. They also concluded that the results indicate an elevated risk of adenocarcinoma among women exposed to textile dust, and suggest that asbestos exposure may increase the risk of squamous cell carcinoma.
• Limitations the authors state:
  • Exposures were assessed with a job-exposure matrix based only on job titles, without information on actual working conditions, so misclassification of exposure is likely.
  • Several analyses were limited by small numbers of cases in some subgroups, and no conclusive evidence could be given for several exposures.
  • For formaldehyde and adenocarcinoma, residual confounding by wood dust exposure could not be ruled out.

Topics

Medical terms in this study, explained in our Lexicon: Occupational Exposure, Meta-Analysis, Adenocarcinoma, Squamous Cell Carcinoma, Vitreous, Odds Ratio, confidence interval, Cumulative Exposure.

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