Systematic screening for occupations and occupational exposures in head and neck squamous cell carcinoma patients

Our plain-English summary of Systematic screening for occupations and occupational exposures in head and neck squamous cell carcinoma patients, by S. Deneuve, B. Charbotel, A. Massardier-Pilonchéry, et al (European Archives of Oto-rhino-laryngology, 2019).

The study

• Authors: S. Deneuve, B. Charbotel, A. Massardier-Pilonchéry, E. Fort, C. Milliet-Baude, O. Pérol, J. Fayette, P. Zrounba, B. Fervers
• Journal: European Archives of Oto-rhino-laryngology
• Published: 2019;276(3):857-864
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: The importance of occupational exposures in patients with head and neck squamous cell carcinomas (HNSCC) has received little attention.

Methods: In a single-center study, we prospectively characterized occupational exposures in 154 HNSCC cancer patients in a systematic occupational consultation and examined the association between most frequent exposures, HNSCC stage and localization.

Results: Patients occupied a mean of 3.3 different positions during their working life. The prevalence of asbestos, the most frequent exposure (46 patients; 29.9%) was higher than in the French population > 50 years. Other frequent exposures were solvents (n = 26; 16.9%) and silica (n = 19; 12.3%). For 37 patients (24%) a possible link was identified between occupational exposures and HNSCC. Duration of asbestos exposure was significantly higher (p = 0.04) in patients with hypopharyngeal and laryngeal cancer compared to other localizations.

Conclusions: Occupational exposures are frequent in patients with HNSCC and should receive increased attention by physicians.

In plain English

This was a prospective study at one cancer center in Lyon, France. From January 2009 to July 2011, 154 patients (125 men, 29 women) referred for a first head and neck squamous cell carcinoma met a doctor specialised in occupational health, who recorded their job histories and workplace exposures. At least one occupational exposure was found in 102 patients (66.2%). Asbestos was the most frequent, in 46 patients (29.9%), with a mean exposure of 15.7 years. The article does not name asbestos fiber types. Solvents (26 patients) and silica (19 patients) came next. Asbestos exposure lasted significantly longer in patients with hypopharyngeal and laryngeal cancer than in those with cancers at other sites (p = 0.04). Asbestos-exposed patients also drank more alcohol and were more often exposed to silica and welding fumes. Cancer stage did not differ significantly between asbestos-exposed and unexposed patients. The cancer was judged possibly work-related in 37 patients (24%). One patient's disease was recognised as occupational. The authors noted limited statistical power for subgroup analyses.

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: Prospective single-center study (described by the authors as a prospective cohort) using a systematic occupational health consultation
• Who was studied: 154 patients (125 men, 29 women) referred to the Léon Bérard cancer center, Lyon, France, for a first head and neck squamous cell carcinoma between January 2009 and July 2011; 157 tumours in total (oral cavity, oropharynx, hypopharynx, larynx)
• Exposure: Lifetime occupational exposures collected by an occupational health physician. Asbestos was the most frequent exposure (fiber type not specified). Solvents, silica and other agents were also recorded.
• Main results:
  • At least one occupational exposure was identified in 102 of 154 patients (66.2%)
  • Asbestos exposure was found in 46 patients (29.9%), with a mean exposure duration of 15.7 years (standard deviation 12.1)
  • Solvent exposure was found in 26 patients (16.9%) and silica exposure in 19 patients (12.3%)
  • Duration of asbestos exposure was significantly higher in patients with hypopharyngeal and laryngeal cancer than in patients with cancers at other sites (p = 0.04)
  • In the hypopharyngeal cancer group, 12 of 21 patients had asbestos exposure, a significantly higher prevalence than at other tumour sites (p = 0.02), with a mean exposure duration of 18.2 years
  • There was no significant difference in tumour stage between asbestos-exposed and non-exposed patients
  • Alcohol consumption was significantly higher in asbestos-exposed patients. Tobacco consumption did not differ.
  • Asbestos-exposed patients were significantly more often exposed to silica (28.3 vs. 4.6 as printed, p less than 0.0001), welding fumes, acids and glues
  • The disease was considered imputable to occupational exposures in 37 patients (24%), most with a low level of imputability
  • A compensation claim was judged possible for 4 patients (2.6%). One patient had his disease recognised as a professional disease.
• The authors' conclusion: The authors concluded that occupational exposures are frequent among patients with head and neck squamous cell carcinoma. They said physicians should be aware of a possible causal connection with asbestos exposure and should ask about occupational exposures more systematically, especially in patients with low tobacco consumption. Because only one patient's disease was recognised as occupational, they did not move to generalise systematic screening.
• Limitations the authors state:
  • Statistical power was limited for subgroup analyses

Topics

Medical terms in this study, explained in our Lexicon: Occupational Exposure, Squamous Cell Carcinoma, Asbestos Exposure, Laryngeal Cancer.

Related studies

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• Occupational exposure to flour dust and the risk of head and neck cancer — M. Carton, G. Menvielle, et al. (2018)
• Occupational exposures and squamous cell carcinoma of the oral cavity, pharynx, larynx, and oesophagus: a case-control study in Sweden — P. Gustavsson, R. Jakobsson, et al. (1998)
• 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)
• Chrysotile fibers in tissue adjacent to laryngeal squamous cell carcinoma in cases with a history of occupational asbestos exposure — S.K. Wronkiewicz, V.L. Roggli, et al. (2020)

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