Use of job-exposure matrix in an occupational analysis of lung and bladder cancers on the basis of death certificates

Our plain-English summary of Use of job-exposure matrix in an occupational analysis of lung and bladder cancers on the basis of death certificates, by D. Coggon, B. Pannett, E.D. Acheson (Journal of the National Cancer Institute, 1984).

The study

• Authors: D. Coggon, B. Pannett, E.D. Acheson
• Journal: Journal of the National Cancer Institute
• Published: 1984;72(1):61-5
• Cited by: 105 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001678).

Abstract

A job-exposure matrix has been applied in a case-control study of lung and bladder cancer on the basis of occupational information abstracted from British death certificates. The expected association between lung cancer and jobs entailing exposure to asbestos was clearly demonstrated (relative risk, 1.5; 95% confidence interval, 1.2-1.9). The effects of three other known industrial carcinogens were not apparent, and reasons for this were discussed. Also included in the matrix were five substances whose carcinogenicity in humans has not been established. Formaldehyde, diesel fumes, and cutting oils were all associated with carcinoma of the bronchus, but the absence of a risk in "high-exposure" occupations was against a causal relationship. Bladder cancer was more common in jobs involving high exposure to printing inks (relative risk, 5.0; 95% confidence interval, 1.0-25.8) and cutting oils (relative risk, 1.5; 95% confidence interval, 0.8-2.8). Use of the job-exposure matrix added considerably to the conventional analysis of cancer risk in individual occupational categories.

In plain English

This case-control study used British death certificates to link men's last recorded job with lung or bladder cancer. The lung cancer cases were 598 men under 40 who died of carcinoma of the bronchus in England and Wales in 1975-79, each matched with men who died of other causes. Bladder cancer deaths in men under 50 were analyzed the same way. A job-exposure matrix graded each job's likely exposure to nine substances, including asbestos, as high, low or none. Asbestos-exposed jobs were associated with lung cancer (relative risk 1.5, 95% confidence interval 1.2 to 1.9). The relative risk was 1.9 (1.2 to 2.9) in heavily exposed jobs. Asbestos-exposed jobs showed no statistically significant association with bladder cancer (relative risk 0.8, 95% confidence interval 0.6 to 1.1). The study did not detect known risks from arsenic, chromates or aromatic amines. Death certificates recorded only the last full-time job, with no industry or smoking information. The authors stated that firm conclusions about carcinogenicity cannot be drawn from such studies, but that the matrix enhanced death certificate data, particularly for asbestos.

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: Case-control study based on death certificates, with occupations grouped by exposure using a job-exposure matrix
• Who was studied: Lung cancer: 598 men under 40 who died of carcinoma of the bronchus in England and Wales in 1975-79. Of these, 582 were matched with 2 controls and 16 with 1 control who died of other causes. Bladder cancer: 291 men under 50 who died of bladder cancer in 1975-79. All but 4 were assigned 2 controls.
• Exposure: The most recent full-time occupation on the death certificate was coded. A matrix graded each job's likely exposure as high, low or none to nine known or putative carcinogens: asbestos, arsenic, chromates, aromatic amines, formaldehyde, cutting oils, diesel fumes, printing ink and solder. No asbestos fiber type was specified.
• Main results:
  • Lung cancer: occupations with asbestos exposure showed an association with lung cancer (relative risk 1.5, 95% confidence limits 1.2 to 1.9).
  • Lung cancer: there was a dose-response effect, with a relative risk of 1.9 (95% confidence limits 1.2 to 2.9) for occupations heavily exposed to asbestos.
  • Bladder cancer: all asbestos-exposed occupations (53 cases, 126 controls) had a relative risk of 0.8 (95% confidence interval 0.6 to 1.1). High-exposure occupations (10 cases, 18 controls) had a relative risk of 1.1 (0.5 to 2.5). Neither was statistically significant.
  • Construction workers showed an increased risk of lung cancer. The authors said exposure to asbestos is a possible explanation.
  • The study found no significant association between lung cancer and chromates. It found no evidence of the known lung cancer risk from arsenic or the bladder cancer risk from aromatic amines.
  • Formaldehyde, cutting oils and diesel fumes were each significantly associated with lung cancer, but none showed a dose-response relationship.
  • Bladder cancer: associations were found for cutting oils, printing ink and solder, with higher relative risks in heavily exposed occupations. In high-exposure occupations the relative risks were 1.5 (0.8 to 2.8) for cutting oils, 5.0 (1.0 to 25.8) for printing ink and 1.8 (0.9 to 3.6) for solder. These associations just failed to reach significance at the 5% level.
• The authors' conclusion: The authors concluded that they had shown how a job-exposure matrix can enhance occupational information from death certificates. They said this applies particularly when, as with asbestos, the exposure occurs in many different industries and jobs.
• Limitations the authors state:
  • Death certificates in England and Wales record only the most recent full-time occupation.
  • There was no information on the industries in which subjects worked.
  • Smoking, the most important possible confounder, could not be accounted for.
  • With 223 comparisons for each cancer, some associations could be expected to be significant by chance.
  • The asbestos relative risk was much lower than in cohort studies of asbestos workers. The authors attributed this to incomplete specificity in assigning exposures through the matrix.
  • How long subjects had held their jobs was unknown.
  • The cases were young. Carcinogens with a long minimum latent period will have little effect below age 50.
  • Firm conclusions about carcinogenicity cannot be drawn from studies of this kind.

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: Death Certificate, Case-Control Study, Lung Cancer, Relative Risk, confidence interval, Carcinoma, Bronchus.

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