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Pohlabeln, H.* ; Boffetta, P.* ; Ahrens, W.* ; Merletti, F.* ; Agudo, A.* ; Benhamou, E.* ; Brüske, I. ; Ferro, G.* ; Fortes, Ch.* ; Kreuzer, M. ; Wichmann, H.-E.

Occupational Risks for Lung Cancer among Nonsmokers.

Epidemiology 11, 532-538 (2000)

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Open Access Gold as soon as Publ. Version/Full Text is submitted to ZB.

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We conducted a case-control study in 12 European study centers to evaluate the role of occupational risk factors among nonsmokers. We obtained detailed occupational histories from 650 nonsmoking cases (509 females/141 males) and 1,542 nonsmoking controls (1,011 females/531 males). On the basis of an a priori definition of occupations and industries that are known (list A) or suspected (list B) to be associated with lung carcinogenesis, we calculated odds ratios (ORs) for these occupations, using unconditional logistic regression models and adjusting for sex, age, and center effects. Among nonsmoking men, an excess relative risk was observed among those who had worked in list-A occupations [OR = 1.52; 95% confidence interval (CI) = 0.78–2.97] but not in list-B occupations (OR = 1.05; 95% CI = 0.60–1.83). Among nonsmoking women, there was an elevation of risk for list-A occupations (OR = 1.50; 95% CI = 0.49–4.53), although this estimate was imprecise, given that less than 1% of cases and controls were exposed. Exposure to list-B occupations was associated with an increase in relative risk (OR = 1.69; 95% CI = 1.09–2.63) in females, but not in males. Women who had been laundry workers or dry cleaners had an OR of 1.83 (95% CI = 0.98–3.40). Our findings confirm that certain occupational exposures are associated with an increased risk for lung cancer among both female and male nonsmokers; however, knowledge on occupational lung carcinogens is biased toward agents to which mainly men are exposed. Since the early 1950s, it has been well established that smoking is the most important risk factor for lung cancer. 1–3 About 98% of male cases worldwide and 70–90% of European and American female cases report a history of smoking. 4 The population attributable risk percentage for smoking has been estimated to be between 80% and 95% in men 5–7 and about 80% in women. 8 Occupational exposures to carcinogens, indoor radon exposure, dietary habits, industrial air pollution, and environmental tobacco smoke (ETS) are other causes of lung cancer. 9 To examine the separate influence of these risk factors, it is important to control adequately for the impact of smoking. Rough or incomplete recording of the smoking history as well as inadequate consideration of tar contents, inhalation depth, time since smoking cessation, and other smoking behavior patterns have all been discussed as sources of incomplete control of confounding that could be responsible for incorrect risk estimates. Restriction of the analysis to those cases and controls who never smoked should avoid such confounding effects. But, because of the small proportion of lung cancer cases who have never smoked, such restrictions tend to result in imprecise risk estimates. To avoid the problem of low power, an international multicenter case-control study of lung cancer in nonsmokers was initiated in 1988, coordinated by the International Agency for Research on Cancer (IARC). The main objective of the study was to investigate the association between ETS and lung cancer. Results on this exposure have been published elsewhere. 10,11 Here, we investigate the relation between occupational exposures and lung cancer in nonsmokers.

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