Cancer of the urinary bladder in Finland: association with occupation

Bladder cancer and occupation: a report from the Belgian case-control study on bladder cancer risk

BACKGROUND

The aim of this study was to add to the data on associations between occupation and bladder cancer thereby strengthening the case for focused research on specific occupational categories.

METHODS

Two hundred two cases and 390 controls participated in this population-based case-control study. Age, sex, smoking, and education adjusted odds ratios (ORs) were calculated for each occupation by unconditional logistic regression.

RESULTS

The occupational group of domestic helpers, cleaners, and launderers exhibited a significantly elevated risk of bladder cancer. Elevated non-significant risks (OR > 1.5) were observed for painters and varnishers, electronic equipment assemblers, general laborers, building finishers, carpenters and joiners, architects and engineers, and textile and garment workers.

CONCLUSIONS

This study suggests that domestic helpers, cleaners, and launderers probably experience an increased risk of bladder cancer. Although no other occupations showed significantly increased risks, the non-significantly elevated risks for painters, carpenters, and textile workers could be confirmed by results from earlier studies.

Increased urinary excretion of 8-hydroxydeoxyguanosine in engine room personnel exposed to polycyclic aromatic hydrocarbons

BACKGROUND

Previous investigations indicate that engine room personnel on ships are exposed to polycyclic aromatic hydrocarbons (PAH) from oil and oil products, with dermal uptake as the major route of exposure. Several PAH are known carcinogens and mutagens.

AIMS

To investigate the urinary excretion of a marker for oxidative DNA damage, 8-hydroxydeoxy-guanosine (8OHdG), in engine room personnel, and to study the association between 8OHdG and 1-hydroxypyrene (1OHP), a biological marker for PAH exposure.

METHODS

Urine samples were collected from engine room personnel (n = 36) on 10 Swedish and Norwegian ships and from unexposed controls (n = 34) with similar age and smoking habits. The exposure to oils, engine exhaust, and tobacco smoke 24 hours prior to sampling was estimated from questionnaires. The urinary samples were frozen for later analyses of 8OHdG and 1OHP by high performance liquid chromatography.

RESULTS

Excretion in urine of 8OHdG (adjusted to density 1.022) was similar for controls (mean 18.0 nmol/l, n = 33), and for those who had been in the engine room without skin contact with oils (mean 18.7 nmol/l, n = 15). Engine room personnel who reported skin contact with oil had increased excretion of 8OHdG (mean 23.2 nmol/l, n = 19). The difference between this group and the unexposed controls was significant. The urinary levels of ln 1OHP and ln 8OHdG were significantly correlated, and the association was still highly significant when the effects of smoking and age were accounted for in a multiple regression analysis.

CONCLUSION

Results indicate that exposure to PAH or possibly other compounds from skin contact with oils in engine rooms may cause oxidative DNA damage.

Risk of bladder cancer in foundry workers: a meta-analysis

To clarify the inconsistent reports of bladder cancer risk in foundry workers, a meta-analytic review of epidemiological studies was undertaken. Summary risk estimates (SRE) were calculated from 40 systematically extracted results. Weakly increased risks were observed overall, with an SRE of 1.11. Twenty three selected study results with better exposure information yielded an SRE of 1.16. This weak increase in risk is consistent with estimates obtained from dose-response trends of PAH exposures in aluminium smelter workers. Summary estimates did not vary substantially with exposure quality, study design, control for smoking, or when limiting the meta-analysis to large study results. Exposure-response findings showed significantly increased risks of about 1.6 to 1.7 after 20 or more years of employment, but this was based on few studies. Occupation specific SREs showed a 40-50% increased risk among moulders, casters, and unskilled foundry labourers. There was limited evidence that bladder cancer risk correlated with lung cancer risk, which is a more established risk among foundry workers. The small increased risk observed is prone to bias and confounding. Further studies of dose-response trends would greatly aid in determining whether this observed association is causal.

Cancers in concrete workers: results of a cohort study of 33,668 workers

OBJECTIVES

To study cancer morbidity patterns in concrete workers.

METHODS

A cohort of 33,503 concrete workers was enrolled in the study from 1971-86. The average duration of follow up was 19.4 years (582,225 person-years). The workers' cancer morbidity was compared with the morbidity of the general population.

RESULTS

A total of 3572 incident cancers were observed. Significantly increased standardised incidence ratios (SIRs) were found for all malignant neoplasms (SIR 107; 95% confidence interval (95%CI) 103 to 110), cancer of the lip (SIR 179; 95%CI 134 to 234), cancer of the stomach (SIR 139; 95%CI 122 to 158), cancer of the lung (SIR 125; 95%CI 114 to 137), and cancer of the prostate (SIR 108; 95%CI 101 to 116). Reduced risk was found for cancer of the large intestine (SIR 80; 95%CI 69 to 93) and cancer of the testis (SIR 50; 95%CI 26 to 87). Smoking was more prevalent among the concrete workers than in the general population (50% v 35%).

CONCLUSION

The study has shown a slightly increased overall risk of cancer among concrete workers. The increased risk of lung cancer could entirely be due to differences in smoking habits between concrete workers and the general population. There is a possibility that the smoking also has contributed to the increased risks of stomach cancer and lip cancer, but occupational factors may have contributed to these cancer sites.

Smoking as a confounder in case-control studies of occupational bladder cancer in women

BACKGROUND

In studies in men, risk estimates on occupation and bladder cancer are distorted by about 10% when not adjusting for smoking. We examined the degree to which occupational risk estimates for bladder cancer in women are confounded by smoking, and the degree of residual confounding by inadequate control of this effect.

METHODS

Primary data of 11 case-control studies on occupation and bladder cancer from Denmark, France, Germany, Greece, Italy, and Spain were pooled. Information for smoking and lifetime occupational history for 700 female cases and 2,425 female controls ages 30-79 was abstracted and recoded. Logistic regression was used to calculate odds ratios (OR) by occupation, applying five models which differed in their degree of adjustment for smoking.

RESULTS

In major occupational groups, risk estimates were distorted by less than 10% when not adjusting for smoking. A statistically significant excess risk for bladder cancer was found in 13 specific occupations and industries. In most occupations, adjustment for smoking led the ORs towards the null value, but all statistically significant associations were maintained after adjustment. In three occupations (lathe operators, field crop workers, and wood manufacturers), a statistically significant excess risk was masked when not adjusting for smoking. In six occupations, estimates were distorted by more than 10% (-22% up to +40%). In occupations where smoking acted as a positive confounder, the proportion of confounding removed using a dichotomous smoking variable (ever/never) was around 60%. In one occupation (buyers), controlling for smoking status (ever, never) led to over-adjustment, because the percentage of smokers was high but the quantity smoked was low.

Cancer, cigarette smoking and premature death in Europe: a review including the Recommendations of European Cancer Experts Consensus Meeting, Helsinki, October 1996

Cigarette smoking has been clearly and unambiguously identified as a direct cause of cancers of the oral cavity, oesophagus, stomach, pancreas, larynx, lung, bladder, kidney and leukaemia, especially acute myeloid leukaemia. Additionally, cigarette smoking is a direct cause of ischaemic heart disease (the commonest cause of death in western countries), respiratory heart disease, aortic aneurysm, chronic obstructive lung disease, stroke, pneumonia and cirrhosis and cancer of the liver. Cigarette smoking can kill in 24 different ways and, although smoking protects against several fatal and non-fatal conditions, the adverse effect of smoking on health is largely negative. In developed countries as a whole, tobacco is responsible for 24% of all male deaths and 7% of all female deaths: these figures rise to over 40% in men in some countries of central and eastern Europe and to 17% in women in the United States. The average loss of life of smokers is 8 years. Among United Kingdom doctors followed for 40 years, overall death rates in middle age were about three times higher among doctors who smoked cigarettes as among doctors who had never smoked regularly. About half of all regular cigarette smokers will eventually be killed by their habit. The important information is that it is never too late to stop smoking: among United Kingdom doctors who stopped smoking, even in middle age, there was a substantial improvement in life expectancy. World-wide, smoking is killing three million people each year and this figure is increasing. In most countries the worst is yet to come, since by the time the young smokers of today reach middle or old age there will be about 10 million deaths/year from tobacco. Approximately 500 million individuals alive today can expect to be killed by tobacco, 250 million of these deaths will occur in middle age. Tobacco is already the biggest cause of adult death in developed countries. Over the next few decades tobacco could well become the biggest cause of adult death in the world. For men in developed countries, the full effects of smoking can already be seen. Tobacco now causes one-third of all male deaths in middle age (plus one fifth in old age). Tobacco is a cause of about half of all male cancer deaths in middle age (plus one-third in old age). Of those who start smoking in their teenage years and keep on smoking, about half will be killed by tobacco. Half of these deaths will be in middle age (35-69) and each will lose an average of 20-25 years of non-smoker life expectancy. In non-smokers in many countries, cancer mortality is decreasing slowly and total mortality rapidly. The war against cancer is being won slowly: the effects of cigarette smoking are holding back this victory. Lung cancer now kills more women in the United States each year than breast cancer. For women in developed countries, the peak of the tobacco epidemic has not yet arrived. Tobacco now causes almost one-third of all deaths in women in middle age in the United States. Although it has only 5% of the world's female population, the United States has 50% of the world's deaths from smoking in women. Tobacco smoking is a major cause of premature death. Throughout Europe, in 1990 tobacco smoking caused three quarters of a million deaths in middle age (between 35 and 69). In the Member States of the European Union in 1990 there were over one quarter of a million deaths in middle age directly caused by tobacco smoking: there were 219700 in men and 31900 in women. There were many more deaths caused by tobacco at older ages. In countries of central and eastern Europe, including the former USSR, there were 441200 deaths in middle age in men and 42100 deaths in women. There is a need for urgent action to help contain this important and unnecessary loss of life. In formulating Recommendations, the European Cancer Experts Consensus Committee recognised that Tobacco Control depends on various parts of society and not only on the individual.

Assessment of exposure to polycyclic aromatic hydrocarbons in engine rooms by measurement of urinary 1-hydroxypyrene

OBJECTIVE

Machinists have an increased risk of lung cancer and bladder cancer, and this may be caused by exposure to carcinogenic compounds such as asbestos and polycyclic aromatic hydrocarbons (PAHs) in the engine room. The aim of this study was to investigate the exposure of engine room personnel to PAHs, with 1-hydroxypyrene in urine as a biomarker.

METHODS

Urine samples from engine room personnel (n = 51) on 10 ships arriving in different harbours were collected, as well as urine samples from a similar number of unexposed controls (n = 47) on the same ships. Urinary 1-hydroxypyrene was quantitatively measured by high performance liquid chromatography. The exposure to PAHs was estimated by a questionnaire answered by the engine room personnel. On two ships, air monitoring of PAHs in the engine room was performed at sea. Both personal monitoring and area monitoring were performed. The compounds were analysed by gas chromatography of two types (with a flame ionisation detector and with a mass spectrometer).

RESULTS

Significantly more 1-hydroxypyrene was found in urine of personnel who had been working in the engine room for the past 24 hours, than in that of the unexposed seamen. The highest concentrations of 1-hydroxypyrene were found among engine room personnel who had experienced oil contamination of the skin during their work in the engine room. Stepwise logistic regression analysis showed a significant relation between the concentrations of 1-hydroxypyrene, smoking, and estimated exposure to PAHs. No PAHs were detected in the air samples.

CONCLUSION

Engine room personnel who experience skin exposure to oil and oil products are exposed to PAHs during their work. This indicates that dermal uptake of PAHs is the major route of exposure.

Tumors of the urinary bladder in painters: a case-control study

In a case-control study, 403 male patients with a diagnosis of "bladder tumor" and (as controls) 426 patients suffering from prostate disease were investigated. The results of this study indicate that past employment as a painter was associated with an excess risk of bladder tumor. The relative risk of bladder tumor estimated for painters was 2.76. The possible role of benzidine-based azodyes (or azodyes based on substituted benzidines) as a carcinogenic risk factor for painters is discussed.

Proportion of lung and bladder cancers in males resulting from occupation: a systematic approach

Studies conducted in several countries that investigated the relationship of occupation and cancer in men were reviewed and compared. Estimates of the proportion of cancers due to occupational exposure that occurred in the general population were analyzed, and sources of variation were explored. A systematic and standardized evaluation of studies on lung and bladder cancer were undertaken, and only investigations that allowed for confounding from tobacco smoking were included. The proportion of lung cancers attributable to occupation ranged between 1 and 5% (when considering only exposure to asbestos) and 40% (in a study with a high proportion of subjects exposed to ionizing radiation); for bladder cancer, estimates were between 0 and 3% in a few studies and between 16 and 24% in several investigations. No similar attempt of systematic comparison was possible for other cancers.

Urothelial cancer and some industry-related chemicals: an evaluation of the epidemiologic literature

In a previous cohort study by our group, certain industry-related chemicals were judged as warranting further attention as possible urothelial carcinogens. In this paper, the epidemiologic literature of cancer of the lower urinary tract is evaluated for these substances. We would like to add combustion gases/soot from coal to the substances considered as increasing the risk of urothelial cancer. It is, however, uncertain whether this risk is due to contaminants of aromatic amines in tar volatiles or whether it depends on other agents, such as nitroarenes or polycyclic aromatic hydrocarbons. Furthermore, we find some support for the hypothesis that exposure to chlorinated aliphatic hydrocarbons increases the risk of urothelial cancer. For creosote, cutting fluids and cutting oils, hair dyes, and polychlorinated biphenyls, data are scarce. Available data do not support the hypothesis that asbestos is associated with urothelial cancer. "Publication bias," such that only limited information was available, was judged to be a potential problem in the review for many, but not all, of the substances investigated.

Occupation and risk of cancer of the lower urinary tract among men. A case-control study

Data from a hospital-based matched case-control study with 531 male pairs were analyzed for risks of cancer of the lower urinary tract associated with previous employment and particular occupational exposures. Statistically significant odds ratios were obtained for ever-employment as mining workers (2.0), turners (2.3), tailors (2.7), truck drivers (1.8), locomotive drivers (3.0) and janitors (3.5), whereas odds ratios of 3.0 or more, found for rubber and plastics workers, printing workers, gas workers, artists and chemists were not statistically significant. When adjusted for smoking, there was a trend toward increasing relative risks with increasing duration of employment as truck drivers and as turners, and relative risks rose 3-fold for 30 or more years of employment. With regard to a priori high-risk industries, ever-employment in the rubber, plastics and synthetics, dyestuff and paints, mining, and printing industries and secondary processing was associated with significantly higher relative risks, and a statistically significant trend in risk with increasing duration of employment was found for the first 3 industries mentioned. With regard to job-related exposures to specified substances, the relative risks observed for increasing duration of exposure suggest that exposures to petroleum, oils, chromium/chromate, spray paints, and zinc, which correspond to exposures involved in the occupations showing a higher relative risk in this study, are associated with a higher risk for cancer of the lower urinary tract.

Bladder cancer among workers in the textile industry: results of a Spanish case-control study

This paper presents results from a case-control study carried out in the county of Mataro, Spain. The study was designed to investigate the possible causes of an unusually high mortality rate from bladder cancer in Mataro county as compared to Spain as a whole, and this report focuses on occupational exposures. The study is based on 57 cases who were hospitalized for or died from bladder cancer between 1978 and 1981. Two controls per case were matched for sex, age, residence, and date of either hospitalization or death. Information was collected on smoking, coffee drinking, and occupation. Occupational histories were then evaluated and coded blind by a group of occupational health physicians. Analyses were carried out by means of conditional logistic regression. Among a group of common occupational sectors, an increased risk for past employment in the textile industry (OR = 2.2; p = .038) was found. Further analyses indicated that the risk is particularly elevated (OR = 4.41; 95% confidence limits; 1.15-16.84) for subjects who worked in dyeing or printing and who were most probably exposed to azo-dyes. Exposure in the textile industry may be responsible for 16% of the bladder cancers in the Mataro area. A list of dyes commonly used in the Mataro textile industries was compiled and cross-checked with lists of substances tested or evaluated for carcinogenesis.

Bladder cancer and occupational exposure to leather

A large case-control study of bladder cancer (2982 cases; 5782 controls) included information about occupational exposure to leather. Occupational histories of exposed white study subjects were reviewed and 150 were determined to have had "true" on the job exposure to leather. The odds ratio estimate (OR) of bladder cancer associated with such exposure in white subjects (n = 8063) was 1.4 (95% confidence limits = 1.0, 1.9) after adjustment for sex, age, and cigarette smoking. The risk was highest in those first employed in a leather job before 1945, although no dose-response relation with duration of leather employment was found. Subjects employed in "dusty" leather jobs had a slightly higher risk than those with other types of leather jobs. Our results are consistent with reports of an increased risk of bladder cancer associated with exposure to leather. Although the agents responsible have not been identified, our findings of an increased risk associated with exposure in the earlier years of this century and in dusty jobs suggest that leather dusts may be important.

Occupation and bladder cancer in males: a case-control study

A case-control study of 512 male cases of bladder cancer and 596 male hospital controls (all living in the province of Turin, Northern Italy, an area with a high proportion of car workers) has been analyzed for occupations. Relative risks were 1.8 (95% c.l. 0.9-3.6) for the textile industry, 3.8 (1.3-11.5) for the leather industry, 1.8 (0.8-4.0) for printing, 8.8 (2.7-28.6) for dyestuff production, 1.2 (0.6-2.4) for tire production and 2.5 (1.0-6.0) for other rubber goods, 2.0 (0.9-4.5) for brickyards and related activities. A relative risk of 3.1 (0.9-10.5) was found for turners having started work before 1940 and with at least 10 years of activity. For truck drivers the relative risk was 1.2 (0.6-2.5). A job-exposure matrix was developed for the development of new hypotheses; an association with bladder cancer was found for aromatic amines only. The attributable risk percent in the population was estimated as 10%, when only those occupations consistently associated with bladder cancer were considered.

Cigarette smoking and bladder cancer in females

In a hospital-based case-control study, 55 women with bladder cancer and 202 female surgical controls were compared for life-long smoking habits. The relative risk associated with cigarette smoking was 2.1; the proportion of bladder cancers attributable to such habit was estimated to be 22%. In comparison with a parallel study in men, it seems that age at diagnosis and age at start of smoking play a different role in the two sexes.

Bladder cancer and smoking in males: types of cigarettes, age at start, effect of stopping and interaction with occupation

A case-control study of 512 male cases of bladder cancer and 596 male hospital controls (all living in the province of Turin, Northern Italy) has been analyzed for cigarette smoking. Relative risks (RRs) decreased with years since stopping, whereas they seemed not to change with age starting to smoke. A multiplicative effect of RRs for smoking and high-risk occupations was suggested. Filters exerted a protective effect (RR = 0.3 for smokers of filter-tip cigarettes only vs. smokers of non-filter-tip cigarettes). A previously unreported difference was noticed between black types and blond types of tobacco (RR = 0.4 for smokers of the blond types only vs. smokers of the black types, adjusted for age, average daily amount, years since stopping, occupation and use of filter).

A cancer register-based case study of occupations of patients with acute myeloid leukemia

All 636 cases of acute myeloid leukemia (AML) reported to the Finnish Cancer Registry between 1971 and 1977 inclusive were compared with patients with other forms of cancer (non-AML) from the same registry. We found no increasing trend in the incidence of AML for either sex, but we found some evidence for regional clusters in certain provinces of Finland. A statistically significant higher incidence was found for men than women in the age group of 50 to 80 years. Classification according to occupation at the time of diagnosis revealed no statistically significant differences between the leukemia cases and the patients with other forms of cancer, but forestry work was more common among the men with AML, and both health care and food industry work were more common among the women with AML. Classification for exposure to chemicals, solvents, or drugs did not yield any statistical differences. The results were inconclusive with regard to the possible role of occupational factors in the etiology of acute myeloid leukemia.