1
|
Xu M, Ho V, Lavoué J, Olsson A, Schüz J, Richardson L, Parent ME, McLaughlin JR, Demers PA, Guénel P, Radoi L, Wichmann HE, Ahrens W, Jöckel KH, Consonni D, Landi MT, Richiardi L, Simonato L, 't' Mannetje A, Świątkowska B, Field JK, Pearce N, Siemiatycki J. Prevalent occupational exposures and risk of lung cancer among women: Results from the application of the Canadian Job-Exposure Matrix (CANJEM) to a combined set of ten case-control studies. Am J Ind Med 2024; 67:200-213. [PMID: 38192156 DOI: 10.1002/ajim.23562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/19/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Worldwide, lung cancer is the second leading cause of cancer death in women. The present study explored associations between occupational exposures that are prevalent among women, and lung cancer. METHODS Data from 10 case-control studies of lung cancer from Europe, Canada, and New Zealand conducted between 1988 and 2008 were combined. Lifetime occupational history and information on nonoccupational factors including smoking were available for 3040 incident lung cancer cases and 4187 controls. We linked each reported job to the Canadian Job-Exposure Matrix (CANJEM), which provided estimates of probability, intensity, and frequency of exposure to each selected agent in each job. For this analysis, we selected 15 agents (cleaning agents, biocides, cotton dust, synthetic fibers, formaldehyde, cooking fumes, organic solvents, cellulose, polycyclic aromatic hydrocarbons from petroleum, ammonia, metallic dust, alkanes C18+, iron compounds, isopropanol, and calcium carbonate) that had lifetime exposure prevalence of at least 5% in the combined study population. For each agent, we estimated lung cancer risk in each study center for ever-exposure, by duration of exposure, and by cumulative exposure, using separate logistic regression models adjusted for smoking and other covariates. We then estimated the meta-odds ratios using random-effects meta-analysis. RESULTS AND CONCLUSIONS None of the agents assessed showed consistent and compelling associations with lung cancer among women. The following agents showed elevated odds ratio in some analyses: metallic dust, iron compounds, isopropanol, and organic solvents. Future research into occupational lung cancer risk factors among women should prioritize these agents.
Collapse
Affiliation(s)
- Mengting Xu
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| | - Vikki Ho
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| | - Jérôme Lavoué
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| | - Ann Olsson
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Lesley Richardson
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| | - Marie-Elise Parent
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique, Laval, Quebec, Canada
| | - John R McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | - Pascal Guénel
- Center for Research in Epidemiology and Population Health (CESP), Team Exposome and Heredity, U1018 Inserm, Institut Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Loredana Radoi
- Center for Research in Epidemiology and Population Health (CESP), Team Exposome and Heredity, U1018 Inserm, Institut Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Heinz-Erich Wichmann
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Lorenzo Richiardi
- Department of Medical Sciences, Cancer Epidemiology Unit, University of Turin, Turin, Italy
| | - Lorenzo Simonato
- Department of Cardiovascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Andrea 't' Mannetje
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand
| | | | - John K Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, Liverpool, UK
| | - Neil Pearce
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jack Siemiatycki
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| |
Collapse
|
2
|
Oraby T, Chakraborty S, Sivaganesan S, Kincl L, Richardson L, McBride M, Siemiatycki J, Cardis E, Krewski D. Adjusting for Berkson error in exposure in ordinary and conditional logistic regression and in Poisson regression. BMC Med Res Methodol 2023; 23:225. [PMID: 37817074 PMCID: PMC10566152 DOI: 10.1186/s12874-023-02044-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/26/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND INTEROCC is a seven-country cohort study of occupational exposures and brain cancer risk, including occupational exposure to electromagnetic fields (EMF). In the absence of data on individual exposures, a Job Exposure Matrix (JEM) may be used to construct likely exposure scenarios in occupational settings. This tool was constructed using statistical summaries of exposure to EMF for various occupational categories for a comparable group of workers. METHODS In this study, we use the Canadian data from INTEROCC to determine the best EMF exposure surrogate/estimate from three appropriately chosen surrogates from the JEM, along with a fourth surrogate based on Berkson error adjustments obtained via numerical approximation of the likelihood function. In this article, we examine the case in which exposures are gamma-distributed for each occupation in the JEM, as an alternative to the log-normal exposure distribution considered in a previous study conducted by our research team. We also study using those surrogates and the Berkson error adjustment in Poisson regression and conditional logistic regression. RESULTS Simulations show that the introduced methods of Berkson error adjustment for non-stratified analyses provide accurate estimates of the risk of developing tumors in case of gamma exposure model. Alternatively, and under some technical assumptions, the arithmetic mean is the best surrogate when a gamma-distribution is used as an exposure model. Simulations also show that none of the present methods could provide an accurate estimate of the risk in case of stratified analyses. CONCLUSION While our previous study found the geometric mean to be the best exposure surrogate, the present study suggests that the best surrogate is dependent on the exposure model; the arithmetic means in case of gamma-exposure model and the geometric means in case of log-normal exposure model. However, we could present a better method of Berkson error adjustment for each of the two exposure models. Our results provide useful guidance on the application of JEMs for occupational exposure assessments, with adjustment for Berkson error.
Collapse
Affiliation(s)
- Tamer Oraby
- School of Mathematical and Statistical Sciences, University of Texas Rio Grande Valley, Edinburg, TX, USA.
| | - Santanu Chakraborty
- School of Mathematical and Statistical Sciences, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Siva Sivaganesan
- Department of Mathematical Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Laurel Kincl
- College of Health, Oregon State University, Corvallis, OR, USA
| | - Lesley Richardson
- CRCHUM, Centre de Recherche Hospitalier de L'université de Montréal, Montreal, QC, Canada
| | | | - Jack Siemiatycki
- CRCHUM, Centre de Recherche Hospitalier de L'université de Montréal, Montreal, QC, Canada
| | - Elisabeth Cardis
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON, Canada
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Risk Sciences International, Ottawa, Canada
| |
Collapse
|
3
|
Brown JS. Comparison of Oncogenes, Tumor Suppressors, and MicroRNAs Between Schizophrenia and Glioma: The Balance of Power. Neurosci Biobehav Rev 2023; 151:105206. [PMID: 37178944 DOI: 10.1016/j.neubiorev.2023.105206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/25/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
The risk of cancer in schizophrenia has been controversial. Confounders of the issue are cigarette smoking in schizophrenia, and antiproliferative effects of antipsychotic medications. The author has previously suggested comparison of a specific cancer like glioma to schizophrenia might help determine a more accurate relationship between cancer and schizophrenia. To accomplish this goal, the author performed three comparisons of data; the first a comparison of conventional tumor suppressors and oncogenes between schizophrenia and cancer including glioma. This comparison determined schizophrenia has both tumor-suppressive and tumor-promoting characteristics. A second, larger comparison between brain-expressed microRNAs in schizophrenia with their expression in glioma was then performed. This identified a core carcinogenic group of miRNAs in schizophrenia offset by a larger group of tumor-suppressive miRNAs. This proposed "balance of power" between oncogenes and tumor suppressors could cause neuroinflammation. This was assessed by a third comparison between schizophrenia, glioma and inflammation in asbestos-related lung cancer and mesothelioma (ALRCM). This revealed that schizophrenia shares more oncogenic similarity to ALRCM than glioma.
Collapse
|
4
|
Li S, Wang C, Chen J, Lan Y, Zhang W, Kang Z, Zheng Y, Zhang R, Yu J, Li W. Signaling pathways in brain tumors and therapeutic interventions. Signal Transduct Target Ther 2023; 8:8. [PMID: 36596785 PMCID: PMC9810702 DOI: 10.1038/s41392-022-01260-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 01/05/2023] Open
Abstract
Brain tumors, although rare, contribute to distinct mortality and morbidity at all ages. Although there are few therapeutic options for brain tumors, enhanced biological understanding and unexampled innovations in targeted therapies and immunotherapies have considerably improved patients' prognoses. Nonetheless, the reduced response rates and unavoidable drug resistance of currently available treatment approaches have become a barrier to further improvement in brain tumor (glioma, meningioma, CNS germ cell tumors, and CNS lymphoma) treatment. Previous literature data revealed that several different signaling pathways are dysregulated in brain tumor. Importantly, a better understanding of targeting signaling pathways that influences malignant behavior of brain tumor cells might open the way for the development of novel targeted therapies. Thus, there is an urgent need for a more comprehensive understanding of the pathogenesis of these brain tumors, which might result in greater progress in therapeutic approaches. This paper began with a brief description of the epidemiology, incidence, risk factors, as well as survival of brain tumors. Next, the major signaling pathways underlying these brain tumors' pathogenesis and current progress in therapies, including clinical trials, targeted therapies, immunotherapies, and system therapies, have been systemically reviewed and discussed. Finally, future perspective and challenges of development of novel therapeutic strategies in brain tumor were emphasized.
Collapse
Affiliation(s)
- Shenglan Li
- grid.24696.3f0000 0004 0369 153XDepartment of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Can Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jinyi Chen
- grid.24696.3f0000 0004 0369 153XDepartment of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yanjie Lan
- grid.24696.3f0000 0004 0369 153XDepartment of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Weichunbai Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhuang Kang
- grid.24696.3f0000 0004 0369 153XDepartment of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi Zheng
- grid.24696.3f0000 0004 0369 153XDepartment of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Rong Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianyu Yu
- grid.24696.3f0000 0004 0369 153XDepartment of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenbin Li
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
5
|
Rémen T, Richardson L, Siemiatycki J, Lavoué J. Impact of Variability in Job Coding on Reliability in Exposure Estimates Obtained via a Job-Exposure Matrix. Ann Work Expo Health 2021; 66:551-562. [PMID: 34931220 DOI: 10.1093/annweh/wxab106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 09/27/2021] [Accepted: 11/01/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES The use of a job-exposure matrix (JEM) to assess exposure to potential health hazards in occupational epidemiological studies requires coding each participant's job history to a standard occupation and/or industry classification system recognized by the JEM. The objectives of this study were to assess the impact of inter-coder variability in job coding on reliability in exposure estimates derived from linking the job codes to the Canadian job-exposure matrix (CANJEM) and to identify influent parameters. METHOD Two trained coders independently coded 1000 jobs sampled from a population-based case-control study to the ISCO-1968 occupation classification at the five-digit resolution level, of which 859 could be linked to CANJEM using both assigned codes. Each of the two sets of codes was separately linked to CANJEM and thereby generated, for each of the 258 occupational agents available in CANJEM, two exposure estimates: exposure status (yes/no) and intensity of exposure (low, medium, and high) for exposed jobs only. Then, inter-rater reliability (IRR) was computed (i) after stratifying agents in 4 classes depending, for each, on the proportion of occupation codes in CANJEM defined as 'exposed' and (ii) for two additional scenarios restricted to jobs coded differently: the first one using experts' codes, the other one using codes randomly selected. IRR was computed using Cohen's kappa, PABAK and Gwet's AC1 index for exposure status, and weighted kappa and Gwet's AC2 for exposure intensity. RESULTS Across all agents and based on all jobs, median (Q1, Q3; Nagents) values were 0.68 (0.59, 0.75; 220) for kappa, 0.99 (0.95, 1.00; 258) for PABAK, and 0.99 (0.97, 1.00; 258) for AC1. For the additional scenarios, median kappa was 0.28 (0.00, 0.45; 209) and -0.01 (-0.02, 00; 233) restricted to jobs coded differently using experts' and random codes, respectively. A similar decreasing pattern was observed for PABAK and AC1 albeit with higher absolute values. Median kappa remained stable across exposure prevalence classes but was more variable for low prevalent agents. PABAK and AC1 decreased with increasing prevalence. Considering exposure intensity and all exposed jobs, median values were 0.79 (0.68, 0.91; 96) for weighted kappa, and 0.95 (0.89, 0.99; 102) for AC2. For the additional scenarios, median kappa was, respectively, 0.28 (-0.04, 0.42) and -0.05 (-0.18, 0.09) restricted to jobs coded differently using experts' and random codes, with a similar though attenuated pattern for AC2. CONCLUSION Despite reassuring overall reliability results, our study clearly demonstrated the loss of information associated with jobs coded differently. Especially, in cases of low exposure prevalence, efforts should be made to reliably code potentially exposed jobs.
Collapse
Affiliation(s)
- Thomas Rémen
- Health Innovation and Evaluation Hub Department, University of Montreal Hospital Research Center (CRCHUM), Pavillon S, 850 Rue Saint-Denis, Montréal QC, Canada
| | - Lesley Richardson
- Health Innovation and Evaluation Hub Department, University of Montreal Hospital Research Center (CRCHUM), Pavillon S, 850 Rue Saint-Denis, Montréal QC, Canada
| | - Jack Siemiatycki
- Health Innovation and Evaluation Hub Department, University of Montreal Hospital Research Center (CRCHUM), Pavillon S, 850 Rue Saint-Denis, Montréal QC, Canada
| | - Jérôme Lavoué
- Health Innovation and Evaluation Hub Department, University of Montreal Hospital Research Center (CRCHUM), Pavillon S, 850 Rue Saint-Denis, Montréal QC, Canada
| |
Collapse
|
6
|
Batisse E, Labrèche F, Goldberg MS, Lavoué J, Parent ME, Pasquet R, Richardson L, Siemiatycki J, Ho V. Inter-rater reliability of occupational exposure assessment in a case-control study of female breast cancer. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:522-531. [PMID: 34491879 DOI: 10.1080/15459624.2021.1976412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The objective of this paper was to estimate the inter-rater reliability of expert assessments of occupational exposures. An inter-rater reliability sub-study was conducted within a population-based case-control study of postmenopausal breast cancer. Detailed information on lifetime occupational histories was obtained from participants and two industrial hygienists assigned exposures to 185 jobs using a checklist of 293 agents. Experts rated exposure for each job-agent combination according to exposure status (unexposed/exposed), confidence that the exposure occurred (possible/probable/definite), intensity (low/medium/high), and frequency (% time per week). The statistical unit of observation was each job-agent assessment (185 jobs × 293 agents = 54,205 assessments per expert). Crude agreement, Gwet AC1/2 statistics, and Cohen's Kappa were used to estimate inter-rater agreement for confidence and intensity; for frequency, the intra-class correlation coefficient (ICC) was used. The majority of job-agent combinations were evaluated by the two experts to be not exposed (crude agreement >98% of decisions). The degree of agreement between the experts for the confidence of exposure status was Gwet AC1/2 = 0.99 (95% CI: 0.99-0.99), and for intensity, a Gwet AC2 = 0.99 (95% CI: 0.99-0.99). For frequency, an ICC of 0.31 (95% CI: 0.26-0.35) was found. A sub-analysis restricted to job-agent combinations for which the two experts agreed on exposure status revealed a moderate agreement for confidence of exposure (Gwet AC2 = 0.66) and high agreement for intensity (Gwet AC2 = 0.96). For frequency, the ICC was 0.52 (95% CI: 0.47-0.57). A high level of inter-rater agreement was found for identifying exposures and for coding intensity, but agreement was lower for the coding of frequency of exposure.
Collapse
Affiliation(s)
- E Batisse
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - F Labrèche
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail, Montreal, Quebec, Canada
- Department of Environmental and Occupational Health, ESPUM, University of Montreal and CIUSSS Centre-Sud, Montreal, Quebec, Canada
| | - M S Goldberg
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Hospital Centre, Montreal, Quebec, Canada
| | - J Lavoué
- Department of Environmental and Occupational Health, ESPUM, University of Montreal and CIUSSS Centre-Sud, Montreal, Quebec, Canada
- Health Innovation and Evaluation Hub, University of Montreal Hospital Centre Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - M E Parent
- Health Innovation and Evaluation Hub, University of Montreal Hospital Centre Research Centre (CRCHUM), Montreal, Quebec, Canada
- Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique, Laval, Quebec, Canada
- Department of Social and Preventive Medicine, ESPUM, University of Montreal, Montreal, Quebec, Canada
| | - R Pasquet
- Health Innovation and Evaluation Hub, University of Montreal Hospital Centre Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - L Richardson
- Health Innovation and Evaluation Hub, University of Montreal Hospital Centre Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - J Siemiatycki
- Health Innovation and Evaluation Hub, University of Montreal Hospital Centre Research Centre (CRCHUM), Montreal, Quebec, Canada
- Department of Social and Preventive Medicine, ESPUM, University of Montreal, Montreal, Quebec, Canada
| | - V Ho
- Health Innovation and Evaluation Hub, University of Montreal Hospital Centre Research Centre (CRCHUM), Montreal, Quebec, Canada
- Department of Social and Preventive Medicine, ESPUM, University of Montreal, Montreal, Quebec, Canada
| |
Collapse
|
7
|
Rana I, Rieswijk L, Steinmaus C, Zhang L. Formaldehyde and Brain Disorders: A Meta-Analysis and Bioinformatics Approach. Neurotox Res 2021; 39:924-948. [PMID: 33400181 PMCID: PMC8102312 DOI: 10.1007/s12640-020-00320-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023]
Abstract
While there is significant investigation and investment in brain and neurodegenerative disease research, current understanding of the etiologies of illnesses like Alzheimer's disease (AD), Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), and brain cancer remains limited. Environmental exposure to the pollutant formaldehyde, an emerging neurotoxin widely used in industry, is suspected to play a critical role in mediating these disorders, although findings are limited and inconsistent. Focusing on highly exposed groups, we performed a meta-analysis of human epidemiological studies of formaldehyde and neurodegenerative disease (N = 19) or brain tumors (N = 12). To assess the biological plausibility of observed associations, we then conducted a bioinformatics analysis using WikiPathways and the Comparative Toxicogenomics Database and identified candidate genes and pathways that may be related to these interactions. We reported the meta-relative risk (meta-RR) of ALS following high exposures to formaldehyde was increased by 78% (meta-RR = 1.78, 95% confidence interval, CI 1.20-2.65). Similarly, the meta-RR for brain cancer was increased by 71% (meta-RR = 1.71; 95% CI 1.07-2.73) among highly exposed individuals. Multiple sensitivity analyses did not reveal sources of heterogeneity or bias. Our bioinformatics analysis revealed that the oxidative stress genes superoxide dismutase (SOD1, SOD2) and the pro-inflammatory marker tumor necrosis factor (TNF) were identified as the top relevant genes, and the folate metabolism, vitamin B12 metabolism, and the ALS pathways were highly affected by formaldehyde and related to the most brain diseases of interest. Further inquiry revealed the two metabolic pathways are also intimately tied with the formaldehyde cycle. Overall, our bioinformatics analysis supports the link of formaldehyde exposure to ALS or brain tumor reported from our meta-analysis. This new multifactorial approach enabled us to both interrogate the robustness of the epidemiological data and identify genes and pathways that may be involved in these interactions, ultimately lending strong evidence and potential biological plausibility for the association between formaldehyde exposure and brain disease.
Collapse
Affiliation(s)
- Iemaan Rana
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Linda Rieswijk
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
- Institute of Data Science, Maastricht University, Maastricht, Netherlands
| | - Craig Steinmaus
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Luoping Zhang
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA.
| |
Collapse
|
8
|
Rodrigues EG, Herrick RF, Stewart J, Palacios H, Laden F, Clark W, Delzell E. Case-control study of brain and other central nervous system cancer among workers at semiconductor and storage device manufacturing facilities. Occup Environ Med 2020; 77:238-248. [PMID: 32019845 DOI: 10.1136/oemed-2019-106120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/08/2020] [Accepted: 01/15/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study evaluated the relationship between brain and other central nervous system cancer ('CNS cancer') and exposures at two semiconductor and electronic module manufacturing facilities and at a storage device manufacturing facility. METHODS The case-control study, nested in a cohort of 126 836 employees, compared 120 CNS cancer cases and 1028 matched controls with respect to employment in 10 process groups and estimated cumulative exposure to 31 known or possible carcinogens. RESULTS CNS cancer was associated with module manufacturing operations at two facilities. Module manufacturing is a process that begins with production of ceramic substrates followed by attachment of completed semiconductor chips and metal-containing circuitry resulting in a high performing electronic device. Positive associations with the highest tertile of estimated cumulative exposure were found for several chemicals, including 2-butoxyethanol, cyclohexanone, ortho-dichlorobenzene, cadmium, molybdenum, trichloroethylene and vinyl chloride. CONCLUSIONS Results suggested positive associations between CNS cancer and specific operations and chemicals experienced in the semiconductor and electronic module manufacturing industry. However, lack of external support for these findings precludes a causal interpretation, and the observed associations may have been due to chance.
Collapse
Affiliation(s)
- Ema G Rodrigues
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Robert F Herrick
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - James Stewart
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Helena Palacios
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Francine Laden
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - William Clark
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth Delzell
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
9
|
Sauvé JF, Sylvestre MP, Parent MÉ, Lavoué J. Bayesian Hierarchical Modelling of Individual Expert Assessments in the Development of a General-Population Job-Exposure Matrix. Ann Work Expo Health 2020; 64:13-24. [PMID: 31671187 DOI: 10.1093/annweh/wxz077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 06/26/2019] [Accepted: 09/14/2019] [Indexed: 11/14/2022] Open
Abstract
The CANJEM job-exposure matrix compiles expert evaluations of 31 673 jobs from four population-based case-control studies conducted in Montreal. For each job, experts had derived indices of intensity, frequency, and probability of exposure to 258 agents. CANJEM summarizes the exposures assigned to jobs into cells defined by occupation/industry, agent, and period. Some cells may, however, be less populated than others, resulting in uncertain estimates. We developed a modelling framework to refine the estimates of sparse cells by drawing on information available in adjacent cells. Bayesian hierarchical logistic and linear models were used to estimate the probability of exposure and the geometric mean (GM) of frequency-weighted intensity (FWI) of cells, respectively. The hierarchy followed the Canadian Classification and Dictionary of Occupations (CCDO) classification structure, allowing for exposure estimates to be provided across occupations (seven-digit code), unit groups (four-digit code), and minor groups (three-digit code). The models were applied to metallic dust, formaldehyde, wood dust, silica, and benzene, and four periods, adjusting for the study from which jobs were evaluated. The models provided estimates of probability and FWI for all cells that pulled the sparsely populated cells towards the average of the higher-level group. In comparisons stratified by cell sample size, shrinkage of the estimates towards the group mean was marked below 5 jobs/cell, moderate from 5 to 9 jobs/cell, and negligible at ≥10 jobs/cell. The modelled probability of three-digit cells were slightly smaller than their descriptive estimates. No systematic trend in between-study differences in exposure emerged. Overall, the modelling framework for FWI appears to be a suitable approach to refine CANJEM estimates. For probability, the models could be improved by methods better adapted to the large number of cells with no exposure.
Collapse
Affiliation(s)
- Jean-François Sauvé
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, chemin de la Côte Ste-Catherine, Montréal, Québec, Canada.,Centre de recherche du CHUM, Montréal, Québec H2X 0A9, Canada
| | - Marie-Pierre Sylvestre
- Centre de recherche du CHUM, Montréal, Québec H2X 0A9, Canada.,Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Québec, Canada
| | - Marie-Élise Parent
- Centre de recherche du CHUM, Montréal, Québec H2X 0A9, Canada.,Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Québec, Canada.,INRS-Institut Armand-Frappier, Université du Québec, Laval, Québec, Canada
| | - Jérôme Lavoué
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, chemin de la Côte Ste-Catherine, Montréal, Québec, Canada.,Centre de recherche du CHUM, Montréal, Québec H2X 0A9, Canada
| |
Collapse
|
10
|
Sauvé JF, Siemiatycki J, Labrèche F, Richardson L, Pintos J, Sylvestre MP, Gérin M, Bégin D, Lacourt A, Kirkham TL, Rémen T, Pasquet R, Goldberg MS, Rousseau MC, Parent MÉ, Lavoué J. Development of and Selected Performance Characteristics of CANJEM, a General Population Job-Exposure Matrix Based on Past Expert Assessments of Exposure. Ann Work Expo Health 2018; 62:783-795. [PMID: 29897403 DOI: 10.1093/annweh/wxy044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/20/2018] [Indexed: 11/12/2022] Open
Abstract
Objectives We developed a job-exposure matrix called CANJEM using data generated in population-based case-control studies of cancer. This article describes some of the decisions in developing CANJEM, and some of its performance characteristics. Methods CANJEM is built from exposure information from 31673 jobs held by study subjects included in our past case-control studies. For each job, experts had evaluated the intensity, frequency, and likelihood of exposure to a predefined list of agents based on jobs histories and descriptions of tasks and workplaces. The creation of CANJEM involved a host of decisions regarding the structure of CANJEM, and operational decisions regarding which parameters to present. The goal was to produce an instrument that would provide great flexibility to the user. In addition to describing these decisions, we conducted analyses to assess how well CANJEM covered the range of occupations found in Canada. Results Even at quite a high level of resolution of the occupation classifications and time periods, over 90% of the recent Canadian working population would be covered by CANJEM. Prevalence of exposure of specific agents in specific occupations ranges from 0% to nearly 100%, thereby providing the user with basic information to discriminate exposed from unexposed workers. Furthermore, among exposed workers there is information that can be used to discriminate those with high exposure from those with low exposure. Conclusions CANJEM provides good coverage of the Canadian working population and possibly that of several other countries. Available in several occupation classification systems and including 258 agents, CANJEM can be used to support exposure assessment efforts in epidemiology and prevention of occupational diseases.
Collapse
Affiliation(s)
- Jean-François Sauvé
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, chemin de la Côte Ste-Catherine, Montréal, Québec, Canada.,Centre de recherche du CHUM, rue St-Denis, Montréal, Québec, Canada
| | - Jack Siemiatycki
- Centre de recherche du CHUM, rue St-Denis, Montréal, Québec, Canada.,Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, avenue du Parc, Montréal, Québec, Canada
| | - France Labrèche
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, chemin de la Côte Ste-Catherine, Montréal, Québec, Canada.,Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, avenue du Parc, Montréal, Québec, Canada.,Institut de Recherche Robert-Sauvé en Santé et en Sécurité du Travail, Boul. de Maisonneuve Ouest, Montréal, Québec, Canada
| | | | - Javier Pintos
- Centre de recherche du CHUM, rue St-Denis, Montréal, Québec, Canada
| | - Marie-Pierre Sylvestre
- Centre de recherche du CHUM, rue St-Denis, Montréal, Québec, Canada.,Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, avenue du Parc, Montréal, Québec, Canada
| | - Michel Gérin
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, chemin de la Côte Ste-Catherine, Montréal, Québec, Canada
| | - Denis Bégin
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, chemin de la Côte Ste-Catherine, Montréal, Québec, Canada
| | - Aude Lacourt
- Bordeaux Population Health Research Center, Team EPICENE, Université de Bordeaux, UMR, rue Léo Saignat, Bordeaux Cedex, France
| | - Tracy L Kirkham
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Rémen
- Centre de recherche du CHUM, rue St-Denis, Montréal, Québec, Canada
| | - Romain Pasquet
- Centre de recherche du CHUM, rue St-Denis, Montréal, Québec, Canada.,Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, avenue du Parc, Montréal, Québec, Canada
| | - Mark S Goldberg
- Department of Medicine, McGill University, Montréal, Québec, Canada.,Division of Clinical Epidemiology, McGill University Health Centre, Montréal, Québec, Canada
| | - Marie-Claude Rousseau
- Centre de recherche du CHUM, rue St-Denis, Montréal, Québec, Canada.,Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, avenue du Parc, Montréal, Québec, Canada.,INRS-Institut Armand-Frappier, Université du Québec, Laval, Québec, Canada
| | - Marie-Élise Parent
- Centre de recherche du CHUM, rue St-Denis, Montréal, Québec, Canada.,Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, avenue du Parc, Montréal, Québec, Canada.,INRS-Institut Armand-Frappier, Université du Québec, Laval, Québec, Canada
| | - Jérôme Lavoué
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, chemin de la Côte Ste-Catherine, Montréal, Québec, Canada.,Centre de recherche du CHUM, rue St-Denis, Montréal, Québec, Canada
| |
Collapse
|
11
|
Availability of a New Job-Exposure Matrix (CANJEM) for Epidemiologic and Occupational Medicine Purposes. J Occup Environ Med 2018; 60:e324-e328. [DOI: 10.1097/jom.0000000000001335] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Abstract
Incidence, prevalence, and survival for brain tumors varies by histologic type, age at diagnosis, sex, and race/ethnicity. Significant progress has been made in identifying potential risk factors for brain tumors, although more research is warranted. The strongest risk factors that have been identified thus far include allergies/atopic disease, ionizing radiation, and heritable genetic factors. Further analysis of large, multicenter, epidemiologic studies, as well as well annotated omic datasets (including genomic, epigenomic, transcriptomic, proteomic, or metabolomics data) can potentially lead to further understanding of the relationship between gene and environment in the process of brain tumor development.
Collapse
|
13
|
Bencsik A, Lestaevel P, Guseva Canu I. Nano- and neurotoxicology: An emerging discipline. Prog Neurobiol 2018; 160:45-63. [DOI: 10.1016/j.pneurobio.2017.10.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 09/10/2017] [Accepted: 10/20/2017] [Indexed: 12/12/2022]
|
14
|
McElvenny DM, van Tongeren M, Turner MC, Benke G, Figuerola J, Fleming S, Hours M, Kincl L, Krewski D, McLean D, Parent MÉ, Richardson L, Schlehofer B, Schlaefer K, Sadetzki S, Schüz J, Siemiatycki J, Cardis E. The INTEROCC case-control study: risk of meningioma and occupational exposure to selected combustion products, dusts and other chemical agents. Occup Environ Med 2018; 75:12-22. [PMID: 28947494 DOI: 10.1136/oemed-2016-104280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 06/08/2017] [Accepted: 06/20/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Little is known about occupational risk factors for meningioma. OBJECTIVES To study whether risk of meningioma is associated with several occupational exposures, including selected combustion products, dusts and other chemical agents. METHODS The INTEROCC study was an international case-control study of brain cancer conducted in seven countries. Data collection by interview included lifetime occupational histories. A job exposure matrix was used to derive estimates of exposure for the 12 agents. ORs for ever versus never exposed and for exposure-response using duration of exposure and cumulative exposure were derived using conditional logistic regression stratified by sex, age group, country/region, adjusted for education. RESULTS These analyses included 1906 cases and 5565 controls. For 11 of the 12 agents, no excess risk was found for ever exposed. For ever exposure to oil mists, an elevated OR of 1.57 (95% CI 1.10 to 2.22, 51 exposed cases) was found. Statistically significant exposure-response relationships were observed with cumulative exposure (p=0.01) and duration of exposure (p=0.04). Among women, there were also significant trends for cumulative and duration of exposure to asbestos and excesses in the highest exposure categories for formaldehyde. CONCLUSIONS Most agents examined did not provoke excess risks of meningioma. The main finding from this study is that it is the first study to identify a statistical association between exposure to oil mists and meningioma. This may be a chance finding or could be due to confounding with iron exposure and further research is required to understand whether the relationship is causal.
Collapse
Affiliation(s)
| | - Martie van Tongeren
- Institute of Occupational Medicine, Edinburgh, UK
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Medicine, Biology and Health, University of Manchester, UK
| | - Michelle C Turner
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Canada
| | | | - Jordi Figuerola
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Sarah Fleming
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Martine Hours
- Unité Mixte de Recherche Epidémiologique Transport Travail Environnement Université Lyon 1/IFSTTAR, Université de Lyon, Lyon, France
| | - Laurel Kincl
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Canada
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Dave McLean
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | | | | | - Brigitte Schlehofer
- Unit of Environmental Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Klaus Schlaefer
- Unit of Environmental Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Siegal Sadetzki
- The Cancer & Radiation Epidemiology Unit, The Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC), Section of Environment and Radiation, Lyon, France
| | - Jack Siemiatycki
- University of Montreal Hospital Research Centre, Montreal, Canada
| | - Elisabeth Cardis
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| |
Collapse
|
15
|
El-Zaemey S, Anand TN, Heyworth JS, Boyle T, van Tongeren M, Fritschi L. Case–control study to assess the association between colorectal cancer and selected occupational agents using INTEROCC job exposure matrix. Occup Environ Med 2017; 75:290-295. [DOI: 10.1136/oemed-2017-104795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 11/07/2017] [Accepted: 11/23/2017] [Indexed: 01/29/2023]
Abstract
BackgroundColorectal cancer is the third most prevalent cancer in the world and is twice as common in developed countries when compared with low-income and middle-income countries. Few occupational risk factors for colorectal cancer have been identified. This case–control study aimed to assess the association between colorectal cancer and occupational exposure to selected solvents, combustion products, metals, dusts and other agents.MethodsCases (n=918) were enrolled from the Western Australian Cancer Registry from June 2005 to August 2007. Controls (n=1021) were randomly selected from the Western Australian electoral roll. We collected lifetime occupational history from cases and controls, in addition to their demographic and lifestyle characteristics. We applied the INTEROCC job exposure matrix to convert the occupational history to occupational exposure for 18 selected agents. Three exposure indices were developed: (1) exposed versus non-exposed; (2) lifetime cumulative exposure; and (3) total duration of exposure. The associations between colorectal cancer and the selected agents were estimated using logistic regression models adjusting for sex and age.ResultsNone of the 18 selected agents showed an association with colorectal cancer. No dose–response relationships with lifetime cumulative exposure or duration of exposure were observed.ConclusionThere was no evidence to suggest that occupational exposure to 18 selected agents increased the risk of colorectal cancer.
Collapse
|
16
|
Turner MC, Benke G, Bowman JD, Figuerola J, Fleming S, Hours M, Kincl L, Krewski D, McLean D, Parent ME, Richardson L, Sadetzki S, Schlaefer K, Schlehofer B, Schüz J, Siemiatycki J, van Tongeren M, Cardis E. Interactions between occupational exposure to extremely low frequency magnetic fields and chemicals for brain tumour risk in the INTEROCC study. Occup Environ Med 2017; 74:802-809. [PMID: 28600451 PMCID: PMC8640944 DOI: 10.1136/oemed-2016-104080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 05/02/2017] [Accepted: 05/10/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVES In absence of clear evidence regarding possible effects of occupational chemical exposures on brain tumour aetiology, it is worthwhile to explore the hypothesis that such exposures might act on brain tumour risk in interaction with occupational exposure to extremely low frequency magnetic fields (ELF). METHODS INTEROCC is a seven-country (Australia, Canada, France, Germany, Israel, New Zealand and UK), population-based, case-control study, based on the larger INTERPHONE study. Incident cases of primary glioma and meningioma were ascertained from 2000 to 2004. Job titles were coded into standard international occupational classifications and estimates of ELF and chemical exposures were assigned based on job-exposure matrices. Dichotomous indicators of cumulative ELF (≥50th vs <50th percentile, 1-4 year exposure time window) and chemical exposures (ever vs never, 5-year lag) were created. Interaction was assessed on both the additive and multiplicative scales. RESULTS A total of 1939 glioma cases, 1822 meningioma cases and 5404 controls were included in the analysis, using conditional logistic regression. There was no clear evidence for interactions between ELF and any of the chemical exposures assessed for either glioma or meningioma risk. For glioma, subjects in the low ELF/metal exposed group had a lower risk than would be predicted from marginal effects. Results were similar according to different exposure time windows, to cut-points of exposure or in exposed-only analyses. CONCLUSIONS There was no clear evidence for interactions between occupational ELF and chemical exposures in relation to glioma or meningioma risk observed. Further research with more refined estimates of occupational exposures is recommended.
Collapse
Affiliation(s)
- Michelle C Turner
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Canada
| | | | - Joseph D Bowman
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Jordi Figuerola
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Martine Hours
- Université de Lyon, Université Lyon 1/IFSTTAR, Unité Mixte de Recherche Epidémiologique Transport Travail Environnement, Lyon, France
| | | | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Canada
- School of Epidemiology, Public Health and Disease Prevention, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | | - Siegal Sadetzki
- The Cancer & Radiation Epidemiology Unit, The Gertner Institute, Chaim Sheba Medical Center, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Klaus Schlaefer
- Unit of Environmental Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Brigitte Schlehofer
- Unit of Environmental Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC), Section of Environment and Radiation, Lyon, France
| | - Jack Siemiatycki
- University of Montreal Hospital Research Centre, Montreal, Canada
| | | | - Elisabeth Cardis
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| |
Collapse
|
17
|
Benke G, Turner MC, Fleming S, Figuerola J, Kincl L, Richardson L, Blettner M, Hours M, Krewski D, McLean D, Parent ME, Sadetzki S, Schlaefer K, Schlehofer B, Siemiatycki J, van Tongeren M, Cardis E. Occupational solvent exposure and risk of glioma in the INTEROCC study. Br J Cancer 2017; 117:1246-1254. [PMID: 28910824 PMCID: PMC5674105 DOI: 10.1038/bjc.2017.285] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 12/23/2022] Open
Abstract
Background: The aetiology of glioma remains largely unknown. Occupational solvent exposure has been suggested as a putative cause of glioma, but past studies have been inconsistent. We examined the association between a range of solvents and glioma risk within the INTEROCC project, a study of brain tumours and occupational exposures based on data from seven national case–control studies conducted in the framework of the INTERPHONE study. We also investigated associations according to tumour grade. Methods: Data from the seven countries were standardised and then combined into one aggregate data set. Pooled odds ratios (ORs) were estimated for adjusted models that included sex, age, country–region of residence and level of educational attainment. Exposures to any solvent or 11 specific solvents or subgroups were assessed using a modified version of the FINJEM job exposure matrix (JEM) specifically developed for the study, called INTEROCC-JEM. Results: Analysis included 2000 glioma cases and 5565 controls. For glioma and ever/never exposure to any solvent, the OR was 0.91 (95% confidence interval: 0.74–1.11). All ORs were <1.0 for specific solvents/subgroups. There were no increases in risk according to high or low grade of tumour. Conclusions: The results of this study show no consistent associations for any solvent exposures overall or by grade of tumour.
Collapse
Affiliation(s)
- Geza Benke
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Michelle C Turner
- Barcelona Institute for Global Health (ISGlobal), Barcelona 08036, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona 08003, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid 028020, Spain.,McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa K1H 8M5, Canada
| | - Sarah Fleming
- Leeds Institute of Cardiovascular and Metabolic Medicine, Institute of Cancer &Pathology, University of Leeds, Leeds LS2 9LN, UK
| | - Jordi Figuerola
- Barcelona Institute for Global Health (ISGlobal), Barcelona 08036, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona 08003, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid 028020, Spain
| | - Laurel Kincl
- Environmental and Occupational Health program in the College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA
| | - Lesley Richardson
- University of Montreal Hospital Research Centre (CRCHUM), Montreal H2X OA9, Canada
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes-Gutenberg University Mainz, Mainz 55131, Germany
| | - Martine Hours
- Unité Mixte de Recherche Epidémiologique Transport Travail Environnement Université Lyon 1/IFSTTAR, Université de Lyon, Lyon 69675, France
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa K1H 8M5, Canada.,School of Epidemiology, Public Health and Disease Prevention, Faculty of Medicine, University of Ottawa, Ottawa K1G 5Z3, Canada
| | - David McLean
- Centre for Public Health Research, Massey University, Wellington 6140, New Zealand
| | - Marie-Elise Parent
- INRS-Institut Armand-Frappier, Université du Québec, Laval H7V 1B7, Canada
| | - Siegal Sadetzki
- The Cancer &Radiation Epidemiology Unit, The Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer 52620, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Klaus Schlaefer
- German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | | | - Jack Siemiatycki
- University of Montreal Hospital Research Centre (CRCHUM), Montreal H2X OA9, Canada
| | - Martie van Tongeren
- Institute of Occupational Medicine, Edinburgh EH14 4AP, UK.,Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Elisabeth Cardis
- Barcelona Institute for Global Health (ISGlobal), Barcelona 08036, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona 08003, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid 028020, Spain
| |
Collapse
|
18
|
Parent ME, Turner MC, Lavoué J, Richard H, Figuerola J, Kincl L, Richardson L, Benke G, Blettner M, Fleming S, Hours M, Krewski D, McLean D, Sadetzki S, Schlaefer K, Schlehofer B, Schüz J, Siemiatycki J, van Tongeren M, Cardis E. Lifetime occupational exposure to metals and welding fumes, and risk of glioma: a 7-country population-based case-control study. Environ Health 2017; 16:90. [PMID: 28841833 PMCID: PMC5574088 DOI: 10.1186/s12940-017-0300-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/15/2017] [Indexed: 05/04/2023]
Abstract
BACKGROUND Brain tumor etiology is poorly understood. Based on their ability to pass through the blood-brain barrier, it has been hypothesized that exposure to metals may increase the risk of brain cancer. Results from the few epidemiological studies on this issue are limited and inconsistent. METHODS We investigated the relationship between glioma risk and occupational exposure to five metals - lead, cadmium, nickel, chromium and iron- as well as to welding fumes, using data from the seven-country INTEROCC study. A total of 1800 incident glioma cases and 5160 controls aged 30-69 years were included in the analysis. Lifetime occupational exposure to the agents was assessed using the INTEROCC JEM, a modified version of the Finnish job exposure matrix FINJEM. RESULTS In general, cases had a slightly higher prevalence of exposure to the various metals and welding fumes than did controls, with the prevalence among ever exposed ranging between 1.7 and 2.2% for cadmium to 10.2 and 13.6% for iron among controls and cases, respectively. However, in multivariable logistic regression analyses, there was no association between ever exposure to any of the agents and risk of glioma with odds ratios (95% confidence intervals) ranging from 0.8 (0.7-1.0) for lead to 1.1 (0.7-1.6) for cadmium. Results were consistent across models considering cumulative exposure or duration, as well as in all sensitivity analyses conducted. CONCLUSIONS Findings from this large-scale international study provide no evidence for an association between occupational exposure to any of the metals under scrutiny or welding fumes, and risk of glioma.
Collapse
Grants
- 001 World Health Organization
- R01 CA124759 NCI NIH HHS
- National Institutes of Health
- Agence Française de Sécurité Sanitaire de l'Environnement et du Travail
- European Fifth Framework Program
- International Union against Cancer
- Australian National Health and Medical Research Council
- University of Sydney Medical Foundation Program;
- Cancer Council NSW (AU)
- Cancer Council Victoria (AU)
- Canadian Institutes of Health Research
- Canada Research Chairs
- Guzzo-Cancer Research Society
- Fonds de Recherche du Québec - Santé
- National Sciences and Engineering Research Council of Canada
- Association pour la recherche sur le cancer
- German Federal Ministry for the Environment, Nuclear 45 Safety, and Nature Protection
- Ministry for the Environment and Traffic of the state of Baden
- Ministry for the Environment of the state of North Rhine-Westphalia
- MAIFOR Program (Mainzer Forschungsforderungsprogramm) of the University of Mainz
- Health Research Council of New Zealand
- Hawkes Bay Medical Research Foundation
- Wellington Medical Research Foundation
- Waikato Medical Research Foundation
- Cancer Society of New Zealand
- Mobile Telecommunications, Health and Research (MTHR) program, UK
- Health and Safety Executive, UK
- Department of Health, UK
- UK Network Operators (O2, Orange, T-Mobile, Vodafone, ‘3’)
- Scottish Executive
- Mobile Manufacturers’ Forum and GSM Association (with UICC)
- Canadian Wireless Telecommunications Association (with CIHR)
- Network operators Orange, SFR and Bouygues Telecom
Collapse
Affiliation(s)
- Marie-Elise Parent
- Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Université du Québec, 531, Boul. Des Prairies, Laval, Quebec, H7V 1B7 Canada
- School of Public Health, University of Montreal, Montreal, Canada
- University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada
| | - Michelle C. Turner
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Canada
| | - Jérôme Lavoué
- School of Public Health, University of Montreal, Montreal, Canada
- University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada
| | - Hugues Richard
- Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Université du Québec, 531, Boul. Des Prairies, Laval, Quebec, H7V 1B7 Canada
| | - Jordi Figuerola
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Lesley Richardson
- University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada
| | | | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes-Gutenberg University Mainz, Mainz, Germany
| | | | - Martine Hours
- Unité Mixte de Recherche Epidémiologique Transport Travail Environnement Université Lyon 1/IFSTTAR, Université de Lyon, Lyon, France
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Canada
- School of Epidemiology, Public Health and Disease Prevention, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - David McLean
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Siegal Sadetzki
- The Cancer & Radiation Epidemiology Unit, The Gertner Institute, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Joachim Schüz
- International Agency for Research on Cancer (IARC), Section of Environment and Radiation, Lyon, France
| | - Jack Siemiatycki
- School of Public Health, University of Montreal, Montreal, Canada
- University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada
| | - Martie van Tongeren
- Institute of Occupational Medicine, Edinburgh, UK
- Centre for Occupational and Environmental Health, Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Elisabeth Cardis
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| |
Collapse
|
19
|
Quach P, El Sherif R, Gomes J, Krewksi D. A systematic review of the risk factors associated with the onset and progression of primary brain tumours. Neurotoxicology 2016; 61:214-232. [PMID: 27212451 DOI: 10.1016/j.neuro.2016.05.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/13/2016] [Indexed: 12/17/2022]
Abstract
The overall aim of this systematic review was to identify risk factors for onset and natural progression, which were shown to increase, decrease, or have a null association with risk of primary brain tumour. For onset, the project was separated into two phases. The first phase consisted of a systematic search of existing systematic reviews and meta-analyses. Moderate to high methodological quality reviews were incorporated and summarized with relevant observational studies published since 2010, identified from a systematic search performed in phase 2. For natural progression, only the first phase was conducted. Standard systematic review methodology was utilized. Based on this review, various genetic variants, pesticide exposures, occupational farming/hairdressing, cured meat consumption and personal hair dye use appear to be associated with increased risk of onset amongst adults. The specific EGF polymorphsm 61-A allele within Caucasian populations and having a history of allergy was associated with a decreased risk. For progression, M1B-1 antigen was shown to increase the risk. High birth weight, pesticide exposure (childhood exposure, and parental occupational exposure) and maternal consumption of cured meat during pregnancy may also increase the risk of onset of childhood brain tumours. Conversely, maternal intake of pre-natal supplements (folic acid) appeared to decrease risk. Children with neurofibromatosis 2 were considered to have worse overall and relapse free survival compared to neurofibromatosis 1, as were those children who had grade III tumours compared to lesser grades.
Collapse
Affiliation(s)
- Pauline Quach
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Reem El Sherif
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - James Gomes
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Canada
| | - Daniel Krewksi
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada; McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Risk Sciences International, Ottawa, ON, Canada
| |
Collapse
|
20
|
Taha MM, Gaber OAEA, Sabbah NA, Abd Elazem AAS. Association between δ-aminolevulinate dehydratase G177C polymorphism and blood lead levels in brain tumor patients. Mol Clin Oncol 2015; 3:995-1000. [PMID: 26623039 DOI: 10.3892/mco.2015.589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/15/2015] [Indexed: 11/06/2022] Open
Abstract
As the δ-aminolevulinic acid dehydratase (ALAD) G177C polymorphism affects the toxicokinetics of lead in the body, and the corresponding exposure to lead may increase the risk of adult brain tumors, we hypothesize that there is a possible association of the ALAD G177C genotype and the risk of brain tumors in human. Therefore, the aim of the present study was to clarify the role of the ALAD enzyme gene polymorphism at position G177C in the pathogenesis of brain tumors and its correlation to lead exposure. The ALAD gene polymorphism at position G177C was genotyped using the polymerase chain reaction with restriction fragment length polymorphism method and measured the blood lead level by atomic absorption in 81 brain tumor patients and compared the results with 81 controls. The frequency of the GC genotype (ALAD1-2) was significantly increased in primary brain tumor patients compared to the control group. The genotype frequency of ALAD2 (ALAD1-2 and ALAD2-2) was significantly higher in the meningioma patients but was not significant in glioma patients. There was no significant difference in the number of patients and blood lead level when compared with the control. There was a significant increase when compared to ALAD1 regarding a mean value of the lead level. The genotyping of the ALAD G177C polymorphism in the present study revealed a significant association between ALAD2 and brain tumors. The ALAD G177C polymorphism may modify the lead kinetics in the blood, is associated with higher blood lead burden and may provide a biomarker of neurotoxic risk.
Collapse
Affiliation(s)
- Mahmoud Mostafa Taha
- Department of Neurosurgery, Faculty of Medicine, Zagazig University, Zagazig 44512, Egypt
| | - Osama Abd El Aziz Gaber
- Department of Medical Biochemistry, Faculty of Medicine, Zagazig University, Zagazig 44512, Egypt
| | - Norhan Abdalla Sabbah
- Department of Medical Biochemistry, Faculty of Medicine, Zagazig University, Zagazig 44512, Egypt
| | - Abd Allah S Abd Elazem
- Department of Medical Biochemistry, Faculty of Medicine, Al-Azhar University, Assiut 71511, Egypt
| |
Collapse
|
21
|
Turner MC, Benke G, Bowman JD, Figuerola J, Fleming S, Hours M, Kincl L, Krewski D, McLean D, Parent ME, Richardson L, Sadetzki S, Schlaefer K, Schlehofer B, Schüz J, Siemiatycki J, van Tongeren M, Cardis E. Occupational exposure to extremely low-frequency magnetic fields and brain tumor risks in the INTEROCC study. Cancer Epidemiol Biomarkers Prev 2014; 23:1863-72. [PMID: 24935666 PMCID: PMC4154968 DOI: 10.1158/1055-9965.epi-14-0102] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Occupational exposure to extremely low-frequency magnetic fields (ELF) is a suspected risk factor for brain tumors, however the literature is inconsistent. Few studies have assessed whether ELF in different time windows of exposure may be associated with specific histologic types of brain tumors. This study examines the association between ELF and brain tumors in the large-scale INTEROCC study. METHODS Cases of adult primary glioma and meningioma were recruited in seven countries (Australia, Canada, France, Germany, Israel, New Zealand, and the United Kingdom) between 2000 and 2004. Estimates of mean workday ELF exposure based on a job exposure matrix were assigned. Estimates of cumulative exposure, average exposure, maximum exposure, and exposure duration were calculated for the lifetime, and 1 to 4, 5 to 9, and 10+ years before the diagnosis/reference date. RESULTS There were 3,761 included brain tumor cases (1,939 glioma and 1,822 meningioma) and 5,404 population controls. There was no association between lifetime cumulative ELF exposure and glioma or meningioma risk. However, there were positive associations between cumulative ELF 1 to 4 years before the diagnosis/reference date and glioma [odds ratio (OR) ≥ 90th percentile vs. < 25th percentile, 1.67; 95% confidence interval (CI), 1.36-2.07; PLinear trend < 0.0001], and, somewhat weaker associations with meningioma (OR ≥ 90th percentile vs. < 25th percentile, 1.23; 95% CI, 0.97-1.57; PLinear trend = 0.02). CONCLUSIONS Results showed positive associations between ELF in the recent past and glioma. IMPACT Occupational ELF exposure may play a role in the later stages (promotion and progression) of brain tumorigenesis.
Collapse
Affiliation(s)
- Michelle C Turner
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain. Universitat Pompeu Fabra (UPF), Barcelona, Spain. CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa, Ottawa, Canada.
| | | | - Joseph D Bowman
- National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Jordi Figuerola
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain. Universitat Pompeu Fabra (UPF), Barcelona, Spain. CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | - Martine Hours
- Unité Mixte de Recherche Epidémiologique Transport Travail Environnement Université Lyon 1/IFSTTAR, Université de Lyon, Lyon, France
| | | | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa, Ottawa, Canada. Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | | | | | - Siegal Sadetzki
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. The Cancer and Radiation Epidemiology Unit, The Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Klaus Schlaefer
- Unit of Environmental Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Brigitte Schlehofer
- Unit of Environmental Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC), Section of Environment and Radiation, Lyon, France
| | - Jack Siemiatycki
- University of Montreal Hospital Research Centre, Montreal, Canada
| | | | - Elisabeth Cardis
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain. Universitat Pompeu Fabra (UPF), Barcelona, Spain. CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| |
Collapse
|
22
|
Kauppinen T, Uuksulainen S, Saalo A, Mäkinen I, Pukkala E. Use of the Finnish Information System on Occupational Exposure (FINJEM) in epidemiologic, surveillance, and other applications. ACTA ACUST UNITED AC 2014; 58:380-96. [PMID: 24401793 DOI: 10.1093/annhyg/met074] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper reviews the use of the Finnish Information System on Occupational Exposure (Finnish job-exposure matrix, FINJEM) in different applications in Finland and other countries. We describe and discuss studies on FINJEM and studies utilizing FINJEM in regard to the validity of exposure estimates, occupational epidemiology, hazard surveillance and prevention, the assessment of health risks and the burden of disease, the assessment of exposure trends and future hazards, and the construction of job-exposure matrices (JEMs) in countries other than Finland. FINJEM can be used as an exposure assessment tool in occupational epidemiology, particularly in large register-based studies. It also provides information for hazard surveillance at the national level. It is able to identify occupations with high average exposures to chemical agents and can therefore serve the priority setting of prevention. However, it has only limited use at the workplace level due to the variability of exposure between workplaces. The national estimates of exposure and their temporal trends may contribute to the assessment of both the recent and future burden of work-related health outcomes. FINJEM has also proved to be useful in the construction of other national JEMs, for example in the Nordic Occupational Cancer study in the Nordic countries. FINJEM is a quantitative JEM, which can serve many purposes and its comprehensive documentation also makes it potentially useful in countries other than Finland.
Collapse
Affiliation(s)
- Timo Kauppinen
- 1. Surveillance and Reviews, Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41aA, FI-00250 Helsinki, Finland
| | | | | | | | | |
Collapse
|