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Oral Session 23 – Cancer and textile workers

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O23.1 SYSTEMATIC REVIEW AND META-ANALYSIS OF MORTALITY AND CANCER INCIDENCE AMONG WORKERS IN THE TEXTILES, FIBRES, AND FABRICS SECTOR OF THE CHEMICAL INDUSTRY

K. Abrams1, J. Fenty2, D. R. Jones1, L. S. Levy2, L. Rushton2, A. J. Sutton1, F. C. Warren2.1Department of Health Sciences, University of Leicester, Leicester, UK; 2MRC Institute for Environment and Health, University of Leicester, Leicester, UK

Introduction: An update of a meta-analysis of cohort studies of chemical workers1 is being carried out for the American Chemistry Council. This paper reports the results for one subsector of the chemical manufacturing industry.

Methods: Papers published in English from 1966 to 2003 are included. A database has been developed for systematic recording of extracted information, including location and time of the study, and definition of the cohort, comparison population and confounders. The analysis, carried out in STATA, includes investigation of heterogeneity and publication bias.

Results: Fourteen unique cohorts were identified: 6,3,3 and 2 from the rayon, cellulose, acrylic fiber and polyester manufacturing industry sectors respectively. The pooled Standardised Mortality Ratio (SMR) for all causes of death for all 14 studies together was 0.90 (95% confidence interval (CI) 0.82-0.99) using a random effects model, with significant heterogeneity between studies. The all cause SMR for the rayon industry was higher than those from the other industry sectors, due mainly to elevated risks from cardiovascular disease, in particular coronary heart disease (pooled SMR 1.16, 95%CI 1.04 to 1.29). Four rayon sector studies investigated exposure response but used widely differing exposure categories.

Discussion: Our investigation has demonstrated the need to take into account toxicological aspects in defining appropriate industry, chemical and process subgroups and has confirmed and quantified the risk of CHD with exposure to carbon disulphide, the main exposure of concern in the rayon industry. However, the biases inherent in occupational cohort study designs, including a possible healthy worker effect, may perpetuate through to any meta-analysis. Future research will include investigation of potential publication bias and development of the methodology for combining disparate exposure categories, where data allow.

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O23.2 OCCUPATION AND BREAST CANCER PREVALENCE AMONG CHINESE WOMEN IN A POPULATION BASED COHORT

B. T. Ji1, A. Blair1, X. O. Shu2, M. Dosemeci1, M. Hauptmann1, G. Yang2, W. H. Chow1, J. Lubin1, N. Rothman1, Y. T. Gao3, W. Zheng2.1National Cancer Institute, NIH, DHHS, Bethesda, MD, USA; 2Vanderbilt University, Nashville, TN, USA; 3Shanghai Cancer Institute, Shanghai, China

Introduction: Little is known about occupational risk factors for breast cancer. We examined the relationship between occupations and prevalence of breast cancer using baseline survey data from a population based cohort study in Shanghai, China.

Methods: During 1997 to 1999, 75 044 women aged 40–70 years were recruited and interviewed regarding lifetime occupation history and other lifestyle factors. Of these, 567 women reported a physician diagnosed breast cancer. A total of 4536 women were selected from non-cancer cohort members and frequency matched to the cases by year of birth and age at diagnosis. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of breast cancer prevalence associated with occupations adjusting for typical breast cancer risk factors.

Results: Preliminary analyses indicated that employment in engineering, agriculture, forestry, education, electric equipment installation maintenance and assembling, and production work increased prevalence of breast cancer, particularly when the job had been started 20 years previously. Specific occupation categories associated with a significantly elevated prevalence included light industry and textile technique personnel (odds ratio 4.3; 95% confidence interval 1.6 to 11.2); elementary school teachers (1.7; 1.1 to 2.5); electricians (2.8; 1.2 to 6.4); plastic process machine operators (2.7; 1.2 to 6.3), and packaging and bailing workers (2.0; 1.0 to 4.0). A dose–response pattern for years of employment was found for elementary school teachers (p for trend 0.015) and electricians (0.016) among those who had started the jobs 20 years previously.

Conclusions: This study suggests that white collar professionals and several production occupations may be associated with an increased risk of breast cancer. Further analyses linking specific occupational exposures and conditions are warranted to identify the factors responsible for the increased risk.

O23.3 EXPOSURES OF TEXTILE WORKERS AND BLADDER CANCER IN SPAIN

C. Serra1,2, D. Turuguet3, M. Kogevinas3, T. Stewart4, N. Malats3, D. Silverman4, F. Real3, N. Rothman4, A. Tardon5, R. Garcia-Closas6, A. Carrato7, G. Castaño-Vinyals3, M. Dosemeci4.1Pompeu Fabra University, Barcelona, Spain; 2Corporació Parc Tauli, Sabadell, Spain; Municipal Institute of Medical Research, Barcelona, Spain; 4National Cancer Institute, Bethesda, USA; 5Universidad de Oviedo, Spain; 6Hospital Unversitario de Canarias, Tenerife, Spain, 7Hospital General de Elche, Spain

Introduction: The textile industry has traditionally been associated with an increased bladder cancer risk that was attributed to exposure to aromatic amine based dyes. Weavers were found at high risk in some studies and the causative exposures are not well understood. We report a detailed analysis of bladder cancer risk in textile workers.

Methods: We conducted a hospital based case–control study in Spain between 1998 and 2001, including 1226 cases of bladder cancer and 1271 controls (87% men). Lifetime occupational history was recorded through a computer assisted personal interview and exposures in the textile industry were assessed by a detailed modular questionnaire. Occupations, specific locations, tasks, and materials used within the industry were recorded. Odds ratios (OR) and 95% confidence intervals (CI) were adjusted for age, sex, region, other high risk occupations, and smoking.

Results: In the study, 248 participants (126 cases, 122 controls) had been ever textile workers, including a higher proportion of women than the total study population. No overall excess risk was found for textile workers (OR 1.1; 95% CI 0.8 to 1.4) compared with non-textile workers. Excess risks were found for weavers (OR 1.9; 1.0 to 3.6), for those who had ever worked in winding (OR 2.9; 1.0 to 8.5), warping, sizing, and/or dressing (OR 7.23; 1.53 to 34.24), and for exposure to synthetic materials (OR 1.88; 1.00 to 3.53) and cotton (OR 1.5; 0.9 to 2.4). No excess risk was found for dyers and finishers. Risks estimates tended to be higher in female than in male textile workers.

Conclusions: Results from this detailed analysis on exposures in the textile industry suggest that the excess risk in weavers could be associated with chemicals used for sizing and/or dressing. Risks associated with production of synthetic materials have rarely been examined in the past, and could be associated with chemical substances used to synthesise textile fibres.

O23.4 OCCUPATIONAL RISKS FOR NASOPHARYNGEAL CARCINOMA: A CASE–COHORT STUDY OF FEMALE TEXTILE WORKERS IN SHANGHAI, CHINA

W. Li1, R. M. Ray1, D. Gao2, E. D. Fitzgibbons1, N. Seixas3, J. Camp3, K. J. Wernli1, G. Astrakianakis3, Z. Feng1, 3, D. B. Thomas1, 3, H. Checkoway1,3.1Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; 2Department of Epidemiology, Zhong Shan Hospital Cancer Center, Shanghai, China; 3Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA

Objective: To investigate whether occupational exposures to dusts and chemicals in the Chinese textile industry are associated with risk of nasopharyngeal cancer.

Methods: A cohort of approximately 267 000 women enrolled in a trial of breast self examination conducted in the textile industry in Shanghai, China was followed for cancer incidence from 1989 to 1998. In this case–cohort analysis, 67 incident nasopharyngeal cancer cases and a random sample (n = 3188) of women in the trial were included. A complete occupational history of work in the textile industry was obtained for each woman. A job exposure matrix developed by experienced industrial hygienists was used to assess work in specific processes and probable exposures to specific dusts and chemical agents.

Results: After adjusting for age and cigarette use, women who worked in printing and dyeing processes for at least 1 year were respectively found to have a 4.3 fold (95% confidence interval 1.2 to 15.3) and 3.0 fold (1.1 to 8.8) excess risk of nasopharyngeal carcinoma. The risk of nasopharyngeal carcinoma increased with increasing duration of working in dyeing processes (p = 0.06). A trend of increasing risk was also found for increasing duration of exposure to acids and caustics (p = 0.05).

Conclusions: Dyeing work, printing work, and exposure to acids and caustics were associated with an increased risk of nasopharyngeal carcinoma in this cohort of women who had worked in the textile industry in Shanghai. This study provides important evidence for a role of occupational exposures in the textile manufacturing industry in the development of nasopharyngeal carcinoma. Ongoing research in this cohort will be seeking to identify specific causative agents.

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