Occup Environ Med 67:568-573 doi:10.1136/oem.2009.051565
  • Review

Bladder cancer risk in painters: a meta-analysis

Editor's Choice
  1. Kurt Straif1
  1. 1Section of IARC Monographs, International Agency for Research on Cancer, Lyon cedex, France
  2. 2Rollins School of Public Health, Department of Environmental and Occupational Health, Emory University, Atlanta, Georgia, USA
  3. 3Unit of Cancer Epidemiology, Department of Biomedical Sciences and Human Oncology, University of Turin, Turin, Italy
  4. 4Emerging Risks Unit, European Food Safety Authority, Parma, Italy
  1. Correspondence to Dr Neela Guha, Section of IARC Monographs, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France; guhan{at}
  1. Contributors All authors have read and contributed to the article.

  • Accepted 13 October 2009


The International Agency for Research on Cancer has classified occupational exposure as a painter as ‘carcinogenic to humans’, largely based on increased risks of bladder and lung cancer. A meta-analysis, including more than 2900 incident cases or deaths from bladder cancer among painters reported in 41 cohort (n=2), record linkage (n=9) and case–control (n=30) studies, was conducted to quantitatively compare the results of the different study designs and the potential confounding effect of smoking as well as other occupational exposures. The summary relative risk (meta-RR, random effects) for bladder cancer in painters was 1.25 (95% CI 1.16 to 1.34; 41 studies) overall and 1.28 (95% CI 1.15 to 1.43; 27 studies) when including only smoking adjusted risk estimates. The elevated risk persisted when restricted to studies that adjusted for other occupational exposures (meta-RR 1.27; 95% CI 0.99 to 1.63; 4 studies). The results remained robust when stratified by study design, gender and study location. Furthermore, exposure–response analyses suggested that the risk increased with duration of employment. There was no evidence of publication bias. Taken together, these results support the conclusion that occupational exposures in painters are causally associated with the risk of bladder cancer.


  • Linked articles 053215.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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