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A comparison of exposure assessment approaches: lung cancer and occupational asbestos exposure in a population-based case–control study
  1. Jill S Hardt1,
  2. Roel Vermeulen2,
  3. Susan Peters2,3,
  4. Hans Kromhout2,
  5. John R McLaughlin1,4,
  6. Paul A Demers1
  1. 1Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada
  2. 2Environmental Epidemiology Division, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
  3. 3Epidemiology Group, Centre for Medical Research, University of Western Australia, Perth, Australia
  4. 4Public Health Ontario, and Lunenfeld-Tannenbaum Research Institute, Toronto, Ontario, Canada
  1. Correspondence to Jill S Hardt, Occupational Cancer Research Centre, Cancer Care Ontario, 505 University Avenue, 17th Floor, Toronto, ON, Canada M5G 1X3; jill.hardt{at}occupationalcancer.ca

Abstract

Objectives In attempts to overcome the limitations of self-reported data in occupational health research, job-exposure matrices, which assign exposure by occupation, have emerged as an objective approach for assessing occupational exposures. On the basis of a lung cancer case–control study conducted in the Greater Toronto Area, 1997–2002, assessment of occupational exposure to asbestos was compared using self-reports and a general population job-exposure matrix (DOM-JEM).

Methods Cases and frequency matched controls provided life-time job histories and self-reported exposures to potential lung carcinogens including asbestos through a detailed questionnaire. Exposure to asbestos was also assigned to each job by linking occupational histories with DOM-JEM. Agreement in classification of exposed and unexposed jobs according to self-reports and DOM-JEM was evaluated using Cohen's κ. Risks for lung cancer were estimated using unconditional logistic regression for each exposure assessment approach.

Results The prevalence of occupational asbestos exposure was greater when based on DOM-JEM than when based on self-reports. Agreement in classifying exposure to jobs between the two assessment approaches was poor. The risk of lung cancer was not elevated among workers who self-reported asbestos exposure, whereas workers considered exposed on the basis of DOM-JEM were almost twice as likely as unexposed workers to be diagnosed with lung cancer (OR 1.9, 95% CI 1.3 to 2.7).

Conclusions It is generally assumed by epidemiologists that self-reported exposure assessments result in inflated risk estimates. In this study, self-reports found no association with a well-established risk factor, whereas a high-quality job-exposure matrix revealed relative risk estimates that are more consistent with previous findings.

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