Objectives To present the rationale behind the qualitative IARC evaluation of outdoor air pollution and the new findings on bladder cancer derived from occupational epidemiological studies.
Method The International Agency for Research on Cancer recently used a series of systematic reviews to classify ‘outdoor air pollution’ as carcinogenic to humans (Group 1). Meta-analytic techniques, including forest plots and the I2 statistic, were used by the IARC Working Group to guide the hazard identification process.
Results The IARC Group 1 evaluation was based on an increased risk of lung cancer but the Working Group also noted limited epidemiological evidence for an increased risk of bladder cancer, after accounting for tobacco smoking, from studies of workers occupationally exposed to potentially high levels of outdoor air pollution. These studies were of both cohort and case-control designs and directly evaluated the association of cancer of the bladder with metrics of exposure to outdoor air pollution, traffic or traffic fumes or specific occupations (bus, taxi, and truck drivers).
Conclusions Although positive associations were observed in a number of studies that adjusted for smoking, the interpretation of the results is complicated by co-exposures and crude assessment of exposure in some studies.
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