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Occupational polycyclic aromatic hydrocarbon exposure and risk of larynx cancer: a systematic review and meta-analysis
  1. Mandy Wagner1,
  2. Ulrich Bolm-Audorff2,
  3. Janice Hegewald1,
  4. Alba Fishta1,3,
  5. Peter Schlattmann4,
  6. Jochen Schmitt1,
  7. Andreas Seidler1
  1. 1Institute and Policlinic of Occupational and Social Medicine, TU Dresden, Germany
  2. 2Occupational Health Division, Labor Inspection, Wiesbaden, Germany
  3. 3Federal Institute for Occupational Safety and Health, Berlin, Germany
  4. 4Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany
  1. Correspondence to Dr Andreas Seidler, Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, TU Dresden, Fetscherstraße 74, 01309 Dresden, Germany; andreas.seidler{at}tu-dresden.de

Abstract

Polycyclic aromatic hydrocarbons (PAH) are genotoxic substances formed during combustion. Occupational PAH exposure has been shown to increase the risk of lung cancer and may be associated with other respiratory cancers. We conducted a systematic review and meta-analysis to clarify the relationship between occupational PAH exposures and larynx malignancies. We searched EMBASE and MEDLINE (until July 2014) using a series of search strings developed to seek case–control studies or longitudinal studies of workers (Population) exposed to PAHs (Exposure) and their risk for larynx cancer incidence and/or mortality (Outcome). Two independent reviewers screened the titles and abstracts for eligible articles and a third reviewer negotiated consensus. Further assessments of eligibility and sources of bias were conducted in a similar manner. The study results were pooled with random effects meta-analysis. The search resulted in 3377 records. The data of 92 full-text articles representing 63 studies were included and extracted. The majority of studies (n=47) was judged likely to be biased; only 16 studies were judged as methodologically adequate. The pooled effect size was 1.45 (95% CI 1.30 to 1.62; I2=30.7%; Graphic=0.03) for larynx cancer incidence and 1.34 (95% CI 1.18 to 1.53; I2=23.8%; Graphic=0.03) for larynx cancer mortality. While few studies allowed an investigation of dose–response, these indicate a positive dose–response effect. Although most studies may underestimate the true effect due to inexact approximations of PAH exposure, the meta-analysis suggests a robust positive association between PAH and larynx cancer.

  • Larynx Cancer

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