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Workplace
Original Article
Occupational exposure to endotoxins and lung cancer risk: results of the ICARE Study
  1. Soumaya Ben Khedher1,
  2. Monica Neri1,
  3. Florence Guida2,
  4. Mireille Matrat1,3,4,
  5. Sylvie Cenée1,
  6. Marie Sanchez1,
  7. Gwenn Menvielle5,
  8. Florence Molinié6,
  9. Danièle Luce7,8,
  10. Isabelle Stücker1
  11. the ICARE Study Group
  1. 1 Centre de recherche en Epidemiologie et Sante des Populations, Universite Paris-Sud, illejuif, France
  2. 2 Department of Epidemiology and Biostatistics, Imperial College London, MRC-PHE Centre for Environment and Health, School of Public Health, London, UK
  3. 3 Faculty of medicine, University Paris Est-Créteil, Créteil Cedex, France
  4. 4 Centre Hospitalier Intercommunal, Service de Pneumologie et de Pathologie Professionnelle, Créteil Cedex, France
  5. 5 Department of Social Epidemiology, Sorbonne University, Paris, France
  6. 6 Loire-Atlantique et Vendée Cancer Registry, Nantes, France
  7. 7 Faculté de Médecine, INSERM, Pointe-à-Pitre, France
  8. 8 University of Rennes, Rennes, France
  1. Correspondence to Dr Soumaya Ben Khedher, CESP Centre for Research in Epidemiology and Population Health 16 avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France; soumaya.ben-khedher{at}inserm.fr

Abstract

Objectives To investigate the role of occupational exposure to endotoxins in lung cancer in a French population-based case–control study (ICARE (Investigation of occupational and environmental causes of respiratory cancers)).

Methods Detailed information was collected on the occupational history and smoking habits from 2926 patients with histologically confirmed lung cancer and 3555 matched controls. We evaluated each subject’s endotoxin exposure after cross referencing International Standard Classification of Occupations (ISCO) codes (for job tasks) and Nomenclature d'Activités Françaises (NAF) codes (for activity sectors). Endotoxin exposure levels were attributed to each work environment based on literature reports. ORs and 95% CIs were estimated using unconditional logistic regression models and controlled for main confounding factors.

Results An inverse association between exposure to endotoxins and lung cancer was found (OR=0.80, 95% CI 0.66 to 0.95). Negative trends were shown with duration and cumulative exposure, and the risk was decreased decades after exposure cessation (all statistically significant). Lung cancer risk was particularly reduced among workers highly exposed (eg, in dairy, cattle, poultry, pig farms), but also in those weakly exposed (eg, in waste treatment). Statistically significant interactions were shown with smoking, and never/light smokers were more sensitive to an endotoxin effect than heavy smokers (eg, OR=0.14, 95% CI 0.06 to 0.32 and OR=0.80, 95% CI 0.45 to 1.40, respectively, for the quartiles with the highest cumulative exposure, compared with those never exposed). Pronounced inverse associations were shown with adenocarcinoma histological subtype (OR=0.37, 95% CI 0.25 to 0.55 in the highly exposed).

Conclusions Our findings suggest that exposure to endotoxins, even at a low level, reduces the risk of lung cancer.

  • case-control studies
  • endotoxins
  • lung cancer
  • occupational exposure

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/oemed-2016-104117

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    Footnotes

    • Contributors IS and DL are the co-principal investigators of the ICARE (Investigation of occupational and environmental CAuses of REspiratory cancers) Study. They designed the study, directed its implementation and oversaw all aspects of the study, including recruitment of patients and controls, funding and quality control of data. SBK carried out the statistical analyses, interpreted the results and wrote the manuscript. MN participated in writing the manuscript.

      FG contributed to the statistical analysis and interpretation of the results. SC and MS managed the data, and prepared datasets for statistical analyses. MM and GM conceived the variables included in the analysis and the strategy of the analysis. FM is responsible for a cancer registry and coded the histology of the lung cancer cases.

    • Funding The ICARE Study was supported by Agence Nationale de Sécurité Sanitaire, de l’alimentation, del’environnement et du travail (ANSES); Fondation de France; Agence Nationale de la Recherche (ANR); Institut National du Cancer (INCA ; Fondation pour la Recherche Médicale (FRM); Institut National de Veille Sanitaire (InVS); Direction Générale de la Santé (DGS); Fondation ARC pour la Recherche sur le Cancer; Direction Générale du Travail rattachée au Ministère du travail, de l’emploi, de la formation professionnelle et du dialogue social (DGT). MN was partially supported by the University of Genoa, Genoa, Italy. This work was funded by la Fondation de France.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The international review board of the French National Institute of Health and Medical Research (IRB-INSERM, n 01-036) and by the French Data Protection Authority (CNIL n90120)

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

    • Collaborators Members of ICARE Study Group : Registre des cancers du Calvados, France (Anne-Valérie Guizard); Registre des cancers du Doubs et du Territoire de Belfort, France (Arlette Danzon, Anne-Sophie Woronoff); Registre des cancers du Bas-Rhin, France (Velten Michel); Registre des cancers du Haut-Rhin, France (Antoine Buemi, Émilie Marrer); Registre des cancers de l’Hérault, France (Brigitte Tretarre); Registre des cancers de l’Isère, France (Marc Colonna, Patricia Delafosse); Registre des cancers de Loire-Atlantique-Vendée, France (Paolo Bercelli, Florence Molinie); Registre des cancers de la Manche, France (Simona Bara); Registre des cancers de la Somme, France (Benedicte Lapotre-Ledoux, Nicole Raverdy); Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Environmental Epidemiology of Cancer Team, F-94807, Villejuif, France (Oumar Gaye, Farida Lamkarkach).