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Wastewater exposure and health—a comparative study of two occupational groups
  1. E S Hansen1,
  2. J Hilden1,
  3. H Klausen2,
  4. N Rosdahl3
  1. 1University of Copenhagen
  2. 2Occupational Health Service of Copenhagen
  3. 3Medical Office of Health, Municipality of Copenhagen
  1. Correspondence to:
 Associate Professor E S Hansen, Department of Occupational and Environmental Health, Institute of Public Health, University of Copenhagen, Panum Institute, Blegdamsvej 3, DK 2200, Copenhagen N, Denmark; 


Aims: To investigate whether wastewater workers are at increased risk of developing cancer.

Methods: Two cohorts of workers employed by the City of Copenhagen, 591 wastewater workers and 1545 water supply workers (controls), were followed from 1965 until 1998. These two cohorts were compared in terms of cause specific mortality and cancer incidence.

Results: The wastewater workers’ mortality exceeded that of the controls (relative risk (RR) = 1.25, 95% CI: 1.03 to 1.51). A similar small excess was seen for cancer incidence (RR = 1.27, 95% CI: 0.97 to 1.67). Though rare, there was a strongly increased incidence of primary liver cancer among the wastewater workers (RR = 8.9, 95% CI: 1.5 to 51.5).

Conclusion: The excess mortality seen among the wastewater workers was smaller than originally feared. It may partly have been due to their occupational exposure, and for preventive purposes, exposure to wastewater and sludge should be minimised. The possibility that sewage exposure confers an increased risk of primary liver cancer deserves further investigation.

  • biliary tract cancer
  • liver cancer
  • sewage

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