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Lung cancer and occupational exposures other than cotton dust and endotoxin among women textile workers in Shanghai, China
  1. H Checkoway1,2,
  2. R M Ray3,
  3. J I Lundin1,
  4. G Astrakianakis4,
  5. N S Seixas1,
  6. J E Camp1,
  7. K J Wernli5,
  8. E D Fitzgibbons5,
  9. W Li2,3,
  10. Z Feng3,
  11. D L Gao6,
  12. D B Thomas2,3
  1. 1University of Washington, Department of Environmental and Occupational Health Sciences, Seattle, Washington, USA
  2. 2University of Washington, Department of Epidemiology, Seattle, Washington, USA
  3. 3Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, Washington, USA
  4. 4University of British Columbia, School of Environmental Health, Vancouver, British Columbia, Canada
  5. 5Group Health Research Institute, Seattle, Washington, USA
  6. 6Zhong Shan Hospital Cancer Center, Shanghai, China
  1. Correspondence to Harvey Checkoway, University of Washington, Department of Environmental and Occupational Health Sciences, Box 357234, Seattle, WA 98195-7234, USA; checko{at}


Objectives Numerous epidemiological studies of lung cancer among textile workers worldwide consistently indicate reduced risks related to cotton dust exposure, presumably due to endotoxin contamination. Our objective was to investigate associations with other exposures potentially related to lung cancer, including wool and synthetic fibre dusts, formaldehyde, silica, dyes and metals, that have only been studied to a limited extent in the textile industry.

Methods We conducted a case–cohort study nested within a cohort of 267 400 women textile workers in Shanghai, China. We compared work assignments and exposure histories of 628 incident lung cancer cases, diagnosed during 1989–1998, with those of a reference subcohort of 3188 workers. We reconstructed exposures with a job–exposure matrix developed specifically for textile factories. Cox proportional hazards modelling was applied to estimate age/smoking-adjusted relative risks (hazard ratios) and risk gradients associated with job assignments and specific agents other than cotton dust and endotoxin.

Results No associations were observed for lung cancer with wool, silk or synthetic fibre dusts, or with most other agents. However, increased risks, although statistically imprecise, were noted for ≥10 years’ exposures to silica (adjusted HR 3.5, 95% CI 1.0 to 13) and ≥10 years’ exposures to formaldehyde (adjusted HR 2.1, 95% CI 0.4 to 11).

Conclusions Exposures to silica and formaldehyde, although not widespread among the cohort, may have increased lung cancer risk. Silica is an established human lung carcinogen, whereas there is only weak prior evidence supporting an association with formaldehyde. Both exposures warrant consideration as potential lung carcinogens in textile manufacturing.

  • Lung cancer
  • textile industry
  • silica
  • formaldehyde
  • epidemiology
  • cancer

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  • Funding This research was supported by grant R01CA80180 from the U.S. National Cancer Institute, National Institutes of Health, Department of Health and Human Services, and U.S. National Institute of Environmental Health Sciences Training Grant ES07262 (to KJW).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The study procedures were approved by the Institutional Review Board (IRB) Committee to Protect Human Subjects, Biomedical Research at the University of Washington, the IRB for Research on Human Subjects at the Fred Hutchinson Cancer Research Center, and the IRB for Research on Human Subjects at the Station for the Prevention and Treatment of Cancer of the STIB at Zhong Shan Hospital, Shanghai, China.

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