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Cholangiocarcinoma among workers in the printing industry: using the NOCCA database to elucidate the generalisability of a cluster report from Japan
  1. Jelle Vlaanderen1,
  2. Kurt Straif2,
  3. Jan Ivar Martinsen3,
  4. Timo Kauppinen4,
  5. Eero Pukkala5,6,
  6. Pär Sparén7,
  7. Laufey Tryggvadottir8,9,
  8. Elisabete Weiderpass3,7,10,11,
  9. Kristina Kjaerheim3
  1. 1Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
  2. 2Section of IARC Monographs, International Agency for Research on Cancer, Lyon, France
  3. 3Cancer Registry of Norway, Oslo, Norway
  4. 4Department of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
  5. 5School of Health Sciences, University of Tampere, Tampere, Finland
  6. 6Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
  7. 7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  8. 8Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  9. 9Icelandic Cancer Registry, Reykjavik, Iceland
  10. 10Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
  11. 11Folkhälsan Research Centre, Samfundet Folkhälsan, Helsinki, Finland
  1. Correspondence to Dr K Straif, International Agency for Research on Cancer, Section of IARC, Monographs, 150 Cours Albert Thomas, 69372 Lyon, Cedex 08, France; straifk{at}


Objectives A cluster of 11 cases of cholangiocarcinoma (CC) was observed in a small Japanese printing firm. To elucidate whether the identified cluster is indicative of an elevated risk of CC among workers in the printing industry at large, we explored the risk of cancer of the liver and CC among individuals employed in the printing industry in a large cohort set-up in four Nordic countries (Finland, Iceland, Norway and Sweden) over a period of 45 years.

Methods The cohort was set-up by linking occupational information from censuses to national cancer registry data utilising personal identity codes in use in all Nordic countries. We calculated standardised incidence ratios (SIRs) for men and women working in the printing industry, and stratified by occupational category (typographers, printers, lithographers, bookbinders).

Results Among men, we observed elevated SIRs for cancer of the liver (1.35, 95% CI 1.14 to 1.60; 142 cases), specifically intrahepatic CC (2.34, 95% CI 1.45 to 3.57; 21 cases). SIRs for liver cancer were especially elevated among printers and lithographers, and SIRs for intrahepatic CC among typographers and printers. SIRs for extrahepatic CC were not elevated. SIRs for women followed a similar pattern but the number of cases was low.

Conclusions Our study supports the notion that the finding of excess CC risk among workers in a small Japanese printing firm possibly extends beyond this specific firm and country. Further studies should focus on the specific exposures that occur in the printing industry.

  • Printers
  • Liver cancer
  • Cholangiocarcinoma

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