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Kumagai et al recently observed a striking increase in mortality from cholangiocarcinoma (CC) among workers in a colour proof-printing shop in Japan, based on six deaths among 11 CC cases in a group of 62 workers employed between 1991 and 2006. Exposure to 1,2-dichloropropane and dichloromethane was reported.1 Kubo et al extended the observation including 111 workers employed from 1981 to 2012, and reported 17 CC cases.2
The Nordic Occupational Cancer Study (NOCCA) was used to explore the generalisability of the Japanese cluster findings to the printing industry and related occupations at large.3 An overall standardised incidence ratio (SIR) of 2.34 (95% CI 95% CI 1.45 to 3.57) was found for intrahepatic CC, based on 21 cases in men. Women had an SIR of 1.95 (95% CI 0.84 to 3.85) with …
Contributors WA conducted the analyses, all authors designed the study, assessed results and wrote the letter.
Competing interests None.
Patient consent Obtained.
Ethics approval Multicentric study: all participating countries and centres obtained approval by the appropriate independent ethical Committee.
Provenance and peer review Not commissioned; internally peer reviewed.