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0347 Possible pro-carcinogenic effect of endotoxin on lung cancer in an extended follow-up of Shanghai women textile workers
  1. Harvey Checkoway1,
  2. Jessica Lundin2,
  3. Sadie Costello3,
  4. Roberta Ray4,
  5. Wenjin Li4,
  6. Ellen Eisen3,
  7. George Astrakianakis5,
  8. Noah Seixas2,
  9. Kate Applebaum6,
  10. Dao Li Gao7,
  11. David Thomas4
  1. 1University of California, San Diego, La Jolla, CA, USA
  2. 2University of Washington, Seattle, WA, USA
  3. 3University of California, Berkeley, Berkeley, CA, USA
  4. 4Fred Hutchinson Cancer Research Center, Seattle, WA, USA
  5. 5University of British Columbia, Vancouver, BC, Canada
  6. 6George Washington University, Washington, DC, USA
  7. 7Zhong Shan Hospital, Shanghai, China


Objectives To examine further the association between endotoxin and risk of lung cancer among Shanghai women textile workers in an extended follow-up of the cohort. The initial follow-up indicated an inverse exposure-response relation.

Method We updated a case-cohort study nested within a cohort of 267 400 women. We compared exposure histories of 1456 incident lung cancers cases diagnosed during 1989–2006 with those of a reference subcohort of 3022 workers who were free of lung cancer at the end of follow-up. Endotoxin exposures were based on a quantitative job/exposure matrix. Relative risks (hazard ratios [HR]) associated with cumulative exposure, adjusted for age and smoking history, were estimated by Cox proportional hazards modelling adapted for the case-cohort design. We conducted exposure-response trend analyses for cumulative exposures lagged by 0, 10, and 20 years, and separately for time windows of <15 and >15 years since first exposure.

Results Overall, we observed no associations between cumulative exposure and lung cancer. In contrast, analyses by exposure time windows revealed a modestly elevated risk at the highest 3 exposure quintiles for exposures that occurred >15 years since first exposure; HR=1.28 (95% CI 0.90–1.82), HR=1.27 (95% CI 0.93–1.73), and HR=1.27 (95% CI 0.91–1.77), respectively; p-trend = 0.13.

Conclusions Exposures to endotoxin with long-term, relatively intense exposures were at most weakly associated with lung cancer risk in this cohort. The findings do not support a protective effect of endotoxin, but are suggestive of possible lung cancer promotion with increasing time since first exposure.

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