Objectives To quantitatively evaluate exposure-response associations between occupational exposures to rubber dust, fumes and N-nitrosamines and cancer mortality in the UK rubber industry.
Methods Competing risk survival analyses were used to examine cancer mortality risk in a cohort of 36 441 males aged 35+ years employed in the British rubber industry in 1967, followed up to 2015 (94% mortality). Exposure measurements are based on a population-specific quantitative job-exposure matrix for rubber dust, rubber fumes and N-nitrosamines from the EU-EXASRUB project.
Results Exposure (lifetime cumulative (LCE))-response associations were found for N-nitrosomorphiline and all cancers (subdistribution HR (SHR) 1.48, 95% CI 1.39 to 1.57) and cancers of the bladder, stomach, multiple myeloma, oesophagus, prostate and pancreas, as well as for N-nitrosodimethylamine and all cancers (SHR 2.08, 95% CI 1.96 to 2.21) and cancers of the bladder, stomach, leukaemia, multiple myeloma, prostate and liver. LCE to the N-nitrosamines sum were associated with increased risks from all cancers (SHR 1.89, 95% CI 1.78 to 2.01) and cancers of the lung, non-Hodgkin’s lymphoma and brain. LCE to rubber dust and fumes are associated with increased mortality from all cancers (rubber dust SHR 1.67, 95% CI 1.58 to 1.78; rubber fumes SHR 1.91, 95% CI 1.80 to 2.03) and cancers of the bladder, lung, stomach, leukaemia, multiple myeloma, non-Hodgkin’s lymphoma, oesophagus, prostate, pancreas and liver.
Conclusions Consistent with previous studies, N-nitrosamines exposures are associated with mortality from cancers of the bladder, lung, stomach, leukaemia, multiple myeloma, oesophagus, prostate, pancreas and liver. The long follow-up with nearly complete mortality enabled estimations of lifetime cancer mortality risk from occupational exposures in the rubber industry.
- occupational exposures
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Contributors FdV and DMMcE conceived of the study. FdV, DMMcE, AD, RMA and JWC obtained funding. FdV, DMMcE, PR, AD and WM worked on coding of data not in digital format. MH conducted the statistical analyses and wrote the first draft version of the manuscript. All authors contributed to interpretation of the results and commented on the various iterations of the manuscript. All authors approved the final version.
Funding This study was funded by Cancer Research UK (C29425/A16521). Additional funding for tracing of the cohort was provided by the UK Health and Safety Executive (PRJ787).
Disclaimer The views expressed are those of the author(s) and not necessarily those of the Cancer Research UK or UK Health and Safety Executive.
Competing interests None declared.
Ethics approval The study obtained clearances from an NHS ethics committee (Ref: 13/NW/0543), the Health Research Authority’s Confidentiality Advisory Group (Ref: CAG 5-08(d)/2013), the Office for National Statistics and NHS Digital’s Data Access Advisory Group (now Independent Group Advising on the Release of Data, Ref: NIC-323309-L2G9T).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Use of these data was granted by the NHS ethics committee, the Health Research Authority’s Confidentiality Advisory Group, the Office for National Statistics and NHS Digital’s Data Access Advisory Group (now Independent Group Advising on the Release of Data) for the specific purpose of this study only.
Patient consent for publication Not required.