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Original article
Cancer mortality in an international cohort of reinforced plastics workers exposed to styrene: a reanalysis
  1. Dana Loomis1,2,
  2. Neela Guha1,
  3. Manolis Kogevinas3,4,5,6,
  4. Vincenzo Fontana7,
  5. Valerio Gennaro7,
  6. Henrik A Kolstad8,
  7. Damien Martin McElvenny9,
  8. Markku Sallmén10,
  9. Rodolfo Saracci1
  1. 1International Agency for Research on Cancer, Lyon, France
  2. 2University of Nevada, Reno, Reno, Nevada, USA
  3. 3ISGlobal, Barcelona, Spain
  4. 4CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
  5. 5Universitat Pompeu Fabra (UPF), Barcelona, Spain
  6. 6IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
  7. 7Policlinico San Martino, IRCCS Scientific Institute for Research and Care in Oncology, Genova, Italy
  8. 8Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
  9. 9Insitute of Occupational Medicine, Edinburgh, UK
  10. 10Centre of Expertise for Health and Work Abili, Finnish Institute of Occupational Health, Helsinki, Finland
  1. Correspondence to Professor Dana Loomis, International Agency for Research on Cancer, Lyon 69008, France; loomisd{at}


Objective To investigate the carcinogenicity of styrene by reanalysing data from a previous international cohort study of workers in the reinforced plastics industry.

Methods Mortality from cancers of prior interest was analysed with more detailed consideration of exposure–response relations and an updated classification of leukaemias and lymphomas in data from a previous international cohort study of 37 021 reinforced plastics workers exposed to airborne styrene.

Results Increased mortality from non-Hodgkin’s lymphoma (NHL) was associated with the mean level of exposure to styrene in air (relative risk (RR) 2.31, 95% CI 1.29 to 4.12 per 100 ppm), but not with cumulative styrene exposure. Similar associations with mean exposure were observed for the oesophagus (RR 2.44, 95% CI 1.11 to 5.36 per 100 ppm) and pancreas (RR 1.89, 95% CI 1.17 to 3.09). Oesophageal cancer mortality was also associated with cumulative styrene exposure lagged 20 years (RR 1.16, 95% CI 1.03 to 1.31). No other cancer, including lung cancer, was associated with any indicator of styrene exposure.

Conclusion This reanalysis does not substantially change the conclusions of the original study with respect to NHL or lung cancer but new evidence concerning cancers of the oesophagus and pancreas merits further investigation.

  • cancer
  • organ system
  • disease
  • disease type
  • epidemiology

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  • Contributors DL and NG performed the data analysis and drafted the papers. All other authors contributed to data collection and critically reviewed the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was cleared by the IARC Ethics Committee as not presenting any potential ethical implications because it analyses deidentified historical data and reports aggregate statistical results.

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

  • Correction notice This article has been corrected since it first published online. It is no longer open access.