Workplace exposures and oesophageal cancer

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Abstract
OBJECTIVES To describe the relation between oesophageal cancer and many occupational circumstances with data from a population based case-control study. METHODS Cases were 99 histologically confirmed incident cases of cancer of the oesophagus, 63 of which were squamous cell carcinomas. Various control groups were available; for the present analysis a group was used that comprised 533 population controls and 533 patients with other types of cancer. Detailed job histories were elicited from all subjects and were translated by a team of chemists and hygienists for evidence of exposure to 294 occupational agents. Based on preliminary results and a review of literature, a set of 35 occupational agents and 19 occupations and industry titles were selected for this analysis. Logistic regression analyses were adjusted for age, birthplace, education, respondent (self or proxy), smoking, alcohol, and β-carotene intake. RESULTS Sulphuric acid and carbon black showed the strongest evidence of an association with oesophageal cancer, particularly squamous cell carcinoma. Other substances showed excess risks, but the evidence was more equivocal—namely chrysotile asbestos, alumina, mineral spirits, toluene, synthetic adhesives, other paints and varnishes, iron compounds, and mild steel dust. There was considerable overlap in occupational exposure patterns and results for some of these substances may be mutually confounded. None of the occupations or industry titles showed a clear excess risk; the strongest hints were for warehouse workers, food services workers, and workers from the miscellaneous food industry. CONCLUSIONS The data provide some support for an association between oesophageal cancer and a handful of occupational exposures, particularly sulphuric acid and carbon black. Many of the associations found have never been examined before and warrant further investigation.