Abstract
BackgroundSinonasal cancer (SNC) has been related to occupational exposures, but the relative risk associated to specific jobs and/or carcinogen exposures other than wood and leather dust is generally based on small or inadequate sample sizes and the range of observed estimates is large. This paper is aimed at investigating such relationship through a systematic review of the literature followed by a meta-analysis of studies meeting specific inclusion criteria.MethodsSystematic search was made with PubMed, Google Scholar and Scopus engines using related keywords. Occupational exposures include wood and leather dust, formaldehyde, nickel and chromium compounds, textile industry, farming and construction. Meta-analysis of published studies after 1985 with a case-control or cohort design was performed, firstly using the fixed-effect model. Heterogeneity was assessed with the Q statistical test and quantified by the I2 index. When the heterogeneity hypothesis appeared relevant, the random-effect model was chosen. Sources of heterogeneity were explored using subgroup analyses.ResultsOut of 63 reviewed articles, 28 (11 cohort, 17 case-control) were used in the meta-analysis. Heterogeneity among studies was observed and random-effects models were used. Exposure to wood dust results associated with SNC (RRpooled = 5.91, 95% CI: 4.31-8.11 for the case-control studies and 1.61, 95% CI: 1.10-2.37 for the cohort studies), as well as to leather dust (11.89, 95% CI: 7.69-18.36). The strongest associations are with adenocarcinomas (29.43, 95% CI: 16.46-52.61 and 35.26, 95% CI: 20.62-60.28 respectively). An increased risk of SNC for exposures to formaldehyde (1.68, 95% CI: 1.37-2.06 for the case control and 1.09, 95% CI: 0.66-1.79 for the cohort studies), textile industry (2.03, 95% CI: 1.47-2.8), construction (1.62, 95% CI: 1.11-2.36) and nickel and chromium compounds (18.0, 95% CI: 14.55-22.27) was found. Subset analyses identified several sources of heterogeneity and an exposure-response relationship was suggested for wood dust (p = 0.001).ConclusionsBy confirming the strength of association between occupational exposure to causal carcinogens and SNC risk, our results may provide indications to the occupational etiology of SNC (not only wood and leather dusts). Future studies could be focused on specific occupational groups to confirm causative agents and to define appropriate preventive measures.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1042-2) contains supplementary material, which is available to authorized users.
Highlights
Sinonasal cancer (SNC) has been related to occupational exposures, but the relative risk associated to specific jobs and/or carcinogen exposures other than wood and leather dust is generally based on small or inadequate sample sizes and the range of observed estimates is large
Articles published in peer reviewed journals; English language; Epidemiologic studies published after 1985, with a case-control or cohort design; Studies involving humans; Including the SNC subtypes AC and squamous cell carcinomas (SCC); Referring to occupations and/or occupational setting with a potential risk of SNC; Exposure or potential exposure to specific risk factors stated explicitly, or from an industry/ economic-activity recognized as having exposure to the risk factor; Providing effect estimates with the corresponding measures of variability, or available data allowing for their calculation
The search in PubMed, Google Scholar and Scopus yielded more than 1,300 results but the most were excluded because regarding anatomical cancer sites other than sinonasal cavities, or nasal cancer risk factors other than occupational or not included in the present study
Summary
Sinonasal cancer (SNC) has been related to occupational exposures, but the relative risk associated to specific jobs and/or carcinogen exposures other than wood and leather dust is generally based on small or inadequate sample sizes and the range of observed estimates is large. Sinonasal malignant neoplasms (ICD-10: C30-C31; ICD-9: 160) are rare tumors with annual incidence rates around 1 per 100,000 in most developed countries They represent less than 1% of all neoplasms and less than 4% of those arising in the head and neck region [1,2,3,4]. A recent US analysis on sinonasal cancer (SNC) incidence and survival found that almost half of SNCs are localized to the nasal cavity (43.9%), most others originated in the maxillary (35.9%) or ethmoid (9.5%) sinus. These lesions were composed mostly of tumors of epithelial origin, including squamous cell carcinomas (SCC: 51.6%), adenocarcinomas (AC: 12.6%), esthesioneuroblastoma (ENB: 6.3%), and adenoid cystic carcinoma (ACC: 6.2%) [5]. The low absolute risk in the general population associated with high relative risks for specific chemical exposures and occupational settings, has entitled SNC a ‘sentinel’ for monitoring occupational and environmental risk factors
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