Excess Risk Of Bladder Cancer Research Articles

Mortality from bladder cancer in dyestuff workers exposed to aromatic amines: A 73-year follow-up.

Objective:To update the analysis of mortality of a cohort of dyestuff workers, in northern Italy, heavily exposed to carcinogenic aromatic amines.Methods:We updated to 2018 overall and cause-specific mortality in a cohort of 590 male workers heavily exposed to carcinogenic aromatic amines in a dyestuff factory from 1922 to 1972. Workers were censored at age 85. Expected cases for the period 1946-2018 were computed using Piedmont mortality rates and standardized mortality ratios (SMR) were computed.Results:Between 1946 and 2018, 470 deaths were reported. The overall SMR from all causes was 1.59 (95% confidence interval [CI] 1.45-1.74) and the SMR from all cancers was 2.05 (95% CI = 1.77-2.37); compared to a previous report, there were 4 additional deaths from bladder cancer, for a total of 60 deaths compared with 4.0 expected (SMR 14.86, 95% CI 11.34-19.12). The SMR for bladder cancer increased with younger age at first exposure and longer duration of exposure, while it decreased with time since last exposure, albeit it was still 3.5, 30, or more years since last exposure. An increased risk was observed among workers exposed to fuchsine or ortho-toluidine (SMR=16.3; 95% CI = 6.0-35.5).Conclusions:This 73-year follow-up confirms the results from previous analyses, with increased overall mortality, and increased mortality from all cancers and especially for bladder cancer. The excess risk of bladder cancer persisted several decades after stopping exposure.

No Excess Risk of Second Malignancies in Chronic Myeloid Leukemia (CML) Patients Treated with Tyrosine Kinase Inhibitors (TKIs)

Introduction With the introduction of tyrosine kinase inhibitors (TKI), the outcomes of patients with chronic myeloid leukemia (CML) has improved dramatically, with the majority of patients in chronic phase achieving near normal life expectancy. As pts live longer on TKIs, they may be more susceptible to subsequent malignancies either as late effects of TKI treatment, or due to genomic instability from having an established hematologic malignancy. Theoretical mechanisms of TKI carcinogenesis include impaired DNA repair mechanisms, inhibition of T-lymphocytes or impaired differentiation of peripheral blood progenitor cells. In this study, we evaluated the risk of subsequent cancers in CML pts at the population level and compared the effect of treatment period (pre- and post-TKI era) on that risk. Methods We used the April 2017 release of all 18 registries of the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute to assemble the study cohort. Only patients with CML, not otherwise specified or BCR/ ABL-positive CML were included in the analysis. Patients aged >20 years who had CML as a first cancer diagnosed between January 1973 and December 2013 who developed second cancers (excluding myeloid neoplasms and acute lymphocytic leukemia [to avoid misclassification with CML in blast crisis] and non-melanoma skin cancer) were studied. CML pts with third and subsequent cancers were excluded. Pt and disease characteristics including sex, race and ethnicity, age at diagnosis, year of diagnosis, and year of last follow-up or death were collected. Standardized incidence ratios (SIR) were calculated to assess the risk of a second malignancy by dividing the number of observed second malignancies in CML pts with the number of expected malignancies in the US population, using SEER*Stat. SIRs for the five most common second cancer types were analyzed by treatment eras (1973-1985 [era 1, in which busulfan and hydroxyurea predominated], 1986-2000 [era 2, in which interferon and hematopoietic cell transplantation predominated] and 2001-2014 [era 3, the TKI era] per Blood. 2011; 117(3):755-63 and by age groups (20-39 yrs; 40 -60 yrs and > 60 yrs). Results Of 26,810 patients diagnosed with CML between 1973 and 2014, 1,324 (4.94%) developed a subsequent cancer. The prevalence of second malignancies was 4.59% in era 1, 5.35% in era 2, and 4.84% in era 3 (with the increase from era 1 to 2 likely due to improved capture of cancers and possible transplant effects (BBMT 2007: 13(10):1121-1134)). The most common second cancers in the study period were prostate (17.98%), lung and bronchus (16.01%), breast (8.31%), urinary bladder (5.36%) and non-Hodgkin lymphoma (4.38%) with distribution by treatment era shown in Figure 1. The majority of subsequent malignancies occurred in Caucasians (85.95%), males (61.25%) and in pts > 60 years (68.43%). Table 1 shows SIR of second cancers by treatment eras. In era 1, an excess risk for bladder cancer was observed compared to matched population controls without CML (SIR 2.04, 95% CI 1.14-3.37). In era 2, SIRs for lung cancer and non-Hodgkin lymphoma were marginally elevated [1.34 (95% CI 1.03-1.72) and 1.81 (95% CI 1.01-2.98)], respectively. No excess risk of subsequent cancers was detected in the TKI era. Differences in excess risk of second cancers compared to matched population controls without CML were observed in the study period (1973-2014) when analyzed by age groups, as shown in table 2. Excess risk of oral (SIR 28.46, 95% CI 5.87-83.18) and cervical cancers (SIR 7.61, 95% CI 2.47-17.75) was observed in 20-39 yr age group, melanoma (SIR 1.83, 95% CI 1.02-3.02) in 40-59 yr age cohort, and lung and bronchus (SIR 1.31, 95% CI 1.07-1.58) and non-Hodgkin lymphoma (SIR 2.13, 95% CI 1.43-3.06) in patients >60 yrs. Conclusions In the TKI era of treatment for CML, there does not appear to be an excess risk of second cancers compared to what is seen in matched population controls without CML. Types of second cancers differ by age group. The paucity of second cancers may contribute to the survival of CML patients treated with TKIs approaching that of the general population. Download : Download high-res image (278KB) Download : Download full-size image Disclosures Advani: Pfizer: Consultancy; Takeda/ Millenium: Research Funding. Gerds: CTI BioPharma: Consultancy; Incyte: Consultancy. Maciejewski: Alexion Pharmaceuticals, Inc.: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Speaker Fees; Apellis Pharmaceuticals: Consultancy; Ra Pharma: Consultancy. Majhail: Sanofi: Honoraria; Anthem, Inc.: Consultancy. Sekeres: Celgene: Membership on an entity's Board of Directors or advisory committees.

Association betweenrice consumption andrisk of cancer incidence in the California Teachers Study.

We evaluated the contribution of rice intake, a source of dietary arsenic, to cancer risk in a population of women with likely low arsenic exposure from drinking water and variable rice intake who participated in the California Teachers Study. Rice consumption was categorized into quartiles (< 9.6, 9.7-15.6, 15.7-42.7, and ≥ 42.8g/day). Multivariable-adjusted hazard ratios and 95% confidence intervals (95% CI) for incident cancer were estimated comparing rice consumption categories with bladder, breast, kidney, lung, and pancreatic cancer, with progressive adjustment for age, total calories, BMI, race, smoking status, physical activity, and cancer-specific covariates. The number of breast, lung, pancreatic, bladder, and kidney cancer cases was 7,351; 1,100; 411; 344; and 238, respectively. The adjusted hazard ratios (95% CI) comparing the highest versus lowest rice intake quartiles were 1.07 (1.00-1.15); 0.87 (0.72-1.04); 0.95 (0.66-1.37); 1.11 (0.81-1.52) and 1.07 (0.72-1.59) for breast, lung, pancreatic, bladder, and kidney cancers, respectively. Results were consistent when rice was modeled as a continuous variable and in analyses stratified by smoking status. Rice consumption was not associated with risk of kidney, lung or pancreatic cancer, except maybe a small excess risk for breast cancer and a small non-significant excess risk for bladder cancer, comparing the highest versus lowest quartile of rice intake. Due to lower consumption patterns in this cohort, future studies should involve populations for which rice is a staple food and use of an arsenic biomarker.

Another Study of Pioglitazone Use and Risk for Bladder Cancer

Evidence is mixed on whether pioglitazone (Actos), an oral thiazolidinedione drug used for managing type 2 diabetes, is associated with excess risk for bladder cancer. In this retrospective cohort study from four European countries, researchers assessed risk for bladder cancer in 56,000 patients (age, >40) with type 2 diabetes who started treatment with pioglitazone. Participants were matched (based …

Is Pioglitazone Associated with Excess Risk for Bladder Cancer

In a 2012 study of pioglitazone, an oral thiazolidinedione drug used for managing type 2 diabetes, excess risk for bladder cancer was detected (NEJM JW Gen Med Jul 15 2012 and BMJ 2012; 344:3645), whereas a 2015 study showed no excess risk (NEJM JW Gen Med Sep 1 2015 and JAMA 2015; 314:265). In this population-based U.K. cohort study of 146,000 people with type 2 diabetes who were newly treated with …

Local bladder cancer clusters in southeastern Michigan accounting for risk factors, covariates and residential mobility.

BackgroundIn case control studies disease risk not explained by the significant risk factors is the unexplained risk. Considering unexplained risk for specific populations, places and times can reveal the signature of unidentified risk factors and risk factors not fully accounted for in the case-control study. This potentially can lead to new hypotheses regarding disease causation.MethodsGlobal, local and focused Q-statistics are applied to data from a population-based case-control study of 11 southeast Michigan counties. Analyses were conducted using both year- and age-based measures of time. The analyses were adjusted for arsenic exposure, education, smoking, family history of bladder cancer, occupational exposure to bladder cancer carcinogens, age, gender, and race.ResultsSignificant global clustering of cases was not found. Such a finding would indicate large-scale clustering of cases relative to controls through time. However, highly significant local clusters were found in Ingham County near Lansing, in Oakland County, and in the City of Jackson, Michigan. The Jackson City cluster was observed in working-ages and is thus consistent with occupational causes. The Ingham County cluster persists over time, suggesting a broad-based geographically defined exposure. Focused clusters were found for 20 industrial sites engaged in manufacturing activities associated with known or suspected bladder cancer carcinogens. Set-based tests that adjusted for multiple testing were not significant, although local clusters persisted through time and temporal trends in probability of local tests were observed.ConclusionQ analyses provide a powerful tool for unpacking unexplained disease risk from case-control studies. This is particularly useful when the effect of risk factors varies spatially, through time, or through both space and time. For bladder cancer in Michigan, the next step is to investigate causal hypotheses that may explain the excess bladder cancer risk localized to areas of Oakland and Ingham counties, and to the City of Jackson.

A case-control study of occupational exposure to metalworking fluids and bladder cancer risk among men

ObjectivesMetalworking has been associated with an excess risk of bladder cancer in over 20 studies. Metalworking fluids (MWFs) are suspected as the responsible exposure, but epidemiological data are limited. We...

0253 Hairdressers are occupationally exposed to ortho- and meta- toluidine0253 Hairdressers are occupationally exposed to ortho- and meta- toluidine

ObjectivesHairdressing work is classified as carcinogenic based on excess risk for bladder cancer. We aimed at evaluating if current hairdressers are exposed to established/suspected bladder carcinogens (aromatic amines) and indicate...

Probabilistic framework for assessing the arsenic exposure risk from cooked fish consumption.

Geogenic arsenic (As) contamination of groundwater is a major ecological and human health problem in southwestern and northeastern coastal areas of Taiwan. Here, we present a probabilistic framework for assessing the human health risks from consuming raw and cooked fish that were cultured in groundwater As-contaminated ponds in Taiwan by linking a physiologically based pharmacokinetics model and a Weibull dose-response model. Results indicate that As levels in baked, fried, and grilled fish were higher than those of raw fish. Frying resulted in the greatest increase in As concentration, followed by grilling, with baking affecting the As concentration the least. Simulation results show that, following consumption of baked As-contaminated fish, the health risk to humans is <10(-6) excess bladder cancer risk level for lifetime exposure; as the incidence ratios of liver and lung cancers are generally acceptable at risk ranging from 10(-6) to 10(-4), the consumption of baked As-contaminated fish is unlikely to pose a significant risk to human health. However, contaminated fish cooked by frying resulted in significant health risks, showing the highest cumulative incidence ratios of liver cancer. We also show that males have higher cumulative incidence ratio of liver cancer than females. We found that although cooking resulted in an increase for As levels in As-contaminated fish, the risk to human health of consuming baked fish is nevertheless acceptable. We suggest the adoption of baking as a cooking method and warn against frying As-contaminated fish. We conclude that the concentration of contaminants after cooking should be taken into consideration when assessing the risk to human health.

Tetrachloroethylene exposure and bladder cancer risk: a meta-analysis of dry-cleaning-worker studies.

Background: In 2012, the International Agency for Research on Cancer classified tetrachloroethylene, used in the production of chemicals and the primary solvent used in dry cleaning, as “probably carcinogenic to humans” based on limited evidence of an increased risk of bladder cancer in dry cleaners.Objectives: We assessed the epidemiological evidence for the association between tetrachloroethylene exposure and bladder cancer from published studies estimating occupational exposure to tetrachloroethylene or in workers in the dry-cleaning industry.Methods: Random-effects meta-analyses were carried out separately for occupational exposure to tetrachloroethylene and employment as a dry cleaner. We qualitatively summarized exposure–response data because of the limited number of studies available.Results: The meta-relative risk (mRR) among tetrachloroethylene-exposed workers was 1.08 (95% CI: 0.82, 1.42; three studies; 463 exposed cases). For employment as a dry cleaner, the overall mRR was 1.47 (95% CI: 1.16, 1.85; seven studies; 139 exposed cases), and for smoking-adjusted studies, the mRR was 1.50 (95% CI: 0.80, 2.84; 4 case–control studies).Conclusions: Our meta-analysis demonstrates an increased risk of bladder cancer in dry cleaners, reported in both cohort and case–control studies, and some evidence for an exposure–response relationship. Although dry cleaners incur mixed exposures, tetrachloroethylene could be responsible for the excess risk of bladder cancer because it is the primary solvent used and it is the only chemical commonly used by dry cleaners that is currently identified as a potential bladder carcinogen. Relatively crude approaches in exposure assessment in the studies of “tetrachloroethylene-exposed workers” may have attenuated the relative risks.Citation: Vlaanderen J, Straif K, Ruder A, Blair A, Hansen J, Lynge E, Charbotel B, Loomis D, Kauppinen T, Kyyronen P, Pukkala E, Weiderpass E, Guha N. 2014. Tetrachloroethylene exposure and bladder cancer risk: a meta-analysis of dry-cleaning-worker studies. Environ Health Perspect 122:661–666; http://dx.doi.org/10.1289/ehp.1307055

Cancer Risk for Patients Using Thiazolidinediones for Type 2 Diabetes: A Meta-Analysis

To clarify and quantify the effect of thiazolidinediones (TZDs; e.g., pioglitazone, rosiglitazone) on the risk of bladder cancer, other selected cancers, and overall cancer in patients with type 2 diabetes, we performed a systematic review and meta-analysis of observational studies. A PubMed/MEDLINE search was conducted for studies published in English up to June 30, 2012. Random-effect models were fitted to estimate summary relative risks (RR). Seventeen studies satisfying inclusion criteria (3 case-control studies and 14 cohort studies) were considered. Use of TZDs was not associated to the risk of cancer overall (summary RR: 0.96; 95% confidence interval [CI]: 0.91-1.01). A modest excess risk of bladder cancer was reported in pioglitazone (RR: 1.20; 95% CI: 1.07-1.34 from six studies) but not in rosiglitazone (RR: 1.08; 95% CI: 0.95-1.23 from three studies) users. The RRs of bladder cancer were higher for longer duration (RR: 1.42 for >2 years) and higher cumulative dose of pioglitazone (RR: 1.64 for >28,000 mg). Inverse relations were observed with colorectal cancer (RR: 0.93; 95% CI: 0.90-0.97 from six cohort studies) and liver cancer (RR: 0.65; 95% CI: 0.48-0.89 from four studies), whereas there was no association with pancreatic, lung, breast, and prostate cancers. Adequate evidence excludes an overall excess cancer risk in TZD users within a few years after starting treatment. However, there is a modest excess risk of bladder cancer, particularly with reference to pioglitazone. Assuming that this association is real, the potential implications on the risk-benefit analysis of TZD use should be evaluated.

Low-level arsenic exposure is associated with bladder cancer risk and cigarette smoking: a case–control study among men in Tunisia

Although exposure to high levels of arsenic is associated with excess bladder cancer risk, lower exposures generally are not. This study represents the first biomonitoring of arsenic exposure in Tunisia and focuses on a possible association with bladder cancer risk. In this context, 124 male bladder cancer cases and 220 controls were recruited and blood samples were analyzed to determine the concentration of As. The study subjects were stratified into median groups based on concentrations of arsenic in their blood. Blood arsenic (B-As) was significantly two to threefold higher in bladder cancer cases than in controls (p<0.05). The arsenic concentrations were significantly higher among both smokers and workers in construction. However, neither drinking water nor seafood was found to be incriminated as exposure sources. The adjusted risk ratios for B-As concentration categories 0.1-0.67 and ≥ 0.67 μg/L were 0.18 (95% CI=0.014-2.95) and 2.44 (95% CI=1.11-5.35), respectively. Arsenic levels were not found to be associated with tumor grade or stage. The considerable risk in the category of highest cumulative exposure argues for an association between bladder cancer risk and low-level arsenic exposure. Future investigations with larger samples and using techniques that allow the distinction of the different arsenic species should better elucidate this association. Furthermore, the modulation of arsenic level according to the histological grade may be of potential to be used as a diagnostic marker of the disease process and its possible relationship etiologically.

EXPOSURE TO METALWORKING FLUIDS AND RISK OF BLADDER CANCER

Background and Aims: Many studies have observed an excess bladder cancer risk among metalworkers that is thought to be due to metalworking fluid (MWF) exposure. We used data from a large population...

6537 Blood group A and risk of gastric cancer in Colombia

Despite considerable research, the issue of hair dyes and bladder cancer is still open to discussion. In January 2013, we searched in PubMed/EMBASE to identify observational studies investigating the association between personal use of hair dyes and bladder cancer incidence/mortality. Pooled relative risks (RRs) and corresponding 95% confidence intervals (CIs) were calculated using random-effects models. Fifteen case-control and two cohort studies were available for meta-analysis (8504 cases/deaths, 14,102 controls, and 617,937 persons at risk). Compared with no use, the pooled RR of bladder cancer for personal use of any type of hair dyes was 0.93 (95% CI, 0.82–1.05), with moderate heterogeneity among studies (I2 = 34.1%, P = .07). Similar RRs were found for females (RR = 0.95) and males (RR = 0.81). Based on seven studies, the pooled RR for personal use of permanent hair dyes was 0.92 (95% CI, 0.77–1.09). Compared with no use, no association was observed for the highest categories of duration of use and lifetime frequency of use of both any type of dyes and permanent dyes. The pooled RR from four studies reporting results for use of dark-colored dyes was 1.29 (95% CI, 0.98–1.71). This meta-analysis allows to definitively exclude any appreciable excess risk of bladder cancer among personal hair dye users.

Bladder Cancer Clusters in Florida: Identifying Populations at Risk

Modifiable risk factors for bladder cancer have been identified, ie tobacco and chemical exposure. We identified high risk bladder cancer areas and risk factors associated with bladder cancer clusters in Florida using individual and area based data. Spatial modeling was applied to 23,266 early and advanced bladder cancer cases diagnosed between 1998 and 2002 in Florida to identify areas of excess bladder cancer risk. Multivariable regression was used to determine whether sociodemographic indicators, smoking history and proximity to known arsenic contaminated drinking water well sites were associated with bladder cancer diagnosis in a specific area (cluster). A total of 25 clusters were found to have a higher than expected bladder cancer rate, including 13 and 12 of early and late stage disease, respectively. Urban white patients were more likely to live in an advanced bladder cancer cluster. Advanced bladder cancer cluster membership was associated with living in close proximity to known arsenic contaminated drinking water wells. There are multiple areas of early and late stage bladder cancer clusters in Florida. Individuals in an advanced bladder cancer cluster tended to live close to arsenic contaminated wells. Increased evaluation of potentially contaminated well water is warranted in these high risk areas. Targeted bladder cancer public awareness campaigns, smoking cessation support and potentially targeted screening should also be considered in communities at increased risk for bladder cancer. Our analytical approach can also be used by others to systematically identify communities at high risk for bladder and other cancers.

Cancer incidence in the wastewater treatment plant of a large chemical company

To evaluate cancer incidence among employees assigned to BASF's wastewater treatment plant. We conducted a retrospective cohort study including 477 male employees who had ever worked in the facility for at least 1 year since the start of operations in 1974. Cancers were identified by review of occupational medical records and a standardized questionnaire completed by the participants or their next of kin. Confirmation through hospital records was sought for all reported cases after obtaining informed consent. Standardized incidence ratios (SIR) and 95% confidence intervals (CI) were computed using comparison data provided by the Saarland Cancer Registry. Further comparisons were made between three different subgroups of employees, working in maintenance, wastewater processing, and sewage sludge treatment. A total of 50 cancers were observed (SIR 1.14, CI 0.85-1.51). Colorectal (1.14, 0.42-2.48), bronchial (1.40, 0.67-2.57) and prostate (1.15, 0.42-2.50) were the most frequently observed cancers. Five cases of bladder cancer were found in the total cohort (1.75, 0.57-4.09), with four of them occurring in the sewage sludge treatment area (6.82, 1.86-17.46). Allowing for a 10-year lag did not significantly change the results. The overall cancer experience among employees of the wastewater treatment plant was similar to that of the corresponding general population. The finding of an excess risk for bladder cancer in one subgroup of workers was unexpected with regard to the available literature. There is no straightforward explanation for this finding, and it may be due to chance. An extended follow-up of this cohort will take place after 5 years. Annual bladder cancer screening is offered to active and retired employees from this plant for the time being. The current working conditions and work practices have been re-assessed by occupational hygienists and deemed to be safe.

Drink a Toast to Tap Water: Study Suggests Water Consumption Benefit Outweighs THM Hazard

Vol. 115, No. 11 EnvironewsOpen AccessDrink a Toast to Tap Water: Study Suggests Water Consumption Benefit Outweighs THM Hazard John Tibbetts John Tibbetts Search for more papers by this author Published:1 November 2007https://doi.org/10.1289/ehp.115-a551aAboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit Many water treatment systems use chlorine to disinfect drinking water. However, chlorine reacts with dissolved organic matter in water to create trihalomethanes (THMs), which have been associated with excess risk of bladder cancer in people who drink chlorinated water. Now, in a large study conducted in Spain, an international team of scientists has examined the role of tap water and total fluid intake in bladder cancer risk, while also assessing the effect of exposure to THMs in water [EHP 115:1569–1572; Michaud et al.]. The results suggest that higher water consumption is associated with lower risk of bladder cancer, regardless of THM exposure.Some studies have linked high consumption of fluids including tap water with a lower risk of bladder cancer, perhaps because urinating more frequently allows more flushing of the bladder. Other studies suggest that high tap water consumption could increase bladder cancer risk if chlorination by-products or other water contaminants such as arsenic are elevated in the water source. Adding to this complexity is that still other studies have shown a THM-related excess risk of bladder cancer in men but not women.Between June 1998 and June 2001, researchers conducted a hospital-based case–control study of bladder cancer in multiple centers in Spain. Male and female bladder cancer patients aged 20–80 years were recruited from 18 participating hospitals. For the 397 bladder cancer cases available for this analysis, the team recruited 664 matched controls who had been admitted to the same hospitals around the same time for hernias, fractures, orthopedic problems, and other reasons.Trained interviewers collected information during each subject’s hospitalization that included sociodemographic characteristics, family history of cancer, smoking history, occupational history, residential history, drinking water source at each residence, beverage consumption (including water), and medical history. The researchers used local government and water company data on annual average THM levels, water source history since 1920, and chlorination history to calculate average year-by-year THM exposure. These data were available for 78.5% of the total study person-years.The researchers examined the association between total fluid and water consumption and bladder cancer risk, while also examining the interaction between water intake and THM exposure. The results suggest that drinking more water, even from chlorinated sources with high THM levels, is beneficial in reducing risk of bladder cancer. The authors found a 53% lower risk of bladder cancer in people who drank 1,400 mL or more water per day compared with those who drank less than 400 mL per day after adjusting for known and potential confounders. This inverse association held across all strata of smoking status and THM exposure, and for both men and women.The study was strengthened by high response rates from cases and controls, detailed interview data on individual beverage consumption, detailed assessment of THM exposure, and detailed data on smoking, which is believed to be the greatest risk factor for bladder cancer.Drink up! Despite the potential for THM exposure, water is still a healthy choice of beverage.FiguresReferencesRelatedDetails Vol. 115, No. 11 November 2007Metrics About Article Metrics Publication History Originally published1 November 2007Published in print1 November 2007 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact [email protected]. Our staff will work with you to assess and meet your accessibility needs within 3 working days.

Occupation and bladder cancer in a hospital-based case–control study in Spain

Objectives:We investigated the association between occupation and bladder cancer in a hospital-based case–control study conducted in Spain.Methods:1219 patients with transitional cell carcinoma of the urinary bladder and 1271 controls selected...

Bladder Cancer Risk in Painters: a Review of the Epidemiological Evidence, 1989–2004*

Epidemiological studies on the potential association between painting and the risk of bladder cancer published after the Monograph of the International Agency for Research on Cancer N. 47 of 1989 have been systematically reviewed. These included four cohort studies on the incidence of bladder cancer among painters, with a pooled relative risk (RR) of 1.10 (95% confidence interval, CI, 1.03-1.18), based on 893 cases observed. The corresponding summary RR from four cohort studies on mortality was 1.23 (95% CI 1.11-1.37), based on 370 deaths. The pooled RR from 14 case-control studies and a pooled-analysis of other 11 case-control studies was 1.35 (95% CI 1.19-1.53), based on 465 cases exposed. Overall, the RR from all epidemiological studies was 1.17 (95% 1.11-1.27). Thus, recent epidemiological evidence indicates a moderate excess risk for bladder cancer in painters. Some studies, however, suggested that any such risk would have been greater for exposures in the distant past. Open issues for interpretation include residual confounding by social class and tobacco smoking, and understanding the time-risk relation. In particular, the potential residual risk related to exposure over the last two to three decades remains to be defined.

Cancer in Persons Working in Dry Cleaning in the Nordic Countries

U.S. studies have reported an increased risk of esophageal and some other cancers in dry cleaners exposed to tetrachloroethylene. We investigated whether the U.S. findings could be reproduced in the Nordic countries using a series of case–control studies nested in cohorts of laundry and dry-cleaning workers identified from the 1970 censuses in Denmark, Norway, Sweden, and Finland. Dry-cleaning work in the Nordic countries during the period when tetrachloroethylene was the dominant solvent was not associated with an increased risk of esophageal cancer [rate ratio (RR) = 0.76; 95% confidence interval (CI), 0.34–1.69], but our study was hampered by some unclassifiable cases. The risks of cancer of the gastric cardia, liver, pancreas, and kidney and non-Hodgkin lymphoma were not significantly increased. Assistants in dry-cleaning shops had a borderline significant excess risk of cervical cancer not found in women directly involved in dry cleaning. We found an excess risk of bladder cancer (RR = 1.44; 95% CI, 1.07–1.93) not associated with length of employment. The finding of no excess risk of esophageal cancer in Nordic dry cleaners differs from U.S. findings. Chance, differences in level of exposure to tetrachloroethylene, and confounding may explain the findings. The overall evidence on bladder cancer in dry cleaners is equivocal.