Lung Cancer SMR Research Articles

Area-Based Socio-Economic Inequalities in Mortality from Lung Cancer and Respiratory Diseases.

Background: After political transformation in 1989/1990, Poland experienced a general improvement in living conditions and quality of life, but the benefits did not extend evenly across all segments of the society. We hypothesized that the regional differences in mortality due to diseases of the respiratory system are related to socioeconomic status (SES) and its changes over time. Materials and methods: An ecological study was carried out in 66 sub-regions of Poland using the data from the period of 2010 to 2014. Age-standardized mortality rates (SMRs) were calculated separately for men and women in three age categories: ≥15, 25–64 years, and ≥65 years. An area-based SES index was derived from the characteristics of the sub-regions using the z-score method. Multiple weighted linear regression models were constructed to estimate a real socioeconomic gradient for mortality resulting from lung cancer and respiratory diseases. Results: In the regions studied, the SMRs for respiratory disease varied from 70/100,000 to 215/100,000 in men and from 18/100,000 to 53/100,000 in women. The SMRs for lung cancer varied from 36/100,000 to 110/100,000 among men and from 26/100,000 to 77/100,000 among women. After adjusting for the prevalence of smoking and environmental pollution, the SES index was found to be inversely associated with the SMR for lung cancer in each category of age among men, and in the age group of 25–64 years among women. An increase of the SES index between 2010 and 2014 was associated with a decrease of SMR for respiratory disease both in men and women, but this change was not significantly associated with the SMR for lung cancer. Conclusion: SES appears to be an important correlate of mortality from respiratory diseases and lung cancer at the population level, particularly in men. A lower SES was associated with greater mortality from lung cancer and respiratory diseases. An increase in SES over time was related to a decrease in mortality from respiratory disease, but not from lung cancer.

Deaths Due to Screenable Cancers Among People Living With HIV Infection, Florida, 2000–2014

Because of antiretroviral therapy, people living with HIV infection are surviving longer and are at higher risk for chronic diseases. This study's objective was to assess the magnitude of deaths due to cancers for which there are screening recommendations for people living with HIV in Florida. Florida Department of Health Enhanced HIV/AIDS Reporting System data were matched with Department of Health Vital Records and the National Death Index to identify deaths and their causes through 2014. The sex-specific and cause-specific mortality rates and indirect standardized mortality ratios (SMRs, using U.S. mortality rates as a standard) were calculated during 2016 for people reported with HIV infection 2000-2014. Despite the competing risk of HIV mortality, among the 25,678 females, there was a higher risk of cervical (SMR=6.32, 95% CI=4.63, 8.44), colorectal (SMR=2.05, 95% CI=1.44, 2.83), liver (SMR=8.96, 95% CI=5.39, 14.03), and lung (SMR=5.82, 95% CI=4.80, 6.96) cancer mortality and lower risk of breast cancer mortality (SMR=0.57, 95% CI=0.42, 0.76). Among 63,493 males, there was a higher risk of liver (SMR=5.50, 95% CI=4.47, 6.70) and lung (4.63, 95% CI=4.11, 5.19) cancer mortality. Among males, the lung cancer SMR significantly declined 2000-2014 (p<0.05), but was still high in 2012-2014 (SMR=3.59, 95% CI=2.87, 4.43). These results indicate the importance of primary and secondary cancer prevention during primary care for people living with HIV infection.

Mortality from cancer and other causes among Italian chrysotile asbestos miners

ObjectiveTo investigate the long-term mortality of a cohort of Italian asbestos miners.MethodsThe cohort included 1056 men employed in a chrysotile mine between 1930 and 1990, who were followed up during...

Stomach cancer and occupational exposure to asbestos: a meta-analysis of occupational cohort studies.

Background:A recent Monographs Working Group of the International Agency for Research on Cancer concluded that there is limited evidence for a causal association between exposure to asbestos and stomach cancer.Methods:We performed a meta-analysis to quantitatively evaluate this association. Random effects models were used to summarise the relative risks across studies. Sources of heterogeneity were explored through subgroup analyses and meta-regression.Results:We identified 40 mortality cohort studies from 37 separate papers, and cancer incidence data were extracted for 15 separate cohorts from 14 papers. The overall meta-SMR for stomach cancer for total cohort was 1.15 (95% confidence interval 1.03–1.27), with heterogeneous results across studies. Statistically significant excesses were observed in North America and Australia but not in Europe, and for generic asbestos workers and insulators. Meta-SMRs were larger for cohorts reporting a SMR for lung cancer above 2 and cohort sizes below 1000.Conclusions:Our results support the conclusion by IARC that exposure to asbestos is associated with a moderate increased risk of stomach cancer.

Mortality among participants in a lead surveillance program

BackgroundThere is evidence that adult lead exposure increases cancer risk. IARC has classified lead as a ‘probable’ carcinogen, primarily based on stomach and lung cancer associations. MethodsWe studied mortality among men in a lead surveillance program in 11 states,. categorized by their highest blood lead (BL) test (0–<5µg/dl, 5–<25µg/dl, 25–<40µg/dl and 40+ µg/dl). ResultsThere were 58,368 men with a median 12 years of follow-up (6 to 17 years from lowest to higher BL category), and 3337 deaths. Half of the men had only one BL test. There was a strong healthy worker effect (all cause SMR=0.69, 95% CI: 0.66–0.71). The highest BL category had elevated lung and larynx cancer SMRs (1.20, 95% CI: 1.03–1.39, n=174, and 2.11, 95% CI: 1.05–3.77, n=11, respectively); there were no significant excesses of any other cause-specific SMR. Lung cancer RRs by increasing BL category were 1.0, 1.34, 1.88, and 2.79 (test for trend p=<0.0001), unchanged by adjustment for follow-up time. The lung cancer SMR in the highest BL category with 20+ years follow-up was 1.35 (95% CI: 0.92–1.90). ConclusionsWe found an association of blood lead level with lung cancer mortality. Our data are limited by lack of work history (precluding analyses by duration of exposure), and smoking data, although the strong positive trend in RRs by increasing blood lead category in internal analysis is unlikely to be caused by smoking differences. Other limitations include different lengths of follow-up in different lead categories, reliance on few blood lead tests to characterize exposure, and few deaths for some causes.

278 Mortality patterns in a cohort of 70,000 workers with blood lead measurements

ObjectivesTo determine whether adult lead exposure is associated with cause-specific mortality in a cohort with measured blood leadsMethodsWe studied 70,000 US adults from 11 states with blood lead levels measured...

Mortality among shipbreaking workers in Taiwan—A retrospective cohort study from 1985 to 2008

Shipbreaking workers are typically exposed to a wide range of hazardous chemicals. However, long-term follow-up studies of their mortality patterns are lacking. This study examined mortality among shipbreaking workers over a 24-year follow-up period. A total of 4,962 shipbreaking workers were recruited from the database of the Kaohsiung Shipbreaking Workers Union. The data were then linked to the Taiwan National Death Registry from 1985 to 2008. The mortality ratios-standardized for age and calendar years-(SMRs) for various causes of deaths were calculated with reference to the general population of Taiwan. Among men workers, a statistically significant increased SMR was observed for all causes (SMR = 1.28), all cancers (SMR = 1.26; particularly noteworthy for lesions of oral and nasopharyngeal: SMR 2.03, liver: SMR 4.63, and lung: SMR 1.36), cirrhosis of the liver (SMR = 1.32), and accidents (SMR = 1.91). A statistically significant increase in mortality was observed for respiratory system cancer (SMR = 1.87) and lung cancer (SMR = 1.91) among workers with a longer duration of employment (≥7 years). The result also showed that among shipbreaking workers who were still alive, two people had mesothelioma and 10 people have asbestosis. Those employed in shipbreaking industries experienced an increase in mortality from all causes. The increased SMR for lung cancer was probably related to asbestos, metals, and welding fume exposure.

Carbon black and lung cancer – testing a novel exposure metric by multi-model inference

ObjectivesCarbon black is a powdered form of elemental carbon that is manufactured by the controlled vapour-phase pyrolysis of hydrocarbons. IARC concluded in 2006 that the human evidence for lung cancer...

Carbon Black

Carbon Black

Biologic Implications from an Epidemiologic Study of Chromate Production Workers

This analysis of an epidemiologic study of chromate production workers evaluates several variables related to the biologic understanding of chromate-induced lung cancer. Age at hire was found to be negatively associated with lung cancer risk. Reducing exposure was found to have benefits that extended into older age, and the benefits were greater when the reduction began at an earlier age. The same cumulative exposure over a short period of time (30 days) had more effect than if the exposure occurred over 10 years. The greater carcinogenic effect among those exposed at an early working age is consistent with an ability to more efficiently reduce hexavalent chromium intracellularly at younger ages. The greater effect at younger ages may also explain why short-term cumulative hexavalent chromium exposure was found to have more effect than the equivalent cumulative exposure spread over a longer term. The SMR for lung cancer was highest in the decade following cessation of exposure and may reflect the extremely irritating nature of hexavalent chromium.

Occupational exposure to trichloroethylene and cancer risk for workers at the Paducah Gaseous Diffusion Plant.

The Paducah Gaseous Diffusion Plant (PGDP) became operational in 1952; it is located in the western part of Kentucky. We conducted a mortality study for adverse health effects that workers may have suffered while working at the plant, including exposures to chemicals. We studied a cohort of 6820 workers at the PGDP for the period 1953 to 2003; there were a total of 1672 deaths to cohort members. Trichloroethylene (TCE) is a specific concern for this workforce; exposure to TCE occurred primarily in departments that clean the process equipment. The Life Table Analysis System (LTAS) program developed by NIOSH was used to calculate the standardized mortality ratios for the worker cohort and standardized rate ratio relative to exposure to TCE (the U.S. population is the referent for ageadjustment). LTAS calculated a significantly low overall SMR for these workers of 0.76 (95% CI: 0.72-0.79). A further review of three major cancers of interest to Kentucky produced significantly low SMR for trachea, bronchus, lung cancer (0.75, 95% CI: 0.72-0.79) and high SMR for Non-Hodgkin's lymphoma (NHL) (1.49, 95% CI: 1.02-2.10). No significant SMR was observed for leukemia and no significant SRRs were observed for any disease. Both the leukemia and lung cancer results were examined and determined to reflect regional mortality patterns. However, the Non-Hodgkin's Lymphoma finding suggests a curious amplification when living cases are included with the mortality experience. Further examination is recommended of this recurrent finding from all three U.S. Gaseous Diffusion plants.

Bayesian bias adjustments of the lung cancer SMR in a cohort of German carbon black production workers.

BackgroundA German cohort study on 1,528 carbon black production workers estimated an elevated lung cancer SMR ranging from 1.8-2.2 depending on the reference population. No positive trends with carbon black exposures were noted in the analyses. A nested case control study, however, identified smoking and previous exposures to known carcinogens, such as crystalline silica, received prior to work in the carbon black industry as important risk factors.We used a Bayesian procedure to adjust the SMR, based on a prior of seven independent parameter distributions describing smoking behaviour and crystalline silica dust exposure (as indicator of a group of correlated carcinogen exposures received previously) in the cohort and population as well as the strength of the relationship of these factors with lung cancer mortality. We implemented the approach by Markov Chain Monte Carlo Methods (MCMC) programmed in R, a statistical computing system freely available on the internet, and we provide the program code.ResultsWhen putting a flat prior to the SMR a Markov chain of length 1,000,000 returned a median posterior SMR estimate (that is, the adjusted SMR) in the range between 1.32 (95% posterior interval: 0.7, 2.1) and 1.00 (0.2, 3.3) depending on the method of assessing previous exposures.ConclusionsBayesian bias adjustment is an excellent tool to effectively combine data about confounders from different sources. The usually calculated lung cancer SMR statistic in a cohort of carbon black workers overestimated effect and precision when compared with the Bayesian results. Quantitative bias adjustment should become a regular tool in occupational epidemiology to address narrative discussions of potential distortions.

Carbon black and lung cancer: Testing a new exposure metric in a German cohort

A cohort mortality study of a large carbon black production plant in Germany showed an elevation in lung cancer mortality (SMR 1.81 (95% CI: 1.34-2.39)), although the elevation could not be linked to exposure to carbon black. In follow up to a British study of carbon black production workers [Sorahan et al., 2007] in which risk of lung cancer progressively declined after cessation of employment-in contrast to an expected upward trend-we evaluated the German cohort with a similar methodology, that is, by focusing on the first 15 years after leaving employment in terms of lung cancer SMR. In our SMR analysis of the German cohort of 1,528 men and an inception cohort of 1,271 men, distinctly different results from the British cohort were observed. We observed a rising trend in lung cancer SMR, in contrast to the declining SMR trend noted in the British cohort. In fact, Cox models for lung cancer mortality with attained age as the basic time variable showed negative coefficients for the full and inception cohorts. Our analysis of a large German cohort of carbon black workers does not support the concept of a declining risk of lung cancer following cessation of employment.

Comment on Caprolactam Study

There is evidence that adult lead exposure increases cancer risk. IARC has classified lead as a ‘probable’ carcinogen, primarily based on stomach and lung cancer associations.We studied mortality among men in a lead surveillance program in 11 states,. categorized by their highest blood lead (BL) test (0–<5 µg/dl, 5–<25 µg/dl, 25–<40 µg/dl and 40+ µg/dl).There were 58,368 men with a median 12 years of follow-up (6 to 17 years from lowest to higher BL category), and 3337 deaths. Half of the men had only one BL test. There was a strong healthy worker effect (all cause SMR=0.69, 95% CI: 0.66–0.71). The highest BL category had elevated lung and larynx cancer SMRs (1.20, 95% CI: 1.03–1.39, n=174, and 2.11, 95% CI: 1.05–3.77, n=11, respectively); there were no significant excesses of any other cause-specific SMR. Lung cancer RRs by increasing BL category were 1.0, 1.34, 1.88, and 2.79 (test for trend p=<0.0001), unchanged by adjustment for follow-up time. The lung cancer SMR in the highest BL category with 20+ years follow-up was 1.35 (95% CI: 0.92–1.90).We found an association of blood lead level with lung cancer mortality. Our data are limited by lack of work history (precluding analyses by duration of exposure), and smoking data, although the strong positive trend in RRs by increasing blood lead category in internal analysis is unlikely to be caused by smoking differences. Other limitations include different lengths of follow-up in different lead categories, reliance on few blood lead tests to characterize exposure, and few deaths for some causes.

Mortality and cancer incidence in Ontario glass fiber workers

In a previous cohort study of glass fiber manufacturing, we found a significant increase in lung cancer. This study extends the follow-up period. We conducted a historical prospective study of 2557 men employed in producing glass wool. We obtained work histories, causes and dates of death, and date and site of cancer diagnoses. We computed standardized mortality and incidence ratios (SMR, SIR). The overall SMR for lung cancer was 163 (95% CI = 118-221). The SMR did not vary consistently by duration of employment and time since first employment. However, plant workers with >20 years' employment and >40 years since first exposure had an SMR for lung cancer of 282 (95% CI = 113-582). The SMR dropped with later date of first exposure, but the trend was non-significant. There was an unexpected overall increase in kidney cancer incidence. The increase in lung cancer is greater than in other cohorts of glass fiber workers. Since exposure data are lacking from the early years of the plant, we cannot state if the excess was due to glass fibers, other work exposures or other reasons.

Geographic boundaries in breast, lung and colorectal cancers in relation to exposure to air toxics in Long Island, New York

BackgroundThis two-part study employs several statistical techniques to evaluate the geographic distribution of breast cancer in females and colorectal and lung cancers in males and females in Nassau, Queens, and Suffolk counties, New York, USA. In this second paper, we compare patterns in standardized morbidity ratios (SMR values), calculated from New York State Department of Health (NYSDOH) data, to geographic patterns in overall predicted risk (OPR) from air toxics using exposures estimated in the USEPA National Air Toxics Assessment database.ResultsWe identified significant geographic boundaries in SMR and OPR. We found little or no association between the SMR of colorectal and breast cancers and the OPR for each cancer from exposure to the air toxics. We did find boundaries in male and female lung cancer SMR and boundaries in lung cancer OPR to be closer to one another than expected.ConclusionWhile consistent with a causal relationship between air toxics and lung cancer incidence, the boundary analysis does not demonstrate the existence of a causal relationship. However, now that the areas of overlap between boundaries in lung cancer incidence and potential airborne exposures have been identified, we can begin to evaluate local- as well as large-scale determinants of lung cancer.

Epidemiologic study of cancer mortality among Israeli asphalt workers.

We describe the results of a cancer mortality study among asphalt workers in Israel. Personal identifiers and employment histories of 2,176 workers were extracted from company records. Mortality from all malignant neoplasms was significantly reduced in the whole cohort (SMR 0.68, 95% confidence interval (CI) 0.56-0.83). SMR for lung cancer was elevated in workers exposed to bitumen (SMR 1.05, 95% CI 0.62-1.66). No significant elevation or reduction in mortality was observed in relation to a specific site. SMRs for lung cancer was higher among ever exposed to bitumen than among unexposed. There was no association between lung cancer risk and estimated exposure to bitumen fume, and no dose-response was apparent. While the results of this cohort study indicate a slightly increased SMR for lung cancer, it did not produce evidence of a causal link between lung cancer and exposure to bitumen fume.

Evidence of Excess Cancer Mortality in a Cohort of Workers Exposed to Polychlorinated Biphenyls

Evidence of Excess Cancer Mortality in a Cohort of Workers Exposed to Polychlorinated Biphenyls

A retrospective cohort study of male workers exposed to PVA fibers.

In order to ascertain whether PVA fibers can produce cancer in humans or not, we have conducted a retrospective cohort study of workers exposed to PVA fibers. A total of 447 exposed and 2416 non-exposed male workers who were engaged before 1980 were followed up until the end of 1996. The SMR for all causes was 0.57 (observed 38, 95% CI: 0.41-0.78) for the exposed, and 0.66 (observed 210, 95% CI: 0.58-0.75). As for lung cancer, its SMR was 0.77 (observed 3, 95% CI: 0.15-2.24) for the exposed workers and 0.67 (12 observed, 95% CI: 0.34-1.16) for the non-exposed workers. Lung cancer SMR was 0.86 (observed 2, 95% CI: 0.10-3.11) for the workers with 20 or more years' employment. This study showed no difference in lung cancer risk between the workers exposed to PVA fibers and the non-exposed workers.

Adjustment for the confounding effect of cigarette smoking in an historical cohort mortality study of workers in a fiberglass manufacturing facility.

In 1986 a statistically significant lung cancer SMR based on U.S. white male national mortality rates was reported for male fibrous glass workers for follow-up through 1982 of a cohort of U.S. man-made mineral fiber workers. The Newark, Ohio, plant of Owens-Corning, which comprised 38% of the fibrous glass workers in that cohort, also exhibited a statistically significant lung cancer standardized mortality ratio based on U.S. white male mortality rates. A case-control study of the Newark workers demonstrated that a history of cigarette smoking and not exposure to respirable glass is the most important factor in lung cancer risk for workers at the Newark plant. We provide an estimate of the extent of confounding by cigarette smoking for the Newark plant nationally based lung cancer standardized mortality ratio with data not previously available and which suggests that adjusting for the confounding effect of cigarette smoking could reduce the lung cancer standardized mortality ratio to a non-statistically significant level.