Occupational exposures and risk of pancreatic cancer Authors
First Online: 17 July 2010 Received: 31 March 2010 Accepted: 05 July 2010 DOI:
Cite this article as: Santibañez, M., Vioque, J., Alguacil, J. et al. Eur J Epidemiol (2010) 25: 721. doi:10.1007/s10654-010-9490-0 Abstract
The objective was to analyze the relationship between occupation (and specific occupational exposures) and risk of exocrine pancreatic cancer (EPC). We conducted a multicenter hospital-based case–control study in Eastern Spain. We included 161 incident cases of EPC (59.6% men, 94 with histological confirmation, of whom 80% had ductal adenocarcinoma). Cases were frequency-matched with 455 controls by sex, age and province of residence. Information was elicited using structured questionnaires. Occupations were coded according to the Spanish version of the International Standard Classification of Occupations 1988. Occupational exposure to a selection of carcinogenic substances was assessed with the Finnish Job-Exposure Matrix (FINJEM). Odds ratios (OR) and 95% confidence intervals (CI) were estimated by multiple logistic regression, adjusting for sex, age, province, education, alcohol and smoking. A higher risk of EPC was associated with having worked as ‘Miners, shotfirers, stone cutters and carvers’, ‘Machinery mechanics and fitters’, ‘Building trades workers’ and ‘Motor vehicle drivers’ in men, ‘Office Clerks’ in women, and ‘Waiters’ in both sexes. Cases with ductal adenocarcinomas were more likely to have been exposed to chlorinated hydrocarbon solvents (OR = 4.1, 95% CI: 1.1–15.2,
p-trend = 0.04). We also observed significant associations with exposure to ‘synthetic polymer dust exposure’ and ‘ionizing radiation’. Suggestive increases in risk were observed for ‘pesticides’, ‘diesel and gasoline engine exhaust’, and ‘hydrocarbon solvents’. Results support the hypothesis that occupational exposure to chlorinated hydrocarbon solvents is associated with exocrine pancreatic cancer. Keywords Chlorinated hydrocarbons Occupation Occupational exposures Pancreatic neoplasms Abbreviations CHC
Chlorinated hydrocarbon solvents
Exocrine pancreatic cancer
Finnish job-exposure matrix
Odds ratio for the highest level of exposure
Odds ratio restricted to men
Odds ratio restricted to women
Polycyclic aromatic hydrocarbons
Spanish national classification of occupations, 1994
This study is conducted for the PANESOES Study Group. Please see the Appendix section for the members of PANESOES Study Group.
Weiderpass E, Partanen T, Kaaks R, et al. Occurrence, trends and environment etiology of pancreatic cancer. Scand J Work Environ Health. 1998;24:165–74.
Ferraroni M, Negri E, La Vecchia C, et al. Socioeconomic indicators, tobacco and alcohol in the aetiology of digestive tract neoplasms. Int J Epidemiol. 1989;18:556–62.
Fernandez E, La Vecchia C, Decarli A. Attributable risks for pancreatic cancer in northern Italy. Cancer Epidemiol Biomarkers Prev. 1996;5:23–7.
Parkin D, Bray F, Ferlay J, et al. Estimating the world cancer burden: Globocan 2000. Int J Cancer. 2001;94:153–6.
American Cancer Society. Cancer facts & figures 2004. Atlanta: American Cancer Society, Inc.; 2004.
Bray F, Sankila R, Ferlay J, et al. Estimates of cancer incidence and mortality in Europe in 1995. Eur J Cancer. 2002;38:99–166.
Sahmoun A, D’Agostino RJ, Bell R, et al. International variation in pancreatic cancer mortality for the period 1955–1998. Eur J Epidemiol. 2003;18:801–16.
Anderson KE, Mack TM, Silverman DT. Cancer of the Pancreas. In: Schottenfeld D, Fraumeni J, editors. Cancer epidemiology and prevention, 2nd ed. New York: Oxford University Press; 2006. p. 721–62.
Ojajarvi IA, Partanen TJ, Ahlbom A, et al. Occupational exposures and pancreatic cancer: a meta-analysis. Occup Environ Med. 2000;57:316–24.
Seilkop S. Occupational exposures and pancreatic cancer: a meta-analysis. Occup Environ Med. 2001;58:63–4.
Ojajärvi A, Partanen T, Ahlbom A, et al. Risk of pancreatic cancer in workers exposed to chlorinated hydrocarbon solvents and related compounds: a meta-analysis. Am J Epidemiol. 2001;153:841–50.
Alguacil J, Porta M, Benavides FG, et al. Occupation and pancreatic cancer in Spain: a case-control study based on job titles. Int J Epidemiol. 2000;29:1004–13.
Alguacil J, Kauppinen T, Porta M, et al. Risk of pancreatic cancer and occupational exposures in Spain. Ann Occup Hyg. 2000;44:391–403.
Alguacil J, Porta M, Malats N, et al. Occupational exposure to organic solvents and K-ras mutations in exocrine pancreatic cancer. Carcinogenesis. 2002;23:101–6.
Santibañez M, Vioque J, Alguacil J, et al. Occupational exposures and risk of oesophageal cancer by historical type: a case-control study in Eastern Spain. Occup Environ Med. 2008;65:774–81.
Vioque J, Barber X, Bolumar F, et al. Esophageal cancer risk by type of alcohol drinking and smoking: a case-control study in Spain. BMC Cancer. 2008;8:221.
Kauppinen T, Toikkanen J, Pukkala E. From cross-tabulations to multipurpose exposure information systems: a new job-exposure matrix. Am J Ind Med. 1998;33:409–17.
Armitage P, Berry G. Statistical methods in medical research. 3rd ed. Oxford: Blackwell; 1994.
Breslow N, Day N. Statistical methods in cancer research. The analysis of case-control studies. IARC Sci Publ. 1980;I:5–338.
IARC working group on the evaluation of carcinogenic risks to humans: IARC monographs on the evaluation of carcinogenic risks to humans. Alcohol drinking, vol 44
. Lyon, France: International Agency for Research on Cancer; 1988.
Partanen T, Kauppinen T, Degerth R, et al. Pancreatic cancer in industrial branches and occupations in Finland. Am J Ind Med. 1994;25:851–66.
Kauppinen T, Partanen T, Degerth R, et al. Pancreatic cancer and occupational exposures. Epidemiology. 1995;6:498–502.
Smith P, Doll R. Mortality from cancer and all causes among British radiologists. Br J Radiol. 1981;54:187–94.
Tolley H, Marks S, Buchanan J, et al. A further update of the analysis of mortality of workers in a nuclear facility. Radiat Res. 1983;95:211–3.
Polednak A, Stehney A, Lucas H. Mortality among male workers at a thorium-processing plant. Health Phys. 1983;44(Suppl 1):239–51.
Darby S, Whitley E, Howe G, et al. Radon and cancers other than lung cancer in underground miners: a collaborative analysis of 11 studies. J Natl Cancer Inst. 1995;87:378–84.
Committee on the Biological Effects of Ionizing Radiation (BEIR V), National Research Council. Health effects of exposure to low levels of ionizing radiation. Washington DC: National Academy Press; 1990.
Weiderpass E, Vainio H, Kauppinen T, et al. Occupational exposures and gastrointestinal cancers among Finnish women. J Occup Environ Med. 2003;45:305–15.
Kernan G, Ji B, Dosemeci M. et al. Occupational risk factors for pancreatic cancer: a case-control study based on death certificates from 24 U.S. states. Am J Ind Med. 1999;36:260–70.
Falk R, Pickle L, Fontham E, et al. Occupation and pancreatic cancer risk in Louisiana. Am J Ind Med. 1990;18:565–76.
Bao Y, Michaud D. Physical activity and pancreatic cancer risk: a systematic review. Cancer Epidemiol Biomarkers Prev. 2008;17:2671–82.
Yassi A, Tate R, Routledge M. Cancer incidence and mortality in workers employed at a transformer manufacturing plant: update to a cohort study. Am J Ind Med. 2003;44:58–62.
Alguacil J, Porta M, Kauppinen T, et al. Occupational exposure to dyes, metals, polycyclic aromatic hydrocarbons and other agents and K-ras activation in human exocrine pancreatic cancer. Int J Cancer. 2003;107:635–41.
Ji B, Silverman D, Dosemeci M, et al. Occupation and pancreatic cancer risk in Shanghai, China. Am J Ind Med. 1999;35:76–81.
Mallin K, Rubin M, Joo E. Occupational cancer mortality in Illinois white and black males, 1979–1984, for seven cancer sites. Am J Ind Med. 1989;15:699–717.
Silverstein M, Park R, Marmor M, et al. Mortality among bearing plant workers exposed to metalworking fluids and abrasives. J Occup Med. 1988;30:706–14.
Mur J, Moulin J, Meyer-Bisch C, et al. Mortality of aluminium reduction plant workers in France. Int J Epidemiol. 1987;16:257–64.
Rockette H, Arena V. Mortality studies of aluminum reduction plant workers: potroom and carbon department. J Occup Med. 1983;25:549–57.
Maruchi N, Brian D, Ludwig J, et al. Cancer of the pancreas in Olmsted County, Minnesota, 1935–1974. Mayo Clin Proc. 1979;54:245–9.
Calvert G, Ward E, Schnorr T, et al. Cancer risks among workers exposed to metalworking fluids: a systematic review. Am J Ind Med. 1998;33:282–92.
Alguacil J, Pollán M, Gustavsson P. Occupations with increased risk of pancreatic cancer in the Swedish population. Occup Environ Med. 2003;60:570–6.
Viadana E, Bross I, Houten L. Cancer experience of men exposed to inhalation of chemicals or to combustion products. J Occup Med. 1976;18:787–92.
Ji B, Silverman D, Stewart P, et al. Occupational exposure to pesticides and pancreatic cancer. Am J Ind Med. 2001;39:92–9.
Porta M, Malats N, Jariod M, et al. Serum concentrations of organochlorine compounds and K-
mutations in exocrine pancreatic cancer. Lancet. 1999;354:2125–9.
Fryzek J, Garabrant D, Harlow S, et al. A case-control study of self-reported exposures to pesticides and pancreas cancer in southeastern Michigan. Int J Cancer. 1997;72:62–7.
Friedman G, van den Eeden S. Risk factors for pancreatic cancer: an exploratory study. Int J Epidemiol. 1993;22:30–7.
Cocco P, Kazerouni N, Zahm S. Cancer mortality and environmental exposure to DDE in the United States. Environ Health Perspect. 2000;108:1–4.
Wong O, Brocker W, Davis H, et al. Mortality of workers potentially exposed to organic and inorganic brominated chemicals, DBCP, TRIS, PBB, and DDT. Br J Ind Med. 1984;41:15–24.
Wiklund K, Dich J, Holm L, et al. Risk of cancer in pesticide applicators in Swedish agriculture. Br J Ind Med. 1989;46:809–14.
Brown D. Mortality of workers employed at organochlorine pesticide manufacturing plants–an update. Scand J Work Environ Health. 1992;18:155–61.
Beard J, Sladden T, Morgan G, et al. Health impacts of pesticide exposure in a cohort of outdoor workers. Environ Health Perspect. 2003;111:724–30.
Garabrant D, Held J, Langholz B, et al. DDT and related compounds and risk of pancreatic cancer. J Natl Cancer Inst. 1992;84:764–71.
Porta M, López T, Pumarega J, et al. In pancreatic ductal adenocarcinoma blood concentrations of some organochlorine compounds and coffee intake are independently associated with KRAS mutations. Mutagenesis. 2009;24:513–21.
Malats N, Real F, Porta M. DDT and pancreatic cancer. J Natl Cancer Inst. 1993;85:328–9.
Porta M, Malats N, Piñol JL, et al. Diagnostic certainty and potential for misclassification in exocrine pancreatic cancer. J Clin Epidemiol. 1994;47:1069–79.
Porta M, Malats N, Piñol J, et al. Relevance of misclassification of disease status in epidemiologic studies of pancreatic cancer. J Clin Epidemiol. 1996;49:602–3. Response to Silverman et al.
Silverman D, Schiffman M, Devesa S. Diagnostic certainty in pancreatic cancer. J Clin Epidemiol. 1996;49:601–3.
Garabrant H, Held J, Homa D. DDT and pancreatic cancer. J Natl Cancer Inst. 1993;85:328–9. Response to Malats et al.
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