A hybrid expert approach for retrospective assessment of occupational exposures in a population-based case-control study of cancer.

BACKGROUND: While the expert-based occupational exposure assessment approach has been considered the reference method for retrospective population-based studies, its implementation in large study samples has become prohibitive. To facilitate its application and improve upon it we developed, in the context of a Montreal population-based study of prostate cancer (PROtEuS), a hybrid approach combining job-exposure profiles (JEPs) summarizing expert evaluations from previous studies and expert review. We aim to describe the hybrid expert method and its impacts on the exposures assigned in PROtEuS compared to those from a previous study coded using the traditional expert method. METHODS: Applying the hybrid approach, experts evaluated semi-quantitative levels of confidence, concentration and frequency of exposure to 313 agents for 16,065 jobs held by 4005 subjects in PROtEuS. These assessments were compared to those from a different set of jobs coded in an earlier study of lung cancer, conducted on the same study base, for 90 blue-collar occupations and 203 agents. Endpoints evaluated included differences in the number of exposures and in the distribution of ratings across jobs, and the within-occupation variability in exposure. RESULTS: Compared to jobs from the lung cancer study, jobs in PROtEuS had on average 0.3 more exposures. PROtEuS exposures were more often assigned definite confidence ratings, but concentration and frequency levels tended to be lower. The within-occupation variability in ratings assigned to jobs were lower in PROtEuS jobs for all metrics. This was particularly evident for concentration, although considerable variability remained with over 40% of occupation/agent cells in PROtEuS exposed at different levels. The hybrid approach reduced coding time by half, compared to the traditional expert assessment. CONCLUSIONS: The new hybrid expert approach improved on efficiency and transparency, and resulted in greater confidence in assessments, compared to the traditional expert method applied in an earlier study involving a similar set of jobs. Assigned ratings were more homogeneous with the hybrid approach, possibly reflecting clearer guidelines for coding, greater coherence between experts and/or reliance on summaries of past assessments. Nevertheless, significant within-occupation variability remained with the hybrid approach, suggesting that experts took into account job-specific factors in their assessments.

Postmenopausal breast cancer and occupational exposures.

OBJECTIVE: To determine whether exposures in the workplace to organic solvents and to other agents, such as polycyclic aromatic hydrocarbons, are associated with increased risks of developing postmenopausal breast cancer. METHODS: Between 1996 and 1997 a case-control study was conducted in Montreal, Quebec. Cases comprised 556 women, aged 50-75 years, with incident malignant breast cancer, and their controls were 613 women with other cancers, frequency matched for age, date of diagnosis and hospital. An expert team of chemists and industrial hygienists translated their job histories into exposure to about 300 agents. RESULTS: Odds ratios (ORs) were increased for the usual risk factors for breast cancer and, adjusting for these, risks increased with occupational exposure to several agents, and were highest for exposures occurring before age 36 years. Increased ORs were found for each 10-year increment in duration of exposure, before age 36 years (OR(<36)), to acrylic fibres (OR(<36)=7.69) and to nylon fibres (OR(<36)=1.99). For oestrogen-positive and progesterone-negative tumours, the OR doubled or more for each 10-year increase in exposure to monoaromatic hydrocarbons, and to acrylic and rayon fibres. The OR(<36) also doubled for exposure to organic solvents that metabolise into reactive oxygen species, and to acrylic fibres. A threefold increase was found for oestrogen- and progesterone-positive tumours, with exposure to polycyclic aromatic hydrocarbons from petroleum sources. CONCLUSION: Certain occupational exposures appear to increase the risk of developing postmenopausal breast cancer, although some findings might be due to chance or to undetected bias. Our findings are consistent with the hypothesis that breast tissue is more sensitive to adverse effects if exposure occurs when breast cells are still proliferating. More refined analyses, adjusting for hormonal receptor subtypes and studies focusing on certain chemical exposures are required to further our understanding of the role of chemicals in the development of breast cancer.

Exposures in painting related occupations and risk of selected cancers: results from a case-control study in Montreal.

BACKGROUND: Painters are considered to be at increased risk of lung cancer. The objective was to evaluate risk of several cancers, apart from lung, in painting-related professions. Most previous studies have focused on the job title rather than on exposures incurred. METHODS: A large population based case-control study was carried out during 1979-1986 in Montreal including several types of cancer and focusing on occupational exposures. Interviews elicited detailed lifetime job histories; those were evaluated by a team of industrial hygienists to assign exposure. The exposure checklist included three paint-related substances: metal coatings, wood varnishes and stains, and wood and gypsum paints. Seven types of cancer were analyzed (numbers interviewed): esophagus (97), stomach (248), colorectal (754), prostate (438), bladder (478), kidney (174) and non-Hodgkin's lymphoma (215). For each cancer type, a pooled control group was constituted from 533 population controls and 533 cancer patients selected from other types of cancer. Odds ratios (ORs) were estimated between each of the paint-related agents and each of the seven cancer types, adjusting for several potential confounders, including smoking. RESULTS: The job title of "painters" was not associated with risk of any of the cancers under study. Most of the ORs between the three agents and the seven cancers were close to null. However, there was a tendency for ORs to be above 1.0 for subjects who had substantial exposure to metal coatings, with noteworthy associations for cancers of the esophagus (OR = 4.2; 95% CI: 1.1-17.0; n = 4), prostate (OR = 2.7; 95% CI: 1.0-7.7; n = 13), and bladder (OR = 1.7; 95% CI: 0.7-4.4; n = 13). CONCLUSION: These results are compatible with an absence of risk among painting-related professions; they are also compatible with excess risk of certain cancers, especially among those exposed to metal coatings.

The INTERPHONE study: design, epidemiological methods, and description of the study population.

The very rapid worldwide increase in mobile phone use in the last decade has generated considerable interest in the possible health effects of exposure to radio frequency (RF) fields. A multinational case-control study, INTERPHONE, was set-up to investigate whether mobile phone use increases the risk of cancer and, more specifically, whether the RF fields emitted by mobile phones are carcinogenic. The study focused on tumours arising in the tissues most exposed to RF fields from mobile phones: glioma, meningioma, acoustic neurinoma and parotid gland tumours. In addition to a detailed history of mobile phone use, information was collected on a number of known and potential risk factors for these tumours. The study was conducted in 13 countries. Australia, Canada, Denmark, Finland, France, Germany, Israel, Italy, Japan, New Zealand, Norway, Sweden, and the UK using a common core protocol. This paper describes the study design and methods and the main characteristics of the study population. INTERPHONE is the largest case-control study to date investigating risks related to mobile phone use and to other potential risk factors for the tumours of interest and includes 2,765 glioma, 2,425 meningioma, 1,121 acoustic neurinoma, 109 malignant parotid gland tumour cases and 7,658 controls. Particular attention was paid to estimating the amount and direction of potential recall and participation biases and their impact on the study results.

Maternal exposure to occupational solvents and childhood leukemia.

Many organic solvents are considered probable carcinogens. We carried out a population-based case-control study including 790 incident cases of childhood acute lymphoblastic leukemia and as many healthy controls, matched on age and sex. Maternal occupational exposure to solvents before and during pregnancy was estimated using the expert method, which involves chemists coding each individual's job for specific contaminants. Home exposure to solvents was also evaluated. The frequency of exposure to specific agents or mixtures was generally low. Results were generally similar for the period ranging from 2 years before pregnancy up to birth and for the pregnancy period alone. For the former period, the odds ratio (OR), adjusted for maternal age and sex, for any exposure to all solvents together was 1.11 [95% confidence interval (CI), 0.88-1.40]. Increased risks were observed for specific exposures, such as to 1,1,1-trichloroethane (OR = 7.55; 95% CI, 0.92-61.97), toluene (OR = 1.88; 95% CI, 1.01-3.47), and mineral spirits (OR = 1.82; 95% CI, 1.05-3.14). There were stronger indications of moderately increased risks associated with exposure to alkanes (C5-C17; OR = 1.78; 95% CI, 1.11-2.86) and mononuclear aromatic hydrocarbons (OR = 1.64; 95% CI, 1.12-2.41). Risk did not increase with increasing exposure, except for alkanes, where a significant trend (p = 0.04) was observed. Home exposure was not associated with increased risk. Using an elaborate exposure coding method, this study shows that maternal exposure to solvents in the workplace does not seem to play a major role in childhood leukemia.

Mortality in an Australian cohort of textile workers.

BACKGROUND: Workers in the textile industry may be exposed to textile dusts, a wide range of chemicals and electromagnetic radiation. AIM: To investigate the risk of mortality in a cohort of textile workers and examine whether specific occupational exposures were associated with mortality. METHOD: Data on members and former members of a textile industry union were extracted from membership cards and matched with the National Death Index to obtain date and cause of death. Exposure to 31 different substances was assessed using a specifically designed job exposure matrix that consisted of profiles of exposures in 11 occupational titles. These profiles were modified according to individual circumstances. Standardized mortality ratios (SMRs) were computed comparing the cohort to the Australian population and Mantel-Haenszel estimates of the rate ratios were computed comparing exposed with unexposed for each of the substances. RESULTS: There were 113 deaths in the cohort of 7684 workers. Male and female textile workers had similar risks of death from any cause, cancer or cardiovascular disease to the general Australian population. Male workers had an increased risk of death from injury (SMR = 157, 95% confidence interval 113-213). There were no statistically significant increases in risk with particular occupational exposures. CONCLUSION: Male textile workers are at higher risk of death from injury.

Occupational exposures to extremely low frequency magnetic fields and postmenopausal breast cancer.

BACKGROUND: The association between occupational exposure to extremely low frequency magnetic fields (ELF-MF) and risk of postmenopausal breast cancer was assessed in a case-control study. METHODS: Breast cancer cases were compared to cancer controls. Interviewers elicited information on risk factors and on lifetime work history. Industrial hygienists assigned to each job average duration of exposure to ELF-MF at four levels of intensities ("none," <0.2 microT; "low," 0.2-<0.5microT; "medium," 0.5-<1microT; "high," > or =1-10microT). Unconditional logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: A total number of 608 cases and 667 controls participated. Adjusting for accepted breast cancer risk factors, we found an OR of 1.13 for lifetime occupational exposure to ELF-MF at medium or high intensities. Risks were larger for exposures before age 35 (OR = 1.40), and statistically significant for exposures before 35 among cases with progesterone receptor positive tumors (OR = 1.56, 95% CI=1.02-2.39). CONCLUSIONS: There appears to be a small increased risk for breast cancer among postmenopausal women exposed occupationally to ELF-MF.

Controlling for potential confounding by occupational exposures.

Occupational exposure is an important potential confounder in air pollution studies because it is plausible that individuals who live in highly polluted areas also work in more polluted environments. While the original investigators made some efforts to control for possible confounding by occupational variables, it was felt that these could be improved upon. The reanalysis team attempted to control for occupational confounding by supplementing the original data sets with two new variables, an indicator of the "dirtiness" of a subject's job and an indicator of possible exposure to occupational lung carcinogens. The attribution of these variables was based on the job title recorded by the original investigators and on the judgment of our experts concerning typical exposure patterns in different occupations. We fitted Cox proportional-hazards models identical to those that had been used by the original investigators while also including one or both of the new occupational covariates in the models. In none of the analyses did the inclusion of the occupational variables materially change the results. It would therefore appear that, in general, the results reported by the original investigators were not distorted by inadequate control of occupational variables. We also carried out some analyses using the dirtiness index as a stratification variable to assess effect modification. There was some indication, albeit inconsistent, that the effect of air pollution on mortality was greater among subjects with dirty jobs than among those with clean jobs.

Validation of expert assessment of occupational exposures.

BACKGROUND: Assessment by experts may be the best method available for retrospective occupational exposure measurement in community-based studies. This study was undertaken to examine the validity of occupational exposure assessment by comparing the ratings of experienced raters with previously recorded industrial hygiene measurements. METHODS: We obtained 50 measurements from industrial hygiene records, covering a variety of jobs and substances and created 47 job descriptions around these measurements. Three raters were asked to assess exposure to a checklist of 19 substances (including those substances which had been measured). We estimated the sensitivity of the raters in correctly detecting those substances known to have been present. RESULTS: Using a liberal criterion for the ratings, the average sensitivity among the raters was 90%. Using a more stringent criterion, the average sensitivity was 73%. Among substances coded as present, the raters were quite accurate in rating the relative concentration and frequency of exposure. CONCLUSIONS: This trial demonstrated that a team of experienced raters could successfully characterize jobs in which important exposures occurred.