吸烟与油毡生产工人肺癌死亡关系的研究

我国油毡生产工人肺癌死亡束显著超出对照人群。为了进一步探讨吸烟与油毡工人肺癌的职业暴露的交互作用，我们在前期13年（1977—1989）历史性前瞻研究基础上，继续前瞻研究4年，对吸烟与接触沥青烟的油毡生产工人肺癌死亡做了进一步调查分析，现将结果报告如下；材料与方法以天津、北京、上海、齐齐哈尔等全国15个省市20个油毡（防水材料）企业山，接触煤焦沥青和石油沥青油毡生产工人，1977年1月工资在册全部正式职工6005人（男4320人，女1685人）作为接触组。根据接触沥青种类分为混合组（接触煤焦沥青和石油沥青）共2081人（男1793入，…     

吸烟致癌及其机理研究进展

WHO调查表明，全世界1／3的癌症归因于吸烟。我国人群肺癌死亡率正以每年久．5％的速度递增，其中农村上升速度达10％[1]。世界银行估算，到2030年我国将有170万中年人死于肺癌，其中1／3是完全可以避免的[2]。1吸烟致癌，证据确凿有人曾对美国、英国、加拿大等国100万以上人群进行过7次大规模调查统计，吸烟者肺癌的发病率是不吸烟者的10．8倍[3]。肺癌死亡率，不吸烟者为12．8／10万；每日吸烟少于10支者为95．2／10万，每日吸烟多于20支者为235．4／10万，比不吸烟者高18．4倍。上海市卫生防疫站近年调查表明’‘’，吸烟者与不吸烟者…     

螺旋CT低剂量扫描联合血清p16基因甲基化检测进行肺癌筛查的可行性研究

目的：探讨在无症状的肺癌高危人群中，利用低剂量CT（low-radiationdose spiral CT，LDCT）联合血清p16基因甲基化检测进行肺癌早期诊断的可行性。方法：523名受检者被随机分为2组。LDCT-p16组262名，进行LDCT联合血清p16基因甲基化检测；胸部X射线组261名，接受后前位胸部X射线检查。受检者入组标准包括：男，年龄55～75岁；吸烟指数≥20包／年，目前仍在吸烟或戒烟≤10年。结果：LDCT-p16组与胸部X射线组分别有96．6％（253／262）和93．5％（244／261）的受检者完成了检查。LDCT-p16组中10．7％（27／253）患者可疑为肺癌，胸部X射线组中为6．6％（16／244）。其中LDCT-p16组中有4名，胸部X射线组中有1名确诊为肺癌。结论：低剂量CT联合血清p16基因甲基化检测是一种敏感、安全与可行的筛查早期肺癌的方法，能够取代胸部X射线筛查早期肺癌。     

低剂量化疗在中晚期肺癌治疗中的应用

肺癌是严重影响人类健康的恶性肿瘤，随着吸烟、环境污染等危险因素的增加，肺癌的发病率和病死率正在逐年递增。1999年，发展中国家的男性肺癌发病率为14．1例／10万，女性为5．1例／10万；发达国家男性为71．4例／10万，女性为21．2例／10万。全球每年有近100万人死于肺癌，肺癌已成为世界上人类恶性肿瘤最常见的死因。[第一段]     

广州市2000～2002年肺癌发病率与死亡率分析

[目的]分析广州市肺癌发病率和死亡率，为广州市肺癌的防治研究提供科学依据。[方法]收集广州市肿瘤登记处2000～2002年肺癌的发病资料和死亡资料．统计和分析肺癌发病数和死亡病例数、粗发病率和死亡率、中国标化发病率和死亡率、世界标化发病率和死亡率等指标。[结果]广州市2000—2002年肺癌粗发病率和死亡率分别为51．8／10万（其中男性68．8／10万，女性33．7／10万）和45．4／10万（其中男性60．6／10万，女性29．2／10万）。男性肺癌的发病率居所有恶性肿瘤之首，女性居第二位。男女肺癌的死亡率均居所有恶性肿瘤的第一位。[结论]广州市肺癌的发病率和死亡率较高，应加强防治研究。     

T．S．P等大气污染物与肺癌发病关系的岭回归分析

Ｔ．Ｓ．Ｐ等大气污染物与肺癌发病关系的岭回归分析楚建军徐州医学院流行病学教研室（徐州２２１００２）江苏徐州１９９１年居民肺癌死亡率达３１．８９／１０万，标准化死亡率２９．１２／１０万，较１０年前升高达２倍。肺癌发病因素较多，除吸烟、厨房、烹调油烟污染...     

青岛市区1987年—1992年肺癌死亡状况

青岛市肿瘤防治研究办公室先后于1990年和1993年两次对青岛市1987年—1992年三区县（市）城市人口进行了死亡回顾性调查，共累计调查人口244．2万人。采取抽样选点的办法、国际疾病分类。死亡情况：青岛市1987年—1989年男性肺癌死亡率为32．43／10万，女性肺癌死亡率为22．47／10万，男女合计死亡率为27．54／10万。到1990年—1992年肺癌死亡率上升为：男性33．22／10万，女性24．04／10万，平均为28．70／10万。青岛市区1987年—1992年肺癌死亡状况@潘立国@吕华珍…     

河北省90年代肺癌死亡水平分析

河北省男女性肺癌死亡率有逐年上升的趋势。为了掌握其流行规律,以便有针对性制定防治措施,我们在开展1990年-1992年全省1／10人口全死因回顾调查的基础上,对河北省肺癌死亡资料进行了分析。1990年-1992年河北省四个市县肺癌共死亡3739人,3年平均粗死亡率为19．26／10万,中国标化死亡率问．06／10万（按1982年人口标化,下同）,其中男性肺癌死亡率为24．86／10万,中国标化死亡率为22．97／10万,占癌死因构成的17．37％;女性肺癌死亡率为13．37／10万,中国标化死亡率为11．30／10万,占癌死因构成的15．07％。男女肺癌死因占全死因…     

宝鸡市肺癌死亡率20年变化趋势

目的：了解目前宝鸡市肺癌分布,流行状况及自70年代以来肺癌死亡率变化趋势,方法：肺癌病人为宝鸡市金台区及渭我恶性肿瘤监测点1992－1996年登记的全部肺癌病人共63例,男46,女17;同时从主要具有诊治肺癌条件的二所医院获得漏报病例45人,结果：宝鸡市1992－1996年肺癌粗死亡率为13．52／10万,男性18．28／10万,女性8．43／10万,标准化死亡率为8．70／10万,男性8．12／10万,女性6．34／10万,均低于同期全国水平。与70 年代相比宝鸡市肺癌粗死亡率男性由9．23／10万升至18．28／10万,女性由4．85／10万升至8．43／10万,标化死亡率女性基本不变,男性下降,减寿年数分析肺癌使男性寿命的损失高于女性。结论：宝鸡市目前在我国不属于肺癌高发区。     

2000~2009年浙江省肿瘤登记地区肺癌流行趋势分析

[目的]分析浙江省肿瘤登记地区2000～2009年肺癌流行趋势,为制定肺癌预防控制措施与策略提供依据。[方法]根据浙江省6个肿瘤登记处上报的数据,计算并分析浙江省肿瘤登记地区居民肺癌的发病率和死亡率、中国人口标化率（中标率）、世界人口标化率（世标率）、年龄别发病率和死亡率等指标。2000～2009年肺癌发病率和死亡率变化趋势采用年度变化百分比（APC）估计。[结果]男女合计肺癌粗发病率为49．57／10万,中标率和世标率分别为24．69／10万和33．09／10万,占全部癌症病例的18．26％;位居各类癌症之首。肺癌发病率从2000年的40．59／10万上升到2009年的57．63／10万,上升了41．98％,APC为3．84％（95％CI：2．18％～5．53％）。男女合计肺癌死亡率为43．33／10万,中标率和世标率分别为20．15／10万、27．53／10万;肺癌死亡率位居各类癌症死亡的第1位。肺癌死亡率基本上呈逐年上升趋势。[结论]肺癌发病率、死亡率均位居浙江省各类癌症第1位,加强肺癌预防与控制工作已成为当务之急。     

Exploring the joint effects of silicosis and smoking on lung cancer risks

Cigarette smoking and silicosis are potential causes of lung cancer among workers exposed to silica dust, but their joint effects are unclear. We explored the possible interactions between silicosis and smoking on lung cancer risks by summarizing data from the published literature. The standardized mortality ratio or standardized incidence ratio reported in each published report was first adjusted using "smoking adjustment factors" to correct for the biased estimation of the expected numbers of lung cancer among smokers and nonsmokers when using general population rates in the indirect standardization process. The ratio of the effect of silicosis on lung cancer risk among smokers to that among nonsmoker was calculated and named the "relative silicosis effect (RSE)". The synergy index was estimated to assess the additive interaction. Metaanalyses were used to obtain the weighed means of the RSE and synergy index. Ten cohort studies were reviewed and combined to yield a weighed RSE of 0.29 (95% CI: 0.20, 0.42), indicating negative risk-ratio multiplication between smoking and silicosis on the lung cancer risk. The combined weighed synergy index was 1.00 (95% CI: 0.79, 1.26), suggesting no departure from additivity. Sensitivity analyses showed that both estimates were quite robust. The independent risk-ratio effect of silicosis on lung cancer in smokers was about 30% of that in nonsmokers, and the joint effects of smoking and silicosis on the risk of lung cancer did not deviate from additivity and hence did not support biological synergism/antagonism.     

Cohort mortality and nested case-control study of lung cancer among structural pest control workers in Florida (United States)

A previous report on the mortality of this cohort of Florida (United States) pest control workers found the risk of lung cancer was positively associated with the number of years licensed. An additional follow-up (1977–82) of this male cohort confirmed the excess (SMR=1.4) and the rising risk with increasing number of years licensed (SMR=2.2 among workers employed more than 20 years). A nested case-control study was undertaken to determine the effects of smoking and the type of pesticide exposure on lung cancer risk. Occupational histories and other data were obtained on 65 deceased lung cancer cases, 122 deceased controls, and 172 living controls. Interviews were conducted with next-of-kin regardless of the vital status of the subject. Odds ratios (OR) were adjusted by age and smoking. Adjustments for diet and other occupations had no effect on risk estimates and were not included in the final model. Using information from licensing records, ORs for lung cancer were greater for workers first licensed before age 40 (OR=2.4, 95 percent confidence interval [CI]=1.0–5.9 with deceased controls) and increased from 1.4 (CI=0.7–3.0) for subjects licensed 10–19 years to 2.1 (CI=0.8–5.5) for subjects licensed 20 or more years. Using living controls, an association with duration of employment was observed when years of licensure were lagged five years, but was not observed in unlagged analyses. Using information from the questionnaire, the risk of lung cancer was greater among those who worked as pest control operators than non-pest control workers. Although numbers were typically small, lung cancer risk among pest control operators was associated with reported exposure to carbamates, organophosphates, and phenoxyacetic acids and more specifically with diazinon, DDT, carbaryl, and propoxur. These results further suggest that pesticides may play a role in lung cancer risk and underscore the need for research that focuses on specific chemicals.     

Lung cancer among women in north-east China

A case-control study of lung cancer involving interviews with 965 female patients and 959 controls in Shenyang and Harbin, two industrial cities which have among the highest rates of lung cancer in China, revealed that cigarette smoking is the main causal factor and accounted for about 35% of the tumours among women. Although the amount smoked was low (the cases averaged eight cigarettes per day), the percentage of smokers among women over age 50 in these cities was nearly double the national average. Air pollution from coal burning stoves was implicated, as risks of lung cancer increased in proportion to years of exposure to 'Kang' and other heating devices indigenous to the region. In addition, the number of meals cooked by deep frying and the frequency of smokiness during cooking were associated with risk of lung cancer. More cases than controls reported workplace exposures to coal dust and to smoke from burning fuel. Elevated risks were observed for smelter workers and decreased risks for textile workers. Prior chronic bronchitis/emphysema, pneumonia, and recent tuberculosis contributed significantly to lung cancer risk, as did a history of tuberculosis and lung cancer in family members. Higher intake of carotene-rich vegetables was not protective against lung cancer in this population. The findings were qualitatively similar across the major cell types of lung cancer, except that the associations with smoking and previous lung diseases were stronger for squamous/oat cell cancers than for adenocarcinoma of the lung.     

Lung cancer mortality in workers exposed to sulfuric acid mist and other acid mists

Mortality patterns were studied in 1,165 workers exposed to sulfuric acid mist and other acid mists (primarily hydrochloric acid mist) in steel-pickling operations. Standardized mortality ratio (SMR) analysis of the full "any acid exposure" cohort (n = 1,165), with the use of U.S. death rates as a standard, showed that lung cancer was significantly elevated, with a mortality ratio of 1.64 [95% confidence interval (CI) = 1.14-2.28, based on 35 observed deaths]. The lung cancer mortality ratio for workers exposed only to sulfuric acid (n = 722) was lower (SMR = 1.39), but further restriction to the time 20 years and more from first employment in a job with probable daily sulfuric acid exposure (approximately equal to 0.2 mg/m3) yielded a mortality ratio of 1.93 (95% CI = 1.10-3.13). An excess lung cancer risk was also seen in workers exposed to acids other than sulfuric acid (SMR = 2.24; 95% CI = 1.02-2.46). When comparison was made to other steel workers (rather than to the U.S. general population) to control for socioeconomic and life-style factors such as smoking, the largest lung cancer excess was again seen in workers exposed to acids other than sulfuric acid (SMR = 2.00; 95% CI = 1.06-3.78). Adjustment for potential differences in smoking habits showed that increased smoking was unlikely to have entirely explained the increased risk. Mortality from causes of death other than lung cancer was unremarkable, with the exception of significantly low rates for deaths due to digestive system diseases.     

Predictors of lung cancer among former asbestos-exposed workers

ObjectivesDespite extensive literature concerning the risk of lung cancer incidence among asbestos workers there is still lack of data specifying the association between the level of exposure and the frequency of cancer occurrence. The aim of the analysis was to assess the influence of smoking and selected factors related to occupational exposure on the risk of the incidence of lung cancer among the workers who were exposed to asbestos dust in the past.Material and methodsThe assessment was performed based on the case-control studies carried out within a cohort including 7,374 former workers of asbestos processing plants, examined over the years 2000–2013. Analysis of the material was based on the calculation of the odds ratio (OR) using conditional logistic regression modeling, adjusted for cigarette smoking, cumulative exposure, branch and time since last exposure.ResultsDuring the survey period there were 165 cases of lung cancer. Among the individuals who smoked, the relative risk of lung cancer incidence was twice as high in the persons smoking more than 20 pack-years (OR = 2.23; 95%CI: 1.45–3.46) than it was in the case of the non-smokers. Analysis revealed that the risk of lung cancer in the group with the highest exposure was two times higher in comparison with the low cumulative asbestos exposure (OR = 1.99; 95%CI: 1.22–3.25). The risk continued to increase until 30 years after cessation of asbestos exposure and started to decline many years after the last exposure. Influence of the mentioned above characteristics is particularly visible for tumors located in the lower parts of the lungs.ConclusionOur findings confirm the strong evidence that the lung cancer risk is associated with asbestos exposure and it increases along with the increasing exposure. A strategy of smoking cessation among the individuals exposed to asbestos dust would potentially have health promoting effects.     

Exposure-specific lung cancer risks in Chinese chrysotile textile workers and mining workers

Objective

Whether there is a difference in the exposure–response slope for lung cancer between mining workers and textile workers exposed to chrysotile has not been well documented. This study was carried out to evaluate exposure-specific lung cancer risks in Chinese chrysotile textile workers and mining workers.

Subjects and methods

A chrysotile mining worker cohort and a chrysotile textile worker cohort were observed concurrently for 26 years. Information on workers’ vital status, occupational history and smoking habits were collected, and causes and dates of deaths were verified from death registries. Individual cumulative fiber exposures were estimated based on periodic dust/fiber measurements from different workshops, job title and duration, and categorized into four levels (Q1–Q4). Standardized mortality ratios (SMRs) for lung cancer were calculated and stratified by industry and job title with reference of the national rates. Cox proportional hazard models were fit to estimate the exposure-specific lung cancer risks upon adjustment for age and smoking, in which an external control cohort consisting of industrial workers without asbestos exposure was used as reference group for both textile and mining workers.

Results

SMRs were almost consistent with exposure levels in terms of job titles and workshops. A clear exposure–response relationship between lung cancer mortality and exposure levels was observed in both cohorts. At low exposure levels (Q1 and Q2), textile workers displayed higher death risks of lung cancer than mining workers. However, similarly considerably high risks were observed at higher exposure levels, with hazard ratios of over 8 and 11 at Q3 and Q4, respectively, for both textile and mining workers, after both age and smoking were adjusted.

Conclusion

The chrysotile textile workers appeared to have a higher risk of lung cancer than the mining workers at a relatively low exposure level, but no difference was observed at a high exposure level, where both cohorts displayed a considerably high risk.     

A mortality follow-up study of pottery workers: preliminary findings on lung cancer

The possible association between exposure to low levels of silica and lung cancer was investigated by following up pottery workers included in a survey conducted in 1970-71 of respiratory disease among such workers. The initial results show that, among men under the age of 60 at the time of the original survey, mortality has been similar to that expected, but that there was an excess of lung cancer of over 30% even after allowance had been made for cigarette smoking and place of residence. There were no particular excesses of lung cancer by product group or job group. However, there was some indication that lung cancer risk increased with estimated cumulative exposure to respirable quartz. These findings do suggest an association between lung cancer and the low levels of silica found in potteries, and the follow-up will therefore be continued and a more detailed analysis of the data carried out.     

Lung cancer near an industrial site in Lithuania with major emissions of airway irritants

To assess the relation between air pollution with airway irritants, including sulfuric acid and lung cancer, a case-control study was performed near an industry producing sulfuric acid and fertilizers in Kedainiai county, central Lithuania. The county had the highest lung cancer rates of the country among men. Between 1967 and 1973, the levels of sulfuric acid exceeded 500 microg/m(3) within 2 km of the industry and 100 microg/m(3) more than 5 km away. A total of 277 men who were diagnosed as having lung cancer during 1981-1991 in Kedainiai county were included as well as 1,108 population controls. Information on residential history since 1960, smoking habits, occupations and workplaces during lifetime was obtained from questionnaires mailed to next-of-kin. The relative risk of lung cancer associated with living within approximately 5 km from the plant was 1.02 (95% CI: 0.76-1.38) compared to those who had never lived in this area. No relation with distance or duration of residence was observed. Furthermore, workers at the plant did not have an increased lung cancer risk. The relative risk of lung cancer associated with smoking was 21.2 (95% CI: 7.51; 60.1) for current smokers and 14.0 (95% CI: 4.88; 40.3) for exsmokers. The duration of smoking, a low age at start and amount of cigarettes smoked daily were positively associated with lung cancer risk. Smoking levels appeared more pronounced among study controls than in the rest of the country. Our study could not confirm earlier evidence of an association between exposure to airway irritants, such as sulfuric acid and lung cancer. Smoking is the major determinant of the risk of lung cancer in men in Kedainiai county. It is probable that higher smoking rates constitute the main reason for the increased lung cancer risk among men in this area.     

A cohort study of cancer mortality among Biology Research Laboratory workers in The Netherlands

OBJECTIVE: To examine cancer mortality among persons employed in biology research institutes. METHOD: A historical cohort study was undertaken in the Netherlands. The cohort, comprising 7307 laboratory workers employed by the four participating institutes between 1960 and 1992, was followed for mortality from 1960 to 1995 (median follow-up time 16.5 years). Causes of death were obtained for 98% of all deaths. Cancer mortality in the cohort was compared with that in the general population by computation of the standardized mortality ratio (SMR). The Cox proportional hazards model was used to compare cancer mortality among laboratory workers with that in an internal reference population consisting of unexposed research personnel (n = 2,404). RESULTS: All-cause mortality among laboratory workers was significantly lower than that in the general population. Total cancer mortality and lung cancer mortality were also significantly decreased (SMR = 0.8; 95% confidence interval CI = 0.7-0.9 and SMR = 0.7; 95% CI = 0.6-0.9), respectively. However, when compared to the internal reference population, laboratory workers had a slightly increased cancer mortality (relative risk (RR) = 1.3 95% CI = 0.9-1.9). Among men, a 2.5-fold (95% CI = 1.0-6.3) increase of lung cancer mortality was observed which could not be explained by differences in smoking habits. Lung cancer mortality increased with longer follow-up. Results with regard to a priori defined fields of research showed significantly increased cancer mortality (in particular from lung cancer) for men working in genetics (RR = 3.8), virology (RR = 4.1) and plant physiology (RR = 2.1). CONCLUSION: Laboratory workers have a favorable cancer mortality pattern as compared to the general population. However, this favorable pattern disappears when a comparison is made with a control group of unexposed research personnel. The excess lung cancer mortality among male laboratory workers was concentrated in certain fields of research, which warrants further research to identify specific exposures related to the increased risk.     

Environmental determinants of lung cancer in Shenyang, China

To investigate determinants of the high rates of lung cancer in Shenyang, an industrial city in north-eastern China, a case-control study was conducted. Interviews with 1249 lung cancer patients and 1345 population-based controls revealed that cigarette smoking was the main cause of lung cancer. Smoking accounted for 55% of the lung tumours in men and 37% in women. In addition, air pollution from coal-burning heating and cooking devices was significantly linked to lung cancer, with risks rising in proportion to duration of exposure to indoor pollutants. Measurement of benzo[a]pyrene revealed average wintertime levels in air that were nearly 60 times the recommended upper limit for US cities, with even higher concentrations indoors in traditional single-storey homes using coal-burning kang (stoves). Occupational factors were also involved, the risk being elevated by three fold among smelter workers. Soil levels of arsenic and other metals rose with increasing proximity to the Shenyang copper smelter, and elevated risks of lung cancer were found among men, but not women, living within 1 km of its central stacks. Prior nonmalignant lung disease was common and was reported more often among the lung cancer patients than among controls. The findings suggest that cigarette smoking and environmental pollutants combine to account for most of the excess risk of lung cancer in this population.