吸烟、危险职业与膀胱癌关系的病例对照研究

目的　探讨吸烟危险职业对我国人群膀胱癌发生作用。方法　应用 110例膀胱癌住院进行了病例对照研究。结果　吸烟者有显著升高的膀胱癌危险度 (OR =2 .13,95 %CI为 1.18— 3.84) ,尤其吸烟年限在 40年以上者 ,其危险度高达 4.10倍。开始吸烟年龄越小危险性越大 ,并随吸烟年限、吸烟量、吸烟深度的增加而增加 ,随戒烟年限的增加而减小 ,呈明显的剂量———反应关系。危险职业暴露者患膀胱癌的危险性增加 (OR =3.5 3) ,开始暴露年龄越早危险性越高 ,并随暴露年限的增加而增加。吸烟与危险职业暴露对膀胱癌的发生有交互作用 ,其相对超额危险度为 4.6 8。结论　吸烟对膀胱癌既是诱癌因素又是促癌因素 ,且吸烟者又暴露于危险职业则发生膀胱癌的危险性将显著增加     

吸烟、被动吸烟与肺癌发病风险的病例对照研究

目的 探讨吸烟、被动吸烟与肺癌的关联.方法 采用病例对照研究设计,面访肺癌新发病例1 303例和按性别、年龄(±2岁)频数匹配的健康对照1 303例.结果 吸烟是男性肺癌的重要危险因素(调整OR=4.974,95％ CI:3.933 ～6.291),随着开始吸烟年龄提前、吸烟年限延长、日吸烟量、吸烟包年以及吸烟深度的增加,患肺癌危险性增高,呈剂量反应关系(Ptrend＜0.001),戒烟≥10年患肺癌的危险性降低45.4％.男性吸烟患肺鳞癌的危险性比患肺腺癌大.被动吸烟是非吸烟者肺癌的危险因素(调整OR=1.912,95％CI:1.486～2.460),工作环境被动吸烟的男性非吸烟者患肺癌的调整OR为2.221(95％CI:1.361 ～3.625),家庭环境被动吸烟的女性非吸烟者患肺癌的调整OR为1.804(95％ CI:1.270～2.562).68.04％男性肺癌的发生可归因于吸烟,26.51％非吸烟者肺癌的发生可归因于被动吸烟.结论 吸烟是肺癌的重要危险因素,工作环境被动吸烟是男性非吸烟者肺癌的主要危险因素,家庭环境被动吸烟是女性肺癌的主要危险因素.戒烟具有重大的公共卫生学意义.     

不同来源的被动吸烟与肺癌关系的研究

作者对１０４名非吸烟肺癌和１６３名对照进行了非条件ＬＯＧＩＳＴＩＣ回归分析以估计不同来源的被动吸烟对非吸烟肺癌的危险性。分析发现在不同来源的被动吸烟中，父母吸烟和工作场所接触吸烟者均对患肺癌无明显的影响；而暴露于配偶吸烟可使非吸烟者患肺癌危险性增加１．７７倍。结果提示，在不同来源的被动吸烟中，暴露于配偶的被动吸烟是导致非吸烟者尤其是女性肺癌的主要危险因素。     

被动吸烟增加患癌危险

据英国的一份科学报告说,被动吸烟增加患肺癌的危险性。报告估计,从长远看,与吸烟者生活在一起的人比不与吸烟者生活在一起的人患肺癌的危险性高２６％,患心血管病的危险高２３％。父母吸烟的婴儿患致命综合症的危险性比非吸烟父母的高两倍,而患呼吸器官疾病的危险高...     

铀矿工氡职业暴露与肺癌风险:巢式病例-对照研究

[目的]探讨铀矿工氡职业暴露与肺癌的关系。[方法]采用回顾性巢式病例-对照研究的方法,以1958—2000年在某铀矿山工作,且由当地省市级医院确诊为肺癌的72例男性死亡病例为病例组,以与病例组年龄相差不超过5岁、同性别、1∶4配比方法选取的288例铀矿工为对照组,采用条件logistic回归方法对职业性氡暴露与肺癌关系进行分析,并计算氡致肺癌的危险系数[每工作水平月(WLM)引起的肺癌风险增量]。[结果]病例组及对照组的氡暴露量几何均数分别为171.8 WLM和127.5 WLM。单因素条件logistic回归分析显示:病例组与对照组的首次下井年龄、坑龄、年龄差异无统计学意义;吸烟(OR=1.88,95%CI:1.07~3.31)和氡职业暴露(OR=1.61,95%CI:1.19~2.16)增加肺癌风险。多因素条件logistic回归分析显示:吸烟及氡暴露仍是矿工肺癌发生的主要危险因素,吸烟致肺癌的OR为2.27(95%CI:1.26~4.09),氡致肺癌的OR为1.62(95%CI:1.18~2.24)。使用OR=1.62计算出氡致肺癌的危险系数为0.36%WLM-1,即每WLM的职业氡暴露可使铀矿工患肺癌死亡的风险增加0.36%。[结论]除吸烟外,氡职业暴露是铀矿工肺癌的主要危险因素。     

室内空气污染与女性肺癌

为探讨室内空气燃料污染,被动吸烟,烹饪与女性肺癌的关系。搜索经省级医院确诊的哈尔滨市女性原发性肺癌１１５例及对照１２４例进行调查及单因素Ｌｏｇｉｓｔｉｃ回归分析。结果表明冬天取暖和做饭室内有烟,被动吸烟年限均与女性肺癌有关系显著,女性患肺癌危险性与终动吸烟总量呈明显的剂量－效应关系。     

膀胱癌的职业因素与流行病学调查

1900年以前就有人首次把膀胱癌与职业暴露联系起来,过去的二十年,人们证实多种职业均可使患膀胱癌的危险性增加,如化工、橡胶、制革、印刷、印染、卡车司机、汽车修理和加油工等职业。大量的调查还发现吸烟可使患膀胱癌的危险性成倍增长,而饮酒与膀胱癌的关系过去尚未确定。本次调查就是为了进一步探讨在膀胱瘤的危险因素中,职业、吸烟和饮酒所起的作用。     

谷胱苷肽转硫酶基因多态性与吸烟因素对肺癌影响的研究

目的探讨谷胱苷肽转硫酶(GST)和吸烟因素对肺癌易感性的影响。方法选取2002年广州市新发肺癌病人91例及同期非肺部疾患病人91例进行病例-对照研究。对两组研究对象分别进行问卷调查及采用聚合酶链式反应(PCR)方法用限制性片段长度多态性(RFLP)技术测定GST的基因多态性,并分析GST的基因多态性与吸烟因素对肺癌患病结局的影响。结果对GST基因多态性单独分析时,与肺癌关系较弱。其OR值为1.38,与对照组差异无统计学意义(P>0.05)。而吸烟因素存在下,两者联合作用可增加患肺癌的危险,吸烟且GST-M1缺失者发生肺癌危险性为不吸烟而GST-M1正常者的3.07倍(P<0.01)。结论GST的单一基因的多态性不能增加患肺癌的危险,而与吸烟联合作用时则可增强患肺癌的风险。     

天津市肺癌与吸烟关系的病例对照研究

我们于1981年3月至10月在天津市六所大医院里进行了肺癌的病例对照研究,着重了解吸烟与肺癌的联系。调查了肺癌病例135人(男99,女36)、对照病人135人。病例与对照均为住院病人,90%的肺癌病例有病理学诊断依据。病例与对照作年龄、性别、民族、居住地配对。病例组与对照组的吸烟习惯有显著差异。吸烟者患肺癌的相对危险性男性为6,女性为4,两者的99%可信限均大于1。男女性均可见吸烟量与相对危险性之间有显著的剂量反应关系,其回归系数的95%可信限都不包括零。开始吸烟至发现肺癌的时间(潜隐期)的分布为正态分布,其均数为30年。     

DNA损伤结合蛋白（DDB2）基因单核苷酸多态性与肺癌易感性研究

目的探讨DNA修复基因（DDB2）单核苷酸多态位点rs830083C〉G变异与肺癌易感性的关系。方法采用病例对照研究,选取湖北省各地区医院经病理诊断确诊的原发性肺癌406例,社区对照人群478例为研究对象,以Taqman探针进行基因分型,采用多因素非条件logistic回归调整年龄、性别、吸烟、一级亲属家族肿瘤史,比较不同基因型与肺癌危险的关系,并探讨吸烟与基因的交互作用。结果与携带野生型纯合子CC基因型者相比,携带CG杂合子者肺癌风险增加0.49倍,而携带GG变异纯合子者肺癌发生风险增加0.72倍,呈剂量-效应关系。有一个C〉G变异的个体,累计吸烟量与肺癌发生危险度呈剂量-效应关系。交互作用分析显示,吸烟暴露与DDB2基因rs830083多态存在交互作用,同时存在高暴露累计吸烟量和杂合子CG基因型或变异纯合子GG基因型的个体肺癌发病危险度分别为5.99和2.89;吸烟与rs830083位点变异两因素同时存在时对肺癌发生的危险远大于两因素单独存在时对肺癌发生危险的影响。结论DDB2基因SNP位点rs830083C〉G变异可能与肺癌遗传易感性有关,并可显著增加吸烟对肺癌的危险性。     

Lung cancer mortality in a Dutch cohort of asphalt workers: evaluation of possible confounding by smoking

BACKGROUND: Using data from a Dutch cohort of workers in road construction and asphalt mixing companies, this article describes possible confounding of the association between exposure to bitumen fume and lung cancer mortality by smoking. METHODS: A retrospective cohort of 3,714 workers with at least one season of employment was identified. Semi-quantitative exposure to bitumen fume was assessed by a job-exposure matrix. Information on smoking habits was available for a sub-cohort of 1,138 workers, who underwent medical examinations by the occupational health services in the past. RESULTS: Smoking habits differed between occupational title groups and there was a positive association between cumulative exposure and smoking. Internal analyses using the non-exposed subjects as reference category, showed a positive association between semi-quantitative bitumen fume exposure and lung cancer risk. After adjusting for differences in smoking habits, all relative risks were reduced, but a weak positive association could still be observed. CONCLUSION: Confounding by smoking on the association between exposure to bitumen fume and lung cancer mortality is possible, although the positive trend (not statistically significant) for lung cancer mortality remained. Only a nested case-control study may allow proper treatment of potential (residual) confounding by smoking in this population.     

Lung cancer risk of workers in shoe manufacture and repair

BACKGROUND: The occupational lung cancer risk in manufacturing and repair of shoes was studied by pooling of two major case-control studies from Germany. METHODS: Some 4184 incident hospital-based cases of primary lung cancer and 4253 population controls, matched for sex, age, and region of residence were intensively interviewed with respect to their occupational and smoking history. Based on the occupational coding and a free text search, all individuals who had ever worked in shoe manufacturing or repair for at least half a year were identified. Shoemaker-years were calculated as the cumulated duration of working in shoe manufacturing or repair. Odds ratios (OR) and 95% confidence intervals (CI) were calculated via conditional logistic regression. Additional adjustment for smoking and occupational asbestos exposure was used. RESULTS: Seventy-six cases and 42 controls who had ever worked in shoe manufacture or repair (OR = 1.89, 95% CI: 1.29-2.78). After adjustment for smoking, this risk was lowered to 1.69 (95% CI: 1.09-2.62). Further adjustment for asbestos exposure only slightly changed the risk estimates upwards. The smoking adjusted OR in males was 1.50 (95% CI: 0.93-2.41) and 2.91 (95% CI: 0.90-9.44) in females. Logistic regression modeling showed a positive dose-effect relationship between duration of exposure in shoe manufacture and repair and lung cancer risk. The odds ratio for 30 years of exposure varied between 1.98 and 2.24 depending on the model specified. CONCLUSIONS: The study demonstrates an increased lung cancer risk for shoemakers and workers in shoe manufacturing. The risk seems to double after being 30 years in these occupations.     

Smoking,occupational exposure and mortality in workers in Guangzhou,China

PURPOSE: To compare the mortality risk of smoking and overall occupational exposure in Guangzhou, China. METHODS: Baseline data on smoking and occupational exposure of 82159 workers aged 30+ were retrieved from medical records established in 1988-92. Vital status and causes of death were followed through 1998. RESULTS: During follow-up 1584 workers had died. Adjusted relative risks (RR) with 95% confidence intervals (95%CI) for ever-smoking in men was 1.23 (1.07-1.41) for total deaths, 1.43 (1.17-1.74) for all cancer, 3.77 (2.31-6.14) for lung cancer and 2.54 (1.09-5.92) for stomach cancer (all showing significant linear trends with amount and duration of smoking). The RR in women of 1.10 (0.59-2.06) for total deaths and 1.60 (0.65-3.92) for all cancer were positive but not significant. No significant excess mortality risk was observed for occupational exposure in each gender. In both genders combined, the RR for total deaths was 1.23 (1.08-1.40) for smoking and 1.07 (0.96-1.19) for occupational exposure. If the relationships were causal, 12% of all deaths could be attributed to smoking but only 3% to occupational exposure. CONCLUSION: Smoking was more predictive of premature deaths than overall occupational exposures in middle aged workers. Smoking cessation should be a top priority in occupational health practice.     

中国非吸烟女性肺癌危险因素的病例-对照研究

目的探讨中国非吸烟女性患肺癌的危险因素。方法应用1∶2配对的病例对照方法,收集2001年9月~2004年2月在北京、上海和成都指定医院经病理诊断确诊的非吸烟女性新发肺癌住院病例157例,按照性别、年龄(±2岁)、不吸烟等配对因素选取医院对照和人群对照。利用统一调查表对调查对象进行面对面问卷调查,收集病例和对照有关危险因素的暴露史等情况。通过单因素分析和多因素条件Logistic回归分析筛选肺癌的主要危险因素。结果单因素分析发现28个暴露因素与非吸烟女性肺癌发生有关。多因素分析发现,被动吸烟指数≥50人年(OR=1·77,95%CI为1·07~2·92)、经常吃动物内脏(OR=1·85,95%CI为1·06~3·22)、职业接触粉尘(OR=2·47,95%CI为1·21~5·03)和工作场所通风不良(OR=4·02,95%CI为1·74~9·29)为非吸烟女性肺癌发生的危险因素;常吃蔬菜(OR=0·26,95%CI为0·12~0·59)、经常服用维生素(OR=0·53,95%CI为0·30~0·93)、结婚后家庭人均月收入≥500元(OR=0·50,95%CI为0·28~0·91)和初次生育年龄在24~30岁之间(OR=0·53,95%CI为0·32~0·90)为非吸烟女性肺癌发生的保护因素。趋势性检验发现,被动吸烟与非吸烟女性发生肺癌的相对危险度之间存在一定剂量反应关系。结论被动吸烟、职业接触粉尘、经常吃动物内脏和工作场所通风不良会增加非吸烟女性患肺癌的危险性。常吃蔬菜和经常服用维生素等因素可以降低非吸烟女性发生肺癌的危险性。     

Diesel motor exhaust and lung cancer mortality: reanalysis of a cohort study in potash miners

The aim of the reanalysis is to reassess lung cancer risk associated with occupational exposure to diesel motor exhaust in potash miners, while controlling for potential confounders such as smoking and previous occupational history. Our investigation is based on a cohort study of nearly 6,000 German potash miners, who were followed up from 1970 to 2001. The reanalysis also takes into account the employment periods before potash mining, in particular uranium mining. Different approaches (nested case–control study and Cox model) were used to adjust for confounding. The exposure estimates were recalculated, lagging the exposure by 5 years. Exposure groups were defined by tertiles of cumulative respirable elemental carbon (REC) exposure estimates and occupational categories, where exposure was estimated originally by representative measurements of total carbon for different occupations. The highest REC concentration was measured for production workers, about twice as much as for other occupations. The reanalysis revealed that while about 4 % of all study subjects had worked earlier in uranium mines, 10.3 % of later lung cancer cases did so. Although their absolute number was small, the corresponding relative risk estimator was significantly elevated. Our analysis did not show any notable association between cumulative REC exposure and lung cancer risk. Introducing cumulative REC exposure as a continuous variable into the conditional logistic regression model yielded an odds ratio of OR = 1.04 [0.70–1.53]_95 % adjusted for smoking and previous employment. The study results give no evidence for an association between REC exposure and lung cancer risk. Only for very high cumulative dose, corresponding to at least 20 years of exposure in the production area, some weak hints for a possible risk increase could be detected. The study underlines the importance of assessing the entire occupational history in occupational studies, especially if the supposed dose–response-relationship is weak.     

Occupational exposure to carcinogens and risk of lung cancer: results from The Netherlands cohort study.

OBJECTIVES: To investigate risk of lung cancers associated with common established carcinogenic occupational exposures (asbestos, paint dust, polycyclic aromatic hydrocarbons, and welding fumes) in a prospective cohort study among the general population, and to estimate the proportion of lung cancer cases attributable to these occupational exposures. METHODS: A prospective cohort study on diet, other lifestyle factors, job history, and cancer risk that started in 1986 in The Netherlands on 58,279 men, aged 55-69 years. Based on information about job history obtained from a self-administered questionnaire, case by case expert assessment was carried out to assign to each study subject a cumulative probability of occupational exposure for each carcinogenic exposure. For analysis, a case-cohort approach was used, in which the person-years at risk were estimated from a randomly selected subcohort (n = 1688). After 4.3 years of follow up, 524 lung cancer cases with complete job history were available. RESULTS: After adjustment for age, each of the other occupational exposures, and for smoking habits and intake of vitamin C, beta-carotene, and retinol, significant associations were found between risk of lung cancer and cumulative probability of occupational exposure to asbestos (relative risk (RR) highest/no exposure = 3.49, 95% confidence interval (95% CI) 1.69 to 7.18, trend P < 0.01 or paint dust (RR highest/no exposure = 2.48, 95% CI 0.88 to 6.97, trend P < 0.01). The population attributable risks (PARs) for the four exposures based on the multivariately adjusted RRs for ever exposed versus never exposed workers were calculated. The PAR of lifetime occupational exposure to asbestos was calculated to be 11.6%. CONCLUSIONS: This prospective cohort study among the general population showed that occupational exposure to asbestos or paint dust is associated with higher RRs for lung cancer. This study shows that after adjustment for smoking and diet about 11.6% of the cases of lung cancer in men is attributable to lifetime occupational exposure to asbestos.     

Lung cancer risk associated to exposure to radon and smoking in a case-control study of French uranium miners

A case-control study nested in the cohort of French uranium miners took smoking information into account in investigating the effect of radon exposure on lung cancer risk. This study included 100 miners who died of lung cancer and 500 controls matched for birth period and attained age. Data about radon exposure came from the cohort study, and smoking information was retrospectively determined from a questionnaire and occupational medical records. Smoking status (never vs. ever) was reconstructed for 62 cases and 320 controls. Statistical analyses used conditional logistic regression. The effect of radon exposure on lung cancer risk was assessed with a linear excess relative risk model, and smoking was considered as a multiplicative factor. Mean cumulative radon exposures were 114.75 and 70.84 Working Level Months (WLM) among exposed cases and controls, respectively. The crude excess risk of lung cancer per 100 WLM was 0.98 (95% CI: 0.18-3.08%). When adjusted for smoking, the excess risk was 0.85 per 100 WLM (95% CI: 0.12-2.79%), which is still statistically significant. The relative risk related to smoking was equal to 3.04 (95% CI: 1.20-7.70). This analysis shows a relative risk of lung cancer related to smoking similar to that estimated from previous miners' cohorts. After adjustment for smoking, the effect of radon exposure on lung cancer risk persists, and its estimated risk coefficient is close to that found in the French cohort without smoking information.     

Lung cancer and occupation: results of a multicentre case-control study.

The objective of the current study was to estimate the risk of lung cancer attributable to occupational factors and not due to tobacco. At 24 hospitals in nine metropolitan areas in the United States, 1793 male lung cancer cases were matched for race, age, hospital, year of interview, and cigarette smoking (never smoker, ex-smoker, smoker (1-19 and > or = 20 cigarettes per day)) to two types of controls (cancer and non-cancer hospital patients). Information on usual occupation, exposure to specific potential carcinogens, and cigarette smoking was obtained by interview. Risk of lung cancer was increased significantly for electricians; sheetmetal workers and tinsmiths; bookbinders and related printing trade workers; cranemen, derrickmen, and hoistmen; moulders, heat treaters, annealers and other heated metal workers; and construction labourers. All of these occupations are potentially exposed to known carcinogens. Odds ratios (ORs) were increased for exposure to coal dust (adjusted OR = 1.5; 95% confidence interval (95% CI) 1.1-2.1). After stratification, this association was statistically significant only after 10 or more years of exposure. Lung cancer was also related to exposure to asbestos (adjusted OR = 1.8; 95% CI 1.5-2.2). The ORs increased with increasing duration of exposure to asbestos for all smoking categories except for current smokers of 1-19 cigarettes per day. The statistical power to detect ORs among occupations that were previously reported to be at increased risk of lung cancer but that failed to show an OR of at least 1.5 in the current study was small. The cumulative population attributable risk (PAR) of lung cancer due to occupation was 9.2%. It is concluded that occupational factors play an important part in the development of lung cancer independently of cigarette smoking. Because occupations at high risk of lung cancer were under-represented, the cumulative PAR of the present study is likely to be an underestimate of the true contribution of occupation to risk of lung cancer.     

Low-dose exposure to asbestos and lung cancer: dose-response relations and interaction with smoking in a population-based case-referent study in Stockholm,Sweden

This population-based case-referent study investigated the lung cancer risk associated with occupational exposure to asbestos, focusing on dose-response relations and the interaction with tobacco smoking. Incident cases of lung cancer among males aged 40-75 years in Stockholm County, Sweden, were identified from 1985 to 1990. Referents were selected randomly within strata (age, inclusion year) of the study base. Questionnaires administered to subjects or their next of kin gave information on occupations, tobacco smoking habits, and residences. Response rates of 87% and 85% resulted in 1,038 cases and 2,359 referents, respectively. Occupational exposures were assessed by an industrial hygienist. Lung cancer risk increased almost linearly with cumulative dose of asbestos. The risk at a cumulative dose of 4 fiber-years was 1.90 (95% confidence interval (CI): 1.32, 2.74), higher than that predicted by downward linear extrapolation from highly exposed occupational cohorts. The relative risk (exp(beta)) for a transformed dose variable ln(fiber-years + 1) was 1.494 (95% CI: 1.193, 1.871) per unit of exposure. The joint effect of asbestos and smoking was estimated to be 1.15 (95% CI: 0.77, 1.72) times that predicted from the sum of their individual effects and 0.31 (95% CI: 0.11, 0.86) times that predicted from their product, indicating a joint effect between additivity and multiplicativity.     

Lung cancer risk in male workers occupationally exposed to diesel motor emissions in Germany.

BACKGROUND: Although in several epidemiological studies exposure to diesel motor emissions (DME) shows an elevated lung cancer risk, it is still controversial whether DME is a human carcinogen. METHODS: In a pooled analysis of two case-control studies on lung cancer in Germany a total of 3498 male cases with histologically or cytologically ascertained lung cancer and 3541 male population controls were included. Information about lifelong occupational and smoking history was obtained by questionnaire. Drivers of lorries, buses, taxies, diesel locomotives and forklift trucks, bulldozers, graders, excavators, and tractors, were considered as exposed to DME and their cumulative exposure was estimated. All odds ratios were adjusted for smoking and asbestos exposure. RESULTS: The evaluation of lung cancer risk for all jobs with DME-exposure combined showed an odds ratio of OR=1.43 (95%-CI: 1.23-1.67). Most pronounced was the increase in lung cancer risk in heavy equipment operators (OR=2. 31 95%-CI: 1.44-3.70). The risk of tractor drivers increased with length of employment and reached statistical significance for exposures longer than 30 years (OR=6.81, 95%-CI: 1.17-39.51). The group of professional drivers (e.g., trucks, buses, and taxies), showed an increased risk only in West Germany (OR=1.44, 95%-CI: 1. 18-1.76), but not in East Germany (OR=0.83, 95%-CI: 0.60-1.14). DME-exposure in other traffic related jobs (e.g., diesel engine locomotive drivers, switchmen, forklift operators) was associated with an odds ratio of OR=1.53 (95%-CI: 1.04-2.24). CONCLUSIONS: The study provides further evidence that occupational exposure to diesel motor emissions is associated with an increased lung cancer risk.