The Italian surveillance system for occupational cancers: characteristics, initial results, and future prospects

BACKGROUND: Occupational cancer monitoring is important for cancer prevention and public health protection. A surveillance system for identifying occupational cancer risks and cancer cases in Italy that are likely to be of occupational origin using information available in the Italian Social Security archives was created and assessed. Persons employed in the private sector, the employing company, its industrial sector, and years of employment are available in these archives. METHODS: A method to find known occupational hazards was first tested using a case-control approach. Cases were from six Italian cancer registries (CRs) and controls were sampled from source populations and as "exposure" the economic sector of the employing company was used. The potential of using hospital discharge records as case sources was subsequently assessed: these cover larger populations and are available more quickly than CR case series. RESULTS: In the CR-based study many known occupational cancer risks related to specific industrial sectors were identified. By using cases from hospital discharge records many industries at risk were identified, as well as cases of recent diagnosis likely to be of occupational origin. However, for some industrial sectors (e.g., the chemical industry) the approach was unable to detect any excess risk. Furthermore, information on employees in important areas like agriculture, self-employment, and the public sector is not available in the Social Security archives. CONCLUSIONS: This approach appears to be a promising low-cost method for occupational cancer surveillance, at least for some industries, and can be easily implemented in other countries.     

Bladder cancer and occupation: a report from the Belgian case-control study on bladder cancer risk

BACKGROUND: The aim of this study was to add to the data on associations between occupation and bladder cancer thereby strengthening the case for focused research on specific occupational categories. METHODS: Two hundred two cases and 390 controls participated in this population-based case-control study. Age, sex, smoking, and education adjusted odds ratios (ORs) were calculated for each occupation by unconditional logistic regression. RESULTS: The occupational group of domestic helpers, cleaners, and launderers exhibited a significantly elevated risk of bladder cancer. Elevated non-significant risks (OR > 1.5) were observed for painters and varnishers, electronic equipment assemblers, general laborers, building finishers, carpenters and joiners, architects and engineers, and textile and garment workers. CONCLUSIONS: This study suggests that domestic helpers, cleaners, and launderers probably experience an increased risk of bladder cancer. Although no other occupations showed significantly increased risks, the non-significantly elevated risks for painters, carpenters, and textile workers could be confirmed by results from earlier studies.     

北京市怀柔区职业健康状况调查

目的全面了解怀柔区存在职业病危害因素企业的基本情况和防治现状,探讨存在的问题并提出建议,推动怀柔区职业病防治工作的开展,保护劳动者的身体健康,为政府制定职业病防治政策提供依据。方法采用横断面调查方法,使用统一的调查表,分级、分批培训调查员,统一要求、方法和标准;于2011年8月—2012年12月对怀柔区存在职业病危害因素的企业进行现场调查,由疾病预防控制中心专业技术人员审核后录入职业健康状况信息管理系统,并撰写调查报告,对职业健康现状进行描述性分析。结果怀柔区存在职业病危害因素的企业共297家,主要分布在杨宋镇、北房镇、雁栖开发区、庙城镇、雁栖镇和怀柔镇6个镇乡及开发区,以金属制品业、印刷业和交通运输设备制造业为主,小型、私营企业所占比例最高。存在职业病危害因素59种,主要为粉尘、噪声、苯系物等。有生产工人22 597人,接触职业病危害工人8 051人,接触职业危害因素比例为22.9%;企业职业健康检查覆盖率：上岗前为24.6%,离岗时为7.1%,在岗期间为61.3%;企业职业病危害因素检测覆盖率为77.1%。5年内重点职业病发病17人,主要为尘肺和噪声聋,占职业病发病总数的76.5%。结论怀柔区职业健康监护率、职业病危害因素检测率、职业卫生管理达标率均有待提高,提示相关部门应加强对小型、私营企业的监管,加大宣传和培训力度,提高企业的自身法律意识和广大劳动者的自我防范意识。     

Occupational risk factors for prostate cancer

BACKGROUND: Occupational risk factors for prostate cancer have been investigated with inconsistent findings. METHODS: This was a population-based case-control study of men in Northeastern Ontario, Canada. Cases (n = 760) were from the Ontario Cancer Registry, 50 to 84 years old, and diagnosed with prostate cancer between 1995 and 1998. Age-frequency matched controls (n = 1,632) were obtained from telephone listings. A questionnaire yielded information on occupational history and self-reported exposures to a list of occupational hazards. Exposures to these hazards were assessed by an occupational hygienist. RESULTS: An odds ratio estimate (OR) of 1.21 (95 percent confidence interval (% CI) 1.01, 1.46) was found for employment in trades, transport and equipment operators and related occupations, possibly related to exposure to whole-body vibration (OR = 1.38, 95% CI 1.07, 1.78). For the highest quartile of lifetime cumulative workplace physical activity an OR of 1.33 (95% CI 1.02, 1.74) was found. No statistically significant associations were found for any other occupational category or exposure. CONCLUSIONS: This study does not provide strong evidence for significant occupational risk factors for prostate cancer. However, whole-body vibration exposures, as well as physical activity, may be worth pursuing in future occupational studies.     

Occupational risk factors for renal cell carcinoma in Montreal

BACKGROUND: Little is known about the role of workplace exposures on the risk of renal cell cancer. METHODS: A population-based case-control study was undertaken in Montreal to assess the association between hundreds of occupational circumstances and several cancer sites, including the kidney. A total of 142 male patients with pathologically confirmed renal cell carcinoma, 1900 controls with cancer at other sites and 533 population-based controls were interviewed. Detailed job histories and relevant data on potential confounders were obtained. A group of chemists-hygienists evaluated each job reported and translated them into a history of occupational exposures using a checklist of 294 substances. Multivariate logistic regression models using either population, cancer controls, or a pool of both groups were used to estimate odds ratios. RESULTS: There were some indications of excess risks among printers, nursery workers (gardening), aircraft mechanics, farmers, and horticulturists, as well as in the following industries: printing-related services, defense services, wholesale trade, and retail trade. Notwithstanding the low precision of many of the odds ratio estimates, the following workplace exposures showed some evidence of excess risk: chromium compounds, chromium (VI) compounds, inorganic acid solutions, styrene-butadiene rubber, ozone, hydrogen sulphide, ultraviolet radiation, hair dust, felt dust, jet fuel engine emissions, jet fuel, aviation gasoline, phosphoric acid and inks. CONCLUSIONS: For most of these associations there exist no, or very little, previous data. Some associations provide suggestive evidence for further studies.     

Ten years of anti-smoking programs in Italy: a review

A diverse anti-smoking program for the prevention of cancer and cardiovascular diseases has been ongoing in Italy since 1981, coordinated by the National Cancer Institute of Genoa and the Italian League Against Cancer of Genoa. The program includes several initiatives addressed to different target groups; schoolchildren and teachers, military personnel, doctors and nurses, and women. A preliminary inquiry on the attitudes and habits towards smoking was implemented by the distribution of questionnaires to the various groups involved in the program. An annual school-based anti-smoking program involves about 10,000 students aged four to 18 and their teachers. Meetings are delivered by experts to groups of 20 to 40 students with the aid of specific audiovisual material, which are periodically updated. Additional informative material, leaflets, and posters are distributed to both schoolchildren and teachers. Another educational program on primary prevention of smoking-related health hazards is addressed to military recruits, career soldiers, and medical officers. It consists of several initiatives: training of military doctors and nurses, lectures to military recruits, and distribution of informative material in the barracks. An annual meeting is organized to discuss program implementation and results. Surveys are carried out by distributing an anonymous questionnaire to health professionals in several Italian hospitals to assess the smoking habits of doctors and their attitudes and practices towards counseling patients against smoking. The results show marked differences in smoking habits in the cities under study. Annually since 1983, an updated course is organized and addressed to teachers of primary and secondary schools in Genoa. The aim of the course is to train school personnel and to help them to implement prevention programs in the schools, with the aid of experts in the field of prevention. A series of initiatives are addressed to women at different ages to sensitize them not only to the more common tobacco risks but also those regarding pregnancy, oral contraception, and so on. The survey was conducted on a representative sample of 12- to 65-year-old female population groups. It is the first of this kind in Italy to ascertain trends in smoking behavior among Italian women in relation to age, educational achievement, and occupation.     

Mesothelioma registry of the Liguria region. Incidence and occupational etiology in a high risk area

This paper presents the epidemiological analyses based on the first 5 years of activity of the Mesothelioma Registry of Liguria (REM). REM is a population-based cancer registry specialized in the study of both the incidence and etiology of primary pleural and peritoneal mesothelioma in Liguria (Italy). The REM completes normal clinical information with occupational and environmental anamnestic data in order to identify working and living areas at risk for asbestos-related pathologies. The REM started its activity in 1994 describing the incidence of pleural mesothelioma (PM) exclusively in the population resident in the city of Genoa (660,000 inhabitants); since 1996 the REM has studied the entire Liguria Region (1,640,000 inhabitants), where nearly 120 new cases of PM are diagnosed annually (20% are women). In the city of Genoa, between 1986-1987 and 1997-1998, PM crude incidence rate rose from 13.8 to 26.7 per 100,000 males over 40 years old. From 1994 to 1998 the REM registered 495 new patients with histologically (62%) and cytologically (9%) confirmed diagnosis of PM. 54% of them were immunocytohistochemically evaluated. Occupational information has been gathered for 248 subjects, i.e., 61% of cases with sure or probable diagnosis of PM. For 126 patients, occupational asbestos exposure (direct, indirect or only presence in the workplace) was identified on average 40 years before diagnosis. In particular, asbestos exposure was documented in shipyards, docks and cargo handling settings, building trades, iron and steel industries. Interestingly, during the same period (1955-1960), a large fraction of subjects without proved or declared direct asbestos exposure claimed to have worked in the same occupational settings. This suggests a possible unconscious indirect exposure to asbestos fibers in the workplace.     

Firefighting and risk of testicular cancer: results from a German population-based case-control study

BACKGROUND: There is some evidence of an elevated risk for testicular cancer among firefighters. METHODS: We performed a population-based case-control study including 269 testicular cancer cases and 797 controls matching on age and region with a special focus on occupational exposures. Job tasks were coded according to the International Standard Classification of Occupations (ISCO 68). We used conditional logistic regression to calculate odds ratios (OR). RESULTS: Three controls (0.4%) and four cases (1.5%) ever worked as firefighters. Firefighters showed an increased odds of testicular cancer in the matched evaluation (OR = 4.3, 95% confidence interval (95% CI) 0.7-30.5). The adjustment for a history of cryptorchidism or family history of testicular cancer did not alter our results. CONCLUSION: Although the association between firefighting and testicular cancer risk is based on only small numbers of exposed subjects in our study, the finding is consistent with a recent cohort study from New Zealand. Occupational hazards experienced by firefighters may increase the risk of testicular cancer.     

Occupation and breast cancer risk in Polish women: a population-based case-control study

BACKGROUND: The etiology of breast cancer is not well understood and the role of occupational exposures in breast carcinogenesis is still uncertain. METHODS: The population-based case-control study included 2,386 incident breast cancer cases diagnosed in 2000-2003, and 2,502 controls. Lifetime occupational histories and information on other potential breast cancer risk factors were obtained through personal interviews. Conditional logistic regression analyses calculated odds ratios (ORs) associated with various occupations and industries after control for potential confounders. RESULTS: We found statistically significant excesses of breast cancer among engineers (OR=2.0; 95% CI: 1.0-3.8), economists (2.1; 1.1-3.8), sales occupations-retail (1.2; 1.0-1.5), and other sales occupations (1.2; 1.0-1.5). Industries showing significantly elevated risks included special trade contractors (2.2; 1.2-4.3), electronic and electric equipment manufacturers (1.7; 1.1-2.7); and public administration/general government n.e.c. (2.7; 1.3-5.7). Each of these findings was supported by a statistically significant positive trend for duration of employment (P<0.05). A decreased breast cancer risk was observed in janitors and cleaners (0.7; 0.5-0.8). CONCLUSIONS: In this study, we found few associations for breast cancer and occupations or industries. The suggestive findings for the electronic and electric equipment manufacturing industry and for the occupations with potential exposure to magnetic fields deserve further evaluation.     

Perceptions of the causes of bladder cancer, nasal cancer, and mesothelioma among cases and population controls

To understand the reasons for underreporting of occupational cancers, we investigated cases' perceptions of the causes of cancer. As part of a case-control study in the province of British Columbia, Canada, 105 bladder cancer cases, 48 nasal cancer cases, 51 mesothelioma cases, and 159 population-based controls (frequency matched to cases on age and sex) were interviewed using structured questions about their smoking, medical, residential, occupational, and carcinogen exposure histories. We asked cases what they thought caused their disease, and asked population controls about their understanding of the etiologies of the three cancers. Most cases and controls (69%) indicated that they had "no idea" about causes, with the exception that the majority of mesothelioma cases (70%) recognized asbestos as a cause. Smoking was perceived as a cause of bladder cancer by 21 percent of cases. Many cases knew about the asbestos and smoking etiologies from discussions with their physicians. Chemicals were commonly cited as causes of nasal and bladder cancer, but very few specific known or probable carcinogens for these sites were named. Cases (12%) more frequently than controls (2%) thought prior disease or trauma was a cause for all three types of cancer. Other etiologic factors less frequently listed by subjects included environmental pollution, hereditary factors, drugs, and radiation. Most cases recognized the major cause of mesothelioma, but few subjects knew about lifestyle or occupational causes of bladder cancer or nasal cancer, suggesting that education about the multiple cancer risks of smoking and about occupational carcinogens needs to be improved.     

National Institute for Occupational Safety and Prevention (ISPESL): role in occupational health and safety

The article explains the role of the Italian National Institute for Occupational Safety and Prevention (ISPESL), a public research body dealing with occupational and environmental health. Its organization, institutional roles, activities, facilities, and resources are outlined. Especially important is ISPESL's participation in national and international occupational safety and health networks. The Institute is active in epidemiologic surveillance of workers exposed to physical, chemical, and biological hazards.     

Occupational exposures and breast cancer among women textile workers in Shanghai

BACKGROUND: Breast cancer incidence rates have been increasing in China over the past 2 decades. Most studies have focused on reproductive, dietary, and genetic risk factors. Little is known about the contribution of occupational exposures. METHODS: We conducted a case-cohort study within a cohort of female textile workers who had participated in a randomized trial of breast self-examination in Shanghai, China. We compared 1709 incident breast cancer cases with an age-stratified reference subcohort (n = 3155 noncases). Cox proportional hazards modeling, adapted for the case-cohort design, was used to estimate hazard ratios for breast cancer in relation to duration of employment in various job processes and duration of exposure to several agents. We also evaluated the associations of cotton dust and endotoxin with breast cancer. RESULTS: Cumulative exposures to cotton dust and endotoxin demonstrated strong inverse gradients with breast cancer risk when exposures were lagged by 20 years (trend P-values <0.001). We did not observe consistent associations with exposures to electromagnetic fields, solvents, or other chemicals. CONCLUSION: Endotoxin or other components of cotton dust exposures may have reduced risks for breast cancer in this cohort, perhaps acting at early stages of carcinogenesis. Replication of these findings in other occupational settings with similar exposures will be needed to confirm or refute any hypothesis regarding protection against breast cancer.     

A case-control study of the relationship between the risk of colon cancer in men and exposures to occupational agents

BACKGROUND: We conducted a population-based case-control study in Montreal, Canada, to explore associations between hundreds of occupational circumstances and several cancer sites, including colon. METHODS: We interviewed 497 male patients with a pathologically confirmed diagnosis of colon cancer, 1514 controls with cancers at other sites, and 533 population-based controls. Detailed job histories and relevant potential confounding variables were obtained, and the job histories were translated by a team of chemists and industrial hygienists into a history of occupational exposures. RESULTS: We found that there was reasonable evidence of associations for men employed in nine industry groups (adjusted odds ranging from 1.1 to 1.6 per a 10-year increase in duration of employment), and in 12 job groups (OR varying from 1.1 to 1.7). In addition, we found evidence of increased risks by increasing level of exposures to 21 occupational agents, including polystyrene (OR for "substantial" exposure (OR(subst)) = 10.7), polyurethanes (OR(subst) = 8.4), coke dust (OR(subst) = 5.6), mineral oils (OR(subst) = 3.3), polyacrylates (OR(subst) = 2.8), cellulose nitrate (OR(subst) = 2.6), alkyds (OR(subst) = 2.5), inorganic insulation dust (OR(subst) = 2.3), plastic dusts (OR(subst) = 2.3), asbestos (OR(subst) = 2.1), mineral wool fibers (OR(subst) = 2.1), glass fibers (OR(subst) = 2.0), iron oxides (OR(subst) = 1.9), aliphatic ketones (OR(subst) = 1.9), benzene (OR(subst) = 1.9), xylene (OR(subst) = 1.9), inorganic acid solutions (OR(subst) = 1.8), waxes, polishes (OR(subst) = 1.8), mononuclear aromatic hydrocarbons (OR(subst) = 1.6), toluene (OR(subst) = 1.6), and diesel engine emissions (OR(subst) = 1.5). Not all of these effects are independent because some exposures occurred contemporaneously with others or because they referred to a group of substances. CONCLUSIONS: We have uncovered a number of occupational associations with colon cancer. For most of these agents, there are no published data to support or refute our observations. As there are few accepted risk factors for colon cancer, we suggest that new occupational and toxicologic studies be undertaken focusing on the more prevalent substances reported herein.     

Survey on health status of workers exposed in the past to carcinogens in a glass factory in Leghorn, Italy

BACKGROUND: For a few years now in Italy there has been wide discussion on the advisability of developing health surveillance programmes for workers who were exposed to occupational carcinogens in the past (incompliance with Italian D.Lgs. 626/94, art. No. 69). The purpose of the present paper was to contribute to the discussion on operative guidelines for public or private Occupational Health Services intending to address this issue. METHODS: A cross-sectional survey was undertaken on former workers of a glass factory located in Leghorn, Italy. Six hundred and seventy-seven workers discharged in the period 1/1/1942 - 30/6/1992, with at least 1 year of service, resident in the area of Leghorn, were identified from the personnel records of the company and invited to medical examination at the local public Occupational Health Service. A structured questionnaire was developed in order to standardize the collection of occupational and health histories. RESULTS: 370 subjects were examined and for each of them occupational and health histories were collected. Occupational exposure to carcinogens in the factory in the last decades was reconstructed using the workers' occupational histories and the available plant records: 3 periods with different production activities (1942/49, 1950/69, 1970/92), and 4 main carcinogens (asbestos, PAH, silica and glass fibres) were identified. Thirty cancers were recorded and 10 of these were occupationally related. CONCLUSIONS: The health survey allowed occupational exposures to carcinogens to be defined in a factory where historical environmental data were not available. It was also possible to assess individual past occupational risk and provide information to each former worker on his risk, on available preventive measures, and on possible diagnostic, therapeutic and insurance procedures available in relation to diseases related to the different hazards. Via this survey it was also possible to identify and notify the Italian Institute of Insurance against Occupational Diseases and Accidents of 6 cases of bladder cancer, i.e., cancers with long survival that would be impossible to identify via current health data bases.     

Occupational exposures and risks of liver cancer among Shanghai female textile workers--a case-cohort study

BACKGROUND: Liver cancer is the fifth most frequent malignancy worldwide. Viral hepatitis B and C, alcohol, and aflatoxin are the major established risk factors. Little is known about the aetiological contributions of occupational exposures, as previous occupational epidemiological studies of liver cancer suggest few agent-specific associations. We investigated associations of occupational exposures to dusts and chemicals in a cohort of female textile workers. METHODS: Cancer incidence was determined among 267,400 female textile workers in Shanghai, China, who had been enrolled in an intervention trial of breast self-exam efficacy during 1989-98. Subjects were interviewed at baseline regarding basic demographics, smoking habits, alcohol consumption, and contraceptive practices. A case-cohort study of 360 liver cancer cases and 3,186 age-stratified randomly chosen subcohort subjects was conducted within this cohort. Exposures to workplace dusts and chemicals were reconstructed from complete work history data, historical exposure monitoring data for selected agents, and a specially designed job-exposure matrix for the textile industry. Relative risks and dose-response trends were estimated by Cox proportional hazards modelling, adapted for the case-cohort design. Latency analyses with different lag years were also applied. RESULTS: 2,095,904 person-years were contributed by this female cohort. The results of the case-cohort analysis revealed a protective effect of cotton fibre exposure years [adjusted hazards ratio (HR) = 0.64; 95% confidence interval (95% CI) 0.44-0.92] or endotoxin exposure (adjusted HR = 0.60; 95% CI 0.41-0.88) for the fourth quartile with significant trends for 20 year exposure lags. CONCLUSIONS: This study suggests that chronic exposure to endotoxin or some other component of cotton dust exposure may have reduced liver cancer risk in this population.     

Gliomas and Farm Pesticide Exposure in Men: The Upper Midwest Health Study

The National Institute for Occupational Safety and Health evaluated farm pesticide exposure and glioma risk in a study that included 457 glioma cases and 648 population-based controls, all adult men (18–80 yr old) and nonmetropolitan residents of Iowa, Michigan, Minnesota, and Wisconsin. Multiple logistic regressions were used to control for farm residence, age, age group, education, and exposure to other pesticides. No associations were found between glioma and 12 specific pesticides. We estimated adjusted odds ratios (ORs) and 95% confidence intervals (Cls) and found reduced glioma risk for insecticides (OR = 0.53, Cl = 0.37–0.77), fumigants (OR = 0.57, Cl = 0.34–0.95), and organochlorines (OR = 0.66, Cl = 0.47–0.94). In analyses excluding proxy respondents (47% of cases) most Cls included 1.0. No positive association of farm pesticide exposure and glioma was found. Other farm exposures may explain the excess brain cancer risk seen in previous studies.     

Household and occupational exposure to pesticides and risk of breast cancer

The association between breast cancer in women and the use of household or occupational pesticides was examined in a population-based case-control study. This study was conducted in Western Australia in 2009–2011and included 1,789 controls and 1,205 cases. Information on household pesticide exposure was collected from questionnaires. For occupational pesticide exposure, job-specific modules (JSMs) were used. To evaluate potential recall bias, we stratified the analysis by belief about whether pesticides contribute to breast cancer. Unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Women’s exposures to pesticides in households and workplaces were not related to increased risk of breast cancer (OR?=?1.10; CI: 0.86–1.37) and (OR?=?0.77; CI: 0.45–1.32), respectively. The prevalence of occupational exposure to pesticides among women in our study was low. In the stratified analyses, the odd ratios associated with household pesticide use were similar among participants who believed pesticides increased breast cancer risk and those who did not. The results of our study did not show associations between breast cancer and household or occupational exposure to pesticides.     

Gliomas and farm pesticide exposure in men: the upper midwest health study

The National Institute for Occupational Safety and Health evaluated farm pesticide exposure and glioma risk in a study that included 457 glioma cases and 648 population-based controls, all adult men (18-80 yr old) and nonmetropolitan residents of Iowa, Michigan, Minnesota, and Wisconsin. Multiple logistic regressions were used to control for farm residence, age, age group, education, and exposure to other pesticides. No associations were found between glioma and 12 specific pesticides. We estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) and found reduced glioma risk for insecticides (OR = 0.53, CI = 0.37-0.77), fumigants (OR = 0.57, CI = 0.34-0.95), and organochlorines (OR = 0.66, CI = 0.47-0.94). In analyses excluding proxy respondents (47% of cases) most CIs included 1.0. No positive association of farm pesticide exposure and glioma was found. Other farm exposures may explain the excess brain cancer risk seen in previous studies.     

Occupation and pancreatic cancer risk in Louisiana

To study the relation of occupational exposures and pancreatic cancer, we evaluated data from males (198 cases and 209 controls) participating in a hospital-based case-control study conducted in a high-risk area of Louisiana between 1979 and 1983. The questionnaire obtained information on lifetime occupational history, as well as dietary, smoking, and drinking habits and demographic characteristics. After adjustment for smoking and dietary patterns, white collar occupations showed consistent elevations in risk, whereas associations for other occupations were in general unremarkable. Although not significantly elevated, risks for truck drivers (OR = 1.7) and those with long-term employment in machine repair or as mechanics were suggestive (OR = 2.5). No association was found for jobs in oil refining or oil and gas extraction (ORs were 0.5 and 0.4, respectively), although risks were slightly elevated for long-term workers in the chemical processing industry (OR = 1.2). While these associations deserve further study, our findings are consistent with results of other studies which do not suggest that occupational exposures are important determinants of pancreatic cancer.