Exposure to Diesel Motor Exhaust and Lung Cancer Risk in a Pooled Analysis from Case-Control Studies in Europe and Canada

International Agency for Research on Cancer, Lyon, France.
American Journal of Respiratory and Critical Care Medicine (Impact Factor: 13). 10/2010; 183(7):941-8. DOI: 10.1164/rccm.201006-0940OC
Source: PubMed


Diesel motor exhaust is classified by the International Agency for Research on Cancer as probably carcinogenic to humans. The epidemiologic evidence is evaluated as limited because most studies lack adequate control for potential confounders and only a few studies have reported on exposure-response relationships.
Investigate lung cancer risk associated with occupational exposure to diesel motor exhaust, while controlling for potential confounders.
The SYNERGY project pooled information on lifetime work histories and tobacco smoking from 13,304 cases and 16,282 controls from 11 case-control studies conducted in Europe and Canada. A general population job exposure matrix based on ISCO-68 occupational codes, assigning no, low, or high exposure to diesel motor exhaust, was applied to determine level of exposure.
Odds ratios of lung cancer and 95% confidence intervals were estimated by unconditional logistic regression, adjusted for age, sex, study, ever-employment in an occupation with established lung cancer risk, cigarette pack-years, and time-since-quitting smoking. Cumulative diesel exposure was associated with an increased lung cancer risk highest quartile versus unexposed (odds ratio 1.31; 95% confidence interval, 1.19-1.43), and a significant exposure-response relationship (P value < 0.01). Corresponding effect estimates were similar in workers never employed in occupations with established lung cancer risk, and in women and never-smokers, although not statistically significant.
Our results show a consistent association between occupational exposure to diesel motor exhaust and increased risk of lung cancer. This association is unlikely explained by bias or confounding, which we addressed by adjusted models and subgroup analyses.

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Available from: Dario Consonni, Dec 17, 2013
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    • "Our significant OR for DME provides rather weak evidence, as we could not devise a cumulative exposure estimate. However, our results are again comparable both with respect to the prevalence of exposure and OR to a recent combined analysis of 11 case – control studies from Europe and Canada (Olsson et al, 2011), which found an overall 37% prevalence among controls and a summary OR of 1.4 in the highest exposure group. "
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    ABSTRACT: The aim of this study was to compute attributable fractions (AF) to occupational factors in an area in North-Eastern France with high lung cancer rates and a past of mining and steel industry. A population-based case-control study among males aged 40-79 was conducted, including confirmed primary lung cancer cases from all hospitals of the study region. Controls were stratified by broad age-classes, district and socioeconomic classes. Detailed occupational and personal risk factors were obtained in face-to-face interviews. Cumulative occupational exposure indices were obtained from the questionnaires. Attributable fractions were computed from multiple unconditional logistic regression models. A total of 246 cases and 531 controls were included. The odds ratios (ORs) adjusted on cumulative smoking and family history of lung cancer increased significantly with the cumulative exposure indices to asbestos, polycyclic aromatic hydrocarbons and crystalline silica, and with exposure to diesel motor exhaust. The AF for occupational factors exceeded 50%, the most important contributor being crystalline silica and asbestos. These AFs are higher than most published figures. This can be because of the highly industrialised area or methods for exposure assessments. Occupational factors are important risk factors and should not be forgotten when defining high-risk lung cancer populations.
    British Journal of Cancer 03/2012; 106(7):1346-52. DOI:10.1038/bjc.2012.75 · 4.84 Impact Factor
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    • "Recently, a large pooled analysis of case–control studies on the joint effects of occupational carcinogens and smoking in the development of lung cancer was initiated (Olssonetal.,2011).Thisprojectiscalled'SYNERGY'. Up until now, 14 lung cancer case–control studies from 13 European countries (Czech Republic, France, Germany , Hungary, Italy, the Netherlands, Poland, Romania , Russia, Slovakia, Spain, Sweden, and the UK) and Canadahavebeenincluded.Together,thesestudiescomprise 39 518 subjects:17 705 cases and 21 813 controls. "
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    ABSTRACT: SYNERGY is a large pooled analysis of case-control studies on the joint effects of occupational carcinogens and smoking in the development of lung cancer. A quantitative job-exposure matrix (JEM) will be developed to assign exposures to five major lung carcinogens [asbestos, chromium, nickel, polycyclic aromatic hydrocarbons (PAH), and respirable crystalline silica (RCS)]. We assembled an exposure database, called ExpoSYN, to enable such a quantitative exposure assessment. Existing exposure databases were identified and European and Canadian research institutes were approached to identify pertinent exposure measurement data. Results of individual air measurements were entered anonymized according to a standardized protocol. The ExpoSYN database currently includes 356 551 measurements from 19 countries. In total, 140 666 personal and 215 885 stationary data points were available. Measurements were distributed over the five agents as follows: RCS (42%), asbestos (20%), chromium (16%), nickel (15%), and PAH (7%). The measurement data cover the time period from 1951 to present. However, only a small portion of measurements (1.4%) were performed prior to 1975. The major contributing countries for personal measurements were Germany (32%), UK (22%), France (14%), and Norway and Canada (both 11%). ExpoSYN is a unique occupational exposure database with measurements from 18 European countries and Canada covering a time period of >50 years. This database will be used to develop a country-, job-, and time period-specific quantitative JEM. This JEM will enable data-driven quantitative exposure assessment in a multinational pooled analysis of community-based lung cancer case-control studies.
    Annals of Occupational Hygiene 01/2012; 56(1):70-9. DOI:10.1093/annhyg/mer081 · 2.10 Impact Factor
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    Frontiers in Oncology 04/2011; 1:3. DOI:10.3389/fonc.2011.00003
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