Occupation and cancer - European Trade Union Institute (ETUI)

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776 E. Pukkala et al.
above are largely supportive of the interpretation
that the varying smoking habits do not explain all
the occupational variation in risk.
Occupation and alcohol consumption. Alcohol consumption
is, like tobacco smoking, unevenly distributed
across the occupational categories. The
sparse data indicate that the higher social classes
and some categories within the lowest social classes
have had the highest and farmers the lowest average
alcohol consumption. Alcohol consumption was
throughout the study period higher in Denmark
than in the other Nordic countries (Figure 4). In
Denmark, 23% of men in 1976 reported consumption
of 11 alcoholic drinks or more per week. The
proportion was 30% in university graduates and
office workers, but only 7% among farmers. Five
percent of women reported consumption of at
least 11 alcoholic drinks per week. Consumption of
wine increased after Denmark joined the European
Union in 1972, and wine consumption in 1985
showed a marked social class gradient from 41% in
university graduate workers to 4% in blue-collar
workers. Beer consumption showed the opposite
trend with 38% in academic occupations and 75%
in blue-collar workers [175].
Beverage manufacture workers in Denmark
[176], and male waiters and cooks in Norway
[177] have reported higher consumption of alcoholic
beverages than the general population. In Finland,
the highest indices for alcohol-related utilisation of
health care resources in the early 1970s were
obtained among labourers, painters, seamen, construction
workers, forestry workers, artists and
journalists [178]. FINJEM includes estimates of
average alcohol consumption in each occupation
based on surveys of health habits of the Finnish
adult population 1978 1991 [173]. In males, the
consumption was lowest among clergymen (10 g
of alcohol per week, agricultural workers (36 g)
and bench carpenters (39 g). The consumption
was highest among waiters in restaurants (219 g),
dockers (197 g) and engineers in ships (197 g). In
women the consumption was highest (78 98 g of
alcohol per week) among journalists, commercial
managers and musicians) and lowest (7 g) among
farmers.
In Sweden, a high consumption of alcohol is more
common among men than among women, and
highest among men with a low level of education.
Swedish women with a high level of education have
had higher alcohol consumption than women in
manual occupations [89].
In the present study, it was seen that occupations
with easy access to alcohol and with cultural tradi-
tions of alcohol consumption also have a high risk
of cancers associated with alcohol consumption.
Table 86 shows the mortality from alcohol related
liver disease and the incidence of alcohol related
cancer by occupation in the Nordic countries
combined in the cohort of the present study.
‘‘Alcohol related cancer’’ has been defined here as
cancer of the mouth, tongue, pharynx, larynx,
oesophagus, and liver. There are other cancer sites
with an established association with alcohol, such as
colorectal cancer and breast cancer, but these were
not included due to the weaker associations with
alcohol and presumed lower attributable fractions.
In the group’alcohol related liver disease’, alcoholic
liver cirrhosis, fatty liver, hepatitis, fibrosis, and
hepatic failure have been included (ICD-7 581.1,
ICD-8 571.0, ICD-9 571.0-3, ICD-10 K70).
High-risk groups are, to a large extent, the same
for both diagnostic groups, supporting the interpretation
that alcohol consumption is the main factor
explaining the high risk of cancer of the upper
aerodigestive tract and liver among, for instance,
waiters and waitresses, male beverage workers,
female journalists and seamen. Farmers and teachers
are among the low risk groups for both genders. It
should be noted, that all cancer sites included in the
group’ alcohol related cancer’, except liver cancer,
are also related to tobacco smoking. This may
explain why some occupational categories, for instance
male drivers, shoe and leather workers, and
engine operators, and female smelting workers and
launderers, have an elevated risk for the’ alcohol
related cancers’ but not for the’ alcohol related liver
diseases’. In these groups, smoking may play a
relatively stronger role than alcohol consumption in
the elevating risk of upper aerodigestive tract cancer,
but this finding may also point to possible carcinogenic
occupational exposures.
Occupation and dietary habits. Foods rich in fibre
probably decrease the risk of colorectal cancer,
while diets rich in fruits and vegetables probably
decrease the risk of cancer in several sites such as
mouth, pharynx, larynx, oesophagus, stomach, colorectum,
lung, pancreas, and prostate. Red meat
and processed meat have been convincingly shown
to increase the risk of colorectal cancer, and diets
rich in milk may also increase the risk. There is
limited evidence for an association between the
consumption of fat, in particular saturated fat, and
cancers of the lung, breast and prostate [179].
There is very little systematic information on
dietary habits according to occupational category.
More information is available on diet according to
the socio-economic status or education. Several