Occupation and cancer - European Trade Union Institute (ETUI)

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Acta Oncol Downloaded from informahealthcare.com by 212.35.100.66 on 04/06/11 For personal use only. time of the census. These differences will probably not have affected the classification of men, but parttime working women could have been classified differently across the countries. There are differences across the countries in the way a distinction was made between economically inactive housewives and economically active housewives at the family farm or in the family shop. The proportion of economically inactive men of the total 30 64-year-old male population at the time of the first available population census of the current study was 7.3%, including a great proportion of men unable to work, for instance due to a disease. The large category of economically inactive women (42.4% of the total 30 64-year-old female population) included housewives and farmers’ spouses not taking part in farm work and was thus less selected in terms of health status than that of males. The total cancer incidence among economically inactive men was 6% (95% CI 5% 7%) larger than the incidence among economically active men, whereas there was a slightly decreased cancer incidence among the economically inactive women (SIR 0.99, 95% CI 0.98 0.99). (http://astra.cancer. fi/NOCCA/Incidence/economically-inactive). The highest site-specific SIRs among economically inactive men were obtained for alcohol-related cancers of the pharynx other than nasopharynx (2.08, 1.94 2.23), oral cavity (1.73, 1.60 1.87), tongue (1.59, 1.44 1.75), liver (1.54, 1.46 1.62), oesophagus (1.50, 1.43 1.58), and larynx (1.42, 1.35 1.50). The SIR for lung cancer was 1.33 (1.31 1.35), indicating that economically active men also smoked more than men on average. Besides the common cancer sites illustrated in Figure 53, penile cancer also showed a significant excess (SIR 1.40, 1.25 1.56) quite consistently across the Nordic countries (Table 49). There is no obvious explanation for this finding. The SIRs were lowest for skin melanoma (0.70, 0.67 0.74) and prostate cancer (0.80, 0.79 0.82), suggesting that economically inactive men do not get sunburns and do not go to PSA tests as frequently as other men. The elevated SIR of 1.34 (1.24 1.45) for cancer of the gallbladder among economically inactive men might be related to obesity, which is likely to be more common among economically inactive men than among economically active ones. Cancer of the gallbladder was the only cancer to show a significant more than 5% excess risk among economically inactive women, but the SIR was not higher than 1.07 (1.05 1.09). The SIR was lowest in cancer of the Fallopian tube (0.88, 0.82 0.94). Lip Tongue Oral cavity Pharynx Oesophagus Stomach Colon Rectum Primary liver Gallbladder Pancreas Larynx Lung Breast Cervix uteri Prostate Testis Kidney Bladder Melanoma Brain Thyroid All sites Occupation and cancer in Nordic countries 783 0.5 0.7 1 SIR 1.5 2 Men Women Figure 53. Standardised incidence ratios (SIR) and 95% confidence intervals for selected cancers among economically inactive men and women. Conclusions The surveillance system described in this publication systematically produced standardised incidence ratios (SIRs) among men and women in all five Nordic countries for all main cancer sites by occupation. It was based on the computerised record linkage of the nationwide population-based cancer Registries and population census files including occupational data from a time-point 0 45 years prior to the cancer diagnosis. Because of the high coverage, precision and validity of the linked files, the cancer risk estimates can be considered very reliable, and the large numbers of cases downplay the role of chance variation even in the case of relatively rare cancer forms. For the many small occupational categories and cancer sites, the possibility to combine data from several countries made it possible to get meaningful risk evaluations, and the possibility for five independent country-specific observations to have a tool to estimate consistency of the findings. The occupation at one point in time may not always correspond to the lifelong occupational history of a person. However, comparison with
Acta Oncol Downloaded from informahealthcare.com by 212.35.100.66 on 04/06/11 For personal use only. 784 E. Pukkala et al. results of special occupational cancer studies indicates that the risk diluting effect of misclassification is small. The study was able to find well-known, confirmed occupational risks such as a high lip cancer incidence in farmers and fishermen. Comparisons made earlier have indicated that even the numerical relative risk estimates derived from register-based analyses like the present one have repeatedly been seen to be similar to those obtained in studies investigating more specific hypotheses [6,173]. Because the present survey was based on incident cancer cases and exact person-years, there was no bias caused by occupational variation in cancer survival and in mortality from competing causes of death that may be a serious problem in analyses based on cancer deaths and cross-sectional proportionate analyses. Known or suspected associations, such as a high risk of nasal adenocarcinoma among woodworkers, mesothelioma among asbestos exposed workers, and lung cancer among asbestos and silica dust exposed workers, can be picked up from the numerous site and occupation-specific risk ratios. Sedentary workers tend to have an increased risk of breast cancer, while the association with colon cancer was not so evident. Skin melanoma was most common among indoor workers who are not used to sun radiation and thus easily burn due to intensive sunbathing during the holidays. Thousands of new significant associations came up, and these should be confirmed in other studies before they can be believed to be true causal associations. For instance in ovarian cancer, especially borderline tumours, there was a cluster of chemical-exposed occupations with a high risk. Even in such a rare disease as male breast cancer there were enough cases (2 336) to reveal a hint of an increase in risk in occupations characterised by shift work. The rare occupational category of chimney sweeps, who are exposed to known carcinogens, showed a significant excess risk of cancers of the pharynx, oesophagus, lung, colon, pancreas and bladder. Occupation-related social factors seem to be more important determinants of some cancer risks than the real occupational ones. There were high risks of alcohol-related cancers among workers having easy access to alcoholic beverages in their work. Occupations can also create a protective environment against cancer: it is not suitable for a primary school teacher, dentist or priest to smoke at work (or elsewhere), which is reflected in a low incidence of smoking-related cancers. Cancer is socially discriminating, more so for men than for women. The highly discriminating cancers were found to be those aetiologically related to asbestos, sunlight, and tobacco and/or alcohol exposures. Occupational categories of high risk for one cancer may be of low risk for another cancer, and this resulted in the present study in a 1.9-fold variation in the overall cancer risk for men and in a 1.5-fold variation for women. It was estimated from a similar results pattern in Finland from 1971 1985 that some 5% of all cancers both in males and in females would be related to work, and about 35% of cancer incidence in males and 16% in females would be attributable to socio-economic position [6]. The current risk estimates indicate that the population attributable fractions for the Nordic region would still be of similar magnitude. Acknowledgements This study was financially supported by the Nordic Cancer Union and Scientific Council in Sweden. Data for the study were prepared in collaboration with the national statistical offices, Statistics Denmark; Statistiska Centralbyra˚n, Sweden; Statistics Norway; Statistics Iceland, and Statistics Finland. We are indebted to Aage Andersen, Lotti Barlow, Tor Haldorsen, and Lene Bjørk Clausen for assistance in early phases of this study. We thank Ms. Luanne Siliämaa for language corrections, and Margrethe Meo for help with the references and preparation of the manuscript. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. References [1] Andersen A, Barlow L, Engeland A, Kjaerheim K, Lynge E, Pukkala E. Work-related cancer in the Nordic countries. Scand J Work Environ Health 1999;/25(Suppl 2):/1 116. [2] Danmarks Statistik [Statistics Denmark]. Folke og boligtællingen 1. januar 1981. Landstabelværket [Populationand housing census 1st January 1981. Tables for all Danmark]. Copenhagen (Denmark): Danmarks Statistik; 1984. Danish. [3] National Board of Health and Welfare [Socialstyrelsen]. The Swedish Cancer-Environment Registry 1961 1973. Stockholm (Sweden): National Board of Health and Welfare; 1980. [4] Eklund G, Barlow L, Vaittinen P. Cancer-Milö-Registeret 1960 70 [Cancer-environment registry 1960 70]. Epcreport No. 4. Stockholm (Sweden): Socialstyrelsen; 1994. Swedish. [5] Lynge E, Thygesen L. Occupational cancer in Denmark. Cancer incidence in the 1970 census population. Scand J Work Environ Health 1990;/16(Suppl 2):/3 35. [6] Pukkala E. Cancer risk by social class and occupation. A survey of 109,000 cancer cases among Finns of working age. In: Wahrendorf J, editor. Contributions to epidemiology and biostatistics. Vol 7. Basel (Switzerland): Karger; 1995.
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