Risk of bladder cancer in foundry workers: a meta-analysis.

To clarify the inconsistent reports of bladder cancer risk in foundry workers, a meta-analytic review of epidemiological studies was undertaken. Summary risk estimates (SRE) were calculated from 40 systematically extracted results. Weakly increased risks were observed overall, with an SRE of 1.11. Twenty three selected study results with better exposure information yielded an SRE of 1.16. This weak increase in risk is consistent with estimates obtained from dose-response trends of PAH exposures in aluminium smelter workers. Summary estimates did not vary substantially with exposure quality, study design, control for smoking, or when limiting the meta-analysis to large study results. Exposure-response findings showed significantly increased risks of about 1.6 to 1.7 after 20 or more years of employment, but this was based on few studies. Occupation specific SREs showed a 40-50% increased risk among moulders, casters, and unskilled foundry labourers. There was limited evidence that bladder cancer risk correlated with lung cancer risk, which is a more established risk among foundry workers. The small increased risk observed is prone to bias and confounding. Further studies of dose-response trends would greatly aid in determining whether this observed association is causal.