Calvin Ge1, Susan Peters1, Ann Olsson2, Lützen Portengen1, Joachim Schüz2, Josué Almansa1, Wolfgang Ahrens3, Vladimir Bencko4, Simone Benhamou5, Paolo Boffetta6,7, Bas Bueno-de-Mesquita8, Neil Caporaso9, Dario Consonni10, Paul Demers11, Eleonóra Fabiánová12,13, Guillermo Fernández-Tardón14, John Field15, Francesco Forastiere16, Lenka Foretova17, Pascal Guénel18, Per Gustavsson19, Vladimir Janout20, Karl-Heinz Jöckel21, Stefan Karrasch22,23,24, Maria Teresa Landi9, Jolanta Lissowska25, Danièle Luce26, Dana Mates27, John McLaughlin28, Franco Merletti29, Dario Mirabelli29, Tamás Pándics30, Marie-Élise Parent31, Nils Plato19, Hermann Pohlabeln3, Lorenzo Richiardi29, Jack Siemiatycki32, Beata Świątkowska33, Adonina Tardón14, Heinz-Erich Wichmann34,35, David Zaridze36, Kurt Straif2, Hans Kromhout1, Roel Vermeulen1. 1. Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands. 2. International Agency for Research on Cancer (IARC/WHO), Lyon, France. 3. Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany. 4. Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic. 5. INSERM U 1018, Villejuif, France. 6. Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York. 7. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. 8. The National Institute for Public Health and Environmental Protection, Bilthoven, the Netherlands. 9. National Cancer Institute, Bethesda, Maryland. 10. Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 11. Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada. 12. Regional Authority of Public Health, Banská Bystrica, Slovakia. 13. Faculty of Health, Catholic University, Ružomberok, Slovakia. 14. Fundación para la Investigación e Innovación Biomédica en el Principado de Asturias - Instituto de Investigación Sanitaria del Principado (FINBA-ISPA), Faculty of Medicine, University of Oviedo and Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Oviedo, Spain. 15. Roy Castle Lung Cancer Research Programme, Cancer Research Centre, University of Liverpool, Liverpool, United Kingdom. 16. Consiglio Nazionale delle Ricerche-Istituto per la Ricerca e l'Innovazione Biomedica (CNR-Irib), Palermo, Italy. 17. Masaryk Memorial Cancer Institute, Brno, Czech Republic. 18. Center for research in Epidemiology and Population Health (CESP), Cancer and Environment team, Inserm U1018, University Paris-Sud, University Paris-Saclay, Villejuif, France. 19. The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. 20. Faculty of Health Sciences, Palacky University, Olomouc, Czech Republic. 21. Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany. 22. Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany. 23. Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany. 24. Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Neuherberg, Germany. 25. The M. Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. 26. Univ Rennes, Inserm, Ecole des hautes études en santé publique (EHESP), Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Pointe-à-Pitre, France. 27. National Institute of Public Health, Bucharest, Romania. 28. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. 29. Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and ll Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica in Piemonte (CPO-Piemonte), Torino, Italy. 30. National Public Health Center, Budapest, Hungary. 31. Institut national de la recherche scientifique, University of Quebec, Laval, Quebec, Canada. 32. University of Montreal Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada. 33. The Nofer Institute of Occupational Medicine, Lodz, Poland. 34. Institut für Medizinische Informatik Biometrie Epidemiologie, Ludwig Maximilians University, Munich, Germany. 35. Institut für Epidemiologie, Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany; and. 36. Russian Cancer Research Centre, Moscow, Russia.
Abstract
Rationale: Although the carcinogenicity of diesel engine exhaust has been demonstrated in multiple studies, little is known regarding exposure-response relationships associated with different exposure subgroups and different lung cancer subtypes. Objectives: We expanded on a previous pooled case-control analysis on diesel engine exhaust and lung cancer by including three additional studies and quantitative exposure assessment to evaluate lung cancer and subtype risks associated with occupational exposure to diesel exhaust characterized by elemental carbon (EC) concentrations. Methods: We used a quantitative EC job-exposure matrix for exposure assessment. Unconditional logistic regression models were used to calculate lung cancer odds ratios and 95% confidence intervals (CIs) associated with various metrics of EC exposure. Lung cancer excess lifetime risks (ELR) were calculated using life tables accounting for all-cause mortality. Additional stratified analyses by smoking history and lung cancer subtypes were performed in men.Measurements and Main Results: Our study included 16,901 lung cancer cases and 20,965 control subjects. In men, exposure response between EC and lung cancer was observed: odds ratios ranged from 1.09 (95% CI, 1.00-1.18) to 1.41 (95% CI, 1.30-1.52) for the lowest and highest cumulative exposure groups, respectively. EC-exposed men had elevated risks in all lung cancer subtypes investigated; associations were strongest for squamous and small cell carcinomas and weaker for adenocarcinoma. EC lung cancer exposure response was observed in men regardless of smoking history, including in never-smokers. ELR associated with 45 years of EC exposure at 50, 20, and 1 μg/m3 were 3.0%, 0.99%, and 0.04%, respectively, for both sexes combined.Conclusions: We observed a consistent exposure-response relationship between EC exposure and lung cancer in men. Reduction of workplace EC levels to background environmental levels will further reduce lung cancer ELR in exposed workers.
Rationale: Although the carcinogenicity of diesel engine exhaust has been demonstrated in multiple studies, little is known regarding exposure-response relationships associated with different exposure subgroups and different lung cancer subtypes. Objectives: We expanded on a previous pooled case-control analysis on diesel engine exhaust and lung cancer by including three additional studies and quantitative exposure assessment to evaluate lung cancer and subtype risks associated with occupational exposure to diesel exhaust characterized by elemental carbon (EC) concentrations. Methods: We used a quantitative EC job-exposure matrix for exposure assessment. Unconditional logistic regression models were used to calculate lung cancer odds ratios and 95% confidence intervals (CIs) associated with various metrics of EC exposure. Lung cancer excess lifetime risks (ELR) were calculated using life tables accounting for all-cause mortality. Additional stratified analyses by smoking history and lung cancer subtypes were performed in men.Measurements and Main Results: Our study included 16,901 lung cancer cases and 20,965 control subjects. In men, exposure response between EC and lung cancer was observed: odds ratios ranged from 1.09 (95% CI, 1.00-1.18) to 1.41 (95% CI, 1.30-1.52) for the lowest and highest cumulative exposure groups, respectively. EC-exposed men had elevated risks in all lung cancer subtypes investigated; associations were strongest for squamous and small cell carcinomas and weaker for adenocarcinoma. EC lung cancer exposure response was observed in men regardless of smoking history, including in never-smokers. ELR associated with 45 years of EC exposure at 50, 20, and 1 μg/m3 were 3.0%, 0.99%, and 0.04%, respectively, for both sexes combined.Conclusions: We observed a consistent exposure-response relationship between EC exposure and lung cancer in men. Reduction of workplace EC levels to background environmental levels will further reduce lung cancer ELR in exposed workers.
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