7 7
Cad. Saúde Púb lic a, Rio d e Jane iro , 14(Sup. 3):77-86, 1998 A RTIGO A RT I C L E
E n v i ronmental and occupational cancer in
A rgent ina: a case-control lung cancer st udy
Cánc e r amb ie ntal y o c up ac io nal e n Arg e n t i n a :
e stud io d e un c aso -c o ntro l e n c ánc e r d e pulmó n
1 In stitu t o de On c o l o g í a ‘An gel H. R o f f o’, U n i ve r s i d a d d e Bu en os Aire s .
Av. Sa n M a rt ín 5 481, 1 4 1 7 , Bu en o s Aire s , Ar g e n t i n a . 2 In tern at ion a l Agen cy f or Re s e a rch on Ca n c e r. 1 5 0 , Cou rs Al b e rt - T h o m a s , 6 9 3 7 2 ,c e d ex 08, Ly o n , Fra n c e . Elen a M a t o s 1 M a rt a Vilen sk y 1 Pa olo Bo ff et t a 2
Abst ract T h e m a in o b ject i v e o f t h i s st u d y w a s t o a n a lyz e t h e ri sk s for lu n g ca n cer a ssoci a t e d w i th occu p a ti on al ex p o s u res in a d ev elo p in g cou n t ry w h ere lu n g ca n cer is th e first cau se of m ort a li ort y from ca n cer in m en . T h e sort u d y i n v o l v ed 200 m en w i ort h lu n g ca n cer a n d 397 h osp iort a l con -t ro l s . Th e OR for cu rren -t sm o k ers w a s 8.5, w h e rea s form er sm o k ers d isp la yed a n OR o f 5.3. T h e f ra ct i o n a t t rib u t a b le t o sm ok in g w a s 85%. S t a t ist ica l ly si gn i fi ca n t h i gh ORs w ere observ ed f or e m p l o ym en t i n t h e a lco h o lic b ev e ra ges in d u st r y (4.5 , 9 5% CI:1.02- 20.2 ), sa w m ills a n d w o o d m ills (4.6, 95% CI:1.118.4), ch em ica ls/p la st ics (1.8, 95% CI:1.043.2), an d p o t t ery, g l a s s , or m in -e ral m a n u fa ct u r-es (3.4, 95% CI:1.1-10.6). Ot h -er h igh , b u t n ot st at i st ica lly si gn ifi ca n t , risk s w -er-e o b s e rved for em p loym en t in lea th er sh oe in d u st ry a n d rep a ir (2.1, 95% CI:0.8- 5.4), ru bber in du s-t ries (3.4, 95% CI:0.9-12.4), m es-ta l w o rk e r s , in clu din g w eld ers (1.9, 95% CI:0.8-4.4), m o s-t or ve h i c l e m ech a n i cs (2.0, 95% CI:0.94.2), w o rk ers in clea n in g serv ices (1.9, 95% CI:0.8 4.5), a n d for w ork -ers i n a gricu l t u re ( 2.4, 95 % CI:0. 9- 6.0). Alt h o u gh so m e of t h e p rese n t resu lt s m a y b e d u e t o c h a n c e , m ost a re con sist en t w it h t h ose o f p rev iou s in v est igat io n s in ot h er cou n t ries.
Key words O ccu p at ion a l Ex p o s u re ; Lu n g N e o p l a s m s ; Ca s e - C o n t rol St u d i e s
Resumen El ob jet iv o p rin ci p a l d e est e est u di o f u e a n a li z a r los riesgos p a ra cá n cer d e p u lm ón a so ci a d os con ex p o si cio n es ocu p a ci on a les, en u n p a ís en v ía s d e d esa rro llo d on d e e l cá n cer d e p u lm ón es la p rim era ca u sa d e m ort a li d a d p or cá n cer en h om bre s . El est u d io in clu yó 200 h o m -b res co n est a p a t o logía y 3 97 co n t rol es h o sp i t a la ri os. El O R p a ra f u m a d ores a ct u a les f u e 8,5, m i e n t ra s qu e los ex f u m a d o res m o st ra ron u n OR d e 5,3. La f ra cció n a t ribu i b le a l h á b it o d e fu -m a r fu e d e 85%. S e observa ron riesgo s est a d íst ica -m en t e sign ifica t iv os p a ra : e-m p leo en la i n d u s-t ria d e bebi da s a lcoh ólica s (4,5, 95% CI:1,02-20,2), a s e r ra d e ros (4,6, 95% CI:1,1-18,4), i n d u s s-t r i a s q u í m i c a s , p lá st i co s (1 ,8, 95% CI:1, 04- 3, 2), c e r á m i c a , l oz a , v i d ri o o p ro d u ct o s m i n era les n o m et álicos (3,4, 95% CI:1,1- 10,6). Ot ros riesgos elev a d o s , p e ro sin sign ifica ción est ad ística , f u e ro n e n c o n t ra d os p ara la in d u st ria y el t ra baj o en la re p a ración d el calza do d e cu ero (2,1, 95% CI:0,8-5 , 4 ) , la in d u st ria de la gom a (3,4, 9CI:0,8-5% CI:0,9- 12,4), el gru p o de m et a lú rgi cos qu e in clu ye los sol-d a sol-d o res (1 ,9, 95 % CI:0 ,8- 4,4), lo s m ecá n i co s sol-d e a u t om o t o res (2 ,0, 95 % CI:0,9- 4,2), lo s t ra b a-j a d o res en se rv i ci o s d e li m p i ez a (1,9, 95 % CI:0,8- 4,5) y los t ra b a a-j a d o res a grí co la s (2,4, 9 5 % C I : 0 , 9 - 6 , 0 ) . Si bien a lgu n os d e los p resen t es resu lt a d os p u ed en ser d ebid os al a za r, la m a yo ría son con sist en t es con los obt en id os en in v est iga cion es p rev ia s en ot ro s p a íses.
Cad. Saúd e Púb lic a, Rio d e Jane iro , 14(Sup. 3):77-86, 1998
I n t ro d u c t i o n
In Argen tin a, a s in m a n y in du str ializin g co u n -t ri e s, va scu la r an d n eo p la s-tic d isea ses a re n ow th e ch ief cau ses o f p re m a t u re d ea th . Can cer is th e seco n d ca u se o f d ea th , an d lu n g ca n c er is th e first n eop lastic cau se of death am on g m ales, with a n a ge-a d ju sted m o r tality ra te o f 39.0/ 100,000 fo r th e p erio d 1989-1992. Th e ra t e f o r f e m a l e s, 6.1/ 100,000 for th e sa m e period , is still l ow co m p ared to th e ra tes in d evelo p ed c ou n -t ries (Ma -to s e-t al., 1997).
Ve r y few d a t a a re a va ila b le re g a rd in g c a n -cer in cid en ce in th e co u n try. In La Plata , th e in t h e Pro vin ce of Bu en o s Aire s, d a ta fro m 1980 s h owed a n a n n u a l a gesta n da rd i zed lu n g ca n -cer in cid en ce rate of 40.3/ 100,000 am on g m a les ( A l va rez - Ge l ves & Pe rez - A ri a s, 1986). Mo re re c e n t f i g u re s in th e co u n tr y a re a va ila b le on ly fro m t h e p o p u la tio n -b a s ed Tu m o r Re g i s t r y o f th e De p a rtm en t o f Co n c o rdia , En t re Rio s. Th e ra t e s we re 55.8/ 100,000 for m ales an d 8.3 fo r fem ales, fo r th e p er iod 1990-1994 (Prin ce et a l., 1997).
En v i ron m en ta l an d occup a tion a l can cer re-s e a rch ire-s re-still in itre-s in itial develop m en ta l re-sta ge in Argen tin a. Is su es th a t h a ve b een a d d re s s e d re g a rd in g en viro n m en tal ca u ses o f ca n cer a re n a t u ral exp o su re to gro u n dwa ter with h igh lev-els of a rsen ic, exp osu re to su n ligh t, an d to ba c-c o s m okin g. Ca n c-cer in p o p u la tion s im m igra t-in g t-in to Argen tt-in a , a llowt-in g th e co m p ar iso n o f d is ea s e ris k in p o p u la t io n s o f sim ila r gen e tic b a c k g ro u n d livin g in d iffer en t en viro n m e n t s, h a s also b een a n a lyzed .
A rgen tin a h a s seve r al area s with h igh n a t-u ral co n cen tra tio n s o f a rsen ic in gro t-u n d w a t e r. El e vated sta n d a rd i zed m o rta lity ra tio s (SMRs) fo r b la d d er c an cer, a ss o cia te d with a ve ra g e c o n c e n t ra tio n s of u p to 533 µ g/ liter m e asu re d in th e p ro vin c e o f Co rd o b a , we re re p o rted fo r b o th s exes (Ho p en h a yn Rich et al., 1996). In -c rea sin g tr en d s fo r kid n ey a n d lu n g -ca n -ce rs with exp osu re, as in d ica ted by SMRs, we re a lso o b s e r ved fo r th e sa m e p rovin ce (Ho p e n h a y n -Rich et a l., 1998).
Ex p o s u re t o s u n ligh t wa s a n a lyzed in a c a s e - c o n t ro l stu d y o n s kin m ela n o m a . In a m u l t i va r ia te a n a lysis, sign ifica n tly e leva t e d r isks we re o bser ved fo r th e oc cu rren ce of su n -b u r n in ch ild h o od, skin sen sitivity to su n ligh t, an d sp o r t s - related e xp o su re to su n ligh t (Lo ri a , 1 9 9 8 ) .
To ba cco sm o kin g is th e m a in ca u se of lun g ca n cer wo rld wid e (IARC, 1986). 85% o f lu n g ca n cer ca ses in m a les h a ve b een a ttrib u ted to tob a cco sm okin g (Pa rkin et a l., 1994). A sim ilar f i g u re wa s o b s er ve d in a s tu d y p erf o r m ed in Bu e n o s Aires (Ma t os et a l., 1998). Re g a rd i n g
bladd er can cer, Is c ovich et al. (1987), in a ca se-c o n t rol stu d y in th e se-city of La Plata , ob served a risk o f 4.3 fo r th o se wh o h a d ever sm oked a n d wh ic h wa s 2-3 tim e s h igh er fo r s m o ke rs o f b la ck tob acco cigare t t e s.
M i g ra n ts fro m a lm o st a ll co u n t r ie s h a ve h igh e r m o r ta lity r a te s fr o m ga st r ic ca n c e r th a n b o rn Arg e n t i n e s, b u t th e risk d eclin es in m i g ra n t s, a n d fo r Eu ro p e a n m igra n ts it is a p -p ro a c h in g th a t o f b o rn Arg e n t i n e s. Mo rt a l i t y f r om e so p h a ge a l ca n cer is sign ific an t ly lowe r in n a t ive Eu r o p e a n s t h a n in Arg e n t i n e - b o rn i n d i v i d u a l s, a n d a lt h o u gh r isk in c re a s es fo l-l o win g m igr a t io n , it re m a in s b e l-lo w t h a t o f A r g e n t i n e - b o rn in d ivid u a ls fo r a ll gro u p s ex-cep t Po l e s. Fo r ca n cer of th e colon a n d b re a s t , m o st c o u n tries o f o rigin sh ow lowe r m o rt a l i-t y r a i-te s i-th a n A rg e n i-t i n e - b o rn , i-th e exc e p i-t i o n s b ein g Ur u gu a y a n d Ge rm a n y, a n d m igra n t s d e m o n s t rate a co n ve rgen ce of risk tow a rds th at o f Arg e n t i n e - b o rn . Th ese res u lt s su gges t th at i m m i g ra n ts in to Argen tin a u n d ergo ch an ges in so m e en viro n m e n ta l e xp o su re s, in p a r t i c u l a r diet, wh ich su bsta n tially a lter th eir ca n cer ri s k ( Ma to s et al., 1991; Ma tos et al., 1993).
Th e on ly p revio u s ep id em io lo gica l stu d y o f o ccu p at io n a l ca n c er w as c o n d u c te d b y Is c ovich et a l. (1987) on 117 ca ses of b lad der ca n -cer a n d two gro u p s o f con tro ls in the city o f La Pla t a , Pro vin ce o f Bu e n o s Aire s. In t h is stu d y th e th ree o ccu p a tio n s o f lo n gest d u ra tio n a n d th e m o st rec en t o n e we re re c o rd e d . A sign ifi-ca n t a sso ciatio n was o bserved for tr uck d ri ve r s o r ra i l r oa d c o n d u ct o rs (RR = 4.3 b a sed o n 20 exp os ed ca se s, a n d 4 a n d 5 exp o se d in ea ch c o n t ro l grou p ) an d o il re f i n e ry workers (RR 6.2, b a s ed o n 7 exp o se d ca ses a n d 2 exp o se d in ea ch co n tro l gro u p ). After ad ju stin g fo r sm o kin g, th e ris k fo r d ri ve r s/ co n d u c to r s wa s re -d u c e-d , wh e rea s th at fo r oil re f i n e r y wor k e r s wa s in cre a s e d .
Cad . Saúd e Púb lic a, Rio de Jane iro , 14(Sup. 3):77-86, 1998 m o re p o llu tin g an d o f typ es n o lo n ger u sed in
i n d u s t ri a l i zed n a tio n s; evid en ce fr o m so m e ep id em io lo gica l stu dies m ay in fa ct b e re l a t e d p ri m a r ily to th e h igh er levels o f exp osu re th a t o c c u r re d in d evelop ed c o u n tr ies in th e p a s t (Va in io et a l., 1994).
Occ u p a t io n a l exp o s u r es an d lu n g ca n c er we re t h e su b ject o f s eve ra l stu d ies in La tin A m e r ic a n co u n t rie s (De Stefa n i e t al., 1996; Wu n s c h - Filh o et al., 1998; Su zu ki et a l., 1994). A s eries o f lu n g ca n ce r ca se s c ollect ed in th e c ity o f Ro s a ri o, Argen tin a , wa s r e p o rt ed with b ro ad in fo rm atio n a n d po o rly defin ed o ccup a -tio n a l ca tego ri e s, p reclu din g valid con clu sio n s ( Mah ua d et al., 1994).
Th e o b je ctive o f th is p resen t atio n is to re-p o rt th e resu lts o f a ca se-co n tro l stu d y on lu n g c an c er a n d o c cu p a tion c on d u ct ed in Bu e n o s A i re s.
Patients and methods
All in ciden t m ale lu n g can cer cases, residen ts in th e city or Provin ce of Buen o s Aire s, wh o wh ere a d m itted for trea tm en t in fo u r h o sp ita ls o f Bu en o s Aires city from Ma rc h 1994 to Ma rc h 1996 we re co n sid ere d eligib le fo r th e p re s e n t s t u d y. A to tal o f 216 lu n g ca n cer ca s es we re id en tified in the p a rticip atin g h ospita ls. Fi f t e e n p atien ts were too ill or m en tally in cap able of be-in g be-in terv i e wed , a n d o n e p a tien t refu sed to b e i n t e rv i e wed, leavin g 200 p atien ts, wh o we re in -clu ded a s cases in th e a n a lysis, with a n ave ra g e age of 60 years. Fifty cases (25%) h ad squ am ou s-cell carcin om a , 86 (42.5%) ad en o carcin o m a , 20 (10%) sm all-cell ca rcin o m a , 13 (6.5%) larg e - c e l l c a rcino m a, a n d 21 (10.5%) o th er typ es or un dif-f e ren tiated carcin o m a. El e ven cases (5.5%) h a d o n ly a clin ica l d ia gn o sis. All ca ses re p o r te d by th e p a th o lo gists a s u n differen tia ted ca rc i n o m a were reviewed in order to con firm th e diagn osis. Two co n tro l s, resid e n ts in th e sa m e a re a , we re m a tch ed to each ca se by h o sp ita l an d a ge (± 5 yea rs), wit h t h e excep t io n o f t h re e c a s es wh o h a d o n e co n trol o n ly. A to ta l o f 397 m a les h o s p i t a l i zed fo r co n d ition s u n related to to ba c-c o u se d u r in g t h e sa m e p erio d we re in t erv i e wed . Th e m a in gro u p s of d ia gn o s es, a b s t ra cted fro m m ed ic a l re c o r d s a n d co d ed ac c o rd in g t o ICD 9 (W H O, 1975) we r e: skin d is ea ses (20%), d igestive tra ct d isea ses (16%), in -fectio u s a n d p a ra sitic disea ses (9%), circ u l a t o-ry s yst em d ise a s es, a n d n eo p la sm s u n re l a t e d to t o b a cco s m o kin g (9% ea ch ), gen ito u ri n a r y t ra c t d isea ses (7%), in ju ries (6%), a n d m u sc u lo skeletal system d isea ses (5.3%). Fi ve p o ten -tia l co n trols refu sed to b e in terv i e we d .
LUNG CANCER AND O C CUPATIO N IN ARG ENTINA 7 9
All th e cases a n d co n tro ls we re in ter v i e we d in p ers o n by t ra in e d in te rv i e we r s. Th e q u e s-t i o n n a i re in clu ded a secs-tio n o n d em o gra p h i c s, c om p lete h is to r ie s on o cc u p at io n , to b a cc o sm o kin g, re s i d e n c e, h eatin g h a b its, a n d n u tri-t io n . Level o f e d u c a tri-tio n wa s u s ed a s a p r ox y va ria b le for so cio econ om ic sta tu s.
For th e a n a lysis o f sm okin g h a bits, in d ivid-u als wh o ha d sm o ked a t least o n e ciga rette da i-ly o r equ ivalen t a m o u n t of tob acco for on e ye a r o r m ore a t an y tim e we re cla ssified a s sm okers. Th o se wh o h a d sto p p ed sm o kin g fo r a t le a st o n e yea r p r io r to th e dia gn o sis we re cla ss ified a s ex-sm okers. Ch an ges in typ e a n d bra n d, da i-ly n u m b er of ciga re t t e s, d u ra tion o f h ab it, a ge a t s ta rtin g, a ge a t q u itt in g, filt er u se, a n d in -h a la tio n -h ab it we re re c o rd ed . On e ca se a n d 4 c o n t ro ls sm o ked o n ly p ip es o r ciga rs a n d we re e xclu d ed from th e an alysis.
Th e s u b je ct’s en tire o ccu p at io n a l h is to ry wa s re c o rd e d . For ea ch c h a n ge in o ccu p a tio n g reater th a n on e yea r th rou gh o u t life, in form a-tio n wa s req u ested on jo b h e ld , sp ecific ta sks p e rf o rm ed in tha t jo b, a n d n am e an d bra n ch o f activity of th e in du stry.
Cas es a n d co n tro ls we re c la ssified in b ra n ch es of in d u str ia l ac tivit ie s a c co rd in g t o th e In t e r n a tion a l St a n d a rd In d u s t ria l Cla ssifi-c a tio n o f All Essifi-co n o m issifi-c Assifi-c tivit ies (ISIC, 1971) a n d in o cc u p a t ion a l c at ego ries a cco rd in g th e In t e rn a tion al St a n d a rd Cla ssifica tio n o f Oc c u -p a tion s (CIU O-88, 1991). Ca t e g o ries in clu din g a t lea st 10 ca se s or c on tro ls we re reta in ed fo r t h e a n a lysis. Fo r e a ch b r a n ch o f in d u st ry o r c a t e g o ry o f occu p ation , su b jects ever em p loye d we re co m p a red to th o se n ever em p loye d .
Fo r d a ta a n a lys is, t h e fo llo win g va ri a b l e s we re ca lcu lated: lifetim e u rba n resid en ce (p er-cen ta ge of yea rs spen t in a reas with p op u la tion g rea t er th a n o r eq u a l to 100,000 in h a b ita n ts), d u r a t io n o f co n su m p tio n o f to b ac c o, m e a n d a ily a n d cu m u la tive c o n s u m p t io n o f c iga -re t t e s, age a t sta rtin g sm o kin g, n u m ber o f ye a r s sin ce q u ittin g, m a in typ e o f to ba cco, an d m ain u se o f filter over th e to ta l n u m ber of ye a r s. Va ri-a b les in clu din g d u rri-atio n of em p loym en t in oc-cu p a tio n a l o r in d u s tria l c at ego r ies ove r life we re also calcu la ted for ea ch in d ividu a l.
Cad. Saúde Púb lica , Rio d e Jane iro , 14(Sup. 3):77-86, 1998
g ro u p of a ge a n d p a ck-year s o f ciga re t t e s. Oc-c u p a t i o n s / i n d u s t ries resu ltin g in high risk esti-m a t es we re a ls o a d ju st ed b y eesti-m p lo yesti-m en t in o ther h igh risk o ccu p a tion s/ in du stri e s. Po t e n -t ia l c on fou n d ers we re c o n -t ro lled fo r b y u sin g u n co n ditio n al lo gistic re g ressio n m o delin g. All c a lcu lat io n s we re p er f o rm e d u s in g SPSSPC+ a n d EGRET so ftwa re s.
R e s u l t s
Se le cte d c h a ra c t e r istic s of c a s es a n d co n tro l s a re re p o rted in Table 1. No differen ces betwe e n ca se s a n d c o n tro ls we re o b s er ved in e d u ca -tio n a l level or lifet im e res id en c e in u r b an o r ru ra l a re a s. El e ven ca s es we re n o n -sm o ker s a n d all of th em we re h isto lo gica lly ve ri f i e d .
Ta b le 2 sh ows th e resu lts fo r th e u n iva ri a t e a n a lysis o f t h e to b a cc o va r ia b les by s m o kin g s t a t u s. Th e OR fo r c u rre n t s m o ke r s w as 8.5, w h e rea s fo r m er sm oker s d is p la yed a n OR of 5.3. Th e ORs in c re a s ed with d u ra t io n o f ciga -ret tes u s e, n u m b e r o f ciga -ret te s s m o ke d p e r d a y, o r p ac k-ye a r s. Men wh o s ta r ted sm o kin g wh e n a ge d 20 o r m o re h a d a lower ris k th a n m e n wh o s ta r te d b e fo re. In a m u ltiva ri a t e a n a l y s i s, t h e fitt ed fin a l m o d e l in clu d e d t h e n u m b er o f yea rs sin ce qu ittin g, th e n u m ber o f c i g a ret tes sm o ked d a ily, a n d th e d u ra tio n o f th e h a b it. The add itio n of a ge a t sta r tin g to th e m o del was n ot sta tistica lly sign ifican t.
Th e m ean n u m ber of jo bs am on g ca ses wa s 4.0 a n d am o n g c o n tro ls 3.7. Ta b le 3 sh ows th e sm o kin g-a d ju s te d ORs fo r e m p loym en t in b ra n ch es of a ctivities with a t lea st 10 su b jects e ver em p loye d . Estim ates o f risks we re sim ila r wh e n life lo n g n u m b e r o f ciga re t t e s, a ve ra g e n u m ber of ciga rettes p er d ay, o r du ra tion o f the sm o kin g h a b it we re u se d fo r ad ju s tin g b y sm o kin g.
Sta tistica lly s ign ifica n t ORs we re o b ser ve d fo r em p loym en t in th e a lc oh o lic b eve ra ges in -d u s t r y (4.5), s a wm ills a n -d wo o -d m ills (4.6), ch em ic a ls/ p lastics (1.8), an d p otter y, gla ss, o r m i n e r als (3.4). El e va ted (b u t n o t sign ifica n t) ORs we re a lso o b s erved for a gri c u l t u re (1.5), lea th er s h o e m a n u fa c tu rin g a n d re p a ir (2.1), ru bb er (3.4), an d wa ter tra n s p o rtatio n (3.3).
Wh en d u ra tio n o f em p loym e n t wa s ta ke n in to a c co u n t , th e OR fo r wo rkin g les s th an 10 ye a rs in a gr i c u l t u re (2.5, 1.2- 5.3) wa s h igh e r tha n th e OR for lon ger du ra tio n of em p loy m e n t . No o th er s ta tistically sign ifica n t fin d in gs we re o b s e rved re g a rdin g d u ra tion o f em p loym en t.
Ta b le 4 p resen ts th e s m o kin ga d ju st ed re -su lts o f th e o ccu p a tio n al ca tego ries exa m in ed . On ly o n e c at ego r y, sa les p e rs o n s (exc l u d i n g s t reet ven d o rs ), sh owe d a sta tis tica lly s ign ifi-ca n t OR (1.8). Th e risk wa s h igh e r fo r m e n w o rkin g for 10 yea rs or m ore (2.7, 1.1-6.8).
An eleva ted b u t n o t sta tistica lly sign ifican t va lu e wa s o b s er ved fo r a gri c u l t u ra l a n d live -st o ck wo rkers (1.5, 0.9- 2.4). Th e r is k d id n ot i n c reas e with lon ger du ra tio n o f em p loy m e n t , bu t ch a n ged with th e a ge gro u p.
Wh en the a n alysis was re s t ricted to a gri c u l-t u ra l wo rke rs o n ly, l-t h e r isk wa s 2.4 (0.9- 6.0)
Tab le 1
Distrib utio n o f c ase s and c o ntro ls ac co rd ing to se le cte d c harac te ristics.
C a s e s C o n t ro l s
n ( % ) n ( % )
To t a l 2 0 0 ( 1 0 0 . 0 ) 3 9 7 ( 1 0 0 . 0 )
Ag e gro u p
3 0 - 3 9 5 ( 2 . 5 ) 1 7 ( 4 . 2 )
4 0 - 4 9 3 0 ( 1 5 . 0 ) 6 5 ( 1 6 . 4 ) 5 0 - 5 9 5 6 ( 2 8 . 0 ) 8 6 ( 2 1 . 7 ) 6 0 - 6 9 6 6 ( 3 3 . 0 ) 1 4 7 ( 3 7 . 0 ) 7 0 - 7 9 3 7 ( 1 8 . 5 ) 6 7 ( 1 6 . 9 )
≥ 8 0 6 ( 3 . 0 ) 1 5 ( 3 . 8 )
H o s p i t a l
To rn u 4 8 ( 2 4 . 0 ) 9 6 ( 2 4 . 2 ) B r i t i s h 4 4 ( 2 2 . 0 ) 8 8 ( 2 2 . 2 ) I t a l i a n 6 5 ( 3 2 . 5 ) 1 2 7 ( 3 1 . 9 ) R o ff o 4 3 ( 2 1 . 5 ) 8 6 ( 2 1 . 7 )
E d u c a t i o n
0 - 7 9 7 ( 4 8 . 5 ) 1 8 2 ( 4 5 . 9 ) 8 - 1 2 4 6 ( 2 3 . 0 ) 1 1 4 ( 2 8 . 7 ) ≥ 13 5 7 ( 2 8 . 5 ) 1 0 1 ( 2 5 . 4 )
Lifet ime re s i d e n c e*
≥ 75% urb an 1 0 3 ( 5 1 . 5 ) 1 9 9 ( 5 0 . 6 ) ≥ 7 5% ru r a l 1 0 ( 5 . 0 ) 1 6 ( 4 . 1 ) urb an and ru r a l 8 7 ( 4 3 . 5 ) 1 7 8 ( 4 5 . 3 )
Smoking st atus
n e v e r- s m o k e r 1 1 ( 5 . 5 ) 1 1 0 ( 2 7 . 7 ) c u rre nt smo ke r 1 1 2 ( 5 6 . 0 ) 1 3 2 ( 3 3 . 2 ) e x - s m o k e r 7 6 ( 3 8 . 0 ) 1 5 1 ( 3 8 . 1 ) p ip e / c ig ar o nly 1 ( 0 . 5 ) 4 ( 1 . 0 )
Smoking habit s* *
o nly/ mainly b lac k 5 7 ( 3 0 . 3 ) 6 5 ( 2 3 . 0 ) o nly/ mainly filte r 1 6 3 ( 8 6 . 7 ) 2 2 9 ( 8 0 . 9 ) o nly/ mainly inhalatio n 1 7 8 ( 9 4 . 7 ) 2 3 2 ( 8 2 . 0 )
Type of diagnosis
s q u a m o u s - c e l l 5 0 ( 2 5 . 0 ) a d e n o c a rc i n o m a 8 6 ( 4 2 . 5 ) s m a l l - c e l l 2 0 ( 1 0 . 0 ) l a rg e - c e l l 1 3 ( 6 . 5 ) u n d i ff e re n t i a t e d 2 1 ( 1 0 . 5 ) c l i n i c a l 11 (5.5)
LUNG CANCER AND O CCUPATIO N IN ARG ENTINA 8 1
Cad. Saúde Púb lic a, Rio d e Jane iro , 14(Sup . 3):77-86, 1998 rea ch in g 4.2 (1.2-15.6) fo r m en wo rkin g fo r 10
o r m o re yea rs (6 case s a n d 8 con trols). Oth er h igh b u t n o t s ta t ist ic a lly s ign ifica n t r isks we re o b ser ved fo r m e ta l wo rkers in clu d -in g weld ers (1.9, 0.8- 4.4), m ot o r ve h icle m e-ch a n ic s (2.0, 0.9-4.2), a n d wo rkers in clea n in g s e rvices (1.9, 0.8-4.5). Th e risk fo r bu tch ers was 1.5, rea ch in g 2.4 (95% CI: 0.5-11.1) fo r th o s e with m ore th an 10 years o f du ra tio n o f em p loy-m en t. Th e risk wa s h igh er, bu t n o t statistica lly sign ifica n t, for th o se w ith lo n ger d u ra t io n o f e m p l oym en t. No sp ec ia l fe a t u re s we re o b -s e rved re g a r d in g d i-s tr ib u t io n o f h i-sto lo gica l typ es a m o n g th e d ifferen t in d u stri e s / o c c u p a-tion s o r ca tego r ies o f s m o kers, a lth o u gh th e n u m b e r o f exp o sed c as es wa s in m o st in -stan ces sm a ll.
D i s c u s s i o n
Ou r fin d in gs a re co n sis ten t with s tu d ies fro m o th er co u n tries in th a t tob a cco sm o kin g in Argen tin a is an im p or tan t risk fa ctor fo r lun g ca n -cer (IARC, 1986), wit h fo rm er co n s u m p tio n s h owin g a lower effec t th an cu r ren t co n su m p tio n . Risk o f lu n g ca n cer in crea sed with d u ra -tion o f ciga ret te u s e, n u m b er o f ciga re t t e s sm o ked p e r d a y, a n d n u m b er o f p a ck-ye a r s s m o k e d .
Re g a rd in g o ccu p a tio n a l exp o su re s, th e su lts a re d isc u ssed b elow in rela tio n with p re-vio u s fin din gs.
A g ri c u l t u re, a n im p o rta n t bran ch o f a ctivity in Argen tin a, sh owed a h igh bu t n ot sign ifican t risk fo r a ll a ge s, a ch ie vin g sign ific a n tly h igh risks fo r m en aged 65 or m ore b o th in a gri c u lt u re a s b olt h a b r an ch o f a c ltivilty a n d o ccu p a -tio n . Men em p lo ye d fo r 10 o r m o re ye ar s in a g ri c u l t u re sh owed a st at is tica lly s ign ific a n t risk o f 4.2, b u t th is risk wa s b a s ed o n s m a ll n u m b e rs (6 c as es a n d 8 co n tro ls). In a stu d y p e rf o r m ed in Sh a n gh a i, a r is k o f 1.6 wa s o b -s e rved fo r agr i c u l t u re bo th a -s an in du -strial cat-e g o ry a n d as an o ccu p atio n (Lcat-evin cat-et a l., 1988). De Stefa n i et a l. (1996) fo u n d a n on -sign ifican t i n c re a se d risk th a t wa s h igh e r for c as es with sm a ll-cell carcin om a . Agri c u l t u ra l wo rkers also s h owed a h igh risk fo r lu n g c a n c er in De t ro i t , Mich iga n , Un ited Sta te s (Bu r n s & Sw a n s o n , 1991). Th ese h igh ris ks a re con s isten t with th e a s so c ia tio n o f lu n g ca n cer with wo rkin g in a g ri c u l t u re, a tt rib u te d to th e u se o f ar s en ica l a n d n o n - a r se n ica l in sec tic id es (IARC, 1994). Ne ve rt h e l e s s, in o th er d evelo p in g c o u n tri e s like Bra zil a n d In d ia, n e ga tive a ss o cia tion s we re fo u n d (Wu n s c h - Filh o et a l., 1998; No t a n i et al., 1993). Di s c rep an t resu lts h ave a lso been
o b s e r ved in d evelo p ed c ou n tries (Ro n co et a l., 1992; Kr ist en s en e t a l., 1996; Wiklu n d et a l., 1988; Bu rn s & Swa n so n , 1991).
Th e la rge size o f th e m ea t in d u s tr y in Ar -gen tin a fo cu ses p ar t icu la r in t ere st o n th e a n a lysis o f p oten tial risks a sso ciated to th e re-lated in du str ies o r o ccu p a tio n s. Previou s stu dies in Ur u g u a y, the Un ited Kin gdo m , a n d Sca n -d in avian cou n tr ies h ave su ggeste-d a n excess o f lu n g ca n cer a m o n g b u tch er s (De Stefa n i et a l., 1996; Griffith , 1982; Fo x et a l., 1982; Lyn ge et a l., 1983) a n d th ro u gh o u t t h e m e at in d u st r y ( Jo h n s o n , 1991). Ex p o s u re t o live a n im a ls in th e sto ckya rd an d em p loym en t in th e killin g/ d ressin g area s we re iden tified a s facto rs a sso
ci-Tab le 2
Lung canc e r and c ig are tte smo king hab its.
c a / c o O R* 9 5% CI
N on-smoker (re f e rence cat egory ) 1 1 / 1 1 0 1 . 0 –
C u rrent smoker 1 1 2 / 1 3 2 8 . 5 4 . 3 - 1 6 . 7
E x - s m o k e r 7 6 / 1 5 1 5 . 3 2 . 6 - 1 0 . 7
N umber of cigare t t e s / d a y
1 - 1 4 1 7 / 8 8 2 . 0 0 . 9 - 4 . 5
1 5 - 2 4 6 5 / 9 0 7 . 5 3 . 7 - 1 5 . 0 2 5 1 0 6 / 1 0 5 1 0 . 4 5 . 3 - 2 0 . 7
t re n da p < 0 . 0 0 1
Durat ion of consumpt ion (years)
1 - 2 4 2 0 / 8 4 2 . 2 1 . 0 - 4 . 9
2 5 - 3 9 8 2 / 1 1 0 7 . 2 3 . 6 - 1 4 . 5 4 0 - 7 0 8 6 / 8 9 1 2 . 7 6 . 1 - 2 6 . 1
t re n da p < 0 . 0 0 1
Ag e at start
< 15 6 9 / 9 0 7 . 8 3 . 9 - 1 5 . 7 1 5 - 1 9 9 1 / 1 2 0 7 . 8 4 . 0 - 1 5 . 5
≥ 2 0 2 8 / 7 3 3 . 9 1 . 8 - 8 . 3
t re n da p = 0. 022
P a c k - y e a r s
0 . 2 5 - 2 0 . 0 1 2 / 9 7 1 . 3 0 . 5 - 3 . 0 2 0 . 2 5 - 4 0 . 0 5 2 / 6 8 7 . 7 3 . 7 - 1 5 . 8 4 0 . 2 5 - 2 1 0 . 0 1 2 4 / 1 1 8 1 1 . 1 5 . 6 - 2 1 . 9
t re n da p < 0.001
Years since quit t ing
c u rre nt sm o ke r 1 1 2 / 1 3 2 1 . 0 –
1 - 5 2 8 / 2 3 1 . 4 0 . 8 - 2 . 6
6 - 1 0 2 1 / 2 7 0 . 9 0 . 4 - 1 . 6
≥ 11 2 7 / 1 0 1 0 . 3 0 . 2 - 0 . 6
n o n - s m o k e r 1 1 / 1 1 0 0 . 1 0 . 0 6 - 0 . 2
t re n da p < 0 . 0 0 1
O R* adjuste d b y de sig n variab le s, ag e g ro up and ho sp ital.
Cad. Saúde Púb lica , Rio de Jane iro , 14(Sup . 3):77-86, 1998
a ted with th e grea test risk. In o u r stu d y, workin g workin t h e m ea t workin d u s tr y d id n o t p o se a n workin -c rea sed risk, a n d t h e u n a d ju st ed r isk o f 2.4 (0.9-6.7) fo r b u tc h er s, b a s ed o n 9 ca se s a n d 7 c o n t ro ls wa s red u c ed to 1.5 (0.5- 4.3) wh en a d-ju st ed by sm o kin g. Th e risk fo r th o s e wit h lon ger tim e o n th e jo b wa s n o t sign ifica n tly el-e va tel-ed (2.4, 0.5-11.1). Th el-esel-e rel-esu lts a rel-e co n sis-t en sis-t wisis-th sis-th o s e re p o r sis-ted b y Co ggo n & Wi e l d (1995), wh o d id n o t fin d an o ccu p a tio n a l h a z-a r d o f lu n g c z-an cer in e ith er b u tc h ers o r c o o ks in a SM R s tu d y c o n d u cte d in th e UK. Co n s i
s-ten t with th es e re s u l t s, a n d n o t with th e p osi-t i ve ris k o b s er ve d in Bo m b a y (No osi-ta n i eosi-t al., 1993), co o ks d id n o t sh ow an in crea sed risk in o u r s tu d y. Th e effects o f co al d u st a n d p o ly-c yly-clily-c h yd ro ly-c ar b o n s o r n itr o sa m in es in ly-c o o k-in g fum es h a ve been k-in crim k-in ated k-in a n exc e s s risk o f lu n g can cer.
A h igh statistica lly sign ifica n t r isk (4.6) was o b s e rved for sawm ills an d wo o d m ills, bu t n o t for th e fu rn i t u re in d u s try. A n o n -s ign ifica n tly i n c re ase d r isk fo r e m p lo ym en t in lu m b er a n d f u rn i t u re m a n u fa ctu re was o b s er ve d in Sã o
Tab le 3
Emp lo ym e nt in se le cte d ind ustrie s and risk o f lung c anc e r.
Ind ustrial b ranch ISIC code* c a / c o* * O R1 a 95% CI
A g r i c u l t u re 1 1 x x 3 6 / 6 6 1 . 5 0 . 9 - 2 . 6
F o o d 31 1x, 3 12x 3 8 / 5 2 1 . 1 0 . 7 - 2 . 2
M e a t 3 1 1 1 1 5 / 2 2 1 . 2 0 . 6 - 2 . 5
B a k e ry 3 1 1 7 1 4 / 1 7 1 . 0 0 . 4 - 2 . 1
Alco ho lic b e ve rag e s 3131 to 3 133 5 / 5 4 . 5 1 . 0 2 - 2 0 . 2 Te x t i l e 32 1x, 3 22x 3 0 / 5 1 1 . 2 0 . 7 - 2 . 0 Le athe r sho e s/ re p a i r 3240, 9511 1 2 / 1 0 2 . 1 0 . 8 - 5 . 4 Sawmills, wo o d m ills 3 3 1 1 8 / 4 4 . 6 1 . 1 - 1 8 . 4
F u rn i t u re 3320 1 3 / 2 4 1 . 1 0 . 5 - 2 . 3
P a p e r 3 4 1 x 3 / 7 0 . 7 0 . 1 - 2 . 8
P r i n t i n g 3 4 2 0 9 / 2 4 0 . 8 0 . 3 - 1 . 9
C h e m i c a l s / p l a s t i c s 3 5xx (no t 3 55x) 3 4 / 3 8 1 . 8 1 . 0 4 - 3 . 2 P e t ro le um, c o al 35 30, 3 540 4 / 8 1 . 2 0 . 3 - 4 . 8
R u b b e r 3 5 5 x 9 / 4 3 . 4 0 . 9 - 1 2 . 4
P o t t e ry, g lass, mine rals 3 6 x x 1 0 / 7 3 . 4 1 . 1 - 1 0 . 6
Basic me tals 3 7 x x 1 5 / 3 1 1 . 1 0 . 5 - 2 . 2
Me tal p ro d u c t s 3 8 1 x 2 2 / 4 2 0 . 9 0 . 5 - 1 . 7 M a c h i n e ry (no t e le ctric al) 3 8 2 x 2 1 / 2 5 1 . 4 0 . 7 - 2 . 7 M a c h i n e ry (e le c tric al) 3 8 3 x 9 / 1 5 1 . 0 0 . 4 - 2 . 5 Tr a n s p o rt e q uip me nt (no t ship b uild ing ) 3 8 4 x 6 / 1 9 0 . 6 0 . 2 - 1 . 6 O the r manufacture s 3 851 to 3 909 9 / 1 0 1 . 2 0 . 5 - 3 . 4 C o n s t ru c t i o n 5 0 0 0 4 5 / 8 8 1 . 2 0 . 7 - 1 . 9
Tr a d e 6100, 6 200 7 8 / 1 3 7 1 . 1 0 . 8 - 1 . 7
Re staurants, ho te ls 6 3 x x 1 7 / 3 3 0 . 9 0 . 5 - 1 . 7 Tr a n s p o rt 71 xx, 712x 3 6 / 7 9 0 . 8 0 . 5 - 1 . 3
R a i l w a y 7 1 1 1 8 / 2 0 0 . 8 0 . 3 - 2 . 0
Urb an, sub urb an, inte r- urb an 71 12, 7113 1 5 / 3 8 0 . 6 0 . 3 - 1 . 2
Truc ks 7 1 1 4 1 0 / 1 8 1 . 3 0 . 5 - 3 . 1
Wa t e r 7 1 2 x 7 / 5 3 . 3 0 . 9 - 1 2 . 6
C o m m u n i c a t i o n s 7 2 0 0 4 / 1 2 0 . 6 0 . 2 - 2 . 1 F i n a n c e / b u s i n e s s 8 x x x 3 0 / 6 8 0 . 8 0 . 5 - 1 . 3 So c ial se rv i c e s 91xx to 94xx 6 1 / 1 3 6 0 . 8 0 . 5 - 1 . 2 Mo to r ve hic le s, re p a i r 9 5 1 3 1 2 / 2 3 1 . 1 0 . 5 - 2 . 5 L a u n d ry, c le aning 9 5 2 0 6 / 6 1 . 1 0 . 3 - 3 . 5
* Inte rnatio nal Standard Industrial Classific atio n o f All Ec o no mic Activitie s (ISIC ). Unite d Natio ns. Ne w Yo r k - 1 9 7 1 . ** Num b e r o f c ase s and c o ntro ls e ve r e mp lo ye d .
LUNG CANCER AND O CCUPATIO N IN ARG ENTINA 8 3
Cad. Saúde Púb lic a, Rio de Jane iro , 14(Sup . 3):77- 86, 1998 Pa u lo a n d Bo m b a y fo r ca n c er of th e lu n g
(Wu n s c h - Filh o et a l., 1998; No tan i et a l., 1993). Ro n co et a l. (1988) re p o r ted in Tu r in , It a l y, n o e xcess risk fo r wo rkers en ga ged in ca rp en tr y o r j o i n e r y b u t a b o rderlin e-sign ifica n t in cre a s e d risk fo r th ose em p loyed in fu rn i t u re an d ca b i-n et- m a kii-n g. Wo o d d u s t a i-n d fo rm a l d e h yd e h a ve b een su ggested a s lu n g ca rcin ogen s in th e wo od in d u stry, but som e resu lts a re n ot co n sis-ten t with su ch in crea sed ri s k s. Kau p p in en et a l. (1993), d id n o t fin d e xp o s u re t o wo o d d u s t to b e a sso c iat ed with lu n g ca n ce r. No evid en c e wa s fo u n d fo r a n exc ess r is k o f d e a t h d u e to lu n g ca n ce r in a p o o led re- a n alysis o f c o h or t stu d ies o f wo o d wo rkers (IARC, 1997a ).
Tab le 4
Emp lo ym e nt in se le cte d o cc upatio ns and risk o f lung c ance r.
Job tit le ISCO code* c a / c o** O R1 a 95% CI
P ro fe ssio nals, te c hnicians, ad ministrative 1xxx to 4xxx 1 0 7 / 2 2 4 0 . 8 0 . 5 - 1 . 1
Co o ks, waite rs 5122 , 5123 7 / 1 7 0 . 9 0 . 3 - 2 . 5
Wa i t e r s 5 1 2 3 5 / 1 3 0 . 9 0 . 3 - 3 . 0
Sale s wo rke rs (no t stre e t ) 5 2 x x 3 5 / 4 2 1 . 8 1 . 0 2 - 3 . 1 Sale s wo rke rs (stre e t ) 9111 to 911 3 1 0 / 2 6 0 . 9 0 . 4 - 2 . 0 Ag ric ultural, animal husb and ry wo rke rs 6111 to 6 130 , 921 1 3 6 / 7 1 1 . 5 0 . 9 - 2 . 4
Ag ricultural wo rke rs 61 11 to 6114 1 1 / 1 8 2 . 4 0 . 9 - 6 . 0
Bric klaye rs, sto ne m aso ns 7 122 , 712 3 2 3 / 4 5 1 . 2 0 . 6 - 2 . 2 Wo o d wo rke rs (c arp e nte rs, c ab ine t make rs, 7124, 7422 , 824 0 1 0 / 2 8 0 . 7 0 . 3 - 1 . 5 machine o p e rato rs)
Plum b e rs, p ip e fitte rs 7 1 3 6 4 / 1 1 0 . 7 0 . 2 - 2 . 5
Ele c tric ians 7 1 3 7 3 / 7 0 . 6 0 . 1 - 2 . 4
Painte rs 7 1 4 x 1 6 / 2 7 1 . 1 0 . 5 - 2 . 3
Painte rs (b lo wto rc h ) 7 1 4 2 8 / 7 1 . 5 0 . 5 - 4 . 6
Me tal wo rke rs 72 11 to 722 4, 8122, 8211 3 4 / 6 8 1 . 2 0 . 7 - 2 . 0 Me tal p atte rn make rs, we ld e rs, she e t me tal 72 1x 1 4 / 1 4 1 . 9 0 . 8 - 4 . 4 wo rke rs, asse m b le rs
We l d e r s 7 2 1 2 5 / 5 1 . 5 0 . 4 - 5 . 7
Blac ksmiths, p o lishe rs, me tal p atte rn m ake rs, 722x, 821 1 2 3 / 4 4 1 . 0 0 . 5 - 1 . 8 t u rne rs, mac hine to o l o p e rato rs
Mo to r ve hicle me c hanic s 7 2 3 x 1 7 / 2 3 2 . 0 0 . 9 - 4 . 2
E l e c t r i c i a n s 7 2 4 x 7 / 8 1 . 6 0 . 5 - 5 . 1
P r i n t e r s 7 341, 734 2 4 / 9 0 . 7 0 . 2 - 2 . 6
B u t c h e r s 7 4 1 1 9 / 7 1 . 5 0 . 5 - 4 . 3
Te xtile wo rke rs 7 43x, 8261 to 8263 1 3 / 2 5 1 . 2 0 . 5 - 2 . 6 Le athe r sho e manufac ture / re p a i r 7 4 4 2 8 / 9 1 . 4 0 . 5 - 4 . 0 Asse mb le rs (no t me tal) 8281 to 829 0 5 / 1 6 0 . 5 0 . 1 - 1 . 4 Drive rs, mo to r ve hic le s 832x, 833x 2 8 / 6 4 0 . 7 0 . 4 - 1 . 2
Drive rs (tru c k s ) 8 3 2 4 1 3 / 1 7 1 . 4 0 . 6 - 3 . 3
S e rvic e wo rke rs (c le aning ) 9 1 3 2 1 4 / 1 5 1 . 9 0 . 8 - 4 . 5 Ho me d e live ry wo rke rs 9 151, 933 1 4 9 / 1 0 2 0 . 8 0 . 5 - 1 . 2 Day lab o re rs (no t ag ric ulture ) 9311 to 931 3 6 / 2 1 0 . 6 0 . 2 - 1 . 6
* ISCO Inte rnatio nal Stand ard Classificatio n o f O cc upatio ns 1988. (ILO , 1991). ** numb e r o f c ase s and c o ntro ls e ve r e mp lo ye d .
aFo r e ac h o c c up atio n, re lative to a risk o f 1 .0 fo r me n ne ve r e m plo ye d in that o c cup atio n. O R1ad juste d b y ag e g ro up , ho sp ital and p ac k-ye ars.
Wu n s c h - Filh o et a l. (1998), fo u n d an exc e s s r isk fo r p o t ter y of 2.07 (0.944.59) th at in -c rea sed t o 6.2 (1.07- 36.01) fo r th o s e e xp os ed fo r m o re th a n 10 ye a r s. We fo u n d a r is k o f 3.4 (1.1-10.6) fo r t h e in d u st r ia l b ra n c h in clu d in g p o t t e ry, glass, an d m in era l m an u fa ctu re. T h e s e i n d u s t r ies p resen t a lu n g can cer exc ess d u e to t h e p res en c e o f kn o wn ca rc in o ge n s like c ry s-ta llin e s ilic a in t h e fo rm o f qu a rtz an d cr y s t o-b o l i t e, a n d p o ten tia l ca rcin o ge n s like talc d u st a n d m et a ls c on ta in in g a n t im o n y, ch ro m i u m , c o p p e r, iron , an d titan iu m (IARC, 1997b ).
Cad . Saúde Púb lic a, Rio de Jane iro , 14(Sup. 3):77-86, 1998
with th e wide va riety o f in d u stries in clu d ed in th is gro u p, m a n y o f th em a sso cia ted (defin ite-ly o r p rob ab ite-ly) with ca n cer of th e lu n g ( Va i n i o e t a l., 1994). A sim ilar ris k wa s re p o rte d in Sh a n gh a i (Le vin et a l., 1988). Th e r u b b er in -d u s t r y was a n a lyze-d sep a ra t e l y, a n -d a b o d e r-lin e s t a t is tic a lly s ign ifica n t OR wa s o b s er ve d (3.4, 0.9- 12.4), wit h 9 c ase s a n d 4 c on tro ls exp o se d . Va rio u s o c cu exp a t io n s in r u b b er m a n u f a c t u r in g we re re p o r ted to p resen t a lu n g ca n -cer exc e s s, b u t th e a sses sm en t o f th e ca rc i n o-gen ic r isk fo r t h is s ite is n o t d efin it ive ( Va i n i o et a l., 1994).
Th e b o rd erlin e sign ifican t OR o f 2.1 o b -served for th e m an u factu re an d rep air of leath er sh oes is co n sisten t with th e lu n g can cer risk a so ciate d with wor kin g a s ta n n ers a n d p ro c e s-s o r s-s, b u t n o t with b o ot a n d s-sh o e m a n u fa ctu re a n d re p a ir ( Vain io et a l., 1994). An in c re a s e d b o rd e rlin e sign ifica n t risk (4.8) wa s o b se r ve d fo r s h oe m a kers b u t n o t fo r lea th er wo rkers in Uru gu ay (De Stefa n i et al., 1996).
T h e re is su ffic ie n t e vid e n ce t h a t m in era l o ils c o n ta in in g va rio u s a d d it ives a n d im p u rit i e s, an d rith arit h a ve been u sed in m erita l m a ch in -in g p r o ces se s a re c arc -in o gen ic t o h u m a n s ( I A RC, 1984). Wu n s c h - Filh o et a l. (1998) re p o rted a n exces s risk of 1.6 (1.01 2.50) fo r th e m a -c h i n e r y in d u stry in Bra zil. In o u r stu d y a risk o f 1.4 (0.72.7) wa s ob ser ved fo r m a ch in ery (n on -e l -e c t r ic a l), b u t n o in c r-ea s-e d ris ks w-e r -e fo u n d for a n y o th er of th e m eta l in d u stri e s.
Resu lts of stu d ies o f lu n g ca n cer risk am o n g textile workers a re n ot con sisten t a m o n g differ-e n t co u n t r idiffer-e s (IARC, 1990). Lo w r isks a m o n g m en in th e co tto n t ext ile in d u str y we r e o b -s e r ved in th e Ch in e-se -stu d y (Levin et al., 1988) a n d h igh r isks in th e Uru gu a yan stu dy, sp ecial-ly fo r sm a ll-cell carcin o m a a n d a d en oca rc i n o-m a (D e Stefa n i et a l., 1996). In t h is s tu d y, th e risk fo r textile wo rk e r s, eith er as an in d u str y or a n occu p a tio n , wa s 1.2, n ot sign ifica n t.
Co n s t r u c tio n wo rk, e n ta ilin g exp o su re t o a sb es to s a n d p o lyc yclic a ro m a tic h yd ro c a r-b o n s, is a ssocia ted with lu n g ca n cer ( Vain io et a l., 1994). In o u r s tu d y, t h e ris k fo r th e co n -s t ru ctio n in d u-str y wa -s 1.2, n ot -sign ifican t, an d b ri c k l a yers a n d s to n e m a so n s sh owe d n o in c rea sed risk. Ne g a t i ve, n o n sign ifica n t asso cia -tio n s we re ob served by Le rch en et a l. (1987) in New Mexico a n d Wu n s c h - Filh o e t a l. in Bra z i l (1998). Oth er au th o rs h ave re p o rted h igh ri s k s for co n st ru ctio n wo rke rs in th e Un it ed St a t e s ( Sh o e n b e rg e t a l., 1987; Mo ra b ia et a l., 1992), a n d Ur u gu a y (De Stefa n i et a l., 1996).
Two co h o rt s tu d ies fou n d a sm a ll ris k fo r lu n g ca n cer related to em p loym en t in th e alco-h o lic b eve ra ges in d u stries; o n e a m o n g Da n i s alco-h
b re we r y worke rs (O/ E: 1.16, 95% CI:1.03-1.30) ( Jen s en , 1980) a n d th e o th er a m o n g US ve t e r -an s (sm okin g ad ju sted risk: 1.2, 95% CI:0 . 7 - 1 . 9 ) ( H ru b ec et a l., 1995). In th e p resen t stu dy an ele va teled r isk wa s o b seler veled fo r su bjelects eleveler elem -p l oyed in t h o s e in d u s tr ie s (4.5, 95% CI:1.02-2 0 . CI:1.02-2 0 ) .
Se ve n ca s es a n d 5 co n tr o ls we re ever em -p l oyed in in d u s tr ies rela te d to wa te r tra n p o rta tion , in th e o pe ra tio n of vessels for tra n s-p o r t o f freigh t a n d s-p a s s en ge rs o ve r se as a n d s u p p o rtin g serv i c e s. The sm okin g-a dju sted ri s k of 3.3, o f b o rd er lin e sign ifica n ce, h as n o clea r explan atio n . A bro ad ra n ge o f o ccu p a tion s wa s d e s c ribed by ca ses a n d co n tro l s.
St ren gth s of th is stu dy are th at all cases an d c o n t ro ls we re in ter v i e we d in p e rso n , with n o da ta o bta in ed from p rox i e s.
We a kn es se s o f th e s tu d y a re: 1) th a t c a se s we re e n ro lled in fo u r h o s p ita ls, a n d , co n se -qu en tly th e sa m p le m a y n o t b e re p re s e n t a t i ve of a ll ca se s in th e city; 2) th a t th e d iagn o s es we re p er f o rm ed by th e p a th ology u n it a t ea ch h osp ital; an d 3) th at th e n u m bers we re sm a ll in m an y of th e categor ies an alyze d .
It is a lso t r u e th a t c o m p u t in g OR by co m p a rin g su bjects ever em p loyed in o n e o ccu p a tio n wit h su b jec ts n ever em p lo yed in th a t o c -cu p a tio n c an likely u n derestim a te th e tr u e OR b eca u se th e re f e ren ce ca t ego ry in clu d e s jo b s th at m ay be a t h igh risk of lu n g ca n cer. Howe v-e r, wh v-en o ccu p a tio n s an d bra n ch v-es o f activity th a t res u lted in h igh r is ks we re a d ju st ed fo r e m p l oym e n t in o t h er h igh -risk oc c u p a t io n s/ i n d u s t ri e s, estim a tes of risks did n o t ch a n ge.
LUNG CANCER AND O C CUPATIO N IN ARG ENTINA 8 5
Cad. Saúd e Púb lic a, Rio d e Jane iro , 14(Sup. 3):77-86, 1998 H RU BEC, Z.; BLAIR, A. E. & VAU G H T, J., 1995. Mo rt a l
i-ty r isks b y In d u s t ry am on g U .S ve t e ran s of kn ow n sm okin g statu s. NIH Pu b lication no9 5 - 2 7 4 7 .
I A RC (In t e rn a tion al Age ncy fo r Re s e a rch on Ca n c e r ), 1984. Polyn u clear Arom atic Com p ou n d s, p a rt 2, Carbon Black s, Min eral Oils an d Som e N itroaren es. I A RC Mo n o g rap hs on th e Evalu at ion o f Ca rc i n o -gen ic Risks o f Ch em icals t o Hu m a n s, v. 33. Lyo n : IARC.
I A RC (In t e rn atio na l Agen cy for Re s e a rch on Ca n c e r ) , 1986. Tobacco sm okin g. IARC Mo n o g rap h s o n th e e va lu at io n of ca rcin ogen ic risks to h u m an s, v. 38. Lyon : IARC .
I A RC (In t e rn at io na l Agen cy for Re s e a rch on Ca n c e r ) , 1 9 8 7 .O ve ra ll ev a lu at i on s of ca rc i n o g e n i c i t y :a n u p d a t i n g of IARC M o n o g ra p h s volu m es 1 t o 42. I A RC Mo n o g ra p h s o n th e Evalu a tion o f Ca r -cin o ge n ic Risks o f Ch e m ica ls t o Hu m a n s (Su p . 7). Lyo n : IARC .
I A RC (In t e rn a tion al Agen cy fo r Re s e a rch on Ca n c e r ) , 1990. Som e Flam e Re t a rd an ts an d Tex tile Ch em i-c a l s , an d Ex p o s u res i n th e Tex ti le M a n u f a i-c t u r i n g In d u s t ry.I A RC Mo n o g ra p hs on the Evalu ation of Ca rcin ogenic Risks of Ch em ica ls to Hu m a n s, v. 48. Lyon : IARC .
I A RC (In t e rn a tion al Agen cy for Re s e a rch on Ca n c e r ) , 1 9 9 4. Occu p a ti on a l can cer i n d ev elop in g cou n -t r i e s(N. Pe a rc e, E. Ma t o s, H. Va i n i o, P. Bo ffett a & M. Ko g e v i n a s, ed s.). Scie n t ific Pu b lica tion s 129. Lyon : IARC .
I A RC (In t e rn atio nal Agen cy for Re s e a rch on Ca n c e r ) , 1997a. Can cer i n w ood -d u st w ork e r s( P. De m e r & P. Boffetta, e ds). Te ch n ical Re p o rt 30. Lyon: IARC . I A RC (In t e rn ation al Agen cy for Re s e a rch on Ca n c e r ) ,
1 9 9 7 b. Si l i c a , som e si licates, coa l d u st an d p a ra -a r-am id fibrils.I A RC Mo n o g raphs on the eva l u a t i o n of ca rcin oge nic risk to h u m a ns, v. 68. Lyon : IARC . I LO (In t e rn ational Lab ou r Office), 1991. In t e r n a t i o n a l
St a n d a rd Cla ssi fi ca ti on of O ccu p at ion s 19 88. Ge n e va: In t e rnation al Labo ur Office.
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A c k n o w l e d g m e n t s
Th e au t ho rs are gr atefu l to th e fo llowin g p h ysician s fo r th eir co n t ri b u t i o n s : Brit ish H o s p i t a l: G. An -g a ra m o, M. Bl a s c o, D. J. Ch im on de-guy, T. M. An -ge lillo Mc Ki n l e y, J. D. Em e r y; Itali an Ho s p i t a l: J. La st ir i, G. Pa llo tt a, M. Va re la ; Roff o In s t i t u t e :R. d e l Agu ila, A. Go n z a l ez, R. Ki rchu ck, C. Sp e c t o r; Torn ú Ho s p i t a l: C. Ba g n e s, M. Elffm an, H. Vi c e n t e.
We ar e in d e b ted to Man olis Kogevin as fo r h is kin d c olla b o rat io n ; to Nat alie Rive ra, MIRT fe llow f ro m th e Un i versity of Wash in gton , Se a t t l e, USA, wh o w o rked in Bu en o s Aire s wit h t h e d a ta b a se an d p ro -g ra m m in-g; to An a Ko u k u ru tz for h er a ssista nce.
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