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Respirable crystalline silica in mineral dust, wood dust, diesel engine exhaust emissions and welding fumes are among the most common process‐generated substances to which millions of workers are exposed daily. The composition of process‐generated substances can vary substantially, depending on the parameters of the underlying processes; for example, the composition and intensity of diesel motor emissions differs among the various generations of diesel engines and working environments (e.g. surface or underground mining). We illustrate how common these occupational exposures are and discuss challenges in estimating their global prevalence and their contribution to the burden of occupational cancer. Estimates of the number and proportion of workers exposed in most countries and on a global scale are generally scarce. A remarkable exception is based on the proactive bottom‐up estimates generated within the European Network for Silica. Actions to reduce exposures and research to fill gaps in knowledge adapted to local settings are warranted to mitigate the occupational cancer burden, especially in under‐researched settings including low‐ and middle‐income countries. Occupational exposure to respirable crystalline silica, diesel engine exhaust emissions and welding fumes are widespread risk factors for lung cancer and account for approximately half of the occupational lung cancer burden. If employers succeed in controlling workplace exposures to these process‐generated substances, the fraction of lung cancers attributable to occupational exposures could be reduced dramatically.

Petroleum extraction and refining are major sources of various occupational exposures and of air pollution and may therefore contribute to the global cancer burden. This systematic review and meta-analysis is aimed at evaluating the cancer risk in petroleum-exposed workers and in residents living near petroleum facilities. Relevant studies were identified and retrieved through PubMed and Web of Science databases. Summary effect size (ES) and 95% confidence intervals (CI) were analysed using random effect models, and heterogeneity across studies was assessed (I2). Overall, petroleum industry work was associated with an increased risk of mesothelioma (ES = 2.09, CI: 1.58–2.76), skin melanoma (ES = 1.34, CI: 1.06–1.70 multiple myeloma (ES =1.81, CI: 1.28–2.55), and cancers of the prostate (ES = 1.13, Cl: 1.05–1.22) and urinary bladder (ES = 1.25, CI: 1.09–1.43) and a decreased risk of cancers of the esophagus, stomach, colon, rectum, and pancreas. Offshore petroleum work was associated with an increased risk of lung cancer (ES = 1.20; 95% CI: 1.03–1.39) and leukemia (ES = 1.47; 95% CI: 1.12–1.92) in stratified analysis. Residential proximity to petroleum facilities was associated with childhood leukemia (ES = 1.90, CI: 1.34–2.70). Very few studies examined specific exposures among petroleum industry workers or residents living in oil producing communities. The present review warrants further studies on specific exposure levels and pathways among petroleum-exposed workers and residents living near petroleum facilities.

Abstract Rationale Previous respiratory diseases have been associated with increased risk of lung cancer. Respiratory conditions often co-occur and few studies have investigated multiple conditions simultaneously. Objectives Investigate lung cancer risk associated with chronic bronchitis, emphysema, tuberculosis, pneumonia, and asthma. Methods The SYNERGY project pooled information on previous respiratory diseases from 12,739 case subjects and 14,945 control subjects from 7 case–control studies conducted in Europe and Canada. Multivariate logistic regression models were used to investigate the relationship between individual diseases adjusting for co-occurring conditions, and patterns of respiratory disease diagnoses and lung cancer. Analyses were stratified by sex, and adjusted for age, center, ever-employed in a high-risk occupation, education, smoking status, cigarette pack-years, and time since quitting smoking. Measurements and Main Results Chronic bronchitis and emphysema were positively associated with lung cancer, after accounting for other respiratory diseases and smoking (e.g., in men: odds ratio [OR], 1.33; 95% confidence interval [CI], 1.20–1.48 and OR, 1.50; 95% CI, 1.21–1.87, respectively). A positive relationship was observed between lung cancer and pneumonia diagnosed 2 years or less before lung cancer (OR, 3.31; 95% CI, 2.33–4.70 for men), but not longer. Co-occurrence of chronic bronchitis and emphysema and/or pneumonia had a stronger positive association with lung cancer than chronic bronchitis “only.” Asthma had an inverse association with lung cancer, the association being stronger with an asthma diagnosis 5 years or more before lung cancer compared with shorter. Conclusions Findings from this large international case–control consortium indicate that after accounting for co-occurring respiratory diseases, chronic bronchitis and emphysema continue to have a positive association with lung cancer.

IntroductionOccupational cancer epidemiology has been a core activity of the International Agency for Research on Cancer (IARC), the World Health Organization’s specialized cancer agency, for more than 50 years. The aim of today’s Occupational Cancer Epidemiology Team at IARC is to conduct studies worldwide and to synthesize evidence contributing to the prevention of occupation-related cancers among workers and their offspring.Material and MethodsInternational collaborations are needed to establish large-scale studies examining occupational exposures and risks that cannot otherwise be adequately studied, and both community-based and industry-based studies are useful to identify and quantify risks.ResultsThe Occupational Cancer Epidemiology Team gathers scientists and early career scientists from various Branches at IARC, as well as international experts and collaborators. The specific objectives are to 1) identify occupational carcinogens; 2) characterize effects of known and suspected occupational carcinogens, including exposure-response and joint effects with other exposures (e.g. tobacco smoking); 3) estimate the cancer burden due to occupational exposures, based on high-quality data and standard methodology; 4) enhance the development of exposure and risk assessment tools and registries in low- and middle-income countries, so that carcinogenic hazards or risks associated with work in these countries can be identified; 5) encourage epidemiological studies and cancer registers to collect and record occupational data in a standardized manner; 6) build capacity and facilitate knowledge exchange in occupational cancer epidemiology, including in under-researched settings, via close collaborations with local partners and by hosting internships at IARC; and 7) develop a long-term strategy for occupational cancer research at IARC, including standard operating procedures and recommendations adaptable to different settings for future studies.ConclusionsThe Occupational Cancer Epidemiology Team’s on-going key programmes and projects are presented on https://www.iarc.who.int/teams-oce/

BACKGROUND:Evidence is limited regarding risk and the shape of the exposure–response curve at low asbestos exposure levels. We estimated the exposure–response for occupational asbestos exposure and assessed the joint effect of asbestos exposure and smoking by sex and lung cancer subtype in general population studies. METHODS:We pooled 14 case–control studies conducted in 1985–2010 in Europe and Canada, including 17,705 lung cancer cases and 21,813 controls with detailed information on tobacco habits and lifetime occupations. We developed a quantitative job-exposure-matrix to estimate job-, time period-, and region-specific exposure levels. Fiber-years (ff/ml-years) were calculated for each subject by linking the matrix with individual occupational histories. We fit unconditional logistic regression models to estimate odds ratios (ORs), 95% confidence intervals (CIs), and trends. RESULTS:The fully adjusted OR for ever-exposure to asbestos was 1.24 (95% CI, 1.18, 1.31) in men and 1.12 (95% CI, 0.95, 1.31) in women. In men, increasing lung cancer risk was observed with increasing exposure in all smoking categories and for all three major lung cancer subtypes. In women, lung cancer risk for all subtypes was increased in current smokers (ORs ~two-fold). The joint effect of asbestos exposure and smoking did not deviate from multiplicativity among men, and was more than additive among women. CONCLUSIONS:Our results in men showed an excess risk of lung cancer and its subtypes at low cumulative exposure levels, with a steeper exposure–response slope in this exposure range than at higher, previously studied levels. (See video abstract at, http://links.lww.com/EDE/B161.)

OBJECTIVES: Etiological factors of testicular germ cell tumors (TGCT) remain largely unknown, but a causal role of occupational exposures to solvents has been suggested. Previous studies analyzing these exposures reported discordant results, potentially related to exposure assessment methods. The aim of this study was to investigate the role of occupational exposure to solvents on the risk of developing TGCT among young men. METHODS: This study examined occupational exposures to solvents and TGCT risk based on the lifetime work histories of 454 cases and 670 controls, aged 18–45 years, of the French national TESTIS case–control study. Solvent exposure was estimated using: (i) exposure assignment by job-exposure matrix (JEM) and (ii) JEM combined with self-reported exposure data from specific questionnaires (SQ) and expert assessment (EA). Odds ratios (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression models. RESULTS: Both approaches (JEM and JEM+SQ+EA) showed a consistent association between TGCT and trichloroethylene exposure (exposed versus not exposed; JEM=OR 1.80 [95% confidence interval (CI) 1.12–2.90] and JEM+SQ+EA= OR 2.59 (95% CI 1.42–4.72). Both approaches also observed positive associations with ketone esters and fuels & petroleum-based solvents. CONCLUSION: The results suggest that some organic solvents might be involved in the pathogenesis of TGCT among occupationally exposed men. The combined use of JEM+SQ+EA seemed to limit misclassification by considering individual exposure variability and is, therefore, an appealing approach to assess occupational exposures in epidemiological studies.

A historical cohort study in workers occupationally exposed to chrysotile was set up in the town of Asbest, the Russian Federation, to study their cause-specific mortality, with a focus on cancer. Chrysotile has different chemical and physical properties compared with other asbestos fibres; therefore it is important to conduct studies specifically of chrysotile and in different geographical regions to improve the knowledge about its carcinogenicity. Setting was the town of Asbest, Sverdlovsk oblast, the Russian Federation. Participants were all current and former employees with at least one year of employment between 1/1/1975 and 31/12/2010 in the mine, enrichment factories, auto-transport and external rail transportation departments, the central laboratory, and the explosives unit of the company. Of the 35,837 cohort members, 12,729 (35.5%) had died (2,373 of them of cancer, including 10 of mesothelioma), 18,799 (52.5%) were known to be alive at the end of the observation period (2015), and 4,309 (12.0%) were censored before the end of 2015. Mean follow-up duration was 21.7 years in men and 25.9 years in women. The mean age at death was 59.4 years in men and 66.5 years in women. This is the largest occupational cohort of chrysotile workers to date, and the only one with a large proportion of exposed female workers.

Objectives Complementing the previously published cohort-internal comparison we hereby compare the cause-specific mortality in workers of the Asbest Chrysotile Cohort study (ACC) with the general population of Sverdlovsk Oblast where the mine and factories are located. Methods The ACC cohort database and the regional Federal State Statistic Service for the Sverdlovsk Oblast population were used. We calculated sex-specific standardized mortality ratios (SMRs) and 95% confidence intervals (CI) for the main ICD-10 disease groups and for selected cancer sites for the populations ≥ 15 years from 1980 to 2015. In relation to exposure, we applied the Sverdlovsk rates to the person-years in each exposure category to obtain expected numbers of lung cancer deaths. For comparing types of ACC workers (mine, enrichment factories, both), we calculated lung cancer SMRs in men by duration of employment (< 5 years, 5–14 years, and ≥ 15 years) and start of employment (before or after 1975) with miners as reference in each stratum. Results Overall mortality of men in the ACC was reduced by 14%, mainly because of the most common cause of death, circulatory disease; this effect was much weaker in women. Elevated mortality was observed for both sexes from diseases of the digestive system (10–30%) and blood and blood forming organs (121–181%). Lung cancer mortality in men was increased from the 3rd quartile of chrysotile containing dust and in the highest quartile with SMR 1.30, 95% CI 1.07–1.57, while the increase in high exposed women was not reaching statistical significance (SMR 1.69, 95% CI 0.87–2.96). No increased SMRs were seen for laryngeal, stomach or ovarian cancers. Male factory workers first employed before 1975 had higher lung cancer mortality compared to miners, but not when employed after 1974. Conclusions The observed excess in lung cancer confirms previous observations in the ACC. Risk management measures in the enrichment factories may have reduced the lung cancer risk to the level of the miners in recent decades.

Abstract Rationale Diesel motor exhaust is classified by the International Agency for Research on Cancer as probably carcinogenic to humans. The epidemiologic evidence is evaluated as limited because most studies lack adequate control for potential confounders and only a few studies have reported on exposure–response relationships. Objectives Investigate lung cancer risk associated with occupational exposure to diesel motor exhaust, while controlling for potential confounders. Methods The SYNERGY project pooled information on lifetime work histories and tobacco smoking from 13,304 cases and 16,282 controls from 11 case–control studies conducted in Europe and Canada. A general population job exposure matrix based on ISCO-68 occupational codes, assigning no, low, or high exposure to diesel motor exhaust, was applied to determine level of exposure. Measurements and Main Results Odds ratios of lung cancer and 95% confidence intervals were estimated by unconditional logistic regression, adjusted for age, sex, study, ever-employment in an occupation with established lung cancer risk, cigarette pack-years, and time-since-quitting smoking. Cumulative diesel exposure was associated with an increased lung cancer risk highest quartile versus unexposed (odds ratio 1.31; 95% confidence interval, 1.19–1.43), and a significant exposure–response relationship (P value < 0.01). Corresponding effect estimates were similar in workers never employed in occupations with established lung cancer risk, and in women and never-smokers, although not statistically significant. Conclusions Our results show a consistent association between occupational exposure to diesel motor exhaust and increased risk of lung cancer. This association is unlikely explained by bias or confounding, which we addressed by adjusted models and subgroup analyses.

BackgroundLung cancer incidence in Central and Eastern Europe (CEE) is among the highest in the world, and the role of occupational exposures has not been adequately studied in these countries.ObjectivesTo investigate the contribution of occupational exposure to polycyclic aromatic hydrocarbons (PAH) to lung cancer in CEE.MethodsA case–control study was conducted in the Czech Republic, Hungary, Poland, Romania, Russia and Slovakia, as well as the United Kingdom (UK) between 1998 and 2002. Occupational and socio-demographic information was collected through interviews from 2861 newly diagnosed lung cancer cases and 2936 population or hospital controls. Industrial hygiene experts in each country evaluated exposure to 70 occupational agents, whereof 15 mixtures containing PAH. ORs of lung cancer were calculated after adjusting for other occupational exposures and tobacco smoking.ResultsThe OR for ever exposure to PAH in the CEE countries was 0.93 (95% CI 0.77 to 1.14). The ORs for the highest category of cumulative exposure, duration of exposure and intensity of exposure were 1.13 (95% CI 0.80 to 1.58), 1.02 (95% CI 0.66 to 1.57) and 1.11 (95% CI 0.60 to 2.05), respectively. The OR for ever PAH exposure in the UK was 1.97 (95% CI 1.16 to 3.35).ConclusionOccupational PAH exposure does not appear to substantially contribute to the burden of lung cancer in CEE. The apparently stronger effect observed in the UK may be due to high exposure levels and a joint effect with asbestos.