American Journal of Epidemiology Vol. 148, No. 3: 241-248
Copyright © 1998 by The Johns Hopkins University School of Hygiene and Public Health
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Lung Cancer Risk in Hard-Metal Workers
1 Service Epidémiologie, Institut National de Recherche et de Sécurité (INRS) Vandoeuvre Cedex, France
2 Service de Médecine du Travail, H
pital A. Michallon, Institut Universitaire de Médecine du Travail et d'Ergonomie La Tronche, France
3 Service de Médecine B, Hpital Bretonneau, Institut de Médecine du Travail du Val de Loire Tours, France
4 Service Evaluation et Prévention du Risque Chimique, Institut National de Recherche et de Sécurité (INRS) Vandoeuvre Cedex, France
5 Eramet Paris Cedex, France
6 Sandvik Hard Materials Epinouze, France
Reprint requests to Dr. Jean Jacques Moulin, Service Epidémiologie, Institut National de Recherche et de Sécurité, Avenue de Bourgogne, BP 27, 54501 Vandoeuvre Cedex, France.
An industry-wide mortality study on the association between lung cancer and occupational exposure to cobalt and tungsten carbide was carried out in the French hard-metal industry. This case-control study was nested in the historical cohort of workers ever employed in this Industry's 10 facilities, most of which are located in eastern France. Workers were followed up from 1968 to 1991. Occupational exposure was assessed using a job-exposure matrix that provided semiquantitative scores for 320 job periods. These scores were significantly correlated with the levels of cobalt measured in 744 historical air samples. In this cohort, which comprised 5,777 males and 1, 682 females, the death rate from lung cancer was significant (63 deaths, standardized mortality ratio = 1.30, 95% confidence interval (CI) 1.00–1.66) when compared with national death rates. Sixty-one cases and 180 controls were included in the study. When the exposures during the last 10 years were ignored, a twofold lung cancer risk was observed among workers simultaneously exposed to cobalt and tungsten carbide (odds ratio (OR) = 1.93, 95% CI 1.03–3.62) adjusted for other cobalt exposure (OR) = 2.21, 95% CI 0.99–4.90). The odds ratios increased with cumulative exposure (first quartile, OR = 1.00; second quartile, OR = 2.64; third quartile, OR = 2.59; fourth quartile, OR = 4.13) and, to a lesser degree, with duration of exposure (one decade, OR = 1.00; two decades, OR =1.61; three decades, OR = 2.77; four decades, OR = 2.03). Adjustments for smoking and for exposures to known or suspected carcinogens did not change the results, yet the odds ratio for smoking (3.38) was lower than expected, suggesting the possibility of some misclassification. Occupational risk was highest among smokers. This study supports the hypothesis that workers who manufacture hard metals have an increased mortality from lung cancer due to simultaneous exposure to cobalt and tungsten carbide. Am J Epidemiol1998;148:241–8.
case-control studies; cobalt; cohort studies; lung neoplasms; tungsten compounds
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