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American Journal of Epidemiology Advance Access originally published online on February 8, 2006
American Journal of Epidemiology 2006 163(8):717-725; doi:10.1093/aje/kwj091
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

Original Contribution

Occupational Risk Factors for Esophageal and Stomach Cancers among Female Textile Workers in Shanghai, China

Karen J. Wernli1,2, E. Dawn Fitzgibbons1, Roberta M. Ray1, Dao Li Gao3, Wenjin Li1, Noah S. Seixas4, Janice E. Camp4, George Astrakianakis4, Ziding Feng1, David B. Thomas1,2 and Harvey Checkoway2,4

1 Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA
2 Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA
3 Department of Epidemiology, Zhong Shan Hospital Cancer Center, Shanghai, China
4 Department of Environmental and Occupational Health Sciences, School of Public Health and Community Medicine, University of Washington, Seattle, WA

Correspondence to Karen J. Wernli, Program in Epidemiology, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M4-A402, Seattle, WA 98109-1024 (e-mail: kwernli{at}fhcrc.org).

The authors evaluated associations between occupational exposures in the textile industry and the risks of esophageal cancer and stomach cancer. The authors conducted a case-cohort study nested in a cohort of female textile workers in Shanghai, China. One hundred and two workers with incident esophageal cancer and 646 workers with incident stomach cancer diagnosed between 1989 and 1998 were compared with an age-stratified reference subcohort (n = 3,188). Work histories were ascertained for all study subjects from factory personnel records or interviews. Exposures were reconstructed for chemicals and dusts by linking work history data with a job-exposure matrix developed for the Shanghai textile industry. Hazard ratios and 95 percent confidence intervals were calculated with Cox proportional hazards modeling adapted for the case-cohort design. Risk of esophageal cancer was associated with long-term (≥10 years) exposure to silica dust (hazard ratio = 15.8, 95% confidence interval: 3.5, 70.6) and metals (hazard ratio = 3.7, 95% confidence interval: 1.9, 7.1). Cumulative exposure to endotoxin, a contaminant of cotton dust, was inversely related to risks of both esophageal cancer (p-trend = 0.01) and stomach cancer (p-trend < 0.001) when exposures were lagged 20 years. Endotoxin has not been previously reported to be a protective factor for either stomach cancer or esophageal cancer and therefore warrants further study.

cotton fiber; endotoxins; esophageal neoplasms; occupational exposure; occupations; silicon dioxide; stomach neoplasms; textile industry

Abbreviations: CI, confidence interval; EU, endotoxin units; HR, hazard ratio; STIB, Shanghai Textile Industry Bureau


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