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Occupational Exposures, Environmental Tobacco Smoke, and Lung Cancer

Veglia, Fabrizio*; Vineis, Paolo*†‡; Overvad, Kim§; Boeing, Heiner; Bergmann, Manuela M.; Trichopoulou, Antonia; Trichopoulos, Dimitrios∥**; Palli, Domenico††; Krogh, Vittorio‡‡; Tumino, Rosario§§; Linseisen, Jakob¶¶; Steindorf, Karen¶¶; Raaschou-Nielsen, Ole∥∥; Tjønneland, Anne∥∥; Gonzalez, Carlos A.***; Martinez, Carmen†††; Dorronsoro, Miren‡‡‡; Barricarte, Aurelio§§§; Cirera, Lluis¶¶¶; Quiros, J Ramon∥∥∥; Day, Nicholas E.****; Saracci, Rodolfo††††; Riboli, Elio

doi: 10.1097/EDE.0b013e318142c8a1
CANCER: Original Article

Background: There is uncertainty regarding the association of occupational exposures with lung cancer. We have studied the association between 52 high-risk job titles and lung cancer incidence in a large prospective study, with more than 200,000 participants followed for more than 6 years and 809 incident cases of lung cancer.

Methods: Hazard ratios and 95% confidence intervals were computed by the Cox proportional-hazard regression model, adjusting for country, age, sex, social class, diet, physical activity, and smoking habits. We used a CAREX-based job-exposure matrix to infer exposure to lung carcinogens. False-positive report probability was calculated as a measure of potentially false-positive results.

Results: Eighteen occupations, mainly related with agriculture, constructions, and metal processing, were associated with increased risk. In addition, incidence tended to increase with the number of hazardous jobs reported. When the occupations were classified according to the presumed exposure to specific carcinogenic agents, the hazard ratios were 1.5 (95% confidence interval = 1.2–1.9) for asbestos, 1.4 (1.1–1.8) for heavy metals, 1.4 (1.1–1.8) for polycyclic aromatic hydrocarbons, and 1.6 (1.2–2.1) for work-related environmental tobacco smoke. The estimated population attributable risk for employment in at least 1 at-risk job was 16% in men and 12% in women.

Conclusions: This large prospective study suggests that exposure to occupational lung carcinogens is still a problem, with such exposures producing moderate to large increases in risk.

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From the *ISI Foundation, Turin, Italy; †Imperial College London, London, United Kingdom; ‡University of Turin, Turin, Italy; §Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark; ¶Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Germany; ∥Department of Hygiene and Epidemiology, Medical School, University of Athens, Athens, Greece; **Harvard School of Public Health, Harvard University, Boston, Massachusetts; ††Cancer Risk Factor Branch, CSPO Scientific Institute of Tuscany Region, Florence, Italy; ‡‡Department of Epidemiology, National Cancer Institute, Milan, Italy; §§Cancer Registry, Azienda Ospedaliera “Civile MP Arezzo,” Ragusa, Italy; ¶¶Unit of Environmental Epidemiology, German Cancer Research Centre, Heidelberg, Germany; ∥∥Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark; ***Department of Epidemiology, Catalan Institute of Oncology, Consejería de Sanidad y Servicios Sociales, Barcelona, Spain; †††Andalusian School of Public Health, Granada, Spain; ‡‡‡Department of Public Health of Guipuzkoa, San Sebastian, Spain; §§§Public Health Institute, Navarra, Spain; ¶¶¶Department of Epidemiology, Regional Health Council, Murcia, Spain; ∥∥∥Public Health and Health Planning Directorate, Asturias, Spain; ****MRC Dunn Human Nutrition Unit, Cambridge, United Kingdom; and ††††International Agency for Research on Cancer, Lyon, France.

Submitted 23 October 2006; accepted 15 June 2007.

Supported by the European Community 5th Framework Programme Grant QLK4CT199900927 (to P.V.) and 6th Framework Programme Grant 513943 (to P.V.) for the Network of Excellence ECNIS (Environmental Cancer risk, Nutrition and Individual Susceptibility) (WP4 and WP8) and a grant of the Compagnia di San Paolo to the ISI Foundation. The work described in the paper was carried out with the financial support of Europe Against Cancer Program of the European Commission (SANCO); Deutsche Krebshilfe; Deutsches Krebsforschungszentrum; German Federal Ministry of Education and Research; Danish Cancer Society; Health Research Fund (FIS) of the Spanish Ministry of Health; Spanish Regional Governments of Andalucia, Asturias, Basque Country, Murcia and Navarra; ISCIII, Red de Centros RCESP, C03/09, Spain; Cancer Research, United Kingdom; Medical Research Council, United Kingdom; Stroke Association, United Kingdom; British Heart Foundation; Department of Health, United Kingdom; Food Standards Agency, United Kingdom; Wellcome Trust, United Kingdom; Greek Ministry of Health; Greek Ministry of Education; Italian Association for Research on Cancer (AIRC); Italian National Research Council; Dutch Ministry of Public Health, Welfare and Sports; World Cancer Research Fund; Swedish Cancer Society; Swedish Scientific Council; Regional Government of Skåne, Sweden; Norwegian Cancer Society; and Research Council of Norway.

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Correspondence: F. Veglia, Institute for Scientific Interchange (ISI) Foundation, Viale Settimio Severo 65, 10133 Turin, Italy. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.