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Occupational Risk Factors for Small Bowel Carcinoid Tumor: A European Population-Based Case-Control Study

Kaerlev, Linda MD, PhD; Teglbjaerg, Peter Stubbe MD; Sabroe, Svend MD; Kolstad, Henrik A. MD, PhD; Ahrens, Wolfgang PhD; Eriksson, Mikael MD, PhD; Guénel, Pascal MD, PhD; Hardell, Lennart MD, PhD; Cyr, Diane; Ballard, Terri DrPH; Zambon, Paola MD; Morales Suárez-Varela, María M. MD, PhD; Stang, Andreas MD, PhD; Olsen, Jorn MD, PhD

Journal of Occupational and Environmental Medicine: June 2002 - Volume 44 - Issue 6 - p 516-522

Learning Objectives (1) Characterize small bowel carcinoid tumor (SBC) as to its clinical features and relationship to occupational exposures. (2) Identify specific industries and occupations that, in this case-control study, seem to confer an increased risk of SBC. (3) Give examples of common denominators that may connect identified types of work with an increased risk of SBC.

Small bowel carcinoid tumor (SBC) is a rare disease of unknown etiology but with an age-, sex-, and place-specific occurrence that may indicate an occupational origin. A European multicenter population-based case-control study was conducted from 1995 through 1997. Incident SBC cases between 35 and 69 years of age (n = 101) were identified, together with 3335 controls sampled from the catchment area of the cases. Histological review performed by a reference pathologist left 99 cases for study; 84 cases and 2070 population controls were interviewed. The industries most closely associated (a twofold or more odds ratio [OR]) with SBC, taking into account a 10-year time lag after exposure were, among women, employment in wholesale industry of food and beverages (OR, 8.2; 95% confidence interval [CI], 1.9 to 34.9]) and among men, manufacture of motor vehicle bodies (OR, 5.2; 95% CI, 1.2 to 22.4), footwear (OR, 3.9; 95% CI, 0.9 to 16.1), and metal structures (OR, 3.3; 95% CI, 1.0 to 10.4). The identified high-risk occupations with an OR above 2 were shoemakers, structural metal preparers, construction painters and other construction workers, bookkeepers, machine fitters, and welders (men). The OR for regular occupational use of organic solvents for at least half a year was 2.0 (95% CI, 1.0 to 4.2). Exposure to rust-preventive paint containing lead was suggested as another potential occupational exposure (OR, 9.1; 95% CI, 0.8 to 107). This explorative study suggests an association between certain occupational exposures and SBC, but some of these associations could be attributable to chance. All findings should be regarded as tentative.

From the Department of Epidemiology and Social Medicine, University of Aarhus (Dr Kaerlev, Dr Sabroe); the Research Unit of Maritime Medicine, University of Southern Denmark (Dr Kaerlev); the Institute of Pathology, Aalborg Hospital, Aalborg, Denmark (Dr Teglbjaerg); the Department of Occupational Medicine, Aarhus University Hospital (Dr Kolstad); the Bremen Institute for Prevention Research and Social Medicine, Bremen, Germany (Dr Ahrens); the Department of Oncology, University Hospital Lund, Lund, Sweden (Dr Eriksson); the Institut National de la Santé et de la Recherche Médicale, Unité 88, Hôpital National de Saint-Maurice (Dr Guénel, Ms Cyr); the Department of Oncology, Örebro Medical Center, Örebro, Sweden (Dr Hardell); the Department of Oncology and Surgery, University of Padova, Italy (Dr Ballard, Dr Zambon); the Unit of Public Health, Hygiene and Environmental Health, Faculty of Pharmacy, Valencia University (Dr Morales Suárez-Varela), and the Unit of Clinical Epidemiology, Dr Peset University Hospital (Dr Morales Suárez-Varela), Valencia, Spain; the Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Essen, Essen, Germany (Dr Stang); and The Danish Epidemiology Science Centre, Aarhus University (Dr Olsen).

Address correspondence to: Dr Linda Kaerlev, Department of Epidemiology and Social Medicine, University of Aarhus, Vennelyst Boulevard 6, DK-8000 Aarhus C, Denmark;

The authors have no commercial interest related to this article.

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©2002The American College of Occupational and Environmental Medicine