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Lung Cancer Among Firefighters

Smoking-Adjusted Risk Estimates in a Pooled Analysis of Case-Control Studies

Bigert, Carolina MD, PhD; Gustavsson, Per MD, PhD; Straif, Kurt MD, PhD; Taeger, Dirk PhD; Pesch, Beate PhD; Kendzia, Benjamin MSc; Schüz, Joachim PhD; Stücker, Isabelle PhD; Guida, Florence PharmD; Brüske, Irene MD; Wichmann, Heinz-Erich PhD; Pesatori, Angela C. MD, PhD; Landi, Maria Teresa MD, PhD; Caporaso, Neil MD; Tse, Lap Ah PhD; Yu, Ignatius Tak-sun PhD; Siemiatycki, Jack PhD; Lavoué, Jérôme PhD; Richiardi, Lorenzo MD, PhD; Mirabelli, Dario MD; Simonato, Lorenzo MD; Jöckel, Karl-Heinz PhD; Ahrens, Wolfgang PhD; Pohlabeln, Hermann PhD; Tardón, Adonina PhD; Zaridze, David MD, PhD; Field, John K. PhD; ’t Mannetje, Andrea PhD; Pearce, Neil PhD; McLaughlin, John PhD; Demers, Paul PhD; Szeszenia-Dabrowska, Neonila PhD; Lissowska, Jolanta PhD; Rudnai, Peter MD; Fabianova, Eleonora MD, PhD; Stanescu Dumitru, Rodica PhD; Bencko, Vladimir MD, PhD; Foretova, Lenka MD, PhD; Janout, Vladimir PhD; Boffetta, Paolo MD, MPH; Peters, Susan PhD; Vermeulen, Roel PhD; Kromhout, Hans PhD; Brüning, Thomas MD, PhD; Olsson, Ann C. PhD

Journal of Occupational and Environmental Medicine: November 2016 - Volume 58 - Issue 11 - p 1137–1143
doi: 10.1097/JOM.0000000000000878

Objectives: The aim of this study was to explore lung cancer risk among firefighters, with adjustment for smoking.

Methods: We used pooled information from the SYNERGY project including 14 case-control studies conducted in Europe, Canada, New Zealand, and China, with lifetime work histories and smoking habits for 14,748 cases of lung cancer and 17,543 controls. We estimated odds ratios by unconditional logistic regression with adjustment for smoking and having ever been employed in a job known to present an excess risk of lung cancer.

Results: There was no increased lung cancer risk overall or by specific cell type among firefighters (n = 190), neither before nor after smoking adjustment. We observed no significant exposure-response relationship in terms of work duration.

Conclusions: We found no evidence of an excess lung cancer risk related to occupational exposure as a firefighter.

The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (Drs Bigert, Gustavsson); International Agency for Research on Cancer, Lyon, France (Drs Straif, Schüz, Olsson); Institute for Prevention and Occupational Medicine of the German Social Accident Insurance – Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany (Drs Taeger, Pesch, Kendzia, Brüning); Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Environmental Epidemiology of Cancer Team (Drs Stücker, Guida); Université Paris-Sud, UMRS 1018, F-94807, Villejuif, France (Drs Stücker, Guida); Institut für Epidemiologie I, Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg (Dr Brüske); Institute of Medical Informatics, Biometry and Epidemiology, Ludwig Maximilians University (Dr Wichmann); Helmholtz Center Munich, Institute of Epidemiology I (Dr Wichmann); Institute of Medical Statistics and Epidemiology, Technical University Munich, Munich, Germany (Dr Wichmann); Department of Clinical Sciences and Community Health, Università degli Studi di Milano and IRCCS Ca’ Granda Foundation, Milan, Italy (Dr Pesatori); National Cancer Institute, Bethesda, Maryland (Drs Landi, Caporaso); Division of Occupational and Environmental Health, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Drs Tse, Yu); Research Centre of University of Montréal Hospital Centre, University of Montréal, Montréal, Quebec, Canada (Drs Siemiatycki, Lavoué); Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy (Drs Richiardi, Mirabelli); Department of Environmental Medicine and Public Health, University of Padua, Padua, Italy (Dr Simonato); Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany (Dr Jöckel); Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany (Drs Ahrens, Pohlabeln); CIBERESP, University of Oviedo, Oviedo, Spain (Dr Tardón); Russian Cancer Research Centre, Moscow, Russia (Dr Zaridze); Roy Castle Lung Cancer Research Programme, Cancer Research Centre, University of Liverpool, Liverpool, UK (Dr Field); Centre for Public Health Research, Massey University, Wellington, New Zealand (Drs ’t Mannetje, Pearce); Public Health Ontario, Toronto (Dr McLaughlin); Occupational Cancer Research Centre, Cancer Care Ontario, Ontario, Toronto, Canada (Dr Demers); The Nofer Institute of Occupational Medicine, Lodz (Dr Szeszenia-Dabrowska); The M Sklodowska-Curie Cancer Center and Institute of Oncology, Warsaw, Poland (Dr Lissowska); National Public Health Center, Budapest, Hungary (Dr Rudnai); Regional Authority of Public Health, Banska Bystrica, Slovakia (Dr Fabianova); Institute of Public Health, Bucharest, Romania (Dr Stanescu Dumitru); Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Charles University, Prague (Dr Bencko); Masaryk Memorial Cancer Institute, Brno, Czech Republic (Dr Foretova); Palacky University, Faculty of Medicine, Olomouc (Dr Janout); Faculty of Medicine, Ostrava University, Ostrava, Czech Republic (Dr Janout); The Tisch Cancer Institute and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Boffetta); Institute for Risk Assessment Sciences, Utrecht, the Netherlands (Drs Peters, Vermeulen, Kromhout); and Occupational Respiratory Epidemiology, School of Population Health, University of Western Australia, Perth, Western Australia, Australia (Dr Peters).

Address correspondence to: Dr Carolina Bigert, MD, PhD, Institute of Environmental Medicine, Karolinska Institutet, Solnavägen 4 10th Floor, SE-113 65 Stockholm, Sweden (

This study was funded by AFA Insurance in Sweden (grant no. 130104). AFA Insurance is owned by Sweden's labor market parties: the Confederation of Swedish Enterprise, the Swedish Trade Union Confederation and The Council for Negotiation and Co-operation. The SYNERGY project is funded by the German Social Accident Insurance (DGUV). The original studies were funded by a list of agencies, including the Canadian Institutes for Health Research and Guzzo-SRC Chair in Environment and Cancer, the National Cancer Institute of Canada with funds provided by the Canadian Cancer Society and Cancer Care Ontario; the French agency of health security (ANSES), the Fondation de France, the French National Research Agency (ANR), the National Institute of Cancer (INCA), the Fondation for Medical Research (FRM), the French Institute for Public Health Surveillance (InVS), the Health Ministry (DGS), the Organization for the Research on Cancer (ARC), and the French Ministry of work, solidarity and public function (DGT). In Germany, the studies were funded by the Federal Ministry of Education, Science, Research, and Technology grant no. 01 HK 173/0 and the Federal Ministry of Science and the Ministry of Labour and Social Affairs. The INCO study was supported by a grant from the European Commission's INCO-COPERNICUS program, a grant from the Polish State Committee for Scientific Research, and the Roy Castle Foundation as part of the Liverpool Lung Project. In Brno, Czech Republic, the study was supported by MH CZ – DRO (MMCI, 00209805) in the INCO part. The EAGLE study was funded by the Intramural Research Program of the National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MD; the Environmental Epidemiology Program of the Lombardy Region, Italy; and the Istituto Nazionale per l’Assicurazione contro gli Infortuni sul Lavoro, Rome, Italy. The TURIN study was supported by the Italian Association for Cancer Research, Region Piedmont, Compagnia di San Paolo. The CAPUA study was supported by the Instituto Universitario de Oncologia, Universidad de Oviedo, Asturias, the Fondo de Investigacion Sanitaria (FIS), and the Ciber de Epidemiologia y Salud Publica (CIBERESP), Spain. The Hong Kong study was supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China. The OCANZ study was funded by the Health Research Council of New Zealand, the New Zealand Department of Labour, Lottery Health Research, and by the Cancer Society of New Zealand. The Swedish study LUCAS was supported by the Swedish Council for Work Life Research and the Swedish EPA.

The authors do not have any competing financial interests.

Ethical approvals for the original studies were obtained in accordance with legislation in each country, and for the SYNERGY project from the IARC Institutional Review Board Committee. The Regional Ethics Committee in Stockholm, Sweden, gave approval for the present analyses.

Lung cancer among firefighters: smoking-adjusted risk estimates in a pooled analysis of case-control studies.

Copyright © 2016 by the American College of Occupational and Environmental Medicine