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Occupations and the Risk of Head and Neck Cancer

A Pooled Analysis of the International Head and Neck Cancer Epidemiology (INHANCE) Consortium

Khetan, Prerna MPH; Boffetta, Paolo MD; Luce, Daniele PhD; Stucker, Isabelle PhD; Curado, Maria Paula PhD; Menezes, Ana PhD; Wunsch-Filho, Victor PhD; Ahrens, Wolfgang PhD; Lagiou, Pagona MD; Serraino, Diego PhD; Richiardi, Lorenzo PhD; Kjaerheim, Kristina PhD; Conway, David PhD; Thomson, Peter MD; Muscat, Joshua PhD; Mates, Dana PhD; Ramroth, Heribert PhD; Menvielle, Gwenn PhD; Vaughan, Thomas L. MD; Brenner, Hermann MD; Lee, Yuan-Chin Amy PhD; La Vecchia, Carlo PhD; Hashibe, Mia PhD; Hashim, Dana MD

Journal of Occupational and Environmental Medicine: May 2019 - Volume 61 - Issue 5 - p 397–404
doi: 10.1097/JOM.0000000000001563

Objective: To investigate the associations between head and neck cancer (HNC) risk and occupations.

Methods: We harmonized data on occupations in a pooled analysis of 8839 HNC cases and 13,730 controls in International Head and Neck Cancer Epidemiology (INHANCE) consortium. Logistic regression was used to estimate odds ratios (ORs) for associations of occupations and HNC risk. Population attributable fraction (PAF) for occupations was calculated using the formula PEC × (OR − 1)/OR.1

Results: Trend of increasing HNC risk was found with increasing duration of employment for many occupations, including cooks (OR = 1.36; 95% confidence interval [CI] 1.09 to 1.68), cleaners (OR = 1.38; 95% CI 1.13 to 1.69), painters (OR = 1.82; 95% CI 1.42 to 2.35). The PAF for a priori occupations was 14.5% (95% CI 7.1% to 21.9%) for HNC.

Conclusions: We found associations between certain occupations and HNC risks, including for subsites, with a duration–response relationship.

The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, New York (Dr Khetan, Dr Boffetta, Dr Hashim); University of Rennes, National Institute of Health and Medical Research, School of Advanced Studies in Public Health, Institute for Health, Environment and Work Research - Research Unit UMR_S 1085, Pointe-à-Pitre, France (Dr Luce); Cancer and Environment Team, National Institute of Health and Medical Research U1018, Paris-Sud University, Paris-Saclay University, Villejuif, France (Dr Stucker); Cancer and Environment team (CESP), (Inserm) National Institute of Health and Medical Research U1018, Paris-Sud University, Paris-Saclay University, Villejuif, France (Dr Stucker); Federal University of Pelotas, Pelotas (Dr Menezes); University of Sao Paulo, Sao Paulo, Brazil (Dr Wunsch-Filho); Leibniz Institute for Prevention Research and Epidemiology, Bremen Institute for Prevention Research and Social Medicine , Bremen, Germany (Dr Ahrens); School of Medicine, National and Kapodistrian University of Athens, Greece (Dr Lagiou); Oncological Reference Center, Institute of Scientific Characterization and Hospitalization, Aviano, Italy (Dr Serraino); Department of Medical Sciences, University of Turin, Turin (Dr Richiardi); Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway (Dr Kjaerheim); School of Medicine, Dentistry, and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK (Dr Conway); University of Hong Kong, Hong Kong, China (Dr Thomson); Penn State College of Medicine, Hershey, Pennsylvania (Dr Muscat); National Institute of Public Health, Bucharest, Romania (Dr Mates); University of Heidelberg (Dr Ramroth); National Institute of Health and Medical Research, Sorbonne University, Pierre Louis Institute of Epidemiology and Public Health, Paris, France (Dr Menvielle); Fred Hutchinson Cancer Research Center, Seattle, Washington (Dr Vaughan); Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany (Dr Brenner); Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany (Dr Brenner); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany Hermann Brenner (Dr Brenner); Division of Public Health, Department of Family & Preventive Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah (Dr Lee, Dr Hashibe); Department of Clinical Sciences and Community Health, University of Milan, Milan (Dr La Vecchia), Italy.

Address correspondence to: Prerna Khetan, MPH, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 (

Sources of Funding: The INHANCE Consortium was supported by NIH grants NCI R03CA113157 and NIDCR R03DE016611. Studies participating in the pooled analysis were supported by: Latin America study: Fondo para la Investigacion Cientifica y Tecnologica (FONCYT) Argentina, IMIM (Barcelona), Fundaco de Amparo a‘ Pesquisa no Estado de Sao Paulo (FAPESP) [No 01/01768-2], and European Commission [IC18-CT97-0222]. Sao Paulo: Sao Paulo Research Foundation (FAPESP) (GENCAPO 04/12054-9, 10/51168-0). Western Europe multicenter (ARCAGE): European Community (5th Framework Programme) grant no QLK1-CT-2001-00182. New York multicenter: NY multicenter study: NIH [P01CA068384 K07CA104231]. Central Europe multicenter (INCO): Central Europe study: World Cancer Research Fund and the European Commission INCO-COPERNICUS Program [Contract No. IC15-CT98-0332]. Tampa study: NIH [P01CA068384, K07CA104231, R01DE013158] Germany-Heidelberg: Germany-Heidelberg study: grant No. 01GB9702/3 from the German Ministry of Education and Research. Seattle-Leo: Seattle-LEO study: NIH[R01CA030022]. MSKCC: MSKCC study: NIH [R01CA051845]. Germany-Saarland: Saarland study: Ministry of Science, Research and Arts Baden-Wurttemberg. France multicenter (ICARE): French National Research Agency (ANR); French National Cancer Institute (INCA); French Agency for Food, Environmental and Occupational Health and Safety (ANSES); French Association for Research on Cancer (ARC); Fondation pour la Recherche Médicale (FRM); French Institute for Public Health Surveillance (InVS); Fondation de France; Ministry of Labour; Ministry of Health. For the remaining authors none were declared.

Conflict of Interest: None declared.

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