We studied the mortality from lung and pleural cancers in a cohort of 62,937 male workers employed for at least 1 year in the pulp and paper industry in 13 countries during 1945 to 1996. Mill departments were classified according to probability and level of exposure to asbestos on the basis of available dust measurements and mill-specific information on exposure circumstances. Thirty-six percent of workers were classified as ever exposed to asbestos. Standardized mortality ratios of lung cancer were 0.99 (95% confidence interval [CI], 0.90 to 1.08) among unexposed and 1.00 (95% CI, 0.90 to 1.11) among ever exposed workers. The number of pleural cancer deaths among unexposed workers was 10; that among exposed workers was 14, most of which occurred among maintenance workers. In internal analyses, a trend in mortality from either neoplasm was suggested for estimated cumulative exposure to asbestos, weighted for the individual probability of exposure within the department and for duration of exposure (relative risk for lung cancer for 0.78+ f/cc-years, as compared with ≤0.01 f/cc-years: 1.44; 95% CI, 0.85 to 2.45; corresponding relative risk for pleural cancer: 2.43; 95% CI, 0.43 to 13.63). Despite a possible nondifferential misclassification of exposure and outcome, this study suggests that the carcinogenic effect of asbestos can be detected among workers employed in industries such as the pulp and paper industry, in which it is not considered to be a major hazard.
From the International Agency for Research on Cancer, Lyon, France (R. Carel, P. Boffetta, D. Colin); Ben Gurion University, Beer Sheva, Israel (R. Carel); Finnish Institute of Occupational Health, Helsinki, Finland (T. Kauppinen); University of British Columbia, Vancouver, Canada (K. Teschke); Norwegian Cancer Registry, Oslo, Norway (A. Andersen); Stora Enso Oyj, Imatra, Finland (P. Jäppinen); Massey University, Wellington, New Zealand (N. Pearce); Danish Cancer Society, Copenhagen, Denmark (B. Rix); Claude Bernard University, Lyon, France (A. Bergeret); MRC Environmental Epidemiology Unit, University of Southampton, UK (D. Coggon); University Hospital Department of Occupational & Environmental Medicine, Linköping, Sweden (B. Persson); Nofer Institute of Occupational Medicine, Lodz, Poland (I. Szadkowska-Stanczyk); National Centre for Occupational Health, Johannesburg, South Africa (D. Kielkowski); National Institute for Occupational Safety and Health, Morgantown, WV (P. Henneberger); Hokkaido University Graduate School of Medicine, Hokkaido, Japan (R. Kishi); Federal University of Pelotas, Pelotas, RS, Brazil (L. Facchini); Municipal Institute of Medical Research, Barcelona, Spain (M. Sala, M. Kogevinas).
Address correspondence to: Dr Paolo Boffetta, Unit of Environmental Cancer Epidemiology, International Agency for Research on Cancer, 150 cours Albert-Thomas, 69008 Lyon, France; email@example.com.
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