Occupation and Lung Cancer in Non-Smokers

Abstract

Lung cancer remains a significant burden on society, with approximately 157,200 deaths from this disease in 2003 occurring in the United States alone. Smoking causes the vast majority of cases (and deaths) from lung cancer, occupation may account for as many as 16,700 of such deaths. To examine the influence of occupation independent of smoking, we reviewed the literature on occupational lung cancer in nonsmokers. We found that most individual studies and summaries of occupational lung cancer are based on data having a heavy preponderance of male smokers. Relatively little data are available concerning females and nonsmokers. Specific dose-response information is often lacking. Although many studies have been adjusted for smoking, there remains a significant potential for residual confounding because of the overwhelming importance of smoking in the etiology of this disease. Our review has found some evidence that asbestos, environmental tobacco smoke, and radon decay products (progeny) are occupational carcinogens in nonsmokers. Increased risk for lung cancer might also occur in nonsmokers from occupational exposure to arsenic. Nevertheless, for many agents and occupations occupations or industries listed in the database of the International Agency for Research on Cancer (IARC), we could not locate any study that found them to be occupational risk factors for lung cancer in nonsmokers. Thus, considerable uncertainty exists about their ability to cause lung cancer in the nonsmoking working population. We discuss problems with the original occupational studies and the IARC list of carcinogens. Besides the absence of information on nonsmokers, these problems include lack of sufficient detail on exposure to the primary agent of concern and to other occupational lung carcinogens. Further research on occupational causes of lung cancer in nonsmokers should be given high priority.

Risk factors for lung cancer in Iowa women: Implications for prevention

“…Only seven of the original studies found a significantly elevated risk [40]. Additional discussion of studies may be found in our previous summary [4].…”

“…There were a relatively small number of women who worked in high-risk occupations (n=68). While occupational causes of lung cancer among men have been studied extensively for years, relatively little is known about the effect of occupational exposures on lung cancer in women [4,[24][25][26][27]. Studies in males have documented lung cancer related exposures such as underground uranium mining (radon progeny), asbestos, arsenic, beryllium, hexavalent chromium, crystalline silica, and polycyclic aromatic hydrocarbons.…”

“…In Illinois, significantly increased risks were found for non-smoking white women employed in eating and drinking places; occupation as a registered nurse was of borderline significance [27]. A more detailed discussion of occupational risks for lung cancer in non-smokers may be found elsewhere [4].…”

“…Risk factors also contributing to this disease include occupational exposure to arsenic, asbestos, crystalline silica, environmental tobacco smoke, and radon progeny [4]. Non-occupational risk factors include environmental tobacco smoke, residential radon progeny, a diet low in fruit and vegetable intake, and lower educational level [4].…”

The clinical effectiveness and cost-effectiveness of computed tomography screening for lung cancer: systematic reviews

“…From a number of studies of specific workforce populations the International Agency for Research in Cancer (IARC) has identified 16 specific occupations, exposures or processes that they class as having 'sufficient evidence' to say that they cause lung cancer (IARC evidence grade 1) 9,10 ( Table 1, with fuller review in Appendix 1).…”