Occupation and Bladder Cancer Phenotype: Identification of Workplace Patterns That Increase the Risk of Advanced Disease Beyond Overall Incidence

Autor: James W.F. Catto, Eero Pukkala, Jan Ivar Martinsen, Aidan P. Noon
Rok vydání: 2018
Předmět:
Zdroj: European Urology Focus. 4:725-730
ISSN: 2405-4569
DOI: 10.1016/j.euf.2016.06.014
Popis: Background We examined a national data set to determine if workers employed in specific occupations develop distinct bladder cancer (BCa) phenotypes. Objective To compare the incidence and disease-specific mortality (DSM) of localized and advanced BCa in workers with different job titles. Design, setting, and participants BCa incidence, stage at diagnosis, and DSM in 1.7 million Finnish men (13 717 with BCa) and 1.7 million women (4282 with BCa) with annotated occupational descriptions. Follow-up was 37 and 43 million person-years, respectively. Outcome measurements and statistical analysis The gender-specific incidence and BCa DSM within each occupational category was compared with the expected number of cases based on the entire Finnish population to generate standardized incidence ratios (SIRs) and standard mortality ratios (SMRs). Results and limitations Occupations were found that had significant differences in the incidence of localized (SIR loc ) and advanced (SIR adv , SMR adv ) BCa and DSM. Male chemical process workers (SIR loc /SIR adv : 5.19; 95% confidence interval [CI], 1.73–25.7), male military personnel (SIR loc /SIR adv : 6.4; 95% CI, 1.09–259.0), and male public safety workers (SIR loc /SIR adv : 1.77; 95% CI, 1.04–3.23) had significantly more localized than advanced tumors. In contrast, miscellaneous construction workers had more advanced than localized cancers for both genders (male SIR loc /SIR adv : 0.67; 95% CI, 0.53–0.86; female SIR loc /SIR adv : 0.12; 95% CI, 0.09–0.54). Male chemical process workers had fewer deaths from BCa than expected from advanced tumors (SMR adv : 0.32; 95% CI, 0.07–0.94), and miscellaneous constructions workers had more deaths from advanced tumors than expected (male SMR adv : 1.44; 95% CI, 1.10–1.85; female SMR adv : 3.35; 95% CI, 1.23–7.30). Limitations of this study are failure to control accurately for the effects of smoking and a lack of specific treatment information. Conclusions Occupations exist that may differ in their risks for localized and advanced BCa and for DSM. Patient summary Occupations have been identified that may have different patterns of bladder cancer than expected. These findings may be explained by confounding factors such as exposure to tobacco smoke; however, it could be that workers with these job titles are exposed to specific bladder carcinogens.
Databáze: OpenAIRE
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