International Journal of Epidemiology 2000;29:238-247
© International Epidemiological Association 2000
Occupational risk factors for urothelial carcinoma: agent-specific results from a case-control study in Germany
a Medical Institute for Environmental Hygiene at the Heinrich Heine University of Düsseldorf, Germany.
b Institute of Medical Epidemiology, Biometry and Medical Informatics at the Martin Luther University, Halle, Germany.
c Institute for Kidney and Hypertension Research, Berlin, Germany.
d Bremen Institute for Prevention Research and Social Medicine, Bremen, Germany.
e Collaborators of the Multicenter Urothelial and Renal Cancer Study (MURC Study Group): Wolfgang Barth, Uta Brettschneider, Elisabeth Bronder,
Reprint requests to: Beate Pesch, Unit of Environmental Epidemiology, Medical Institute for Environmental Hygiene, Auf'm Hennekamp 50, 40225 Düsseldorf, Germany.
Background This multicentre population-based case-control study was conducted to estimate the urothelial cancer risk for occupational exposure to aromatic amines, polycyclic aromatic hydrocarbons (PAH), and chlorinated hydrocarbons besides other suspected risk factors.
Methods In a population-based multicentre study, 1035 incident urothelial cancer cases and 4298 controls matched for region, sex, and age were interviewed between 1991 and 1995 for their occupational history and lifestyle habits. Exposure to the agents under study was self-assessed as well as expert-rated with two job-exposure matrices and a job task-exposure matrix. Conditional logistic regression was used to calculate smoking adjusted odds ratios (OR) and to control for study centre and age.
Results Urothelial cancer risk following exposure to aromatic amines was only slightly elevated. Among males, substantial exposures to PAH as well as to chlorinated solvents and their corresponding occupational settings were associated with significantly elevated risks after adjustment for smoking (PAH exposure, assessed with a job-exposure matrix: OR = 1.6, 95% CI : 1.1–2.3, exposure to chlorinated solvents, assessed with a job task-exposure matrix : OR = 1.8, 95% CI : 1.2–2.6). Metal degreasing showed an elevated urothelial cancer risk among males (OR = 2.3, 95% CI : 1.4–3.8). In females also, exposure to chlorinated solvents indicated a urothelial cancer risk. Because of small numbers the risk evaluation for females should be treated with caution.
Conclusions Occupational exposure to aromatic amines could not be shown to be as strong a risk factor for urothelial carcinomas as in the past. A possible explanation for this finding is the reduction in exposure over the last 50 years. Our results strengthen the evidence that PAH may have a carcinogenic potential for the urothelium. Furthermore, our results indicate a urothelial cancer risk for the use of chlorinated solvents.
Keywords Bladder cancer, urothelial cancer, case-control study, aromatic amines, polycyclic aromatic hydrocarbons (PAH), chlorinated solvents, job-exposure matrix
Accepted 29 September 1999
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