TY - JOUR
T1 - Diesel exhaust and bladder cancer risk by pathologic stage and grade subtypes
AU - Koutros, Stella
AU - Kogevinas, Manolis
AU - Friesen, Melissa C.
AU - Stewart, Patricia A.
AU - Baris, Dalsu
AU - Karagas, Margaret R.
AU - Schwenn, Molly
AU - Johnson, Alison
AU - Monawar Hosain, G. M.
AU - Serra, Consol
AU - Tardon, Adonina
AU - Carrato, Alfredo
AU - Garcia-Closas, Reina
AU - Moore, Lee E.
AU - Nickerson, Michael L.
AU - Hewitt, Stephen M.
AU - Lenz, Petra
AU - Schned, Alan R.
AU - Lloreta, Josep
AU - Allory, Yves
AU - Zhang, Haoyu
AU - Chatterjee, Nilanjan
AU - Garcia-Closas, Montserrat
AU - Rothman, Nathaniel
AU - Malats, Núria
AU - Silverman, Debra T.
N1 - Funding Information:
The authors thank Dr. Francisco X. Real for his contribution to the Spanish Bladder Cancer Study and molecular characterization of tumors. This work was supported by the Intramural Research Program of the National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics (Z01 CP010121-23 and Z01 CP010125-23). The authors declare no competing financial interests.
Funding Information:
This work was supported by the Intramural Research Program of the National Institutes of Health , National Cancer Institute , Division of Cancer Epidemiology and Genetics ( Z01 CP010121-23 and Z01 CP010125-23 ).
Publisher Copyright:
© 2019
PY - 2020/2
Y1 - 2020/2
N2 - Background: The International Agency for Research on Cancer (IARC) classifies diesel engine exhaust as carcinogenic to humans based on sufficient evidence for lung cancer. IARC noted, however, an increased risk of bladder cancer (based on limited evidence). Objective: To evaluate the association between quantitative, lifetime occupational diesel exhaust exposure and risk of urothelial cell carcinoma of the bladder (UBC) overall and according to pathological subtypes. Methods: Data from personal interviews with 1944 UBC cases, as well as formalin-fixed paraffin-embedded tumor tissue blocks, and 2135 controls were pooled from two case-control studies conducted in the U.S. and Spain. Lifetime occupational histories combined with exposure-oriented questions were used to estimate cumulative exposure to respirable elemental carbon (REC), a primary surrogate for diesel exhaust. Unconditional logistic regression and two-stage polytomous logistic regression were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for smoking and other risk factors. Results: Exposure to cumulative REC was associated with an increased risk of UBC; workers with cumulative REC >396 μg/m3-years had an OR of 1.61 (95% CI, 1.08–2.40). At this level of cumulative exposure, similar results were observed in the U.S. and Spain, OR = 1.75 (95% CI, 0.97–3.15) and OR = 1.54 (95% CI, 0.89–2.68), respectively. In lagged analysis, we also observed a consistent increased risk among workers with cumulative REC >396 μg/m3-years (range of ORs = 1.52–1.93) for all lag intervals evaluated (5–40 years). When we accounted for tumor subtypes defined by stage and grade, a significant association between diesel exhaust exposure and UBC was apparent (global test for association p = 0.0019). Conclusions: Combining data from two large epidemiologic studies, our results provide further evidence that diesel exhaust exposure increases the risk of UBC.
AB - Background: The International Agency for Research on Cancer (IARC) classifies diesel engine exhaust as carcinogenic to humans based on sufficient evidence for lung cancer. IARC noted, however, an increased risk of bladder cancer (based on limited evidence). Objective: To evaluate the association between quantitative, lifetime occupational diesel exhaust exposure and risk of urothelial cell carcinoma of the bladder (UBC) overall and according to pathological subtypes. Methods: Data from personal interviews with 1944 UBC cases, as well as formalin-fixed paraffin-embedded tumor tissue blocks, and 2135 controls were pooled from two case-control studies conducted in the U.S. and Spain. Lifetime occupational histories combined with exposure-oriented questions were used to estimate cumulative exposure to respirable elemental carbon (REC), a primary surrogate for diesel exhaust. Unconditional logistic regression and two-stage polytomous logistic regression were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for smoking and other risk factors. Results: Exposure to cumulative REC was associated with an increased risk of UBC; workers with cumulative REC >396 μg/m3-years had an OR of 1.61 (95% CI, 1.08–2.40). At this level of cumulative exposure, similar results were observed in the U.S. and Spain, OR = 1.75 (95% CI, 0.97–3.15) and OR = 1.54 (95% CI, 0.89–2.68), respectively. In lagged analysis, we also observed a consistent increased risk among workers with cumulative REC >396 μg/m3-years (range of ORs = 1.52–1.93) for all lag intervals evaluated (5–40 years). When we accounted for tumor subtypes defined by stage and grade, a significant association between diesel exhaust exposure and UBC was apparent (global test for association p = 0.0019). Conclusions: Combining data from two large epidemiologic studies, our results provide further evidence that diesel exhaust exposure increases the risk of UBC.
KW - Bladder cancer
KW - Diesel exhaust
KW - Occupation
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U2 - 10.1016/j.envint.2019.105346
DO - 10.1016/j.envint.2019.105346
M3 - Article
C2 - 31864026
AN - SCOPUS:85076625937
SN - 0160-4120
VL - 135
JO - Environment international
JF - Environment international
M1 - 105346
ER -