Document nez57mB6yvRK1NB3g9o8nMKz

American Journal of Hematology 38:147-149 (1991) Occupational Risk for Hematological Malignancies Paolo Pasqualetti, Raffaele Casale, Domenico Colantonio, and Antonio Collacciani Department of Internal Medicine, School of Medicine and Surgery, Chair of M e d i i 1 Patho@y, Universlty of CAquiia (P.P..R.C.. D.C.) and Division of Internal Medicine, Section of Hematology, General Hospital of Aveuano (A.C.), L`Aquila, Italy A casecontrol study was conducted in 620 cases of hematological malignanciesand In 1.240 age- and sex-matched controls in order to verify the possible association between occupation, toxic substances exposure, and the risk of hematological neoplasia& The results demonstrate that farmers and Industrial workers have a significant risk for hematological malignancies. Exposure to asbestos, aromatic hydrocarbons, fertlllzers, mlneraloils,pesticides,and radiations is associatedwith a signMcant increaseinthe rlsk for thcur malignantdiseases. mesa data are in agreement with previously reporteddata, and requlre a confirmation in larger, praspectlve studies. Key words: occupation, exposureto toxic substances, casecontrolstudy, epidemiology INTRODUCTION nomic status 1-3_1.. area of residence, alcohol intake, otci[tinr2ocoev]cuTAnn,eunadhsbptl.terucaiirgtateTiiaissstonhehtknec-ei[arsiItfdel]happfe,cefeernatorrpoaccecpnoretneosodsntrrsohttsiaissfbaotegivlusnveecedeapasyornrbseafocseelvoweemcreincasasniisaniovststcuoniicroegaooibrnglnnnleeycbmddsrueeuteeetneacawsnddtttshteieeiamsndterloegnasaatietonteniitxmcdndrpicobaaluoatwrusepcditedncae4e*udt.r.ri[nt$0oh1-%ttni1oos.,'--tfst(ttohho5ruxoeeb9bEimya%cjxec1hpc)cts,hatoo2uswdes4;bsiue0irmsenrrtveeraotescehnkoloreacibntntebootitsgeavrt.eoi,hennolOcesec.urudecircnxturadetppoesinoraefrtesvtsiceot,iohetdrtlnehwypate,osrl6eiw2novtw0fonhiooexeecrurirmeacosesaraoesptscmiruioc1onobun,vt0rspeiwet5dara4vaetonisdifoce(one8wabs,5bstyl%a,aiwnsi)3tndte6heoori6deefff exposure to occupatioqil toxic substances, and risk of hematological malignancies. grouped in 21 risk categories, such as reported by Moms et al. [4]. A matched-pair analysis was used with the relative risk of hematological malignancies estimated by : the odds ratio (OR) of discordant pairs (b/c); and the PATIENTS, CONTROLS, AND METHODS confidence intervals at 95% of probability (95%CI)were A total of 620 cases of hematological malignancies, 355 males and 275 females, ages ranging from 24 to 85 years, and 1,240 sex- and age-matched hospital controls were considered for the study. Among the patients, there were 59 cases with acute non-lymphoblastic leukemia (ANLL), 29 with acute lymphoblastic leukemia (ALL), computed on the basis of the normal approximation; the statistical significance of each association was calculated using the "Mantel's chi-square test," with a degree.of freedom; finally, also the etiological fraction of each association was calculated [ 5 ] .All these procedures have been reported previously in detail [6]. 65 with chronic lymphocytic leukemia (CLL), 69 with Hodgkin disease (HD), 108 with non-Hodgkin lym- RESULTS phoma (NHL), 44 with myeloproliferative syndromes (MPS), 48 with rnyelodysplatic syndromes (MDS),198 with malignant monoclonal gammopathies (MG), 190 Table I summarizes the results. No significant ( P > 0.05) association was demonstrated for socioeco- multiple myeloma, and 8 with Waldenstrom's macroglo- bulinemia. The controls were. selected from the same Received for publication March 28, 1991; accepted April 8. 1 9 9 1 geographic areas as .the cases, and were affected with "medical diseases," except cancer or congenital diseases. All subjects, cases and controls, were interviewed, without knowledge of subject's state, about socioeco- Address reprint requests to Paolo Pasqualetti, M.D., Department of Internal Medicine. School of Medicine and Surgery, Chair of Medical Pathology, University of L'Aquila, Via san Sisto, n.2ZE. 1-67100 L'Aquiia, Italy. 0 1991 Wiley-Liss, Inc. I ! 148 Brief Report: Pasqualetti et al. TABLE 1. Association Between Socloeconomk Status, Occupation,Occupational Exposures, and Risk of Hematological Mallgnancies Categories of risk Cases Controls bl? OR 95% CI P Socioeconomic status High Medium LOW Residence Urban Rural Habits Alcohol Tobacco Occupations Private proctitionm office workers Teach Modicli doctors and nurses sales workers Building workers Inductry workers Handctahen Auto mechanics Railroad workers FPnners Housekeepers Oh ~posurrs Acids Aldehydes and ketones Aliphatic hydrocarboos Alkalies Aromatic hydrocarbons kcbatos Carbon monoxide Chemical asphyxiants Chlorinated hydmmbons DllStS Dyes and inks Esters Ethers Fertilizers Metals M i n d oils Organically high polymeres Other caustic substances Paints and related products Pesticides Radiation I72 245 203 326 294 256 228 55 92 16 23 18 67 105 38 8 9 143 27 19 I12 43 102 121 64 68 85 30 58 206 71 35 64 136 164 98 49 30 98 I5 I 46 402 861197 0.87 443 691164 0.84 395 811108 Iso 635 871163 1.07 605 931171 1.09 482 681162 0.84 425 761131 1.16 138 29/83 0.70 228 sa1123 0.94 58 11/24 0.92 54 18/27 1.33 43 12/26 0.92 125 39/75 I .04 178 58/39 2.97 59 21126 1.62 16 519 1.1 1 19 715 2.80 229 71/52 2.73 58 16/47 0.68 45 18/32 0.13 -225 31151 87 21150 1.21 0.84 I89 %-I67 112 258 63798. 1.29 89 42/39 2.15 59 35/23 3.04 127 58/95 1.22 74 22/59 0.75 95 3716I 1.21 376 681116 1.17 85 32/50 1.28 48 34/47 I .45 139 30175 0.80 219 44/54 1.63 319 671126 1.06 139 57/44 2.59 75 22/37 1.19 46 24/41 ' 1.17 I58 48/62 1.55 233 63/46 2.74 32 38115 5.07 (0.68 + 1.08) (0.63 + 1.11) (1.12 + 1.98) (0.83 + 1.39) (0.85 + 1.40) (0.63 i 1.11) (0.87 i 154) (0.46+ 1.07) (0.69 + 1.28) (0.45 + 1.88) (0.73 + 2.4 I ) (0.'47 + 1.82) (0.71 f 1.53) ( I .98 9 4.46) (0.91 + 2.88) (0.37 f 3.3 I ) (0.89 f 8.83) (1.91 f 3.91) (0.39 + 1.20) (0.63 f2.01) (0.77 + 1.89) (050 t 1.40) (0.83 f 1.80) (0.94 t 1.77) (1.39 t 3.32) (1.79 i5.14) (0.88 f 1.69) (0.46 f 1.22) (0.81 f 1.82) (0.87 i158) (1.11 f 1.99) (0.93 + 2.25) (0.53 + 1.22) (1.09 + 2.43) (0.75 f 1.43) (1.75 f 3.84) (0.70 f2.02) (0.71 f 1.94) (1.06 f 2.26) (2.14 f 4.01) (2.00 + 12.87) ns ns ns ns ns ns ns ns ns ns ns ns ns <O.o005 ns ns ns <o.Ooo 1 ns ns ns ns ns ns co.001 <om I ns ns ns ns ns ns ns co.05 ns co.Ooo5 ns ns ns <O.o005 <O.OooI 'Discordant pain; OR = ManteCHaenszel odds ratios; 95% CI = 95% confidence intervals EF = etiological fractions. - EF, % - 33.0 6.5 8.3 - 3.8 - 2-4.8 3.8 66.3 38.3 9.9 64.3 55.2 - 11.5 17.3 - 18.0 22.5 53.5 67.1 1-8.0 17.4 14.4 21.9 3-1.0 38.7 5.7 61.4 16.0 14.5 43.8 63.5 86. I nomic status, area of residence, and habits. Among the cases, there was a significant (P < 0.05) excess of individuals employed in agriculture and in industry. Regarding toxic substances exposure, significant associations ( P C 0.05) were demonstrated for asbestos, fertilizers, aromatic hydrocarbons, mineral oils, pesticides, and radiations. When the occupational exposures were analyzed with respect to each hematological malignancy, significant associations were found between asbestos and MG (OR = 4.61; 958CI: 1.63 + 12.30; P < 0.02) and CLL (OR = 4.71;95%CI: 1.23 + 18.05;P < 0.05); between fertilizers and MG (OR = 3.13; 95%CI: 1.33 + 7.19; P < 0.05); between aromatic hydrocarbons and ANLL (OR = 5.28; 95%CI: 2.13 i 13.64;P C 0.05); between mineral oils and NHL (OR = 3.4; 958CI: I .65 + 7.38; Brief Report: Occupation and Hematological Malignancies 149 p c 0.02).and MG (OR= 3.00;95%CI: 1.53 + 6.22; certain environmental factor capable of inducing cancer P c 0.01);between pesticides and NHL (OR = 4.40; in humans [1,2]. 95%CI: 1.54 + 12.67;P C 0.05), CLL (OR = 4.00; In conclusion, further special attention might be paid 95%CI: 1.52 + 10.73;P < 0.05).and MG (OR = 3.55; to these substances in occupational epidemiological stud95%CI: 1.58 + 7.33;P C 0.01);and between radiations ies of workers, especially with respect to hematological and MG (OR = 10.00 95%CI: 3.00 f 33.84; malignancies; nevertheless, further research appears warP C 0.01).Work in agriculture was associated signifi- ranted to assess the strength of any association in cantly ( P C 0.05) with each malignant hematological prospective, larger population-based studies. disease. DISCUSSION This study extends our previous investigation [6],and REFERENCES I . Davis DL,Hoel D, Fox 1. Lopet A lntemational Wends in cancer mortality in France. West Gen~~anIyta,ly, Japan. England and Wales. the results are in agreement with previously reported data [2'4*68i*suggesting a pational exposures and the risk of hematologiscoaml neeOocpClau-- sias. Despite the potential limitations to the case-referent studies [4,5],the observation that the farmers have been and the USA. k+ncet 1~474.19x1. 2. Doll R. Pet0 R: The causes of cancc, quantitative estimates of avoidable fishof he United Stam t h y . JNCI 66:1 192, 1981. 3. Liberat& p, BG, ~~l~~ JL: -mmnB of social in epidemiology. Epidemiol Rev 1087, 1988. found to be at hi& risk in many studies supporn he that are exposed to `gens* such as Or pesticides [1,4,6,71, as to carcinogen zoonotic viruses [7].Workers in indus- try are exposed to many potential carcinogens for blood 4. Morris PD. Koepsell TD, Daling JR. Taylor JW. 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