Finnish woodworkers

A case-control study of respiratory cancer, nested within a cohort of male woodworkers, was updated in Finland. The update extended the initial follow up of 3805 workers from 19 plants to 7307 workers from 35 plants. Each case of respiratory cancer (n = 136) diagnosed between 1957 and 1982 within the cohort was matched by year of birth with three controls (n = 408) from the cohort. Chemical exposures were assessed for the cases and the controls by a plant and period specific job exposure matrix. An excess ofrespiratory cancer was associated with phenol. Concomitant exposures to several other agents occurred as well, however, and no exposure-response relation for phenol was seen. An excess risk and an increasing exposure-response relation were found for engine exhaust from petrol and diesel driven factory trucks. The excess risk associated with pesticides was lower than in our previous study, an indication ofqualitative and quantitative differences in exposure between the initial and augmented cohorts. Slightly increased risks were found for terpenes and mould spores, which may be due to chance although the contribution of occupational exposure cannot be ruled out. Exposure to wood dust, mainly from pine, spruce and birch, at a level of about 1 mg/m3, was not associated with lung cancer, upper respiratory cancer, or adenocarcinoma of the lung. (British Journal of Industrial Medicine 1993;50:143-148) Furniture workers have been shown to have an excess risk of nasal cancer in many studies from different countries.' The relative risks have been 10-fold or I Nickels, R A Luukkonen, T R Hakulinen, even higher, especially for nasal adenocarcinomas.' Slightly lower and less consistent risks have been found among carpenters and other woodworkers. The probable cause of these excesses is exposure to wood dust,'3 but neither the causative agents in the dust nor the hazardous species of wood have been identified conclusively. Although mainly oak, beech, mahogany, and other hardwood species have been processed by the workers studied,4 exposure to species of softwood cannot be ruled out as a risk factor.5 Because a significant proportion of the inhaled wood dust is transported to the lungs, woodworkers may also have an increased risk of lung cancer. Epidemiological publications are inconsistent, however. Some studies showed an excess of lung cancer among woodworkers"' whereas others did not."'0 There are indications that the increased lung cancer may, parallel to nasal cancer, concern mainly adenocarcinomatous tumours. In a United States case-control study of lung cancer, the odds ratios for adenocarcinomas among carpenters and cabinet and furniture makers were higher than for other histological types of lung cancer.8 Lung cancer is potentially an important occupational disease among woodworkers. Should there be even a small work related excess among woodworkers, the absolute number of lung cancer cases caused by occupational exposure easily overshadows that of nasal cancers. So far the associations between cancer and specific exposures encountered in the wood industry have rarely been scrutinised. As well as wood dust, many other agents related to gluing (formaldehyde, phenol, melamine, etc), wood preservation (chlorophenols, arsenic compounds, chromium compounds, other pesticides), surface treatment (solvents, pigments) or other activities (engine exhaust, terpenes, etc) are present in the wood processing facilities. The objective of the present study was to investigate associations between chemical agents in the wood industry and respiratory cancer. The associations were studied conditionally on potential confounding factors (smoking, vital status), grade of exposure, and the induction period of the disease. This paper reports the results of chemical exposures other than formaldehyde. Formaldehyde has been Institute of Occupational Health, Helsinki, Finland T P Kauppinen, T J Partanen, S G Hernberg, J I Nickels, R A Luukkonen The Finnish Cancer Registry, Helsinki, Finland T R Hakulinen, E I Pukkala 143 group.bmj.com on October 19, 2017 Published by http://oem.bmj.com/ Downloaded from