Finished thinking
Young E, Kreiger N, Purdham J, Sass-Kortsak A.
International Archives of Occupational and Environmental Health. 2009;82(5):551-6. doi:10.1007/s00420-009-0403-z.
Purpose: To summarize the literature on the risk of prostate cancer in whole body vibration (WBV) related occupations and estimate a combined meta-rate ratio.
Methods: A systematic review and meta-analysis of five case-control and three cohort studies published between 1996 and 2004 was conducted. A pooled relative risk (RR) estimate was calculated and the studies were evaluated for homogeneity and publication bias.
Results: The overall pooled RR estimate was 1.14 (95% CI 0.99-1.30) for the random effects model, based on 17 estimates of relative risk from the eight studies. Significant heterogeneity was found. There was no indication of publication bias.
Conclusions: The increased, though not statistically significant pooled RR for prostate cancer obtained in this meta-analysis indicates that occupational exposure to WBV cannot be ruled out as a possible risk factor for the disease. However, all included studies involved driving occupations with exposure to other risk factors for prostate cancer. Therefore, further epidemiologic studies are needed to better understand this association.
Sass-Kortsak AM, Purdham JT, Kreiger N, Darlington G, Lightfoot NE.
American Journal of Industrial Medicine. 2007;50(8):568-76. doi:10.1002/ajim.20495.
Background: Occupational risk factors for prostate cancer have been investigated with inconsistent findings.
Methods: This was a population-based case-control study of men in Northeastern Ontario, Canada. Cases (n = 760) were from the Ontario Cancer Registry, 50 to 84 years old, and diagnosed with prostate cancer between 1995 and 1998. Age-frequency matched controls (n = 1,632) were obtained from telephone listings. A questionnaire yielded information on occupational history and self-reported exposures to a list of occupational hazards. Exposures to these hazards were assessed by an occupational hygienist.
Results: An odds ratio estimate (OR) of 1.21 (95 percent confidence interval (% CI) 1.01, 1.46) was found for employment in trades, transport and equipment operators and related occupations, possibly related to exposure to whole-body vibration (OR = 1.38, 95% CI 1.07, 1.78). For the highest quartile of lifetime cumulative workplace physical activity an OR of 1.33 (95% CI 1.02, 1.74) was found. No statistically significant associations were found for any other occupational category or exposure.
Conclusions: This study does not provide strong evidence for significant occupational risk factors for prostate cancer. However, whole-body vibration exposures, as well as physical activity, may be worth pursuing in future occupational studies.
Carvalho RB, Carneiro MFH, Barbosa F, et al.
Environmental Science and Pollution Research International. 2018;25(19):18620-18631. doi:10.1007/s11356-018-2007-1.
Vehicles play an important role in modern life; however, they also generate hazards. Occupational exposed subjects are in long-term contact with harmful products, which sets these professionals in a susceptible group to air pollutant damage. The aims of this study were to quantify individual exposure to pollutant gases and chemical elements and to evaluate oxidative and genetic damage in professional motorcyclists and office workers. We recruited professional motorcyclists and office workers from Porto Alegre, Brazil, between January and December 2016. Individual exposure to air pollutants was assessed by passive monitoring. Fingernail trace elements were determined by using inductively coupled plasma mass spectrometry. Oxidative stress biomarkers were quantified spectrophotometrically, and genotoxicity was evaluated by micronuclei assay. Individual exposure to NO and O, trace element content (Sb, Pt, As, Cd, V, Mn, and Co), oxidative stress factors, and genetic damage were statistically higher in professional motorcyclists (p < 0.05). Moreover, NO and O levels showed very strong positive correlation with plasmatic lipid peroxidation (p < 0.001 and r = 0.8849 and 0.8995) and strong positive correlation with micronuclei frequency (p < 0.001 and r = 0.7683 and 0.7280). Results suggest that professional motorcyclists are at high risk due to long-term air pollution exposure, which implies in the onset of several harmful effects and worsening of pre-existent diseases.
Sritharan J, Demers PA, Harris SA, et al.
Cancer Epidemiology. 2017;48:96-103. doi:10.1016/j.canep.2017.04.006.
Background: The etiology of prostate cancer continues to be poorly understood, including the role of occupation. Past Canadian studies have not been able to thoroughly examine prostate cancer by occupation with detailed information on individual level factors.
Methods: Occupation, industry and prostate cancer were examined using data from the National Enhanced Cancer Surveillance System, a large population-based case-control study conducted across eight Canadian provinces from 1994 to 1997. This analysis included 1737 incident cases and 1803 controls aged 50 to 79 years. Lifetime occupational histories were used to group individuals by occupation and industry employment. Odds ratios and 95% confidence intervals were calculated and adjustments were made for known and possible risk factors.
Results: By occupation, elevated risks were observed in farming and farm management (OR=1.37, 95% CI 1.02-1.84), armed forces (OR=1.33, 95% CI 1.06-1.65) and legal work (OR=2.58, 95% CI 1.05-6.35). Elevated risks were also observed in office work (OR=1.20, 95% CI 1.00-1.43) and plumbing (OR=1.77, 95% CI 1.07-2.93) and with ≥10 years duration of employment. Decreased risks were observed in senior management (OR=0.65, 95% CI 0.46-0.91), construction management (OR=0.69, 95% CI 0.50-0.94) and travel work (OR=0.37, 95% CI 0.16-0.88). Industry results were similar to occupation results, except for an elevated risk in forestry/logging (OR=1.54, 95% CI 1.06-2.25) and a decreased risk in primary metal products (OR=0.70, 95% CI 0.51-0.96).
Conclusion: This study presents associations between occupation, industry and prostate cancer, while accounting for individual level factors. Further research is needed on potential job-specific exposures and screening behaviours.
Sharpe CR, Siemiatycki J, Parent ME.
Cancer Epidemiology, Biomarkers & Prevention : A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. 2001;10(8):855-60.
The objective of this study was to identify activities and exposures during leisure that might be associated with the development of prostate cancer. We analyzed data derived from a population-based case-control study that was carried out in Montreal between 1979 and 1985. Men (>4000) were interviewed, including cases of prostate cancer, other cancers, and population controls. The present analysis was restricted to the subset, aged 45-70 years, who underwent face-to-face interviews in which aspects of activities and exposures during leisure were ascertained. There were 400 incident cases of prostate cancer and 476 population controls. We calculated odds ratios (OR) for prostate cancer, adjusted for age, ethnic origin, respondent status, family income, body mass index, cigarette smoking, and alcohol consumption. Home or furniture maintenance was associated with an increased risk [OR, 1.4; 95% confidence interval (CI), 1.0-1.9], as was painting, stripping, or varnishing furniture (OR, 2.1; 95% CI, 0.7-6.7). Exposure during leisure to metal dust was associated with prostate cancer (OR, 3.2; 95% CI, 1.0-9.9), as was exposure to lubricating oils or greases (OR, 2.2; 95% CI, 1.2-3.7) and exposure to pesticides or garden sprays (OR, 2.3; 95% CI, 1.3-4.2). These findings are consistent with results derived from studies of occupational exposures.
Aronson KJ, Siemiatycki J, Dewar R, Gérin M.
American Journal of Epidemiology. 1996;143(4):363-73. doi:10.1093/oxfordjournals.aje.a008750.
A population-based case-control study of cancer and occupation was carried out in Montréal, Canada. Between 1979 and 1986, 449 pathologically confirmed cases of prostate cancer were interviewed, as well as 1,550 cancer controls and 533 population controls. Job histories were evaluated by a team of chemist/hygienists using a checklist of 294 workplace chemicals. After preliminary evaluation, 17 occupations, 11 industries, and 27 substances were selected for multivariate logistic regression analyses to estimate the odds ratio between each occupational circumstance and prostate cancer with control for potential confounders. There was moderate support for risk due to the following occupations: electrical power workers, water transport workers, aircraft fabricators, metal product fabricators, structural metal erectors, and railway transport workers. The following substances exhibited moderately strong associations: metallic dust, liquid fuel combustion products, lubricating oils and greases, and polyaromatic hydrocarbons from coal. While the population attributable risk, estimated at between 12% and 21% for these occupational exposures, may be an overestimate due to our method of analysis, even if the true attributable fraction were in the range of 5-10%, this represents an important public health issue.
Zeegers MP, Friesema IH, Goldbohm RA, van den Brandt PA.
Journal of Occupational and Environmental Medicine. 2004;46(3):271-9. doi:10.1097/01.jom.0000116961.48464.6b.
A wide variety of occupations has been associated with prostate cancer in previous retrospective studies. Most attention has been paid to farming, metal working, and the rubber industry. Today, these results cannot be affirmed with confidence, because many associations could be influenced by recall bias, have been inconsistent, or have not been confirmed satisfactory in subsequent studies. This study was conducted to investigate and confirm these important associations in a large prospective cohort study. The authors conducted a prospective cohort study among 58,279 men. In September 1986, the cohort members (55-69 years) completed a self-administered questionnaire on potential cancer risk factors, including job history. Related job codes were clustered in professional groups. These predefined clusters were investigated in 3 time windows: 1) profession ever performed, 2) longest profession ever held, and 3) last profession held at baseline. Follow up for incident prostate cancer was established by linkage to cancer registries until December 1993. A case-cohort approach was used based on 830 cases and 1525 subcohort members. To minimize false-positive results, 99% confidence intervals (99% CI) were calculated. Although moderately decreased prostate cancer risks were found for electricians, farmers, firefighters, woodworkers, textile workers, butchers, salesmen, teachers, and clerical workers, none of the relative risks (RR) were found to be statistically significant. For road transporters, metal workers, and managers, no association with prostate cancer risk was found. Although the RR for railway workers, mechanics, welders, chemists, painters, and cooks was moderately increased, these estimates were not statistically significant. For men who reported to have ever worked in the rubber industry, we found a substantially increased prostate cancer risk, but not statistically significant (RR, 4.18; 99% CI = 0.22-80.45). For policemen, we found a substantial and marginally statistically significant increased prostate cancer risk, especially for those who reported working as a policeman for most of their occupational life (RR, 3.91; 99% CI = 1.14-13.42) or as the last profession held at baseline (RR, 4.00; 99% CI = 1.19-13.37). Most of the previously investigated associations between occupation and prostate cancer risk could not be confirmed with confidence in this prospective study. The lack of statistical significance for rubber workers could be caused by the scarcity of rubber workers in this cohort and subsequent lack of power. The results for policemen were substantial and statistically significant, although a conservative value for significance level was used.
Giovannucci E, Liu Y, Platz EA, Stampfer MJ, Willett WC.
International Journal of Cancer. 2007;121(7):1571-8. doi:10.1002/ijc.22788.
Risk factors for prostate cancer could differ for various sub-groups, such as for "aggressive" and "non-aggressive" cancers or by grade or stage. Determinants of mortality could differ from those for incidence. Using data from the Health Professionals Follow-Up Study, we re-examined 10 factors (cigarette smoking history, physical activity, BMI, family history of prostate cancer, race, height, total energy consumption, and intakes of calcium, tomato sauce and alpha-linolenic acid) using multivariable Cox regression in relation to multiple subcategories for prostate cancer risk. These were factors that we previously found to be predictors of prostate cancer incidence or advanced prostate cancer in this cohort, and that have some support in the literature. In this analysis, only 4 factors had a clear statistically significant association with overall incident prostate cancer: African-American race, positive family history, higher tomato sauce intake (inversely) and alpha-linolenic acid intake. In contrast, for fatal prostate cancer, recent smoking history, taller height, higher BMI, family history, and high intakes of total energy, calcium and alpha-linolenic acid were associated with a statistically significant increased risk. Higher vigorous physical activity level was associated with lower risk. In relation to these risk factors, advanced stage at diagnosis was a good surrogate for fatal prostate cancer, but high-grade (Gleason >/= 7 or Gleason >/= 8) was not. Only for high calcium intake was there a close correspondence for associations among high-grade cancer, advanced and fatal prostate cancer. Tomato sauce (inversely) and alpha-linolenic acid (positively) intakes were strong predictors of advanced cancer among those with low-grade cancers at diagnosis. Although the proportion of advanced stage cancers was much lower after PSA screening began, risk factors for advanced stage prostate cancers were similar in the pre-PSA and PSA era. The complexity of the clinical and pathologic manifestations of prostate cancer must be considered in the design and interpretation of studies.
Wigle DT, Turner MC, Gomes J, Parent ME.
Journal of Toxicology and Environmental Health. Part B, Critical Reviews. 2008;11(3-4):242-59. doi:10.1080/10937400701873548.
American men have a lifetime risk of about 18% for prostate cancer diagnosis. Large international variations in prostate cancer risks and increased risks among migrants from low- to high-risk countries indicate important roles for environmental factors. Major known risk factors include age, family history, and country/ethnicity. Type 2 diabetes appears to reduce risk, while high birth weight and adult height are linked to increased risk of aggressive prostate cancer. Limited evidence supports an association with a history of sexually transmitted infections. A previous meta-analysis of eight cohort studies indicated no associations with plasma androgen, estrogen, or sex hormone binding globulin (SHBG) levels. However, there were dose-response relationships with baseline plasma testosterone levels in two studies that adjusted for other serum hormones and obesity. Finasteride (a drug that blocks testosterone activation) reduced prostate cancer risk by 25%. Low-frequency genes linked to familial prostate cancer only explain a small fraction of all cases. Sporadic cases were linked to relatively common polymorphisms of genes involved in (1) androgen synthesis, activation, inactivation and excretion, (2) hormone and vitamin D receptors, (3) carcinogen metabolism, and (4) DNA repair. Epidemiologic evidence supports protective roles for dietary selenium, vitamin E, pulses, tomatoes/lycopene, and soy foods, and high plasma 1,25-dihydroxyvitamin D levels. There is inadequate evidence that vegetables, fruit, carotenoids, and vitamins A and C reduce risk and that animal fat, alpha-linoleic acid, meat, coffee, and tea increase risk. Two major cohort studies found dose-response relationships with dietary calcium intake. Total dietary energy intake may enhance risk. Limited evidence supports a protective role for physical activity and elevated risk for farmers and other men with occupational pesticide exposure, particularly to organochlorine compounds and phenoxy herbicides. There is inadequate evidence for a relationship with alcohol or smoking. Most known or suspected external risk factors may act through hormonal mechanisms, but our review found little supporting evidence, and substantial further research is needed.