Environmental and occupational risk factors of lung cancer: a case-control study

Öz

Aim: Lung cancer has been demonstrated to be caused by several occupational and environmental exposures. We conducted a large case–control study to evaluate exposure to known and suspected carcinogens and by performing an exploratory analysis.
Material and Method: This study is a Case / Control study. Between January 2009 and March 2014, 57 (9.1%) women, 572 (90.9%) men, a total of 629 cases who had primary lung cancer and 219 volunteers were included without selection. Data of sociodemographic features, environmental and occupational history and specific exposures (asbestos, silica, chemical and organic substances), physical activity properties and dietary factors were evaluated.
Results: There was no difference between the subjects and the control group in terms of age, gender, education level, and income. Smoking and pack / year were higher than the control group (p <0.001). Occupational and environmental exposure to asbestos and indoor air pollution (biomass and radon), exposure to occupational risk factors such as exhaust gas, organic dust, silica, pesticides and metal fumes was significantly higher than control group (p<0.001). In logistic regression analysis, low fruit and vegetable consumption (p<0.001, OR:21.998, 95%CI=8.408-57.552), working in agriculture and animal husbandry (p=0.007, OR:5.158, 95%CI=1.571-16.934), being a worker in industrial sector (p=0.013, OR:6.751, 95%CI=1.494-30.504), cigarette smoking, (p=0.033, OR: 1.782, 95%CI=1.09-3.029) and tobacco use (packyears) (p<0.001, OR:1.053, 95% CI=1.038-1.069) were determined as independent risk factors.
Conclusion: Determining various risk factors that may have a place in the etiology of lung cancer is important in terms of finding a place of use in preventive medicine and screening.
Keywords: Lung cancer, occupational exposure, risk factors

Anahtar Kelimeler

• Lung cancer
• occupational exposure
• risk factors

Akciğer Kanseri Tanılı Hastalarda Çevresel ve Mesleki Risk Faktörlerinin Değerlendirilmesi: Bir Olgu Kontrol Çalışması

Öz

Giriş: Akciğer kanseri, dünyada en sık görülen kanser türüdür. Sigara gibi temel etmenin dışında birçok etkenin patofizyolojide yer almaktadır. Bu çalışma ile akciğer kanseri için mesleki ve çevresel maruz kalım özelliklerin değerlendirilmesi amaçlanmıştır. Yöntemler: Çalışmamız kesitsel olgu/kontrol çalışmasıdır. Ocak 2009 ve Mart 2014 tarihleri arasında primer akciğer kanseri almış 57 kadın, 572 erkek toplam 629 olgu ve 219 gönüllü olgu seçimi yapılmadan dahil edilmiştir. Olguların sosyodemografik bulguları, çevresel ve mesleksel maruziyet oluşturacak etkenleri, spesifik maruz kalımları (asbest, silika, kimyasal ve organik madde), tütün kullanım öyküleri değerlendirilmiştir. Çoklu Değişkenli Lojistik Regresyon analizi kullanılarak grupları birbirinden ayırt etmede en fazla belirleyiciliği olan risk faktörleri tespit edildi. Bulgular: Olgular ile kontrol grubu arasında yaş, cinsiyet, eğitim durumu, gelir açısından fark yoktu. Sigara içme durumu ve paket yıl kontrol grubuna göre yüksek izlendi (p<0.001). Mesleki ve çevresel asbest maruz kalımı, iç ortam hava kirliliği (biomass ve radon), egzoz gazı, organik toz, silika, tarım ilacı ve metal dumanı gibi mesleksel risk faktörlerine olan maruziyet anlamlı düzeyde daha yüksekti (p<0,001). Lojistik regresyon analizinde meyve tüketmeme (p<0,001, OR:21,998, %95 CI=8,408-57,552), tarım ve hayvancılıkla uğraşmak (p=0,007, OR:5,158, %95 CI=1,571-16,934), işçi olmak (p=0,013, OR:6,751, %95 CI=1,494-30,504), tütün kullanımı (p=0,033, OR:1,782, %95 CI=1,09-3,029) ve tütün kullanım miktarı (p<0,001, OR:1,053, %95 CI=1,038-1,069) bağımsız risk faktörleri olarak saptandı. Sonuç: Akciğer kanseri etiyolojisinde tütün kullanımı, artmış tütün kullanım miktarı, meyve tüketmeme, işçi olmak ve tarım hayvancılıkla uğraşmak bağımsız birer risk faktörü olarak bulunmuştur. Akciğer kanserinin etiyolojisinde yeri olabilecek çeşitli risk faktörlerinin saptanması önleyici hekimlik alanında ve taramada kullanım yeri bulması açısından önemlidir.

Anahtar Kelimeler

• : Akciğer kanseri
• mesleki maruziyet
• risk faktörleri

Kaynakça

1. Alberg AJ, Ford JG, Samet JM. Epidemiology of lung cancer. Chest 2007; 132:29S-55S.
2. Devesa SS, Diamond EL. Socioeconomic and racial differences in lung cancer incidence. Am J Epidemiol. 1983; 118 ( 6 ): 818 - 831.
3. Van Loon AJ, Goldbohm RA, Kant IJ, Swaen GM, Kremer AM, vanden Brandt PA. Socioeconomic status and lung cancer incidence in men in The Netherlands: is there a role for occupational exposure? J Epidemiol Community Health. 1997; 51 ( 1 ): 24 - 29.
4. Ou SH, Zell JA, Ziogas A, Anton-Culver H. Low socioeconomic status is a poor prognostic factor for survival in stage I nonsmall cell lung cancer and is independent of surgical treatment, race, and marital status. Cancer. 2008; 112 ( 9 ): 2011 - 2020.
5. Tardon A, Lee WJ, Delgado-Rodriguez M, et al. Leisure- time physical activity and lung cancer: a meta-analysis. Cancer Causes Control. 2005; 16 ( 4 ): 389 - 397.
6. Straif K, Benbrahim-Tallaa L, Baan R, et al; WHO International Agency for Research on Cancer Monograph Working Group. A review of human carcinogens—part C: metals, arsenic, dusts, and fibres. Lancet Oncol. 2009; 10( 5 ):4 53- 4 54.
7. Olsson AC, Gustavsson P, Kromhout H, et al. Exposure to diesel motor exhaust and lung cancer risk in a pooled analysis from case-control studies in Europe and Canada. Am J Respir Crit Care Med. 2011; 183 ( 7 ): 941 - 948.
8. International Agency for Research on Cancer (IARC). Monographs on the Evaluation of Carcinogenic Risks to Humans. Vol 68: Silica, Some Silicates, Coal Dust and Para- aramid Fibrils. Lyon, France: World Health Organization, IARC; 1997.

9. Fakhri G, Al Assaad M, Tfayli A. Association of various dietary habits and risk of lung cancer: an updated comprehensive literature review. Tumori. 2020 Dec;106(6):445-456. doi: 10.1177/0300891619900675. Epub 2020 Mar 4. PMID: 32129158.
10. Tse LA, Yu IT, Qiu H, Au JS, Wang XR. Occupational risks and lung cancer burden for Chinese men: a population-based case-referent study. Cancer Causes Control. 2012 Jan;23(1):121-31. doi: 10.1007/s10552-011-9861-1. Epub 2011 Oct 22. PMID: 22037909.
11. Sato T, Shimosato T, Klinman DM. Silicosis and lung cancer: current perspectives. Lung Cancer (Auckl). 2018 Oct 26;9:91-101. doi: 10.2147/LCTT.S156376. PMID: 30498384; PMCID: PMC6207090.
12. Loomis D, Guha N, Hall AL, Straif K. Identifying occupational carcinogens: an update from the IARC Monographs. Occup Environ Med. 2018 Aug;75(8):593-603. doi: 10.1136/oemed-2017-104944. Epub 2018 May 16. PMID: 29769352; PMCID: PMC6204931.
13. Turner MC , Krewski D , Pope CA III , Chen Y , Gapstur SM ,Thun MJ . Long-term ambient fine particulate matter air pollution and lung cancer in a large cohort of never-smokers.Am J Respir Crit Care Med . 2011 ; 184 ( 12 ): 1374 - 1381.
14. Lewis SZ, Diekemper R, Addrizzo-Harris DJ.Methodology for development of guidelines for lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guide- lines. . Cilt Chest. 2013 May;143(5 Suppl):41S-50S. doi: 10.1378/chest.12-234.
15. World Cancer Research Fund. Diet, nutrition, physical activity and lung cancer.Washington, DC: World Cancer Research Fund/American Institute for Cancer Research;2017 avaible from:https://www.wcrf.org/sites/default/files/Lung-cancer-report.pdf. Cilt accessed Agust 2019.
16. International Agency for Research on Cancer(IARC) Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Man. Lyon :International Agency for Research on Cancer, volume 14, Asbestos. avaible from: https://publications.iarc.fr/32 accessed2020.
17. Aldrich MC, Selvin S, Wrensch MR ,et. al. Socioeconomic status and lung cancer: unraveling the contribution of genetic admixture. Am J Public Health. 2013 Oct;103(10):e73-80. doi: 10.2105/AJPH.2013.301370.
18. Bak H, Christensen, Thomsen BL, et al. Physical activity and risk for lung cancer in a Danish cohort. Int. J. Cancer. 2005: 116, 439–445.
19. Alberg AJ , Yung R , Strickland PT, et al . Respiratory cancer and exposure to arsenic, chromium, nickel and polycyclic aromatic hydrocarbons . Clin Occup Environ Med . 2002 ; 2 (4): 779 - 801 .
20. Brenner DR, Yannitsos DH, Farris MS, et al. Leisure-time physical activity and lung cancer risk: A systematic review and meta-analysis. Lung Cancer. 2016 May;95:17-27. doi: 10.1016/j.lungcan.2016.01.021. Epub 2016 Feb 4.
21. Cortez BA, Machadosantelli GM. Chrysotile effects on human lung cell carcinoma in culture: 3-D reconstruction and DNA quantification by image analysis. BMC Cancer. 2008;8(1):181.
22. Gariazzo C, Binazzi A, Alfò M, et al. Predictors of Lung Cancer Risk: An Ecological Study Using Mortality and Environmental Data by Municipalities in Italy. Int J Environ Res Public Health. 2021 Feb 16;18(4):1896.
23. Lacasse Y, Martin S, Simard S,et al. Meta-analysis of silicosis and lung cancer. Scand J Work Environ Health. 2005; 31 ( 6 ): 450 - 458.
24. Luce D, Stücker I. ICARE Study Group. Investigation of occupational and environmental causes of respiratory cancers (ICARE): a multicenter, population-based case-control study in France. BMC Public Health. 2011 Dec 14;11:928. doi: 10.1186/1471-2458-11-928.
25. Marinaccio A, Scarselli A, Binazzi A, et al.Magnitude of asbestos-related lung cancer mortality in Italy. Br J Cancer.2008;99(1):173-5.