[The causes of increased risk for lung cancer in the pulp and paper industry workers. The effect of smoking and exposure to chemicals].

An analysis of mortality in a cohort of workers employed in the pulp and paper industry, carried out by the authors of this presentation several years ago, indicated an increase of 22% in the risk of mortality from lung cancer. This risk decreased by only 4% after taking account of smoking. The results obtained then were considered as sufficient to undertake further studies aimed at identifying specific occupational factors responsible for an increased risk for mortality from lung cancer in the population under study. The nested case-control study, in which cases (of lung cancer) and controls were selected from the same cohort observed earlier, was approved as the most suitable method for achieving the aforesaid aim. The study covered 79 cases of deaths from lung cancer confirmed by histological and cytological or radiological examinations, and 237 'healthy' controls matched in the ratio of one to three, taking into account gender, date of birth and date of employment. A group of experts carried out in-depth analysis of exposure to harmful factors in each case of death and in each control. Using a questionnaire, specially developed for this purpose, detailed data on smoking habits among persons under study were collected. Odds ratio was used as a measure of a relative risk for death from lung cancer. A crude relative risk and risk adjusted by eliminating the effect of smoking, applying the model of conditional logistic regression, were calculated for individual exposure factors. Smoking proved to be a significant causal factor responsible for the development of lung cancer in the cohort studied. That was evidenced by relative risk accounting for 12.9 for smokers in relation to non-smokers and an enhanced risk with the increasing number of cigarettes smoked daily, the number of smoking years and an accumulated dose. The study does not confirm a hypothesis that chemical factors specific of the pulp and paper industry exert a significant effect on the risk of death from lung cancer. Odds ratios, crude and adjusted for smoking, were lower than one in all distinguished categories of exposure.