Amandus H E, Castellan R M, Shy C, Heineman E F, Blair A
Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, WV.
Am J Ind Med. 1992;22(2):147-53. doi: 10.1002/ajim.4700220202.
We previously reported on the lung cancer mortality through 1983 of 760 males who were diagnosed with silicosis during 1930-1983 by the State of North Carolina's medical examination program for dusty trades workers. The lung cancer SMR (95% confidence interval) was 2.6 (1.8-3.6) among 655 white members of this group. In this paper, we report the results of a reanalysis of mortality among a subgroup for whom chest radiographs were currently available for rereading. Technically acceptable radiographs were available for 306 white males and were independently reclassified for pneumoconiosis by 3 "B" readers using the 1980 ILO Classification. Lung cancer SMRs were 1.7 (0.8-3.1) for the entire group of 306 white males, 2.5 (1.1-4.9) for 143 subjects reclassified as simple silicosis, and 1.0 (0.1-3.5) for 96 subjects whose radiographs were reclassified as ILO category 0. There were no lung cancer deaths among 67 subjects whose radiographs were reclassified as progressive massive fibrosis. Corresponding lung cancer SMRs for subjects who had never been employed in a job with exposure to known occupational carcinogens were 1.2 (0.2-4.4) for those reclassified as category 0, and 2.4 (1.0-5.0) for those reclassified as having simple silicosis. The age-adjusted lung cancer rate ratio among subjects with simple silicosis compared to those with category 0 was 1.5 (0.4-5.8). Our findings from this reanalysis, which effectively controls for misclassification of silicosis due to errors in radiograph interpretation by North Carolina program readers, offer additional evidence consistent with the hypothesis of an association between silicosis and lung cancer in this study group.
我们之前报告了北卡罗来纳州针对从事粉尘作业工人的医学检查项目在1930年至1983年间诊断出矽肺病的760名男性至1983年的肺癌死亡率。该组655名白人成员的肺癌标准化死亡比（95%置信区间）为2.6（1.8 - 3.6）。在本文中，我们报告了对一个亚组死亡率重新分析的结果，该亚组目前有胸部X光片可供重新解读。306名白人男性有技术上可接受的X光片，并由3名“B”级阅片者根据1980年国际劳工组织分类标准对尘肺病进行独立重新分类。306名白人男性的整个亚组肺癌标准化死亡比为1.7（0.8 - 3.1），重新分类为单纯矽肺病的143名受试者为2.5（1.1 - 4.9），X光片重新分类为国际劳工组织0类的96名受试者为1.0（0.1 - 3.5）。67名X光片重新分类为进行性大块纤维化的受试者中无肺癌死亡病例。从未从事过接触已知职业致癌物工作的受试者，重新分类为0类的肺癌标准化死亡比为1.2（0.2 - 4.4），重新分类为患有单纯矽肺病的为2.4（1.0 - 5.0）。单纯矽肺病受试者与0类受试者的年龄调整肺癌发病率比为1.5（0.4 - 5.8）。我们此次重新分析的结果有效地控制了因北卡罗来纳州项目阅片者X光片解读错误导致的矽肺病误诊，为该研究组中矽肺病与肺癌之间存在关联的假设提供了更多一致的证据。
