Mastrangelo Giuseppe, Grange John M, Fadda Emanuela, Fedeli Ugo, Buja Alessandra, Lange John H
Department of Environmental Medicine and Public Health, University of Padova, Padova, Italy.
Am J Epidemiol. 2005 Jun 1;161(11):1037-46. doi: 10.1093/aje/kwi138.
The aim of this study was to confirm the exposure-dependent reduction in lung cancer risk reported for dairy farmers exposed to endotoxin and to evaluate the consequence of leaving dairy farming and taking employment in industry or services, where exposure to microbial agents is lower. Standardized mortality ratios, with 95% confidence intervals, for 2,561 self-employed dairy farmers were estimated, considering the general population of Veneto, Italy, from 1970 to 1998 as the reference. Sixty-two lung cancer cases, whose information was checked against clinical records, were compared with 333 controls in a cohort-nested case-control study. Odds ratios with 95% confidence intervals were estimated by logistic regression analysis. A downward trend of standardized mortality ratios for lung cancer across tertiles of number of dairy cattle on the farm was significant (p < 0.05) from 1970 to 1984 but not from 1985 to 1998, when most subjects were no longer dairy farmers. Age- and smoking-adjusted odds ratios for lung cancer significantly decreased with increasing number of dairy cattle (p for trend = 0.001) for workers for whom < or =15 but not >15 years had elapsed from the end of work to the end of follow-up. In conclusion, increased levels of endotoxin (or other associated environmental factors) might be protective against lung cancer; protection diminishes over time after that exposure is removed.
本研究的目的是确认此前报道的、接触内毒素的奶农肺癌风险随接触程度降低的情况,并评估离开奶业转而从事工业或服务业(接触微生物制剂较少)的后果。以1970年至1998年意大利威尼托大区的普通人群为参照,估算了2561名个体经营奶农的标准化死亡比及其95%置信区间。在一项队列巢式病例对照研究中,将62例经临床记录核对信息的肺癌病例与333例对照进行了比较。通过逻辑回归分析估算了比值比及其95%置信区间。1970年至1984年,农场奶牛数量三分位数分组的肺癌标准化死亡比呈显著下降趋势(p<0.05),但1985年至1998年期间则不然,此时大多数研究对象已不再是奶农。对于工作结束至随访结束间隔时间≤15年而非>15年的工人,肺癌的年龄和吸烟调整后比值比随奶牛数量增加而显著降低(趋势p值=0.001)。总之,内毒素(或其他相关环境因素)水平升高可能对肺癌具有保护作用;接触消除后,这种保护作用会随时间减弱。
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