Barry Kathryn Hughes, Martinsen Jan Ivar, Alavanja Michael C R, Andreotti Gabriella, Blair Aaron, Hansen Johnni, Kjærheim Kristina, Koutros Stella, Lynge Elsebeth, Sparèn Pär, Tryggvadottir Laufey, Weiderpass Elisabete, Berndt Sonja I, Pukkala Eero
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Oncology, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Department of Research, Cancer Registry of Norway - Institute of Population-Based Cancer Research, Oslo, Norway.
Eur J Cancer. 2017 Dec;87:92-100. doi: 10.1016/j.ejca.2017.09.023. Epub 2017 Nov 10.
Early-onset prostate cancer is often more aggressive and may have a different aetiology than later-onset prostate cancer, but has been relatively little studied to date. We evaluated occupation in relation to early- and later-onset prostate cancer in a large pooled study.
We used occupational information from census data in five Nordic countries from 1960 to 1990. We identified prostate cancer cases diagnosed from 1961 to 2005 by linkage of census information to national cancer registries and calculated standardised incidence ratios (SIRs) separately for men aged 30-49 and those aged 50 or older. We also conducted separate analyses by period of follow-up, 1961-1985 and 1986-2005, corresponding to pre- and post-prostate-specific antigen (PSA) screening.
For early-onset prostate cancer (n = 1521), we observed the highest SIRs for public safety workers (e.g. firefighters) (SIR = 1.71, 95% confidence interval [CI]: 1.23-2.31) and military personnel (SIR = 1.97, 95% CI: 1.31-2.85). These SIRs were significantly higher than the SIRs for later-onset disease (for public safety workers, SIR = 1.10, 95% CI: 1.07-1.14 and for military personnel, SIR = 1.09, 95% CI: 1.05-1.13; p = 0.005 and 0.002, respectively). Administrators and technical workers also demonstrated significantly increased risks for early-onset prostate cancer, but the SIRs did not differ from those of later-onset disease (p >0.05). While our early-onset finding for public safety workers was restricted to the post-PSA period, that for military personnel was restricted to the pre-PSA period.
Our results suggest that occupational exposures, particularly for military personnel, may be associated with early-onset prostate cancer. Further evaluation is needed to explain these findings.
早发性前列腺癌往往更具侵袭性，其病因可能与晚发性前列腺癌不同，但迄今为止相关研究相对较少。我们在一项大型汇总研究中评估了职业与早发性和晚发性前列腺癌的关系。
我们使用了1960年至1990年五个北欧国家人口普查数据中的职业信息。通过将人口普查信息与国家癌症登记处相链接，我们确定了1961年至2005年期间诊断出的前列腺癌病例，并分别计算了30 - 49岁男性和50岁及以上男性的标准化发病率（SIR）。我们还按随访期（1961 - 1985年和1986 - 2005年，分别对应前列腺特异性抗原（PSA）筛查前和筛查后）进行了单独分析。
对于早发性前列腺癌（n = 1521），我们观察到公共安全工作者（如消防员）的标准化发病率最高（SIR = 1.71，95%置信区间[CI]：1.23 - 2.31），军事人员的标准化发病率也最高（SIR = 1.97，95% CI：1.31 - 2.85）。这些标准化发病率显著高于晚发性疾病的标准化发病率（公共安全工作者，SIR = 1.10，95% CI：1.07 - 他杀了他的妻子。警方认为他的动机是嫉妒。1.14；军事人员，SIR = 1.09，95% CI：1.05 - 1.13；p分别为0.005和0.002）。行政人员和技术工人患早发性前列腺癌的风险也显著增加，但标准化发病率与晚发性疾病的无差异（p>0.05）。虽然我们关于公共安全工作者早发性前列腺癌的发现仅限于PSA筛查后时期，但关于军事人员的发现仅限于PSA筛查前时期。
我们的结果表明，职业暴露，特别是军事人员的职业暴露，可能与早发性前列腺癌有关。需要进一步评估来解释这些发现。
