Lung cancer mortality in the French cohort of titanium dioxide workers: some aetiological insights.

OBJECTIVES

Titanium dioxide (TiO) is widely used in construction, food, cosmetic and medical industry. The current evidence on TiO carcinogenicity in humans is considered inadequate. As French participants of the European cohort of TiO workers exhibited an increase in mortality from lung cancer, we aimed at investigating whether TiO exposure, co-exposures or smoking can explain this increase.

METHODS

We reanalysed the data of 833 French male workers (follow-up period 1968-1997) and used multiple imputation to complete their smoking status. We considered respirable TiO dust as primary exposure of interest, estimated as continuous cumulative (mg/m-year) and annual average (mg/m) concentrations and binary and 4-class categorical variables, with cut-off values of 0.3 and 2.4 mg/m (the German and American occupational exposure limits, respectively). For each exposure metric, we estimated HRs and associated 95% CIs, using Cox regression models adjusted for calendar period, exposure duration and smoking.

RESULTS

The fully adjusted model yielded a HR=3.7 (95% CI=0.79 to 17.95) for TiO-exposed workers vs unexposed and a HR=27.33 (95% CI=4.35 to 171.84) for those exposed to >2.4 mg/m as annual average concentration. Employment duration was negatively related with lung cancer mortality, therefore cumulative exposure had a small effect on mortality (HR=1.03 (95% CI=0.99 to 1.08) per mg/m-year).

CONCLUSION

This study suggests a positive relationship between TiO exposure and lung cancer mortality in TiO workers, whatever the exposure variable used, despite a limited statistical power in some models. The results question the current evidence on TiO carcinogenicity in humans but need to be confirmed in other cohorts, using different statistical approaches.