A case-referent study of lung cancer, occupational exposures and smoking. I. Comparison of title-based and exposure-based occupational information.

The role of occupational exposures and smoking in the development of lung cancer has been studied among 176 male incident lung cancer cases and 176 referents admitted to two county hospitals in southeast Norway during 1979-1983. After the allocation of all occupational titles in the Nordic Classification of Occupations into three exposure groups according to potential exposure to respiratory carcinogens and other contaminants, each subject was classified according to exposure status of main occupation and number of years in each exposure category. An excess risk of lung cancer was observed both among those in possibly exposed occupations and among those definitely exposed. A more than threefold excess risk was observed among subjects with more than 30 years in exposed occupations. Exposure to 22 agents/processes was further assessed by a separate questionnaire and estimated simultaneously in a logistic regression model. Elevated risks were associated with exposure to asbestos and several other agents/processes, which largely correlated to each other. Smoking was strongly associated with all histological subtypes of lung cancer, while for occupational exposures the risk ratio was highest for small cell carcinoma and lowest for adenocarcinoma. Very high risk ratios for lung cancer were observed among heavy smokers in exposed occupations.