Imbernon E, Goldberg M, Bonenfant S, Chevalier A, Guénel P, Vatré R, Dehaye J
Electricité de France-Gaz de France, Service Général de Médecine du Travail, Paris, France.
Am J Ind Med. 1995 Sep;28(3):339-52. doi: 10.1002/ajim.4700280304.
Cancers of the pleura, lung, and larynx between 1978 and 1989 among active male workers of Electricité de France-Gaz de France were studied in association with asbestos exposure using a case-control design nested within the cohort of workers of the company. The cohort included about 1,400,000 person-years, corresponding to a mean of 117,000 men per year. Exposure to asbestos and to some potential occupational confounders selected among agents from groups I, IIa, and IIb of the International Agency for Research on Cancer was assessed by a job-exposure matrix specific to the company. During the observation period, 12 cases of pleural cancer, 310 cases of lung cancer, and 116 cases of larynx cancer were registered in the cancer register of the company social security department. Four controls per case, matched for year of birth, were randomly selected among the cohort. Conditional logistic regression was used to estimate the odds ratios. A first analysis was conducted in order to assess the validity of the job-exposure matrix by investigating already known relationships between asbestos exposure and asbestosis. For asbestosis, a strong exposure-response relation was found with an odds ratio (OR) of 57.4 [95% confidence interval (CI): 17.0-194.0] in the highest exposure group. There was an elevated risk of pleural cancer (OR, 4.8, CI, 1.2-19.8). For lung cancer, significant ORs of 2.0 (CI, 1.3-3.2) and 1.9 (CI, 1.2-3.0) were found among the two highest cumulative exposure groups; adjustement for confounders slightly decreased the ORs. Squamous cell neoplasm of the lung was associated with asbestos exposure. The association between larynx cancer and asbestos exposure showed a tendency towards a nonsignificant increase in ORs in the highest cumulative exposure categories; this tendency disappeared when adjusting for occupational confounders. This study showed that occupational exposure to asbestos could increase the risk of pleural and lung cancer in a sector in which exposure levels are not considered to be high compared with other industrial settings.
采用巢式病例对照研究设计，在法国电力公司 - 法国燃气公司在职男性工人队列中，研究了1978年至1989年间胸膜癌、肺癌和喉癌与石棉暴露之间的关系。该队列约有140万人年，平均每年有11.7万名男性。通过该公司特有的工作暴露矩阵，评估了石棉暴露以及从国际癌症研究机构第I、IIa和IIb组的致癌物中挑选出的一些潜在职业混杂因素的暴露情况。在观察期内，公司社会保障部门的癌症登记处记录了12例胸膜癌、310例肺癌和116例喉癌病例。从队列中随机选取每例病例4名对照，按出生年份进行匹配。采用条件逻辑回归估计比值比。首先进行了一项分析，通过调查石棉暴露与石棉沉着病之间已知的关系来评估工作暴露矩阵的有效性。对于石棉沉着病，在最高暴露组中发现了强烈的暴露 - 反应关系，比值比（OR）为57.4 [95%置信区间（CI）：17.0 - 194.0]。胸膜癌风险升高（OR，4.8，CI，1.2 - 19.8）。对于肺癌，在两个最高累积暴露组中发现显著的OR分别为2.0（CI，1.3 - 3.2）和1.9（CI，1.2 - 3.0）；对混杂因素进行调整后，OR略有降低。肺鳞状细胞瘤与石棉暴露有关。喉癌与石棉暴露之间的关联显示，在最高累积暴露类别中，OR有非显著增加的趋势；在对职业混杂因素进行调整后，这种趋势消失。该研究表明，在一个与其他工业环境相比暴露水平不被认为很高的行业中，职业性石棉暴露会增加患胸膜癌和肺癌的风险。
