Abstract
BACKGROUND: A nested case-control study for lung cancer was performed on a cohort of 2260 South African gold miners in whom an association between exposure to silica dust and risk of lung cancer was previously reported. The objective was to investigate an expanded set of risk factors and also cancer cell type. METHODS: The 78 cases of lung cancer found during the follow up period from 1970 to 1986 were matched with 386 controls. Risk of lung cancer was related to smoking, exposure to silica dust, incidence of silicosis, and uranium production and the uranium content of the mine ore. RESULTS: The risk of lung cancer was associated with tobacco smoking, cumulative dust exposure, duration of underground mining, and with silicosis. The best predictive model included pack years of cigarette consumption (adjusted relative risk (RR) = 1.0 for < 6.5 pack years, 3.5 (95% confidence interval (CI) 0.7 to 16.8) for 6.5-20 pack years, 5.7 (95% CI 1.3 to 25.8) for 21-30 pack years, and 13.2 (95% CI 3.1 to 56.2) for more than 30 pack years) and silicosis (RR = 2.45 (95% CI 1.2 to 5.2)). No association was found with uranium production. The lung tumour cell type distribution was 40.3% small cell carcinoma, 38.8% squamous cell, 16.4% adenocarcinoma, and 4.5% large cell carcinoma. Small and large cell cancer combined were associated with exposure to dust. CONCLUSIONS: The results cannot be interpreted definitively in terms of causal association. Possible interpretations are: (1) subjects with high dust exposure who develop silicosis are at increased risk of lung cancer; (2) high levels of exposure to silica dust on its own is important in the pathogenesis of lung cancer and silicosis is coincidental; and (3) high levels of silica dust exposure may be a surrogate for the exposure to radon daughters.
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- Hessel P. A., Sluis-Cremer G. K., Hnizdo E. Case-control study of silicosis, silica exposure, and lung cancer in white South African gold miners. Am J Ind Med. 1986;10(1):57–62. doi: 10.1002/ajim.4700100107. [DOI] [PubMed] [Google Scholar]
- Hnizdo E., Sluis-Cremer G. K. Risk of silicosis in a cohort of white South African gold miners. Am J Ind Med. 1993 Oct;24(4):447–457. doi: 10.1002/ajim.4700240409. [DOI] [PubMed] [Google Scholar]
- Reid P. J., Sluis-Cremer G. K. Mortality of white South African gold miners. Occup Environ Med. 1996 Jan;53(1):11–16. doi: 10.1136/oem.53.1.11. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Weill H., McDonald J. C. Exposure to crystalline silica and risk of lung cancer: the epidemiological evidence. Thorax. 1996 Jan;51(1):97–102. doi: 10.1136/thx.51.1.97. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wyndham C. H., Bezuidenhout B. N., Greenacre M. J., Sluis-Cremer G. K. Mortality of middle aged white South African gold miners. Br J Ind Med. 1986 Oct;43(10):677–684. doi: 10.1136/oem.43.10.677. [DOI] [PMC free article] [PubMed] [Google Scholar]