1^st Auth, Yr Study Type

Population Studied

Bladder Cancer Rate*

Comments†

Cohort Studies

Sherson/91

19 years follow-up

6,144 male Danish foundry workers invited to national silicosis surveys.

Total Iron and steel:

moulders; oven; casters;

crane; shake-out:

core room:

finishing:

unspecified:

other metal foundry:

not foundry:

<10

10-19

20-29

³ 30

SIR:

SIR= 118 (88-155)[52]

114 (81-161)[32]

102 (28-261)[4]

93 (42-176)[9]

283 (114-584)[7]

216 (79-470)[6]

126 (34-322)[4]

83 (46-140)[14]

97 (48-173)[11]

172 (105-266)[20]

165 (96-265)[17]

Exposure quality: 4

Person-years at risk with no latency period for the period 1967-1974 used.

No smoking information.

Among the 63 cases, there are 6 with other metal foundry exposures. Four had no foundry exposures (managers were also included) who showed the same SIR (126) as the active workers (124).

This group showed a modest but significant increased risk of lung cancer (SIR= 130).

Sorahan/94

46 year follow-up

10,438 males employed for >1 year 1946-1965 in one of 10 steel foundries in the UK. 3976 deaths and 1129 cancers in follow-up to 1991.

SMR= 107 (76-148)[37]

Exposure quality: 4

No dose-response analysis for bladder cancer.

No smoking information.

Lung cancer SMR= 146 [551]

Selden/97

35-year follow-up

6,454 Swedish workers in 7 aluminum foundries and 3 secondary scrap smelters. There were 325 male cancers.

SIR= 87 (52-136)[19] §

SIR by duration:

<1 yr 92 (30-214)[5]

1-4 yr 96 (31-224)[5]

5-9 yr 64 (8-230)[2]

19. 92 (25-236)[4]

³ 20 yr 83 (17-240)[3]

Exposure quality: 4

Lung cancer risk was significantly elevated. Results are for males. Some differences in exposure compared to iron/steel foundries.

Koskela/97

29-year follow-up

6,415 Finnish foundry workers in 22 foundries 1950-1976, followed to 1978.

No remarkable findings for bladder cancer reported. (An increase of urogenital cancers was noted in a group of electrical workers in the same study)

Exposure quality: 4

qualitative exposure estimates were made.

Control for smoking habits were made.

Lung cancer SMR= 127 [47]

Bladder cancer rates apparently not elevated. For example out of 81 cancers among foundry labourers, all but 4 are accounted for by other cancers.

Hansen/97

22 year follow-up

3,056 unskilled Danish foundry workers compared to 43,024 unskilled workers in other industries. There were 886 deaths and 255 cancers 1970-1992.

urinary organs:

SMR= 132 (85-195[25]

Urothelial cancer (bladder, ureter, renal pelvis):

SMR= 141 (86-217)[19] §

Exposure quality: 4

Control group with comparable SES and work-demands, but appeared to smoke more than foundry workers. No lung cancer increase found.

Rotimi/93

18-year follow-up

18,770 male foundry and engine plant workers in the US. 2742 deaths from 1970-1987.

Total male SMR:

113 (62-189)[14]

White male:

100 (50-179)[11]

black male:

211 (42-617)[3]

Exposure quality: 2

28% only in foundries, 33% in both foundries and engine plants. The two engine plants involve machining fluid exposures.

No results reported separately for the 5,540 males employed only in the foundry (exposure quality: 3) Lung cancer SMR here was 121 [72] compared to 113 [224] overall.

Starzynski/96

22-year follow-up

1,796 males diagnosed with pneumoconiosis 1970-1985 and working in the metallurgical industry and iron and nonferrous foundries in Poland for >20 years, followed to 1991.

Bladder and kidney SMR:

138 (66-254)[10]

Exposure quality: 2

Cohort exposed >20 years.

Information on smoking was available. 75% of Polish males smoke, whereas 85% of metallurgical/foundry workers smoked. Lung cancer SMR= 159 [69]. The disease category is broad.

Firth/99

47-year follow-up

3,522 men employed ³ 3 months 1945-1991 in a New Zealand railway plant which included an iron and steel foundry, and construction, repair and machine shops.

SMR= 86 (27-203)[5]

Exposure quality: 2

longest held job used, but cohort also included those exposed to machining fluids and asbestos.

No smoking information.

Lung cancer SMR= 125 [78].

Andjelkovich/90

35 year follow-up

5,337 white and 2,810 non-white male iron foundry workers in the US 1950-1979 and followed to 1984. There were 836 white male and 859 black male deaths.

white male SMR:

98 (32-229)[5]

black male SMR:

102 (20-297)[3]

Overall SMR used:

101 {44-199}[8]

Exposure quality: 3

person-years at risk, minimum 6 months.

No information on smoking.

Lung cancer SMR= 123 [72] in whites and 132 [67] in blacks.

Andjelkovich/95

30-year follow-up

3,929 US foundry workers exposed to formaldehyde 1960-1987, followed to 1989. Compared to US population and 2,032 internal non-formaldehyde exposed workers.

Formaldehyde SMR:

40 (1-221)[1]

No formaldehyde foundry men SMR:

82 (9-298)[2]

Exposure quality: 5

Detailed work history for workers used to construct formaldehyde exposure.

Smoking status was similar in workers exposed and unexposed to formaldehyde.

Hansen/91

10-year follow-up

632 male foundry molders (skilled workers) in Denmark, compared to other skilled male workers, 1970-1980.

SMR= 896 (329-1949)[6]

Exposure quality: 4

Person-years at risk as skilled molder. Lung cancer SMR was not significant (137). No control for smoking. Workers may be included in later update by Hansen/97.

Surveillance Studies

Anderson/99

20-year incidence experience

10 million Nordic people, 1million cancers during 197-1991. Results are for 77,288 male and 2,874 female smelter/founders.

Male smelter and metal foundry workers SIR:

Denmark;127 [248](S)

Finland; 130 [59]

Norway; 102 [127]

Sweden; 94 [224]

Total: 109 (101-118)[658]§

Female SIR= 78 (21-199}[4] §

Exposure quality: 2

Person-years at risk used, but inclusion of ore and metal smelter workers lowers the exposure quality.

Overall SIR used:

109 {101-118} [662]

Malker/87

19-year incidence experience

11,702 bladder cancers in employed Swedish men, 1961-1979. Census data on employment linked with cancer registry data.

Iron & steel industry SIR:

107 (92-124)[182]

Foundry & metal occupation, SIR:

106 (92.5-121)[222]

Exposure quality: 3

No smoking information.

Steineck/89

19-year cancer experience

All 1.9 million employed men in Sweden in 1960 were linked to a cancer registry. There were 10,123 bladder cancers. Controls were taken from 7,432 unexposed men as determined from a job-exposure matrix.

Metal industry foundry RR:

1.1 (0.8-1.6)

Exposure quality: 3

RR adjusted for age, SES, and urbanization, but not smoking directly. Number of cases not reported.

Results from Malker/87 used.

Xu/96

10-year mortality experience

8,887 deaths in male workers at an iron-steel complex in China, compared to 22,005 deaths in the city without iron-steel exposures.

SPMR for bladder cancer was not significant elevated, but exact results were not reported.

Exposure quality: 3

longest held jobs used. Separate results for foundry workers. Foundry lung cancer SPMR= 120 [68]

Egan-Baum/81

5-year mortality experience

2,990 death certificates from a Union benefit program for US foundrymen.

White males, PMR:

129 (92-176)[39]

Black males, PMR:

165 (45-421)[4]

Overall PMR used:

132 {96-178} [43]

Exposure quality: 3

No smoking information.

Lung cancer PMR= 144 [224] in whites and 176 [39] in blacks.

Burnett/94

9 years mortality experience

Death certificate analysis with 8,644 bladder cancers in the US.

All metal mach. and fabrication:

Forge, hammer, roller, finisher:

metal heater:

File, polish, sand, buff:

Overall PMR used:

106 {76-143} [42]

104 {88-123}[141]

101 {70-142}[33]

133 {61-253}[9]

95 {57-148}[19]

Exposure quality: 2

No smoking information.

{calculated 95% CI }

Dolin/92

Death certificate study

2,457 male bladder cancer deaths in the UK, 1965-80, aged 25-64.

metal furnaceman:

rolling tube mill operator:

foundry molder, coremaker:

smith, forgeman:

metal workers, n.e.c.:

fettler, metal dresser:

labourer- foundry works:

iron and steel:

iron castings:

other metals/alloys:

SMR:

138 (55-284)[7]

24 (1-134)[1]

172 (79-327)[9]

79 (29-171)[6]

372 (45-1342)[2]

24 (1-131)[1]

115 (42-252)[6]

117 (94-146)[77]

149 (55-325)[6]

47 (17-103)[6]

Exposure quality: 3

Occupation at death used.

No smoking information. But degree of urbanization was used as a proxy measure for smoking and other factors in standardizing ratios along with age.

No increased bladder cancer risk was observed in any of the occupations with exposure to PAHs.

Zheng/92

Bladder cancer incidence study

1,219 bladder cancer cases in Shanghai between 1980-1984 compared to 1982 census data.

Metal refining and processing:

Metallurgy industry:

SIR:

men: 139 (96-194)[34]

men: 107 (75-149)[35]

women 561(242-1105)[8]

Exposure quality: 2

Employment at time of diagnosis.

No information on smoking.

Pukkala, 1995

15-year incidence experience

108,886 cancer cases among Finns of working age (from census in 1970) followed from 1971-1985. 1780 working men with bladder cancer. Results are for males (few females in these occupations).

Smelting, metal and foundry work SIR:

128 (81-192)[23]

Founders:

116 (43-252)[6]

Exposure quality: 3

SIR adjusted for age, social class and gender. SIR for bladder cancer in whole male population was 104 compared to economically active persons.

Mallin/89

6-year mortality experience

986 white male and 105 black male deaths from bladder cancer, ages 35-74 in Illinois from 1979-1984, with 2,100 controls for whites and 1,100 controls for blacks.

No significant excess for bladder cancer.

No results reported.

Odds ratios race-specific and age adjusted. No adjustment for smoking.

Gallagher, 1989

35-year mortality experience

320,423 deaths in men of working age in Canada, 1950-1984.

Metal furnace work PMR:

21 (0-115)[1]

Moulder/coremakerPMR:

146 (30-427)[3] §

Other metal mill PMR:

126 (54-248)[8]

Overall PMR used:

59 {16-151} [4]

Exposure quality: 3

Metal workers may have smoked more than other white collar workers but no control for smoking possible.

Milham/97

40-year mortality experience

588,090 male deaths in Washington state 1950-1989. 1,686 deaths among smelter workers (includes 509 deaths in foundry furnacemen), and 546 deaths among metal molders.

Metal molders, PMR:

97 {26-248}[4] §

Smelter workers, PMR:

72 {33-137}[9]

Exposure quality: 3

Smoking information available but not used in analysis. {calculated 95% CI}

Sitas/89

23- year mortality experience

578 deaths in a Union benefit program for South African iron moulders.

No PMR results for bladder cancer reported.

Exposure quality: 3

No smoking information.

73 cancers observed, and 28 lung cancers (PMR= 116).

Aronson, 2000

27-year mortality experience

Surveillance of 457,224 working Canadian men from 1965-1991. Occupation for at least one year from 1965-1969. 115,957 deaths.

654 Furnacemen and metal heaters:

RR= 0.71 (0.1-5.09)[1]

233 rolling mill operators:

RR= 3.54 (0.88-14.2)[2] §

667 Moulders:

RR= 3.08 (1.15-8.23)[4]

Overall RR used:

2.59 {1.23-5.46}[7]

Exposure quality: 3

Results for women were not considered since few were employed in these occupations. The study used internal standardization by socio-economic status (blue or white collar), gender, and age. No direct control for smoking.

Dubrow, 1984

3 year mortality experience

34,879 deaths in males, 16,629 cancers, in 1971-1973 Massachusetts death records.

Foundry workers sMOR:

158 {43-405}[4]

Foundry nec. SMOR:

90 [1]

metal molders, sMOR:

210 [3]

Exposure quality: 3

usual occupation from death certificate.

Standardized on both age and social class. {calculated 95% CI}

Hall/91

Cancer incidence study

Out of 208,975 incident cancers in the 6 year period 1979-1984, only 10,824 white males, 4,248 white females, 1.957 black males and 592 black females could be analyzed.

No PCIR results for bladder cancer reported.

Exposure quality: 2

Findings for "fabricated metal", and "primary metal manufacture" industries were reported for lung cancer. Only significant results with at least three cases were reported

Petersen/80

3-year mortality experience

Mortality 1959-1961 of about 200,000 white male Californians, with 211 deaths among metal molders.

Metal molder, PMR:

197 {41-576}[3] §

Exposure quality: 3

Usual occupation from death certificate. {calculated 95% CI}

Spinelli/90

26 year mortality experience

6,389 male cancer patients in BC, Canada, 1950-1979 with 1.687 lung cancers and 427 bladder cancers.

Results for bladder cancer not reported.

Exposure quality: 2

Occupation of metal processing showed a significant OR of 2.8 for lung cancer. Only significant OR, or OR > 2 and > 5 cases, were reported.

Silverstein/86

12 year mortality experience

221 white male ferrous foundry workers employed >10 years in a US plant.

SPMR= 210 (42-616)[3]

Exposure quality: 3

Smoking information available.

PMR indirectly standardized for age at death, sex, race, and year of death with reference to US death registry.

Lung cancer SPMR= 148 [28] but in non-smokers, SPMR= 96 [4].

Case-Control Studies

Sorahan/98

Population-based

1 427 (1 106 men and 321 women) with urothelial tumor 1991-1993 in the UK. 803 cases (624 men and 179 women) matched with 2 199 controls, using conditional logistic regression. 1 427 cases not directly matched with controls with unconditional logistic regression.

Ever iron casting:

OR₁ = 1.26 (0.90-1.77) [65]

OR₂ = 1.47 (1.13-1.90) [133] §

OR₂ not adjusted for smoking = 1.50 (1.17-1.93)

1971 furnace, forge, Foundry, rolling-mill:

OR₁ = 1.76 (1.08-2.88) [32]

Exposure quality: 3

Two analyses recorded here: OR₁ is for 803 cases/2 135 controls adjusted for smoking; OR₂ is for 1 427 cases/2 135 controls with adjustment for age, sex, and smoking.

Jensen/87

Population-based

389 bladder cancers and 790 matched controls from Copenhagen, Denmark.

Iron and metal Ind. OR:

0.85 (0.64-1.25)[85]

Exposure quality: 1

RR adjusted for age and sex, not smoking.

Pesch/00

multi-centre population-based

1,035 urothelial cancers and 4,298 matched controls in East and West Germany.

Male Metal processing OR:

medium: 0.9 (0.6-1.2)[63]

Long: 1.2 (0.9-1.6)[84]

Very long: 1.3 (0.8-1.9)[35] §

Exposure quality: 1

medium, long and very long are 30^th, 60^th, and 90^th percentile of durations.

OR adjusted for age, study centre and smoking. Most (90%) of urothelial cancers (incl. ureter and renal pelvis) are of the urinary bladder.

Silverman/89

Population-based

2,100 white males with bladder cancer and 3,874 controls from 10 areas of the US.

Ore refining and foundry:

OR= 1.0 (0.7-1.5)[37]

Metal working and fab:

OR= 1.2 (1.0-1.4)[255]

·

finish OR= 1.4 (0.6-3.4)[11]

·

• file/polish/sand/buf OR= 1.5 (1.0-2.2) [53]

Exposure quality: 2

RR adjusted for smoking.

Significant trend found for Stationary firemen or Furnace Operator:

<5yrs 0.8 [22]

5-9 yrs 3.8 [19]

10+ yrs 1.2 [13]

Silverman/89

Population-based

126 nonwhite men with bladder cancer and 383 controls from 10 areas of the US.

Ore refining and foundry:

OR= 0.5 (0.2-1.4)[5]

·

OR= 0.6 (0.1-2.2)[3]

·

OR= 0.4 (0.1-1.7)[2]

Overall W/B OR used:

0.91 {0.65-1.27} [42]

Exposure quality: 2

RR adjusted for smoking.

The RR for stationary fireman or furnace operator was 1.4 (0.4-5.1)[5]

Risch/88

Population-based

826 bladder cancers and 792 controls from several cities in Canada 1979-1982. Controls matched for age, gender, and area of residence.

Male ever exp:

OR= 0.86 (0.6-1.25)

8-28 year lag OR= 0.99

10 yrs exp dur OR= 0.96

Female ever exp:

OR= 0.56 (0.18-1.62)

8-28 yr lag OR= 0.54

10 yrs exp dur OR= 0.73

Exposure quality: 1

Exposure was ever employment more than 6 months.

Conditional logistic regression analysis controlled for cumulative lifetime cigarette consumption. No dose-response trend was evident for males or females.

Overal M/F OR used:

0.83 {0.59-1.17}

Coggon/86

Population-based

2,942 cancers in the UK, with 272 bladder cancer cases, 179 with useable responses, compared to all other cancers.

Furnace, forge, foundry, rolling mill workers OR:

1.1 (0.7-1.9)[18]§

Exposure quality: 3

RR adjusted for age and smoking.

Lifetime occupation used.

Schoenberg/84

Population-based

658 bladder cancers in white males and 1,258 population controls in New Jersey 1978-1979.

All Metal workers OR:

1.08 (0.77-1.52)[65]

Primary metal workers:

OR= 1.12 (0.71-1.76)[37]

Fabric. metal workers:

OR= 0.85 (0.53-1.39)[29]

Exposure quality: 1

Prospective logistic regression controlled for age, duration of cigarette smoking, and some other employment categories.

Barbone/94

Hospital-based

273 bladder cancer cases and 573 hospital controls in Italy, 1986-1990.

<1 year 1 [198]

1-10 yrs 0.9 (0.4-2.1)[9]

³

Exposure quality: 1

RR adjusted for age, smoking, coffee, and area of residence.

Overall OR used:

0.76 {0.48-1.20}

Vineis/85

Hospital-based

512 male bladder cancers and 596 hospital controls in Italy.

Foundry OR:

0.7 (0.4-1.3)[15]

Exposure quality: 3

OR adjusted for age.

Kunze/92

Hospital-based

531 males and matched controls in Germany.

Years foundry work; 1-9:

10-19:

20-29: 30+:

Foundry work OR:

1.6 (0.8-2.9)[26]

1. [6]

1.6 [9]

2. [7]

3.0 [4]

Exposure quality: 4

Dose-response analysis adjusted for smoking. Trend not significant, but suggestive.

Bladder cancer included tumors of lower urinary tract (bladder, ureters, renal pelvis and urethra).

Claude/88

Hospital-based

531 male pairs.

OR= 1.56 (0.84-2.91) based on ratio of discordant pairs.

Clavel/94

Hospital-based

658 male bladder cancer cases and 658 controls in five areas of France.

All Foundry:

smelting furnacemen:

rolling-mill:

melters and reheaters:

casters:

moulders:

drawers and extruders:

Any PAH, OR:

• (1.0-1.7)[231]

OR by Occupation:

1.6 (0.8-3.4)[21] §

0.7 (0.2-3.7)[3]

0.6 (0.1-3.7)[2]

1.5 (0.1-17)[2]

3.6 (0.7-18)[7]

3.9 (0.4-35)[4]

1.0 (0.1-7.1)[2]

Exposure quality: 3

OR adjusted for age, place and smoking. Exposure assessed by expert from questionnaire.

Estimates for PAH exposure includes many other occupations than foundries, and also adjustment for coffee drinking.

Average PAH exposure (no aromatic amines) dose-response found:

low: 1.2 (0.9-1.7) [127]

medium: 1.4 (0.9-2.2) [64]

high: 1.8 (0.8-3.9) [26]

Cordier/93

Hospital-based

The same multi-centre study as above. Results by industrial group.

Foundry OR:

1.72 (0.67-4.41)[13]

Steel foundry OR:

2.86 (0.75-10.9)[9]

Exposure quality: 3

OR adjusted for age, place and smoking.

Grimsrud/98

Population-based

52 cases and 156 controls in a Norwegian area with an iron and steel plant.

>1 yr at plant, no PAHs:

OR= 1.4 (0.7-2.9)[20]

>1 yr at plant, with PAHs:

OR= 0.5 (0.1-1.9)[3]

Exposure quality: 1

Primarily smelter exposures, also a coke plant.

No control for smoking.

Gonzalez/89

Multi-centre hospital-based

497 cases (438 male) and 583 matched hospital and 530 population controls in Spain.

Metal proc. OR:

1.23 (0.8-1.8)[35]

Fab. metal prod. OR:

1.68 (0.8-3.4)[20]

Met. manuf. OR:

0.84 (0.6-1.1)[57]

Exposure quality: 1

RR adjusted for smoking and high risk occupations/activities.

All results are for males.

Silverman/83

Population-based

300 white males with cancer of the lower urinary tract and 296 controls in Detroit.

Metal Industry OR:

1. (0.6-1.4)[59]

Metlwrk. And fab. met. OR= 1.4 (1.0-2.1)[80]

heater OR= 3.0 (0.3-29)[3]

Ore ref. & foundry OR:

0.5 (0.2-1.4)[5]

Exposure quality: 2

Adjustment for age and smoking only if different from crude or RR elevated. Crude rates reported here, but adjustment for smoking and other high-risk occupations reduced the heater RR to 1.8.

Schifflers/87

Population-based

74 bladder cancers and matched controls in Belgium.

Blacksmiths, stokers and workers exposed to hot metal, OR:

2.33 (0.88-6.15)[9]

Exposure quality: 1

RR adjusted for smoking.

Porru/96

Hospital-based

355 bladder cancers (275 men) and 579 urologic non-cancer controls (397 men) in Italy.

Hot rollers OR:

0.8 (0.3-2.2)[10]

All metal processors:

1.2 (0.6-1.3)[31]

Exposure quality: 2

OR adjusted for age smoking, alcohol and coffee, education, and place of residence.

Burns/91

Population-based

2,160 bladder cancers and 3,979 colorectal cancer controls from a US cancer surveillance study.

Molders OR:

0.8 (0.2-2.4)[5]

Iron primary metal manufacturing OR:

1.3 (0.8-2.1)[47]

Exposure quality: 2

Usual occupation and industry used.

OR adjusted for smoking, age, race and gender.

Golka/98

Hospital-based

412 male urothelial bladder cancer patients and 414 controls with benign prostate hyperplasia in Germany.

OR for iron and steel industry: 1.1 (0.69-1.69)[44]

OR for foundry workers:

2.22 (0.53-9.08)[8]

Exposure quality: 3

Exposure duration ³ 1 year, and 10-year latency used.

OR adjusted for smoking. Results indicate that ex-smokers for 10 years had the same bladder cancer risk as non-smokers. This cessation interval did not apply to occupational exposures.

Steenland/87

Population-based

731 male bladder cancer deaths and two matched controls per death in Ohio.

Foundry industry:

Death certificate OR:

1.5 (0.27-7.9)[3]

City directory OR:

3.5 (0.9-14)[7]

Exposure quality: 3

Industry group from death certificate and commercial city directory. Directory (and death certificate) information about 75% accurate. Death certificate indicates usual lifetime job, while directory information includes ever in any short-term employment which can lead to false-positive results.

Tola/80

Hospital-based

180 bladder cancer cases and age/gender matched controls in Finland, 1975-1976.

Crude OR calculated for foundry workers:

2.0 (0.2-22)[2]

metal exposure, crude OR:

0.44 (0.17-1.07)[9]

Exposure quality: 3

No control for smoking or other factors.

Authors conclude the study is uninformative; no significant excess risk of bladder cancer in relevant exposure groups was found.

Mallin/98

Nested case-control

16 cases and 75 controls with ³ 10 years in a US steel manufacturing plant which converts scrap to molten steel with casting building, steel rod and wire mills, and structural mills. Heaters work with gas-fired re-heat furnaces after the electric furnaces melt the scrap.

Heater OR= 21 (2.2-206)[3]

Heater in smoker

OR= 8.4 (0.77-92.2)[2] §

Laborer OR:

0.9 (0.3-2.8)[4] §

Machine operator OR:

1.1 (0.3-4.4)[3] §

Overall OR used:

1.24 {0.56-2.73}[9]

Exposure quality: 2

ORs adjusted for age. Too few non-smokers for adjustment. OR for heaters calculated for smokers only.

This study was initiated by findings of bladder cancer in a surveillance study. The small numbers and possibility of a pre-selected cluster limit the reliability of findings.

Siemiatycki/94

Population-based

484 bladder cancers and 1,879 controls with other cancers (and 533 other population controls) in Canada.

Benzo(a)pyrene OR:

0.6 (0.3-1.1)[15]

Clay dust OR:

0.9 (0.3-2.6)[5]

Exposure quality: 1

BaP exposure mechanics, machinists and foundry. Clay primarily foundry molders, coremakers and labourers, but also painters and perhaps others.

OR adjusted for age, race, SES, smoking, coffee, and other exposures. Results not used due to heterogeneous exposures.

Notani/93

Hospital-based

153 bladder cancers and 212 controls in Bombay. These males were interviewed for lifetime occupational history.

No OR reported for foundry workers.

Exposure quality: 1

Control for age and smoking.

Occupational categories were very broad.

Bonassi/89

Population-based

121 male bladder cancers and 342 controls in Italy.

possible PAH exp. OR:

1.05 (0.45-2.44)[74]

Definite PAH exp. OR:

2.14 (0.82-5.6)[25]

Exposure quality: 1

OR adjusted for smoking and aromatic amine exposure. Results not used since only glass foundry workers, among other occupations, were exposed.

Iscovich/87

Hospital-based

117 bladder cancers and 117 matched hospital and 117 matched population controls in Argentina.

Metal workers OR:

1.88 [5]

Exposure quality: 1

Detailed exposure information available but when using the job exposure matrix, no difference between cases and controls emerged. Results not used.

Anton-Culver/92

Population- based

1,079 male and 386 female bladder cancers and 1,223 male and 1,692 non-cancer controls.

No results specific for foundry workers.

Exposure quality: 1

Very broad exposure categories.

Swanson/95

Population-based

5,714 female cancer cases in Detroit and 1,972 controls. There were 627 bladder cancers.

No remarkable results for fabricated metal manufacturing (FMM).

Exposure quality: 1

No elevated OR found for bladder cancer, but OR was elevated for lung cancer FMM usual industry, and eye cancer and ever in FMM industry.