a death certificate analysis of nasal cancer among...
TRANSCRIPT
Distribution of occupations of casesandCasesControlsOccupationNo.%No.%Furniture
maker821.656.8Lumber-sawmillworker38.134.1Carpenter25.411.4Other
exposure towood003Textileworker513.51216.4Farmer-rancher616.21926.0Other1335.12534.2None-unknown0056.8Total37100.073100.0
[CANCERRESEARCH37, 3473-3474.October19771
SUMMARY
A case-control study of nasal cancer, based on deathcertificate statements on occupation in North Carolinacounties with furniture-manufacturing industries, revealeda 4-fold excess risk linked to this occupation. Althoughwoodworking exposures have been associated with nasaladenocarcinomas in several areas of the world, this is thefirst report of such a relationship in the United States.
INTRODUCTION
In 1965 a clinical report suggested a relation betweenfurniture making and nasal adenocarcinomas in Buckinghamshire, England (6). The association was confirmed byepidemiological studies in several areas of the world.Among furniture workers in England, the annual incidencerate for nasal adenocarcinoma was 60/100,000, which approximated the rate for cancer of the bronchus in the general male population (1). Subsequent studies in Denmark(10), France (4), Belgium (3), and Australia (5) also revealedan excess risk of nasal cancer among furniture workers. Asurvey of death certificates in the state of Washington uncovered no nasal cancer excess for the wood and pulpindustry, but the number of furniture workers was small (9).
In a preliminary attempt to determine whether nasal cancer occurs excessively among furniture workers in theUnited States, age-adjusted cancer mortality rates for theperiod 1950 to 1969 were calculated for counties with asubstantial proportion of the population employed in furniture manufacture. These rates were then compared withrates for counties with similar socioeconomic and demographic characteristics but no involvement in the industry(2). Nasalcancer mortality was significantly elevated in furniture industry counties, while rates for nearly all othercancers were at or below control levels.
To investigate this association further, we obtained deathcertificates from North Carolina, where the furniture industry is heavily concentrated , and employed a case-controlapproach in examining the statementson usual occupationfor persons dying of nasal cancer.
METHODS
Table1
residents of North Carolina were obtained for counties inwhich at least 1% of the total population was employed infurniture and fixtures manufacture (Code 25) according tothe 1963 U. S. Census of Manufactures (12).1 We receivedcopies of certificates for the 37 deaths attributed to cancerof the nasal cavity and sinuses (Code 160 of the EighthRevision of the International Classification of Disease (11)]among white males. For each case we obtained 2 controlcertificates matched by sex, race, county of death, age atdeath (within 2 years), and time of death (exact year match).Heart disease, stroke, and other circulatory diseases accounted for 64% of the control deaths, and cancer accounted for 11%. The median age at death for both casesand controls was66years.No major differences were foundbetween cases and controls with respect to marital statusor place of birth.
Industry and occupation, as recorded on the certificate,were considered together to categorize each individual withregard to woodworking exposure. Exposure was defined in2 ways: (a) those employed in furniture manufacturing; and(b) those with other exposure to wood, including carpenters, sawyers, lumbermen, and loggers. Odds ratios, significance tests, and 95% confidence intervals were then calcu
RESULTS
Table 1 shows the distribution of occupations recordedamong casesand controls. Eight of the 37 people dead fromnasal cancer (21.6%) were employed in the furniture industry, compared with 5 of 73 (6.8%) controls. An additional 5cases(13.5%)were peoplewith jobs involving other types of
, Counties included Alexander, Ashe, Burke, Caidwell, Catawba,Chatham,Davidson,Davie,Guilford, Haywood,Iredell, Lee, Lincoln, McDoweIl.Moore,Randolph,Stanly,Surry,and wilkes.
Computerized listings of deaths from 1956 to 1974 for
ReceivedMay4, 1977;acceptedJune29, 1977.
3473OCTOBER1977
A Death Certificate Analysis of Nasal Cancer among FurnitureWorkers in North Carolina
Louise A. Brinton, William J. Blot, B. J. Stone, and Joseph F. Fraumeni, Jr.
EnvironmentalEpidemiologyBranch,NationalCancerInstitute,Bethesda,Maryland20014
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Number of certificates and percTable2
entage employed iand age at death
Casesn
the furniture md
Controlsustry
byyearYr
of deathAge at deathN@ %N@ %Oddsratiob1955-1964
1965-1974@65>65
@65>6511
18.29 33.36 33.311 9.121
4.818 5.612 0.022 13.64.0
6.0oc
0.5
L. A: Brinton et a!.
a N, total number in each stratum, used as denominator for calculation of percentages.
b Odds ratios were calculated from matched triplet analysis.
lated for each category of exposure according to matchedtriplet procedures (7, 8).woodworking, as compared with 7 (9.6%) of the controls.The actual statements on the death certificates for these 25individuals are presented in the “Appendix.―
The matched triplet analysis resulted in an odds ratio of4.4 (95% confidence limits, 1 .3 to 15.4) for employment asfurniture workers and 1.5 (95% confidence limits, 0.4 to 4.3)for other woodworking occupations. The excess risk amongfurniture workers was apparent below and above age 65 andin both halves of the study period, except for those whodied over age 65 from 1965 to 1974 (Table 2).
Twenty-four of the 37 deaths (65%) from nasal cancerwere reported to arise from the maxillary sinus. Histologywas recorded on only 13 of the certificates: 4 adenocarcinomas, 4 squamous cell or epidermoid carcinomas, 1 lymphoepithelioma, 1 myxosarcoma, and 3 undifferentiatedcarcinomas. Three of the 4 cases of adenocarcinoma wereamong workers in the furniture industry.
DISCUSSION
ACKNOWLEDGMENTS
We thank Charles J. Rothwell and Glenn Flinchum of the Division of VitalStatistics, North Carolina Department of Human Resources, for providing theappropriate death certificates and Debbie Watts and Anne Lee for manuscriptpreparation.
REFERENCES
1.Acheson,E.D.,Hadfield,E.H.,and Macbeth,R.G. CarcinomaoftheNasal Cavity and Accessory Sinuses in Woodworkers. Lancet, 1: 311-312, 1967.
2. Brinton, L. A., Stone, B. J., Blot, W. J., and Fraumeni, J. F., Jr. NasalCancer In U. S. Furniture Industry Counties. Lancet, 1: 628, 1976.
3. Debois,J. N. Tumorenvan de Neusholtebij Houtbewerkers.Tijdschr.Geneeskd., 25: 92-93, 1969.
4. Glgnoux, M.. and Bernard, P. Tumeurs Malignes de l'Ethmoide chez leeTravailleurs du Bols. J. Med. Lyon, 50: 731-736. 1969.
5. Ironslde, P. , and Matthews, J. Adenocarcinoma of the Nose and Paranasal Sinuses In Woodworkers in the State of Victoria. Australia. Cancer.36:1115—1121,1975.
6. Macbeth,A. MalignantDiseaseof the ParanasalSinuses.J. Laryngol.Otol.. 79: 592-612, 1965.
7. Miettinen, 0. S. Individual Matching with Multiple Controls in the Case ofAll or NoneResponses.Biometrics,25: 339-354.1969.
8. Mlettinen, 0. 5. Simple Interval Estimation of Risk Ratios. Am. J. Epidemiol., 100: 515-516, 1974.
9. Mllham, S., Jr. Neoplasiain the Wood and Pulp Industry.Ann. N. V.Acad.Sci.,271:294-300,1976.
10. Mosbech,J., and Acheson,E. D. NasalCancerin Furniture-MakersInDenmark. Danish Med. Bull. , 18: 34—35,1971.
11. NationalCenterfor HealthStatistics.EighthRevisionInternationalClassification of Diseases (adapted), USPHS Publication 1693. Washington,D. C.: U. S. GovernmentPrintingOffice, 1975.
12. U. S. Departmentof Commerce.Censusof Manufactures1963,Vol. 1and2. Washington.D. C.: U. S. GovernmentPrintingOffice, 1966.
APPENDIX
Statementson the deathcertificatespertainingto furniture or woodexposures
RetiredPartnerFurnltureFurniture worker'Furniture worker'Machineroom'CarpenterFurniture'LumbermanFurniture worker'CarpenterFurniture factory'Retired lumberman
Furniture'CarpenterTruckdriverGlueroomworkerMachineroom'Sawmill workerandfarmerRetired'Retired'Retired'LaborerSawmillworkerFurniture salesman and service station
operator‘Those classified as employed in furniture making.
This study provides the 1st indication of an excess risk ofnasal cancer among furniture workers in the United States,although the relation has been established elsewhere (1, 3—6, 10). Basedon a crude assessmentof occupational exposure in individuals, the results confirm an earlier link basedon a county-by-county correlation between aggregate mortality and industrial data (2). Despite the limitations of deathcertificate data on occupation, this approach seems to beuseful as a quick and inexpensive 1st step in generating andevaluating hypotheses linking industrial exposures to cancer. Further study is needed to clarify the risk of nasalcancer in U. S. furniture workers and to identify the specificcarcinogens involved.
Occupation IndustryLumberinspectorFurniturecompanyFurniture factory
Mantel & Table Co.Furniture factoryGeneralconstructionFurniture manufacturingLumbermanFurniture
Furniture factory
IndustryFurniturefactoryRetiredLoggingVeneer companyFurniture factory
FurnitureFurnitureFurniture workerLumbercompanySelf
CASES
CONTROLSOccupation
3474 CANCERRESEARCHVOL.37
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1977;37:3473-3474. Cancer Res Louise A. Brinton, William J. Blot, B. J. Stone, et al. Workers in North CarolinaA Death Certificate Analysis of Nasal Cancer among Furniture
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