APPENDIX E
Case-Control Results Tables

TABLE E.1 Pharyngeal Cancer and Exposure to Asbestos—Case-Control Studies

Reference*

Study Population

Exposed Cases

Estimated RR (95% CI)

Berrino et al. 2003

100 male cases of hypopharyngeal cancer from six centers in Southern Europe, < 55 years old (adjusted for smoking and alcohol consumption)

 

 

 

Possible

na

1.8 (0.9-3.9)

 

Probable

na

1.8 (0.6-5.0)

 

(More detailed findings from combined analysis with 215 cases of laryngeal cancer on Table E.2)

 

 

Luce et al. 2000

5 hypopharyngeal cancer cases among residents of New Caledonia

 

 

 

Whitewash from tremolite asbestos

1

0.64 (0.01-6.68)

Marchand et al. 2000

206 hypopharyngeal cancer cases among male residents of six cities in France (adjusted for smoking and alcohol consumption)

 

 

 

Any exposure

161

1.80 (1.08-2.99)

 

Low cumulative exposure

52

1.92 (1.03-3.57)

 

Intermediate

52

1.40 (0.74-2.63)

 

High

57

2.14 (1.14-4.01)



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APPENDIX E Case-Control Results Tables TABLE E.1 Pharyngeal Cancer and Exposure to Asbestos—Case-Control Studies Exposed Estimated RR Reference* Study Population Cases (95% CI) Berrino 100 male cases of hypopharyngeal cancer et al. 2003 from six centers in Southern Europe, < 55 years old (adjusted for smoking and alcohol consumption) Possible na 1.8 (0.9-3.9) Probable na 1.8 (0.6-5.0) (More detailed findings from combined analysis with 215 cases of laryngeal cancer on Table E.2) Luce et al. 5 hypopharyngeal cancer cases among 2000 residents of New Caledonia Whitewash from tremolite asbestos 1 0.64 (0.01-6.68) Marchand 206 hypopharyngeal cancer cases among et al. 2000 male residents of six cities in France (adjusted for smoking and alcohol consumption) Any exposure 161 1.80 (1.08-2.99) Low cumulative exposure 52 1.92 (1.03-3.57) Intermediate 52 1.40 (0.74-2.63) High 57 2.14 (1.14-4.01) continues 297

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298 ASBESTOS TABLE E.1 Pharyngeal Continued Exposed Estimated RR Reference* Study Population Cases (95% CI) Gustavsson 138 pharyngeal cancer cases among male et al. 1998 residents of two regions in Sweden (adjusted for smoking and alcohol consumption) Asbestos (low) 24 1.01 (0.57-1.80) Asbestos (high) 22 1.08 (0.62-1.91) Zheng et al. 115 male oral or pharyngeal cancer cases 1992b among residents of Shanghai, China 1.81 (0.91-3.60)a Asbestos, occupational exposure 16 Merletti 86 oral cavity or oropharynx (n = 12) cancer et al. 1991 cases among male residents of Turin, Italy (adjusted for smoking and alcohol consumption) Any exposure 45 1.1 (na) Probable or definite 3 0.4 (na) NOTES: CI = Confidence interval; na = not available; RR = relative risk. Data points included in meta-analyses are bolded. * Full citations can be found in the reference list for Chapter 6. aOR and 95% CI calculated with standard methods from observed numbers of exposed cases and controls in original paper.

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299 APPENDIX E TABLE E.2 Laryngeal Cancer and Exposure to Asbestos—Case-Control Studies Exposed Estimated RR Reference* Study Population Cases (95% CI) Berrino 213 male cases of endolaryngeal cancer from et al. 2003 six centers in Southern Europe, < 55 years old Possible na 1.7 (1.0-3.0) Probable na 1.8 (0.8-4.0) Combined analysis with 100 hypopharyngeal cancer cases Asbestos (JEM-derived agent), any 215 1.6 (1.0-2.5) exposure 10+ years duration and 20+ years lag 121 1.4 (0.8-2.4) Likelihood of exposure Possible 175 1.7 (1.1-2.8) Probable 40 1.9 (0.9-3.8) Duration of exposure < 10 years na 1.3 (0.6-2.7) 10-19 years na 1.4 (0.7-2.7) ≥ 20 years na 1.7 (0.9-3.0) p-trend > 0.05 Tertiles of weighted exposure 1 na 1.4 (0.8-2.3) 2 na 1.9 (1.2-3.2) 3 na 1.6 (1.0-2.6) p-trend = 0.037 Dietz et al. 257 laryngeal cancer cases among residents 2003 of Rhein-Neckar region, Germany Asbestos 59 1.3 (0.8-2.1) Elci et al. 940 laryngeal cancer cases among male 2002 residents of Istanbul, Turkey (smoking- adjusted) Asbestos (JEM-derived agent) 150 1.0 (0.8-1.3) Glottis 28 0.8 (0.5-1.2) Supraglottis 71 1.0 (0.8-1.4) Other laryngeal 51 1.2 (0.9-1.7) Intensity of exposure Low 45 0.9 (0.6-1.3) Medium 93 1.2 (0.9-1.6) High 12 0.6 (0.3-1.1) Probability of exposure Low 121 1.2 (0.9-1.5) Medium 20 0.6 (0.4-1.1) High 9 0.7 (0.3-1.5) continues

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300 ASBESTOS TABLE E.2 Laryngeal Continued Exposed Estimated RR Reference* Study Population Cases (95% CI) Luce et al. 20 laryngeal cancer cases among male 2000 residents of New Caledonia (all smokers) Whitewash from tremolite asbestos 3 0.72 (0.22-2.30) Melanesians 2 0.71 (0.14-3.63) Non-Melanesians 1 0.60 (0.07-5.22) Marchand 296 laryngeal cancer cases among male et al. 2000 residents of six cities in France (smoking- adjusted) Any exposure 216 1.24 (0.83-1.90) Low cumulative exposure 67 1.10 (0.66-1.82) Intermediate 72 1.20 (0.73-1.99) High 77 1.47 (0.87-2.46) Supraglottic, any exposure 56 1.12 (0.61-2.05) Low cumulative exposure 15 0.84 (0.38-1.84) Intermediate 22 1.31 (0.62-2.76) High 19 1.27 (0.58-2.78) Glottic and subglottic, any exposure 75 1.15 (0.68-1.95) Low cumulative exposure 27 1.19 (0.62-2.27) Intermediate 21 0.90 (0.45-1.78) High 27 1.44 (0.73-2.83) Epilarynx, any exposure 77 1.77 (0.94-3.30) Low cumulative exposure 22 1.45 (0.67-3.13) Intermediate 25 1.69 (0.79-3.64) High 30 2.22 (1.05-4.71) De Stefani 112 laryngeal cancer cases among male et al. 1998 residents of Montevideo, Uruguay (smoking- adjusted) Asbestos (self-reported agent) 23 1.8 (0.9-3.2) 1-20 years 4 0.9 (0.3-2.7) 20+ years 19 2.4 (1.2-4.8) Supraglottic na 2.3 (0.9-5.7) Glottic na 2.9 (0.8-10.5) Gustavsson 157 laryngeal cancer cases among male et al. 1998 residents of two regions in Sweden Asbestos (low) 28 1.21 (0.73-2.02) Asbestos (high) 34 1.69 (1.05-2.74) Quartile I 13 1.16 (1.02-1.32) Quartile II 15 1.35 (1.04-1.74) Quartile III 16 1.56 (1.06-2.30) Quartile IV 18 1.82 (1.08-3.04) p-trend = 0.02

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301 APPENDIX E TABLE E.2 Laryngeal Continued Exposed Estimated RR Reference* Study Population Cases (95% CI) Muscat and 186 laryngeal cancer cases among white, Wynder male residents of New York, Illinois, 1992 Michigan, and Pennsylvania, US Asbestos, any exposure 66 1.1 (0.7-1.9) Glottis 40 1.3 (0.7-2.7) Supraglottis 26 1.1 (0.5-2.6) Wortley 235 laryngeal cancer cases among residents et al. 1992 of western Washington state, US Asbestos—peak None 145 1.0 Low 3 1.2 (0.6-7.1) Medium 57 1.3 (0.8-2.0) High 30 1.1 (0.6-1.9) Asbestos—duration < 1 year 151 1.0 1-9 50 1.0 (0.5-2.1) ≥ 10 34 1.2 (0.6-2.3) Asbestos—exposure scores <5 173 1.0 5-19 25 1.1 (0.6-2.1) ≥ 20 37 1.4 (0.7-2.5) Zheng et al. 201 laryngeal cancer cases among residents 1992a of Shanghai, China (smoking-adjusted) Asbestos, occupational exposure 26 2.0 (1.0-4.3) Ahrens et al. 85 laryngeal cancer cases among male 1991 residents of Bremen, Germany (smoking- adjusted) Asbestos na 1.1 (0.5-2.4) Brown et al. 180 laryngeal cancer cases among male 1988 residents along Gulf Coast of Texas (smoking-adjusted) Asbestos 88 1.5 (1.0-2.2) < 5 years 20 1.3 (0.7-2.6) 5-14 24 2.2 (1.1-4.3) ≥ 15 40 1.4 (0.8-2.4) unknown 4 Zagraniski 92 laryngeal cancer cases among white, male et al. 1986 residents of New Haven, CT (smoking- adjusted) Asbestos workers (ever held occupation) 11 1.1 (0.4-2.9) continues

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302 ASBESTOS TABLE E.2 Laryngeal Continued Exposed Estimated RR Reference Study Population Cases (95% CI) Olsen and 276 male laryngeal cancer cases among Sabroe 1984 residents of Denmark (smoking-adjusted) Asbestos 17 1.8 (1.0-3.4) Burch et al. 184 laryngeal cancer cases among male 1981 residents of southern Ontario, Canada (smoking-adjusted) Self-reported asbestos exposure 36 1.6 (p = 0.069) Occupational hygienist classified exposure 14 2.3 (p = 0.052) Hinds et al. 47 laryngeal cancer cases among male 1979 residents of three counties in WA; self- reported asbestos exposure All subtypes 25 1.75 (p = 0.21) Glottis na 1.29 (p = 0.63) Supraglottis na 4.00 (p = 0.22) Shettigara 43 laryngeal cancer cases among male and Morgan hospital patients in Toronto, Canada 1975 Asbestos 10 ∞ (0 exposed controls) Stell and 100 laryngeal cancer cases among male McGill 1973 hospital patients in Liverpool, UK 14.53 (4.27-49.43)a Asbestos 31 NOTES: CI = Confidence interval; na = not available; RR = relative risk. Data points included in meta-analyses are bolded. * Full citations can be found in the reference list for Chapter 6. aOR and 95% CI calculated with standard methods from observed numbers of exposed cases and controls in original paper.

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303 APPENDIX E TABLE E.3 Esophageal Cancer and Exposure to Asbestos—Case-Control Studies Exposed Estimated RR Reference* Study Population Cases (95% CI) Parent et al. 99 esophageal cancer cases among male 2000 residents of Montreal, Canada; IH-derived agent: chrysotile asbestos (smoking-adjusted) All subtypes Any exposure 21 1.4 (0.8-2.4) Nonsubstantial 19 1.4 (0.8-2.5) Substantial 2 1.3 (0.3-6.2) 63 squamous-cell carcinomas Any exposure 17 2.0 (1.1-3.8) Nonsubstantial 16 2.1 (1.1-4.0) Substantial 1 1.1 (0.1-9.7) Gustavsson 122 esophageal cancer cases among male et al. 1998 residents of two regions in Sweden; IH- derived agent (smoking-adjusted) Asbestos (low) 22 1.21 (0.67-2.17) Asbestos (high) 21 1.00 (0.54-1.82) Hillerdal Gastrointestinal carcinoma cases among 1980 male residents of Uppsala county, Sweden (exposure = pleural plaques) 2.86 (0.07-15.91)a 21 esophageal 1 NOTES: CI = Confidence interval; na = not available; RR = relative risk. Data points included in meta-analyses are bolded. * Full citations can be found in the reference list for Chapter 6. aOR and 95% CI calculated with standard methods from observed and expected numbers presented in original paper.

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304 ASBESTOS TABLE E.4 Stomach Cancer and Exposure to Asbestos—Case-Control Studies Exposed Estimated RR Reference* Study Population Cases (95% CI) Krstev et al. 443 stomach cases among residents of 2005 Warsaw, Poland 285 males, ever exposed 42 1.5 (0.9-2.4) 1-9 years 19 1.2 (0.6-2.3) ≥ 10 years 23 1.9 (0.9-3.8) 158 females, ever exposed 1 0.3 (0.03-3.0) 1-9 years 1 0.4 (0.0-6.0) ≥ 10 years 0 — Ekstrom 565 gastric cancer cases among residents of 155 1.11 (0.87-1.42) et al. 1999 Sweden Parent et al. 250 male gastric cancer cases among 1998 residents of Montreal, Canada Chrysotile asbestos Nonsubstantial 43 1.2 (0.8-1.7) Substantial 4 0.7 (0.2-1.8) Amphibole asbestos Nonsubstantial 10 0.6 (0.3-1.2) Substantial 3 1.9 (0.6-6.9) Cocco et al. 640 gastric cancer cases among male 1994 residents of Italy Ever exposed 239 0.7 (0.5-1.1) 21+ years na 1.4 (0.6-3.0) Hillerdal Gastrointestinal carcinoma cases among 1980 male residents of Uppsala county, Sweden (exposure = pleural plaques) 2.40 (0.88-5.22)a 148 stomach 6 NOTES: CI = Confidence interval; na = not available; RR = relative risk. Data points included in meta-analyses are bolded. * Full citations can be found in the reference list for Chapter 6. a95% CI calculated with standard methods from observed and expected numbers presented in original paper.

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305 APPENDIX E TABLE E.5 Colorectal Cancer and Exposure to Asbestos—Case-Control Studies Exposed Estimated RR Reference* Study Population Cases (95% CI) Goldberg 497 colon cancer cases among male residents et al. 2001 of Montreal, Canada; industrial-hygiene- derived agent Adjusted for age and non-occupational factors Nonsubstantial 60 0.9 (0.6-1.3) Substantial 18 2.1 (1.1-4.0) Further adjusted for occupational factors Nonsubstantial 60 0.9 (0.6-1.3) Substantial 18 1.8 (0.9-3.6) Frequency 1-5% 21 0.9 (0.5-1.6) 6-30% 49 1.1 (0.7-1.5) > 30% 8 1.5 (0.6-3.7) Concentration Low 40 0.9 (0.6-1.4) Medium 32 1.2 (0.8-1.8) High 6 1.4 (0.4-4.3) Duration (10-year increment) 78 1.1 (0.9-1.2) Dumas et al. 257 rectal cancer cases among male residents 2000 of Montreal, Canada Chrysotile, any 30 0.7 (0.5-1.0) Substantial 3 0.5 (0.2-1.6) Amphiboles, any 11 0.7 (0.3-1.2) Substantial 2 1.5 (0.3-7.6) Demers et al. 261 colorectal cancer cases among white 15 0.5 (0.3-1.0) 1994 males residents of southeast Michigan Duration (years) < 20 9 0.6 (0.3-1.5) 20+ 6 0.4 (0.1-1.2) Latency (years) < 40 5 0.4 (0.1-1.3) 40+ 10 0.6 (0.2-1.4) Vineis et al. 74 colon cancer cases among male residents 4 4.8 (1.05-21.5) 1993 of industrialized northern Italy (job titles) Jobs with putative asbestos exposure Garabrant 419 male colon cancer cases among residents et al. 1992 of Los Angeles County, CA Never exposed 353 1.00 continues

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306 ASBESTOS TABLE E.5 Colorectal Continued Exposed Estimated RR Reference* Study Population Cases (95% CI) No latency Any exposure 66 0.99 (0.66-1.50) Asbestos on hands and clothes Did not get on hands or clothes 17 2.32 (0.87-6.23) Got on hands or clothes 49 0.82 (0.52-1.30) Use of mask Did not wear mask 55 0.95 (0.61-1.46) Wore mask 11 1.43 (0.49-4.17) Frequency of exposure < 5 times/week 18 1.00 (0.50-2.00) ≥ 5 times/week 31 0.79 (0.43-1.46) Brief, intense exposure 17 1.48 (0.64-3.38) Ordinal trend p = 0.70 Duration of exposure (years) <5 24 0.98 (0.53-1.84) 5-14 20 1.47 (0.67-3.22) ≥ 15 22 0.76 (0.39-1.49) Continuous trend p = 0.61 Ordinal trend p = 0.81 Time since first exposure (years) < 1-14 10 1.66 (0.54-5.10) 15-29 21 1.37 (0.65-2.91) ≥ 30 35 0.77 (0.45-1.31) Continuous trend p = 0.61 Ordinal trend p = 0.66 Cumulative exposure index 1-30 41 1.26 (0.74-2.15) 31-60 11 0.80 (0.34-1.88) ≥ 61 14 0.65 (0.28-1.51) Continuous trend p = 0.22 Ordinal trend p = 0.46 15-year latency Exposed, latency > 15 years 56 0.93 (0.60-1.44) Asbestos on hands and clothes Did not get on hands or clothes 12 1.75 (0.62-4.94) Got on hands or clothes 44 0.83 (0.51-1.33) Use of mask Did not wear mask 46 0.86 (0.55-1.37) Wore mask 10 1.95 (0.55-6.90) Frequency of exposure < 5 times/week 14 0.83 (0.39-1.76) ≥ 5 times/week 30 0.93 (0.49-1.77) Brief, intense exposure 12 1.14 (0.46-2.87) Ordinal trend p = 0.78

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307 APPENDIX E TABLE E.5 Colorectal Continued Exposed Estimated RR Reference Study Population Cases (95% CI) Duration of exposure (years) <5 19 0.74 (0.37-1.47) 5-14 21 1.60 (0.75-3.44) ≥ 15 16 0.69 (0.30-1.55) Continuous trend p = 0.58 Ordinal trend p = 0.79 Cumulative exposure index 1-30 36 1.07 (0.63-1.81) 31-60 10 0.94 (0.33-2.65) ≥ 61 10 0.55 (0.21-1.47) Continuous trend p = 0.33 Ordinal trend p = 0.40 Gerhardson Colon and rectal cancer cases among male de Verdier residents of Stockholm, Sweden; self- et al. 1992 reported agents 163 colon cancers 22 1.9 (0.9-4.2) Right colon 16 2.6 (1.2-5.9) Left colon 3 0.5 (0.1-1.9) 107 rectal cancers 17 1.9 (0.8-4.6) Colorectal cancer: latency (years) 1-19 5 1.4 (0.3-9.9) 20+ 34 2.0 (1.0-3.9) 1-29 12 1.6 (0.5-5.0) 30+ 27 2.0 (1.0-4.4) 1-39 22 1.4 (0.7-3.0) 40+ 17 3.2 (1.1-11.5) Neuget et al. 51 colorectal cancer cases among males 1991 undergoing colonoscopy in 3 NYC medical centers Asbestos exposure 10 1.8 (0.8-5.6) Significant exposure 3 4.3 (0.8-23.5) Fredriksson 329 colon cancer cases among residents of et al. 1989 Umea, Sweden Asbestos, low grade na 1.2 (0.6-2.4) Asbestos, high grade na 2.1 (0.8-5.8) Spiegelman Colorectal cancer cases in seven US and Wegman metropolitan areas and two states; JEM- 1985 derived agent Males: 343 colorectal cancer na 1.28 (p = 0.17) 224 colon cancer only na 1.22 (p = 0.33) Females: 208 colorectal cancer na 1.08 (p = 0.65) 171 colon cancer only na 1.09 (p = 0.64) continues

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308 ASBESTOS TABLE E.5 Colorectal Continued Exposed Estimated RR Reference* Study Population Cases (95% CI) Hardell 153 colon cancer cases among male residents 1981 of Umea, Sweden Asbestos, any 16 1.9 (1.0-3.6) Hillerdal Gastrointestinal carcinoma cases among 1980 male residents of Uppsala county, Sweden (exposure = pleural plaques) 1.67 (0.34-4.87)a 108 colon 3 1.76 (0.36-5.16)a 101 rectal 3 NOTES: CI = Confidence interval; na = not available; RR = relative risk. Data points included in meta-analyses are bolded. * Full citations can be found in the reference list for Chapter 6. aOR and 95% CI calculated with standard methods from observed and expected numbers presented in original paper.