Documents Gustavsson, Per 10 results

"In an editorial in an earlier issue of this journal, Johanson & Tinnerberg (1) expressed serious and well-founded concern over the large number of future occupational cancer cases that will result if exposures for a number of substances are not reduced below the so-called "binding occupational exposure limit values" (BOELV) issued by the EU (2). The balance between what is perceived as possible to comply with and the foreseeable health gain when setting BOELV is further discussed in a letter to the Editor by Cherrie (3). This debate raises several important aspects of how to protect workers from cancer as well as other potentially lethal diseases. Herewith, we discuss some of these aspects. ..."

The effect of exposure to man made vitreous fibers (MMVF) on workers in the prefabricated wooden house manufacturing industry was investigated. A model was developed to measure the past exposure to MMVF of 478 insulators among a staff of 2,807 workers at 11 factories in Sweden. The insulators who had a mean employment time of 9.6 years and never used respirators were identified as the workers at greatest risk of exposure to MMVF. One hundred and twenty samples were taken of airborne fiber in 11 facilities to determine current exposure levels. Using the model to estimate past exposure the highest mean fiber exposure level for insulators was calculated as 0.18 fiber/milliliter (f/ml), which occurred during the mid 1970s, compared to 0.10 f/ml at the end of the 1980s and the early 1960s. Changes in production rate, improved ventilation control, and the surface area of the total amount of MMVF sheets handled by the insulator were the most important variables in the model. No increased risk of lung cancer was found for the insulators who were presently working in the house prefabrication industry.

"Objectives
The aim of this study was to investigate if exposure to chemicals in the workplace was associated with an increased risk of postmenopausal breast cancer.
Methods
The study comprised women born 1923–1950 living in Malmö city, Sweden, 1991–1996, and enrolled for a prospective population cohort study. Occupational exposure to various chemicals was assessed from job-exposure matrices. An extensive set of individual data on hormonal breast cancer risk factors were collected via a baseline questionnaire and used for confounding control. First time diagnoses of invasive breast cancer were identified through the Swedish Cancer Registry until end of follow-up on 31 December 2013.
Results
Of 16 084 women, 1011 were diagnosed with breast cancer. Women exposed to chemicals in their occupational environment had a statistically significant increased risk [adjusted hazard ratio (HRadj) 1.26, 95% confidence interval (CI) 1.02–1.54] of breast cancer, and the risk correlated with duration of exposure. Investigation of risk in association with specific chemicals showed a non-significantly elevated risk after exposure to organic solvents. More than ten years of exposure to diesel exhaust was associated with an increased risk (HRadj 1.69, 95% CI 1.01–2.82). Occupational chemical exposures account for 2% of the breast cancer cases in this population.
Conclusions
Occupational exposure to chemicals in general was associated with an elevated risk of breast cancer. A slight elevation of risk was seen after exposure to organic solvents. A statistically significant elevation of risk after >10 years of exposure to diesel exhaust was an unexpected finding."

"Diesel engine exhaust is a complex mixture of gaseous and particulate compounds produced during the combustion of diesel fuels. The gas phase includes carbon dioxide, nitrogen oxides (NOX), carbon monoxide and small amounts of sulphur dioxide and various organic compounds. Diesel exhaust particles (DEP) contain elemental carbon (EC), organic compounds, sulphates, nitrates and trace amounts of metals and other elements. New technology diesel engines are characterised by a significant reduction of the DEP mass emissions. Occupational exposure to diesel exhaust occurs in mining, construction work, professional driving, agri-culture and other activities where diesel-powered vehicles and tools are applied. The critical health effects of diesel exhaust are considered to be pulmonary inflammation and lung cancer. For older technology diesel engines, pulmonary inflammatory responses were observed in human volunteers after single exposure at 100
g DEP/m3 (~ 75
g EC/m3), and in rats after long-term exposure at 210
g DEP/m3 (~ 160
g EC/m3). Development of lung tumours was seen in rats at 2 200
g DEP/m3 (~ 1 650
g EC/m3). For new technology diesel engines, pulmonary inflammatory changes were reported in rats after 13 and 130 weeks of exposure at 3.6 and 4.2 ppm NO2 (12–13
g DEP/m3, ~ 3
g EC/m3). The effect was absent at 0.9–1.0 ppm NO2 (4–5
g DEP/m3, ~ 1
g EC/m3). No indication of tumour development was detected. Epidemiological studies associate occupational exposure to exhaust from older technology diesel engines with increased lung cancer risk. Based on a log-linear meta-regression model, 45 years of occupational exposure to diesel exhaust at 1, 10 and 25
g EC/m3 was estimated to result in 17, 200 and 689 extra lung cancer deaths per 10 000 individuals, respectively, by the age of 80 years. Although data allowing a direct comparison of the carcinogenic potential of exhaust from new and older technology diesel engines are not available, the significant reduction of the DEP mass concentration in the new technology diesel engine exhaust is expected to reduce the lung cancer risk (per kWh). In addition to the critical effects, human and animal inhalation studies associate exposure to older technology diesel engine exhaust with sensory irritation, increased airway resistance, cardiovascular effects, genotoxicity and adjuvant allergenic effects. There are also animal studies indicating neuroinflammatory effects, developmental effects and effects on the male reproductive function. When evaluating the health risk of diesel exhausts it is important to take into account that the transition from “old” to “new” technology diesel engines is expected to take a long time. Keywords: cancer, cardiovascular, diesel engine, diesel exhaust, elemental carbon, inflammation, nitrogen dioxide, occupational exposure limit, particles, pulmonary, review, risk assessment, toxicity."

"We investigated occupational exposure to diesel motor exhaust (DME) and the risk of lung cancer by histological subtype among men, using elemental carbon (EC) as a marker of DME exposure. 993 cases and 2359 controls frequency-matched on age and year of study inclusion were analyzed by unconditional logistic regression in this Swedish case-control study. Work and smoking histories were collected by a questionnaire and telephone interviews. DME was assessed by a job-exposure matrix. We adjusted for age, year of study inclusion, smoking, occupational exposure to asbestos and combustion products (other than motor exhaust), residential exposure to radon and exposure to air pollution from road traffic. The OR for lung cancer for ever vs. never exposure to DME was 1.15 (95% CI 0.94-1.41). The risk was higher for squamous and large cell, anaplastic or mixed cell carcinoma than for alveolar cell cancer, adenocarcinoma and small cell carcinoma. The OR in the highest quartile of exposure duration (≥34 years) vs. never exposed was 1.66 (95% CI 1.08-2.56; p for trend over all quartiles: 0.027) for lung cancer overall, 1.73 (95% CI 1.00-3.00; p: 0.040) for squamous cell carcinoma and 2.89 (95% CI 1.37-6.11; p: 0.005) for the group of undifferentiated, large cell, anaplastic and mixed cell carcinomas. We found no convincing association between exposure intensity and lung cancer risk. Long-term DME exposure was associated with an increased risk of lung cancer, particularly to squamous cell carcinoma and the group of undifferentiated, large cell, anaplastic or mixed carcinomas."

"OBJECTIVES:
Previous studies on firefighters indicate an increased risk of cancer although findings regarding which cancer sites are in excess have been inconsistent. The aim of this study was to investigate the cancer incidence among Swedish firefighters.
METHODS:
This updated cohort study included 1080 men who worked at least 1 year as a firefighter in the city of Stockholm, Sweden during 1931-1983. First-time diagnoses of cancer were identified through the Swedish Cancer Registry from 1958 until 2012. Employment as a firefighter was determined from the annual fire station enrolment records. Standardized incidence ratios were calculated using the Stockholm population as reference.
RESULTS:
Firefighters in Stockholm had a low overall risk of cancer (SIR = 0.81 95% CI 0.71-0.91). However, firefighters were at an increased risk of stomach cancer (SIR = 1.89 95% CI 1.25-2.75). Firefighters had significantly low risks for prostate cancer (SIR = 0.68 95% CI 0.52-0.87) and malignant melanoma of the skin (SIR = 0.30 95% CI 0.06-0.88). There was a statistically significant trend of increasing overall risk of cancer with increasing employment duration, although there was still no excess of cancer overall in any of the categories of employment duration.
CONCLUSION:
Stockholm firefighters had an increased risk of stomach cancer but a low overall risk of cancer. The trend of increasing overall risk of cancer with increasing employment duration could potentially be related to the carcinogenic exposures at work."

"Abstract
Objectives Occupational exposure to respirable crystalline silica (RCS) is common. The study aimed to assess the risk for acute myocardial infarction (AMI) after long-term exposure to RCS and to explore differences in risk between men and women.
Methods
The cohort included all manual workers identified from the Swedish National Census in 1980 using data on job titles and demography altogether from five censuses from 1960 to 1990, in total 605 246 men and 480 607 women. Information on AMI was obtained from nationwide registers from 1992 to 2006. Exposure to RCS was assessed with a job-exposure matrix. HRs and 95% CIs were estimated by Cox regression, adjusted for age, socioeconomic status and urbanisation index.
Results
Among manual workers ever exposed to RCS, the adjusted risk of AMI was HR 1.29 (95% CI 1.15 to 1.46) in women, and HR 1.02 (95% CI 1.00 to 1.04) in men. In the highest quartile of cumulative exposure, the risk of AMI was HR 1.66 (95% CI 1.27 to 2.18) for women, and HR 1.06 (95% CI 1.03 to 1.10) for men, respectively. The risk of AMI increased with cumulative exposure to RCS both in women (p=0.001) and in men (p=0.016). An interaction analysis showed that the relative risk from exposure to RCS was statistically significantly lower in men than in women at similar exposure levels.
Conclusions
Occupational exposure to RCS was related to the risk of AMI. Women were more sensitive to exposure to RCS than men.

"Objectives
Night work has been classified as probably carcinogenic to humans by the International Agency for Research on Cancer, but epidemiological evidence was considered limited due to variability in findings and potential bias. This study aimed to investigate the risk of breast cancer in a cohort with detailed and registry-based data on night work.
Methods
The cohort comprised 25 585 women (nurses and nursing assistants) employed 1 year or more between 2008 and 2016 in the healthcare sector in Stockholm. Information on work schedules was obtained from employment records. Breast cancer cases were identified from the national cancer register. HRs were estimated by a discrete time proportional hazards model, adjusting for age, country of birth, profession and childbirth.
Results
There were 299 cases of breast cancer, 147 in premenopausal and 152 in postmenopausal women. The adjusted HR of postmenopausal breast cancer in association with ever versus never working nights was 1.31 (95% CI 0.91 to 1.85). Eight or more years of night work was associated with an increased risk of postmenopausal breast cancer, HR=4.33 (95% CI 1.45 to 10.57), based on five cases only, though.
Conclusions
This study is limited by a short period of follow-up and a lack of information on night work before 2008. Most exposure metrics showed no association with breast cancer risk, but there was an elevated risk of postmenopausal breast cancer in women after 8 or more years of night work."

"Objectives
Chronic Obstructive Pulmonary Disease (COPD) is a common respiratory disorder. Next to tobacco smoking, occupational exposure is the most important risk factor for COPD in high-income countries. To enable preventative measures, more knowledge is needed on which specific occupational exposures that are related to risk of developing COPD in men and women.
Methods
A population-based cohort was formed from subjects responding to the Stockholm Public Health Surveys in 2002, 2006, and 2010, followed up until 2014. The dataset was linked to a quantitative job exposure matrix via occupational titles from the 1990 nation-wide Population and housing census. We identified COPD among subjects having medication for COPD and/or reporting a physician's diagnosis of COPD. The gender-specific risks to develop COPD from occupational particle-exposure were estimated by proportional hazards regression model, adjusted for age and individual data on tobacco-smoking.
Results
Men exposed to respirable crystalline silica (RCS) (HR 1.46, CI 1.13–1.90), gypsum and insulation material (HR 1.56, CI 1.18–2.05), diesel exhaust (HR 1.18, CI 0.99–1.41) and high levels of particles from asphalt/bitumen (HR 1.71, CI 1.06–2.76) as well as welding fumes (HR 1.57, CI 1.12–2.21) had an increased smoking-adjusted risk for developing COPD. An increased risk was also observed among women highly exposed to various organic particles from soil, leather, plastic, soot, animal, textile, flour (HR 1.53, CI 1.15–2.04). Furthermore, a significant positive exposure-response trend was found among men exposed to RCS, iron dust, gypsum and insulation material, and diesel exhaust. A tendency towards an exposure-response relationship was also seen among both men and women exposed to welding fumes and various organic particles, and among men exposed to particles from asphalt/bitumen. The population attributable fraction for COPD from occupational exposure to particles was 10.6% among men and 6.1% among women.
Conclusions
This study indicates an increased smoking-adjusted risk of developing of COPD due to occupational exposure to particles. A positive exposure-response relationship was found for RCS, gypsum and insulation, diesel exhaust, and welding fumes. Also, exposure to high levels of asphalt/bitumen and various organic particles was associated with a higher risk for COPD. Reduction of these exposures in the work environment are important to prevent future cases of COPD. More studies are needed to investigate exposure-response relationships further, but this study indicates that the European occupational exposure limit (OEL) for RCS needs to be re-evaluated."