title: Exposure to high concentrations of nitrosamines and cancer mortality among a cohort of rubber workers.
abstract: OBJECTIVE
  To examine if the occurrence of different cancers was increased among rubber workers, as the highest known exposures of humans to nitrosamines have occurred in the rubber industry.
  
  
  METHODS
  A cohort of 8933 rubber workers (hired after 1 January 1950, still active or retired on 1 January 1981 and employed for at least 1 year in one of five study factories) was followed up for mortality from 1 January 1981 to 31 December 1991. Work histories were reconstructed with routinely documented cost centre codes, which allowed identification by employment in specific work areas. For each cost centre code time and factory specific, semi-quantitative exposures to nitrosamines (three levels: low, medium, high) and other compounds were estimated by industrial hygienists. Rate ratios for medium (RRm) and high (RRh) exposures and 95% confidence intervals (95% CIs) were calculated with Cox's proportional hazards models with the low exposure as reference.
  
  
  RESULTS
  Exposure to nitrosamines was significantly associated with an increased mortality from cancers of the oesophagus (13 deaths: RRm 1.7, 95% CI 0.3 to 10.3; RRh 7.3, 95% CI 1.9 to 27.8) and of the oral cavity and pharynx (17 deaths: RRm 0.8, 95% CI 0.2 to 4.1; RRh 3.9, 95% CI 1.4 to 11.1). A non-significant trend of increasing mortality with exposure to higher concentrations of nitrosamines was found for mortality from cancer of the prostate (26 deaths: RRm 1.4, 95% CI 0.5 to 3.8; RRh 2.2, 95% CI 0.9 to 5.6), and the brain (six deaths: RRm 3.9, 95% CI 0.3 to 42.6; RRh 6.0, 95% CI 0.6 to 57.6). No association was found between exposure to nitrosamines and cancer of the stomach (RRm 0.8, 95% CI 0.4 to 1.8; RRh 1.2, 95% CI 0.5 to 2.5) or lung (RRm 1.0, 95% CI 0.6 to 1.5; RRh 1.0, 95% CI 0.7 to 1.6).
  
  
  CONCLUSIONS
  Exposure to high concentrations of nitrosamines is associated with increased mortality from cancers of the oesophagus, oral cavity, and pharynx, but not with increased mortality from cancers of the stomach or lung.
authors.affiliation: Institute of Epidemiology and Social Medicine, University of Münster, Germany. straif@nwz.uni-muenster.de
authors.forename: K
authors.initials: K
authors.lastname: Straif
authors.forename: S K
authors.initials: SK
authors.lastname: Weiland
authors.forename: M
authors.initials: M
authors.lastname: Bungers
authors.forename: D
authors.initials: D
authors.lastname: Holthenrich
authors.forename: D
authors.initials: D
authors.lastname: Taeger
authors.forename: S
authors.initials: S
authors.lastname: Yi
authors.forename: U
authors.initials: U
authors.lastname: Keil
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000209:etiology / Q000401:mortality; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000209:etiology / Q000401:mortality; D009369:Neoplasms / Q000453:epidemiology / Q000401:mortality*; D009602:Nitrosamines / Q000009:adverse effects* / Q000145:classification; D009784:Occupational Diseases / Q000453:epidemiology / Q000401:mortality*; D016273:Occupational Exposure / Q000009:adverse effects; D010610:Pharyngeal Neoplasms / Q000209:etiology / Q000401:mortality; D012408:Rubber
chemical_list: D009602:Nitrosamines; D012408:Rubber