title: Risks of biliary tract cancer and occupational exposures among Shanghai women textile workers: a case-cohort study.
abstract: BACKGROUND
  Biliary tract cancer (BTC) is a relatively rare malignancy worldwide. Little is known about potential etiologic contributions of occupational exposures.
  
  
  METHODS
  The associations between occupational exposures to textile dusts and chemicals and BTC are investigated in a cohort of 267,400 women textile workers in Shanghai, China. A nested case-cohort analysis of 162 BTC cases diagnosed during 1989-1998 was conducted with a reference subcohort of 3,188 workers. Exposures to workplace dusts and chemicals were reconstructed by linking complete work history data with a job-exposure matrix (JEM). Hazard ratios (HR) and dose-response trends were estimated by Cox proportional hazards modeling modified for case-cohort design.
  
  
  RESULTS
  An elevated risk of > or = 1-year employment in maintenance jobs (HR 2.92, 95% CI: 1.48, 5.73) with a significant trend by duration is observed. Excess risk was also found for > or = 20 years exposure to metals (HR 2.50, 95% CI: 1.09, 5.72).
  
  
  CONCLUSIONS
  Long-term exposure to maintenance work and metals in the textile industry may have increased BTC risk in this population.
authors.affiliation: Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA. ckchang@cuhk.edu.hk
authors.forename: Chin-Kuo
authors.initials: CK
authors.lastname: Chang
authors.forename: George
authors.initials: G
authors.lastname: Astrakianakis
authors.forename: David B
authors.initials: DB
authors.lastname: Thomas
authors.forename: Noah S
authors.initials: NS
authors.lastname: Seixas
authors.forename: Janice E
authors.initials: JE
authors.lastname: Camp
authors.forename: Roberta M
authors.initials: RM
authors.lastname: Ray
authors.forename: Dao Li
authors.initials: DL
authors.lastname: Gao
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Wernli
authors.forename: Wenjin
authors.initials: W
authors.lastname: Li
authors.forename: E Dawn
authors.initials: ED
authors.lastname: Fitzgibbons
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Vaughan
authors.forename: Harvey
authors.initials: H
authors.lastname: Checkoway
mesh_terms: D000328:Adult; D001661:Biliary Tract Neoplasms / Q000453:epidemiology* / Q000209:etiology; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D004391:Dust; D005260:Female; D006801:Humans; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology* / Q000209:etiology; D016273:Occupational Exposure / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013783:Textile Industry; D013784:Textiles / Q000633:toxicity*
chemical_list: D004391:Dust