title: Characterization of initial clinical symptoms and risk factors for sinonasal adenocarcinomas: results of a case-control study.
abstract: OBJECTIVE
  Sinonasal adenocarcinoma is a rare cancer, frequently associated with occupational exposure to inhalable wood dust. Among the EU member States, Germany was reported to have the highest number of exposed workers. Location and long latency make early diagnosis difficult. This case-control study was aimed at assessing potential risk factors and at characterizing initial clinical symptoms, both serving as matrix to identify persons at increased risk and to improve management of this cancer.
  
  
  METHODS
  Of 58 patients, 31 diagnosed with sinonasal adenocarcinoma (cases) between 1973 and 2007 were identified and underwent standardized interview on clinical data. A total of 85 patients diagnosed over the same period with carcinoma of the oral cavity served as controls.
  
  
  RESULTS
  The ethmoid was confirmed as the predominant site of adenocarcinoma associated with wood dust exposure, whereas the nasal cavity was most commonly affected in patients denying any exposure to wood dust. Cases were significantly engaged in mainly woodworking occupations compared to controls. The main initial clinical symptoms were nasal obstruction 6 months (71%) and epistaxis 4 years (41.9%) prior to diagnosis. Hardwood dust from beech and oak proved to be the most common occupational exposure, with a mean exposure period of 32.3 years and a latency of 43.5 (34-58) years.
  
  
  CONCLUSIONS
  Our investigation confirms the importance of regular screenings for persons exposed to wood dust even years after the end of occupational or private exposure. Banal clinical symptoms such as epistaxis and nasal obstruction might be predictive, requiring early and thorough investigation.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University of Erlangen-Nuremberg, Waldstrasse 1, 91054 Erlangen, Germany. susanne.mayr@uk-erlangen.de
authors.forename: Susanne Ingrid
authors.initials: SI
authors.lastname: Mayr
authors.forename: Kamber
authors.initials: K
authors.lastname: Hafizovic
authors.forename: Frank
authors.initials: F
authors.lastname: Waldfahrer
authors.forename: Heinrich
authors.initials: H
authors.lastname: Iro
authors.forename: Birgitta
authors.initials: B
authors.lastname: Kütting
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000503:physiopathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004391:Dust; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D010255:Paranasal Sinus Neoplasms / Q000453:epidemiology* / Q000503:physiopathology*; D012307:Risk Factors; D014934:Wood; D055815:Young Adult
chemical_list: D004391:Dust