title: Occupational exposure to ethylene oxide and risk of lymphoma.
abstract: BACKGROUND
  Ethylene oxide, a high-volume commodity, is an established human carcinogen, although the relevant epidemiologic evidence is limited.
  
  
  METHODS
  We explored the association between occupational exposure to ethylene oxide and risk of lymphoma in a case-control study, including 2347 lymphoma cases first diagnosed in 1998-2004 and 2463 controls, from 6 European countries. The diagnosis of lymphoma was based on the 2001 World Health Organization Classification of lymphoma. Occupational exposure to ethylene oxide was retrospectively assessed by industrial hygienists and occupational physicians based on detailed self-reported information. We modeled risk of lymphoma with unconditional logistic regression analysis as a function of various exposure measures, adjusting for age, sex, and participating center.
  
  
  RESULTS
  Thirty-one cases and 27 controls (1.2% of the total study population) were defined as ever having been exposed to ethylene oxide (odds ratio = 1.3 [95% confidence interval [CI] = 0.7-2.1]). Lymphoma risk showed a 4.3-fold increase associated with medium-high frequency of exposure to ethylene oxide (95% CI = 1.4-13). Among major subtypes, chronic lymphocytic leukemia was consistently associated with ethylene oxide exposure, related in a dose-response manner to probability, frequency, and duration of exposure, as well as to cumulative exposure and (less definitively) with exposure intensity.
  
  
  CONCLUSIONS
  Our results add to the evidence that ethylene oxide is a human carcinogen.
authors.affiliation: Department of Public Health, Institute of Health Sciences, Centre of Workers' Health and Work Safety, Zonguldak Karaelmas University, Zonguldak, Turkey.
authors.forename: Sibel
authors.initials: S
authors.lastname: Kiran
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Cocco
authors.forename: Andrea't
authors.initials: A
authors.lastname: Mannetje
authors.forename: Giannina
authors.initials: G
authors.lastname: Satta
authors.forename: Ileana
authors.initials: I
authors.lastname: D'Andrea
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Becker
authors.forename: Silvia
authors.initials: S
authors.lastname: de Sanjosé
authors.forename: Lenka
authors.initials: L
authors.lastname: Foretova
authors.forename: Anthony
authors.initials: A
authors.lastname: Staines
authors.forename: Silke
authors.initials: S
authors.lastname: Kleefeld
authors.forename: Marc
authors.initials: M
authors.lastname: Maynadié
authors.forename: Alexandra
authors.initials: A
authors.lastname: Nieters
authors.forename: Paul
authors.initials: P
authors.lastname: Brennan
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
mesh_terms: D000328:Adult; D000368:Aged; D002273:Carcinogens / Q000633:toxicity*; D016022:Case-Control Studies; D005027:Ethylene Oxide / Q000633:toxicity*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000139:chemically induced* / Q000145:classification / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D016017:Odds Ratio; D012307:Risk Factors
chemical_list: D002273:Carcinogens; D005027:Ethylene Oxide