Occupational exposure to ethylene oxide and risk of lymphoma.
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.
Kiran
Sibel
S
Department of Public Health, Institute of Health Sciences, Centre of Workers' Health and Work Safety, Zonguldak Karaelmas University, Zonguldak, Turkey.
Cocco
Pierluigi
P
Mannetje
Andrea't
A
Satta
Giannina
G
D'Andrea
Ileana
I
Becker
Nikolaus
N
de Sanjosé
Silvia
S
Foretova
Lenka
L
Staines
Anthony
A
Kleefeld
Silke
S
Maynadié
Marc
M
Nieters
Alexandra
A
Brennan
Paul
P
Boffetta
Paolo
P
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
D002273:Carcinogens; D005027:Ethylene Oxide