title: Cholangiocarcinoma among workers in the printing industry: using the NOCCA database to elucidate the generalisability of a cluster report from Japan.
abstract: OBJECTIVE
  A cluster of 11 cases of cholangiocarcinoma (CC) was observed in a small Japanese printing firm. To elucidate whether the identified cluster is indicative of an elevated risk of CC among workers in the printing industry at large, we explored the risk of cancer of the liver and CC among individuals employed in the printing industry in a large cohort set-up in four Nordic countries (Finland, Iceland, Norway and Sweden) over a period of 45 years.
  
  
  METHODS
  The cohort was set-up by linking occupational information from censuses to national cancer registry data utilising personal identity codes in use in all Nordic countries. We calculated standardised incidence ratios (SIRs) for men and women working in the printing industry, and stratified by occupational category (typographers, printers, lithographers, bookbinders).
  
  
  RESULTS
  Among men, we observed elevated SIRs for cancer of the liver (1.35, 95% CI 1.14 to 1.60; 142 cases), specifically intrahepatic CC (2.34, 95% CI 1.45 to 3.57; 21 cases). SIRs for liver cancer were especially elevated among printers and lithographers, and SIRs for intrahepatic CC among typographers and printers. SIRs for extrahepatic CC were not elevated. SIRs for women followed a similar pattern but the number of cases was low.
  
  
  CONCLUSIONS
  Our study supports the notion that the finding of excess CC risk among workers in a small Japanese printing firm possibly extends beyond this specific firm and country. Further studies should focus on the specific exposures that occur in the printing industry.
authors.affiliation: Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France.
authors.forename: Jelle
authors.initials: J
authors.lastname: Vlaanderen
authors.forename: Kurt
authors.initials: K
authors.lastname: Straif
authors.forename: Jan Ivar
authors.initials: JI
authors.lastname: Martinsen
authors.forename: Timo
authors.initials: T
authors.lastname: Kauppinen
authors.forename: Eero
authors.initials: E
authors.lastname: Pukkala
authors.forename: Pär
authors.initials: P
authors.lastname: Sparén
authors.forename: Laufey
authors.initials: L
authors.lastname: Tryggvadottir
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
authors.forename: Kristina
authors.initials: K
authors.lastname: Kjaerheim
mesh_terms: D000328:Adult; D001650:Bile Duct Neoplasms / Q000453:epidemiology*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000453:epidemiology*; D016000:Cluster Analysis; D015331:Cohort Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008113:Liver Neoplasms / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology*; D011327:Printing; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology
keywords: Cholangiocarcinoma; Liver cancer; Printers