title: Occupational asbestos exposure and risk of oral cavity and pharyngeal cancer in the prospective Netherlands Cohort Study.
abstract: OBJECTIVE
  The evidence for an association between occupational asbestos exposure and pharyngeal cancer (PhC) is limited, while for oral cavity cancer (OCC) the literature is even sparser. We studied OCC and PhC risk both separately and combined (OCPC) in relation to occupational asbestos exposure, specifically addressing the influence of potential confounders, the existence of an exposure-response relation, and the presence of interaction between asbestos and smoking.
  
  
  METHODS
  Using the prospective Netherlands Cohort Study (N=58 279 men, aged 55-69 years), we estimated asbestos exposure by linkage to a general population job-exposure matrix (DOMJEM) and a Finnish job exposure matrix (FINJEM). After 17.3 years of follow-up, 58 OCC and 53 PhC cases were available for analysis.
  
  
  RESULTS
  No association between asbestos and risk of OCC was observed for either JEM. Hazard ratios (HR) of PhC and OCPC increased after adjusting for confounders, particularly alcohol consumption and socioeconomic status. For PhC, a multivariable-adjusted increased HR was observed for "ever" versus "never" exposed to asbestos [HR 2.20, 95% confidence interval (95% CI) 1.08-4.49] when using FINJEM, but a trend of increased risks with higher cumulative exposure could not be demonstrated for either JEM. Results for OCPC showed patterns similar to those observed for PhC. None of the cancers showed a significant interaction between asbestos and smoking.
  
  
  CONCLUSIONS
  This prospective population-based study showed no convincing evidence of an association between asbestos and risk of OCC, PhC, and OCPC as an exposure-response relation was lacking, and results were not robust against the use of different JEM. However, the potentially increased HR of PhC and OCPC observed in this and previous studies warrant further research.
authors.affiliation: Department of Epidemiology, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands. pa.vandenbrandt@maastrichtuniversity.nl.
authors.forename: Nadine S M
authors.initials: NS
authors.lastname: Offermans
authors.forename: Roel
authors.initials: R
authors.lastname: Vermeulen
authors.forename: Alex
authors.initials: A
authors.lastname: Burdorf
authors.forename: R Alexandra
authors.initials: RA
authors.lastname: Goldbohm
authors.forename: András P
authors.initials: AP
authors.lastname: Keszei
authors.forename: Susan
authors.initials: S
authors.lastname: Peters
authors.forename: Timo
authors.initials: T
authors.lastname: Kauppinen
authors.forename: Hans
authors.initials: H
authors.lastname: Kromhout
authors.forename: Piet A
authors.initials: PA
authors.lastname: van den Brandt
mesh_terms: D000368:Aged; D001194:Asbestos / Q000009:adverse effects*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000453:epidemiology / Q000209:etiology*; D009426:Netherlands / Q000453:epidemiology; D016273:Occupational Exposure / Q000009:adverse effects / Q000032:analysis*; D010610:Pharyngeal Neoplasms / Q000453:epidemiology / Q000209:etiology*; D016016:Proportional Hazards Models
chemical_list: D001194:Asbestos