title: Cancer incidence among waiters: 45 years of follow-up in five Nordic countries.
abstract: OBJECTIVE
  To study cancer risk patterns among waiters in the Nordic countries.
  
  
  METHODS
  We identified a cohort of 16,134 male and 81,838 female waiters from Denmark, Finland, Iceland, Norway and Sweden. During the follow-up period from 1961 to 2005, we found that 19,388 incident cancer cases were diagnosed. Standardised incidence ratio (SIR) was defined as the observed number of cancer cases divided by the expected number, based on national age, time period and gender-specific cancer incidence rates in the general population.
  
  
  RESULTS
  The SIR of all cancers in waiters, in the five countries combined, was 1.46 (95% CI 1.41-1.51) in men and 1.09 (1.07-1.11) in women. In male waiters, the SIR decreased from 1.79 (1.63-1.96) in 1961-1975, to 1.33 (1.26-1.40) in 1991-2005, but remained stable among women. The SIR among male waiters was highest for cancers in the pharynx (6.11; 95% CI 5.02-7.37), oral cavity (4.91; 95% CI 3.81-6.24) and tongue (4.36; 95% CI 3.13-5.92); and in female waiters, in the larynx (2.17; 95% CI 1.63-2.82), oral cavity (1.96; 95% CI 1.60-2.34) and lung (1.89; 95% CI 1.80-1.99).
  
  
  CONCLUSIONS
  The risk of cancer among waiters was higher than in the general population. The elevated incidence in some cancer sites can likely be explained by higher alcohol consumption, the prevalence of smoking and occupational exposure to tobacco smoke. Hopefully, the incidence of cancer among waiters will decrease in the future, due to the banning of tobacco smoking in restaurants and bars in the Nordic countries.
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland University of Helsinki, Hjelt Institute, Helsinki, Finland.
authors.forename: Jere
authors.initials: J
authors.lastname: Reijula
authors.affiliation: Cancer Registry of Norway, Oslo, Norway.
authors.forename: Kristina
authors.initials: K
authors.lastname: Kjaerheim
authors.affiliation: University of Copenhagen, Copenhagen, Denmark.
authors.forename: Elsebeth
authors.initials: E
authors.lastname: Lynge
authors.affiliation: Cancer Registry of Norway, Oslo, Norway.
authors.forename: Jan I
authors.initials: JI
authors.lastname: Martinsen
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland University of Helsinki, Hjelt Institute, Helsinki, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Reijula
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Pär
authors.initials: P
authors.lastname: Sparén
authors.affiliation: Cancer Registry of Iceland, Reykjavik, Iceland.
authors.forename: Laufey
authors.initials: L
authors.lastname: Tryggvadottir
authors.affiliation: Cancer Registry of Norway, Oslo, Norway Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway Samfundet Folkhalsan, Helsinki, Finland.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
authors.affiliation: Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland School of Health Sciences, University of Tampere, Tampere, Finland eero.pukkala@cancer.fi.
authors.forename: Eero
authors.initials: E
authors.lastname: Pukkala
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D016273:Occupational Exposure / Q000009:adverse effects; D009790:Occupations; D012147:Restaurants / Q000331:legislation & jurisprudence; D018570:Risk Assessment; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology / Q000331:legislation & jurisprudence; D014028:Tobacco Smoke Pollution / Q000009:adverse effects
chemical_list: D014028:Tobacco Smoke Pollution
keywords: Alcohol; Nordic countries; cancer incidence; epidemiology; gender differences; malignant neoplasm; occupation; restaurant; tobacco smoke; waiter