title: A case-case study on sinonasal cancer prevention: effect from dust reduction in woodworking and risk of mastic/solvents in shoemaking.
abstract: OBJECTIVE
  Sinonasal cancers (SNCs) are rare neoplasms, accounting for about 3 % of head and neck cancers, with squamous cell carcinoma (SCC) and adenocarcinoma (ADC) as the most common subtypes. ADCs present strong associations with occupational wood dust exposure. Preventive measures have progressively reduced wood dust concentrations in workplaces but no study has evaluated the effectiveness of such interventions. Few studies indicate associations between ADC and exposure to solvents, which is common in the shoe industry, but this hypothesis still needs confirmation.
  
  
  METHODS
  In a case-case study, we contrasted 32 ADCs against 21 Non-Adenocarcinoma Epithelial Tumors (NAETs) - all recruited from the same clinical setting (Padua's University Hospital; period 2004-2015) - using questionnaires and clinical records to collect information on potential predictors. Non-occupational factors were age, sex, smoking, allergy and chronic sinusitis. Occupational factors were intensity and frequency of wood dust exposure, protection from wood dust, type of wood (in woodworking); frequency of exposure to leather dust or mastic/solvent (in shoemaking). Odds-ratio (OR), 95 % confidence interval (95 % CI) and two-tail p-values were obtained through stepwise backward logistic regression for each industry, always using as reference patients never employed in either trade and adjusting for non-occupational risk factors.
  
  
  RESULTS
  Adjusted OR was 22.5 (95 % CI = 3.50-144; p = 0.001) and 9.37 (95 % CI = 1.29-67.6; p = 0.026), respectively, in patients with low or high degree of protection against wood dust. In the shoe industry, adjusted OR was 1 and 18.8 (95 % CI = 1.29-174; p = 0.030), respectively, in patients with low or high exposure to only mastic/solvent; and 1 and 22.5 (95 % CI = 2.07-244; p = 0.011), respectively, in patients with low or high exposure to only leather dust.
  
  
  CONCLUSIONS
  The questionnaire used was able to estimate with simple algorithms past exposures in wood and footwear industries. The case-case design considerably increased the validity of this small study. Results in this study were always consistent with the extant literature; this could support reliability of novel findings. In woodworking, respiratory protective equipment and local exhaust ventilation reduced the risk of occupational SNC; in footwear manufacture, where preventive interventions were seldom adopted, SNC risk was significantly greater for high exposure from mastic/solvent and leather dust.
authors.affiliation: Department of Otolaryngology and Endoscopic Surgery of the Upper Airways, University Hospital of Padua, Via Giustiniani 2, 35100 Padua, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Emanuelli
authors.affiliation: Department of Otolaryngology and Endoscopic Surgery of the Upper Airways, University Hospital of Padua, Via Giustiniani 2, 35100 Padua, Italy.
authors.forename: Enrico
authors.identifier: 0000-0002-5227-341X
authors.initials: E
authors.lastname: Alexandre
authors.affiliation: Department of Otolaryngology and Endoscopic Surgery of the Upper Airways, University Hospital of Padua, Via Giustiniani 2, 35100 Padua, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Cazzador
authors.affiliation: Department of Occupational Medicine, University Hospital of Padua, Via Giustiniani 2, 35100 Padua, Italy.
authors.forename: Vera
authors.initials: V
authors.lastname: Comiati
authors.affiliation: Department of Otolaryngology and Endoscopic Surgery of the Upper Airways, University Hospital of Padua, Via Giustiniani 2, 35100 Padua, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Volo
authors.affiliation: Department of Otolaryngology and Endoscopic Surgery of the Upper Airways, University Hospital of Padua, Via Giustiniani 2, 35100 Padua, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Zanon
authors.affiliation: Department of Occupational Medicine, University Hospital of Padua, Via Giustiniani 2, 35100 Padua, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Scapellato
authors.affiliation: Department of Occupational Medicine, University Hospital of Padua, Via Giustiniani 2, 35100 Padua, Italy.
authors.forename: Mariella
authors.initials: M
authors.lastname: Carrieri
authors.affiliation: Department of Otolaryngology and Endoscopic Surgery of the Upper Airways, University Hospital of Padua, Via Giustiniani 2, 35100 Padua, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Martini
authors.affiliation: Department of Occupational Medicine, University Hospital of Padua, Via Giustiniani 2, 35100 Padua, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mastrangelo
keywords: Case-case study; Leather dust; Mastic solvent; Occupational risk; Shoe industry; Sinonasal cancer; Wood dust; Wood industry