Nested case-control study of lung cancer among pulp and paper workers in relation to exposure to dusts

Am J Ind Med. 2001 Jun;39(6):547-56. doi: 10.1002/ajim.1053.


Background: Numerous studies have indicated an increased risk of lung cancer in pulp and paper industry workers. In a 1990 survey, standardized mortality ratio (SMR) was found to be 122 (95% CI:96-153) for lung cancer in Polish male workers in the pulp and paper industry, and 166 (95% CI:95-270) among workers engaged in paper production.

Methods: A nested case-control design within a cohort of pulp and paper workers was applied. Seventy-nine lung cancer cases and 237 "healthy" controls were selected from the cohort of 10,460 workers employed during the years 1968-1990, and observed until the end of 1995. Based on personnel files, occupational exposure was reconstructed by experts. Using a questionnaire, data on smoking habits were collected. ORs unadjusted and adjusted for smoking were calculated applying the model of conditional logistic regression.

Results: Occupational exposure to inorganic dusts (kaolin, lime, cement, brick, grindstone) adjusted for smoking was a significant lung cancer risk factor, with a 4.0-fold risk (95% CI:1.3-12.6), and a dose-response by cumulative dose index. Among organic dusts only wood dust increased albeit insignificantly the risk for those exposed (adjusted for smoking OR = 2.1, 95% CI:0.9-4.9), but without dose-response relationship.

Conclusions: Exposure to occupational dust with relatively low content of silica, but at high concentrations may be considered as a factor increasing lung cancer risk. However, the observation made in this study should be viewed with caution as it was based on a small number of cases, and further evidence is needed to confirm or refute the authors' hypothesis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Air Pollutants, Occupational / adverse effects
  • Case-Control Studies
  • Dust / adverse effects
  • Female
  • Humans
  • Logistic Models
  • Lung Neoplasms / etiology*
  • Lung Neoplasms / mortality
  • Male
  • Multivariate Analysis
  • Occupational Diseases / etiology*
  • Occupational Diseases / mortality
  • Occupational Exposure / adverse effects*
  • Odds Ratio
  • Paper*
  • Silicon Dioxide / adverse effects
  • Smoking / adverse effects
  • Surveys and Questionnaires
  • Wood


  • Air Pollutants, Occupational
  • Dust
  • Silicon Dioxide