Cholangiocarcinoma among workers in the printing industry: using the NOCCA database to elucidate the generalisability of a cluster report from Japan

Occup Environ Med. 2013 Dec;70(12):828-30. doi: 10.1136/oemed-2013-101500. Epub 2013 Aug 28.


Objectives: 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.

Keywords: Cholangiocarcinoma; Liver cancer; Printers.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Bile Duct Neoplasms / epidemiology*
  • Bile Ducts, Intrahepatic*
  • Cholangiocarcinoma / epidemiology*
  • Cluster Analysis
  • Cohort Studies
  • Female
  • Finland / epidemiology
  • Humans
  • Iceland / epidemiology
  • Incidence
  • Japan / epidemiology
  • Liver Neoplasms / epidemiology
  • Male
  • Middle Aged
  • Occupational Diseases / epidemiology*
  • Printing
  • Scandinavian and Nordic Countries / epidemiology