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Review
. 2014 Jul;122(7):661-6.
doi: 10.1289/ehp.1307055. Epub 2014 Mar 21.

Tetrachloroethylene exposure and bladder cancer risk: a meta-analysis of dry-cleaning-worker studies

Jelle Vlaanderen  1 , Kurt Straif, Avima Ruder, Aaron Blair, Johnni Hansen, Elsebeth Lynge, Barbara Charbotel, Dana Loomis, Timo Kauppinen, Pentti Kyyronen, Eero Pukkala, Elisabete Weiderpass, Neela Guha
Affiliations
Review

Tetrachloroethylene exposure and bladder cancer risk: a meta-analysis of dry-cleaning-worker studies

Jelle Vlaanderen et al. Environ Health Perspect. 2014 Jul.

Abstract

Background: In 2012, the International Agency for Research on Cancer classified tetrachloroethylene, used in the production of chemicals and the primary solvent used in dry cleaning, as "probably carcinogenic to humans" based on limited evidence of an increased risk of bladder cancer in dry cleaners.

Objectives: We assessed the epidemiological evidence for the association between tetrachloroethylene exposure and bladder cancer from published studies estimating occupational exposure to tetrachloroethylene or in workers in the dry-cleaning industry.

Methods: Random-effects meta-analyses were carried out separately for occupational exposure to tetrachloroethylene and employment as a dry cleaner. We qualitatively summarized exposure-response data because of the limited number of studies available.

Results: The meta-relative risk (mRR) among tetrachloroethylene-exposed workers was 1.08 (95% CI: 0.82, 1.42; three studies; 463 exposed cases). For employment as a dry cleaner, the overall mRR was 1.47 (95% CI: 1.16, 1.85; seven studies; 139 exposed cases), and for smoking-adjusted studies, the mRR was 1.50 (95% CI: 0.80, 2.84; 4 case-control studies).

Conclusions: Our meta-analysis demonstrates an increased risk of bladder cancer in dry cleaners, reported in both cohort and case-control studies, and some evidence for an exposure-response relationship. Although dry cleaners incur mixed exposures, tetrachloroethylene could be responsible for the excess risk of bladder cancer because it is the primary solvent used and it is the only chemical commonly used by dry cleaners that is currently identified as a potential bladder carcinogen. Relatively crude approaches in exposure assessment in the studies of "tetrachloroethylene-exposed workers" may have attenuated the relative risks.

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Conflict of interest statement

Five of the co-authors were members of the IARC Working Group that assessed the carcinogenicity of tetrachloroethylene (A.R., A.B., J.H., E.L., and B.C.). The findings and conclusions in this report are those of the authors and do not necessarily represent the views of any of the U.S. federal agencies with which some of the authors are affiliated.

The authors declare they have no actual or potential competing financial interests.

Figures

Figure 1
Figure 1
Forest plot of cohort and case–control studies included in the meta-analysis that assessed the risk of bladder cancer in relation to occupation as a dry cleaner. See Table 1 for details on included studies.
See this image and copyright information in PMC

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