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. 2020 Oct 21;15(10):e0239338.
doi: 10.1371/journal.pone.0239338. eCollection 2020.

Occupational bladder cancer: A cross section survey of previous employments, tasks and exposures matched to cancer phenotypes

Oliver Reed  1 , Ibrahim Jubber  1 , Jon Griffin  2 , Aidan P Noon  3 , Louise Goodwin  1 , Syed Hussain  4 , Marcus G Cumberbatch  1   5 , James W F Catto  1   3
Affiliations

Occupational bladder cancer: A cross section survey of previous employments, tasks and exposures matched to cancer phenotypes

Oliver Reed et al. PLoS One. .

Abstract

Objectives: Up to 10% of Bladder Cancers may arise following occupational exposure to carcinogens. We hypothesised that different cancer phenotypes reflected different patterns of occupational exposure.

Methods: Consecutive participants, with bladder cancer, self-completed a structured questionnaire detailing employment, tasks, exposures, smoking, lifestyle and family history. Our primary outcome was association between cancer phenotype and occupational details.

Results: We collected questionnaires from 536 patients, of whom 454 (85%) participants (352 men and 102 women) were included. Women were less likely to be smokers (68% vs. 81% Chi sq. p<0.001), but more likely than men to inhale environmental tobacco smoke at home (82% vs. 74% p = 0.08) and use hair dye (56% vs. 3%, p<0.001). Contact with potential carcinogens occurred in 282 (62%) participants (mean 3.1 per worker (range 0-14)). High-grade cancer was more common than low-grade disease in workers from the steel, foundry, metal, engineering and transport industries (p<0.05), and in workers exposed to crack detection dyes, chromium, coal/oil/gas by-products, diesel fumes/fuel/aircraft fuel and solvents (such as trichloroethylene). Higher staged cancers were frequent in workers exposed to Chromium, coal products and diesel exhaust fumes/fuel (p<0.05). Various workers (e.g. exposed to diesel fuels or fumes (Cox, HR 1.97 (95% CI 1.31-2.98) p = 0.001), employed in a garage (HR 2.19 (95% CI 1.31-3.63) p = 0.001), undertaking plumbing/gas fitting/ventilation (HR 2.15 (95% CI 1.15-4.01) p = 0.017), undertaking welding (HR 1.85 (95% CI 1.24-2.77) p = 0.003) and exposed to welding materials (HR 1.92 (95% CI 1.27-2.91) p = 0.002)) were more likely to have disease progression and receive radical treatment than others. Fewer than expected deaths were seen in healthcare workers (HR 0.17 (95% CI 0.04-0.70) p = 0.014).

Conclusions: We identified multiple occupational tasks and contacts associated with bladder cancer. There were some associations with phenotype, although our study design precludes robust assessment.

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Conflict of interest statement

The authors have read the journal’s policy and have the following potential competing interests: SH has received research funding from CR UK, MRC/NIHR, UHB charities, CCC charities, North West Cancer Research and reimbursement for consultancy from Bayer, Janssen, Boehringer Ingelheim, Pierre Fabre, Eli Lilly. SAH Advisory board/Consultancy: Roche, MSD, AstraZeneca, BMS, Janssen, Pfizer, Astellas, Bayer, Pierre Fabre, Sotio, GSK, Ipsen and Eisai. JWFC has received reimbursement for consultancy from Astra Zeneca, Roche and Janssen, speaker fees from BMS, MSD, Nucleix and Roche, and honoraria for membership of an advisory board for Ferring. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare.

Figures

Fig 1
Fig 1
a. Progression free survival of bladder cancer of patients exposed and not exposed to occupational diesel fumes. b. Radical treatment free survival of bladder cancer of patients exposed and not exposed to occupational diesel fumes. c. Radical treatment free survival of bladder cancer of patients exposed and not exposed to occupational welding. d. Overall survival of bladder cancer from patients who were healthcare workers compared to any other form of work.
See this image and copyright information in PMC

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