Laryngeal Cancer Risks in Workers Exposed to Lung Carcinogens: Exposure-Effect Analyses Using a Quantitative Job Exposure Matrix

Amy L Hall*, Hans Kromhout, Joachim Schüz, Susan Peters, Lützen Portengen, Roel Vermeulen, Antonio Agudo, Wolfgang Ahrens, Paolo Boffetta, Paul Brennan, Cristina Canova, David I Conway, Maria Paula Curado, Alexander W Daudt, Leticia Fernandez, Mia Hashibe, Claire M Healy, Ivana Holcatova, Kristina Kjaerheim, Rosalina KoifmanPagona Lagiou, Danièle Luce, Gary J Macfarlane, Ana Menezes, Gwenn Menvielle, Jerry Polesel, Heribert Ramroth, Lorenzo Richiardi, Isabelle Stücker, Peter Thomson, Marta Vilensky, Victor Wunsch-Filho, Amy Lee Yuan-Chin, Ariana Znaor, Kurt Straif, Ann Olsson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


INTRODUCTION: Various established occupational lung carcinogens are also suspected risk factors for laryngeal cancer. However, individual studies are often inadequate in size to investigate this relatively rare outcome. Other limitations include imprecise exposure assessment and inadequate adjustment for confounders.

METHODS: This study applied a quantitative job exposure matrix (SYN-JEM) for four established occupational lung carcinogens to five case-control studies within the INHANCE Consortium. We used occupational histories for 2256 laryngeal cancer cases and 7857 controls recruited from 1989-2007. We assigned quantitative exposure levels for asbestos, respirable crystalline silica, chromium-VI, and chromium-VI & nickel combined (to address highly correlated exposures) via SYN-JEM. We assessed effects of occupational exposure on cancer risk for males (asbestos, respirable crystalline silica, chromium-VI, chromium-VI & nickel) and females (asbestos, respirable crystalline silica), adjusting for age, study, tobacco smoking, alcohol consumption, and asbestos exposure where relevant.

RESULTS: Among females, odds ratios (ORs) were increased for ever versus never exposed. Among males, p-values for linear trend were <0.05 for estimated cumulative exposure (all agents) and <0.05 for exposure duration (respirable crystalline silica, chromium-VI, and chromium-VI & nickel); strongest associations were for asbestos at >90%ile cumulative exposure (OR=1.3, CI=1.0-1.6), respirable crystalline silica at 30+ years duration (OR=1.4, CI=1.2-1.7) and 75%-90%ile cumulative exposure (OR=1.4, CI=1.1-1.8), chromium-VI at >75%ile cumulative exposure (OR=1.9, CI=1.2-3.0), and chromium-VI & nickel at 20-29 years duration (OR=1.5, CI=1.1-2.2).

CONCLUSIONS: These findings support hypotheses of causal links between four lung carcinogens (asbestos, respirable crystalline silica, chromium-VI, and nickel) and laryngeal cancer.

Original languageEnglish
Pages (from-to)145-154
Number of pages10
Issue number1
Early online date1 Oct 2019
Publication statusPublished - Jan 2020

Bibliographical note

Acknowledgments: We thank Véronique Luzon (IARC) for her assistance with data management.


  • Occupational Exposure
  • Laryngeal Neoplasms
  • Case–control Studies
  • Asbestos
  • Respirable Crystalline Silica
  • Nickel, Chromium(VI)
  • Carcinogens
  • Cancer
  • chromium(VI)
  • Occupational exposure
  • Respirable crystalline silica
  • Laryngeal neoplasms
  • Case-control studies
  • Nickel


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