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Annals of Oncology 2007 18(6):1056-1063; doi:10.1093/annonc/mdm089
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© 2007 European Society for Medical Oncology

lung cancer

Lung cancer mortality among silicotic workers in Hong Kong—no evidence for a link

ITS Yu1,*, LA Tse1, CC Leung2, TW Wong1, CM Tam2 and ACK Chan2

1 Department of Community and Family Medicine, The Chinese University of Hong Kong
2 Pneumoconiosis Clinic, Tuberculosis and Chest Service, Department of Health, Hong Kong SAR, China

* Correspondence to: Dr I. T. S. Yu, The Chinese University of Hong Kong, Department of Community and Family Medicine, 4/F School of Public Health, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, China. Tel: +852-2252-8773; Fax: +852-2606-3500; E-mail: iyu{at}cuhk.edu.hk

Background: The link between silica dust/silicosis and lung cancer is still very controversial. We examined the relationship between silica dust exposure and/or silicosis and lung cancer in a large cohort of silicotic workers in Hong Kong.

Patients and methods: All workers with silicosis in Hong Kong diagnosed during the period 1981–1998 were followed up till the end of 1999 to ascertain their vital status and causes of death. Standardized mortality ratio (SMR) for lung cancer and other major causes of death were calculated. Axelson's indirect method was used to adjust for smoking effect. Multiple Cox regression models were carried out to examine the exposure–response relationship between silica dust and lung cancer.

Results: About 10% (86) of all 853 deaths were from lung cancer, giving a SMR of 1.69 [95% confidence interval (CI) 1.35–2.09]. Lung cancer SMR for caisson and surface construction workers were 2.39 (95% CI 1.50–3.62) and 1.61 (95% CI 1.21–2.10), respectively, which became 1.56 (95% CI 0.98–2.36) and 1.09 (95% CI 0.82–1.42) after adjusting for smoking. No consistent exposure–response relationship was detected between silica dust or severity of silicosis and lung cancer death.

Conclusion: Our cohort study did not offer positive support to a link between silica or silicosis and lung cancer.

Key words: epidemiology, exposure–response relationship, lung neoplasms, mortality, silicosis, smoking

Received for publication September 30, 2006. Revision received December 28, 2006. Accepted for publication February 12, 2007.


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