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ObjectivesElevated risk of cancer at several sites has been reported among firefighters, although with mixed findings. The purpose of this study was to calculate standardised incidence ratios (SIRs) and standardised mortality ratios (SMRs) for cancer and compare them to assess whether use of the different measures could be a source of inconsistencies in findings.MethodsThe Norwegian Fire Departments Cohort, comprising 4295 male employees who worked at 15 fire departments across Norway, was linked to health outcome registries for the period 1960–2018. SIRs and SMRs were derived using national reference rates.ResultsOverall, we observed elevated incidence of colon cancer (SIR, 95% CI 1.27, 1.01 to 1.58), mesothelioma (2.59, 1.12 to 5.11), prostate cancer (1.18, 1.03 to 1.34) and all sites combined (1.15, 1.08 to 1.23). Smaller, non-significant elevations were found for mortality of colon cancer (SMR, 95% CI 1.20, 0.84 to 1.67) and mesothelioma (1.66, 0.34 to 4.86), while SMR for prostate cancer was at unity. Potential errors were observed in some of the mortality data, notably for mesothelioma cases. Among those who died of cancer, 3.7% (n=14) did not have a prior diagnosis of malignancy at the same site group.ConclusionsAssessment of incidence or mortality did not greatly influence the interpretation of results. The most prominent differences in SIR and SMR appeared to be due to inconsistencies between sites of cancer diagnosis and cause of death. The difference in SIR and SMR for prostate cancer suggested a detection bias from differential screening practices.

ObjectivesTo investigate temporal trends in the ‘healthy soldier effect’ (HSE) among 28 300 Royal Norwegian Navy servicemen who served during 1950–2004.MethodsStandardised mortality ratios (SMRs) for all causes, diseases and external causes were calculated from national rates for the entire study period (1951–2017), and for seven successive follow-up periods after the first recorded day of Naval service, for the overall cohort and for two subgroups: land-based personnel and vessel crews. Poisson regression, expressed as rate ratios, was used to compare all-cause mortality between the subgroups.ResultsIn the overall cohort, SMRs for all-cause mortality increased steadily during the first six 10-year follow-up periods, from 0.52 to 0.94, which was still lower than national rates. After 60 years, the lower mortality compared with national rates was no longer statistically significant (SMR=0.93). Low non-neoplastic disease mortality contributed most to the longevity of the HSE. For neoplastic diseases, there was a mortality deficit only for the first and third 10-year follow-up periods. External-cause mortality rose to national rates after 40 years. An HSE was present among vessel crews, but their total mortality rate was 24% higher than that among land-based personnel, who also showed a longer-lasting HSE.ConclusionsThe HSE eroded gradually over time but was still present at 60 years of follow-up for all-cause mortality. The effect was strongest and most long-lived for non-neoplastic disease, lasted up to 40 years for external causes, and was relatively short for cancers. Land-based personnel showed stronger and longer-lasting HSE than vessel crews.

Background: Evidence suggests that among some occupational groups, there is an elevated risk of kidney cancer. This might, however, derive from a difference in smoking habits across occupational groups. The objective of this study was to determine smoking-adjusted occupational variation in the incidence of kidney cancer in Nordic males.Material and Methods: The source population for this study consisted of 7.4 million men from Denmark, Iceland, Finland, Norway, and Sweden. Data on occupation were obtained from national censuses conducted in the years 1960-1990. Data on cancer cases came from national cancer registries. A proxy for the occupation-specific smoking prevalence among all Nordic men was calculated based on the occupation-specific smoking prevalence and lung cancer incidence data for Finnish men. Smoking-adjusted standardized incidence ratio (SIRadj) with 95% confidence intervals (95%CI) were calculated for each occupational group.Results: The highest SIRadj estimates were observed in dentists (1.32, 95%CI 1.06-1.62), journalists (1.20, 95%CI 1.00-1.42), physicians (1.19, 95%CI 1.03-1.36), public safety workers (1.18, 95%CI 1.10-1.26), administrators (1.17, 95%CI 1.13-1.22), military personnel (1.16, 95%CI 1.05-1.28), and religious workers (1.17, 95%CI 1.09-1.26). The lowest SIRadj was observed among forestry workers (0.82, 95%CI 0.76-0.88).Conclusions: Tobacco smoking plays an important role in the occupational variation in the risk of kidney cancer. The smoking-adjusted incidence of kidney cancer was increased in dentists, physicians, journalists, administrators, and public safety workers.

Background: There are studies suggesting that participation in musical activities may protect from cancer. On the other hand, some musicians have a lifestyle that might increase the risk of cancer. The objective of this study was to assess the cancer pattern of musicians in four Nordic countries. Material and methods: This study combines census and cancer registry data from 1961 to 2005 for 13 million people from Finland, Iceland, Norway, and Sweden. Standardized incidence ratio (SIR) analyses were conducted with the cancer incidence rates for entire national populations used as reference rates. Results: There were 11,401 male and 3105 female musicians with 2039 cancer cases. The SIR for all sites combined was 1.02 (95% confidence interval 0.97–1.07) in men and 1.04 (0.94–1.15) in women. In male musicians, there were statistically significant excesses in oropharyngeal cancer (4.36, 2.73–6.60), esophageal cancer (2.08, 1.51–2.81), liver cancer (1.81, 1.26–2.52), and skin melanoma (1.40, 1.10–1.75). The risk was decreased in lip cancer (0.13, 0.02–0.48), stomach cancer (0.66, 0.50–0.82), and lung cancer (0.77, 0.65–0.90). In female musicians, there were no statistically significant SIRs in any of the cancer types studied, but the risk of breast cancer was significantly elevated in the age category of 70+ (1.52, 1.04–2.15). The overall SIR was stable over the 45 year period of observation, but strong decreases were observed in the SIRs of esophageal cancer, liver cancer, laryngeal cancer, and skin melanoma. Conclusion: Musicians have characteristics of indoor workers such as low incidence of lip cancer and high incidence of skin melanoma. The low incidence of lung cancer suggests that the prevalence of smoking among musicians is lower than in the general population while the elevated risk of alcohol-related cancer types suggest that drinking is likely more common among musicians. The cancer risk for all sites combined is still similar to that of the general population in the four countries studied. acceptedVersion

Objectives To evaluate cancer incidence among Swedish firefighters and analyze risk in relation to work duration as a proxy for cumulative exposure. Methods This cohort study is based on the Swedish component of the Nordic Occupational Cancer (NOCCA) project. The cohort includes six million people who participated in one or more of the population censuses in 1960, 1970, 1980 and 1990. The census data were linked to the Swedish Cancer Registry for the 1961–2009 period, extending a previous NOCCA follow-up time by 4 years. We identified 8136 male firefighters. SIRs were calculated using cancer incidence rates in the national population as a reference. Results We found a statistically significant excess of non-melanoma skin cancer (SIR = 1.48, 95% CI 1.20–1.80) but no positive relationship between risk and work duration. There was a small, yet statistically significant increased risk of prostate cancer among firefighters with service times of 30 years or more. The first follow-up period (1961–1975) showed an increased risk of stomach cancer relative to the reference group, while the last period (1991–2009) showed an increased risk of non-melanoma skin cancer. There was no excess risk for all cancer sites combined (SIR = 1.03, 95% CI 0.97–1.09). Conclusions Our results do not support an overall risk of cancer among Swedish firefighters, but a possible risk of non-melanoma skin cancer exists. The previously noted excess of prostate cancer among Swedish firefighters in NOCCA was no longer statistically significant in this extended follow-up but was present among those with the longest service times.

Objectives To determine whether occupational exposure to heavy metals (chromium (VI), iron, nickel, lead) and welding fumes is associated with the risk of kidney cancer and to describe whether other occupational exposures included in the Job Exposure Matrix of the Nordic Occupational Cancer (NOCCA) study are associated with the risk. Materials and methods Nested case-control study among individuals registered in population censuses in Finland, Iceland, and Sweden in 1960–1990. A total of 59,778 kidney cancer cases, and 298,890 controls matched on sex, age, and country. Cumulative occupational exposures to metals (chromium (VI), iron, nickel, lead), welding fumes, and 24 other occupational exposure covariates, lagged 0, 10, and 20 years. Results Overall, there was no or very little association between kidney cancer and exposures studied. The risk was elevated in individuals with high exposure to asbestos (OR 1.19, 95%CI 1.08–1.31). The risk was significantly decreased for individuals characterized with high perceived physical workload (OR 0.86, 95%CI 0.82–0.91), high exposure to ultraviolet radiation (OR 0.85, 95%CI 0.79–0.92), and high exposure to wood dust (OR 0.82, 95%CI 0.71–0.94). The risk of kidney cancer under the age of 59 was elevated in individuals with high exposure to nickel (OR 1.49, 95%CI 1.03–2.17). The risk of kidney cancer in age 59–74 years was elevated for individuals with high exposure to iron (OR 1.41, 95%CI 1.07–1.85), and high exposure to welding fumes (OR 1.43, 95%CI 1.09–1.89). Conclusions The only markedly elevated risks of kidney cancer were seen for the highest exposures of nickel and iron/welding fumes in specific age strata.

Publisher's version (útgefin grein), Background: Evidence on associations between occupational diesel exhaust and gasoline exposure and colorectal cancer is limited. We aimed to assess the effect of workplace exposure to diesel exhaust and gasoline on the risk of colorectal cancer. Methods: This case–control study included 181,709 colon cancer and 109,227 rectal cancer cases diagnosed between 1961 and 2005 in Finland, Iceland, Norway, and Sweden. Cases and controls were identified from the Nordic Occupational Cancer Study cohort and matched for country, birth year, and sex. Diesel exhaust and gasoline exposure values were assigned by country-specific job-exposure matrices. Odds ratios and 95% confidence intervals were calculated by using conditional logistic regression models. The results were adjusted for physical strain at work and occupational exposure to benzene, formaldehyde, ionizing radiation, chlorinated hydrocarbons, chromium, and wood dust. Results: Diesel exhaust exposure was associated with a small increase in the risk of rectal cancer (odds ratio = 1.05, 95% confidence interval 1.02-1.08). Gasoline exposure was not associated with colorectal cancer risk. Conclusion: This study showed a small risk increase for rectal cancer after workplace diesel exhaust exposure. However, this finding could be due to chance, given the limitations of the study., The authors thank the Nordic Occupational Cancer Studies (NOCCA) project members for the development of NOCCA cohort data and job-exposure matrix.

Objectives Maritime workers may be exposed to several occupational hazards at sea. The aim of this study was to assess cancer incidence among seafarers and fishermen in the Nordic countries and identify patterns in morbidity in the context of existing studies in this field. Methods A cohort of 81 740 male seafarers and 66 926 male fishermen was established from census data on 15 million citizens in the five Nordic countries. Using personal identity codes, information on vital status and cancer was linked to members of the cohort from the national population and cancer registries for the follow-up period 1961–2005. Standardized incidence ratios (SIR) were calculated applying national cancer incidence rates for each country and pooling results. Results The overall incidence of cancer was increased among the male seafarers [SIR 1.22, 95% confidence interval (CI) 1.19–1.23]. Significant excesses were observed for multiple cancer sites among the seafarers, while results for the fishermen were mixed. Lip cancer incidence was increased among both maritime populations. For mesothelioma (SIR 2.17, 95% CI 1.83–2.56 seafarers) and non-melanoma skin cancer (SIR 1.23, 95% CI 1.14–1.32 seafarers), incidence was increased among the seafarers. Conclusion In our cohort, seafaring was associated with a higher overall incidence of cancer compared to the general population. While the majority of cancers could not be linked to specific occupational factors, increases in mesothelioma, lip and non-melanoma-skin cancer indicate previous exposure to asbestos, ultraviolet radiation and potentially also chemicals with dermal carcinogenic properties at sea. publishedVersion

Objectives To evaluate occupational variation in the incidence of the malignant neoplasm of the renal pelvis in the population of the Nordic countries: Denmark, Iceland, Finland, Norway and Sweden. Materials and methods The study cohort comprised 14.9 million individuals. Data on occupational history were obtained from national censuses. Standardized incidence ratios (SIRs) were calculated for each occupation. Results The highest SIRs were found in seamen (1.51, 95% confidence interval [CI] 1.23-1.82), printers (1.39, 95% CI 1.11-1.71), welders (1.37, 95% CI 1.03-1.78), and public safety workers (1.35, 95% CI 1.12-1.62). The lowest SIRs were observed in forestry workers (0.47, 95% CI 0.35-0.62), gardeners (0.72, 95% CI 0.62-0.83) and woodworkers (0.81, 95% CI 0.72-0.91). Conclusions The study suggests that there is an association between profession and risk of malignancy of the renal pelvis. The possible associations between exposure to asbestos, heavy metals and welding fumes, and risk of developing the disease should be studied further.

Background We examined a national data set to determine if workers employed in specific occupations develop distinct bladder cancer (BCa) phenotypes. Objective To compare the incidence and disease-specific mortality (DSM) of localized and advanced BCa in workers with different job titles. Design, setting, and participants BCa incidence, stage at diagnosis, and DSM in 1.7 million Finnish men (13 717 with BCa) and 1.7 million women (4282 with BCa) with annotated occupational descriptions. Follow-up was 37 and 43 million person-years, respectively. Outcome measurements and statistical analysis The gender-specific incidence and BCa DSM within each occupational category was compared with the expected number of cases based on the entire Finnish population to generate standardized incidence ratios (SIRs) and standard mortality ratios (SMRs). Results and limitations Occupations were found that had significant differences in the incidence of localized (SIR loc ) and advanced (SIR adv , SMR adv ) BCa and DSM. Male chemical process workers (SIR loc /SIR adv : 5.19; 95% confidence interval [CI], 1.73–25.7), male military personnel (SIR loc /SIR adv : 6.4; 95% CI, 1.09–259.0), and male public safety workers (SIR loc /SIR adv : 1.77; 95% CI, 1.04–3.23) had significantly more localized than advanced tumors. In contrast, miscellaneous construction workers had more advanced than localized cancers for both genders (male SIR loc /SIR adv : 0.67; 95% CI, 0.53–0.86; female SIR loc /SIR adv : 0.12; 95% CI, 0.09–0.54). Male chemical process workers had fewer deaths from BCa than expected from advanced tumors (SMR adv : 0.32; 95% CI, 0.07–0.94), and miscellaneous constructions workers had more deaths from advanced tumors than expected (male SMR adv : 1.44; 95% CI, 1.10–1.85; female SMR adv : 3.35; 95% CI, 1.23–7.30). Limitations of this study are failure to control accurately for the effects of smoking and a lack of specific treatment information. Conclusions Occupations exist that may differ in their risks for localized and advanced BCa and for DSM. Patient summary Occupations have been identified that may have different patterns of bladder cancer than expected. These findings may be explained by confounding factors such as exposure to tobacco smoke; however, it could be that workers with these job titles are exposed to specific bladder carcinogens.

It has been suggested that the association between self-reported occupational noise exposure and vestibular schwannoma (VS), found in several studies, represents recall bias. Therefore, we aimed to study the relationship in a large case-control study using occupational noise measurements. We performed a case-control study using data from Sweden for 1,913 VS cases diagnosed in 1961–2009 and 9,566 age- and sex-matched population controls. We defined occupational history by linkage to national censuses from 1960, 1970, 1980, and 1990. We estimated occupational noise exposure for each case and control using a job-exposure matrix. There was no association between occupational noise exposure and VS. Among subjects assessed as ever exposed to occupational noise levels of ≥85 dB (214 cases and 1,142 controls), the odds ratio for VS per 5 years of exposure was 1.02 (95% confidence interval: 0.90, 1.17). Workers with noise levels of ≥85 dB for at least 15 years (5-year latency period), showed no increased risk of VS (odds ratio = 0.98, 95% confidence interval: 0.73, 1.31) compared with those who had never been exposed to noise levels of 75 dB or higher. In summary, our large study does not support an association between occupational noise exposure and VS.

The current study aims to provide stronger evidence to aid in our understanding of the role of cumulative occupational exposure to (softwood-dominated) mixed wood dust in aetiology of nasal cancer. We included broad exposure occurred in a range of wood-processing occupation across varied industries in four Nordic countries. A population-based case-control study was conducted on all male cases with nasal adenocarcinoma (393 cases), other types of nasal cancer (2,446) and nasopharyngeal cancer (1,747) diagnosed in Finland, Sweden, Norway and Iceland between 1961 and 2005. For each case, five male controls, who were alive at the time of diagnosis of the case (index date), were randomly selected, matched by birth-year and country. Cumulative exposures (CE)s to wood dust and formaldehyde before the index date were quantified based on a job-exposure matrix linked to occupational titles derived from population censuses. Hazard ratios (HRs) for the CE of wood dust were estimated by conditional logistic regression, adjusted for CE to formaldehyde and 95% confidence intervals (CIs) were calculated. There was an increasing risk of nasal adenocarcinoma related to wood dust exposure. The HR in the highest CE category of wood dust (≥ 28.82 mg/m3 -years) was 16.5 (95% CI 5.05-54.1). Neither nonadenocarcinoma of the nose nor nasopharyngeal cancer could be linked to wood dust exposure. CE to softwood-dominated mixed wood dusts is strongly linked with elevated risk in nasal adenocarcinoma but not with other types of nasal or nasopharyngeal cancer.

The aim of this study was to assess the effect of occupational solvent exposure on the risk of adult chronic lymphocytic leukemia (CLL). The current case-control study was nested in the Nordic Occupational Cancer Study (NOCCA) cohort. 20,615 CLL cases diagnosed in 1961-2005 in Finland, Iceland, Norway, and Sweden, and 103,075 population-based controls matched by year of birth, sex, and country were included. Occupational histories for cases and controls were obtained from census records in 1960, 1970, 1980/1981, and 1990. Exposure to selected solvents was estimated by using the NOCCA job-exposure matrix (NOCCA-JEM). Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated by using conditional logistic regression models. Overall, nonsignificant CLL risk elevations were observed for methylene chloride, perchloroethylene, and 1,1,1-trichloroethane. Compared to unexposed, significantly increased risks were observed for cumulative perchloroethylene exposure ≤13.3 ppm-years (OR = 1.85, 95% CI 1.16-2.96) and average life-time perchloroethylene exposure ≤2.5 ppm (1.61, 95% CI 1.01-2.56) among women, and cumulative methylene chloride exposure ≤12.5 ppm-years (OR = 1.19, 95% CI 1.01-1.41) and 12.5-74.8 ppm-years (OR = 1.23, 95% CI 1.01-1.51) among men in an analysis with 5 years lag-time, though without dose-response pattern. Decreased CLL risk was observed for aliphatic and alicyclic hydrocarbon solvents and toluene. This study did not support associations for solvent exposure and CLL. Observed weak associations for methylene chloride, perchloroethylene, 1,1,1-trichloroethane exposures, aliphatic and alicyclic hydrocarbons and toluene were not consistent across sexes, and showed no gradient with amount of exposure.

Objective To investigate external-cause mortality among 21 609 Norwegian male military peacekeepers deployed to Lebanon during 1978–1998. Methods The cohort was followed from the 1st day of deployment through 2013, and mortality during deployment and post discharge was assessed using SMRs calculated from national rates in Norway. Poisson regression was used to see the effect of high-conflict versus low-conflict exposure. Results For the total cohort, external-cause mortality was within expected values during deployment (SMR=0.80) and post discharge (SMR=1.05). In the low-conflict exposure group, a lower mortality from all external causes (SMR=0.77), transport accidents (SMR=0.55) and accidental poisoning (SMR=0.53) was seen. The high-conflict exposure group showed an elevated mortality from all external causes (SMR=1.20), transport accidents (SMR=1.51) and suicide (SMR=1.30), but these risks were elevated only during the first 5 years after discharge. This group also showed elevated mortality from all external causes (rate ratio, RR=1.49), and for transport accidents (RR=3.30) when compared with the low-conflict exposure group. Conclusions Overall external-cause mortality among our peacekeepers was equal to national rates during deployment and post discharge. High-conflict exposure was associated with elevated mortality from all external causes, transport accidents and suicide during the first 5 years after discharge from service.

Purpose Tobacco smoking and alcohol consumption are risk factors for several types of cancer and may act as confounders in aetiological studies. Large register-based cohorts often lack data on tobacco and alcohol. We present a method for computing estimates of cancer risk adjusted for tobacco and alcohol without exposure information. Methods We propose the use of confirmatory factor analysis models for simultaneous analysis of several cancer sites related to tobacco and alcohol. In the analyses, the unobserved pattern of smoking habits and alcohol drinking is considered latent common factors. The models allow for different effects on each cancer site, and also for appropriate latent site-specific factors for subgroup variation. Results may be used to compute expected numbers of cancer from reference rates, adjusted for tobacco smoking and alcohol consumption. This method was applied to results from a large, published study of work-related cancer based on census data (1970) and 21 years of cancer incidence data from the national cancer registry. Results The results from our analysis were in accordance with recognised risks in selected occupational groups. The estimated relative effects from tobacco and alcohol on cancer risk were largely in line with results from Nordic reports. For lung cancer, adjustment for tobacco implied relative changes in SIR between a decrease from 1.16 to 0.72 (Fishermen), and an increase from 0.47 to 0.95 (Forestry workers). Conclusions We consider the method useful for achieving less confounded estimates of cancer risk in large cohort studies with no available information on smoking and alcohol consumption. Electronic supplementary material The online version of this article (doi:10.1007/s10552-016-0847-x) contains supplementary material, which is available to authorized users.

Knowledge of possible causes of renal pelvis malignancies is an important area of attention both within the field of urological oncology and epidemiology. The International Agency for Research on C...

Introduction In 2012, Norwegian news media reported on cases of brain cancer among Norwegian peacekeeping troops who served in Kosovo, allegedly caused by exposure to depleted uranium fired during airstrikes before the peacekeepers arrived in 1999. A first study followed 6076 military men and women with peacekeeping service in Kosovo during 1999–2011 for cancers and deaths throughout 2011. The study did not support to the idea that peacekeeping service in Kosovo could lead to increased risk of brain cancer or other cancers. However, the average time of follow-up (10.6 years) was rather short for cancer development; therefore the aim of the present study was to evaluate cancer risk and general mortality in an updated cohort after 5 years of additional follow-up. Materials and Methods The updated cohort consisted of 6,159 peacekeepers (5,884 men and 275 women) who served in Kosovo during 1999–2016 and were followed for cancer incidence and mortality from all causes combined throughout 2016. We calculated standardized incidence ratios (SIR) for cancer and standardized mortality ratios (SMR) from national population rates. Poisson regression was used to assess the effect of length of service ( Results We observed 149 cancer cases and 75 deaths in the updated cohort. Observed cancer incidence did not exceed national rates. In men, the SIR for brain cancer was 0.73 (95% confidence interval (CI) 0.32–1.44), based on eight cases, while the risk of colon cancer was lowered (SIR = 0.14, 95% CI 0.00–0.79). The Poisson regression showed no effect of service duration on all-site cancer incidence. Mortality from all causes combined was lower than expected (SMR = 0.62, 95% CI 0.49–0.78) and in accordance with a “healthy soldier effect”. Conclusion The extended follow-up did not give support to the suggestion that peacekeeping service in Kosovo could lead to increased risk of cancer.

IntroductionSurveillance of unintended effects of pharmaceuticals (pharmacovigilance or drug safety) is crucial, as knowledge of rare or late side effects is limited at the time of the introduction of new medications into the market. Side effects of drugs may involve increased or decreased risk of cancer, but these typically appear after a long induction period. This fact, together with low incidences of many cancer types, limits the usefulness of traditional pharmacovigilance strategies, primarily based on spontaneous reporting of adverse events, to identify associations between drug use and cancer risk. Postmarketing observational pharmacoepidemiological studies are therefore crucial in the evaluation of drug-cancer associations.Methods and analysisThe main data sources in this project will be the Norwegian Prescription Database and the Cancer Registry of Norway. The underlying statistical model will be based on a multiple nested case–control design including all adult (~200 000) incident cancer cases within the age-range 18–85 years from 2007 through 2015 in Norway as cases. 10 cancer-free population controls will be individually matched to these cases with respect to birth year, sex and index date (date of cancer diagnosis). Drug exposure will be modelled as chronic user/non-user by counting prescriptions, and cumulative use by summarising all dispensions’ daily defined doses over time. Conditional logistic regression models adjusted for comorbidity (National Patient Register), socioeconomic parameters (Statistics Norway), concomitant drug use and, for female cancers, reproduction data (Medical Birth Registry), will be applied to identify drug-use–cancer-risk associations.Ethics and disseminationThe study is approved by the regional ethical committee and the Norwegian data protection authority. Results of the initial screening step and analysis pipeline will be described in a key paper. Subsequent papers will report the evaluation of identified signals in replication studies. Results will be published in peer-reviewed journals, at scientific conferences and through press releases.

Background Male breast cancer (MBC) is a rare and understudied disease. There is limited evidence on association between environmental and occupational agents and MBC. Some similarities in risk factors may be shared with female breast cancer. We evaluated solvents, metals, exhaust gases and other agents in relation to MBC within the large Nordic Occupational Cancer Study (NOCCA). Methods The study included 1469 MBC cases and 7345 controls from Finland, Iceland and Sweden, matched for the date of birth, sex and country. Cases were identified through national cancer registries. Data on occupation and other demographic indicators were collected from census records and population registries. Overall, 24 occupational exposures were assessed. Exposure estimates were assigned by linking job titles to job-exposure matrices (NOCCA-JEM). Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated by using conditional logistic regression models. Results Significantly decreased overall OR was observed for physical workload (OR = 0.78, 95% CI 0.67–0.91). Protective effect of physical workload was stronger by increasing exposure level with significant dose-response relationship (p-trend Conclusions The current study showed 20–25% protective effect for physical workload at work, while no strong evidence for other agents was observed.

Background: Alcohol and tobacco strongly increases the risk of cancers of the tongue, mouth, pharynx, larynx, and oesophagus, and are also established risk factors for cancer of the liver, colon, and rectum. It is well documented that these habits are unequally distributed among occupational groups. Most occupational cohort studies lack information on these potentially important confounders, and may therefore be prone to bias. Aim: The aim of the study is to present Nordic standardized incidence ratios (SIRs) for alcohol and tobacco related cancer by occupation, after adjustment for alcohol and tobacco, and to compare to the unadjusted SIRs. Material and Methods: The study is based on the Nordic Occupational Cancer (NOCCA) database. We used confirmatory factor analysis models for simultaneous analysis of the cancer sites related to alcohol and tobacco, to obtain factors that allow for computation of adjusted expected numbers from the reference rates. We then calculated adjusted SIRs for the relevant cancer sites for each occupation. Results: For some occupations and cancers, the changes of risk estimates were striking, from significantly high to significantly low and vice versa. Among Nordic farmers, unadjusted SIRs for cancer of the mouth and oesophagus were 0.56 (95% confidence interval (CI) 0.51&ndash, 0.61) and 0.67 (CI 0.63&ndash, 0.70), respectively. After adjustment, estimates changed to 1.10 (CI 1.01&ndash, 1.21) and 1.16 (CI 1.10&ndash, 1.22). Unadjusted SIR for pharynx cancer among wood workers was 0.83 (CI 0.75&ndash, 0.91), adjusted SIR was 1.14 (CI 1.03&ndash, 1.25). For larynx cancer, results in the opposite direction were seen: unadjusted SIR for economically inactive was 1.38 (CI 1.31&ndash, 1.46) while the adjusted SIR was 0.91 (CI 0.86&ndash, 0.96). Conclusions: Adjustment for the latent indicators of alcohol and tobacco consumption changed risk estimates for several occupations, gave a less confounded description of risk, and may guide in the identification of true risk factors.

Bakgrunn: Helsestasjonstjenesten er i kontakt med nesten alle foreldre og barn det første leveåret og frem til skolestart og har en sentral rolle med å veilede, støtte og trygge foreldrene. Oslo kommune har i tillegg til det ordinære helsestasjonsprogrammet iverksatt hjemmebesøksprogrammet «Nye familier» som en del av helsestasjonstilbudet for å gi ekstra støtte til alle førstegangsforeldrene. Helsedirektoratet iverksatte våren 2020 midlertidige nasjonale retningslinjer for helsestasjonstjenesten som følge av covid-19, der helsestasjonsprogrammet ble kraftig redusert. Hensikt: Hensikten med undersøkelsen var å kartlegge hvordan førstegangsmødre erfarte helsestasjonstilbudet i forbindelse med covid-19- pandemien. Vi ønsket også å undersøke om førstegangsmødre som mottok hjemmebesøksprogrammet «Nye familier», hadde andre erfaringer enn dem som ikke mottok programmet. Metode: Studien var en tverrsnittsundersøkelse, og dataene ble samlet inn ved å bruke Nettskjema. Deskriptive analyser ble utført i SPSS. Studien rekrutterte mødre som deltar i forskningsprosjektet «Nye familier». Resultat: Responsraten var 62 prosent (111 mødre). Syttiåtte mødre (70 prosent) hadde benyttet en eller ere kontaktformer til helsestasjonen, og re (4 prosent) hadde ikke fått kontakt med en helsesykepleier ved behov. En større andel av mødrene i bydelene med hjemmebesøksprogrammet (intervensjonsbydelene) hadde hatt kontakt med helsestasjonen (p = 0,028). Mødrene som hadde hatt telefonkontakt, rapporterte at slik kontakt fungerte dårligere (n = 17 / 63 prosent) eller like godt (n = 5 / 19 prosent) som tidligere helsestasjonskonsultasjoner. Majoriteten av mødrene (n = 71 / 64 prosent) hadde erfart helsestasjonstilbudet som forventet. Konklusjon: En stor andel av mødrene hadde vært i kontakt med helsestasjonen i perioden, og signikant ere i intervensjonsbydelene enn i kontrollbydelene. Mer enn en tredjedel av mødrene rapporterte at de kk utilstrekkelig informasjon om endringer i tjenestetilbudet i perioden. Mødrene foretrakk det ordinære tilbudet, men så likevel ut til å tilpasse seg endringene og det tilbudet som ble gitt.

Occupational exposure has been identified as the most important risk factor for bladder cancer second to smoking. The objective of this study was to estimate the occupational variation in risk of bladder cancer that is not attributable to smoking.In the Nordic Occupational Cancer study (NOCCA), 111,458 cases of bladder cancer and 208,297 cases of lung cancer cases were observed among men in Denmark, Finland, Iceland, Norway and Sweden during 1961-2005. Relative smoking prevalence in an occupation was estimated based on standardized incidence ratio (SIR) for lung cancer in the given occupation. Crude and smoking-adjusted SIRs with 95% confidence intervals (CI) for bladder cancer were calculated for each occupation.The smoking-adjusted SIR for most of the occupations was closer to 1.00 than the unadjusted SIR. The highest statistically significant smoking-adjusted SIRs were observed among chimney sweeps (SIR 1.29, 95% CI 1.05-1.56), waiters (1.22, 1.07-1.38) hairdressers (1.14, 1.02-1.26), cooks and stewards (1.12, 1.01-1.25), printers (1.11, 1.04-1.18) and seamen (1.09, 1.03-1.14).Smoking is a strong risk factor for bladder cancer but there may also be other factors in some specific occupations in addition to smoking. The occupational variation in risk of bladder cancer is small when adjusted for smoking, but risk increasing factors are indicated in some occupations.

The aim of this study was to describe the occupational variation in the incidence of kidney cancer in the Nordic population.The population comprised of 14.9 million individuals included in censuses between 1960 and 1990. Standardized incidence ratios (SIRs) were calculated for each occupational group.Significantly increased SIRs were observed in welders [1.24, 95% confidence interval (95% CI) 1.14 to 1.35], public safety workers (1.16, 95% CI 1.08 to 1.25), and seamen (1.16, 95% CI 1.07 to 1.26). Significantly decreased SIRs were found in laboratory assistants (0.76, 95% CI 0.60 to 0.94) and forestry workers (0.77, 95% CI 0.72 to 0.83).A relatively small variation in the incidence of malignancies of the kidney between occupational groups was found in the cohort. There is abundant room for further progress in determining the effect of smoking in particular occupational groups.

The evidence that prostate cancer is associated to physical inactivity is inconsistent. We studied the association of perceived physical workload (PPWL) at work and incidence of prostate cancer in a case-control setting. We used data from the Nordic Occupational Cancer study from Finland and Sweden. Five population controls were selected for each prostate cancer patient, matched on age and country. We had 239,835 cases and 1,199,175 controls in our study. For each case and control we estimated cumulative PPWL based on probability, level and duration of PPWL using the NOCCA Job Exposure Matrix. We then stratified individuals as having no exposure (reference category), low physical activity (below 50th percentile of the exposed), moderate exposure (50th-90th percentile) and high exposure (90th percentile and higher). The hazard ratios for prostate cancer from the lowest to highest cumulative PPWL levels were 0.90 (95% confidence interval 0.89-0.91), 0.88 (0.87-0.89) and 0.93 (0.92-0.95). There was no statistically significant dose response effect of PPWL on prostate cancer incidence. Inclusion of socioeconomic status in the model did not substantially change the result. The results were similar before Prostate Specific Antigen (PSA) testing and during the years of PSA testing in these countries. In summary, individuals with physical strain at work had a lower risk of invasive prostate cancer as compared to individuals without physical strain at work.

Objective The aim of this case-control study was to assess the effect of occupational benzene exposure on the risk of colorectal cancer, including its subtypes. Methods The study included 181,709 colon cancer and 109,227 rectal cancer cases diagnosed between 1961 and 2005 in Finland, Iceland, Norway and Sweden. Cases were identified from the Nordic Occupational Cancer Study (NOCCA) cohort. Five controls per case were selected from the same cohort, matched for country, birth year, and sex. Occupational benzene exposure for each study participant was estimated by linking their job titles to country specific job-exposure matrices. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by using conditional logistic regression models. The results were adjusted for physical strain at work, formaldehyde, ionizing radiation and wood dust. Results Increased risk was observed for all colorectal cancer (OR = 1.12, 95% CI 1.05–1.18) for the high decile of cumulative benzene exposure, indicating a statistically significant dose-response relationship. This excess risk was mainly seen in ascending colon (OR = 1.27, 95% CI 1.13–1.43), and transversal colon (OR = 1.21, 95% CI 1.01–1.41). The ORs in the highest exposure category were markedly higher in women than in men in all subsites of colon and rectum. Conclusion This study showed an association between workplace benzene exposure and colorectal cancer. The risk was restricted to ascending and transversal colon, and was the strongest among women.

Objective We aimed to investigate cancer incidence and all-cause mortality in a cohort of 8358 civilians (5134 men and 3224 women) employed by the Royal Norwegian Navy at any time between 1950 and 2005. Methods The cohort was followed for cancer incidence and all-cause mortality from 1960 through 2015. Standardised incidence ratios (SIR) and mortality ratios (SMR) were calculated from national rates. Separate SIRs were calculated for a subgroup of male workshop workers and another of female cleaners. Results Overall cancer incidence among men was similar to the reference rate; male breast cancer was more frequent (SIR = 3.23). Male workshop workers showed a SIR of 1.77 for stomach cancer, while their incidence of lympho-haematopoietic cancers was half that of the reference rates. Women had increased risks of overall cancer (SIR = 1.11), lung cancer (SIR = 1.35), and ovarian cancer (SIR = 1.39). Female cleaners showed a SIR of 2.33 for bladder cancer and a lowered incidence of brain cancer (SIR = 0.18). In the overall cohort, all-cause mortality was lower than expected for men (SMR = 0.92) and closer to the reference rate for women (SMR = 0.95). Conclusion In men, we observed a lowered all-cause mortality and an excess of stomach cancer in workshop workers. In women, increased risks of overall cancer, lung cancer and ovarian cancer was seen. An increased risk of bladder cancer and a lowered incidence of brain cancer was observed among female cleaners.

Source at https://doi.org/10.1016/j.shaw.2018.04.003. Background: There is little information on the doseeresponse relationship between exposure to occupational carcinogenic agents and mesothelioma. This study aimed to investigate this association as well as the existence of agents other than asbestos that might cause mesothelioma. Methods: The Swedish component of the Nordic Occupational Cancer (NOCCA) study consists of 6.78 million individuals with detailed information on occupation. Mesothelioma diagnoses recorded in 1961e 2009 were identified through linkage to the Swedish Cancer Registry. We determined cumulative exposure, time of first exposure, and maximum exposure intensity by linking data on occupation to the Swedish NOCCA job-exposure matrix, which includes 29 carcinogenic agents and corresponding exposure for 283 occupations. To assess the risk of mesothelioma, we used conditional logistic regression models to estimate hazard ratios and 95% confidence intervals. Results: 2,757 mesothelioma cases were identified in males, including 1,416 who were exposed to asbestos. Univariate analyses showed not only a significant excess risk for maximum exposure intensity, with a hazard ratio of 4.81 at exposure levels 1.25e2.0 fb/ml but also a clear doseeresponse effect for cumulative exposure with a 30-, 40-, and 50-year latency time. No convincing excess risk was revealed for any of the other carcinogenic agents included in the Swedish NOCCA job-exposure matrix. Conclusion: When considering asbestos exposure, past exposure, even for short periods, might be enough to cause mesothelioma of the pleura later in life.

Background The age-adjusted incidence of cutaneous melanoma (CM) in the Nordic countries has increased during the last 60 years. In Europe, the legislation of five out of 11 surveyed countries acknowledges CM as an occupational disease (Ulrich, et al, 2016). To our knowledge, population-based studies with a prospective design have not yet described the variation in the relative risk of CM among different occupational categories. Aim 1. To describe the variation in the relative risk of CM according to occupational categories with outdoor, mixed, and indoor work, as well as socioeconomic status (SES). 2. To evaluate trends across periods. Methods Historical prospective cohort study based on record linkages between census data for 15 million people and cancer registry data from 1961 to 2005 (Nordic Occupational Cancer Project, http://astra.cancer.fi/NOCCA). Standardised incidence ratios (SIR) were estimated for 53 occupational categories classified according to indoor, outdoor and mixed work and socioeconomic status. Results During follow-up of 385 million person-years, there were 83 898 incident cases of CM. Statistically significant SIRs of CM were found among occupational categories with indoor work for male workers (1.09) and the highest socio-economic status for men (1.36) and women (1.31). Occupational categories with outdoor work for both men (0.79) and women (0.92), and the lowest socio-economic status showed lowest SIRs for both sexes (men: 0.69, women: 0.97). The SIR pattern was similar in all periods for occupational categories with outdoor, mixed and indoor work. Findings were consistent between the different Nordic countries. Conclusion This historical prospective cohort study provides evidence of an increased relative risk of CM amongst occupational categories with indoor work for men, and highest SES for both sexes.

Introduction Firefighters may be exposed to a wide range of carcinogens by inhalation or dermal exposure. They also work shift which may disrupt the circadian rhythm. Previous studies have been inconsistent concerning cancer risks among firefighters. The aim was to evaluate the cancer incidence in Swedish firefighters. Methods This cohort study is based on the Swedish part of the Nordic Occupational Cancer (NOCCA) project, including 6 million people who participated in one or more population censuses in 1960, 1970, 1980 and 1990. Cancer diagnoses 1961–2009 were obtained from the Swedish Cancer Registry. We identified 8136 male firefighters. Female firefighters were excluded because there were too few. SIRs were calculated with the cancer incidence rates for the entire national population used as reference rates. Result There was no excess risk for all cancer sites combined (SIR=1.01, 95% CI: 0.96 to 1.06). A statistically significant excess was found only for non-melanoma skin cancer (SIR=1.48, 95% CI: 1.20 to 1.80), although the risk did not increase with duration of employment. There was a small, but statistically significant excess of prostate cancer among firefighters who had worked 30 years or more. Discussion The risk of prostate cancer was increased among long-term exposed firefighters, and a possible excess of non-melanoma skin cancer was found. An increased risk of prostate cancer has been reported in some earlier studies of firefighters, but excesses of others cancers earlier reported in association with firefighting were not confirmed. Our results do not support an overall excess risk of cancer among Swedish firefighters.

Background/Aim: Associations with bladder cancer have been observed for more than 40 occupations. While some findings have been consistent, others have been inconsistent or limited. Outside of the ...

Objective The aim of this case–control study was to assess the effect of night-shift work on the risk of hematological cancers. Methods The study included 39 371 leukemia, 56 713 non-Hodgkin lymphoma, 9322 Hodgkin lymphoma, and 26 188 multiple myeloma cases diagnosed between 1961 and 2005 in Finland, Sweden, and Iceland. Five controls for each case were selected from the Nordic Occupational Cancer Study (NOCCA) cohort, matched by year of birth, sex and country. Night-shift exposure was assessed by using the NOCCA job-exposure matrix (JEM). Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated from conditional logistic regression models. Results Overall, night work was not associated with a risk of hematological cancers. We observed a small but non-significantly increased risk for leukemia (OR 1.07, 95% CI 0.99–1.16), especially for acute myeloid leukemia (OR 1.15, 95% CI 0.97–1.36) among workers exposed to a high level of cumulative night work exposure. Night work exposure was not associated with lymphatic cancers and multiple myeloma. Conclusion This study did not support associations between night-shift work and hematological cancers.

Objectives To assess the association between occupational exposure to asbestos and the risk of cholangiocarcinoma (CC). Methods We conducted a case–control study nested in the Nordic Occupational Cancer (NOCCA) cohort. We studied 1458 intrahepatic CC (ICC) and 3972 extrahepatic CC (ECC) cases occurring among subjects born in 1920 or later in Finland, Iceland, Norway and Sweden. Each case was individually matched by birth year, gender and country to five population controls. The cumulative exposure to asbestos (measured in fibres (f)/ml × years) was assessed by applying the NOCCA job-exposure matrix to data on occupations collected during national population censuses (conducted in 1960, 1970, 1980/81 and 1990). Odds ratios (OR) and 95% CI were estimated using conditional logistic regression models adjusted by printing industry work. Results We observed an increasing risk of ICC with cumulative exposure to asbestos: never exposed, OR 1.0 (reference category); 0.1–4.9 f/mL × years, OR 1.1 (95% CI 0.9 to 1.3); 5.0–9.9 f/mL × years, OR 1.3 (95% CI 0.9 to 2.1); 10.0–14.9 f/mL × years, OR 1.6 (95% CI 1.0 to 2.5); ≥15.0 f/mL × years, OR 1.7 (95% CI 1.1 to 2.6). We did not observe an association between cumulative asbestos exposure and ECC. Conclusions Our study provides evidence that exposure to asbestos might be a risk factor for ICC. Our findings also suggest that the association between ECC and asbestos is null or weaker than that observed for ICC. Further studies based on large industrial cohorts of asbestos workers and possibly accounting for personal characteristics and clinical history are needed., Nordic Cancer Union funded the NOCCA project. The work by AF, GBr, SC, GBi, FSV and SM was partially supported by internal funds of the Department of Medical and Surgical Sciences and the Department of Experimental, Diagnostic, and Specialty Medicine of the University of Bologna.

Submitted manuscript version. Published version available in European Journal of Cancer (2017), 87, p. 92-100. Background: Early-onset prostate cancer is often more aggressive and may have a different etiology than later-onset prostate cancer, but has been relatively little studied to date. We evaluated occupation in relation to early-onset and later-onset prostate cancer in a large pooled study. Methods: We used occupational information from census data in five Nordic countries from 1960-1990. We identified prostate cancer cases diagnosed from 1961-2005 by linkage of census information to national cancer registries and calculated standardized incidence ratios (SIRs) separately for men aged 30-49 and those aged 50 or older. We also conducted separate analyses by period of follow-up, 1961-1985 and 1986-2005, corresponding to pre- and post-prostatespecific antigen (PSA) screening. Results: For early-onset prostate cancer (n=1,521), we observed the highest SIRs for public safety workers (e.g., firefighters) [SIR=1.71, 95% confidence interval (CI): 1.23-2.31] and military personnel (SIR=1.97, 95% CI: 1.31-2.85). These SIRs were significantly higher than the SIRs for later-onset disease (for public safety workers, SIR=1.10, 95% CI: 1.07-1.14, and for military personnel, SIR=1.09, 95% CI: 1.05- 1.13; pheterogeneity=0.005 and 0.002, respectively). Administrators and technical workers also demonstrated significantly increased risk for early-onset prostate cancer, but the SIRs did not differ from those for later-onset disease (pheterogeneity>0.05). While our early-onset finding for public safety workers was restricted to the post-PSA period, that for military personnel was restricted to the pre-PSA period. Conclusion: Our results suggest that occupational exposures, particularly for military personnel, may be associated with early-onset prostate cancer. Further evaluation is needed to explain these findings.

To assess associations between occupation and risk of oesophageal adenocarcinoma (AC) and squamous-cell carcinoma (SCC), data from the Nordic Occupational Cancer Study, a large population-based cohort with long-term follow-up, was used. The Nordic Occupational Cancer Study includes 12.9 million individuals aged 30-64 years who participated in national censuses in Finland, Iceland, Norway and Sweden in 1960-1990. Individuals were assigned to one of the 54 occupational categories, and individuals with oesophageal cancer were identified through nationwide cancer registries with follow-up through 2005. Country-specific standardised incidence ratios (SIRs) with 95% confidence intervals (CIs) were estimated. During follow-up, 4,722 ACs and 14,496 SCCs were observed. Among men, increased risks of AC and SCC were observed among waiters (SIR = 2.58, 95% CI 1.41-4.32 and SIR = 3.22, 95% CI 2.30-4.38 for AC and SCC, respectively), cooks and stewards (1.72, 1.04-2.69 and 2.53, 1.94-3.25), seamen (1.52, 1.16-1.95 and 1.77, 1.53-2.05), food workers (1.51, 1.18-1.90 and 1.21, 1.03-1.42), miscellaneous construction workers (1.24, 1.04-1.48 and 1.39, 1.25-1.54) and drivers (1.16, 1.01-1.33 and 1.23, 1.13-1.34). Decreased risks of AC and SCC were observed among technical workers, physicians, teachers, religious workers and gardeners. The SIR for AC was significantly different from that for SCC in six occupational categories. Among women, increased risks among food workers and waiters and decreased risks among teachers, nurses and assistant nurses were observed for SCC only. In both sexes, increased risks were observed among waiters and food workers, and decreased risks were observed among teachers. This large cohort study indicates that the risk of oesophageal cancer varies by occupation, but not by histological type in most occupational categories.

ObjectivesThe objective of this study was to compare occupational variation of the risk of bladder cancer in the Nordic countries and Canada.MethodsIn the Nordic Occupational Cancer study (NOCCA), 73 653 bladder cancer cases were observed during follow-up of 141.6 million person-years. In the Canadian Census Health and Environment Cohort (CanCHEC), 8170 cases were observed during the follow-up of 36.7 million person-years. Standardised incidence ratios with 95% CI were estimated for 53 occupations in the NOCCA cohort and HR with 95% CIs were estimated for 42 occupations in the CanCHEC.ResultsElevated risks of bladder cancer were observed among hairdressers, printers, sales workers, plumbers, painters, miners and laundry workers. Teachers and agricultural workers had reduced risk of bladder cancer in both cohorts. Chimney-sweeps, tobacco workers and waiters had about 1.5-fold risk in the Nordic countries; no risk estimates for these categories were given from the CanCHEC cohort.ConclusionWe observed different occupational patterns in risk of bladder cancer in Nordic countries and Canada. The only occupation with similarly increased risk was observed among sales workers. Differences in smoking across occupational groups may explain some, but not all, of this variation.