Linköping University Medical Dissertations,0345-0082 ;352
Papers, included in the Ph.D. thesis, are not registered and included in the posts from 1999 and backwards.
The object of the present research has been to elucidate the associations between malignant epithelial neoplasms of the nasal cavities and paranasal sinuses and workplace exposures to ascertained as well as suspected cancer causing agents and processes.The research includes six independent case-control studies, located in various Italian regions. These regions are characterized by different patterns of industrialization, resulting in an involvement of various occupations of interest. Furthermore, the main findings of a national programme of surveillance of nasal cancer are presented.The regions selected for the studies were the district ofBiella in Piedmont (high proportion of the active population employed in textile industry), the province of Brescia in Lombardy (high proportion of the activepopulation employed in metal industry), the provinces of Verona and Vicenza in Venetia (an area characterized by textile and leather industry and by farming), the province of Siena (a mainly rural area, with a well-established wood industry) and the province of Pisa (characterized by the presence of wood and leather industry); the two latter provinces are both located in Tuscany. The national surveillance program was based on the collaborative effort of 61 ear, nose and throat departments operating all over Italy. Finally, a case-control study involving subjects from the National Cancer Institute in Milan provided information at a national level, since patients from all over the country attend this centre.The present research confrrmed the well established risk of nasal cancer associated with the occupations of woodworker and leatherworker. The combined estimates of the odds ratios were 6.0 (90% CI: 3.8-9.3) and 5. 7 (90 % Cl: 2.8-12), respectively, which are lower and somewhat less dramatic effects than seen in some of the earlier studies.A significant association between nasal cancer and some other occupations was detected, namely metal industry, the combined estimate of the odds ratio being 2.3 (90 % Cl: 1.2-4.3), textile and gannent industry (OR: 2.2; 90% Cl: 1.2-4.1), mining and construction industry (OR: 2.8; 90% Cl: 1.6·5.0), fanning (OR: 2.3; 90% Cl: 1.4-3.8) and other occupations entailing exposures to dusts and fumes (OR: 2.0; 90% Cl: 1.1-3.6).The etiologic fraction associated with all hazardous occupational exposures was about 60 %, indicating that a considerable preventive effect could be achievable by improving the quality of the work environment. With regard to the high fatality of this disease, and the serious impairments of quality of life among the survivors, the importance of prevention is not only obvious but also ethically imperative.