Background: Exposure to polycyclic aromatic hydrocarbons (PAH) occurs widely in occupational settings. We investigated the association between occupational exposure to PAH and lung cancer risk and joint effects with smoking within the SYNERGY project. Methods: We pooled 14 case-control studies with information on lifetime occupational and smoking histories conducted between 1985 and 2010 in Europe and Canada. Exposure to benzo[a]pyrene (BaP) was used as a proxy of PAH and estimated from a quantitative general population job exposure matrix. Multivariable unconditional logistic regression models, adjusted for smoking and exposure to other occupational lung carcinogens, estimated odds ratios (ORs) and 95% confidence intervals (CIs). Results: We included 16,901 lung cancer cases and 20,965 frequency-matched controls. Adjusted OR for PAH exposure (ever) was 1.08 (CI, 1.02-1.15) in men and 1.20 (CI, 1.04-1.38) in women. When stratified by smoking status and histologic subtype, the OR for cumulative exposure >0.24 BaP µg/m3-years in men was higher in never smokers overall (1.31 (CI, 0.98-1.75)), for small cell (2.53 (CI, 1.28-4.99)) and squamous cell cancers (1.33 (CI, 0.80-2.21)). Joint effects between PAH and smoking were observed. Restricting analysis to the most recent studies showed no increased risk. Conclusions: Elevated lung cancer risk associated with PAH exposure was observed in both sexes, particularly for small cell and squamous cell cancers, after accounting for cigarette smoking and exposure to other occupational lung carcinogens. Impact: The lack of association between PAH and lung cancer in more recent studies merits further research under today's exposure conditions and worker protection measures.

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