[The public health status of occupational cancer in Finland].
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Biomedical subjects
Publications and source records attributed to E Pukkala.
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The cancer incidence of 3,545 workers in the Finnish pulp and paper industry was assessed in a retrospective cohort study. The cohort included workers with continuous employment of at least one year between 1 January 1945 and 31 December 1961 and was followed until 31 December 1980. Six subcohorts were formed (sulfite mill, sulfate mill, paper mill, board mill, maintenance department, and power plant). Separate analyses were made for the 2,597 workers hired after 1 January 1945. The smoking habits were surveyed. Among the men, 196 cases of primary cancer were detected versus 203.8 expected [standardized incidence ratio (SIR) 96, 95% confidence interval (95% CI) 82-114], and there were 47 cancer cases among the women versus 57.9 expected (SIR 91, 95% CI 60-108). Lung cancer occurred in 78 men (62.6 expected, SIR 125, 95% CI 98-155), and the excess was the most prominent for the male board mill workers (40 observed, 81.1 expected, SIR 222, 95% CI 158-302), particularly after 20 year's latency (25 observed, 7.8 expected, SIR 323, 95% CI 209-476). Analogous excesses of lung cancer occurred among the men (especially the male board mill workers) who began work after 1 January 1945. The findings were not explained by smoking habits.
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Standardized incidence ratios were calculated for cancers of the gastrointestinal tract in different socioeconomic and educational groups in Finland. The series constituted all patients with cancers of the esophagus, stomach, colon, rectum, liver (primary only), gallbladder, and pancreas recorded in the Finnish Cancer Registry in 1971-1975 (8,802 cases). Data on socioeconomic status and education were obtained from the records of the national census of December 31, 1970. Cancers of the colon and rectum were associated with high socioeconomic status and higher levels of education, cancers of the esophagus and stomach with lower classes. These associations are most likely to be mediated by dietary habits. No clear-cut association was found for other cancers.
Time trends and differentials in cancer incidence in the five Nordic countries, Denmark, Finland, Iceland, Norway and Sweden, were investigated, using material collected by the cancer registries in each country. The incidence at all sites combined and at 23 anatomical sites was studied by age, birth cohort and time period. The maximum lengths of the trends were used for each country. In Denmark the material comprised all the tumours diagnosed in 1943-1980, in Finland and Norway those diagnosed in 1953-1980, in Iceland those diagnosed in 1955-1980, and in Sweden those diagnosed in 1958-1980. For males the age-adjusted cancer incidence rates at all sites combined were highest in Denmark and Finland, and lowest in Sweden and Norway. In females the incidence was highest in Denmark and Iceland, and lowest in Finland. The rates increased slightly for both sexes. For cancer of the pancreas, Hodgkin's disease, acute leukaemia and childhood cancer (all sites combined) the rates in all the Nordic countries were similar every year. For cancers of the stomach, colon, breast, corpus uteri, ovary, prostate, testis, urinary bladder, melanoma of the skin and non-Hodgkin's lymphomas the trends were similar but on different levels. For cancers of the larynx and lung in males the rates in Finland decreased during the 1970s, whereas the rates were increasing in the other Nordic countries. For cancer of the rectum, the trend showed a decrease in Denmark but an increase in the other Nordic countries. For lip cancer the rate in Sweden was almost constant over time, but in Denmark, Finland and Norway a decrease occurred. For oesophageal cancer in males the rates decreased in Finland and Iceland in the 1970s, whereas in Denmark and Norway there was very little change, and in Sweden there was an increase in the rates. For cancer of the cervix uteri the rates started to decrease in Denmark, Finland, Iceland and Sweden in the mid-1960s, but in Norway not until some ten years later. The differentials between the countries were largest for cancers of the testis and thyroid, in which the highest incidence was five to six times as large as the lowest. For testicular cancer the rate was the highest in Denmark, for thyroid cancer in Iceland. For both of these cancers the rate was the lowest in Finland. Melanoma of the skin was the cancer with the most rapid increase in incidence with time in all the Nordic countries.(ABSTRACT TRUNCATED AT 400 WORDS)
A case-referent study was undertaken to investigate the associations between formaldehyde exposure and respiratory and related cancers. Fifty-seven such cancers from a retrospective cohort of male woodworkers formed the case group. They were matched by year of birth with 171 referents. Exposure to formaldehyde was assessed with job-exposure matrices. The median of the time-weighted average concentration was about 1 ppm, and the mean duration of exposure was 10 years among the exposed. Odds ratios (OR) were calculated for formaldehyde exposure (1.44), peak exposure to formaldehyde (1.26), and exposure to formaldehyde-containing wood dust (1.22). None of the values exceeded unity with statistical significance. Allowance was also made for a 10-year period from the onset of exposure. Birth year, cigarette smoking and exposure to wood dust, chlorophenols, pesticides, and terpenes were controlled by stratification. The adjusted ORs did not change appreciably. The highest OR was 1.95 for formaldehyde exposure without allowance for minimum latency, adjusted for exposure to terpenes. No exposure-response relation was observed for the level, duration, or dose (ppm-years) of formaldehyde exposure. The result is nonpositive and may be explained by absence of effect, by too short a follow-up, or by insufficient power for detecting a mild excess risk.
The material of the Finnish Cancer Registry from 1953-79 (279,745 cancer patients, 774,518 person-yr at risk) was analyzed for the occurrence of multiple cancer. There were 5,871 new primary cancers in the series (excluding the first 12 mo from diagnosis of the first cancer). A positive association between cancers with similar etiology could be demonstrated, e.g., between cancers of the lip, larynx, and lung (smoking) and between cancers of the breast and endometrium (hormones, reproductive history). Clustering of different risk factors resulted, e.g., in an excess risk of colon cancer among female breast cancer patients (risk factors in both cancers are prevalent particularly in higher-social classes). Differences in the distribution of the risk factors resulted in risk deficits, e.g., low relative risk of lung cancer among male colon cancer patients (the prevalence of smoking was highest in the lower-social classes and the prevalence of risk factors in colon cancer was highest in the higher-social classes). The risk of leukemia was increased among patients with cancers of the breast, endometrium, and thyroid (possibly due to irradiation). There was a high relative risk of salivary gland cancer among patients with skin cancer other than melanoma or basal cell carcinoma in both sexes. The relative risk of a new primary cancer decreased with increasing age at diagnosis of the first cancer. The length of follow-up was positively associated with the relative risk of many cancers, although this finding was not as consistent as that with age.
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The standardized incidence ratio (SIR) of lung cancer was determined for different occupational groups in Finland. The data on all cases of lung cancer diagnosed in Finland in age groups of 35-69 years in 1971-1975 were supplemented by information on occupation from the 1970 census (Central Statistical Office). The expected numbers of cases were based on the sex, age and occupation-specific numbers of person-years computed in the Central Statistical Office, and sex- and age-specific incidence rates of lung cancer among the economically active population (as defined 1 January 1971). Compared with the risk of the total economically active population, the relative risk of those not active (SIR) was 1.69 for men and 0.86 for women. Lower than expected relative risks were encountered among highly educated and white-collar male workers (religious, legal, pedagogical, medical, technical and administrative work), in sales work, transport service work and among farmers. High SIRs were found in mining and quarrying, forestry, woodworking (joiners), construction, painting and among unskilled workers. Among women the numbers of cases were small and only one significant SIR was obtained; the risk was lower than expected in farming. Data on the smoking habits of males in different main occupational categories in Finland show that variation between different occupational groups in the prevalence of smoking closely corresponds to that in the SIR for lung cancer (R = 0.96).
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A follow-up study was carried out among workers in the processing and tire and tube fabrication departments of a Finnish rubber plant. A total of 1.331 workers were followed up for cancer through the files of the Finnish Cancer Registry from 1953 to 1976 (11,709 person years). The expected number of cancer cases was calculated on the basis of the age and sex-specific incidence rates for the urban population of the surrounding province. Twenty-one cancer cases were found against 18.9 expected (RR 1.1, 95% confidence interval 0.7-1.7). The risk of cancer of the digestive organs, respiratory organs, and urinary bladder was higher than expected, and the risk increased with the length of the follow-up time. However, the differences were not statistically significant.
Ecologic and individual risk indicators were derived from the population censuses of Finland Cancer Registry. The years covered in the study were 1955-1974 for the ecologic analysis and 1971-1975 for the analysis on individuals. The incidence of both diseases was high in an urban environment with high standard of living. The individuals with high risk of breast cancer were of high socioeconomic status and were well educated, whereas cervical cancer was common among women of low socioeconomic status and with less education. Conceptually similar indicators used on both the ecologic and individual levels characterize different aspects of risk; for example, a woman with a low standard of living in a well-to-do environment has a high risk of cervical cancer.
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The standardized morbidity ratios (SMR) of lip and non-melanomatous skin cancer (basal-cell carcinoma excluded) of the head and neck in males were determined for different occupational groups in Finland. The data on all cases of these types of cancer diagnosed in Finland in the age group 35-69 years in 1971-75 were supplemented by information on occupations from the 1970 census (Central Statistical Office of Finland). The expected numbers of cases were based on the age and occupation-specific numbers of person-years computed by the Central Statistical Office, and the age-specific incidence rates of lip and skin cancers among the economically active population. The highest SMR of lip cancer among all the occupational groups was found in agriculture, forestry and fishing (1.64). In contrast, the SMR of skin cancer was not higher than expected in occupations related to agriculture and forestry. Significantly lower than expected risks of lip cancer were observed among highly educated white-collar workers, among whom the risk of contracting skin cancer was the highest (technical, scientific, humanistic and artistic work, SMR 1.78). The morbidity of both lip and skin cancers varies considerably by occupation, and the risks seem to be, at least in part, inversely related. Thus, it is probable that there are also differences in the risk factors, contrary to several earlier suggestions. The nature of these factors are discussed.
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