Occupational factors and prostate cancer risk : EPICAP (France), PROtEuS (Canada) and MCC-SPAIN (Spain) studies

Des associations positives entre le cancer de la prostate et certaines professions telles que les pompiers, les agriculteurs, les travailleurs des métaux lourds ou encore les travailleurs de nuit ont été observées dans plusieurs études et ont également fait l'objet de monographie par le Centre International de Recherche sur le Cancer (CIRC). Cependant, les faiblesses méthodologiques concernant l'évaluation de l'exposition professionnelle, le manque de puissance statistique ou la non-prise en compte de l'agressivité dans la plupart des études publiées constituent des freins pour émettre des conclusions fiables. Dans ce contexte, nous avons étudié le rôle des facteurs professionnels dans la survenue du cancer de la prostate, avec un intérêt particulier pour les cancers agressifs, d'abord à partir des données de l'étude cas-témoins française EPICAP, puis des données poolées d'EPICAP avec deux autres études similaires, PROtEuS réalisée au Canada et MCC-SPAIN en Espagne, regroupant 3859 cas incidents et 4359 témoins. Un historique professionnel complet pour tous les emplois occupés a été effectué suivie d'une description détaillée de chaque emploi. Des informations sur le travail de nuit de même que des données médicales, comme le score de Gleason pour les cas, ont également été collectées. Dans l'étude EPICAP, nous avons observé une augmentation du risque de cancer agressif dans les professions médicales, chez les membres des forces armées et les pêcheurs et de cancer faiblement agressif chez les législateurs et cadres supérieurs de l'administration publique et dirigeants d'entreprises ayant exercé au moins 10 ans. Les analyses poolées nous ont permis d'observer une augmentation du risque de cancer faiblement agressif dans les professions des services de protection [toutes professions confondues] exercées une dizaine d'années ou plus, particulièrement chez les pompiers. Une augmentation du risque de cancer faiblement agressif a également été retrouvée chez les policiers et les inspecteurs de la police judiciaire et détectives ayant occupé leur emploi moins de 10 ans. Quant aux analyses stratifiées sur le travail de nuit, une augmentation du risque de cancer faiblement agressif chez les pompiers et policiers, qui ont fait du travail de nuit pendant 10 ans ou plus, a également été retrouvée. Nos résultats soutiennent l'hypothèse d'un lien entre certaines professions et le risque de cancer de la prostate, particulièrement chez les travailleurs à col blanc qui exercent la même profession pratiquement toute leur carrière et chez les travailleurs des services de protection qui ont fait du travail de nuit, bénéficiant néanmoins d'un accès privilégié au dépistage.Positive associations between prostate cancer and some occupations such as firefighters, farmers, metal workers or nightshift workers have been found in several studies highlighted by the International Agency for Research on Cancer (IARC). However, methodological weaknesses in the assessment of occupational exposure, a limited statistical power or the lack of considering cancer aggressiveness in most published studies have hampered the ability to draw reliable conclusions. In this context, we studied the role of occupation in the occurrence of prostate cancer, with a particular interest in aggressive cancers, first using data from the French case-control study, EPICAP. We then pooled data from EPICAP and two other similar studies, PROtEuS developed in Canada and MCC-SPAIN in Spain, involving 3859 incident cases and 4359 controls. For each subject, a complete history for all jobs held was available. Information on nightshift work as well as medical data, such as the Gleason score describing the degree of aggressiveness of tumours, was also collected. In EPICAP, we observed an increased risk of aggressive cancer among medical professions, members of the armed forces and fishermen and non-aggressive cancer in legislators and government administrators and managers who had worked for at least 10 years. In the pooled analyses of the three studies, we found an increased risk of non-aggressive cancer in protective service occupations overall employed ten years or more, and especially among firefighters. An increased risk of non-aggressive cancer was also found among police officers, police inspectors and detectives who had worked for less than 10 years. An increased risk of non-aggressive cancer among firefighters and police officers, who did nightshift work for 10 years or more, was also found. Our results support the hypothesis of an association between occupations and the risk of prostate cancer, particularly among white-collar workers who have been in the same occupation for most of their career and among men involved in protective service occupations who did nightshift work over a prolonged period. Sustained prostate screening practices among these workers might explain some the associations observed

Occupation and prostate Cancer risk: results from the epidemiological study of prostate cancer (EPICAP)

International audienceAbstract Background Although prostate cancer (PCa) is the most frequent male cancer in industrialized countries, little is known about its aetiology. The literature has suggested an influence of the environment, including occupational exposures, but results are inconsistent. In this context, we investigated PCa risk associated to employment among several occupations using data from EPICAP study. Methods EPICAP is a French population-based case-control study including 819 PCa incident cases and 879 controls frequency-matched on age. In-person interviews gathered data on potential risk factors and lifetime occupational histories for each job held at least 6 months. Then, occupations were coded using ISCO 68. Unconditional logistic regressions were performed to assess the association between occupations (ever occupied and by duration) and PCa risk, whether all and aggressive, after adjusting for potential confounders. Results For ≥10 years of employment, we found positive associations with PCa, whether overall and aggressive, among Medical, Dental and Veterinary workers (OR (odds ratios) =5.01 [95% confidence interval] [1.27; 19.77]), Members of the armed forces (OR = 5.14 [0.99; 26.71]) and Fishermen, hunters and related workers (OR = 4.58 [1.33; 15.78]); whether overall and non-aggressive PCa, among Legislative officials and Government administrators (OR = 3.30 [1.10; 9.84]) or Managers (OR = 1.68 [1.18; 2.41]); however a negative association, whether overall and non-aggressive PCa, among Material-Handling and Related Equipment Operators, Dockers and Freight Handlers (OR = 0.40 [0.17; 0.97]). Conclusion Excess PCa risks were observed in the EPICAP study mostly among white collar workers exposed to several factors in their work environment. These emerging associations can be used to lead future research investigating specific occupational exposures

Occupational heat exposure and prostate cancer risk: A pooled analysis of case-control studies

International audienceBackground: Heat exposures occur in many occupations. Heat has been linked to key carcinogenic processes, however, evidence for associations with cancer risk is sparse. We examined potential associations between occupational heat exposure and prostate cancer risk in a multi-country study. Methods: We analysed a large, pooled dataset of 3142 histologically confirmed prostate cancer cases and 3512 frequency-matched controls from three countries: Canada, France, and Spain. Three exposure indices: ever exposure, lifetime cumulative exposure and duration of exposure, were developed using the Finnish Job-Exposure Matrix, FINJEM, applied to the lifetime occupational history of participants. We estimated odds ratios (ORs) and 95% confidence intervals (CIs), using conditional logistic regression models stratified by 5-year age groups and study, adjusting for potential confounders. Potential interactions with exposure to other occupational agents were also explored. Results: Overall, we found no association for ever occupational heat exposure (OR 0.97; 95% CI 0.87, 1.09), nor in the highest categories of lifetime cumulative exposure (OR 1.04; 95% CI 0.89, 1.23) or duration (OR 1.03; 95% CI 0.88, 1.22). When using only the Spanish case-control study and a Spanish Job Exposure Matrix (JEM), some weakly elevated ORs were observed. Conclusions: Findings from this study provide no clear evidence for an association between occupational heat exposure and prostate cancer risk