Lung cancer risk and do-it-yourself activities. A neglected risk factor for lung cancer☆
Introduction
Lung cancer is an important public health problem worldwide (Jemal et al., 2011). It is the leading cause of cancer incidence and mortality, with 2.1 million new cases diagnosed and 1.8 million deaths predicted in 2018, representing close to 11.6% of the total diagnosed cancer cases and 18.4% cancer deaths (Bray et al., 2018). Among males, it remains the most frequent cancer and the leading cause of cancer mortality and the second cause of cancer death in females (Bray et al., 2018).
Tobacco consumption is the primary cause of lung cancer (De la Cruz et al., 2011) though lung cancer also occurs in never-smokers. Lung cancer among never-smokers impacts a considerable part of the population comprising approximately 15–25% of all lung cancer cases (Rudin et al., 2009; Sun et al., 2007). Residential radon is the second most common cause of lung cancer after smoking and the first in never-smokers (Darby et al., 2005; Krewski et al., 2005, World Health Organization (WHO), 2009). Other known risk factors include, secondhand tobacco smoke, occupational exposures, diet (including alcohol) and air pollution (Fehringer et al., 2017; Hamra et al., 2014; Kim et al., 2014; Loomis et al., 2013; Malhotra et al., 2016; Mori et al., 2017; Ruano-Ravina et al., 2003).
Previously published studies have linked occupational exposures to lung cancer risk. High lung cancer risks have been found in some occupations or industries, and there is a well-known association for these jobs and lung cancer risk. This is the case of construction workers, shipyard workers or painters. Other occupations are believed to increase lung cancer risk though the association is not completely clear. In the category we can include rubber industry workers, or woodworkers (including carpentry) (Barcenas et al., 2005; Boniol et al., 2017; Guha et al., 2010; Villeneuve et al., 2012). Several substances present in workplaces associated with lung cancer have been highlighted by the International Agency for Research on Cancer (IARC) (Steenland et al., 1996). The population attributable fraction of lung cancer deaths due to occupational carcinogens has been estimated between 4% and 24% worldwide (Boffetta et al., 2010; Doll and Peto, 1981; Nurminen and Karjalainen, 2001; Steenland et al., 2003). Similar data were obtained in more recent studies (Consonni et al., 2010; De Matteis et al., 2012).
Exposures to carcinogens that occur during do-it-yourself activities (e.g. painting, model making, furniture varnishing or do-it-yourself activities) may be similar to those occurring in workplaces, involving exposure to certain carcinogens such as paint, wood dust and glues (NIOSH, 2018). It is common for these hobbyists to spend many hours of their spare time in these activities. Furthermore, these activities are frequently performed with no protection, and therefore increasing the potential harm of these substances. Despite this, to date, scarce investigation has been carried out analyzing the existing relationship between exposure to carcinogens during do-it-yourself activities and risk of lung cancer. Two previous studies of our group have observed that the fact to be exposed to potential carcinogens when practicing do-it-yourself activities increased the risk of lung cancer in ever-smokers (Ruano-Ravina et al., 2002; Prini-Guadalupe et al., 2012). In addition, this association was also found in a study conducted only on never-smokers (Ruano-Ravina et al., 2014).
The main objective of this study was, through a pooled case-control study and including a new set of cases and controls, to assess the relationship between do-it-yourself risk activities entailing the exposure to carcinogenic substances and the risk of lung cancer in both ever and never-smokers.
Section snippets
Design, subjects and settings
Individual data from various case-control studies conducted in Northwestern Spain on residential radon and lung cancer were combined in a pooling study. Participants from fourteen Spanish hospitals have been recruited though most of them are residents of Galicia, which has been defined in previous studies as a radon-prone area (Barros-Dios et al., 2007; Lorenzo-González et al., 2017).
All studies included incident lung cancer cases in ever and never-smokers using a consecutive sampling with an
Results
A total of 2985 participants were included, 1528 cases and 1457 controls. Among them 510 cases and 794 controls were never-smokers. Sample description is shown in Table 1. There are not notable differences by gender between cases and controls. The median age was 67 years for cases (interquartile range 59–74) and 63 years for controls (interquartile range 55–72). The attained education level was similar between both groups. Practicing do-it-yourself risk activities was more frequent among cases:
Discussion
These results support the hypothesis that do-it-yourself activities or hobbies entailing exposure to certain carcinogenic compounds are associated with an increased risk of lung cancer, both in ever and never-smokers with a risk of approximately two-fold in those individuals who have performed these risky activities for at least ten years compared with those not performing these activities. Some specific do-it-yourself activities seem to be more associated with lung cancer than others, with
Funding
This paper has been funded by the following competitive research grants awarded to the individual case-control studies, which are part of this pooled study:
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Xunta de Galicia: 10CSA208057PR “Risk factors of lung cancer in never smokers: a multicentre case-control study in the Northwest of Spain.” Year 2010.
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Instituto de Salud Carlos III, Ministry of Science and Innovation of Spain, grant number PI03/1248. Year 2003.
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Instituto de Salud Carlos III, Ministry of Science and Innovation of Spain, grant
Conflict of interest
The authors declare that there is no conflict of interest regarding the publication of this article
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This research is part of the work conducting to PhD degree of María Lorenzo González.