Using employer-based information as reference, a slight underreporting of PER exposure by the employees was observed, suggesting that the opposite situation was unlikely on a cohort basis. Besides the obvious limited power to detect increases in rare cancer sites, this study also had some limitations with respect to assessment of occupational exposure. Firstly, no quantitative data on exposure to the compound of interest, PER, were available at either an individual or company
#TGF beta inhibitor randurls[1|1|,|CHEM1|]# level, so crude surrogate measures had to be used. While this approach is concordant with most other epidemiological studies of cancer in dry-cleaners (Mundt et al. 2003), it has been a consistent problem in evaluating the carcinogenicity of PER in the occupational setting. Secondly, the occupational Selleckchem Captisol history of the cohort members was available for a time window of only 11 years, precluding an assessment of possible confounding from occupational exposures outside this period. This could result in non-differential misclassification of subjects into the
specific exposure categories used here. Moreover, historical data on PER exposure in Swedish dry-cleaning establishments suggest that exposure levels were generally low already in the 1970s and 1980s (Johansen et al. 2005; Andersson et al. 1981; Lindberg and Bergman 1984; Arbetarskyddsstyrelsen 1988), tending to reduce the power of detecting any carcinogenic risks pertaining to PER. The so-called healthy worker effect is an example of confounding related to the observation that employed populations tend to have lower mortality or morbidity than the general population used as reference (Monson 1986; Pearce et al. 2007). This observation, however, is rarely a cause for concern in occupational cancer studies, since it is not practically feasible to take risks of future cancer development into account in pre-employment evaluations Sodium butyrate (Hernberg 1986; Thériault et al. 1994). This argument is considered applicable to the present study. The occurrence of an “unhealthy worker effect”, i.e. the increased mortality/morbidity sometimes noted in studies involving unskilled workers with short
duration of employment (Juel 1994; Wingren 2006), might be considered as a mirror image of the “healthy worker effect” and more related to lifestyle-associated than strictly occupational risk factors. Some aspects of such lifestyle-related factors are discussed in the following. The elevated incidence of lung cancer in both male and female workers observed here was not found to be confined to dry-cleaning agent exposure, suggesting alternative risk factors. An association between dry-cleaning and lung cancer has been noted previously in studies of both Scandinavian and North American dry-cleaning and/or laundry workers (IARC 1995a; Ruder et al. 2001; Blair et al. 2003) but confounding from smoking has been difficult to evaluate due to lack of data.
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