Occupation and small bowel adenocarcinoma: a European case-control study

Objectives-Because of the rarity of small bowel adenocarcinoma (SBA), littl e is known about the aetiology of this disease. This study aimed to identif y occupational clustering of cases SEA as a systematic approach to new hypo theses on the aetiology of this disease. Methods-A European multicentre case-control study was conducted in 1995-7, inclusive. Incident cases aged 35-69 years with SEA (n=168) were recruited before acceptance by a pathologist. Altogether 107 cases and 3915 controls were accepted, of which 79 cases, 579 colon cancer controls, and 2070 popul ation controls were interviewed. Results-The strongest industrial risk factors for SEA taking account of 10 years' exposure lag were dry cleaning, manufacture of workwear, mixed farmi ng (women), and manufacture of motor vehicles (men). A significantly increa sed risk of SEA (odds ratio (OR) and 95% confidence interval (95% CI)) was found among men employed as building caretakers, OR 6.7 (1.7 to 26.0) and w omen employed as housekeepers, OR 2.2 (1.1 to 4.9); general farm labourers, OR 4.7 (1.8 to 12.2); dockers, OR 2.9 (1.0 to 8.2); dry cleaners or launde rers, OR 4.1 (1.2 to 13.6); and textile workers (sewers or embroiders), OR 2.6 (1.0 to 6.8). For the last four groups, together with welders OR 2.7 (1 .1 to 6.6) (men) an exposure-response pattern was found when calculating th e ORs for jobs held 1-5 years and >5 years, with never having held the job as reference. The ORs (95% CIs) for 1-5 years and >5 years were 4.3 (0.4 to 44.0) and 3.5 (0.9 to 13.7), 3.0 (0.3 to 26.2) and 4.3 (0.9 to 21.2), 4.6 (0.4 to 48.1) and 11.0 (2.0 to 60.4), 1.3 (0.2 to 11.0) and 5.8 (2.0 to 17. 2), and 2.8 (0.3 to 23.8) and 4.6 (1.3 to 16.6), respectively, for each of these occupations. Among welders, people performing semiautomatic are weldi ng (MIG/MAG) were identified as a high risk group (OR 5.0 (1.3 to 19.6)). Conclusions-This explorative study suggests an increased occurrence of SEA in certain occupations, which needs further evaluation.