Cáncer de pulmón relacionado con la exposición ocupacional: revisión integrativa

Brey, Christiane; Gouveia, Fernanda Thaysa; Silva, Brenda Silva; Sarquis, Leila Maria Mansano; Miranda, Fernanda Moura D’Almeida; Consonni, Dario

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Revista Gaúcha de Enfermagem

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Brasil

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Sumário

Integrative Review • Rev. Gaúcha Enferm. 41 • 2020 • https://doi.org/10.1590/1983-1447.2020.20190378 copiar

Cáncer de pulmón relacionado con la exposición ocupacional: revisión integrativa

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Identificar en la literatura los agentes cancerígenos presentes en el entorno laboral, las ocupaciones y el riesgo de cáncer de pulmón.

Método:

Estudio descriptivo y analítico de una revisión integradora realizada en una base de datos nacional e internacional de los últimos diez años, entre 2009 y 2018, que comprende 32 estudios referidos a la vinculación entre el cáncer de pulmón y las sustancias cancerígenas de exposición ocupacional.

Resultados:

Nueve (28,1%) publicaciones tuvieron su origen en China y solo una en Brasil. Los trabajadores más expuestos pertenecían al sector secundario, el 50% a la industria y un 6,2% a la construcción, siendo en su mayoría hombres. El asbesto y la sílice se destacaron entre las sustancias cancerígenas más asociadas con el riesgo de cáncer de pulmón, con índices de 37,5% y el 28,1%, respectivamente.

Conclusiones:

La vinculación entre la exposición ocupacional y el riesgo de cáncer de pulmón se caracterizó en esta investigación por la evidencia científica sustancial de los estudios descriptos que confirman esta asociación.

Palabras clave:
Neoplasias pulmonares; Exposición profesional; Carcinógenos; Sustancias, productos y materiales carcinogénicos

Portal	Search strategy	N	Total
BVS	tw:(lung neoplasm AND (carcinogens OR carcinogenic substances products and materials))	18	1,028
	tw:(lung neoplasm AND occupational exposure)	912
	tw:(occupational exposure AND (carcinogens OR carcinogenic substances products and materials))	97
	tw:(lung neoplasm AND occupational exposure AND (carcinogens OR carcinogenic substances products and materials))	1
EBSCO	(lung neoplasm AND (carcinogens OR carcinogenic substances products and materials))	172	598
	(lung neoplasm AND occupational exposure)	153
	(occupational exposure AND (carcinogens OR carcinogenic substances products and materials))	233
	(lung neoplasm AND occupational exposure AND (carcinogens OR carcinogenic substances products and materials))	40
PUBMED	(“lung neoplasm” [MeSH Terms] AND (“carcinogens” [MeSH Terms] OR carcinogenic substances products and materials”))	194	606
	(“lung neoplasm” [MeSH Terms] AND (“occupational exposure” [MeSH Terms]))	141
	(“occupational exposure” [MeSH Terms] AND (“carcinogens” [MeSH Terms] OR carcinogenic substances products and materials”))	208
	(“lung neoplasm” [MeSH Terms] AND (“occupational exposure” [MeSH Terms] AND (“carcinogens” [MeSH Terms] OR carcinogenic substances products and materials”))	63

Author/Year/ Country of the study	Title	Objective/Type of Study N= participants	Level of Evidence	Exposure	Outcome
Wu WT, Lin YJ, Li Y, Tsai PJ, Yang CY, Liou SH. 2015, China1515. Wu WT, Lin YJ, Li CY, Tsai PJ, Yang CY, Liou SH, et al. Cancer attributable to asbestos exposure in shipbreaking workers: A matched-cohort study. PLoS One. 2015;10(7):e0133128. doi: https://doi.org/10.1371/journal.pone.0133128 https://doi.org/10.1371/journal.pone.013...	Cancer Attributable to Asbestos Exposure in Shipbreaking Workers: A Matched-Cohort Study	To examine the relationship between cancer incidence and asbestos exposure among former Taiwanese ship workers. Cohort study N: 26,562	IV	Asbestos	The increase in the incidence of lung cancer is associated with the level of exposure to asbestos among naval workers. Significant difference in cancer compared to the combined cohort.
Algranti E, Buschinelli JT, De Capitani EM. 2010, Brazil1616. Algranti E, Buschinelli JTP, De Capitani EM. Câncer de pulmão ocupacional. J Bras Pneumol. 2010;36(6):784-94. doi: https://doi.org/10.1590/S1806-37132010000600017 https://doi.org/10.1590/S1806-3713201000...	Câncer de pulmão ocupacional	To list the agents recognized as causes of lung cancer and discuss the contribution of occupation to the development of the disease. Review, descriptive.	VI	Group 1/IARC carcinogenic agents	Publications on the relationship between occupation and cancer in Brazil are restricted to the area of public health or occupational pulmonology services. There are few epidemiological records of occupational cancer that allow for the detection of risk situations and their prevention.
Westberg H, Andersson L, Bryngelsson L, Ngo Y, Ohlson CG. 2013, Sweden1717. Westberg H, Andersson L, Bryngelsson IL, Ngo Y, Ohlson CG. Cancer morbidity and quartz exposure in Swedish iron foundries. Int Arch Occup Environ Health. 2013;86(5):499-507. doi: https://doi.org/10.1007/s00420-012-0782-4 https://doi.org/10.1007/s00420-012-0782-...	Cancer morbidity and quartz exposure in Swedish iron foundries	To determine the cancer morbidity among Sweden iron foundry workers with exposure to quartz. Cohort study N: 3,045	IV	Quartz	Overall cancer morbidity was not increased among the foundry workers, but the incidence of lung cancer was significantly high.
Kishimoto T, Gemba K, Fujimoto N, Onishi K, Usami I, Mizuhashi K, Kimura K. 2011, Japan1818. Kishimoto T, Gemba K, Fujimoto N, Onishi K, Usami I, Mizuhashi K, et al. Clinical study of asbestos-related lung cancer in Japan with special reference to occupational history. Cancer Sci. 2010;101(5):1194-8. doi: https://doi.org/10.1111/j.1349-7006.2010.01509.x https://doi.org/10.1111/j.1349-7006.2010...	Clinical study of asbestos-related lung cancer in Japan with special reference to occupational history	To investigate clinical characteristics and occupational history for patents with asbestos-related lung cancer in Japan and compare with patients with non-asbestos-related lung cancer. Analytical, cross-sectional study. N: 152	VI	Asbestos	The risk for lung cancer increased almost linearly with the cumulative dose of asbestos, and was increased in the presence of asbestosis. The incidence of non-small cell lung cancer for patients with asbestosis increased compared to exposed patients, but without asbestosis.
Hosgood HD, Chapman RS, Wei H, He X, Tian L, Liu LZ, et al. 2012, China1919. Hosgood HD, Chapman RS, Wei H, He X, Tian L, Liu LZ, et al. Coal mining is associated with lung cancer risk in Xuanwei, China. Am J Ind Med. 2012;55(1):5-10. doi: https://doi.org/10.1002/ajim.21014 https://doi.org/10.1002/ajim.21014...	Coal mining is associated with lung cancer risk in Xuanwei, China	To evaluate the risk for lung cancer in coal miners, upon absence of diesel exposure. Case-control study. N: 520	IV	Coal	Increased risk for lung cancer in coal miners. There was a relation between dose-response and the lung cancer risk with the years working as a coal miner.
Sun Y, Bochmann F, Nold A, Mattenklott M, 2014, Germany2020. Sun Y, Bochmann F, Nold A, Mattenklott M. Diesel exhaust exposure and the risk of lung cancer-a review of the epidemiological evidence. Int J Environ Res Public Health. 2014;11(2):1312-40. doi: https://doi.org/10.3390/ijerph110201312 https://doi.org/10.3390/ijerph110201312...	Diesel Exhaust Exposure and the Risk of Lung Cancer: A Review of the Epidemiological Evidence	To evaluate the association between diesel exposure and lung cancer risk. Systematic review.	V	Diesel engine exhaust	The evaluated studies do not indicate a clear relationship between the exposure to diesel exhaust and lung cancer.
Lacasse Y, Martin S, Gagné D, Lakhal L. 2009, Netherlands2121. Lacasse Y, Martin S, Gagné D, Lakhal L. Dose-response meta-analysis of silica and lung cancer. Cancer Causes Control. 2009;20(6):925-33. doi: https://doi.org/10.1007/s10552-009-9296-0 https://doi.org/10.1007/s10552-009-9296-...	Dose-response meta-analysis of silica and lung cancer	To examine the association between occupational exposure to silica and lung cancer. Systematic review and meta-analysis.	V	Silica	An increased risk for lung cancer was found with the increase of the cumulative exposure to silica.
Doi M, Hattori N, Yokoyama UM, Onari Y, Kanehara H, Masuda K, et al. 2009, Japan2222. Doi M, Hattori N, Yokoyama A, Onari Y, Kanehara M, Masuda K, et al. Effect of mustard gas exposure on incidence of lung cancer: a longitudinal study. Am J Epidemiol. 2011;173(6):659-66. doi: https://doi.org/10.1093/aje/kwq426 https://doi.org/10.1093/aje/kwq426...	Effect of Mustard Gas Exposure on Incidence of Lung Cancer: A Longitudinal Study	To examine the incidence of lung cancer among former mustard gas factory workers. Cohort study N: 1,682	IV	Mustard gas	The relative risk in those involved in making mustard gas decreased with increasing age at the beginning of exposure.
Ahn Y-S, Jeong KS. 2014, Korea2323. Ahn Y-S, Jeong KS. Epidemiologic characteristics of compensated occupational lung cancers among Korean workers. J Korean Med Sci. 2014;29(11):1473. doi: https://doi.org/10.3346/jkms.2014.29.11.1473 https://doi.org/10.3346/jkms.2014.29.11....	Epidemiologic Characteristics of Compensated Occupational Lung Cancers among Korean Workers	To analyze the characteristics of occupational lung cancers in workers compensated by the Industrial Accident Compensation Insurance Law between 1994 and 2011. Descriptive study. N: 179	VI	Asbestos 307. Silica Chromium VI Nickel Diesel engine exhaust PAH Tar	Asbestos was the main exposure (48.6%). There was no significant difference in the mean duration of exposure or latency with the agent type. The main industries were manufacturing, construction and transportation, and maintenance and repair, casting, welding, painting and weaving occupations.
Olsson AC, Gustavsson P, Kromhout H, Peters S, Vermeulen R, Brüske I, et al. 2010, Multicentric 2424. Olsson AC, Gustavsson P, Kromhout H, Peters S, Vermeulen R, Brüske I, et al. Exposure to diesel motor exhaust and lung cancer risk in a pooled analysis from case-control studies in Europe and Canada. Am J Respir Crit Care Med. 2011;183(7):941-8. doi: https://doi.org/10.1164/rccm.201006-0940OC https://doi.org/10.1164/rccm.201006-0940...	Exposure to Diesel Motor Exhaust and Lung Cancer Risk in a Pooled Analysis from Case-Control Studies in Europe and Canada	To investigate the risk for lung cancer associated to occupational exposure to diesel engine exhaust. Case-control study. N: 29,586	IV	Diesel engine exhaust	Inconsistent association between occupational exposure to diesel exhaust and the risk for lung cancer. The Odds Ratio (OR) was significant for cumulative diesel exposure in the largest quartile.
Liu Y, Steenland K, Rong Y, Hnizdo E, Huang X, Zhang H, et al. 2013, China2525. Liu Y, Steenland K, Rong Y, Hnizdo E, Huang X, Zhang H, et al. Exposure-response analysis and risk assessment for lung cancer in relationship to silica exposure: a 44-year cohort study of 34,018 workers. Am J Epidemiol. 2013;178(9):1424-33. doi: https://doi.org/10.1093/aje/kwt139 https://doi.org/10.1093/aje/kwt139...	Exposure-response analysis and risk assessment for lung cancer in relationship to silica exposure: a 44 years cohort study of 34,018 workers	To investigate the risk for developing lung cancer in workers exposed to silica. Cohort study N: 34,018	IV	Silica	Silica is a human carcinogen and current exposure limits are insufficient to protect workers from the lung cancer. Even with 0.1mg/m³of silica exposure, the estimated risk along life was 0.51%.
Lin CK, Chang AA, Wang JD, Lee LJ. 2015, China2626. Lin CK, Chang YY, Wang J Der, Lee LJH. Increased standardised incidence ratio of malignant pleural mesothelioma in Taiwanese asbestos workers: a 29-year retrospective cohort study. Biomed Res Int. 2015:678598. doi: https://doi.org/10.1155/2015/678598 https://doi.org/10.1155/2015/678598...	Increased Standardised Incidence Ratio of Malignant Pleural Mesothelioma in Taiwanese Asbestos Workers: A 29-Year Retrospective Cohort Study	To determine the incidence rate of malignant pleura mesothelioma (MPM) in workers exposed to asbestos in Taiwan. Cohort study N: 160,640	IV	Asbestos	Association between occupational exposure to asbestos and Pleural Malignant Mesothelioma (PMM). The greatest risk was found among male workers employed before 1979 and working for more than 20 years in asbestos factories.
Garshick E, Laden F, Hart JE, Davis ME, Eisen EA, 367. Smith TJ. 2012, USA2727. Garshick E, Laden F, Hart JE, Davis ME, Eisen EA, Smith TJ. Lung cancer and elemental carbon exposure in trucking industry workers. Environ Health Perspect. 2012;120(9):1301-6. doi: https://doi.org/10.1289/ehp.1204989 https://doi.org/10.1289/ehp.1204989...	Lung Cancer and Elemental Carbon Exposure in Trucking Industry Workers	To evaluate the risk of mortality due to lung cancer among workers in the truck industry of the USA 373. Cohort study N: 31,135	IV	Elemental carbon	The mortality by lung cancer in workers of the truck industry increased in association with the cumulative exposure to elemental carbon.
Consonni D, De Matteis S, Lubin JH, Wacholder S, Tucker M, Pesatori AC, et al. 2010, Italy2828. Consonni D, De Matteis S, Lubin JH, Wacholder S, Tucker M, Pesatori AC, et al. Lung cancer and occupation in a population-based case-control study. Am J Epidemiol. 2010;171(3):323-33. doi: https://doi.org/10.1093/aje/kwp391 https://doi.org/10.1093/aje/kwp391...	Lung Cancer and Occupation in a Population-based Case-Control Study	To examine the relationship between the occupation type and lung cancer. Case-control study N: 4,220	IV	Only occupations were defined	Excessive risks were found in metal workers, barbers and hairdressers, and vehicle drivers. Exposure to occupational carcinogens is a determining factor in lung cancer occurrence.
Bugge MD, Kjærheim K, Foreland S, Eduard W, Kjuus H. 2012, Norway2929. Bugge MD, Kjrheim K, Freland S, Eduard W, Kjuus H. Lung cancer incidence among Norwegian silicon carbide industry workers: associations with particulate exposure factors. Occup Environ Med. 2012;69(8):527-33. doi: https://doi.org/10.1136/oemed-2011-100623 https://doi.org/10.1136/oemed-2011-10062...	Lung cancer incidence among Norwegian silicon carbide industry workers: associations with particulate exposure factors	To examine the relationship between exposure to silicon carbide (SiC) and lung cancer in workers from a Norwegian SiC industry. Cohort study N: 1,687	IV	Silicon carbide (SiC)	2 to 3 times higher risk for lung cancer associated with a higher level of cumulative exposure to SiC particles and fibers among workers in the SiC industry compared to the general male population.
Yano E, Wang X, Wang M, Qiu H, Wang Z. 2010, China3030. Yano E, Wang X, Wang M, Qiu H, Wang Z. Lung cancer mortality from exposure to chrysotile asbestos and smoking: a case-control study within a cohort in China. Occup Environ Med. 2010;67(12):867-71. doi: https://doi.org/10.1136/oem.2009.051615 https://doi.org/10.1136/oem.2009.051615...	Lung cancer mortality from exposure to chrysotile asbestos and smoking: a case-control study within a cohort in China	To analyze the association between the exposure to chrysotile asbestos and the risk for lung cancer and demonstrate the combined effect of smoking and the exposure to this substance. Case-control study. N: 1,139	IV	Asbestos	The risk for lung cancer in the group with high exposure to asbestos was 3 times higher than in the reference group. There was a strong association between exposure to chrysotile asbestos and the risk for lung cancer and, increased risk in the interaction with smoking.
Consonni D, De Matteis S, Pesatori AC, Bertazzi PA, Olsson AC, Kromhout H, et al. 2015, Multicentric 3131. Consonni D, De Matteis S, Pesatori AC, Bertazzi PA, Olsson AC, Kromhout H, et al. Lung cancer risk among bricklayers in a pooled analysis of case-control studies. Int J Cancer. 2015;136(2):360-71. doi: https://doi.org/10.1002/ijc.28986 https://doi.org/10.1002/ijc.28986...	Lung cancer risk among bricklayers in a pooled analysis of case-control studies	To examine the risk for lung cancer among construction workers and the joint effects of occupational carcinogens. Case-control study. N: 34,139	IV	Silica	There was an increased risk for lung cancer adjusted to smoking for bricklayers and a positive association with working time. The association was greater in the exposure to crystalline silica.
Brenner DR, Hung RJ, Tsao MS, Shepherd FA, Johnston MR, Narod S, et al. 2010, Canada3232. Brenner DR, Hung RJ, Tsao MS, Shepherd FA, Johnston MR, Narod S, et al. Lung cancer risk in never-smokers: A population-based case-control study of epidemiologic risk factors. BMC Cancer. 2010;10:285. Available from: https://doi.org/10.1186/1471-2407-10-285 https://doi.org/10.1186/1471-2407-10-285...	Lung cancer risk in never-smokers: a population-based case-control study of epidemiologic risk factors	To evaluate potential risk factors for lung cancer. Case-control study. N: 948	IV	Smoking 459. Solvents and paints, Solder Soot or exhaustion	Association of increased risk for lung cancer in non-smokers exposed to occupational carcinogens, family history of cancer with recent onset and past history of respiratory diseases.
Ghanei M, Harandi AA. 2011, USA3333. Ghanei M, Harandi AA. Lung carcinogenicity of sulfur mustard. Clin Lung Cancer. 2010;11(1):13-7. doi: https://doi.org/10.3816/CLC.2010.n.002 https://doi.org/10.3816/CLC.2010.n.002...	Lung Carcinogenicity of Sulfur Mustard	To review all published documents on the mustard lung carcinogenicity after chronic exposure. Review, descriptive.	VI	Mustard gas	Mustard gas has been shown to cause lung cancer after chronic (long-term) exposure. It was not possible to conclude whether the single exposure to high doses of the gas causes lung cancer.
Wang X, Lin S, Yu IT, Tse L, et al. 2011, China3434. Wang X, Lin S, Yano E, Qiu H, Yu ITS, Tse L, et al. Mortality in a Chinese chrysotile miner cohort. Int Arch Occup Environ Health. 2012;85(4):405-12. doi: https://doi.org/10.1007/s00420-011-0685-9 https://doi.org/10.1007/s00420-011-0685-...	Mortality in a Chinese chrysotile miner cohort	To evaluate the association between exposure to asbestos and mortality due to specific causes in workers at asbestos mine. Cohort study N: 1,539	IV	Asbestos	The most prominent death causes were lung cancer and non-malignant respiratory diseases in workers who were directly involved in chrysotile asbestos mining.
Poinen-Rughooputh S, Rughooputh MS, Guo Y, Rong Y, Chen W. 2016, China3535. Poinen-Rughooputh S, Rughooputh MS, Guo Y, Rong Y, Chen W. Occupational exposure to silica dust and risk of lung cancer: an updated meta-analysis of epidemiological studies. BMC Public Health. 2016;16:1137. doi: https://doi.org/10.1186/s12889-016-3791-5 https://doi.org/10.1186/s12889-016-3791-...	Occupational exposure to silica dust and risk of lung cancer: an updated meta-analysis of epidemiological studies	To review the epidemiological evidences on the relationship between occupational exposure to silica and the risk for lung cancer. Systematic review and Meta-analysis.	V	Silica	Association between crystalline silica and lung cancer and an exposure-response relationship between them, with a high degree of heterogeneity. The risk is greater in the presence of silicosis and in the mining industry.
Chang CJ, Tu YK, Chen PC, Yang HY. 2017, China3636. Chang CJ, Tu YK, Chen PC, Yang HY. Occupational exposure to talc increases the risk of lung cancer: a meta-analysis of occupational cohort studies. Can Respir J. 2017:1270608. doi: https://doi.org/10.1155/2017/1270608 https://doi.org/10.1155/2017/1270608...	Occupational Exposure to Talc Increases the Risk of Lung Cancer: A Meta-Analysis of Occupational Cohort Studies	To evaluate how occupational exposure to inhaled talc affects the risk for lung cancer. Systematic Review and Meta-analysis.	V	Talc	Positive association between exposure to talc and lung cancer.
Ferrante D, Mirabelli D, Tunesi S, Terracini B, Magnani C. 2016, Italy3737. Ferrante D, Mirabelli D, Tunesi S, Terracini B, Magnani C. Pleural mesothelioma and occupational and non-occupational asbestos exposure: A case-control study with quantitative risk assessment. Occup Environ Med. 2016;73(3):147-53. doi: https://doi.org/10.1136/oemed-2015-102803 https://doi.org/10.1136/oemed-2015-10280...	Pleural mesothelioma and occupational and non-occupational asbestos exposure: a case-control study with quantitative risk assessment	To quantify the association between pleural malignant mesothelioma and cumulative exposure to asbestos. Case-control study. N: 548	IV	Asbestos	Relationship between the incidence of pleural malignant mesothelioma and cumulative exposure to asbestos, even at low exposure levels.
Swiatkowska B, Szubert Z, Sobala W, Szeszenia-Dąbrowska N. 2015, Poland3838. Swiatkowska B, Szubert Z, Sobala W, Szeszenia-Dabrowska N. Predictors of lung cancer among former asbestos-exposed workers. Lung Cancer. 2015;89(3):243-8. doi: https://doi.org/10.1016/j.lungcan.2015.06.013 https://doi.org/10.1016/j.lungcan.2015.0...	Predictors of lung cancer among former asbestos-exposed workers	To evaluate the influence of smoking and factors related to occupational exposure on the risk of lung cancer incidence in workers exposed to asbestos. Case-control study. N: 7,374	IV	Asbestos	The risk for lung cancer is associated with exposure to asbestos and increases with cumulative exposure. The risk continued to increase until 30 years after the end of asbestos exposure.
Clin B, Andujar P, AbdAl Samad I, Azpitarte C, Billon-Galland MA, et al. 2012, France3939. Clin B, Andujar P, Abd Al Samad I, Azpitarte C, Le Pimpec-Barthes F, Billon-Galland MA, et al. Pulmonary carcinoid tumors and asbestos exposure. Ann Occup Hyg. 2012;56(7):789-95. doi: https://doi.org/10.1093/annhyg/mes017 https://doi.org/10.1093/annhyg/mes017...	Pulmonary carcinoid tumors and asbestos exposure	To analyze the relationship between exposure to asbestos and pulmonary carcinoid tumors. Retrospective, case-control. N: 84	IV	Asbestos	There is a relationship between occupational exposure to asbestos and certain lung carcinoid tumors. Cumulative exposure to asbestos was greater in cases with a carcinoid tumor and older than 40 years than in the controls.
Zurbriggen R, Capone L. 2013, Argentina4040. Zurbriggen R, Capone L. Enfermedad pulmonar por amianto en trabajadores de acería. Medicina (Buenos Aires). 2013 [citado 2019 mai 20];73(3):224-30. Disponible en: http://www.medicinabuenosaires.com/PMID/23732197.pdf http://www.medicinabuenosaires.com/PMID/...	Enfermedad pulmonar por amianto en trabajadores de acería	To describe the general, clinical, and radiological characteristics of patients exposed to chrysotile asbestos in the steel industry. Descriptive study N: 27	VI	Asbestos	Steel kiln workers had a high degree of exposure to chrysotile asbestos, in its use as insulation. Presence of benign pleural lesions and asbestosis, and 18.5% with mesothelioma and lung cancer.
Sogl M, Taeger D, Pallapies D, Bruning T, Dufey F, Schnelzer M, et al. 2012, Germany4141. Sogl M, Taeger D, Pallapies D, Brüning T, Dufey F, Schnelzer M, et al. Quantitative relationship between silica exposure and lung cancer mortality in German uranium miners, 1946-2003. Br J Cancer. 2012;107(7):1188-94. doi: https://doi.org/10.1038/bjc.2012.374 https://doi.org/10.1038/bjc.2012.374...	Quantitative relationship between silica exposure and lung cancer mortality in German uranium miners, 1946-2003	To investigate the exposure-response relationship between crystalline silica exposure and lung cancer mortality and the combined effect of silica and radon. Cohort study N: 58,987	IV	Silica	High risk for lung cancer in accumulated silica exposures. The findings support the IARC's assessment to classify silica as a carcinogen for lung cancer in humans.
Tse LA, Yu IT, Au JSK, Qiu H, Wang X. 2011, China4242. Tse LA, Yu IS, Au JSK, Qiu H, Wang XR. Silica dust, diesel exhaust, and painting work are the significant occupational risk factors for lung cancer in nonsmoking Chinese men. Br J Cancer. 2011;104(1):208-13. doi: https://doi.org/10.1038/sj.bjc.6606006 https://doi.org/10.1038/sj.bjc.6606006...	Silica dust, diesel exhaust, and painting work are the significant occupational risk factors for lung cancer in nonsmoking Chinese men	To explore the associations between occupational exposures and lung cancer in non-smoking men throughout their lives. Case-control study. N: 668	IV	Silica Diesel engine exhaust Spray paint	Construction workers and those who had already been occupationally exposed to silica dust, diesel exhaust and spray paint were associated with an increased risk for lung cancer, regardless of smoking.
Steenland K, Ward E. 2014, USA4343. Steenland K, Ward E. Silica: a lung carcinogen. CA Cancer J Clin. 2014;64(1):63-9. doi: http://doi.org/10.3322/caac.21214 http://doi.org/10.3322/caac.21214...	Silica: A Lung Carcinogen	To highlight the effects of silica on health and the prevention of disease and death from exposure to silica at work. Review, descriptive.	VI	Silica	Exposure to silica increases the risk for lung cancer. Compared to smoking or asbestos, the risk for lung cancer is lower, making it more difficult to differentiate the contributions of exposure to silica, silicosis and smoking to cancer.
Silverman DT, Samanic CM, Lubin JH, Blair AE, Stewart PA, Vermeulen R, et al. 2012, Canada4444. Silverman DT, Samanic CM, Lubin JH, Blair AE, Stewart PA, Vermeulen R, et al. The diesel exhaust in miners study: a nested case-control study of lung cancer and diesel exhaust. J Natl Cancer Inst. 2012;104(11):855-68. doi: https://doi.org/10.1093/jnci/djs034 https://doi.org/10.1093/jnci/djs034...	The Diesel Exhaust in Miners Study: A Nested Case - Control Study of Lung Cancer and Diesel Exhaust	To evaluate the relationship between quantitative estimates of diesel exhaust exposure and lung cancer mortality. Case-control study N: 864	IV	Diesel engine exhaust	The results provide evidence that exposure to diesel can cause lung cancer in humans and represent a potential public health burden.
Järvholm B, Åstrom E. 2014, Sweden4545. Järvholm B, Åstrom E. The risk of lung cancer after cessation of asbestos exposure in construction workers using pleural malignant mesothelioma as a marker of exposure. J Occup Environ Med. 2014;56(12):1297-301. doi: https://doi.org/10.1097/JOM.0000000000000258 https://doi.org/10.1097/JOM.000000000000...	The Risk of Lung Cancer After Cessation of Asbestos Exposure in Construction Workers Using Pleural Malignant Mesothelioma as a Marker of Exposure	To investigate the risk for lung cancer after ending the asbestos exposure and compare the risk for lung cancer in construction workers exposed to asbestos before and after the exposure. Cohort study N: 189,896	IV	Asbestos	The risk for lung cancer was similar among workers with high and low exposure 20 years after the last exposure. The same is not true for the risk for mesothelioma, which is greater 20 years after the last exposure.
De Matteis S, Conssoni D, Lubin JH, Tucker M, Peters S, Vermeulen RCh, et al. 2012, Italy4646. De Matteis S, Conssoni D, Lubin JH, Tucker M, Peters S, Vermeulen RCh, et al. Impact of occupational carcinogens on lung cancer risk in on general population. Int J Epidemiol. 2012; 41(3):711-21. doi: https://doi.org/10.1093/ije/dys042 https://doi.org/10.1093/ije/dys042...	Impact of occupational carcinogens on lung cancer risk in on general population	To quantify lung cancer burden attributable to occupational carcinogens in a general population. Case-control study N: 4,220	IV	Asbestos Silica Nickel-chromium	Men showed an increased lung cancer risk even at low exposure to carcinogens The risk is great to asbestos (OR: 1.76; IC 95%). The risk increased with exposure level.

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[1] Corresponding author:
Christiane Brey e-mail: christianebrey@gmail.com