Of the construction trades, carpenters have high risk for mesothelioma. Most carpenters today may still not be aware that the products they used historically contained asbestos. these products included joint compound, transite, caulking compound, ceilings, counter tops and fire doors.
The following is a reprint form a study performed by Doctor Dement that appeared in the New England Journal of medicine concerning the risk of mesothelioma in New jersey carpenters.
JOEM • Volume 45, Number 10, October 2003 1059
cohort is prohibitively large. Studies
of cancer morbidity using casecontrol
study designs with cases
identified from clinical records or
cancer registries have been most useful
in elucidating the risk of sinonasal
cancers among carpenters and
other wood dust-exposed workers.
For example, nasopharyngeal cancer
was significantly elevated (PCIR
227; P 0.05) among construction
workers, including carpenters, in a
study that used incidence data from
the New Jersey State Cancer Registry.
18
The purpose of this study was to
estimate the risk of all cancers and
site-specific cancers among members
of United Brotherhood of Carpenters
and Joiners of America
(UBC) in New Jersey by individually
matching them with New Jersey
State Cancer Registry (NJSCR) data.
Cancer registry data are valuable for
providing information about incident
cases of cancer; however, no information
is available through the Registry
with regard to occupation or
workplace exposures. By combining
these data sets, we sought to examine
the incidence of various cancers, especially
those with low fatality rates
that may not have been detected in
previous mortality studies, among a
large cohort of carpenters within the
same geographical region. We calculated
standardized incidence ratios
(SIRs) for various cancers using national
incidence rates provided by
the Surveillance, Epidemiology and
End Results (SEER) program. The
SEER program of the National Cancer
Institute collects information
about persons diagnosed with incident
cases of cancer from 11 population-
based cancer registries, covering
approximately 14% of the US
population, and is considered the
gold standard for providing national
estimates of cancer incidence.
Materials and Methods
The current analyses of cancer incidence
among carpenters were undertaken
as part of an ongoing communication
intervention trial to
increase colorectal cancer screening
among potentially higher-risk bluecollar
workers funded by the National
Cancer Institute. This study is
being conducted in collaboration
with the New Jersey Carpenters
Health Fund. The New Jersey Carpenters
Fund provides and administers
health and welfare benefits for
UBC members in New Jersey.
The initial data file used to define
the cancer incidence study cohort
consisted of 15,375 male UBC members
in New Jersey who had participated
in the New Jersey Carpenters
Fund at some time prior to July 1,
2000. This cohort was matched to the
New Jersey Carpenters Pension Fund
to define starting and ending dates of
UBC membership (month and year),
pension fund contributions by year,
and state and date of last known
address for retired UBC members.
The cohort was further restricted to
13,354 workers with some period of
TABLE 1
Previous Epidemiologic Studies of Cancer Mortality Among Carpenters and Construction Laborers
All Cancers
Bronchus and
Lung
Pleura/
Other Parts
of Respiratory
System Rectum Stomach
Author Year (n) n RR n RR n RR n RR n RR
Hall et al* 1991 (10,824) – – 152 1.24a 17 3.06a – – 13 1.72b
Hrubec et al† 1992 (248,046) 383 0.9 79 1.0 – – 18 1.2 32 1.60c
Milham‡ 1974 (16,443) 3,629 0.97 1,218 1.06b 6 1.33 110 0.85 218 1.07
Milham§ 1983 (16,843) 2,974 1.04b 261 1.18a 2 0.69 NS NS 285 1.20a
Registrar 1986 (3,771) 3,771 1.05a – – 47 3.61a – – – –
Robinson et al¶ 1995 (61,682) 3,731 1.02 1,489 1.16a 14 1.63 – – – –
Robinson et al** 1996 (26,435) 7,337 1.15a 2,648 1.23a 27 3.01a – – 252 1.30a
Stern et al†† 1995 (11,685) 3,285 1.00 1,208 1.06b 12 1.13 62 1.20 170 1.44a
Dement et al# 2001 (43,180) 2,140 1.00 914 1.17b 8 1.15 26 0.88 55 1.06
a P 0.01; b P 0.05; c P 0.10; NS not significant, specific ratio not reported.
SMR, standardized mortality ratio; PMR, proportionate mortality ratio, PCMR, proportionate cancer mortality ratio; PCIR, proportionate
cancer incidence ratio.
* PCIR cancer cases among construction workers in New Jersey (white males only included in this table) 1979–1984. Expected deaths
based on New Jersey cancer rates.
† SMR deaths among US veterans by occupation-known smoking status 1954–1980. Expected deaths based on US death rates.
‡ SMR death claims among carpenter union members 1969–1970. Expected deaths based on U.S. rates for 1968.
§ PMR death certificates among carpenters in Washington State 1950–1979. Expected deaths based on WA mortality.
PMR death certificates among carpenters 1979–1983. Expected deaths based on England and Wales population mortality.
¶ PMR death certificates among carpenters from 19 U.S. 1984–1986. Expected deaths based on US death rates.
** PMR deaths among white, male carpenter union members from 1987–1990. Expected deaths based on US death rates.
†† PMR deaths among construction workers in the LIUNA, 1985–1988. Expected deaths based on US death rates.
# PMR deaths among NC construction workers, 1988–1997. Expected deaths based on NC death rates.
1060 Cancer Incidence Among Carpenters • Dement et al
active UBC work after January 1,
1979, the starting date for the
NJSCR.
The UBC study cohort of 13,354
carpenters was matched to the
NJSCR through December 31, 2000
using worker social security number
as the primary matching criteria followed
by last name, date of birth,
and gender. The NJSCR is a population-
based incidence registry and includes
all cancer cases diagnosed
among New Jersey residents since
October 1, 1978. New Jersey regulations
require reporting of all newly
diagnosed cancer cases to the
NJSCR within 3 months of hospital
discharge or 6 months of diagnosis,
whichever occurs first. All primary
malignant and in situ neoplasms are
reportable, except for certain carcinomas
of the skin (ICD-9 Code 173).
The NJSCR collects demographic
data on each cancer patient (social
security number, gender, race, date
of birth) as well as information on
each cancer (diagnosis date, anatomic
site, histology, behavior, and
summary stage). Annual follow-up
status (alive/dead), dates of death,
and underlying cause of death are
recorded for each reported cancer
case. Using data on primary cancer
site (ICD-O-2), histology, and behavior,
an ICD-9 code was assigned
to each reported cancer using the
software program IARCtools (Version
2.01) developed by the International
Agency for Research on Cancer.
19
The PC version of Life Table
Analysis System (LTAS) (LTAS
Version 1.0 days) developed by the
National Institute for Occupational
Safety and Health was used to calculate
SIRs of all cancers and sitespecific
cancers.20,21 The LTAS
stratified person-years at risk
(PYAR) for each worker into strata
by 5-year age groups, 5-year calendar
time periods, length of UBC
membership, and time since initial
UBC membership. The PYAR for
each worker began accumulating on
January 1, 1979 or the date of first
participation in the pension fund,
which ever occurred later. The
PYAR for each worker was stopped
on the last date of New Jersey union
pension fund contribution or last date
of known residence in New Jersey
for retired workers. Workers were
assumed to have been a resident of
New Jersey and therefore subject to
cancer reporting requirements for
each year in which contributions
were made to the New Jersey pension
fund. Only cancer cases occurring
within the periods of PYAR
accumulation were used for the SIR
analyses. PYAR in each age and
calendar time strata were multiplied
by corresponding cancer incidence
rates from the SEER Program of the
National Cancer Institute to calculate
expected malignant neoplasms by
site. Although race data were not
available for the entire cohort, race
data were available for cancer cases
reported to NJSCR and for workers
participating in the colorectal cancer
risk communication intervention
study. Among 1236 workers with
cancers reported to the NJSCR,
97.4% were white; therefore, SEER
incidence rates for white males were
used for all analyses.
SIRs by cancer site were calculated
as the ratio of observed to
expected cases. To account for occupational
cancer induction periods,
additional analyses were undertaken
which lagged duration of carpenter
union work by 15 years. These analyses
discounted person-years and
cancer cases prior to 15 years since
initiation of work in the carpenter
union.22,23 The 95% confidence interval
(CI) was computed for each
site-specific SIR using the Byar approximation
when the number of
cases was five or more or the Fisher’s
exact method when the number
of cases was fewer than five.24
For selected cancer sites, trends in
risk by duration of carpenter union
work were further investigated by
calculation of directly standardized
rate ratios (SRR) using procedures
provided by the National Institute for
Occupational Safety and Health
LTAS. The LTAS calculates the
SRR as a ratio of weighted rates in
which the weight for each stratumspecific
weight is the combined person-
years for the observed cohort
across a duration of union work categories.
In these analyses, the lowest
duration of carpenter work strata
(10 years) was used as the referent
group for comparison with higher
duration of work strata. Taylor series
approximation procedures were used
to calculate 95% confidence intervals
for each SRR and tests for linear
trend in the SRR with duration of
carpenter union work were preformed
using procedures described
by Rothman.23
Results
A total of 162,520 PYARs were
contributed by the 13,354 union carpenters
included in this study and
approximately 97% of the PYARs
occurred among workers less than 65
years of age. Overall SIR analyses,
as well as analyses by cancer site, are
given in Table 2. Union carpenters
were found to have an overall cancer
incidence approximately equal to the
United States (SIR 1.07; 95%
CI 0.99–1.16); however, the distribution
of cancers by site demonstrated
interesting patterns. Cancers
of the digestive organs and peritoneum
were significantly higher than
expected (SIR 1.24; 95% CI
1.04–1.47). Cancers of all sites of
the digestive system except the peritoneum
were in excess of expected;
however, only rectal cancer was significantly
higher than expected
(SIR 1.51; 95% CI 1.05–2.10).
Significant excess risk was observed
for all cancers of the respiratory system
(SIR 1.52; 95% CI 1.29–
1.76). Cancers of the trachea, bronchus,
and lung were significantly in
excess (SIR 1.45; 95% CI
1.22–1.72) as well as cancers of
other parts of the respiratory system
(SIR 4.19; 95% CI 2.35–6.92).
In these overall analyses, the only
statistically significant deficit observed
was for skin melanoma
(SIR 0.43; 95% CI 0.23–0.72).
JOEM • Volume 45, Number 10, October 2003 1061
Analyses by age demonstrated that
most excess cancer risk occurred
among workers over 50 years of age
as shown in Table 3. The SIR for all
cancer was significantly reduced for
workers less than 50 years of age
(SIR 0.60, P 0.05); however,
excess cancer was seen among workers
over the age of 50 (SIR 1.18,
P 0.05). This pattern with age is
consistent with the “healthy worker
effort” observed in many mortality
studies of occupational cohorts.22
Significant excess cancer incidence
(P 0.05) was observed for all
cancers of the digestive organs and
peritoneum (SIR 1.33), rectum
(SIR 1.62), lung (SIR 1.59),
and other parts of the respiratory
system (SIR 4.88) among workers
older than 50 years. Cancers of the
intestine except rectum were excess
among older workers (SIR 1.22),
although the excess was not statistically
significant.
To account for occupational cancer
induction periods, additional
analyses discounted (lagged) personyears
and cancer cases prior to 15
years since initiation of work in the
carpenter union. Table 4 presents
results for cancer sites with significant
excess or deficits in the lagged
TABLE 2
Overall Cancer Incidence, New Jersey Carpenters 1979–2000
Cancer Site
ICD-9
Codes Obs Exp SIR 95% CI
All malignant (Mn) neoplasms 140–208.9 592 551.67 1.07 0.99–1.16
Buccal cavity and pharynx 140–149 24 25.27 0.95 0.61–1.41
Mn of lip 140–140.9 3 3.70 0.81 0.17–2.37
Mn of tongue 141–141.9 5 5.56 0.90 0.29–2.10
Mn of other parts of buccal cavity 142–145.9 5 7.91 0.63 0.20–1.48
Mn of pharynx 146–149.9 11 8.11 1.36 0.67–2.42
Digestive organs and peritoneum 150–159 130 104.84 1.24 1.04–1.47
Mn of esophagus 150–150.9 8 7.23 1.11 0.48–2.18
Mn of stomach 151–151.9 12 11.74 1.02 0.53–1.79
Mn of intestine except rectum 152–153.9 49 42.04 1.17 0.86–1.54
Mn of rectum 154–154.9 35 23.21 1.51 1.05–2.10
Mn of biliary passages, liver, and gallbladder 155–155.1
156–156.9 12 7.31 1.64 0.85–2.87
Mn of liver not specified as primary/secondary 155.2 0 0.00 – –
Mn of pancreas 157–157.9 14 11.97 1.17 0.64–1.96
Mn of peritoneum and other and unspecified of
digestive organs
158–159.9 0 1.34 0.00 –
Respiratory system 160–165 166 109.53 1.52 1.29–1.76
Mn of larynx 161–161.9 14 11.59 1.21 0.66–2.03
Mn of trachea, bronchus, and lung 162–162.9 137 94.37 1.45 1.22–1.72
160–160.9
Mn of other parts of respiratory system 163–165.9 15 3.58 4.19 2.35–6.92
Male genital organs 185–187 123 122.40 1.00 0.84–1.20
Mn of prostate 185–185.9 104 107.66 0.97 0.79–1.17
Mn of testes 186–186.9 19 14.74 1.29 0.78–2.01
Urinary organs 188–189 45 53.90 0.83 0.61–1.12
Mn of kidney 189.0–189.2 16 18.64 0.86 0.49–1.39
Mn of bladder and other urinary organs 188.0–188.9
189.3–189.9 29 35.27 0.82 0.55–1.18
Other and unspecified sites Mixed 57 92.89 0.61 0.46–0.80
Mn of skin melanoma 172–172.9 14 32.84 0.43 0.23–0.72
Mn of eye 190–190.9 0 1.37 – –
Mn of brain and other parts of nervous system 191–192.9 14 12.78 1.10 0.60–1.84
Mn of thyroid gland 193–193.9 6 6.36 0.94 0.34–2.05
Mn of bone 170–170.9 1 1.61 0.62 0.02–3.46
Mn of connective tissue 171–171.9 2 4.37 0.46 0.06–1.65
Mn of other and unspecified sites 187–187.9
194–199.9 20 14.46 1.38 0.84–2.13
Neoplasms of lymphatic and haematopoietic tissues
200–208 46 60.74 0.76 0.55–1.01
Non-Hodgkins lymphoma 200–200.9
202–202.9 19 32.18 0.59 0.36–0.92
Hodgkin’s disease 201–201.9 6 7.01 0.86 0.31–1.86
Leukemia and aleukemia 204–208.9 12 15.48 0.78 0.40–1.35
Myeloma 203–203.9 9 6.08 1.48 0.68–2.81
1062 Cancer Incidence Among Carpenters • Dement et al
analyses. These analyses demonstrated
the same patterns of excess
cancer risk as the overall analyses,
although the SIR values were somewhat
higher. In the lagged analyses,
malignant neoplasms of the testes
was significantly elevated (SIR
2.48, 95% CI 1.29–3.32) and melanoma
of the skin was significantly
deficit (SIR 0.46, 95% CI
0.24–0.79).
Duration of carpenter union work
was used as a surrogate of occupational
exposures among these workers.
Trends in the risk of cancer were
analyzed by examination of the SIR
values by 10-year strata of carpenter
work in the 15-year lagged analyses
(Table 5). Prior to 10 years of carpenter
union work, only cancers of
other parts of the respiratory system
(SIR 4.22, P 0.05) and testes
(SIR 2.58, P 0.05) were significantly
elevated. However, all other
sites that were shown to be in excess
in the lagged analyses demonstrated
increasing trends in the SIR with
duration of carpenter work, with the
highest SIR values for carpenters
having worked in the union for more
than 30 years. In the strata greater
than 30 years, the SIR for all cancers
was 3.34 (P 0.05) with very large
excesses being observed for all cancers
of the digestive organs and peritoneum
(SIR 3.98, P 0.05),
rectum (SIR 4.85, P 0.05), lung
(SIR 4.56, P 0.05), and other
parts of the respiratory system
(SIR 11.00, P 0.05).
Trends in the risk of selected cancers
were further examined in the
analyses using directly standardized
rate ratios (SRR) and these results
are shown in Table 6. Tests for linear
trends in the SRR with duration of
carpenter union work were significant
(P 0.05) for all cancers of the
digestive organs and peritoneum,
lung, and other parts of the respiratory
system. The SRRs for cancers of
the intestine except rectum increased
with work duration although the
trend was not statistically significant.
Although not shown in Table 6,
SRRs were calculated for cancers of
the rectum; however, the observed
patterns of risk were not stable as a
result of only one observed cancer in
the reference strata (1 observed and
3.1 expected). It should be noted that
all trends except cancers of other
parts of the respiratory system were
positive. The negative trend for cancers
of other parts of the respiratory
system is largely because of the significant
excess for cancers at these
sites observed for workers with less
than 10 years of union work (see
Table 5). As previously discussed,
cancers in this category are largely
pleural cancers (including mesotheli-
TABLE 3
Cancer Incidence by Age Group for Selected Cancer Sites, New Jersey Carpenters 1979–2000
Standardized Incidence Ratios
Age
Group
(Years)
Digestive
Organs and
Peritoneum
Intestine
Except
Rectum Rectum
Trachea,
Bronchus,
and Lung
Other
Respiratory
System Areas All Cancers
50 0.82 0.88 1.00 0.45* 2.68 0.60*
50 1.33* 1.22 1.62* 1.59* 4.88* 1.18*
Overall 1.24* 1.17 1.51* 1.46* 4.21* 1.07
* P 0.05.
TABLE 4
Cancer Incidence for Selected Sites 15-Year Lag from Initial Date of Carpenter Union Work, New Jersey Carpenters, 1979–
2000
Cancer Site
ICD-9
Codes Obs Exp SIR 95% CI
All malignant (Mn) neoplasms 140–208 485 404.90 1.20 1.10–1.31
Digestive organs and peritoneum 150–159 110 80.74 1.36 1.16–1.60
Mn of intestine except rectum 152–153.9 42 32.52 1.29 0.98–1.67
Mn of rectum 154–154.9 28 17.84 1.57 1.12–2.15
Respiratory system 160–165 146 86.34 1.69 1.47–1.94
Mn of trachea, bronchus, and lung 162–162.9 127 74.88 1.70 1.46–1.97
Mn of other parts of respiratory system 160–160.9
163–165.9 11 2.45 4.47 2.50–7.39
Male genital organs 185–187 100 94.37 1.06 0.89–1.25
Mn of Testes 186–186.9 9 3.63 2.48 1.29–4.32
Other and unspecified sites Mixed 42 45.47 0.92 0.66–1.24
Mn of skin melanoma 172–172.9 9 19.69 0.46 0.24–0.79
Mn of other and unspecified sites 187–187.9
194–199.9 17 10.76 1.58 1.01–2.37
JOEM • Volume 45, Number 10, October 2003 1063
oma) with asbestos exposures being
the most likely risk factor. Numerous
studies have shown mesothelioma to
be increased among workers with
low cumulative exposures.25
The distribution of cancers in several
categories was further investigated
to determine the most prominent
sub-site. Within the category of
“cancers of the intestine except rectum”
(ICD-9 codes 152–153.9), 44
of 49 cancers were in the colon
(ICD-9 codes 153–153.9). In the category
cancers of ‘other parts of the
respiratory system’ (ICD-9 codes
160–160.9 and 163–165.9), 11 of 15
cancers were of the pleura (ICD-9
codes 163– 163.9), and 2 of 15 were
of the nasal cavity (160.0).
Discussion
Our analyses used SEER cancer
rates for the US population to calculate
expected cancers by site among
the carpenter cohort. We chose to use
SEER rates as opposed to rates for
only New Jersey because of their
general acceptance and stability of
rates when stratified by age, race,
sex, and calendar time. However,
cancer incidence rates vary with geographic
location, and this could have
some impact on our results and interpretations.
Analyses of New Jersey
cancer incidence for 1994
through 1998 compared with SEER
data for white males have shown
New Jersey age-adjusted total cancer
incidence rates (cases per 100,000)
to be approximately 10% higher than
the US (505.3 vs. 457.7). During this
same time period, rates for colorectal
cancer in New Jersey also were
shown to be higher than the US (62.7
vs. 53.6); however, lung cancer rates
where slightly lower than US rates
(77.2 vs. 78.0).26 Based on these
data, our analyses may have slightly
overestimated the risk for all cancer
sites combined and for colorectal
cancers and slightly underestimated
the risk of lung cancer among New
Jersey carpenters. However, the differences
in New Jersey and SEER
rates are not sufficient to explain the
large and statistically significant excesses
observed for all cancers
(SIR 3.34), digestive system cancers
(SIR 3.98), and lung cancers
(SIR 4.56) among workers in the
carpenter union for more than 30
years, after controlling for a minimum
cancer latency of 15 years.
These data suggest occupational exposures
as contributing factors for
risks at these cancer sites.
The excess risk for cancers of the
trachea, bronchus and lung that we
observed is consistent with findings
from prior mortality studies, as well
as hospital and community-based
case control studies. Elevated lung
cancer mortality risk estimates ranging
from 1.1 to 1.2 among carpenters
and related crafts have been observed,
4–7,10,11 in addition to elevated
odds ratios (OR 1.1– 1.8)
when exposure to employment as a
carpenter or construction worker and
lung cancer have been examined.
27–30 Exposures to asbestos, sil-
TABLE 5
Cancer Incidence for Selected Cancer Sites by Duration of Carpenter Union Work 15 Year Lag from Initial Date of
Carpenter Union Work, New Jersey Carpenters, 1979–2000
Standardized Incidence Ratios
Years of
Union
Work
Digestive
Organs and
Peritoneum
Intestine
Except
Rectum Rectum
Trachea,
Bronchus,
and Lung
Other
Respiratory
System Areas Testes All Cancers
0–10 0.88 0.89 1.25 1.01 4.22* 2.58* 0.83*
11–20 1.51* 1.62* 1.58 1.82* 1.08 2.57 1.15
21–30 1.39 1.06 1.54 2.03* 10.02* – 1.40*
30 3.98* 2.73 4.85* 4.56* 11.00* – 3.34*
Overall 1.36* 1.29 1.57* 1.70* 4.47* 2.48* 1.20*
* P 0.05.
TABLE 6
Directly Standardized Rate Ratios by Duration of Carpenter Union Work, New Jersey Carpenters, 1979–2000
Standardized Rate Ratio (95% Confidence Interval)
Years of Union
Work
Digestive
Organs and
Peritoneum
Intestine
Except Rectum
Trachea,
Bronchus,
and Lung
Other
Respiratory
System Areas
0–10 1.0 1.0 1.0 1.0
11–20 2.7 (1.0–7.7) 0.7 (0.2–3.0) 2.7 (0.9–7.8) 1.3 (0.2–9.2)
21–30 3.5 (1.3–9.3) 1.8 (0.6–4.9) 2.8 (1.0–8.1) 0.9 (0.2–4.0)
30 3.8 (1.5–10.0) 1.6 (0.5–4.7) 4.5 (1.7–12.4) 0.7 (0.2–2.7)
Rothman Trend Test P 0.05 P 0.05 P 0.05 P 0.05
1064 Cancer Incidence Among Carpenters • Dement et al
ica, and wood dust, which are common
among carpenters, have also
been associated with an elevated risk
for these cancers.31 An increasing
trend for cancers of the respiratory
system was observed, with carpenters
who were UBC members for at
least 30 years to be at greatest risk.
Duration of employment as a construction
worker was also explored
by Stern7 who noted an elevated risk
for lung cancer mortality for each
10-year period of union membership;
however this trend did not reach
statistical significance, which was
observed in our study. Higher-thanexpected
numbers of cases were
noted for other respiratory cancers,
which consisted mostly of cancers of
the pleura. The large excess observed
for pleural cancers is largely explained
by occupational exposures to
asbestos, known to occur among carpenters.
32
An increase in rectal cancer and
intestinal cancer contributed to the
overall increase in the incidence of
cancers of the digestive tract;
whereas no increased risk of stomach
cancer occurred. Some studies have
noted an excess in morality due to
stomach cancer with risk estimates
ranging from 1.2 to 1.4,6,7,11 as well
as a case-control study that observed
an elevated odds ratio (OR 1.7,
95% CI 1.0–2.7) for stomach
cancer among workers exposed to
wood dust for at least 15 years.33
Prior study findings with regard to
cancers of the colon and rectum have
been mixed, while some study findings
are difficult to use for comparison
because these cancers were combined
into a single category of
colorectal cancer in the analyses. Elevated
odds ratios of 9.4 (95% CI
2.0–44.7) for rectal cancer34 and 1.4
(95% CI 0.9–2.2) for colorectal
cancer33 were observed among
workers exposed to wood dust. However,
no increase in rectal cancer was
observed by Dumas et al.35 who
examined workers exposed to wood
dust for a minimum of 15 years.
Furthermore, employment as a carpenter
was not associated with an
increased risk of either colon or rectal
cancer in a case-control study
conducted by Arman et al.36
A new finding from this study
includes a higher than expected incidence
of testicular cancer when a
15-year latency period was considered.
This excess was seen only
among workers with less than 10
years of union membership. Testicular
cancer accounts for only 1% of all
cancers in men, but it is the most
common form of cancer in young
men ages 15 to 35 years.37 Of the 19
workers with testicular cancer in the
present study, 15 occurred among
workers less than 45 years of age.
The 5-year survival rate for testicular
cancer is 93%,12 which may explain
why previous mortality studies have
not observed an increased risk for
this cancer among carpenters or related
trades. Pollan et al.38 observed
an excess incidence of testicular cancer
(nonseminoma tumors only;
SIR 1.71, 95% CI 1.01–2.92)
among construction workers in Sweden;
however, these findings were
not noted in other studies that used
incidence data.18 The etiology of testicular
cancer is poorly understood
and only a few risk factors have been
identified, including cryptorchidism
(undescended testis), abnormal testicular
development, and
Klinefelter’s syndrome. Occupational
agents that have been explored
as possible risk factors include plastics,
pesticides, and solvents including
dimethylformamide (DMF),
which is commonly used in acrylic
fiber spinning, chemical manufacturing,
and pharmaceutical production.
39 Two small case studies observed
higher than expected cases of
testicular cancer among airframe repair
shop workers,40 and finishers in
a leather tannery41 who used DMF in
their jobs. The degree to which DMF
is used among carpenters and considered
as a possible risk factor for this
workgroup is not known.
We observed a lower-than-expected
incidence of melanoma
(SIR 0.46) among our cohort of
carpenters compared with national
data. After considering a 15-year lag
period, lower than expected cases
were also noted when we used New
Jersey State Cancer Registry data for
comparison, but these findings were
not statistically significant (SIR
0.65, 95% CI 0.30–1.23). Although
carpenters may be exposed to
sunlight while at work, the pattern of
exposure may reflect lower than expected
risk estimates for melanoma.
Intermittent high intensity exposure
to sunlight, especially that results in
sunburn has been associated with
melanoma; whereas, chronic low
dose exposure, which may be the
more typical type of occupational
exposure among carpenters, has been
associated more with nonmelanoma
skin cancer including basal cell and
squamous cell carcinomas.42
Cigarette smoking is an established
cause of lung cancer and has
been positively associated with cancers
at numerous other sites including
the stomach,43 rectum,44and colon.
45,46 Other lifestyle factors such
as alcohol use and high dietary fat
intake have also been implicated as
possible risk factors for these cancers.
45,47,48 Unfortunately, information
about these lifestyle factors
among our cohort of carpenters was
not available and therefore were not
considered as possible confounders
in the analyses.
Workers in the construction industry
have been identified as heavy
consumers of both tobacco and alcohol.
For example, a higher prevalence
of cigarette smoking was observed
among construction laborers
in National Health and Nutrition Examination
Survey III compared with
the overall population of employed
study participants.49 In addition, the
construction industry was ranked as
the third highest for alcohol use
among workers ages 18 to 49 among
all U.S. industry groups.50 These
study findings support the importance
of controlling for these behaviors
in the analyses among carpenters,
especially when examining
cancers that are associated with both
lifestyle and occupational factors.
JOEM • Volume 45, Number 10, October 2003 1065
However, given the significant excess
risk of respiratory cancers and
cancers of the digestive system that
we observed, especially among carpenters
who were employed in the
union for at least 30 years, it is
unlikely that these elevated risk estimates
can be attributed solely to
these lifestyle factors.51,52
There are numerous strengths to
this study including a reasonably
large cohort size and the availability
of union membership and health
fund participation information that
allowed us to maintain follow-up of
carpenters who were either active
UBC members or retired and still
residing in New Jersey. Another
strength of the study is the linkage
with a well-established cancer registry.
Furthermore, our data allowed us
to examine the duration of union
membership as a risk factor for selected
cancers, which has been examined
in prior mortality studies of
carpenters6,7; however, this has not
been conducted in a large cohort
study that used cancer incidence
data. Like other studies of construction
workers, a limitation of our
study is the lack of information on
specific exposures experienced by
cohort members. The cohort covers
most union carpenters in New Jersey
but does not include nonunion carpenters.
The degree to which union
carpenters are representative of carpenters
as a whole has not been
investigated; however, a general observation
is that union carpenters are
more likely to be employed by larger
contractors. Nationally, only 19% of
carpenters are union members; however,
this percentage is higher in
New Jersey where more than 30% of
construction workers are unionized.
53
Conclusions
Carpenters enrolled in the UBC
had elevated risk estimates for cancers
that have been observed in prior
studies. The cancer sites with excesses
are consistent with carpenter
exposures to known and suspected
carcinogens, such as asbestos, silica,
and wood dust. An increased risk of
rectal cancer has been suggested in
prior studies; however, our study
provided stronger evidence that carpenters
are in fact at risk, especially
those who were employed for more
than 30 years. Further research is
needed to explore possible risk factors
for the elevated risk of testicular
cancer that we observed.
Acknowledgments
This work could not have been accomplished
without the collaboration of the New
Jersey Carpenters Funds and the valuable
assistance provided by George R. Laufenberg,
George Fernett, and Mary K. Willis.
Toshi Abe of the New Jersey State Cancer
Registry provided the cancer case data for this
project and expert assistance in their interpretation.
References
1. Bureau of Labor Statistics, U. S. Department
of Labor. Occupational Outlook
Handbook, 2002–03 Edition. Carpenters,
on the Internet at http://www.bls.gov/
oco/ocos202.htm.
2. Lipscomb HJ, Dement JM, Loomis DP,
Silverstein B, Kalat J. Surveillance of
work-related musculoskeletal injuries
among union carpenters. Am J Ind Med.
1997;32:629–640.
3. Blair A. Cancer rates and risks. Occupational
Studies Section, Division of Cancer
Etiology, National Cancer Institute,
2003, http://seer.cancer.gov/publications/
raterisk/risks94.html.
4. Milham S. Mortality Experience of the
AFL-CIO United Brotherhood of Carpenters
and Joiners of America, 1969–
1970. US DHHS, National Institute for
Occupational Safety and Health; HEW
Publication No. (NIOSH) 74–129, 1974.
5. Robinson CE, Stern F, Halperin W, et al.
Assessment of mortality in the construction
industry in the United States, 1884–
1986. Am J Ind Med. 1995;28:49–70.
6. Robinson CE, Peterson M, Sieber WK,
Palu S, Halperin WE. Mortality of carpenters’
union members employed in
U.S. construction or wood products industries,
1987–1990. Am J Ind Med.
1996;30:674–694.
7. Stern F, Schulte P, Sweeney MH, et al.
Proportionate mortality among construction
laborers. Am J Ind Med. 1995;27:
485–509.
8. Register General’s Decennial Supplement
for England and Wales, 1979–
1980, 1982–83. London, UK: Occupational
Mortality, Office of Population
Censuses and Surveys, Her Majesty’s
Stationary Office; 1986.
9. Hrubec Z, Balir AE, Rogot E, Vaught J.
Mortality risks by occupation among
U.S. veterans of known smoking status,
1954–1980. NIH Publication No. 92–
3407; 1992.
10. Dement J, Lipscomb H, Epling C, Desai
T, Li L, DeLarco B. Surveillance of
construction workers: final report to the
Center to Protect Workers’ Rights -
CPWR/NIOSH Cooperative Agreement
(CCU312014); January, 2001.
11. Milham S. Occupational mortality in
Washington State, 1950 –1979. US
DHHS, National Institute for Occupational
Safety and Health; Publication No.
(NIOSH) 83–116; 1983.
12. Ries LAG, Eisner MP, Kosary CL, et al.
SEER cancer statistics review, 1973–
1999, National Cancer Institute, 2000.
http://seer.cancer.gov/
csr.1973 1999.htm
13. Dement J Wood Dust. In: Bingham E,
Cohrssen B, Powell CH, eds. Patty’s
Toxicology, Vol I. 5th ed. New York:
John Wiley & Sons, Inc.; 2001:619–659.
14. Nylander LA, Dement J. Carcinogenic
effects of wood dust: review and discussion.
Am J Ind Med. 1993;24:619–647.
15. International Agency for Research on
Cancer. IARC Monographs on the Evaluation
of Carcinogenic Risk to Humans:
Volume 62: Wood Dust and Formaldehyde.
Lyon, France: World Health Organization;
1995.
16. Blot WJ, Chow W, McLaughlin JK.
Wood dust and nasal cancer risk: a review
of the evidence from North America.
J Occup Med. 1997;39:148–156.
17. Demers PA, Kogevinal M, Boffetta P et
al. Wood dust and sino-nasal cancer:
pooled reanalysis of twelve case-control
studies. Am J Ind Med. 1995;28:151–166.
18. Hall NEL, Rosenman KD. Cancer by
industry: analysis of a population-based
cancer registry with an emphasis on bluecollar
workers. Am J Ind Med. 1991;19:
145–159.
19. Ferlay J. IARCtools Version 2.01, Lyon,
France: Unit of Descriptive Epidemiology,
International Agency for Research
on Cancer, World Health Organization;
2001.
20. Steenland K, Beaumont J, Spaeth S, et al.
New developments in the life table analysis
system of the National Institute for
Occupational Safety and Health. J Occup
Med. 1990;32:1091–1098.
21. Cassinelli R, Kock KJ, Steenland K,
Spaeth S, Laber P. User Documentation—
PC LTAS: Life Table Analysis
System for Use on the PC. Cincinnati,
1066 Cancer Incidence Among Carpenters • Dement et al
OH: USDHHS, Centers for Disease Control
and Prevention, National Institute for
Occupational Safety and Health; 2001.
22. Checkoway H, Pearce N, Crawford-
Brown DJ. Research Methods in Occupational
Epidemiology. New York: Oxford
University Press; 1989:153–155.
23. Rothman KJ, Greenland, S. Modern Epidemiology.
2nd ed. Philadelphia: Lippincott,
Williams & Wilkins; 1998:15.
24. Rothman KJ, Boice JD. Epidemiologic
Analysis With A Programmable Calculator.
Washington, DC: US Government
Printing Office; 1979.
25. Rodelsperger K, Jockel KH, Pohlabeln
H, Romer W, Woitowitz HJ. Asbestos
and man-made vitreous fibers as risk
factors for diffuse malignant mesothelioma:
results from a German hospitalbased
case-control study. Am J Ind Med.
2001;36:262–275.
26. Burger SS, Klotz JB, Weinstein R, Abe
T, Van Loon S. Cancer incidence in New
Jersey 1995–1999: implementation of the
year 2000 population standard. New Jersey
Department of Health and Senior
Services. Cancer Epidemiology Services.
New Jersey State Cancer Registry; September,
2001.
27. Burns, PB, Swanson, GM. The occupational
cancer incidence surveillance
study: risk of lung cancer by usual occupation
and industry in the Detroit metropolitan
area. Am J Ind Med. 1991;19:
655–671.
28. Coggon D, Pannett B, Osmond C,
Acheson ED. A survey of cancer and
occupation in young and middle aged
men I: cancers of the respiratory tract.
Br J Ind Med 1986;43:332–338.
29. Hoar-Zahm S, Brownson R, Chang J,
Davis J. Study of lung cancer histologic
types, occupation, and smoking in Missouri.
Am J Ind Med. 1989;15:565–578.
30. Jockel KH, Ahrens W, Wichmann HE, et
al. Occupational and environmental hazards
associated with lung cancer. Int J
Epidemiol. 1992;21:202–213.
31. Blot WJ, Davies JE, Brown LM, et al.
Occupation and the high risk of lung
cancer in Northeast Florida. Cancer.
1982;50:365–371.
32. Lipscomb HJ, Dement JM. Respiratory
diseases among union carpenters: cohort
and case-control analyses. Am J Ind Med.
1998;33:131–150.
33. Siemiatycki J, Richardson L, Gerin M, et
al. Associations between several sites of
cancer and nine organic dusts: results
from an hypothesis-generating casecontrol
study in Montreal, 1979–1983.
Am J Epidemiol 1986;123:235–249.
34. Peters RK, Garabrant DH, Yu MC, Mack
TM. A case-control study of occupational
and dietary factors in colorectal cancer in
young men by subsite. Cancer Res. 1989;
49:5459–5468.
35. Dumas S, Parent, ME, Siemiatycki J,
Brisson J. Rectal cancer and occupational
risk factors: a hypothesis-generating, exposure-
based case-control study. Int J
Cancer. 2000;87:874–879.
36. Arbman G, Axelson O, Fredriksson M,
Nilsson E, Sjodahs R. Do occupational
factors influence the risk of colon and
rectal cancer in different ways? Cancer.
1993;72:2543–2549.
37. Landis SH, Murray T, Bolden S, Wingo
PA. Cancer statistics, 1988. Cancer
J Clin. 1998;48:6.
38. Pollan M, Gustavsson P, Cano MI. Incidence
of testicular cancer and occupation
among Swedish men gainfully employed
in 1970. Ann Epidemiol. 2001;118:554–
562.
39. NIOSH: Preventing adverse health effects
from exposure to Dimethylformamide
(DMF). USDHHS, Centers for
Disease Control, National Institute for
Occupational Safety and Health. NIOSH
Publication No.1990:90–105.
40. Ducatman AM, Conwill DE, Crawl J.
Germ cell tumors of the testicle among
aircraft repairmen. J Urol. 1986;136:
834–836.
41. Levin SM, Landrigan PJ, Baker DB,
Monaghan SV. Testicular cancer in
leather tanners exposed to dimethylformamide.
Lancet. 1987;2:1154.
42. Armstrong BK, Kricker A. The epidemiology
of UV induced skin cancer. Potochem
Photobiol. 2001;63:8–18.
43. Chao A, Thun MJ, Henley SJ, Jacobs EJ,
McCullough ML, Calle EE. Cigarette
smoking, use of other tobacco products
and stomach cancer mortality in U. S.
adults: the cancer prevention study II. Int
J Cancer. 2002;1014:380–389.
44. Heineman EF, Hoar Zahm S, McLaughlin
JK, Vaught JB. Increased risk of
colorectal cancer among smokers: results
of a 26-year follow-up of U.S. veterans
and a review. Int J Cancer. 1995;59:728–
738.
45. Le Marchand L, Wilkens LR, Kolonel
LN, Hankin JH, Lyu LC. Associations of
sedentary lifestyle, obesity, smoking, alcohol
use, and diabetes and the risk of
colorectal cancer. Cancer Res. 1997;57:
4787–4794.
46. Slattery ML, Potter JD, Friedman GD,
Ma KN, Edwards S. Tobacco use and
colon cancer. Int J Cancer. 1997;70:259–
264.
47. Giovannucci E, Rimm EB, Stampfer MJ,
Colditz GA, Ascherio A, Willett WC.
Intake of fat, meat, and fiber in relation to
risk of colon cancer in men. Cancer Res.
1994;54:2390–2397.
48. Wynder EL, Hebert JR, Kabat GC. Association
of dietary fat and lung cancer.
J Natl Cancer Inst. 1987;794:631–637.
49. Bang KM, Kim JH. Prevalence of cigarette
smoking by occupation and industry
in the United States. Am J Ind Med.
2001;40:233–239.
50. U.S. Department of Commerce. Drug use
among U.S. workers: prevalence and
trends by occupation and industry categories.
USDHHS. Substance Abuse and
Mental Health Services. DHHS Publication
No. (SMA) 96–3089; 1996.
51. Axelson O. Aspects of confounding in
occupational health epidemiology. Scand
J Work Environ Health. 1978;4:85–89.
52. Flanders WD, Khoury MJ. Indirect assessment
of confounding: graphic description
and limits on effect of adjusting
for covariates. Epidemiology. 1990;1:
239–246.
53. Sullivan EC, Englund A, Dunlop JT,
Frankowski R. The Construction Chart
Book: The U.S. Construction Industry
and Its Workers, Third Edition, Center to
Protect Workers’ Rights.
