High-Risk Occupations

The evidence linking occupational exposures to PC is inconsistent, reflecting the difficulty

of quantifying workplace exposure to carcinogens and of differentiating these exposures
from other risk factors. A number of epidemiologic investigations have suggested excess
risk of PC in certain occupations. Definitively establishing certain occupations as high risk
for the development of PC is difficult because of the problems with self-reported exposures,
lack of objective quantitative monitoring data, personal comorbidities, and the presence of
other confounding and modifying risk factors. The available studies are summarized
in Table 61.3 .

TABLE 61.3
Occupations Associated With Excess Risk of Pancreatic Cancer
Reference Occupation Risk Estimate
Falk et al, 1994 Chemical processor 1.22 OR
Chemical fertilizer 1.20 OR
Li et al, 1969 Chemist 10.2 MH
Lin et al, 1981 ; Falk et al, Auto mechanic (gasoline exposure) 5.1 RR if >10 years
1990 exposure
Service station worker 1.6 SMR
Machine repairer 2.45 OR
Lin & Kessler, 1981 Dry cleaner 2.1 RR
Edling et al, 1985 Leather tanner 3.1 MH
Pickle et al, 1980 Oil refinery worker 2.11 OR

Rockette et al, 1983 Aluminum mill worker 125.2 SMR

Norell et al, 1986 Floor polisher 1.3 SMR
Falk et al, 1990 Electrical 2.20 OR
assembler/installer/repairer
Tolbert et al, 1992 Metalworker 2.0 SMR
Eisen et al, 1992 Manufacturing plant worker 3.0 SMR
Bardin et al, 1997 Assembly worker 3.0 SMR
Rotimi et al, 1993 Foundry and engine plant workers 3.0 SMR
Bu-Tian et al, 2001 Plant/system operator 6.1 OR
Bu-Tian et al, 2001 Pharmacist, dietician, therapist 7.1 OR
 Ver a tamaño completo
CI,  Confidence interval; MH, Mantel-Haenszel estimate; NR,  not reported; OR, odds
ratio; RR, relative risk; SMR,  standardized mortality ratio.
Occupational Exposures
Studies examining specific occupational exposures that increase a worker's risk of
developing PC have been conducted both in the United States and in Europe, particularly in
the Scandinavian countries. Occupational exposures linked to PC are summarized in Table
61.4 . Overall, the occupational etiologic fraction for PC was estimated at 12% in a meta-
analysis of 20 occupational studies conducted between 1969 and 1998 ( Ojajarvi et al,
2000 ). A retrospective analysis of more than 22 occupational and environmental studies
reporting on people with PC found that exposure to asbestos, pesticides and herbicides,
residential radon, coal products, welding products, and radiation were the most commonly
reported exposures ( Yeo et al, 2009 ).

TABLE 61.4
Occupational Exposures Linked to Pancreatic Cancer (PC)
Data from references cited in Table 61.3 .
Chemical Exposure Route PC Ri
Estim
Methylene chloride (chlorinated  Spray paints 
hydrocarbons)
 Paint strippers 

 Aerosol propellant 

 Metal degreasing agent

 Paint/paint thinners

 Varnish

 Solvents

Pesticides/herbicides Corn wet-milling 1.4 O

DDT Farming 4.8 RR
DDD Flight attendants 4.3 RR
Ethylan 5.0 RR
Asbestos Industrial 3.0 O
Fertilizer Farming 1.2 O
Cotton dust Farming 4.37 O
Cement Construction work (manufacturing of 1.28 O
cement)
Chemical Exposure Route PC Ri
Estim
Lead Various 1.28 O
Metalworking fluids Machinist 2.0 O
 Ver a tamaño completo
DDD, Dichlorodiphenyl-dichlorethane; DDT,  dichlorodiphenyl-trichloroethane; OR,  odds
ratio; RR, relative risk.
Calvert and colleagues (1989) conducted a review supported by the National Institute for
Occupational Safety and Health of five cohort studies reporting an association between the
use of metalworking fluids (MWFs) used in industrial machining and grinding operations
and the development of all types of cancer, including PDAC ( Acquavella et al,
1993 ; Hoppin et al, 2000 ; Porta et al, 1999 ; Rotimi et al, 1993 ; Tolbert et al, 1992 ). More
than 1 million workers are exposed to MWFs according to National Institute for
Occupational Safety and Health estimates ( Calvert et al, 1989 ). Substantial evidence was
found for an increased risk of cancer at several sites, including the pancreas, larynx, rectum,
skin, scrotum, and bladder. MWFs contain a number of compounds suspected to be cancer
initiators or promoters, including long-chain aliphatics, PAHs, nitrosamines, sulfur-
containing compounds, formaldehyde-releasing biocides, and heavy metals ( Tolbert et al,
1992 ).