A Population-Based Feasibility Study of Occupation and Thoracic Malignancies in New Mexico

Our plain-English summary of A Population-Based Feasibility Study of Occupation and Thoracic Malignancies in New Mexico, by C.R. Pestak, T.W. Boyce, O.B. Myers, et al (Southwest Journal of Pulmonary & Critical Care, 2021).

The study

• Authors: C.R. Pestak, T.W. Boyce, O.B. Myers, L.O. Hopkins', C.L. Wiggins, B.R. Wissore, A. Sood, L.S. Cook
• Journal: Southwest Journal of Pulmonary & Critical Care
• Published: 2021;22(1):23-25
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Occupational exposures in mining and oil/gas extraction are known risk factors for thoracic malignancies (TMs). Given the relatively high proportion of these industries in New Mexico (NM), we conducted a feasibility study of adult lifetime occupational history among TM cases. We hypothesized a higher proportion of occupational TM in NM relative to the estimated national average of 10-14%.

Methods: We identified incident TM cases through the population-based New Mexico Tumor Registry (NMTR), from 2017-2018. Cases completed a telephone interview. An adjudication panel reviewed case histories and classified cancers as probable, possible, or non-occupational related, taking into account the presence, duration, and latency of exposures. We characterized recruitment and describe job titles and exposures among those with occupational TMs. We also compared the distributions of industry between those with and without occupational TM.

Results: The NMTR identified 400 eligible TM cases, 290 of which were available to be recruited (n=285 lung/bronchial cancer; n=5 mesotheliomas). Of the latter, 60% refused and 18% were deceased, 9% had invalid addresses, 11% were unable to be reached by telephone, and 3% were too ill to participate. The 43 cases who completed an interview held 236 jobs. A total of 33% of cases were classified as probable occupational TM and 5% as possible occupational TM.

Conclusions: High rates of early mortality and refusals were significant barriers to study participation. Nonetheless, the proportion of probable occupational TMs greatly exceeded the estimated national average, highlighting the need for further study of occupational TM in the state.

In plain English

This feasibility study in New Mexico tested whether lifetime work histories could be collected from people with thoracic cancers (lung cancer and mesothelioma) found through the state tumor registry. The registry identified 400 eligible cases diagnosed between February 2017 and February 2018. Of these, 290 were invited (285 with lung cancer, 5 with mesothelioma), and 43 completed a telephone interview about every job held for six months or longer from age 18. Refusals (60%) and deaths (18%) were the main reasons invited people did not take part. Three voting members of an adjudication committee, chaired by a non-voting member, reviewed the 43 histories. The committee classified 14 (33%) as probable occupational cancers and 2 (5%) as possible. Among the 14 probable cases, 7 reported asbestos, 9 silica and 7 diesel exposure, and 11 were men. The authors concluded that early deaths and refusals made a definitive study impossible with these methods. The 33% figure was two to three times national estimates of 10 to 14%, but they could not say whether it reflected selection bias from the low response. They also noted that rural cases were under-represented.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Population-based feasibility study of registry-identified cancer cases. It used structured telephone interviews on lifetime occupational history. An adjudication committee of three voting members and a non-voting chair classified each case as probable, possible, or non-occupational.
• Who was studied: Incident thoracic malignancy cases (lung cancer and mesothelioma) identified by the New Mexico Tumor Registry from February 1, 2017 to February 2, 2018: 400 eligible, 290 invited (285 lung cancer, 5 mesothelioma), 43 interviewed
• Exposure: Self-reported adult lifetime occupational history: every job held 6 months or longer from age 18, inside or outside New Mexico, with exposure information on a list of more than 30 relevant agents. The committee considered exposures with a latency of at least 10 years and a duration of at least one year.
• Main results:
  • Of the 400 eligible cases, 110 (28%) were not released to study staff, including 33 who refused and 47 who were deceased
  • Among the 290 invited cases, refusals (60%) and deaths (18%) were the two main reasons for not being interviewed. Other reasons were invalid addresses (9%), being unreachable by telephone (11%) and being too ill (3%).
  • The adjudication committee had three voting members (a pulmonologist, a preventive medicine specialist and an attorney) and a non-voting chair who tallied votes
  • The 43 interviewed cases reported 236 jobs. 14 (33%) were classified as probable and 2 (5%) as possible occupational thoracic malignancy.
  • Among the 14 probable occupational cases, 11 (79%) were men. Both possible occupational cases were men.
  • The 14 probable occupational cases self-reported one or more of these exposures: aluminum production (n=1), arsenic (n=1), asbestos (n=7), cadmium (n=1), coal-tar (n=1), diesel (n=7), ether (n=5), nickel (n=2), paint (n=1), radiation (n=1), silica (n=9), soot (n=2)
  • Among the 43 interviewed cases, 72% were current or former cigarette smokers
  • 23% of the 400 cases identified during the study period lived in rural areas, compared with 44% of the 513 cases the registry identified later for the same diagnosis period (p less than 0.001)
• The authors' conclusion: The authors concluded that high rates of early death and refusal were significant barriers to enrollment, so a definitive study is not possible with these methods. They noted that the proportion of occupational cases among participants (33%) was two to three times prevailing national estimates (10 to 14%).
• Limitations the authors state:
  • The authors could not say whether the 33% figure was due to the low response and possible selection bias toward cases with relevant exposures, or truly reflects New Mexico exposures
  • Rural cases were under-represented, so the authors said the 33% estimate might be an underestimate
  • The intensity and duration of each exposure at each job were difficult to estimate retrospectively
  • There were too few cases to account for tobacco use, comorbidities and socioeconomic factors in the analysis
  • No information was collected on environmental tobacco smoke or biomass/coal smoke at each job, or on indoor smoke at home

Topics

Medical terms in this study, explained in our Lexicon: Occupational Exposure, Occupational History, Cancer Registry, Latency, Mesothelioma.

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