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Occupational exposure to Benzene and risk of Cancer

Khalade, Abdul (2010)
Ph.D. thesis, University of Birmingham.

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This thesis assessed the risk of cancer in relation to exposure from benzene at work. The thesis is in three major sections. The first section consisted of a systematic review and meta-analysis to assess the risk of leukemia from occupational exposure to benzene. The systematic review confirmed leukemia to be important in relation to benzene exposure; 15 selected studies yielded 16 effect estimates with an overall statistically significant effect size (relative risk) of 1.40 (95% CI, 1.23-1.57). A dose response analysis was performed and provided evidence for a strong positive trend between leukemia risks and estimated exposure to benzene. The risk of all leukemia combined increased with a dose-response pattern with a summary effect size (ES) of 1.64 (95% CI 1.13-2.39) for low (<40 ppm-years), 1.90 (95% CI 1.26-2.89) for medium (40-99.9 ppm-years), and 2.62 (95% CI 1.57-4.39) for high exposure (>100 ppm-years). The risk of AML also increased from low (ES 1.94, 95% CI 0.95-3.95), medium (ES 2.32, 95% CI 0.91-5.94) to high exposure category (ES 3.20, 95% CI 1.09-9.45), but the trend was not statistically significant. The second section used the same method to assess other cancer risks by conducting a systematic review and further meta-analysis. The most common other cancer sites for which a possible occupational involvement from benzene has been suggested were lung, bladder, melanoma, stomach and kidney cancer. Consequently, a systematic review and meta-analysis was performed on each of these cancer sites. The results obtained did not show any clear evidence of risk for lung cancer (ES 0.99, 95% CI 0.96-1.03), bladder cancer (ES 1.00, 95% CI 0.96-1.03), or stomach cancer (ES 0.96, 95% CI 0.90-1.03). However increased risks were shown for melanoma (ES 1.25, 95% CI 1.09-1.44) and kidney cancer (ES 1.14, 95% CI 1.04-1.25). The systematic review and meta-analysis for melanoma was based on 7 available studies reporting 8 cohorts. It was not possible to conclude that benzene exposure is a cause of melanoma as many other chemicals were also used in the factories. There was no significant heterogeneity in the study-specific findings for melanoma (P=0.26). The systematic review and meta-analysis for kidney cancer was based on 22 available studies reporting 24 cohorts. There was also no significant heterogeneity in the study-specific findings for kidney cancer (P=0.41). Therefore, further research is needed to establish a strong link between exposure to benzene and risk of kidney cancer. The final section of the thesis examined the risk of leukemia, lung cancer and all cause mortality in workers exposed to benzene in a large cohort of workers employed at 233 factories during 1966/67 in England & Wales. The results however provided no clear evidence of a dose response effect for leukemia risks in relation to estimated cumulative exposure from benzene. The major limitations of the study related to the recording of limited work histories and the collection of incomplete or limited exposure assessments. The method used in recording the levels of exposure were not clear as different factories were measured by individual personnel at differing times over the years, and at differing areas within factory to factory. It was not possible, therefore, to gain a comprehensive and consistent exposure assessment throughout the factories. To obtain an accurate and viable outcome there needs to be a sound measurement of exposure technique implemented such as taking personal samples using a personal sampler for each individual and indicating specific areas where low, medium and high exposures are evident alongside adequate ventilation. Job exposure matrix also needs to be considered alongside socio-economic classification and ethnicity as this may show some effect on how different minorities may be better or worse adapted to certain chemical exposures.

Type of Work:Ph.D. thesis.
Supervisor(s):Jaakkola, Jouni and Sorahan, Tom
School/Faculty:Colleges (2008 onwards) > College of Medical & Dental Sciences
Department:Institute of Occupational and Environmental Medicine
Additional Information:

see also Khalade, Abdul and Jaakkola, Maritta S and Pukkala, Eero and Jaakkola, Jouni JK (2010) Exposure to benzene at work and the risk of leukemia: a systematic review and meta-analysis. Environmental Health, 9 (1). p. 31. ISSN 1476-069X found at

Subjects:RC0254 Neoplasms. Tumors. Oncology (including Cancer)
RA Public aspects of medicine
Institution:University of Birmingham
ID Code:1076
This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder.
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