Endotoxin exposure and lung cancer risk: a systematic review and meta-analysis of the published literature on agriculture and cotton textile workers

Lenters, Verissa, Basinas, Ioannis, Beane-Freeman, Laura, Boffetta, Paolo, Checkoway, Harvey, Coggon, David, Portengen, Lützen, Sim, Malcolm, Wouters, Inge M, Heederik, Dick and Vermeulen, Roel (2010) Endotoxin exposure and lung cancer risk: a systematic review and meta-analysis of the published literature on agriculture and cotton textile workers. Cancer Causes & Control, 21 (4), 523-555. (doi:10.1007/s10552-009-9483-z).

Abstract

Objective

To examine the association between exposure
to endotoxins and lung cancer risk by conducting a systematic review and meta-analysis of epidemiologic studies of workers in the cotton textile and agricultural industries; industries known for high exposure levels of endotoxins.

Methods

Risk estimates were extracted from studies
published before 2009 that met predefined quality criteria,
including 8 cohort, 1 case–cohort, and 2 case–control
studies of cotton textile industry workers, and 15 cohort
and 2 case–control studies of agricultural workers. Summary
risk estimates were calculated using random effects
meta-analyses. Potential sources of heterogeneity were
explored through subgroup analyses.

Results

The summary risk of lung cancer was 0.72 (95%
CI, 0.57–0.90) for textile workers and 0.62 (0.52–0.75) for
agricultural workers. The relative risk of lung cancer was
below 1.0 for most subgroups defined according to sex,
study design, outcome, smoking adjustment, and
geographic area. Two studies provided quantitative estimates of endotoxin exposure and both studies tended to
support a dose–dependent protective effect of endotoxins
on lung cancer risk.

Conclusion

Despite several limitations, this meta-analysis
based on high-quality studies adds weight to the
hypothesis that occupational exposure to endotoxin in
cotton textile production and agriculture is protective
against lung cancer.

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Contributors

Author: David Coggon

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