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Scand J Work Environ Health 2008;34(6):444-450

https://doi.org/10.5271/sjweh.1296
Issue date: 00 Dec 2008

Exposure to iron and welding fumes and the risk of lung

cancer
by Siew SS, Kauppinen T, Kyyrönen P, Heikkilä P, Pukkala E

Affiliation: Finnish Institute of Occupational Health, Topeliuksenkatu

41 a A, FI-00250 Helsinki, Finland. [email protected]

Refers to the following texts of the Journal: 2007;33(5):379-386

2006;32(1):22-31 1997;23(2):104-113 2005;31(2):97-107

The following article refers to this text: 2022;48(1):21-30

Key terms: exposure; iron; job-exposure matrix; lung cancer;

occupational epidemiology; register-based study; risk; welding fume

This article in PubMed: www.ncbi.nlm.nih.gov/pubmed/19137206

This work is licensed under a Creative Commons Attribution 4.0 International License.

Print ISSN: 0355-3140 Electronic ISSN: 1795-990X

Original article
Scand J Work Environ Health 2008;34(6):444–450

Exposure to iron and welding fumes and the risk of lung cancer
by Sie Sie Siew, MSc,1 Timo Kauppinen, PhD,1 Pentti Kyyrönen,2 Pirjo Heikkilä, PhD,1
­Eero Pukkala, PhD 2, 3

Siew SS, Kauppinen T, Kyyrönen P, Heikkilä P, Pukkala E. Exposure to iron and welding fumes and the risk of lung
cancer. Scand J Work Environ Health 2008:34(6):444–450.

Objectives Exposure to iron fumes and dust and welding fumes is widespread and may increase the risk of lung
cancer. The aim of this study was to identify associations between exposure to iron and welding fumes and the
incidence of lung cancer among Finnish men.
Methods The cohort of all economically active Finnish men, born in 1906–1945, who participated in the
national census in 1970 was followed through the Finnish Cancer Registry for lung cancer cases (N=30 137)
during 1971–1995. Their census occupations in 1970 were converted to estimates of cumulative exposure to iron
and welding fumes with the Finnish job-exposure matrix on the basis of likelihood, average level, and estimated
duration of exposure. Relative risk estimates for categorized cumulative exposure were defined by a Poisson
regression, adjusted for smoking, socioeconomic status, and exposure to asbestos and silica dust.
Results The relative risks for lung cancer increased as the cumulative exposure to iron and welding fumes
increased. The relative risks in the highest exposure category was 1.35 [95% confidence interval (95% CI)
1.05–1.73] for iron and 1.15 (95% CI 0.90–1.46) for welding fumes. The respective relative risks estimated for
squamous-cell carcinoma of the lungs were 1.94 (95% CI 1.35–2.78) and 1.55 (95% CI 1.08–2.24). There was
no excess risk of small-cell carcinoma in any exposure category.
Conclusions Occupational exposure to iron and welding fumes was associated with an increase in lung cancer
risk, mainly that of squamous-cell carcinoma. The simultaneous exposure to both of these agents and other po-
tential work-related carcinogens complicates the interpretation of the independent roles of the risk factors.

Key terms job-exposure matrix; register-based study; occupational epidemiology.

There is extensive exposure to iron fumes or dust and Due to the widespread exposure, the number of cancer
welding fumes in the work environment across various cases attributable to exposure to iron fumes or dust or
industries worldwide. In Finland, the estimated number welding fumes would be very high if iron fumes or dust
of workers exposed to iron fumes or dust or welding or welding fumes turn out to be carcinogenic.
fumes in 1960–1984 was about 100 000 (ie, 4% of the In 1990, the International Agency for Research on
2.3 million economically active population) (1). Two- Cancer (IARC) categorized welding fumes as possibly
thirds of them were exposed to welding fumes, which carcinogenic to humans (group 2B) on the basis on 23
contain iron fumes as one component. If it is assumed epidemiologic studies. The National Institute of Oc-
that 1% of the 2.9 billion global workforce perform cupational Safety and Health (NIOSH) concluded that
welding as part of their work duties, the number of ex- there is an elevated risk of lung cancer among welders
posed workers would be about 30 million. In Finland, that cannot be completely accounted for by smoking or
the most common occupations with exposure to welding asbestos exposure (2). More recent papers also support
fumes are welder (N=15 000), machine and engine me- the view that welding fumes could increase the risk of
chanic (N=12 000), sheet metal worker (N=15 000), and lung cancer (3–10).
plumber (N=12 000). There are also occupations with On the other hand, iron dust and fumes were not clas-
no exposure to welding fumes but which have exposure sified as carcinogenic by the American Conference of
to iron fumes or dust, such as foundry and steel work. Governmental Industrial Hygienists (10), and they have

1 Finnish Institute of Occupational Health, Helsinki, Finland.

2 Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.
3 School of Public Health, University of Tampere, Tampere, Finland.
Correspondence to: Siew Sie Sie, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FI-00250 Helsinki,
­Finland. [E-mail: [email protected]]

444 Scand J Work Environ Health 2008, vol 34, no 6

 Siew et al

not been evaluated by IARC. Although numerous studies and 1995 among men born between 1906 and 1945
suggest that there is an association between exposure to (30 137 cases) were extracted from the Finnish Cancer
iron fumes or dust at work and lung cancer risk (11–14), Register and sent to Statistics Finland for linkage with
the possible effect from other agents in simultaneous the data in the population census in 1970. Cancer cases
exposure could not be ruled out completely. Exposure of persons who had no record in the 1970 census (2.2%)
to iron fumes or dust and welding fumes is associated were excluded.
because the main constituent of welding fumes is iron The occupational exposure estimates used in this
and its compounds. In most cancer studies in relation to study were based on the Finnish job-exposure matrix
welding fumes, iron is generally neglected because the (FINJEM) (1). Each occupational category is charac-
focus falls upon nickel, chromium or chromium VI, and terized by the proportion of exposed persons (P) and
other possible carcinogens. In addition, there has been the mean level of exposure among the exposed (L).
a debate about whether exposure to mild steel or stain- The exposure estimates were based on the judgment of
less steel could lead to an increased risk of lung cancer about 20 experts at the Finnish Institute of Occupational
among welders. Health. In our study, iron fumes or dust exposure is
The aim of our present study was to identify the expo- defined as the occupational inhalation exposure to iron
sure�����������������������������������������������������
–����������������������������������������������������
response relationship of occupational exposure with dust or fumes from welding, smelting, grinding, or other
iron fumes or dust and welding fumes and the risk of lung processing of steel and other materials containing iron.
cancer in a follow-up of the entire Finnish workforce. It includes metallic iron and all iron compounds. Weld-
ing fume exposure is defined as occupational inhalation
exposure to fumes from welding. The level of exposure
to iron fumes or dust and welding fumes is expressed
Study population and methods in milligrams of agent in cubic meters of workroom
air. Occupations that had more than 5% of the persons
The study cohort consisted of all of the 1.2 million exposed to the individual agent at any time between
economically active Finnish men who were born in 1945 and 1984 are considered as potentially exposed
1906–1945 and who participated in the national popula- occupations in the FINJEM. For welding fumes, the P-
tion census on 31 December 1970. The Finnish census values were collected mainly from the work and health
data maintained by Statistics Finland were updated for surveys carried out by the Finnish Institute of Occupa-
vital status to allow exact person-year calculation. Data tional Health in 1997–2003, whereas the mean levels of
on the occupations held for the longest time in 1970 exposure were estimated on the basis of exposure mea-
were obtained from the population census 1970 records surements made by the the same institute. The FINJEM
(15). The occupational classification was based on a also includes exposure estimates for asbestos, silica,
modification of the International Standard Classifica- nickel, chromium, lead, benzo(a)pyrene, and smoking,
tion of Occupations in 1958. Some of the 311 basic which are potential confounders in our current study.
occupational codes were further divided according to Smoking is expressed as the proportion of those in the
industry. The cohort was also categorized into the fol- occupation who smoked daily, according to data from
lowing five socioeconomic strata: higher white-collar, annual surveys on the health behavior of the Finnish
clerical, skilled blue-collar, and unskilled workers, and adult population in 1978–1991 (18).
also farmers. The socioeconomic status of each person We estimated the agent-specific and occupation-spe-
was determined on the basis of occupation and educa- cific cumulative exposure (cumulative exposure) for ev-
tion in 1970 (16). ery 5-year birth cohort (from 1906–1910 to 1941–1945)
The cancer data were obtained from the Finnish and 5-year calendar periods of observation from 1971–
Cancer Registry, which has maintained a nationwide 1975 to 1991–1995 (figure 1). For each birth cohort, it
database on all cancer cases in Finland since 1953. It was assumed that the exposure started when the average
is the responsibility of all physicians, hospitals, insti- age of the birth cohort was 20 years and ended in the
tutions, and laboratories to notify the Registry of all middle year of the observation period minus 20 years
diagnosed cancer cases. In addition, Statistics Finland (latency) or at 65 years of age, whichever came first.
sends the Registry the death certificates on which cancer In each calendar year, the annual average exposure was
is mentioned. The data in the Registry are accurate and the product of the proportion of exposed persons and
virtually complete (17). An 11-digit personal identifica- the mean level of exposure in that occupation. When the
tion code has been given to every resident in Finland exposure occurred before 1960, we used the FINJEM
since 1967, and it is used in health care and all regis- estimates for the period 1945–1959; otherwise the esti-
ters throughout the country. The codes allow reliable mates for the period 1960–1984 were used.
computerized record linkage. In our present study, the The limits of the cumulative exposure categories for
incident cases of lung cancer diagnosed between 1971 all of the chemical agents were set a priori on the basis

Scand J Work Environ Health 2008, vol 34, no 6 445

Iron and welding fume exposure and the risk of lung cancer

were rather weak. Occupational exposure to nickel,

chromium, lead, and benzo(a)pyrene were so strongly
correlated with iron fumes or dust and welding fumes
that they could not be included in the statistical model.
The Pearson correlations of the cumulative exposure
between iron fumes or dust and nickel, chromium, lead,
and benzo(a)pyrene were 0.79, 0.66, 0.62, and 0.63, re-
spectively, and those for welding fumes were 0.80, 0.68,
0.64, and 0.53, respectively. Their potential confounding
effect was limited by excluding the workers who had
high or moderate cumulative exposure to these agents
from the cohort.

Results

Table 1 shows the occupations exposed to iron fumes

or dust and welding fumes and the standardized inci-
dence ratios (SIR) of lung cancer in these occupations.
The exposure decreased slightly from 1945–1959
to 1960–1984. The highest standardized incidence
Figure 1. Units of observation, defined by birth year of the persons in ratio [SIR 1.81, 95% confidence interval (95% CI)
the cohort (1906–1910 through 1941–1945) and calendar period of
Figure 1. Units
follow-up of observation,
(1971–1975 defined
through by birth year
1991–1995), of the persons
theoretical in the cohort
exposure (work) 1.42–2.27]
(1906–1910, …, was found for sheet metal workers in the
1941–1945) and calendar period of follow-up (1971–1975, …, 1991–1995), theoretical exposure
time, andFINJEM
time, and the periods of the
(Finnish Finnish
national job-exposure
job-exposure matrix)matrix
periods(FINJEM)
building
used estimation.
used for exposure
industry.
for estimating the exposure. The relative risk for lung cancer increased as the cu-
mulative exposure increased for iron fumes or dust and
of the distribution of the exposures in such a way that welding fumes (tables 2–3). The relative risk in the high-
the highest category included only the cluster of workers est exposure category was 1.35 (95% CI 1.05–1.73) for
with evidently the highest exposure (ie, not automati- iron fumes or dust (table 2) and 1.15 (95% CI 0.90–1.46)
cally to include, for example, one-fourth of the popula- (table 3) for welding fumes. The parameter correlation
tion). The rest of the potentially exposed workers were for exposure to iron fumes or dust and welding fumes
divided into medium and low categories. The catego- is so high (correlation 0.86) that it was not possible to
rized cumulative exposures to iron fumes or dust were put both factors in the same model.
0.1–9.9 mg/m -years (low), 10–49.9 mg/m -years (me-
3 3 The exclusion of the high-exposure categories of
dium), and ≥50 mg/m -years. The respective thresholds
3 nickel, chromium, lead, and benzo(a)pyrene did not
for welding fumes were 100 and 200 mg/m -years. 3 change the relative risk estimate for the highest cumu-
The expected numbers of cases for every occupation lative exposure to iron fumes or dust but increased the
were calculated for each 5-year birth cohort and 5-year relative risk for medium exposure (table 2). Further
calendar period (figure 1) by multiplying person-years exclusion of the high-exposure categories of welding
lived by persons in that occupation with the cancer fumes increased the relative risk (RR) for the high-
incidence rate of the entire Finnish population in the est cumulative iron fumes or dust exposure (RR 1.57,
respective stratum. The standardized incidence ratio was 1.17–2.09).
defined as the ratio of the observed number of cases to The exclusion of the high-exposure categories for
the expected number of cases. nickel, chromium, lead, benzo(a)pyrene, and iron fumes
The exposure�������������������������������������
–������������������������������������
response patterns were studied with or dust did not markedly change the relative risk esti-
the Poisson regression analysis of the stratum-specific mate for welding fume exposure (table 3).
observed numbers of cases and person-years at risk. The Of the histological subtypes of lung cancer, squa-
unexposed persons formed the reference category. mous-cell carcinoma showed the strongest dose���� –���
re-
Statistical analyses were conducted separately for sponse relationship (tables 4 and 5). The relative risk
exposure to iron fumes or dust and welding fumes of the highest category of iron fumes or dust was 1.94
because they were strongly correlated with each other. (95% CI 1.35–2.78) and that of the highest category of
Smoking and occupational exposure to asbestos and welding fumes was 1.55 (95% CI 1.08–2.24). The pat-
silica could be controlled in the Poisson regression tern for adenocarcinoma was less consistent, and there
models because their mutual correlations and the cor- was virtually no excess risk in any exposure category for
relations with iron fumes or dust and welding fumes small-cell carcinoma.

446 Scand J Work Environ Health 2008, vol 34, no 6

 Siew et al

Table 1. Exposure to iron fumes or dust and welding fumes, according to the Finnish job-exposure matrix, and the incidence of lung
cancer by occupation among the Finnish men who were born in 1906–1946 and who participated in the population census in 1970. [P
= proportion of exposed persons, L = level (mean) of exposure, SIR = standardized incidence ratio, 95% CI = 95% confidence interval,
NEC = not elsewhere classified]

Occupation
a Iron fumes or dust Welding fumes Daily Risk of
smoking lung cancer
1945–1959 1960–1984 1945–1959 1960–1984 (1978– (1971–1995)
1991)
P
P L P L P L P L (%) Observed SIR
b
95%CI
(%) (mg/m3) (%) (mg/m3) (%) (mg/m3) (%) (mg/m3) cases
(N)

Smelter worker, iron or steel (6301) 100 1.5 100 0.9 10 0.9 10 0.9 54 28 1.04 0.69–1.50
Smelter worker, NEC (6309) 85 0.80 85 0.50 10 0.9 10 0.9 54 14 0.85 0.46–1.43
Hardener, temperer, etc (6310) 90 0.50 90 0.25 10 0.9 10 0.9 47 10 1.33 0.64–2.45
Hot-roller (6320) 90 0.50 90 0.25 10 0.9 10 0.9 47 19 1.40 0.85–2.19
Cold-roller (6330) 90 0.20 90 0.10 10 0.9 10 0.9 47 5 0.91 0.30–2.13
Blacksmith (6340) 90 0.50 90 0.25 15 0.9 15 0.9 47 117 1.43 1.18–1.71
Foundry worker, iron or steel (6351) 90 2.00 90 1.70 5 0.9 5 0.9 46 43 1.27 0.92–1.70
Foundry worker, NEC (6359) 90 1.00 90 0.80 5 0.9 5 0.9 46 73 0.25 0.98–1.57
Wire and tube drawer (6360) 60 0.50 60 0.25 10 0.9 10 0.9 47 14 1.29 0.71–2.17
Metal mill worker, iron or steel (6391) 70 0.50 70 0.25 5 0.5 5 0.5 44 24 1.33 0.85–1.97
Metal mill worker, NEC (6399) 70 0.20 70 0.10 5 0.5 5 0.5 44 42 1.15 0.83–1.56
Turner, machinist (6500) 90 0.50 90 0.30 5 0.9 5 0.9 36 522 0.98 0.89–1.06
Fitter–assembler, etc (6510) 50 0.20 50 0.20 40 0.9 40 0.9 37 212 0.91 0.79–1.04
Car mechanic (6521) 50 0.20 50 0.17 40 0.3 40 0.3 39 266 1.14 1.01–1.29
Machine repairer, except cars (6529) 50 0.20 50 0.17 40 0.3 40 0.3 39 305 1.00 0.89–1.12
Sheetmetal worker, building (6531) 90 1.50 90 1.00 75 4.0 90 3.5 40 75 1.81 1.42–2.27
Sheetmetal worker, except building (6539) 90 2.70 90 2.00 75 8.0 90 7.0 40 203 1.18 1.02–1.35
Plumber, building (6541) 50 0.05 50 0.05 50 0.5 50 0.5 35 243 1.30 1.14–1.47
Plumber, except building (6549) 50 0.05 50 0.05 50 0.5 50 0.5 35 134 1.17 0.98–1.39
Welder and flame cutter, stainless steel >10% (6551) 100 2.00 100 1.50 100 6.0 100 4.5 44 110 0.95 0.78–1.15
Welder, shipyard (6552) 100 3.30 100 2.60 100 10.0 100 8.0 44 26 1.05 0.69–1.55
Welder, building (6553) 80 2.00 80 1.50 80 6.0 80 4.5 44 24 1.31 0.84–1.95
Welder, NEC (6559) 80 3.00 70 2.10 80 9.0 70 6.5 44 102 1.39 1.14–1.69
Plate or constructional steel worker (6560) 80 0.80 80 0.80 60 2.0 60 2.0 40 69 0.97 0.75–1.23
Metal plater and coater (6570) 50 0.03 50 0.03 5 0.2 5 0.2 40 23 1.63 1.03–2.45
Machine shop worker, NEC (6590) 25 0.50 25 0.50 10 0.9 10 0.9 40 260 1.16 1.02–1.31

a The occupational code of the Finnish job-exposure matrix is given in parentheses after the occupation.
b Reference population: all Finnish men.

Discussion lated to iron fumes or dust exposure was the strongest for
squamous-cell carcinoma, weaker for adenocarcinoma,
The excess risk of lung cancer among the Finnish male and nonexisting for small-cell carcinoma of the lung.
workers having the highest exposure to welding fumes An excess risk of lung cancer in relation to iron fumes
was 15%, which is in accordance with the excess risk sug- or dust exposure has been suggested only in a few stud-
gested by a meta-analysis of 60 studies related to welding ies (10, 14, 19–21). Our findings are in line with these
fumes in 1954–2004 (4). The excess related to the highest studies. Exposure to iron fumes or dust may give rise
exposure to iron fumes or dust was 35%. Due to the high to siderosis, an accumulation of iron in the lungs (14,
correlation of exposure to iron fumes or dust and welding 22, 23), interstitial pulmonary fibrosis, or siderofibrosis
fumes in several occupational categories, the observed (24), which have been suspected to be associated with an
excess risk may not have been allocated accurately be- increased risk of lung cancer (25, 26). IARC has defined
tween these two exposures. Simultaneous exposure to iron welding fumes as possibly carcinogenic to humans (27).
fumes or dust, welding fumes and other potential lung The IARC evaluation of carcinogenicity did not differen-
carcinogens at the workplace complicated the interpreta- tiate between exposure to stainless steel welding and mild
tion of the independent roles of the risk factors. steel welding, although some previous studies explain the
A restriction of the analysis to categories without carcinogenic effects as being predominantly related to
major exposure to the potential confounding agents stainless steel welding. A slight excess risk of lung cancer
tended to give slightly higher risk estimates and to illus- was suggested in most of the studies among welders, in-
trate the exposure��������������������������
–�������������������������
response characteristics. The risk re- cluding stainless steel, mild steel, and unspecified welding

Scand J Work Environ Health 2008, vol 34, no 6 447

Iron and welding fume exposure and the risk of lung cancer

Table 2. Observed number of cases and the relative risk (RR) and 95% confidence interval (95% CI) for lung cancer, with a 20-year latency
period for cumulative exposure to iron fumes or dust among the Finnish men who were born in 1906–1946 and who participated in the
population census in 1970. The workers who had simultaneous high or medium exposure to welding fumes, nickel, chromium, lead, or
benzo(a)pyrene were excluded.

Exclusion due to concurrent work-related co-exposure Cumulative exposure to iron fumes or dust

Low Medium High

(0.1–9.9 mg/m3-years) (10–49.9 mg/m3-years) (≥50 mg/m3-years)

Observed RR a 95% CI Observed RR a 95% CI Observed RR a 95% CI

cases cases cases
(N) (N) (N)

No exclusion 2536 1.11 1.06–1.16 311 1.10 0.97–1.23 61 1.35 1.05–1.73

Categories with ≥100 mg/m3-years of
exposure to welding fumes 2341 1.10 1.05–1.15 282 1.08 0.96–1.22 4 1.33 0.50–3.55
Categories with ≥200 mg/m3-years of
exposure to welding fumes 2494 1.11 1.06–1.15 306 1.10 0.97–1.24 50 1.54 1.17–2.04
Categories with medium and high exposure to
nickel or chromium or lead or benzo(a)pyrene 1156 1.09 1.03–1.75 45 1.26 0.94–1.69 57 1.35 1.04–1.75
Categories with high exposure to nickel or
chromium or lead or benzo(a)pyrene 2460 1.11 1.07–1.16 137 1.27 1.08–1.51 57 1.35 1.04–1.75
Categories with medium and high exposure to welding
fumes or nickel or chromium or lead or benzo(a)pyrene 975 1.07 1.00–1.14 21 1.23 0.80–1.88 0 – –
Categories with high exposure to welding fumes or
nickel or chromium or lead or benzo(a)pyrene 2418 1.11 1.06–1.16 132 1.28 1.08–1.52 46 1.57 1.17–2.09

a Adjusted for smoking, exposure to asbestos and silica, socioeconomic status, age, and periods of follow-up, the reference category being workers unex-
posed to iron.

Table 3. Observed number of cases and the relative risk (RR) and 95% confidence interval (95% CI) for lung cancer, with a 20-year la-
tency period for cumulative exposure to welding fumes, among the Finnish men who were born in 1906–1946 and who participated in the
population census in 1970. Workers who had simultaneous high or medium exposure to iron, nickel, chromium, lead, and benzo(a)pyrene
were excluded.

Exclusion dueto
Excluded due toconcurrent
concurrentwork-related
work-relatedco-exposure
co-exposure Cumulative exposure to welding fumes

Low Medium High

(0.1–99.9 mg/m3-years) (100–199.9 mg/m3-years) (≥200 mg/m3-years)

Observed RR a 95% CI Observed RR a 95% CI Observed RR a 95% CI

cases cases cases
(N) (N) (N)

No exclusion 2591 1.09 1.05–1.14 287 1.16 1.03–1.31 67 1.15 0.90–1.46

Categories with ≥10 mg/m3-years of exposure
to iron 2305 1.10 1.05–1.15 217 1.09 0.95–1.65 51 1.25 0.95–1.65
Categories with ≥50 mg/m3-years of exposure
to iron 2587 1.09 1.05–1.14 241 1.11 0.98–1.26 56 1.23 0.95–1.61
Categories with medium and high exposure to nickel
or chromium or lead or benzo(a)pyrene 926 1.07 1.00.1.15 213 1.31 1.14–1.50 49 1.13 0.85–1.50
Categories with high exposure to nickel or chromium
or lead or benzo(a)pyrene 2332 1.10 1.06–1.16 275 1.18 1.04–1.33 58 1.11 0.86–1.44
Categories with medium and high exposure to iron or
nickel or chromium or lead or benzo(a)pyrene 905 1.07 1.00–1.15 143 1.25 1.06–1.47 38 1.24 0.90–1.71
Categories with high exposure to iron or nickel or
chromium or lead or benzo(a)pyrene 2332 1.10 1.06–1.16 229 1.12 0.98–1.28 47 1.19 0.90–1.59

a Adjusted for smoking, exposure to asbestos and silica, socioeconomic status, age, and periods of follow-up, the reference category being workers unex-
posed to welding fumes.

(4, 5, 28). In our study, we found a higher standardized suggested to contribute to the generation of reactive oxy-
incidence ratio for mild steel welders in comparison with gen or nitrogen species, which may lead to cancer (30).
stainless steel welders (table 1). The general problems in previous studies include too
The mechanism of carcinogenicity for welding fumes short a follow-up and inadequate control of occupational
is unresolved. Exposure to any kind of granular biodu- co-exposures and other confounders. For instance, ship-
rable particles may lead to lung cancer, as reported in a yard welders and car mechanics could have had exposure
series of animal studies (29). Iron particles have also been to asbestos, smelters and foundry workers to silica and

448 Scand J Work Environ Health 2008, vol 34, no 6

 Siew et al

Table 4. Observed number of cases and the relative risk (RR) and 95% confidence interval (95% CI) for lung cancer according to its three
main types and all types with a 20-year latency period, for cumulative exposure to iron fumes or dust among the Finnish men who were
born in 1906–1946 and who participated in the population census in 1970.

Cancer type Cumulative exposure to iron fumes or dust

None Low Medium High

(0.1–10 mg/m3 -years) (10.1–49.9 mg/m3 -years) (≥50 mg/m3 -years)

Observed RR a 95% CI Observed RR a 95% CI Observed RR a 95% CI Observed RR a 95% CI

cases (N) cases (N) cases (N) cases (N)

All lung cancers 27229 1.00 ·· 2536 1.11 1.06–1.16 311 1.10 0.97–1.23 61 1.35 1.05–1.73
Squamous-cell carcinoma 9292 1.00 ·· 853 1.08 1.00–1.16 109 1.16 0.95–1.41 30 1.94 1.35–2.78
Small-cell carcinoma 4652 1.00 ·· 475 1.21 1.09–1.33 58 1.16 0.88–1.52 7 0.98 0.47–2.01
Adenocarcinoma 3392 1.00 ·· 336 1.07 0.95–1.21 38 1.15 0.83–1.61 8 1.49 0.74–2.98

a Adjusted for smoking, exposure to asbestos and silica, socioeconomic status, age, and periods of follow-up, the reference category being unexposed
workers.

Table 5. Observed number of cases and the relative risk (RR) and 95% confidence interval (95% CI) for lung cancer according to its three
main types and all types with a 20-year latency period, for cumulative exposure to welding fumes among the Finnish men who were born
in 1906–1946 and who participated in the population census in 1970.

Cancer type Cumulative exposure to welding fumes

None Low Medium High

(0.1–10 mg/m3 -years) (10.1–49.9 mg/m3 -years) (≥50 mg/m3 -years)

Observed RR a 95% CI Observed RR a 95% CI Observed RR a 95% CI Observed RR a 95% CI

cases (N) cases (N) cases (N) cases (N)

All lung cancers 27192 1.00 ·· 2591 1.09 1.05–1.14 287 1.16 1.03–1.31 67 1.15 0.90–1.46
Squamous-cell carcinoma 9275 1.00 ·· 870 1.07 0.99–1.15 110 1.26 1.04–1.53 29 1.55 1.08–2.24
Small-cell carcinoma 4570 1.00 ·· 479 1.15 1.04–1.27 46 1.10 0.82–1.48 7 0.83 0.40–1.75
Adenocarcinoma 3379 1.00 ·· 342 1.08 0.95–1.21 46 1.42 1.06–1.91 7 1.14 0.54–2.40
a
Adjusted for smoking, exposure to asbestos and silica, socioeconomic status, age, and periods of follow-up, the reference category being unexposed
workers.

benzo(a)pyrene (in the FINJEM, benzo(a)pyrene is an study. The adjustment for social class often gives the
indicator for polyclic aromatic hydrocarbons), plumbers same results as the use of carefully collected data on
and some subgroups of welders to asbestos, silica and specific lifestyle factors (32). Therefore we adjusted the
benzo(a)pyrene, and sheet metal workers to nickel and relative risks for socioeconomic status.
chromium. We minimized the effect of confounding by Although, nowadays in Finland, smoking coincides
adding exposure to asbestos, silica, and smoking to the with poor socioeconomic status, in our modeling, smok-
models and excluding worker groups with high exposure ing had an effect on lung cancer that was partially inde-
to confounders from the study population. pendent of social class and was therefore included in the
The strengths of our study were the large popu- final model. Our smoking data (1978–1991) are partially
lation-based cohort, a sufficient latency period, the too recent in terms of the causation of the cancers di-
high-coverage data on incident cancer cases from the agnosed in 1971–1995. An adjustment based on these
Finnish Cancer Register, and the availability of exposure smoking data might have biased the relative risk estimates
estimates for major confounders. The identification of if the recent occupation-specific smoking habits did not
the cohort and the follow-up for incident cancer cases, correlate with those in earlier decades. Fortunately the
emigration, and vital status are virtually complete (17). time trends for smoking among Finnish men have shown a
Stability is relatively high in most occupations (31), and rather parallel decrease in most population subgroups, and
therefore the cross-sectional information on occupation therefore it is justified to use the smoking estimates from
corresponds rather well to life-long occupational his- 1978–1991 to represent the long-time relative differences
tory. This correspondence is especially true for the older in smoking prevalence (16). Still, as in any study related
populations in Finland, whose turnover rate between to the etiology of lung cancer, residual confounding may
occupations is low. have had an effect on the relative risk estimates.
Social class was a satisfactory approximation for a The current FINJEM-based method has been adopted
whole range of lifestyle-related factors in the present for the analysis of registered-based data sets in studies in

Scand J Work Environ Health 2008, vol 34, no 6 449

Iron and welding fume exposure and the risk of lung cancer

European countries, and this study method replicates a cup Environ Med. 1998;55(6):387–92.
risk ratio similar to that found in previous studies (16). 13. Moulin JJ, Clavel T, Roy D, Dananche B, Marquis N, Fevotte
J, et al. Risk of lung cancer in workers producing stainless
The ecological fallacy that theoretically might dilute or
steel and metallic alloys. Int Arch Occup Environ Health.
artificially create associations in a study based on ag- 2000;73(3):171–80.
gregated data like the current one has been a problem in 14. Billings CG, Howard P. Occupational siderosis and welders’
earlier studies in which it has been possible to compare lung: a review. Monaldi Arch Chest Dis. 1993;48(4):304–14.
relative risks derived from individual-level data and 15. Central Statistical Office of Finland. Population Census 1970:
group-level data (32). occupation and social position. Helsinki: Central Statistical
Office of Finland; 1974.
In conclusion, our study suggests that iron fumes or
16. Pukkala E, Guo J, Kyyrönen P, Lindbohm M, Sallmén M,
dust and welding fumes may have caused an elevated Kauppinen T. National job-exposure matrix in analyses of
risk of lung cancer among Finnish male workers. Si- census-based estimates of occupational cancer risk. Scand J
multaneous exposure to other potential lung carcinogens Work Environ Health. 2005;31(2):97–107.
in the workplace may have affected these results. The 17. Teppo L, Pukkala E, Lehtonen M. Data quality and quality
clustering of the excess risk especially with regard to control of a population-based cancer registry: experience in
Finland. Acta Oncol. 1994;33(4):365–9.
squamous-cell cancer is a new finding and requires
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further investigation. The possible synergic and antago- Finnish adult population. Helsinki: Finnish National Public
nistic effects of the mixed exposures are a challenge for Health Institute; 1992. 130 p.
future studies on exposure to iron fumes or dust and 19. Hoshuyama T, Pan G, Tanaka C, Feng Y, Yu L, Liu T, et al. Mor-
welding fumes. tality of iron-steel workers in Anshan, China: a retrospective co-
hort study. Int J Occup Environ Health. 2006;12(3):193–202.
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