{
  "abstract": "Objective Hexavalent chromium (Cr(VI)) is a human carcinogen. It is unclear whether Cr(VI) can cause cancer of the small intestine, oral cavity, pancreas, prostate and urinary bladder. We performed a systematic review and meta-analyses of epidemiological studies on occupational exposure to Cr(VI) and incidence and mortality of these cancer sites.Material and Methods A comprehensive review of human studies on Cr(VI) and cancer was performed in Embase and Scopus. 131 potentially relevant epidemiological studies were identified. Study quality was assessed using Newcastle-Ottawa Scale. 29 publications including 81 observations for meta-analyses were based on cohort or case-control studies with exposure assessment of sufficient quality. Site-specific random-effects meta-analyses were done separately for incidence and mortality. Sensitivity analyses focused on the studies with the highest quality scores.Results No indications for an association between Cr(VI) exposure and oral or small intestine cancer were found. Incidence of pancreatic cancer was not associated with Cr(VI) exposure (meta-RR 1.04; 95%CI 0.85-1.28) while for specific mortality RR was 1.41 (0.96-2.08) with moderate heterogeneity (I2=41%) and an asymmetric funnel plot (Egger’s test; p=0.002). For incidence of prostate cancer meta RR was 1.16 (0.99-1.37) while the RR for mortality was 1.03 (0.84-1.25). For bladder cancer, RR was 1.04 (0.91-1.20) for incidence and 1.76 (1.20-2.60) for mortality.Conclusion There are indications that pancreas, prostate and bladder cancer may be related to occupational exposure to Cr(VI) compounds, but in the meta-analyses sufficient evidence was not provided. For oral cavity and small intestine cancer, reported indications from animal models were not supported by human studies.",
  "authors": [
    {
      "affiliations": [
        "RIVM (National Institute for Public Health and the Environment) Centre for Sustainability, Environment and Health, RIVM. IRAS, Utrecht University"
      ],
      "name": "Jan-Paul Zock"
    },
    {
      "affiliations": [
        "RIVM (National Institute for Public Health and the Environment) Centre for Sustainability, Environment and Health, RIVM. IRAS, Utrecht University"
      ],
      "name": "Kelly J Rijs"
    },
    {
      "affiliations": [
        "RIVM (National Institute for Public Health and the Environment) Centre for Sustainability, Environment and Health, RIVM. IRAS, Utrecht University"
      ],
      "name": "Susan Peters"
    },
    {
      "affiliations": [
        "RIVM (National Institute for Public Health and the Environment) Centre for Sustainability, Environment and Health, RIVM. IRAS, Utrecht University"
      ],
      "name": "Jelle J Vlaanderen"
    }
  ],
  "title": "8234966 Occupational exposure to chromium(VI) and five selected cancer sites: systematic review and meta-analyses",
  "uid": "0cd78417-5e68-5402-b3dc-bdee9c25eb00"
}