{
  "abstract": "Objective The association between occupational exposure to chlorinated solvents and lung cancer remains inconclusive. This study investigated this relationship using data from the internationally pooled SYNERGY study.Methods Data from 14 case–control studies conducted in 13 European countries and Canada were pooled, including 28 048 participants (12 329 cases and 15 719 controls). Lifetime occupational exposure to chlorinated solvents was assessed using the ALOHA+job-exposure matrix. ORs and 95% CIs were estimated using unconditional logistic regression, adjusted for study centre, age, sex, smoking (pack-years and cessation), cumulative exposure to five occupational lung carcinogens (asbestos, hexavalent chromium, polycyclic aromatic hydrocarbons, respirable crystalline silica and diesel engine exhaust), cumulative benzene exposure and employment in high-risk occupations (‘List A’ jobs). Associations were estimated across categories of exposure levels, durations and analyses stratified by smoking status and lung cancer subtypes.Results We found no evidence of an association between ever exposure to chlorinated solvents and lung cancer risk (OR 1.03; 95% CI 0.96 to 1.10). Among exposed individuals, a positive trend with cumulative exposure was observed (p=0.031), but not when non-exposed individuals were included (p=0.173). Positive trends were found with exposure duration (p=0.005 for exposed; p=0.048 overall); risks were modestly elevated (OR 1.11) in those exposed for 20 or more years. No increased risk was observed across smoking strata or lung cancer subtypes.Conclusions This pooled analysis provides limited evidence of an association between occupational exposure to chlorinated solvents and lung cancer, though exposure-response trends were noted among exposed individuals.",
  "authors": [
    {
      "affiliations": [
        "Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands",
        "International Agency for Research on Cancer (IARC/WHO), Lyon, France"
      ],
      "name": "Wenxin Wan"
    },
    {
      "affiliations": [
        "Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands"
      ],
      "name": "Roel Vermeulen"
    },
    {
      "affiliations": [
        "Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands"
      ],
      "name": "Lützen Portengen"
    },
    {
      "affiliations": [
        "International Agency for Research on Cancer (IARC/WHO), Lyon, France"
      ],
      "name": "Ann Olsson"
    },
    {
      "affiliations": [
        "International Agency for Research on Cancer (IARC/WHO), Lyon, France"
      ],
      "name": "Joachim Schüz"
    },
    {
      "affiliations": [
        "International Agency for Research on Cancer (IARC/WHO), Lyon, France"
      ],
      "name": "Wendy Bijoux"
    },
    {
      "affiliations": [
        "Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany"
      ],
      "name": "Wolfgang Ahrens"
    },
    {
      "affiliations": [
        "Université de Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Pointe-à-Pitre, France"
      ],
      "name": "Christine Barul"
    },
    {
      "affiliations": [
        "Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany"
      ],
      "name": "Thomas Behrens"
    },
    {
      "affiliations": [
        "Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany"
      ],
      "name": "Thomas Brüning"
    },
    {
      "affiliations": [
        "Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA"
      ],
      "name": "Neil E Caporaso"
    },
    {
      "affiliations": [
        "Occupational Health Unit, IRCCS Foundation Maggiore Policlinico Hospital, Milan, Italy"
      ],
      "name": "Dario Consonni"
    },
    {
      "affiliations": [
        "Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada"
      ],
      "name": "Paul A Demers"
    },
    {
      "affiliations": [
        "Regional Authority of Public Health, Banská Bystrica, Slovakia",
        "Catholic University in Ruzomberok, Ružomberok, Slovakia"
      ],
      "name": "Eleonora Fabianova"
    },
    {
      "affiliations": [
        "Health Research Institute of Asturias, University of Oviedo, ISPA and CIBERESP, Oviedo, Spain"
      ],
      "name": "Guillermo Fernández-Tardón"
    },
    {
      "affiliations": [
        "Roy Castle Lung Cancer Research Programme, Cancer Research Centre, University of Liverpool, Liverpool, UK"
      ],
      "name": "John Field"
    },
    {
      "affiliations": [
        "Department of Epidemiology—Regional Health Service, ASL Roma 1, Roma, Italy"
      ],
      "name": "Francesco Forastiere"
    },
    {
      "affiliations": [
        "Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic"
      ],
      "name": "Lenka Foretova"
    },
    {
      "affiliations": [
        "Netherlands Organization for Applied Scientific Research, Utrecht, The Netherlands"
      ],
      "name": "Calvin B Ge"
    },
    {
      "affiliations": [
        "Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Per Gustavsson"
    },
    {
      "affiliations": [
        "Faculty of Health Sciences, Palacky University Olomouc, Olomouc, Czech Republic"
      ],
      "name": "Vladimir Janout"
    },
    {
      "affiliations": [
        "Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany"
      ],
      "name": "Karl-Heinz Jöckel"
    },
    {
      "affiliations": [
        "Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich, München, Germany",
        "Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany"
      ],
      "name": "Stefan Karrasch"
    },
    {
      "affiliations": [
        "Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany"
      ],
      "name": "Benjamin Kendzia"
    },
    {
      "affiliations": [
        "Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA"
      ],
      "name": "Maria Teresa Landi"
    },
    {
      "affiliations": [
        "Department of Cancer Epidemiology and Prevention, Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland"
      ],
      "name": "Jolanta Lissowska"
    },
    {
      "affiliations": [
        "National Institute of Public Health, Bucharest, Romania"
      ],
      "name": "Dana Mates"
    },
    {
      "affiliations": [
        "University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada"
      ],
      "name": "John McLaughlin"
    },
    {
      "affiliations": [
        "Department of Medical Sciences, Cancer Epidemiology Unit, University of Turin, Turin, Italy"
      ],
      "name": "Franco Merletti"
    },
    {
      "affiliations": [
        "Department of Medical Sciences, Cancer Epidemiology Unit, University of Turin, Turin, Italy"
      ],
      "name": "Enrica Migliore"
    },
    {
      "affiliations": [
        "Directorate for Laboratory and Methodology, National Centre for Public Health and Pharmacy, Budapest, Hungary",
        "Department of Public Health Sciences, Faculty of Health Sciences, Semmelweis University Budapest, Budapest, Hungary"
      ],
      "name": "Tamás Pándics"
    },
    {
      "affiliations": [
        "Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany"
      ],
      "name": "Hermann Pohlabeln"
    },
    {
      "affiliations": [
        "CESP Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, INSERM, Villejuif, France"
      ],
      "name": "Loredana Radoï"
    },
    {
      "affiliations": [
        "Department of Medical Sciences, Cancer Epidemiology Unit, University of Turin, Turin, Italy"
      ],
      "name": "Lorenzo Richiardi"
    },
    {
      "affiliations": [
        "First Faculty of Medicine, Institute of Hygiene and Epidemiology, Charles University, Prague, Czech Republic"
      ],
      "name": "Miriam Schejbalova"
    },
    {
      "affiliations": [
        "Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada"
      ],
      "name": "Jack Siemiatycki"
    },
    {
      "affiliations": [
        "Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland"
      ],
      "name": "Beata Świątkowska"
    },
    {
      "affiliations": [
        "Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany",
        "Institut für Medizinische Informatik Biometrie Epidemiologie, Ludwig-Maximilians-University of Munich, Munich, Germany"
      ],
      "name": "Heinz-Erich Wichmann"
    },
    {
      "affiliations": [
        "Department of Clinical Epidemiology, N.N. Blokhin National Research Centre for Oncology, Moscow, Russia"
      ],
      "name": "David Zaridze"
    },
    {
      "affiliations": [
        "ISGlobal, Barcelona, Spain",
        "Boston College, Chestnut Hill, Massachusetts, USA"
      ],
      "name": "Kurt Straif"
    },
    {
      "affiliations": [
        "Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands"
      ],
      "name": "Hans Kromhout"
    },
    {
      "affiliations": [
        "Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands"
      ],
      "name": "Susan Peters"
    }
  ],
  "title": "Occupational exposure to chlorinated solvents and lung cancer: results of the SYNERGY case–control study",
  "uid": "ac87e297-ec60-538a-ba70-90eea2ec31a7"
}