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What this paper adds
The International Agency for Research on Cancer has classified occupational exposure as a painter as 'carcinogenic to humans', largely based on increased risks of lung and bladder cancer.
This meta-analysis quantitatively summarises all of the literature to date reporting on the association between occupational exposure as a painter and bladder cancer.
These results support the conclusion that occupational exposures in painters are causally associated with the risk of bladder cancer, after controlling for smoking, other occupational exposures, gender, study design and study location.
The robustness of the results is also indicated by the presence of a duration-response relationship, with higher RRs seen for exposure occurring for >10 years (meta-RR 1.81) when compared to <10 years of exposure (meta-RR 1.41) (the reference category was no exposure).
It is important for cancer control and prevention to design studies with more specific exposure assessment that quantifies individual agents or classes of agents to identify the underlying carcinogenic agents encountered in painting.
Introduction
The International Agency for Research on Cancer (IARC) estimated that bladder cancer is the 9th most common cancer diagnosis worldwide, with more than 330000 new cases each year and more than 130000 deaths per year. 1 Cigarette smoking is the most important risk factor for bladder cancer, accounting for approximately 66% of new cases in men and 30% of the cases in women in industrialised populations. 2 3 Much of this risk is likely due to the presence of aromatic amines in cigarette smoke, such as 2-naphthylamine, 4-aminobiphenyl and 4-chloro-ortho -toluidine. 4 An increased risk of bladder cancer has also been reported among workers in certain industries, such as rubber manufacture and painting, 5 that also involve exposure to the same aromatic amines found in cigarette smoke (eg, 2-naphthylamine, 4-aminobiphenyl). 4 6 The IARC has classified occupational exposure as a painter as 'carcinogenic to humans' (group 1). 5 7 8 Although the previous IARC group 1 evaluation was largely based on an increased risk of lung cancer in painters, in 2007 the IARC newly identified that there was sufficient evidence that occupational exposure as a painter causes bladder cancer.
Cohort and record linkage studies demonstrating a relatively consistent increased incidence and mortality from bladder cancer among painters 9-24 have supported the...