Occupational Risk Factors for Lung Cancer among U. S. Women

Purpose Lung cancer accounts for 29% of cancer deaths among U.S. women, i.e., 162,460 estimated deaths in 2006. Between 2–20% of lung cancer deaths in women are estimated to be due to classic industrial lung carcinogens, or workplace exposure to side-stream smoke or radon. There are a limited number of studies of occupational lung cancer in women. Our aim was to identify occupations and industries with elevated proportionate lung cancer mortality among working women, and to focus attention on preventable occupational risk factors for lung cancer. Methods We reviewed the scientific literature on risk factors for occupational lung cancer in women, and undertook a race-specific proportionate mortality (PMR) analysis of nearly 4 million deaths among women who died from 1984–1998 in the 28 U.S. states that code industry sector and occupation on death certificates. Results Industries with significantly elevated proportionate mortality ratios (PMRs) accounting for the largest number of lung cancer deaths among white working women during the 15-year period were eating and drinking places (PMR=136; n=7783 deaths), hotels and motels (PMR=135; n=1422), several wholesale and retail trades (PMRs range 126–145; n=1405 deaths), several manufacturing sub-sectors (PMRs range 126–142; n=2108), real estate (PMR=137; n=1863), and construction (PMR=125; n=940). Industries accounting for excess lung cancer deaths among white and black women were entertainment and recreation services (PMR=136 white women, PMR=143 black women; n=1209), beauty and barber shops (PMR=124 white women, PMR=122 black women; n=2274), and among black women, public administration (PMR=147; n=718). Focusing on occupation, our analysis revealed significant excess proportionate lung cancer mortality among white women working as waitresses (PMR=152), in sales (PMR=139), as legislative and public administrators (PMR=130), and as managers or administrators (PMR=130). Among black women, financial officers (PMR=175) and receptionists (PMR=183) also experienced excess lung cancer deaths. Conclusion Women experience significant excess lung cancer mortality associated with occupation. Review of potential exposures in the occupations and industry sectors with elevated lung cancer PMRs suggested several potential lung carcinogens. Workplace exposure to cigarette smoke is a risk factor in some of these industries and occupations, e.g., occupations in the hospitality industry. Other possible explanatory factors in some work environments include a number of known occupational carcinogens. Our findings suggest a need for additional research on occupational risk factors for lung cancer among women working in a wide range of industrial and white collar settings.