Lung Cancer Risk in Painters: A Meta-Analysis

OBJECTIVE: We conducted a meta-analysis to quantitatively compare the association between occupation as a painter and the incidence or mortality from lung cancer. DATA SOURCES: PubMed and the reference lists of pertinent publications were searched and reviewed. For the meta-analysis, we used data from 47 independent cohort, record linkage, and case–control studies (from a total of 74 reports), including > 11,000 incident cases or deaths from lung cancer among painters. DATA EXTRACTION: Three authors independently abstracted data and assessed study quality. DATA SYNTHESIS: The summary relative risk (meta-RR, random effects) for lung cancer in painters was 1.35 [95% confidence interval (CI), 1.29–1.41; 47 studies] and 1.35 (95% CI, 1.21–1.51; 27 studies) after controlling for smoking. The relative risk was higher in never-smokers (meta-RR = 2.00; 95% CI, 1.09–3.67; 3 studies) and persisted when restricted to studies that adjusted for other occupational exposures (meta-RR = 1.57; 95% CI, 1.21–2.04; 5 studies). The results remained robust when stratified by study design, sex, and study location and are therefore unlikely due to chance or bias. Furthermore, exposure–response analyses suggested that the risk increased with duration of employment. CONCLUSION: These results support the conclusion that occupational exposures in painters are causally associated with the risk of lung cancer.