Quantitative relationship between silica exposure and lung cancer mortality in German uranium miners, 1946–2003

BACKGROUND: In 1996 and 2009, the International Agency for Research on Cancer classified silica as carcinogenic to humans. The exposure–response relationship between silica and lung cancer risk, however, is still debated. Data from the German uranium miner cohort study were used to further investigate this relationship. METHODS: The cohort includes 58 677 workers with individual information on occupational exposure to crystalline silica in mg m(−3)-years and the potential confounders radon and arsenic based on a detailed job-exposure matrix. In the follow-up period 1946–2003, 2995 miners died from lung cancer. Internal Poisson regression with stratification by age and calendar year was used to estimate the excess relative risk (ERR) per dust-year. Several models including linear, linear quadratic and spline functions were applied. Detailed adjustment for cumulative radon and arsenic exposure was performed. RESULTS: A piecewise linear spline function with a knot at 10 mg m(−3)-years provided the best model fit. After full adjustment for radon and arsenic no increase in risk <10 mg m(−3)-years was observed. Fixing the parameter estimate of the ERR in this range at 0 provided the best model fit with an ERR of 0.061 (95% confidence interval: 0.039, 0.083) >10 mg m(−3)-years. CONCLUSION: The study confirms a positive exposure–response relationship between silica and lung cancer, particularly for high exposures.