Occupational Exposures and Risk of Stomach and Esophageal Cancers: Update of a Cohort of Female Textile Workers in Shanghai, China Lisa G. Gallagher, DSc, 1 Wenjin Li, MD, PhD, 2 Roberta M. Ray, MS, 2 Megan E. Romano, PhD, 3 Karen J. Wernli, PhD, 4 DaoL.Gao, MD, 5 David B. Thomas, MD, DrPH, 2,6 and Harvey Checkoway, PhD 7 Background Associations between stomach and esophageal cancer and exposures to dusts, metals, chemicals, and endotoxin in the workplace are not very well understood, particularly in women. Methods We followed 267,400 female textile workers in Shanghai, China for cancer incidence from 1989 to 2006. Stomach (n ¼ 1374) and esophageal (n ¼ 190) cancer cases were identified and a comparison subcohort (n ¼ 3187) was randomly selected. Cox proportional hazard modeling was used, adjusting for age and smoking. Results Increasing stomach cancer risk was observed with increasing duration of synthetic fiber dust exposure (p ¼ 0.03), although the magnitude of effect was small (20 þ years: HR ¼ 1.2, 95% CI 1.1–1.4). Trends with endotoxin exposure were modestly inversed for esophageal cancer and increased for stomach cancer, but with little deviation from a null association. Conclusions Our findings demonstrate that long durations of synthetic fiber dust exposure can increase stomach cancer risk in women, but provide limited support for associations with other textile industry exposures. Am. J. Ind. Med. ß 2015 Wiley Periodicals, Inc. KEY WORDS: cohort; cancer; China; endotoxin; textiles INTRODUCTION Rates of stomach and esophageal cancer in Eastern Asia are among the highest in the world [Jemal et al., 2011]. Tobacco use and excessive alcohol consumption are risk factors for both diseases [Jemal et al., 2011]. Dietary factors, specifically low intake of fruits and vegetables and high intake of salted and preserved foods, and Helicobacter pylori infection may increase risk of stomach cancer [Jemal et al., 2011]. Obesity and chronic gastroesophageal reflux disease, which triggers Barrett’s esophagus, may increase the risk of esophageal cancer, although primarily in Western countries, whereas smokeless tobacco and betel liquid increase risk mainly in Asian countries. Both of these cancers are more common in men than women [Jemal et al., 2011], however, given the low prevalence of many of the known risk factors among women, 1 Department of Environmental and Occupational Health Sciences, University of Washington, Seattle,Washington 2 Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle,Washington 3 Center for Environmental Health and Technology, Brown University, Providence, Rhode Island 4 Group Health Research Institute, Seattle,Washington 5 Zhong Shan Hospital Cancer Center, Shanghai,China 6 Department of Epidemiology,University of Washington, Seattle,Washington 7 Department of Family & Preventive Medicine,University of California San Diego, San Diego,California Contract grant sponsor: The National Cancer Institute at the National Institutes of Health; Contractgrantnumber:R01CA80180.  Correspondence to: Lisa G. Gallagher, DSc, Department of Environmental and Occupational Health Sciences, University of Washington, Box 357234, Seattle,WA 98195. E-mail:lgallag@u.washington.edu Accepted 6 November 2014 DOI10.1002/ajim.22412.PublishedonlineinWileyOnline Library (wileyonlinelibrary.com). AMERICAN JOURNAL OF INDUSTRIAL MEDICINE ß 2015 Wiley Periodicals, Inc.