ORIGINAL ARTICLE Occupation and Head and Neck Cancer Risk in Men Results From the ICARE Study, a French Population-Based Case–Control Study Sophie Paget-Bailly, PhD, Florence Guida, PharmD, PhD, Matthieu Carton, MD, Gwenn Menvielle, PhD, Loredana Rado¨ ı, DDS, PhD, Diane Cyr, MS, Annie Schmaus, MS, Sylvie C´ en´ ee, MS, Alexandra Papadopoulos, PhD, Jo¨ elle F´ evotte, MS, Corinne Pilorget, PhD, Michel Velten, MD, Anne-Val´ erie Guizard, MD, Isabelle St¨ ucker, PhD, and Dani` ele Luce, PhD Objective: To investigate the associations between occupations and head and neck (HN) cancer risk in men. Methods: ICARE is a French population- based case–control study on HN cancer. Analyses included 1833 cases and 2747 controls. Complete occupational history was collected. Odds ratios (ORs) were estimated for occupations and industries ever held and according to duration of employment. Results: Elevated ORs, increasing with duration of employment, were observed for several occupations, including cleaners (OR = 1.7; 95% confidence interval [CI], 1.0 to 2.8), launderers (OR = 6.8; CI, 1.3 to 34.4), firefighters (OR = 3.9; CI, 1.4 to 11.2), several agricultural occupations, welders (OR = 1.9; CI, 1.3 to 2.8), structural metal preparers and erectors (OR = 2.1; CI, 1.2 to 3.7), rubber workers (OR = 2.0; CI, 1.0 to 3.9), several construction occupations, and material-handling equipment operators (OR = 1.8; CI, 1.1 to 2.9). Analyses by industry corroborated these findings. Conclusions: These results confirmed the role of occupational exposures in HN cancer. F rance experiences a particularly high incidence of cancers of oral cavity (OC), pharynx, and larynx, which are the most fre- quent head and neck (HN) cancers. Incidence of these malignant neoplasms is one of the highest in the world, with almost 14,000 esti- mated new cases in 2011. 1 The two major risk factors are alcohol and tobacco consumption, which seem to have a joint effect greater than From the Inserm, Centre for Research in Epidemiology and Population Health, U1018, Epidemiology of Occupational and Social Determinants of Health Team (Dr Paget-Bailey, Dr Carton, Dr Menvielle, Dr Rado¨ ı, Ms Cyr, Ms Schmaus, and Dr Luce) and Environmental Epidemiology of Cancer Team (Dr Guida, Ms C´ en´ ee, Dr Papadopoulos, and Dr St¨ ucker), Villejuif, France; University Versailles St-Quentin (Dr Paget-Bailly, Dr Carton, Dr Menvielle, Dr Rado¨ ı, Ms Cyr, Ms Schmaus, and Dr Luce), Versailles, France; Univer- sity Paris-Sud (Dr Guida, Ms C´ en´ ee, Dr Papadopoulos, and Dr St¨ ucker), UMRS1018, Villejuif, France; University Lyon 1 (Ms F´ evotte and Dr Pilor- get), Unit´ e mixte de recherche ´ epid´ emiologique et de surveillance en transport, travail et environment (Umrestte), Lyon, France; Institut de Veille Sanitaire (Dr Pilorget), D´ epartement Sant´ e Travail, Saint Maurice, France; Bas-Rhin Cancer Registry (Dr Velten), Strasbourg, France; and Calvados Cancer Reg- istry (Dr Guizard), Caen, France. The ICARE study was supported by the French National Research Agency (ANR); the French National Cancer Institute (INCA); the French Agency for Food, Environmental and Occupational Health and Safety (ANSES); the French Institute for Public Health Surveillance (InVS); Fondation pour la Recherche M´ edicale (FRM); Fondation de France; Association pour la Recherche sur le Cancer (ARC); Ministry of Labour (Direction G´ en´ erale du Travail); Ministry of Health (Direction G´ en´ erale de la Sant´ e). Sophie Paget-Bailly received funds from the Health Environment Toxicology program (SEnT) of the Ile-de France regional council (Conseil regional d’Ile de France) and from La Ligue contre le cancer for this work. The authors declare that they have no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.joem.org). Address correspondence to: Dani` ele Luce, PhD, Hˆ opital Paul Brousse, Bˆ atiment 15/16, 16, avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France (daniele.luce@inserm.fr). Copyright C  2013 by American College of Occupational and Environmental Medicine DOI: 10.1097/JOM.0b013e318298fae4 multiplicative on HN cancer risk. 2 Diet, 3 viral infection by human papillomavirus, 4 and socioeconomic status 5 could also be associated with these cancers. Occupational exposures could explain partly the wide social inequalities that are observed. 6 Thus, some occupational exposures are confirmed risk factors. Exposures to asbestos 7 and strong acid mists 8 are known to be associated with laryngeal cancer. Several other exposures have been suggested to be associated with HN cancer, such as polycyclic aromatic hydrocarbons, 9,10 textile dust, 10 working in the rubber industry, 10 metal working fluids, 11 and man-made vitreous fibers. 12 . Some case–control studies 13–28 have investigated the associations between occupations and cancer of the OC, pharynx, and larynx. Nevertheless, most of these studies have small sample size and the associations between occupational expo- sures and HN cancer remain unclear to a large extent. The ICARE study, which is currently one of the largest population-based case– control studies on occupational risk factors and HN cancer, should allow a better understanding on this topic. The objective of this study was to examine the associations between occupations and industries and HN cancer risk, to generate hypotheses for further analyses. Because occupations and occupa- tional exposures are likely to differ between men and women, 29 the present analyses were restricted to men; results for women will be presented in another publication. METHODS Study Population The design of the study has been detailed previously. 30 Briefly, ICARE is a multicenter population-based case–control study, con- ducted in France in 10 departments (geographic and administrative areas) covered by cancer registries, which included a group with lung cancer, a group with HN cancer, and a common control group. All incident primary cancer cases of the HN diagnosed between 2001 and 2007 were included, comprising malignant neoplasms of lip, OC, and pharynx (International Classification of Diseases for Oncology, Third Edition (ICD-O-3) code: C00-C14), nasal cavity and acces- sory sinuses (C30.0, C31), and larynx (C32). Included cases were all histologically confirmed cases, aged 18 to 75 years at diagnostic. All histological types were included. Controls were selected from the general population of the de- partments included in the study, by list-assisted random digit dialing sampling, using incidence density sampling method. A random sam- ple of listed numbers was first drawn from telephone directories. By incrementing each number by one, a list of random numbers was then obtained and allowed to reach unlisted numbers. Controls were frequency-matched to the cases by sex, age, and residence area (de- partments), on the basis of the distribution of all cases (lung and HN cancers). Additional stratification was used to achieve a distribution by socioeconomic status among the controls comparable to that of the general population in the department. Subjects were interviewed face to face by specially trained interviewers. The standardized questionnaire included sociodemo- graphic data, lifetime smoking history, and lifetime alcohol-drinking Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. JOEM  Volume 55, Number 9, September 2013 1065