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Occupational and nonoccupational factors associated with high grade bronchial pre-invasive lesions

Depts of ¹ Occupational Diseases, ² Biostatistics, ³ Pneumology, and the⁴ Pathology Laboratory, Rouen University Hospital

CORRESPONDENCE: C. Paris, Occupational Diseases Dept, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France. Fax: 33 232888184. E-mail: christophe.paris@chu-rouen.fr

Keywords: asbestos, bronchoscopy, lung neoplasms, occupational exposure

Received: January 1, 2002
Accepted September 30, 2002

This research was supported by a "Programme Hospitalier de Recherche Clinique" grant from the French Ministry of Research (1996).

Besides tobacco exposure, factors associated with the development of pre-invasive bronchial lesions are not known. Autofluorescence bronchoscopy was used to assess the prevalence of severe dysplasia and carcinoma in situ (SD/CIS) of the proximal bronchial tree in relation to occupational or nonoccupational carcinogen exposure.

Among the 241 individuals in this study, the overall prevalence of at least one SD/CIS was 9% (21 subjects). Multivariable analysis revealed significant and independent associations between presence of SD/CIS and: 1) active smoking, relative to former smokers; 2) presence of synchronous invasive lung cancer; 3) duration of asbestos exposure and; 4) exposure to other occupational carcinogens.

The independent associations of synchronous lung cancer with severe dysplasia and carcinoma, after adjusting for both occupational and nonoccupational carcinogen exposures, suggest other mechanisms than a field cancerisation may be involved in the carcinogenesis of these pre-invasive lesions. Moreover, active smokers, patients with recently resected invasive lung cancer and workers occupationally exposed to bronchial carcinogens may represent a population of choice for early cancer endoscopic detection programmes in view of their high severe dysplasia and carcinoma prevalence.

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