Rationale: Although the carcinogenicity of diesel engine exhaust has been demonstrated in multiple studies, little is known regarding exposure-response relationships associated with different exposure subgroups and different lung cancer subtypes.Objectives: We expanded on a previous pooled case-control analysis on diesel engine exhaust and lung cancer by including three additional studies and quantitative exposure assessment to evaluate lung cancer and subtype risks associated with occupational exposure to diesel exhaust characterized by elemental carbon (EC) concentrations.Methods: We used a quantitative EC job-exposure matrix for exposure assessment. Unconditional logistic regression models were used to calculate lung cancer odds ratios and 95% confidence intervals (CIs) associated with various metrics of EC exposure. Lung cancer excess lifetime risks (ELR) were calculated using life tables accounting for all-cause mortality. Additional stratified analyses by smoking history and lung cancer subtypes were performed in men.Measurements and Main Results: Our study included 16,901 lung cancer cases and 20,965 control subjects. In men, exposure response between EC and lung cancer was observed: odds ratios ranged from 1.09 (95% CI, 1.00-1.18) to 1.41 (95% CI, 1.30-1.52) for the lowest and highest cumulative exposure groups, respectively. EC-exposed men had elevated risks in all lung cancer subtypes investigated; associations were strongest for squamous and small cell carcinomas and weaker for adenocarcinoma. EC lung cancer exposure response was observed in men regardless of smoking history, including in never-smokers. ELR associated with 45 years of EC exposure at 50, 20, and 1 μg/m3 were 3.0%, 0.99%, and 0.04%, respectively, for both sexes combined.Conclusions: We observed a consistent exposure-response relationship between EC exposure and lung cancer in men. Reduction of workplace EC levels to background environmental levels will further reduce lung cancer ELR in exposed workers.

Cancer Epidemiology Unit Department of Medical Sciences University of Turin and ll Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica in Piemonte Torino Italy

Center for research in Epidemiology and Population Health Cancer and Environment team Inserm U1018 University Paris Sud University Paris Saclay Villejuif France

Comprehensive Pneumology Center Munich Member of the German Center for Lung Research Munich Neuherberg Germany

Consiglio Nazionale delle Ricerche Istituto per la Ricerca e l'Innovazione Biomedica Palermo Italy

Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada

Department of Medical and Surgical Sciences University of Bologna Bologna Italy

Epidemiology Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy

Faculty of Health Catholic University Ružomberok Slovakia

Faculty of Health Sciences Palacky University Olomouc Czech Republic

Fundación para la Investigación e Innovación Biomédica en el Principado de Asturias Instituto de Investigación Sanitaria del Principado Oviedo Spain

INSERM U 1018 Villejuif France

Institut für Epidemiologie Deutsches Forschungszentrum für Gesundheit und Umwelt Neuherberg Germany; and

Institut für Medizinische Informatik Biometrie Epidemiologie Ludwig Maximilians University Munich Germany

Institut national de la recherche scientifique University of Quebec Laval Quebec Canada

Institute and Outpatient Clinic for Occupational Social and Environmental Medicine Inner City Clinic University Hospital of Munich Ludwig Maximilians Universität Munich Germany

Institute for Medical Informatics Biometry and Epidemiology University of Duisburg Essen Essen Germany

Institute for Risk Assessment Sciences Utrecht University Utrecht the Netherlands

Institute of Epidemiology Helmholtz Zentrum München German Research Center for Environmental Health Neuherberg Germany

Institute of Hygiene and Epidemiology 1st Faculty of Medicine Charles University Prague Czech Republic

International Agency for Research on Cancer Lyon France

Leibniz Institute for Prevention Research and Epidemiology BIPS Bremen Germany

Masaryk Memorial Cancer Institute Brno Czech Republic

National Cancer Institute Bethesda Maryland

National Institute of Public Health Bucharest Romania

National Public Health Center Budapest Hungary

Occupational Cancer Research Centre Cancer Care Ontario Toronto Ontario Canada

Regional Authority of Public Health Banská Bystrica Slovakia

Roy Castle Lung Cancer Research Programme Cancer Research Centre University of Liverpool Liverpool United Kingdom

Russian Cancer Research Centre Moscow Russia

The Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden

The M Sklodowska Curie National Research Institute of Oncology Warsaw Poland

The National Institute for Public Health and Environmental Protection Bilthoven the Netherlands

The Nofer Institute of Occupational Medicine Lodz Poland

Tisch Cancer Institute Icahn School of Medicine at Mount Sinai New York New York

Univ Rennes Inserm Ecole des hautes études en santé publique UMR_S 1085 Pointe à Pitre France

University of Montreal Hospital Research Centre University of Montreal Montreal Quebec Canada

Am J Respir Crit Care Med. 2020 Aug 1;202(3):317-319. doi: 10.1164/rccm.202004-1404ED. PubMed

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