OBJECTIVES: We evaluated the risk of lung cancer associated with ever working as a painter, duration of employment and type of painter by histological subtype as well as joint effects with smoking, within the SYNERGY project. METHODS: Data were pooled from 16 participating case-control studies conducted internationally. Detailed individual occupational and smoking histories were available for 19 369 lung cancer cases (684 ever employed as painters) and 23 674 age-matched and sex-matched controls (532 painters). Multivariable unconditional logistic regression models were adjusted for age, sex, centre, cigarette pack-years, time-since-smoking cessation and lifetime work in other jobs that entailed exposure to lung carcinogens. RESULTS: Ever having worked as a painter was associated with an increased risk of lung cancer in men (OR 1.30; 95% CI 1.13 to 1.50). The association was strongest for construction and repair painters and the risk was elevated for all histological subtypes, although more evident for small cell and squamous cell lung cancer than for adenocarcinoma and large cell carcinoma. There was evidence of interaction on the additive scale between smoking and employment as a painter (relative excess risk due to interaction >0). CONCLUSIONS: Our results by type/industry of painter may aid future identification of causative agents or exposure scenarios to develop evidence-based practices for reducing harmful exposures in painters.

California Environmental Protection Agency Oakland California USA

Center for Research in Epidemiology and Population Health Exposome and Heredity team Inserm U1018 University Paris Saclay Villejuif France

Centre for Public Health Research Massey University Wellington New Zealand

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

Department of Cancer Epidemiology and Prevention N N Blokhin National Research Centre of Oncology Moscow Russian Federation

Department of Epidemiology ASL Roma E Rome Italy

Department of Medical and Surgical Sciences University of Bologna Bologna Italy

Department of Medical Sciences Cancer Epidemiology Unit University of Turin Turin Italy

Department of Molecular and Clinical Cancer Medicine University of Liverpool Roy Castle Lung Cancer Foundation Liverpool UK

Department of Non communicable Disease Epidemiology London School of Hygiene and Tropical Medicine London UK

Department of Public Health University of Oviedo ISPA and CIBERESP Oviedo Spain

Department of Social and Preventive Medicine University of Montreal Montreal Quebec Canada

Division of Cancer Epidemiology and Genetics National Cancer Institute National Institutes of Health Bethesda Maryland USA

Epidemiology Unit Department of Cancer Epidemiology and Prevention M Sklodowska Curie National Research Institute of Oncology Warsaw Poland

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

Faculty of Mathematics and Computer Science Institute of Statistics University of Bremen Bremen Germany

Former senior scientist Department for Determinants of Chronic Diseases National Institute for Public Health and the Environment Bilthoven The Netherlands

Health Capital School; Department of Environmental Epidemiology Nofer Institute of Occupational Medicine Lodz Poland

Institut für Epidemiologie Deutsches Forschungszentrum für Gesundheit und Umwelt Neuherberg Germany

Institut für Medizinische Informatik Biometrie Epidemiologie Ludwig Maximilians University Munich Germany

Institute and Outpatient Clinic for Occupational Social and Environmental Medicine Inner City Clinic University Hospital of Munich Ludwig Maximilians Universität; Comprehensive Pneumology Center Munich Munchen Germany

Institute for Medical Informatics Biometry and Epidemiology University Hospital Essen Essen Germany

Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Institute of the Ruhr University Bochum Germany

Institute for Risk Assessment Sciences Utrecht University Utrecht The Netherlands

Institute of Environmental Medicine Unit of Occupational Medicine Karolinska Institute Stockholm Sweden

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

JC School of Public Health and Primary Care The Chinese University of Hong Kong Hong Kong Hong Kong

Leibniz Institute for Prevention Research and Epidemiology BIPS Bremen Germany

Masaryk Memorial Cancer Institute Brno Jihomoravský Czech Republic

National Institute of Public Health Bucharest Romania

National Public Health Center Budapest Hungary

Occupational Cancer Research Centre Ontario Health Toronto Ontario Canada

Occupational Health and Toxicology Regional Authority of Public Health Banska Bystrica Slovakia

Stony Brook Cancer Center Stony Brook University Stony Brook New York USA

Univ Rennes Inserm EHESP Irset UMR_S 1085 Pointe à Pitre France

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Lung Cancer Risks Associated with Occupational Exposure to Pairs of Five Lung Carcinogens: Results from a Pooled Analysis of Case-Control Studies (SYNERGY)