WAH/
Articles/
2509001299
  • Open Access
  • Article

The Relationship between Occupation and Lung Cancer Incidence in the Women’s Health Initiative Observational Study

  • Ripon Hosain 1,   
  • Yvonne L. Michael 2,   
  • Robert B. Wallace 3,   
  • Rowan T. Chlebowski 4,   
  • David O. Garcia 5,   
  • Rami Nassir 6,   
  • Lucy F. Robinson 2,   
  • Rebecca A. Seguin-Fowler 7,   
  • Julie C. Weitlauf 8, 9,   
  • Anneclaire J. De Roos 1, *

Received: 31 Jul 2025 | Revised: 19 Aug 2025 | Accepted: 15 Sep 2025 | Published: 19 Sep 2025

Abstract

Background. Lung cancer remains the foremost cause of cancer mortality among US women, with a notable proportion arising in never-smokers. While occupational exposures contribute to lung cancer risk, women have been underrepresented in occupational studies. Therefore, we examined the relationship between occupational titles and lung cancer incidence in women, stratified by smoking exposure. Methods. Postmenopausal women (N = 93,676) entered the Women’s Health Initiative Observational Study prospective cohort beginning in 1993. Participants reported their three longest-held paid jobs at the study baseline and women were followed for health outcomes. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for lung cancer incidence in association with ever working in a given occupation, as well as by employment duration (<10 years, ≥10 years), with adjustment for smoking, demographics, and lifestyle factors. Effect modification by smoking status was assessed in stratified models. Results. Higher lung cancer risks were observed among women employed in management, sales, food service, and personal care occupations, as well as for several less common occupations, including life sciences, museum-related technical roles, and farming, construction, and production jobs. For example, ever working as Archivists, Curators, and Museum Technicians was associated with higher risk (OR = 2.55; 95% CI: 1.22–5.32), as was employment in Farming, Fishing, and Forestry occupations (OR = 1.98; 95% CI: 1.11–3.55), compared to women who never worked in those jobs. Longer-duration employment (≥10 years) as Life Scientists was also associated with elevated risk (OR = 2.31; 95% CI: 1.19–4.49). Most associations did not differ significantly by smoking, or were stronger among never-smokers than smokers, suggesting potential occupational risks independent of smoking. Conclusions. Occupational factors may increase women’s lung cancer risk beyond smoking, necessitating targeted prevention and future research.

References 

  • 1.
    American Cancer Society. Lung Cancer Survival Rates. Available online: https://www.cancer.org/cancer/types/lung-cancer/detection-diagnosis-staging/survival-rates.html (assessed on 21 April 2024).
  • 2.
    North, C.M.; Christiani, D.C. Women and lung cancer: What is new? Semin. Thorac. Cardiovasc. Surg. 2013, 25, 87–94.
  • 3.
    Jung, J.K.H.; Feinstein, S.G.; Palma Lazgare, L.; et al. Examining lung cancer risks across different industries and occupations in Ontario, Canada: The establishment of the Occupational Disease Surveillance System. Occup. Environ. Med. 2018, 75, 545–552. https://doi.org/10.1136/oemed-2017-104926.
  • 4.
    Bardin-Mikolajczak, A.; Lissowska, J.; Zaridze, D.; et al. Occupation and risk of lung cancer in Central and Eastern Europe: The IARC multi-center case-control study. Cancer Causes Control 2007, 18, 645–654. https://doi.org/10.1007/s10552-007-9010-z.
  • 5.
    Li, L.; Jiang, M.; Li, X.; et al. Association between Coalmine Dust and Mortality Risk of Lung Cancer: A Meta-Analysis. Biomed. Res. Int. 2021, 2021, 6624799. https://doi.org/10.1155/2021/6624799.
  • 6.
    Leonard, R.; Zulfikar, R.; Stansbury, R. Coal mining and lung disease in the 21st century. Curr. Opin. Pulm. Med. 2020, 26, 135–141. https://doi.org/10.1097/MCP.0000000000000653.
  • 7.
    Kwak, K.; Kang, D.; Paek, D. Environmental exposure to asbestos and the risk of lung cancer: A systematic review and meta-analysis. Occup. Environ. Med. 2022, 79, 207–214. https://doi.org/10.1136/oemed-2020-107222.
  • 8.
    Honaryar, M.K.; Lunn, R.M.; Luce, D.; et al. Welding fumes and lung cancer: A meta-analysis of case-control and cohort studies. Occup. Environ. Med. 2019, 76, 422–431. https://doi.org/10.1136/oemed-2018-105447.
  • 9.
    Purdue, M.P.; Gold, L.; Jarvholm, B.; et al. Impaired lung function and lung cancer incidence in a cohort of Swedish construction workers. Thorax 2007, 62, 51–56. https://doi.org/10.1136/thx.2006.064196.
  • 10.
    Gupta, S. Risk of lung cancer among welders and flame cutters: A systematic review and meta-analysis of case controlled studies. Bull. Cancer 2023, 110, 1279–1287. https://doi.org/10.1016/j.bulcan.2023.08.003.
  • 11.
    Hosseini, B.; Olsson, A.; Bouaoun, L.; et al. Lung cancer risk in relation to jobs held in a nationwide case-control study in Iran. Occup. Environ. Med. 2022, 79, 831–838. https://doi.org/10.1136/oemed-2022-108463.
  • 12.
    Boulanger, M.; Tual, S.; Lemarchand, C.; et al. Lung cancer risk and occupational exposures in crop farming: Results from the AGRIculture and CANcer (AGRICAN) cohort. Occup. Environ. Med. 2018, 75, 776–785. https://doi.org/10.1136/oemed-2017-104976.
  • 13.
    Settimi, L.; Comba, P.; Carrieri, P.; et al. Cancer risk among female agricultural workers: A multi-center case-control study. Am. J. Ind. Med. 1999, 36, 135–141. https://doi.org/10.1002/(sici)1097-0274(199907)36:1<135::Aid-ajim19>3.0.Co;2-h.
  • 14.
    Curiel-Garcia, T.; Candal-Pedreira, C.; Varela-Lema, L.; et al. Wood dust exposure and small cell lung cancer: A systematic review and meta-analysis. J. Expo. Sci. Environ. Epidemiol. 2023, 34, 457–464. https://doi.org/10.1038/s41370-023-00538-w.
  • 15.
    Hancock, D.G.; Langley, M.E.; Chia, K.L.; et al. Wood dust exposure and lung cancer risk: A meta-analysis. Occup. Environ. Med. 2015, 72, 889–898. https://doi.org/10.1136/oemed-2014-102722.
  • 16.
    Corbin, M.; McLean, D.; Mannetje, A.; et al. Lung cancer and occupation: A New Zealand cancer registry-based case-control study. Am. J. Ind. Med. 2011, 54, 89–101. https://doi.org/10.1002/ajim.20906.
  • 17.
    Pukkala, E.; Martinsen, J.I.; Lynge, E.; et al. Occupation and cancer—Follow-up of 15 million people in five Nordic countries. Acta Oncol. 2009, 48, 646–790. https://doi.org/10.1080/02841860902913546.
  • 18.
    Bovio, N.; Richardson, D.B.; Guseva Canu, I. Sex-specific risks and trends in lung cancer mortality across occupations and economic activities in Switzerland (1990–2014). Occup. Environ. Med. 2020, 77, 540–548. https://doi.org/10.1136/oemed-2019-106356.
  • 19.
    Tsoi, C.T.; Tse, L.A. Professional drivers and lung cancer: A systematic review and meta-analysis. Occup. Environ. Med. 2012, 69, 831–836. https://doi.org/10.1136/oemed-2012-100666.
  • 20.
    Myong, J.P.; Cho, Y.; Choi, M.; et al. Overview of occupational cancer in painters in Korea. Ann. Occup. Environ. Med. 2018, 30, 10. https://doi.org/10.1186/s40557-018-0222-3.
  • 21.
    Ramanakumar, A.V.; Parent, M.E.; Richardson, L.; et al. Exposures in painting-related occupations and risk of lung cancer among men: Results from two case-control studies in Montreal. Occup. Environ. Med. 2011, 68, 44–51. https://doi.org/10.1136/oem.2009.049957.
  • 22.
    Guha, N.; Merletti, F.; Steenland, N.K.; et al. Lung cancer risk in painters: A meta-analysis. Environ. Health Perspect. 2010, 118, 303–312. https://doi.org/10.1289/ehp.0901402.
  • 23.
    Clayton, J.A.; Collins, F.S. NIH to balance sex in cell and animal studies. Nature 2014, 509, 282–283.
  • 24.
    Baiu, I.; Titan, A.L.; Martin, L.W.; et al. The role of gender in non-small cell lung cancer: A narrative review. J. Thorac. Dis. 2021, 13, 3816–3826. https://doi.org/10.21037/jtd-20-3128.
  • 25.
    Camp, P.G.; Dimich-Ward, H.; Kennedy, S.M. Women and occupational lung disease: Sex differences and gender influences on research and disease outcomes. Clin. Chest Med. 2004, 25, 269–279. https://doi.org/10.1016/j.ccm.2004.01.004.
  • 26.
    Bureau of Labor Statistics, U.S. Department of Labor. Women in the Labor Force: A Databook. Available online: https://www.bls.gov/opub/reports/womens-databook/2021/home.htm (accessed on 23 April 2024).
  • 27.
    Gu, F.; Han, J.; Laden, F.; et al. Total and cause-specific mortality of U.S. nurses working rotating night shifts. Am. J. Prev. Med. 2015, 48, 241–252. https://doi.org/10.1016/j.amepre.2014.10.018.
  • 28.
    Schernhammer, E.S.; Feskanich, D.; Liang, G.; et al. Rotating night-shift work and lung cancer risk among female nurses in the United States. Am. J. Epidemiol. 2013, 178, 1434–1441. https://doi.org/10.1093/aje/kwt155.
  • 29.
    Olsson, A.C.; Xu, Y.; Schuz, J.; et al. Lung cancer risk among hairdressers: A pooled analysis of case-control studies conducted between 1985 and 2010. Am J Epidemiol 2013, 178, 1355–1365. https://doi.org/10.1093/aje/kwt119.
  • 30.
    Takkouche, B.; Regueira-Mendez, C.; Montes-Martinez, A. Risk of cancer among hairdressers and related workers: A meta-analysis. Int. J. Epidemiol. 2009, 38, 1512–1531. https://doi.org/10.1093/ije/dyp283.
  • 31.
    Lin, P.C.; Peng, C.Y.; Pan, C.H.; et al. Gender differences and lung cancer risk in occupational chefs: Analyzing more than 350,000 chefs in Taiwan, 1984–2011. Int. Arch. Occup. Environ. Health 2019, 92, 101–109. https://doi.org/10.1007/s00420-018-1358-8.
  • 32.
    Ko, Y.C.; Cheng, L.S.; Lee, C.H.; et al. Chinese Food Cooking and Lung Cancer in Women Nonsmokers. Am. J. Epidemiol. 2000, 151, 140–147.
  • 33.
    Jia, P.L.; Zhang, C.; Yu, J.J.; et al. The risk of lung cancer among cooking adults: A meta-analysis of 23 observational studies. J. Cancer Res. Clin. Oncol. 2018, 144, 229–240. https://doi.org/10.1007/s00432-017-2547-7.
  • 34.
    Jahn, I.; Ahrens, W.; Brüske-Hohlfeld, I.; et al. Occupational risk factors for lung cancer in women: Results of a case-control study in Germany. Am. J. Ind. Med. 1999, 36, 90–100. https://doi.org/10.1002/(sici)1097-0274(199907)36:1<90::Aid-ajim13>3.0.Co;2-v.
  • 35.
    Atramont, A.; Guida, F.; Mattei, F.; et al. Professional Cleaning Activities and Lung Cancer Risk Among Women: Results From the ICARE Study. J. Occup. Environ. Med. 2016, 58, 610–616. https://doi.org/10.1097/JOM.0000000000000722.
  • 36.
    Brownson, R.C.; Alavanja, M.C.R.; Chang, J.C. Occupational risk factors for lung cancer among nonsmoking women: A case-control study in Missouri (United States). Cancer Causes Control. 1993, 4, 449–454.
  • 37.
    Kiyohara, C.; Ohno, Y. Sex differences in lung cancer susceptibility: A review. Gend. Med. 2010, 7, 381–401. https://doi.org/10.1016/j.genm.2010.10.002.
  • 38.
    Ruano-Ravina, A.; Figueiras, A.; Barreiro-Carracedo, M.A.; et al. Occupation and smoking as risk factors for lung cancer: A population-based case-control study. Am. J. Ind. Med. 2003, 43, 149–155. https://doi.org/10.1002/ajim.10171.
  • 39.
    Olsson, A.; Bouaoun, L.; Schuz, J.; et al. Lung Cancer Risks Associated with Occupational Exposure to Pairs of Five Lung Carcinogens: Results from a Pooled Analysis of Case-Control Studies (SYNERGY). Environ. Health Perspect. 2024, 132, 17005. https://doi.org/10.1289/EHP13380.
  • 40.
    Steenland, K.; Thun, M. Interaction between tobacco smoking and occupational exposures in the causation of lung cancer. J. Occup. Environ. Med. 1986, 28, 110–118.
  • 41.
    Carey, M.A.; Card, J.W.; Voltz, J.W.; et al. It's all about sex: Gender, lung development and lung disease. Trends Endocrinol. Metab. 2007, 18, 308–313. https://doi.org/10.1016/j.tem.2007.08.003.
  • 42.
    Capili, B.; Anastasi, J.K. Cohort Studies. Am. J. Nurs. 2021, 121, 45–48. https://doi.org/10.1097/01.NAJ.0000803196.49507.08.
  • 43.
    The Women’s Health Initiative. Available online: https://www.whi.org/ (accessed on 2 April 2024).
  • 44.
    National Heart, Lung, and Blood Institute. Women’s Health Initiative. Available online: https://www.nhlbi.nih.gov/science/womens-health-initiative-whi (accessed on 2 April 2024).
  • 45.
    Hays, J.; Hunt, J.R.; Hubbell, F.A.; et al. The Women's Health Initiative recruitment methods and results. Ann. Epidemiol. 2003, 13, S18–S77. https://doi.org/10.1016/s1047-2797(03)00042-5.
  • 46.
    Langer, R.D.; White, E.; Lewis, C.E.; et al. The Women's Health Initiative Observational Study: Baseline characteristics of participants and reliability of baseline measures. Ann. Epidemiol. 2003, 13, S107–S121. https://doi.org/10.1016/s1047-2797(03)00047-4.
  • 47.
    Myneni, A.A.; Giovino, G.A.; Millen, A.E.; et al. Indices of Diet Quality and Risk of Lung Cancer in the Women's Health Initiative Observational Study. J. Nutr. 2021, 151, 1618–1627. https://doi.org/10.1093/jn/nxab033.
  • 48.
    Bureau of Labor Statistics, U.S. Department of Labor. Standard Occupational Classification (SOC) System. Available online: https://www.bls.gov/soc/ (accessed on 2 April 2024).
  • 49.
    Centers for Disease Control and Prevention. The National Institute for Occupational Safety and Health (NIOSH). Available at https://www.cdc.gov/niosh/topics/coding/code.html (accessed on 25 April 2024).
  • 50.
    National Cancer Institute. Secondhand Tobacco Smoke (Environmental Tobacco Smoke). Available online: https://www.cancer.gov/about-cancer/causes-prevention/risk/substances/secondhand-smoke (accessed on 10 June 2024).
  • 51.
    Ma, Z.; Zhu, C.; Wang, H.; et al. Association between biological aging and lung cancer risk: Cohort study and Mendelian randomization analysis. iScience 2023, 26, 106018. https://doi.org/10.1016/j.isci.2023.106018.
  • 52.
    Castro, S.; Sosa, E.; Lozano, V.; et al. The impact of income and education on lung cancer screening utilization, eligibility, and outcomes: A narrative review of socioeconomic disparities in lung cancer screening. J. Thorac. Dis. 2021, 13, 3745–3757. https://doi.org/10.21037/jtd-20-3281.
  • 53.
    Fairley, T.L.; Tai, E.; Townsend, J.S.; et al. Racial/Ethnic Disparities and Geographic Differences in Lung Cancer Incidence—38 States and the District of Columbia, 1998–2006. Morb. Mortal. Wkly. Rep. 2010, 59, 1434–1438.
  • 54.
    Cranford, H.M.; Koru-Sengul, T.; Lopes, G.; et al. Lung Cancer Incidence by Detailed Race-Ethnicity. Cancers 2023, 15, 2164. https://doi.org/10.3390/cancers15072164.
  • 55.
    Matakidou, A.; Eisen, T.; Houlston, R.S. Systematic review of the relationship between family history and lung cancer risk. Br. J. Cancer 2005, 93, 825–833. https://doi.org/10.1038/sj.bjc.6602769.
  • 56.
    Freudenheim, J.L.; Ritz, J.; Smith-Warner, S.A.; et al. Alcohol consumption and risk of lung cancer: A pooled analysis of cohort studies. Am. J. Clin. Nutr. 2005, 82, 657–667. https://doi.org/10.1093/ajcn.82.3.657.
  • 57.
    Underwood, J.M.; Townsend, J.S.; Tai, E.; et al. Racial and regional disparities in lung cancer incidence. Cancer 2012, 118, 1910–1918. https://doi.org/10.1002/cncr.26479.
  • 58.
    Knol, M.J.; Janssen, K.J.; Donders, A.R.; et al. Unpredictable bias when using the missing indicator method or complete case analysis for missing confounder values: An empirical example. J. Clin. Epidemiol. 2010, 63, 728–736. https://doi.org/10.1016/j.jclinepi.2009.08.028.
  • 59.
    Altman, D.G.; Bland, J.M. Interaction revisited: The difference between two estimates. BMJ 2003, 326, 219.
  • 60.
    Robinson, C.F.; Sullivan, P.A.; Li, J.; et al. Occupational lung cancer in US women, 1984–1998. Am. J. Ind. Med. 2011, 54, 102–117. https://doi.org/10.1002/ajim.20905.
  • 61.
    Possenti, I.; Romelli, M.; Carreras, G.; et al. Association between second-hand smoke exposure and lung cancer risk in never-smokers: A systematic review and meta-analysis. Eur. Respir. Rev. 2024, 33. https://doi.org/10.1183/16000617.0077-2024.
  • 62.
    Friedenreich, C.M.; Ryder-Burbidge, C.; McNeil, J. Physical activity, obesity and sedentary behavior in cancer etiology: Epidemiologic evidence and biologic mechanisms. Mol. Oncol. 2021, 15, 790–800. https://doi.org/10.1002/1878-0261.12772.
  • 63.
    Steenland, K.; Deddens, J.; Stayner, L. Diesel exhaust and lung cancer in the trucking industry: Exposure-response analyses and risk assessment. Am. J. Ind. Med. 1998, 34, 220–228. https://doi.org/10.1002/(sici)1097-0274(199809)34:3<220::aid-ajim3>3.0.co;2-z.
  • 64.
    Van Barneveld, T.A.; Sasco, A.J.; Van Leeuwen, F.E. A Cohort Study of Cancer Mortality among Biology Research Laboratory Workers in the Netherlands. Cancer Causes Control 2004, 15, 55–66.
  • 65.
    Baldelli, A.; Couch, B.; Loosley, B.; et al. Occupational exposure of librarians to mold spores and metal particles: A real-time case study. SN Appl. Sci. 2021, 3. https://doi.org/10.1007/s42452-021-04575-8.
  • 66.
    Sequeira, S.; Cabrita, E.J.; Macedo, M.F. Antifungals on paper conservation: An overview. Int. Biodeterior. Biodegrad. 2012, 74, 67–86. https://doi.org/10.1016/j.ibiod.2012.07.011.
  • 67.
    Tanasescu, E.C.; Lite, M.C. Harmful health effects of pesticides used on museum textile artifacts—overview. Ecotoxicol. Environ. Saf. 2022, 247, 114240. https://doi.org/10.1016/j.ecoenv.2022.114240.
  • 68.
    Dou, M.; Wang, X.; Li, Y.; et al. Occupational hazard exposures among archivists. Front. Public. Health 2025, 13, 1631626. https://doi.org/10.3389/fpubh.2025.1631626.
  • 69.
    Kjaerheim, K.; Andersen, A. Cancer incidence among waitresses in Norway. Cancer Causes Control 1994, 5, 31–37.
  • 70.
    Torres-Cadavid, E.; Perez-Rios, M.; Candal-Pedreira, C.; et al. Lung cancer risk associated with occupations in women: A pooling study. Occup. Med. 2024, 74, 348–354. https://doi.org/10.1093/occmed/kqae050.
  • 71.
    Kachuri, L.; Harris, M.A.; MacLeod, J.S.; et al. Cancer risks in a population-based study of 70,570 agricultural workers: Results from the Canadian census health and Environment cohort (CanCHEC). BMC Cancer 2017, 17, 343. https://doi.org/10.1186/s12885-017-3346-x.
  • 72.
    Schlunssen, V.; Mandrioli, D.; Pega, F.; et al. The prevalences and levels of occupational exposure to dusts and/or fibres (silica, asbestos and coal): A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Environ. Int. 2023, 178, 107980. https://doi.org/10.1016/j.envint.2023.107980.
  • 73.
    Astrakianakis, G.; Seixas, N.S.; Ray, R.; et al. Lung cancer risk among female textile workers exposed to endotoxin. J. Natl. Cancer Inst. 2007, 99, 357–364. https://doi.org/10.1093/jnci/djk063.
  • 74.
    IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Some flame retardants and textile chemicals, and exposures in the textile manufacturing industry. Available online: https://www.ncbi.nlm.nih.gov/books/NBK519215/ (accessed on 9 September 2025).
  • 75.
    Markowitz, S.B.; Levin, S.M.; Miller, A.; et al. Asbestos, asbestosis, smoking, and lung cancer. New findings from the North American insulator cohort. Am. J. Respir. Crit. Care Med. 2013, 188, 90–96. https://doi.org/10.1164/rccm.201302-0257OC.
  • 76.
    Benke, G.; Sim, M.R.; McKenzie, D.P.; et al. Comparison of first, last, and longest-held jobs as surrogates for all jobs in estimating cumulative exposure in cross-sectional studies of work-related asthma. Ann. Epidemiol. 2008, 18, 23–27. https://doi.org/10.1016/j.annepidem.2007.06.007.
  • 77.
    Gomez-Marin, O.; Fleming, L.E.; Caban, A.; et al. Longest held job in U.S. occupational groups: The National Health Interview Survey. J. Occup. Environ. Med. 2005, 47, 79–90. https://doi.org/10.1097/01.jom.0000147213.76606.55.
  • 78.
    Luckhaupt, S.E.; Cohen, M.A.; Calvert, G.M. Concordance between current job and usual job in occupational and industry groupings: Assessment of the 2010 national health interview survey. J. Occup. Environ. Med. 2013, 55, 1074–1090. https://doi.org/10.1097/JOM.0b013e318297321d.
  • 79.
    Archer, V.E.; Coons, T.; Saccomanno, G.; et al. Latency and the lung cancer epidemic among United States uranium miners. Health Phys. 2004, 87, 480–489. https://doi.org/10.1097/01.hp.0000133216.72557.ab.
  • 80.
    Huh, D.A.; Chae, W.R.; Choi, Y.H.; et al. Disease Latency according to Asbestos Exposure Characteristics among Malignant Mesothelioma and Asbestos-Related Lung Cancer Cases in South Korea. Int. J. Environ. Res. Public. Health 2022, 19, 15934. https://doi.org/10.3390/ijerph192315934.
  • 81.
    Lipfert, F.W.; Wyzga, R.E. Longitudinal relationships between lung cancer mortality rates, smoking, and ambient air quality: A comprehensive review and analysis. Crit. Rev. Toxicol. 2019, 49, 790–818. https://doi.org/10.1080/10408444.2019.1700210.
Share this article:
Download PDF
Supplementary Materials
DOI
10.53941/wah.2025.100010
Issue
Volume 1, Issue 2
How to Cite
Hosain, R.; Michael, Y. L.; Wallace, R. B.; Chlebowski, R. T.; Garcia, D. O.; Nassir, R.; Robinson, L. F.; Seguin-Fowler, R. A.; Weitlauf, J. C.; De Roos, A. J. The Relationship between Occupation and Lung Cancer Incidence in the Women’s Health Initiative Observational Study. Work and Health 2025, 1 (2), 10. https://doi.org/10.53941/wah.2025.100010.
RIS
BibTex
Copyright & License
article copyright Image
Copyright (c) 2025 by the authors.