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Elsebeth Lynge,¹ Aage Andersen,² Lars Rylander,³ Håkan Tinnerberg,³ Marja-Liisa Lindbohm,⁴ Eero Pukkala,⁵ Pål Romundstad,⁶ Per Jensen,¹ Lene Bjørk Clausen,¹ and Kristina Johansen¹

¹Institute of Public Health, University of Copenhagen, Copenhagen, Denmark; ²Cancer Registry of Norway, Oslo, Norway; ³Department of Occupational and Environmental Medicine, Lund University Hospital, Lund, Sweden; ⁴Finnish Institute of Occupational Health, Helsinki, Finland; ⁵Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; ⁶Department of Community Medicine and General Practice, Norwegian University of Science and Technology, Trondheim, Norway

Abstract
U.S. studies have reported an increased risk of esophageal and some other cancers in dry cleaners exposed to tetrachloroethylene. We investigated whether the U.S. findings could be reproduced in the Nordic countries using a series of case-control studies nested in cohorts of laundry and dry-cleaning workers identified from the 1970 censuses in Denmark, Norway, Sweden, and Finland. Dry-cleaning work in the Nordic countries during the period when tetrachloroethylene was the dominant solvent was not associated with an increased risk of esophageal cancer [rate ratio (RR) = 0.76 ; 95% confidence interval (CI) , 0.34-1.69], but our study was hampered by some unclassifiable cases. The risks of cancer of the gastric cardia, liver, pancreas, and kidney and non-Hodgkin lymphoma were not significantly increased.Assistants in dry-cleaning shops had a borderline significant excess risk of cervical cancer not found in women directly involved in dry cleaning. We found an excess risk of bladder cancer (RR = 1.44 ; 95% CI, 1.07-1.93) not associated with length of employment. The finding of no excess risk of esophageal cancer in Nordic dry cleaners differs from U.S. findings. Chance, differences in level of exposure to tetrachloroethylene, and confounding may explain the findings. The overall evidence on bladder cancer in dry cleaners is equivocal. Key words: cancer incidence, case-control study, dry cleaning, occupational exposure, tetrachloroethylene. Environ Health Perspect 114: 213-219 (2006) . doi:10.1289/ehp.8425 available via http://dx.doi.org/ [Online 13 October 2005]

Address correspondence to E. Lynge, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, opg. B, Postboks 2099, DK-1014 Copenhagen K, Denmark. Telephone: 45-35-32-76-35. Fax: 45-35-32-73-83. E-mail: elsebeth@pubhealth.ku.dk

We thank the Central Bureau of Statistics in the Nordic countries for collaboration. P. Heikkilä provided the Finnish industrial hygiene data, and M. Kaurin collected the Norwegian interview data.

This study was financially supported by the Halogenated Solvents Industry Alliance, Inc. (HSIA) and the Danish Medical Research Council.

The authors received funding from the HSIA for professional services.

Received 23 June 2005 ; accepted 12 October 2005.

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