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Eric Garshick,^1,2 Francine Laden,^2,3 Jaime E. Hart,^2,3 Bernard Rosner,² Thomas J. Smith,³ Douglas W. Dockery,^2,3 and Frank E. Speizer^2,3

¹Pulmonary and Critical Care Medicine Section, Medical Service, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA; ²Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; ³Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA

Abstract
Diesel exhaust has been suspected to be a lung carcinogen. The assessment of this lung cancer risk has been limited by lack of studies of exposed workers followed for many years. In this study, we assessed lung cancer mortality in 54,973 U.S. railroad workers between 1959 and 1996 (38 years) . By 1959, the U.S. railroad industry had largely converted from coal-fired to diesel-powered locomotives. We obtained work histories from the U.S. Railroad Retirement Board, and ascertained mortality using Railroad Retirement Board, Social Security, and Health Care Financing Administration records. Cause of death was obtained from the National Death Index and death certificates. There were 43,593 total deaths including 4,351 lung cancer deaths. Adjusting for a healthy worker survivor effect and age, railroad workers in jobs associated with operating trains had a relative risk of lung cancer mortality of 1.40 (95% confidence interval, 1.30-1.51) . Lung cancer mortality did not increase with increasing years of work in these jobs. Lung cancer mortality was elevated in jobs associated with work on trains powered by diesel locomotives. Although a contribution from exposure to coal combustion products before 1959 cannot be excluded, these results suggest that exposure to diesel exhaust contributed to lung cancer mortality in this cohort. Key words: diesel exhaust, lung cancer, occupational exposure. Environ Health Perspect 112:1539-1543 (2004) . doi:10.1289/ehp.7195 available via http://dx.doi.org/ [Online 5 August 2004]

Address correspondence to E. Garshick, Pulmonary and Critical Care Medicine Section, 1400 VFW Parkway, West Roxbury, MA 02132 USA. Telephone: (617) 323-7700 ext. 5536. Fax: (617) 363-5670. E-mail: eric.garshick@med.va.gov

We thank M. Jacobson Canner and H. Guan for programming assistance ; E. Larkin and S. Campbell for data management ; L. Stayner, National Institute for Occupational Safety and Health (NIOSH) , for state of death from Social Security records ; D. Gagnon for analysis suggestions ; and the Railroad Retirement Board, particularly E. Binkus and A. Alden.

This work was supported by NIOSH grant CCR115818 and National Cancer Institute grant CA79725.

The authors declare they have no competing financial interests.

Received 20 April 2004 ; accepted 5 August 2004.