Mortality from bladder cancer in dyestuff workers exposed to aromatic amines: A 73-year follow-up

Main Article Content

Catalina Ciocan
Alessandro Godono
Nicolò Franco
Carlo La Vecchia
Eva Negri
Paolo Boffetta
Enrico Pira


Aromatic amines, Bladder cancer, Dyestuff


Objective. To update the analysis of mortality of a cohort of dyestuff workers, in Northern Italy, heavily exposed to carcinogenic aromatic amines.

Methods. We updated to 2018 overall and cause-specific mortality in a cohort of 590 male workers heavily exposed to carcinogenic aromatic amines in a dyestuff factory from 1922 to 1972. Workers were censored at age 85. Expected cases for the period 1946-2018 were computed using Piedmont mortality rates and standardized mortality ratios (SMR) were computed.

Results. Between 1946 and 2018, 470 deaths were reported. The overall SMR was 1.59 (95% confidence interval [CI] 1.45-1.74) and SMR from all cancers was 2.05 (95% CI = 1.77-2.37); Compared to a previous report, there were 4 additional  deaths from bladder cancer,  for a total of 60 deaths compared  with 4.0 expected  (SMR 14.86, 95% CI 11.34-19.12).The SMR for bladder cancer increased with younger age at first exposure  and longer duration of exposure, while it  decreased with time since last exposure, albeit it was still 3.5, 30 or more years since last exposure. An increased risk was observed among workers exposed to fuchsine or ortho-toluidine (SMR=16.3; 95% CI = 6.0-35.5).

Conclusions. This 73 year follow up confirms the results from previous analyses, with an increased overall mortality and, an increased mortality from all cancers and especially for bladder cancer. The excess risk of bladder cancer persisted several decades after stopping exposure.

Abstract 522 | PDF Downloads 372


1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. (2021) Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin.;71:209–49. PMID: 33538338.
2. Godono A., Clari M, Franco N, Ciocan C, Mansour I, Zunarelli C, et al. . (2021). The association between occupational asbestos exposure with the risk of incidence and mortality from prostate cancer: A systematic review and meta-analysis. Prostate Cancer and Prostatic Diseases, online ahead of print. PMID: 34413482
3. Sanli O, Dobruch J, Knowles MA, Burger M, Alemozaffar M, Nielsen ME, et al. (2017) Bladder cancer. Nat Rev Dis Primers. Apr 13;3:17022. PMID: 28406148
4. Saginala K, Barsouk A, Sukumar Aluru J, Rawla P, Anand Padala S, Barsouk A. (2020) Epidemiology of Bladder Cancer. Med Sci (Basel) Mar 13;8(1):15. PMID: 32183076
5. Pira E., Garzaro G., Ciocan C., Boffetta P. (2020) Occupational Cancer in the Practice of Occupational Medicine. In: Anttila S., Boffetta P. (eds) Occupational Cancers. Springer, Cham.
6. Westhoff, J. Maria de Oliveira-Neumayer, K.K. Aben, A. Vrieling, L.A. Kiemeney (2016) Low awareness of risk factors among bladder cancer survivors: New evidence and a literature overview. Eur J Cancer, 60, pp. 136-45. PMID: 27125965
7. Pira, E., Garzaro, G., De Cillis, E., Donato, F., Ciocan, C., & Patrucco, M. (2018). Evolution of the concept OS&H from the second post-war to today: From prescriptive system to assessment and management of risks in system quality -the extended model in collaboration with large facilities. evolution of multidisciplinary culture of safety and OS&H. [Evoluzione del concetto di OS&H dal secondo dopoguerra ad oggi: Dal sistema prescrittivo alla Valutazione e Gestione dei rischi in qualità di sistema - il modello esteso in collaborazione alle grandi strutture. Evoluzione della cultura multidisciplinare della sicurezza e OS&H] Geoingegneria Ambientale e Mineraria, 154(2), 16-20. Retrieved from
8. Cumberbatch M.G.K., Cox A., Teare D., Catto J.W.F. (2015) Contemporary occupational carcinogen exposure and bladder cancer: a systematic review and meta-analysis JAMA Oncol, 1, pp. 1282-1290. PMID: 30268659
9. L. Rehn. (1895) Blasengeschwülste bei Fuchsin-Arbeitern. Verh Dtsch Gesellsch Chir.; 24: 240-252
10. Matanosky GM, Elliott EA. (1981) Bladder Cancer Epidemiology. Epidemiol Rev.; 3, 203. PMID: 7030761
11. Rubino G, Coscia GC. (1973) I tumori professionali del tratto urinario. II Cancro, 3, 151-159.
12. Rubino G, Scansetti G, Piolatto G, Pira E. (1982) The carcinogenic effect of aromatic amines: an epidemiological study on the role of o-toluidine and 4,4′-methylene bis (2-methylaniline) inducing bladder cancer in man. Environ Res. 27(2):241–254. PMID:7084156
13. Decarli A, Peto J, Piolatto G, La Vecchia C. (1985) Bladder cancer mortality of workers exposed to aromatic amines: analysis of models of carcinogenesis. Br J Cancer. 51(5):707–712. PMID:3994914
14. Piolatto G, Negri E, La Vecchia C, Pira E, Decarli A, Peto J. (1991) Bladder cancer mortality of workers exposed to aromatic amines: an updated analysis. Br J Cancer. 63(3):457–459. PMID: 2003988
15. Pira E, Piolatto G, Negri E, Romano C, Boffetta P, Lipworth L, McLaughlin J K., La Vecchia C. (2010) Bladder Cancer Mortality of Workers Exposed to Aromatic Amines: A 58-Year Follow-up. J Natl Cancer Inst. 102:1096–1099. PMID: 20548022
16. Breslow N E, Day N E. (1980) Statistical methods in cancer research. Volume I. The analysis of case-control studies. IARC Sci Pub (32):5-338. PMID: 7216345.
17. Armitage P. (1985) Tests for linear trend in proportions and frequencies. Biometrics 1,375-386
18. International Agency for Research on Cancer, Global Cancer Observatory, from, last accessed on Feb 1st, 2022