Background
Sarcomas are rare connective tissue tumours with more than 80 histological subtypes. Their incidence is estimated at 5 per 100,000 person-years, and an increase over recent decades suggests the involvement of environmental factors. The etiology of sarcomas is rarely studied, and most research focuses on men with soft tissue sarcomas (STS). Ionizing radiation, vinyl chloride, and dioxins at high doses have been identified as risk factors for STS. In contrast, dioxins at low doses and pesticides (chlorophenols and phenoxyherbicides) have also been suspected of causing STS. Some studies have suggested associations between sarcomas and certain occupations among men: farmers (STS), gardeners (STS), woodworkers (bone sarcomas – BS), and construction workers (all sarcomas). Among women, one study has identified associations with farmers, teachers, and shoe and leather workers for visceral sarcomas (VS).
Objective
The objective of this study is to describe the associations between occupations and sarcomas, STS, and VS on the one hand, and BS on the other, separately for men and women.
Methods
Between 2019 and 2023, cases comprised all diagnosed primary sarcoma patients aged 18 to 80 in six French geographical areas. Two controls per case, matched on sex, age (in 5-year age groups), and geographical area, were randomly selected from the electoral rolls. Cases and controls completed a self-administered questionnaire and then participated in a face-to-face interview. Odds ratios and 90% confidence intervals, adjusted for age and education level, were estimated using conditional logistic regression for each occupation held for at least 6 months. Sarcomas were divided into two groups: STS and VS, grouped together, and BS as the other group. Analyses were stratified by gender.
Results
There are 671 STS and VS cases and 74 BS cases, with equal proportions of men and women. The median age of cases is 58.3 for men and 57.3 for women.
Among men, refuse workers and other elementary workers (OR=11.93, 90% CI=2.07-68.72), non-commissioned armed forces officers (OR=3.87, 90% CI=1.33-11.29), personal service workers (OR=1.95, 90% CI=1.18-3.22), and building and related trades workers (OR=1.48, 90% CI=1.02-2.13) are significantly associated with STS and VS. For BS, electrical and electronic trades workers (OR=3.72, 90% CI=0.92-15.11) is the only occupation associated with the threshold of significance.
Among women, food preparation assistants (OR=3.47, 90% CI=1.09-11.03) and business and administration associate professionals (OR=1.34, 90% CI=1.01-1.80) are associated with STS and VS, whereas sales workers (OR=5.62, 90% CI=1.68-18.79) are associated with BS.
No association has been identified between agricultural workers and sarcomas in either men or women.
Conclusions
This is the first large-scale case-control study to document associations between occupations and sarcomas among men and women. This analysis identified new occupations associated with sarcomas. The next stage will be to specifically explore the role of pesticide exposure, which will be assessed by experts and will include jobs not covered by this analysis (seasonal jobs, family helpers, etc.).
In conclusion, ETIOSARC highlights key occupational associations and paves the way for future research that integrates lifestyle and genetic factors to better understand and prevent sarcomas.