Email updates

Keep up to date with the latest news and content from BMC Public Health and BioMed Central.

Open Access Open Badges Study protocol

Investigation of occupational and environmental causes of respiratory cancers (ICARE): a multicenter, population-based case-control study in France

Danièle Luce12*, Isabelle Stücker34 and ICARE study group

Author Affiliations

1 INSERM UMRS 1018, CESP, Epidemiology of occupational and social determinants of health Centre for research in Epidemiology and Population Health, 15/16, avenue Paul Vaillant Couturier, 94807 Villejuif, France

2 UMRS 1018, University of Versailles Saint-Quentin, Villejuif, France

3 INSERM UMRS 1018, Environmental epidemiology of cancer, Centre for research in Epidemiology and Population Health, Villejuif, France

4 UMRS 1018, University Paris Sud, Villejuif, France

For all author emails, please log on.

BMC Public Health 2011, 11:928  doi:10.1186/1471-2458-11-928

Published: 14 December 2011



Occupational causes of respiratory cancers need to be further investigated: the role of occupational exposures in the aetiology of head and neck cancers remains largely unknown, and there are still substantial uncertainties for a number of suspected lung carcinogens. The main objective of the study is to examine occupational risk factors for lung and head and neck cancers.


ICARE is a multi-center, population-based case-control study, which included a group of 2926 lung cancer cases, a group of 2415 head and neck cancer cases, and a common control group of 3555 subjects. Incident cases were identified in collaboration with cancer registries, in 10 geographical areas. The control group was a random sample of the population of these areas, with a distribution by sex and age comparable to that of the cases, and a distribution by socioeconomic status comparable to that of the population. Subjects were interviewed face to face, using a standardized questionnaire collecting particularly information on tobacco and alcohol consumption, residential history and a detailed description of occupational history. Biological samples were also collected from study subjects. The main occupational exposures of interest are asbestos, man-made mineral fibers, formaldehyde, polycyclic aromatic hydrocarbons, chromium and nickel compounds, arsenic, wood dust, textile dust, solvents, strong acids, cutting fluids, silica, diesel fumes, welding fumes. The complete list of exposures of interest includes more than 60 substances. Occupational exposure assessment will use several complementary methods: case-by-case evaluation of exposure by experts; development and use of algorithms to assess exposure from the questionnaires; application of job-exposure matrices.


The large number of subjects should allow to uncover exposures associated with moderate increase in risks, and to evaluate risks associated with infrequent or widely dispersed exposures. It will be possible to study joint effects of exposure to different occupational risk factors, to examine the interactions between occupational exposures, tobacco smoking, alcohol drinking, and genetic risk factors, and to estimate the proportion of respiratory cancers attributable to occupational exposures in France. In addition, information on many non-occupational risk factors is available, and the study will provide an excellent framework for numerous studies in various fields.