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Nasal cancer in the U.S. shoe industry: does it exist?

Studies in England and Italy have demonstrated a striking association between employment in the shoemaking industry and cancer of the nasal cavities and sinuses. However, three recent, large-scale proportionate mortality studies of U.S. shoeworkers do not show any deaths from these tumors. This paper reviews the methodology of those studies, emphasizing the underlying data and statistical power. In addition, epidemiologic and other considerations important in assessing and interpreting the apparent absence of a nasal cancer risk in the U.S. shoe industry are discussed.