Several cohort and case-control studies have found an increased risk of bladder cancer among hairdressers and barbers who are occupationally exposed to hair dyes. However, the carcinogenic risk associated with personal use of hair dyes remains uncertain since several large case-control and cohort studies did not find an association between personal hair dye use and bladder cancer. To address this question, the authors used data collected on 459 bladder cancer cases and 665 controls who were interviewed as part of a case-control study conducted in New Hampshire between 1994 and 1998. Participants underwent a structured personal interview with regard to history of hair dye use and bladder cancer risk factors. Unconditional logistic regression analysis was used to compute odds ratios that were associated with hair dye use, while controlling for potential confounding factors. A history of any hair dye use was inversely associated with bladder cancer incidence in men [adjusted odds ratio (OR) ؍ 0.5; 95% confidence interval (CI)-3.0؍ 0.8], although risk reductions were not statistically significant for individual dye types. In women, use of permanent (adjusted OR ؍ 1.5; 95%CI ؍ 0.8 -2.7) and rinse-type hair dye (adjusted OR ؍ 1.7; 95%CI ؍ 0.8 -3.6) were associated with a modestly elevated risk of bladder cancer but with limited statistical precision; no association was found with use of semi-permanent dyes (adjusted OR ؍ 0.7; 95%CI ؍ 0.3-1.4). For permanent hair dye use, odds ratios were most pronounced for younger age at first use, higher frequency and prolonged time since first use; however there were no clear trends in risk by these factors. In light of the prevalence of hair dye use, further studies are needed that address the effects of specific colors and types of hair dyes along with the possible role of individual susceptibility. © 2004 Wiley-Liss, Inc.
Key words: hair dye; bladder cancer; permanent dye; case-control; logistic regressionIt is estimated that about 33% of women above age 18 and over 10% of men over age 40 in the USA use hair dyes. 1 Occupational use of hair dyes by hairdressers and barbers has been associated with an increased risk of bladder-cancer in a number of cohort and case-control studies. 1 Combined, the cohort studies estimated a relative risk of bladder cancer associated with occupational exposure to hair dyes of 1.4 for 81,075 subjects (RR ϭ 1.1 for females, RR ϭ 1.6 for males), although control for smoking may be problematic. 1 Results of a recent follow-up cohort study in Sweden indicated an excess risk of bladder cancer among male hairdressers working at the 1960 census [standardized incidence ratio (SIR) ϭ 1.25; 95% confidence interval (CI) 1.1-1.6], however no excess risk was observed in recent decades. 2 Furthermore, the carcinogenic risk associated with personal use of hair dyes remains unclear. Several large studies, including the Nurses' Health cohort study 3 and the American Cancer Society cohort study, 4,5 indicated no increased risk of bladder cancer among ...