Cancer morbidity and quartz exposure in Swedish iron foundries

The prevalence of respiratory symptoms and diseases and declined lung function among foundry workers

BACKGROUND

Foundry workers are occupationally exposed to a variety of inhalable chemical substances. Occupational exposure to vapors, gases, dusts, and fumes can lead to adverse health effects on the respiratory system and cause chronic respiratory diseases, such as interstitial lung diseases (ILDs), chronic obstructive lung disease (COPD), chronic bronchitis, and emphysema. Research on respiratory symptoms, diseases, and lung function in foundry workers over the past few decades has been limited. The aim of this cross-sectional study was to assess the prevalence of respiratory symptoms and diseases and declined lung function of current foundry workers, ex-foundry workers, and unexposed controls.

METHODS

We assessed respiratory symptoms, diseases, and lung function among 335 current foundry workers, 64 ex-foundry workers, and 161 unexposed controls. The cumulative dust exposure (mg-y) of each participant was calculated, and the median cumulative dust exposure according to the main places of exposure was determined.

RESULTS

A higher prevalence of chronic bronchitis, as reported in a questionnaire, was found among current and ex-foundry workers compared to unexposed controls, even after adjusting for pack-years of smoking (p = 0.009). Additionally, cough and wheezing in adulthood without respiratory infection, and chronic rhinitis symptoms were more common among current and ex-foundry workers compared to unexposed controls. These differences remained significant even after adjusting for pack-years of smoking and body mass index (BMI) (p = 0.007 and p  < 0.001, respectively). Impaired lung function was more prevalent among both ex-foundry workers (29.7%) and current foundry workers (15.5%) compared to the unexposed controls (8.7%), with the difference remaining significant even after adjusting for the pack-years of smoking and BMI (p = 0.009). According to the questionnaire, the number of physician-diagnosed cases of chronic obstructive pulmonary disease (COPD) or chronic bronchitis was unexpectedly low compared to the indications from the symptom questionnaire and lung function test results, suggesting a potential underdiagnosis. The prevalence of silicosis was low (0.8%) among current and ex-foundry workers.

CONCLUSIONS

Respiratory symptoms are common among foundry workers. Current and ex-foundry workers exhibited lower lung function in spirometry compared to unexposed controls. There is a potential underdiagnosis of COPD and chronic bronchitis among foundry workers.

Occupational exposure to silica and risk of gastrointestinal cancers: a systematic review and meta-analysis of cohort studies

BACKGROUND

Although silica is a proven lung carcinogen, there is no convincing evidence linking crystalline silica to gastrointestinal malignancies.

METHODS

We detailedly searched studies on the link between gastrointestinal malignancies and occupational silica exposure. Studies published between 1987 and 2023 were found by searching PubMed, Scopus, Cochrane Library, and Web of Science databases. Further studies were included from reference searching. We conducted a meta-analysis of the incidence and mortality of gastrointestinal malignancies and occupational silica exposure. We computed pooled-risk estimates using random effects models. Egger's regression asymmetry test and a funnel plot were used to identify publication bias. Moreover, sensitivity analysis and subgroup analysis were out.

RESULTS

We identified 40 research with individuals from 13 different countries. The results indicate that occupational silica exposure raises the risk of gastric and esophageal cancer incidence, with pooled standardized incidence ratio of 1.35 (95% CI 1.21-1.51, p < 0.001), 1.31 (95% CI 1.04-1.65, p = 0.023), respectively, but there was a lack of statistically significant relationship between standardized mortality ratio. In addition, we found that silica exposure did not increase the risk of colorectal and pancreatic cancers. Occupational silica exposure was found to increase the risk of liver cancer, with pooled SIR and SMR of 1.19 (95% CI 1.04-1.35, p = 0.009), 1.24 (95% CI 1.03-1.49, p = 0.026), respectively.

CONCLUSIONS

We discovered a link between occupational silica exposure and gastrointestinal malignancies, with cancers of the liver, stomach, and esophagus being the most prevalent. Colorectal and pancreatic cancer were not linked to occupational silica exposure.

Occupational exposure to respirable crystalline silica and lung cancer: a systematic review of cut-off points

BACKGROUND

Respirable crystalline silica (RCS) is associated with the development of lung cancer. However, there is uncertainty around the exposure threshold at which exposure to RCS may pose a clear risk for the development of lung cancer. The objective of this study was to review the cut-off points at which the risk of mortality or incidence of lung cancer due to occupational exposure to RCS becomes evident through a systematic review.

METHODS

We conducted a search in PubMed, including cohort and case-control studies which assessed various categories of RCS exposure. A search was also conducted on the webpages of institutional organizations. A qualitative data synthesis was performed.

RESULTS

Twenty studies were included. Studies that assessed lung cancer mortality and incidence displayed wide variability both in RCS exposure categories and related risks. Although most studies found no significant association for RCS exposure categories, it appears to be a low risk of lung cancer for mean concentrations of less than 0.07mg/m3. Regulatory agencies set annual RCS exposure limits ranging from 0.025mg/m3 through 0.1mg/m3.

CONCLUSIONS

There is a wide degree of heterogeneity in RCS exposure categories, with most studies observing no significant risk of lung cancer for the lowest exposure categories. Cut-off points differ between agencies but are nonetheless very similar and do not exceed 0.1mg/m3.

Silica Exposure and Cardiovascular, Cerebrovascular, and Respiratory Morbidity in a Cohort of Male Swedish Iron Foundry Workers

OBJECTIVE

We present quantitative exposure-response data on silica exposure in male Swedish iron foundry workers for cardiovascular, cerebrovascular, and respiratory morbidity.

METHODS

This research is a cohort study of 2063 male Swedish iron foundry workers. From the Swedish National Patient Registers, data on morbidity incidence were retrieved. A historical measurement database of 1667 respirable silica exposure measurements from 10 Swedish iron foundries was used to calculate the cumulative exposure dose for each worker.

RESULTS

Increased morbidity risk for the whole group of foundry workers was determined for ischemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), bronchitis, and pneumonia. In addition, an increased risk for COPD at cumulative silica exposures ranging from 0.11 to 0.84 mg/m 3 year is presented.

CONCLUSIONS

The study presents a significantly increased COPD risk at cumulative silica exposures below the Swedish occupational exposure limit.

Risk of Lung Cancer and Occupational Exposure to Polycyclic Aromatic Hydrocarbons Among Workers Cohorts - Worldwide, 1969-2022

What is already known about this topic?

Lung cancer has a high mortality, resulting in a severe disease burden. Polycyclic aromatic hydrocarbons (PAHs) are definitive carcinogen to human, and occupational exposure to PAHs is associated with lung cancer.

What is added by this report?

We analyzed the cancer cases from cohort studies on various PAHs exposed workers in China and other countries, calculated the quantitative risk of lung cancer based on meta-analyses, and confirmed the increased risk from lung cancer in selected PAHs exposed occupations.

What are the implications for public health practices?

There is a clear need to prevent lung cancer on a wide range of PAHs-related occupations in China and around the world. It is crucial to establish guidelines for improving the monitoring on exposure and health promotion in related working environments.

Occupational Quartz Exposure in a Population of Male Individuals-Association With Risk of Developing Atrial Fibrillation

OBJECTIVE

Occupational quartz exposure is a health risk, with increased risk of developing lung, autoimmune diseases, and elevated mortality in cardiovascular diseases.

METHODS

The population was obtained from the period 2005 to 2016 and consisted of 5237 cases of patients with atrial fibrillation (AF). Quartz exposure information was obtained through a Swedish job exposure matrix.

RESULTS

The risk of developing AF was increased for the quartz-exposed male population who were within a year of having commenced employment OR 1.54; (95% CI 1.06-2.24); this increased in the age group 20 to 55 (OR 2.05; CI 95% 1.02-4.10).

CONCLUSION

Our main conclusion is that quartz dust exposure may be related to increased risk of AF in high exposed (above 0.05 mg/m mean quartz dust) in men aged 20 to 55 years.

Biological Monitoring of Occupational Exposure to Metals in Electric Steel Foundry Workers and Its Contribution to 8-Oxo-7,8-Dihydro-2'-Deoxyguanosine Levels

In this study, the urinary concentrations of selected metals in workers from an electric steel foundry in Tunisia were assessed and compared with existing biological limit values and general population reference values. Moreover, the association between oxidative DNA damage, measured as urinary 8-oxo-7,8-dihydro-2'deoxyguanosine (8-oxodG) and co-exposure to metals and polycyclic aromatic hydrocarbons (PAHs) was evaluated. Urinary levels of 12 metals were determined by inductively coupled plasma-mass spectrometry (ICP-MS) in end-shift spot samples from 89 workers. The urinary levels of phenanthrene (U-PHE), as marker of exposure to PAHs, and 8-oxodG were also available. Median levels ranged from 0.4 µg/L (cobalt, Co, and thallium, Tl) to 895 µg/L (zinc, Zn). Only 1% of samples was above the biological limit values for Co, and up to 13.5% of samples were above limit values for Cd. From 3.4% (Co) to 72% (lead, Pb) of samples were above the reference values for the general population. Multiple linear regression models, showed that manganese (Mn), Zn, arsenic (As), barium (Ba), Tl, and Pb were significant predictors of 8-oxodG (0.012 ≤ p ≤ 0.048); U-PHE was also a significant predictor (0.003 ≤ p ≤ 0.059). The variance explained by models was low (0.11 ≤ R2 ≤ 0.17, p < 0.005), showing that metals and PAHs were minor contributors to 8-oxodG. Overall, the comparison with biological limit values showed that the study subjects were occupationally exposed to metals, with levels exceeding biological limit values only for Cd.

Lung cancer related to occupational exposure: an integrative review

ABSTRACT Objective: To identify in the literature the carcinogenic agents found in the work environment, the occupations and the risk for lung cancer. Method: A descriptive and analytical study of the Integrative Literature Review type was carried out in national and international databases from the last ten years in the period from 2009 to 2018, concerning 32 studies referring to association between carcinogenic substances to which the worker is exposed and lung cancer. Results: Nine (28.1%) publications originated in China and only one in Brazil. The most exposed workers were from the secondary sector, 50% being from industry and 6.2% from construction, mostly male. Asbestos and silica stood out among the carcinogenic substances most associated with lung cancer risk, accounting for 37.5% and 28.1%, respectively. Conclusions: The association between occupational exposure and the risk for lung cancer was characterized in this research by the substantial scientific evidence from the described studies that confirm this association.

Respiratory health and inflammatory markers - Exposure to respirable dust and quartz and chemical binders in Swedish iron foundries

Purpose

To study the relationship between respirable dust, quartz and chemical binders in Swedish iron foundries and respiratory symptoms, lung function (as forced expiratory volume FEV₁ and vital capacity FVC), fraction of exhaled nitric oxide (FENO) and levels of club cell secretory protein 16 (CC16) and CRP.

Methods

Personal sampling of respirable dust and quartz was performed for 85 subjects in three Swedish iron foundries. Full shift sampling and examination were performed on the second or third day of a working week after a work free weekend, with additional sampling on the fourth or fifth day. Logistic, linear and mixed model analyses were performed including, gender, age, smoking, infections, sampling day, body mass index (BMI) and chemical binders as covariates.

Results

The adjusted average respirable quartz and dust concentrations were 0.038 and 0.66 mg/m³, respectively. Statistically significant increases in levels of CC16 were associated with exposure to chemical binders (p = 0.05; p = 0.01) in the regression analysis of quartz and respirable dust, respectively. Non-significant exposure-responses were identified for cumulative quartz and the symptoms asthma and breathlessness. For cumulative chemical years, non-significant exposure–response were observed for all but two symptoms. FENO also exhibited a non significant exposure-response for both quartz and respirable dust. No exposure-response was determined for FEV₁ or FVC, CRP and respirable dust and quartz.

Conclusions

Our findings suggest that early markers of pulmonary effect, such as increased levels of CC16 and FENO, are more strongly associated with chemical binder exposure than respirable quartz and dust in foundry environments.

Environmental risk factors for liver cancer and nonalcoholic fatty liver disease

Purpose of review

The objective of this review was to summarize recent epidemiologic research examining the associations between environmental exposures and liver cancer and nonalcoholic fatty liver disease (NAFLD).

Recent findings

There were 28 liver cancer studies showing positive associations for exposures to aflatoxin, air pollution, polycyclic aromatic hydrocarbons, asbestos, chimney sweeping occupation, and paints; an inverse association for ultraviolet radiation; and null/inconsistent results for organic solvents, pesticides, perfluorooctanoic acid, nuclear radiation, iron foundry occupation, and brick kiln pollution. There were n=5 NAFLD studies showing positive associations for heavy metals, methyl tertiary-butyl ether, and selenium; and no association with trihalomethanes.

Summary

Evidence suggests that particular environmental exposures may be associated with liver cancer and NAFLD. Future liver cancer studies should examine specific histological subtypes and assess historical environmental exposures. Future NAFLD research should examine incident, biopsy-confirmed cases and the potential role of obesity and/or diabetes in studies of environmental factors and NAFLD.

Probabilistic risk-based pollution prevention model for a foundry: a case study of casting

Hazardous air pollutants from industrial activities have long been associated with serious health effects. Traditional health risk assessment uses point estimates of inhalation concentrations based on standard Gaussian diffusion models with steady-state emission rate assumptions. This traditional approach was criticized because it does not account for variability and thus leading to a potential overestimate of the health risk from the batch processes. To overcome this deficiency, a probabilistic risk assessment model is proposed. The foundry industry with processes typically associated with several hazardous air pollutants is identified and iron casting is chosen as a case study to compare risk estimates. Existing data, representing historical proprietary information of the case study, were used to deliver representative risk values and help identify potential replacements or interventions in the manufacturing process. A probability distribution function of emitted concentrations was simulated to model the batch process emissions from mold and core resin binders, a major source of pollution. The same method was applied to exposure factors to feed into the risk model resulting in a probabilistic risk evaluation. Several alternative resin binders in commercial use were examined to offer a risk-based substitute to the resin binder in use. The risk results provided an opportunity to consider newer and environmentally friendlier options. A comparison of the results from this approach and those from the point estimate analysis reveals a gross over estimation of risks. The point estimate risk values were about eight time larger than the mean value and about twice the 95th percentile values of the probabilistic risk approach. The wide range of variability among resin binders associated risk results, close to two orders of magnitude in some cases, presented opportunities to select from a variety of binders with lesser emissions and lower risk. Optimal selection will depend on several pollutants emitted from this process to help address cumulative impacts of multiple pollutants. Investigations are underway for a multi-pollutant strategy including trade-offs, and other quality controls vital to the decision-making.

Silica exposure increases the risk of stroke but not myocardial infarction-A retrospective cohort study

Introduction

Work-related exposure to silica is a global health hazard that causes diseases such as silicosis. Some studies have also reported that silica exposure is linked to elevated cardiovascular disease mortality. However, these diagnoses have not been investigated in detail and there have been few studies on morbidity. The aim of this study is to examine morbidity and mortality from different cardiovascular diseases among silica-exposed Swedish foundry workers.

Methods

Historical and contemporary measurements (1968–2006) of respiratory silica exposure were matched to job categories, individual foundries, and 4 time periods (1968–1979, 1980–1989, 1990–1999, 2000–2006) using a mixed model. Morbidity and mortality data for the studied cohorts were matched against the General Population Registry. Statistical analyses were performed with SPSS and STATA, and the data were stratified by age, gender, and year.

Results

Mortality from cardiovascular disease (SMR 1.3; 95% CI 1.2–1.4) and stroke (SMR 1.6, 95% CI 1.2–2.1) was significantly elevated among the studied population. The cohort also exhibited significantly elevated morbidity from stroke (SIR 1.34; 95% CI 1.2–1.5) but not myocardial infarction. The mean age at the time of first morbidity from stroke was 64 years, with 36% of the cases occurring before the age of 60.

Conclusions

Swedish foundry workers exposed to respirable silica exhibit elevated morbidity and mortality from stroke, but not from myocardial infarction. Our results also suggest a relationship between silica exposure and morbidity from stroke at a younger age than the general population.

Risk of sarcoidosis and seropositive rheumatoid arthritis from occupational silica exposure in Swedish iron foundries: a retrospective cohort study

OBJECTIVE

To study the impact of occupational silica exposure on the incidence rates of sarcoidosis and rheumatoid arthritis (RA) in a cohort of exposed workers in Swedish iron foundries.

DESIGN

The prevalence of sarcoidosis and RA in a cohort of silica exposed workers was compared with the prevalence in the general Swedish population in this register study. A mixed model was used to calculate silica exposure, and individual silica exposures were used to compute dose responses.

SETTING

Personnel records from 10 iron foundries were used to identify workers whose employment began before 2005 which was then linked to the national non-primary outpatient visits register.

PARTICIPANTS

The final cohort consisted of 2187 silica-exposed male workers who had been employed for at least 1 year and were still alive without having emigrated when the follow-up study began. The cohort's employment period covers 23 807 person-years at risk.

MAIN OUTCOME

The presented results indicate that moderate to high levels of silica exposure increase risks for sarcoidosis and seropositive RA.

RESULTS

Mean levels of airborne silica dust in the foundries decreased significantly between the 1970s and 2000s. Incidence rates of sarcoidosis (3.94; 95% CI 1.07 to 10.08) and seropositive RA (2.59; 95% CI 1.24 to 4.76) were significantly higher among highly exposed individuals.

CONCLUSION

Our results reveal increased risks for sarcoidosis and seropositive RA among individuals with high exposure to silica dust (>0.048 mg/m³) compared with non-exposed and less-exposed groups.

Occupational exposure to silica dust and risk of lung cancer: an updated meta-analysis of epidemiological studies

BACKGROUND

Crystalline silica is considered as one of the most common and serious occupational hazards to workers' health. Although its association with lung cancer has been studied for many decades, the conclusion remains somewhat controversial. Our objectives are to review and summarize the epidemiological evidence on the relationship between occupational silica exposure and risk of lung cancer and to provide an update on this major occupational health concern.

METHODS

Eligible studies up to 29 April 2016 were identified. Pooled effect estimates were calculated according to the reported outcome and the study design. Cohort, case control and proportional mortality studies were examined separately. Studies reporting results according to silicotic status were grouped together and analyzed. Due to the significant amount of heterogeneity expected, random effects models were implemented. Subgroup and meta-regression analyses (both univariate and multivariate) were performed in an attempt to explain heterogeneity. Studies which had adequate exposure characterization were selected to find out whether there was an exposure-response relationship between silica and lung cancer.

RESULTS

The risk of lung cancer was found to be elevated in both silicotics and non-silicotics. The pooled standardized mortality ratio (SMR) was 2.32 with a 95 % confidence interval (95 % CI) of 1.91-2.81 and 1.78 (95 % CI 1.07-2.96) respectively. The pooled standardized incidence ratio (SIR) was 2.49 (95 % CI 1.87-3.33) and 1.18 (95 % CI 0.86-1.62) respectively. Subgroup analysis showed that workers in the mining industry had the highest risk of lung cancer with a pooled SMR of 1.48 (95 % CI 1.18-1.86) and the weakest association was seen in potteries with a pooled SMR of 1.14 (95 % CI 1.05-1.23). A positive exposure-response relation was found between cumulative silica exposure and risk of lung cancer.

CONCLUSION

The results of our meta-analysis supported the carcinogenic role of silica on the lungs, which was more pronounced at higher levels of exposure, in the presence of silicosis and in the mining industry. Further research is needed to evaluate whether non-silicotics are truly at risk, whether a predisposing factor would explain this potential risk, and to determine the mechanism of carcinogenicity of silica in humans.

Occupational risk factors for relapse-free survival in bladder cancer patients

The influence of occupational risk factors on bladder cancer development is well investigated. However, studies on the influence on bladder cancer prognosis are rare. Therefore, it was of interest to investigate the time to first relapse in the follow-ups of three case-control series from Dortmund, Neuss, and Lutherstadt Wittenberg, Germany. Relapse-free survival of in total 794 urinary bladder cancer patients (Dortmund 174, Neuss 407, Lutherstadt Wittenberg 213) was derived from medical records. Cox regression models were used to determine the impact of profession and exposure to bladder carcinogens if the risk factor was present in at least four cases. One or several relapses were observed in 416 cases (52%). Median time to first relapse was 0.94 yr. Ten professions were observed in at least 4 patients. No significant associations were found. However, workers in the leather industry (n = 4), printing industry (n = 4), transportation (n = 43), and chemical industry (n = 40) and locksmiths/mechanics (n = 44) showed shorter relapse-free times. No trend to shorter relapse-free time was observed for miners (n = 42), agriculturists (n = 18), painters/lacquerers (n = 21), colorant production and processing workers (n = 7), foundry workers (n = 5), and persons exposed to aromatic amines (n = 45). Although the follow-up comprised nearly 800 cases, data on occupations and exposures of interest were not sufficient to obtain significant results. However, first results indicated potential associations that are worth further investigations.

Variation of airborne quartz in air of Beijing during the Asia-Pacific Economic Cooperation Economic Leaders' Meeting

Quartz particles are a toxic component of airborne particulate matter (PM). Quartz concentrations were analyzed by X-ray diffraction in eighty-seven airborne PM samples collected from three locations in Beijing before, during, and after the Asia-Pacific Economic Cooperation (APEC) Leaders' Meeting in 2014. The results showed that the mean concentrations of quartz in PM samples from the two urban sites were considerably higher than those from the rural site. The quartz concentrations in samples collected after the APEC meeting, when the pollution restriction lever was lifted, were higher than those in the samples collected before or during the APEC meeting. The quartz concentrations ranged from 0.97 to 13.2 μg/m(3), which were among the highest values amid those reported from other countries. The highest quartz concentration exceeded the Californian Office of Environmental Health Hazard Assessment reference exposure level and was close to the occupational threshold limit values for occupational settings. Moreover, a correlation analysis showed that quartz concentrations were positively correlated with concentrations of pollution parameters PM10, PM2.5, SO2 and NOx, but were negatively correlated with O3 concentration. The results suggest that the airborne quartz particles may potentially pose health risks to the general population of Beijing.

Pulmonary inflammation in foundry workers

OBJECTIVE

To assess whether cumulative dust exposure in foundry work is associated with airway inflammation measured by the analysis of fractionated exhaled nitric oxide (NO) concentration, or by inflammatory markers in exhaled breath condensate or serum.

METHODS

We examined 476 dust-exposed and nonexposed foundry workers, and assessed the individual cumulative exposure to dusts and respirable quartz. Bronchial and alveolar NO production and inflammatory markers in exhaled breath condensate and in serum samples were also analyzed.

RESULTS

After adjusting for pack-years of smoking, increased levels of alveolar NO, serum C-reactive protein, and interleukin-8 were associated with a higher level of cumulative exposure to dust. The referents had higher serum myeloperoxidase levels, bronchial NO output, and 8-isoprostane levels in exhaled breath condensate than in the dust-exposed groups.

CONCLUSIONS

Dust exposure in foundry work may induce both systemic and alveolar inflammation.