Workplace airborne hexavalent chromium concentrations for the Painesville, Ohio, chromate production plant (1943-1971)

Inhalation cancer risk assessment for environmental exposure to hexavalent chromium: Comparison of margin-of-exposure and linear extrapolation approaches

Hexavalent chromium [Cr(VI)] exists in the ambient air at low concentrations (average upperbound ~0.1 ng/m³) yet airborne concentrations typically exceed EPA's Regional Screening Level for residential exposure (0.012 ng/m³) and other similar benchmarks, which assume a mutagenic mode of action (MOA) and use low-dose linear risk assessment models. We reviewed Cr(VI) inhalation unit risk estimates developed by researchers and regulatory agencies for environmental and occupational exposures and the underlying epidemiologic data, updated a previously published MOA analysis, and conducted dose-response modeling of rodent carcinogenicity data to evaluate the need for alternative exposure-response data and risk assessment approaches. Current research supports the role of non-mutagenic key events in the MOA, with growing evidence for epigenetic modifiers. Animal data show a weak carcinogenic response, even at cytotoxic exposures, and highlight the uncertainties associated with the current epidemiological data used in risk assessment. Points of departure from occupational and animal studies were used to determine margins of exposure (MOEs). MOEs range from 1.5 E+3 to 3.3 E+6 with a median of 5 E+5, indicating that current environmental exposures to Cr(VI) in ambient air should be considered of low concern. In this comprehensive review, the divergent results from default linear and MOE assessments support the need for more relevant and robust epidemiologic data, additional mechanistic studies, and refined risk assessment strategies.

Evaluation of chromium accumulation and resulting histopathological changes in Libyan jirds (Mammals, Rodentia), affected by effluent from Ghazghan leather industrial town, Iran

The leather industry is one of the major producers of wastewater, releasing large amounts of various chemicals into the environment. Chromium (Cr) is the most commonly used agent in the tanning industry. Accumulation in the animal body can adversely affect the functioning of animal tissues. The current study investigated the toxic effects of Cr on lung, kidney, liver, and testicular tissues in Libyan jirds (Meriones libycus) inhabiting the area surrounding Ghazghan leather industrial town, Mashhad, Iran. Average Cr concentrations were found to be significantly higher in samples from contaminated areas than controls (p < 0.05). The highest accumulation of Cr was found in lung tissue, while the liver tissue showed the lowest. The results also showed that sex and age had no significant effect on Cr accumulation in any tissue at either sampling area (p < 0.05). Histological analyses showed that Cr accumulation had caused changes in tissue samples from Libyan jirds from the contaminated area. Hyperemia was observed in all tissues. In kidney tissue, necrosis and degeneration of the epithelial cells of the tubules were seen as well, and in one case, we also observed hemorrhage. In liver tissue, necrosis, degeneration, and inflammation were observed, along with one case, of fibrosis. In lung tissue, we observed emphysema, hemorrhage, and inflammation. Testicular tissue also showed a considerable lesion. Given the proximity of specimens' habitat to an area of importance, i.e., the industrial town, and the species' dependence on its habitat for nutrition, Libyan jirds are particularly useful for monitoring. Thus, they can be used to monitor the level of contamination in future studies.

Molecular and epigenetic mechanisms of Cr(VI)-induced carcinogenesis

Chromium (Cr) is a naturally occurring metallic element found in the Earth's crust. While trivalent chromium ([Cr(III)] is considered non-carcinogenic, hexavalent chromium [Cr(VI)] has long been established as an IARC class I human carcinogen, known to induce cancers of the lung. Current literature suggests that Cr(VI) is capable of inducing carcinogenesis through both genetic and epigenetic mechanisms. Although much has been learned about the molecular etiology of Cr(VI)-induced lung carcinogenesis, more remains to be explored. In particular, the explicit epigenetic alterations induced by Cr(VI) in lung cancer including histone modifications and miRNAs, remain understudied. Through comprehensive review of available literature found between 1973 and 2019, this article provides a summary of updated understanding of the molecular mechanisms of Cr(VI)-carcinogenesis. In addition, this review identifies potential research gaps in the areas of histone modifications and miRNAs, which may prompt new niches for future research.

Cancer Risks of Hexavalent Chromium in the Respiratory Tract

Hexavalent chromium (Cr(VI)) compounds are recognized as carcinogens in the respiratory tract, giving rise to cancers of the lung, nose and nasal sinuses, especially in certain occupational environments. Inhalation exposure of Cr(VI)-containing particles, dusts and fumes commonly occurs in chromium-related occupational environments, such as chromium production, plating, welding of chromium-containing metals and alloys, electroplating, chromium-containing pigments and paints. Epidemiological surveys of chromium compounds have shown strong associations between exposure to Cr(VI) and mortality due to lung cancer, as well as positive associations with cancers of the nose and nasal cavity. Nasal symptoms, such as nasal irritation, ulceration and perforation of the nasal septum, nasal turbinate engorgement and hypertrophy, are important signs for the early diagnosis of lung cancer and cancers of the nose and nasal cavity in those with an occupational history of Cr(VI) exposure. Cr(VI) exposure in the workplace remains a serious problem as a cause of lung cancer and cancers of nose and nasal cavity, especially in relatively small enterprises that use chromium compounds. Appropriate protection for workers should be considered in occupations that involve exposure to chromium compounds.

Toxicity and oxidative stress induced by chromium in workers exposed from different occupational settings around the globe: A review

The present review focused on the levels and toxicological status of heavy metals especially chromium (Cr) in the exposed workers from different occupational settings around the globe and in Pakistan. It was found that exposed workers from leather tanning and metal plating units showed elevated levels of Cr than the workers from other occupational settings. Cr and other heavy metals level in biological matrices of the exposed workers in different occupational settings revealed that developing countries are severely contaminated. Occupational settings from the Sialkot district, Pakistan exhibited elevated level of Cr in biological entities of the exposed workers. Review suggested that higher level of Cr exposure to the workers enhance the oxidative stress (reactive oxygen species (ROS) and hydroxyl (OH) radical generation) which may cause; cellular and molecular damage such as genotoxicity and chromosomal aberration formations, and carcinogenic effects. This review will help to understand the Cr contamination mechanisms and associated health implications in different occupational settings around the globe in general and particularly to Pakistan. This study will also assist occupational health and safety management authorities to devise or change the Cr recommended exposure limits (REL) for different occupational settings.

Inhalation cancer risk assessment of hexavalent chromium based on updated mortality for Painesville chromate production workers

The exposure-response for hexavalent chromium (Cr(VI))-induced lung cancer among workers of the Painesville Ohio chromate production facility has been used internationally for quantitative risk assessment of environmental and occupational exposures to airborne Cr(VI). We updated the mortality of 714 Painesville workers (including 198 short-term workers) through December 2011, reconstructed exposures, and conducted exposure-response modeling using Poisson and Cox regressions to provide quantitative lung cancer risk estimates. The average length of follow-up was 34.4 years with 24,535 person-years at risk. Lung cancer was significantly increased for the cohort (standardized mortality ratio (SMR)=186; 95% confidence interval (CI) 145-228), for those hired before 1959, those with >30-year tenure, and those with cumulative exposure >1.41 mg/m(3)-years or highest monthly exposures >0.26 mg/m(3). Of the models assessed, the linear Cox model with unlagged cumulative exposure provided the best fit and was preferred. Smoking and age at hire were also significant predictors of lung cancer mortality. Adjusting for these variables, the occupational unit risk was 0.00166 (95% CI 0.000713-0.00349), and the environmental unit risk was 0.00832 (95% CI 0.00359-0.0174), which are 20% and 15% lower, respectively, than values developed in a previous study of this cohort.

Chromium exposure and germinal embryonal carcinoma: first two cases and review of the literature

The aim of the study was to determine the potential role of occupational exposures to chromium (Cr) in the onset of extragonadal germinal embryonal carcinoma. The first two cases of workers in a company with Cr exposure are reported. The published scientific literature regarding the topic in peer-reviewed journals including MEDLINE and CancerLit databases was extensively reviewed. Two young patients who were coworkers in the same company, exposed to Cr, developed extragonadal germinal embryonal carcinomas. One of them also developed angiosarcoma of the mediastinum. To the best of our knowledge these are the first two cases of germinal embryonal carcinoma in patients with occupational exposure to Cr.

Assessment of the mode of action for hexavalent chromium-induced lung cancer following inhalation exposures

Inhalation of hexavalent chromium [Cr(VI)] is associated with increased lung cancer risk among workers in several industries, most notably chromate production workers exposed to high concentrations of Cr(VI) (≥100 μg/m(3)), for which clear exposure-response relationships and respiratory irritation and tissue damage have been reported. Data from this industry are used to assess lung cancer risk associated with environmental and current occupational exposures, occurring at concentrations that are significantly lower. There is considerable uncertainty in the low dose extrapolation of historical occupational epidemiology data to assess risk at current exposures because no published or well recognized mode of action (MOA) for Cr(VI)-induced lung tumors exists. We conducted a MOA analysis for Cr(VI)-induced lung cancer evaluating toxicokinetic and toxicological data in humans and rodents and mechanistic data to assess plausibility, dose-response, and temporal concordance for potential MOAs. Toxicokinetic data support that extracellular reduction of Cr(VI), which limits intracellular absorption of Cr(VI) and Cr(VI)-induced toxicity, can be overwhelmed at high exposure levels. In vivo genotoxicity and mutagenicity data are mostly negative and do not support a mutagenic MOA. Further, both chronic bioassays and the epidemiologic literature support that lung cancer occurs at exposures that cause tissue damage. Based on this MOA analysis, the overall weight of evidence supports a MOA involving deposition and accumulation of particulate chromium in the bifurcations of the lung resulting in exceedance of clearance mechanisms and cellular absorption of Cr(VI). Once inside the cell, reduction of Cr(VI) results in oxidative stress and the formation of Cr ligands. Subsequent protein and DNA damage lead to tissue irritation, inflammation, and cytotoxicity. These effects, concomitant with increased cell proliferation, result in changes to DNA sequences and/or methylation status that can lead to tumorigenesis. This MOA supports the use of non-linear approaches when extrapolating lung cancer risk occurring at high concentration occupational exposures to environmentally-relevant exposures.

Occupational exposure to hexavalent chromium and cancers of the gastrointestinal tract: a meta-analysis

INTRODUCTION

We conducted a systematic literature review and meta-analysis of oral cavity, esophageal, stomach, small intestine, colon, and rectal cancers among workers occupationally exposed to Cr(VI).

METHODS

Using PubMed, studies published from 1950 to 2009 evaluating the relationship between Cr(VI) exposure and GI cancers were identified. Measures of effect and variability were extracted from 32 studies meeting specific inclusion criteria, and meta-analysis summary relative risk measures were calculated using random effects models and inverse variance weighting methods.

RESULTS

Meta-standardized mortality ratios (SMRs) were, for cancer of the: oral cavity [1.02 (95% CI=0.77-1.34)]; esophagus [1.17 (95% CI=0.90-1.51)]; stomach [1.09 (95% CI=0.93-1.28)]; colon [0.89 (95% CI=0.70-1.12)]; and rectum [1.17 (95% CI=0.98-1.39)]. Analyses of more highly exposed subgroups included in the studies or subgroups based on geographic region or by industry with recognized Cr(VI) exposures (welding, chrome plating, chromate production, and pigment production) did not result in elevated meta-SMRs except for esophageal cancer among US cohorts [meta-SMR=1.49 (95% CI=1.06-2.09)]. However, that finding was based on a subgroup of only four studies, one of which was a PMR study. Potential confounding by socioeconomic status (SES), diet and/or smoking, or limitations due to the healthy-worker effect (HWE) were evaluated, and while smoking, diet and SES may be important factors that may have upwardly biased the meta-SMRs, HWE is not likely to have significantly affected the summary results. None of three studies reporting small intestine cancers observed a statistically significant increased risk.

DISCUSSION

These meta-analyses and literature review indicate that Cr(VI)-exposed workers are not at a greater risk of GI cancers than the general population.

Past occupational exposure to airborne manganese in a manganese alloy plant

A retrospective exposure assessment of a group of manganese (Mn) alloy workers was performed in conjunction with a 2004 follow-up study, 14 years after cessation of exposure, to evaluate the long-term effects of occupational Mn exposure on neurobehavioral functions. The ferro- and silico-Mn alloy plant opened in 1973 and closed in 1991. The airborne total Mn (TMn) exposures for job groupings were established using personal sampling data from a 1991 industrial hygiene survey. Historical short-term total dust (TDust) data were used to estimate past TDust exposure for job groupings and plant areas. Relationships between Mn content and TDust from the 1991 survey, supported by sparse historical data, were used to estimate TMn content in the historical TDust data. Results showed past personal TDust exposure levels much higher than those found in 1991. Changes in TDust levels and corresponding TMn levels were a function of changes in ventilation, work practices, and operations, not of product (ferro- or silico-Mn). Relationships between TMn and respirable Mn (RMn) from area sampling in 1991 were used to estimate RMn exposure for the job groups. Work histories for 112 workers were developed from payroll records, questionnaires, and interviews and combined with Mn exposure estimates to develop cumulative exposure indices (CEIs). The TMn CEI ranged from 0.27 mg/m(3)x years to 100.24 mg/m(3)x years, with an AM of 24.40 mg/m(3)x years and a GM of 14.06 mg/m(3)x years. The RMn CEI had an AM of 2.95 mg/m(3)x years and a GM of 1.78 mg/m(3)x years with a range of 0.05-12.03 mg/m(3)x years. Overall average TMn exposure intensity, the TMn CEI divided by time worked in years for each worker, had an AM of 1.6 mg Mn/m(3), a GM of 1.0 mg Mn/m(3), range 0.02-6.2 6 mg Mn/m(3). The results of the 2004 follow-up study showed several concentration-response relationships between TMn CEI and neurobehavioral outcomes, which suggest that increase in cumulative TMn exposure level has long-term consequences on the nervous system.

New developments in exposure assessment: the impact on the practice of health risk assessment and epidemiological studies

The field of exposure assessment has matured significantly over the past 10-15 years. Dozens of studies have measured the concentrations of numerous chemicals in many media to which humans are exposed. Others have catalogued the various exposure pathways and identified typical values which can be used in the exposure calculations for the general population such as amount of water or soil ingested per day or the percent of a chemical than can pass through the skin. In addition, studies of the duration of exposure for many tasks (e.g. showering, jogging, working in the office) have been conducted which allow for more general descriptions of the likely range of exposures. All of this information, as well as the development of new and better models (e.g. air dispersion or groundwater models), allow for better estimates of exposure. In addition to identifying better exposure factors, and better mathematical models for predicting the aerial distribution of chemicals, the conduct of simulation studies and dose-reconstruction studies can offer extraordinary opportunities for filling in data gaps regarding historical exposures which are critical to improving the power of epidemiology studies. The use of probabilistic techniques such as Monte Carlo analysis and Bayesian statistics have revolutionized the practice of exposure assessment and has greatly enhanced the quality of the risk characterization. Lastly, the field of epidemiology is about to undergo a sea change with respect to the exposure component because each year better environmental and exposure models, statistical techniques and new biological monitoring techniques are being introduced. This paper reviews these techniques and discusses where additional research is likely to pay a significant dividend. Exposure assessment techniques are now available which can significantly improve the quality of epidemiology and health risk assessment studies and vastly improve their usefulness. As more quantitative exposure components can now be incorporated into these studies, they can be better used to identify safe levels of exposure using customary risk assessment methodologies. Examples are drawn from both environmental and occupational studies illustrating how these techniques have been used to better understand exposure to specific chemicals. Some thoughts are also presented on what lessons have been learned about conducting exposure assessment for health risk assessments and epidemiological studies.

A search for thresholds and other nonlinearities in the relationship between hexavalent chromium and lung cancer

The exposure-response relationship for airborne hexavalent chromium exposure and lung cancer mortality is well described by a linear relative rate model. However, categorical analyses have been interpreted to suggest the presence of a threshold. This study investigates nonlinear features of the exposure response in a cohort of 2,357 chemical workers with 122 lung cancer deaths. In Poisson regression, a simple model representing a two-step carcinogenesis process was evaluated. In a one-stage context, fractional polynomials were investigated. Cumulative exposure dose metrics were examined corresponding to cumulative exposure thresholds, exposure intensity (concentration) thresholds, dose-rate effects, and declining burden of accumulated effect on future risk. A simple two-stage model of carcinogenesis provided no improvement in fit. The best-fitting one-stage models used simple cumulative exposure with no threshold for exposure intensity and had sufficient power to rule out thresholds as large as 30 microg/m3 CrO3 (16 microg/m3 as Cr+6) (one-sided 95% confidence limit, likelihood ratio test). Slightly better-fitting models were observed with cumulative exposure thresholds of 0.03 and 0.5 mg-yr/m3 (as CrO3) with and without an exposure-race interaction term, respectively. With the best model, cumulative exposure thresholds as large as 0.4 mg-yr/m3 CrO3 were excluded (two-sided upper 95% confidence limit, likelihood ratio test). A small departure from dose-rate linearity was observed, corresponding to (intensity)0.8 but was not statistically significant. Models in which risk-inducing damage burdens declined over time, based on half-lives ranging from 0.1 to 40 years, fit less well than assuming a constant burden. A half-life of 8 years or less was excluded (one-sided 95% confidence limit). Examination of nonlinear features of the hexavalent chromium-lung cancer exposure response in a population used in a recent risk assessment supports using the traditional (lagged) cumulative exposure paradigm: no intensity (concentration) threshold, linearity in intensity, and constant increment in risk following exposure.

Benzene exposures associated with tasks performed on marine vessels (circa 1975 to 2000)

In this article, we assemble and synthesize the available industrial hygiene data that describe exposure during the marine transport of benzene-containing products in the United States and abroad. A total of 25 studies were identified and summarized. The measured airborne concentrations of benzene on marine vessels were found to vary depending on several key factors, including the job task, vessel characteristics, cargo type, and sample type and duration. Despite the differences in sampling strategies and benzene content of the liquids being transported, personal time-weighted-average benzene air concentrations typically ranged from 0.2-2.0 ppm during closed loading and 2-10 ppm during open loading operations. Benzene exposures during these activities are likely due to specific short-term tasks, such as connecting and disconnecting hoses and tank gauging and sampling. Similar concentrations of benzene have been reported in the pump room during marine loading operations and during tank cleaning activities in various settings. When compared with contemporaneous occupational health standards, our review indicates that most activities performed on marine vessels from the 1970s to 1990s usually did not result in benzene exposures that exceeded these standards. The information and data presented here may be useful for quantitatively estimating or reconstructing historical exposures during the marine transport of benzene-containing cargo if details about individual's work histories in the maritime industry are available.

Cancer prevention: a global perspective

This review will be restricted to measures aimed at primary prevention of cancer; reduction of the death rate through screening will not be covered. In many instances, cancer prevention is just one outcome of the benefits of good health practices, which may also benefit cardiovascular, lung, infectious, and metabolic diseases. Thus, reducing tobacco smoking will bring benefits in heart disease, neonatal and maternal health, stroke, and peripheral vascular disease as well as a variety of cancers, while dietary advice appropriate to cancer risk reduction will bring benefits in diabetes, stroke, kidney, and heart disease.

Estimating historical occupational exposure to airborne hexavalent chromium in a chromate production plant: 1940--1972

This article presents a retrospective exposure assessment for 493 workers who were occupationally exposed to airborne hexavalent chromium, Cr(VI), at a Painesville, Ohio, chromate production plant from 1940-1972. Exposure estimates were reconstructed using a job-exposure matrix approach that related job titles with area monitoring data from 21 industrial hygiene surveys conducted from 1943 to 1971. No personal monitoring data were collected. Specifically, airborne Cr(VI) concentration profiles for 22 areas of the plant, termed job-exposure group (JEG) areas, were constructed for three distinct time periods (1940-1949, 1950-1964, and 1965-1972), with cut points based on known major plant and process changes. Average airborne Cr(VI) concentrations were the highest for the bridge crane operators (5.5 mg/m3) prior to 1965, although only four cohort members held this job title. Airborne concentrations for the rest of the production areas of the plant ranged from 1.9 mg/m3 for packers in the 1940s to 0.012 mg/m3 for ore mill operators after 1964. For nearly all JEG areas, exposures decreased over time, particularly after 1964. For example, average airborne concentrations in production areas of the plant decreased from 0.72 mg/m3 in the 1940s to 0.27 mg/m3 from 1950 to 1964, and the average was 0.039 mg/m3 after 1964. Former workers were interviewed to determine activity patterns in the plant by job title. This information was combined with Cr(VI) monitoring data to calculate cumulative occupational exposure for each worker. Cumulative exposures ranged from 0.003 to 23 (mg/m3) x years. The highest monthly 8-hour average exposure concentration for each worker ranged from 0.003 to 4.1 mg/m3. These exposure estimates have been combined with mortality data for this cohort to assess the lung cancer risk associated with inhaled Cr(VI), and a positive dose-response relationship was observed for increases in lung cancer mortality with measures of cumulative exposure and highest monthly exposure.

Dose-response and risk assessment of airborne hexavalent chromium and lung cancer mortality

This study evaluates the dose-response relationship for inhalation exposure to hexavalent chromium [Cr(VI)] and lung cancer mortality for workers of a chromate production facility, and provides estimates of the carcinogenic potency. The data were analyzed using relative risk and additive risk dose-response models implemented with both Poisson and Cox regression. Potential confounding by birth cohort and smoking prevalence were also assessed. Lifetime cumulative exposure and highest monthly exposure were the dose metrics evaluated. The estimated lifetime additional risk of lung cancer mortality associated with 45 years of occupational exposure to 1 microg/m3 Cr(VI) (occupational exposure unit risk) was 0.00205 (90%CI: 0.00134, 0.00291) for the relative risk model and 0.00216 (90%CI: 0.00143, 0.00302) for the additive risk model assuming a linear dose response for cumulative exposure with a five-year lag. Extrapolating these findings to a continuous (e.g., environmental) exposure scenario yielded an environmental unit risk of 0.00978 (90%CI: 0.00640, 0.0138) for the relative risk model [e.g., a cancer slope factor of 34 (mg/kg-day)-1] and 0.0125 (90%CI: 0.00833, 0.0175) for the additive risk model. The relative risk model is preferred because it is more consistent with the expected trend for lung cancer risk with age. Based on statistical tests for exposure-related trend, there was no statistically significant increased lung cancer risk below lifetime cumulative occupational exposures of 1.0 mg-yr/m3, and no excess risk for workers whose highest average monthly exposure did not exceed the current Permissible Exposure Limit (52 microg/m3). It is acknowledged that this study had limited power to detect increases at these low exposure levels. These cancer potency estimates are comparable to those developed by U.S. regulatory agencies and should be useful for assessing the potential cancer hazard associated with inhaled Cr(VI).