Respiratory cancer among soap production workers

Application of Standardized Proportional Mortality Ratio to the Assessment of Health Risk in Relatively Healthy Populations: Using a Study of Cancer Risk in Telecommunication Workers with Excess Exposure to Acid Mists as an Example

When a study population is relatively healthy, such as an occupational population, epidemiological studies are likely to underestimate risk. We used a case study on the cancer risk of workers with exposure to acid mists, a well-documented carcinogen, to demonstrate that using proportional mortality ratios (PMRs) is more appropriate than mortality ratios in assessing risk in terms of mortality. The study included 10,229 employees of a telecommunication company who worked in buildings with battery rooms. In these buildings, the battery rooms had the highest levels of sulfuric acid in the air (geometric mean = 10.7 μg/m³). With the general population in Taiwan as a reference, a decreased standardized mortality ratio (0.42, p < 0.01) from all causes combined, between 1 January 1985 and 31 December 1996, was observed, indicating a healthy worker effect. When we reanalyzed the data using standardized PMR, elevated risks were observed for all cancers combined (1.46, p = 0.01) and cancers of the digestive organs and peritoneum (1.61, p = 0.02), especially stomach cancer (2.94, p = 0.01). The results showed that PMR can detect increases in mortality when a study population is generally healthier than the comparison population and call for further studies on the possible carcinogenic effects of low-level acid mist exposures on the stomach.

Work in the metal industry and nasopharyngeal cancer mortality among formaldehyde-exposed workers

OBJECTIVE

To investigate further the possibility that the large nasopharyngeal cancer (NPC) mortality excess among a cohort of formaldehyde-exposed workers may be related to occupational factors external to the study plant.

METHODS

Subjects were 7345 workers employed at a plastics-producing plant (1941-1984) in Wallingford, Connecticut evaluated independently as part of a National Cancer Institute cohort study. Vital status for 98% of the cohort and cause of death for 95% of 2872 deaths were determined through 2003. Reconstructed worker exposures to formaldehyde were used to compute unlagged and lagged exposure measures. We computed standardized mortality ratios (SMRs) based on US and local county rates. In a nested case-control study we evaluated mortality risks from NPC and from all other pharyngeal cancers combined (AOPC) in relation to formaldehyde exposure while accounting for potential confounding or effect modification by smoking or external (non-Wallingford) employment. Job applications, Connecticut commercial city directories and a previous survey were used to assign subjects to three external job groups.

RESULTS

We observed no new deaths from NPC and one additional AOPC death (pharynx unspecified) yielding, respectively, SMRs of 4.43 (7 deaths, 95% CI=1.78-9.13) and 1.71 (16 deaths, 95% CI=1.01-2.72). Five of seven NPC cases worked in silver smithing (including brass plating and other jobs related to silver or brass) or other metal work (including steel working and welding), and this type of work was relatively rare in the remaining study population (OR=14.41, 95% CI=1.08-82.1). For AOPC, we found a moderate increase in risk for other metal work (OR=1.40, 95% CI=.31-5.1). Interaction models suggested that NPC and AOPC risks were not elevated in subjects exposed only to formaldehyde.

CONCLUSIONS

The results of our nested case-control study suggest that the large nasopharyngeal cancer mortality excess in the Wallingford cohort may not be due to formaldehyde exposure, but rather reflects the influence of external employment in the ferrous and non-ferrous metal industries of the local area that entailed possible exposures to several suspected risk factors for upper respiratory system cancer (e.g., sulfuric acid mists, mineral acid, metal dusts and heat). Our findings may also help to explain why the associations with formaldehyde and nasopharyngeal cancer reported in the 1994 update of the 10-plant NCI formaldehyde cohort study were unique to the Wallingford plant (Plant 1 in NCI study). Further updates of the NCI formaldehyde cohort study should include co-exposure data on silver smithing and other metal work for all study plants to help explain the unique findings for nasopharyngeal cancer in Plant 1 compared with the other nine plants.

Lung cancer near an industrial site in Lithuania with major emissions of airway irritants

To assess the relation between air pollution with airway irritants, including sulfuric acid and lung cancer, a case-control study was performed near an industry producing sulfuric acid and fertilizers in Kedainiai county, central Lithuania. The county had the highest lung cancer rates of the country among men. Between 1967 and 1973, the levels of sulfuric acid exceeded 500 microg/m(3) within 2 km of the industry and 100 microg/m(3) more than 5 km away. A total of 277 men who were diagnosed as having lung cancer during 1981-1991 in Kedainiai county were included as well as 1,108 population controls. Information on residential history since 1960, smoking habits, occupations and workplaces during lifetime was obtained from questionnaires mailed to next-of-kin. The relative risk of lung cancer associated with living within approximately 5 km from the plant was 1.02 (95% CI: 0.76-1.38) compared to those who had never lived in this area. No relation with distance or duration of residence was observed. Furthermore, workers at the plant did not have an increased lung cancer risk. The relative risk of lung cancer associated with smoking was 21.2 (95% CI: 7.51; 60.1) for current smokers and 14.0 (95% CI: 4.88; 40.3) for exsmokers. The duration of smoking, a low age at start and amount of cigarettes smoked daily were positively associated with lung cancer risk. Smoking levels appeared more pronounced among study controls than in the rest of the country. Our study could not confirm earlier evidence of an association between exposure to airway irritants, such as sulfuric acid and lung cancer. Smoking is the major determinant of the risk of lung cancer in men in Kedainiai county. It is probable that higher smoking rates constitute the main reason for the increased lung cancer risk among men in this area.

Epidemiologic evidence on the relationship between mists containing sulfuric acid and respiratory tract cancer

This review identified and evaluated 25 epidemiologic studies pertaining to the carcinogenicity of mists containing sulfuric acid (MSA). Few studies were designed with acid mists as the principal exposure under investigation, and in all studies exposure assessment was limited. The results of the follow-up studies from industries with high or moderate exposure potential and the case-control studies indicate, in aggregate, a moderate association between MSA and larynx cancer. The data suggest a dose-response relationship. However, many of the results from individual studies are imprecise, and confounding by smoking, alcohol, and other occupational agents is not adequately adjusted for. The biologic plausibility and the possible carcinogenic mechanism remain uncertain. There is little evidence in support of a causal relationship between exposure to MSA and lung cancer. Information is inadequate for drawing any meaningful inference about the association between exposure to MSA and nasal cancer.

Upper aerodigestive cancer in battery manufacturers and steel workers exposed to mineral acid mists

OBJECTIVE

To assess the risk of cancer from inhalation of mineral acid mists.

METHODS

A cohort study and nested case-control study of upper aerodigestive tumours were carried out in men employed since 1950 at two battery plants and two steel works in Britain. The cohort was identified from personnel records and included 2678 men with definite exposure to acid mists (mainly sulphuric acid), 367 with possible exposure, and 1356 who were unexposed. Mortality was compared with that in the national population by the person-years method. Cases of upper aerodigestive cancer were identified from death certificates and cancer registrations, and their exposure to acids was compared with that of age matched controls (five per case) from the same plant by conditional logistic regression.

RESULTS

In follow up to 31 December 1993, 93% of men were traced, including 1277 who had died. Among the men definitely exposed to acid mists, overall mortality was less than in the national population (standardised mortality ratio (SMR) 0.92, 95% confidence interval (95% CI) 0.85-0.98) as was mortality from all cancers (SMR 0.92, 95% CI 0.79-1.05) and specifically from cancer of the larynx (SMR 0.48, 95% CI 0.01-2.70) and lung (SMR 0.98, 95% CI 0.78-1.22). A total of 15 incident or fatal cases of upper aerodigestive cancer were identified during follow up. When these men were compared with controls, risk was moderately increased in those who had worked for at least five years in jobs entailing exposures to sulphuric or hydrochloric acid in excess of 1 mg/m3 (OR 2.0, 95% CI 0.4-10).

CONCLUSIONS

These findings are consistent with those from other studies which have indicated a hazard of upper aerodigestive cancer from acid mists. However, they indicate that any risk from exposures to sulphuric and hydrochloric acid below 1 mg/m3 is small.

Epidemiologic and toxicologic evidence for chronic health effects and the underlying biologic mechanisms involved in sub-lethal exposures to acidic pollutants

Since the 1880s, a disparate and extensive literature has evolved examining the biologic effects of acidification on cells. More recently, effects on the health of human and other species of acidic agents contained, for example, in pollutants have been suggested, particularly relating to long-term exposures. This paper provides a review of the epidemiologic and toxicologic evidence concerning health effects--particularly carcinogenicity--attributable to sub-lethal acid exposure. Underlying biologic mechanisms that explain adverse health outcomes include pH modulation of toxicity for a number of xenobiotics (including carcinogens, genotoxins, and teratogens), and low-pH-induced changes of cells involving, for example, alterations in mitotic and enzyme regulation. More focused research is recommended to test the relationship between long-term exposures to acidic agents (with a consequent lowered cellular pH) and various health effects.