Perchloroethylene and Dry Cleaning: It's Time to Move the Industry to Safer Alternatives

Perchloroethylene (PERC) is the most common solvent used for dry cleaning in the United States. PERC is a reproductive toxicant, neurotoxicant, potential human carcinogen, and a persistent environmental pollutant. The Environmental Protection Agency is evaluating PERC under the Frank R. Lautenberg Chemical Safety for the 21st Century Act, which amended the Toxic Substances Control Act (amended TSCA), and has mandated that PERC dry cleaning machines be removed from residential buildings. Some local and state programs are also requiring or facilitating transitions to alternative cleaning technologies. However, the potential for these alternatives to harm human health and the environment is not well-understood. This review describes the issues surrounding the use of PERC and alternative solvents for dry cleaning while highlighting the lessons learned from a local government program that transitioned PERC dry cleaners to the safest current alternative: professional wet cleaning. Implications for future public health research and policy are discussed: (1) we must move away from PERC, (2) any transition must account for the economic instability and cultural aspects of the people who work in the industry, (3) legacy contamination must be addressed even after safer alternatives are adopted, and (4) evaluations of PERC alternatives are needed to determine their implications for the long-term health and sustainability of the people who work in the industry.

Drug use disorder following early life exposure to tetrachloroethylene (PCE)-contaminated drinking water: a retrospective cohort study

BACKGROUND

Many studies of adults with occupational exposure to solvents such as tetrachloroethylene (PCE) have shown adverse effects on cognition, mood and behavioral problems. Much less is known about neurotoxic effects in early life at lower exposure levels seen in community settings. We recently reported that illicit drug use was more frequent among adults from Cape Cod, Massachusetts who were exposed to PCE-contaminated drinking water during gestation and early childhood than their unexposed counterparts. Using newly collected data from this population-based retrospective cohort study, the current analysis examines whether early life PCE exposure is also associated with drug use disorder over the life course.

METHODS

Three-hundred and sixty-three subjects with prenatal and early childhood PCE exposure and 255 unexposed subjects were studied. These individuals (median age: 40-41 years) completed self-administered questionnaires on the eleven established diagnostic criteria for drug use disorder and confounding variables. A validated leaching and transport model was used to estimate exposure to PCE-contaminated water.

RESULTS

Overall, 23.3% of subjects reported having at least one criterion for drug use disorder over their lifetime. Early life PCE exposure was associated with a modest increase in the lifetime presence of one or more diagnostic criteria for drug use disorder (adjusted RR: 1.4, 95% CI: 1.0-1.8). Compared to unexposed subjects, PCE-exposed subjects were more likely to report having most diagnostic criteria of drug use disorder, including neglecting major roles due to drug use, physical and psychological problems related to drug use, and giving up activities due to drug use. No dose-response relationships were observed with increasing levels of PCE exposure.

CONCLUSIONS

These results suggest that exposure to PCE-contaminated drinking water during early life modestly increases the risk of developing diagnostic criteria for drug use disorder later in life. Because this study has several limitations, these findings should be confirmed in follow-up investigations of other exposed populations with more diverse racial and socioeconomic characteristics.

Modeled exposure to tetrachloroethylene-contaminated drinking water and the occurrence of birth defects: a case-control study from Massachusetts and Rhode Island

BACKGROUND

Residents of Massachusetts and Rhode Island were exposed to tetrachloroethylene-contaminated drinking water from 1968 through the early 1990s when it leached from the vinyl lining of asbestos cement water distribution pipes. While occupational exposure to solvents during pregnancy has consistently been linked to an increased risk of certain birth defects, mixed results have been observed for environmental sources of exposure, including contaminated drinking water. The present case-control study was undertaken to examine further the association between prenatal exposure to tetrachloroethylene-contaminated drinking water and the risk of central nervous system defects, oral clefts and hypospadias.

METHODS

Cases were comprised of live- and stillborn infants delivered between 1968 and 1995 to mothers who resided in 28 Massachusetts and Rhode Island cities and towns with some PCE-contaminated water supplies. Infants with central nervous system defects (N = 268), oral clefts (N = 112) and hypospadias (N = 94) were included. Controls were randomly selected live-born, non-malformed infants who were delivered during the same period and geographic area as cases (N = 771). Vital records and self-administered questionnaires were used to gather identifying information, birth defect diagnoses, and other relevant data. PCE exposure during the first trimester was estimated using water distribution system modeling software that incorporated a leaching and transport model. Prenatal PCE exposure was dichotomized as "high" or "low" exposure at the level corresponding to an estimated average concentration of 40 μg/L, the criterion for remediation when PCE contamination was discovered in 1980.

RESULTS

Mothers with "high" levels of exposure to PCE-contaminated drinking water during the first trimester (> 40 μg/L) had increased odds of having a child with spina bifida (OR: 2.0, 95% CI: 0.8-5.4), cleft lip with or without cleft palate (OR: 3.8, 95% CI: 1.2-12.3) and hypospadias (OR: 2.1, 95% CI:0.5-8.3). No increases in the odds of other defects were observed in relation to "high" exposure levels.

CONCLUSIONS

The results of the present study suggest that mothers with "high" PCE exposure levels during the first trimester have increased odds of having a child with spina bifida, cleft lip with or without cleft palate, and hypospadias. These findings support several prior studies that observed an increased risk of selected birth defects following prenatal exposure to solvents in occupational and environmental settings. Even though PCE contamination from vinyl lined pipes was remediated many years ago, it remains a widespread contaminant across the U.S and so environmental regulations must be guided by a precautionary perspective that safeguards pregnant women and their offspring.

Primary DNA Damage in Dry Cleaners with Perchlorethylene Exposure

BACKGROUND

Perchloroethylene is a halogenated solvent widely used in dry cleaning. International agency of research on cancer classified this chemical as a probable human carcinogen.

OBJECTIVE

To evaluate the extent of primary DNA damage in dry cleaner workers who were exposed to perchloroethylene as compared to non-exposed subjects. The effect of exposure modifying factors such as use of personal protective equipment, perceived risk, and reported safe behaviors on observed DNA damage were also studied.

METHODS

59 exposed and non-exposed workers were selected from Yazd, Iran. All the 33 exposed workers had work history at least 3 months in the dry cleaning shops. Peripheral blood sampling was performed. Microscope examination was performed under fluorescent microscope (400×). Open comet software was used for image analysis. All biological analysis was performed in one laboratory.

RESULTS

Primary DNA damage to leukocytes in dry cleaners was relatively high. The median tail length, %DNA in tail, and tail moment in exposed group were significantly higher than those in non-exposed group. There was no significant difference between smokers and nonsmokers in terms of tail length, tail moment, and %DNA in tail. There was no significant correlation between duration of employment in dry cleaning and observed DNA damage in terms of tail length, tail moment and %DNA in tail. Stratified analysis based on exposed and nonexposed category showed no significant relationship between age and observed DNA damage.

CONCLUSION

Occupationally exposure to perchloroethylene can cause early DNA damage in dry cleaners.

Occupational exposure to chlorinated solvents and kidney cancer: a case-control study

OBJECTIVES

Trichloroethylene, a chlorinated solvent widely used for metal degreasing, is classified by the International Agency for Research on Cancer as a kidney carcinogen. Other chlorinated solvents are suspected carcinogens, most notably the cleaning solvent perchloroethylene, although it is unclear whether they are associated with kidney cancer. We investigated kidney cancer associations with occupational exposure to 6 chlorinated solvents (trichloroethylene, perchloroethylene, 1,1,1-trichloroethane, carbon tetrachloride, chloroform, and methylene chloride) within a case-control study using detailed exposure assessment methods.

METHODS

Cases (n=1217) and controls (n=1235) provided information on their occupational histories and, for selected occupations, on tasks involving potential exposure to chlorinated solvents through job-specific interview modules. Using this information, an industrial hygienist assessed potential exposure to each solvent. We computed ORs and 95% CIs for different exposure metrics, with unexposed participants as the referent group.

RESULTS

1,1,1-trichloroethane, carbon tetrachloride, chloroform, and methylene chloride were not associated with kidney cancer. Among jobs with high exposure intensity, high cumulative hours exposed to perchloroethylene was associated with increased risk, both overall (third tertile vs unexposed: OR 3.1, 95% CI 1.3 to 7.4) and after excluding participants with ≥50% exposure probability for trichloroethylene (OR 3.0, 95% CI 0.99 to 9.0). A non-significant association with high cumulative hours exposed to trichloroethylene was observed (OR 1.7, 95% CI 0.8 to 3.8).

CONCLUSIONS

In this study, high exposure to perchloroethylene was associated with kidney cancer, independent of trichloroethylene. Additional studies are needed to further investigate this finding.

Combined effects of exposure to occupational noise and mixed organic solvents on blood pressure in car manufacturing company workers

BACKGROUND

Recent studies suggest that occupational exposures such as noise and organic solvents may affect blood pressure. The aim of this study was to investigate interaction of noise and mixed organic solvents on blood pressure.

METHODS

Four hundred seventy-one workers of a car manufacturing plant were divided into four groups: group one or G1 workers exposed to noise and mixed organic solvents in the permitted limit or control group, G3 exposed to noise only, G2 exposed to solvents only, and G4 workers exposed to noise and mixed organic solvents at higher than the permitted limit or co-exposure group. Biological interaction of two variables on hypertension was calculated using the synergistic index.

RESULTS

The workers of co-exposure group (G4), noise only group (G3), and solvents only group (G2) had significantly higher mean values of SBP and DBP than workers of control group (G1) or office workers (P < 0.05). Also logistic regression analysis showed a significant association between hypertension and exposure to noise and mixture of organic solvents. Odds ratio for hypertension in the co-exposure group and the noise only and solvents only exposed groups was 14.22, 9.43, and 4.38, respectively, compared to control group. In this study, the estimated synergism index was 1.11.

CONCLUSIONS

Our results indicate that exposure to noise or a mixture of organic solvents may be associated with the prevalence of hypertension in car manufacturing company workers and co-exposure to noise and a mixture of solvents has an additive effect in this regard. Therefore appropriate preventive programs in these workers recommended.

Cancer morbidity in Swedish dry-cleaners and laundry workers: historically prospective cohort study

PURPOSE

Despite decades of experimental and observational studies, the carcinogenic risks to humans associated with occupational exposure to perchloroethylene (PER) remain uncertain. The aims of the present study were to further examine the possible associations.

METHODS

A national cohort of dry-cleaning and laundry workers (n = 10,389) assembled in 1984 was followed up for new cases of cancer by matching with the Swedish cancer register from 1985 to 2006 (inclusive), and the results were compared with expected frequencies derived from national reference data.

RESULTS

Follow-up was complete for 90.9% of the cohort (2,810 men, 6,630 women). The overall standardised cancer incidence ratio (SIR) for all subjects was close to unity (SIR 0.96; 95% confidence interval (CI) 0.91-1.02) with a slightly more favourable outcome in women (SIR 0.91; 95% CI 0.85-0.98) than in men (SIR 1.10; 95% CI 0.99-1.23). Significantly elevated rates of lung cancer (SIR 1.45; 95% CI 1.03-1.98) and non-Hodgkin's lymphoma (SIR 2.05; 95% CI 1.30-3.07) were seen in men, but for both types of cancer, the point estimates were similar in genuine laundry workers and dry-cleaners exposed to PER, respectively. There was no significant excess of cancer of the oesophagus, larynx, uterine cervix, liver, kidney or urinary bladder.

CONCLUSIONS

The absence of individual or collective data on PER exposure from participating dry-cleaning shops and laundries involved and limited information on exposure time hampered the risk assessment related to PER. However, no clear association between PER exposure and subsequent cancer morbidity in the workers was evident from this historically prospective cohort.

Cytogenetic analysis of an exposed-referent study: perchloroethylene-exposed dry cleaners compared to unexposed laundry workers

BACKGROUND

Significant numbers of people are exposed to tetrachloroethylene (perchloroethylene, PCE) every year, including workers in the dry cleaning industry. Adverse health effects have been associated with PCE exposure. However, investigations of possible cumulative cytogenetic damage resulting from PCE exposure are lacking.

METHODS

Eighteen dry cleaning workers and 18 laundry workers (unexposed controls) provided a peripheral blood sample for cytogenetic analysis by whole chromosome painting. Pre-shift exhaled air on these same participants was collected and analyzed for PCE levels. The laundry workers were matched to the dry cleaners on race, age, and smoking status. The relationships between levels of cytological damage and exposures (including PCE levels in the shop and in workers' blood, packyears, cumulative alcohol consumption, and age) were compared with correlation coefficients and t-tests. Multiple linear regressions considered blood PCE, packyears, alcohol, and age.

RESULTS

There were no significant differences between the PCE-exposed dry cleaners and the laundry workers for chromosome translocation frequencies, but PCE levels were significantly correlated with percentage of cells with acentric fragments (R2 = 0.488, p < 0.026).

CONCLUSIONS

There does not appear to be a strong effect in these dry cleaning workers of PCE exposure on persistent chromosome damage as measured by translocations. However, the correlation between frequencies of acentric fragments and PCE exposure level suggests that recent exposures to PCE may induce transient genetic damage. More heavily exposed participants and a larger sample size will be needed to determine whether PCE exposure induces significant levels of persistent chromosome damage.

Visual contrast sensitivity in children exposed to tetrachloroethylene

This study examined relationships between indoor air, breath, and blood tetrachloroethylene (perc) levels and visual contrast sensitivity (VCS) among adult and child residents of buildings with or without a colocated dry cleaner using perc. Decreasing trends in proportions of adults or children with maximum VCS scores indicated decreased VCS at a single spatial frequency (12 cycles per degree [cpd]) among children residing in buildings with colocated dry cleaners when indoor air perc level averaged 336 μg/m³; breath perc level averaged 159.5 μg/m³; and blood perc level averaged 0.51 μg/L. Adjusted logistic regression indicated that increases in indoor air, breath, and blood perc levels among all child participants significantly increased the odds for decreased VCS at 12 cpd. Adult VCS was not significantly decreased by increasing indoor air, breath, or blood perc level. These results suggest that elevated residential perc exposures may alter children's VCS, a possible subclinical central nervous system effect.

Preliminary study of propyl bromide exposure among New Jersey dry cleaners as a result of a pending ban on perchloroethylene

Many states are considering, and some states have actively pursued, banning the use of perchloroethylene (PERC) in dry cleaning establishments. Proposed legislation has led many dry cleaners to consider the use of products that contain greater than 90% n-propyl bromide (n-PB; also called 1-bromopropane or 1-BP). Very little information is known about toxicity and exposure to n-PB. Some n-PB-containing products are marketed as nonhazardous and "green" or "organic." This has resulted in some users perceiving the solvent as nontoxic and has resulted in at least one significant poisoning incident in New Jersey. In addition, many dry cleaning operators may not realize that the machine components and settings must be changed when converting from PERC to n-PB containing products. Not performing these modifications may result in overheating and significant leaks in the dry cleaning equipment. A preliminary investigation was conducted of the potential exposures to n-PB and isopropyl bromide (iso-PB; also called 2-bromopropane or 2-BP) among dry cleaners in New Jersey who have converted their machines from PERC to these new solvent products. Personal breathing zone and area samples were collected using the National Institute for Occupational Safety and Health Sampling and Analytical Method 1025, with a slight modification to gas chromatography conditions to facilitate better separation of n-PB from iso-PB. During the preliminary investigation, exposures to n-PB among some workers in two of three shops were measured that were greater than the American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit value (TLV) for n-PB. The highest exposure measured among a dry cleaning machine operator was 54 parts per million (ppm) as an 8-hr time-weighted average, which is more than 5 times the ACGIH TLV of 10 ppm. The preliminary investigation also found that the work tasks most likely to result in the highest short-term exposures included the introduction of solvent to the machine, maintenance of the machine, unloading and handling of recently cleaned clothes, and interrupting the wash cycle of the machine. In addition, this assessment suggested that leaks may have contributed to exposure and may have resulted from normal machine wear over time, ineffective maintenance, and from the incompatibility of n-PB with gasket materials.

A first French assessment of population exposure to tetrachloroethylene from small dry-cleaning facilities

Used as a solvent in the dry-cleaning industry, tetrachloroethylene (C(2)Cl(4)) can be a pollutant of residential indoor air, which can cause long-term harmful exposures because of its neurotoxicity and probable carcinogenicity. In France, dry-cleaning facilities are integrated in urban environments (shopping malls, residential buildings) and can contribute to C(2)Cl(4) exposure for customers and residents. This exploratory work presents the results from five studies carried out in one shopping mall and four residential buildings housing a dry-cleaning facility. These studies involved dry-cleaning machines fitted with a Carbon Adsorber and unfitted, with or without Air Exhaust System. Samples were collected in the cleaning facilities and in the apartments located above with passive samplers allowing measurement of time-integrated concentrations on a 7 days sampling period. It has obviously shown the degradation of indoor air quality in these environments and underlined the contributing role of the machine technology and ventilation system on the amount of released C(2)Cl(4) in the indoor air. To temper these results, it must be pointed out that some parameters (building insulation, amount of solvent used...) which would influence C(2)Cl(4) fugitive release have not been quantified and should be looked at in further studies.

PRACTICAL IMPLICATIONS

In France, dry-cleaning facilities are frequently integrated in urban environments (large shopping malls or residential buildings) and can significantly contribute to tetrachloroethylene (C(2)Cl(4)) population exposure. The amount of fugitive releases in these environments depends on several parameters such as the dry-cleaning machine technology (fitted or unfitted with a carbon adsorber) and the ventilation (air exhaust system). To reduce C(2)Cl(4) exposure in residential buildings and other indoor environments with on-site dry cleaners, carbon adsorber unequipped machine should be replaced by newer technology and dry cleaners should be equipped with mechanical air exhaust systems.

[Diffuse systemic sclerosis after occupational exposure to trichloroethylene and perchloroethylene]

BACKGROUND

Diffuse systemic sclerosis (DSS) is an autoimmune disease that is most often endogenous but which can also be induced by exogenous substances of occupational origin.

PATIENTS AND METHODS

We report a case of DSS involving prolonged intermittent occupational exposure to solvents (trichloroethylene [TCE] and perchloroethylene [PCE]). The disease was rapidly fatal with cardiac arrest secondary to myocardial fibrosis.

DISCUSSION

In the event of exposure to TCE/PCE, we suggest more systematic prevention and diagnosis of DSS.

Long-term perchloroethylene exposure: a meta-analysis of neurobehavioral deficits in occupationally and residentially exposed groups

The literature concerning the neurobehavioral and neurophysiological effects of long-term exposure to perchloroethylene (PERC) in humans was meta-analyzed to provide a quantitative review and synthesis in the form of dose-effect curves. The useable database from this literature comprised studies reporting effects of long-term exposure to PERC, effects that included slowed reaction times, cognitive deficits, impaired color vision, and reduced visual contrast sensitivity. For the meta-analyses, dose was defined as the product of the concentration inhaled PERC and the duration of exposure, expressed in unites of ppm-h/1000 (for numerical convenience). Dose-related results were highly variable across studies. Reports involving low exposure concentrations characteristic of nonoccupational exposures consistently produced effects of a magnitude that were comparable to those reported for higher concentration occupational studies. If this finding is reliable and general, studies of occupationally exposed persons may underestimate the magnitude of effects of PERC and other chemicals in the total population. Given the limited scope of the available data for PERC and its methodological and reporting problems (small sample sizes, testers were not blind to the subjects' exposure conditions, and the timing and location of testing were insufficiently documented), it seems important to test this conclusion with a well-documented study of two groups (occupational and nonoccupational exposure) in which subjects are evaluated in randomized order, using the same procedures and with the testers kept blind to the status of the subjects.

Estimating risk during showering exposure to VOCs of workers in a metal-degreasing facility

The incremental risk of workers in a metal-degreasing facility exposed to volatile organic compounds (VOCs) present in the water supply during showering was estimated. A probabilistic and worst-case approach using specific-site concentration data and a generalized multipathway exposure model was applied. Estimates of hazard index and lifetime cancer risk were analyzed for each chemical and each route of exposure (inhalation and dermal absorption). The results showed that dermal exposure to trichloroethylene (TCE) and tetrachloroethylene (perchloroethylene, PCE) represented the main contribution to total risk. Although the inhalation route did not produce significant exposure, it was mainly influenced by the liquid flow rate of the shower. Lower values of this parameter during showering resulted in a significant reduction of both carcinogenic and noncarcinogenic risk, while decreasing water temperature produced a minimal effect on exposure by this pathway. The results obtained in the present study indicated that significant exposures of workers may be produced during showering in metal degreasing installations where releases to water of VOCs occur. A sensitivity analysis was developed for investigating the effect of scenario parameters on exposure. Although site-specific data were employed, the exposure of workers was assessed in a model scenario and thus the quantification of risk is associated with uncertainty. Considering that occupational exposure to organic solvents of workers in metal-degreasing facilities may also be significant, risk assessment must be included in the planning of this kind of industrial installation.

The use of Markov chain Monte Carlo uncertainty analysis to support a Public Health Goal for perchloroethylene

The current Public Health Goal (PHG) for perchloroethylene (PCE) was derived using upper-bound estimates of fractional PCE metabolism in humans. These estimates were in part obtained from a published evaluation of the uncertainty and variability in human PCE metabolism conducted using a physiologically-based pharmacokinetic (PBPK) model in a Markov chain Monte Carlo (MCMC) analysis; however, the data used in that analysis were limited to post-exposure PCE blood and exhaled air concentrations from a single study. A more recent study [Volkel, W., Friedewald, M., Lederer, E., Pahler, A., Parker, J., Dekant, W., 1998. Biotransformation of perchloroethene: dose-dependent excretion of trichloroacetic acid, dichloroacetic acid, and N-acetyl-S-(trichlorovinyl)-l-cysteine in rats and humans after inhalation. Toxicol. Appl. Pharmacol. 153(1), 20-27.] provides data on blood concentrations of PCE and its major metabolite, trichloroacetic acid (TCA), and urinary excretion of TCA following exposure of human subjects to lower concentrations of PCE (10-40ppm) than in previous studies. In the present effort, a new MCMC analysis was performed that focused on data from this study along with two others [Fernandez, J., Guberan, E., Caperos, J., 1976. Experimental human exposures to tetrachloroethylene vapor and elimination in breath after inhalation. Am. Ind. Hyg. Assoc. J. 37, 143-150; Monster, A., Boersma, G., Steenweg, H., 1979. Kinetics of tetrachloroethylene in volunteers; influence of exposure concentration and work load. Int. Arch. Occup. Environ. Health 42, 303-309.] providing data on PCE blood concentrations and urinary excretion of TCA. To provide an accurate prediction of TCA kinetics, the PBPK model used here includes a description of the metabolism of PCE to TCA in both the liver and kidney. The resulting upper 95th percentile estimates of fraction of PCE metabolized by inhalation and oral routes were 2.1 and 5.2%, respectively, compared to 58 and 79% used in the derivation of the PHG.

Effect of petroleum derivatives and solvents on colour perception

BACKGROUND

Occupational exposure to various neurotoxic chemicals has been shown to be associated with colour vision impairment. It seems that this can occur at low exposure levels, sometimes well below the recommended occupational threshold limits. This study was undertaken to determine the effect of exposure to petroleum derivatives (polyethylene, polystyrene) and solvents (perchloroethylene) on colour perception.

METHODS

Colour vision was assessed using the Ishihara plates, the D-15 test and the Farnsworth Munsell 100 Hue test. Two factories using petroleum derivatives and three dry cleaning premises were chosen at random. A total of 93 apparently healthy employees were recruited from the five workplaces. Two age-matched control groups comprising 56 people, who were support staff of the university with no exposure to petroleum, solvents or their derivatives, were also recruited.

RESULTS

All subjects passed the Ishihara test, showing that none had a congenital red-green defect. Some of the exposed employees failed the D-15 and had abnormally high FM100 Hue scores. All control subjects passed all the colour vision tests. The D-15 test showed that 28 per cent (26 of 93) of exposed employees had a colour vision defect whereas the FM 100 Hue test found that 63 per cent (59 of 93) had a colour vision defect. Most defects were of the blue-yellow type (22.6 per cent) when using the D-15 test. However, with the FM 100 Hue test, most defects were of the non-polar type with no specific axis (50.5 per cent). Mean total error scores calculated from the FM100 Hue test for exposed employees were statistically significantly higher than those of the control subjects.

CONCLUSION

Employees directly exposed to petroleum derivatives and solvents have a higher risk of acquiring colour vision defects compared to subjects who are not.

Can We Still Miss Tetrachloroethylene-Induced Lung Disease? The Emperor Returns in New Clothes

Hypersensitivity pneumonitis (HP) is a complex syndrome of varying intensity and clinical presentation, and has been described in association with numerous exposures. Early diagnosis is essential to limit irreversible lung damage. We describe a case of HP in a 42-year-old dry cleaner following occupational exposure to tetrachloroethylene (TCE). The diagnosis was suspected based on clinical presentation and radiographic studies, and confirmed by lung biopsy. A review of the literature reveals that HP has not been reported previously as an occupational lung disease in dry cleaners. We conclude that HP should be suspected in dry cleaners presenting with pulmonary complaints, and TCE should be considered as a potential trigger of disease. The spectrum of TCE-related occupational diseases and the diagnosis of HP are reviewed.

Chlorinated hydrocarbon solvents

Chlorinated hydrocarbon solvents, such as trichloroethylene and 1,1,1-trichloroethane, have been used widely in many industries because of their ready ability to dissolve oils, greases, and other materials, their low acute toxicity, and their non-flammability. Although these materials share certain toxicologic, functional, and chemical similarities, important differences exist. These differences largely explain why certain solvents, once common, are no longer in use and why others have become more widely used over time. This article reviews the properties, toxicologic effects of interest, workplace limits, and use history of the most common chlorinated hydrocarbon solvents.

Evaluating the efficacy of a mental models approach for improving occupational chemical risk protection

Chemical risk protection in the workplace relies partly on informing workers about possible risks using material safety data sheets (MSDS). This article reports on phase 2 of a project (phase 1 reported in Cox et al.), which employed a mental models approach to improve on data sheets as communicative interventions for perchloroethylene in dry cleaning and rosin-based solder flux in the electronics industry within small businesses in the United Kingdom (small enterprises (SEs) < 25 employees in the workplace). It focuses on the efficacy of a multimethod evaluation strategy to assess (1) the capacity of a mental models approach to yield contextually relevant data for intervention design and (2) the effectiveness of the strategy itself in validating the mental models data. The evaluation was conducted using postal questionnaires and semi-structured verbal protocols to provide responses to the alternative intervention content and to prioritize risk messages. User discussion groups were then employed, particularly as a means of establishing whether contextual information could be obtained that would differ qualitatively from the kind elicited through individual (semi) structured methods. We conclude that the mental models approach as part of an iterative process including systematic multimethod evaluation is successful in supporting the design of relevant communications to the users of chemicals. The overall viability of communicative interventions in the context of health and safety in small businesses remains in question. Future research might aim to develop a more holistic approach to interventions in complex occupational contexts.

[Progress on industrial ecological studies of dry-cleaning process]

The safety assurance of dry cleaning solvent and rational residue criteria of volatile hazardous organic compounds in clothes are vital to clean production and green service in dry cleaning industry. Therefore, the environmental behavior of the enterprises should be regulated and assurance to the human health and the environment through the combination of environmental technologies and economic instruments. Progress on industrial ecological studies of dry-cleaning process was reviewed and the protective strategies and approaches of environmental safety technologies to the sustainable development of dry cleaning were put forward in this paper.

Perchloroethylene-contaminated drinking water and the risk of breast cancer: additional results from Cape Cod, Massachusetts, USA

In 1998 we published the results of a study suggesting an association between breast cancer and perchloroethylene (PCE; also called tetrachloroethylene) exposure from public drinking water. The present case-control study was undertaken to evaluate this association further. The cases were composed of female residents of eight towns in the Cape Cod region of Massachusetts who had been diagnosed with breast cancer from 1987 through 1993 (n = 672). Controls were composed of demographically similar women from the same towns (n = 616). Women were exposed to PCE when it leached from the vinyl lining of water distribution pipes from the late 1960s through the early 1980s. A relative delivered dose of PCE that entered a home was estimated using an algorithm that took into account residential history, water flow, and pipe characteristics. Small to moderate elevations in risk were seen among women whose exposure levels were above the 75th and 90th percentiles when 0-15 years of latency were considered (adjusted odds ratios, 1.5-1.9 for > 75th percentile, 1.3-2.8 for > 90th percentile). When data from the present and prior studies were combined, small to moderate increases in risk were also seen among women whose exposure levels were above the 75th and 90th percentiles when 0-15 years of latency were considered (adjusted odds ratios, 1.6-1.9 for > 75th percentile, 1.3-1.9 for > 90th percentile). The results of the present study confirm those of the previous one and suggest that women with the highest PCE exposure levels have a small to moderate increased risk of breast cancer.

Perchloroethylene-contaminated drinking water and the risk of breast cancer: additional results from Cape Cod, Massachusetts, USA

In 1998 we published the results of a study suggesting an association between breast cancer and perchloroethylene (PCE; also called tetrachloroethylene) exposure from public drinking water. The present case-control study was undertaken to evaluate this association further. The cases were composed of female residents of eight towns in the Cape Cod region of Massachusetts who had been diagnosed with breast cancer from 1987 through 1993 (n = 672). Controls were composed of demographically similar women from the same towns (n = 616). Women were exposed to PCE when it leached from the vinyl lining of water distribution pipes from the late 1960s through the early 1980s. A relative delivered dose of PCE that entered a home was estimated using an algorithm that took into account residential history, water flow, and pipe characteristics. Small to moderate elevations in risk were seen among women whose exposure levels were above the 75th and 90th percentiles when 0-15 years of latency were considered (adjusted odds ratios, 1.5-1.9 for > 75th percentile, 1.3-2.8 for > 90th percentile). When data from the present and prior studies were combined, small to moderate increases in risk were also seen among women whose exposure levels were above the 75th and 90th percentiles when 0-15 years of latency were considered (adjusted odds ratios, 1.6-1.9 for > 75th percentile, 1.3-1.9 for > 90th percentile). The results of the present study confirm those of the previous one and suggest that women with the highest PCE exposure levels have a small to moderate increased risk of breast cancer.

[Tetrachloroethylene in drycleaning shops]

Tetrachloroethylene -- also known as Perchloroethylene, PCE and perc -- is a chlorinated hydrocarbon with the formula C2 Cl4, which is widely used as a degreasing solvent in drycleaning. This resulted in environmental pollution in apartments and groceries adjacent to drycleaners. The highest exposure levels were measured in the eighties of the last century. One case from Goslar is presented with human biomonitoring and remedial actions. The second German Federal Immission Control Ordinance (2. BImSchV) on limitation of emission of volatile halogenated hydrocarbons from 1990 resulted in new methods of drycleaning and a substantial elimination of environmental and health problems.

In silico toxicology: simulating interaction thresholds for human exposure to mixtures of trichloroethylene, tetrachloroethylene, and 1,1,1-trichloroethane

In this study, we integrated our understanding of biochemistry, physiology, and metabolism of three commonly used organic solvents with computer simulation to present a new approach that we call "in silico" toxicology. Thus, we developed an interactive physiologically based pharmacokinetic (PBPK) model to predict the individual kinetics of trichloroethylene (TCE), perchloroethylene (PERC), and methylchloroform (MC) in humans exposed to differently constituted chemical mixtures of the three solvents. Model structure and parameterization originate from the literature. We calibrated the single-compound PBPK models using published data and described metabolic interactions within the chemical mixture using kinetic constants estimated in rats. The mixture model was used to explore the general pharmacokinetic profile of two common biomarkers of exposure, peak TCE blood levels and total amount of TCE metabolites generated, in rats and humans. Assuming that a 10% change in the biomarkers corresponds to a significant health effect, we calculated interaction thresholds for binary and ternary mixtures of TCE, PERC, and MC. Increases in the TCE blood levels led to higher availability of the parent compound for glutathione conjugation, a metabolic pathway associated with kidney toxicity/carcinogenicity. The simulated change in production rates of toxic conjugative metabolites exceeded 17% for a corresponding 10% increase in TCE blood concentration, indicating a nonlinear risk increase due to combined exposures to TCE. Evaluation of metabolic interactions and their thresholds illustrates a unique application of PBPK modeling in risk assessment of occupational exposures to chemical mixtures.

Apartment residents' and day care workers' exposures to tetrachloroethylene and deficits in visual contrast sensitivity

Tetrachloroethylene (also called perchloroethylene, or perc), a volatile organic compound, has been the predominant solvent used by the dry-cleaning industry for many years. The U.S. Environmental Protection Agency (EPA) classified perc as a hazardous air pollutant because of its potential adverse impact on human health. Several occupational studies have indicated that chronic, airborne perc exposure adversely affects neurobehavioral functions in workers, particularly visual color discrimination and tasks dependent on rapid visual-information processing. A 1995 study by Altmann and colleagues extended these findings, indicating that environmental perc exposure at a mean level of 4,980 microg/m(3) (median=1,360 microg/m(3)) alters neurobehavioral functions in residents living near dry-cleaning facilities. Although the U.S. EPA has not yet set a reference concentration guideline level for environmental exposure to airborne perc, the New York State Department of Health set an air quality guideline of 100 microg/m(3). In the current residential study, we investigated the potential for perc exposure and neurologic effects, using a battery of visual-system function tests, among healthy members of six families living in two apartment buildings in New York City that contained dry-cleaning facilities on the ground floors. In addition, a day care investigation assessed the potential for perc exposure and effects among workers at a day care center located in the same one-story building as a dry-cleaning facility. Results from the residential study showed a mean exposure level of 778 microg/m(3) perc in indoor air for a mean of 5.8 years, and that perc levels in breath, blood, and urine were 1-2 orders of magnitude in excess of background values. Group-mean visual contrast sensitivity (VCS), a measure of the ability to detect visual patterns, was significantly reduced in the 17 exposed study participants relative to unexposed matched-control participants. The groups did not differ in visual acuity, suggesting that the VCS deficit was of neurologic origin. Healthy workers in the day care investigation were chronically exposed to airborne perc at a mean of 2,150 microg/m(3) for a mean of 4.0 years. Again, group-mean VCS, measured 6 weeks after exposure cessation, was significantly reduced in the nine exposed workers relative to matched controls, and the groups did not differ significantly in visual acuity. These results suggested that chronic, environmental exposure to airborne perc adversely affects neurobehavioral function in healthy individuals. Further research is needed to assess the susceptibility of the young and elderly to perc-induced effects, to determine whether persistent solvent-induced VCS deficits are a risk factor for the development of neurologic disease, and to identify the no observable adverse effect level for chronic, environmental, perc exposure in humans.

Integrating pollution prevention technology into public policy: the case of professional wet cleaning

This paper discusses opportunities to promote pollution prevention technologies through public policy, describing the case of dry cleaning. The crisis in dry cleaning is associated with the industry's reliance on perchloroethylene (PCE), the chemical cleaning solvent used by the vast majority of cleaners. The limits to the current pollution control or end-of-pipe system of laws and regulations and the search for nontoxic alternatives are analyzed in light of the environmental and occupational hazards associated with PCE use. Criteria to evaluate those alternatives are then described, including their application to professional wet cleaning, a commercially available pollution prevention alternative to PCE. The article concludes with an evaluation of several public policy instruments that could be used to promote the diffusion of professional wet cleaning as a potential solution to this regulatory crisis. These include environmental and occupational regulations designed to reduce or eliminate risk from exposure to toxic substances as well as incentive-based programs. Both barriers and opportunities for the use of each instrument are identified. This review reveals that, while the pollution control approach to public policy has deepened the regulatory crisis in the garment care industry, policy instruments are currently available to create an effective transition toward a pollution prevention outcome.

Concordance across species in the reproductive and developmental toxicity of tetrachloroethylene

Reproductive and developmental toxicities resulting from exposure to tetrachloroethylene include delayed or impaired conception, sperm quality, death during development, developmental neurotoxicity, and growth retardation. In most cases there was concordance between rodents and humans. The risk assessments indicated that neurotoxicity was the most sensitive endpoint for inhalation, whereas growth retardation was the most sensitive endpoint when exposure was by the oral route. The reference concentration (RfC) of 0.01 ppm was based on neurotoxicity among human subjects. The reference dose (RfD) of 0.0006 mg/kg per day was based on small for gestation age infants. In both cases, studies in rodents supported the credibility of these assessments. For the RfD, similar findings for other trihalomethanes have been reported. The latter part of pregnancy and early life may constitute a susceptible period for alterations leading to behavioral deficits. During this period, the capacity to metabolize tetrachloroethylene is reduced and may further contribute to the sensitivity during this phase of development. Studies suggest that an effect on dopamine metabolism is a plausible mode of action for some types of neurotoxicity. In addition, it has been suggested that this alteration may affect reproductive integrity by influencing prolactin levels.

[Stevens-Johnson syndrome accompanied by acute hepatitis in workers exposed to trichloroethylene or tetrachloroethylene]

Since the late 1980s, there has been an increasing tendency in the number of case reports on Stevens-Johnson syndrome accompanied by acute hepatitis in workers exposed to trichloroethylene from Asian countries. Recently, mass outbreaks of it have been disclosed in the Philippines and China. Besides trichloroethylene, although the number is small, a similar health disorder has also occurred in workers using tetrachloroethylene. Since the above-mentioned facts are not yet well recognized in the occupational health community, this review is aimed at making clear (1) the clinical features of the health disorder, (2) details of patients' jobs, working environments, and exposure to hazardous chemicals, and (3) the relationship between exposure to trichloroethylene or tetrachloroethylene and the health disorder. Based on a critical review of articles, the following were pointed out. First, it is important to carefully observe the health status of workers exposed to trichloroethylene or tetrachloroethylene and to take countermeasures to reduce exposure. Secondly, circumstantial evidence suggests a cause-effect relationship between the two chemicals and the health disorder; but at the present time it is impossible to rule out the participation of unelucidated factors promoting the occurrence of the health disorder or the existence of a hidden genuine causative substance. Therefore further investigation to trace such a case is needed. Thirdly, the mechanism of the health disorder and the reason why there seems to be a large inter-individual difference in sensitivity to the causative agent should be clarified.

The influence of maternal exposure to volatile organic compounds on the cytokine secretion profile of neonatal T cells

Indoor VOC (volatile organic compound) exposure has been shown to be correlated with airway symptoms and allergic manifestations in children. An investigation was conducted within an ongoing birth cohort study (LISA: Lifestyle-Immune System-Allergy) of the association between maternal exposure to VOCs and immune status at birth, in particular the cytokine secretion profile of cord-blood T cells. In a randomly selected group of 85 neonates, cytokine-producing cord-blood T cells were analyzed using intracellular cytokine detection. VOC exposure was measured in children's dwellings by passive sampling, while parents were asked to complete questionnaires about possible sources of VOC exposure. Adjusted odds ratios (ORs) were calculated by logistic regression based on categorized quartiles. A positive association was found between elevated percentages of interleukin-4-producing (IL-4) type 2 T cells and exposure to naphthalene (OR = 2.9) and methylcyclopentane (OR = 3.3). Exposure to tetrachloroethylene was associated with reduced percentages of interferon-gamma-producing (IFN-gamma) type 1 T cells (OR = 2.9). In addition, smoking during pregnancy was correlated with a higher indoor air concentration of naphthalene (OR = 3.8), new carpets in infants' bedrooms with elevated methylcyclopentane concentrations (OR = 4.1), and home renovation with a higher trichloroethylene burden (OR = 4.9). Our data suggest that maternal exposure to VOC may have an influence on the immune status of the newborn child.

Tetrachloroethylene in drinking water and birth outcomes at the US Marine Corps Base at Camp Lejeune, North Carolina

A study of mean birth weight, small-for-gestational-age infants, and preterm birth was conducted at the US Marine Corps Base at Camp Lejeune, North Carolina, where drinking water was contaminated with volatile organic compounds. Tetrachloroethylene (PCE) was the predominant contaminant. The authors used multiple linear and logistic regression to analyze 1968-1985 data from 11,798 birth certificates. Overall, at most weak associations were observed between PCE exposure and study outcomes. However, associations were found between PCE exposure and birth-weight outcomes for infants of older mothers and mothers with histories of fetal loss. Adjusted mean birth-weight differences between PCE-exposed and unexposed infants were -130 g (90% confidence interval (CI): -236, -23) for mothers aged 35 years or older and -104 g (90% CI: -174, -34) for mothers with two or more previous fetal losses. Adjusted odds ratios for PCE exposure and small-for-gestational-age infants were 2.1 (90% CI: 0.9, 4.9) for older mothers and 2.5 (90% CI: 1.5, 4.3) for mothers with two or more prior fetal losses. These results suggest that some fetuses may be more vulnerable than others to chemical insult.

The application of physiologically based pharmacokinetic modelling in the analysis of occupational exposure to perchloroethylene

A physiologically based pharmacokinetic model for perchloroethylene was parameterized, calibrated and validated using anatomic, physiologic, biochemical and physicochemical data obtained from the literature. The model was used to analyse human exposure data obtained under controlled conditions and from dry cleaning establishments in the Padua area of northern Italy. Whilst the model satisfactorily simulated the urinary excretion of trichloroacetic acid, following experimental inhalation exposure to 10, 20 and 40 ppm perchloroethylene under controlled conditions the opposite was true for the occupational exposure data. However, further model refinement to incorporate inter-individual variability of anatomical, physiological and biochemical parameters which have an impact on model output, would further improve the predictive capabilities of the model. The possibility of perchloroethylene and trichloroethylene co-exposure in the occupational setting was indicated by the model.

Neoantigen formation and clastogenic action of HCFC-123 and perchloroethylene in human MCL-5 cells

In this study, the metabolic activation of 2,2-dichloro-1,1,1-trifluoroethane (hydrochlorofluorocarbons-123, HCFC-123), halothane or 1,1-dichloro-1-fluoroethane (HCFC-141b) was compared to that of perchloroethylene, using lymphoblastoma derived cell lines expressing human CYP1A1, CYP1A2, CYP2E1, CYP2A6 and CYP3A4 (MCL-5 cells). A dose dependent increase in micronucleus formation was detected over a nominal concentration range of 0.05-2 mM for HCFC-123 and halothane, but this was not seen with HCFC-141b. No dose response for HCFC-123 was seen in a control cHo1 cell line not expressing this cytochrome P450's. Cell lines expressing individual human cytochrome P-450 (CYP) forms were also used to define the enzymes responsible for the clastogenic events and to investigate the formation of immunoreactive protein by microsomal fractions. It was shown that CYP2E1 or CYP2B6 catalysed the clastogenic response, but CYP2D6, CYP3A4, CYP1A2 or CYP1A1 all appeared to be inactive. The formation of neoantigenic trifluoroacetylated protein adducts by microsomal mixtures incubated with HCFC-123 and NADPH was catalysed primarily by CYP2E1 and to a lesser extent by CYP2C19, whereas, only trace levels of immunoreactive protein were seen with microsomes expressing CYP2B6 or CYP2C8. With perchloroethylene as a substrate, the extent of activation was low in comparison with HCFC-123, as judged by the absence of micronuclei formation in the MCL-5 cell line and the weak immunoreactivity of proteins following Western blotting. CYP1A2, CYP2B6 and CYP2C8 appeared to be responsible for perchloroethylene immunoreactivity and in contrast to the findings with the HCFC's, no activation of perchloroethylene by CYP2E1 could be detected. These results show that even though both saturated and unsaturated halocarbons can result in neoantigen formation, there is a marked difference in the specificity of the CYP enzymes involved in their metabolic activation.

Mortality in dry-cleaning workers: an update

BACKGROUND

A cohort of 1,708 dry-cleaning workers identified from union records was exposed to perchloroethylene (PCE), a known animal carcinogen and probable human carcinogen, for at least 1 year before 1960. Many workers also had exposure to Stoddard solvent, a petroleum-based dry-cleaning solvent.

METHODS

Vital status was updated through 1996 and life table analyses conducted.

RESULTS

The cohort had excess cancer mortality (271 deaths, standardized mortality ratio [SMR] 1.25, 95% confidence interval [CI] 1.11-1.41). Elevated SMRs for tongue, bladder, esophagus, intestine, lung, and cervical cancer, pneumonia, and diseases of the stomach and duodenum were statistically significant.

CONCLUSION

The current study confirms findings of prior updates and other studies that dry-cleaning workers have excess cancer mortality at several sites. Although important lifestyle and socioeconomic risk factors exist for both cervical and esophageal cancer mortality, excesses of these sites in the PCE only subcohort and among workers with longer duration of PCE exposure suggest an association with PCE exposure.

Analysis of PBPK models for risk characterization

Adoption of a Bayesian framework for risk characterization permits the seamless integration of different kinds of information available in order to choose and parameterize risk models. It also becomes easy to disentangle uncertainty from variability, through hierarchical statistical modeling. Appropriate numerical techniques can be found, for example, in the recently developed arsenal of Markov chain, Monte Carlo simulations. The developments in this area can actually be viewed as extensions of the traditional or standard Monte Carlo methods for uncertainty analysis. Following a brief review of the techniques, examples of Bayesian analyses of physiologically-based pharmacokinetic models are presented for tetrachloroethylene and dichloromethane. The discussion touches on some open problems and perspectives for the proposed methods.

Mortality among aircraft manufacturing workers

OBJECTIVES

To evaluate the risk of cancer and other diseases among workers engaged in aircraft manufacturing and potentially exposed to compounds containing chromate, trichloroethylene (TCE), perchloroethylene (PCE), and mixed solvents.

METHODS

A retrospective cohort mortality study was conducted of workers employed for at least 1 year at a large aircraft manufacturing facility in California on or after 1 January 1960. The mortality experience of these workers was determined by examination of national, state, and company records to the end of 1996. Standardised mortality ratios (SMRs) were evaluated comparing the observed numbers of deaths among workers with those expected in the general population adjusting for age, sex, race, and calendar year. The SMRs for 40 cause of death categories were computed for the total cohort and for subgroups defined by sex, race, position in the factory, work duration, year of first employment, latency, and broad occupational groups. Factory job titles were classified as to likely use of chemicals, and internal Poisson regression analyses were used to compute mortality risk ratios for categories of years of exposure to chromate, TCE, PCE, and mixed solvents, with unexposed factory workers serving as referents.

RESULTS

The study cohort comprised 77,965 workers who accrued nearly 1.9 million person-years of follow up (mean 24.2 years). Mortality follow up, estimated as 99% complete, showed that 20,236 workers had died by 31 December 1996, with cause of death obtained for 98%. Workers experienced low overall mortality (all causes of death SMR 0.83) and low cancer mortality (SMR 0.90). No significant increases in risk were found for any of the 40 specific cause of death categories, whereas for several causes the numbers of deaths were significantly below expectation. Analyses by occupational group and specific job titles showed no remarkable mortality patterns. Factory workers estimated to have been routinely exposed to chromate were not at increased risk of total cancer (SMR 0.93) or of lung cancer (SMR 1.02). Workers routinely exposed to TCE, PCE, or a mixture of solvents also were not at increased risk of total cancer (SMRs 0.86, 1.07, and 0.89, respectively), and the numbers of deaths for specific cancer sites were close to expected values. Slight to moderately increased rates of non-Hodgkin's lymphoma were found among workers exposed to TCE or PCE, but none was significant. A significant increase in testicular cancer was found among those with exposure to mixed solvents, but the excess was based on only six deaths and could not be linked to any particular solvent or job activity. Internal cohort analyses showed no significant trends of increased risk for any cancer with increasing years of exposure to chromate or solvents.

CONCLUSIONS

The results from this large scale cohort study of workers followed up for over 3 decades provide no clear evidence that occupational exposures at the aircraft manufacturing factory resulted in increases in the risk of death from cancer or other diseases. Our findings support previous studies of aircraft workers in which cancer risks were generally at or below expected levels.

Tetrachloroethylene-contaminated drinking water in Massachusetts and the risk of colon-rectum, lung, and other cancers

We conducted a population-based case-control study to evaluate the relationship between cancer of the colon-rectum (n = 326), lung (n = 252), brain (n = 37), and pancreas (n = 37), and exposure to tetrachloroethylene (PCE) from public drinking water. Subjects were exposed to PCE when it leached from the vinyl lining of drinking-water distribution pipes. Relative delivered dose of PCE was estimated using a model that took into account residential location, years of residence, water flow, and pipe characteristics. Adjusted odds ratios (ORs) for lung cancer were moderately elevated among subjects whose exposure level was above the 90th percentile whether or not a latent period was assumed [ORs and 95% confidence intervals (CIs), 3.7 (1.0-11.7), 3.3 (0.6-13.4), 6.2 (1.1-31.6), and 19.3 (2.5-141.7) for 0, 5, 7, and 9 years of latency, respectively]. The adjusted ORs for colon-rectum cancer were modestly elevated among ever-exposed subjects as more years of latency were assumed [OR and CI, 1.7 (0.8-3.8) and 2.0 (0.6-5.8) for 11 and 13 years of latency, respectively]. These elevated ORs stemmed mainly from associations with rectal cancer. Adjusted ORs for rectal cancer among ever-exposed subjects were more elevated [OR and CI, 2.6 (0. 8-6.7) and 3.1 (0.7-10.9) for 11 and 13 years of latency, respectively] than were corresponding estimates for colon cancer [OR and CI, 1.3 (0.5-3.5) and 1.5 (0.3-5.8) for 11 and 13 years of latency, respectively]. These results provide evidence for an association between PCE-contaminated public drinking water and cancer of the lung and, possibly, cancer of the colon-rectum.

Tetrachloroethylene-contaminated drinking water in Massachusetts and the risk of colon-rectum, lung, and other cancers

We conducted a population-based case-control study to evaluate the relationship between cancer of the colon-rectum (n = 326), lung (n = 252), brain (n = 37), and pancreas (n = 37), and exposure to tetrachloroethylene (PCE) from public drinking water. Subjects were exposed to PCE when it leached from the vinyl lining of drinking-water distribution pipes. Relative delivered dose of PCE was estimated using a model that took into account residential location, years of residence, water flow, and pipe characteristics. Adjusted odds ratios (ORs) for lung cancer were moderately elevated among subjects whose exposure level was above the 90th percentile whether or not a latent period was assumed [ORs and 95% confidence intervals (CIs), 3.7 (1.0-11.7), 3.3 (0.6-13.4), 6.2 (1.1-31.6), and 19.3 (2.5-141.7) for 0, 5, 7, and 9 years of latency, respectively]. The adjusted ORs for colon-rectum cancer were modestly elevated among ever-exposed subjects as more years of latency were assumed [OR and CI, 1.7 (0.8-3.8) and 2.0 (0.6-5.8) for 11 and 13 years of latency, respectively]. These elevated ORs stemmed mainly from associations with rectal cancer. Adjusted ORs for rectal cancer among ever-exposed subjects were more elevated [OR and CI, 2.6 (0. 8-6.7) and 3.1 (0.7-10.9) for 11 and 13 years of latency, respectively] than were corresponding estimates for colon cancer [OR and CI, 1.3 (0.5-3.5) and 1.5 (0.3-5.8) for 11 and 13 years of latency, respectively]. These results provide evidence for an association between PCE-contaminated public drinking water and cancer of the lung and, possibly, cancer of the colon-rectum.

[Obstructive sleep apnea syndrome caused by occupational exposure to solvents]

HISTORY AND ADMISSION FINDINGS

A 52-year-old man working in a chemical laboratory was referred with the possible diagnosis of toxic encephalopathy. For 17 years he had been exposed to high concentrations of perchlorethylene and n-butanol vapours which every day had caused acute symptoms of organic solvent intoxication. Current complaints were autonomic nervous system symptoms, loss of concentration and memory, and fatigue in the second half of the day. The patient was obese but in good general condition.

INVESTIGATIONS

Neuropsychiatric examination confirmed the reported loss of concentration and planning ability at work. The polysomnogram indicated an increased number of largely obstructive apnoea attacks.

DIAGNOSIS, TREATMENT AND COURSE

As the patients had an obstructive type of sleep apnoea treatment consisted of positive pressure ventilation at night and weight reduction. The occupational exposure to organic solvents was the likely cause.

CONCLUSIONS

As the symptoms of encephalopathy and sleep apnoea syndrome overlap, the latter should be considered before an encephalopathy is diagnosed. Because a rare cause of the sleep apnoea syndrome is prolonged and marked occupational exposure to organic solvents this should be asked about in taking the history. If indeed there has been occupational exposure, it should cease at once and be reported.

Occupational exposure to tetrachloroethene and its effects on the kidneys

Occupational exposure to tetrachloroethene (TCE) has been reported to cause early adverse effects on the kidneys. We investigated the effects of TCE exposure on the kidneys in 82 exposed and 19 nonexposed workers from four dry-cleaning shops in The Netherlands. The mean inhaled amount of TCE in the exposed group, which was assessed by determination of its concentration in alveolar air samples, was 8.4 mg/m3 (range, 2.2-44.6 mg/m3). This value corresponds to a mean 8-hour time-weighted average exposure of 7.9 mg/m3 (range, 1-221 mg/m3). A chronic dose index (CDI) was estimated from data on the current TCE dose and the occupational history of the individual subjects. The mean CDI in the exposed group was 400 months X mg/m3 (range, 12-4882 months X mg/m3). Effects on the tubules were assessed with the parameters N-acetyl-beta-D-glucosaminidase, beta-galactosidase, alanine aminopeptidase, and retinol-binding protein (RBP) in urine. Early effects on the glomeruli were monitored with the parameter albumin in urine. Total protein in urine was determined for the general assessment of effects on the glomeruli and tubules. The tubular parameter RBP was increased in the exposed group, compared with the nonexposed group. None of the other parameters differed between the study groups, and none of the renal-effect parameters correlated with the TCE dose or the CDI. In conclusion, occupational exposure to TCE may cause a minor effect on the tubular RBP at exposure levels below the Dutch occupational exposure limit (240 mg/m3).

Tetrachloroethylene-contaminated drinking water and the risk of breast cancer

We conducted a population-based case-control study to evaluate the relationship between cases of breast cancer and exposure to tetrachloroethylene (PCE) from public drinking water ( n = 258 cases and 686 controls). Women were exposed to PCE when it leached from the vinyl lining of water distribution pipes. The relative delivered dose was estimated using an algorithm that accounted for residential history, water flow, and pipe characteristics. Only small increases in breast cancer risk were seen among ever-exposed women either when latency was ignored or when 5 to 15 years of latency was considered. No or small increases were seen among highly exposed women either when latency was ignored or when 5 years of latency was considered. However, the adjusted odds ratios (ORs) were more increased for highly exposed women when 7 and 9 years of latency, respectively, were considered (OR 1.5 95% CI 0.5-4.7 and OR 2.3, 95% CI 0.6-8.8 for the 75th percentile, and OR 2.7, 95% CI 0.4-15.8 and OR 7.6, 95% CI 0.9-161.3 for the 90th percentile). The number of highly exposed women was too small for meaningful analysis when more years of latency were considered. Because firm conclusions from these data are limited, we recently undertook a new study with a large number of more recently diagnosed cases.