Silica exposure, silicosis, and lung cancer: a mortality study of South African gold miners.

The effects of exposure to gold mining dust with a high concentration of free silica and tobacco smoking on mortality from lung cancer was assessed in a sample of 2209 white South African gold miners who started mining exposure during 1936-43, and were selected for a study of respiratory disorders in 1968-71 when they were aged 45-54. The mortality follow up was from 1968-71 to 30 December 1986. The relative risk for the effect of dust cumulated to the start of the follow up period was estimated as 1.023 (95% confidence interval (CI) 1.005-1.042) for a unit of 1000 particle-years. The combined effect of dust and tobacco smoking was better fitted by the multiplicative model than the additive model, suggesting that the two exposures act synergistically. No association between lung cancer and silicosis of the parenchyma or pleura was found, but a positive association existed between silicosis of the hilar glands and lung cancer.     

Case-control study of silicosis, silica exposure, and lung cancer in white South African gold miners

A case-control study was undertaken to assess the association between lung cancer and silicosis or silica dust exposure in white South African gold miners. Cases and controls were identified from deaths reported to the Gold Miners Provident Fund for the period January, 1979-October, 1983. Two controls were matched to each case by year of birth (+/- 2 years) and by smoking (+/- 5 cigarettes or equivalents per day) assessed 10 years (+/- 2 years) prior to death. One hundred thirty-three matched triplets were identified. The results showed no overall association between lung cancer and radiological silicosis (OR = 1.08, p = 0.92). Autopsy data indicated no overall associations between lung cancer and silicosis of the lung parenchyma (OR = 1.49, p = 0.11), the pleura (OR = 0.72, p = 0.30), or the hilar glands (OR = 0.85, p = 0.72). A trend toward increased severity of silicosis of the parenchyma was evident; however, this was not statistically significant (p = 0.08). Odds ratios for lung cancer and silicosis were higher at lower levels of cumulative silica dust exposure (ORs = 2.43, 1.72, 1.35 and 0.62 for lung cancer and autopsy silicosis of the parenchyma for the lowest, second, third, and highest quartiles of dust exposure, respectively; all p greater than 0.05). Cases did not differ from controls for total silica dust exposure, length of exposure, weighted average intensity of exposure, or number of shifts at high dust (all p greater than 0.20). The data do not support the hypothesis of a carcinogenic role for silica dust and no statistically significant associations were found between lung cancer and silicosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Silica exposure, silicosis, and lung cancer: a necropsy study.

Recent studies of the association between lung cancer and silicosis and silica dust have been inconclusive; some showing positive association and some showing none. The present study matched 231 cases of lung cancer with 318 controls by year of birth. Subjects were selected from the necropsy records of the National Centre for Occupational Health. Data on intensity and duration of exposure to silica dust were obtained from personnel records. Presence or absence of lung cancer and the presence and severity of silicosis of the parenchyma, pleura, and hilar glands were documented from necropsy reports. Smoking data were abstracted from records of routine examinations. No case-control differences were noted for any of the exposure indicators including cumulative dust exposure, total dusty shifts, weighted average intensity of exposure, total underground shifts, and shifts in high dust. Similarly, no association was found between lung cancer and the presence or severity of silicosis and any site. Stratified analyses showed neither significant nor suggestive trends when case-control comparisons for silicosis were examined by level of dust exposure or smoking. Reasons for disparity between these results and those of some other studies may include concomitant exposures to radon daughters, asbestos, diesel emissions, and cigarette smoking; idiosyncracies of the compensation process; and the possibility of a threshold in the relation(s).     

Silica exposure, silicosis, and lung cancer: a necropsy study

Recent studies of the association between lung cancer and silicosis and silica dust have been inconclusive; some showing positive association and some showing none. The present study matched 231 cases of lung cancer with 318 controls by year of birth. Subjects were selected from the necropsy records of the National Centre for Occupational Health. Data on intensity and duration of exposure to silica dust were obtained from personnel records. Presence or absence of lung cancer and the presence and severity of silicosis of the parenchyma, pleura, and hilar glands were documented from necropsy reports. Smoking data were abstracted from records of routine examinations. No case-control differences were noted for any of the exposure indicators including cumulative dust exposure, total dusty shifts, weighted average intensity of exposure, total underground shifts, and shifts in high dust. Similarly, no association was found between lung cancer and the presence or severity of silicosis and any site. Stratified analyses showed neither significant nor suggestive trends when case-control comparisons for silicosis were examined by level of dust exposure or smoking. Reasons for disparity between these results and those of some other studies may include concomitant exposures to radon daughters, asbestos, diesel emissions, and cigarette smoking; idiosyncracies of the compensation process; and the possibility of a threshold in the relation(s).     

Risk of silicosis in a cohort of white South African gold miners

The risk of silicosis was investigated in a cohort of 2,235 white South African gold miners who had, on average, 24 years of net service from 1940 to the early 1970s and who were followed up to 1991 for radiological signs of onset of silicosis (ILO category 1/1 or more). There were 313 (14%) miners who developed signs of silicosis at an average age of 55.9 years. The latency period was largely independent of the cumulative dust exposure. In 57% of the silicotics, the radiological signs developed, on average, 7.4 years after mining exposure ceased. The risk of silicosis increased exponentially with the cumulative dust dose, the accelerated increase being after 7 mg/m³-years. At the highest exposure level of 15 mg/m³-years, which represents approximately 37 years of gold mining at an average respirable dust concentration of 0.4 mg/m³, the cumulative risk for silicosis reached 77%. In conclusion, the risk of silicosis was strongly dose dependent; however, the latency period was largely independent of the dose. © 1993 Wiley-Liss, Inc.     

Tuberculosis and silica exposure in South African gold miners

Aims

To examine the effect of silica exposure, in the absence of silicosis, on the prevalence of pulmonary tuberculosis (PTB), which is epidemic among South African gold miners.

Methods

Cross‐sectional study of 520 gold miners over 37 years of age. Length of service, and cumulative and average dust and quartz exposure indices were derived for each miner. Chest radiographs were read for PTB by two NIOSH “B” readers. PTB was defined as a self‐reported history of PTB or PTB on chest radiograph. Logistic regression was used to adjust for age, smoking, and silicosis. PTB effects of different exposure metrics for silica, scaled on their interquartile range (IQR), were compared.

Results

Means (ranges) were: age 46.7 (37.1–59.9) years; length of service 21.8 (6.3–34.5) years; average intensity of respirable quartz 0.053 (0–0.095) mg/m³. PTB prevalence was 19.4% (95% CI 16.0 to 22.8) on history alone, and 35.2% (95% CI 31.1 to 39.3) on history or on chest radiograph. Length of service was poorly predictive of PTB, while all exposure indices which included dust or quartz yielded prevalence odds ratios (PORs) of approximately 1.4 (95% CI ∼1.1 to 1.8) for changes of one interquartile range in exposure. Controlling for silicosis—by adjustment or restriction—did not modify these results. Drillers and winch operators had the highest PTB prevalences and the highest dust and silica exposures.

Conclusion

Older in‐service gold miners in South Africa have a high prevalence of PTB, which is significantly associated with dust and silica exposure, even in the absence of silicosis. Limitations include a survivor workforce and the use of cumulative exposures based on current exposures. Dust control is an important component in control of the PTB epidemic in South African gold mines.     

Estimating the quartz exposure of South African gold miners

The possibility that dust and silica exposure estimates in epidemiological studies of South African gold miners have been underestimated has been postulated for some years. These exposure estimates were obtained by converting particle number concentrations measured with konimeters and thermal precipitators to respirable mass concentrations, primarily on theoretical considerations. A detailed review of the methodology has revealed that the theoretically based dust and silica estimates were probably underestimated. In the absence of systematic side-by-side thermal precipitator and modern respirable mass measurements in the South African gold mines, the true relationship between the respirable mass concentrations and the theoretically derived concentrations cannot be known. However, with many uncertainties, we estimate that the quartz exposures of South African miners derived from past theoretically based conversions from particle number to respirable mass underestimate the actual quartz exposures by a factor of about 2.     

Silica exposure and silicosis among Ontario hardrock miners: I. Methodology

An epidemiological investigation was undertaken to determine the relationship between silicosis in hardrock miners in Ontario and cumulative exposure to silica (crystalline silica--alpha quartz) dust. This first report describes the cohort, the method of classifying the radiographs, and the identification of a case of silicosis.     

Lung cancer among tin miners in Southeast China: Silica exposure,silicosis, and cigarette smoking

The Dachang Tin Mine is an industrial facility with high rates of lung cancer compared to the resident population in Guangxi province in southern China. Historically, exposure to silica dust was very high in the 1950s, falling in recent years to levels in keeping with international standards. Radon levels in the mine are low. We report the findings of a case-control study nested into a cohort study on miners working in Dachang. Cases of lung cancer among miners incident from 1973–1989 were obtained from local comprehensive medical records covering workers employed at the mine. These were matched approximately 3 to 1 with miners randomly chosen from the district surrounding the mine within the same birth decade. Matched odds ratios of 2.42 (95% confidence limit [CL] 1.3, 4.4) for underground employment, 3.52 (95% CL 1.7, 7.5) for smoking, and 2.04 (95%) CL 1.2, 3.7) for silicosis as determined on chest film were noted. Multi-factor analysis of unconditional logistic regression showed that among the risk factors for excess mortality from lung cancer only the years spent drilling underground and the cumulative smoking index (product of daily cigarette consumption and number of years smoking) were independent contributors to risk and there was no interaction observed. The presence of silicosis did not contribute to predicting risk independently of the years spent underground.     

Silica exposure and silicosis among Ontario hardrock miners: II. Exposure estimates

An epidemiological investigation was carried out to determine the relationship between silicosis in hardrock miners in Ontario and cumulative exposure to silica (free crystalline silica--alpha quartz) dust. This second report describes a side-by-side air-sampling program used to derive a konimeter/gravimetric silica conversion curve. A total of 2,360 filter samples and 90,000 konimeter samples were taken over 2 years in two mines representing the ore types gold and uranium, both in existing conditions as well as in an experimental stope in which dry drilling was used to simulate the high dust conditions of the past. The method of calculating cumulative respirable silica exposure indices for each miner is reported.     

Mortality of white South African gold miners.

OBJECTIVES--This two part study aimed to determine whether there was an excess mortality generally or for some diseases among middle aged white South African gold miners on the Witwatersrand and whether the underground dust exposure of these miners contributed to the development of lung cancer, chronic obstructive pulmonary disease (COPD), or ischaemic heart disease (IHD). METHODS--A cohort of 4925 white miners in South Africa, born between 1 January 1916 and 31 December 1930 who were alive and working in the vicinity of Johannesburg on 1 January 1970, then aged between 39 and 54, was followed up for 20 years by which time 2032 had died. Most were gold miners (about 87% had worked 85% or more of their shifts in gold mines). Standardised mortality ratios (SMRs) were calculated as percentages of the number of deaths observed in the cohort for a condition as stated on the death certificate divided by the number expected on the basis of concurrent mortality in the reference population (the total age specific white male population of South Africa). A case-control analysis was performed for three diseases (lung cancer, COPD, and IHD), the results of which are presented for those miners in the cohort who had spent at least 85% of their service on gold mines and had worked at least 15% of their shifts underground. RESULTS--The SMR for all causes of death was 129.6%, raised because of excess mortality due to the following causes: lung cancer (SMR = 139.8%), IHD (124.1%), COPD (189%) and cirrhosis of the liver (155.3%). Smoking was confirmed to be the main risk factor for lung cancer and COPD although cumulative dust exposure was found to increase the risk of COPD in conjunction with smoking. No significant risk of lung cancer resulted from exposure to dust. High blood pressure and smoking were found to increase the risk of IHD, but no association between IHD and the quetelet index (weight/height2) was found. CONCLUSIONS--The most significant and unexpected finding was the 30% increase in the SMR for all causes. Very little of this increase could be attributed to mining and the main factor for this was probably the adoption of an unhealthy lifestyle by these men (compared with other South African white men) particularly smoking (86% were smokers) and alcohol consumption.     

Silica exposure and silicosis among Ontario hardrock miners: III. Analysis and risk estimates

An epidemiological investigation was undertaken to determine the relationship between silicosis in hardrock miners in Ontario and cumulative exposure to silica (free crystalline silica--alpha quartz) dust. This report describes the analytic method and presents the risk estimates.     

Silica exposure, smoking, silicosis and lung cancer--complex interactions

Background Establishing a clear relationship between workplaceexposures and cancer is often difficult. The latent period forcancer development can make it difficult to establish a definitecause–effect relationship. The picture is further complicatedby variable job histories, concomitant exposure to other carcinogensand other factors such as genetic susceptibility and poor nutrition.The lack of accurate and detailed record keeping may potentiallymask informative differences among group of workers. Removingor reducing exposures to probable and known carcinogens, however,can prevent workplace cancer. Aim This paper gives an overview of the literature reportinginvestigations of the relationship between exposure to silicaand development of lung cancer with a focus on the controversyconcerning the roles of silicosis and smoking in the developmentof cancer. Method A literature search was conducted to identify epidemiologicpapers on silica, silicosis and lung cancer using electronicdatabases (MEDLINE, PubMed, Web of Science) from 1996 onwardsand paper bibliographies. Results If silicosis were the necessary step leading to lungcancer, enforcing the current silica standards would protectworkers against lung cancer risk as well. Alternatively, a directsilica–lung cancer association that has been suggestedimplies that regulatory standards should be revised accordingly. Conclusion Further research is needed in order to understandthe complex pattern of interactions leading to lung cancer amongsilica-exposed workers (and cancers and workplace exposuresin general) and to understand whether and to what extent otherworkplace lung carcinogens, total respirable dust and totalsurface size and age of silica particles affect the carcinogenicpotential of silica. In addition, the apparent paradox of alower lung cancer risk in some workplaces with high-level silicaexposure needs further investigation.     

Loss of lung function associated with exposure to silica dust and with smoking and its relation to disability and mortality in South African gold miners.

The data from a lung function study on 2209 white 45-54 year old South African gold miners in 1968-71 and at a five year follow up examination, were analysed to establish the actual loss of lung function associated with exposure to silica dust and with smoking. Ex-smokers were excluded from the analysis. Of the remaining 1625 subjects, 1249 had the five year follow up test of lung function. The estimated excess loss of lung function for a 50 year old gold miner, associated with 24 years of underground dust exposure of an average respirable dust concentration of 0.30 mg m-3 (14.4 ghm-3) was 236 ml of FEV1 (95% confidence interval (95% CI 134-337) and 217 ml of FVC (95% CI 110-324). By comparison, the effect of smoking one packet of cigarettes a day over 30 years was associated with an estimated loss of 552 ml of FEV1 (95% CI 461-644) and 335 ml of FVC (95% CI 170-500). The cumulative dust exposure was not associated with the longitudinal loss of FEV1 or FVC when the initial FEV1 and FVC were adjusted in the models. According to the predicted values, however, gold miners appear to have a greater loss of lung function from 50 to 55 years of age than that predicted for a general population.