Alcohol drinking and mortality among men enrolled in an American Cancer Society prospective study

We studied whether moderate alcohol drinkers have a lower total and coronary heart disease (CHD) mortality than nondrinkers. Among 276,802 U.S. men aged 40-59 enrolled in 1959 in an American Cancer Society prospective study, 42,756 deaths, 18,771 from CHD, occurred during the following 12 years (3% of the cohort was lost to follow-up). Using nondrinkers (55.3% of the cohort) as a reference category, age- and smoking-stratified relative risks (RR) of total mortality were 0.88 for occasional drinkers, 0.84 for those drinking 1 drink per day, 0.93, 1.02, 1.08, 1.22, and 1.38 for those drinking 2, 3, 4, 5, and 6 or more drinks per day, respectively. RRs of CHD mortality were 0.86, 0.79, 0.80, 0.83, 0.74, 0.85, and 0.92, respectively. Multivariate analysis failed to identify other confounders. No changes in RRs were introduced by excluding subjects with poor health or history of chronic disease at enrollment (32.8% of the cohort) or excluding subjects who died during the first 6 years of follow-up. These data indicate an apparent protective effect of moderate alcohol intake on CHD mortality that cannot be attributed to the inclusion of subjects with CHD or related diseases into the nondrinker category.     

Cancer mortality and wood dust exposure among participants in the American Cancer Society Cancer Prevention Study-II (CPS-II)

In 1994, the International Agency for Research on Cancer (IARC) classified wood dust as a human carcinogen, based on very strong evidence of a carcinogenic risk of sino-nasal cancer. Excesses of other cancers, including lung and stomach, have been reported among persons employed in wood industries or occupationally exposed to wood dust, but not as consistently. We investigated such possible associations using the mortality experience of 362,823 men enrolled in the American Cancer Society's Cancer Prevention Study — II in 1982 and followed up for 6 years. Within this group, 45,399 men (12.5%) reported either employment in a wood-related occupation or exposure to wood dust or both. Among woodworkers, a small but significant excess risk was found for all causes of death (RR 1.17 (95% CI 1.11–1.24)) and for total malignancies (RR 1.17 (1.05–1.30)). Among men who reported exposure to wood dust, there was an elevated risk of total mortality (RR 1.07 (1.03–1.11)), total malignancies (RR 1.08 (1.01—1.15)), and lung cancer (RR 1.17 (1.04–1.31)). Among woodworkers, a significant trend (P = 0.02) of increasing risk of lung cancer with increasing duration of exposure was observed. An unexpected, significantly increased mortality from prostate cancer was observed in both wood-employed and wood-exposed, and a twofold increased risk of fatal brain cancer was seen among the former. Lung cancer mortality was especially high among woodworkers who also reported exposure to asbestos or formaldehyde, and it appears that exposure to these known carcinogens may partly explain the observed increased risks. Excess sino-nasal cancer was not observed, but the number of cases was small. Am. J. Ind. Med. 34:229–237, 1998. © 1998 Wiley-Liss, Inc.     

An update of mortality from all causes among white uranium miners from the Colorado plateau study group

To place previously recognized mortality risks into the context of the total mortality from all causes, an updated retrospective cohort mortality study was conducted on 3,238 white males from the US Public Health Service cohort of Colorado Plateau uranium miners. Vital status was followed from 1960 through 1990. Life-table analyses used combined New Mexico, Arizona, Utah, and Colorado mortality rates for external comparison and mortality risks within the lowest radon-exposure or duration-employed category for internal comparison. Significantly elevated SMRs were found for pneumoconioses (SMR = 24.1, 95% CI 16.0–33.7), lung cancer (SMR = 5.8, 95% CI 5.2–6.4), tuberculosis (SMR = 3.7, 95% CI 1.9–6.2), chronic obstructive respiratory diseases (SMR = 2.8, 95% CI 2.2–3.5), emphysema (SMR = 2.5, 95% CI 1.9–3.2), benign and unspecified tumors (SMR = 2.4, 95% CI 1.0–4.6), and diseases of the blood and blood-forming organs (SMR = 2.4, 95% CI 1.0–5.0). No significantly lowered SMRs were found for any disease. For lung cancer and pneumoconioses, standardized rate ratios increased with increasing exposure to radon progeny or duration of employment. Most findings from this update are consistent with previous studies. Not observed were previously elevated SMRs for chronic nephritis and for acute alcoholism. New findings observed were elevated SMRs for benign and unspecified tumors and for diseases of the blood and blood-forming organs. The most important long-term mortality risks for the white uranium-miners continue to be lung cancer and pneumoconioses, for which SMRs remain significantly elevated after a mean period of 22.4 years since last uranium mining. Am. J. Ind. Med. 31:211–222, 1997. © 1997 Wiley-Liss, Inc.     

Influence of arsenic exposure and smoking on lung cancer among smelter workers: A pilot study

A pilot study of 300 smelter workers from the cohort reported by Lee and Fraumeni [1969] has been studied: 150 men from their heavy exposure group and 150 men from the rest of the cohort randomly selected. Usable smoking habits were obtained from 86% of the sample. Estimates of the total lifetime work exposure were made from available measurements. A very high risk of lung cancer (SMR 1429) was observed among the most heavily exposed workers. Excess risks, though still present, were much less in those with lower exposures. There was a lower proportion of nonsmokers among the heavily exposed arsenic workers than among the other workers. This suggests that there may be some interaction between smoking and arsenic exposure. Moreover, comparison of smoking habits reported by smelter workers suggested that, as a group, they smoked more heavily than average for the United States population. A small study of proxy smoking histories suggested that these were valid and unbiased. The work continues on an enlarged sample.     

Cancer mortality among shoe and leather workers in Massachusetts

A proportional mortality analysis of death certificates of 2,798 shoe and leather workers demonstrated a statistically significant excess of bladder cancer among female shoe workers (PMR = 2.51, 95% confidence interval 1.23 to 5.12). A case-referent analysis of 289 leather workers, on whom detailed occupational information was available, demonstrated an association of lung cancer with work in leather-tanning jobs (odds ratio = 4.2, 95% confidence interval 1.09 to 16.2).     

Nonmalignant respiratory disease mortality among woodworkers participating in the American Cancer Society Cancer Prevention Study-II (CPS-II)

Nonmalignant respiratory disease (NMRD) mortality was examined among woodworkers participating in the American Cancer Society's CPS-II cohort study. During the 6-year prospective follow-up, there were 97 NMRD deaths among 11,541 men reporting employment in wood-related occupations and 1,338 NMRD deaths among 317,424 men reporting no exposure to wood dust or wood-related jobs. Relative risks, adjusted for age and smoking, were calculated using Poisson regression. A small excess of NMRD was observed among woodworkers. However, the relative risk was higher among woodworkers who did not report exposure to wood dust (RR = 1.52, 95% CI = 1.18–1.97) than those who did (RR = 1.27, 95% CI = 0.91–1.77), and no clear trend with duration of exposure was observed. An excess of NMRD was observed among woodworkers reporting exposure to asbestos (RR = 1.59, 95% CI = 0.85–2.96), as well as the small number of woodworkers reporting exposure to formaldehyde (RR = 1.95, 95% CI = 0.63–6.06), but men not reporting exposure to these substances also had an excess risk. Although limited by a short follow-up period and crude indicators of exposure, the strengths of this analysis were the ability to compare woodworkers to a similar, healthy population and to adjust for the effects of smoking. Cohort studies with better exposure information are needed to examine the role of occupational exposures among woodworkers in the etiology of respiratory disease. Am. J. Ind. Med. 34:238–243, 1998. © 1998 Wiley-Liss, Inc.     

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)     

An update of a mortality study of talc miners and millers in Italy

BACKGROUND: While talc containing asbestiform fibers is considered a human carcinogen, only limited animal and human data are available on non-asbestiform talc. To provide further evaluation on the issue, we updated the analysis of an Italian cohort of talc miners and millers in Val Chisone; talc found here is free from asbestiform fibers. METHODS: The cohort was comprised of 1,795 men who had worked for at least 1 year in the mine and/or in the factory between 1946 and 1995. Vital status and death certificates were obtained from registration offices in the municipality of death or of birth. Employment, termination of employment, and detailed job history were obtained from personnel records at the plant. RESULTS: No excess was found for total cancer mortality, nor mortality for lung cancer. No case of mesothelioma was reported. There was a significant excess mortality from non-neoplastic respiratory diseases (SMR 228.2, 95% CI 190.2-271.5). Mortality excess for non-neoplastic respiratory diseases was mainly due to silicosis. CONCLUSIONS: This study provides additional support for an association between talc in mining and milling and non-neoplastic respiratory diseases, while showing no significant excess risk for lung cancer and mesothelioma. The results also provide additional information of interest to evaluate the potential association between silica and lung cancer.     

Asbestos disease in sheet metal workers: the results of a proportional mortality analysis

The results of a proportional mortality analysis of a cohort of sheet metal workers who have only intermittent exposure to asbestos demonstrates a significant excess of cancer at the three sites most frequently associated with asbestos: lung, colon and rectum, and the mesothelium. No excess nonmalignant respiratory disease was detected. These data strongly suggest that significant asbestos-related disease is present in populations with secondary exposure to asbestos and emphasize the importance of considering possible asbestos-related disease when treating patients with a history of employment in the construction industry.     

Diesel exhaust and lung cancer in the trucking industry: Exposure–response analyses and risk assessment

Background Diesel exhaust is considered a probable human carcinogen by the International Agency for Research on Cancer (IARC). The epidemiologic evidence rests on studies of lung cancer among truck drivers, bus drivers, shipyard workers, and railroad workers. The general public is exposed to diesel exhaust in ambient air. Two regulatory agencies are now considering regulating levels of diesel exhaust: the California EPA (ambient levels) and the Mine Safety Health Administration (MSHA) (occupational levels). To date, there have been few quantitative exposure–response analyses of diesel exhaust and lung cancer based on human data. Methods We conducted exposure–response analyses among workers in the trucking industry, adjusted for smoking. Diesel exhaust exposure was estimated based on a 1990 industrial hygiene survey. Past exposures were estimated assuming that they were a function of 1) the number of heavy duty trucks on the road, 2) the particulate emissions (grams/mile) of diesel engines over time, and 3) leaks from trucks' exhaust systems for long-haul drivers. Results Regardless of assumptions about past exposure, all analyses resulted in significant positive trends in lung cancer risk with increasing cumulative exposure. A male truck driver exposed to 5 μg/m³ of elemental carbon (a typical exposure in 1990, approximately five times urban background levels) would have a lifetime excess risk of lung cancer of 1–2%, above a background risk of 5%. Conclusions We found a lifetime excess risk ten times higher than the 1 per 1,000 excess risk allowed by OSHA in setting regulations. There are about 2.8 million truck drivers in the U.S. Our results depend on estimates about unknown past exposures, and should be viewed as exploratory. They conform reasonably well to recent estimates for diesel-exposed railroad workers done by the California EPA, although those results themselves have been disputed. Am. J. Ind. Med. 34:220–228, 1998. Published 1998 Wiley-Liss, Inc.     

Cancer risks among iron and steel workers in Anshan,China, part I: Proportional mortality ratio analysis

A standardized proportional mortality ratio (SPMR) study of 8,887 deaths during 1980–1989 among male workers in a large integrated iron-steel complex in Anshan, China, was conducted to provide clues to occupational risk factors. Accidents and cancer accounted for a higher proportion of deaths among the iron-steel workers than among the general male population (SPMR = 1.21; 95% CI = 1.12–1.31 and 1.14; 95% CI = 1.10–1.18, respectively). Among all workers, SPMRs were significantly elevated for stomach, lung, and colorectal cancers (SPMR = 1.37, 1.37, 1.38, respectively), but not other cancers. Risks of stomach cancer appeared to be highest among workers employed in jobs with exposure to iron and coal dust, whereas significant increases in colorectal cancer were seen for loading and other dusty jobs and for administrative and sedentary jobs without dust exposure. Risks of lung cancer appeared increased for a variety of jobs throughout the complex, especially those with probable high levels of exposure to polycyclic hydrocarbons and asbestos. Risk of esophageal cancer was significantly elevated for fire-resistant brick makers, and risk of nonmalignant respiratory disease was significantly elevated for those employed as furnace workers, foundry workers, and fire-resistant brick makers. (This article is a US Government work and, as such, is in the public domain in the United States of America.) © 1996 Wiley-Liss, Inc.     

Truck drivers and heart disease in the United States, 1979-1990

BACKGROUND: Studies of truck drivers and cardiovascular disease (CVD), myocardial infarction, or ischemic heart disease (IHD) are limited, although studies of other professional drivers reported increased risk. METHODS: US mortality data from 1979 to 1990 for ages 15-90 were used to calculate proportional mortality ratios (PMRs) for heart disease and lung cancer for short and long haul truck drivers. Analysis was performed for Black (998 short haul and 13,241 long haul) truck drivers and White (4,929 short and 74,315 long haul) truck drivers separately. RESULTS: The highest significantly elevated proportionate heart disease (IHD, acute myocardial infarction (AMI), and other forms of heart disease) and lung cancer mortality was found for White and Black male long haul truck drivers age 15-54. Mortality was not significantly elevated for short haul truck drivers of either race or gender, nor for truck drivers who died after age 65, except for lung cancer among White males. An indirect adjustment suggested that smoking could explain the excess IHD mortality, but no direct data for smoking or the other known risk factors for heart disease were available and occupational exposures were not measured. CONCLUSIONS: The highest significant excess proportionate mortality for lung cancer, IHD and AMI was found for long haul truck drivers who were under age 55 at death. A cohort or longitudinal study of heart disease among long haul truck drivers, that obtains data for occupational exposures as well as lifestyle risk factors, could help explain inconsistencies between the findings of this and previous studies.     

Cancer incidence among laboratory workers in biomedical research and routine laboratories in Israel: Part II-nested case-control study

BACKGROUND: A case-control study nested within a cohort study of biomedical laboratory workers was conducted to examine whether the excess cancer morbidity that we found can be explained by exposure to a particular group of substances, taking into consideration potential confounders. METHODS: The study population included 163 cases and two matched control groups: laboratory workers (311) and general population (448) workers. RESULTS: Multiple conditional regression analysis showed that working in research laboratories involved an increased risk of cancer generally among women [risk ratio 2.2 (1.2-4.3)], and of breast cancer particularly [risk ratio 2.3 (1.1-4.7). Seventy-six percent (76%) of breast, 87% of thyroid, 60% of ovary and prostate, 94% of melanoma, and 50% of leukemia cases were ever exposed to at least one known human carcinogen. CONCLUSION: Our results exclude the possibility that the excess cancer morbidity was related to personal risk factors but they may be explained by exposure factors. Am. J. Ind. Med. 44:611-626, 2003.     

Cancer incidence among laboratory workers in biomedical research and routine laboratories in Israel: Part I-the cohort study

BACKGROUND: Laboratory work is associated with exposure to a mixture of carcinogens. METHODS: The cohort is comprised of 4,300 laboratory workers. Cancer incidence was followed from 1960 to 1997. RESULTS: A total of 230 cases were included in the cohort. The overall cancer standardized incidence ratio (SIR) was 1.04 (0.91-1.18). When a 20-year latency was introduced, SIR was increased significantly: 1.35 (1.13-1.61). Among routine workers and researchers, SIR was elevated significantly for the total population and for women, when a 20-year latency was introduced. SIR was also elevated significantly in research, routine, bacteriology and virology, and isotope laboratories. With respect to specific sites, significantly increased SIR was observed in breast, ovary, and thyroid cancer among women; and prostate cancer, leukemia, and melanoma among men. CONCLUSIONS: We suggest that work in research and biomedical laboratories might involve an increased risk of certain types of cancer. Am. J. Ind. Med. 44:600-610, 2003.     

Accelerated loss of lung function and alveolitis in a longitudinal study of non-smoking individuals with occupational exposure to asbestos.

Long-term asbestos workers who insulate pipes and boilers may develop interstitial lung disease associated with loss of lung function. To quantitate annual loss of lung function, 77 individuals with chest X-rays greater than or equal to 1/0 ILO category who were life-long non-smokers or ex-smokers for greater than 5 years were evaluated. Study parameters included pulmonary function tests and bronchoalveolar lavage for a mean of 3 visits over 30 +/- 2 months. The study participants were 56 +/- 1 years old and had 31 +/- 1 years' occupational exposure to asbestos. At the first visit, multiple regression analysis revealed significant associations between rales or radiographic opacities and VC, FEV1, and total lung capacity; significant associations were also found between neutrophils/ml lavage fluid with FEV1 and diffusing capacity (all p less than 0.05). Annual declines for the asbestos-exposed were VC -92 +/- 28 ml/yr and FEV1 -66 +/- 21 ml/yr. Declines in VC and FEV1 were less in those with reduced lung function at the initial visit. There were no significant associations between any of the annual declines and cells recovered by bronchoalveolar lavage. Compared to other asbestos-exposed cohorts followed longitudinally, asbestos insulators with radiographs greater than or equal to 1/0 and exposure greater than or equal to 20 years have larger rates of FVC and FEV1 decline for both non-smokers and ex-smokers.     

Lymphoma and multiple myeloma mortality in relation to magnetic field exposure among electric utility workers

Associations between occupational magnetic field exposure and non-Hodgkin's lymphoma (NHL), Hodgkin's disease, and multiple myeloma mortality were evaluated in 138,905 electrical utility workers. A job-exposure matrix based on measured magnetic fields was used to derive individual exposure estimates. There was a small positive association between all NHL and low-grade NHL and duration of employment in any magnetic field-exposed job, but only up to 20 years. Cumulative magnetic field exposure was associated with a rising, then falling, risk of NHL. Rate ratios for intermediate/high-grade lymphoma were increased for the highest levels of lifetime cumulative exposure (RR = 3.7 and RR = 2.3), and were most pronounced for those exposures occurring 10–20 years previously. Hodgkin's disease and multiple myeloma mortality did not appear to be associated with exposure. Associations were stronger for NHL subgroups, suggesting that further analysis by subgroup may be warranted, but the absence of dose-response gradients diminishes the likelihood that associations represent causal relationships. Am. J. Ind. Med. 32:392–402, 1997. © 1997 Wiley-Liss, Inc.     

饮酒与男性肺癌发病关系的前瞻性队列研究

目的 研究我国男性饮酒与肺癌发病风险之间的关联。方法 对开滦集团队列（2006－2015年）男性人群每两年随访一次,收集饮酒相关信息及肺癌发病资料;此外,检索开滦附属医院医疗信息系统、开滦集团社保系统、唐山市医疗保险系统,补充收集随访过程中可能遗漏的肺癌新发病例。以不饮酒人群为参比组,利用Cox风险比例回归模型分别分析饮酒频率、饮酒类型与男性肺癌发病风险的关联,计算发病风险比（HR）及其95% CI。按照吸烟状况对研究人群分层,分别分析从不吸烟与既往吸烟/现在吸烟人群中饮酒与肺癌发病的关联。结果 共纳入101 751名男性,总随访808 146.56人年,中位随访时间8.88年,共收集肺癌新发病例913名。调整年龄、吸烟状态、吸烟量、文化程度、粉尘暴露、BMI等潜在的混杂因素后,既往饮酒、现在饮酒频率<1次/d、现在饮酒频率≥1次/d人群肺癌发病风险HR值（95% CI）分别为1.30（0.90～1.88）、0.80（0.64～1.01）和1.04（0.85～1.27）。饮用啤酒/红酒（HR=0.91,95% CI：0.69～1.20）和饮用白酒（HR=0.99,95% CI：0.83～1.19）与肺癌发病无统计学关联。依据吸烟状况分层分析,所得结果类似。结论 本研究结果尚不支持饮酒与男性肺癌发病风险存在关联。     

Occupational exposure to phenoxy herbicides and chlorophenols and cancer mortality in the Netherlands

As part of the “IARC International Register of Persons Exposed to Phenoxy Herbicides and Contaminants,” a cohort of workers who manufacture and prepare chlorophenoxy herbicides was recruited in The Netherlands. The cohort comprised 2,310 workers from two plants, operated by different companies, who were followed during the periods 1955–1985 and 1965–1986, respectively. In 1963, there had been an industrial accident in one factory with concomitant release of dioxin into the environment. Loss to followup was 3%. Mortality data on 963 exposed and 1,111 nonexposed men were evaluated by external and internal comparison. Compared with national rates, total mortality (94 deaths, standardized mortality ratio [SMR] + 101; 95% confidence interval [CI], 82–124) and cancer mortality (31 deaths, SMR + 107; 95% CI, 73–152) for exposed workers were not significantly increased. A statistically insignificant increase was observed for non-Hodgkin's lymphoma (2 deaths, SMR + 299; 95% CI, 36–1,078). No cases of soft-tissue sarcoma were encountered. There was no increase in either total mortality (25 deaths, SMR + 111; 95% CI, 72–163) or cancer mortality (10 deaths, SMR + 137; 95% CI, 66–252) among the 139 workers probably exposed to dioxins during the 2,4,5-trichlorophenol production accident or the subsequent clean-up operations. Compared with nonexposed workers, exposed workers did not exhibit a higher total mortality (rate ratio [RR] + 1.28; 95% CI, 0.89–1.82). Mortality due to all cancers (RR + 1.7; 95% CI, 0.9–3.4) and respiratory cancer (RR + 1.7; 95% CI, 0.5–6.3) was insignificantly elevated. These findings suggest that the increases in cancer mortality among workers exposed to phenoxy herbicides and chlorophenols may be attributable to chance. Lack of power prevented evaluation with respect to specific cancers. © 1993 Wiley-Liss, Inc.     

Nested case-control study of lung cancer among pulp and paper workers in relation to exposure to dusts

BACKGROUND: Numerous studies have indicated an increased risk of lung cancer in pulp and paper industry workers. In a 1990 survey, standardized mortality ratio (SMR) was found to be 122 (95% CI:96-153) for lung cancer in Polish male workers in the pulp and paper industry, and 166 (95% CI:95-270) among workers engaged in paper production. METHODS: A nested case-control design within a cohort of pulp and paper workers was applied. Seventy-nine lung cancer cases and 237 "healthy" controls were selected from the cohort of 10,460 workers employed during the years 1968-1990, and observed until the end of 1995. Based on personnel files, occupational exposure was reconstructed by experts. Using a questionnaire, data on smoking habits were collected. ORs unadjusted and adjusted for smoking were calculated applying the model of conditional logistic regression. RESULTS: Occupational exposure to inorganic dusts (kaolin, lime, cement, brick, grindstone) adjusted for smoking was a significant lung cancer risk factor, with a 4.0-fold risk (95% CI:1.3-12.6), and a dose-response by cumulative dose index. Among organic dusts only wood dust increased albeit insignificantly the risk for those exposed (adjusted for smoking OR = 2.1, 95% CI:0.9-4.9), but without dose-response relationship. CONCLUSIONS: Exposure to occupational dust with relatively low content of silica, but at high concentrations may be considered as a factor increasing lung cancer risk. However, the observation made in this study should be viewed with caution as it was based on a small number of cases, and further evidence is needed to confirm or refute the authors' hypothesis.