温石棉与肺癌——二十七年追踪研究

目的 探讨单纯接触温石棉的工人恶性肿瘤,尤其肺癌是否超高。方法 采用固定队列研究方法。研究队列为515例男性石棉工人,人列条件为1972年1月1日工资在册,工龄满1年,没有明显心肺疾患者。对照队列为650例不接尘男性工人,其余条件同研究队。追踪27年（1972－1998）。结果 （1）研究队列全癌死亡50例（SMR＝144）,其中肺癌22例（SMR＝652）;．对照队列全癌死亡1例（SMR＝34）,肺癌3例（SMR＝89）。两队列间全癌和肺癌差异均有显著性（P＜0．05）。（2）不接触石棉的吸烟者肺癌RR为2．6,不吸烟的石棉接触者肺癌RR为12．2,而接触石棉的吸烟者RR高达32．1。吸烟和石棉暴露协同指数为2．2。（3）研究队列发生胸膜间皮瘤2例。结论 单纯暴露于温石棉的工人肺癌显著超高。     

手纺石棉女工肿瘤死亡的调查研究

目的：对手纺石棉女工肿瘤发病情况进行研究,方法：采用历史性队列研究方法。结果：发现肿瘤死亡144人,以肺癌居首位（74人,占51．39％）,死亡率各为108．97／10万与56．00／10万,SMR分别为1．16、4．17,均显著高于对照,结论：手纺石棉作业也能使接触人员肺癌高发。     

青石棉污染区恶性肿瘤9年回顾队列研究

为了证实非职业性环境接触青石棉与恶性肿瘤，特别是肺癌和间皮瘤危险的关系，采用回顾性队列调查方法对大姚县青石棉污染区进行９年的死亡率调查。选择同省无石棉污染的禄丰县作为对照。结果表明：恶性肿瘤的死亡率为１８２．６０／１０万，其中肺癌死亡率为５３．２６／１０万，相对危险度高于对照，ＲＲ分别为１．４７，２．１４（Ｐ＜０．０１）；观察组中７例死于间皮瘤。提示：间皮瘤的死亡率在青石棉污染区是很高的，在３０岁以上人中，年死亡率为１７．７５／１０万人年，而对照组中未观察到间皮瘤。     

青石棉污染区农民恶性肿瘤死亡率的回顾队列调查

目的：了解在生活环境中接触低浓度青石棉、农民患恶性肿瘤,特别是间皮瘤和肺癌之间的关系。方法：采用回顾队列调查方法对青石棉污染区的农民进行恶性肿瘤死亡率的调查,以该县无石棉污染的农民为对照,结果：观察组有5人死于间皮瘤死亡率为36．46／10万人年,而对照组无1例发生;肺癌死亡率为43．75／10万人年,与对照组比较,差别有非常显著性意义（P＜0．001）,结论：间皮瘤死亡率在青石棉污染区很高,青石棉与间皮瘤,肺癌之间存在很强的病因学联系。     

大姚县农村疾病死亡回顾性队列研究

本文采用回顾性队列研究的方法，调查了云南省大姚县青石棉污染区农民疾病死亡率。结果显示：农村中肺心病的死亡率仍占第一位。观察组恶性肿瘤死亡的危险性高于对照组（ＲＲ＾＝１．８３，Ｐ＜０．０５）。在不同部位的肿瘤中，以肺癌占首位，年死亡率为８０．１２／１０万（ＲＲ＾＝５．５３，Ｐ＜０．０５）；间皮瘤死亡率为３６．４６／１０万，对照组中无一例死于间皮瘤。提示非职业性环境接触青石棉可导致石棉相关肿瘤肺癌和间皮瘤的死亡率增高。     

接触不同沥青类型工人的肺癌汉行病学研究

在回顾性队列研究基础上，对全国１５个省市２０个油毡厂工人肺癌发病情况继续进行前瞻性上，结果表明，混合组和石油组肺癌显著超出对照人群和全国城市居民，ＳＭＲ分别为３．３３（Ｐ〈０．０１），１．７７（Ｐ〈０．０１）和３．４６（Ｐ〉０．０１），１．８８（Ｐ〈０．０１），接触不同种类沥青作业的油毡工人肺癌存在剂量－反应关系。接触人君 中非吸烟乾的肺癌也显示超量，其肺癌发病具有职业特点，是一种有有关癌症。     

接触石棉工人恶性肿瘤死亡回顾性队列研究

接触石棉工人恶性肿瘤死亡回顾性队列研究张忠群张华强王元林关于石棉致癌已众所公认，为进一步调查研究石棉接触工人恶性肿瘤（尤其是肺癌）是否高发，为制定诊断原则和防治措施提供科学依据，我们进一步对石棉生产工人恶性肿瘤发病和有关因素进行了２３年回顾性队列研究...     

炊事员肺癌流行病学调查研究

目的 为了解决事炊员肺癌发病情况。方法 采用回顾性方法，对２３４５名炊事员进行了２５年死因流行病学调查，结果 炊事员肺癌粗死亡率为９８．０２／１０万，与当地居民比较，男女肺癌死亡率明显增高，ＳＭＲ分别为１．９９，２．４０（Ｐ〈０．０５），进一步分析发现，炊事员现癌高发主要集中于接触油烟浓度较大的烹调工，ＳＭＲ分别为３．８８，６．６７（Ｐ〈０．０５），而接触油烟较轻的白案工肺癌发病率较低。结论 提示     

大连市区1991～2005年乳腺癌流行趋势分析

目的分析大连市区1991～2005年女性乳腺癌流行趋势，为制定防治策略提供依据。方法利用女性乳腺癌新发病例资料，计算粗发病率、世界人口调整发病率、截缩率、累积率、年度变化百分比（APC），作年龄-时期-队列发病分析。结果（1）流行趋势概况：粗发病率为36．6／10万。其APC为7．36％（P〈0．001）：调整发病率为27．7／10万，其APC为5．13％（P〉0．001）。（2）流行趋势分析：与30-34岁相比，35-39岁的RR已升至2．311倍（P〈O．001），至45-49岁上升到6．752倍：1931～1960年出生队列的RR均为1911年的2．4倍以上（P〈0．001）。结论大连市区女性乳腺癌发病存在人口老龄化和发病年轻化的趋势。     

大姚县青石棉污染的危害及预防与控制

目的 探讨环境中低浓度接触石棉对居民健康的影响及石棉对居民健康的影响及石棉相关疾病的预防。方法 采用横断面调查、回顾队列调查和动物实验等方法。结果 大姚县居民胸膜斑检出率为１０．７％,在４０岁以上人群中高达１９．８％,并相继发现８３例地方性石棉肺。１９７７￣１９８３年期间肺癌的ＳＭＲ为６．６３,ＲＲ为７．２３,间皮瘤死亡率为８．５／１０万人年。１９８７￣１９９９５年肺癌死亡率为５３．２６／１０万人     

Exposure to vinyl chloride monomer: report on a cohort study.

In 1980 a prospective exposed/non-exposed cohort study was initiated in France by the Institut National de la Santé et de la Recherche Médicale (INSERM U 287) to evaluate the association between mortality and cancer morbidity and occupational exposure to vinyl chloride monomer (VCM). Eleven hundred VCM exposed subjects and 1100 VCM non-exposed controls matched for age (+/- 2 years), plant, and physician were included and followed up over a five year period for vital, health, and occupational status. The percentages of deaths observed among the exposed (1.8%) and non-exposed subjects (1.6%) did not differ. Eighteen (1.6%) and 15 (1.4%) cases of cancer were reported among exposed and non-exposed subjects, respectively (NS). One case of angiosarcoma of the liver occurred among the exposed group; six cases of lung cancer occurred among exposed subjects and two among non-exposed subjects (NS). The percentage of diseases of the circulatory system was higher (p less than 0.02) in the exposed group than in the non-exposed group: this difference was explained mainly by the high incidence of Raynaud's disease (p less than 0.006). The percentages of diseases of the respiratory system did not differ between the two groups.     

Exposure to vinyl chloride monomer: report on a cohort study

In 1980 a prospective exposed/non-exposed cohort study was initiated in France by the Institut National de la Santé et de la Recherche Médicale (INSERM U 287) to evaluate the association between mortality and cancer morbidity and occupational exposure to vinyl chloride monomer (VCM). Eleven hundred VCM exposed subjects and 1100 VCM non-exposed controls matched for age (+/- 2 years), plant, and physician were included and followed up over a five year period for vital, health, and occupational status. The percentages of deaths observed among the exposed (1.8%) and non-exposed subjects (1.6%) did not differ. Eighteen (1.6%) and 15 (1.4%) cases of cancer were reported among exposed and non-exposed subjects, respectively (NS). One case of angiosarcoma of the liver occurred among the exposed group; six cases of lung cancer occurred among exposed subjects and two among non-exposed subjects (NS). The percentage of diseases of the circulatory system was higher (p less than 0.02) in the exposed group than in the non-exposed group: this difference was explained mainly by the high incidence of Raynaud's disease (p less than 0.006). The percentages of diseases of the respiratory system did not differ between the two groups.     

Cancer mortality among workers exposed to amphibole-free chrysotile asbestos.

The issue of whether exposure to chrysotile asbestos alone, without contamination from amphibole asbestos, causes lung cancer and mesothelioma was investigated in a 25-year longitudinal study (1972-1996) in Chongqin, China. The study cohort comprised 515 male asbestos plant workers exposed to chrysotile only; the control cohort included 650 non-dust-exposed workers. The results of analysis in which the proportional hazards model was used indicated that mortality due to all causes, all cancers, and lung cancer was related to asbestos exposure; the relative risks, adjusted for age and smoking, were 2.9, 4.3, and 6.6, respectively. Fiber concentrations in the raw material section and the textile section of the plant were 7.6 and 4.5 fibers/ml, respectively. Because of differences between the study and control plants, the authors also compared various sections of the asbestos plant that had different levels of dust exposure. The adjusted relative risk of lung cancer was 8.1 for workers exposed to high versus low levels of asbestos. Two cases of malignant mesothelioma, one pleural and the other peritoneal, were found in the asbestos cohort. These results suggest that heavy exposure to pure chrysotile asbestos alone, with negligible amphibole contamination, can cause lung cancer and malignant mesothelioma in exposed workers.     

Study of occupational lung cancer in asbestos factories in China.

A retrospective cohort study (1972-81) of occupational cancers in asbestos (chrysotile) factories has been previously published. In this paper the results of continued tracing and interviewing of members of this cohort from 1982 to 1986 is reported. The cohort included 5893 persons (45,974 person-years for men and 39,445 person-years for women). Malignant tumours played a large part in causes of death (36.9%). There were 183 cancers and 67 lung cancers among 496 deaths. The mortality due to lung cancer had a tendency to increase. By comparison with a control group, the RR of lung cancer was 5.32 (p < 0.01), and the SRR of lung cancer was 4.2 (p < 0.01), significantly higher than those of a control group. Among 148 cases of death from asbestosis there were 33 cases complicated with lung cancer (22.3%). The dose-response relations between exposure to asbestos and incidence of asbestosis and lung cancer were also studied in one asbestos factory. There was a positive correlation. A synergistic effect was found between cigarette smoking and lung cancer. Preventive and control measures and exposure limits for asbestos dust in the air of workplaces were recommended.     

The quantitative risks of mesothelioma and lung cancer in relation to asbestos exposure

Mortality reports on asbestos exposed cohorts which gave information on exposure levels from which (as a minimum) a cohort average cumulative exposure could be estimated were reviewed. At exposure levels seen in occupational cohorts it is concluded that the exposure specific risk of mesothelioma from the three principal commercial asbestos types is broadly in the ratio 1:100:500 for chrysotile, amosite and crocidolite respectively. For lung cancer the conclusions are less clear cut. Cohorts exposed only to crocidolite or amosite record similar exposure specific risk levels (around 5% excess lung cancer per f/ml.yr); but chrysotile exposed cohorts show a less consistent picture, with a clear discrepancy between the mortality experience of a cohort of xhrysotile textile workers in Carolina and the Quebec miners cohort. Taking account of the excess risk recorded by cohorts with mixed fibre exposures (generally<1%), the Carolina experience looks uptypically high. It is suggested that a best estimate lung cancer risk for chrysotile alone would be 0.1%, with a highest reasonable estimate of 0.5%. The risk differential between chrysotile and the two amphibole fibres for lunc cancer is thus between 1:10 and 1:50.Examination of the inter-study dose response relationship for the amphibole fibres suggests a non-linear relationship for all three cancer endpoints (pleural and peritoneal mesotheliomas, and lung cancer). The peritoneal mesothelioma risk is proportional to the square of cumulative exposure, lung cancer risk lies between a linear and square relationship and pleural mesothelioma seems to rise less than linearly with cumulative dose. Although these non-linear relationships provide a best fit ot the data, statistical and other uncertainties mean that a linear relationship remains arguable for pleural and lung tumours (but not or peritoneal tumours).Based on these considerations, and a discussion fo the associated uncertainties, a series of quantified risk summary statements for different elvels of cumulative exposure are presented.     

Epidemiology of occupational asbestos-related diseases in China

In 1950s and 60s, asbestosis had been a major health hazard for asbestos exposed workers. In the late 1970s, lung cancers with or without asbestosis were found among asbestos workers. All cohort studies on asbestos workers and on chrysotile miners in China showed excess deaths from lung cancer. In a large scale of cohort study on asbestos workers, a synergistic effect was found between cigarette smoking and asbestos exposure in the production of lung cancer. There have been not so many cases of malignant mesotheliomas reported, so far. In the cohort of chrysotile miners, 4 cases of pleural mesothelioma were observed. In the large scale of cohort study on asbestos workers in 9 factories using only chrysotile only one case of pleural mesothelioma was detected for 10 years' observation. In another 2 cohort studies, 2 cases of peritoneal mesotheliomas were found, one in Shanghai asbestos factory where a small amount of crocidolite had been used in 1960s, and one in Anqing asbestos factory that was located near tremolite mine. Further study is needed especially for the relationship between exposure to Chinese chrysotile and malignant mesotheliomas.     

Cancer incidence and mortality of isocyanate exposed workers from the Swedish polyurethane foam industry: updated findings 1959-98

Aims: To assess whether cancer incidence and mortality in chronic obstructive lung diseases were increased in the Swedish polyurethane foam industry cohort, updated with 11 more years of follow up.

Methods: The mortality and cancer incidence (1959–98) experienced by a cohort of 4175 male and female employees employed for at least one year in the period 1959–87 at one of nine Swedish polyurethane foaming plants were investigated. Comparisons were based on calendar year, sex, and five-year age group specific mortality and incidence rates for Sweden. Workplaces and job tasks were categorically assessed for exposure to toluene diisocyanate (TDI) and methylene diphenyldiisocyanate (MDI) by occupational hygienists.

Results: Fewer cancer cases than expected were observed, but the lung cancer incidence was enhanced in women. Women with "apparent exposure" to TDI or MDI did not, however, have a higher lung cancer incidence than those with "no or low exposure". Moreover, a nested case referent study did not find that polyurethane dust exposure had been more prevalent among the female lung cancer cases than among referents. No increased mortality in chronic obstructive lung diseases was observed in the cohort.

Conclusions: Results support the findings from two other cohort studies of an increased lung cancer risk among female workers in the polyurethane foam manufacturing industry. Chance or confounding from smoking are not obvious explanations for the coherent findings. However, the study was not able to link isocyanate exposed employment with lung cancer risk.

     

Exposure-response analysis of risk of respiratory disease associated with occupational exposure to chrysotile asbestos.

OBJECTIVES: To evaluate alternative models and estimate risk of mortality from lung cancer and asbestosis after occupational exposure to chrysotile asbestos. METHODS: Data were used from a recent update of a cohort mortality study of workers in a South Carolina textile factory. Alternative exposure-response models were evaluated with Poisson regression. A model designed to evaluate evidence of a threshold response was also fitted. Lifetime risks of lung cancer and asbestosis were estimated with an actuarial approach that accounts for competing causes of death. RESULTS: A highly significant exposure-response relation was found for both lung cancer and asbestosis. The exposure-response relation for lung cancer seemed to be linear on a multiplicative scale, which is consistent with previous analyses of lung cancer and exposure to asbestos. In contrast, the exposure-response relation for asbestosis seemed to be nonlinear on a multiplicative scale in this analysis. There was no significant evidence for a threshold in models of either the lung cancer or asbestosis. The excess lifetime risk for white men exposed for 45 years at the recently revised OSHA standard of 0.1 fibre/ml was predicted to be about 5/1000 for lung cancer, and 2/1000 for asbestosis. CONCLUSIONS: This study confirms the findings from previous investigations of a strong exposure-response relation between exposure to chrysotile asbestos and mortality from lung cancer, and asbestosis. The risk estimates for lung cancer derived from this analysis are higher than those derived from other populations exposed to chrysotile asbestos. Possible reasons for this discrepancy are discussed.     

Chrysotile,tremolite and carcinogenicity

It has been suspected for many years that amphibole fibres in the tremolite series, a low level contaminant of chrysotile asbestos, may contribute disproportionately to the incidence of mesothelioma and perhaps other exposure-related cancers. A cohort of some 11000 Quebec chrysotile workers, 80% of whom have now died, provided the opportunity to examine this hypothesis further. An analysis was made of deaths from mesothelioma (21), cancers of the lung (262), larynx (15), stomach (99), and colon and rectum (76), in men employed by the largest company in Thetford Mines, with closely matched referents. Risks were estimated by logistic regression for these five cancers in two groups of mines—five mines located centrally and ten mines located peripherally; tremolite contamination had been demonstrated to be some four times higher in the former than in the latter. Odds ratios for work in the central mines were raised substantially and significantly for mesothelioma and lung cancer, but not for the gastric, intestinal or laryngeal cancer sites. In the peripheral mines, there was little or no evidence of increased risk for any of the five cancers. The hypothesis that, because of the difference in distribution of fibrous tremolite, cancer risks in the central area would be greater than in the periphery was thus substantiated. That the explanation may lie in the greater biopersistence of amphibole fibres than chrysotile is important in framing policies for the use and control of asbestos and is directly relevant to the selection of man-made mineral fibre substitutes.