A historical prospective study of European stainless steel, mild steel, and shipyard welders

A multicentre cohort of 11,092 male welders from 135 companies located in nine European countries has been assembled with the aim of investigating the relation of potential cancer risk, lung cancer in particular, with occupational exposure. The observation period and the criteria for inclusion of welders varied from country to country. Follow up was successful for 96.9% of the cohort and observed numbers of deaths (and for some countries incident cancer cases) were compared with expected numbers calculated from national reference rates. Mortality and cancer incidence ratios were analysed by cause category, time since first exposure, duration of employment, and estimated cumulative dose to total fumes, chromium (Cr), Cr VI, and nickel (Ni). Overall a statistically significant excess was reported for mortality from lung cancer (116 observed v 86.81 expected deaths, SMR = 134). When analysed by type of welding an increasing pattern with time since first exposure was present for both mild steel and stainless steel welders, which was more noticeable for the subcohort of predominantly stainless steel welders. No clear relation was apparent between mortality from lung cancer and duration of exposure to or estimated cumulative dose of Ni or Cr. Whereas the patterns of lung cancer mortality in these results suggest that the risk of lung cancer is higher for stainless steel than mild steel welders the different level of risk for these two categories of welding exposure cannot be quantified with precision. The report of five deaths from pleural mesothelioma unrelated to the type of welding draws attention to the risk of exposure to asbestos in welding activities.     

Risk of lung cancer according to mild steel and stainless steel welding

OBJECTIVES: Whether the elevated risk of lung cancer observed among welders is caused by welding emissions or by confounding from smoking or asbestos exposure is still not resolved. This question was addressed in a cohort with a long follow-up and quantified estimates of individual exposure to welding fume particulates. METHODS: Male metal workers employed at least 1 year at one or more Danish stainless or mild steel industrial companies from 1964 through 1984 were enrolled in a cohort. Data on occupational and smoking history were obtained by questionnaire in 1986. Welders in the cohort who started welding in 1960 or later (N=4539) were followed from April 1968 until December 2003, when information on cancer diagnosis was obtained from the Danish Cancer Registry. During the follow-up, 75 cases of primary lung cancer were identified. Lifetime accumulated exposure to welding fume particulates was estimated by combining questionnaire information and more than 1000 welding-process-specific measurements of fume particulates in the Danish welding industry. RESULTS: The standardized incidence ratio (SIR) for lung cancer was increased among the welders [SIR 1.35, 95% confidence interval (95% CI) 1.06-1.70)]. Among the stainless steel welders, the risk increased significantly with increasing accumulative welding particulate exposure, while no exposure-response relation was found for mild steel welders, even after adjustment for tobacco smoking and asbestos exposure. CONCLUSIONS: The study corroborates earlier findings that welders have an increased risk of lung cancer. While exposure-response relations indicate carcinogenic effects related to stainless steel welding, it is still unresolved whether the mild steel welding process carries a carcinogenic risk.     

A mortality study among mild steel and stainless steel welders.

A mortality study was carried out in conjunction with the European mortality study among welders coordinated by the International Agency for Research on Cancer (IARC). The study was aimed at assessing risks for lung cancer in relation to exposure to asbestos, welding fumes containing chromium and nickel, and tobacco smoke. The study included a cohort of 2721 welders and an internal comparison group of 6683 manual workers employed in 13 factories in France. The mortality of the two cohorts was studied from 1975 to 1988 by the historical prospective method. Job histories of welders were traced including welding processes used, metals welded, and proportion of worktime spent in welding. Data on smoking habits were collected from medical records. The observed number of deaths were compared with those expected (standardised mortality ratio (SMR)) based on national rates with adjustments for age, sex, and calendar time. The smoking habits of 87% of the whole study population were known. The distribution of welders and controls according to smoking was not statistically different. The overall mortality was slightly higher for welders (SMR = 1.02, 95% confidence interval (95% CI) 0.89-1.18) than for controls (SMR = 0.91, 95% CI 0.84-0.99). For lung cancer, the SMR was 1.24 (95% CI 0.75-1.94) for welders, whereas the corresponding value was lower for controls (SMR = 0.94, 95% CI 0.68-1.26). The SMR for lung cancer was 1.59 among non-shipyard mild steel welders (95% CI 0.73-3.02). This contrasted with the results for all stainless steel welders (SMR = 0.92, 95% CI 0.19-2.69), and for stainless steel welders predominantly exposed to chromium VI (SMR = 1.03, 95% CI 0.12-3.71). Moreover, SMRs for lung cancer for mild steel welders tended to increase with duration of exposure and time since first exposure, leading to significant excesses for duration > or = 20 years and latency > or = 20 years. Such a pattern was not found for stainless steel welders.     

Lung cancer in mild steel welders

To investigate lung cancer risk, the authors conducted a historical cohort mortality study of 4,459 mild steel welders who had been employed at three midwestern plants which manufactured heavy equipment. Follow-up began in the mid-1950s and extended through 1988. All welders had at least 2 years welding experience (average duration, 8.5 years). This cohort had no occupational exposure to asbestos or stainless steel fumes (containing nickel and chromium), two potential confounders in previous welders studies. A comparison population of 4,286 nonwelders, all with at least 2 years employment at the same plants, was also studied. Nonwelders had never been welders and were allowed to have no more than 90 days employment as a painter, foundryman, or machinist. Sampling data collected from 1974-1987 indicated that welders were exposed to 6-7 mg/m3 of total particulate and 3-4 mg/m3 of iron oxide, while nonwelders had negligible exposures to welding fumes. When compared with the United States population, both welders and nonwelders had elevated rates for lung cancer (standardized mortality ratios (SMRs): welders, SMR = 1.07; nonwelders, SMR = 1.17), but neither SMR was significantly elevated. Limited smoking data based on a 1985 survey indicated that both welders and nonwelders smoked more than the United States population, possibly accounting for part of their elevated lung cancer rates. There was no trend of increased risk for welders with increased duration of exposure. The only other cause of death significantly elevated was emphysema among welders. Nonmalignant respiratory disease was not elevated for welders (SMR = 0.96). When welders were compared with nonwelders directly for lung cancer, the rate ratio was 0.90.     

Incidence of cancer among Norwegian boiler welders.

OBJECTIVES: The cancer incidence among 2957 boiler welders was investigated. The subjects were registered electrical welders from 1942 to 1981. A subcohort of 606 stainless steel welders was studied separately. METHODS: The investigation was a historical prospective cohort study based on a national registry. The loss of follow up was 4.9%. RESULTS: There were 625 deaths (659 expected). There were 269 cancer cases (264 expected). An excess of lung cancer was found; 50 cases v 37.5 expected. There were three cases of pleural mesotheliomas v 1.1 expected. The subcohort of stainless steel welders had six cases of lung cancer v 5.8 expected, and one case of pleural mesothelioma v 0.2 expected. CONCLUSIONS: The welders in the study were assumed to represent a qualified work force. These welders had a small excess risk of lung cancer. The excess risk did not seem to be associated with stainless steel welding. Smoking and asbestos exposure were potential confounders.     

Ten-year update on mortality among mild-steel welders

OBJECTIVES: This study is an update on the lung cancer risk of mild-steel welders with no asbestos exposure using a cohort of nonwelders for comparison. METHODS: The subjects came from three United States (US) plants that manufactured heavy equipment. The follow-up was extended from 1988 to 1998. The welders were not exposed to asbestos (typical of shipyard welders) or to chromium or nickel (present in stainless steel). RESULTS: There were 108 lung cancer deaths among the welders and 128 such deaths among the nonwelders (double the previous number of lung cancer deaths). The standardized mortality ratio (SMR) for lung cancer was 1.46 [95% confidence interval (95% CI 1.20-1.76] for the welders and 1.18 (95% CI 0.98-1.40) for the nonwelders, both in comparison with the US general population. Direct comparison between the welders and nonwelders yielded a rate ratio of 1.22 (95% CI 0.93-1.59). Analyses using a 15-year lag time did not differ greatly from those of an unlagged analysis. There were no marked trends for lung cancer risk by duration of exposure or latency. Evidence from cross-sectional data from a sample of the cohort indicated that the welders smoked somewhat more than the US population and more than the nonwelders. An approximate adjustment of the rate ratios for possible confounding by smoking suggested that smoking may have accounted for about half of the excess lung cancer observed among the welders versus that of either reference population. CONCLUSIONS These data provide suggestive but not conclusive evidence of a modest lung cancer risk from mild-steel welding.     

Cancer incidence among mild steel and stainless steel welders and other metal workers

The cancer incidence in a historical cohort of 10,059 metal workers employed during the period 1964–1984 was investigated. Standardized incidence ratios (SIR) were calculated based on registry extracts from the Danish Cancer registry. Lifetime exposure data (occupational and other) were obtained by a postal questionnaire in living cohort members and interviews by proxy for deceased and emigrated subjects. The incidence of lung cancer was increased among workers ever “employed as welders” (SIR = 1.38, 95% C.I. 1.03–1.81). There was a significant excess risk of lung cancer among “mild steel (MS) only welders” (SIR = 1.61, 95% C.I. 1.07–2.33) and “nonwelders” (SIR = 1.69, 95% C.I. 1.23–2.26) (indicating carcinogenic exposures other than welding), a borderline significant lung cancer excess among “MS ever welders” (SIR = 1.32, 95% C.I. 0.97–1.76), and a nonsignificant excess risk of lung cancer among “stainless steel (SS) only welders” (SIR = 2.38, 95% C.I. 0.77–5.55). In spite of signs of inconsistency in the risk estimation by duration and latency, we find the results support the conclusions of other studies: employment as a welder is associated with an increased lung cancer risk. © 1996 Wiley-Liss, Inc.     

Exposure to stainless steel welding fumes and lung cancer: a meta-analysis.

Stainless steel welding is associated with exposure to metals including hexavalent chromium and nickel. This study is a meta-analysis of five studies of stainless steel welders and the occurrence of lung cancer. Asbestos exposure and smoking habits have been taken into account. The calculated pooled relative risk estimate was 1.94 with a 95% confidence interval of 1.28-2.93. This result suggests a causal relation between exposure to stainless steel welding and lung cancer.     

Lung cancer mortality in stainless steel and mild steel welders: A nested case-referent study

The association between welding and lung cancer has been studied in a nested case-referent study within a cohort of 8,372 metal workers. Lifetime exposure data on welding and other occupational exposures, as well as alcohol and smoking habits, were obtained by interviews of spouses and colleagues. Analysis was based on 439 deceased referents and 94 deceased cases. There was 70% excess of lung cancer associated with “welding exposure ever” (OR ± 95% C.I.: 1.68, 1.02–2.78). Overall OR “mild steel (MS) welding ever” was 1.64, 0.99-2.72. The risk estimates for welding exposures showed an increasing tendency up to 15 years of exposure. The pattern of stainless steel (SS) welding resembles that of mild steel with an estimated OR of 1.65, 0.88–3.0. The general conclusion is that MS welding as well as SS welding seems to be associated with an increased risk of lung cancer. Further followup of the cohort will enhance precision of the estimates. © 1996 Wiley-Liss, Inc.     

Semen quality and sex hormones among mild steel and stainless steel welders: a cross sectional study

Welding may be detrimental to the male reproductive system. To test this hypothesis, semen quality was examined in 35 stainless steel welders, 46 mild steel welders, and 54 non-welding metal workers and electricians. These figures represent a participation rate of 37.1% in welders and 36.7% in non-welding subjects. The mean exposure to welding fume particulates was 1.3 mg/m3 (SD 0.8) in stainless steel welders using tungsten inert gas, 3.2 mg/m3 (SD 1.0) in low exposed mild steel welders using manual metal arc or metal active gas (n = 31), and 4.7 mg/m3 (SD 2.1) in high exposed mild steel welders (n = 15). The semen quality of each participant was defined in terms of the mean values of the particular semen parameters in three semen samples delivered at monthly intervals in a period with occupational exposure in a steady state. The sperm concentration was not reduced in either mild steel or stainless steel welders. The sperm count per ejaculate, the proportion of normal sperm forms, the degree of sperm motility, and the linear penetration rate of the sperm were significantly decreased and the sperm concentration of follicle stimulating hormone (FSH) was non-significantly increased in mild steel welders. A dose response relation between exposure to welding fumes and these semen parameters (sperm count excepted) was found. Semen quality decreased and FSH concentrations increased with increasing exposure. Significant deteriorations in some semen parameters were also observed in stainless steel welders. An analysis of information from questionnaires obtained from the whole population including subjects who declined to participate indicated an underestimation of effects due to selection bias. Potential confounding was treated by restriction and statistical analysis. The results support the hypothesis that mild steel welding and to a lesser extent stainless steel welding with tungsten inert gas is associated with reduced semen quality at exposure in the range of the Danish process specific threshold limit values of welding.     

Semen quality and sex hormones among mild steel and stainless steel welders: a cross sectional study.

Welding may be detrimental to the male reproductive system. To test this hypothesis, semen quality was examined in 35 stainless steel welders, 46 mild steel welders, and 54 non-welding metal workers and electricians. These figures represent a participation rate of 37.1% in welders and 36.7% in non-welding subjects. The mean exposure to welding fume particulates was 1.3 mg/m3 (SD 0.8) in stainless steel welders using tungsten inert gas, 3.2 mg/m3 (SD 1.0) in low exposed mild steel welders using manual metal arc or metal active gas (n = 31), and 4.7 mg/m3 (SD 2.1) in high exposed mild steel welders (n = 15). The semen quality of each participant was defined in terms of the mean values of the particular semen parameters in three semen samples delivered at monthly intervals in a period with occupational exposure in a steady state. The sperm concentration was not reduced in either mild steel or stainless steel welders. The sperm count per ejaculate, the proportion of normal sperm forms, the degree of sperm motility, and the linear penetration rate of the sperm were significantly decreased and the sperm concentration of follicle stimulating hormone (FSH) was non-significantly increased in mild steel welders. A dose response relation between exposure to welding fumes and these semen parameters (sperm count excepted) was found. Semen quality decreased and FSH concentrations increased with increasing exposure. Significant deteriorations in some semen parameters were also observed in stainless steel welders. An analysis of information from questionnaires obtained from the whole population including subjects who declined to participate indicated an underestimation of effects due to selection bias. Potential confounding was treated by restriction and statistical analysis. The results support the hypothesis that mild steel welding and to a lesser extent stainless steel welding with tungsten inert gas is associated with reduced semen quality at exposure in the range of the Danish process specific threshold limit values of welding.     

Mortality in two cohorts of welders exposed to high- and low-levels of hexavalent chromium

Hexavalent chromium particles are generated in the welding of stainless steel. These particles have manifested a mutagenic action in bacterial test systems and produced chromosome aberrations in cultured Chinese hamster cells. A cohort consisting of 234 welders working on stainless steel and exposed to high levels of chromium was selected. According to an earlier survey the hexavalent chromium exposure of such welders was often above 20 micrograms/m3. Another cohort consisting of 208 railway track welders exposed to low levels of chromium was also selected. The participants of both cohorts had welded for at least five years some time between 1950 and 1965 and were followed for mortality until December 1984. Among the welders exposed to high chromium levels five deaths occurred due to pulmonary tumors. This number is significantly greater than the one death that occurred among the welders exposed to low levels of chromium, but not significantly greater than the corresponding mortality of the general population. Thus exposure to stainless steel welding fumes might be associated with an increased incidence of pulmonary tumors.     

Mortality study among workers producing ferroalloys and stainless steel in France.

A mortality study was carried out among the workers of a plant that had produced ferrochromium and stainless steel, and was still producing stainless steel, in order to determine whether exposure to chromium compounds, to nickel compounds, and to polycyclic aromatic hydrocarbons (PAH) could result in a risk of lung cancer for the exposed workers. The cohort comprised 2269 men whose vital status were recorded between 1 January 1952 and 31 December 1982. The smoking habits of 67% of the cohort members were known from medical records. The observed numbers of deaths were compared with the expected ones based on national rates with adjustment for age, sex, and calendar time. A low mortality, achieving statistical significance, was found from all causes (observed = 137, standardised mortality ratio (SMR) = 0.82) and from benign respiratory diseases (observed = one, SMR = 0.15). With regard to mortality from lung cancer, a non-significant excess appeared in the whole cohort (observed = 12, SMR = 1.40). Among the exposed workers, however, a significant lung cancer excess was found (observed = 11, SMR = 2.04) that contrasted with a low SMR (0.32) in the non-exposed group. This excess is unlikely to be explained by smoking, as the tobacco consumption of these two groups was similar. No trend was observed for mortality from lung cancer either according to time since first exposure, or according to duration of exposure. A nested case-control study clearly suggested that this excess of deaths from lung cancer was attributable to former PAH exposures in the ferrochromium production workshops rather than to exposures in the stainless steel manufacturing areas.     

Mortality study among workers producing ferroalloys and stainless steel in France

A mortality study was carried out among the workers of a plant that had produced ferrochromium and stainless steel, and was still producing stainless steel, in order to determine whether exposure to chromium compounds, to nickel compounds, and to polycyclic aromatic hydrocarbons (PAH) could result in a risk of lung cancer for the exposed workers. The cohort comprised 2269 men whose vital status were recorded between 1 January 1952 and 31 December 1982. The smoking habits of 67% of the cohort members were known from medical records. The observed numbers of deaths were compared with the expected ones based on national rates with adjustment for age, sex, and calendar time. A low mortality, achieving statistical significance, was found from all causes (observed = 137, standardised mortality ratio (SMR) = 0.82) and from benign respiratory diseases (observed = one, SMR = 0.15). With regard to mortality from lung cancer, a non-significant excess appeared in the whole cohort (observed = 12, SMR = 1.40). Among the exposed workers, however, a significant lung cancer excess was found (observed = 11, SMR = 2.04) that contrasted with a low SMR (0.32) in the non-exposed group. This excess is unlikely to be explained by smoking, as the tobacco consumption of these two groups was similar. No trend was observed for mortality from lung cancer either according to time since first exposure, or according to duration of exposure. A nested case-control study clearly suggested that this excess of deaths from lung cancer was attributable to former PAH exposures in the ferrochromium production workshops rather than to exposures in the stainless steel manufacturing areas.     

Relation between various chromium compounds and some other elements in fumes from manual metal arc stainless steel welding.

For the years 1987-1990 160 individual samples of manual metal arc stainless steel (MMA/SS) welding fumes from the breathing zone of welders in four industrial plants were collected. Concentrations of soluble and insoluble chromium (Cr) III and Cr VI compounds as well as of some other welding fume elements (Fe, Mn, Ni, F) were determined. Concentration of welding fumes in the breathing zone ranged from 0.2 to 23.4 mg/m3. Total Cr amounted to 0.005-0.991 mg/m3 (including 0.005-0.842 mg/m3 Cr VI). Total Cr content of fumes varied from 0.1 to 7.4%. The distribution of particular Cr compounds was: 52.6% soluble Cr (including 50.7% Cr VI), 65.5% total Cr VI, and 11.4% insoluble Cr VI. The results obtained indicate that MMA/SS welding is a process that could be highly hazardous to human health. Evaluation of occupational exposure has shown that MMA/SS welders may exceed the admissible concentrations of soluble and insoluble Cr VI forms as well as of Mn and Ni. In the plants investigated the sum of the ratios of concentrations of particular welding fumes in the breathing zone of welders exceeded corresponding maximum allowable concentration values by 24 times (including 17 times for total Cr VI). Due to the variety and changeability of particular parameters occurring in the working environment, the composition of MMA/SS welding fumes (in the welder's breathing zone) is so variable that it is not possible to assess the exposure by means of one universal exposure indicator (maximum additive hygienic limit value). The evaluation should be based on the results of measurements of concentrations of particular elements in welding fumes.     

Incidence of cancer among welders of mild steel and other shipyard workers.

The incidence of cancer among 4571 shipyard workers with first employment between 1940 and 1979, including 623 welders of mild steel, was investigated in a historical cohort study. The loss to follow up was 1.1%. The total number of deaths was 1078 (974.5 expected) and there were 408 cases of cancer v 361.3 expected. Sixty five cases of lung cancer were found v 46.3 expected based on the national rates for males. Four pleural mesotheliomas had occurred (1.2 expected), none among the welders. An excess of lung cancers was found among the welders (nine cases v 3.6 expected). There were six cases of lung cancer v 1.6 expected in a high exposure group of 255 welders. A survey of the smoking habits as of 1984 indicated 10%-20% more daily smokers among the shipyard production workers than among Norwegian males. Exposure to smoking and asbestos were confounding variables in this study.     

Male-mediated spontaneous abortion among spouses of stainless steel welders

OBJECTIVES: Male-mediated spontaneous abortion has never been documented for humans. The welding of stainless steel is associated with the pulmonary absorption of hexavalent chromium, which has genotoxic effects on germ cells in rodents. Clinical and early subclinical spontaneous abortions were examined among spouses of stainless-steel welders. METHODS: A cohort of first-pregnancy planners was recruited from members of the union of metal workers and 3 other trade unions. The cohort was followed for 6 menstrual cycles from the cessation of contraceptive use. Altogether, 280 pregnancies were conceived, of which 35 were detected by human chorionic gonadotrophic hormone analysis and did not survive to a clinically recognized pregnancy. Information on exposure was collected prospectively in relation to the outcome and was available for all cycles resulting in a pregnancy. Information on pregnancy outcome was collected for all 245 clinically recognized pregnancies. RESULTS: Increased risk of spontaneous abortion was found for pregnancies with exposure to paternal stainless-steel welding (adjusted relative risk 3.5, 95% confidence interval 1.3-9.1). The results were consistent in analyses of both biochemically and clinically recognized abortions. There was no increased risk for spontaneous abortion in pregnancies with paternal exposure to the welding of metals other than stainless steel. CONCLUSIONS: Male welding of stainless steel was associated with an increased risk of spontaneous abortion in spouses. A mutagenic effect of hexavalent chromium has been found previously in both somatic and germ cells, and the findings could be due to mutations in the male genome.     

Assessment of risk of lung cancer for welders

Certain welding fumes contain significant amounts of chromium, manganese, and nickel, and trace amounts of arsenic and lead. These metals exhibit mutagenicity in one or more in vitro bioassays, and several are strongly suspected human carcinogens, albeit in unknown forms. It might, therefore, be expected that welders experience an excess risk of respiratory tract cancer because of their occupation. A survey of the world literature has disclosed 22 epidemiological studies of cancer incidence among welders, 16 of which yield a total of 586 cases of lung cancer observed, based on approximately 600,000 man-years at risk; a risk ratio of less than unity was excluded within 95% confidence limits for 5 of these studies. A risk ratio of 1.3 was not excluded in any study. Although there may be many possible origins to the excess risk, if welders of stainless steels suffer an "equivalent lung cancer risk" to that of chromate workers because of their equivalent chromium (VI) exposure, then a resulting three-fold risk ratio for 10% of all welders engaged in stainless steel welding would account for the total over-incidence experienced by the entire occupational group.     

Incidence of cancer among welders and other workers in a Norwegian shipyard

The incidence of cancer among 4778 male shipyard workers, including 783 mild steel welders, was investigated in a historical cohort study. The workers had been employed for at least three months between 1 January 1946 and 31 March 1977. The incidence of cancer was observed from 1 January 1953 through 1986. The loss during follow-up was only 0.9%. There were 53 observed cases of lung cancer in the whole cohort versus 31.3 expected on the basis of the national rates for men. There was an increased incidence of lung cancer among the welders, with seven observed cases versus 3.2 expected. Twenty-two cases of bladder cancer were observed versus 15.2 expected. Two malignant mesotheliomas had occurred (0.7 expected). Smoking was likely to be a confounder in the present study. Due to concomitant exposure to asbestos, the results are inconclusive concerning the possible relationship between exposure to welding fumes and lung cancer.     

Semen quality in welders before and after three weeks of non-exposure

In a cross sectional field study concerning the male reproductive system in metalworkers, the major findings were a moderate deterioration of semen quality in mild steel welders and less reliable changes in semen quality in low exposed stainless steel welders. In the present study, a longitudinal design was adopted to deal with methodological drawbacks inherent in the cross sectional approach. The study relies on the assumption that the effect of welding is causal and reversible. The semen quality of 19 mild steel welders, 18 stainless steel welders and 16 non-welding metal-workers, was examined before and three, five, and eight weeks after a three week break in exposure (summer vacation). No consistent improvement in any semen parameter in the follow up period relative to the prevacation period was found in either mild steel or stainless steel welders. The results indicate either a non-causal nature of reported associations between welding exposure and poor semen quality, or that the effect of welding is non-reversible within the rather short non-exposure period.