Mortality of iron miners in Lorraine (France): relations between lung function and respiratory symptoms and subsequent mortality.

An increased mortality from lung and stomach cancer was found in previous studies on Lorraine iron miners. A detailed analysis, however, was not possible due to the lack of data for survivors. In this study the cohort included 1178 workers selected at random from all the 5300 working miners aged between 35 and 55 at the start of the follow up period, which ranged from 1975 to 1985. Occupational exposures and tobacco consumption, lung function tests, and respiratory symptoms were assessed for each subject in 1975, 1980, and 1985. This study confirmed the excess of lung cancer (standardised mortality ratio (SMR) = 389, p < 0.001) and of stomach cancer (SMR = 273, p < 0.05). There was no excess of lung cancer in non-smokers and moderate smokers (< 20 pack-years) or the miners who worked only at the surface or underground for less than 20 years. A significant excess (SMR = 349, p < 0.001) was found in moderate smokers when they worked underground for between 20 and 29 years. Heavy smokers (over 30 pack-years) or subjects who worked underground for more than 30 years experienced a high risk: SMR = 478 (p < 0.001) for moderate smokers who worked underground for over 30 years; 588 (p < 0.001) for heavy smokers who worked underground for between 20 and 29 years; and 877 (p < 0.001) for heavy smokers who worked underground for over 30 years. This showed an interaction between smoking and occupational exposure. The excess mortality from lung cancer was because there were some subjects who died young (from 45 years old). Comparison with the results of a previous study showed that additional hazards produced by diesel engines and explosives increased the mortality from lung cancer. The SMR was higher than 400 (p < 0.001) from 45 years old instead of from 56 years. A relation was found between a decrease in vital capacity (VC), forced expiratory volume in one second (FEV1) and of FEV1/VC and mortality from all causes and from lung cancer in heavy smokers or men who had worked underground for more than 20 years. Respiratory symptoms were related to mortality from lung cancer among smokers (moderate and heavy) who worked underground for more than 20 years. It is considered that the risk of lung cancer in the Lorraine iron miners was mainly due to dust, diesel engines, and explosives although the role of low exposure to radon daughters could not be totally excluded.     

Mortality experience of haematite mine workers in China

The mortality risk of iron ore (haematite) miners between 1970 and 1982 was investigated in a retrospective cohort study of workers from two mines, Longyan and Taochong, in China. The cohort was limited to men and consisted of 5406 underground miners and 1038 unexposed surface workers. Among the 490 underground miners who died, 205 (42%) died of silicosis and silicotuberculosis and 98 (20%) of cancer, including 29 cases (5.9%) of lung cancer. The study found an excess risk of non-malignant respiratory disease and of lung cancer among haematite miners. The standardised mortality ratio for lung cancer compared with nationwide male population rates was significantly raised (SMR = 3.7), especially for those miners who were first employed underground before mechanical ventilation and wet drilling were introduced (SMR = 4.8); with jobs involving heavy exposure to dust, radon, and radon daughters (SMR = 4.2); with a history of silicosis (SMR = 5.3); and with silicotuberculosis (SMR = 6.6). No excess risk of lung cancer was observed in unexposed workers (SMR = 1.2). Among current smokers, the risk of lung cancer increased with the level of exposure to dust. The mortality from all cancer, stomach, liver, and oesophageal cancer was not raised among underground miners. An excess risk of lung cancer among underground mine workers which could not be attributed solely to tobacco use was associated with working conditions underground, especially with exposure to dust and radon gas and with the presence of non-malignant respiratory disease. Because of an overlap of exposures to dust and radon daughters, the independent effects of these factors could not be evaluated.     

Mortality experience of haematite mine workers in China.

The mortality risk of iron ore (haematite) miners between 1970 and 1982 was investigated in a retrospective cohort study of workers from two mines, Longyan and Taochong, in China. The cohort was limited to men and consisted of 5406 underground miners and 1038 unexposed surface workers. Among the 490 underground miners who died, 205 (42%) died of silicosis and silicotuberculosis and 98 (20%) of cancer, including 29 cases (5.9%) of lung cancer. The study found an excess risk of non-malignant respiratory disease and of lung cancer among haematite miners. The standardised mortality ratio for lung cancer compared with nationwide male population rates was significantly raised (SMR = 3.7), especially for those miners who were first employed underground before mechanical ventilation and wet drilling were introduced (SMR = 4.8); with jobs involving heavy exposure to dust, radon, and radon daughters (SMR = 4.2); with a history of silicosis (SMR = 5.3); and with silicotuberculosis (SMR = 6.6). No excess risk of lung cancer was observed in unexposed workers (SMR = 1.2). Among current smokers, the risk of lung cancer increased with the level of exposure to dust. The mortality from all cancer, stomach, liver, and oesophageal cancer was not raised among underground miners. An excess risk of lung cancer among underground mine workers which could not be attributed solely to tobacco use was associated with working conditions underground, especially with exposure to dust and radon gas and with the presence of non-malignant respiratory disease. Because of an overlap of exposures to dust and radon daughters, the independent effects of these factors could not be evaluated.     

Mortality from lung cancer among copper miners.

A cohort mortality study of lung cancer in 7088 copper miners was made from 1 January 1969 to 31 December 1988. There was an excess of deaths from lung cancer in the copper miners. The standardised mortality ratio (SMR) was 147 (p < 0.01). The SMR increased with calendar period. There was a higher risk of deaths from lung cancer in the miners employed in the 1950s. Age at the start of exposure had no effect on the risk of lung cancer. The risk of death from lung cancer increased with the duration of exposure and the time since first exposure. The SMR for lung cancer was 173 in underground miners and 193 for drilling miners (both p < 0.01). These data show that exposure to dust is associated with an excess of deaths from lung cancer in copper miners whereas exposure to radiation does not seem to carry such risk.     

Mortality from lung cancer in Ontario uranium miners.

Mortality from lung cancer was greater in Ontario uranium miners than in the general male population of Ontario (observed = 152, expected = 67.6, standardised mortality ratio 225, 95% confidence interval 191-264). Part of the excess of lung cancer may be because the proportion of men who are smokers or have smoked is greater in uranium miners than in Ontario men. Smoking does not explain the whole excess. Mortality from lung cancer in Ontario uranium miners is clearly related to exposure to short lived radon progeny. The excess relative risk of lung cancer from the same degree of exposure to short lived radon progeny is greatest five to 14 years after exposure and less subsequently. It is greater in men under the age of 55 years and less in older men. Part of the excess of lung cancer mortality in Ontario uranium miners is probably also due to exposure to arsenic that occurred earlier in gold mines. In Ontario uranium miners, the lung cancer mortality from exposure to arsenic increases as the intensity of exposure to short lived radon progeny increases. This finding is consistent with the hypothesis that the risk of lung cancer from exposure to arsenic is enhanced by exposure to other carcinogens. In Ontario uranium miners, the proportion of lung cancers that are small cell carcinomas is greater than in the general population. The proportion of small cell carcinomas is especially great five to 14 years after exposure to short lived radon progeny and in men who die from lung cancer at younger ages.     

Lung cancer and smoking in a group of iron ore miners

Several studies have shown that miners, in both uranium and nonuranium mines, have an increased lung cancer mortality, probably caused by exposure to radon and its daughters. The excess mortality has been observed primarily among smoking miners but some recent studies have also indicated a considerably increased risk among nonsmoking miners. This study, among a group of iron ore miners, was undertaken to further elucidate the somewhat unclear and presumably complex relationship of mining, smoking, and lung cancer. The results show a 16-fold increase in lung cancer mortality among miners versus nonminers. Even nonsmoking miners seem to be at a rather high risk of developing lung cancer, but there was a tendency for the most heavy smoking miners to die earlier and to have a slightly shorter induction-latency period for development of lung cancer than was found among the nonsmoking miners.     

Mortality and cancer incidence in a small cohort of miners exposed to low levels of alpha radiation

Due to the continuing controversy over the effects on humans of low-level ionizing radiation, overall mortality and cancer incidence among miners from a magnetite mine was investigated. The study comprises 332 underground miners. The average concentration of Rn progeny is presently 0.10-0.15 working levels (WL). Included in the study were those employed for more than 36 months in the period 1940-1960, who were still alive in 1953. The follow-up period covers 1953-1980. Mortality was equal to estimated values based on age-specific national figures. The observed/expected ratio for lung cancer incidence was 1.1. Comparison was also made to 190 miners from a mine with negligible radiation (less than 0.02 WL). The same mortality was observed, but this mine showed a ratio for lung cancer incidence of 2.2. The study population is too small to repudiate the hypothesis of increased health risk after exposure to low levels of alpha radiation.     

Radon and lung cancer risk: an extension of the mortality follow-up of the Newfoundland fluorspar cohort

Radon is a well-recognized cause of lung cancer, and studies of underground miners have provided invaluable insights on the mechanisms of radon carcinogenesis. Given the dramatic decreases in occupational exposures and the latent interval between the time of exposure and the development of lung cancer, continued follow-up of these cohorts is needed to address uncertainties in risk estimates. Here, we report on the relationship between radon and lung cancer mortality in a cohort of 1,742 Newfoundland fluorspar miners between 1950 and 2001; follow-up has been extended 11 y from previous analyses. The standardized mortality ratio (SMR) was used to compare the mortality experience of the cohort to similarly aged Newfoundland males. Poisson regression methods were used to characterize the radon-lung cancer relationship with respect to: age at first exposure, attained age, time since last exposure, interactions with cigarette smoking, and exposure rate. In total, 191 lung cancers were observed among underground miners (SMR = 3.09; 95% CI = 2.66, 3.56). ERR/WLMs decreased with attained age and time since last exposure. An inverse dose-rate effect was observed, while age at first exposure was not associated with lung cancer risk. An important strength of this study is that the effects of gamma radiation, thoron, and radioactive dust, common exposures in other miner studies, can be ruled out because the source of radon was from water running through the mine. However, the results should be interpreted cautiously due to uncertainties associated with the estimation of radon exposure levels before ventilation was introduced into the mine, and the relatively small number of lung cancer deaths that precluded joint modeling of multiple risk factors.     

Latency and the lung cancer epidemic among United States uranium miners

The latency of occupational cancer was a key factor in the recent epidemic of lung cancer among U.S. uranium miners. A review of the epidemic and analysis of latency periods with a near lifetime follow-up found that among former and nonsmokers, the mean mid-induction latent period is nearly a constant at about 25 y, regardless of age at starting or magnitude of exposure. Among cigarette smokers, the mean is shorter (about 19 y). It is not influenced by age at start of smoking, amount smoked, or magnitude of exposure, but there is a marked shortening as the age at start of radiation exposure rises. These latency variables affect lifetime risk models. By disregarding the European radon mine exposures and waiting for strong evidence of lung cancer among U.S. uranium miners (ignoring the exposures occurring while waiting during the latency period), the epidemic became inevitable.     

Dust exposure, pneumoconiosis, and mortality of coalminers

General mortality in approximately 25 000 British coalminers over 22 year periods ending in 1980 was 13% lower on average than in English and Welsh men in the same regions of Britain. There were significant within region variations between collieries, and standardised mortality ratios increased during the later years of the follow up, approaching or slightly exceeding 100 in most of the 20 coalmines studied. Age specific comparisons of 22 year survival rates were made in subgroups. Relative risks of death from all non-violent causes for men with the earliest stage of progressive massive fibrosis (PMF category A), compared with risks in miners with no pneumoconiosis (category O), ranged from 1.2 in those aged 55-64 initially to 3.5 for those aged 25-34. Mortality in miners with higher categories of PMF (B or C) was even more severe. Survival rates in men with category 1 simple pneumoconiosis were about 2% to 3% lower than in miners with radiographs classified as category O, but there was no consistent evidence of an increase in mortality with increasing category of simple pneumoconiosis. Mortality from all non-violent causes increased systematically with increases in estimates of exposure to dust before the start of the follow up. That gradient was attributable primarily to deaths certified as due to pneumoconiosis and those recorded as due to bronchitis and emphysema (p less than 0.001). There was some evidence of a dust related increase in deaths from cancers of the digestive system (p approximately equal to 0.05), but none of an association between exposure to coalmine dust and lung cancer. Lung cancer mortality, assessed over 17 year periods, was about 5.5 times higher in smokers than in life long non-smokers. Smokers with no pneumoconiosis had slightly higher lung cancer death rates than smokers with pneumoconiosis. We conclude that miners exposed to excessive amounts of respirable coalmine dust are at increased risk of premature death, either from progressive massive fibrosis or from chronic bronchitis or emphysema.     

Occupational exposure to ionising radiation and mortality among workers of the former Spanish Nuclear Energy Board.

OBJECTIVES: Firstly, to ascertain whether mortality among workers of the former Spanish Nuclear Energy Board (Junta de Energía Nuclear-JEN) was higher than that for the Spanish population overall; and secondly, if this were so, to ascertain whether this difference was associated with exposure to ionising radiation. METHODS: A retrospective follow up of a cohort of 5657 workers was carried out for the period 1954-92. Cohort mortality was compared with that for the Spanish population overall, with standardised mortality ratios (SMRs) adjusted for sex, age, and calendar period. Also, Poisson models were used to analyse mortality from lung cancer in the cohort by level of exposure to ionising radiation. RESULTS: Workers' median and mean cumulative exposures were 4.04 and 11.42 mSv, respectively. Mean annual exposure was 1.33 mSv. Excess mortality due to bone tumours was found for the cohort as a whole (six deaths observed; SMR 2.95; 95% confidence interval (95% CI) 1.08 to 6.43). Among miners, excess mortality was found for non-malignant respiratory diseases (SMR 2.94; 95% CI 2.27 to 3.75), and for lung cancer bordering on statistical significance (SMR 1.50; 95% CI 0.96 to 2.23; P = 0.055). Relative risks of dying of lung cancer from ionising radiation in the dose quartiles 2, 3, and 4 versus the lowest dose quartile, were 1.00, 1.64, and 0.94, respectively. CONCLUSIONS: Excess mortality from lung cancer was found among JEN miners. Nevertheless, no clear relation was found between mortality from lung cancer and level of exposure to ionising radiation in the JEN cohort. Continued follow up of the cohort is required to confirm excess mortality from bone tumours.     

Dust exposure, pneumoconiosis, and mortality of coalminers.

General mortality in approximately 25 000 British coalminers over 22 year periods ending in 1980 was 13% lower on average than in English and Welsh men in the same regions of Britain. There were significant within region variations between collieries, and standardised mortality ratios increased during the later years of the follow up, approaching or slightly exceeding 100 in most of the 20 coalmines studied. Age specific comparisons of 22 year survival rates were made in subgroups. Relative risks of death from all non-violent causes for men with the earliest stage of progressive massive fibrosis (PMF category A), compared with risks in miners with no pneumoconiosis (category O), ranged from 1.2 in those aged 55-64 initially to 3.5 for those aged 25-34. Mortality in miners with higher categories of PMF (B or C) was even more severe. Survival rates in men with category 1 simple pneumoconiosis were about 2% to 3% lower than in miners with radiographs classified as category O, but there was no consistent evidence of an increase in mortality with increasing category of simple pneumoconiosis. Mortality from all non-violent causes increased systematically with increases in estimates of exposure to dust before the start of the follow up. That gradient was attributable primarily to deaths certified as due to pneumoconiosis and those recorded as due to bronchitis and emphysema (p less than 0.001). There was some evidence of a dust related increase in deaths from cancers of the digestive system (p approximately equal to 0.05), but none of an association between exposure to coalmine dust and lung cancer. Lung cancer mortality, assessed over 17 year periods, was about 5.5 times higher in smokers than in life long non-smokers. Smokers with no pneumoconiosis had slightly higher lung cancer death rates than smokers with pneumoconiosis. We conclude that miners exposed to excessive amounts of respirable coalmine dust are at increased risk of premature death, either from progressive massive fibrosis or from chronic bronchitis or emphysema.     

Recent results from a study of thorium lung burdens and health effects among miners in China.

The purpose of this study was to obtain more information about health effects among the dust-exposed male miners of Bayun Obo Rare-Earth and Iron Mine, China. From 2,390 male miners from the seven dust-generating workshops of the mine, 136 dust-exposed miners were randomly selected for study. Of these, 64 men were from the high-dust-generating workshop and 72 from the lower-dust-generating workshops; the latter group was used as an internal control. Physical measurements and medical examinations were carried out on each of these 136 men. The average measured thorium lung burden for the high-dust-exposure miners was significantly greater than that for the group of lower-exposure miners, and the incidence of severe breathlessness and pneumoconiosis of stage 0(+) was also significantly raised in the high-exposure group relative to the low-exposure group. An epidemiological study of lung cancer mortality among all the miners and staff of this mine was also carried out. This showed significantly raised levels of lung cancer mortality in both exposed miners and unexposed workers when compared with the Chinese population, and the level in exposed miners was significantly higher than that in unexposed men. The general high rate of lung cancer mortality in the workers of the mine is attributed to high levels of cigarette smoking, and the raised rate in the exposed miners relative to the unexposed workers to inhalation of silica- and thorium-bearing dusts and thoron progeny.     

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.     

吸烟在云锡矿工肺癌发病中的作用

本文以1975-1984年为时段,对云南锡业公司所属六个单位工人进行了吸烟情况的调查分析。结果表明,吸烟者的肺癌发病率是非吸烟者的3.65倍。吸烟者的SMR为29.41;非吸烟者为8.42。无论吸烟程度如何,其发病、死亡都是有井下史者高于无井下史者。吸烟与职业性因素的复合作用是:吸烟+井下>单纯井下>单纯吸烟>非吸烟无井下史者。     

Mortality in gold and coal miners in Western Australia with special reference to lung cancer.

Cohorts of 1974 gold miners and 213 coal miners in Western Australia surveyed for respiratory symptoms, smoking habits, occupational history and radiographic evidence of pneumoconiosis have been followed up for 13-14 years. Overall, neither group had a significantly higher mortality than expected from the experience of Western Australian men in general. Lung cancer mortality was relatively high in the gold miners (59 deaths observed, 40.8 expected) but weakly and inconclusively related to the extent of their underground mining experience. Cigarette smoking may explain the excess of lung cancer in the gold miners because the prevalence of the habit in the latter (66.3%) was higher than in the coal miners (58.7%) or in other men in Western Australia (53.2%). Radiographic evidence of silicosis was present in 21.7% of the gold miners but did not appear to have contributed substantially to their mortality. The coal miners showed a lower than expected rate of lung cancer but an excess of deaths from all other forms of cancer (11 observed, 5.6 expected). This excess was not attributable to any one cancer site and cannot be explained readily.     

Mortality in gold and coal miners in Western Australia with special reference to lung cancer.

Cohorts of 1974 gold miners and 213 coal miners in Western Australia surveyed for respiratory symptoms, smoking habits, occupational history and radiographic evidence of pneumoconiosis have been followed up for 13-14 years. Overall, neither group had a significantly higher mortality than expected from the experience of Western Australian men in general. Lung cancer mortality was relatively high in the gold miners (59 deaths observed, 40.8 expected) but weakly and inconclusively related to the extent of their underground mining experience. Cigarette smoking may explain the excess of lung cancer in the gold miners because the prevalence of the habit in the latter (66.3%) was higher than in the coal miners (58.7%) or in other men in Western Australia (53.2%). Radiographic evidence of silicosis was present in 21.7% of the gold miners but did not appear to have contributed substantially to their mortality. The coal miners showed a lower than expected rate of lung cancer but an excess of deaths from all other forms of cancer (11 observed, 5.6 expected). This excess was not attributable to any one cancer site and cannot be explained readily.     

Radon daughter exposure to uranium miners

Radon exposures to U.S. uranium miners under present conditions average about 1.3 WLM per year approximately or equal to 60 WLM per full working lifetime. This is intermediate between (a) the lowest exposures for which there have been excess lung cancers reported among U.S. miners (120-240 WLM) and (b) average environmental radon exposures (16 WLM), so models based on these two situations are used to estimate expected effects on present uranium miners. In Model A, the loss of life expectancy is 45 days, the SMR (standardized mortality ratio) for lung cancer is 1.10, and the SMR for all causes between ages 18 and 65 is 1.013. In Model B these are 10 days, 1.03 and 1.002 respectively. It is shown that the radon exposures to miners are similar to those to millions of Americans from environmental exposure, and that miner health risks are comparable to those of other radiation workers. Their lung cancer risk from radon is 7-50 times less than their job-related accident mortality risk, and represents 0.7-4% of their total risk in mining. Miners suffer from many diseases with SMR very much larger than that for radon-induced lung cancer, and there are many other occupations and industries with far higher SMR for lung cancer than that from radon exposure to miners.     

Does Coal Workers Pneumoconiosis Predict to Lung Cancer? Some Evidence from a Case-Control Study

Previous reports on the relationship between coal workers' pneumoconiosis(CWP) and lung cancer mortality have shown widely differingresults. Concern has centred especially around whether or notthere is an aggregation of complicated CWP, or Progressive MassiveFibrosis (PMF), with lung cancer. This paper evaluates, amongUS coal miners, the CWP-lung cancer relationship by computingthe lung cancer mortality risk of simple and complicated CWPas well as the interactions with cigarette smoking and ventilatoryfunction. Two case-control studies based on 317 white male lungcancer mortality cases are presented. A one-to-one matched-casedesign allows examination of the lung cancer mortality riskof CWP and cigarette smoking. A two-to-one matched-case designcontrols on smoking status. Based upon these data, no evidenceof a CWP-lung cancer risk was found, although the expected increasedrisk for lung cancer mortality in cigarette smokers was observed.No relationship was found between PMF and lung cancer mortalityrisk. Finally, no evidence was found of interaction effectsbetween cigarette smoking or ventilatory function and CWP aspredictors of lung cancer mortality risk. Requests for reprints should be addressed to: R. G. Ames, Appalachian Laboratory, US National Institute for Occupational Safety and Health, 944 Chestnut Ridge Road, Morgantown, West Virginia 26505, USA.