氯乙烯作业工人恶性肿瘤流行病学调查研究

目的 为了解氯乙烯作业工人恶性肿瘤发病情况。方法 采用回顾前瞻性观察法,对921名氯乙烯作业工人进行了40年死因流行病学调查。结果 男性接触组肝癌死亡率明显高于对照组。RR为2．16（P＜0．05）;接触组恶性肿瘤、肝癌的死亡也显著高于1994年全国城市居民恶性肿瘤的死亡率及1995年全国城市居民肝癌的死亡水平。SMR分别为1．8、29（P＜0．05）。在恶性肿瘤分类构成中,接触组肝癌居首位。结论 氯乙烯作业工人肝癌高发具有职业性特征。     

A Meta-analysis of Mortality among Workers Exposed to Organic Solvents

It has been suggested that organic solvent exposure may contributeto an increased risk of blood disorders, neurological, liverand renal disease, and cancer. A meta-analysis has been performedof 55 published mortality studies which involved solvent exposureand provided standardised mortality ratios (SMR) or relativerisk (RR). The combined results showed the overall SMR to be86.7 (95% confidence interval [CI] = 83.7–89.9), whilethat for all sites of cancer was 92.3 (CI = 87.5–97.4).Risk of death from leukaemia was increased (SMR = 112.2, CI= 101.6–146.9) as was that from cancer of liver and biliarypassages (SMR = 119.7, CI = 104.4–137.2), even thoughthe risk of death from cirrhosis was reduced (SMR = 81.5, CI= 68.1–97.4). No excess risk of death from other diseaseshas been found. The favourable mortality might be from a ‘healthyworker effect’, but the increase in death from liver cancerin the absence of excess deaths from cirrhosis is biologicallyplausible and justifies further investigation. The increasein mortality from leukaemia is likely to have been associatedwith exposure to benzene.     

Mortality from all cancers of asbestos factory workers in east London 1933-80

OBJECTIVE—To give the observed and expected deaths due to cancer at all separate sites in asbestos workers in east London, and to analyse these for overall effect and exposure-response trend.
METHODS—The mortality experience of a cohort of over 5000 men and women followed up for over 30 years since first exposure to asbestos has been extracted.
RESULTS—There was a large excess of deaths due to cancer (537 observed, 222 expected). Most of these were due to cancer of the lung (232 observed, 77 expected) and pleural (52) and peritoneal (48) mesothelioma. The exposure-response trend for all these three causes was highly significant. There was also an excess of cancer of the colon (27 observed, 15 expected) which was significantly related to exposure. There were significant excesses of cancer of the ovary, of the liver, and of the oesophagus but with no consistent relation to exposure.
CONCLUSIONS—The excess risk of cancer after exposure to asbestos was mainly due to cancer of the lung and mesothelioma. An exposure related excess of cancer of the colon was also detected but the possibility that some of these deaths may have been peritoneal mesotheliomas could not be excluded. There was no consistent evidence of exposure related excesses at any other site.


Keywords: asbestos; cancer; exposure-response     

Cigarette smoking and cancer: intensity patterns in the alpha-tocopherol, beta-carotene cancer prevention study in Finnish men

Relative risks for lung and bladder cancers by smoking intensity level off at more than 15-20 cigarettes per day. A three-parameter excess relative risk model in pack-years and intensity quantified this leveling (Lubin et al., Am J Epidemiol 2007;166:479-89). Above 15-20 cigarettes per day was an "inverse exposure rate" effect whereby, for equal pack-years, the excess relative risk/pack-year decreased with increasing intensity; that is, smoking at a lower intensity for a longer duration was more deleterious than smoking at a higher intensity for a shorter duration. After adjustment for pack-years, intensity effects were quantitatively homogeneous across multiple case-control studies of lung, bladder, oral cavity, pancreas, and esophagus cancers. The authors extended those analyses to examine intensity patterns for incident bladder, esophagus, kidney, larynx, liver, lung, oropharynx, and pancreas cancers by using data from a single prospective cohort in Finland, the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, with follow-up from enrollment, which occurred between 1985 and 1988, through April 2004. At more than 10 cigarettes per day, they found an inverse exposure rate pattern for each cancer site. After adjustment for pack-years, intensity effects were quantitatively homogeneous across the diverse cancer sites and homogeneous with intensity effects from the prior analysis of multiple studies. Consistency of intensity patterns suggested a general phenomenon and may provide clues to the molecular basis of smoking-related cancer risk.     

An industry-wide epidemiologic study of vinyl chloride workers, 1942-1982

The cohort consisted of 10,173 men who had worked for at least one year in jobs involving exposure to vinyl chloride prior to 1 January 1973. These men were employed at 37 plants in the U.S., belonging to 17 companies. Observation of the mortality experience of the cohort was updated from 31 December 1972 to 31 December 1982 (the study now covering 1942-1982). A total of 1,536 cohort members were identified as having died. The observed mortality, by cause, was compared with the expected based on U.S. mortality rates, standardized for age, race, and calendar time. Analyses by length of exposure, latency, age at first exposure, calendar year of first exposure, and type of products were performed. The study confirmed that the vinyl chloride workers experience a significant mortality excesses in angiosarcoma (15 deaths), cancer of the liver and biliary tract (SMR = 641), and cancer of the brain and other central nervous system (SMR = 180). In addition, the study also found a significant mortality excess in emphysema/chronic obstructive pulmonary disease (COPD) (SMR = 179). On the other hand, the study did not find any excess in either respiratory cancer or lymphatic and hematopoietic cancer. This study also found an increase in biliary tract cancers, independent from liver cancer.     

Magnitude of misclassification bias when using a job-exposure matrix.

A job-exposure matrix constructed in Southampton, the United Kingdom, was assessed with the use of 1205 occupational histories collected for a case-referent study on primary liver cancer in Finland. The odds ratios calculated on the basis of the matrix and an assessment by occupational hygienists were compared. The ability of the matrix to detect excess risk was generally satisfactory for chemical and physical agents to which about 10% or more of the studied population was exposed. If only probable exposure at a high level was assigned to the category of the exposed, an excess risk was usually detectable also when the prevalence of exposure was below 10%. This assessment indicates that the British job-exposure matrix is an acceptably valid screening tool also outside the United Kingdom, provided that the misclassification characteristics of the matrix and the significant differences in exposure between the countries are taken into account.     

Mortality in dry-cleaning workers: an update

BACKGROUND: A cohort of 1,708 dry-cleaning workers identified from union records was exposed to perchloroethylene (PCE), a known animal carcinogen and probable human carcinogen, for at least 1 year before 1960. Many workers also had exposure to Stoddard solvent, a petroleum-based dry-cleaning solvent. METHODS: Vital status was updated through 1996 and life table analyses conducted. RESULTS: The cohort had excess cancer mortality (271 deaths, standardized mortality ratio [SMR] 1.25, 95% confidence interval [CI] 1.11-1.41). Elevated SMRs for tongue, bladder, esophagus, intestine, lung, and cervical cancer, pneumonia, and diseases of the stomach and duodenum were statistically significant. CONCLUSION: The current study confirms findings of prior updates and other studies that dry-cleaning workers have excess cancer mortality at several sites. Although important lifestyle and socioeconomic risk factors exist for both cervical and esophageal cancer mortality, excesses of these sites in the PCE only subcohort and among workers with longer duration of PCE exposure suggest an association with PCE exposure.     

Trichloroethylene cancer epidemiology: a consideration of select issues

A large body of epidemiologic evidence exists for exploring causal associations between cancer and trichloroethylene (TCE) exposure. The U.S. Environmental Protection Agency 2001 draft TCE health risk assessment concluded that epidemiologic studies, on the whole, support associations between TCE exposure and excess risk of kidney cancer, liver cancer, and lymphomas, and, to a lesser extent, cervical cancer and prostate cancer. As part of a mini-monograph on key issues in the health risk assessment of TCE, this article reviews recently published scientific literature examining cancer and TCE exposure and identifies four issues that are key to interpreting the larger body of epidemiologic evidence: a) relative sensitivity of cancer incidence and mortality data ; b) different classifications of lymphomas, including non-Hodgkin lymphoma ; c) differences in data and methods for assigning TCE exposure status ; and d) different methods employed for causal inferences, including statistical or meta-analysis approaches. The recent epidemiologic studies substantially expand the epidemiologic database, with seven new studies available on kidney cancer and somewhat fewer studies available that examine possible associations at other sites. Overall, recently published studies appear to provide further support for the kidney, liver, and lymphatic systems as targets of TCE toxicity, suggesting, as do previous studies, modestly elevated (typically 1.5-2.0) site-specific relative risks, given exposure conditions in these studies. However, a number of challenging issues need to be considered before drawing causal conclusions about TCE exposure and cancer from these data.     

Mortality of workers exposed to polychlorinated biphenyls--an update

A retrospective cohort mortality study of workers exposed to polychlorinated biphenyls (PCBs) in two plants manufacturing electrical capacitors was reported in 1981. The study was conducted primarily to examine the risk of cancer mortality associated with exposure to PCBs. Based on animal data, liver cancer was the disease of most interest. Due to the small number of deaths and a relatively short observation period, the study was considered inconclusive. This study has been updated by adding 7 yr of observation. The number of deaths in the study cohort has increased from 163 to 295. Mortality from all causes was found to be lower than expected (295 observed vs. 318 expected deaths) as well as mortality from all cancers (62 observed vs. 80 expected deaths). A statistically significant excess in deaths was observed in the disease category that includes cancer of the liver (primary and unspecified), gall bladder, and biliary tract (5 observed vs. 1.9 expected; p less than .05). Most of this excess was observed in women employed in one plant. Due to the small number of deaths and the variability of specific cause of death within this category, it remains difficult to interpret these findings in regard to PCB exposure.     

Cancer mortality in an Italian rubber factory

The purpose of the study was to describe the mortality experience of an Italian cohort of rubber workers and an attempt was made to identify any occupational cancer hazards that might currently be affecting men employed in this type of work. A total of 4917 male workers who first started working in a large rubber factory between 1962 and 1972 have been followed up until 31 January 1983. The number of deaths from all causes and from malignant neoplasms was determined and compared with the expected number of deaths calculated from mortality rates for the province in which the population of the plant lived. Mortality from all causes was 85% of that expected. A slight overall excess of deaths from cancer (SMR = 119) was found; this was entirely due to the excess mortality in the 35-44 age group. In order further to evaluate the possible existence of a cancer risk SMRs were analysed by duration of exposure, time since first exposure, and for specific sites of cancer. A trend in SMR with duration of exposure was found for employees with 10 years of follow up or more. A high risk for some tumour sites emerged.     

Cancer mortality in an Italian rubber factory.

The purpose of the study was to describe the mortality experience of an Italian cohort of rubber workers and an attempt was made to identify any occupational cancer hazards that might currently be affecting men employed in this type of work. A total of 4917 male workers who first started working in a large rubber factory between 1962 and 1972 have been followed up until 31 January 1983. The number of deaths from all causes and from malignant neoplasms was determined and compared with the expected number of deaths calculated from mortality rates for the province in which the population of the plant lived. Mortality from all causes was 85% of that expected. A slight overall excess of deaths from cancer (SMR = 119) was found; this was entirely due to the excess mortality in the 35-44 age group. In order further to evaluate the possible existence of a cancer risk SMRs were analysed by duration of exposure, time since first exposure, and for specific sites of cancer. A trend in SMR with duration of exposure was found for employees with 10 years of follow up or more. A high risk for some tumour sites emerged.     

Cancer incidence among physicians occupationally exposed to ionizing radiation in Finland

OBJECTIVES: Occupational radiation exposure was estimated, and the cancer incidence among physicians working with radiation was compared to that of unexposed physicians. METHODS: A cohort of 1312 physicians was identified from the Finnish occupational radiation exposure registry. Radiation exposure data were obtained from 1970 to 2001 on the basis of individual dosimeters. Never-monitored Finnish physicians (N=15 821) were used as a reference group, identified from census data of Statistics Finland. Incident cancer cases were identified by record linkage with the Finnish Cancer Registry. RESULTS: The cumulative radiation dose exceeded the recording level (0.3-3.0 mSv during a 3-month period for 1029 radiation-exposed physicians (59.8%). Six percent of the radiologists had received a cumulative dose of 50 mSv or more. Altogether there were 41 cancers observed among the radiation-exposed physicians and 998 cases found in the never-monitored group. Standardized incidence ratios (SIR) for all cancers were comparable with those of the general population among physicians monitored for radiation [SIR 1.0, 95% confidence interval (95% CI) 0.7-1.4] and other physicians (SIR 1.0, 95% CI 1.0-1.1). For specific cancer sites, a slightly elevated risk of female breast cancer was found among monitored physicians when compared with other physicians (rate ratio 1.7, 95% CI 1.0-3.1). No obvious dose-response relationship was found for the overall cancer incidence. CONCLUSIONS: According to the results from a nationwide cohort, occupational exposure to medical radiation is not a strong risk factor for cancer among physicians. Possible excess risk could not be reliably demonstrated even after the follow-up of a nationwide cohort for up to 30 years.     

Mortality among workers from a plastics producing plant: a matched case-control study nested in a retrospective cohort study

Earlier proportional mortality studies of workers in a plastics producing plant in Massachusetts indicated excess mortality from certain digestive and genitourinary cancers. To more definitively examine mortality among these workers a retrospective cohort study was conducted for 2,490 male wage earners who worked at least one year during 1949-1966. Vital status was determined as of Dec. 31, 1976, for 99.7% of the cohort and death certificates were obtained for 98.0% of 603 observed deaths. Comparison with the local county white males revealed a slight excess in digestive system cancer (standard mortality ratio [SMR] = 101.8) and a statistically significant excess (p less than .05) in genitourinary cancer (SMR = 153.6). A relationship was suggested between cancer of the rectum, liver, and pancreas and both the duration and interval from onset of exposure. A secondary matched case-control study was conducted to determine if particular jobs or work areas were related to the excesses found in the primary study. This analysis did not support the hypothesis that digestive or genitourinary cancer was related to a general plant exposure or date of hire. Possible associations warranting continued surveillance were found between rectal cancer and cellulose nitrate production and between prostatic cancer and polystyrene processing. Digestive and genitourinary cancers other than rectal and prostate were not related to employment in any of 21 occupational exposure categories examined.     

Acrylamide cohort mortality study.

The mortality experience of 371 employees assigned to acrylamide monomer and polymerisation operations was examined with particular emphasis on cancers at sites identified from animal studies such as the central nervous system, thyroid gland, other endocrine glands, and mesotheliomas. A total of 29 deaths was observed up until 1982 (38.0 expected). No statistically significant excesses were noted in the total cohort and no deaths were found for the hypothesised sites of cancer. The observed deaths in the total cohort for the all cancers category were somewhat in excess (11 v 7.9); however, this was due entirely to excess cancers of the digestive tract and respiratory system in the subgroup with previous exposure to organic dyes. Among those employees not exposed to organic dyes, four deaths were due to malignancies versus 6.5 expected. This study does not support a cause effect relation between exposure to acrylamide at this work site and overall mortality, total malignant neoplasms, or any specific cancers.     

Acrylamide cohort mortality study

The mortality experience of 371 employees assigned to acrylamide monomer and polymerisation operations was examined with particular emphasis on cancers at sites identified from animal studies such as the central nervous system, thyroid gland, other endocrine glands, and mesotheliomas. A total of 29 deaths was observed up until 1982 (38.0 expected). No statistically significant excesses were noted in the total cohort and no deaths were found for the hypothesised sites of cancer. The observed deaths in the total cohort for the all cancers category were somewhat in excess (11 v 7.9); however, this was due entirely to excess cancers of the digestive tract and respiratory system in the subgroup with previous exposure to organic dyes. Among those employees not exposed to organic dyes, four deaths were due to malignancies versus 6.5 expected. This study does not support a cause effect relation between exposure to acrylamide at this work site and overall mortality, total malignant neoplasms, or any specific cancers.     

Exposures to silica mixed dust and cohort mortality study in tin mines: exposure-response analysis and risk assessment of lung cancer

BACKGROUND: Mineral dusts that contain crystalline silica have been associated directly or indirectly with the development of pneumoconiosis or silicosis, non-malignant respiratory diseases, lung cancer, and other diseases. The health impacts on workers with silica mixed dust exposure in tin mines and dose-response relationships between cumulative dust exposure and the mortality from lung cancer are investigated. METHODS: A cohort of 7,837 workers registered in the employment records in 4 Chinese tin mines between 1972 and 1974 was identified for this study and the mortality follow-up was traced through 1994. Of the cohort, the cause of death was ascertained for 1,061 (97%) of the 1,094 deceased workers. Standardized mortality ratios (SMRs) were calculated for all workers, non-exposed workers, and dust-exposed workers with different exposure levels, silicotics, and non-silicotics based on Chinese national rates. RESULTS: The mortality from all causes in four tin mines was nearly the same as the national mortality. Malignant neoplasm, cerebrovascular disease, and cardiovascular disease accounted for 68.6% of all deaths. Mortality excess from lung cancer, liver cancer, all malignant diseases, and non-malignant respiratory diseases was observed among dust-exposed workers; a 50-fold excess of pneumoconiosis was observed. There was an upward trend for SMRs of lung cancer was noted from no exposure to low, medium, and high exposure levels (SMRs=1.29, 2.65, 2.66, 3.33). The shape of the exposure-response curve for risk of lung cancer at high exposure levels was inconsistent in these four mines. CONCLUSIONS: The findings indicated a positive dose-response relation between exposure to cumulative dust and the mortality of lung cancer. High arsenic content in dust particles, together with crystalline silica, may play an important role in causing increased mortality from lung cancer.     

Cancer mortality among rice growers in Novara Province,Northern Italy

Some excess of non-Hodgkin lymphomas (NHL) and soft tissue sarcomas (STS) was reported in the literature among agricultural workers, mainly in relation to exposure to phenoxyacids and chlorophenols. In this study, information was analyzed for a cohort of rice growers that comprised 1,493 subjects, and for a follow-up that was more than 99% complete with regard to both traced subjects and known causes of deaths. A total of 960 subjects (65%) died during the observation period (1957–1992). Lower than expected standardized mortality ratios (SMRs) were found for all causes, for cardiovascular diseases (especially ischemic heart disease) and for all cancers. Slightly increased SMRs were found for some cancer sites (oral cavity, esophagus, liver, intestines, pancreas, bladder, STS, and NHL), although none of these was statistically significant in the overall analysis. An excess risk of close to statistical significance was found for NHL among workers with longer exposure during the period when phenoxyacid herbicide was in use (1950–1992). Thus, a prolonged follow-up is advisable. At present the study should be evaluated in the context of the data set suggesting a tendency toward an increased risk of NHL among farmers. Am. J. Ind. Med. 31:435–441, 1997. © 1997 Wiley-Liss, Inc.     

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.     

Cancer risk due to occupational exposure to polycyclic aromatic hydrocarbons

Polycyclic aromatic hydrocarbons (PAHs) demonstrate carcinogenic activity in animal models. Although some epidemiologic studies have implicated PAHs as risk factors for human cancer, the evidence reported to date has not been consistent. The purpose of this report is to describe the associations between occupational exposure to PAHs in the workplace and each of 14 types of cancer. A population-based, case-control study was carried out in Montreal to investigate associations between a large variety of environmental and occupational exposures on the one hand, and several types of cancer on the other. A detailed job history was obtained from each subject along with information on a number of potential confounders. Each job history was reviewed by a team of experts, who used this information to construct a corresponding history of occupational exposures. Among the PAH exposures considered were benzo(a)pyrene (B(a)P) and five categories of PAHs defined on the basis of the source material, namely, wood, petroleum, coal, other sources, and any source. Altogether, 3,730 cancer patients and 533 population controls were interviewed and their job exposure histories coded. For each of 14 types of cancer analyzed, three control groups were available: other cancer patients, population controls, and the pooled set of cancer and population controls. The associations between 14 cancer types and 6 PAH exposures were analyzed using logistic regression methods. For most types of cancer evaluated, there was no evidence of excess risk due to PAHs at the levels encountered in the occupations in which PAH exposure has been prevalent in the Montreal area. For a few cancer sites–the esophagus, the pancreas, and the prostate gland–there were suggestions of excess risk; these observations are noteworthy hypotheses for further investigation. For lung cancer, there appeared to be an increased risk due to PAHs among nonsmokers and light smokers, but not among heavy smokers.     

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.