Metal concentrations in human lung tissue,with special reference to age,sex, cause of death,emphysema and contamination of lung tissue

Summary Nine element concentrations in the lung tissues of 2,274 autopsies were determined in Japan by atomic absorption spectrometry. The metals determined were iron, calcium, magnesium, zinc, copper, cobalt, nickel, lead, and chromium. The range, mean, standard deviation, mode and median are described for each metal. Moreover, these data were analyzed statistically, based on their sex, age, degree of lung contamination (color and the amount of particle deposition), severity of pulmonary emphysema and cause of death. Iron, calcium, magnesium, zinc, copper and cobalt concentrations in the lung tissue seemed to be affected mostly by physiological variation and the levels in the blood. On the other hand, nickel, lead and chromium concentrations might reflect environmental exposure. Chromium concentration especially increased with age and showed a significantly positive correlation with the degree of contamination and severity of emphysema.     

Analyses of chromium and nickel in human pulmonary tissue

After inhalative occupational exposure to certain compounds containing nickel and chromium (mostly over many years), an accumulation of these metals may occur in the lung tissue. This is of particular importance, both from a toxicological point of view and with regard to expert reports, since certain nickel and chromium compounds may induce lung cancers. In the context of this study, samples of pulmonary tissue from 34 deceased persons from the Bergen area (Norway) were analysed by atomic absorption spectrometry with regard to their content of chromium and nickel. The deceased comprised 21 men and 13 women. In 15 cases, death resulted from lung cancer; in the other 19 deceased, there was no indication of a malignant disease of the airways. The concentrations of nickel found in the lung tissue do not differ between patients with lung cancer and patients with healthy lungs. On the other hand, the concentration of chromium in the pulmonary tissue in the patients who had died of lung cancer and who had all been inhalative smokers, are higher (statistically significant) than in the nonsmokers or in those with healthy lungs. An accumulation of these two metals in the tumor matrix could not be detected. Both the average nickel and the average chromium concentrations were higher in the persons who had probably been exposed occupationally. Considering the present state of scientific knowledge, the aspects relevant to expert reports which result from the analyses of metals in the pulmonary tissue are discussed.     

Analyses of chromium and nickel in human pulmonary tissue

Summary After inhalative occupational exposure to certain compounds containing nickel and chromium (mostly over many years), an accumulation of these metals may occur in the lung tissue. This is of particular importance, both from a toxicological point of view and with regard to expert reports, since certain nickel and chromium compounds may induce lung cancers. In the context of this study, samples of pulmonary tissue from 34 deceased persons from the Bergen area (Norway) were analysed by atomic absorption spectrometry with regard to their content of chromium and nickel. The deceased comprised 21 men and 13 women. In 15 cases, death resulted from lung cancer; in the other 19 deceased, there was no indication of a malignant disease of the airways. The concentrations of nickel found in the lung tissue do not differ between patients with lung cancer and patients with healthy lungs. On the other hand, the concentration of chromium in the pulmonary tissue in the patients who had died of lung cancer and who had all been inhalative smokers, are higher (statistically significant) than in the nonsmokers or in those with healthy lungs. An accumulation of these two metals in the tumor matrix could not be detected. Both the average nickel and the average chromium concentrations were higher in the persons who had probably been exposed occupationally. Considering the present state of scientific knowledge, the aspects relevant to expert reports which result from the analyses of metals in the pulmonary tissue are discussed.     

Occupational lung cancer. A comparison between humans and experimental animals

Many epidemiological and experimental studies have suggested that the respiratory tract is one of the most sensitive organs to environmental carcinogens. Nevertheless there is little evidence to determine the relationship between a specific environmental carcinogen and a cell type of lung cancer, because the cell types of lung cancer and their relative frequencies are highly complex compared with those of other organs and tissues. In the present paper, occupational lung-cancer characteristics, which are the clearest in the relation between cause and effect in human lung cancers, were reviewed in comparison with the results of animal experiments concerned with occupational lung carcinogens. Through accumulation of histopathological examinations of the lung cancer cases, the following relationships between cause and cell type were conjectured: chromium and squamous cell carcinoma; asbestos and adenocarcinoma; nickel and squamous cell carcinoma; beryllium and small cell carcinoma; bis (chloromethyl) ether and small cell carcinoma; mustard gas and squamous cell or small cell carcinoma; vinyl chloride and large cell or adenocarcinoma; radionuclides and small cell carcinoma. The relation pertaining to arsenic, benzotrichloride and tar could not be conjectured because of insufficient cases and information in the histological diagnosis. On the other hand, the carcinogenicity of these substances in occupational exposure has been confirmed by animal experiments administered intratracheally or by inhalation studies under relatively higher concentration. As a result of recent refinements of inhalation study, all-day and life-span exposure to extremely low concentrations, such as microgram/m3 orders, of certain substances has been possible. The characteristics of lung tumors occurring in these animals are rather different from those of human. For example, in mouse, almost all of the malignant lung tumors developed by carcinogens are adenocarcinomas and it is rare to find the squamous cell carcinoma. Moreover, small cell carcinoma and large cell carcinoma have not known to occur in the lungs of rats and mice. Therefore, future research should focus elucidating the specific relationship between cause and cell type of human lung cancer by means of animal experiments on lung cancer that give attention to the specificities of each experimental animal and the origin of the resultant lung tumor.     

Investigations on the quantitative determination of nickel and chromium in human lung tissue

Summary Nickel (Ni) and some of its relatively insoluble compounds as well as chromates may be able to induce cancer in the region of the lungs, as well as in the nose and paranasal sinuses after occupational exposure. Latency periods may amount to 20 years and more. The results of recent investigations have shown that these metals cumulate in the lung tissue after inhalation of relatively insoluble chromium and nickel compounds. The quantitative detection of these heavy metals in samples of pulmonary tissue hence permits the amount of past exposure to be estimated. To establish the normal values, samples of pulmonary tissue from 30 normal subjects were investigated for chromium and nickel content. The samples were taken from different segments and lobes of the lungs, taking topographical anatomical criteria into consideration. In addition, 15 persons who had formerly been exposed to nickel and/or chromium (11 nickel refinery workers, of whom 10 had died of lung cancer, 2 stainless steel welders, 1 foundry worker, 1 electrical technician) were also investigated. From the results of 495 tissue samples from the normal group, median chromium concentrations between 130 and 280 ng/g were calculated, with median nickel concentrations of 20–40 ng/g (wet weight). If these values are related to the nickel concentrations measured in refinery workers, values 112-5,860 times higher were found. The concentrations were about 500 times higher than normal for nickel, and about 60 times higher than normal for chromium in the stainless steel welders. For the foundry workers who died of lung cancer, chromium and nickel concentrations in the normal range were calculated, with the exception of the nickel concentrations in the upper and lower lobes of the right lung. The very high nickel concentrations found in the samples of lung tissue from former nickel refinery workers should be regarded as a guideline with regard to the appraisal of the causal relationship between lung cancer and occupational exposure to relatively insoluble nickel compounds. This result is also supported by epidemiological investigations on this subgroup and must thus be considered etiologically conclusive. For the welders, chromium and nickel concentrations were found that were markedly above normal, but as yet there is no epidemiologically reliable verification for the increased occurrence of malignancies in this occupational group. On the basis of present scientific knowledge, no indications were found of relevant chromium and/or nickel exposure of the lung tissue that might be able to induce lung cancer in either foundry workers or for electric technicians.Dedicated to Professor V. Becker on his 65th birthday     

Inhalation carcinogenesis from various forms of asbestos

Rats, rabbits, guinea pigs, gerbils, and mice were exposed to the inhalation of chrysotile, crocidolite, or amosite for 2 years. Mean atmospheric concentrations were 47.9–50.2 mg/m³, but only 0.08–1.82% of the dusts retained fibrous morphology during the dissemination procedure which involved hammer milling. Trace contamination especially by chromium and nickel was also increased. Light microscopic fiber counts per ml chamber air were 54 (chrysotile), 1105 (crocidolite), and 864 (amosite). A fibrogenic response to these dusts was observed in all five animal species, the severity corresponding to the extent of exposure (with reaction to chrysotile frequently very slight). Gerbils developed frequent alveolar proteinosis. Mice developed spontaneous papillary carcinomas in the lungs. Disregarding the latter species, carcinogenic response to asbestos inhalation was restricted to rats and occurred in all three exposure groups. There were 2 lung cancers and 1 pleural mesothelioma after chrysotile inhalation; 4 lung cancers after crocidolite inhalation; and 1 lung cancer and 2 pleural mesotheliomas after amosite inhalation. These cases constituted 7–9% incidence of malignancy among rats with adequate survival record. Hypotheses of asbestos carcinogenesis are reviewed and it is suggested that different etiologic principles may be involved in the causation of lung cancer and of pleural mesothelioma.     

Preexisting lung disease and lung cancer among nonsmoking women.

Preexisting lung disease was examined as a risk factor for lung cancer in a population-based, case-control study of nonsmoking women in Missouri conducted between June 1, 1986, and April 1, 1991. A history of lung disease was reported by approximately 41% of 618 cases and 35% of 1,402 controls (odds ratio (OR) = 1.2; 95% confidence interval (Cl) 1.0-1.5. The risk was more pronounced when next-of-kin interviews were excluded (OR = 1.5). Previous lung disease was significantly related both to adenocarcinoma (OR = 1.4), which accounted for 62% of the cancers, and to all other cell types of lung cancer combined (OR = 1.8). Despite having discontinued smoking for more than 15 years, long-term ex-smokers were at a 2.2-fold risk of lung cancer compared with lifetime nonsmokers. Among lifetime nonsmokers, significant risks were noted for asthma (OR = 2.7) and pneumonia (OR = 1.5). Emphysema (OR = 2.6) and tuberculosis (OR = 2.0) were also significantly related to lung cancer, but only among former smokers. Chronic bronchitis was linked to elevated risks of nonadenocarcinomas only (OR = 2.3). Pleurisy was not reported more frequently by cases than by controls. Approximately 16% of all lung cancers among nonsmoking women could be attributed to previous lung diseases, most notably asthma, pneumonia, emphysema, and tuberculosis.     

Histologic types of lung cancers among male Japanese copper smelter workers

This study was done to investigate which histologic type of lung cancer is prevalent among male Japanese copper smelter workers. A panel of eight pathologists was asked to diagnose uniformly prepared materials for 19 occupational series, 87 nonoccupational bronchogenic carcinomas, and 14 benign lesions. The consensus diagnosis was used as reference. The reference diagnoses and the originals without materials employed for verification were designated as finals. Squamous cell carcinoma was the most frequent cell type in the occupational group, which comprised 21 (75.0%) of 28 histologically proven cases. There were three (10.7%) small cell carcinomas, one (3.6%) large cell carcinoma, and three (10.7%) adenocarcinomas. The proportion of Kreyberg group I in the occupational cases was significantly larger than that of lung cancers in the population-based cancer registries in Japan. These findings are compatible with Kreyberg's hypothesis. Above all, squamous and small cell carcinomas were prominent and appeared to be environmentally related bronchogenic carcinomas.     

Protective effect of selenium on lung cancer in smelter workers

A possible protective effect of selenium against lung cancer has been indicated in recent studies. Workers in copper smelters are exposed to a combination of airborne selenium and carcinogens. In this study lung tissue concentrations of selenium, antimony, arsenic, cadmium, chromium, cobalt, lanthanum, and lead from 76 dead copper smelter workers were compared with those of 15 controls from a rural area and 10 controls from an urban area. The mean exposure time for the dead workers was 31.2 years, and the mean retirement time after the end of exposure 7.2 years. Lung cancer appeared in the workers with the lowest selenium lung tissue levels (selenium median value 71 micrograms/kg wet weight), as compared with both the controls (rural group, median value 110; urban group, median value 136) and other causes of death among the workers (median value 158). The quotient between the metals and selenium was used for comparison: a high quotient indicating a low protective effect of selenium and vice versa. The median values of the quotients between antimony, arsenic, cadmium, lanthanum, lead, chromium, and cobalt versus selenium were all numerically higher among the cases of lung cancer, the first five significantly higher (p less than 0.05) in 28 of the 35 comparisons between the lung cancer group and all other groups of smelter workers and controls. The different lung metal concentrations for each person were weighted according to their carcinogenic potency (Crx4 + Asx3 + Cdx2 + Sbx1 + Cox1 + Lax1 + Pbx1) against their corresponding selenium concentrations. From these calculations the protective effect of selenium was even more pronounced.     

Protective effect of selenium on lung cancer in smelter workers.

A possible protective effect of selenium against lung cancer has been indicated in recent studies. Workers in copper smelters are exposed to a combination of airborne selenium and carcinogens. In this study lung tissue concentrations of selenium, antimony, arsenic, cadmium, chromium, cobalt, lanthanum, and lead from 76 dead copper smelter workers were compared with those of 15 controls from a rural area and 10 controls from an urban area. The mean exposure time for the dead workers was 31.2 years, and the mean retirement time after the end of exposure 7.2 years. Lung cancer appeared in the workers with the lowest selenium lung tissue levels (selenium median value 71 micrograms/kg wet weight), as compared with both the controls (rural group, median value 110; urban group, median value 136) and other causes of death among the workers (median value 158). The quotient between the metals and selenium was used for comparison: a high quotient indicating a low protective effect of selenium and vice versa. The median values of the quotients between antimony, arsenic, cadmium, lanthanum, lead, chromium, and cobalt versus selenium were all numerically higher among the cases of lung cancer, the first five significantly higher (p less than 0.05) in 28 of the 35 comparisons between the lung cancer group and all other groups of smelter workers and controls. The different lung metal concentrations for each person were weighted according to their carcinogenic potency (Crx4 + Asx3 + Cdx2 + Sbx1 + Cox1 + Lax1 + Pbx1) against their corresponding selenium concentrations. From these calculations the protective effect of selenium was even more pronounced.     

Risk of lung cancer among masons in Iceland.

OBJECTIVES: To estimate the risk of gastrointestinal cancer and lung cancer in a cohort of masons exposed to cement and hexavalent chromium by a follow up in the Icelandic Cancer Registry. METHODS: The cohort, 1172 men, was defined as those who had served their apprenticeship and were fully licensed as masons (cement finishers) in Iceland, were born after 1880 and were alive in 1955. The men were exposed to an aerosol of wet concrete, particularly when spraying. According to the analyses of urinary chromium the masons were exposed to hexavalent chromium. A computer file on masons was record linked to the Cancer Registry by making use of the personal identification numbers. Expected cancer incidence was calculated on the basis of number of person-years for each five-year age category during the individual calendar years of the study period and multiplied by the specific incidence for cause and calendar year for men in Iceland provided by the Cancer Registry. RESULTS: The standardised incidence ratio (SIR) for all cancers was 1.13 in the total cohort and 1.33 when allowance was made for 30 years to elapse before starting to count person years of risk. The risk for gastrointestinal cancers was not increased. The SIR for lung cancer was 1.69 in the total cohort and 1.77 when a lag of 30 years was included. The SIR for lung cancer among those born in 1920 or later was 1.86. Results from a postal questionnaire showed that fewer masons had never smoked and more masons had stopped smoking than the controls from the general population. CONCLUSION: The increased risk of lung cancer among the masons may be related to their work. The exposure information, although limited, supports the suggestion that hexavalent chromium in the cement may be the causal link, as information on the smoking habits indicate that the control for this important possible confounder is adequate.     

高分辨率CT对周围型小肺鳞癌的诊断价值

目的研究多层螺旋高分辨率CT（HRCT）对直径小于2cm的周围型肺癌的诊断价值。方法选取从2006年8月～2008年6月诊断为肺癌，并经病理证实的29例病灶直径不到2cm的周围型肺鳞癌患者资料进行分析，其中男24例，女5例。年龄在45～87岁之间（平均60．6岁）。其中位于右肺上叶的12例，右肺中叶的2例，右肺下叶的4例，左肺上叶的8例，左肺下叶的3例。在这些病例中有15例为中分化，14例为重度分化。结果HRCT病灶无1例钙化（0％），空洞形成1例（3．4％），空气支气管征5例（17．2％），毛玻璃高密度影1例（3．4％），毛刺8例（27．6％），分叶8例（27．6％），边界不规则19例（65．5％），胸膜凹陷14例（48．3％），周围肺气肿19例（65．5％）见图1—3，卫星灶1例（3．4％）。结论高分辨螺旋CT（HRCT）能够清晰显示直径小于2cm周围型肺癌的形态，在周围型鳞癌的诊断中有重要价值。     

Biomonitoring of nickel and chromium in human pulmonary tissue

Nickel (Ni) and chromium (Cr) and some of its compounds may be able to induce cancer in the lungs as well as in the nose and paranasal sinuses after occupational exposure. Latency periods amount to 20 years and more. Therefore objective exposure data are not available in the most cases and expert evaluation of the causal connection is often difficult. Recent investigations have shown, that Ni and Cr can cumulate in human lung tissue after occupational exposure. For the evaluation of normal Ni- and Cr-values a total of 495 human lung tissue samples of 30 occupationally non-exposed persons were analysed by AAS including ZEEMAN-compensation after wet oxidative digestion. Additional samples of 10 deceased persons who have been occupationally exposed to nickel in previous times by nickel-refining and welding, especially flame spraying have been investigated. The median Ni- and Cr- concentrations in the lungs of the non-exposed persons ranged between 20–40 resp. 133–277 ng/g (wet weight). In nickel refinery workers Ni- concentrations were found which exceeded the normal range about 1,000. In welders, especially flame sprayers, also values more than 100 times higher could be analysed for Ni and Cr. Partially these concentrations were found years after the end of the inhalative exposure.     

Increased cancer risk among relatives of nonsmoking lung cancer cases

Lung cancer has been shown to aggregate in families of nonsmoking lung cancer cases with an earlier age at onset. The current study evaluates whether relatives of nonsmoking lung cancer cases are at increased risk of cancers at sites other than lung. Families were identified through 257 population‐based, nonsmoking lung cancer cases and 277 population‐based, nonsmoking controls residing in metropolitan Detroit. Data were collected for 2,252 relatives of cases and 2,408 relatives of controls. First‐degree relatives of nonsmoking lung cancer cases were at 1.52‐fold (95% CI, 1.02–2.27) increased risk of cancer of the digestive system after adjustment for each relative's age, race, sex, and smoking status. Relative risk estimates also were elevated, but not significantly, for tobacco‐related cancers (RR = 1.39) and breast cancer (RR = 1.72). Among first‐degree relatives of younger probands (age 40–59), risk was non‐significantly increased 72% (95% CI 0.95–3.10) for all cancers combined and 3.14‐fold for cancers of the digestive system (95% CI 0.76–12.9). Nonsmoking relatives of cases were at increased risk of all cancer sites combined (RR = 1.32; 95% CI 1.003–1.73), cancers other than lung (RR = 1.37; 95% CI 1.03–1.82), and digestive system cancers (RR = 2.01; 95% CI 1.20–3.37). These findings of moderate familial aggregation for cancers of the lung, digestive system, breast, and tobacco‐related sites suggest that common susceptibility genes may act to increase risk for a variety of cancers in families. Genet. Epidemiol. 17:1–15, 1999. © 1999 Wiley‐Liss, Inc.     

南京地区正常人和病人血中十一种元素含量的测定

本文报告用原子吸收光谱分析法(AAS),测定南京地区正常人血清中钙、镁、铜、锌、铁、铬、锰、镍、硒及全血中铅、镉元素的含量,经过分组统计处理,探讨了微量元素与性别及年龄的关系,同时通过大量病例测定,探讨了某些疾病与元素含量的关系。     

Men, women and primary lung cancer--a Saskatchewan personal interview study

In a previous study conducted by mail questionnaire and with a large proportion of surrogate responders, we found differences in smoking habits, age at diagnosis, tumour cell type distribution and occupational exposures between men and women who developed primary lung cancer. This study was designed to confirm those findings by conducting personal case interviews and extend them by examining the impact of certain biological factors. We have investigated demographic, smoking, occupational and medical history sex differences in cases with primary lung cancer by interviewing 273 male and 103 female cases diagnosed between November 1983 and July 1986. The females were significantly younger at diagnosis, a pattern consistent for all cell types. Squamous cell (40%), small cell anaplastic (20%) and adenocarcinomas (16%) were the most prevalent cell types in men. In women, similar frequencies of adenocarcinomas (32%) and squamous cell carcinomas (29%) occurred. Despite a higher prevalence of physician diagnosed allergy and asthma among women, minimal sex differences in the prevalence of atopy as measured by prick skin test were found. Female cases were more likely to be lifetime non-smokers (15% vs 3%), to have started smoking on average 3 years older and to smoke 6 fewer cigarettes per day. The mean pack years of female cases was significantly lower than males' for squamous, adenocarcinoma and small cell anaplastic tumours. The majority of these women had not been occupationally exposed to any substance known to be carcinogenic or to damage the lung. However, in a small subset of cases pulmonary function variables were as depressed in women as in men with significantly higher mean pack years.(ABSTRACT TRUNCATED AT 250 WORDS)     

Excess of cancer in Swedish chimney sweeps.

The incidence of cancer was investigated among 5266 Swedish chimney sweeps employed for any period between 1918 and 1980. An analysis of the mortality has been reported earlier and showed an increased number of deaths from coronary heart disease, respiratory diseases, and lung, oesophageal, and liver cancer. Excess risks for cancer of the lung and oesophagus were confirmed in this analysis. Among the lung cancers, both squamous cell carcinoma and oatcell/undifferentiated carcinoma were in excess. In addition, a more than doubled risk for bladder cancer (23 observed v 9.8 expected cases) and an increase of malignancies of the haematopoietic system was found. There were, however, no cases of scrotal cancer, the classic occupational hazard among chimney sweeps. Chimney sweeps are exposed to polycyclic aromatic hydrocarbons generated by the combustion of organic material (coal, wood, coke, and oil). They are also exposed to cancerogenic metals (arsenic, nickel, and chromium). These results support the need for improved working conditions.     

Excess of cancer in Swedish chimney sweeps

The incidence of cancer was investigated among 5266 Swedish chimney sweeps employed for any period between 1918 and 1980. An analysis of the mortality has been reported earlier and showed an increased number of deaths from coronary heart disease, respiratory diseases, and lung, oesophageal, and liver cancer. Excess risks for cancer of the lung and oesophagus were confirmed in this analysis. Among the lung cancers, both squamous cell carcinoma and oatcell/undifferentiated carcinoma were in excess. In addition, a more than doubled risk for bladder cancer (23 observed v 9.8 expected cases) and an increase of malignancies of the haematopoietic system was found. There were, however, no cases of scrotal cancer, the classic occupational hazard among chimney sweeps. Chimney sweeps are exposed to polycyclic aromatic hydrocarbons generated by the combustion of organic material (coal, wood, coke, and oil). They are also exposed to cancerogenic metals (arsenic, nickel, and chromium). These results support the need for improved working conditions.     

Dietary iron, zinc, and calcium and the risk of lung cancer

BACKGROUND: Iron, zinc, and calcium are all involved in the metabolism of reactive oxygen species and may compete with each other for similar binding sites. Dietary intakes of these micronutrients have been associated with altered risks of colorectal, breast, and prostate cancers. METHODS: In this Massachusetts hospital-based case-control study of 923 patients with lung cancer and 1125 healthy controls, we studied the associations between dietary iron, zinc, and calcium intake and the risk of lung cancer. Dietary intake was assessed at the time of recruitment (1992 to 2000) with the use of a 126-item semiquantitative food-frequency questionnaire. We analyzed the data using multiple logistic regression models adjusting for smoking history and other potential risk factors. RESULTS: The adjusted odds ratios of dietary iron, zinc, and calcium from food sources were 1.45 (95% confidence interval=1.03-2.06), 0.71 (0.50-0.99), and 1.64 (1.17-2.29), respectively, for the highest quintile versus the lowest quintile of each micronutrient. Stronger associations between micronutrients and lung cancer risk were found when iron, zinc, and calcium were included together in the same model. The associations between dietary micronutrients intake and lung cancer risk were stronger among current smokers than among former smokers. When we examined intake from supplements as well as diet, associations were similar to those for diet alone. CONCLUSIONS: Dietary iron, zinc, and calcium may play an important role in the development of lung cancer, especially among current smokers. These results need to be confirmed in large prospective studies.     

Epidemiological study of mortality from cancer among chromium platers

Cancer mortality was studied among 265 male workers in 40 small plating factories (chromium, copper and nickel) where bicycle parts are plated. The study utilized record linkage with the Osaka Cancer Registry file between January 1, 1965 and December 31, 1979. The results showed that seven workers had died of cancer, and the Standardized Mortality Ratio (SMR) calculated for all cancers, stomach cancer and lung cancer were 1.13, 1.23 and 1.11, respectively, with no significant relationship found between the observed and expected values. The SMR for lung cancer among those workers with a high degree of skin ulceration and with perforation of the nasal septum was high, 11.22 and 5.13, respectively, although not statistically significant because of the small sample size in the study. The results suggest that lung cancer occurs in those subjected to a high degree of exposure to chromium.