Lung cancer mortality and airways obstruction among metal miners exposed to silica and low levels of radon daughters

Exposure to Residential Radon and COPD: A Systematic Review

Introduction

The aim of this study was to analyse the relationship between exposure to residential radon and chronic obstructive pulmonary disease (COPD) by means of a systematic review.

Material and Methods

A search was conducted in PubMed and OVID for papers making reference to the radon–COPD relationship. No search filters were applied, whether by date of publication, study type or sample size. All studies not written in English or Spanish were discarded.

Results

A total of 174 and 57 papers were found in PubMed and OVID, respectively: of these, 13 (11 on miners and 2 on the general population) fulfilled the inclusion criteria. Only four of the studies on cohorts of miners analysed COPD as a specific disease, and only one reported statistically significant results. In addition, many of these studies lacked information on tobacco use among miners. In contrast, studies conducted on the general public showed an association between mortality and hospital admissions, on the one hand, and residential radon on the other.

Conclusion

There are not enough studies to provide a basis for confirming or ruling out an association between radon exposure and COPD. Nonetheless, the most recent general population studies point to evidence of a possible association. In view of the heterogeneity of available studies, it is impossible to say whether this gas may or may not affect COPD morbidity and mortality, until such a time as further studies are carried out.

Morbidity and Health Risk Factors Among New Mexico Miners: A Comparison Across Mining Sectors

OBJECTIVE

This study examines differences in chronic health outcomes between coal, uranium, metal, and nonmetal miners.

METHODS

In a cross-sectional study using data from a health screening program for current and former New Mexico miners, log-binomial logistic regression models were used to estimate relative risks of respiratory and heart disease, cancer, osteoarthritis, and back pain associated with mining in each sector as compared with coal, adjusting for other relevant risk factors.

RESULTS

Differential risks in angina, pulmonary symptoms, asthma, cancer, osteoarthritis, and back pain between mining sectors were found.

CONCLUSIONS

New Mexico miners experience different chronic health challenges across sectors. These results demonstrate the importance of using comparable data to understand how health risks differ across mining sectors. Further investigation among a broader geographic population of miners will help identify the health priorities and needs in each sector.

Current knowledge of US metal and nonmetal miner health: Current and potential data sources for analysis of miner health status

Little is known about the current health status of US metal and nonmetal (MNM) miners, in part because no health surveillance systems exist for this population. The National Institute for Occupational Safety and Health (NIOSH) is developing a program to characterize burden of disease among MNM miners. This report discusses current knowledge and potential data sources of MNM miner health. Recent national surveys were analyzed, and literature specific to MNM miner health status was reviewed. No robust estimates of disease prevalence were identified, and national surveys did not provide information specific to MNM miners. Because substantial gaps exist in the understanding of MNM miners' current health status, NIOSH plans to develop a health surveillance program for this population to guide intervention efforts to reduce occupational and personal risks for chronic illness.

Renewable energy and occupational health and safety research directions: a white paper from the Energy Summit, Denver Colorado, April 11-13, 2011

Renewable energy production may offer advantages to human health by way of less pollution and fewer climate-change associated ill-health effects. Limited data suggests that renewable energy will also offer benefits to workers in the form of reduced occupational injury, illness and deaths. However, studies of worker safety and health in the industry are limited. The Mountain and Plains Education and Research Center (MAP ERC) Energy Summit held in April 2011 explored issues concerning worker health and safety in the renewable energy industry. The limited information on hazards of working in the renewable energy industry emphasizes the need for further research. Two basic approaches to guiding both prevention and future research should include: (1) applying lessons learned from other fields of occupational safety and health, particularly the extractive energy industry; and (2) utilizing knowledge of occupational hazards of specific materials and processes used in the renewable energy industry.

Indoor radon concentration measurement in the dwellings of district Poonch (Azad Kashmir), Pakistan

The present study deals with measurement of indoor radon concentrations in dwellings of the district Poonch of the state of Azad Jammu and Kashmir, Pakistan. In this context, CR-39-based box-type radon detectors were installed in drawing rooms and bedrooms of 80 selected houses and were exposed to indoor radon for 3 months. After exposure, the CR-39 detectors were etched for 9 h in 6 mol NaOH at 70 degrees C and the observed track densities were related to radon concentrations. Measured indoor radon concentrations in the studied area ranged from 27 +/- 6 to 169 +/- 4, 29 +/- 6 to 196 +/- 4 and 31 +/- 5 to 142 +/- 2 Bq m(-3) in the drawing rooms and 74 +/- 5 to 172 +/- 3, 32 +/- 6 to 191 +/- 4 and 27 +/- 5 to 155 +/- 2 Bq m(-3) in bedrooms of the Abbaspur, Hajira and Rawalakot regions of the district Poonch, respectively; whereas weighted average radon concentration ranged from 93 +/- 6 to 159 +/- 4, 33 +/- 5 to 118 +/- 3 and 31 +/- 6 to 155 +/- 5 Bq m(-3) in the dwellings of Abbaspur, Hajira and Rawalakot, respectively. Estimated doses due to the indoor radon ranged from 2.35 +/- 0.15 to 4.00 +/- 0.10, 0.83 +/- 0.08 to 2.98 +/- 0.08 and 0.78 +/- 0.15 to 3.91 +/- 0.13 mSv y(-1) for Abbaspur, Rawalakot and Hajira, respectively. Comparing the current indoor radon results with those of the Health Protection Agency UK and US EPA (i.e. 200 and 148 Bq m(-3)) limits, majority of the houses surveyed in the present study are within the safe limits.

General public's and physicians' perception of health risk associated with radon exposure in the state of Azad Jammu and Kashmir

OBJECTIVE

To conduct a radon awareness survey to examine the level of awareness and risk perception of indoor radon exposure among the general public, medical students, and physicians of the state of Azad Jammu and Kashmir, given that long-term exposure to indoor radon increases lifetime risk of lung cancer and may pose a substantial threat to public health.

DESIGN

Cross-sectional survey.

SAMPLE

Households by telephone (500), interviews with menial laborers (200), questionnaires to shopkeepers and government employees (1,000), undergraduates (200), social science graduates (1,500), science graduates (1,500), medical students (325), and physicians (100).

MEASURES

Familiarity with radioactivity and the nature and health hazards of radiation and radon.

ANALYSIS

Significance of data trends was measured using the Kruskal-Wallis test.

RESULTS

About 30% people (excluding medical students and physicians) were aware of radon, and about 6% had knowledgeable awareness of radon. About 80% of the medical students and physicians had heard about radon and about 30.5% of them had knowledgeable awareness about radon and its hazards.

CONCLUSION

The study suggested a positive relationship of awareness of radon and its hazards with the educational level of people.

Ischemic heart disease mortality among miners and other potentially silica-exposed workers

BACKGROUND

Some previous studies have observed an increased mortality regarding ischemic heart disease (IHD) among miners and industrial sand workers. The purpose was to study the occurrence of IHD mortality among silica-exposed workers.

METHODS

Male miners, well borers, dressing plant workers, and other mine and stone workers were identified in the Swedish National Census of 1970. The total cohort (n = 11,896) was followed from 1970 until December 31, 1995 and linked to the Cause of Death Register. The referent group comprised all gainfully employed men identified in the same census. The Standardized Mortality Ratio was calculated as the ratio between observed and expected numbers of deaths.

RESULT

An increased risk due to IHD mortality was observed among miners, well borers, dressing plant workers, and other mine and stone workers.

CONCLUSION

These results indicate a possible relation between silica-dust exposure and IHD. The increased risk of IHD mortality is unlikely explained by smoking habits. Shift work might explain some of the increased risk. A low-grade inflammation in the lungs as a result of dust exposure is discussed as a possible cause. However, the key message is that better dose estimates and better confounding control is needed to study the possible relation between silica-dust exposure and IHD.

Occupational silica exposure and risk of various diseases: an analysis using death certificates from 27 states of the United States

BACKGROUND

Although crystalline silica exposure is associated with silicosis, lung cancer, pulmonary tuberculosis, and chronic obstructive pulmonary disease (COPD), there is less support for an association with autoimmune disease, and renal disease.

METHODS

Using data from the US National Occupational Mortality Surveillance (NOMS) system, a matched case-control design was employed to examine each of several diseases (including silicosis, lung cancer, stomach cancer, oesophageal cancer, COPD, pulmonary tuberculosis, sarcoidosis, systemic lupus erythematosus, systemic sclerosis, rheumatoid arthritis, and various types of renal disease). Cases were subjects whose death certificate mentioned the disease of interest. A separate control group for each of the diseases of interest was selected from among subjects whose death certificate did not mention the disease of interest or any of several diseases reported to be associated with crystalline silica exposure. Subjects were assigned into a qualitative crystalline silica exposure category based on the industry/occupation pairing found on their death certificate. We also investigated whether silicotics had a higher risk of disease compared to those without silicosis.

RESULTS

Those postulated to have had detectable crystalline silica exposure had a significantly increased risk for silicosis, COPD, pulmonary tuberculosis, and rheumatoid arthritis. In addition, a significant trend of increasing risk with increasing silica exposure was observed for these same conditions and for lung cancer. Those postulated to have had the greatest crystalline silica exposure had a significantly increased risk for silicosis, lung cancer, COPD, and pulmonary tuberculosis only. Finally, those with silicosis had a significantly increased risk for COPD, pulmonary tuberculosis, and rheumatoid arthritis.

CONCLUSIONS

This study corroborates the association between crystalline silica exposure and silicosis, lung cancer, COPD, and pulmonary tuberculosis. In addition, support is provided for an association between crystalline silica exposure and rheumatoid arthritis.

Mortality from lung cancer among silicotic patients in Sardinia: an update study with 10 more years of follow up

OBJECTIVES

To evaluate the association between silica, silicosis and lung cancer, the mortality of 724 patients with silicosis, first diagnosed by standard chest x ray film between 1964 and 1970, has been analysed by a cohort study extended to 31 December 1997.

METHODS

Smoking and detailed occupational histories were available for each member of the cohort as well as the estimated lifetime exposure to respirable silica dust and radon daughters. Two independent readers blindly classified standard radiographs according to the 12 point International Labour Organisation (ILO) scale. Lung function tests meeting the American Thoracic Society's criteria were available for 665 patients. Standardised mortality ratios (SMRs) for selected causes of death were based on the age specific Sardinian regional death rates.

RESULTS

The mortality for all causes was significantly higher than expected (SMR 1.35, 95% confidence interval (95% CI) 1.24 to 1.46) mainly due to tuberculosis (SMR 22.0) and to non-malignant chronic respiratory diseases (NMCRD) (SMR 6.03). All cancer deaths were within the expected numbers (SMR 0.93; 95% CI 0.76 to 1.14). The SMR for lung cancer was 1.37 (95% CI 0.98 to 1.91, 34 observed), increasing to 1.65 (95% CI 0.98 to 2.77) allowing for 20 years of latency since the first diagnosis of silicosis. Although mortality from NMCRD was strongly associated to the severity of radiological silicosis and to the extent of the cumulative exposure to silica, SMR for lung cancer was weakly related to the ILO categories and to the cumulative exposure to silica dust only after 20 years of lag interval. A significant excess of deaths from lung cancer (SMR 2.35) was found among silicotic patients previously employed in underground metal mines characterised by a relatively high airborne concentration of radon daughters and among ever smokers who showed an airflow obstruction at the time of the first diagnosis of silicosis (SMR 3.29). Mortality for lung cancer related to exposure was evaluated with both the Cox's proportional hazards modelling within the entire cohort and a nested case-control study (34 cases of lung cancer and 136 matched controls). Both multivariate analyses did not show any significant association with cumulative exposure to silica or severity of silicosis, but confirmed the association between mortality for lung cancer and relatively high exposure to radon, smoking, and airflow obstruction as significant covariates.

CONCLUSIONS

The findings indicate that the slightly increased mortality for lung cancer in this cohort of silicotic patients was significantly associated with other risk factors-such as cigarette smoking, airflow obstruction, and estimated exposure to radon daughters in underground mines-rather than to the severity of radiological silicosis or to the cumulative exposure to crystalline silica dust itself.

Non-malignant respiratory diseases and lung cancer among Chinese workers exposed to silica

The objective of this study was to explore whether a medical history for non-malignant respiratory disease contributes to an increased lung cancer risk among workers exposed to silica. We analyzed data from a nested case-control study in 29 dusty workplaces in China. The study population consisted of 316 lung cancer cases and 1356 controls matched to cases by facility type and decade of birth who were alive at the time of diagnosis of the index case and who were identified in a follow-up study of about 68,000 workers. Age at first exposure and cigarette smoking were accounted for in the analysis. Smoking was the main risk factor for both lung cancer and chronic bronchitis. Lung cancer risk showed a modest association with silicosis and with cumulative silica exposure, which did not vary by history of previous pulmonary tuberculosis. Among subjects without a medical history for chronic bronchitis or asthma, lung cancer risk was associated with silicosis (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1 to 2.2), and it was increased in each quartile of cumulative silica exposure. However, risk was not elevated in the highest quartile (OR, 1.3, 1.6, 1.8, 1.4). Among subjects with a medical history for chronic bronchitis or asthma, lung cancer risk was associated with neither silicosis (subjects with chronic bronchitis: OR, 0.6; subjects with asthma: OR, 0.4) nor with silica exposure. In this study population, we observed a modest association of both silicosis and cumulative exposure to silica with lung cancer among subjects who were not previously diagnosed with chronic bronchitis or asthma, but not among subjects who had a medical history for either disease. Risk of lung cancer associated with silicosis or cumulative exposure to silica did not vary by previous medical history of pulmonary tuberculosis.

A relative power table for nested matched case-control studies

OBJECTIVE

To calculate relative powers for nested case-control studies for different values of both relative risk and numbers of controls per case, given a fixed number of cases available for analysis.

METHODS

Algebraic and numerical methods.

RESULTS

In nested case-control studies, statistical power is a function of relative risk, rarity of exposure, number of case-control sets, and the number of controls per case.

CONCLUSION

The dictum that sufficient power will be obtained in a nested case-control study by selecting only four controls per case cannot be sustained. Appropriate numbers need to be calculated for specific studies.

p53 and Bcl-2 expression in pneumoconiosis-related pre-cancerous lesions and lung cancers: frequent and preferential p53 expression in pneumoconiotic bronchiolar dysplasias

To explore the mechanism by which lung cancers excessively arise from pneumoconiosis, we determined the altered expression of p53 and Bcl-2 by immunohistochemistry (IHC) in lung cancers, dysplasias and non-cancerous pulmonary epithelia in pneumoconiotics in comparison with those from non-pneumoconiotic patients. We examined p53 expression in squamous cell carcinomas (SCCs) and dysplasias separately in the central and peripheral zones of bronchial trees, based on observations that SCCs from pneumoconiotic patients occurr more frequently in peripheral epithelia than those from non-pneumoconiotic patients (55 of 72 SCCs with pneumoconiosis vs. 33 of 72 SCCs without pneumoconiosis). Forty-one of 72 patients with pneumoconiosis-related lung cancers had altered p53 expression, which was comparable to the positivity of p53 expression in lung cancers without pneumoconiosis. p53 expression was observed significantly more frequently in bronchiolar dysplasias with pneumoconiosis than in those from non-pneumoconiotic patients (13 of 23 vs. 4 of 22), while p53 expression was found in bronchial dysplasias with pneumoconiosis as frequently as those without pneumoconiosis. Moreover, in patients with pneumoconiosis, bronchiolar dysplasias exhibited p53 expression more frequently than bronchial dysplasias (13 of 23 vs. 4 of 19). When comparison was restricted to bronchiolar dysplasias from patients without lung cancer, p53 expression had a strikingly higher frequency in the dysplasias with pneumoconiosis than in those from non-pneumoconiotic patients (8 of 15 vs. 0 of 14). Bcl-2 occasionally was expressed in squamous metaplasias and basal cell hyperplasias, in contrast to p53, for which immunostaining was negative in these lesions. Altogether, our results show that pre-cancerous and/or cancerous targets in pneumoconiosis may be distributed over a more peripheral zone than those in patients without pneumoconiosis.

Cancer risk and mortality patterns among silicotic men in Sweden and Denmark

Data from nationwide registry-based cohorts of patients hospitalized for silicosis in Sweden from 1965 to 1983 and Denmark from 1977 to 1989 were linked to national cancer registries in both countries and to mortality data in Sweden to evaluate the risk of cancer and other disorders among hospitalized silicotic patients. The overall cancer standardized incidence ratio (SIR) was 1.5 (95% confidence interval [CI], 1.3 to 1.7) in Sweden and 1.7 (95% CI, 1.2 to 2.3) in Denmark, primarily because of elevations in primary lung cancer in both Sweden (SIR, 3.1; CI, 2.1 to 4.2) and Denmark (SIR, 2.9; CI, 1.5 to 5.2). For Sweden, the all-causes standardized mortality ratio (SMR) was 2.0 (1.9 to 2.2). The SMR for all malignancies was 1.5 (1.2 to 1.7), primarily because of excesses of lung cancer (SMR, 2.9; CI, 2.1 to 3.9). The significant increase in mortality for all infectious and parasitic conditions (SMR, 11.2) was primarily due to tuberculosis (SMR, 21.8). Significant excesses in mortality from silicosis (SMR, 523), bronchitis (SMR, 2.6) and emphysema (SMR, 6.7) contributed to the elevation in nonmalignant respiratory deaths (SMR, 8.8), whereas excess mortality from musculoskeletal disorders (SMR, 5.9) was due to six deaths from autoimmune diseases. Despite limitations of the available data, our findings are consistent with previous reports indicating that silicotic patients are at elevated risk of lung cancer, nonmalignant respiratory diseases, tuberculosis, and certain autoimmune disorders.

Mortality of a cohort of U.S. workers employed in the crushed stone industry, 1940-1980

The mortality of 3,246 males who had been employed 1 or more years during 1940-1980 at 20 crushed stone operations was evaluated for possible association between employment and death from lung cancer, pneumoconiosis, and other respiratory diseases. Four deaths were attributed to pneumoconiosis. Based on available work histories, at least two of these deaths were probably due to dust exposures in the crushed stone industry. Mortality attributed to pneumoconiosis and other nonmalignant respiratory diseases, including chronic obstructive lung disease, was significantly increased overall (SMR: 1.98; 95% CI: 1.21-3.05), and especially so for a subcohort of crushed stone workers that processed granite (SMR: 7.26; 95% CI: 1.97-18.59). With regard to lung cancer, overall SMRs were elevated (although not statistically significant). Analyzed by rock type, there was a significantly elevated lung cancer SMR among granite workers with at least 20 years latency (SMR: 3.35; 95% CI: 1.34-6.90). Although not definitive, results of this study are consistent with the hypothesis that exposure to respirable silica dust is a risk factor for lung cancer.

Does occupational exposure to dust prevent colorectal cancer?

OBJECTIVES

To explore the impression that occupational epidemiologists tend to focus on associations suggestive of increased risk and tend to ignore those associations in which risk is not increased. To examine the risk of colorectal cancer in cohorts exposed to dust, cohorts in which it has been suggested that occupational exposure is a cause of increased risk of stomach cancer.

METHODS

A review of the publications in the English language on mortality among hard rock miners, granite, and quarry workers identified from a MEDLINE search and the index of the library of the Ontario Ministry of Labour.

RESULTS

When all of the studies were combined, there were significant excesses of lung and stomach cancers, but a significant deficit of colorectal cancer (standardised mortality ratio (SMR) = 83.9; 95% confidence interval (95% CI) 76-91). Overall mortality from gastrointestinal cancer was close to expectation (SMR = 105; 95% CI 99-111). Among those cohorts with increased risk of stomach cancer, rates of colorectal cancer were significantly decreased (SMR = 80; 95% CI 72-88). Among cohorts without increased risk of stomach cancer, the SMR for colorectal cancer was not significantly different from 100 (SMR = 98; 95% CI 81-115).

CONCLUSIONS

This review supports the impression that occupational epidemiologists tend to focus on associations suggestive of increased risk and tend to ignore those associations in which risk is not increased. The explanation for the inverse association between risk of stomach and colorectal cancer is uncertain and deserves further study.

Mortality of Sardinian lead and zinc miners: 1960-88

The mortality of 4740 male workers of two lead and zinc mines was followed up from 1960 to 1988. Exposure to respirable dust was comparable in the two mines, but the median concentration of silica in respirable dust was 10-fold higher in mine B (12.8%) than in mine A (1.2%), but the mean annual exposure to radon daughters in underground workplaces differed in the opposite direction (mine A: 0.13 working levels (WL), mine B: 0.011 WL). Total observed deaths (1205) were similar to expected figures (1156.3) over a total of 119 390.5 person-years at risk. Underground workers of mine B had significant increases in risk of pulmonary tuberculosis (SMR 706, 95% confidence interval (95% CI) 473-1014) and non-malignant respiratory diseases (SMR 518; 95% CI 440-1606), whereas the only significant excess at mine A was for non-malignant respiratory diseases (SMR 246; 95% CI 191-312). Total cancer and lung cancer mortality did not exceed the expectation in the two mines combined. A 15% excess mortality for lung cancer, increased up to an SMR 204 (95% CI 89-470) for subjects employed > or = 26 years, was, however, found among underground workers in mine A who on the average experienced an exposure to radon daughters 10-fold higher than those of mine B. By contrast, despite their higher exposure to silica, mine B underground workers experienced a lower than expected lung cancer mortality. A ninefold increase in risk of peritoneal and retroperitoneal cancer combined was also found among underground workers of mine A (SMR 917; 95% CI 250-2347; based on four deaths). A causal association with workplace exposures is unlikely, however, as the SMR showed an inverse trend by duration of employment. These findings are consistent with low level exposure to radon daughters as a risk factor for lung cancer among metal miners. Exposure to silica at the levels estimated for the mine B underground environment did not increase the risk of lung cancer.

Occupational exposures as risk factors for gastric cancer in Italy

Occupational associations with gastric cancer were investigated in a multicenter case-control study in Italy involving interviews with 640 histologically confirmed male cases and 959 controls, randomly selected from the resident populations of the study areas. From information on the three jobs each person held the longest, risks were evaluated according to employment in 35 occupations (ever or 21+ years) and to estimated exposure (ever or 21+ years) to six chemicals using a job-exposure matrix. All risk estimates were adjusted by personal, demographic, and dietary variables identified as gastric-cancer risk factors in previous analyses. The only significantly increased risk was observed for sailors, seamen, and allied groups (ever employed: odds ratio [OR] = 2.9; 95 percent confidence interval [CI] = 1.1-8.0; 21+ years: OR = 3.1, CI = 0.8-13). Nonsignificant increases after 21+ years of employment were observed for forestry workers, miners, and janitors and cleaners. Crude ORs were elevated significantly among farmers, but adjusting for demographic and lifestyle factors largely eliminated the association: a nonsignificant 30 percent excess risk remained for farm laborers, but there was no rise in risk among long-term farm laborers and no excess among farm owners. Application of the job-exposure matrix revealed excess risks of borderline significance associated with potential exposure to mineral dusts and nitrogen oxides. For subjects with 21+ years of potential exposure, nonsignificantly increased risks were related to mineral dusts, asbestos, fertilizers, and nitrosamines.(ABSTRACT TRUNCATED AT 250 WORDS)