Research Recommendations for Selected IARC-Classified Agents: Impact and Lessons Learned

BACKGROUND

The International Agency for Research on Cancer (IARC) Monographs program assembles expert working groups who publish a critical review and evaluation of data on agents of interest. These comprehensive reviews provide a unique opportunity to identify research needs to address classification uncertainties. A multidisciplinary expert review and workshop held in 2009 identified research gaps and needs for 20 priority occupational chemicals, metals, dusts, and physical agents, with the goal of stimulating advances in epidemiological studies of cancer and carcinogen mechanisms. Overarching issues were also described.

OBJECTIVES

In this commentary we review the current status of the evidence for the 20 priority agents identified in 2009. We examine whether identified Research Recommendations for each agent were addressed and their potential impact on resolving classification uncertainties.

METHODS

We reviewed the IARC classifications of each of the 20 priority agents and identified major new epidemiological and human mechanistic studies published since the last evaluation. Information sources were either the published Monograph for agents that have been reevaluated or, for agents not yet reevaluated, Advisory Group reports and literature searches. Findings are described in view of recent methodological developments in Monographs evidence evaluation processes.

DISCUSSION

The majority of the 20 priority agents were reevaluated by IARC since 2009. The overall carcinogen classifications of 9 agents advanced, and new cancer sites with either "sufficient" or "limited" evidence of carcinogenicity were also identified for 9 agents. Examination of published findings revealed whether evidence gaps and Research Recommendations have been addressed and highlighted remaining uncertainties. During the past decade, new research addressed a range of the 2009 recommendations and supported updated classifications for priority agents. This supports future efforts to systematically apply findings of Monograph reviews to identify research gaps and priorities relevant to evaluation criteria established in the updated IARC Monograph Preamble. https://doi.org/10.1289/EHP12547.

Toxicological evaluation of polycrystalline wools in human lung cells

Aim: Polycrystalline wools (PCW) are included with Refractory ceramic fibers (RCF) in the alumino-silicates family of High Temperature Insulation Wools (HTIW). IARC includes PCW in the ceramic fibers group and considers them as possible human carcinogens (GROUP 2B). Since PCW toxicity is not yet clear, our aim was to evaluate their toxic and inflammatory effects and to compare them with the known RCF effects.Method: We exposed human bronchial (BEAS-2B) and alveolar (A549) cells to 2-100 µg/mL (2.4 × 10³-1.2 × 10⁵ fibers/mL; 2.51 × 10³-1.26 × 10⁵ fibers/cm² of PCW and 7.4 × 10³-3.7 × 10⁵ fibers/mL; 7.75 × 10³-3.87 × 10⁵ fibers/cm² of RCF) of the tested fibers to evaluate potential viability reduction, apoptosis, membrane damage, direct/oxidative DNA-damage, cytokine release.Results: In A549, PCW did not induce cytotoxicity and apoptosis but they induced significant dose-dependent DNA-damage, although lower than RCF; only RCF induced oxidative effects. PCW also induced an increase in IL-6 release at 100 µg/mL (1.2 × 10⁵ fibers/mL; 1.26 × 10⁵ fibers/cm²). In BEAS-2B, PCW did not induce cell-viability reduction RCF induced a dose-dependent cell-viability decrease. Both fibers show a dose-dependent increase of apoptosis. In BEAS-2B, PCW also induced dose-dependent DNA-damage, although lower than RCF, and slight oxidative effects similar to RCF. PCW also induced an increase of IL-6 release; RCF induced a decrease of IL-8. Summarizing, PCW induce direct-oxidative DNA-damage although to a lower extent than RCF observed by both mass-based and fiber number-based analysis.Conclusion: For the first time, the study shows the potential toxicity of PCW, usually considered safe, and suggests to perform further in vitro studies, also on other cell types, to confirm these findings.

Mortality of workers employed in refractory ceramic fiber manufacturing: An update

This study evaluates the possible association between refractory ceramic fibers (RCF) exposure and all causes of death. Current and former employees (n=1,119) hired from 1952-1999 at manufacturing facilities in New York (NY) state and Indiana were included. Work histories and quarterly plant-wide sampling from 1987-2015 provided cumulative fiber exposure (CFE) estimates. The full cohort was evaluated as well as individuals with lower and higher exposure, <45 and >45 fiber-months/cc. The Life-Table-Analysis-System was used for all standardized mortality estimates (SMR). Person-years at risk accumulated from start of employment until 12/31/2019 or date of death. There was no significant association with all causes, all cancers, or lung cancer in any group. In the higher exposed there was a significant elevation in both malignancies of the "urinary organs" (SMR=3.59, 95% CI 1.44, 7.40), and "bladder or other urinary site" (SMR=4.04, 95% CI 1.10, 10.36) which persisted in comparison to regional mortality rates from NY state and Niagara County. However, six of the nine workers with urinary cancers were known smokers. In the lower exposed there was a significant elevation in malignancies of the lymphatic and hematopoietic system (SMR=2.54, 95% CI 1.27, 4.55) and leukemia (SMR=4.21, 95% CI 1.69, 8.67). There was one pathologically unconfirmed mesothelioma death. A second employee currently living with a pathologically confirmed mesothelioma was identified, but the SMR was non-significant when both were included in the analyses. The association of these two mesothelioma cases with RCF exposure alone is unclear because of potential past exposure to asbestos.

Changes in genotoxicity, inflammatory and oxidative stress parameters of workers in marble processing plants

Workers in marble processing plants are at high risk of exposure to high levels of marble dust containing silica, but there are limited studies evaluating the genotoxicity and oxidative stress parameters of workers occupationally exposed to marble dust. In this study, we aimed to clarify how marble dust affects genotoxicity and immunotoxicity mechanisms alongside oxidative stress in the workers in the marble processing plants of Iscehisar, Turkey. The oxidative stress and immune system parameters were determined spectrophotometrically using commercial kits. Genotoxicity was evaluated by Comet and micronucleus (MN) assays in the lymphocytes and buccal cells, respectively. The enzyme activities of superoxide dismutase, catalase, glutathione reductase, glutathione peroxidase, and the levels of glutathione, and Clara cell secretory protein CC16 in workers (n = 48) were significantly lower than in controls (n = 41), whereas the levels of malondialdehyde, 8-oxo-7,8-dihydro-2'-deoxyguanosine, tumor necrosis factor-alpha, interleukin-1beta were significantly higher in workers. DNA damage in workers were significantly higher than in controls and there was a clear correlation between the increase in DNA damage and the duration of exposure. Marble workers had significantly higher MN frequencies when compared to controls. The results indicate the possibility of immunotoxic and genotoxic risks to workers in marble industry.