Mortality among orchard workers exposed to lead arsenate spray: a cohort study

Lead exposure in US worksites: A literature review and development of an occupational lead exposure database from the published literature

BACKGROUND

Retrospective exposure assessment of occupational lead exposure in population-based studies requires historical exposure information from many occupations and industries.

METHODS

We reviewed published US exposure monitoring studies to identify lead measurement data. We developed an occupational lead exposure database from the 175 identified papers containing 1,111 sets of lead concentration summary statistics (21% area air, 47% personal air, 32% blood). We also extracted ancillary exposure-related information, including job, industry, task/location, year collected, sampling strategy, control measures in place, and sampling and analytical methods.

RESULTS

The measurements were published between 1940 and 2010 and represented 27 2-digit standardized industry classification codes. The majority of the measurements were related to lead-based paint work, joining or cutting metal using heat, primary and secondary metal manufacturing, and lead acid battery manufacturing.

CONCLUSIONS

This database can be used in future statistical analyses to characterize differences in lead exposure across time, jobs, and industries.

Arsenic exposure and toxicology: a historical perspective

The metalloid arsenic is a natural environmental contaminant to which humans are routinely exposed in food, water, air, and soil. Arsenic has a long history of use as a homicidal agent, but in the past 100 years arsenic, has been used as a pesticide, a chemotherapeutic agent and a constituent of consumer products. In some areas of the world, high levels of arsenic are naturally present in drinking water and are a toxicological concern. There are several structural forms and oxidation states of arsenic because it forms alloys with metals and covalent bonds with hydrogen, oxygen, carbon, and other elements. Environmentally relevant forms of arsenic are inorganic and organic existing in the trivalent or pentavalent state. Metabolism of arsenic, catalyzed by arsenic (+3 oxidation state) methyltransferase, is a sequential process of reduction from pentavalency to trivalency followed by oxidative methylation back to pentavalency. Trivalent arsenic is generally more toxicologically potent than pentavalent arsenic. Acute effects of arsenic range from gastrointestinal distress to death. Depending on the dose, chronic arsenic exposure may affect several major organ systems. A major concern of ingested arsenic is cancer, primarily of skin, bladder, and lung. The mode of action of arsenic for its disease endpoints is currently under study. Two key areas are the interaction of trivalent arsenicals with sulfur in proteins and the ability of arsenic to generate oxidative stress. With advances in technology and the recent development of animal models for arsenic carcinogenicity, understanding of the toxicology of arsenic will continue to improve.

Arsenic, lead, and other trace elements in soils contaminated with pesticide residues at the Hanford site (USA)

The primary purpose of this study was to characterize arsenic (As) and lead (Pb) concentrations in former orchard soils contaminated with lead arsenate pesticides at the Hanford site in Washington state (USA). Surface samples (n = 31) were collected from former orchard soils (in cultivation during the pre-Hanford period) at five locations at the 100 Areas and at one location at the Old Hanford Townsite (OHT). Another set of samples (n = 17) was collected over a soil depth interval of 10-50 cm at the four locations with the highest As and Pb surface concentrations. All samples were analyzed for 22 trace elements (including As and Pb) with inductively coupled plasma-atomic emission spectrometry (ICP-AES). The mean, standard deviation, and range for As in the surface soils were 30, 61, and 2.9-270 mg/kg dry wt, respectively. The corresponding statistics for Pb were 220, 460, and 6.5-1900 mg/kg dry wt, respectively. As and Pb concentrations in the surface soils were positively and significantly correlated (r = 0.91, Bonferroni p < 0.05). Descriptive statistics and bivariate correlations were also computed for other trace elements. As and Pb mean concentrations in the surface soils each differed significantly (p < 0.05) among Hanford locations, with the highest concentrations at the 100-H and 100-F Areas. Although both As and Pb mean concentrations decreased with soil depth, regression and correlation coefficients only, for Pb significantly differed from zero (b = -0.0372, r = -0.805, Bonferroni p < 0.05). Compared with data in the literature As and Pb concentrations found in this study exceeded background levels but were typical of orchard soils. Furthermore, mean As and Pb soil concentrations were in the range of various toxicological benchmarks derived for protection of human and ecological receptors.

When to be skeptical of negative studies: pitfalls in evaluating occupational risks using population-based case-control studies

This study investigated arsenic and lung cancer incidence in a community setting in the Montreal area. Job histories and sociodemographic factors were collected by interview from 857 lung cancer cases, 533 general population controls, and 1,360 controls with other cancers. Chemist-hygienists assessed each subject's life-time occupational exposure to 294 substances. Logistic regressions yielded arsenic/lung cancer odds ratios of 1.1 (95% confidence interval = 0.60, 1.7) based on cancer controls, and 0.82 (95% confidence interval = 0.41, 1.6) based on population controls. Risk did not rise with increasing level or probability of exposure. Worksite studies consistently show lung carcinogenicity from arsenic. Since confounding from other chemicals was well controlled, the most likely explanation is substantially lower exposures than in previous studies. The lack of association in this study demonstrates the need for caution in interpreting negative findings from population-based case-control studies, particularly when exposures are low or rare, as well as the difficulty in generating hypotheses from such studies.

An assessment of the developmental toxicity of inorganic arsenic

A critical analysis of the literature base regarding the reproductive and developmental toxicity of arsenic compounds, with emphasis on inorganic arsenicals, was conducted. The analysis was stimulated by the great number of papers that have purported to have shown an association between exposure of pregnant laboratory animals to arsenic compounds and the occurrence of offspring with cranial neural tube defects, particularly exencephaly. For the most part, the literature reports of arsenic developmental toxicity in experimental animals are inadequate for human risk assessment purposes. Despite the shortcomings of the experimental database, several conclusions are readily apparent when the animal studies are viewed collectively. First, cranial neural tube defects are induced in rodents only when arsenic exposure has occurred early in gestation (on Days 7 [hamster, mouse], 8 [mouse], or 9 [rat]). Second, arsenic exposures that cause cranial neural tube defects are single doses that are so high as to be lethal (or nearly so) to the pregnant animal. Third, the effective routes of exposure are by injection directly into the venous system or the peritoneal cavity; even massive oral exposures do not cause increases in the incidence of total gross malformations. Fourth, repetition of similar study designs employing exaggerated parenteral doses is the source of the large number of papers reporting neural tube defects associated with prenatal arsenic exposure. Fifth, in five repeated dose studies carried out following EPA Guidelines for assessing developmental toxicity, arsenic was not teratogenic in rats (AsIII, 101 micromol/kg/d, oral gavage; 101 micromol/m3, inhalation), mice (AsV, 338 micromol/kg/d, oral gavage; est. 402 micromol/kg/d, diet), or rabbits (AsV, 21 micromol/kg/d, oral gavage). Data regarding arsenic exposure and adverse outcomes of pregnancy in humans are limited to several ecologic epidemiology studies of drinking water, airborne dusts, and smelter environs. These studies failed to (1) obtain accurate measurements of maternal exposure during the critical period of organogenesis and (2) control for recognized confounders. The lone study that examined maternal arsenic exposure during pregnancy and the presence of neural tube defects in progeny failed to confirm a relationship between the two. It is concluded that under environmentally relevant exposure scenarios (e.g., 100 ppm in soil), inorganic arsenic is unlikely to pose a risk to pregnant women and their offspring.

Spatial pattern of arsenic and lead distributions in Jamaican soils

The spatial patterns of arsenic and lead distribution in Jamaican soils were studied using the Geographical Resources Analysis Support System (GRASS) and data from an island wide soil survey. Arsenic and lead were analysed by instrumental neutron activation analysis (INAA) and energy-dispersive X-ray fluorescence (EDXRF) techniques. The frequency distribution of each element is discussed in relation to major lithological groups. The As-Pb background levels for different areas in Jamaica were estimated.

Arsenic in Dermatology

BACKGROUND

Arsenic is a chemical carcinogen that exists naturally and in the workplace.

OBJECTIVES

Review exposure, clinical signs of arsenic exposure, and the carcinogenic potential.

METHOD

Review of literature.

RESULTS

Arsenic is a known carcinogen that occurs both naturally and in the workplace. It causes cutaneous malignancies, hyperpigmentation, palmer and plantar keratosis, and internal malignancies, especially of the lung and bladder.

CONCLUSION

Exposure risks need to be well publicized. Those people with known exposure need regular full skin exams as well as close follow-up by their primary care physician.

Mortality in a cohort of orchard workers exposed to lead arsenate pesticide spray

During the period from 1890 to 1940, lead arsenate was the major pesticide used in apple orchards to control the coddling moth. In the Wenatchee area of Washington State, lead arsenate spray was used for longer periods and in larger quantities than in other areas of the United States. In 1938, a cohort of 1,231 people who lived in this area was selected for a study to determine the effects of exposure to lead arsenate spray and residue. This same cohort was re-examined to determine whether there was excess mortality that could be attributed to the lead arsenate exposure. Three levels of exposure (i.e., orchardist, intermediate, consumer) were defined, based upon the use of lead arsenate pesticide spray before and during the 1938 apple growing season. Age-adjusted hazard ratios for all causes of mortality were elevated for both male orchardists and male intermediates. The only significantly increased age-adjusted hazard ratio (1.94) was heart disease in male intermediates. No significantly elevated age-adjusted hazard ratios were observed for women in any exposure group. The lack of evidence that supported an increase in mortality from respiratory cancer in this cohort may have resulted from the lower cumulative concentration of arsenic exposure, the type of arsenical compound, and the small number of study subjects.

Multiple risk factors associated with arsenic-induced skin cancer: effects of chronic liver disease and malnutritional status

In order to evaluate the prevalence and multiple risk factors of arsenic-induced skin cancer among residents in Taiwanese villages in which chronic arseniasis is hyperendemic, a total of 1571 subjects aged 30 or more years were recruited between September 1988 and March 1989. All of them were interviewed personally by a public health nurse using a structured questionnaire, and 1081 interviewed study subjects, including 468 men and 613 women, participated in physical examination, giving a participation rate of 68.8%. The overall prevalence of skin cancer was as high as 6.1%, showing an increase with age in both men and women. There was a significant dose-response relation between skin cancer prevalence and chronic arsenic exposure as indexed by duration of residence in the endemic area, duration of consumption of high-arsenic artesian well water, average arsenic exposure in parts per million (p.p.m.) and cumulative arsenic exposure in p.p.m.-years. Chronic carriers of hepatitis B surface antigen with liver dysfunction had an increased prevalence of skin cancer. Undernourishment, indexed by a high consumption of dried sweet potato as a staple food, was also significantly associated with an increased prevalence of arsenic-induced skin cancer. All these risk factors remained statistically significant in the multiple logistic regression analysis. Consistent with animal experiments, the findings imply that liver function and nutritional status may affect the metabolism of inorganic arsenic and the development of subsequent skin cancers.

A review of the carcinogenicity of chemicals most frequently found at National Priorities List sites

Several studies have shown that numerous National Priorities List (NPL) sites have been contaminated with arsenic (747), cadmium (791), chloroform (596), or nickel (664). The National Toxicology Program (NTP, 1991) has classified these substances as known human carcinogens (arsenic and certain arsenic compounds) or as substances that may reasonably be anticipated to be carcinogens (cadmium and certain cadmium compounds, chloroform, and nickel and certain nickel compounds). The general population is probably exposed to low levels of these hazardous substances through drinking water, eating food, or inhaling contaminated air. People working or living near industries and facilities that manufacture and use chloroform, nickel, arsenic, or cadmium may be exposed to higher than background levels of these hazardous substances. Multiple pathways of exposure may exist for populations near hazardous waste sites. For example, high levels of chloroform (1,890 ppb) were found in well water near a waste site; high levels of cadmium exposure may exist for individuals living near cadmium-contaminated waste sites.

Inorganic arsenic compounds: are they carcinogenic, mutagenic, teratogenic?

This review examines and evaluates the literature on the ability of inorganic arsenic compounds to cause cancer in humans and laboratory animals. The epidemiological data that supports the position that inorganic arsenical derivatives are carcinogenic in humans is convincing and difficult to deny because of their consistency. These data are from studies of different occupational exposures such as smelter and pesticide workers, as well as from studies of drinking water, wines and medicinal tonics that contained or were contaminated with inorganic compounds of arsenic. Indeed, positive dose-response relationships between cancer incidence or mortality with many inorganic arsenical substances have been shown. Despite the presence of data which confuse the interpretation and evaluation of epidemiological data, associated neoplasms of the lungs, skin and gastrointestinal systems have been observed as a result of exposure to inorganic arsenic compounds.The mechanism of carcinogenicity of inorganic arsenical substances in humans is unknown. Inorganic arsenic compounds are not carcinogenic in laboratory animals by most routes of administration. However, further studies (subchronic, chronic, carcinogenic) using intratracheal and other conventional routes in other animal species would appear to be warranted. Moreso, especially since there is no evidence that organic arsenic compounds are carcinogenic in numerous mammalian species. Inorganic derivatives of arsenic are not mutagenic but may be teraiogenic. This latter conclusion is dependent on the method of administration and size of the dose, as well as on the species of animal used for the study.

Arsenic-induced skin toxicity

We reviewed available literature on the effects of inorganic arsenic on the skin to determine the potential hazards and to collate information regarding dosage and exposure to the incidence of skin cancer. Arsenic intake may result from occupational or medicinal exposure, or from drinking well water in areas with high arsenic levels in the soil. Arsenic causes a variety of benign skin lesions including hyperpigmentation and hyperkeratosis. Some hyperkeratotic lesions and squamous cell carcinomas in situ may progress to invasive carcinoma; other invasive squamous cell carcinomas will develop de novo. These cutaneous squamous cancers may metastasize; mortality is low, but has been reported. Locally invasive but non-metastasizing basal cell carcinomas may arise as well. These lesions occur in a characteristic pattern of distribution and are usually multiple. Observers reporting medicinally administered arsenic have described dose-response relationships between the amount of arsenic ingested and the frequency of various skin lesions. For arsenic found in drinking water, however, there is more controversy regarding the doses and exposure times necessary for cutaneous toxicity.

Non-Hodgkin's lymphoma and farming: an expanded case-control study

A previously published case-control study of agricultural risk factors involved male cases of non-Hodgkin's lymphoma registered under code 202 of the International Classification of Diseases (ICD). This study has been expanded with the inclusion of cases registered under ICD code 200, and additional controls. The expanded study comprises 100 ICD 200 cases and 83 ICD 202 cases registered during the period 1977-81, together with 338 controls selected from other cancer registrations during the same period. The largest relative risk for specific farming types was for orchard workers (odds ratio = 3.7, 90% confidence limits 1.1-12.1). No elevated risks were observed for exposure to farm animals, nor for potential exposure to phenoxy herbicides (odds ratio = 1.0, 90% confidence limits 0.7-1.5), or chlorophenols (odds ratio = 1.4, 90% confidence limits 0.8-2.3). The previous finding of an excess risk associated with fencing work was weakly supported by the expanded study (odds ratio = 1.4, 90% confidence limits 1.0-2.0). However, the previous finding of an excess risk associated with meat works employment was more strongly supported (odds ratio = 1.8, 90% confidence limits 1.2-2.6). One relevant risk factor is 2,4,6-TCP which is used in the treatment of pelts, but the excess risks do not appear to be confined to pelt department workers. An alternative hypothesis is that meat workers may be exposed to oncogenic viruses.

Health effects of pesticides: a review of epidemiologic research from the perspective of developing nations

Acute poisoning among pesticide applicators is still a prominent health hazard in rural areas in developing countries, but published reports are very rare. Registration analysis and descriptive study are helpful in giving guidance for orientation and evaluation of preventive strategies and measures. Data and material from China show that, in circumstances with a well organized grass-roots-level network of primary health care services, poisoning episodes can be prevented through dissemination of information of hazards and provision of prevention training courses. Among pesticide manufacturing workers, especially manual packers of organophosphorus insecticides, there is suggestive evidence of subacute poisoning resulting from continuous low-level exposure. Chronic delayed neuropathy has, rarely, been reported. Further study of the cause of subacute poisoning now requires analytical rather than descriptive investigations. There is still no solid documentation of an association of excess human cancer and the use of chlorinated hydrocarbon insecticides. Phenoxyacetic and chlorophenol herbicides recently have been widely studied for causation of soft tissue sarcoma, non-Hodgkin's leukemia, and lymphoma. Although the evidence at present indicates a positive association, discrepancies in findings and resultant controversy require further study. Epidemiological surveys on the harmful effect of DBCP are quite instructive. Investigations in exposed populations verified and extended the observation in animals as infertility and gender ratio change in the next generation. Adverse reproductive effects of a number of pesticides, particularly birth defects resulting from pesticides (other than those already documented for organomercurials), require further study.

Urinary arsenic, chromium, and copper levels in workers exposed to arsenic-based wood preservatives

Urinary excretion of arsenic, chromium, and copper in workers exposed to arsenic-based wood preservatives was examined to evaluate occupational exposure to these chemicals. Spot urine samples were collected from 89 wood treaters and a comparison group of 232 individuals with no known exposure to arsenicals. The results of urinalysis revealed that the wood treaters averaged 103 micrograms arsenic/L while the comparison group averaged 74 micrograms arsenic/L. The mean urinary chromium and copper levels of the wood treaters were 41 micrograms chromium/L and 191 micrograms copper/L compared with 63 micrograms chromium/L and 221 micrograms copper/L for the comparison group. Covariance analysis of urinary arsenic level between the exposed and comparison groups revealed that the adjusted mean arsenic levels of the exposed population (78 to 122 micrograms arsenic/L) were significantly higher than that of the comparison group (72 micrograms arsenic/L). The adjusted mean urinary arsenic levels of these wood treaters, however, were within published normal limits. Analysis of covariance allowed comparison of group means after statistical adjustments for possible confounding variables such as seafood intake and age. The results indicate that urinary arsenic values can provide a useful index of occupational exposure to chromated copper arsenate wood preservatives, when the effects of dietary arsenic are controlled statistically.

Increased risk of lung cancer in pesticide-exposed male agricultural workers

The cancer morbidity in a large group of male German agricultural workers exposed to pesticides was investigated through a retrospective cohort study. A total of 169 malignant tumors were diagnosed in 1658 men who began to work with pesticides between 1948 and 1972, and who continued this type of activity for at least 5 yr. The SMR (standardized mortality ratio) of 2.0 for lung cancer morbidity (mortality) in these pesticide-exposed subjects was significantly higher than that for the general male population of the German Democratic Republic. A positive correlation between the duration of employment and the mortality due to lung cancer (mainly undifferentiated and small-cell carcinomas) suggested a dose-effect relation. The smoking habits of the exposed men did not differ from those of the general male population of the German Democratic Republic. Because the subjects had been exposed to many different substances, the study does not permit any conclusions to be drawn in respect to the carcinogenicity of individual pesticides. The increased mortality due to lung cancer is presumably the result of an additive effect of different pesticide ingredients or of by-products whose carcinogenic effect has been definitely or tentatively established through experimental or epidemiologic studies (e.g. arsenic, asbestos, chlorinated dibenzodioxins, DDT). The results of the present investigation emphasize the need for effective measures to protect workers during occupational contact with pesticides.

The carcinogenicity of lead

The potential for lead to cause neoplasm in animals and man is reviewed. A multitude of studies indicate that principally renal tumours may be produced by various forms of inorganic lead in small rodents. No human study either of an epidemiological form or of a case report in industrial, agricultural or community medicine has proven that lead may cause cancer in man.

Mortality experience of arsenic-exposed workers

The mortality experience of all pensioners from a copper smelter who were aged 65 or over between 1949 and 1973 has been studied. An index of arsenic exposure was developed for all operations in the plant for 1973. This was applied to all individuals studied so that a comparative measure could be made of each individual's working-life exposure to arsenic. The overall mortality of this cohort was 12.2% higher than for males living in the same area, of the same ages, and in the same time periods. The excess mortality was due chiefly to respiratory cancer where mortality was three times the expected. Because other contaminants were present in the atmosphere, it is not certain that arsenic was entirely responsible for the respiratory cancer observed, yet a close association with arsenic seems highly likely.

Arsenic and cancer: the still unanswered question

For some 2,500 years, arsenic was considered an important element of pharmacopeias and was praised for its medicinal qualities. However, an incidental link with cancer was suggested during the nineteenth century, and since that time a controversy has ensued with regard to the compound's tumorigenicity. Several epidemiological surveys, for example, have suggested that arsenic induces lung, liver, or skin cancer in humans. On the other hand, all experimental attempts to reproduce such neoplasms in laboratory animals have consistently failed, thereby denying support to the human data. Recently arsenic was reported to be mutagenic. However, because of the inconsistency of most mutagenesis findings at present, this also cannot be regarded as supporting evidence. Furthermore, a recent trend has been to consider arsenic as beneficial in cancer prevention and in maintaining the health of farm animals, and, perhaps, humans. A critical review of epidemiological and experimental data from the literature has been made in an attempt to present an objective picture of this controversial and sensitive question and to encourage further research, which may ultimately determine whether arsenic deserves its execrable reputation.

Inorganic arsenic--ambient level approach to the control of occupational cancerigenic exposures

In 1820 the first malignancies ascribed as due to occupational arsenic exposure were reported as scrotal cancers among smelters. A century later the causal relationship between chronic occupational, environmental or medical arsenical exposure and skin carcinogenesis was firmly established. From 1948 to 1975, nine out of eleven epidemiological studies have shown, initially or upon review, significant excess mortality from respiratory cancer among diverse occupations exposed to various inorganic arsenicals. Two of the nine studies have shown concommitant, significant excess mortality from lymphatic cancer, and another, from skin cancer. Additionally, two such studies have revealed a dose-response relationship between arsenical exposure and lung carcinogenesis. In the first, reported in 1969, the relationship was semi-quantitative, with a possible interactive role by sulfur dioxide or other contaminants. The other demonstrated a dose-response which was quantitative for arsenic per se. Upon our reinterpretation, this dose-response also demonstrated an increased lung cancer mortality risk apparently at arsenic concentrations above 1 mug/M3, calculated as the 8-hour TWA daily exposure over a 40-year working life. However, these and related data do not reveal a definite no-effect exposure level. Thus, in the absence of data documenting a cancerigenically safe level of occupational exposure and because of the environmental ubiquity of arsenic, the conclusion is drawn that the arsenic body burden of workers should not be occupationally increased above that produced by the ambient level.