Occupational lung cancer

Inhalation of inorganic particles as a risk factor for idiopathic pulmonary fibrosis--elemental microanalysis of pulmonary lymph nodes obtained at autopsy cases

Exposure to inorganic particles may induce fibrosis in the lung. However, the association between exposure to inorganic particles and the pathogenesis of idiopathic pulmonary fibrosis (IPF)/usual interstitial pneumonia (UIP) is obscure. We examined inorganic particles in the pulmonary hilar lymph nodes affected by IPF/UIP to investigate whether inhaled elements are involved in the etiology, and whether there is an increasing risk of developing IPF/UIP. Twenty-three IPF/UIP cases and 23 controls without IPF/UIP were investigated. Pulmonary hilar lymph nodes constituted the study material. The elemental analysis was performed using scanning electron microscopy with an energy dispersive X-ray spectroscope, and we analyzed particles quantitatively and qualitatively. The results showed that the cases contained silicon and aluminum as compared with the control in lymph nodes, and these deposits were statistically significantly associated with an increased risk of IPF/UIP (adjusted odds were 2.99, 95% CI: 1.29-6.85 and 57.84, 95% CI: 1.45-2306.19, respectively). In addition, higher nickel levels in lymph nodes were associated with lung cancer. This study shows that inorganic particles, such as Si and Al, have higher concentrations in the hilar lymph nodes in IPF/UIP, and may play a role in one of the risk factors in the pathogenesis of IPF/UIP.

Retrospective Cohort Mortality Study of Workers Engaged in Motion Picture Film Processing

OBJECTIVE

To assess potential health risks associated with work in a large motion picture film-processing facility.

METHODS

A retrospective cohort mortality study was conducted during 1960-2000 among 2646 film workers. Job family categories, created from detailed employee work history information, were used to evaluate chemical exposure patterns.

RESULTS

Overall mortality was as expected (standardized mortality ratio [SMR] = 1.1; 95% confidence interval [CI] = 1.0-1.2). Statistically significant associations were found for suicides (SMR = 2.0; 95% CI = 1.2-3.0) among the hourly workers and AIDS (SMR = 5.3; 95% CI = 1.7-12.3) among the administrative workers. Film developers had increases of respiratory cancer (SMR = 1.9; 95% CI = 1.1-3.0) and suicides (SMR = 2.4; 95% CI = 1.0-4.7), whereas film assemblers had an increase in suicides (SMR = 2.4; 95% CI = 1.2-4.4) only.

CONCLUSIONS

Excess deaths resulting from suicides and AIDS among the workforce suggest that nonoccupational influences may be involved in the mortality of this cohort and warrant further investigations.

Tobacco and public health

OBJECTIVES

An interactive program for physicians and surgeons was used to focus their attention on current issues of lung cancer in the United States. The issues examined were the risks for the development of lung cancer in smokers, spouses of smokers, recipients of second-hand or sidestream smoke, and the appropriate workup and treatment of patients with lung cancer.

DESIGN

Case presentation with interactive questions and answers.

PATIENTS

Six patients are presented whose cases demonstrate issues that are relevant and timely to the practice of thoracic surgery and oncology Interventions: Treatment for the five case presentations is used for interactive teaching purposes.

CONCLUSIONS

Lung cancer is epidemic in the United States, particularly among women at the present time. Physician awareness of the environmental and other factors contributing to the disease should stay current with the population variables that we are seeing in clinical practice.