Mortality and Cancer Experience of Quebec Aluminum Reduction Plant Workers. Part I: The Reduction Plants and Coal Tar Pitch Volatile (CTPV) Exposure Assessment

Disparities in job characteristics by race and sex in a Southern aluminum smelting facility

BACKGROUND

Former workers at a Southern aluminum smelting facility raised concerns that the most hazardous jobs were assigned to Black workers, but the role of workplace segregation had not been quantified or examined in the company town. Prior studies discuss race and gender disparities in working conditions, but few have documented them in the aluminum industry.

METHODS

We obtained workers' company records for 1985-2007 and characterized four job metrics: prestige (sociologic rankings), worker-defined danger (worker assessments), annual wage (1985 dollars), and estimated total particulate matter (TPM) exposure (job exposure matrix). Characteristics of job at hire and trajectories were compared by race and sex using linear binomial models.

RESULTS

Non-White males had the highest percentage of workers in low prestige and high danger jobs at hire and up to 20 years after. After 20 years tenure, 100% of White workers were in higher prestige and lower danger jobs. Most female workers, regardless of race, entered and remained in low-wage jobs, while 50% of all male workers maintained their initial higher-wage jobs. Non-White females had the highest prevalence of workers in low-wage jobs at hire and after 20 years-increasing from 63% (95% CI: 59-67) to 100% (95% CI: 78-100). All female workers were less likely to be in high TPM exposure jobs. Non-White males were most likely to be hired into high TPM exposure jobs, and this exposure prevalence increased as time accrued, while staying constant for other race-sex groups.

CONCLUSIONS

There is evidence of job segregation by race and sex in this cohort of aluminum smelting workers. Documentation of disparities in occupational hazards is important for informing health interventions and research.

Cancer and noncancer mortality among aluminum smelting workers in Badin, North Carolina

BACKGROUND

Badin, North Carolina, hosted an aluminum smelting plant from 1917 to 2007. The Concerned Citizens of West Badin reported suspected excess cancer mortality among former employees. This study aimed to investigate these concerns.

METHODS

The study cohort was enumerated from United Steel Workers' records of workers employed from 1980 to 2007. Cause-specific mortality rates in the cohort were compared with North Carolina population mortality rates using standardized mortality ratios (SMRs), standardized by age, sex, race, and calendar period. We estimated cause-specific adjusted standardized mortality ratios (aSMRs) using negative controls to mitigate healthy worker survivor bias (HWSB). Standardized rate ratios (SRRs) were calculated to compare mortality rates between workers ever employed vs never employed in the pot room.

RESULTS

All-cause mortality among Badin workers was lower than in the general population (SMR: 0.81, 95% confidence interval [CI]: 0.71-0.92). After adjusting for HWSB, excesses for all cancers (aSMR: 1.55, 95% CI: 1.10-2.21), bladder cancer (3.47, 95% CI: 1.25-9.62), mesothelioma (17.33, 95% CI: 5.40-55.59), and respiratory cancer (1.24, 95% CI: 0.77-1.99) were observed. Black males worked the highest proportion of their employed years in the pot room. Potroom workers experienced higher respiratory cancer (SRR: 2.99, 95% CI: 1.23-7.26), bladder cancer (SRR: 1.58, 95% CI: 0.15-15.28), and mesothelioma (SRR: 3.36, 95% CI: 0.21-53.78) mortality rates than never workers in the pot room.

CONCLUSIONS

This study responds to concerns of a group of former aluminum workers. The results, while imprecise, suggest excess respiratory and bladder cancers among pot room workers in a contemporary cohort of union employees at a US smelter.

NF-E2-related factor 2 serves a key function in resistance to malignant transformation of BEAS-2B cells induced by coal tar pitch

Coal tar pitch (CTP) is a key factor in the development of occupational lung cancer. In order to investigate the function of the anti-oxidative signaling pathway regulated by NF-E2-related factor 2 (Nrf2) during cancer development, BEAS-2B cells were cultured with CTP extract for 30 passages. It was revealed that malignant transformation occurred in cells between the 20 and 30th passage. The expression levels of Nrf2 and NAD(P)H:quinone oxidoreductase 1 (NQO1) were promoted throughout the CTP exposure culture, and there was a positive linear correlation between the expression levels of Nrf2 and NQO1. Following knockdown of Nrf2 expression, the level of NQO1 decreased markedly and malignant transformation was more likely to occur. It was hypothesized that CTP may be toxic to BEAS-2B cells, which may lead to malignant transformation. Nrf2 was a quick response factor: Counteracting cytotoxicity by promoting the expression of anti-oxidative genes. Thus, Nrf2 was associated with the malignant transformation of BEAS-2B cells exposed to CTP and may be a potential therapeutic target.

Bladder cancer screening in aluminum smelter workers

Objective:

To present results of a bladder cancer screening program conducted in 18 aluminum smelters in the United States from January 2000 to December 2010.

Methods:

Data were collected on a cohort of workers with a history of working in coal tar pitch volatile exposed areas including urine analysis for conventional cytology and ImmunoCyt/uCyt+ assay.

Results:

ImmunoCyt/uCyt+ and cytology in combination showed a sensitivity of 62.30%, a specificity of 92.60%, a negative predictive value of 99.90%, and a positive predictive value of 2.96%. Fourteen cases of bladder cancer were detected, and the standardized incidence ratio of bladder cancer was 1.18 (95% confidence interval, 0.65 to 1.99). Individuals who tested positive on either test who were later determined to be cancer free had undergone expensive and invasive tests.

Conclusions:

Evidence to support continued surveillance of this cohort has not been demonstrated.

Cancer risks in aluminum reduction plant workers: a review

OBJECTIVE AND METHODS

This review examines epidemiological evidence relating to cancers in the primary aluminum industry where most of what is known relates to Söderberg operations or to mixed Söderberg/prebake operations.

RESULTS AND CONCLUSIONS

Increased lung and bladder cancer risks have been reported in Söderberg workers from several countries, but not in all. After adjustment for smoking, these cancer risks still increase with cumulative exposure to benzo(a)pyrene, used as an index of coal tar pitch volatiles exposure. Limited evidence has been gathered in several cohorts for an increased risk of tumors at other sites, including stomach, pancreas, rectum/rectosigmoid junction, larynx, buccal cavity/pharynx, kidney, brain/nervous system, prostate, and lymphatic/hematopoietic tissues (in particular non-Hodgkin lymphoma, Hodgkin disease, and leukemia). Nevertheless, for most of these tumor sites, the relationship with specific exposures has not been demonstrated clearly and further follow-up of workers is warranted.

Mortality and cancer experience of Quebec aluminum reduction plant workers, part 4: cancer incidence

OBJECTIVE

To describe the cancer experience of Quebec aluminum smelter workers.

METHODS

Cancer incidence was compared with that of the Quebec general population and examined in relation to benzo[a]pyrene (B[a]P) and smoking exposure indices.

RESULTS

There was a statistically significant increased incidence of stomach (two cohorts), pancreatic (one cohort), laryngeal (one cohort), lung (three cohorts), and bladder (four cohorts) cancers. Unlike lung and bladder cancers, pancreatic and stomach cancer risks do not relate meaningfully to cumulative B[a]P exposure. Laryngeal and buccal cavity cancer standardized incidence ratios (SIRs) seem to increase with increasing B[a]P exposure. SIRs from lung cancer have greatly diminished whereas bladder cancer SIRs remain elevated in all but one cohort.

CONCLUSIONS

The cancer incidence results are consistent with those from mortality studies, but identify other cancers that deserve scrutiny in future follow-ups.

Mortality and cancer experience of Quebec aluminum reduction plant workers. Part 3: monitoring the mortality of workers first employed after January 1, 1950

OBJECTIVE

To monitor changes over time in mortality of workers first employed in Quebec aluminum smelters after January 1, 1950 (1951-one cohort).

METHODS

Mortality of cohorts by decade of hire was compared with Quebec and same plant experience before 1950 (1951).

RESULTS

Chronic obstructive pulmonary disease and respiratory cancer (one cohort each) mortality were statistically in excess. In the combined cohorts, standardized mortality ratios exceeded 110 for cancers of esophagus, rectum, and rectosigmoid junction, pancreas, larynx, lung, non-Hodgkin lymphoma, cerebrovascular disease, and asthma. These findings essentially mirrored the experience of pre-1950 workers. There was a significant downward trend in mortality from all causes, lung and bladder cancer.

CONCLUSIONS

Statistically significant improvements were found in mortality from all causes combined, from cancer and from cancer of the lung and bladder. Slightly increased mortality continues from certain other causes.