A report on brain tumors from a retrospective cohort study of refinery workers

Update of a study of crude oil production workers 1946-94

OBJECTIVE

To update information on workers in the petroleum industry engaged in the production of crude oil to determine whether the patterns of mortality have changed with 14 additional years of follow up.

METHODS

All workers were employed at company production and pipeline locations sometime during 1946-94. The cohort now consists of 24 124 employees with an average of 22 years of follow up.

RESULTS

The overall mortality, and most cause specific mortalities were lower than or similar to those for the general United States population. For white men (81% of the cohort), there were 4361 observed deaths and 5945 expected, resulting in a significantly lower standardised mortality ratio (SMR) of 73. There were significant deficits for all the leading causes of death in the United States including all cancers, cancer of the lung, stroke, heart disease, respiratory disease, and accidents. Slightly increased mortality was found for cancer of the prostate, cancer of the brain and central nervous system, and cancer of other lymphatic tissue. For benign and unspecified neoplasms, the SMR was 152 (95% confidence interval (95% CI) 95 to 230). There was a significant increase for acute myelogenous leukaemia that was restricted to people who were first employed before 1940 and who were employed in production and pipeline jobs for >30 years. Overall mortality patterns for non-white men and women were similar to those for white men. Mortality patterns for white men were also examined by duration of employment, time first employed, and by job group.

CONCLUSIONS

The results of the updated study showed a favourable mortality experience for crude oil production workers compared with the United States population.

Update of the Texaco mortality study 1947-93: Part II. Analyses of specific causes of death for white men employed in refining, research, and petrochemicals

OBJECTIVE

To examine patterns of mortality for specific causes of death with increases in the Texaco mortality study to determine if the patterns are related to employment in the petroleum industry.

METHODS

Mortality patterns by duration of employment in various job groups were examined for mesothelioma, non-Hodgkin's lymphoma, multiple myeloma, cell type specific leukaemia, and brain tumours.

RESULTS

Mortality from mesothelioma was examined for the total cohort and for two maintenance groups with the greatest potential for exposure to asbestos. The insulator group had a standardised mortality ratio (SMR) of 3029, and a larger group consisting of insulators, carpenters, labourers, electricians, pipefitters, boiler-makers, and welders had an SMR of 411. The mortalities from mesothelioma increased with increasing duration of employment. Mortality was lower for those first employed after 1950. An analysis of all brain tumours for the total cohort and some job and unit subgroups resulted in an SMR of 178 for those employed on the units related to motor oil and 166 for those employed as laboratory workers. Mortality from brain tumours in both of these job groups was higher for those employed > or = 5 years in the group. An analysis of non-Hodgkin's lymphoma showed no consistent patterns among the various employment groups. Mortality from multiple myeloma was non-significantly increased among people employed on the crude (SMR = 155) and fluid catalytic cracking units (SMR = 198). Leukaemia mortality was not increased for the total cohort, and a cell type analysis of leukaemia mortality for the total cohort showed no significant increases for the major cell types. However, there were significant increases for acute unspecified leukaemia (SMR = 276) and leukaemia of unknown cell type (SMR = 231).

CONCLUSIONS

Analyses of specific causes of death by duration of employment in various job and process units did not show any patterns which suggest that, other than for mesothelioma, any of these increases in mortalities were likely to have resulted from workplace exposures or from employment at one of the places included in the Texaco mortality study.

A 50-year mortality follow-up of a large cohort of oil refinery workers in Texas

To investigate further the possible role of occupational exposures on mortality, an update of a large Texas petroleum refinery cohort was undertaken. Between 1937 and 1987, 6799 deaths were identified among 17,844 employees. Relative to the general population of Texas, the overall standardized mortality ratio (SMR) showed a statistically significant deficit, as did nine other cause-of-death categories. Statistically significant mortality excesses were found for bone cancer (SMR = 207.8: 95% confidence interval [CI], 110.6 to 355.3), acute lymphocytic leukemia (ALL) (SMR = 259.6; 95% CI, 112.1 to 511.5), and benign/unspecified neoplasms (SMR = 194.9; 95% CI, 129.5 to 281.7). However, none of these diseases demonstrated an exposure-response relationship with length of employment. Subcohort mortality analyses by sex and race groups, length of employment, interval since hire, period of hire, and pay status were also performed. Overall, the update findings do not indicate that any excess mortality occurred as a result of employment at the refinery.

A cluster of brain tumours in a New South Wales colliery: a problem in interpretation

Following the reporting of a cluster of cases of brain tumour in the workforce of an underground coal mine (Mine A) in the Newcastle coalfield, a study was carried out to determine whether this phenomenon was due to chance alone or whether an environmental cause could be postulated. The study design was a historical cohort study over 15 years comparing the incidence of brain tumour (ICD9 191 and 192) in the index mine with that in two control mines (Mines B and C) in the same area and with that in the general Australian population. We compared environmental exposures (ionising and nonionizing radiation and chemical exposure) in the three mines. With Australian brain tumour incidence rates as reference, the standardised incidence ratio for brain tumour in Mine A was 5.3 (95 per cent confidence interval (CI) 1.08 to 14.04) and in Mines B and C combined was 1.23 (CI 0.02 to 3.80). On most environmental assessments the three mines were similar but Mine A used larger volumes of solvents than the other mines. This study poses two questions: was the increase in cases of brain tumour in Mine A 'real' and if so, was it related to the use of solvents? Data, from an investigation of a cluster such as this, are unlikely to be conclusive. Nevertheless, such answers are demanded not only by those at risk but also by the mine management, which is responsible for a safe working environment. Some of the difficulties involved with this judgment are discussed.

No increase in chromosome aberrations in workers from an oil catalytic cracking plant

A study of structural chromosome aberration frequencies in blood lymphocytes was performed in a group of 20 oil catalytic cracking unit workers and in 26 subjects belonging to the office staff of an oil refining plant, as well as in 35 matched controls. Subjects in the latter group were of the same sex (males) and similar age as the exposed group, and had similar smoking habits. Benzo[a]pyrene levels in workplace air samples were also determined. The cytogenetic analysis failed to show any differences between the exposed and control groups. A slight increase in benzo[a]pyrene level above the Cuban national standard of 1 ng/m3 was found during the air sample analysis in the oil catalytic cracking unit.

Mortality patterns among petroleum refinery and chemical plant workers

A historical cohort study was conducted to evaluate the mortality experience of 6,831 employees of the Shell Oil Company, Deer Park, Texas, petroleum refinery and chemical plant with emphasis on cancer mortality. Subjects were all workers with potential plant exposure who were employed for at least 3 months during 1948-72. Vital status was determined as of 12/31/83 for 98% of the cohort and death certificates were obtained for 95.4% of 1,180 observed deaths. The statistical analyses excluded 159 female study members. For all causes of death combined, all cancers combined, and for most of the nonmalignant disease categories examined, there were deficits in mortality among refinery workers, chemical plant workers, and workers with experience in both areas. These deficits were generally most pronounced for chemical plant workers. An analysis of specific cancer sites revealed patterns of increased risk suggestive of a possible relationship between occupational exposures in the refinery and lympho-reticulosarcoma. Patterns of increased risk were also observed among chemical plant workers for a category of lymphopoietic tissue cancers, including multiple myeloma, myelofibrosis, polycythemia vera, and certain non-Hodgkin's lymphomas. Some very limited evidence of a possible workplace association was also found among refinery workers for leukemia and cancers of the central nervous system and biliary passages/liver. No evidence was found of an increased risk for cancer of the respiratory system or stomach or for malignant melanoma. A work history review of all suspect cancer excesses failed to identify any common work areas, job assignments, or exposure potentials, although the lack of detailed data on specific chemical exposures precluded accurate assessments of exposure-response.

Are non-whites at greater risk for occupational cancer?

All occupational cancer epidemiology articles that reported data on non-whites from four major journals were identified for the years 1984-1987. In addition to these 14 papers, four more papers were identified from computer searches, and another 13 were found by following up references from the original 14. Within these 31 papers, there were 36 analyzable cohorts (subgroups by job and sex). Five cohorts had elevated all-cancer mortality ratios in non-whites without an increase in whites. Sixteen cohorts showed elevated ratios in both racial groups, with 11 of the 16 having a higher non-white cancer mortality ratio than white cancer mortality ratio. For the 25 studies in which at least one racial group's cancer ratio was elevated, the non-white ratio exceeded the white ratio in 17 (68%). The overall paucity of articles on non-white cancer mortality, as well as the apparent trend toward increased occupational cancer mortality in non-whites, is discussed.

Critical review of cancer epidemiology in petroleum industry employees, with a quantitative meta-analysis by cancer site

A critical review of close to 100 published and unpublished but otherwise available epidemiologic reports of petroleum industry employees from the United States, United Kingdom, Canada, Europe, Australia, and Japan was conducted. Analyses by duration of employment and latency are discussed, and summary standardized mortality ratios (SMRs) or meta-SMRs are developed for selected cancer sites. Findings indicate that the industry experienced a significantly lower cancer mortality than the general population for all cancer sites combined, digestive system, stomach, and lung. For the industry as a whole, SMRs similar to the general population were observed for skin, brain, pancreatic, prostatic, and kidney cancers. However, some data indicate that certain small groups within the industry might have elevated prostatic and kidney cancer risk. This review supports the conclusion that some refinery employees, particularly those employed before the 1940s, may have been at increased risk of leukemia. There is some indication that cancer of other lymphatic tissue may also be elevated. Unresolved issues affecting these conclusions are discussed, and specific directions for future research are offered.

Epidemiology of brain tumours in man and their relationship with chemical agents

The 2000 or so deaths that result each year in England and Wales from brain tumours, as defined by ICD 191, represent approximately 0.3-0.4% of all deaths, with a slightly greater incidence in men than in women. Because of the low incidence of mortality from other causes in childhood, brain cancer accounts for 3.5% of all deaths in the 1-14-year age group. Mortality from brain cancer increased considerably between 1931 and 1961 but this is probably explained by changes in disease classification and improvements in diagnostic techniques. Because of the relatively low incidence of brain cancer in man, cohort studies need to be large in order to accrue sufficient cases for meaningful interpretation. Large cohort studies may run the risk of diluting a high-risk group of workers with lesser or non-exposed individuals. These considerations have encouraged the investigation of brain cancer by case-control studies and the interpretation of these must take into account possible sources of bias. At present the evidence for any chemical causation of brain cancer in man is inconclusive.