Mortality and cancer morbidity in workers from an aluminium smelter with prebaked carbon anodes--Part II: Cancer morbidity

Association between Asbestos Exposure and the Incidence of Kidney Cancer: a Weight-of-Evidence Evaluation and Meta-analysis

PURPOSE OF REVIEW

Occupational asbestos exposure has been extensively linked to various cancers, with ongoing debates regarding its association with kidney cancer. This study aims to investigate the correlation between occupational asbestos exposure and kidney cancer incidence. Additionally, potential influencing factors are analyzed to enhance the comprehension of the relationship between asbestos exposure and kidney cancer.

RECENT FINDING

While asbestos has established strong associations with malignant mesothelioma and lung cancer, its connection to other malignancies such as gastric, colorectal, and kidney cancers remains under scrutiny. The current study presents mixed opinions on the relationship between asbestos exposure and kidney cancer. Our analysis revealed a potential association between asbestos exposure and the incidence of kidney cancer. Notably, among different types of asbestos, exposure to amphibole appeared to be particularly linked to a higher incident risk of kidney cancer.

Occupational heat exposure and prostate cancer risk: A pooled analysis of case-control studies

BACKGROUND

Heat exposures occur in many occupations. Heat has been linked to key carcinogenic processes, however, evidence for associations with cancer risk is sparse. We examined potential associations between occupational heat exposure and prostate cancer risk in a multi-country study.

METHODS

We analysed a large, pooled dataset of 3142 histologically confirmed prostate cancer cases and 3512 frequency-matched controls from three countries: Canada, France, and Spain. Three exposure indices: ever exposure, lifetime cumulative exposure and duration of exposure, were developed using the Finnish Job-Exposure Matrix, FINJEM, applied to the lifetime occupational history of participants. We estimated odds ratios (ORs) and 95% confidence intervals (CIs), using conditional logistic regression models stratified by 5-year age groups and study, adjusting for potential confounders. Potential interactions with exposure to other occupational agents were also explored.

RESULTS

Overall, we found no association for ever occupational heat exposure (OR 0.97; 95% CI 0.87, 1.09), nor in the highest categories of lifetime cumulative exposure (OR 1.04; 95% CI 0.89, 1.23) or duration (OR 1.03; 95% CI 0.88, 1.22). When using only the Spanish case-control study and a Spanish Job Exposure Matrix (JEM), some weakly elevated ORs were observed.

CONCLUSIONS

Findings from this study provide no clear evidence for an association between occupational heat exposure and prostate cancer risk.

Occupational Heat Exposure and Breast Cancer Risk in the MCC-Spain Study

BACKGROUND

Mechanisms linking occupational heat exposure with chronic diseases have been proposed. However, evidence on occupational heat exposure and cancer risk is limited.

METHODS

We evaluated occupational heat exposure and female breast cancer risk in a large Spanish case-control study. We enrolled 1,738 breast cancer cases and 1,910 frequency-matched population controls. A Spanish job-exposure matrix, MatEmEsp, was used to assign estimates of the proportion of workers exposed (P ≥ 25% for at least 1 year) and work time with heat stress (wet bulb globe temperature ISO 7243) for each occupation. We used three exposure indices: ever versus never exposed, lifetime cumulative exposure, and duration of exposure (years). We estimated ORs and 95% confidence intervals (CI), applying a lag period of 5 years and adjusting for potential confounders.

RESULTS

Ever occupational heat exposure was associated with a moderate but statistically significant higher risk of breast cancer (OR 1.22; 95% CI, 1.01-1.46), with significant trends across categories of lifetime cumulative exposure and duration (P _trend = 0.01 and 0.03, respectively). Stronger associations were found for hormone receptor-positive disease (OR ever exposure = 1.38; 95% CI, 1.12-1.67). We found no confounding effects from multiple other common occupational exposures; however, results attenuated with adjustment for occupational detergent exposure.

CONCLUSIONS

This study provides some evidence of an association between occupational heat exposure and female breast cancer risk.

IMPACT

Our results contribute substantially to the scientific literature. Further investigations are needed considering multiple occupational exposures.

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.

Radiation protection in non-ionizing and ionizing body composition assessment procedures

Body composition assessment (BCA) represents a valid instrument to evaluate nutritional status through the quantification of lean and fat tissue, in healthy subjects and sick patients. According to the clinical indication, body composition (BC) can be assessed by different modalities. To better analyze radiation risks for patients involved, BCA procedures can be divided into two main groups: the first based on the use of ionizing radiation (IR), involving dual energy X-ray absorptiometry (DXA) and computed tomography (CT), and others based on non-ionizing radiation (NIR) [magnetic resonance imaging (MRI)]. Ultrasound (US) techniques using mechanical waves represent a separate group. The purpose of our study was to analyze publications about IR and NIR effects in order to make physicians aware about the risks for patients undergoing medical procedures to assess BCA providing to guide them towards choosing the most suitable method. To this end we reported the biological effects of IR and NIR and their associated risks, with a special regard to the excess risk of death from radio-induced cancer. Furthermore, we reported and compared doses obtained from different IR techniques, giving practical indications on the optimization process. We also summarized current recommendations and limits for techniques employing NIR and US. The authors conclude that IR imaging procedures carry relatively small individual risks that are usually justified by the medical need of patients, especially when the optimization principle is applied. As regards NIR imaging procedures, a few studies have been conducted on interactions between electromagnetic fields involved in MR exam and biological tissue. To date, no clear link exists between MRI or associated magnetic and pulsed radio frequency (RF) fields and subsequent health risks, whereas acute effects such as tissue burns and phosphenes are well-known; as regards the DNA damage and the capability of NIR to break chemical bonds, they are not yet robustly demonstrated. MRI is thus considered to be very safe for BCA as well US procedures.

Trivalent metal ions based on inorganic compounds with in vitro inhibitory activity of matrix metalloproteinase 13

Collagenase-3 (MMP-13) inhibitors have attracted considerable attention in recent years and have been developed as a therapeutic target for a variety of diseases, including cancer. Matrix metalloproteinases (MMPs) can be inhibited by a multitude of compounds, including hydroxamic acids. Studies have shown that materials and compounds containing trivalent metal ions, particularly potassium hexacyanoferrate (III) (K3[Fe(CN)6]), exhibit cdMMP-13 inhibitory potential with a half maximal inhibitory concentration (IC50) of 1.3μM. The target protein was obtained by refolding the recombinant histidine-tagged cdMMP-13 using size exclusion chromatography (SEC). The secondary structures of the refolded cdMMP-13 with or without metal ions were further analyzed via circular dichroism and the results indicate that upon binding with metal ions, an altered structure with increased domain stability was obtained. Furthermore, isothermal titration calorimetry (ITC) experiments demonstrated that K3[Fe(CN)6]is able to bind to MMP-13 and endothelial cell tube formation tests provide further evidence for this interaction to exhibit anti-angiogenesis potential. To the best of our knowledge, no previous report of an inorganic compound featuring a MMP-13 inhibitory activity has ever been reported in the literature. Our results demonstrate that K3[Fe(CN)6] is useful as a new effective and specific inhibitor for cdMMP-13 which may be of great potential for future drug screening applications.

Ischemic Heart Disease Incidence in Relation to Fine versus Total Particulate Matter Exposure in a U.S. Aluminum Industry Cohort

Ischemic heart disease (IHD) has been linked to exposures to airborne particles with an aerodynamic diameter <2.5 μm (PM_2.5) in the ambient environment and in occupational settings. Routine industrial exposure monitoring, however, has traditionally focused on total particulate matter (TPM). To assess potential benefits of PM_2.5 monitoring, we compared the exposure-response relationships between both PM_2.5 and TPM and incidence of IHD in a cohort of active aluminum industry workers. To account for the presence of time varying confounding by health status we applied marginal structural Cox models in a cohort followed with medical claims data for IHD incidence from 1998 to 2012. Analyses were stratified by work process into smelters (n = 6,579) and fabrication (n = 7,432). Binary exposure was defined by the 10^th-percentile cut-off from the respective TPM and PM_2.5 exposure distributions for each work process. Hazard Ratios (HR) comparing always exposed above the exposure cut-off to always exposed below the cut-off were higher for PM_2.5, with HRs of 1.70 (95% confidence interval (CI): 1.11–2.60) and 1.48 (95% CI: 1.02–2.13) in smelters and fabrication, respectively. For TPM, the HRs were 1.25 (95% CI: 0.89–1.77) and 1.25 (95% CI: 0.88–1.77) for smelters and fabrication respectively. Although TPM and PM_2.5 were highly correlated in this work environment, results indicate that, consistent with biologic plausibility, PM_2.5 is a stronger predictor of IHD risk than TPM. Cardiovascular risk management in the aluminum industry, and other similar work environments, could be better guided by exposure surveillance programs monitoring PM_2.5.

Medical follow-up for workers exposed to bladder carcinogens: the French evidence-based and pragmatic statement

BACKGROUND

The aim of this work was to establish recommendations for the medical follow-up of workers currently or previously exposed to carcinogenic substances for the bladder.

METHODS

A critical synthesis of the literature was conducted. Sectors of activity where workers are or were exposed to carcinogenic substances for the bladder were listed and classified according to the level of bladder cancer risk. Performances of techniques available for the targeted screening of bladder cancer were analysed, including a simulation of results among high-risk populations in France.

RESULTS

The risk level for the professional group and the latency period between the start of exposure and the natural history of the disease were selected to define a targeted screening protocol. The NMP22BC test, exclusive haematuria testing, and combinations of urine cytology with, respectively, the NMP22BC test and haematuria test, generated an extremely high proportion of false positive results.

CONCLUSION

Urine cytology is the test that offers the best specificity. Although poor for all bladder cancer stages and grades combined, its sensitivity is better for high grades, which require early diagnosis since late-stage cancers are of very poor prognosis. These results suggest that urine cytology is currently the only technique suitable for proposal within the context of a first line targeted screening strategy for occupational bladder cancer. An algorithm summarising the recommended medical follow-up for workers currently or previously exposed to carcinogenic substances for the bladder is proposed, based on the level of risk of bladder cancer.

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.

Urinary 1-hydroxypyrene as a biomarker of exposure to polycyclic aromatic hydrocarbons: biological monitoring strategies and methodology for determining biological exposure indices for various work environments

This article reviews the published studies on urinary 1-hydroxypyrene (1-OHP) as a biomarker of exposure to polycyclic aromatic hydrocarbons (PAHs) in work environments. Sampling and analysis strategies as well as a methodology for determining biological exposure indices (BEIs) of 1-OHP in urine for different work environments are proposed for the biological monitoring of occupational exposure to PAHs. Owing to the kinetics of absorption of pyrene by different exposure routes and excretion of 1-OHP in urine, in general, 1-OHP urinary excretion levels increase during the course of a workday, reaching maximum values 3-9 h after the end of work. When the contribution of dermal exposure is important, post-shift 1-OHP excretion can however be lower than pre-shift levels in the case where a worker has been exposed occupationally to PAHs on the day prior to sampling. In addition, 1-OHP excretion levels in either pre-shift, post-shift or evening samples increase during the course of a work-week, levelling off after three consecutive days of work. Consequently, ideally, for a first characterization of a work environment and for an indication of the major exposure route, considering a 5-day work-week (Monday to Friday), the best sampling strategy would be to collect all micturitions over 24 h starting on Monday morning. Alternatively, collection of pre-shift, post-shift and evening urine samples on the first day of the work-week and at the end of the work-week is recommended. For routine monitoring, pre-shift samples on Monday and post-shift samples on Friday should be collected when pulmonary exposure is the main route of exposure. On the other hand, pre-shift samples on Monday and Friday should be collected when the contribution of skin uptake is important. The difference between beginning and end of work-week excretion will give an indication of the average exposure over the workweek. Pre-shift samples on the first day of the work-week will indicate background values, and, hence, reflect general environment exposure and body burden of pyrene and/or its metabolites. On the other hand, since PAH profile can vary substantially in different work sites, a single BEI cannot apply to all workplaces. A simple equation was therefore developed to establish BEIs for workers exposed to PAHs in different work environments by using a BEI already established for a given work environment and by introducing a correction factor corresponding to the ratio of the airborne concentration of the sum of benzo(a)pyrene (BaP) equivalent to that of pyrene. The sum of BaP equivalent concentrations represents the sum of carcinogenic PAH concentrations expressed as BaP using toxic equivalent factors. Based on a previously estimated BEI of 2.3 μmol 1-OHP mol(-1) creatinine for coke-oven workers, BEIs of 4.4, 8.0 and 9.8 μmol 1-OHP mol(-1) creatinine were respectively calculated for vertical pin Söderberg workers, anode workers and pre-bake workers of aluminium plants and a BEI of 1.2 μmol 1-OHP mol(-1) creatinine was estimated for iron foundry workers. This approach will allow the potential risk of cancer in individuals occupationally exposed to PAHs to be assessed better.

Aluminum ammonium sulfate dodecahydrate purified from traditional Chinese medicinal herb Korean monkshood root is a potent matrix metalloproteinase inhibitor

Matrix metalloproteinases (MMPs) are zinc-dependent endopeptidases and key regulators for many physiological and pathological functions. The MMP inhibitors have been shown to modulate diseases such as cancer, inflammation, and cardiovascular diseases. In this paper we tracked the MMP inhibitory activities of the traditional Chinese medicinal herb Korean Monkshood Root. The purified active ingredient was identified by the elemental analysis, infrared spectrum (IR) and X-ray diffraction as aluminum ammonium sulfate dodecahydrate. This inorganic compound showed inhibitory activities toward a number of MMP family members. In particular, it has a strong inhibitory effect toward MMP-2 and MMP-9, with IC50 values of 0.54 and 0.50 μM, respectively. Further analysis suggested that the MMP inhibitory activity is mainly due to Al(3+). Cell viability assays using human fibrosarcoma HT1080 cells showed aluminum ammonium sulfate had minimal cyto-toxicity with a concentration up to 500 μM. However, within 50 μM, it exhibited significant inhibition of cell invasion. To our knowledge, there has been no previous report of inorganic form of the MMP inhibitor with strong inhibitory activity. Our results for the first time showed that aluminum ammonium sulfate is an inorganic form of MMP inhibitor with high potency, and can be used to interfere with MMP related cellular processes.

Lifestyle Factors, Exposures, Genetic Susceptibility, and Renal Cell Cancer Risk: A Review

Malignant kidney tumors account for approximately 2% of all new primary cancer cases diagnosed in the United States, with an estimated 30,000 cases occurring annually. Although a variety of agents, chemical and biological, have been implicated as causal agents in the development of renal cell carcinoma (RCC), the etiology remains enigmatic. The strongest association has been developed between cigarette smoking and renal cancer however consistent, positive associations between RCC and obesity, diabetes, and hypertension have also been reported. In addition, more recent investigations of familial kidney cancer syndromes indicate that a strong genetic component contributes to RCC development. Several genes have been identified through investigation of familial kidney cancer syndromes. This review article describes recent trends in RCC incidence and the currently identifiable etiological causes that account for approximately half of the RCC cases diagnoses. The remainder of this review then focuses on additional risk factors that have thus far not been well examined but may be helpful in explaining the increasing incidence trends and the geographic or racial variation observed nationally and worldwide.

Relationship between cardiopulmonary mortality and cancer risk and quantitative exposure to polycyclic aromatic hydrocarbons, fluorides, and dust in two prebake aluminum smelters

OBJECTIVES

We examined the risk of mortality and cancer incidence with quantitative exposure to benzene-soluble fraction (BSF), benzo(a)pyrene (BaP), fluoride, and inhalable dust in two Australian prebake smelters.

METHODS

A total of 4,316 male smelter workers were linked to mortality and cancer incidence registries and followed from 1983 through 2002 (mean follow-up: 15.9 years, maximum: 20 years). Internal comparisons using Poisson regression were undertaken based on quantitative exposure levels.

RESULTS

Smoking-adjusted, monotonic relationships were observed between respiratory cancer and cumulative inhalable dust exposure (trend p = 0.1), cumulative fluoride exposure (p = 0.1), and cumulative BaP exposure (p = 0.2). The exposure-response trends were stronger when examined across the exposed categories (BaP p = 0.1; inhalable dust p = 0.04). A monotonic, but not statistically significant trend was observed between cumulative BaP exposure and stomach cancer (n = 14). Bladder cancer was not associated with BaP or BSF exposure. No other cancer and no mortality outcomes were associated with these smelter exposures.

CONCLUSIONS

The carcinogenicity of Söderberg smelter exposures is well established; in these prebake smelters we observed an association between smelter exposures and respiratory cancer, but not bladder cancer. The exploratory finding for stomach cancer needs confirmation. These results are preliminary due to the young cohort and short follow-up time.

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 2: mortality of three cohorts hired on or before january 1, 1951

OBJECTIVE

To describe the mortality of Quebec aluminum smelter workers employed before 1951.

METHODS

The mortality of 5,977 men hired at three plants on or before January 1, 1951 was compared with that of Quebec men. Relationships to benzo[a]pyrene, benzene-soluble material, and smoking were examined.

RESULTS

Statistically significant causes of death were lung cancer (three plants); bladder cancer; chronic obstructive lung disease (two plants each); cancers of the stomach, digestive system unspecified, rectum and rectosigmoid, pancreas, and larynx; Alzheimer's disease (one plant); and cerebrovascular disease (one plant). Not significant increases were also observed.

CONCLUSIONS

Mortality from cancer of the lung and bladder and chronic obstructive pulmonary disease are related to exposure in Söderberg smelters. The cause of increased stomach cancer mortality is unclear. Excess mortality from some other diseases may be explained by factors other than coal tar pitch volatiles exposure.

Comparison of two indices of exposure to polycyclic aromatic hydrocarbons in a retrospective aluminium smelter cohort

BACKGROUND

The association between coal tar-derived substances, a complex mixture of polycyclic aromatic hydrocarbons, and cancer is well established. However, the specific aetiological agents are unknown.

OBJECTIVE

To compare the dose-response relationships for two common measures of coal tar-derived substances, benzene-soluble material (BSM) and benzo(a)pyrene (BaP), and to evaluate which among these is more strongly related to the health outcomes.

METHODS

The study population consisted of 6423 men with > or =3 years of work experience at an aluminium smelter (1954-97). Three health outcomes identified from national mortality and cancer databases were evaluated: incidence of bladder cancer (n = 90), incidence of lung cancer (n = 147) and mortality due to acute myocardial infarction (AMI, n = 184). The shape, magnitude and precision of the dose-response relationships and cumulative exposure levels for BSM and BaP were evaluated. Two model structures were assessed, where 1n(relative risk) increased with cumulative exposure (log-linear model) or with log-transformed cumulative exposure (log-log model).

RESULTS

The BaP and BSM cumulative exposure metrics were highly correlated (r = 0.94). The increase in model precision using BaP over BSM was 14% for bladder cancer and 5% for lung cancer; no difference was observed for AMI. The log-linear BaP model provided the best fit for bladder cancer. The log-log dose-response models, where risk of disease plateaus at high exposure levels, were the best-fitting models for lung cancer and AMI.

CONCLUSION

BaP and BSM were both strongly associated with bladder and lung cancer and modestly associated with AMI. Similar conclusions regarding the associations could be made regardless of the exposure metric.

Cancer risk in aluminum reduction plant workers (Canada)

A 14-year update to a previously published historical cohort study of aluminum reduction plant workers was conducted [1]. All men with three or more years at an aluminum reduction plant in British Columbia (BC), Canada between the years 1954 and 1997 were included; a total of 6,423 workers. A total of 662 men were diagnosed with cancer, representing a 400% increase from the original study. Standardized mortality and incidence ratios were used to compare the cancer mortality and incidence of the cohort to that of the BC population. Poisson regression was used to examine risk by cumulative exposure to coal tar pitch volatiles (CTPV) measured as benzene soluble materials (BSM) and benzo(a)pyrene (BaP). The risk for bladder cancer was related to cumulative exposure to CTPV measured as BSM and BaP (p trends <0.001), and the risk for stomach cancer was related to exposure measured by BaP (p trend BaP <0.05). The risks for lung cancer (p trend <0.001), non-Hodgkin lymphoma (p trend <0.001), and kidney cancer (p trend <0.01) also increased with increasing exposure, although the overall rates were similar to that of the general population. Analysis of the joint effect of smoking and CTPV exposure on cancer showed the observed dose-response relationships to be independent of smoking.

Occupational exposures to polycyclic aromatic hydrocarbons, and respiratory and urinary tract cancers: a quantitative review to 2005

BACKGROUND

Exposure to polycyclic aromatic hydrocarbons (PAHs) has been reported in several industries, including those of the aluminum production, coal gasification, coke production, iron and steel foundries, coal tar and related products, carbon black and carbon electrodes production.

PATIENTS AND METHODS

This paper reviews the results from cohort studies conducted on workers exposed to PAHs in these industries, with a focus on cancers of the respiratory and urinary tract.

RESULTS

An excess risk from lung/respiratory cancers was found in most industries, the pooled relative risk (RR) being 2.58 (95% CI 2.28-2.92) for coal gasification, 1.58 (95% CI 1.47-1.69) for coke production, 1.40 (95% CI 1.31-1.49) for iron and steel foundries, 1.51 (95% CI 1.28-1.78) for roofers and 1.30 (95% CI 1.06-1.59) for carbon black production. The evidence for cancers of the bladder and of the urinary system is less consistent, with a significant increased risk only for workers in aluminum production (pooled RR = 1.29, 95% CI 1.12-1.49), coal gasification (pooled RR = 2.39, 95% CI 1.36-4.21), and iron and steel foundries (pooled RR = 1.29, 95% CI 1.06-1.57).

CONCLUSIONS

Increased risks from lung and bladder cancers were found in PAH-related occupations. These were modest in most industries, apart from those for coal gasification, and whether they are due at least partially to some bias or confounding remains open to discussion.

Evidence for excess colorectal cancer incidence among asbestos-exposed men in the Beta-Carotene and Retinol Efficacy Trial

The relation between asbestos exposure and colorectal cancer remains controversial. The authors of this 1984-2004 US study examined the association among 3,897 occupationally exposed participants in the Beta-Carotene and Retinol Efficacy Trial (CARET) for chemoprevention of lung cancer, followed prospectively for 10-18 years. When a Cox stratified proportional hazards model was used, risks of colorectal cancer were elevated among male heavy smokers exposed to asbestos. Their relative risk was 1.36 (95% confidence interval: 0.96, 1.93) when compared with that for CARET heavy smokers not exposed to asbestos, after adjusting for age, smoking history, and intervention arm. The presence of asbestos-induced pleural plaques at baseline was associated with a relative risk of 1.54 (95% confidence interval: 0.99, 2.40); colorectal cancer risk also increased with worsening pulmonary asbestosis (p = 0.03 for trend). A dose-response trend based on years of asbestos exposure was less evident. Nonetheless, these data suggest that colorectal cancer risk is elevated among men occupationally exposed to asbestos, especially those with evidence of nonmalignant asbestos-associated radiographic changes.

EMF and health

Electric and magnetic fields are ubiquitous in the modern society, and concerns have been expressed regarding possible adverse effects of these exposures. This review covers epidemiologic research on health effects of exposures to static, extremely low-frequency (ELF), and radio frequency (RF) fields. Research on ELF fields has been performed for more than two decades, and the methodology and quality of studies have improved over time. Studies have consistently shown increased risk for childhood leukemia associated with ELF magnetic fields, whereas ELF fields most likely are not a risk factor for breast cancer and cardiovascular disease. There are still inadequate data for other outcomes. More recently, focus has shifted toward RF exposures from mobile telephony. There are no persuasive data suggesting a health risk, but this research field is still immature with regard to the quantity and quality of available data. This technology is constantly changing and there is a need for continued research on this issue. Almost no epidemiologic data are available for static fields.

Health effects of static magnetic fields--a review of the epidemiological evidence

Potential health effects of static magnetic fields have received far less attention than, for example, power frequency or radiofrequency fields. Static fields are found in certain occupational settings, e.g. in the aluminium and chloralkali industries, in arc-welding processes, and certain railways systems. Magnetic resonance imaging (MRI) for medical diagnosis is another source. This paper summarizes the epidemiological evidence of static magnetic field exposure and long-term health effects. There are only a few epidemiological studies available, and the majority of these have focused on cancer risks. There are some reports on reproductive outcomes, and sporadic studies of other outcomes. Overall, few occupational studies have focused specifically on effects of static magnetic field exposure, and exposure assessment have consequently been poor or non-existent. Results from studies that have estimated static magnetic field exposure have not indicated any increased cancer risks, but they are generally based on small numbers of cases and crude exposure assessment. Control of confounding has been limited, and it is likely that the "healthy worker" effect have influenced the results. A few studies have reported results on reproductive outcomes among aluminium workers and MRI operators, but limitations in study designs prevent conclusions. A problem in epidemiological studies of static magnetic fields is that workers in exposed occupations are also exposed to a wide variety of other potentially harmful agents, including some known carcinogens. In conclusion, the available evidence from epidemiological studies is not sufficient to draw any conclusions about potential health effects of static magnetic field exposure.

Differences in mortality by radiation monitoring status in an expanded cohort of Portsmouth Naval Shipyard workers

Studies of leukemia and lung cancer mortality at the Portsmouth Naval Shipyard (PNS) have yielded conflicting results. In an expanded cohort of PNS workers employed between 1952 and 1992 and followed through 1996, the all-cause standardized mortality ratio (SMR) was 0.95 (95% confidence interval, 0.93-0.96). Employment duration SMRs were elevated with confidence intervals excluding 1.00 for lung cancer, esophageal cancer, and all cancers combined. Leukemia mortality was as expected overall, but standardized rate ratio analyses showed a significant positive linear trend with increasing external radiation dose. The role of solvent exposures could not be evaluated. Findings differed by radiation monitoring subcohort, with excess asbestosis deaths limited to radiation workers and several smoking-related causes of death higher among nonmonitored workers. At PNS, asbestos exposure and possibly smoking could be nonrandomly distributed with respect to radiation exposure, suggesting potential for confounding in internal analyses of an occupational cohort.

A single nocturnal exposure to 2-7 millitesla static magnetic fields does not inhibit the excretion of 6-sulfatoxymelatonin in healthy young men

The present study sought to evaluate possible acute effects on 6-sulfatoxymelatonin (aMT6s) excretion, a surrogate for melatonin levels in blood, in volunteers exposed to static magnetic fields with flux densities representative for workers in light metal reduction plants and operators of medical MRI in hospitals. Eleven healthy male volunteers (23-43 years) participated. Urine samples were collected for two consecutive 24 h periods from 22:00 hours day 1 (exposure day) through day 2 (day after exposure) and then for 24 h from 07:00 hours on day 7 (control day). On the day of exposure the subjects slept in the MRI room from 22:00 hours until 07:00 hours next morning, thus receiving a 9 h exposure to the magnetic field (2-7 mT). On the day after exposure and on the control day, they slept at home and otherwise performed their ordinary daily activities. Total daily urine production was collected in four parts: 22:00-07:00 hours, 07:00-11:00 hours, 11:00-18:00 hours, 18:00-22:00 hours, and the volume for each interval was measured and recorded. Samples were transferred to coded bottles and frozen for later RIA analysis of aMT6s. Pairs of values of mean hourly aMT6s excretion, both diurnal and for the four daily intervals, were compared using two-sided Wilcoxon signed ranks test. The day of exposure and the day after exposure were not significantly different from the control day, either for the total diurnal secretion or the interval data. In summary, the study shows no association between a single nocturnal exposure to a static magnetic field of strength 2-7 mT and excretion of aMT6s in urine.

Cancer incidence and cause specific mortality among workers in two Norwegian aluminum reduction plants

BACKGROUND

Concern about the health hazards in the aluminum industry has initiated this study where we have investigated associations between exposure to polycyclic aromatic hydrocarbons (PAH) and fluorides, and cancer incidence and cause specific mortality among workers in two Norwegian aluminum plants in operation since 1954 and 1957, respectively.

METHODS

The study was designed as a historical cohort study and comprised 5627 identified men employed for more than six months. Cancer incidence was investigated from start of employment to 1995, and cause specific mortality was investigated from 1962 to 1995. The observed cases of cancers and observed deaths were compared with expected numbers calculated from national rates. Internal comparisons were made using Poisson regression with age and smoking included in the models. Historical exposure to PAH and fluoride had been estimated previously by use of statistical modeling on industrial hygiene measurements and process parameters. A job exposure matrix was used to investigate possible associations between cumulative exposures, and cancer incidence and cause specific mortality. Smoking habits were identified for 92% of the cohort members.

RESULTS

The study showed a significant excess risk for urinary bladder cancer among workers exposed to PAH, but no clear dose-response relationship. When using a 30-year lag period, a significant excess of bladder cancer in the highest exposure category (> 2000 microg/m(3);year PAH) was shown (SIR 4.08). The data also suggested an association between exposure to PAH and pancreatic cancer, but no association with lung cancer was seen. The mortality analysis indicated an association between exposure to pot-room emissions (fluorides) and mortality from chronic bronchitis, emphysema and asthma, but no associations with cardiovascular diseases.

CONCLUSIONS

The study findings are compatible with an excess risk for bladder cancer for aluminum plant workers exposed to PAH. The increased risk for cancer of the pancreas indicated, should be further evaluated in larger exposed populations.

Occupational cancer research in the Nordic countries

Occupational cancer research in the Nordic countries benefits from certain structural advantages, including the existence of computerized population registries, national cancer registries with high-quality data on cancer incidence, and a personal identification number for each inhabitant. This article outlines the utilization of this research infrastructure in Denmark, Finland, Iceland, Norway, and Sweden, together with research examples from the different countries. Future research on occupational cancer in this region requires that national legislation on electronic handling of sensitive personal information should not be stricter than the European Union Directive on individual protection with regard to personal data. A personal identification number is essential both for keeping up the high quality of data of the registers and for the high quality of the process of linking the different data sources together. Although previous occupational research has focused on male workers, a broader approach is needed in the future, including a study of how cancer risk in women may be affected by occupational activity and the question of possible cancer risk in offspring of men and women exposed to workplace carcinogens.

Health survey of former workers in a Norwegian coke plant: Part 2. Cancer incidence and cause specific mortality

OBJECTIVES

A Norwegian coke plant that operated from 1964 to 1988 was investigated to ascertain whether the male workers in this plant had increased morbidities of cancer or increased mortality from specific causes, particularly associated with specific exposures at the coke plant.

METHODS

Personal data on all the employees of the plant were obtained from the plant's archives. With additional data from the Norwegian Bureau of Statistics we identified 888 male former workers at the plant. Causes of death were obtained from the Norwegian Bureau of Statistics, and cancer diagnoses from the Norwegian Cancer Registry. The results were compared with national averages adjusted for age. Specific exposures were estimated with records of actual measurements done at the plant and interviews with former workers at the plant.

RESULTS

A significant excess of stomach cancer (standardised incidence ratio (SIR) 2.22, 95% confidence interval (95% CI) 1.01 to 4.21) was found. Mortality from ischaemic heart disease and sudden death was positively associated with work in areas which entailed peak exposures to CO. When considering work in such areas the past 3 years before death, the association was significant (p = 0.01). The last result is based on only two deaths.

CONCLUSIONS

Considering the short follow up time and the small size of the cohort the results should be interpreted with a certain caution. The positive results would justify a re-examination of the cohort at a later date.

Lung and bladder cancer in a Norwegian municipality with iron and steel producing industry: population based case-control studies

OBJECTIVES

To investigate the influence of occupation on the rising incidence of lung and bladder cancer among men in a Norwegian municipality where an iron and steel plant constituted the key industry between 1955 and 1989.

METHODS

Based on the lung cancer cases reported to the Cancer Registry of Norway from 1980 to 1992 a population based case-control study was performed, including 86 cases and 196 controls. Information on occupations and smoking habits was collected through interviews and from the personnel files from the industrial plants. A case-control study on bladder cancer with 52 cases and 156 controls was carried out to cast light on the role of polycyclic aromatic hydrocarbons (PAHs).

RESULTS

An odds ratio (OR) for lung cancer of 2.9 (95% confidence interval (95% CI) 1.2 to 6.7) was associated with exposure to PAHs. Based on data from personnel files, increased risk of lung cancer (OR 2.8 95% CI 1.1 to 7.0) was associated with work experience in the pig iron department at the ironworks. A non-significant OR of 1.8 was associated with exposure to asbestos. Bladder cancer was not associated with exposure to PAHs at the iron, steel, and coke plant, or with experience from any of the production departments at the plant.

CONCLUSIONS

One fifth of the lung cancer cases were attributed to exposure to PAHs or asbestos. More than 80% of the cases of lung cancer were attributed to tobacco smoking. The cancer risk in the pig iron department may be due to a combination of exposures to PAH, asbestos, or dust of mixed composition.

Urothelial cancer of the bladder in an area of former coal, iron, and steel industries in Germany: a case-control study

In a case-control study performed in an area of former coal, iron, and steel industries, the professional and lifestyle histories of 412 male urothelial bladder cancer inpatients (cases) and 414 inpatients with benign prostatic hyperplasia (controls) were investigated. Smoking habits were identified as the main confounder for occupational bladder cancer risk. Two hundred and forty (58.3%) of the bladder cancer inpatients and 146 (35.3%) of the inpatients with benign prostatic hyperplasia were smokers. The percentage of ex-smokers in the bladder cancer cases was 10.2%; the percentage of ex-smokers in the controls was 9.7%. Smoking-adjusted Mantel-Haenszel estimates of the odds ratios (OR&infMH;) for bladder cancer were elevated in underground hard-coal miners (OR&infMH; =2. 54, 95% CI =[1.64; 3.93]), chemical workers (OR&infMH; =2.16, 95% CI =[0.87; 5.38]), painters/varnishers (OR&infMH; = 2.42, 95% CI =[1. 05; 5.57]), technicians (OR&infMH; = 1.99, 95% CI =[0.95; 4.16]), and foundry workers (OR&infMH; = 2.22, 95% CI = [0.53; 9.08]). Administrative officers had significantly lower smoking-adjusted odds ratios (OR&infMH; = 0.61, 95% CI = [0.42; 0.88]). Although statistically not significant, the results of the Breslow-Day test of homogeneity of the odds ratios over the strata are compatible with interactions between tobacco smoking and the occupations of underground hard-coal miners (chi(2)&infBD; = 4.91, p=0.07) and chemical workers (chi(2)&infBR; = 3.32, p=0.06).

Coal tar therapy. Is it carcinogenic?

Epidemiological studies indicate that occupational exposure to coal tar may lead to an increased risk of lung, scrotum and skin cancer. Furthermore, studies with laboratory rodents show carcinogenicity of coal tar after dermal application. This effect may be attributable to polycyclic aromatic hydrocarbons (PAH), which are ubiquitous coal tar constituents. Absorbed PAH can be metabolised to reactive derivatives that bind to DNA. These PAH-DNA binding products are thought to be involved in PAH-induced carcinogenesis. However, no clearly increased skin cancer incidences have been reported in psoriasis patients who have been exposed to therapeutically high doses of coal tar. To determine whether patients treated with coal tar actually have an altered risk of cutaneous malignancies, we suggest that further controlled studies and experiments are necessary. Future research should also focus on the possibility of increased risks of developing internal malignancies.

Investigation of a cluster of pituitary adenomas in workers in the aluminum industry

OBJECTIVE

Four cases of pituitary adenoma among employees at a primary aluminum production factory were identified over a five year period by a community physician. The objective of this investigation was to determine whether there has been a comparable high incidence in other aluminum factories, and if particular jobs, departments, or activities in the industry are associated with higher rates of the disease.

METHOD

Pituitary adenoma in employees at all United States factories of the company for the years 1989-94 was assessed by a search of a health data information bank and an insurance data base covering present and past employees of the corporation. The incidence in the aluminum workers was estimated and compared with the workers in the index plant. A nested case control study was conducted to compare employment histories of identified cases with those of age and sex matched controls selected from the health information data base.

RESULTS

25 cases, including the index cases, were identified which had been diagnosed during the period 1989-94. The resulting rate of 10.4/100,000 person-years was much lower than that at the index plant. Case-control analysis showed no coherent pattern of location, department, or job significantly associated with risk. In particular, jobs and departments associated with exposures common to aluminum smelting-such as coal tar pitch volatiles and fluorides-were shown to be uncommon among cases compared with age and sex matched controls.

CONCLUSION

Overall, despite the unprecedented cluster at a single plant, no strong evidence was found that the rate of pituitary adenoma is increased in aluminum workers generally. We found no association with any work activity or location in the industry to suggest a work related or exposure related cause for the disease.

Mortality and cancer morbidity in workers from an aluminium smelter with prebaked carbon anodes--Part I: Exposure assessment

OBJECTIVES

To design a job-exposure matrix for epidemiological studies of men who had worked in a Norwegian aluminium smelter between 1922 and 1975.

METHODS

Jobs held by cohort members were identified from personnel records. Tasks and their locations were determined for all jobs, and information was gathered about changes in exposure conditions over time. The jobs were combined into categories thought to have experienced similar exposure conditions, and time weighted average exposures were estimated on a relative scale. The results were reviewed by a panel of former smelter employees and an experienced industrial hygienist.

RESULTS

96 different jobs could be identified from the cohort members' work histories. These were grouped into 18 categories, and relative exposure intensities were estimated for 31 different combinations of category and period. The most prevalent exposure in the cohort was pot emissions (fluorides, sulphur dioxide, and carbon monoxide; 74% ever exposed), followed by magnetic fields and heat stress (65-68%), asbestos (40%), and coal tar pitch volatiles (33%).

CONCLUSIONS

Although the use of this job-exposure matrix in the subsequent epidemiological studies may result in some misclassification of exposure, this is unlikely to seriously attenuate true risks in a stratified analysis based on cumulative exposure.

Mortality and cancer morbidity in workers from an aluminium smelter with prebaked carbon anodes--Part III: Mortality from circulatory and respiratory diseases

OBJECTIVE

To investigate associations between exposure to pot emissions (fluorides, sulphur dioxide) and mortality from chronic obstructive lung disease, coal tar pitch volatiles and mortality from diseases related to atherosclerosis, and carbon monoxide and mortality from ischaemic heart disease.

METHODS

Mortality between 1962 to 1991 was investigated in a cohort of 1085 men hired by a Norwegian aluminium smelter between 1922 and 1975. Associations between cumulative exposure and mortality were investigated through SMR analysis based on national mortality rates; temporal relations were explored by considering exposures only within specific time windows. Circulatory mortality was also investigated by Poisson regression analysis.

RESULTS

There were 501 deaths v 471.3 expected in the cohort. The excess was confined to short term workers and did not seem to be associated with exposures in the smelter. Analysis of mortality among the 661 men with at least three years employment showed associations between cumulative exposure to tar 40 years before observation and atherosclerotic mortality (P = 0.03), and between exposure to pot emissions 20-39 years before observation and mortality from chronic obstructive lung disease (P = 0.06). No association was found between exposure to carbon monoxide and mortality from ischaemic heart disease, but cerebrovascular mortality was associated with exposure to pot emissions (P = 0.02). Results for atherosclerotic and cerebrovascular diseases were confirmed through Poisson regression analysis.

CONCLUSIONS

The data support previous findings of increased mortality from ischaemic heart disease in workers exposed to tar, and some support is also provided for earlier reports of increased respiratory mortality in potroom workers.