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Perlman D, Mandel JH, Odo N, Ryan A, Lambert C, MacLehose RF, Ramachandran G, Alexander BH. Pleural abnormalities and exposure to elongate mineral particles in Minnesota iron ore (taconite) workers. Am J Ind Med 2018. [PMID: 29516526 DOI: 10.1002/ajim.22828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Iron ore (taconite) mining and processing are an important industry in northern Minnesota and western Michigan. Concerns around exposures have centered largely on exposure to non-asbestiform amphibole elongate mineral particles (EMPs) found in the eastern portion of the Minnesota iron range. METHODS A cross sectional survey was undertaken of current and former taconite workers and spouses along with a detailed exposure assessment. Participants provided an occupational history and had a chest radiograph performed. RESULTS A total of 1188 workers participated. Potential exposures to non-amphibole EMPs were evident across multiple jobs in all active mines. Pleural abnormalities were found in 16.8% of workers. There was an association of pleural abnormalities with cumulative EMP exposure that was not specific to the eastern portion of the range. CONCLUSION There was evidence of a mild to moderate increase in pleural abnormalities in this population of miners, associated with geographically non-specific cumulative EMP exposure.
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Affiliation(s)
- David Perlman
- Department of Medicine; University of Minnesota School of Medicine; Minneapolis Minnesota
| | - Jeffrey H. Mandel
- Division of Environmental Health Sciences; University of Minnesota School of Public Health; Minneapolis Minnesota
| | | | - Andy Ryan
- Division of Environmental Health Sciences; University of Minnesota School of Public Health; Minneapolis Minnesota
| | - Christine Lambert
- Department of Medicine; University of Minnesota School of Medicine; Minneapolis Minnesota
| | - Richard F. MacLehose
- Division of Epidemiology and Community Health; University of Minnesota School of Public Health; Minneapolis Minnesota
| | - Gurumurthy Ramachandran
- Department of Environmental Health and Engineering; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland
| | - Bruce H. Alexander
- Division of Environmental Health Sciences; University of Minnesota School of Public Health; Minneapolis Minnesota
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McCunney RJ, Li J. Radiation risks in lung cancer screening programs: a comparison with nuclear industry workers and atomic bomb survivors. Chest 2014; 145:618-624. [PMID: 24590022 DOI: 10.1378/chest.13-1420] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 09/02/2013] [Indexed: 01/09/2023] Open
Abstract
The National Lung Cancer Screening Trial (NLST) demonstrated that screening with low-dose CT (LDCT) scan reduced lung cancer and overall mortality by 20% and 7%, respectively. The LDCT scanning involves an approximate 2-mSv dose, whereas full-chest CT scanning, the major diagnostic study used to follow up nodules, may involve a dose of 8 mSv. Radiation associated with CT scanning and other diagnostic studies to follow up nodules may present an independent risk of lung cancer. On the basis of the NLST, we estimated the incidence and prevalence of nodules detected in screening programs. We followed the Fleischner guidelines for follow-up of nodules to assess cumulative radiation exposure over 20- and 30-year periods. We then evaluated nuclear worker cohort studies and atomic bomb survivor studies to assess the risk of lung cancer from radiation associated with long-term lung cancer screening programs. The findings indicate that a 55-year-old lung screening participant may experience a cumulative radiation exposure of up to 280 mSv over a 20-year period and 420 mSv over 30 years. These exposures exceed those of nuclear workers and atomic bomb survivors. This assessment suggests that long-term (20-30 years) LDCT screening programs are associated with nontrivial cumulative radiation doses. Current lung cancer screening protocols, if conducted over 20- to 30-year periods, can independently increase the risk of lung cancer beyond cigarette smoking as a result of cumulative radiation exposure. Radiation exposures from LDCT screening and follow-up diagnostic procedures exceed lifetime radiation exposures among nuclear power workers and atomic bomb survivors.
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Asbestos-Related Radiographic Findings Among Household Contacts of Workers Exposed to Libby Vermiculite. J Occup Environ Med 2013; 55:1300-4. [DOI: 10.1097/jom.0b013e31829fcf1a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Ameille J. Les différentes pathologies pleuropulmonaires liées à l’amiante : définitions, épidémiologie et évolution. Rev Mal Respir 2012; 29:1035-46. [DOI: 10.1016/j.rmr.2012.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 02/17/2012] [Indexed: 01/09/2023]
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Laney AS, Petsonk EL. Small pneumoconiotic opacities on U.S. coal worker surveillance chest radiographs are not predominantly in the upper lung zones. Am J Ind Med 2012; 55:793-8. [PMID: 22517570 DOI: 10.1002/ajim.22049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2012] [Indexed: 01/09/2023]
Abstract
BACKGROUND Radiographic shadows of coal workers' pneumoconiosis (CWP) are commonly described as predominantly in the upper lung zones. METHODS We evaluated the lung distribution of small opacities on surveillance chest radiographs (CXRs) taken between 1981 and 2010 among 2,467 underground US coal miners. All had evidence of pneumoconiosis (category ≥1/0), based on the contemporary International Labour Office Classification of Radiographs of Pneumoconioses. RESULTS Small opacity involvement was approximately equal over all lung zones, with 30.7% of the total involvement reported in the upper zones, 37.1% in the middle zones, and 32.1% in the lower zones. Primarily rounded opacities were seen in 62.1% of miners and primarily irregular opacities were seen in 37.9%. Miners with primarily rounded opacities had a distribution with moderate upper zone predominance (upper = 36.8%, middle = 36.5%, and lower = 27.2%). In contrast, miners with primarily irregular opacities showed a lower zone preponderance (upper = 20.5%, middle = 38.4%, and lower = 41.1%). CONCLUSION The distribution of small pneumoconiotic opacities on surveillance CXRs of working US coal miners is not consistent with the conventional expectations of upper lung zone predominance.
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Affiliation(s)
- A Scott Laney
- Surveillance Branch, Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA.
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Laney AS, Tramma S, Petsonk EL, Attfield MD. The association between tobacco burden and "dirty chest" is unlikely to follow a linear dose-response pattern. Br J Radiol 2012; 85:470-1; author reply 472. [PMID: 22457407 DOI: 10.1259/bjr/27455728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Erionite in road gravel associated with interstitial and pleural changes--an occupational hazard in western United States. J Occup Environ Med 2011; 53:892-8. [PMID: 21775901 DOI: 10.1097/jom.0b013e318223d44c] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To determine the rate of chest radiographic abnormalities among residents of North Dakota potentially exposed to road gravel containing the fibrous mineral erionite. METHODS Participants (n = 34) completed a questionnaire, chest radiograph, and high resolution computed tomography scan to assess the rate of interstitial and pleural changes consistent with fibrous mineral exposure. RESULTS Interstitial, pleural, or both changes typically associated with asbestos exposure were observed by high resolution computed tomography in seven (21%) individuals. The primary exposure pathway for six of these was from gravel pits, road maintenance, or both. Three participants (8.8%) demonstrated bilateral localized pleural changes with calcification; two of these also had accompanying interstitial changes. All three reported extensive work in gravel pits, road maintenance, or both. CONCLUSIONS These results indicate that occupational exposure to erionite contained within road gravel in the United States represents a potential health hazard. CLINICAL SIGNIFICANCE This study identifies chest radiographic changes among residents of North Dakota occupationally exposed to road gravel containing erionite. Public health officials and physicians in affected areas should be aware of the potential health effects of erionite exposure. Precautionary measures should be taken to limit occupational exposure to gravel containing erionite.
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Risk and Significance of Chest Radiograph and Pulmonary Function Abnormalities in an Elderly Cohort of Former Nuclear Weapons Workers. J Occup Environ Med 2011; 53:1046-53. [DOI: 10.1097/jom.0b013e318229aaff] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Change of exposure response over time and long-term risk of silicosis among a cohort of Chinese pottery workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:2923-36. [PMID: 21845166 PMCID: PMC3155337 DOI: 10.3390/ijerph8072923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 07/06/2011] [Accepted: 07/06/2011] [Indexed: 01/09/2023]
Abstract
An analysis was conducted on a cohort of Chinese pottery workers to estimate the exposure-response relationship between respirable crystalline silica dust exposure and the incidence of radiographically diagnosed silicosis, and to estimate the long-term risk of developing silicosis until the age of 65. The cohort comprised 3,250 employees with a median follow-up duration of around 37 years. Incident cases of silicosis were identified via silicosis registries (Chinese X-ray stage I, similar to International Labor Organisation classification scheme profusion category 1/1). Individual exposure to respirable crystalline silica dust was estimated based on over 100,000 historical dust measurements. The association between dust exposure, incidence and long-time risk of silicosis was quantified by Poisson regression analysis adjusted for age and smoking. The risk of silicosis depended not only on the cumulative respirable crystalline silica dust exposures, but also on the time-dependent respirable crystalline silica dust exposure pattern (long-term average concentration, highest annual concentration ever experienced and time since first exposure). A long-term "excess" risk of silicosis of approximately 1.5/1,000 was estimated among workers with all annual respirable crystalline silica dust concentration estimates less than 0.1 mg/m(3), using the German measurement strategy. This study indicates the importance of proper consideration of exposure information in risk quantification in epidemiological studies.
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Ngatu NR, Suzuki S, Kusaka Y, Shida H, Akira M, Suganuma N. Effect of a Two‐hour Training on Physicians' Skill in Interpreting Pneumoconiotic Chest Radiographs. J Occup Health 2010; 52:294-301. [DOI: 10.1539/joh.l10065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Nlandu Roger Ngatu
- Department of Environmental MedicineKochi Medical School, Kochi UniversityJapan
| | - Shun Suzuki
- Department of Environmental MedicineKochi Medical School, Kochi UniversityJapan
| | - Yukinori Kusaka
- Department of Environmental HealthSchool of Medicine, Fukui UniversityJapan
| | | | - Masanori Akira
- Department of Radiology, NHO‐Kinki Chuo Chest Disease CenterJapan
| | - Narufumi Suganuma
- Department of Environmental MedicineKochi Medical School, Kochi UniversityJapan
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Rohs AM, Lockey JE, Dunning KK, Shukla R, Fan H, Hilbert T, Borton E, Wiot J, Meyer C, Shipley RT, Lemasters GK, Kapil V. Low-level fiber-induced radiographic changes caused by Libby vermiculite: a 25-year follow-up study. Am J Respir Crit Care Med 2007; 177:630-7. [PMID: 18063841 DOI: 10.1164/rccm.200706-841oc] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
RATIONALE From 1921 to 1990, vermiculite ore from Libby, Montana, was shipped worldwide for commercial and residential use. A 1980 study of a manufacturing facility using Libby vermiculite was the first to demonstrate a small but significant prevalence of pleural chest radiographic changes associated with amphibole fibers contained in the ore. OBJECTIVES This follow-up study of the original cohort evaluated the extent of radiographic changes and cumulative fiber exposure (CFE) 25 years after cessation of exposure. METHODS From the original cohort of 513 workers, 431 (84%) were living and available for participation and exposure reconstruction. Of these, 280 (65%) completed both chest radiographs and interviews. Primary outcomes were pleural and/or interstitial changes. MEASUREMENTS AND MAIN RESULTS Pleural and interstitial changes were demonstrated in 80 (28.7%) and 8 (2.9%) participants, respectively. Of those participants with low lifetime CFE of less than 2.21 fiber/cc-years, 42 (20%) had pleural changes. A significant (P < 0.001) exposure-response relationship of pleural changes with CFE was demonstrated, ranging from 7.1 to 54.3% from the lowest to highest exposure quartile. Removal of individuals with commercial asbestos exposure did not alter this trend. CONCLUSIONS This study indicates that exposure within an industrial process to Libby vermiculite ore is associated with pleural thickening at low lifetime CFE levels. The propensity of the Libby amphibole fibers to dramatically increase the prevalence of pleural changes 25 years after cessation of exposure at low CFE levels is a concern in view of the wide national distribution of this ore for commercial and residential use.
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Affiliation(s)
- Amy M Rohs
- Department of Environmental Health, University of Cincinnati College of Medicine, 3223 Eden Avenue, ML 0056, Cincinnati, OH 45267, USA
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Chen W, Bochmann F, Sun Y. Effects of work related confounders on the association between silica exposure and lung cancer: a nested case-control study among Chinese miners and pottery workers. Int Arch Occup Environ Health 2006; 80:320-6. [PMID: 16897095 DOI: 10.1007/s00420-006-0137-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2006] [Accepted: 07/17/2006] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The role of silica in the causation of lung cancer is an ongoing debate. In order to explore whether observed association between silica exposure and lung cancer is confounded by exposure to other occupational carcinogens, we updated a previously nested case-control study among a cohort of male workers in 29 Chinese mines and factories on the basis of an extended follow-up. METHODS Five hundred and eleven lung cancer cases and 1,879 matched controls were selected. Exposure to respirable silica as well as relevant occupational confounders were quantitatively assessed based on historical industrial hygiene data. The relationship between exposure to silica and lung cancer was analyzed by conditional logistic regression analysis adjusted for exposure to arsenic, polycyclic aromatic hydrocarbons (PAHs), radon, and smoking. RESULTS In a crude analysis adjusted for smoking only, a significant trend of increasing risk of lung cancer with exposure to silica was found for tin, iron/copper miners, and pottery workers. But after adjustment for relevant occupational confounders, no relationship between silica and lung cancer can be observed. Instead, there is a significant association between lung cancer mortality and cumulative exposure to inorganic arsenic (OR = 1.86, 95% CI: 1.14, 3.04 for each mg/m(3)-year increase) and carcinogenic PAHs (OR = 1.35, 95% CI: 1.08, 1.69 for each 100 microg/m(3)-year increase). CONCLUSION This analysis does not provide any evidence to show that exposure to silica causes lung cancer in the absence of confounding factors.
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Affiliation(s)
- Weihong Chen
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ghio AJ, Roggli VL. Diagnosis and initial management of nonmalignant diseases related to asbestos. Am J Respir Crit Care Med 2005; 171:527; author reply 528-30. [PMID: 15722421 DOI: 10.1164/ajrccm.171.5.950] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Martin L. 2004 Asbestos Disease Guidelines Ignore Mass Screening Abuse. Am J Respir Crit Care Med 2005; 171:665; author reply 666-7. [PMID: 15753487 DOI: 10.1164/ajrccm.171.6.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Vehmas T, Kivisaari L, Huuskonen MS, Jaakkola MS. Scoring CT/HRCT findings among asbestos-exposed workers: effects of patient?s age, body mass index and common laboratory test results. Eur Radiol 2004; 15:213-9. [PMID: 15662476 DOI: 10.1007/s00330-004-2552-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2004] [Revised: 08/05/2004] [Accepted: 10/12/2004] [Indexed: 01/09/2023]
Abstract
We studied the effects of age, body mass index (BMI) and some common laboratory test results on several pulmonary CT/HRCT signs. Five hundred twenty-eight construction workers (age 38-80, mean 63 years) were imaged with spiral and high resolution CT. Images were scored by three radiologists for solitary pulmonary nodules, signs indicative of fibrosis and emphysema, ground glass opacities, bronchial wall thickness and bronchiectasis. Multivariate statistical analyses were adjusted for smoking and asbestos exposure. Increasing age, blood haemoglobin value and erythrocyte sedimentation rate correlated positively with several HRCT signs. Increasing BMI was associated with a decrease in several signs, especially parenchymal bands, honeycombing, all kinds of emphysema and bronchiectasis. The latter finding might be due to the suboptimal image quality in obese individuals, which may cause suspicious findings to be overlooked. Background data, including patient's age and body constitution, should be considered when CT/HRCT images are interpreted.
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Affiliation(s)
- T Vehmas
- Department of Radiology, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, 00250, Helsinki, Finland.
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Ross RM. The clinical diagnosis of asbestosis in this century requires more than a chest radiograph. Chest 2003; 124:1120-8. [PMID: 12970045 DOI: 10.1378/chest.124.3.1120] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Asbestosis can cause significant impairment and even death. It is also a well-recognized risk factor for the development of lung cancer. However, asbestosis is usually diagnosed on clinical grounds without the aid of pathology. Many physicians and researchers believe that in asbestos-exposed individuals with adequate latency, chest radiographic findings that are compatible with asbestosis are sufficient for the diagnosis. In order to determine whether this approach is reasonable, the positive predictive value of the chest radiograph for the diagnosis of pathologic asbestosis must be determined. This requires information about the prevalence of asbestosis, and the sensitivity and specificity of the chest radiograph in its diagnosis. In this article, the sensitivity and specificity of the chest radiograph in diagnosing asbestosis is determined from a literature analysis. The prevalence of asbestosis among present-day cohorts, such as construction workers and petrochemical workers, is assessed based on the relative risk of lung cancer in patients with asbestosis and the overall relative risk of lung cancer in these occupationally asbestos-exposed cohorts. The results indicate a positive predictive value for abnormal chest radiograph findings alone to be significantly < 50%. Therefore, the chest radiograph is inadequate as the sole clinical tool to be used to diagnose asbestosis in these cohorts. However, when rales and a low diffusing capacity of the lung for carbon monoxide are also present, the diagnosis of asbestosis on clinical grounds can be made with reasonable confidence.
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Affiliation(s)
- Robert M Ross
- Baylor College of Medicine, 6550 Fannin, Suite 2403, Houston, TX 77030, USA.
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Dement JM, Welch L, Bingham E, Cameron B, Rice C, Quinn P, Ringen K. Surveillance of respiratory diseases among construction and trade workers at Department of Energy nuclear sites. Am J Ind Med 2003; 43:559-73. [PMID: 12768606 DOI: 10.1002/ajim.10226] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Medical screening programs were begun in 1996 and 1997 at three Department of Energy (DOE) nuclear weapons facilities (Hanford Nuclear Reservation, Oak Ridge, and the Savannah River Site) to evaluate whether current and former construction workers are at significant risk for occupational illnesses. The focus of this report is pneumoconiosis associated with exposures to asbestos and silica among workers enrolled in the screening programs through September 30, 2001. METHODS Workers provided a detailed work and exposure history and underwent a respiratory examination, which included a respiratory history and symptom questionnaire, a posterior-anterior (P-A) chest radiograph, and spirometry. Both stratified and multivariate logistic regression analyses were used to explore the risk of disease by duration of DOE employment and frequency of exposure, while controlling for potential confounders such as age, race, sex, and other work in the construction and building trades. RESULTS Of the 2602 workers, 25.2% showed one or more chest X-ray changes by ILO criteria and 42.7% demonstrated one or more pulmonary function defects. The overall prevalence of parenchymal changes by ILO criteria (profusion 1/0 or greater) was 5.4%. In the logistic regression models, the odds ratio for parenchymal disease was 2.6 (95% confidence interval (CI) = 1.0-6.6) for workers employed 6 to 20 years at Hanford or Savannah River and increased to 3.6 (95% CI = 1.1-11.6) for workers employed more than 35 years, with additional incremental risks for workers reporting routine exposures to asbestos or silica. CONCLUSIONS Continued surveillance of workers is important given their increased risk of disease progression and their risk for asbestos related malignancies. Smoking cessation programs should also be high priority and continued abstinence for former smokers reinforced. Although the observed respiratory disease patterns are largely reflective of past exposures, these findings suggest that DOE needs to continue to review industrial hygiene control programs for work tasks involving maintenance, repair, renovation, and demolition.
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Affiliation(s)
- John M Dement
- Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Tjoe Nij E, Burdorf A, Parker J, Attfield M, van Duivenbooden C, Heederik D. Radiographic abnormalities among construction workers exposed to quartz containing dust. Occup Environ Med 2003; 60:410-7. [PMID: 12771392 PMCID: PMC1740554 DOI: 10.1136/oem.60.6.410] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Construction workers are exposed to quartz containing respirable dust, at levels that may cause fibrosis in the lungs. Studies so far have not established a dose-response relation for radiographic abnormalities for this occupational group. AIMS To measure the extent of radiographic abnormalities among construction workers primarily exposed to quartz containing respirable dust. METHODS A cross sectional study on radiographic abnormalities indicative of pneumoconiosis was conducted among 1339 construction workers mainly involved in grinding, (jack)-hammering, drilling, cutting, sawing, and polishing. Radiological abnormalities were determined by median results of the 1980 International Labour Organisation system of three certified "B" readers. Questionnaires were used for assessment of occupational history, presence of respiratory diseases, and symptoms and smoking habits. RESULTS An abnormality of ILO profusion category 1/0 and greater was observed on 10.2% of the chest radiographs, and profusion category of 1/1 or greater on 2.9% of the radiographs. The average duration of exposure of this group was 19 years and the average age was 42. The predominant type of small opacities (irregularly shaped) is presumably indicative of mixed dust pneumoconiosis. The prevalence of early signs of nodular silicosis (small rounded opacities of category 1/0 or greater) was low (0.8%). CONCLUSIONS The study suggests an elevated risk of radiographic abnormalities among these workers with expected high exposure. An association between radiographic abnormalities and cumulative exposure to quartz containing dust from construction sites was observed, after correction for potentially confounding variables.
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Affiliation(s)
- E Tjoe Nij
- Utrecht University, Division of Environmental and Occupational Health, Institute for Risk Assessment Sciences, Netherlands.
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Henry DA. International Labor Office Classification System in the age of imaging: relevant or redundant. J Thorac Imaging 2002; 17:179-88. [PMID: 12082369 DOI: 10.1097/00005382-200207000-00002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The 1980 International Labor Office International Classification of Radiographs of Pneumoconioses is a widely used epidemiologic tool with a storied past. This article reviews its development and examines its applications to occupational lung disease and the controversies generated in that process. The question of its relevancy to current imaging practices is discussed.
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Affiliation(s)
- Daniel A Henry
- American College of Radiology Committee (formerly Task Force) on the Pneumoconioses and Department of Radiology, Medical College of Virginia Hospitals, School of Medicine, Virginia Commonwealth University, Richmond, USA.
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Park R, Rice F, Stayner L, Smith R, Gilbert S, Checkoway H. Exposure to crystalline silica, silicosis, and lung disease other than cancer in diatomaceous earth industry workers: a quantitative risk assessment. Occup Environ Med 2002; 59:36-43. [PMID: 11836467 PMCID: PMC1740205 DOI: 10.1136/oem.59.1.36] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To estimate excess lifetime risk of (a) mortality from lung disease other than cancer (LDOC), and, (b) onset of radiographic silicosis, arising from occupational exposure to respirable crystalline silica dust. METHODS Data from a cohort of California diatomaceous earth mining and processing workers exposed to crystalline silica dust (mainly as cristobalite) were reanalyzed with Poisson regression methods with internal and external adjustments for potential confounding by calendar time, age, smoking, Hispanic ethnicity, and time since first observation. Model fit was evaluated by comparing deviances and fitting cubic spline models. Lifetime risks of death from LDOC and radiographic silicosis were estimated up to age 85 with an actuarial approach accounting for competing causes of death. RESULTS For deaths due to LDOC, a linear relative rate model gave the best fit in Poisson regression analyses. At the mean cumulative exposure of LDOC cases to silica, after adjustment for smoking, the estimated rate ratio was 4.2 (p<0.0001); at the maximum cumulative exposure of cases, the rate ratio was 18.4. The excess lifetime risk for white men exposed to respirable cristobalite dust for 45 years at the current permissible exposure limit (PEL; about 0.05 mg/m(3)) of the Occupational Safety and Health Administration was 54/1000 (95% confidence interval (95% CI) 17 to 150). For 70 incident cases of radiographic silicosis largely manifest before the end of employment, the best fit was also the linear relative rate model, predicting a rate ratio of 25.6 for silicosis at the mean cumulative exposure of the cases (p<0.0001). The excess lifetime risk for silicosis at the current PEL was 75/1000. CONCLUSION Current occupational health standards for crystalline silica permit risks of lung disease other than cancer far in excess of what is usually considered acceptable by the Occupational Safety and Health Administration (a lifetime risk of less than one in a thousand deaths).
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Affiliation(s)
- R Park
- US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, 4676 Columbia Parkway, MS C-15, Cincinnati, OH 45226-1998, USA.
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Pneumoconiosis in Coal Workers: Cellular Concepts of Dust-Induced Lung Injury, Radiographic Diagnosis, and Pulmonary Infections With Mycobacteria. ACTA ACUST UNITED AC 2001. [DOI: 10.1097/00045413-200101000-00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abstract
BACKGROUND Abundant epidemiologic and experimental evidence supports the 1997 International Agency for Research on Cancer classification of crystalline silica as a human lung carcinogen. Nonetheless, there remains uncertainty about whether excessive lung cancer occurs exclusively among workers with silicosis. METHODS A review was performed of published occupational epidemiologic literature directly pertinent to the interrelations among silica exposure, silicosis, and lung cancer. RESULTS The association between silica and lung cancer is generally, but not uniformly, stronger among silicotics than nonsilicotics. However, the existing literature is ambiguous due to incomplete or biased ascertainment of silicosis, inadequate exposure assessment, and the inherently strong correlation between silica exposure and silicosis which hinders efforts to disentangle unique contributions to lung cancer risk. CONCLUSIONS Until more conclusive epidemiologic findings become available, population-based or individually-based risk assessments should treat silicosis and lung cancer as distinct entities whose cause/effect relations are not necessarily linked.
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Affiliation(s)
- H Checkoway
- University of Washington, Department of Environmental Health, Seattle, Washington 98195-7234, USA.
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Weiss W. Asbestosis: a marker for the increased risk of lung cancer among workers exposed to asbestos. Chest 1999; 115:536-49. [PMID: 10027457 DOI: 10.1378/chest.115.2.536] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This review examines the hypothesis that excess lung cancer risk in worker cohorts exposed to asbestos occurs only among those with asbestosis. The adequately designed studies in the literature support this hypothesis. The summary relative risk for lung cancer was 1.00 in seven cohorts with no deaths from asbestosis. In addition, there is a high correlation between asbestosis rates and lung cancer rates in 38 cohorts in contrast to a poor correlation between cumulative exposure data and lung cancer relative risks in eight cohorts with adequate data. The evidence indicates that asbestosis is a much better predictor of excess lung cancer risk than measures of exposure and serves as a marker for attributable cases.
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Affiliation(s)
- W Weiss
- MCP Hahnemann School of Medicine, Allegheny University of the Health Sciences, Philadelphia, PA, USA
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25
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On Perception, Perspicuity, and Precision. Chest 1999. [DOI: 10.1016/s0012-3692(15)38132-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Hessel PA, Melenka LS, Michaelchuk D, Herbert FA, Cowie RL. Lung health among electricians in Edmonton, Alberta, Canada. J Occup Environ Med 1998; 40:1007-12. [PMID: 9830609 DOI: 10.1097/00043764-199811000-00012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Respiratory symptoms, lung function, and radiographic changes among 100 actively employed electricians in Edmonton, Alberta, Canada, with 20 or more years of union membership were compared with those of 100 telephone workers. Posteroanterior chest radiographs were evaluated by two experienced chest physicians, with a third arbitrating films that were disagreed upon. Employment in a number of industrial sectors was compared for time and for time-weighted exposure to dust and fumes. Compared with telephone workers, electricians had more usual cough (odds ratio [OR] = 3.36; 95% confidence interval [CI], 1.36-8.31), usual phlegm (OR = 2.44; 95% CI, 1.01-5.86), chronic phlegm (OR = 2.74; 95% CI, 1.13-6.60), and shortness of breath (OR = 2.26; 95% CI, 1.10-4.67), but no differences in lung function. The prevalence of radiographic changes in both groups was low. The electricians had more radiographic changes, but only for the category "any change" was the difference statistically significant (OR = 5.2; 95% CI, 1.06-23.93). Only two electricians had small irregular opacities. Phlegm, chronic phlegm, and chest tightness were significantly associated with cumulative exposure to fumes in the gas and oil industry and to total industrial construction.
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Affiliation(s)
- P A Hessel
- Department of Public Health Sciences, University of Alberta, Edmonton, Canada
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27
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Hessel PA, Melenka LS, Michaelchuk D, Herbert FA, Cowie RL. Lung health among plumbers and pipefitters in Edmonton, Alberta. Occup Environ Med 1998; 55:678-83. [PMID: 9930089 PMCID: PMC1757517 DOI: 10.1136/oem.55.10.678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES A cross sectional study was undertaken to assess lung health among plumbers and pipefitters. Respiratory symptoms, lung function, and radiographic changes among 99 actively employed plumbers and pipefitters with > or = 20 years of union membership were compared with 100 telephone workers. METHODS A respiratory symptom questionnaire was administered, including smoking and occupational histories. Spirometry was conducted according to standard criteria. Posteroanterior chest radiographs were evaluated by two experienced chest physicians, with a third arbitrating disagreed films. Members of the union were categorised as pipefitters (n = 57), plumbers (n = 16), or welders (n = 26), based on longest service, and compared with the telephone workers and internally (between groups). Lung health was also compared with employment in several work sectors common to Alberta for time, and for time weighted by exposure to dust and fumes. RESULTS Compared with the telephone workers, plumbers and pipefitters had more cough and phlegm, lower forced vital capacity, and more radiographic changes (20% with any change), including circumscribed (10%) and diffuse pleural thickening (9%). None of the plumbers and pipefitters had small radiographic opacities. Among the three subgroups of workers, plumbers had the highest prevalence of radiographic changes. Both plumbers and pipefitters showed higher odds ratios for cough and phlegm than the welders. No differences between groups were found for lung function. Indicators of lung health were not related to work in any sector. CONCLUSIONS Plumbers and pipefitters had increased prevalence of symptoms suggestive of an irritant effect with no evidence of bronchial responsiveness. The chest radiographs showed evidence of asbestos exposure, especially in the plumbers, but at lower levels than previously reported. Health screening programmes for these workers should be considered, although the logistical problems associated with screening in this group would be considerable.
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Affiliation(s)
- P A Hessel
- Department of Public Health Sciences, University of Alberta, Edmonton, Canada.
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28
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Hughes JM, Weill H, Checkoway H, Jones RN, Henry MM, Heyer NJ, Seixas NS, Demers PA. Radiographic evidence of silicosis risk in the diatomaceous earth industry. Am J Respir Crit Care Med 1998; 158:807-14. [PMID: 9731009 DOI: 10.1164/ajrccm.158.3.9709103] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
There is limited and conflicting evidence regarding the exposure-response relationship between exposure to crystalline silica and silicosis; the level of risk to current workers remains uncertain. We conducted an epidemiologic investigation of 1,809 workers in the diatomaceous earth industry, where exposures to crystalline silica are primarily to the cristobalite form. On the basis of the median of three independent readings, 81 (4.5%) workers were judged to have opacities on chest radiographs (small opacities, profusion >= 1/0, and/or large opacities). Age-adjusted relative risk of opacities increased significantly with cumulative exposure to crystalline silica. The concentration of respirable crystalline silica to which workers were exposed (highly correlated with period of hire) was an important determinant of risk after accounting for cumulative exposure. For workers with an average exposure to crystalline silica of <= 0.50 mg/m3 (or hired >= 1950), the cumulative risk of opacities for a cumulative exposure to crystalline silica of 2.0 mg/m3-yr was approximately 1.1%; for an average exposure > 0.50 mg/m3 (or hired < 1950), the corresponding cumulative risk was 3.7%. These findings indicate an exposure-response relationship between cumulative exposure to crystalline silica and radiographic opacities; moreover, the relationship was substantially steeper among workers exposed at the highest average concentrations of crystalline silica.
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Affiliation(s)
- J M Hughes
- Department of Biostatistics and Epidemiology, and Department of Medicine, Tulane University, New Orleans, Louisiana, USA.
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29
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McCunney RJ. EPA ruling on environmental particulates and the occupational physician. J Occup Environ Med 1998; 40:768-71. [PMID: 9777559 DOI: 10.1097/00043764-199809000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- R J McCunney
- Environmental Medical Service, Massachusetts Institute of Technology, Cambridge, USA
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