Mortality for Lung Cancer among PVC Baggers Employed in the Vinyl Chloride Industry

Abstract

Vinyl-chloride monomer (VCM) is classified as a known carcinogen of the liver; for lung cancer, some results suggest a potential association with polyvinyl chloride (PVC) dust. We evaluated the relationship between lung cancer mortality and exposure as PVC baggers in a cohort of workers involved in VCM production and polymerization in Porto Marghera (Venice, Italy) considering both employment status and smoking habits. The workers were studied between 1973 and 2017. A subset of them (848 over 1658) was interviewed in the 2000s to collect information about smoking habits and alcohol consumption. Missing values were imputed by the Multivariate Imputation by Chained Equations (MICE) algorithm. We calculated standardized mortality ratios (SMR) and 95% confidence intervals (95% CIs) using regional reference rates by task (never, ever, and exclusively baggers) and by smoking habits. Mortality rate ratios (MRR), adjusted for age, calendar time, time since first exposure, and smoking habits, were obtained via Poisson regression using Rubin’s rule to combine results from imputed datasets calculating the fraction of information due to non-response. Lung cancer mortality was lower than the regional reference in the whole cohort (lung cancer SMR = 0.92; 95% CI 0.75–1.11). PVC baggers showed a 50% increase in lung cancer mortality compared to regional rates (SMR = 1.48; 95% CI 0.82–2.68). In the cohort analyses, a doubled risk of lung cancer mortality among PVC baggers was confirmed after adjustment for smoking and time-dependent covariates (MRR = 1.99, 95% CI 1.04–3.81). Exposure to PVC dust resulting from activity as bagger in a polymerization PVC plant was associated with an increase in lung cancer mortality risk after adjustment for smoking habits.

The status and influencing factors of lung ventilation function in employees exposed to dust in enterprises of the XPCC, China

“…It is worth noting that the higher number of surface area atoms per unit mass of PVC dust greatly increases the surface area available for chemical reactions with body fluids and tissues that come into contact with it (40). Hence, PVC dust may lower FVC, artificially raise the FEV 1 /FVC ratio, and even lead to lung fibrosis or cancer (41). Compared to coal dust, other dusts, mainly some unidentified types of dust, reduced the abnormal rates of FEV 1 and FEV 1 /FVC, which might be influenced by factors such as the concentration of the dust.…”

Improvements in protective measures in factories with acetylene hydrochlorination and ethylene oxychlorination techniques declined risk assessment levels and affected liver health status

“…By excluding a potentially important source of bias, the adjustment for smoking strengthened the results of previous studies showing an increased risk for lung cancer among PVC baggers. Long-term exposure to high levels of PVC dust might cause pulmonary carcinogenesis through persistent alveolar inflammation, alveolar macrophage activation, and the release of growth factors ( 44 ).…”

Ion channels in lung cancer: biological and clinical relevance

“…LC is more frequent in high-income countries, mainly due to smoking habits that represent the main risk factor for this malignancy ( McIntyre and Ganti, 2017 ; Sung et al, 2021 ). Other common risk factors are the exposure to some chemicals such as asbestos ( Markowitz, 2022 ), mustard gas ( Ghanei and Harandi, 2010 ), radon ( Lorenzo-González et al, 2019 ), arsenic ( Soza-Ried et al, 2019 ), chromium ( Kouokam et al, 2022 ), nickel ( Shen and Zhang, 1994 ), uranium ( Zhang et al, 2022 ), vinyl chloride ( Girardi et al, 2022 ) and high dose ionizing radiations ( Yan et al, 2022 ).…”