Mortality from lung cancer in workers exposed to sulfur dioxide in the pulp and paper industry.

Abstract

Our objective in this study was to evaluate the mortality of workers exposed to sulfur dioxide in the pulp and paper industry. The cohort included 57,613 workers employed for at least 1 year in the pulp and paper industry in 12 countries. We assessed exposure to SO(2) at the level of mill and department, using industrial hygiene measurement data and information from company questionnaires; 40,704 workers were classified as exposed to SO(2). We conducted a standardized mortality ratio (SMR) analysis based on age-specific and calendar period-specific national mortality rates. We also conducted a Poisson regression analysis to determine the dose-response relations between SO(2) exposure and cancer mortality risks and to explore the effect of potential confounding factors. The SMR analysis showed a moderate deficit of all causes of death [SMR = 0.89; 95% confidence interval (CI), 0.87-0.96] among exposed workers. Lung cancer mortality was marginally increased among exposed workers (SMR = 1.08; 95% CI, 0.98-1.18). After adjustment for occupational coexposures, the lung cancer risk was increased compared with unexposed workers (rate ratio = 1.49; 95% CI, 1.14-1.96). There was a suggestion of a positive relationship between weighted cumulative SO(2) exposure and lung cancer mortality (p-value of test for linear trend = 0.009 among all exposed workers; p = 0.3 among workers with high exposure). Neither duration of exposure nor time since first exposure was associated with lung cancer mortality. Mortality from non-Hodgkin lymphoma and from leukemia was increased among workers with high SO(2) exposure; a dose-response relationship with cumulative SO(2) exposure was suggested for non-Hodgkin lymphoma. For the other causes of death, there was no evidence of increased mortality associated with exposure to SO(2). Although residual confounding may have occurred, our results suggest that occupational exposure to SO(2) in the pulp and paper industry may be associated with an increased risk of lung cancer.

Cohort mortality study of Swedish pulp and paper mill workers—nonmalignant diseases

“…In a former case-referent study on rheumatoid arthritis, pulp and paper workers were shown to have an increased risk (8). The authors related their finding to occupational exposure to respirable organic dust.…”

“…There seems to be a short-term effect of sulfur dioxide air pollution levels with respect to ischemic heart diseases (28). In the IARC cohort of pulp and paper mill workers, mortality was reported for the workers exposed to sulfur dioxide (8). Among the workers never exposed, the mortality from diseases of the circulatory system reached an SMR value of 0.92 (95% CI 0.87-0.96), and for highly exposed workers the SMR was 0.96 (95% CI 0.86-1.07).…”

“…There have been reports of increased mortality due to ischemic heart Andersson et al disease among pulp and paper mill workers (1,(3)(4)(5), but myocardial infarction, specifically, has rarely been studied. Mill workers exposed to sulfur dioxide have been reported to have increased mortality from nonmalignant respiratory diseases and asthma (6,7), and also from lung cancer (8). Even rheumatoid arthritis has been found to be associated with pulp and paper work in a case-referent study from Sweden (9).…”

“…Data on mortality in relation to shift work in mills 4 and 5 (3) and cardiovascular mortality until 1992 in mills 1, 2, and 3 have been published earlier (4). Mills 1-3 were included in the IARC pulp and paper cohort study (8,13,14). With regard to asthma and exposure to sulfur dioxide, results from a questionnaire study for mills 5-8 have also been published earlier (15).…”

Cashew nut roasting: Chemical characterization of particulate matter and genotocixity analysis

“…Previous studies have observed association of increased lung cancer risk with occupational and environmental exposure to SO 2 (Lee et al, 2002;Tseng et al, 2012). DNA methylation has emerged as a promising biomarker for environmental-related diseases, including lung cancer.…”