Mortality patterns among industrial workers exposed to chloroprene and other substances

Marsh, Gary M.; Youk, Ada O.; Buchanich, Jeanine M.; Cunningham, Michael; Esmen, Nurtan A.; Hall, Thomas A.; Phillips, Margaret

doi:10.1016/j.cbi.2006.08.012

Cited by 15 publications

(73 citation statements)

References 37 publications

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“…For categorical analyses of cumulative and maximum DWA exposures, approximate quartiles of the case distribution were used to select cutpoints (560, 2600 and 10 000 μg/m 3 -days for cumulative and 4.1, 24 and 60 μg/m 3 for maximum exposure), as is common in categorical analyses 16. For mean exposure, approximate quintiles of the case distribution (with cutpoints at 2, 8, 16 and 35 μg/m 3 ) were used to permit better evaluation of low-exposure associations.…”

Section: Methodsmentioning

confidence: 99%

Risk of lung cancer associated with quantitative beryllium exposure metrics within an occupational cohort

et al. 2010

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Objectives Beryllium has been identified as a human carcinogen on the basis of animal and epidemiological studies. The authors recently reported updated associations between lung cancer and beryllium exposure in a large, pooled occupational cohort. The authors conducted the present study to evaluate the shape of exposureeresponse associations between different exposure metrics and lung cancer in this cohort, considering potential confounders (race, plant, professional and short-term work status, and exposure to other lung carcinogens). Methods The authors conducted Cox proportional hazards regression analyses of lung cancer risk with cumulative, mean and maximum 'daily weighted average' (DWA) exposure among 5436 workers, using age-based risk sets. Different exposureeresponse curves were fitted to the exposure metrics, including categorical, power, restricted cubic spline and piecewise log-linear fits. Results The authors found significant positive associations between lung cancer and mean (p<0.0001) and maximum (p<0.0001) exposure, adjusting for age, birth cohort and plant, and for cumulative (p¼0.0017) beryllium exposure, adjusting for these factors plus short-term work status and exposure to asbestos. The best-fitting models were generally categorical or piecewise log-linear, with the steepest increase in lung cancer risk between 0 and 10 mg/m 3 for both mean and maximum DWA exposure and between 0 and 200 mg/m 3 -days for cumulative DWA exposure. The estimated mean DWA beryllium exposure associated with 10 À3 excess lifetime risk based on the piecewise log-linear model is 0.033 mg/m 3 . Conclusion This study provides evidence that lung cancer risk is elevated at levels near the current US Occupational Safety and Health Administration beryllium exposure limit of 2.0 mg/m 3 DWA for workers.Beryllium exposure has long been associated with an immune-mediated, granulomatous lung disease termed chronic beryllium disease. 1 Toxicological and epidemiological studies have more recently led the International Agency for Research on Cancer to designate beryllium as a human carcinogen. Epidemiological evidence for the carcinogenicity of beryllium derives largely from studies within a pooled cohort of male workers 4 5 at seven US beryllium processing plants, and a nested casee control study of lung cancer at one of the plants. 6 7 We recently reported updated associations between cumulative and maximum beryllium exposure and several diseases of a priori interest (including lung cancer), within a three-plant subcohort having detailed beryllium exposure data. 5Although smoking data were available for only a subset (25%) of cohort members, the positive exposureeresponse associations observed in that study showed little evidence of confounding by smoking, as measured by indirect methods.The present study was conducted to evaluate the association of mean, maximum and cumulative beryllium exposure with lung cancer mortality, considering potential confounders, including age, race, birth cohort, exposure to other lung ca...

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Section: Methodsmentioning

confidence: 99%

Risk of lung cancer associated with quantitative beryllium exposure metrics within an occupational cohort

et al. 2010

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“…The causes of death were ascertained from French national records, with SMR based on national mortality rates calculated via the Occupational Cohort Mortality Program (OCMAP) developed by the authors. ( 1 ) Internal analyses for respiratory cancer were performed using RR regression models to compare higher‐exposure categories with those with the lowest level of exposure. Analyses for lung cancer were also conducted using lag periods of 5 or 15 years.…”

Section: Summary Of Individual Studiesmentioning

confidence: 99%

“…Furthermore, the reference categories had substantially lower mortality compared with national rates (SMR 0.64–0.76), making these weak baselines for comparison. ( 7 )…”

Section: Summary Of Individual Studiesmentioning

confidence: 99%

“…However, the baseline exposure groups for the RR analysis had significantly lower lung cancer mortality (SMR 0.47–0.54) compared with national rates, making these weak baselines for comparison. ( 7 )…”

Section: Summary Of Individual Studiesmentioning

confidence: 99%

“…In fact, early production processes using acetylene produced vinyl chloride (a known liver carcinogen) as a by‐product. ( 1 ) Concerns about cancer were exacerbated when early Soviet studies suggested increased risks of skin and lung cancer among workers exposed to chloroprene monomer. These early studies were essentially case series with serious methodological flaws and were later retracted by the Soviet Ministry of Health.…”

Section: Introductionmentioning

confidence: 99%

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Epidemiologic Evidence for Chloroprene Carcinogenicity: Review of Study Quality and its Application to Risk Assessment

Bukowski¹

2009

Risk Analysis

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This article evaluates the quality and weight of evidence associated with epidemiologic studies of cancer among occupational cohorts exposed to chloroprene. The focus is on liver, lung, and lymphohematopoietic cancers, which had been increased in early studies. Literature searches identified eight morbidity/mortality studies covering seven chloroprene-exposed cohorts from six countries. These studies were summarized and their quality was assessed using the 10 criteria suggested by the U.S. Environmental Protection Agency. The limitations within this literature (primarily the early studies) included crude exposure assessment, incomplete follow-up, uncertain baseline rates, and uncontrolled confounding by factors such as smoking, drinking, and co-exposure to benzene and vinyl chloride. Four cohorts were studied by the same group of investigators, who reported no overall increased associations for any cancers. This four-cohort study was by far the most rigorous, having the most comprehensive exposure assessment and follow-up and the most detailed documentation. This study also contained the two largest cohorts, including an American cohort from Louisville, Kentucky, that ranked at or near the top for each of the 10 quality criteria. There was evidence of a strong healthy worker effect in the four-cohort study, which could have hidden small excess risks. Small increased risks were suggested by internal or company-specific analyses, but these were most likely caused by uncontrolled confounding and low baseline rates. Overall, the weight of evidence does not support any substantial link between chloroprene exposure and cancer, but inconsistencies and a lack of control for major confounders preclude drawing firmer conclusions.

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Classification of worker exposures

Esmen

Kennedy

Hall

et al. 2007

Chemico-Biological Interactions

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Mortality patterns among industrial workers exposed to chloroprene and other substances

Cited by 15 publications

References 37 publications

Risk of lung cancer associated with quantitative beryllium exposure metrics within an occupational cohort

Risk of lung cancer associated with quantitative beryllium exposure metrics within an occupational cohort

Epidemiologic Evidence for Chloroprene Carcinogenicity: Review of Study Quality and its Application to Risk Assessment

Classification of worker exposures

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