Quantitative estimated exposure to vinyl chloride and risk of angiosarcoma of the liver and hepatocellular cancer in the US industry-wide vinyl chloride cohort: mortality update through 2013

Mundt, Kenneth A.; Dell, Linda; Crawford, Lori; Gallagher, Alexa E.

doi:10.1136/oemed-2016-104051

Cited by 54 publications

(57 citation statements)

References 31 publications

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“…The risk for both angiosarcoma of the liver and hepatocellular carcinoma increased for higher cumulative exposure. However, the actual incidence of angiosarcoma of the liver and hepatocellular carcinoma for workers employed after 1975 is lower than those employed before this time, with an increased latency period for the development of cancer in those employed after 1975 [45,53]. The link between liver cancer and VCM is now well established, with these results being witnessed in other studies, and further confirmed by the follow-up studies of these original cohorts [53][54][55][56].…”

Section: History Of Recognition Of Issues With Vcm and Setting Of Expsupporting

confidence: 67%

“…However, an increased risk of liver cirrhosis, which is a risk factor for hepatocellular carcinoma, as a result of exposure has been observed in other studies [52]. This was not confirmed by either the US or European cohorts [53]. The risk for both angiosarcoma of the liver and hepatocellular carcinoma increased for higher cumulative exposure.…”

Section: History Of Recognition Of Issues With Vcm and Setting Of Expmentioning

confidence: 58%

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Improving the Healthiness of Sustainable Construction: Example of Polyvinyl Chloride (PVC)

Petrović

Hamer

2018

Buildings

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Abstract:With the increasing emphasis on sustainable construction, it has become important to better understand the impacts of common materials. This is especially paramount with the introduction of the United Nations (UN) Sustainable Development Goals (SDGs) which call for more comprehensive evaluations, adding many aspects of social consideration to the issues of environmental sustainability, including human health. Polyvinyl chloride (PVC)/vinyl can be seen as a material with potential for significant adverse effects on a multiplicity of levels, and the construction industry is its single most significant consumer. This article presents a transdisciplinary review of adverse health impacts associated with PVC showing a number of issues: some that could be eliminated through design, but also some which appear inherent to the material itself and therefore unavoidable. The totality of issues revealed in relation to PVC presents a compelling case for a call for complete elimination of use of this material in sustainable construction.

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Section: History Of Recognition Of Issues With Vcm and Setting Of Expsupporting

confidence: 67%

Section: History Of Recognition Of Issues With Vcm and Setting Of Expmentioning

confidence: 58%

Improving the Healthiness of Sustainable Construction: Example of Polyvinyl Chloride (PVC)

Petrović

Hamer

2018

Buildings

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“…Rather than concluding that associations observed suggested possible links between volatile airborne contaminants and HCC, they instead dropped any qualification when singling out VCM exposure and HCC. Strangely, the associations in the logistic regression for VCM were strongest for the shortest latency period, which is inconsistent with established epidemiology [2]. Nor do the authors account for the most likely cause of increased occurrence – hepatitis C or B virus infection [7] 4 .…”

mentioning

confidence: 67%

“…Those data were compared with hepatocellular carcinoma (HCC) rates from 2 time frames: 2000–2013 and 2006–2013. The latency period for angiosarcoma of the liver (ASL) and HCC is much longer than the 7- to 13-year duration used in the study (36–48 years) [2]. The time between measurement and observation periods for HCC is far too short.…”

mentioning

confidence: 99%

Vinyl Institute Comments on Cicalese et al.: “An Ecological Study of the Association between Air Pollution and Hepatocellular Carcinoma Incidence in Texas”

Krock¹

2018

Liver Cancer

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“…Specifically, a study examining vinyl chloride exposure and HCC risk reported that the median latency for HCC deaths was 48 years (range 31.5-66.6) [3]. Due to this, the exposure time points evaluated in this analysis are likely biologically irrelevant and inappropriate, as any impact on disease would not yet have been clinically diagnosed or detected.…”

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confidence: 99%

Methodological Limitations to the Analysis by Cicalese et al.

Marsh

Towle

2018

Liver Cancer

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Dear Editor, This letter is in response to the article "An ecological study of the association between air pollution and hepatocellular carcinoma incidence in Texas" by Cicalese et al. [1], where the authors used nonparametric generalized additive logistic regression and gamma regression models to examine the association between county-level concentrations of air pollutants and hepatocellular carcinoma (HCC) incidence rates, concluding that vinyl chloride is a significant contributor to the incidence of HCC in Texas. We believe that these findings are unsubstantiated and misleading given the severe methodological limitations of the paper that we describe below.As an ecological study, this study is limited by measuring both exposure and outcome at the population level rather than the individual level. Ecological studies are useful for generating hypotheses but are severely limited in their ability to establish causality given their many methodologic problems, including the lack of adequate data, uncontrolled confounding, specification bias, aggregation bias, multicollinearity, and temporal ambiguity [2]. In addition, several potential confounders were not considered by the authors. Therefore, the findings may be a statistical artifact of uncontrolled confounding. For example, gender, race, alcohol use, type II diabetes, and smoking are all important risk factors for HCC that were not included in the model analyses. While the authors did include an obesity term, the reported findings could have been influenced by heterogeneity and the distribution of uncontrolled risk factors at the county level.The authors' attempt to lag exposure by using National Air Toxics Assessment ( However, these time points (range 1-17 years) do not allow for sufficient induction and latency periods for HCC. Specifically, a study examining vinyl chloride exposure and HCC risk reported that the median latency for HCC deaths was 48 years (range 31.5-66.6) [3]. Due to this, the exposure time points evaluated in this analysis are likely biologically irrelevant and inappropriate, as any impact on disease would not yet have been clinically diagnosed or detected.By crudely assigning exposure values at the county level, the NATA data is a spatially diluted average value that is not an adequate representation of exposures at more refined, local levels, such as residences. Specifically, the "EPA suggests that the results of (NATA) be used cautiously… (and) (i)n many cases more localized assessments, including monitoring and modeling, may be needed to better characterize local-level risk" [4]. Regarding the 1996 NATA data, the "EPA strongly cautions that these modeling results should not be used to draw conclusions about local exposure concentrations or risk" [5].

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Quantitative estimated exposure to vinyl chloride and risk of angiosarcoma of the liver and hepatocellular cancer in the US industry-wide vinyl chloride cohort: mortality update through 2013

Cited by 54 publications

References 31 publications

Improving the Healthiness of Sustainable Construction: Example of Polyvinyl Chloride (PVC)

Improving the Healthiness of Sustainable Construction: Example of Polyvinyl Chloride (PVC)

Vinyl Institute Comments on Cicalese et al.: “An Ecological Study of the Association between Air Pollution and Hepatocellular Carcinoma Incidence in Texas”

Methodological Limitations to the Analysis by Cicalese et al.

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