Document 21V7pxBNXZMQGYzQaED42dz6

, Current Intelligence /- R&S 135394 Angiosarcoma of the Liver in Vinyl Chloride/Polyvinyl Chloride Workers In the December, 1974, issue of the IOM (76:809), 26 cases of angiosarcoma of the liver were reported. As of January 22, 1975, 38 cases have been collected. The new data are given in this report. J. William Lloyd, Sc.D. o n January 22, 1974, the National Institute for Occupational Safety and Health was advised of three deaths from angiosarcoma of the liver at a single vinyl chloride polymerization plant. Since that time, 29 additional cases among polymerization workers in the United States and nine other nations have been reported. Details are given in Table 1. Review c` these cases according to (date of diagnosis shows that all but three were diagnosed within the last seven years. Although the cases have clustered since that lime, it is probable that the high risk of this disease for polymeriza tion workers might have gone unnoticed except for the observation of a case in 1973 by a plant physician who reviewed earlier records and identified four cases during the prior ten-year period. The dif ficulty of making an early determination of an association of such a rare disease with an occupational exposure, even when the exposed worker is at very high risk, is also pointed up by the distribution of cases over time. Of the first eight cases diagnosed between 1961 and the end of 1968, six were from four plants in the United States, one was from France, and one was from West Germany. While an exact estimate of the in cidence of liver angiosarcoma among polymerization workers cannot he deter mined until cxposed-to-risk figures become available, it is already apparent that these workers are at very high risk of D:. Lloyd iv Dm-ilor, CMitr of OffupJhon.il Ilrjlth Surveillance and CiorTKirits. NlOSH, Rock* villi:, Md Rc-print lo Km 3*40, V00 fuhm Ijh?, Kofl.vilk*. Ml) 20052 Table 1, *-- Reported Cases of Angiosarcoma of the Liver Among Vinyl Chloride Polymerisation Workers. Country 1st VC DX Alt Tn 1st Cjw Birth or fVC AnfiO' At 1st Exp Yft Ko. D-iti Exposure Sarcoma DX To DX Exp Canada Canada Canada Canada 01 AWAITING DETAILS 02 AWAITING DETAILS 03 AWAITING DETAILS 04 AWAITING DETAILS Ci'cMwkja Czechoslovakia France Crejt Butam Great Britain Italy Norway Rumania S*edc.i United Stitts United States United States United States United Slates Untied States United States United States United States United States United States United Stales Unitrd Stales United States United States W. Crimjn/ W Germany W. Gerroiny W, Crrmar.y 01 AWAITING DETAILS 0? AWAITING DETAILS op 00 00-00 00 cooo 01* 00-0001 0000-16 03 06-00-37 0200-66 02- 11-13-20 0000 57 or 12-23-15 03 00 50 01 AWAITING DETAILS or 06-23-27 08 14-51 OP 1017-23 1209 48 02- 08-19 33 11-1555 03* 05-25-15 1 1-28 45 04* QMS 24 0705-52 05' 01-25-12 06-1944 OS' 00 00-29 01-17 62 07' 05 03 22 C3 C0-44 03' 0506-20 100745 09- 1108 31 05-03-54 to- 08-16-13 06 12-51 lr 05-27-09 10-1446 12' 11-17-18 09 1349 13- 12-01*21 08-1944 16' 1104-27 OSCE SO 17 05-06-31 C5 23 55 OP 07-26 31 13-14 57 02' 06-24-30 1001 57 04* 00 CO 00 CO COOO 05* 00 00 00 00 CO 00 00-00001 12-00 72 00 00-74 12-13-72 12-20 71 02 00-70 03-03-73 050070 12,19-73 08-19 67 * 04-09 $4 0200-74 00-00 63 03 DO-61 0301-74 05 03 68 03 0070 05 02-69 0500-74 00 00-69 10 11-74 09-25-70 09 19 63 C0-00 00 00 00 00 43 71 . 33 43 56 43 49 36 58 43 52 45 45 41 43 55 61 50 53 41 43 40 3S 44 49 19 19 26 20 34 IS 6 22 21 19 IS 22 16 14 13 28 28 IS IS 20 18 12 12 24 18 15 15 17 17 17 ' 17 23 23 20 ' 15 30 30 17 4 19 19 nu 13 13 17 It u 11 Tclal Reeled Cues =-*32 Median Vitus1 IS U,s Ciid? 10 Non US Cues 25 Total Cur, 45,0 190 170 43,0 16.0 12.0 44.0 17.0 16.0 Indicates microscopically confirmed angiosarcoma o( lh< liver. "00" Indicates unknown data. Journal of Occupational Mcdicine/Vol. 17, No. 5/M3y 1975 : Date of Doth 00-00 67 1200 72 12-24-74 1200-72 0104-72 10-20-70 03-03-73 69-28-71 12-19-73 010768 04-09-64 ALIVE ' 03-23 68 08-2961 ALIVE 05-1068 03-16-70 05 0269 ; 0704-74 03 2769 ' A1IVE 12-14-71 01-2569 0G 00 00 AllVE s' 333 * v Tibte 1 -- Reported Cases of Anjiosjrcomj cl the liver Amot Kan-Polyni!irtzation Workers Eiposed to Vinyl Chloride. Country lit VC 01 A| Trj let Cj-v Birth v PVC Anyi> At 1st tip In Dele of No. Date Capture Sjrc-jnj 01 To OX tip Death Great Britain Italy Sweden United States Untied States W. Germany 12- 00 03 14 C0-CCM5 02 00 70 55 01 OS-15-34 C0 00 65 04-13 71 35 02- 1127-11 00 00-45 05-15-72 61 H 00 00 13 03-13-33 OS-00-73 60 !5* 0000-25 00 00-00 07-00-72 47 03- QMS-30 00-00 GO 02 00 33 43 74 ii 63 27 . 23 36 00 00 00 14 14 12-00 70 Note I 04M5-71 Nate 2 i 7 03-16-72 Nate 3 07-03-73 Nate 4 l i 0215-73 Nate 5 10-10-73 Nate S Hot* 1 Pcurtnj PVC Oil mutur* onto (abnt basts Note 2 Production of PVC sacks Note 3 Production of V.n>1 Chloride ' Hots 4 Machine Operator cottrinj electrical wire with PVC plastic insulation /tote 5 Accountant at plant mahmj PYC fabric Note i Leading pestcidi cans with VC propellant Note 7 Angiosarcoma involving liver, lung, and pericardium. Although difficult to determine, primary site seems to be pericar dium. . Note ! Diagnosis: Sarcoma (possibly "angiosarcoma"), liver. Possibility cl feneraliced neoplasm o/ the reticuloendothelial ; cell system annot be ruled oul .r .____ ____. .... J, * Indicates microscopically confirmed angiosarcoma oj the liver. "00" Indicates unknown data. this disease. Approximately 5,600 men are coming from the older plants is seen are currently employed at 36 facilities in in the distribution by date of initial ex the United States. To date, 15 cases of posure. All but one case was initially angiosarcoma of the liver have been employed prior to 1958 and more than reported from four of these facilities, all 70% of the cases were initially employed of which have been in operation for 20 or more years ago. Since the average more than 25 years. Nine cases have latent period from first exposure to been reported from a single facility diagnosis is about 19 years, we would which employs less than 300 workers. A not expect to see many cases at this time further indication that the earliest cases from the newer plants. Preliminary findings from continuing epidemiological investigations of U.S. polymerization workers indicate that these men also may be at high risk for other malignant neoplasms, particularly of the brain where a significant excess has been noted. Details of reported cases of angiosar coma of the liver among other workers with exposure to vinyl chloride are shown in Table 2. It should be noted that in two of these cases primary angiosarcoma of the liver cannot be definitely confirmed. While too few Cases have been reported to draw any definitive conclusions regarding a cause and effect relationship, the age of diagnosi; for these cases, which like that for the polymerization workers is con siderably lower than that observed for cancer of the liver in the general population, suggests the possibility of a common etiology. It also should be pointed out that with such a rare disease it may be some time before we can determine whether workers exposed to lower levels of vinyl chloride are at ex cess risk for angiosarcoma of the liver or other malignancies. It is, therefore, im perative that the non-polymerization workers be kept under continued sur veillance. R&S 135395 334 Angiosarcoma of the Liver/Lloyd Translations Unit 135S9 , ______________U - I III'T ' PAHaEsoos M>jrai;xs 4 TZDZ3AL EZPIJTIIC usersicns cf ths o;:ianKOTs katshtajs cs-on BMA notification of 19 Kerch 1975 - Hlb i-^99.7 - 15S7//5 kefcronco: Artbnitsgchuts, -t Arrll 1975 R&S 135396 jy->o-;*cr*nded industrial concentration (TZ<) for vinyl chloride jfrte .Tvonxxended industrial concentration for vinyl chloride an iron 1-7.75 v-tlj-1 ! 5 ?px. The TkX Taluo ie to bo interpreted an the nnnrr.l conn. Tho ttUtin. <rrccentration over a period of 1 hour oust not exceed 3 tines the IEX Wwlus. Tp-e TCK value applies in particular to fields of activity involving: ia) rtbr production, recovery, storago, drawing-off, conveying and use of vcinyi chloride oonoaer tb) th.-e conversion of vinyl chloride into unshaped vinyl chloride polynors `.Crx* the production of l'VC) cc) shwling with unshaped vinyl chloride polyxers and their moulding *icpositions. -'1'.THK-value of 10 ppn will be lepoeed for cxieting plants for the conversion cef rvivyi chloride into unshopod vinyl chloride polynero (eg. the production rdf -t'ivi. Under a transitional arrangement a value of 20 ppa will b= allowed lie plants up to 1.7.76. 7fh< valuon for vinyl chlorido will be reviowoc at 1.1.77 end adapted to unrii i.hv otato of industrial development at that tine, toting account of the liviheci findings in the field of industrial cedicino. Grounds tTYtf d^ff-lve factor in eatabliching the T2X value (1) an an annual naan wan tthai '.vi;>y! chloride is currently rogarded iron the toxicological and industrial -fiandpointc as being a hnrxful substance with n prir-irily chronic node Ojf ^dird-n--* It is tberoforo admissible to use an r basis a lung tern aean csdWf a period of one year, assunirg an overage woriiing weeh of up to <5 hours. rl) /'-"'1-road definition eoel Tcchniccho EichV.onncntration ftlr gornbrlluho "-'t'setoffe (Hecoxnended industrial concentration for dcng-.roua x*tcriole) bf. A-.^chutc 097-0 No, 5. pp. 169-170 w- -2- The catablichcent of three tinea the TEii value as the naan concentration over 1 hour coto a licit cn panic loads. It also c-akoG allowanco,.^or the natural fluctuations in the concentration of harmful substances^ . The following were the decisive factors in ectahlinhlng tho cagaitude of TKK value: ft) The resulto of tho cteps already trJcon with regard to proceon and rontilntion tochnology, giving duo consideration to vhat is likoly to bo achieved*industrially in tho near futurei b) Tho facilities for tho analytical dotomination of the vinyl chloride conceatratio'uin tho vicinity of tho TK vnluo And for conitoriug anH recording it ^ . c) Tho fact that in the light of exporlcnceo to date in the industrial hygiono field, tho proposed TKX vnluo reducoa the rick of endangering health corps.red with tho working conditions used hithorto. (2) Tor industrial regulation on "Moacurerent planning, ataiietical anoeocnent" (in preparation) in escoelation wila "Soconuendationa for tho neasurenent and esooesront of toxic dustc" see -Staub-noinhslt Luft (1973) i Ko. 1, pp, 1-3 and Coonor. ti: "Hnosurooont ar.d osoossnont of the concentration of toxic dusto, j.nrtlculcrly thooo containing silica, in working areas in eurfaco industriec", Steub-Boinholt Luft 2X, 1971, lio. 12, pp, <2^90. (3) Brochure entitled "VC/TVC: Procedure;; for Safeguarding Health" published by the Vcrbnad iCunctatoffcrnougondor Industrie oV, rrenkfurt (1970. T\