Document 3Q8MVLLdY4D1O6ZVLVqvB8VzD

t Current Intelligence t Angiosarcoma of the Liver in Vinyl Chloride/Polyvinyl Chloride Workers In the December, 197-1, issue of the )OM (76 809) 26 cases of angiosarcoma of the liver were reported. As of lanuary 22, 1975. W cases have been collected, The new data are given in this report. ]. William Lloyd, Sc.O. s--Jn lanuary 22, 1974, the National Institute for Occupational Safety and Health was advised of three deaths from angiosarcoma of the liver at a single vinvl chloride polymerization plant. Since that time, 29 additional cases among polymerization workers in the United Slafps and nine other nations have been repotted Details are given in Table 1. Review of 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 time, 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 ftom 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 be deter mined until exposed-io-risk figures become available, it is already apparent that these workers are at very high risk ot f)r llmd i\ Director Other* *>t Hwilth <turvffl|jnrf> and Biorm*lncs MOSH. Rock* tlllr M<l kopnm ipquf\ to MOW. Rm J 40 VrfX) Ftshm LAOf RorkvHr MO TlMn L -- kidortid Cam* of Aniioarcami M the limr Ahmn| Viuyt CMaridd PolymdriiitiaN WwLirt Cmtr) 1st *C 01 AH In W Case Krth * me Anti* M tit t* T-S (Ute Inm Sarmni DX In M In CXvdl Ciwdj Ciwdi Cnnidi CndmtMAu CtKltosionta France but OritM but Italy Norway VtNniiNj Swlden United Sum Undid sum unM sum Undid Sum Undid SUm Undid StMB Untied Stain UniMd Sum Undid Sum Undid sum Undid sum Undid sum United states Undid Mu United Stitn W Germany W GiriMny W Gtrniny W Gtrmldy 01 AWAITING DETAILS 02 AWAITING DETAILS 03 awaiting on ails M AWAITING DETAILS 01 AWAITING DETAILS 07 AWAITING DETAILS or 00 00DO 000000 004040 43 1) Of 004041 004046 124072 71 26 03 0640 37 024066 0000 74 38 * i Of 1113 71 0040 57 1213 72 <3 15 Of 12 23 IS 0340 50 12 20 71 56 27 01 AWAITING DETAILS 01* 06 73 77 03 14 51 02 00 70 43 19 Of 1017 73 124)46 0343 73 49 22 Of 01 IS 33 II1555 05 00 70 36 14 :i 03' OS 7S IS 11 2*45 12,19-73 51 2* 04- 01 IS 24 0746 52 011)47 43 15 15 OS' 012512 061)44 04 0944 52 OS' 0040 2) 0117-62 0240 74 45 20 12 <'A69 07' 0543 22 0)0044 0040 61 45 24 ' f or 0506 20 104746 0)4041 41 15 A or 114131 0)4)54 0301 74 43 17 ;7 tr 0*1613 06 12 SI 05404* 55 17 j tf OS-274) 101448 0340 70 61 23 13 if 11171* 0)134) 05424) 50 20 15 tr 124121 011)44 0540-74 53 30 ]Q IG' 1144 27 05 0*50 00404) 4) IT i IT 4S46 3I 062355 1411-74 43 1) D Of 07 26-31 1014 57 0)75 70 40 It it Of 06 74 30 100157 0)1941 3* 13 13 04' OS' 004040 004040 004000 44 000040 004040 004040 4) 17 11 I I1 Mat lmW Cun=32 Man VUmi ts U S Ctm 10 Non U S Can 75 TtH dm 45.0 1)0 '.'0 43.0 160 12 0 44.0 17.0 ICO Indicates rmcimcooicaily confirmed anrourtoma of the liver. 00' Indicates unknown data Journal of Occupational Medieine/Vol. 17, No. 5/May 1975 mu w um 12 cr; 12 7* ** 12" - Off it:- 03 72 13 032? '! 1213 73 010'M 04-5? 54 4LI.E 03 7: E) 0*2361 ALIVE 05 12 -8 03 1* 70 OSCE 63 014* 74 0327 63 alive 121*71 01 27 9 004743 AfVE 333 SL 071254 / T*M* 2. -- IbparM Cam < ta{turcMu f the Unr tawi Non-f*l|(iwu>tiwi Mtrktri EipMtO t* Vinyl CMwM*. Cwittrf Great Britain Maly Sweden United States United States W Getmany til VC tl X* If* W Cm kirtb at PVC Ml* ftt 1* trt In Dali <1 Nr Dtf* (iKUfl Sarcoma 04 t* PI Eip Death 02* coot II 00 00-46 0200 70 55 24 11 1200 70 Holt 1 01 06 IS M 00-0045 04 1 9 71 36 6 3 04 16 71 Holt 2 t 7 02- 112711 000045 05 15 72 61 27 23 01 16 72 Note 3 14 00-00 13 Ot IS 38 06 00 73 60 36 00 0703 73 Holt 4 6 I is- 00-00 25 00 00 00 0700 72 47 00 00 02 15 73 Note 5 03* 07 16 30 oooooo 020041 13 14 14 1010 73 Nutt 6 Note 1 l*ot< 2 Not* 3 Note 4 Note $ Note 6 Note 7 Note 8 Povrmi PVC 0*1 nurture onto tibnc btui Products ot PVC uda Production Of Vinyl ChMridt Machine Operator covenni tkctrrcit we with PVC plastic i Accountant it plant matuft( PVC fabric Loatfinf pesticide cans with VC propellant An|iQMrcoma invotaR| butt, hint and pericardium Althoufh difficult to determine, primary site teems to be patear dium. Dtafnosis Sarcoma (pwstbty 'anpouravna"), liver Possibility of poerafieed neoplasm of the reticuioendotbefiof cell system cannot be ruled out * Indicates microscopically cc^'med inpcsarcomi of 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 ot tnese 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 Sine 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 \sorkers. A not expect to see many cases at this time further indication that tne 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 diagnosis tor 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 mav 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-polvmenzation workers be kept under continued sur veillance 334 Angiosarcoma of the Liver/lloyd SL 071255