Document 44V84Eqro6nznbbyRVz8mexE1

,\tin i iu.i itj st'AHY 31, IV76 ANGIOSARCOMA OF TIIK UVKR IN P.V.C. FARKICATORS Sir, Since the beginning of 1974 a number of ease* of the rare tumour angiosarcoma of the liver have been reported amongst worsen exposed to high concentrations of vinyl chloride, a chemical used to nnnufacturc the plastic polyvinyl chloride (p.v.c,), Exposure to much smaller amounts of vinyl chloiide may also occur when the raw iw.r., is vised to fabri cate plastic articles, av residual amounts of untreated vinyl chloride may then be released. Hpidcrmofugicn) $iuJ:*:s of r.v.<\ manufacturers have been set up in several countries, and the risk of occupational exposure to different level* of vinyl chloride will eventually be evaluated, but it is not known whether there is any risk to iw.g. fabricators. 'Hie Ortke of Population Censuses and Surveys (O.I'.C.S.) categorises per sons employed i.t extruding, moulding, tuning, and turning or otherwise machining plastics/ which includes r.v.c. fabri cators, under the title of "workers in plastics" (occupational unit code 90). An analysis of death certificates for workers in this category should be a guide to the mortality pattern of plas tics workers overall and, by inference, to the effects of \inyi chloride in P.v.c. fabricators. The last published rates for plastics workers showed no sig nificant excels nf deaths in any of the given disease categories, the standardised mortality ratio being 7K.3 4Uecause the figures for 1971 arc not yet available we decided to undertake a pro portional-mortality study using death certificates for 1970-72 to detect any recent change m the pattern of mortality which may have occurred and he ascribable to vn) l-chloride expo sure. Death certificates fur male plastics workers, 1970-72, were coded by the O.lkC.S. according to the International Classifi cation of Diseases, eighth revision. Age-standardised propor tional-mortality ratios were calculated for each cause of drjth in ten-year age-groups, expected rates being obtained from mortality data for England and Wales for each yc..r under study.' Approximately 60 000 men were recorded as plastics workers at the last England and Wales population Census* About 35 000 of these (60%) arc thought to be partly or w holly engaged in working with iw.c. (based on H.M. Factory In spectorate records for 1S75). As shown in the table the only statistically significant excesses for the causes of death were stomach cancer and dis eases of the urogenitary system. I he number of deaths due to .`ill cancer? were slightly higher than expected but there w-.x u deficit of lung cancer and only 1 death from liver cancer (certi fied as primary carcinoma), '("here were 3 deatns from liver dis ease, with 3-6 expected. The deaths from diseases of the urogcniiar> system were analysed further into those due to nephritis and nephrosis (I.C.I), 5fcO-$K4), there were 10 deaths in ihis category with 5-6 iwjK'Cird, a dilJcinicc which did not ({title attain significance at the .VI level Fewer de.ahs than expected were allubuted to neoplasms of lymphatic and hiunopoietic til sue, . The excess deaths from cancer of the stomach and diseases of the urogenitary system were surprising because vinyl 1 Oilier nf Population Cermnet and Survey* CUluhcmion of Occupation* It Vt Simmun 0;t,ct. )V70. 2 Kepmrar Central Ofse-miia! Supplement Pn^lanri ai.J Wain 196) ocrup#- ) | ) )iioTi.il miculii, uSie* MM StJtmne-rv OfSet, 1971. RrpMrur (1-nrr.1I, SlotiMi, jt Rcvir* , if npIanJ unJ VC Kiri for 970, V71. IU>J )V?v i. table*. rr.rjifd! I| V. Siki,,M.-r* (Wife 4 OiIili- nf I`o,',.l*iurn t .ni'.ofi und S, -i e\ (j-nsuv 197 1, Crrrft Urn *<( eco nomic namti tbHr* part id, 10', winpic M M Stationery Ofti*e. )9I}. **! Fil,: K-nn-Ootj) ticnu>] 2-4 J MAI I f'l AVIJt.l WOAAf *V iM7m m*om ai I cm x> x )970 72 1!iuk of Uf Jlh 1 C !> no ) All oturrv fM(> 7JV) St..... v)Jlj 1 ,ivcr (iSii 1 m* (Uil l It'jih (1 i 1 \ 1 Mrplwin.,/)i^iii*`|>.irtu. *0J) I'n.t.Kf/nuir .'.'411 27VJ C iriii)j|jiy rtOU 4VX` Iwli^mu (410 414; Kespu 4try (4f,(t >1*1, Hfun.'hiUv (4V0 4VJ; D.^r.tive (S20 J7I) l Ier (570 S7V) t'rn^e.-Hlary* i'X(t (>}'*) AtoJtnik (l.XUa 949, SuixiJrv a.V'P VSV; AU tit!><t 4jvm All >bv to; l-.p (h) :u4 Ui-v 74 M. 4 1M NX yv t 5 s > > 15 2 4 67 u* Uf. 0 :js ;>x-o 77 60 0 42 >4 4 14 P-1 3 ^ f. 1' 6 > 74 ^ 6 J ]1 X 19 2J 1 707 7uT 0 0/1 HO 05 chloride has not so far Ken hnket with either of ihcsx lions. However, u wide range of other chemical substances is used in the plastics industry, some of which may eventually prove to he carcinogenic or nephrotoxic and giving rise to these excesses. When interpreting a studs of this kind it must be remembered that a proportional excess in a disease category may nut reflect a real increase in death-rates over u compara tive population, hut may also arise if there is a deficiency of deaths in other categories in lhr study group. Vinyl chlorue has Ken suggested is causing cancrr nf the lung and brain/ as well ns angiosarcoma of the liver and other liver diseases.** In this study the observed numbers of deaths front these causes were not in excess of those expected. Any excess mortality from these causes which may be present in p.v.C. fabricators is consequently not large enough to be detected amongst plastics workers as a group. 'n*i& is not to say that there is no excess risk; this study w ax undertaken to assess the order of magnitude of any excess ri*k nx quickly as pos sible. However, recent studies of p.v.c. manufacturer* also show little indication of an excess risk of lung and brain cancer associated with exposure to vinyl chloride.1 2* Health anJ Safety 1 ntcuhvc, Lmpoyrnenl Mc\Ik<i1 Ailwwry Service, I Chej'Mu* Plate, I^uruli'n 'w.'} 4'J V, OfTke of Population Cer>y,j>o ;*iid Surveys, Mclo-al StaliWus Dmiiyn, Si Catherine IPmse, 10 kin^ni), Umdon NXC2H 6JP. J. liim A. J. I'f'x. 5. M.rW 'ft, K K , Peir/>, J M,, Jyhmurt, M S' Luni ft, ] 974. i, 3V7, 6 Tlur-M, 1. H , Porter, H , lierfc, I*. I),, SrtifctA, {,, 1 a!it. H .N'eu i ngl 7 MrJ )V?5. 292, 17 7 J7u,'X. it W . C.*ncr. J T., CnornSei, h J /.w'l. e.\ I '>7 }, n, J)97 X I u*. A J , Collier, P I . '1 he .Mortal,;y l j*iof V\ p,*kcr\ t p.*.r,J jo Vinyl Chiuride Monomer m the Mmoij^ture of Polyn>)'I C.fJ,.(i.ie m (,rrl H.-ilam (L npubliiheJ } R&S 026837