Document 4JJ2o8VeodzBj2RLD50ev8Qjj
EXHIBIT
WCD-252
AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 44:63-59 (2003)
An Update of a Mortality Study of Talc Miners and M illers in Italy
Maurizio Coggiola, m d, 1* Davide Bosio, m d, 1 Enrico Pira, m d ,1 Pier Giorgio Piolatto, m d ,1 Carlo La Vecchia, m d,23 va Negri, PhD,3
Marco Michelazzi, md,4 and Alessandro Bacaloni, pkd5
Background While talc containing ashestiformfibers is considered a human carcinogen, only limited animal and human data are available on non-asbestiform talc. To provide further evaluation on the issue, we updated the analysis o f an Italian cohort o f talc miners and millers in Val Chisone; talc found here is free from asbestiform fibers. M ethods The cohort was comprised o f1,795 men who had workedfo r at least 1year in the mine and/or in thefactory between 1946 and 1995. Vital status and death certificates were obtained from registration offices in the municipality o f death or o f birth. Employment, termination o f employment, and detailedjob history were obtainedfrom personnel records at the plant. Results No excess was found fo r total cancer mortality, nor mortality fo r lung cancer. No case o f mesothelioma was reported. There was a significant excess mortality from non-neoplastic respiratory diseases (SMR 228.2, 95% Cl 190.2-271.5). Mortality excess fo r non-neoplastic respiratory diseases was mainly due to silicosis. Conclusions This study provides additional support fo r an association between talc in mining and milling and non-neoplastic respiratory diseases, while showing no significant excess risk fo r lung cancer and mesothelioma. The results also provide additional information o f interest to evaluate the potential association between silica and lung cancer. Am. J. Ind. Med. 44:63-69, 2003. 2003 Wiley-Liss, Inc.
KEY WORDS: cohort mortality study; talc; silica; miners and millers; mesothelioma; lung cancer
INTRODUCTION
' Dipartimento di Traumatologia, Ortopedia e Medicina del Lavoro dell'Universit di Torino, Turin, Italy
is titu to di Statistica Medica e Biometria dell'Universit di Milano, Milan, Italy is titu to di Ricerche Farmacologiche "Mario Negri" di Milano, Milan, Italy 4Scuoia di Specializzazione in Medicina del Lavoro dell'Universit di Siena, Siena, Italy 5Dipartimento di Chimica dell'Universit di Roma La Sapienza, Rome, Italy Institution at which the work was performed: Dipartimento di Traumatologia, Ortopedia e Medicina del Lavoro dell'Universit degli Studi di Torino. ` Correspondence to: Maurizio Coggiola, Dipartimento di Traumatologia, Ortopedia e Med icina del Lavoro dell'Universit di Torino, Via Zuretti 29,10126 Torino, Italy. E-mail: maurizio.coggiola@unito.it
Accepted 19 March 2003 D0110.1002/ajim.10240. Published online in Wiley InterScience (www.interscience.wiley.com)
Talc is a silicate with a lamellar structure that can be contaminated with other minerals including asbestiform fibers. That is the reason why a former definition was ``fibrous talc."
While talc containing asbestiform fibers is considered a human carcinogen [IARC, 1997], only limited animal and human data are available on the potential carcinogenic effect of non-asbestiform talc.
Lung cancer and pleural mesothelioma have been the main sites considered in occupational cohort studies of nonasbestiform talc. Of these, three showed no excess risk. A historical cohort study of 1992 talc miners and millers in Italy followed between 1946 and 1974 showed a standardized mortality ratio (SMR) of 47 among miners and 66 among millers for lung cancer, and no cases of pleural mesothelioma
2003 Wiley-Liss, Inc.
64 Coggiola et al.
[Rubino et al., 1976, 1979]. A study of 392 workers from Vermont, US [Selevan et al., 1979] and one of 389 workers from Norway [Wergeland et al., 1990] found no excess risk for millers, but some excess for miners, which may however be related to radon exposure. A study o f2,055 pottery workers from the US, in contrast, showed an excess lung cancer mortality (relative risk (RR): 2.5) among workers exposed to non-fibrous talc plus silica [Thomas and Stewart, 1987].
To provide further evaluation on the issue, we updated the analysis of the Italian cohort of talc miners and millers in Val Chisone, Turin [Rubino et al., 1976,1979], in which the talc was free from asbestiform fibers [Verdel et al,, 1983; Parkes, 1994], The large size of the cohort and the uniquely long follow-up allow separate analyses by job title, besides detailed considerations of latency and other time factors. The presence of data on exposure levels between 1946 and 1975 [Rubino etal., 1976] and between 1990 and 1995 allow further considerations.
SUBJECTS AND METHODS
(n = 1,244) were all men who worked in the mine only, or with mixed exposure in the mine and in the plant. The job category defined as "millers" comprised millers and other workers of the plant only (n = 551).
RESULTS
Table I gives observed and expected death and the corresponding SMR for all causes of death, selected cancer sites and other major non-neoplastic causes of death. Total mortality was significantly higher than expected (880 observ ed vs. 735 expected, SMR 119.7, 95% Cl 111.9-127.9).
There was no excess mortality for all cancers (185 observed, 186.5 expected, SMR 99.2, 95% Cl 85.4-114.5). No deaths were seen from pleural or peritoneal mesothelio mas, and there was no excess deaths from lung cancer (44 observed, 46.9 expected, SMR 93.8, 95% Cl 68.1-125.9).
A significant excess mortality was found from oral cavity cancer (31 observed vs. 6 expected, SMR 514.4, 95% Cl 349.4-730.1) and esophageal cancer (10 observed,
The cohort was comprised of 1,974 men who had worked for at least 1 year in the mine and/or in the factory between 1946 and 1995. After exclusion of 179 men with no follow-up information, the analyses were based on 1,795 subjects (90.9% of the total).
Dates of birth, employment and termination of employ ment, the last known address and detailed job history were obtained from personnel records at the plant. No information was available on smoking habits. Death certificates were ob tained from registration offices in the municipality of death.
Further verification of vital status was obtained from registries of current residence.
For the present analysis, the follow-up began 1 January 1946 and ended at 31 December 1995. A total of 880 deaths and 50,701 man-years were documented.
DATA ANALYSIS
The expected number of deaths from all causes, selected cancer sites and other selected non-neoplastic conditions were computed using national and regional death rates for each 5 year calendar period and age group. Regional rates were provided by the Regional Cancer Register of Piedmont for the period 1970-95, and national death rates were used before 1970. Rates for the early 1950s were applied to the period 1946-49. No regional rates for cancers of the oral cavity and esophagus and for suicides were available; national rates were also used after 1970.
We computed SMRs (SMR = observed/expected x 100) and the corresponding 95% confidence intervals (Cl) [Breslow and Day, 1987]. We also computed observed and expected numbers by year of first employment, duration of employment, and type of job (miners and millers). Miners
TABLE I. Total Mortality and Selected Causes of Death in a Cohort of Talc Minersand Millers inVal Chisone,Italy,1946-1995
0BS EXP SMR
95%Cl
All causes
880 735 119.7 111.9 127.9
All cancers
185 186.5 99.2 85.4 114.5
Oral cavity
31 6 514.4 349.4 730.1
Esophagus
10 4.7 212.9 101.9 391.6
Stomach
31 26.8 115.5 78.5 164
Intestines
13 19.9 65.4 34.8 111.8
Liverandgall bladder
10 8.6 116.6 55.8 214.5
Pancreas
7 6.2 112.7 45.2 232.3
Peritoneum
0 0.9 0
0 393.8
Larynx
8 7 115 49.5 226.7
Lung 44 46.9 93.8 68.1 125.9
Pleura
0 1.8 0
0 206.9
Connectival sarcoma
1 0.2 469 6.1 2609.3
Skin 3 1.6 183.1 36.8 535
Prostate
6 10.5 57.3 20.9 124.7
Bladder
1 8.7 11.5 0.2 64
Kidney
1 2.9 33.9 0.4 188.9
NonHodgkinlymphomas 2 2.9 69.7 7.8 251.8
Hodgkin's disease
0 1.8 0 0
204.7
Leukemia
5 7 71.7 23.1 167.4
Diabetes
5 11.0 45.3 14.6 105.8
Cardiovasculardiseases
288 309.2 93.2 82.7 104.6
Ischemicheartdisease
88 101.6 86.6 69.5 106.7
Cerebrovasculardisease
60 90.2 66.5 50.8
85.7
Respiratorytractdiseases 127 55.7 228.2 190.2 271.5
Digestivetractdiseases
79 55.5 142.2 112.6 177.3
Cirrhosis
55 31.2 176.3 132.8 229.4
Injuries
49 49.2 99.6 73.7 131.7
Mortality Study of Talc Workers in Italy
65
4.7 expected, SMR 212.9,95% Cl 101.9-391.6). There was similar for miners and millers. Conversely the excess in all
a non-significant excess mortality from stomach cancer causes mortality and particularly respiratory tract diseases
(31 observed,26.8expected,SMR 115.5,95%CI 78.5-164). were confined to miners only.
With reference to non-neoplastic causes of death, there
Table II gives corresponding stratified analysis for
was a significant excess mortality from respiratory tract miners and millers.
diseases (127 observed, 55.7 expected, SMR 228.2, 95% Cl
The excess risk for miners is attributable to silicosis
190.2-271.5), from digestive tract diseases (79 observed, (58 silicosis observed in miners compared to 4 in millers).
55.5 expected, SMR 142.2,95% Cl 112.6-177.3), and from No increase in mortality from lung cancer was seen in miners
liver cirrhosis (55 observed, 31.2 expected, SMR 176.3, or millers.
95% Cl 132.8-229.4). Mortality excess for non-neoplastic
Table III shows mortality by duration of exposure. For
respiratory diseases was mainly due to silicosis (62 deaths). lung cancer, no significant increase in mortality was found in
In fact, excluding silicosis from deaths for non-malignant the four duration levels (less than 10 years--SMR 135.8,
respiratory disease, the SMR was 116.6 (95% Cl 97.1 -- between 10 and 19 years--SMR 66.7, between 20 and
138.5). The SMR was 93.2 for cardiovascular disease, 29 years--SMR 94.1, over 30 years--SMR 73.2). For oral
86.6 for ischemic heart disease, 66.5 for cerebrovascular cavity cancer, the SMR was significantly elevated in the
disease. For 62 subjects, the cause of death was unknown or exposure category under 20 years and over 30 years, and for
undefined.
esophageal cancer a significant SMR was seen in the group
The excess mortality from cancers of the oral cavity and between 10 and 19 years of exposure, in the absence,
esophagus, digestive tract disease, and liver cirrhosis was however, of any trend in risk with duration. The excess in
TABLE II. Total Mortalityand Selected Causes ofDeathinaCohortofTalc Minersand MillersInVal Chlsone, Italy,1946-1995 byJob Category
Miners
Millers
0BS EXP SMR
95% Cl
DBS EXP SMR
95%Cl
All causes All cancers
Oral cavity Esophagus Stomach Intestines Liverandgall bladder Pancreas Peritoneum Larynx Lung Pleura Connectlval sarcoma Skin Prostate Bladder Kidney NonHodgkinlymphomas Hodgkin's disease Leukemias Diabetes Cardiovasculardiseases Ischemicheartdisease Cerebral vasculopathy Respiratorytractdiseases Digestivetract diseases Cirrhosis Injuries
590 130 24
7 20 11 4
4 0 7 33 0 1 2 3 0 1 0 0 4 2 177 56 42 105 50 37 34
466.8 120.6
3.9 3 16.8 12.9 5.4 4.1 0.6 4.5 30.9 1.2 0.1 1.1 6.5 5.6 2.2 1.9 1.2 4.6 7 192.8 64.7 55.5 34.4 36 20.5 33.2
126.4 107.8 611.8 231.9 119.2 85.5 73.7 98.7
0 154.1 106.7
0 699.2 188.2
46 0 46.3 0 0 87.8 28.7 91.8 86.5 75.7 305.2 138.9 180.3 102.4
116.4 90.1 391.8 92.9 72.8 42.6 19.8 26.5
0 61.7 73.4 0 9.1 21.1 9.2 0 0.6 0 0 23.6 3.2 78.8 65.3 55.5 249.6 103.1 127 70.9
137 128 910.3 477.8 184.1 152.9 188.6 252.6 599.6 317.6 149.9 312 3890.3 679.4 134.4 65.9 257.7 192.9 302.6 224.7 103.5 106.4 112.3 102.3 369.5 183.1 248.6 143.1
290 55 7 3 11 2 6 3 0 1 11 0 0 1 3 1 0 2 0 1 3 111 32 18 22 29 18 15
268.3 65.6 2.1 1.7 10.1 7 3.1 2.2 0.3 2.4 16 0.6 0.1 0.6 4 3.1 1.1 1 0.6 2.4 4.1 116.4 36.9 34.7 21.3 19.5 10.7 16
108.1 83.4 332.7 178.8 109.4 28.5 190.8 139.2
0 41.4 68.8 0 0 173.8 75.3 31.9 0 206.9 0 41.4 74 95.4 86.8 51.9 103.5 148.4 168.4 93.8
96 62.8 133.3 35.9 54.5 3.2 68.7 28 0 0.5 34.3 0 0 2.3 15.1 0.4 0 23.2 0 0.5 14.9 78.5 59.4 30.7 64.8 99.4 99.8 52.5
121.3 108.6 685.6 522.5 195.7 102.8 415.3 406.7 1147.1 230.6 123 614.6 5224.2 966.7 220.1 177.5 327.2 747.1 632.8 230.5 216.2 114.9 122.6 82 156.7 213.2 266.2 154.7
66 Coggiola et al.
TA B LE III. Total Mortality and Selected Causes of Death in a Cohort of Talc Miners and Millers inVal Chisone, Italy, 1946-1995 by Duration of Exposure
< 10years(n= 519)
10--19years (n --421)
20-29years(n = 504)
>30 years(n= 351)
OBS SMR 95%1C OBS SMR 95% 1C OBS SMR 95%1C OBS SMR 95% 1C
All causes
212
All cancers
47
Oral cavity
10
Esophagus
2
Stomach
4
Intestines
3
Liverandgallbladder
2
Pancreas
0
Peritoneum
0
Larynx
2
Lung 15
Pleura
0
Skin 0
Connectival sarcoma
0
Prostate
0
Bladder
1
Kidney
0
NonHodgkinlymphomas 0
Hodgkin's disease
0
Leukemias
3
Diabetes
1
Cardiovasculardiseases 66
Cerebral vasculopathy
11
Respiratorytractdiseases 23
Digestivetractdiseases 18
Cirrhosis
13
Injuries
18
Suicide
2
134.7 117.2 154.1 221 113.6 83.4 151.1 50 713.5 341.6 1312.2 11 198.6 22.3 717.1 4 77.3 20.8 197.9 9 70.1 14.1 204.9 4 110.4 12.4 398.7 5
0 0 258.0 3 0 0 1598.4 0 126.6 14.2 457.1 0 135.8 75.9 223.9 6 0 0 857.6 0 0 0 902.1 2 0 0 6222.6 0 0 0 199.8 1 57.3 0.7 318.6 0 0 0 461.5 0 0 0 475.4 1 0 0 632.6 0 175.9 35.4 514.0 1 46.1 0.6 256.8 1 113.4 87.7 144.3 70 69.2 34.5 123.9 13 225.3 142.7 338.0 27 139.0 82.4 219.8 22 173.6 92.4 296.9 17 110.6 65.5 174.8 14 88.4 9.9 319.2 6
138.2 120.6 157.7 300 130.6 96.9 172.2 53 846.6 422.0 1514.9 5 399.1 107.4 1021.9 4 141.7 64.7 269.1 10 110.0 29.6 281.6 3 247.7 79.8 578.1 2 245.0 49.2 715.8 0
0 0 1875.2 2 0 0 256.3 5 66.7 24.4 145.3 15 0 0 1195.2 0 545.8 61.3 1970.7 1 0 0 8646.7 0 50.7 0.7 281.8 2 0 0 227.4 0 0 0 571.8 1 161.3 2.1 897.2 1 0 0 771.9 0 69.6 0.9 387.0 0 45.6 0.6 253.7 3 107.1 83.5 135.3 108 68.6 36.5 117.3 24 223.3 147.1 324.9 53 174.7 109.4 264.4 22 250.1 145.6 400.4 15 115.9 63.3 194.4 11 324.8 118.6 706.9 2
112.6 80.7 244 241.3 101.2 41.4 66.7 0 93.4 207.3 94.1 0 183.3 0 47.9 0 91.3 109.6 0 0 72.5 91 67.5 246 114.3 140.6 79.1 93.8
100.2 126.1 60.4 105.5 78.6 569.4 64.9 617.7 48.4 186.1 8.3 120.9 7.5 240.7 0 1170.6 10.5 337.1 66.8 483.8 52.6 155.2 0 600.7 2.4 1019.7 0 5460 5.4 173 0 112.7
1.2 507.8 1.4 609.6 0 728.1 0 153.5 14.6 211.7 74.6 109.9 43.2 100.4 184.3 321.8 71.6 173 78.7 232 39.4 141.5 10.5 338.6
147 97.2 35 85 5 391.6 00 8 147.4 3 63.5 1 57.3 00 2 140.8 1 65.3 8 73.2 00 00 1 2238.1 3 119 00 00 00 00 1 69.6 00 44 65.7 12 60.7 24 203.1 17 158.2 10 159.9 6 86.7 2 182.2
82.1 114.2 59.2 118.3 126.2 913.8 0 356.3 63.5 290.5 12.8 185.5
0.7 319 0 1899.3 15.8 508.3 0.9 363.2 31.5 144.2 0 858.4 0 1147.6 29.3 12452.4 23.9 347.6 0 175.9 0 490.5 0 651.2 0 1572.6 0.9 387 0 145 47.8 88.2 31.3 106.1 130.1 302.2 92.1 253.3 76.6 294.1 31.7 188.8 20.5 657.9
mortality from non-neoplastic respiratory disease was increased in subsequent duration exposure groups, again in the absence of a clear trend of increasing risk with duration. Moreover, there was no consistent duration-risk relation when the analysis was restricted to miners only.
The duration of exposure for total mortality and selected causes of death is considered in Table IV for miners only. The SMR for the longest category (>20 years) were 112.8 for all causes, 91.6 for all cancers, 323.2 for oral cancer, 173.6 for esophageal cancers, 95.9 for lung cancer, and 322.9 for non-neoplastic respiratory diseases. A direct trend in risk with exposure was observed only for non-neoplastic respiratory diseases.
Table V considers the role of time since first exposure (latency) for the same causes of deaths. For the longest latency level, the SMR was 111.1 for all causes, 92.1 for all cancers, 481.7 for oral cancer, 69.1 for esophageal cancer, 90.8 for lung cancer, and 242.4 for non-neoplastic respiratory diseases. Again a direct trend in risk with time from first
exposure was observed only for non-neoplastic respiratory diseases.
DISCUSSION
In this cohort, there was an excess total mortality due chiefly to non-neoplastic respiratory diseases (mainly classi fied as silicosis), liver cirrosis, other digestive tract diseases, and suicides. Furthermore, a non-negligible number of deaths (7%) was for unknown cause. Consequently, assum ing a non-differential distribution, the SMR for various causes of deaths may also be somewhat underestimated. The potential error due to the use of national rates is in contrast small, since rates for Piedmont were similar to national ones for most diseases considered [Cislaghi et al., 1986].
Our study found no relation between occupational exposure to non-asbestiform talc and risk of mesothelioma and lung cancer. This finding was common to both millers and miners. Miners were also exposed to quartz, radon, and to
Mortality Study of Talc Workers in Italy
67
TA B LE IV. Total Mortality and Selected Causes of Death by Duration of Exposure for Miners Only
<10 years
10-20 years
>20 years
0BS SMR
95% Cl
0BS SMR
95% Cl
0BS SMR
95% Cl
All causes All cancers
Oral cavity Esophagus Stomach Intestines Larynx Lung Cardiovasculardiseases Cerebral vasculopathy Respiratorytractdiseases Digestivetractdiseases Cirrhosis Injuries
Suicide
144 37 9 2 2 3 2 11 43 7 17 11 9 12 1
145.4 136.6 967.2 306.7 63.9 106.9 190.8 147.0 123.6 75.9 284.8 130.5 179.6 106.2 64.2
122.6 96.2 441.3 34.4 7.2 21.5 21.4 73.3 89.4 30.4 165.8 65.0 81.9 54.8 0.8
171.2 188.3 1836.2 1107.4 230.6 312.5 689.0 263.0 166.5 156.5 455.9 233.4 340.9 185.5 357.0
150 30 8
2 5 4 0 5 45 10 22 15 12 11 5
142.4 121.4 967.6 313.3 123.0 166.9
0 87.5 104.1 79.7 275.1 182.6 274.0 134.0 407.6
120.5 81.9 416.6 35.2 39.6 44.9 0 28.2 75.9 38.2 172.4 102.1 141.4 66.8 131.4
167.1 173.3 1906.7 1131.1 287.1 427.4 402.2 204.1 139.3 146.6 416.6 301.3 478.7 239.8 951.2
296 63 7 3 13 4 5 17 89 25 66 24 16 11 3
112.8 91.6 323.2 173.6 135.7 52.2 193.7 95.9 77.5 74.1 322.9 124.0 143.8 80.3 140.5
100.3 70.3 129.5 34.9 72.2 14.0 62.4 55.9 62.3 48.0 249.7 79.4 82.2 40.1 28.2
126.4 117.1 666.0 507.1 232.0 133.6 452.0 153.6 95.4 109.4 410.9 184.5 233.6 143.8 410.6
diesel exaust (this last exposure was confined to a short period of time, since 1991). Our results strengthen previous findings on the absence of a major role of non-asbestiform talc in inducing mesothelioma and lung cancer [Rubino et al,, 1976, 1979; Leophonte, 1983; Rubino, 1983; Wergeland et al., 1990], A recent study by Wild et al. [2002] is consistent with our results, since the authors did not find any lung cancer excess mortality from talc exposure.
The results support therefore that excess mortality from mesothelioma and lung cancer can be attributed to asbestiform fibers contained in talc exposure [Kleinfeld et al., 1974; Brown, 1979; Vianna, 1981],
A significant excess mortality from non-malignant respiratory diseases was found in miners only. This obser vation had already been made by Rubino et al. [1976,1979] in previous follow-up of the same cohort, and was attributed to the high frequency of silicosis as a cause of death in this cohort. This can be explained by the mixed exposure (including a certain amount of inhalable silica particles) that took place in the past, when rock drilling activity was frequent and technical prevention means had not yet been introduced. Before 1950, dry drilling was still in use and forced ventilation system (FVS) had yet to come; since 1950 wet drilling was introduced and more widely applied in the following years, FVS was introduced between 1958 and 1959 and completed in 1963. Therefore the exposure levels of total respirable dust have been progressively decreasing from 1950 to 1995 (from 100 to 1000 MPPCF--million particles per cubic foot before 1955 to less than 10 MPPCF between 1960 and 1975 [Rubino et al., 1976]). In the last years, exposure levels to talc dusts were monitored and the values in the mine were between 0.5 and 2.5 mg/m3, mean 1.1 mg/m3
for respirable fraction and 0.3-2.0 mg/m3, mean 1.0 mg/m3 for talc alone. There was a remarkable difference in the amount of free silica in air dust, respectively, in mines and mills and within the mine jobs between drilling and other operations. This was mainly due to the high content of quartz in footwall rocks, as opposed to the absence of free silica in talc minerals. In spite of such an exposure to silica particles, no excess lung cancer was observed in this cohort.
Together with other recent reports, including experi mental and epidemiological data evaluations [Chan et al., 2000; Hessel et al., 2000; Soutar et al., 2000; Carta et al., 2001; Cocco et al., 2001], the present study provides additional information of interest to further evaluate the association between silica and lung cancer [IARC, 1997; Steenland et al., 2001].
Combined exposure to talc and asbestos has been asso ciated to gastric cancer risk in one German study of 11,633 rubber workers, with a significant RR of 2.3 [Straif et al., 2000]. The RR for lung cancer was 1.7. However we did not find any significant excess mortality for those cancers.
The significant excess mortality from oral cavity and esophageal cancers is likely due to alcohol consumption and cigarette smoking [La Vecchia et al., 1986; Franceschi et al,, 1990]. Elevated alcohol drinking in this cohort is also suggested by the excess mortality from liver cirrosis [Corrao et al., 1998],
CONCLUSIONS
In conclusion, no association was found between ex posure to talc containing no asbestos fibers and lung cancer or pleural mesothelioma. An excess mortality from alcohol
68 Coggiola et al.
TA B LE V. Total Mortality and Selected Causes of Death byTime Since First Exposure (Latency) for Miners and Millers
<20years
20-30 years
>30years
0BS SMR
95% Cl
0BS SMR
95% Cl
0BS SMR
95% Cl
All causes All cancers
Oral cavity Esophagus Stomach Intestines Liverand gall bladder Pancreas Peritoneum Larynx Lung Pleura Skin Connectival sarcoma Prostate Bladder Kidney NonHodgkinlymphomas Hodgkin'sdisease Leukemias Diabetes Cardiovasculardiseases Cerebral vasculopathy Respiratorytractdiseases Digestivetractdiseases Cirrhosis Injuries
Suicide
154 29 7 2 3 2 3 2 0 1 6 0 0 0 0 0 0 1 0 0 1 32 7 11 16 11 25 6
129.6 109.9 151.7 215 137.7 119.9 157.4
112.2 75.1
161.2 46
111.4 81.5 148.6
741.1 296.9 1526.9
7 450.7 180.6 928.6
304.6 34.2 1099.8
6 521.0 190.3 1134.1
61.7 12.4 180.2
8 117.0 50.4 230.6
118.9 13.3 429.2
2 57.4 6.4 207.2
190.6 38.3 557.0
3 136.1 27.4 397.8
277.9 31.2 1003.4
1 75.9 1.0 422.5
0
0 2153.3
0
0
0 1647.3
96.0 1.3 533.9
2 114.5 12.9 413.3
107.6 39.3 234.2 10 95.2 45.6 175.2
0
0 2325.3
0
0
0 1085.7
0
0 1190.2
0
0
0 937.5
0
0 1048.5
0
0
0 8013.8
0
0 691.1
0
0
0 229.9
0
0 501.1
0
0
0 231.5
0
0 906.7
0
0
0 522.9
167.9 2.2 934.3
0
0
0 573.5
0
0 493.7
0
0
0 768.8
0
0 285.7
2 138.8 15.6 501.2
91.1 1.2 506.7 0 0 0 170.6
90.5 61.9 127.8 72
117.6 92.0 148.1
78.9 31.6 162.6 15 87.1 48.7 143.6
147.6 73.4 263.6 26 234.8 153.4 344.1
136.0 77.7 220.9 26 182.7 119.3 267.7
180.8 90.1 323.5 23 265.8 168.4 398.8
134.6 87.1 198.6
8 70.1 30.2 138.1
233.6 85.3 508.5
2 107.8 12.1 389.2
511 111.1 101.7 121.1
110 92.1 75.7 111.0
17 481.7 280.4 771.3
2 69.2 7.8 250.0
20 132.1 80.7 204.1
9 61.1 27.9 116.0
4 83.4 22.4 213.5
4 95.9 25.8 245.5
00
0 681.1
5 120.0 38.7 280.1
28 90.8 60.3 131.2
00
0 287.3
3 319.5 64.2 933.6
1 754.9 9.9 4200.0
6 71.6 26.1 155.9
1 15.7 0.2 87.2
1 46.0 0.6 256.0
1 61.3 0.8 340.8
0 0 0 641.2
3 70.7 14.2 206.4
4 51.4 13.8 131.6
184 86.6 74.5 100.0
38 59.3 42.0 81.4
90 242.4 194.9 298.0
37 125.2 88.2 172.6
21 127.5 78.9 195.0
16 83.3 47.6 135.3
4 137.2 36.9 351.3
related cancers and from other non-malignant disease relative to alcohol was found. Mortality from non-malignant respiratory diseases was increased only in miners, and this excess can be attributed to a mixed exposure to quartz in past years. Furthermore our mortality data from silicosis in miners, in the absence of an excess mortality from lung cancer, do not support the hypothesis of an association between silica exposure, silicosis, and the development of lung cancer.
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