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mortality Patterns Among U.S. Veterans by Occupation. I. Cancer1
Aaron Blair,2 3 Judy Walrath,2-4* and Eugene Rogot5
ABSTRACT--The mortality experience of a nation-wide cohort ol 293,958 veterans was analyzed by occupation and industry to t jjpgrate hypotheses in occupational cancer. Results are pre sented on 107,563 deaths occurring between 1954 and t970. tolormatlon on usual employment (occupation and industry) and smoking habits was available from questionnaires completed in 1354 and 1957. Complete enumeration of these results by occupa tion and industry is available as special National Cancer Institute monographs from the author (A. B.). This report presents the mortality experience for selected occupations. Excesses of lung cancer among shipyard workers, truck drivers, and plumbers are consistent with previous reports. Elevated risks lor stomach cancer 1 among carpenters and machinists may reflect exposure to dusts, . abrasives, and Culling oils.--JNCI 1985:75:1039-1047.
Studies of occupational groups have played a major role in identifying environmental carcinogens- Many of the well-established occupation-cancer associations were first noted in- anecdotal reports by physicians. Recently, the need for more systematic surveys has become evident, and in several countries projects linking occupational data with mortality or morbidity statistics have been developed to meet this need (1-4).
In the United States, no national survey linking occupation-industry information with vital statistics has been attempted since the report by Guralnick in 1963 (5). Several surveys using data from state or local areas, however, have appeared recently. "These reports, although valuable, suffer from one or more limitations including 1) limitation in geographic coverage, 2) reli ance on occupational designations from death certifi cates, 3} lack of information on tobacco use, and 4) small numbers. Resources available for systematic sur veys of occupational and industrial groups in the United States have recently been reviewed by the Occu pational Cancer Risk Subcommittee of the Department of Health and Human Services (6).
This paper presents the results of the analysis of the mortality experience, by occupation, of a cohort of U.S. veterans established by Harold Dom in 1954. The general and smoking-related mortality experiences of his cohort have been evaluated by Dom (7), Kahn (8), and Rogot (9), but mortality by occupation has not been previously reported. The major strength of these data is he availability of detailed smoking histories on each subject which can be analyzed in conjunction with information on occupation and industry. Occupation is generally believed to be a more precise indicator of Workplace exposures than industry, and for brevity only mortality by occupation is presented here.
MATERIALS AND METHODS
This cohort is comprised of 293,958 veterans aged 31-84 who held active U.S. government life-insurance policies in December 1953 and responded to question naires in 1954 and 1957 requesting a detailed smoking history and information on usual occupation and indus try. Those not responding to the first questionnaire were sent a follow-up questionnaire in 1957. A total of 85% of the cohort responded to one of the two questionnaires (9).
A total of 107.563 veterans were known to be deceased as of January 1, 1970, and death certificates were obtained for 97.6% of the decedents. Underlying cause of death was coded according to the seventh revision of the International Classification of Diseases. Usual occupa tion as reported by the subjects on the questionnaire was classified according to the 1950 Census codes. Occupa tions were included in this paper if the total number of observed or expected deaths for a specific cause was 5 or greater in the all-groups category.
The method of analysis is similar to that reported elsewhere (10). The observed number of deaths by cause for a specific occupation by smoking is compared with an expected number based on the experience of the entire cohort for that smoking category, adjusted for each year of follow-up and for each given age (in single years). Expected numbers of deaths by cause were summed over all ages, and cause-specific mortality ratios were computed for each occupation (ratio of observed to expected numbers of deaths multiplied by 100). SMR for cancers by occupation and smoking category are pre sented when 5 or more deaths are expected. Since the crude and smoking-adjusted SMR were similar for all smoking groups combined, only the crude SMR is pre sented in table 1. Statistical significance of ratios of
Abbreviations used: NEC=not elsewhere classified; NlH=National Institutes of Health: SMR=standardired mortality ratiofs).
1 Received March 28, 1985; accepted August 9. 1985. 1 Environmental Epidemiology Branch, National Cancer Institute, National Institutes of Health, Public Health Service, U.S. Department ol Health and Human Services, Bcthesda, MD 208925 Address reprint requests to Dr. Blair at the Landow Building, Room 4CI6. Bcthesda. MD 20892. 1 Present address: Employee Relations Department. E. 1. DuPont de Nemours and Co.. N1I510. Wilmington, DE 19898. 1 Epidemiology Branch, National Heart, Lung, and Blood Institute. National Institutes of Health.
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EXHIBIT
JNCI. VOL 75, NO. 6. DECEMBER 1985
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HWBUI0008897
1040 Blair, Walralh, and Rogot
Wi
Table 1.--Standardized mortality ratios for cancers by occupation and smoking status"
(Census code) Occupation
Never smoked* Obs Exp SMR
Ever smoked' Obs Exp SMR
Aft groups* Obs Exp
O
I. Stomach
(544) Machinists (510) Carpenters
(690) Operatives and kindred workers, NEC
(773) Policemen and detectives (612) Compositors and typesetters (336) Mail carriers
(616) Electricians
(093) Teachers, NEC (623) Foremen, NEC (043) Civil engineers
(100) Farmers (596) Members of the armed forces (076) Physicians and surgeons (90) Managers, officials, and proprietors, NEC (490) Salesmen and sales clerks (390) Clerical and kindred workers, NEC (674) Plumbers and pipe fitters (029) College professors (000) Accountants and auditors (056) Lawyers and judges (460) Insurance agents and brokers
(554) Mechanics and repairmen, NEC (042, 045, 047-4)49) Chemical, industrial, metal, and
mineral engineers (560) Automobile mechanics and repairmen
(044) Electrical engineers (470) Real estate agents and brokers (009) Clergymen (032) Dentists (046) Mechanical engineers (073) Pharmacists
4 1.6
3 3.0
4 2.8
0 0.8
2 0.9
l 2.8
1 1.2
14 7.9 177
1U
3 3.9
15 18.6
81
1 1.9
8 6.3 128
24 22.4 107
7 7.5 93
10 12.7
79
0 1.0
3 2.9
5 4.8
4 6.1 65
0 1.9
0 1.3
5 4.0
4 1.7
3 2.6 2 1.2 1 2.9 0 1.9 0 1.6 0 1.1
9 6.2 144 17 9.9 173* [
16 7.2 223 22 13.3 165' [
14 9.3 151 24 16.3 157' \
4 3.0
8 5.1 167 (
5 3.6
.9
6.0 149
12 6.0 200 15 11.1 135
8 4.8
9 7.4 122 -
7 10.8 64
28 24.4 115 1
5 4.4
8 7.0 114 i
13 13.2 98
24 21.9 109 *
34 25.6 132 14 10.1 138
60 66.1 107 , 15 14.7 102 ?
18 20.4
88
34 35.5 96 |
70 82.8 84 132 137.1 96
42 43.2 97
63 65.4 96
38 42.8 88
64 70.8 90
3 3.3
5 5.6 89 l
4 4.6
8 9.E 85
15 17.3 86
24 28.7 84
20 18.8 106
28 33.8 83 ;
7 8.6 81 11 13.4 82 ;
5 4.8
6 7.7 78 1
7 14.8 47
18 23.8 76
2 6.0 40 2 6.3 31 0 4.2
2 1.7 3 6.5 48 3 4.5
2 4.9
6 8-2 73 1 7 11.2 63 i
4 7.0 57 3 6.1 50 ! 5 10.7 47 ; 3 7.8 39
2 7.9 26*
II. Intestines
(300) Agents, NEC
1 1.3
13 6.1 253 16 8.7 184*
(099) Professional, technical, and kindred workers. NEC 2 1.3
6 2.8
9 6.1 175
(007) Chemists (778) Policemen and detectives
`
5 2.7 4 1.9
13 6.5 235 18 10.4 172
6
5.5 109
18 10.5 172
t
(762) Firemen, fire protection
1 1.0
6 3.4
8 5.7 141
(540) Telegraph, telephone, and power line
0 1.2
9 5.5 164 12 8.6 139 \
servicemen (210) Inspectors and public administration officials
2 1.1
5 3.6
8 6.3 126 .
(612) Compositors and typesetters
3 2.1
10 7.0 142 15 12.7 119
(065) Lawyers and judges
9 14.3 63 50 38.9 128 87 74.2 117
(696) Members of the armed forces
2 4.4
27 20.3 182
35 31.7 no
(032) Dentists
5 4.6
17 13.0 131
25 22.9 109
(260) Officials and administrators, NEC
0 1.6
6 6.1 98 11 10.3 107
(490) Salesmen and sales clerks
21 17.6 119
81 85.1
96 147 137.6 107
(000) Accountants and auditors
9 11.2 80 38 84.7 109 65 61.3 106
(044) Electrical engineers
6
6.1
82
14 13.1 107
26 24.6 106
>
(075) Physicians and surgeons
21 14.2 148
43 43.7 98
85 80-3 106
'
(290) Managers, officials, and proprietors, NEC (390) Clerical and kindred workers, NEC
(460) Insurance agents and brokers
65 52.6 124 167 167.5
99 309 294.9 106
41 29.6 138
83 84.8
97 158 150.6 105
4 4.4
20 17.2 116
30 28.6 105
1
(554) Mechanics and repairmen, NEC (574) Plumbers and pipe fitters
3 3.0 1 2.3
10
8.8 113
16 16.6 102
|
7 6-4 109 12 11.7 102
(690) Operatives and kindred workers. NEC (036) Editors and reporters
5 6.6 76 17 17.3 98 3L 32.4 99
3 1.5
7 6.4 109 10 10.3 98
(380) Ticket, station, and express agents
(583) Stationary engineers (042, 045.047-049) Chemical, industrial, metal', and
2 1.0
2 3.5 .
6 6.1 98
3 2.0
3 6.7 52 10 10.2 98 '
7 9.3 76 SO 30-0 99 M 51.3 97 . .
mineral engineers (310) Bookkeepers
3 1.9
2 3.6
7 7.3 96 _
" Obs=observed; Exp=expected. * Never 3moked tobacco. r Includes current cigarette and ex-cigarette smokers.
Includes never smoked, ever smoked, and cigar and pipe smokers plus unknown smoking categories. r P< 05.
JNCf, VOL 75. NO. 6. DECEMBER 1985
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Cancer Mortality by Occupation 1041
Table 1 (continued).--Standardized mortality ratios for cancers by occupation and smoking status*
(Census code) Occupation
{740) Barbers, beauticians, and manicurists (009) Clergymen (073) Pharmacists (093) Teachers, NEC ($44) Machinists (029) College professors (541) Locomotive engineers (335) Mail carriers (470) Real estate agents and brokers (510) Carpenters (550) Automobile mechanics and repairmen (523) Foremen, NEC (325) Express messengers and railway mail clerks (615) Electricians (683) Truck and tractor drivers (100) Farmers (046) Mechanical engineers (043) Civil engineers (970) Laborers. NEC (061-069) Natural scientists (003) Architects (564) Construction and maintenance painters (036) Draftsmen (650) Mine operatives and laborers
III. Rectum (554) Mechanics and repairmen. NEC (336) Mail carriers (470) Real estate agents and brokers (450) Insurance agents and brokers (029) College professors (595) Members of the armed forces (046) Mechanical engineers (523) Foremen. NEC (000) Accountants and auditors (510) Carpenters (544) Machinists (390) Clerical and kindred workers. NEC (690) Operatives and kindred workers. NEC (290) Managers, officials, and proprietors, NEC (055) Lawyers and judges (490) Salesmen and sales clerks (043) Civil engineers (044) Electrical engineers (075) Physicians and surgeons (100) Farmers (515) Electricians (042. 045,047-049) Chemical, industrial, metal and
mineral engineers (093) Teachers, NEC (550) Automobile mechanics and repairmen (073) Pharmacists (032) Dentists
IV. Lung and bronchus (002) Pilots and navigators (574) Plumbers and pipe fitters (682) Taxicab drivers and chauffeurs (054) Funeral directors and embalmers (683) Truck and tractor drivers (541) Locomotive engineers (740) Barbers, beauticians, and manicurists (564) Construction and maintenance painters
------N---e-v--e--r--s-m---o-k--e-d--6--- ---------E--v--e--r--s-m---o-k--e--d-'------------------ A* tl gyro_u_p_s_'_* Obs Exp SMR Obs Exp SMR Obs Exp SMR
1 1.1 8 6.6 3 2.5 19 18.5
2 3.7 4 6.8
1 1.0 6 6.5
0 2.8
3 7.1 4 3.9 i 2.5 2 1.8 2 2.7
2 1.5
29 43.5
5 3-6
5 8.8 2 1.7
2 1.7
0 1.6
0 1.9 0 1-4 0 1.6
121 103 59 93 42
67 67
4 3.7
1 3.7
6 9.6 62
17 22.2 76
ll 11.6 95
12 9.6 125
2 3.6
8 11.6 68
8 8.5 93
11 13.8 79
8 9.5 84
9 8.6 105
4 4.2
8 8.8 90
3 4.7
34 50.4
67
4 9.4 42
22 27.4 80
t 4.1
1 3.4
2 4.2
3 5.7 62
3 4.3
3 3.9
6 6.3 13 18.8 15 16.7 49 54.2
18 20.0 18 21.1
5 - 6.1 19 23.7 12 16.2 22 28,4
13 17.0 a 14.6 6 8.1 a 14.8 6 8.3
87 122.2
12 17.1
33 48.0
5 8.0 4 6.7 4 7.4
5 9.6
3 7.5 3 7.5
96 94 90 90 30 85 82 80 79 77 76 75 74 74 72 71' 70
69' 63 60 54
52 40 40
0 1.0
5 2.3
1 0.9
2 1.5
4 2.5
3 1.4
1 1.3
1 0.9
4 4.0
3 2.3
2 1.2
3 10.4
29
1 2.2
24 18.5 130
4 4.9
8 6.1 131
6 3.0
2 2.3
4 4.6
10 14.6
69
1 0.9
4 3.3
5 6.6 76 1 1.3
1 0.9 0 1.6
6 3.4
8 4.0
2 2.9
8 5.9 135
5 3.1
5 6.9 72
5 3.2
3 3.0
18. 11.9 150
4 4.9
2 4.2
44 29.0 151
6 6.2 97
48 56.6 84
14 12.9 108
24 29.0
82
4 9.0 44
3 4.5
11 13.5
81
16 17.3
92
S 3.3
7 10.3
67
5 7.5 66 2 3.4 1 3.2 1 4.4
12 5.7 211'
17 8.1 209' 8 5.0 159
15 9.8 153 10 7.2 139 13 10.3 126 7 5.9 119 6 6.0 119 25 21.1 118 11 9.5 116 8 6.9 116 57 51.4 111 12 10.8 111 95 100.1 95 23 24.4 94 43 46.5 92 13 15.6 83 7 8-7 80 19 24.0 79 32 40.7 79 4 6.4 76 13 17.7 74
12 18.6 64 3 5.9 61 2 5.6 36 2 7.7 26'
0 0.3
1 0.9 0 0.2 0 0.2 0 0.6 1 0.4 1 0.4
0 0.8
21 9.7 217 35 18.6 188
11 6.0 183 10 6.6 179 23 15.0 153 13 9.7 133 13 10.7 121 23 17.2 134
21 10.3 204'
89 21.2 184' II 6.7 163 10 6.4 157 25 16.7 149 16 U.0 146 17 11.9 142 27 19.1 141
"Obs=observed; Exp=expected. ' Never smoked tobacco. 'Includes current cigarette and ex-cigarette smokers. Includes never smoked, ever smoked, and cigar and pipe smokers plus unknown smoking categories. 'PS.05.
JNCI. VOL. 75. NO, 6. DECEMBER 1985
HWBUI0008899
Blair, Walrath, and Rogot
Table 1 (continued).--mortaifty radiosfor cancers by occupation and smoking status*
1
(Census code) Occupation
(240) Ship officers, pilots, pursers, and engineers (591) Tinsmiths, copper, and sheet metal workers (544) Machinists (380) Ticket, station, and express agents (970) Laborers, NEC (650) Mine operatives and laborers (300) Agents, NEC (540) Telegraph, telephone, and power line servicemen (490) Salesmen and sales clerks (773) Policemen and detectives (250) Officials and administrators, NEC (400) Advertising agents and salesmen (515) Electricians (583) Stationary engineers (210) Inspectors and public administration officials (000) Accountants and auditors (762) Firemen, fire protection (036) Editors and reporters (480) Stock and bond salesmen (335) Mall carriers (325) Express messengers and railway mail clerks (055) Lawyers and judges (550) Automobile mechanics and repairmen (554) Mechanics and repairmen. NEC (035) Draftsmen (098) Veterinarians (512) Compositors and typesetters (290) Managers, officials, and proprietors. NEC (470) Rea! estate agents and brokers (390) Clerical and kindred workers. NEC (510) Carpenters
(644) Meateuttets except slaughter and packing house (450) Insurance agents and brokers (685) Welders and flamecutters (042, 045, 047-049) Chemical, industrial, metal, and
mineral engineers
(690) Operatives and kindred workers, NEC (003) Architects (099) Professional, technical, and kindred workers, NEC (595) Members of the armed forces (100) Farmers (504) Brickmasons (545) Airplane mechanics and repairmen (046) Mechanical engineers (072) Personnel and labor relations workers (004) Artists and art teachers (592) Toolmakers, diemakers, and setters (043) Civil engineers (076) Physicians and surgeons (634) Jewelers, watchmakers, gold and silversmiths (032) Dentists (073) Pharmacists (280) Purchasing agents and buyers, NEC (044) Electrical engineers
(623) Foremen, NEC (200) Buyers and department store heads (533) Inspectors, NEC (061-069) Natural scientists (093) Teachers. NEC (081-084) Social scientists (310) Bookkeepers
(007) Chemists
Never smoked4
Obs Exp SMR
1 0.1 0 0.2 | 1.4 0 0.4 2 0.7 0 0.6 0 0.5 0 0.5 11 6.8 162 1 0.7 1 0.6 D 0.1 2 1.1 0 0.8 0 0.4 4 4.3 0 0.4 0 0.5 0 0.2 3 2.6 1 0.7 5 6.4 93 2 1.5 0 1.2 1 0.5 l 0.3 0 0.8 21 20.3 104 1 1.0 12 11.4 106 2 2.7 0 0.2 1 1.7 1 0.3 3 3.5
1 2.6 1 0.6 O 0.5 1 1.5 15 16.9 . 89 0 0.3 0 0.2 1 1.4 1 0.2 0 0.2 0 0.2 2 3.3 7 6.4 130 0 0.3 2 1.8 1 1.0 0 0.3 2 2.3 0 1.0 0 0.3 0 0.3
I 0.6 4 7.1 56 0 0.3 1 0.7 1 1.0
Ever smoked'
Obs Exp SMR
7 6.2 8 5.2 48 35.4 12 9.2 17 13.0
17 11.2
20 14.3 23 16.3 316 250.0 22 17.5
20 16.8
7 6.2
32 27.5
17 15.7
12 9.8
109 98.8
11 10.4 21 17.8 10 8.4 36 34.4
9 11.3 107 101.4 26 28.5
29 26.9
13 12.2 4 5.0 21 20.8
469 467.8 23 23.1
246 245.7
38 39.8 4 4.5
48 48.2 4 5.7
72 81.9
134 155 135 130 130 161
139141 126 126 126 112 116 108 122 110 106 117 118 104 79 105 91 107
106 80
100 100 99 100 95
99 70 87
All groups'*
Obs Exp SMR
8 5.7 140 " 8 5.7 140 55 39.5 139 14 10.5 134 20 14.9 134 17 13.0 131 21 16.1 130 23 17.8 129 361 276.5 127' 25 20.0 125 22 17.8 123 8 6.7 119 36 30.4 . 118 21 17.9 117 13 11.2 116 127 111.9 113 13 11.6 113 22 19.7 ill 10 9.3 108 43 40.1 107 14 13.2 106 122 118.6 103 33 32.0 103 31 30.2 103 14 13.7 102 6 5.9 101 24 23.7 101 533 530.7 100 26 26.3 99 272 277.5 SB 46 46-8 98 5 5.2 97 51 53.8 95 6 6-5 93 83 92.3 90
46 52.9
87
10 11.1
90
6 8.2 . 72
46 54.2
84
116 141.4
82
5 5.4 93
6 6.7 88
20 24.8
80
4 5.7 70
4 5.6 70
6 5.6 89
64 71.8
76
89 107.4
82
5 6.9 86
28 37.3
76
21 28.9
72
5 7.6 66
23 34.3
67
18 25-6
70
6 8.5 70
4 7.0 56
4 8.3 48
34 60.0
66
3 6-0 60
4 102
39
7 15.0
46
54 59.7 11 12.6 8 9.3 51 59.5 144 174.1
5 6.1 6 7.3 23 28.5 5 6.2 5 6.8 S 6.3 64 81.5 99 124.6 5 6.7 31 42.1
24 32.4 6 8.6 27 39.7
19 28.6 6 9.4
5 7.8 6 9.9 40 74.9
3 6.8
6 12.0 8 17.3
90 87
86 86 83 82 82 81 81 80 80 79
79* 76 74
74 71 68*
5 64
64
01 63'
62 60 -
46
` Obs=observed; Exp==expected.
4 Never smoked tobacco, ' Includes current cigarette and ex-cigarette smokers. * Includes never smoked, ever smoked, and cigar and pipe smokers plus unknown smoking categories. f PS.05.
JNCI. VOL. 75, NO. 6. DECEMBER. 1985
HWBUI0008900
Cancer Mortality by Occupation 1043
TABLE 1 (continued).--Standardized mortality ratios for cancers by occupation and smoking status'1
(Census code) Occupation
Never smoked* Obs Exp SMR
Ever smoked' Obs Exp SMR
Alt groups' Obs Exp SMR
(009) Clergymen (029) College professors (632) Deliverymen and routemen
y. prostate gland (773) Policemen and detectives [061-962) Natural scientists 1046) Mechanical engineers (042, MS, 047-049) Chemical, industrial, metal, and
mineral engineers
(970) Laborers, NEC (075) Physicians and surgeons (250) Officials and administrators, NEC (470) Real estate agents and brokers
(029) College professors [490) Salesmen and sales clerks
(641) Locomotive engineers (683) Truck and tractor drivers (674) Plumbers and pipe fitters (055) Lawyers and judges (640) Telegraph, telephone, and power line servicemen
(100) Farmers (650) Automobile mechanics and repairmen (043) Civil engineers (325) Express messengers and railway mail clerks
(523) Foremen, NEC (740) Barbers, beauticians, and manicurists (390) Clerical and kindred workers, NEC
(036) Editors and reporters (336) Mail carriers (644) Machinists (044) Electrical engineers (093) Teachers, NEC (450) Insurance agents and brokers (510) Carpenters (690) Operatives and kindred workers, NEC (007) Chemists (595) Members of the armed forces (035) Draftsmen (310) Bookkeepers (000) Accountants and auditors (290) Managers, officials, and proprietors. NEC (E15) Electricians (032) Dentists
(073) Pharmacists (380) Ticket, station, and express agents (300) Agents. NEC
(564) Mechanics and repairmen, NEC (583) Stationary engineers (009) Clergymen (612) Compositors and typesetters (650) Mine operatives and laborers
(003) Architects (664) Construction and maintenance painters (210) Inspectors and public administration officials
2 2.4 2 2.6 0 0.2
2 1.8
2 1.4 7 3.2 10 8.1 123
2 1.7
27 16.0 169
4 1.3
5 2.7
6 6.0 100
22 16.0 138
2 1.0
1 1.3
4 2.2
8 13.9
58
0 1.0
43 41.3 104
3 3.5
8 8.8 91
1 1.5
3 22
0 1.1
27 26.8 101
0 1.4
8 5.8 137
3 3.3
4 5.2 76
23 16.7 137
4 3.9
5 6.8 74
.7 6.1 115
3 2.1
6 4.5
0 1.3
1 1.8
7 9.9 70
41 47.5
86
l 2.2
1 4.1
3 2.3
0 0.9
0 1.1
0 2.6
0 1.8
5 6.3 80
2 2.0
1 1.4
2 1.5
0 2.0
0 1.0
2 8.5 9 24.5 2 4.6
23 36
10 4.8 4 2.8 12 8.4
39 27.2
6 3.9
56 47.3 7 5.3 7 8.0 10 8.7 87 77.9 6 3.5 5 4.2 5 6.0 46 36.3 4 4.9 65 47.9 9 8.7 24 26.4 4 3.7 7 7.8 4 3.6 78 77.5 8 5.7 9 10.6 11 11.0 8 11.2 14 19.6 13 15.4 18 13.0 14 16.S 3 4.8 18 21.0 6 3.9 5 3.3 32 31.1 134 152.6 6 7.6 9 12.1 6 9.3 2 3.3 3 4.5 7 7.9 6 5.1 1 3.4
4 6.5 3 8.6 1 4.0 3 6.5 1 3.8
142 143
118 131 87 114 111
82 126
114 103 90
89
100 141 84 99 71 71 84 138 84
85
102 87 78 74 64
88 98
61
54
6 12.9 46 12 29-8 40' 2 5.1 39
18 8 21 63
9.0 5.7 15.1 45.7
10 7.6 114 88.1
11 9.0 17 14.1
23 19.1 146 123.7
7 6.0 8 13 12 10.9 76 69.3
8 7.5
120 113.7 16 152 48 46.5
7 6.8 13 12.9 6 ` 6.0
135 135.3 9 9.1
21 21.2 18 18.6 20 20.9 46 47.9
24 25.3 25 26.6
27 29.1 8 8.7
30 33.1
6 6.7
6 6.7 47 54.0 231 264.0 11 12.6 16 20.6 11 15.4
4 6.6
6 7.6 9 13.6 6 9.1 8 13.0 7 11.4 4 6.9
4 7.1
4 9.3
2 5.7
199r 141 139 138'
134 129' 123 121 120 118' 117 111 110 108 107 106 105 103 103 101 101 100 99 99 97 96
96 S5 94 93 92 91 90 90 87 87' 87 77 71 71 66 66 66 61 61 68 66 43 35
VL Bladder (470) Real estate agents and brokers
(073) Pharmacists ' (044) Electrical engineers
(515) Electricians (000) Accountants and auditors (654) Mechanics and repairmen, NEC
1 0:6 1 0.7 2 1.6 1 0.6
4 3.0 2 0.7
6 3.5 7 4.1
7 5.0 138 5 3.6 20 14.3 139 4 3.5
9 5.2 173 9 5.9 173 12 7.9 163 7 5.0 140 26 21.0 124
6 6.2 116
" Obs=observed; Exp=expecled.
* Never smoked tobacco. 'Includes current cigarette and ex-cigarette smokers. 4 Includes never smoked, ever smoked, and cigar and pipe smokers plus unknown smoking categories.
' <P<.0S.
JNC1. VOL. 75. NO. 6. DECEMBER 1985
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1044 Blair, Walrath, and Rogot
Tahue 1 (continued)---Standardized mortaWy ratios/or cancers by occupation and smoking status"
(Census code) Occupation
(690) Operatives and kindred workers, NEC (046) Mechanical engineers (490) Salesmen and sales clerks (290) Managers, officiate, and proprietors. NEC (544) Machinists (076) Physicians and surgeons (623) Foremen. NEC (042, 045, 047-049) Chemical, industrial, metal, and
mineral engineers (055) Lawyers and judges (390) Clerical and kindred workers, NEC (450) Insurance agents and brokers (335) Mail carriers (595) Members of the armed forces (043) Civil engineers (029) College professors (093) Teachers, NEC (550) Automobile mechanics and repairmen (032) Dentists (510) Carpenters (100) Farmers
Never smoked*
Ever smoked'
Obs Exp SMR Obs Exp SMR Obs Exp
2 1.8
7 7.3 95 12 10.9
1 0.9
6 3.7
6 5.6
5 4.7
39 35.7 109
52 48.7
13 14.1 92 76 68.8 110 106 100.9
l 1.0
4 4.9
7 7.0
8 4.8
15 17.6 85 28 28.3
1 0.7
2 3.6
5 5.1
3 2.5
9 12.0
74- 17 17.4
3 4.0
15 15.7 95 23 24.9
7 7.9 89 28 35.3 79 48 52.0
2 1.1
5 7.0 71
9 9.8
2 1.7
3 4.9
7 7.9
2 1.4
5 8.2 60
9 11.4
2 2.6
9 11.1 80 13 16.6
4 1.8
0 as
5 6.7
I 4.9
8 8.9 90 12 17.1
1U
3 4.0
4 5.9
0 12
3 5.4 65
6 7.9
0 2.0
4 5.7 70
S 9.4
8 12.0 67
9 20.9 42 20 39.6
VII. Malignant lymphoma
(523) Foremen. NEC (007) Chemists (512) Compositors and typesetters (044) Electrical engineers (075) Physicians and surgeons (544) Machinists (595) Members of the armed forces (450) Insurance agents and brokers (583) Stationary engineers (290) Managers, officials, and proprietors, NEC
(100) Farmers (032) Dentists (550) Automobile mechanics and repairmen (043) Civil engineers (690) Operatives and kindred workers, NEC (490) Salesmen and sales clerks
(470) Real estate agents and brokers (000) Accountants and auditors
(093) Teachers. NEC (029) College professors (042, 045, 047-049) Chemical, industrial, metal, and
mineral engineers
(073) Pharmacists (390) Clerical and kindred workers, NEC
(515) Electricians (055) Lawyers and judges (773) Policemen and detectives (610) Carpenters (046) Mechanical engineers (554) Mechanics and repairmen, NEC
(335) Mail carriers (009) Clergymen (674) Plumbers and pipe filters
2 1.4
1 1.6 2 1.2 2 3.6 12 7.7 157 0 2.1 l 2.4 1 2.5 1 1.1 36 29.7 121 27 23.9 113 2 2.6 3 2.2 7 4.8 5 3.7 15 9.9 152 1 1.5 5 6-4 79 8 10.5 . 76 3 3.9 3 5.3 56
2 1.4 19 16.8 113 0 1.6 4 7-9 60 0 1.1 2 3.9
3 2.1 2 1.7 3 3.6 1 3.7
0 1.3
S 4.4
14 7.2
6 2.8
7 5.3
4 3.6
8 6.1
11 6.7 164 16 12.4
23 19.8 116
42 35.8
8 ti.3 126 12 10.3
16 10.4 154
18 15.5
10 6.7 114 16 14.0
4 3.1
s 5.2
89 83.1 107 159 142.2
26 25.3 102
65 59.9
7 6.4 108 12 11.1
4 6.1 78
9 8.7
12 13.0 92 23 22.4
8 9-2 86 16 15.$
39 4ao 90 66 66.4
5 42
7 7.2
la 17.6 ' 91
29 29.9
a 11.0 99 26 26.8
6 4.6
10 10.4
16 15.3 104
24
6 4.8
34 42.8
79
4 6.2 77
19 18.8 100
1 3.1
8 7.2 .110
2 4.7
i 6.2 19
0 6.t)
1 1.7
0 3.3
7 7.9 64 73.7 7 8.0 28 85.0 4 5.5 10 13.9
5 8.4 5 8.4 5 11.8 2 6.7
i 5.8
VIII. Leukemia (695) Members of the armed forces
(470) Real estate agents and brokers (009) Clergymen (612) Compositors and typesetters (032) Dentists
0 1.7 1 1.0
5 2.4 1 0.8 0 1.6
22 9.6 228 25 14.2
6 3.8
9 6.2
0 1,6
7 b.E
5 3.2
7 b.<
12 205 12 9.4
" Obs=observed; Exp=expected.
4 Never smoked tobacco. ' Includes current cigarette and ex-cigarette smokers. * Includes never smoked, ever smoked, and cigar and pipe smokers plus unknown smoking categories.
'P<05.
3
smr"
110 107 107 105 100 99 99 98
92 92 91 85 79 78 74 70 67 63 53 50*
194' 132 131 129 117 117 116 114 114
:)112
HD . 108 104 i03 101 99 98 97 97 96 $5
S3 87 87 80 7J 72 6U 50 43 30 17
176' 146 134
jNCI. VOL- 75. NO. 6. DECEMBER 1985
HWBUI0008902
Cancer Mortality by Occupation 1045
Table 1 (continued).--Standardized mortality ratios for cancers by occupation and smoking status"
(Census code) Occupation
! (
ro43) Civil engineers
(893) Teachers, NEC
(06) Lawyers and judges I (873) Pharmacists
(100) Farmers
(844) Machinists
(490) Salesmen and sales clerks
(842, 045, 047-049) Chemical, industrial, metal, and
mineral engineers
(875) Physicians and surgeons
(880) Operatives and kindred workers. NEC
(844) Electrical engineers (290) Managers, officials, and proprietors. NEC
(829) College professors
(460) Insurance agents and brokers
(000) Accountants and auditors
(574) Plumbers and pipe fitters
(390) Clerical and kindred workers, NEC
(SIS) Electricians
i (335) Mail carriers (045) Mechanical engineers
i (810) Carpenters
f (650) Automobile mechanics and repairmen (823) Foremen, NEC
(554) Mechanics and repairmen, NEC
Never smoked4
Obs Exp SMR
4 3.3
7 6.6 108
5 5.1
97
1 0.9
16 15.6 103
0 1.3
5 6.3 30
4 3.3
4 5.8 69
2 2.4
2 2.1
20 18.5 108
3 2.4
2 1.5
3 3.9
1 0.8
9 10.4
86
1 0.9
2 2.2
2 1.3
3 2.5
1 1.4
1 0.9
1 1.1
Ever smoked'
Obs Exp SMR
19 12.0 168
13 9.7 133
22 16.9 129
4 4.4
26 23.2 112
9 5.7 156
37 38.5
96
14 13.4 104
20 18.9 9 8.4 4 5.8
66 74.3 4 . 4.1
7 7.7
15 16.5 3 3.1 30 38.3 4 4.6
4 6.3 2 4.2
4 6.6 4 4.6 3 3.9 1 4.4
105 106 69 88
91 96
78
75
60
All groupsi
Obs Exp SMR
25 19.7 127 26 21.1 123 36 29.8 121 8 6.9 116 55 48.8 113 10 8.9 113 63 .67.3 110 23 21.2 108
36 33.5 107 14 13.6 103 10 9,9 101 116 120.1 97 8 8.3 96 11 11.8 93 21 26.0 84 4 5.0 80 47 61.9 76 5 6.7 75 7 9.6 73 5 7.0 72 8 11.8 68 5 7.3 68 4 6.1 66 3 7.1 42
1 *Obs=observed: Exp=expected.
`Never smoked tobacco. I 'Includes current cigarette and ex-cigarette smokers. ; 'Includes never smoked, ever smoked, and cigar and pipe smokers plus unknown smoking categories. [ 'P<05.
)
* observed and expected numbers is based on the ratio of a
I Poisson variable to its expectation (22). Smoking as reported on the questionnaire was sumi marked for three types of tobacco: cigarette, cigar, and
[pipe. A three-digit number, in which the first, second,
and third digits represent cigarette, cigar, and pipe . smoking, respectively, was used to code the usage data
for each type of tobacco as follows: 0=never smoked, l=ex-smoker (regular smoker in the past but not now), 2=regular smoker now or current smoker, i.e. at time of questionnaire, 6--either never smoked or ex-smoker, 2=either never smoked or current smoker, 8=either cur rent or ex-smoker, and 9=unknown whether never, exf smoker, or current smoker. (Categories 6-9 represent the : different kinds of unknowns.) ! Mortality data were calculated separately for 1) non-
smokers (category 000), 2) ex-cigarette smokers (category
l I--), and current cigarette smokers (category 2..) (i.e.,
current as of time of questionnaire), and miscellaneous
. r unknown smoking categories. Cigar and pipe smok ers who had never smoked cigarettes were included in
} the latter group. The proportions of the cohort in each , smoking category are: nonsmokers= .222, ex-cigarette
smokers=.196, current cigarette smokers=.379, and all ! other categories=.203. Cause-specific mortality is re-
i Ported for two smoking status categories: 1) "never t smoked,'* (category 000). and 2) "ever smoked" (catex Eries I.. and .) which includes ex-dgarette smokers jand current cigarette smokers because smoking status
has not been updated since the original questionnaire data were collected, and for S) the "all-groups" total, which includes the miscellaneous and unknown smok ing categories in addition to the "ever smoked" and "never smoked." Cigar-pipe smokers and ex-smokers were not presented separately because numbers were too small for analysis in nearly all occupations.
RESULTS
SMR for specific cancers are shown ranked by occupa tion in table h For many cancers, the number of deaths was small in sperific occupations, particularly for the never-smoked category.
DISCUSSION
This paper presents the mortality experience of a nation-wide cohort of U.S. veterans which can be used for generating hypotheses on the occupational deter minants of cancer. Comprehensive tables for all occupations-industries are available from the author (A. B.) as special National Cancer Institute monographs [NIH publication No. 85-2747 (industry) and 85-2756 (occupation)].
Surveys of this type inevitably have limitations that must be considered in interpreting the results. First, the information on occupation was based on self-reported "usual" occupation on the 1954 or 1957 questionnaires.
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1046 Blair, Watrath, and Rogot
Job changes subsequent to those years were not availa ble. Second, despite the size of this cohort (293,958 per sons), the large number of cause-of-death and occupa tion combinations resulted in many categories with too few deaths to compute reliable cause-specific SMR, par ticularly among the nonsmokers. This unreliability, coupled with the numerous comparisons made, ensures that some associations in these data would arise by chance alone. Also, this population of veterans is not a random sample of the general population and contains a larger proportion of white-collar workers than found in the general population. Finally, although informa tion on smoking is available, we lacked information on other important life-style factors, such as diet and alco hol, that are major determinants for certain cancers.
Despite limitations, the availability of information on tobacco use for each study subject makes this an extremely valuable resource. Although several large record systems wilh broad occupational data are availa ble (1-5, 12,13), few include information on tobacco use (14, 15). The variation in tobacco use among persons with different occupations (16, 17) and the strong asso ciation between tobacco smoking and certain cancers (18, 19) make results from occupational surveys lacking information on tobacco use difficult to interpret for all except the strongest associations.
Comments on selected associations.--No statistically significant associations with occupation were observed for cancers of the buccal cavity, pharynx, esophagus, liver, pancreas, larynx, kidney, or brain, and these sites are not presented in the table.
Stomach cancer.--Mortality from cancer of the stom ach was elevated among persons employed as ma chinists. carpenters, and operatives (NEC). Among car penters the excesses occurred only among smokers. Excess risk has previously been reported among car penters and machinists (5,14, 20,21) where exposures to cutting oils, abrasives, and wooddusts may be involved.
Intestinal cancer.--Elevated SMR for intestinal cancer were seen among veterans in white-collar occupations (agents, professional and kindred workers, chemists, wholesale trade, and public administration). This asso ciation has been observed in other surveys (l, 5, 20, 21) and is assumed to reflect life-style factors, rather than occupational exposures. Farmers are at low risk for colon cancer as has been noted previously (22). Physical activity has recently been suggested as a protective factor for colon cancer (23). High-activity occupations at low risk among veterans include miners and farmers, but there is no clear grouping of low-activity occupations in
the high-risk category. Rectal cancer.--Mortality from cancer of the rectum
was slightly elevated in some white-collar occupations (real estate, insurance, and college teaching), resembling
the pattern for colon cancer. Mortality was highest, however, among smokers who are mechanics and repair men or mail carriers, associations not previously reported.
Lung cancer.--Mortality from lung cancer was exces sive among pilots and navigators and plumbers and
pipefitters. Smaller excesses were noted for taxi driver
funeral directors and embalmers, truck drivers, loconto- - -
tive engineers, barbers and beauticians, painters, ships
officers, metal workers, and machinists. Although not
shown in the table, workers in the shipbuilding and
repair industry had significantly elevated mortality for
lung cancer (SMR= 180).
Exposure to asbestos is the likely explanation for the
excess risk among shipbuilders (24). The excess of lung
cancer among truck drivers has'been reported in several
other surveys (/, 5, 15, 20, 21, 25), and polycylic aro
matic hydrocarbons are suspected agents. The excess of
lung cancer among plumbers has been reported before
(/, 5, 21, 26). Plumbers may have contact with several
respiratory carcinogens, especially asbestos, but also
arsenic, beryllium, and acrylonitrile (25). The excess
among funeral directors and embalmers has not been
noted in other studies of this group where information
of tobacco use was lacking (27, 28).
Slight, but not statistically significant, excesses were
noted among machinists and painters, as has been
reported by others (1, 5, 14, 20, 21, 25). On the other
hand, we saw no evidence of the reported associations
with mechanics and repairmen (5, 14, 20, 21, 25), meat-
cutters (29-31), brickmasons (/, 20, 21), or welders (l,
25, 32). Deficits among physicians and surgeons, electri
cal engineers, chemists, and college professors were most
striking among smokers, probably reflecting the lesser
intensity of smoking among persons in professional
groups as compared to those in blue-collar occupation-y
(16).
Prostate cancer.--Mortality from prostate cancer was
elevated among policemen and detecu'ves, engineers,
physicians, and salesmen and clerks. These occupations
lack obvious common exposures to workplace carcino
gens. The risks may reflect socioeconomic and life-style
factors or simply chance associations from multiple
comparisons.
Bladder cancer.--No significantly elevated SMR were
.identified, although farmers experienced a deficit of
bladder cancer in contrast to the' positive association
with dairy farming reported in New York (14). The low
risk among farmers occurred among nonsmokers as well
as smokers and thus cannot be entirely attributed to dif
ferences in smoking habits.
Afaiignrtnc lymphoma and leukemia.--The occupa
tional categories showing an association with malignant
lymphoma (foremen, not elsewhere classified) and leu
kemia (members of the armed forces) are too broad to
suggest any particular exposure. Neither lymphoma nor
leukemia showed much of an association with agricul
ture (SMR=11Q and 113, respectively) as has been pre
viously reported (22). Nonsignificant excesses were noted
for compositors and typesetters (lymphoma and leu
kemia) and chemists (lymphoma), occupations pte*
viously associated with these cancers (33-35).
Occupations were scanned for evidence of elevated
mortality for several sites to identify areas requiring sp*
cial attention, but no occupation showed significantly
elevated mortality for more than one cancer. Compos*-
J
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HWBUI0008904
tors and typesetters, however, had nonsignificant eleva tions for lymphoma and leukemia and cancer of the stomach.
In summary, this survey of U.S. veterans can be used to generate hypotheses for productive new areas of research in occupational epidemiology. The availability of data on tobacco use is particularly important, but the small numbers of deaths in certain occupations is a major limitation. We are, however, updating the vital status of this cohort from 1970 to 1980 and have identi fied approximately 100,000 additional deaths. This addi tional information will enhance the usefulness of this surveillance system for the monitoring of occupational cancer risks.
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