Document 5kO22G7kpbbpYKpoqQ1x4mOD4

FILE NAME: RT Vanderbilt (RTV) DATE: 1982 June DOC#: RTV123 DOCUMENT DESCRIPTION: Journal Article - The Mortality Experience of Upstate NY Talc Workers From (613) 998-3260 Order # 05543491DP04581959 Mon Hun 13 20:50:18 2005 Page 2 o f 6 The Mortality Experience of Upstate New York Talc Workers All W. T. Stille, D.P.H., and Irving R. Tabershaw, M.D. All ; Deaths fo r a 31-year period (1948 to 1978) were ana lyzed In a historical prospective cohort study o f 655 white male tafc workers. Death rates from all causes, from cancer o f th e respiratory system, and from nonmalignant respira to ry disease were n o t significantly different from those o f th e U.S, white male population. However, significant differences fo r these causes o f death were found among workers who had previous occupational histories. An analysis o f th e latency periods o f th e observed lung cancer suggests th a t exposure to an etotoglc agent during previous work experience m ay play a role in the development o f lung cancer. laic pneumoconiosis was first associated with talc mining and milling by Thorel in 18961 arid since that time this association has been repeatedly documented in studies from various geographic sites. However, there are a number o f contradictory reports regarding disability from talc pneumoconiosis and its effect on workingcapacity and respiratory function. The contradiction in these reports has been ascribed to the differences in the mineral compo sition of the various talcs. Kleinfeld et al,s-s in a series of reports, confirmed the increased Incidence o f talc pneu moconiosis and noted that among the talc workers who were 60 to 79 years of age and had 15 or more years of exposure the incidence o f lung cancer was four times that among the general population. Their follow-up study repeated these findings but noted that the observed deaths from -1945 to 1959 dropped to approach the expected mortality between 1960 and 1969. The authors attributed this improved mortality experience to better environ mental dust control. Brown and Wagoner,* using a similar cohort from tile ' same population base; i.c., talc miners and millers in upstate New York, also found a statistically significant increase in the occurrence o f bronchogenic cancer. The average latency for these cancer deaths was 20 years. They noted that data on several variables, particularly cigarette smoking and previous work history, were not available. Thus, from the work o f Kleinfeld et a!2*3 and Brown and Wagoner, it From Tabershaw Occupational Medicine Associates, 6110 Ex ecutive Btvd., Rockville, MD 20852. Dr. Stille was formerly Senior Epidemiologist. Dr. Tabcrshavi'-is Senior Occupational Physician. 480 appeared that talc mining in upstate New York is associated with an increase in lung cancer. Selevan et al,8 in studying workers in Vermont talc mines and mills/ showed an excess o f deaths due to nonmalignant respiratory disease among milters and an excess o f lung cancer mortality among miners. The lung cancer rate was similar to that found by Brown and Wagoner in their cohort of New York State workers. Selevan et al concluded, however, that agents other than talc, '"either alone or in combination With talc dust, affect mine workers. The possible role of radon daughter exposures for this cancer mortality risk cannot be eliminated."3 The present study Includes all workers in one talc mine and mill (TMX) in upper New York State who were em ployed between 1948, when operations began, and Dec 31, 1977. Materials and Methods The work force consisted of 744 persons employed between Jan 1,1948 and Dec 31,1977. Thirty-five women, primarily employed in office and administrative jobs, were not included because of the small numbers and a lack of exposure to talc. Nearly all employees were white and records indicate that to date ail decedents have been white. The vital status of 36 (5.1%) men remained unresolved after Social Security and New York State Motor Vehicle Bureau records were searched. The maximum cohort available for analysis consisted o f 708 white men, 113 of whom were known to be dead by Dec. 12,1978, which was established as the vital status cutoff date. Demographic data' (microfilmed from employment records) consisted of the following: worker identifiers; sex; date o f birth, employment and death; cause or death and Information on prior employers. Data on cigarette smoking were not available. The occupational history in cluded dates o f work, job codes, and work location codes. Records were updated for the dates and causes of death as such information became available. Death certificates were coded according to the eighth revision of the International Classification o f Diseases by a trained nosologist. Compari sons o f observed deaths by age and year of death with those expected in the U.S. white male population were done by means o f the modified life-table methods described by Monson,8 All standard mortality ratios (SMRs) were com puted by this program. Killy-three workers whose records lacked dales of birth or other significant data had to be MortalityandTalcWorkers/Stille &Tabershaw Ail Ml { All Ext WES001126 From (613) 998-3280 Order # 05543491DP04581959 Mon Jun 13 20:50:18 2005 Page 3 of 6 Table 1 - Obsatued and Expected Numbers of Deaths and SMRs Among TMXWorkers (665White MalesWith 11,350 Yearsat Risk), Cause of Death (CD,* tth Revision Deaths Observed Expected MUR o ik Is associated al,s in studying ills, showed an ipiratory disease ancer mortality . similar to that o rto f New York , however, that ombination with ile role o f radon ty risk cannot be In one talc mine s who were embegan, and Dec rsons'employed irty-fivc women, ratiye jobs, were rs and a lack of were while and have been white, ined unresolved 3 Motor Vehicle axitnum cohort rite men, 113 of 1978, which was m employment fk er Identifiers; ; cause o f death ata on cigarette Iona! history in: location codes, tuses o f death as certificates were die International tiogist. Comparideath with those m were done by ds described by MRs) were corn 's whose records data had to be AH deaths 113 T07 108 Tuberculosis (010-019)1 3 .7 414 All cancer (140-209) 25 206 122 Digestive system (150-159) 6 5.7 105 Esophagus (160) 1 h 216 1 Stomach (151) liver (155-156) 1 I.I 92 2 .4 511 Pancreas {167) 1 1.1 89 Respiratory system (150-163) 11 6.8 153 lung (182) 10 fi.4 IS7 Prostate (186) 1 U 79 Kidney (189) 1 J5 185 Brain (181-192) 1 .1 149 Lymphosarcoma (200) 1 208 Hodgkin's disease (201) 2 2 631 Leukemia (204-207) 2 2 229 AS lymphopoietic cancer (200-209) 5 2.1 230 All circulatory system (390468) 48 " 53.7 81 Myocardial Infarction (410413) 33 38.3 86 Cerebrovascular disease (4304381 S 7.1 71 All respiratory disease (460-519) ID 6.1 164 Pneumonia (480466) 4 2.2 162 Emphysema (492) 2 1.7 121 All digestive system (520-677) 3 52 67 External causes of death (800-898) 11 12.6 87 Motor vehicle accidents (810-827) 4 42 93 Suicide (950-958) 2 U 70 * ICO indicates International- Classification of Diseases f Numbers referto (CD code dropped from the life-table analyses. Thus, the study cohort consisted of 655 white males, a relatively small sample size and therefore a limitation on the study. Results Table 1 shows the numbers of observed and expected deaths in the study cohort o f 655 white male talc workers. I Although the SMRs are elevated, the numbers of deaths | from all causes, from cancer of the respiratory tract and lung from nonmallgnant respiratory disease, or from other causes o f death are n o t significantly different from those occurring In the U.S, white male population. Numbers o f j; deaths from circulatory diseases, digestive tract diseases, and accidental and external causes are lower, but not sig nificantly so. The SMR o f 106 for all causes of death has 95% confidence limits from 87 to 128, thus the total talc worker population has an SMR within the usual range of variation from the national data. Since people who are chronically ill or disabled are usually unemployable and have higher death rates, healthy working populations typically have SMRs below 100. The SMRs In an occupa tio n a l group with values over 100 Indicate either possible ills&Tebeishaw M Journal of Occupational Medicine/M24, No. 8/June 1982 Tibia 2 - Qbsarvsd and Expected Numhars ef Deaths nil 1 SMRs Among Tiic Woikets With Known Prior Employment I Before Workat the TMX1540Whitt Male*With I _____________ 8,168 Yea at Risk). J Cause of Death ICD,* 8tb Revfsien --------- jlSjffg---------- ... Observed Expected SMR All deaths 90 Tuberculosis (010-019)1 3 All cancer (140-209) 22 Digestive system (150-159) 5 Esophagus (150) 1 Stomach (IS)) 1 Liver (155-156) 2 Pancreas (157) t Respiratory system (160-163) 8 Ltmg{162) 8 Kidney (189) 1 Brain (191-192) 1 Lymphosarcoma (200) 1 Hodgkin's disease (201) 2 Leukemia (204-207) 2 All lymphopoietic cancer (200-209) 5 All circulatory system (380458) 36 Myocardial Infarction (410-413) 27 Cerebrovascular diseas* (430-438) 3 Ml respiratory disease (460-5191 9 Pneumonia (480-486) 3 Emphysema (492) 2 All .dfgastive system (520-577) 1 External causesof death (800-098) 11 Kotor vahiclBaccidents (810-827) 4 Suicide (950-959) 2 60.6 148* .4 680* 116 192* 3D 201 .3 362 .6 180 .2 1,013* .6 164 4.0 228 3.7 214 .3 325 .5 206 2 326 2 649 .6 391 U 374 28.0 129 20.3 133 3.1 97 29 307* 1.0 274 .7 276 35 28 9.8 112 34 119 2.2 92 * ImUcatetstatittlul significance at the 1%level t Numbers in parenthesesrefer to tCD aides t Indicates statistical significance i t the 8%level work place hazards or possible confounding with nonoccupational exposures. One such nomoccupational exposure is smoking, and it !$ noted that the SMR of 163 for respiratory cancer in this population is consistent with a smoking effect While the actual smoking experience of this population Is not known, insight into it is gained from knowing the smoking patterns o f current TMX workers, many o f whom are Included in the study cohort. Among 151 workers given a medical examination at TMX in 1979, 69 (46%) were current smokers, 38 (2S%) were past smokers and 44 (29%) were nonsmokers, The percentage o f current smokers Is higher than in the general population, but is consistent with pat terns seen In the mining industry. The SMR for all causes o f death, 106, may also reflect In part inclusion in the cohort o f everyone ever employed during the study period, regardless o f their length of employment. Universal cohort membership generally tends to increase SMRs, since short-term workers often have a greater mortality experience than long-term employees. Most study designs exclude workers with less than one year o f working experience. The practice was not followed y " , I 4811 WES001127 From ( 613) 998-3280 Order # 05543491DP04581959 Mon 3un 13 20:50;18 2005 Page 4 of 6 Table 3 - Observedand Expected Numbers of Deaths and SMRs Among Talc WarfcanWith No Known Work Prior to TMX Employment (115 White MaleeWith 2,184 Teen of Risk). Causa of Death ICB, Stir Revision -------UMttB . Observed Expected SMR Age at Case Ne./Deith, yr Pre-TMX Emptoymeat Years or Day* Employed at tin TMX Post-TMX Employment Table S All d Baths 23 All cancar (140-20911 3 Lung (162) 2 Prstate (195) 1 All circulatory system (390-45B) 12 Myocardial infarction (419-413) 6 Carahrovasadar disease (430438) 2 Ail respiratory diseases (460-519) 1 . Pneumonia (430-486) 1 Ail digestivo system (620-677) 2 45.9 60* 98 33 2.6 76 .6 120 268 46 188 33 441 50 3.2 31 1.1 90 U 112 1/39 2/49 3/63 4/63 5/54 6/55 7/69 8/62 0/84 10/79 10 4 7 8 17 6 8 47 days 27 13 66 days 23 12 3 21 21 3 13 16 345 days 24 26 17 1 25 17 days 21 39 8 days 22 < 1 10-K 15-I 20-24 25-21 30 35 * Indicates itstisticel significance at the 1%level; note that this SMR Is lower than expected with respect to the U.S. national t Numbers in parentheses refer to ICD codes this study in order to maximize cohort size. The use o f the U.S. white mate population as the exter nal comparative group does net necessarily' describe the TMX mortality experience, since the mortality experience the entire cohort at age of hire. For those workers with TMX-only employment, 63% were under 25 when hired, contrasted with 35% for those with previous experience. The difference in age at hire between the two cohorts may partially explain die deficit in disease mortality among TMX-only workers and the lung cancer experience o f those with other work history. 40-4 46-41 50-54 55-69 >60 Total Latent o f the U.S. white male population is likely to vary substan Discussion tially from that o f this cohort For example, thfe New York Workers with previous jobs before employment at the State cancer death rate is 199,24 compared to the national TMX were found to have high mortalities, as shown In average o f 174.04, approximately a 13% difference.7 Table 2. Work* with no known work history before em Since exposures -prior to employment a t the TMX could have Included carcinogens and other substances hazardous ployment at the TMX were found to have much lower mortalities (Tabic 3). Thus, it would seem that exposures to * Fn r to the lungs, the results have been analyzed to investigate health hazards occurred in these earlier Jobs and that these mined \ this possibility. Tabic 2 shows the observed and expected exposures are causally related to the higher rates o f death. iTM X ; ai numbers o f deaths and the SMRs for all workers whose job Obviously, mines and mining operations are not uniform : diagnosis histories show prior work before employment a t the TMX. Deaths for dll causes are significantly increased, as are with respect to the occurrence o f health hazards and, as previously stated, Selevan ot al5 have described increased ; Table 4, noted. T deaths for a number o f cancers and for nonmallgnant respiratory diseases. Since the cancers and lung diseases rates of lung cancer in some talc miners exposed to radon daughters. No significant radon daughter exposures oc . 47 after he died. typically have long latencies, the possibility exists that exposures prior to work a t the TMX warn responsible for curred at the TMX,8*9 The low mortalities given In Table 3 are in agreement with the absence o f radon daughter and were 29 years pc i a t least some of these diseases. other related hazardous exposures a t the TMX. However, .The sect I Table 3 shows the observed and expected numbers of mortality studies such as ours lend themselves to various date. His deaths for workers with no known employment prior to the conclusions, lacking data on smoking and other personal , TMX, Z i TMX. Mortalities for all disease categories do not differ risk factors, we sought to obtain confirmation for our }' To ex siffiiflcantly front those for the comparable U.S. popula interpretations by an Independent analysis of lung cancer ?. column ` tion! In fact, the SMRs from all cancers and all respiratory tract diseases (33 and 31, respectively} were among the lowest oFall the mortalities. It should be noted that workers whose employment records were devoid o f work history latencies. Oata for an analysis o f the lung cancer latencies are given In Tabic 4. For each of the ten cases of lung cancer, the employee's years of occupational history are given as the i- employe j. ure. The / are inclu \ the first data were Judged as having had no known prior employ ment and thus were included in Table 3. If some of these workers did indeed have work experience before employ ment a t theTMX, the effect would be to increase the SMRs. However, even with this possible compromising effect, Table 3 shows a remarkably healthy work force, with most mortalities at 50% or less o f those o f the comparable U.S. population. As noted earlier, however, the small sample size limits the conclusions that can be drawn from this study. Five o f the 12 lung cancer cases, which are included In Table 5, were substantially older than the median age o f following; pre-TMX employment (employment was deter- 5 <k 4 $ 3 -1 m h 1 iiH in 10 A i t i i IS TTTT 20 YEARS EMPLOYED AT.TUX Fig. 1 - Nnmint of lung cancer eases by yean of emptoymeat n TMX. Inverse d less o ca response, agreemer TM X em i having lu Know determm processes be usefu causal ex 482 Mortality anti Talc Workars/Stillu & Tahersliaw ! Journal o WES001128 From (613) 998-3280 Order # 05543491DP04581959 Table B - Latencies of Bronchogenic Cereinames in TMX Workers 5 With hired, ience. ts may among f those at the >wn in ire cnri' lower urcsto it these death, mifbrm and, as creased ) radon res ocTable 3 ter and awever, various tersonal for our cancer re given cer, the i as the s deter- Latency, *yr <10 ID-14 16-ia 20-24 26-29 30-34 35-39 40-44 46-49 50-54 65-59 50 Total Latency Bronchogenic Carcinomas in TMX Workers Whose Exposure is Hypothesized to Bogin On Employment ot the TMX At Age 18, Prior to TMX Employment 1 _ 1 2 -- 5 1 3 1 -- 1 -- 4 _ 3 - 1 - - - - 1 12 12 199 382 I' . * From onset of exposure to diagnosis or death mined arbitrarily to have begun at age 18); tenure at the I. TMX; and the period from TMX employment until the ; diagnosis of lung cancer or death. Although not included in I' Table 4, two additional persons with lung cancer should be noted. The first was surgically treated for lung cancer at age 47 after 137 days o f employment at the TMX. A t age 57 he died of pneumonia. His significant occupational periods | were 29 years pre-TMX, 137 days of TMX tenure, and zero I' years post-TMX to the time o f diagnosis of lung cancer. | The second individual died o f lung cancer after the cutoff : date. His significant occupational periods were 15 years pre TMX, 23 years o f TMX tenure, and six years post-TMX. To explore the nature o f the dose-response relationship, column 3 in Table 4 , which Ijsts numbers of years or days : employed at die TMX, is graphically represented In the Fig| ure. The two additional cases o f lung cancer just described ; are-included. The clustering of nine of the 12 cases within the first five years of employment at the TMX shows an Inverse dose response, i.e., higher risks of lung cancer with . less occupational exposure to talc. The lack of a dose response, in terms o f years of exposure at the TMX, is in agreement with our findings that workers with "exclusive" f-TMX employment seem to be at no considerable risk of . having lung cancer develop. Knowledge o f the latency period of a disease permits : determination o f the probable time at which pathological processes began. Thus, the analysis o f disease latencies can be useful in attributing or refitting evidence as to when causal exposures occurred. Armenian and Lllienfeld10 have |; Journal of Occupational Medicins/Vol. 24, No. 6/June 1982 Mon Jun 13 20:50:18 2005 Page 5 of 6 reviewed the latency periods o f a number o f cancers. Jhey present evidence that leukemias in different populations and under different conditions have median latency periods and latency variabilities that re quite similar. They also re viewed data that indicate (hat the intensity or exposure has very little effect on latencies of other neoplasms. Hence, we hypothesize that if occupational talc exposure results in pulmonary exposure to a carcinogen, then the distribution o f TMX workers Sung cancer latencies should be similar to those reported for lung cancer in other studies. However, if such exposure is n o t carcinogenic to the lung, then the' distribution of TMX lung cancer latencies would be dis similar to lung cancer latencies reported elsewhere. To test the hypothesis that carcinogenic exposure began at TMX, the median lung cancer latency o f 36.5 years, as calculated by Armenian and Lilicnfeld,10 was compared to the latency period from the onset o f TMX employment to the diagnosis o f each lung cancer. As can be seen from Column 2 In Table 5, the average latency period of 19.9 years for lung cancer among the TMX workers is almost half the 36.5 years noted above. The Chi Square goodness of fit test provides a quantitative basis for rejecting the hypothesis at the 5% level o f statistical significance. if the occupational talc exposures to the TMX are not carcinogenic, then the question shifts to what other ex posures occurred that may have caused tire lung carreers. Since each of the subjects with lung cancer included in Table 4 had between eight and 39 years of possible occupa tional exposure from tire time o f his 18th birthday to em ployment a t the TMX, this prior period o f exposure may be related to subsequent cancers. To test this possibility, we hypothesized that the causal exposure for the lung cancer occurred before employment at the TMX. The data in the last column of Table 5 reveal a much more reasonable relationship to the lung cancos reported by Armenian and Lilienfetd. This second hypothesis, that the causal exposure began before TMX employment, yields an average latency period o f 38.2 .years, which is only slightly longer than the Armenian and Lllienfeld median of 36.5 years. The Chi Square goodness o f fit is almost, zero, indicating a very close agreement between the lung cancer worker latency periods and those o f talc workers when exposures prior to TMX employment are hypothesized as .carcinogenic. Hence, the initiation o f cigarette smoking in the late teenage years, World War II exposures, excessive exposures to mineral dust in the past, diet and nutritional status, absence o f complete work history, preexisting diseases, and other unknown etiologic agents could contribute to the etiology o f the observed lung cancers, while exposures at TMX seem to be noncarcinogenic. It should be noted that nine of the 12 employees .with lung cancer worked underground In TMX, which suggests that their other jobs also were likely to have been underground, Review o f the death certificates tends to confirm the observation that these men worked in occupa tions known .for their dusty environment. The employment policy o f TMX to preferentially hire experienced workers appears to have resulted in the confounding o f prior hazardous exposures with employment at TMX. Summary and Conclusions A historical prospective mortality study of workers at an upstate New York talc mine demonstrated elevated mortali- 483 WES001129 From (613) 998-3280 Order 05543491DP04581959 Mon 3un 13 20:50:18 2005 Page 6 ties but no significant Increases in the numbers o f deaths from lung cancer, from nonmallgnant respiratory disease, and from ail causes. However, workers with exposures In other jobs prior to work at the TMX were found to have excessive mortality from lung cancer .and from nonmalignant respiratory tract disease. Exposures In jobs held prior to TMX employment also were Implicated in an indepen dent analysis of lung cancer latencies. Acknowledgment Technical and editorial contributions were made to this com munication bv Maureen A. Vogt and M. James Sharpe. Juliet A. Foster, Pamela J. Trotter, and Deborah Rogers aided In data col lection and processing. References 1. Thorel C: Die speckstelnlunge (ein beitragzur pathologlschen anatomic der raublungen). BeJtr Path A n t 18:85-101,1898, 2, Kielnfeld M, Mosslte J, Kooyman O, t at: Mortality among talc miners and millers in New York State. Arch environ Health 14:663-667,1967. 3. Kielnfeld M, Messlte J, Zaki MH: Mortality experiences among talc workers: A follow-up study. JO M 16:345-349,1974. 4. Brown DP, Wagoner JK: Occupational exposure to talc con. tabling asbestos: til. Retrospective cohort study o f mortality. U.S Dept, of HEW, (NIOSH) Pub. 80-115:31-33,1980. 5. Selevan SG, Dement |M, Wagoner JK, et al: Mortality, patterns among miners and millers of non-asbertlform talc: Pr. Ilmlnary report.; Environ Pathol To xico l 2:273-284,1979. 6. Monson RR: Analysis of relative survival and proportional mortality. Comp B io l Res 7:325-332,1974. 7. Mason TJ, McKay FW: U.S. Cancer Mortality by County 1950-1969. HEW (N|H) Pub. 74-615:68$, 1974. 8. Health and Safety Report, Health and Safety Spot Inspec tion (Radiation), American Mine, Gouverneur Talc Co., Inc., Batmat, St. Lawrence County, N.Y., Feb 28,1973. US , Department of Interior, Bureau of Mines Health and Safety Activity. 9. Health and Radiation Inspection Report, Gouvemcur Talc Co., Mine No. 1 and Mill, Balmat, N.V., March 24, 1976. US. Department of Interior, Mining Enforcement and Safety Admlnts. tiatlon, 10. Armenian HK, LHIenfeld AM: The distribution o f incuba tion periods of neoplastic diseases. Am J Epltlem ol 99:92-100,1974. I- S e l e < fw m I Thoms i Depart \ Cl I Gr Wi De Jar CJe Jwi C!n Chi Cfn Shaping Mural Neuters Common to the various "moral education" approaches offered today is the idea that there is nothing right or wrong and that to teach any substantive ethical percept or idea is to "Indoctrinate" students. In one approach, students are Invited to "clarify1' their own values; the focus is on "rationality,"'"creativity," '`autonomy" and "process." In another approach, students are asked to dwell on ethical dilemmas such as when lying can be justified, or on public policy questions such as the morality of racial quotas. The problems with these approaches are obvious to anyone raised in the basic morality. In the values approach, no one need fear a teacher's judgment If his values are wrong, because there are no wrong values (other than, o f course, the value of opposing "values" education). Upon learning that alt choices are equally valid, a student will be educated into skepticism about morality, fertile soil for wrong action----- Today's "moral education" fails in the mast critical way because it addresses the intellect b ut' not the emotions. Ho one is taught to dislike and certainly not to hate anything. If young Americans are shaped, they are unfortunately shaped to be moral neuters/ The inculcation of the basic morality in the minds and hearts o f young people, as given In American education since the 17th Century; has for the most part ceased to be in the latter part o f the 20th. --From "Teaching Morality In Public Schools'' by Terry Eastland In The Wall StreetJournal, Feb. 22,1982. If: En T./ Nev Geo Alki Epi, Phlii Pitts Ergc E. R New Suzai Roch Exp* M. P. Lindt 484 Mortality and Talc Wortere/Stille & Tabenlww J o u m u l o f WES001130