Document 7MR6xr1r2zeJyEnDQRbKK95GR

Current Intelligence Angiosarcoma of the Liver in Vinyl Chloride/Polyvinyl Chloride Workers In the December. 1974. issue or the iOM (76 809). 26 cases of angiosarcoma of the Itver were reported. As of January 22. 1975. 38 cases have been collected. The new data are given m this report. j. William Lloyd. Sc.D. On lanuary 22. 1974. the National Institute for Occupational Safety and Health was advised of three deaths from angiosarcoma of the liver at a single vinyl chloride polymerization plant. Since that time. 29 additional cases among polymerization workers in the United States and nme other nations have been reported. Details are given in Table 1. Review of these cases according to date of diagnosis shows that all but three were diagnosed within the last seven years. Although the cases have clustered since that time, it is probable that the high risk of this disease for polymeriza tion workers might have gone unnoticed except for the observation of a case in 1973 by a plant physician who reviewed earlier records and identified four cases during the prior ten-year period. The dif ficulty of making an early determination of an association of such a rare disease with an occupational exposure, even when the exposed worker is at very high risk, is also pointed up by the distribution of cases over time. Of the first eight cases diagnosed between 1961 and the end of 1968, six were from four plants in the United States, one was from France, and one was from West Germany, 'While an exact estimate of the in cidence of liver angiosarcoma among polymerization workers cannot be deter mined until exposed-to-risk figures become available, it is already apparent that these workers are at very high risk of 'Jr IhimI c- Dirvcvnr timer m Ocryrwtmn.il H.-Vlll A. ji\ t-tiLii* i- ji'U Mi | NlO'.fl ffryL- Ki |)'.m iihcii-i. m MOM! Km i--tl ShO0fi-.hr-- Ik.kmh'.. v,n > Table L -- Reported Caui f Aryfusmona pt tbe Uw Ament Vinyf CMoride PolyiMrtntmt Workers. Cewetry Cue ft* larth Dele let TC m rvc (mewre tiwti Canada Canada Canada ClKhOIIOrtUll CzccftcBwnti* Frinet Great 8m*n Giut frrtiin 01 WAITING OETAtlS 07 AWAITING DETAILS 03 AWAITING DETAILS 04 AWAITING DETAILS 01 AWAITING DETAILS 07 AWAITING OfTAHS 01' 00-0000 00-0000 oi- 00-0001 000046 03 0600 3? 020046 Italy Norway Rumania Sweden United Sia*n United SUtea United sntu United Statu United Statu (Juried Statu United Slitu United Statu United Statu United Slain United Suits Unded St llmitd States United Statu United Statu or 11-13-79 0000-57 01* 12-23-15 0300 50 01 AWAITING DETAILS 01* 06-23-2? 06-14-51 01* 10-17 23 120948 37* 06-19 33 U-1555 or 05-25 15 It 2845 04* 01-15 24 0706 52 os- 01 2512 06-1944 06- 00-00-29 01-17-67 07- 0503-22 060044 or 0506-70 100746 or 1101-31 9909-54 io- 06-16-13 06 )251 n- 052709 10-1446 12- 21-17-18 09 1349 13- 1201 21 08-1944 16- 11042? 0508 50 (7 050(11 06 23 55 W Germany W. Germany W Germany W Germany 31- 0? 26-31 or 06 24 30 C4- 0000-00 os- 000000 Tetal Reputed Caau = 32 Moian Values IS U S. Cases 10 Non US Cases 2S Total Cases 1014 57 1001-57 0000-00 oooooo 01 bN* Sweame t OX 0000-00 12-OOJ2 0000-74 32 13-72 12 2071 43 71 38 43 iS 0200-70 0303 73 0500-70 12,19-73 08 19-67 040944 0200-74 00-0048 080041 0301-74 050048 0340-70 050249 0500 74 000049 10 11 74 0925-70 091968 0000-00 oooooo . 43 49 36 58 43 52 15 45 41 43 55 61 50 53 41 43 40 28 44 49 450 410 <4 0 Tn let Ea Te OX let Tu Eip 19 19 76 20 I 15 6 22 21 19 IS 22 16 14 13 28 28 15 15 20 IE 12 12 24 18 15 15 17 17 17 17 23 23 20 15 30 30 1? 19 19 11 11 13 13 :? 11 n 11 190 173 16 0 120 170 ISO indisaies micftos'Cjiir co"ii"rd in^oMrc^* of ise iwer 00" Ing.uici un*nmn :aia Journal of Occupational Medicine/Vol. 17. No. 5/May 1975 Date tf Out* oo-io-: 12-00 72 12 24 :i :2-M:: oio< 72 13-23 73 0303 r3 39 :2:??3 010743 0409 S4 ALIVE 03 23 6? 08 79 61 ALIVE 05 13 S3 03 1G '3 95 02:4 <TG< 4 ia 4L--.5 ". 31 76 53 03 :: :: >: -6 533 RSV 0012454 Tab)* Z -- ltep*rt4 ChM ot MfMjrtwnj t IK* Um fcftoftf NM-Mjmtriiitim Vhrim tsooul (9 Vinyl Cbtorife Cwtrtry Gftir BntM lllly SiR*** Jailed SIMM IMrf SUM H Qttnrtwf \* tc Dl T Tt c*m rt* m m 11 1* lif Tn Dt at **. Ort* tllBirt Snow 01 T* 01 Etf Dull or OS08-14 00004* 020070 . 55 24 11 1200-70 Non l 01 Q6-15-J4 000045 W-l*7l 36 6 3 04-16 7! Nett 2 * 7 or 11-2711 90004S 05-1572 SI 27 23 08 15-72 Non 3 M MOO-13 ai-is-u MOO-73 M 36 GO inyn Ns* 4 14 15* OQdfl-n 000000 a? oo-r? 47 00 00 02 IS-7J Non s or OMS-JO 000000 32 004* 43 14 it 101073 Nor* 6 Aloti 1 Not* 2 Not* 3 Nett 4 Not* 5 Not* 9 Non 7 Non I Pmnftf nvc Qii mrAri onto bene mm Protaoton Of PVC IXB PrWctww a VMq4 Oilariy* Wjefttn* Opmrtor cawriwt manm ' mtn PVC ftauic inulatic* <ta*M *ttA mbaf PVC h*ne toMwf pawn* amt *mm VC erowiwm UpoMiwm mui--n )*, in pmlaramm. AHMuv OiAcsit to aMr"* anmn on owi 0* pmtat- Oioml ttavnaar Sarcw<o90n -niyrcwnil. Inr Noattihtr gl jmirHirrt rtnoioui of ut* ntieaMnuawnl cat iftinw onwi o* nm ml * Indium imerotneiullv onfirm** anfiowcoma sf thi (me*. "OCT Indium uni**** don. this disease. Approximately 5.600 men are coming from the older plants is seen are currently employed at 36 facilities m in the distribution by date of initial ex rhe United States. To date, 15 cases of posure. All but one case was initially angiosarcoma of the liver have been employed prior ro 1958 and more than reported from four of these facilities, all 70% of the cases were initially employed of which have been in operation for 20 or more years ago. Since the average more than 2S years. Nine cases have latent period from first exposure to been reported from a single facility diagnosis is about 19 years, we would which employs less than 300 workers. A not expect to see many cases at this time further indication that the earliest cases from the newer plants. Preliminary findings from continuing epidemiological investigations of L' 5 polymenaation workers indicate that these men also may be at high risk for other malignant neoplasms, particulars of the brain where a significant excess has been noted. Details of reported cases of angtosarCOma of the liver among other workers with exposure to vinyl chloride are shown m Table 2. It should be noted that in two of these cases primary angiosarcoma of the liver cannot be definitely confirmed. While too few cases have been reported to draw anv definitive conclusions regarding a cause and effect relationship, the age of diagnosis for these cases, which like that for the polymenzatton workers is con siderably lower than that observed for cancer of the liver in the general population, suggests the possibility of 3 common etiology It also should be pointed out that with such a rare disease it may be some time before we can determine whether workers exposed to lower levels of vinyl chloride are at ex cess risk for angiosarcoma of the liver or other malignancies. It is. therefore, im perative that the non-polvmenzat:on workers be kept under continued sur veillance. \ RSV 00X2455 334 Angiosarcoma at the Uver/L'cyd