Document 8Vk64n1V96QwO9Kn5bVqvQnbB
FILE NAME Brakes BRK
DATE 1976 December
DOC BRK056
DOCUMENT DESCRIPTION Journal Article - Occupational Differences in Rates of Lung Cancer - Journal of Occupational Medicine
~
Occupational Differences in
Rates of Lung Cancer
Herman R. Menck M.B.A and Brian E. Henderson M.D.
Many investigators have associated lung cancer with occupa-
tional exposure.1-17 In an earlier study we reported an excess of lung cancer in males in the industrialized central area of Los Angeles County This may have been the result of air pollution of industrial origin specifically elevated levels of polycyclic aromatic hydrocarbons.18 However since the excess was confined to males occupational exposure would be an alternative explana-
tion
Interest in better understanding the different factors affecting lung cancer in Los Angeles County in drawing clues toward identification of high risk occupations and in setting a base line for future occupational observation and control programs led us to review five years of lung cancer data for white males in the
county
Methods
Subjects - All 2,161 death certificates mentioning lung cancer trachea bronchus and lung in white males ages 20-64 for the period 1968-1970 and all 1,777 incident cases of lung cancer in white males of the same age group reported to the Los Angeles County Cancer Surveillance Program CSP for 1972-1973 were reviewed These mortality and morbidity data were pooled we consider this justified because of the high mortality rate of lung cancer and the relatively high accuracy of death certification regarding lung cancer 21 During this reporting period the CSP abstracted all incident cancer cases from 198 hospitals and six private laboratories in Los Angeles County including all hospitals known to treat cancer The primary source of case selection was hospital pathology files including hematology cytology and autopsy reports The medical chart was reviewed when necessary to establish primary site or first date of diagnosis of the malignancy or to determine missing demographic data Pathology records of nearby county hospitals were searched for inclusion of residents of Los Angeles County who were cancer patients All Los Angeles County death certificates mentioning malignancies were reviewed to further insure completeness of in-
From the University of Southern California School of Medicine Department of Pathology 2025 Zonal Avenue Los Angeles CA 90033
Journal of Occupational Medicine 18 No. December 1976
cident case ascertainment The study was limited to the age group
20-64 to minimize the number of retired persons without stated
occupations Of the 3,938 subjects 689 424 deaths 265 incident cases had no reported occupation and 1,222 619 deaths 603 incident cases had no reported industry of employment
Classification of Occupation - One occupational title and one industry of employment were obtained per subject California death certificates include the subjects last occupation name of last employing firm and type of industry The CSP demographic data were abstracted from hospital admission sheets and in some cases medical records and represent the last occupation and industry of employment which the patient or next of kin reported at admission The occupation and industry of each subject were coded into one of 417 occupational codes and one of 215 industry codes per the 1970 U.S. Census occupational classification system.22
Analytic Methods - Detailed occupation and industry popu-
lations for white males in age groups 20-24 25-34 35-44
45-54 and 55-64 were developed from the two Public Use Samples PUS of Basic Records from the 1970 Census for Los Angeles County.23 These included respondent information on current occupation and industry Combined use of the two PUS provided a 50 sample of Los Angeles County There were 31,216 white males aged 20-64 in the combined sample
Expected deaths and expected incident cases were calculated for each specific occupation assuming the specific rates of cancer in each occupation were the same as those for all occupations The ratio % of observed deaths plus incident cases to expected deaths plus incident cases hereinafter referred to as a Standard Mortality Ratio SMR was then used as the measure of risk for the individual occupations In a similar way an SMR was calculated for each industry assuming the specific rates of lung cancer in each industry were the same as those for all industries
The Haenszel method was used to measure statistical
significance.74
Results
The occupations with statistically significantly increased Standard Mortality Ratios for lung cancer are listed in Table 1. Among
797
the populations in these occupations there were 942 observed lung cancers compared to an expected 537 cases The Standard Mortality Ratio for lung cancer among these combined workers was 175 There were 16 occupational groups with an SMR of 200 or greater Twenty percent of the lung cancer in males ages 20-64 who reported an occupation occurred in the high risk workers listed in Table 1 who comprise only 15 of that age group The number of deaths 1968-1970 and the number of incident cases 1972-1973 were listed separately the proportion of lung cancer cases from death certificates and the CSP was consistent across the occupations listed with few exceptions All but one of the high risk occupations were among craftsmen operatives laborers and service workers There were two occupations bookbinders and blasters which were calculated to be at greater than fourfold risk to lung cancer but where the risk calculation
was based on so few cases that any inference drawn would be
speculative There were 16 occupations with an SMR below 70 including
pharmacists assemblers cranemen physicians barbers foremen sales managers checkers judges secretaries teachers personnel workers dentists stock brokers photographers and school ad-
ministrators
The Standard Mortality Ratios of workers in Los Angeles County
to lung cancer by industry are given in Table 2 Workers in 13 in-
dustries were at significantly increased risk with SMR's ranging from 127 to 279. Forty percent of the lung cancer in males
reporting an industry of employment age 20-64 occurred in these high risk workers who comprised 27 of that age group The proportion of lung cancer cases from death certificates and the CSP in these industries were consistent with few exceptions
Discussion
There were clear occupational differences in rates of lung cancer among white males in Los Angeles County These occurred by broad occupational group and by individual job classification However there are limitations to the epidemiologic techniques
used and whether these risk diff^'renceswere the result of occu-
pational carcinogens or reflected differences in smoking habits and other factors e.g. general air pollution cannot be determined Thus the absence of information on smoking limits our ability to delineate the risk of lung cancer due to occupational exposure alone However the pattern of these Los Angeles data their consistency with earlier reports of excess lung cancer risks in certain occupational groups asbestos workers machinists cooks painters and their consistency with reports of other occupational
diseases related to airborne agents skin cancer silicosis asbestosis pneumoconiosis bronchitis suggest that the data may be generally indicative of the impact of occupational exposure on
lung cancer rates Occupational groups found to be at excess risk who have not
been previously implicated included roofers dental lab technicians decorators nonautomotive mechanics photoengravers
Table 1 - Standard Mortality Ratios SMR = 100 for All Occupations for Occupations at Significantly Increased Risk to Lung Cancer White Males 20-64 Years Los Angeles County
Occupation
Asbestos Insulation Workers
Roafers
Heat Treaters
Dental Lab Technicians
Decorators
Taxi Drivers
Mechanics Excl Auto
Photoengravers
Pressmen
Clothing Ironers
.
Mariners Longshoremen
Shoe Repairers
Mine Operatives
Electricians Bartenders
Plasterers Dry Wall Workers
Cocks
Machine Shop Workers Truck Drivers
Restaurant Bar Managers
Painters
Plumbers
Welders
Janitors
Subtotal
All Occupations + so denoted p4005 else 001
Estimated Population
at Risk 23
400
2000 550
900 1,200 3,100
8 050
1,350
5,300
1.100
3.150 1,350
1.250 12,400 7.100 3,800
11450 11450 52,550 34 800
8,150 19,500
9.700
15,300
050
231,500
1,560,800
No. of
Deathn
1968-1970
3 5 i 2 6 16 19 4 10 6 11
-
3 5
40
16 3
23 117
58 16 45 25
71
48
504
1,738
Incident Cases
1972-1973 2 5 3 3 1 7
27 4
10 3
12 4 3
18 19 14 18
82
51 11 42 11 27 61 438
1,511
SMA 878 496 433+
405
358
344
332 320 276 267 266
:
233+ 217+ 217+ 205 204 200 180 167 165 159 158 138+ 137+ 127
175
100
798
Occupational Differences in Rates of Lung Cancer and Henderson
janitors clothing ironers electricians bar and restaurant managers and
Occupational groups found at high risk who have been reported elsewhere included asbestos workers 26 heat treaters machine shop workers 15 pressmen 2 27-29 longshoremen 14 15 shoe repairmen 5 15 mine operatives 15 bartend-
9 15
ers
5
drivers
15
plasterers
cooks 14
taxi
11 15 16
12 15
painters
plumbers
and truck 5 15 16 and
welders 15 16 Industry groups not previously implicated include
radio broadcasting dairy leather food and drink bakery and
auto repair Industry groups at high risk to lung cancer in Los Angeles County which have been previously reported include
steel paper petroleum refining and transportation.31 No significant risk to lung cancer was detected among chemical
and rubber workers both groups have been found to have
elevated risks other studies.31-34 This discrepancy in our data
be due to the small number of such workers in Los Angeles
may
County and to geographical variation in the types of exposure
within the industry Most of the risk to lung cancer associated with the high risk
occupations and industries listed in Tables 1 and 2 may be related
to exposure to asbestos or polycyclic aromatic hydrocarbons
PAH or both Asbestos has been identified as a potent car-
cinogen both in animal studies and in occupational studies of humans 26 35 36 Besides asbestos insulation workers ship and
shipyard workers including stevedores have been reported at ex-
cess risk to lung cancer elsewhere.3
15 Other risk groups who
Table 2 - Standard Mortality Ratios SMR 100 for All Industries of Lung Cancer
By Industry White Males 20-64 Years Los Angeles County
.
.
Industry
Steel Mfg Radio TV Broadcasting Dairy Mfg and Sales Leather Mfg and Sales Eating Drinking Places Paper Mfg and Sales Bakery Mfg and Sales Petroleum Coal Products Other Food Mfg Auto Repair Transport Eqt Mfg & Sales Public Administration
Transportation
Other Metal Mfg Telephone Telegraph Electrical Mach Mfg Textile Apparel Lumber Wood Furniture
Chemical
Utilities Sanitary Service
Rubber
Stone Clay Glass Printing Newspaper Entertainment Recreation Personal Services Business Repair Services Other Retail Trade
Mining Construction Plastic
Elec Mach Mfg Finance Insurance Real Estate Prof Eqt Mfg
Professional
Wholesale Trade Agric Forestry Fisheries All Industries
Estimated
_ Population
at Risk 23
10,900
4,750 5,700 4,550 35,600 11,900 6.250 7,900 17,500
12,050
154,550 82,950 73,600 47,350
20,650 57,500 19,600
22,150
17,250
28,800 6,450 13,750 27,850 42,900
32,800 64,600
138,650
8,700 118,700
7,200 56,800
73,950 67,500
163,400
80,500
15,550 1,560,800
=
No. of
Deaths 1968-1970
39 10 10
6 59 14 10 14 19 20 238
78 92 57
6 69 27 20 11 25
8 18 30 53 41 63
122
12 127
6 49 43 20 74 43 10
1,543
Incident
Cases
1972-1973
:
;
SMR
20
:
279
i
:
4
216
ae
15
195
8
172+
37
i
14
171 171
12
169
13
23
,
160
148
8
146
205
143
,
96
132
74
127
47
126
18
123
24
,
20
119 119
19
114
14
- 110
19
108
8
105
7
102
16
98
29
97
22
91
32
89
78
86
5
49
:
5
27
48
43
83
26
5
.
84 84
82
67
;
63
58
48
46
1,173
100
significantly high 0.01 significantly high < 0.05
799
Journal of Occupational Medicine 18 No. December 1976
may have been exposed to asbestos include clothing ironers plasterers dry wall workers electricians and plumbers
PAH compounds have also been identified as carcinogenic in animal and human studies.38 Exposure to PAH compounds is very characteristic of metal working occupations and several of these
occupations were at excess risk to lung cancer in Los Angeles County including heat treaters metal machine shop workers 41 welders and plumbers In addition to these groups
of metal workers steel industry workers in Los Angeles County when analyzed as a single group were also at elevated risk to lung cancer Others have reported elevated risk of respiratory disease including lung cancer in steel industry workers.30 43 47 Other groups at high risk to lung cancer who have probably had exposure to PAH compounds include roofers vehicle drivers
employees of auto repair companies photoengravers printing trade pressmen 27-29 40 56 57 Cooks bakers employees of petroleum refineries 59 and dental lab technicians.59
For the remaining occupations and industries at excess risk to lung cancer specific carcinogenic hypotheses are difficult to
propose Shoe workmen and repairmen have been previously reported at excess risk to lung cancer. 5 15 Several investigators have also reported excess nasal cancer in the boot and shoe industry with the excess apparently associated with the leather and
cork dust areas rather than the spraying and lacquering 60 areas.6 61
Besides shoe repairmen other workers in the leather industry also were at excess risk in these Los Angeles data SMR's of 11015 and
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Journal of Occupational Medicine 18 No. December 1976