Document 9J4g8qGG5Qg7VnX5RpgqngVm6

1I I i i i 1 r ! I THE LANCET Vol338 Sarurday 26 October 1991 1 -_ ORIGINAL ARTICLES No 8774 Cancer mortality in workers exposed to chlorophenoxy herbicidesand chlorophenols Epidemiological studies have reveaiea an increased risk of cancer, notably soh-tissue Sarcomas and non-Hodgkin's lymphomas. in people occupationally exposed to chlorophenoxy herbicides. including those contaminated by 2.3,7,8-tetrachlorodibenzo-p-dioxin(TCDD). We report here a htstoricalcohort study of mortality inan international register of 18 910 production workers or sprayers from ten countries. EADiislire 'was reconstructd rhrough questionnaires. factory or spraying records. and lob C2Li6?.>;.t?C f l C Sdl'C-31 <jot!h '3;e.E '.*.e''? "3 reference No ?*cess ,%as obsaned 'r ?I[-rause monaliry for all necplasms for :re .nos; common epirhelial cancers. or for lymphomas. A statistically non-significant two-fold excess risk. based on 4 observed deaths. was noted tor sokh % e sarcoma with a standardised mortaltry ratio (SMR) of 196 and 95% confidence interval (CI) 53-502: this was concentrated as a six-fold ~ t a t ~ s t i csi~onl if~icant excess. occumng 10-19 vean 'om f,rs: ;xposure in rhe cohort as 3 wnole i S M R - = 6 0 6 [ 1 6 5 1 5 5 2 ] ) and, for the same time ? a r g W 1- 2 n , p ~ . l q l d py:iozi amon0 SD'.T,'SrS w? vnail numbers nt arxns exceu of soft.:issue sarcomas among SPrWefS IS compatible with a causal role 01 chlwophenoxv herbicides but the excess does not VOL 338: OCT 16,1991 THE LLUCET 1029 TABLE ICMORTALITY BY DETAILED CAUSE AND EXPOSURE TO CHLOROPHENOXY HERBICIDES AND/OR CHLOROPHENOLS. BOTH SEXES SMA 195%CI)(no 01 obnfna dwlh) I Ii !' i; I .I ii i I' 1030 THELAh'cEr VOL 338: OCT 26,1991 1 112 ~ yu 19 , I I0670 ?ma !be w hl IS0 I* 00 (3 +5I3 u I- 70 1b 230 Y 155 68 boY) 4.202 )9 b5 _I 1 4 _10 Docm , ,\) Id l QYI is0 i)* la) 100 14-723) I IV 193 2MW 5 0 2.) '! 52 4 //VI 3 050 3 3!5 2 029 0 089 2 0 59 0 029 0 0 I5 1 0 16 -0 0 3 5 , 0'0-10541 iI 5 76 ?pP exposure sums Id high all-cauw rnonalin. uhlc 11'. np%lddY!or dCCldCllIS. polwnmg, md rlt~lcnced u d m g s u a d e S I W = 319 [l82-5I8lj. Table 11 g v a S.\Uls (and 95'506 CIS)and obscrvcd d o r h s for rnapr aux, of dear$ and for mslignvl~neoplasms by site and aposw for both sua mrnbmcd s m a d y IO dcarhs h t n c m r WT 3vmlable Icr m d n s m o n g n p w d f e ~ a l eS~i p : f i m r SXC~SSLSuerc ,~hw-.cdm m g Xlln :or 3.l>g.?x: 5y:~J:d Lld k-.:q.Jd41.pcilfid neoplasmn rhc a@ atcgov.malignanr ncoplasrnsof mchea, bronchus and lung III rhe probably apoxd atcgory, and rmlignant n m p h of unspmficd digesove organs and b a g n and unspeaficd neoplasm m the noncrpmd cucgory; n&iant defiau wcrc obvrved for malignant n e o p h of skin and of brun. Exposed wokm had SMRS above Mo for n m p h of unspmficd Agesnvc organs. neoplasms of rhc now and ruvl umy, dc-osrue y ~ c o m a ,breast anm ,in MJai and for ncophms of rhe rcsns. other c n d m m glands and :5>rLlt. Table 111 g v a mmbmcd S.CtRs for e.xpmcd and probably cxpscd w c r k m of turh xxcs, for dl neoplasm. soli-rissuc WCDIWmd non-Hdgkm's I>mphomas. n c panem of nsk for dl ncoplarrns bv tunc first exposure drd not u l d ~ a r ac strung halthv worker c t f m , and m o d i c y dId not vary s u b s a n a v berwrm rhe pups orammed. Soff tissue sarcoma 4 deaths were obwrrcd,all m n g exposed d e workm 'table 111, S o mcreved nsk UIS obvrvcd among produnion unrlrm 11 death , whereas m n a h app=arcd Malignant lymphoma !4 deaths from non-Hufgkm's I!mphoma ,ICD200, m,Sth and hh m w o n ) were observed among mar and 1 i r n m n wornrn: I I ,.ic%h wcrc !n mp-c! a--.rkcr. 311 r.en Mortality for c x p s d probably ccpoud w o k e n was c l m 10 cxpcc~cd SMR = 05: w x h producnon U Q ~ ~ C ThSavlng a s d ,utist:d:v rn,ignifianr ni~u=.cn rnonalrn. S dearhs,S.MR= 1-19: ~ablelllr.lOoutof11dathsoccurrcd more I h n 10 y a m &cr erst exporurc. 0 d a r h r K m c d among workm apoxd for dun a y a r , and no d d f m c c rn nsk could bc YPI m rclaaon to cxporurc IO TCDD or rype o f c h a n r d pruduccd.The lughcst S M R among producnon workm was for rhm UI "orho pbs" :trampon storage, Lborato? wrlrm, plan1 ruprmson). 4 deaths from n o n - H o d g h ' s lymphoma were o k c d among nonqxxdworlrm m one D a s h factory,&OK 4!. .\lonality for n o n a p o v d w o r k m was lughcrdun that of all atposed ..-...?A ..C. ..e -. c.Y' 1 ,1 Se. age ,Y M I 01 duih* TABLE IV-DESCRIPTION OF 9 CASES OF SOFT TISSUE SARCOMAS C a u u of death Hm01wv~ iMoa,Mld ]ob Y c m Years snwfml of slpnumleapoula uwkcn. md ~ u n ~ l ator that 01 prrxlucnun w r k c n uhie 11iJ The ~n armc m u\en sounrncs hot includLd m abk 111arc 3cpys m m h o n mcmbcrs who were ahve at rhe cnd of follow-up or whose ccrnfied underlbmg d u x of darh uasnot ICD 200 or 202 \lonalln Invn H d & m 5 dime \tz.k l o n a p m n o n 1 1032 - THELLh'CET VOL 338: 26, 1991