Document RkYmDLnrjJpN550Y4o09N5n7

R&S 110424 A . RNT DESCRIPTION FORM 53 68 69 76 duplicate in all cards:--$> TFT!v^86 year as-1961- File number [Right justify [Numeric only] Author(s), as Last Name FS (No Punctuation) and coden for journal as JAHA preceeded-by. one blank space 1 20 21 40 41 --- ---------- ** 77 78 Sub-Index Code 60 61 62 11 12 13 Title of Report: end with space-hyphen-hyphen-space. Follow with Index Terrs, separated from each other with .comma-space. Avoid other punctuation; do not abbreviate, 12 . V 61'62 21 . 22 . ' -fV -- --- /f:s r -t- /'' 'r-y S 23 24 (Journal, Vol., Number, Pages, Date) 12 61 6231 32 Brief Summary' 12 10 SUMMARY: * 61 62 61 62 63 64 R&S 110425 Angiosarcoma of the Liver in Vinyl Chloride/Polyvinyl Chloride Workers 1977 Update of the NIOSH Register i Robert Spirtas, Dr. P.H., and Rose Kaminski, M.S. Hyg, In the December 1974 issue of the Journal of Occupational Medicine (16:809), NIOSH presented data on 26 cases of liver sngiosarcoma among vinyl chloride workers, 21 of whom worked in the polymerization process. The present update pro vides details on 64 cases of angiosarcoma among vinyl chloride polymerization workers reported as of October, 1977. Con tinued surveillance of these workers is encouraged for the pur pose of furthering our knowledge of this disease process in relation to vinyl chloride exposure. Since the original publication of NlOSH's register of 26 cases of liver angiosarcoma associated with occupational exposure to vinyl chloride or polyvinyl chloride CVC/PVC).' evidence has continued to accumulate which further confirms this association. In the May 1979 issue of JOM.! an additional 12 cases were presented. Since that updJte. 33 more cases have been reported to NIOSH and one case has been discounted (U.S. Case No. 14) as of October, 1977. This yields a total of 70 cases known to NIOSH. 64 of whom were polymerization workers. Details of the 64 cases among poly merization workers are provided in Table 1. Data on non-poly merization workers is not presented in this update since there has been essentially no change. (One West German case was added to-the previously published table of six cases among non-poly merization workers.** w* hile one U.S. case (No. 141 was removed because the diagnosis could not be confirmed.) Table 1 consists of 23 U.S. cases and 41 foreign cases from 11 different countries. The 23 cases identified among U.S. poly merization workers represents approximately 10% of all liver angiosarcomas identified in the U.S. since 1964. This percentage estimate is based on the number of cases identified by the Chronic Diseases Division. Bureau of Epidemiology. CDC. through their nationwide case finding effort for liver angiosarcoma for the years Stnm the ULvss EtftTU Section. SB/DShf FS/NIOSH. Zobert A Ta/t laboratories. <676 Columbia Pjfkway, Cmonnau, OH 41226 1964-1974.* In the course of their study. CDC identified approxi mately 240 cases (confirmed by a panel of pathologists', of which 75% occurred during the 1964-1974 study period. Some of the information presented in Table 1 is summarized below. The numbers in parentheses represent the medians which were calculated from the data in the previous update.* (1) The ages at diagnosis ranged from 37 to 71 years with a median of 49 years (44 years). (21 The latency periods, i.e.. years from first expo sure to diagnosis, ranged from nine to 38 years with a median of 21 years (17 years). (31 The total years exposed ranged from four to 31 years with a median of 18 years (16 yearsi. A distribution of the cases by date of diagnosis is presented in Fig 1. Although it is difficult to interpret the aggregation of dif fering sources of data, and while the data for 1977 is incomplete, this figure suggests a gradual increase over time in the reported cases of VC-induced angiosarcoma. During the past 17 years (1961-1977), a total of 23 cases have been identified in U.S. poly merization workers. Fifty-two percent of these cases had been diagnosed over the past five years. The rise in the number of cases diagnosed m these workers during the 1970 s is probablv the reflection of two events: (1) the increased surveillance of VC PVC workers during this time and (2* the growth of the VC PVC in dustry after World War II. The 20 to 30 year tag between the growth of the industry after World War II and the increase in-the number of diagnosed angiosarcomas among VC 'PVC workers ob served during the 19?0's roughly coincides with the median latency period (21 years). In regard to some of the observations made from the data in Table 1. it will be interesting to note whether certain trends con tinue. For instance, the age at diagnosis and latency period appear to be increasing. Some possible explanations for these phenomena are (1) the i.nilial cases may have had heavier exposures. (21 the ini- *The (Cults nl COCs case (aiding effort wet* ohtamed ih.-.su$h personal iomrruniC4IHVI With Of Henry talk. Chrome Disease Division. Bureau ofEp-demoloRV- CDC Atlanta, (a****;1^ Reprinted from Journtl of Occupation*! ModUlft* 1078. Volum* 20, No- 8 pp. <-27-420 tjow 1078 i ii ! iii t f I J I I j l Ta6l* I. -- Reported Case* of Angiosarcoma of the Liver Among Vinyl Chloride Polymerization Worker*. Crttry Cr\Mfj Cavdi CiMdi C*udi Cxudi CmxU Canada CAflJdi Clmdl Canada Crtctoikrolu bcdKHIOMkU Fed Rap Crnar> fett *eo Orman fl ftp Cerran Fed Re? GtrnaAy Fed Rep Germany Fed Res Gen^ty Fed Re Cerrwy Fed Res Germany Fed Res Germany France France France Fr*<f fati France Franc* Franc* Crit Bmini Great 8n:*n Italy Italy iacjft Nora ! Sweden Sweden Sweden USA USA USA USA USA USA USA USA USA USA USA USA USA USA USA USA USA USA USA USA USA USA USA Yuko?MU YuyftUmi Ttfil Reported Cites 54 Cate No. 6>rtti Date 01 01" OF* 03* 04* 05* os* 07* 03 09 10 01* 02a;02' 04 05* 07* 03* (IS* 1011or 02 03* 04' os* 0* 07 03* 01* 03 02* 03* 01 01* 01* 03* C4* 01* 02* 03* 04* 05* os* 07* 03* 09* :o* ii* 12* 13* IS* 17* 18* 19* 70* 21* . 27* 21* 74* 25* 01* 02* Q00000 12 1513 0306 14 08 26-19 04 05 19 0507 11 121519 110919 05 13 20 07 1921 05-16-15 0030 23 000026 0604-33 072631 0904-30 0101-32 097926 10 19 17 121334 07 25 29 17-2936 04 15-24 0603-11 0000-19 01 2727 01-29 38 04-14-34 0000-27 040134 04-2001 0602 37 . 1113-29 03-K20 0801 22 12-23-15 0673 77 06 1010 11-1614 10-17-23 0819 33 05 7515 01 1524 01 25 12 1123-28 050322 0506-20 110831 031613 052709 111718 1201-21 110127 0506 31 04 22 28 000315 08 31 17 09 0709 1002 23 0300 23 0507 17 08 07 10 04 05 14 11 15)1 'Dujoosis wit m*aosep<jiJy canltffred "00" mdci'et u-'iincwn difi lit VC or PVC Eiposur* QCO0 0S 00 0044 0000 41 0C 0-341 000045 000041 000047 000346 000061 000046 OOOC53 000057 0000-51 1001-56 10-14 57 04-16-57 1216S? 04-15 $4 04 1954 120259 10-1055 010761 010046 07 05 59 03004$ 101949 * 000055 000053 070150 05-2357 0000-44 020066 GW 57 000053 040053 030050 06 14 51 0500 47 00 00 45 120948 11 1555 112845 0706 57 061944 01 1762 08 2144 100745 05 2845 06-12-51 1314 46 091349 12-11-47 050353 06 23 55 0915 54 00004} OOCC 55 1200 16 07-1147 C9C53 CO 00 39 020047 00 CO 53 000053 Diijflotii el Angiourcama 030000 0000 55 QCQC57 wOO-52 00 00 57 03-0068 0000 71 0300 72 00-3073 0-300-74 0030-76 0000 73 000065 09-19 63 09-25-70 0000 74 0C 00*75 COOO-75 08-00-75 06 16 76 0625 77 00-00*77 02 13 57 0133 75 0130-75 0134 76 04 30 76 0930-7$ 0730-76 123376 1230-72 124X174 12-13-72 07-10-75 08 21 74 12-2071 OS 00 74 03 19 76 05-1277 030373 050070 1219 73 08 19 V 04 OSSA 0230 74 000063 080061 0301 74 053068 03 03 70 050269 0530-74 03 30 6 !9 11-74 003-3-75 05 19 75 0130-76 GO 0077 0130 76 0435 7} 0577 77 , 0110 77 04 OS 73 07 17 7} Afit a Dujr.oti* 00 41 43 42 43 57 51 53 S3 53 61 46 <0 38 39 44 43 A9 58 42 47 41 43 63 55 49 38 42 4942 71 37 43 55 52 .56 43 65 62 49 37 58 43 52 4o 45 41 43 55 61 50 57 41 43 46 60 58 67 52 50 60 67 55 42 Yejrt from Ut culture to DiJjrrosis 00 11 14 21 22 21 24 2o 12 28 23 16 IS 12 13 17 13 21 22 17 22 16 21 15 29 26 M 18 26 19 28 09 15 22 22 22 19 29 3! 24 14 28 15 20 12 24 15 29 17 23 20 -'32 19 15 21 37 21 30 29 15 33 30 20 23 Total Ytan of Eipoture 00 11 14 23 22 05 23 25 05 2$ 1* 16 15 12 12 17 -12 12 21 15 22 10 19 12 29 26 10 17 23 19 22 04 06 21 22 21 18 21 31 21 13 78 15 20 17 i: IS 24 17 23 19 26 04 19 11 22 18 21 28 14 26 20 20 18 Oite of Dtiih 06 29 75 0902 55 12-21 57 0322-62 01-2166 C'G5 53 04-tO 71 12-24-72 06-1273 09434-74 0400-77 0040 74 0000 55 01-25-59 1214-71 11 25 74 0109-75 11 13-75 1225-75 Aitve 06 28 77 0307-77 02-19-67 01 24 75 06-24-75 01-34-76 35-13-75 C9-12-76 0702-75 0130-27 1203-72 1224-74 1203-72 07-1-2-75 1024 75 0104 72 10 20 70 03 19 76 85 12 77 030373 0928 71 17 19 73 0107 68 54 09*4 37-24.75 032363 08 2461 0100 75 OS-1053 03-16 70 050259 07-04 74 032769 Alne 1102 75 0406-76 013077 0102-77 1204-76 04-06-/3 052? 77 03 10 77 04 08 73 07-12 73 R & s 110426 One of the values in maintaining this register of cases among vinyl chloride workers is that it provides a base from which hy potheses for future research can be generated. However, the ex tremely rare occurrence of liver angiosarcoma lends great impor tance to the need for as complete reporting of the cases as possi ble if we are to develop a better understanding of liver angiosar coma in relation to vinyl chloride exposure. The occupational!] health community is asked to report all new or as of yet un-t reported cases of angiosarcoma among VC.'PVC workers to either? Dr. Robert Spirtas or Ms. Rose Kaminski. Surveillance Branch.' DSHEFS/NIOSH, 4676 Columbia Parkway, Cincinnati. OH 45226, (513' 684-3284. In addition to vinyl chloride's association with angiosarcoma of the liver, recent studies have also found vinyl chloride to be asso ciated with excesses in brain cancer and neoplasms of the respira tory and lymphatic systems.' 4 * More studies are needed to assess these findings. For an overview of the literature concerning the health effects associated with VC.'PVC exposure, the reader is referred to Volume 246 of the Annals of the New York Academy of Sciences.* The abhors with to trunk Or. |. Wiliam Lloyd. Or. Henry ?aR< and Mr. Richard Wat* wetfer tor th*'f contUuctive criticisms, fit 1. -- Number at uhi of VC/PVC reined angiosarcomas reported to NIOSH by yeir of diagnosis. (This represents only 63 of the 64 coses known to NIOSH since infarmilion on diagnosis is missing for one cose.) tial cases were more biologically susceptible, or (3) random fluc tuation. Analysis of the latency period for this disease in vinyl chloride workers should be a fruitful area for future study since multiple etiologies do not seem to be a factor in these cases and the exposure periods can be fairly well defined via employment histories.* Recent preliminary finding* by NiOSrCs Oivnexi of Biomedical and Behavioral Science surest that the interaction of disuliuram with the enrymauc detoxification of ethylene dibromxie results in increased carcinogenicity (including angiosarcoma of the (vert in laboratory rats. References 1. Lloyd JVV: Angiosarcoma of the liver in vinyl chloride'polyvinyl chloride worker*. JO-M 16:809. 1974. 2. Lloyd |W: Angiosarcoma of the liver in vinyl ehlnride'polyvinyl chlo ride workers. lOM 17:331-134. 1975. 3. Waxwinter R|. Stringer W. Wagoner IK. et a): Neoplastic risk among workers exposed to vinyl chloride. Ann .VY Arad Sci 271:40-48. 1976. 4. Tabcrshaw IR and Caffey WR: Mortality study of workers in the manu facture of vinyl chloride and its polymers. |()M 16:509-518, 1974. 5. Munson Rfi. Peters |M. and lohnson MN: Proportional mortality among vinyl chloride workers, lancet 2:397. 1974. 6. Toxicity of vinyl chloride-polyvinyl chloride. Ann N'Y Acad Sci 246. 1975. 33 8 0) o -fcx l\3 Nl v 4