Document V3qQE25ydZXypd2yVpBZejO2j

1. m\n I I ,ah Journal of Occupational Medicine (ISSN 009a1736) - / I I I August, 1980, Vol. 22 No. 8 1- 1I ORIGINAL ARTICLES , M i a t e Editor ROBERT R 1. HILKER. M.D. f,&ive Editor DORIS L. FLOU~~NOMY..S. tdto,iil Board H. DEAN BELK. M.D I PATRICIAY. HAGENDORN. M.D. JAMES P. HUGHES. M.D BRUCE W. KARRH. M.D. PAUL KOTIN. M D. 1 ~ 0 h i A SA. LIF;COLN. M 0. BRIAN MacA14HOX. kt 0 . ROBERT L. RALEIGH. ht 0. \ DAVID 8 ROBBINS. M O . f 6 i O r i J l AssirIan1 MARY STEVENS ? M l i G n .H;nrgcr ELlZABETh CAMERON uJnuscript Coardinalor BARBARA VASUMPAUR ! CiculJlion Manager NANCY OLSON . The loumal of Occupational Medi- .-ne is owned. copyrighted. and pub:&ed monthly by the American Occupa- ' renal Medical Association. 150 North Sacker Or.. Chicago. I L 60606.Second ~ ! J Npostage paid at Chicago. IL. Title ' yistered. United States Patent Office. Subscriptions: 525.00 per year. US.: SUO per year, Canada and elsewhere. i mgle copies 53.50. Allow four weeks ior ! .'%I issue. Publisher cannot assume ' -5msibility for replacing undelivered *cues. or issues damaged in transit ; n k i notified not later than the end of ?* second month following the month 3 !me. Although all advertising material acitpled is intended t o coniorm to ethical 1 medical standards. acceptance does not .-dv endorsement bv the lournal. rhanae oi Address: Nottces should in.& old a d d n s as well as new Attach 2 . 4 ifom recent trsue if availabie Be .L+ 10 include rip coder for both o l d '.-J M.w address. Allow iour weeks for "Jnge to become effective. strnuscripts submitted ior publication . *.'Id be cent to Doris Flournov. Ex- - 2 t w Editor. lournal of Occupational "Odlcine. 150 N. Wacker Drive. - 4 r s o . IL 6ObI)6. ~ E R T I S I N CREPRESENTATION CHARLES 8. SLACK, INC. Thorofare. NI 08086 (609)848-1m Marketing Director RICHARD N. KOASH Incidence of l o w Back Pain and Prdlacement X-Ray Screening. . . . . . ..515 E. 5. Gibson. M.D.; R. H.Martin, M.D.; and C. W. Terry, BSc. Mortality Among Automobile Assembly Workers 1. Spray Painters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Leonard Chiazze, Ir., Sc.0.; Lorraine D. Ferrence, M.S.; and Pamela H. Wolf, Dr.P.H. .520 The Cigarette Factor i n LungCancer Due to Chloromethyl Ethers. . . . . . .527 William Weiss, M.D. Mortality Experience of Employees Exposed to 2,3,7,8-Tetr;rchloro- dibenzo-p-dioxin (fCD0). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ralph R. Cook, M.D., M.P.H.; JeanC.Townsend. M.S.; M. Gerald Ott, M.S.; and Lawrence C. Silverstein. M.S. .530 A Case-Control Study of Prostate Cancer Within a Cohort of RubberandTire Workers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . David F. Goldsmith, M.S.P.H.; Allan H. Smith, M.D.. Ph.D.; and Anthony I . McMichael, M.D., Ph.D. 533 Cause-SpecificMortality Among Newspaper Web Pressmen. . . . . . . . . . .542 Annlia Paganini-Hill. Ph.D.; Eva Glazer, M.B., B.S.; Brian E. Henderson, M.D.; and Ronald K. Ross, M.D. NurselHealth Counseling Model for a Successful Alcoholism Assistance Program. .......................................... Paul R. Eggum, M.D.; Phillip 1. Keller, M.S.; and Wayne N. Burton, M.D. .545 Genital Ulceration Due to Stoddard Solvent. . . . . . . . . . . . . . . . . . . . . . . 1. R. Nethercott. M.D.; 1. M. Pierce; C. Likwornick, M.D.; and A. H. Murray, M.D. .549 Occupational Medicine in the People's Republic of China. . . . . . . . . . . . .5f3 Herbert K. Abrams, M.D. DEPARTMENTS Letters-to-the-Editor Use of ,\tedijector Disputed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . An indexing Oversight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Adjudicators Defended. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Law in Conflict: Another View. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Authof s Response. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .508 .508 .508 .SO9 .511 Selected Reviews from the Literature Dermatology ........................... . . . . . . . . . . . . . . . . . . . . 5% Energy Technology. . . . . . . . . . . . . . . . . . . . . . .................... 559 Internal Medicine. . . . . . . . . . . . . . . . ..-\.. . . . Mental Health. . . . . . . . . . . . . . . . . . . . . . . . . .................... .................... 559 559 Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................... 560 Advertising Sales Manager General DAVID C. TOWNSEND People and Events. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Coordinator . Classified Advertising. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BETTY 1. SHELDON (Classiited A& also appear as display advmising. See Advertisers' Index) 561 .566 i w Advertisers' Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .568 \ POSTMASTER: MANUSCRIPTS Contributors are rcquested to read Informarion for Aurhors, which is pu& : IcFnorm d%lo J''ourONf OlccU-- lished In the ianuaty. May and September Issues of the Journal and which may be obtained Newspaper Web Pressmen c Annlia Paganini-Hill, Ph.D; Eva Glazer, M.E., BS.;Brian E. Henderson, M.D.; and Ronald K. Ross, M.D. A mortality study of 7.367 newspaper web pressmen had been in the union during the specified period, 1,361 - -who were members of the 10s Angeles PressmenS Union met the criteria for inclusion in the mortality study, i.e., for at least one year between 1949 and 7965 was h e y had been employedas pressmenforat least one year conducted. Vital status as of December 37, 7978, was (42 eliminated) and their birthdates were known (139 determined for 7,267 (%%I, and aeath certificates were eliminated). The 181 rejected tended to be those who obtained for 344 of the 354 decedents. Using a modified were in the union for only a short perlod o i time (82% less lifetable technique, causespecific monality among the pressmen was compared to that in the UnitedStates white male population. Overall mortality was similar to that ex- than five years) and therefore are a group with a very short duration of exposure to the pressroom environment Of the 1,361, vital status was determined for 1,241(91%I. pected. Analysis of the cancer mortalityby site showed no The remainder were initially active workers who sub* significant differences between observedand expected except for leukemia (7 observed vs. 28 expected)andkidney cancer(5 observedvs. 7.6 expect& A significant excess of deaths due to cirrhosis of the Iiwr (I7 observed vs. 8 3 expected) was also observed quently terminated their employment and went to work in other occupations or in nonunion shops. All members of the cohort were white males. Death certificates were recovered for 34.4 of the 354 known decedents in the cohort, and the underlyingcause of death was classified according to the International Classificationof Oiseases (ICD), Eighth Revision.' A modified lifetable technique' was used to obtain person-yearsat risk of dying by ten-year age and f ive-year Newspaper web pressmenconstitute an occupational subgroup in which there is potentially hazardous chemical exposure.' These men operatethe rotary presses that print a continuous roll of paper called the "web." They are exposed to the atmosphere of the pressroom which contains printing ink, paper dust lubricating oil and solvents. The high-speed rotating rollers of the presses may accentuate the presence of these substances by filling the pressroom with ink spray and paper fly. The study reported here describes the mortality experience of calendar groups. The observation period for an individual began with the first year between1949 and 1965 in which he was a member of the local union. The date last at which he was known to be alive was used as the date of follow-up for the 120 pressmen whose vital status as of December 31,1978,was unknown. Causespecific mortal; ty rates for the United States white male population' for 1952,1957,1962,1967.1972a.nd 1975 were used to COT puteexpected number of deaths for the study cohort The expected numbers were calculated by applying the rates a cohort of newspaper web pressmen. specific for age and calendar year group to the set of Methods A list of all individuals who were members of a Los Angeles Pressmen's Union at some time between 1949 and 1965 inclusive was obtained from that union. Utiliz- person-years at risk in that age and calendar year group. Standard mortality ratios (SMRs) were calculated as observed loo- expected ing the records of the local union and of the International Printing and Graphic Communications Union, the authors attempted to procure for each individual the following iw formation: date of birth, year first worked as pressman, year last worked as pressman, and vital status as of December 31.1978.From a total of 1.542 individuals who Reurlb 1 Table 1 summarizes the duration of employment as pressmen for the men in the study. A high percentage (65%) had worked for 20 or more years, indicating that turnover of active members not due to retirement is relatively slight Most workers began employment at an From the Department of Communw and Familv Medicine. University of early age (Table 21.Therefore, this industrial group i s one Sourhem Calilwnu khool of Medicine. 2025 Zonal h e . . lor Angeler. CA 90033 (On.PaganmcHill. H m d k a d R a r L and Caifomtr Sate Dcp~n- in which exposure is often continuous and of long dura- mmt of Health krvlces. Berkelev. CA 947C4 (MS.Clazerl. tion. 542 . I Yoars Em~loyod 1-9 10-19 20-29 30-39 40 + Unknown . Total -Tabla 1. Distribution by Number of Years Employed as Pressman. Alirr No. x 35 4 217 24 354 40 1a2 21 89 10 10 1 a87 100 Doad No. 9 23 65 69 115 73 354 K 3 6 18 19 32 21 100 Status Unknown No. K ' 49 41 30 25 13 11 00 10 27 23 120 100 c Table 3 shows that the total mortality among web pressmen was eight percent less than expected (344 deaths observed vs. 374 expected).This deficit in mortality extends to most major causeofdeath categories. How- ever, significantly elevated SMRs were seen for kidney cancer, leukemia. and cirrhosis. In this study, the autnors were unable to associate the observed excess for either leukemia or kidney cancer to any particular group either by age started work, year started work, total number of years worked or interval since first worked, but the numbers became very small when tnese variables were stratified. Discussion Seven deaths from leukemia were observed, which represented a significant excess over the 2.8 expected six of the seven leukemiaswere of the myelomonocytic type. In addition, myeloid leukemia was mentioned in the secondary role on the death certificate of one pressman and one other had myelofibrosis. An excess in leukemia mortality among pressmen is also evident in the 1951 Registrar General's Occupational Mortality Report' Uoyd et ai' found a modest increase in the number of deaths from leukemia (8 observed vs. 5.1 expected) in a proportional mortality study of newspaper pressmenwhile Viadana and Bross' found evidenceof an excess of leukemia incidence among printers over the years 1959 to 1962 (a relative risk of 1.9 for printers vs. clerks). There is strong epidemiological and clinical evidence of an association between benzene exposure and risk to leukemia Infante et alereported a fivefold excess risk of all leukemias and temfold excess of deaths from myeloid and monocytic leukemia among pliofilm workers ex- posed to benzene. Earlier published case reports were tabulated by Browning' who showed that there was a consistency in the histologic types (myelogenous and monocytic) of benzeneinduced leukemias. In the past benzene has been used in pressroomsas a solvent and in ink formulation. Although toluene and other hydrocarbon solvents have now been substituted for benzenc. l h t l chemical may still be present as a process impurity." While an excess number of deaths due to blJdder cancer among those in the printing industry has been '*observed," l2 no unusual mortality due to kidnev cancer has been reported previously. Black printing'ilk is composed of approximately two percent carbon b l d dnd one percent asphalt dispensed with mineral oil m d solvents. Colored printing ink contains addition-11 pigments and dyes, and findings in laboratory nriiil1JIj have suggested that kidney damage may result frarn e\posure to lead pigments and to benzidinebased color- ''ants." In addition, of the 37 most commonly used coi- oring pigments and dyes found in printing ink, four ( I d chromate, lead chromatelead molybdate, carbon bl.ick. and cadmium sulfate) are carcinogenic in humans or animaIs.'O Additional studies of newspaper pressmen are needed to verify the association with renal cancer reported here. The finding in this study of an excess of 105% for deaths due to cirrhosis agrees with the excess for deaths due to cirrhosis found by Lloyd et al.' This excess may in part explain the low SMR seen for prostatecancer, as this inverse relationship has been reported previously." " Several investigatorshave reported excess lung cancer mortality among workers in the printing industry'ln However the few previous studies of mortality among newspaper pressmenexclusively have observed no excess of lung cancer,' z* and this report substantiates such findings. Although air levels of oil mists in the pressrooms of newspaper plants have been measured as high as 3 )'mglcu m2* these high levels apparently create no unu- sual lung cancer risk. The finding of an increasein deaths from oral cancer by Lloyd et ai' was also not subswnti- ated. The choice of general population death rates for calculating the expected number of deaths in this OC- cupational group introduces an overestimationof expect- ed mortality. This observed deficit of deaths has been called the "healthy worker effectwa4 Thus, the slightly -Tabla 2. Distribution by Age Staned to Work as Pressman. A90 Started a Work < 24 25-34 35 + Unknown Total Aliw No. A56 358 63 0 887 K 53 40 7 0 100 Doad No. % 112 32 104 29 42 12 96 27 354 100 Status Unknown No. K 47 39 50 42 19 16 43 120 100 Journal of Occupational MedicineNol22. No. 8/August 1980 - 543 I^ Cause at Death .- . - - ~"--I_ -_-_I -[able 2 . C a l i s ~S p e c t i c Mortalitv Experience A m o n g Cohort of Newspaper P r e s s m e n ____I.""^ I IC0 Code Ob% Ex 0 i.C 3 U > l S AII mi1c;naqr neooiasm buccal ana onarvnaiai Lung ana iracnea Esoonaceal Stornacn Colon- kcrum Liver Pancreas Prostate Kioney Blaaoer Leukemia Olner iinanat c and nenlJt3oc!elic ne03 asrns Ca.oic.asc3 j r disezse lntiuenra 2nd pneumonia Ulcer Hernia inleslinal obslrucuon Cirriosis :.I L ` I ~ Sana n e S l is Accqoenis Suiciae anc nomicioe All otner causes 162 ' 50 '51 153 154 `55 157 185 i89 186 204 207 202 233 208 239 353 456 170 4d6 531.532 550 560 571 582 594 EB00-929 E950-969 2: 5 3 1 5 195 1 1 17 I2 12 25 lo E 'f *. ^* 69 GC 3s j: 16 24 28 39 205 8 96 26 12 - -8 3 1. 21 a 92 44 0 I SMR I 149 2 70 90 112 I29 74 303' 85 247. 129 95 72 36 83 20:236 60 131 56t *p<005 tp<O01 I decreased total mortality of the web pressmen is not sur- 9 Browning E: Toxicitv and Metabolism of Industrial Solvents prising and i s similar to results from many other studies of industrial populations." 27 " Follow-up was attempted on all individuals. including those who had left the union to work at other occupa- New York: Elsevier Publishing Co.. 1965.pp 3-65. 10.Kav K: Toxicologic and cancerogenic evaluation of chemicals used in the graphic arts industries. Clin Toxtco/ 9:359-390.1976. 11. Blot Wl and Fraumeni I F lr: Geographic patterns of bladder cancer i n the United States. I Natl Cancer lnsf 61:1017-1023.1978. tions or in nopunion shops. However. as most deaths were obtained from among those entitled to union death benefits, following the others only to the point where they left the union might introduce a bias. One might miss 12. Hoover R and Fraumeni I F Ir: Cancer mortality in US. coun- ties with chemical industries. Environ Res 9:19&207. 1975. 13. Badger CM: The Chemical Basis of Carcinogenic Activity. Springfield. Illinois: C C Thomas. 1962. p 35. 14.Hirsch CH: Effect of chronic lead treatment on renal function deaths due to chronic diseases (if an individual had left Toxrcol Appl Pharmacol 25:84. 1973. the union because of ill health) but most likely not deaths due to acute diseases. If such a bias does exist, it is unlike Iy that it would create any false associations. but it could mask some that do exist. 15. Brernner D A and Tange ID: Renal and neoplastic lesions after injection oi N-h`ldiacetvlbenzidine. Arch Pathol 81:146.1%. 16. Clanu CM: Cirrhosis and carcinoma of the prostate gland. / Urol 911291-2931.964 17.Keiler A Z Liver cirrhosir. tobacco. alcohol.and cancer among The author' w r h ro thank M'iiildrn F Mdrtin and LWJ L Vorhm or.rh- 1nrt.r- nrriondl Printing and Craohic Comrnun~c~rionUrnwn and lohn hd1w.m or the Lo) Angeiei Prer5men's L O C J ~18 lor rhcir dlSiStdnCC in rhn .rudy This work was conducted under Grant No C A 14089 01 the hational Insii. fUtC Of Hedlth blacks. / Natl M e d ASSOC7O:57j-5tOu1)9.78 18. Kennawav EL and K,ennawav Nhl A further studv of the im cidence ofcancer or the lung and Iawnx Er / Cancer 1:260?98.1947. 19. Ask-Upmark E: Bronchial carcinoma in printing workers. Dir Chesr 27:427-435.1955. 20. Creenberg M: A prooortional mortality study of a group of References 1. Occupational diseases - A guide to their recognition. National newspaper workers. Br I Ind M e d 29.15-20.1972. 21.Moss E. Scott TS. and Atherlev CRC: Mortalitv ofnewspaper workers from lung cancer and bronchitis 1952-1966.Br / l n d Med Institute for Occupational Saietv and Health. U.S. Department of 29:l-14.1972. Health. Education and Welfare. Washington. D.C.. 1977 22. Coldstein OH. Benoit IN. and Tvroler HA: An epidemiologic 2. International Classification o i Diseases. Eighth Revision. US. studv of an 011 mist exposure. Arch Environ Health 21.600-603.1970. Department of Health, Education and Welfare. Public Health Ser. 23.Hendrickr NV. Collingr CH. Doolev AE. et al: A review oi ex- vice Publication No. 1693.1968. posures to oil rnistt Arch Environ Health 4.139-145.1962. 3 Hill ID. Computing man vears at risk Er / Prev Soc .\fed 24 .\\cMichael AI. Havnes SC. and T\roler H A : Obrer\.itions cri 26 132-134.1972. fhe evaluation or occupational mortalit) da:3 I Occup hled 4 Vital Statcstics of the United States 1952. 195:. 1962. 1967. 17 128-131, 1975. 1972.1975.United Starer Gokernment Printing Office. Washington. 25 Fox AI and Collier PF Low rnortalitv rates in lndustrlal cohcrt D.C. studies due to selection for work and surtival in the industw 6r I 5 The Reyistrar General's Drcenn!al Suvpicment. England and Prct Soc %led30 225-1 50. 1936 \val.?S, 1951 Part 11. Vol 2. Occupatit..ndI Xlortaiitv Tablaj London: 26 Decodle P Cmcer mortalit\ among \\orAers etpcred to cut- H . v S 0 . 1958. ting oil mist Ann NY Acad Scr 2i1 94-101.1956 6 . Lloyd IW. Decoufle P. and Salvin LC: Unusual mortalitv ex- 27 McMichael AI. Andlelko\ic DA. and Tvroler H A Cancer mor- perience or printing pressmen / Occup Med 19,543-5501.977 tahtv among rubber workers. An epidemiologic study Ann A'Y Acad 7.Viadana E and Bross IDI. Leukemia and occupations Prev Med SCI 271 125-137.1976 1513-521.1972. 8.Infante PF. Rinskv RA. \\'agonet IK. and Young RI. Leukemia in 28 Bdvliss DL. Dement IM.Wagoner IK. and Bleier HP Mortalitt patterns amongfibrous glass production workers. Ann NY Acad Scr benzene workers. Lancet 2.7678.1977 271 324-335.1976