Document YGBkJ0qqLJM79wXnJY2vG0jjV

FILE NAME Talc TALC DATE 1982 June DOC TALC099 DOCUMENT DESCRIPTION Medical Journal Article - The Mortality Experience of Upstate NY Talc Workers From 613 998-3280 Order # 05543491DP04581959 Mon Jun 13 20:50:18 2005 Page 2 of 6 ; The Mortality Experience of Upstate New York Talc Workers W. T. Stille D.P.H. and Irving R. Tabershaw M.D. Deaths for a year period 1948 to 1978 were ano- appeared that talc mining in upstate New York is associated lyzed in a historical prospective cohort study of 655 white male talc workers Death rates from all causes from cancer of the respiratory system and from nonmalignant respiratory disease were not significantly different from those of with an increase in lung cancer Selevan et al in studying workers in Vermont talc mines and mills showed an excess of deaths due to nonmalignant respiratory disease among millers and an excess of lung cancer mortality the U.S. white male population However significant differences for these causes of death were found among among miners The lung cancer rate was similar to that found by Brown and Wagoner in their cohort of New York workers who had previous occupational histories An State workers Selevan et al concluded however that analysis of the latency periods of the observed lung cancer agents other than talc either alone or in combination with suggests that exposure to an etiologic agent during previous talo dust affect mine workers The possible role of radon work experience may play a role in the development of daughter exposures for this cancer mortality risk cannobte All lung cancer eliminated The present study includes all workers in one talc mine Talc pneumoconiosis was first associated with talc mining and milling by Thorel in 18961 and since that time this association has been repeatedly documented in and mill TMX in upper New York State who were employed between 1948 when operations began and Dec 31 1977 studies from various geographic sites However there are a number of contradictory reports regarding disability from talc pneumoconiosis and its effect on capacity and respiratory function The contradiction in these reports has been ascribed to the differences in the mineral composition of the various talcs Kleinfeld et 2,3 in a series of reports confirmed the increased incidence of talc pneumoconiosis and noted that among the tale workers who were 60 to 79 years of age and had 15 or more years of exposure the incidence of lung cancer was four times that among the general population Their follow study repeated these findings but noted that the observed deaths from 1945 to 1959 dropped to approach the expected mortality between 1960 and 1969. The authors attributed this improved mortality experience to better environmental dust control. Brown and Wagoner using a similar cohort from the same population base Lc talc miners and millers in upstate New York also found a statistically significant increase in - the occurrence of bronchogenic cancer The average latency for these cancer deaths was 20 years They noted that data on several variables particularly cigarette smoking and previous work history were not available Thus from the- thework of Kleinfeld et al and Brown and Wagoner it Materials and Methods The work force consisted of 744 personsemployed personsemployed between Jan 1 1948 and Dec 31 1977. Thirty women primarily employed in office and administrative jobs were not included because of the small numbers and a lack of exposure to talc Nearly all employees were white and records indicate that to date all decedents have been white The vital status of 36 5.1 men remained unresolved after Social Security and New York State Motor Vehicle Bureau records were searched The maximum cohort available for analysis consisted of 708 white men 113 of whom were known to be dead by Dec. 12 1978 which was established as the vital status cutoff date Demographic data microfilmed from employment records consisted of the following worker identifiers sex date of birth employment and death cause of death and Information on prior employers Data on cigarette smoking were not available The occupational history included dates of work job codes and work location codes Records were updated for the dates and causes of death as such information became available Death certificates were coded according to the eighth revision of the International Classification of Diseases by a trained nosologist Compartsons of observed deaths by age and year of death with those expected in the U.S. white male population were done by means of the modified table methods described by From Tabershaw Occupational Medicine Associates 6110 Ex- ecutive Blvd. Rockville MD 20852. Dr. Stille was formerly Senior Epidemiologist Dr. Tabershaw Senior Occupational Physician Monson All standard mortality ratios SMRs were computed by this program three workers whose records lacked dates of birth or other significant data had to be 480 Mortality and Talc Workers & Tabershaw WES001126 From 613 998-3280 Order # 05543491DP04581959 Mon Jun 13 20:50:18 2005 Page 3 of 6 Table 1 - Observed and Expected Numberosf Deaths and SMRs Among TMX Workers 655 White Male With 11,350 Yeaat r His sk Cause of Death ICD 1th Revision Deaths Observed Expected SMR ork is associated al in studying ills showed an spiratory disease ancer mortality . similar to that ort of New York , however that ombination with le role of radon ty risk cannot be ^finone talc mine a who were embegan and Dec rsons employed irty women rative jobs were rs and a lack of were while and have been white ined unresolved Motor Vehicle aximum cohort ^fitemen 113 of 1978 which was m employment rker Identifiers ; cause of death ata on cigarette ional history in: location codes auses of death as certificates were the International ologist Comparideath with those on were done by ds described by MRs were coms whose records data had to be ille & Tabershaw All deaths 113 Tuberculosis 010-019 3 All cancer 140-209 26 Digestive system 150-159 6 Ecophagus 160 1 Stomach 151 1 Liver 165-156 2 Pancreas 157 1 Respiratory system 160-163 11 Lung 162 10 Prostate 185 1 Kidney 189 1 Brain 181-192 1 Lymphosarcoma 200 1 Hodgkin's disease 201 2 Leukemia 204-207 2 All lymphopoietic cancer All circulatory system 390-458 Myocardial Infarction 410-413 Cerebrovascular disease 430-438 | All respiratory disease 460-519 Pneumonia 480-486 Emphysema 492 All digestive system 520-577 External causes of death 800-498 Motor vehicle accidents 810-827 Suicide 950-959 48 33 5 10 4 2 3 11 4 2 107 106 .7 414 20.5 122 5.7 105 5 216 1.1 92 .4 511 1.1 6.8 = 163 6.4 157 1.3 78 .5 195 7 148 .5 208 3 631 Sh 229 53.7 89 88.3 88 7.1 71 8.1 164 2.2 182 121 5,3 57 12.6 87 4.3 93 28 * ICO Indicates International Classification of Diseases Numbers refer to ICD coda dropped from the table analyses Thus the study cohort consisted of 655 white males a relatively small - sample size and therefore a limitation on the study . Results Table 1 shows the numbers of observed and expected deaths in the study cohort of 655 white male talc workers Although the SMRs are elevated the numbers of deaths f A from all causes from cancer of the respiratory tract and #3 lung from nonmalignant respiratory disease or from ather Be causes of death are not significantly different from those BS occurring in the U.S. white male population Numbers of Be. deaths from circulatory diseases digestive tract diseases Bm and accidental and external causes are lower but not sig- BX nificantly so The SMR of 106 for all causes of death has > 95 confidence limits from 87 to 128 thus the total tale worker population has an SMR within the usual range of variation from the national data Since people who are i chronically ill or disabled are usually unemployable and have higher death rates healthy working populations * typically have SMRs below 100. The SMRs in an occupa- @& tional group with values over 100 Indicate either possible Journal of Occupational Medicine 24 No. June 1982 Table 2 Observed and Expected Numbers of Deaths and SMRs Among Talc Workers With Known Prior Employment Before Work at the TMX 540 White Males With 9,168 Years at Risk Cause of Death ICD 8th Revisien Deaths _ Observed Expected SMR All deaths 90 60.6 148 Tubercularis 010-019 3 .4 680 All cancer 140-209 22 11.6 182 Digestive system 150-159 Esophagus 150 6 3.0 201 { 3 382 Stomach 151 1 6 180 Liver 155-156 2 NONMAMNA 1,013 Pancreas 157 1 NOONMAMNA 184 Respiratory system 160-163 8 4.0 228 Lung 162 g NOONMAMNA 214 Kidney 189 1 NOONMAMNA 326 Brain 191-192 1 NOONMAMNA 206 Lymphosarcoma 200 t NONMAMNA 326 Hodgkin's disease 201 2 NONMAMNA 848 Leukamia lymphopaletic 204-207 lymphopaletic cancer 2 NONMAMNA 391 All circulatory system 380-458 36 Myocardial Infarction 410-413 27 Cerebrovascular disease 430-438 = 3 All respiratory disease 460-519 8 Pneumonia 480-486 3 Emphysema 492 2 All digestiva system 520-577 1 External causes of death 800-888 11 Motor vehicle accidents 810-827 4 Suicide 950-959 2 28.0 20.3 3.1 2.9 1.0 J 3.5 9.8 3.4 2.2 129 133 97 307 274 278 28 112 119 92 | * Indicatas statistical significence at the % lovel Numbers in parentheses refer to ICD codas 2 Indicates statistical significance at the % lovel work place hazards or possible confounding with non- occupational exposures One such occupational exposure is smoking and it is noted that the SMR of 163 for respiratory cancer in this population is consistent with a smoking effect While the actual smoking experience of this population is not known insight into it is gained from knowing the smoking patterns of current TMX workers many of whom are included in the study cohort Among 151 workers given a medical examination at TMX in 1979 69 46 were current smokers 38 25 were past smokers and 44 29 were nonsmokers The percentage of current smokers is higher than in the general population but is consistent with pat- terns seen in the mining industry The SMR for all causes of death 106 may also reflect in part inclusion in the cohort of everyone ever employed during the study period regardless of their length of employment Universal cohort membership generally tends to increase SMRs since short workers often have a greater mortality experience than term employees Most study designs exclude workers with less than one year of working experience The practice was not followed in 481 WES001127 From 613 998-3280 Order # 05543491DP04581959 Mon Jun 13 20:50:18 2005 Page 4 of 6 3 Table - Observed and Expected Numbers of Deaths and SMRs Among Talc Workers With No Known Work Prior to TMX Employment 115 White Males With 2,184 Years of Risk Cause of Death Revision ICD 8th Revision Deaths Observed Expected SMR All deaths All cancer 140-209 Lung 162 Prostate 185 All circulatory system 390-458 Myocardial infarction 410-413 Cerebrovascular disease 430-438 All respiratory diseases 460-519 Pneumonia 480-486 All digestive system 520-577 332 332 332 1 12 6 2 1 1 2 45.9 9.0 2.6 .8 25.9 18.0 4.0 3.2 1.1 1.8 50 33 76 120 46 33 50 31 90 112 * Indicates statistical significance at the % level note that this SMR is lower than expected with respect to the U.S. national data Numbers in parentheses refer to ICD codes this study in order to maximize cohort size The use of the U.S. white male population as the exter- nal comparative group does not necessarily describe the TMX mortality experience since the mortality experience of the U.S. white male population is likely to vary substan- tially from that of this cohort For example the New York State cancer death rate is 199.24 compared to the national average of 174,04 approximately a 13 difference Since exposures prior to employment at the TMX could have included carcinogens and other substances hazardous to the lungs the results have been analyzed to investigate this possibility Table 2 shows the observed and expected numbers of deaths and the SMRs for all workers whose job histories show prior work before employment at the TMX Deaths for all causes are significantly increased as are deaths for a number of cancers and for nonmalignant respiratory diseases Since the cancers and lung diseases typically have long latencies the possibility exists that exposures prior to work at the TMX were responsible for at least some of these diseases . Table 3 shows the observed and expected numbers of deaths for workers with no known employment prior to the TMX Mortalities for all disease categories do not differ significantly from those for the comparable U.S. popula- tion In fact the SMRs from all cancers and all respiratory tract diseases 33 and 31 respectively were among the of all Jowest the mortalities It should be noted that workers whose employment records were devoid of work history data were judged as having had no known prior employment and thus were included in Table 3. If some of those workers did indeed have work experience before employ- ment the TMX the effect would be to increase the SMRs However even with this possible compromising effect Table 3 shows a remarkably healthy work force with most mortalities at 50 less of those of the comparable U.S. population As noted earlier however the small sample size limits the conclusions that can be drawn from this study Five of the 12 lung cancer cases which are included in Table 5 were substantially older than the median age of 482 at Table 4 Age Quath and Segments of Work History of Workers at the TMX With Bronchogenic Carcinoma Years Age at Case No./Deatyhr or Days TMX = Emplayed Employment the TMX TRAX Employment 2/49 3/53 4/63 5/54 6/55 7/69 8/62 9/84 10/79 10 17 8 8 47 days 22222-22 0222222 56days 22222-22 0222222 3 22222-22 0222222 3 22222-22 0222222 345 daydayss 22222-22 0222222 17 222-2 0222222 17 days 22222-22 38 8 days 22222-22 the entire cohort at age of hire For those workers with TMX employment 63 were under 25 when hired contrasted with 35 for those with previous experience The difference in age at hire between the two cohorts may partially explain the deficit in disease mortality among TMX workers and the lung cancer experience of those with other work history Discussion Workers with previous jobs before employment at the TMX were found to have high mortalities as shown in Table 2. Workers with no known work history before cmployment at the TMX were found to have much lower mortalities Table 3 Thus it would seem that exposures to health hazards occurred in these earlier jobs and that theso exposures are causally related to the higher rates of death Obviously mines and mining operations are not uniform with respect to the occurrence of health hazards and as previously stated Selevan et al have described increased rates of lung cancer in some talc miners exposed to radon daughters No significant radon daughter exposures occurred at the TMX.8.9 The low mortalities given in Table 3 are in agreement with the absence of radon daughter and other related hazardous exposures at the TMX However mortality studies such as ours lend themselves to various conclusions Lacking data on smoking and other personal risk factors we sought to obtain confirmation for our Interpretations by an Independent analysis of lung cancer latencies Data for an analysis of the lung cancer latencies are given in Table 4. For each of the ton cases of lung cancer the employee's years of occupational history are given as the following TMX employment employment was deter- 5 4323 NUMBERNUMBER 4323 8 5 10 15 . 20 25 YEARS EMPLOYED AT THX Fig 1 - Number of lung cancer cases by years of employmenatt TMX Mortality and Talc Workers & Tabershaw WES001128 From 613 998-3280 Order # 05543491DP04581959 Table 5 Latencies of Bronchogenic Carcinomas ^finTMX Workers MX ment 5 with hired rience ts may among f those Latency yr 10 10-14 15-19 20-24 25-29 30-34 35-39 40-44 46-49 50-54 55-59 60 Total Latency Bronchogenic Carcinomas in TMX Workers Whose Exposure is Hypothesized to Begin On Employment at the TMX At Age 18 Prior to TMX Employment 712G 11 712G 11 712G | 5 --- 3 --- . --- ~ 43-1 -2 43-1 -2 - 43-1 -2 - 43-11-2 - 43-11-2 - 43-1-2 12 43-11-2 19.9 38.2 at the wn in ire cm- lower ures ta it these * death iniform and as creased > radon res oc- Table 3 ter and Owever various ersonal for our cancer re given cer the 25 mentat * From onset of exposure to diagnosis or death _ mined arbitrarily to have begun at age 18 tenure at the TMX and the period from TMX employment until the diagnosis of lung cancer or death Although not included in Table 4 two additional persons with lung cancer should be noted The first was surgically treated for lung cancer at age 47 after 137 days of employment at the TMX At age 57 he died of pneumonia His significant occupational periods were 29 years TMX 137 days of TMX tenure and zero years TMX to the time of diagnosis of lung cancer S The second individual died of lung cancer after the cutoff e date His significant occupational periods were 15 years preTMX 23 years of TMX tenure and six years TMX To explore the nature of the response relationship column 3 in Table 4 which lists numbers of years or days =; ge employed at the TMX is graphically represented in the Figure The two additional cases of lung cancer just described included The clustering of nine of the 12 cases within the first five years of employment at the TMX shows an Inverse dose response i.e. higher risks of lung cancer with less occupational exposure to talc The lack of a dose Be response in terms of years of exposure at the TMX is in B agreement with our findings that workers with exclusive me TMX employment seem to be at no considerable risk of having lung cancer develop Knowledge of the latency period of a disease permits determination of the probable time at which pathological B: processes began Thus the analysis of disease latencies can m be useful in attributing or refuting evidence as to when ficausal exposures occurred Armenian and Lilienfeld have Mon Jun 13 20:50:18 2005 Page 5 of 6 reviewed the latency periods of a number of cancers They They present evidence that leukemias in different populations and under different conditions have median latency periods and latency variabilities that are quite similar They also re- viewed data that indicate that the intensity of exposure has very little effect on latencies of other neoplasms Hence we hypothesize that if occupational talc exposure results in pulmonary exposure to a carcinogen then the distribution of TMX workers lung cancer latencies should be similar to those reported for lung cancer in other studies However If such exposure is not carcinogenic to the lung then the distribution of TMX lung cancer latencies would be dissimilar to lung cancer latencies reported elsewhere To test the hypothesis that carcinogenic exposure began at TMX the median lung cancer latency of 36.5 years as calculated by Armenian and Lilienfeld was compared to the latency period from the onset of TMX employment to the diagnosis of cach lung cancer As can be seen from Column 2 in Table 5 the average latency period of 19.9 years for lung cancer among the TMX workers is almost half the 36.5 years noted above The Chi Square goodness of fit test provides a quantitative basis for rejecting the hypothesis at the % level of statistical significance If the occupational talc exposures to the TMX are not carcinogenic then the question shifts to what other exposures occurred that may have caused the lung cancers Since each of the subjects with lung cancer included in Table 4 had between eight and 39 years of possible occupa- tional exposure from the time of his 18th birthday to employment at the TMX this prior period of exposure may be related to subsequent cancers To test this possibility we _ hypothesized that the causal exposure for the lung cancer occurred before employment at the TMX The data in the last column of Table 5 reveal a much more reasonable relationship to the lung cancers reported by Armenian and Lilienfeld This second hypothesis that the causal exposure began before TMX employment yields an average latency period of 38.2.ycars 38.2.ycars which is only slightly longer than the Armenian and Lilienfeld median of 36.5 years The Chi Square goodness of fit is almost zero indicating a very close agreement between the lung cancer worker latency periods and those of talc workers when exposures prior to TMX employment are hypothesized as carcinogenic Hence the initiation of cigarette smoking in the late teenage years World War II exposures excessive exposures to mineral dust In the past diet and nutritional status absence of complete work history preexisting diseases and other unknown etiologic agents could contribute to the etiology of the observed lung cancers while exposures at TMX seem to be noncarcinogenic It should be noted that nine of the 12 employees with lung cancer worked underground in TMX which suggests that their other jobs also were likely to have been underground Review of the death certificates tends to confirm the observation that these men worked in occupa- tions known for their dusty environment The employment policy of TMX to preferentially hire experienced workers appears to have resulted in the confounding of prior hazardous exposures with employment at TMX Summary and Conclusions A historical prospective mortality study of workers at an upstate New York talc mine demonstrated elevated mortali- pershaw # Journal of Occupational Medicine 24 No. Juna 1982 483 WES001129 From 613 998-3280 Order # 05543491DP04581959 Mon Jun 13 20:50:18 2005 Page 6 of 6 ties but no significant Increases in the numbers of deaths talc miners and millers in New York State Arch Environ Health from lung cancer from nonmalignant respiratory disease and from all causes However workers with exposures in other jobs prior to work at the TMX were found to have excessive mortality from lung cancer from nonmalig- 663-667,1967 663-667,1967 3. Kleinfeld M Messite ) Zaki MH Mortality experiences among talc workers A follow study JOM 345-349 1974 4. Brown DP Wagoner JK Occupational exposure to tal^con talning asbestos III Retrospective cohort study of mortality U.S. nant respiratory tract disease Exposures in jobs held prior to TMX employment also were implicated in an independont analysis of lung cancer latencies Dept. of HEW NIOSH Pub 80-115 1980 5. Selovan SG Dement JM Wagoner JK et al Mortality patterns among miners and millers of asbestiform tale Pre- liminary report) Environ Pathol Toxicol 273-284 1979 6. Monson RR Analysis of relative survival and proportional Acknowledgment mortality Comp Blat Res 325-332 1974 7. Mason TJ McKay FW U.S. Cancer Mortality by County Technical and editorial contributions were made to this com- 1950-1969 HEW NIH Pub 74-615 1974 munication by Maureen A. Vogt and M. James Sharpe Juliet A. 8. Health and Safety Report Health and Safety Spot Inspec af Foster Pamela J. Trotter and Deborah Rogers alded in data col- lection and processing tion Radiation American Mine Gouverneur Talc Co. Inc. Balmat St. Lawrence County N.Y. Feb 28 1973. U.S. Department of Interior Bureau of Mines Health and Safety Activity 9. Health and Radiation Inspection Report Gouverneur Talc Gr Co. Mine No. 1 and Mill Balmat N.Y. March 24 1976. U.S. WE References Department of Interior Mining Enforcement and Safety Adminis- . 1. Thorel C Die specksteinlunge ein beitragzur pathologischen tration anatomic der straubluBenitgr ePanth Ant 85-101 1896 10. Ar~-nentan HK Lillenfeld AM The distribution of incuba 2. Kleinfeld M Mossite 1 Kooyman O et al Mortality among tion n rioodf sneoplastic diseasAems/ Epidemo 92-100 1974 Shaping Moral Neuters Common to the various moral education approaches offered today is the idea that there is nothing right or wrong and that to teach any substantive ethical percept or idea is to indoctrinate students In one approach students are invited to clarify their own values the focus is on rationality creativity autonomy and process In another approach students are asked to dwell on ethical dilemmas such as when lying can be justified or on public policy questions such as the morality of racial quotas morality The problems with these approaches are obvious to anyone raised in the basic morality In the values approach no one need fear a teacher's judgment if his values are wrong because there are no wrong values other than of course the value of opposing values education Upon learning that all choices are equally valid a student will be educated into skepticism about morality fertile soil for wrong action Today's moral education fails in the most critical way because it addresses the intellect but not the emotions No one is taught to dislike and certainly not to hate anything If young Americans are shaped they are unfortunately shaped to be moral neuters The inculcation of the basic morality in the minds and hearts of young people as given in American education since the 17th Century has for the most part ceased to be in the latter part of the 20th From Teaching Morality in Public Schools by Terry Eastland in The Wall Street Journal Feb. 22 1982 Jan Cie } Cin Che Cin End T. New AikeAike Epid Phili Pitts Ergo E. New Suzaf Roch Mo 484 Expe M. Linde Mortality and Talc Workers & Tabershaw ge Journal of WES001130