Document kNYb9q9OgkvoVvdbZx9og9LD

` CANCER EXPERIENCE OF WORKERS EMPLOYED M THE STEEL AND ALUMINUM INDUSTRIES * J. William Lloyd, Sc. D., 1 Richard A. Lemen,- M.S.,12 Claudia Miller, M.S.,* David P. Brown, M.P.H. RECEIVED DEC 1 3 1975 a. R Hughes, M.D. Our purpose in preparing this presentation was two-fold. First, we wanted to call attention to the reported high risk of various cancers within certain sections of the steel and aluminum industries. Second, we wanted to use this material to point out the need for systematic industry-wide studies of aluminum and other industries which might hopefully lead to the identification of previously unrecognized occupational carcinogens. In recent years, much attention has been given to the study of cancer due to occupational exposures, and a great variety of agents in the industrial environment have been implicated as human carcinogens (Table 1). We are all now aware, for example, of the lung cancers and mesotheliomas that result from asbestos exposure; the bladder cancers induced by exposure to beta-nepthy- laminc, benzidine and other aromatic amines; and the angiosarcomas of the liver dud to vinyl chloride exposure, to name only a few. Unfortunately, millions of workers have been needlessly exposed to these agents and consequently many have suffered and died from Occupational cancers, because of the long delay between the first introduction of agents into the workplace, the first suspicion of cancer hazard, and the systematic development of evidence 1. United Steelworkers of America, AFL-CIO, CLC 2. Industry-wide Studies Branch, DSIJKFS, NI0S1I Presented at' the International Metalworkers Federation World Conference on Health & Safety in the Metal Industry, Oslow, Norway, . August 16 - 19, 1976. ......... ........ .............................-- TXTINER RMC0082860 -2- considered necessary to demonstrate the carcinogenicity of such agents. A more detailed discussion of this delay period and * alternative approaches to early identification of occupational carcinogens is given elsewhere. Of particular interest to the present discussion is the long delay between the first obser vation of human cancers induced by combustion products of bitum inous coal and the development of evidence describing the cancer risks among men employed at coke plants in the steel industry - a period of two hundred years. In 1962, the United States Public Health Service, in colla boration with the Department of Biostatistics, University of Pittsburgh School of Public Health and three major steel firms, initiated a study to analyze the mortality experience of men employed in the steel indv.^try in 3.95V purpose of this study was to determine whether particular patterns of mortality among workers employed at certain trades or at certain work processes might* provide leads to causative agents for occupational diseases. The methodological approaches to this study and many of the find ings have been presented in a series of papers published in the Journal of Occupational Medicine. 3-12 Using detailed work histories going back to original employment with the steel firms, it was possible to determine cause-specific rates of mortality for more than 60 work areas within the industry, and for a great variety of trades. As shown in Table II, unusual patterns of site specific cancer have been noted for several work areas. Because of the unusually high lung cancer risk observed among coke plant workers and the * variety of cancer sites in excess for men employed in this area, . ' more detailed analysis of this experience was undertaken. As TXTINER RMC0082861 seen in Table III, the greatest risk is noted for those with longest exposure, and those employed where exposure to emissions is greatest (topside). The United States Department of Labor has now'proposed a standard to protect workers from these emissions. The detailed evidence indicating the high risk of specific cancers among men employed at the coke plant,and the demonstration of a relationship between level of exposure to coke oven emissions, and the level of disease response was crucial in reaching this decision. As noted previously, the initial evidence suggesting that carcinogenic agents are produced during the carbonization or com bustion of bituminous coal was presented by Percivall Pott in 1775. Since that time, a great amount of information indicating excess cancer of several sites among workers in other coal combustion or carbonization occupations has been noted .and,in fact, a report of official statistics from England and Wales for the years 1921 1938 showed an excess lung cancer mortality for gas producermen, chimney sweeps, and several categories of gas works employees.^ The excess indicated for gas stokers and coke oven chargers was approximately three-fold. Although many of us might agree that such a high level of risk would be sufficient evidence for initia tion of controls by standard setting agencies, workers have continued to be exposed to carcinogens in these environments and have suffered and died from a variety of cancers while we awaited the more definitive studies of defined cohorts. In trying to assess the extent of the cancer problem in the aluminum industry, we find the same situation as we noted for gas workers and coke oven workers thirty years ago. That is, review of death certificates shows that persons employed in the industry TXTINER RMC0082862 -4- are at high risk of developing cancer. Furthermore, men employed in certain work areas with exposures related to those at the coke plant appear to be at greatest risk. . During the electrolytic reduction of alumina to aluminum a variety of toxic substances are released which may contaminate the workroom air. Among these substances, hydrogen fluoride, fluoride fume, and dust and carbon monoxide arc potential contaminants whose biological effects arc recognized. In addition, coal tar pitch volatiles are also released in the process, either in the anode preparation area for pre-baked anodes, or in the pot lines where Soderberg self-baking cells are used. Investigators from the Soviet Union^"*5 have reported a significantly higher mortality for all cancers and for specific sites such as lung, bronchi and pleuict,. <utd have reported an increased incidence of skin cancer among Workers in the aluminum "electrolyzer shops" in comparison with the general population in the same cities. Unfortunately, neither of these studies is sufficiently documented to allow firm conclusions. Milham*has reported an increase in proportionate mortality from total cancer, cancer of the pancreas, respiratory system, and malignant lymphomas among aluminum workers in Washington State (Table IV). He suggests that the simultaneous increase in pancreatic cancer and lymphoma among aluminum millworkers,N not seen in other occupational groups, may be related to coal / tar pitch volatiles rather than to metal exposures. The National Institute for Occupational Safety and Health has recently conducted environmental surveys of aluminum reduc- tion facilities in East and Northwest United States monitoring TXTINER RMC0082863 for coal tar pitch volatiles and a variety of other potentially hazardous substances. These surveys included reduction plants using pre-baked anodes, the vertical pin Soderberg Anodes, and horizontal pin Soderberg anodes. The findings indicate that the concentration of coal tar pitch volatiles (CTPV) as measured by the benzene soluble fraction technique, were almost all elevated above the current OSHA standard of 0.2rog/M^ CTPV for an 8 hour time-weighted average. The levels were highest in the Soderberg potrooms, presumably because the pitch is heated and "baked off" the anode in these potrooms. In contrast, the lowest measure ments were in the potrooms using pre-baked anodes. This type of carbon anode already has the pitch "baked off" before use in the reduction area. Table V provides a review of these surveys. In a 1976 study of chronic respiratory disease among aluminum reduction workers, sputum cytology was utilized to determine the degree of abnormal cells in the respiratory tract as an early indication of care"e1r.8 Because of certain limitations of tha--t " study, the authors were unwilling to draw any conclusions regarding the carcinogenic risks among the study group, as compared to matched controls. However, review of the results from that study lead's us to conclude that the evidence of potential carcinogenic risk fo? potroora workers is certainly quite consistent with the previously mentioned mortality observations. When consideration is given to the sputum cytology classification of moderate atypia or higher, a significant (p<. 01)'difference is observed between the study group (30/390) and the control group (5/195). Moreover, when consideration is.restricted to cases of suspicious and TX TIMER RMC0082864 6- positive cancer, there are 6/390 meeting such criteria in the study group, compared to 0/193 in the control group. It also should be noted that the control group in this study had a greater exposure to known carcinogens according to prior work history, so that differences in cancer risks are underestimated. Other studies on workers exposed to recognized pulmonary carcin ogens have used sputum cytology and demonstrated its validity as an early indicator of cancer. . CONCLUSION Available evidence from three independent sources strongly suggests an increased cancer risk at one or more sites for aluminum reduction workers, and we have been unable to identify any negative reports on this question. Furthermore, it has been noted that these workers, like the coke.oven workers, are exposed to coal tar pitch volatiles, many of whose constituents are recognized to be carcinogenic. While some would conclude that this is sufficient evidence to initiate action for control of the aluminum reduction environment, others would argue that more detailed study should be undertaken before such decisions are made. The situation you may note is analogous to what we observed in the 1930's with the coke oven workers. It would be most unfortunate if we were to wait another forty years before addressing this problem. At the same time, it must be recognized that agencies of government demand more extensive evidence of excess cancer risk before setting standards for control of such work environments. That being the case, we would strongly suggest to these agencies that in-depth epidemiological cohort studies of aluminum-industry workers be initiated as speedily as possible. # TX TIMER RMC0082865 REFERENCES 1. Lloyd, J.W. Occupational and Industrial Hazards, Symposium on.Environmental Carcinogenesis, Proceedings of the Eleventh Canadian Research Conference, pp. 58-66, Toronto, Canada, May 7, 1976. , .2 Wagoner, J. K. Occupational carcinogenesis: The two hundred years since Percivall Pott. Ann. New York Acad Sci 271: 1-4, May 28, 1976. 3. Lloyd, J.W. Ciocco, A. Long-term mortality study of steel workers: I. Methodology, Journal of Occ Med 11: 299-310, June, 1969. 4. Robinson, H. Long-term mortality study of steelworkers: II. Mortality by level of income in whites and non-whites, Journal of Occ Med 11: 411-416, August, 1969. 5. Redmond, C.K., Smith, E.M., Lloyd, J.W., Rush, H.W. Long-term mortality study of steelworkers: III. Follow-up, Journal of Occ Med 11: 513-521, October, 1969. .6 Lloyd, J.W., Lundin, F.E., Redmond, `C.K., Geiser, P.B. Long term mortality study of steelworkers IV. Mortality by work area. Journal of Occ Med 12: 151-157, May, 1970. 7. 8. Lloyd, J.W. Long-term mortality study of steelworkers Vi WWfcW 'W W Med 13: 53-68, February, 1971. Redmond, C.K., Ciocco, A., Lloyd, J.W. and Rush, H.W. Long term mortality study of steelworker's VI. Mortality from malignant neoplasms among coke oven workers. Journal of Occ Med 14: 621-629, August, 1972. 9. Lerer, T.J., Redmond, C.K., Breslin, P.P., Salvin, L., Rush, H.W. Long-term mortality study of steelworkers VII: Mortality patterns among crane operators 16: 608-614, September, 1974. .10 Redmond, C.K., Gustin, J., Karaon, E. Long-term mortality experience of steelworkers VIII:, Mortality patterns of open hearth steelworkers (A preliminary report). Journal of Occ Med 17s 40-43, January, 1975 . 11 Mazumdar, S., Lerer, T., Redmond, C.K. Long-term mortality study of steelworkers IX: Mortality patterns among sheet and tin mill workers. Journal of Occ Med 17: 751-755, December, 1975. 12. Rockette, H.E., Redmond, C.K. Long-term mortality of steelworkers X: Mortality patterns among siasons. In Press. TX TIMER RMC0082866 13. Konnaway, E.L. . 1 Kennaway, N.M. A furth study of the incidence of cancer of the lung and larynx. Brit. j. cancer 1: 260-293, 1947. 14. Konstantinov, F.G., Kuz'minykh, A.I. Tarry substances and 4-benzpyrcnc in the air of electrolytic shops of aluminum works and their carcinogenic significance. Hygiene and Sanitation 36: 368-373, January-June, 1971. 15. Litvinov, N.N., Goldberg, M.S., Kimina, S.N, Morbidity and mortality in man caused by pulmonary cancer and its relation to the pollution of the atmosphere in the areas of aluminum plants. Acta Unionis Internationalis Contra Cancrum 19: 742-745, 1963. 16. Milham, S. Jr. Cancer mortality patterns associated with exposure to metals. Ann. New York Acad Sci 271: 243-249, May 28, 1976. 17. Shuler, P.J., Bierbaum, P.J. Environmental surveys of Aluminum reduction plants. U. S. Department of HEW. NIOSH. Publication No. (NIOSII) 74-101, April, 1974. 18. Discher, D.P., Breitenstein, B.D., Schweid, A.I. Sputum cytology among aluminum potroom workers. Ann New York Acad Sci 271: 239-242, May 28, 1976. 19. Lemen, R.A., Johnson, W.M., Wagoner, J.K., Archer, V.E., Cacccrr.ar.r.c, C. Cytologic observations and cancer incSdnnnr*. following exposure to BCME. Ann New'York Acad Sci 271: 71-89, May 28, 1976. 20. Frost, J.K. et al. Pulmonary cytologic alterations in toxic environmental inhalation. Human Pathology 4: 521-536, 1973. TXTINER RMC0082867 & s *>r5< vk o' t> qu IS p H CO s 1 bn J & S * V s 3 2 O(4T !* B noc. * s. mis O VBh" P IS RP? n vSrO. tO?WnJ & OeJOoP<U I it t> f> CcJ Is 4 r ri ws mi 1 bn JiOaC v & Phpiq is*. .u nCflJj I Ul b? ^O H* j|$ 3 4 *4 *4 . 55 o n Vi 4> tt uU rh hnO VnV o Sh'S o. g la nQP --aSpt n *cips .Bo Hs itXs X> C <ri VOi VOi IOS. *rt a >5R31 *-CaHoC* 0) 3 sR * tHJOo5 V 3 EE V 3 8 E> Eo OP 5 pp IIb 5 hH t 6*8 Pi At A< Non-Cutaneous Cancers o f O ccupational O rig in By A g e n t,1O ccupation and S ite UN an }& CrOc CM CM CO UN 8 i*N 13 ,.j 5 4 J^sl O 4> s 4 cS o. I H n 1 I1I Ro *5<5 oc n 4 a ) Jf1&i5s M %t 1*3i O *rl 3 as?i Vi n o'tj 1? : ? 1 g js m h i<i > tt H < TX TIMER RMC0082868 i Observed And Expected Death * and R e la tiv e Risks By Cancer S ite s F cr Workers Employed Five o r More Years In S p e cifie d Work Areas Allegheny County Steelworkers , 1953 - 1?66+ .Y tHo o: >0 \A H 0 pi & CO -H*30 .iCnJ ec--*- in m $ r-< f--tO CO co uvh * r-J CO O CM CM cm CM cm CM CM CM CO in cv uo Vt>p I Os Cl VO cv eo cv Vr\ CV O' O CO VO -3_3 O r\ c\ cv v\ cv cv fl> uV 58 C o CJ rt to IA p l< ol o0) On s >o Hcn CM 'O V\N J C^ f-- O VO _3 r-t CV in 5 e m g* 1 > * f ^ & 1 eo <0 ii P s & P 2.5 <S 1. 1 r-l ft, *0 \t % & o O ft) l p (0 ft) X p s n 0 a* r-l a0 a o o Is ft) bo So | X a C.l 5 Mo _ * a0 4B*9 *r4l * CO 4) u*.sc CoMI 0\ $OHn o$ * 3rf? H1 s r* P< CoO rt >CM9 4 cv ** &> > P s> Id `dj few Si *1 rt+<t pi P 8S C45HI.' ^22 IX vI\ - e h 5pv ?15R &Q-gH g55 83 8-J #o sa rS*S 6W i ! 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Cancer M o rta lity P a tte rn s Associated w ith Exposure to M etals Annuals o f th e Kew f o r k Acadeny o f S ciences, Volume 271, 'p* 2U7. \HA CM v\rr*\\ 8 1 9 *U8i m o VI M P> *I TXTINER RMC0082871 l TABLE V Compari son of Time Weighted Average (TWA; Pitch Volatile Results in Aluminum Reduction Facilities in the Eastern United.States Versus Those in the Northwestern United States ype of Plant I & Job Type Eastern Facilities , Number of Concentration, rag/nr Samples Northwestern' Faciliti cs Number of Concentration, mg/nr Samples re-Baked Potrooms Potman Tappers/anode setters Pot reliner arbon Plant 3 3 1 0.2 * 13 0.2 o.5 3l 0.1-0.5 0.3 29 o.h Ball joill opr. Press opr. kixer opr. Lrtical Pin 1 1 1 2.1* 2.9 0.6 3 6 3 0.2 0.1 0.3 >derberg 'otroons !Potman Tapper Pin Setter . trbon Plant 1----- ^------- lixer Operator 10 5 5 l 2.2 12.0 2.5-7.5 2.6 5 0.3 10 0.3 1:0 1.1 2 ' <0.1 irlzontal n SodeiberR 'otrooms Potman {Flcx raisers jPin pullers |Channel hangers Tappers Pot rcllncrs h l 2 1 u 1 li.5 18.5 1.5 3.5 2.O-3.I1 8.3 12 10 h U 5 5 0.5 0.3 0.1| 0.5 0.3 0.1 ter: Shuler, P.J. and Bierbaum, P.J.: 1971: Environmental Surveys of Aluminum Reduction Plants. U. S. Department of Health, Education and Welfare,Public Health Service, National Institute for Occupational Safety and Health, HEN Publication Number (NI0S1I) 71-101, page 26 txtiner RMC0082872