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FILE NAME: Avondale (AVD) DATE: DOC#: AVD126 DOCUMENT DESCRIPTION: D:ZKZ ZZ> MD-001685 Occupational Differences 1 n Rates of Lung Cancer Herman R. Menc:k, M.B.A.; and Brian E. Henderion, M.D. Many investigato,s have associated lung cancer with occupational exposure. 17 In an earli~ study, we reported an excess of lung cancer 1n males in the Industrialized soutlxentral area of Los Angeles County. This may have been the result of air pollution of induWial origin, specifically, elevated levels of polycyclic aromatk hydrocarbons.11 However, since the excess was confined to males, occupational e11posure would be an alternatwe expLma ,n Interest il'I better understanding the different factors affecting lung cancer m Los Angeles County, in drawing clue; toward identlfk::atlon of high risk occupations, and In setting a bve line for future occupational observation and control programs led us to review five years of lung cancer data for white mates in the county. Methods Subjects. -All 21161 death certificates mentioning lung cancer {tracNia, bronchus and lung) in white males, ages 20-64, for the period 1968-1970: and all 1,777 incident case of lung cancer m white males of the same age group reported to the Los Angele, County Cancer Surveillance Program (CSP)'" for 1972-1973, were reviewed. These mortality and morbidity data were pooled; we consider this justified because of the high mortality rate of lung cancer and the relatively high ace uracy of death certification regarding lung cancer.20 u During this reporting pt-rlorl, the CSP abstracted all Incident cancer cues from 198 hospltals and siK private laboratorie5 In Los Angeles County, including c1II hospitals known to treat cancer. The primary source of case selection Wi!S ho5f)ital pathology files, including hematology, cytology and autopsy reports. The medical chart was reviewed when necessary to establilh primary site, or first date of diagnosis of the malignancy, or to determine missing demographic data. Pathology records of nearby out-of-county hospitals were searched for in clusion of residents of Los Angeles County who were cancer 1tients. All Los Angeles County death certificates mentioning malignancies were reviewed to further Insure complett>ness of in From tho, Ur,wer,lty r,I Southlm C,lifotnla, 5chool of MMIClnt, Otpimnent al Pathol..gy. :lOlS 2anal A""" Los Ansales. CA !lOOJl. Journal al OccuJ)ational Medicine.Nol. 18, No. 12/0ecember 1976 cldent case ascertainment. Theswdy was limited to the age group 20-64 to minimi?e the number r f retired persons without stated occupations. Of the 3,938 subjects, 689 (424 deaths, 265 incident cue$) had no reported o,;cupation, and 1,222 (61 'I draths, 603 incident Ci!.!e,1 had no rep0tted industry of employment Claalflcatlon of Occup.ilion. - One occupational title, and one industry of employment went obtained per subject. California death certificates include the wbjKts' last occupation, name of last employing firm, and type of lnduttry. The CSP demographic data were ab~tnu:ted from hospital admission sheet$, and in ~ome Wes medical records, and represent the last occupation and industry of employment which the patient or next of kin reported a.t cldmission. The occupation and industry of each subje<:t were coded Into one of 417 occupational codes, and"" of 215 in dustry codes, per the 1970 U.S. Cen!Ui oc;cupational clilSsifatlon $yJt<em.~2 Analytic Methods. - Detailed occupation and industry popu lations-atrlslt tor white males In as group$ 20-24, .ZSH, JS-44, 45-54, and S5-&4 were developed from the two Public Use Sam pl@J {PLJSJ of Basic Records from the 1970 Census ror Los Angeles County." These Included respondent informatiort on current occupation and industry. Combined use of the two PUS provided w- a 1-in-50 sample of Los Angelm County. There were 31,216 white males, aged 2~. 1n the combined sample. Expected deaths and e,:pected incident cases calcufated for each specific occupation ;usuming the agHpecific rate~ of cancer in each occupation were the i.ame as those for all occ:upation5. The ratio (%) of observed deaths plus Incident~ to ex peeled deaths plus incident cases, hereinafter referred to as a Standard Mortality Ratio (SMRJ, was then used as 1tw measure of risk for the individual occupations. In a. simildr way, an SMR will calculated for each industry assuming the age-specific rates of lung cancer In each industry were the sam& as those for all industries. The MantrlHaemzel method w;u u:oed to measure ,tatlstrcal s1gnificance. 1 Results The occupations with statistically significantly increased Stan dard Mortality Ratios for lung cancer are hsted in Tab!@ l. Among 797 the populations in these cx:c:upatiom there were 942 ob5erved lung cancers compared to an expec~ 531 cases. The Standard Mortality Ratio for lung cancer among the!e combined workl!rs was 175. There were 16 occupational groups with an SMR of 200 'lr greater. Twenty-nine percent of the lung cancer in males ages t0-64, who reported an occupation, occurred in the high risk workers listed 1n Table 1 who comprise only 15% of th.it ~,i-age group. The number of deattts (1968-1970). and the number of 1n cident cases (1972-19731 were listed separately; the proportion of lung cancer cases from death certificate$ and the CSP was con sistent across the occupations listed with few exceptions. All but one of the high risk occupations were among craftsmen, opera lives, laborers, and service workers. Th@re weta two occupations, bookbinders and blasters, which were calculated to be at greater than fourfold ri$k to lung cancer, but where the risk calculation was b~ed on so few cases that any inference drawn would be speculative. . There were 16 occupations with an SMR below 70, including pharmacists, assemblers. cranemen, physicians. barbers, foremen, ,ales m.anagen, checkers, Judges, secretar1e,, teacher,, per.ionnel workers, dentist$, stock brokers, photographers, and school ad- ministrator~. The Standard Mortality Ratios of workers in Los Angeles County to lung cancer by Industry are given in Table 2. Workers in 13 in dustries were at significantly increa,ed nsk with SMR's ranging from 127 to 279. Fotty-two percent of the lung cancer in male$ reporting an industry of employment, age 20-64, occurred in these high risk workers who comprised 27'/, of that seic-age group. The proportion of lung cancer cases from death certificates and the CSP in the;e tndustrie, were consistent with few exceptions. Discussion There were r;le11r occupational differern:~ in ratl!!i ol lung can- cer among white males in Los Angeles County. These ocwrred by broad occupational group, and by Individual job class1f1cation. However, there are limitations to the epkh,miologic techniques u~ and, whether these risk diHerenc~ were the result of occupational carcm089"5, or reflected differences in smoking habiti and other factors (e.g.. general air pollution), cannot be determined. Thus, the absence of information on smoking limits our c1billty to delmote the risk of lung cancer due to occup1tional ex pasure alone. However, the pattern of these Los Angele data, th:ir con:ii:itency with earlier reports of l!KC1!55 lung cancer risks in certain oecupatianal group$ !;ubestos workers, machinisn, coob, paintl!l'5). and their consi,tency with reports of other occupational d~e, related to airborne agents <skin cancer. silicosis, M'-tMIS, pneumoconiosi5, bronchitis), suggest that the data IT14y be generally indicative of the impact of occupation.ii ~posure on lung cancer rate. Occupatlonal groups found to be at excess risk who have not been previously implicated included roofers, dental lab techm cians. decorators. nonautomotive me.::hanic~. photoensra~15, ..~,~~ ';.,..i i ' .,..-. - , ~l: ,!... ,t1 +"AUOcQiialw :; so dCllllp-(0~, 11N J<0.01 r "-~~ _' 798 400 ....... Z.000 '' $50 ~ ,' >: ~~ \1 I.ZW . 3.1(1) ...... 1.090 ,, ' l.l'O ''!:' .t l 5.31111 . ; ~ 1.100 ,'; ,_,_,., 3,151> 1.350 1250 ~ -~ t:j~.._ . -4,--~, - ..,"' ~ 12,llt , .~ I ,'t 7.HJO !L' uou 11.450 52.550 34.100 1.150 19.500 9.100 15.300 27.0~ lll-'00 UI0.100 ,c 6 '(:- -,c z . ,. 6 t ,16 "t 19 I ~/1 4 1 , 10 " ,1,!') -~~ 'II : i :',.. s 40 16 3 23 111 58 I& ,s .25 21 ,DI f.731 ~" It 14 .. ~,8128 _,.. 11 42 II 27 61 Ull ', -::~.:- ..,. ,s ... --. :< 433+'...,..,., -',:, 151 M>t'\_" 344- ~-~J,,' l32 ''.~' DI .-~. m ''.'J<'1Bi ,: J'l,'i"m+ "'" ZIT-+ ;Jf,:, 215 cl.'20& ~ ~1, 20I 11111 l&l' !ii 158 151 l3h 131-+ JZ7 175 100 Ooo.lp,tional Oifferente$ m Rates or Lun1 Gllnrer /Memi ill1ll Hllflllerson I dothing ironP.rs, electricians, b11,r _and re5taurant managers, and nltors. Occupational group5 found at high risk who have been ,ed ebE:Where included asbest0> workers," ,. heat treaten,' 5 r ,Ile shop workers,is u pr@ssmen, 2 212 longshore- men,J 14 15 shoe repairmen,> " mine operatives,1 11 bartenders,' " plutcres, 1 u cooks, 5 14 11 t.-ix, and truck drivers,2 ' 11 11 '' painters,> rt 13 ptumbcrs,2 ' " ,. and welders 1 11 16 Industry groups not previously implicated include radio-TV broadcasting, dairy, leather, food and dr,nk, bakery and auto repair Industry group!i at high risk to lung cancer ,n Los Angeles County which have been previously reported ,ndude steel,:w paper,11 petroleum relining,l1 and transportation-" No s1gnif1cant ri$k to lung cancer was detected among chemical and ,ubber worlcers; both groutl5 have IM!en found to have elevated nsks in other stud,e,." . Thi!; discrepani;;y ln our ~ta may be due. to the small numb~ of such workers in Los Angeles County and to geographic:al var~tion in the types of expruure withm the industry. Most of th! ri5k to lung cancef associated with the high risk occupations and lndustrle$ li5ted in T~les 1 and 2 may be rteldted to e,cposure to a,bestos or polycyclic. aromatic hydrocarbons (PAHi or both. Asbestos has been identified ..s a potent carcinogen both in animal stl.ldies and in occupational studie1 of humans." " 1 Be~idM ube,t~ Unsulationl workers, ship and shipyard workers, including stevedores, h.ive beer> reported at eMcess ri\k to lung cancer elsewhere.' 14 TS Other risk grou~ who Stool Mte Rodi>, f B..-n, IIHy Mfl lrd S,loo Dr.-.,. lal/,or 11ft n S,111 E~ PIia P M1t 1111 SI r,,,._, 8alo!IJ lrlfJ 11,d Sain Cool ,,,_. Otillf food M,._ Au!offeta# TIWpan [Qt MIi ' Salls Publoc ,.,,....tm,,.. T~heo OIiier Mell! Mfr. T~. T....,,. Eltdtical lllldt Iii., r..,~.. Apptw l.llmNr. Woo,, '1mln CNmlal llt1ht111.S......,S..... NIN, s1-. c~. 01m E--- """'.... ""'P"PlbawlNII fllllllllll Sll'llm 9us_R.,..S- 011_. bid Trad~ MIIWI( ConstlllCtloll l'hlst,c lioHIK llllll Jilft, finl,,.., manoe. R Edatt Piel Eqt. M11. IPI'r,,m.._s,~...iTrod Alric. Fcnslrl, F All lnd111trie, '11-~ ti1il. ~d.ol t<111-"""'~ toall. p,cO~ t:.,;; -~,.,s ~ cs ra~ ,:;._~!:, \_l ',/~ ~ ~ raw. 2. ~ ~ 't" MomlllY 1111t101 100 n hlra4rfwl or 1.1,c c-; ,,,, '( IIIM!rJ, Wlllit llalK ZN4 Yun. I.al . . . . Collty. ....-~ 1,n.un t\,!-~'ll~ '._t~j~~ ,~::~_:: I 1090:I 20- ./ ..,,\I' ~'t11'r~r<-.'-ri-,~ :,\, zw 4)51) UI m ,, ' 5.700 10 15 ;1,:~ 'l!:;!;,< t,550 8 '172t .., ~ /)~ ' ' 3).400 59 37 111 < ""iLh' ll.900 14 14 m- V .,. ' i:...,_' < i.250 7,900 u 11 ,'16'1' lJ ,l~ ~ . -,, JISOO 19 2l 1.W 'J:,,; ll.050 20 8 ltl&' 'Vt: 1545,;o 138 20!! loll' 'I<,' 82.9:111 78 '16 Ill" J, .. 13800 92 14 171' .,.'> 4p,i 57 47 126 Ti,'',-, 211.650 II ,m ..,.L' f.1,500 H 24 119 'I ' ~.t 19,llOII 27 211 119 .. ,: <:, -~-' ' ' ,. ' .. .. '}'-"' U,t:111 11.250 ZUill &.4'6 ll.7!0 27,850 4t,K'O ]2.JIOO 19 114 ll 14 110- ZS 19 -;:Jf ,:;1a B 111$ 18 1 ,,isl 39 LS , 191 Sl 2' . . ,1 21 .,,1 64,iGII 63 13&.8!0 121 111Xl IZ 118.70II 121 7:zrti) 3Z 19 " s 1)6 ~ 9 14 s M 55.IOO 4' 21 82 13,950 4& u 67.51111 2D u 6., 1'3.'0II 80.5CQ 14 4J BJ 26 .5.1.1 15.U IG s 46 1.seoioo I.SU 1.173 10\l Jownal of Occupational Medicme/Vol. 18, No lZ/0eeember 1976 799 may hilve been exposed to asbestos include clothing ironers, plasterers, dry wall workers, electricians ;md plumber,. ?AH compound~ have also been identified as cartinogenlc In animal and human studies.la Exposure to PAH compounds is very characteristic of metal working occupation~. and .several of these 2. Hueper WC: Occupatloo,II .ind nWC>'lmental Cancers of ~ Respiratory System. New Yooc: SpnOgt!rVerlag. 1966, 3. Cur~n,d, L Mtal,ty by Occupation and CJuse of Death Among Men ~ YPars of Age: United Stales 1!150 Vital St1ti>tic, Spec.al Report. 53, No. 3, 1962. Wash111gton, o_c U.S Gov@rnmentPnnt,ng Office, 1963. 4. Guralnick L: Mortality by Industry and Cause ol ~th Among Men occ:upatlons were at excfls nsk to lung cancer in l.os Angeles County, including heat treaters, 31 metal machine shop workers,4 ., welders," and plumbers. In addition to these groups of metal worke1s, steel industry workers in Los Angeles County, 21)-64 Years d Age: United Stitll!J 1950, v,u1 Stati5lic5 Special Report, 53, No, 4, 1%3. Washingt011, O.C., U $_ Government Printing Off,ce, 19&3. 5. Enterline P, McK,cvcr MF: 0iff<:rcnt,.,J rno<t.t~ty f,om lung carieer by occupation, /OM 5,283-289, 1963. &, Morris<lll st: Occupat1a1al mortality in Scotland Brir I rndum Med _when analyzed as a single group, were also at elev1ted risk to lung cancf'r. Others have reported elevated n1k of respiratory disease, im;luding luns c~cer, in steel Industry workers." ., " Other groups at high risk to lung cancer who have probably had ex- 14130-132, 1957, 7. fraumem Jf: ~esptratory carc1nogenes1s: an epidem1olog,c appraisal. / Nat Cancer Inst S!i-1039-1046. 1'175 B. Cole P, Goldman MB, Occupation, in Persons at High Risk to Cancer: An ApJ)foach to Cancer ftiology and Control, Editor, fraumm, If, Jr. New posure to PAH compounds include roofers," vehicle drivers,'9 5 York: Acad<!mic Press. Inc., 1975, PP 167-184. employees of auto repair companies, photoengravers," printing 9. Versloys JI: Cancer ittd occupation /11 me Netl!erla11ds. Brit J Cam:ef trade pressmen,27 2' 40 56 f 1 cooks, baken, employees of 3:11185, 1949. I petroleum minl!rle5,,. " and dental lab technkians,n 10. Social Security Administration: Occupallcna! Characteristics of Duabh,d Workers, by Oisabllng Cood,tion< Wuhineton, OC. US. For the reft'liining occupations and 1ndustrll!S at excess risk to Ccllll!rnlN!nt Printing Off1ee, 1967. I,, lung cancet, specific carcinogenic hypotheses are difficult to 11. Kenn1.way EL, KMn1.way NM: A furthl!r Hudy of the 1nc1dence of tne propose. Shoe workmen and repairmen have been previously cancer ol lung 111d larynx. Brit J c,ncer 1:260-298, 1947. reported at excess risk to lung caocer.l ' '' ~wral ln~tlgators 12. Wynder fl. Clallam EA: ftlologtc factoo in broru:hogemc wcmoma with special 1eltre111.e to nwtrldl e~JMU(es. Arch lmJuw Hyg 4.2:21-23', have tl,o reported ex,ess n.ual cancer in the boot and shoe in- 19$1. dustr)I, with the excess apparently associated with the leather and 13, Breslow L: Occup,ttk:IOII factor, In lung 1;1111cer. A prelimlNlry report. f cork dust areas rather than the sprayR1g ind lacqueriog Meas.illi 1 Publ Hlth Rep '8:286-288, 1953. I Sesides shoe r~lrmen, other workers in the leather industry also 14. Breslow t Hoaglill L, bs!NJ$sen C, Ab<ans 1-<l(: Occupations lllld c1garttte smoking as fat.tors in lung cancer. Amer I Pub/ Hfth 44:111-181, I were at excess risk In these Los Angeles data. SMR's of 110'' and 1954. r 1404 ha.lie prev!OusJy been reporb!d for sue h leather workers. Bar- 15. The Registrar een.nl'< Decennial Suppl@fflellt, England and WalM, I' tenders have previously been reported at greater risk to lung can- I cer, but to our knowledge no carcinogenk: exposUl'es have been suggested. It is possible that these bartenders are heavy smokers. have had heavy ei<posure to smoke filled barro~ms, and tt..Js 1961, Occupauonal Mortllllty Tables. London H.M.s.o., 1971. 16. 01.11n If; Linden C, Br~low l: Lung cancer mortality expe1lence o# men In certain occupations In California. Amer J Publ Hlth 50:1476-1486, 1960. 17. Boucat KR, Weiss W, Seidman H, Cernahan WJ, Cooper DA: The smoking may have produced an occupational artifact. Janitors Pllilade!phia pulmonary nt!<:!plasm reseaich project: wic risk factOIS d lung have St!ldom been reported at excess risk to lung cancer,2 and it is possible that the relative weakness of their risk and their low social class mo.y be indic;,.tr,e of a smoking rather than an occupation.JI effect Milk has been studied as an eluan t of !)Olycycllc aromatic c-,,cer In older men, Ame(/ Epldem 95:+16, 19n, 18. Menck HR, C;u;agr~de JT, Hender1on BE: lndust1io1I i1t pcllutlon: possible efft of lung cancer. Science 11l 210.211. 1974. 19. Hlnench JC, Mlrtln SP, Henderson HE An arnwodl! c;ancer r!!port111g network. f'ubl Hlth Rep 90:1518, 1975. hydrocarbons add sugge$ting eii.ceu ed to risk wax,r.z but we if in diry workers, e aware further o, of no other data Investigation worker groups decribed herein and their relationship to lun~ can cer wouk:I seem warranted. 20. Abramson JH, Sicks Ml, Cahana E: CHath certifiet1e data as an 111<11catioo of lhe pr~e of certain common di!iea5e5 at death, / Chron 0is ~:417-431, 1971. 21. Moriyama IM. Blum WS, Haen,zel W. Mattl,cn Bf: Inquiry into dlagno,tlc evidence supporting medical certi/lc;at1on, of death Ame,/ Pub/ Hlth 41:1376-1487, 19S8. 22. U.S, 8ureai, of the Census, 1970 Census of Population Classified In- Sum1111ry dex d lndu1triti .tnd OccupatiOnl. Washington, DC.: US Government Lung cancer rates in Los Angeles County ~e reviewed foe different occupations and 1ndll!itrles. Employment groups found to be at excess risk who have not been previously implicated included roofers, dental lab techn~n,, do,ators, non.iutomotive P!tntlng Offlre, 1971. 23. U..S Bureau of die c.,,,,u,. Publi Use 5 a ~ ol ~,c 11:Kords for the 1'170 Cf!llsus: Description and Tec;hnieal Documentation. Washington, O.C,;_ u,s, Q:Nernment Printing Office, 1972. "24. Mantel N, HaensHI W: Statistical asp,Kts d the an.iyJ~ ot data frcm mechanics, photOl!ngt.a11s, dothlng Ironers, electricians. bar and restaurant managers, janitors: ill1d workers in the radio-TV broadcasting, dairy, leather, food and drinlc, balceiy, .and al!to repair industries. Most of the occupatlOllal and industrial groups found to rwaspcc:tlvc Jtudiei r;J daeue, J Nit C~r lrut 22:719-748, 1959 25. Selikolf IF, Chutg I, Hammol!d EC: Asbestos exposure, smoking and neoplua. /AMA 204:106-112, 1968. 26, Berry C, Newh<>Lm! Ml, Turok M: Combined eff~t of asbe,tos posure Mid smoking on mortality from lung cancl!f in factory workers. La be at greater risk to lung cancer in Los Angeles County had ex- cet l-176-479, 1972. posure to be,to,, polycyclic iromatic hydroca:bon compounds (l>AH), or both. - 27, Nicholsoo Wf: Discussion. Ann Ocr:up Hyg 16197, 1971. 28. M0111 E: A MOttality survey in tt,e ~w1paper industry. Ann 0CCIJ(1 Hyg 1"195-1%, 1971. Support,td by Conllact No. NOHJ'-53500 and Ctafll NO. PO \CA 1?054-01 lroro ~ Na,.,.../ :.new n,mute. 'Oeath certlfi:111! dltl were kndly ,upplied b,- Ma,,.,. ~.... LOI Mgtlu County DoJ;artmant 01 Huhh. Reference, 1, Doll R Occupational lung ancer: a m,iew. Brit/ rlldustr ~dl&:1111- 190, 1959. 2!1, Moss E, Scott TS, Mherly GRC: Monahty of rMWSpapet workers ffom lung cancer and bronchitis 1952-1966. Brll / lndustr Med 20 1-1'. 1972, 30. Redmond CK. Clocco A, Lloyd IW, Rush HW longterm mortality study cf steelworkers VI. Mortallcy from malignant neoplums among coke ~workets, JOM 1,t:621-629, 1972. <:_~ Blot WJ, Ft~i Jf: Geographic patterns of lung canc~r: indll!ltlal correl11i00s, Amer I Epidemh:11 103:53,550, i976. 32. Hoover R. fraumeni JF: Cancer mortality in tJS. counties with chemical indu,tr/eS, Envir Re1 9:196-207, t975. BOO Owlpal1Qllill Oiffor~ in Rot" gf L,mg ,,"cu/Mencl< and f.Jend~l!llllt 33. Fo~ AJ, Undars OC, Owen R: Asurvey of oc;cupalloml unco,r In the rubber and c..blemokins induslll,is: reJults d five year anal)1b. 1961-1971. 8ril I lndwtt Med 31:140-151, 1974. 14. McMichael AJ, Splrw R. Kupper U: An epldemioloSk study ol morv,,ithln "cohort cl rubber worker, 1964-197.2. /OM 16:'458"""4, 1974. 0 Bogovsk, P, T1mbt~I V, Cllsan JC, W,gner JC: 81olcgical Effect! of Asb.,,tos, Proceedings Wc:.k Conference, Lyon, France: lnt..,nat,anal A!',l!ncy for kesearch on (:;oncer, 1973. 36 U.5. Environmental Prottlon Asenc:y, A1betto1 and All' Polludorr An Annotated 81bliography. Washington, O.C.: U.S. Gove,nment Printing Office, 1971 J7', Hames PG, Ma<:t<t:nzie FAF, stw,.,,1 C, Kemp JH, Oliver TP, Wright OS: Radiological ,urvey of men exposed to asbestos in ~val dockyards. Brit J lnc/u>lr Med :zg,2,4-2'9. 1912 38 National Academy of Sciente,: Pa,ticulat& Polycyclic Organic Matter. Washington. DC : NatlQnal Acidemy of Sciencet Pri11ttn3 Office. 1972. 39. La,,on RH: Fumes from casting iron. JAIM 149:622, 1952 40 Hendrldu NV, Colling, GH, Dooley AE. carrett JT, Rather JB; A ,..,.;lew of exposures to oil mbt Arch Enwon Hltl> 4:139, 1962. 41. Geltin GA Cutting lluids and olcitt d1so,dtf!. /nduJlr Med 3':1-67, 1910. , 2. nry,in E, Cerhardsson C, Fornman S: Fumes 411d gam In weldlnji. Arch lnduw Hyg i:382-384. 1952 '43. McLaughlin AIG, H~1ng HE: P-,monconlosi$ and other cil.lM$ of de~th In irort and s!HI foundry workers. /4.lch lnd11Jtr Hlth 350.378, 1956. 44. Spring KR Health and steel lndUilry environment, ,n Steel Industry Environment, Proc C.C. ferme!i 2nd Memorial Coo,fur..,ce, Buti;lo, N.Y. ~w Y01k State Unlvtriity, 1973. 45. Clare NE S1Ucosi1 "'1d dise.nes of reti1ed ilon foundry worken. In du;tr MHI 41 22-25, 1972, 46 Swan~too C The lron i1nd stliel industry Lancet 1:191-197, 195D. 47. Kaw;u M: Ep,demlo/oglc stud), rJ occupatloniil lung c1m;er. A:h En 111ron Hl1h 14:859-864, 19&7. 43. ~wicki E. fox Ff, Elbert W, Haus TR. Meeker J: Pclynuclea.r aro- matlt f,yd1oca,bon composition d air polluted by tOill tat pitch furn ~mer lndustt Hy8 Ass 23:462"8&, 1'i62. 49 Lyons MJ: Comparison of aromatic polycyclic hydrocarbon from gasoline engine, and diesel engine eJ1haW1$. general wnospheru: dust illld c,gau,ue smoke condenute. /lw! Cancrr tnst Mooogrm 9:193-199. 1962. 50 Kotin P, Falk HI. Thomas M: Aromatic hydroorbons. Ill, f'reMnc., in the particulate pl\UC of d-.eael-engino11 exl,aus!J and tl,e c.trcinogenicity of exhaust extracli. Aldi lndwtt Hlth 11:lll-120. 1'955. .S1. Katin P. Falk HI., Thon,u M: AromatlC hydrocarbon, n. Preurtc<> ,n the parl1cul.1ce pha34! ol gwi-g,ne exhausts ~ the c;ucinogenttity <I e><haus! extra.:ts. Arch lndustr Hyg 9'164-171, 1954. 52 Christian HA Cancer of the lung in employ- of a pul,hc ctility. A fifteen-year--sllJdy 11946-19&0). /OM 4.Hl-139, 1962. 53. l<oope,stein SI. 5chlfrin A, Lfihy T): Lung cancer :ind enwon,-,t:.... a 5tudy oi long-term exposure 10 motor fumes in tunnels JOM N,2&-629, 19&5 S'4. Mill5 CA: MOOll' exha1.1st gues iVld l11n11 c.1nc,:,r in Clnc1nnah J Amer M,:d Sc 2)9:)16-319, 1%0, 5S. Krtt! E: Photcsr.wlne sdlll!llt s.un,ey. Ann Occup Hyg 16.167-173, 1973. 56. (ioldstein DH, l!enoit JN, T ~ HA: An ep~lolog1c so.,dy ol an oil mist up011Ure. Arel, EnWOII Hflh 21 :600-603, 1910. 57. c,~nbets M: A proportional mortality study of a group of newspa~ wotkffl. 8'/t I JnduJIJ Md 29:15-20, 1972. ~- llaitd VC: Effects qi atmo,p/lefit cont.imiflation on C.\"cl!f l'I\Ortahty "r-~olel,m refir,ety employees /OM 9:415-420, 19&7 l,:1/ M1l~hell l;)F, Shankwalker CU. Shazer 5: Oe1:ermir,,ng thi, tumorigen,c,ty of cltntat materials. J Oi,nt R'e 3!1:10231028, ?960. 60 Achf!son 1) Cowdell l!H, follt!!I B: Na5al concer in ti-.: Nort!,- amptooshi,e boot ar,d shoe lnclist,y. BtJt Med J 1:385-:193, 1910. 61 Hadield EH: c.ncer hlurd from wood d,at in the, boot and shoe in- dustry. Ann Otcuo Hyg 15:19, 1'17l. 62, Fa.lk Ht. Koon P, Miller A: Milk u an <!luant of polycydi<: hydro- carbons added to wax. NatJJre 1f).11&4-118S, 1959. hurnal ot Occupational Medicine/Vol. 18, No, 12/December 1976 801