Document v1bmj408QgJ0K4v5o26yo5E5R

. ET) AR226-1308-1 F261 T340 P01 FER 11 093 030m es rnd exrwanivn mmoen[repr77] : FsErSeLemoEv SmsEcEeTce mpEg stae,epn gBas Rpm,Aro PseheosmeE orero, n . ' ) : 3 EIDS84220 : . wrTvn I. FPR) T-0 POR FER 11 rep pec AvoENDH emymeplloogyeeneouastInWlaAespuhrkiielnmgita1o9nv89a,Wsordaknisa.agdnodsiWeetdicoaninanlaacsasSuslme-eyoetafhraatcouldttheemaleexpseacltaerdy : snhuozrbtertoifselpeeurkieonida(cJaagneusardyid19n8o3t-Apirniclrea19s8e9)m.easurably in this . cases vithosbtsaenrdvaerddiazneddesitnicimdaetnecdeexrpaetcitoesdfnourmb1e9r5s6-Aopfrillesk1e9m8i9a are as follovs: . Ll euke9 niaMIanl% ceisd,ep nceap tWar sshei sinWol grtkso:n observed [Expected Ratio sWaalgaery a i2.s7 22.02 Total s "2 2.14 ss(ttavot-itsatiilceadl)ly significant at the 10% level Tgersotu)p. 10 ehvaevisctsainodaalrldyizceidgniinrciiodmetnceATrtahteio10o%f l2e.1velfor(ttwhee-staoitiaeld pcoonwterrolofsttWhuiidsythsittsuhbedeyidvniigalglnionBsietiisaltioenfdi.ttehdi,sAltadhduodauittgeihottnhhieel csatsaet,istaiccaalse small number of aleswsxoecniiaatiocnassesv,iths wmoorrek atrheoarouagnhd cihnevaelsctailgateixopnosuirnecse poisssinie warranted. april 1989 y H I0s84221 . i. . swoary the WashingAtnoninWvoersktisgsatiitoeniinntPoarktehreeooncccsu,rreWnVcevaso.fbelgeeuskeinitsera.t fearmpsloiybeees ea xproccRodgcoT ncernH svar recent dlayiees of his tshteaticsotripcoarRlaoltuyetMiseindgeincisafulircvaDeniitvlilsaeinxoccneeshsbayditnhcneiedteEnprcieedveemsofiioeldloegusykyeSmeiactiaomnongof - Wlnayosmphshitanatgtiticoe.ntainWcdoarlkhleeymacaticogtpnioivifeeicteaimncpeltoieysweseeuseesfsrmmaoelmritg1an9la5in6lc-yi8e1s.f.roTnwhhietchrhee vFTarasociuaoldsoerro . Taukenis; aug eclive eaployess and pensioners' fron 1957-s4 Analyls of cases or deaths occurring after 1583 or 1e9m8p4i,oyoressCpeocntcievrenlyv,ashaTadisnaodt. yeTthibseenstuadcycomepsltiismhateedsacthethemustsiemre Scoofmmpcaanrseemss tohfI isleutokn emtihae aecxmtpuescTltendumabtetrhediasgintoesetdh.rougihn 1a9d8d8itiaonnd, - Weassthiinnagtetdon4E.Wi2ogrhkCtsascaaensmepslexopyoefecetsleeduf.kreommTiah1i9s5o6o-ci8su8r,ArOeCLdomaapmeoGrLneagcdmiaswtliitechala:n significant excess. However, four cases vers diagnosed since V`Zteehrpesrelsaoasfnttasscuutarenvenuionlnul-salunyacmleplhypoechryiiigoihdci(nlic.eieu.dkeendacuiers.ing1vo1ef984oc-hf8r8ot)ma,iscw+hiscmhes myelogenous leukemia, and 1 of acute, unspecified, leukesia. Seven of the leukenia cases vere deceased by 1388; no additional cases due to the Epideniology Section's this cause ors, identified thrangh Mortality Registry. The number of Vdeaatnhsotdureeatsosktahbelygraoiuffperoafntlyfmrpohnatiaxcpeacntdedh:ematopoietic cancers - any co Preliminary review of work histories did not reveal mmonality of exposure. It is recorsended thats Enersigh review of the work areas and potential chemical exposures, additional cases. * particularly to benzene and hydrocarbons, be initiated, and `that the site be monitored closely for the occurrence of ) eroseazzz . |-- . rane rn rei ne A INVESTIGATION Timo mE occrmENcE --L OFEUK ATWE ASHIM NGTOI N WORA KS [BACKGROUND CoRATEion tabng thats covorkars tehzeplWoayseheisngAetnxopnriensWvsoereskdtsicgsoainttcieeornniniontvPoearrtkehrreescbeouncrtcgu,r@riWeaVngcnweoasesosfbeolgfeuuntkheimasifaterat Stage of discasa: Tia types of levers Serceciy SIS 14 rouping o`fThReal-diiggigainsceisesntoitfythoef BlLeouGkeenmfioarecioemyprsiseesssa. diLvierrerssee firme types of leukemia vary according to ceil type and four histopathological categories (Linet, 1088): 1)) AE S5c7um3t0ae, Le AynmnpRhEonSccTyitSeiricsaeLneeukInenmniian0c=hiThahtniessv`tipytpeheo1off,leluuekunekomeimotheaiaminmisoggmneeosre 2) @ ChronicJrighoestis Leukemia extremely rare befors age 40, - This type of and increases leukemia is in incidence vith age, especially aftar age 50. ith She thereatters (3) AT accuuttee mNRe ooynno-olyytmipv sh,ocysreiuste sLeauMkyrset lmoiuyla=lec,sThisaooetcsataegoirray inniethe forms. Fifty percent of adult Incidence is lov before age 30, leukemias are of this SE but increases progressively . ( 4) JTCoehuurkkoEEeennaiilcssGirBertsRnananyiuHliBsogecytrFaietcpaonrr(aiede to ae relocytic) Ele chronic sonryetitetisd Leukamia - This type of thy Sliaee agud ac58+ EAITou and fone of these chemicals bay blso be Soriearoeint . bsyecudliafrfepraitnTthgeerdsneesm,odgirasastpihvnieclctlt(yaapsgea,vsarsoefyxi,n1gsrnhakycepemoitaahnsedsaeirtzeohehndiacaritaticyst)ieorgaiinzsdssd (Linet, 1985). associated with Exposure to radiation has been known to be leukemia, except for the chronic lymphocytic type. Various chemicals have been shown to ba toxic tebone Benzene has shown strong evidence of crising leukents, mostly sotfudtihees.acuOtregannoincslhyymdprhoocoayrtbioontsyphea,ve isn hsouwvnessaolmeoecvciudpearnicoenaolf cLoavuoscitnegdlTeou'keamaivae.'seuVkaerimcougsentthceproabpaenuctiiscl,adennctisubhianvge hBeisenyleting aaagpsepsneotacsriauttsoieopdnlahiyanscabaerneocnleerdecimhnoetnmhostethreaerttaeipdoyli.ongyIanovffpeecrtliiemououknascmeialgg:eantnTshtiasslso . -- ToT EID584223 . - studies, and has been supported by studies of in utero exposure and through documentation of clusters in humans. Previonsleukemia InoidengoamdMeweality a8 UadiiusbwnWeida the CorporaRtoeutMiendeicsaulrvDeiivlilsainocnediAdrndotEFpeivdaesmliolnoygyrSeemcatrikoanbleof oeenxfpclelosyyssepehisantciifcdreonmacned19h5o6ef-m8al3te,oupkoenimoeirtaaincaymtoiensxgscWeuasesshmaimlnoigrgttnaoalnnictWiyoerskf,srowmahctithcievhegroup include leukemia, among active toployecs and pensioners from : a1n95d7-m8o4r,talasi.tcyomfpiagriezdestoareheshorvesntbeolfow: the Corporation. Incidence = * BLeeuukkeeanliee Incidence at Washington Works observed | Expected Ratio sWaalgaery 22 22.1 01.29 Total ` 3.3 1.2 -- Lymphatic/HematopoMieatliecsN,olrotSa7lointey at Washingtdn Works observed Expected Ratio wage ` "8 os Salary A aa 3 Total s 7.9 1.0 SR TUDA Y TION ANA DDELSIE GN . 1984, respeAcntailvyesliys, ohfacdaRsoets oyertdbeeaetnhsaSceccoxuprliinsghedafatterth1e983timoer employee concern vas raised." This study estimates the number - nCfomcpaasreess tofhisletuokemtihae eacxtpueacltedmuamtb.erthadiaogintoesetdh.reugh 1908 aul identifiedCafsreosm tofhelEepuikdeemmiiaoldoigaygnSoescetdioanft'esrCa1n9c83ervReergeistry and cSaagtteaegogarotirzeiddaiagnboysihsi.ssttooppsathoo)loogsical type,yyeear oofdiagnAloagsmeictsand The expected nusber of Cases, based on the Du Pont \ fQoorrpt8ohr3ea.tap-ewriidoed w1a9p8w4s-i8w8ncaen,d waadsdedesttoimtahteeaextporecWtaesdhinnugmtboenr Wfoorrks : 7 EIDS84224 esa ra ors ros BEACH FT calculatingIxtpheectaidncnruesabseersperofyelaerukeianiathecaesxepsecwteerde estimated nusberof by cases for Washington 1956-77 and 1956-83, WaonrdkaspbpleytiwnegenthtihsesuchravnegielltaonctheepeSr-iyoedasr IdentifofiLc eukaemtiaiCaosn es RELL loukenia From cases the records of the pusEotedanon Du Pont aetive Cancer Registry, employees at the four Cn SHEe rip moerEpoorTteETa ErLollI )E eTar he$N 5 fetemB eDhemEtEierres HtEa2n records,howte hisv cae ser vas, def tobe a lymphoma vere Thus available Aforleannkaelnyisaisc.asesDes(c6riwpatgei,ve 3 isnafloarrmya)ticfsivomn 1`9t8he-swey - eight casas ix in the Appendix. RESULTS .- DistrbyiYb earuoftDii ago nosn is Year of histopathological diagnosis type: is distributed as follows by Acute ~Shrenic Lymphocytic Leukenia 1976 -- Non-Lyaphooytic a 196, 1978, 1977, 1386 : . SeeA me ig Eh en =LL identifiedFsoiunrcceatshees l(a5s0t3 osfurtvheeiltloatnacle cpaesreiosder(iie.se). dhuarvienbgeen 1984-88). Among an au. population of 80, Distribution of the histopathological category is leukemia cacos as follows: by . oo . LeLuykspehaoicaytic TNeounx-eLayimaphooytic Unspecified Total --dqute 1 (22.5%) 4050.08) ios (12.0%) chronic. _Tota 1 (2sy 2 (25.08) 0 3 (25.08) 6 (75.08) 1gasy 8 . 1eakeing,ntas, TLcE5YombiPSetrecntenvtitohf Cthoemeccaaysepsopaurleataciuotne,finndoinn-glsy.mphocytic n3nodn-l1y0mapzhoOaofcyutttiechellee4uukkreeemmciieaan,tolfy1 Uvdnaissapgecnchoirsfoeindeidccamctyoysep,el.og2enwoeurse Jaecwurteemia Distrbiy AbgeuattDiiagnoosnis agnosis Disisatsrifboultlioowns:of tha leukesia cases by age at LLeyuakpehnoicaytic ZNeounk<eLaytmsphooytic Unspecified --Awmute " 3(6m,ean43,= 44i4l,s)57 5 _chrenig (m3e8a, =a'140) uS2an9rcoonm4im0coninsoinTun-hnieacyghmecapsarnsaoe2cc5ty-oet6fr0ii.casctluietScueiknfceloemryimattphshheio.iscnyictcnriecelcialdselentescyupekveei,nGtifhawhaidacgciuehatregniemo.nsded at : ygoiusntgribbuuttiwointhoifntnhoersmsaltyrpaensgea.t Washington Works may betshieightly | mEyreilhogeepnaocuiAstgeecsasnaooanf-nltdyhme5p3h4orcfyeotcriecnthteclaysacedusit,aeg,n4o4sunefsdoprecctaihsfeeisecdvherproaensiec4.2 and 44 LndateofIsuxenisIncidence TlaetuikcesntafordOib1as9g5an6ro-vs8ee8dd aaarnmedonSeghsetwikmaemStpeliodyseee.sxapancdtesdtannduamrbdeirzsedof{cnaesiegsonocfy . TTT TT q E1Dses2z26 . i. . Leukemia ITnhcaidleensc;ela9t5WgagshgiTrgotonn MOWorks Shserved Dmactes Ratlo sage sag 2.2 Salary 2 As 2.3 Total 8 4.2 1.9 . + z1(ot%rvovToaetnacihle:dTBeetaaftsseittes)ect.aidEcanerd)i1is:zie9gdnfidofnrictciaghenencceteootatrlaBtthiegyorsoTuofpporaJlpIperuTokaecnht:aboetf3.i2s Observed and estinated expected nuabers of deatha dus SBtonoo13wonhbeeariaostwi:oc/nhenaTtopeoletAic maAligTnaSnnie1s,. taamonngg gemuepllooyyoonoesaanndd - Lymphatic/Hematopoietic Cancer Mortality --_-- Males.2957-88 at Washington Works wTaogteal obs1e.rved D06ae..c33ted m11a23ss Salary "4 4.0 pH Sevesi of the 12 deaths in this category vere dus to lenkenia (5 wage, 2 incidence analyses. ealary). All 7 ware cases No additional casesSA0ng duluded in the JStive exploysas or ponoionors vars identified Lisuugh the Nos lity Registry. FatatWeaashdinogrtAosWnessutnRoVTiErng,ianniaanavie(rmsaaciTonoafT]eG21ak5ma0enemarlfeossoecamitptaleRojryoeesreessBrooer year hice males as follows, 119965007-6595:: 971.07//210000,,000000 (Average = 3.4/100,000) 1970-79: 8.4/100,000 Foor, Tor the tiaa'veriod 1/1/1087 Lo 13/00/1088 (03 parce), ) 0.181 deaths from leukemia would be expected at tha site we wouldhi from leukemia fro5.m8 19l5e7u-k8e8miiasdenaotthss.tatiSsetviecnaldleyasthisgnoibfsiercvaendt'ly different from the 5.8 leukemia deaths expected. To 1007 rmsesazr . . J. oe ETO Pn FER sz one RISCUSSTON tlheiusketmnyipaae iaoOnfvcneicdr,oemntpechaseer,ivemsanostinisorenbeesgseslrttevaucetdtdtiyssopteinrciagolldyac(tw1ii9vo5e6n-i8We8al)so,hainantgntoeRnxocvWeoosvrsekrso,f year of diagnosis. Had evenly over the study these the distribution of cases bean distributed dagenyby more . nltohenius-koecfmiconugdpeianntgiiconvasogluelndtfsamctososurtpcsehrlioaiotckde,trlbayadbcnieodatamaimcooetncr`ieoxbfpuotbseeunnrrseeesnvetooidkennotwinfied, fianonis iHosveuvneers,perttheet.disWthriilbeutdiocnacoofocvaesrees by yealairmsceodfduring `the surveillance identified from period 1984-83. from 1956-83, the remai Datas of diagnosis for 4 vere these 4 cases vers from 1/86 to 7/48. indicate laukenia excess cases leukemia Since analysis incidence, the through 1983 did apparent Cluster not of - attention. diagnosed in recent years warrants particular p2r0ae7rv,tiiCecovumlomafernlAtayhLepitrtoewylobiroekmfnihzneieaxanrpreyoasaurrrineeedv.siheyavdnIrdtoofcpiaowsrtobarronekntcsi,ohamilesaetmncoyihreeidmaeiscetadhliadtsxnapouttshurererevesee,agln CCsahosoneucsle.dntbreatmioonnitoonretdheclroesceelnyt fcaosrest,heboecciunrirteiantceed.of Tahdeditsiiotenal The various suspected differences batveen cell types, etiologies of leukemia, rtaiahrndisistathtaiiisnsoovnecs,sittuaidbtygee,nadzteivlnoiientm,.hittcGhhteeehnmeedotetcivhoecenlrcaoalsppumesveuaiantnoltidnlcstohafhagesieLcneestuhnmksvae,ilcnrlaioanannrn.dmbueemn{bsdTneirireseaewontnfCiianccfsiatrsosomemss a$Xgaemnptlse,haovnee amlallabeefnromimtphliiscactaesde isnerlieoukcemhoagdanPerseivsi.ousFlyorLue tsreecaotneddaryfotrotthryreoaitdmecnatncfeorr, tahnadt hneiospllaesumk.emiaHomweavyerh:avhe ibeeamnoss . nexoptospurroecsl.ude a thorough investigation of his work history ana ) 1 10504220 . rman ' : F261 T30 F010 FEB 11 19208:3 -10- : REFERENCES 1. LNienwetY,orkN:.S.Ox(f1o98r5d)UTnhievelresuikteyniFnraes:s.EpidemiologicAspects. 2. MRWoiargstghaailnni,gttyoWn.R,Ba.t,DeC:sMaasnodNnC,TIr/TEe.PnJAd..s,.e1t95a0l-.197(91.983)WS.Cancer ' : EIDs84229 12 . -11- . onanescm Ba T ae EE IRE SE S--U-- a SwIe oEmEe wows wm we 8 m=Emx. mmm we ow 3 : ons ws mer or - a- Ecmr sum we " r we ww wa wm ow eEm e w we we m 4 mm wm uw Hf wame wg Ce ee ow em 4 wm Ti Bre 3 = mm we -- Lg s==m= mew ay wa un wa om aby doy Fa=cmr mm wm 5 aw Me Glogs ' xD , 13