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J. R. COOTS J. F- MALONE CROUP, 1 .sJ MORBIDITY AND MORALITY WEEKLY REPORT 15, 1974 /tffJjfofoUgrfill EPIDEMIOLOGIC NOTES AND REPORTS antmrpm ^tvp UVER - Connecticut From January 1935 through December 1973. 8 cases of mgiOMrcoma of the liver were reported to the Connecticut Tumor Registry; the diagnosis of hepatic angiosarcoma has been confirmed in 6 of these cases by pathologists at the National Cancer Institute. One case was diagnosed in 1950, l in 1967, and 4 In 1972 and 1973. The 1950 case occurred in a resident of north-central Connecticut, while the 5 more recent cases were found in residents of 4 closely adjacent communities in the southwestern portion of the state (Figure 1). Two of the patients appear to have had occupational exposure to polyvinyl chloride (PVC). One, a 47-year-old man diagnosed in January 1973. had been employed for the -10 preceding years as an accountant in a factory which produces vinyl sheets and processes PVC resins; it is reported that he frequently visited the production area of the plant. Another patient, a 61-year-old man diagnosed in June 1973, had worked from 1933 through 1971 in an electrical products manufac turing concern, and from 1938 through 1963 he had operated Figure l CASES OF ANGIOSARCOMA OF THE LIVER BY PLACE OF RESIDENCE CONNECTICUT - 1935-1973 (Continued on back page) ANGIOSARCOMA - Continued machinery there which applied plastics containing PVC to wires as insulating ir.ateriaL Another 2 patients who had no occupational exposure to PVC had been long-time residents of the BridgeportStratford area. One of these was a 73-year-old man, diagnosed in 1967, who had lived his entire life within 2 miles of the electrical products factory mentioned above. He had worked as a firefighter from 1917 to 1942, as a metal worker from 1942 to 1944, and as a corset cutter from 1945 until his retirement in 1961; additionally he had a history of chronic alcohol ingestion. The other resident was an 83-year-old woman, a housewife and retired cook, who was diagnosed in December 1973. She had lived for35 years within 1/2 mile of the vinyl products plant. There was no history of occupational or of potential community exposure to PVC for the 2 remaining patients. One was a housewife in north-central Connecticut, the other an unemployed, disabled man'with chronic alcoholism who had moved to Connecticut from New York City 4 months before his diagnosis in May 1973. None of the 6 confirmed' patients had known exposure to thorium dioxide (Dor to arsenical compounds (2k 2 materials known specifically to Induce angiosarcoma of the liver in- man. By history, none had excessive exposure to aerosol sprays. None had a past history of hepatitis. Two had histories of alcoholism, as noted, but none are known to have taken other potentially hepatotoxic drugs or medications. (Reported by Barbara It'. Christine. M.D., Chief, Chronic Disease Control Section. Harold S. Barrett. M.D., Deputy Commissioner of Health, and Douglas S. Lloyd. M.D.. Comtttissioncr ofHealth. Connecticut State Department of Health: the National Institute of Occupational Safety and Health, and the Cancer and Birth Defects Division. Bureau of Epi demiology, CDC.i Edicori.il Nute Recent reports (J. O have described 13 cases of angiosorcom.i of (he liver among men engaged ir. the synthesis of Vfco MorMOU, i,a uciimi, v-,h<v fi,>i. tt/oniruoa, ss.ooo. it a,,oii,r>a at IA, Ctitltr (of Oil,!,, Com,o<. Ainu, Cl. Olf,lof. Crtta, for Qtuiit Control QI4 J. Sooorr. M.Q. pi>cioi. #r Cv<ofntoioor, CSC PMHp J. bri>nii, m.d. C*l(f>r. Uthvd Wtnivl Lailof. uuwn UlCl-i.rl U, Cl*-.*. M.cv. . pOr>r<r> L. O S, tc. 0,1, In OM. IIOI.I 0,n.l,<o>'. Oat.do* wiibl, ltl<('ll1 lo COC y Of htt, ftni.lMmlt, ,00 rffiorOOT out conctvd.a ,1 .t, or t.wt.itft, ,it *ld,,i 00 ftjllonol boat, atl.o.K, talaaitl to Ilia OaaaH.e on VO, aa.C(.diA, trior,. PVC from vinyl chloride monomer (VCM). There is evidence to suggest, that VCM may have been the cause of hepatic angiosarcoma in those cases (S.6k In the present series 2 cases of hepatic angiosarcoma are described in men who had no known exposure to VCM, but who did work with PVC. While these findings establish no causal connection between exposure to PVC and angiosarcoma of the liver, they do raise the possibility of such a relationship. Further studies throughout the nation wilt be nfccded to define the possible risk factors in persons who have worked with PVC. The additional finding in this study of angiosarcoma of the liver irr 2 persons who had no occupational exposure Co vinyl chloride, but who may have had community exposure, is also worrisome but again establishes no causal connection. It might be expected on the basis of data from the Third National Cancer Survey that approximately 4 cases of angio sarcoma of the liver would occur in Connecticut in a 10-year period and that approximately 0.6 cases would occur in the 4 previously mentioned communities in southern Connecticut during the seme interval. Epidemiologic investigation of addi tional cases of hepatic angiosarcoma that may be found to have had possible community exposure to vinyl chloride will be necessary to clarify the significance of these cases. References 1. da Silva Ilona J. Abbait JD. Cayolla da Motta L. Roriz ML: Malig nancy and other late effects following administration of thorotrasi. Lancet 2:20!-20S. !9<5S 2. Regclson W, Kim U. Orpins J. Holland JF: Hcmansioendothelial sarcoma of liver from chronic arsenic intoxication by Fowler's solu tion. Cancer 21:514.522. 196S 3. Center for Disease Control: Angiosarcoma of the liver among poly vinyl chloride workers -- Kentucky. Morbidity and Mortality Weekly Rep 23{6M'+-SQ. Feb 1974 4. Creech JL Jr. Johnson MM: Angiosarcoma of the liver in die manu facture uf polyvinyl chloride. J Occ Med Ifi: 150-151. 1974 5. Falk II, Heath CW Jr. Key MM: Unpublished observations. 13 May 1974 6. Maltoni C, Lel'cniinc C: Carcinogenicity bio-assays of vinyl chloride: Current results. In Program of New York Academy of Sciences Working Group on Toxicity of Vun | Chloride -- Polyvinyl Chloride. New Yock City. tO-lt May IV74 *~ <0 rc.iii.oo lo ir> raarc.iiir.ro oro<otrr,. (or rrpdfttnt rnoabidti, jod rraorirtal,. to, ,4.tor *dti.rt Itti-.iii o' alcrctilrai oariUMrot or tao .rar rl l> r li-roa of A44oai ,n <0''f>t'0f>Cr< lor C-otfr (or Olatlt, Cbfilrol Attnr da lo f Harbldll, rod Mo.la'll, Vfl, IS.I Alltolr. Crorflt JOJJJ OHEW Publication No. (COC) 7-1 0017 _ ______ _ _ BFG02661 Toooszoz T" T