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. 2000 Oct;108(10):1003–1006. doi: 10.1289/ehp.001081003

Government laboratory worker with lung cancer: comparing risks from beryllium, asbestos, and tobacco smoke.

C Steinmaus 1, J R Balmes 1
PMCID: PMC1240137  PMID: 11049824

Abstract

Occupational medicine physicians are frequently asked to establish cancer causation in patients with both workplace and non-workplace exposures. This is especially difficult in cases involving beryllium for which the data on human carcinogenicity are limited and controversial. In this report we present the case of a 73-year-old former technician at a government research facility who was recently diagnosed with lung cancer. The patient is a former smoker who has worked with both beryllium and asbestos. He was referred to the University of California, San Francisco, Occupational and Environmental Medicine Clinic at San Francisco General Hospital for an evaluation of whether past workplace exposures may have contributed to his current disease. The goal of this paper is to provide an example of the use of data-based risk estimates to determine causation in patients with multiple exposures. To do this, we review the current knowledge of lung cancer risks in former smokers and asbestos workers, and evaluate the controversies surrounding the epidemiologic data linking beryllium and cancer. Based on this information, we estimated that the patient's risk of lung cancer from asbestos was less than his risk from tobacco smoke, whereas his risk from beryllium was approximately equal to his risk from smoking. Based on these estimates, the patient's workplace was considered a probable contributing factor to his development of lung cancer.

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Selected References

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  1. Barnard A. E., Torma-Krajewski J., Viet S. M. Retrospective beryllium exposure assessment at the Rocky Flats Environmental Technology Site. Am Ind Hyg Assoc J. 1996 Sep;57(9):804–808. doi: 10.1080/15428119691014477. [DOI] [PubMed] [Google Scholar]
  2. Cholak J., Schafer L., Yeager D. Exposures to beryllium in a beryllium alloying plant. Am Ind Hyg Assoc J. 1967 Sep-Oct;28(5):399–407. doi: 10.1080/00028896709342657. [DOI] [PubMed] [Google Scholar]
  3. Doll R., Peto R. Mortality in relation to smoking: 20 years' observations on male British doctors. Br Med J. 1976 Dec 25;2(6051):1525–1536. doi: 10.1136/bmj.2.6051.1525. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Eisenbud M. Re: Lung cancer incidence among patients with beryllium disease. J Natl Cancer Inst. 1993 Oct 20;85(20):1697–1699. doi: 10.1093/jnci/85.20.1697. [DOI] [PubMed] [Google Scholar]
  5. Finch G. L., March T. H., Hahn F. F., Barr E. B., Belinsky S. A., Hoover M. D., Lechner J. F., Nikula K. J., Hobbs C. H. Carcinogenic responses of transgenic heterozygous p53 knockout mice to inhaled 239PuO2 or metallic beryllium. Toxicol Pathol. 1998 Jul-Aug;26(4):484–491. doi: 10.1177/019262339802600404. [DOI] [PubMed] [Google Scholar]
  6. Flegal K. M., Keyl P. M., Nieto F. J. Differential misclassification arising from nondifferential errors in exposure measurement. Am J Epidemiol. 1991 Nov 15;134(10):1233–1244. doi: 10.1093/oxfordjournals.aje.a116026. [DOI] [PubMed] [Google Scholar]
  7. Frome E. L., Cragle D. L., Watkins J. P., Wing S., Shy C. M., Tankersley W. G., West C. M. A mortality study of employees of the nuclear industry in Oak Ridge, Tennessee. Radiat Res. 1997 Jul;148(1):64–80. [PubMed] [Google Scholar]
  8. Halpern M. T., Gillespie B. W., Warner K. E. Patterns of absolute risk of lung cancer mortality in former smokers. J Natl Cancer Inst. 1993 Mar 17;85(6):457–464. doi: 10.1093/jnci/85.6.457. [DOI] [PubMed] [Google Scholar]
  9. Hammond E. C. Smoking in relation to the death rates of one million men and women. Natl Cancer Inst Monogr. 1966 Jan;19:127–204. [PubMed] [Google Scholar]
  10. Higgins I. T., Wynder E. L. Reduction in risk of lung cancer among ex-smokers with particular reference to histologic type. Cancer. 1988 Dec 1;62(11):2397–2401. doi: 10.1002/1097-0142(19881201)62:11<2397::aid-cncr2820621125>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
  11. Infante P. F., Wagoner J. K., Sprince N. L. Mortality patterns from lung cancer and nonneoplastic respiratory disease among white males in the beryllium case registry. Environ Res. 1980 Feb;21(1):35–43. doi: 10.1016/0013-9351(80)90005-5. [DOI] [PubMed] [Google Scholar]
  12. Kreiss K., Mroz M. M., Newman L. S., Martyny J., Zhen B. Machining risk of beryllium disease and sensitization with median exposures below 2 micrograms/m3. Am J Ind Med. 1996 Jul;30(1):16–25. doi: 10.1002/(SICI)1097-0274(199607)30:1<16::AID-AJIM3>3.0.CO;2-Q. [DOI] [PubMed] [Google Scholar]
  13. Kreiss K., Mroz M. M., Zhen B., Martyny J. W., Newman L. S. Epidemiology of beryllium sensitization and disease in nuclear workers. Am Rev Respir Dis. 1993 Oct;148(4 Pt 1):985–991. doi: 10.1164/ajrccm/148.4_Pt_1.985. [DOI] [PubMed] [Google Scholar]
  14. Kreiss K., Wasserman S., Mroz M. M., Newman L. S. Beryllium disease screening in the ceramics industry. Blood lymphocyte test performance and exposure-disease relations. J Occup Med. 1993 Mar;35(3):267–274. [PubMed] [Google Scholar]
  15. Kriebel D., Sprince N. L., Eisen E. A., Greaves I. A. Pulmonary function in beryllium workers: assessment of exposure. Br J Ind Med. 1988 Feb;45(2):83–92. doi: 10.1136/oem.45.2.83. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Lang L. Beryllium: A Chronic Problem. Environ Health Perspect. 1994 Jun;102(6-7):526–531. doi: 10.1289/ehp.94102526. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. MacMahon B. The epidemiological evidence on the carcinogenicity of beryllium in humans. J Occup Med. 1994 Jan;36(1):15–26. [PubMed] [Google Scholar]
  18. Mancuso T. F. Mortality study of beryllium industry workers' occupational lung cancer. Environ Res. 1980 Feb;21(1):48–55. doi: 10.1016/0013-9351(80)90007-9. [DOI] [PubMed] [Google Scholar]
  19. Martyny J. W., Hoover M. D., Mroz M. M., Ellis K., Maier L. A., Sheff K. L., Newman L. S. Aerosols generated during beryllium machining. J Occup Environ Med. 2000 Jan;42(1):8–18. doi: 10.1097/00043764-200001000-00006. [DOI] [PubMed] [Google Scholar]
  20. Nicholson W. J. Case study 1: asbestos--the TLV approach. Ann N Y Acad Sci. 1976;271:152–169. doi: 10.1111/j.1749-6632.1976.tb23104.x. [DOI] [PubMed] [Google Scholar]
  21. Ritz B., Morgenstern H., Froines J., Young B. B. Effects of exposure to external ionizing radiation on cancer mortality in nuclear workers monitored for radiation at Rocketdyne/Atomics International. Am J Ind Med. 1999 Jan;35(1):21–31. doi: 10.1002/(sici)1097-0274(199901)35:1<21::aid-ajim4>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  22. Rogot E., Murray J. L. Smoking and causes of death among U.S. veterans: 16 years of observation. Public Health Rep. 1980 May-Jun;95(3):213–222. [PMC free article] [PubMed] [Google Scholar]
  23. Saracci R. Beryllium and lung cancer: adding another piece to the puzzle of epidemiologic evidence. J Natl Cancer Inst. 1991 Oct 2;83(19):1362–1363. doi: 10.1093/jnci/83.19.1362. [DOI] [PubMed] [Google Scholar]
  24. Steenland K., Ward E. Lung cancer incidence among patients with beryllium disease: a cohort mortality study. J Natl Cancer Inst. 1991 Oct 2;83(19):1380–1385. doi: 10.1093/jnci/83.19.1380. [DOI] [PubMed] [Google Scholar]
  25. Vainio H., Rice J. M. Beryllium revisited. J Occup Environ Med. 1997 Mar;39(3):203–204. doi: 10.1097/00043764-199703000-00008. [DOI] [PubMed] [Google Scholar]
  26. Wagoner J. K., Infante P. F., Bayliss D. L. Beryllium: an etiologic agent in the induction of lung cancer, nonneoplastic respiratory disease, and heart disease among industrially exposed workers. Environ Res. 1980 Feb;21(1):15–34. doi: 10.1016/0013-9351(80)90004-3. [DOI] [PubMed] [Google Scholar]
  27. Wynder E. L., Mabuchi K., Beattie E. J., Jr The epidemiology of lung cancer. Recent trends. JAMA. 1970 Sep 28;213(13):2221–2228. [PubMed] [Google Scholar]
  28. Yoshida T., Shima S., Nagaoka K., Taniwaki H., Wada A., Kurita H., Morita K. A study on the beryllium lymphocyte transformation test and the beryllium levels in working environment. Ind Health. 1997 Jul;35(3):374–379. doi: 10.2486/indhealth.35.374. [DOI] [PubMed] [Google Scholar]

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