Skip to main content
PMC home page
Occupational and Environmental Medicine logoLink to Occupational and Environmental Medicine
. 2000 Nov;57(11):774–781. doi: 10.1136/oem.57.11.774

Historical cohort study of 10 109 men in the North American vinyl chloride industry, 1942-72: update of cancer mortality to 31 December 1995

K Mundt 1, L Dell 1, R Austin 1, R Luippold 1, R Noess 1, C Bigelow 1
PMCID: PMC1739879  PMID: 11024202

Abstract

OBJECTIVES—To update and assess mortality from neoplasms to 31 December 1995 among 10 109 men employed in a job exposed to vinyl chloride for at least 1 year between 1942 and 1972 at any of 37 North American factories. Previous analyses indicated associations between employment in vinyl production and increased mortality risk from cancers of the liver and biliary tract, due to increased mortality from angiosarcoma of the liver, and brain cancer.
METHODS—Standardised mortality ratio (SMR) analyses, overall and stratified by several work related variables, were conducted with United States and state reference rates. Cox's proportional hazards models and stratified log rank tests were used to further assess occupational factors.
RESULTS—895 of 3191 deaths (28%) were from malignant neoplasms, 505 since the previous update to the end of 1982. Mortality from all causes showed a deficit (SMR 83, 95% confidence interval (95% CI) 80 to 86), whereas mortality from all cancers combined was similar to state referent rates. Mortality from cancers of the liver and biliary tract was clearly increased (SMR 359, 95% CI 284 to 446). Modest excesses of brain cancer (SMR 142, 95% CI 100 to 197) and cancer of connective and soft tissue (SMR 270, 95% CI 139 to 472) were found. Stratified SMR and Cox's proportional hazard analyses supported associations with age at first exposure, duration of exposure, and year of first exposure for cancers of the liver and soft tissues, but not the brain.
CONCLUSIONS—Excess mortality risk from cancer of the liver and biliary tract, largely due to angiosarcoma, continues. Risk of mortality from brain cancer has attenuated, but its relation with exposure to vinyl chloride remains unclear. A potentially work related excess of deaths from cancer of connective and soft tissue was found for the first time, but was based on few cancers of assorted histology.


Keywords: vinyl chloride; angiosarcoma; liver; brain; connective tissue; soft tissue; neoplasms

Full Text

The Full Text of this article is available as a PDF (140.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Buffler P. A., Wood S., Eifler C., Suarez L., Kilian D. J. Mortality experience of workers in a vinyl chloride monomer production plant. J Occup Med. 1979 Mar;21(3):195–203. [PubMed] [Google Scholar]
  2. Byrén D., Engholm G., Englund A., Westerholm P. Mortality and cancer morbidity in a group of Swedish VCM and PCV production workers. Environ Health Perspect. 1976 Oct;17:167–170. doi: 10.1289/ehp.17-1475258. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Collins J. J., Strauss M. E., Levinskas G. J., Conner P. R. The mortality experience of workers exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin in a trichlorophenol process accident. Epidemiology. 1993 Jan;4(1):7–13. doi: 10.1097/00001648-199301000-00003. [DOI] [PubMed] [Google Scholar]
  4. Cooper W. C. Epidemiologic study of vinyl chloride workers: mortality through December 31, 1972. Environ Health Perspect. 1981 Oct;41:101–106. doi: 10.1289/ehp.8141101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Creech J. L., Jr, Johnson M. N. Angiosarcoma of liver in the manufacture of polyvinyl chloride. J Occup Med. 1974 Mar;16(3):150–151. [PubMed] [Google Scholar]
  6. Davis D. L., Ahlbom A., Hoel D., Percy C. Is brain cancer mortality increasing in industrial countries? Am J Ind Med. 1991;19(4):421–431. doi: 10.1002/ajim.4700190402. [DOI] [PubMed] [Google Scholar]
  7. Dinman B. D., Cook W. A., Whitehouse W. M., Magnuson H. J., Ditcheck T. Occupational acroosteolysis. I. An epidemiological study. Arch Environ Health. 1971 Jan;22(1):61–73. doi: 10.1080/00039896.1971.10665816. [DOI] [PubMed] [Google Scholar]
  8. Dodson V. N., Dinman B. D., Whitehouse W. M., Nasr A. N., Magnuson H. J. Occupational acroosteolysis. 3. A clinical study. Arch Environ Health. 1971 Jan;22(1):83–91. doi: 10.1080/00039896.1971.10665818. [DOI] [PubMed] [Google Scholar]
  9. Doll R. Effects of exposure to vinyl chloride. An assessment of the evidence. Scand J Work Environ Health. 1988 Apr;14(2):61–78. doi: 10.5271/sjweh.1943. [DOI] [PubMed] [Google Scholar]
  10. Forman D., Bennett B., Stafford J., Doll R. Exposure to vinyl chloride and angiosarcoma of the liver: a report of the register of cases. Br J Ind Med. 1985 Nov;42(11):750–753. doi: 10.1136/oem.42.11.750. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Friede A., Reid J. A., Ory H. W. CDC WONDER: a comprehensive on-line public health information system of the Centers for Disease Control and Prevention. Am J Public Health. 1993 Sep;83(9):1289–1294. doi: 10.2105/ajph.83.9.1289. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Ghandur-Mnaymneh L., Gonzalez M. S. Angiosarcoma of the penis with hepatic angiomas in a patient with low vinyl chloride exposure. Cancer. 1981 Mar 15;47(6):1318–1324. doi: 10.1002/1097-0142(19810315)47:6<1318::aid-cncr2820470614>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  13. Greenwald P., Friedlander B. R., Lawrence C. E., Hearne T., Earle K. Diagnostic sensitivity bias -- an epidemiologic explanation for an apparent brain tumor excess. J Occup Med. 1981 Oct;23(10):690–694. doi: 10.1097/00043764-198110000-00012. [DOI] [PubMed] [Google Scholar]
  14. Hagmar L., Akesson B., Nielsen J., Andersson C., Lindén K., Attewell R., Möller T. Mortality and cancer morbidity in workers exposed to low levels of vinyl chloride monomer at a polyvinyl chloride processing plant. Am J Ind Med. 1990;17(5):553–565. doi: 10.1002/ajim.4700170502. [DOI] [PubMed] [Google Scholar]
  15. Hoppin J. A., Tolbert P. E., Flanders W. D., Zhang R. H., Daniels D. S., Ragsdale B. D., Brann E. A. Occupational risk factors for sarcoma subtypes. Epidemiology. 1999 May;10(3):300–306. [PubMed] [Google Scholar]
  16. Infante P. F. Observations of the site-specific carcinogenicity of vinyl chloride to humans. Environ Health Perspect. 1981 Oct;41:89–94. doi: 10.1289/ehp.814189. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Jones R. D., Smith D. M., Thomas P. G. A mortality study of vinyl chloride monomer workers employed in the United Kingdom in 1940-1974. Scand J Work Environ Health. 1988 Jun;14(3):153–160. doi: 10.5271/sjweh.1937. [DOI] [PubMed] [Google Scholar]
  18. Kogevinas M., Becher H., Benn T., Bertazzi P. A., Boffetta P., Bueno-de-Mesquita H. B., Coggon D., Colin D., Flesch-Janys D., Fingerhut M. Cancer mortality in workers exposed to phenoxy herbicides, chlorophenols, and dioxins. An expanded and updated international cohort study. Am J Epidemiol. 1997 Jun 15;145(12):1061–1075. doi: 10.1093/oxfordjournals.aje.a009069. [DOI] [PubMed] [Google Scholar]
  19. Kogevinas M., Kauppinen T., Winkelmann R., Becher H., Bertazzi P. A., Bueno-de-Mesquita H. B., Coggon D., Green L., Johnson E., Littorin M. Soft tissue sarcoma and non-Hodgkin's lymphoma in workers exposed to phenoxy herbicides, chlorophenols, and dioxins: two nested case-control studies. Epidemiology. 1995 Jul;6(4):396–402. [PubMed] [Google Scholar]
  20. Mack T. M. Sarcomas and other malignancies of soft tissue, retroperitoneum, peritoneum, pleura, heart, mediastinum, and spleen. Cancer. 1995 Jan 1;75(1 Suppl):211–244. doi: 10.1002/1097-0142(19950101)75:1+<211::aid-cncr2820751309>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  21. Monson R. R., Peters J. M., Johnson M. N. Proportional mortality among vinyl-chloride workers. Lancet. 1974 Aug 17;2(7877):397–398. doi: 10.1016/s0140-6736(74)91771-1. [DOI] [PubMed] [Google Scholar]
  22. Pirastu R., Comba P., Reggiani A., Foa V., Masina A., Maltoni C. Mortality from liver disease among Italian vinyl chloride monomer/polyvinyl chloride manufacturers. Am J Ind Med. 1990;17(2):155–161. doi: 10.1002/ajim.4700170202. [DOI] [PubMed] [Google Scholar]
  23. Prout M. N., Davis H. L., Jr Hemangiopericytoma of the bladder after polyvinyl alcohol exposure. Cancer. 1977 Mar;39(3):1328–1330. doi: 10.1002/1097-0142(197703)39:3<1328::aid-cncr2820390347>3.0.co;2-0. [DOI] [PubMed] [Google Scholar]
  24. Rhomberg W. Exposure to polymeric materials in vascular soft-tissue sarcomas. Int Arch Occup Environ Health. 1998 Jul;71(5):343–347. doi: 10.1007/s004200050290. [DOI] [PubMed] [Google Scholar]
  25. Rhomberg W., Gruber-Mösenbacher U., Eiter H., Fritzsche H., Breitfellner G. Zur Prognose und Epidemiologie des malignen Hämangio-endothelioms der Schilddrüse. Schweiz Med Wochenschr. 1993 Sep 4;123(35):1640–1644. [PubMed] [Google Scholar]
  26. Saurin J. C., Tanière P., Mion F., Jacob P., Partensky C., Paliard P., Berger F. Primary hepatocellular carcinoma in workers exposed to vinyl chloride: a report of two cases. Cancer. 1997 May 1;79(9):1671–1677. doi: 10.1002/(sici)1097-0142(19970501)79:9<1671::aid-cncr6>3.0.co;2-f. [DOI] [PubMed] [Google Scholar]
  27. Shah H. C. Diagnostic bias in occupational epidemiologic studies. Am J Ind Med. 1993 Aug;24(2):249–256. doi: 10.1002/ajim.4700240214. [DOI] [PubMed] [Google Scholar]
  28. Simonato L., L'Abbé K. A., Andersen A., Belli S., Comba P., Engholm G., Ferro G., Hagmar L., Langård S., Lundberg I. A collaborative study of cancer incidence and mortality among vinyl chloride workers. Scand J Work Environ Health. 1991 Jun;17(3):159–169. doi: 10.5271/sjweh.1715. [DOI] [PubMed] [Google Scholar]
  29. Smulevich V. B., Fedotova I. V., Filatova V. S. Increasing evidence of the rise of cancer in workers exposed to vinylchloride. Br J Ind Med. 1988 Feb;45(2):93–97. doi: 10.1136/oem.45.2.93. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Steenland K., Beaumont J., Spaeth S., Brown D., Okun A., Jurcenko L., Ryan B., Phillips S., Roscoe R., Stayner L. New developments in the Life Table Analysis System of the National Institute for Occupational Safety and Health. J Occup Med. 1990 Nov;32(11):1091–1098. doi: 10.1097/00043764-199011000-00008. [DOI] [PubMed] [Google Scholar]
  31. Suruda A. J., Ward E. M., Fingerhut M. A. Identification of soft tissue sarcoma deaths in cohorts exposed to dioxin and to chlorinated naphthalenes. Epidemiology. 1993 Jan;4(1):14–19. doi: 10.1097/00001648-199301000-00004. [DOI] [PubMed] [Google Scholar]
  32. Tabershaw I. R., Gaffey W. R. Mortality study of workers in the manufacture of vinyl chloride and its polymers. J Occup Med. 1974 Aug;16(8):509–518. [PubMed] [Google Scholar]
  33. Thériault G., Allard P. Cancer mortality of a group of Canadian workers exposed to vinyl chloride monomer. J Occup Med. 1981 Oct;23(10):671–676. doi: 10.1097/00043764-198110000-00009. [DOI] [PubMed] [Google Scholar]
  34. Waxweiler R. J., Stringer W., Wagoner J. K., Jones J., Falk H., Carter C. Neoplastic risk among workers exposed to vinyl chloride. Ann N Y Acad Sci. 1976;271:40–48. doi: 10.1111/j.1749-6632.1976.tb23091.x. [DOI] [PubMed] [Google Scholar]
  35. Williamson I. G., Ramsden R. T. Angiosarcoma of maxillary antrum--association with vinyl chloride exposure. J Laryngol Otol. 1988 May;102(5):464–467. doi: 10.1017/s0022215100105365. [DOI] [PubMed] [Google Scholar]
  36. Wong O., Raabe G. K. Critical review of cancer epidemiology in petroleum industry employees, with a quantitative meta-analysis by cancer site. Am J Ind Med. 1989;15(3):283–310. doi: 10.1002/ajim.4700150305. [DOI] [PubMed] [Google Scholar]
  37. Wong O., Whorton M. D., Foliart D. E., Ragland D. An industry-wide epidemiologic study of vinyl chloride workers, 1942-1982. Am J Ind Med. 1991;20(3):317–334. doi: 10.1002/ajim.4700200305. [DOI] [PubMed] [Google Scholar]
  38. Wu W., Steenland K., Brown D., Wells V., Jones J., Schulte P., Halperin W. Cohort and case-control analyses of workers exposed to vinyl chloride: an update. J Occup Med. 1989 Jun;31(6):518–523. doi: 10.1097/00043764-198906000-00007. [DOI] [PubMed] [Google Scholar]

Articles from Occupational and Environmental Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES