Abstract
OBJECTIVES: To determine if there is an increased risk of admission to hospital for various diseases among vinyl chloride monomer (VCM) workers. METHODS: 2224 workers with occupational exposure to VCM were identified for occurrence of disease based on a search of hospital computer files on labour insurance. These data were compared with those of workers manufacturing optical equipment and motorcycles from 1 January 1985 to 31 March 1994. Cardiovascular and cerebrovascular diseases were used as reference diseases, and the age adjusted morbidity odds ratio (MOR) was calculated. RESULTS: A significantly increased risk of admission to hospital among VCM workers due to primary liver cancer (MOR 4.5-6.5), cirrhosis of the liver (MOR 1.7- 2.1), and other chronic diseases (MOR 1.5-2.0) was found. There were eight cases of primary liver cancer, all with heavy previous exposure to VCM. Another four cases of hepatoma in polyvinyl chloride (PVC) workers were found in the death registry. Ten out of 11 cases of hepatoma, with detailed medical information, were carriers of hepatitis B virus. The average latent period (20 years) was not different from other studies. Alternative agents of primary liver cancer were largely ruled out, suggesting that the combination of hepatitis B and VCM may lead to primary liver cancer. CONCLUSION: There is an increased risk of primary liver cancer in workers exposed to VCM, although the incomplete coverage of the Labor Insurance Bureau data warrants cautious interpretation of the results. Further study exploring the synergistic effects of VCM and hepatitis B is also indicated.
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- Austin H., Delzell E., Grufferman S., Levine R., Morrison A. S., Stolley P. D., Cole P. A case-control study of hepatocellular carcinoma and the hepatitis B virus, cigarette smoking, and alcohol consumption. Cancer Res. 1986 Feb;46(2):962–966. [PubMed] [Google Scholar]
- Austin H., Delzell E., Grufferman S., Levine R., Morrison A. S., Stolley P. D., Cole P. Case-control study of hepatocellular carcinoma, occupation, and chemical exposures. J Occup Med. 1987 Aug;29(8):665–669. [PubMed] [Google Scholar]
- Benvegnù L., Fattovich G., Noventa F., Tremolada F., Chemello L., Cecchetto A., Alberti A. Concurrent hepatitis B and C virus infection and risk of hepatocellular carcinoma in cirrhosis. A prospective study. Cancer. 1994 Nov 1;74(9):2442–2448. doi: 10.1002/1097-0142(19941101)74:9<2442::aid-cncr2820740909>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
- Berk P. D., Martin J. F., Young R. S., Creech J., Selikoff I. J., Falk H., Watanabe P., Popper H., Thomas L. Vinyl chloride-associated liver disease. Ann Intern Med. 1976 Jun;84(6):717–731. doi: 10.7326/0003-4819-84-6-717. [DOI] [PubMed] [Google Scholar]
- Chen C. J., Kuo T. L., Wu M. M. Arsenic and cancers. Lancet. 1988 Feb 20;1(8582):414–415. doi: 10.1016/s0140-6736(88)91207-x. [DOI] [PubMed] [Google Scholar]
- Chen D. S., Kuo G. C., Sung J. L., Lai M. Y., Sheu J. C., Chen P. J., Yang P. M., Hsu H. M., Chang M. H., Chen C. J. Hepatitis C virus infection in an area hyperendemic for hepatitis B and chronic liver disease: the Taiwan experience. J Infect Dis. 1990 Oct;162(4):817–822. doi: 10.1093/infdis/162.4.817. [DOI] [PubMed] [Google Scholar]
- Chuang W. L., Chang W. Y., Lu S. N., Su W. P., Lin Z. Y., Chen S. C., Hsieh M. Y., Wang L. Y., You S. L., Chen C. J. The role of hepatitis B and C viruses in hepatocellular carcinoma in a hepatitis B endemic area. A case-control study. Cancer. 1992 Apr 15;69(8):2052–2054. doi: 10.1002/1097-0142(19920415)69:8<2052::aid-cncr2820690808>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
- Cordier S., Le T. B., Verger P., Bard D., Le C. D., Larouze B., Dazza M. C., Hoang T. Q., Abenhaim L. Viral infections and chemical exposures as risk factors for hepatocellular carcinoma in Vietnam. Int J Cancer. 1993 Sep 9;55(2):196–201. doi: 10.1002/ijc.2910550205. [DOI] [PubMed] [Google Scholar]
- Covey L. S., Wynder E. L. Smoking habits and occupational status. J Occup Med. 1981 Aug;23(8):537–542. [PubMed] [Google Scholar]
- Dannaher C. L., Tamburro C. H., Yam L. T. Occupational carcinogenesis: the Louisville experience with vinyl chloride-associated hepatic angiosarcoma. Am J Med. 1981 Feb;70(2):279–287. doi: 10.1016/0002-9343(81)90763-4. [DOI] [PubMed] [Google Scholar]
- Du C. L., Chan C. C., Wang J. D. Comparison of personal and area sampling strategies in assessing workers' exposure to vinyl chloride monomer. Bull Environ Contam Toxicol. 1996 Apr;56(4):534–542. doi: 10.1007/s001289900077. [DOI] [PubMed] [Google Scholar]
- Evans D. M., Williams W. J., Kung I. T. Angiosarcoma and hepatocellular carcinoma in vinyl chloride workers. Histopathology. 1983 May;7(3):377–388. doi: 10.1111/j.1365-2559.1983.tb02251.x. [DOI] [PubMed] [Google Scholar]
- Froment O., Boivin S., Barbin A., Bancel B., Trepo C., Marion M. J. Mutagenesis of ras proto-oncogenes in rat liver tumors induced by vinyl chloride. Cancer Res. 1994 Oct 15;54(20):5340–5345. [PubMed] [Google Scholar]
- Geubel A. P., Pauwels S., Buchet J. P., Dumont E., Dive C. Increased cyt P-450 dependent function in healthy HBsAg carriers. Pharmacol Ther. 1987;33(1):193–196. doi: 10.1016/0163-7258(87)90050-7. [DOI] [PubMed] [Google Scholar]
- Kiyosawa K., Sodeyama T., Tanaka E., Gibo Y., Yoshizawa K., Nakano Y., Furuta S., Akahane Y., Nishioka K., Purcell R. H. Interrelationship of blood transfusion, non-A, non-B hepatitis and hepatocellular carcinoma: analysis by detection of antibody to hepatitis C virus. Hepatology. 1990 Oct;12(4 Pt 1):671–675. doi: 10.1002/hep.1840120409. [DOI] [PubMed] [Google Scholar]
- Miettinen O. S., Wang J. D. An alternative to the proportionate mortality ratio. Am J Epidemiol. 1981 Jul;114(1):144–148. doi: 10.1093/oxfordjournals.aje.a113161. [DOI] [PubMed] [Google Scholar]
- Peers F., Bosch X., Kaldor J., Linsell A., Pluijmen M. Aflatoxin exposure, hepatitis B virus infection and liver cancer in Swaziland. Int J Cancer. 1987 May 15;39(5):545–553. doi: 10.1002/ijc.2910390502. [DOI] [PubMed] [Google Scholar]
- 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]
- Popper H., Thomas L. B. Alterations of liver and spleen among workers exposed to vinyl chloride. Ann N Y Acad Sci. 1975 Jan 31;246:172–194. doi: 10.1111/j.1749-6632.1975.tb51093.x. [DOI] [PubMed] [Google Scholar]
- 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]
- Sterling T. D., Weinkam J. J. Smoking characteristics by type of employment. J Occup Med. 1976 Nov;18(11):743–754. doi: 10.1097/00043764-197611000-00011. [DOI] [PubMed] [Google Scholar]
- Thomas L. B., Popper H., Berk P. D., Selikoff I., Falk H. Vinyl-chloride-induced liver disease. From idiopathic portal hypertension (Banti's syndrome) to Angiosarcomas. N Engl J Med. 1975 Jan 2;292(1):17–22. doi: 10.1056/NEJM197501022920104. [DOI] [PubMed] [Google Scholar]
- Wang J. D., Lai M. Y., Chen J. S., Lin J. M., Chiang J. R., Shiau S. J., Chang W. S. Dimethylformamide-induced liver damage among synthetic leather workers. Arch Environ Health. 1991 May-Jun;46(3):161–166. doi: 10.1080/00039896.1991.9937444. [DOI] [PubMed] [Google Scholar]
- Wang J. D., Miettinen O. S. The mortality odds ratio (MOR) in occupational mortality studies--selection of reference occupation(s) and reference cause(s) of death. Ann Acad Med Singapore. 1984 Apr;13(2 Suppl):312–316. [PubMed] [Google Scholar]
- 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]
