Journal of occupational medicine. : official publication of the Industrial Medical Association最新文献

This article summarizes published data on employment and cancer patterns in the motor vehicle manufacturing (MVM) industry and presents results from a new study of female MVM workers. Historically, female MVM employees worked primarily in aerospace; electric and electronic equipment manufacturing; and paint, plastic, and trim operations. Women are now moving into vehicle assembly and metal parts production. Investigations of cancer have focused on men and reported excesses of lung cancer in foundry operations, of gastrointestinal cancer in metal processing operations involving exposure to machining fluids, and of colorectal cancer in wood pattern making. Numbers of women were insufficient for a meaningful evaluation of their cancer patterns. A recent study found that white women employed at a MVM company, compared to the female general US population, had small excesses of lung cancer (standardized mortality ratio (SMR) = 1.26; 95% confidence interval (CI) = 0.96-1.63) and of colorectal cancer (SMR = 1.27, 95% CI = 0.87-1.78) and a deficit of breast cancer (SMR = 0.68, 95% CI = 0.48-0.92). The lung cancer increase was concentrated among women in assembly jobs (SMR = 1.58, 95% CI = 1.07-2.26); the colorectal cancer increase, among women in nonproduction jobs (SMR = 1.78, 95% CI = 0.97-2.98); and the breast cancer deficit, among women in production-related jobs (SMR = 0.60, 95% CI = 0.37-0.91). Further investigation is needed to determine if these patterns are due to the occupational environment and to clarify causes of cancer among women in the MVM industry.

Lung cancer mortality rates are increasing for women, despite the fact that 90% of these deaths could be prevented by smoking cessation. Targeted workplace smoking cessation programs may increase the effectiveness of lung cancer prevention for women. This study uses proportionate mortality ratio analysis of occupationally coded death certificates, from 28 states between 1979 and 1990, to identify occupations in which women are at high risk of lung cancer mortality. The study found gender and racial variation in the results for broad occupational groups. Blue-collar occupations associated with potentially carcinogenic workplace exposures also had elevated proportionate mortality ratios, probably reflecting both occupational and tobacco exposure. For women, specific occupations such as managers and financial officers revealed significant elevations in lung cancer mortality. Cessation programs targeting women in these occupational groups may increase the effectiveness of lung cancer prevention.

Using a nationwide linked registry, we evaluated the incidence of several hematopoietic and lymphoproliferative (HLP) malignancies among Swedish women from 1961 to 1979 by industry and occupation. The risks of one or more types of HLP cancers (including the leukemias, non-Hodgkin's lymphoma, multiple myeloma, and mycosis fungoides) were significantly increased among women working in the agriculture and textile industries, housekeepers, and post office employees. Limitations of these linked-registry data include lack of detailed information on specific exposures and duration of employment, and the relatively small sizes of specific occupational cohorts. Nevertheless, as the proportion of women entering the workforce continues to increase, this data resource may provide additional clues to occupational determinants of HLP and other malignancies.

A recently developed source of occupational mortality data from 28 states for the years 1979 through 1990 can be used to meet goals for the surveillance of women's work-related diseases. A proportionate cancer mortality ratio analysis is used to illustrate use of the data to address the goals of identifying previously unrecognized work-related disease and targeting consultation or health promotion programs to appropriate occupations. Strengths of the data include broad geographical coverage and coverage of all causes of death and numerous industries and occupations. The data set is current and very large, with annual additions. The data have certain limitations. Death certificate information collected regarding occupation and cause of death may not be accurate; furthermore, death certificates have little information on potential confounding factors, such as smoking.

Data on the occupation and industry in which 242,196 females worked in Canada between 1965 and 1971 are available from a national survey of employers by Statistics Canada. As an example of the future utility of this cohort, computerized record linkage was conducted with the Canadian National Mortality Data Base through 1979. This article presents selected results. Associations are measured by standardized relative risks. Those meeting specific criteria (two or more observed deaths, relative risk > 2.0, and 95% confidence interval excluding 1.00) include (a) buccal cavity and pharyngeal cancer among mechanics and repairers, tobacco preparers and product makers, and telephone systems industry workers; (b) lung cancer among service station attendants, motor vehicle mechanics, and petroleum refinery workers; and (c) breast cancer among workers manufacturing electrical industrial equipment and printing and publishing industry workers. The mortality experience of the cohort through 1991 is currently being determined by another record linkage, thus providing up to 25 years of follow-up and over 8,500 cancer deaths anticipated among females.

In the context of a national program for occupational health surveillance, we examined cancer mortality among women from two study populations. The Torino Longitudinal Study includes 159,039 women, resident in Torino, northern Italy, 18 to 64 years old and economically active at the 1981 census. The Italian Cross-sectional Study includes 2,038 deaths among 6,073,071 Italian women, 18 to 64 years old and economically active at the 1981 census. Preliminary results indicate that women in higher socioeconomic classes showed excess overall cancer mortality. This excess was almost entirely explained by increased breast cancer among teachers, managers, and public officials. Metal, wood, and clothing manual workers showed a significantly increased risk of ovarian cancer. Some excesses of lung and digestive cancers were noticeable among women in the textile and clothing industry and in the restaurant, bar, and hotel trade. Further study is under way.

This article presents the preliminary results of a follow-up study (1950-1992) of 1,146 subjects (person-years = 30,954; 23,055 for women) receiving compensation for mercury poisoning. In a province of Tuscany in central Italy, severe exposure to mercury occurred during fur hat production. A deficit in all causes of mortality was observed in both sexes, whereas mortality due to cancer was slightly higher than expected. Mortality from stomach cancer was significantly elevated for men and women. A significant excess of lung cancer was observed in women only. Whereas the excess of stomach cancer probably reflects elevated rates in the study area rather than exposure to mercury, the excess of lung cancer mortality does appear to be related to mercury exposure. Smoking habits or other exposures at work do not seem to explain the excess of lung cancer.

Numerous occupational studies of cancer risks related to agriculture, agricultural practices, and agricultural exposures have been conducted among male farmers and farmworkers. Relatively few studies of female farmers and farmworkers have been conducted. Excesses of non-Hodgkin's lymphoma, leukemia, multiple myeloma, soft tissue sarcoma, and cancers of the breast, ovary, lung, bladder, cervix, and sinonasal cavities have been observed in women in agriculture or with agricultural exposures. Agents that contribute to ill health in exposed men may also affect exposed women, sometimes in unexpected ways.