Quantitative estimated exposure to vinyl chloride and risk of angiosarcoma of the liver and hepatocellular cancer in the US industry-wide vinyl chloride cohort: mortality update through 2013

• Published in: Occupational and environmental medicine (London, England) England), 2017-10, Vol.74 (10), p.709-716
• Main Authors: Mundt, Kenneth A, Dell, Linda D, Crawford, Lori, Gallagher, Alexa E
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Brain; Cancer; Cause of Death; Explosions; Exposure; Factories; Hazards; Health risk assessment; Health risks; Hemangiosarcoma - mortality; Hepatocellular carcinoma; Hodgkin's lymphoma; Humans; Liver; Liver - drug effects; Liver cancer; Liver Neoplasms - mortality; Lung cancer; Lymphoma; Male; Manufacturing Industry; Melanoma; Mesothelioma; Middle Aged; Mortality; Mortality risk; Non-Hodgkin's lymphoma; Occupational Diseases - mortality; Occupational exposure; Occupational Exposure - adverse effects; Polyvinyl chloride; Polyvinyl Chloride - adverse effects; Proportional Hazards Models; Risk; United States - epidemiology; Vinyl chloride; Vinyl Chloride - adverse effects; Workplace
• ISSN: 1351-0711; 1470-7926
• DOI: 10.1136/oemed-2016-104051

ObjectiveTo evaluate mortality risks of angiosarcoma of the liver (ASL), primary hepatocellular carcinoma (HCC) and other cancers among 9951 men employed between 1942 and 1972 at 35 US vinyl chloride (VC) or polyvinyl chloride plants followed for mortality through 31 December 2013.MethodsSMR and time-dependent Cox proportional hazards analyses were used to evaluate mortality risks by cumulative VC exposure.ResultsLiver cancer mortality was elevated (SMR=2.87, 95% CI 2.40 to 3.40), and ASL and HCC were strongly associated with cumulative VC exposure ≥865 parts per million-years (ppm-years) (ASL: HR=36.3, 95% CI 13.1 to 100.5; and HCC: HR=5.3, 95% CI 1.6 to 17.7 for ≥2271 ppm-years). Excess deaths due to connective and soft tissue cancers (SMR=2.43, 95% CI 1.48 to 3.75), mesothelioma (SMR=2.29, 95% CI 1.18 to 4.00) and explosions (SMR=3.43, 95% CI 1.25 to 7.47) were seen. Mortalities due to melanoma, brain cancer, lung cancer and non-Hodgkin’s lymphoma were not increased or associated with VC exposure.ConclusionThe association between VC and ASL first reported in this cohort 44 years ago persisted and was strongest among workers most highly exposed. VC exposure also was associated with HCC mortality, although it remains possible that misdiagnosis of early ASLs influenced findings.