接触2,3,7,8-四氯二苯并对二恶英的工人的癌症死亡率。

Cancer mortality in workers exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin.

作者信息

Fingerhut M A, Halperin W E, Marlow D A, Piacitelli L A, Honchar P A, Sweeney M H, Greife A L, Dill P A, Steenland K, Suruda A J

机构信息

Industrywide Studies Branch, National Institute for Occupational Safety and Health Centers for Disease Control, Cincinnati, OH 45226.

出版信息

N Engl J Med. 1991 Jan 24;324(4):212-8. doi: 10.1056/NEJM199101243240402.

DOI:10.1056/NEJM199101243240402

PMID:1985242

Abstract

BACKGROUND

In both animal and epidemiologic studies, exposure to dioxin (2,3,7,8-tetrachlorodibenzo-p-dioxin, or TCDD) has been associated with an increased risk of cancer.

METHODS

We conducted a retrospective cohort study of mortality among the 5172 workers at 12 plants in the United States that produced chemicals contaminated with TCDD. Occupational exposure was documented by reviewing job descriptions and by measuring TCDD in serum from a sample of 253 workers. Causes of death were taken from death certificates.

RESULTS

Mortality from several cancers previously associated with TCDD (stomach, liver, and nasal cancers, Hodgkin's disease, and non-Hodgkin's lymphoma) was not significantly elevated in this cohort. Mortality from soft-tissue sarcoma was increased, but not significantly (4 deaths; standardized mortality ratio [SMR], 338; 95 percent confidence interval, 92 to 865). In the subcohort of 1520 workers with greater than or equal to 1 year of exposure and greater than or equal to 20 years of latency, however, mortality was significantly increased for soft-tissue sarcoma (3 deaths; SMR, 922; 95 percent confidence interval, 190 to 2695) and for cancers of the respiratory system (SMR, 142; 95 percent confidence interval, 103 to 192). Mortality from all cancers combined was slightly but significantly elevated in the overall cohort (SMR, 115; 95 percent confidence interval, 102 to 130) and was higher in the subcohort with greater than or equal to 1 year of exposure and greater than or equal to 20 years of latency (SMR, 146; 95 percent confidence interval, 121 to 176).

CONCLUSIONS

This study of mortality among workers with occupational exposure to TCDD does not confirm the high relative risks reported for many cancers in previous studies. Conclusions about an increase in the risk of soft-tissue sarcoma are limited by small numbers and misclassification on death certificates. Excess mortality from all cancers combined, cancers of the respiratory tract, and soft-tissue sarcoma may result from exposure to TCDD, although we cannot exclude the possible contribution of factors such as smoking and occupational exposure to other chemicals.

摘要

背景

在动物研究和流行病学研究中，接触二噁英（2,3,7,8 - 四氯二苯并 - p - 二噁英，即TCDD）均与癌症风险增加相关。

方法

我们对美国12家生产受TCDD污染化学品工厂的5172名工人进行了一项死亡率回顾性队列研究。通过查阅工作描述以及检测253名工人样本血清中的TCDD来记录职业暴露情况。死因取自死亡证明。

结果

在该队列中，先前与TCDD相关的几种癌症（胃癌、肝癌、鼻癌、霍奇金病和非霍奇金淋巴瘤）的死亡率并未显著升高。软组织肉瘤的死亡率有所增加，但未达到显著水平（4例死亡；标准化死亡比[SMR]为338；95%置信区间为92至865）。然而，在暴露时间≥1年且潜伏期≥20年的1520名工人亚组中，软组织肉瘤的死亡率显著增加（3例死亡；SMR为922；95%置信区间为190至2695），呼吸系统癌症的死亡率也显著增加（SMR为142；95%置信区间为103至192）。总体队列中所有癌症合并的死亡率略有但显著升高（SMR为115；95%置信区间为102至130），在暴露时间≥1年且潜伏期≥20年的亚组中更高（SMR为146；95%置信区间为121至176）。