Bladder cancer in crack testers applying azo dye-based sprays to metal bodies.

Bladder cancer may be produced by azo dyes due to the presence of carcinogenic aromatic amines. Nine cases of suspected occupational bladder cancer that were exposed to different crack test sprays in metal-related jobs were examined. A detailed occupational history was taken and, if possible, the N-acetyltransferase 2 (NAT2) status was determined. The first exposure to crack test sprays ranged from 1957 to 1986. Age at first exposure was between 14 and 33 yr. Age at first diagnosis of bladder cancer varied from 35 to 64 yr. Latency periods were between 17 and 45 yr. The maximal reported exposure period was 29 yr. Four of six genotyped cases were slow NAT2 acetylators. The handling of the crack test spray included spraying the red dye-containing matter on the metal body and washing off the spray with a rag. Thus, workers were exposed by dermal contact as well as by inhalation. The crack test spray, which makes the cracks visible after washing off the red testing spray compounds and applying an additional white spray, contained dyes such as solvent red 19 (Sudan red 7B, N-ethyl-1[[4-(phenylazo)phenyl]azo]-2-naphthylamine) or a mixture of p-phenylazoaniline-N-ethyl-2-naphthylamine and p-phenylazoaniline-N-ethyl-1-naphthylamine. The aromatic amine 2-naphthylamine is classified as human carcinogen by IARC and the national authorities and has been banned in many countries since the mid 1950s. Bladder cancer patients with metal-related jobs need to be explicitly asked about the use of crack test sprays.