Davis D L, Bridbord K, Schneiderman M
Int J Health Serv. 1983;13(3):337-72. doi: 10.2190/A7ND-8Y2T-TL07-B4GB.
This paper addresses some enduring issues concerning prevention of environmental and occupational cancer. The first part reviews methodological problems of estimating cancer risks and outlines some research priorities. The second part documents countervailing trends in chemical production during the past two decades, noting the doubling of some synthetic organic human carcinogens and the leveling off of some heavy metal carcinogens. The final section details recent increases in site-specific causes of cancer mortality for men old enough to have developed workplace cancers (ages 35 to 84), considering those cancers that have been linked with exposures to toxic chemicals and to cigarette smoking. This paper points out that Doll and Peto's (1981) analysis of U.S. cancer trends does not indicate some important increases in older males; they conclude that apart from cigarette smoking, there is no generalized increase in cancer for persons up to age 64. In fact, there has been a sharp reduction in cancer mortality for those under age 45. This reduction more than offsets increases in some cancers for those ages 45 to 65. Men ages 55 to 84 have experienced major increases in mortality for certain cancers plausibly associated with occupational exposures, including cancers of the brain, lung, and multiple myeloma. These older age groups have potentially sustained longer workplace exposures to carcinogens, some of which have 25-year or greater latencies. Changes in infectious diseases, workplace exposures, diagnostic trends, environment, and nutrition require further study.
本文探讨了一些有关预防环境与职业性癌症的长期问题。第一部分回顾了估计癌症风险的方法学问题，并概述了一些研究重点。第二部分记录了过去二十年化学品生产中的抵消趋势，指出一些合成有机人类致癌物增加了一倍，而一些重金属致癌物则趋于平稳。最后一部分详细阐述了对于年龄足够大（35至84岁）、已患上职业性癌症的男性而言，特定部位癌症死亡率最近的上升情况，其中考虑了那些与接触有毒化学品和吸烟有关的癌症。本文指出，多尔和佩托（1981年）对美国癌症趋势的分析并未表明老年男性中有一些重要的增长情况；他们得出结论，除吸烟外，64岁以下人群的癌症没有普遍增加。事实上，45岁以下人群的癌症死亡率大幅下降。这一下降足以抵消45至65岁人群中某些癌症的增加。55至84岁的男性中，某些可能与职业接触有关的癌症死亡率大幅上升，包括脑癌、肺癌和多发性骨髓瘤。这些年龄较大的人群可能在工作场所接触致癌物的时间更长，其中一些致癌物的潜伏期长达25年或更长时间。传染病、工作场所接触、诊断趋势、环境和营养方面的变化需要进一步研究。
