L'amiante est probablement le cancerogene environnemental et professionnel le mieux caracterise et le plus etudie. Pourtant, certaines incertitudes demeurent, qui empechent une evaluation exacte des risques de cancer du poumon et de mesotheliome, malgre le developpement de modeles statistiques de plus en plus sophistiques.

Abstract This chapter describes union-based efforts to develop and use epidemiologic surveillance techniques as routine accessible tools in the day-to-day conduct of a health and safety program.

For many chemical exposures, the most appropriate study populations are among the diverse end-users of the materials rather than the large producers or processors. Important exposures often occur in complex process settings that are not easily characterized but which could be epidemiologically evaluated. Industrial hygiene approaches are needed for characterizing process emissions when the relevant constituents are unspecified. Aggregating study populations from plants where there is a mature labor-management dynamic allows access to the collective memory of the plant populations, a major resource in exposure reconstruction. In population-based studies that apply exposure matrices to interview data, the use of interviewers trained in industrial hygiene would help minimize misclassification. Restricting population-based studies to a subset of employers would also facilitate exposure classification. Analyses using internal exposure comparisons are essential to address noncomparability of study and reference populations. Improved statistical efficiency can be achieved through the latency weighting of exposures and the modeling of exposure-mortality associations using external reference rates. Paradoxical dose-response can arise from imprecise exposure classifications if a worker's duration in the exposure is dependent on exposure level. When exposure data are limited, statistically significant excesses showing paradoxical dose-responses should be interpreted as evidence in support of an exposure effect.

Epidemiologic studies have reported associations between gastrointestinal cancer mortality and exposure to cutting fluids and abrasives in metal machining and precision grinding operations. Two previous studies found excess stomach cancer among workers exposed to water-based cutting fluids in bearing plants. This study reports similar findings in a third and larger population. Cause of death and work histories were determined for 1,766 bearing plant workers who died between Jan 1, 1950 and June 30, 1982. Mortality odds ratios (SMOR) and proportional mortality ratios (PMR) revealed significant excesses of gastrointestinal malignancies. The proportional mortality excess for stomach cancer among white men was greatest among those with more than 10 years' exposure in the major grinding group (PMR = 13/3.8 = 3.39; P less than .001). The SMOR by logistic regression for stomach cancer among white men was 2.3 (P = .02) for 25 years' grinding experience. For cancer of the pancreas among white men, there were significant associations with both machining and grinding jobs in straight oil (SMOR = 9.9 and 3.2, respectively, for 25 years duration). These findings could not be explained by confounding due to the ethnic background of the decedents. This study confirms previous evidence that grinding operations using water-based cutting fluids increase the risk for stomach cancer and provides moderate evidence that exposures to straight oil-cutting fluids increase the risk for cancer of the pancreas. There were indications, meriting further investigation, that non-malignant liver disease is associated with cutting fluid exposures and that lung cancer is associated with oil smoke from operations such as forging or heat treating.

Silverstein, et al., Respond Michael Silverstein, Robert Park, Franklin Mirer, and Neil Maizlish Pedro A. Poma Robert C. Klesges, and Russell E. Glasgow CopyRight https://doi.org/10.2105/AJPH.76.7.819 Published Online: October 07, 2011

Mortality analyses were carried out for 278 male hourly workers who were employed for at least 10 years at a gray iron foundry and who died between January 1, 1970 and December 31, 1981. Statistically significant excess proportional mortality due to non-malignant respiratory disease (SPMR = 177), lung cancer (SPMR = 148), and leukemia (SPMR = 284) was found among the 221 white males. Among nonwhite males there was a significant excess in proportional mortality due to circulatory diseases (SPMR = 143). White males in the Finishing classification experienced a significant excess of proportional mortality due to nonmalignant respiratory disease (SPMR = 279) and lung cancer (SPMR = 179). White males in the Core Room classification experienced an excess of proportional mortality due to nonmalignant respiratory disease (SPMR = 321). Case-control studies demonstrated a significant association between nonmalignant respiratory disease and the Finishing classification after controlling for the effects of age, prior occupations in coal mining or foundries, and smoking. A positive but nonsignificant association between lung cancer and Finishing was also found after controlling for age, prior work history, and smoking in case control studies.

The United Automobile Workers International Union has established a system of epidemiologic triage to evaluate patterns of mortality among groups of union members. In response to worker concerns, the Union examined mortality at a metal stamping plant, using a method which linked pension records with the State of Michigan computerized death registry. The observed proportion of malignant neoplasms was nearly twice that expected (95% Confidence Limits 1.36, 2.62). Two- to five-fold excess proportional mortality from cancer of the digestive organs, lung cancer, and leukemia accounted for most of the overall excess. Strong associations were found between lung and digestive organ cancer and employment as maintenance welders or millwrights in the plant (odds ratios greater than 10). High levels of six polycyclic aromatic hydrocarbons with mutagenic and carcinogenic properties were found during hot coal tar application to wood block floors, work conducted by the high-risk groups. These levels were substantially reduced following the purchase of new tar pots. The example demonstrates that epidemiologic tools can play a valuable role in occupational health decision making, but care must be taken to avoid mechanical reliance on quantitative testing and to acknowledge the important role of social and political value judgments in the establishment of responsible public policy.

Health and Safety Department, International Union, United Automobile, Acrospace and Agricultural Impletnent Workers of Amcrica, U.A.W., 8000 E. Jefferson Ave., Detroit, MI 48214

A proportional mortality and case-referent analysis of 238 deaths among hourly employees in an automobile hardware manufacturing plant was conducted. The major operations of the plant were zinc die casting and electroplating. Chemical exposure included die-casting emissions and mists from chrome and nickel plating. The chief proportional mortality finding was a significant excess of lung cancer among both white men and women. A case-referent analysis indicated a possible association between lung cancer and work in certain departments. The findings support the hypothesis of a work-related carcinogenic risk. Follow-up recommendations have been made.