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T!05280087

not be located were assumed-to have died of uriknown cause on the date reported. Underlying cause of death was coded from available death certificates according to the International Classification of.Diseases, 7th Revision. For each employment group, observed numbers of deaths were compared to numbers expected based on relevant U.S. mortality rates specific for cause, age, calen- dar time, sex and race. (Cause-specific mortality ratesfor Ohio are virtual)y identical to those for'ithe United States~; the U.S. rates wer~ used because they. ar~ avai!-. .-. enced excesses in deaths from cancers of the ..biliary passages and liver (12% excess] and of the bladder [17%) and from leukemia (21%] (-Fable I). There were marked deficits in deaths from causes other than cancei" and Vas- cular lesions of the central nervous system. Bladder cancer and leukemia mortality were elevated during both follow-up periods. In addition, there were excess deaths " from several cancers during 1974 through 1978 only,in-I .. i.:. . ::'.cluding cancers of theesophagus~ )arge intestin~,biliary'.:':. :" :': system and liver: brain and lymphatic tissues and rn'iJltiple :" .... " able in greater detail.) "I " ".. -" "myeloma. In the lymphatic Cancer ~nd multiple myeloma '-. :..::.. To compute expected n~mbers, person-years of obse~- category (led codes 200-203), excess mortality'wa~co'm'... ~' ,. ':.~ vation were allocated to five-year age and calendartime~.~ ," fined to ICD codes 202-203 ("other lymphoma" and multi- " " :- categories and multiplied by corresp6nding U.S. death " " ple myeloma: 16 observedl6.8 expected deaths). . .- " ~' rates.' The resulting quantities ~'vere summed over all ages ". Examination separately of SMRs for men en~'ployed " "' " ~ and years to obtain total expected numbers. Ratios of oh- i" .t~o .through four years and those employed at least five :'~'. " - served to expected numbers of deaths were expressed as • years showed that with the exceptions of lung ca.ncer and standardized mortality ratios (SMRs), which are estimates in percentage fo~m of rate ratios for rubber ~rkers com- pared ~ the 'U,S. general population, adiustud for age and calendar time t~o the person-years dist.r~ution of the em- ployment group of inlerest. Confidence intervals were derived assuming that observed numbers of.de=th follow a Poisson distribution,s .. ' Mortality patterns for the interva~l covered in previous r~ports, ] enuary I, 1940, lhrough ] u'ne 30,1974, were com- pared to those for the period Jul~, I, 1974, through July 1, ~78 lymphatic cancer and multiple myeloma, cancer excesses " occurred only among men who worked for at least five • years, hten employed for two" through four'~ear~",~x- " • perienced slight excesses in lung cancer [16 ob~erve~c~ 3.7:. expected) and in lymphatic cancer and mul:~ple myeloma • • (:3 obsen,'edtl.9 expected] during 1974 through 1978. • :. "Table 2 gives age-sta,~dardized rabls and rate ratios" - [RR) for selected can~ers among men employed for five or ""' more years. Several patterns for causes of death included in this table are noteworth~ " . - . /,'.~alily A=r~ag Rubber ~%~kefsl~lzzll ~d M~son TI05280088

.... 2.-Large intestine cancer rates rose:only ~lightly for both WM union members and U.S, white males. 3. Bladder cancer and leukemia rates among WM union members did n~t change appreciably, nor were there marked trends in these rates for U.S. white males. greater thantwofold excess in deaths from these dise~s(~s" - during the period 1974 through 1978. -, .~. -': " : " ! Further examination of mortality among WM •union members who worked for at least five years and died in . 1974 through 1978 showed that the observed excesses in • " Teble 2. -- Mortelity from Selected Cancers Among White Male Union Members Employed for at Least Five Years, According to Follow-Up Period. "" .'." ~ .... .19,~0-1974 .197:4-1978 Cause of Death . Obs° .. Rate'J" Esophageal cancer 23 Large intestine cancer " 108 BlEary and liver cancer 27. Bladder cancer " 46 ,L~kemia 57 Other lymphoma an~ muttipte myeloma¶ 18 .'.." 8.6 -... 128 . 27 .:.. 6.7§ " • 1.7 "2.2§ ...,.'. :'~-: -.- ", *.'-.., "" .3.8 . . • 136 11 .. ' • 2.8§ "- _. ,3,4 .."15z .: : ~. 2.2§ - 1.2 • 109 14 • '1.1§ 2.0 1.1§ -: 3.8 ~.9§ 2.8§ 4.8 . -- . 2.0§ *Obsezved Dumber .of deaths. "* 1Rate (x 10.000 person-years)• Pates for 1940-1974 are adjusted for age accoidfn9 to the d~st[;bution of me~ emptied ~e or ~o~e ~ears -" ~ ' and foll~ed 1974-1978 " " " " = " " ~' '-: ; "L~ " ~ ~R31io (x l~J of slenderized rate in rubber y;orkers and slandardlz~ rate inU S ~h;te n~es " " : "' ". " ~ :'-"'~ ."-.~: ~ : ] ~The~ nu~rs are rates {x i0,000 ~son. yea:s) for U.S ~hite ma~es, age sta~dat~iz~ to the distr~utioq of me~ e,~p'c-y~d ~s ~ ~e ~ars - : . , a~d f~t~,~ed 1974-1978 .. ~ J~r~l ~ ~c~t~ ~in~V~. ~3, ~. iO/O~to~r 1~1 " 679 ~ -t"t05280089

": Diseases of Ih(~ circulatory System (400-468) Oiseases of Ihe .d!gestive syste_m.(530:58.7) • "'Accidents, pois.or~in.g and violence Olher known causes " analys s of morta ity by work are~ _for al! WM union mere- ~-:.- causes was also lower.than expected, there were excesses -:., . -bers revealed excesses in other ly~nphoma'and multiple "~::: ddHng both follow-up periods jndeaths from cancersof ~~:',']: " _. -" -" ~yelomaamong men employed for five 6rmore ~,ears in" '.---the biliary passages and !iver, pancreas'and lymphatic .... - Table 4. -- Mortality ~,mong Famale Union Members According to Cause and Follow-Up Period. ;: Cause el Death (ICD No.) • ' Follow- Up'Period "'" 194D-1974 -. .. 1974-1975 • -SMR" Obs SMR Obs SMR 1940-1978 Obs 95% CI All causes : :, • ... 79 730 85 Malignanl neoplasms (140-205) ...... .82 " "205 .. .. 57 Digestive organs and peritoneum (150-159) ....~-:.:. ".76 . 52 43 .sto~.h (151) ...-, • ... ..,...~ .:. :. .... :.;:::. :~..,.. • :.3.'.7~ " ' " ~ "Large Intestine (153) - • " :" : ~ ' • ;~::'-"- '- ;.,- 92 . "2 ":'":: 90 ...... .~; ,~., : . 36 Bilia~ passages and liver (155. 156) .'-:.,i!':,~:" .:'"" " :~..106 ..." .', " 8 "70 Pancreas(157)': , - " • 38 ." : 4 .;'0 • ' ..... ':.! .:... ..:~.~ .... 1~ ~6 Lung (162, 163) . = Breast (170) Uterus (171-174}t ": Cervix (171) . •.. Corpus (172) B!adder (181) • " " 75 • 181 123 ." , 223 0 " 223 - 30 81 76 125 103 113 65 n=27 233 80 • 35 • • 77 .'..-" 8 69 • ,::.:,.2" : 77 • ....".: 3 79 ":'". I ,:: .100 ".::"" 0 .',';:: 28 : 2 " 75 :'.."9 ' 83 ""77 • ' 'I08 ~"" 2 "'::.149 ,,..:.. -- 5 :;> : 58 '0 : 119 3 -124 • 1 " 74 ' 1 79 28 - 73 92 74 16 , " 87 - 10 • " .- 79 " 9 .. " 86 " 15 - 58 '11.6% n=74 963 10 :. 29 .. 16 ,. 56 ". '3? - ..:. • 9 : 11 8 97 342 39 42 47 81 7.6% 75- 85 68- 52- 88 38- 278 " . 57 - 236 . • 62-i19 ~- 57 - 107 62- 112 .• *Expected e=,'mL.ers Io; SMRs are based e~ age-, c~lendar lime-, a; d c~..~s~, s~:.eciFc de.--:.:= ~a;es [o~ U S..whi:e !em~les "tCo,.*cs 171. 200. 202 and 203 a~e not i:,ctc~.~d bcfo,~ 1950 . '. Ido~:~..'.ily ~.~: -".O Rub~r g/Orkars,"Oal:ea and -fI0528~)090

" - ..... ....... -'-:-". ..... ":=' ............ ' ..... ~'" " " " " and Follow-UpPenod. ~.~,.~>;;:,;~.~,.;:~ "~ . :. :.:. ~ ;L ~" .: -::'~,'~-:.'~ ~'~ Table 5~.Mortality Am, o,ng Sa.J,ar, zed..Males According to Cause " " :"~ ='~-"'¢"~" ~ ~"~" "': ....... ;'-" ' ;"='" ........i ':'~ F~.-~:','-~;-~.~?~'~194"0-1974 1974-1978 ,-: ..... 1940-197B -....."'-"~-, .: Cause, of De~th,~lCl~'XbJ., .. ~-'.~,:-'.:-';;"-": •'-''" ?~-- ;SMR" Obs" SMR • Obs .SMR ~" Obs ," 95% Cl : All causes ~" : =" -'- ...... - ~- .... <'"-.- ~ ~- ='" " -75 ==; " 866 . 69 -',- ;.. 198 . 70. ~.'' 1064 65 - : 74 .... • -- :;:;,_ ".". 1,.; .": . "~,~'~e~m~ ":- ....... -: ...."'= "-';'" -"." 76 4 . 14'5, t-" z .~u. . ,o ..~-,o- : ........ - " "'~.'~'"=~.'"~v*',~,'"/_".'..^. " ...... ;":~ " : " ~.n 14 105 6 11~ " " ZU " ~/- /1~, ." • . ' " 811~ry.i~agsa~es and I~er (155, 156) ~'"..";.::..~ ".'; ' ".~ .: ,.•. ]~" • = . o=_t..- ' .o ,. ~: • . ,~ ~, .;.~; . . • - ..-. [ - ~l~g~~, ~'1o.~-: ;:" t~.-..~.5 -..1~" ...--,. I. :. . .. " -"~( Diseases o1 the'circulatory "system (440-468) '.!~-;;-~ "-'-~;.~..~'~.~'~~-~ /'.." ,-'c-_~ • ..'~.-. "~ ; . ..." L. . :. ;. .'. '~ : ~ :.:.~.:. I .~';", • "~" -.: " ":" :";';DisPosalS'of the"rb~iratory system (470-527) ;~,~......'.~%~,:_.._..::,-51 ~ :-.- 33 ~::.,:.1_28 .;..,..,:~ 2_6 ~.:..,6.9 -:...,:,;:,,59. ::..;;:53 .F,,8,, ~:.."cc'~_ I ~.; ~" . . t -..'- Dzseases of the d=gestzve system (5 -587) ,:-.~'~.~-;,;;~,,-L-,'.-..~-,o-. .~;-, -.'. ......':=-~,;-..;-. o ,:--"...'.~'.~-';.--~..:'-~;.. ~=.,,o'---~:,[ -. - . J .-- Acczdents, pozsonmg and y.~,ole.n.c.e.(800-9, 8} ,*~:;.y.~..-~;..,.:~.:.,.~..~.~..,-... ...... ~ .... __ . :.-., ,_. :-~.:,.:.~,.., -~..-.-.. ,, ...~-....~;,^ ,.,..~...,.....--:,-: . .- -,°,..-[ .... ' - = Olherkno~ncaus~s " ~ "- ~.~.--=--.'~.,~:", ';, ,'.- :"'_~;'.:;"•.':';'.::'; ;."':58 ~'.: -- I~ • ~ br --"-i:];' .- ,~o . ou .-...,'. -.-;~/., ~'"'~"1 :" " " ...... • " ...... "; -o"" ;" -'"~ ~'~'~,:;=:~".~-~':~:'~'n..:-47 ""' 53% ; "n-12 "3' 61% ~=59 - '55% -;--=~"~'~:'~,~::'.= - : "" " . -. Death~:w/thOut eerttfzcatos ('~ total deatl~s)..:-:;...~..:.,,',,.~::~..~.-. - ... /" ' • " - "~: " .... . " " " ~ ~;'" "".:".~:": " f ;' " - • :. -~p~t] ~i~_~: for ~[~h's ~re ,b-~d ~ri~e,::i~le-~d~r t~m~.-,'~d cause-specific d~a!h rates f.or U.S,. white, mal~s. -:-" ':." "..:~ ~.:~'~':~-'.~\~(~'i:.:~i.'.:- :.i " "~" • . " ' "'~ ~C~'EO~_OE-~O'2 ~ 2LO3~-'~eL~zn~!o~b~fb-~ 1.950 ~. ..... .. ........ • ...... -. ': • - - • - : , .. :.. -:' ; ........ ".. t=~s~u~s,~a-~[~i!~;~m,~l~a' ..L~~~p.a~,•~:p~f;i¢~l~-j.:-~r~)t~ 2~ .~r :p.a~¢~r~as can(::e~ t~o, 10~ for cancer of .the . • "- : ............. :"~;'~:-'~>:" ~'~" -" " .... '"" ......... ' ......... ' ' " r re ba~ed on five and nine observed deaths, . -- excess m'~]~ity in the lymph.at~ .Lcan.ce.r and multzple..-cance s we . . . ........... . '- m~eloma c'ate~orv. Ther~'w~'r~0-1e~E-~mi~-deaths,'while "" .respectively, The i.ncrease in bladder cancer .m.o~ta!i.ty w..a,s " " ;"" :" ~'~ ~ere"~xp~ct~d durin~"th~ 0~all study pe~i~d. -.The: -~-.,seen only in the years 1940 through 1974, wh~le the brain • " ".,. " 21% excess in digestive ~:ance~ deaths for the period..19~4 ..:-: £ancer excess occurred only in .the year~ .197~4 thro'u..gh ~ :,* .. through 1978 was accounted for by'Eanc'ers of the large :.; : 1978. There was no excess morality ,from respiratory ~ - • - " intestine, biliary passages-and liver and pancreaS. ~..'.:. .... -:.. cancer, even among women Who worked for at lea~t 20 - ~" "Ambdg female union members ~able 4), there wer~ ex- ;.-, yea~'s• (6 observed/8.8 ,~pectecr). Excess cervical ~ah~er~; cesses in deaths from. cancer of the cervix, bladder and deaths occurred during both follow-up periods. Further brain during 1940 through 1978, For most other causes, "analysis of the cervical cancer deaths she\red that there were deficits in observed deaths, with SMRs ranging elevated mortality was confined to_. women who were Table 6, -- I~fo~tality Amor~g Salaried Females According to Cause and Follow-Up Period, : .. " " ~'i~i " Follow-Up Period . - .;. - 1940-1974 1974-1978 Cause of Death(lCDFIo.) " :~ .- •.. "..-:..~. :~ " :'-'. :..~. SMR° " Obs • .SMR Obs .SMR 1940-1978 • • Obs 95% CI " All causes . •.. Malignant neoplasms (14Q'-2"05i' ~ "''?" ~: ~i~i:~':" ;'. :'."~ :.-~ ." " "" ,'::': 8975 • '" 19265 ;'.5156 Digestive organs and peritoneum (150-i59) • .: ~: . ..,.. " •106 . 17 • " " 83 Lung (162, 163) ' ~..-." :-. ~". ," ~ - - ." 74 . 4 .. 0 Breast (170) ~: " .'~'" / :" " "-~" 90 • 16 . -100 Uterus (171-174)t . " ' :'~"" - .;. '45 4 ." 0 Ce~,ix(171) ." ~ .~-,.-; ." . • "" ~'-20 '':" 1 . ..~-" 0 Corpus (172) ;~. "" ' 39 ." ~ 1 : " 0 81adder (181) - 282 - 2 ". 0 "'~- " ~ ......""':: " '"'. " 135 3 0 . Drain (193) . Lymphatic and multiple myeloma (200-203)~ " : ~' " ~; " " 1161 .. " 6 78 Le~ken~(204) - .-- ~ -;.. ". ....... 38 . 1 0 Vascular lesions o! the Cer~tral ne~ous~sys~em(330-334} . ~ 68 - ~. 58 I~S~S Ot the ¢|tcuta~er,y sysIem. ,(440-468) . 61 • - 5I Diseases .of the respiratory .syslem (470-527) . 55 :=. 26 E~s,,,~s.es of the digestive system (530-587) " " - .. 66 23 Accidents, poisoning and violence (800-998) . .- 62 115 "~ O~er known causes 49 36 . Oeetbs w~'thout certificates (% total d~aths} "~-': . .... n = 19: n.=4 15 • 47 5 9 14 18 9 9% • " i-...", • 70 • " 79 '. 100 ' 93 .. 17 0 103 1 139 0 " 29 5 65 16 " 58 .1 . .46 1 55 6 72 3 46 82% n =23 • 241 .'.-.'" 62 " . 80 .... 78 "'. "-.': 62 '" 98 " • " . .23 "': .63 " 150 " • • 4;,12-115 " • " 22 ?'- 58 ." ,140 • 5 • ~ 1 :::!~'i':0 -'94 "' ,; 1 " ..0-168 - "' ' 2 "-":::"23 :.733 "; 3 -- :; 21 -'300- 7 56- 287 . • 1 1 ;..1.62 20 ..39 -~100 63 :: 45 ~,~ ' .. 6 • L.17-,100 10 "~-27-103 20 44-.112.. . 9.5% . ,... *Expected ~[abers for SMFLs are b.-.-sed on age-o caler~dar time-, a~d causz-specific de~tt,, rat~s'lor U.S. v,.h;.te fGnates | Cod~,s 171,200, 202 and 203 a;e r, et iP.c~ud~.d be:me 1950 Jc, u~nai o~ Occu~tior~J M:.,~in~/Vol. 23,.No~ lO/Octobc~ 1981 681 T105280091

Causes "ahd !rom,.Al! C,a.n¢~rs According to'Em~}ioyn~ent ~roup'and Foll~v-Up Period~~ .... "" ..,.cancer death rates for U.S..white females from+5.7 per+..',~'myeloma were from Hodgkin's disease (2 observe~d/~L.1 ex.- .+- ~ +.. _ • 10,000 person-years .in 3940 .through +.1974 -io 2.9 per " : pected~ and from otherlymphomaand multiple myeloma ~. 10,000 person-yeai's in 1975 through 1978,+ while similarly +, - (4 obs.erved/l+2 expected). In contrast tO +mien females, ,.L:.= .. '". age-adjusted rates for+ uni~n females ~:hanged only slight- ', salaried-females experienced a marked deficit in cervical .~, • cancer deaths during both f011ow-up periods. Table 7 gives all-cause and all-cancer age-a~justed mortality rates for each employment group. NWM union members experienced the highest overall mortality rates during both follow-up periods and the highest cancer mortality rate for the years 1974 through 1978. All-cause and all-cancer mortality rates either increased slightly.or Iy from 5,9 to 5.2 per 10,O00 person-years during the same intervals. , -: Compared to U.S. white males, salaried males (Table S) experienced no increased mortality during the overall study period. For the period 1974 throush 197a there were excesses in deaths from esophageal and biliary and liver cancer, based on two and three deaths, respectively, and Table 8. -- Mortal!ty Item All Caus~ Comblne~! Ac'cording to Employmnt Group and Duration of Employment. ' " Duration of Employment (Yrs.) .," ...." -- ".;~,, .:: Obs "- Crude Rate"., , .. :f.•;: " - .Ralet 2-4 ....... "+... .... ;. ' 730 .' 25 .... " -"~', " .%.. ....6067 - : . " • N0n-white male union members ~! .-~.. .+.~, "+~":'..'.":~ .'.'_...+ :" " ;.+..~:+ ~i.. ' "" Female union members '. 2-4 - -." 2 ..... '~+ .:- ..'.- .. .843. ' >~. Sal~rled mates . ' " ..... 2+4' " . :~ : " 101 .~S ":- .:..... . , ,; 963 Sa!adsd females .. .- 2-4 .. : " 50 _>5 ~+.. ~ 191 7.8 17.4 ~82 !:c~l+Jity ~mm~g Rt,~ Workm s/l~'t,,etl and Monson • *Crude annual rate [x 1,000 person-yea=s) - "." .~- . -" "" "" " . t~,:r~u~t m,:rla~ty rate (x 1,000 person.~'ears), .~l~.n.dardized for age tO the'person-~ears dlstribulion ~.N,.,mbe.+s In p:z~.ntheses are st=ndard criers (x .t .C;.~O i;erson-y~,~s) ~ th~ s!a,~a,J~d =ales T10528OO92

/ i;- ;,.., :.,-.-:- • ." :!-: ~ten,. ~l~e..ap;i~oxim,a,l~e 40% ,d'ec},i~.e in:" canc'e~ ,mo~ali~ ?. :,~e W~ u~ie~ ,member..Fo~ ~is ~e.~on, t~e remainin~ ~:.: ' • " " .~ates &mon~ female rubber ~or~ers wasnot parallel~' by ".;= :. discussion ~'1~ focus. ~n f.indin~ in the la~er study 8roup~" ~ si?~lar,~e~elin,,,~ncer mo~a~l,i~ ~at~ for.U:s, w~i.~'-... Ee~' = ~on~ming mor~ali~ dudn~ !9~ through " - " .~~,~.es~ ~'[~ fr~em;~tZ4:i~er 1,~. ~1~74 amon¢ ~e ~bbe~ .w~e~s inc~uded~ i, this. per 1,~ ~qrsoo-years ~n 19~5 ~rough 1978.~ For unio~ der cancer and leukemia in WM union members; ~) lyre-' ~maJ~s ~.perc~ ~f repo~ed deaths in ~bi~ ~se ,. "phatic cancer aed mel~iple-m~el~ma in N~M ~nion : ......... - ~~~h~~~~~ [:~e~.:." ".. m~]~s; A~o~,. ~emales ~he~e ~ excess cewi~l,' can~er :'.:-1" ~:, . " : can~er SMR ~able 4) and r~te b~en ~he ~o follow-up :" only in union ~emb~r~, and ~cess lymphati~ caAcerahd :7:~--::~"£.:- . . ; ~ ~i]~ds. Ho~ever, c~ncerSMRs corrected by distributing ~ ..myeloma -~ccurred =only in .salaried .employees. Ehe ;-.~:. • .- ... :: deaths w~th "Mi;sfO~'~ertif]c~t~" b~e ~6r~ing ~o the .;~;~solU:o[ :(~c~Gt ;~9!~owCup 3hr~h ~'~id-1978 :sOrest ~, ::,<':.'.~ ~.. • .;~iskib~tio~;6f cer~ifi~ de~ths ;~er~.~.(or~~he p~i0d.~::£{~'se¢~ral.additiodal f~ipg~: ~E~;~:~.~;t".~~:~-~::~k~T~]C " ~' ~19~ '~rough ~974 "~n~ ~ f6~'~97~ ihi65gh ~978. It ~ "..- ~ -Amdn~'W~ U~iO~em~;~iiher SMRs'~6"r=~di~tl~'.S~;. ~.. " " •--;.,.therefore unlikely ~hat failure t~ ~oEate death ce~ificates'_., standardized rat~(atios ~E bladder~ancer and leukemia"~": ~:'~ , ..... comffle[ffly ~l~.~},~is:fin:d[n8.' 5.~;~.- -. '.~ ~f • • .-.~ : . :, chan~6 a~pre~iably be~en the ~o fo~16~:'6"~ ~ri~s;.::... . ,.%: .[~ ~e¢,~' ~n~. ~.W.M,.~G~i~n ";me~rs, ~or~e~ ~"~" indicating .that ~'e excesses rOf these diseases among ru~' ~-': ~,--'~:- '.~ ." ..-em~l~y~[e~9~ ~' ~ fo~~v~$~ :~p:er~;ced`~o~-r ~-ve~ll ~:':.:.'b~t w~ers h~ve 66t d:i~[Ois~e~ in re~ent ye&rs:. Several ~/ . .... , , .,~~,;~,~,~~e~,~,¢~e~,~i~ll~r~..~.,.,.~,~,s ~ e:~ffatlona.I explores, assoc,ated ~th, these ..... i~ the "~d~u~atien" of ~m.p'[eymFnt:¢ategories. NWM ,.' cancers; ~) sufficlent time has not elapsed for such reduc- "" " " " ~" " : unig~'~embe~"who ~orked for ~0 to four years ~p~r~;~::..;tions to ~esult in'de~r~ased mo~ali~ and (3) persistent ;~.~ . ,.: enced higher ~erall mortali~ than.m~n.~hp.worke~.~o~.~/diffe~n~es .in non0c~upational risk faclors .for these ~-"". . : - ,. fwe or more years, although [he magmtude of the s[an- -~ malignancies exist baleen tubber workers and U,S, wh~te ~-" -. . _ ~ ":~ard errors ~f "the-rate~'-sugges~'that.this difference is -,~-males. Several studies have ideoSfied smoking as a deter- ". ~" ~~ .. " .~" consistent with sampling variabili~.-'Numbers of deaths ~." .minant of bladder :cancer? ~.:.Emphysema ,and.lung .. f~om specific ..~au~es ,amOng short-te~m .~orEe~s W~re ,. cancer are also strongly positively associated with smok-~..~. .... -." .-:__ generally'insufficient.for meaningful analysis. ApparenL :.- : ing, and mo~tali~ from these diseases woul~ be elevat~ . ~cesses in deaths (rom cer~ai~ cancers amongWM unio~ " among the rubber workers in this study if they smoE~ members employed for two to fou~ years were mentioned earlier in this paper. The present st~dy~valu'atecl mortality occurring be- tween January 1, 1940, and July 1, 1978, among 29,087 men and women who worked for'at least two years at a more than the general population. However, WM. union members experienced deficits of 14% and 16% in lung cancer and emphysema deaths, respectively, and it is thus unlikely that they smoked more than U.S. white males in general. :- • WM unior~ membe;s 'employed ft~r at least five years experier~ced twofold excesses in deaths from esophageal large rubber manpfacturing facility. These workers have . cancer and from other Iymphoma and multiple myeloma . now b~en obse'rged for an ,average'of 27 years per arty" ~ ' and an 80% increase in biliary and INer ca0cer mortality" ' ployee. Before'discussing specific findings based on their :". during the period july 1, 197.40 through July'l, "1978. AI- "~ " " mortality experience, it is "important to note'several limi- '~: though previous stu'dies bf rubber workers nbt~d in- rations imposed b'y the metho~Jology used in the ~tud~: ~. :. creased, mortality ..from stom'~ch :and ..large intestine First, SMRs and RRs reported in this stody are probably ' cancer~ ?~ ~z ~. an~t linked th~s~ e~sses to ~ccupational conservative estimates of causal.associations, if any, be- ...i.exposures?~4~s there• have been no ~rior reports of .. tween rubber industry employment and specific diseases. ~. ::.elevated esophageal cancer among rubber industry am- Failure to identif3, all deaths during the. study period, " . ploye~s. Alcohol and cig~e'~t~ ~nsumption are the ma- unavailabilit7 of death certificates for nearly 5% of the . .. jor known risk factors for this malignancy. However, :, reported deaths and use of the U.S. ~eneral population as ,. evidence cited above suggests that rubber workers in this a comparison group are .likely sources of undetesti.m..a-.., s[udy did not smbke more than the ~eneial l~oPula~ofi, tion.z . a~d a ~imilar argument can be "advanced ngain~t" the Lack of infom,~a.tJon on d~sease det~=:n'~inants" bther possibility of higher alcohol consumption among rubber • than employment and demographic charact~.ristics corn workers: WM un|on members experienced a 17% deficit stitu~es another limitation of the study. Without this infor: . in deaths from diseases of the digestive system; and the .. mation, it is difficult to judge whether Observed assm:ia- - everall S.MR for cirrhosis, ~'hich is strongly associated " ." tions reflect causal links between disease and work- ~.ith alcohol intake, was 79. "- ; , - - ~- --. related exposures. " .... .. .. Manc~¢.o and Brennan'.= ~u~'st~d that ~llbl.adder ~0urnal of 0ccupa~.~onal t ~.=,dicin~./Val, 23, No. 10/P. cl, ober 198i" 683 " T105280093

and bile duct cancers are increased among rubber ~ork-" : 3. Monson RR and Fine tl: Cancer mortality and morbidityamong ". " .= : "" ers.Tc~;u-pp~cthishypoth'esis, .th.~;pointedoutthatthe ';"rubberw°r~ers'INatlCancerln~tellO47"lOS3"197a'"';~':':i~'" " "~ " : ~ ..... ~ Mo~son RR: Analysis of relativ~ survival and proportional .mot- rubber in~lust~, employs numerous hepatotoxic agents and that several nitrosamines "chemically related to sub stances use~l ia .rubber manufactu~i~ bare been sh~p experimentaily m be liver and biliaw carcinogens. Biliaw an~ l~i~e~ ~ancer mo~aliW rates among. WM union me~ be~ i~ the p~ent s~ud~ rose o~1~ sl~gh~l;y be~ee~ the seen for Ihe period ~974 through ~978 resulted almost e~ tireiy from a sharp decline in rates for U.S. white males a~t~ tality. Comp.ut Blamed Res 7:3,25-332,1974. S. Rothma'n Kt and Boice ID Jr. Epidemiologic Analysis with i~ Pro- 8~ammabIe. Calcuta~or. NIH Publication N~ 79-1649. Washingto~ D.C: U.~ Covt. Pdnting Office, 19~. pp 28-~. . 6. N~tional Center for Health Statistics [NCHS), Vital statisti~ of the U.nit~. States, ~ol II, M=tality, Part A. Washington, D.~: U.S. Occup M~ 17:126-127, 1975. 8.Cole P, ~onson RR, Hanin8 H, and Fri~ell GH: Smokln8 and ¢~ncer ef t~e lower urina~:~ract. N £ngl I M'~ 2~1~13~, 1971.. : Proceedin~ of the 12th International Cancer Congress, Buenos Aires, 193~. ~I. IlL Epi~emiolo~, I', M. Birch led.). New York: Pergamon • Press, 1978; -pp 97+1~5. +'+ " "~"-~" + 14. M~Mt¢~ael. ~]~ Spina's R, Gamble JE and Tousey PM: Mortal~ am~.n~'~.~r we.!~ers: Relationship te ~ecific i~bs. I Occup M~ 15. Andjelkovich D, Taulbee l, Symons M. and Williams T: Mortalb cupafiorial groi~ps "exp0~d to chemicals,=' == =~ and to ' "w of rubber worl~ers with reference towork experlence, l Occup Me(] - In co~clusioh, :results 0f ~ecent follow~ ~v~re "~o~ . ..16 Mancuso TF and B~ennan MhEpidemi61ogic considerations 6f - cancer of the gallbladd~E bile ducts and salivary glands in therubber sisten{ wit~ mortally'patterns :previously described for-7.-., indust~. I Occuphf~ 12:333-3~,1970. these workers+ and for other 8C~UpS +O~_[~bb~ w~rk~ ~ ~. ~ 1~. ~dj~koyich D, Ta~IbeeJ,~d Symons MLh~0~al~+~.exp~rience ~ ers.~Z~ ~z~ez~ Compared to their~eneral population cou~ -:. ' of a coho~ of ~ubber workers, 1964d973. I Occup Med 18:387-394, 18. Fox AJ, [indars De, and Owen R: A survey of occupational tq, experience deficits in overall deaths and in deaths from most specific causes but sustain increased mortality from seve{al cancers. Although cancer excesses observed during' recent follow-up were based on small numbers and may have occurred by chance or because of systema- tic differences in nonoccupational risk factors between rubber workers and the general population, the possibility that they are related to industrial exposures should be considered. Currently being examined in detail are associ- ations between specific work areas within the rubber in- dustry and the "occurrence c~f esophageal, biliary and liver, lymphatic and other cancers .in order to identify groups of work.ers having high c.ancer risks. This informa- tion will aid in foc~Jsin8 efforts to control Workplace ex- posur.es to hazardous substances. ::,' ' ...';".. " ". 1 Monson RR ahd Nakano KK: Mortality amon~ rubber workers. I, White male union em. ploye.es+ in Akron, Ohio. Am I Epidemiol 103.284-296. 1976. - 2. Monson RR and Nakano KK: Mortaiity among rubber ~,orl~ers. II. Other er~p]o3'ees. Am ] Ep~demtol 103.:297+303, 1976+ + cancer in the rubber and cablemaking industries:. Rc.~ults of a five- year analysis, 1967-71. Br ! ~nd Med 31.140-151, 1974. .. 19. U.S. DHEW: Eighth Revision International CIassification of Diseases Adapted for Use in the United States. PHS PubL No. 1693. Washington, D.C.: U.S. Covt, Printing Office. 198~+ 20. McMichael AJ, Spirtas R, Kupper LL and Camble J F: Solvent ex- posure and leukemia among rubber workers: An epidemlologic study. J Occup Med 17:2.34-239. 1975. 21. Li FP. Fraumeni JF, Mantel IN. and Miller RW: Cancer mortality among chemists• ] Nall Cancer Inst 43;1159-1164, 1969. 22. Tabershaw IR and Galley WR: Mortality study' of workers in the manufacture of vinyl chloride and its .polymers. ! Occup Meal 16.~09-518, 1974. • . " . 23. De Kraay WH: Pesticides ~.-.d ~ ml:~:omas in Iowa. ] Iowa Meal • ~oc 68.50-53, 1978. - - 24. Wagoner JK, Archer VE. Cari':~ll BE, et al. Cancer mortality pat- "terns among U.S. uranium rn!n~rs and millers, 19S0 through 1962. ~ ~ Nail Cancer Inst 3~:787-801, 1964. • 25. Matanoski CM, Seltser R, Sart,',cl] PEo et al: The current mortali- • ty rates of radiologists and other ph~ sician specialists. Specific causes of death. Amer ] Ep?~emlol 101:1q9 210, 1975. 26. Pox A] and Collier PF: A sur~ey of occupational career in the . rubber and cab|emaklng industries. Analysis of deaths occurrin8 in 1972-74. Brit J Ind Meal 33:249-264, 1976. 684 TtO528(X)94