Breast cancer risk and residence near industry or traffic in Nassau and Suffolk Counties, Long Island, New York.

A case-control interview study was used to evaluate the relationship between breast cancer risk and residential proximity to industrial facilities and traffic for pre- and postmenopausal women in Nassau and Suffolk Counties on Long Island, New York. A geographic information system was used to assign industry and traffic counts to 1-km2 grid cells (5-kM2 grid cells for traffic) and to assign potential exposure values to study subjects, based on 20-y residential histories. A significantly elevated risk of breast cancer was observed among postmenopausal subjects who were ever potentially exposed to chemical facilities (Nassau County adjusted odds ratio [OR] = 1.61, 95% confidence interval [95% CI] = 1.06-2.43; Suffolk County adjusted OR = 1.58, 95% CI = 0.71-3.51. This elevated risk, however, was not observed among premenopausal subjects. Risk increased for post-menopausal subjects as number of chemical facilities increased from one (adjusted OR = 1.45, 95% CI = 0.93-2.25) to two or more (adjusted OR = 3.47, 95% CI = 1.06-11.38). Crude and adjusted ORs for high traffic density were elevated among Nassau--but not Suffolk--county subjects and were not significant statistically.

Cardiovascular disease among firefighters.

The author reviews the literature of the past 20 years on heart disease among firefighters, covering the specific aspects of firefighting that may be related to potential cardiovascular disease. The author then outlines steps that can be taken to reduce the risks of developing cardiovascular disease.

New-onset asthma after exposure to the steam system additive 2-diethylaminoethanol. A descriptive study.

Through a leak in the steam heating system, the anticorrosive agent 2-diethylaminoethanol was released into the air of a large office building. Irritative symptoms were experienced by most of the 2500 employees, and 14 workers developed asthma within 3 months of exposure. This study was undertaken to review clinical characteristics of these asthmatics. Environmental exposure monitoring data and medical records were reviewed. Seven of 14 cases were defined as "confirmed" and 7 of 14 as "suspect," using the National Institute for Occupational Safety and Health surveillance case definition of occupational asthma. Spirometry was positive in 4 of 14 of the cases and peak flow testing in 10 of 14. Three cases were diagnosed on the basis of work-related symptoms and physical examination alone. The study suggests that acute exposure to the irritating steam additive 2-diethylaminoethanol was a contributing factor in the development of clinical asthma in this population.

Risk factors for developing eosinophilia myalgia syndrome among L-tryptophan users in New York.

Using a case-control study design, patients with eosinophilia myalgia syndrome (EMS) who had used L-tryptophan (LT) were compared with LT users who did not develop EMS. Of the 113 case patients and 95 controls who had used a retail brand that could be traced to a bulk LT producer, all (100%) case-patients and 69 (73%) controls used LT brands that were traced to Showa Denko K.K. (lower 95% CL = 10.0). Among the users of LT produced by Showa Denko K.K., the risk of EMS was greater for persons who used LT produced after December 1, 1988 (OR = 25.8, [95% CL = 7.1, 101.4]). The risk of developing EMS increased with increased dosage of LT, increased age, and use of LT as a sleeping aid. These epidemiologic data support the hypothesis that the etiologic agent in EMS is a contaminant introduced into LT products during production.

Bone cancer incidence rates in New York State: time trends and fluoridated drinking water.

BACKGROUND: Recent animal studies of the potential carcinogenicity of fluoride prompted an examination of bone cancer incidence rates. METHODS: Trends in the incidence of primary bone cancers, including the incidence of osteosarcomas were examined among residents of New York State, exclusive of New York City. Average annual osteosarcoma incidence rates in fluoridated and non-fluoridated areas were also compared. RESULTS: Among persons less than 30 years of age at diagnosis, bone cancer incidence among males demonstrated a significant increase since 1955, while incidence among females has remained unchanged. A significant decrease in bone cancer incidence rates since 1955 was observed among both males and females age 30 years and over at time of diagnosis. Osteosarcoma incidence rates have remained essentially unchanged since 1970, among both younger and older males and females. The average annual age adjusted incidence of osteosarcomas (1976-1987) in areas served by fluoridated water supplies was not found to differ from osteosarcoma incidence rates in non-fluoridated areas. CONCLUSIONS: These data do not support an association between fluoride in drinking water and the occurrence of cancer of the bone.

Investigation of a testicular cancer cluster using a case-control approach.

A case-control methodology was developed and utilized to investigate a reported cluster of testicular cancer among leather workers in New York. Eighteen cases of testicular cancer, including the three index cases, diagnosed from 1974 to 1986 among residents of two counties with substantial leather tanning and finishing establishments made up the case group. Controls (n = 259) consisted of men of similar age who had been diagnosed with cancers of all other sites during the same time period. Reports of usual occupation for cases and controls, obtained from cancer registry reports and death certificates, indicated that cases were much more likely to be leather workers (28%) than controls (7%). After adjustment for age, the relative risk estimate for occupation and testicular cancer was 7.2 (95% Cl: 1.9-27.7). The association was further supported by occupational histories showing similar work environments within the leather industry for five out of six cases known to have been leather workers. Case-control analysis of a reported cluster does not provide independent confirmation of an association between occupational factors and testicular cancer. The methodology, however, can provide a timely way to evaluate the significance of occupational cancer clusters.

OSHA standard for medical surveillance of hazardous waste workers.

The increasing amount of work involving hazardous waste sites and the heavy involvement of the federal and state governments in this work have led to the gradual development of guidelines and standards providing for occupational safety and health programs for these sites. On March 6, 1989, the Occupational Safety and Health Administration published its final rule governing occupational safety and health matters at hazardous waste sites and emergency operations. This rule is currently scheduled to take effect on March 6, 1990. This chapter will briefly describe this regulation, particularly its medical surveillance requirements.

Health effects three years after potential exposure to the toxic contaminants of an electrical transformer fire.

A medical surveillance program has been established for 482 persons who were potentially exposed to polychlorinated biphenyls (PCBs), dibenzo-p-dioxins, and dibenzofurans from an electrical transformer fire in a Binghamton, NY office building in 1981. Vital Record and Cancer Registry data, medical records, and mail questionnaires were used to assess mortality, symptomatology, cancer incidence, and reproductive events through 1984. The numbers of deaths, cancers, fetal deaths, and infants with low birth weight or congenital malformations were similar to those expected on the basis of age- and sex-specific rates for upstate New York and other comparison populations. Two suicides were observed compared with 0.31 expected, but the difference was not statistically significant. After adjustment for possible confounders, persons with the greatest degree of potential exposure were significantly more likely than those with less exposure to report unexplained weight loss (relative risk [RR] = 12.80), muscle pain (RR = 5.07), frequent coughing (RR = 4.14), skin color changes (RR = 3.49), and nervousness or sleep problems (RR = 3.19). The possibility of recall bias and the intervening effects of stress, however, weaken the conclusion that toxic chemicals caused the symptomatology. Exposure-related systemic disorders, e.g., chloracne or peripheral neuropathy, were not diagnosed by personal physicians; however, some persons refused to release their medical records because of ongoing litigation. The findings are consistent with those of our earlier assessment.

Case-control study of lung cancer in civilian employees at the Portsmouth Naval Shipyard, Kittery, Maine.

Case-control analysis of deaths due to lung cancer (International Classification of Diseases, Eighth Revision, code 162) among persons who worked at the Portsmouth Naval Shipyard, Kittery, Maine, between 1952 and 1977 found elevated odds ratios for exposures to ionizing radiation, asbestos, and welding byproducts. The radiation-related excess was statistically significant in persons with cumulative lifetime exposures of 1.0-4.999 rem. When asbestos and welding histories were combined into a single risk factor, odds ratios for the combined exposure were significantly elevated for two of three duration-of-exposure categories examined. Further analysis of data on radiation exposure, controlling for exposures to asbestos and welding, found reductions in initial estimates of radiation risk at all levels of radiation exposure. This reduction suggests that radiation workers were more heavily exposed to asbestos and/or welding fumes than were other workers and that those exposures confounded the observed association between radiation and lung cancer. Analysis of mortality by time since first exposure to radiation revealed no pattern of progressive increase as latency increased. By contrast, odds ratios for asbestos/welding increased with latency. Data on cigarette smoking and socioeconomic status were not available. The results of this study do not preclude a possible association between radiation exposure at the Portsmouth Naval Shipyard and excess mortality from lung cancer. However, they provide no evidence in support of such a relation.

Assessing the health effects of potential exposure to PCBs, dioxins, and furans from electrical transformer fires: the Binghamton State Office Building medical surveillance program.

A medical surveillance program has been established for 482 persons who were potentially exposed to polychlorinated biphenyls (PCBs), dibenzo-p-dioxins, and dibenzofurans from an electrical transformer fire in a Binghamton, NY office building in 1981. Blood samples were analyzed for serum concentrations of PCBs and for biochemical and hematologic parameters at the time of the fire and 9 to 12 mo later. Firefighters and individuals who were in the building for 25 hr or more were also asked about post-fire symptomatology and examined after 1 yr for disorders of the skin, eyes, liver, and neurologic system. The results indicated that reported exposure was positively related to mean serum PCB levels (p = .004). The means and individual values, however, were within the range reported by other studies of persons with no unusual exposures. Significant correlations were observed between serum PCB concentrations and levels of liver enzymes and lipids, but mean levels of these biochemical parameters were not associated with reported exposure after adjustment for relevant covariables. Approximately one-half of those examined had skin lesions, but no cases of chloracne were detected, and there was no clinical evidence of any other exposure-related systemic disorder. The data suggest that exposure to contaminants from the building did not result in substantial absorption or cause any major short-term health effects.

Investigation of a fatal heatstroke.

On June 30, 1981, a young, apparently healthy, obese white male suffered a fatal heatstroke. This was the beginning of summer in southern Ohio, when mid-day temperatures can reach into the 30s degrees C (90s degrees F) and the humidity can climb above 70%. The predisposition of the individual in terms of acclimatization, physical size and dietary intake, along with strong motivation to perform well on a job requiring a heavy workload in a hot environment, pushed him beyond his physiologic capacity. Of those people who attended him, only professional rescue personnel recognized the illness and properly treated the man. The death may have prevented by acclimatization and training as to the hazards, recognition and treatment of heat illness.

Medical surveillance for hazardous waste workers.

The efforts to clean up hazardous waste disposal sites have led to an increasing number of workers involved in these activities. Industrial hygiene surveys have demonstrated that these workers are potentially exposed to low levels of multiple contaminants during the work day and to high levels of some contaminants for very short time periods. Personal protective equipment and work practices are important components in protecting workers from these exposures. Medical monitoring for these workers is problematic. While monitoring for the potential health effects of these multiple exposures may be useful, any attempt to monitor for possible health effects of all potential exposures could lead to a long array of medical tests. The utility and effectiveness of this approach is doubtful. Screening for a worker's physical ability to conduct hazardous waste cleanup jobs while he wearing protective equipment is also important and may cause difficulties due to our limited knowledge in this area. These issues will be discussed in the context of various programs designed to monitor these workers.

Neurologic dysfunction from exposure to 2-t-butylazo-2-hydroxy-5-methylhexane (BHMH): a new occupational neuropathy.

Seven cases of subacute central and peripheral neurologic dysfunction developed in 18 workers employed in the manufacture of reinforced plastic bathtubs. Cases were characterized by weight loss, dizziness, paresthesias, muscle weakness, incontinence, memory loss, and loss of peripheral, color, and night vision. Neuropathies began distally, involved both sensory and motor function, and were associated with prolonged sensory latency, muscle fibrillation, and reduced numbers of functioning motor units. One patient developed posterior lenticular cataracts. Slow improvement occurred on removal from exposure, but residual neuropathies persisted for as long as two years. Epidemiologic investigation disclosed that the first case developed approximately two weeks after introduction of a new plastic foaming agent, 2-t-butylazo-2-hydroxy-5-methylhexane (BHMH). All cases occurred in workers exposed directly to BHMH. No new cases developed after use of BHMH was discontinued. A survey of the firm which produced BHMH and of 68 user firms found two additional clusters of mild neuropathy which may have been caused by BHMH. BHMH was withdrawn from distribution following discovery of these cases. Subsequently, BHMH has been shown in rats to be a potent neurotoxin. Adequate premarket testing could have averted this outbreak.

Nonoccupational exposures to indoor air pollutants: a survey of state programs and practices.

A national survey of health department activities in 1982 revealed that 32 states (63 per cent) had a program or person(s) responsible for evaluating exposures to one or more nonoccupational indoor air pollutants (NIAPs). Only four states (8 per cent) had existing or proposed NIAP exposure standards. Twenty-nine (57 per cent) of the states had a program to evaluate nonoccupational exposures to formaldehyde, but these varied widely. There is a need for coordinated, consistent approaches to defining and controlling emerging environmental public health problems such as indoor air pollution.

Sentinel Health Events (occupational): a basis for physician recognition and public health surveillance.

A Sentinel Health Event (SHE) is a preventable disease, disability, or untimely death whose occurrence serves as a warning signal that the quality of preventive and/or therapeutic medical care may need to be improved. A SHE (Occupational) is a disease, disability, or untimely death which is occupationally related and whose occurrence may: 1) provide the impetus for epidemiologic or industrial hygiene studies; or 2) serve as a warning signal that materials substitution, engineering control, personal protection, or medical care may be required. The present SHE(O) list encompasses 50 disease conditions that are linked to the workplace. Only those conditions are included for which objective documentation of an associated agent, industry, and occupation exists in the scientific literature. The list will serve as a framework for developing a national system for occupational health surveillance that may be applied at the state and local level, and as a guide for practicing physicians caring for patients with occupational illnesses. We expect to update the list periodically to accommodate new occupational disease events which meet the criteria for inclusion.

Reproductive hazards in the workplace. Development of epidemiologic research.

Application of the techniques of epidemiology and clinical toxicology has accelerated study of the reproductive effects of toxic chemical and physical exposures in the workplace. Three examples of work in progress are included in the present communication. The first concerns 1,2-dibromo-3-chloropropane, a known cause of male sterility, which continues to be used as a nematocide in Hawaii. Occupational exposures of Hawaiian agricultural workers to airborne 1,2-dibromo-3-chloropropane are mainly in the range of parts per billion. A prospective study of pineapple field workers has been undertaken to evaluate sperm counts and morphology before, during, and after 1,2-dibromo-3-chloropropane application. To date, no sperm count depression is evident at this level of exposure. The second example involves a cluster of seven spontaneous abortions in female office workers exposed to video display terminals. The cluster has been analyzed with the use of fetal life tables. Excess incidence was confirmed (p = 0.0045), but no etiology was determined. The findings may have been due to chance. The third example pertains to male chemical workers manufacturing diaminostilbene, an optical brightener, and the workers' reported sexual impotence. Impotence was confirmed in 7 of 29 workers by questionnaire and suggested for another 7. Serum testosterone analyses found depressed values (less than 300 mg/ml) in 8 of 28 exposed workers. The luteinizing hormone and follicular stimulating hormone levels were generally normal.

Epidemiologic design for field studies: occupational neurotoxicity.

Assessing the neurotoxicity effects of occupational exposures has become increasingly sophisticated in the past decade with the application of neurophysiological and neurobehavioral research techniques to occupational disease problems. With a good epidemiologic study design and the careful application of these techniques, occupational field studies of neurotoxic effects are possible. Three examples from recent health hazard evaluations of the National Institute for Occupational Safety and Health (NIOSH) illustrate some of the problems in performing these studies and methods to overcome these problems.