American Journal of Epidemiology Vol. 145, No. 12: 1061-1075
Copyright © 1997 by The Johns Hopkins University School of Hygiene and Public Health
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Cancer Mortality in Workers Exposed to Phenoxy Herbicides, Chlorophenols, and Dioxins An Expanded and Updated International Cohort Study
1Unit of Environmental Cancer Epidemiology, International Agency for Research on Cancer Lyon, France
2Respiratory and Environmental Health Research Unit, Municipal, Institute of Medical Research Barcelona, Spain
3Division of Epidemiology, German Cancer Research Center Heidelberg, Germany
4Epidemiology and Medical Statistics Unit, Health and Safety Executive Bootle, England, United Kingdom
5Institute of Occupational Health, University of Milan Milan, Italy
6Department of Chronic Disease and Environmental Epidemiology, National Institute of Public Health and the Environment Bilthoven, The Netherlands
7Medical Research Council Environmental Epidemiology Unit Southampton, England, United Kingdom
8Medical Center for Chemical Workers' Health Hamburg, Germany
9Industrywide Studies Branch, National Institute of Occupational Safety and Health Cincinnati, Ohio, United States
10Health Services Department, Ontario Hydro, Toronto Ontario, Canada
11Department of Epidemiology and Biostatistics, Finnish Institute of Occupational Health Helsinki, Finland
12Department of Occupational and Environmental Medicine, Lund University Lund, Sweden
13Danish Cancer Society Copenhagen, Denmark
14Menzies School of Health Research Casuarina NT, Australia
15Department of Preventive Medicine, University of Vienna Vienna, Austria
16Department of Medicine, Wellington School of Medicine Wellington, New Zealand
17National Research Council Pisa, Italy
Reprint requests to Dr. Manolis Kogevinas, Respiratory and Environmental Health Research Unit, Institut Municipal d'Investigacio Mèdica (IMIM), c/Doctor Aiguader 80, E-08003 Barcelona, Spain.
The authors examined cancer mortality in a historical cohort study of 21,863 male and female workers in 36 cohorts exposed to phenoxy herbicides, chlorophenols, and dioxins in 12 countries. Subjects in this updated and expanded multinational study coordinated by the International Agency for Research on Cancer were followed from 1939 to 1992. Exposure was reconstructed using job records, company exposure questionnaires, and serum and adipose tissue dioxin levels. Among workers exposed to phenoxy herbicides contaminated with 2,3,7,8-tetrachlo-rodibenzo-p-dioxin (TCDD) or higher chlorinated dioxins, mortality from soft-tissue sarcoma (6 deaths; standardized mortality ratio (SMR) = 2.03,95% confidence interval (CI) 0.75–4.43) was higher than expected from national mortality rates. Mortality from all malignant neoplasms (710 deaths; SMR = 1.12, 95% CI 1.04–1.21), non-Hodgkin's lymphoma (24 deaths; SMR = 1.39, 95% CI 0.89–2.06), and lung cancer (225 deaths; SMR = 1.12, 95% CI 0.98–1.28) was slightly elevated. Risks for all neoplasms, for sarcomas, and for lymphomas increased with time since first exposure. In workers exposed to phenoxy herbicides with minimal or no contamination by TCDD and higher chlorinated dioxins, mortality from all neoplasms (398 deaths; SMR = 0.96, 95% CI 0.87–1.06), non-Hodgkin's lymphoma (9 deaths; SMR = 1.00), and lung cancer (148 deaths; SMR = 1.03) was similar to that expected, and mortality from soft-tissue sarcoma was slightly elevated (2 deaths; SMR = 1.35). In a Poisson regression analysis, workers exposed to TCDD or higher chlorinated dioxins had an increased risk for all neoplasms (rate ratio = 1.29,95% CI 0.94–1.76) compared with workers from the same cohort exposed to phenoxy herbicides and chlorophenols but with minimal or no exposure to TCDD and higher chlorinated dioxins. These findings indicate that exposure to herbicides contaminated with TCDD and higher chlorinated dioxins may be associated with a small increase in overall cancer risk and in risk for specific cancers. Am J Epidemiol 1997;145:1061-75.
chlorophenols; cohort studies; dioxins; herbicides; mortality; neoplasms; occupational exposure; tetrachlorodibenzodioxin
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