Cancer Mortality in Workers Exposed to Organochlorine Compounds in the Pulp and Paper Industry: An International Collaborative Study

By McLean, David; Pearce, Neil et al. | Environmental Health Perspectives, July 2006 | Go to article overview

Cancer Mortality in Workers Exposed to Organochlorine Compounds in the Pulp and Paper Industry: An International Collaborative Study


McLean, David, Pearce, Neil, Langseth, Hilde, Jappinen, Paavo, Szadkowska-Stanczyk, Irena, Persson, Bodil, Wild, Pascal, Kishi, Reiko, Lynge, Elsebeth, Henneberger, Paul, Sala, Maria, Teschke, Kay, Kauppinen, Timo, Colin, Didier, Kogevinas, Manolis, Boffetta, Paolo, Environmental Health Perspectives


The objective of this study was to evaluate cancer mortality in pulp and paper industry workers exposed to chlorinated organic compounds. We assembled a multinational cohort of workers employed between 1920 and 1996 in 11 countries. Exposure to both volatile and nonvolatile organochlorine compounds was estimated at the department level using an exposure matrix. We conducted a standardized mortality ratio (SMR) analysis based on age and calendar-period-specific national mortality rates and a Poisson regression analysis. The study population consisted of 60,468 workers. Workers exposed to volatile organochlorines experienced a deficit of all-cause [SMR = 0.91; 95% confidence interval (CI), 0.89-0.93] and all-cancer (SMR = 0.93; 95% CI, 0.89-0.97) mortality, with no evidence of increased risks for any cancer of a priori interest. There was a weak, but statistically significant, trend of increasing risk of all-cancer mortality with increasing weighted cumulative exposure. A similar deficit in all-cause (SMR = 0.94; 95% CI, 0.91-0.96) and all-cancer (SMR = 0.94; 95% CI, 0.89-1.00) mortality was observed in those exposed to nonvolatile organochlorines. No excess risk was observed in cancers of a priori interest, although mortality from Hodgkin disease was elevated (SMR = 1.76; 95% CI, 1.02-2.82). In this study we found little evidence that exposure to organochlorines at the levels experienced in the pulp and paper industry is associated with an increased risk of cancer, apart from a weak but significant association between all-cancer mortality and weighted cumulative volatile organochlorine exposure. Key words: epidemiology, mortality, neoplasms, organochlorines, pulp and paper industry. Environ Health Perspect 114:1007-1012 (2006). doi:10.1289/ehp.8588 available via http://dx.doi.org/ [Online 13 March 2006]

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Pulp and paper production workers have been exposed to a complex mixture of hazardous substances, including known or suspected carcinogens such as wood dust, various wood extracts and associated bioaerosols, reduced sulfur compounds, talc, formaldehyde, combustion products, epichlorohydrin, acid mists, auramine and other benzidine-based dyes, and a range of chlorinated organic compounds (Kauppinen et al. 1997, 2002). The patterns of exposure in the industry are complicated because of the range of different processes that have been used over time in the various stages of pulp and paper manufacture, which together with the relatively small numbers of workers within specific departments has limited the power of epidemiologic studies of mill-based cohorts. A number of studies, nevertheless, have suggested increased risks of gastrointestinal cancers (Henneberger et al. 1989; Milham and Demers 1984), respiratory system cancers (Milham and Demers 1984; Siemiatycki et al. 1986; Toren et al. 1991), and certain lymphatic and hematopoietic neoplasms (Coggon et al. 1997; Matanoski et al. 1998) in pulp and paper industry workers. Despite the large number of studies conducted, there is still uncertainty about the exact nature and extent of cancer risks associated with work in this industry (Toren 1996).

The International Agency for Research on Cancer (IARC) therefore coordinated an international collaborative cohort study to investigate mortality and cancer incidence in the pulp, paper, paperboard, recycled paper, and paper product industries. This study has combined cohorts from 13 countries, consisting of 98,665 workers (2,110,913 person-years), and included the development of a comprehensive database of exposure measurements for the retrospective assessment of study participants' exposure (Kauppinen et al. 1997, 2002). The results for mortality and incidence in selected national cohorts (Fassa et al. 1998; Henneberger and Lax 1998; Henneberger et al. 1989; Jappinen and Pukkala 1991; Jappinen and Tola 1986; Langseth and Andersen 1999, 2000; McLean et al. 2002; Rix et al. 1997, 1998; Sala-Serra et al. …

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