Documents Fine, Lawrence J. 4 results

Epidemiologic studies investigating the cancer risk associated with using metalworking fluids (MWFs) were reviewed. Results of a comprehensive, systemic survey of the epidemiologic evidence for occupational use of MWFs being associated with cancer of the skin and scrotum, larynx, rectum, pancreas, and bladder by NIOSH and which were included in a NIOSH criteria document for MWFs were presented. Specific studies covered included retrospective cohort mortality and cancer incidence studies of MWF exposed cohorts and associated nested case/control studies, proportionate mortality ratio (PMR) studies, and population based (PB) studies. A case/control study and a cancer incidence study and several case reports suggested MWFs, primarily straight oil MWFs, were associated with increased risk of skin and scrotal cancer. None of three PMR studies found an increased risk for skin and scrotal cancer. A number of cohort, PMR, and PB studies found increased risks for laryngeal and rectal cancer, especially for exposure to straight oil MWFs. Several cohort and PMR studies found increased risks for pancreatic cancer among MWF exposed workers. The strongest evidence was for grinding with synthetic MWFs and machining with straight oil MWFS. Some studies were inconsistent; for example, excess cancer risk was found in black, but not white, workers. One of six PMR studies and several PB case control studies found significant excess risks for bladder cancer after controlling for smoking. Neither of two cohort cancers found an elevated bladder cancer risk; however, both were based on small numbers. The route of MWF exposure was generally through dermal contact or inhalation; however, because of the large sizes of many airborne MWF droplets, gastrointestinal exposure may also have occurred. The authors conclude that increased risks for larynx, rectal, pancreatic, skin and scrotal, and bladder cancer were associated with the use of some types of MWFs. Because of the long latency period for solid organ tumors, the MWF exposures probably occurred before the mid 1970s. The risk of cancer from MWF exposures since the mid 1970s is undetermined because a definitive study of workers entering jobs with MWF exposure during this time period has not yet been performed.

Data sources for conducting surveillance of work related musculoskeletal disorders were evaluated. The data were obtained from four automotive facilities that were in the process of implementing ergonomic programs to reduce work related musculoskeletal disorders. Sources of data included workers' compensation records, sickness and accident insurance records, OSHA 200 logs, facility medical records, self administered symptoms questionnaires, professional interviews, and physical examinations. Hazard surveillance based on evaluation of job exposures to physical stressors was also considered. The highest rate of symptoms was obtained using university administered health interview data. Prevalence based on physical examination plus interview was similar to that obtained using self administered questionnaires. The lowest rate was obtained using facility medical records. Work related musculoskeletal disorder status on self administered questionnaires and on physical examination was associated with risk factor scores for different body areas. The authors conclude that symptoms questionnaires and checklist based hazard surveillance are reliable and reasonably sensitive data sources for identifying and tracking symptomatic workers and work related risk factors for musculoskeletal disorders.

"This paper presents a conceptual model for the pathogenesis of work-related musculoskeletal disorders. The model contains sets of cascading exposure, dose, capacity, and response variables, such that response at one level can act as dose at the next. Response to one or more doses can diminish or increase the capacity for responding to successive doses. The model is used as a framework for discussing the development of work-related muscle, tendon, and nerve disorders. It is intended as a beginning, to be modified to explain new findings as they become available. In research, it can help to identify areas needing additional data for the development and expression of work-related musculoskeletal disorders. Researchers can use it to design laboratory and field studies. In practice, it demonstrates the relationship between common exposure factors and different responses. This information can be used to evaluate and design jobs for the prevention of work-related musculoskeletal disorders."