title: Cancer mortality in workers exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin.
abstract: BACKGROUND
  In both animal and epidemiologic studies, exposure to dioxin (2,3,7,8-tetrachlorodibenzo-p-dioxin, or TCDD) has been associated with an increased risk of cancer.
  
  
  METHODS
  We conducted a retrospective cohort study of mortality among the 5172 workers at 12 plants in the United States that produced chemicals contaminated with TCDD. Occupational exposure was documented by reviewing job descriptions and by measuring TCDD in serum from a sample of 253 workers. Causes of death were taken from death certificates.
  
  
  RESULTS
  Mortality from several cancers previously associated with TCDD (stomach, liver, and nasal cancers, Hodgkin's disease, and non-Hodgkin's lymphoma) was not significantly elevated in this cohort. Mortality from soft-tissue sarcoma was increased, but not significantly (4 deaths; standardized mortality ratio [SMR], 338; 95 percent confidence interval, 92 to 865). In the subcohort of 1520 workers with greater than or equal to 1 year of exposure and greater than or equal to 20 years of latency, however, mortality was significantly increased for soft-tissue sarcoma (3 deaths; SMR, 922; 95 percent confidence interval, 190 to 2695) and for cancers of the respiratory system (SMR, 142; 95 percent confidence interval, 103 to 192). Mortality from all cancers combined was slightly but significantly elevated in the overall cohort (SMR, 115; 95 percent confidence interval, 102 to 130) and was higher in the subcohort with greater than or equal to 1 year of exposure and greater than or equal to 20 years of latency (SMR, 146; 95 percent confidence interval, 121 to 176).
  
  
  CONCLUSIONS
  This study of mortality among workers with occupational exposure to TCDD does not confirm the high relative risks reported for many cancers in previous studies. Conclusions about an increase in the risk of soft-tissue sarcoma are limited by small numbers and misclassification on death certificates. Excess mortality from all cancers combined, cancers of the respiratory tract, and soft-tissue sarcoma may result from exposure to TCDD, although we cannot exclude the possible contribution of factors such as smoking and occupational exposure to other chemicals.
authors.affiliation: Industrywide Studies Branch, National Institute for Occupational Safety and Health Centers for Disease Control, Cincinnati, OH 45226.
authors.forename: M A
authors.initials: MA
authors.lastname: Fingerhut
authors.forename: W E
authors.initials: WE
authors.lastname: Halperin
authors.forename: D A
authors.initials: DA
authors.lastname: Marlow
authors.forename: L A
authors.initials: LA
authors.lastname: Piacitelli
authors.forename: P A
authors.initials: PA
authors.lastname: Honchar
authors.forename: M H
authors.initials: MH
authors.lastname: Sweeney
authors.forename: A L
authors.initials: AL
authors.lastname: Greife
authors.forename: P A
authors.initials: PA
authors.lastname: Dill
authors.forename: K
authors.initials: K
authors.lastname: Steenland
authors.forename: A J
authors.initials: AJ
authors.lastname: Suruda
mesh_terms: D001984:Bronchial Neoplasms / Q000401:mortality; D002617:Chemical Industry; D015331:Cohort Studies; D006801:Humans; D015993:Life Tables; D008297:Male; D009369:Neoplasms / Q000401:mortality*; D016273:Occupational Exposure; D000072317:Polychlorinated Dibenzodioxins / Q000009:adverse effects*; D012189:Retrospective Studies; D012306:Risk; D012509:Sarcoma / Q000401:mortality; D012983:Soft Tissue Neoplasms / Q000401:mortality; D014134:Tracheal Neoplasms / Q000401:mortality; D014481:United States / Q000453:epidemiology
chemical_list: D000072317:Polychlorinated Dibenzodioxins