title: Cumulative lead exposure in relation to mortality and lung cancer morbidity in a cohort of primary smelter workers.
abstract: OBJECTIVE
  The purpose of this study was to determine the mortality and cancer incidence of long-term lead smelter workers at a primary smelter.
  
  
  METHODS
  A cohort of 3979 workers employed for at least 1 year during 1928-1979 and a subcohort of 1992 workers employed in lead-exposed departments (lead only workers) was formed. The expected mortality in 1955-1987 and cancer incidence in 1958-1987 were calculated relative to the county rates, specified for cause, gender, 5-year age groups, and calendar year. A cumulative blood-lead index was used for the dose-response analyses.
  
  
  RESULTS
  The lung cancer incidence of the total cohort [standardized incidence ratio (SIR) 2.8, 95% confidence interval (95% CI) 2.1-3.8] and the group with the highest exposure (SIR 3.1, 95% CI 2.0-4.6) was high. Similar risk estimates were observed with a latency of 15 years. The workers hired before 1950 had higher lung cancer risk estimates (SIR 3.6, 95% CI 2.6-5.0) than the workers hired later (SIR 1.3, 95% CI 0.6-2.6, no latency period). The risk estimates for lung cancer were further elevated in the subcohort of lead-only workers (SIR 5.1, 95% CI 2.0-10.5 in the highest exposed subgroup; latency period of 15 years). No excesses of other malignancies were noted.
  
  
  CONCLUSIONS
  The increased relative risks were probably mainly due to interactions between lead and other carcinogenic exposures, including arsenic. Further study is required concerning such possible interactions before a role in the induction of lung cancer can be ascribed to lead.
authors.affiliation: Department of Occupational and Environmental Medicine, Umeå University, Sweden.
authors.forename: N G
authors.initials: NG
authors.lastname: Lundström
authors.forename: G
authors.initials: G
authors.lastname: Nordberg
authors.forename: V
authors.initials: V
authors.lastname: Englyst
authors.forename: L
authors.initials: L
authors.lastname: Gerhardsson
authors.forename: L
authors.initials: L
authors.lastname: Hagmar
authors.forename: T
authors.initials: T
authors.lastname: Jin
authors.forename: L
authors.initials: L
authors.lastname: Rylander
authors.forename: S
authors.initials: S
authors.lastname: Wall
mesh_terms: D000368:Aged; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007855:Lead Poisoning / Q000150:complications*; D008175:Lung Neoplasms / Q000139:chemically induced* / Q000401:mortality*; D008297:Male; D008669:Metallurgy; D008875:Middle Aged; D009784:Occupational Diseases / Q000139:chemically induced* / Q000401:mortality*; D016273:Occupational Exposure; D012307:Risk Factors; D013548:Sweden