title: Lung cancer mortality in a site producing hard metals.
abstract: OBJECTIVE
  To study the mortality from lung cancer from exposures to hard metal dust at an industrial site producing hard metals--pseudoalloys of cobalt and tungsten carbide--and other metallurgical products many of which contain cobalt.
  
  
  METHODS
  A historical cohort was set up of all subjects who had worked for at least 3 months on the site since its opening date in the late 1940s. A full job history could be obtained for 95% of the subjects. The cohort was followed up from January 1968 to December 1992. The exposure was assessed by an industry specific job exposure matrix (JEM) characterising exposure to hard metal dust from 1 to 9 and other possibly carcinogenic exposures as present or absent. Smoking information was obtained by interview of former workers. Standard lifetable methods and Poisson regression were used for the statistical analysis of the data.
  
  
  RESULTS
  Mortality from all causes was close to the expected (standardised mortality ratio (SMR) 1.02, 399 deaths) whereas mortality from lung cancer was significantly increased among men (SMR 1.70; 46 deaths, 95% confidence interval (95% CI) 1.24 to 2.26). By workshop, lung cancer mortality was significantly higher than expected in hard metal production before sintering (SMR 2.42; nine deaths; 95%CI 1.10 to 4.59) and among maintenance workers (SMR 2.56; 11 deaths; 95%CI 1.28 to 4.59), whereas after sintering the SMR was lower (SMR 1.28; five deaths; 95%CI 0.41 to 2.98). The SMR for all exposures to hard metal dust at a level >1 in the JEM was in significant excess (SMR 2.02; 26 deaths; 95%CI 1.32 to 2.96). The risks increased with exposure scores, duration of exposure, and cumulative dose reaching significance for duration of exposure to hard metal dust before sintering, after adjustment for smoking and known or suspected carcinogens.
  
  
  CONCLUSIONS
  Excess mortality from lung cancer was found among hard metal production workers which cannot be attributed to smoking alone. This excess occurred mostly in subjects exposed to unsintered hard metal dust.
authors.affiliation: Institut National de Recherche et de Sécurité, Service Epidémiologie, BP 27, 54501 Vandoeuvre Cedex, France. wild@inrs.fr
authors.forename: P
authors.initials: P
authors.lastname: Wild
authors.forename: A
authors.initials: A
authors.lastname: Perdrix
authors.forename: S
authors.initials: S
authors.lastname: Romazini
authors.forename: J J
authors.initials: JJ
authors.lastname: Moulin
authors.forename: F
authors.initials: F
authors.lastname: Pellet
mesh_terms: D015331:Cohort Studies; D004391:Dust / Q000009:adverse effects*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007221:Industry; D008175:Lung Neoplasms / Q000401:mortality*; D008297:Male; D019216:Metals, Heavy / Q000009:adverse effects*; D016273:Occupational Exposure; D012907:Smoking / Q000009:adverse effects
chemical_list: D004391:Dust; D019216:Metals, Heavy