title: Cancer risks in naval divers with multiple exposures to carcinogens.
abstract: We investigated risks for cancer and the case for a cause-effect relationship in five successive cohorts of naval commando divers (n = 682) with prolonged underwater exposures (skin, gastrointestinal tract, and airways) to many toxic compounds in the Kishon River, Israel's most polluted waterway, from 1948 to 1995. Releases of industrial, ship, and agricultural effluents in the river increased substantially, fish yields decreased, and toxic damage to marine organisms increased. Among the divers (16,343 person-years follow-up from 18 years of age to year 2000), the observed/expected ratio for all tumors was 2.29 (p<0.01). Risks increased in cohorts first diving after 1960 compared to risks in earlier cohorts, notably for hematolymphopoietic, central nervous system, gastrointestinal, and skin cancer; induction periods were often brief. The findings suggest that the increases in risk for cancer and short induction periods resulted from direct contact with and absorption of multiple toxic compounds. Early toxic effects in marine life predicted later risks for cancer in divers.
authors.affiliation: Unit of Occupational and Environmental Medicine, Hebrew University-Hadassah, Jerusalem, Israel. elir@huji.ac.il
authors.forename: Elihu D
authors.initials: ED
authors.lastname: Richter
authors.forename: Lee S
authors.initials: LS
authors.lastname: Friedman
authors.forename: Yuval
authors.initials: Y
authors.lastname: Tamir
authors.forename: Tamar
authors.initials: T
authors.lastname: Berman
authors.forename: Or
authors.initials: O
authors.lastname: Levy
authors.forename: Jerome B
authors.initials: JB
authors.lastname: Westin
authors.forename: Tamar
authors.initials: T
authors.lastname: Peretz
mesh_terms: D000328:Adult; D000368:Aged; D002273:Carcinogens / Q000009:adverse effects*; D015331:Cohort Studies; D006801:Humans; D015994:Incidence; D007557:Israel; D008297:Male; D019216:Metals, Heavy / Q000009:adverse effects*; D008875:Middle Aged; D008889:Military Personnel; D009369:Neoplasms / Q000453:epidemiology / Q000209:etiology*; D016273:Occupational Exposure; D018570:Risk Assessment; D014874:Water Pollutants, Chemical / Q000009:adverse effects*
chemical_list: D002273:Carcinogens; D019216:Metals, Heavy; D014874:Water Pollutants, Chemical