title: Lung cancer and mesothelioma among engine room crew--case reports with risk assessment of previous and ongoing exposure to carcinogens.
abstract: OBJECTIVE
  The aim of this article is to illustrate, by means of case reports on occupational exposure in four men with cancer, the hazards of previous and ongoing carcinogenic exposures in ships' engine rooms. Several cases of cancer occurred within a few years among the engine room crew of a passenger ferry. An investigation was undertaken to establish the number of cases, the types of cancers involved, and their possible relation to work.
  
  
  METHODS
  Nine cases of cancer among crew members of the ferry were reported between 2001 and 2006, six of which occurred in crew working in the engine room. During the investigated time period, 65 men had been employed in the engine room (mean age 40, range 16-65, years). Four cases were referred to our department. Medical history, personal risk factors and specific diagnoses were collected by medical examinations and from the medical files. An experienced occupational hygienist evaluated work-related exposure to carcinogens.
  
  
  RESULTS
  Two engine room ratings contracted lung cancer at the age of 54 and 61, respectively. Both men had been smokers for many years (33 and 45 years, respectively). One engine room rating and one electrical engineer were diagnosed with mesothelioma at the age of 61 and 63, respectively. All four had started to work in engine rooms between 1959 and 1967. Carcinogenic exposure included asbestos, with an estimated cumulative exposure of 2-5 fibreyears/mL, as well as polycyclic aromatic hydrocarbons (PAHs) and nitroarenes from oils, soot and engine exhaust.
  
  
  CONCLUSIONS
  For the lung cancer cases, smoking and asbestos exposure were considered clear risk factors, and PAHs and nitroarenes possible risk factors. For the mesothelioma cases, former asbestos exposure was considered a causal factor. Asbestos can still be present on ships. Steps should be taken to reduce the exposure to asbestos, PAHs and nitroarenes, and smoking.
authors: Occupational and Environmental Medicine, Sahlgrenska University Hospital/Sahlgrenska, Goeteborg, Sweden. karl.forsell@amm.gu.se
authors: Karl
authors: K
authors: Forsell
authors: S
authors: S
authors: Hageberg
authors: Ralph
authors: R
authors: Nilsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000395:Air Pollutants, Occupational / Q000032:analysis*; D001194:Asbestos / Q000633:toxicity; D002273:Carcinogens / Q000633:toxicity*; D006801:Humans; D008175:Lung Neoplasms / Q000139:chemically induced*; D008297:Male; D054526:Men's Health; D008654:Mesothelioma / Q000139:chemically induced*; D008875:Middle Aged; D009784:Occupational Diseases / Q000139:chemically induced*; D016273:Occupational Exposure; D011084:Polycyclic Aromatic Hydrocarbons / Q000633:toxicity; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012767:Ships; D013548:Sweden
chemical_list: D000395:Air Pollutants, Occupational; D002273:Carcinogens; D011084:Polycyclic Aromatic Hydrocarbons; D001194:Asbestos