title: Cause-specific mortality of Dutch chlorophenoxy herbicide manufacturing workers.
abstract: OBJECTIVE
  A retrospective cohort study was conducted in two chlorophenoxy herbicide manufacturing factories, producing mainly 2,4,5-trichlorophenoxyacetic acid (factory A) and 4-chloro-2-methylphenoxyacetic acid, 4-chloro-2-methylphenoxy propanoic acid and 2,4-dichlorophenoxyacetic acid (factory B). Previously, we have shown elevated risks for mortality and cancer mortality in this cohort. The purpose of the current, third follow-up, is to provide an updated assessment of cause-specific mortality for both factories.
  
  
  METHODS
  The study population was defined as all persons working in one of the two factories during 1955-1985 for factory A, or during 1965-1986 for factory B. Analyses were performed using Cox proportional hazard models, using attained age as the timescale. Exposure to phenoxy herbicides and dioxins was expected to be different for factory A and factory B and the factories were therefore analysed separately.
  
  
  RESULTS
  Previously reported increased risks for respiratory cancer, non-Hodgkin's lymphoma and ischaemic heart disease in factory A could not be confirmed in the present analysis. However, increased risks were observed for all cancers in both factory A (hazard ratio (HR) 1.31; 95% CI 0.86 to 2.01) and factory B (HR 1.54; 95% CI 1.00 to 2.37). Increased risks for urinary cancers (HR 4.2; 95% CI 0.99 to 17.89) and genital cancers (HR 2.93; 95% CI 0.61 to 14.15) were observed in factory A, consistent with earlier reported results in this population. More detailed analyses showed that this increased risk for urinary and genital cancers in exposed workers was not due to selection of healthy controls and could not be attributed to specific products or departments.
  
  
  CONCLUSIONS
  The results of this study showed only slight increases in cancer mortality risk. The increased risk for urinary cancers is noteworthy, but could not be linked to a specific exposure and needs to be confirmed in similar cohorts.
authors.affiliation: Utrecht University, Institute for Risk Assessment Sciences, Department of Environmental Epidemiology, PO Box 80178, 3508 TD, Utrecht, the Netherlands. d.boers@uu.nl
authors.forename: D
authors.initials: D
authors.lastname: Boers
authors.forename: L
authors.initials: L
authors.lastname: Portengen
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.forename: D
authors.initials: D
authors.lastname: Heederik
authors.forename: R
authors.initials: R
authors.lastname: Vermeulen
mesh_terms: D015085:2,4,5-Trichlorophenoxyacetic Acid / Q000633:toxicity*; D015084:2,4-Dichlorophenoxyacetic Acid / Q000633:toxicity; D000328:Adult; D002423:Cause of Death; D015331:Cohort Studies; D005500:Follow-Up Studies; D005834:Genital Neoplasms, Male / Q000139:chemically induced / Q000401:mortality*; D006540:Herbicides / Q000633:toxicity*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000139:chemically induced / Q000401:mortality; D009426:Netherlands / Q000453:epidemiology; D009784:Occupational Diseases / Q000139:chemically induced / Q000401:mortality*; D016273:Occupational Exposure / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D014571:Urologic Neoplasms / Q000139:chemically induced / Q000401:mortality*
chemical_list: D006540:Herbicides; D015084:2,4-Dichlorophenoxyacetic Acid; D015085:2,4,5-Trichlorophenoxyacetic Acid