title: Cancer risk among tetrafluoroethylene synthesis and polymerization workers.
abstract: Tetrafluoroethylene (TFE), a compound used for the production of fluorinated polymers including polytetrafluoroethylene, increases the incidence of liver and kidney cancers and leukemia in rats and mice. This is the first time the cancer risk in humans has been explored comprehensively in a cohort mortality study (1950-2008) that included all polytetrafluoroethylene production sites in Europe and North America at the time it was initiated. A job-exposure matrix (1950-2002) was developed for TFE and ammonium perfluoro-octanoate, a chemical used in the polymerization process. National reference rates were used to calculate standardized mortality ratios (SMRs) and 95% confidence intervals. Among 4,773 workers ever exposed to TFE, we found a lower rate of death from most causes, as well as increased risks for cancer of the liver (SMR = 1.27; 95% confidence interval: 0.55, 2.51; 8 deaths) and kidney (SMR = 1.44; 95% confidence interval: 0.69, 2.65; 10 deaths) and for leukemia (SMR = 1.48; 95% confidence interval: 0.77, 2.59; 12 deaths). A nonsignificant upward trend (P = 0.24) by cumulative exposure to TFE was observed for liver cancer. TFE and ammonium perfluoro-octanoate exposures were highly correlated, and therefore their separate effects could not be disentangled. This pattern of findings narrows the range of uncertainty on potential TFE carcinogenicity but cannot conclusively confirm or refute the hypothesis that TFE is carcinogenic to humans.
authors.affiliation: Epidemiology Unit, Department of Preventive Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Via San Barnaba, 8, 20122 Milan, Italy. dario.consonni@unimi.it
authors.forename: Dario
authors.initials: D
authors.lastname: Consonni
authors.forename: Kurt
authors.initials: K
authors.lastname: Straif
authors.forename: J Morel
authors.initials: JM
authors.lastname: Symons
authors.forename: John A
authors.initials: JA
authors.lastname: Tomenson
authors.forename: Ludovic G P M
authors.initials: LG
authors.lastname: van Amelsvoort
authors.forename: Anne
authors.initials: A
authors.lastname: Sleeuwenhoek
authors.forename: John W
authors.initials: JW
authors.lastname: Cherrie
authors.forename: Paolo
authors.initials: P
authors.lastname: Bonetti
authors.forename: Ilaria
authors.initials: I
authors.lastname: Colombo
authors.forename: David G
authors.initials: DG
authors.lastname: Farrar
authors.forename: Pier Alberto
authors.initials: PA
authors.lastname: Bertazzi
mesh_terms: D002423:Cause of Death; D002617:Chemical Industry; D015331:Cohort Studies; D004784:Environmental Monitoring / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D005466:Fluorocarbons / Q000009:adverse effects* / Q000032:analysis / Q000138:chemical synthesis; D006801:Humans; D007674:Kidney Diseases / Q000401:mortality; D007680:Kidney Neoplasms / Q000139:chemically induced / Q000401:mortality*; D007938:Leukemia / Q000139:chemically induced / Q000401:mortality*; D008107:Liver Diseases / Q000401:mortality; D008113:Liver Neoplasms / Q000139:chemically induced / Q000401:mortality*; D008297:Male; D009784:Occupational Diseases / Q000139:chemically induced* / Q000401:mortality*; D016273:Occupational Exposure / Q000032:analysis*; D058105:Polymerization; D018570:Risk Assessment; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
chemical_list: D005466:Fluorocarbons; C015531:tetrafluoroethylene
keywords: cohort studies; mortality; neoplasms; occupational health; polytetrafluoroethylene; tetrafluoroethylene