• Safety and Health at Work
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• 제12권2호
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• pp.174-183
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• 2021

Background: Toluene diisocyanate (TDI) is a highly reactive chemical that causes sensitization and has also been associated with increased lung cancer. A risk assessment was conducted based on occupational epidemiologic estimates for several health outcomes. Methods: Exposure and outcome details were extracted from published studies and a NIOSH Health Hazard Evaluation for new onset asthma, pulmonary function measurements, symptom prevalence, and mortality from lung cancer and respiratory disease. Summary exposure-response estimates were calculated taking into account relative precision and possible survivor selection effects. Attributable incidence of sensitization was estimated as were annual proportional losses of pulmonary function. Excess lifetime risks and benchmark doses were calculated. Results: Respiratory outcomes exhibited strong survivor bias. Asthma/sensitization exposure response decreased with increasing facility-average TDI air concentration as did TDI-associated pulmonary impairment. In a mortality cohort where mean employment duration was less than 1 year, survivor bias pre-empted estimation of lung cancer and respiratory disease exposure response. Conclusion: Controlling for survivor bias and assuming a linear dose-response with facility-average TDI concentrations, excess lifetime risks exceeding one per thousand occurred at about 2 ppt TDI for sensitization and respiratory impairment. Under alternate assumptions regarding stationary and cumulative effects, one per thousand excess risks were estimated at TDI concentrations of 10 - 30 ppt. The unexplained reported excess mortality from lung cancer and other lung diseases, if attributable to TDI or associated emissions, could represent a lifetime risk comparable to that of sensitization.

• Safety and Health at Work
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• 제7권3호
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• pp.251-255
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• 2016

Background: Building demolition can lead to emission of dust into the environment. Exposure to silica dust may be considered as an important hazard in these sites. The objectives of this research were to determine the amount of workers' exposure to crystalline silica dust and assess the relative risk of silicosis and the excess lifetime risk of mortality from lung cancer in demolition workers. Methods: Four sites in the Tehran megacity region were selected. Silica dust was collected using the National Institute for Occupational Safety and Health method 7601 and determined spectrophotometrically. The Mannetje et al and Rice et al models were chosen to examine the rate of silicosis-related mortality and the excess lifetime risk of mortality from lung cancer, respectively. Results: The amount of demolition workers' exposure was in the range of $0.085-0.185mg/m^3$. The range of relative risk of silicosis related mortality was increased from 1 in the workers with the lowest exposure level to 22.64/1,000 in the employees with high exposure level. The range of the excess lifetime risk of mortality from lung cancer was in the range of 32-60/1,000 exposed workers. Conclusion: Geometric and arithmetic mean of exposure was higher than threshold limit value for silica dust in all demolition sites. The risk of silicosis mortality for many demolition workers was higher than 1/1,000 (unacceptable level of risk). Estimating the lifetime lung cancer mortality showed a higher risk of mortality from lung cancer in building demolition workers.

• Journal of Radiation Protection and Research
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• 제17권1호
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• pp.57-70
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• 1992

실내 라돈-222 자핵종의 농도에 피폭되므로서 유발될 수 있는 한국인의 초과 폐암위험을 방사선피폭의 확율론적 위험예측 모형을 이용하여 정량적으로 평가하였다. 1989년 기준 표준 생명표와 사망원인 통계연보 자료로부터 유도한 한국인의 폐암 사망률은 남, 여별로 각각 $22.4/10^5-$년 및 $9.5^/10^5-$년으로 추정 되었다. 이 폐암 사망율을 근거로 수학적으로 예상한 한 모든 사망원인하의 기저 폐암사망위험은 남, 여별로 각각 0.047(4.7%) 및 0.019(1.9%)로 1984년도 미국의 0.067(6.7%) 및 0.025(2.5%)보다 낮았다. 방사선 피폭의 확률론적 수정 상대위험 예측모형을 사용하여 예상한 한국인의 라돈자핵종 피폭당의 초과 폐암위험 계수는 남자 : 0.022/WLM, 여자 : 0.009/WLM 및 평균 : 0.017/WLM로 나타났으며 이로부터 추정한 한국인의 평균 수명중 라돈자핵종 피폭유발 초과 폐암의 사망빈도는 $230/10^6$인-WLM으로 최근 외국의 관련연구에서 보고한 $120{\sim}450/10^6-WLM$의 거의 중간치(median)정도에 해당하는 것으로 평가되었다.

• Journal of Radiation Protection and Research
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• 제46권3호
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• pp.83-97
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• 2021

Background: The lifetime risk of lung cancer incidence due to radiation for nonsmokers is overestimated because of the use of the average cancer baseline risk among a mixed population, including smokers. In recent years, the generalized multiplicative (GM)-excess relative risk (ERR) model has been developed in the life span study of atomic bomb survivors to consider the joint effect of radiation and smoking. Based on this background, this paper discusses the issues of radiation risk assessment considering smoking in two parts. Materials and Methods: In Part 1, we proposed a simple method of estimating the baseline risk for nonsmokers using current smoking data. We performed sensitivity analysis on baseline risk estimation to discuss the birth cohort effects. In Part 2, we applied the GM-ERR model for Japanese smokers to calculate lifetime attributable risk (LAR). We also performed a sensitivity analysis using other ERR models (e.g., simple additive (SA)-ERR model). Results and Discussion: In Part 1, the lifetime baseline risk from mixed population including smokers to nonsmokers decreased by 54% (44%-60%) for males and 24% (18%-29%) for females. In Part 2, comparison of LAR between SA- and GM-ERR models showed that if the radiation dose was ≤200 mGy or less, the difference between these ERR models was within the standard deviation of LAR due to the uncertainty of smoking information. Conclusion: The use of mixed population for baseline risk assessment overestimates the risk for lung cancer due to low-dose radiation exposure in Japanese males.

• Journal of Radiation Protection and Research
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• 제48권2호
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• pp.59-67
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• 2023

Background: This study aims to reevaluate natural radiation exposure, following up on our previous study conducted in 2019, and to assess the associated risk of lung cancer to the public residing in the gold mining areas of Betare-Oya, east Cameroon, and its vicinity. Materials and Methods: Gamma-ray spectra collected using a 7.62 cm×7.62 cm in NaI(Tl) scintillation spectrometer during a car-borne survey, in situ measurements and laboratory measurements performed in previous studies were used to determine the outdoor absorbed dose rate in air to evaluate the annual external dose inhaled by the public. For determining internal exposure, radon gas concentrations were measured and used to estimate the inhalation dose while considering the inhalation of radon and its decay products. Results and Discussion: The mean value of the laboratory-measured outdoor gamma dose rate was 47 nGy/hr, which agrees with our previous results (44 nGy/hr) recorded through direct measurements (in situ and car-borne survey). The resulting annual external dose (0.29±0.09 mSv/yr) obtained is similar to that of the previous study (0.33±0.03 mSv/yr). The total inhalation dose resulting from radon isotopes and their decay products ranged between 1.96 and 9.63 mSv/yr with an arithmetic mean of 3.95±1.65 mSv/yr. The resulting excess lung cancer risk was estimated; it ranged from 62 to 216 excess deaths per million persons per year (MPY), 81 to 243 excess deaths per MPY, or 135 excess deaths per MPY, based on whether risk factors reported by the U.S. Environmental Protection Agency, United Nations Scientific Committee on the effects of Atomic Radiation, or International Commission on Radiological Protection were used, respectively. These values are more than double the world average values reported by the same agencies. Conclusion: There is an elevated level of risk of lung cancer from indoor radon in locations close to the Betare-Oya gold mining region in east Cameroon. Therefore, educating the public on the harmful effects of radon exposure and considering some remedial actions for protection against radon and its progenies is necessary.

• Safety and Health at Work
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• 제8권3호
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• pp.258-266
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• 2017

Background: Welders are exposed to many known and suspected carcinogens. An excess lung cancer risk among welders is well established, but whether this is attributable to welding fumes is unclear. Excess risks of other cancers have been suggested, but not established. We investigated welding cancer risks in the population-based Canadian Census Health and Environmental Cohort. Methods: Among 1.1 million male workers, 12,845 welders were identified using Standard Occupational Classification codes and followed through retrospective linkage of 1991 Canadian Long Form Census and Canadian Cancer Registry (1992-2010) records. Hazard ratios (HRs) were calculated using Cox proportional hazards models based on estimated risks of lung cancer, mesothelioma, and nasal, brain, stomach, kidney, and bladder cancers, and ocular melanoma. Lung cancer histological subtypes and risks by industry group and for occasional welders were examined. Some analyses restricted comparisons to blue-collar workers to minimize effects of potential confounders. Results: Among welders, elevated risks were observed for lung cancer [HR: 1.16, 95% confidence interval (CI): 1.03-1.31], mesothelioma (HR: 1.78, 95% CI: 1.01-3.18), bladder cancer (HR: 1.40, 95% CI: 1.15-1.70), and kidney cancer (HR: 1.30, 95% CI: 1.01-1.67). When restricted to blue-collar workers, lung cancer and mesothelioma risks were attenuated, while bladder and kidney cancer risks increased. Conclusion: Excess risks of lung cancer and mesothelioma may be partly attributable to factors including smoking and asbestos. Welding-specific exposures may increase bladder and kidney cancer risks, and particular sources of exposure should be investigated. Studies that are able to disentangle welding effects from smoking and asbestos exposure are needed.

• Journal of the Korean Data and Information Science Society
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• 제17권2호
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• pp.581-598
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• 2006

In many epidemiological and medical studies, a number of cancer mortalities in categorical classification may be considered as having Poisson distribution with person-years at risk depending upon time. The cancer mortalities have been evaluated by additive or multiplicative models with regard to background and excess risks based on several covariances such as sex, age at the time of bombings, time at exposure, or ionizing radiation, cigarette smoking habits, duration of smoking habits, etc. An interest herein is to examine an additive, synergistic, or antagonistic relationship between radiation exposures and cigarette smoking habits for cancer mortalities. The results revealed a highly significant antagonistic in uence for cancer mortalities from all non-hematologic findings, lung and respiratory system with negative interaction between radiation exposures and cigarette smoking amounts.

• 보험의학회지
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• 제32권2호
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• pp.39-49
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• 2013

The textbook of insurance medicine is very bulky volume and it's revision time may be long. Nowadays medical knowledge and evidences are developing rapidly. It is necessary to revise current insurance risk of certain disease. Review of respiratory diseases in terms of insurance medicine may be valuable information for insurance doctors and life underwriters. Newly estimated mortality ratio and excess death rate of several respiratory diseases in this review are organizing pneumonia, 266%/44‰; multi-drug resistant tuberculosis, 1200%/110‰; idiopathic interstitial pneumonia, 869%/85‰; VATS lobectomy of stage I lung cancer, 550%/33‰; lymphangioleiomyomatosis 9826%/66‰; lung transplantation 2026%/92‰, respectively.

• Asian Pacific Journal of Cancer Prevention
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• 제14권4호
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• pp.2643-2647
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• 2013

Background: Despite anti-smoking campaigns, smoking prevalence among Thai males aged 30 or older is high, at around 50%. The purpose of this study was to determine the relationship between smoking and mortality in a rural Thai community. Materials and Methods: Subjects enrolled into the Khon Kaen cohort study between 1990 and 2001 were followed up for their vital status until $16^{th}$ March 2012. The death resource was from the Bureau of Policy and Strategy, Ministry of Interior, Thailand. A Cox proportional hazards model was used to analyse the association between smoking and death, controlling for age, education level and alcohol drinking, and confidence intervals were calculated using the floating risk method. Results: The study recruited 5,962 male subjects, of whom 1,396 died during a median 13.5 years of follow-up. Current smokers were more likely to die than never smokers after controlling for age, education level and alcohol drinking (HR, 95%CI: 1.41, 1.32-1.51), and the excess mortality was greatest for lung cancer (HR, 95%CI: 3.51, 2.65-4.66). However, there was no increased risk with increasing dose of tobacco, and no difference in risk between smokers of yamuan (hand-rolled cigarettes) and manufactured tobacco. Conclusion: Mortality from cancer, particularly lung cancer, and from all causes combined is dependent on smoking status among men in rural Thailand, but the relative risks are lower than have been reported from studies in high income countries, where the tobacco epidemic is more established.

• Journal of Radiation Protection and Research
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• 제38권4호
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• pp.214-227
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• 2013

MDCT의 등장과 함께 병적 증상이 없는 개인이 조기검진을 위해 CT검사를 하는 예가 꾸준히 증가하고 있다. 이러한 검사의 임상적 효용성과 방사선에 의한 암 발생위험에 대한 여러 가지 논란을 살펴보았다. 1. 저선량흉부CT(LDCT)를 이용한 폐암의 조기 검진 효용성을 보기 위해 설계된 무작위배정대조검사(randomized controlled trial)인 NLST(National Lung Screening Trial)의 분석 결과, CT선별검사가 선별검사를 하지 않은 그룹의 사망률 1.67%를 1.33%로, 20% (p=0.004) 감소시키는 것으로 나타났다. CT선별검사군에서 양성결과를 보인 사람의 96.4%는 위양성(false-positive)이었다. 그리고 방사선에 의한 폐암의 ERR (excess radiation risk)은 다른 고형암과는 달리 나이와 함께 감소하지 않으며, 더욱이 흡연 위험과 방사선 위험이 상승작용을 하여 폐암 검진 대상인 고위험군에게 더욱 위험할 수 있는 것으로 평가되었다. 따라서 방사선에 의한 위험이 NLST에서 관측한 이득을 상쇄할 수도 있다. 아직은 최적의 전략이 확립되지 않은 상태이므로 임상에서 광범위하게 적용하기에는 한계가 있다. 2. 대장CT검사(CT colonography)는 10 mm보다 큰 용종의 검출에는 정확도가 뛰어나지만 이보다 작은 경우에는 민감도와 특이도가 급격히 감소하고, 용종이 발견되어 제거하고자 하는 경우 다시 기존의 대장내시경을 이용해야 하는 불편함이 있다. 현재 대장CT검사 1회 시행의 평균유효선량은 약 8-10 $mS{\nu}$로 보고되어, 만약 이 검사가 많은 사람들을 대상으로 일상적으로 행해지면 공중보건에 영향을 미칠 수 있다. 따라서 집단검진 방법으로 정착하기 위해서 는 용종 크기 6-10 mm 범위에서 높은 민감도와 특이도를 확립하고, 하제를 사용하지 않는 방법을 개발하여야 하며, 선량을 더 감소시킬 수 있는 최적화된 전략을 세워 표준화하여야만 한다. 3. 전신CT검사는 그 효용성이 검증된 선행연구가 없는 상태이다. 이 검사는 약 90%의 검사자들에게서 최소한 하나 이상의 이상소견을 확인하였지만 그 중 약 2%만이 임상적으로 중요한 질환으로 판명되었다. 전신CT검사 1회 시행으로 인한 평균유효선량은 약 12 $mS{\nu}$이며 45세부터 75세까지 매년 검사를 받는 경우 LAR (lifetime attributable risk)이 1.9%로 보고되었다. 현재 의학계의 어떤 단체도 이 검사를 권고하고 있지 않다. 현재까지 CT선별검사는 정당화에 대한 충분한 논의를 위해 심도 있는 다양한 연구가 필요하며 최적화된 프로토콜이 확립된 후 이용하는 것이 바람직하다.