Occupational lead exposures lung cancer

It has been postulated that wood dust carcinoma results from a multistep process Exposure causes loss of cilia and hyperplasia of the goblet cells and initiation of cuboidal cell metaplasia, followed (after a quiescent period) by squamous cell metaplasia. Decades later, cellular aplasia leads to nasal adenocarcinoma. The time between first occupational exposure to wood dust and the development of nasal cavity adenocarcinoma averages 40 years. Other cancers, including lung cancer, Hodgkin disease, multiple myeloma, stomach cancer, and colorectal cancer and lymphosarcoma, have been mentioned in relation to wood... 

Lead exposure can produce a number of other effects. One of the most common effects is on the red blood cells, which results in anemia. The red blood cells become fragile and hemoglobin synthesis is impaired. Changes in the red blood cells and some enzymatic changes were used as a marker for lead exposure. Similar to other metals, lead adversely affects kidney function, but this is now rare with reductions in occupational exposure. Several studies have demonstrated that elevated lead exposure is related to elevated blood pressure levels, particularly in men. There appears to be a weak association between lead exposure and increased incidence of lung and brain cancer. Lead exposure is a reproductive hazard for both males and females. In males, lead affects sperm count and sperm motility, resulting in decreased offspring. 

Mark Cullen is professor of medicine and public health at Yale University School of Medicine. His research interests are in occupational and environmental medicine, including isocyanate exposure in automobile-shop workers, lung cancer in people exposed to asbestos, and lead toxicity in workers. He has published several textbooks, including Clinical Occupational Medicine and Textbook of Clinical Occupational and Environmental Medicine. Dr. Cullen received his MD from Yale University and did his residency in internal medicine. He is a member of the DuPont Epidemiology Review Board, a member of the MacArthur Foundation Network on Socioeconomic Status and Health, and a corporate medical director for the Aluminum Company of America. Dr. Cullen is a member of the Institute of Medicine and served as a member of its Board on Health Sciences. 

Cancer. There is no doubt that inhalation of asbestos can lead to increased risk of lung cancer and mesothelioma. This has been conclusively demonstrated in numerous studies of occupationally exposed workers, and has been confirmed in a number of animal experiments. For lung cancer, the magnitude of the risk appears to be a complex function of a number of parameters, the most important of which are (1) the level and the duration of exposure (2) the time since exposure occurred (3) the age at which... 

Hexavalent chromium compounds are classified as substances known to be carcinogenic to humans. This is based upon sufficient evidence of carcinogenicity in humans exposed in chrome production facilities, chromium-alloy facilities, in the chrome plating industry as well as in chrome pigment industries. This exposure results in an increased incidence of lung cancer among these workers. The incidence of cancers at other sites may be increased in these occupational workers There is not sufficient evidence to show that barium chromate, calcium chromate, chromium trioxide, lead chromate, sodium dichromate and strontium chromate are carcinogenic in humans. 

The potential for unusual health effects of chemical mixtures due to the interaction of chemicals or their metabolites (e.g., metabolites of trichloroethylene and benzene) in or with the biosystem constitutes a real issue in the public health arena. However, toxicity testing to predict effects on humans has traditionally studied one chemical at a time for various reasons convenient to handle, physiochemical properties readily defined, dosage could easily be controlled, biologic fate could easily be measured, and relevant data were often available from human occupational exposures. Chemicals are known to cause disease for example, arsenic and skin cancer, asbestos and lung cancer, lead and decrements of IQ, and hepatitis B predisposes to aflatoxin-induced liver cancer but the link between the extent of human exposure to even well-defined chemical mixtures and disease formation remains relatively unexplored, but of paramount importance to public health. 

Occupational exposure to chromium(VI) compounds has been related to an increased risk of lung cancer. Several hexavalent compounds of chromium, including chromium trioxide, are hsted in lARC Group 1 ("carcinogenic to humans") and are classified as "select carcinogens" under the criteria of the OSHA Laboratory Standard. Long-term exposure to chromium trioxide or chromium(VI) salts may cause ulceration of the respiratory system and skin. Exposure to chromium trioxide by inhalation or skin contact may lead to sensitization. Chromium trioxide has exhibited teratogenic activity in animal tests. 

The objective of this chapter is to put into perspective some of the current knowledge with respect to trace metals and their health implications. Potential adverse health effects of occupational exposures to trace metals are dis cussed cancer (arsenic, beryllium chromium nickel, and perhaps cadmium) chronic lung disease (beryllium and cadmium) neurologic and reproductive disorders (lead and mercury) and kidney disorders (lead and cadmium). Also discussed are the National Institute for Occupational Safety and Health (NIOSH) recommended standards for occupational exposure to several trace metals, the difficulty of establishing safe levels of exposure (particularly for carcinogens), and problems involved in identifying toxic components of trade name products. Special attention is given to the role of chemists to help protect the public health. 

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