Work-relatedness Assessment of Hexavalent Chromium-induced Occupational Lung Cancer: A Review and Case Investigation
Keywords:
lung cancer, hexavalent chromium, Cr (VI), occupational disease, occupational medicine, work-relatedness assessmentAbstract
Stainless steel has long been ubiquitously used in cookware manufacturing. In the production process, workers are potentially subject to exposure to many metal fumes, including chromium. Lung cancer is not uncommon in Thailand; however, lung cancer caused by hexavalent chromium [Cr (VI)] exposure had never previously been reported. A worker presented with respiratory symptoms and weight loss for 3 months. After rigorous investigation, the diagnosis was a non-small cell cancer (adenocarcinoma). He had worked at stainless steel polishing for 25 years without any history of smoking or other health risk factors. Polishing chromium-containing metal and lubricating it with trivalent chromium [Cr (III)] wax can create heat high enough to produce the known human lung carcinogen Cr (VI). Instead of wearing an appropriate respirator, he usually wore an activated charcoal mask. During his health treatment, an occupational medicine physician was consulted regarding the work-relatedness of his cancer. This article reviews the process of work-relatedness assessment of non-small cell lung cancer in Cr (VI) exposure by workers in the stainless steel industry and provides details of the first case of what from an occupational medicine point of view the authors consider an occupational disease.
References
Dela Cruz CS, Tanoue LT, Matthay RA. Lung cancer: epidemiology, etiology, and prevention. Clin Chest Med. 2011;32:605-44.
The International Agency for Research on Cancer (IARC). Incidence, Mortality and Prevalence of Cancer in Thailand [Internet]. 2020 [cited 2021 July 9]. Available from: https://gco.iarc.fr/today/data/factsheets/populations/764-thailand-fact-sheets.pdf
Social Security Office (SSO). Thailand occupational diseases and injury in 2011 -2018 [Internet]. 2019 [cited 2021 July 1]. Available from: https://www.sso.go.th/wpr/assets/upload/files_storage/sso_th/8eef9d7b1286d85845a801c7d492964d.pdf
LaDou J, Harrison RJ. Current Occupational and Environmental Medicine. 5th ed. New York: McGraw Hill Medical; 2014.
Taylor AN, Paul C, Paul B, Pickering A. Parkes’ Occupational lung disorders. 4th ed. London: CRC Press; 2017.
American Conference of Governmental Industrial Hygienists. TLVs and BEIs: threshold limit values for chemical substances and physical agents and biological exposure indices. United States: Cincinnati. OH: ACGIH Worldwide; 2020.
United States Environmental Protection Agency. Toxicological review of hexavalent chromium (CAS No. 18540–29-9): In Support of Summary Information on The Integrated Risk Information System (IRIS). Washington, DC: US. EPA; 1998.
International Agency for Research on Cancer (IARC). Arsenic, Metals, Fibres and Dusts.vol.100 part c: A Review of Human Carcinogens. IARC Monographs. France: International Agency for Research on Cancer (IARC); 2012.
Kusnetz S, Hutchison MK, editors. A guide to the work-relatedness of disease [Internet]. USA.: The National Institute for Occupational Safety and Health (NIOSH); 1979 [cited 2021 Jul 27]. Available from: https://www.cdc.gov/niosh/docs/79-116/default.html.
Greaves WW, Das R, McKenzie JG, Sinclair DC. Hegmann KT. Work-Relatedness. J Occup Environ Med. 2018;60:e640-6.
Dubin S, Griffin D. Lung Cancer in Non-Smokers. Mo Med. 2020;117:375-9.
Rowe WB, Morgan MN, Batako A, Jin T. Energy and temperature analysis in grinding. WIT Trans Eng Sci. 2003 Jul 2;44.
Bulsara VH, Ahn Y, Chandrasekar S, Farris TN. Polishing and lapping temperatures. ASME J Tribol. 1997;119:163-70.
Kim J, Seo S, Kim Y, Kim DH. Review of carcinogenicity of hexavalent chrome and proposal of revising approval standards for an occupational cancers in Korea. Ann Occup Environ Med. 2018;30:7.
International Agency for Research on Cancer (IARC). IARC monographs on the Evaluation of Carcinogenic Risk to Humans: Chromium, Nickel and Welding. Lyons: IARC; 1990;49:213-4.
National Institute for Occupational Safety and Health (NIOSH). Criteria for a Recommended Standard: Occupational Exposure to Chromium (VI). Washington, DC: National Institute for Occupational Safety and Health; 2013. (DHHS publication no 2013–128).
U.S. Environmental Protection Agency. Integrated Risk Information System (IRIS) on Chromium VI. National Center for Environmental Assessment, Office of Research and Development, Washington, DC.: Government Printing Office; 1999.
Deng Y, Wang M, Tian T, Lin S, Xu P, Zhou L, et al. The Effect of hexavalent chromium on the inci-dence and mortality of human cancers: a meta-analysis based on published epidemiological cohort studies. Front Oncol. 2019;9:24.
Occupational Safety and Health Administration (OSHA), Department of Labor. Occupational exposure to hexavalent chromium. Final rule. Fed Regist. 2006;71:10099-385.
Shekhawat K, Chatterjee S, Joshi B. Chromium Toxicity and its Health Hazards. Int J Adv Res. 2015;3:167-72.
Agency for Toxic Substances and Disease Registry (ATSDR). Toxicological profile for chromium. Atlanta, GA: U.S. Public Health Service, U.S. Department of Health and Human Services; 1998.
Directorate-General for Employment, Social Affairs and Inclusion (European Commission). Information notices on occupational diseases a guide to diagnosis. Luxembourg: Office for Official Publications of the European Communities; 2019.
Thailand Workmen’s Compensation Fund of the Social Security Office. Guideline for disability evaluation. Bangkok: saeng chan Press; 2016.
Department of Labor Protection and Welfare, The Ministry of Labor. Occupational exposure limit [Internet]. 2017 [cited 2021 Jul 20]. Available from: https://www.labour.go.th/index.php/labor-law/category/6-laws-labor-4
Shin YC, Yi GY, Lee NR, Oh SM, Kang SK, Moon YH, et al. Welder’s exposure to airborne hexavalent chromium and nickel during arc welding in shipyard. J Korean Soc Occup Environ Hyg. 1998;8: 209-23.
Torkmahalleh MA, Yu CH, Lin L, Fan Z, Swift JL, Bonanno L, et al. Improved atmospheric sampling of hexavalent chromium. J Air Waste Manag Assoc. 2013;63:1313-23.
Aslanoğlu SY, Öztürk F, Güllü G. Investigating ambient air quality of a shooting range during official national competitions. Environmental Research and Technology. 2022;5:11-23.
