Annals of Occupational and Environmental Medicine

  • 제22권3호
  • /
  • Pages.230-239
  • /
  • 2010
  • /
  • 1225-3618(pISSN)
  • /
  • 2052-4374(eISSN)
대한직업환경의학회 (The Korean Society of Occupational & Environmental Medicine)
권호 표지

역학조사를 통해 직업성 폐암으로 판단된 사례분석

Characteristics of Occupational Lung Cancer from 1999 to 2005

  • 임정욱 (한강성심병원 산업의학과) ;
  • 박소영 (직업성폐질환연구소) ;
  • 최병순 (한국산업안전보건공단 산업안전보건연구원)
  • Lim, Jung-Wook (Department of Occupational and Environmental Medicine, Hangang Sacred Hospital) ;
  • Park, So-Young (Occupational Lung Diseases Institute) ;
  • Choi, Byung-Soon (Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency)
  • 투고 : 2010.01.27
  • 심사 : 2010.08.05
  • 발행 : 2010.09.30
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 역학조사를 통해 업무 관련성이 높다고 판단된 직업성 폐암 사례의 특성을 살펴보고자 하였다. 방법: 폐암으로 진단된 후 근로복지공단에 산업재해보상보험에 의한 요양급여 또는 유족급여를 신청한 사례의 업무상 질병 여부 판정을 위해 근로복지공단이 1999년부터 2005년까지 7년간 산업안전보건연구원에 역학조사를 의뢰한 128예 중에서 업무 관련성이 높다고 판단된 직업성 폐암 53예의 진단 당시 연령, 흡연력, 세포형, 직업 및 발암물질을 분석하였다. 결과: 직업성 폐암 53예와 비직업성 폐암 75예는 연령, 흡연력, 세포형의 분포에 있어서 서로 유의한 차이가 없었다(p>0.05). 직업성 폐암의 발암물질로는 석면이 33예(62.3%)로 가장 많았고, 다핵방향족탄화수소 23예(43.4%), 6가 크롬 17예(32.1%), 결정형 유리규산 14예(26.4%), 니켈화합물 12예(22.6%)이었으며 그 외 라돈자핵종(2예), 비소(1예) 등이었다. 18예(34.0%)는 하나의 폐암 발암물질에 노출되었고, 둘 이상의 물질이 복합적으로 작용한 사례가 35예(66.0%)이었다. 폐암 발암물질에 노출된 직업은 보수, 설비, 정비 등 16예(30.2%), 용접 13예(24.5%), 연마 및 사상 6예(11.3%), 주물이 4예(7.5%), 운전, 조형, 도장이 각 3예(5.7%)이었고 그 외 14예(26.4%)이었다. 석면이 원인이었던 사례는 평균 19.8년 동안 석면에 노출되고 최초 노출로부터 평균 22.4년이 지나 폐암이 발생하였다. 다핵방향족탄화수소는 평균 노출기간과 잠재기가 각각 18.7년 및 22.8년, 6가 크롬은 21.4년 및 22.8년, 결정형 유리규산은 20.5년 및 26.6년, 니켈화합물은 23.6년 및 25.0년, 라돈 자핵종은 11.3년 및 13.6년, 비소는 27.3년 및 60.8년이었다. 결론: 역학조사를 통해 업무 관련성이 높다고 판단된 사례들의 진단 당시 연령, 흡연력, 세포형, 직업 및 발암물질 분석을 통해 직업성 폐암의 특성을 파악할 수 있었다.

Objectives: The aim of this study was to investigate the characteristics of occupational lung cancer. Methods: We analyzed the characteristics of 53 occupational lung cancer cases among 128 lung cancer cases applied for industrial accident compensation insurance benefits and referred for the decision of work-relatedness between 1999 and 2005. Statistical analysis was conducted using the Chi-square test on 128 lung cancer cases. Results: The age of diagnosis, smoking history, and cell type of lung cancer cases were not significantly different between 53 cases of occupational lung cancer and 75 cases of non-occupational lung cancer (p>.05). Here is a list of occupational lung cancer case numbers associated with certain carcinogens were: 33(62.3%) cases with asbestos, 23(43.4%) cases with polycyclic aromatic hydro carbon (PAH), 17 cases(32.1%) with chromium VI (Oxidation state), 14 cases(26.4%) with crystalline silica, 12 cases (22.6%) with nickel compounds, 2 cases(3.8%) with radon daughters, and 1 case(1.9%) with arsenic. Eighteen cases(34.0%) of occupational lung cancer had exposures to a single carcinogen, and 35 cases (66.0%) had exposures to more than 2 carcinogens. Job types associated with occupational lung cancer cases were: 16 cases(30.2%) with maintenance, 13 cases(24.5%) with welding; 6 cases(11.3%) with grinding; 4 cases(7.5%) with foundry; 3 cases(5.7%) with driving, casting, and painting' and 14 cases (26.4%) with 'other'. Conclusions: This study identified the characteristics of occupational lung cancer through the analysis of the age of diagnosis, smoking history, cell type, job, and carcinogen. There is no difference between occupational lung cancer and non-occupational lung cancer except exposure to the carcinogens. these results indicate that past exposure to occupational carcinogens remains an important determinant of occupational lung cancer occurrence.

키워드

참고문헌

  1. Korea National Statistical Office. Death rates for condensed list of 103 causes by sex and age. Available: http://www.kosis.kr/online/on00_index.jsp [cited 18 January 2010].
  2. Doll R, Peto R. The cause of cancer: quantitative estimates of avoidable risks of cancer in the United States today. J Natl Cancer Inst 1981;66(6):1191-308.
  3. Steenland K, Loomis D, Shy C, Simonsen N. Review of occupational lung carcinogens. Am J Ind Med 1996; 29(5):474-90. https://doi.org/10.1002/(SICI)1097-0274(199605)29:5<474::AID-AJIM6>3.0.CO;2-M
  4. Kang SK, Ahn YS, Chung HK. Occupational cancer in Korea in the 1990s. Korean J Occup Environ Med 2001;13(4):351-9. (Korean)
  5. International Agency for Research on Cancer. Complete List of Agents Evaluated and Their Classification. Available: http://monographs.iarc.fr/ ENG/ Classification/index.php [cited 18 January 2010].
  6. International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. supplement 7. Overall Evaluations of Carcinogenicity: an Updating of IARC Monographs volumes 1 to 42. IARC. Lyon. 1987. pp 100-6.
  7. International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. supplement 7. Overall Evaluations of Carcinogenicity: an Updating of IARC Monographs volumes 1 to 42. IARC. Lyon. 1987. pp 106-16.
  8. International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. volume 43. Man-made Mineral Fibres and Radon. IARC. Lyon. 1988. pp 239-41.
  9. International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. volume 49. Chromium, Nickel and Welding. IARC. Lyon. 1990. pp 208-14.
  10. International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. volume 49. Chromium, Nickel and Welding. IARC. Lyon. 1990. pp 401-11.
  11. International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. volume 58. Beryllium, Cadmium, Mercury, and Exposures in the Glass Manufacturing Industry. IARC. Lyon. 1993. pp 100-3.
  12. International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. volume 58. Beryllium, Cadmium, Mercury, and Exposures in the Glass Manufacturing Industry. IARC. Lyon. 1993. pp 206-10.
  13. International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. volume 68. Silica, Some Silicates, Coal Dust and Para-aramid Fibrils. IARC. Lyon. 1997. pp 204-11.
  14. International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. volume 83. Tobacco Smoke and Involuntary Smoking. IARC. Lyon. 2004. pp 1179-87.
  15. International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. volume 46. Diesel and Gasoline Engine Exhausts and Some Nitroarenes. IARC. Lyon. 1989. pp 148-54.
  16. Ahn YS. Kang SK. Asbestos-related Occupational Cancers Compensated under the Industrial Accident Compensation Insurance in Korea. Ind Health. 2009;47(2):113-22. https://doi.org/10.2486/indhealth.47.113
  17. Samet JM, Alberg AJ, Ford JG. Epidemiology of lung cancer and mesothelioma. Eur Respir Mon 2009; 44:349-91.
  18. World Health Organization. Country Profiles Tobacco or Health 2000. Available:http://www.wpro.who.int/ internet/resources.ashx/TFI/country+profiles+2000.pdf [cited 18 January 2010].
  19. International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. volume 83. Tobacco Smoke and Involuntary Smoking. IARC. Lyon. 2004. pp 913-972.
  20. Devesa SS, Shaw GL, Blot WJ. Changing patterns of lung cancer incidence by histological type. Cancer Epidemiol Biomarkers Prev. 1991;1(1):29-34.
  21. Hillerdal G, Henderson DW. Asbestos, asbestosis, pleural plaques and lung cancer. Scand J Work Environ Health 1997;23(2):93-103. https://doi.org/10.5271/sjweh.186
  22. Erren TC, Jacobsen M, Piekarski C. Synergy between asbestos and smoking on lung cancer risks. Epidemiology 1999;10(4):405-11. https://doi.org/10.1097/00001648-199907000-00011
  23. Lee PN. Relation between exposure to asbestos and smoking jointly and the risk of lung cancer. Occup Environ Med 2001;58(3):145-53. https://doi.org/10.1136/oem.58.3.145
  24. Liddell FD. The interaction of asbestos and smoking in lung cancer. Ann Occup Hyg 2001;45(5):341-56. https://doi.org/10.1016/S0003-4878(00)00060-0
  25. Lloyd JW, Lundin FE Jr, Redmond CK, Geiser PB. Long-term mortality study of steel workers. IV. Mortality by work area. J Occup Med 1970;12(5):151-7. https://doi.org/10.1097/00043764-197005000-00002
  26. Costantino JP, Redmond CK, Bearden A. Occupationally related cancer risk among coke oven workers: 30 years of follow-up. J Occup Environ Med 1995;37(5): 597-604. https://doi.org/10.1097/00043764-199505000-00009
  27. Steenland NK, Silverman DT, Hornung RW. Case-control study of lung cancer and truck driving in the Teamsters Union. Am J Public Health 1990;80(6):670-4. https://doi.org/10.2105/AJPH.80.6.670
  28. Steenland K, Deddens J, Stayner L. Diesel exhaust and lung cancer in the trucking industry: exposure-response analyses and risk assessment. Am J Ind Med 1998; 34(3):220-8. https://doi.org/10.1002/(SICI)1097-0274(199809)34:3<220::AID-AJIM3>3.0.CO;2-Z
  29. Doll R, Vessey MP, Beasley RW, Buckley AR, Fear EC, Fisher RE, Gammon EJ, Gunn W, Hughes GO, Lee K, Norman-Smith B. Mortality of gas workersfinal report of a prospective study. Br J Ind Med 1972; 29(4):394-406.
  30. Andersen A, Dahlberg BE, Magnus K, Wannag A. Risk of cancer in the Norwegian aluminium industry. Int J Cancer 1982;29(3):295-8. https://doi.org/10.1002/ijc.2910290312
  31. Gibbs GW. Mortality of aluminum reduction plant workers, 1950 through 1977. J Occup Med 1985; 27(10):761-70.
  32. Armstrong B, Tremblay C, Baris D, Theriault G. Lung cancer mortality and polynuclear aromatic hydrocarbons: a case-cohort study of aluminum production workers in Arvida, Quebec, Canada. Am J Epidemiol 1994;139(3):250-62. https://doi.org/10.1093/oxfordjournals.aje.a116992
  33. Garshick E, Schenker MB, Munoz A, Segal M, Smith TZ, Woskie SR, Hammond SK, Speizer FE. A casecontrol study of lung cancer and diesel exhaust exposure in railroad workers. Am Rev Respir Dis 1987; 135(6):1242-8. https://doi.org/10.1164/arrd.1987.135.6.1242
  34. Zaebst DD, Clapp DE, Blade LM, Marlow DA, Steenland K, Hornung RW, Scheutzle D, Butler J. Quantitative determination of trucking industry workers' exposures to diesel exhaust particles. Am Ind Hyg Assoc J 1991;52(12):529-41. https://doi.org/10.1080/15298669191365162
  35. Jarvholm B, Silverman D. Lung cancer in heavy equipment operators and truck drivers with diesel exhaust exposure in the construction industry. Occup Environ Med 2003;60(7):516-20. https://doi.org/10.1136/oem.60.7.516
  36. Garshick E, Laden F, Hart JE, Rosner B, Smith TJ, Dockery DW, Speizer FE. Lung cancer in railroad workers exposed to diesel exhaust. Environ Health Perspect 2004;112(15):1539-43. https://doi.org/10.1289/ehp.7195
  37. Hesterberg TW, Bunn WB 3rd, Chase GR, Valberg PA, Slavin TJ, Lapin CA, Hart GA. A critical assessment of studies on the carcinogenic potential of diesel exhaust. Crit Rev Toxicol 2006;36(9):727-76. https://doi.org/10.1080/10408440600908821
  38. Davis ME, Smith TJ, Laden F, Hart JE, Blicharz AP, Reaser P, Garshick E. Driver exposure to combustion particles in the U.S. Trucking industry. J Occup Environ Hyg 2007;4(11):848-54. https://doi.org/10.1080/15459620701643347
  39. Garshick E, Laden F, Hart JE, Rosner B, Davis ME, Eisen EA, Smith TJ. Lung cancer and vehicle exhaust in trucking industry workers. Environ Health Perspect 2008;116(10):1327-32. https://doi.org/10.1289/ehp.11293
  40. Occupational Safety and Health Research Institute (OSHRI). Health Effect and Management by Harmful factor: Chromium (translated by Lim JW). Korea Occupational Safety and Health Agency. Incheon, Korea. 2005. pp 24. (Korean)
  41. Becker N, Claude J, Frentzel-Beyme R. Cancer risk of arc welders exposed to fumes containing chromium and nickel. Scand J Work Environ Health 1985;11(2):75- 82. https://doi.org/10.5271/sjweh.2242
  42. Hayes RB, Sheffet A, Spirtas R. Cancer mortality among a cohort of chromium pigment workers. Am J Ind Med 1989;16(2):127-33. https://doi.org/10.1002/ajim.4700160204
  43. Cocco P, Rice CH, Chen JQ, McCawley MA, McLaughlin JK, Dosemeci M. Lung cancer risk, silica exposure, and silicosis in Chinese mines and pottery factories: the modifying role of other workplace lung carcinogens. Am J Ind Med 2001;40(6):674-82. https://doi.org/10.1002/ajim.10022
  44. Hughes JM, Weill H, Rando RJ, Shi R, McDonald AD, McDonald JC. Cohort mortality study of North American industrial sand workers. II. Case-referent analysis of lung cancer and silicosis deaths. Ann Occup Hyg 2001;45(3):201-7. https://doi.org/10.1016/S0003-4878(00)00078-8
  45. Rice FL, Park R, Stayner L, Smith R, Gilbert S, Checkoway H. Crystalline silica exposure and lung cancer mortality in diatomaceous earth industry workers: a quantitative risk assessment. Occup Environ Med 2001;58(1):38-45. https://doi.org/10.1136/oem.58.1.38
  46. Steenland K, Sanderson W. Lung cancer among industrial sand workers exposed to crystalline silica. Am J Epidemiol 2001;153(7):695-703. https://doi.org/10.1093/aje/153.7.695
  47. Calvert GM, Rice FL, Boiano JM, Sheehy JW, Sanderson WT. Occupational silica exposure and risk of various diseases: an analysis using death certificates from 27 states of the United States. Occup Environ Med 2003;60(2):122-9. https://doi.org/10.1136/oem.60.2.122
  48. Attfield MD, Costello J. Quantitative exposureresponse for silica dust and lung cancer in Vermont granite workers. Am J Ind Med 2004;45(2):129-38. https://doi.org/10.1002/ajim.10348
  49. Cassidy A, Mannetje A, van Tongeren M, Field JK, Zaridze D, Szeszenia-Dabrowska N, Rudnai P, Lissowska J, Fabianova E, Mates D, Bencko V, Foretova L, Janout V, Fevotte J, Fletcher T, Brennan P, Boffetta P. Occupational exposure to crystalline silica and risk of lung cancer: a multicenter case-control study in Europe. Epidemiology 2007;18(1):36-43. https://doi.org/10.1097/01.ede.0000248515.28903.3c
  50. Andersen A, Berge SR, Engeland A, Norseth T. Exposure to nickel compounds and smoking in relation to incidence of lung and nasal cancer among nickel refinery workers. Occup Environ Med 1996;53(10): 708-13. https://doi.org/10.1136/oem.53.10.708
  51. Darby SC, Whitley E, Howe GR, Hutchings SJ, Kusiak RA, Lubin JH, Morrison HI, Tirmarche M, Tomasek L, Radford EP, Roscoe RJ, Samet JM, Yao SX. Radon and cancers other than lung cancer in underground miners: a collaborative analysis of 11 studies. J Natl Cancer Inst 1995;87(5):378-84. https://doi.org/10.1093/jnci/87.5.378
  52. Hertz-Picciotto I, Smith AH, Holtzman D, Lipsett M, Alexeeff G. Synergism between occupational arsenic exposure and smoking in the induction of lung cancer. Epidemiology 1992;3(1):23-31. https://doi.org/10.1097/00001648-199201000-00006
  53. Simeonova PP, Luster MI. Mechanisms of arsenic carcinogenicity: genetic or epigenetic mechanisms? J Environ Pathol Toxicol Oncol 2000;19(3):281-6.
  54. Sferlazza SJ, Beckett WS. The respiratory health of welders. Am Rev Respir Dis 1991;143(5 Pt 1):1134-48. https://doi.org/10.1164/ajrccm/143.5_Pt_1.1134
  55. Sjogren B, Hansen KS, Kjuus H, Persson PG. Exposure to stainless steel welding fumes and lung cancer: a meta-analysis. Occup Environ Med 1994;51(5):335-6. https://doi.org/10.1136/oem.51.5.335
  56. Langard S. Nickel-related cancer in welders. Sci Total Environ 1994;148(2-3):303-9. https://doi.org/10.1016/0048-9697(94)90408-1
  57. Simonato L, Fletcher AC, Andersen A, Anderson K, Becker N, Chang-Claude J, Ferro G, Gerin M, Gray CN, Hansen KS, Kalliomaki P-L, Kurppa K, Langard S, Merlo F, Moulin JJ, Newhouse ML, Peto J, Pukkala E, Sjogren B, Wild P, Winkelmann R, Saracci R. A historical prospective study of European stainless steel, mild steel, and shipyard welders. Br J Ind Med 1991;48(3):145-54.
  58. Moulin JJ. A meta-analysis of epidemiologic studies of lung cancer in welders. Scand J Work Environ Health 1997;23(2):104-13. https://doi.org/10.5271/sjweh.187
  59. Steenland K, Beaumont J, Elliot L. Lung cancer in mild steel welders. Am J Epidemiol 1991;133(3):220-9. https://doi.org/10.1093/oxfordjournals.aje.a115866
  60. Steenland K. Ten-year update on mortality among mild-steel welders. Scand J Work Environ Health 2002;28(3):163-7. https://doi.org/10.5271/sjweh.660
  61. International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. supplement 7. Overall Evaluations of Carcinogenicity: an Updating of IARC Monographs volumes 1 to 42. IARC. Lyon. 1987. pp 224-5.
  62. Koskela RS, Hernberg S, Karava R, Jarvinen E, Nurminen M. A mortality study of foundry workers. Scand J Work Environ Health 1976;2 (Suppl 1):73-89. https://doi.org/10.5271/sjweh.2829
  63. Egan B, Waxweiler RJ, Blade L, Wolfe J, Wagoner JK. A preliminary report of mortality patterns among foundry workers. J Environ Pathol Toxicol 1979; 2(5):259-72.
  64. Tola S, Koskela RS, Hernberg S, Jarvinen E. Lung cancer mortality among iron foundry workers. J Occup Med 1979;21(11):753-9. https://doi.org/10.1097/00043764-197911000-00010
  65. Sherson D, Svane O, Lynge E. Cancer incidence among foundry workers in Denmark. Arch Environ Health 1991;46(2):75-81. https://doi.org/10.1080/00039896.1991.9937432
  66. Moulin JJ, Wild P, Mantout B, Fournier-Betz M, Mur JM, Smagghe G. Mortality from lung cancer and cardiovascular diseases among stainless-steel producing workers. Cancer Causes Control 1993;4(2):75-81. https://doi.org/10.1007/BF00053147
  67. Sherson D, Sabro P, Sigsgaard T, Johansen F, Autrup H. Biological monitoring of foundry workers exposed to polycyclic aromatic hydrocarbons. Br J Ind Med 1990;47(7):448-53.
  68. Consonni D, De Matteis S, Lubin JH, Wacholder S, Tucker M, Pesatori AC, Caporaso NE, Bertazzi PA, Landi MT. Lung cancer and occupation in a population- based case-control study. Am J Epidemiol. 2010; 171(3):323-33. https://doi.org/10.1093/aje/kwp391
  69. De Matteis S, Consonni D, Bertazzi PA. Exposure to occupational carcinogens and lung cancer risk. Evolution of epidemiological estimates of attributable fraction. Acta Biomed. 2008;79 (Suppl 1):34-42.