The Relationship between the Occupational Exposure of Trichloroethylene and Kidney Cancer

Inah Kim; Jaehyeok Ha; June-Hee Lee; Kye-mook Yoo; Jaehoon Rho

doi:10.1186/2052-4374-26-12

Journal List > Ann Occup Environ Med > v.26(1) > 1124821

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Ha, Lee, Yoo, and Rho: The Relationship between the Occupational Exposure of Trichloroethylene and Kidney Cancer

Review

Ann Occup Environ Med 2014;26(1):12.

Published online: 4 February 2014

DOI: https://doi.org/10.1186/2052-4374-26-12

The Relationship between the Occupational Exposure of Trichloroethylene and Kidney Cancer

Inah Kim^1,², Jaehyeok Ha³, June-Hee Lee^1,², Kye-mook Yoo⁴, Jaehoon Rho^1,^2,^5,^*

¹Department of occupational health, Yonsei University Graduate School of Public Health, Seoul, Korea

²Institutes for Occupational Health, Yonsei University College of Medicine, Seoul, Korea

³Department of occupational health, Seoul National University Graduate School of Public Health, Seoul, Korea

⁴Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Ulsan, Korea

⁵Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea

^*Correspondence: jhroh@yuhs.ac ¹Department of occupational health, Yonsei University Graduate School of Public Health, Seoul, Korea ²Institutes for Occupational Health, Yonsei University College of Medicine, Seoul, Korea Full list of author information is available at the end of the article

Received 15 May 2014 Revised 21 May 2014 Accepted 3 June 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Abstract Trichloroethylene (TCE) has been widely used as a degreasing agent in many manufacturing industries. Recently, the International Agency for Research on Cancer presented “sufficient evidence” for the causal relationship between TCE and kidney cancer. The aim of this study was to review the epidemiologic evidences regarding the relationship between TCE exposure and kidney cancer in Korean work environments. The results from the cohort studies were inconsistent, but according to the meta-analysis and case–control studies, an increased risk for kidney cancer was present in the exposure group and the dose–response relationship could be identified using various measures of exposure. In Korea, TCE is a commonly used chemical for cleaning or degreasing processes by various manufacturers; average exposure levels of TCE vary widely. When occupational physicians evaluate work-relatedness kidney cancers, they must consider past exposure levels, which could be very high (>100 ppm in some cases) and associated with jobs, such as plating, cleaning, or degreasing. The exposure levels at a manual job could be higher than an automated job. The peak level of TCE could also be considered an important exposure-related variable due to the possibility of carcinogenesis associated with high TCE doses. This review could be a comprehensive reference for assessing work-related TCE exposure and kidney cancer in Korea.

Keywords: Trichloroethylene, Kidney cancer, Korea, Work-related, Occupation, Exposure

References

1. NIOSH. Special Occupational Hazard Review with Control Recommendations Trichloroethylene. U.S: Dept. of Health Education and Welfare Public Health Services;1978. p. 1–59.

2. Dekant W, Metzler M, Henschler D. Novel metabolites of trichloroethylene through dechlorination reactions in rats, mice and humans. Biochem Pharmaco. 1984; 33(13):2021–2027.

3. Guha N, Loomis D, Grosse Y, Lauby-Secretan B, El Ghissassi F, Bouvard V, Benbrahim-Tallaa L, Baan R, Mattock H, Straif K. International agency for research on cancer monograph working group. Carcinogenicity of trichloroethylene, tetrachloroethylene, some other chlorinated solvents, and their metabolites. Lancet Oncol. 2012; 13(12):1192–1193.

6. McCredie M, Ford JM, Stewart JH. Risk factors for cancer of the renal parenchyma. Int J Cancer. 1988; 42:13–16.

7. Christensen PJ, Craig JP, Bibro MC, O'Connell KJ. Cysts containing renal cell carcinoma in von Hippel-Lindau diseases. J Urol. 1982; 128:798–800.

8. IARC. List of Classifications by Cancer Sites with Sufficient or Liited Evidence in Human, Volumes 1 to 109. http://monographs.iarc.fr/ENG/Classification/Table4.pdf.

9. Korea Occupational Safety and Health Agency. National working.

10. Cho HY, Cho SH, Ryoo JJ, Kim BG, Park S, Kang SK. A survey on the status of using trichloroethylene (TCE) in Korea. J Korean Soc Occup Environ Hyg. 2007; 17(3):254–260.

11. Paik NW, Choi YS, Meng KH. Trichloroethylene poisoning in degreasing process of an electric appliances manufacturing. Korean J Occup Health. 1970; 9(2):4–8.

12. Kim HA, Lee KM. Urinary excretion of total trichloro-compounds and air trichloroethylene concentration in trichloroethylene related workers. Korean J Occup Health. 1989; 28(1):9–13.

13. Kim CY, Cho CJ, Kim YH, Park DY, Paik NW, Kim HA, Lee KM. Trichloroethylene exposure of workers employed in degreasing process of metal manufacturing. Korean J Occup Health. 1989; 28(4):126–137.

14. Lee KH, Paik NW. A study on worker exposure to trichlorethylene and emission factor for degreasers in plating plants. J Korean Soc Occup Environ Hyg. 1993; 3(1):3–13.

15. Jeon HS, Kim HW. The relationship between airborne trichloroethylene concentrations and total trichloro – compounds and trichloroacetic acid in urine. J Korean Soc Occup Environ Hyg. 1994; 4(1):7–16.

16. Kang SK, Cho YS, Moon YH. Brain stem auditory evoked potential and R-R interval analysis of the workers exposed to trichloroethylene. Korean J Occup Environ Med. 1995; 7(1):111–119.

17. Scott CS, Jinot J. Trichloroethylene and cancer: systematic and quantitative review of epidemiologic evidence for identifying hazards. Int J Environ Res Public Health. 2011; 8:4238–4272.

18. Karami S, Lan Q, Rothman N, Stewart PA, Lee KM, Vermeulen R, Moore LE. Occupational trichloroethylene exposure and kidney cancer risk: a meta-analysis. Occup Environ Med. 2012; 69(12):858–867.

19. Bruckner JV, Anand SS, Warren DA. Toxic Effects of Solvents and Vapors. In The Basic Science of Poisons. InCasarett & Doull's Toxicology: Klaassen CD. McGrqw-Hill Education;2013. p. 1031–1130.

20. Zhao Y, Krishnadasan A, Kennedy N, Morgenstern H, Ritz B. Estimated effects of solvents and mineral oils on cancer incidence and mortality in a cohort of aerospace workers. Am J Ind Med. 2005; 48:249–258.

21. Raaschou-Nielsen O, Hansen J, McLaughlin JK, Kolstad H, Christensen JM, Tarone RE, Olsen JH. Cancer risk among workers at Danish companies using trichloroethylene: a cohort study. Am J Epidemiol. 2003; 158(12):1182–1192.

22. Morgan RW, Kelsh MA, Zhao K, Heringer S. Mortality of aerospace workers exposed to trichloroethylene. Epidemiology. 1998; 9:424–431.

23. Boice JD Jr, Marano DE, Cohen SS, Mumma MT, Blot WJ, Brill AB, Fryzek JP, Henderson BE, McLaughlin JK. Mortality among Rocketdyne workers who tested rocket engines, 1948–1999. J Occup Environ Med. 2006; 48:1070–1092.

24. Moore LE, Boffetta P, Karami S, Brennan P, Stewart PS, Hung R, Zaridze D, Matveev V, Janout V, Kollarova H, Bencko V, Navratilova M, Szeszenia-Dabrowska N, Mates D, Gromiec J, Holcatova I, Merino M, Chanock S, Chow WH, Rothman N. Occupational trichloroethylene exposure and renal carcinoma risk: evidence of genetic susceptibility by reductive metabolism gene variants. Cancer Res. 2010; 70:6527–6536.

25. Charbotel B, Fevotte J, Hours M, Martin JL, Bergeret A. Case– control study on renal cell cancer and occupational exposure to trichloroethylene. Part II: Epidemiological aspects. Ann Occup Hyg. 2006; 50:777–787.

26. Bruning T, Pesch B, Wiesenhutter B, Rabstein S, Lammert M, Baumuller A, Bolt HM. Renal cell cancer risk and occupational exposure to trichloroethylene: results of a consecutive case–control study in Arnsberg, Germany. Am J Ind Med. 2003; 43(3):274–285.

27. Pesch B, Haerting J, Ranft U, Klimpel A, Oelschlägel B, Schill W. Occupational risk factors for renal cell carcinoma: agent-specific results from a case-control study in Germany. MURC Study Group. Multicenter urothelial and renal cancer study. Int J Epidemiol. 2000; 29(6):1014–1024.

28. Goeptar AR, Commandeur JNM, van Ommen B, van Bladeren PJ, Vermeulen NPE. Metabolism and kinetics of trichloroethylene in relation to carcinogenicity. Relevance of the mercapturic acid pathway. Chem Res Toxicol. 1995; 8:3–21.

Table 1

Crude incidence rate (CR) and age-standardized incidence rate (ASR) of kidney cancer per 100,000 persons from 1999 to 2011 in Korea

	Total		Men		Women
	CR	ASR	CR	ASR	CR	ASR
1999	3.0	3.1	4.1	4.7	1.9	1.7
2000	3.0	3.0	4.1	4.6	1.9	1.8
2001	3.5	3.4	4.7	5.1	2.2	2.0
2002	3.6	3.5	5.0	5.2	2.3	2.1
2003	3.9	3.6	5.3	5.4	2.5	2.2
2004	4.3	3.9	5.8	5.7	2.8	2.4
2005	4.9	4.2	6.6	6.3	3.1	2.5
2006	5.4	4.6	7.4	6.8	3.5	2.7
2007	6.0	5.0	8.3	7.4	3.7	2.9
2008	6.6	5.2	9.0	7.8	4.1	3.1
2009	7.0	5.5	9.4	7.9	4.5	3.3
2010	7.3	5.5	10.1	8.3	4.3	3.1
2011	8.0	6.2	10.9	8.6	5.1	3.6
APC*	6.2	2 (p<0.05)	5.9	9 (p<0.05)	6.3	3 (p<0.05)

^* APC; Annual Percentage Change, expressed as (exp(b)-1)×100, where b is the estimated slope of a linear regression from a logarithmic scaled age-standardized rates and calendar years.

Table 2

Trends in kidney cancer incidence rates in Korea (per 100,000 persons)

Age (years)	Men								Women
Age (years)	2002	2003	2004	2005	2009	2010	2011	2002	2003	2004	2005	2009	2010	2011
0–9	0.6	0.6	0.7	0.6	0.8	0.9	0.8	0.8	0.5	0.5	0.6	0.6	0.7	0.7
10–19	0.0	0.1	0.3	0.1	0.1	0.1	0.1	0.0	0.1	0.0	0.1	0.1	0.1	0.2
20–29	0.4	0.4	0.4	0.6	0.8	0.7	0.7	0.4	0.3	0.3	0.3	0.6	0.3	0.6
30–39	1.9	2.0	2.1	2.2	3.8	3.9	4.3	0.9	1.2	1.1	1.0	1.3	1.7	2.1
40–49	5.4	6.7	6.5	7.1	9.4	9.8	10.3	1.9	3.0	3.0	2.5	4.1	3.7	4.0
50–59	13.7	13.0	12.4	15.0	18.4	20.5	21.1	5.3	4.3	6.3	5.6	8.1	7.7	8.5
60–69	22.7	23.2	24.7	24.5	31.8	33.1	33.6	8.1	8.9	8.1	10.1	12.8	12.3	13.5
≥70	26.2	25.4	32.4	36.5	42.2	41.5	44.5	9.6	9.5	9.8	13.0	15.3	13.6	16.5

Table 3

Exposure status according to trichloroethylene use in 2006 in Korea

Type of industry	No. of factories	No. of workers	Amount used (L/month)	Concentration range (ppm)
Total	103	390	87,320	–
Chemical	3	19	4,116	0.97∼13.26
Plastics & rubber products	1	35	6,830	ND∼42.63
Primary metal	6	18	6,787	2.91∼37.35
Fabricated metal products	24	59	11,990	ND∼30.80
Machinery	18	59	3,950	ND∼48.48
Computer & electronic products	9	62	19,596	0.08∼41.55
Electrical equipment, appliance	10	56	4,771	ND∼21.29
Transportation equipment	18	30	23,920	ND∼49.87
Others	14	52	5,360	ND∼39.51

ND; Non-detectable, concentration level was lower than the detection limit.(Source: Cho et al. 2007) [10].

Table 4

Exposure levels of trichloroethylene by Korean manufacturing industry jobs according to the regular work environment measurement (2002∼2010)

Job	No. of samples	Arithmetic mean (ppm)	Median (ppm)	Geometric mean (ppm)	Maximum (ppm)
Cleaning	8,374	8.953	2.33495	0.16013	598
Degreasing	421	7.780	2.01080	0.04185	152
Assembly	1,146	2.850	0.08975	0.00101	237
Adhesion	700	1.044	0.16850	0.00172	29
Coating	671	3.250	0.48790	0.01499	154
Painting	3,713	1.326	0.00000	0.00015	148
Processing	1,046	3.955	0.41855	0.01159	108
Inspection	890	2.704	0.59650	0.01061	94
Printing	1,519	1.948	0.17800	0.00518	65
Soldering	802	2.053	0.42860	0.00881	50
Plating	399	8.508	3.17970	0.25311	63
Molding	507	4.545	0.71700	0.01194	60
Laboratory	317	0.692	0.00000	0.00006	48
Impregnation	199	7.697	0.18200	0.00839	185
Mixing	511	1.807	0.09700	0.00111	54
Heat treatment	201	4.982	1.00000	0.01987	64
Plugging	34	0.565	0.08136	0.00063	8
Infusion	267	5.846	0.40630	0.01467	270
Reaction	138	0.461	0.00000	0.00005	6
Packing	273	2.128	0.27600	0.00597	45
Cast	124	2.601	0.04165	0.00060	43
Others	11,400	9.318	0.27935	0.00540	1,471
Total	33,652	6.497	0.40790	0.00840	–

Table 5

Exposure levels of cleaning or degreasing jobs using assessment of reliability of work environment monitoring in 2006 in Korea

Industry in manufacturer	Job1	Job2	Method	Range of concentration (ppm)
Electronic components (LCD panel frame)	Press	Processing & cleaning	Solid sampler. NIOSH method 1022	8.258∼11.995
Power electric equipment (painting transformers)	Storing component & cleaning	Printing & cleaning	Solid sampler. NIOSH method 1022	Painting and cleaning: 0.343∼9.742 masking: 1.099∼16.432, touch up:0.149∼2.462
Measuring, optic and precision instrument	Press & cleaning	Grinding & cleaning	Solid sampler. diffusive sample	16.99∼114.41 (including manual work)
Television and communication equipment	Press molding & processing	Assembly & cleaning	Solid sampler. NIOSH method 1022	85.44 in manual (closed 1 years ago), 2.16∼3.75 in automatic
Optic equipment and lens	Cutting	Cleaning	Solid sampler. NIOSH method 1022	52.90 (in indoor)
Parts and accessories for motor vehicle	Assembly & dipping	Bonding & cleaning	Sorbent tube	11.57∼18.52
Electronic components	Press	Cleaning	Sorbent tube	31.72∼49.86
Textile	Degummed and twist thread	Decontamination	Sorbent tube	0.14∼1.38
Plating	1 ^st cleaning	2nd cleaning	Sorbent tube	1st cleaning: 28.59, 3.55 2nd cleaning: 39.28, 1.81
Metal tooling	Press	Cleaning	Solid sampler. NIOSH method 1022	8.75∼9.22
Parts and accessories for motor vehicle	Mixing & surface treatment	Degreasing	KOSHA CODE-A-1–2004 (Method No. 016)	2.56
Other electric equipment	Wring & dipping	Assembly & impregnation	KOSHA CODE-A-1–2004 (Method No. 016)	0.03∼0.05
Rubber goods production	Preparation	Degreasing	KOSHA CODE-A-1–2004 (Method No. 016)	15.49∼88.84
Other metal product	Press and spot welding	Cleaning	KOSHA CODE-A-1–2004 (Method No. 016)	7.21∼11.7
Transport machineries and equipment	Press and spot welding	Cleaning	KOSHA CODE-A-1–2004 (Method No. 016)	14.90∼49.83
Non-metallic mineral product	Melting & extrusion	Press & cleaning	KOSHA CODE-A-1–2004 (Method No. 016)	41.32∼116.62

Table 6

Summary o of risk measurement of the major cohor rt and case– control studies

Authors, (years) country	Study subjects/design	Exposure measurement	Overall OR or RR	ORs or RRs according to exposure level
Moore et al. (2010) [24] Czech Republic, Poland, Romania, Russia	Hospitals in 4 European countries (n = 1,097),1999–2003; hospital controls with diagnoses unrelated to smoking or genitourinary disorders (n = 1,476)/case–control	Specialized job-specific questionnaire for specific jobs or industries of interest focused on TCE with exposure assignment by frequency and confidence of TCE exposure	1.63 (1.04–2.54) for all subjects 2.05 (1.13–3.73) for high-confidence assessments only	Duration <13.5 yrs: 1.89 (0.84–4.28)≥13.5 yrs: 2.25 (0.95–5.29)<1080 hrs: 1.22 (0.48–3.12)≥1080 hrs: 2.86 (1.31–6.23) Cumulative <1.58 ppm·yr: 1.77 (0.64–4.80)≥1.58 ppm·yr: 2.23 (1.07–4.64) Average intensity <0.076 ppm: 1.73 (0.75–4.02)≥0.076 ppm: 2.41 (1.05–5.56)*reference group: non-exposed
Chabotel et al. (2006)[25] France	RCC (n = 87), from urologists' files and area teaching hospitals, 1993–2003; urologist or general practitioner patient controls (n = 316)/case–control	Semi-quantitative cumulative TCE exposure and presence/absence of peak TCE exposure assigned to subjects using a JEM designed using information obtained from questionnaires and routine atmospheric monitoring of workshops or biological monitoring (U-TCA) of workers carried out since the 1960s.	1.64 (0.95–2.84) for full study;1.68 (0.97–2.91) with 10-yr lag	High cumulative level: 3.34(1.27–8.74) ppm·yrs 1–154: 0.85 (0.10–7.41)155–335: 1.03 (0.29–3.70)>335: 3.34 (1.27–8.74) peak + cumulative level (−)/low-medium: 0.90 (0.27–3.01)(+)/low-medium: 1.34 (0.13–14.0)(−)/high: 2.74 (0.66–11.4)(+)/high: 3.80 (1.27–11.4) with 10-yr lag high: 2.16 (1.01–4.65)+peaks: 3.15 (1.19–8.38)
Zhao et al. (2005)[20] USA	Aerospace workers with >2 yrs of employment at Rockwell/Rocketdyne's Santa Susana Field Laboratory, 1950–1993, follow up 1950–2001(mortality, n = 6,044), 1988–2000 (incidence, n = 5,049) /cohort	Using job titles, job codes, dates of employment related with JEM and calculated cumulative intensity scores		mortality medium: 0.85 (0.15–4.93) & 1.69 (0.29–9.70) with 20-yrs lag high: 0.96 (0.09–9.91) & 1.82(0.09–38.6) with 20-yrs lag incidence medium: 1.26 (0.26–6.14) & 1.19 (0.22–6.40) with 20-yrs lag high: 7.71 (0.65–91.4) & 7.40(0.47–116)
Brüning et al. (2003)[26] Germany	Histologically confirmed RCC (n = 134), from hospitals, 1992–2000; hospital controls (n = 401)/case–control	Self-reported exposure duration using JEM	2.47 (1.36–4.49)	<10 yr: 3.78 (1.54–9.28)10-<20 yr: 3.78 (1.54–9.28)≥20 yr: 2.69 (0.84–8.66)
Raaschou-Nielsen et al.(2003) Denmark	Blue-collar workers employed >1,968 at 347 TCE-using companies (n = 40,049; 14,360 with presumably higher-level exposure to TCE). Follow up to 1997/cohort	duration of employment, yrs of 1 ^st employment at a TCE-using company, number of employees in the company	1.20 (0.94–1.50)	≥5 years all subject: 1.6 (1.1–2.2) in subcohort with expected higher exposure levels: 1.7 (1.1–2.4)
Pesch et al. (2000)[27] Germany	Histologically confirmed RCC from hospitals (5 regions) (n = 935), 1991–1995; controls randomly selected from residency registries (n = 4,298)/case–control	TCE and other exposures assigned by questionnaire, assessed occupational history using job title (JEM approach)	1.24 (1.03–1.49)	substantial exposure men: 1.3 (0.8–2.1) women: 1.8 (0.6–5.0) high exposure men: 1.1 (0.8–1.5) women: 1.8 (0.6–1.9) medium exposure men: 1.3 (1.0–1.8) women: 1.3 (0.7–2.6)
Morgan et al. (1998)[22] USA	Aerospace workers with >6 mths during 1950–1985 at Hughes (Tucson, AZ)(n = 20,503; 4,733 with TCE exposure), follow up 1950–19/cohort	TCE exposure intensity assigned using JEM.	1.14 (0.51–2.58)	High cumulative exposure score:1.59 (0.68–3.71)

TOOLS

Similar articles