American Journal of Industrial Medicine 20123-125 (1991)
SHORT COMMUNICATION
Renal Cell Carcinoma Among Architects Jan T. Lowery, BA, John M. Peters, MD, Stephanie J. London, MD, DrPH
ScD,
Dennis Deapen, DrPH, and
Data from a population-based cancer registry were analyzed according to occupation and industry at the time 'of diagnosis as part of a routine surveillance of the data for associations between occupation and cancer risk. A total of 119 cases of cancer of all sites were reported among architects between 1972-1986. From a total of 2,059 renal cell carcinomas in the registry, the 13 cases were observed among male architects, aged up to 64,3.1 were expected. Significant elevations were not observed among other professional groups. Architects are exposed to several toxic and potentially carcinogenic chemicals. We suggest that investigators with cancer registry data coded according to occupation evaluate whether an association between employment as an architect and renal carcinoma exists in their data. Key words: surveillance, cancer registry, occupational cancer, epidemiology, etiology, kidney neoplasms
INTRODUCTION
As part of a surveillance activity to look for occupationally related cancers, data from the Los Angeles County Cancer Surveillance Program were analyzed according to occupation. The number of renal cell carcinomas among male architects exceeded the number of expected cases for that population. This report describes these findings and discusses some potential etiologic factors. MATERIALS AND METHODS
The Cancer Surveillance Program (CSP) at the University of Southern California School of Medicine identifies nearly all new cases of cancer in Los Angeles County [Hisserich et al., 19751. When a new case is identified, information is abDivision of Environmental Health Sciences, University of California Los Angeles, School of Public Health (J.T.L.). Division of Occupational and Environmental Medicine (S.J.L., J.M.P.), and the Department of Preventive Medicine (D.D.), University of Southern California School of Medicine, Los Angeles, CA. Address reprint requests to Dr. Stephanie London, Division of Occupational and Environmental Medicine, University of Southern California School of Medicine, PMB B306, 1420 San Pablo St., Los Angeles, CA 90033. Accepted for publication November 14, 1990.
0 1991 Wiley-Liss, Inc.
124
Lowery et al.
stracted from the medical record on age, sex, race, religion, address, tumor type and site, and occupation or industry at time of diagnosis. Data were analyzed for 485 occupational groups. Age-adjusted proportional incidence ratios (PIR) are calculated for specific tumor types and sites by occupational category for persons aged 20-64 with a known occupation. The PIR for a given cancer site and specific occupation or industry is the ratio of the observed number of cases occurring among persons in that occupation or industry to the expected number of cases multiplied by 100. The expected number of tumors of a specific site and type within a given occupation is derived by multiplying the number of all tumors occurring in persons with the occupation of interest by the proportion of all tumors accounted for by the tumor of interest among persons of all occupations. We examined data for cases diagnosed between 1972 and 1986. To characterize the likely exposures of architects, we conducted open-ended interviews with six architects in the Los Angeles area about work practices and products used over the past 20 years. In order to identify specific agents, we examined the labels of commercially available products used by architects. RESULTS
We present data for the 13 males only because there were too few female architects to calculate stable estimates. The PIR for renal cell carcinoma among male architects diagnosed between 1972 and 1986 was found to be elevated (3.1 expected, 13 observed, PIR = 420, 95% confidence interval 223-77 1). Twelve cases were white and one was Asian. All cases had been married. We found no predominance of any religious preference. We did not observe a significant increase in renal cell carcinoma among other groups of professionals such as doctors, dentists, administrative personnel, or sales workers. DISCUSSION
We observed an excess of renal cell carcinoma among architects. In screening routinely collected data, we calculated many statistical comparisons and a statistically significant association might have resulted by chance. Furthermore, an elevated risk among male architects might be consistent with the predominance of renal cancers among upper socioeconomic status white males [Paganini-Hill et al., 19881. However, we did not observe a significantly increased risk of renal carcinoma among other predominantly white, male, upper socioeconomic status professions. We have no data on risk factors for renal cell carcinoma that might explain the elevated risk among architects. Nevertheless, it is possible that occupational exposure to carcinogens might be related to the apparent excess of renal cancers. Our survey of six architects and inspection of labels of commercially available products they use indicate that this group is exposed to some potential carcinogens, including toluene, xylene, carbon tetrachloride, butane, heptane, and 1,l ,1 trichloroethane. Past exposures to compounds such as benzene, which are no longer primary constituents of products used by architects, are likely to have occurred. Many architects work long hours in direct contact with these potentially toxic compounds and are frequently self-employed or work in small firms. They may not always use proper
Renal Carcinoma Among Architects
125
ventilation controls. Past exposures may have been higher due to a lack of awareness of the potential dangers of some of the materials. We know of no experimental data, however, implicating any of these compounds as renal carcinogens in particular. Some epidemiologic studies suggest a possible link between hydrocarbon exposure and renal cancer [Kadamani et al., 1989, Brownson, 1988, Shalat et al., 1989, Redmond et al., 1972, Paganini-Hill et al., 19801. Data from the Swedish CancerEnvironment Registry indicated a significant increased risk of renal cancer among several professional and white collar occupations [McLaughlin et al., 19871; data for architects alone were not presented. Investigators with access to cancer registry data from other locations may wish to examine a possible association between employment as an architect and renal cancer. REFERENCES Brownson RC (1988): A case-control study of renal cell carcinoma in relation to occupation, smoking, and alcohol consumption. Arch Environ Hlth 43:238-40. Hisserich JC, Martin SP, Henderson BE (1975): An area-wide cancer reporting network. Public Health Rep 90:15-17. Kadamani S, Asal N, Nelson R (1989): Occupational hydrocarbon exposure and risk of renal cell carcinoma. Am J Ind Med 15:131-141. McLaughlin JK, Malker HSR, Stone BJ, Weiner JA, Malker BK, Ericsson JL, Blot WJ, Fraumeni JF (1987): Occupational risks for renal cancer in Sweden. Br J Ind Med 44:119-123. Paganini-Hill A, Ross RK, Henderson BE (1988): Epidemiology of renal cancer. In Skinner D, Lieskovsky G (eds): “Diagnosis and Management of Genitourinary Cancer. ” Philadelphia: W.B. Saunders Co. pp 32-39. Paganini-Hill A, Glazer E, Henderson BE, Ross RK (1980): Cause-specific mortality among newspaper web pressmen. J. Occup Med 22:542-44. Redmond CK, Ciocco A, Lloyd W, Rush H (1972): Long-term mortality study of steelworkers. J Occup Med 14:621-29. Shalat SL, True LD, Fleming LE, Pace P (1989): Kidney cancer in utility workers exposed to polychlorinated biphenyls (PCBs). Br J Ind Med 46:823-24.
SHORT COMMUNICATION
Renal Cell Carcinoma Among Architects Jan T. Lowery, BA, John M. Peters, MD, Stephanie J. London, MD, DrPH
ScD,
Dennis Deapen, DrPH, and
Data from a population-based cancer registry were analyzed according to occupation and industry at the time 'of diagnosis as part of a routine surveillance of the data for associations between occupation and cancer risk. A total of 119 cases of cancer of all sites were reported among architects between 1972-1986. From a total of 2,059 renal cell carcinomas in the registry, the 13 cases were observed among male architects, aged up to 64,3.1 were expected. Significant elevations were not observed among other professional groups. Architects are exposed to several toxic and potentially carcinogenic chemicals. We suggest that investigators with cancer registry data coded according to occupation evaluate whether an association between employment as an architect and renal carcinoma exists in their data. Key words: surveillance, cancer registry, occupational cancer, epidemiology, etiology, kidney neoplasms
INTRODUCTION
As part of a surveillance activity to look for occupationally related cancers, data from the Los Angeles County Cancer Surveillance Program were analyzed according to occupation. The number of renal cell carcinomas among male architects exceeded the number of expected cases for that population. This report describes these findings and discusses some potential etiologic factors. MATERIALS AND METHODS
The Cancer Surveillance Program (CSP) at the University of Southern California School of Medicine identifies nearly all new cases of cancer in Los Angeles County [Hisserich et al., 19751. When a new case is identified, information is abDivision of Environmental Health Sciences, University of California Los Angeles, School of Public Health (J.T.L.). Division of Occupational and Environmental Medicine (S.J.L., J.M.P.), and the Department of Preventive Medicine (D.D.), University of Southern California School of Medicine, Los Angeles, CA. Address reprint requests to Dr. Stephanie London, Division of Occupational and Environmental Medicine, University of Southern California School of Medicine, PMB B306, 1420 San Pablo St., Los Angeles, CA 90033. Accepted for publication November 14, 1990.
0 1991 Wiley-Liss, Inc.
124
Lowery et al.
stracted from the medical record on age, sex, race, religion, address, tumor type and site, and occupation or industry at time of diagnosis. Data were analyzed for 485 occupational groups. Age-adjusted proportional incidence ratios (PIR) are calculated for specific tumor types and sites by occupational category for persons aged 20-64 with a known occupation. The PIR for a given cancer site and specific occupation or industry is the ratio of the observed number of cases occurring among persons in that occupation or industry to the expected number of cases multiplied by 100. The expected number of tumors of a specific site and type within a given occupation is derived by multiplying the number of all tumors occurring in persons with the occupation of interest by the proportion of all tumors accounted for by the tumor of interest among persons of all occupations. We examined data for cases diagnosed between 1972 and 1986. To characterize the likely exposures of architects, we conducted open-ended interviews with six architects in the Los Angeles area about work practices and products used over the past 20 years. In order to identify specific agents, we examined the labels of commercially available products used by architects. RESULTS
We present data for the 13 males only because there were too few female architects to calculate stable estimates. The PIR for renal cell carcinoma among male architects diagnosed between 1972 and 1986 was found to be elevated (3.1 expected, 13 observed, PIR = 420, 95% confidence interval 223-77 1). Twelve cases were white and one was Asian. All cases had been married. We found no predominance of any religious preference. We did not observe a significant increase in renal cell carcinoma among other groups of professionals such as doctors, dentists, administrative personnel, or sales workers. DISCUSSION
We observed an excess of renal cell carcinoma among architects. In screening routinely collected data, we calculated many statistical comparisons and a statistically significant association might have resulted by chance. Furthermore, an elevated risk among male architects might be consistent with the predominance of renal cancers among upper socioeconomic status white males [Paganini-Hill et al., 19881. However, we did not observe a significantly increased risk of renal carcinoma among other predominantly white, male, upper socioeconomic status professions. We have no data on risk factors for renal cell carcinoma that might explain the elevated risk among architects. Nevertheless, it is possible that occupational exposure to carcinogens might be related to the apparent excess of renal cancers. Our survey of six architects and inspection of labels of commercially available products they use indicate that this group is exposed to some potential carcinogens, including toluene, xylene, carbon tetrachloride, butane, heptane, and 1,l ,1 trichloroethane. Past exposures to compounds such as benzene, which are no longer primary constituents of products used by architects, are likely to have occurred. Many architects work long hours in direct contact with these potentially toxic compounds and are frequently self-employed or work in small firms. They may not always use proper
Renal Carcinoma Among Architects
125
ventilation controls. Past exposures may have been higher due to a lack of awareness of the potential dangers of some of the materials. We know of no experimental data, however, implicating any of these compounds as renal carcinogens in particular. Some epidemiologic studies suggest a possible link between hydrocarbon exposure and renal cancer [Kadamani et al., 1989, Brownson, 1988, Shalat et al., 1989, Redmond et al., 1972, Paganini-Hill et al., 19801. Data from the Swedish CancerEnvironment Registry indicated a significant increased risk of renal cancer among several professional and white collar occupations [McLaughlin et al., 19871; data for architects alone were not presented. Investigators with access to cancer registry data from other locations may wish to examine a possible association between employment as an architect and renal cancer. REFERENCES Brownson RC (1988): A case-control study of renal cell carcinoma in relation to occupation, smoking, and alcohol consumption. Arch Environ Hlth 43:238-40. Hisserich JC, Martin SP, Henderson BE (1975): An area-wide cancer reporting network. Public Health Rep 90:15-17. Kadamani S, Asal N, Nelson R (1989): Occupational hydrocarbon exposure and risk of renal cell carcinoma. Am J Ind Med 15:131-141. McLaughlin JK, Malker HSR, Stone BJ, Weiner JA, Malker BK, Ericsson JL, Blot WJ, Fraumeni JF (1987): Occupational risks for renal cancer in Sweden. Br J Ind Med 44:119-123. Paganini-Hill A, Ross RK, Henderson BE (1988): Epidemiology of renal cancer. In Skinner D, Lieskovsky G (eds): “Diagnosis and Management of Genitourinary Cancer. ” Philadelphia: W.B. Saunders Co. pp 32-39. Paganini-Hill A, Glazer E, Henderson BE, Ross RK (1980): Cause-specific mortality among newspaper web pressmen. J. Occup Med 22:542-44. Redmond CK, Ciocco A, Lloyd W, Rush H (1972): Long-term mortality study of steelworkers. J Occup Med 14:621-29. Shalat SL, True LD, Fleming LE, Pace P (1989): Kidney cancer in utility workers exposed to polychlorinated biphenyls (PCBs). Br J Ind Med 46:823-24.
