Navy Cable Manufacturers (Chlorinated Naphthalenes Exposure)
NOTICE: These are NIOSH
Archive Documents, and may not represent current NIOSH Policy.
They are presented here as historical content, for research
and review purposes only. This collection of Worker Notification
Materials and any recommendations made herein are relevant
for specific worker populations. The results do not predict
risk for a given individual. The results may not be universally
applicable.
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The following information will answer questions regarding the
findings of the NIOSH Study of workers exposed to Chlorinated
Naphthalenes (such as Halowax):
Chlorinated Naphthalenes and Cirrhosis of the Liver
1996
This sheet provides more information and answers some questions
you may have about the study, Halowax exposure, liver disease,
and steps to protect your health.
Why Didn't You Give Us This Information 50 Years Ago?
Although the exposures we studied happened during World War II, NIOSH
didn't begin this study until 1982. We only completed the
study in 1994. We could not provide the study results until
the study was done.
How Could I Have Been in a Study Without Knowing It?
Because the study was based on records – we didn't need to contact
workers. The study was based on work records and death certificates.
When Were the Effects of CNs First Known?
Doctors have known since World War I that chlorinated naphthalenes
(CNs) can cause the acne-like skin disease chloracne. Chloracne
is a severe land of acne that results only from certain types
of chemical exposures. In the late 1930's, doctors began to
suspect that CNs could cause immediate harm to the liver and
even death. This was because a number of people exposed to
CNs died from acute yellow atrophy of the liver. This is a
severe type of liver damage. During this time, studies on
lab animals also showed that CNs damaged the liver. However,
the NIOSH study is the first one to look at long-term effects.
Until it was completed, we didn't know that CNs could cause
cirrhosis of the liver years after exposure ended.
What Do You Mean by "Long-Term Effects?"
When a chemical causes illness right away, it is said to have short-term
or acute effects. For example, a very high exposure to carbon
monoxide in an enclosed space (like a car running in a closed
garage) can cause death very quickly. When CNs were first
used, high exposures caused chloracne and acute yellow atrophy
of the liver to develop very quickly. Sometimes chemicals
don't cause immediate illness. An illness might not show up
until years later. Years of exposure may be required. This
is called a long-term or chronic effect. An example is cigarette
smoking and lung cancer. It can take decades of smoking before
the lung cancer appears. Really, it's been slowly developing
all that time. Diseases that develop over a long time are
said to have a long latency period.
Where Do CNs Fit into This?
Before the NIOSH study, we knew that high exposures to CNs could
cause immediate liver disease, but we didn't know if lower
exposures could cause liver disease years after exposure.
Our study has now suggested that they can. Not
every exposed person gets sick, though. Whether you get sick
depends on the dose you received, your exposure to other harmful
substances, hereditary sfactors, and your general health.
What Do "Exposure" and "Dose" Mean?
Exposure means that a chemical or physical agent could be taken into
or affect your body. For example, when you lie on a beach,
you are exposed to the sun (a physical agent), which can cause
sunburn. When you work in a factory with chemicals, you could
be exposed to the chemicals. The amount of chemicals that
get into your body is called the dose. The
dose is a combination of the concentration of the chemical
and the length of time that you are exposed to it.
Dose-Response
For most diseases, the higher the dose, the more likely you
will become sick. This association between dose and sickness
is called the dose-response relationship. In our study,
we didn't know the concentration of Halowax in the air.
We didn't even know where in the plant people worked. Therefore,
our best estimate of exposure and dose was how long each
person had worked in the plant. However,
length of employment is not a very good estimate of exposure
or dose, and sometimes a workplace chemical causes disease
without showing an association with length of employment.
Rectal Cancer
In our study, we did see a relationship between length of employment
and rectal cancer. This was confusing, however, because
no chemicals known to cause rectal cancer were present.
Therefore, we cannot tell if the rectal cancer was related
to work.
Cirrhosis of the Liver
On the other hand, even though there is good evidence that
CNs can cause deaths from liver disease, we did not see
a clear link between death from cirrhosis of the liver and
length of employment. This probably was due to the limitations
of using length of employment as a measure of dose. Since
we had to count workers with little exposure to Halowax
the same as those with a lot of exposure, this might have
kept us from seeing a clear dose-response relationship with
cirrhosis. In addition, most workers were exposed to Halowax
for less than 2 years. It is difficult to see a dose-response
relationship with such short exposures.
Chlorination
Another factor that is important with chlorinated naphthalenes is
the number of chlorine atoms on the naphthalene molecule.
A naphthalene molecule could have anywhere from 1 to 8 atoms
of chlorine on it. (The number of chlorine atoms describes
the degree of chlorination of the naphthalene). Usually, the
more chlorine atoms, the more toxic the chlorinated naphthalene
is.
How Do Chemicals Get into Our Bodies?
The 3 routes of exposure are: eating, breathing, and through the skin.
Eating
Eating is a less common route in the workplace, but can happen
if it's dirty where people eat, if they can't wash their
hands, or if they smoke with dirty hands.
Breathing
Breathing chemicals in the air is a common route of exposure at work.
These chemicals often affect the lungs, but could get to
other organs in the body, too. Heating the wax-like Halowax
lets off vapors in the air that can be breathed in. Breathing
was probably the most important route of exposure for Halowax.
We think that Halowax was in the air throughout the factory,
not just in the Asbestos Department.
Skin
Some chemicals can be absorbed through the skin. Halowax is one
of them. These chemicals can affect various organs in the
body, not just the skin. The skin disease chloracne is usually
caused by skin contact, but also can be caused by breathing
CNs.
Why Do CNs Affect the Liver?
The liver is the body's chemical factory. One of the functions
of the liver is to get rid of the poisons or toxins that get
in our bodies. The liver performs chemical reactions that
change the chemicals so we can excrete them. Since harmful
chemicals are processed by the liver, they sometimes hurt
the liver itself. Alcohol is the best-known substance that
harms the liver, but there are many more as well. Although
CNs are quite different from alcohol, the effect of CNs is
also mainly on the liver.
What Is Cirrhosis of the Liver?
It is the last stage of chronic liver disease. It consists of
widespread fibrosis or scarring and the death of liver cells.
It usually happens over the course of several years.
Can You Tell What Caused Someone's Cirrhosis?
This sometimes can be difficult. Late stage cirrhosis of the liver
tends to look the same whatever caused it. Also, like many
occupational diseases, cirrhosis from CNs can develop years
after exposure. With that type of delay, it is hard to connect
the disease to the exposure. A doctor would look at a patient's
history of exposures to liver poisons to try to determine
the cause. Sometimes, there could be a combination of causes,
such as both alcohol and CNs. Since there is research evidence
from both humans and animals that CNs cause cirrhosis of the
liver, potential exposure to CNs (even years ago) would certainly
suggest that they played an important role. Doctors who specialize
in diseases caused at work (occupational medicine) are trained
to make these evaluations. You may want to see a doctor at one of the
clinics listed on the green sheet, if one is near you.
How Can I Avoid Getting Cirrhosis?
The first thing to do is to see your doctor. Tell him or her that
you were exposed to CNs 50 years ago, and that you may still
be at increased risk of developing cirrhosis of the liver.
Your doctor will probably do some tests to see if your liver
is functioning properly. He or she will then advise you based
on the results. These tests may be slightly abnormal even
though you do not feel any symptoms. Even if the tests show
that your liver has some problems, that does not necessarily
mean that they will become serious. Not everyone exposed to
CNs will develop liver disease. 150 people out of the 9,028
in our study died of cirrhosis of the liver during our study.
We're not sure why these people were affected. Perhaps their
exposures to CNs were higher. Maybe they drank more alcohol
or were exposed to other liver poisons. Possibly hereditary
factors made them more susceptible.
Should I Avoid Other Liver Poisons?
Yes. Even though your liver is healthy today, it's best to avoid
other substances that harm the liver. Your liver may have
survived the CNs just fine, but a "double whammy"
from another chemical that also hurts the liver could be too
much.
Avoid Alcohol
Discuss with your doctor whether you should restrict your consumption of alcohol.
Avoid Certain Medications
Some medications harm the liver, even over-the-counter ones. Ask your doctor about the ones you take.
Avoid Harmful Chemicals
Many other chemicals used at work, around the home, or in hobbies
could hurt the liver. Examples include furniture strippers,
solvents, weed killers, and pesticides. Ask your doctor
or NIOSH about the chemicals that you use. Some chemicals
might be used safely with the proper protection. Protective
gloves and clothing could prevent skin contact. Respirators
can prevent breathing chemicals. Call NIOSH for advice on
protection because the clothing and respirators must be
right for the specific substance that you are using or they
won't help.
How Concerned Should I Be?
You should be concerned, but not anxious. Most people will not
develop liver problems, and that's true for you, too. The
best thing is to talk to your doctor, so you know for sure.
If you have other questions, call at the NIOSH toll-free
number: 1-800-356-4674.
Findings of the NIOSH Halowax Study
Findings of the NIOSH Halowax Study
What Is NIOSH?
NIOSH is the National Institute for Occupational Safety and Health.
It is a federal agency that does research on health and safety
in the workplace. We recently did a study to look at the long-term
effects of exposure to chlorinated naphthalenes (CNs). The
purpose of the study was to see if exposure to CNs causes
cirrhosis of the liver or the cancers soft tissue sarcoma
(STS), lymphoma, or liver cancer.
How the Study Was Done (Manufacturing Process)
This plant made asbestos-insulated cable for the Navy during World
War II. Halowax was the trade name of the CN used to insulate
the electrical cable in the Asbestos Department. In addition
to Halowax, other possible toxic exposures included asbestos,
carbon tetrachloride, and polychlorinated biphenyl (PCBs).
Subjects
The study group included 9,028 men and women who were employed
from 1940 through 1944. We weren't able to find out which
departments people worked in. Therefore, our study group
included workers who never worked in the Asbestos Department,
as well as those who did.
Records
The study was based entirely on records. Workers were not medically
examined. They did not know they were included in the study.
We first looked at the death rates for the whole U.S. population.
This gave us the expected number of deaths. Then we compared
this to the death rates of workers at the study plant.
What the Study Found
Cirrhosis of the Liver
The most important and striking finding was an increase in deaths
from cirrhosis of the liver. We expected about 81 deaths,
but found 150. This is 1½ to 2 times greater than
expected. Most of the deaths (131) were in men. We don't
know why men were more affected than women. Unfortunately,
deaths from cirrhosis have continued into recent years.
Cirrhosis of the liver is the liver disease usually associated with
alcoholism. According to the death certificates, 59 of the
deaths were related to alcoholism. 83 of the cirrhosis deaths
were not. It's possible that drinking and Halowax exposure
together caused some of the cirrhosis of the liver. However,
Halowax by itself also appeared to cause cirrhosis of the
liver.
Soft Tissue Sarcoma (STS)
STS is a catch-all term for cancers in soft tissues of the body.
We found some association between Halowax and deaths from
STSs, but the findings were not as clear as those for cirrhosis.
We expected about 3 deaths from STS, and found 5. Four of
them were in men.
Lung Cancer
A small increase in death from lung cancer was seen (303 deaths
seen, about 231 expected). There are two likely explanations.
First, this may have been related to the asbestos used to
insulate the cable. However, it doesn't appear that most
workers had heavy asbestos exposure because we did not see
the pattern of disease typically seen with heavy asbestos
exposure. Second, smoking may have caused the lung cancer.
Liver Cancer
Because CNs affect the liver, we were concerned about liver cancer
before the study. We found a small increase in deaths from
liver cancer (23 seen, about 18 expected). However, we could
not determine whether there was a link to Halowax.
Lymphoma
One of the cancers we were concerned about before the study
was lymphoma. How- ever, we did not find a link between
Halowax and deaths from lymphoma.
Oral Cancer
We were surprised to find an elevation of cancers inside the
mouth and throat in our study. This hadn't been seen in
other studies, so we had not expected it. This elevation
in oral cancers only occurred in men, not women. Among men,
we expected about 21 deaths from oral cancer, but we found
39. We don't know why men had this increase or whether it
was due to work. The main risk factors for these cancers
are the use of snuff or chewing tobacco, smoking, and drinking.
These behaviors may have played a role.
Rectal Cancer
We were also surprised to find an increase in cancer of the
rectum. We expected about 28 deaths, but we found 58. We
don't know for sure if this excess was associated with work,
but there was some evidence that it was linked to how long
people had worked.
What Does This Mean for You?
It is important for you to understand the results of this study
and to discuss them with your doctor. Even though we found
some increased risks, that doesn't mean that you will get
cirrhosis of the liver or cancer. There are steps you can
take today to protect your health. The blue sheet lists these.
The most important ones are:
to discuss your Halowax exposure with your doctor,
to discuss with your doctor whether to reduce or stop drinking, and
not to smoke or use snuff or chewing tobacco.
Thank You
Thank you for being a part of this valuable study. Any Questions?
If you have any questions about this study or want a copy
of the technical reports, call the NIOSH toll-free
number: 1-800-356-4674.
Steps to Protect Your Health
Steps to Protect Your Health
If you have any questions, please call the NIOSH toll-free
number: 1-800-356-4674.
Talk to Your Doctor
Tell your doctor that you were exposed 50 years ago to chlorinated
naphthalenes. You and your doctor can watch for signs of liver problems.
Talk to your doctor about screening tests for cancer of the rectum.
Everyone over age 50 is advised to have a digital rectal
exam and a stool slide test every year and a sigmoidoscopy
every 3 to 5 years. These tests screen for colon and rectal
cancer.
Drinking
If you drink alcoholic beverages, discuss with your doctor
whether you should reduce the amount or quit. This is because
of your exposure to Halowax, even though it was long ago.
It's possible that Halowax and alcohol together could increase
your risk of cirrhosis of the liver.
Other Liver Poisons
Avoid exposure to chemicals or drugs that could hurt your liver.
The chemicals and drugs that damage the liver are too numerous
to name here. Ask your doctor about any medications that
you take (even over-the-counter).
Before using solvents, furniture strippers, weed killers, bug killers,
or other chemicals, call your doctor or NIOSH to find out
if they harm the liver. Avoid breathing and skin contact
with chemicals. Call NIOSH for advice on protective gloves,
clothing, and respirators.
Tobacco Products
If you smoke or use smokeless tobacco products, NIOSH recommends
that you quit. Smoking causes lung cancer, especially in
people exposed to asbestos. It also causes heart disease
and oral cancer. Snuff and chewing tobacco cause oral cancer.
Even if you have smoked or used smokeless tobacco for a long
time, stopping now will improve your health. The back of
this sheet lists information on programs to quit.
See Your Dentist
Ask your dentist to check your mouth for signs of cancer at
your regular check-up.
Sources of Information
If you have any questions about any information in this packet,
call the NIOSH toll-free number: 1 -800-356-4674.
Information on Tobacco Use
The American Cancer Society has pamphlets on stopping tobacco
use and classes on quitting smoking. Call their toll-free
number, 1-800-227-2345, which will connect you with an ACS
office in your State.
The American Lung Association also has pamphlets and classes
on quitting smoking. Call their toll-free number, 1-800-232-5864,
which will connect you with an ALA office in your State.
For Your Doctor - The NIOSH Halowax Study
For Your Doctor - The NIOSH Halowax Study
This fact sheet contains technical information for your doctor.
The National Institute for Occupational Safety and Health (NIOSH)
is a federal agency that does research on health and safety
in the workplace. We recently completed a study of the long-term
effects of exposure to chlorinated naphthalenes (CNs)
Chlorinated Naphthalenes
The study plant used CNs (sold under the trade name Halowax) to
insulate electrical cable from 1939 to 1944. Chlorinated naphthalenes
consist of 2 fused aromatic rings with 1 to 8 of the hydrogens
substituted with chlorine.
Summary
The major study finding was that workers exposed to the chlorinated
naphthalene product Halowax during World War II have an increased risk
of dying from cirrhosis of the liver that continues today.
Certain cancers were also elevated.
Suggested Evaluation, Treatment, and Screening
Liver function test (ALT, AST, or GTP). If normal, repeat periodically.
If serum transaminase levels are persistently elevated, review
patient's medical and occupational history, consider additional
tests of liver function, and consider referral to a liver
specialist or consultation with an occupational medicine
specialist.
Annual digital rectal exam and hemoccult, sigmoidoscopy every 3-5
years, and annual dental exam.
Exposure to Other Hepatotoxins
Although it has not been shown that exposure to other hepatotoxins
in conjunction with Halowax increases the risk of cirrhosis in
humans, consider advising your patient to reduce his or her consumption of
alcohol and caution your patient about exposure to other hepatotoxic chemicals
and Pharmaceuticals. Chlorinated naphthalenes are wax-like substances that have
been used in cable, insulation, wood preservatives, capacitors,
engine oils, and cutting and grinding fluids. In the US, production
of CNs steadily declined after World War II, and ceased in 1980.
At the study site, CNs were melted in open vats through which
wires coated with asbestos were drawn. It appears that CN
vapor exposure was widespread throughout the plant. Vapor
from the impregnating vats blown out the stacks may have drifted
back into the plant, particularly on the west side. Chlorinated
biphenyls and carbon tetrachloride were also present, but
it is not possible to document how extensive worker exposure
may have been to these compounds. Most of the cohort members did not continue employment after
WWII ended. Maximum exposure to Halowax was 5 years, and over
80% of the workers were exposed for less than 2 years.
Health Effects of Chlorinated Naphthalenes
Chloracne
Use of CNs during World War I led to the first large outbreaks
of chloracne. Chloracne is an acne-like disorder with comedone
formation with or without cysts or pustules, with the follicular
orifices filed with sebaceous and keratinous material. Outbreaks
of chloracne from CN vapor exposure occurred in the late 1930s
and 1940s. 460 cases occurred among workers in the NIOSH study.
Liver Disease
A number of deaths from acute yellow atrophy of the liver (including
8 at the study plant) were reported in the 1930s and 1940s
following exposure to CN vapor over several weeks to months,
with post-mortem liver changes of widespread degeneration
and necrosis. Hepatotoxicity from CN exposure has also been
well documented in animal studies, with a histological pattern
of fatty infiltration, centrilobular degeneration, necrosis,
and cirrhosis. No long-term studies have been done of liver function among
groups of workers exposed to CNs.
A Priori Hypotheses
NIOSH initiated this study because of the toxicologic similarity
of CNs to chlorinated dibenzodioxins and polychlorinated biphenyls
(PCBs). We hypothesized that CN exposure might be associated
with an increased risk of soft tissue sarcoma, lymphoma, liver
cancer, and cirrhosis of the liver.
Methods
The mortality experience of workers was compared to that expected
based on US and Westchester County death rates. The underlying
cause of death was taken from death certificates.
Study Group
The study cohort included 9,028 men and women employed from 1940
- 1944. Of the 9,028, a subcohort of 460 workers who had had
chloracne was also identified. Records do not exist to identify
which departments employees worked in or to determine their
exposure levels.
Study Results
There was no substantial difference in death rates between the workers
who had chloracne and those who did not.
Cancer
A non significant elevation in liver cancer was seen in the total
cohort (23 deaths seen, 18 expected), with no elevation among
the chloracne subcohort. The investigators concluded that
the study results were inconclusive for liver cancer. No association
between CNs and cancer of lymphatic and hematopoietic
tissue was found (56 deaths seen, 75 expected).
It is difficult to assess soft tissue sarcomas in a mortality
study such as this one. The investigators concluded that the
data were suggestive of an association, but did not conclusively
demonstrate one. No excess was observed among women (1 death),
but 4 deaths were seen among men, where 2.25 were expected.
One of the male deaths was in the chloracne subcohort, where
only 0.21 deaths were expected. Neither the male nor the chloracne
elevations in risk were statistically significant.
We found elevations in 3 cancers not hypothesized to be elevated:
lung, oral, and rectal cancers. There was a small increase
in death from lung cancer (303 seen, 231 expected). This could
have been related to smoking or to the asbestos used to insulate
the cable. However, we did not see the pattern of diseases
typically seen among people heavily exposed to asbestos (no
excess of asbestosis and only 1 case of mesothelioma), so
it does not appear that most workers were heavily exposed
to asbestos.
Oral cancer was only elevated in males (39 seen, 21 expected) and
may have been associated with non-occupational risk factors
(smokeless tobacco, smoking, and alcohol). Rectal cancer was
elevated in both males and females (58 seen, 28 expected).
Whether this excess had an occupational or non-occupational
etiology is not clear.
Cirrhosis of the Liver
The most striking finding of the study was a significant increase
in mortality from cirrhosis of the liver (150 deaths seen,
81 expected). Excess mortality was more pronounced in males
(n=131) than females, but was not higher in the chloracne
subcohort than in the total cohort.
According to death certificates, mortality was significantly elevated
for both "cirrhosis of the liver with mention of alcohol"
and for "cirrhosis of the liver without mention of alcohol."
Deaths from alcoholic cirrhosis peaked in individuals aged
60+ at death. Deaths from non-alcoholic cirrhosis peaked in
the 40-49 year old age group. Deaths from cirrhosis have continued
into the most recent years of follow-up.
Recommendations for Evaluation, Treatment, and Screening
Liver Function Tests
Although we do not know the extent of your patient's exposure to Halowax,
the people in the NIOSH study cohort as a group have an elevated
risk for cirrhosis of the liver. Therefore, we suggest that
he or she be offered a liver function test.
Serum transaminase levels are the most sensitive, most commonly
available tests for hepatic dysfunction. It does not matter
if the ALT, AST, or GTP is measured, as there is probably
no difference in the sensitivity or specificity or these
tests in the diagnosis of hepatotoxicity from chemical exposure.
However, all of these tests are nonspecific, and an elevated
result does not necessarily indicate liver disease from
CN exposure.
If no abnormality is found in serum transaminase levels, we
recommend repeat testing at regular intervals.
It is not known whether avoiding the ingestion of alcoholic beverages
reduces the risk of developing cirrhosis related to previous
CN exposure, but it may be prudent to caution your patient
to minimize alcohol consumption on this basis. Additional
Evaluation If a persistently elevated serumtransaminase level
is found, additional evaluation should proceed to determine
the cause. The work-up should include:
A review of the patient's medical history to determine if
other risk factors for liver disease are present. These
include the use of certain hepatotoxic medications, viral
infections, and the use of alcohol. Consider advising a
patient with abnormal findings who drinks alcoholic beverages
to quit.
A review of the individual's occupational history for exposure
to other potentially hepatotoxic chemicals. See Table 1.
Additional tests of liver function, including alkaline phosphatase,
bilirubin, lactate dehydrogenase, and protime; and diagnostic
aids such as ultrasound, radionuclide scan, computerized
axial tomography, or magnetic resonance imaging.
Possible referral to a specialist in liver diseases for
consideration of a liver biopsy. A liver biopsy may be helpful
in determining the histology of the liver disease and may
help guide potential treatment.
Possible consultation with an occupational medicine specialist. The
Association of Occupational and Environmental Clinics (phone
202-347-4976) maintains a roster of member clinics around
the country with specialists who may be helpful. Each worker
was sent a list of these clinics.
Cancer Screening
Encourage your patient to have a digital rectal examination and hemocult
annually, a sigmoidoscopy every 3 to 5 years, and an annual
dental examination.
Any Questions?
If you have any questions about the study, wish to obtain a copy
of the technical reports, or want to speak to an occupational
physician at NIOSH, contact NIOSH toll-free number:
1-800-356-4674.
Collier E, Glasg MB (1943): Poisoning by chlorinated naphthalene.
Lancet 244:72 74.
Cotter LH (1944): Pentachlorinated naphthalenes in industry. JAMA
125:273-274.
Drinker CK (1937): Further observations on the possible systemic toxicity
of certain of the chlorinated hydrocarbons with suggestions
for permissable concentrations in the air of workrooms. J
Ind Hyg Tox 21:155-159.
Flinn FB, Jarvik NE (1936): Action of certain chlorinated naphthalenes
on the liver. Proc Soc Exp Biol Med 35:118-120.
Greenburg L, Mayers MR, Smith AR (1939): The systemic effects resulting
from exposure to certain chlorinated hydrocarbons. J Ind Hyg
Tox 21:29-38.
Kleinfeld M, Messite J, Swencicki R (1972): Clinical effects of chlorinated
naphthalene exposure. J Occ Med 14:377-379.
Strauss N (1944): Hepato-toxic effects following occupational exposure
to Halowax (chlorinated hydrocarbons). Rev of Gastroenterology
11:381-396.
Von Wedel H, Holla WA, Denton J (1943): Observations on the toxic
effects resulting from exposure to chlorinated naphthalene
and chlorinated phenyls with suggestions for prevention. The
Rubber Age 53:419-426.
Ward EM, Ruder AM, Suruda A, et al. (1994a): Acute and chronic
liver toxicity resulting from exposure to chlorinated naphthalenes
at a cable manufacturing plant during World War II. (In press).
Ward EM, Ruder AM, Suruda A, et al. (1994b): Cancer mortality patterns
among female and male workers employed in a cable manufacturing
plant during World War II. J Occ Med 36:860-866.
Table 1
Chemical Agents Associated with Occupational Liver Disease
Compound
Type of Injury
Occupation or Use
Arsenic
Grrhosis, hepatocellular carcinoma, angiosarcoma
Pesticides
Beryllium
Granulomatous disease
Ceramics workers
Carbon tetrachloride
Acute hepatocellular injury, cirrhosis
Dry cleaning
Dimethylformamide
Acute hepatocellular injury
Solvent, chemical manufacturing
Dimethylnitrosamine
Hepatocellular carcinoma
Rocket manufacturing
Dioxin
Porphyrea cutanea tarda
Pesticides
Halothane
Acute hepatocellular injury
Anesthesiology
Hydrazine
Steatosis
Rocket manufacturing
Methlene
dianiline Cholestasis
MDA production workers
2-nitropropane
Acute hepatocellular injury
Painters
Phosphorus
Acute hepatocellular injury
Munitions workers
Polychlorinated biphenyls
Subacute liver injury
Production, electrical utility
Tetrachloroethane
Acute or subacute hepatocellular injury
Aircraft manufacturing
Trichloroethylene
Acute hepatocellular injury
Cleaning solvent sniffing
Trinitrotoluene
Acute or subacute hepatocellular injury
Munitions workers
Vinyl chloride
Angiosarcoma
Rubber workers
From: Harrison RJ (1990): Liver Toxicology. In: LaDou J, ed. Occupational
Medicine. East Norwalk: Appleton and Lange, pp 247-258.
Additional Resources
Ward E, Ruder A, Suruda A et al. (1994). Cancer mortality patterns
among female and male workers employed in a cable manufacturing
plant during World War II. Journal of Occupational Medicine
36 (8): 860-866. (Study Report)
Page last modified: February 26, 2002
Page last reviewed: February 26, 2002
(archived document) Content Source: National Institute for Occupational Safety and Health (NIOSH)