Annals of Occupational and Environmental Medicine

Original Article

Distribution of Lung-RADS categories according to job type in a single shipyard workers: Eui Yup Chung, Young Hoo Shin, Young Wook Kim, Jun Seok Son, Chan Woo Kim, Hyoung Ouk Park, Jun Ho Lee, Seung Hyun Park, Sung Joon Woo, Chang Ho Chae; Ann Occup Environ Med 2021;33:e22. Published online June 23, 2021; DOI: https://doi.org/10.35371/aoem.2021.33.e22

Abstract Abstract in Korean PDF PubReader ePub

Background

Recently, lung cancer screenings based on age and smoking history using low-dose computed tomography (LDCT) have begun in Korea. This study aimed to evaluate the distribution of lung imaging reporting and data system (Lung-RADS) categories in shipyard workers exposed to lung carcinogens such as nickel, chromium, and welding fumes according to job type, to provide basic data regarding indications for LDCT in shipyard workers.

Methods

This study included 6,326 workers from a single shipyard, who underwent health examinations with LDCT between January 2010 and December 2018. Data on age, smoking status and history, medical history, and job type were investigated. The participants were categorized into high-exposure, low-exposure, and non-exposure job groups based on the estimated exposure level of nickel, chromium, and welding fumes according to job type. Cox proportional hazard regression analysis was used to determine the difference between exposure groups in Lung-RADS category ≥ 3 (3, 4A, and 4B).

Results

Out of all participants, 97 (1.5%) participants were classified into Lung-RADS category ≥ 3 and 7 (0.1%) participants were confirmed as lung cancer. The positive predictive value (ratio of diagnosed lung cancer cases to Lung-RADS category ≥ 3) was 7.2%. The hazard ratio (HR) of Lung-RADS category ≥ 3 was 1.451 (95% confidence interval [CI]: 0.911–2.309) in low-exposure and 1.692 (95% CI: 1.007–2.843) in high-exposure job group. Adjusting for age and pack-years, the HR was statistically significant only in the high-exposure job group (HR: 1.689; 95% CI: 1.004–2.841).

Conclusions

Based on LDCT and Lung-RADS, among male shipyard workers, Lung-RADS category ≥ 3 were significantly higher in the high-exposure job group. Their HR tended to be > 1.0 and was statistically significant in the high-exposure job group. Additional studies should be conducted to establish more elaborate LDCT indications for occupational health examination.

일개 조선소 근로자의 직종간 Lung-RADS 비교
목적
최근 폐암의 조기 발견을 위해 저선량 흉부CT (LDCT)를 이용하기 시작했으며, 국내에서도 연령과 흡연력을 기준으로 한 국가폐암검진이 시작되었다. 니켈, 크롬, 용접흄은 조선소 근로자에서 흔히 노출될 수 있는 폐암 발암물질로 알려져 있으나, 이러한 위험 요인은 아직 폐암 검진의 기준이 되지 못하였다. 이 연구는 LDCT를 이용하여 니켈, 크롬, 용접흄에 노출되는 일개 조선소 근로자들에서 직종과 폐 CT 선별 판독 시스템 (Lung-RADS) 양상을 비교하여, 조선소 근로자의 LDCT 적응증에 대한 기초 자료를 생성하고자 하였다.
방법
2010년 1월부터 2018년 12월까지 건강검진에 참여한 경남지역 조선소 근로자 6,326명이 연구에 참여했다. 문진과 자기기입식 설문지를 이용하여 연령, 흡연력, 과거력, 직종 등을 확인하여, 직군에 따른 크롬, 니켈, 용접흄의 노출 추정 정도에 따라 고노출 직군, 저노출 직군, 비노출군으로 분류하였다. 그룹 간 Lung-RADS 3 이상인 군에 차이가 있는지 cox 비례위험 회귀분석을 시행하였다. 또한 연령과 갑년을 보정하여 그룹간 hazard ratio (HR)를 비교하였다.
결과
전체 대상자 6,326명 중 Lung-RADS 3 이상인 군은 97명, 폐암으로 확진된 대상자는 7명으로, 양성예측도 (PPV)는 7.2%이였다. Lung-RADS 3 이상에 대하여 직군에 따른 HR은 저노출 직군 1.451 (95% confidence interval [CI]: 0.911-2.309), 고노출 직군 1.692 (95% CI: 1.007-2.843)으로 나타났다. 연령과 갑년을 보정했을 시 HR은 고노출 직군에서만 유의하게 1.689 (95% CI: 1.004-2.841)로 나타났다.
결론
현행의 폐암검진 방법인 LDCT와 진단기준인 Lung-RADS를 이용하였을 때, 일개 조선소 남성 근로자 중 니켈, 크롬, 용접흄 노출 직군에서 Lung-RADS 3 이상군이 유의하게 많으며, HR이 1.0보다 높은 경향을 보이고, 고노출 직군에서는 유의한 결과를 보였다. 향후 추가적인 연구를 통해 보다 정밀한 근로자 건강검진 상 LDCT 적응증을 만들어야 한다.

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Research Article

Review of carcinogenicity of hexavalent chrome and proposal of revising approval standards for an occupational cancers in Korea: Jungwon Kim, Sangyun Seo, Yangho Kim, Dae Hwan Kim; Ann Occup Environ Med 2018;30:7. Published online January 31, 2018; DOI: https://doi.org/10.1186/s40557-018-0215-2

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Background

The objective of this study is to suggest revised recognition standards for occupational disease due to chromium (VI) by reflecting recent domestic and international research works and considering domestic exposure status with respect to target organs, exposure period, and cumulative exposure dose in relation to the chromium (VI)-induced occupational disease compensation.

Methods

In this study, the reports published by major international institutions such as World Health Organization (WHO) International Agency for Research on Cancer (IARC) (2012), Occupational Safety and Health Administration (OSHA) (2006), National Institute for Occupational Safety and Health (NIOSH) (2013), American Conference of Governmental Industrial Hygienists (ACGIH) (2004), National Toxicology Program (NTP) (2014), and Agency for Toxic Substances and Disease Registry (ASTDR) (2012) were reviewed and the recent research works searched by PubMed were summarized.

Results

Considering the recent research works and the domestic situation, only lung cancer is conserved in the legislative bill in relation to chromium (VI), and the exposure period is not included in the bill. Nasal and paranasal sinus cancer was excluded from the list of cancers that are compensated as the chromium (VI)- induced occupational disease, while lung cancer remains in the list. In the view of legislative unity, considering the fact that only the cancers having sufficient evidence are included in the conventional list of cancers compensated as occupational disease, nasal and paranasal sinus cancer having limited evidence were excluded from the list.

The exposure period was also removed from the legislative bill due to the insufficient evidence. Recent advices in connection with cumulative exposure dose were proposed, and other considerable points were provided with respect to individual occupational relevance.

Conclusions

It is suggested that the current recognition standard which is “Lung cancer or nasal and paranasal sinus cancer caused by exposure to chromium (VI) or compounds thereof (exposure for two years or longer), or nickel compounds” should be changed to “Lung cancer caused by exposure to chromium (VI) or compounds thereof, and lung cancer or nasal and paranasal sinus cancer caused by exposure to nickel compounds”.

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A Comparative Research on Corrosion Behavior of Electroplated and Magnetron Sputtered Chromium Coatings
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Case Report

Malignant Fibrous Histiocytoma of the Maxillary Sinus in a Spray Painter from an Automobile Repair Shop: Seok-Hwan Choi, Se-Yeong Kim, Man-Ki Son, Hui-Seok Yang, Sun-Woo Lee, Jung-Il Kim, Kap-Yeol Jung; Ann Occup Environ Med 2013;25:30-30. Published online November 1, 2013; DOI: https://doi.org/10.1186/2052-4374-25-30

Abstract PDF PubReader ePub

Background

We report a case of a spray painter who developed malignant fibrous histiocytoma (MFH) of the maxillary sinus following long-term exposure to chromium, nickel, and formaldehyde, implying that these agents are probable causal agents of MFH.

Case report

The patient developed right-sided prosopalgia that began twenty months ago. The symptom persisted despite medical treatment. After two months, he was diagnosed with MFH through imaging studies, surgery, and pathological microscopic findings at a university hospital in Seoul. His social, medical, and family history was unremarkable.

The patient had worked for about 18 years at an automobile repair shop as a spray painter. During this period, he had been exposed to various occupational agents, such as hexavalent chromium, nickel, and formaldehyde, without appropriate personal protective equipment. He painted 6 days a week and worked for about 8 hours a day.

Investigation of the patient’s work environment detected hexavalent chromium, chromate, nickel, and formaldehyde.

Conclusions

The study revealed that the patient had been exposed to hexavalent chromium, formaldehyde, and nickel compounds through sanding and spray painting. The association between paranasal cancer and exposure to the aforementioned occupational human carcinogens has been established. We suggest, in this case, the possibility that the paint spraying acted as a causal agent for paranasal cancer.

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Original Articles

Effects of Chromium Exposure on the Level of Urinary 8-Hydroxydeoxyguanosine: Seong Joon Kim, Byung Chul Yu, Sang Hwa Ohm, Ki Won Jeong, Luck Hee Sung, Won Chang Shin, Jong Rae Cho, Jin Ho Chun; Korean Journal of Occupational and Environmental Medicine 2001;13(3):253-261. Published online September 30, 2001; DOI: https://doi.org/10.35371/kjoem.2001.13.3.253

Abstract PDF

OBJECTIVES
To investigate the possibility of utilizing DNA adduct as a carcinogenic biological marker for workers exposed to chromium, and the effect of chromium exposure on the formation of urinary 8-hydroxydeoxyguanosine(8-OH-dG) was also evaluated.
METHODS
The chromium concentrations of venous blood and urine were measured in 20 chromium exposed workers(exposure group) and in 11 chromium workers(control group) who were not exposed. The concentration of 8-OH-dG in their urine was determined using high performance liquid chromatography with electrochemical detection.
RESULTS
The blood chromium concentration was significantly higher in the exposure group ( 0.46+/-0.18 microgram/100 ml) than in control group(0.27+/-0.15 microgram/100 ml), but the urinary chromium concentration was not significantly higher in the exposure group. The urinary 8-OH-dG was higher in the exposure group(1.71+/-1.82 micromol/mol creatinine) than that in the control group(0.45+/-0.46 micromol/mol creatinine) and was significantly correlated with the blood chromium concentration(r=0.49). Results of multiple regression analysis revealed that the level of urinary 8-OH-dG depended upon the level of the blood chromium conc entration ( r2= 0.21).
CONCLUSIONS
Urinary 8-OH-dG was significantly related to chromium exposure and this finding suggests the possibility that urinary 8-OH-dG could be used as a biological index of chromium induced DNA damage.

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Olfactory Function in Chromium Exposed Workers Without Nasal Septum Perforation: Jae Wook Choi, Soung Hee Lee, Yeon Kuk Choi, Eun Il Lee, Hae Joon Kim; Korean Journal of Occupational and Environmental Medicine 2000;12(2):198-208. Published online June 30, 2000; DOI: https://doi.org/10.35371/kjoem.2000.12.2.198

Abstract PDF: OBJECTIVES
The chrome-induced olfactory alterations is caused by inhalation of chromic acid, a highly corrossive and toxic materials. And nasal septum perforation(NSP) has been suspected with possible causative factor of olfactory alterations. To our knowledge, there has been no report of the detailed findings of the olfactory alterations in chrome exposed subjects without nasal septum perforation(NSP). So we present the results of olfactory function test measured by T&T olfactometer and olfactometer perception test among chromium exposed workers without NSP.
METHODS
We performed this study in 25 study subjects and 25 control subjects matched with age, alcohol and smoking. All of subjects are man. We performed olfactory function test measured by T&T olfactometer and olfactometer perception test.
RESULTS
1) The age distribution of the subjects involved in this study was from 20 to 54 years old (average 33.3 years old) and the mean duration exposed to chromium was from 64. 9 months. 2) The olfactory function was checked by detection and recognition thresholds in five odorants. The detection thresholds of exposed group dealing with chromium were significantly increased in A and B ordorants than nonexposed group. The recognition thresholds of exposed group were significantly increased in D ordorants than nonexposed group. 3) The mean threshold of olfactometer perception test of exposed group were more increased than nonexposed group. But thresholds difference did not show statistical significance, 4) The detection thresholds of A and D ordorants, recognition threshold of C ordorants and thresholds of olfactometer perception test were increased in the relation with duration of chrome exposure.
CONCLUSIONS
There has been no remarkable alterations in olfactory sense (TkT olfactometer and Olfactometer Perception Test) in subjects without nasal septum perforation(NSP) exposed to chromic acid.

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Case Reports

Nasal Septum Perforation of Welders: Choong Ryeol Lee, Cheol In Ryu, Ji Ho Lee, Jeong Hak Kang, Seong Kyu Kang, Jung Sun Yang, Yong Cheol Shin; Korean Journal of Occupational and Environmental Medicine 1998;10(3):404-411. Published online August 31, 1998; DOI: https://doi.org/10.35371/kjoem.1998.10.3.404

Abstract PDF

Six cases of nasal septum perforation were found among welders during periodic physical checkup in 1997. Considering the size, shape and margin, the perforations were assumed to have been occurred several years before of which the diameter were 8~15 mm. To investigate the cause of perforation, we reviewed the past history of preemployment, the results of annual working environment survey and the material safety data sheets of welding rods and steels with which they have dealt, and analyzed the concentration of several metals of welding fume and the concentration of blood and urinary chromium. In the result, we presupposed that the nasal septum perforations of welders were due to chronic exposure to low level hexavalent chromium and/or nickel, and report these cases with literatures review.

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A Case of Occupational Asthma Associated with Chromium: Hyun Sul Lim, Ji Yong Kim, Young Hyun Lee; Korean Journal of Occupational and Environmental Medicine 1997;9(2):283-291. Published online June 30, 1997; DOI: https://doi.org/10.35371/kjoem.1997.9.2.283

Abstract PDF

Occupational asthma is an important occupation-related disease. We experienced a case of asthma induced by chromium. After discovery, chromium has been widely used in industry. Health effects of chromium and its compounds are contact dermatitis (allergic and irritant), mucosal irritation, basal septal perforation, asthma, and lung cancer. Their toxicity depends on valency, solubility, concentration, pH, exposure duration and route. The patient was a 47-year-old male and an ex-smoker. He complained of cough, sputum and dyspnea while working. Total eosinophil count was elevated but serum IgE value was normal. Bronchoprovocation test with 0.5 % (w/v) chromium solution revealed early and late asthmatic responses. Although his initial methacholine bronchial challenge test shoved a negative result, bronchial hyperresponsiveness developed after bronchoprovocation test with chromium solution. After discharge, he has complained of an intermittent dyspnea. It was suggested that chromium could induce occupational asthma in exposed workers. Further investigations are needed to clarify their pathogenetic mechanisms.

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Occupational Diseases in Korea
Seong-Kyu Kang, Eun A Kim
Journal of Korean Medical Science.2010; 25(Suppl): S4. CrossRef

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Original Articles

A study on the Frequency of Sister Chromatid Exchanges in Peripheral Lymphocytes among Painters: Seung Rim Yang; Korean Journal of Occupational and Environmental Medicine 1994;6(2):332-341. Published online September 30, 1994; DOI: https://doi.org/10.35371/kjoem.1994.6.2.332

Abstract PDF: The author studied the frequencies of sister chromatid exchanges of cultured peripheral Iymphocytes from 51 chromium exposed workers and 29 controls in order to examine the inductivity of sister chromatid exchanges of cultured peripheral lymphocytes of chromium exposed workers, from June 1989 to March 1990. The results obtained were as follows; 1. Mean frequencies of sister chromatid exchanges of cultured peripheral lymphocytes were 9.33+/-2.57 from chromium exposed workers and 7.59+/-0.81 from control, respectively, and the former was significantly higher than the latter (p<0.01) . 2. The frequencies of sister chromatid exchanges of cultured peripheral lymphocytes by duration of employment from chromium exposed workers was increased in proportion to that, but there was no statistical significance. 3. The frequencies of sister chromatid exchanges of cultured peripheral lymphocytes by chromium concentration in blood and urine of chromium exposed workers were not significantly increased. 4. The frequencies of sister chromatid exchanges of cultured peripheral lymphocytes by levels of alcohol consumption in chromium exposed workers was inclined to increase in proportion to that. 5. The frequencies of sister chromatid exchanges of cultured peripheral lymphocytes by number of cigarettes smoked was significantly increased in proportion to that in both chromium exposed workers and controls (p<0.05) . 6. In drinkers of chromium exposed workers, the frequencies of sister chromatid exchanges of cultured peripheral lymphocytes in smokers was higher than non-smokers, but there was no statistical significance.

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Health Hazards of Plating Workers: Jung Gyun Park, Jaehoon Roh, Kyung Jong Lee, Young Hahn Moon; Korean Journal of Occupational and Environmental Medicine 1989;1(2):218-227. Published online November 30, 1989; DOI: https://doi.org/10.35371/kjoem.1989.1.2.218

Abstract PDF

Chromic acid has widely been used for decorative chromium plating, hard chromium plating, and surface treatment of raw materials. However, its strong oxidizing action has been found to cause corrosion of mucous membranes and skin, such as the nasal septum, conjunctiva, face, and hand skin. Excessive exposure to chmmic acid has frequently caused ulceration and perforation of a nasal septum. These ulcerations are painless and confined to the cartilaginous portion at the lower anterior part of the septum known as Kisselbach's or Little's area. This study was undertaken to investigate the general characteristics, actual conditions of the working environment and the prevalence rate of nasal septal perforation due to inhalation of chromic acid mist in workers employed at plating industries. This study was conducted on 627 workers who were exposed to chromic acid from July to November 1988. The results were summarized as follows: 1. The mean age of workers with septal perforation was 26 years and the mean working duration was 84 months. 2. The prevalence rates of nasal septal perforation and ulceration of mucosa of the plating workers were 31.7% and 10.5% respectively. 3. The significant variables related with occurrence of nasal septal perforation were age of workers, working duration, kinds of plating, efficiency of local ventilation and performance of health examinations. From the above results, occurrences of nasal septal perforation in plating workers were affected by the duration of chromium exposed work and state of the working environment. Prevention of occupationsl diseases fri plating workers will be accomplished by implementation of an industrial health care system which includes thorough health checkups for workers and regular environmental monitoring.

Citations

Citations to this article as recorded by

Occupational Diseases in Korea
Seong-Kyu Kang, Eun A Kim
Journal of Korean Medical Science.2010; 25(Suppl): S4. CrossRef

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