Endüstriyel kimyasallara maruz kalan işçilerde mesane ve akciğer kanser oranlarının sitolojik incelemeyle değerlendirilmesi

Öz

Amaç: Bu çalışmanın amacı, Kırıkkale’de endüstriyel kimyasallara maruz kalan işçilerin, mesane ve akciğer kanseri oranlarının idrar ve balgam sitolojisi yöntemleri uygulanarak değerlendirilmesidir.Yöntem: Barut fabrikasında çalışan 123 işçinin idrar sitolojisi örnekleri, ağır silah ve çelik, silah ve mühimmat fabrikalarında çalışan 408 işçinin balgam sitoloji örnekleri Papanicolaou yöntemiyle hazırlanmış ve ışık mikroskobunda değerlendirilmiştir.Bulgular: 123 işçiden 15’inin idrarında atipik sitolojik bulgular görülmüştür. Bu işçilerin hiçbirinde önceden mesane kanseri hikâyesi belirlenememiş ve ultrasonlarında da anormal bulgular görülmemiştir. 408 işçinin 209’u nun balgam sitoloji uygunsuz materyal nedeniyle değerlendirmeye alınamamıştır. Kalan 199 işçiden 103’ünde normal sitoloji, 33’ünde skuamoz metaplazi, 2’sinde displazi belirlenirken, 61 işçide de inflamasyon görülmüştür. İşçilerin kimyasallara maruziyet süresi ve sitoloji bulguları arasında bilimsel olarak anlamlı bir ilişki bulunamamıştır p>0.05 . Günde 20 adetten fazla sigara içenlerde anormal balgam %1,2 ve idrar %13 sitoloji bulguları saptanmasına karşın istatistiksel olarak yalnızca balgam sitolojisi sonuçlarıyla sigara alışkanlığı arasında bir kolerasyon bulunmuştur p=0.015

Anahtar Kelimeler

• İdrar sitolojisi, balgam sitolojisi, tarama, kimyasal karsinojenler, erken teşhis, mesleki maruziyet

THE CYTOLOGICAL EVALUATION OF BLADDER AND LUNG CARCINOMA RATES ON THE WORKERS EXPOSED TO INDUSTRIAL CHEMICALS

Öz

Objective: The aim of this study is to evaluate the ratios of bladder and lung carcinomas of workers exposed to industrial chemicals in Kırıkkale, Turkey by urinary and sputum cytology methods. Method: Urinary cytology preparations for a total of 123 workers in the gun powder production plant and sputum cytology preparations for a total of 408 workers in the heavy gun and steel, gun, and ammunition plants were prepared using Papanicolaou staining and evaluated by light microscopy.Results: For the cytological diagnoses of voided urine in all 123 workers, 15 workers had atypical cytological findings. None of them had a prior history of bladder cancer and no significant abnormality was found in their ultrasound examinations. Regarding the cytologic diagnoses of sputum in 408 workers, 209 individuals could not be evaluated because of inappropriate materials. Of the remaining 199 workers, 103 of them had results within normal limits while 33 of them showed squamous metaplasia, 2 dysplasia and 61 inflammations. No statistically significant relatedness could be found between the workers’ exposure time to chemicals and the cytological findings p>0.05 . Although abnormal cytological findings of sputum 1.2% and urine 13% was found for the smokers of more than 20 cigarettes a day, a statistical correllation was determined between only sputum cytology results and smoking habits p=0.015

Anahtar Kelimeler

• Urine cytology, sputum cytology, screening, chemical carcinogens, early diagnosis, occupational exposure

Kaynakça

1. Crabbe JGS. Exfoliative cytological control in occupational cancer of the bladder. Br. Med. J. 1952; 2:1072-76.
2. International Agency for Research on Cancer. Tobacco smoking. IARC Monogr Eval Carcinog Risk Chem Hum 1986; 38.
3. Vineis P, Simonato L. Proportion of lung and bladder cancers in males resulting from occupation: a systematic approach. Arch Environ Health 1991; 46:6-15.
4. Case RAM, Hosker ME, McDonald DB, et al. Tumors of the urinary bladder in workmen engaged in the manufacture and use of certain dyestuff intermediates in the British chemical industry. I. The role of aniline, benzidine, alphanaphthylamine and beta-naphthylamine. Br. J. Ind Med 1954; 11:75-104.
5. Case RAM, Hosker ME. Tumor of the urinary bladder as an occupational disease in the rubber industry in England and Wales. Br. J. Prev. Soc Med. 1954; 8:39-50.
6. Saccomanno G, Archer VE, Auerbach O, et al. Development of carcinoma of the lung as reflected in exfoliated cells. Cancer 1974; 33:256-70.
7. Prindiville SA, Byers T, Hirsch FR, et al. Sputum cytological atypia as a predictor of incident lung cancer in a cohort of heavy smokers with airflow obstruction. Cancer Epidemiology, Biomarkers and Prevention 2003; 12:987-93.
8. Tockman MS, Gupta PK, Myers JD, Frost JK, Baylin SB, Gold EB, et al. Sensitive and specific monoclonal antibody recognition of human lung cancer antigen on preserved sputum cells: a new approach to early lung cancer detection. J Clin Oncol 1988; 6:1685-93.

9. Risse EK, Vooijs GP, van’t Hof MA. Diagnostic significance of ‘severe dysplasia’ in sputum cytology. Acta Cytol 1988;32: 629-34.
10. Bates D.V. Air pollutants and the human lung, Am. Rev. Respir Dis; 1972; 105:1.
11. Parkes W.R. Occupational Lung Disorders, London, Butterworths, 1974.
12. Viswanathan R, Modi R, Prasad S. and Singh S.I. Bronchial Asthma and Chronic Bronchitis. J. Ind. Med. Assoc, 1965; 45:480.
13. Roland H. Ingram (Jr.) In Harrison’s Principles of Internal Medicine, llth ed. McGraw Hill Book Company; 1987, 1087.
14. Akrill, P, Guiver R, Cocker, J. Biological monitoring of nitroglycerin exposure by urine analysis. Toxicology letters 2002; 134(1-3): 271-6.
15. Sabbioni, G. Rumler, R. Biomonitoring of workers cleaning up ammunition waste sites. Biomarkers 2007; 12(6): 559-73.
16. Sabbioni G, Liu Yu-Y, Yan H and Sepai O. Hemoglobin adducts, urinary metabolites and health effects in 2, 4, 6-trinitrotoluen exposed workers. Carcinogenesis 2005; 26, 7: 1272-9.
17. Sabbioni G, et al. Comparison of biomarkers in workers exposed to 2, 4, 6-trinitrotoluene. Biomarkers 2007; 12(1):21-37.
18. Sabbioni G, et al. Biomarkers of exposure, effect, and susceptibility in workers exposed to nitrotoluenes. Cancer Epidemiol Biomarkers Prev 2006; 15(3): 559-66.
19. Tchounwou PB, et al. Environmental toxicology and health effects associated with dinitrotoluene exposure. Reviews on Environmental Health; 2003; 18(3): 203-29.
20. Withers RMJ, Lees FP. The lethal toxicity of bromine. Journal of Hazardous Materials 1987; 14(2): 274-5.
21. Humsan, Kaj, Kuopio R. Symptomps of car painters with long term exposure to a mixture of organic solvents. Scandiniavian Journal of Work Environment and Health 1980; 6(6)1: 19-32.
22. Huang, W-Y, Lian H-Q. Study of occupational experience of workers exposed to organic solvents and its effective factors.. Xiandai Yufang Yixue 2005; 32(6): 611-2.
23. Alekperov II, et al. Hygienic and toxicological evaluation of labor conditions and state of health of workers in the production of isopropyl alcohol. Azerbaidzhanskii Meditsinskii Zhurnal 1981; 58(8): 44-9.
24. Takeuchi, Y. Hisanaga, N. Ono, Y. Ogawa, T. Hamaguchi, Y. Cerebellar dysfunction caused by sniffing of toluenecontaining thinner. Industrial Health 1981; 19(3): 163-9.
25. Steenland K, Schnorr T. Beaumont J, Halperin W, Bloom T. Incidence of laryngeal cancer and exposure to acid mists. British Journal of Industrial Medicine 1998; 45(11): 766-76
26. Ida S, Yokato M, Yoshioka H, Takiguchi Y. Single exposure to gasoline or ether reduces cytochrome p-450 activities without affecting UDP-glucuronosyltransferase activity in rat liver. Journal of Occupational Health 2000;42(2): 84-5
27. Salandova J, et al. Health state of persons occupationaly exposed to diethyl ether and ethyl alcohol. Pracovni Lekarstvi 1990; 42(8): 337-40.
28. Buchet JP, Roels H, Bernard A, Jr Lauwerys R. Assessment of renal function of workers exposed to inorganic lead, cadmium or mercury vapor. Journal of Occupational Medicine 1980; 22(11): 741-50.
29. Puntoni R, Ceppi M, Reggiardo G, Merlo F. Occupational exposure to carbon black and risk of bladder cancer. The Lancet 2001; 358:562.
30. Jex TT and Wyman DO A Minireview of benzene. Toxic substance mechanisms, 1996; 15:135-43.
31. Koss LG. Diagnostic Cytology and its histopathologic Bases. Third edition. Philadelphia, JB Lippincott, 1979; 711-817.
32. Kennedy TC, Proudfoot, SP, Franklin, WA, Merrick, TA, Saccomanno, G, Corkill, M E, Mumma, DL, Sirgi, KE, Miller, YE, Archer, PG, and Prochazka, A. Cytopathological analysis of sputum in patients with airflow obstruction and significant smoking histories. Cancer Res., 1996; 56: 4673–8.
33. Davies JM, Parkes HG. Benefits of cytological screening for bladder cancer. Acta Cytol 1982; 26:98.
34. Fox AJ, White GC. Bladder cancer in rubber workers. Lancet 1976; 1:1009-1011.
35. Koss LG. Environmental carcinogens and cytology. Acta Cytol 1980; 24:281-2.
36. Forni A, Ghetti G, Armeli G. Urinary cytology in workers exposed to carcinogenic aromatic amines: A six-year study. Acta Cytol 1972; 16:142-5.
37. Glashan RW, Wijesinghe DP, Riley A. The early changes in the development of bladder cancer in patients exposed to known industrial carcinogens. Br. J Urol 1981; 53:571-7.
38. Koss LG, Melamed MR, Kelly RE. Further cytological and histologic studies of bladder lesions in workers exposed to para-aminodiphenyl: Progress report. J Natl Cancer Inst 1969; 43:233-43.
39. Reichborn-Kjennerud S, Hoeg K. The value of urine cytology in the diagnosis of recurrent bladder tumors. Acta Cytol 1972; 16:269-72.
40. Murphy WM, Irving CC. The cellular features of developing carcinoma in murine urinary bladder. Cancer 1981; 47:514-22.
41. Brüning T, Chronz C, Their R, Havelka J, Ko Y, Bolt HM. Occurrence of urinary tract tumors in miners highly exposed to dinitrotoluene. J. Occup Environ Med 1999;41:144-9.
42. Yan C, Wang Y, Xia B, Li L, Zhang Y, Liu Y. The retrospective survey of malignant tumor in weapon workers exposed to 2, 4, 6-trinitrotoluene. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2002; 20: 184-8.
43. Puntoni R, Ceppi M, Reggiardo G, Merio F. Occupational exposure to carbon black and risk of bladder cancer. Lancet 2001;358:562.
44. Thunnissen FBJM. Sputum examination for early detection of lung cancer. J Clin. Pathol. 2003; 56: 805-10. Bates D.V. Air pollutants and the human lung, Am. Rev. Respir Dis. 1972;105:1.
45. Morabia A, Markowitz S, Garibaldi K, Wynder E. Lung cancer and occupation: Results of a multicentre casecontrol study. Br J Ind Med 1992;49:721-7.
46. Vineis P, Thomas T, Hayes R, Blot W, Mason T, Pickle L, Lorrea P. Proportion of lung cancers in males due to occupation in different areas of the U.S. Int J Can 1988;42:851-6.
47. Steenland K, Loomis D, Shy C, Simonsen N. Review of occupational lung carcinogens. Am J of Ind Med 1996; 29:474-90.
48. Rodriguez V, Tardon A, Kogevinas M, Prieto CS et al. Lung cancer risk in iron and steel foundry workers: a nested case control study in Asturias, Spain. Am J of Ind Med 2000; 38: 644-50.