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      The Effect of Hexavalent Chromium on the Incidence and Mortality of Human Cancers: A Meta-Analysis Based on Published Epidemiological Cohort Studies


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          Background: Hexavalent chromium [Cr(VI)] is an occupational carcinogen that can cause lung and nasal cancers, but its association with mortality and incidence in many other cancers is unclear.

          Objectives: In this meta-analysis, we aimed to evaluate the relationship between exposure to Cr(VI) and the mortality and incidence of human cancers.

          Methods: We performed a search of the literature and extracted the standardized mortality ratios (SMRs), standardized incidence ratios (SIRs), and their corresponding 95% confidence intervals (CIs), to estimate risk values. Subgroup analyses were conducted by sex, occupation, and types of cancer to identify groups that were at high-risk or predisposed to certain cancers.

          Results: A total of 47 cohort studies covering the period 1985–2016 were included (37 studies reporting SMRs and 16 studies reporting SIRs). The summary SMR for all studies combined was 1.07 (95% CI: 1.01–1.15). Summary SMRs were higher among chromate production workers, chrome platers, and masons, and especially male workers. In the subgroup analysis, Cr(VI) exposure was related to a higher risk of death owing to lung, larynx, bladder, kidney, testicular, bone, and thyroid cancer. The meta-SIR of all studies combined was 1.06 (95% CI: 1.04–1.09). Summary SIRs were elevated among cement industry workers and tanners. Cr(VI) exposure was related to an elevated risk of respiratory system, buccal cavity, pharynx, prostate, and stomach cancers.

          Conclusions: Cr(VI) might cause cancers of the respiratory system, buccal cavity and pharynx, prostate, and stomach in humans, and it is related to increased risk of overall mortality owing to lung, larynx, bladder, kidney, testicular, bone, and thyroid cancer. In addition, there was a strong association between incidence and mortality risk of cancers and concentration of Cr(VI) in the air and the exposure time.

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          Most cited references60

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          A review of human carcinogens—Part C: metals, arsenic, dusts, and fibres

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            Hexavalent chromium and lung cancer in the chromate industry: a quantitative risk assessment.

            The purpose of this investigation was to estimate excess lifetime risk of lung cancer death resulting from occupational exposure to hexavalent-chromium-containing dusts and mists. The mortality experience in a previously studied cohort of 2,357 chromate chemical production workers with 122 lung cancer deaths was analyzed with Poisson regression methods. Extensive records of air samples evaluated for water-soluble total hexavalent chromium were available for the entire employment history of this cohort. Six different models of exposure-response for hexavalent chromium were evaluated by comparing deviances and inspection of cubic splines. Smoking (pack-years) imputed from cigarette use at hire was included in the model. Lifetime risks of lung cancer death from exposure to hexavalent chromium (assuming up to 45 years of exposure) were estimated using an actuarial calculation that accounts for competing causes of death. A linear relative rate model gave a good and readily interpretable fit to the data. The estimated rate ratio for 1 mg/m3-yr of cumulative exposure to hexavalent chromium (as CrO3), with a lag of five years, was RR=2.44 (95% CI=1.54-3.83). The excess lifetime risk of lung cancer death from exposure to hexavalent chromium at the current OSHA permissible exposure limit (PEL) (0.10 mg/m3) was estimated to be 255 per 1,000 (95% CI: 109-416). This estimate is comparable to previous estimates by U.S. EPA, California EPA, and OSHA using different occupational data. Our analysis predicts that current occupational standards for hexavalent chromium permit a lifetime excess risk of dying of lung cancer that exceeds 1 in 10, which is consistent with previous risk assessments.
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              Chromium VI and stomach cancer: a meta-analysis of the current epidemiological evidence.

              Chromium VI (hexavalent chromium, Cr(VI)) is an established cause of lung cancer, but its association with gastrointestinal cancer is less clear. The goal of this study was to examine whether the current human epidemiological research on occupationally inhaled Cr(VI) supports the hypothesis that Cr(VI) is associated with human stomach cancer.

                Author and article information

                Front Oncol
                Front Oncol
                Front. Oncol.
                Frontiers in Oncology
                Frontiers Media S.A.
                04 February 2019
                : 9
                : 24
                [1] 1Department of Breast Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou, China
                [2] 2Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an, China
                [3] 3Department of Epidemiology and Biostatistics, Xi'an Jiaotong University Health Science Center, School of Public Health , Xi'an, China
                Author notes

                Edited by: Tianhui Chen, Zhejiang Academy of Medical Sciences, China

                Reviewed by: Guangwen Cao, Second Military Medical University, China; Xiangqian Guo, Henan University, China

                *Correspondence: Guihua Zhuang zhuanggh@ 123456xjtu.edu.cn

                This article was submitted to Cancer Epidemiology and Prevention, a section of the journal Frontiers in Oncology

                †These authors have contributed equally to this work

                Copyright © 2019 Deng, Wang, Tian, Lin, Xu, Zhou, Dai, Hao, Wu, Zhai, Zhu, Zhuang and Dai.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                : 09 November 2018
                : 08 January 2019
                Page count
                Figures: 6, Tables: 3, Equations: 0, References: 67, Pages: 15, Words: 9393
                Funded by: National Natural Science Foundation of China 10.13039/501100001809
                Award ID: 81471670
                Systematic Review

                Oncology & Radiotherapy
                hexavalent chromium,cancer,mortality,incidence,meta-analysis
                Oncology & Radiotherapy
                hexavalent chromium, cancer, mortality, incidence, meta-analysis


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