Objective-To evaluate the long term health consequences of past occupational exposure to 2,3,7,8 tetrachlorodibenzo-pdioxin (TCDD). Methods Polychlorinated dioxins and furans have been identified as unwanted byproducts of numerous chemical and thermal processes.' The toxic potency of these planar halogenated compounds is well documented and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the most toxic member of the class, has been shown to cause a wide range of effects including hyperplastic changes in epithelial tissues of the skin, liver, gastric mucosa, bile duct, and urinary bladder.2 It is an animal carcinogen and promotes skin, lung, and liver tumours under appropriate experimental conditions.34 The mechanisms through which TCDD acts to alter tumour incidence are unknown, but are unlikely to include direct genetic effects. Three recent mortality studies with exposure assessments supported by TCDD measurements in blood, have been interpreted as showing an increased risk of cancer in humans after dioxin exposure.25 The present investigation updates the mortality experience of one of the three cited studies,7 reports cancer incidence for the first time, and examines cancer outcomes in relation to dose of TCDD with more extensive biomonitoring than was previously available.
Materials and methods
STUDY BACKGROUNDOn 17 November 1953, an uncontrolled decomposition reaction occurred in a trichlorophenol (TCP) production unit owned by BASF AG and located in Ludwigshafen, Germany. Byproducts that escaped from the damaged autoclave contaminated surfaces throughout the immediate work area of the enclosed production building. Within days, workmen who were engaged in clean up efforts developed severe acne as well as other signs and symptoms and some were taken into hospital. The agent most likely to have caused these responses was not identified until 1957 when TCDD was chemically shown to be a byproduct p of TCP production and was shown to be a potent acnegen.9 1lFurther confirmation that TCDD had been present was provided by biomonitoring data collected more than 30 years after the incident.7' 1 These data showed increases of TCDD concentrations in blood lipid that related to both the extent of involvement in clean up activities and an employee's chloracne status. A non-linear regression model relating TCDD concentrations in blood lipid to duration of exposure under various working conditions was developed in 1993