Mustard gas exposure and mortality among retired workers at a poisonous gas factory in Japan: a 57-year follow-up cohort study

Abstract

MG exposure significantly increases the long-term risk of death from respiratory cancer and chronic bronchitis/emphysema. The Okuno-jima MG Index may be a useful indicator for estimating cumulative MG exposure.

A mass spectrometric platform for the quantitation of sulfur mustard-induced nucleic acid adducts as mechanistically relevant biomarkers of exposure

“…In addition, the eyes and the respiratory tract are other major targets of SM-induced toxicity (Kehe et al 2009). Long-term effects include impaired wound healing, chronic suppression of the immune system, and carcinogenesis, such as the development of lung cancers (Balali-Mood and Hefazi 2005;Doi et al 2011;Hosseini-khalili et al 2009;Mukaida et al 2017). Moreover, early on, it was recognized that SM suppresses hematopoiesis and causes bone marrow depletion and leukopenia (Balali-Mood and Hefazi 2005;Krumbhaar 1919;Pappenheimer and Vance 1920;Vedder 1925).…”

Importance of updating old cohorts for new findings

“…Several studies have consistently shown an increased risk of lung cancer among World War I veterans and workers from mustard gas production factories. The study by Mukaida et al 3 demonstrates excesses in cancer mortality from upper respiratory tract cancer, lung cancer, liver cancer and chronic bronchitis/emphysema, as well as cumulative dose-related increased mortality from respiratory cancer, lung cancer and chronic bronchitis/emphysema among former workers. Excesses in mortality from liver and stomach cancer were also observed, but the risks did not follow the cumulative estimates of mustard gas exposure.…”

“…The long-term health consequences of such exposure include epithelial fibrosis and cancer and have been the subject of long-term follow-up studies, especially among military personnel and inhabitants of war-stricken areas in which chemical weapons were used 2. So, does the study by Mukaida et al 3 bring anything new to the existing knowledge on the consequences of long-term exposure to mustard gas? We are convinced that that answer is yes, and here we will dwell on the reasons why.…”

“…Fourth, the long-term follow-up in the article by Mukaida et al 3 makes it possible to analyse the overall health of the cohort members. The study found low standardised mortality ratios for all-cause mortality for male and female workers, which they suggest is a sign of the healthy worker effect, originating from very low standardised mortality ratios for circulatory and digestive diseases.…”

“…Overall, the study by Mukaida et al 3 demonstrates the fact that old cohorts can reveal new aspects of disease risk and that we should be ready to reanalyse and update established cohorts from the past.…”