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Appendix E
Details of Epidemiologic Studies on Trichloroethylene
and Perchloroethylene
272
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TABLE E-1 Exposure Information on Epidemiologic Studies Involving Exposure to TCE or PCE
Reference Study Design, Exposure, Outcomes Exposure Assessment Exposure Metrics Comments
Aschengrau et al. Population-based case-control Relative dose of PCE estimated by Ever vs never exposed (served by private Nine latency periods
2003 algorithm with variables for residential well for entire Cape Cod residence) examined (0, 5, 7, 9, 11,
Cape Cod, MA history, water flow (geometry, load on 13, 15, 17, 19 years)
water-distribution system), pipe Cumulative exposure for each latency
PCE from inner vinyl liner in cement characteristics (such as pipe diameter, period: sum of RDDs for each residence
pipes distributing tap water age); inputs determined from maps from (mass of TCE entering home in tap water
local water suppliers or state DEPs over time at each address); categorized as
Breast cancer never, low (up to and including median
RDD), high RDD (above 50th, 75th, or 99th
percentile)
Blair et al. 2003 Cohort study of dry cleaners Exposure score for jobs based on published Exposure score assigned on basis of jobs Adjustment for age, sex,
monitoring studies of dry-cleaning held (cleaners, high, score of 40; pressers, calendar time
PCE used as solvent in dry cleaning industry; scores increased with proximity sewers, counter workers, score of 7; pickup
workers, low, score of 0)
Cancers, other causes of death
Little or no exposure (score of 0) vs
medium-high exposure (score of 7 or 40)
Boice et al. 2006 Cohort of rocket-engine testing- All Rocketdyne workers employed on or Duration of employment (years) (SMR) Adjustment for year of
facility workers after Jan. 1, 1948, for 6+ mo at SSFL, birth, year of hire
nearby facilities (for comparison group); Potential for exposure (flush engine parts or
Hydrazine, TCE identified from personnel files, work utility solvent use) (SMR)
history cards; exposed were test-stand
All causes of death mechanics, inspectors, test-stand Duration of employment (RR)
engineers, research engineers; personnel
listings used to place test-stand mechanics 4 decades of employment (RR)
at specific stands in calendar years;
descriptive industrial-hygiene information Years worked as test-stand mechanic (RR)
to classify potential exposure to hydrazine,
TCE, other chemicals; discussions with Years worked with any potential TCE
workers exposure (less than 4 years vs at least 4
years) (RR)
Years worked with potential TCE exposure
via engine cleaning, weighted by number of
engine tests (less than 4 test-years vs at least
4 test-years )
(Continued)
273
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274
TABLE E-1 Continued
Reference Study Design, Exposure, Outcomes Exposure Assessment Exposure Metrics Comments
Brüning et al. 2003 Hospital-based case-control Telephone interview, occupational Ever employed in specific occupations
questionnaire devoted to screw-cutting
West Germany (site of metal, paper, industry and general for other jobs; TCE, Longest job held
wood-processing industries) PCE exposure for at least one job period
(1+ year), cumulative of TCE in ppm per Ever worked in tasks, occupations, or
TCE, PCE job per year in job, peaks; assessment industries with TCE or PCE exposure
semiquantitative for exposure to TCE,
Renal-cell cancer PCE; qualitative for other occupational Cumulative exposure assessed with JEM
exposures; confidence score (certain, (Pannet et al. 1985): none, low, high
probable, possible) used for each exposure (dichotomized at median)
assessed; assessed industry and job-title
codes Self-reported exposure to TCE, PCE
(separately)
Occurrence of narcotic symptoms (any,
nondaily, or daily) (TCE)
Duration of exposure to TCE (none, less
than 10 years, 10 to less than 20 years, 20+
years), PCE (none, less than 10 years, 10+
years)
Chang et al. 2003 Cohort-mortality study of electronics Employment histories at different Duration of employment (SMR) categorized
factory workers factories, changes in insurance status from as 1 year or less, more than 1 year but less
Bureau of Labor Insurance computer than or equal to 5 yrs, more than 5 years)
Taiwan database for 1978-1997; confirmed,
supplemented with list of names of patients Year of death from cancer (1985-1990,
TCE, PCE in labor-insurance hospitalization dataset, 1991-1997)
United Labor Association; duration of
Cancers employment calculated from insurance
records, operation history of index
electronics factory (1968-1992); EPA in
Taiwan verified pollution of wells with
TCE, PCE
Charbotel et al. 2006 Case-control Information from occupational By industry (NACE codes) (OR) Adjustment for tobacco-
questionnaires, task-exposure matrix for smoking, BMI
Arve Valley (France) screw-cutting tasks; employee’s activity, By Job title (ILO 68 codes) (OR)
job title encoded; assessed for exposure to
TCE used as degreasing agent in solvents, oils, welding fumes, etc.; Ever vs never exposed (OR)
screw-cutting industry in Arve semiquantitative assessment for exposure
Valley to TCE, qualitative (low, medium, high) Cumulative exposure (ppm-years); task-
for other exposures exposure matrix used to estimate cumulative
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Other exposures (chlorinated dose for each job period (OR) (categorized
solvents, oxygenated solvents, white- into tertiles)
spirit and petroleum solvents), oils,
welding fumes, lead, cadmium, Cumulative exposure with assessment for
asbestos peaks (low-medium without peaks, low-
medium with peaks, high without peaks,
Renal-cell cancer high with peaks) (OR)
Cumulative exposure with assessment for
peaks (low-medium without peaks, low-
medium with peaks, high without peaks,
high with peaks) with only exposures scored
certain or probable summed in cumulative-
exposure score (OR)
Costas et al. 2002 Case-control Exposure assessed based on potential for With water-distribution model, exposure
residence to receive water from index developed for each hydraulic area and
Woburn, MA contaminated wells G and H, not on actual month (exposure index: fraction of month
contaminant concentration in wells; water- when contaminated water reached hydraulic
TCE-contaminated groundwater distribution model used, validated; area multiplied by fraction of water supplied
wells in Woburn, MA (site of cumulative exposure based on exposure by contaminated wells)
tannery, chemical manufacturing periods, operation of wells
wastes) Average, cumulative exposure scores (for
seven etiologic windows) categorized as
TCE (primary), PCE never vs some or never, least, most (median
of some exposure used to define least, most)
Childhood leukemia
Etiologic windows: entire etiologic period (2
years before conception to date of case
diagnosis); preconception period, duration of
pregnancy; 1st, 2nd, 3nd trimester of
pregnancy; period from time of birth to case
diagnosis
De Roos et al. 2001 Case-control (cases identified from Self-reported occupational exposures to Self-reported parental exposure to five Adjustment for child’s
hospitals participating in two solvents obtained by telephone interview; categories of chemicals (halogenated age, maternal race,
pediatric collaborative clinical trials) industrial-hygienist review of self-reported hydrocarbons; nonvolatile hydrocarbons; maternal age, maternal
exposures volatile hydrocarbons; paints, inks, education
Occupational exposure to five pigments; metals, alloys, solders (any vs
categories of chemicals none)
Neuroblastoma Industrial hygienist reviewed assessment of
exposure on basis of questionnaire data
(probable exposure assigned yes, otherwise
no)
(Continued)
275
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276
TABLE E-1 Continued
Reference Study Design, Exposure, Outcomes Exposure Assessment Exposure Metrics Comments
Diot et al. 2002 Hospital-based case-control Employment periods of over 6 mo Ever vs never exposed
recorded from interview, but only
Central region of France employment corresponding to period High cumulative exposure score vs those
before patient’s diagnosis was included; without high cumulative exposure score
Occupational exposures to silica, exposure to various occupational hazards
organic solvents (including TCE) asked; expert committee (occupational Cumulative exposure score: sum of exposure
physicians, epidemiologists, industrial scores for each employment
Systemic sclerosis hygienists) assessed exposure
Exposure score: probability x intensity x
frequency x duration; probability of
exposure: 0 = nonexposure, 0.25 = possible
exposure, 0.75 = probable exposure, 1 =
certain exposure; intensity of exposure: 0 for
nonexposure to 1 for highest level of
exposure; length of time worked daily:
50% = 0.75;
number of years worked
Fabbro-Peray et al. Population-based case-control Cohort interviewed about occupational Self-reported exposure (yes vs no) Lag time of 5 years
2001 exposures, including chemicals, pesticides, before diagnosis (or
Languedoc-Roussillon, France electromagnetic radiation; asked about Age at first exposure interview for controls)
smoking; subjects considered exposed if
Occupational exposure to benzene, exposure lasted more than 1 year Duration of exposure (never, up to 15 years, Adjustment for age, sex,
rubber, coal tar, paints, waste oil, over 15 years) urban setting, education
dry-cleaning solvents, petroleum
products, pesticides Cumulative exposure (lifetime-days of
exposure) (never-erratic, up to 810 days,
Non-Hodgkin lymphoma over 810 days)
Time since first exposure (never, up to 10
years, over 10 years)
Further classifications for benzene,
pesticides
Garabrant et al. Case-control Women asked whether ever worked at Self-reported exposure to specific, all Adjustment for age, year
2003 least once a week for 3 mo or more in any solvents of birth
Michigan, Ohio of 16 jobs or hobbies that commonly
involve solvents; information obtained on Expert-reviewed exposure to specific, all
Occupational or hobby-related job title, years, specific tasks, nine specific solvents
exposure to hydrocarbons, solvents (paint thinners and removers,
chlorinated solvents mineral spirits naphtha or white spirits, Self-reported jobs, hobbies
gasoline, toluene, xylene, benzene, TCE,
Systemic sclerosis PCE, trichloroethane), other solvents),
safety precautions; reviewed by expert
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Hansen et al. 2001 Cohort Historical files of individual air, urinary Period of first employment (1947-1964, Sensitivity analyses: 10-
measurements of TCE exposure ( from 1965-1989) year, 20-year lag periods
Denmark Labor Inspection Services of Denmark); (data not shown; no
job information reconstructed from Duration of employment (less than 75 mo vs change in results)
TCE national pension fund at least 75 mo)
Cancer Average personal TCE exposure (less than
19 mg/m3 vs at least 19 mg/m3)
Cumulative TCE exposure (less than 1,080
months-mg/m3 vs at least 1,080 months-
mg/m3)
Infante-Rivard et al. Population-based case-control Maternal occupational exposures to Jobs held during 2 years before, during Adjustment for age,
2005 solvents before and during pregnancy pregnancy coded as “possible,” “probable,” education
Quebec, Canada estimated by coding by job for specific “definite”; level assigned (low = 1, medium
contaminants (also called expert method); = 2, high = 3)
Maternal occupational exposure to coded for 21 solvents; home exposure to
solvents, solvent mixtures solvents evaluated on basis of activities, Any vs no exposure
including hobbies, furniture stripping,
Childhood ALL electronic and motor-vehicle repair, home Any vs no exposure (none and “possible” vs
painting “probable” and “definite”)
Level of exposure (0 = baseline, 1 = some
exposure (concentration x frequency less
than 4), 2 = greater exposure (concentration
x frequency at least 4)
Krishnadasan et al. Nested case-control Workers employed 1950-1992 at nuclear- Industry-based JEM (for all jobs held) 20-year (and zero lag)
2007 energy, rocket-engine-testing facility; exposure estimates
Nuclear-energy, rocket-engine company records used to construct JEM For each job and by chemical, likelihood
development, testing facility in for exposures to hydrazine, TCE, PAHs, (none, low, high), intensity (low, medium, Adjustment for
Southern California benzene, mineral oil; from job-description high) for three periods (1950-1969, 1970- occupational physical
manuals, walk-throughs, interviews; 1979, 1989-1999) activity, SES, other
PAHs, TCE, hydrazine, mineral oil, industrial hygienist created estimate of chemical exposures
benzene likelihood, intensity of exposures during Cumulative-exposure score for each worker
three periods (1950s-1960s, 1970s, 1980s- for all jobs held (none, low, moderate, high);
Prostatic cancer 1990s); duration of employment of cumulative-exposure score = sum of
longest-held job (and others) duration of employment x estimated
intensity for each job
Cumulative-exposure scores categorized by
quartiles: unexposed vs low-moderate vs
high
(Continued)
277
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TABLE E-1 Continued
278
Reference Study Design, Exposure, Outcomes Exposure Assessment Exposure Metrics Comments
Lee et al. 2003 Case-control; residents of two Groundwater sampling from off-site Upstream (referent) vs downstream village
villages in vicinity of electronics residential wells in nearby communities (validated by groundwater well samples—
factory October 1999-May 2000; exposed were detectable vinyl chloride, TCE, PCE, 1,1-
downstream residents; stratified on dichloroethylene, 1,1,1,-trichloroethane, cis-
Chlorinated hydrocarbons in calendar periods based on establishment of 1,2-dichloroethylene, 1,1-dichloroethane)
groundwater contaminated by factory (allowing 10 years to detect health
hazardous-waste site (formerly effects of exposure) Period of death: 1966-1979 (referent), 1980-
electronics factory) 1989, 1990-1997
Hepatic-cancer mortality
Lynge et al. 2006 Nested case-control; cohort of Occupation code “laundry and dry- Exposure categories: unexposed, dry cleaner
laundry, dry-cleaning workers cleaning worker” or industry code and other exposed, other in dry cleaning,
“laundry and dry cleaning”; categorized on unclassifiable
Denmark, Finland, Norway, Sweden basis of fewer than 10 workers in shop,
laundry workers and other workers in dry- Dry cleaner length of employment (0-1
Occupational exposure to dry- cleaning shops; length of employment in years, 2-4 years, 5-9 years, at least 10 years,
cleaning solvents (predominantly shop where worked in 1970 (only the unknown)
PCE) period of 1964-1979 was included);
interviews with next of kin; detailed
Cancer history of dry cleaning in Nordic countries
Miligi et al. 2006 Population-based case-control study Job-exposure matrix of most frequent job Unexposed vs very low, low and medium, Adjustment for sex, age,
titles and sectors to assign probability- and high intensity levels and duration of education, area
Italy intensity-weighted scales of exposure to exposure (15 yr or less vs 15 yr)
solvents, five specific categories of
Occupational solvent use in chemical classes, eight individual
manufacturing industries or chemicals; occupational history
agriculture questionnaires
Lymphoma
Morgan and Cohort study of residents with Residence in census tracts near Redlands, None (SIRs—indirect standardization)
Cassady 2002 contaminated drinking water CA (where concerns about contamination
of groundwater, drinking water with TCE,
San Bernardino County, CA (13 ammonium perchlorate; 1980 assessment
census tracts) of TCE in Redlands wells ranged from
0.09 to 97 ppb; since 1991, wells either
PCE, chlorate, TCE treated or removed to maintain TCE under
5 ppb
Cancers
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Perrin et al. 2007 Cohort study; offspring of dry Occupations of parents obtained from birth Mother and/or father dry cleaner(s) at time
cleaners certificate of birth (yes vs no)
Jerusalem, Israel
Maternal or paternal occupational
(dry-cleaning) exposure to TCE
Schizophrenia in offspring
Raaschou-Nielsen et Cohort Employment based on companies Duration of employment (less than 1 year, 1- Stratified analysis by sex
al. 2003 classified by air TCE measurements in 4.9 years, at least 5 years)
Denmark workplace 1947-1989 by Danish Labor
Inspection Service, area and personal Year of first employment (before 1970,
TCE measurements (after 1974);included 1970-1979, 1980-)
companies determined by size; iron and
Cancers, including non-Hodgkin metal, electronics, painting, printing, Lag time (none, 20 years)
lymphoma, renal-cell carcinoma, chemical, dry cleaning, other; workers
esophageal adenocarcinoma identified by Pension Fund or Central Number of employees (fewer than 50, 50-99,
Population Registry (most recent job title) 100-200)
Radican et al. 2006 Retrospective cohort; aircraft Subjects identified from database of Cumulative-exposure score: frequency
workers former civilian employees of Hill Air (times/day), duration (min/day), calendar
Force Base I, Utah; semiquantitative period of use, years of exposure; categorized
TCE, 1,1,1-trichloroethane, estimate of TCE exposure obtained from into tertiles
methylene chloride, carbon comprehensive exposure assessment;
tetrachloride, cumulative exposure score computed for
JP4 gasoline, Freon, each subject
isopropyl alcohol,
acetone, toluene,
methyl ethyl ketone,
o-dichlorobenzene, PCE, chloroform,
stoddard solvent, styrene, xylene
End-stage renal disease
(Continued)
279
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280
TABLE E-1 Continued
Reference Study Design, Exposure, Outcomes Exposure Assessment Exposure Metrics Comments
Ruder et al. 2001 Cohort study; dry-cleaning workers Dry-cleaning union records , people not Time since first employment (less than 20
(in IOM report) known to ever have been exposed to years, at least 20 years), duration of
San Francisco, Oakland, CA; carbon tetrachloride who had worked 1+ employment in dry-cleaning shops (1-5
Chicago, IL; Detroit, MI; New York, year before 1960 in shop using PCE; shops years, 5+ years)
NY visited to verify solvent use history; PCE-
only subcohort, PCE-plus cohort (records PCE only solvent, PCE and other solvents
Occupational exposure to PCE inadequate to confirm PCE use or another used in dry-cleaning shops
solvent, mostly Stoddard solvent or other
Cancer deaths petroleum solvents)
Schreiber et al. 2002 Cross-sectional; residents above dry- Apartment residents above dry cleaner; air Personal monitoring of PCE with passive
cleaning shops, day-care workers sampling of PCE in apartments; day-care monitors (3M organic vapor monitors) for
sharing building with dry cleaner workers sharing building with dry cleaner exposed persons
compared with NY State Department
of Health controls, matched by age Creatinine-adjusted urinary PCE,
(within 2 years), sex trichloroacetic acid, trichloroethanol for
exposed persons
PCE
Exposed vs control groups
Visual contrast sensitivity
Seidler et al. 2007 Population-based case-control Complete occupational history obtained by Intensity of exposure (low, medium, high—
interview: dates, job title, industry, job assigned in ppm depending on chemical);
Germany tasks, job-task-specific supplementary frequency of exposure based on 40-h
questions; industrial physician assessed workweek (low = 1-5%, medium = over 5 to
Occupational exposure to intensity, frequency of exposure to specific 30%, high = over 30%); confidence
chlorinated, organic solvents chlorinated hydrocarbons (including TCE, (possible but not probable, probable, certain)
PCE), aromatic hydrocarbons
Lymphoma
Cumulative exposure (ppm x years): sum of
intensity x frequency x duration for all jobs
held; categorized among controls at 50th,
90th percentiles
Sonnefeld et al. Case-control Residents of Tarawa Terrace were Duration of exposure (never exposed, 1-3
2001 considered exposed; exposure magnitude weeks, 4-10 weeks, 11-20 weeks, over 20
Camp Lejeune, NC determined by length of residence weeks and less than entire pregnancy, entire
pregnancy and less than 1 year before LMP,
Contaminated drinking-water TCE, entire pregnancy and at least 1 year before
other compounds LMP
Birthweight, small for gestational
age, preterm birth
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Sung et al. 2007 Retrospective cohort; female workers Female workers of former electronics Duration of employment (less than 1 mo, 1- Latency accounted for in
at electronics factory factory identified through Bureau of labor 11 mo, 1-4 years, 5-9 years, at least 10 assessing person-years at
Insurance 1973-1997; duration of years) risk (5 years, cancer of
Taoyuan, Taiwan employment thyroid, leukemia; 15
years, breast cancer; 10
Occupational exposure to solvents years, other cancers)
Stratified by calendar
Cancer year (in which
regulations were enacted
on use of organic
solvents in factories):
before and after June 20,
1974
Vieira et al. 2005 Population-based case-control Used personal delivered-dose model that PDD: sum of PCE from inhalation, dermal Nine latency periods
included personal data on tap-water absorption, ingestion based on RDD; examined (0, 5, 7, 9, 11,
Cape Cod, MA consumption, bathing habits from subjects categorized into four groups based on 13, 15, 17, 19 years)
or next of kin distribution among exposed controls: at least
PCE from inner vinyl liner leaching 50th percentile, over 50th percentile, over Adjustment for age at
from cement pipes distributing tap 75th percentile, over 90th percentile; ever vs diagnosis or index year,
water never exposed family history of breast
cancer, personal history
Breast cancer Inhalation exposure: function of of breast cancer, age at
temperature, frequency, duration of baths, first live birth or
showers, concentration of PCE volatilized in stillbirth, occupational
air from water exposure to PCE
Dermal absorption: function of surface area,
Fick’s law
Ingestion: function of volume of tap water
consumed
Yauck et al. 2004 Case-control GIS used to calculate distances between Proximity measure using classification-tree
Milwaukee,WI maternal residence, TCE sites; method: distance from maternal residence to
classification tree analysis used to TCE-emitting facility dichotomized into
TCE-emitting sites in Milwaukee, determine distance for dichotomizing exposed (residence within 1.32 miles of at
surrounding areas, 1996-1999 exposure: within or outside 1.32 miles of at least one site), nonexposed (residence more
least one TCE site than 1.32 miles of at least one site
Congenital heart defects
(Continued)
281
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282
TABLE E-1 Continued
Reference Study Design, Exposure, Outcomes Exposure Assessment Exposure Metrics Comments
Zhao et al. 2005 Retrospective cohort; California aerospace workers 1950-1993 at JEM used to assess exposure in each job Adjustment for time
Rockwell/Rocketdyne (now Boeing) several Boeing North America facilities in group: Intensity (0-3) (1950-1969, 1970- since first employment,
aerospace male workers employed LA, employed before 1980 in aerospace 1979, 1980-1989) × duration SES, age at diagnosis
before 1980 division of SSFL, worked 2+ years and
never monitored for radiation exposure; Cumulative-exposure score: low (up to 3),
Los Angeles, CA extensive industrial-hygienist review medium (over 3 up to 12), high (over 12)
interested in exposure to rocket fuel
Hydrazine, TCE, PAHs, mineral oil, hydrazine, TCE, PAHs, mineral oil,
benzene benzene
Cancer mortality, incidence
Abbreviations: ALL = acute lymphocytic leukemia, BMI = body-mass index, DEP = Department of Environmental Protection, EPA = U.S. Environmental Protection Agency, GIS
= geographic information system, ILO = International Labor Organization, IOM = Institute of Medicine, JEB = job-exposure matrix, LMP = last menstrual period, OR = odds
ratio, PAH = polycyclic aromatic hydrocarbon, PCE = perchloroethylene, PDD = personal delivered dose, RDD = relative delivered dose, RR = relative risk, SES = socioeconomic
status, SIR = standardized incidence ratio, SMR = standardized mortality ratio, SSFL = Santa Susana Field Laboratory, TCE = trichloroethylene
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308
TABLE E-4 Continued
No. Exposed MOR, OR, RR, SIR, or SMR
Persons (95% CI)
Reference Study Population
Case-Control Studies
Aschengrau et al. 2003 Women with breast cancer in Cape Cod, MA, towns:g
≤ median exposure (latency 0-15 years) 377 0.9-1.5 OR
> median exposure (latency 0-15 years) 402 1.1-1.4 OR
> 75th percentile exposure (latency 0-15 years) 253 1.6-1.9 OR
> 90th percentile exposure (latency 0-15 years) 90 1.3-1.9 OR
Vieira et al. 2005 Women with breast cancer in Cape Cod, MA, towns:
0-year latency:
Nonproxy subjects 101 1.1 (0.8-1.5) OR
All subjects 155 1.1 (0.8-1.4) OR
5-year latency
Nonproxy subjects 87 1.2 (0.9-1.8) OR
All subjects 129 1.1 (0.9-1.6) OR
7-year latency
Nonproxy subjects 71 1.1 (0.8-1.6) OR
All subjects 111 1.1 (0.8-1.5) OR
9-year latency
Nonproxy subjects 63 1.1 (0.7-1.6) OR
All subjects 97 1.1 (0.8-1.5) OR
11-year latency
Nonproxy subjects 49 1.1 (0.6-1.7) OR
All subjects 79 1.2 (0.8-1.7) OR
13-year latency
Nonproxy subjects 43 1.3 (0.7-2.1) OR
All subjects 61 1.3 (0.9-2.0) OR
15-year latency
Nonproxy subjects 30 1.4 (0.7-2.6) OR
All subjects 44 1.4 (0.9-2.3) OR
17-year latency
Nonproxy subjects 15 1.0 (0.4-2.2) OR
All subjects 21 1.0 (0.6-2.0) OR
19-year latency
Nonproxy subjects 6 1.1 (0.3-3.5) OR
All subjects 9 1.1 (0.4-2.9) OR
CERVICAL CANCER
Cohort Studies—Incidence
Morgan and Cassady 2002 Redlands, CA, community exposed to TCE, PCE in drinking water 29 0.65 (99%CI 0.38-1.02) SIR
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Chang et al. 2005 Electronics-manufacturing workers in Taiwan exposed to TCE, PCE
(women):
Employed <1 year 177 1.1 (0.9-1.2) SIR
Employed 1-5 years 69 1.1 (0.8-1.3) SIR
Employed 5-10 years 26 1.6 (1.1-2.4) SIR
Employed >10 years 1 0.1 (0.0-0.8) SIR
Cohort Studies—Mortality
Blair et al. 2003 Dry cleaners in St. Louis, MO: 27 1.6 (1.0-2.3) SMR
Little or no exposure 12 1.5 (0.8-2.7) SMR
Medium-high exposure 11 1.4 (0.7-1.7) SMR
Chang et al. 2003 Electronics-manufacturing workers in Taiwan exposed to TCE, PCE 21 0.80 (0.49-1.22) SMR
(women):
Employed <1 year 14 0.84 SMR
Employed 1-5 years 6 0.89 SMR
Employed >5 years 1 0.34 SMR
Case-Control Studies
Lynge et al. 2006 Nordic dry-cleaning workers 36 0.98 (0.65-1.47) RR
UTERINE CANCER
Cohort Studies—Incidence
Morgan and Cassady 2002 Redlands, CA, community exposed to TCE, PCE in drinking water 124 1.35 (99%CI 1.06-1.70) SIR
1.06 (0.95-1.18) SIR
Chang et al. 2005 Electronics-manufacturing workers in Taiwan exposed to TCE, PCE 337h
Cohort Studies—Mortality
Blair et al. 2003 Dry cleaners in St. Louis, MO 15 1.1 (0.6-1.8) SMR
Chang et al. 2003 Electronics-manufacturing workers in Taiwan exposed to TCE, PCE 5 0.91 (0.29-2.13) SMR
(women):
Employed <1 year 3 0.88 SMR
Employed 1-5 years 2 1.42 SMR
Employed >5 years 0 —
OVARIAN CANCER
Cohort Studies—Incidence
Morgan and Cassady 2002 Redlands, CA, community exposed to TCE, PCE in drinking water 81 1.16 (99%CI 0.85-1.53) SIR
PROSTATIC CANCER
Cohort Studies—Incidence
Morgan and Cassady 2002 Redlands, CA, community exposed to TCE, PCE in drinking water 483 1.11 (99%CI 0.98-1.25) SIR
Cohort Studies—Mortality
Blair et al. 2003 Dry cleaners in St. Louis, MO 17 1.0 (0.6-1.6) SMR
Chang et al. 2003 Electronics-manufacturing workers in Taiwan exposed to TCE, PCE 0 —
(men)
(Continued)
309
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310
TABLE E-4 Continued
No. Exposed MOR, OR, RR, SIR, or SMR
Persons (95% CI)
Reference Study Population
TESTICULAR CANCER
Cohort Studies—Incidence
Chang et al. 2005 Electronics-manufacturing workers in Taiwan exposed to TCE, PCE 1i 0.14 (0.00-0.76) SIR
Cohort Studies—Mortality
Chang et al. 2003 Electronics-manufacturing workers in Taiwan exposed to TCE, PCE 0 —
(men)
RENAL CANCER
Cohort Studies—Incidence
Morgan and Cassady 2002 Redlands, CA, community exposed to TCE, PCE in drinking water 54 0.80 (99%CI 0.54-1.12) SIR
Chang et al. 2005 Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
1.06 (0.45-2.08) SIR
Men 8j
Women 12j 1.09 (0.56-1.91) SIR
Cohort Studies—Mortality
Blair et al. 2003 Dry cleaners in St. Louis, MO: 8 1.0 (0.4-2.0) SMR
Little or no exposure 1 0.3 (<0.1-1.6) SMR
Medium-high exposure 7 1.5 (0.6-3.1) SMR
Chang et al. 2003 Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
—
Men 0j
Women 3j 1.18 (0.24-3.44) SMR
Employed <1 year 1j 0.62 SMR
Employed 1-5 years 2j 3.08 SMR
Employed >5 years 0j —
Case-Control Studies
Brüning et al. 2003 Hospital-based study in Arnsberg, Germany:
Self-reported exposure 7 1.64 (0.61-4.40) OR
Self-reported narcotic symptoms 5 1.84 (0.57-5.96) OR
Duration of self-reported exposure:
None 127 1 OR
<10 years 4 2.46 (0.65-9.34) OR
10+ years 3 1.02 (0.24-4.27) OR
Lynge et al. 2006 Nordic dry-cleaning workers 29 0.67 (0.43-1.05) RR
BLADDER CANCER
Cohort Studies—Incidence
Morgan and Cassady 2002 Redlands, CA, community exposed to TCE, PCE in drinking water 82 0.98 (99%CI 0.71-1.29) SIR
Cohort Studies—Mortality
Blair et al. 2003 Dry cleaners in St. Louis, MO: 12 1.3 (0.7-2.4) SMR
Little or no exposure 5 1.4 (0.4-3.2) SMR
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Medium-high exposure 7 1.5 (0.6-3.1) SMR
Chang et al. 2003 Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
Men 1 0.96 (0.01-5.36) SIR
Women 1 0.96 (0.01-5.33) SIR
Case-Control Studies
Lynge et al. 2006 Nordic dry-cleaning workers: 93 1.44 (1.07-1.93) RR
Employed 0-1 years 6 1.50 (0.57-3.96) RR
Employed 2-4 years 10 2.39 (1.09-5.22) RR
Employed 5-9 years 17 0.91 (0.52-1.59) RR
Employed 10 years or more 53 1.57 (1.07-2.29) RR
SKIN MELANOMAS
Cohort Studies—Incidence
Morgan and Cassady 2002 Redlands, CA, community exposed to TCE, PCE in drinking water 137 1.42 (99%CI 1.13-1.77) SIR
Chang et al. 2005 Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
Men 2 0.48 (0.05-1.73) SIR
Women 13 0.99 (0.53-1.69) SIR
Cohort Studies—Mortality
Blair et al. 2003 Dry cleaners in St. Louis, MO 4 0.8 (0.2-2.1) SMR
Chang et al. 2003 Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
Men 0 —
Women 0 —
CENTRAL NERVOUS SYSTEM CANCER
Cohort Studies—Incidence
Morgan and Cassady 2002 Redlands, CA, community exposed to TCE, PCE in drinking water 37 1.54 (99%CI 0.96-2.31) SIR
Chang et al. 2005 Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
Men 2 0.40 (0.05-1.46) SIR
Women 15 0.97 (0.54-1.61) SIR
Cohort Studies—Mortality
Blair et al. 2003 Dry cleaners in St. Louis, MO 5 0.6 (0.2-1.4) SMR
Chang et al. 2003 Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
Men 1 0.48 (0.01-2.66) SMR
Women 6 0.91 (0.33-1.99) SMR
CENTRAL NERVOUS SYSTEM CANCER IN CHILDREN
Cohort Studies—Incidence
Morgan and Cassady 2002 Redlands, CA, community exposed to TCE, PCE in drinking water 6 1.05 (99%CI 0.24-2.70) SIR
LYMPHATIC AND HEMATOPOIETIC CANCER
Cohort Studies—Incidence
(Continued)
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312
TABLE E-4 Continued
No. Exposed MOR, OR, RR, SIR, or SMR
Persons (95% CI)
Reference Study Population
Chang et al. 2005 Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
Men 6 0.73 (0.27-1.60) SIR
Women 16 0.65 (0.37-1.05) SIR
Cohort Studies—Mortality
MALIGNANT LYMPHOMA
Case-Control Studies
Seidler et al. 2007 Cases with occupational exposure in Germany:
>0 to ≤ 9.1 ppm-year 16 1.1 (0.5-2.3) OR
>9.1 to ≤78.8 ppm-year 13 1.0 (0.5-2.2) OR
>78.8 ppm-year 2 3.4 (0.7-17.3) OR
NON-HODGKIN LYMPHOMA
Cohort Studies—Incidence
Morgan and Cassady 2002 Redlands, CA, community exposed to TCE, PCE in drinking water 111 1.09 (99%CI 0.84-1.38) SIR
Cohort Studies—Mortality
Blair et al. 2003 Dry cleaners in St. Louis, MO 12 0.9 (0.5-1.6) SMR
Case-Control Studies
Lynge et al. 2006 Nordic dry-cleaning workers 42 0.95 (0.65-1.41) RR
Miligi et al. 2006 Cases with occupational exposure in Italy:
Very low-low 18 0.6 (0.3-1.2) OR
Medium-high 14 1.2 (0.6-2.5) OR
≤15 years 10 1.3 (0.5-3.3) OR
>15 years 3 —
Seidler et al. 2007 Cases with occupational exposure in Germany:
B-non-Hodgkin lymphoma:
>0 to ≤ 9.1 ppm-year 12 0.9 (0.4-2.0) OR
>9.1 to ≤78.8 ppm-year 12 1.0 (0.5-2.3) OR
>78.8 ppm-year 5 3.2 (0.6-16.7) OR
T-non-Hodgkin lymphoma:
>0, ≤ 9.1 ppm-year 1 1.7 (0.2-14.4) OR
>9.1 to ≤78.8 ppm-year 1 1.5 (0.2-12.5) OR
>78.8 ppm-year 1 —
HODGKIN DIESASE
Cohort Studies—Incidence
Morgan and Cassady 2002 Redlands, CA, community exposed to TCE, PCE via drinking water 17 0.93 (99%CI 0.44-1.67) SIR
Cohort Studies—Mortality
Blair et al. 2003 Dry cleaners in St. Louis, MO 5 2.0 (0.6-4.6) SMR
Chang et al. 2003 Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
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Men 0 —
Women 1 2.23 (0.03-12.40) SMR
Case-Control Studies
Seidler et al. 2007 Cases with occupational exposure in Germany:
>0 to ≤ 9.1 ppm-year 3 1.7 (0.4-6.9) OR
>9.1 to ≤78.8 ppm-year 1 0.7 (0.1-6.3) OR
>78.8 ppm-year 0 —
MULTIPLE MYELOMA
Cohort Studies—Mortality
Blair et al. 2003 Dry cleaners in St. Louis, MO 7 0.8 (0.3-1.6) SMR
Case-Control Studies
Seidler et al. 2007 Cases with occupational exposure in Germany:
>0 to ≤ 9.1 ppm-year 3 1.8 (0.5-6.7) OR
>9.1 to ≤78.8 ppm-year 0 —
>78.8 ppm-year 0 —
LEUKEMIA
Cohort Studies—Incidence
1.02 (99%CI 0.74-1.35) SIR
Morgan and Cassady 2002 Redlands, CA, community exposed to TCE, PCE in drinking water 77k
Cohort Studies—Mortality
Blair et al. 2003 Dry-cleaners in St. Louis, MO 12 0.8 (0.4-1.4) SMR
Chang et al. 2003 Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
Men 2 0.44 (0.05-1.59) SMR
Women 8 0.54 (0.23-1.07) SMR
CHRONIC LYMPHOCYTIC LEUKEMIA
Case-Control Studies
Seidler et al. 2007 Cases with occupational exposure in Germany:
>0, ≤ 9.1 ppm-year 1 —
>9.1, ≤78.8 ppm-year 2 0.6 (0.1-2.8) OR
>78.8 ppm-year 0 —
DIFFUSE LARGE B-CELL LYMPHOMA
Case-Control Studies
Seidler et al. 2007 Cases with occupational exposure in Germany:
>0 to ≤ 9.1 ppm-year 3 0.9 (0.3-3.9) OR
>9.1 to ≤78.8 ppm-year 6 2.1 (0.8-5.9) OR
>78.8 ppm-year 1 2.3 (0.2-26.0) OR
FOLLICULAR LYMPHOMA
Case-Control Studies
Seidler et al. 2007 Cases with occupational exposure in Germany:
(Continued)
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314
TABLE E-4 Continued
Reference No. Exposed MOR, OR, RR, SIR, or SMR
Persons (95% CI)
Study Population
>0 to ≤ 9.1 ppm-year 2 1.2 (0.3-5.5) OR
>9.1 to ≤78.8 ppm-year 0 —
>78.8 ppm-year 0 —
MARGINAL ZONE LYMPHOMA
Seidler et al. 2007 Cases with occupational exposure in Germany:
>0 to ≤ 9.1 ppm-year 1 —
Costas et al. 2002 Cases in Woburn, MA (drinking water contaminated with TCE, PCE,
other chemicals):
Ever exposed:
From 2 years before conception to case diagnosis 16 2.39 (0.54-10.59) OR
During 2 years before conception 8 2.61 (0.47-14.37) OR
During pregnancy 10 8.33 (0.73-94.67) OR
From birth to diagnosis 12 1.18 (0.28-5.05) OR
Cumulative exposure:
From 2 years before conception to case diagnosis:
Least exposed 9 5.00 (0.75-33.50) OR
Most exposed 7 3.56 (0.51-24.78) OR
During 2 years before conception:
Least exposed 4 2.48 (0.42-15.22) OR
Most exposed 4 2.82 (0.30-26.42) OR
During pregnancy:
Least exposed 3 3.53 (0.22-58.14) OR
Most exposed 7 14.30 (0.92-224.52) OR
From birth to diagnosis:
Least exposed 7 1.82 (0.31-10.84) OR
Most exposed 5 0.90 (0.18-4.56) OR
Infante-Rivard et al. 2005 Maternal occupational exposure:
2 years before pregnancy up to birth 0.96 (0.41-2.25) OR
During pregnancy 0.84 (0.30-2.34) OR
a
Digestive organs and peritoneum.
b
Colon and rectum.
c
Results are for liver and biliary cancer combined.
d
Lungs and bronchi.
e
Trachea, bronchi, and lungs.
f
Bone and articular cartilage.
g
Combined data from present and previous study by Aschengrau et al. (1998).
h
Female genital organs.
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i
Testes and other male genital organs.
j
Kidney and other unspecified urinary organs.
k
All leukemias.
Abbreviations: CI = confidence interval, MOR = mortality odds ratio, OR = odds ratio, PCE = perchloroethylene, RR = relative risk, SIR = standardized
incidence ratio, SMR = standardized mortality ratio, TCE = trichloroethylene.
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316
TABLE E-5a Studies of Noncancer End Points and Exposure to PCE
Reference Study Population No. Exposed Persons OR (95% CI)
SYSTEMIC SCLEROSIS
Case-Control Studies
Garabrant et al. 2003 Women in Michigan, Ohio:
Self-reported exposure 7 1.4 (0.6-3.4)
Expert-confirmed exposure 5 1.1 (0.4-2.9)
PRETERM LOSS
Sonnefeld et al. 2001 Infants of Camp Lejeune residents, 1968-1985:
Exposure 1-3 weeks 14 1.0 (90% CI 0.6-1.6)
Exposure 4-10 weeks 55 1.3 (90% CI 1.0-1.7)
Exposure 11-20 weeks 86 1.3 (90% CI 1.1-1.6)
Exposure >20 weeks, less than entire pregnancy 94 0.8 (90% CI 0.7-1.0)
Exposure, entire pregnancy, less than 1 year before 158 1.1 (90% CI 0.9-1.3)
last menstrual period
Exposure entire pregnancy, at least 1 year before last 36 0.8 (90% CI 0.6-1.1)
menstrual period
SMALL FOR GESTATIONAL WEIGHT
Sonnefeld et al. 2001 Infants of Camp Lejeune residents, 1968-1985
Exposure 1-3 weeks 15 0.9 (90% CI 0.5-1.3)
Exposure 4-10 weeks 60 1.1 (90% CI 0.9-1.4)
Exposure 11-20 weeks 84 1.0 (90% CI 0.8-1.2)
Exposure >20 weeks, less than entire pregnancy 16 1.2 (90% CI 1.0-1.4)
Exposure entire pregnancy, less than 1 year before 207 1.2 (90% CI 1.0-1.3)
last menstrual period
Exposure entire pregnancy, at least 1 year before last 61 1.1 (90% CI 0.9-1.4)
menstrual period
All births 622 1.2 (90% CI 1.0-1.3)
Mother’s age <35 years 611 1.1 (90% CI 0.9-1.2)
Mother’s age ≥ 35 years 11 2.1 (90% CI 0.9-4.9)
Mother had no previous fetal losses 475 1.1 (90% CI 0.9-1.2)
Mother had one previous fetal loss 104 1.5 (90% CI 1.1-2.0)
Mother had at least two previous fetal losses 43 2.5 (90% CI 1.5-4.3)
MEAN BIRTH WEIGHT
Sonnenfeld et al. 2001 Infants of Camp Lejeune residents, 1968-1985
Exposure 1-3 weeks 189 Mean difference: 18 g (90% CI -40 to 76)
Exposure 4-10 weeks 597 Mean difference: -17 g (90% CI -51 to 17)
Exposure 11-20 weeks 915 Mean difference: -31 g (90% CI -59 to -3)
Exposure >20 weeks, less than entire pregnancy 1,551 Mean difference: -28 g (90% CI -50 to -5)
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Exposure entire pregnancy , less than 1 year before 1,994 Mean difference: -15 g (90% CI -35 to 5)
last menstrual period
Exposure entire pregnancy, at least 1 year before last 605 Mean difference: -18 g (90% CI -51 to 16)
menstrual period
All births 6,039 Mean difference: -26 g (90% CI -43 to -9)
Mother’s age <35 years 5,968 Mean difference: -2 g (90% CI -17 to 13)
Mother’s age ≥ 35 years 71 Mean difference: -130 g (90% CI -236 to -23)
Mother had no previous fetal losses 4,985 Mean difference: -2 g (90% CI -17 to 13)
Mother had one previous fetal loss 806 Mean difference: -16 g (90% CI -79 to 24)
Mother had at least two previous fetal losses 245 Mean difference: -104 g (90% CI -174 to -34)
NEUROBLASTOMA
Case-Control Studies
De Roos et al. 2001 Offspring with paternal occupational exposure
(Unites States, Canada)
Self-reported exposure to PCE 8 0.5 (0.2-1.4) OR
Industrial-hygiene-reviewed exposure 4 0.5 (0.1-1.7) OR
SCHIZOPHRENIA
Cohort Studies—Incidence
Perrin et al. 2007 Offspring of dry cleaners in Jerusalem 4 3.4 (1.3-9.2) RR
NEUROBEHAVIORAL
Cohort Studies
Janulewicz et al. 2008 Offspring of Cape Cod, MA, residents born 1969- 1,349
(Note: end point included two 1983
diagnoses—ADD and HD—
and six indicators of learning
disabilities)
Prenatal exposure: 1,244
Low exposure 1.0-1.5 (0.7-2.7) OR
High exposure 0.8-1.1 (0.4-1.6) OR
Exposure 5 years postnatally: 1,326
Low exposure 0.9-1.4 (0.7-2.5) OR
High exposure 0.6-1.0 (0.3-1.7) OR
Abbreviations: ADD = attention deficit disorder, CI = confidence interval, HD = hyperactivity disorder, OR = odds ratio, PCE = perchloroethylene.
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TABLE E-5b Visual Contrast Sensitivity and Visual Acuity
318
Reference Population Exposure, Duration Effects
Schreiber et al. Apartment residents above dry cleaner Mean, 778 µg/m3 Visual contrast sensitivity trend in Lanthony D15-d; no change
2002 Median, 350 µg/m3 in visual acuity
Mean residence, 5.8 years
Lifetime dose, 3,400 µg/m3
Day-care workers sharing building with Mean, 2,150 µg/m3 Visual contrast sensitivity; no change in visual acuity
dry cleaner Median, 2,150 µg/m3
Mean work, 4.0 years
Lifetime dose, 1,978 µg/m3
