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Priority Substances List Assessment Report for Ethylene Oxide

2.0 Summary of Information Critical to Assessment of "Toxic" under CEPA 1999

2.4.4.2 Cancer

Table 5 Summary of risk measures for selected cancers (stomach, pancreas, brain, hematopoietic) from epidemiological studies
Cancer	Exposure to ethylene oxide	Risk measure¹	Reference
Stomach Blood and lymphatic Leukemia	male and female ethylene oxide production workers (two plants) and medical equipment sterilizers	SMR = 546: 10 SMR = 459: 9 SMR = 921: 7	Hogstedt (1988)
Stomach Leukemia	workers from older production plant workers from older production plant	SMR = 707: 9 SMR = 703: 3	Hogstedt (1988)
Stomach Pancreas Brain and nervous system Leukemia and aleukemia	10-year update of male workers producing or using ethylene oxide (excluding chlorohydrin production) studied by Greenberg et al. (1990) entire cohort entire cohort entire cohort entire cohort	SMR = 160 (95% CI = 69-315): 8 SMR = 61 (95% CI = 17-156): 4 SMR = 150 (95% CI = 55-327): 6 SMR = 106 (95% CI = 35-248): 5	Teta et al. (1993)
Stomach Stomach	intermediate-exposure subgroup low-exposure subgroup	SMR = 364 (95% CI = 102-957): 4 ^* SMR = 222 (95% CI = 61-575): 4	Teta et al. (1993)
	male and female workers in facilities producing sterilized medical equipment and spices		Steenland et al. (1991)
Hematopoietic cancers Hematopoietic cancers Lymphosarcoma/ reticulosarcoma Non-Hodgkin's lymphoma Hematopoietic cancers	those with >20 years since first exposure males only males only males only males with >7 years exposure and >20 years since first exposure	SMR = 1.76 (95% CI = 0.94-3.01): 34 SMR = 1.55 (p = 0.05): 27^* SMR = 2.6 (p = 0.05): 7^* SMR = 2.16: 7 SMR = 2.63 (95% CI = 1.05-5.42): 7^*	Steenland et al. (1991)
Hematopoietic cancers Non-Hodgkin's lymphoma Leukemia/aleukemia	workers with highest cumulative exposure workers with highest cumulative exposure workers with highest cumulative exposure	SMR = 124 (95% CI = 66-213): 13 SMR = 192 (95% CI = 77-395): 7 SMR = 75 (95% CI = 15-218): 3	Stayner et al. (1993)
Hematopoietic cancers Hematopoietic cancers Hematopoietic cancers Hematopoietic cancers	males with highest cumulative exposure males with moderate cumulative exposure males with lowest cumulative exposure workers with >20 years since first exposure	SMR = 196 (95% CI = 101-343): 12^* SMR = 143 (95% CI = 62-283): 8 SMR = 95 (95% CI = 26-243): 4 SMR = 155 (95% CI = 77-277): 11	Stayner et al. (1993)
Lympho-/hematopoietic cancers Leukemia	male and female workers sterilizing medical equipment male and female workers sterilizing medical equipment	SIR = 1.78 (95% CI = 0.65-3.88): 6 SIR = 2.44 (95% CI = 0.3-8.81): 2	Hagmar et al. (1995)
Leukemia Brain	workers having a minimum 10 years latency (but excluding those with cumulative exposure <0.13 ppm-years)	SIR = 7.14 (95% CI = 0.87-25.8): 2 SIR = 3.80 (95% CI = 0.78-11.1): 3	Hagmar et al. (1995)
Hodgkin's disease Hodgkin's disease	male workers at a chemical manufacturing plant nested case-control analysis of male workers at the chemical manufacturing plant	SIR = 497 (95% CI = 238-915): 10^* OR = 8.5 (95% CI = 1.4-39.9): 3² ^*	Swaen et al. (1996)
Leukemia Stomach	male workers at chemical plants male workers at chemical plants	SMR = 0.85 (95% CI = 0.10-3.07): 2 SMR = 1.38 (95% CI = 0.75-2.31): 14	Kiesselbach et al. (1990)
Pancreas Brain and central nervous system Hodgkin's disease	male petroleum plant workers	SMR = 377 (95% CI = 76-1102): 3 SMR = 285 (95% CI = 32-1030): 2 SMR = 570 (95% CI = 64-2058): 2	Morgan et al. (1981)
Brain and central nervous system Lympho-/hematopoietic	male workers involved in the production of ethylene chlorohydrin and propylene chlorohydrin	SMR = 123 (95% CI = 25-358): 3 SMR = 129 (95% CI = 62-238): 10	Olsen et al. (1997)
Lympho-/hematopoietic Lympho-/hematopoietic	male workers involved in the production of ethylene chlorohydrin male workers involved in the production of ethylene chlorohydrin (analysis included a 25-year latency period)	SMR = 149 (95% CI = 60-307): 7 SMR = 194 (95% CI = 71-423): 6	Olsen et al. (1997)
Hematopoietic cancers Lympho/reticulosarcoma Leukemia/aleukemia Stomach Pancreas	male workers licensed to handle ethylene oxide and other chemicals male workers licensed to handle ethylene oxide and other chemicals male workers licensed to handle ethylene oxide and other chemicals male workers licensed to handle ethylene oxide and other chemicals male workers licensed to handle ethylene oxide and other chemicals	SMR = 250 (95% CI = 91-545): 6 SMR = 682 (95% CI = 186-1745): 4^* SMR = 193 (95% CI = 23-699): 2 SMR = 122 (95% CI = 40-287): 5 SMR = 254 (95% CI = 52-744): 3	Bisanti et al. (1993)
Hematopoietic cancers Lympho/ reticulosarcoma Leukemia/aleukemia	male workers licensed to handle ethylene oxide only male workers licensed to handle ethylene oxide only male workers licensed to handle ethylene oxide only	SMR = 700 (95% CI = 227-1637): 5^* SMR = 1693 (95% CI = 349-4953): 3^* SMR = 650 (95% CI = 79-2349): 2	Bisanti et al. (1993)
Leukemia Pancreas	male and female workers using ethylene oxide as a sterilant male and female workers using ethylene oxide as a sterilant	SMR = 1.85 (p = 0.42): 1 SMR = 3.92 (p = 0.09): 2	Norman et al. (1995)
Leukemia Non-Hodgkin's lymphoma Stomach Pancreas Brain and central nervous system	meta-analysis of reports published between 1979 and 1993	sSMR = 1.06 (95% CI = 0.73-1.48): 31 sSMR = 1.35 (95% CI = 0.93-1.90): 31 sSMR = 1.28 (95% CI = 0.98-1.65): 57 sSMR = 0.98 (95% CI = 0.69-1.36): 34 sSMR = 0.89 (95% CI = 0.55-1.36): 19	Shore et al. (1993)
Leukemia Non-Hodgkin's lymphoma Stomach Pancreas Brain	update of Shore et al. analyses, but including two additional studies	mSMR = 1.08 (95% CI = 0.61-1.93): 35 mSMR = 1.34 (95% CI = 0.96-1.89): 33 mSMR = 1.23 (95% CI = 0.71-2.13): 59 mSMR = 0.95 (95% CI = 0.69-1.31): 37 mSMR = 0.96 (95% CI = 0.49-1.91): 25	Teta et al. (1999)

¹ Unless otherwise noted, value in italics is the number of observed deaths or cases. Asterisk (^*) indicates increase reported as statistically significant.

² Number of cases exposed to ethylene oxide.

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