A retrospective cohort study of cause-specific mortality and incidence of hematopoietic malignancies in Chinese benzene-exposed workers

Abstract

Benzene exposure has been causally linked with acute myeloid leukemia (AML), but inconsistently associated with other hematopoietic, lymphoproliferative and related disorders (HLD) or solid tumors in humans. Many neoplasms have been described in experimental animals exposed to benzene. We used Poisson regression to estimate adjusted relative risks (RR) and the likelihood ratio statistic to derive confidence intervals for cause-specific mortality and HLD incidence in 73,789 benzene-exposed compared with 34,504 unexposed workers in a retrospective cohort study in 12 cities in China. Follow-up and outcome assessment was based on factory, medical and other records. Benzene-exposed workers experienced increased risks for all-cause mortality (RR=1.1, 95% CI=1.1, 1.2) due to excesses of all neoplasms (RR=1.3, 95% CI=1.2, 1.4), respiratory diseases (RR=1.7, 95% CI=1.2, 2.3) and diseases of blood forming organs (RR=∞, 95% CI=3.4, ∞). Lung cancer mortality was significantly elevated (RR=1.5, 95% CI=1.2, 1.9) with similar RRs for males and females, based on three-fold more cases than in our previous follow-up. Significantly elevated incidence of all myeloid disorders reflected excesses of myelodysplastic syndrome/acute myeloid leukemia (RR=2.7, 95% CI=1.2, 6.6) and chronic myeloid leukemia (RR=2.5, 95% CI=0.8, 11), and increases of all lymphoid disorders included excesses of non-Hodgkin lymphoma (RR=3.9, 95%CI=1.5, 13) and all lymphoid leukemia (RR=5.4, 95%CI=1.0, 99). The 28-year follow-up of Chinese benzene-exposed workers demonstrated increased risks of a broad range of myeloid and lymphoid neoplasms, lung cancer, and respiratory diseases and suggested possible associations with other malignant and non-malignant disorders. What's new? More than two million workers worldwide are exposed to benzene each year. In this long-term study of Chinese workers, the authors found that chronic benzene exposure was associated with a substantial increase in the risk of myeloid and lymphoid neoplasms, lung cancer, and respiratory diseases. The results also suggest possible associations with other malignant and non-malignant disorders.