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Alexander Hawes, LLP: Non-Hodgkins Lymphoma: "Why Do I Have Non-Hodgkins Lymphoma? How Did I Get It?" Non-Hodgkins Lymphoma has long been associated with exposure to workplace chemicals
By Richard Alexander (bio)
Alexander Hawes, LLP is a leading toxic tort plaintiffs' law firm. Over the last 20 years we have represented hundreds of individuals and their families as a result of cancers and birth defects caused by chemical exposures. As recognized experts in toxic chemical litigation we are called upon by lawyers across the United States to provide our expertise in this challenging are of defective product litigation.
If you have been diagnosed with Non-Hodgkins Lymphoma [NHL], and have worked with industrial solvents you may have a claim against the manufacturers and suppliers who sold these chemicals to your employer. Please contact us now for a free consultation with an attorney.
This article is one of many offered to the public to provide useful information on the causes of cancer. We invite you to review our library of articles and hope they are helpful to you.
Common industrial solvents used in a variety of manufacturing operations from electronics to printing have been associated with increasing the risk of suffering cancer. These solvents include acetone, benzene, bisphenol A diglycidyl ether resin (BADGE), 1-butoxy-2,3-epoxypropane, bisphenol A, diglycidyl ether, diglycidyl ether of bisphenol, 1,4-dioxane, epichlorohydrin, epoxy-3-phenoxypropane, ethyl benzene, ethylene oxide, freon TF (113), , isopropyl alcohol, m-xylene, o-xylene, , toluene, 1,1,1-trichloroethane, trichloroethylene (TCE), mixed xylene, and p-xylene .
For more than 20 years scientific literature has consistently reported that organic solvent exposure increases the risk of NHL. Below in chronological order is detailed what medical and industrial health officials around the world were learning about industrial solvents year by year. While it is no surprise that chemicals cause cancer, mixtures of chemicals used at work are particularly dangerous, but that information is never adequately communicated to workers. The following articles show that organic solvent exposure has long been associated with a substantially increased risk for NHL.
In 1981 Hardell, L., M. Eriksson, et al. (1981) published “Malignant lymphoma and exposure to chemicals, especially organic solvents, chlorophenols and phenoxy acids: a case-control study.” Br J Cancer 43(2): 169-76. This research shows in Table 5 shows the relative risk for exposure to organic solvents, other than styrene, trichloroethylene, perchloroethylene, and benzene, was 2.8 (95% confidence limit or level with a confidence interval (“C, I.”) ranging from 1.6 to 4.8).
A relative risk of 2.8 means that an exposed person is 2.8 times more likely to suffer NHL than a non-exposed person.
The confidence limit, reported as a percentage, gives the likelihood that an estimated range of values will occur if independent samples are taken repeatedly from the same population.
A 95% confidence limit for a confidence interval of 1.6 to 4.8 means that a re-analysis of this data will show that 95% of the time an exposed person will be between 1.6 times to 4.8 time more likely to suffer NHL.
In 1984, Wilcosky, T. C., H. Checkoway, et al. (1984) published “Cancer mortality and solvent exposures in the rubber industry.” Am Ind Hyg Assoc J 45(12): 809-11. This study reports on solvent exposure and lymphoma deaths between 1964 to 1973. Statistically significant elevated odds ratios were found for lymphosarcoma and exposure to isopropanol, benzene, trichloroethylene, carbon tetrachloride, xylenes, carbon disulfide, and hexane, all of which are organic solvents.
In 1988, Olsson, H. and L. Brandt (1988) published “Risk of non-Hodgkin's lymphoma among men occupationally exposed to organic solvents.” Scand J Work Environ Health 14(4): 246-51. Reports on patients who used organic solvents daily at work for at least one year were classified as exposed. Categorization in five-year age groups gave an elevated odds ratio of 3.3 (95 percent confidence interval of 1.9 to 5.8) The odds ratio was 6.5, (95 percent confidence interval from 3.2 to 13.) for tumors located above the diaphragm. The odds ratio was 2.3, ( 95 percent confidence interval ranging from 1.3 to 4.3), for other lymphomas.
In the 1988 Olsson study, a logistical regression model including age and exposure to organic solvents, including phenoxy acid, and chlorophenol exposure, showed that solvent exposure was an independent risk factor for NHL. This study revealed that with an increasing duration of exposure there was a significantly increased risk of lymphoma, confirming a strong association between solvent exposure and an initial lymphoma located above the diaphragm. Table 3 expressed the risk of lymphoma related to exposure to solvents, herbicides, and chlorophenols, and tumor site. Using multivariant models the odds ratio for solvents ranged from 2.0 to 3.4 ( 95 percent confidence interval: 1.5 to 2.6); for solvent exposure among those with supradiaphragmatic presentations of NHL the odds ratio was 2.3 to 5.2 with a 95 percent confidence interval. Table 4, Exemplified Risk of Lymphoma in Relation to Duration of Solvent Exposure, reports that for 10 years of exposure to organic solvents the odds ratio was 1.8 ( 95 percent confidence interval: 1.2 to 2.7).
In the 1988 Olsson study, for 20 years of exposure to organic solvents, the odds ratio rose to 3.3, (95 percent confidence interval: 1.5 to 7.1. For 30 years of exposure, the odds ratio for NHL and organic solvent exposure rose to 6.0, (95 percent confidence interval rang 1.9 to 19.0. The patients with NHL were more often exposed to solvents than the control group with a corresponding odds ratio of 3.3, ( 95 percent confidence interval: 1.9 to 5.8.). For the 55 patients with localized supradiaphragmatic lymphoma, the odds ratio for exposure to solvents was 6.5 ( 95 percent confidence interval: 3.2 to 13.3.). For 112 other patients with lymphomas localized below the diaphragm or with generalized lymphoma, their odds ratio was 2.3 (95 percent confidence interval: 1.3 to 4.3).
In 1989, Brandt, L., U. Kristoffersson, et al. (1989) published “Relation between occupational exposure to organic solvents and chromosome aberrations in non-Hodgkin's lymphoma.” Eur J Haematol 42(3): 298-302. Among men age 25 to 85 years with histologically verified malignant lymphoma there were increased frequencies of chromosomal aberrations in lymphocytes of workers handling organic solvents and other petroleum products.
The 1989 Brandt study showed a statistically significant association between chromosomal aberrations in NHL patients and occupational organic solvent exposure (defined as handling organic solvents every working day for at least one year). The intermediate or high-grade lymphomas displayed chromosomal translocations involving the band 14q32, while in unexposed patients only five out of 28 unexposed patients (18 percent) showed such chromosomal damage. These findings were highly significant.
In 1989, Ott, M. G., M. J. Teta, et al. (1989) published “Lymphatic and hematopoetic tissue cancer in a chemical manufacturing environment.” Am J Ind Med 16(6): 631-43. Table 1 shows exposure odds ratios for men having ever or never been employed in selected work areas. For the ethanol unit, the odds ratio was 5.4 for non-Hodgkin's lymphoma, a statistically significant elevation. The definition of exposure for purposes of calculating that particular odds ratio was work in the ethanol unit at three different facilities where workers were exposed to two or more chemicals. Table 3 reports on the ever-never classification of having worked with 21 selected chemicals. For the chemical allyl alcohol, the odds ratio for non-Hodgkin's lymphoma was 2.6.
In 1990, Blair, A., P. A. Stewart, et al. (1990) published “Cancer and other causes of death among a cohort of dry cleaners.” Br J Ind Med 47(3): 162-8. This study showed an association between work in the dry cleaning industry (and specific dry cleaning solvents) and lymphosarcoma and reticulosarcoma. Deaths rates from lymphoma and Hodgkin's disease were elevated. For lymphosarcoma and reticulosarcoma, the standard mortality ratio (SMR) was 1.7, 95 % CI = 0.7 - 3.4. For the lymphatic and hematopoetic malignancies, the SMR for those with a high exposure was 4.0. The exposure response trend was statistically significant for all race and sex groups combined for cancers of the lymphatic and hematopoetic system.. The excess of lymphatic and hematopoetic cancer occurred primarily among white men.
In 1992, Blair, A., A. Linos, et al. (1992) reported “Comments on occupational and environmental factors in the origin of non- Hodgkin's lymphoma.” Cancer Res 52(19 Suppl): 5501-5502. The odds ratios for the different subtypes of non-Hodgkins lymphoma were reported by the intensity of exposure to various solvents. Elevated odds ratio of 1.4 between exposure to solvents other than benzene and non-Hodgkin's lymphoma among those exposed in the higher intensity category. See table 4. Exposure to solvents other than benzene showed elevated odds ratio of 1.4 for lower intensity exposure and 1.1 for higher intensity exposure for the subgroup follicular non-Hodgkin's lymphoma (table 4). For diffuse non-Hodgkin's lymphoma with exposure to organic solvents other than benzene, in the higher intensity category, there is an odds ratio of 2.4, with statistically significant confidence interval of 1.2 to 5.0.
In 1995, Anttila, A., E. Pukkala, et al. (1995) published “Cancer incidence among Finnish workers exposed to halogenated hydrocarbons.” J Occup Environ Med 37(7): 797-806. An excess risk for non-Hodgkin’s lymphoma was shown for workers exposed to one or more of three halogenated hydrocarbons: trichloroethylene, tetrachloroethylene, and 1,1,1- trichloroethane. Table 2 shows observed numbers of cancer cases and SIRs, in the period 1967 to 1992. For non-Hodgkin's lymphoma, the standardized incidence ratio for the entire cohort was 2.13. (95% C.I. 1.06 to 3.80 when subgroup analyses were performed. For those with 0-9 years since first measurement and those with ten or more years, the standardized incidence ratio was elevated at 2.55. For those with ten or more years since first measurement, the SIR was a statistically significant 5.0 (95% C.I. 1.17 to 4.84).
In 1996, Fu, H., P. A. Demers, et al. (1996) reported “Cancer mortality among shoe manufacturing workers: an analysis of two cohorts.” Occup Environ Med 53(6): 394-8. The primary basis of cancer mortality among workers in shoe manufacturing for NHL was high-solvent exposure.
In 1997 Tatham, L., P. Tolbert, et al. (1997) published “Occupational risk factors for subgroups of non-Hodgkin's lymphoma.” Epidemiology 8. (5) which reviews the literature on solvent exposure and non-Hodgkin’s lymphoma. Table 3 “Associations between occupational exposures and subgroups of non-Hodgkin's Lymphomas” shows an odds ratio of 1.6 with the 95 percent confidence interval ranging from 1.10 to 2.20 for exposure to chemical solvents and the development of small cell diffuse lymphomas. Chemical solvent groups consisted of chlorophenols and chlorinated hydrocarbons. Table 4 shows a modest increase of the odds ratio for small cell diffuse lymphomas and solvent exposure; for those never exposed to solvents, the odds ratio is 1.00. Those exposed to solvents less than nine years had an odds ratio for lymphoma of 1.50 which is of borderline statistical significance (95 percent confidence interval: 0.99 to 2.20) Those exposed more than nine years had an odds ratio of 1.70, a statistically significant finding ( 95 percent confidence interval ranging from 1.10 to 2.60).
In 1997 Tatham, L., P. Tolbert, et al. (1997) “Occupational risk factors for subgroups of non-Hodgkin's Lymphoma” Epidemiology 8 (5), the study reports that persons exposed to chemical solvents more than nine years had an odds ratio of 1.70, a statistically significant finding (95 percent confidence interval ranging from 1.10 to 2.60).
in 1998, Blair, A., P. Hartge, et al. (1998) published “Mortality and cancer incidence of aircraft maintenance workers exposed to trichloroethylene and other organic solvents and chemicals: extended follow up.” Occup Environ Med 55(3): 161-7. For exposure to any solvent the relative risk of death from lymphoma in men was 1.6, and for women the relative risk was 2.8. (Trichloroethylene had been the major degreasing solvent until 1978 when it was replaced by 1,1,1-trichloroethane or TCA.) Eleven men who died from non-Hodgkin’s lymphoma had exposures to freon, solder flux, isopropyl alcohol, trichloroethane, or methylene chloride. Four were exposed to all five chemicals; four more were exposed to four of the five. Four of the five women who died from non-Hodgkin's lymphoma had been exposed to freon, solder flux, isopropyl alcohol, and acetone.
In 1998, Blair, A., P. Hartge, et al. (1998) published “Mortality and cancer incidence of aircraft maintenance workers exposed to trichloroethylene and other organic solvents and chemicals: extended follow up.” Occup Environ Med 55(3): 161-71. Table 6 reports rate ratios for mortality for non-Hodgkin's lymphoma among workers with exposure to selected chemicals (compared to those with no such exposure). There are two entries from this table, one for the category of the chemical isopropyl alcohol. In men, the rate ratio is1.8, which was not a statistically significantly elevated relative risk ratio. Among women, the ratio is 5.8 (95 percent confidence interval extending from 1.0 to 34.6.*
If you or a member of your family has suffered Non-Hodgkins Lymphoma please contact Alexander Hawes, LLP, immediately to protect your rights. There is no charge, and no obligation. If we take your case, there is no fee for our services unless we win your case, or settle it in your favor.
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*The association between exposure to organic solvents and NHL is further supported by the following research reports. Abstracts and full text can be found on PubMed, the website for the National Medical Library.
Katz, R. M. and D. Jowett (1981). “Female laundry and dry cleaning workers in Wisconsin: a mortality analysis.” Am J Public Health 71(3): 305-7.
Olsson, H. and L. Brandt (1981). “Supradiaphragmatic presentation of non-Hodgkin's lymphoma in men occupationally exposed to organic solvents.” Acta Med Scand 210(5): 415-8.
Bernard, S. M., R. A. Cartwright, et al. (1984). “Aetiologic factors in lymphoid malignancies: a case-control epidemiological study.” Leuk Res 8(4): 681-9.
Walrath, J., F. P. Li, et al. (1985). “Causes of death among female chemists.” Am J Public Health 75(8): 883-5.
Zoloth, S. R., D. M. Michaels, et al. (1986). “Patterns of mortality among commercial pressmen.” J Natl Cancer Inst 76(6): 1047-51.
Mallin, K., L. Berkeley, et al. (1986). “A proportional mortality ratio study of workers in a construction equipment and diesel engine manufacturing plant.” Am J Ind Med 10(2): 127-41.
Woods, J. S., L. Polissar, et al. (1987). “Soft tissue sarcoma and non-Hodgkin's lymphoma in relation to phenoxyherbicide and chlorinated phenol exposure in western Washington.” J Natl Cancer Inst 78(5): 899-910.
Maizlish, N., J. Beaumont, et al. (1988). “Mortality among California highway workers.” Am J Ind Med 13(3): 363-79.
La Vecchia, C., E. Negri, et al. (1989). “Occupation and lymphoid neoplasms.” Br J Cancer 60(3): 385-8.
Persson, B., A. M. Dahlander, et al. (1989). “Malignant lymphomas and occupational exposures.” Br J Ind Med 46(8): 516-20.
Christie, D., K. Robinson, et al. (1991). “A prospective study in the Australian petroleum industry. II. Incidence of cancer.” Br J Ind Med 48(8): 511-4.
Spirtas, R., P. A. Stewart, et al. (1991). “Retrospective cohort mortality study of workers at an aircraft maintenance facility. I. Epidemiological results.” Br J Ind Med 48(8): 515-30.
Pearce, N. and P. Bethwaite (1992). “Increasing incidence of non-Hodgkin's lymphoma: occupational and environmental factors.” Cancer Res 52(19 Suppl): 5496s-5500s.
Partanen, T., T. Kauppinen, et al. (1993). “Malignant lymphomas and leukemias, and exposures in the wood industry: an industry-based case-referent study.” Int Arch Occup Environ Health 64(8): 593-6.
Blair, A., A. Linos, et al. (1993). “Evaluation of risks for non-Hodgkin's lymphoma by occupation and industry exposures from a case-control study.” Am J Ind Med 23(2): 301-12.
Frangos, S. A. and J. M. Peters (1993). “Chlorinated hydrocarbon solvents: substituting our way toward human carcinogenicity [see comments].” Am J Ind Med 24(4): 355-64.
Persson, B., M. Fredriksson, et al. (1993). “Some occupational exposures as risk factors for malignant lymphomas.” Cancer 72(5): 1773-8.
Petrelli, G., G. Siepi, et al. (1993). “Solvents in pesticides.” Scand J Work Environ Health 19(1): 63-5.
Hansen, J. and J. H. Olsen (1994). “Cancer morbidity among Danish female pharmacy technicians.” Scand J Work Environ Health 20(1): 22-6.
Ruder, A. M., E. M. Ward, et al. (1994). “Cancer mortality in female and male dry-cleaning workers.” J Occup Med 36(8): 867-74.
Berlin, K., C. Edling, et al. (1995). “Cancer incidence and mortality of patients with suspected solvent- related disorders.” Scand J Work Environ Health 21(5): 362-7.
Persson, B. (1996). “Occupational exposure and malignant lymphoma.” Int J Occup Med Environ Health 9(4): 309-21.
Lynge, E., A. Anttila, et al. (1997). “Organic solvents and cancer (review).” Cancer Causes Control 8(3): 406-19.
Hardell, L., G. Lindstrom, et al. (1998). “Some aspects of the etiology of non-Hodgkin's lymphoma.” Environ Health Perspect 106 Suppl 2: 679-81.
Hardell, L. and O. Axelson (1998). “Environmental and occupational aspects on the etiology of non-Hodgkin's lymphoma.” Oncol Res 10(1): 1-5.
O'Connor, S. R., P. B. Farmer, et al. (1999). “Benzene and non-Hodgkin's lymphoma.” J Pathol 189(4): 448-53.
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