Cancer Consequences of Mulch Production on Public Health

"5.2 Human carcinogenicity data

The risk for cancer, and particularly cancer of the nasal cavities and paranasal sinuses, among woodworkers has been investigated in many epiderniological studies. Some of the studies provided specific information on cancer risk associated with exposure to wood dust, and those studies were given greatest weight in the evaluation. Most of the available cohort and case-control studies of cancer of the nasal cavities and paranasal sinuses have shown increased risks associated with exposure to wood dust. These findings are supported by numerous case reports. Very high relative risks for adenocarcinoma at this site, associated with exposure to wood dust, have been observed in many countries, particularly in Europe. The lower risks observed in the studies in the United States rnay be due to differences in concentration or type of wood dust, but in one of these studies the more heavily exposed groups had significantly increased risks. A pooled analysis of 12 case-control studies revealed a clearly increasing risk with increasing estimated levels of exposure to wood dust, overall and in most individual studies. The excess appears to be attributable to wood dust per se, rather than to other exposures in the workplace, since the excess was observed in various countries during different periods and among different occupational groups, and because direct exposures to other chemicals do not produce relative risks of the magnitude associated with exposure to wood dust.

Adenocarcinoma of the nasal cavities and paranasal sinuses is clearly associated with exposure to hardwood dust; in several series of cases of adenocarcinoma from different countries, a high proportion of cases had been exposed to hardwood, and these findings were confirmed in several case-control studies as well. There were too few studies of any type to evaluate cancer risks attributable to exposure to softwood alone. ln the few studies in which exposure was primarily to softwood, the risk for cancer of the nasal cavities and paranasal sinuses was elevated but considerably lower than that in studies of exposure to hardwood or to mixed wood types; furthermore, in the studies of exposure to softwood, exposure to hardwood could not clearly be ruled out. It is more difficult to attribute excess risk to any particular species of wood. The concentration of wood dust and the duration of exposure may also contribute to differences in the risks of workers exposed to different types of wood. These studies consistently indicate that occupational exposure to wood dust is causally related to adenocarcinorna of the nasal cavities and paranasal sinuses. ln studies of squamous-cell carcinoma of the nasal cavities and paranasal sinuses, smaller excesses were generally reported than for adenocarcinomas, and a pooled analysis of 12 case- control studies found no association with exposure to wood dust.

A number of case-control studies on nasopharyngeal cancer have reported an association with employment in wood-related occupations; however, confounding was not ruled out from these studies, and the largest study, from Denmark, in which exposure to wood dust was estimated, did not confirm the association. Case-control studies of laryngeal cancer consistently showed an association with exposure to wood dust or woodworking; however, cohort studies of woodworkers gave consistently negative results. Overall, these studies provide suggestive but inconclusive evidence for a causal role of occupational exposure to wood dust in cancers of the nasopharynx. Studies of the association between exposure to wood dust and cancers of the oropharynx, hypopharynx, lung, lymphatic and haematopoietic systems, stomach, colon or rectum individually gave null or low risk estimates, gave inconsistent results across studies, and did not analyze exposure-response relationships. The evidence for an association between exposure to wood dust and Hodgkin's disease was somewhat more suggestive, in that some case-control studies showed moderately high risks, but these results were not substantiated by the results of cohort studies or some of the well-designed case-control studies. ln view of the overall lack of consistent findings, there is no indication that occupational exposure to wood dust has a causal role in cancers of the oropharynx, hypopharynx, lung, lymphatic and haematopoietic systems, stomach, colon or rectum.

5.4 Other relevant data

General knowledge of particle size indicates that wood dust can be deposited in human upper and lower airways, the deposition pattern depending partly on particle size. Heavy exposure to wood dust may result in decreased mucociliar clearance and, sometimes, in muco- stais. No data were available on clearance of wood dust from the lower airways.

Exposure to wood dust may cause cellular changes in the nasal epithelium. Increased frequencies of cuboidal metaplasia and dysplasia were found in some studies of workers exposed to dust from both hardwood and softwood. These changes can potentially progress to nasal carcinoma.

Impaired respiratory function and increased prevalences of pulmonary symptoms and asthma occur in workers exposed to wood dust, especially that from western red cedar. There is little reliable information on the effects of wood dusts on the respiratory tract of rodents. One study in vitro showed that various wood dusts are cytotoxic and can induce drug metabolizing enzymes. Constituents of beech that can be extracted with polar organic solvents are genotoxic, as demonstrated by the induction of point mutations in bacteria, DNA single-strand breaks in rat hepatocytes in vitro and micronuclei in rodent tissues in vivo. Extracts of oak wood showed similar activity, but fewer data were available. Extracts of spruce, the only softwood tested, gave consistently negative results."