Use of Surrogate Measures of Exposure to Diesel Exhaust to Estimate Historical Exposures

BACKGROUND Diesel exhaust is an animal carcinogen, although evidence of the carcinogenicity in humans is "limited". (World Health Org. , 1989) Of the eight cohort studies in the 19808, five found an increased risk for lung cancer among workers who may have been exposed to diesel exhaust (RR from 1.3-1.5, SMR from 101-132). (Howe, et al., 1983) Only two studies accounted for smoking indirectly. Of the ten case-control studies in the 1980's, eight reported increased risk of lung cancer among those populations purportedly exposed to diesel exhaust. (Benhamou, et al. , 1988) All but one of these adjusted for smoking and other occupational exposures. The odds ratios ranged from 1.2 to 2.1. In two of these studies, miners experienced a two to three fold risk. (Benhamou, et al., 1988) Bladder cancer has also been linked to diesel exhaust in cohort and case-control studies. Excesses of approximately 50% were observed among truck drivers in studies by NCI. (Hoar, et al., 1985) In the National Bladder Cancer Study, risks for truck drivers rose with duration of employment. A study by NIOSH in Ohio also found an excess of bladder cancer among truck drivers, particularly among those with 20 or more years of employment. (Steenland, et al, 1987) Despite the large number of studies in which the relation between diesel exhaust exposure and lung cancer has been examined, exposure to diesel exhaust has been quantitatively estimated only in the studies of railroad workers and truck drivers. (Woskie, et al., 1988) The excess lung cancer risk experienced by workers in these two occupational groups was modest, ranging from 40 to 90% for those with long-term employment. However, diesel exhaust exposure among railroad workers and truck drivers is lower than that seen among miners. Several markers of diesel exhaust have been utilized in these studies. Diesel exhaust is a complex mixture of particulates, vapors and gases. One group of these gases, the nitrogen oxides, react with polynuclear aromatic hydrocarbons, forming mutagenic and possible carcinogenic nitrated derivatives. (World Health Organization, 1989) For this reason, and because it is easy to measure and analyze, NO, was frequently used as a marker of diesel exhaust exposure. As part of the Garshick (Garshick, et al., 1988) study of railroad workers, Woskie measured NO, exposures of 477 railroad workers. (Woskie, et al., 1988) Geometric mean exposures of 13 job groups ranged from 12 to 80 ppb. In a New Mexico potash mine, (Attfield, et al. , 1982) exposures of from 100 to 3300 ppb nitrogen dioxide