ENVIRONMENTAL POLLUTANTS
The
polychlorinated biphenyls (PCBs,
coplanar biphenyls) have been used in a large variety of applications as
dielectric and heat trans-fer fluids, lubricating oils, plasticizers, wax
extenders, and flame retardants. Unfortunately, PCBs persist in the
environment. Their industrial use and manufacture in the USA were terminated by
1977. The products used commercially were actually mixtures of PCB iso-mers and
homologs containing 12–68% chlorine. These chemicals are highly stable and
highly lipophilic, poorly metabolized, and very resistant to environmental
degradation; they bioaccumulate in food chains. Food is the major source of PCB
residues in humans.
A serious exposure to
PCBs—lasting several months—occurred in Japan in 1968 as a result of cooking
oil contamination with PCB-containing transfer medium (Yusho disease). Possible
effects on the fetus and on the development of the offspring of poisonedwomen
were reported. It is now known that the contaminated cooking oil contained not
only PCBs but also polychlorinated dibenzofurans (PCDFs) and polychlorinated
quaterphenyls (PCQs). Consequently, the effects that were initially attributed
to the presence of PCBs are now thought to have been caused by a mixture of
contaminants. Workers occupationally exposed to PCBs have exhibited the
following clinical signs: dermatologic problems (chloracne, folliculitis,
erythema, dryness, rash, hyper-keratosis, hyperpigmentation), some hepatic
involvement, and elevated plasma triglycerides.
The effects of PCBs
alone on reproduction and development, as well as their carcinogenic effects,
have yet to be established in humans—whether workers or the general
population—even though some subjects have been exposed to very high levels of
PCBs. Repeated epidemiologic studies have found some increases in various
cancers including melanoma, breast, pancreatic, and thyroid cancers, but the
small number of cases and uncertain exposure status have left the
carcinogenicity question unclear. In 1977, the IARC recommended that PCBs be
regarded as likely carcinogenic to man, although the evidence for this
classification was lacking. Some adverse behavioral effects in infants have
been reported. An association between prenatal exposure to PCBs and deficits in
childhood intellectual function was described for chil-dren born to mothers who
had eaten large quantities of contami-nated fish. The polychlorinated dibenzo-p-dioxins
(PCDDs), or dioxins, have been
mentioned as a group of congeners of which the most important is 2,3,7,8-tetrachlorodibenzo-p-dioxin(TCDD).In addition, there is a larger group of dioxin-like
com-pounds, including certain polychlorinated
dibenzofurans(PCDFs) and coplanar
biphenyls. While PCBs were used com-mercially, PCDDs and PCDFs are unwanted
byproducts that appear in the environment and in manufactured products as
con-taminants because of improperly controlled combustion processes. PCDD and
PCDF contamination of the global environment is considered to represent a
contemporary problem produced by human activities. Like PCBs, these chemicals
are very stable and highly lipophilic. They are poorly metabolized and very
resistant to environmental degradation.
In laboratory animals,
TCDD administered in suitable doses has produced a wide variety of toxic
effects, including a wasting syndrome (severe weight loss accompanied by
reduction of muscle mass and adipose tissue), thymic atrophy, epidermal
changes, hepatotoxicity, immunotoxicity, effects on reproduction and
development, teratogenicity, and carcinogenicity. The effects observed in
workers involved in the manufacture of 2,4,5-T (and therefore presumably
exposed to TCDD) consisted of contact dermatitis and chloracne. In severely TCDD-intoxicated
patients, discrete chloracne may be the only manifestation.
The
presence of TCDD in 2,4,5-T is believed to be largely responsible for other
human toxicities associated with the herbi-cide. There is epidemiologic
evidence indicating an association between occupational exposure to the phenoxy
herbicides and an excess incidence of non-Hodgkin’s lymphoma. The TCDD
con-taminant in these herbicides seems to play a role in a number of cancers
such as soft tissue sarcomas, lung cancer, Hodgkin’s lym-phomas, and others.
The
potential hazardous effects of some chemicals in the envi-ronment are receiving
considerable attention because of their estrogen-like or antiandrogenic
properties. Compounds that affect thyroid function are also of concern. Since
1998, the pro-cess of prioritization, screening, and testing of chemicals for
such actions has been undergoing worldwide development. These chemicals mimic,
enhance, or inhibit a hormonal action. They include a number of plant constituents
(phytoestrogens) and some mycoestrogens as well as industrial chemicals,
particularly persistent organochlorine agents such as DDT and PCBs. Some
brominated flame retardants are now being investigated as pos-sible endocrine
disrupters. Concerns exist because of their increasing contamination of the
environment, the appearance of bioaccumulation, and their potential for
toxicity. In vitro assays alone are unreliable for regulatory purposes, and
animal studies are considered indispensable. Modified endocrine responses in
some reptiles and marine invertebrates have been observed. In humans, however,
a causal relation between exposure to a spe-cific environmental agent and an
adverse health effect due to endocrine modulation has not been established.
Epidemiologic studies of populations exposed to higher concentrations of
endo-crine disrupting environmental chemicals are underway. There are
indications that breast and other reproductive cancers are increased in these
patients. Prudence dictates that exposure to environmental chemicals that
disrupt endocrine function should be reduced.
Asbestos
in many of its forms has been widely used in industry for over 100 years. All
forms of asbestos that have been used in industry have been shown to cause
progressive lung disease that is characterized by a fibrotic process. Higher
levels of exposure produce the process called asbestosis. Lung damage develops
even at low concentrations of shorter fibers, whereas higher con-centrations of
longer fibers are required to cause lung damage. Every form of asbestos,
including chrysotile asbestos, causes an increase in lung cancer. Lung cancer
occurs in people exposed at fiber concentrations well below concentrations that
produce asbestosis. Cigarette smoking and exposure to radon daughters increase
the incidence of asbestos-caused lung cancer in a syner-gistic fashion.
All forms of asbestos
also cause mesothelioma of the pleura or peritoneum at very low doses. Other
cancers including colon can-cer, laryngeal cancer, stomach cancer, and perhaps
even lymphoma are increased in asbestos-exposed patients. The mechanism for
asbestos-caused cancer is not yet delineated. Arguments that chrysotile
asbestos does not cause mesothelioma are contradicted by many epidemiologic
studies of worker populations. Recognition that all forms of asbestos are
dangerous and carcinogenic has led many countries to ban all uses of asbestos.
Countries such as Canada, Zimbabwe, and others that still produce asbestos
argue that asbestos can be used safely with careful workplace environ-mental
controls. However, studies of industrial practice make the “safe use” of
asbestos highly improbable.
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