8282278 Mortality study in a cohort of workers producing fluoropolymers in Italy, 1960–2023

<h3>Objective</h3> Tetrafluoroethylene (TFE) and perfluorooctanoic acid (PFOA) are used for the synthesis of fluoropolymers. The International Agency for Research on Cancer classified TFE as probably carcinogenic and PFOA as carcinogenic to humans (based on limited evidence for kidney and testis cancer). Within a multicentre cohort study, mortality (1960-2008) had been evaluated of workers employed (1960-1999) in a plant producing fluoropolymers in Piedmont, North West Italy. We updated the follow-up through 2023. <h3>Material and Methods</h3> Workers’ job histories were merged with a semi-quantitative job-exposure matrix (JEM) to calculate cumulative exposure to TFE (still used) and PFOA (phased-out in 2013). Person-years were calculated for the period 1960-2023. Expected deaths were calculated using national and regional reference rates. We calculated standardised mortality ratios (SMR) and 95% confidence intervals (CI). <h3>Results</h3> Among 505 male workers elevated SMRs (reference: regional rates) were found for cancer of lung (SMR 1.50, CI: 1.00-2.26, 23 deaths) and testis (SMR 7.03, CI: 0.99-49.9, 1 death), and for non-Hodgkin’s lymphoma (NHL, SMR 2.84, CI 1.28-6.33, 6 deaths). Lung cancer morality was not associated with length of employment or with exposure to TFE or PFOA. The testis cancer death occurred among workers exposed to TFE and unexposed to PFOA. NHL was positively associated with length of employment, time since first employment, and cumulative exposure to TFE (all 6 deaths exposed), while 3 deaths occurred among workers unexposed to PFOA. The NHL excess occurred among older workers (65+ years) first employed before 1980 and last employed before 2000. Pleural cancer was also in excess (SMR 3.33 using national rates, CI: 1.07-10.3, 3 deaths). <h3>Conclusion</h3> This study found elevated mortality from NHL. The available information suggests an association with TFE rather than PFOA exposure, although exposure misclassification cannot be ruled out.