Review of the Department of Labor's Site Exposure Matrix Database (2013) / Chapter Skim
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3 Site Exposure Matrix Dat
3 Site Exposure Matrix Dat
Pages 51-94
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From page 51... ...
The committee recognizes that the database might be more accurately described as a "hazardous substance" rather than an "exposure" database. Exposure information -- that is, the potential of a toxic substance to enter the body and cause harm -- includes route (inhalation, dermal, oral)
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From page 52... ...
gov; accessed January 24, 2013) DOL states that "SEM represents the most current, accurate, and comprehensive information regarding toxic substances and their known health effects, and is updated regularly" (DOL, 2008)
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From page 53... ...
NOTE: DAR = document acquisition request; DMC = district medical consultant; Dx = diagnosis; EE 1/2 = employee's claim form and survivor's claim form; EE 3 = employment history form; FWP = former Figure 3-1b IH = industrial hygiene; OHQ = occupa worker program; tional health questionnaire; RD = recommended decision; SEM = site exposure matrix. SOURCE: Anders, 2012b.
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From page 54... ...
The database also contains information about occupational diseases that are associated with each toxic substance found at a site. DOL determined that an appropriate source for such associations was Haz-Map,which is published
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. CONTENT AND STRUCTURE OF SEM SEM is a site exposure–driven database.
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From page 56... ...
. The "Specific Health Effects" field contains health effects information based solely on "established relationships between toxic substance exposures and occupational diseases as reported by the National Library of Medicine (NLM)
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SITE EXPOSURE MATRIX DATABASE 57 FIGURE 3-3 Example of SEM record for a health physics technician at the Alba Craft Facility.
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From page 58... ...
from exposure to kerosene (see Box 2-1) , but, only the latter two health effects are included in SEM (see Figure 3-4)
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, whereas SEM contains 13,697 toxic substances as of October 2012 (DOL, 2012d) and more than 120 occupational diseases (Stalnaker, 2012)
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Statements such as these can be confusing to the user. The committee recognizes that the periodic updating of both Haz-Map and SEM as new information on toxic substances and occupations disease links become available is essential to assisting claimants and claims examiners.
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From page 61... ...
Another button on the SEM homepage labeled "Status of disease-related input" allows users to view the toxic substance–disease links that have been submitted and indicates whether the proposed link has been accepted by DOL and, therefore, is in the queue to be added to the SEM (see Figure 3-6)
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From page 62... ...
. Updating Health Effects The toxic substance–occupational disease links in SEM are updated after revisions are made to the occupational disease fields in Haz-Map, because the source of those links is Haz-Map.
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From page 63... ...
NLM publishes quarterly updates to Haz-Map, as described in Chapter 2. Changes to the toxic substance–disease links in that database are then imported into SEM for all toxic substances common to both databases.
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. In particular, the report cites the lack of independent review for "the detailed information in the site exposure matrix" (GAO, 2010)
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From page 65... ...
; lack of exposure information; incomplete or inconsistent exposure profiles based on location and job; inability to handle complex exposures, including exposure to mixtures and radioactive substances; failure to consider epidemiologic studies of DOE workers; and the sole use of Haz-Map for the toxic substance–disease links. These problems are discussed in the following sections.
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From page 66... ...
While this restriction supports a site exposure matrix and limits searches to toxic substances and health effects for a particular site, it prevents the public from investigating exposures and health effects that may have occurred at more than one site or across sites, except for construction jobs (DOL, 2012c)
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From page 67... ...
Incomplete Site Exposure Profiles DOL acknowledges that SEM is incomplete. The committee found numerous examples where the lack of toxic substances information for a site could potentially impact claimants.
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From page 68... ...
The extent to which other sites lack information on labor categories for processes or activities that potentially involve exposure to toxic substances is not clear, but should be assessed. These missing toxic substances for labor categories or processes were considered by the committee as a major weakness because links to associated diseases would be missed.
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From page 69... ...
and can result in the omission of important toxic substance–disease links or erroneous inclusion of health effects for which there is no evidence. Many of the mixtures used at DOE sites were trade name products, but SEM does not include the identity of the manufacturer, the dates of manufacture, or the component concentrations of these products.
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From page 70... ...
Using only SEM links, it would be logical for a claims examiner or claimant to assume that the risks of developing any of the linked diseases is the same for all components of the mixture regardless of the actual product composition and how it is used. Without appropriate contextual information, the potential for misinterpreting the SEM toxic substance–disease links is substantial.
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From page 71... ...
Toluene, benzene -- bone marrow toxicity (Plappert et al., 1994) synergism as required by its the statement of task, but notes that synergism is just one of several types of chemical–chemical interactions that may occur from exposure to multiple chemicals at DOE sites.
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From page 72... ...
Synergy Between Radiation and Chemical Exposures Chemical interactions may be particularly relevant for workers who are exposed to radiation -- which can act as a tumor initiator by changing normal cells into cancerous cells -- and to toxic substances -- which can act as tumor promoters by encouraging the growth of cancerous cell. Such interactions may enhance the potency of radiation exposures (Little, 1990)
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From page 73... ...
As new information becomes available, these issues should be reassessed. Because toxic substances interactions are more likely to influence the magnitude rather than the nature of health effects (i.e., synergistic or potentiative
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might be useful because they are conducted in the population of interest -- workers at DOE facilities -- and provide specific site, job, process, and in particular, exposure information. The committee urges DOL to reconsider the epidemiologic and medical surveillance studies conducted on DOE workers to inform substance–disease links in SEM.
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, but has ambiguous criteria for identifying toxic substances that cause noncancerous occupational diseases (see Chapter 2)
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From page 76... ...
However, it does not provide a framework, such as the one formalized for probability of causation calculations under Part B, for incorporating uncertainty into judgments on causation. Information Sources for Evaluating Human Health Effects Although the use of Haz-Map for toxic substance–disease links in SEM has advantages such as the relatively large number of substances in the former and the established links for those substances, the committee finds that Haz-Map should not be the sole source of such links for SEM and suggests that other databases and information sources should be considered by DOL.
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From page 77... ...
To assess usefulness, content quality, and ease of use, each database was evaluated on the basis of the availability of a search engine, the factual information on toxic substances, and user costs. The authors found five databases to be particularly useful for occupational health professionals: GESTIS, an international database of occupational exposure limits (http://www.dguv.de/ifa/en/gestis/limit_values)
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From page 78... ...
Department of Health http://www.atsdr.cdc.gov/ Profiles and Human Services, Agency toxprofiles/index.asp for Toxic Substances and Disease Registry Technical Support California Environmental http://www.oehha.org/tcdb Documents for Describing Protection Agency, Office Available Cancer Potency of Environmental Health Factors* Hazard Assessment Pocket Guide to Chemical U.S.
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From page 79... ...
Therefore, to capture the wealth of information provided by these bibliographic databases, trained and knowledgeable individuals would be needed to synthesize all the data and make judgments about causal substance–disease links. The committee noted that all of these information sources and databases would require some interpretation to distill and analyze the data to achieve the causal substance–disease links that the SEM currently contains.
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From page 80... ...
The committee's assessments of toxic substance–disease links that are not in SEM are shown in Tables 3-2 through 3-4. The committee recognizes that SEM and Haz-Map are active databases that undergo frequent updates.
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From page 81... ...
. Additional, but unspecified, criteria or rationales, other than IARC classifications of sufficient evidence in humans appear to be used for some toxic substance– cancer links in SEM.
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From page 82... ...
IARC (2012) reclassified diesel exhaust as sufficient evidence of cancer in humans.
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From page 83... ...
Chromium VI 1 Nasal Cavity and Paranasal Sinus Coal Tar Pitch Volatiles 1 Urinary Bladder Cobalt Metal with 2A Lung Tungsten Carbide Diesel Exhaust 1 Urinary Bladder Ethylene Oxide 1 Breast; Non-Hodgkin Lymphoma and Multiple Myelomab Formaldehyde 1 Nasal Cavity and Paranasal Sinus Hepatitis B Virus 1 Liver (cholangiocarcinoma) ; non-Hodgkin lymphoma Iodine-131 1 Bone and Soft Tissue; Digestive Tract; Leukemia; Salivary Gland Lead 2A Stomach Plutonium 1 Solid Tumors (other than bone, liver, and lung)
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From page 84... ...
Tetrachloroethylene Central Nervous System EPA, 2012; NRC, 2010 (Perchloroethylene) (visual changes, increased reaction time, decrements in cognition from low level occupational exposures)
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From page 85... ...
Additionally, the lung cancer links for diesel exhaust and coal tar pitch volatiles presumably also will be added to SEM, although the links are not in Haz-Map. As a part of the revisions to Haz-Map, based on the 2012 IARC cancer evaluation (Cogliano et al., 2011; IARC, 2012)
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From page 86... ...
The toxic substance–cancer links include 11 cancers -- prostate, colorectum, pharynx, multiple myeloma, breast, digestive tract, salivary gland, hepatobiliary tract, cervix, esophagus, and pancreas -- that were not listed in Haz-Map.
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From page 87... ...
As a result, according to the limited information available in Haz-Map, the links appear to be consistent with its criteria for determining noncancer disease causality. Regarding noncancer disease links, Haz-Map states that "for chronic diseases, linkage between an agent and a disease means that a causal relationship has been determined based on human case reports or epidemiological studies" (www.hazmap.com; accessed January 22, 2013)
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From page 88... ...
This is because SEM lists toxic substance–disease links for the constituents of mixtures as opposed to the mixture as a whole. Metal fume fever can result from exposure to welding fumes (DOL, 1989; IARC, 1990; NIOSH, 1988)
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From page 89... ...
However, the committee also identified several major weaknesses in SEM, specifically the difficulty in accessing some information in the database, lack of detailed exposure information; inability to handle complex exposures, including exposure to mixtures, chemical compounds, and radioactive substances; ambiguity in why certain links are not listed; incomplete or inconsistent exposure profiles based on location and job; disregard of epidemiologic studies in DOE workers; and the sole use of Haz-Map for substance–disease links. In particular, the sole use of Haz-Map for disease causation was problematic for several reasons, and the committee conducted an exercise that illustrated examples of toxic substance–disease links that are not currently in SEM.
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From page 90... ...
2012b. DEEOIC Claims Process Flow Charts for the Committee on Review of the Depart ment of Labor's Site Exposure Matrix (SEM)
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From page 91... ...
2012e. Office of Workers' Compensation Program Site Exposure Matrix (SEM)
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From page 92... ...
http://ec.europa.eu/ health/scientific_committees/environmental_risks/docs/scher_o_155.pdf (accessed January 23, 2013)
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From page 93... ...
2005. Pulmonary abnormalities associated with occupational exposures at the Savannah River Site.
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From page 94... ...
U.S. DOL Site Exposure Matrices, EEOICPA Part E
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