Prevalence of hereditary hemochromatosis in a Massachusetts corporation: is Celtic origin a risk factor?

The prevalence of homozygous hereditary hemochromatosis (HHC) is estimated at 1:250 in Caucasian adults. Little is known about ethnic subpopulations that might be at increased risk for this disease. HLA data have suggested a Celtic origin for HHC. Screening for HHC was offered to all employees of the Massachusetts Polaroid Corporation. Participants with a transferrin saturation of >55% or >45% and an elevated serum ferritin concentration on two screenings were referred for liver biopsy. The diagnosis of HHC was based on histological criteria, quantitative hepatic iron determination, hepatic iron index, and the phlebotomy requirement for iron depletion. Participants completed a questionnaire regarding their ethnic background. Two thousand two hundred ninety-four employees were screened, and 5 cases of HHC were detected. All 5 cases involved Caucasian men, yielding a prevalence of 1:395 for the Caucasian population. Four of the 5 cases were of 100% British-Irish ancestry based on the country of origin of their grandparents. Additional analysis revealed that the majority of grandparents of all 4 individuals came from Ireland or Wales. The exact two-tailed trend test showed a significant association of HHC with Celtic background (P = .012). The estimated cost of screening per patient identified was $18,041. Polaroid Corporation has a high representation of employees of British-Irish ancestry. Our data suggest that they are at high risk for developing HHC. A significant association of HHC with Celtic ancestry was found in this subpopulation, supporting the concept of a Celtic origin for this disease.

Prostate cancer screening in a large corporation population.

The Polaroid Medical Department conducted a prostate cancer screening program of all male employees over the age of 49 years. The screening consisted of a World Health Organization (WHO) questionnaire, a digital rectal examination (DRE) by an occupational medicine doctor, and a serum prostate-specific antigen (PSA) study. There were 2241 eligible employees (males between 50 and 65 years of age). 1219 (54%) took part in the screening. Thirty-seven PSAs above the 3.9 level were found (3%) and were further evaluated with ultrasound and/or biopsy. Twelve previously unknown cancers of the prostate (1%) were discovered. The cost of the entire program to the Polaroid Medical Department, including ultrasound and biopsy studies, was $72,130 ($6,012 per cancer detected). Of the 12 cancers, two were discovered by abnormal DRE alone, eight by an elevated PSA alone, and two by both an abnormal DRE and elevated PSA. There appeared to be no correlation between the WHO symptom score and the detection of prostate cancer. Our final conclusion was that a corporate medical department screening for cancer of the prostate is both effective and cost efficient.

An investigation of a workplace cluster of Bell's palsy.

We undertook a study to confirm the existence of an apparent cluster of Bell's palsy in an industrial plant ("W4"), and to test etiologic hypotheses regarding chemical exposures, immune suppression, and infectious etiologies. Cases were enumerated by questionnaire. Employees with a history of Bell's palsy ("cases") were invited to participate in a study that included medical history, T cell studies, viral and Lyme disease serologies, and blink reflex studies. Thirty-three unaffected volunteers from W4 and 32 from a comparison building were also tested. Extensive environmental studies were carried out in W4, evaluating infectious, chemical, and radiation exposures. The lifetime incidence of self-reported Bell's palsy was 11.6/10,000 person-years (P-Y) in W4 and 2.4 cases/10,000 P-Y in the comparison building (RR = 4.8, P < .05); the comparison rate was similar to that reported in previous population studies. When restricted to cases occurring after the onset of work, the W4 incidence was 29.2 cases/10,000 P-Y, compared to 4.8 cases/10,000 P-Y in the comparison building (RR = 6.1, P < .05). The cases and noncases did not differ with respect to clinical histories or infectious disease titers. The W4 noncases had small but significant decreases in T lymphocyte (1974 +/- 86 vs 2291 +/- 103) and CD4 (1083 +/- 318 vs 1459 +/- 494) counts compared to the remote noncases. The cases had significantly prolonged RR1, LR1, and LFC values compared to both groups of noncases. No medical or environmental factors were identified that could explain an excess of disease.

Cancer clusters in the workplace: an approach to investigation.

The investigation of cancer clusters has received much recent attention. In this paper we present the approach used by one company. We emphasize the need for a methodical, stepwise procedure that includes both epidemiology and industrial hygiene input, and for communication with workers throughout the investigation. Cluster investigations are expected to be most useful not in etiologic research, but rather in addressing worker concerns and as part of larger surveillance efforts.