(Group 2B)

For definition of Groups, see Preamble Evaluation.

VOL: 63 (1995) (p. 33)

4. Summary of Data Reported and Evaluation

4.1 Exposure data

The process of cleaning fabrics with nonaqueous liquids is believed to have begun in France in 1825. The process has evolved into an industry called 'dry cleaning'. 'Camphene' (turpentine) was used initially; in the late 1800s, benzene, benzene soap, naphtha and gasoline began to be used. In the 1920s, Stoddard solvent (mineral spirits or white spirits) was introduced in the United States in order to minimize the fire hazards associated with use of the more volatile hydrocarbon-based solvents. Carbon tetrachloride, the first chlorinated solvent used for dry cleaning, was introduced because of the high cost of petroleum solvents and was widely used until the 1950s. Its use was discontinued because of its toxicity and corrosiveness. Trichloroethylene was introduced in the 1930s. It is still used to a limited extent in Europe and in industrial cleaning plants throughout the world, but it has had a limited market in dry cleaning in the United States because of its incompatibility with acetate dyes.

Use of tetrachloroethylene began to increase in the 1940s, and by the late 1950s it had virtually replaced carbon tetrachloride and trichloroethylene in commercial dry cleaning. Tetrachloroethylene is currently the solvent of choice in most of the world, except in regions, such as Japan, where petroleum-based solvents have remained important in the dry cleaning industry. In 1990, about 53% of the world demand for tetrachloroethylene was for dry cleaning, and about 75% of all dry cleaners used it to clean garments. Chlorofluorocarbon solvents (especially CFC-113) were introduced for use in dry cleaning in the 1970s; however, because of environmental concerns, their use is declining rapidly.

It is estimated that several million people are employed in dry cleaning worldwide. The predominant route of exposure to the solvents used in dry cleaning is by inhalation, although skin absorption and ingestion may also occur. In addition, a wide range of chemicals are used in 'spotting' (treatment of spots); they include chlorinated solvents, amyl acetate, bleaching agents, acetic acid, aqueous ammonia, oxalic acid, hydrogen peroxide and dilute hydrogen fluoride solutions.

Improvements in equipment, solvent reclamation and engineering controls in the dry cleaning industry are resulting in decreasing occupational exposures to chlorinated solvents. The trend to use of 'dry-to-dry' machines, as opposed to the transfer process, has also resulted in reduced emissions and exposures. Typical average exposures to tetrachloroethylene in dry cleaning declined from about 350-700 mg/m3 in the 1970s to 70-350 mg/m3 in the late 1980s. The differences in airborne concentrations between dry cleaning shops are often many times greater than the differences in the exposures of machine operators and other staff within a shop.

4.2 Human carcinogenicity data

The relationship between employment in dry cleaning and the occurrence of cancer has been assessed in proportionate mortality studies, case-control studies and four cohort studies. Two cohort studies restricted to dry-cleaning workers in the United States were given greater weight in the evaluation than were the results of cohort studies of laundry and dry-cleaning workers (from Denmark and Sweden).

The relative risks for mortality from urinary bladder cancer were elevated in both United States cohorts (relative risks of 1.7 and 2.5, total of 17 deaths), with evidence in one of the studies of an increasing risk with increasing duration of employment. These results are consistent with those from case-control studies in the United States and in Canada and with the findings of a proportionate mortality study in the United States (although the Danish cohort study found no elevated incidence of bladder cancer) and do not appear to be due to confounding by cigarette smoking.

The relative risk for mortality from oesophageal cancer was elevated by a factor of two in both United States cohorts (23 observed deaths in the two studies combined) and increased with increasing duration and/or intensity of employment. This cancer also occurred in slight excess in a proportionate mortality study in the United Kingdom with respect to launderers, dry cleaners and pressers. Risk estimates for oesophageal cancer were not provided in either of the two Nordic studies of laundry and dry cleaning workers. While in a case-control study of oesophageal cancer in Montréal, Canada, none of the case subjects had worked in dry cleaning, the study was relatively small. The relative incidence of oesophageal cancer is increased by consumption of alcohol drinking and cigarette smoking, but potential confounding by these exposures could not be explored directly in these studies.

The relative risk for mortality from cancer of the pancreas was modestly increased in both United States cohort studies; however, this result was not confirmed in two North American case-control studies.

The occurrence of lung cancer was increased slightly in each of the four cohort studies. The mortality rate from lung cancer in the subgroup with long duration of employment and a long interval since first employment (in the one study that evaluated these characteristics) was not elevated. Two case-control studies in North America gave conflicting results.

The relative risk for mortality from cervical cancer was increased by 70-80% in the two United States cohort studies but not at all among Danish dry cleaning and laundry workers. Socioeconomic characteristics were not adjusted for in these studies.

While in a Swedish case-control study and in one of the United States cohort studies moderate increases were found in the relative risk for cancer of the colon in association with employment in dry cleaning, there was no suggestion of an increase in the risk for this form of cancer in the other relevant studies. Furthermore, in the United States cohort study, there was no particular accentuation of the increased risk in relation to increasing duration of employment.

The Danish cohort study of dry cleaning and laundry workers showed some increase in the incidence of cancers of both the liver and the gall-bladder; however, this result was not confirmed in the two United States cohort studies. The results of the case-control studies of liver cancer in the United States are conflicting.

There was a suggestion of an increased risk for non-Hodgkin's lymphoma in one of the two United States cohort studies (relative risk, 1.7, based on seven deaths) and in a large case-control study in the United States; however, no increase in risk for non-Hodgkin's lymphoma was observed in the other United States cohort study, in the Danish cohort study or in a case-control study from Montréal, Canada.

The results of the four cohort studies do not suggest an increase in the risk for cancer of the kidney, while the results of proportionate mortality studies in Wisconsin and Oklahoma and of the case-control studies from Canada, Denmark and the United States indicate an increase in risk associated with a history of work as a dry cleaner. It may be noteworthy that the petroleum solvents used for dry cleaning in Oklahoma are not typical of those used in much of the rest of the world.

Variation within individual studies of dry cleaners may depend on the nature and level of exposure, which varies from shop to shop and across studies of dry cleaning workers. There is also variation in the types of solvents used over time and across geographic regions. These limitations notwithstanding, the epidemiological studies on dry cleaning indicate that the risks for cancers at two sites, urinary bladder and oesophagus, may be increased by employment in dry cleaning.

4.3 Other relevant data

Inconsistent evidence of slight renal damage among workers exposed to tetrachloroethylene in dry cleaning shops was found in two studies, whereas two other studies in which exposure to tetrachloroethylene was at least as high did not find such an association.

Disturbances of sperm quality and fertility have been observed among dry cleaning workers in a few studies of limited size. Several studies performed in Nordic countries have shown a consistent increase in the risk for spontaneous abortion among dry cleaners, but the studies are not entirely independent of each other. No effect has been observed on other reproductive outcomes, such as stillbirth, congenital malformation or low birth weight, but the power of the studies was limited.

In single studies, lymphocytes from dry cleaning workers showed no increase in the frequency of alkaline-labile sites/DNA single-strand breaks. There was inadequate information to evaluate the genetic effects in humans of exposures in dry cleaning.

4.4 Evaluation

There is limited evidence in humans for the carcinogenicity of occupational exposures in dry cleaning.

Overall evaluation

Dry cleaning entails exposures that are possibly carcinogenic to humans (Group 2B).

Last updated 05/20/97

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       Toxicological Abbreviations