We examined the epidemiology of chronic beryllium disease among a stratified, random sample (n= 895) of nuclear weapons workers using the blood beryllium lymphocyte transformation (BelT) test and chest radiograph for case identification. Of 18 new cases of beryllium sensitization, 12 had beryllium disease, and three more developed pulmonary granulomas on lung biopsy over the succeeding 2 yr. Berylliumsensitized cases did not differ from noncases in age, gender, race, ethnicity, smoking, most respiratory symptoms, spirometric or radiographic abnormalities, or job tenure. The six sensitized cases without initial disease differed from beryllium disease cases in having greater pack-years of smoking. Sensitization occurred among workers with inadvertent or bystander exposure, such as a secretary and security guard. However, beryllium sensitization risk was higher for machinists (4.70/0) and for persons reporting measured overexposure (7.4%, odds ratio 5.1); exposure beginning before 1970 (3.6%, odds ratio 2.7); consistent beryllium exposure (3.4%); and sawing (4.7%) or band sawing (6.00/0) of beryllium metal. We conclude that both individual susceptibility to sensitization and exposure circumstances are important in developing disease. Kreiss K, Mroz MM, Zhen B, Martyny JW, Newman LS. Epidemiology of beryllium sensitization and disease in nuclear workers. Am Rev Respir Dis 1993; 148: 985-91.

In beryllium industries, screening of workers for beryllium disease can rely on blood tests of the cell-mediated immunity to beryllium that accompanies the disease and distinguishes it from sarcoidosis. In the beryllia ceramics industry, the beryllium-specific lymphocyte transformation (BelT) test had high positive and negative predictive values for beryllium disease in a work force with beryllium oxide exposure concluding approximately 15 yr earlier (1). Now that a sensitive and specific test is available to identify both subclinical and clinical disease, we can reexamine the epidemiology of beryllium disease in population-based screening. We report here a cross-sectional study of beryllium workers in a nuclear weapons plant where beryllium exposure was ongoing, permitting us to examine the relationships among beryllium sensitization, beryllium disease, job-related factors, and personal attributes. Our findings have implications for the conduct of beryllium disease surveillance in industry, as well as for disease prevention.