Evaluation of take home (para-occupational) exposure to asbestos and disease: a review of the literature

Our plain-English summary of Evaluation of take home (para-occupational) exposure to asbestos and disease: a review of the literature, by E.P. Donovan, B.L. Donovan, M.A. McKinley, et al (Critical Reviews in Toxicology, 2012).

The study

• Authors: E.P. Donovan, B.L. Donovan, M.A. McKinley, D.M. Cowan, D.J. Paustenbach
• Journal: Critical Reviews in Toxicology
• Published: 2012;42(9):703-31
• Type of article: Review
• Cited by: 37 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The potential for para-occupational (or "take-home") exposure to a number of chemicals has been recognized for over 60 years. We conducted a literature review in order to characterize reported cases of asbestos-related disease among household contacts of workers occupationally exposed to asbestos. Over 200 published articles were evaluated. Nearly 60 articles described cases of asbestos-related disease thought to be caused by para-occupational exposure. Over 65% of these cases were in persons who lived with workers classified as miners, shipyard workers, insulators, or others involved in the manufacturing of asbestos-containing products, with nearly all remaining workers identified as craftsmen. 98% of the available lung samples of the persons with diseases indicated the presence of amphibole asbestos. Eight studies provided airborne asbestos concentrations during (i) handling of clothing contaminated with asbestos during insulation work or simulated use of friction products; (ii) ambient conditions in the homes of asbestos miners; and (iii) wearing previously contaminated clothing. This review indicates that the literature is dominated by case reports, the majority of which involved household contacts of workers in industries characterized, generally, by high exposures to amphiboles or mixed mineral types. The available data do not implicate chrysotile as a significant cause of disease for household contacts. Also, our analysis indicates that there is insufficient information in the published literature that would allow one to relate airborne asbestos concentrations in a workplace to those that would be generated from subsequent handling of contact with clothing that had been contaminated in that environment. Ideally, a simulation study could be conducted in the future to better understand the relationships between the airborne concentrations in the workplace and the fiber characteristics that influence retention on fabric, as well as the concentrations that can be generated by handling the contaminated clothing by the persons in the home.

In plain English

This article was a literature review, not a new study of patients. The authors searched public documents and Johns-Manville company files, identifying more than 200 relevant publications. Nearly 60 described disease in household contacts of asbestos-exposed workers; most were case reports or case series. Among the cases reported were 259 pleural and 19 peritoneal mesotheliomas and 27 lung cancers. Over 70% of household cases were linked to miners, manufacturers of asbestos or asbestos products, shipyard workers or insulators. Of household contacts' lung samples analyzed for fiber type, 98% showed amphibole asbestos. Excluding the earliest study, mesothelioma relative risks in the reviewed epidemiology studies ranged from about 2 to 18. The few clothing-handling simulation studies all used chrysotile-only end products; many results were below 0.01 fibers per cubic centimeter. The authors did not check whether each case was truly caused by take-home exposure. The authors concluded that the data do not implicate chrysotile alone as a significant cause of disease in household contacts. They could not rule out that chronic chrysotile exposure high enough to cause asbestosis, with very long fibers, may increase mesothelioma risk.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Literature review of published and other publicly available documents, including a targeted search of Johns-Manville company documents
• Who was studied: More than 200 relevant, publicly available publications. These were publications reporting disease thought to be caused by take-home exposure, or giving data on take-home exposure levels. Nearly 60 of them described disease in household contacts, and about 60% of those were case reports or case series.
• Exposure: Para-occupational (take-home) exposure of household members to asbestos brought home from a worker's job. Neighborhood exposure and asbestos materials used in home construction or renovation were excluded.
• Main results:
  • Nearly 60 studies described disease among household contacts, and approximately 60% of these were case reports or case series
  • Over 70% of the household cases in the reviewed literature were associated with workers classified as miners, manufacturers of asbestos or asbestos-containing products, shipyard workers, or insulators
  • Among household-exposure cases in the reviewed literature, 19 mesotheliomas were peritoneal versus 259 pleural
  • The review identified 27 lung cancer cases among household contacts
  • 98% of lung tissue samples from household contacts that were analyzed for fiber type showed amphibole asbestos
  • Ten epidemiology studies estimated relative risks. The first such study (Newhouse and Thompson 1965) gave the highest mesothelioma estimate, an odds ratio of 23. In the remaining studies, relative risks for pleural and peritoneal mesothelioma ranged from approximately 2 to 18.
  • In one reviewed study (Mangold 1982), wearing heavily contaminated coveralls previously worn during rip-out of pipe insulation gave an average 8-hour time-weighted average of 1.4 f/cc
  • The recent simulation studies linking workplace conditions to later clothing handling all involved encapsulated end products containing only chrysotile. Many of their results (workplace and clothing handling) were below 0.01 f/cc or non-detect.
  • To the authors' knowledge, release of fibers from asbestos-contaminated clothing had never been quantitatively evaluated
• The authors' conclusion: The authors concluded that the available data do not implicate chrysotile alone as a significant cause of disease among household contacts. They acknowledged one possibility they could not rule out: that chronic exposures to chrysotile at concentrations high enough to cause asbestosis, and involving very long fibers, may increase the risk of developing mesothelioma.
• Limitations the authors state:
  • The authors did not assess case by case whether each disease was truly due to para-occupational exposure rather than another cause
  • Household contacts may have had other asbestos exposures they were unaware of
  • Smoking status was not provided for the lung cancer cases, except one
  • The studies reporting airborne concentrations during clothing handling have several limitations
  • The review was limited to English-language literature unless translations were available

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Take-home Exposure, Insulator, Amphibole Asbestos, Friction Products, Amphibole Group, Chrysotile, Work Practice Simulation.

Related studies

• Commentary on 'evaluation of take home (para-occupational) exposure to asbestos and disease: a review of the literature', Donovan et al.1 — D.S. Egilman, N.M. Druar (2013)
• Evaluation of take-home exposure to asbestos from handling asbestos-contaminated worker clothing following the abrasive sawing of cement pipe — A. Abelmann, J.R. Maskrey, et al. (2017)
• Evaluation of take-home exposure and risk associated with the handling of clothing contaminated with chrysotile asbestos — J. Sahmel, C.A. Barlow, et al. (2014)
• Evaluation of bystander exposures to asbestos in occupational settings: a review of the literature and application of a simple eddy diffusion model — E.P. Donovan, B.L. Donovan, et al. (2011)
• An evaluation of the risks of lung cancer and mesothelioma from exposure to amphibole cleavage fragments — J.F. Gamble, G.W. Gibbs (2008)
• Evaluation of asbestos-containing products and released fibers in home appliances — S.H. Hwang, W.M. Park (2016)

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