Exposure to asbestiform minerals and radiographic chest abnormalities in a talc mining region of upstate New York

Our plain-English summary of Exposure to asbestiform minerals and radiographic chest abnormalities in a talc mining region of upstate New York, by E.F. Fitzgerald, A.D. Stark, N. Vianna, et al (Archives of Environmental Health, 1991).

The study

• Authors: E.F. Fitzgerald, A.D. Stark, N. Vianna, S.A. Hwang
• Journal: Archives of Environmental Health
• Published: 1991;46(3):151-4
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 004156).

Abstract

A radiologist in New York reported a high prevalence of pulmonary fibrosis in St. Lawrence and Jefferson counties. The New York State Department of Health responded by conducting a case history study of radiographic abnormalities found in the lung parenchyma and pleura of residents in Lawrence and Jefferson counties, where tremolitic talc has been mined for many years. During a 1-y period, all radiographs from 6 hospitals in the region were reviewed. A B-reader confirmed that 355 of 9,442 patients who were at least 40 y of age (3.8%) had a relevant abnormality; 60% of them reported occupational exposure to asbestiform minerals, and another 15% had a chest condition or injury that could have accounted for the abnormal radiograph. The results should be interpreted cautiously, but there was no evidence of widespread radiographic abnormalities resulting from ambient dust exposure. The data, however, support earlier studies that indicate that talc miners and millers experience excess parenchymal fibrosis and pleural changes. The data also suggest that individuals in the paper industry and construction trades may be at risk.

In plain English

After a local radiologist reported a cluster of lung fibrosis and pleural changes in St. Lawrence and Jefferson counties, a tremolite- and anthophyllite-containing talc mining area, New York State health officials did this case history study. He screened films of 9,442 patients aged 40 or older living in the two counties, taken at six hospitals from April 1982 to March 1983. A B-reader confirmed 355 of the 500 he referred (71%), or 3.8% of all patients. Of all 9,442, 246 (2.6%) had pleural changes only and 109 (1.2%) lung tissue abnormalities with or without pleural findings. Men were affected more often than women. Interviews of 306 cases or their next-of-kin found 182 (59.5%) reported a year or more in a job with potential asbestiform mineral exposure, mostly talc mining and milling or construction. The authors, cautioning that this descriptive study could not establish cause, concluded the data did not generally support widespread abnormalities from environmental exposure. They said the findings supported earlier studies tying talc work to fibrosis and pleural changes and suggested paper and construction workers may be at 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: Case history (descriptive) study of radiographic chest abnormalities among general hospital patients, with interviews of confirmed cases and comparison of their occupations to 1960 U.S. Census data for men in the two counties
• Who was studied: Inpatients, outpatients and emergency room patients aged at least 40 living in St. Lawrence or Jefferson County, New York, whose chest films were taken between April 1, 1982 and March 31, 1983 at five St. Lawrence County hospitals and one Jefferson County hospital. In total, 9,442 patients met the criteria.
• Exposure: Occupational exposure to asbestiform minerals, recorded by detailed job history and a checklist of 13 occupations or industries. The main focus was mining and milling of local Gouverneur talc, which contains the amphibole minerals tremolite and anthophyllite. The study also considered possible ambient (environmental) exposure of area residents.
• Main results:
  • The radiologist screened 500 of the 9,442 patients' films as positive. The B-reader confirmed 355 (71%) of the 500 as showing a chest abnormality consistent with dust exposure. That is a prevalence of 3.8% among all 9,442 eligible patients.
  • Among all 9,442 eligible patients, 246 (prevalence 2.6%) had pleural thickening or calcification without parenchymal involvement. Another 109 (1.2%) had parenchymal disorders with or without pleural findings. Only 8 of the 109 had large opacities.
  • Men were 12 times more likely than women to show parenchymal abnormalities and 5 times more likely to show pleural changes (p less than .001). The overall prevalence was 7.1% for men and 1.0% for women.
  • Abnormalities became more common with age. The linear trend was statistically significant only for parenchymal disorders (p = .005), not for pleural changes (p = .076).
  • Interviews were conducted with 306 (86.2%) cases or their next-of-kin. Two-thirds were at least 60, 86.5% were men, and about 70% had ever smoked cigarettes.
  • 182 interviewed cases (59.5%) reported at least one year in an occupation or industry known to entail exposure to asbestiform minerals. These included talc mining and milling (111, 36.3%), construction (76, 24.8%) and paper (50, 16.3%). A case could be counted in more than one occupation.
  • Talc mining/milling was the usual occupation of 15.5% of cases and construction of 13.4%. The 1960 Census showed 2.4% and 6.5% of men in the two counties in such work.
  • About 15% of cases reported no relevant job but did report a chest condition or injury that could explain the film, such as emphysema (6.2%), broken ribs (4.2%) or pleurisy (3.6%). The remaining one-quarter reported neither.
  • More than half of the women with unexplained abnormalities lived with a spouse or other relative who worked in the talc mines or another high-risk industry. The authors suggested secondary exposure may have been involved.
• The authors' conclusion: The authors concluded that the data do not generally support the claim that environmental exposures to asbestiform minerals in the region are causing widespread chest X-ray abnormalities. They said the findings support earlier studies associating occupational exposure to Gouverneur talc with parenchymal fibroses and pleural changes. They suggested that paper industry and construction workers may be at risk, and called for analytical studies to quantify these risks.
• Limitations the authors state:
  • Only films the local radiologist judged positive were sent to the B-reader. As a result, false negative and false positive errors could not be estimated, and both may have influenced the prevalence rates.
  • People with normal films were not interviewed, so occupational exposures could not be compared between cases and internal controls.
  • As a descriptive study, it could not establish causality, and the authors said results should be interpreted cautiously.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Asbestiform, Talc, Pulmonary Fibrosis, Parenchyma, Pleura, B-Reader, Occupational Exposure, Parenchymal Fibrosis.

Related studies

• Malignant mesothelioma incidence among talc miners and millers in New York State — M.M. Finkelstein (2012)
• Letter to the editor on commentary: malignant mesothelioma incidence among talc miners and millers in New York state by M M Finkelstein — R.P. Nolan, J.F. Gamble, et al. (2013)
• Reply to letter by Nolan and colleagues--re: the carcinogenicity of New York state talc dusts in humans — M. Finkelstein (2013)
• Mortality among talc miners and millers in New York State — M. Kleinfeld, J. Messite, et al. (1967)
• Lung cancer risk and talc not containing asbestiform fibres: a review of the epidemiological evidence — P. Wild (2006)
• The dust hazard in tremolite talc mining — L. Greenburg (1947)

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