American Journal of Industrial Medicine

About the journal

Publisher: Wiley-Blackwell
Published: 1980 to the present, United States
Language: English
ISSN: 0271-3586 (print), 1097-0274 (electronic)
Its record in the NLM Catalog

2020s

An Evaluation of Mortality Rates and Their Determinants in a Cohort of Former Asbestos Miners in South Africa. Y. Williams-Mohamed, R. Ehrlich, J. teWaterNaude, et al. 2026;69(6):446-460. PubMed · Publisher · Free full text

Abstract

Background: A causal association between occupational asbestos exposure and lung disease, including pneumoconiosis and mesothelioma, is well established. Elevated mortality among former asbestos miners is expected. However, large-scale South African studies examining all-cause mortality in this population are lacking. We assessed all-cause mortality among former asbestos miners recorded in the Asbestos and Kgalagadi Relief Trusts' Inyosi database.

Methods: All-cause standard mortality ratios (SMRs) and crude mortality rates (CMRs) were calculated for 11,343 ex-miners. Mortality predictors were modeled using Cox regression analysis, and mortality trends were assessed by examining annual all-cause CMRs and SMRs over the 20-year study period.

Results: The cohort's all-cause mortality exceeded that of the general population by 4% (SMR = 1.04; 95% CI: 1.01-1.07), with excess mortality confined to women (SMR = 1.17; 95% CI: 1.09-1.25). Increasing ILO radiographic profusion category strongly predicted mortality, with adjusted hazard ratios (aHRs) ranging from 1.13 (95% CI: 1.05-1.23) to 2.42 (95% CI: 1.58-3.71). Severely reduced lung function was also associated with increased risk, including forced expiratory volume in 1 s and forced vital capacity z-scores below -3.0 (aHR = 1.60; 95% CI: 1.41-1.81 and aHR = 1.26; 95% CI: 1.12-1.42, respectively). Additional predictors included body mass index less than 18.5 kg/m² (aHR = 1.46; 95% CI: 1.36-1.58) and previous smoking (aHR = 1.43; 95% CI: 1.35-1.53). SMRs declined over time.

Conclusion: Radiological and spirometric indicators were key predictors of mortality. These findings support risk stratification and targeted interventions, particularly early management of respiratory complications and smoking cessation, to reduce mortality. The excess female mortality highlights the occupational hazards of aboveground asbestos activities, gender‑specific work practices, and insufficient control measures in this setting. Although standardized mortality was only modestly elevated, interpretation was limited by incomplete data.

© 2026 The Author(s). American Journal of Industrial Medicine published by Wiley Periodicals LLC.
Cancer Incidence Among Swedish Seafarers Between 1985 and 2020. M. Wallin, H.P. Eriksson, K. Forsell, et al. 2026;69(11):960-971. PubMed · Publisher · Free full text

Abstract

Background: Several studies from different countries have shown that merchant seafarers have an increased cancer risk compared to the general population. The aim of this study was to provide updated information on cancer incidence in a cohort of Swedish seafarers.

Methods: A cohort consisting of all Swedish seafarers from the Swedish Seafarers' Register 1985-2013 was linked to the Swedish Cancer Register 1985-2020. Seafarers with at least 5 years of sea service (N = 38,030; 76% men and 24% women) were included in the analyses. Standardized incidence ratios (SIR) were calculated for cancer by specific site, period of first signing, job category, type of vessel, and gender, using cancer incidence in the general population as reference.

Results: In seafarers who had worked on different types of vessels (not solely passenger ferries), there were 5076 cases of cancer during the follow-up period, and total cancer risk was increased (SIR 1.14; 95% confidence interval [CI] 1.11-1.17). Most cases occurred in seafarers who had their first signing before 1985. The risk of lung cancer was increased in all job categories, especially in engine room crew members (SIR 1.98; 95% CI 1.53-2.57). There were 16 mesothelioma cases in engine officers (SIR 3.75; 95% CI 2.30-6.12).

Conclusions: This cohort study of seafarers in Sweden confirms that Swedish seafarers had an increased overall cancer risk compared with the general population, particularly those signing before 1985 and working on different types of vessels.

© 2026 The Author(s). American Journal of Industrial Medicine published by Wiley Periodicals LLC.
Commentary on Notification and Recordkeeping of Occupational Mesothelioma in India. R. Singh, A.L. Frank. 2026;69(4):219-225. PubMed · Publisher · Free full text

Abstract

In India, some occupational diseases are notifiable under the Mines Act, 1952, and the Factories Act, 1948. Mesothelioma, primarily attributable to asbestos exposure, has been listed specifically as one of the notifiable diseases under the Mines Act, 1952, and is notifiable under the category of occupational cancer in the Factories Act, 1948. The total number of cases of mesothelioma notified to the Directorate General of Mines Safety under the mining safety law was zero from 2004 to 2024. Similarly, under the factory safety law, only one case of occupational cancer was notified in one state, in a country of 28 states and 8 union territories (mesothelioma being listed under occupational cancer and not a separate entry under the factories law). This is in sharp contrast to the medical literature, where a large number of cases have been published by researchers and doctors from Indian hospitals. The absence of notified disease may not automatically mean the absence of disease. Further, a parallel National Cancer Registry Program, which is not only for occupational cancers, but which may overlap with occupational cases, covers only 16% of the country's population. With clear lack of notification of cases and underreporting of occupational mesothelioma, and cancer not being declared as universally notifiable at the national level, disease surveillance in India may need to be invigorated so that easily preventable disease is reduced, load on the already strained healthcare infrastructure is decreased, and overall national medical costs are reduced in the future.

© 2026 The Author(s). American Journal of Industrial Medicine published by Wiley Periodicals LLC.
Twenty-Year Longitudinal Cohort Study of Cancer Incidence and Mortality Among Workers in Two Primary Aluminum Prebake Smelters. N. Kinsman, C. Dimitriadis, A. Del Monaco, et al. 2026;69(4):269-282. PubMed · Publisher · Free full text

Abstract

Background: Classified as carcinogenic to humans by the International Agency for Research on Cancer, aluminum production has been transitioning towards lower polycyclic aromatic hydrocarbon-emitting prebake smelters. This study explored the risk of cancer and mortality over 20 years follow-up among a cohort of aluminum prebake smelter workers.

Method: Time-weighted average estimated exposure to the following airborne contaminants was available: total fluoride, sulfur dioxide, asbestos, oil mist, inhalable dust, benzene (a) pyrene (BaP), and benzene soluble fraction (BSF). Data about diagnosed cancers were accessed from the Australian Cancer Database and deaths and cause of deaths from the National Death Index, updating a previous linkage 9 years earlier.

Results: The cohort included 4495 male smelter workers. Mesothelioma was associated with historic asbestos exposure. BaP/BSF exposure were found associated with stomach cancer (10-year lag RR = 2.89 (1.19-6.98) [BaP], 2.88 (1.21-6.87) [BSF]), liver and prostate cancers, and Alzheimer's disease mortality. Oil mist exposure was associated with chronic obstructive pulmonary disease (COPD) mortality. There was no association between any smelter exposure and incidence of either lung or bladder cancer.

Conclusion: In this updated linkage of aluminum prebake smelter workers' data, the association between respiratory cancer and fluoride, inhalable dust and BaP exposure (found in the 2002 linkage analysis) was not confirmed. There was also no increased incidence of bladder cancer. However, compared with the earlier linkage, a stronger association was found for stomach cancer and BaP/BSF exposure. The strong association between mesothelioma and asbestos exposure, found in earlier linkages, remains. Other associations identified will require further investigation.

© 2026 The Author(s). American Journal of Industrial Medicine published by Wiley Periodicals LLC.
A Review of Job Assignments and Asbestos Workplace Exposure Measurements for TAWP Mesothelioma Deaths Through 2011. V.J. Willis, J.L. Levin, D.E. Nessim. 2025;68(1):89-95. PubMed · Publisher

Abstract

Introduction: Asbestos workers have a higher risk of developing mesothelioma; however, few studies have looked at specific jobs and job locations within asbestos factories. The purpose of this study was to investigate asbestos exposure in different job locations of the Tyler, Texas asbestos plant to determine if there was a relationship between the duration of exposure and air fiber concentration burden in workers who developed pleural versus peritoneal mesothelioma.

Methods: This study used a patient information database to compile secondary data on 23 workers who died from mesothelioma through 2011. The airborne fiber exposure burdens for each of the 23 workers were estimated and then stratified by job location category and by type of mesothelioma for analysis.

Results: Most of the worker cases were assigned to the forming area which had the overall highest fiber concentration of all the plant's job locations. Workers who developed pleural mesothelioma spent the most time in the packing and miscellaneous locations, whereas workers who developed peritoneal mesothelioma worked mostly in the forming and miscellaneous locations. There were significant differences in days worked and estimated airborne exposure fiber burden between the pleural and peritoneal mesothelioma cases in the forming and curing locations.

Conclusion: Results from this study reiterate the association between occupational asbestos exposure and mesothelioma, emphasizing the importance of concentration of respirable asbestos dust levels and duration of exposure.

© 2024 Wiley Periodicals LLC.
Asbestos Burden in Lungs of Subjects Deceased From Mesothelioma Who Lived in Proximity to an Asbestos Factory: A Topographic Post-Mortem SEM-EDS Study. S.D. Visonà, M. Untalan, B. Bertoglio, et al. 2025;68(2):112-121. PubMed · Publisher · Free full text

Abstract

Background: Asbestos exposure and its pathological consequences, especially malignant mesothelioma (MM) still represent a major public health problem on a global scale. After the ban of asbestos in most western countries, nonoccupational exposure plays an essential role in MM pathogenesis. However, few studies have quantified asbestos lung burden after environmental exposure. The main objective of this work is to understand if asbestos lung content is different between occupationally and environmentally exposed individuals, and if the distance between the subjects' residences and the source of exposure is significantly associated with the asbestos lung burden.

Methods: In this retrospective, observational study we quantified, with analytical scanning electron microscopy, asbestos content in lungs of individuals deceased from MM between 2005 and 2019, who were exposed to asbestos (occupationally and/or environmentally) in Broni, a small town in northern Italy where an important asbestos-cement plant operated until 1993.

Results: We analyzed asbestos lung content of 77 subjects. We found that the asbestos lung content in MM patients who lived around the asbestos factory was as high as that seen in occupationally exposed individuals; this holds true in residents up to 10 km radius from the factory. We found no significant associations between the residence duration/distance ratio and asbestos lung burden.

Conclusions: This study suggests that heavy asbestos pollution involves not only the area adjacent to the factory, but the entire town of Broni and the surroundings. This is alarming if we consider that most asbestos factories still active in some countries are located close to towns and dwellings.

© 2024 The Author(s). American Journal of Industrial Medicine published by Wiley Periodicals LLC.
Mortality and Cancer Incidence After Exposure to Blue Asbestos in Childhood: A Further 10 Years of Follow-Up. R.N. Carey, A. Reid, N. de Klerk, et al. 2025;68(9):772-783. PubMed · Publisher · Free full text

Abstract

Objectives: The impact of early-life exposure to asbestos on disease risk remains uncertain. Childhood exposure to blue asbestos at Wittenoom has previously been linked to the development of malignant mesothelioma and various cancers in adulthood, as well as to a greater risk of all-cause mortality compared with the general population. This study aims to provide an update on mortality and cancer incidence rates after this exposure.

Methods: The cohort of all those who lived in the asbestos mining town of Wittenoom as children (less than 15 years of age; 1279 males and 1185 females) was linked to state and national cancer and death registries. We calculated standardized incidence ratios (SIRs) for a range of cancers, and standardized mortality ratios (SMRs) for all-cause and cause-specific mortality for the cohort compared with the general Western Australian population.

Results: Compared with the Western Australian population, males from the cohort had an increased risk of all cancers and mesothelioma, as well as melanoma and cancers of the lip and mouth, liver, and brain. Females had a significantly elevated risk of all cancers, mesothelioma, and cancers of the ovary and brain. Higher rates of mesothelioma were observed among those with a longer duration of exposure and higher cumulative exposure, consistent with a known exposure-response relationship. Former Wittenoom children also had a greater risk of all-cause mortality and mortality from cancer, mesothelioma, and ill-defined symptoms.

Conclusions: This update confirms earlier studies and shows that exposure to asbestos in childhood is associated with several cancer and mortality outcomes in adulthood.

© 2025 The Author(s). American Journal of Industrial Medicine published by Wiley Periodicals LLC.
Supporting companies dealing with asbestos risk: Practical tools for occupational health services, risk prevention specialists, and companies. I. Monnerais, M. Loizeau. 2025;68 Suppl 1:S8-S11. PubMed · Publisher

Abstract

Although asbestos has been officially banned in France for over two decades, it remains a major public health and occupational health issue. In 2012, French asbestos regulations became considerably more stringent and complex. Consequently, French Public Works and Building Trades Prevention Organisation (OPPBTP) and occupational health services have been working together for several years to support construction professionals. This support involves information, training and advice. This article presents the range of tools developed by OPPBTP and occupational health services to better understand the asbestos risk as it affects construction companies. These tools and this partnership have demonstrated positive results in confronting risk and in the implementation of suitable means of prevention. They serve the best interests of employees, companies and clients, by combining safeguards to employees' health and worksite performance.

© 2024 Wiley Periodicals LLC.
A cluster of mesotheliomas reported in a case series does not implicate chrysotile asbestos-containing friction products as the cause of mesotheliomas. S.J. Geyer. 2024;67(1):81-82. Letter PubMed · Publisher
Asbestos exposure and asbestosis mortality in Italian cement-asbestos cohorts: Dose-response relationship and the role of competing death causes. P. Girardi, S. Rigoni, D. Ferrante, et al. 2024;67(9):813-822. PubMed · Publisher

Abstract

Objectives: In Italy, asbestos was used intensively until its ban in 1992, which was extended for asbestos cement factories until 1994. The aim of this study was to evaluate the dose-response between asbestos exposure and asbestosis mortality across a pool of Italian occupational cohorts, taking into account the presence of competing risks.

Methods: Cohorts were followed for vital status and the cause of death was ascertained by a linkage with mortality registers. Cause-specific (CS) Cox-regression models were used to evaluate the dose-exposure relationship between asbestosis mortality and the time-dependent cumulative exposure index (CEI) to asbestos. Fine and Gray regression models were computed to assess the effect of competing risks of death.

Results: The cohort included 12,963 asbestos cement workers. During the follow-up period (1960-2012), of a total of 6961 deaths, we observed 416 deaths attributed to asbestosis, 879 to lung cancer, 400 to primary pleural cancer, 135 to peritoneal cancer, and 1825 to diseases of the circulatory system. The CS model showed a strong association between CEI and asbestosis mortality. Dose-response models estimated an increasing trend in mortality even below a CEI of 25 ff/mL-years. Lung cancer and circulatory diseases were the main competing causes of death.

Conclusions: Asbestos exposure among Italian asbestos-cement workers has led to a very high number of deaths from asbestosis and asbestos-related diseases. The increasing risk trend associated with excess deaths, even at low exposure levels, suggests that the proposed limit values would not have been adequate to prevent disability and mortality from asbestosis.

© 2024 Wiley Periodicals LLC.
Cause specific mortality in an Italian pool of asbestos workers cohorts. D. Ferrante, A. Angelini, F. Barbiero, et al. 2024;67(1):31-43. PubMed · Publisher

Abstract

Background: Asbestos is a known human carcinogen and is causally associated with malignant mesothelioma, lung, larynx and ovarian cancers.

Methods: Cancer risk was studied among a pool of formerly asbestos-exposed workers in Italy. Fifty-two Italian asbestos cohorts (asbestos-cement, rolling-stock, shipbuilding, and other) were pooled and their mortality follow-up was updated to 2018. Standardized mortality ratios (SMRs) were computed for major causes of death considering duration of exposure and time since first exposure (TSFE), using reference rates by region, age and calendar period.

Results: The study included 63,502 subjects (57,156 men and 6346 women): 40% who were alive, 58% who died (cause known for 92%), and 2% lost to follow-up. Mortality was increased for all causes (SMR: men = 1.04, 95% confidence interval [CI] 1.03-1.05; women = 1.15, 95% CI 1.11-1.18), all malignancies (SMR: men = 1.21, 95% CI 1.18-1.23; women = 1.29, 95% CI 1.22-1.37), pleural and peritoneal malignancies (men: SMR = 10.46, 95% CI 9.86-11.09 and 4.29, 95% CI 3.66-5.00; women: SMR = 27.13, 95% CI 23.29-31.42 and 7.51, 95% CI 5.52-9.98), lung (SMR: men = 1.28, 95% CI 1.24-1.32; women = 1.26, 95% CI 1.02-1.53), and ovarian cancer (SMR = 1.42, 95% CI 1.08-1.84). Pleural cancer mortality increased during the first 40 years of TSFE (latency), reaching a plateau thereafter.

Conclusions: Analyses by time-dependent variables showed that the risk for pleural neoplasms increased with latency and no longer increases at long TSFE, consistent with with asbestos clearance from the lungs. Peritoneal neoplasm risk increased over all observation time.

© 2023 The Authors. American Journal of Industrial Medicine published by Wiley Periodicals LLC.
Occupational lung cancer screening: A Collegium Ramazzini statement. S. Markowitz, K. Ringen, J.M. Dement, et al. 2024;67(4):289-303. PubMed · Publisher
Quality of life in retired workers with past exposure to asbestos. E. Siefert, F. Delva, C. Paris, et al. 2024;67(7):610-623. PubMed · Publisher

Abstract

Background: Asbestos causes cancer and non-cancerous lung and pleural diseases and can also have a negative psychological impact but little is known about its effect on health-related quality of life.

Objectives: The aim of this study is to describe the health-related quality of life (HRQoL) of retired men with a history of occupational exposure to asbestos and examine factors linked with low HRQoL.

Methods: Retired male workers of the French Asbestos-Related Disease Cohort (ARDCO) completed self-questionnaires that included SF-36v2 and HAD scales, questions about their perception of asbestos (perceived dangers and level of exposure, expectations to fall ill, or knowing someone who is) and their respiratory symptoms. Asbestos exposure was assessed by industrial hygienists. A perceived risk score was created using factorial analysis. Multivariable regressions were performed for all SF-36 subscales.

Results: A total of 1266 of 2075 questionnaires (61%) were returned complete and included in analysis. After adjustment for potential confounders, an increase in perceived risk score resulted in a decrease in physical component summary score (PCS), up to 10.7 points (p = 0.048) and in mental component summary score (MCS) (p = 0.044). Presence of respiratory symptoms was also associated with significantly decreased PCS and MCS (p < 0.001). Poor HRQoL was linked to higher perceived risk score with p ≤ 0.01 for all SF-36 dimensions. Asbestos exposure assessed by an expert was not associated with any outcome.

Conclusions: All dimensions of HRQoL appear to be affected by the perceived risk of incurring asbestos-related disease and respiratory symptoms.

© 2024 The Author(s). American Journal of Industrial Medicine published by Wiley Periodicals LLC.
Recognizing the pleura in asbestos-related pleuropulmonary disease: Known and new manifestations of pleural fibrosis. A. Miller. 2024;67(1):73-80. PubMed · Publisher

Abstract

Pleural thickening (PT) is a major consequence of exposure to all fiber types of asbestos. In recent decades, it is more prevalent than parenchymal asbestosis. Its manifestations occupy a full clinical and radiographic spectrum. Six major manifestations can be identified: (a) acute pleuritis generally with effusion; (b) diffuse PT or fibrous pleuritis; (c) rounded atelectasis; (d) circumscribed PT or plaques; (e) chronic pleuritic pain; and (f) mesothelioma. Review of the experience of workers and community members in Libby, MT to asbestiform fibers in vermiculite has confirmed the appearance of these previously known benign and malignant asbestos-related diseases as well as a unique pleuropulmonary disease characterized as lamellar PT and associated with progressive decline in pulmonary function and pleuritic pain. Despite previous literature asserting that PT represents a marker for asbestos exposure without significant effect on pulmonary function and physiology, the experience of Libby amphibole (LA) disease, along with other studies, indicates that PT plays a role in declining vital capacity in those with prolonged or unusual exposures such as those arising from LA.

© 2023 Wiley Periodicals LLC.
Surveillance of asbestos related disease among workers enrolled in an exposure registry. V.H. Arrandale, C. Berriault, C. Song, et al. 2024;67(12):1077-1088. PubMed · Publisher

Abstract

Introduction: Contemporary asbestos exposure occurs during construction, remediation, and maintenance involving asbestos-containing materials (ACM), as compared to the historical exposure scenarios of asbestos mining and milling. The Ontario Asbestos Workers Register (AWR) was established in 1986 to track asbestos exposure among construction workers. This study reports on the risk of asbestos-related diseases (ARD) among workers in the AWR.

Methods: AWR registrants were linked probabilistically with administrative health databases (1986-2019) to identify cases of ARD including both cancer and chronic respiratory disease. Follow-up began at AWR enrollment and continued prospectively. Incidence rates were compared to the general population using standardized incidence ratios (SIRs). Associations between ACM exposure and ARD were estimated among AWR registrants using Poisson regression.

Results: In total, 26,204 (81%) registrants were linked successfully. Common industries of employment were construction (62%), manufacturing (19%) and education (8%). Among men and women mesothelioma (M:SIR 6.83 [95% CI = 5.56-8.31]; W:SIR 19.2 [3.86-56.1]) and pulmonary fibrosis (M:SIR 14.1 [12.2-16.2]; W:SIR 9.25 [2.49-23.7]) rates were higher than the general population. Asbestosis risk was elevated among men (M:SIR 11.2 [9.59-13.1]). Workers with longer reported exposures (≥140 h) had increased rates of lung cancer (RR 1.34 [1.10-1.63]), mesothelioma (RR 2.83 [1.75-4.58]), asbestosis (RR 3.07 [2.12-4.43]), chronic obstructive pulmonary disease (RR 1.42 [1.29-1.57]), and pulmonary fibrosis (RR 1.88 [1.35-2.62]).

Conclusion: Exposure to asbestos in construction and building maintenance continues to contribute to ARD incidence. Despite a Canadian ban on asbestos in new products, exposures to existing ACM will persist from construction activities. The AWR offers an opportunity for ongoing surveillance of resulting ARD in Ontario.

© 2024 The Author(s). American Journal of Industrial Medicine published by Wiley Periodicals LLC.
Cancer incidence among workers in soft paper mills: A cohort study. K. Torén, R.L. Neitzel, H.P. Eriksson, et al. 2023;66(9):728-735. PubMed · Publisher

Abstract

Objectives: To elucidate whether occupational exposure to soft paper dust increases the incidence of cancer.

Methods: We studied 7988 workers in Swedish soft paper mills from 1960 to 2008, of whom 3233 (2 187 men and 1046 women) had more than 10 years of employment. They were divided into high exposure (>5 mg/m3 for >1 year) or lower exposure to soft paper dust based on a validated job-exposure matrix. They were followed from 1960 to 2019, and person-years at risk were stratified according to gender, age, and calendar-year. The expected numbers of incident tumors were calculated using the Swedish population as the reference, and standardized incidence ratios (SIR) with 95% confidence intervals (95% CI) were assessed.

Results: Among high-exposure workers with more than 10 years of employment, there was an increased incidence of colon cancer (SIR 1.66, 95% CI 1.20-2.31), small intestine cancer (SIR 3.27, 95% CI 1.36-7.86), and thyroid gland cancer (SIR 2.68, 95% CI 1.11-6.43), as well as lung cancer (SIR 1.56, 95% CI 1.12-2.19). Among the lower-exposed workers there was an increased incidence of connective tissue tumors (sarcomas) (SIR 2.26, 95% CI 1.13-4.51) and pleural mesothelioma (SIR 3.29, 95% CI 1.37-7.91).

Conclusion: Workers in soft paper mills with high exposure to soft paper dust have an increased incidence of large and small intestine tumors. Whether the increased risk is caused by paper dust exposure or some unknown associated factors is unclear. The increased incidence of pleural mesothelioma is probably linked to asbestos exposure. The reason for increased incidence of sarcomas is unknown.

© 2023 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals LLC.
Four mesothelioma cases from a single automotive dealership: A case series. A.L. Frank. 2023;66(10):904-906. Case report PubMed · Publisher

Abstract

Background: Four cases of mesothelioma were noted in a workplace of some 110 persons at a tractor dealership between 2006 and 2023. Each worker had a different job title.

Methods: Medical-legal case material was reviewed and abstracted from four cases from the same dealership, all supplied via one law firm.

Results: Four mesotheliomas are reported from this single facility that used chrysotile asbestos automotive products. Two of the four cases had no other known exposures to asbestos.

Discussion: Automotive products containing chrysotile do appear capable of causing mesothelioma. Job category is not a good surrogate for exposure.

© 2023 The Authors. American Journal of Industrial Medicine published by Wiley Periodicals LLC.
How much have adverse occupational health outcomes among construction workers improved over time? Evidence from 25 years of medical screening. K. Ringen, J. Dement, L. Welch, et al. 2023;66(1):18-29. PubMed · Publisher

Abstract

Background: Construction workers have always had a high risk of occupational illnesses. We used 25 years of data from a medical screening program serving older construction workers to determine how much health outcomes have improved over the past 60 years.

Methods: We investigated changes in relative risk for chest radiographs consistent with pneumoconiosis, COPD by spirometry, lung cancer mortality, and audiometry-assessed hearing impairment among workers participating in a medical screening program. Results were stratified by decade of first construction employment: before 1960, 1960-1969, 1970-1979, 1980-1989, and after 1990. Poisson and Cox regression analyses assessed relative risk by decade adjusted for age, sex, smoking, and years of construction trade work.

Results: Subjects were 94% male and, on average, 60 years old with 25 years of construction work. When compared to workers employed before 1960, those first employed after 1990 experienced the following reductions in model-adjusted relative risks: chronic obstructive pulmonary disease, 32%; all pneumoconiosis, 68%; parenchymal abnormalities, 35%; pleural abnormalities, 71%; hearing impairment, 20%; and lung cancer mortality, 48%. Risks started to decline in the 1960s with greatest reductions among workers first employed after 1970.

Conclusions: This study demonstrates the positive impact that adoption of occupational health protections have had over the past 60 years. The greatest risk reductions were observed for outcomes with strong regulatory and legal incentives to reduce exposures and associated risks, such as those associated with inhalation hazards (asbestos and silica), while lowest improvement was for hearing impairment, for which little regulatory enforcement and few prevention incentives have been adopted.

© 2022 Wiley Periodicals LLC.
Manufactured doubt and the EPA 2020 chrysotile asbestos risk assessment. J.M. Dement, D. Loomis. 2023;66(7):543-553. PubMed · Publisher

Abstract

While all forms of asbestos have been determined to be carcinogenic to humans by the International Agency for Research on Cancer (IARC) as well as other authoritative bodies, the relative carcinogenic potency of chrysotile continues to be argued, largely in the context of toxic tort litigation. Relatively few epidemiologic studies have investigated only a single form of asbestos; however, one study that included an asbestos textile plant located in Marshville, North Carolina that processed chrysotile asbestos was used by the United States Environmental Protection Agency (EPA) in 2020 to help inform the agency's chrysotile asbestos risk assessment. During the EPA proceedings toxic tort defense consultants submitted comments to the EPA docket and made public presentations asserting that the Marshville plant had processed amphibole asbestos types and should not be used for the chrysotile risk assessment. A detailed evaluation of defense consultant assertions and supporting information and a full assessment of the available information concerning asbestos types used at the Marshville plant was undertaken. The preponderance of evidence continues to support the conclusion that neither amosite nor crocidolite were likely to have been processed in the Marshville textile plant. Defense consultants' assertions about chrysotile use are not supported by the preponderance of evidence and constitute an example of manipulation of information to cast uncertainty and doubt rather than to seek truth and contribute to the body of scientific evidence.

© 2023 Wiley Periodicals LLC.
Pneumoconiosis incidence and prevalence among US Medicare beneficiaries, 1999-2019. L. Kurth, M.L. Casey, J.M. Mazurek, et al. 2023;66(10):831-841. PubMed · Publisher · Free full text

Abstract

Background: Pneumoconiosis is a group of occupational lung diseases caused by dust and fiber exposure. This study analyzes Medicare claims to estimate the burden of pneumoconiosis among fee-for-service (FFS; Medicare Parts A and B) Medicare beneficiaries during 1999-2019 in the United States.

Methods: Claim and enrollment information from 81 million continuously enrolled FFS Medicare beneficiaries were analyzed. Beneficiaries with any pneumoconiosis and cause-specific pneumoconiosis (e.g., asbestosis, silicosis) were identified using three case definitions (broad, intermediate, and narrow) with varying diagnostic criteria based on claim International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis codes and Healthcare Common Procedure Coding System codes. Results are presented as ranges of values for the three case definitions.

Results: The 21-year prevalence range for any pneumoconiosis was 345,383-677,361 (412-833 per 100,000 beneficiaries) using the three case definitions. The highest prevalence was among those ≥75 years of age, males, Whites, and North American Natives. Most claims (70.0%-72.5%) included an ICD-CM diagnosis code for asbestosis. The broad pneumoconiosis prevalence rate increased significantly (p < 0.001) during 2002-2009 by 3%-10% annually and declined significantly by 3%-5% annually starting in 2009. The average annual broad incidence rate declined significantly by 7% annually during 2009-2019.

Conclusions: Despite the decline in rate for any pneumoconiosis among Medicare beneficiaries, which is primarily attributed to a decline in asbestosis, pneumoconiosis is prevalent among FFS Medicare beneficiaries.

© 2023 Wiley Periodicals LLC.
Case-fatality study of workers and residents with radiographic asbestos disease in Libby, Montana. A. Miller, C.B. Black, G. Loewen, et al. 2022;65(3):196-202. PubMed · Publisher · Free full text

Abstract

Background: Vermiculite ore from Libby, Montana contains on average 24% of a mixture of toxic and carcinogenic amphibole asbestiform fibers. These comprise primarily winchite (84%), with smaller quantities of richterite (11%) and tremolite (6%), which are together referred to as Libby amphibole (LA).

Methods: A total of 1883 individuals who were occupationally and/or environmentally exposed to LA and were diagnosed with asbestos-related pleuropulmonary disease (ARPPD) following participation in communitywide screening programs supported by the Agency for Toxic Substances and Disease Registry (ATSDR) and followed up at the Center for Asbestos Related Disease (CARD) between 2000 and 2010. There were 203 deaths of patients with sufficient records and radiographs. Best clinical and radiologic evidence was used to determine the cause of death, which was compared with death certificates.

Results: Asbestos-related mortality was 55% (n = 112) in this series of 203 patients. Of the 203 deaths, 34 (17%) were from asbestos-related malignancy, 75 (37%) were from parenchymal asbestosis, often with pleural fibrosis, and 3 (1.5%) were from respiratory failure secondary to pleural thickening.

Conclusions: Asbestos is the leading cause of mortality following both occupational and nonoccupational exposure to LA in those with asbestos-related disease.

© 2021 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals LLC.
Concerns re Harris et al.: Low-dose CT-detected interstitial lung abnormalities in a population with low asbestos exposure. R.G. Sangani, A.J. Ghio, J.E. Parker. 2022;65(5):425-426. Letter PubMed · Publisher
Estimating mortality from coal workers' pneumoconiosis among Medicare beneficiaries with pneumoconiosis using binary regressions for spatially sparse data. R. Paul, O. Adeyemi, A.A. Arif. 2022;65(4):262-267. PubMed · Publisher · Free full text

Abstract

Background: Coal workers' pneumoconiosis (CWP) is an occupational lung disease due to inhalation of coal dust. We estimated mortality from CWP and other pneumoconioses among Medicare beneficiaries.

Methods: We used the 5% Medicare Limited Claims Data Set, 2011-2014, to identify patients diagnosed with ICD-9-CM 500 (CWP) through 505 (Asbestosis, Pneumoconiosis due to other silica or silicates, Pneumoconiosis due to other inorganic dust, Pneumonopathy due to inhalation of other dust, and Pneumoconiosis, unspecified) codes. We applied binary regression models with spatial random effects to determine the association between CWP and mortality. Our inferences are based on Bayesian spatial hierarchical models, and model fitting was performed using Integrated Nested Laplace Approximation (INLA) algorithm in R/RStudio software.

Results: The median age of the sample was 76 years. In a sample of 8531 Medicare beneficiaries, 2568 died. Medicare beneficiaries with CWP had 25% higher odds of death (adjusted OR: 1.25, 95% CI: 1.07, 1.46) than those with other types of pneumoconiosis. The number of comorbid conditions elevated the odds of death by 10% (adjusted OR: 1.10, 95% CI: 1.09, 1.10).

Conclusion: CWP increases the likelihood of death among Medicare beneficiaries. Healthcare professionals should make concerted efforts to monitor patients with CWP to prevent premature mortality.

© 2022 The Authors. American Journal of Industrial Medicine published by Wiley Periodicals LLC.
Lung cancer and mesothelioma risks in a prospective cohort of workers with asbestos-related lung or pleural diseases. D. Taeger, K. Wichert, M. Lehnert, et al. 2022;65(8):652-659. PubMed · Publisher

Abstract

Background: Asbestos causes mesothelioma and lung cancer. In the European Union, asbestos was banned in 2005, but it is still in use in many other countries. The aim of this study was to estimate the lung cancer and mesothelioma incidence risk of men with benign asbestos-related lung or pleural diseases.

Methods: Between 2008 and 2018, 2439 male participants of a German surveillance program for asbestos workers were included in the cohort. All participants had a recognized occupational asbestos-related disease of the pleura or lung. We estimated the mesothelioma and lung cancer risks by calculating standardized incidence ratios (SIR) with corresponding 95% confidence intervals (95% CI).

Results: We observed 64 incident lung cancer and 40 mesothelioma cases in the cohort. An SIR of 17.60 (95% CI: 12.57-23.96) was estimated for mesothelioma and 1.27 (95% CI: 0.98-1.62) for lung cancer. The presence of pleural plaques was associated with a strongly increased risk (SIR: 13.14; 95% CI: 8.51-19.40) for mesothelioma, but not for lung cancer (SIR: 1.05; 95% CI: 0.76-1.41). The highest lung-cancer risk (SIR: 2.56; 95% CI 1.10-5.04) was revealed for cohort members with less than 40 years since first asbestos exposure. Lung cancer risks by duration of asbestos exposure did not show a consistent time trend, but for time since last exposure a trend for mesothelioma was seen.

Conclusions: Compared to the general population, we demonstrated an association between benign asbestos-related lung or pleural disease and mesothelioma risk in workers with a history of occupational asbestos exposure. Because lung-cancer risk is dominated by smoking habits, a possible effect of asbestos exposure may have been masked. Efforts should be made to ban production and use of asbestos worldwide and to establish safe handling rules of legacy asbestos.

© 2022 Wiley Periodicals LLC.
Mesothelioma in situ with regressive malignant pleural effusion and an unexpected evolution: A case report. G.C. Almeida, U.P. Santos, Y.D.M. Parente, et al. 2022;65(7):620-623. Case report PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive neoplasm that originates from hyperplasia and metaplasia of the mesothelial cells that cover the pleural cavity. Previous exposure to asbestos is the main risk factor. Since MPM is often diagnosed at an advanced stage with rapid evolution and resistance to treatment, it is associated with an unfavorable outcome. Mesothelioma in situ (MIS) has been postulated as a preinvasive phase of MPM; however, its diagnostic criteria have been defined only recently. Diagnosis of MIS may represent an opportunity for early therapies with better results, but the optimal approach has not been defined thus far. Here, we report on a case of a 74-year-old man with right-sided pleural effusion and a previous history of occupational exposure to asbestos for 9 years who was diagnosed with MIS after a latency of 36 years. During follow-up, spontaneous disease regression was observed 5 months after the initial diagnosis; however, it recurred in the form of invasive epithelioid MPM. There is a paucity of literature on MIS and its evolution; however, our case provides relevant knowledge of this unusual behavior, which is important to define follow-up and therapeutic strategies for future cases.

© 2022 Wiley Periodicals LLC.
Public health risks from asbestos cement roofing. M. Kottek, M.L. Yuen. 2022;65(3):157-161. PubMed · Publisher · Free full text

Abstract

There is no identified risk-free threshold exposure to asbestos. Based on epidemiology and toxicology, asbestos fiber dimensions have been implicated in causing asbestos-related diseases. Phase-contrast microscopy provides only a limited index of exposure to fiber dimensions implicated in mesothelioma induction. Installed asbestos-containing materials (ACMs) create an ongoing risk of intense exposure during natural disasters and remodeling, along with low-level exposure arising from the continual emission of airborne asbestos into the environment arising from weathering of installed ACM. Epidemiological studies have demonstrated a risk of disease associated with proximity to asbestos cement roofing (ACR), while ongoing environmental emissions of asbestos from installed ACR have also been demonstrated. Owing to the limitations of the available data, a precautionary approach is warranted; asbestos-free roofing materials should be used in new construction and existing ACR should be removed at the earliest opportunity.

© 2021 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals LLC.
Causes of death in former asbestos-cement workers in the state of São Paulo, Brazil. G.A. Fernandes, E. Algranti, V. Wunsch-Filho, et al. 2021;64(11):952-959. PubMed · Publisher

Abstract

Background: In low- and middle-income countries, such as Brazil, studies on the causes of death in asbestos-exposed workers are scarce.

Methods: A cohort study was performed involving 988 males who had worked in the asbestos-cement industry in the state of São Paulo, with a total of 12,217 person-years of observation between 1995 and 2016. The standardized mortality ratio (SMR) stratified by age was calculated as the ratio between the observed rate and the expected rate in the state of São Paulo.

Results: Increased SMRs were observed for overall mortality (SMR 1.1, 95% confidence interval [CI], 0.98-1.23) and mortality due to pleural malignant neoplasms (MN) (SMR, 69.4; 95% CI, 22.55-162.1), asbestosis (SMR, 975.7; 95% CI, 396.4-2031), peritoneal MN (SMR, 5.0; 95% CI, 0.13-27.78), laryngeal MN (SMR, 1.4; 95% CI, 0.30-4.20), and pulmonary MN (SMR, 1.5; 95% CI, 0.82-2.64).

Conclusion: The present study highlights the damage caused by asbestos exposure and reinforces the existing evidence of a causal association between exposure and increased mortality due to pleural MN, pulmonary MN, and asbestosis.

© 2021 Wiley Periodicals LLC.
Incidence of mesothelioma and asbestosis by occupation in a diverse workforce. N.L. DeBono, H. Warden, C. Logar-Henderson, et al. 2021;64(6):476-487. PubMed · Publisher

Abstract

Objective: We sought to characterize detailed patterns of mesothelioma and asbestosis incidence in the workforce as part of an occupational disease surveillance program in Ontario, Canada.

Methods: The Occupational Disease Surveillance System (ODSS) cohort was established using workers' compensation claims data and includes 2.18 million workers employed from 1983 to 2014. Workers were followed for mesothelioma and asbestosis diagnoses in Ontario Cancer Registry, physician, hospital, and ambulatory care records through 2016. Trends in incidence rates were estimated over the study period. Cox proportional hazard models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: A total of 854 mesothelioma and 737 asbestosis cases were diagnosed during follow-up. Compared with all other workers in the ODSS, those employed in construction trades occupations had the greatest adjusted incidence rate of both mesothelioma (223 cases; HR, 2.38; 95% CI: 2.03-2.78) and asbestosis (261 cases; HR, 3.64; 95% CI: 3.11-4.25). Rates were particularly elevated for insulators, pipefitters and plumbers, and carpenters. Workers in welding and flame cutting, boiler making, and mechanic and machinery repair occupations, as well as those in industrial chemical and primary metal manufacturing industries, had strongly elevated rates of both diseases. Rates were greater than anticipated for workers in electrical utility occupations and education and related services.

Conclusions: Results substantiate the risk of mesothelioma and asbestosis in occupation and industry groups in the Ontario workforce with known or suspected asbestos exposure. Sustained efforts to prevent the occurrence of additional cases of disease in high-risk groups are warranted.

© 2021 Wiley Periodicals LLC.
Incident chronic obstructive pulmonary disease associated with occupation, industry, and workplace exposures in the Health and Retirement Study. S.R. Silver, W.A. Alarcon, J. Li. 2021;64(1):26-38. PubMed · Publisher · Free full text

Abstract

Background: Chronic health effects from accumulated occupational exposures manifest as the workforce ages. The Health and Retirement Study (HRS), a panel survey of U.S. adults nearing/in retirement, allows assessment of associations among industry and occupation (I/O), workplace exposures, and incident chronic obstructive pulmonary disease (COPD).

Methods: The study population comprised respondents from the 1992 HRS cohort employed in 1972 or later and not diagnosed with COPD as of initial interview. We examined associations with incident COPD through 2016 and: (1) broad and selected detailed I/O, (2) workplace exposures, and (3) exposures within I/O. Given the cohort's baseline age (50-62), we calculated subhazard ratios (SHRs) for COPD accounting for competing risk of death.

Results: SHRs for COPD were significantly elevated for several industries: mining; blast furnaces, steelworks, rolling and finishing mills; groceries and related products; and automotive repair shops. Occupations with significantly elevated SHRs were maids and housemen; farmworkers; vehicle/mobile equipment mechanics and repair workers; material moving equipment operators; and nonconstruction laborers. Significantly elevated COPD SHRs were observed for specific I/O-exposure pairs: blast furnace/steelworks/rolling/finishing mills and asbestos; automotive repair shops and aerosol paints; farmworkers and pesticide exposures; and both material moving equipment operators and nonconstruction laborers exposed to dust and ash.

Conclusions: Certain jobs and occupational exposures are associated with increased risk for developing COPD in late preretirement and during retirement. Given the disability and economic costs of COPD, these findings support focusing exposure prevention and medical monitoring resources on groups of workers at increased risk.

© 2020 Wiley Periodicals LLC.
Low dose CT detected interstitial lung abnormalities in a population with low asbestos exposure. E.J.A. Harris, K.P. Lim, Y. Moodley, et al. 2021;64(7):567-575. PubMed · Publisher

Abstract

Background: The use of low dose CT (LDCT) chest is becoming more widespread in occupationally exposed populations. There is a knowledge gap as to heterogeneity in severity and the natural course of asbestosis after low levels of exposure. This study reports the characteristics of LDCT-detected interstitial lung abnormalities (ILA).

Methods: The Asbestos Review Program offers annual LDCT, health assessments, and pulmonary function tests to an asbestos-exposed cohort. Asbestosis was defined using the Helsinki Consensus statement and the presence of ILA defined using a protocol for occupational CT reports. At least two of three pulmonary function tests: forced expiratory volume in 1 s (FEV1 ); forced vital capacity (FVC); and diffusion capacity for carbon monoxide (DLco) were required for analysis of physiological decline.

Results: From 1513 cases, radiological ILA was present in 485 (32%). The cohort was 83.5% male with a median age of 68.3 years and a median (IQR) asbestos exposure of 0.7 (0.09-2.32) fiber/ml-year. A mixed occupation, mixed asbestos fiber cohort comprised the majority of the cohort (65.8%). Of those with ILA, 40 (8.2%) had an FVC decline of ≥10% and 30 (6.2%) had a DLco decline of ≥15% per year. Time since first exposure, increasing tobacco exposure and reported dyspnea were independently associated with the presence of ILA.

Conclusions: In this population with relatively low asbestos exposure, LDCT-detected ILA that fits criteria for asbestosis is common, but physiological decline is not. This mild chronic stable phenotype of asbestos-associated ILA contrasts with the traditionally accepted views that asbestosis requires high exposures.

© 2021 Wiley Periodicals LLC.
Malignant mesothelioma: Ongoing controversies about its etiology in females. X. Baur, A.L. Frank, C.L. Soskolne, et al. 2021;64(7):543-550. PubMed · Publisher

Abstract

Malignant mesothelioma (MM) is one of the most aggressive cancers with the poorest of outcomes. There is no doubt that mesothelioma in males is related to asbestos exposure, but some authors suggest that most of the cases diagnosed in females are "idiopathic." In our assessment of the science, the "low risk" of mesothelioma in females is because of the nonsystematic recording of exposure histories among females. Indeed, asbestos exposure is mentioned in only some of the studies that include females. We estimate the risk of MM among females to be close to that in males. The absence of detailed exposure histories should be rectified in future studies involving women. As a matter of social justice, the ongoing failure to recognize asbestos as the cause of a majority of cases of MM in females does them, and their kin, a profound disservice.

© 2021 Wiley Periodicals LLC.
Smoking, occupational exposures, and idiopathic pulmonary fibrosis among Swedish construction workers. M. Andersson, P.D. Blanc, K. Torén, et al. 2021;64(4):251-257. PubMed · Publisher

Abstract

Background: Cigarette smoking and occupational exposures each have been reported to increase the risk of idiopathic pulmonary fibrosis (IPF), a disease previously considered of unknown origin. We investigated the risk of IPF mortality associated with combined smoking and occupational exposures.

Methods: A registry study of Swedish construction workers (N = 389,132), linked baseline smoking and occupational data with registry data on cause of death and hospital care diagnoses. Occupation was classified by the likelihood of exposure to vapors, gases, dusts, or fumes using a job-exposure matrix. Those likely exposed to asbestos or silica were excluded from the analysis. Age-adjusted relative risks [RRs] were calculated using Poisson regression. Follow-up observation began at age 40 and ended at age 89.

Results: Heavy smokers at baseline who were exposed to inorganic dusts during their working life had an increased risk of IPF mortality (RR 1.70; 95% confidence interval [CI] 1.11-2.60), while there was no statistically increased risk in the other exposure groups. There were dose-response relationships between smoking at baseline and IPF mortality among both unexposed and dust exposed workers, with similar risk for dust exposed and unexposed, except among baseline heavy smokers, where workers exposed to inorganic dust manifested the highest risk (RR 4.22; 95% CI 2.69-6.60). Excluding workers with chronic obstructive pulmonary disease or emphysema did not affect the results substantively.

Conclusion: A clear dose-response relationship was seen between smoking at baseline and IPF, supporting a causal relationship. Occupational exposure to inorganic dusts, excluding silica and asbestos, was associated with increased risk of IPF in baseline heavy current smokers.

© 2021 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals LLC.
A clinical evaluation and tissue fiber burden analysis of a lifetime resident of Libby, Montana with adenocarcinoma of the lung. R.F. Dodson, B. Black, L.W. Poye, et al. 2020;63(5):456-462. Case report PubMed · Publisher

Abstract

Introduction: Vermiculite mining operations near Libby, Montana were active from the 1920s to 1990. Rail facilities for shipment of the mined material as well as some vermiculite processing activities were ongoing within the community of Libby. A fibrous component within the mined material has been associated with asbestos-related diseases in vermiculite miners and in the local citizens of the community.

Clinical History/Methods: We present a clinical case history and tissue fiber burden analysis of an individual with a multifocal adenocarcinoma of the lung who was a lifelong resident of Libby and whose history of exposure was as a member of the general population there.

Results/Discussion: To our knowledge this is the first time tissue from a member of the general population of Libby, Montana has been evaluated and shown to contain an appreciable presence of "Libby amphibole" fibers.

© 2020 Wiley Periodicals, Inc.
An overview of existing mesothelioma registries worldwide, and the need for a US Registry. M. van Gerwen, N. Alpert, R. Flores, et al. 2020;63(2):115-120. Review PubMed · Publisher

Abstract

The association between asbestos exposure, mainly in occupational settings, and malignant mesothelioma has been well established; this has prompted several countries to establish mesothelioma epidemiologic surveillance programs often at the request of national agencies. This review compares currently existing mesothelioma registries worldwide to develop a concept model for a US real-time case capture mesothelioma registry. Five countries were identified with a mesothelioma specific registry, including Italy, France, UK, Australia, and South Korea. All, except the UK, used interviews to collect exposure data. Linkage with the national death index was available or was in future plans for all registries. The registries have limited information on treatment, quality of life, and other patient-centered outcomes such as symptoms and pain management. To thoroughly collect exposure data, "real-time" enrollment is preferable; to maximize the capture of mesothelioma cases, optimal coverage, and a simplified consent process are needed.

© 2019 Wiley Periodicals, Inc.
Authors' response to "malignant mesothelioma following exposure to cosmetic talc: Association, not causation". T.S. Emory, J.C. Maddox, R.L. Kradin. 2020;63(7):651-652. Letter · Comment PubMed · Publisher
Cancer and noncancer mortality among aluminum smelting workers in Badin, North Carolina. E.S. McClure, P. Vasudevan, N. DeBono, et al. 2020;63(9):755-765. PubMed · Publisher · Free full text

Abstract

Background: Badin, North Carolina, hosted an aluminum smelting plant from 1917 to 2007. The Concerned Citizens of West Badin reported suspected excess cancer mortality among former employees. This study aimed to investigate these concerns.

Methods: The study cohort was enumerated from United Steel Workers' records of workers employed from 1980 to 2007. Cause-specific mortality rates in the cohort were compared with North Carolina population mortality rates using standardized mortality ratios (SMRs), standardized by age, sex, race, and calendar period. We estimated cause-specific adjusted standardized mortality ratios (aSMRs) using negative controls to mitigate healthy worker survivor bias (HWSB). Standardized rate ratios (SRRs) were calculated to compare mortality rates between workers ever employed vs never employed in the pot room.

Results: All-cause mortality among Badin workers was lower than in the general population (SMR: 0.81, 95% confidence interval [CI]: 0.71-0.92). After adjusting for HWSB, excesses for all cancers (aSMR: 1.55, 95% CI: 1.10-2.21), bladder cancer (3.47, 95% CI: 1.25-9.62), mesothelioma (17.33, 95% CI: 5.40-55.59), and respiratory cancer (1.24, 95% CI: 0.77-1.99) were observed. Black males worked the highest proportion of their employed years in the pot room. Potroom workers experienced higher respiratory cancer (SRR: 2.99, 95% CI: 1.23-7.26), bladder cancer (SRR: 1.58, 95% CI: 0.15-15.28), and mesothelioma (SRR: 3.36, 95% CI: 0.21-53.78) mortality rates than never workers in the pot room.

Conclusions: This study responds to concerns of a group of former aluminum workers. The results, while imprecise, suggest excess respiratory and bladder cancers among pot room workers in a contemporary cohort of union employees at a US smelter.

© 2020 Wiley Periodicals LLC.
Ferrante et al respond. D. Ferrante, D. Mirabelli, S. Silvestri, et al. 2020;63(9):836-837. Letter · Comment PubMed · Publisher
Malignant asbestos-related disease in a population exposed to asbestos. R. Orriols, J. Tarrés, C. Albertí-Casas, et al. 2020;63(9):796-802. PubMed · Publisher

Abstract

Objectives: The first asbestos fiber cement plant in Spain operated in Cerdanyola, in the Barcelona metropolitan area, between 1907 and 1997. We describe clinical and epidemiological characteristics of patients diagnosed with the malignant asbestos-related disease (ARD) in the area of the plant between 2007 and 2016.

Methods: A prospective, descriptive study was undertaken in the 12 municipalities of the county of Barcelona most proximate to the plant. We describe malignant ARD cases by time of diagnosis, source of exposure, periods of exposure and latency, and distribution by sex. Cumulative incidence and age-standardized incidence rates (ASIR) are calculated.

Results: Of 477 patients diagnosed with ARD between 2007 and 2016, 128 (26%) presented with asbestos-associated malignancy. Pleural mesothelioma was noted in 105 patients (82.0%) with a linear trend Z-score of -0.2 (NS) in men and 2.7 (P < .01) in women. The highest ASIRs for malignant ARD (6.1/100 000 residents/year; 95% confidence interval [CI], 2.2-13.3) and pleural mesothelioma (4.8/100 000 residents/year; 95% CI, 1.5-11.6) occurred in municipalities closest to the focal point of contamination. The origin of malignant ARD was nonoccupational in 32.2% of men and 81.6% of women (P < .001).

Conclusions: More than 20 years after the closure of the fiber cement plant, the grave consequences of exposure to asbestos remain. The detection of cases of pleural mesothelioma in men seems to have plateaued whereas in women an ascending trend continues, which principally has its origin in nonoccupational exposures.

© 2020 Wiley Periodicals LLC.
Malignant mesothelioma following exposure to cosmetic talc: Association, not causation. S.J. Geyer. 2020;63(7):649-650. Letter · Comment PubMed · Publisher
Malignant mesothelioma following repeated exposures to cosmetic talc: A case series of 75 patients. T.S. Emory, J.C. Maddox, R.L. Kradin. 2020;63(6):484-489. PubMed · Publisher · Free full text

Abstract

Background: Asbestos is the primary known cause of malignant mesothelioma. Some cosmetic talc products have been shown to contain asbestos. Recently, repeated exposures to cosmetic talc have been implicated as a cause of mesothelioma.

Methods: Seventy-five individuals (64 females; 11 males) with malignant mesothelioma, whose only known exposure to asbestos was repeated exposures to cosmetic talcum powders, were reviewed in medical-legal consultation. Out of the 75 cases, 11 were examined for asbestiform fibers.

Results: All subjects had pathologically confirmed malignant mesothelioma. The mean age at diagnosis was 61 ± 17 years. The mean latency from exposure to diagnosis was 50 ± 13 years. The mean exposure duration was 33 ± 16 years. Four mesotheliomas (5%) occurred in individuals working as barbers/cosmetologists, or in a family member who swept the barber shop. Twelve (16%) occurred in individuals less than 45 years old (10 females; 2 males). Forty-eight mesotheliomas were pleural (40 females; 8 males), 23 were peritoneal (21 females; 2 males). Two presented with concomitant pleural and peritoneal disease. There was one pericardial, and one testicular mesothelioma. The majority (51) were of the epithelioid histological subtype, followed by 13 biphasic, 8 sarcomatoid, 2 lymphohistiocytoid, and 1 poorly differentiated. Of the 11 individuals whose nontumorous tissues were analyzed for the presence of asbestiform fibers, all showed the presence of anthophyllite and/or tremolite asbestos.

Conclusions: Mesotheliomas can develop following exposures to cosmetic talcum powders. These appear to be attributable to the presence of anthophyllite and tremolite contaminants in cosmetic talcum powder.

© 2020 The Authors. American Journal of Industrial Medicine published by Wiley Periodicals, Inc.
Mortality and mesothelioma incidence among chrysotile asbestos miners in Balangero, Italy: A cohort study. D. Ferrante, D. Mirabelli, S. Silvestri, et al. 2020;63(2):135-145. PubMed · Publisher

Abstract

Background: We studied cancer mortality and mesothelioma incidence in 974 male workers employed at least 6 months at the Balangero mine (Italy), the largest chrysotile mine in Western Europe, active from 1917 to 1985.

Methods: Vital status as of 31 May 2013, causes of deaths and mesothelioma incidence from 1990 were ascertained. Past exposure to asbestos by working area and calendar period was estimated, based on historical data of fibers concentrations. Individual cumulative exposure was assessed by applying estimates to the job history of cohort members. Standardized mortality ratios (SMRs) for selected causes and standardized incidence ratios for malignant mesothelioma (MM) were calculated based on regional reference rates. Poisson regression analysis was used to study MM and lung cancer risk by latency, duration, and cumulative exposure.

Results: Mortality was increased for all causes (SMR = 1.28; 95% confidence interval [CI] = 1.17-1.40), pleural cancer (SMR = 4.30; 95% CI = 1.58-9.37), asbestosis (SMR = 375.06; 95% CI = 262.68-519.23). An increase was also found for lung cancer (SMR = 1.14; 95% CI = 0.81-1.55) and peritoneal cancer (SMR = 3.25; 95% CI = 0.39-11.75). The risk of both pleural and peritoneal cancer mortality and of mesothelioma incidence increased with increasing cumulative exposure, duration, and latency. Poisson regression analyses showed an increase in mesothelioma risk with cumulative asbestos exposure and suggest a similar trend for lung cancer. Asbestosis mortality also increased with cumulative exposure.

Conclusions: Among Balangero chrysotile miners and millers, the occurrence of malignant and nonmalignant asbestos-related diseases was increased by exposure, with dose-response relation. The study confirms the carcinogenicity of chrysotile asbestos, in particular for pleural mesothelioma.

© 2019 Wiley Periodicals, Inc.
Re Ferrante et al (2020). Mortality and mesothelioma incidence among chrysotile asbestos miners in Balangero, Italy: A cohort study. J. Schüz, H. Kromhout. 2020;63(9):834-835. Letter · Comment PubMed · Publisher
Workshop summary: Potential usefulness and feasibility of a US National Mesothelioma Registry. K.J. Cummings, M.J. Becich, D.J. Blackley, et al. 2020;63(2):105-114. PubMed · Publisher · Free full text

Abstract

The burden and prognosis of malignant mesothelioma in the United States have remained largely unchanged for decades, with approximately 3200 new cases and 2400 deaths reported annually. To address care and research gaps contributing to poor outcomes, in March of 2019 the Mesothelioma Applied Research Foundation convened a workshop on the potential usefulness and feasibility of a national mesothelioma registry. The workshop included formal presentations by subject matter experts and a moderated group discussion. Workshop participants identified top priorities for a registry to be (a) connecting patients with high-quality care and clinical trials soon after diagnosis, and (b) making useful data and biospecimens available to researchers in a timely manner. Existing databases that capture mesothelioma cases are limited by factors such as delays in reporting, deidentification, and lack of exposure information critical to understanding as yet unrecognized causes of disease. National disease registries for amyotrophic lateral sclerosis (ALS) in the United States and for mesothelioma in other countries, provide examples of how a registry could be structured to meet the needs of patients and the scientific community. Small-scale pilot initiatives should be undertaken to validate methods for rapid case identification, develop procedures to facilitate patient access to guidelines-based standard care and investigational therapies, and explore approaches to data sharing with researchers. Ultimately, federal coordination and funding will be critical to the success of a National Mesothelioma Registry in improving mesothelioma outcomes and preventing future cases of this devastating disease.

© 2019 Wiley Periodicals, Inc.

2010s

Asbestos in commercial indian talc. S. Fitzgerald, E. Harty, T.K. Joshi, et al. 2019;62(5):385-392. PubMed · Publisher · Free full text

Abstract

Background: Easily available commercial Indian talc products widely used in Southeast Asia were examined for the presence of asbestos. Asbestos in talc products carry all risks of asbestos-related disease.

Methods: Using polarizing light microscopy, transmission electron microscopy (TEM), electron diffraction, and X-ray analysis, multiple over-the-counter Indian talc products were examined for the presence of asbestos.

Results: Results In an initial group of five Indian talc products, one was found to contain tremolite asbestos. The second group of eight products was tested and six of eight contained tremolite asbestos as well. No other regulated amphibole was found.

Conclusion: Large quantities of body talc products containing asbestos are used throughout Southeast Asia and are likely to pose a public health risk for asbestos-related diseases, especially for the cancers related to asbestos exposure. The country of origin in which the talc examined was sourced for production is unknown to the authors, and further investigation to measure associated public health risk is needed.

© 2019 The Authors American Journal of Industrial Medicine Published by Wiley Periodicals, Inc.

In plain English

This brief report was a laboratory analysis of cosmetic talcum powders sold in India and marketed as "beat the heat" products. In February 2015, five over-the-counter products were bought in India. After one tested positive, eight more were bought online from an Indian retailer: four from the maker of the positive product and four from another brand. Samples were examined with light microscopy and transmission electron microscopy. In the first set, tremolite asbestos was found in one of five products ("ID Talc"), and repeat testing confirmed it. In the second set, the results section and table identify tremolite asbestos in five of eight products, although the article's abstract says six of eight. Amounts in those five ranged from 4.55 million to 59.9 million tremolite asbestos structures per gram of powder. No other regulated amphibole was found. Fibrous talc was seen in all samples but was not counted. The authors concluded that asbestos exposure in India and possibly elsewhere is possible through non-occupational routes. They noted the study did not examine health outcomes and that the source of the talc was unknown.

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.
Change in prevalence of asbestos-related disease among sheet metal workers 1986 to 2016. G.H. West, R.K. Sokas, L.S. Welch. 2019;62(7):609-615. PubMed · Publisher

Abstract

Background: A medical screening program began in 1986 for sheet metal workers exposed to asbestos, primarily while working alongside insulators applying spray-on asbestos materials, a practice banned in 1973. Exposure continues during maintenance, renovation, and repair.

Methods: Radiographic abnormalities among 26 397 sheet metal workers examined from 1986 to 2016 were analyzed by year of entry into the trade. Logistic regression was used to examine risk factors for parenchymal and pleural abnormalities among the overall study population and among the subcohort who entered the trade after 1973.

Results: Prevalence of parenchymal disease was 17.4% for those starting work before 1950 compared with 0.8% for those starting work after 1973 (adjusted prevalence odds ratio [pOR] = 26.65, 95% confidence interval [CI] = 18.46-38.46). For each calendar year after 1973, entering the trade 1 year later was associated with an estimated 12.7% decreased odds of acquiring asbestos-related disease (adjusted pOR = 0.873, 95% CI = 0.832-0.916).

Conclusion: Sheet metal workers who began work after the US implemented environmental and occupational regulations develop asbestos-related disease at much reduced rates, consistent with regulatory projections made for nonmalignant asbestos-related disease by the Occupational Safety and Health Administration at the time. Cancer remains a concern among this cohort, and lung cancer screening recommendations should consider year of entry into the trade. This study highlights the importance of regulatory intervention and of continued surveillance.

© 2019 Wiley Periodicals, Inc.
Employment characteristics and cause-specific mortality at automotive electronics manufacturing plants in Huntsville, Alabama. N. DeBono, D. Richardson, A. Keil, et al. 2019;62(4):296-308. PubMed · Publisher

Abstract

Background: This study was carried out in response to worker concerns over their exposure to lead solder and chlorinated solvents at automotive electronics manufacturing plants in Huntsville, Alabama.

Methods: A study of 4396 United Autoworkers members ever-employed at the plants between 1972 and 1993 was conducted with mortality follow-up through 2016. Poisson regression was used to estimate mortality rate ratios (RR) according to employment characteristics, including calendar period of employment.

Results: Pre-1977 hires exhibited elevated adjusted rates of all-cause (RR, 1.29; 95% confidence interval [CI], 1.09-1.52), cardiovascular (RR, 1.38; 95% CI, 1.03-1.86), and digestive system (RR, 2.31; 95% CI, 1.04-5.10) disease mortality relative to the most recent hire group (1984-1993). Never- versus ever-employment in a skilled trade job was associated with elevated adjusted rates of all-cause, all-cancer, and cardiovascular disease mortality. Nervous system disorder mortality was greatest among 1977-1983 hires.

Conclusions: Elevated mortality among pre-1977 hires is consistent with worker concerns over greater exposure to hazards at the original plant building.

© 2019 Wiley Periodicals, Inc.
High frequency and severity of pleural changes in former workers exposed to anthophyllite associated with other contaminating amphibole asbestos in Brazil. R.F. Macedo, E.M.F.P. Cerqueira, E. Algranti, et al. 2019;62(6):503-510. PubMed · Publisher

Abstract

Objective: To evaluate the frequency and severity of pleuropulmonary alterations in anthophyllite-exposed former workers in Itapira, São Paulo, Brazil. The amphibole anthophyllite, a magnesium-iron silicate, had its mining, marketing, and use forbidden in Brazil in 1995.

Methods: Former workers were followed from 1999 to 2011. All completed chest X-ray interpreted using the International Labour Office (ILO) classification. High-resolution computed tomography was used at the final evaluation. Spirometry assessed forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV1/FVC throughout the follow-up period. Samples from the mined ore were analyzed by X-ray diffraction (XRD) and scanning electron microscopy coupled to energy dispersive spectroscopy (SEM-EDS).

Results: XRD and SEM-EDS confirmed the presence in ore of anthophyllite at a concentration of 75%, in addition to tremolite and other amphiboles in lower concentrations. Twenty-eight subjects were evaluated. Median time of exposure was 3 years (minimum = 1; maximum = 18; interquartile interval = 1-4). Twenty cases of pleural abnormalities were diagnosed in 26 evaluated (77%). The average latency time was 25.6 ± 7.4 years. Two individuals (7.7%) showed progressive worsening of diffuse pleural thickening (DPT) and exhibited an annual FVC decrease of 85 mL and 150 mL, respectively.

Conclusion: This small sample showed a very high index of nonmalignant pleural abnormalities in anthophyllite-exposed workers compared with workers exposed to other kinds of fibers. Rapidly progressive DPT, defined by the severity of pleural compromise, was possibly secondary to the presence of other amphibole types in the inhaled dust. No significant loss of FVC was found in the studied group as a whole. No cases of asbestosis, lung carcinoma, and mesothelioma were diagnosed in this cohort.

© 2019 Wiley Periodicals, Inc.
Lung cancer screening in patients with Libby amphibole disease: High yield despite predominantly environmental and household exposure. G. Loewen, B. Black, T. McNew, et al. 2019;62(12):1112-1116. PubMed · Publisher · Free full text

Abstract

Background: Lung cancer screening with low-dose computed tomography (CT) scanning (LDCT) is accepted as a screening tool, but its application to populations exposed to recognized occupational or environmental carcinogens is limited. We apply LDCT to a population with a predominantly nonoccupational exposure to a recognized human lung carcinogen, Libby amphibole asbestos (LA).

Methods: Patients in an asbestos disease clinic in Libby, Montana who were aged 50 to 84 years, greater than or equal to 20 pack-year history of tobacco use (irrespective of quit date), and asbestos-related pleuropulmonary disease on high-resolution CT scan were offered free annual lung cancer screening over a 39-month period.

Results: Of 2897 clinic patients, 1149 (39.7%) met eligibility criteria, and 567 (49%) were screened with 1014 low-dose CT scans. Most screened patients had principally environmental (333 or 59%) or household exposure (145 or 25%) to LA. Seventeen primary lung cancers were identified, mostly in early stages: 10 at stage 1, two at stage 2, three at stages 3 to 4, and two at limited small-cell cancers. The screening yield was 1.9 at baseline scan and 1.5% on the first annual scan.

Conclusions: Consistent with the guidelines of the National Comprehensive Cancer Network and American Association of Thoracic Surgery, LDCT for early lung cancer detection should be offered to people with significant exposure to occupational or environmental human lung carcinogens.

© 2019 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc.
Malignant mesothelioma in Lynch syndrome: A report of two cases and a review of the literature. A.R. Shih, R.L. Kradin. 2019;62(5):448-452. Case report PubMed · Publisher

Abstract

Malignant mesothelioma is a rare and aggressive cancer most typically associated with prior asbestos exposure. The nature of the relationship between asbestos exposure and hereditary familial syndromes predisposing to malignancy has not been determined. We report two Lynch syndrome patients with paraoccupational asbestos exposure who developed diffuse malignant mesothelioma of the pleura or peritoneum. Interestingly, one showed a separate focus of pleural well-differentiated papillary mesothelioma. It is likely that Lynch syndrome patients are at increased risk for the development of mesothelioma in the setting of exposure to asbestos, even at what is generally considered to be low levels. In the presence of a documented history of low-level asbestos exposure, patients with genetic predisposition disorders (including Lynch syndrome) should be considered to have an independent risk factor modifying the effects of asbestos exposure.

© 2019 Wiley Periodicals, Inc.
Mortality among autoworkers manufacturing electronics in Huntsville, Alabama. N. DeBono, K. Kelly-Reif, D. Richardson, et al. 2019;62(4):282-295. PubMed · Publisher

Abstract

Background: Workers raised concerns over suspected excesses of mortality at automotive electronics manufacturing facilities in Huntsville, Alabama.

Methods: A study of 4396 UAW members ever-employed at Huntsville facilities between 1972 and 1993 was conducted with mortality follow-up through 2016. Standardized Mortality Ratios (SMRs) were estimated using U.S. and Alabama reference rates.

Results: Relative to U.S. rates, there was a modest excess of all-cause mortality among White female workers (SMR 1.08, 95%CI: 0.99-1.18) and among all workers hired <1977 at the original plant building (SMR 1.10, 95%CI: 0.99-1.22). There was excess nervous system disorder (SMR 1.24, 95%CI: 0.91-1.65) and brain and nervous system cancer (SMR 1.31, 95%CI: 0.67-2.28) mortality. Estimates for several causes of interest were imprecise.

Conclusions: All-cause mortality estimates were greater than anticipated based on results from other UAW cohorts. The excess of nervous system disease mortality is consistent with other studies of electronics workers exposed to lead-solder and chlorinated solvents.

© 2018 Wiley Periodicals, Inc.
Mortality of older construction and craft workers employed at department of energy nuclear sites: Follow-up through 2016. K. Ringen, J. Dement, S. Hines, et al. 2019;62(9):742-754. PubMed · Publisher

Abstract

Background: To determine if construction and trades workers employed at U.S. Department of Energy (DOE) nuclear sites facilities are at significant risk for diseases associated with occupational exposures, we compared the mortality experience of participants in the Building Trades National Medical Screening Program (BTMed) to that of the US population.

Methods: The cohort includes 24,086 BTMed participants enrolled between 1998 and 2016 and 5203 deaths. Cause-specific standardized mortality ratios were calculated based on US death rates.

Results: Mortality was elevated for all causes, all cancers, cancers of the trachea, bronchus, and lung and lymphatic and hematopoietic system, mesothelioma, chronic obstructive pulmonary disease, asbestosis, transportation injuries, and other injuries, particularly those caused by accidental poisoning, suggesting a possible effect of the opioid epidemic.

Conclusions: Apart from other injuries, mortality patterns were very similar to those reported in the past in this population. Construction workers employed at DOE sites have a significantly increased risk for occupational illnesses. Risks are associated with employment during all time periods covered including possibly after 1990. The cancer risks closely match the cancers identified for DOE compensation from radiation exposures. The high risk of lung cancer supports the value of early lung cancer detection. Continued medical surveillance is important.

© 2019 Wiley Periodicals, Inc.
North-south gradient of mesothelioma and asbestos consumption-production in the United States-Progresses since the 1st asbestos partial ban in 1973. H. Sun. 2019;62(4):337-346. PubMed · Publisher

Abstract

Background: Temporal trends and broad geographical distributions of asbestos use and the incidence of malignant mesothelioma (MM) in the US still need to be studied.

Methods: Data on asbestos consumption and production between 1900 and 2015 and MM mortality and incidence rates between 1975 and 2015 in the US were examined. Spatial distributions of MM mortality and incidence rates and their association with climate zone were analyzed.

Results: Decline of MM incidence and mortality rates in the US occurred about 20 years after the peak of asbestos consumption-production in 1973. There are apparent north-south (N-S) gradients in MM mortality and incidence rates in the US.

Conclusion: Recent decline of MM incidence and mortality rates in the US may be associated with reduced US asbestos consumption. N-S MM gradients between 1999 and 2015 were likely related to larger asbestos requirements in building materials in the northern states.

© 2019 Wiley Periodicals, Inc.
Quantitative relationships of exposure to chrysotile asbestos and mesothelioma mortality. D. Loomis, D.B. Richardson, L. Elliott. 2019;62(6):471-477. PubMed · Publisher · Free full text

Abstract

Background: While asbestos has long been known to cause mesothelioma, quantitative exposure-response data on the relation of mesothelioma risk and exposure to chrysotile asbestos are sparse.

Methods: Quantitative relationships of mortality from mesothelioma and pleural cancer were investigated in an established cohort of 5397 asbestos textile manufacturing workers in North Carolina, USA. Eligible workers were those employed between 1950 and 1973 with mortality follow-up through 2003. Individual exposure to chrysotile fibres was estimated on the basis of 3420 air samples covering the entire study period linked to work history records. Exposure coefficients adjusted for age, race, and time-related covariates were estimated by Poisson regression.

Results: Positive, statistically significant associations were observed between mortality from all pleural cancer (including mesothelioma) and time since first exposure (TSFE) to asbestos (rate ratio [RR], 1.19; 95% confidence interval [CI], 1.06-1.34 per year), duration of exposure, and cumulative asbestos fibre exposure (RR, 1.15; 95% CI, 1.04-1.28 per 100 f-years/mL; 10-year lag). Analyses of the shape of exposure-response functions suggested a linear relationship with TSFE and a less-than-linear relationship with cumulative exposure. Restricting the analysis to years when mesothelioma was coded as a unique cause of death yielded stronger but less precise associations.

Conclusions: These observations support with quantitative data the conclusion that chrysotile causes mesothelioma and encourage exposure-response analyses of mesothelioma in other cohorts exposed to chrysotile.

© 2019 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc.
Re: Comments on Egilman's response to Hessel regarding the health hazards of brake dust and his reflections on corporate behavior. D. Paustenbach. 2019;62(7):616-624. Letter · Comment PubMed · Publisher
Variations in exposure to carcinogens among shift workers and non-shift workers. S. El-Zaemey, R.N. Carey. 2019;62(4):352-356. PubMed · Publisher

Abstract

Background: There is limited information on whether the prevalence of exposure to workplace carcinogens varies among shift workers and non-shift workers.

Methods: This analysis used data from the Australian Work Exposures Study-Cancer, a telephone survey which examined exposure to carcinogens in the workplace. Workers were classified as shift workers if they indicated that their usual roster ever included work between the hours of midnight and 5 am. Modified Poisson regression was used to estimate the adjusted prevalence ratios (aPRs) and 95% confidence internals (CIs).

Results: Among the 5425 workers, 6.88% reported being exposed to shift work. Overall, shift workers were more likely to be exposed to any carcinogen (aPR = 1.16; 95% 1.06-1.26) and to specific carcinogens such as asbestos (aPR = 1.93; 95% 1.33-2.83) than non-shift workers.

Conclusions: Our study shows that there are differences in exposure to carcinogenic agents among shift and non-shift workers, and so there is a need for prevention programs in order to reduce these discrepancies.

© 2019 Wiley Periodicals, Inc.
Asbestos standards: Impact of currently uncounted chrysotile asbestos fibers on lifetime lung cancer risk. D.B. Richardson, A.P. Keil, S.R. Cole, et al. 2018;61(5):383-390. PubMed · Publisher · Free full text

Abstract

Background: Current regulations require that asbestos fibers are collected and examined using a light microscope. This method fails to enumerate fibers that are too short or thin to reliably count using a light microscope under normal conditions.

Methods: A cohort of 3054 workers employed at an asbestos textile plant was followed to ascertain causes of death. Exposure was almost entirely chrysotile. Fiber counts were quantified using light microscopy and electron microscopy. The g-formula was used to estimate impacts on lung cancer of policies defined in terms of fiber counts quantified using light and electron microscopy.

Results: Given exposure at the current standard, the estimated lung cancer risk was 7.33%, comparable to the risk expected under a standard of 1 fiber/mL counted using electron microscopy (7.30%). The lifetime risk of lung cancer under a standard of 0.1 fiber/mL counted by electron microscopy was estimated to be 7.10%.

Conclusions: We identify policies defined in terms of electron microscopy-based asbestos exposure metrics that yield comparable, or lower, lung cancer mortality than that expected under the current standard.

© 2018 Wiley Periodicals, Inc.
Autoimmune antibodies and asbestos exposure: Evidence from Wittenoom, Western Australia. A. Reid, P. Franklin, N. de Klerk, et al. 2018;61(7):615-620. PubMed · Publisher

Abstract

Background: Studies comparing different forms of asbestos are rare, and limited by the failure to compare results with unexposed populations. We compare autoimmune responses among former workers and residents of the crocidolite mining and milling town of Wittenoom, Western Australia, with an unexposed population.

Methods: ANA testing using indirect immunofluorescence was performed on randomly selected serum samples from Wittenoom workers or residents and compared with those from participants of another unexposed cohort study.

Results: ANA scores were higher in the Wittenoom participants compared with Busselton and the odds of being ANA positive was fivefold greater among Wittenoom participants than Busselton (OR 5.5, 95%CI 2.3-13.0).

Conclusions: This study is the first to report increased ANA positivity among persons exposed exclusively to crocidolite. This finding of a high frequency of positive ANA tests among crocidolite-exposed subjects may be an indicator for an increased risk of systemic autoimmune diseases and needs further scrutiny.

© 2018 Wiley Periodicals, Inc.
Commentary to the article lung function not affected by asbestos exposure in workers with normal Computed Tomography scan, by Schikowsky, Felten, et al., 2017. X. Baur, B. Terracini, F. Belpoggi, et al. 2018;61(4):351-354. Letter · Comment PubMed · Publisher
Occupational exposure to flour dust and the risk of head and neck cancer. M. Carton, G. Menvielle, D. Cyr, et al. 2018;61(10):869-873. PubMed · Publisher

Abstract

Background: To investigate the association between head and neck squamous cell cancer (HNSCC) risk and occupational exposure to flour dust in women and men, using data from ICARE, a French population-based case-control study.

Methods: The analysis included 2053 cases of HNSCC and 3507 controls. Lifelong occupational history was collected. A job-exposure matrix was used to assess exposure to flour dust. Odds-ratios (ORs) and 95% confidence intervals (CI), adjusted for smoking, alcohol drinking, and asbestos exposure, were estimated with logistic regression models.

Results: Ever exposure to flour dust was associated with elevated ORs in women (OR = 2.15, 95%CI: 1.01 4.55) and in men (OR = 1.55, 95%CI: 1.11 2.17). In women, the risk increased with the probability, the duration, and the cumulative level of exposure. No dose-response relationships were observed in men.

Conclusions: Although the results were less conclusive in men than in women, overall, these findings provide some support to the hypothesis of a role of flour dust in the occurrence of HNSCC.

© 2018 Wiley Periodicals, Inc.
Occupational exposure to textile dust and lung cancer risk: Results from the ICARE Study. S. Ben Khedher, M. Neri, F. Guida, et al. 2018;61(3):216-228. PubMed · Publisher

Abstract

Background: To investigate the association of lung cancer with occupational exposure to textile dust and specifically to cotton dust in the population-based case-control study ICARE.

Methods: Lifelong occupational history of 2926 cases and 3555 controls was collected using standardized questionnaires, with specific questions for textile dust exposure. Odds ratios (ORs) and 95% confidence intervals (CI) were estimated using unconditional logistic regression models controlling for confounding factors including smoking and asbestos exposure.

Results: An inverse association between textile dust exposure and lung cancer was found among workers exposed ≥5% of their work time (OR = 0.80, 95%CI = 0.58-1.09), more pronounced for distant exposures (40+ years; up to a 56% reduced risk, statistically significant). The OR of lung cancer was significantly decreased among workers exposed to cotton fibers (OR = 0.70, 95%CI = 0.48-0.97).

Conclusions: Our results provide some evidence of a decreased risk of lung cancer associated with exposure to textile dust, particularly cotton.

© 2017 Wiley Periodicals, Inc.
Prevalence of occupational exposure to asbestos and crystalline silica according to phenotypes of lung cancer from the CaProMat study: A case-only study. M. El Zoghbi, P. Salameh, I. Stücker, et al. 2018;61(1):85-99. PubMed · Publisher

Abstract

Background: The objective of the study was to compare the prevalence of occupational exposure to asbestos and crystalline silica according to histological types of lung cancer and age at diagnosis.

Methods: CaProMat study is a pooled case-only study conducted between 1996 and 2011. The current study consisted of 6521 lung cancer cases. Occupational exposure to asbestos and crystalline silica was assessed by two Job-Exposure Matrices. A weighted prevalence of exposure was derived and compared according to histological types and age at diagnosis.

Results: There was no difference of weighted prevalence of exposure to asbestos and crystalline silica according to histological types of lung cancer. There was a statistically significant difference of weighted prevalence of exposure to asbestos and crystalline silica according to age at diagnosis.

Conclusions: Due to the limited clinical importance of the difference, neither the histological type, nor the age at diagnosis can be used as an indicator for the occupational exposure to asbestos or crystalline silica.

© 2017 Wiley Periodicals, Inc.
Recovering missing mesothelioma deaths in death certificates using hospital records. V.S. Santana, E. Algranti, F. Campos, et al. 2018;61(7):547-555. PubMed · Publisher

Abstract

Background: In Brazil, underreporting of mesothelioma and cancer of the pleura (MCP) is suspected to be high. Records from death certificates (SIM) and hospital registers (SIH-SUS) can be combined to recover missing data but only anonymous databases are available. This study shows how common data can be used for linkage and as an assessment of accuracy.

Methods: Mesothelioma (all sites, ICD-10 codes C45.0-C45.9) and cancer of the pleura (C38.4) were retrieved from both information systems and combined using a linkage algorithm. Accuracy was examined with non-anonymous databases, limited to the state of São Paulo.

Results: We found 775 cases in death certificates and 283 in hospital registers. The linkage matched 57 cases, all accurately paired. Three cases, 0.4% in SIM and 1.3% in SIH-SUS, could not be matched because of data inconsistencies.

Conclusions: A computer linkage can recover MCP cases from hospital records not found in death certificates in Brazil.

© 2018 Wiley Periodicals, Inc.
Response to Baur et al. (2017). C. Schikowsky, M.K. Felten, C. Eisenhawer, et al. 2018;61(4):355-357. Letter · Comment PubMed · Publisher
Review on the adverse health effects of asbestiform antigorite, a non-regulated asbestiform serpentine mineral. X. Baur. 2018;61(7):625-630. Review PubMed · Publisher

Abstract

Background: Although antigorite is generally described as platy, its fibrous (asbestiform) variant is present widespread in serpentinite rocks. In addition to its primarily fibrous occurrence, asbestiform antigorite may also be formed from serpentinite with massive appearance during tunneling and mining. It is not of commercial interest, but exposure may occur in the certain environments.

Methods And Results: Detailed studies of the structural features of this antigorite type revealed characteristics closely related to those of chrysotile. Therefore, it is plausible that this serpentine mineral may present a similar health risk for exposed subjects. This is in agreement with results from clinical and animal studies, as well as in vitro experiments showing the cytotoxic, fibrogenic, and carcinogenic potential of antigorite, similar to that of chrysotile and amphibole asbestos.

Conclusions: Current evidence supports a need for an update to existing regulations to include unregulated asbestiform antigorite, similar to regulatory measures taken for asbestos.

© 2018 Wiley Periodicals, Inc.
The psychological distress and care needs of mesothelioma patients and asbestos-exposed subjects: A systematic review of published studies. M. Bonafede, M. Ghelli, M. Corfiati, et al. 2018;61(5):400-412. Systematic review PubMed · Publisher

Abstract

Background: The purpose of this study is to present the results of a systematic review of published research that focuses on psychological aspects of malignant mesothelioma patients and asbestos-exposed people.

Methods: Our research includes primary studies published between 1980 and 2016, using information from the Cochrane Library, the Psychology Behavioral Sciences Collection, PsychINFO, PubMed, PubGet, PubPsych, and Scopus, in compliance with PRISMA guidelines.

Results: We identified 12 papers that investigated the psychological distress and care needs of mesothelioma patients, and nine papers for asbestos-exposed subjects.

Conclusions: This paper highlights the paucity of studies on the psychological distress and care needs of mesothelioma patients and asbestos-exposed subjects. It confirms that malignant mesothelioma is associated with the physical, emotional, and social functioning of patients, while also suggesting that the risk of developing asbestos-related diseases among asbestos-exposed subjects is associated with high levels of psychological distress, despair, and mental health difficulties.

© 2018 Wiley Periodicals, Inc.
Asbestos, asbestosis, and cancer: The Helsinki criteria for diagnosis and attribution. Critical need for revision of the 2014 update. X. Baur, H.J. Woitowitz, L.T. Budnik, et al. 2017;60(5):411-421. Comment PubMed · Publisher

Summary

In this commentary, nine authors from Germany, the United States, Canada and Australia set out their concerns about the 2014 update of the Helsinki Criteria for the diagnosis and attribution of asbestos-related diseases and its Consensus Report, particularly the Pathology and Biomarkers section. They listed nine points of contention and discussed each with reference to published literature. They objected that the criteria limited the clinical diagnosis of asbestosis to cases with chest X-ray or tomography findings. They also objected that the criteria equated occupational history with fiber-years of exposure, which physicians generally cannot calculate. A further objection was reliance on counts of asbestos bodies and fibers in lung tissue, which they said grossly underestimate exposure to chrysotile because it is not biopersistent. They also criticised laboratory-specific reference values, criteria implying surgical lung biopsy, low-magnification scanning electron microscopy, the adoption of the 2010 CAP/PPS pathology criteria in place of the 1982 CAP/NIOSH criteria, and the omission of short fibers (<5 μm). They disputed the single figure of 25 fiber-years as the dose that doubles lung cancer risk, citing studies reporting increased risk at lower doses, including a relative risk of 1.90 at 4 fiber-years. The authors concluded that the 2014 criteria would lead to under-diagnosis, under-compensation, unnecessary biopsies and underestimation of chrysotile-induced disease. They pointed to possible bias, including conflicts of interest declared only after publication, and called for formal revision.

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Cancer of the esophagus and asbestos exposure. B. Clin, I. Thaon, M. Boulanger, et al. 2017;60(11):968-975. PubMed · Publisher

Abstract

Background: Our study aimed at analyzing incidence and mortality from esophageal cancer within a cohort of workers with previous occupational asbestos exposure (ARDCo Program).

Methods: A 10-year follow-up study was conducted in the 14 515 male subjects included in this program between October 2003 and December 2005. Follow-up began when exposure stopped. Asbestos exposure was analyzed by industrial hygienists using data from a standardized questionnaire. The Cox model was used, with age as the time axis variable adjusted for smoking, time since first exposure (TSFE) and cumulative exposure index (CEI) of exposure to asbestos.

Results: We reported a significant dose-response relationship between CEI of exposure to asbestos and esophageal cancer, in both incidence (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.00-1.58), and mortality (HR 1.40, [95%CI 1.12-1.75]).

Conclusions: This large-scale study suggests the existence of a relationship between asbestos exposure and cancer of the esophagus.

© 2017 Wiley Periodicals, Inc.
Corporate corruption of science-Another asbestos example. D. Egilman, R. Monárrez. 2017;60(2):152-162. PubMed · Publisher

Abstract

Background: Kelsh et al. [2007]: Occup Med (Lond) 57:581-589 published a paper reanalyzing one of the few data sources publicly available on mesothelioma amongst brake workers, the Australian Mesothelioma Surveillance Registry (AMSR). This reanalysis was commissioned by lawyers representing the automobile manufacturing companies and did not align with an independent analysis published by Leigh and Driscoll [2003]: Occup Environ Health 9:206-217.

Methods: We sought to reevaluate the AMSR data ourselves to understand how the company-sponsored research categorized the data.

Results: In our re-analysis of the 78 brake-related folios in the AMSR, we determined that 57 were employed brake mechanics, 35 were employed brake mechanics with no other asbestos exposure besides brake work or repair, and 41 of these cases had no other asbestos exposure besides brake work or repair. Our classifications differed significantly from Kelsh et al.

Conclusions: We discuss how Kelsh et al. methodically reduced the relevant cases by following overly stringent criteria for inclusion. Am. J. Ind. Med. 60:152-162, 2017. © 2017 Wiley Periodicals, Inc.

© 2017 Wiley Periodicals, Inc.
Diffuse peritoneal mesothelioma: A case series of 62 patients including paraoccupational exposures to chrysotile asbestos. R.L. Kradin, G. Eng, D.C. Christiani. 2017;60(11):963-967. PubMed · Publisher

Abstract

Background: Diffuse peritoneal malignant mesothelioma (DPM) is caused by exposure to asbestos. The medical literature has linked DPM primarily to high levels of asbestos exposure, in particular amosite. Controversy persists as to whether chrysotile is capable of causing DPM, especially when exposures are paraoccupational.

Methods: Sixty-two subjects (51 men, 11 women) with DPM were reviewed in medical-legal consultation with deposition and product identification evidence.

Results: All had pathologically confirmed DPM. Most were exposed to both amphibole and chrysotile, but chrysotile alone was documented in 14/62 (26%) cases. A total of 7/14 (50%) cases of the paraoccupational exposures were to chrysotile alone. Women were younger than men as were those with paraoccupational versus those with occupational exposure. The mean duration of exposure for all cases was 17.9 ± 10 years and latency from time of first exposure was 45.9 + 11.6 years.

Conclusions: DPM occurs with both occupational and paraoccupational exposures to asbestos and may be seen in paraoccupational exposures to chrysotile asbestos.

© 2017 Wiley Periodicals, Inc.
Erratum to "Lung function not affected by asbestos exposure in workers with normal Computed Tomography scan". C. Schikowsky, M.K. Felten, C. Eisenhawer, et al. 2017;60(9):839. PubMed · Publisher
Experimental asbestos studies in the UK: 1912-1950. M. Greenberg. 2017;60(11):956-962. Historical article PubMed · Publisher

Abstract

The asbestos industry originated in the UK in the 1870s. By 1898, asbestos had many applications and was reported to be one of the four leading causes of severe occupational disease. In 1912, the UK government sponsored an experimental study that reported that exposure to asbestos produced no more than a modicum of pulmonary fibrosis in guinea pigs. In the 1930s, the newly established Medical Research Council, with assistance from industry, sponsored a study of the effects of exposing animals to asbestos by injection (intratracheal and subcutaneous) and by inhalation in the factory environment. Government reports, publications, and contemporary records obtained by legal discovery have been reviewed in the context of the stage of scientific development and the history of the times. Experimenters were engaged in a learning process during the 1912-1950 period, and their reports of the effects of asbestos were inconsistent. Pathologists who studied the effects of asbestos experimentally, at whole animal, tissue and cellular levels, advanced experimental methodology and mechanistic knowledge. In the hands of public relations experts, however, research was exploited to preserve an industry and perpetuate preventable diseases, a practice that continues to this day.

© 2017 Wiley Periodicals, Inc.
Lung cancer in a patient with predominantly short tremolite fibers in his lung. N. Kohyama, M. Fujiki, T. Kishimoto, et al. 2017;60(9):831-838. Case report PubMed · Publisher

Abstract

The carcinogenicity of short tremolite fibers in human has not been cleared and has been argued hitherto. A lung cancer patient had worked at a gabbro quarry. Particles isolated from the excised lung parenchyma of the patient were measured for asbestos bodies (ABs) and asbestos fibers (AFs). The concentrations of ABs were 3964 AB/g dry lung, and AFs were 5.60 × 106 fibers/g dry lung (>5 um in length) and 22.5 × 106 fibers/g dry lung (>1 um in length). AFs were mostly tremolite fibers and under 7 um in length (mean length 4.0 um, standard deviation 2.8 um). Almost all fibers were <10 um in length and an aspect ratio (AR) of <20:1 and ≥3:1. The patient had never smoked. His wife, who had worked with him in the quarry, had died of pleural mesothelioma. This study strongly indicates that such short tremolite fibers will induce lung cancer and possibly mesothelioma in human.

© 2017 Wiley Periodicals, Inc.
Lung function not affected by asbestos exposure in workers with normal Computed Tomography scan. C. Schikowsky, M.K. Felten, C. Eisenhawer, et al. 2017;60(5):422-431. PubMed · Publisher

Abstract

Background: It has been suggested that asbestos exposure affects lung function, even in the absence of asbestos-related pulmonary interstitial or pleural changes or emphysema.

Methods: We analyzed associations between well-known asbestos-related risk factors, such as individual cumulative asbestos exposure, and key lung function parameters in formerly asbestos-exposed power industry workers (N = 207) with normal CT scans. For this, we excluded participants with emphysema, fibrosis, pleural changes, or any combination of these.

Results: The lung function parameters of FVC, FEV1, DLCO/VA, and airway resistance were significantly associated with the burden of smoking, BMI and years since end of exposure (only DLCO/VA). However, they were not affected by factors directly related to amount (eg, cumulative exposure) or duration of asbestos exposure.

Conclusions: Our results confirm the well-known correlation between lung function, smoking habits, and BMI. However, we found no significant association between lung function and asbestos exposure.

© 2017 Wiley Periodicals, Inc.
Malignant mesothelioma due to asbestos exposure in dental tape. S.B. Markowitz, J.M. Moline. 2017;60(5):437-442. Case report PubMed · Publisher

Abstract

Although most cases of malignant mesothelioma of the pleura are caused by one or more readily recognized sources of exposure to asbestos, cases of the disease with more occult exposure occur, especially since asbestos has been used in over 3,000 products. Dental lining tape contained asbestos from the 1930s until at least the 1970s and was used in the lost wax method of casting crowns, bridges, and other metal dental prosthetic devices. We report six cases of pathology-verified malignant mesothelioma, mostly among dentists, following exposure to airborne dust from asbestos dental tape, which resulted in asbestos tort litigation. According to evidence available at present, chrysotile asbestos was the type of asbestos used in dental tape in the past in the United States, and the described cases followed relatively brief and intermittent exposure to this type of asbestos. These cases underscore the need for comprehensive exposure histories to determine exposure scenarios. Am. J. Ind. Med. 60:437-442, 2017. © 2017 Wiley Periodicals, Inc.

© 2017 Wiley Periodicals, Inc.
Mortality in asbestos cement workers in Pavia, Italy: A cohort study. E. Oddone, D. Ferrante, S. Tunesi, et al. 2017;60(10):852-866. PubMed · Publisher

Abstract

Background: The aim of this study was to describe the mortality of a cohort of asbestos-cement workers in the largest plant in the most industrialized Italian region (Lombardy).

Methods: A cohort study was carried out on 1818 subjects, corresponding to 47 536.1 person-years of observation. Standardized mortality ratios (SMRs) were computed for the major causes of death.

Results: Increased SMRs were observed for pleural, peritoneal and lung cancers, and for asbestosis (SMR 26.73, 95% Confidence Interval (CI) 20.99-33.55; 9.15, 95%CI 5.00-15.34; 1.48, 95%CI 1.27-1.72; and 368.05, 95%CI 214.40-589.29, respectively). No excess in mortality for laryngeal cancer was observed (SMR 0.70, 95%CI 0.30-1.39). An increased mortality for ovarian cancer (SMR 3.64, 95%CI 0.99-9.33) was observed, although it was not statistically significant. Among men, mortality for pleural malignant mesothelioma was observed to be related to the duration of exposure, though not to latency.

Conclusions: The results of this study are generally consistent with present knowledge. Conversely, our results do not support the hypothesis that pleural malignant mesothelioma risk indefinitely increases after exposure, suggesting instead that the alternative hypothesis of a risk plateau or decrease after a time since first exposure of more than 40 years is more consistent with the observed data.

© 2017 Wiley Periodicals, Inc.
Pleural malignant mesothelioma in dental laboratory technicians: A case series. C. Mensi, F. Ciullo, G.P. Barbieri, et al. 2017;60(5):443-448. Case report PubMed · Publisher

Abstract

Asbestos was used in dentistry as a binder in periodontal dressings and as lining material for casting rings and crucible. However, until now, only one case of malignant mesothelioma with occupational exposure to asbestos in dental practice has been reported. We present 4 pleural mesotheliomas out of 5344 cases identified in Lombardy, Italy, in 2000-2014. Three men had been working as dental laboratory technicians, with asbestos exposure for 10, 34, and 4 years, and one woman had been helping her husband for 30 years in manufacturing dental prostheses. The men described the use of asbestos as a lining material for casting rings, while the woman was not able to confirm this use. We confirm the association of malignant mesothelioma with dental technician work. Dental technicians suffering from mesothelioma should be questioned about past occupational asbestos exposure.

© 2017 Wiley Periodicals, Inc.
Pulmonary abnormalities as a result of exposure to Libby amphibole during childhood and adolescence-The Pre-Adult Latency Study (PALS). J. Szeinuk, C.W. Noonan, C.I. Henschke, et al. 2017;60(1):20-34. PubMed · Publisher

Abstract

Background: The purpose of Pre-Adult Latency Study was to evaluate lung findings among adults who had been environmentally exposed to Libby Amphibole only during childhood and adolescence.

Methods: Recruitment was restricted to volunteers who attended primary and/or secondary school, lived in Libby, MT, prior to age 23 years for males and 21 years for females and subsequently left the area. Subjects completed exposure and respiratory questionnaires, underwent pulmonary function tests (PFTs), and chest CT scans. A Pleural Score was calculated for degree and extent of pleural thickening. Logistic regression and multivariate linear regression were used.

Results: Of the 219 who met inclusion criteria, 198 participated. Pleural thickening was found in 96 (48%) of 198 participants. In almost half of these, it was of the lamellar type, not generally seen in exposure to other asbestos. Environmental Libby amphibole exposure was associated with pleural thickening, and the likelihood of pleural thickening increased with the number of years lived in the area. An inverse association between Pleural Score and PFT was found, which remained significant for FVC and DLco after additional sensitivity analyses.

Conclusions: Cumulative environmental exposure was associated with risk of pleural thickening. Among this cohort, quantitative measures of pleural thickening were associated with decreased PFT. Am. J. Ind. Med. 60:20-34, 2017. © 2016 Wiley Periodicals, Inc.

© 2016 Wiley Periodicals, Inc.
Pulmonary adenocarcinoma with epidermal growth factor receptor-mutations in asbestos exposed non-smokers: A case series. R.L. Kradin, J. Iafrate, D.C. Christiani. 2017;60(3):306-309. Case report PubMed · Publisher

Abstract

Background: Cigarette smoke and asbestos are recognized causes of lung carcinoma and together promote carcinogenesis. Adenocarcinoma is currently the most common cause of lung cancer in the USA and it has been linked to both smoking and asbestos exposure. Mutations in the epidermal growth factor gene receptor (EGFR) occur predominantly in non-smokers with adenocarcinoma. Methods Mutations in the EGFR gene were investigated using next-generation sequencing.

Results: We report the presence of EGFR exon point mutations in the pulmonary adenocarcinomas of three never-smokers occupationally exposed to asbestos.

Conclusion: The role of asbestos as a possible cause of EGFR mutagenesis requires further investigation. Am. J. Ind. Med. 60:306-309, 2017. © 2017 Wiley Periodicals, Inc.

© 2017 Wiley Periodicals, Inc.
Response to Hessel. D. Egilman. 2017;60(10):915-920. Letter PubMed · Publisher

Summary

In this letter, the author replied to Dr. Patrick Hessel's defence of Kelsh et al. (2007), a reanalysis of Australian mesothelioma registry data on vehicle mechanics, and to Hessel's question, "Where is the corruption?" The author argued that Kelsh et al.'s failure to report that defence lawyers commissioned the research to assist in asbestos brake litigation, combined with results-driven methods, constituted corruption. He drew on litigation documents: an Exponent, Inc. 2002 work plan titled "Support Tasks for Asbestos Litigation," invoices, deposition testimony, and a 2010 letter from Dr. Dennis Paustenbach to Ford. From these he described how lawyers for automobile companies hired Exponent in 2000 to generate publications. He said Exponent agreed to provide defence experts before doing any research, and that the lawyers could have blocked unfavourable results. He stated that the disclosures in Hessel et al., Goodman et al. and Kelsh et al. did not report this litigation context. He also criticised the Goodman et al. (2004) and Garabrant et al. (2016) meta-analyses, arguing that studies based on job titles misclassified brake exposure. He noted that the all-tier meta-relative risk of 0.67 (95% CI 0.53-0.84) implied an implausible protective effect, and that upper confidence limits were consistent with increased risk. He cited industrial hygiene measurements and a 1973 industry address acknowledging high exposures from brake work. He concluded that consulting companies had been established to manufacture doubt.

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Risk factors for malignant mesothelioma in people with no known exposure to asbestos. B. Musk, L. Gordon, H. Alfonso, et al. 2017;60(5):432-436. PubMed · Publisher

Abstract

Objectives: Malignant mesothelioma (MM) is a rare and generally fatal cancer, usually caused by asbestos, although about 5-10% of cases report no asbestos exposure. This study aimed to identify sources whereby people in Western Australia (WA) may be unknowingly exposed to asbestos or to other exposures which may cause MM.

Methods: Cases with no known asbestos exposure were selected from the WA Mesothelioma Register (WAMR). Matched controls were selected from hospital patients admitted for conditions unrelated to asbestos. Occupational histories were coded by an industrial hygienist. Data were analyzed using conditional logistic regression.

Results: Thirty-eight MM participants and 134 controls were recruited. Risk of MM was increased (OR = 3.1, 95%CI 1.0-9.6) after no known, but likely, exposure to asbestos at work.

Conclusions: Because of its extensive use, few people in WA have never been exposed to asbestos. Unrecognized exposure may cause most MM cases initially regarded as "no exposure." Am. J. Ind. Med. 60:432-436, 2017. © 2017 Wiley Periodicals, Inc.

© 2017 Wiley Periodicals, Inc.
Where is the "Corruption?". P.A. Hessel. 2017;60(10):911-912. Comment PubMed · Publisher

Summary

This letter to the editor responded to an article by Egilman and Monárrez that called a study by Kelsh et al. an example of "corporate corruption of science." Egilman and Monárrez had re-evaluated 78 data sheets from the Australian Mesothelioma Registry that Leigh and Driscoll (2003) had classified as vehicle mechanics, 59 of them as having no other asbestos exposures. Kelsh et al. had classified at most 18 of the 59 as professional vehicle mechanics with no other known exposure. Egilman and Monárrez classified 35 as "motor/brake mechanics" with no other exposure. The author argued that the difference in approach could explain all or most of the differing results. He noted that Egilman and Monárrez had included aircraft and railway brake mechanics and had classified questionable data sheets as brake-only exposure. He argued that biasing data collection toward a positive association was unscientific, and that funding does not imply manipulation. He described two industry-funded studies he took part in. One, using National Cancer Institute data, found no increased mesothelioma risk among brake workers. The other was a meta-analysis that found a summary risk estimate below 1.0, though not significantly. He reported that, of 22 epidemiologic studies of mesothelioma and vehicle repair, 16 found relative risks below 1.0, two found non-significant risks above 1.0, one found a significantly elevated risk, and three gave no estimate. He stated that only one of these studies was industry-funded. He disclosed consulting for, and receiving research funding from, companies whose automotive products contained asbestos.

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A review of mortality associated with elongate mineral particle (EMP) exposure in occupational epidemiology studies of gold, talc, and taconite mining. J.H. Mandel, B.H. Alexander, G. Ramachandran. 2016;59(12):1047-1060. Review PubMed · Publisher

Abstract

Background: Mining of gold, taconite, and talc may involve exposure to elongate mineral particles (EMP). The involved EMPs are typically non-asbestiform, include dimensions that regulatory definitions exclude, and have been less studied.

Methods: A review of the literature was undertaken for this exposure and occupational epidemiological studies that occur in gold, talc, and taconite mining.

Results: Quantitative EMP exposure information in these industries is incomplete. However, there are consistent findings of pneumoconiosis in each of these types of mining. A recent case-control study suggests a possible association between this exposure and mesothelioma. Lung cancer is inconsistently reported in these industries and is an unlikely outcome of non-asbestiform EMP exposure. There is evidence of cardiovascular mortality excess across all of these types of mining.

Conclusions: Non-malignant respiratory disease and cardiovascular mortality have been consistently increased in these industries. Further investigation, including additional insights for the role of non-asbestiform EMP, is warranted. Am. J. Ind. Med. 59:1047-1060, 2016. © 2016 Wiley Periodicals, Inc.

© 2016 Wiley Periodicals, Inc.
Collegium Ramazzini: Comments on the 2014 Helsinki consensus report on asbestos. X. Baur, A.L. Frank, L.T. Budnik, et al. 2016;59(7):591-4. PubMed · Publisher
Comments on the causation of malignant mesothelioma: Rebutting the false concept that recent exposures to asbestos do not contribute to causation of mesothelioma. B. Terracini, D. Mirabelli, X. Baur, et al. 2016;59(6):506-7. PubMed · Publisher

Summary

In this commentary on behalf of the Collegium Ramazzini, an international scientific society of 180 physicians and scientists from 35 countries, the authors addressed a claim used in Italian civil and criminal mesothelioma trials. The Italian asbestos industry and its expert witnesses had argued that, in cases of prolonged exposure, only the earliest periods of asbestos exposure contribute to mesothelioma, and later exposures have no causal role. The authors described the consequences in court. Only firms that employed workers in the early years, often since liquidated, were held liable. Managers in charge during later years of exposure were acquitted. They described a "hard" version of the thesis, a small trigger dose acting in susceptible individuals, presented in a 2005 paper by Chiappino. They also described a "soft" version in a 2012 review by La Vecchia and Boffetta, which they called biased and highly selective. They cited a 2011 systematic review by a working group of the Second Italian Consensus Conference on Pleural Mesothelioma, which concluded that incidence is proportional to cumulative exposure, without setting a time limit after which further exposure adds no risk. They also cited a 2015 review finding that both intensity and duration of exposure determine risk. The Collegium concluded that all exposures, early and late, contribute to risk. It rejected the contrary claim as false and scientifically unfounded, and warned that its acceptance could lead to unjust denial of compensation and hinder prevention.

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Erratum to "reduced lung function in smokers in a lung cancer screening cohort with asbestos exposure and pleural plaques". S. Lopatin, J.C. Tsay, D. Addrizzo-Harris, et al. 2016;59(5):424. PubMed · Publisher
Exposure-response estimate for lung cancer and asbestosis in a predominantly chrysotile-exposed Chinese factory cohort. M.N. Courtice, X. Wang, S. Lin, et al. 2016;59(5):369-78. PubMed · Publisher

Abstract

Background: Cumulative fiber exposures, predominantly chrysotile, were estimated in a Chinese asbestos worker cohort and exposure-response relationships with lung cancer mortality and cumulative incidence of asbestosis were determined.

Methods: Individual time-dependent cumulative exposures were estimated for 577 asbestos workers, followed prospectively for 37 years. Occupational history and smoking data were obtained from company records and personal interviews; vital status and causes of death were ascertained from death registries and hospital records. Hazard ratios were generated for disease outcomes, with adjustments for smoking and age.

Results: Median cumulative fiber exposure for the cohort was 132.6 fiber-years/ml (IQR 89.3-548.4). Exposure-response relationships were demonstrated for both disease outcomes, with nearly sixfold and threefold increased risks seen at the highest exposure level for lung cancer deaths and asbestosis, respectively.

Conclusion: Evidence using quantitative exposure estimates was provided for increased risks of lung cancer mortality and development of asbestosis in a predominantly chrysotile-exposed cohort.

© 2016 Wiley Periodicals, Inc.
Occupational exposure to carcinogens in Australian road transport workers. S. Si, R. Carey, A. Reid, et al. 2016;59(1):31-41. PubMed · Publisher

Abstract

Background: Road transport workers (RTWs) are at high risk of exposure to several occupational carcinogens. However, there are gaps in knowledge regarding the extent and the circumstances of exposure. As a sub-study of the Australian Work Exposures Study, this study investigated the prevalence of occupational exposure in Australian RTWs.

Methods: A random sample of Australian working population was invited to a telephone interview regarding their current jobs. An automated expert-assessment procedure was applied to self-reported job-related tasks using a web-based application. 162 RTWs were included in this study.

Results: RTWs were exposed to diesel exhaust (97%), solar ultraviolet radiation (78%), environmental tobacco smoke (55%), benzene (29%), silica (15%), and asbestos (10%) at work. Besides driving on roads, vehicle maintenance-related tasks were the major source of carcinogen exposures among RTWs.

Discussion: Most RTWs are exposed to at least one carcinogen at work. We have identified tasks where the use of control measures could potentially reduce exposures.

© 2015 Wiley Periodicals, Inc.
Re: Comments on the causation of malignant mesothelioma: Rebutting the false concept that recent exposures to asbestos do not contribute to causation of mesothelioma. B. Terracini, D. Mirabelli, X. Baur, et al. 2016;59(12):1180-1182. Comment PubMed · Publisher
Re: Terracini et al. Comments on the causation of malignant mesothelioma: Rebutting the false concept that recent exposures to asbestos do not contribute to causation of mesothelioma. Am J Ind Med 2016;59:506-507. P. Boffetta. 2016;59(12):1177-1179. Comment PubMed · Publisher
Reduced lung function in smokers in a lung cancer screening cohort with asbestos exposure and pleural plaques. S. Lopatin, J.C. Tsay, D. Addrizzo-Harris, et al. 2016;59(3):178-85. PubMed · Publisher

Abstract

Background: While low dose computed tomography (LDCT) screening for lung cancer is recommended for high-risk smokers, ages 55-74 years, information about asbestos exposure may not be routinely elicited. Asbestos exposure is associated with declining respiratory function over time; however, the effect of a history of asbestos exposure in LDCT screening cohorts is limited. We report the relationship between asbestos exposure and pulmonary function in a cohort of heavy smokers with a history of occupational asbestos exposure, hypothesizing that these subjects will have additional decreased pulmonary function. We also examined relationships between spirometric measurements and the presence of isolated pleural plaques.

Methods: A cross-sectional study was performed using data from the NYU Lung Cancer Biomarker Center cohort to compare study subjects with a history asbestos exposure primarily in the period since 1970 when tighter federal standards were in place (n = 359) to those without asbestos exposure (n = 1038) with respect to pulmonary function, LDCT lung imaging findings, and clinical symptoms. We further classified individuals with asbestos exposure by length of exposure time to examine the effect of duration of exposure on pulmonary function. Lastly, for asbestos-exposed participants, we examined the association of spirometric measurements with the presence of absence of isolated pleural plaques.

Results: Individuals with asbestos exposure had decreased FVC % predicted compared to those with no asbestos exposure (76% vs. 85% predicted, P < 0.01) and FEV1 % predicted (64% vs. 67% predicted, P < 0.01). Since there was no change in FEV1 /FVC ratio, the findings are consistent with restrictive impairment. Those with ≥20 years of exposure had a lower mean FVC % predicted compared to those with less than 20 years of exposure (74% vs. 78% predicted, P = 0.017). Individuals with asbestos exposure were more likely to have pleural plaques (P < 0.001) on CT. Those with isolated pleural plaques had lower mean % predicted FEV1 (P = 0.005) and FVC (P = 0.001) compared to those without pleural plaques.

Conclusions: Occupational asbestos exposure in a cohort of heavy smokers was associated with a significant restrictive decline in pulmonary function, with longer duration of exposure associated with greater decline. The presence of isolated pleural plaques was also associated with reduced lung function.

© 2016 Wiley Periodicals, Inc.
Short fiber tremolite free chrysotile mesothelioma cohort revealed. D. Egilman, T. Bird. 2016;59(3):196-9. PubMed · Publisher

Abstract

In 1995, Dell and Teta published a cohort mortality study of asbestos molding compound workers at a Union Carbide Corporation (UCC) plastics manufacturing plant in Bound Brook, New Jersey. They reported that the factory workers were exposed to "asbestos (mostly chrysotile)," implying that the asbestos used at the Bound Brook plant occasionally contained amphiboles. However, UCC statements and testimony from recent litigation indicate that the Bound Brook plant exclusively used short fiber chrysotile asbestos. These recent documents also point to lower exposures than those reported by Dell and Teta. This chrysotile-only cohort should be included in analyses of chrysotile potency.

© 2016 Wiley Periodicals, Inc.
The comparison of high-resolution computed tomography findings in asbestosis and idiopathic pulmonary fibrosis. M. Akira, K. Morinaga. 2016;59(4):301-6. PubMed · Publisher

Abstract

Background: To determine whether the HRCT findings are useful to differentiate asbestosis from idiopathic pulmonary fibrosis (IPF).

Methods: We assessed HRCT scans from patients with asbestosis (n = 96) and IPF (n = 65). The frequencies and extent of parenchymal abnormalities and the frequencies of pleural changes were evaluated by consensus of two chest radiologists.

Results: There was a significant difference between IPF and asbestosis in pleural changes. In addition, there were significant differences between IPF and asbestosis in several parenchymal abnormalities on CT, especially in the less advanced stage of both diseases. On multivariate analysis, HRCT features that distinguished asbestosis from IPF were subpleural lines at a distance of less than 5 mm from the inner chest wall, subpleural dots and parenchymal bands.

Conclusions: There are significant differences between IPF and asbestosis in the parenchymal and pleural abnormalities on CT.

© 2016 Wiley Periodicals, Inc.
Airborne fiber size characterization in exposure estimation: Evaluation of a modified transmission electron microcopy protocol for asbestos and potential use for carbon nanotubes and nanofibers. J.M. Dement, E.D. Kuempel, R.D. Zumwalde, et al. 2015;58(5):494-508. PubMed · Publisher · Free full text

Abstract

Background: Airborne fiber size has been shown to be an important factor relative to adverse lung effects of asbestos and suggested in animal studies of carbon nanotubes and nanofibers (CNT/CNF).

Materials And Methods: The International Standards Organization (ISO) transmission electron microscopy (TEM) method for asbestos was modified to increase the statistical precision of fiber size determinations, improve efficiency, and reduce analysis costs. Comparisons of the fiber size distributions and exposure indices by laboratory and counting method were performed.

Results: No significant differences in size distributions by the ISO and modified ISO methods were observed. Small but statistically-significant inter-lab differences in the proportion of fibers in some size bins were found, but these differences had little impact on the summary exposure indices. The modified ISO method produced slightly more precise estimates of the long fiber fraction (>15 μm).

Conclusions: The modified ISO method may be useful for estimating size-specific structure exposures, including CNT/CNF, for risk assessment research.

© 2015 Wiley Periodicals, Inc.
Asbestos textile production linked to malignant peritoneal and pleural mesothelioma in women: Analysis of 28 cases in Southeast China. Z. Gao, K. Hiroshima, X. Wu, et al. 2015;58(10):1040-9. PubMed · Publisher

Abstract

Background: Chrysotile had been used in asbestos textile workshops in Southeast China but a clear relation to mesothelioma is lacking.

Methods: All patients diagnosed with mesothelioma from 2003 to 2010 at Yuyao People's Hospital were re-evaluated by multiple expert pathologists with immunohistochemistry and asbestos exposure data were collected.

Results: Of 43 patients with a mesothelioma diagnosis, 19 peritoneal and nine pleural cases were finally diagnosed as mesothelioma. All were females, and the mean age of the patients with peritoneal or pleural mesothelioma was 52.4 and 58.2 years, respectively. All these cases had a history of domestic or occupational exposure to chrysotile. Two-thirds of the patients were from two adjoining towns with multiple small asbestos textile workshops. Contamination of tremolite was estimated to be less than 0.3%.

Conclusions: This is a report of mesothelioma in women exposed to chrysotile asbestos at home and at work, with an over-representation of peritoneal mesothelioma.

© 2015 Wiley Periodicals, Inc.
Commentary on pathologic diagnosis of asbestosis and critique of the 2010 Asbestosis Committee of the College of American Pathologists (CAP) and Pulmonary Pathology Society's (PPS) update on the diagnostic criteria for pathologic asbestosis. S.P. Hammar, J.L. Abraham. 2015;58(10):1034-9. PubMed · Publisher

Abstract

We reviewed the 2010 Asbestosis Committee's update on the diagnostic criteria for pathologic asbestosis. We must respectfully disagree with many of the criteria set forth therein, especially for recognizing asbestosis at its earliest stages; with statements focusing on the number of asbestos bodies needed in order to make a pathologic diagnosis of asbestosis; and regarding the benefits and pitfalls of relying on fiber analysis for diagnostic purposes, especially where chrysotile asbestos is concerned, including the methodology used for fiber determination. This critique has become even more relevant with the 2014 Helsinki criteria publication, which adopted the 2010 CAP/PPS criteria. Based on our review of these newer criteria and our experience in this field, we find that the CAP-NIOSH 1982 criteria is still the most acceptable method for the pathologic diagnosis and grading of asbestosis, which can be described as pulmonary fibrosis caused by inhalation of asbestos fibers.

© 2015 Wiley Periodicals, Inc.
EV@LUTIL: An open access database on occupational exposures to asbestos and man-made mineral fibres. E. Orlowski, S. Audignon-Durand, M. Goldberg, et al. 2015;58(10):1059-74. PubMed · Publisher

Abstract

Objectives: The aim of Evalutil is to document occupational exposure to asbestos and man-made mineral fibers.

Methods: These databases provide grouped descriptive and metrological data from observed situations of occupational exposure, collected through the analysis of scientific articles and technical reports by industrial hygienists.

Results: Over 5,000 measurements were collected. We describe the occupations, economic activities, fiber-containing products, and operations on them that have been documented most often. Graphical measurement syntheses of these data show that the situations presented for asbestos and RCF, except mineral wools, report fiber concentrations mainly above historical occupational exposure limits.

Conclusion: Free access to these data in French and in English on the Internet (https://ssl2.isped.u-bordeaux2.fr/eva_003/) helps public health and prevention professionals to identify and characterize occupational exposures to fibers. Extended recently to nanoscale particles, Evalutil continues to contribute to the improvement of knowledge about exposure to inhaled particles and the health risks associated with them.

© 2015 Wiley Periodicals, Inc.
Incidence of malignant mesothelioma of the pleura in Québec and Canada from 1984 to 2007, and projections from 2008 to 2032. A. Krupoves, M. Camus, L. De Guire. 2015;58(5):473-82. PubMed · Publisher

Abstract

Background: Continuous increase in male incidence of malignant mesothelioma of the pleura (MMP) despite the drop of asbestos production since 1980 in Québec motivated this study aiming to assess when the rates of MMP will decline.

Methods: Age-standardized rates and trends were estimated over the 1984-2007 period by sex for Québec versus "Canada-excluding-Québec" (Can-Qc). An age-cohort regression was used to make projections for 2008-2032.

Results: Average rates of MMP in Québec men and women were significantly higher than in Can-Qc. Projected rates peak between 2003 and 2012 in all four study populations and decline thereafter.

Conclusion: The higher MMP rates and observed/projected time patterns in Québec men are consistent with past asbestos production and occupational exposures. The excess in Québec women may also be explained by domestic and, for some, by neighborhood exposures. To pursue the decrease in MMP rates beyond 2032, efforts to reduce asbestos exposure should be maintained.

© 2015 Wiley Periodicals, Inc.
Latency attention deficit: Asbestos abatement workers need us to investigate. C. Roelofs. 2015;58(12):1231-4. PubMed · Publisher

Abstract

Little is known of the impact of asbestos on the health of the workers in the United States who have removed or abated asbestos from buildings following recognition of its adverse effects on health. The United States does not have a national occupational health surveillance network to monitor asbestos-related disease and, while the United States Occupational Health and Safety Administration has a strong and detailed asbestos standard, its enforcement resources are limited. A significant proportion of asbestos abatement workers are foreign-born, and may face numerous challenges in achieving safe workplaces, including lack of union representation, economic vulnerability, and inadequate training. Public health surveillance and increased and coordinated enforcement is needed to monitor the health and exposure experiences of asbestos-exposed workers. Alarming disease trends in asbestos removal workers in Great Britain suggest that, in the United States, increased public attention will be necessary to end the epidemic of asbestos-related disease.

© 2015 Wiley Periodicals, Inc.
Mortality among sheet metal workers participating in a respiratory screening program. L. Welch, J. Dement, G. West. 2015;58(4):378-91. PubMed · Publisher

Abstract

Background: The Sheet Metal Occupational Health Institute Trust (SMOHIT) established a screening program in 1985 to examine the health hazards of the sheet metal industry in the U.S. and Canada.

Methods: 17,345 individuals with over 20 years in the trade and who participated in the program were followed for causes of death between 1986 and 2010. Both SMRs and Cox proportional hazards models investigated predictors of death due to lung cancer, mesothelioma, and chronic obstructive pulmonary disease (COPD).

Results: Significant excess mortality was seen for mesothelioma and asbestosis. Controlling for smoking, a strong trend for increasing lung cancer risk with increasing chest x-ray profusion >0/0 was observed. With an profusion score <1/0, FEV1 /FVC <80% was associated with lung cancer risk. COPD risk increased with increasing profusion score.

Conclusions: This study demonstrates asbestos-related diseases among workers with largely indirect exposures and an increased lung cancer risk with low ILO scores.

© 2015 Wiley Periodicals, Inc.
Mortality of older construction and craft workers employed at department of energy (DOE) nuclear sites: follow-up through 2011. K. Ringen, J. Dement, L. Welch, et al. 2015;58(2):152-67. PubMed · Publisher

Abstract

Background: The Building Trades National Medical Screening Program (BTMed) was established in 1996 to provide occupational medicine screening examinations for construction workers who have worked at US Department of Energy nuclear sites. Workers participating in BTMed between 1998 and 2011 were followed to determine their vital status and mortality experience through December 31, 2011.

Methods: The cohort includes 18,803 BTMed participants and 2,801 deaths. Cause-specific Standardized Mortality Ratios (SMRs) were calculated based on US death rates.

Results: Mortality was elevated for all causes, all cancers, cancers of the trachea, bronchus, and lung and lymphatic and hematopoietic system, mesothelioma, COPD, and asbestosis.

Conclusions: Construction workers employed at DOE sites have a significantly increased risk for occupational illnesses. Risks are associated with employment during all time periods covered including after 1980. The cancer risks closely match the cancers identified for DOE compensation from radiation exposures. Continued medical surveillance is important.

© 2014 Wiley Periodicals, Inc.
Peritoneal mesothelioma in Italy: Trends and geography of mortality and incidence. S. Conti, G. Minelli, V. Ascoli, et al. 2015;58(10):1050-8. PubMed · Publisher

Abstract

Introduction: Peritoneal mesothelioma, a very rare and lethal malignancy, has not been investigated as extensively as pleural mesothelioma, although the role of asbestos exposure in its occurrence is well-known. Data from Italy are relevant, as it was the largest European asbestos producer, and asbestos was widely used in many economic activities.

Methods: A population-based mortality and incidence analysis was performed in Italy. Data sources were the National Multiple-causes-of-death Database (1995-2010) and the Italian Mesothelioma Register (1993-2008).

Results: We found an increasing trend of age standardized mortality rates in men, but no clear trend in women; moreover, we showed significant risks of death in several northern regions, formerly heavy asbestos users; finally, mortality/incidence ratios similar for both genders (about 0.8) were estimated.

Conclusions: The study, based on national data, showed a higher risk of mortality from and incidence of peritoneal mesothelioma in areas with formerly heavy exposure to asbestos.

© 2015 Wiley Periodicals, Inc.
Significant relationship between the extent of pleural plaques and pulmonary asbestos body concentration in lung cancer patients with occupational asbestos exposure. T. Yusa, K. Hiroshima, F. Sakai, et al. 2015;58(4):444-55. PubMed · Publisher

Abstract

Background: The aim of this study was to elucidate whether there is a relationship between the extent of pleural plaques and pulmonary asbestos body concentration (PABC).

Methods: The subjects were 207 lung cancer patients with occupational asbestos exposure. We determined the plaque extent by findings on chest images using our own criteria. PABCs were measured in resected or autopsy lung specimens.

Results: There was a significant relationship between plaque extent and PABC. Seventy-five percent of the patients determined to have extensive plaques based on our criteria had a PABC of ≥5,000 asbestos bodies per gram of dry lung tissue, which is one of the certification criteria of lung cancer caused by asbestos for workers' compensation in Japan.

Conclusions: In lung cancer patients, the plaque extent had a significant positive relationship with the PABC. The plaque extent would be useful as a proxy for PABC for lung cancer compensation purposes.

© 2015 Wiley Periodicals, Inc.
"Not your grandfather's pleural disease": rapid progression, ventilatory impairment, and chronic pleuritic pain from Libby vermiculite/amphibole. A. Miller. 2014;57(11):1195-6. Comment PubMed · Publisher

Summary

In this commentary, the author discussed a report by Black and colleagues, published in the same journal issue, on pleural disease in people exposed to Libby vermiculite/amphibole. He summarized established knowledge of benign asbestos-related pleural disease, including acute exudative pleural effusion, plaques and diffuse pleural thickening. He also noted problems with the ILO X-ray classification, including discrepancies between X-ray and CT findings. He reviewed earlier Libby studies, including a reported latency of 8.6 years for pleural thickening, progression in 64 of 84 patients, and accelerated yearly loss of lung function in 94 of 123 patients (vital capacity 3.2%, total lung capacity 2.3%, diffusing capacity 3.3%). He described the disease shown in Black and colleagues' five illustrative cases as remarkably thin, smooth and non-dense, and often missed on X-ray and even on CT. It was unassociated with pleural effusion and more likely to be accompanied by progressive dyspnea, restrictive ventilatory impairment and difficult-to-treat pleuritic pain. He stated that the reason for this behavior was not known and noted the possible role of autoimmunity discussed by those authors. He concluded that their message was to make the medical community and government agencies aware of this devastating progressive asbestos-related disease.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Diseases attributable to asbestos exposure: years of potential life lost, United States, 1999-2010. K.M. Bang, J.M. Mazurek, J.M. Wood, et al. 2014;57(1):38-48. PubMed · Publisher · Free full text

Abstract

Background: Although asbestos use has been restricted in recent decades, asbestos-associated deaths continue to occur in the United States.

Objectives: We evaluated premature mortality and loss of potentially productive years of life attributable to asbestos-associated diseases.

Methods: Using 1999-2010 National Center for Health Statistics mortality data, we identified decedents aged ≥25 years whose death certificate listed asbestosis and malignant mesothelioma as the underlying cause of death. We computed years of potential life lost to life expectancy (YPLL) and to age 65 (YPLL65 ).

Results: During 1999-2010, a total of 427,005 YPLL and 55,184 YPLL65 were attributed to asbestosis (56,907 YPLL and 2,167 YPLL65 ), malignant mesothelioma (370,098 YPPL and 53,017 YPLL65 ). Overall and disease-specific asbestos-attributable total YPLL and YPLL65 and median YPLL and YPLL65 per decedent did not change significantly from 1999 to 2010.

Conclusions: The continuing occurrence of asbestos-associated diseases and their substantial premature mortality burden underscore the need for maintaining prevention efforts and for ongoing surveillance to monitor temporal trends in these diseases.

© 2013 Wiley Periodicals, Inc.
Rapid progression of pleural disease due to exposure to Libby amphibole: "Not your grandfather's asbestos related disease". B. Black, J. Szeinuk, A.C. Whitehouse, et al. 2014;57(11):1197-206. Case report PubMed · Publisher

Abstract

Background: Residents and mine employees from Libby, Montana, have been exposed to asbestiform amphiboles from the vermiculite mine that operated in this location from the mid-1920s until 1990. Clinical observations show a different form of asbestos-related toxicity than other forms of asbestos.

Methods: Five illustrative cases from the Center for Asbestos-Related Diseases in Libby were selected. All had clear exposure histories, multiple follow-up visits, illustrative chest radiographic studies, serial pulmonary function tests, and sufficient length of follow-up to characterize disease progression.

Results: These cases developed increasing symptoms of dyspnea and chest pain, progressive radiological changes that were predominantly pleural, and a restrictive pattern of impaired spirometry that rapidly progressed with significant loss of pulmonary function.

Conclusions: LA exposure can cause a non-malignant pleural disease that is more rapidly progressive and more severe than the usual asbestos-related disease.

© 2014 Wiley Periodicals, Inc.
Retrospective cohort study of a microelectronics and business machine facility. S.R. Silver, L.E. Pinkerton, D.A. Fleming, et al. 2014;57(4):412-24. PubMed · Publisher · Free full text

Abstract

Objectives: We examined health outcomes among 34,494 workers employed at a microelectronics and business machine facility 1969-2001.

Methods: Standardized mortality ratio (SMR) and standardized incidence ratios were used to evaluate health outcomes in the cohort and Cox regression modeling to evaluate relations between scores for occupational exposures and outcomes of a priori interest.

Results: Just over 17% of the cohort (5,966 people) had died through 2009. All cause, all cancer, and many cause-specific SMRs showed statistically significant deficits. In hourly males, SMRs were significantly elevated for non-Hodgkin's lymphoma and rectal cancer. Salaried males had excess testicular cancer incidence. Pleural cancer and mesothelioma excesses were observed in workers hired before 1969, but no available records substantiate use of asbestos in manufacturing processes. A positive, statistically significant relation was observed between exposure scores for tetrachloroethylene and nervous system diseases.

Conclusions: Few significant exposure-outcome relations were observed, but risks from occupational exposures cannot be ruled out due to data limitations and the relative youth of the cohort.

© 2013 Wiley Periodicals, Inc.
The impact of asbestos exposure in Swedish construction workers. B. Järvholm, A. Englund. 2014;57(1):49-55. PubMed · Publisher

Abstract

Objective: To study the occurrence of pleural mesothelioma as a measure of the impact on health from asbestos exposure in the construction industry.

Methods: The occurrence of pleural mesothelioma in different occupations, time periods and birth cohorts was studied in a cohort of construction workers. They were prospectively followed after they had participated in health examinations between 1971 and 1993. The analysis was restricted to men and in total 367,568 men was included in the analysis.

Results: In total there were 419 cases of pleural mesotheliomas between 1972 and 2009. As expected the age adjusted incidence was high in insulation workers and plumbers (39 and 16 cases per 100,000 person-years, respectively). However, only 21% of the pleural mesotheliomas occurred in those occupational groups. Occupational groups with many cases of pleural mesothelioma were concrete workers (N = 56), wood workers (N = 55), painters (N = 32), electricians (N = 48), and foremen (N = 37). The highest risk was in birth cohorts born between 1935 and 1945. Between 1995 and 2009 around one-third of all male cases in the country occurred in this birth cohort. The risk seemed to decrease considerably in men born after 1955.

Conclusion: In Sweden a considerable proportion of pleural mesotheliomas occur among construction workers; and not only in jobs traditionally associated with asbestos exposure such as insulators and plumbers but also among electricians, for example. The results shows that asbestos exposure occurs in many occupational groups, indicating that safe handling of asbestos is a very difficult or even impossible task in the construction industry.

© 2013 Wiley Periodicals, Inc.
All-cause mortality and cancer incidence among adults exposed to blue asbestos during childhood. A. Reid, P. Franklin, N. Olsen, et al. 2013;56(2):133-45. PubMed · Publisher

Abstract

Background: There are few data on the long-term health outcomes of exposure to asbestos in childhood. This study investigated cancer and mortality of adults exposed to blue asbestos as children.

Methods: Data linkage to relevant health registries was used to identify cancers and mortality in a cohort of adults (n = 2,460) that had lived in an asbestos mining town during their childhood (<15 years).

Results: There were 217 (93 female) incident cancers and 218 (70 female) deaths among the cohort. Compared with the Western Australian population females had elevated mesothelioma, ovarian and brain cancers, and increased "all cause" and "all cancer" mortality. Males had elevated mesothelioma, leukemia, prostate, brain, and colorectal cancers, and excess mortality from "all causes," "all cancers," circulatory disease, diseases of the nervous system, and accidents.

Conclusion: Exposure to blue asbestos in childhood is associated with an increased risk of cancer and mortality in adults.

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Characterization of a French series of female cases of mesothelioma. E. Camiade, C. Gramond, M.A. Jutand, et al. 2013;56(11):1307-16. PubMed · Publisher

Abstract

Background: More than 80% of mesothelioma cases in men are attributable to occupational asbestos exposure compared to only 40% in women. The objective of the study was to characterize a series of female pleural mesotheliomas according to known and suspected risk factors.

Methods: From the exhaustive recording of 318 female mesothelioma cases in the French National Mesothelioma Surveillance Program between 1998 and 2009, multiple correspondence analysis and hybrid clustering were performed to characterize these cases according to expert assessed occupational and non-occupational exposure to asbestos and man-made vitreous fibers, X-ray exposure, and history of cancer and non-malignant respiratory diseases.

Results: Four clusters were identified: (1) occupational exposure to asbestos and man-made vitreous fibers (7.9% of subjects); (2) radiation exposure during radiotherapy (12.9%); (3) increased asbestos exposure (19.8%); and (4) "non-exposure" characteristics (59.4%).

Conclusion: These results will allow hypotheses to be generated about associations between mesothelioma and non-occupational asbestos exposure, X-ray exposure and history of respiratory disease.

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Compensation of pleural mesothelioma in France: data from the French National Mesothelioma Surveillance Programme. S. Chamming's, B. Clin, P. Brochard, et al. 2013;56(2):146-54. PubMed · Publisher

Abstract

Background: The aim of this study was to determine the rates of compensation awarded to patients presenting with pleural mesothelioma and factors linked to such compensation in France.

Methods: The study population consisted of 2,407 patients presenting with pleural mesothelioma, recorded by the National Mesothelioma Surveillance Programme between January 1, 1999 and December 31, 2009. Analysis of claims for recognition as "occupational disease" (OD) and claims for compensation by the Compensation Fund for Asbestos Victims (FIVA) were analyzed.

Results: Approximately 30% of subjects presenting with pleural mesothelioma, affiliated to the General National Health Insurance fund, neither sought recognition as an OD nor claimed for FIVA compensation. Gender, age at diagnosis, type of health insurance, and socio-professional category influence the likelihood of patients presenting with mesothelioma seeking compensation for this disease.

Conclusions: Results show an under-compensation of pleural mesothelioma as OD and by the FIVA in France.

Copyright © 2012 Wiley Periodicals, Inc.
Diffusing capacity and forced vital capacity in 5,003 asbestos-exposed workers: relationships to interstitial fibrosis (ILO profusion score) and pleural thickening. A. Miller, R. Warshaw, J. Nezamis. 2013;56(12):1383-93. PubMed · Publisher

Abstract

Background: Asbestosis is an interstitial lung disease whose radiographic severity has long been graded by the International Labour Office (ILO) profusion score. Its effect on pulmonary function is further impacted by asbestos related pleural thickening.

Objectives: This report aims to describe the relationships between radiographic grading of interstitial and pleural fibrosis and a key test of pulmonary function, the diffusing capacity, which measures gas exchange and has rarely been assessed in large groups, and to confirm the relationship to an independent test of pulmonary function, the vital capacity, which measures a mechanical property of the lungs.

Methods: The data were derived from a survey during the period 1997-2004 of 5,003 workers (all white males) exposed to asbestos in various trades. Tests included chest radiographs read by a certified expert ("B") reader, forced vital capacity (FVC), and carbon monoxide diffusing capacity (DLco). Cigarette smoking was adjusted for in the predictive equation for DLCO . Workers were evaluated at a mobile facility at work sites in four southern states.

Results: Both diffusing capacity and vital capacity were negatively correlated with profusion score over the full spectrum of radiographic severity. ILO profusion scores 0/1 (conventionally classified as normal) and 1/0 (conventionally classified as abnormal) were associated with similar diffusing capacity and vital capacity values. The highest profusion scores were associated with a greater proportionate decrease in diffusing capacity than in FVC. Both tests showed an effect of pleural fibrosis.

Conclusions: Both radiographic severity graded by the profusion score and pleural thickening are correlated with two independent measures of pulmonary function. FVC (which had been reported in smaller work forces) and DLCO (which has not been reported). Both measures show a decrease from normal to intermediate (0/1, 1/0) scores and a further decrease with greater scores, demonstrating the consistency of radiographic and functional assessments.

© 2013 Wiley Periodicals, Inc.
Impact of chemical exposure on cancer mortality in a French cohort of uranium processing workers. S. Zhivin, D. Laurier, S. Caër-Lorho, et al. 2013;56(11):1262-71. PubMed · Publisher

Abstract

Background: Nuclear workers may be exposed to a variety of chemical hazards, in addition to radiation. We examined the effect of chemical exposures on cancer mortality among French uranium processing workers at the AREVA NC Pierrelatte facility.

Methods: A cohort of 2,897 uranium processing workers employed for at least 6 months was followed from 1968 through 2006. Exposure to uranium and potentially carcinogenic chemicals was assessed with a plant-specific job-exposure matrix. Mortality hazard ratios (HRs) for cancers of the lung, lymphohematopoietic system, kidney and bladder, brain and central nervous system (BCNS), and prostate were estimated for each specific chemical exposure, with Cox regression models stratified for sex and calendar period and adjusted for socioeconomic status. Additional adjustments enabled us to examine the effect of co-exposure to uranium and other chemicals.

Results: Exposure to aromatic solvents was associated with increased risk of BCNS malignancies after adjustment for other chemicals (HR=6.53, 95% CI=1.14-37.41; n=6) and for other chemicals and uranium (HR=7.26, 95% CI=0.90-58.19) in the annual exposure status model. Selected groups of lymphohematopoietic cancers were found associated with solvent exposure. Inconclusive results were found regarding chromium (VI) exposure, since only 2 workers died from lung cancer among 109 exposed.

Conclusion: Based on our pilot study, it seemed important to take into account chemical exposures in the analyses of cancer mortality among French uranium processing workers.

© 2013 Wiley Periodicals, Inc.
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, G.W. Gibbs. 2013;56(9):1116-8. Letter · Comment PubMed · Publisher
Mesothelioma and employment in massachusetts: analysis of cancer registry data 1988-2003. C.R. Roelofs, G.J. Kernan, L.K. Davis, et al. 2013;56(9):985-92. PubMed · Publisher

Abstract

Background: Cancer registries can be used to monitor mesothelioma cases and to identify occupations and industries previously and newly associated with mesothelioma-causing asbestos exposure by using standard registry data on the "usual" occupation and industry of the case.

Methods: We used the National Institute for Occupational Safety and Health's Standardized Occupational Industry Coding Software to code 564 mesothelioma cases for occupation and 543 for industry of the 1,424 incident mesothelioma in the Massachusetts Cancer Registry from 1988 to 2003. Additionally, we coded the occupation and industry of 80,184 comparison cancer cases (35% of comparison cases in our database). These were used to compute Standardized Morbidity Odds Ratios (SMORs).

Results: Seventeen occupations and 11 industries had statistically significant elevated SMORs for mesothelioma. Occupations and industries historically associated with mesothelioma remained elevated in these results. However, we also found statistically significant elevated SMORs for several occupations and industries for which there was previously weak or no association such as chemical engineers, machine operators, and automobile mechanics and machine manufacturing, railroads, and the U.S. Postal Service.

Conclusions: Incident cases of mesothelioma do not appear to be declining in Massachusetts, as legacy exposures to asbestos continue to produce cases in individuals involved in shipbuilding and construction. Exposures in occupations and industries not previously associated with mesothelioma also contribute cases. Cancer registries, with improved data collection, should continue to be monitored for mesothelioma cases and asbestos exposures.

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Mortality among shipbreaking workers in Taiwan--a retrospective cohort study from 1985 to 2008. W.T. Wu, Y.H. Lu, Y.J. Lin, et al. 2013;56(6):701-8. PubMed · Publisher

Abstract

Background: Shipbreaking workers are typically exposed to a wide range of hazardous chemicals. However, long-term follow-up studies of their mortality patterns are lacking. This study examined mortality among shipbreaking workers over a 24-year follow-up period.

Methods: A total of 4,962 shipbreaking workers were recruited from the database of the Kaohsiung Shipbreaking Workers Union. The data were then linked to the Taiwan National Death Registry from 1985 to 2008. The mortality ratios-standardized for age and calendar years-(SMRs) for various causes of deaths were calculated with reference to the general population of Taiwan.

Results: Among men workers, a statistically significant increased SMR was observed for all causes (SMR = 1.28), all cancers (SMR = 1.26; particularly noteworthy for lesions of oral and nasopharyngeal: SMR 2.03, liver: SMR 4.63, and lung: SMR 1.36), cirrhosis of the liver (SMR = 1.32), and accidents (SMR = 1.91). A statistically significant increase in mortality was observed for respiratory system cancer (SMR = 1.87) and lung cancer (SMR = 1.91) among workers with a longer duration of employment (≥7 years). The result also showed that among shipbreaking workers who were still alive, two people had mesothelioma and 10 people have asbestosis.

Conclusions: Those employed in shipbreaking industries experienced an increase in mortality from all causes. The increased SMR for lung cancer was probably related to asbestos, metals, and welding fume exposure.

Copyright © 2013 Wiley Periodicals, Inc.
Mortality among workers at Oak Ridge National Laboratory. D.B. Richardson, S. Wing, A. Keil, et al. 2013;56(7):725-32. PubMed · Publisher

Abstract

Background: Workers employed at the Oak Ridge National Laboratory (ORNL) were potentially exposed to a range of chemical and physical hazards, many of which are poorly characterized. We compared the observed deaths among workers to expectations based upon US mortality rates.

Methods: The cohort included 22,831 workers hired between January 1, 1943 and December 31, 1984. Vital status and cause of death information were ascertained through December 31, 2008. Standardized mortality ratios (SMRs) were computed separately for males and females using US and Tennessee mortality rates; SMRs for men were tabulated separately for monthly-, weekly-, and hourly-paid workers.

Results: Hourly-paid males had more deaths due to cancer of the pleura (SMR = 12.09, 95% CI: 4.44, 26.32), cancer of the bladder (SMR = 1.89, 95% CI: 1.26, 2.71), and leukemia (SMR = 1.33, 95% CI: 0.87, 1.93) than expected based on US mortality rates. Female workers also had more deaths than expected from cancer of the bladder (SMR = 2.20, 95% CI: 1.20, 3.69) and leukemia (SMR = 1.64, 95% CI: 1.09, 2.36). The pleural cancer excess has only appeared since the 1980s, approximately 40 years after the start of operations. The bladder cancer excess was larger among workers who also had worked at other Oak Ridge nuclear weapons facilities, while the leukemia excess was among people who had not worked at other DOE facilities.

Conclusions: Occupational hazards including asbestos and ionizing radiation may contribute to these excesses.

Copyright © 2013 Wiley Periodicals, Inc.
No association between simian virus 40 and diffuse malignant mesothelioma of the pleura in Iranian patients: a molecular and epidemiologic case-control study of 60 patients. Z. Mohammad-Taheri, S.A. Nadji, F. Raisi, et al. 2013;56(10):1221-5. PubMed · Publisher

Abstract

Background: Diffuse malignant mesothelioma (DMM) is increasing in incidence on a worldwide basis and is linked to exposure to asbestos. Simian virus 40 (SV40), a DNA virus, was introduced inadvertently to human populations through contaminated polio vaccine during the years 1956-1963. It has been associated with various types of malignancy in animal experiments. There have been suggestions that SV40 might play a role in the pathogenesis of DMM.

Objective: To evaluate the association between SV40 and DMM in Iranian patients.

Method: In a case-control study between the years 2007-2008, isolated DNA from 60 paraffin blocks of patients with DMM and 60 controls was assessed to detect three human polyomaviruses (JCV, BKV, and SV40) using three different sets of primers by multiplex nested PCR analysis. We related the patients with diffuse malignant mesothelioma to possible sites of exposure to asbestos.

Results: None of the DMMs nor any patient in the control group had SV40 genome on polymerase chain reaction (PCR). All of the cases were SV40 T antigen negative.

Conclusion: This study suggests that DMM is independent of SV40 infection in Iran.

Copyright © 2013 Wiley Periodicals, Inc.
Pneumoconiosis and malignant mesothelioma in a family operated metal casting business that used industrial talc from New York state. M.M. Finkelstein. 2013;56(5):550-5. Case report PubMed · Publisher

Abstract

Background: The United States is second only to the People's Republic of China in annual talc production. U.S. talc is used in the production of ceramics, paint, paper, plastics, roofing, rubber, cosmetics, flooring, caulking, and agricultural applications. A number of U.S. talc deposits consistently contain talc intergrown with amphiboles such as tremolite and/or anthophyllite. It has long been recognized that miners and millers of talc deposits are at risk for pneumoconiosis and it has recently been reported that it is prudent, on the balance of probabilities, to conclude that dusts from New York State talc ores are capable of causing mesothelioma in exposed workers. This is a report of the diagnosis of pneumoconiosis and mesothelioma in a husband and wife who operated a small metal casting business that used industrial talc from New York as a parting agent.

Methods: Case reports, including medical records and exposure histories, were provided by an attorney who had also commissioned laboratory investigation of the industrial talc product used in the factory.

Results: Mrs X was diagnosed with pneumoconiosis characterized by interstitial fibrosis and heavily calcified pleural plaques. Mr X had calcified pleural plaques and developed a fatal pleural mesothelioma. Samples of the industrial talc contained fibrous tremolite and anthophyllite.

Conclusions: The author concludes that end users of industrial talc from New York State may be at risk of pneumoconiosis and malignant disease. End users of talcs from other regions of the United States, where talc formation arose from processes driven by regional metamorphism, might also be at risk.

Copyright © 2013 Wiley Periodicals, Inc.
Potential carcinogenic effects of world trade center dust after intratracheal instillation to Sprague-Dawley rats: first observation. M. Soffritti, L. Falcioni, L. Bua, et al. 2013;56(2):155-62. PubMed · Publisher

Abstract

Background: More than 10 years have passed since the terrorist attack on the New York City World Trade Center on September 11, 2001. It is well known that long-term carcinogenic bioassays on rodents can predict the potential carcinogenic effects of chemical and physical agents for humans.

Objective: A life-span carcinogenicity bioassay was conducted on Sprague-Dawley rats at the CMCRC of the Ramazzini Institute to test the potential carcinogenic effects of settled dust collected at the WTC immediately after the terrorist attack.

Methods: The WTC material tested is a complex mixture of coarse particles (95%) contain pulverized cement, glass fibres, asbestos, lead, polycyclic aromatic hydrocarbons (PAH(S) ), polychlorinated biphenyls (PCB(S) ) and polychlorinated furans, and dioxin. The test matter was suspended in sterile saline and administered by intratracheal instillation (IT) to 8-week-old Sprague-Dawley rats (100 animals/sex), 3-4 days/week for 4 weeks. A group of 200 male and female rats served as controls. The animals were kept under observation until natural death.

Results: Histopathological evaluation of the lungs (target organ) of instilled control and treated male and female rats, did not show any significant increased incidence of lung tumors. Two hemangiomas (one with endothelial atypia) and one hemangiosarcoma were found in the lungs of treated males. Moreover a modest increased incidence of terminal bronchiolar hyperplasia (TBH) and squamous metaplasia occurred in the lung of treated males and females compared to the controls.

Conclusion: Hemangioma and hemangiosarcoma are extremely rare tumors in the lung of our colony and we believe they are caused by WTC dust.

Copyright © 2012 Wiley Periodicals, Inc.
Potential years of life lost (PYLL) caused by asbestos-related diseases in the world. R. Diandini, K. Takahashi, E.K. Park, et al. 2013;56(9):993-1000. PubMed · Publisher

Abstract

Background: We applied the well-established, but rather under-utilized, indicator of Potential Years of Life Lost (PYLL) to estimate the global burden of mesothelioma and asbestosis.

Methods: We analyzed all deaths caused by mesothelioma and asbestosis that were reported by 82 and 55 countries, respectively, to the World Health Organization (WHO) from 1994 to 2010.

Results: The 128,015 and 13,885 persons who died of mesothelioma and asbestosis, potentially lost a total of 2.18 million and 180,000 years of life (PYLL), or, an annual average PYLL of 201,000 years and 17,000 years, respectively. The average PYLL per decedent were 17.0 and 13.0 years for mesothelioma and asbestosis, respectively.

Conclusions: The current burden of asbestos-related diseases (ARDs) in terms of PYLL is substantial. The future burden of ARDs can be eliminated by stopping the use of asbestos.

Copyright © 2013 Wiley Periodicals, Inc.
Reply to letter by Nolan and colleagues--re: the carcinogenicity of New York state talc dusts in humans. M. Finkelstein. 2013;56(9):1119-24. Letter · Comment PubMed · Publisher
Short, fine and WHO asbestos fibers in the lungs of quebec workers with an asbestos-related disease. G. Adib, F. Labrèche, L. De Guire, et al. 2013;56(9):1001-14. PubMed · Publisher

Abstract

Background: The possible role of short asbestos fibers in the development of asbestos-related diseases and availability of lung fiber burden data prompted this study on the relationships between fiber characteristics and asbestos-related diseases among compensated workers.

Methods: Data collected between 1988 and 2007 for compensation purposes were used; lung asbestos fibers content of 123 Quebec workers are described according to socio-demographic characteristics, job histories and diseases (asbestosis, mesothelioma, lung cancer).

Results: Most workers (85%) presented chrysotile fibers in their lungs, and respectively 76%, 64%, and 43% had tremolite, amosite, and crocidolite. Half of the total fibers were short, 30% were thin fibers and 20% corresponded to the World Health Organization definition of fibers (length ≥ 5 μm, diameter ≥ 0.2 and <3 μm). Chrysotile fibers were still observed in the lungs of workers 30 years or more after last exposure.

Conclusion: Our findings stress the relevance of considering several dimensional criteria to characterize health risks associated with asbestos inhalation.

© 2013 Wiley Periodicals, Inc.
The analysis of asbestos count data with "nondetects": the example of asbestos fiber concentrations in the lungs of brake workers. M.M. Finkelstein. 2013;56(12):1482-9. PubMed · Publisher

Abstract

Objectives: In the analysis of tissue for asbestos fibers, some measurements may be below the analytical detection limit (nondetects). The use of maximum likelihood and survival analysis methods have been recommended to perform comparisons between subjects in the presence of nondetects. When the data consist of "counts" another method is useful. This method is discussed, and illustrated with an analysis of asbestos lung burden data among brake mechanics previously analyzed by other methods.

Methods: Statistical models for count data, namely Poisson and negative binomial regression, were used to compare the asbestos fiber concentrations in the lungs of brake mechanics with those of control subjects. The fit of the models was assessed with an analysis of residuals.

Results: The negative binomial regression models fit the data well. The concentrations of Quebec asbestos fibers in the lungs of the brake mechanics were significantly higher than in the control population.

Conclusions: Helsel recommended the use of maximum likelihood and survival analysis methods to perform comparisons in the presence of nondetects. When analyzing asbestos fiber count data, or other count data arising in occupational or environmental health, the use of models such as the Poisson and negative binomial may be added to the analyst's toolbox. Benefits are that neither of these methods requires the substitution of arbitrary values for the nondetects and that programs for the computation of count data models are contained in popular statistical software packages.

© 2013 Wiley Periodicals, Inc.
Trades of dangers: a study of asbestos industry transfer cases in Asia. Y. Choi, S. Lim, D. Paek. 2013;56(3):335-46. PubMed · Publisher

Abstract

Background: In a study of asbestos industry transfers in Asia, we examined the transfer of health and safety measures at the time of industry transfer and resulting health outcomes thereafter.

Methods: Field surveys were conducted in Japan, Germany, Indonesia, and South Korea over a 5 year period beginning in 2007. The surveys involved interviews and field assessments of health and safety conditions.

Results: Even when there were transfers of entire engineering plant processes, we observed that the health and safety measures that should have accompanied the transfer, including technical capacities of risk assessment and management, regulatory protection, and cultural practices, were not actually transferred. According to work environment assessment records, there were differences in airborne asbestos levels of approximately 5-6 fibers/cc between the exporting and importing sides of the transfer. This amounted to a 10 years of time delay in comparable health and safety conditions. These differences resulted in repeated adverse health consequences at each factory operation site.

Conclusions: Dangerous transfers of asbestos industry technology have occurred repeatedly over the years with the result that Asia has become the largest consumer of asbestos in the world. No effective internationally accepted safety measures have been introduced in the region. The study results support the need for both improved public awareness and international cooperation, such as sharing of substitute material technologies by the exporting countries, and provide the rationale for the creation of an Asian fund for asbestos victims.

Copyright © 2012 Wiley Periodicals, Inc.
A decade of malignant mesothelioma surveillance in Korea. S.H. Jung, H.R. Kim, S.B. Koh, et al. 2012;55(10):869-75. PubMed · Publisher

Abstract

Background: The objectives of this study were to examine trends in mesothelioma incidence over a decade and to identify histories of asbestos exposure among cases in Korea.

Methods: In 2001, The Korea Occupational Safety and Health Agency organized a nationwide cardiopulmonary pathology group and established a malignant mesothelioma surveillance system covering all general hospitals in Korea. Mesothelioma cases were reported to this surveillance system with information about age, gender, location, occupational history, asbestos exposure environment, date of diagnosis, diagnostic method, histopathologic subtype, occurrence site, and other clinical information. Additionally, an epidemiological survey was conducted using a structured verbal questionnaire to allow further evaluation of asbestos exposures.

Results: A total of 399 cases of malignant mesothelioma were reported in the last decade, translating to approximately 40 annual cases, and an annual average incidence rate of 0.83 cases per million. Of the 152 patients interviewed by occupational physicians, 56 had occupational asbestos exposure histories (36.8%). Their occupations and industries included construction (19.7%), automobile repair (5.9%), asbestos textile, shipbuilding and repair, refinery work, boiler making, and asbestos cement work. Another 31 patients had environmental asbestos exposure histories.

Conclusions: Surveillance data indicate that malignant mesothelioma incidence in Korea is, thus far, lower than that of other developed countries, and that construction and environmental asbestos exposure were the main identifiable causes of malignant mesothelioma.

Copyright © 2012 Wiley Periodicals, Inc.
Cancer incidence in a chlorochemical plant in Isère, France: an occupational cohort study, 1979-2002. V. Bonneterre, G. Mathern, O. Pelen, et al. 2012;55(9):756-67. PubMed · Publisher

Abstract

Background: A major French chlorine chemical plant (chlor-alkali process with diaphragm cell and manufacturing of organochlorine chemicals) has used or produced known or suspected carcinogenic compounds.

Methods: A cohort study, based on the plant occupational health service and the regional cancer registry, analyzed the standardized incidence ratios of malignant tumors for the period 1979-2002. Individual exposures were estimated from workers' occupational histories in a dual division of jobs into 9 sectors and 115 workshops with known exposures.

Results: Men (2,742) were followed, corresponding to 52,794 person-years. Primary tumors (304) were observed for 290 expected cases, a non-significant 5% excess. A significant excess was found of pleural mesothelioma and bladder cancer in employees hired before 1964.

Conclusion: Excesses of mesothelioma and bladder cancer were found, whereas there was no excess of hematopoietic cancers despite high benzene and dioxin exposures. Surprisingly, mesothelioma cases did not include workers who were the most exposed to asbestos.

Copyright © 2012 Wiley Periodicals, Inc.
Choice of rating method for assessing occupational asbestos exposure: study for compensation purposes in France. C. Gramond, P. Rolland, A. Lacourt, et al. 2012;55(5):440-9. PubMed · Publisher

Abstract

Background: In the course of setting up the National Mesothelioma Surveillance Program (PNSM), established in France in 1998, the question arose as to the most suitable method of assessing occupational exposure. The aim of this study was to define the most suitable rating method for assessing occupational asbestos exposure in order to assess medico-social care.

Method: The study included 100 subjects-50 cases of mesothelioma and 50 controls-randomly selected and representing 457 jobs held. Job asbestos exposure was assessed by a six-expert panel using two methods: "by job" rating, where all the jobs in were assessed regardless of the subjects; and "by subject" rating, where all the jobs of a subject were assessed at the same time. Consensus was obtained and subjects' exposure was calculated for each rating. Then, two internal experts assessed job asbestos exposure with the "by subject" rating. Kappa coefficients were used to measure agreement between the ratings.

Results: Agreement between "by job" and "by subject" ratings was very good for subject probability of exposure (kappa = 0.84) and cumulative exposure index (kappa = 0.80). Agreement between the six-expert panel and the two internal experts was good for subject exposure (kappa for probability = 0.71; kappa for cumulative exposure index= 0.68).

Conclusion: This study shows that the two rating systems have good or very good agreement. These results validate the routine use in the PNSM of the "by subject" rating, with the advantage of being convenient and quick to provide feedback on occupational asbestos exposure to mesothelioma cases for compensation.

Copyright © 2012 Wiley Periodicals, Inc.
Malignant mesothelioma incidence among talc miners and millers in New York State. M.M. Finkelstein. 2012;55(10):863-8. PubMed · Publisher

Abstract

Background: There is controversy about the potential for dust from the talc mines and mills of New York State to cause mesothelioma. Honda et al. published a study of mortality among New York talc workers and concluded that it was unlikely that the two deaths from mesothelioma were caused by talc ore dust. However, fibers of tremolite and anthophyllite have been found in the lungs of talc workers and Hull concluded that "New York talc exposure is associated with mesothelioma, and deserves further public health attention."

Methods: Data concerning additional cases of mesothelioma in the cohort have been posted by NIOSH. I used information from the NIOSH website and the Honda report to analyze the incidence of mesothelioma during the years 1990-2007.

Results: There were at least five new cases of mesothelioma in the cohort and mesothelioma incidence rates were at least five (1.6-11.7) times the rate in the general population (P < 0.01).

Conclusions: I conclude that: (1) mesothelioma has been diagnosed among members of the cohort at a rate in excess of that in the general population; (2) fibers of tremolite and anthophyllite have been detected in dust and the lungs of talc workers; and (3) these fibers are known causes of mesothelioma. It is prudent, on the balance of probabilities, to conclude that dusts from New York State talc ores are capable of causing mesothelioma in exposed individuals.

Copyright © 2012 Wiley Periodicals, Inc.
Pleural mesothelioma mortality and asbestos exposure mapping in Italy. L. Fazzo, M. De Santis, G. Minelli, et al. 2012;55(1):11-24. PubMed · Publisher

Abstract

Background: An epidemic of asbestos-related diseases is ongoing worldwide. Mortality from malignant pleural neoplasms in Italy was analyzed, to estimate the health impact of asbestos at national and local level.

Methods: Mortality from ICD-9 code 163 was considered, in the time-window 1995-2002, using National Bureau of Statistics data. National and regional standardized rates and municipal Standardized Mortality Ratios (SMR) were calculated. Municipal clusters were identified by applying Spatial Scan Statistics procedure. Relative risks (RR) express the ratio of risk within the cluster to the risk outside the cluster.

Results: The national standardized annual mortality rate was 1.9 per 100,000. Significant clusters corresponded to asbestos-cement industries (Casale Monferrato: RR = 11.63), shipyards (Monfalcone, RR = 7.43), oil refineries (Falconara, RR = 2.52), petrochemical industries (Priolo, RR = 3.81).

Conclusions: The present study confirms malignant pleural neoplasms mortality as a suitable indicator of asbestos exposure at geographic level. In addition to asbestos-cement industries and shipyards, other industrial settings are associated with pleural neoplasm mortality.

Copyright © 2011 Wiley Periodicals, Inc.
A case of occupational peritoneal mesothelioma from exposure to tremolite-free chrysotile in Quebec, Canada: A black swan case. D. Egilman, L.M. Menéndez. 2011;54(2):153-6. Case report PubMed · Publisher

Abstract

Background: Tremolite contamination has been proposed as the cause of mesothelioma in workers exposed to commercial chrysotile. The asbestos industry and scientists it has sponsored, for example, have argued that commercial chrysotile does not cause peritoneal mesothelioma.

Method: Case report of peritoneal mesothelioma in a mill worker from a tremolite free Canadian mine.

Results: Reports from pathology and occupational health and safety panels conclude that this mill worker developed work-related peritoneal mesothelioma.

Conclusion: Chrysotile without tremolite can cause peritoneal mesothelioma.

Copyright © 2010 Wiley-Liss, Inc.
A case-control study of asphalt and tar exposure and lung cancer in minorities. M.D. McClean, K.T. Kelsey, J.D. Sison, et al. 2011;54(11):811-8. PubMed · Publisher · Free full text

Abstract

Objectives: Considerable controversy surrounds the carcinogenic potential of asphalt and tar. Since minority individuals may have had relatively high historical exposures, we investigated asphalt and tar exposure and lung cancer risk among African Americans and Latino Americans.

Methods: We conducted a case-control study of lung cancer among African Americans and Latino Americans in the San Francisco Bay area (422 cases, 894 controls). A questionnaire was used to obtain detailed work histories and exposure information. Self-reported exposure to asphalt and tar as well as other factors (e.g., smoking, automobile exhaust, and asbestos) were evaluated as predictors of lung cancer risk. Potential effect modification by cytochrome P450 (CYP) 1A1 was also explored.

Results: Self-reported duration of exposure to asphalt and tar was associated with a statistically significant excess risk of lung cancer in the overall population (OR: 1.11, 95% CI: 1.01-1.22), evaluating risk per year of exposure. Years of exposure to automobile exhaust (OR: 1.02, 95% CI: 1.00-1.05) and asbestos (OR: 1.04, 95% CI: 1.02-1.06) were also associated with statistically significant elevations in risk. In Latino Americans, the lung cancer risks associated with polycyclic aromatic hydrocarbon-related exposures were consistently higher in the CYP1A1 wild-type subjects as compared to the variant genotype subjects, and the interaction was statistically significant for smoking and the CYP1A1 M2 polymorphism (P-value(interaction) = 0.02).

Conclusions: These data are consistent with the literature suggesting that exposure to asphalt and tar may increase risk of lung cancer. However, it was not possible to separate the effects and asphalt and tar in this study.

Copyright © 2011 Wiley Periodicals, Inc.
An elaboration of "proof" of peritoneal mesothelioma from tremolite free chrysotile. D. Egilman. 2011;54(8):647. Comment PubMed · Publisher
Asbestos is still with us: Repeat call for a universal ban. C. Ramazzini. 2011;54(2):168-73. PubMed · Publisher

Abstract

All forms of asbestos are proven human carcinogens. All forms of asbestos cause malignant mesothelioma, lung, and laryngeal cancers, and may cause ovarian, gastrointestinal, and other cancers [Straif et al., 2009]. No exposure to asbestos is without risk. Asbestos cancer victims die painful lingering deaths. These deaths are almost entirely preventable. When evidence of the carcinogenicity of all forms of asbestos became incontrovertible, concerned parties, including the Collegium Ramazzini, called for a universal ban on the mining, manufacture, and use of asbestos in all countries around the world [Collegium Ramazzini, 1999]. Asbestos is now banned in 52 countries [IBAS, 2010], and safer products have replaced many materials that once were made with asbestos. Nonetheless, a large number of countries still use, import, and export asbestos and asbestos-containing products. And in many countries that have banned other forms of asbestos, the so-called ‘‘controlled use’’ of chrysotile asbestos is exempted from the ban, an exemption that has no basis in medical science but rather reflects the political and economic influence of the asbestos mining and manufacturing industry. All countries of the world have an obligation to their citizens to join in the international endeavor to ban all forms of asbestos. An international ban on asbestos is urgently needed.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.
Lung diffusing capacity relates better to short-term progression on HRCT abnormalities than spirometry in mild asbestosis. C.R. Nogueira, L.M. Nápolis, E. Bagatin, et al. 2011;54(3):185-93. PubMed · Publisher

Abstract

Background: Pulmonary function tests (PFT), particularly spirometry and lung diffusing capacity for carbon monoxide (DL(CO) ), have been considered useful methods for the detection of the progression of interstitial asbestos abnormalities as indicated by high-resolution computed tomography (HRCT). However, it is currently unknown which of these two tests correlates best with anatomical changes over time.

Methods: In this study, we contrasted longitudinal changes (3-9 years follow-up) in PFTs at rest and during exercise with interstitial abnormalities evaluated by HRCT in 63 ex-workers with mild-to-moderate asbestosis.

Results: At baseline, patients presented with low-grade asbestosis (Huuskonen classes I-II), and most PFT results were within the limits of normality. In the follow-up, most subjects had normal spirometry, static lung volumes and arterial blood gases. In contrast, frequency of DL(CO) abnormalities almost doubled (P < 0.05). Twenty-three (36.5%) subjects increased the interstitial marks on HRCT. These had significantly larger declines in DL(CO) compared to patients who remained stable (0.88 vs. 0.31 ml/min/mm Hg/year and 3.5 vs. 1.2%/year, respectively; P < 0.05). In contrast, no between-group differences were found for the other functional tests, including spirometry (P > 0.05).

Conclusions: These data demonstrate that the functional consequences of progression of HRCT abnormalities in mild-to-moderate asbestosis are better reflected by decrements in DL(CO) than by spirometric changes. These results might have important practical implications for medico-legal evaluation of this patient population.

Copyright © 2010 Wiley-Liss, Inc.
Mesothelioma and aircraft industry. C. Bianchi, T. Bianchi. 2011;54(6):494. Comment · Letter PubMed · Publisher
Occupational asbestos exposure as a risk factor for laryngeal carcinoma in a population-based case-control study from Germany. H. Ramroth, W. Ahrens, A. Dietz, et al. 2011;54(7):510-4. PubMed · Publisher

Abstract

Background: As several studies have identified asbestos exposure as an independent occupational risk factor for laryngeal cancer, the aim of our study was to confirm this association.

Methods: In a population-based case-control study on laryngeal cancer in South-West Germany occupational exposures and other risk factors were obtained by face-to-face interviews using a detailed standardized questionnaire covering the complete individual working history, supplemented by job-specific questionnaires (JSQ) especially for selected jobs known to entail exposure to asbestos. Detailed exposure information was collected over a wide range of asbestos related jobs and branches and analyzed using different modeling strategies.

Results: Seventy-three (28.4%) cases and 158 (20.5%) controls reported any exposure to asbestos. Elevated risk estimates for asbestos exposure were found. However, those became substantially reduced after adjustment for smoking and alcohol.

Conclusion: Moderately elevated risks for laryngeal cancer after exposure to asbestos were confirmed. Difficulties in the collection of adequate exposure data were demonstrated.

Copyright © 2011 Wiley-Liss, Inc.
Rarity of malignant mesothelioma prior to the widespread commercial introduction of asbestos: the Mount Sinai autopsy experience 1883-1910. J.A. Strauchen. 2011;54(6):467-9. Historical article PubMed · Publisher

Abstract

Background: Most malignant mesotheliomas are related to asbestos exposure. Whether malignant mesothelioma occurs in the absence of asbestos exposure remains unsettled. To address this question we reviewed a series of 2,025 autopsies performed at the Mount Sinai Hospital between 1883 and 1910, prior to the widespread commercial introduction of asbestos.

Methods: Retrospective autopsy review.

Results: No cases of malignant mesothelioma were identified in 2,025 autopsies performed between 1883 and 1910.

Conclusions: Malignant mesothelioma was rare prior to the widespread commercial introduction of asbestos.

Copyright © 2011 Wiley-Liss, Inc.
Regarding "absence of radiographic asbestosis and the risk of lung cancer among asbestos-cement workers: extended follow-up of a cohort", by Murray Finkelstein, American Journal of Industrial Medicine 2010. R.M. Ross. 2011;54(6):495-6; author reply 497-8. Letter · Comment PubMed · Publisher
Reproducibility of asbestos body counts in digestions of autopsy and surgical lung tissue. M.I. Velasco-García, M.J. Cruz, L. Ruano, et al. 2011;54(8):597-602. PubMed · Publisher

Abstract

Background: Asbestos body (AB) counting by a single observer is the most commonly used objective technique to demonstrate asbestos deposition in the lung. In this study, the accuracy and reliability of this procedure is analyzed by evaluating the degree of agreement between two experienced readers.

Methods: Lung tissue specimens from 66 individuals, most of whom had not been exposed to asbestos, were studied: 35 were obtained in postmortem studies (upper, middle, and lower lung) and 31 were from patients who underwent surgery for lung cancer. Overall, 167 samples were analyzed. Lung tissue sections weighing 0.5 g were obtained prospectively and processed, and the inorganic residue was analyzed by light microscopy at 400× magnification by two experienced readers. Results were expressed as AB/g of dry lung tissue. Interobserver variability was analyzed using the Spearman correlation coefficient and agreement was evaluated by the Bland-Altman method and the kappa index.

Results: The interobserver correlation was 0.8975: 0.8029 for autopsy samples and 0.9592 for biopsy samples. Bland-Altman plots showed that most values were grouped around the 95% limits of agreement. The kappa index was 0.87 for all samples, and 0.79, 0.65, and 0.54 for upper, middle, and lower lung specimens, respectively.

Conclusions: Asbestos body counting by a single reader is a reliable method, especially at low concentrations of asbestos bodies in lung tissue. Double reading may be indicated in borderline cases with asbestos body levels close to levels of 1 000 AB/g.

Copyright © 2011 Wiley-Liss, Inc.
The need for pathological confirmation of the diagnosis of peritoneal malignant mesothelioma. S.J. Geyer. 2011;54(8):646. Letter · Comment PubMed · Publisher
Absence of radiographic asbestosis and the risk of lung cancer among asbestos-cement workers: Extended follow-up of a cohort. M.M. Finkelstein. 2010;53(11):1065-9. PubMed · Publisher

Abstract

Background: It has been a matter of controversy whether there is an increased risk of lung cancer among asbestos-exposed workers without radiographic asbestosis. A previous study of lung cancer risk among asbestos-cement workers has been updated with an additional 12 years of follow-up.

Methods: Subjects had received radiographic examination at 20 and 25 years from first exposure to asbestos. Radiographs were interpreted by a single National Institute of Safety and Health (NIOSH)-certified B-reader using the 1971 International Labor Office (ILO) Classification of the pneumoconioses as reference standard. Asbestosis was defined as an ILO coding of 1/0 or higher. Standardized Mortality Ratios (SMRs) were calculated using the general population of Ontario as reference.

Results: Among asbestos-cement workers without radiographic asbestosis at 20 years latency the lung cancer SMR was 3.84 (2.24-6.14). Among workers without asbestosis when examined at 25 years latency the SMR was 3.69 (1.59-7.26).

Conclusions: Workers from an Ontario asbestos-cement factory who did not have radiographic asbestosis at 20 or 25 years from first exposure to asbestos continued to have an increased risk of death from lung cancer during an additional 12 years of follow-up.

© 2010 Wiley-Liss, Inc.
Airways obstruction among older construction and trade workers at Department of Energy nuclear sites. J.M. Dement, L. Welch, K. Ringen, et al. 2010;53(3):224-40. PubMed · Publisher

Abstract

Background: A study of chronic obstructive pulmonary disease (COPD) among 7,579 current and former workers participating in medical screening programs at Department of Energy (DOE) nuclear weapons facilities through September 2008 was undertaken.

Methods: Participants provided a detailed work and exposure history and underwent a respiratory examination that included a respiratory history, respiratory symptoms, a posterior-anterior (P-A) chest radiograph classified by International Labour Office (ILO) criteria, and spirometry. Statistical models were developed to generate group-level exposure estimates that were used in multivariate logistic regression analyses to explore the risk of COPD in relation to exposures to asbestos, silica, cement dust, welding, paints, solvents, and dusts/fumes from paint removal. Risk for COPD in the study population was compared to risk for COPD in the general US population as determined in National Health and Nutrition Examination Survey (NHANES III).

Results: The age-standardized prevalence ratio of COPD among DOE workers compared to all NHANES III data was 1.3. Internal analyses found the odds ratio of COPD to range from 1.6 to 3.1 by trade after adjustment for age, race, sex, smoking, and duration of DOE employment. Statistically significant associations were observed for COPD and exposures to asbestos, silica, welding, cement dusts, and some tasks associated with exposures to paints, solvents, and removal of paints.

Conclusions: Our study of construction workers employed at DOE sites demonstrated increased COPD risk due to occupational exposures and was able to identify specific exposures increasing risk. This study provides additional support for prevention of both smoking and occupational exposures to reduce the burden of COPD among construction workers.

2009 Wiley-Liss, Inc.
Asbestos-related cancers among 28,300 military servicemen in the Royal Norwegian Navy. L.A. Strand, J.I. Martinsen, V.F. Koefoed, et al. 2010;53(1):64-71. PubMed · Publisher

Abstract

Introduction: This study focus on the incidence of asbestos-related cancers among 28,300 officers and enlisted servicemen in the Royal Norwegian Navy. Until 1987, asbestos aboard the vessels potentially caused exposure to 11,500 crew members.

Methods: Standardized incidence ratios (SIR) were calculated for malignant mesothelioma, lung cancer, and laryngeal, pharyngeal, stomach, and colorectal cancers according to service aboard between 1950 and 1987 and in other Navy personnel.

Results: Increased risk of mesothelioma was seen among engine room crews, with SIRs of 6.23 (95% CI = 2.51-12.8) and 6.49 (95% CI = 2.11-15.1) for personnel who served less than 2 years and those with longer service, respectively. Lung cancer was nearly 20% higher than expected among both engine crews and non-engine crews. An excess of colorectal cancer bordering on statistical significance was seen among non-engine crews (SIR = 1.14; 95% CI = 0.98-1.32). Land-based personnel and personnel who served aboard after 1987 had lower lung cancer incidence than expected (SIR = 0.77; 95% CI = 0.64-0.92). No elevated risk of laryngeal, pharyngeal, or stomach cancers was seen.

Conclusion: The overall increase (65%) in mesotheliomas among military Navy servicemen was confined to marine engine crews only. The mesothelioma incidence can be taken as an indicator of the presence or absence of asbestos exposure, but it offered no consistent explanation to the variation in incidence of other asbestos-related cancers.

(c) 2009 Wiley-Liss, Inc.
Asbestosis and mesothelioma among British asbestos workers (1971-2005). A.H. Harding, A.J. Darnton. 2010;53(11):1070-80. PubMed · Publisher

Abstract

Background: Ascertainment of asbestosis and mesothelioma from underlying cause of death underestimates the burden of these diseases. The aims of this study were to estimate the true frequency of asbestosis and mesothelioma among asbestos workers in Great Britain (GB), and to identify factors associated with the risk of death with these diseases.

Methods: The GB Asbestos Survey was established in 1971 to monitor long-term health outcomes among workers covered by regulations to control asbestos at work. Asbestosis and mesothelioma cases were defined by multiple cause of death, and were ascertained by identifying asbestos workers on the GB Asbestosis and Mesothelioma Registers. Standardized mortality ratios (SMRs) were calculated; the risks of asbestosis and mesothelioma were modeled with Poisson regression analysis. Deaths to the end of 2005 were included.

Results: There were 15,557 deaths between 1971 and 2005 among the 98,912 workers. Altogether 477 asbestosis and 649 mesothelioma cases were identified. The SMR for all causes was 1.42, for asbestosis 51.3, and for mesothelioma 13.5. In multiply adjusted analysis, age, sex, job, and birth cohort were significantly associated with asbestosis and mesothelioma. For asbestosis year of first exposure, and for mesothelioma latency, were also statistically significant.

Conclusions: The asbestos workers experienced high mortality from all causes, asbestosis, and mesothelioma. There was some evidence that the risk of asbestosis and mesothelioma was lower in later birth cohorts and among those first occupationally exposed to asbestos more recently. Due to the long latency of both diseases, further follow-up is required to confirm these trends.

© 2010 Wiley-Liss, Inc.
Case-control study of pleural mesothelioma in workers with social security in Mexico. G. Aguilar-Madrid, E. Robles-Pérez, C.A. Juárez-Pérez, et al. 2010;53(3):241-51. PubMed · Publisher

Abstract

Background: Environmental and occupational exposure to asbestos in Mexico in the past has been a cause of deaths and health damages. Its magnitude is unknown to date. Our objective was to identify the proportion of cases of malignant pleural mesothelioma (MPM) that can be attributed to and occupational exposure to asbestos.

Methods: We carried out a case-control study of MPM in 472 workers insured by the Mexican Institute of Social Security, all Valley of Mexico residents, with 119 incident cases and 353 controls. Cases were histologically confirmed. Participants were questioned concerning their occupational history and sociodemographic data. Assignment to one of the four exposures was performed qualitatively by an expert hygienist. Odds ratios (ORs) and attributable risks (ARs) were calculated using a non-conditional logistic regression model.

Results: A total of 80.6% of cases and 31.5% of controls had occupational exposure to asbestos. ORs were adjusted for age and gender and by exposure category, and exhibited an increase with probability of exposure as follows: 3.7(95% CI 1.3-10.4) for the likely category and 14.3(95% CI 8-26) for the certain category; AR in the group occupationally exposed to asbestos was 83.2%, and the population AR was 44%.

Conclusions: Our results show that the relationship between industrial uses of all forms of asbestos is generating an increase in mesothelioma-related diseases and deaths among Mexican workers. As a public health policy, Mexico should prohibit the use of asbestos in all production processes with the aim of controlling the epidemic and preventing the occurrence of new cases of MPM.

2009 Wiley-Liss, Inc.
Clinical study on mesothelioma in Japan: Relevance to occupational asbestos exposure. T. Kishimoto, K. Gemba, N. Fujimoto, et al. 2010;53(11):1081-7. PubMed · Publisher

Abstract

Background: In 2003, the number of deaths due to malignant mesothelioma in Japan was 878; however, only 85 cases of mesothelioma due to asbestos exposure were authorized for compensation. The reasons for this discrepancy require evaluation.

Method: We examined medical records, X-rays, and pathology results to evaluate mesothelioma cases in Japan between 2003 and 2005; used a questionnaire to identify occupational and environmental histories, and determined the concentration of asbestos fibers in pathology specimens.

Results: We identified 442 definite cases of malignant mesothelioma with a median age of 68 years. There were 316 malignant mesothelioma cases with occupational asbestos exposure, 12 cases with neighborhood exposure and 5 cases with likely domestic exposure. Most (78%) of the 87 cases exceeded 1,000 asbestos particles per gram of dry lung tissue.

Conclusion: We conclude that 79.2% of cases of mesothelioma in Japan in recent years were caused by asbestos exposure.

© 2010 Wiley-Liss, Inc.
Lung cancer in the melt shops of Ontario steelmakers. M.M. Finkelstein. 2010;53(7):762. Letter PubMed · Publisher
Occupations and industries in France at high risk for pleural mesothelioma: A population-based case-control study (1998-2002). P. Rolland, C. Gramond, A. Lacourt, et al. 2010;53(12):1207-19. PubMed · Publisher

Abstract

Background: Occupational exposure to asbestos, widely used in various industries for decades, is the most important risk factor for pleural mesothelioma. We report here the ranking of occupations and industries in France at high risk for this cancer among men and women.

Methods: A population-based case-control study, conducted from 1998 to 2002, included 462 cases (80.3% men) and 897 controls. Data were collected in face-to-face interviews with a standardized questionnaire. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each occupation and industry; subjects never employed in each category were the reference.

Results: For men, risks were high for several occupations and industries. Besides the expected high risks for non-metallic mineral product makers and manufacturing asbestos products, occupations such as plumbers (OR = 5.57, 95% CI: 2.90-10.69), sheet-metal workers, welders, metal molders, coremakers, and cabinetmakers were also at high risk. Elevated risks were found in the industries of shipbuilding (OR = 9.13, 95% CI: 5.20-16.06) and construction, but also in the manufacturing of metal products, chemicals, and railroad and aircraft equipment. The results for women showed increased but not significant risks in several occupational activities.

Conclusions: This report provides new insight into the epidemiology of mesothelioma, confirming risks for occupational activities reported earlier and pointing out risks in activities never previously reported. It offers guidance to authorities for the compensation of asbestos victims and for prevention in at-risk activities still involving asbestos-containing products.
South Africa's export trade in asbestos: demise of an industry. J.S. Harington, N.D. McGlashan, E.Z. Chelkowska. 2010;53(5):524-34. PubMed · Publisher

Abstract

Background: South Africa's export of each of its three types of asbestos, crocidolite, amosite, and chrysotile, and the total amounts to 84 countries in metric tonnes is examined over a 24-year period, 1980-2003.

Methods: For convenience, the countries are divided into nine world regional groups, Europe, Eastern Europe, North America with the Caribbean, South America, Africa, Middle East, Far East, South Asia, and Oceania.

Results: The three greatest importing countries of total asbestos in metric tonnes were all in the Far East region, ranging from Japan, South Korea to Thailand, and followed by USA and Italy. All exports to all countries diminished steadily as the South African trade came virtually to an end by 2003, due to ever increasing international pressure.

Conclusion: The export trade has changed significantly since 1960 from being dominantly to European countries to being directed in recent years to the Far East, with serious implications for asbestos-related ill-health in those countries.

2010 Wiley-Liss, Inc.

2000s

Asbestos exposure and benign asbestos diseases in 772 formerly exposed workers: dose-response relationships. G. Mastrangelo, M.N. Ballarin, E. Bellini, et al. 2009;52(8):596-602. PubMed · Publisher

Abstract

Background: Since previous studies have provided conflicting results, we investigated the relationship between the risk of benign asbestos-related diseases and different aspects of asbestos exposure in previous asbestos workers who underwent low-dose computed tomography (CT).

Methods: CT scans were carried out in 772 subjects. A questionnaire was employed to collect data on smoking habits and duration, peak and cumulative exposure, and time since first exposure to asbestos. Multiple logistic regression models with stepwise selection of variables were used to evaluate the associations.

Results: Fourteen (1.8%) cases of asbestosis, 187 (24.2%) of pleural plaques (PP), and 50 (6.5%) of diffuse pleural thickening (DPT) were found. The significant risk factors were: cumulative exposure for asbestosis (P for trend = 0.004); time since first exposure (P for trend <0.001), and peak exposure (P for trend <0.001) for PP; and time since first exposure for DPT (P for trend = 0.024).

Conclusions: Parenchymal asbestosis and PP are associated with different aspects of asbestos exposure. DPT appears to be less specific for asbestos exposure.
Asbestos fiber concentration in the area surrounding a former asbestos cement plant and excess mesothelioma deaths in residents. S. Kumagai, N. Kurumatani. 2009;52(10):790-8. PubMed · Publisher

Abstract

Background: Many persons who had lived near a former asbestos cement plant (AC plant) died from mesothelioma in Amagasaki city, Japan.

Methods: Asbestos fiber concentration in the area surrounding the AC plant was estimated so that the female mesothelioma death number predicted by a mathematical model was the same as the observed excess death number. We used the estimated asbestos fiber concentration to predict the excess mesothelioma deaths from 1970 to 2049.

Results: In a grid just south of the AC plant, the fiber concentration was estimated to be more than 3 f/ml for K(M) (asbestos potency factor for mesothelioma) of 7.75 x 10(-9). An uncertainty factor of five yields a K(M) range 1.55 x 10(-9) to 38.8 x 10(-9); these in turn correspond to fiber concentrations of 15 and 0.6 f/ml. For K(M) = 7.75 x 10(-9), grid units with higher fiber concentrations than 0.01 f/ml were estimated to extend 4.1 km (95% CI: 3.8-4.4 km) south-southwest of the plant. Over the 80-year study period (1970 to 2049), we predicted that the exposure under study will cause 346 excess mesothelioma deaths with range of 296 to 382 deaths.

Conclusions: This prediction suggests that considerable medical resources will be needed through 2049 as a result of past asbestos exposure in this region.

Copyright 2009 Wiley-Liss, Inc.
Asbestos fibers in para-aortic and mesenteric lymph nodes. T. Uibu, E. Vanhala, A. Sajantila, et al. 2009;52(6):464-70. PubMed · Publisher

Abstract

Background: Asbestos fibers are known to accumulate in lung parenchyma and thoracic lymph nodes, but their presence and translocation into the extrapulmonary tissues need clarification. We assessed the presence of asbestos in the para-aortic (PA) and mesenteric (ME) lymph nodes.

Methods: PA and ME lymph nodes and lung tissue from 17 persons who underwent medicolegal autopsy for suspicion of asbestos-related disease and from five controls were analyzed for asbestos fibers using transmission electron microscopy.

Results: High concentrations of amphibole asbestos fibers were detected in several lung tissue samples and in the respective PA and ME lymph nodes. The mean concentration for the 10 persons with a lung asbestos content of >/=1 million fibers/g of dry tissue (f/g) was 0.85 (<0.05-4.36) million f/g in the PA lymph nodes and 0.55 (<0.02-2.86) million f/g in the ME lymph nodes. The respective mean values for the 12 persons with a lung asbestos concentration of <1 million f/g were 0.07 for the PA lymph nodes and 0.03 million f/g for the ME nodes. The lung asbestos burden that predicted the detection of asbestos in abdominal lymph nodes was 0.45 million f/g.

Conclusions: In addition to their accumulation in lung tissue, asbestos fibers also collect in the retroperitoneal and the mesenteric lymph nodes. Even low-level occupational exposure results in the presence of crocidolite, amosite, anthophyllite, tremolite, or chrysotile in these abdominal lymph nodes. Our results support the hypothesis of lymph drainage as an important translocation mechanism for asbestos in the human body.
Asbestos-related disease among sheet metal workers 1986-2004: radiographic changes over time. L.S. Welch, E. Haile. 2009;52(7):519-25. PubMed · Publisher

Abstract

Background: In 1985, the Sheet Metal Workers International Association and the Sheet Metal and Air Conditioning National Association formed The Sheet Metal Occupational Health Institute Trust (SMOHIT) to examine the health hazards of the sheet metal industry. Between 1986 and 2004 18,211 individuals were examined. At the time of the first examination 9.6% of all participants (1,745) had findings consistent with parenchymal disease (ILO > 1/0), and 21% (3,827) had pleural scarring.

Methods: 2181-Two thousand hundred eighty-one who had no radiographic evidence of pneumoconiosis on baseline examination underwent a second examination.

Results: By the second examination, 5.3% had developed parenchymal disease on chest radiograph; an additional 12.4% had developed pleural scarring without parenchymal disease. Factors that predicted new cases of pneumoconiosis on radiograph were the calendar year the worker entered the sheet metal trade, smoking, and shipyard work. Forty-seven percent of those smoking at the time of initial exam reported having quit smoking by the second examination.

Conclusions: Asbestosis is still occurring 50 years after first exposure. Exposed workers benefit from medical screening programs that incorporate smoking cessation.
Developments in asbestos cancer risk assessment. M.A. Silverstein, L.S. Welch, R. Lemen. 2009;52(11):850-8. PubMed · Publisher

Abstract

Background: Efforts have been made for 25 years to develop asbestos risk assessments that provide valid information about workplace and community cancer risks. Mathematical models have been applied to a group of workplace epidemiology studies to describe the relationships between exposure and risk. EPA's most recent proposed method was presented at a public meeting in July 2008.

Methods: Risk assessments prepared by USEPA, OSHA, and NIOSH since 1972 were reviewed, along with related literature.

Results And Conclusions: None of the efforts to use statistical models to characterize relative cancer potencies for asbestos fiber types and sizes have been able to overcome limitations of the exposure data. Resulting uncertainties have been so great that these estimates should not be used to drive occupational and environmental health policy. The EPA has now rejected and discontinued work on its proposed methods for estimating potency factors. Future efforts will require new methods and more precise and reliable exposure assessments. However, while there may be genuine need for such work, a more pressing priority with regard to the six regulated forms of asbestos and other asbestiform fibers is to ban their production and use.

(c) 2009 Wiley-Liss, Inc.
Factors associated with cancer distress in the Asbestos Post-Exposure Survey (APEXS). M. Maurel, A. Stoufflet, L. Thorel, et al. 2009;52(4):288-96. PubMed · Publisher

Abstract

Objectives: CT-scan screening programs for lung cancer detection have been proposed in high-risk subjects, and more recently in former asbestos-exposed subjects. However, to date no data are available on psychological impact of such programs. The aim of this study is to examine the risk factors of psychological distress at baseline of a CT-scan screening program among asbestos-exposed subjects.

Methods: The Asbestos Post-Exposure Survey (APEXS) was carried out in France between October 2003 and December 2005 in order to screen asbestos-related diseases by CT-scan. Volunteers underwent self-administered questionnaires including an asbestos exposure assessment and, for a large sub-sample, a validated psychological distress scale. Non-exposed subjects were used as reference group.

Results: At baseline, a significant higher level of distress was observed in exposed subjects (n = 3,122) relative to the reference group (n = 486) after adjustment on age, sex, and tobacco status. This distress is associated independently with the self-perception of (i) intensity of asbestos exposure and (ii) the risk of current or future disease related to the asbestos exposure. The perception of the cancer risk related to asbestos seems to play a fundamental role in this psychological distress.

Conclusion: In this study, asbestos-exposed subjects experienced a higher significant cancer distress than previously described in literature. These findings may be of potential public health importance. First, the impact of such occupational exposures on quality of life of patients who suffer from cancer related to these exposures has to be appraised. Secondly, the assessment of psychological impact of CT-scan screening programs among asbestos-exposed subjects is also required.
Hospitalization in Winnipeg, Canada due to occupational disease: a pilot study. A.G. Kraut. 2009;52(5):372-9. PubMed · Publisher

Abstract

Background: The objectives of this study were to identify the extent of occupational exposures to hazardous substances amongst male medical inpatients and to determine the extent to which these exposures may have contributed to the development of medical conditions.

Methods: A random sample of 297 male who were admitted from outside the hospital to the medical wards to a large tertiary care hospital, were between age 18-75 and could communicate in English completed an occupational history questionnaire. This information was merged with an inpatient database which contained patient demographics, admission diagnoses, and co-morbidity data. A specialist in occupational medicine and internal medicine determined whether the medical conditions the participants had were related to their exposures.

Results: One individual had a condition causing admission that was related to his work and 12 others (4%) had a condition that was possibly related to their work which had caused symptoms. One additional individual was found to have asymptomatic asbestos related pleural fibrosis. Fourteen of 37 possible harmful occupational exposures were reported by more than 10% of the study participants. On average each participant reported 5.5 exposures.

Conclusions: Occupational exposures to male medical inpatients are common. For 4.4% (13/297) of male admissions to the general medical wards from the emergency room occupational factors may have played a role in the development of medical conditions which led to admission or to major co-morbidities. Detailed occupational histories will likely lead to more suspected cases of work related medical admissions.

Copyright 2009 Wiley-Liss, Inc.
Identification of occupational cancer risk in British Columbia: a population-based case-control study of 2,998 lung cancers by histopathological subtype. A.C. MacArthur, N.D. Le, R. Fang, et al. 2009;52(3):221-32. PubMed · Publisher

Abstract

Background: Few studies have investigated occupational lung cancer risk in relation to specific histopathological subtypes.

Methods: A case-control study was conducted to evaluate the relationship between lung cancer and occupation/industry of employment by histopathological subtype. A total of 2,998 male cases and 10,223 cancer controls, diagnosed between 1983 and 1990, were identified through the British Columbia Cancer Registry. Matched on age and year of diagnosis, conditional logistic regression analyses were performed for two different estimates of exposure with adjustment for potentially important confounding variables, including tobacco smoking, alcohol consumption, marital status, educational attainment, and questionnaire respondent.

Results: For all lung cancers, an excess risk was observed for workers in the primary metal (OR = 1.31, 95% CI, 1.01-1.71), mining (OR = 1.53, 95% CI, 1.20-1.96), machining (OR = 1.33, 95% CI, 1.09-1.63), transport (OR = 1.50, 95% CI, 1.08-2.07), utility (OR = 1.60, 95% CI, 1.22-2.09), and protective services (OR = 1.27, 95% CI, 1.05-1.55) industries. Associations with histopathological subtypes included an increased risk of squamous cell carcinoma in construction trades (OR = 1.25, 95% CI, 1.06-1.48), adenocarcinoma for professional workers in medicine and health (OR = 1.73, 95% CI, 1.18-2.53), small cell carcinoma in railway (OR = 1.62, 95% CI, 1.06-2.49), and truck transport industries (OR = 1.51, 95% CI, 1.00-2.28), and large cell carcinoma for employment in the primary metal industry (OR = 2.35, 95% CI, 1.11-4.96).

Conclusions: Our results point to excess lung cancer risk for occupations involving exposure to metals, polyaromatic hydrocarbons and asbestos, as well as several new histopathologic-specific associations that merit further investigation.
Mesothelioma in a worker who spun chrysotile asbestos at home during childhood. E. Yano, Z.M. Wang, X.R. Wang, et al. 2009;52(4):282-7. Case report PubMed · Publisher

Abstract

Background: Malignant mesothelioma has a long latency period and more commonly found in those exposed to amphibole than chrysotile asbestos.

Method: A 35 years old asbestos worker in an asbestos textile plant in Chongqing, China, developed mesothelioma after only 4 years of employment. He was born and bred in a company residence of an asbestos plant and manually spun asbestos thread during school age. In the plant, not amphibole but only chrysotile has been used.

Results: Diagnosis of malignant mesothelioma was confirmed by comprehensive approaches including gross appearance, histology, histochemistry, and immunocytochemistry. In the lung and tumor tissues, huge number of tremolite with exceptional chrysotile was observed despite the reverse proportion in the work environment.

Discussion: Residential exposure and home spinning of asbestos seemed contributed to the early development of mesothelioma in this subject. Although only chrysotile was used and contamination of tremolite was low in the work environment, chrysotile seemed to be cleared leaving tremolite remain in the tissue.

Conclusion: Chrysotile with little contamination of tremolite can lead to early development of malignant mesothelioma when heavily exposed from childhood at a company residence with household exposure. There can be several mechanisms for tremolite to remain in the lung tissue, far exceeding chrysotile in number.
Mortality among sheet metal workers participating in a medical screening program. J. Dement, L. Welch, E. Haile, et al. 2009;52(8):603-13. PubMed · Publisher

Abstract

Background: The Sheet Metal Occupational Health Institute Trust (SMOHIT) was formed in 1985 to examine the health hazards of the sheet metal industry in the U.S. and Canada through an asbestos disease screening program. A study of mortality patterns among screening program participants was undertaken.

Methods: A cohort of 17,345 individuals with 20 or more years in the trade and who participated in the asbestos disease screening program were followed for vital status and causes of death between 1986 and 2004. Data from the screening program included chest X-ray results by International Labour Office (ILO) criteria and smoking history. Standardized mortality ratios (SMRs) by cause were generated using U.S. death rates and Cox proportional hazards models were used to investigate lung cancer risk relative to chest X-ray changes while controlling for smoking.

Results: A significantly reduced SMR of 0.83 (95% CI = 0.80-0.85) was observed for all causes combined. Statistically significant excess mortality was observed for pleural cancers, mesothelioma, and asbestosis in the SMR analyses. Both lung cancer and COPD SMRs increased consistently and strongly with increasing ILO profusion score. In Cox models, which controlled for smoking, increased lung cancer risk was observed among workers with ILO scores of 0/1 (RR = 1.17, 95% CI = 0.89-1.54), with a strong trend for increasing lung cancer risk with increasing ILO profusion score >0/0.

Conclusions: Sheet metal workers are at increased risk for asbestos-related diseases. This study contributes to the literature demonstrating asbestos-related diseases among workers with largely indirect exposures and supports an increased lung cancer risk among workers with low ILO profusion scores.
Mortality of older construction and craft workers employed at Department of Energy (DOE) nuclear sites. J.M. Dement, K. Ringen, L.S. Welch, et al. 2009;52(9):671-82. PubMed · Publisher

Abstract

Background: The U.S. Department of Energy (DOE) established medical screening programs at the Hanford Nuclear Reservation, Oak Ridge Reservation, the Savannah River Site, and the Amchitka site starting in 1996. Workers participating in these programs have been followed to determine their vital status and mortality experience through December 31, 2004.

Methods: A cohort of 8,976 former construction workers from Hanford, Savannah River, Oak Ridge, and Amchitka was followed using the National Death Index through December 31, 2004, to ascertain vital status and causes of death. Cause-specific standardized mortality ratios (SMRs) were calculated based on US death rates.

Results: Six hundred and seventy-four deaths occurred in this cohort and overall mortality was slightly less than expected (SMR = 0.93, 95% CI = 0.86-1.01), indicating a "healthy worker effect." However, significantly excess mortality was observed for all cancers (SMR = 1.28, 95% CI = 1.13-1.45), lung cancer (SMR = 1.54, 95% CI = 1.24-1.87), mesothelioma (SMR = 5.93, 95% CI = 2.56-11.68), and asbestosis (SMR = 33.89, 95% CI = 18.03-57.95). Non-Hodgkin's lymphoma was in excess at Oak Ridge and multiple myeloma was in excess at Hanford. Chronic obstructive pulmonary disease (COPD) was significantly elevated among workers at the Savannah River Site (SMR = 1.92, 95% CI = 1.02-3.29).

Conclusions: DOE construction workers at these four sites were found to have significantly excess risk for combined cancer sites included in the Department of Labor' Energy Employees Occupational Illness Compensation Program (EEOCIPA). Asbestos-related cancers were significantly elevated.

(c) 2009 Wiley-Liss, Inc.
Occupational cancer in Italy: evaluating the extent of compensated cases in the period 1994-2006. A. Scarselli, P. Scano, A. Marinaccio, et al. 2009;52(11):859-67. PubMed · Publisher

Abstract

Objective: The aim of this study is to analyze occupational cancer claims compensated in the industrial sector in Italy between 1994 and 2006.

Methods: A descriptive analysis of compensated occupational cancers based on the Italian Workers' Compensation Authority (INAIL) data was performed. Summary statistics were compiled by sex and age of worker, cancer type, workplace agent and economic sector. The temporal trend in the period 1994-2006 was investigated for the most frequently compensated cancers (mesothelioma and lung cancer from asbestos; nasal cavities cancer from wood and leather dust).

Results: Between 1994 and 2006, 6,243 cancer claims were compensated by INAIL due to occupational exposure in the industrial sector. Most (5,288, or 85%) of these compensated claims occurred in the period 2000-2006, when the annual mean of the most compensated cancers increased approximately four times compared to the period 1994-1999.

Conclusions: There is an increasing trend in compensation for work-related cancers in Italy in recent years, even if occupational cancers are still widely underreported.

(c) 2009 Wiley-Liss, Inc.
Pleural plaques in dentists from occupational asbestos exposure: a report of three cases. L. Sichletidis, D. Spyratos, D. Chloros, et al. 2009;52(12):926-30. Case report PubMed · Publisher

Abstract

Background: White asbestos (chrysotile) has been used in dentistry since 1930 when it was introduced as a lining material for casting rings.

Methods: All three patients presented with pleural plaques on chest X-rays as well as on CT-scans. They were working as dentists for 35-45 years. Under the instructions of the first dentist we represented precisely the whole process of manipulating a kind of paper that contained asbestos. In order to measure asbestos fibers concentration we used the membrane filter method and phase contrast optical microscopy. Dry asbestos sheets were scanned with x-ray diffraction and electron microscope.

Results: Analysis of the filter demonstrated 0.008 fibers/cm(3) during the sampling period. X-ray diffraction analysis revealed that the material consisted of chrysotile exclusively. Electron microscope pictures confirmed the presence of chrysotile.

Conclusion: Everyday occupational exposure for many years even to low asbestos levels, under poor ventilation conditions in a closed space, could cause pleural lesions.

Copyright 2009 Wiley-Liss, Inc.
Transfer of occupational health problems from a developed to a developing country: lessons from the Japan-South Korea experience. J. Park, N. Hisanaga, Y. Kim. 2009;52(8):625-32. Historical article PubMed · Publisher

Abstract

Many corporations move their manufacturing facilities or technologies from developed to developing countries. Stringent regulations have made it costly for industries to operate in developed, industrialized countries. In addition, labor costs are high in these countries, and there is increasing awareness among the general public of the health risks associated with industry. The relocation of hazardous industries to developing countries is driven by economic considerations: high unemployment, a cheaper labor force, lack of regulation, and poor enforcement of any existing regulations make certain countries attractive to business. The transfer of certain industries from Japan to Korea has also brought both documented occupational diseases and a new occupational disease caused by chemicals without established toxicities. Typical examples of documented occupational diseases are carbon disulfide poisoning in the rayon manufacturing industry, bladder cancer in the benzidine industry, and mesothelioma in the asbestos industry. A new occupational disease due to a chemical without established toxicities is 2-bromopropane poisoning. These examples suggest that counter-measures are needed to prevent the transfer of occupational health problems from a developed to a developing country. Corporate social responsibility should be emphasized, close inter-governmental collaboration is necessary and cooperation among non-governmental organizations is helpful.
Under-reporting of compensable mesothelioma in Alberta. M.W. Cree, M. Lalji, B. Jiang, et al. 2009;52(7):526-33. PubMed · Publisher

Abstract

Background: When combined with a history of occupational asbestos exposure, mesothelioma is often presumed work-related. In Canada, workers diagnosed with mesothelioma caused by occupational asbestos exposure are often eligible for compensation under provincial workers' compensation boards. Although occupational asbestos exposure causes the majority of mesothelioma, Canadian research suggests less than half of workers actually apply for compensation. Alberta's mandatory reporting requirements may produce higher filing rates but this is currently unknown. This study evaluates Alberta's mesothelioma filing and compensation rates.

Methods: Demographic information on all mesothelioma patients diagnosed between 1980 and 2004 were extracted from the Alberta Cancer Board's Cancer Registry and linked to Workers' Compensation Board of Alberta claims data.

Results: Alberta recorded a total of 568 histologically confirmed mesothelioma cases between 1980 and 2004. Forty-two percent of cases filed a claim; 83% of filed claims were accepted for compensation.

Conclusions: Patient under-reporting of compensable mesothelioma is a problem and raises larger questions regarding under-reporting of other asbestos-related cancers in Alberta. Strategies should focus on increasing filing rates where appropriate.
Correction to R. Lemen's review article, 'Asbestos in Brakes: Exposure and Risk of Disease'. J. Turim. 2008;51(6):475; author reply 476. Comment · Letter PubMed · Publisher
Environmental exposure to Libby Asbestos and mesotheliomas. A.C. Whitehouse, C.B. Black, M.S. Heppe, et al. 2008;51(11):877-80. Case report PubMed · Publisher

Abstract

Background: Thirty-one cases of mesothelioma resulting from exposure to Libby Asbestos have been identified from Libby, Montana. Eleven cases not previously reported are the subject of this report.

Methods: These cases are in non-occupationally exposed people, appearing to have resulted from exposure to contamination of the community, the surrounding forested area, and areas in proximity to the Kootenai river and railroad tracks used to haul vermiculite.

Results: These exposures are considered to be of a low degree of magnitude, but are similar to those in Western Australia's crocidolite mine at Wittenoom Gorge. An epidemic of mesothelioma can likely be expected from this type of asbestos contamination over the next 20 plus years.

Copyright 2008 Wiley-Liss, Inc.
Proportionate mortality study of the United Association of Journeymen and Apprentices of the Plumbing and Pipe Fitting Industry. E.J. Lehman, M.J. Hein, C.F. Estill. 2008;51(12):950-63. PubMed · Publisher

Abstract

Background: This study examined causes of deaths among unionized plumbers, pipefitters and allied trades.

Methods: Deaths of union members from the years 1971, 1979, 1987, and 1995 were selected as a representative sample from a computer file provided by the union. These years provided 15,411 deaths for proportionate mortality ratio (PMR) analysis.

Results: PMRs for lung cancer and asbestosis were significantly elevated compared to U.S. white males. PMRs for chronic disease of the endocardium and cardiomyopathy were also elevated. Elevations were not observed in other a priori causes: laryngeal cancer, lymphatic cancer, and neurological disorders. PMRs for transportation accidents for pipe/steam-fitters were elevated in 1971 and 1979, but not in 1987 or 1995.

Conclusion: Despite the limitations of a PMR analysis, study results indicate mortality related to asbestos exposure is, and will continue to be, an area of concern for members of the union.

Copyright 2008 Wiley-Liss, Inc.
Trends in suspected and recognized occupational respiratory diseases in Germany between 1970 and 2005. V. van Kampen, R. Merget, M. Butz, et al. 2008;51(7):492-502. PubMed · Publisher

Abstract

Background: Respiratory diseases represent a major proportion of occupational diseases in many countries. Little information is available about their incidences over the past several decades.

Methods: Based on the reports of the three German federal accident insurance agencies, the numbers of suspected and recognized cases of occupational respiratory diseases between 1970 and 2005 were collected and combined. The trends in the rates per 100,000 insured workers were calculated.

Results: In total, a decline in occupational respiratory diseases since 1998 could be observed. This trend is mainly based on the decrease in non-malignant respiratory diseases due to silica and obstructive airway diseases. In contrast, asbestos-induced diseases showed a leveling off or an increase (mesothelioma) during the last 10years.

Conclusions: Although trends in occupational disease may be influenced by several factors, the presented data indicate that prevention has been effective in reducing some ofthe most frequent occupational respiratory diseases in Germany.

(c) 2008 Wiley-Liss, Inc.
Asbestos update. L. Reinstein, L. Kazan-Allen. 2007;50(1):73-5. Editorial PubMed · Publisher
Ending asbestos poisoning: global advocacy from a survivor's view. P.S. Zygielbaum. 2007;50(1):68-70. PubMed · Publisher
Mesothelioma in blood related subjects: report of 11 clusters among 1954 Italy cases and review of the literature. V. Ascoli, D. Cavone, E. Merler, et al. 2007;50(5):357-69. PubMed · Publisher

Abstract

Background: Malignant mesothelioma is a sporadic tumor related to asbestos. Its occurrence in blood relatives raises the question of potential contribution of predisposing factors.

Methods: The study analyses the features of mesothelioma in blood relatives that might explain the disease clustering. Data sources of familial clusters were three population-based Mesothelioma Registries in Italy (Veneto and Apulia Regions, Brescia province; 1978-2005) and Medline, Toxline, and Oshline/Hseline databases for a review of the literature (1968-2006).

Results: Eleven clusters (22 cases) were identified among 1954 Italy mesothelioma cases, and 51 clusters (120 cases) were extracted from 33 studies. The proportion of Italy familial cases was 1.4 per 100 mesothelioma cases; the ratio between the number of familial clusters and the number of non-familial mesothelioma cases was 1:148. The mesothelioma profile in consanguineous is the same as in non-consanguineous subjects (male prevalence; pleural site; age at diagnosis >50 years; asbestos exposure). Most clusters occurred in asbestos workers (shipyard, asbestos-cement production/processing, and insulation) and household-exposed blood relatives. Others were related to asbestos-cement factory pollution, asbestos-in-place, and handling asbestos-contaminated textiles. Two clusters were without any known exposure. Cancer family history revealed lung cancer cases in eight clusters.

Conclusions: Available data support asbestos exposure as the main risk factor in mesothelioma cases among blood relatives. Our finding of a low proportion of familial cases would not suggest the influence of a large genetic component for mesothelioma in blood relatives.
Mortality among workers at the Savannah River Site. D.B. Richardson, S. Wing, S. Wolf. 2007;50(12):881-91. PubMed · Publisher

Abstract

Background: Workers employed at the Savannah River Site (SRS) were potentially exposed to a range of chemical and physical hazards, many of which are poorly characterized. We therefore compared the observed deaths among workers to expectations based upon death rates for referent populations.

Methods: The cohort included 18,883 SRS workers hired between 1950 and 1986. Vital status and cause of death information were ascertained through 2002. Sex-specific standardized mortality ratios (SMR) were computed using U.S. and South Carolina mortality rates. SMRs were tabulated separately for monthly-, weekly-, and hourly-paid men.

Results: Males had fewer deaths from all causes [SMR=0.80, 90% confidence interval (CI): 0.78, 0.82], all cancers (SMR=0.85, 90% CI: 0.81, 0.89), and lung cancer (SMR=0.88, 90% CI: 0.82, 0.95) than expected based upon US mortality rates. The SMR for cancer of the pleura was 4.25 (90% CI: 1.99, 7.97) for men. The SMR for leukemia was greater than unity for monthly-paid (SMR=1.33, 90% CI: 0.88, 1.93) and hourly-paid (SMR=1.36, 90% CI: 1.02, 1.78) men. Female workers had fewer deaths from all causes (SMR=0.75, 90% CI: 0.69, 0.82) than expected, but more deaths than expected from cancer of the kidney (SMR=2.58, 90% CI: 1.21, 4.84) and skin (SMR=3.90, 90% CI: 2.11, 6.61).

Conclusions: While the observed numbers of deaths in most categories of cause of death were less than expected, there are greater than expected numbers of deaths due to cancer of the pleura and leukemia, particularly among hourly-paid male workers. It is plausible that occupational hazards, including asbestos and ionizing radiation, contribute to these excesses.
Occupational asbestos exposure among respiratory cancer patients in Lithuania. R.P. Everatt, G. Smolianskiene, A. Tossavainen, et al. 2007;50(6):455-63. PubMed · Publisher

Abstract

Background: Despite intensive use of asbestos, no cancer case has ever been diagnosed as asbestos related in Lithuania. This paper attempts to estimate the proportion of those occupationally exposed to asbestos among respiratory cancer patients.

Material And Methods: Occupational exposure to asbestos was assessed retrospectively for 298 lung cancer and four mesothelioma patients, admitted to the Institute of Oncology, Vilnius. The evaluation was based on personal interview data using an internationally established questionnaire covering most likely activities of asbestos exposure at the workplace. Cumulative exposure to asbestos at work was estimated in fiber years. Lung tissue asbestos fiber burden analysis was conducted by scanning transmission electron microscopy on 23 samples.

Results: A cumulative asbestos exposure of > or =25 fiber years was found for 10 lung cancer patients (3.4%). They worked in foundries, construction, installation, shipyard, power plant, railway, asbestos cement, glass and chemical industry. In a further 56 lung cancer patients (18.8%) and for one (25%) mesothelioma patient, a cumulative exposure from 5 to 24.9 fiber years was assessed. Asbestos fibers were detected in 18 cases, the burden ranged from 0.1 to 4.1 million fibers/g dry lung tissue; concentrations exceeding 1 million f/g dry lung tissue were found in four cases. All fibers were chrysotile.

Conclusions: Findings indicate that a fraction (3.4%) of the lung cancer cases could be attributed to heavy occupational exposure to asbestos using the Helsinki criterion of > or =25 fiber years. Therefore, approximately 50 lung cancer cases per year in Lithuania could be asbestos-related compensable occupational diseases.
Radiographic readings for asbestosis: misuse of science--validation of the ILO classification. A. Miller. 2007;50(1):63-7. Review PubMed · Publisher

Abstract

Background: Radiographic readings for pneumoconiosis (both asbestosis and silicosis), even those using the International Labour Office (ILO) Classification, have received widespread negative coverage in the media and strong judicial rebuke.

Methods: The medical literature over the past 90 years was reviewed for the relationships between radiographic severity (standardized as the ILO profusion score) and indices of exposure to silica or asbestos, tissue burden of silica particles or asbestos fibers, histologic fibrosis, various measurements of pulmonary function and mortality.

Results: Evidence from many different disciplines has demonstrated that the ILO profusion score correlates with occupational exposure, dust burden in the lung, histologic fibrosis and, more recently, with physiologic impairment and mortality.

Conclusions: The ILO Classification has therefore been validated as a scientific tool. Its fraudulent misuse by "hired-gun" physicians, attorneys and elements of the compensation system to falsify claims of asbestosis and/or silicosis (often in the same claimant) must be condemned.

(c) 2006 Wiley-Liss, Inc.
The 2nd ADAO Asbestos Conference. L. Kazan-Allen. 2007;50(1):52-62. PubMed · Publisher

Abstract

On National Asbestos Awareness Day 2006, a conference was held at Mount Sinai, the home ground of Dr. Irving J. Selikoff, who, more than any other single individual, started the debate about occupational hazards in the U.S. Four decades after the pioneering conference on the Biological Effects of Asbestos was organized by Drs. Selikoff and Churg, asbestos victims and their relatives, public health campaigners, medical professionals, journalists and community representatives convened in New York City to assess the progress that had been made in raising public, professional and political awareness of asbestos-related diseases. The report which follows conveys the substance of their presentations and highlights key issues which were discussed.

(c) 2006 Wiley-Liss, Inc.
Treatment of nonmalignant asbestos-related diseases. M.R. Harbut. 2007;50(1):71-2. Editorial PubMed · Publisher
Adverse effects of asbestos exposure and smoking on lung function. X. Wang, E. Yano, Z. Wang, et al. 2006;49(5):337-42. PubMed · Publisher

Abstract

Background: Exposure to asbestos is a well-recognized cause of both malignant and nonmalignant diseases of lung parenchyma and pleura. This study was conducted to determine the adverse effects of exposure to asbestos and smoking on pulmonary function.

Methods: Four hundred and sixty-eight workers who were occupationally exposed to asbestos for an average of 13 years were selected from an asbestos-product factory in China. Of them, 85 workers were diagnosed with asbestosis. Additionally, 282 workers who had no experience of exposure to industrial dust were included as a control group. A questionnaire was administered during a face-to-face interview and spirometric maneuvers and single-breath CO diffusing capacity (DL(CO)) were performed.

Results: Multivariate regression analysis showed that exposure to asbestos was more strongly associated with decreased forced vital capacity (FVC) and DL(CO), and asbestosis more strongly associated with decreased FVC, while smoking was a major contributing factor to reduced FEV1/FVC. The results were confirmed by a further analysis where the subjects were grouped exclusively by smoking, asbestos exposure, and chest radiographic changes. No interaction or joint effect was observed between asbestos exposure and smoking.

Conclusions: This analysis suggested that asbestos and smoking might play independent roles, in which asbestos caused mainly a restrictive impairment, and smoking was a major causal factor for airway obstruction in the workers who were intensively exposed to asbestos.

Copyright 2006 Wiley-Liss, Inc.
Diachronic study of pleural plaques in rural population with environmental exposure to asbestos. L. Sichletidis, D. Chloros, N. Chatzidimitriou, et al. 2006;49(8):634-41. PubMed · Publisher

Abstract

Background: The progress of pleural plaques in persons exposed to environmental asbestos in Almopia, Greece were studied prospectively.

Methods: During a 15-year period, 198 individuals, in whom pleural plaques had been observed during the period 1988-1990 were followed. Respiratory function was initially evaluated in 23. All were inhabitants of seven villages of Northern Greece, where rocks with high concentration in asbestos fibers were used for whitewashing until 1935.

Results: Out of this population, 126 survived and underwent chest X-ray in 2003 while respiratory function was retested in 18. New radiological findings were compared to previous ones using digital technology. Furthermore, the cause of death of the remaining 72 was recorded. Deterioration of X-ray findings was observed in all survivors. Not only did the surface area of previous plaques increase (8.66 +/- 12.6 cm2, mean value +/- SD) but new ones also appeared. Total lung capacity decreased from 95.6 +/- 14.8 in 1998 to 76.5 +/- 9.3% predicted in 2003. It was found that out of 72 deaths, 11 people died of malignant lung neoplasm, and 4 of mesothelioma.

Conclusions: Radiological appearance of pleural plaques and respiratory function of people previously exposed to asbestos environmental pollution worsens over the years. Prevalence of mesothelioma was found to be higher than expected.

Copyright 2006 Wiley-Liss, Inc
Estimation of future mortality from pleural malignant mesothelioma in Japan based on an age-cohort model. T. Murayama, K. Takahashi, Y. Natori, et al. 2006;49(1):1-7. PubMed · Publisher

Abstract

Background: Japanese consumption of asbestos increased rapidly after the 1950s and lingered at a high level while the world's consumption decreased substantially after the 1980s. Mesothelioma is due primarily to asbestos, and the number of deaths in Japan is expected to increase in the future.

Method: We estimated the future number of pleural mesothelioma deaths among males in Japan using an age-cohort model.

Results: Analyses showed that there would be about 100,000 deaths in Japan due to pleural mesothelioma in the next 40 years. Compared with the statistics in European countries, the ratio of expected death numbers to the population size is remarkably close to linear. The data-point for Japan was slightly lower than that which could be expected from the linear relationship.

Conclusions: The limited availability of data may result in underestimation. Taking into consideration the consumption pattern of asbestos in recent decades, the incorporation of later cohorts will improve the estimation.

Am. J. Ind. Med. 49:1-7, 2006. (c) 2005 Wiley-Liss, Inc.
Finnish Institute of Occupational Health (FIOH): prevention and detection of asbestos-related diseases, 1987-2005. M.S. Huuskonen, J. Rantanen. 2006;49(3):215-20. PubMed · Publisher

Abstract

Background: Between 1987 and 1992, the Finnish Institute of Occupational Health (FIOH) initiated and implemented the Asbestos Program that aimed at reducing asbestos-related risks. It was a cooperative effort between government authorities, labor market organizations, and health care and labor protection personnel.

Methods: During the Program and its follow-up since 1993 several preventive actions were taken, and considerable new legislation and official instructions were issued.

Results: Approximately 200,000 people in Finland have been exposed to asbestos in their work. Through the cooperative efforts of government, labor, health care and worker protection programs, the import of asbestos was ceased in 1993 with a few exceptions. Almost all imports ceased in 2005 following European Union directives. Regulation of asbestos abatement companies has been greatly increased. The occupational exposure limit has been reduced from 2.0 fibers/cm(3) to the present 0.1 fibers/cm(3). Asbestos-related diseases are closely monitored and education of health care providers regarding the occupational source of these conditions is now emphasized.

Conclusions: The success of the primary goal of the Program, a reduction in asbestos-related morbidity, will not be fully realized for many decades.

(c) 2006 Wiley-Liss, Inc.
Immunotoxic effects of chemicals: A matrix for occupational and environmental epidemiological studies. A. Veraldi, A.S. Costantini, V. Bolejack, et al. 2006;49(12):1046-55. PubMed · Publisher

Abstract

Background: Many biological and chemical agents have the capacity to alter the way the immune system functions in human and animals. This study evaluates the immunotoxicity of 20 substances used widely in work environments.

Methods: A systematic literature search on the immunotoxicity of 20 chemicals was performed. The first step was to review literature on immunotoxicity testing and testing schemes adopted for establishing immunotoxicity in humans. The second step consisted of providing a documentation on immunotoxicity of substances that are widely used in work environment, by building tables for each chemical of interest (benzene, trichloroethylene, PAHs, crystalline silica, diesel exhausts, welding fumes, asbestos, styrene, formaldehyde, toluene, vinyl chloride monomer, tetrachloroethylene, chlorophenols, 1,3-butadiene, mineral oils, P-dichlorobenzene, dichloromethane, xylene, 1,1,1-trichloroethane, ethylene oxide). The third step was the classification of substances; an index (strong, intermediate, weak, nil) was assigned on the basis of the evidence of toxicity and type of immunotoxic effects (immunosuppression, autoimmunity, hypersensitivity) on the basis of the immune responses. Finally substances were assigned a score of immunotoxic power.

Results: Tables have been produced that include information for the 20 substances of interest, based on 227 animal studies and 94 human studies. Each substance was assigned an index of immunotoxic evidence, a score of immunotoxic power and type of immunotoxic effect.

Conclusions: This matrix can represent a tool to identify chemicals with similar properties concerning the toxicity for the immune system, and to interpret epidemiological studies on immune-related diseases.
Re: Evaluation of the size and type of free particulates collected from unused asbestos-containing brake components as related to potential for respirability. D.J. Paustenbach, B.L. Finley, P.J. Sheehan, et al. 2006;49(1):60-1; author reply 62-4. Letter PubMed · Publisher

Abstract

Background: In Atkinson et al. 2004 rinsates of unused brake components were analyzed by transmission electron microscopy (TEM) for the presence of asbestos fibers.

Results: We do not believe that the findings of Atkinson et al. are informative and could have been predicted based on the study design and the fact that one would expect to find measurable TEM asbestos fibers on an unused brake component. We also find that the paper did not provide a full or even partial discussion of the published literature with respect to industrial hygiene or epidemiology data.

Conclusion: The findings of Atkinson et al. do not, in our view, "further raise concerns" about historical asbestos exposures experienced by automotive mechanics because of the vast amount of published literature to the contrary.

Am. J. Ind. Med. 49:60-61, 2006. (c) 2005 Wiley-Liss, Inc.
Respiratory health in Turkish asbestos cement workers: the role of environmental exposure. I. Akkurt, B. Onal, A.U. Demir, et al. 2006;49(8):609-16. PubMed · Publisher

Abstract

Aim: Benign and malignant pleural and lung diseases due to environmental asbestos exposure constitute an important health problem in Turkey. The country has widespread natural deposits of asbestos in rural parts of central and eastern regions. Few data exists about the respiratory health effects of occupational asbestos exposure in Turkey. A cross-sectional study was conducted to investigate respiratory health effects of occupational asbestos exposure and the contribution of environmental asbestos exposure.

Methods: Investigations included asbestos dust measurements in the workplace and application of an interviewer-administered questionnaire, a standard posteroanterior chest X-ray and spirometry. Information on birthplace of the workers was obtained in 406 workers and used to identify environmental exposure to asbestos, through a map of geographic locations with known asbestos exposure.

Results: Asbestos dust concentration in the ambient air of the work sites (fiber/ml) ranged between 0.2 and 0.76 (mean: 0.25, median: 0.22). Environmental exposure to asbestos was determined in 24.4% of the workers. After the adjustment for age, smoking, occupational asbestos exposure, and potential risk factors environmental asbestos exposure was associated with small irregular opacities grade > or = 1/0 (44.2% vs. 26.6%, P < 0.01), FVC% (97.8 vs. 104.5, P < 0.0001), and FEV1% (92.4 vs. 99.9, P < .0001). Occupational exposure to asbestos was associated with small irregular opacities grade > or = 1/0 (OR: 2.0, 95% CI: 1.3-3.1, per 1 unit increase in the natural logarithm of fiber/ml) and FEV1/FVC% (beta: 1.1, SEM: 0.54; P < 0.05, per 1 unit increase in the natural logarithm of fiber/ml).

Conclusions: Environmental exposure to asbestos could increase the risk of asbestosis and lung function impairment in workers occupationally exposed to asbestos, independent from occupational exposure and smoking.

Copyright 2006 Wiley-Liss, Inc.
Revising the British Occupational Hygiene Society asbestos standard: 1968-1982. M. Greenberg. 2006;49(7):577-604. Historical article PubMed · Publisher

Abstract

Background: In 1968 the British Occupational Hygiene Society (BOHS) published a chrysotile asbestos hygiene standard. As a consequence of acknowledged inadequacies of the data, it underestimated the risks of exposure, but its influence was international and operated for longer than it merited. Five years later, BOHS reported the standard not to be in need of amending, despite its own doubts and no cognizance having been taken of the cancer hazard. Within months, stung by criticism from Dr. Irving J. Selikoff, industry required it to review the standard, which BOHS continued to do for a number of years before giving up.

Methods: Material obtained for the American Courts by means of legal discovery from an asbestos company's archive, provided information on the membership of the new BOHS committees, and on its operation.

Results: Alterations in the composition of the new committees included importantly the introduction of certain independent scientists, whose rigor militated against the ready production of a new hygiene standard acceptable to industry.

Conclusions: There was a time in Britain when a learned society might with impunity omit to consult the views of workers or their representatives when making value judgments about their health and safety, but consider it proper to accede to industry's decision as to what hygiene standard it would accept. Health and Safety at Work legislation in 1974, established an organization on which industry and labor were represented, with the onus for recommending hygiene standards. For several years the BOHS Asbestos Sub-Committee continued attempting to reconcile the interests of industry, until finally abandoning hygiene standard setting as its mission.

(c) 2006 Wiley-Liss, Inc.
A proportionate mortality study of bricklayers and allied craftworkers. J. Salg, T. Alterman. 2005;47(1):10-9. PubMed · Publisher

Abstract

Background: Mortality among members of the International Union of Bricklayers and Allied Craftworkers (IUBAC) is examined. Bricklayers and allied craft workers may be exposed to cobalt, epoxy resins, pitch, lime, and to lung carcinogens such as asbestos, silica, and nickel.

Methods: Proportionate mortality ratios (PMRs) were computed using US age-, gender-, and race-specific mortality rates for members who died during 1986-1991.

Results: Statistically significant PMRs among white men were found for cancers of the esophagus (PMR=134), stomach (PMR=131), respiratory system, trachea, bronchus, and lung (PMR=144), other parts of the respiratory system (PMR=216), other and unspecified sites (PMR=125). Elevated PMRs were also found for other diseases of the blood and blood forming organs (PMR=201), emphysema (PMR=133) and for asbestosis (PMR=554), and other respiratory diseases (PMR=119).

Conclusions: Results are consistent with those found in previous studies, and suggest the need for intervention activities directed at the prevention of these cancers, and other respiratory diseases.

Copyright (c) 2004 Wiley-Liss, Inc.
A report on the health of asbestos, Quebec miners 1940. M. Greenberg. 2005;48(3):230-7. Historical article PubMed · Publisher

Abstract

Background: Twenty years after the start-up of the Canadian asbestos industry, reports began to appear of respiratory disease and deaths in asbestos workers in England and in France. An inquiry from the UK in 1912 as to the health of Quebec miners was met by a denial of ill-health, but the loading of the premiums of asbestos workers in the 1930s indicated that, despite further reassuring health studies on Quebec miners, actuaries had data that gave cause for serious concern.

Methods: A report made to the Canadian asbestos industry by a company doctor in 1940, reviewing the literature and presenting his health findings on some 500 employees, was studied in the context of the published information available at the time, and of unpublished contemporaneous material subsequently obtained by legal discovery.

Results: The physician denied that the health and longevity of Quebec's miners and millers were adversely affected, and was dismissive of earlier reports of there being serious health risks associated with working with asbestos.

Conclusions: The methodology employed in his health study was defective and his denial of the literature uninformed. The study was widely circulated, and while it may have boosted Canadian industry morale, it met with a sceptical response from British industry. In denying that conditions in Quebec's asbestos mines and mills disabled and killed workers, the author allied himself to fellow professionals loyal to Government and to industry.
Collegium Ramazzini call for an international ban on asbestos. P.J. Landrigan, M. Soffritti. 2005;47(6):471-4. Editorial PubMed · Publisher

Summary

In this editorial, the Collegium Ramazzini, an international academic society of some 180 physicians and scientists from 30 countries, called for an immediate international ban on all mining and use of asbestos. The authors summarised published evidence that all forms of asbestos, including chrysotile, can cause asbestosis, lung cancer, malignant mesothelioma and gastrointestinal cancers, and that the risks extend to workers' families, neighbours, product users and the public. They cited estimates that asbestos had caused over 200,000 deaths in the United States, that the annual global toll was at least 100,000, and that the eventual toll could reach 5–10 million. They argued that the risks could not be controlled by technology or by regulating work practices: the strictest exposure limit for chrysotile (0.1 f/cc) was estimated to carry lifetime risks of 5/1,000 for lung cancer and 2/1,000 for asbestosis. They stated that country-by-country bans had shifted rather than eliminated the hazard. World use had levelled off at around 2 million metric tons per year, concentrated in countries with minimal prevention and compensation. Per capita use exceeded 2,000 g a year in Russia, Kazakhstan and Zimbabwe, compared with less than 20 g in the United States. The authors concluded that safe use of asbestos was not practicable, that safer substitutes were available, and that a ban must be international in scope and enforced in every country.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Collegium Ramazzini statement on the Tokyo Declaration banning asbestos. P.J. Landrigan, M. Soffritti. 2005;48(2):89-90. Editorial PubMed · Publisher
Comparison of asbestos exposure assessments by next-of-kin respondents, by an occupational hygienist, and by a job-exposure matrix from the National Occupational Hazard Survey. J.M. Nam, C. Rice, M.H. Gail. 2005;47(5):443-50. PubMed · Publisher

Abstract

Background: Assessments of occupational exposures in case-control studies of rapidly fatal illnesses often rely on data from next-of-kin respondents, which may be inaccurate.

Methods: Three methods for assessing exposure to asbestos from case-control data on mesothelioma, including next-of-kin assessment, expert assessment, and use of a generic job-exposure matrix (JEM). Interview data [Spirtas et al. (1994): Occup Environ Med 51:804-811] were reviewed to determine exposure status by an occupational hygienist (C.R.) who was unaware of disease status. Exposure odds ratios were calculated using standard methods, and measures of agreement included the kappa statistic and conditional and marginal odds ratios.

Results: Expert assessment detected higher proportions of exposed subjects than the next-of-kin respondents or JEM methods. The disease-exposure odds ratios were highest for respondents, perhaps because of recall bias, and lowest for the JEM method. The agreement was highest between the respondent and expert assessments. A combination of respondent's assessment and JEM assessment led to the best prediction of the expert's assessment. Results for spouse respondents were similar to those for other "next-of-kin" respondents.

Conclusions: Expert assessments were the most plausible, but the data indicate that disease associations could also be detected with the other exposure assessment methods. Using some combination of the proxy respondent's assessment and the JEM assessment, one can predict the expert's assessment. A strategy that relied on the respondent's assessment when it was positive and otherwise obtained an expert assessment could reduce costs with little error, compared to expert assessment on all subjects.

Published 2005 Wiley-Liss, Inc.
Mesothelioma in household members of asbestos-exposed workers: 32 United States cases since 1990. A. Miller. 2005;47(5):458-62. PubMed · Publisher

Abstract

Background: Mesothelioma is significant as an indicator of asbestos exposure, as a continuing major cause of death in those exposed, and as a risk following lesser exposures. One such exposure is living in the household of an asbestos worker, and coming into contact with fibers brought home on his/her body, clothing, etc.

Methods: Law firms throughout the US known for their pursuit of asbestos claims were polled for mesothelioma claims brought on behalf of family members of identifiable asbestos-exposed workers. Cases with any occupational, environmental, or other possible exposure were not included.

Results: This study reports 32 household-exposure mesothelioma cases, diagnosed since 1990. Relationships were wife (15), daughter (11), son (3), sister-in law (1), niece (1), and boarder (1). Occupations of the workers included shipyard (13), insulator (7), and other (12). Of the 27 pleural cases, 13 were epithelial, 5 fibrous, 3 biphasic, and 6 not specified; of the 5 peritoneal cases, 4 were epithelial and 1 fibrous. Latency was greater than 40 years in 27 cases; 6 cases were 40-49 years of age and 17 were 60 or older.

Conclusions: Records from law firms were a useful source of information. Mesothelioma resulting from household exposure is a continuing problem. It is more likely to present in the elderly, after latencies of >40 years.

(c) 2005 Wiley-Liss, Inc.
Occupational asbestos exposure and predictable asbestos-related diseases in India. S.K. Dave, W.S. Beckett. 2005;48(2):137-43. PubMed · Publisher

Abstract

Background: India imports nearly 100,000 metric tons of asbestos per year, and small-scale asbestos (chrysotile and tremolite) mining and milling contributes nearly 5%-10% of the total national usage. The industry is relatively young, having started in the 1950s and 1960s.

Methods: Surveys of asbestos-exposed workers have identified significant occupational exposures, early pleural and parenchymal changes on chest radiograph, and decrements in lung function.

Results And Conclusions: Based on knowledge of past and current exposures to asbestos in industry, we can predict a future occurrence of clinical asbestos-related diseases-pleural changes, pulmonary fibrosis, bronchogenic carcinoma, and diffuse malignant mesothelioma. These cases of asbestos related disease are expected to occur in asbestos exposed workers from mining, milling, and manufacturing as well as in those with secondary exposures to asbestos-containing materials, including construction and maintenance workers, users of asbestos-containing consumer products, and the occupants of asbestos-containing buildings.

Copyright (c) 2005 Wiley-Liss, Inc.
One agent, many diseases: exposure-response data and comparative risks of different outcomes following silica exposure. K. Steenland. 2005;48(1):16-23. PubMed · Publisher

Abstract

Background: Evidence in recent years indicates that silica causes lung cancer, and probably renal disease, in addition to its well-known relationship to silicosis. There is also suggestive evidence that silica can cause arthritis and other auto-immune diseases. Silica has, therefore, joined a handful of other toxic exposures such as tobacco smoke, dioxin, and asbestos which cause multiple serious diseases.

Methods: The available exposure-response data for silica and silicosis, lung cancer, and renal disease are reviewed. We compare the corresponding excess risks (or absolute risks in the case of silicosis) of death or disease incidence by age 75 for these three diseases, subsequent to a lifetime (45 years) of exposure to silica at current US standard (0.1 mg/m(3) respirable crystalline silica).

Results: The absolute risk of silicosis, as defined by small opacities greater than or equal to ILO classification 1/1 on an X-ray, ranges from 47% to 77% in three cohort studies with adequate follow-up after employment. The absolute risk of death from silicosis is estimated at 1.9% (0.8%-2.9%), based on a pooled analysis of six cohort studies. The excess risk of lung cancer death, assuming US male background rates, is 1.7% (0.2%-3.6%), based on a pooled analysis of ten cohort studies. The excess risk of end-stage renal disease (assuming male background rates) is 5.1% (2.2%-7.3%), based on a single cohort. The excess risk of death from renal disease is estimated to be 1.8% (0.8%-9.7%), based on a pooled analysis of three cohorts.

Conclusions: Keeping in mind that the usual OSHA acceptable excess risk of serious disease or death for workers is 0.1%, it is clear that the current standard is far from sufficiently protective of workers' health. Perhaps surprisingly, kidney disease emerges as perhaps a higher risk than either mortality from silicosis or lung cancer, although the data are based on fewer studies.
Pulmonary abnormalities associated with occupational exposures at the Savannah River Site. T. Makie, D. Adcock, D.T. Lackland, et al. 2005;48(5):365-72. PubMed · Publisher

Abstract

Background: A program of medical evaluation for former Savannah River Site (SRS) workers at health effects due to exposures to hazardous or radioactive agents was conducted.

Methods: This study includes data from 1,368 participants aged 45 years or older who were assessed regarding work-history and exposures to industrial agents. According to the standard industrial classification (SIC), participants were employed in five of the SIC divisions. Based on the International Labour Office Classification of Radiographs, two categories of pleural and parenchymal abnormalities were evaluated by a single radiologist. The SRS results were compared with the second national health and nutrition examination survey (NHANES II) results.

Results: The odds ratio of the SRS male aged 45-75 compared to NHANES was 2.4 for pleura abnormalities and 0.8 for parenchymal abnormalities. Using logistic regression, the highest-risk worker division was construction (OR = 2.76); asbestos exposure was clearly associated with pleural abnormality (OR = 2.15).

Conclusions: Pulmonary abnormalities were higher in former SRS workers than that in general population. Asbestos and possibly other exposures were related to pulmonary disease in this population.
RE: Asbestos in brakes: exposure and risk of disease. V.L. Roggli, A.M. Langer. 2005;47(3):276-7; author reply 278-80. Comment · Letter PubMed · Publisher
Asbestos in brakes: exposure and risk of disease. R.A. Lemen. 2004;45(3):229-37. Review PubMed · Publisher

Abstract

Asbestos has been incorporated into friction products since the early 1900s. Epidemiological studies have been equivocal in their analysis of the incidence of disease among mechanics servicing brakes. Decomposition of asbestos occurs during the normal usage of the brake due to thermal decomposition into forsterite, although not all asbestos is so converted. Short fibers, below 5 microm in length, are also found in brake products. Several facts are discussed including the toxicity of the remaining asbestos fibers, short asbestos fibers, and the health implications of exposure to forsterite. Control methodologies, when used appropriately, have reduced exposure to asbestos during brake servicing, but have not been able to entirely eliminate exposure to asbestos, thus bring into question the controlled use of asbestos for friction product such as brakes. Even the so called "controlled" use of asbestos containing brakes poses a health risk to workers, users, and their families.

Copyright 2004 Wiley-Liss, Inc.
Asbestos-related pleural disease due to tremolite associated with progressive loss of lung function: serial observations in 123 miners, family members, and residents of Libby, Montana. A.C. Whitehouse. 2004;46(3):219-25. PubMed · Publisher

Abstract

Background: The community of Libby, Montana has recently been the focus of national attention secondary to widespread amphibole contamination associated with vermiculite mining and processing.

Methods: Patients who had occupational and non-occupational exposure to amphibole asbestos in Libby, Montana were evaluated for progressive loss of pulmonary function.

Results: Of the 123 patients evaluated, 94 demonstrated average age-corrected accelerated loss per year of vital capacity at 3.2%, total lung capacity (TLC) 2.3%, and DLCO 3.3%. All patients all had predominantly pleural changes with minimal to no interstitial disease.

Conclusions: The study demonstrates a progressive loss of pulmonary function in patients exposed to tremolite asbestos.
Asbestos-related pleural diseases: dimensional criteria are not appropriate to differentiate diffuse pleural thickening from pleural plaques. J. Ameille, M. Matrat, C. Paris, et al. 2004;45(3):289-96. PubMed · Publisher

Abstract

Background: In the literature, the criteria used to define pleural plaques (PP) and diffuse pleural thickening (DPT) are very heterogeneous and often imprecise. A multicenter restropective study was conducted to assess the relevance of two radiographic definitions of DPT.

Methods: The study population consisted of 287 subjects with asbestos-related pleural thickening. Two definitions were used to characterize DPT on postero-anterior chest radiographs: definition 1: pleural thickening associated with obliteration of the costophrenic angle; definition 2: pleural thickening at least 5 mm wide, extending for more than one quarter of the chest wall. Prevalence of respiratory symptoms and pulmonary function tests were compared in the DPT and PP groups resulting from the two definitions of DPT.

Results: According to definition 1, 34 patients (11.8%) were classified in the DPT group. Prevalence of chronic sputum, dyspnea, and chest pain was significantly higher in this group than in the PP group. FEV(1), FVC, and TLC were significantly lower. The differences persisted after adjustment for confounding factors. According to definition 2,102 patients (36.6%) were classified in the DPT group. DPT and PP groups did not differ in terms of prevalence of respiratory symptoms, or pulmonary function tests. Agreement between readers was significantly better when using definition 1.

Conclusions: Obliteration of costophrenic angle is a much more reliable sign than dimensional criteria to characterize DPT.

Copyright 2004 Wiley-Liss, Inc.
Attorney-directed screenings can be hazardous. D. Egilman, S. Rankin Bohme. 2004;45(3):305-7. Case report PubMed · Publisher

Abstract

Background: The history of occupational health screenings indicate that they are often necessary to protect the health and interests of workers. However, medical screenings for asbestos and other occupational diseases which are organized and funded by attorneys may result in serious adverse outcomes to those screened.

Methods: We report a case of death that appears to have been heavily influenced by an attorney-initiated and -directed screening program.

Results: While well-run medical screening programs are essential to disease detection in workers, attorney-run and corporate screenings can be fraught with ethical and practical problems. Screenings have been used by corporations to identify workers with occupational illness in order to terminate their employment and avoid legal liability. Screenings can also be used to motivate workers to stop smoking and implement workplace controls. However, these screenings must be conducted responsibly.

Conclusions: Although this is only one case it illustrates the gravity and potential danger of attorney-directed screening programs.

Copyright 2004 Wiley-Liss, Inc.
Concentration of hydroxyproline in blood: a biological marker in occupational exposure to asbestos and its relationship with Pi*Z and Pi*S polymorphism in the alpha-1 antitrypsin gene. S. Mas, X. Casterad, N. Laso, et al. 2004;45(2):186-93. PubMed · Publisher

Abstract

Background: Hydroxyproline (OHP) is one of the most abundant amino acids in collagen and, in general, it provides a good measure of overall collagen catabolism.

Methods: Asbestos workers suffering from asbestosis (cases n = 85); asbestos exposed workers without asbestosis (exposed controls, EC, n = 86), and non-exposed population (non-exposed controls, NEC, n = 122) were studied. The concentration of free OHP in whole blood was measured following the Pico-Tag procedure.

Results: Concentration of OHP in blood was significantly different in the three groups studied (P < 0.001), being higher in cases (19.8 +/- 14.7 micromol/L) than in EC (16 +/- 12.4) and NEC (13.5 +/- 6.7). When all individuals were grouped and stratified by the Pi*S and Pi*Z polymorphisms in the alpha-1-antitrypsin gene, the highest OHP levels were detected in the Pi*S homozygotes, one of the asbestosis-at risk-genotypes (Pi*S homozygotes, x = 24.5 +/- 11.7; Pi*S heterozygotes, x = 16.6 +/- 10.0; wild type, wt, x = 15.9 +/- 11.8).

Conclusions: Blood OHP concentration could be used for monitoring human exposure to asbestos, either as a marker for occupational monitoring or as an additional clinical parameter in diagnostic exploration of asbestosis.

Copyright 2004 Wiley-Liss, Inc.
Dr. T.K. Joshi and asbestos in India: a message from the Collegium Ramazzini. P. Landrigan. 2004;45(2):125-8. PubMed · Publisher
Evaluation of the size and type of free particulates collected from unused asbestos-containing brake components as related to potential for respirability. M.A. Atkinson, M. O'sullivan, S. Zuber, et al. 2004;46(6):545-53. PubMed · Publisher

Abstract

Background: Chrysotile asbestos has found multiple applications in the production of friction products. At one point it comprised 40-50% of the composition of brake linings thus generating the potential for the development of asbestos related diseases in millions of workers involved in vehicle repairs. While some attention has been given to the health status of workers involved in the handling of worn components, little has been given to the potential for exposure during the handling and fitting of new (unused) components as replacement parts.

Methods: Unused brake linings or brake shoes with attached linings from four different sources were gently rinsed with prefiltered water that was then collected on filters for analysis by Analytical Transmission Electron Microscope.

Results: Large numbers of chrysotile asbestos containing structures, the majority of respirable size, were present in each sample.

Conclusions: We conclude that any manipulation of new asbestos containing brake components would be expected to yield free dust containing chrysotile asbestos of respirable size. That the vast majority of these fibers and particulates would not be counted as regulated fibers rendering assessment of potential exposures in the work place, based on data of Permissible Exposure Limits or Regulated Fibers, questionable.
Loyalty of the asbestos worker: a brief historical note. M. Greenberg. 2004;45(5):475-7. Historical article PubMed · Publisher
Malignant mesothelioma in Italy, 1997. M. Nesti, A. Marinaccio, E. Chellini. 2004;45(1):55-62. PubMed · Publisher

Abstract

Background: The Italian National Mesothelioma Register (ReNaM) was set up at the Istituto Superiore Prevenzione e Sicurezza Lavoro (ISPESL), in Rome, in accordance with Art. 36 of Italian Legislative Decree No. 277 [1991].

Methods: Five Italian regions, Piedmont, Liguria, Emilia-Romagna, Tuscany, and Apulia, agreed to record mesothelioma cases according to guidelines established by ISPESL, to define exposure to asbestos and transmit the data systematically to ISPESL.

Results: Four hundred and twenty-nine mesothelioma cases, diagnosed in 1997, are recorded. The standardized annual incidence rate for definite pleural mesothelioma is 1.51 per 100,000 inhabitants (2.26 for males and 0.79 for females). Exposure was defined for 198 mesotheliomas with a histological diagnosis: 125 (63%) refer to occupational exposure, 10 (5%) to environmental exposure, and 5 (2.5%) to household exposure.

Conclusions: Despite the ReNaM's work, many limitations still have to be overcome. Clear-cut information on asbestos exposure is available for a limited number of cases; and differing regional procedures in collecting and evaluating mesotheloma cases exist. At this stage the identification and evaluation of a large number of cases of mesothelioma is a worthwhile result. This epidemiological surveillance, currently being extended to other regions, will enable us to better assess the impact and diffusion of this disease in future, and to monitor more closely the effects of ceasing asbestos use in 1992, and the efficacy of preventive measures since mid '70s. Am. J. Ind. Med. 45:55-62, 2004.

Copyright 2003 Wiley-Liss, Inc.
Mineral fiber problems and their management: UK 1890-1935. M. Greenberg. 2004;46(3):304-11. Historical article PubMed · Publisher

Abstract

Background: The first intimation that mineral fibers other than asbestos were biologically active, is generally identified with reports of experimental studies by Stanton and Wrench, and Pott and Friedrichs, in the early 1970s. In 1890 however, man-made mineral fiber was recognized to present human health hazards; in 1912 experimental study confirmed asbestos to be fibrogenic, and by 1935 other mineral fibers came to notice as potential lung hazards.

Methods: Published and archival sources have been reviewed to trace the emergence between 1890 and 1935 of the awareness of the health hazards of various fibrous minerals, and the development of strategies for their control.

Results: By the early 1900s there was evidence that the asbestos substituted for the man-made mineral fiber insulation material employed to improve the thermal efficiency of steam powered engines, presented a serious health problem. In the early 1930s, other mineral fibers came to be suspected of causing pneumoconiosis.

Conclusions: Containment, local exhaust ventilation and personal respiratory protection were instituted for the amelioration of asbestosis, but because of the limitations of what was perceived to be reasonably practicable on economic grounds, and what was feasible technologically, their benefits were severely limited. Initial and periodic medical examination were introduced as precautionary measures, based on hope rather than on experience. When in the early 1930s, the investigation of coal mine dust and siliceous dust, threw up the hypothesis that fibrous natural mineral dusts other than asbestos might be fibrogenic, this was ignored and no further investigations were pursued and no precautionary measures were set in train.
Occupational exposure to diesel and gasoline engine exhausts and risk of lung cancer among Finnish workers. J. Guo, T. Kauppinen, P. Kyyrönen, et al. 2004;45(6):483-90. PubMed · Publisher

Abstract

Background: Studies on engine exhausts and lung cancer have given inconsistent results.

Methods: Economically active Finns were followed-up for lung cancer during 1971-95 (33,664 cases). Their Census occupations in 1970 were converted to exposures to diesel and gasoline engine exhausts with a job-exposure matrix. The relative risks (RRs) for cumulative exposure (CE) were defined by Poisson regression, adjusted for smoking, asbestos, and quartz dust exposure, and socioeconomic status.

Results: RR for engine exhausts among men did not increase with increasing CE. In women, RR for gasoline engine exhaust was 1.58 (95% CI 1.10-2.26) in the CE-category of 1-99 mg/m(3)-y and 1.66 (1.11-2.50) among those with > or =100 mg/m(3)-y (lag 20 years). With a lag of 10 years RR for the middle/highest diesel exhaust category in women was 1.42 (0.94-2.13).

Conclusions: Occupational exposure to engine exhausts was not consistently associated with lung cancer in this study, possibly due to low exposure levels.

Copyright 2004 Wiley-Liss, Inc.
RE: Asbestos in brakes: exposure and risk of disease. M.J. Teta. 2004;46(3):312-4; author reply 315-8. Comment · Letter PubMed · Publisher
Statement of the Collegium Ramazzini. M. Soffritti, P.J. Landrigan. 2004;46(1):88. PubMed · Publisher
The British approach to asbestos standard setting: 1898-2000. M. Greenberg. 2004;46(5):534-41. Historical article PubMed · Publisher

Abstract

Background: The asbestos industry started in the late 1870s, and the first accounts of severe respiratory disease in its workers were published in England (1898, 1906), France (1907), and Italy (1908). For a hundred years, a series of increasingly lower standards were set for asbestos in Britain: initially they purported to prevent asbestosis, and latterly to reduce asbestosis and malignancies to acceptable levels.

Methods: Published accounts of how British asbestos exposure standards came to be derived are reviewed in the light of archival materials originated by industry and government.

Results: The earliest standard, of necessity, was not evidence based and while subsequent standards purported to relate doses to effects, the indifferent quality of the measurement of dose, and the poor discrimination of effects, militated against arriving at a standard in which trust should be placed. Each successive standard that was accepted, conformed to what could be achieved in production processes, as far as it was reasonably practicable on technological and economic grounds.

Conclusions: For the better part of a hundred years, confidence was misplaced in the ability of process engineers and physicians to protect workers against asbestos. Finally, deciding that asbestos was neither technologically nor economically essential, and was unsafe in use, Europe issued a Directive, to which Britain will conform, that will virtually ban it use throughout the Community by 2006.

Copyright 2004 Wiley-Liss, Inc.
The doctors and the dockers. M. Greenberg. 2004;45(6):573-81. Historical article PubMed · Publisher

Abstract

Background: London Dockers unloading a dusty asbestos cargo in 1965, consulted an eminent Occupational Health physician, Dr. Donald Hunter who informed them that they had been at serious risk. A second, opinion provided jointly by a Consultant Chest Physician, the Port Medical Officer, and the Medical Advisor to the Trades Union Congress, declared that they knew of no disease affecting dockers, and stated that intermittent exposure to asbestos constituted an inconsiderable risk that with certain precautions would be eradicated.

Methods: Archival material have been obtained to supplement limited published material and eyewitness accounts of the event, to provide a clearer picture of the issues.

Results: Reassured by the Chest Physician, the Port Medical Officer, and the Medical Advisor to the Trades Union Congress that they had little to fear, London dockers resumed unloading asbestos. From time to time dockers at other ports were to express concern and interrupt work, only to be similarly reassured.

Conclusions: Had the medical troika in 1965 considered the available health statistics, they would have had reason to take a less sanguine attitude to the cancer mortality of dockers. An analysis of data for 16 selected occupations for the years 1900-1902, showed dockers to have an unhealthy job, with deaths from 'All Cancers' of 1.09 per 1,000 years of life (the fourth highest). The Registrar General's occupational mortality report for 1951, noted excess tumors of the lung and stomach for dockers. Elevated Standardized Mortality Ratios for lung cancer had consistently been calculated by the Registrar General for the 20-64 age group of dockers; in 1931 (183), 1951 (149), and 1961 (169): by 1971 it would be 182. A total of 266 dockers were to be registered in the UK by 1999 as having died of malignant mesotheliomas, proving that Donald Hunter's concern for dockers had not been excessive.

Copyright 2004 Wiley-Liss, Inc.
An update of a mortality study of talc miners and millers in Italy. M. Coggiola, D. Bosio, E. Pira, et al. 2003;44(1):63-9. PubMed · Publisher

Abstract

Background: While talc containing asbestiform fibers is considered a human carcinogen, only limited animal and human data are available on non-asbestiform talc. To provide further evaluation on the issue, we updated the analysis of an Italian cohort of talc miners and millers in Val Chisone; talc found here is free from asbestiform fibers.

Methods: The cohort was comprised of 1,795 men who had worked for at least 1 year in the mine and/or in the factory between 1946 and 1995. Vital status and death certificates were obtained from registration offices in the municipality of death or of birth. Employment, termination of employment, and detailed job history were obtained from personnel records at the plant.

Results: No excess was found for total cancer mortality, nor mortality for lung cancer. No case of mesothelioma was reported. There was a significant excess mortality from non-neoplastic respiratory diseases (SMR 228.2, 95% CI 190.2-271.5). Mortality excess for non-neoplastic respiratory diseases was mainly due to silicosis.

Conclusions: This study provides additional support for an association between talc in mining and milling and non-neoplastic respiratory diseases, while showing no significant excess risk for lung cancer and mesothelioma. The results also provide additional information of interest to evaluate the potential association between silica and lung cancer.

Copyright 2003 Wiley-Liss, Inc.
Application of a method to evaluate the quality of work histories and document the exposure assessment process. C. Rice, E.F. Heineman. 2003;44(1):94-106. PubMed · Publisher

Abstract

Background: Review of work history records by industrial hygienists is an important component of many occupational epidemiologic studies. A number of factors may influence the hygienist, such as the quality of the data and his or her previous experience. As part of a case-control study of mesothelioma, a system was developed to capture data on several factors that can be considered in a review of work history information.

Methods: The overall quality of the work history record was described by noting the completeness and the consistency of the information; for any potential exposures, the reviewer experience on which the decision was based and the relative quality of the information were categorized. Because of the potential for mesothelioma cases and their next-of-kin to have undergone rigorous questioning about previous asbestos exposure an evaluation of the knowledge of the respondent was included. The frequency and intensity of exposure were also evaluated.

Results: Evaluation of 3,444 work records is described. The importance of data completeness in the overall evaluation of quality is shown; follow-up questions regarding specific work tasks provide information not elicited in the standard interview process. The use of the literature was an important resource to the reviewer. Asbestos was reported by the respondent as an exposure on 149 work records; of these, 111 (74%) were judged to represent an unusual level of knowledge for a next-of-kin respondent.

Conclusions: The approach presented allows capture of information about data quality and experience of the reviewer in an epidemiologic analysis. The ratings of frequency and intensity of exposure allow exploration of differences in exposure-response analyses using various exposure metrics.

Copyright 2003 Wiley-Liss, Inc.
Asbestos fiber length as related to potential pathogenicity: a critical review. R.F. Dodson, M.A. Atkinson, J.L. Levin. 2003;44(3):291-7. Review PubMed · Publisher

Abstract

Background: Asbestos inhalation is recognized as an exposure that increases the risk for the development of lung disease. It is unique among dusts in that it is both a carcinogen and capable of inducing extrapulmonary responses such as pleural thickening and fibrosis as well as malignancy. One feature of asbestos suggested as crucial in its pathological activity is its fibrous morphology. Long fibers that have been inhaled are cleared less readily and are thus more persistent in the body. Furthermore certain experimental models link fiber length to levels of risks for development of certain diseases. The present review will survey the data on this subject.

Methods: The review considers experimental models that have been used to assess the response to various lengths of fibers in animal models in addition to data obtained from studies of human materials. The review also emphasizes the importance in defining the method by which a sample is categorized.

Results: Data are offered which support the potential for longer fibers as well as shorter fibers to contribute to pathological responses.

Conclusions: The data presented argue that asbestos fibers of all lengths induce pathological responses and that caution should be exerted when attempting to exclude any population of inhaled fibers, based on their length, from being contributors to the potential for development of asbestos-related diseases.

Copyright 2003 Wiley-Liss, Inc.
Biological effects of asbestos: New York Academy of Sciences 1964. M. Greenberg. 2003;43(5):543-52. Historical article PubMed · Publisher

Abstract

Background: In 1964, the New York Academy of Sciences held a conference on asbestos that was to promote the slow decline in the fortunes of asbestos. It brought together a Who's Who of international scientists who had conducted and reported on experimental and human studies of the effects of asbestos. Very little new data were presented at the conference, but by bringing together a compendium of knowledge of the adverse effects of asbestos, it served further notice to asbestos-using industry of the major public health problem that they had created. With the assistance of its employees and certain scientists, industry mounted public relations exercises to counter the adverse publicity of lung cancer and malignant mesothelioma. Attempts were made to minimize the impact of these diseases by suggesting that their alleged associations with asbestos were spurious, and by diversionary ad hominem attacks on Professor Irving J. Selikoff who had played an important role in the organization of the conference.

Methods: Consideration of the contents of the meeting program, other previously published information and documents revealed through legal discovery by Chase Manhattan Bank provide the sources on which this paper is based.

Conclusions: Today, asbestos is no longer seen as a material indispensable on technical grounds and a mainstay of industry and the economy. Its progressive banning in developed countries may be seen as the consequence of the momentum initiated in New York in 1964.

Copyright 2003 Wiley-Liss, Inc.
Cancer mortality among European asphalt workers: an international epidemiological study. II. Exposure to bitumen fume and other agents. P. Boffetta, I. Burstyn, T. Partanen, et al. 2003;43(1):28-39. PubMed · Publisher

Abstract

Background: An increased risk of lung cancers among asphalt workers has been suggested in epidemiological studies based on large scale statistical analyses.

Methods: In a multi-country study of 29,820 male workers employed in road paving, asphalt mixing and roofing, 32,245 ground and building construction workers and 17,757 other workers from Denmark, Finland, France, Germany, Israel, the Netherlands, Norway, and Sweden, with mortality that was documented from 1953-2000. Exposures to bitumen fume, coal tar, 4-6 ring polycyclic aromatic hydrocarbons, organic vapor, diesel exhaust, asbestos, and silica dust were assessed via a job-exposure matrix. Standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) based on national mortality rates, as well as relative risks (RRs) based on Poisson regression models were calculated.

Results: The SMR of lung cancer among workers exposed to bitumen fume (1.08, 95% CI 0.99-1.18) was comparable to that of non-exposed workers (SMR 1.05, 95% CI 0.92-1.19). In a sub-cohort of bitumen-exposed workers without exposure to coal tar, the SMR of lung cancer was 1.23 (95% CI 1.02-1.48). The analysis based on the semi-quantitative, matrix-based exposures in the whole cohort did not suggest an increased lung cancer risk following exposure to bitumen fume. However, in an analysis restricted to road pavers, based on quantitative estimate of bitumen fume exposure, a dose-response was suggested for average level of exposure, applying a 15-year lag, which was marginally reduced after adjustment for co-exposure to coal tar. The results for cancer of the head and neck were similar to those of lung cancer, although they were based on a smaller number of deaths. There was no clear suggestion of an association with bitumen fume for any other neoplasm.

Conclusions: The results of the analysis by bitumen fume exposure do not allow us to conclude on the presence or absence of a causal link between exposure to bitumen fume and risk of cancer of the lung and the head and neck.

Copyright 2003 Wiley-Liss, Inc.
Cape Asbestos, Barking, health and environment: 1928-1946. M. Greenberg. 2003;43(2):109-19. Historical article PubMed · Publisher

Abstract

Background: The mining of chrysotile began in the province of Quebec in the late 1870s. Twenty years later, while annual exports were still measured in hundreds of tons, serious and lethal effects were being reported in England and shortly after in France. In 1913, after a number of years of operating in South Africa, Cape Asbestos Company established a factory in Britain in Barking, Essex. Some 15 years later, in 1929, the local Medical Officer of Health was seeing their asbestotic workers at his Chest Clinic, the local Chest Hospital was investigating them and publishing their findings, and the Coroner began what was to be a long series of inquests.

Methods: Documents from the Institute of Mining and Metallurgy, The Royal School of Mines, Central Library of Imperial College, The Porton and Barking Archives, and documents obtained by legal discovery were utilized in preparing this historical perspective.

Results: Despite complaints from the local authority, Parliament was assured that there was no special incidence of disease at Cape, Barking, and that its exhaust ventilation was quite up to the general standard and constantly being improved. Reports on the factory environment and information on the health of Cape's workforce that are available for the years 1928-1934, provide a less sanguine view of the situation, as was confirmed by subsequent health reports on its workforce.

Conclusions: The case of asbestos is considered as a paradigm for the economic considerations that are considered to justify the perpetuation of unsafe and unhealthy occupations, decisions with which medical opinion can be found to concur.

Copyright 2003 Wiley-Liss, Inc.
Estimating exposures in the asphalt industry for an international epidemiological cohort study of cancer risk. I. Burstyn, P. Boffetta, T. Kauppinen, et al. 2003;43(1):3-17. PubMed · Publisher

Abstract

Background: An exposure matrix (EM) for known and suspected carcinogens was required for a multicenter international cohort study of cancer risk and bitumen among asphalt workers.

Methods: Production characteristics in companies enrolled in the study were ascertained through use of a company questionnaire (CQ). Exposures to coal tar, bitumen fume, organic vapor, polycyclic aromatic hydrocarbons, diesel fume, silica, and asbestos were assessed semi-quantitatively using information from CQs, expert judgment, and statistical models. Exposures of road paving workers to bitumen fume, organic vapor, and benzo(a)pyrene were estimated quantitatively by applying regression models, based on monitoring data, to exposure scenarios identified by the CQs.

Results: Exposures estimates were derived for 217 companies enrolled in the cohort, plus the Swedish asphalt paving industry in general. Most companies were engaged in road paving and asphalt mixing, but some also participated in general construction and roofing. Coal tar use was most common in Denmark and The Netherlands, but the practice is now obsolete. Quantitative estimates of exposure to bitumen fume, organic vapor, and benzo(a)pyrene for pavers, and semi-quantitative estimates of exposure to these agents among all subjects were strongly correlated. Semi-quantitative estimates of exposure to bitumen fume and coal tar exposures were only moderately correlated. EM assessed non-monotonic historical decrease in exposures to all agents assessed except silica and diesel exhaust.

Conclusions: We produced a data-driven EM using methodology that can be adapted for other multicenter studies.

Copyright 2003 Wiley-Liss, Inc.
Exposing the "myth" of ABC, "anything but chrysotile": a critique of the Canadian asbestos mining industry and McGill University chrysotile studies. D. Egilman, C. Fehnel, S.R. Bohme. 2003;44(5):540-57. PubMed · Publisher

Abstract

Background: Beginning in the 1930s, the Canadian asbestos industry created and advanced the idea that chrysotile asbestos is safer than asbestos of other fiber types.

Methods: We critically evaluate published and unpublished studies funded by the Quebec Asbestos Mining Association (QAMA) and performed by researchers at McGill University.

Results: QAMA-funded researchers put forth several myths purporting that Quebec-mined chrysotile was harmless, and contended that the contamination of chrysotile with oils, tremolite, or crocidolite was the source of occupational health risk. In addition, QAMA-funded researchers manipulated data and used unsound sampling and analysis techniques to back up their contention that chrysotile was "essentially innocuous."

Conclusions: These studies were used to promote the marketing and sales of asbestos, and have had a substantial effect on policy and occupational health litigation. Asbestos manufacturing companies and the Canadian government continue to use them to promote the use of asbestos in Europe and in developing countries. Am. J. Ind. Med. 44:540-557, 2003.

Copyright 2003 Wiley-Liss, Inc.
Quantitative analysis of asbestos burden in women with mesothelioma. R.F. Dodson, M. O'Sullivan, D.R. Brooks, et al. 2003;43(2):188-95. PubMed · Publisher

Abstract

Background: Lung tissue from 15 women who died from mesothelioma was evaluated for tissue burden of ferruginous bodies and uncoated asbestos fibers. The group contained individuals who had occupational exposure to asbestos and others had family members whose work history included vocations where contact with asbestos containing materials occurred.

Methods: Tissue samples from tumor free lung were digested and filtered and then investigated for ferruginous bodies by light microscopy and asbestos and non-asbestos fibers by analytical transmission electron microscopy (ATEM). Size and type of fibers were also analyzed.

Results: Asbestos bodies were found in 13 of the 15 samples and asbestos fibers were found in all cases. The most commonly found uncoated asbestos fiber in these individuals was amosite whereas tremolite was the second most commonly found form. The asbestos fiber burden in these females was often of mixed types.

Conclusions: The asbestos body and fiber burden in these cases show variation in tissue burden. Some cases in this study had appreciable burden, which was attributed to secondhand exposure from occupationally exposed family members. Mesothelioma can occur also in individuals with comparatively low tissue burdens of asbestos.

Copyright 2003 Wiley-Liss, Inc.
Smoking prevalence of asbestos workers: a comment. J.H. Lange, K.W. Thomulka. 2003;44(2):218-9; author reply 220-1. Comment · Letter PubMed · Publisher
Surveillance of respiratory diseases among construction and trade workers at Department of Energy nuclear sites. J.M. Dement, L. Welch, E. Bingham, et al. 2003;43(6):559-73. PubMed · Publisher

Abstract

Background: Medical screening programs were begun in 1996 and 1997 at three Department of Energy (DOE) nuclear weapons facilities (Hanford Nuclear Reservation, Oak Ridge, and the Savannah River Site) to evaluate whether current and former construction workers are at significant risk for occupational illnesses. The focus of this report is pneumoconiosis associated with exposures to asbestos and silica among workers enrolled in the screening programs through September 30, 2001.

Methods: Workers provided a detailed work and exposure history and underwent a respiratory examination, which included a respiratory history and symptom questionnaire, a posterior-anterior (P-A) chest radiograph, and spirometry. Both stratified and multivariate logistic regression analyses were used to explore the risk of disease by duration of DOE employment and frequency of exposure, while controlling for potential confounders such as age, race, sex, and other work in the construction and building trades.

Results: Of the 2602 workers, 25.2% showed one or more chest X-ray changes by ILO criteria and 42.7% demonstrated one or more pulmonary function defects. The overall prevalence of parenchymal changes by ILO criteria (profusion 1/0 or greater) was 5.4%. In the logistic regression models, the odds ratio for parenchymal disease was 2.6 (95% confidence interval (CI) = 1.0-6.6) for workers employed 6 to 20 years at Hanford or Savannah River and increased to 3.6 (95% CI = 1.1-11.6) for workers employed more than 35 years, with additional incremental risks for workers reporting routine exposures to asbestos or silica.

Conclusions: Continued surveillance of workers is important given their increased risk of disease progression and their risk for asbestos related malignancies. Smoking cessation programs should also be high priority and continued abstinence for former smokers reinforced. Although the observed respiratory disease patterns are largely reflective of past exposures, these findings suggest that DOE needs to continue to review industrial hygiene control programs for work tasks involving maintenance, repair, renovation, and demolition.

Copyright 2003 Wiley-Liss, Inc.
Asbestos screenings. D. Egilman. 2002;42(2):163. Letter PubMed · Publisher
Association between asbestos exposure, cigarette smoking, myeloperoxidase (MPO) genotypes, and lung cancer risk. M.B. Schabath, M.R. Spitz, G.L. Delclos, et al. 2002;42(1):29-37. PubMed · Publisher

Abstract

Background: As observed in tobacco-associated carcinogenesis, genetic factors such as the polymorphic metabolic/oxidative enzyme myeloperoxidase (MPO) could modulate individual susceptibility to asbestos-associated carcinogenesis.

Methods: RFLP-PCR analysis identified the MPO genotypes in 375 Caucasian lung cancer cases and 378 matched controls. An epidemiological interview elicited detailed information regarding smoking history and occupational history and exposures.

Results: Asbestos exposure was associated with a significantly elevated risk estimate (OR = 1.45; 95% CI 1.04-2.02). On stratified analysis, we found the MPO genotypes modified the effect of asbestos exposure on lung cancer risk. Specifically, G/G carriers who were exposed to asbestos had an odds ratio (OR) of 1.72 (95% CI; 1.09-2.66), while A-allele carriers (G/A + A/A) exposed to asbestos exhibited a reduced OR of 0.89 (95% CI; 0.56-1.44). The OR was further reduced to 0.73 (0.49-1.06) for A-allele carriers not exposed to asbestos. A similar trend was observed for the joint effects between the MPO genotypes and pack-years smoking. Next, all three risk factors (MPO genotypes, asbestos exposure, and smoking) were analyzed simultaneously for joint effects. Heavy smokers with the G/G genotype and a history of asbestos exposure demonstrated a statistically significant elevated risk estimate (OR = 2.19; 95% CI 1.16-4.11), while the A-allele carriers with the same exposure profile were at a lower risk for lung cancer (OR = 1.18; 95% CI 0.58-2.38). The A-allele genotypes demonstrated similar protective effects for the other three exposure profiles.

Conclusions: For a similar level of exposure to established carcinogens, individuals with the MPO A-allele genotypes appear to have a reduced risk of lung cancer.

Copyright 2002 Wiley-Liss, Inc.
Development of a medical examination program for former workers at a Department of Energy national laboratory. P.N. Breysse, V. Weaver, M. Cadorette, et al. 2002;42(5):443-54. PubMed · Publisher

Abstract

Background: As a part of the U.S. Department of Energy (DOE) Former Workers' Medical Surveillance Program, a Needs Assessment was conducted at Los Alamos National Laboratory (LANL). The objective was to identify former LANL employees who may be at significant risk for occupational disease and determine whether a medical examination program could reduce morbidity or mortality. We describe the needs assessment approach used at LANL.

Methods: An algorithm was developed to make needs determinations. Information on factors including exposure, health impacts, size of exposed populations, and LANL worker concerns and recommendations were obtained. Each of these factors was scored from 1 to 3. The resulting factor sum was then multiplied by a binary (1 or 0) intervention suitability factor which was 1 if both of the following were available: (1) a screening test with acceptable sensitivity and specificity for the health outcome of concern; and (2) an intervention that decreases morbidity or mortality. This resulted in an Intervention Needs Score that was used to set priorities for the medical examination program for the estimated 35,000 former LANL workers.

Results: Analysis of the algorithm output suggested that six exposure categories be recommended for consideration in a medical examination program. Beryllium, asbestos, and noise clearly warranted inclusion. Lead and ionizing radiation required careful consideration regarding availability of screening tests. Solvents were problematic due to the lack of screening tests and suitable intervention in formerly exposed workers.

Conclusions: The algorithm approach to the needs assessment at LANL documented that six chemical and physical agents should be considered as candidates for inclusion in a medical examination program for former workers.

Copyright 2002 Wiley-Liss, Inc.
Estimation of the incidence of pleural mesothelioma according to death certificates in France. Y. Iwatsubo, M. Matrat, E. Michel, et al. 2002;42(3):188-99. PubMed · Publisher

Abstract

Background: The number of cases of pleural mesothelioma in France has varied substantially according to methods of assessment.

Materials And Methods: We collected information from certifying physicians about 316 subjects who died between 1 July 1992 and 30 June 1993 in three regions of France with a cause of death coded as ICD-9 category 163. The ICD codes selected as the cause of death for 178 deaths between 1 January 1987 and 31 December 1992 histologically confirmed and diagnosed as pleural mesothelioma by an expert committee were examined. Finally, we used this information to estimate the number of deaths from pleural mesothelioma in France in 1992.

Results: In Part I, 45% (men: 54%; women: 28%) of the cases coded as ICD-9 section 163 were definitely or probably mesothelioma; 18% (men: 16%; women: 21%) possibly mesothelioma; and 37% (men: 30%; women: 51%) other tumors, primarily adenocarcinoma metastases. In Part II, 74% of the confirmed pleural mesotheliomas were coded in category 163 (men: 75%; women: 70%). Extrapolation nationwide indicated that 902 deaths were coded as ICD-9 163 in 1992: 521 cases involved definite or probable mesothelioma and 724 definite, probable, and possible cases.

Conclusions: The analysis of this sample suggests that estimating the number of mesothelioma cases from the cause-of-death statistics may overestimate their incidence, but that death certificates appeared to report the diagnosis of histologically confirmed mesothelioma accurately.

Copyright 2002 Wiley-Liss, Inc.
Malignant mesothelioma in Australia, 1945-2000. J. Leigh, P. Davidson, L. Hendrie, et al. 2002;41(3):188-201. PubMed · Publisher

Abstract

Background: Australia has maintained a total national malignant mesothelioma case register since 1980. There has been a marked increase in the incidence of mesothelioma in the last 20 years. Currently 450-600 cases are notified annually in a population of 20 million. While the history of the Wittenoom (Western Australia) crocidolite mine and its aftermath is well known, these cases comprise only 5% of the total. This study describes the incidence of mesothelioma in Australia from 1945 to 2000.

Methods: Using register data, time trends in mesothelioma incidence were calculated. Analyses of incidence are reported by age, sex, anatomical site, and state of notification. Associations with occupational and environmental asbestos exposure histories are described. Lung fiber content measurements were made on a subset of cases.

Results: Australia has had 6,329 cases of mesothelioma from 1 January 1945 to 31 December 2000. (A further 620 cases were notified in the period from 1 January 2001 to 31 October 2001.) Annual incidence rates for Australia per million population > or = 20 years (1997) were: male, 59.8; female, 10.9; total, 35.4. Incidence rates have been continually increasing and are the highest reported national rates in the world. While Western Australia has the highest rate (1997 total rate, 52.8), most cases arise from the two most populous eastern states, New South Wales and Victoria. In 88% (male 90%, female 61%) of cases, a history of asbestos exposure was obtained. Exposures occurred in a wide variety of occupational and environmental circumstances. In 80% of cases with no history of exposure, TEM lung asbestos fiber counts > 200,000 fibers > 2 microm length per gm dry lung were obtained, suggesting unrecognized exposure.

Conclusions: Australia's high incidence of mesothelioma is related to high past asbestos use, of all fiber types, in a wide variety of occupational and environmental settings. The number of cases in total is expected to be about 18,000 by 2020, with about 11,000 yet to appear.

Copyright 2002 Wiley-Liss, Inc.
Past asbestos exposure levels in foundries and cement-asbestos factories. S. Mattioli, D. Nini, G. Mancini, et al. 2002;42(4):363. Letter · Comment PubMed · Publisher
Re: Malignant mesothelioma from neighborhood exposure to anthophyllite asbestos. M. Kottek, D. Kilpatrick. 2002;41(6):514. Comment · Letter PubMed · Publisher
Respiratory cancer and exposure to man-made vitreous fibers: a systematic review. D. Berrigan. 2002;42(4):354-62. Meta-analysis · Systematic review PubMed · Publisher

Abstract

Background: Man-made vitreous fibers (MMVF's) have some structural features similar to those found in asbestos. This has lead to concern that exposure to MMVF's could increase the risk of respiratory cancer.

Methods: Bibliographic resources were used to identify 10 case-control and 10 cohort studies, which analyzed the relationship between exposure to MMVF's and cancer of the respiratory system. Standardized mortality ratio's (SMR's) were extracted from the cohort studies for a meta-analysis.

Results: A significant increase in SMR was observed for workers exposed to rock and glass wool, but not in workers exposed to glass filament. Meta-analysis of SMR's after stratification by fiber type resulted in aggregate estimates of risk of 1.23 (95% CI = 1.10-1.38), 1.08 (95% CI = 0.93-1.26), and 1.32 (95% CI = 1.15-1.52) for exposure to glass wool, glass filament, and rock wool, respectively. Some or all of the increased mortality could be attributed to tobacco use.

Conclusions: The results highlight the difficulty of assessing small increases in risk of respiratory cancer potentially caused by occupational exposure in populations with high prevalence of tobacco use.

Published 2002 Wiley-Liss, Inc.
Safety and health of heavy equipment operators at Ground Zero. B.E. Lippy. 2002;42(6):539-42. PubMed · Publisher
Study of smoking behavior in asbestos workers. O.Y. Osinubi, A.A. Afilaka, J. Doucette, et al. 2002;41(1):62-9. PubMed · Publisher

Abstract

Background: Asbestos exposure and concomitant cigarette smoking markedly increase the risk of lung cancer and contribute to the prevalence and severity of pulmonary interstitial fibrosis.

Methods: A cross-sectional survey of 214 asbestos workers was initiated to determine the prevalence of smoking and their readiness to quit smoking using the stage of change theory.

Results: The study was comprised of 61 never smokers (28.5%), 118 ex-smokers (55.1%), and 35 current smokers (16.4%). Reasons for smoking cessation in ex-smokers included perception of ill-health (51%) and knowledge of smoking-asbestos hazards (3.4%). Stage of change of current smokers revealed: precontemplation (26.5%), contemplation (35%), preparation (29%), and action (8.8%). Current smokers had the highest prevalence of small airway obstruction on spirometry.

Conclusions: A detailed smoking history during medical surveillance activities will enable the occupational physician to identify asbestos workers who have difficulty quitting and to develop a system in which such individuals can be referred to comprehensive smoking cessation programs.

Copyright 2002 Wiley-Liss, Inc.
The exposure-time-response relationship between occupational asbestos exposure and lung cancer in two German case-control studies. M. Hauptmann, H. Pohlabeln, J.H. Lubin, et al. 2002;41(2):89-97. PubMed · Publisher

Abstract

Background: Numerous studies have been carried out to evaluate the association between lung cancer and occupational asbestos exposure. However, the effects of timing of exposure have not been analyzed thoroughly.

Methods: Two German case-control studies with data on occupational asbestos exposure histories have been pooled. Duration of work in potentially asbestos exposed jobs and two derived weighted exposure measures are analyzed together with time since last exposure. A spline function is used to model the effect of time since exposure.

Results: The odds ratios (OR) and corresponding 95% confidence intervals were 1.8 (1.2, 2.7) and 2.4 (1.7, 3.4) for subjects having worked for 3 to 7 years and 8 or more years, respectively, in a job with potential asbestos exposure compared to never-exposed. Based on an evaluation of time since last exposure, the OR decreased significantly to about one-half after more than 20 years since exposure ceased. Using a spline function, applied to workers' complete exposure histories, the effect of an increment of exposure is greatest 10-15 years after that exposure was received.

Conclusions: In contrast to previous indications, the risk of lung cancer increases soon after asbestos exposure, with its maximum effect from 10 to 15 years after the exposure was received.
A case-control study of the relationship between the risk of colon cancer in men and exposures to occupational agents. M.S. Goldberg, M.E. Parent, J. Siemiatycki, et al. 2001;39(6):531-46. PubMed · Publisher

Abstract

Background: We conducted a population-based case-control study in Montreal, Canada, to explore associations between hundreds of occupational circumstances and several cancer sites, including colon.

Methods: We interviewed 497 male patients with a pathologically confirmed diagnosis of colon cancer, 1514 controls with cancers at other sites, and 533 population-based controls. Detailed job histories and relevant potential confounding variables were obtained, and the job histories were translated by a team of chemists and industrial hygienists into a history of occupational exposures.

Results: We found that there was reasonable evidence of associations for men employed in nine industry groups (adjusted odds ranging from 1.1 to 1.6 per a 10-year increase in duration of employment), and in 12 job groups (OR varying from 1.1 to 1.7). In addition, we found evidence of increased risks by increasing level of exposures to 21 occupational agents, including polystyrene (OR for "substantial" exposure (OR(subst)) = 10.7), polyurethanes (OR(subst) = 8.4), coke dust (OR(subst) = 5.6), mineral oils (OR(subst) = 3.3), polyacrylates (OR(subst) = 2.8), cellulose nitrate (OR(subst) = 2.6), alkyds (OR(subst) = 2.5), inorganic insulation dust (OR(subst) = 2.3), plastic dusts (OR(subst) = 2.3), asbestos (OR(subst) = 2.1), mineral wool fibers (OR(subst) = 2.1), glass fibers (OR(subst) = 2.0), iron oxides (OR(subst) = 1.9), aliphatic ketones (OR(subst) = 1.9), benzene (OR(subst) = 1.9), xylene (OR(subst) = 1.9), inorganic acid solutions (OR(subst) = 1.8), waxes, polishes (OR(subst) = 1.8), mononuclear aromatic hydrocarbons (OR(subst) = 1.6), toluene (OR(subst) = 1.6), and diesel engine emissions (OR(subst) = 1.5). Not all of these effects are independent because some exposures occurred contemporaneously with others or because they referred to a group of substances.

Conclusions: We have uncovered a number of occupational associations with colon cancer. For most of these agents, there are no published data to support or refute our observations. As there are few accepted risk factors for colon cancer, we suggest that new occupational and toxicologic studies be undertaken focusing on the more prevalent substances reported herein.

Copyright 2001 Wiley-Liss, Inc.
A historical cohort mortality study among shipyard workers in Genoa, Italy. R. Puntoni, F. Merlo, L. Borsa, et al. 2001;40(4):363-70. PubMed · Publisher

Abstract

Background: A historical cohort mortality study was conducted among 3984 shipyard workers assigned to ship repair, refitting, and construction in the harbor of Genoa, Italy, between 1960 and 1981. These workers were exposed to asbestos fibers, welding fumes and gases, silica dust, polycyclic aromatic hydrocarbons, and solvents.

Methods: Workers were classified in 20 different job-titles depending upon the type of activity. Standardized mortality ratios (SMRs) were computed using male residents of the Province of Genoa as the referent population.

Results And Conclusions: For the whole cohort significantly increased SMRs were detected for all causes, all cancers, liver, larynx, lung, pleural and bladder cancers, respiratory tract diseases, and cirrhosis of the liver. The analysis by job-title showed increased SMRs not only for pleural cancer, but also for lung, laryngeal cancers and respiratory tract diseases in occupations entailing heavy asbestos exposure. Bladder and liver cancers and liver cirrhosis mortality also appeared to be related to occupational exposure.

Copyright 2001 Wiley-Liss, Inc.
Asbestos and man-made vitreous fibers as risk factors for diffuse malignant mesothelioma: results from a German hospital-based case-control study. K. Rödelsperger, K.H. Jöckel, H. Pohlabeln, et al. 2001;39(3):262-75. PubMed · Publisher

Abstract

Background: This study examines the role of occupational factors in the development of diffuse malignant mesothelioma with special emphasis on the dose-response relationship for asbestos and on the exposure to man-made vitreous fibers (MMVFs).

Methods: One hundred and twenty-five male cases, diagnosed by a panel of pathologists, were personally interviewed concerning their occupational and smoking history. The same number of population controls (matched for sex, age and region of residence) underwent similar interviews by trained interviewers. Odds ratios (OR) were calculated for an expert-based exposure index using conditional logistic regression.

Results: Exposure to asbestos shows the expected sharp gradient with an OR of about 45 for a cumulative exposure > 1.5 fiber years (arithmetic mean 16 fiber years). A significant OR was calculated even for the lowest exposure category "> 0 - < or = 0.15 fiber years". Although the mean cumulative exposure to MMVF is roughly 10% of the exposure to asbestos, an increased OR is observed in an ever/never evaluation. This observation is heavily hampered by methodical problems. A corresponding case-control study was performed using a lung tissue fiber analysis in addition to interviews. Both interviews and the lung tissue analysis yielded similar OR levels between the reference and the maximum exposure intervals.

Conclusions: Despite a possible influence as a result of selection and information bias, our results confirm the previously reported observation of a distinct dose-response relationship even at levels of cumulative exposure below 1 fiber year. Moreover, the study confirms that asbestos is a relevant confounder for MMVF. A causal relationship between exposure to MMVF and mesothelioma could neither be detected nor excluded, as in other studies.

Copyright 2001 Wiley-Liss, Inc.
Increased body mass index is related to apparent circumscribed pleural thickening on plain chest radiographs. Y.C. Lee, C.K. Runnion, S.C. Pang, et al. 2001;39(1):112-6. PubMed · Publisher

Abstract

Background: Diffuse pleural thickening and pleural plaques are the commonest radiological manifestations of asbestos exposure. Differentiation between subpleural fat and non-calcified pleural plaques is important clinically and medico-legally. This study aims to determine if apparent circumscribed pleural thickening on chest radiographs is related with obesity.

Methods: Surveillance chest x-rays of 693 former asbestos workers were read with the ILO classification. Subjects with costophrenic angle obliteration (n = 57) were analyzed separately. The remaining subjects were subdivided according to their body mass index (BMI): Group 1 < 26 kg/m(2); Group 2 26-30 kg/m(2); Group 3 > 30 kg/m(2).

Results: Baseline characteristics, asbestos exposure, and profusion scores were evenly distributed. BMI of > 30 kg/m(2) was associated with a higher prevalence of pleural thickening on CXR (Gp1 = 8.5%; Gp2 = 9.3%; Gp3 = 18.3%). This relationship was strongest in the subgroups with 25-50% of the lateral chest wall involved and pleural thickness of < 10 mm.

Conclusions: Obesity (BMI > 30 kg/m(2)) is related to apparent circumscribed pleural thickening on CXR, especially thin (< 1 cm) shadows covering 25-50% of the lateral chest wall.

Copyright 2001 Wiley-Liss, Inc.
Malignant mesothelioma from neighborhood exposure to anthophyllite asbestos. W.N. Rom, S.P. Hammar, V. Rusch, et al. 2001;40(2):211-4. Case report PubMed · Publisher

Abstract

Background: Anthophyllite asbestos has been reported to cause asbestosis, lung cancer, mesothelioma, and pleural plaques in occupationally exposed workers. Anthophyllite has also been associated with pleural plaques in Finland and Japan among those who live near mines and mills and have neighborhood or environmental exposure.

Methods: We evaluated a 38-year-old patient with pleural mesothelioma who lived, attended school, and delivered newspapers near a manufacturing facility that used exclusively anthophyllite asbestos fiber from ages 8-17 years. He had no work exposure to asbestos.

Results: The pleural mesothelioma was an epithelial type with tubulopapillary structures and was treated with an extrapleural pneumonectomy followed by radiation therapy. The malignant cells were positive by immunohistochemistry for cytokeratin but negative for carcinoembryonic antigen, S100, B72.3, and leu M1 antigen. Anthophyllite fibers were > 5 microm in length in lung tissue compared to 3 microm from a general population study.

Conclusions: Anthophyllite asbestos has been associated with neighborhood environmental exposure and pleural plaques; we now report a neighborhood exposure and pleural mesothelioma.

Copyright 2001 Wiley-Liss, Inc.
Malignant pleural mesothelioma in bakers and pastry cooks. V. Ascoli, R. Calisti, C. Carnovale-Scalzo, et al. 2001;40(4):371-3. Case report PubMed · Publisher

Abstract

Background: The occurrence of malignant pleural mesothelioma (MPM) among bakers and pastry cooks has never been documented.

Case Reports: We detected eight cases of MPM in bakers, pastry cooks, and biscuit cooks engaged in making, baking/cooking, and selling pastry/bread in two hospital-based series (Rome and Orbassano/Turin, Italy; period 1990-1997; 222 cases). Field-investigations revealed asbestos-containing material (ACM) in ovens for baking bread, that were manufactured prior to the 1980s.

Conclusions: It is suggested that there is a possible new association of the risk of having worked as a baker or pastry cook and MPM. Presumptive source of exposure to asbestos was the use of asbestos-insulated ovens.

Copyright 2001 Wiley-Liss, Inc.
Mortality among unionized construction plasterers and cement masons. F. Stern, E. Lehman, A. Ruder. 2001;39(4):373-88. PubMed · Publisher

Abstract

Background: Plasterers perform a variety of duties including interior and exterior plastering of drywall, cement, stucco, and stone imitation; the preparation, installation, and repair of all interior and exterior insulation systems; and the fireproofing of steel beams and columns. Some of the current potential toxic exposures among plasterers include plaster of Paris, silica, fiberglass, talc, and 1,1,1-trichloroethylene; asbestos had been used by the plasterers in the past. Cement masons, on the other hand, are involved in concrete construction of buildings, bridges, curbs and gutters, sidewalks, highways, streets and roads, floors and pavements and the finishing of same, when necessary, by sandblasting or any other method. Exposures include cement dust, silica, asphalt, and various solvents.

Methods: Proportionate mortality ratios (PMRs) and proportionate cancer mortality ratios (PCMRs) were calculated for 99 causes of death among 12,873 members of the Operative Plasterers' and Cement Masons' International Association who died between 1972 and 1996 using United States age-, race-, and calender-specific death rates. Statistical significance (P value) of results was based upon the Poisson distribution.

Results: Among plasterers, statistically significant elevated mortality was observed for asbestosis, where the PMR reached 1,657 (P < 0.01) with eleven observed deaths and less than one death expected, for lung cancer (PCMR = 124, P < 0.01), and for benign neoplasms (PMR = 210, P < 0.05). Among cement masons, statistically significant elevated mortality was observed for cancer of the stomach (PCMR = 133, P < 0.01), benign neoplasms (PMR = 132, P < 0.01), and poisonings (PMR = 159, P < 0.05). Except for poisonings, which were not thought to be occupationally related, all of the statistically significant results occurred among those members who entered the union prior to 1950. However, the risk for lung cancer among plasterers was still elevated among those entering the union after 1970 as was the risk for stomach cancer among cement masons who entered the union after 1950.

Conclusions: The present study suggests that plasterers and cement masons still have elevated risks for certain diseases, especially lung and stomach cancer. Therefore, union members currently living should be screened for asbestos-related diseases and educated about the future risks for these diseases.
Non-malignant asbestos-related diseases in Brazilian asbestos-cement workers. E. Algranti, E.M. Mendonça, E.M. DeCapitani, et al. 2001;40(3):240-54. PubMed · Publisher

Abstract

Background: Production of asbestos-cement products in Brazil started in the 1940s, peaked in the 60-70s and is still an active industry. This study was designed to assess the non-malignant effects of asbestos exposure in the asbestos-cement industry in Brazil.

Methods: A group of 828 former asbestos-cement workers enrolled in a cross-sectional and cohort study of respiratory morbidity, submitted to a detailed occupational history, respiratory symptoms questionnaire, spirometry, PA chest x-ray, and high resolution computed chest tomography (HRCT). Asbestos exposure was assessed by years of exposure, cumulative exposure (a semi-quantitative method), and latency time from first exposure. Asbestosis and pleural thickening were assessed according to HRCT criteria.

Results: Asbestosis was present in 74 (8.9%) and pleural thickening in 246 (29.7%). Using the HRCT as the "best available evidence", it was shown that were more false negatives than false positives in the x-ray readings for parenchymal (21.6% false negatives, 4.2% false positives) and pleural (26.0% false negatives, 14.4% false positives) diseases due to asbestos. Latency time from first exposure was the best predictor for both asbestosis and pleural thickening. Subjects in the higher exposure groups presented lower levels of lung function. Obstructive defects were significantly related to smoking, shortness of breath, body mass index, and age, whereas restrictive defects were related to asbestosis, shortness of breath, and latency time. Chronic bronchitis increased with latency time in the three smoking groups and was significantly related to pleural thickening (OR 1.56 (1.00-2.42)). Shortness of breath was significantly associated with body mass index and pleural thickening (OR 1.30 (1.24-2.09)).

Conclusions: Pleural thickening and asbestosis showed a significant association with latency time and exposure. FVC and FEV(1) decreased across increasing profusion with an added effect of pleural thickening. There was a significant and independent effect of exposure on lower levels of FVC and FEV(1). Obstructive defects were mainly related to smoking and restriction to asbestosis. Dust exposure and smoking were synergistic in increasing chronic bronchitis and shortness of breath report. Shortness of breath report was also related to pleural thickening and higher body mass index.

Copyright 2001 Wiley-Liss, Inc.
Re: Doll's 1955 study on cancer from asbestos. B.I. Castleman. 2001;39(2):237-40. Historical article PubMed · Publisher

Summary

This commentary examined the history of Richard Doll's 1955 report on lung cancer among workers at a Turner & Newall (T&N) asbestos plant in Rochdale, England. It drew on company documents obtained in legal discovery, correspondence, court records, and the author's 2000 interview and letters with Doll. The 1955 study had shown a 10-fold excess of lung cancer among men who worked 20 years or more in the plant's 'scheduled' areas. The author described T&N's efforts in 1954 to block publication. These included disapproving of company medical officer John Knox being listed as co-author, drafting a letter threatening legal action, approaching the journal editor, and an executive pressing Doll to withdraw the paper. The originally submitted manuscript concluded that insufficient data were available to determine whether the excess risk had been eliminated. The published version instead concluded that the risk had diminished after the 1932 regulations. The author also described Doll's later co-authored follow-up studies, his 1980s affidavits for Johns-Manville and T&N, and his 1982 talk to Rochdale workers about cancer risk at 1 f/cc. In correspondence, Doll stated that the changes resulted from reviewers' comments and his further analyses. The author concluded that it was not clear the changes arose exclusively from referees' recommendations. He wondered how high the price of rapprochement between T&N and Doll had been.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
RE: Mesothelioma and lung tumors attributable to asbestos among petroleum workers. Am. J. Ind. Med. 2000. 37:275-282. W.J. Bailey. 2001;39(5):513-4, 522-3; author reply 517-21. Comment · Letter PubMed · Publisher
RE: Mesothelioma and lung tumors attributable to asbestos among petroleum workers. Am. J. Ind. Med. 2000. 37:275-282. E.R. Ludwig, L. Madeksho, D. Egilman. 2001;39(5):524-7. Comment · Letter PubMed · Publisher

Summary

In this letter, the authors responded to Gennaro et al. (2000), the latest in a series of articles on asbestos effects in petroleum refinery workers, and to the wider controversy over cancer rates in chemical and petroleum refinery workers. They argued that the petroleum and chemical industries used their own negative epidemiological studies of workers to oppose EPA and OSHA regulation and to avoid paying compensation. They stated that these campaigns were run by the same firms and individuals who had obscured the link between tobacco smoke and lung cancer. Citing industry documents, they stated that petroleum companies had recognized since the 1930s that exposures in their plants, including asbestos, could cause cancer and pneumoconiosis. They described practices that they said produced low or inverse rate ratios: excluding "contract workers", the practice of "tolling", and using general-population rather than unexposed company workers as controls for standardized mortality ratios. They noted a 1960 report, co-authored by Texaco's medical director, of two mesothelioma cases in asbestos workers at the Port Arthur, Texas, refinery. They also noted that Selikoff et al. (1979) reported many such cases among union contract workers, who had the heaviest asbestos exposures but were not included in company studies. The authors concluded that there can be no doubt that asbestos causes lung cancer and mesothelioma, and that refinery studies finding otherwise reveal problems in study design, data collection or analysis.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
RE: Mesothelioma and lung tumors attributable to asbestos among petroleum workers. Am. J. Ind. Med. 2000. 37:275-282. S.P. Tsai, L.C. Waddell, J.C. Ransdell. 2001;39(5):515-21; author reply 517-21. Comment · Letter PubMed · Publisher
Re: mortality among workers in the geothermal power plants at Larderello, Italy. Am. J. Ind. Med. 35:536-539, 2000. E. Merler, S. Silvestri, L. Mauro, et al. 2001;39(4):436-7; author reply 438. Comment · Letter PubMed · Publisher
Re: Researchers should talk to workers. Am. J. Ind. Med. 2000. 37:668. J.C. McDonald. 2001;39(3):346-7. Comment · Letter PubMed · Publisher
Asbestos content in the lymph nodes of nonoccupationally exposed individuals. R.F. Dodson, J. Huang, J.R. Bruce. 2000;37(2):169-74. PubMed · Publisher

Abstract

Background: The thoracic lymph nodes are a part of the clearance system from lung tissue. Accumulation of dust in these nodes are known to occur following some types of exposure. However, no information exists as to asbestos content in lymph nodes from the general population.

Methods: The study cohort consisted of 21 individuals previously defined as nonoccupationally exposed to asbestos. Tissue burden of asbestos obtained from lung analysis by analytical electron microscopy was compared with burden in the lymph nodes.

Results: No asbestos fibers were detected in nodes from 8 cases. The majority of the fibers found in lymph nodes were short (<5 microm) and most often noncommercial amphiboles. Ferruginous bodies (FBs) were detected in lymph node from only two samples.

Conclusions: The total asbestos burden in the lung tissue from these individuals was quite low. However, in 12 of the 13 cases that had positive nodes, the tissue burden in the node was appreciably heavier per gram than in the lung. This raises the question as to whether the lymph nodes, though less efficient clearance, may be better indicators of lifetime exposure to dust than lung tissue.

Copyright 2000 Wiley-Liss, Inc.
Laryngeal and hypopharyngeal cancer and occupational exposure to asbestos and man-made vitreous fibers: results of a case-control study. J.L. Marchand, D. Luce, A. Leclerc, et al. 2000;37(6):581-9. PubMed · Publisher

Abstract

Background: The data from a case-control study performed in France between 1989 and 1991 were used to test whether exposure to either asbestos or to man-made vitreous fibers (MMVF) is a risk factor for cancer of the larynx or the hypopharynx.

Methods: This study involved 315 incident cases of laryngeal cancer, 206 cases of hypopharyngeal cancer, and 305 hospital-based controls with other types of cancer, all recruited in 15 hospitals in six French cities. The subjects' past occupational exposure to asbestos and to four types of MMVF (mineral wool, refractory ceramic fibers, glass filaments, and microfibers) was evaluated based on their job history, with the aid of a job-exposure matrix. Odds ratios were calculated with unconditional logistic regression, with adjustment for smoking and drinking levels.

Results: Exposure to asbestos resulted in a significant increase in the risk of hypopharyngeal cancer (OR = 1.80, 95% CI: 1.08-2.99) and a nonsignificant increase in the risk of laryngeal cancer (OR = 1.24, 95% CI: 0.83-1.90). Risk was highest for the epilarynx (highest cumulative level of exposure: OR = 2.22, 95% CI: 1.05-4.71). Exposure to mineral wools was of borderline significance for the risk of hypopharyngeal cancer (OR = 1.55, 95% CI: 0.99-2.41), and nonsignificantly associated with the risk of laryngeal cancer (OR-1.33, 95% CI: 0.91-1.95). The risk was again highest for the epilarynx (OR = 1.85, 95% CI: 1.08-3.17). No significant results were observed for the other MMVF.

Conclusions: These results suggest that asbestos exposure increases the risk of epilaryngeal and hypopharyngeal cancers. It is difficult to reach a conclusion about the effects of mineral wools, because nearly all the exposed subjects were also exposed to asbestos. The possible effects of other MMVF were difficult to assess in this study, because of the paucity of exposed subjects.

Copyright 2000 Wiley-Liss, Inc.
Lung cancer and exposure to man-made vitreous fibers: results from a pooled case-control study in Germany. H. Pohlabeln, K.H. Jöckel, I. Brüske-Hohlfeld, et al. 2000;37(5):469-77. PubMed · Publisher

Abstract

Background: To investigate the association between lung cancer and occupational exposure to man-made vitreous fibers (MMVF), a pooled analysis of two case-control studies was conducted in the years 1988-1994.

Methods: The case series consisted of 3498 males who were histologically or cytologically verified primary lung cancer cases. 3541 male population controls were drawn at random from the general population and matched to cases by sex, age, and place of residence. To examine the relationship between MMVF and lung cancer we asked all study subjects who worked for at least 6 months as construction and installation workers whether they ever installed or removed insulations and what kind of insulation material they used.

Results: Some 304 (8.7%) cases and 170 (4.8%) controls reported to have insulated with glass wool or mineral wool mats. Coded as ever/never exposed, the odds ratio was 1.48 (95% CI: 1.17-1.88), adjusted for smoking and asbestos. To be sure to exclude any confounding effect of asbestos, we tried to identify those cases and controls who insulated with glass wool or mineral wool mats only and never reported any asbestos exposure. For this group we calculated an odds ratio of 1.56 (95% CI: 0.92-2.65), after adjustment for smoking. An elevated risk was also estimated on the basis of an expert rating which was done for a subgroup of cases and controls. Ever exposure to MMVF (but not to asbestos) in this subgroup yielded an odds ratio of 1.30 (95% CI: 0.82-2.07).

Conclusions: Our study provides some indication for an excess risk of man-made vitreous fibers. This result also persists after adjustment for smoking and asbestos.

Copyright 2000 Wiley-Liss, Inc.
Lung cancer risk of workers in shoe manufacture and repair. K.H. Jöckel, H. Pohlabeln, U. Bolm-Audorff, et al. 2000;37(6):575-80. PubMed · Publisher

Abstract

Background: The occupational lung cancer risk in manufacturing and repair of shoes was studied by pooling of two major case-control studies from Germany.

Methods: Some 4184 incident hospital-based cases of primary lung cancer and 4253 population controls, matched for sex, age, and region of residence were intensively interviewed with respect to their occupational and smoking history. Based on the occupational coding and a free text search, all individuals who had ever worked in shoe manufacturing or repair for at least half a year were identified. Shoemaker-years were calculated as the cumulated duration of working in shoe manufacturing or repair. Odds ratios (OR) and 95% confidence intervals (CI) were calculated via conditional logistic regression. Additional adjustment for smoking and occupational asbestos exposure was used.

Results: Seventy-six cases and 42 controls who had ever worked in shoe manufacture or repair (OR = 1.89, 95% CI: 1.29-2.78). After adjustment for smoking, this risk was lowered to 1.69 (95% CI: 1.09-2.62). Further adjustment for asbestos exposure only slightly changed the risk estimates upwards. The smoking adjusted OR in males was 1.50 (95% CI: 0.93-2.41) and 2.91 (95% CI: 0.90-9.44) in females. Logistic regression modeling showed a positive dose-effect relationship between duration of exposure in shoe manufacture and repair and lung cancer risk. The odds ratio for 30 years of exposure varied between 1.98 and 2.24 depending on the model specified.

Conclusions: The study demonstrates an increased lung cancer risk for shoemakers and workers in shoe manufacturing. The risk seems to double after being 30 years in these occupations.

Copyright 2000 Wiley-Liss, Inc.
Malignant pleural mesothelioma presenting as spontaneous pneumothorax: a case series and review. S. Alkhuja, A. Miller, A.J. Mastellone, et al. 2000;38(2):219-23. Case report PubMed · Publisher

Abstract

Background: Malignant pleural mesothelioma (MPM) is thought to arise from the mesothelial cells that line the pleural cavities. Most patients initially experience the insidious onset of chest pain or shortness of breath, and it rarely presents as spontaneous pneumothorax.

Case Reports: We report four patients who presented in this manner. Three of the patients were exposed to asbestos directly or indirectly at shipyards during World War II; the fourth was exposed as an insulator's wife. Two of our cases were not recognized to have MPM on histologic examination at first thoracotomy and remained asymptomatic for 12 and 22 months, respectively. In none of the patients described herein, was spontaneous pneumothorax the cause of death.

Conclusions: Since many people were exposed to asbestos during and after World War II, spontaneous pneumothorax in a patient with the possibility of such exposure should raise the suspicion of malignant pleural mesothelioma.

Copyright 2000 Wiley-Liss, Inc.
Medical examination for asbestos-related disease. S.M. Levin, P.E. Kann, M.B. Lax. 2000;37(1):6-22. Review PubMed · Publisher

Abstract

There are millions of workers whose exposure to asbestos dust prior to the implementation of asbestos regulation and improved control measures places them at risk of asbestos-related disease today. In addition, workers are still being exposed to significant amounts of asbestos, when asbestos materials in place are disturbed during renovation, repair, or demolition. Given the continued presence of asbestos-containing materials in industrial, commercial, and residential settings throughout the U.S., a sizeable population remains at risk of asbestos-related disease. This article reviews the health effects associated with exposure to asbestos and delineates the steps necessary for the comprehensive screening and clinical assessment for asbestos-related disease, in order to assist physicians in identifying and preventing illness associated with exposure to asbestos among their patients.

Copyright 2000 Wiley-Liss, Inc.
Mesothelioma and lung tumors attributable to asbestos among petroleum workers. V. Gennaro, M.M. Finkelstein, M. Ceppi, et al. 2000;37(3):275-82. PubMed · Publisher

Abstract

Background: Asbestos exposure has been definitively found to be associated with both mesothelioma and lung cancer. Nevertheless, in the overall population of oil refinery workers potentially exposed to asbestos, many studies clearly show a definitely increased risk of mesothelioma, but no proven excess of lung cancer after comparison to the general population. Through the presentation of new data and the re-appraisal of two recent and independent epidemiological studies conducted in Liguria, Italy, and Ontario, Canada, we attempt to shed light on this apparently paradoxical finding.

Methods: Lung cancer mortality was studied among maintenance workers exposed to asbestos, and among two other subgroups of refinery employees: blue collar and white collar workers. The comparison with blue collar workers was performed in order to take into account the role of healthy worker effect, smoking habit, and the socioeconomic level. The comparison with white collar workers was performed to control for other occupational lung carcinogens.

Results And Conclusions: Results reveal a consistency between the two studies and show that 96-100% of the mesotheliomas and 42-49% of the lung tumors arising among maintenance workers were attributable to asbestos exposure. Our new analysis, estimating two cases of asbestos-related lung cancer for each case of mesothelioma, confirms published findings on the magnitude of asbestos-related tumors in oil refineries.

Copyright 2000 Wiley-Liss, Inc.
Mortality from six work-related cancers among African Americans and Latinos. D. Loomis, M. Schulz. 2000;38(5):565-75. PubMed · Publisher

Abstract

Background: Ethnic minorities have been omitted from many occupational health studies, despite their substantial contributions to the labor force and documented cases of high exposures in some settings. To describe the occurrence of potentially work-related cancers among African American and Latino Workers, we conducted an epidemiologic study based on death certificate data.

Methods: Data were obtained from 21 states during 1985-1992. Directly adjusted proportionate mortality ratios (PMRs) and standardized mortality rate ratios (SRRs) for ages 20-64 years were computed for cancers of the lung, nasal cavity, pleura, and peritoneum, malignant melanoma and leukemia using the mortality data and population counts from the 1990 census.

Results: Proportionate mortality was generally low for both groups, but African Americans had higher than expected mortality rates for leukemia and cancers of the lung, nasal cavity, and peritoneum. Industry-specific analyses indicate excess leukemia among African American men in the rubber industry (PMR 2.08, 95% confidence interval (CI) 1.29 - 3.35), Latino men in textile (PMR 2. 31, 95% CI 0.81 - 5.13) and wood industries (PMR 2.03, 95% CI 0.81 - 5.13), and Latino women in the chemical industry (PMR 2.18, 95% CI 0.59 - 8.10), among other findings. Excess cancer of the pleura and peritoneum was observed among workers with a variety of usual occupations, consistent with widespread exposure to asbestos.

Conclusions: This study demonstrates the utility of surveillance data bases for generating basic epidemiologic information on historically neglected workers. Leads about specific workplace exposure can be followed up in more detailed studies.

Copyright 2000 Wiley-Liss, Inc.
Occupation and risk of malignant pleural mesothelioma: A case-control study in Spain. A. Agudo, C.A. González, M.J. Bleda, et al. 2000;37(2):159-68. PubMed · Publisher

Abstract

Background: The association of mesothelioma and asbestos exposure is well known, but some data suggest that probably many people are still being exposed to asbestos without knowing it.

Methods: Between 1993 and 1996, 132 cases (77% males) of histologically confirmed malignant pleural mesothelioma and 257 controls, residents in two provinces of Spain (Barcelona and C¿adiz), were interviewed. They were classified according to their probability and intensity of occupational asbestos exposure by a panel of industrial hygienists, based on a detailed occupational history.

Results: Age and sex-adjusted odds ratio (OR) for the highest probability of exposure to asbestos was 13.2 (95% confidence interval 6.4-27.3), and 27.1 (9. 28-79.3) for high intensity. A dose-response trend was observed for both, probability and intensity. Overall, 61% of cases and 42% of controls had ever worked in an occupation with risk of asbestos exposure, with an OR of 2.59 (1.60-4.22). In our population 62% of cases could be attributed to occupational asbestos exposure.

Conclusions: A high risk of pleural mesothelioma due to occupational asbestos exposure is confirmed, but there is still a sizeable proportion for which no evidence of occupational exposure was found. Most of these cases could be due to other sources of asbestos exposure, mainly domestic or environmental.

Copyright 2000 Wiley-Liss, Inc.
Proportionate mortality among unionized roofers and waterproofers. F.B. Stern, A.M. Ruder, G. Chen. 2000;37(5):478-92. PubMed · Publisher

Abstract

Background: The United Union of Roofers, Waterproofers, and Allied Workers (UURWAW) is one of the 15 building and construction trades departments in the AFL-CIO. The U.S. roofing industry, including both roofing and waterproofing applications, both unionized and nonunionized, comprises about 25,000 firms, employing approximately 300,000 people, about 200,000 of whom are involved in the application of roofs. The specific toxins to which roofers may be exposed at the job site include, among others, bitumens (asphalt and/or coal tar pitch) as well as asbestos and fiberglass from roof removal operations. Excess deaths from occupational injuries are also of concern.

Methods: This study evaluated causes of mortality among 11,144 members of the UURWAW. Age-adjusted proportionate mortality ratios (PMRs) were computed with 95% confidence intervals (CI) using U.S. age-, gender-, and race-specific proportional mortality rates for the years of the study, 1950-1996.

Results: Statistically significant increased PMRs were found for all injuries (PMR = 142, CI = 134-150), especially falls (PMR = 464, CI = 419-513) and other injuries (PMR = 121, CI = 107-137), cancers of the lung (PMR = 139, CI = 131-148), bladder (PMR = 138, CI = 111-170), esophagus (PMR = 134, CI = 107-166), larynx (PMR = 145, CI = 106-193), and cancers of other and unspecified sites (PMR = 130, CI = 112-149), pneumoconioses and other nonmalignant respiratory diseases (PMR = 115, CI = 103-128), and homicides (PMR = 153, CI = 135-172). The occupational exposures which may have contributed to the excess risks of malignant and nonmalignant respiratory diseases include, among others, asphalt fumes, coal tar pitch volatiles and asbestos; however, cigarette smoking must also be considered a contributing factor.

Conclusions: The present study underscores the need to control airborne exposures to hazardous substances and especially to examine fall prevention efforts within the roofing industry. Am. J. Ind. Med. 37:478-492, 2000. Published 2000 Wiley-Liss, Inc.
Pulmonary mineral fibers after occupational and environmental exposure to asbestos in the Russian chrysotile industry. A. Tossavainen, E. Kovalevsky, E. Vanhala, et al. 2000;37(4):327-33. PubMed · Publisher

Abstract

Background: As an indicator of occupational, domestic, and environmental exposure, the level and type of asbestos fibers were determined from lung tissue samples of workers and residents who resided in the area of the world's largest asbestos mine at Asbest, Russia.

Methods: Electron microscopy was used to analyze and measure the concentration of asbestos fibers in a series of 47 autopsies at the Asbest Town Hospital. Work histories were obtained from pathology reports and employment records.

Results: In 24 chrysotile miners, millers, and product manufacturers, the pulmonary concentrations of retained fibers (over 1 microm in length) were 0. 8-50.6 million f/g for chrysotile, and < 0.1-1.9 million f/g for amphiboles (tremolite and anthophyllite). The concentrations were lower in 23 persons without any known occupational contact with asbestos; 0.1-14.6 million f/g for chrysotile, and < 0.1-0.7 million f/g for amphiboles. On average, 90% of all inorganic fibers were chrysotile, and 5% tremolite/anthophyllite. No amosite or crocidolite fibers were detected in any of the samples.

Conclusions: The mean and range of pulmonary chrysotile concentrations were about the same as reported previously from the Canadian mining and milling industry. In the Russian samples, the mean concentration of tremolite fibers were less by at least one order of magnitude. Occupational contact was the most important source of asbestos exposure.

Copyright 2000 Wiley-Liss, Inc.
Re: Call for an International Ban on Asbestos. W.J. Nicholson. 2000;37(2):238. Comment · Letter PubMed · Publisher
Re: Call for an International Ban on Asbestos. C. Maltoni. 2000;37(2):230-1. Letter PubMed · Publisher
Re: Call for an International Ban on Asbestos: Trust me, I'm a doctor. M. Greenberg. 2000;37(2):232-4. Letter PubMed · Publisher
RE: Call for an International Ban on Asbestos: Why asbestos should be banned. R.A. Lemen. 2000;37(2):236-7. Comment · Letter PubMed · Publisher
Re: Call for an International Ban on Asbestos: Why not ban asbestos?. B. Castleman. 2000;37(2):239-40. Comment · Letter PubMed · Publisher
Re: Call for an International Ban on Asbestos: Why not ban asbestos?. J.C. McDonald. 2000;37(2):235. Letter PubMed · Publisher

Summary

In this letter to the editor, written in July 1999, the author responded to a call by the Collegium and the journal for an international ban on asbestos. He compared such bans to witch burning, prohibition and McCarthyism, which he described as sometimes counter-productive. He stated that the substantial and still rising mortality from asbestos-related cancers in most industrialized countries resulted from uncontrolled use of asbestos 20 to 60 years earlier, and that crocidolite and amosite were disproportionately responsible. Because neither of these amphibole fibers had been mined for many years, he argued that the call for a ban in practice meant chrysotile. He stated that abundant epidemiological evidence showed that chrysotile, even when contaminated with fibrous tremolite, which he called the main culprit, could be mined and used safely for cement and friction products with effective dust control. He described the experimental evidence on man-made fiber substitutes as less assuring because most types are more biopersistent than chrysotile. He argued that wealthy countries that manufacture and export substitutes had a right to prohibit asbestos imports. He argued that countries that mine chrysotile, such as Zimbabwe and Brazil, had the same right to use it, noting that these countries may have little or no tremolite contamination and have pressing needs for asbestos-cement products. He concluded that chrysotile free from amphiboles is a remarkably safe and valuable natural resource whose exploitation should be encouraged.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Recent geographic patterns of lung cancer and mesothelioma mortality rates in 49 shipyard counties in the United States, 1970-94. A. Jemal, D. Grauman, S. Devesa. 2000;37(5):512-21. PubMed · Publisher

Abstract

Background: Lung cancer mortality rates among white males in the United States were observed to be elevated during 1950-69 in counties with shipbuilding industries during World War II; risk was found to be associated with asbestos exposure. We evaluated the geographic patterns in more recent years, 1970-94, for whites and compared them with the 1950-69 patterns.

Methods: We calculated age-adjusted rates and estimated rate ratios between comparison groups.

Results: Rates generally were higher in shipyard counties than in all nonshipyard counties and in coastal nonshipyard counties for both sexes and time periods. Rates increased markedly from 1950-69 to 1970-94 in all groups, with the changes more pronounced in females than males. Pleural mesothelioma mortality rates were also significantly higher in shipyard counties than coastal nonshipyard counties in all regions among males but not among females.

Conclusions: The more pronounced changes in lung cancer mortality rates among females in shipyard counties may be attributed to the combined effects of low asbestos exposures and changes in smoking behavior. Am. J. Ind. Med. 37:512-521, 2000. Published 2000 Wiley-Liss, Inc.
Researchers should talk to workers. D. Egilman. 2000;37(6):668. Comment · Letter PubMed · Publisher
Science or public relations? The inside story of the Asbestosis Research Council, 1957-1990. G. Tweedale. 2000;38(6):723-34. PubMed · Publisher

Abstract

In 1957, the leading British asbestos companies (Turner & Newall, Cape Asbestos, and British Belting & Asbestos) founded the Asbestosis Research Council (ARC). This was a response to rising asbestosis and asbestos cancer mortality in the UK and the attendant political and social problems that threatened the existence of the asbestos industry. An ARC research program was launched, that by the 1970s was mainly based within the Institute of Occupational Medicine at Edinburgh University. By the end of the 1980s, well over a hundred papers had been published with ARC support. The bulk of the work involved animal experiments and the chemical analysis of fibers, but the asbestos companies showed little enthusiasm for wider epidemiological studies or for exploring the cancer threat. The sponsoring companies dictated the ARC's research strategy and also vetted (and sometimes censored) publications; while using the ARC as a counterweight to government regulation and media attacks. The ARC's history highlights the compromises that were made by individual scientists and demonstrates the dilemmas inherent in industry-controlled research.

Copyright 2000 Wiley-Liss, Inc.
The prevalence of pleural plaques and/or pulmonary changes among construction workers in Okayama, Japan. T. Kishimoto, K. Morinaga, S. Kira. 2000;37(3):291-5. PubMed · Publisher

Abstract

Background: Since asbestos has been widely used in Japanese building materials since 1960s, a large number of Japanese construction workers may be exposed to asbestos occupationally.

Methods: Among 2951 construction workers in Okayama, Japan, the prevalence of asbestos-induced pleural or pulmonary changes was examined by screening chest x-rays; these findings were confirmed by computed tomography (CT) scanning of the chest.

Results: Among 2951 construction workers, 168 (5.7%) were found to have significant findings for pleural plaque or pulmonary changes on chest x-ray. Seventy-four had both pleural plaque and asbestosis, 85 pleural plaques alone, and 9 asbestosis alone. In 11 subjects, pleural plaques were suggested by chest x-ray, but neither pleural plaque nor asbestosis was demonstrated by chest CT. Honeycombing as one of the characteristic findings of asbestosis was found in 29 subjects. Others showed subpleural spots or curvilinear shadow, which suggested the early stage of asbestosis. The occupations of these workers were carpenters (64), plasterers (27), and concrete board cutters (14). About 30% of the workers with these findings were aware that they were handling asbestos in activities such as installation of asbestos boards, and/or asbestos spraying.

Conclusions: As the incidence of malignant mesothelioma and primary lung cancer associated with asbestos exposure are high, screening by chest CT is necessary for detecting asbestos-induced pulmonary and/or pleural lesions. Education for protection such as telling about the presence of asbestos in building materials is also necessary.

Copyright 2000 Wiley-Liss, Inc.
The South African asbestos trade, 1994-1999. J.S. Harington, N.D. McGlashan. 2000;37(2):229. Letter PubMed · Publisher

1990s

A study of lung cancer mortality in asbestos workers: Doll, 1955. M. Greenberg. 1999;36(3):331-47. Historical article PubMed · Publisher

Abstract

Between 1935 and 1953, a series of publications appeared in England, Germany and America reporting cases of lung cancer amongst asbestos workers. As early as 1943, the German scientific consensus was that the evidence was strong enough to deem the association to be causal. On reviewing a more extensive bibliography, this view was shared by an American cancer expert. The results of industry sponsored experiments, in which lung tumors had been induced in mice by asbestos, were circulated in confidence to its scientists, but being unpublished were unknown to the general scientific community. There were also cancer mortality data recorded for populations of exposed asbestos workers, but these were confidential and remained to be analyzed. To deal with the persistent allegations of a lung cancer hazard, in 1953 Dr. Richard Doll was asked by Turner Brothers Asbestos ("the Company"), whose in-house analyses had been reassuring, to study the mortality data of a group of its workers. Despite the limitations of the data, Doll convincingly demonstrated so substantial an excess of lung-cancer in heavily exposed long-term asbestos workers as to overcome honest doubt. Despite determined attempts made to dissuade them, Doll and the editor of the journal to which he submitted his paper, courageously went ahead and published the paper. Industry overestimated the harm that publication of the paper would do to their immediate interests. It produced so profound a lack of sense of urgency, that legislation addressed to the control of lung cancer specifically had to wait 20 years, and asbestos workers contracting it were to wait 25 years, before they might be considered for compensation, and even then, only under extremely limiting conditions.
Asbestos exposure in lung carcinoma: a necropsy-based study of 414 cases. C. Bianchi, A. Brollo, L. Ramani, et al. 1999;36(3):360-4. PubMed · Publisher

Abstract

Background: The prerequisites necessary for attributing lung carcinoma to asbestos, represent a controversial issue.

Methods: Three parameters (occupational history, pleural plaques, and lung asbestos bodies) were investigated in 414 consecutive cases of lung carcinoma, examined at necropsy at the Hospital of Monfalcone, Italy. Occupational data were obtained from the patients' relatives by personal or telephone interviews. Pleural plaques were classified into three classes (small, moderate, large). Routine lung sections were examined for asbestos bodies in all cases; isolation and counting were performed in 408 cases.

Results: The series included 353 men, and 61 women, aged between 38 and 97 years. The male patients had worked in industries in 74% of cases (60% in shipbuilding). Men showed pleural plaques in 82% of cases (moderate or large plaques in 58.7%). Asbestos bodies were observed in routine lung sections in 34.8%, and in 31% exceeded the value of 5,000 bodies per gram of dried tissue. Among women the principal features were: history or domestic exposure to asbestos in 36% of the cases, prevalence of pleural plaques 34% (moderate or large plaques 15%), asbestos bodies in routine lung sections in 3.3% and there was no case with an asbestos body burden over 5,000/g. The fraction of asbestos-related carcinomas among male patients varied between 24.7 and 61%, depending on the criteria used for attribution.

Conclusions: Different criteria indicated about 60% of the present lung carcinomas among men as plausibly attributable to asbestos.
Breast cancer and occupational exposures in women in Finland. E. Weiderpass, E. Pukkala, T. Kauppinen, et al. 1999;36(1):48-53. PubMed · Publisher

Abstract

Background: The etiology of breast cancer is not fully understood. Environmental and occupational exposures may contribute to breast cancer risk.

Methods: We linked 324 job titles from the 1970 census of 892,591 Finnish women with incidence of breast cancer (23,638 cases) during 1971-1995. We converted job titles to 31 chemical and two ergonomic agents through a measurement-based, period-specific, national job-exposure matrix. Poisson regression models were fit to the data, with adjustment for birth cohort, follow-up period, socioeconomic status, mean number of children, mean age at first delivery, and turnover rate.

Results: For premenopausal breast cancer, medium/high level of occupational exposure to ionizing radiation was associated with a standardized incidence ratio (SIR) of 1.3 (95% confidence interval (CI) 0.7-2.5; trend P = 0.03). For postmenopausal breast cancer, we found on SIR of 1.2 (1.1-1.3) for low level and 1.4 (1.1-1.8) for medium/high level of ionizing radiation (trend P = 0.001); and an SIR 1.3 (1.1-1.7) for medium/high levels of both asbestos and man-made vitreous fibers. Aromatic hydrocarbon solvents showed a significant trend for a modest excess of postmenopausal breast cancer.

Conclusions: Our study indicates that occupational exposure to ionizing radiation may be associated with an increased risk of female breast cancer. High-quality studies on environmental and occupational etiology of breast cancer are needed for further elucidation of risk factors.
Cancer in ex-asbestos cement workers in Israel, 1953-1992. T.H. Tulchinsky, G.M. Ginsberg, J. Iscovich, et al. 1999;35(1):1-8. PubMed · Publisher

Abstract

A cohort of 3,057 male workers employed in an asbestos-cement plant using 90% chrysotile-10% crocidolite, located in Northern Israel, was followed from 1953-1992 for incidence and mortality from cancer. In the years 1978-1992, the cohort had an elevated risk for all malignant neoplasms combined (n = 153, SIR = 117, ns), lung cancer (n = 28, SIR = 135, ns), mesothelioma (n = 21; SIR > 5000, p < .0001), unspecified pleural cancer (n = 5; SIR = 278, P < .0001), and liver cancer (n = 7, SIR 290, ns). Risks for colo-rectal (n = 19; SIR = 79, ns), bladder (n = 12, SIR 69) and renal cancers (n = 5, SIR 104) were less than expected. Risk for mesothelioma showed a sharp risk gradient with duration of exposure, increasing from 1 per 625 for those employed less than 2 years to 1 per 4.5 workers employed over 30 years. The ratio of mesothelioma to excess lung cancer cases was 2.9 to 1, or 3.6 to 1, if pleural cases of unspecified origin were included; the pleura to peritoneum ratio of verified mesothelioma cases was 20 to 1. This atypically high ratio of mesothelioma to excess lung cancer cases is suggested to be the combined result of high past asbestos exposures in the workers and their low prior risk for lung cancer, and possibly, relatively early smoking cessation in relation to asbestos exposure.
Cancer mortality among women in the Russian printing industry. M.A. Bulbulyan, S.A. Ilychova, S.H. Zahm, et al. 1999;36(1):166-71. PubMed · Publisher

Abstract

Background: This study evaluates cancer mortality among women employed in two large printing plants in Moscow.

Methods: A total of 3,473 women who were actively employed as of December 31, 1978, with a minimum of 2 years employment were followed from 1 January 1979 to 31 December 1993. There were 47,791 person-years observed, with only 51 women lost to follow-up (1.5%). Standardized mortality ratios (SMRs) were calculated using the population of Moscow to generate expected numbers. Analyses by job (compositors, press operators, and bookbinders), age hired, latency, and duration of employment were conducted.

Results: Among women employed in the two printing plants, there was a significant excess of esophageal cancer, based on seven deaths (expected = 2.7, SMR = 2.7, 95% CI = 1.1-5.4). Four of the seven esophageal cancer deaths occurred among bookbinders (expected = 1.0, SMR = 4.1, 95% CI = 1.1-10.4), all among workers hired before 1957 (expected = 0.6, SMR = 7.1, 95% CI = 1.9-18.3), the last year benzene was used in bookbinding. Ovarian cancer was also significantly elevated among bookbinders (12 observed, 4.2 expected, SMR = 2.9, 95% CI = 1.5-5.0), which, along with one death from mesothelioma of the abdomen, might be related to the use of asbestos-contaminated talc fillers in paper. Press operators had significantly elevated mortality from stomach cancer (observed = 9, expected = 4.1, SMR = 2.2, 95% CI = 1.0-4.2) and, based on two deaths each, melanoma and bladder cancer.

Conclusions: Women in this printing industry cohort experienced excess mortality of cancer of the esophagus and stomach, with suggested increases of melanoma and bladder cancer. Further follow-up of this cohort, which would allow more in-depth analysis of rare cancer sites, latency, and duration of employment, is warranted. Gender comparisons within the cohort should also be conducted to clarify the role of occupational and lifestyle factors in the etiology of cancer among workers in the printing industry.
Case-control study of mesothelioma in South Africa. D. Rees, J.E. Myers, K. Goodman, et al. 1999;35(3):213-22. PubMed · Publisher

Abstract

Background: South Africa has, uniquely, mined, transported, and used crocidolite, amosite, and chrysotile. A multicenter case-control study was done in South Africa to examine the details of asbestos exposure in cases and controls, and to calculate relative risks for level of certainty of asbestos exposure, nature of exposure (e.g., environmental, occupational) and fiber type.

Methods: Cases and controls (one cancer and one medical per case) were collected by six study centers from referral hospitals, and exposure information was collected by interviewing cases and controls in life.

Results: One hundred and twenty-three cases were accepted into the study. None had purely chrysotile exposure. Twenty-three cases had mined Cape crocidolite; three had mined amosite; and three Transvaal crocidolite plus amosite. A minimum of 22 of the cases had exclusively environmental exposure, 20 were from the NW Cape crocidolite mining area. The relative risks associated with environmental exposure in the NW Cape (crocidolite) were larger than for environmental exposure in the NE Transvaal (amosite and crocidolite): 21.9 vs. 7.1 and 50.9 vs. 12.0 for the cancer control and medical control datasets, respectively.

Conclusions: The results confirm the importance of environmental exposure in the Cape crocidolite mining area, the relative paucity of cases linked to amosite, the rarity of chrysotile cases and are consistent with a fiber gradient in mesotheliomagenic potential for South African asbestos with crocidolite > amosite > chrysotile.
Cohort mortality study of women compensated for asbestosis in Italy. D. Germani, S. Belli, C. Bruno, et al. 1999;36(1):129-34. PubMed · Publisher

Abstract

Background: The carcinogenic effect of asbestos is accepted for lung cancer and mesothelioma, while conflicting opinions exist for other cancer sites. The aim of the present investigation is to study cause-specific mortality of women compensated for asbestosis who had certainly been exposed to high levels of asbestos fibers.

Methods: The cause-specific mortality of all Italian women compensated for asbestosis and alive December 31, 1979, was investigated through October 30, 1997. In the total cohort, which included 631 subjects, 277 deaths occurred. Cause-specific SMRs (Standardized Mortality Ratio) were computed using the national rates for comparison.

Results: A significantly increased mortality for all diseases related to asbestos exposure was observed. Mortality for all causes, all neoplasms, lung cancer, uterine cancer, ovarian cancer, and non-neoplastic respiratory diseases was significantly increased. Separate analyses for textile (n = 276) and asbestos-cement (n = 278) workers were performed. Women employed in the textile industry, mainly exposed to chrysotile, who are compensated at a younger age, showed higher SMRs for lung cancer and asbestosis. Women in the asbestos-cement industry, mainly exposed to crocidolite containing asbestos mixtures, experienced higher mortality for pleural malignancies.

Conclusions: The role of asbestos exposure in the development of gastrointestinal and genital neoplasms is discussed.
Health and exposure surveillance of Siberian asbestos miners: A joint Finnish-American-Russian project. A. Tossavainen, R. Riala, A. Zitting, et al. 1999;Suppl 1:142-4. PubMed · Publisher
High-resolution computed tomography abnormalities in ex-insulators annually exposed to asbestos dust. J.M. Soulat, D. Lauque, Y. Esquirol, et al. 1999;36(6):593-601. PubMed · Publisher

Abstract

Background: characterize To the effects of high asbestos exposure during annual periods of insulation.

Method: 170 ex-workers underwent clinical examination, spirometry, standard chest X-rays and high-resolution computed tomography (HRCT). Asbestos exposure was retrospectively assessed for latency, duration, and intensity.

Results: Sixty-six percent of these workers were annually exposed to high concentrations of asbestos dust. Respiratory symptoms were mild. One hundred and nineteen subjects had pleural or pulmonary changes on HRCT, compatible with asbestos exposure. Localized pleural thickening was found in 113 subjects (66.5%); pulmonary nodules or lines in 35 (20.6%). The presence of pleural plaques was linked to intensity of asbestos exposure (P <.01), and length of employment (P <.05). Parenchymal lesions were related to intensity (P <.05) and duration of exposure (P <.05). Lung function of subjects with X-ray changes was not significantly altered.

Conclusions: Annual asbestos exposure led to a high prevalence of pleural plaques and to mild parenchymal anomalies.

Copyright 1999 Wiley-Liss, Inc.
Inferences on the kinetics of asbestos deposition and clearance among chrysotile miners and millers. M.M. Finkelstein, A. Dufresne. 1999;35(4):401-12. PubMed · Publisher

Abstract

Background: The health effects of asbestos are intimately related to the fate of inhaled fibers in the lungs. The kinetics of asbestos fibers have been studied primarily in rodents. The objective of this study was to explore the application of these kinetic models to human autopsy data.

Methods: We analyzed the asbestos fiber content of the lungs of 72 Quebec chrysotile miners and millers and 49 control subjects using analytical transmission electron microscopy. Statistical methods included standard multivariate linear regression and locally weighted regression methods.

Results: The lung burdens of asbestos bodies and chrysotile and tremolite fibers were correlated, as were the concentrations of short, medium, and long fibers of each asbestos variety. There were significant associations between the duration of occupational exposure and the burdens of chrysotile and tremolite. The concentration of chrysotile decreased with the time since last exposure but the concentration of tremolite did not. The clearance rate varied inversely with the length of chrysotile fibers. For fibers greater than 10 mu in length the clearance half-time was estimated to be 8 years.

Conclusions: The patterns in our data are compatible with both of the hypotheses suggested from rodent experiments; the existence of a long-term sequestration compartment and overload of clearance mechanisms in this compartment.
Lung cancer risk in male workers occupationally exposed to diesel motor emissions in Germany. I. Brüske-Hohlfeld, M. Möhner, W. Ahrens, et al. 1999;36(4):405-14. PubMed · Publisher

Abstract

Background: Although in several epidemiological studies exposure to diesel motor emissions (DME) shows an elevated lung cancer risk, it is still controversial whether DME is a human carcinogen.

Methods: In a pooled analysis of two case-control studies on lung cancer in Germany a total of 3498 male cases with histologically or cytologically ascertained lung cancer and 3541 male population controls were included. Information about lifelong occupational and smoking history was obtained by questionnaire. Drivers of lorries, buses, taxies, diesel locomotives and forklift trucks, bulldozers, graders, excavators, and tractors, were considered as exposed to DME and their cumulative exposure was estimated. All odds ratios were adjusted for smoking and asbestos exposure.

Results: The evaluation of lung cancer risk for all jobs with DME-exposure combined showed an odds ratio of OR=1.43 (95%-CI: 1.23-1.67). Most pronounced was the increase in lung cancer risk in heavy equipment operators (OR=2. 31 95%-CI: 1.44-3.70). The risk of tractor drivers increased with length of employment and reached statistical significance for exposures longer than 30 years (OR=6.81, 95%-CI: 1.17-39.51). The group of professional drivers (e.g., trucks, buses, and taxies), showed an increased risk only in West Germany (OR=1.44, 95%-CI: 1. 18-1.76), but not in East Germany (OR=0.83, 95%-CI: 0.60-1.14). DME-exposure in other traffic related jobs (e.g., diesel engine locomotive drivers, switchmen, forklift operators) was associated with an odds ratio of OR=1.53 (95%-CI: 1.04-2.24).

Conclusions: The study provides further evidence that occupational exposure to diesel motor emissions is associated with an increased lung cancer risk.

Copyright 1999 Wiley-Liss, Inc.
Maintenance work and asbestos-related cancers in the refinery and petrochemical sector. M.M. Finkelstein. 1999;36(2):326. Letter PubMed · Publisher
Maintenance work and asbestos-related cancers in the refinery and petrochemical sector. M.M. Finkelstein. 1999;35(2):201-5. Review PubMed · Publisher

Summary

This commentary examined whether maintenance workers in the refinery and petrochemical sector, who have the greatest potential for asbestos exposure, are at increased risk of lung cancer. The author noted that refinery and petrochemical workers overall have lower lung cancer rates than the general population, with one review reporting lung cancer mortality at 77% of the population average. He argued that internal comparisons within plants were therefore needed. He reviewed published evidence on asbestos use, radiographic surveys and mesotheliomas, which have generally been diagnosed in maintenance workers. In one survey of 995 employees, 9% had asbestos-related X-ray changes. He also reviewed the limited data on smoking habits. He then assembled five cohort studies and one case-control study that compared lung cancer among maintenance workers with other blue-collar workers at the same plants. For one study he derived the comparison by subtraction from published tables. Study-specific relative risks ranged from 0.80 to 1.73. He combined them as a weighted average, using the inverse of the squared standard error as the weight. The combined relative risk was 1.40 (95% CI 1.15–1.69) excluding the Hanis et al. 1985 study, and 1.28 (95% CI 1.08–1.52) including it. The author concluded that maintenance employees had a significantly higher lung cancer risk than other blue-collar workers. He judged that smoking differences were unlikely to account for a 30–40% elevation. He considered it reasonable to conclude the excesses were work-related and to reinforce asbestos control measures.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Mortality among workers in the geothermal power plants at Larderello, Italy. E. Pira, M. Turbiglio, M. Maroni, et al. 1999;35(5):536-9. PubMed · Publisher

Abstract

Background: Since the early 1990s various European electricity companies have set up a research program, named EURELEX, devoted to the development of a comprehensive and validated title-occupation--job-exposure matrix (i.e., an instrument to assess exposures from occupations and jobs), in order to estimate and quantify past exposure to a number of potentially carcinogenic agents plus a few selected other toxic substances. The EURELEX program was first applied in Italy to a cohort of geothermal workers in Larderello, Tuscany.

Methods: The cohort mortality study comprised 4,237 men who had worked at the geothermal power plant between 1950 and 1990. Vital status and death certificates were obtained from registration offices in the municipality of birth or death. Particular attention was paid to neoplastic effects of exposure to asbestos, largely used in the past for pipeline insulating purposes. The matrix allowed the workers to be subdivided into several categories according to estimated absestos exposure. Smoking information was not available.

Results: No excess mortality was found for all causes and total cancer mortality. A small excess of pleural cancer (2 obs. vs. 1.4 exp.) was not statistically significant. The effect of other agents included in the matrix was also examined: the small excess of leukemia among those exposed to solvents prior to 1963 (year of benzene ban in Italy) did not reach the level of statistical significance. No cases of leukemia were found among the workers presumed to have been exposed to important ELF electromagnetic fields.

Conclusion: The study provides reassuring information on a large cohort of a unique geothermal power plant since no significant excess mortality for asbestos related cancers was observed. Furthermore, it represents a useful application and validation of a comprehensive job-exposure matrix for the electric industry in Europe.
Mortality patterns among electrical workers employed in the U.S. construction industry, 1982-1987. C.F. Robinson, M. Petersen, S. Palu. 1999;36(6):630-7. PubMed · Publisher

Abstract

Background: Studies of electrical workers in the utility and manufacturing industries have reported excess site-specific cancer. No previous studies of electrical workers in the construction industry have been conducted.

Methods: Our study evaluated the mortality patterns of 31,068 U.S. members of the International Brotherhood of Electrical Workers who primarily worked in the construction industry and died 1982-1987.

Results: Comparison to the U.S. population by using the NIOSH life table showed significantly elevated proportionate mortality for many causes. Excess mortality for leukemia (proportionate mortality ratio (PMR)=115) and brain tumors (PMR=136) is similar to reports of electrical workers with occupational exposure to electric and magnetic fields in the electric utility or manufacturing industry. Excess deaths due to melanoma skin cancer (PMR=123) are consistent with findings of other PCB-exposed workers. A significantly elevated PMR was observed for the diseases caused by asbestos: lung cancer (PMR=117), asbestosis (PMR=247), and malignant mesothelioma (PMR=356) and from fatal injuries, particularly electrocutions (PMR=1180). The findings of statistically significant excess deaths for prostate cancer (PMR=107), musculoskeletal disease (PMR=130), suicide (PMR=113), and disorders of the blood-forming organs (PMR=141) were unexpected.

Conclusions: Results suggest that more detailed investigations of occupational risk factors and evaluation of preventive practices are needed to prevent excess mortality in this hazardous occupation. Am. J. Ind. Med. 36:630-637, 1999. Published 1999 Wiley-Liss, Inc.
Occupational risk factors for lung cancer in women: results of a case-control study in Germany. I. Jahn, W. Ahrens, I. Brüske-Hohlfeld, et al. 1999;36(1):90-100. PubMed · Publisher

Abstract

Background: To investigate the association between lung cancer and occupational factors in women.

Methods: Six hundred eighty-six women with lung cancer and 712 controls matched for age and region were interviewed to gather occupational histories and information about other risk factors and confounders. Odds ratios (OR) and 95%-confidence intervals (CI) were calculated.

Results: There were 11 cases and 2 controls who reported occupational asbestos exposure. Significantly elevated risks (P < 0.05, smoking-adjusted), were observed in the following industries: chemical, oil (OR 3.7), pottery, glass (OR 2.5), engine, vehicle building (OR 2.2), paper, wood, print (OR 1.9), cleaning service, hairdressing, housekeeping, waste disposal (OR 1.5); and occupations: assemblers, unskilled metal workers (OR 2.5), stock clerks, etc. (OR 1.6), restaurant owners and hoteliers (OR 2.7), as well as waitresses and travel attendants (OR 2.6).

Conclusions: The study provides evidence that both occupations previously observed as hazardous in males, and occupations of particular significance for women only, play a role in the risk of lung cancer in women.
Ovarian cancer and occupational exposures in Finland. K. Vasama-Neuvonen, E. Pukkala, H. Paakkulainen, et al. 1999;36(1):83-9. PubMed · Publisher

Abstract

Background: No single occupational or environmental agent has been established as causing ovarian cancer, existing studies often being based on ecologic or proportional mortality data in which potential confounders related to reproductive history have not been taken into account.

Methods: This study linked 324 job titles of occupationally active Finnish women (n = 892,591) at 1970 census with incidence of ovarian cancer (Finnish Cancer Registry, 5,072 cases) during 1971-1995 (over 15 million person-years). The job titles were converted into indicators of exposure to 33 agents, using a national job-exposure matrix based on measurements and surveys (FINJEM). Poisson regression analyses were performed with stratification by birth cohort, follow-up period, and socioeconomic status, and adjusted for mean number of children, mean age at first delivery, and turnover rate for each job title.

Results: We found indications of elevated risks for aromatic hydrocarbon solvents (standardized incidence ratio 1.3 (95% CI 1.0-1.7), leather dust (1.4; 0.7-2.7), man-made vitreous fibers (1.3; 0.9-1.8), and high levels of asbestos (1.3; 0.9-1.8), and diesel (1.7; 0.7-4.1), and gasoline (1.5; 1.0-2.0) engine exhausts). Previously reported findings for hairdressers and women in the printing industry were supported in our data, but not for women in dry cleaning jobs.

Conclusions: Given the various drawbacks in linkage studies and job-exposure matrices, the excesses found in this study need confirmation in individual-level studies.
Peritoneal cancer and occupational exposure to asbestos: results from the application of a job-exposure matrix. P. Cocco, M. Dosemeci. 1999;35(1):9-14. PubMed · Publisher

Abstract

Background: Because of the rarity of peritoneal mesothelioma, occupational risks associated with it have seldom been studied, particularly among women. In this respect, death certificates databases may provide numbers large enough for analysis, although the International Classification of Diseases, 9th revision (ICD-9) does not single out mesothelioma from the rest of peritoneal cancers. The aim of this paper is twofold: to explore occupational risks of peritoneal cancer among men and women, and to test the performance of a job-exposure matrix in detecting its association with asbestos exposure using the occupation and industry reported in the death certificate.

Methods: From a large database containing information on the 1984-1992 death certificates of 24 U.S. states, we identified 657 deaths from peritoneal cancer and 6,570 controls who died from non-malignant diseases, 1:10 matched by region, gender, race, and 5-year age group.

Results: Occupations at risk included insulators among men, and machine operators among women. Among men, we found a significant increase in risk associated with employment in manufacturing industries, such as industrial and miscellaneous chemicals; miscellaneous non-metallic mineral and stone products; construction and material handling machines; and electrical machinery, equipment, and supplies; as well as in services to dwellings and other buildings. Industries at increased risk among women included elementary and secondary schools; miscellaneous retail stores; and publishing and printing. Our job-exposure matrix classified 17 male cases and 3 controls in the high probability category of exposure to asbestos (OR = 61.6). Among men, risk of peritoneal cancer increased significantly by probability and intensity of exposure to asbestos. No such pattern was observed among women. The job-exposure matrix did not classify any female subjects in the high probability or intensity of asbestos exposure.

Discussion: This study provides evidence that death certificate data and job-exposure matrices are useful tools to observe well-established associations, such as the one existing between peritoneal cancer and asbestos exposure among men, in spite of crude information, disease misclassification, and occupational misclassification. These factors are more likely to preclude meaningful results among women.
Potential significance of airborne fiber dimensions measured in the U.S. refractory ceramic fiber manufacturing industry. T.J. Lentz, C.H. Rice, J.E. Lockey, et al. 1999;36(2):286-98. PubMed · Publisher

Abstract

Background: To determine dimensions of airborne fibers in the U.S. refractory ceramic fiber (RCF) manufacturing industry, fibers collected through personal air sampling for employees at RCF manufacturing and processing operations have been measured.

Methods: Data were derived from transmission electron microscopy analyses of 118 air samples collected over a 20-year period.

Results: Characteristics of sized fibers include: diameter measurements of <60; 0.19 to 1.0 micron, m of which 75% are less than 0.6 micron and length ranging from < 0.6 to > 20 micron, with 68% of fibers between 2.4 and 20 micron.

Conclusions: Exposures in RCF manufacturing include airborne fibers with dimensions (diameter < 0.1-0.4 micron, length < 10 micron) historically associated with biological effects in pleural tissues. Air sampling data and a review of studies relating fiber size to pleural effects in animals and humans support the belief that information on fiber dimensions is essential for studies with synthetic vitreous fibers.

Copyright 1999 Wiley-Liss, Inc.
Serum levels of pantropic p53 protein and EGF-receptor, and detection of anti-p53 antibodies in former uranium miners (SDAG Wismut). J. Schneider, P. Presek, A. Braun, et al. 1999;36(6):602-9. PubMed · Publisher

Abstract

Background: The oncogene product EGF-receptor (EGF-R), the tumor suppressor gene product p53, and anti-p53 antibodies are detectable in serum of certain cancer patients. Increased levels of some of these products were reported in lung cancer patients after occupational asbestos exposure, after exposure to polycyclic aromatic hydrocarbons or vinyl chloride. This molecular epidemiological study investigated the use of serum EGF-R, p53-protein, and anti-p53 antibodies as biomarkers for detection of effects of radon and its decay products.

Methods: Serum EGF-R, p53-protein, and anti-53 antibodies were measured using ELISA in former uranium miners of SDAG Wismut without lung disease (n=106) and miners with Schneeberg lung cancer (n=22). They were compared with healthy subjects (n=23), patients with lung cancer not due to ionizing radiation (n=88), and patients with non-malignant lung or pleural diseases (n=50).

Results: No significantly elevated or decreased serum values for p53 protein, EGF-R, or anti-p53 antibodies could be found. There was no correlation of these with Working Level Months (WLM).

Conclusions: p53 protein, EGF-R, or anti-p53 antibodies in serum are not useful as biomarkers for detection of lung cancer related to ionizing radiation (i.e., Schneeberg lung cancer).

Copyright 1999 Wiley-Liss, Inc.
Tissue burden of asbestos in nonoccupationally exposed individuals from east Texas. R.F. Dodson, M.G. Williams, J. Huang, et al. 1999;35(3):281-6. PubMed · Publisher

Abstract

Background: The potential for asbestos exposure among members of the general population is appreciable, considering its widespread use in many products. This study examined tissue burden of asbestos in such a population.

Methods: A group of 33 individuals who had no work history of occupational exposure to asbestos were included in the study. Tissue sections from areas adjacent to those sites sampled for digestion were found to be without ferruginous bodies (FB) or histopathology consistent with asbestos-induced changes. All individuals had 20 or less FBs per gram of digested wet lung, a number considered to reflect general population levels. Tissue analysis of uncoated fiber burden was carried out by analytical electron microscopy. There was a trend of a higher likelihood of FB and asbestos fiber content correlated with age.

Results: The data are not consistent with the findings that chrysotile is readily found in lung tissue from the general population, in that none was found in 19 of the cases. It was almost as likely that one would find anthophyllite (12 of 33 cases) in this study. The commercial amphiboles (amosite and crocidolite) were occasionally found in the tissue from the general population and, when observed, were few in numbers. Twenty-six of the patients had no FBs and ten had no uncoated asbestos fibers within the limits of detectability in this study.

Conclusions: The total tissue burden of asbestos in this study is much less than earlier reported observations from other general populations.
Women's occupation and cancer: preliminary analysis of cancer registrations in England and Wales, 1971-1990. J. Simpson, E. Roman, G. Law, et al. 1999;36(1):172-85. PubMed · Publisher

Abstract

Background: In recent years increasing attention has been paid to examining the relation between women's health and their own occupation. The findings presented here relate to an analysis of 381,915 cancers in women registered in England and Wales over the 20-year period 1971-1990.

Methods: To explore the value of the data for epidemiological research, five sites (pleura, bladder, stomach, lung, and breast) and two occupations (agriculture and textile) were selected. Associations between cancer and occupation were evaluated using age and social class adjusted proportional registration ratios (PRRs) and 95% confidence intervals (CI).

Results: Pleural cancer risk was increased in a range of occupations with a potential for asbestos exposure (e.g., PRR 608, 95% CI 381-921 for craft and other production process workers), and the well-established link between bladder cancer and employment in the rubber industry was confirmed (PRR 303, 95% CI 188-464). Associations between "dusty" occupations and stomach cancer were noted (e.g., PRR 198, 95% CI 126-298 for ceramic decorators and finishers), and possible links with lung cancer and smoke in the work environment were highlighted (e.g., PRR 167, 95% CI 147-189 for publicans). As a group, agricultural workers were found to be at increased risk of non-Hodgkin's lymphoma (PRR 164, 95% CI 126-211), and textile workers at increased risk of pleural cancer (PRR 145, 95% CI 111-185). No evidence for an occupational aetiology for breast cancer was found within these data.

Conclusions: Occupational information collected at cancer registration in the United Kingdom can be reliably used to identify groups that may be at increased risk of disease.
A cross-sectional study on asbestos workers carried out in Italy in 1940: a forgotten study. E. Merler. 1998;33(1):90-3. Historical article PubMed · Publisher
An updated mortality study of workers at a petroleum refinery in Beaumont, Texas. G.K. Raabe, K.W. Collingwood, O. Wong. 1998;33(1):61-81. PubMed · Publisher

Abstract

The mortality experience of 7,119 workers who were employed at a Beaumont, Texas, refinery for at least 1 year between 1945 and 1987 was investigated. Mortality analyses based on standardized mortality ratios (SMRs) and 95% confidence intervals (95% CI) showed overall mortality was significantly lower than expected compared with the U.S. general population (SMR = 82, 95% CI = 79-86). Total cancer mortality was also lower than expected (SMR = 92, 95% CI = 84-100). Significant mortality deficits from several malignant and nonmalignant diseases were reported. A significant mortality increase in the broad category of lymphatic and hematopoietic cancers was found (SMR = 133, 95% CI = 103-170). This increase was attributed to a nonsignificant elevation in leukemia of all cell types combined (SMR = 139, 95% CI = 92-201) and a borderline significant increase in other lymphatic tissue cancer (SMR = 158, 95% CI = 101-235). The elevation in leukemia was confined to workers hired before 1950. Furthermore, the leukemia excess was shown to have peaked during the 1960s, with mortality no longer elevated post-1980. Analyses of cell type-specific leukemias showed a similar temporal pattern for acute myeloid leukemia (AML) which was not significantly elevated (SMR = 136, 95% CI = 59-268). Mortality from other leukemia cell types was similar to or lower than expected. Mortality from non-Hodgkin's lymphoma (NHL) (SMR = 140, 95% CI = 88-211) and multiple myeloma (MM) (SMR = 121, 95% CI = 55-230) were increased, but neither was statistically significant nor likely to be related to refinery employment. No death from asbestosis was reported, and mortality from mesothelioma and pulmonary fibrosis was lower than expected. Lung cancer mortality for the overall cohort was similar to expected. For the overall cohort, analyses by duration of employment and time since first employment showed no evidence of any trends for increasing cause-specific mortality. Separate analyses of male workers employed in operator jobs showed mortality patterns that were more favorable than those of the total cohort. Maintenance craftworkers showed statistically significant elevations in mortality for prostate cancer (SMR = 145, 95% CI = 107-194), leukemia (SMR = 179, 95% CI = 111-273), and other lymphatic tissue cancer (SMR = 233, 95% CI = 138-368). Detailed analyses indicated that, among maintenance craftworkers, mortality was elevated for AML, NHL, and MM, but none was significant. Furthermore, no upward trend by duration of maintenance jobs was observed. A small increase of lung cancer was observed among maintenance craftworkers (SMR = 120, 95% CI = 99-145), which was borderline significant. No relationship between lung cancer and duration of maintenance employment was found. In contrast, a deficit of pulmonary fibrosis was reported among maintenance craftworkers (SMR = 62, 95% CI = 17-159). These findings are discussed in conjunction with results from other refinery studies, and the limitations of the study are discussed.
Asbestos exposure: a potential cause of retroperitoneal fibrosis. R. Sauni, P. Oksa, R. Järvenpää, et al. 1998;33(4):418-21. PubMed · Publisher

Abstract

The etiology of retroperitoneal fibrosis is unknown in 70% of the cases. The aim of our study was to examine the possible association between occupational asbestos exposure and retroperitoneal fibrosis; only two cases have been reported in the literature. We gathered all the cases of retroperitoneal fibrosis diagnosed in the Tampere University Hospital between 1987 and 1995. We examined their hospital records to evaluate the possible etiology of the disease. We also sent a structured questionnaire to all living patients (10/13) to obtain information on their asbestos exposure. The chest radiographs of the patients were re-read to evaluate possible changes resulting from asbestos exposure. We found 13 cases of idiopathic retroperitoneal fibrosis. Seven patients (all male) had been exposed to asbestos in the past. The chest radiographs of the four most-exposed patients showed characteristic asbestos-related abnormalities, including bilateral pleural plaques, round atelectasis and small irregular lung opacities. In our study, we found that asbestos exposure and asbestos-induced changes in the lung and pleura were common among male retroperitoneal fibrosis patients. We suggest that occupational exposure to asbestos may be an important etiological factor for retroperitoneal fibrosis.
Asbestos-related lung cancer mortality in Piedmont, Italy. M. Martuzzi, P. Comba, M. De Santis, et al. 1998;33(6):565-70. PubMed · Publisher

Abstract

This study investigates the association between pleural neoplasm mortality, a possible proxy for asbestos exposure, and lung cancer mortality among males resident in Piedmont (northwestern Italy). Pleural neoplasm mortality was estimated in the 1,209 municipalities of the region for the period 1980-1992, applying Bayesian methods. The association with lung cancer mortality for municipalities was studied using Poisson regression. Urban/rural indicators and altitude were also included in the analysis. A positive, statistically significant association was found between pleural neoplasm and lung cancer mortality (beta = 0.025, P < 0.001); lung cancer risk was associated also with urban status (vs. rural, beta = 0.223, P < 0.001) and altitude (P = 0.01). The proportion of lung cancer deaths attributable to living in municipalities with increased pleural neoplasm mortality was 3.9% (95% confidence interval, 2.1-5.7%). The observed association and the presence of a dose-response relationship at the municipality level underscore the dangers of asbestos for human health.
Asbestos-related x-ray changes in foundry workers. K.D. Rosenman, M.J. Reilly. 1998;34(2):197-201. Case report PubMed · Publisher

Abstract

Michigan has a statewide mandatory occupational disease reporting system. As part of that system, reports are received from hospital, physicians, death certificates, the worker's compensation bureau, and company medical departments. Based on this reporting, the State of Michigan has a special emphasis program for the surveillance of silicosis, a known disease outcome among foundry workers. From 1985-1996, 115 cases reported to the State Surveillance System as silicosis, pneumoconiosis not specified, or pulmonary fibrosis were reclassified as having asbestos related x-ray changes after a B-reader interpretation of each case's chest x-ray. During this same period there were an additional 697 reports confirmed as silicosis and 6,724 cases reported to the surveillance system as asbestosis. Among the 115 reports reclassified as having asbestos-related x-ray changes without evidence of silicosis-related x-ray changes, 54 had worked in foundries. Only 7 (14.8%) of these individuals had their primary work in maintenance in the foundry; 40 (85.1%) had their primary foundry work in a production job; and for 10 individuals the occupation was not known. Asbestos has been used in foundries on pipe laggings, boiler coverings, as insulation in fan housings, in gloves, aprons and curtains, as insulation in cupolas, and in ladles and insulation in sand molds. Clinicians caring for foundry workers need to be aware that asbestos-related x-ray changes are not uncommon in this population and asbestos exposure should be considered as one of the carcinogens contributing to the known increased risk of lung cancer among foundry workers.
Availability of epidemiologic data for chemicals known to cause cancer in animals: an update. M. Karstadt. 1998;34(5):519-25. PubMed · Publisher

Abstract

Between 1972 and 1996, the International Agency for Research on Cancer (IARC) identified 282 chemicals as having experimental evidence "sufficient" to conclude that the chemicals cause cancer in animals. Of the 282 IARC animal carcinogens, 7% (20) also had "sufficient" evidence from epidemiology studies. "Limited" human evidence was available for 5% (13) of the 282 IARC animal carcinogens. A 1996 IARC international compendium of cancer studies indicated that epidemiologic studies of chemicals determined by IARC to cause cancer in both humans and animals were considerably more common than studies of chemicals determined to cause cancer in animals but for which human data were inadequate or limited. Of the 1,101 studies reported to IARC by investigators, the IARC animal carcinogens, with the most ongoing studies were asbestos (50 studies) and benzene (26 studies). Both chemicals have sufficient evidence of carcinogenicity from studies of humans. There were epidemiologic studies ongoing for 65% (13/20) of the chemicals for which evidence of carcinogenicity was sufficient in both animals and humans. Epidemiologic studies were reported to IARC for 12% (30/247) of the IARC animal carcinogens for which human data were inadequate or for which no human data were available. Two factors appear critical in determining whether an IARC animal carcinogen becomes the subject of an epidemiologic study: the likelihood of overcoming methodological obstacles to carrying out successful epidemiologic studies, and the economic and/or regulatory interest in the chemical.
Cancer mortality and wood dust exposure among participants in the American Cancer Society Cancer Prevention Study-II (CPS-II). S.D. Stellman, P.A. Demers, D. Colin, et al. 1998;34(3):229-37. PubMed · Publisher

Abstract

In 1994, the International Agency for Research on Cancer (IARC) classified wood duct as a human carcinogen, based on very strong evidence of a carcinogenic risk of sino-nasal cancer. Excesses of other cancers, including lung and stomach, have been reported among persons employed in wood industries or occupationally exposed to wood dust, but not as consistently. We investigated such possible associations using the mortality experience of 362,823 men enrolled in the American Cancer Society's Cancer Prevention Study-II in 1982 and followed up for 6 years. Within this group, 45,399 men (12.5%) reported either employment in a wood-related occupation or exposure to wood dust or both. Among woodworkers, a small but significant excess risk was found for all cases of death (RR 1.17 (95% CI 1.11-1.24)) and for total malignancies (RR 1.17 (1.05-1.30)). Among men who reported exposure to wood dust, there was an elevated risk of total mortality (Rr 1.07 (1.03-1.11)), total malignancies (RR 1.08 (1.01-1.15)), and lung cancer (RR 1.17 (1.04-1.31)). Among woodworkers, a significant trend (P = 0.02) of increasing risk of lung cancer with increasing duration of exposure was observed. An unexpected, significantly increased mortality from prostate cancer was observed in both wood-employed and wood-exposed, and a twofold increased risk of fatal brain cancer was seen among the former. Lung cancer mortality was especially high among woodworkers who also reported exposure to asbestos or formaldehyde, and it appears that exposure to these known carcinogens may partly explain the observed increased risks. Excess sino-nasal cancer was not observed, but the number of cases was small.
Carcinogenic implications of the lack of tremolite in UICC reference chrysotile. A.L. Frank, R.F. Dodson, M.G. Williams. 1998;34(4):314-7. PubMed · Publisher

Abstract

Using light and electron microscopy analysis, as well as electron diffraction, and energy-dispersive x-ray analysis, an aliquot of UICC chrysotile B was analyzed with special attention given to any tremolite contamination. Polarized light microscopy, with its limit of detection of approximately 1 micron when using dispersion staining, revealed chrysotile as the only fibrous asbestos component. Analytical electron microscopy at 333,000x of more than 20,000 consecutive fibers showed only the tubular morphology characteristic of chrysotile. These findings highlight that when this sample was used for exposure disease induced in animal models correlates with chrysotile-induced pathology, and does not support an explanation based on the "amphibole hypothesis." Thus, chrysotile should be considered as having the biologic ability to produce cancers, including mesotheliomas, based on the extensive use of this material as a standard reference material.
Corruption of the medical literature: a second visit. D.S. Egilman, C.M. Hom. 1998;34(4):401-4; discussion 409-10. Historical article PubMed · Publisher
Lung cancer risk and welding: results from a case-control study in Germany. K.H. Jöckel, W. Ahrens, H. Pohlabeln, et al. 1998;33(4):313-20. PubMed · Publisher

Abstract

In a case-control study, 839 male hospital-based cases of primary lung cancer and the same number of population-based controls--matched by sex, age, and region of residence--were personally interviewed for their job and smoking histories. The study allows to quantify occupational asbestos exposure that was thought to be a welding-associated risk: 6% of cases and 2% of controls were classified into the occupational category "welders or burners# (odds ratio [OR] = 2.65). This OR was reduced to 1.93 (95% confidence limit [CL]: 1.03-3.61) after adjustment for smoking and asbestos. In contrast, a history of welding in general for at least a half-year is 28% among cases and 23% among controls, yielding an OR of 1.25 (95% CL: 0.94-1.65) after adjustment for both confounders. The OR of welding for more than 6,000 hr is 1.45 (95% CL = 1.04-2.02), reduced to 1.10 after adjustment for smoking and asbestos. Oxyacetylene welding for more than 6,000 hr lifelong is associated with an OR of 1.86 (95% CL = 1.01-3.43) reduced to 1.46 (n.s.) after adjustment for smoking and asbestos. The risk of oxyacetylene welding seems to be highest for oat cell carcinoma with an adjusted OR for ever-exposure of 1.46 (95% CL = 0.69-3.10). Therefore, the present study supports the hypothesis that some, but not all, of the excess risk of welders observed in the literature may be due to a history of cigarette smoking and occupational asbestos exposure. The elevated risk for the subgroup of employees in the aircraft industry reported for the midterm evaluation of the study still prevails, though no longer statistically significant. However, employees in this industry who ever welded show an OR of 2.29 (95% CL = 1.19-4.42) after adjustment for smoking and asbestos.
Lung health among boilermakers in Edmonton, Alberta. P.A. Hessel, L.S. Melenka, D. Michaelchuk, et al. 1998;34(4):381-6. PubMed · Publisher

Abstract

Background: Construction boilermakers may be exposed to a variety of substances, including asbestos and welding fumes. Past studies of boilermakers have shown increases in mortality from lung cancer and asbestosis and radiographic changes consistent with asbestos exposure.

Methods: Respiratory symptoms, lung function, and radiographic changes were compared for 102 actively employed boilermakers with 20 or more years of union membership and 100 telephone workers. Posteroanterior chest radiographs were evaluated by two experienced chest physicians, with a third arbitrating disagreed films. Union members were further categorized as boilermakers (n = 50) or welders (n = 52), based on longest service. Lung health was also compared with employment in a number of work sectors for time, and time-weighted exposure to dust and fumes.

Results: Boilermakers had more respiratory symptoms than telephone workers, but lung function did not differ. Radiographic changes were more common among the boilermakers (20% with any change, 8% circumscribed, and 9% diffuse pleural thickening). None of the boilermakers had small radiographic opacities. Several symptoms suggestive of bronchial responsiveness were associated with fume exposures in the gas and oil industry. Workers whose longest service was as a boilermaker demonstrated more symptoms than did welders. FEV1, FEV1/FVC, FEF25-75, and FEF50 were significantly lower among boilermakers compared with welders.

Conclusion: Health screening programs for these workers are warranted.
Nonmalignant respiratory disease mortality among woodworkers participating in the American Cancer Society Cancer Prevention Study-II (CPS-II). P.A. Demers, S.D. Stellman, D. Colin, et al. 1998;34(3):238-43. PubMed · Publisher

Abstract

Nonmalignant respiratory disease (NMRD) mortality was examined among woodworkers participating in the American Cancer Society's CPS-II cohort study. During the 6-year prospective follow-up there were 97 NMRD death's among 11,541 men reporting employment in wood-related occupations and 1,338 NMRD deaths among 317,424 men reporting no exposure to wood dust or wood-related jobs. Relative risks, adjusted for age and smoking, were calculated using Poisson regression. A small excess of NMRD was observed among woodworkers. However, the relative risk was higher among woodworkers who did not report exposure to wood dust (RR = 1.52, 95% CI = 1.18-1.97) than those who did (RR = 1.27, 95% CI = 0.91-1.77), and no clear trend with duration of exposure was observed. An excess of NMRD was observed among woodworkers reporting exposure to asbestos (RR = 1.59, 95% CI = 0.85-2.96), as well as the small number of woodworkers reporting exposure to formaldehyde (RR = 1.95, 95% CI = 0.63-6.06), but men not reporting exposure to these substances also had an excess risk. Although limited by a short follow-up period and crude indicators of exposure, the strengths of this analysis were the ability to compare woodworkers to a similar, healthy population and to adjust for the effects of smoking. Cohort studies with better exposure information are needed to examine the role of occupational exposures among woodworkers in the etiology of respiratory disease.
Occupation and the risk of laryngeal cancer in Uruguay. E. De Stefani, P. Boffetta, F. Oreggia, et al. 1998;33(6):537-42. PubMed · Publisher

Abstract

In a case-control analysis involving 112 patients afflicted by laryngeal cancer and 509 controls diagnosed with cancers not related to tobacco and alcohol exposures, we studied the effects of type of employment and of substances present in the workplace on laryngeal cancer risk. Effects were measured relative to those never employed or never exposed to the substances. All analyses were controlled for age, tobacco smoking, and alcohol drinking through unconditional logistic regression and stratified analysis. Among job titles, butchers, vintners, bakers, and car assemblers presented elevated risks of laryngeal cancer (OR for butchers 2.8, 95% CL 1.1-7.2). Similarly, asbestos, mists from strong inorganic acids and pesticide exposures were associated with increased risks of laryngeal cancer (OR for strong acids 1.8, 95% 1.1-2.9).
RE main asbestos type in pleural mesothelioma. P. Dumortier, P. De Vuyst, F. Rey, et al. 1998;33(1):94-6. Comment · Letter PubMed · Publisher
South African asbestos: production, exports, and destinations, 1959-1993. J.S. Harington, N.D. McGlashan. 1998;33(4):321-6. Review PubMed · Publisher

Abstract

Production and export figures of South African asbestos were analyzed over 1959-1993. They show stable sales of chrysotile. Those of crocidolite and amosite reached their peaks in the mid-1970s, after which trade fell drastically, crocidolite to 5% of its earlier peak and amosite to nil. Factors responsible for these virtual collapses were health issues, stricter legislation in First World countries, and litigation. In 1992, 21 countries continued to import crocidolite, although in reduced quantities. In the early 1960s, Europe and North America were the major recipients of South African asbestos. By 1989-91, these regions were surpassed by the Far East, which took over 90% of chrysotile and 70% of amosite. For crocidolite at that time, the Middle East took nearly 40%, Europe 28%, and Africa 21%. This implies that the newly importing countries can confidently expect an increase in asbestos-related disease and death well into the twenty-first century, even if the trade ceased now.
A battle for compensation for Welsh coal miners: JS Haldane v "Sericite" Jones, 1932-1934. M. Greenberg. 1997;32(3):309-14. Historical article PubMed · Publisher

Abstract

Toward the end of the 1920s, technical advances in mining led to an increase in airborne burdens of dust in the South Wales coal mines. This coincided with a dramatic increase in the incidence of disability and death from respiratory disease among the miners. For their condition to be compensable, claimants were required to have worked with rock containing more than 50% 'free silica.' Dr W.R. Jones, a mining geologist, was asked to help obtain compensation for those claimants who could not satisfy the 'free silica' condition. He was unable to identify high-silica rocks where none had been said to exist. He did however, successfully argue the brief against the eminent Professor J.S. Haldane (who was the dominant authority, having had lengthy experience in the field of health and mining), for the fibrous form of sericite being commonly the important agent responsible for pneumoconiosis. As a consequence, the category of miner eligible for compensation was broadened. Evidence was gathered worldwide that supported the hypothesis that silicates and not just crystalline silica could cause pneumoconiosis. Despite the suspicions raised about the special power of mineral fibers during this public debate, some 40 years were to elapse before potential health hazards from fibers other than asbestos were to be taken seriously and investigated.
A cohort mortality study of construction workers. J. Sun, E. Shibata, N. Hisanaga, et al. 1997;32(1):35-41. PubMed · Publisher

Abstract

This report presents a mortality study among the 17,344 members of the Construction Workers' Health Insurance Society of Mie Prefecture in Japan. The study period was between 1973 and 1993. During this period, 480 members died. Age-specific mortality rates of Mie Prefecture were used as comparison standards. Significantly elevated standardized mortality ratio (SMR) and proportionate mortality ratio (PMR) were observed for "accidents and adverse effects." In addition, the PMRs of all cancers and "cancers of trachea, bronchus and lung" were also significantly elevated. The job classifications were reorganized into three groups, according to the frequency of asbestos exposure the workers experienced on the construction sites. The asbestos exposure was based on job classifications among 7,411 workers who had completed a self-administered survey questionnaire. In the frequent-exposure group, the PMR was significantly elevated for all cancers. In the medium-exposure group, the SMRs were significantly elevated for all cancers and "cancer of trachea, bronchus and lung." The PMR was significantly elevated for "cancer of trachea, bronchus and lung." In the less-exposure, group, the PMR was significantly elevated for "accidents and adverse effects." This study provided support for the hypothesis that working in the construction industry might be associated with high risks for asbestos-associated cancers and accidental deaths.
An early study of pulmonary asbestosis among manufacturing workers: original data and reconstruction of the 1932 cohort. S.W. Borron, S.A. Forman, J.E. Lockey, et al. 1997;31(3):324-34. Historical article PubMed · Publisher

Abstract

A cross-sectional prevalence survey of asbestosis, including all 1,140 employees of a diversified asbestos products manufacturer, was conducted in 1932 by Drs. Anthony J. Lanza and Frank V. Meriwether. Occupational histories were obtained from workers in order to identify job tasks with exposure to asbestos and other fibrogenic dusts. Abbreviated medical histories, physical examinations, fluoroscopy, and chest radiographs were performed. Radiographs were interpreted according to applicable criteria for pneumoconiosis, the presence of which was confirmed in 327 subjects (29%). Among those, 64% had previous exposure to dusts in addition to asbestos, coal being the leading non-asbestos exposure. Thirty-six percent of cases had prior exposure only to asbestos dust. The original conclusions do not survive. Contemporaneous related documents suggest that the original authors believed asbestosis to be a milder form of lung disease than silicosis. It was subsequently recommended that the company institute pre-employment physicals, including chest radiographs; not hire people with prior coal-dust exposure; warn workers against excessive exposure to asbestos dust; remove those with disease to less dusty areas; and begin periodic medical surveillance for pneumoconiosis. The study, which has never appeared in the medical or scientific literature, holds important lessons for those concerned with occupational health today and in the future.
Analysis of asbestos bodies in BAL from subjects with particular exposures. P. De Vuyst, P. Dumortier, P.A. Gevenois. 1997;31(6):699-704. Case report PubMed · Publisher

Abstract

Four patients with asbestos-related diseases and with unusual exposures underwent bronchoalveolar lavage (BAL) for mineralogical analysis. Asbestos bodies (AB) were counted by light microscopy and analyzed by transmission electron microscopy and X-ray energy spectrometry. AB's were found in all cases, after a mean delay from the end of exposure of 27.7 years. Analysis of the core fibers indicated the type of alveolar asbestos burden and was compared with the previous exposures: Pleural plaques due to household exposure to amosite and crocidolite. Pleural plaques due to occult occupational exposure to crocidolite in a coal miner. Asbestosis due to environmental exposure to tremolite in Turkey. Asbestosis, pleural plaques, and peritoneal mesothelioma due to a short, intense exposure to crocidolite. AB counting in BAL and identification of the central fibers by analytical electron microscopy is a useful, non-invasive and reliable method to evaluate the alveolar retention of bio-persistent fibers and to relate them to specific exposures.
Cancer incidence and mortality among Finnish asbestos sprayers and in asbestosis and silicosis patients. P. Oksa, E. Pukkala, A. Karjalainen, et al. 1997;31(6):693-8. PubMed · Publisher

Abstract

Cohorts of Finnish asbestos sprayers and of asbestosis and silicosis patients were followed for cancer with the aid of the Finnish Cancer Registry in the period 1967-1994. Compared with the cancer incidence of the total Finnish population, asbestos sprayers had an increased risk for total cancer (standardized incidence ratio [SIR] 6.7, 95% confidence interval [95% CI] 4.2-10); lung cancer (SIR 17.95% CI 8.2-31); and mesothelioma (SIR 263, 95% CI 85-614). The SIR of the asbestosis patients was 3.7 (95% CI 2.8-5.0) for all sites, 10 (95% CI 6.9-14) for lung cancer, and 65 (95% CI 13-188) for mesothelioma. The silicosis patients also had significantly high SIR values for all sites (1.5, 95% CI 1.0-2.1) and lung cancer (2.7, 95% CI 1.5-4.5). The values for the SIR and the standardized mortality ratio for all sites and lung cancer were very similar, and therefore it seems that both are reliable indicators of the occurrence of occupational cancer. It was concluded that pneumoconioses patients and asbestos-exposed workers have a markedly elevated risk for cancer. Asbestos-induced occupational cancers are not only diseases of the elderly, since the relative risk is high also for middle-aged people.
Comparison of U.S. Occupational Safety and Health Administration standards and German Berufsgenossenschaften Guidelines for Preventive Occupational Health Examinations. K. Straif, M. Silverstein. 1997;31(4):373-80. PubMed · Publisher

Abstract

Thirty-three U.S. Occupational Safety and Health Administration (OSHA) standards contain mandated medical service provisions. The German Berufsgenossenschaften Guidelines for Preventive Occupational Health Examinations currently comprise 38 guidelines, which contain mandated medical service provisions. Based on a previously published method for scoring several medical program elements, the Berufsgenossenchaften guidelines were compared with the OSHA standards. Specific program elements were combined to generate and compare quality control scores, screening scores and surveillance scores. The asbestos standard/guidelines were compared in more detail (e.g., physical examination, laboratory tests, examination schedule, eligibility). The German medical requirements consistently ranked higher than their U.S. counterparts for overall scores and the scoring indices for quality control, screening, and surveillance. However, this comparison also reveals that few surveillance features have been incorporated into the medical requirements of either country, suggesting that neither country is making full use of workplace medical services for primary prevention.
Exposure to mineral oil mist and respiratory symptoms in marine engineers. K. Svendsen, B. Hilt. 1997;32(1):84-9. PubMed · Publisher

Abstract

The purpose of the study was to see if marine engineers have an increased prevalence of respiratory symptoms, and if so whether it can be related to occupational exposures. A self-administered questionnaire was sent to 700 male seamen from three Norwegian ferry companies. Of the 492 respondents, 169 were currently working as marine engineers and 295 had never worked as marine engineers. The outcomes of cough and wheezing, chronic bronchitis, severe dyspnea, any dyspnea, and mucous membrane irritation (MMI) were defined from the questionnaire. Age and smoking-adjusted prevalences of these respiratory conditions were compared between the groups. Logistic regression was used to further elucidate the explanatory variables. The exposure assessment indicated an exposure (TWAC) to oil mist for marine engineers in the range from 0.12 to 0.74 mg/m3 (mean 0.45 mg/m3) When comparing current marine engineers with those who had never worked as marine engineers, the prevalence ratios were 1.38 (95% CI 1.0-1.9) for MMI, 1.53 (95% CI 1.2-1.9) for any dyspnea, and 1.63 (95% CI 1.0-2.6) for severe dyspnea. The differences remained for some of the symptoms after controlling for self-reported former asbestos exposure in the regression analysis. The increased prevalence of respiratory symptoms found among marine engineers in this investigation may partly be explained be oil-mist exposure, or more probably by a combination of past asbestos exposure and past and present oil-mist exposure.
Gastrointestinal cancer mortality of workers in occupations with high asbestos exposures. S.K. Kang, C.A. Burnett, E. Freund, et al. 1997;31(6):713-8. PubMed · Publisher

Abstract

Asbestos, which is a well-known risk factor for lung cancer and malignant mesothelioma, has also been suggested as a gastrointestinal (GI) carcinogen. This study was conducted to assess the relationship between high asbestos exposure occupations and the occurrence of G1 cancer. Death certificate data were analyzed from 4,943,566 decedents with information on occupation and industry from 28 states from 1979 through 1990. Elevated proportionate mortality ratios (PMRs) for mesothelioma were used to identify occupations potentially having many workers exposed to asbestos. All PMRs were age-adjusted and sex- and race-specific. The PMRs for GI cancers in white males were then calculated for these occupations after excluding mesothelioma, lung cancer, and non-malignant respiratory disease from all deaths. We identified 15,524 cases of GI cancer in the 12 occupations with elevated PMRs for mesothelioma. When these occupations were combined, the PMRs for esophageal, gastric, and colorectal cancer were significantly elevated at 108 (95% confidence interval = 107-110), 110 (106-113), and 109 (107-110), respectively. Esophageal cancer was elevated in sheet metal workers and mechanical workers. Gastric cancer was elevated in supervisors in production and managers. Colorectal cancer was elevated in mechanical and electrical and electronic engineers. However, high exposure occupations like insulation, construction painter supervisors, plumbers, furnace operators, and construction electricians showed no elevations of GI cancers. In conclusion, this death certificate study supports an association between asbestos exposure and some GI cancer, however the magnitude of this effect is very small.
Hospital records: an underutilized source of information regarding occupational diseases and exposures. G.M. Liss, R.A. Kusiak, M.M. Gailitis. 1997;31(1):100-6. PubMed · Publisher

Abstract

A 1993 study examined the association between pneumoconiosis and cor pulmonale using a computerized data base of hospital records in Ontario (Hospital Medical Records Institute, HMRI). The present investigation was undertaken to confirm the coding of the diagnoses of a subset of the hospital discharges from that study, to determine the validity of the coding of the diagnoses of coal workers' pneumoconiosis (CWP), and to identify work exposure (occupation and industry) information available in hospital records. We sent abstraction forms to hospitals for 521 subjects who were hospitalized for pneumoconiosis, cor pulmonale, or both conditions, requesting information regarding diagnoses, occupation and industry data, and X-ray results. Abstracts were received for 720 (76%) of 944 discharges that were sought. The hospital abstractions confirmed the HMRI coding for 90% of the charts with these conditions, including 63%, 97%, and 96% discharges for CWP, silicosis, and asbestosis, respectively. Specific dust exposures were indicated in 42% of the charts with a code indicating a diagnosis of CWP, and of these, 67% indicated exposure to coal dust. Of charts with a code indicating a diagnosis of silicosis, 73% with specific dust information indicated silica exposure, and 95% of those for asbestosis indicated exposure to asbestos. Of 34 individuals in this data set known from the Ministry of Labour's Chest Clinic X-ray Surveillance Program of miners to have silicosis, 33 (97%) were diagnosed by the hospitals as having pneumoconiosis, and all but two were silicosis. Hospital records, as reflected by HMRI data, are reliable indicators of cor pulmonale and pneumoconiosis. The agreement with the Chest Clinic's X-ray diagnoses provides additional objective confirmation of the accuracy of the hospital information. There were relatively few cases of silicosis miscoded as CWP. At least for pneumoconioses, hospital records contained information about the exposures that led to these diseases in approximately 50% of the cases. However, whether hospital records would prove useful for detecting other work-related conditions that are not pathognomonic of occupation is not known. The importance of taking occupational histories needs continued emphasis in medical education and training.
Lobe of origin and histologic type of lung cancer associated with asbestos exposure in the Carotene and Retinol Efficacy Trial (CARET). C.A. Brodkin, J. McCullough, B. Stover, et al. 1997;32(6):582-91. PubMed · Publisher

Abstract

Lower lobe origin and histologic diagnosis of adenocarcinoma have been described as useful parameters for attributing lung cancer to prior asbestos exposure. To assess whether these characteristics differed between asbestos-exposed individuals and smokers, we evaluated lobe of origin and histologic type of tumors in 78 asbestos-exposed and 214 nonexposed heavy smokers developing lung cancer during the Carotene and Retinol Efficacy Trial (CARET), a prospective cancer chemoprevention trial. Most tumors in both cohorts, regardless of radiographic fibrosis at baseline, originated in upper lobes, representing 67% in asbestos-exposed and 80% in smokers, respectively (adjusted OR for lower lobe = 1.41; 95% CI = 0.69-2.91). Adenocarcinoma represented 32% of lung tumors in the asbestos cohort, and 30% in the smoking cohort (adjusted OR = 0.78; 95% CI = 0.40-1.55), and was inversely associated with radiographic fibrosis (adjusted OR = 0.19; 95% CI = 0.06-0.62). We conclude that neither anatomic site nor histologic cell type of tumors distinguishes effectively between smoking and asbestos as causal factors in development of lung cancer.
Loss of lung function among sheet metal workers: ten-year study. P.M. Glencross, J.M. Weinberg, J.G. Ibrahim, et al. 1997;32(5):460-6. PubMed · Publisher

Abstract

One hundred and twenty-two sheet metal workers in New England were examined over a 10-year interval for loss of pulmonary function and the development of asbestosis or asbestos-related pleural fibrosis. Regression models using the generalized estimating equation (GEE) approach were created to investigate the relationship between exposure and pulmonary function after adjusting for smoking status, age, height, and asbestos-related x-ray changes. A history of shipyard work was a significant contributor to the loss of forced vital capacity (FVC). Among smokers, loss in forced expiratory volume at 1 sec (FEV1) also had a significant relationship to prior shipyard work. There was a borderline significant relationship between percentage predicted FEV1 and cumulative years of asbestos exposure in smokers, as well as years-since-initial-exposure in never-smokers. This study supports previous findings of obstructive airway changes in asbestos-exposed workers and identifies shipboard work as an important predictor of loss in pulmonary function even years after shipyard exposure to asbestos has ceased.
Major and trace element compositions of the UICC standard asbestos samples. D.R. Bowes, C.M. Farrow. 1997;32(6):592-4. PubMed · Publisher

Abstract

Major and trace element compositions for chrysotile (2 samples), amosite, crocidolite, and anthophyllite UICC standard asbestos samples have been determined using UV-visible spectrophotometry, atomic absorption spectometry, flame photometry, volumetric analysis, and gravimetric analysis for major elements and x-ray and optical spectrometry for trace elements. The trace element data are for Li, S, Cl, Sc, V, Cr, Co, Ni, Cu, Zn, Ga, Rb, Sr, Zr, Nb, Ba, La, Ce, Pb, and Th and distribution in the various mineral phases is discussed.
Mortality from a Chinese asbestos plant: overall cancer mortality. Z.C. Pang, Z. Zhang, Y. Wang, et al. 1997;32(5):442-4. PubMed · Publisher

Abstract

The cancer mortality in a Chinese asbestos plant using only chrysotile was studied. Opened in the 1950s, all workers with at least 1 year of employment by 1972 were followed through 1994. Most workers were female. Excess cancer mortality, compared to local city data, was found for lung cancer, including many cases among nonsmoking women, and stomach cancer. Plant asbestos levels have been high in the past but have consistently come down over the decades.
Pleural plaques as risk indicators for malignant pleural mesothelioma: a necropsy-based study. C. Bianchi, A. Brollo, L. Ramani, et al. 1997;32(5):445-9. PubMed · Publisher

Abstract

Pleural plaque is recognized as a reliable marker of previous exposure to asbestos. However, it is controversial whether pleural plaque is a risk indicator for asbestos-related malignancies. In the present study, the thoracic cavities were examined for pleural plaques in 3,005 necropsies performed at the Monfalcone Hospital in people aged 15 years or older. Plaques were classified into three classes: 1, small (plaques measuring 1-4 cm in major diameter); 3, large (plaques involving a major part of a hemithorax); and 2, moderate (intermediate conditions). The prevalences of pleural plaques were 70.9% among men, and 24.0% among women. The prevalences of plaques (total plaques, various classes) among subjects with pleural mesothelioma were compared with those observed in the remaining cases. The series included 92 subjects with malignant pleural mesothelioma (82 men and 10 women). Mesothelioma cases showed higher prevalences of total plaques as well as higher prevalences of classes 1, 2, and 3, when compared with controls. These differences reached the statistical significance for total plaques, and classes 2, 3. The present data are consistent with the idea that pleural plaque is a risk indicator for pleural mesothelioma.
Professor Matthew Stewart: asbestosis research 1929-1934. M. Greenberg. 1997;32(5):562-9. Historical article PubMed · Publisher

Abstract

Matthew Stewart, Professor of Pathology at Leeds University, developed an interest in asbestosis during the late 1920s. In 1929, the Medical Research Council (MRC), encouraged by an advisory committee, funded research into asbestosis at Leeds University. Stewart supported by physicians designed a program of clinical, radiological and physiological studies to follow up Merewether's affected asbestos workers. Unfortunately, this met with opposition from industry, and the Home Office Factory Department was reluctant to assist, so it was abandoned. Industry did, however, cooperate with Stewart's studies on the effects of exposing guinea pigs in the factory environment, but this led to little in the way of publication. The failure of the Leeds School to realize its potential in investigating the effects of asbestos in humans, results in part from the discouragement it received and in part from the limited time and energies available to persons with a wide range of active interests. Some 45 years were to elapse before the MRC were enabled to carry out an analysis of the clinical, radiological and physiological data of a population of asbestos workers.
Proportionate mortality among unionized construction ironworkers. F.B. Stern, M.H. Sweeney, E. Ward. 1997;31(2):176-87. PubMed · Publisher

Abstract

This report presents the results of proportionate mortality ratios (PMR) and proportionate cancer mortality ratios (PCMR) among 13,301 members of the International Union of Bridge, Structural, and Ornamental Ironworkers who had been members for a minimum of 1 year, were actively paying dues into the death beneficiary fund, and had died between 1984-1991. Using the United States proportionate mortality rates as the comparison population, statistically significant elevated risks, using 95% confidence intervals (CI), were observed for several types of injuries: falls (N = 259, PMR = 3.57, CI = 3.15-4.03), transportation injuries (N = 363, PMR = 1.22, CI = 1.10-1.35), and other types of injuries (N = 225, PMR = 1.63, CI = 1.43-1.86). The deaths due to falls were significantly elevated for each 10-year age group under age 60 (PMR > 7.00) and for those workers with < 20 years in the union (PMR > 6.00). Elevated mortality risks were also observed for all malignant neoplasms combined (N = 3,682, PMR = 1.09, CI = 1.06-1.13) as well as for site-specific malignant neoplasms of the lung (N = 1,523, PMR = 1.28, CI = 1.21-1.35), pleural mesothelioma (N = 7, PMR = 1.67, CI = 0.67-3.44) and "other and unspecified sites" (N = 307, PMR = 1.29, CI = 1.15-1.44). The category "pneumoconiosis and other respiratory diseases" was also significantly elevated (N = 690, PMR = 1.11, CI = 1.03-1.20); in this category, deaths due to asbestosis had the greatest elevated risk (N = 10, PMR = 3.56, CI = 1.70-6.54). No elevation in risk was found for kidney cancer or for chronic nephritis which were of interest because of Ironworkers' potential exposure to lead. The present study underscores the importance of fall protection and other injury prevention efforts in the construction industry, as well as the need to control airborne exposures to asbestos, welding fumes and other respirable disease hazards.
Radiographic asbestosis is not a prerequisite for asbestos-associated lung cancer in Ontario asbestos-cement workers. M.M. Finkelstein. 1997;32(4):341-8. PubMed · Publisher

Abstract

In recent years, controversy has developed about whether pre-existing asbestosis is a prerequisite for the diagnosis of asbestos-related lung cancer. This paper presents the results of a prospective study, in a cohort of Ontario asbestos-cement workers, of lung cancer in relation to radiographs obtained 20 and 25 years from first exposure to asbestos. Radiographs were interpreted by a single NIOSH-certified "B" reader, and asbestosis was defined to mean an ILO code of 1/0 or greater. There were 143 subjects (123 without asbestosis, 20 with asbestosis), with a radiograph available for interpretation at 20 years from first exposure or later. The lung cancer standardized mortality ratio (SMR) among men without asbestosis at 20 years latency was 5.53 (95% CI: 2.9-9.7). There were 128 subjects (114 without asbestosis, 14 with asbestosis) with a radiograph available for interpretation at 25 years from first exposure or later. The lung cancer SMR among men without asbestosis at 25 years latency was 5.81 (95% CI 2.7-11). The results of this study are consistent with those of epidemiologic studies of asbestos-exposed populations in a variety of exposure situations. These studies have demonstrated that lung cancer risk is elevated in the presence of radiographic asbestosis, but they have also shown that lung cancer risk may be elevated in the absence of radiographic asbestosis.
Respiratory impairments due to dust exposure: a comparative study among workers exposed to silica, asbestos, and coalmine dust. X. Wang, E. Yano, K. Nonaka, et al. 1997;31(5):495-502. PubMed · Publisher

Abstract

We conducted a comparative study of pulmonary dysfunction among workers who were exposed to silica, asbestos, or coalmine dust. The results showed that all three groups of dust-exposed workers, even those without radiographic signs of pneumoconiosis, had decreased spirometric parameters and diffusing capacity (DLco) in both nonsmokers and smokers. Pulmonary function was further decreased when pneumoconioses were present in the three groups. In accord with increasing radiographic categories, pulmonary function in the workers with either silicosis or asbestosis was even lower, whereas in those with coal workers' pneumoconiosis (CWP), it changed relatively little. Workers with mild to moderate (radiographic category I-II) silicosis or asbestosis showed similarly decreased DLco, but those with silicosis showed lower FEV1/FVC than those with abestosis. The workers with CWP also showed a lower FEV1/FVC than those with asbestosis. The major impairment patterns for silica workers, asbestos workers, and coal miners were mixed, restrictive and mixed, and obstructive, respectively. Smoking obviously increased the prevalence of obstruction for all the groups. We conclude from the present study that all the three dusts cause functional abnormalities that precede radiographic changes of pneumoconiosis. We should pay more attention to respiratory impairment in the initial stage of silicosis and CWP.
Smoking intervention in subjects at risk of asbestos-related lung cancer. H.P. Waage, L.J. Vatten, E. Opedal, et al. 1997;31(6):705-12. PubMed · Publisher

Abstract

A smoking intervention counseling program was applied among asbestos-exposed male smokers younger than 65 years of age to examine the effect of an intervention based on risk communication. Intervention subjects (n = 431) were invited to a health status checkup combined with physician-delivered smoking intervention counseling. Control subjects (n = 141) received no intervention. After 1 year, 5% of the responders in the intervention group, versus 3.4% in the control group, had stopped smoking. Corresponding conservative estimates were 3.5% and 2.6%, respectively. The quitters had been exposed to a higher "dose" of asbestos but had smoked less, and for a shorter period, than had the continuing smokers. Counseling by a general physician increased successful quitting threefold, compared to counseling by a physician in a specialized institution. These results suggest a potential for smoking cessation among subjects at high risk of lung cancer due to asbestos exposure. General practice care may be an appropriate setting both for identification of such subjects and for intervention.
The CARET asbestos-exposed cohort: baseline characteristics and comparison to other asbestos-exposed cohorts. S. Barnhart, J. Keogh, M.R. Cullen, et al. 1997;32(6):573-81. PubMed · Publisher

Abstract

The Carotene and Retinol Efficacy Trial (CARET) was a double-blind, placebo-controlled trial of the daily administration of 25,000 IU vitamin A and 30 mg beta-carotene for the prevention of lung cancer. Of close to 18,500 participants, more than 4,000 were asbestos-exposed men recruited from shipyard and construction trades at five study centers in the United States. While the primary endpoint of the trial was the incidence of lung cancer, a number of questions about the natural history of asbestos-related disease will also be addressed. The mean age at entry into the trial was 57 years and the mean duration of follow-up on active intervention was 4 years. With the exception of 133 never-smoker pilot participants (3%), all subjects recruited were by intention current (38%) or ex-smokers (58%), with a mean cumulative smoking exposure at entry of 43 pack-years. Mean years from first asbestos exposure were 35, and mean duration of asbestos exposure in a high-risk trade was 19 years. The distribution of radiographic abnormalities was as follows: normal, 34%; parenchymal opacities (ILO profusion score > 1/0) alone, 18%; pleural thickening alone, 27%; both parenchymal opacities and pleural thickening, 21%. The CARET cohort, when compared to previously reported asbestos-exposed cohorts, is characterized by substantial asbestos exposure and high proportion of asbestos-related radiographic findings. The active intervention was halted in 1996, after a mean duration of 40 years. Passive follow-up of the cohort will continue until the year 2000.
The glutathione S-transferase theta and mu deletion polymorphisms in asbestosis. K.T. Kelsey, H.H. Nelson, J.K. Wiencke, et al. 1997;31(3):274-9. PubMed · Publisher

Abstract

The glutathione S-transferases (GSTs) catalyze the conjugation of a wide variety of reactive, electrophilic substrates with glutathione, facilitating their excretion. There is also evidence that GSTs can catalyze glutathione conjugation of lipid radicals as well as act in the generation of leukotriene inflammatory mediators. Studying construction carpenters screened for the presence of asbestos-related diseases, we have previously reported that the constitutional deletion of GSTM1 (the gene coding for glutathione S-transferase class mu) is associated with an increased risk of asbestos-related interstitial lung disease, measured radiographically. In the current work, we have further studied this group of workers, investigating the distribution of a novel deletion polymorphism in the newly described GSTT1 gene, that codes for the GST class theta enzyme. A total of 666 carpenters were studied, and 124 (19%) had the deleted genotype. There was no association between the GSTT1 deletion and the radiographic diagnosis of either asbestos-related pleural or parenchymal disease. The GSTM1 deletion remained associated with the presence of x-ray evidence of asbestosis after adjustment for GSTT1 genotype. The GSTM1 null genotype was also associated with a family history of any malignancy. These data suggest that the association of polymorphic GSTs with asbestos-induced radiographic changes is specific for substrates of the GST class mu.
Toxicity in vitro of some silicon carbides and silicon nitrides: whiskers and powders. I. Svensson, E. Artursson, P. Leanderson, et al. 1997;31(3):335-43. PubMed · Publisher

Abstract

The objectives of this work were to investigate the toxicity of silicon carbide whiskers and powders and silicon nitride whiskers and powders and to compare their toxicity with the toxicity of crocidolite. The effects studied were inhibition of the cloning efficiency of V79 cells, formation of DNA strand breaks by means of a nick translation assay, formation of oxygen radicals in three different assays, and the ability to stimulate neutrophils to produce hydroxyl radicals. All materials showed concentration-dependent inhibition of the cloning efficiency of V79 cells. The inhibition by the most toxic whiskers was in the same order of magnitude as that of crocidolite. Milled whiskers and powders were less toxic than the whiskers. There was a high DNA breaking potential for crocidolite and four of the silicon carbide whiskers and a rather low one for the other materials. Formation of hydroxyl radicals was found for crocidolite and one of the silicon carbide whiskers. In the neutrophil activation test, there was a great variation in the different materials' abilities to activate neutrophils. There was also a good correlation between chemiluminescence and H2O2 formation. The highest activation was found in neutrophils exposed to two of the silicon carbide whiskers and one milled whisker. The conclusion of the investigation is that some of the ceramic materials studied had damaging biological effects comparable to or greater than those of crocidolite. The results from the investigation clearly imply that caution is needed in the introduction of new ceramic fiber materials, so that the correct precautions and protective devices are used in order to avoid harm to the personnel handling the material.
Approaches for assessing the efficacy of occupational health and safety standards. L. Stayner, E. Kuempel, F. Rice, et al. 1996;29(4):353-7. Review PubMed · Publisher

Abstract

The regulation of hazards is one of the most dramatic forms of intervention in occupational safety and health (OSH). Despite their high degree of potential social and economic impact, relatively little research has been conducted to specifically evaluate the effectiveness of OSH standards with regard to preventing occupational diseases and injuries. This paper reviews the basic scientific approaches that may be used to evaluate the efficacy of OSH standards. These approaches encompass the following research areas: (1) exposure surveillance, (2) disease surveillance, and (3) prospective studies following the introduction of the standard. Research on asbestos and asbestosis, respirable crystalline silica (quartz) and silicosis, and respirable coal mine dust and coal workers' pneumoconiosis (CWP) are used to illustrate these approaches and the type of information that is currently available. The examples (quartz, coal dust, asbestos) reveal substantial limitations in the types of information currently available for evaluating the efficacy of these OSH standards. Ideally, plans for evaluating the efficacy of OSH standards should be developed for existing and future standards. These plans should include programs for the surveillance of exposures and adverse health effects and, when possible, for prospective studies designed to evaluate how the risk of disease (or injury) is modified by the introduction of the standard.
Asbestos exposure and ovarian fiber burden. D.S. Heller, R.E. Gordon, C. Westhoff, et al. 1996;29(5):435-9. PubMed · Publisher

Abstract

Epidemiologic studies suggest increased risk of epithelial ovarian cancer in female asbestos workers and increased risk of malignancy in general in household contacts of asbestos workers. Ovaries were studied from 13 women with household contact with men with documented asbestos exposure and from 17 women undergoing incidental oophorectomy. Ovarian tissue was examined by analytic electron microscopy. Significant asbestos fiber burdens were detected in 9 out of 13 women with household asbestos exposure (69.2%), and in 6 out of 17 women who gave no exposure history (35%). Three exposed women had asbestos counts over 1 million fibers per gram wet weight (23%), but only 1/17 women without an exposure history had a count that high (6%). Although asbestos has been documented as a contaminant of some older cosmetic talc preparations, the chrysotile and crocidolite types of asbestos we detected are more indicative of background and/or occupational exposure. This study demonstrates that asbestos can reach the ovary. Although the number of subjects is small, asbestos appears to be present in ovarian tissue more frequently and in higher amounts in women with a documentable exposure history.
Asbestos plaques in a typical Veteran's hospital population. J.A. Miller, J.V. Zurlo. 1996;30(6):726-9. PubMed · Publisher

Abstract

Previous authors have described several pleural abnormalities on chest radiology as being pathognomonic for asbestos exposure. We sought to determine the percentage of admissions and outpatients at a typical Veteran's Affairs hospital with these findings, and researched medical records to verify the frequency at which patients having positive radiographs were suspected either by clinical/occupational history or radiologically to have had prior significant exposure to asbestos. Radiographs of 1,212 consecutive patients were evaluated by a certified B reader, and the medical records as well as previous radiology reports of all positive patients were reviewed. Twenty-eight (2.3%t) of the radiographs had pleural abnormalities consistent with asbestos exposure, with the patients, all male, ranging in age from 50 to 98 years (mean 75.6). Radiology reports described pleural plaques in only 12 of the 21 (57%) cases with prior exams available; in only seven (33%) was an asbestos etiology considered by the interpreting radiologist. The plaques were misdiagnosed in four instances as being indicative of other, unrelated pathology. A history of known dust exposure was expressed by only five patients (18%). Eleven described working in occupations now known to have a high incidence of exposure, but neither patient nor examining physician expressed consideration of dust inhalation. In conclusion, we have found that a significant percentage of patients in certain subpopulations show radiographic evidence of asbestos exposure that may be a harbinger of related pathology. Unfortunately, because of a low index of suspicion, thorough environmental histories are often deferred, many radiographic changes are either not recognized or are misdiagnosed, and these patients are not followed with the stringent protocols they deserve.
Asbestos-associated cancers in the Ontario refinery and petrochemical sector. M.M. Finkelstein. 1996;30(5):610-5. PubMed · Publisher

Abstract

Asbestos has been widely used in the refinery and petrochemical sector. Mesothelioma has occurred among maintenance employees, and it was hypothesized that mesothelioma is a marker for exposures which might increase lung cancer risk. A death certificate-based case-control study of mesothelioma and lung cancer from 1980 to 1992 was conducted in an Ontario county with a substantial presence of these industries. Each of the 17 men who died of mesothelioma and 424 with lung cancer were matched with controls who died of other causes. The Job and Industry fields on the death certificates were abstracted. Employment as a maintenance worker in the refinery and petrochemical sector was associated with an increased risk of mesothelioma (odds ratio: 24.5; 90% confidence interval 3.1-102). The risk of lung cancer among petrochemical workers, in comparison with all other workers in the county, was 0.88. In an internal comparison of maintenance employees with other blue-collar workers in the refinery and petrochemical sector, the odds ratio for lung cancer was 1.73 (90% confidence interval 0.83-3.6). This finding is consistent with no difference in risk between maintenance and other employees, but it is also compatible with study power being too low to achieve statistical significance. The hypothesis of increased lung cancer risk could be examined more fully with nested case-control studies in existing cohorts. Meanwhile, it would be prudent to reinforce adherence to asbestos control measures in the refinery and petrochemical sector.
Cancer incidence among mild steel and stainless steel welders and other metal workers. K.S. Hansen, J.M. Lauritsen, A. Skytthe. 1996;30(4):373-82. PubMed · Publisher

Abstract

The cancer incidence in a historical cohort of 10,059 metal workers employed during the period 1964-1984 was investigated. Standardized incidence ratios (SIR) were calculated based on registry extracts from the Danish Cancer registry. Lifetime exposure data (occupational and other) were obtained by a postal questionnaire in living cohort members and interviews by proxy for deceased and emigrated subjects. The incidence of lung cancer was increased among workers ever "employed as welders" (SIR = 1.38, 95% C.I. 1.03-1.81). There was a significant excess risk of lung cancer among "mild steel (MS) only welders" (SIR = 1.61, 95% C.I. 1.07-2.33) and "nonwelders" (SIR = 1.69, 95% C.I. 1.23-2.26) (indicating carcinogenic exposures other than welding), a borderline significant lung cancer excess among "MS ever welders" (SIR = 1.32, 95% C.I. 0.97-1.76), and a nonsignificant excess risk of lung cancer among "stainless steel (SS) only welders" (SIR = 2.38, 95% C.I. 0.77-5.55). In spite of signs of inconsistency in the risk estimation by duration and latency, we find the results support the conclusions of other studies: employment as a welder is associated with an increased lung cancer risk.
Cancer risks among iron and steel workers in Anshan, China, Part I: Proportional mortality ratio analysis. Z. Xu, G.W. Pan, L.M. Liu, et al. 1996;30(1):1-6. PubMed · Publisher

Abstract

A standardized proportional mortality ratio (SPMR) study of 8,887 deaths during 1980-1989 among male workers in a large integrated iron-steel complex in Anshan, China, was conducted to provide clues to occupational risk factors. Accidents and cancer accounted for a higher proportion of deaths among the iron-steel workers than among the general male population (SPMR = 1.21; 95% CI = 1.12-1.31 and 1.14; 95% CI = 1.10-1.18, respectively). Among all workers, SPMRs were significantly elevated for stomach, lung, and colorectal cancers (SPMR = 1.37, 1.37, 1.38, respectively), but not other cancers. Risks of stomach cancer appeared to be highest among workers employed in jobs with exposure to iron and coal dust, whereas significant increases in colorectal cancer were seen for loading and other dusty jobs and for administrative and sedentary jobs without dust exposure. Risks of lung cancer appeared increased for a variety of jobs throughout the complex, especially those with probable high levels of exposure to polycyclic hydrocarbons and asbestos. Risk of esophageal cancer was significantly elevated for fire-resistant brick makers, and risk of nonmalignant respiratory disease was significantly elevated for those employed as furnace workers, foundry workers, and fire-resistant brick makers.
Chrysotile asbestos is the main cause of pleural mesothelioma. A.H. Smith, C.C. Wright. 1996;30(3):252-66. Review PubMed · Publisher

Abstract

In contrast to amphibole forms of asbestos, chrysotile asbestos is often claimed to be only a minor cause of malignant pleural mesothelioma, a highly fatal cancer of the lining of the thoracic cavity. In this article we examine the evidence from animal and human studies that relates to this issue. Reported data do not support widely quoted views regarding the relative inertness of chrysotile fibers in mesothelioma causation. In fact, examination of all pertinent studies makes it clear that chrysotile asbestos is similar in potency to amphibole asbestos. Since asbestos is the major cause of mesothelioma, and chrysotile constitutes 95% of all asbestos use world wide, it can be concluded that chrysotile asbestos is the main cause of pleural mesothelioma in humans.
Colorectal cancer in asbestos cement workers in Denmark. E. Raffn, E. Villadsen, E. Lynge. 1996;30(3):267-72. PubMed · Publisher

Abstract

Recent data on the risk of colorectal cancer following exposure to chrysotile are conflicting. We report on colorectal cancer morbidity in a large cohort of asbestos cement workers from Denmark mainly exposed to chrysotile. The total cohort had an SIR of 1.23 (95% CI 1.01-1.48). With a latency period of 15 years, men employed in the early (1928-1950) production period had an SIR of 1.47 (95% CI 1.05-2.01). With the observation of excess risks of colorectal cancer morbidity among chrysotile exposed asbestos cement workers in both Sweden and Denmark the question on the role of chrysotile in the etiology of colorectal cancer remains open.
Comparison of measures of exposure to asbestos in former crocidolite workers from Wittenoom Gorge, W. Australia. N.H. de Klerk, A.W. Musk, V. Williams, et al. 1996;30(5):579-87. PubMed · Publisher

Abstract

Determinations of exposure-response relationships between crocidolite and the major asbestos-related diseases in the Wittenoom cohort have previously depended on the validity of estimates of airborne exposure to asbestos. This work aims to validate the airborne exposure measurements by obtaining measurements of the concentrations of uncoated crocidolite fibers and asbestos bodies retained in the lungs of individual workers, and to estimate the half-life of crocidolite fibers in the lungs. Samples of lung tissue, excluding tumor, of all former Wittenoom workers known to have died in Western Australia (WA) were sought from teaching hospitals, pathology departments, and the Coroner's pathologist. The lung specimens were processed using Pooley's method with TEM for counts of fibers of all types and using Smith and Naylor's method with conventional light microscopy for asbestos bodies (AB). Multiple linear regression was utilized to examine the associations between crocidolite concentrations in the lung and duration of employment at Wittenoom, time since last employed at Wittenoom, nature of job, estimated average fiber concentration at the worksite, and estimated cumulative crocidolite exposure (CCE) in fiber-years/ml for each subject. Lung tissue from 90 cases was processed and there was good agreement between counts of crocidolite fibers, asbestos bodies, and CCE. Correlations were 0.77 for AB and fibers, 0.54 for AB and CCE, and 0.58 for CCE and fibers, after log transformation. The half-life of crocidolite fibers in the lung was estimated at 92 months (95% CI 55-277 months). Previous estimates of airborne exposure to Wittenoom crocidolite have been reasonably reliable. The relatively simple technique of light microscopy for counting ABs in lung tissue also provides a useful and reliable indication of the level of past occupational exposure to crocidolite in subjects whose exposure has been only to crocidolite. The half-life of crocidolite fibers in the lungs of former Wittenoom workers is about 7-8 years.
Fibrous glass insulation and cancer: response and rebuttal. P.F. Infante, L.D. Schuman, J. Huff. 1996;30(1):113-20. Comment PubMed · Publisher

Abstract

In response to our commentary on fibrous glass and cancer [Infante et al., 1994], three letters have been received by the journal. The arguments put forth in these letters do not lead us to alter our scientific view that fibrous glass insulation is carcinogenic. No information is given in the letters that has not previously been stated. Even though these letters raise the same diaphanous arguments, we believe that to preserve occupational and public health we must respond in detail to ensure that the contentions of the fibrous glass industry do not gain further acceptance. Thus, we respond to each letter in turn: The first by Weiss questions and distorts epidemiologic findings, the second by McConnell attempts to recant his past views on the carcinogenicity of fibrous glass and on the value of rodent bioassays in general, and the third by Hesterberg and Chase impugns our analyses demonstrating a positive cancer response in their study. Lastly, we have not debated every issue raised in these three letters because of space limitations, and have centered our responses on what we consider the major incongruities and falsities in each letter. Likewise, we have been selective in citing only relevant literature, or those reports used by the industry or its consultants to support their views.
Health effects of working in pulp and paper mills: malignant diseases. K. Torén, B. Persson, G. Wingren. 1996;29(2):123-30. Review PubMed · Publisher

Abstract

This paper reviews the available literature regarding the work environment in pulp and paper mills and the risk for malignant diseases. An increased risk for lung cancer among pulp and paper mill workers has been reported. Most studies are inconclusive with regard to considerations of etiologic agents. However, maintenance workers seem to be at an increased risk for lung cancer, as well as for malignant mesothelioma, indicating that this occupational group was (is) exposed to asbestos. Workers exposed to chlorine compounds also seem to run an increased risk for lung cancer. An increased risk for malignant lymphomas among pulp mill workers is a constant finding. The increased risk is observed both among sulfite and sulfate workers, indicating a common exposure. Such an exposure could be wood dust, terpenes, or preservatives present in the wood. An increased risk for leukemias has been found in many studies carried out on pulp and paper workers, but the studies do not permit any conclusions about etiologic factors. In some studies an increased risk for stomach cancer has been found. However, the socioeconomic status of the workers is strongly related to stomach cancer, and factors, such as dietary habits, have not been taken into account in any of the reviewed studies. Hence, no further conclusions can be drawn regarding etiologic agents.
Long-term follow-up mortality study of petroleum refinery and chemical plant employees. S.P. Tsai, E.L. Gilstrap, S.R. Cowles, et al. 1996;29(1):75-87. PubMed · Publisher

Abstract

A previous report presented the 1948-1983 mortality patterns of the Shell Deer Park Manufacturing Complex employees who were employed for at least 3 months from 1948 through 1972. The present study updates the earlier investigation by extending the vital status follow-up through 1989 and by expanding the cohort to include employees hired after 1972. As in the previous study, the overall mortality and cancer mortality for both refinery and chemical employees were quite favorable compared to residents in the local population. Among refinery workers, cancers for which a suspicion of work-relatedness was raised in the previous study, i.e. leukemia and cancers of the central nervous system and biliary passage/liver, no supportive evidence was found in this update. For both refinery and chemical plant employees, the mortality rate due to cancers of all lymphopoietic tissue increased with increasing duration of employment; this finding was also noted by the original study. This was also evident for lymphoreticulosarcoma in refinery employees and for leukemia in chemical plant employees. However, elevations of cancers of all lymphatic and hematopoietic tissue are primarily confined to employees who started work at the complex before 1946. By contrast, deaths from cancer of all lymphatic and hematopoietic tissue for employees hired after 1945 were 22% lower than the comparison population. Seven deaths with mesothelioma mentioned on the death certificates were identified, with 3.2 deaths expected, resulting in a statistically nonsignificant SMR of 219.
Lung cancer and asbestos exposure: asbestosis is not necessary. D. Egilman, A. Reinert. 1996;30(4):398-406. Review PubMed · Publisher

Abstract

Recent commentaries on the issue of asbestos-related lung cancer have raised important points. One major question is whether lung cancer can be attributed to asbestos exposure in the absence of asbestosis. This review attempts to place the debate in the proper context for establishing causation. Relevant epidemiologic and pathologic studies are analyzed, as well as the scientific basis for each position in the debate. The assertion that asbestosis must be present in order to attribute a lung cancer to asbestos exposure does not meet accepted standards for establishing causation. In addition, some evidence has been incorrectly cited in support of this position. This discussion can benefit from clearer definitions of asbestosis, a more thorough evaluation of the available scientific information, and a proper context for determining causation. This review of the available evidence indicates that lung cancers can occur as a result of asbestos exposure, in the absence of clinical or histologic asbestosis. Causation in an individual should be assessed by considering duration of exposure, intensity of exposure, and appropriate latency.
Lung cancer mortality in stainless steel and mild steel welders: a nested case-referent study. J.M. Lauritsen, K.S. Hansen. 1996;30(4):383-91. PubMed · Publisher

Abstract

The association between welding and lung cancer has been studied in a nested case-referent study within a cohort of 8,372 metal workers. Lifetime exposure data on welding and other occupational exposures, as well as alcohol and smoking habits, were obtained by interviews of spouses and colleagues. Analysis was based on 439 deceased referents and 94 deceased cases. There was a 70% excess of lung cancer associated with "welding exposure ever" (OR +/- 95% C.I.: 1.68, 1.02-2.78). Overall OR for "mild steel (MS) welding ever" was 1.64, 0.99-2.72. The risk estimates for welding exposures showed an increasing tendency up to 15 years of exposure. The pattern of stainless steel (SS) welding resembles that of mild steel with an estimated OR of 1.65, 0.88-3.0. The general conclusion is that MS welding as well as SS welding seems to be associated with an increased risk of lung cancer. Further followup of the cohort will enhance precision of the estimates.
Malignant mesothelioma in paper mill workers: where might the asbestos have come from?. M. Greenberg. 1996;30(5):641. Comment · Letter PubMed · Publisher
Mineral phases and some reexamined characteristics of the International Union Against Cancer standard asbestos samples. N. Kohyama, Y. Shinohara, Y. Suzuki. 1996;30(5):515-28. PubMed · Publisher

Abstract

Standard asbestos samples to be used for biomedical research were first prepared by the International Union Against Cancer (UICC) in 1966 in the United Kingdom and South Africa. Using modern techniques, X-ray diffractometry, analytical transmission electron microscopy, and thermal analysis, we have now analyzed these UICC samples to determine the mineral compositions (mineral phases) and their respective quantities. UICC chrysotile A (from Zimbabwe) contains 2% fibrous anthophyllite as impurity; chrysotile B (from Canada) does not contain any fibrous impurities, only non-fibrous minerals. UICC amosite and crocidolite are almost pure. UICC anthophyllite has 20-30% talc as impurity. The chemical compositions and fiber size distributions of the UICC asbestos samples have also been determined. The mean widths of the fibers of chrysotile A and B are smaller than those of the amphibole fibers. This agrees well with the earlier results which showed the two chrysotile samples to have a larger respirable fraction than the amphiboles.
Mortality among maintenance employees potentially exposed to asbestos in a refinery and petrochemical plant. S.P. Tsai, L.C. Waddell, E.L. Gilstrap, et al. 1996;29(1):89-98. PubMed · Publisher

Abstract

This paper reports the mortality experience from 1948 to 1989 of 2,504 maintenance employees who had a minimum of one year of employment in jobs with potential exposure to asbestos at a Texas refinery and petrochemical plant. For the purposes of this study, "potential exposure" is equated with those jobs or crafts having the greatest direct potential proximity to, or which worked directly with, asbestos-containing materials, especially asbestos-containing thermal insulation. Approximately one-half of the study population had 10 years or longer potential exposure, and 80% had their first potential exposure before 1970. The total population exhibited significantly lower mortality for all causes, the standardized mortality ratio (SMR = 77); and for all cancer (SMR = 85), as compared to residents in the surrounding communities. Statistically significant deficits in mortality were also observed in a number of noncancerous diseases such as heart disease (SMR = 78; 95% CI = 69-88), nonmalignant respiratory disease (SMR = 70; 95% CI = 50-95), and cirrhosis of the liver (SMR = 44; 95% CI = 22-79). Mortality among employees who had 20 years or longer since their first potential exposure was also examined; the pattern of mortality was similar to that exhibited by the total cohort, with a slight increase in the SMR for most of the causes. The only statistically significant excess of mortality found was a fourfold increase in mesothelioma (5 observed and 1.2 expected deaths) the SMR was 428 (95% CI = 139-996) for the total cohort and was 469 (95% CI = 152-1093) for those who had 20 years or more since first potential exposure. In contrast to asbestos industry worker studies, mortality for lung cancer was substantially lower than the general population (SMR = 81; 95% CI = 63-103). The observed number of deaths for cancer of the larynx was virtually the same as expected (3 observed vs. 2.8 expected). This study also showed decreased mortality for cancers of gastrointestinal organs such as the esophagus (SMR = 78), stomach (SMR = 63), large intestine (SMR = 91), rectum (SMR = 55), or pancreas (SMR = 90)--cancers that have been reported to be elevated in studies of various industry workers directly exposed to asbestos.
Mortality of Carpenters' Union members employed in the U.S. construction or wood products industries, 1987-1990. C.F. Robinson, M. Petersen, W.K. Sieber, et al. 1996;30(6):674-94. PubMed · Publisher

Abstract

This study evaluated the mortality of 27,362 members of the U.S. Carpenters' Union who died in 1987-1990. Age-adjusted proportionate mortality ratios (PMRs) and proportionate cancer mortality ratios (PCMRs) were computed using the U.S. age-, gender-, and race-specific proportional mortality for the years of the study. For white male carpenters who were last employed while in construction industry locals, raised mortality was observed for lung cancer (PCMR = 107, CI = 103, 111), bone cancer (PMR = 181, CI = 107, 286), asbestosis (PMR = 283, CI = 158, 457), emphysema (PMR = 115, CI = 102, 130), transportation injuries (PMR = 121, CI = 109, 135), and falls (PMR = 122, CI = 104, 142). For white male carpenters who were last employed while in industrial wood products locals, significantly raised mortality occurred for stomach cancer (PMR = 187, CI = 136, 250), male breast cancer (PCMR = 469, CI = 128, 720), and transportation injuries (PMR = 136, CI = 110, 173). Excess breast cancer was associated with last employment inn wood machining trades. Nasal cancer mortality was not elevated. A total of 121 mesotheliomas were observed. Contributing cause of death analyses revealed raised mortality for these and additional causes; 4,594 (18%) death certificates mentioned occupational and other lung disease as a contributing factor, resulting in significantly elevated mortality. These data show that construction carpenters have moderately elevated mortality for the diseases caused by asbestos (lung cancer and malignant mesothelioma) and from traumatic injuries. The finding of elevated mortality for stomach, bone, and breast cancer was unexpected and requires further evaluation of possible occupational factors. This study confirms that construction carpentry is an extremely hazardous trade. The data suggest that additional preventive action guarding against asbestos exposure and occupational injury is urgently needed in this occupation.
Pulmonary function, smoking habits, and high resolution computed tomography (HRCT) early abnormalities of lung and pleural fibrosis in shipyard workers exposed to asbestos. S. Neri, P. Boraschi, A. Antonelli, et al. 1996;30(5):588-95. PubMed · Publisher

Abstract

To evaluate the presence of asbestos-related pleural and parenchymal abnormalities and their correlation with pulmonary function and smoking habits, 119 asbestos-exposed asymptomatic workers (mean age, 46.2 years; mean duration of asbestos exposure, 8.6 years; mean latency time, 21.6 years) with normal standard P.A chest radiographs were submitted to HRCT, CO-diffusing capacity and pulmonary function tests. HRCT scans were normal only in 31 (26%) examined workers; 31 (26%) subjects showed both pleural and parenchymal involvement, and 50 (42%) and seven (6%) had exclusively pleural and parenchymal abnormalities, respectively. Based on CO-diffusing capacity and pulmonary function tests, no significant difference was demonstrated between workers with pleural lesions and subjects with normal pleura; however, lower values of FVC were observed in the nonsmoking workers with parenchymal abnormalities in comparison with nonsmoking subjects with normal parenchyma (78.2 vs. 89.7% of predicted values; p = 0.03 by student's two-tailed t test), and lower values of FEV1/FVC in the smokers with parenchymal lesions with respect to smokers with normal parenchyma (93.7 vs. 100.2% of predicted values; p = 0.005 by students' two-tailed t test). In conclusion, our results demonstrate that HRCT may detect early parenchymal abnormalities which correlate with exposure to asbestos and respiratory function impairment, including a reduction in obstructive indices in smokers occupationally exposed to asbestos, without any clinically evident disease.
Respiratory health in asbestos-exposed ironworkers. A.Z. Rocskay, M.R. Harbut, M.A. Green, et al. 1996;29(5):459-66. PubMed · Publisher

Abstract

This study aimed to determine the prevalence of respiratory morbidity among asbestos-exposed ironworkers and to determine the relationship between respiratory morbidity indices and length of exposure. A medical screening provided information on chest radiographic abnormalities, pulmonary function, rales, finger clubbing, and respiratory symptoms for 547 asbestos-exposed ironworkers. Union pension records furnished data on length of exposure. The study group exhibited on increased prevalence of small irregular opacities, pleural plaques, and pleural thickening on chest x-ray; reduced FEF 25-75; rales; and respiratory symptoms. After controlling for the effect of cigarette smoking and age, years since joining the ironworkers union were significantly associated with profusion, pleural thickening, pleural plaques, rales, percent predicted FVC, reduced FVC, reduced FEV1, reduced FEV1/FVC, and dyspnea grades I, II, III, and IV.
Review of occupational lung carcinogens. K. Steenland, D. Loomis, C. Shy, et al. 1996;29(5):474-90. Review PubMed · Publisher

Abstract

Lung cancer is the most common malignancy in the United States and is ranked second only to bladder cancer in the proportion of cases thought to be due to occupational exposures. We review the epidemiology of occupational lung cancer, focusing on agents identified as pulmonary carcinogens by the International Agency for Research on Cancer. We derive estimates of overall relative risks from the major studies of these lung carcinogens, and we also provide estimates of the number of exposed workers. Using our data as well as estimates from other authors, we estimate that approximately 9,000-10,000 men and 900-1,900 women develop lung cancer annually in the United States due to past exposure to occupational carcinogens. More than half of these lung cancers are due to asbestos. This estimate is likely conservative, in that we have restricted our analysis to confirmed lung carcinogens and have ignored occupations with documented excess risk but for which the specific agents are unknown. Also, our estimate of the proportion of workers exposed in the past is probably too low. Our estimate should be viewed only as broad approximation. Nevertheless, it is in line with other estimates by authors using different methods. The current number of cases estimated to be due to occupational exposure reflects past high exposures and is likely to drop in the future, unless other occupational lung carcinogens are confirmed or new carcinogens are introduced into the workplace.
Screening for asbestos-induced diseases in Finland. K. Koskinen, J.P. Rinne, A. Zitting, et al. 1996;30(3):241-51. PubMed · Publisher

Abstract

Screening for asbestos-induced diseases in Finland was carried out in 1990-1992 as a part of the Asbestos Program of the Finnish Institute of Occupational Health. The aim of the present study was to find the workers who had developed an asbestos-induced disease in certain occupations. Examination of active or retired workers included a personal interview on work history and asbestos exposure, and a chest X-ray. The target group for the screening comprised workers under 70 years of age who had worked at least for 10 years in construction, 1 year in a shipyard or in the manufacture of asbestos products. A preliminary questionnaire was sent to 54,409 workers, 18,943 of whom finally participated in the screening examination. The mean age of the workers was 53 years; 95% were employed in construction, 2% in shipyards, and 3% in the asbestos industry. The criteria for a positive screening result were (1) a radiographic finding clearly indicating lung fibrosis (at least ILO category 1/1), (2) a radiographic finding indicating mild lung fibrosis (ILO category 1/0) with unilateral or bilateral pleural plaques, (3) marked abnormalities of the visceral pleura (marked adhesions with or without pleural thickening), or (4) bilateral pleural plaques. The positive cases totalled 4,133 (22%) and were sent for further investigation. In addition to the screening, information on the presence of asbestos in the work environment, prevention of asbestos exposure, as well as on the health effects of asbestos exposure and smoking were given to the participating workers. The screening acted as a preliminary survey to prompt further national follow-up of asbestos-induced diseases among the workers who have been exposed to asbestos. This article presents the material, methods, and overall results of the screening.
The asbestos TLV: early evidence of inadequacy. D. Egilman, A. Reinert. 1996;30(3):369-70. Historical article PubMed · Publisher
Toxic torts: are they poisoning the scientific literature?. P.E. Enterline. 1996;30(1):121-2. Comment PubMed · Publisher
Unrecognized asbestos-induced disease. M.C. Barroetavena, K. Teschke, D.V. Bates. 1996;29(2):183-5. PubMed · Publisher

Abstract

It is being slowly recognized that there is serious under-reporting of cancers that are occupationally related, in the sense that they would not have occurred without the occupational exposure. Data from the Workers' Compensation Boards of New South Wales in Australia and British Columbia in Canada relating to disease attributable to asbestos exposure indicate that in both jurisdictions the ratio of lung cancer cases to mesothelioma cases is much lower than epidemiological studies indicate must be occurring. Over the period from 1980 to 1994, if both jurisdictions are considered together, about 1,207 cases of lung cancer that would not have occurred without asbestos exposure went unrecognized as occupationally related. The data also suggest that it is unlikely that radiological asbestosis should be regarded as a necessary condition for there to be an increased risk of lung cancer following asbestos exposure.
Validity of occupational exposure and smoking data obtained from surviving spouses and colleagues. K.S. Hansen. 1996;30(4):392-7. PubMed · Publisher

Abstract

The accuracy of exposure data from surrogate sources such as spouses and colleagues was estimated in an historical cohort of 10,059 metal workers. In a 2 year period from 1986 to 1988, 118 subjects who, in 1986, answered a questionnaire on occupational exposures and smoking habits had died. In 1988 spouses and long-term colleagues were interviewed on the same items. Separate contingency tables were developed comparing case and spouse/colleague responses. Percentage of concordance, sensitivity, specificity, the kappa measure of agreement, and a bias factor (exposed to nonexposed ratio between surrogates and cohort members) were calculated. Compared with the index subjects indications, the colleagues' and spouses' reports represented a moderately high level of concordance on occupational exposures, primarily for exposures with a moderate prevalence. There was a considerable under-reporting on both occupational exposures and smoking habits expressed in low values of sensitivity and bias factor values below one. The described misclassification of exposure data by using surrogate information might seriously influence the risk estimation and introduce bias.
Asbestos bodies in lung tissue following exposure to crocidolite. V. Williams, N.H. de Klerk, D. Whitaker, et al. 1995;28(4):489-95. PubMed · Publisher

Abstract

A series of 206 necropsies in Western Australia (WA) have had routine counts made of asbestos bodies in samples of lung tissue using conventional light microscopy. Thirty-two cases had worked in the asbestos industry at Wittenoom, WA and (log) counts of asbestos bodies in their lung tissue correlated well with estimates of their (log) cumulative airborne exposure to crocidolite fibers (r = 0.60). There was no association between the number of asbestos bodies and time since exposure to asbestos ceased. In subjects without known exposure to asbestos, there was a weak but nonsignificant increase in number of asbestos bodies with increasing age, with 26% of cases having no asbestos bodies present. It is concluded that the relatively simple technique of light microscopy for counting of asbestos bodies in lung tissue provides a reliable indication of the level of past occupational exposure to crocidolite in subjects whose exposure has been only to crocidolite. This could be extremely useful in follow-up studies of cohorts that lack reliable measures of airborne exposure to crocidolite asbestos.
Asbestos exposures in public and commercial buildings. A.C. Upton, R.A. Shaikh. 1995;27(3):433-7; discussion 439-41. PubMed · Publisher
Asbestos-induced visceral pleural fibrosis reduces pulmonary compliance. E.H. Valkila, M.M. Nieminen, A.K. Moilanen, et al. 1995;28(3):363-72. PubMed · Publisher

Abstract

To determine the nature of respiratory functional impairment caused by asbestos-induced visceral pleural fibrosis (VPF) and to discover which pulmonary physiological variable best reveals it, we examined 59 asbestos-exposed construction workers having asbestos-related changes on chest radiographs. Computed tomography scans of the thorax were also performed. Visceral pleural fibrosis was diagnosed in 29 subjects: seven had only VPF, 17 had VPF and pleural plaques, and five had VPF, plaques, and asbestosis. In subjects without VPF, 23 had plaques, six had plaques and asbestosis, and one had only minor fibrotic parenchymal changes insufficient for a diagnosis of asbestosis. Flow-volume spirometry, body plethysmography, static and dynamic compliance, and pulmonary diffusing capacity for carbon monoxide were measured. The subjects with VPF had significantly lower static (p = 0.005) and dynamic (p = 0.007) compliance values than those without. Other respiratory function variables failed to show any significant differences. We conclude that the measurement of static and dynamic compliance is a useful method in assessing pulmonary function impairment caused by visceral pleural fibrosis.
Asbestos-related diseases in construction carpenters. M. García-Closas, D.C. Christiani. 1995;27(1):115-25. PubMed · Publisher

Abstract

To assess the association of minimal parenchymal fibrosis and pleural plaques with respiratory functional impairment, we conducted a survey of 631 asbestos-exposed construction carpenters. This population had a relatively low prevalence of radiographic abnormalities and lung function impairment. Pleural plaques was the asbestos-related disease most prevalent, followed by interstitial fibrosis with predominantly low profusion scores. The most frequent functional impairment was the obstructive pattern, followed by restrictive and mixed patterns. After adjusting for potential confounders, the presence of pleural plaques was significantly associated with a mixed respiratory pattern of impairment (OR = 3.7, 95% CI 1.4-12.3). Furthermore, our data were consistent with a weak association between pleural plaques and a predominantly restrictive defect (OR-1.3, 95% CI 0.4-3.9). This study also suggested an association between minimally detectable profusions and both obstructive (OR = 1.9, 95% CI 0.6-6.3) and mixed (OR = 1.6, 95% CI 0.3-7.1) defects. Although only 631 of a potential 7,649 active and retired union members participated in this first-time survey and were relatively young, these findings add new evidence to the functional importance of pleural fibrosis and minimal parenchymal fibrosis.
Assessment of mortality in the construction industry in the United States, 1984-1986. C. Robinson, F. Stern, W. Halperin, et al. 1995;28(1):49-70. PubMed · Publisher

Abstract

Construction, one of the larger industries in the United States, employs 7.6 million workers, many in skilled trades occupations. Previously published data about potential worksite exposures and mortality of construction site workers are limited. We analyzed occupation and industry codes on death certificates from 19 U.S. states to evaluate mortality risks among men and women usually employed in construction occupations. Proportionate mortality ratios (PMRs) for cancer and several other chronic diseases were significantly elevated among 61,682 white male construction workers who died between 1984 and 1986. Men younger than age 65, who were probably still employed immediately prior to death, had significantly elevated PMRs for cancer, asbestos-related diseases, mental disorders, alcohol-related disease, digestive diseases, falls, poisonings, traumatic fatalities that are usually work-related, and homicides. Elevated PMRs for many of the same causes were observed to a lesser degree for black men and white women whose usual industry was construction. In addition, women experienced excess cancer of the connective tissue and suicide mortality. Various skilled construction trades had elevated PMRs for specific sites, such as bone cancer and melanoma in brickmasons, stomach cancer in roofers and brickmasons, kidney and bone cancer in concrete/terrazzo finishers, nasal cancer in plumbers, pulmonary tuberculosis in laborers, scrotal cancer and aplastic anemia in electricians, acute myeloid leukemia in boilermakers, rectal cancer and multiple sclerosis in electrical power installers, and lung cancer in structural metal workers. Using a standard population of blue collar workers did not result in fewer elevated PMRs for construction workers. Despite lifestyle differences and other limitations of the study, the large numbers of excess deaths observed in this study indicate the need for preventive action for construction workers.
Biopersistence of cerium in the human respiratory tract and ultrastructural findings. J.C. Pairon, F. Roos, P. Sébastien, et al. 1995;27(3):349-58. Case report PubMed · Publisher

Abstract

For diagnostic purposes, mineralogical analysis was performed in bronchoalveolar lavage fluid and lung tissue from a 58-year-old patient previously exposed to asbestos and rare earth dusts. No significant retention of asbestos was demonstrated in lung tissue by light microscopy (asbestos bodies) or transmission electron microscopy analysis (uncoated fibers). Particles containing rare earth (cerium, lanthanum) and phosphorus were identified in alveolar macrophages in bronchoalveolar lavage fluid, and cerium-containing particles accounted for 70% of particles observed in the lung tissue. Ultrastructural analysis of lung tissue revealed the presence of particles containing cerium and phosphorus in interstitial macrophages and elastic fibers. These results suggest that rare earth is metabolized and should be considered as biopersistent in the human respiratory tract, since occupational inquiries revealed that exposure to cerium oxide abrasive powder had ceased at least 15 years earlier.
Chronology of asbestos cancer discoveries: experimental studies of the Saranac Laboratory. G.W. Schepers. 1995;27(4):593-606. Historical article PubMed · Publisher

Abstract

This commentary challenges a recently published perception that Dr. Le Roy Upson Gardner had not actually discovered in 1942 that inhaled chrysotile fibers could induce malignant neoplasia in mice. The handwritten laboratory notes and some of Dr. Gardner's slides have recently been found. They verify that the tumors he saw in the mice included truly malignant neoplasms. Gardner had by then also accumulated 11 cases of human lung cancer (two mesotheliomas) derived from Quebec asbestos miners and millers. An inhalation study designed by Dr. Gardner and conducted between 1951 and 1954, using cancer-insusceptible mice, yielded neoplasia risk ratio of 5.7 compared with control animals. The studies also showed that the primary effect of chrysotile is to cause epithelial proliferation in alveoli adjacent to bronchioles. Chrysotile type asbestos bodies were shown to remain only transiently ferruginous, but even though invisible in direct light they can be visualized at high magnification through use of phase contrast and polarized light micrography.
Fibers in lung tissues of mesothelioma cases among miners and millers of the township of Asbestos, Quebec. A. Dufresne, M. Harrigan, S. Massé, et al. 1995;27(4):581-92. PubMed · Publisher

Abstract

Twenty cases of mesothelioma among miners of the township of Asbestos, Quebec, Canada, have been reported. To further explore the mineral characteristics of various fibrous material, we studied the fibrous inorganic content of postmortem lung tissues of 12 of 20 available cases. In each case, we measured concentrations of chrysotile, amosite, crocidolite, tremolite, talc-anthophyllite, and other fibrous minerals. The average diameter, length, and length-to-diameter ratio of each type of fiber were also calculated. For total fibers > 5 microns, we found > 1,000 asbestos fibers per mg tissue (f/mg) in all cases; tremolite was above 1,000 f/mg in 8 cases, chrysotile in 6 cases, crocidolite in 4 cases, and talc anthophyllite in 5 cases. Among cases with asbestos fibers, the tremolite count was highest in 7 cases, chrysotile in 3 cases, and crocidolite in 2 cases. The geometric mean concentrations of fibers > or = 5 microns were in the following decreasing order: tremolite > crocidolite > chrysotile > other fibers > talc-anthophyllite > amosite. For total fibers < 5 microns, we found > 1,000 fibers per mg tissue (f/mg) in all cases; tremolite was above 1,000 f/mg in 12 cases, chrysotile in 8 cases, crocidolite in 7 cases, and talc-anthophyllite in 6 cases. Tremolite was highest in 8 cases, chrysotile in 2 cases, and crocidolite and amosite in 2 cases. The geometric mean concentrations of fibers < 5 microns were in the following decreasing order: tremolite > other fibers > chrysotile > crocidolite > talc-anthophyllite > amosite. We conclude, on the basis of the lung burden analyses of 12 mesothelioma cases from the Asbestos township of Quebec, that the imported amphibole (crocidolite and amosite) were the dominant fibers retained in the lung tissue in 2/12 cases. In 10/12 cases, fibers from the mine site (chrysotile and tremolite) were found at highest counts; tremolite was clearly the highest in 6, chrysotile in 2, and 2 cases had about the same counts for tremolite and chrysotile. If a relation of fiber burden-causality of mesothelioma is accepted, mesothelioma would be likely caused by amphibole contamination of the plant in 2/12 cases and by the mineral fibers (tremolite and chrysotile) from the mine site in the 10 other cases.
Finnish Institute of Occupational Health Asbestos Program 1987-1992. M.S. Huuskonen, K. Koskinen, A. Tossavainen, et al. 1995;28(1):123-42. PubMed · Publisher

Abstract

In 1987-1992, the Finnish Institute of Occupational Health (FIOH) implemented a nationwide asbestos program aimed at preventing asbestos-related risks in good cooperation with governmental authorities, industry, trade unions, the health care and insurance systems, and mass media. The goals were to minimize all exposure to asbestos, identify people exposed at work, and improve the diagnostics of asbestos diseases, especially cancers. The program entailed several concrete actions and extensive dissemination of information, training, services, and scientific research. As proposed by the State Asbestos Committee, new use of asbestos products was banned and strict regulations were applied to renovation and inspection of old buildings. The screening study of asbestos-induced diseases included 18,943 current and retired workers from house building, shipyard, and asbestos industries. Pleural and parenchymal changes were found in 4,133 persons (22%), who were referred to further clinical examinations as suspected cases of an occupational disease. It was estimated that past exposure of asbestos among the Finnish population of 5 million causes > 150 mesotheliomas and lung cancers annually, totalling > 2,000 asbestos-induced cancer deaths by the year 2010. Although several major control actions were made or started during the program, the bulk of the preventive work still lies ahead.
Insulation, asbestos, smoking habits, and lung cancer cell types. J.E. Muscat, S.D. Stellman, E.L. Wynder. 1995;27(2):257-69. PubMed · Publisher

Abstract

The association between occupational exposure to asbestos and histological type of lung cancer was analyzed in a multicenter hospital-based case-control study (2,871 male cases and 5,240 male controls) conducted from 1981-1991. Twenty-two percent of cases and 18% of controls were employed in asbestos-related occupations for at least 1 year. Most of these asbestos jobs were in the construction field. The odds ratio (OR) among current smokers was 1.0 [95% confidence intervals (CI) 0.9 to 1.3]; for ex-smokers, the OR was 1.4 (95% CI 1.1 to 1.6). In contrast, 10% of cases and 5% of controls self-reported that they were chronically exposed to asbestos for at least 1 year. Self-reported asbestos exposure was significantly related to all lung cancer cell types among smokers and ex-smokers, although a trend in the ORs with duration of self-reported exposure was not found for current smokers. Among 48 cases and 52 controls reporting distinct exposure to building insulation, the OR was 2.2 (95% CI 1.2 to 4.3) for current smokers, and 1.8 (95% CI 0.9 to 3.6) for ex-smokers, compared to subjects who were not exposed to building insulation and asbestos. A nonsignificant association with self-reported exposure to asbestos was observed for a small number of never smokers (eight of 83 nonsmoking cases, OR = 2.0, 95% CI 0.9 to 4.6). When examining these results and their causal implications, possible misclassification and reporting biases need to be considered.

In plain English

This hospital-based case-control study compared 2,871 men with lung cancer and 5,240 male hospital controls interviewed 1981 to 1991. Exposure measures were jobs likely to involve asbestos (mostly construction trades and mechanics), self-reported asbestos dust at work, and, from 1986, self-reported building insulation exposure. 22% of cases and 18% of controls held asbestos-related jobs. The odds ratio (OR) was 1.0 (95% CI 0.9 to 1.3) for current smokers and 1.3 (1.1 to 1.6) for ex-smokers. Self-reported asbestos dust exposure was linked to higher odds of lung cancer (all cell types combined): ORs 1.5 (1.1 to 2.1) and 2.5 (1.5 to 4.1) for current smokers in the earlier and later periods, and 1.9 (1.3 to 2.8) and 2.2 (1.4 to 3.5) for ex-smokers. Current smokers showed no significant trend with years exposed. For building insulation, ORs were 2.2 (1.2 to 4.3) in current smokers and 1.8 (0.9 to 3.6) in ex-smokers. Never smokers' OR for self-reported exposure, based on eight cases, was 2.0 (0.9 to 4.3), not statistically significant. The authors said recall bias and misclassification need consideration.

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.
Malignant mesothelioma in thermoelectric power plant workers in Italy. P. Crosignani, F. Forastiere, G. Petrelli, et al. 1995;27(4):573-6. Case report PubMed · Publisher

Abstract

Asbestos has been widely used in Italian thermoelectric power plants and instances of exposure to workers have been documented in a variety of jobs. Preventive measures were put into effect only in the late 1970s. We report here on four mesothelioma cases among workers of three Italian power plants where cohort studies were carried out, and on three additional cases recorded by a systematic survey carried out on this neoplasm in Tuscany. When the data of the cohorts sources are merged, a significant excess of lung cancer is also evident. Even without a quantitative assessment of exposure, this report shows the importance of asbestos risk in thermal power plants. The risk appears not to be restricted to any particular category of workers.
Mortality among workers at a plastics manufacturing and research and development facility: 1946-1988. L. Dell, M.J. Teta. 1995;28(3):373-84. PubMed · Publisher

Abstract

Mortality through 1988 was studied for 5,932 male employees who worked between January 1, 1946 and December 31, 1967 at a New Jersey plastics manufacturing and research and development facility. The cohort was followed for an average of 32 years and included 1,859 deaths. Potential exposures included asbestos, formaldehyde, and polyvinyl chloride (PVC). Mortality rates for the cohort were compared to both U.S. and state mortality rates, and analyses were also performed by lagging duration of employment. Based on U.S. rates, mortality among hourly males (n = 3,853) from all cancers was similar to expected [standardized mortality ratio (SMR), 102; 95% confidence interval (CI), 92-114]. Excess mortality among hourly workers was seen for pancreatic cancer (SMR, 146; 95% CI, 95-216) and "malignancies of other parts of the respiratory system" (SMR, 373; 95% CI, 121-870). The latter excess was due entirely to five deaths from pleural mesothelioma. There were no deaths identified due to nasal cavity or nasopharyngeal cancers, or angiosarcoma of the liver. Mortality from leukemia among research and development workers (n = 1,421) was significantly elevated (SMR, 265; 95% CI, 115-524) and related to assignment to process development. This study verifies the excess of pancreatic cancer among workers at the facility seen in earlier studies and observes excesses of mesothelioma due to asbestos exposure and leukemia in process development workers.
Occupational associations with lung cancer in two Ontario cities. M.M. Finkelstein. 1995;27(1):127-36. PubMed · Publisher

Abstract

A death certificate based case-control study of lung cancer in two Ontario cities was performed to estimate the risk of lung cancer attributable to occupation in Ontario, and to estimate the proportion of occupational lung cancers receiving compensation from the Workers' Compensation Board. Occupation and industry were identified from the death certificate. A priori occupations for analysis were those whose members had received compensation for occupational cancer from the Ontario Workers' Compensation Board. Population attributable risks were computed using the relative risks observed in this study and employment data from the 1986 Census of Canada. Subjects were all men (N = 967) between the ages of 45 and 75 years resident in the cities of Hamilton and Sault Ste-Marie who died of lung cancer from 1979 to 1988. Controls (2,821) were matched on age, year of death, and city of residence. In agreement with other studies, an increased risk of lung cancer was observed for workers in the construction sector, for miners, and for truck drivers. It was estimated that only a small proportion of lung cancers attributable to occupation are compensated in Ontario. It is believed that many occupational cancers go uncompensated because of the failure to file claims, rather than because claims are rejected by Compensation Boards. Physicians are in a position to advise patients about the possibility of compensable disease and to act as advocates for them. By recognizing compensable illness, physicians have the opportunity to ease the financial burden of patients and their families. The challenge is a difficult one, but it is well worth pursuing.
Occupational exposures to fibers and quartz at 19 crushed stone mining and milling operations. G.J. Kullman, A.L. Greife, J. Costello, et al. 1995;27(5):641-60. PubMed · Publisher

Abstract

From 1979 to 1982, the National Institute for Occupational Safety and Health (NIOSH) conducted a cross-sectional exposure assessment and mortality study of selected crushed stone facilities in the United States. This study was undertaken in part to address concerns that asbestos exposures could be occurring in some crushed stone operations due to the presence of amphibole and serpentine minerals. The investigation was also designed to characterize exposures to crystalline silica and other mineral compounds. Nineteen crushed stone operations, mining limestone, granite, or traprock were surveyed to assess exposures to respirable and total dusts, mineral compounds including crystalline silica, asbestos, and mineral fibers. At the initiation of the study, crushed stone operations were selected from a Mine Safety and Health Administration (MSHA) listing of the active industry in 1978. With the exception of requiring inclusion of the traprock operation in Maryland where asbestos fibers were initially discovered, a stratified sample of operations was randomly selected by rock type (granite, limestone, traprock, or sandstone). However, because of reluctance or refusal of some companies to participate and because of the closures of some of the selected operations, replacements were randomly selected. Some replacement selections were likewise replaced due to lack of cooperation from the companies. The studied sample included only 10 of the 27 randomly selected operations in the original sample. Asbestos fibers were detected at one traprock facility, the Maryland operation where asbestos was originally found. Measured personal exposures to fibers exceeded the NIOSH Recommended Exposure Limit (REL) for two out of 10 samples. All of the samples were below the MSHA Permissible Exposure Limit (PEL), which was in effect at the time of the survey. However, due to the presence of nonasbestos mineral fibers in the environment, it could not be stated with certainty that all of the fibers counted by phase contrast microscopy were asbestos. A variety of silicate mineral fibers (other than those classified by NIOSH as asbestos) were detected in the traprock operations and at one granite operation. Crystalline silica was detected at 17 of the 19 surveyed crushed stone operations. Overexposures to crystalline silica were measured at 16 of the crushed stone operations; approximately one in seven personal-respirable dust samples (14%) exceeded the MSHA PEL for crystalline silica. Approximately 25% of the respirable dust samples exceeded the NIOSH REL for crystalline silica. Mill operators and mill laborers consistently had the highest and most frequent overexposures to crystalline silica.
Occupational respiratory cancer and exposure to asbestos: a case-control study in a cohort of workers in the electricity and gas industry. E. Imbernon, M. Goldberg, S. Bonenfant, et al. 1995;28(3):339-52. PubMed · Publisher

Abstract

Cancers of the pleura, lung, and larynx between 1978 and 1989 among active male workers of Electricité de France-Gaz de France were studied in association with asbestos exposure using a case-control design nested within the cohort of workers of the company. The cohort included about 1,400,000 person-years, corresponding to a mean of 117,000 men per year. Exposure to asbestos and to some potential occupational confounders selected among agents from groups I, IIa, and IIb of the International Agency for Research on Cancer was assessed by a job-exposure matrix specific to the company. During the observation period, 12 cases of pleural cancer, 310 cases of lung cancer, and 116 cases of larynx cancer were registered in the cancer register of the company social security department. Four controls per case, matched for year of birth, were randomly selected among the cohort. Conditional logistic regression was used to estimate the odds ratios. A first analysis was conducted in order to assess the validity of the job-exposure matrix by investigating already known relationships between asbestos exposure and asbestosis. For asbestosis, a strong exposure-response relation was found with an odds ratio (OR) of 57.4 [95% confidence interval (CI): 17.0-194.0] in the highest exposure group. There was an elevated risk of pleural cancer (OR, 4.8, CI, 1.2-19.8). For lung cancer, significant ORs of 2.0 (CI, 1.3-3.2) and 1.9 (CI, 1.2-3.0) were found among the two highest cumulative exposure groups; adjustement for confounders slightly decreased the ORs. Squamous cell neoplasm of the lung was associated with asbestos exposure. The association between larynx cancer and asbestos exposure showed a tendency towards a nonsignificant increase in ORs in the highest cumulative exposure categories; this tendency disappeared when adjusting for occupational confounders. This study showed that occupational exposure to asbestos could increase the risk of pleural and lung cancer in a sector in which exposure levels are not considered to be high compared with other industrial settings.
Pleural mesotheliomas are underreported as occupational cancer in Sweden. E. Andersson, K. Torén. 1995;27(4):577-80. PubMed · Publisher

Abstract

The aim of this study was to estimate to what degree malignant pleural mesotheliomas were reported as occupational cancers. The study included all malignant pleural mesotheliomas (n = 210) found in the Cancer Registry 1980-1989 from four Swedish counties. Whether or not a case was reported as occupational cancer was found in the Swedish Register of Reported Occupational Diseases. To evaluate the presence of exposure histories, the chest department files for 58 mesotheliomas from one county were reviewed. The reporting was low, with only 75 mesotheliomas (36%) reported. All the cases were men, and for the men, the reporting frequency was 42%. The reporting was significantly lower for the last part of the decade than for the first part. The reporting frequency decreased with age. In the review of the chest department files, an exposure history was found in 93% of the reported cases and in 47% of the unreported cases. It is concluded that physicians must give more priority to exposure histories in patients with pleural mesotheliomas.
Potential pitfall in using cumulative exposure in exposure-response relationships: demonstration and discussion. M.M. Finkelstein. 1995;28(1):41-7. Randomized trial PubMed · Publisher

Abstract

Cumulative exposure is frequently used as a measure of exposure in the quantitative analysis of epidemiologic studies. It is recognized that the imposed symmetry between duration and intensity of exposure is a potential problem with this measure, but it is less widely recognized that the finding of an exposure-response relationship, using cumulative exposure as the exposure metric, does not necessarily imply that exposures were accurately or even consistently estimated. This report describes a simulation study drawn from a nested case-control analysis of mesothelioma in a cohort of asbestos cement workers. Intensity of exposure in the range of 0.1-40 fibers/ml was randomly assigned to subjects. Logistic regression analysis demonstrated that there was no association between mesothelioma risk and the randomly assigned intensity of exposure. However, in 171 (86%) of 200 trials, mesothelioma risk was significantly associated with cumulative exposure, even though intensity of exposure remained randomly assigned. A strong exposure-response relationship might thus be misleading. One would be more confident about quantitative risk assessment when there are a large number of independent studies available for analysis.
Proportionate mortality among construction laborers. F. Stern, P. Schulte, M.H. Sweeney, et al. 1995;27(4):485-509. PubMed · Publisher

Abstract

This report presents the results of proportionate mortality ratio (PMR) analyses and proportionate cancer mortality ratio (PCMR) analyses among the 11,685 members of the Laborers' International Union of North America (LIUNA), who died between 1985-1988, using U.S. proportionate mortality rates as the comparison population. Statistically significant elevated mortality risks were observed for all malignant neoplasms (N = 3285, PMR = 1.13, CI = 1.09-1.17), as well as for site-specific neoplasms of the lung (N = 1208, PCMR = 1.06, CI = 1.00-1.12), stomach (N = 170, PCMR = 1.44, CI = 1.23-1.68), and thyroid gland (N = 10, PCMR = 2.24, CI = 1.07-4.12). The PCMRs for these malignant neoplasms were elevated among both white and non-white males, regardless of length of union membership, in most 10-year categories of age at death above 40 and for the three largest LIUNA regions examined. The study also observed 20 mesothelioma deaths, which indicated that some LIUNA members had been previously exposed to asbestos. Statistically significant elevated risks were also observed for deaths from transportation injuries (N = 448, PMR = 1.37, CI = 1.25-1.51), falls (N = 85, PMR = 1.34, CI = 1.07-1.66), and other types of injuries (N = 245, PMR = 1.61, CI = 1.42-1.83). The deaths due to injuries were most often observed among those members who had the shortest amount of time within the union, were younger, and first entered the union after 1955. This is the first study that has examined the general mortality experience limited to construction laborers only (Bureau of Census code 869).
Quantitative comparison of asbestos and talc bodies in an individual with mixed exposure. R.F. Dodson, M. O'Sullivan, C.J. Corn, et al. 1995;27(2):207-15. Case report PubMed · Publisher

Abstract

Tissue from an individual with a history of exposure to asbestos and other dust was referred for particulate analysis. The digested material was reviewed by light microscopy to establish the numbers of ferruginous bodies per gram of tissue. Typical asbestos bodies were found at levels consistent with occupational exposure. A second type of elongated ferruginous body was formed on a thicker transparent core which suggested the minerals were sheet silicates. The number of ferruginous bodies with nonasbestos cores was over four times the number of asbestos cored ferruginous bodies. Electron microscopy was used to confirm the core composition of both populations and also to establish the levels of uncoated fibers. The nonasbestos ferruginous bodies were predominantly formed on talc.
Unbiased vs. conservative estimators of etiological fractions: examples of misclassification from studies of occupational lung cancer. O. Olsen. 1995;27(6):837-43. PubMed · Publisher

Abstract

Theoretical studies emphasize the importance of making unbiased etiological fraction estimates. In empirical works, however, the published estimates are usually conservative. The purpose of the present report is to study, empirically, the numerical magnitude of such conservative biases. Examples from the literature on occupational exposure and lung cancer are reported. It is demonstrated that conservative bias may decrease a numerical estimate by more than a factor 10 and that decreases by a factor 2 or 3 are not unusual. It is concluded that it is important, in future review studies, to pay attention to the magnitude of the conservative biases in the published empirical estimates and to put most emphasis on the least biased estimates in the review process.
Asbestos bodies in bronchoalveolar lavage fluid in relation to occupational history. A. Karjalainen, S. Anttila, T. Mäntylä, et al. 1994;26(5):645-54. PubMed · Publisher

Abstract

Concentrations of asbestos bodies (AB) were assessed by optical microscopy of 10 ml iron-stained samples and compared with the exposure history acquired by personal interview for 156 patients. Concentrations equalling or exceeding 1 AB/ml were found in 85% of patients who had been heavily exposed to asbestos and only 7% of those who were unlikely to have been exposed. Elevated AB concentrations were observed among primary asbestos, shipyard and construction workers. Smoking was not found to affect the AB concentrations. The use of Papanicolaou-stained cytological Millipore preparations during routine screening was a less sensitive method for the assessment of AB concentrations than that involving iron-stained preparations. The expression of AB concentration as AB/ml or AB/million cells were found to be equally useful indicators of exposure. The correlation between AB concentration and exposure history was greater than in earlier studies on workers exposed to chrysotile. Concentrations exceeding 1 AB/ml were indicative of a nontrivial exposure to asbestos. Despite the observed correlation between AB concentration and exposure history, the individual variability of AB counts, methodological differences and laboratory-bound reference values are important in the interpretation of AB concentrations in bronchoalveolar lavage (BAL) fluid at individual level.
Asbestos inhalation, not asbestosis, causes lung cancer. J.L. Abraham. 1994;26(6):839-42. PubMed · Publisher

Summary

In this commentary, the author responded to a 1993 editorial by Andrew Churg which held that asbestosis must be present before a lung cancer can be attributed to asbestos. The author disagreed and identified three problems with that position: the strength of the evidence, biological plausibility, and medical-legal issues, including conflicts of interest. He argued that because asbestos causes asbestosis, asbestos exposure remains the cause of lung cancer even when asbestosis is present. He also noted that studies defined asbestosis very differently, from radiological ILO category 1/0 or more to biopsy-proven disease. He stated that the epidemiologic studies cited by Churg gave no evidence on asbestosis. He cited McDonald et al. (1994), whose data indicated increased lung cancer risk in workers with a high probability of asbestos exposure without radiological evidence of fibrosis. He criticized an airway fiber study by Churg and Stevens (six lungs of nonsmokers with mesothelioma; 33 of 40 airways showed no detectable amosite) as limited in sensitivity and as not examining the most relevant tissues, and considered Churg's conclusion premature. He argued that asbestosis is a marker of heavier exposure rather than a cause of lung cancer, and that asbestos inhalation causes both diseases. He concluded that the controversy originates in litigation rather than science. He suggested that such editorials discuss their medico-legal ramifications.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Asbestos-induced lung injury among Danish jewelry workers. M. Døssing, S.W. Langer. 1994;26(6):755-8. Case report · Review PubMed · Publisher

Abstract

Asbestos has been used extensively in a variety of occupations. In the jewelry industry, inadequate hygiene practices may often go unrecognized with resultant exposure to hazardous amounts of asbestos. We report on four retired jewelers. Two of these had both pleural and parenchymal changes. One had isolated pleural plaques and the final patient showed only parenchymal infiltrates. Their work involved hand cutting asbestos plates used for protection during soldering. In the soldering process asbestos fibers were then blown into the workroom air as the plates broke down. In addition, at the end of each work day the workroom floor was swept, with subsequent airborne asbestos dust distribution. Any patient with pleural plaques or interstitial lung disease should be questioned about potential sources of asbestos exposure in the past, regardless of present employment status.
Asbestos-related disease associated with exposure to asbestiform tremolite. S.H. Srebro, V.L. Roggli. 1994;26(6):809-19. Case report PubMed · Publisher

Abstract

Tremolite is nearly ubiquitous and represents the most common amphibole fiber in the lungs of urbanites. Tremolite asbestos is not mined or used commercially but is a frequent contaminant of chrysotile asbestos, vermiculite, and talc. Therefore, individuals exposed to these materials or to end-products containing these materials may be exposed to tremolite. We have had the opportunity to do asbestos body counts and mineral fiber analysis on pulmonary tissue from five mesothelioma cases and two asbestosis cases with pulmonary tremolite burdens greater than background levels. There were no uncoated amosite or crocidolite fibers detected in any of these cases. Three patients were occupationally exposed to chrysotile asbestos; two patients had environmental exposures (one to vermiculite and one to chrysotile and talc) and one was a household contact of a shipyard worker. The tremolite burdens for the asbestosis cases were one to two orders of magnitude greater than those for the mesothelioma cases. Our study confirms the relationship between tremolite exposure and the development of asbestos-associated diseases. Furthermore, the finding of relatively modest elevations of tremolite content in some of our mesothelioma cases suggests that, at least for some susceptible individuals, moderate exposures to tremolite-contaminated dust can produce malignant pleural mesothelioma.
Cohort mortality study of rock salt workers in Italy. M. Tarchi, D. Orsi, P. Comba, et al. 1994;25(2):251-6. PubMed · Publisher

Abstract

A cohort mortality study of rock salt workers was carried out in Volterra, Italy. The occupational risk factors identified during environmental hygiene surveys were high noise levels and exposure to dusts and to chrysotile asbestos. The cohort consists of 487 subjects (367 males and 120 females) employed in the mine between 1/1/1965 and 12/31/1989. At the end of follow-up, 387 individuals were alive (295 males and 92 females), and 100 were decreased (72 males and 28 females). For two decedents, the cause of death was unknown. Regional rates were used for the computation of standardized mortality ratios (SMRs). In the entire cohort, observed mortality for all causes was similar to expected (SMR = 98, 100 obs); SMR for all cancer was 127 (41 obs); for lung cancer, the SMR was 146 (10 obs). Two cases of pleural mesothelioma, both in males, resulted in a statistically significant elevation of this cause (SMR = 741, 90% confidence interval (CI) 131-2,332). Two malignant brain tumors were detected (SMR 328, 90% CI 58-1,032); one of these was identified as a secondary neoplasm with consideration of additional clinical information. Among males, mortality for all cancers was significantly increased (SMR = 140, 90% CI 106-192). The observed mortality for malignant tumors of the digestive and the respiratory systems was higher than expected. In women, two cases of malignant ovarian cancer were observed vs. 0.42 expected on the basis of the regional rates. Increased mortality from lung and pleural tumors was consistent with the exposure to asbestos, which has also been shown to play a role in the development of ovarian tumors. The main limitations of this study were the small number of subjects and the definition of exposure solely in terms of duration of employment. Further studies of rock salt workers are needed to elucidate our findings.
Does asbestos or asbestosis cause carcinoma of the lung?. V.L. Roggli, S.P. Hammar, P.C. Pratt, et al. 1994;26(6):835-8. PubMed · Publisher

Summary

In this commentary, the authors responded to a 1993 editorial by Andrew Churg on whether asbestosis (asbestos-induced interstitial fibrosis) must be present for asbestos to cause lung cancer. They accepted that asbestos exposure is associated with lung cancer but argued that parts of the debate had been understated or omitted. They stated that studies finding no link between lung cancer and asbestos exposure without asbestosis did not report whether they had the statistical power to detect one, and included few such cases. They cited a study of nearly 19,000 lung cancer cases in the west of Scotland that estimated about 5.7% of lung cancers in men there were asbestos related. They also cited a prospective study by Hillerdal that found a modest but statistically significant increased lung cancer risk in people with pleural plaques without radiographic asbestosis. They noted that other lung fibroses carry lower cancer rates and different tumour types. They added that cancers in asbestos workers resemble those of smokers and are predominantly proximal, whereas asbestosis is mainly basilar and subpleural. They considered animal studies of little help. They cited a fibre analysis study linking higher tissue fibre burdens with lower-lobe tumours after adjustment for smoking and asbestosis. They concluded that whether asbestos or asbestosis causes the cancer remained unresolved. In their view, it did not seem reasonable to attribute the tumours simply to scarring rather than to the inhaled fibres.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Extended mortality follow-up among men and women in a U.S. furniture workers union. B.A. Miller, A. Blair, E.J. Reed. 1994;25(4):537-49. PubMed · Publisher

Abstract

The addition of 5 years of follow-up and over 411,000 person-years of observation to a cohort of 34,081 men and women employed in U.S. furniture and other related industries allowed the investigation of mortality patterns among women and minority races in addition to white men. A significant excess of pleural mesotheliomas occurred among white men (standardized mortality ratio [SMR] = 3.7, 95% confidence interval [CI] = 1.2-8.7) but could not be linked to a particular type of furniture manufacturing. SMRs for myeloid leukemia and chronic nephritis were elevated among white men employed in the wood furniture industry but were not statistically significant. Males in the black/other race categories in wood furniture plants showed nonsignificant mortality excesses for infectious diseases and cancers of the prostate and colon and rectum. Among white women employed in wood furniture plants, mortality was elevated for cancers of the pancreas and lung during the most recent follow-up period. In metal furniture plants, mortality was raised among men in both race groups for kidney cancer (black/other SMR = 8.0, 95% CI = 1.6-23.2; white SMR = 2.1, 95% CI = 0.4-6.2) and diabetes mellitus (black/other SMR = 2.2, 95% CI = 0.6-5.6; white SMR = 1.8, 95% CI = 0.7-3.9). Stomach cancer mortality was significantly elevated (SMR = 3.3, 95% CI = 1.3-6.8) among white men in metal furniture plants and was of the same magnitude over both the previous and the most recent follow-up periods. Among those working with textiles, SMRs were significantly elevated for leukemia (SMR = 6.1, 95% CI = 1.2-7.8) and cancers of the colon and rectum (SMR = 3.2, 95% CI = 1.3-4.5) for white women. Lung cancer mortality was increased for white men and women in textile operations, but SMRs were not statistically significant. SMRs for a number of other causes of death that were elevated at the end of the earlier follow-up period were not increased during the new follow-up period.
Fiber potency vs. importance. V.L. Roggli, P.C. Pratt, A.R. Brody. 1994;25(4):611-2. Comment · Letter PubMed · Publisher
Fibrous glass and cancer. P.F. Infante, L.D. Schuman, J. Dement, et al. 1994;26(4):559-84. Review PubMed · Publisher

Abstract

Some argue that fibrous glass (glass wool) should not be considered as a likely human carcinogen and hence should not be listed in the Seventh Annual Report on Carcinogens (ARC) prepared by the National Toxicology Program (NTP) and mandated by the U.S. Congress. In examining this issue, data from both laboratory experiments (animal studies) and epidemiologic studies (human data) are reviewed with the results evaluated according to the criteria established by the International Agency for Research on Cancer (IARC) and adopted in slightly modified form by the NTP for classifying substances as human carcinogens or likely human carcinogens. From our comprehensive review of the available information, we conclude that fibrous glass materials are carcinogenic, and in view of the NTP and IARC definitions should be listed in the ARC. Our review then examines the carcinogenic potency of glass fibers to humans in comparison with asbestos fibers and concludes that on a fiber-per-fiber basis, glass fibers may be as potent or even more potent than asbestos. The implications of these findings are then presented for regulatory purposes in the occupational setting.
Follow-up study of chrysotile asbestos textile workers: cohort mortality and case-control analyses. J.M. Dement, D.P. Brown, A. Okun. 1994;26(4):431-47. PubMed · Publisher

Abstract

Previous studies of mortality among white males employed in a Charleston, South Carolina asbestos textile plant using chrysotile demonstrated significant excess mortality due to asbestos-related disease and a steep exposure-response relationship for lung cancer. This cohort was further studied by adding 15 years of follow-up and including mortality among white female and black male workers. Nested case-control analyses were undertaken to further explore possible differences in lung cancer risk by textile operation as well as possible confounding by mineral oil exposures. Preliminary data for white males have been previously published. White males experienced statistically significant excess mortality due to lung cancer (standardized mortality ratio [SMR] = 2.30; confidence interval [CI] = 1.88-2.79), all causes (SMR = 1.48; CI = 1.38-158), all cancers (SMR = 1.50; CI = 1.29-1.72), diabetes mellitus (SMR = 2.05; CI = 1.18-3.33), heart disease (SMR = 1.41; CI = 1.26-1.58), cerebrovascular disease (SMR = 1.50; CI = 1.08-2.02), pneumoconiosis and other respiratory diseases (SMR = 4.10; CI = 3.10-5.31), and accidents (SMR = 1.49; CI = 1.15-1.91). Among white females, statistically significant excesses occurred for lung cancer (SMR = 2.75; CI = 2.06-3.61), all causes (SMR = 1.21; CI = 1.11-1.32), pneumoconiosis and other respiratory diseases (SMR = 2.40; CI = 1.53-3.60), and other respiratory cancers (SMR = 14.98; CI = 4.08-38.7). Among the total cohort of black males, the only statistically significant excess observed was for pneumoconiosis (SMR = 2.19; CI = 1.23-3.62). Based on historical exposure measurements at the plant, there was a positive exposure-response relationship for both lung cancer and pneumoconiosis. Data for the entire cohort demonstrate an increase in the lung cancer relative risk of 2-3% for each fiber/cc-year of cumulative chrysotile exposure. This relationship was more consistent for the white male workers. The excess risk for lung cancer among white males and females appeared to occur at cumulative exposures lower than those for black males. Possible reasons for the lesser lung cancer risk among black males include less smoking and differences in airborne fiber characteristics experienced by black males as a result of plant job placement patterns. The case-control analysis found employment in preparation and carding operations (where most of the black males worked) to be associated with a slightly reduced lung cancer risk, although not statistically significant, whereas spinning and twisting employment was associated with a statistically significant increased lung cancer risk compared to other plant operations.(ABSTRACT TRUNCATED AT 400 WORDS)
Inconsistencies and delays in asbestos evaluations. J. Ribak. 1994;25(3):455-6. Comment · Historical article · Letter PubMed · Publisher
Lung cancer among steelworkers in Ontario. M.M. Finkelstein. 1994;26(4):549-57. PubMed · Publisher

Abstract

A population-based case-control study was carried out to follow up observations of increased lung cancer risk in the steel pouring areas of two Ontario steel mills. Study subjects were all men, aged 45-75 years, who died of lung cancer in the cities of Hamilton or Sault Ste-Marie, Ontario from 1979-1988. Nine hundred sixty-seven lung cancer victims were matched with 2,827 control subjects who died of other causes. Work histories were provided by the employers of steelworkers. In comparison with other residents of their cities, the relative risk of death from lung cancer was 0.85 (95% confidence interval [CI]: 0.58-1.23) for steelworkers in Sault-Ste Marie and was 1.10 (95% CI: 0.89-1.37) for steelworkers in Hamilton. In internal comparisons within the steel companies, increased lung cancer risk was observed among foundry, coke oven, and pouring pit workers. Retrospective hygiene assessment suggested that the increased risk of lung cancer among steel pourers might be related to the use of tar-based mold coating agents or to exposure to mineral fibers.
Lung cancer risk and welding--preliminary results from an ongoing case-control study. K.H. Jöckel, W. Ahrens, U. Bolm-Audorff. 1994;25(6):805-12. PubMed · Publisher

Abstract

In a hospital-based case-control study, 391 male cases or primary lung cancer and the same number of controls--matched by sex, age, and region--were personally interviewed for their job and smoking histories. The data reported reflect the midpoint of a study aiming at a total of 1,000 cases. One objective of the study was to assess confounding by asbestos exposure in what was thought to be a welding-associated risk. While the odds ratios (OR) increased steeply with cumulative exposure to tobacco smoke and were raised also for lifelong asbestos exposure of over 4,100 working hours (OR = 1.91), the effect of welding exposure was reduced after adjustment for smoking and exposure to asbestos. Furthermore, no consistent dose-response relationship could be shown in relation to welding hours. Therefore the present study supports the hypothesis that some, if not all, of the excess risk of welders observed in the literature may be due to the exposure to asbestos. The finding that the subgroup of employees in the aircraft industry showed an increased odds ratio of 2.14 after adjustment for smoking and exposure to asbestos deserves further attention. This suggests the need for further research on the role of berryllium-containing alloys, which has been suggested by other authors.
Mortality studies of machining fluid exposure in the automobile industry. III: A case-control study of larynx cancer. E.A. Eisen, P.E. Tolbert, M.F. Hallock, et al. 1994;26(2):185-202. PubMed · Publisher

Abstract

A case-control study of larynx cancer was conducted within a cohort of automobile workers exposed to metal working fluids, commonly referred to as machining fluids (MF). Results are based on 108 cases of larynx cancer and 5:1 matched controls. Risks associated with specific types of MF, as well as specific components of the fluids were evaluated. Based on a retrospective exposure assessment, lifetime exposures to straight and soluble fluids, grinding particulate, biocides, selected metals, sulfur, and chlorine were examined. Exposure to asbestos and acid mists at two of the three study sites was also characterized. Results suggest that straight mineral oils are associated with almost a two-fold excess in larynx cancer risk. There was also evidence of an association with elemental sulfur, commonly added to straight MF to improve the integrity of the materials under extreme pressure and heat. It is not clear whether sulfur is causally related to an excess relative risk of larynx cancer or whether the observed association is the result of unmeasured confounding by another contaminant or process feature. For example, the high stress operations that require MF enriched with sulfur are also more likely to produce polycyclic aromatic hydrocarbons (PAHs) during the process. Thus, the observed association with sulfur may be due to an association with PAH. The finding of excess risk of laryngeal cancer associated with MF is consistent with several previous reports in the literature. This is the first study, however, to distinguish straight mineral oils from other types of MF. Based on these findings, a general reduction in concentrations of straight mineral oil particulate in occupational environments would be prudent.
Pleural mesothelioma: a descriptive analysis based on a case-control study and mortality data in Ile de France, 1987-1990. Y. Iwatsubo, J.C. Pairon, C. Archambault de Beaune, et al. 1994;26(1):77-88. PubMed · Publisher

Abstract

Incidence rates of pleural mesothelioma in Ile de France were examined for the period 1987-1990, on the basis of information collected in a case-control study. This study was designed to include all new cases of pleural mesothelioma occurring in the region. On the other hand, mortality rates from pleural malignancies in the same region were examined on the basis of death certificates recorded by INSERM for the same period. A large difference was found between the two types of data. Average annual incidence rates were 7.5 per million among men and 1.6 per million among women. Average annual mortality rates due to primary pleural malignancies were 25.2 per million in males and 8.9 per million in females. This study confirms discordances between incidence and mortality data for pleural malignancies already reported in several countries. However, contrasting with some previous reports, the annual mortality rate from pleural malignancies was higher than the incidence rate of mesothelioma in this study. This emphasizes the usefulness of a specific investigation to explain such discordances, prior to comparison of data from one country to another.
Pleural plaques, asbestos exposure, and asbestos bodies in bronchoalveolar lavage fluid. E. Orlowski, J.C. Pairon, J. Ameille, et al. 1994;26(3):349-58. PubMed · Publisher

Abstract

The profiles of occupational asbestos exposure were investigated in a series of 66 hospital patients in whom pleural plaques constituted the only asbestos-induced abnormality. The relationship between a radiological semiquantitative score of pleural plaques and indices of asbestos exposure was also examined. On the basis of a standardized occupational questionnaire, four classes of asbestos exposure were distinguished in our study population: no evidence of exposure, low-level exposure, sporadic exposure at higher levels, and a remaining group of individuals with substantial exposure. Asbestos body count in bronchoalveolar lavage fluid (BALF) was used as an objective indicator of cumulative lung retention of asbestos. Our results support the data indicating that pleural plaques may occur in subjects with low-level or sporadic asbestos exposure. Although it is admitted that pleural plaques are strongly associated with past asbestos exposure, our data suggest that the stage of pleural plaques was not correlated to the level, frequency, duration of exposure nor to the amount of asbestos bodies in the BALF in subjects free of any lung parenchymal abnormalities on high resolution computerized tomography.
Potency versus importance in fiber pathogenicity. J.M. Hughes, H. Weill. 1994;25(4):609-10. Comment · Letter PubMed · Publisher

Summary

This letter to the editor responded to a study by Roggli et al. [1993] that analyzed asbestos fiber types in lung tissue from 94 mesothelioma cases. Of 1,512 fibers identified in that study, the most frequent type was amosite, followed by other mineral fibers, tremolite, crocidolite and chrysotile. Crocidolite and chrysotile each made up 3%, or approximately 45 fibers. From this, Roggli et al. concluded that the order of importance of asbestos fiber types for mesothelioma in the U.S. was amosite > tremolite > chrysotile = crocidolite. Hughes and Weill argued that the study blurred the difference between relative potency and relative importance. In a population with much more exposure to amosite than to crocidolite, a fiber could be more important without being more potent. They noted that among U.S. insulators and shipyard workers, crocidolite exposure was rare or nonexistent, while chrysotile and amosite exposure was common. They also stated that the study had no comparison group of people without mesothelioma. Because most people have asbestos fibers in their lungs, much of it chrysotile, noncases might show similar chrysotile levels but lower amosite and crocidolite levels. The authors concluded that without a reference population, no conclusions could be drawn about the relative importance or potency of chrysotile. They stated that the data did not weaken the evidence from human studies that crocidolite and amosite are far more potent than chrysotile in causing mesothelioma.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Re: Asbestos exposures in public and commercial buildings. T.P. Sterling, W.L. Rosenbaum, J.J. Weinkam. 1994;26(6):845-7. PubMed · Publisher
Re: Attitudes and opinions regarding asbestos and cancer, 1937-1965. D.J. Kilpatrick, M. Kottek. 1994;25(3):461-2. Comment · Historical article · Letter PubMed · Publisher

Summary

This letter to the editor responded to a 1993 commentary by Prof. Harrington on Prof. Enterline's 1991 article, "Changing Attitudes and Opinions Regarding Asbestos and Cancer 1934-1965." The authors addressed Harrington's observation, based on a personal communication from Nick Wikeley, that in January 1932 a trade unionist in Britain had suggested to Sir Thomas Legge, described as "then Chief Medical Inspector of Factories," that cancer might be a complication of asbestosis. To check Legge's position at that date, the authors quoted at length from the preface that Dr. S.A. Henry, HM Medical Inspector of Factories, wrote in June 1934 for Legge's posthumously published book, Industrial Maladies. According to Henry, Legge resigned as Senior Medical Inspector of Factories on 29 November 1926, after the British Government refused to ratify the Geneva White Lead Convention, which he had helped to draft. In December 1929 he accepted the post of Medical Adviser to the Trades Union Congress, and he died on 7 May 1932 at the age of 69. The authors concluded that, assuming Henry was correct about Legge's appointments, the trade union communication described by Harrington would have occurred 2 years into Legge's post with the Trades Union Congress and some 5 years after his resignation as Senior Medical Inspector of Factories.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Retention of asbestos bodies in the lungs of welders. J.C. Pairon, L. Martinon, Y. Iwatsubo, et al. 1994;25(6):793-804. PubMed · Publisher

Abstract

Examination of asbestos bodies (AB) retained in the lungs is a useful way of assessing past occupational exposure to this material. AB retention has been extensively studied in workers directly exposed to asbestos, but less so in those end users, such as welders, who use asbestos-containing products. We therefore retrospectively studied AB retention in 211 welders, for whom biological testing procedures had been requested by a chest physician, between 1988 and 1991. Optical microscopy of AB was performed on samples of sputum (40 subjects), bronchoalveolar lavage fluid (BAL) (147 subjects), and lung tissue obtained after thoracotomy (38 subjects). Information on previous jobs and exposure was obtained using a questionnaire (the mean duration of welding activities was 16.6 years). Eighty-two subjects (38.9%) had elevated lung retention of AB in all the samples studied. Significant AB retention occurred in only 30% of sputum samples, but in 40.1% of BAL samples and 39.5% of lung tissue samples. The duration of welding activities correlated with the density of AB in BAL or lung tissue (r = 0.31, p < 0.01 and r = 0.49, p < 0.05, respectively). On the basis of the questionnaire, only two of the welders with significant AB retention had other occupational exposure to asbestos. Our findings suggest that welding activities may increase lung retention of AB, and consequently might produce higher risks of fibrotic and/or malignant pulmonary diseases. These potential risks need to be brought to the attention of doctors; a longitudinal follow-up may also be warranted in such populations, even after individuals have ceased their welding jobs.
The National Sheet Metal Worker Asbestos Disease Screening Program: radiologic findings. National Sheet Metal Examination Group. L.S. Welch, D. Michaels, S.R. Zoloth. 1994;25(5):635-48. PubMed · Publisher

Abstract

This report presents data gathered from a series of asbestos disease screening examinations of 9,605 United States sheet metal workers who were first employed in the trade at least 20 years before the examination. The overall prevalence of asbestos-related radiographic changes was 31.1%: 18.8% had pleural abnormalities alone, 6.6% had parenchymal abnormalities (International Labour Office (ILO) score of 1/0 or higher) alone, and 5.7% had both. Among those with 40 years or more since entering the trade, 41.5% had radiographic signs of asbestos-related disease, 24.2% pleural alone, 7.7% parenchymal alone, and 9.6% both pleural and parenchymal abnormalities. After controlling for several surrogates for asbestos exposure level, cigarette smoking was found to increase risk of parenchymal, and more modestly, pleural abnormalities. Each pack-year was associated with a 1% increased prevalence odds ratios for parenchymal abnormalities (ILO category 1 compared to category 0), and 0.4% increased prevalence odds ratios for pleural abnormalities. A history of shipyard employment also produced significantly increased prevalence odds ratios for each radiographic category. More that 90% of chest radiographs were classified by A or B readers; after adjustment for other risk factors, A readers were more likely to report parenchymal abnormalities of category 1, but not more likely to report category 2 or pleural abnormalities, than B readers.
Thoughts inspired by reading the correspondence: Hughes and Weill vs. Roggli et al., April 1994. M. Greenberg. 1994;26(6):843-4. PubMed · Publisher
Unpublished data on asbestos dust continue to surface. T.F. Mancuso. 1994;25(3):457-60. Historical article · Letter PubMed · Publisher
Workers' compensation for nonmalignant asbestos-related lung disease. C. Nevitt, W. Daniell, L. Rosenstock. 1994;26(6):821-30. PubMed · Publisher

Abstract

Workers' compensation claims filed for occupational illness are generally more complicated to resolve than are injury claims, and they may therefore face higher likelihood of rejection. This study analyzed outcomes and predictive factors for claims filed from one clinic in Washington State between 1982 and 1986 by 157 male patients for nonmalignant asbestos-related lung disease. Among 50 federal Longshore claims, 46 (92%) were unresolved or could not be located by claims administrators. In contrast, 118 (89%) of State Fund claims had been resolved, with 48% accepted without consistent relationship to disease severity. Claims filed under both jurisdictions showed a twofold greater risk of rejection by the State Fund (relative risk, RR = 2.0; 95% confidence interval, 95% CI = 1.3-3.2). State Fund claims filed for nonwhite patients were rejected more often than those of white patients, although the association was explained at least partially by jurisdictional overlap (adjusted RR = 1.5; 95% CI = 1.05-2.1). This study indicates a need to scrutinize the handling of occupational disease claims by the federal Longshore system and to consider the adverse influences of jurisdictional conflicts and possible race-associated factors on compensation of occupational illness.
A diagnostic approach to asbestosis, utilizing clinical criteria, high resolution computed tomography, and gallium scanning. V.E. Klaas. 1993;23(5):801-9. PubMed · Publisher

Abstract

Seventy-five individuals known to have significant exposure to asbestos were evaluated by physical exam, pulmonary function tests (PFT), chest radiographs, high resolution computed tomography (HRCT), gallium-67 scanning, and various laboratory exams. Sixteen subjects met three of the following four criteria and were considered to have clinical asbestosis: 1) bibasilar rales, 2) FVC < 80% of predicted, 3) DLCO < 80% of predicted, and 4) an abnormal chest radiograph. Evaluations which included HRCT and Ga scanning detected pulmonary disease in these asbestos-exposed individuals in many cases where other modalities were unable to demonstrate significant abnormalities. While only 21% of the subjects satisfied commonly accepted criteria for the diagnosis of asbestosis, 75% had evidence of disease by both HRCT and gallium scanning. These data suggest that it may be time to include HRCT and Ga scanning when evaluating asbestos-exposed individuals, especially in cases where evaluations by physical exam, PFTs, and chest radiographs are non-diagnostic.
Asbestos disease risk communication conducted by the New Jersey Department of Health. M. Stanbury, G. Solice-Sample, J. Pescatore. 1993;23(1):97-104. PubMed · Publisher

Abstract

Since October 1985, the New Jersey Department of Health (NJDOH) has required hospitals to report all patients with a discharge diagnosis of asbestosis. As follow-up to a needs assessment survey of these patients, the NJDOH developed an educational packet including an information bulletin titled "Asbestos Disease: Medical and Legal Facts for Employees" and a pre-stamped postcard evaluation survey. The packet was sent to 1,418 patients reported by hospitals; 433 patients returned the evaluation questionnaire. The survey assessed attitudinal responses (were the materials helpful and easy to understand?) and behavioral responses (did the respondent plan on discussing the materials with a doctor or lawyer?) to the information in the packet. Of the postcard respondents, 85% found the materials helpful, and approximately half indicated that they would discuss the materials with a doctor or lawyer. Of the 33% who were proxy respondents, half appeared not to have understood that the materials had relevance to them as family members. Modifications to the protocol for the asbestos disease educational packet were made based on the evaluation data. Limitations of the evaluation survey and the value of process evaluations in risk communication projects are discussed.
Asbestos exposure among Finnish lung cancer patients: occupational history and fiber concentration in lung tissue. A. Karjalainen, S. Anttila, L. Heikkilä, et al. 1993;23(3):461-71. PubMed · Publisher

Abstract

In a series of 65 surgically treated lung cancer patients, past exposure to asbestos was evaluated by personal interviews, and by scanning electron microscopy analyses of the mineral fibers in lung tissue. Lung tissue samples of 17 autopsied male office workers were analyzed as referents. According to occupational history, 37% of the lung cancer patients had definite or probable, 31% possible, and 32% unlikely exposure to asbestos. The fiber concentration in the lung tissue ranged from < 0.1 to 65 million fibers per gram dry tissue in the lung cancer group, and from < 0.1 to 0.8 million fibers per gram dry tissue in the reference group. In 26% of the lung cancer patients, but in none of the referents, the fiber concentration exceeded 1 million fibers per gram dry tissue. Most of the exposed patients had been employed in various construction jobs, and valuable information about the exposure levels could be obtained by the mineral fiber analyses. In general, there was a good accord between the exposure categorization and the fiber burden measured in the lung.
Asbestos fiber type in malignant mesothelioma: an analytical scanning electron microscopic study of 94 cases. V.L. Roggli, P.C. Pratt, A.R. Brody. 1993;23(4):605-14. PubMed · Publisher

Abstract

Although the association between asbestos exposure and malignant mesothelioma is indisputable, controversy continues regarding the relative contribution of the various types of asbestos fibers to the development of mesothelioma. We examined the types of asbestos fibers recovered from lung parenchyma in more than 90 cases of malignant mesothelioma from the United States, using an analytical scanning electron microscope. Almost half of the patients were former asbestos insulators or shipyard workers. The fibers were recovered from lung tissues obtained at autopsy or surgical resection by means of a sodium hypochlorite digestion procedure. Amosite asbestos was identified in 81% of the cases and accounted for 58% of all fibers 5 microns or greater in length. Tremolite/actinolite/anthophyllite were identified in 55% of the cases and accounted for 10% of all fiber types. Chrysotile was identified in 21% of the cases and accounted for 3% of fibers exceeding 5 microns in length. Crocidolite was found in 16% of the cases and accounted for 3% of fibers exceeding 5 microns in length. Nonasbestos mineral fibers (commonly found in the lungs of the general population) were observed in 71% of the cases and accounted for 25% of all fibers 5 microns or greater in length. The findings in this study are at odds with the assertion that crocidolite asbestos is responsible for most mesotheliomas in the United States.
Asbestos screening and education programs for building and construction trades unions. S. Tillett, P. Sullivan. 1993;23(1):143-52. PubMed · Publisher

Abstract

Worker notification involves informing current and past employees of their risk of disease. It also involves suggesting ways to reduce their risks. The asbestos screening and education programs designed for the building and construction trades unions were a national multisite effort that focused on improving the health of eligible union members and retirees at high risk of developing asbestos-related disease. The asbestos screening and education programs were made available to "high-risk," asbestos-exposed local union members through the efforts of a number of international unions, including the International Union of Elevator Constructors and the Laborers' International Union of North America--both affiliates of the Building and Construction Trades Department, AFL-CIO. Consultation and program assistance in developing and implementing these programs were provided by the Occupational Health Foundation, a labor-sponsored, nonprofit organization with a multidisciplinary safety and health staff. Program components included identification of "high-risk" individuals, notification of risk, education, medical screening, legal referral, and various support services. Community-based physicians and/or physician-staffed mobile testing units provided services on a contractual basis according to a standardized medical protocol. Between 1988 and 1991, 2,136 union members and retirees from 89 local unions affiliated with the Elevator Constructors or the Laborers were screened in 59 regional programs. A general description and historical perspective are offered concerning program implementation, integration into existing union infrastructures. Emphasis is placed on the role of the unions in advancing members' interests when dealing with the health and socioeconomic implications of asbestos-related disease.
Asbestos-related mesothelioma in Monfalcone, Italy. C. Bianchi, A. Brollo, L. Ramani, et al. 1993;24(2):149-60. PubMed · Publisher

Abstract

The Monfalcone area, in northeastern Italy, is a small industrial territory (population about 60,000), with a large shipyard. Between October 1979 and April 1992, ninety-two malignant mesotheliomas were diagnosed at the Monfalcone Hospital. The series included 84 men and 8 women, aged 42 to 89 years (median age 68 years). There were 89 pleural and 3 peritoneal tumors. Seventy patients (69 men and 1 woman) had worked in the shipyards; six were seamen, and four insulators. Five men had been exposed to asbestos in various industries; six women had histories of domestic exposure, and one woman had a history of possible environmental exposure. The latency periods (intervals between first exposure to asbestos and diagnosis of the tumor) ranged from 20 to 65 years (median 52 years). Latency periods among insulators were significantly lower than among shipyard workers, as well as lower than among the other categories (p < 0.01). Lung asbestos bodies were isolated after chemical digestion in 73 cases at necropsy, and in two cases at surgery. In necropsy cases, asbestos body burdens ranged between 100 and 10,000,000 bodies per gram of dried tissue (median 11,000). Pleural plaques were observed at necropsy in 62 out of 73 cases, and in two cases at surgery. In the time period we considered, the annual incidence rates for pleural mesothelioma were very high among male Monfalcone residents, being 189 per 100,000 among people aged 75 years or more. On the basis of occupational data and of objective signs (lung asbestos bodies, pleural plaques), all the cases of the present series but one (that with possible environmental exposure) were considered as asbestos-related. The role of co-factors in the development of asbestos-related mesothelioma is suggested.
Assessing quality of life when planning and evaluating worker notification programs: two case examples. B.E. Meyerowitz. 1993;23(1):221-7. PubMed · Publisher

Abstract

Notifying workers that they have been placed at risk for serious medical problems may affect their lives in unexpected ways. Although very little evidence supports the fear of notification causing grave psychological problems, more subtle disruptions in quality of life may result. In addition, psychological reactions to notification, such as anxiety or denial, may impede or enhance workers' abilities to process, remember, or act upon the information presented. Measuring how different notification strategies affect quality of life is crucial; this process can enable us to design and select effective strategies that improve, rather than disrupt, the lives of workers and their families. Two preliminary efforts to include consideration of quality of life in planning and evaluating notification programs are described.
Beyond notification: a case study from Cloquet, Minnesota. M.J. Finendale. 1993;23(1):153-9. PubMed · Publisher

Abstract

All members of Local 158 of the United Paperworkers International Union in Cloquet, Minnesota, were invited to attend a meeting to notify them about the outcome of the Union's study concerning exposure to asbestos fiber. Union members and their families were contacted by letter, radio and television announcements, area newspapers, and word of mouth. They were informed about the medical screening that was being planned and about other information on asbestos-related diseases. During the meeting, they were asked to attend one of the educational sessions, to schedule an appointment for the screening, and to fill out a medical history. It was determined that paperworkers with asbestos-related disease might have rights to at least two types of compensation: worker's compensation from their employers and/or court- or jury-awarded compensation from asbestos manufacturers. Other sources of compensation such as social security of disability pensions might also be available to eligible individuals. The Union did not have a complete listing of all the individuals who worked at plants or in operations where asbestos exposure may have occurred. The Union solicited the aid of the Minnesota Department of Health to help identify former asbestos-exposed workers and to develop an ongoing screening and medical program for workers who were exposed but did not develop symptoms of asbestos-related disease; these illnesses usually take 20 years or more to develop. However, the Union was able to follow-up the notification and subsequent screening by sending members and their families the results of the initial screenings and other information concerning the status of any legal actions taken on behalf of the exposed.(ABSTRACT TRUNCATED AT 250 WORDS)
Channels and vehicles of communication: the asbestos awareness campaign. V.S. Freimuth, J.P. Van Nevel. 1993;23(1):105-11. PubMed · Publisher

Abstract

In April 1978, the U.S. Department of Health, Education, and Welfare launched a multimedia campaign to inform doctors, workers, and others about the increased risks of asbestos exposure. Unlike most worker notification efforts, this one has no lists of workers or even of workplaces but faced the challenge of locating people who had worked in the shipbuilding industries more than 30 years earlier. Multiple mass media channels were used, but since most messages were distributed as public service announcements, gatekeepers were critical to the success of the campaign. Some campaign messages were aired, but mostly at hours other than prime time, and the coverage focused more on the controversial, fast-breaking events rather than on estimates of risk or on behaviors to reduce risk. The campaign was effective in increasing the number of people who believed they were at risk, but was less successful with older Americans than with manual laborers.
Characterization of asbestos fibers in lungs and mesotheliomatous tissues of baboons following long-term inhalation. K. Hiroshima, Y. Murai, Y. Suzuki, et al. 1993;23(6):883-901. PubMed · Publisher

Abstract

Changes in the dimensions of inhaled asbestos fibers in the lung and translocation of intrapulmonary asbestos fibers into mesothelial tissues were investigated in 17 baboons (5 exposed to amosite, 4 to chrysotile, 5 to crocidolite, and 3 unexposed). The animals received different cumulative doses of asbestos by inhalation, followed by varying recovery periods (0-69 months). All asbestos types induced pulmonary asbestosis with severity directly related to the cumulative dose. There were a larger number of asbestos bodies in the lung of the amphibole-exposed animals than in those exposed to chrysotile. A tissue burden study, using transmission electron microscopy on 25-microns paraffin sections, ashed in a low-temperature asher, was performed. Intrapulmonary amosite fibers were shorter in geometric mean length compared with a standard amosite sample (UICC) (3.3 microns). In explanation, it was considered that long fibers might not be able to reach the lower respiratory tract and/or long fibers might be fragmented into shorter fibers. Further, in the amosite-exposed group, the mean length of intrapulmonary fibers increased with the extension of recovery period, suggesting that shorter fibers had been cleared from the lung. The chrysotile standard sample (UICC) had a shorter geometric mean length (1.1 microns) than amosite. The mean length of intrapulmonary chrysotile did not noticeably change with the extension of inhalation and recovery periods; however, the mean width decreased with the extension of these periods. This finding strongly suggested that separation of thick chrysotile fibers had occurred in the lung. The crocidolite standard sample (Transvaal) had a shorter geometric mean length (1.4 microns) than amosite.(ABSTRACT TRUNCATED AT 250 WORDS)
Comments on the Health Effects Institute-Asbestos Research (HEI-AR) report: "Asbestos in public and commercial buildings," with emphasis on risk assessment methods used. T.D. Sterling, C.W. Collett, W.L. Rosenbaum, et al. 1993;24(6):767-81. PubMed · Publisher

Abstract

A Health Effects Institute--Asbestos Research Report calculates the risk of exposure to environmental asbestos fibers (EAF) by downward extrapolation from the mortality of workers exposed for 20 years. This extrapolation is improper because 1) relative risks of asbestos exposure very likely are not linearly progressive; 2) the composition of EAF may not be equivalent to that in mining or fabricating; 3) the same environmental asbestos concentration probably represents different exposure doses for different populations; and 4) health effects of asbestos exposure on children, seniors, patients, the institutionalized, the handicapped, and the chronically ill may not be the same as those of healthy workers. Evidence of asbestos-related disease among family members of exposed workers demonstrates that the risk observed for EAF is substantially larger than that estimated from downward extrapolation and suggests a basis for an alternative approach to estimating asbestos-related health risks. Such epidemiologic procedures are well established and ought to form the basis for detecting the health effects of EAF. It is also unclear which industry supports HEI-AR.
Considerations of specificity in assessing the relationship between asbestos and cancer. O. Wong. 1993;23(3):521-3. Comment · Review PubMed · Publisher

Summary

In this commentary, the author responded to a 1991 paper by Dr. Enterline, which had concluded that scientists decided asbestos was a cause of cancer in Germany in 1943 and reached a consensus in the United States in 1964. The author argued that the statement "asbestos is a cause of cancer" lacked specificity. He said causal statements should specify fiber type, fiber length, fiber concentration, duration of exposure, type of industry and cancer site. He suggested applying causation criteria such as those set out by Hill in 1965, and stated that case reports cannot replace epidemiologic studies. He noted that scientists were still debating whether chrysotile can cause mesothelioma. As a second example, he discussed lung cancer in garage mechanics. He gave their typical 8-hour time-weighted average exposure to chrysotile in brake lining dust as below 0.05 fibers/cc. He summarized three cohort studies: London bus mechanics (SMR 0.92), Danish auto mechanics (SMR 1.01) and Stockholm bus garage workers (SMR 1.15, not statistically significant). His meta-analysis of these studies gave a summary lung cancer SMR of 1.01 (95% confidence limits 0.80-1.26), based on 80 observed deaths. He also cited a French case-control study of 1,625 lung cancer cases, which reported a smoking-adjusted relative risk of 1.06 for motor vehicle mechanics. The author concluded that the data did not support an association between brake lining dust and lung cancer, and that specificity is vital in cancer risk assessment.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Diffuse thickening superimposed on circumscribed pleural thickening related to asbestos exposure. A. Miller, J.A. Miller. 1993;23(6):859-71. PubMed · Publisher

Abstract

Circumscribed and diffuse pleural thickening (PT), the most common radiographic manifestations of asbestos-related disease, have different pathogeneses, differential diagnostic criteria, and effects on pulmonary function. The important distinction between the two disorders is demonstrated by six patients in whom typical circumscribed PT was followed by diffuse PT in the same hemithorax. The diffuse PT came on 18-47 (mean 32.3) years after first exposure to asbestos. In four patients, clinically evident pleural effusions preceded the diffuse PT; the latter left all with moderate to severe restrictive ventilatory impairment. Patients with stable pleural plaques are at risk for diffuse PT and consequent greater ventilatory impairment, even though they are many years from first exposure to asbestos.
Early animal research on asbestos cancer. P.E. Enterline. 1993;24(6):783-5; author reply 787-91. Letter PubMed · Publisher
Experiences of a state-sponsored notification and screening program for asbestos workers. A.P. Bender, A.N. Williams, D.L. Parker. 1993;23(1):161-9. PubMed · Publisher

Abstract

Worker notification can involve a broad range of activities including medical screening, personal and mass communications, cohort identification and tracing, and even litigation. The inclusion or exclusion of various supporting activities in a worker notification program may pose significant medical, public health, financial, logistical, and even legal implications for targeted individuals as well as for the agencies involved. This report describes some experiences in a state-sponsored notification and screening program of approximately 4,500 asbestos workers in Minnesota. In this program, a variety of factors led to the decision to provide medical screening to 1,101 workers and 451 spouses. It is anticipated that another 3,400 workers will be notified but not screened. A follow-up survey of notified workers showed overwhelming support for this program. It is estimated that this program will cost more than $650,000 by its completion. The decision to institute medical screening and other support activities should be made with careful consideration of the diverse implications of these activities to the individuals, communities, and agencies involved.
Job tasks, potential exposures, and health risks of laborers employed in the construction industry. G. Burkhart, P.A. Schulte, C. Robinson, et al. 1993;24(4):413-25. Review PubMed · Publisher

Abstract

Construction laborers have some of the highest death rates of any occupation in the United States. There has been very little systematic research focused exclusively on "laborers" as opposed to other workers in the construction industry. We reviewed the English language literature and various data bases describing the occupational tasks, exposures, and work-related health risks of construction laborers. The sources of information included 1) occupational mortality surveillance data collected by the states of California and Washington and the National Institute for Occupational Safety and Health (NIOSH); 2) National Occupational Exposure Survey; 3) national fatality data; 4) cancer registry data; and 5) case reports of specific causes of morbidity. While the literature reported that construction laborers have increased risk for mesothelioma, on-the-job trauma, acute lead poisoning, musculoskeletal injury, and dermatitis, the work relatedness of excess risks for all-cause mortality, cirrhosis, cerebrovascular disease, chronic obstructive pulmonary disease, ischemic heart disease, and leukemia is less clear. Furthermore, while laborers are known to be potentially exposed to asbestos, noise, and lead, and the NIOSH Job Exposure Matrix describes other potential hazardous exposures, little research has characterized other possible exposures and no research has been found that describes the exposures associated with specific job tasks. More advanced study designs are needed that include a better understanding of the job tasks and exposures to construction laborers, in order to evaluate specific exposure-disease relationships and to develop intervention programs aimed at reducing the rate of work-related diseases.
Malignant mesothelioma induced in baboons by inhalation of amosite asbestos. I. Webster, B. Goldstein, F.S. Coetzee, et al. 1993;24(6):659-66. PubMed · Publisher

Abstract

Ten out of 12 South African baboons (Papio ursinus) survived exposure to amosite asbestos dust for periods ranging from 242 days to 898 days at an aerosol level ranging between 1,100 and 1,200 fibers per milliliter. After exposure, they were kept under observation until they died; the total residence time of amosite varied from 1.2-10.2 years. All underwent detailed postmortem necropsy examinations. All baboons had asbestosis. Five of the baboons developed malignant diffuse mesothelioma; three peritoneal, and two pleural with peritoneal invasion. These results indicate that amosite is highly carcinogenic. Since it is difficult to accomplish follow-up of persons exposed to amosite asbestos because of the geographic location of the amosite mines and mills in South Africa (a majority of the workers being migrant laborers from countries bordering on the Transvaal), it is therefore probable that cases of peritoneal mesothelioma have been missed. If human beings are likely to react to amosite as do baboons, epidemiological follow-up should include identification of abdominal as well as thoracic neoplasms.
Measurement of asbestos dust levels in British asbestos factories in the 1930s. N.J. Wikeley. 1993;24(5):509-20. Historical article PubMed · Publisher

Abstract

Since the early reports of the deleterious health effects of asbestos first appeared in the British literature, the paucity of information on dust levels has been decried. Research into archival material reporting various methods of assessing asbestos dust levels in British factories during the 1930s indicates that these levels were high indeed.
Re: "Changing attitudes and opinions regarding asbestos and cancer, 1934-1965". L.O. Meurman. 1993;23(3):517. Comment PubMed · Publisher
Re: "TLVs for asbestos". T.F. Mancuso. 1993;23(6):961-5. Comment · Letter PubMed · Publisher
Re: "TLVs for asbestos". M. Corn. 1993;23(6):959. Comment · Letter PubMed · Publisher
Re: "TLVs for asbestos". G.V. Coles. 1993;23(6):955-7. Comment · Letter PubMed · Publisher
Re: "TLVs for asbestos". G.W. Schepers. 1993;23(6):967-9. Comment · Letter PubMed · Publisher
Re: Asbestos and cancer, 1934-1965. H. Bohlig. 1993;23(3):519. Comment PubMed · Publisher
Re: Asbestos and cancer, 1934-1965. W.T. McCaughey. 1993;23(3):503-4. Comment PubMed · Publisher
Re: Attitudes and opinions regarding asbestos and cancer, 1934-1965. M.A. Schneiderman. 1993;23(3):509-10. Comment PubMed · Publisher
Re: Attitudes and opinions regarding asbestos and cancer, 1934-1965. J.M. Harrington. 1993;23(3):505-6. Comment PubMed · Publisher
Re: Attitudes and opinions regarding asbestos and cancer, 1934-1965. G.K. Sluis-Cremer. 1993;23(3):511. Comment PubMed · Publisher
Re: Historical reasons for attitudes and opinions regarding asbestos and cancer, 1934-1965. M. Corn, J.K. Corn. 1993;23(3):513-5. Comment PubMed · Publisher
Reginald Tage: a UK asbestos prophet--a postscript. M. Greenberg. 1993;24(5):521-4. Historical article PubMed · Publisher
Technique dependent variations in asbestos burden as illustrated in a case of nonoccupational exposed mesothelioma. R.F. Dodson, M. O'Sullivan, C. Corn. 1993;24(2):235-40. Case report PubMed · Publisher

Summary

This commentary used a single case to show how the method used to count asbestos fibers in tissue can change the measured lung burden. The patient was a 45-year-old white man who died of malignant peritoneal mesothelioma, diagnosed at two major medical centers. He worked in the legal profession and had no known occupational, hobby or lifestyle asbestos exposure, but recalled being in areas of public schools where asbestos had been present. Digested lung tissue was examined by light microscopy for ferruginous bodies and by analytical transmission electron microscopy at 5,000x, 15,000x and 20,000x. No ferruginous bodies were found. At 5,000x, which had a fiber limit of 5 µm or longer, only 1 chrysotile fiber was found (17,900 fibers/g dry weight). At the higher magnifications the average total asbestos burden was 1.7 x 10^6 fibers/g dry weight, 79% chrysotile and 21% amphiboles. The authors judged these levels only slightly above those reported for general urban populations. They stated that the findings did not support an "amphibole theory" as the cause of this mesothelioma. They then raised unanswered questions about the clearance and relocation of short fibers over time, the exclusion of short and thin fibers from counting schemes, and individual susceptibility. They concluded that tissue burden studies must define their detection limits for both fiber length and width.

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A case-control study of lung cancer at a dye and resin manufacturing plant. F. Barbone, E. Delzell, H. Austin, et al. 1992;22(6):835-49. PubMed · Publisher

Abstract

This case-control study evaluated the relationship between lung cancer and occupational factors among employees at a dye and resin manufacturing plant. The study included 51 lung cancer cases and 102 controls who were members of a cohort of workers investigated in a previous retrospective follow-up study. Information on area of employment and on potential exposure to certain chemicals was obtained from plant personnel and medical records and from interviews with long-term employees. Information on potential confounders, including cigarette smoking, was obtained by interviewing study subjects or their next-of-kin. The odds ratio (OR) for heavy smokers compared with light or nonsmokers was 5.9 (95% confidence interval (CI) = 2.4-15). An elevated OR for lung cancer was observed for subjects who worked in the anthraquinone dye and epichlorohydrin manufacturing area of the plant (OR = 2.4; 95% CI = 1.1-5.2) and for employees who were seen at the plant infirmary for acute exposure to chlorine (OR, adjusted for smoking = 27; 95% CI = 3.5-205). Pipefitters employed at the plant for five or more years also had an elevated OR (3.3; 95% CI = 0.8-14).
A mortality cohort study of seamen in Italy. E. Rapiti, E. Turi, F. Forastiere, et al. 1992;21(6):863-72. PubMed · Publisher

Abstract

A total of 2,208 male subjects, enrolled as merchant marine seamen at the Civitavecchia (Italy) harbor from 1936 to 1975 were followed up through 1989 in order to evaluate their mortality experience. Available information about the number of sailings made it possible to divide subjects into two subgroups: 948 workers with at least one sailing (cohort A) and 1,260 with no reported sailing (cohort B). Fewer than expected overall deaths were observed in both cohorts (cohort A: SMR = 0.83; cohort B: SMR = 0.81), mainly due to a lower mortality from circulatory, respiratory, and digestive diseases. Lung cancer deaths were significantly increased in cohort A (O = 30, SMR = 1.71, 95% CI = 1.15-2.44), whereas no excess was observed in cohort B (O = 6, SMR = 0.57, 95% CI = 0.21-1.26). Among subjects employed aboard ship, a trend in SMRs for lung cancer increasing with duration of employment was observed. Furthermore, three neoplasms of other parts of the respiratory system (including one mesothelioma) were detected in cohort A (SMR = 5.87), and one in cohort B. The study substantiates an increased risk of respiratory cancer among subjects with an occupational history of sailing; past exposure to asbestos and to other environmental carcinogens aboard could be implicated.
Accelerated loss of lung function and alveolitis in a longitudinal study of non-smoking individuals with occupational exposure to asbestos. W.N. Rom. 1992;21(6):835-44. PubMed · Publisher

Abstract

Long-term asbestos workers who insulate pipes and boilers may develop interstitial lung disease associated with loss of lung function. To quantitate annual loss of lung function, 77 individuals with chest X-rays greater than or equal to 1/0 ILO category who were life-long non-smokers or ex-smokers for greater than 5 years were evaluated. Study parameters included pulmonary function tests and bronchoalveolar lavage for a mean of 3 visits over 30 +/- 2 months. The study participants were 56 +/- 1 years old and had 31 +/- 1 years' occupational exposure to asbestos. At the first visit, multiple regression analysis revealed significant associations between rales or radiographic opacities and VC, FEV1, and total lung capacity; significant associations were also found between neutrophils/ml lavage fluid with FEV1 and diffusing capacity (all p less than 0.05). Annual declines for the asbestos-exposed were VC -92 +/- 28 ml/yr and FEV1 -66 +/- 21 ml/yr. Declines in VC and FEV1 were less in those with reduced lung function at the initial visit. There were no significant associations between any of the annual declines and cells recovered by bronchoalveolar lavage. Compared to other asbestos-exposed cohorts followed longitudinally, asbestos insulators with radiographs greater than or equal to 1/0 and exposure greater than or equal to 20 years have larger rates of FVC and FEV1 decline for both non-smokers and ex-smokers.
An environmental survey in chrysotile asbestos milling processes in India. A.K. Mukherjee, H.R. Rajmohan, S.K. Dave, et al. 1992;22(4):543-51. PubMed · Publisher

Abstract

Environmental monitoring to determine airborne asbestos fiber levels has been carried out in four different mills processing chrysotile asbestos in the Cuddapah District (Andhra Pradesh) of India. The "membrane filter method" comprising standard asbestos sampling techniques, acetone-triacetin method for sample preparation, fiber counting, and sizing using the phase contrast optical microscope were adopted in the study. Fiber concentrations both with respect to personal exposures and processing areas were found in most of the cases to be much higher than the prescribed Threshold Limit Value (TLVs) of the developed and developing countries for chrysotile asbestos. By optical microscopy, fiber length distribution showed 70% of fibers in the milling processes were in size range > 5-10 microns, whereas in > 10-20 and > 20 microns, 20% and 8%, respectively. Fiber identification for major elemental content, also done by using scanning electron microscope equipped with an energy dispersive X-ray analyzer, indicated the presence of tremolite along with chrysotile. The study stresses the urgent need to adopt suitable engineering controls at the dust generating sources to reduce the fiber level in the mill environment below the threshold limit.
Asbestos and cancer 1934-1965: and what happened thereafter?. Y. Lerman. 1992;22(3):455-6. Historical article PubMed · Publisher
Asbestos and cancer: an early warning to the British TUC. N.J. Wikeley. 1992;22(3):449-54. Historical article PubMed · Publisher

Summary

The author, a lawyer at the University of Birmingham, examined Trades Union Congress (TUC) archives held at the Modern Records Centre, University of Warwick. The archives related to the drafting of Britain's Asbestos Industry Regulations 1931 and the accompanying workmen's compensation scheme. They showed that in 1931 the TUC and its medical adviser, Sir Thomas Legge, received unsolicited help from Reginald Tage, a self-described "Asbestos Research Worker" who had studied conditions at the Cape Asbestos factory in Barking. Several of Tage's proposed amendments entered the final regulations. He criticized the compensation scheme for excluding workers not actively engaged in manufacturing and those who had left the relevant processes more than 3 years before the disease occurred. After bringing Legge X-ray plates of a packer with asbestosis who died of stomach cancer, he began investigating two other cancer cases, which lack of funds stopped him from pursuing. In January 1932 he identified two issues needing investigation: whether amphibole asbestos posed a greater risk than serpentine, and cancer as a complication of asbestosis. Doubts about his standing led the TUC to pay him a grant in March 1932 and end the relationship. Legge wrote that Tage was "inclined to develop wrong ideas about the possible effects of asbestos." The article also described 1930s inquest reports and a 1939 parliamentary disclosure of 39 asbestosis deaths among Cape Barking workers. The author concluded that Legge rather than Tage was misguided and that the 1931 Regulations proved inadequate.

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Asbestos exposures: known and underrecognized sources. J.L. Levin, J.M. Stocks, J.R. Shepherd, et al. 1992;22(4):607-8. Letter PubMed · Publisher
Asbestos fiber analysis in 27 malignant mesothelioma cases. Y. Murai, M. Kitagawa. 1992;22(2):193-207. PubMed · Publisher

Abstract

The asbestos body counts per 5 gm wet lung tissue in 27 (23 pleural and 4 peritoneal) malignant mesothelioma cases derived from 19 autopsy and 8 surgical cases were, according to our own criteria, low level exposure in 13 cases (48.2%), moderate level exposure in 2 cases (7.4%), and high level exposure in 12 cases (44.4%). In our previous study on 235 consecutive autopsy cases, the low level exposure was considered to be environmental, the moderate level was secondary or blue collar, and the high level was occupational. In the present study, about half of the cases examined (44.4%, high level exposure) are closely related to some occupational asbestos exposure and the other half (48.2%) to environmental exposure. The type and size of asbestos fibers from the 12 cases of high level exposure were analyzed and the characteristics were compared with those of cases of low level exposure without lung cancer or mesothelioma. Most fibers analyzed (98%) were longer than 5 microns and thicker than 0.10 micron by our counting rules. In the control group, predominant fibers were tremolite or actinolite. In all the 11 pleural mesothelioma cases, the content of amosite fibers was significantly higher than in the controls. In one case of peritoneal mesothelioma, incipient asbestosis was found and the predominant fibers were crocidolite. It is suggested that the presence of amosite and crocidolite is linked to mesothelioma. The mean lengths of amosite and crocidolite, as detected by our resolution capabilities, were 36.0 and 20.9 microns, and the mean diameters were 0.51 and 0.27 micron, respectively. Both amosite and crocidolite fibers had high aspect ratios (94.2 and 115.4).
Attitudes about asbestos and lung cancer. R.W. Morgan. 1992;22(3):437-41. Meta-analysis PubMed · Publisher

Summary

This commentary responded to a 1991 paper by Enterline on changing attitudes and opinions about asbestos and cancer between 1934 and 1965. The author argued that many would disagree with Enterline about when a causal link between asbestos and lung cancer came to be accepted. He stated that early evidence consisted mostly of case reports, which he described as useful only for forming hypotheses. He also stated that applying Bradford Hill's criteria to the early evidence would not have supported accepting the relationship until well into the 1960s, and that medicine at the time was generally sceptical of epidemiologic evidence on non-infectious disease. He added that Enterline had not mentioned the relative weakness of the association. To support this, he presented a meta-analysis of asbestos-exposed occupational cohorts published from 1964 to 1990. It gave a meta-SMR for lung cancer of 165 (confidence limits 1.60 to 1.70), and seven cohorts had an SMR below 100. Mesotheliomas counted as lung cancers were subtracted where their number was published. The author said the meta-SMR was still exaggerated to an unknown degree. He also said that confounding by social class, heavier smoking and passive smoking was possible. He concluded that the roles of smoking, dose, fiber type and asbestosis remained poorly understood, that current risk estimates may be biased upward, and that asbestos alone might not cause lung cancer.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Blood superoxide dismutase and plasma malondialdehyde among workers exposed to asbestos. A.A. Kamal, M. el Khafif, S. Koraah, et al. 1992;21(3):353-61. PubMed · Publisher

Abstract

Blood superoxide dismutase (SOD) and plasma malondialdehyde (MDA) (an indicator of lipid peroxidation [LPO]) were determined in 97 randomly selected asbestos exposed workers (age range: 25-60 years, mean duration of exposures 19.8 +/- 8.3 years) and in 42 healthy male controls. MDA, SOD, and MDA/SOD ratio in asbestos exposed workers were significantly higher than in controls. Among both the controls and exposed workers neither age nor smoking was related to SOD or MDA levels. SOD was significantly positively correlated with MDA among the exposed workers. Such correlation was not observed among the controls. SOD but not MDA was significantly positively correlated with the duration of exposure to asbestos. Mean levels of SOD or MDA in exposed workers with radiographic signs of lung fibrosis or pleural thickening did not differ significantly from those without such signs. The results confirm the possible involvement of LPO and development of anti-oxidant mechanism(s) of prolonged exposure to asbestos in humans. However, SOD seems not to be the essential anti-asbestos-induced LPO. Relation between these factors and lung fibrosis is still unclear.
Chest radiographs in subjects with asbestos-related abnormalities: comparison between ILO categorizations and clinical reading. B. Hilt, A. Borgerson, J.T. Lien, et al. 1992;21(6):855-61. PubMed · Publisher

Abstract

The findings of a previous chest X-ray screening, determined without using standardized criteria, were reassessed by means of the ILO classification. Of 470 radiographs that had been determined as showing asbestos-related changes, 430 were categorized according to the ILO Classification. Small opacities with profusion greater than or equal to 1/0 were described in 39 (52%) of 75 participants who, on the original clinical reading, had been determined as having lung fibrosis, and in 45 (12.7%) of 355 who were determined as having pleural changes only. When considering circumscribed pleural thickening at the chest wall or diaphragm, as categorized by the ILO Classification, such changes were present in 401 (93.7%) of 428 subjects with pleural changes as determined on the clinical reading. In addition to the improved sensitivity and specificity achieved, the ILO Classification also allows comparison with other studies. The most apparent disadvantage of the ILO system is that it cannot firmly separate the various types of asbestos-related pleural changes. The study revealed that the previous asbestos exposure of the case subjects had occurred in many different workplaces and occupations.
Chrysotile asbestos, mesothelioma, and garage mechanics. O. Wong. 1992;21(3):449-55. Comment · Letter PubMed · Publisher

Summary

In this letter to the editor, the author responded to a 1991 letter by Woitowitz and Rodelsperger, who had reported mesothelioma patients at their clinic who had worked as garage mechanics and had concluded that mesothelioma incidence was increased among car mechanics exposed only to chrysotile. The author argued that their report was a case report, not a case-control study, because it had no controls and no estimate of relative risk. Of the 14 patients who had worked as garage mechanics, only three had no other occupational asbestos exposure. The author noted that mesothelioma has a background rate and that about 250,000 garage mechanics worked in Germany. The letter summarized four case-control studies. McDonald and McDonald found 11 cases and 12 controls among 480 matched pairs had been garage mechanics (approximate relative risk 0.9). Teta et al. (Connecticut, 1955-1977, 220 cases) reported a relative risk of 0.65 for automobile repair. Spirtas et al. (259 cases) reported 1.0 (95% CI 0.6-1.6) for brake lining work. Schiffman et al. (Louisiana) found no mechanics among 37 cases and two among controls. The author also cited chrysotile fiber type, transformation to non-fibrous forsterite at braking temperatures of 600-800°C, garage averages below 0.05 fibers/cc, and few fibers longer than 5 µm. The author concluded that garage mechanics are not at increased mesothelioma risk.

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Death certificates in epidemiological studies, including occupational hazards: inaccuracies in occupational categories. I.J. Selikoff. 1992;22(4):493-504. PubMed · Publisher

Abstract

We compared death certificates for asbestos-associated diseases (mesothelioma, lung cancer, asbestosis) in two asbestos workers' cohorts. One (insulation workers) had current or recent employment and a strong, continuing union support system which gave them much information about the effects of asbestos exposure. The second cohort, asbestos factory workers, had no such advantage. The factory had closed almost 30 years before, and its workers had dispersed into many areas of the state and nation. Accuracy of medical diagnosis was comparable in the two groups, but occupational listings were not. Three-quarters of the insulators' death certificates told of asbestos work, while virtually none of the factory workers' certificates provided such information, even for deaths of mesothelioma and asbestosis. The data indicate that disease categories, based on medical and pathological diagnoses, at least for asbestos-associated disease, tend to be accurate. Attempts to identify groups at risk by sorting occupational categories can give variable results, good for those with current exposures, much less satisfactory for those with long-past occupational exposures.
Electron microscopy analysis of mineral fibers in human lung tissue. K.H. Friedrichs, M. Brockmann, M. Fischer, et al. 1992;22(1):49-58. PubMed · Publisher

Abstract

In the present study, lung samples from 126 autopsied cases were examined to determine the content of mineral fibers using analytical transmission electron microscopy (ATEM). The cases were divided into four groups (22 lungs of persons exposed to ambient environmental pollution, 32 cases of mesothelioma, 38 cases of primary lung cancer, and 34 asbestosis cases, 13 of these with additional pleural plaques). Fibers were counted, measured, and mineralogically identified using a combination of X-ray microanalysis and electron diffraction of the non-oriented fiber. Concentration of fibrous particles (defined as particles above 1 micron in length with roughly parallel long sides and an aspect ratio of 5:1 and greater) was calculated as fibers 10(6)/g dry lung weight. The concentration of chrysotile was found to be similar throughout the groups except for two cases in the asbestosis group with comparably high numbers of chrysotile. However, a remarkable difference for amphiboles could be observed between the groups. Asbestos bodies were mostly found in the asbestosis group. There was a rather good correlation between numbers of amphibole fibers and asbestos bodies, with an average ratio of 10:1. For comparison purposes between occupationally exposed/non-exposed individuals, a transition was found in the concentration range of 3-10(7) asbestos fibers/g dried lung weight.
Environmental household exposures to asbestos and occurrence of pleural mesothelioma. D. Dodoli, M. Del Nevo, C. Fiumalbi, et al. 1992;21(5):681-7. PubMed · Publisher

Abstract

We reviewed the certificates of 39,650 deaths which occurred in the period 1975-1988 in Leghorn and of 45,900 in La Spezia (Italy) in the period 1958-1988. In total 262 cases have been recorded as pleural mesothelioma. The main occupational exposures occurred in the shipbuilding industry. Regarding non-occupational exposures to asbestos, 13 cases of mesothelioma were found in women who had washed the work clothes of their relatives at home; we also found other domestic uses of asbestos which were rarely or never discussed previously in the literature: six cases might be explained by the installation of fireproof or non-conductive materials in the domestic environment. These exposures probably are more frequent than realized until now.
Epidemiologic evidence of cancer in aluminum reduction plant workers. A. Rönneberg, F. Langmark. 1992;22(4):573-90. Review PubMed · Publisher

Abstract

This paper reviews the epidemiologic evidence of cancer risks among workers in aluminum reduction plants with emphasis on associations with specific work areas and exposures. Studies of workers manufacturing carbon products outside the aluminum industry were also reviewed since the work environment is similar to that encountered in the carbon area of aluminum plants. We obtained 22 reports from references cited in earlier reviews, through compact disc literature search 1980-1990, and from the Nordic Aluminum Industry's Secretariat for Health, Environment and Safety. Six reports were excluded because the material was included in later studies or because a critical evaluation was impossible. This left 16 publications from 11 separate studies. Work in potrooms with Söderberg electrolytic cells was associated with increased risk of bladder cancer, and the increase was correlated to duration of tar exposure. There was a suggestion of increased risk of leukemias and pancreatic cancers in potroom workers, and of kidney and brain cancers without any clear association with specific exposures or work areas. Singular results showed associations between lung cancer risk and tar exposure in Söderberg plants, and between lung cancer and work in prebake or carbon plants, but interpretation was limited by inadequate data on smoking and asbestos exposure, and by problems connected with the choice of reference populations in these studies.
Esophageal carcinoma with asbestos bodies. J.P. Parmar. 1992;21(4):605-8. Case report · Letter PubMed · Publisher

Summary

In this letter to the editor, a pathologist at Wheeling Hospital, West Virginia, described two men with esophageal carcinoma for whom occupational histories and abundant autopsy tissue, including sections of the esophagus and the tumor, were available. He examined routine hematoxylin and eosin-stained slides under light microscopy for asbestos bodies and fibers. The first patient, a 72-year-old man, had worked as an insulation worker for 32 years and had smoked one pack of cigarettes a day for 40 years. Autopsy showed an adenocarcinoma in the distal third of the esophagus that had spread through the muscle wall into regional lymph nodes. Four unequivocal asbestos bodies were found in the esophageal stroma, and the lungs showed severe asbestosis. The second patient, a 57-year-old man, had worked for 30 years as a pitman and teemer at a Pittsburgh steel plant, where he was stated to have used asbestos-containing materials. He was a 30 pack-year smoker with a long history of alcohol abuse. He had a poorly differentiated squamous cell carcinoma of the mid-esophagus and died within 18 months of diagnosis. One asbestos body and two long asbestos fibers were found in the stroma of the tumor, and the lungs showed mild to moderate asbestosis. The author stated that he believed asbestos bodies had not previously been demonstrated near esophageal cancers in asbestos workers. He recommended that pathologists look for them in gastroesophageal tumors and concluded that the findings confirm the epidemiological evidence linking asbestos to these tumors.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Fibrous minerals in the lungs of mesothelioma patients: comparison between data on SEM, TEM, and personal interview information. T. Tuomi. 1992;21(2):155-62. PubMed · Publisher

Abstract

To determine and compare the fiber types and size distributions in the lung tissue of mesothelioma patients in Finland, samples from 29 patients with known work history were analyzed with transmission electron microscopy (TEM) and X-ray microanalysis. Compared with the earlier results using scanning electron microscopy (SEM), the fiber concentrations were about three times as high and ranged from 0.1 million to 5,200 million fibers per gram of dry tissue. In 15 patients (52%), crocidolite/amosite were the dominating fiber types, representing more than 70% of all fibers. Anthophyllite asbestos was the most prevalent fiber type in eight patients (28%), and it was found in the samples of 13 patients (45%). One-half of the anthophyllite fibers were longer than 5 microns, whereas other fiber types were somewhat smaller.
Fifty-year experience in diagnosing asbestos-related cancers in Finland: progress and detours. M.S. Huuskonen, A. Tossavainen. 1992;22(2):259-61. Comment · Historical article PubMed · Publisher
Hospital records as a data source for occupational disease surveillance: a feasibility study. J. Balmes, D. Rempel, M. Alexander, et al. 1992;21(3):341-51. PubMed · Publisher

Abstract

To assess the feasibility of using hospital records for occupational disease surveillance and to evaluate the quality of the industry/occupation (I/O) information available in these records, the computer file of all discharge diagnoses from a large health maintenance organization during 1985 was reviewed. The frequencies of discharge diagnoses previously listed as Sentinel Health Events (Occupational), or SHE (O), were calculated and three possible SHE(O) diagnoses--lung cancer, bladder cancer, and toxic hepatitis--were selected for further review. Outpatient charts of patients discharged for each diagnosis were abstracted with regard to I/O information and the discharged patients were interviewed by telephone to obtain a lifetime occupational history. The accuracy of the I/O information obtained from the hospital chart was compared to that obtained by patient interview by number of digits matched on standard classification codes. The frequencies of matches for occupation and industry were greater for "usual" than for "last" categories with both cancer diagnoses, but were similar for "usual" and "last" categories with toxic hepatitis. To assess the proportion of each possible SHE(O) diagnosis that was related to workplace exposures, the I/O information obtained by interview was rated in a blinded fashion by an experienced occupational medicine physician. The highest probability ratings for work-relatedness were noted for lung cancer, primarily due to asbestos exposure. The results of this study suggest that hospital records can be used to identify possible SHE(O); if adequate I/O information is available, then work-relatedness can be assessed. However, the accuracy of I/O obtained from hospital charts is relatively low. The efficient and accurate collection of I/O information from hospital records will require the use of a simple, easily coded instrument to be routinely administered on admission.
How are we going to change our attitudes and opinions regarding asbestos and cancer in the next 20 years?. J. Bignon. 1992;22(3):443-6. PubMed · Publisher
In vitro activity of silicon carbide whiskers in comparison to other industrial fibers using four cell culture systems. N.F. Johnson, M.D. Hoover, D.G. Thomassen, et al. 1992;21(6):807-23. PubMed · Publisher

Abstract

Silicon carbide whiskers (SiCW) and continuous glass filaments are important components of composite materials having potentially widespread use in the automotive, aerospace, and power generation industries. We determined the in vitro activity of three well-characterized samples of silicon carbide whiskers and a continuous glass filament sample in four different cellular assays and compared this to the activities of UICC crocidolite, JM Code 100 glass microfiber, and erionite in the same assay systems. The SiCW had a diameter range of 0.32-0.75 microns and a length range of 4.5-20.1 microns. The SiCW was significantly toxic; on a mass basis, one SiCW sample was more toxic than crocidolite; however, JM Code 100 glass microfiber, which is not toxic in vivo (i.e., it does not cause fibrogenesis or carcinogenesis when inhaled), was also more toxic than crocidolite. The glass filament sample was the least cytotoxic of all the samples tested. On a fiber number basis, all three SiCW samples were more toxic than crocidolite. The results of our study showed that SiCW exhibits significant in vitro biological reactivity. Thus, despite the caution that must be exercised in extrpolating the results of in vitro studies to conclusions about in vivo health effects, SiCW should be considered toxic until further toxicological data are available.
Influence of age at death on accuracy of death certificate disease diagnosis: findings in 475 consecutive deaths of mesothelioma among asbestos insulation workers and asbestos factory workers. I.J. Selikoff. 1992;22(4):505-10. PubMed · Publisher

Abstract

Age at death had no appreciable influence on accuracy of death certificate diagnoses of 475 consecutive deaths of mesothelioma among asbestos insulation and asbestos factory workers, until age 75 or older.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.
Irregular opacities in the lung, occupational asthma, and airways dysfunction in aluminum workers. K.H. Kilburn, R.H. Warshaw. 1992;21(6):845-53. PubMed · Publisher

Abstract

We examined chest X-rays, measured expiratory flows and FVC by spirometry and TLC by projected lung area, ascertained respiratory data by questionnaires, and performed chest examinations in 670 Southeastern aluminum workers and 659 unexposed regional controls. Both groups were asbestos exposed. More aluminum workers had irregular opacities and fewer had pleural abnormalities than did regional pipefitter referents. The pulmonary function tests were expressed as percentage of predicted to adjust for height, age and duration of smoking based on a randomly selected U.S. reference population. Data from aluminum workers were compared to regional controls with students "t" tests run for unequal size groups. Aluminum workers had significant reductions in FEV1 of 3.2% predicted (p less than .003), FEF25-75 of 11.3% predicted (p less than .0001), FEF75-85 of 22.5% predicted (p less than .0001), and an increased TLC of 2.0% predicted (p less than .005). The 145 who had never smoked (NS) were compared with 124 NS controls and showed this same pattern of differences; but in smokers, the differences were significant for mid and terminal flows, but not for FEV1. In aluminum workers who never smoked, asthma prevalence by history was 7.6% vs. 4.0% in controls, and wheezes were heard in 21.4% vs. 2.4% in controls. In aluminum workers who were current smokers, asthma prevalence was 16.4% vs. 9.4% in controls, and wheezes were heard in 43.7% vs. 21.1% in controls. Aluminum workers had significantly more asthma, wheezing, airways obstruction, and pulmonary parenchymal abnormalities similar to asbestosis than did regional blue collar controls not melting and casting aluminum.
Localized pleural plaques and lung cancer. T. Partanen, M. Nurminen, A. Zitting, et al. 1992;22(2):185-92. PubMed · Publisher

Abstract

In a mass chest radiography survey conducted in 1971 for 7,986 residents of three Finnish communities, 604 subjects (7.6%) with pleural plaques but not other asbestos-related radiographic signs were identified. The same number of referents, each individually matched to each plaque carrier on sex, birth year, and community, was selected from among persons in the same source population with no pleural plaques. The two groups were followed for investigation of incidence of lung cancer during 1972-1989. Twenty-eight of those with plaques and 25 referents contracted lung cancer (crude conditional RR = 1.1; CL95 = 0.7, 1.9). The application of the proportional hazards model, with adjustment for sex, age, and residence, resulted in a hazard ratio of 1.1 (CL = 0.6, 1.8). The risk ratio estimate may be biased; hence, the result is inconclusive in regard to the predictive assessment of lung cancer risk among carriers of pleural plaques.
Lung function and exposure to asbestos among vehicle mechanics. M. Dahlqvist, R. Alexandersson, G. Hedenstierna. 1992;22(1):59-68. PubMed · Publisher

Abstract

Vehicle mechanics (n = 99) exposed to asbestos (annual median value 0.08 f/ml), and local controls (n = 83) not occupationally exposed to asbestos were studied with regard to symptoms and pulmonary function. The inclusion criteria to participate in this study was an age of at least 40 years with no known exposure to lung irritating agents, and for the exposed subjects, more than 15 years occupational exposure to asbestos with at least 20 years from the first exposure. The subjects were studied during identical conditions by means of dynamic and static spirometry, single breath wash-out with nitrogen (N2) and carbon monoxide (CO). The median for cumulative exposure of asbestos during the entire work life among the studied mechanics was 2.3 f*y/ml. The mechanics had reduced transfer factor (TLCO), after adjustment for age, height, and smoking category. A significant dose-response relationship was noted between the cumulative exposure of asbestos and CV%. The findings suggest a slight influence of small airways and alveoli. The evaluation of the prognostic significance of this requires a longitudinal study.
Malignant mesothelioma in the jewelry industry. D.G. Kern, K.T. Hanley, V.L. Roggli. 1992;21(3):409-16. Case report PubMed · Publisher

Abstract

We conducted a clinical, environmental, pathologic, and mineral lung burden investigation of a 61-year-old man with malignant mesothelioma. For 35 years, up until three weeks prior to pneumonectomy, the patient made asbestos soldering forms at a costume jewelry production facility. Only chrysotile asbestos was used at the plant during the last decade of the patient's employment, and recent environmental sampling of the work-place identified no other asbestos fiber type. Anticipating that the patient would add to the very small number of cases of mesothelioma attributable solely to chrysotile, we found instead that the patient's lung tissue contained large numbers of both coated and uncoated amosite asbestos fibers but, surprisingly, no chrysotile. We subsequently learned that a distributor of both chrysotile and amosite supplied the company during the first 25 years the patient was fabricating soldering forms. The findings underscore the futility of estimating environmental exposure to chrysotile on the basis of fiber counts in lung tissue. Although we previously described non-neoplastic asbestos-related disease among patients engaged in similar work, this case, to the best of our knowledge, represents the first report of mesothelioma in the commercial jewelry industry. As such, it prompted us to initiate a public health campaign to replace asbestos soldering forms in this industry with readily available, safer alternatives.
Malignant mesothelioma of the pleura in Trieste, Italy. L. Giarelli, C. Bianchi, G. Grandi. 1992;22(4):521-30. PubMed · Publisher

Abstract

One hundred and seventy malignant pleural mesotheliomas seen at necropsy at the Institute of Pathological Anatomy of the Trieste University during the period 1968-1987 were reviewed. The series included 153 men and 17 women, aged between 33 and 92 years (median 70 years). Lifetime work histories were obtained from the patients' relatives by personal or telephone interviews in 162 cases. A majority of the male subjects had been employed in "naval" work, 99 people having worked in the ship-building industry, 19 in the navy and merchant marine, and 7 in docks. A variety of trades appeared in the remaining histories. Work histories were indicative of occupational exposure to asbestos in 150 cases. A further 5 patients with negative or insufficient data showed asbestos bodies in routine lung sections and 5 women had a history of domestic exposure. A majority of the patients had had their first exposure before 1950. The intervals between first exposure and death ranged from 14 to 71 years (median 48 years).
Merchant Marine is not such a strange place for asbestos exposure. J.E. Myers. 1992;21(3):457. Comment · Letter PubMed · Publisher
Mesothelioma among workers in the Québec chrysotile mining and milling industry. J.S. Harington. 1992;22(6):925-6. Letter PubMed · Publisher
Occupational exposure to carcinogens in Finland. P. Heikkilä, T. Kauppinen. 1992;21(4):467-80. PubMed · Publisher

Abstract

Finland has kept a registry on the manufacture and use of carcinogenic agents involving occupational exposure since 1979. Employers must report annually to the labor safety authorities the employees who have been exposed to carcinogens and provide information on carcinogenic agents produced, used, or formed. Out of 131 substances or groups of agents listed as carcinogenic, occupational exposure to 78 of them was reported in 1987. About half of the agents reported were used or produced in industry and half were handled on a laboratory scale. About 15,000 employees from 1,700 work departments were reported to the registry; 17% of them were women. The number of workers reported in 1987 accounted for 0.6% of the total work force. It has been estimated that at least 60,000 workers are exposed annually to carcinogens in Finland. The three most prevalent exposures--hexavalent chromium compounds, nickel and its inorganic compounds, and asbestos--accounted for over 60% of all exposed workers; only five carcinogenic chemicals were produced in Finland in 1987.
Occupational exposures and cancer of the colon and rectum. M. Gerhardsson de Verdier, N. Plato, G. Steineck, et al. 1992;22(3):291-303. PubMed · Publisher

Abstract

The associations between occupational risks and colorectal cancer were examined in a Swedish population-based, case-referent study. The study was performed in Stockholm in 1986-1988 and included 569 cases and 512 referents. Relative risks (RRs) with 95% confidence intervals were calculated for different occupations/chemicals. Elevated risks of colon cancer were found among male petrol station/automobile repair workers (RR = 2.3, 0.8-6.6) and among males exposed to asbestos (RR = 1.8, 0.9-3.6), while elevated risks of rectal cancer were found among males exposed to soot (RR = 2.2, 1.1-4.3), asbestos (RR = 2.2, 1.0-4.7), cutting fluids/oils (RR = 2.1, 1.1-4.0), and combustion gases from coal/coke/wood (RR = 1.9, 1.0-3.7). However, due to a high correlation between the above-mentioned variables and the few exposed subjects, it is difficult to separate their effects properly. These analyses were adjusted for age. Further adjustments for diet, body mass, and physical activity had little or no influence on the results.
Parenchymal and pleural fibrosis in construction workers. P. Oksa, H. Koskinen, J.P. Rinne, et al. 1992;21(4):561-7. PubMed · Publisher

Abstract

Exposure to mineral dust was studied among construction workers (N = 437) with the aid of a questionnaire and a chest X-ray examination of the lungs. The results of the questionnaire showed that 81% of the construction workers had been exposed to asbestos. Exposure had occurred in all of the occupational groups studied. Pleural plaques and/or lung fibrosis (ILO greater than or equal to 1/1) were found in 26% of the examined workers; the prevalence varied from 18 to 40% among the various occupational groups. Comparison with a representative sample of the Finnish male population from another investigation indicates that the frequency of lung fibrosis (ILO greater than or equal to 1/1) is at least two times higher among the examined construction workers than among the general population. It seems likely that exposure to asbestos dust can be considered an etiological factor for an appreciable number of the X-ray findings.
Patterns of asbestosis in New Jersey. P.K. Henneberger, M.J. Stanbury. 1992;21(5):689-97. PubMed · Publisher

Abstract

Hospital discharge data from New Jersey were used to identify cases of asbestosis for the 8 years 1979-1986. Multiple admissions were deleted so that each individual was counted once at the time of his/her first hospitalization with an asbestosis diagnosis. White males had the highest age-adjusted average annual discharge rate of 19.3 cases/100,000 population, followed by black males (12.3 cases/100,000) and white females (1.2 cases/100,000). The discharge rate was positively associated with age in each race/sex category. The relationship between rates for black males and white males depended on age: under 65 years, the rates were almost equal, and at 65 years and older, the white rates were nearly twice the black rates. There were two areas of the state where the rates were highest: the north-central and southwest regions. These two areas represent manufacturing and shipbuilding applications of asbestos, respectively. During the years 1979-1986, the annual percentage increase in asbestosis rates was 20% for white males, 17% for black males, and 8% for white females. Continued surveillance will reveal when the rates for asbestosis stop increasing.
Pleural malignant mesothelioma in Tuscany, Italy (1970-1988): I. Anatomo-pathologic aspects. S. Dini, M. Santucci, M. Biancalani, et al. 1992;21(4):569-76. PubMed · Publisher

Abstract

Our investigation did not confirm the general experience that significant numbers of cases initially considered malignant mesothelioma or metastatic carcinoma are actually found to be metastatic carcinoma or malignant mesothelioma, respectively, upon deeper investigation using ancillary techniques (e.g., histochemistry, immunohistochemistry, electron microscopy). Well-trained pathologists, expert in thoraco-pulmonary pathology, have a high inter- and intra-rater agreement and significantly better results than standard hospital pathologists in correctly differentiating malignant mesothelioma from metastatic carcinoma. Therefore, epidemiologic investigations which exclude an accurate and rigorous reevaluation of the histologic slides have to be considered unreliable, unless the data come from a specialized medical center experienced in this type of pathology.
Pleural malignant mesothelioma in Tuscany, Italy (1970-1988): II. Identification of occupational exposure to asbestos. E. Chellini, G. Fornaciai, E. Merler, et al. 1992;21(4):577-85. PubMed · Publisher

Abstract

Following the finding of an unexpected cluster of mesotheliomas in textile workers, a surveillance system of malignant mesotheliomas was implemented in the region of Tuscany, Italy. This article reports on the investigation of 124 cases of mesothelioma diagnosed and reviewed by the Institutes of Morbid Anatomy and Histopathology at the Universities of Florence, Pisa, and Siena between 1970 and 1988. A complete occupational and asbestos exposure history was assessed through a semi-structured questionnaire directly administered to resident cases of Tuscany or, if deceased, to their closest living relatives, for a total of 100 interviews. The hypothesis of past occupational asbestos exposure was verified and documented. Seventy-two cases have been classified as occupationally exposed to asbestos; four were classified in the category of "possible domestic" exposure to asbestos. For two others, the role of other risk factors was stressed, and for 22 cases, either no asbestos exposure was found or the available data were not adequate to define it. The present study allowed identification of some unknown or scarcely known occupational asbestos exposures in the study area.
Possible cellular and molecular mechanisms for asbestos carcinogenicity. C. Walker, J. Everitt, J.C. Barrett. 1992;21(2):253-73. Review PubMed · Publisher

Abstract

Asbestos fibers may exert their carcinogenic effects on mesothelial cells and bronchial epithelial cells by direct and indirect mechanisms. Direct effects can occur following the physical interaction of fibers with target cells or by the generation of free radicals from the fiber surface; indirect effects, following the interaction of fibers with inflammatory cells can result in the production of cellular mediators such as cytokines and various reactive oxygen species. As a result, target cells may be induced to proliferate and/or sustain genetic alterations, which lead to tumor development.
Prevention delayed is prevention denied. S.M. Levin. 1992;22(3):435-6. Historical article PubMed · Publisher
Public health and epistemology. D.S. Egilman. 1992;22(3):457-9. PubMed · Publisher
Re: "Attitudes and opinions regarding asbestos and cancer 1934-1965". S. Langård. 1992;22(2):267-9. Comment PubMed · Publisher
Re: "Attitudes and opinions regarding asbestos and cancer 1934-1965". D.O. Hourihane. 1992;22(2):275-7. Comment PubMed · Publisher
Re: "Attitudes and opinions: asbestos and cancer". M. Greenberg. 1992;22(2):263-5. Comment PubMed · Publisher
Re: "Changing attitudes and opinions regarding asbestos and cancer 1934-1965". J. Keane. 1992;22(3):429-33. Historical article PubMed · Publisher
Re: "Changing attitudes and opinions regarding asbestos and cancer 1934-1965". J.E. Craighead. 1992;22(2):271-3. Comment PubMed · Publisher
Re: "Changing attitudes and opinions regarding asbestos and cancer 1934-1965". R. Ehrlich, J. Myers. 1992;22(2):279-80. Comment PubMed · Publisher
Re: "Changing attitudes and opinions: asbestos and cancer 1934-1965". G.W. Schepers. 1992;22(3):461-6. Historical article PubMed · Publisher
Re: "Changing opinions and attitudes regarding asbestos and cancer 1934-1965". G. Berry. 1992;22(3):447-8. Historical article PubMed · Publisher
Re: "Tiger's-eye pneumoconiosis". R.S. Du Toit. 1992;22(4):605-6. Comment · Letter PubMed · Publisher
Regulation of priority carcinogens and reproductive or developmental toxicants. K. Hooper, J. LaDou, J.S. Rosenbaum, et al. 1992;22(6):793-808. PubMed · Publisher

Abstract

In California, 370 carcinogens and 112 reproductive/developmental toxicants have been identified as a result of the State's Safe Drinking Water and Toxic Enforcement Act of 1986. They include pesticides, solvents, metals, industrial intermediates, environmental mixtures, and reactive agents. Occupational, environmental, and consumer product exposures that involve these agents are regulated under the Act. At levels of concern, businesses must provide warnings for and limit discharges of those chemicals. The lists of chemicals were compiled following systematic review of published data, including technical reports from the U.S. Public Health Service--National Toxicology Program (NTP), and evaluation of recommendations from authoritative bodies such as the International Agency for Research on Cancer (IARC) and the U.S. Environmental Protection Agency (USEPA). Given the large number of chemicals that are carcinogens or reproductive/developmental toxicants, regulatory concerns should focus on those that have high potential for human exposure, e.g., widely distributed or easily absorbed solvents, metals, environmental mixtures, or reactive agents. In this paper, we present a list of 33 potential priority carcinogens and reproductive/developmental toxicants, including alcoholic beverages, asbestos, benzene, chlorinated solvents, formaldehyde, glycol ethers, lead, tobacco smoke, and toluene.
Some lessons learned from using participatory methods in asbestos worker training. J. Cromley. 1992;22(5):781-4. PubMed · Publisher

Abstract

A nonprofit worker training center changed its teaching methods in response to teacher feelings of burnout, student expressions of boredom, and the requests of new staff members. The paper presents one problem-solving case study that was developed. The author discusses some obstacles to using the case study, and her experiences in overcoming those obstacles.
T-cell alveolitis in lung lavage of asbestos-exposed subjects. N.L. Sprince, L.C. Oliver, T.C. McLoud, et al. 1992;21(3):311-9. PubMed · Publisher

Abstract

In sarcoidosis and idiopathic pulmonary fibrosis, it has been reported that lymphocyte proportions in lung lavage predict the subsequent clinical course. Recent evidence has suggested that lymphocytes are important in the alveolitis of asbestosis. We hypothesized that a greater relative proportion of T-lymphocytes in lung lavage of asbestos-exposed subjects is associated with immune activation and may predict the subsequent clinical course. We assessed lymphocyte subsets in lung lavage and peripheral blood (PB) of 97 asbestos-exposed subjects and 10 unexposed normal, using flow cytometry analysis of monoclonal antibody-treated cells. T-cell alveolitis was defined as follows: [%lymphocytes in lavage x %CD3 in lavage] greater than 2 SD above that product in normals. Eighteen subjects had T-cell alveolitis (group 1) and 79 did not (group 2). There were no significant differences between the groups in age, smoking status, duration of exposure, lung function results, or frequency of plaques or profusion greater than or equal to 1/0. Percent CD2 was higher in lavage of group 1 compared with group 2. There was a trend for higher %Ia in lavage of group 1 compared with group 2. These results identify a subgroup of asbestos-exposed subjects with T-cell alveolitis but no present excess of asbestos-related disease who may be at risk for future asbestos-related disease.
The role of threshold limit values in U.S. air pollution policy. J.C. Robinson, D.G. Paxman. 1992;21(3):383-96. PubMed · Publisher

Abstract

This paper analyzes the role of threshold limit values (TLVs) in national air pollution policy during the 1980s, a period in which the Environmental Protection Agency (EPA) sought to delegate to individual states the authority to evaluate and regulate airborne toxic substances. We focus on 20 carcinogens and 11 substances with non-genotoxic health effects that were regulated by local air toxics programs using TLVs. Data from EPA's National Air Toxics Information Clearinghouse indicate that maximum TLV-based Ambient Air Level guidelines (AALs) frequently exceed minimum TLV-based AALs by a factor of greater than 1,000. Cancer potency data from EPA's Integrated Risk Information System suggest significant risks remain at TLV-based AALs. Cancer risks at the median TLV-based AAL exceed 1,000 cases per million exposed persons for cadmium (1,040), nickel and its compounds (1,420), propylene oxide (1,550), coke oven emissions (1,860), benzene (2,500), arsenic and its compounds (7,300), N-nitrosodimethylamine (21,000), asbestos (21,500), and ethylene dibromide (55,000). We also summarize published studies that report non-genotoxic health effects in workers exposed at levels near the TLV for 11 substances whose AALs were based on TLVs. Contrary to the assumption frequently made by state air toxics program, TLVs cannot be taken to represent no observed effect levels (NOELs) for regulatory purposes.
TLVs for asbestos. W.A. Cook. 1992;21(5):765-6. Letter PubMed · Publisher

Summary

In this letter, an industrial hygienist responded to expert testimony in disability claims alleging employer negligence for asbestos exposure. He stated that this testimony had applied the threshold limit value (TLV) erroneously as a basis for negligence. From 1946 to 1970, the American Conference of Governmental Industrial Hygienists (ACGIH) set an average TLV of 5 million particles of asbestos per cubic foot of air. The author noted that this standard was based principally on a study by Dreessen and others of dust conditions in six asbestos textile plants that used essentially all-asbestos material. The U.S. Public Health Service published that study in 1938 as Public Health Bulletin No. 241. Air sampling in that period used the impinger technique, which collected all particulates. Products such as pipe insulation were often 15% asbestos and 85% other mineral content. For such material, the author stated that 15% of the total particulate count was properly taken as the asbestos concentration, and that a result below 5 million asbestos particles per cubic foot established compliance. He acknowledged that the concentration of fibers longer than 5 microns is a more accurate measure of hazard, and that acceptable fiber concentrations had become progressively lower. He concluded that the standard in force while claimants were exposed should be the controlling factor, and that the concentration of asbestos itself, not of total particulates, is the proper criterion.

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Use of death certificates in epidemiological studies, including occupational hazards: variations in discordance of different asbestos-associated diseases on best evidence ascertainment. I.J. Selikoff, H. Seidman. 1992;22(4):481-92. PubMed · Publisher

Abstract

There is extensive information on discordance in general between accuracy of medical diagnoses on death certificate categorization of cause of death and available clinical and histopathological data. This is as true for occupational disease as for other conditions. But occupational illnesses bear a special problem. Discordance is not equal across the board--it may vary with each occupationally related disease, and no single formula can be applied. It may be high for angiosarcoma and low for acute hydrogen sulfide poisoning, low for bladder cancer, high for unsuspected methyl mercury poisoning. We have found that for one agent--asbestos--there were different rates of discordance for different asbestos-related diseases (e.g., lung cancer, mesothelioma, asbestosis, kidney cancer) among 4,951 deaths studied prospectively from 1967 to 1986. Caution is therefore required before accepting generalizations concerning (unstudied) discordance in occupational mortality studies, and in their use in risk assessment models.
Was the literature "corrupted"?. P.C. Pratt. 1992;22(4):609-13. Comment · Historical article · Letter PubMed · Publisher
Work-related mesothelioma in Québec, 1967-1990. R. Bégin, J.J. Gauthier, M. Desmeules, et al. 1992;22(4):531-42. PubMed · Publisher

Abstract

Prior surveys of malignant mesothelioma in Québec have noted that almost all the excess in occupational exposure related mesothelioma was in the manufacture and industrial application of asbestos rather than in the mining and milling operations. To evaluate the current status of malignant pleural mesothelioma in the Québec workforce, we reviewed all cases of pleural mesothelioma seen and accepted by the Québec Workman's Compensation Board (CSST) for work related compensation of industrial disease. We identified 120 cases, 7 of whom were females. They were of an average age of 59 +/- 8.5 yrs (sd) (range 42-84); they were exposed to asbestos dust in the workplace for an average of 26 +/- 14.3 yrs (range 0.5-50). The cases were subdivided into 3 groups according to workplace asbestos exposures. There were 49 cases originating in the mines and mills of the Québec Eastern Township region (primary industry, group 1), 50 cases from the manufacture and industrial application sector (secondary industry, group 2), and 21 cases from industries where asbestos was not a major work material, often an "incidental" material (tertiary industry, group 3). Group 1 was of an average age of 62 +/- 8 years, exposed to asbestos dust 31 +/- 14 years and the distribution of exposure time was as follows: 15% cases with < or = 10 year-exposure and 77% > or = 25 year-exposure. In group 2, the age was significantly lower at 57 +/- 9 years; the exposure time was also significantly lower at 22 +/- 14 years, and the distribution of exposure time differed from the above (29% cases with < or = 10 year-exposure and 48% > or = 25 year-exposure). In group 3, the average age was 58 +/- 7 years, the exposure time was also significantly lower at 28 +/- 12 years and the distribution of exposure time differed from the above (33% cases with < or = 10 year-exposure and 62% > or = 25 year-exposure). Analyses of the yearly incidence of new cases in each group documented the general incremental trend in all groups, with the sharpest rises in group 3. In the mining towns of Thetford and Asbestos, the incidence of mesothelioma was proportional to the workforce, thus suggesting that the tremolite air contamination, which is 7.5 x higher in Thetford, may not be a significant determinant of the disease in these workers.(ABSTRACT TRUNCATED AT 400 WORDS)
A history of awareness of asbestos disease and the control of occupational asbestos exposures in The Netherlands. L. Burdorf, P.H. Swuste, D. Heederik. 1991;20(4):547-55. Historical article PubMed · Publisher

Summary

This historical article traced how awareness of asbestos-related disease developed in the Netherlands, how it was reflected in occupational disease registration, and how it shaped Dutch regulation of occupational asbestos exposure. The authors compared the first suggestion and first case description of each disease in the international and Dutch literature, and reviewed national registers and legislation. Asbestosis was first mentioned in Dutch literature in 1930, and the Labour Inspectorate described the first Dutch case in 1931. The first Dutch case of asbestos-associated lung cancer was reported in 1956, and mesothelioma was linked to asbestos in 1958. Consensus on mesothelioma followed the 1968 Dresden conference and a 1969 study in which 22 of 25 mesothelioma patients on Walcheren had worked at the same shipyard. Of 324 asbestosis cases registered in 1931-1988, 79% came from Labour Inspectorate investigations. Only 17 mesotheliomas were reported to the Occupational Disease Register between 1965 and 1988, which the authors judged a gross underestimate compared with death certificate data. Regulation progressed from a non-enforced 1971 guidance note, to 1978 regulations banning crocidolite and asbestos spraying with a 2 fibers/ml standard, to 1988 regulations and a proposed total ban from 1991. The authors concluded that the national register played no role in the debate, that mesothelioma was recognized rapidly owing to the academic interest of Dutch pathologists and clinicians, and that public opinion helped bring about the 1978 regulations.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
ACGIH TLVs: a critical analysis of the documentation. P.A. Breysse. 1991;20(3):423-30. Comment · Letter PubMed · Publisher
Alcohol, smoking, and occupational factors in cancer of the larynx: a case-control study. W. Ahrens, K.H. Jöckel, W. Patzak, et al. 1991;20(4):477-93. PubMed · Publisher

Abstract

A hospital-based case-control study of laryngeal cancer was conducted in Bremen in 1986 and 1987 with 100 prevalent male laryngeal cancer patients and 100 male hospital controls with diseases not considered to be related to smoking, alcohol, or occupational exposures, who were frequency matched by age. The odds ratio for heavy smoking (more than 30 pack-years) reached a value of 3.5 (95% confidence limits (CL) 1.1, 7.9). Ex-smokers showed a significant decrease in risk; this reached the level of those who had never smoked about 15 years after smoking cessation. For daily consumers of alcohol an odds ratio of 3.2 (95% CL 1.4, 7.5) was observed. Among the 17 occupations in which at least ten subjects had worked, excess risks were observed for stock keeping and transportation workers, and for leather and textile workers. The odds ratio was significantly increased for the latter (p less than 0.05). Among all those persons ever employed in a priori defined-risk occupations, an odds ratio of 2.74 (95% CL 1.23, 6.06) was observed. Considering responses to an exposure check-list, no increased risks could be shown for exposure to asbestos, coal tar, or welding fumes. On the other hand, excess risks were observed for exposures to diesel oil, gasoline, and mineral oil, controlling for smoking and alcohol. The findings in occupational and exposure subgroups were based on small numbers of cases and controls and, consequently, were subject to large sampling errors. Many of the results are consistent, however, with occupational risk factors reported from other studies.
Asbestos in strange places: two case reports of mesothelioma among merchant seamen. G. Varouchakis, E.G. Velonakis, S. Amfilochiou, et al. 1991;19(5):673-6. Case report PubMed · Publisher

Summary

The authors described two cases of malignant pleural mesothelioma in Greek merchant seamen. Both came from a mesothelioma registry in Greece and were seen at Sismanoglio General Hospital, Athens. The first was a 71-year-old man admitted in September 1989 with a month-long history of right pleuritic chest pain and breathlessness on exertion. He had a 41 pack-year smoking history and had quit 9 years earlier. Fluid drained from the chest was a bloody exudate, and a CT scan showed a large pleural mass in the right chest. Needle biopsy showed epithelial-type malignant mesothelioma. He had worked for 35 years as an engineer in the merchant marine, had retired 10 years earlier, and denied ever working in a shipyard. He was undergoing chemotherapy. The second was a 65-year-old man seen in July 1983 with severe acute pain and breathlessness. He had a 20 pack-year smoking history. Chest X-ray showed a left hydropneumothorax. At surgery a tumor was found affecting the parietal pleura and extending into the chest wall with rib destruction. Pathology showed mixed-type mesothelioma. He died a month later, and necropsy showed liver metastasis and spread to the mediastinal lymph nodes. He had worked for 25 years as a deck-department sailor and later as a restaurant waiter. He had never worked in ship engine departments or shipyards. The authors noted that asbestos had been used extensively in ship insulation. They considered the deck-department case of special interest for the risk from low-level exposure, and stated that secondary or bystander exposure may be a serious health hazard.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Asbestos-related disease in public school custodians. L.C. Oliver, N.L. Sprince, R. Greene. 1991;19(3):303-16. PubMed · Publisher

Abstract

A cross-sectional prevalence study of 120 public school custodians was carried out. The purposes were 1) to investigate the prevalence of asbestos-related disease in a group of custodians at risk for asbestos exposure in public schools and 2) to determine the proportion with disease attributable to exposures in school buildings. Medical and occupational histories, flow-volume loops, and posterior-anterior, lateral, and anterior oblique (AO) chest radiographs were obtained. Single breath DLCO was measured and chest auscultation performed. Mean age of subjects was 57 years and mean duration of work as a custodian, 27 years. Fifty-seven (47.5%) had no known or likely exposure to asbestos outside of their work as a school custodian (NOE). Pleural plaques (PP) occurred in 40 (33%) of the total group and 12 (21%) of the group with NOE. Pulmonary restriction (FVC less than 80% predicted, FEV1/FVC% greater than or equal to 70) occurred in 22 (18%) of the total group and 10 (17%) of those with NOE. DLCO was lower in the group with restriction. Multivariate analysis revealed significant associations (p less than 0.05) between both PP and restriction and duration of asbestos exposure. AO radiographs increased PP detection by a factor of 1.9. Our results reveal PP prevalence in excess of background and pulmonary restriction in the study population, and indicate that PP are attributable to asbestos in schools. Findings with regard to pulmonary restriction need further investigation. Prudent management of asbestos in buildings is indicated for the prevention of related disease.
Cancer incidence among asbestos-exposed chemical industry workers: an extended observation period. B. Hilt, A. Andersen, J. Rosenberg, et al. 1991;20(2):261-4. PubMed · Publisher

Abstract

A previous study on the incidence of cancer in a cohort of 286 asbestos-exposed electrochemical industry workers observed from 1953 through 1980 has been extended with another 8 years of follow-up. The incidence of cancer was derived from the Cancer Registry of Norway, and the expected figures were calculated by a life table method. During the extended follow-up period from 1981 through 1988, among the cohort members there were 12 new cancer cases versus 14.2 expected (SIR 85, 95% CI 44-158). In a lightly exposed sub-cohort, the extended follow-up revealed 4 cases of lung cancer or pleural mesothelioma (ICD, 7th revision 162-163) versus 1.6 cases expected (SIR 256, 95% CI71-654). In a heavily exposed sub-cohort, the corresponding figures were 3 and 0.5 (SIR 588, 95% CI 118-1,725).
Carcinoma of the colon in asbestos-exposed workers: analysis of asbestos content in colon tissue. A. Ehrlich, R.E. Gordon, S.H. Dikman. 1991;19(5):629-36. PubMed · Publisher

Abstract

Epidemiological studies have indicated an increased incidence of carcinoma of the colon in asbestos workers. The present study evaluated the colon tissue asbestos burden, by light and electron microscopic analytic techniques, in patients with a history of occupational asbestos exposure and colon cancer. Asbestos fibers and/or asbestos bodies were present in colon tissue from 14 of 44 (31.8%) asbestos workers with colon carcinoma (range 142,199 to 15,231, 543 fibers/g/wet weight, mean 2,517,823). Chrysotile was identified in 9 patients and amosite in 3 patients. Both amosite and chrysotile were found in the colonic wall in one individual. Other forms of asbestos (e.g., crocidolite, tremolite, or anthophyllite) were not found. Asbestos fibers and asbestos bodies were not found in colon tissue from 20 control patients (colon carcinoma and no asbestos exposure). Asbestos fibers frequently enter and reside in the wall of the colon and are often intimately associated with tumor tissue at the site of colon carcinoma in workers with asbestos exposure and colon carcinoma.
Changing attitudes and opinions regarding asbestos and cancer 1934-1965. P.E. Enterline. 1991;20(5):685-700. Historical article PubMed · Publisher

Abstract

Literature published in the years 1934-1965 was reviewed to determine attitudes and opinions of scientists as to whether asbestos is a cause of cancer. In Germany, the issue was decided in 1943 when the government decreed that lung cancer, when associated with asbestosis (of any degree), was an occupational disease. In the United States, however, there was no consensus on the issue until 1964. Opinions of scientists over a 22 year period are shown and the contributions of various cultural, social, economic and political factors to these opinions are discussed. A lack of experimental and epidemiological evidence played a major role in delaying a consensus. Other important factors included a rejection of science conducted outside of the U.S. during this period, particularly a rejection of German scientific thought during and after WWII, and a rejection of clinical evidence in favor of epidemiological investigations. Individual writers rarely changed their minds on the subject of asbestos as a cause of cancer.
Chrysotile asbestos and health in Zimbabwe: I. Analysis of miners and millers compensated for asbestos-related diseases since independence (1980). M.R. Cullen, R.S. Baloyi. 1991;19(2):161-9. PubMed · Publisher

Abstract

Data on the health effects caused by locally mined chrysotile asbestos in Zimbabwe have been very limited. The prevailing local view has been that risk is minimal. In this report we critically reassess the cases of 51 individuals with asbestos exposure who have been compensated by the Central Pneumoconiosis Bureau since independence in 1980. Results demonstrate that the major health risks of exposure reported elsewhere--morbid asbestosis, nonmalignant pleural disease, malignant mesothelioma, and lung cancer--all occur in Zimbabwe, at least among workers in the asbestos mines and mills. It is concluded that further investigation and control measures in the industry are warranted.
Chrysotile asbestos and health in Zimbabwe: II. Health status survey of active miners and millers. M.R. Cullen, L. Lopez-Carrillo, B. Alli, et al. 1991;19(2):171-82. PubMed · Publisher

Abstract

As part of the effort to establish industrial practice and public policy regarding asbestos in Zimbabwe, we have conducted a cross-sectional study of the chrysotile mines and mills. A stratified random sample of workers with greater than 10 years of exposure has been evaluated by spirometry, chest radiographs, and employment history. The latter was converted to quantitative estimates of exposure dose, using a matrix based on measured and reconstructed fiber levels for each job and facility during the years of work. Based on these data, a clear dose-response between asbestos exposure and functional loss has been demonstrated, with mean losses from predicted of about 400-600 cc in vital capacity in the 10% of the population with heaviest exposures. Low-grade parenchymal radiographic abnormalities (ILO grade greater than or equal to 1/0) were evident in 8.7% of the total study group and were almost 10 times more common in those with more than 100 fibers/cc.years cumulative exposure than in those with 16 fibers/cc.years or less. Pleural disease was relatively rare, occurring in just under 10% of the study group, and was unrelated to exposure dose. Overall, these findings are compatible with results of similar studies in Quebec and Swaziland and suggest that similar control strategies are probably indicated.
Chrysotile asbestos and mesothelioma. H.J. Woitowitz, K. Rödelsperger. 1991;19(4):551-3. Comment · Letter PubMed · Publisher

Summary

In this letter, the authors responded to published discussion, begun by Dunnigan's 1988 proposal, of whether chrysotile asbestos has only a very limited potential to cause mesothelioma. They drew on their own work in Giessen, Federal Republic of Germany: workplace asbestos measurements, analysis of lung fiber burden, and clinical study of occupational cancer. They reported a marked disparity between extensive workplace chrysotile exposure and the lack of increased chrysotile fibers in patients' lung dust. They did not exclude a long-term cancer effect, possibly a "hit-and-run" phenomenon. They argued that experience from mining and milling could not be transferred to other workplaces, citing German car mechanics. In their clinic and in the files of Professor Otto, they found 10 brake mechanics who developed mesothelioma between 1980 and 1985. Their earlier studies, with 90 measurements in 76 garages and 210 mechanics, showed low exposure that was exclusively chrysotile. Other German data found chrysotile in 611 of 615 respirable dust samples in the friction lining industry, and only chrysotile in 338 garage measurements. In a multicenter case-control study begun in 1988, 14 of 175 mesothelioma patients in Hamburg and Munich hospitals were car mechanics. In at least three of them, car mechanic work was the only known asbestos exposure. The authors concluded that mesothelioma incidence was increased among car mechanics exposed only to chrysotile, with a mean dose below 1 fiber/ml × years.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Corruption of occupational medical literature: the asbestos example. H. Hardy, D. Egilman. 1991;20(1):127-9. Letter PubMed · Publisher
Demonstration of asbestos fibers in a ten-year-old sputum sample. D.S. Heller, R.E. Gordon. 1991;20(3):415-9. Case report · Letter PubMed · Publisher
Difficulties of attribution of effect in workers exposed to fiberglass and asbestos. K.H. Kilburn, R.H. Warshaw. 1991;20(6):745-51. PubMed · Publisher

Abstract

Man-made mineral fibers have many properties of asbestos that raise concern about their safety. We studied 175 fiberglass production workers, using chest radiographs, measurement of total lung capacity, chest examinations, and occupational and medical histories. Pulmonary volumes and flows were calculated as percent of predicted, adjusted for height, age, ethnicity, and cigarette smoking. Thirty-one men with radiographically evident small irregular opacities of profusion of 1/0 or greater and/or pleural abnormalities were observed. Eight of 38 men with such changes said they had been exposed only to fiberglass; the other 23 with radiologically detectable pleural and/or pulmonary changes were among the 137 whose histories indicated that they had been exposed to asbestos and to fiberglass. Pulmonary function measurements as group means were reduced in the 175: FVC was 94.8% predicted, FEV1 was 91.3% predicted, FEF25-75 was 80.7% predicted, FEF75-85 was 73.1% predicted and FEV1/FVC was 0.73. Total lung capacity (TLC) was elevated to 114.2% predicted (mean) and RV/TLC (mean 0.46) was also elevated. Although only 78% of fiberglass production workers gave histories of asbestos exposure, all had shared the air in a manufacturing plant where ovens insulated with asbestos were continuously cleaned, repaired, dismantled, and rebuilt. It appears that attribution of the effects of their exposure to fiberglass could not be estimated independently of the effects of asbestos exposure.
Evaluation of selection bias in a cross-sectional survey. I.J. Selikoff, H. Seidman. 1991;20(5):615-27. PubMed · Publisher

Abstract

Selection bias is inherent in all occupational cohorts. Selection bias at entry has long been known and is commonly referred to as a "healthy worker effect." Less well appreciated is selection during the life of a cohort resulting from life-style factors (e.g., cigarette smoking); aging with accompanying chronic diseases, economic and demographic circumstances; and diseases that might result from exposures suffered by the cohort being studied, that influence whether individuals remain in a trade. These factors weigh differently at different times. Thus, at any point in time, "surviving" members of a cohort reflect an amalgam of selection factors. When such groups are studied in cross-sectional surveys there can be uncertainty whether clinical, radiological and physiological findings are necessarily representative for the trade or occupation as a whole. We analyzed the results of a large clinical field survey of long-term asbestos insulation workers to investigate whether the non-participants differed substantially from those who were examined. Five thousand three hundred and fifty-five (5,355) men, of an initial cohort of 17,800 established January 1, 1967, had reached 30 or more years from onset of their work by July 1, 1981. All were invited to come for examination. Two thousand and seventy-seven (2,077) came, and 3,278 did not. We questioned a sample of 1,393 non-responders to see why they failed to appear. The answers did not give evidence of significant health-related selection influence. Sickness only infrequently kept them away. We then followed both groups--those examined and those not examined--to the end of 1987 for their mortality experience. There was no great difference. The non-responders had somewhat fewer deaths overall and proportionately fewer of asbestos-associated cancers, such as mesothelioma and lung cancer. The results indicated that, in this cohort, there did not seem to be health-related selection bias that determined whether or not cohort members responded to invitations for examinations.
Fissural thickening and exposure to asbestos: occurrence, determinants, and functional impact. J. Zejda, P. Ernst. 1991;20(6):785-93. PubMed · Publisher

Abstract

The occurrence and determinants of thickened interlobar fissures were assessed in 147 insulators, in order to test the hypothesis that radiographic abnormalities in minor (FMN) and/or major (FMJ) interlobar fissures are associated with restrictive respiratory impairment, which may reflect early parenchymal lung fibrosis. According to the diagnostic criteria developed, definite interlobar thickening was found in 33 (FMN) and in 73 (FMJ) men, and was frequently associated with the presence of classical asbestos pleural disease, though not parenchymal abnormality. Multivariate analyses did not demonstrate any association between either FMN or FMJ and lung function. Such an association, however, was found in the case of the usual asbestos-related pleural change. These findings suggest that fissural thickening seen on chest radiography represents a component of asbestos pleural disease and not asbestosis.
Inflammation of the visceral pleura, a nonspecific asbestos-related pleural reaction: chest radiograph and computed tomograph correlation. A. Solomon, A.H. Rubin, J. Bar-Ziv, et al. 1991;20(1):49-55. PubMed · Publisher

Abstract

Nonspecific pleuritis, i.e., inflammation of the visceral pleura, is recognized by the presence of pleural strands on the routine posteroanterior chest radiograph. The computed tomograph counterparts of these strands are seen as interlobular septal intrusions and lenticular or wedge-shaped subpleural opacities. The pleural reaction is nonspecific and may be found with asbestos exposure, traumatic hemorrhagic effusions, pulmonary embolism, viral pleurisy, malignant pleural effusions, and lupus or rheumatoid effusions. The asbestos-related pleural changes may be found alone or in association with parietal pleural plaque formation or with asbestotic lung fibrosis.
Lung function and chest radiograph abnormalities among construction insulators. S.M. Kennedy, S. Vedal, N. Müller, et al. 1991;20(5):673-84. PubMed · Publisher

Abstract

We carried out a prevalence survey of pulmonary health parameters among current and retired construction insulators (50 years old and older) from all areas of British Columbia, Canada. The study population included 59 active workers (81 percent participation in this group) and 29 workers who were retired or inactive due to illness (69% participation). Radiograph results were compared to those from actively working bus mechanics from the same age group, and retired grain and civic workers, who were all tested in the same manner. Chest radiographs were read independently by two readers and were graded according to the ILO classification system. Pleural abnormalities alone were found in 34% (20) of active workers (5% in comparison group) and 45% (13) of non-active workers (14% in comparison group). Rates for parenchymal abnormalities for these same groups (ILO grade 1/0 or higher) were 17% (5%) and 20% (5%), respectively. Airflow obstruction was present in 35% (31) of the insulators and was associated with age and the presence of diffuse pleural thickening, and 5 or more years of employment in pulp mills. Restrictive lung function was present in 22% (19) of the insulator population and was associated with age and radiographic evidence of parenchymal fibrosis. The results indicate that construction insulators, a group at high risk for asbestos-related lung disease, also have a high prevalence of airflow obstruction. This was associated not only with smoking, but also with diffuse pleural thickening and a history of pulp-mill employment, suggesting that airflow obstruction in this population is also partly work related.
Medical screening for occupational disease risk is not a control measure. S.M. Kennedy. 1991;20(2):271-2. Comment · Letter PubMed · Publisher
Mesothelioma in the London area. M.L. Newhouse. 1991;20(3):411-3. Historical article PubMed · Publisher
Occult asbestos exposure. M. Huncharek. 1991;20(5):713-4. Case report · Comment · Letter PubMed · Publisher
Occupational asbestos exposure and mesothelioma risk in Los Angeles County: application of an occupational hazard survey job-exposure matrix. C. Cicioni, S.J. London, D.H. Garabrant, et al. 1991;20(3):371-9. PubMed · Publisher

Abstract

We evaluated the newly available National Institute for Occupational Safety and Health (NIOSH) National Occupational Hazard Survey (NOHS) job exposure matrix (JEM) by considering mesothelioma risk from asbestos exposure. We applied this system (NOHS-JEM) to the Los Angeles County Cancer Surveillance Program (CSP) to see how many cancer cases could be assigned asbestos exposure and how asbestos exposure affected mesothelioma risk. Using the same CSP data, our "experts" classified asbestos exposure simply by occupation and industry. Both exposure classifications were divided into low and high; the NOHS-JEM by the number of exposed people per couplet, and ours by judgements of intensity. Odds ratios (OR) for mesothelioma risk for low and high asbestos exposure for the NOHS-JEM were 2.0 (95% C.I. 1.2-3.4) and 2.5 (95% C.I. 1.2-4.8). For ours, corresponding risks were 1.6 (95% C.I. 1.1-2.4) and 6.3 (95% C.I. 2.5-15.1). Our system was able to assign more cases to couplets then the NOHS-JEM (35,895 to 22,369). Three limitations of the NOHS-JEM were that many occupation-industry couplets were not classified at all, many couplets associated with past asbestos exposure (before the 1972-1974 NOHS survey) were not classified as asbestos exposure, and no assessment of intensity was made. These limitations may apply to other exposures and should be carefully considered before the NOHS-JEM is applied to other case-control studies.
Pleural lesions and the ILO classification: the need for a revision. G. Hillerdal. 1991;19(1):125-30. PubMed · Publisher

Abstract

The ILO system for radiographic classification of pneumoconioses is a very important epidemiological tool. Unfortunately, the classification is not precise for pleural lesions, which are especially important for evaluation of asbestos-related diseases. The classification cannot separate extrapleural fat from diffuse thickening of the pleura, nor large plaques from diffuse thickening. In this paper, a short review of the different lesions are given and a revised scheme is suggested. This scheme includes as separate lesions: pleural fat; lesions of the parietal pleura, i.e., pleural plaques; and lesions of the visceral pleura, i.e., diffuse thickening and rounded atelectasis. The extent and width, as in the present ILO scheme, could be abolished.
Pulmonary function and pleural fibrosis: quantitative relationships with an integrative index of pleural abnormalities. R. Lilis, A. Miller, J. Godbold, et al. 1991;20(2):145-61. PubMed · Publisher

Abstract

Pleural fibrosis due to asbestos exposure was fully appreciated considerably later than pulmonary interstitial fibrosis due to similar exposure. This is well exemplified by the fact that pleura face on was included in the International Labour Office's International Classification of Radiographs of Pneumoconioses only in the last revision of the Classification. The functional relevance of pleural fibrosis, in particular circumscribed pleural fibrosis, has remained controversial. Since pleural fibrosis can occur at various sites (diaphragmatic plaques, chest wall in profile and face on, mediastinal) and can be of different thickness and extent, a comprehensive integrative assessment of pleural fibrosis was undertaken in order to permit a quantitative study of relationships between pleural fibrosis and pulmonary function. This approach was used for chest X-ray films of 1,584 asbestos insulation workers examined (1981-1983); 1,185 (75%) had pleural fibrosis. The distribution pattern of the integrative pleural index was found to be different in the subgroup with circumscribed (n = 975) from that with diffuse (n = 197) pleural fibrosis, with a higher profusion of high INDEX values in the latter. Stepwise regression analysis indicated that there was a significant inverse relationship between forced vital capacity (FVC) and the integrative index of pleural fibrosis in the subgroup with circumscribed pleural fibrosis. In the subgroup with diffuse pleural fibrosis, the obliteration of costophrenic angle(s), even with pleural fibrosis of limited extent, resulted in marked decrement in FVC% predicted; higher values of INDEX did not result in additional significant reductions of FVC. In those with both parenchymal and pleural abnormalities (n = 862) the pleural index was found to make a significant contribution, independent of that of parenchymal abnormalities, to decrements of FVC. Since pleural fibrosis has gradually become the predominant radiologically detectable abnormality in asbestos exposed workers, establishing its quantifiable functional relevance is useful.
Radiographic abnormalities in asbestos insulators: effects of duration from onset of exposure and smoking. Relationships of dyspnea with parenchymal and pleural fibrosis. R. Lilis, A. Miller, J. Godbold, et al. 1991;20(1):1-15. PubMed · Publisher

Abstract

Chest radiographs and spirometry were evaluated in 2,907 active and retired asbestos insulators; most (86.8%) had greater than or equal to 30 years from onset of asbestos exposure. Testing was performed in 19 cities in the United States during 1981-1983. Complete demographic, smoking, clinical, and radiologic data were obtained for 2,790 workers. This is the largest single group of insulators that has been studied. Five hundred forty-eight (19.7%) had never smoked cigarettes, 942 (33.9%) were current cigarette smokers, and 1,300 (46.6%) were ex-smokers. Only 439 (15.7%) workers had no radiographic evidence of asbestos-related disease (normal chest X-ray); 668 (23.9%) had pleural fibrosis only, 325 (11.6%) had parenchymal fibrosis alone, and 1,358 (48.7%) had both parenchymal and pleural fibrosis. The prevalence of radiographic parenchymal changes increased significantly (p less than .001) from 38.6% (DURONSET less than 30 years) to 70% (greater than or equal to 40 years). For pleural changes the comparative prevalences were 55% and 82%. Those with no history of cigarette smoking were more likely to have normal films than those with a history of smoking (19.2% versus 14.4% for current smokers and 15.2% among ex-smokers), and were less likely to have parenchymal fibrosis (44.5% versus 69.7% for current smokers and 60.2% of ex-smokers). Dyspnea, MRC grade 3 and higher, was more prevalent when pleural fibrosis was associated with interstitial pulmonary fibrosis (at all profusion levels of small opacities) than when pleural fibrosis was absent. Logistic regression analysis of factors contributing to such dyspnea showed that the presence of combined parenchymal and pleural abnormalities was a significant explanatory variable, in addition to age, smoking, and body mass (Quetelet index); the presence of parenchymal changes only or of pleural changes only, as factors contributing to dyspnea, did not reach the level of statistical significance in the regression analysis. The results of these examinations show that pleural fibrosis is a frequent finding in asbestos-exposed groups with long-term follow-up and that its functional significance is not negligible. The contribution of cigarette smoking to prevalence and severity of interstitial fibrosis is an additional reason for smoking cessation among asbestos-exposed individuals.
Radiological features of asbestos-related visceral pleural changes. A. Solomon. 1991;19(3):339-55. Review PubMed · Publisher

Abstract

The radiological manifestations of asbestos-related visceral pleural changes are described. Generally, visceral pleural reactions follow the mesothelial cells response to various injurious substances, including asbestos, and even saline. The changes are nonspecific. They may occur subsequent to pleural reactions associated with many conditions, which include tuberculosis, viral pleurisy, malignancy and lymphoma, lupus, or rheumatoid-induced effusions, cardiac failure, and pulmonary embolism, among other etiologies. The failure to absorb the fibrinous exudate on the visceral pleural surface can lead to the development of diffuse fibrosis of the serosal surface, interlobar pleural thickening, localized pleural filaments (strands), subpleural wedge, and lenticular-shaped masses, and could be the forerunner of lobular atelectasis (pseudotumor) formation. Some of the features are recognized on posteroanterior chest radiographs and the counterparts corroborated with the use of routine and high-resolution computed tomography studies.
Re: Meta-analysis of asbestos and gastrointestinal cancer. R.W. Morgan. 1991;19(3):407-11. Comment · Letter · Meta-analysis PubMed · Publisher
Relationship of inflammatory cell cytokines to disease severity in individuals with occupational inorganic dust exposure. W.N. Rom. 1991;19(1):15-27. Review PubMed · Publisher

Abstract

The pneumoconioses due to chronic occupational exposure to asbestos, coal, or silica are characterized by an alveolar macrophage-dominated alveolitis with exaggerated spontaneous release of mediators: oxidants, chemotaxins for neutrophils, and fibroblast growth factors. Bronchoalveolar lavage was performed on 66 non-smoking inorganic dust-exposed individuals with a chest x-ray greater than or equal to 1/0 stratified by presence or absence of restrictive respiratory impairment, and 28 unexposed non-smoking controls. Both dust-exposed groups stratified by presence or not of impairment had increased numbers of total cells recovered by lavage compared to normals, and those with respiratory impairment (n = 40) had a significant increase in percent and number of neutrophils recovered. Similarly, only those with respiratory impairment had macrophages that spontaneously released significant amounts of the oxidants superoxide anion and hydrogen peroxide. There was a significant trend for the release of fibronectin by macrophages from controls to dust-exposed without impairment to those with impairment. Both dust-exposed groups also had increased release of alveolar macrophage-derived progression growth factor, but this was significantly less than macrophages from patients with idiopathic pulmonary fibrosis. Since occupational exposure was virtually identical in inorganic dust-exposed individuals with versus without respiratory impairment, the quantitative differences in the release of macrophage mediators may be due to factors in host susceptibility.
Response to qualms about medical screening as a discriminatory tool. F.M. Kogan, E.V. Polzik. 1991;20(2):273-4. Comment · Letter PubMed · Publisher
Silicosis among gemstone workers in South Africa: tiger's-eye pneumoconiosis. N.W. White, R. Chetty, E.D. Bateman. 1991;19(2):205-13. Case report PubMed · Publisher

Abstract

Six cases of silicosis in workers involved in the processing of semiprecious gem stones have been seen in our clinic since 1976. They had been employed as stone sculptors in lapidaries where they processed tiger's-eye, rose quartz, amethyst, quartz crystal, and a variety of other locally occurring semiprecious stones. In five of the cases, exposure was in small and poorly regulated lapidaries without specific dust control measures. The sixth was detected during the course of a health and hygiene survey (including dust sampling) that was conducted in one of two lapidaries still operating in our area. Progressive massive fibrosis (PMF) or accelerated silicosis was noted in four of the six cases, three of whom had progression of their disease after cessation of exposure. With the development of PMF, the initial restrictive pulmonary function abnormalities were followed by steadily worsening airflow obstruction. Lung biopsies confirmed silicosis in three cases. Tuberculosis was confirmed in two cases and suspected and treated in a third. Workmen's Compensation was awarded in five cases. The survey confirmed that in semiprecious gem stone processing, the risk of silicosis appears to be confined to stone sculptors. Tried and proven techniques of general and local exhaust ventilation combined with water or oil to control dust at source were capable of effectively reducing dust emission to acceptable levels.
The diagnosis of mesothelioma by panels. W.T. McCaughey. 1991;19(1):121-4. Review PubMed · Publisher

Summary

This historical article described how diffuse malignant mesothelioma (DMM) came to be diagnosed by panels of pathologists. The author explained that DMM is a rare, aggressive cancer of the linings of the body cavities, arising in the pleura in about 70% of cases. Accurate diagnosis matters because of its sentinel role for the cancer-causing effects of asbestos. Until the 1950s some doubted that DMM existed as a distinct tumor. Pathological studies between 1930 and 1960 established its features. After Wagner and colleagues reported in 1960 that many people with mesothelioma in South Africa had been exposed to asbestos, a 1964 recommendation led to national pathology reference panels in countries including Great Britain, the United States, Canada and the Netherlands. Panels graded tumors by diagnostic certainty, often on a 0-4 scale, and the majority opinion served as the working diagnosis. The author identified several weaknesses: the subjective nature of histological diagnosis, the varied microscopic appearance of DMM, and scanty material and clinical information. Other problems were cases seen by only a few panel members, diagnostic criteria that were not agreed, and panelists working in isolation. The author concluded that the panel system had almost certainly improved mesothelioma diagnosis. The eight to ten members of the United States-Canadian Mesothelioma Panel reached 75% or more agreement on 70% of referred material. Immunohistochemistry, electron microscopy and follow-up studies were said to further improve performance.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
The incidence of malignant mesothelioma in Australia 1982-1988. J. Leigh, C.F. Corvalán, A. Grimwood, et al. 1991;20(5):643-55. PubMed · Publisher

Abstract

From 1980 to 1985, the Australian Mesothelioma Surveillance Program, and since 1986, the Australian Mesothelioma Register, have been collecting data on all cases of malignant mesothelioma that could be ascertained in Australia. Incidence rates were calculated on 854 Program and 696 Register cases (total 1271) diagnosed in Australia between January 1, 1982 and December 31, 1988. Australia has one of the highest national rates of mesothelioma in the world (15.8 cases per million of population aged 20 years and older), and the rate is rising. The rate is far higher in males (28.3) than females (3.3). The Western Australian rate (28.9) is the highest among the states, as may be expected because of the crocidolite mine at Wittenoom; however, the largest numbers of cases occur in the more populous and industrial New South Wales. The high incidence rate, its expected continuing increase, and absence of a history of exposure to asbestos in approximately 28% of cases, demand consideration of potential environmental factors other than asbestos in the causation of this tumor, as well as continued surveillance.
The progression of panels. M. Greenberg. 1991;19(1):1-2. Editorial PubMed · Publisher
The usefulness of bronchoalveolar lavage in identifying past occupational exposure to asbestos: a light and electron microscopy study. R.F. Dodson, J.G. Garcia, M. O'Sullivan, et al. 1991;19(5):619-28. PubMed · Publisher

Abstract

Fiberoptic bronchoscopy has permitted the development of lavage procedures for the collection of lung washes. In certain disease states this material may contain large numbers of phagocytic cells (macrophages and neutrophils). Since these phagocytes are the predominant "dust scavenger cells" in the lung, the assessment of their particulate burden as well as that of the overall lavage material has been suggested as a potentially important diagnostic tool. The studies to date have shown that the presence of ferruginous bodies is an indication of past occupational exposure. In the present study, a digestion procedure was carried out on bronchoalveolar lavage material collected from individuals who were occupationally exposed to asbestos and from samples obtained from the general population. The parameters used for distinguishing the source of these samples included both light microscopy assessment of the filters for the presence of ferruginous bodies and electron microscopic screening for the presence of uncoated fibers.
Translocation of inhaled asbestos fibers from the lung to other tissues. Y. Suzuki, N. Kohyama. 1991;19(6):701-4. PubMed · Publisher

Abstract

To investigate translocation of asbestos fibers, tissue samples from 13 North American insulators were examined, using electron microscopy. Of the two major types of asbestos, chrysotile and amosite, chrysotile was found to be much more active in the translocation than amosite, being the fiber mainly detected in mesotheliomas and hyaline plaques.
Asbestos-cement pneumoconiosis: first surgically confirmed case in Kuwait. I.Y. Mohamed. 1990;17(2):241-5. Case report PubMed · Publisher

Abstract

During the periodic medical examination of workers of the only asbestos-cement pipe factory in Kuwait, an early case of asbestosis was diagnosed. It was the first case of asbestosis to be reported and compensated in Kuwait. According to available information, it is also the first reported case to be confirmed by surgery in the Arabian Gulf countries. Recommendations are given in regard to diagnosis, the institution of very strict preventive and protective measures, and the system of compensation in Kuwaiti law.
Asbestos-related lesions of the pleura: parietal plaques compared to diffuse thickening studied with chest roentgenography, computed tomography, lung function, and gas exchange. G. Hillerdal, P. Malmberg, A. Hemmingsson. 1990;18(6):627-39. PubMed · Publisher

Abstract

Lung function tests, tests of working capacity with gas exchange, and computed tomography (CT) with density measurements with the patient supine and prone were performed in 23 males with asbestos-related bilateral pleural lesions. Two had pulmonary asbestosis grade 1/0 or more; all the others had normal lung parenchyma. On x-ray, the pleural lesions were divided into plaques involving only the parietal pleura There was a and diffuse pleural fibrosis of various degrees involving the visceral pleura. There was a good correlation between the findings at plain chest roentgenography and CT, but more lesions were seen on the CT scan. However, a few pleural plaques seen on conventional films were not observed at CT. Individuals with plaques had slightly lowered lung function compared to reference subjects. Bilateral diffuse pleural fibrosis was associated with a marked decrease in pulmonary function. The two patients with radiologically evident pulmonary asbestosis were found in this group. Decreased lung function was also observed in subjects with pleural fibrosis of only grade 1 (involving less than one fourth of the hemithorax) and a normal exercise capacity. The study shows the importance of differentiation between various asbestos-related pleural lesions.
Asbestos-related pulmonary disease in boilermakers. R.Y. Demers, A.V. Neale, T. Robins, et al. 1990;17(3):327-39. PubMed · Publisher

Abstract

Boilermakers are skilled building tradesmen who construct, repair, and dismantle boilers. The present study reports on the evaluation of members of a Michigan boilermaker's union for the presence of signs and symptoms of chronic pulmonary disease. Study variables included standardized evaluations of chest x-ray findings, pulmonary function testing, physical examination, and respiratory symptoms. An overall participation rate of 69% was achieved. A non-participant survey identified no significant differences between participants and non-participants in dyspnea, cough, age, or smoking history. Among participants with greater than 20 years experience in the trade, the mean FVC was 91% of predicted; the FEV1 was 86% of predicted; 25% showed at least a 1/0 profusion of interstitial markings on chest x-ray; 30% had bilateral pleural abnormalities; and 52% had audible inspiratory rales on physical examination. Forced vital capacity and forced expiratory volume at one second both decreased with years in the trade. Chest x-ray findings of interstitial fibrosis and pleural plaques were related to ten or more years in the trade, as were respiratory symptoms of pulmonary rales, wheeze, and dyspnea.
Morbidity and mortality in talc-exposed workers. E. Wergeland, A. Andersen, A. Baerheim. 1990;17(4):505-13. PubMed · Publisher

Abstract

Cancer incidence and cause-specific mortality were studied in a male cohort of 94 talc miners and 295 talc millers, exposed to non-asbestiform talc with low quartz content. No excess risk was found compared with national age-specific incidence. Six cases of lung cancer occurred versus 6.49 expected (miners: observed 2, expected 1.27; millers: observed 4, expected 5.22). There were 3 deaths due to non-malignant respiratory disease against 10.9 expected (miners: observed 1, expected 2.5; millers: observed 2, expected 8.4). Mesothelioma, tuberculosis, or pneumoconiosis were not recorded as causes of death. Pneumoconiosis was noted as a contributory cause in three cases (silicosis two, talcosis one). Further follow-up will reduce any potential impact of "healthy worker" selection.
Mortality and cancer morbidity in workers exposed to low levels of vinyl chloride monomer at a polyvinyl chloride processing plant. L. Hagmar, B. Akesson, J. Nielsen, et al. 1990;17(5):553-65. PubMed · Publisher

Abstract

To study whether exposure to low levels of vinyl chloride monomer (VCM) causes increased risk for cancer morbidity and death from ischemic heart disease, a cohort study was performed among 2,031 male workers at a polyvinyl chloride (PVC) processing plant who had been employed for at least 3 months during the period 1945-1980. An almost significantly increased total mortality (SMR = 116, 95% CI 99-136) was found. Deaths caused by violence or intoxication were significantly increased (SMR = 153, 95% CI 109-213), but not deaths from ischemic heart disease (SMR = 100, 95% CI 73-135). A significant increase in total cancer morbidity was observed (SMR = 128, 95% CI 101-161). Respiratory cancers were significantly increased (SMR = 213, 95% CI 127-346). Furthermore, six brain tumors (vs. 2.6 expected) were observed. This increase, however, was not significant (SMR = 229, 95% CI 84-498). No liver hemangiosarcoma was observed. Applying a latency period of greater than or equal to 10 years from start of employment did not change the risk patterns. There were no significant exposure-response associations between exposure estimates for VCM, asbestos, and plasticizers and cancer morbidity.
Mortality of a cohort of men in a silicosis register: further evidence of an association with lung cancer. T.P. Ng, S.L. Chan, J. Lee. 1990;17(2):163-71. PubMed · Publisher

Abstract

Lung cancer mortality from 1980 to 1986 was studied in a cohort of 1,419 men in a silicosis register who had no previous exposure to asbestos and polyaromatic hydrocarbons. The 28 deaths from lung cancer were statistically in excess of expected (SMR 2.03; 95% CI 1.35-2.93). Excess risks of lung cancer were found in both underground workers (SMR 3.41; 95% CI 1.10-7.97; based on 5 deaths) and surface workers (SMR 1.87, 95% CI 1.18-2.81; based on 23 deaths). All lung cancer deaths were smokers. There was an increase in SMRs with longer latency periods and years of exposure, with the greatest risk found in those who had worked for 30 or more years after more than 30 years since first exposed (SMR 3.07, based on 16 deaths). The risk for lung cancer was higher in those with tuberculosis (SMR 2.52; 95% CI 1.52-3.94) and showed an increasing trend with severity of silicosis, from category 1 to 3 and from category A to C, with highest risk in those with tuberculosis and category 3 (SMR 4.44 based on 3 deaths) or tuberculosis and category C (SMR 7.63 based on 7 deaths). Most of the excess lung cancer risk in silicotics is due to smoking, but a synergistic effect between smoking and silica/silicosis on the risk of lung cancer is also likely. In particular, a possible role of silicosis and tuberculosis as the fibrotic seedbed for malignant growth in the lung is strongly supported.
Multiplane gallium tomography in assessment of occupational chest diseases. E.M. Cordasco, J. O'Donnell, W. MacIntyre, et al. 1990;17(3):285-97. Case report PubMed · Publisher

Abstract

Gallium-67 scintigraphy is helpful in the evaluation of inflammatory, respiratory diseases. Single-photon emission computed tomography (SPECT) provides three-dimensional tomographic reconstruction of radioisotope distribution in the body. The addition of SPECT to gallium-67 scanning in 27 patients demonstrated an improvement in the sensitivity for detecting the presence and extent of interstitial occupational lung disease. This technique may provide earlier detection of parenchymal lung changes than can the chest x-ray and planar scanning in some patients with asbestosis. Findings in six patients with asbestosis are reported.
Prophylaxis of asbestos-induced diseases: studies and perspectives. F.M. Kogan, E.V. Polzik. 1990;18(1):95-9. Review PubMed · Publisher

Abstract

In recent years, implementation of dust-suppressing measures in USSR asbestos mills has led to significant decrease in dust levels. New cases of asbestosis and asbestotuberculosis in annual medical examinations have not been detected. For prevention of possible future incidence of these diseases, we plan to concentrate efforts on the medical selection of new employees, taking into account not only dust exposure, but also other ascertained risk factors (social, demographic, and biological, especially genetic). It seems to us that the grounds for complete prohibition of asbestos are insufficient. Substitution with alternative materials is discussed.
Re: Asbestos and kidney cancer. 1990;17(5):645-50. Letter PubMed · Publisher
Re: Mesothelioma in railroad machinists. A. Churg, F. Green. 1990;17(4):523-30. Comment · Letter PubMed · Publisher
Study of asbestos bodies in Japanese urban patients. K. Hiraoka, A. Horie, M. Kido. 1990;18(5):547-54. PubMed · Publisher

Abstract

To study whether low-level exposure to asbestos contributes to lung cancer risk, the asbestos body (AB) content in lung tissue was measured in 476 patients with lung cancer and 369 patients with other diseases, all from a Japanese industrialized city. Eleven patients with histologically confirmed asbestosis were included. The findings were stratified into four groups. A significant number of patients with lung cancer were seen in the groups with high counts, as compared to controls. There was no significant difference in histologic type and site of lung cancer among four groups. The patients with lung cancer in high count groups were significantly younger than those with lower counts. A significant number of smokers were seen in the groups with high AB counts among patients with lung cancer as compared to controls, even if the patients with asbestosis were excluded. These findings suggest that there may be a positive interaction of smoking and exposure to asbestos relative to the incidence of lung cancer even at a low exposure level.
Urothelial cancer and some industry-related chemicals: an evaluation of the epidemiologic literature. G. Steineck, N. Plato, S.E. Norell, et al. 1990;17(3):371-91. Review PubMed · Publisher

Abstract

In a previous cohort study by our group, certain industry-related chemicals were judged as warranting further attention as possible urothelial carcinogens. In this paper, the epidemiologic literature of cancer of the lower urinary tract is evaluated for these substances. We would like to add combustion gases/soot from coal to the substances considered as increasing the risk of urothelial cancer. It is, however, uncertain whether this risk is due to contaminants of aromatic amines in tar volatiles or whether it depends on other agents, such as nitroarenes or polycyclic aromatic hydrocarbons. Furthermore, we find some support for the hypothesis that exposure to chlorinated aliphatic hydrocarbons increases the risk of urothelial cancer. For creosote, cutting fluids and cutting oils, hair dyes, and polychlorinated biphenyls, data are scarce. Available data do not support the hypothesis that asbestos is associated with urothelial cancer. "Publication bias," such that only limited information was available, was judged to be a potential problem in the review for many, but not all, of the substances investigated.

1980s

Analysis of mortality patterns and workers' compensation awards among asbestos insulation workers in Ontario. M.M. Finkelstein. 1989;16(5):523-8. PubMed · Publisher

Abstract

Mortality and workers' compensation patterns were studied among 1,064 Ontario asbestos insulation workers. A proportional mortality analysis of 153 asbestos worker deaths found increased mortality from malignant diseases (65 deaths observed; 35.1 expected), cancers of the lungs and pleura (32 deaths observed; 11.5 expected), peritoneal mesothelioma (4 deaths), and respiratory diseases (14 deaths observed; 7.9 expected). Despite the publicity given to asbestos-associated diseases, dependents of many men potentially eligible for workers compensation awards have not received pensions because claims were not filed. These findings suggest that much occupationally related disease is not being recognized in Ontario.
Asbestos and kidney cancer: the evidence supports a causal association. A.H. Smith, V.I. Shearn, R. Wood. 1989;16(2):159-66. Review PubMed · Publisher

Abstract

The role of asbestos in the etiology of lung cancer and of mesothelioma of the pleura and peritoneum has been well documented. The evidence for a causal association between asbestos and other human cancers is not as extensive but suggests that asbestos may be carcinogenic at several different sites. This paper is concerned specifically with a possible causal association between asbestos and human kidney cancer. A review of the evidence to date indicates that only three human studies have sufficient statistical power to detect an excess mortality from kidney cancer among workers exposed to asbestos. All three were occupational cohort studies, and two of these gave strong direct evidence for such an excess; a study of U.S. insulators (kidney cancer SMR = 2.22, 90% CI 1.44-3.30), and a study of U.S. asbestos products company workers (kidney cancer SMR = 2.76, 90% CI 1.29-5.18). The third study, of Italian shipyard workers, reported excess mortality from "cancers of the kidney, urinary bladder, and other urinary organs" (SMR = 1.98, 90% CI 1.42-2.70). Further support for a causal association includes studies finding asbestos fibers in human kidneys and urine, as well as reports of kidney tumors in two animal bioassays. It is concluded that asbestos should be regarded as a probable cause of human kidney cancer.
Asbestos-related chest X-ray changes among Greek merchant marine seamen. E.G. Velonakis, A. Tsorva, A. Tzonou, et al. 1989;15(5):511-6. PubMed · Publisher

Abstract

One hundred forty-one retired Greek mariners were examined radiologically for asbestos-related lung disease. Thirty-eight (27%) had small opacities classified as ILO category 1/0 or more; 37 (26%) had radiologic evidence of pleural lesions; 17 (12%) had both parenchymal and pleural lesions; and a total of 58 (41%) had one or more radiologic findings of asbestos-related lung disease. In discriminant analysis, duration of maritime employment was predictive of pleural lesions, but the association was not statistically significant (one-tail, p = .16). The prevalence of pleural lesions was also higher among sailors than among officers, and this association was statistically significant (one-tail, p = .05). In this group, none of the occupational variables studied (age, duration of maritime employment, and rank) was related to lung fibrosis. After controlling by multiple regression for mutual confounding effects, suggestive negative associations for the presence of pleural lesions were found with FVC (one-tail, p = .13) as well as with FEF25% (one-tail, p = .09) and FEF50% (one-tail, p = .07). By contrast, no association was found between pulmonary fibrosis and any of the respiratory volumes. The results of this study suggest that mariners may present evidence of asbestos-related disease after many years from onset of exposure on ships.
Can the birth certificate yield clues to parental occupational exposures?. S. Milham. 1989;16(2):235-7. PubMed · Publisher

Abstract

An analysis of reported birth record variables by parental occupation suggests that certain birth outcomes may identify toxic or carcinogenic occupational exposures of the parents. Fathers coded to an asbestos and insulation worker rubric sired fewer plural births, and more stillbirths than expected. A number of other fathers' occupations with putative exposure to asbestos and increased lung cancer mortality also showed a deficit of plural births.
Case-control study of lung cancer in Los Angeles county welders. C.J. Hull, E. Doyle, J.M. Peters, et al. 1989;16(1):103-12. PubMed · Publisher

Abstract

A case-control study of lung cancer in white male welders was undertaken to investigate possible environmental and occupational causes of a 50% excess of lung cancer observed in this occupational group. The subjects were identified from a population-based cancer registry in Los Angeles County. A standardized questionnaire was administered to either subjects or proxy informants of 90 lung cancer cases and 116 non-lung-cancer controls. Significantly increased risks of lung cancer were associated with tobacco smoking (odds ratio 7.6, p less than .005) and shipyard welding with at least a 10-year latency since first exposure (odds ratio 1.7, p less than .05). Although there were elevated risks associated with some specific welding processes, none were statistically significant. Control subjects were more likely to have had exposure to confined-space welding (odds ratio 0.6, 95% CI = 0.3-1.2), and this association was greatest where there had been at least a 20-year latency since first exposure (0.5, 95% CI = 0.3-1.0). We conclude that the excess of lung cancer in this welding population is contributed to by a higher frequency of smoking and probable exposure to asbestos in shipyards. Other factors may be important, but probably because of limited power and reliance on proxy information, this study failed to detect other statistically significant risks.
Design and conduct of occupational epidemiology studies: II. Analysis of cohort data. H. Checkoway, N. Pearce, J.M. Dement. 1989;15(4):375-94. Review PubMed · Publisher

Abstract

This paper reviews strategies and statistical methods for analyzing data from occupational cohort studies. Emphasis is placed on the common methods for grouped data analysis involving external and internal comparison populations. Analysis procedures reviewed are standardized mortality ratio, standardized rate ratio, and Mantel-Haenszel techniques for estimating relative risks. Methods for control of confounding, assessment of effect modification, and allowance for disease latency are discussed. These concepts and procedures are illustrated with data from an historical cohort mortality study of workers from an asbestos textile plant.
Design and conduct of occupational epidemiology studies: IV. The analysis of case-control data. N. Pearce, H. Checkoway, J. Dement. 1989;15(4):403-16. Review PubMed · Publisher

Abstract

This paper reviews the basic methods of analysis of data from case-control studies. The standard analytic methods are outlined first for a single stratum. The discussion is then extended to stratified analysis, multiple exposure levels, and analyses allowing for disease induction and latency periods. Finally, logistic regression is discussed as an extension of the more basic forms of analysis. The methods are illustrated with data from a study of lung cancer among asbestos textile plant workers.
Diagnostic value of exercise testing in asbestosis. J. Zejda. 1989;16(3):305-19. PubMed · Publisher

Abstract

The diagnostic value of simple exercise testing was examined in 81 current male asbestos-cement workers, divided into four groups according to the International Labour Office (ILO) category of irregular opacities: 0/0, 25; 1/1, 24; 1/2, 22; and 2/2, 10 men. An increasing X-ray score was accompanied by more severe functional abnormality in keeping with the development of a restrictive defect. Symptom-limited oxygen uptake (VO2SL) did not depend on the X-ray grade and was 76.7, 71.9, 68.7, and 73.5% pv, respectively, for the four groups. Subjects with ILO score 1/1 had significantly higher exercise ventilation at O2 uptake of 1.01.min-1 (VE 1.0) than those with grade 0/0. End-exercise tidal volume (VTSL in 1) decreased with an increasing X-ray score: 2.14, 1.98, 1.85, and 1.62, respectively. VTSL standardized for vital capacity (VTSL/VC) followed the same pattern. Asbestosis was diagnosed in 25 men, in whom VE 1.0 was significantly higher (p less than .02) and VTSL lower (p less than .01) than in the 0/0 group. VO2SL was similar in both groups. The findings suggest that VE 1.0 and VTSL may be early functional indicators of asbestos-related interstitial lung fibrosis. The measurement of both exercise indices may increase the certainty of clinical diagnosis of asbestosis in subjects with less advanced disease.
Diffuse malignant pleural mesothelioma in an urban hospital: clinical spectrum and trend in incidence over time. K.E. Shepherd, L.C. Oliver, H. Kazemi. 1989;16(4):373-83. PubMed · Publisher

Abstract

This retrospective analysis reviews the clinical experience of a major urban referral hospital with diffuse malignant pleural mesothelioma during the 14-year period from 1973 through 1986. Seventy-five cases of definite or equivocal mesothelioma were identified. There were four cases of primary malignant peritoneal mesothelioma, seven cases of benign fibrous mesothelioma, and 64 cases of diffuse malignant pleural mesothelioma. In 43 cases (67%) of diffuse malignant pleural mesothelioma, there was historic evidence of asbestos exposure. In 21 cases (33%), there was no known history of asbestos exposure. An increase in annual incidence of diffuse malignant pleural mesothelioma was observed over the study period, from three cases in 1973 to ten cases in 1986. Despite greater awareness of this disease, the diagnosis remains a difficult one to establish given the nonspecific symptoms, signs and radiographic appearance, variable histologic appearance, and poor diagnostic sensitivity and specificity of thoracentesis and closed pleural biopsy. Thoracotomy, thoracoscopy, and CT-guided needle biopsies gave higher yields and are the diagnostic measures of choice when diffuse malignant pleural mesothelioma is suspected.
High-resolution CT in the diagnosis of asbestos-related pleuroparenchymal disease. G. Gamsu. 1989;16(2):115-7. Editorial PubMed · Publisher

Summary

This editorial reviewed the use of high-resolution computed tomography (HRCT) in diagnosing asbestos-related lung and pleural disease, drawing on published and in-press studies. HRCT used thin sections (1-1.5 mm) and high-resolution reconstruction to show lung and pleural detail. In a study of 100 occupationally exposed individuals, HRCT was abnormal in 43 of 45 with clinical asbestosis and in 34 of 35 with abnormal chest radiographs. HRCT findings highly probable for asbestosis were also seen in 28 of 65 subjects with normal radiographs. These findings did not correlate with smoking or airflow obstruction but did correlate with lung restriction. In another study of 169 exposed workers with normal radiographs, the 57 with HRCT strongly suggestive of asbestosis had lower lung volumes and diffusing capacity than the 76 with normal or near-normal HRCT. The two groups had similar exposure, latency and smoking history. HRCT was more sensitive than radiographs for pleural plaques and calcification. Masses were found incidentally in about 10% of exposed workers, and most were benign. The author stated that asbestosis is several thousand times more common than idiopathic interstitial fibrosis in exposed individuals. He noted that HRCT costs about the same as a four-view chest radiograph series. He concluded that HRCT could be used in equivocal cases or could become a sensitive routine standard for detecting and quantifying pneumoconiosis.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Is chrysotile a significant risk factor for mesothelioma?. C.G. Ohlson. 1989;15(3):351-6. Comment PubMed · Publisher

Summary

In this letter to the editor, the author challenged the conclusion of a 1988 paper by Mancuso that chrysotile is far more hazardous in causing mesothelioma than previously estimated. Mancuso's conclusion was based on a cohort of 181 railroad machinists hired between 1920 and 1929, among whom 14 mesotheliomas were identified through 1986. The author made two comments. First, he questioned the statement that the machinists were exposed almost exclusively to chrysotile. He noted that an earlier paper by Mancuso (1983) reported fiber analysis identifying amosite in four of six samples from old locomotives. He also described a Swedish railroad maintenance shop where padded insulation containing crocidolite was used on steam boiler funnels, and where magnesia lagging containing chrysotile, and probably amosite, was also used. In that Swedish cohort of 3,297 male workers, studied from 1951 to 1980, only five mesotheliomas were observed. The author argued that even small amounts of amphiboles could explain the mesotheliomas, because amphiboles are highly durable in the lungs and chrysotile is not. Second, he noted that the machinists were still employed two decades after 1920-29 and may have had further decades of exposure. The average latent period was 48 years (33-64) for the mesotheliomas and 40 years (27-51) for lung cancers, which he considered longer than generally agreed. He concluded that Mancuso's data did not support the claim that chrysotile poses a considerable mesothelioma risk.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Mesothelioma in railroad workers. C. McDonald, A. McDonald. 1989;15(4):487-90. Letter PubMed · Publisher
Mineral fiber concentration in lung tissue of mesothelioma patients in Finland. T. Tuomi, M. Segerberg-Konttinen, L. Tammilehto, et al. 1989;16(3):247-54. PubMed · Publisher

Abstract

The mineral fibers in lung tissue samples of 19 mesothelioma patients and 15 randomly selected autopsy cases were analyzed using low-temperature ashing, scanning electron microscopy (SEM) and x-ray microanalysis. The fiber concentration ranged from 0.5 to 370 million fibers per gram of dry tissue in the mesothelioma group and from less than 0.01 to 3.2 million fibers per gram of dry tissue in the autopsy group. In 80% of the mesothelioma patients and in 20% of the autopsy cases, the fiber concentration exceeded 1 million fibers per gram of dry tissue. Amphibole asbestos fibers predominated in both groups, and only a few chrysotile fibers were found. In the lungs of six mesothelioma patients, anthophyllite was the main fiber type. The overall analytical precision of sample preparation and fiber counting with SEM was 22%.
Mortality among employees of an Ontario factory manufacturing insulation materials from amosite asbestos. M.M. Finkelstein. 1989;15(4):477-81. PubMed · Publisher

Abstract

The mortality of workers from an Ontario factory manufacturing amosite asbestos insulation materials under poorly controlled environmental conditions is reported here. Seven (58%) of 12 deaths among exposed workers 10 or more years after first exposure were due to malignancies; four (25%) were from lung cancer, and there were two deaths from peritoneal mesothelioma. Those dying from mesothelioma were 47 and 49 years of age. Three (25%) of 12 deaths were from respiratory disease, two were attributed to asbestosis (in men 42 and 53 years of ages), and one to pneumonia in a 54-year-old male.
Mortality among employees of an Ontario factory that manufactured construction materials using chrysotile asbestos and coal tar pitch. M.M. Finkelstein. 1989;16(3):281-7. PubMed · Publisher

Abstract

This paper describes mortality in a cohort of 324 men exposed to chrysotile asbestos and coal tar pitch used in the manufacture of electrical conduit pipe from a mixture of newsprint, bentonite, and asbestos. One death in a factory worker was attributed to pleural mesothelioma, and long-term employees experienced an increased risk of lung cancer (Standardized Mortality Ratio (SMR) 221; six deaths) and non-malignant respiratory disease (SMR 215; four deaths). In a case-control analysis, men whose jobs involved adding asbestos to the mix of raw materials were found to have a risk of lung cancer sevenfold higher (lower 95% confidence limit: 2.3) than men who had never worked at this job. Exposure to coal tar pitch is presumed to be responsible for the death of one worker from squamous cell carcinoma of the scrotum.
Reactions of asbestos-exposed workers to notification and screening. B.E. Meyerowitz, C.D. Sullivan, C.L. Premeau. 1989;15(4):463-75. PubMed · Publisher

Abstract

In the wake of efforts to pass legislation mandating notification of workers at high risk of developing occupational disease, considerable controversy exists regarding the potential costs and benefits of such notification efforts. It has been suggested that individual notification would cause undue psychological distress, especially when primary prevention efforts are no longer possible. In this study, we assessed reactions of asbestos-exposed workers to a letter notifying them of their risk for asbestos-related illnesses and the availability of a medical screening program. Two hundred forty-seven workers who attended the screening program and 53 who chose not to attend completed a questionnaire that tapped reactions to notification. Workers reported neither undue psychological distress nor avoidance behavior in response to notification, and many respondents reported engaging in active and appropriate coping behaviors. Workers who first learned of their risk through the notification letter (33.7%) were no more likely to report distress or denial than were workers who had learned previously through other sources. Individuals who chose not to attend the screening program were less likely than attenders to report experiencing distress upon learning of their risk status, more likely to engage in minimization of risk, and less likely to have taken direct action. Our results suggest that the psychological costs of notifying workers of increased risk for asbestos-related illness appear to be outweighed by the benefits of notification and screening.
Relationship of lung geometry to the development of pleural abnormalities in insulation workers exposed to asbestos. R. Delfino, P. Ernst, J. Bourbeau. 1989;15(4):417-25. PubMed · Publisher

Abstract

The relationship of respiratory airway and airspace geometry to radiographic evidence of pleural abnormality consistent with asbestos exposure was studied in 178 construction insulators. Lung geometry was assessed from tracings of radiographic shadows, and the measures taken were tracheal length and diameter, subcarinal angle, right and left lung lengths, and upper, middle, and lower lung widths. Important modifying variables--age, height, weight, exposure estimates, and smoking history--were included in a logistic regression model to test the significance of the lung geometry measurements as predictors of the presence or absence of pleural abnormality. No such relationships were found. Neither were there any differences in prevalence or severity of pleural disease between the right and left sides which might have been found if airway geometry were a significant determinant of asbestos pleural disease. These results do not support the hypothesis that lung geometry is a host risk factor for the development of asbestos-related pleural disease.
Relationship of mortality, occupation, and pulmonary diffusing capacity to pleural thickening in the First National Health and Nutrition Examination Survey. D.P. Loomis, G.W. Collman, W.J. Rogan. 1989;16(5):477-84. PubMed · Publisher

Abstract

We studied the relationship of pleural thickening consistent with asbestos exposure to mortality, career employment in asbestos-related jobs, and pulmonary diffusing capacity among participants in the first National Health and Nutrition Examination Survey. Three "B" readers examined chest X-rays to identify 59 individuals with such pleural abnormalities. From 1975 to 1984, the all-cause mortality rate ratio (RR) comparing males with and without occupational pleural thickening was 1.3 (95% C.I. 0.8-2.2). For lung cancer, the mortality RR for males was 3.0 (95% C.I. 1.0-9.1). Career asbestos work was not associated with occupational pleural thickening among men, probably because some with the condition had only short-term exposure to asbestos. Pulmonary diffusing capacity was lower in those with occupational pleural thickening, taking smoking into account. These results suggest that individuals in the general population who have occupational pleural thickening are at risk for some of the health consequences of asbestos work, including lung cancer, even if they were not career asbestos workers.
Relative risk of mesothelioma among railroad machinists exposed to chrysotile. I. Higgins. 1989;15(4):483-6. Comment · Letter PubMed · Publisher
Shrinking pleuritis with atelectasis. L. Dernevik. 1989;16(4):451-4. Editorial PubMed · Publisher
X-ray findings, lung function, and respiratory symptoms in black South African vermiculite workers. P.A. Hessel, G.K. Sluis-Cremer. 1989;15(1):21-9. PubMed · Publisher

Abstract

Health effects have been documented among American vermiculite workers who mined and processed vermiculite contaminated with amphibole asbestos, viz., tremolite-actinolite. Workers mining and processing South Africa vermiculite (N = 172), which contains very little asbestos, underwent x-ray examination and lung function testing and completed a respiratory symptom questionnaire. The vermiculite workers were compared with other workers involved in the mining or refining of copper. Only two of the vermiculite workers showed evidence of small opacities of 1/0 or more (according to the ILO 1980 classification); lung function was comparable with the other groups of workers, and there was no excess of respiratory symptoms among the vermiculite workers. It is concluded that workers exposed to vermiculite that is minimally contaminated with asbestos are probably not at risk for pneumoconiosis, lung function impairment, or respiratory symptoms. It is likely that the health effects observed in other studies of vermiculite workers are the result of concomitant asbestos exposure. A risk of mesothelioma caused by the fiber content of the vermiculite cannot be excluded by this study.
A death-certificate case-control study of non-Hodgkin's lymphoma and occupation in men in North Carolina. M.C. Schumacher, E. Delzell. 1988;13(3):317-30. PubMed · Publisher

Abstract

A death certificate-based case-control study was performed to investigate associations between occupation and non-Hodgkin's lymphoma (NHL) in North Carolina. Cases consisted of 501 men who died of NHL (International Classification of Diseases codes 200 and 202) during the years 1968-1970, 1975-1977, and 1980-1982. Controls were selected from other noncancer deaths, and were frequency matched for age, year of death, and race. Occupation and industry were obtained from the death certificates and coded without knowledge of case-control status. An increased risk for men in professional, technical, and managerial occupations, compared with all others, was detected among whites (OR = 2.69, 1.95-3.72). Black men classified as having "low exposures" by an occupational exposure linkage system had an odds ratio of 1.74 (0.84-3.60). Because of this finding, the occupations were ranked by social class and a statistically significant linear relationship was noted in whites, with risk increasing from lower social class to upper social class. An increased risk was also detected among whites in the rubber, plastics, and synthetics industries (p = .03), and among blacks employed in machine trades occupations (OR = 3.63, 1.32-9.97) and structural work occupations (OR = 2.38, 0.93-6.05). An increased risk was also detected for black painters (p = .02), but not for whites. There was no association found between NHL and employment in the following areas: textile industry; farming; laborers; or occupations with exposures to asbestos or benzene. The association with farming was further examined in counties with high use of pesticides and herbicides, and no increased risk of NHL was detected. Cases were more likely to live in the western part of the state than the eastern. However, NHL mortality rates provided by the North Carolina State Center for Health Statistics did not confirm the relationship.
A retrospective cohort mortality study of males mining and milling attapulgite clay. R.J. Waxweiler, R.D. Zumwalde, G.O. Ness, et al. 1988;13(3):305-15. PubMed · Publisher

Abstract

To evaluate the possible health effects of occupational exposure to a nonasbestos mineral fiber, a cohort of 2,302 males employed for at least 1 month between 1940 and 1975 at an attapulgite (clay fiber) mining and milling facility was followed through 1975. A significant deficit of mortality (SMR = 43, 90% CI 23-76) from nonmalignant respiratory disease (NMRD) was observed for the cohort based on age-, calendar year-, and race-specific rates for U.S. males. A marked deficit of NMRD was seen regardless of presumed dust exposure level, induction-latency period, or duration employed. A statistically significant excess of mortality from lung cancer was observed among whites (SMR = 193, 90% CI 121-293), but a deficit occurred among nonwhites (SMR = 53, 90% CI 21-112). Lung cancer risk in either race was not altered substantially with presumed dust exposure level, induction-latency period, or duration employed with one exception-those employed for at least 5 years in high-exposure-level jobs.
Alveolar fiber load in asbestos workers and in subjects with no occupational asbestos exposure: an electron microscopy study. G. Chiappino, K.H. Friedrichs, G. Rivolta, et al. 1988;14(1):37-46. PubMed · Publisher

Abstract

The alveolar fiber load was evaluated by bronchoalveolar lavage and by scanning and transmission electron microscopy (SEM and TEM) in 50 subjects with or without occupational exposure to asbestos. The concentration of asbestos fibers in bronchoalveolar lavage was significantly higher in the groups of people currently and formerly occupationally exposed, compared to the concentration found in people only exposed environmentally, despite wide interindividual variation within the groups. Nonasbestos inorganic fibers were present in all groups, but the concentrations did not differ significantly. Both in people occupationally exposed and in those only environmentally exposed, the alveolar load consisted mainly of ultrashort and ultrathin fibers, which can be studied only with TEM. In fact, the percentage of fibers greater than 5 micron long was only around 15% in the occupationally exposed and was minimal in those only environmentally exposed. The geometric mean diameters of asbestos fibers retained in the alveoli ranged from 0.05 micron for chrysotile to 0.15 micron for amphiboles.
Amphiboles and chrysotile asbestos exposure. V.L. Roggli, P.C. Pratt. 1988;14(2):245-6. Letter PubMed · Publisher

Summary

This letter to the editor responded to an article by Dunnigan (1988), which argued that when patients with mesothelioma have been exposed to both amphiboles and chrysotile asbestos, the amphibole exposure is responsible for the tumor. The authors, pathologists at Duke University Medical Center, agreed that amphiboles are more potent than chrysotile in producing mesothelioma. They noted that long, thin fibers are most likely to cause it and that fiber durability and retention are probably also important. They then raised several points.

First, there are case reports, not mentioned by Dunnigan, of mesothelioma in patients allegedly exposed only to chrysotile-containing products. Second, the few cases in chrysotile cohort studies should be weighed against a background rate of one or two cases per million population per year. Third, because of the long latency, cohorts need 30 or 40 years of follow-up.

On tissue fiber analysis, they cited rat inhalation studies by Wagner et al. (1974). In those studies amphibole fibers accumulated in proportion to exposure duration, while chrysotile burden plateaued after a couple of months. This would raise the amphibole-to-chrysotile ratio as cumulative exposure increased. Yet in the same studies chrysotile was as efficient as amphiboles in producing asbestosis, and Canadian chrysotile produced as many mesotheliomas as crocidolite. In humans, asbestosis occurs with chrysotile-only exposure despite low lung retention.

The authors concluded that one cannot be as complacent as Dunnigan suggested that chrysotile plays no significant role in such patients.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Asbestos disease in sheet metal workers: proportional mortality update. D. Michaels, S. Zoloth. 1988;13(6):731-4. PubMed · Publisher

Abstract

This paper, updating the findings of an earlier study, provides additional evidence that sheet metal workers in the construction trades are at increased risk for asbestos-related disease. A proportional analysis of cause of death among 331 New York sheet metal workers found a significantly elevated PMR for lung cancer (PMR = 186). In addition, there were six deaths attributable to mesothelioma (three classified as lung cancer deaths) and three death certificates mentioned asbestosis or pulmonary fibrosis, although none of these three deaths were attributed to these diseases.
Asbestos exposure and gastrointestinal malignancy review and meta-analysis. H. Frumkin, J. Berlin. 1988;14(1):79-95. Review PubMed · Publisher

Abstract

The epidemiologic literature linking asbestos exposure with gastrointestinal malignancy is reviewed. Problems in comparing studies are discussed, appropriate strategies for comparison are developed, and study results are pooled using a model which accounts for both intrastudy and interstudy variability. Stratification of cohorts by dose reveals that significant asbestos exposure, as indicated by a lung cancer standardized mortality ratio (SMR) of at least 200, is associated with an elevated gastrointestinal cancer of SMR for five of six points examined [corrected].
Asbestos fibers in human pulmonary and extrapulmonary tissues. J. Huang, N. Hisanaga, K. Sakai, et al. 1988;14(3):331-9. Case report PubMed · Publisher

Abstract

The association between asbestos fibers in human lung tissues and those in other extrapulmonary organs was studied by analysing three autopsied cases, one of whom had a high pulmonary asbestos burden, one an intermediate burden, and one a low burden. The amount, types and sizes of asbestos fibers in the tissues of lung, liver, spleen, pancreas, kidney, and gastrointestinal tract were identified and measured by transmission electron microscopy equipped with an energy dispersive X-ray analyser. The following results were obtained: 1) The concentrations of asbestos fibers in extrapulmonary organs tended to increase with that in lung tissues. 2) The types of fibers identified in lungs were approximately consistent with those in other organs. 3) A relatively large range of fiber length was observed in both lungs and other organs. The findings extend and support previous light microscopic studies comparing asbestos bodies in various organs, and may imply that persons with high levels of asbestos in their lungs are also likely to have the same types and high levels of asbestos in their other tissues.
Asbestos-related disease in the jewelry industry: report of two cases. D.G. Kern, H. Frumkin. 1988;13(3):407-10. Case report PubMed · Publisher

Abstract

We describe two cases of asbestos-related pulmonary disease in jewelry workers. Exposures occurred during the hand-mixing of asbestos powder used to make jewelry soldering boards.
Asbestos-related pleural plaques and lung function. L.C. Oliver, E.A. Eisen, R. Greene, et al. 1988;14(6):649-56. PubMed · Publisher

Abstract

The present study examines the association between asbestos-related pleural plaques and lung function in a group of workers with occupational exposure to asbestos. Exposure, smoking, and respiratory histories, chest radiographs, flow-volume loops, and single breath DLCOs were obtained on 383 railroad workers. A score based on the ILO-1980 classification system was used to quantify the extent of plaquelike thickening. In order to eliminate potential confounders, we excluded from final analysis subjects with diffuse pleural thickening (n = 10) or small irregular opacities classified as profusion 0/1 or greater (n = 6) on chest radiograph. Definite pleural plaques were observed in 22.6%. The single breath DLCO was similar in the groups with and without plaques (p = 0.0550). Decrement in FVC and the occurrence of pulmonary restriction were associated with the presence of definite plaques (p = 0.0306 and 0.0431, respectively) and with quantitative pleural score (p = 0.0135 and 0.0126), controlling for duration of asbestos exposure and smoking. A test for trend revealed an association between level of diagnostic certainty (none, suspect, definite) for pleural plaques and these measures of lung function (p less than 0.02). Our findings reveal an association between asbestos-related pleural plaques and decrement in lung function as measured by FVC and criteria for pulmonary restriction.
B cell neoplasms and occupational asbestos exposure. D.A. Schwartz, T.L. Vaughan, N.J. Heyer, et al. 1988;14(6):661-71. PubMed · Publisher

Abstract

To evaluate the etiologic role of asbestos exposure in B cell neoplasms, we compared the estimated level of occupational exposure to asbestos of cases with chronic lymphocytic leukemia (CLL; N = 429) and multiple myeloma (MM; N = 698) with that of controls (N = 1,683). Cases were identified through four population-based cancer registries in the U.S. and controls were randomly selected from the same geographic areas. Exposure to asbestos was assessed by classifying each job held by a subject into one of four categories, based on the estimated intensity of exposure to asbestos. Evidence was found for a modest increasing risk of CLL with increasing asbestos exposure. Relative to persons with no known occupational exposure to asbestos, the risk for CLL was 1.1 (95% confidence interval (CI) = 0.8-1.6) for low, 1.2 (CI = 0.8-1.8) for medium, and 1.4 (CI = 0.8-2.3) for high peak asbestos exposure (p value for trend = 0.13). The association was strongest in white study subjects and in those individuals exposed 10 to 19 years prior to the interview. No association was observed between MM and occupational exposure to asbestos in the entire study population or within specific subgroups. Given the pattern of immunologic abnormalities that occur with increased frequency in asbestos-exposed persons, our observation of an association between occupational asbestos exposure and CLL deserves attention in subsequent studies.
Between- and within-reader variability in the assessment of pleural abnormality using the ILO 1980 international classification of pneumoconioses. J. Bourbeau, P. Ernst. 1988;14(5):537-43. PubMed · Publisher

Abstract

Although there are published data concerning reader variability in the assessment of parenchymal pneumoconiotic changes using the ILO Classification of Radiographs, nothing has been published on reader variability with regard to pleural abnormalities. Therefore, in the context of an epidemiologic study, we assessed between- and within-reader variability in the reading of chest radiographs for pleural abnormality using the ILO 1980 International Classification of Radiographs of Pneumoconioses. Chest radiographs of 182 insulation workers interspersed with 24 subjects without documented exposure to asbestos were assembled and read blindly by two readers, reading separately on two occasions, 1 week apart. The results of this study suggest that confident separation of pleural plaques and diffuse pleural thickening may be difficult to achieve using the present guidelines of the ILO 1980 classification. In the evaluation of the width of chest wall pleural abnormality, within-reader agreement improves as the width increases, while between-reader agreement was much less satisfactory. Excellent agreement is obtained in the evaluation of other sites, especially costophrenic angle obliteration and the presence of pleural calcification.
Corporate influence on threshold limit values. B.I. Castleman, G.E. Ziem. 1988;13(5):531-59. Historical article PubMed · Publisher

Abstract

Investigations into the historical development of specific Threshold Limit Values (TLVs) for many substances have revealed serious shortcomings in the process followed by the American Conference of Governmental Industrial Hygienists. Unpublished corporate communications were important in developing TLVs for 104 substances; for 15 of these, the TLV documentation was based solely on such information. Efforts to obtain written copies of this unpublished material were mostly unsuccessful. Case studies on the TLV Committee's handling of lead and seven carcinogens illustrate various aspects of corporate influence and interaction with the committee. Corporate representatives listed officially as "consultants" since 1970 were given primary responsibility for developing TLVs on proprietary chemicals of the companies that employed them (Dow, DuPont). It is concluded that an ongoing international effort is needed to develop scientifically based guidelines to replace the TLVs in a climate of openness and without manipulation by vested interests.
Effects of informing workers of their health risks from exposure to toxic materials. P.S. Houts, V. McDougall. 1988;13(2):271-9. PubMed · Publisher

Abstract

This study compared the mental health, attitudes, and smoking behaviors of 133 workers who had been informed of health risks from exposure to toxic materials on the job with 137 workers who worked in similar conditions but who had not been told that their health was at risk because of exposure to toxic materials. The informed workers reported more health problems than controls, but there were no significant differences between the informed and uninformed groups in mental health, attitudes toward health hazards in or outside of the workplace, or in smoking rates. Ninety percent of all respondents felt that exposed workers definitely should be told of their health risks. These findings indicate little psychological risk from informing workers about their risks because of exposure to toxic substances and a strong desire on the part of workers to be informed.
Immunological profile of chest x-ray-negative, asymptomatic asbestos workers. N. Lahat, E. Sobel, L. Djerassi, et al. 1988;13(4):473-82. PubMed · Publisher

Abstract

Several immunologic parameters, both humoral and cellular, were studied in the serum and peripheral blood lymphocytes derived from chest x-ray-negative, asymptomatic asbestos workers. All humoral and cellular parameters were intact, except the con-A-induced T cell suppressor activity and T cell division in autologous mixed lymphocyte reaction, which were significantly elevated in the asbestos plant workers. The significance of these increased T cell activities in asbestos exposed people is not clear, and further clinical and immunological follow-up is warranted.
Indirect corrections for confounding under multiplicative and additive risk models. M.H. Gail, S. Wacholder, J.H. Lubin. 1988;13(1):119-30. PubMed · Publisher

Abstract

We define a multiplicative model and an additive model for the hazards associated jointly with exposure and with the presence of a confounder like smoking. Under the multiplicative model, the crude relative risk may be adjusted indirectly, by means of a factor proposed by Axelson [1978], and implicitly by Cornfield et al. [1959] and Schlesselman [1978]. We present corresponding indirect correction formulas under the additive risk model for the risk difference and for the excess relative risk. Conditions are established under which these corrections may be applied to age-adjusted rates from composite study populations. We demonstrate that indirect corrections may be no better than crude measures of risk if one assumes the wrong model for the joint action of the exposure and confounding factors. These results are illustrated on an example of occupational exposure to vermiculite. The limitations of the techniques are discussed.
Linking chrysotile asbestos with mesothelioma. J. Dunnigan. 1988;14(2):205-9. PubMed · Publisher

Summary

In this commentary, the author responded to a court decision, reported in Mealey's Litigation Reports (1987), that chrysotile asbestos caused the mesothelioma of a shipyard worker. The court was aware that the worker had been exposed to substantial amounts of both chrysotile and amphiboles. The author argued that the decision ran counter to a consensus on the different abilities of asbestos fiber types to cause mesothelioma, and he reviewed published studies. The cohort studies he cited covered workers making millboard and paper, textiles, friction materials, asbestos-cement products and gas masks. In several of these studies, the few mesotheliomas found occurred in workers exposed to crocidolite or to mixed fibers. In one U.K. friction-materials factory, at least 8 of 10 mesothelioma deaths among 13,460 workers occurred in workers who made railway brake blocks specified with crocidolite. Lung-burden studies reported more amphibole fibers, mainly amosite and crocidolite, in mesothelioma cases than in controls, with similar amounts of chrysotile. In chrysotile miners and millers with mesothelioma, Churg found about 540 x 10^6 tremolite-group fibers/g, compared with 58 x 10^6 in miner controls. The author concluded that court decisions should rest on the best evidence, including tissue burden analysis, or on the current consensus. He stated that this consensus is that amphiboles are mainly responsible for mesothelioma, whereas chrysotile alone has little or no mesothelioma-producing potential.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Linking chrysotile asbestos with mesothelioma. G.K. Sluis-Cremer. 1988;14(5):631-2. Letter PubMed · Publisher
Methods for testing interactions, with applications to occupational exposures, smoking, and lung cancer. D.C. Thomas, A.S. Whittemore. 1988;13(1):131-47. PubMed · Publisher

Abstract

Various approaches to assessing the interaction between smoking and occupational exposures are described. The definition of interaction depends on the measure of association under consideration and can be expressed in terms of disease risk, time, or dose. Simple descriptive methods and maximum likelihood model fitting methods are presented for analyzing interactions in terms of joint effects on disease risk. Methods for assessing the influence of exposures on times to disease, using appropriate denominators, are also described. The various approaches are illustrated with published data on lung cancer in relation to asbestos, radon daughters, chloromethyl ethers, and arsenic. Some of the mechanisms that can be invoked to explain the observed patterns include initiation and promotion, lung clearance, transport across cell membranes, and mucous secretion.
Methods old and new for analysing occupational cohort data. A.D. McDonald, J.C. McDonald. 1988;13(6):735-6. Letter PubMed · Publisher
Mortality among California highway workers. N. Maizlish, J. Beaumont, J. Singleton. 1988;13(3):363-79. PubMed · Publisher

Abstract

Standardized proportional mortality ratios (PMR) were computed for a population of highway workers. Hazards of highway maintenance work include exposure to solvents, herbicides, asphalt and welding fumes, diesel and auto exhaust, asbestos, abrasive dusts, hazardous material spills, and moving motor vehicles. Underlying cause of death was obtained for 1,570 workers who separated from the California Department of Transportation between 1970 and 1983, and who died in California between 1970 and 1983 (inclusive). Among 1,260 white males, the major findings were statistically significant excesses of cancers of digestive organs (PMR = 128), skin (PMR = 218), lymphopoietic cancer (PMR = 157), benign neoplasms (PMR = 343), motor vehicle accidents (PMR = 141), and suicide (PMR = 154). Black males (N = 66) experienced nonsignificant excesses of cancer of the digestive organs (PMR = 191) and arteriosclerotic heart disease (PMR = 143). Among 168 white females, deaths from lung cancer (PMR = 189) and suicide (PMR = 215) were elevated. White male retirees, a subgroup with 5 or more years of service, experienced excess mortality due to cancers of the colon (PMR = 245), skin (PMR = 738), brain (PMR = 556), and lymphosarcomas and reticulosarcomas (PMR = 514). Deaths from external causes (PMR = 135) and cirrhosis of the liver (PMR = 229) were elevated among white males with a last job in landscape maintenance. White males whose last job was highway maintenance experienced a deficit in mortality from circulatory diseases (PMR = 83) and excess mortality from emphysema (PMR = 250) and motor vehicle accidents (PMR = 196). Further epidemiologic and industrial hygiene studies are needed to confirm the apparent excess mortality and to quantify occupational and nonoccupational exposures. However, reduction of recognized hazards among highway maintenance workers is a prudent precautionary measure.
Obfuscation: a reply to Dr. Dunnigan. D.E. Lilienfeld. 1988;14(5):625-8. PubMed · Publisher
On Dr. Dunnigan's commentary linking chrysotile asbestos with mesothelioma. M.R. Becklake. 1988;14(2):239-40. Letter PubMed · Publisher

Summary

In this letter to the editor, the author responded to the debate raised by Dr. J. Dunnigan's 1988 commentary in the same journal on linking chrysotile asbestos with mesothelioma. The letter presented no new data. The author argued that the debate illustrated the problem of translating scientific evidence, with its fragility and uncertainty, into legal decisions that do not reflect this uncertainty. She stated that science proceeds not by proof but by refutation and suggestion of hypotheses. She added that medical diagnosis, particularly judgments about causality, follows the same steps, using epidemiologic studies of communities to formulate probabilities about the individual case. A pronouncement on an individual case was therefore described as a hypothesis, the best available to explain the facts. The author noted that court records seldom reflect this uncertainty, that expert witnesses who try to convey it are ill received, and that the tentative nature of answers is lost in the record. She held that this degrades science in the public mind, especially when environmental issues and diseases with long incubation periods, such as cancer, are debated in courts before the evidence for causality is complete. She concluded that the public is capable of understanding the scientific approach and could be invited to encourage, enhance, and share its potential rather than mock its fragility.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
On the statement by Jacques Dunnigan. J.M. Davis. 1988;14(5):629-30. PubMed · Publisher
Pleural mesotheliomas and asbestos exposure in the pulp and paper industries: a new risk group identified by linkage of official registers. B. Järvholm, H. Malker, B. Malker, et al. 1988;13(5):561-7. PubMed · Publisher

Abstract

Analysis of data obtained by linking the 1960 Swedish Census and the Swedish Cancer Registry has demonstrated an increased risk of pleural mesothelioma among pulp and paper workers. The present study was undertaken with the aim of revealing possible environmental risk factors. The work histories of the 25 cases identified earlier were reviewed. "Certain" or "probable" exposure to asbestos was found among 70% of these workers. The study illustrates how linkage of official registers can be used to identify new risk environments and encourage the establishment of preventive measures.
Railroad workers with pleural plaques: I. Spirometric and nitrogen washout investigation on smoking and nonsmoking asbestos-exposed workers. U. Hjortsberg, P. Orbaek, M. Aborelius, et al. 1988;14(6):635-41. PubMed · Publisher

Abstract

Eighty-seven workers exposed to asbestos in a railroad car repair shop, with characteristic asbestos-induced pleural plaques, underwent extensive lung-function examination. Vital capacity (VC) showed the greatest reduction among the static lung volumes, with an asymmetrical distribution of one-fourth of the subjects below 80% of the predicted value. Logistic regression demonstrated VC to be sufficient for optimal discrimination of asbestos-exposed subjects from a group of matched controls. No further discriminatory power was gained by additional spirometric measures, lung mechanics, blood gas analysis, or diffusing capacity. Smoking had an influence on dynamic but not on static lung volumes. In conclusion, reduced static lung volumes among smoking asbestos-exposed workers with pleural plaques should, in the absence of other lung diseases, be mainly attributed to the asbestos exposure.
Railroad workers with pleural plaques: II. Small airway dysfunction among asbestos-exposed workers. U. Hjortsberg, P. Orbaek, M. Aborelius, et al. 1988;14(6):643-7. PubMed · Publisher

Abstract

Increased volume of trapped gas (VTG) was found in 87 asbestos-exposed railroad repair shop workers, divided into three subgroups according to smoking habits. All the examined subjects had pleural plaques. Determination of VTG was used to study function of small airways. Increased VTG was found among asbestos-exposed smokers as well as nonsmokers. In both groups the VTG:TLC ratio was elevated compared with controls. Increased VTG is a sign of small airways dysfunction. In asbestos-exposed subjects, it might be caused by an early peribronchial reaction to inhaled asbestos fibers.
Re: Frumkin H, Berlin J (1988): asbestos exposure and gastrointestinal malignancy: review and meta-analysis. Am J Ind Med 14: 79-85. H. Frumkin. 1988;14(4):493. Letter PubMed · Publisher
Relative risk of mesothelioma among railroad machinists exposed to chrysotile. T.F. Mancuso. 1988;13(6):639-57. PubMed · Publisher

Abstract

This study challenges the assertion of low relative risk of chrysotile in the causation of mesothelioma. Data are provided on the time period use of various types of asbestos in the United States and in insulation materials. The focus of the study is on mesothelioma among railroad machinists employed in the steam locomotive era who were exposed to chrysotile. Within a cohort of machinists alive January 1, 1945, a sub-cohort method was applied to all successive machinists hired in each of the respective years (1920-1929) followed through 1986. The total cohort was 181 and the number of deaths 156, with 14 mesotheliomas identified among 41 cancer deaths. The findings demonstrated an extremely high relative risk for machinists exposed to chrysotile for the induction of mesothelioma in the individual year of hire cohorts. A similar observation was noted for other crafts hired in the same time period. One mesothelioma occurred for every 13 machinists hired in the succeeding years (1920-1929) and constituted 34% of all cancer deaths. It is concluded that chrysotile is far more hazardous in the induction of mesotheliomas and that the asbestos cancer risk in the steam locomotive eras was much higher than had been previously estimated.
Reply to Dr. Dunnigan. Chrysotile as a mesothelial carcinogen in man. A. Churg. 1988;14(2):235-8. PubMed · Publisher

Summary

In this letter, Churg replied to a commentary by Dr. Dunnigan (1988) about whether chrysotile asbestos causes mesothelioma in humans and how studies of lung mineral content should be interpreted. Drawing on his own recent review, Churg reported finding 53 cases in which a reasonable argument could be made that mesothelioma was caused by chrysotile. Of these, 41 occurred in people exposed to chrysotile ore, usually through mining and milling, 10 in chrysotile factory workers, and 2 in other settings. In 11 of these cases, mineral analysis of lung tissue found only chrysotile ore components (chrysotile and tremolite). In nine Quebec miners and millers with mesothelioma, the median chrysotile plus tremolite lung burden was about three times that of exposure-period matched miners and millers with asbestosis. It was more than two orders of magnitude greater than the amphibole content in shipyard workers with mesothelioma. Churg argued that chrysotile is a weak mesothelial carcinogen that requires very high exposure, rather than a non-carcinogen. He also argued that low chrysotile lung content may poorly reflect exposure, because chrysotile does not accumulate readily in the lung. He described tremolite as the possible causal agent as consistent with the data but not established, and he declined to comment on legal cases. He concluded that amosite and crocidolite are much more potent, but extremely large doses of chrysotile can produce mesothelioma.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Respiratory morbidity in workers exposed to asbestos in the primary manufacture of building materials. T.G. Robins, M.A. Green. 1988;14(4):433-48. PubMed · Publisher

Abstract

Former employees (214) of a plant that manufactured asbestos-containing building materials (wallboard and acoustic tile) from 1958 through 1974 were screened for asbestos-related pulmonary disease. Results are presented on 182 union members whose names appeared on a 1966 seniority list in one of six departments believed to have had substantial asbestos exposure. The study population demonstrated a high frequency of pulmonary abnormalities often associated with asbestos exposure: low mean forced vital capacity percent of predicted (FVC % predicted), low mean forced expiratory volume at one second percent of predicted (FEV1 % predicted), presence of parenchymal abnormalities (40.1% with profusion scores of 1/0 or higher), and 30.5% with bilateral pleural abnormalities on chest roentgenograms. In addition, râles in two or more locations were found in 22.8% on examination of the chest, 30.6% gave a history of chronic bronchitis, and 34.8% of dyspnea grade two or higher. Calculated asbestos exposure scores, based upon participant recall, were not found to be associated with these abnormalities. The abnormal findings were not adequately explained by potential confounders such as cigarette smoking. Other notable findings in this study include the presence of smoking-adjusted decrements in pulmonary function associated with moderate profusion scores (i.e., 1/0 and 1/1) and the presence of a substantial degree of obstructive lung disease (19.2%) in this population.
Response to Dr. Dunnigan's commentary. The role of chrysotile in the pathogenesis of mesothelioma. J.M. Craighead. 1988;14(2):241-3. Letter PubMed · Publisher
Time to reconsider TLVs. L. Djerassi. 1988;13(5):611-2. Letter PubMed · Publisher
Tremolite, other amphiboles, and mesothelioma. J.C. McDonald. 1988;14(2):247-9. Letter PubMed · Publisher
Usage of personal protective devices among Egyptian industrial workers. A.A. Kamal, G.M. Sayed, M.H. Hassan, et al. 1988;13(6):707-16. PubMed · Publisher

Abstract

A systematic random sample of 405 workers from metal, asbestos cement pipes, textile, and viscose rayon industries were interviewed using a prepared and tested questionnaire. Personal Protective Devices (PPDs), namely goggles, gloves, respirators, and ear defenders, had been distributed to all workers on the payroll and were used by 31.4%. Usage of PPDs was associated with the educational level, duration of occupation, awareness of the work hazards, and knowledge about the purpose of PPDs. Marked association was found between nonusage of PPDs and discomfort, interference with job performance, and the psychological feeling of lowering the person's prestige by the wearing of PPDs. Nonusage was also associated with lack of maintenance of the device and absence of supervision of its usage. Users were more numerous among married workers and workers with urban residence than among unmarried workers and those with rural residence, respectively. No association could be found between the rate of usage and the worker's age except for ear plugs, for which nonusage was proportional to the worker's age. The most important factors were those related to the role of the safety staff and the discomfort of the devices. Recommendations for occupational health authorities on the basis of the above evaluation are suggested.
Use of exposure registration in the prevention of occupational cancer in Finland. J. Alho, T. Kauppinen, E. Sundquist. 1988;13(5):581-92. PubMed · Publisher

Abstract

A nationwide system for monitoring occupational exposure to a wide range of carcinogens has been in operation in Finland since 1979. The primary aim of the system is to lead to the identification, evaluation, and eventual elimination of the exposures. The number of exposed workers reported to the register was about 20,000 out of the work force of 2.3 million in 1979-1984. The most common exposures were chromates, nickel and its inorganic compounds, and asbestos. Data are presented to show that the system has been at least partially successful in decreasing exposures at work places. As an example, we discuss the decrease in the use of hydrazine, which was previously widely used as an anticorrosive agent at power plants. The statistical quality of the system is discussed, and possibilities for future research uses of the computerized data base are outlined.
Use of hospital discharge data in the surveillance of occupational disease. K.D. Rosenman. 1988;13(2):281-9. PubMed · Publisher

Abstract

Computerized hospital discharge diagnoses are useful for occupational disease surveillance. One thousand one hundred twenty-six individuals with asbestosis and 268 individuals with silicosis were identified in New Jersey for the four-year period 1979-1982. Computer-generated maps help to dramatize the localization of these conditions to certain geographic areas. The attributes and limitations of using hospital discharge diagnoses for occupational disease surveillance are discussed: initial follow-up data are presented for individuals with silicosis.
A case-referent study of lung tumors in non-asbestos textile workers. E. Paci, E. Buiatti, M. Geddes. 1987;11(3):267-73. PubMed · Publisher

Abstract

A case series in the Province of Florence showed an increased risk of mesothelioma in textile workers (nonasbestos) and a survey of working conditions confirmed potential exposure to asbestos. In order to investigate the risk in textile workers, including some specific job titles, a case-referent study on lung tumors was carried out. The lung cancer cases included 441 males with histologically confirmed primary lung cancer during the period 1980-1983. Referents included 1,075 males selected from two hospitals and matched for age, sex, and smoking habits. Those who had "ever worked" in the textile industry showed an adjusted odds ratio of 1.52 (95% C.I. 1-2.25) compared with other "industrial workers." This moderately increased risk is maintained in selected jobs in the textile industry. An analysis of the modifying effect of time factors showed an increased risk in the period of 15-35 years from the date of first employment in the industry. The results support the hypothesis that a probable risk of lung cancer in textile workers in the Prato area was related to asbestos exposure.
A rapid and simple method of extracting asbestos bodies from lung tissue by cytocentrifugation. A. Ehrlich, Y. Suzuki. 1987;11(1):109-16. PubMed · Publisher

Abstract

During analyses of alkali digested lung tissue for asbestos bodies, we observed that the number of asbestos bodies in the discarded waste frequently exceeded the number in the filtered residue, the number reported in the standard diagnostic method. This observation led to the exploration of alternative techniques that would optimize the recovery of asbestos bodies. We describe a new, simple, and rapid method for extracting asbestos bodies from digested lung tissue using a cytocentrifuge, in which the waste extraction and filtration steps are eliminated. Samples of digested lung tissue are ready for light microscopy after 10 minutes of cytocentrifugation directly onto a glass slide. The standard method was compared with the cytocentrifuge technique using lung tissue from four asbestos-exposed workers and four controls with no known history of exposure. The number of asbestos bodies extracted by the centrifuge method was, on average, seven times higher than the number found with the standard method. A detailed quantitative study was made of the case that had the most asbestos bodies (comparison of the number of asbestos bodies counted in both "residue" and "waste", applying the filtration and cytocentrifuge methods). The number of asbestos bodies found in the discarded waste significantly exceeded the number in the "reportable" filtered residue.
Accumulation of long asbestos fibers in the peripheral upper lobe in cases of malignant mesothelioma. A. Churg, B. Wiggs. 1987;11(5):563-9. PubMed · Publisher

Abstract

Animal studies suggest that mesothelioma is most effectively induced by fibers longer than 8 mu. However, studies of asbestos fibers recovered from human lungs in cases of mesothelioma indicate that, at least in large-scale samples, relatively few fibers meet this size criterion, perhaps implying that the animal data do not apply to man. Since asbestos concentration in lung is known to be extremely inhomogeneous, it is also possible that long fibers may selectively accumulate in specific sites, such as under the pleura. To examine this possibility, we selected ten cases of mesothelioma that contained relatively large amounts of amosite asbestos and extracted fibers from an 0.5-cm-thick strip of subpleural tissue and an area 3-cm deep to the subpleural sample for upper and lower lobes. Amosite fibers were identified and sized by electron microscopic techniques. Fibers in the peripheral upper lobe were significantly longer, broader, and of higher aspect ratio than those in the central upper lobe. The lower lobe showed a reverse pattern, with longer fibers and broader fibers in the central sample. These data indicate that the two lobes behave differently in regard to fiber size, with selective accumulation of long fibers in the peripheral upper lobe, but not in the peripheral lower lobe. Whether these differences reflect differences in initial deposition of fibers within the lung, or, more likely, specific redistribution of fibers, is unclear, but in either case, accumulation of long fibers immediately under the upper lobe pleura may be important in the genesis of mesothelioma.
An asbestos hazard in the reprocessed textile industry. M.M. Quinn, D. Kriebel, E. Buiatti, et al. 1987;11(3):255-66. PubMed · Publisher

Abstract

Epidemiologic studies have identified an excess risk of lung cancer and mesothelioma among workers in the reprocessed textile industry in Prato, Italy. These studies suggested that there may have been asbestos hazard in this industry although exposure was not known to exist. An industrial hygiene investigation was conducted to determine whether there was previous or current asbestos exposure in the industry. Walk-through surveys, environmental sampling, process documentation, and management and worker interviews were conducted in 13 textile reprocessing establishments. Polypropylene bags that once contained asbestos were found in 2 of the 13. Asbestos bags were cut open and used to cover bales of rags which were then distributed throughout the world. Workers were exposed to asbestos while handling the bags which were contaminated with chrysotile, amosite, and crocidolite. Additional sources of asbestos exposure that may have existed in the past in the industry are also discussed.
Asbestos disease in sheet metal workers: II. Radiologic signs of asbestosis among active workers. D. Michaels, S. Zoloth, M. Lacher, et al. 1987;12(5):595-603. PubMed · Publisher

Abstract

A review of chest x-rays of 707 currently employed New York metropolitan area sheet metal workers found that 29.3% of the workers with 20 years or more of union membership (a surrogate for years of exposure) had radiologic abnormalities characteristic of parenchymal and/or pleural asbestosis, with 18.6% having abnormalities characteristic of parenchymal asbestosis (International Labor Organization [ILO] classification 1/0 or higher) and 17.4% of pleural asbestosis. The prevalence of abnormalities characteristic of either parenchymal and/or pleural asbestosis in the group as a whole was 16.4%, with 10.9% exhibiting signs of parenchymal asbestosis and 9.2% of pleural asbestosis. There was a strong, statistically significant relationship between years in the trade and the prevalence of radiologic abnormalities. These findings underscore the need for medical surveillance of all asbestos-exposed construction workers, including retirees and workers who have had past exposure but who are no longer exposed.
Asbestos exposure, cigarette smoking, and airflow limitation in long-term Canadian chrysotile miners and millers. R. Bégin, R. Boileau, S. Péloquin. 1987;11(1):55-66. PubMed · Publisher

Abstract

To investigate further the relationships of asbestos exposure, cigarette smoking, and airflow limitation, we have obtained detailed pulmonary function tests (PFT) in 331 long-term Canadian chrysotile workers, 34 of whom were lifetime nonsmokers. Three disease categories were defined on the bases of standard diagnostic criteria, gallium-67 lung uptake, and the lung pressure-volume curve. Category A was composed of workers without changes suggestive of alveolitis or asbestosis. There were eight nonsmokers (ns), among whom we found a statistically significant 30% reduction in airflow conductance (Gus) at low lung volume, which is consistent with the concept of an asbestos airway lesion. The 85 smokers (sm) of category A had reduction of Gus at both high and low lung volumes. Category B was composed of workers without asbestosis but with evidence of asbestos alveolitis. In the six ns, Gus was significantly reduced to 50% normal at low lung volume. The 59 sm had reduction of Gus at both high and low lung volumes but less severely than sm in category A. Category C was composed of workers with asbestosis. The 20 ns had restrictive pattern of lung function, and Gus was decreased to 39% normal at 50% TLC. The 153 sm in C had airflow reduction comparable to sm in B. We concluded that asbestos exposure, which leads to asbestos airway disease, asbestos peribronchiolar alveolitis, and asbestosis, causes airflow limitation at low lung volume but does not reduce the expiratory flow rates on the flow-volume curve in lifetime nonsmokers. In the smoking asbestos workers with alveolitis or asbestosis, the major component of airflow limitation is a smoking effect. In these smoking workers, rigidity of the lung lessens airflow obstruction associated with smoking at the expense of increased work of breathing.
Cause-specific mortality among male chemical workers. G.G. Bond, E.A. McLaren, J.B. Cartmill, et al. 1987;12(4):353-83. PubMed · Publisher

Abstract

Cause specific mortality was surveyed among 37,682 male employees with three or more days of service between 1940 and 1982 at the Midland or Bay City, Michigan, locations of Dow Chemical USA. Vital status was ascertained through 1982 for 97.5% of the cohort members, and death certificates were obtained for 97.1% of the 7,751 decedents. Comparisons of observed mortality with expected levels based on any of three general population groups (US, Michigan, or seven local counties) consistently demonstrated lower mortality in the cohort from each of the major causes of death, including total malignant neoplasms. Unique among hourly employees was significant excess mortality in the categories of cancer of other lymphatic tissue, and motor vehicle accidents, and both hourly and salaried nonexempt employees experienced significantly higher mortality from other and ill-defined cancers. The influence of duration of employment and age at and period of hire were explored with the Mantel-Haenszel method as adapted for a cohort study. Results were evaluated both including and excluding the mortality experience of subsets of employees with past exposure to known human carcinogens (arsenic, asbestos, bis-chloromethyl ether, benzene, organic dyes, and vinyl chloride). The use of the general mortality survey in monitoring whether or not there are major health problems among the employees and in setting research priorities is emphasized.
Historical perspective on asbestos: policies and protective measures in World War II shipbuilding. J.K. Corn, J. Starr. 1987;11(3):359-73. Historical article PubMed · Publisher

Abstract

Current public health consequences of poorly controlled utilization of asbestos in the past can be traced back, in part, to decisions made 45 or more years ago. This paper focuses on the extensive use of asbestos as a fireproofing and insulating material in shipbuilding in the 1940s, when World War II industrial expansion brought about a hitherto unprecedented rise in the amount of asbestos utilized. Twenty years after World War II, asbestos diseases began to manifest themselves, affecting thousands of shipyard workers as well as other workers who had been exposed in the 1940s and during the postwar period. By scrutinizing past actions, the paper argues that social forces, as well as science and technology, affect the setting of priorities and the determination of policy regarding needed but hazardous materials.
Lung function and respiratory symptoms in subjects with asbestos-related disorders: a cross-sectional study. B. Hilt, J.T. Lien, P.G. Lund-Larsen. 1987;11(5):517-28. PubMed · Publisher

Abstract

The prevalence of respiratory symptoms and lung function impairment was studied in a sample of men from a population screening of asbestos-related disorders. When the rates were adjusted for age and smoking habits, 83 subjects with lung fibrosis had an increased prevalence of respiratory symptoms, in particular, phlegm when coughing and breathlessness grades 1-3. Among 200 subjects under 70 years of age who had pleural plaques only, a statistically significant increase was observed in the prevalence of breathlessness grade 1 compared to an external reference population. Among 98 asbestos-exposed subjects who had normal chest X-rays, there was an increase in the prevalence of breathlessness grade 2, cough during the day, and phlegm when coughing. There was a higher proportion of subjects with lung fibrosis who were below 80% of the predicted values for forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) than in the other groups. There was also a higher proportion of subjects with pleural plaques only who were below 90% of the predicted value for FVC than in a group of 90 subjects without asbestos exposure. In accordance with previous studies, these results indicate that pleural plaques in asbestos workers may be of greater importance as a clinical feature than has been recognized in the past.
Malignant mesothelioma in non-asbestos textile workers in Florence. E. Paci, S. Dini, E. Buiatti, et al. 1987;11(3):249-54. PubMed · Publisher

Abstract

By means of a review of histological diagnosis in the Pathology Department of the University of Florence, suspected cases of malignant mesothelioma, diagnosed in the period 1979-1984, were identified. Study of histological specimens permitted the selection of 13 cases of malignant mesothelioma resident in the Province of Florence. To these cases, referents were matched for age, sex, and year of hospital admission, with residence weighted for the general population of the Province. Both cases and referents (or their next of kin) completed an occupational questionnaire detailing possible occupational exposures. Out of the 13 cases of mesothelioma, 6 were textile workers and 5 of these were "rag-sorters". There were only 5 textile workers among the 52 controls. No asbestos cloth production plants have been in operation in the area from which the cases and referents are derived. Possible sources of exposure to asbestos in the textile industry of this area are discussed.
Past exposure to asbestos among active railroad workers. E. Garshick, M.B. Schenker, S.R. Woskie, et al. 1987;12(4):399-406. PubMed · Publisher

Abstract

Before the transition from steam- to diesel-powered locomotives during the 1950s certain railroad workers had the opportunity for significant occupational exposure to asbestos. Past studies have demonstrated that older workers with jobs associated with the repair of steam locomotives had the most exposure. To determine the prevalence of currently employed railroad workers with past asbestos exposure we surveyed 514 white male employees of an active US railroad by mail questionnaire. Twenty-one percent (50/242) of the workers 50 years old or greater had likely asbestos exposure compared to 3% (9/275) of the workers 49 years old or less (p less than .001). Fifteen (30%) of the 50 older workers with likely asbestos exposure had current job titles no longer suggestive of past exposure. The duration of exposure of these older active workers was short, (median = 3 years; range, 6 months to 15 years). A history of past asbestos exposure may still be obtained among active railroad workers with past railroad shop employment.
Proportionate mortality ratio analysis of automobile mechanics and gasoline service station workers in New Hampshire. E. Schwartz. 1987;12(1):91-9. PubMed · Publisher

Abstract

A proportionate mortality ratio (PMR) analysis of all deaths recorded from 1975 to 1985 among New Hampshire white male residents (age 20 years or older) was performed using death certificate information. Among automobile mechanics, the analysis revealed increases in mortality from leukemia (PMR = 178, N = 6); cancers of the oral cavity (PMR = 163, N = 4), lung (PMR = 112, N = 36), bladder (PMR = 169, N = 5), rectum (PMR = 182, N = 4), and lymphatic tissues (PMR = 200, N = 6); and cirrhosis of the liver (PMR = 140, N = 13) and suicide (PMR = 177, N = 22; p less than 0.05). Workers in the gasoline service station industry experienced a leukemia mortality excess (PMR = 328, N = 3; p less than 0.05) as well as increases in deaths from suicide (PMR = 162, N = 4), emphysema (PMR = 245, N = 4), and mental and psychoneurotic conditions (PMR = 394, N = 3). These workers are potentially exposed to a variety of substances including gasoline vapor, benzene, solvents, lubricating oils and greases, and asbestos (from brake and clutch repair) as well as welding fumes and car and truck exhaust. Despite limitations regarding the small number of deaths and methodologic constraints, the results of this analysis suggest that one or more of the exposures experienced by these workers poses a significant carcinogenic risk. More definitive epidemiologic studies are required to determine if the leukemia excess is associated with exposure to benzene, gasoline, or other workplace substances.
Serum type III procollagen peptide: indicator for pulmonary fibrosis: II. Application in 80 asbestos insulation workers. I. Okazaki, K. Maruyama, Y. Kobayashi, et al. 1987;11(4):439-46. PubMed · Publisher

Abstract

An assay for type III procollagen peptide (P-III-P) was applied to serum from 80 asbestos insulation workers in order to evaluate its relationship with pulmonary and pleural fibrosis. The serum peptide levels of 16 control workers were 7.8 +/- 2.0 ng/ml (mean +/- SD). An association between the serum values of P-III-P and the profusion of small irregular opacities on chest X-rays was noted. The levels in the group with moderate interstitial pulmonary fibrosis [profusion category 2(2/1, 2/2, and 2/3)] and with marked interstitial pulmonary fibrosis [profusion category 3(3/3)] were 9.9 +/- 2.3 ng/ml (n = 5) and thus tended to be higher than those of 16 control workers (p less than 0.1). On the other hand, there was not correlation between serum peptide levels and pleural lesions nor between the former and duration of asbestos exposure. From the results of the investigation [part I of which is reported elsewhere (Okazaki et al, 1986)] this assay may be useful for detecting individuals with a more marked tendency for progression of interstitial pulmonary fibrosis due to asbestos exposure in insulation work.
Some investigations into the nature and cause of massive fibrosis (MF) in the lungs of South African gold, coal, and asbestos mine workers. M.C. Leibowitz, B. Goldstein. 1987;12(2):129-43. PubMed · Publisher

Abstract

Samples from fibrotic lung lesions greater than 1 cm in diameter macroscopically (by definition, massive fibrosis; MF) were taken from the lungs of 9 randomly selected post-mortem cases of mine workers all showing a background of a pneumoconiosis. These samples were studied histologically, biochemically, and by X-ray diffraction and electron microscopy. As controls for the biochemical and X-ray diffraction investigations, nonfibrosed lung tissue was taken from the same specimens. The findings suggest that the higher quartz content may be the primary cause responsible for the MF formation in this series of cases, while other factors such as tuberculosis may play a part according to some relevant literature on MF. Although an area of MF appears macroscopically to be a solid lesion, on microscopy this is not the case and the lesion is composed of dense and sparse collagen bundles and cellular elements.
The morbidity and mortality of vermiculite miners and millers exposed to tremolite-actinolite: Part I. Exposure estimates. H.E. Amandus, R. Wheeler, J. Jankovic, et al. 1987;11(1):1-14. PubMed · Publisher

Abstract

The vermiculite ore and concentrate of a mine and mill near Libby, Montana, was found to be contaminated with fibrous tremolite-actinolite. Of 599 fibers (length greater than 5 microns and width greater than 0.45 micron) counted in eight airborne membrane filter samples, 96% had an aspect ratio greater than 10 and 16% had an aspect ratio greater than 50. Additionally, 73% of the fibers were longer than 10 microns, 36% were longer than 20 microns, and 10% were longer than 40 microns. Estimates of exposure before 1964 in the dry mill were 168 fibers/cc for working areas, 182 fibers/cc for sweepers, 88 fibers/cc for skipping, and 13 fibers/cc for the quality control laboratory. In 1964-1971, exposure estimates for these areas were 33, 36, 17, and 3 fibers/cc, respectively. Estimates of exposures in the mine before 1971 ranged from 9-23 fibers/cc for drillers and were less than 2 fibers/cc for nondrilling jobs. All 8-hr TWA job exposure estimates decreased from 1972-1976, and from 1977-1982 were less than 1 fiber/cc.
The morbidity and mortality of vermiculite miners and millers exposed to tremolite-actinolite: Part II. Mortality. H.E. Amandus, R. Wheeler. 1987;11(1):15-26. PubMed · Publisher

Abstract

The vermiculite ore and concentrate of a mine and mill located near Libby, Montana was found to be contaminated with a fiber of the tremolite/acetinolite series. A study was conducted to estimate the exposure-response relationship for mortality for 575 men who had been hired prior to 1970 and employed at least 1 year at the Montana site. Individual cumulative fiber exposure (fiber-years) was calculated. Results indicated that mortality from nonmalignant respiratory disease (NMRD) and lung cancer was significantly increased compared to the U.S. white male population. For those workers more than 20 years since hire, the standard mortality rate (SMR) for lung cancer (ICDA 162-163) was 84.7, 225.1, 109.3, and 671.3 for less than 50, 50-99, 100-399, and more than 399 fiber-years respectively. Corresponding results for NMRD (ICDA 460-519) were 327.8, 283.5, 0, and 278.4. Based on a linear model for greater than 20 years since hire, the estimated percentage increase in lung cancer mortality risk was 0.6% for each fiber-year of exposure. At 5 fiber-years, the estimated percentage was 2.9% from an unrestricted (nonthreshold) linear model and 0.6% from a survival model.
The morbidity and mortality of vermiculite miners and millers exposed to tremolite-actinolite: Part III. Radiographic findings. H.E. Amandus, R. Althouse, W.K. Morgan, et al. 1987;11(1):27-37. PubMed · Publisher

Abstract

A study was conducted to estimate the exposure-response relationship for tremolite-actinolite fiber exposure and radiographic findings among 184 men employed at a Montana vermiculite mine and mill. Workers were included if they had been employed during 1975-1982 and had achieved at least 5 years tenure at the Montana site. Past fiber exposure was associated with an increased prevalence of parenchymal and pleural radiographic abnormalities. Smoking was not significantly related to the prevalence of small opacities. However, the number of workers who had never smoked was small, and this prevented measurement of the smoking effect. Under control for smoking and age, the prevalence of small opacities was significantly greater for vermiculite workers with greater than 100 fiber/cc-years exposure than for comparison groups (cement workers, blue collar workers, and coal miners) who had no known occupational fiber exposure. A logistic model predicted an increase of 1.3% in the odds ratio for small opacities at an additional exposure of 5 fiber-years.
Tremolite/chrysotile ratios. G. Scansetti, G. Piolatto. 1987;12(1):117-8. Letter PubMed · Publisher
Advances in asbestos disease research. A symposium. April 22, 1985, Tel Aviv, Israel. Proceedings. 1986;10(5-6):441-572. PubMed
Advances in asbestos disease research. Common practical problems: panel discussion. G.L. Baum, S. Gitter, J.R. Goldsmith, et al. 1986;10(5-6):563-72. PubMed · Publisher
Asbestos dust exposure during brake repair. K. Rödelsperger, H. Jahn, B. Brückel, et al. 1986;10(1):63-72. PubMed · Publisher

Abstract

About 10,000 tons of chrysotile per year are used in the Federal Republic of Germany for the production of friction materials. During brake repair an unknown number of approximately 300,000 mechanics in automobile service stations are exposed to asbestos dust. In a field study, asbestos fiber concentrations during brake repair were measured. Occupational histories and chest X-rays of brake service mechanics are being examined. Ninety dust measurements in 76 service stations were made by phase contrast microscopy and by scanning transmission electron microscopy. By electron microscopy, extremely fine chrysotile fibers with lengths less than 5 microns were identified in brake drum dust. Fibers with lengths greater than or equal to 5 microns constituted less than 1% of all chrysotile fibers counted in brake drum dust. Short-term asbestos dust exposures were measured by light microscopy in 101 personal samples during blowing out of brakes, and grinding and turning of brake linings. During blowing out of car brakes, as well as during grinding of brake linings, the product of fiber concentration with length greater than 5 microns and sampling time amounted to about 4-5 fibers/ml X min corresponding to a concentration of 10(6) fibers/m3 over 4-5 min. For trucks and buses higher amounts of 5-10 X 10(6) fibers/m3 X min were observed during these operations. From occupational histories of 210 vehicle mechanics, an average duration of employment of mean +/- s = 21 +/- 10 years and a mean cumulative fiber dose of mean +/- s = (0.54 +/- 1.1) X 10(6) fibers/m3 X years were calculated.
Asbestosis: interstitial pulmonary fibrosis and pleural fibrosis in a cohort of asbestos insulation workers: influence of cigarette smoking. R. Lilis, I.J. Selikoff, Y. Lerman, et al. 1986;10(5-6):459-70. PubMed · Publisher

Abstract

A cohort of 1,117 asbestos insulation workers was established in 1963 and has been prospectively followed since then. Chest X-ray abnormalities detected at the initial medical examination, and interpreted according to the International Labour Office Classification of Radiographs of Pneumoconioses are reported in this paper. The prevalence of all radiographic abnormalities (pleural and pulmonary) increased with duration from onset of asbestos exposure. A positive smoking history was associated with a significantly higher prevalence of small irregular opacities indicating interstitial pulmonary fibrosis. Such an association was not found for pleural fibrosis. The possible mechanisms which underlie the effect of smoking on asbestos-induced interstitial fibrosis seem to be of much less importance in the development of pleural fibrosis. Progression of radiographic changes over the 20-year interval 1963-1983 will be separately reported as will the predictive significance of these changes.
Clinical findings among asbestos workers in U.S.: influence of cigarette smoking. Y. Lerman, I.J. Selikoff, R. Lilis, et al. 1986;10(5-6):449-58. PubMed · Publisher

Abstract

All members of a large union were invited to participate in a study of potentially adverse effects of asbestos exposure. Clinical findings among 1,117 workers (90% of those eligible for examination) are presented in this study. Cough was much less common among those without a history of cigarette smoking, although duration from onset of employment did not appreciably affect the prevalence of cough among the smokers. Rhonchi present among nonsmokers were limited in extent, but were marked and diffuse among cigarette smokers. Although dyspnea was as prevalent among nonsmokers as in smokers forty years and more after onset of exposure, it was relatively uncommon and found only among smokers when examined shortly after onset of exposure. Cigarette smoking had less influence on the prevalence of râles among asbestos workers; both smokers and nonsmokers showed this finding when examined 30 years and more after onset of asbestos exposure. Analysis of powerhouse work experience and mask use as possible confounders indicated no difference in prevalence of these characteristics between the smokers and nonsmokers.
Common problems in asbestos-related pulmonary diseases. A.H. Rubin. 1986;10(5-6):555-62. PubMed · Publisher

Abstract

Exposure to asbestos is an important public health hazard in all industrialized societies. Although the pulmonary manifestations of prolonged asbestos fiber exposure are well known, there is considerable disagreement over specific clinical features and employment policies. Three of these controversies are the following: a) Can lung cancer be ascribed to asbestos exposure in subjects who lack evidence of asbestosis? b) Is there any clinical significance to benign asbestos pleural changes? c) Is it advisable to change jobs when evidence of asbestosis or benign pleural changes develop? The purpose of this presentation is to help develop a suitable public policy for Israel. Such a policy would have clinical importance as well as economic, legal, and social consequences for the individual and society as a whole.
Comparative epidemiology of men exposed to asbestos and man-made mineral fibers. J.R. Goldsmith. 1986;10(5-6):543-52. PubMed · Publisher

Abstract

Comparative analyses are presented of selected studies of long-term reactions to occupational exposures to asbestos and man-made mineral fibers (MMMF), with emphasis on studies with dose-response information and long enough period of follow-up to observe lung cancer excess, if it occurred. Uniform dose estimates based on average number of fibers per milliliter were derived and tabulated with the corresponding standard mortality (or morbidity) ratio (SMR), crude probability for each unfavorable outcome, and the likelihood that at least as many deaths would have occurred as a result of the expected numbers under Poisson assumptions. A dose-response relationship was said to have been indicated when the crude probability increased monotonically with dose and/or the Poisson probability decreased and reached a value of less than 0.05. Some arbitrary assumptions had to be made in estimation of the dose, and they may need to be corrected. Gravimetric dose estimates may have given different results. Studies selected for analysis included Quebec asbestos miners and asbestos cement workers exposed to asbestos, and pooled U.S. and European studies of MMMF workers, as well as a sample of cigarette-smoking fiberglass workers whose X-ray films were evaluated for fine nodular or irregular opacities. The lowest dose capable of showing either a statistically significant excess (single point criterion--SP) or the median dose in an apparent dose-response relationship with cause of death or radiological results is tabulated. Radiological changes show a dose-response relationship for all types, with a median dose for asbestos of 2.8 fibers/ml. For fiberglass workers, the median dose of electron-microscopically detected fibers was two orders of magnitude less. For asbestos SP, exposures of 1.4 to 22 fibers/ml were associated with increased lung cancer, while for mineral wool, the minimal level with significant SP increase in lung cancer was an order of magnitude less. Based on fiber or particle counts, man-made mineral fibers appear to be more potent than asbestos with regard to chronic pulmonary disease.
Dust levels in an asbestos-cement factory: problem solving. A. Sharon. 1986;10(5-6):533-7. PubMed · Publisher

Abstract

Isasbest Ltd., an asbestos-cement factory in Israel, has established dust-preventive measures, maintained high ecological and medical standards, and assisted afflicted workers suffering from asbestos-related diseases. The problems of the handling of asbestos and its relationship to health should be approached according to the conditions in each specific workplace so that reasonable solutions can be found for proper control.
Fiber size and number in workers exposed to processed chrysotile asbestos, chrysotile miners, and the general population. A. Churg, B. Wiggs. 1986;9(2):143-52. PubMed · Publisher

Abstract

We analyzed chrysotile and chrysotile-associated amphibole (largely tremolite) asbestos fibers in 21 workers exposed to various types of processed (milled) chrysotile ore, 20 long-term chrysotile miners, and 20 members of the general population (controls). Significantly greater amounts of both chrysotile and tremolite were found in processed-ore workers and miners than in controls. On average, the mean fiber lengths and aspect ratios for the mining and processed-ore-exposed workers were similar and were significantly greater than the values seen in the controls; within the processed-ore group, there was a marked variation in these parameters, and some workers appeared to be exposed to fairly long, thin fibers. It was found empirically that the fiber size data, and to a lesser extent the concentration data, could be used to classify workers accurately into those with processed-ore exposure and controls. We conclude that fiber sizes in the lungs of processed-ore-exposed workers are similar to those of chrysotile miners and are considerably longer than those found in the general population; some processed-ore workers have longer fibers which might be responsible for higher disease incidences in certain working groups; tremolite accompanies chrysotile in a variable proportion of workers exposed to processed chrysotile products and might be important in the genesis of mesothelioma in such workers; and mineralogic analysis will usually detect exposure even when chrysotile has largely disappeared from lung tissue.
Gallium scanning in differentiating malignant from benign asbestos-related pleural disease. A.S. Teirstein, P. Chahinian, S.J. Goldsmith, et al. 1986;9(5):487-94. PubMed · Publisher

Abstract

In order to assess the utility of 67gallium citrate in delineating malignant pleural mesothelioma from benign asbestos-related pleural disease, 49 patients with malignant mesothelioma and 16 with benign asbestos-related pleural disease were studied. Seven patients with malignant mesothelioma had no history of asbestos exposure, while the remaining 58 patients were exposed. Forty-three of the 49 patients (88%) with malignant mesothelioma had a positive 67gallium scan including 36 of the 42 (86%) patients with asbestos exposure and all 7 patients without a history of asbestos exposure. Three of 16 patients (19%) with benign asbestos-related pleural disease had a positive scan. 67Gallium radionuclide imaging is nonspecific but may be valuable in noninvasive monitoring of asbestos-exposed populations, which have a high risk for the late development of benign and/or malignant pleural disease.
Malignant mesothelioma caused by childhood exposure to long-fiber low aspect ratio tremolite. F. Magee, J.L. Wright, N. Chan, et al. 1986;9(6):529-33. Case report PubMed · Publisher

Abstract

A 41-year-old man was found to have a malignant mesothelioma of the pleura. During childhood in Corsica, he had been exposed at home to chrysotile ore from the Canari mine. Analysis of lung mineral content revealed background levels of chrysotile but an elevated level of tremolite and actinolite asbestos. The latter had a geometric mean length of 3.7 microns, a value considerably longer than we have found for tremolite and actinolite from Quebec chrysotile miners but roughly the same as the mean length of amosite and crocidolite in workers with occupational amphibole exposure. No tremolite or actinolite fibers of length greater than 8 microns microns and width less than 0.25 micron were observed. The mean aspect ratio of the tremolite and actinolite fibers was 7, a value similar to that found in chrysotile miners with mesothelioma but considerably less than the mean aspect ratio of amosite and crocidolite from those with occupational exposure. These data suggest that long-fiber tremolite is a potential mesothelial carcinogen in humans, and that fiber length is more important than fiber aspect ratio in this regard.
Medical screening of former asbestos cement workers in Israel: a pilot program. H. Tuch, T.H. Tulchinsky, M. Casper, et al. 1986;10(5-6):471-8. PubMed · Publisher

Abstract

A pilot screening program for the evaluation of former asbestos-cement workers was carried out in the Chest Disease Clinic of the Acco Public Health Office (Ministry of Health), Israel. A total of 184 subjects were evaluated using medical and occupational questionnaires, clinical examinations, and pulmonary function tests (forced expiratory volume, forced vital capacity). Thirty percent of individuals with more than 1 year of work experience had symptoms of breathlessness or cough. Individuals with 10 years or more of work experience showed a high prevalence of râles and reduced pulmonary function, as compared to those with shorter work histories. These findings indicate the urgent need for active follow-up of Israeli ex-asbestos workers. A proposed screening and surveillance program for this high-risk group is discussed with emphasis on follow-up, health education, and smoking cessation.
Mortality experience of amosite asbestos factory workers: dose-response relationships 5 to 40 years after onset of short-term work exposure. H. Seidman, I.J. Selikoff, S.K. Gelb. 1986;10(5-6):479-514. PubMed · Publisher

Abstract

A cohort of 820 men in a Paterson, New Jersey, amosite asbestos factory which began work during 1941-1945 was observed from 5 to 40 years after start of work. Most of the cohort had limited duration of work experience (days, weeks, months), though some men worked for several years until the factory closed in 1954. With white males of New Jersey as the control population, Standardized Mortality Ratios (SMRs) of 500 are evident for the cohort for lung cancer and for noninfectious pulmonary diseases (including asbestosis), while being almost 300 for total cancer and about 170 for all causes of death. A statistically significant SMR of almost 200 is seen for colon-rectum cancer. Mesothelioma incidence initially shows a strong relationship with advancing time since onset of exposure and then tails off. The main concern of the study is with dose-response patterns. Response is measured by the mortality for relevant causes of death, while the direct asbestos dosage was measured in two ways. One way was the length of time worked in the factory and the other was the individual's accumulated fiber exposure, calculated by multiplying the aforementioned length of time worked by the estimated fiber exposures associated with the particular job that the worker had in the factory. Whichever measure of dosage is used, it was found that, in general, the lower the dose, the longer it took for adverse mortality to become evident and, also, the smaller the magnitude of that adverse mortality.
Occupational exposure and regional variation of malignant mesothelioma in Norway, 1970-79. G. Mowé, B. Gylseth. 1986;9(4):323-32. PubMed · Publisher

Abstract

This investigation is based on a study of 117 men and 24 women with malignant mesothelioma registered by the Cancer Registry of Norway, 1970-79. The age-adjusted incidence rate in men for each county varied from 1.7 to 13.3 per million per year. Eighty-two percent of the men revealed possible occupational asbestos exposure. They were evenly distributed between counties with high and low mesothelioma incidence. Only 17% of the women had possible occupational asbestos exposure. Total lung fiber concentration was analyzed with scanning electron microscopy in 65 men and 13 women. The median lung fiber concentration in men was 2.4 million per gram of dried tissue (range less than 0.4-490), in women 1.0 million per gram (range less than 0.4-41), and in male controls less than 0.4 million per gram (range less than 0.4-4.8). The median year of first exposure was 1937 (range 1909-60) for men from counties with a high incidence rate and 1945 (range 1938-59) for men from counties with a low incidence rate. The counties with a high compared to a low incidence rate of malignant mesothelioma, 1970-79, showed an apparent difference in the percentage of population employed in industry in 1946. The regional variation in the incidence of malignant mesothelioma in men is mainly attributable to the proportion of population exposed to asbestos in industry per county prior the 1950s and the time since exposure started.(ABSTRACT TRUNCATED AT 250 WORDS)
Patterns of mortality among plumbers and pipefitters. K.P. Cantor, J.M. Sontag, M.F. Heid. 1986;10(1):73-89. PubMed · Publisher

Abstract

A proportionate mortality ratio (PMR) study was undertaken of 7,121 members and retirees of the United Association of Plumbers and Pipefitters in California who died in 1960-79. The PMR for all malignant neoplasms was 1.24, with a major contribution from lung cancers (PMR = 1.41). Lung cancer PMRs were consistently elevated, through the 20-year study period, across the pipe trades and within different birth cohorts. Sixteen mesothelioma deaths occurred, suggesting asbestos as a risk factor. PMRs for malignancies of the stomach, kidney, brain, and lymphopoietic system were also elevated, especially among plumbers. Chronic rheumatic heart disease, emphysema, liver cirrhosis, and all external causes of death were the major non-cancer causes with significantly elevated PMRs. There were significant deficits in diabetes mellitus, all pneumonia, chronic nephritis, and vascular lesions of the central nervous system (CNS). PMRs for successive birth cohorts among all study subjects revealed decreasing emphysema risk, suggesting previous reduction of a risk factor for this disease. Among plumbers, PMRs for death due to several non-respiratory malignancies showed an increasing trend with recency of birth cohort.
Pleural plaques and respiratory function. B. Järvholm, A. Sandén. 1986;10(4):419-26. PubMed · Publisher

Abstract

This cross-sectional study was comprised of 202 nonsmoking shipyard workers with varying exposures to asbestos. Their chest X-rays were normal or contained no abnormality other than pleural plaques. They participated in a health examination of workers exposed to asbestos, which comprised a total of 3,904 persons. One hundred and fifteen of the 202 workers had no deviations from normal X-rays, and 87 had pleural plaques but no other finding on their X-rays. Three out of the 115 workers with normal X-rays and 13 of the 87 with pleural plaques had FVCs below the reference limits (p less than 0.005). The workers with plaques had an average of 6.9% lower FVC. Even after stratification for asbestos exposure, men with plaques were found to have lower FVCs than men without plaques. This difference was largest for those with heavy exposure to asbestos.
Public awareness of the problem of asbestos use in Israel. G.L. Baum. 1986;10(5-6):445-8. PubMed · Publisher

Abstract

Concern for occupational health problems in Israel became manifest in the 1930s with the establishment by Histadrut of a Division of Industrial Medicine. Public awareness of the health problems associated with the use of asbestos gradually increased in the 1970s. The history of the development of current programs is presented.
Recent trends in mesothelioma incidence in the United States. R. Spirtas, G.W. Beebe, R.R. Connelly, et al. 1986;9(5):397-407. PubMed · Publisher

Abstract

Mesothelioma incidence rates based on data from population-based cancer registries in New York State (exclusive of New York City), Los Angeles County, California, and the SEER Program of the National Cancer Institute were analyzed for trends, using original cancer registry diagnoses. Results indicate a significant increase in incidence during 1973-80 for pleural mesothelioma among white males older than 55 at time of diagnosis but not for other age-race-sex-site subgroups. A histopathologic review of New York State and Los Angeles County cases by two independent pathologists, expert in the diagnosis of mesothelioma, lowered the overall estimates but a significant upward trend remained. The observed trend does not appear to be related to changes in diagnostic practice. The results of a five-member panel of expert pathologists will be published in a separate methodology paper.
Review of the Israeli Technical Committee for Asbestos. S. Brenner, Z. Anavi. 1986;10(5-6):527-32. PubMed · Publisher

Abstract

The concern of the Israeli public regarding health hazards arising from asbestos use led to the formation of a governmental body responsible for finding solutions to these problems. This body was formed in 1983 as a National Medical Committee and included representatives from governmental and nongovernmental bodies. The Israeli Technical Committee for Asbestos, which serves as a subsidiary of the National Medical Committee, is concerned with the technical aspects associated with health hazards associated with asbestos and other harmful dusts. This report describes the major activities of the Technical Committee during the last 2 years.
Smoking, morbidity, and pulmonary function in a group of ex-asbestos workers: a pilot study. E.D. Richter, H. Tuch, O. Sarel, et al. 1986;10(5-6):515-23. PubMed · Publisher

Abstract

Thirty-three of 184 formerly exposed asbestos textile workers were interviewed to evaluate knowledge, attitudes, and practices concerning smoking and asbestos. Twenty-three subjects in this group also underwent physical examination to determine smoking-symptom/sign-pulmonary function interrelationships. Approximately half of the exworkers smoked, and the majority who had stopped did so mostly because of illness rather than because of knowledge concerning smoking-asbestos hazards. All workers welcomed the offer of smoking cessation programs. Smokers and exsmokers, but not nonsmokers, were at risk for obstructive-type impairments, but all three groups contained subjects with impairments interpretable as restrictive. The presence of shortness of breath, cough, râles, or decreased breathing sounds alone or in any combination greatly increased the odds that either obstructive- or possible restrictive- or mixed-type impairments would be found on spirometry. Mass screening techniques required about one hour of person time per examinee to assess health status, provide educational material on smoking, and counsel workers on referral arrangements. The findings suggest that smoking alerts, smoking cessation clinics, and medical follow-up are needed, feasible, and acceptable in Israel.
The in vitro cytotoxicity of asbestos fibers: I. P388D1 cells. A. Wright, H. Cowie, I.P. Gormley, et al. 1986;9(4):371-84. PubMed · Publisher

Abstract

In this study, the cytotoxicity of 13 fibrous samples of known fiber number and dimensions has been established in P388D1 cells. The cells were exposed in vitro to dust concentrations of 10 or 50 micrograms/ml and, after incubation for 24 or 48 hours, any changes in cellular viability, lactate dehydrogenase, and glucosaminidase levels were determined. In general, there was a close association between the reduction in cellular viability and the loss of intracellular enzymes induced by each dust, the chrysotile asbestos samples proving more cytotoxic than the amphiboles. The cytotoxicity of the fibrous dusts was shown to be related to the number of fibers greater than 8 micron in length in the samples.
Transmission of occupational disease to family contacts. B. Knishkowy, E.L. Baker. 1986;9(6):543-50. PubMed · Publisher

Abstract

As recognition of occupational illness increases, the scope of health problems related to work widens. An important area of concern is the worker's family, which has been shown to be at increased risk of disease attributable to the hazards previously thought to be relevant only to the worker. Such "para-occupational" disease occurs particularly in spouses and children through transport by the worker of hazardous materials from the worksite into the home. The most common vehicle has been contaminated work clothing brought home for cleaning. Outbreaks of severe illness caused by lead, beryllium, asbestos, and other compounds have been traced to home contamination by industrial dust. In this review, we describe reports of "para-occupational" illness that demonstrate the importance of early recognition by medical professionals of this cause of illness and of strict control of the dissemination of hazardous materials outside the workplace.
Use of asbestos in the Israeli Defense Forces. Z. Schlezinger. 1986;10(5-6):539-41. PubMed · Publisher

Abstract

The Israeli Defense Forces (IDF) have adopted the current standards for asbestos in the workplace (1 fiber/ml). Although average daily exposure to asbestos is relatively limited, nevertheless, the army personnel concerned are defined as "asbestos workers." Four main areas of asbestos use were monitored, and medical examinations of susceptible personnel were performed. Recommendations were suggested for improving conditions. The IDF is now in the process of eliminating the use of materials containing asbestos, with the aim of eliminating asbestos use in the IDF within a three-to five-year period.
A case-control study of renal cancer mortality at a Texas chemical plant. G.G. Bond, R.J. Shellenberger, G.H. Flores, et al. 1985;7(2):123-39. PubMed · Publisher

Abstract

An in-plant case-control study of 26 renal cancer deaths was conducted to determine whether an occupational exposure may be related to an apparent increase in mortality from this disease observed among a sample of employees at a multiple process chemical production facility. None was found that explained the excess. Elevated odds ratios were identified for employment in the cell maintenance area of chlorine production and with those presumptive exposures considered to occur in this job, asbestos and caustic, but not chlorine. While an association between renal cancer and asbestos has been previously reported, an association with caustic, per se, is not consistent with prior observations made by others. Diminished risk estimates were observed for employment in magnesium production and for exposures in this process to sulfur dioxide and heat. Both the increased and decreased risks, while statistically significant, are based on small numbers of exposed subjects and may be spurious owing to the problem of multiple comparisons.
A respiratory epidemiological study of stevedores intermittently exposed to asbestos in a South African port. J.E. Myers, D. Garisch, H.S. Myers, et al. 1985;7(4):273-83. PubMed · Publisher

Abstract

The prevalence of asbestosis in stevedores intermittently transporting crocidolite asbestos in a South African port was found to be 30% in a cross-sectional survey. Diagnostic criteria are discussed in terms of the low index of suspicion for industrial diseases, the high probability of missing slight radiological changes, and the attribution of radiological lesions to other diseases, particularly tuberculosis, in a high prevalence area. Results are compared with other studies. Asbestosis was not associated with tuberculosis. Smoking was not significantly associated with asbestosis, other respiratory signs and symptoms, or radiological abnormality.
Asbestos disease in sheet metal workers: the results of a proportional mortality analysis. S. Zoloth, D. Michaels. 1985;7(4):315-21. PubMed · Publisher

Abstract

The results of a proportional mortality analysis of a cohort of sheet metal workers who have only intermittent exposure to asbestos demonstrates a significant excess of cancer at the three sites most frequently associated with asbestos: lung, colon and rectum, and the mesothelium. No excess nonmalignant respiratory disease was detected. These data strongly suggest that significant asbestos-related disease is present in populations with secondary exposure to asbestos and emphasize the importance of considering possible asbestos-related disease when treating patients with a history of employment in the construction industry.
Asbestos exposure, smoking habits, and cancer incidence among production and maintenance workers in an electrochemical plant. B. Hilt, S. Langård, A. Andersen, et al. 1985;8(6):565-77. PubMed · Publisher

Abstract

The incidence of cancer was studied in a cohort of 287 men who were exposed to asbestos at a nitric acid production plant from 1928 onwards. During the observation period from 1953 through 1980 all cancer cases among the cohort members were identified in The Cancer Registry. For the whole cohort 42 cases of cancer were observed versus 30.6 expected. The figures for cancer of the lungs and pleura combined were 17 observed versus 3.7 expected. The corresponding figures for a heavily exposed subcohort were 11 observed and 1.2 expected. In that group there was also an increased incidence of colon cancer with 3 cases observed against 0.8 cases expected. Within the whole cohort four cases of pleural and one case of peritoneal malignant mesothelioma were found. There was also an increased incidence of malignant melanoma of the skin with 3 cases observed against 0.6 expected. For cancer cases that were registered as of unknown origin there were 7 cases observed and 1.4 expected. There was no increased rate ratio for cancer at any site before 20 years after the first asbestos exposure. The smoking habits of all cohort members were recorded and the relative rates for lung cancer were calculated in relation to smoking habits. In common with previous studies the results indicate a multiplicative model for the interaction between asbestos exposure and smoking in regard to lung cancer risk.
Asbestos-related disease without asbestosis--why not pleural asbestosis?. T. Beritić, S. Kovac. 1985;8(6):517-20. Editorial PubMed · Publisher
Clinical features to stage alveolitis in asbestos workers. R. Bégin, A. Cantin, Y. Berthiaume, et al. 1985;8(6):521-36. PubMed · Publisher

Abstract

To analyze the clinical features of asbestos-induced alveolitis and stage its activity, we evaluated 217 asbestos workers by the usual clinical, radiological, and functional parameters and computerized gallium 67(Ga) lung scan; we obtained bronchoalveolar lavage (BAL) in 33 and lung biopsy in 6. In addition, we scored the profusion of lung rales and correlated it with other parameters of severity of asbestosis. In the 55 workers without asbestosis and normal 67Ga scan, BAL analyses were comparable to those of controls. Of the 56 without asbestosis but increased 67Ga lung uptake, BAL analyses in 8 documented a predominantly macrophagic alveolitis (confirmed on lung biopsy in 3), with the highest levels of BAL fibronectin. In the 106 workers with asbestosis, 67Ga lung uptake was increased in 75; BAL in 17 demonstrated a macrophagic and neutrophilic alveolitis with elevated fibronectin levels. Lung biopsy in 3 of the latter workers documented peribronchiolar fibrosing alveolitis. Rale scores in all workers or in those without asbestosis did not correlate with 67Ga scores; they correlated fairly well with profusion of parenchymal opacities (Rs = 0.42) and rigidity of the lung pressure-volume curve (Rs = 0.39). Thus, 67Ga lung uptake is an early indicator of chronic macrophagic alveolitis in asbestos workers, which usually progresses to asbestosis. In the disease, profusion of lung rales constitutes a simple clinical mode of assessment of disease severity that correlates better with radiological and functional parameters than with parameters of alveolitis.
Safety and health in boatbuilding and repair. C.R. Brigham, P.J. Landrigan. 1985;8(3):169-82. PubMed · Publisher

Abstract

Boatbuilding is a complex, chemically intensive industry which employs approximately 43,000 workers in the United States, 77% of them in shops with fewer than 20 workers. Boatbuilders and repairers are at high risk of occupational injury from falls, lacerations, low back trauma, repetitive motion, noise, burns, fires, and explosions. Also they are at risk of acute and chronic illness, including dermatitis, toxic hepatitis, peripheral neuropathy, and chronic encephalopathy as a result of their occupational exposures to such materials as styrene, resins, solvents, paints, welding fumes, and coating systems. Boatbuilders also are exposed to toxic woods and to lead. Hazard recognition is the first step toward reduction of injury and disease in boat building. Control of recognized hazards is achieved through engineering controls, ventilation in particular, and through medical surveillance. Strong programs for injury prevention and for health and safety education will produce significant health and economic benefit in the boatbuilding industry.
Signs of asbestosis and impaired pulmonary function in women who worked in shipyards. K.H. Kilburn, R. Warshaw, J.C. Thornton. 1985;8(6):545-52. PubMed · Publisher

Abstract

Fifteen of 71 women (21.1%) who had worked in shipyards before May, 1961 had radiographic signs of asbestos disease. There were irregular opacities in the lung parenchyma in seven and pleural disease in eight, two of whom had pleural calcifications. The 71 women who volunteered to be studied had a mean age of 61.5 years. Chronic bronchitis was diagnosed in 21%, 71% had dyspnea on climbing two flights of stairs, and 42% had wheezing. These prevalences were 50% higher than in wives of shipyard workers. In 50 white women, mean values for expiratory flow rates, log (FEF25-75) and log (FEF75-85), were decreased for non-, ex- and current smokers as compared to normal nonsmokers. Ex-smokers and current smokers showed the greater effects. Diffusing capacity (DLCOsb) and alveolar volume (ALV) were also reduced in all three smoking categories. Comparison to a reference population without asbestos exposure showed that for current, ex- and nonsmoking subgroups, there were significant reductions in log (FEF25-75), DLCOsb, and ALV for nonsmokers, reductions in FEV1, log (FEV25-75), and log (FEF75-85) in ex-smokers, and reduced ALV in current smokers. These decreases may reflect a locality effect. Further studies are recommended.
A striking deposition of mineral particles in the lungs of a farmer: a case report. B. Gylseth, L. Stettler, G. Mowè, et al. 1984;6(3):231-40. PubMed · Publisher

Abstract

The object of this study was to analyze mineral particles in lung tissue from a farmer who underwent lobectomy due to a lung tumor and relate these analytical findings to occupational exposure and histopathological and clinical diagnoses. Despite no clear evidence of previous occupational dust exposure, heavy deposits of birefringent particles and slight pulmonary fibrosis were found during histopathological examination. Extracts from the lung tissue were analyzed by electron microscopy and X-ray microanalysis for mineral particles. The major components of the dust were identified as mica, talc, and silica. Minor components included asbestos fibers and rutile fibers. Some of these fibers were coated by ferroproteins. Mica, quartz, feldspars (plagioclase), and rutile fibers were found in the soil from the farmer's potato storehouse. Based on these findings it is assumed that the slight pulmonary fibrosis is probably caused by the different mineral particles deposited.
Calcified plaques on mediastinal pleural reflections associated with asbestos dust exposure: four case reports. A. Solomon, G.K. Sluis-Cremer, R.G. Thomas, et al. 1984;6(1):53-7. PubMed · Publisher
Cancer mortality among woodworkers. S.D. Stellman, L. Garfinkel. 1984;5(5):343-57. PubMed · Publisher

Abstract

The mortality experience of 10,322 men employed in woodworking industries was compared with that of 406,798 nonwoodworkers. All subjects were enrolled in an American Cancer Society study and followed prospectively from 1959 through 1972. Age-adjusted rates of death from all causes and from all cancers were not higher in the woodworker group, but excess rates were observed for cancers of the lung, stomach, and bladder, as well as nonmelanoma skin cancer and possibly leukemia. Woodworkers experienced significantly decreased rates of colon-rectum cancer and coronary heart disease. The elevated cancer rates could not be explained by cigarette smoking habits. If anything, there is evidence to suggest a possible interaction between employment in woodworking trades and heavy cigarette smoking, in increasing the risk of lung and bladder cancer.
Commentary: Exposure and mortality among chrysotile asbestos workers. American Journal of Industrial Medicine 4:421-433, 1983. M.M. Finkelstein. 1984;5(5):407-10. PubMed · Publisher
Decreased lung function in long-term asbestos cement workers: a cross-sectional study. C.G. Ohlson, T. Rydman, L. Sundell, et al. 1984;5(5):359-66. PubMed · Publisher

Abstract

The effect on lung function of exposure in an asbestos cement plant was investigated in male workers, employed more than 10 years. The exposed group was selected to exclude subjects with pneumoconioses and ex-smokers and consisted of 77 smokers and 48 never-smokers. Referents were chosen from plants where asbestos had not been in use and restricted to those without X-ray signs of chest disease. The primary type of asbestos used was chrysotile and the general dust level in the two decades 1950-1970 seems to have been around 10 mg/m3 while the asbestos fiber concentration averaged 2 fibers/ml. The mean differences between exposed and referents were statistically significant for forced vital capacity and forced expiratory volume, -0.25 and -0.30 liters, respectively, after adjustment for age, height, tracheal area, and smoking category. No significant differences were detected between those with and without pleural plaques. Smokers and never-smokers were similarly affected. In conclusion, the group exposed to dust with comparatively low asbestos fiber concentration had a minor impairment of lung function, mainly due to obstructive changes.
Lung function among asbestos cement factory workers: cross-sectional and longitudinal study. A. Siracusa, C. Cicioni, R. Volpi, et al. 1984;5(4):315-25. PubMed · Publisher

Abstract

Ventilatory capacity tests and standardized respiratory questionnaires were used in 1973 and in 1980 to measure the effect of mixed dust exposure in the asbestos cement industry on respiratory symptoms and lung function in 65 exposed workers and 30 controls (exposed to polyvinyl chloride but not to asbestos). Workers exposed to asbestos had 1) a higher prevalence of breathlessness and chest pain, and a higher incidence of breathlessness; 2) lower 1980 values of forced vital capacity (FVC) (0.27-0.83 liters) and forced expiratory volume in 1 sec (FEV1) (0.23-0.62 liters); and 3) a faster decline (nearly 40 ml/year) in FVC and FEV1 between 1973 and 1980. The FVC annual decrease was 52.5 ml in the subjects with more than 15 years since first asbestos exposure, whereas it was 24.3 ml in those with less than 15 years, suggesting a faster decline after 15 years of exposure. The effect of asbestos exposure and smoking habits was less than additive as regards pulmonary function.
Pleural mesothelioma after a short interval from first exposure in the wine filter industry. G. Scansetti, F. Mollo, G. Tiberi, et al. 1984;5(4):335-9. Case report PubMed · Publisher

Abstract

Pleural mesotheliomas are usually reported after a long interval has passed since first exposure to asbestos. We, however, describe a case observed after a latent period of only 7.5 years in a worker exposed in a factory manufacturing auxiliary products for wine treatment, including chrysotile asbestos filters. The exposure to asbestos lasted 3-4 months per year, during which airborne fiber concentrations ranged from 1 to 4 ff/cc in the patient's workplace. Due to the characteristics of the manufacturing process, the asbestos fibers were very thin in diameter. The patient also suffered from nasal breathing impairment. An examination of the literature showed that asbestos-related mesotheliomas have been reported, albeit rarely, after less than 10 years from onset of exposure. Therefore, it is believed that this case should be related to past exposure to asbestos.
Retired and former asbestos workers in Hawaii. G. Fournier-Massey, G. Wong, T.C. Hall. 1984;6(2):139-53. PubMed · Publisher

Abstract

In 1979, a pilot survey defined respiratory status and unmet health care needs of retired and former male asbestos workers in Hawaii. Of 1,401 identified subjects, 741 were contacted and 411 were interviewed. Forty-five subjects were between 39 and 54 years of age; 208, between 55 and 64; and 158, age 65 or more. They represented the main ethnic groups--Caucasian, Chinese, Filipino, Hawaiian and part-Hawaiian, and Japanese--on Oahu. Most subjects had had significant exposure to asbestos in a shipyard, and 83% were current nonsmokers (160 had never smoked, and 111 were ex-smokers for ten years or more). Taking age and ethnicity into account, our group had more chronic respiratory and gastrointestinal problems than the comparable male population of Oahu in 1979, but fewer such problems than active shipyard workers elsewhere. These problems related primarily to current smoking status and secondarily to the length of asbestos exposure. Health care was available, but former workers used it less than retirees, despite having more symptoms. Very few abnormalities were reported by the subjects on their chest X-rays, pulmonary function tests, and sputum cytology performed elsewhere. These findings are compared to those of other shipyards, and support the hypothesis that the biological effects of asbestos exposure are generally mild in Hawaii.
Risk of asbestosis in crocidolite and amosite mines in South Africa: an erratum. L.M. Irwig, R.S. du Toit, G.K. Sluis-Cremer, et al. 1984;5(6):479-83. PubMed · Publisher
S fibers. M. Greenberg. 1984;5(5):421-2. Letter PubMed · Publisher

Summary

In this letter, Greenberg objected to the term "S Fiber", an eponym for the hypothesis of Stanton. He said the term had entered public debate on the regulation of mineral fibers in recent years. He wrote that the term had become associated with claimed "truths": that durable mineral fibers shorter than 8 µm, with diameters greater than variously 0.25 µm or 1.5 µm, are not carcinogenic, and that fiber shape determines carcinogenicity regardless of chemistry. He argued this ignored the careful writing of Stanton et al (1981) and balanced reviews such as Harington (1981). He quoted 1977 personal correspondence in which Stanton said his data pointed to the most carcinogenic dimensional range but said little about the least carcinogenic. In that correspondence Stanton reported that 13 dimensional ranges of crocidolite had been studied, and that two samples were highly carcinogenic although they apparently contained few fibres over 8 µm long. Greenberg also quoted Stanton et al (1981): tumor probability more likely falls as particle diameter increases and length decreases, rather than following a narrow carcinogenic size range. He noted that the two crocidolite samples were never fully explained. He cited a preliminary report by Kolev (1982) that found more tumors with amorphous than with fibrous crocidolite. He concluded that the term "S Fibers" should be abandoned because it had led to gross misconception about the hazards of fibrous minerals.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
The value of computerised axial tomography in the assessment of workers exposed to asbestos. G.K. Sluis-Cremer, R.G. Thomas, I.B. Schmaman. 1984;6(1):27-35. PubMed · Publisher

Abstract

Nineteen men who had been exposed to asbestos for long periods were subjected to an examination of the lungs by means of computerised axial tomography (CT). Some features of asbestos-related disease are shown better on CT than on conventional roentgenograms, and occasionally features not shown at all on conventional films may be demonstrated on CT. It was concluded that CT may be useful in cases with borderline and doubtful signs on conventional films, and very occasionally in persons with long exposure who have normal conventional films.
Asbestosis and tuberculosis. F. Segarra-Obiol, P. Lopez-Ibañez, J. Perez Nicolas. 1983;4(6):755-7. PubMed · Publisher

Abstract

The frequent association between silicosis and tuberculosis has been known for a long time. However, the possible interrelationship between asbestosis and tuberculosis is not entirely clear, and some reports on the subject are contradictory. The incidence of tuberculosis was determined in three groups of people: 1) those with asbestosis, 2) those exposed to asbestos dust but without asbestosis, and 3) healthy people without pneumoconiotic exposure. Chest X-rays of 2,846 workers surveyed in this department between 1976 and 1980 were reviewed. Since only one case of active tuberculosis was detected, residual tuberculosis was the type encountered and this was diagnosed solely on its radiological signs. The incidence of tuberculosis was: 3.87% (N = 257) for group 1; 3.45% (N = 1,215) in group 2; and 3.93% (N = 1,374) for group 3. Statistical analysis confirms the lack of significant differences in the incidence of tuberculosis in the three groups. From these findings, it is concluded that asbestosis is not an influential factor in the appearance and development of tuberculosis.
Exposure to asbestos: psychological responses of mesothelioma patients. A.H. Lebovits, A.P. Chahinian, J.C. Holland. 1983;4(3):459-66. PubMed · Publisher

Abstract

Thirty-eight patients with a diagnosis of malignant mesothelioma participated in a semi-structured interview to evaluate asbestos exposure, acquisition of increased risk information, and retrospective reporting of cognitive and behavioral reactions (particularly smoking behavior) to risk information. Twenty-eight patients (74%) had direct occupational contact with asbestos, and six patients (16%) reported indirect nonoccupational exposure to asbestos. Only two (10%) of the directly exposed patients acquired risk information from professional sources prior to diagnosis of mesothelioma. The most frequently reported reaction to learning of increased risk of cancer was a denial of the risk by minimizing personal exposure. Few patients reported being concerned about the information of increased risk. Smoking behavior did not change as a result of risk information, nor was there any increase in visits to physicians. Guidelines for psychosocial management of at-risk groups are recommended.
Exposures and mortality among chrysotile asbestos workers. Part I: exposure estimates. J.M. Dement, R.L. Harris, M.J. Symons, et al. 1983;4(3):399-419. PubMed · Publisher

Abstract

A detailed study of plant processes and dust control methods over the period 1930-1975 was conducted in an asbestos textile plant processing chrysotile. Linear statistical models for reconstructing historic dust exposure levels, taking into account textile processes, dust control measures, and job assignments, were developed. Parameters of these statistical models were estimated using 5,952 industrial hygiene sampling measurements covering the period 1930-1975. For most textile operations, exposure levels were significantly reduced by about 1940, when most engineering dust control measures were in place. Results of the exposure estimates indicated "precontrol" exposure levels to range from 3 to 78 fibers/cc with typical levels well above 10 fibers/cc. After textile operations were provided with dust control measures, estimated exposure levels ranged from 3 to 17 fibers/cc and were usually in the range of 5 to 10 fibers/cc. These exposure estimates were combined with an assessment of mortality among workers at this plant to investigate exposure-response relationships. Exposure-response results are presented in the companion manuscript in this volume.
Exposures and mortality among chrysotile asbestos workers. Part II: mortality. J.M. Dement, R.L. Harris, M.J. Symons, et al. 1983;4(3):421-33. PubMed · Publisher

Abstract

A retrospective cohort mortality study was conducted among a cohort of 1,261 white males employed one or more months in chrysotile asbestos textile operations and followed between 1940 and 1975. Statistically significant excess mortality was observed for all causes combined (standardized mortality ratio [SMR] = 150), lung cancer (SMR = 135), diseases of the circulatory system (SMR = 125), nonmalignant respiratory diseases (SMR = 294), and accidents (SMR = 134). Using estimated fiber exposure levels in conjunction with detailed worker job histories, exposure-response relationships were investigated. Strong exposure-response relationships for lung cancer and asbestos related non-malignant respiratory diseases were observed. Compared with data for chrysotile miners and millers, chrysotile textile workers were found to experience significantly greater lung cancer mortality at lower lifetime cumulative exposure levels. Factors such as differences in airborne fiber characteristics may partially account for the large differences in exposure response between textile workers and miners and millers.
Mesothelioma among machinists in railroad and other industries. T.F. Mancuso. 1983;4(4):501-13. PubMed · Publisher

Abstract

The first phase of the exploration of occupation-related cancer among machinists was a retrospective review of deaths among members of the International Association of Machinists and Aerospace Workers in 1973, in which mesotheliomas were identified in workers in railroad and other industries. The second phase of the study initiated in 1982 was the establishment of a cohort study of machinists, employed for railroad company A, who were alive in January 1954. The cohort consisted of 197 machinists who had been employed by the same railroad prior to 1935 and observed to 1982. Causes of death were identified for 132 of the cohort. There were 18 alive and 47 not traced. Among the 29 cancer deaths, there were nine mesotheliomas and one endothelioma of the pleura. Additional retrospective surveys of deaths among members of the railroad lodges of the international union, together with the cohort study, identified a total of 42 mesotheliomas, two endotheliomas of the pleura, and two cancers of the pleura among former railroad machinists. Among the machinists employed in other industries, 16 mesotheliomas and six cancers of the pleura were identified. For decades, machinists, by the nature of their craft, have had a high risk of occupation-related cancer due to asbestos exposure.
Proportionate mortality among US shoeworkers, 1966-1977. P. Decouflé, J. Walrath. 1983;4(4):523-32. PubMed · Publisher

Abstract

Proportionate mortality for various causes was examined among 3,754 decedents (2,144 men, 1,610 women) who had worked in shoe manufacturing plants represented by either of two labor unions in the US. None of the shoeworker deaths were attributed to nasal cancer, whereas 2.2 were expected on the basis of general population data. Mortality from leukemia and cancer of the urinary bladder was not unusual in either sex or either union. However, deaths from cancers of the liver and gallbladder combined were significantly increased among male and female members of one union. Three deaths from mesothelioma were seen among members of this same union. Rectal cancer mortality was higher than expected among men and women in both unions. The findings are at variance with previous reports of high risks of certain cancer sites among shoeworkers. However, results for liver and gallbladder cancer and mesothelioma suggest the possibility that other previously unsuspected hazards may have been present in certain areas of the US shoe industry.
Roentgenographic evidence of asbestos exposure in a select population of railroad workers. M.J. Sepulveda, J.A. Merchant. 1983;4(5):631-9. PubMed · Publisher

Abstract

A volunteer population of 266 current and former railroad workers was examined with posteroanterior and oblique chest roentgenograms, and a comprehensive occupational smoking history. Seventy-five percent of participants were over the age of 60, and 80% had fewer than 10 years of railroad-related asbestos exposure. Roentgenographic evidence of asbestosis was found in only six workers (2%), whereas 20% had one or more pleural changes. Radiological abnormalities were related to latency period, age, and occupation, but not to smoking habit. While selection factors qualify the results of this study, the findings support the exposure and suggest a past and future history of asbestos mortality and morbidity among steam era railway workers.
Asbestos as a systemic carcinogen: the evidence from eleven cohorts. J.R. Goldsmith. 1982;3(3):341-8. PubMed · Publisher

Abstract

Most known occupational carcinogens are site-specific, which implies that they are "complete" carcinogens with both "initiating" and "promoting" properties (Berenblum's terminology). Excess cancer at gastrointestinal sites among cohorts occupationally exposed to asbestos has been interpreted as reflecting additional site-specific effects, although excess at other sites has also been observed in some studies. The hypothesis that excess cancer at gastrointestinal sites cannot be distinguished from excess cancer at all nonpulmonary sites is tested by data from New York-New Jersey insulation workers working in 1943; similar workers employed after 1943; U.S.-Canadian insulation workers; London factory workers, male and female; Quebec miners and millers; retired U.S. factory workers; U.S. shipyard insulators; Italian shipyard workers in Genoa; Amosite factory workers; and U.S. factory workers. Excluding lung cancer and mesothelioma, observed-expected ratios for nonpulmonary cancer mortality range from 0.97 to 2.78, and do not differ significantly from gastrointestinal ratios. A dose-response gradient is observed for both ratios, when dose is estimated from lung cancer ratios, or in some studies, measured exposures. Site-specificity is unlikely for nonpulmonary cancer associated with asbestos exposure more than 20 years previously. Systemic carcinogenesis may be an example of promotion or impairment by asbestos of some cancer defense mechanism; immunological mechanisms have been suggested by Turner-Warwick and Parkes. Prospective studies are indicated.
Classical syndromes in occupational medicine: the Montague Murray case. M. Greenberg. 1982;3(3):351-6. Historical article PubMed · Publisher
Features of asbestos-exposed and unexposed mesothelioma. A. Hirsch, P. Brochard, H. De Cremoux, et al. 1982;3(4):413-22. PubMed · Publisher

Abstract

Thirty-six histologically confirmed cases of pleural and peritoneal mesothelioma have been observed in a chest unit over a period of 53 months. The past asbestos exposure was assessed by a standardized questionnaire in all cases and the asbestos lung burden was determined by means of mineralogical analysis of lung-related biological specimens (sputum, bronchoalveolar lavage fluid, lung tissues) in 28 cases. The results of these two methods were found in good agreement. Past asbestos exposure has been definitely implicated in 17 cases and definitely eliminated in 10 cases. The results were inconclusive in other cases. The group with definite past asbestos exposure was different from the nonasbestos-exposed group by clinical, biological, pathological, and prognosis features that were analyzed. In cases without past asbestos exposure there were no other possible causative agents. Younger age and similar incidence in men and women suggest an environmental or natural disease.
Flame-attenuated fiberglass: another asbestos?. K.H. Kilburn. 1982;3(1):121-5. PubMed · Publisher
Incremental value of oblique chest radiographs in the diagnosis of asbestos-induced pleural disease. E.L. Baker, R. Greene. 1982;3(1):17-22. PubMed · Publisher

Abstract

To assess the value of oblique chest radiographs in the diagnosis of asbestos-related pleural disease, we identified 100 asbestos-exposed construction workers and provided separate interpretations of the postero-anterior (PA), left anterior oblique (LAO), and right anterior oblique (RAO) projections using the International Labour Office (ILO) system. We found that the LAO projection identified left-sided pleural thickening more effectively than the PA view and the RAO view improved diagnosis of right-sided disease comparably. Of 62 cases of bilateral pleural thickening, only 43 (68%) were diagnosed by the PA projection alone. The increased diagnostic efficiency of approximately 50% in identifying bilateral pleural thickening appears to justify the routine use of oblique chest films in screening asbestos-exposed populations. Since bilateral pleural thickening among asbestos-exposed workers is an indicator of significant asbestos exposure and increased risk of other asbestos-induced conditions, early detection of this abnormality can lead to interventions designed to reduce asbestos-related morbidity and mortality.
Malignant pericardial mesotheliomas and asbestos exposure: a case report. B. Beck, G. Konetzke, V. Ludwig, et al. 1982;3(2):149-59. Case report PubMed · Publisher

Abstract

Three cases of malignant pericardial mesotheliomas are presented with evidence of occupational asbestos exposure. Examination results are compared with findings from experimental and epidemiological research on biological effects of asbestos dust. There are sufficient indications that time-limited effects of asbestos dust established either by measurements or assessment of the amount of concentration after a latency of more than 20 years are apt to result in the development of mesotheliomas of the pleura and peritoneum and, moreover, the pericardium. It is suggested that malignant pericardial mesothelioma also be recognized as another form of occupational disease caused by asbestos dust.
Occupational exposure to asbestos: population at risk and projected mortality--1980-2030. W.J. Nicholson, G. Perkel, I.J. Selikoff. 1982;3(3):259-311. PubMed · Publisher

Abstract

Estimates have been made of the numbers of cancers that are projected to result from past exposures to asbestos in a number of occupations and industries. From 1940 through 1979, 27,500,000 individuals had potential asbestos exposure at work. Of these, 18,800,000 had exposure in excess of that equivalent to two months employment in primary manufacturing or as an insulator (greater than 2-3 f-yr/ml). 21,000,000 of the 27,500,000 and 14,100,000 of the 18,800,000 are estimated to have been alive on January 1, 1980. It is further estimated that approximately 8,200 asbestos-related cancer deaths are now occurring annually. This will rise to about 9,700 annually by the year 2000. Thereafter, the mortality rate from past exposure will decrease, but still remain substantial for another three decades.
Radiographic progression of asbestosis. H. Suoranta, M.S. Huuskonen, A. Zitting, et al. 1982;3(1):67-74. Case report PubMed · Publisher
Amphibole fibers in a taconite mine and in the lungs of the miners. B. Gylseth, T. Norseth, V. Skaug. 1981;2(2):175-84. Case report PubMed · Publisher

Abstract

Fibers of the amphibole mineral series have been demonstrated in the dust from an open taconite ore mine. Though the total dust levels in some places are high, exposures to fibers are below one fiber/cc. The energy dispersive X-ray spectra of the amphibole fibers correspond to those of cummingtonite-grunerite, hornblende, or actinolite. The same type and size distribution of fibers were found during post mortem analyses of lung tissue from two previously exposed miners. The pathological examination revealed an undifferentiated small cell carcinoma of left lung as well as pulmonary fibrosis in one of the cases. In the second case a poorly differentiated squamous cell carcinoma of left lung was found along with silicosis.
Asbestos-related diseases in the Federal Republic of Germany. H.J. Woitowitz, L. Beierl, M. Rathgeb, et al. 1981;2(1):71-8. PubMed · Publisher

Abstract

Until recently, in the Federal Republic of Germany there has been a lack of epidemiological data on asbestos-related tumors. Only the numbers of occupational diseases accepted for compensation by the German industrial injuries insurance institutes (Berufsgenossenschaften) can be stated. These show, for 1979, 94 cases of asbestosis, 21 cases of asbestosis associated with lung cancer, and 34 cases of mesothelioma. Since 1972 employees exposed to asbestos dust have been included in a central register by the industrial injuries insurance institutes and are medically examined periodically. By December 31, 1979, 28,476 persons were registered. Of those, 6,582 were still being followed medically, although they were no longer working with asbestos dust exposure. In January 1, 1977, a prospective epidemiological study was started with these people who were formerly exposed to asbestos dust. Up to December 31, 1980, altogether 2,944 people were enrolled in the study. Besides several other enrollment criteria, the individual's permission was required to evaluate his personal data. Of the people enrolled, 85 had died by December 31, 1980. Even if five questionable cases of lung cancer are excluded (n = 80), the observed rates of about 43% tumours of all sites, with 15% lung cancer and 6% mesothelioma, seem to be comparable to the international epidemiological mortality pattern.
Cigarette smoking does not produce or enhance the radiologic appearance of pulmonary fibrosis. K.H. Kilburn. 1981;2(3):305-8. PubMed · Publisher

Summary

This commentary asked whether long-term cigarette smoking produced chest X-ray changes that resembled, or could be confused with, pneumoconiosis, including asbestosis. The author critically reviewed published studies. In two studies by Weiss using 70 mm photofluorograms, more smokers than nonsmokers were reported to have prominent bronchovascular markings: 4.2% of current smokers and 14.3% of 98 heavy smokers versus 1.5% of 393 nonsmokers, and, among 2,825 adults, 1.9% of smokers versus 0.6% of nonsmokers. The author argued that these markings did not define interstitial fibrosis, that ILO criteria were not used, and that small films reduced resolution. Only half of the 70 mm films read as fibrosis were confirmed on full-size films. In a chrysotile textile mill study, 57% of smokers (16 of 28) versus 43% of nonsmokers had fibrosis, which the author said was not a statistical difference. A study of 88 workers in two asbestos plants had very small numbers. A larger study of 383 subjects by Samet et al found the same exposure-response relationship regardless of smoking. A study in 20 British collieries found similar pneumoconiosis prevalence in smokers (30.2%) and nonsmokers (29.8%). The smoking beagle studies showed emphysema and small airways disease, not fibrosis. The author concluded that cigarette smoking neither produced radiographic pulmonary fibrosis nor contributed to fibrosis from asbestos or coal dust.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Host rocks and gangue minerals in relation to pneumoconiosis and cancer. A.M. Langer. 1981;2(2):89-90. Editorial PubMed · Publisher
Asbestosis in the industries of the Barcelona area. F. Segarra, M.B. Monte, P.L. Ibañez, et al. 1980;1(2):149-58. PubMed · Publisher

Abstract

This presentation is the result of the survey of eight industries with asbestosis risk in the Barcelona area (two of fibro-cement, three of auto brakes, two of textiles, and one of insulation materials). Of 1,472 workers, 271 or 18.5% have asbestosis. Pleural involvement in asbestosis is twice as common as that of the lung, 15.7% versus 8.5%. Pulmonary asbestosis without pleural participation is seen in only 2.6% of cases. Pleural plaques, calcified and not calcified, are detected in only a few cases. There is a definite correlation between the incidence of asbestosis and the exposure time: from 1% in the group of workers with less than five years of exposure up to 64.58% for those with 30 or more years of exposure. Clinical symptoms (cough, and/or expectoration, and/or dyspnea) were present in 68% of the studied population. Pulmonary crepitations are the most significant physical sign detected, observed in one quarter to one third of the patients. Pulmonary function tests in asbestos workers revealed restrictive and mixed type syndromes in 17% of the cases and obstructive syndrome in 36%. The percentages for those workers without asbestosis are 9% and 16%, respectively. It seems, therefore, that a bronchial factor plays a role in asbestosis. The bronchial pathology would be manifested clinically by the appearance or the exaggeration of the chronic bronchitis symptoms, and physiologically by the presence of the obstructive syndrome. There is no doubt that smoking enhances the incidence of asbestosis, aggravates the respiratory symptoms in those affected, and is a cause of further deterioration of pulmonary function.
Lung cancer prevalence among shipyard workers. W.J. Nicholson, R. Lilis, A.L. Frank, et al. 1980;1(2):191-203. Case report PubMed · Publisher

Abstract

The prevalence of lung cancer has been ascertained during a survey of 286 shipyard workers all 20 to 45 years from onset of asbestos exposure in shipyard work. Two men had had previous thoracic surgery for lung cancer. In addition, bronchogenic carcinoma was found in five men. One was among the 35 men less than 30 years in the yard; three were in the 191 who had begun work 30 to 39 years before, and one was in the group of 60 men who were 40+ years from onset. The potential usefulness of large-scale surveillance programs for the early detection of lung cancer among current and former shipyard workers is discussed.
Radiological evidence of asbestos disease among ship repair workers. I.J. Selikoff, W.J. Nicholson, R. Lilis. 1980;1(1):9-22. PubMed · Publisher

Abstract

Asbestos materials are now infrequently used in new ship construction. However, significant amounts were used in vessels constructed before 1975. As a consequence, for the next 30 or more years, the potential for asbestos exposure in the repair of such vessels will remain. We studied 286 workers who were 30 or more years from onset of employment in ship repair work. Eighty-six percent had radiological evidence of asbestosis, and five instances of previously undiagnosed lung cancer were found. This suggests that unless industrial hygiene precautions are taken in the future repair of vessels that have been built with asbestos, we will add additional decades to the legacy we already face as the result of uncontrolled shipyard exposures of the past.

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