International Archives of Occupational and Environmental Health

Our medical research library holds 68 studies published in International Archives of Occupational and Environmental Health (1977–2025). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 66 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it. For 1 study PubMed has no abstract for, we give the abstract printed in the article or, where there is none, a summary we wrote from it, each labeled as such.

About the journal

• Publisher: Springer-Verlag
• Published: 1975 to the present, Germany
• Language: English
• ISSN: 0340-0131 (print), 1432-1246 (electronic)
• Continues: Internationales Archiv Für Arbeitsmedizin
• Its record in the NLM Catalog

2020s

• Cumulative asbestos exposure as a key predictor of long-term pleuropulmonary outcomes: insights from decades of follow-up. L. Štěpánek, M. Nakládalová, M. Janošíková, et al. 2025;98(6):497-505. PubMed · Publisher · Free full text

  Abstract

  Purpose: Occupational asbestos exposure was widespread before regulatory bans, and it remains a risk during renovations or demolitions of older buildings. While asbestos-related diseases are well-documented, less is known about minor radiological changes in exposed individuals. This longitudinal study aimed to identify predictors of pleural and parenchymal lung disorders in individuals with previous occupational asbestos exposure, focusing on both established asbestos-related diseases and minor radiological abnormalities.

  Methods: The study tracked 445 former employees (334 men, 111 women) of two Czech asbestos-processing plants, who underwent regular examinations from the 1980s to December 2022. Cox proportional hazards regression models were employed to analyse predictors of asbestos-related diseases, as well as minor radiological findings alone.

  Results: Over a median latency of 37 years, 127 participants (28.5%) developed asbestos-related diseases, mainly pleural mesothelioma (59 cases). An additional 168 participants (37.8%) exhibited minor radiological findings, predominantly pleural plaques (129 cases), while 150 (33.7%) had no abnormalities. Substantial cumulative exposure was a strong predictor for minor radiological findings (odds ratio [OR] 1.98, 95% confidence interval [CI] 1.18-3.35, p = 0.010) and any endpoint, including diseases (OR 1.89, 95% CI 1.18-3.02, p = 0.008). Respiratory symptoms and impaired spirometry results significantly increased the likelihood of endpoint occurrence. No significant differences emerged between settings with predominantly chrysotile exposure and those with a chrysotile-crocidolite mixture.

  Conclusion: This study highlights the predictive value of cumulative exposure and the need for ongoing surveillance of occupationally exposed individuals to better understand radiological changes, their significance, and to refine risk assessment models.

  © 2025. The Author(s).

• Breast cancer incidence in a national cohort of female workers exposed to special health hazards in Taiwan: a retrospective case-cohort study of ~ 300,000 occupational records spanning 20 years. Y.S. Chuang, C.Y. Lee, P.C. Lin, et al. 2022;95(10):1979-1993. PubMed · Publisher

  Abstract

  Objective: Breast cancer is the most common cancer among women worldwide. In Taiwan, workers exposed to any of 31 hazardous chemicals or carcinogens in the work environment are designated as especially exposed workers (EEWs) by Taiwan's Ministry of Labor. We assessed the risk of breast cancer in this nationwide female EEW cohort.

  Methods: We conducted a nationwide retrospective study of 4,774,295 workers combining data collected from Taiwan's Ministry of Labor's EEW database between 1997 and 2018 and Taiwan's Cancer Registry between 1997 and 2016. Standardized incidence ratios (SIRs) for women exposed to different hazards and breast cancer incidence rate ratios (IRRs) were calculated by Poisson regression, adjusting for age and duration of exposure.

  Results: 3248 female workers with breast cancer and 331,967 without breast cancer were included. The SIRs and adjusted IRRs were 1.27 (95% CI 1.18-1.35) and 1.31 (95% CI 1.21-1.42) for lead, 1.74 (95% CI 1.23-2.24) and 1.52 (95% CI 1.13-2.04) for 1,1,2,2-tetrachloroethane, 1.47 (95% CI 1.12-1.82) and 1.42 (95% CI 1.12-1.81) for trichloroethylene/tetrachloroethylene), 1.40 (95% CI 1.23-1.57) and 1.38 (95% CI 1.22-1.57) for benzene, and 2.07 (95% CI 1.06-3.09) and 1.80 (95% CI 1.10-2.94) for asbestos. The results remained similar when factoring in a 2- or 5-year latency period.

  Conclusion: This study found possible correlations between occupational exposure to lead, chlorinated solvents (such as 1,1,2,2-tetrachloroethane, trichloroethylene, and tetrachloroethylene), benzene, and asbestos with breast cancer risk among female EEW, suggesting a need for regular screening for breast cancer for employees exposed to these special workplace hazards.

  © 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

• Cancer incidence in a cohort of Swedish merchant seafarers between 1985 and 2011. K. Forsell, O. Björ, H. Eriksson, et al. 2022;95(5):1103-1111. PubMed · Publisher · Free full text

  Abstract

  Purpose: Lung cancer, mesothelioma and several lifestyle-associated cancer forms have been reported more common in merchant seafarers. However, few studies reflect recent occupational settings and women seafarers are usually too scarce for meaningful analyses. We conducted a study on cancer incidence between 1985 and 2011 in a Swedish cohort consisting of male and female seafarers.

  Methods: All seafarers in the Swedish Seafarers' Register with at least one sea service between 1985 and 2011 and a cumulated sea service time of ≥ 30 days (N = 75,745; 64% men, 36% women; 1,245,691 person-years) were linked to the Swedish Cancer Register and followed-up until 31 December 2011. Standardized incidence ratios (SIR) were calculated with the general population as reference.

  Results: There were 4159 cancer cases in total, with 3221 among men and 938 among women. Male seafarers had an increased risk of total cancer (SIR 1.05; 95% CI 1.01-1.09), lung cancer (SIR 1.51; 95% CI 1.35-1.67) and urinary bladder cancer (SIR 1.17; 95% CI 1.02-1.33). Several lifestyle-associated cancer forms were more common in men. Previous work on tankers was associated with leukaemia (SIR 1.41; 95% CI 1.00-1.86). The risk of cancer decreased with a start as a male seafarer after 1985, with a significant trend for total cancer (P < 0.001), lung cancer (P = 0.001) and, for tanker seafarers, leukaemia (P = 0.045). Women seafarers had an increased risk of lung cancer (SIR 1.54; 95% CI 1.23-1.87) but the risk of total cancer was not increased (SIR 0.83; 95% CI 0.78-0.89).

  Conclusions: In this cohort of merchant Swedish seafarers 1985-2011, the risk of total cancer was increased in men but not in women compared to the general population. Lung cancer was increased in both genders. The risk of cancer seems to decrease over the last decades, but better exposure assessments to occupational carcinogens and longer observation times are needed.

  © 2021. The Author(s).

• Factory site analysis of respirable fibers generated during the process of cutting and grinding of carbon fibers-reinforced plastics. J. Kumoi, A. Ikegami, Y. Fujitani, et al. 2022;95(7):1557-1565. PubMed · Publisher

  Abstract

  Objectives: Carbon fibers are used in a variety of industrial applications, based on their lightweight and high stiffness properties. There is little information on the characteristics and exposure levels of debris generated during the factory processing of carbon fibers or their composites. This study revisits the general assumption that carbon fibers or their debris released during composite processing are considered safe for human health.

  Methods: The present interventional study was conducted at a factory located in Japan, and involved on-site collection of debris generated during the industrial processing of polyacrylonitrile (PAN)-based carbon-fiber-reinforced plastic (CFRP). The debris were collected before being exhausted locally from around different factory machines and examined morphologically and quantitatively by scanning electron microscopy. The levels of exposure to respirable carbon fibers at different areas of the factory were also quantified.

  Results: The collected debris mainly contained the original carbon fibers broken transversely at the fiber's major axis. However, carbon fiber fragments morphologically compatible with the WHO definition of respirable fibers (length: > 5 μm, width: < 3 μm, length/width ratio: > 3:1) were also found. The concentrations of respirable fibers at the six examined factory areas under standard working conditions in the same factory were below the standard limit of 10 fibers/L, specified for asbestos dust-generating facilities under the Air Pollution Control Law in Japan.

  Conclusions: Our study identified potentially dangerous respirable fibers with high aspect ratio, which was generated during the processing of PAN-based CFRP. Regular risk assessment of carbon fiber debris is necessary to ensure work environment safety.

  © 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

• Association of occupational burnout and occupational exposure factors on psychological health among factory workers and miners: a propensity score analysis. Y. Lu, Z. Zhang, S. Gao, et al. 2021;94(3):441-450. PubMed · Publisher

  Abstract

  Purpose: This study is to explore the association of occupational burnout and occupational exposure factors on psychological health among factory workers and miners.

  Methods: A total of 6130 factories workers and miners in Urumqi, China were included using a cluster sampling method. The occupational burnout and psychological health were investigates using the Chinese Maslach Burnout Inventory (CMBI) and the Symptom Check List-90 (SCL-90). The propensity score analysis (PSA) was used to eliminate the influence of individual characteristics, and 2164 pairs of participants on psychological healthy and unhealthy were matched. After PSA, the relationship between occupational burnout, occupational hazard exposure, and psychological health was evaluated.

  Results: The results showed that asbestos dust (OR 1.65, CI 95% 1.35-2.02) and CMBI (OR 2.59, CI 95% 2.39-2.83) were risk factors affecting psychological health (P < 0.001).

  Conclusions: Measures need to be taken to ease occupational burnout among factories workers and miners, and strengthen personal protection to improve their psychological health.

• Costs of asbestosis and silicosis hospitalization in Italy (2001-2018) : Costs of asbestosis and silicosis hospitalization. P. Ferrante. 2021;94(4):763-771. PubMed · Publisher

  Abstract

  Background: Asbestosis and silicosis are preventable fibrotic forms of pneumoconiosis. Decades ago, the World Health Organization began prevention campaigns for eliminating these diseases worldwide.

  Purpose: To establish Italian hospitalization costs of asbestosis and silicosis in relation to national adopted prevention policies.

  Methods: This is a retrospective population-based study of Italian hospitalizations treating asbestosis or silicosis in the period 2001-2018. We have extracted data from the National Hospital Discharge Registry and merged with national standard charges of hospitalizations through diagnosis-related group coding. We expressed costs in 2018 euros and evaluated data time-trends by linear normal and logistic regression models.

  Results: During 2001-2018, hospitalization costs per year were 3,787,540 € for asbestosis and 10,103,215 € for silicosis. There were significant annual reductions in frequency (- 41 and - 266 hospitalizations per year for asbestosis and silicosis, respectively), length of stay (- 148 and - 2781 days per year for asbestosis and silicosis, respectively) and cost (- 43,881 and - 959,516 € per year for asbestosis and silicosis, respectively) of diseases. Length and cost of hospital stay per admission significantly increased over time for asbestosis (+ 0.2 days and + 100 €, respectively, per year).

  Conclusion: Overall hospitalizations costs were higher for silicosis than asbestosis. Over time hospitals treated fewer cases with greater severity. The decreased 2001-2018 consumption of hospital resources by patients with asbestosis or silicosis is associated with the occupational health policies instituted from the 1990s to reduce exposures to asbestos and silica. Extending existing epidemiological surveillance systems to pneumoconioses would help to control the social costs of work-related diseases.

• Effects of commodity on the risk of emphysema in South African miners. S.L. Mabila, K.S. Almberg, L. Friedman, et al. 2020;93(3):315-323. PubMed · Publisher

  Abstract

  Purpose: To examine associations between mine commodity such as coal, platinum, or diamonds and emphysema among South African miners at autopsy.

  Methods: We examined the association between mine commodity and emphysema using the Pathology Automation (PATHAUT) database, 1975-2014. Exposure was characterized as longest tenure in each commodity. We constructed separate multivariable logistic regression models for black and white miners. Smoking was assessed in a sub-analysis of white miners.

  Results: Among black miners, coal mining was significantly associated with increased odds of emphysema [OR = 2.39 (95% CI 1.86, 3.07)] when compared to gold mining. Asbestos was also associated with significantly increased odds of emphysema among black miners [OR = 1.47 (95% CI 1.01, 2.12)]. No associations between commodity and emphysema were observed among white miners. Cumulative years of exposure and age at death were significant predictors for emphysema for both black and white miners. Smoking was a significant predictor of emphysema in the sub-analysis of white miners with smoking information, but no effect of commodity was observed.

  Conclusions: We observed a significant association between coal mining and emphysema among black miners. Adverse health effects of coal mining are evidenced by more than twofold increase in emphysema among black coal miners compared to gold miners. This suggests that South African Coal miners are exposed to high dust concentrations or more damaging components compared to other commodities, resulting in elevated risk of emphysema.

2010s

• Mortality by cause of death and risk behaviors in farmers versus non-farmers: the importance of avoiding the healthy worker effect. G. Zhao, E. Ronda, L. Cea, et al. 2019;92(4):599-608. PubMed · Publisher

  Abstract

  Objectives: To compare mortality by cancer sites and by other specific causes of death, and the prevalence of risk behaviors in farmers and non-farmers in Spain.

  Methods: Mortality by cause of death was calculated based on a longitudinal study with 10-years follow-up of 9.5 million men and 6 million women aged 20-64 years who were employed in 2001. The prevalence of risk behaviors was calculated from the 2001 National Health Survey in the 6464 employed men and 5573 employed women aged 20-64. The study subjects were grouped as farmers and non-farmers. For each cause of death, we estimated the ratio of age-standardized mortality rates, and for each risk behavior we estimated the age-standardized prevalence ratio in farmers versus non-farmers.

  Results: In men, the mortality rate for most cancer sites did not differ significantly between farmers and non-farmers, except for cancers of the lip, oral cavity, stomach, larynx and skin epidermoid carcinoma-which was higher in farmers-and cancers of the liver, pancreas and mesothelioma-which was lower in farmers. In contrast, farmers had a higher rate of mortality from most other diseases and from external causes of death. In women, farmers showed lower mortality from lung cancer, breast cancer and chronic lower respiratory disease, and higher mortality from external causes. The prevalence of smoking, excessive alcohol consumption, physical inactivity and obesity was higher in farmers than in non-farmers, except smoking and excessive alcohol consumption in women where prevalence was lower in farmers.

  Conclusions: Findings are different from those found in other studies. In men, greater exposure to the sun and the higher prevalence of risk behaviors in farmers could explain their excess mortality from some cancer sites and the other causes of death. However, other factors may be behind this excess risk of mortality from these causes, given that farmers did not show higher mortality from some cancers related to smoking. In women, no differences were observed in mortality rate for majority of causes of death between farmers and non-farmers.

• Risk of mesothelioma after cessation of asbestos exposure: a systematic review and meta-regression. P. Boffetta, F. Donato, E. Pira, et al. 2019;92(7):949-957. Meta-analysis · Systematic review PubMed · Publisher

  Abstract

  Purpose: A 'risk reversal' has been observed for several human carcinogens following cessation of exposure, but it is unclear whether it also exists for asbestos-related mesothelioma.

  Methods: We conducted a systematic review of the literature and identified nine studies that reported information on risk of mesothelioma after cessation of asbestos exposure, and performed a meta-regression based on random effects models. As comparison we analyzed results on lung cancer risk from four of these studies.

  Results: A total of six risk estimates from five studies were included in the meta-analysis. The summary relative risk (RR) of mesothelioma for 10-year interval since cessation of exposure was 1.02 [95% confidence interval (CI) 0.87-1.19; p-heterogeneity 0.01]. The corresponding RR of lung cancer was 0.91 (95% CI 0.84-0.98).

  Conclusions: This analysis provides evidence that the risk of mesothelioma does not decrease after cessation of asbestos exposure, while lung cancer risk does.

• Cancer incidence in a cohort of asbestos-exposed workers undergoing health surveillance. F. Barbiero, T. Zanin, F.E. Pisa, et al. 2018;91(7):831-841. PubMed · Publisher

  Abstract

  Objectives: To compare a local cohort of 2488 men occupationally exposed to asbestos and enrolled in a public health surveillance program with the 1995-2009 cancer incidence of the general population of Friuli Venezia Giulia (FVG) region, Northeast Italy, we conducted a historical cohort study.

  Methods: Standardized incidence ratios (SIRs), with 95% confidence interval (95% CI), for specific cancer sites were estimated in the cohort and in subgroups of workers employed in shipbuilding between 1974 and 1994. For internal comparisons, we calculated incidence rate ratios (IRRs) for all cancers, lung cancer and mesothelioma, by level of exposure to asbestos and sector of employment adjusted for smoking habits and age at start of follow-up.

  Results: Among cohort members the SIR was 8.82 (95% CI 5.95-12.61) for mesothelioma and 1.61 (95% CI 1.26-2.04) for lung cancer. In subgroup analyses, the SIR for lung cancer in subjects hired in shipbuilding between 1974 and 1984 was 2.09 (95% CI 1.32-3.13). In the overall cohort, a borderline increased incidence was also found for stomach cancer (SIR = 1.53 95% CI 0.96-2.31). Internal comparisons within the cohort show that among men with high asbestos exposure level the relative risk was almost threefold for lung cancer (IRR = 2.94 95% CI 1.01-8.57).

  Conclusions: This cohort experienced an excess in the incidence of both mesothelioma and lung cancer, showing increasing incidence rates at higher level of asbestos exposure. For lung cancer, the relative incidence was highest among workers hired in shipbuilding between 1974 and 1984.

• Cancer incidence in urban, rural, and densely populated districts close to core cities in Bavaria, Germany. M. Radespiel-Tröger, K. Geiss, D. Twardella, et al. 2018;91(2):155-174. PubMed · Publisher

  Abstract

  Objective: An ecologic study on the level of districts was performed to evaluate the possible association between district type and risk of cancer in Bavaria, Southern Germany.

  Methods: Cancer incidence data for the years 2003-2012 were obtained from the population-based cancer registry Bavaria according to sex and cancer site. Data on district type, socio-economic area deprivation, particulate matter exposure, tobacco consumption, and alcohol consumption were obtained from publicly available sources. The possible association between district type and cancer risk adjusted for age, socio-economic area deprivation, particulate matter exposure, tobacco consumption, and alcohol consumption was evaluated using multivariable multi-level negative binomial regression.

  Results: We found a significantly reduced cancer risk in densely populated districts close to core cities and/or rural districts compared to core cities with respect to the cancer sites mouth and pharynx (women only), liver (both sexes), larynx (both sexes), lung (both sexes), melanoma of the skin (both sexes), mesothelioma (men only), connective and soft tissue (both sexes), corpus uteri, other urinary tract (men only), urinary bladder (both sexes), and non-Hodgkin lymphoma (both sexes).

  Conclusion: Our findings require further monitoring. Since the apparently increased cancer risk in core cities may be related to lifestyle factors, preventive measures against lifestyle-related cancer could be specifically targeted at populations in deprived core cities.

• Global DNA hypomethylation has no impact on lung function or serum inflammatory and fibrosis cytokines in asbestos-exposed population. M. Yu, J. Lou, H. Xia, et al. 2017;90(3):265-274. PubMed · Publisher

  Abstract

  Purpose: To examine the effect of asbestos exposure on global DNA methylation and determine whether lung function and inflammatory and fibrosis biomarkers are correlated with the methylation state.

  Methods: A total of 26 healthy subjects without asbestos exposure (Group 1), 47 healthy subjects with exposure (Group 2), and 52 subjects with benign asbestos-related disorders (ARDs) (Group 3) participated in this cross-sectional study. Blood global 5-methylcytosine (5mC) and serum TNF-α, collagen IV, CCL5 and CC16 concentrations were analyzed using enzyme-linked immunosorbent assay-like assays. Spirometric maneuvers were performed to assess lung function.

  Results: Decreased 5mC levels were observed in Groups 2 and 3 compared to Group 1, irrespective of lung function (p < 0.01). There was no significant change in 5mC between Groups 2 and 3. Overall, 5mC was negatively correlated with CCL5 and collagen IV (p < 0.05), but no significant inverse relationship was found between 5mC and CCL5 or collagen IV in each group. Additionally, both 5mC and CC16 were inversely associated with FEV1/FVC% (p = 0.001, adjusted R 2 = 0.145) for non-smokers, and consistently significant inverse relationships were found between CC16 and FEV1/FVC%, independent of asbestos exposure.

  Conclusions: Asbestos exposure causes global DNA hypomethylation. DNA hypomethylation has no influence on serum biomarkers and lung function in asbestos-exposed population with or without pleural and pulmonary parenchymal abnormalities.

• Occupational exposure in the removal and disposal of asbestos-containing materials in Italy. A. Scarselli, M. Corfiati, D. Di Marzio. 2016;89(5):857-65. PubMed · Publisher

  Abstract

  Purpose: A great variety of asbestos-containing materials are present in both residential and work settings because of the widespread use made in the past, and many occupational activities still entail the risk of asbestos exposure in Italy, more than 2 decades after the total national ban, mainly those involved in the removal and disposal of asbestos. The aim of the study was to evaluate the level and extent of asbestos exposure in Italy between the years 1996-2013 in the sector of asbestos abatement.

  Methods: Data were collected from firm registries of asbestos-exposed workers and descriptive statistics were calculated for exposure-related variables.

  Results: Overall, 15,860 measurements of asbestos exposure were selected from the national database of registries, mostly referring to the construction sector (N = 11,353). Despite the mean exposure levels are low, the air concentration of asbestos fibers measured during these activities may overcome the action level established by the Italian legislation and, in a limited number of cases, can exceed even the occupational limit value. Among occupations at higher risk, there are also garbage collectors and insulation workers.

  Conclusions: Starting from the analysis of the Italian database of occupational exposure registries, this study outlines the current levels of asbestos exposure in abatement-related sectors, discussing their possible implications for public health policies and surveillance programs.

• Reducing the underreporting of lung cancer attributable to occupation: outcomes from a hospital-based systematic search in Northern Italy. S. Porru, A. Carta, E. Toninelli, et al. 2016;89(6):981-9. PubMed · Publisher

  Abstract

  Purpose: Occupational exposure to lung carcinogens is and was common in workplaces. 5-25 % of lung cancers (LCs) could be causally attributable to occupation; however, LC underreporting and undercompensation are widespread, with remarkable tolls paid by individuals and society. This work aims to: describe an ongoing hospital-based systematic search (SS) of occupational LC; improve aetiological diagnosis; increase number and quality of LC notifications.

  Methods: Through a short form, physicians at a public hospital referred incident LC to the Occupational Health Unit (OHU). Only patients selected through the form were interviewed; a personal, occupational and clinical history was collected; reports were sent to the ward and Local Health Authority, with aetiological diagnosis criteria and probability of causation.

  Results: From 1998 to 2013, 3274 cases of LC were notified to the OHU; prior to the system, just couple of dozens were assessed. A total of 1522 patients were fully interviewed; in 395 cases, causation was attributed to occupation (26 % of interviewed patients); all were notified to authorities, as compared to the handful reported before the system was adopted. Main aetiological agents were silica, asbestos, polycyclic aromatic hydrocarbons, truck driving, painting, multiple exposures. Compensation rate was remarkable (39 %).

  Conclusions: Through SS, many occupational LCs were found that otherwise would have been lost. Aetiological diagnosis proved to be rich of scientific advantages and practical implications, with attention to equity and social aspects. SS was easy, accountable and fostered multidisciplinary collaboration among medical specialties, significantly reducing underreporting and undercompensation of occupational LC.

• The mental health of asbestos-exposed subjects with pleural abnormalities. P. Franklin, M. Robinson, P. Abaogye-Sarfo, et al. 2015;88(3):343-50. PubMed · Publisher

  Abstract

  Purpose: To examine the effect of knowledge of radiographic abnormalities on the mental health of asbestos-exposed people with and without pleural abnormalities.

  Methods: Subjects were former asbestos mine and mill workers and residents of the mining town who had participated in an annual health review program. Pleural abnormalities (pleural plaques, diffuse pleural thickening and asbestosis) were determined from plain chest X-rays. All Participants completed a questionnaire on mental health status (SF-12) and locus of control (LOC).

  Results: There were no significant differences between asbestos-exposed people with and without radiographic abnormalities for either the SF-12 mental health score or LOC. However, the asbestos-exposed cohorts had lower mental health scores compared with a random sample of the local population.

  Conclusion: The presence of pleural abnormalities did not further affect the mental health of asbestos-exposed people beyond a decrement associated with exposure per se.

• Changes of mesothelin and osteopontin levels over time in formerly asbestos-exposed power industry workers. M.K. Felten, K. Khatab, L. Knoll, et al. 2014;87(2):195-204. PubMed · Publisher

  Abstract

  Purpose: In patients developing malignant pleural mesothelioma (MPM) or lung cancer, using effective tumour markers is the quickest way to ensure early diagnosis and improve survival time. The aim of our study was to assess the influence of age and asbestos exposure on the blood levels of the proposed tumour markers, mesothelin and osteopontin, and to determine the change of these markers over time.

  Methods: We analysed 3,329 blood samples of 2,262 participants including 1,894 formerly asbestos-exposed power industry workers, a mixed group of 266 participants with an unknown history of asbestos exposure and a group of 102 non-asbestos-exposed controls. Marker concentrations were determined using commercial ELISA kits.

  Results: While age had a strong influence on marker levels, there was no association between exposure duration or benign asbestos-related disease and marker levels. In order to assess the maximum increase that can be expected to occur in asbestos-exposed workers those with an at least 10 % increase were selected (n = 290 for mesothelin and n = 81 for osteopontin). The 95th percentile of the annual change was 0.402 nmol/l for mesothelin and 334 ng/ml for osteopontin. In two patients with MPM and five with lung cancer, we could obtain more than one marker result before the diagnosis was made. Both MPM patients showed a steep increase of mesothelin levels.

  Conclusions: Fixed cut-off values for deciding between intensive clinical work-up and continued surveillance appeared inadequate for the evaluated markers. While general conclusions cannot be drawn, we can say that the results of the two patients would be consistent with a mesothelin increase between 6 and 18 months before clinical symptoms developed.

• Cancer incidence among Swedish pulp and paper mill workers: a cohort study of sulphate and sulphite mills. E. Andersson, H. Westberg, I.L. Bryngelsson, et al. 2013;86(5):529-40. PubMed · Publisher

  Abstract

  Purpose: Associations between various malignancies and work in the pulp and paper industry have been reported but mostly in analyses of mortality rather than incidence. We aimed to study cancer incidence by main mill pulping process, department and gender in a Swedish cohort of pulp and paper mill workers.

  Methods: The cohort (18,113 males and 2,292 females, enrolled from 1939 to 1999 with >1 year of employment) was followed up for cancer incidence from 1958 to 2001. Information on the workers' department and employment was obtained from the mills' personnel files, and standardized incidence ratios (SIRs) were calculated using the Swedish population as reference.

  Results: Overall cancer incidence, in total 2,488 cases, was not increased by work in any department. However, risks of pleural mesothelioma were increased among males employed in sulphate pulping (SIR, 8.38; 95 % CI, 3.37-17) and maintenance (SIR, 6.35; 95 % CI, 3.47-11), with no corresponding increase of lung cancer. Testicular cancer risks were increased among males employed in sulphate pulping (SIR, 4.14; 95 % CI, 1.99-7.61) and sulphite pulping (SIR, 2.59; 95 % CI, 0.95-5.64). Female paper production workers showed increased risk of skin tumours other than malignant melanoma (SIR, 2.92; 95 % CI, 1.18-6.02).

  Conclusions: Incidence of pleural mesothelioma was increased in the cohort, showing that asbestos exposure still has severe health consequences, and highlighting the exigency of strict asbestos regulations and elimination. Testicular cancer was increased among pulping department workers. Shift work and endocrine disruptors could be of interest in this context.

• Cancer morbidity and quartz exposure in Swedish iron foundries. H. Westberg, L. Andersson, I.L. Bryngelsson, et al. 2013;86(5):499-507. PubMed · Publisher

  Abstract

  Purpose: The aim of this study was to determine cancer morbidity amongst Swedish iron foundry workers with special reference to quartz exposure. In addition to respirable dust and quartz, phenol, formaldehyde, furfuryl alcohols, polycyclic aromatic hydrocarbons (PAHs), carbon black, isocyanates and asbestos are used or generated by foundry production techniques and exposure to any of these substances could have potentially carcinogenic effects.

  Methods: Cancer morbidity between 1958 and 2004 was evaluated in a cohort of 3,045 male foundry workers employed for >1 year between 1913 and 2005. Standardised incidence ratios (SIRs) with 95 % confidence intervals (95 % CI) were determined by comparing observed numbers of incident cancers with frequencies in the Swedish cancer register. Exposure measures were assessed using information from the personal files of employees and modelling quartz measurement based on a database of 1,667 quartz measurements. Dose responses for lung cancer were determined for duration of employment and cumulative quartz exposure for latency periods >20 years.

  Results: Overall cancer morbidity was not increased amongst the foundry workers (SIR 1.00; 95 % CI, 0.90-1.11), but the incidence of lung cancer was significantly elevated (SIR 1.61; 95 % CI, 1.20-2.12). A non-significant negative dose response was determined using external comparison with a latency period of >20 years (SIR 2.05, 1.72 1.26 for the low, medium and high exposure groups), supported by internal comparison data (hazard ratios 1, 1.01, 0.78) for the corresponding groups. For cancers at sites with at least five observed cases and a SIR > 1.25, non-significant risks with SIRs > 1.5 were determined for cancers of the liver, larynx, testis, connective muscle tissue, multiple myeloma plasmacytoma and lymphatic leukaemia.

  Conclusions: A significant overall risk of lung cancer was determined, but using external and internal comparison groups could not confirm any dose response at our cumulative quartz dose levels.

• Distribution and trends in mesothelioma mortality in Italy from 1974 to 2006. M.P. Gatto, D. Tanna. 2013;86(4):489-96. PubMed · Publisher

  Abstract

  Purpose: Using the epidemiological data of pleural cancer mortality, the authors estimated time trends and distribution of malignant mesothelioma in Italy during the period 1974-2006.

  Methods: To describe temporal trends of the standardized mortality ratios (SMRs) in all the 20 Italian regions, we applied the Joinpoint Regression Model, developed by the National Cancer Institute (USA). The 107 provincial SMRs are represented on maps by using the Arcview GIS software (version 3.2).

  Results: The high values from mesothelioma mortality in construction and shipbuilding sectors, previously reported, are confirmed by our analyses. Furthermore, data show that the annual percentage change is still growing: statistically significant increments in time trends are observed for 11 of 20 Italian regions. Of additional concern has been the identification of changes in 9 of 20 trends partially due to the misdiagnosis in the past.

  Conclusions: Given the long latency of mesothelioma, preventive and legal measures with the ban of asbestos in Italy since 1992 are still not giving effects on mesothelioma mortality trends.

• Lung function predicts mortality: 10-year follow-up after lung cancer screening among asbestos-exposed workers. T. Vehmas, P. Pallasaho, P. Piirilä. 2013;86(6):667-72. PubMed · Publisher

  Abstract

  Purpose: To assess the predictive value of lung function impairment on mortality among asbestos-exposed workers.

  Methods: A total of 590 workers originally screened for occupational lung disease including spirometry and pulmonary diffusing capacity measurements were followed up for mortality data (ICD-10 classification). The mean follow-up time was 10.5 years. Associations of different lung function parameters with mortality from all causes and from cardiovascular (I00-I99) and non-malignant respiratory diseases (J00-J99) were analysed. Factor analysis was used to create obstructive and restrictive factors.

  Results: A total of 191 deaths were found altogether. Most measured lung function variables were associated with increased mortality when studied separately. Both decreased forced expiratory flow in one second (hazard ratio/measurement unit = 0.977, 95 % CI 0.969-0.988, p < 0.001) and impaired diffusing capacity (0.973, 0.965-0.981, p < 0.001) were independently associated with mortality from all causes, as well as from cardiovascular and non-malignant respiratory diseases. Both obstructive factor alone and the sum of obstructive and restrictive factors were associated with all studied mortality categories. The restrictive factor alone was associated with all-cause and respiratory mortality.

  Conclusions: Deteriorated lung function predicts deaths. The reasons for impaired lung function should be medically explored to enable restoring measures aiming thus to prevent premature deaths.

• Lung and pleural CT signs predict deaths: 10-year follow-up after lung cancer screening of asbestos-exposed workers. T. Vehmas, P. Oksa, L. Kivisaari. 2012;85(2):207-13. PubMed · Publisher

  Abstract

  Purpose: To work out the predictive value of pathological (HR)CT signs concerning long-term mortality among those screened for lung cancer.

  Methods: Five hundred and eighty four construction workers (574 males, 10 females) were originally screened for lung cancer and found negative. Their images were also scored for several lung and pleural signs. Mortality data were checked from the National Registry of Causes of Death. Cox regression adjusted for age, sex, smoking, BMI, and asbestos exposure was used to explore the relations between the radiological signs and deaths. The mean follow-up time was 10.53 years (0.56-12.98 years) and a total of 6,150 person years were followed up.

  Results: Altogether, 185 deaths occurred (64 cardiovascular, 51 cancer, 24 non-cancer respiratory deaths, and 46 deaths from other causes). All studied emphysema signs were significant predictors of all-cause deaths as were most fibrosis signs (subpleural nodules, septal lines, parenchymal bands, and honeycombing), ground-glass opacities, thickened bronchial walls, pleural plaque extent, and adherences. Cardiovascular deaths were significantly associated with paraseptal emphysema and bullae. Several lung/pleural signs also predicted cancer and respiratory deaths.

  Conclusion: Pathological lung/pleural CT signs found in screening seem to predict deaths in long term, which may require more careful medical surveillance of such individuals. Further studies are needed to generalize the present findings to general population.

• Mortality in a Chinese chrysotile miner cohort. X. Wang, S. Lin, E. Yano, et al. 2012;85(4):405-12. PubMed · Publisher

  Abstract

  Background: Few data were available to address cause-specific mortality in asbestos miners in China. This study observed a cohort of workers from the largest chrysotile asbestos mine to evaluate the association between asbestos exposure and cause-specific mortality.

  Methods: The cohort consisting of 1,539 male workers was observed from 1981 to 2006. Information on occupational and smoking history and vital status was obtained through personnel records and individual contact. Causes and dates of deaths were verified from hospitals. Workers were divided into two groups: miners and millers (miner group) and control group (not direct exposed). Recent asbestos dust measurements in the workplaces showed that the concentrations ranged from 12 to 197 mg/m(3). Amphibole contamination was very low. Cox proportional hazard models with competing risks were fit to estimate hazard ratios for cause-specific mortality associated with asbestos exposure (miners vs. controls). In addition, standardized mortality ratios (SMRs) were calculated based on national mortality rates.

  Results: All mortality rates of selected causes, particularly lung cancer, were substantially higher in the miner group than in the controls. SMRs of lung cancer and nonmalignant respiratory diseases in the miners were 4.71 (95% CI, 3.57, 6.21) and 3.53 (2.78, 4.48), respectively. The controls had similar mortality rates of all causes, lung cancer, all cancers as national rates, but a higher mortality from respiratory diseases. Asbestos exposure was related to a 4.6-fold mortality risk for lung cancer and over threefold risk for all cancers and respiratory diseases, while smoking and age were adjusted. The highest SMR of lung cancer was observed in miners who smoked.

  Conclusion: The results suggested excessive cause-specific mortality, in particular from lung cancer and respiratory diseases, in the cohort, which was associated with exposure to chrysotile asbestos.

• Mortality in a cohort of cement workers in a plant of Central Italy. F. Giordano, V. Dell'orco, F. Fantini, et al. 2012;85(4):373-9. PubMed · Publisher

  Abstract

  Purpose: Workers of cement production are exposed to alkaline dust with irritant effects on the respiratory system. Most previous studies have examined workers in cement/asbestos factories, but there is limited information of the effects of exposures to Portland cement alone. The present study examines the effects of cement dust in a cohort of Portland cement workers through the analyses of their mortality records.

  Methods: Using the records of a cement plant, we reconstructed the work history of all 748 male employees between 1956 and 2006. SMRs were computed for overall mortality and for specific causes of death for the cohort compared with the reference population. The analysis was also performed by subdividing the cohort in low- and high-exposure groups on the basis of the task of the worker and the length of his exposure.

  Results: The overall mortality of the cohort (SMR = 0.87) as well as the mortality from all cancers (SMR = 0.64) and from cancers of the respiratory system (SMR = 0.56) was significantly lower compared to the reference population. Workers of the cement plant with higher exposures did not have an increased mortality risk from any cause. The only significantly elevated risk observed among these workers was for cancer of the respiratory system (SMR = 2.86), exclusively in the small subgroup of 39 workers with previous exposure to a cement/asbestos plant.

  Conclusions: Portland cement workers had a statistically significant reduced risk of overall mortality and of all cancers mortality probably due to the healthy workers effect. The study confirmed an increased risk of respiratory system cancer only in the subgroup with previous work exposure in a cement/asbestos plant.

• Occupational exposures to asbestos, polycyclic aromatic hydrocarbons and solvents, and cancers of the oral cavity and pharynx: a quantitative literature review. S. Paget-Bailly, D. Cyr, D. Luce. 2012;85(4):341-51. Meta-analysis · Review PubMed · Publisher

  Abstract

  Purpose: The role of occupational risk factors in oral and pharyngeal cancer is not well known and is possibly underestimated. This quantitative review summarizes epidemiological findings on exposure to asbestos, polycyclic aromatic hydrocarbons and solvents, and cancers of the oral cavity and pharynx.

  Methods: A systematic literature search was performed. We analyzed 63 publications: 8 from case-control studies and 55 from cohort studies. For agents with at least five available studies with homogenous exposure, a series of meta-analyses was conducted to provide quantitative pooled estimates of risks, using random effect models.

  Results: Exposure to asbestos (meta-RR 1.25; 95% CI 1.10-1.42) and to polycyclic aromatic hydrocarbons (meta-RR 1.14; 95% CI 1.02-1.28) was found to be associated with oral and pharyngeal cancer risk. On the other hand, no association was found with exposure to solvents in general (meta-RR 0.98; 95% CI 0.77-1.23) but the strong heterogeneity between studies suggested differences in exposures. The small number of studies with homogeneous exposure did not allow meta-analyses for specific solvents.

  Conclusions: Future investigations should overcome common weaknesses of past studies, in terms of sample size, characterization of exposure, and classification of cancer sites.

• An updated historical cohort mortality study of workers exposed to asbestos in a refitting shipyard, 1947-2007. K. Tomioka, Y. Natori, S. Kumagai, et al. 2011;84(8):959-67. PubMed · Publisher

  Abstract

  Purpose: To evaluate the long-term health effects of occupational asbestos exposure, an updated historical cohort mortality study of workers at a refitting shipyard was undertaken.

  Methods: The cohort consisted of 249 male ship repair workers (90 laggers, 159 boiler repairers). To determine relative excess mortality, standardized mortality ratios (SMRs) were calculated using mortality rates among the Japanese male population. Mortality follow-up of study subjects was performed for the period from 1947 till the end of 2007.

  Results: We identified the vital status of 87 (96.7%) laggers and 150 (94.3%) boiler repairers. Of these, 63 (72.4%) and 95 (63.3%), respectively, died. Laggers, who had handled asbestos materials directly, showed a significantly elevated SMR of 2.64 (95% confidence interval [CI]: 1.06-5.44) for lung cancer and 2.49 (95% CI: 1.36-4.18) for nonmalignant respiratory diseases. Boiler repairers, who had many opportunities for secondary exposure to asbestos and a few for direct exposure, showed no significant elevation in SMR for lung cancer but a significantly elevated SMR of 1.78 (95% CI: 1.06-2.81) for nonmalignant respiratory diseases. In an analysis according to duration of employment, there was a significantly elevated SMR of nonmalignant respiratory diseases in the longer working years group. Among workers from both jobs, no deaths caused by mesothelioma in addition to those in the original study were found and no subject died from larynx cancer.

  Conclusion: This updated study confirmed a significant excess of asbestos-related mortality from diseases such as lung cancer and nonmalignant respiratory diseases among workers in a refitting shipyard in Japan.

• Asbestos exposure and malignant lymphoma: a multicenter case-control study in Germany and Italy. A. Seidler, N. Becker, A. Nieters, et al. 2010;83(5):563-70. PubMed · Publisher

  Abstract

  Aims: To analyze the relationship between asbestos exposure and malignant lymphoma in a multicenter case-control study conducted in Germany and Italy according to a common core protocol.

  Methods: Male and female patients with malignant lymphoma (n = 1,034) between 18 and 80 years of age were prospectively recruited in six study areas in Germany (Ludwigshafen/Upper Palatinate, Heidelberg/Rhine-Neckar-County, Würzburg/Lower Frankonia, Hamburg, Bielefeld/East Westphalia, and Munich) and in two study areas in Sardinia, Italy (Cagliari and Nuoro provinces). A total of 1,173 population control subjects were drawn from population registers. In a structured personal interview, we elicited a complete occupational history, including every occupational period that lasted at least 1 year. On the basis of job task-specific supplementary questionnaires, trained experts assessed the exposure to asbestos. As a measure of cumulative asbestos exposure on a time by intensity scale, fiber-years were calculated. 12 cases (1.2%) and 12 control subjects (1.0%) had a cumulative asbestos exposure of more than 2.6 fiber-years (highest exposure category according to the 90th percentile of exposed control subjects). Odds ratios (OR) and 95% confidence intervals (CI) were calculated using unconditional logistic regression analysis adjusted for age, sex and study region. Patients with specific lymphoma sub-entities were additionally compared with the entire control group.

  Results: We observed no statistically significant association between cumulative asbestos exposure and the risk of any lymphoma subtype. An elevated risk was found for the association between exposure to more than 2.6 fiber-years and multiple myeloma (OR = 6.0; 95% CI 1.4-25.1); however, numbers were small (n = 3 cases, all of them from Italy; n = 12 control subjects).

  Conclusions: Our study does not support an association between asbestos exposure and risk of malignant lymphoma.

• Clinical and HRCT screening of heavily asbestos-exposed workers. T. Vierikko, R. Järvenpää, P. Toivio, et al. 2010;83(1):47-54. PubMed · Publisher

  Abstract

  Purpose: To characterize asbestosis today and to clarify the indications for high-resolution computed tomography (HRCT) in the surveillance of heavily exposed workers.

  Methods: Six hundred and twenty-seven workers were screened and HRCT findings were classified and divided in two groups: pulmonary fibrosis (n = 86) and no fibrosis (n = 541).

  Results: Most (65/86 = 76%) of the detected fibrosis cases were mild. The magnitude of asbestos exposure showed an unexpected inverse relation with fibrosis. In multivariate analyses, age, forced expiratory volume in 1 s/forced vital capacity ratio, and poor diffusing capacity were associated with HRCT fibrosis, but asbestos exposure was not.

  Conclusions: Asbestosis seems to be characterized by mild fibrosis today even in heavily exposed workers. To avoid radiation exposure in HRCT, age and lung function data may be used only to a limited extent to select imaging candidates. Selection and recollection biases may distort the relation between asbestos exposure and fibrosis.

• French cohort of the uranium processing workers: mortality pattern after 30-year follow-up. I. Guseva Canu, E. Cardis, C. Metz-Flamant, et al. 2010;83(3):301-8. PubMed · Publisher

  Abstract

  Objective: To investigate mortality among nuclear workers with potential internal exposure to uranium.

  Methods: The cohort included 2,709 workers employed at the AREVA NC Pierrelatte plant for at least 6 months (72,787 person-years). This plant processed uranium enrichment during the period 1960-1996 and chemical conversion since 1980. Mortality was compared to the national and regional mortality rates available for the period 1968-2005. For causes of death of interest with respect to occupational exposure, mortality trends according to occupational characteristics were assessed.

  Results: As expected, an important healthy worker effect (all causes SMR = 0.55 (95% CI: 0.50-0.61), n = 411; all cancers SMR = 0.70 (95% CI: 0.60-0.81), n = 193) was observed. Among cancer sites a priori related to uranium exposure, only mortality for lymphatic cancer was increased among potentially exposed workers (SMR = 1.49 (95% CI: 0.68-2.82); n = 9). An important increase in mortality from pleural cancer was observed (SMR = 2.85 (95% CI: 0.93-6.66), n = 5); none of the deceased workers were exposed to radiation whereas all handled asbestos.

  Conclusion: In spite of limited statistical power, results show consistency with previous studies of nuclear workers potentially exposed to uranium. Further investigation based on more precise uranium exposure data should allow the estimation of uranium hazard effects among this cohort.

• Inter-reader variability in chest radiography and HRCT for the early detection of asbestos-related lung and pleural abnormalities in a cohort of 636 asbestos-exposed subjects. E. Ochsmann, T. Carl, P. Brand, et al. 2010;83(1):39-46. PubMed · Publisher

  Abstract

  Purpose: To compare inter-reader variability of chest X-ray and high resolution computed tomography (HRCT) scans of formerly asbestos-exposed employees over a 4-year period.

  Methods: In this longitudinal study, 636 formerly asbestos-exposed persons were annually examined with chest radiographs and HRCT scans. Ten observer pairs classified the radiographs and HRCT scans, using the ILO classification and a custom-made CT classification. Inter-observer variability was calculated using the kappa-coefficient.

  Results: Despite all expectations, HRCT inter-reader variability according to asbestos-related lung or pleura alterations at an early stage did not turn out to be better than X-ray inter-reader variability. Substantial inter-observer agreement was found for pleural calcifications (kappa(X-ray) = 0.63; kappa(CT) = 0.64). Averaging over kappa led to fair inter-observer agreement of both methods (kappa(X-ray) = 0.36; kappa(CT) = 0.34).

  Conclusions: High resolution computed tomography scans are superior to X-rays in detecting lung alterations after asbestos exposure and are supposedly easier to interpret. Nevertheless, inter-observer variability did not differ between the two methods in this study. This was probably due to the only discrete asbestos-related lung or pleura alterations of this cohort and to the unfamiliar CT classification sheet, which was revised on the basis of the presented results.

2000s

• Longitudinal analysis of respiratory symptoms in population studies with a focus on dyspnea in marine transportation workers. V.H. Arrandale, M. Koehoorn, Y. MacNab, et al. 2009;82(9):1097-105. PubMed · Publisher

  Abstract

  Purpose: Longitudinal respiratory symptoms are rarely studied in occupational epidemiology. We investigated dyspnea change over time and predictors of change over time using two longitudinal modeling techniques, a semi-parametric group-based approach (SAS® Proc Traj) and a generalized linear mixed model (SAS® Proc Glimmix), and compared the two techniques for use in longitudinal studies of respiratory symptoms.

  Methods: Data were previously collected from a lung health surveillance study of marine transportation workers. Subjects were seen two to four times over 12 years (1987-1999). At each visit the American Thoracic Society questionnaire was administered and lung function was tested. The semi-parametric group-based model and the generalized linear mixed model were applied to the data.

  Results: The group-based trajectory model supported two groups of dyspnea change over time. Group 1 (73%) had a steady low-level probability of reporting dyspnea over follow-up, while Group 2 (27%) had an increasing probability of reporting dyspnea over follow-up. The generalized linear mixed model (random intercept) estimated that the probability of reporting dyspnea was increasing over time in the population. Current smoking, female sex, lower lung function and older age were associated with increased probability of reporting dyspnea in both models.

  Conclusions: Results from both models indicate that the probability of reporting dyspnea was increasing over time in this occupational cohort. The group-based model is capable of identifying multiple patterns of linear and non-linear change while the generalized linear mixed model is preferable when the population mean change (linear) is of interest. Both approaches were able to identify similar characteristics associated with longitudinal dyspnea symptoms.

• Lung function predicts survival in a cohort of asbestos cement workers. H. Moshammer, M. Neuberger. 2009;82(2):199-207. PubMed · Publisher

  Abstract

  Purpose: To study the predictive power of respiratory screening examinations a cohort of asbestos workers was followed from active work in an asbestos cement plant until death.

  Methods: From a cohort with data on individual exposure since first employment 309 workers who had a preventive medical examination in 1989/1990 were observed until death or the end of 2006. The impact of asbestos exposure (fibre years) and of smoking history on lung function was examined by linear regression, on specific causes of death and total mortality by Cox regression. The prognostic value of lung function, chest X-ray, and various clinical findings regarding total mortality was also examined by Cox regression.

  Results: Lung function proved to be the best predictor of survival apart from current smoking. Depending on the lung function variable an impairment by the interquartile range resulted in a hazard ratio of 1.5-1.6 while for current smokers it was 2.3. An increase of 70 fibre years (interquartile range) led to a hazard ratio of only 1.1. Lung function was influenced by asbestos exposure, current (but not former) smoking, and by pathological X-ray findings. The risk for pleural mesothelioma was dominated by time since first exposure to crocydolite in the pipe factory while the risk for bronchial cancer increased with smoking and total fibre years. An unexpected finding was an increase of gastric cancer in asbestos cement workers.

  Conclusion: Lung function decrease predicts risk of premature death better than exposure history and regular spirometry should therefore be offered as primary screening to all former asbestos workers. In workers with a history of high cumulative exposure or rapid lung function decrease or radiological signs (diffuse pleural thickening or small irregular opacities) more sensitive techniques (high resolution computer tomography) need to be applied. All smokers with a history of asbestos exposure should be given free smoking cessation therapy to prevent premature death and lung cancer in particular.

• The relationship between malignant mesothelioma and an asbestos cement plant environmental risk: a spatial case-control study in the city of Bari (Italy). M. Musti, A. Pollice, D. Cavone, et al. 2009;82(4):489-97. PubMed · Publisher

  Abstract

  Objectives: To estimate the mesothelioma risk and environmental asbestos exposure (EAE) due to an asbestos-cement plant.

  Methods: A spatial case-control study including 48 malignant mesothelioma (MM) cases occurred in the period 1993-2003 selected from the regional mesothelioma register (RMR) and 273 controls. The disease risk was estimated by means of a logistic-regression model, in which the probability of disease-occurrence is expressed as a function of the classes of distances. A non-parametric method was applied to estimate the full relative risk surface.

  Results: Significant MM odds ratio of 5.29 (95 CI: 1.18-23.74) was found for people living within a range up to 500 m centered on the plant. The non-parametric estimation of relative risk surface unveiled a marked peak near the plant not paralleled by the spatial distribution of controls.

  Conclusion: Evidence of an association between mesothelioma risk and EAE is highlighted. The role played by the RMR in increasing the public health local authorities awareness is stressed.

• Asbestos related diseases in Italy: an integrated approach to identify unexpected professional or environmental exposure risks at municipal level. A. Marinaccio, A. Scarselli, A. Binazzi, et al. 2008;81(8):993-1001. PubMed · Publisher

  Abstract

  Purpose: Past intensive use of asbestos has implied severe public health consequences. Spatial distribution of deaths from malignant mesothelioma and of compensated cases for asbestos related diseases in Italy were compared to identify unexpected sources of asbestos exposure.

  Methods: Mortality for malignant mesothelioma at municipal level and geographical clusters of compensated cases for asbestos related diseases, as proxy of industrial asbestos exposure, were identified in the period 1988-2001.

  Results: Municipalities with at least four mesothelioma deaths and a statistically significant mortality excess were 148; and 53 out of them had no compensated case for asbestos-related diseases. Finally 22 of these lay outside of any aforementioned cluster, thus suggestive of a possible unrecognized exposure.

  Conclusions: Availability long-term national figures and the different etiology of asbestos related diseases are the key features of this exercise that was applied to Italy, but can be replicated wherever registration systems of diseases related to long term exposure to asbestos are available.

• A case of malignant mesothelioma in a rice-starch factory. R. De Zotti, A. Fiorito. 2007;80(8):743-5. Case report PubMed · Publisher

  Abstract

  Introduction: Recent reports of cases of malignant mesothelioma (MM) in "non-traditional" areas of employment are an indication of the numerous occasions in which exposure to asbestos has occurred in the workplace. We describe an unusual case of occupational exposure to asbestos to stress the importance of careful history taking when assessing a patient's work history, especially in generic occupations in which there is apparently no exposure to asbestos.

  Case Report: Malignant mesothelioma was diagnosed in a woman worker employed in a factory making rice starch. She had worked in the storehouse of the factory for approximately 40 years. From circumstantial interviews with relatives and workmates, it emerged that her job involved retrieving, for re-use, the jute sacks in which the rice was transported. More than one source remembered distinctly that some of the sacks had "Asbestos" written on the outside.

  Discussion: This case provides further confirmation of the importance of careful history taking among workers with mesothelioma to avoid failing to diagnose occupational disease. It also highlights the risk of asbestos exposure represented by recycling asbestos-contaminated sacks in both occupational and non-occupational settings.

• 8-Hydroxy-2'-deoxyguanosine as a marker of oxidative DNA damage related to occupational and environmental exposures. A. Pilger, H.W. Rüdiger. 2006;80(1):1-15. Review PubMed · Publisher

  Abstract

  Oxidative DNA damage is considered to play an important role in pathophysiological processes, ageing and cancer. So far major interest has been on measuring 8-hydroxy-2'-deoxyguanosine (8-OHdG), the preferred methods relying on HPLC or GC-mass spectrometry. The high biological relevance of 8-OHdG is due to its ability to induce G-->T transversions, which are among the most frequent somatic mutations found in human cancers. Effects of workplace exposures on the level of white blood cell 8-OHdG or urinary 8-OHdG have been reported with controversial results. Exposures examined include asbestos, azo-dyes, benzene, fine particulate matter (PM(2.5)), glassworks, polycyclic aromatic hydrocarbons (PAHs), rubber manufacturing, silica, metals, styrene, toluene and xylenes. The available data indicate that there is still a lack of well established dose-response relations between occupational or environmental exposures and the induction of 8-OHdG. Smoking has been most consistently identified as a confounder for 8-OHdG, but various occupational studies did not reveal higher levels of 8-OHdG in smokers. Despite the conflicting results, the reported studies show promise for 8-OHdG as a biomarker of oxidative stress associated with chemical exposure. However, there are critical aspects related to the analytical challenge, artifactual production of 8-OHdG, inter- and intra-individual variation, confounding factors and inter-laboratory differences, implying that further work is needed to reach a consensus on the background level of 8-OHdG.

• Asbestos consumption, asbestos exposure and asbestos-related occupational diseases in Germany. O. Hagemeyer, H. Otten, T. Kraus. 2006;79(8):613-20. Historical article · Review PubMed · Publisher

  Abstract

  Like in most industrial countries, asbestos is a leading cause of occupational diseases, especially malignant diseases, in Germany. Following the increased consumption of asbestos after World War I, the recognition of asbestos related diseases developed. At the end of the 1930s, Germany was the first country to accept lung cancer in combination with asbestosis as an occupational disease and to initiate the endeavor for reduction of asbestos dust exposure. Nevertheless after World War II the usage of asbestos increased dramatically. The ban of asbestos first came into force in 1993. Until this time several hundreds of thousands of workers had inhaled asbestos and the number of asbestos related diseases increased. In this review the history and current status on asbestos consumption, asbestos exposure and asbestos related occupational diseases in Germany is presented.

• Lung cancer and mesothelioma in towns with environmental exposure to asbestos in Eastern Anatolia. H.C. Hasanoglu, Z. Yildirim, H. Ermis, et al. 2006;79(1):89-91. PubMed · Publisher

  Abstract

  Objective: Our previous study demonstrated the presence of environmental tremolite and chrysotile asbestos fiber exposure in Hekimhan town in Malatya located in eastern Turkey. The aim of this study was to investigate whether environmental asbestos exposure increases the incidence of lung cancer and mesothelioma.

  Method: One hundred and forty-nine patients with mesothelioma and lung cancer living in the center or in the towns of Malatya were retrospectively analyzed. The Incidences of lung cancer and mesothelioma were calculated.

  Results: The incidences of lung cancer and mesothelioma were 3.39/100,000 and 0.21/100,000, respectively, for the whole population of Malatya; while they were 8.23/100,000 and 1.45/100,000 in Hekimhan. The incidences were strikingly high (22.39/100,000 for lung cancer and 7.46/100,000 for mesothelioma) in Arguvan, another town in Malatya where an analysis for asbestos could not be performed. The overall incidence in Turkey was reported as 5.9/100,000 by the Health Ministry in 1994. The incidences of lung cancer were nearly 1.3-fold higher in Hekimhan and fourfold higher in Arguvan then in the general population of Turkey.

  Conclusion: The incidences of mesothelioma and lung carcinoma in Hekimhan were higher than those of the general population in Turkey, suggesting a role of environmental asbestos exposure in lung cancer and mesothelioma.

• Mineralogical and exposure determinants of pulmonary fibrosis among Québec chrysotile miners and millers. A. Nayebzadeh, B.W. Case, J. Massé, et al. 2006;79(3):227-36. PubMed · Publisher

  Abstract

  Objectives: Lung fibre content was determined for 86 former chrysotile miners and millers in two Québec mining regions: Thetford mines (TM) and the Asbestos region (AR).

  Methods: Fibres were assessed using transmission electron microscopy (TEM) and energy dispersive X-ray spectrometry (EDS). Asbestos body (AB) concentrations were assessed by microscopy of tissue digests. Corresponding histological lung tissue sections were quantitatively graded for the severity of interstitial fibrosis on a 12-point scale. Fibrosis score and its associations with (1) fibre concentrations and fibre dimensions within three fibre length intervals (less than 5 microm, 5-10 microm, and over 10 microm), and (2) several exposure variables were evaluated using correlation coefficients and regression techniques.

  Results: Concentration of short (<5 microm) tremolite fibres was the best predictor of fibrosis grade in both mining groups (r=0.44, P<0.01 and r=0.39, P<0.01 for TM and AR, respectively). Chrysotile fibre concentration showed a lower correlation with the fibrosis grade for subjects from TM only. Long (>10 microm) amosite fibre concentration showed a linear relationship with the fibrosis score in miners and millers from AR. Exposure variables, including smoking, had no predictive value for fibrosis grade. Within fibre length categories, fibre dimension was not related to the fibrosis score.

  Conclusion: Lung fibre concentration as measured by TEM/EDS, especially that of short (<5 microm) tremolite fibres, is a better predictor of fibrosis grade in these two groups of chrysotile miners than either the concentration of ABs or the duration of exposure. Due to the limitation of our counting method, almost all fibres longer than 10 microm observed in this study were shorter than 14 microm. Thus, if length plays a role in fibrogenesis, it may be related to fibres of greater length than those covered in this study.

• Non-malignant occupational respiratory diseases in Germany in comparison with those of other countries. X. Baur, U. Latza. 2005;78(7):593-602. PubMed · Publisher

  Abstract

  Objective: To present recent data on the occurrence of non-malignant occupational airway diseases in Germany and to compare mainly affected occupations of obstructive airway diseases caused by allergens and irritants with available surveillance data from other countries.

  Methods: Sources of German data were statistics for the year 2003 of the Ministry of Labour and Social Affairs and of the federation of statutory accident insurance institutions for the industrial sector.

  Results: Confirmed cases of non-malignant occupational respiratory diseases in Germany are mainly benign asbestos-associated diseases (occupational disease no. 4103: 1,975 cases), silicosis/coal worker's pneumoconiosis (occupational disease no. 4101: 1,158 cases), obstructive airway diseases due to allergens (occupational disease no. 4301: 935 cases), chronic obstructive bronchitis and/or emphysema in hard coal miners (occupational disease no. 4111: 414 cases), obstructive airway diseases due to irritants and toxic agents (occupational disease no. 4302: 181 cases), diseases caused by ionising radiation (171 cases), diseases due to isocyanates (occupational disease no. 1315: 55 cases), and 22 cases of other rare occupational lung and airway diseases. Miners, bakers, chemical workers, hairdressers and health care workers are mostly affected. Bakers were also frequently affected by occupational asthma in Finland, France, Sweden, the United Kingdom, the Piedmont region in Italy, South Africa, and New Zealand. Further, high frequencies of occupational asthma were reported for health care workers in France, Italy, New Jersey, Michigan, and South Africa.

  Conclusion: Despite completely different legal definitions and regulations, comparably high numbers of occupational obstructive diseases in western countries require better primary and secondary prevention in industries with high incidence, especially in bakeries, the health care sector, farming, and mining. Furthermore, there is a urgent need for harmonization of recognition and compensation systems for occupational diseases as well as of respective preventive strategies within the European Union.

• Asbestos exposure and radiological abnormalities among maintenance and custodian workers in buildings with friable asbestos-containing materials. M. Matrat, J.C. Pairon, A.G. Paolillo, et al. 2004;77(5):307-12. PubMed · Publisher

  Abstract

  Objectives: Few studies have been carried out to evaluate the respiratory effects of asbestos exposure of custodian and maintenance workers.

  Methods: By a multicentre cross-sectional study, 277 custodian and maintenance employees working in buildings with friable asbestos-containing materials and 87 unexposed subjects were studied for radiological abnormalities by use of the International Labour Office (ILO) classification of radiographs of pneumoconiosis, in relation to parameters of asbestos exposure.

  Results: The cumulative asbestos exposure index was generally low (fewer than 5 fibres/ml x years in 82.3% of exposed workers). On multivariate analysis, pleural thickening was significantly related to latency since onset of exposure to asbestos in exposed workers, after adjustment for age, body mass index and tobacco smoking.

  Conclusions: Asbestos exposure of custodian and maintenance employees in buildings with friable asbestos-containing materials might be associated with an excess of pleural thickening on chest X-rays.

  Copyright 2004 Springer-Verlag

• Factors influencing long-term survival in mesothelioma patients--results of the German mesothelioma register. V. Neumann, A. Rütten, M. Scharmach, et al. 2004;77(3):191-9. PubMed · Publisher

  Abstract

  Between 1987 and 2000, the German mesothelioma register recorded a total of 4,455 patients with malignant mesotheliomas. Survival times for 498 (11.2%) patients were available; 155 patients (study group, 3.5% of the total group) survived for more than 2 years and 343 patients (control group, 7.7% of the total group) survived for fewer than 24 months. Male patients were over-represented in both groups, with 13% of women in the study and 4.4% in the control group. The proportion of pleural mesotheliomas was more than 90% in both groups, with peritoneal cases comprising 6.5% in the study group and 3.2% in the control group. Histologically, the epithelioid subtype was represented in 58% of the study group, whereas the biphasic subtype predominated (67.6%) in the control group. Only 7% of tumours were of the sarcomatoid subtype. The average age of patients in the study group was 57.4 years, thus lower than in the control group (62.8 years). Lung dust analysis showed an increased pulmonary asbestos burden in 94% of all patients; significant differences between the study and control group were not observed. In the majority of the total group pleural effusions were the first symptoms. Therapeutic data were available in fewer than 40% of all cases. Surgical interventions were performed, partly in combination with radiation and chemotherapy and as alternative treatments. Significant deviations in survival time dependent on therapy applied could not be proved. By multivariate analysis (Cox proportional hazards regression model) favourable prognostic factors for long-term survival were epithelioid tumour subtype, comparatively young age (<60 years), and female gender ( P<0.05).

• Mortality and cancer incidence in a Swedish art glassworks--an updated cohort study. G. Wingren. 2004;77(8):599-603. PubMed · Publisher

  Abstract

  Aim: To study mortality and cancer incidence, in a Swedish art glassworks producing both heavy and semi-crystal glassware, in an extended cohort of workers over a long time period during which some preventive actions had taken place.

  Methods: In the updated study, 1,229 men and women were eligible as cohort members during the period 1964-1997. The observed number of cases was compared with expected numbers, as calculated from cause-, age-, gender- and calendar year-specific national rates for mortality and cancer incidence.

  Results: Among men only, a significant risk was seen for cancer incidence in the colon and rectum [standardised incidence ratio (SIR) 1.92, 95% confidence interval (CI) 1.05-3.23; 14 cases] and increased, but statistically non-significant, risks were also seen for male cases of tumours in the liver/bile ducts and brain. Among women, statistically non-significant risks were seen for tumours in the liver/bile ducts and in the lymphatic and haematopoietic systems. No increased risk for cancer of the lung was found in this updated study. The risk for cancer in the colon/rectum was slightly increased in all work categories, and the increase was statistically significant among male and female unspecified glassworkers (SIR 3.13, 95% CI 1.35-6.16; five male and three female cases). A statistically significantly increased risk for cancer in the liver/bile ducts was seen among refinement workers (SIR 3.96, 95% CI 1.07-10.14; two male and two female cases).

  Conclusion: Most of the causes of death associated with an elevated standardised mortality ratio (SMR) in the 1985 cohort resulted in lower SMRs in this updated cohort, maybe as a consequence of preventive actions taken at the glassworks. On the other hand, the risk for cancers in the digestive system seems to remain, perhaps due to past asbestos exposure or inhalation/digestion of larger particles in the ambient air.

  In plain English

  This Swedish study updated an earlier study of workers at one art glassworks. It included 1,218 workers (848 men, 370 women) employed there more than one month during 1964–1997. Their deaths and cancers were compared with national Swedish rates. Asbestos was used in equipment for handling warm glass until the late 1970s.

  Overall death and cancer rates were close to expected, and lung cancer was not increased. Men had more colorectal cancer than expected when a 15-year latency requirement was applied (SIR 1.92, 95% CI 1.05–3.23; 14 cases). Two job groups had raised cancer incidence. Because numbers were small, these job-group analyses combined men and women and used no latency requirement:

  • Unspecified glassworkers: colorectal cancer, SIR 3.13 (95% CI 1.35–6.16; 8 cases).
  • Refinement workers: liver and bile duct cancer, SIR 3.96 (95% CI 1.07–10.14; 4 cases).

  Women died more often than expected from liver and bile duct cancer (SMR 4.60, 95% CI 1.25–11.77; four cases).

  The author suggested that the digestive cancer risk might relate to past asbestos exposure or to larger airborne particles. The author noted that the cohort was small and that smoking and diet could not be assessed.

  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.

• Occupational exposure to chemical agents in the paper industry. K. Korhonen, T. Liukkonen, W. Ahrens, et al. 2004;77(7):451-60. PubMed · Publisher

  Abstract

  As part of an International Agency for Research on Cancer (IARC) international epidemiological study of workers in the pulp and paper industry, previously unpublished exposure measurements were assembled in a database. This article summarizes the results of 3,873 measurements carried out in the production departments of paper and paperboard mills and recycling plants in 12 countries. In the paper and paperboard mills, most of the agents were measured in the pulping and refining departments and in on-machine coating and winding of paper/paperboard. Exposures to asbestos, carbon monoxide, formaldehyde, fungal spores, bacteria, nitrogen dioxide, minerals dusts, paper dust, sulphuric acid and different solvents sometimes exceeded exposure limit values. In the re-pulping and de-inking departments of recycling plants high exposures to formaldehyde, fungal spores, bacteria and paper dust were observed. High exposures to asbestos, bioaerosols, carbon monoxide and paper dust were found in many departments; ammonia, formaldehyde, mineral and paper dust and solvents were found in coating machines; and diphenyl and polychlorobiphenyls (PCBs) were found in some special circumstances. Measurements in the newsprint and uncoated paper machine departments revealed only a few elevated exposures. In nearly all departments, measurements of epichlorohydrin, PCBs, sulphur dioxide, hydrogen sulphide and mercaptans tended to be low, often even below their detection limits. In spite of some uncertainties in the measurement data, the study provides new insights into the level and variation of occupational exposures of production workers in the paper and paperboard industry.

• Three decades of pleural cancer and mesothelioma registration in Austria where asbestos cement was invented. M. Neuberger, C. Vutuc. 2003;76(2):161-6. PubMed · Publisher

  Abstract

  Recently, a new mesothelioma epidemic was predicted from observations made in Western Europe. From early observations in Austria the lower increase in cases of mesothelioma compared with neighbor countries had been related to different uses of asbestos. In order to test this hypothesis, incidence and mortality of pleural cancer [International Classification of Diseases (ICD)-8/9 163] were analyzed for three decades and supplemented by data from a cohort study in the factory that had been the largest consumer of asbestos imported to Austria and from all Austrian occupational diseases registered between 1990 and 2001. In men, mortality rates (based on 15 to 45 deaths/year) were lowest in 1980-1989, but similar in 1970-1979 and 1990-2001. No increase in younger-birth cohorts was detected. Incidence rates (based on 13 to 44 cases/year) increased (36%) non-significantly ( P=0.14). In women, a significant decrease in mortality and incidence rates ( P<0.01) was observed from 1970. Rates from work-related mesothelioma (based on only 0-7 men and 0-4 women/year) must be interpreted with caution. In the cohort of 2,816 asbestos cement workers 26 pleural mesotheliomas were registered from 1990 through mid-1999. Six of these cases (three male and three female) had not been registered as an occupational disease, but all of these cases had been encoded under ICD 163 in mortality statistics. One female cohort member registered as having asbestosis according to the death certificate had died from mesothelioma according to the statistics of occupational diseases. We conclude that no epidemic of mesothelioma due to past asbestos exposure is to be expected in Austria.

• Computed tomography of asbestos-related pleural abnormalities. M. Tiitola, L. Kivisaari, A. Zitting, et al. 2002;75(4):224-8. PubMed · Publisher

  Abstract

  Objectives: To study the observer agreement in several asbestos-related pleural abnormalities and to define criteria to discriminate between pleural changes in workers with occupational disease, and those in controls.

  Methods: Pleural abnormalities in spiral computed tomography of 602 construction workers with asbestosis or bilateral pleural plaques and 49 controls were reviewed by three radiologists using structured forms.

  Results: Intra- and inter-observer agreement (weighted kappa) was 0.4 or better with regard to the calcification, extent and thickness of pleural disease. These factors all correlated positively with the duration of asbestos exposure. There were significant differences in these pleural changes between the workers (mean extent per side 83 cm(2)) and controls (mean extent per side 40 cm(2)). Of the controls, 84% showed pleural lesions with an estimated extent of 10 cm(2) or more, bilateral in 64%. The extent of 45 cm(2) in pleural disease was the best value for discriminating between the controls and diseased workers, with a sensitivity of 82% and a specificity of 66%. The degree of pleural calcification, however, was the best discriminator between these groups, but quantitative methods are necessary for its use in the diagnostics of individuals.

  Conclusions: The extent, calcification and thickness were well-repeatable indicators of benign pleural pathology and thus their use in future classification systems in computed tomography is recommended. In our material, the extent of 45 cm(2) and the degree of calcification were helpful in discriminating between pleural changes in workers with occupational disease, and those in controls who also presented marked pleural pathology.

  In plain English

  Finnish researchers reviewed CT scans of 602 construction workers diagnosed with asbestosis or bilateral pleural plaques. As controls, they used 49 male hospital patients scanned for suspected or known cancer outside the chest. Three radiologists read the scans separately. Their ratings of the extent, thickness and calcification of pleural disease (changes in the lung lining) were repeatable; ratings of adhesions and lung fissures were less so. Counting changes of 10 cm2 or more seen by at least two radiologists, bilateral changes appeared in 569 of 594 workers with data (95%) and 31 of 49 controls (64%). Mean extent per side of the chest was 83 cm2 in workers and 40 cm2 in controls. For extent, a cut-off of 45 cm2 best separated the groups (sensitivity 82%, specificity 66%), which the authors called modest. Calcification discriminated best overall but would need quantitative measurement for individuals. Longer exposure correlated with more pleural change. The authors recommended extent, calcification and thickness for future CT classification systems. They suggested the frequent changes in controls may reflect past wide use of anthophyllite asbestos in Finland and the sensitivity of CT.

  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.

• Asbestos exposure and malignant lymphomas--a review of the epidemiological literature. N. Becker, J. Berger, U. Bolm-Audorff. 2001;74(7):459-69. Review PubMed · Publisher

  Abstract

  There has been a significant number of case reports on the occurrence of lymphomas in people previously exposed to asbestos. This raises the question of whether corresponding results are available from analytical epidemiological studies. In the present review of the epidemiological literature, we describe the results of the six cohort and 16 case-control studies that - according to our research - were published up to 1999 and, directly or indirectly. shed light on the above question. In summarizing the results of these studies, we have distinguished between non-Hodgkin lymphoma (NHL), chronic lymphatic leukemia (CLL) and plasmocytoma/ multiple myeloma (MM). A causal relationship between asbestos exposure and the subsequent development of lymphomas cannot be derived from the available results. However, since quite a number of studies and the combined analysis indicate a (weakly) increased risk, this question should be considered directly in future epidemiological studies. Such studies should address separately the various sub-entities, employing the latest internationally agreed classification, and should also use the latest methods of quantifying exposure.

• Changes in low molecular weight DNA fragmentation in white blood cells of workers highly exposed to asbestos. B. Marczynski, T. Kraus, P. Rozynek, et al. 2001;74(5):315-24. PubMed · Publisher

  Abstract

  Objective: The aim of this study was to determine low molecular weight (LMW)-DNA fragmentation changes after white blood cell (WBC) incubation in lysis buffer followed by constant-field gel electrophoresis (CFGE). WBCs were isolated from blood samples of workers highly exposed to asbestos fibres at the workplace in Germany, and were compared with those from healthy adults. This study was conducted parallel to the study presented in our preceding paper (Marczynski et al. 2000b) in which we described significant increases in the levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG) adducts in the DNA of white blood cells from the same highly exposed workers relative to the levels found in the control group in all three study years (1994 to 1997).

  Method: We found that 15-h incubation in lysis buffer of WBCs embedded in agarose-plugs from healthy control donors with 2% SDS, proteinase K and Na2-EDTA at 42 degrees C followed by 0.5 h at 4 degrees C produced a characteristic DNA fragmentation pattern below 23 kbp using CFGE.

  Results: In the 1st year of the study (1994-1995) changes were found in LMW-DNA fragmentation in 54.8% of the asbestos workers studied, compared with the DNA fragmentation pattern of controls. Interestingly, in the 2nd year of the study (1995 1996) changes in DNA fragmentation were found in only 39.9% of exposed subjects. In the 3rd year of the study (1996-1997) the highest number of workers exposed to asbestos (67.3%) with changes in the LMW-DNA fragmentation pattern was found. The Chi-square test for each year of the study revealed significant changes (P < 0.001). These changes may be due to the presence of hydrogen peroxide (H2O2), as has been shown in vitro. It is likely that a Fenton reaction involving the heterolytic reduction of H2O2 by traces of reduced transition metals such as Fe2+ and Cu+ is involved in the fragmentation of DNA. No difference was found in the changes in DNA fragmentation between asbestos-exposed subjects with and without benign asbestos-associated diseases (asbestosis, asbestos-associated pleural plaques). Significant correlations were not found after analysis of the changes in DNA fragmentation in relation to different possible occupational and non-occupational confounding factors, such as the duration of asbestos exposure, the latency period, estimated cumulative fibrous dust dose ("fibre-years"), and non-occupational confounding factors, such as age, smoking status, acute febrile infections, the intake of medicines, aspirin, Ca2+, Mg2+ and/or hormones, the intake of vitamins, and cases of cancer.

  Conclusions: Our data confirm that oxidative stress occurs in the WBCs of workers highly exposed to asbestos fibres, thus supporting the hypothesis that asbestos fibres damage cells through an oxidative mechanism. Oxidative stress and oxidative DNA damage may be induced by long-term exposure to asbestos. The new insights into the oxidative effects of asbestos fibres are of great importance because they provide a way forward for new preventive strategies. Preventive and therapeutic approaches using antioxidants should be taken into consideration.

• Inorganic fibres in the lung tissue of Hungarian and German lung cancer patients. K. Rödelsperger, A. Mándi, A. Tossavainen, et al. 2001;74(2):133-8. PubMed · Publisher

  Abstract

  Objective: To ascertain the lung burden of asbestos fibres in Hungarian lung cancer patients in comparison with the cumulative asbestos exposure estimated from the occupational history.

  Methods: For 25 Hungarian lung cancer patients, lung tissue fibre analysis was performed by scanning transmission electron microscopy (STEM) and counting of ferruginous bodies (FBs) by light microscopy. Cumulative asbestos exposure in fibre-years was assessed from a standardised occupational history using the report "fibre years" of the German Berufsgenossenschaften.

  Results: Median and maximum concentrations of fibres longer 5 microns per gram dry lung tissue (g dry) were 0.03 and 7.38 million fibres/g dry for chrysotile, 0.00 and 0.21 million fibres/g dry for amphibole and 0.22 and 0.62 million fibres/g dry for other mineral fibres (OMFs). The maximum values were observed in one patient for whom a high asbestos exposure was evident in advance from the occupational history.

  Conclusions: In comparison with reference values obtained by the same method for German patients with no indication of workplace asbestos exposure, increased concentrations of more than 0.2 million chrysotile fibres/g dry were obtained for six of the 25 Hungarian patients (24%). For one of them, the second highest estimate of a workplace exposure of 60 fibre-years and the highest tissue concentration of 7.38 million chrysotile fibres/g dry substantiate a high probability of a causal relationship to asbestos. A further comparison can be made with the results for 66 German patients treated by surgical lung resection for a disorder other than mesothelioma, mainly lung cancer. For the Hungarian lung cancer patients, similar amounts of chrysotile but distinctly lower amounts of amphibole fibres and distinctly higher amounts of OMFs were observed. A correlation between exposure estimates from occupational history and concentration of fibres in the lung tissue was observed for amphibole (Spearman: R = 0.66, P < 0.001, Pearson: R = 0.50, P = 0.01) and for chrysotile (Pearson: R = 0.48, P = 0.02).

• Malignant mesothelioma--German mesothelioma register 1987-1999. V. Neumann, S. Günthe, K.M. Mülle, et al. 2001;74(6):383-95. PubMed · Publisher

  Abstract

  Objectives: The study group comprised a collective of 1,605 patients with malignant mesotheliomas and with lung tissue available for lung dust analyses.

  Method: Clinical features, occupational histories, expositions and individual data were evaluated, and the asbestos bodies concentrations (asbestos bodies/cm3 lung tissue or g wet tissue) were determined.

  Results: Mesotheliomas developed mainly in men (94.5%). Of the cases, 96.4% were of pleural origin and only 3.3% were peritoneal mesotheliomas. The biphasic subtype predominated (61.3%), followed by the epithelioid type (29.3%). The sarcomatoid subtype was rarely developed (9.4%). Mean age at first diagnosis was 60.4 years. The mean survival time from time of symptom onset was 13.5 months. Patients with epithelioid subtypes had a longer survival time (16.9 months) than those with biphasic (13.1 months) and sarcomatoid subtypes (5.5 months). Of the patients, 73% presented pleural effusions as initial symptoms of the disease. An increased asbestos burden was identified by light microscopy in 84.8% of the patients. There was no association between histological subtypes and the asbestos burden of the lungs. Patients with peritoneal mesotheliomas had distinctly higher asbestos burdens in the lungs than patients with pleural mesotheliomas. There exists no association between lung asbestos burdens and survival times. The mean latency period was 37.8 years. A trend: higher asbestos burden of the lung/shorter latency periods was suggested. About 70% of the patients had a history of occupational exposure to asbestos dust. Most patients worked in the building trade, the locksmith and machine building industries and in the steel and blast-furnace industries. Of the patients, 25.6% had asbestos-associated lung fibroses, in 40.7% of the cases pleural plaques were identified.

  Conclusions: The most important causal factor for development of mesotheliomas is still asbestos, primarily amphibole asbestos. The recurring occurrence of mesotheliomas in younger people without known asbestos exposure needs the urgent investigation of other inducing factors for mesotheliomas.

• Mechanism of refractory ceramic fiber- and rock wool-induced cytotoxicity in alveolar macrophages. K.A. Kim, W.K. Lee, J.K. Kim, et al. 2001;74(1):9-15. PubMed · Publisher

  Abstract

  Objectives: Man-made vitreous fibers (MMVFs) can induce cytotoxicity in a way similar to that of other particles, including silica and asbestos fibers. However, as yet the mechanism of MMVF-induced cytotoxicity is still not clear. This report aims to clarify the mechanism of MMVF-induced cytotoxicity in the alveolar macrophage (AM). In this mechanism, an attempt to prove the involvement of the adenosine triphosphate (ATP) generation system and the polyinosinic acid-inhibitable scavenger receptors was made.

  Methods: Several parameters were observed for cytotoxicity, such as cell viability, the release of lactic dehydrogenase (LDH) and ATP levels in rat AM's that were treated with refractory ceramic fibers (RF2) and rock wool (RW1). A specially designed ATP generation system was used to determine the effect of MMVF on ATP generation. A scavenger receptor ligand was applied to evaluate the relationship between scavenger receptors and MMVF-induced ATP depletion.

  Results: A 3-(4,5-dimethylthiazol)-2,5-diphenyl tetrazolium bromide (MTT) assay indicated that both RF2 and RW1 caused a decrease in cell viability and this decrease was concentration-dependent. RF2 and RW1 increased the release of LDH with increasing fiber concentration. From these parameters, RF2 was shown to exhibit greater cytotoxicity than did RW1. Both fibers decreased the intracellular ATP content and this decrease was concentration-dependent. The decrease was more pronounced in RW1 than in RF2 at all fiber concentrations. These fibers suppressed succinate-triggered oxygen consumption. Polyinosinic acid, a ligand of the scavenger receptor, inhibited the MMVF-induced decrease in ATP concentration.

  Conclusion: These results suggest that RF2 and RW1 can induce cytotoxicity and ATP depletion in the AM through the polyinosinic acid-inhibitable scavenger receptor. ATP depletion was the important factor in MMVF cytotoxicity, especially by RW1.

• Asbestos as reference material for fibre-induced cancer. H. Muhle, F. Pott. 2000;73 Suppl:S53-9. Review PubMed · Publisher

  Abstract

  The objective of this paper is to review published data on the carcinogenicity of asbestos fibres with regard to the elucidation of a potential risk originating from exposure to man-made vitreous fibres (MMVF). Steps in the comparison of the two fibre classes are characterization of the fibres, pulmonary deposition, biodurability and biopersistence and a review of the cancer risk from asbestos fibres after inhalation in rats and humans. Various dust samples of chrysotile, crocidolite, and amosite were used as reference materials in studies with experimental animals. These fibres are normally thinner and shorter than MMVF. These differences in dimensions cause differences in the deposition in the airways. In addition, significant dissimilarities exist in the deposition pattern between rats and humans. Data from biopersistence studies show that focusing only on fibres longer than 20 microm and using weighted half-time for a characterization of risk may be misleading. Inhalation experiments with rats need fibre exposure concentrations over 100 times higher to match the lung cancer risk of asbestos workers, and about 1,000 times higher to reach the same mesothelioma risk. Also, the striking difference between the low lung burden of amphibole fibres of asbestos workers with mesothelioma and the more than 1,000 times higher lung burden of rats with a low mesothelioma risk demonstrates the low sensitivity of the inhalation test model for the carcinogenic potency even of crocidolite fibres. It can be concluded that the rat inhalation model is also not sensitive enough to predict the cancer risk of other fibre types for humans.

• Determinants of the pathogenicity of man-made vitreous fibers (MMVF). G. Oberdörster. 2000;73 Suppl:S60-8. Review PubMed · Publisher

  Abstract

  Introduction And Objectives: A number of man-made vitreous fibers (MMVF) have been developed over the years to replace asbestos fibres in its uses as insulating material. Concerns have been raised that these man-made fibers may also pose a significant health hazard when inhaled during their manufacture and application. As will be discussed in this brief overview, dose, dimension and durability of fibrous particles are key parameters with respect to the induction of adverse pulmonary effects, including carcinogenicity as well as non-cancer effects. In particular, fiber biopersistence plays a most important role for pulmonary pathogenicities, and consequently biopersistence receives greatest attention in the search of new fibrous materials.

  Methods And Results: Tests to evaluate fiber biopersistence include the administration of fibers by a short-term inhalation (5 days) or intratracheal instillation into rats. Advantages of the inhalation methodology include the even distribution throughout the lung administered by a physiological process. A disadvantage of this method is the limited respirability of long fibers in the rat whereas they are well respirable by humans. Such long fibers ( > 20 microm) have the greatest potential for tumorigenicity and need special consideration in connection with the evaluation of fiber biopersistence. Enrichment of the inhaled aerosol by these long fibers needs to be considered in order to deposit enough of them in the lower respiratory tract of the rat. In contrast, the advantage of the instillation technique is that these long fibers can be delivered to the lung. However, the major disadvantages of intratracheal instillations are the potential of the administered fibers to form clumps and aggregates in the airways and the induction of a major inflammatory response when high-bolus doses are administered. This could influence fiber dissolution in the lungs significantly.

  Conclusions: At the same delivered lung dose, a fiber of low biopersistency has the least effect and is, therefore, less likely to induce lung or pleural tumors even under chronic exposure conditions. Respective animal studies with more fibers of different biopersistence have confirmed this general principle. It is very important that, when evaluating and interpreting fiber effects observed in experimental animals, species differences with respect to respirability, lung retention and mechanisms of responses are considered.

• Natural organic fibers--health effects. B. Järvholm. 2000;73 Suppl:S69-74. Review PubMed · Publisher

  Abstract

  Objectives: Natural organic fibers are used in large quantities in the production of paper products and textiles. They are also constituents of food and added to food to promote health. The objective of this review is to evaluate the health effects of natural organic fibers. The health effects of dietary fibers are excluded from the review.

  Methods: This is a literature review.

  Results: Exposure to these fibers in industry is usually not characterized as fibers but as dust. Rather dusty conditions have been reported in both paper and textile industries with concentrations up to and above 30 mg/m3. Both in the paper and textile industry inorganic fibers may occur making it hard to evaluate health effects of natural organic fibers from studies of workers in the paper and textile industry. There seems to be no increased risk of mesothelioma, lung cancer or lung fibrosis in workers exposed to natural organic fibers in contrast to workers exposed to inorganic crystalline fibers as asbestos. However, workers with a heavy exposure to paper dust or textile dust seem to have an increased risk of obstructive lung disease and bronchitis. These effects have not been causally linked to the fibrous shape of the particles but rather to the dust, chemicals absorbed on the dust or microorganisms occurring together with the dust. There is some indication that work in the textile industry may increase the risk of sinonasal cancer, but the etiological agents are unknown.

  Conclusion: Natural organic fibers are not causally linked with the well-known effects of some inorganic fibers, i.e. mesothelioma, lung cancer, lung fibrosis or some pleural diseases. The health effects of natural organic fibers, e.g. irritative effects, seem not to be linked to their fibrous shape.

• Risk of lung cancer in workers producing stainless steel and metallic alloys. J.J. Moulin, T. Clavel, D. Roy, et al. 2000;73(3):171-80. PubMed · Publisher

  Abstract

  Objectives: The mortality of workers involved in the production of stainless and alloyed steel from 1968 to 1992 was studied, in order to investigate the risk of lung cancer due to exposure to metals, i.e. iron oxides, chromium and/or nickel compounds.

  Methods: The study design was a historical cohort mortality study and a nested case-control study concerning lung cancer. Standardized mortality ratios (SMRs) were computed using regional mortality rates as an external reference for comparing observed and expected numbers of deaths, adjusting for age, sex and calendar time. Conditional logistic regression was used to estimate odds ratios (ORs). Occupational exposure was assessed through the complete job histories of cases and controls and a specific job-exposure matrix.

  Results: The cohort comprised 4,288 male and 609 female workers. The observed overall mortality was significantly lower than expected [649 deaths; SMR = 0.91; 95% confidence interval (CI) 0.84-0.98]. No significant SMR was observed for mortality from lung cancer (54 deaths; SMR = 1.19; CI 0.88-1.55). The case-control study was based on 54 cases and 162 individually matched controls. Smoking habits were available for 71%. No lung cancer excess was observed for exposure to (1) metals and/or their compounds, i.e. iron (OR = 0.94, CI 0.48-1.86), chromium and/or nickel (OR = 1.18, CI 0.62-2.25), and cobalt (OR =0.64, CI 0.33-1.25), (2) acid mists (OR = 0.43, CI 0.17-1.10), and (3) asbestos (OR = 1.00, CI 0.54-1.86). With respect to exposure to polycyclic aromatic hydrocarbons (PAHs) and silica, which are often found together in workplaces, (1) high and statistically significant lung cancer excesses were observed, the ORs being 1.95 (CI 1.03-3.72) and 2.47 (CI 1.28-4.77) respectively, (2) quantitative exposure parameters revealed upward trends reaching statistical significance (P < 0.05), and (3) adjustments for tobacco consumption did not reveal any confounding factors from smoking.

  Conclusion: This study failed to detect any relationship between lung cancer and exposure to iron, chromium, nickel and/or their compounds. High and statistically significant relative risks, along with increasing trends, were observed for simultaneous exposure to PAHs and silica.

• Role of occupational asbestos exposure in Hungarian lung cancer patients. A. Mándi, M. Posgay, P. Vadász, et al. 2000;73(8):555-60. PubMed · Publisher

  Abstract

  Objective: What is the frequency of occupational asbestos exposure among patients suffering from malignant respiratory tumours and how many of these tumours are associated with asbestos in Hungary?

  Methods: An internationally established questionnaire with 29 questions, covering the most characteristic activities of asbestos exposure at the workplace was completed for 300 patients with respiratory malignancies, i.e. 297 patients with lung cancer and three with mesothelioma of the pleura. From the questionnaire, the smoking habits were estimated and cumulative asbestos exposure was assessed in fibre-years. Additionally, lung X-rays were classified and the national data on the incidence of malignant pleura mesothelioma were analysed.

  Results: A cumulative asbestos exposure of 25 fibre-years or more was detected in 11 patients with lung cancer (4%) and in each of the three patients with pleural mesothelioma (100%). In a further 72 patients (24%), cumulative occupational asbestos exposure was assessed as below 25 fibre-years (between 0.01 and 23.9 fibre-years). In this group, car and truck mechanics, and installation and construction workers using asbestos-cement were registered. Among patients with an asbestos exposure of 25 fibre-years or more, six asbestos-cement production workers were observed, among them the three mesothelioma cases. A weak but significant association between positive X-ray findings and exposure estimates could be demonstrated. Additionally, results of the lung tissue fibre counts by scanning transmission electron microscopy were available for 25 of the lung cancer patients. A good correlation was observed between the asbestos fibre counts and the assessment of cumulative asbestos exposure. In Hungary, 84 cases of pleural mesothelioma were registered in 1997 and 73 in 1998. These numbers correspond to an annual incidence of about one new case per 100,000 inhabitants older than 15 years.

  Conclusions: The annual incidence of lung cancer in Hungary is about 6,000. Since in our series of lung cancer patients about 4% were observed, which could be accepted as representing occupational disease because of a cumulative exposure to 25 fibre-years or more, the annual asbestos related lung tumour incidences may be estimated to be approximately 150 or more. The proportion of nearly two estimated cases of lung cancer per case of pleural mesothelioma corresponds to international experience. Up to now, lung cancer cases only exceptionally have been registered as occupational diseases, i.e. they were seriously under-diagnosed in Hungary. For improving this situation, diagnostic assistance by a self-interview with a questionnaire covering the working history for all newly diagnosed lung cancer patients would be helpful.

1990s

• Angular and fibrous particles in lung in relation to silica-induced diseases. A. Dufresne, R. Bégin, C. Dion, et al. 1998;71(4):263-9. PubMed · Publisher

  Abstract

  Introduction: The lung concentration of angular and fibrous particles was measured in cases of lung fibrosis only, in cases of lung fibrosis and lung cancer, and in cases of lung cancer only. These patients worked in different trades (mining, foundries, construction and were not a homogeneous group of exposed workers.

  Material And Methods: Particles, both angular and fibrous, were extracted from lung parenchyma by a bleach digestion method, mounted on copper microscopic grids by a carbon replica technique, and analyzed by transmission electron microscopy (TEM) and energy-dispersive spectroscopy (EDS). The quartz concentration was also determined by X-ray diffraction (XRD) on a silver membrane filter after extraction from the lung parenchyma.

  Results: (1) Lung cancer and lung fibrosis cases retained more metal-rich particles (P = 0.02) and more angular particles of all sorts (P = 0.009) than did lung fibrosis cases only, and the differences were statistically significant. (2) However, more quartz was retained in the lungs in lung fibrosis cases than in lung fibrosis or lung cancer cases, but the difference in the concentrations was not statistically significant. (3) More ferruginous bodies were retained in the lungs in lung cancer and lung fibrosis cases than in cases of lung fibrosis only, and the difference in the concentrations was statistically significant (P = 0.02).

  Conclusion: Results obtained from lung tissue must always be interpreted cautiously. However, these results are consistent with the hypothesis that workers in some trades such as foundries were exposed not only to quartz but also to asbestos, ceramic fibers, metal-rich non fibrous particles, and other likely carcinogenic chemicals. The wide range of particle types identified in the lungs of these workers illustrates the complexity of trying to determine disease origins in these work environments. Epidemiology studies have to control for the exposure to these carcinogens as well as for smoking habits.

• Exposure to carbon black: a cancer risk?. M. Brockmann, M. Fischer, K.M. Müller. 1998;71(2):85-99. Review PubMed · Publisher

  Abstract

  Lung cancer is one of the most serious health problems in the industrial nations and is therefore of great public and scientific interest. Although inhalative cigarette smoking is without doubt the main cause for the increasing frequency of lung cancer, during recent years there has been more and more public interest in other substances in the environment or at the work place that are assumed to be potentially carcinogenic especially due to experiences with fibrous particles such as asbestos and their effects. Enhanced attention is also directed to inert or nuisance dusts such as carbon black. Evaluation of the possibly increased risk for humans should first be based on exact epidemiology data. In the absence of those data--as in the case of carbon black--experimental data in animals serve as the point of orientation, especially results gained in rats in long-term inhalation studies. Pathologic anatomy investigations of human lungs under similar exposure conditions, however, render results quite different from those obtained in rats and, thus, preclude ready interpretation of animal results to human risk assessment. This is particularly true for the development of lung tumors in rats under overload conditions as well as for certain tumor types not observed in human lung tissues. It is therefore quite understandable that many researchers propose to interpret the changes observed in rat lung tissues after inhalation of carbon black as rat-specific reaction mechanisms that cannot be applied to human tissues, which in the past have led to the wrong conclusions regarding human risk assessment due, among other factors, to incorrect experimental design and inaccurate nomenclature of tumorous lesions in rats.

• Follow-up of asbestosis patients and predictors for radiographic progression. P. Oksa, M.S. Huuskonen, J. Järvisalo, et al. 1998;71(7):465-71. PubMed · Publisher

  Abstract

  Objective: We followed a group of 85 Finnish asbestosis patients radiographically for an average of 6.5 (range 2-10) years to examine the progression of the disease and to assess possible explanations for the progression.

  Methods: The examinations included full-size chest radiographs and a blood specimen analysis. The radiographs were classified according to the 1980 International Labor Office (ILO) classification. Progression was accepted if the second or third radiography was estimated (in a side-by-side comparison) to have more profusion of small opacities qualitatively than the first, even if the radiographs were classified into the same profusion category.

  Results: In all, 38% of the patients showed progression during the follow-up period. The average progression of small opacities ranged from ILO 1/1 to ILO 2/2 (0.4 minor ILO categories/year). The asbestosis was progressive more often among the sprayers than among the insulators and asbestos factory workers [cross-tabulation, odds ratio (OR) 5.0, 95% confidence interval (95% CI) 1.2-20]. In the logistic regression model the ILO classification category at the beginning of the follow-up (OR 1.54; 95% CI 0.96-2.47), the fibronectin (OR 1.01; 95% CI 1.00-1.01) and angiotensin-converting enzyme (ACE; OR 1.10; 95% CI 1.00-1.20) levels, and the erythrocyte sedimentation rate (ESR; OR 1.05; 95% CI 1.00-1.10) were statistically associated with the radiographic progression of small opacities. Abnormalities of the pleura were found to progress more often among the patients with progressive parenchymal opacities.

  Conclusion: For the progression of small-opacity profusion the significant predictors in the logistic regression model were the ILO profusion category at the beginning of the follow-up period, the fibronectin level, the ACE value, and the ESR. The model correctly classified 94% of the patients with progression and 65% of those without progression. The differences in the mean values recorded for the biomarkers between the progressors and nonprogressors, however, were small and may therefore not be of any importance to the clinician.

• Occupational health in Australia. W.O. Phoon. 1998;71(6):363-71. Review PubMed · Publisher

  Abstract

  Australia is a developed country in the Asia-Pacific Region with a large land area but a small population. Its main economic activities are mining, agriculture and manufacturing, with its service and high-technology industries being the fastest growing sectors in recent years. The regulation and enforcement of Occupational Health and Safety policies are mainly administered by the Industrial Relations Departments of eight State and Territory jurisdictions in the country. A National Occupational Health and Safety Commission coordinates occupational health and safety at the Commonwealth level. In 1987 the six occupational health and safety priorities in Australia were listed as occupational back pain, management of chemicals used at work, occupational noise-induced hearing loss, occupational skin disorders, occupational cancer and mechanical equipment injury. Australia has probably the highest incidence of malignant mesothelioma in the world, although the use of asbestos has been largely phased out. There was an almost explosive "epidemic" of repetition strain injury in the 1980s. Approximately 500 work-related fatalities and 10,000 work-related injuries are notified for workers' compensation every year. In addition, it is estimated that there are several thousand cases of work-related diseases every year, many of which go unreported. Occupational physicians undergo 4 years of specialisation training. Occupational hygienists, nurses and ergonomists receive training supervised by their respective professional organisations.

• Computer-assisted classification system for chest X-ray and computed tomography findings in occupational lung disease. T. Kraus, H.J. Raithel, G. Lehnert. 1997;69(6):482-6. Case report PubMed · Publisher

  Abstract

  The ILO classification of pneumoconiotic changes in the lungs and pleura has become a standardized and widely accepted method of documentation in occupational medicine. Recently a classification system for computed tomography/high-resolution computed tomography (CT/HRCT) findings in the lung has been proposed as well. For both classification systems, computed-assisted programs have been developed that allow the storage and archiving of the results as well as further statistical processing. The programs are compatible with usual hardware configurations, have a comprehensible and transparent structure, and are easy to learn and adaptable to individual needs. The use of the computer-assisted classification systems is presented in the example of an insulator exposed to asbestos. The system of data documentation and processing has proved to be very practicable in the more than 2000 patients studied thus far.

• Determination of carcinogenic potential of mineral fibers by 8-hydroxydeoxyguanosine as a marker of oxidative DNA damage in mammalian cells. N. Murata-Kamiya, T. Tsutsui, A. Fujino, et al. 1997;70(5):321-6. PubMed · Publisher

  Abstract

  8-Hydroxydeoxyguanosine (8-OH-dG) is a typical form of oxidative DNA damage, which causes mutations in vitro and in vivo. To develop a simple method of testing the carcinogenicity of fibrous materials, the formation of 8-OH-dG was determined in the DNA of J774 cells, an established reticulum cell sarcoma line, after treatment with various natural and man-made mineral fibers. The amount of 8-OH-dG was determined using high-pressure liquid chromatography (HPLC) equipped with an electrochemical detector (ECD). We tested three natural mineral fibers (crocidolite, amosite, and chrysotile) and three man-made mineral fibers (ceramic, glass, and potassium octatitanate). Among them, a significant increase in 8-OH-dG formation was observed in the crocidolite- and amosite-treated cells. We also measured the amount of tumor necrosis factor (TNF) produced by J774 cells incubated with the fibrous materials. Cellular TNF production increased after treatment with all the fibers tested, but it was not statistically significant except in the case of chrysotile. Therefore, these results indicate that the mechanism of TNF production is different from that of 8-OH-dG formation, and that the carcinogenicity of various fibrous materials can be better evaluated by measuring the 8-OH-dG level in J774 cellular DNA after treatment with these fibers.

• Immunohistochemical localization of transforming growth factor-beta and insulin-like growth factor-I in asbestosis in the sheep model. T.C. Lee, L.I. Gold, J. Reibman, et al. 1997;69(3):157-64. PubMed · Publisher

  Abstract

  Asbestosis is characterized by increased collagen deposition along the walls of terminal respiratory bronchioles that extends into the alveolar ducts and septae. Alveolar macrophages are activated and release growth factors that stimulate mesenchymal cell proliferation and enhanced formation of extracellular matrix. Both insulin-like growth factor-I (IGF-I), and transforming growth factor beta (TGF-beta) regulate cellular growth and promote matrix accumulation and are hypothesized to play important roles in asbestosis. We performed immunohistochemistry using polyclonal antibodies to specific synthetic peptides of the three mammalian isoforms of TGF-beta (TGF-beta 1, -beta 2, -beta 3) and to IGF-I on lungs of sheep treated intratracheally with chrysotile asbestos. All three TGF-beta isoforms were found in bronchial and bronchiolar epithelium, macrophages, and bronchial and vascular smooth muscle in control lungs. The distribution of TGF-beta was increased in these lung constituents as fibrotic lesions developed. Fibrotic lesions additionally demonstrated intense immunostaining of all three TGF-beta isoforms that localized to the extracellular matrix zones with little staining of interstitial cells. In the control sheep lungs, IGF-I staining was detected in bronchial and bronchiolar epithelium, bronchial glands, bronchial and vascular smooth muscle, endothelium, and macrophages. IGF-I immunostaining was detected in macrophages in peribronchial fibrosis and in fibroblasts along the periphery of and within lesions, but not in the extracellular matrix. Metaplastic proliferating epithelium and macrophages were strongly immunoreactive for IGF-I in advanced lesions. Our data demonstrate different immunostaining patterns for IGF-I and TGF-beta in asbestosis, with IGF-I in the cellular periphery and TGF-beta in the extracellular matrix consistent with a complementary role in stimulating interstitial fibroblast proliferation and new collagen deposition in areas of active fibrosis.

• Occupational exposure and lung cancer risk in a coastal area of northeastern Italy. M. Bovenzi, G. Stanta, G. Antiga, et al. 1993;65(1):35-41. PubMed · Publisher

  Abstract

  A case-control study of lung cancer and occupational exposure was conducted in a coastal area of Northeastern Italy where metallurgical and mechanical industries, docks and shipyards are located. Cases comprised 756 men who died of primary lung cancer in a 5-year period. Controls comprised 756 male subjects dying from other causes during the same period. Occupational exposures to lung carcinogens were assessed according to a job title-based approach, using two separate lists of industries/occupations recognized as being causally associated (list A) or suspected of being causally associated (list B) with lung cancer in humans. Exposure to asbestos was classified as absent, possible, or definite. After adjustment for cigarette smoking and place of residence, a significant association was found between lung cancer and occupations in both list A [relative risk (RR) = 2.25, 95% confidence interval (CI) = 1.68-3.03] and list B (RR = 1.33, 95% CI = 1.03-1.71). A significant excess risk was found for workers with definite exposure to asbestos as compared to those with no exposure to lung carcinogens (RR = 1.98, 95% CI = 1.42-2.75). Among occupations with recognized exposure to lung carcinogens other than asbestos, a significant excess risk for lung cancer was observed in iron and metalware workers. In occupational groups with definite exposure to asbestos, elevated risk estimates were found for shipyard workers, dockworkers, carpenters, and electricians. The combined effect of smoking and asbestos was found to be compatible with that expected under a multiplicative model. The overall population-attributable risk (ARp) for cigarette smoking was found to be 87.5%.(ABSTRACT TRUNCATED AT 250 WORDS)

1980s

• Asbestos exposure, pleural plaques and the risk of lung cancer. D.A. Edelman. 1988;60(6):389-93. Review PubMed · Publisher

  Abstract

  Studies which have evaluated the relationship between pleural plaques and smoking have found a higher prevalence of smokers among persons with pleural plaques. Pleural plaques are a relatively frequent finding among persons with occupational exposure to asbestos. Some studies, but not others, have shown that persons with pleural plaques have a higher risk of lung cancer. None of these studies controlled for the effects of smoking, and since smoking is more prevalent among persons with pleural plaques, it is unlikely that the increased risk of lung cancer to persons with pleural plaques, found in some studies, is due to the pleural plaques.

• Cancer morbidity in Swedish shipyard workers 1978-1983. A. Sandén, B. Järvholm. 1987;59(5):455-62. PubMed · Publisher

  Abstract

  The cancer morbidity in 3787 shipyard workers was studied between 1978 and 1983. In these shipyards the use of asbestos was abandoned in 1972. The overall cancer morbidity was found to be similar to that of the male population of the same city, but there were four cases of mesothelioma. There were 11 cases of lung cancer, as opposed to 9.8 expected cases. Men with both heavy and long exposure to asbestos had no increased risk of lung cancer. The occurrence of pleural plaques was not associated with the risk of developing cancer.

• Mortality in lung and gastrointestinal cancer among shipyard workers. A. Sandén, P.E. Näslund, B. Järvholm. 1985;55(4):277-83. PubMed · Publisher

  Abstract

  The risk of shipyard workers acquiring lung cancer and gastrointestinal cancer was investigated retrospectively by analysing the mortality pattern of 365 deceased shipyard workers. Instead of using the proportional mortality ratio (PMR), the odds ratio (OR) was determined according to a method proposed by Axelson, Miettinen and Der Wang. The pattern of causes of death among Swedish males was used as a reference. The OR was 2.3 for lung cancer and 1.4 for gastrointestinal cancer, using death in cancers of other sites (ICD 170-209) as reference diseases. There was a heavy exposure to asbestos, which is the probable cause of the increased risk of lung cancer in this population.

• Criteria for the diagnosis of asbestosis and considerations in the attribution of lung cancer and mesothelioma to asbestos exposure. Prepared by the Medical Advisory Panel to the Asbestos International Association. 1982;49(3-4):357-61. PubMed · Publisher

  Summary

  The Medical Advisory Panel to the Asbestos International Association, whose 15 listed members came from several countries, set out criteria for diagnosing asbestosis and considerations for attributing mesothelioma and lung cancer to asbestos exposure. The panel defined asbestosis as diffuse, irreversible fibrosis of the lung parenchyma caused by respirable airborne asbestos fibres. Its criteria were evidence of substantial occupational or para-occupational exposure, persistent basal inspiratory crackles, radiographic basal diffuse interstitial fibrosis recorded using the ILO classification, and a restrictive pattern of lung function. It stated that breathlessness, clubbing and asbestos bodies in sputum were not diagnostic on their own, that biopsy was seldom justified, and that the term "pleural asbestosis" was undesirable. For mesothelioma, the panel stated that most cases were related to asbestos and that latency was usually 20 to 40 years or longer. In industrial populations no relationship with asbestos could be established in 10% to over 30% of cases. Smoking played no part, and opinion was divided on whether risk differed by fibre type. It stated that recent work did not support the idea that any slight, casual or brief exposure may lead to mesothelioma. For lung cancer, it stated that cigarette smoking was the primary cause and that risk was greater at higher asbestos exposure. It also stated that no pathological feature allowed a case to be attributed solely to asbestos, and that lower levels of past exposure did not pose a detectable excess risk. Evidence on cancers of other sites was described as equivocal.

  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.

1970s

• Mesothelioma possibly due to environmental exposure to asbestos in childhood. K.J. Arul, P.F. Holt. 1977;40(2):141-3. PubMed · Publisher

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