Journal of Occupational Medicine.

About the journal

Publisher: Williams And Wilkins
Published: 1959–1994, United States
Language: English
ISSN: 0096-1736 (print)
Continued by: Journal of Occupational and Environmental Medicine
Its record in the NLM Catalog

1990s

Cancer mortality patterns among female and male workers employed in a cable manufacturing plant during World War II. E.M. Ward, A.M. Ruder, A. Suruda, et al. 1994;36(8):860-6. PubMed

Abstract

A cohort mortality study was conducted among 9028 (3042 women, 5986 men) workers potentially exposed to chlorinated naphthalenes (chloracnegens structurally similar to dioxins) and asbestos in the manufacture of Navy cable during World War II. Based on mortality through December 31, 1985, standardized mortality ratios (SMRs) for all cancers was 1.03 in women (95% confidence interval [CI] = 0.9 to 1.17) and 1.18 in men (95% CI = 1.10 to 1.26). There were no significant elevations in causes of death hypothesized a prior to be associated with chlorinated naphthalene exposure (malignant neoplasms [MN] of connective tissue, liver, and lymphatic and hematopoietic organs). An excess of MN of the connective tissue was suggested for workers with over 1 year of exposure and 25 years of latency (SMR = 3.54; 95% CI = 0.97 to 9.07). Among cancer sites not hypothesized to be related a priori, three showed concordant excesses among both genders (MN of stomach; rectum; and trachea, bronchus, and lung). No significant elevations occurred in hormonally related cancers among women. Cancer mortality among 460 individuals with chloracne (431 men, 29 women) was similar to that of the entire cohort, although the chloracne subcohort showed significant excesses in two rare causes of death (MN of esophagus, SMR = 3.26; "benign and unspecified neoplasms," SMR = 4.93). Use of county referent rates decreased SMRs for stomach, rectal, and buccal cavity cancer, suggesting a role for nonoccupational risk factors. It is difficult to draw conclusions about carcinogenicity of chlorinated naphthalenes because of study limitations, most importantly, concomitant asbestos exposure and the relatively short duration of exposure to chlorinated naphthalenes among most of the cohort.
Construction occupations, asbestos exposure, and cancer of the colon and rectum. R.Y. Demers, P.B. Burns, G.M. Swanson. 1994;36(9):1027-31. PubMed

Abstract

Colorectal cancer affects more than 157,000 Americans annually. Occupational risk from exposure to asbestos dust has been implicated, leading us to explore further the possible association between colorectal cancer and asbestos. Two hundred sixty-one cases of colon and rectal cancer and 183 control cases were identified within a large, population-based case-control study conducted in southeast Michigan. Employment in occupations historically known to involve heavy exposure to asbestos was used as a surrogate for asbestos exposure. Cancers of the colon showed reduced odds ratios. Our findings differ substantially from those of the previous studies showing elevated risk. Further study is needed to address the same question, with specified asbestos exposure assessment and control for potentially significant confounders such as physical activity and diet.
Detection of serum p53 protein in lung cancer patients. J.C. Luo, R. Zehab, S. Anttila, et al. 1994;36(2):155-60. PubMed · Publisher

Abstract

Serum levels of p53 protein were examined in 23 cases of lung cancer (many with potential asbestos exposure), 23 unexposed matched hospital control subjects, 58 unmatched general population control subjects, and 4 people with nonmalignant lung disease using an enzyme-linked immunosorbent assay and Western immunoblotting. Average levels of serum p53 in the lung cancer patients (0.55 ng/mL) were higher than in the cases of nonmalignant lung disease (0.42 ng/mL) or in the matched (0.32 ng/mL) or unmatched (0.31 ng/mL) control subjects, but the differences were not statistically significant. However, three of the cases of lung cancer (13%) were found to have serum p53 levels much greater than those of the control subjects (> 2 SD above the mean) and to have confirmatory positive Western blots for p53. The tumors from these subjects demonstrated increased levels of p53 in the tissue by immunohistochemistry and/or the presence of mutations in the p53 gene. These results suggest that p53 protein can be detected in serum in a portion of lung cancer cases with p53 alterations in the tumor tissue.
Exposure to biogenic silica fibers and respiratory health in Hawaii sugarcane workers. T. Sinks, R. Hartle, M. Boeniger, et al. 1994;36(12):1329-34. PubMed · Publisher

Abstract

We conducted a cross-sectional environmental and medical survey of 355 male sugarcane workers in Hawaii to determine whether exposure to biogenic silica fibers (BSF) affected their respiratory health. Exposures to BSF ranged from nondetectable to more than 0.700 BSF/mL and varied by job and department. Respiratory symptoms, chest radiograph findings, and pulmonary function were not associated with BSF exposures. Cigarette smoking was associated with respiratory symptoms and pulmonary obstruction. Fifteen workers had pleural thickening or pleural plaques and 3 of these workers were exposed to BSF for more than 10 years. BSF exposure does not appear to influence the respiratory health of sugarcane workers; however, further study is warranted.
Mortality patterns among female and male chrysotile asbestos textile workers. D.P. Brown, J.M. Dement, A. Okun. 1994;36(8):882-8. PubMed

Abstract

This study updates a retrospective cohort mortality analysis of workers from a South Carolina textile plant where chrysotile asbestos was the primary exposure. The update adds 15 years of observation to the original study, adds analyses of white women and black men, and allows comparison of mortality risks between race/gender groups. The total cohort includes 3,022 workers: 1,229 white women (363 deaths), 1,247 white men (607 deaths), and 546 black men (289 deaths). Statistically significant risks for lung cancer were observed among white women (standardized mortality ratio [SMR] = 2.07; 90% confidence interval [CI] = 1.55-2.71) and white men (SMR = 2.24; 90% CI = 1.83-2.72); both of these groups exhibited positive exposure-response trends. Although the lung cancer risk among black men was lower than expected (SMR = 0.70; 90% CI = 0.42-1.08), a statistically significant increase was observed at high levels of exposure. Statistically significant excess risk for pneumoconiosis and other respiratory diseases were observed for all race/gender groups. Despite the relatively high percentage of white women lost to follow-up and missing death certificates, both of which allow underestimation of the true relative risk, statistically significant excess risks were observed for lung cancer and pneumoconiosis among this group.
Mortality rates in a female cohort following asbestos exposure in Germany. J.A. Rösler, H.J. Woitowitz, H.J. Lange, et al. 1994;36(8):889-93. PubMed

Abstract

A cohort study was conducted of 616 German female workers with a history of exposure to asbestos. Standardized proportionate mortality analysis was done except for mesothelioma, for which proportionate mortality was computed based on best evident cause of death. Mortality from lung cancer was increased three times over expected value. Death rates due to mesothelioma were 340 times higher than in the general population. Female mortality rates surpassed those observed in men twofold for lung cancer and fourfold for mesothelioma. In comparison with published data from international cohort studies, the observed mortality for mesothelioma in our female cohort appeared higher than that previously reported. German women with a history of asbestos exposure are considered a high-risk group for developing mesothelioma and lung cancer. They should be a target group for intervention strategies (eg, chemoprevention, smoking cessation, early cancer detection).
The detection of increased amounts of the extracellular domain of the epidermal growth factor receptor in serum during carcinogenesis in asbestosis patients. R. Partanen, K. Hemminki, H. Koskinen, et al. 1994;36(12):1324-8. PubMed · Publisher

Abstract

Overexpression of the epidermal growth factor receptor (EGFr) has been implicated in the pathogenesis of a wide variety of human malignancies and may be related to asbestos-induced carcinogenesis. Overexpression of the EGFr can be detected immunologically by quantitation of the extracellular domain (ECD) in the extracellular fluid in vitro and in serum in vivo. An enzyme-linked immunosorbent assay (ELISA) for the EGFr ECD was used to examine banked serum samples of 38 asbestosis patients who subsequently developed cancer, 72 age-sex-race-smoking-asbestos exposure matched asbestosis controls without cancer, and 20 age-sex-race-smoking matched nonasbestosis noncancer controls. The mean serum level for the EGFr ECD in the cancer cases (636 +/- 299 fmol/ml) was statistically significantly elevated (P < 0.05) in comparison to the mean level in the asbestosis controls (546 +/- 147 fmol/ml) or the nonasbestosis controls (336 +/- 228 fmol/ml). Defining a positive elevation of the serum EGFr ECD as any value more than 2 standard deviations above the nonasbestosis control mean, 7 (18%) of the cancer cases were positive compared to 4 (6%) of the asbestosis controls and one (5%) of the nonasbestosis controls. In addition, all of these cancer cases had positive serum samples prior to the time of disease diagnosis (average = 5.1 years). These results suggest that serum EGFr ECD may be elevated at an early stage of carcinogenesis in some asbestosis patients and that further prospective study of the utility of this biomarker is warranted.
Coal, lead, asbestos, and HIV. The politics of regulating risk. R. Bayer. 1993;35(9):897-901. PubMed
Occupational physicians and environmental medicine. A.M. Ducatman. 1993;35(3):251-9. PubMed

Abstract

Physicians who practice environmental medicine seek to identify and to prevent patient and population exposures that cause adverse human health outcomes. Epidemiologic, toxicologic, clinical, and public health skills essential to this enterprise are indistinguishable from those of the occupational physician. Several important controversies illustrate the essential role of occupational physicians in environmental health science and policy, including environmental asbestos, dioxin, electromagnetic fields, and carcinogenicity testing. Our continuing involvement in "environmental" issues is predicted by three conditions, each unlikely to change. The human remains the animal of greatest interest; the "natural" experiment will have been performed (however unwittingly); and the work site will continue to provide that first and clearest setting for measuring the outcome. Therefore, residency training must be expanded so that future occupational and environmental physicians will recognize their fundamental role in environmental health. The results of our industry cross factory walls with ease. So must our efforts.
Recent studies of man-made vitreous fibers. Chronic animal inhalation studies. W.B. Bunn, J.R. Bender, T.W. Hesterberg, et al. 1993;35(2):101-13. Review PubMed · Publisher

Abstract

The history of asbestos use and asbestos-related disease is replete with comments that the public health would have been better protected if the results of laboratory investigation, epidemiologic surveys, and clinical studies were made available at appropriate intervals during the ongoing research, rather than in the generally accepted method of awaiting completion of studies prior to reporting medical and scientific findings. No substantive evidence of long-term adverse effects has been published in workers exposed to man-made vitreous fibers. Nevertheless, in an effort to preclude a repetition of this error of omission that occurred with asbestos exposure and use, the Thermal Insulation Manufacturers Association is regularly reporting interim and final data from ongoing animal studies. A significant segment of man-made vitreous fibers have now been tested in state-of-the-art chronic studies. This paper includes the recently completed animal inhalation studies on refractory ceramic fibers and fibrous glass. It also reviews interim data on mineral wool studies.
Synthetic mineral fibers. L.D. Schuman, P.F. Infante. 1993;35(12):1173-7. Comment · Letter PubMed
The Canadian Labour Force Ten Percent Sample Study. Cancer mortality among men, 1965-1979. J.P. Lindsay, K.M. Stavraky, G.R. Howe. 1993;35(4):408-14. PubMed

Abstract

The mortality experience of 415,309 men enrolled in the Canadian Labour Force 10% Sample Study has been updated to the end of 1979. The occupation and industry in which these men were employed between 1965 and 1969 were available, and these records were matched to the Canadian National Mortality Data Base by computerized record linkage. A total of 9,739 deaths from cancer between 1965 and 1979 were identified. Analyses were conducted with respect to men employed in 274 occupations and 294 industries with respect to mortality from 33 different types of cancer resulting in 243 associations in which the 90% lower confidence bound for the relative risk compared to the whole cohort had a value of 1.0 or greater. Based on the criteria of strength of association, dose-response, and consistency, 23 associations were identified as being of particular interest. Of these associations, four (waiters, bartenders and breweries with cancer of the buccal cavity and pharynx, and bartenders with lung cancer) seem most likely to be caused by excess smoking and/or alcohol consumption, and could provide a useful guide for intervention strategies focused on those employed in these occupations. A further seven (carpenters and stomach cancer, clerical occupations and colon cancer, truck drivers, plumbers and pipefitters, sheet metal workers, shipbuilding and repair, and asbestos products manufacturers with lung cancer) have support in terms of biological plausibility and/or other studies in the literature and appear to warrant more intensive study. The third group of associations, although demonstrating strength of association, a dose-response effect, and/or consistency, may well have arisen by chance given the many comparisons made in this study.
On the diagnostic accuracy of asbestos-induced disease. W.K. Morgan, M. Bracken, N. Sargent, et al. 1992;34(12):1205-6. Letter PubMed
A study of possible predictors of mesothelioma in shipyard workers exposed to asbestos. A. Sandén, B. Järvholm. 1991;33(7):770-3. PubMed

Abstract

In a prospective cohort study of 3893 shipyard workers, we estimated the value of medical monitoring, including chest radiograph, spirometry, and questions about smoking habits, asbestos exposure, and respiratory symptoms, as predictors of the risk of developing mesothelioma. There was no strong association between different exposure parameters and risk of mesothelioma. Impaired lung function and smoking were not predictors of risk of mesothelioma. Pleural plaque was not found to be associated with an increased risk of mesothelioma. Respiratory symptoms were of low value as predictors of risk of mesothelioma. Thus, traditional methods in health monitoring seem to be of low value in identifying persons with a high risk of mesothelioma in populations exposed to asbestos.
Asbestosis: diagnostic dilution. P. Harber, J. Smitherman. 1991;33(7):786-93. Review PubMed

Abstract

The term "asbestosis" usually has been applied to a disease characterized by diffuse pulmonary interstitial fibrosis. It was often associated with a significant adverse impact on the individual. A review of case definitions employed in published research studies show stability of the criteria for asbestosis case definitions over the past decade. Nevertheless, additional modalities have been suggested for the early diagnosis of asbestosis. It is probable that the significance of such abnormalities may be different from that of usual asbestosis, and there is therefore a need to carefully define the manner in which the terms are used. Additional anomalies may be seen in asbestos-exposed individuals including small airway physiologic abnormality, pathologic evidence of inflammation near the airways, positive gallium scan, abnormal lung compliance, exercise test abnormalities, CAT scan findings, and high-resolution CAT scan findings.
Computed tomography and high-resolution computed tomography of pneumoconioses. G. Gamsu. 1991;33(7):794-6. Review PubMed

Abstract

The traditional imaging technique used in the assessment of patients suspected of having silicosis or asbestos-related disease has been the chest radiograph. However, computed tomography and high-resolution computed tomography have become widely available for these assessments. The relative merits of these techniques in the diagnosis of these diseases warrant review.
Respiratory cancer among mineral wool workers. 1991;33(5):585-8. Comment · Letter PubMed
The reproducibility of the self-report of occupational exposure to asbestos and dust. E. Holmes, E. Garshick. 1991;33(2):134-8. PubMed

Abstract

The reproducibility of self-reported exposure to asbestos and dust was examined in 116 male veterans who completed an initial mail survey and subsequent occupational clinic questionnaire a mean of 213 +/- 68 days later. For the 114 subjects who answered the asbestos question of the mail survey, 68 (60%) gave concordant replies, while 46 (40%) gave discordant answers later in the clinic. Of 51 subjects who answered yes to asbestos exposure in the clinic, 11 (22%) had answered no and 13 (26%) had answered not sure. Failure to note asbestos exposure could not be blamed exclusively on past, relatively low-level of exposure because many of the respondents had significant exposure histories. For dust exposure, 31 (29%) had discordant replies and 77 (71%) had concordant answers. Self-reported history of occupational exposure to asbestos and dust were not as reproducible as the smoking history and may be underreported when mail survey methods alone are used.
Asbestos-related disease in the jewelry industry. D.G. Kern, H. Frumkin. 1990;32(2):87. Comment · Letter PubMed
Cases of alleged asbestos-related disease: a radiologic re-evaluation. R.B. Reger, W.S. Cole, E.N. Sargent, et al. 1990;32(11):1088-90. PubMed · Publisher

Abstract

Chest radiographs were re-evaluated from 439 active and retired tireworkers previously designated as having a condition consistent with an asbestiform mineral exposure. The review was performed in an independent manner by three board-certified radiologists according to guidelines from an international classification system. The percentage of cases with abnormalities consistent with an asbestiform mineral exposure found separately by the three radiologists was 3.7, 3.0, and 2.7%. Application of an algorithm to form a consensus evaluation indicated that approximately 3.6% (16) of the subjects evaluated may have a condition consistent with an asbestos exposure. A more detailed review, however, revealed that only 11 workers, or 2.5% of the total, would have a reasonable likelihood of having such a condition. Most cases were normal and the majority of abnormalities present on the radiographs evaluated were nonoccupational in origin. Prevalent conditions identified included healed tuberculosis, histoplasmosis, emphysema, discoid atelectasis, effusions, healed rib fractures, scarring due to infection or old inflammatory disease, possible cancer, miscellaneous nonspecific linear markings consistent with cigarette smoking and aging, and heart and vascular system diseases--the latter evidenced by an abnormally large number of subjects with healed coronary artery bypass surgery and pacemaker implants. In summary, the best estimate from this study indicates that possibly 16 (3.6%), but more realistically 11 (2.5%), of the 439 tireworkers evaluated may have a condition consistent with exposure to an asbestiform mineral. This represents a 40-fold difference between the re-evaluation results and the original survey work.
Epidemiological evidence indicates asbestos causes laryngeal cancer. A.H. Smith, M.A. Handley, R. Wood. 1990;32(6):499-507. Meta-analysis PubMed · Publisher

Abstract

A variety of opinions have been expressed in the literature concerning asbestos and laryngeal cancer. This paper presents an analysis of epidemiological studies based on criteria that prioritized the most heavily exposed cohorts. Emphasis was given to the six cohorts or subcohorts with lung cancer relative risk estimates of 2 or more. The two groups of workers with the highest lung cancer relative risk estimates (4.06 and 3.28) both gave strong support for a causal association of asbestos and laryngeal cancer, with relative risk estimates of 1.91 (90% confidence limits 1.00 to 3.34) and 3.75 (90% confidence limits 1.01 to 9.68), respectively. Confounding with cigarette smoking or alcohol consumption does not explain the findings. Case-control studies gave mixed results, but generally supported the hypothesis. It was concluded that asbestos is a probable cause of laryngeal cancer in view of the reasonable consistency of the studies, the strength of the association in key studies, the evidence for dose-response relationships, and the biological plausibility for asbestos being a cause of laryngeal cancer.
Influence of smoking on radiographic profusion and pleural changes in asbestos-exposed subjects. G.L. Delclos, R.K. Wilson, B.L. Bradley. 1990;32(7):577-81. PubMed · Publisher

Abstract

The influence of smoking on pleural and parenchymal radiographic changes, particularly in asbestos-exposed cohorts, has been debated. We studied this issue in 440 asbestos-exposed subjects referred for evaluation between 1981 and 1985. Information was obtained on age, exposure, and smoking. Chest radiographs were independently read by three "B" readers under blind conditions and it was determined that 80.5% of the subjects had a history of smoking. The odds ratio for smoking and parenchymal opacities greater than or equal to 1/0 was 1.98 (95% confidence interval, 1.2 to 3.3); this association was not affected by adjustment for asbestos exposure and/or age. A dose-response pattern emerged between increasing pack-years and parenchymal opacities greater than or equal to 1/0; the effect between asbestos exposure and smoking appeared to be additive. No associations were found between smoking and pleural abnormalities. The findings in this investigation are consistent with prior studies showing an influence of smoking on radiographic parenchymal, but not pleural, changes, at least in asbestos-exposed groups. The anatomical equivalent of these radiographic changes and their impact, if any, on the natural history of asbestos-associated disease remains unclear.
Mortality among a cohort of US man-made mineral fiber workers: 1985 follow-up. G.M. Marsh, P.E. Enterline, R.A. Stone, et al. 1990;32(7):594-604. PubMed · Publisher

Abstract

This 1983 to 1985 update of an earlier study examined the mortality experience of 16,661 man-made mineral fiber workers employed 1 year or more (6 months for two plants) during 1945 to 1963 (1940 to 1963 for one plant) at one or more of 17 US manufacturing plants. Using local death rates to estimate expected deaths there was a small statistically significant (P less than .05) excess in all malignant neoplasms (standardized mortality ratio [SMR] = 108.3) and in respiratory cancer (SMR = 112.1) for the total period 1946 to 1985. For respiratory cancer the excess was greatest for mineral wool workers. For glass wool workers and glass filament workers respiratory cancer SMR values were much lower. For workers exposed in the production of small-diameter fibers, the overall respiratory cancer SMR was slightly elevated but lower than in earlier reports. A total of four malignant mesotheliomas have now been noted on death certificates. Two of these were coded to the International Classification of Disease rubrics used to estimate 1.45 expected mesothelioma deaths for the total study. Overall, the evidence of a relationship between exposure to man-made mineral fibers and respiratory cancer appears to be somewhat weaker than in the previous update.

1980s

'B-readers' and asbestos medical surveillance. A.M. Ducatman, W.N. Yang, S.A. Forman. 1988;30(8):644-7. PubMed · Publisher

Abstract

"B-readers" certified in International Labor Office methodology interpret large numbers of randomly distributed asbestos medical surveillance roentgenograms of US Navy employees. Analysis of 23 participating observers, interpreting more than 105,000 radiographs, demonstrated a 300-fold prevalence range of perceived "definite" pulmonary parenchymal abnormalities. There was an evident geographic component to interpretation habits, with East and West Coast observers more likely to interpret films as abnormal than observers from the midcontinent. The most expert observers, a group who instruct the course leading to National Institute for Occupational Safety and Health certification in International Labor Office methodology, also perceived fewer abnormalities than other readers or coastal observers. Instructors still exhibited a sevenfold prevalence range of positive interpretation. Under usual surveillance conditions, the habits of B-readers appear to have a major impact upon the diagnosis of asbestosis from roentgenograms. Certification in B-reading should not be the only quality assurance for radiographic surveillance programs, medical decision-making, epidemiologic comparisons, nor related legal activities.
Asbestos exposure and laryngeal cancer: an analysis of the epidemiologic evidence. C.K. Chan, J.B. Gee. 1988;30(1):23-7. Review PubMed

Abstract

We conducted a critical analysis of the available epidemiologic investigations on the causal relationship between asbestos exposure and laryngeal cancer. A review of nine case-control studies indicates that the estimated risk (odds ratio) attributable to asbestos exposure alone is negligible when smoking and ethanol intake are appropriately controlled for. Six of the 12 cohort studies demonstrated no significant increase in the standardized mortality ratio due to asbestos exposure. The remaining six longitudinal studies showed an increased standardized mortality ratio from 1.91 to 5.41 but no adjustment was made for the confounding effects of smoking and ethanol consumption. In conclusion, the available epidemiologic evidence does not support a causal association between asbestos exposure and laryngeal cancer.
Asbestosis among electricians. M.J. Hodgson, D.K. Parkinson, S. Sabo, et al. 1988;30(8):638-40. PubMed · Publisher

Abstract

In a cross-sectional study of a small group of non-shipyard electricians, the prevalence of asbestosis, defined as irregular opacities of at least 1/0 profusion, was found to be 15% overall and 25% after 20 years of service. Irregular opacities occurred more frequently among smokers. Cost estimates for asbestos-related disease should include construction electricians in the populations at risk.
Chronic occupational exposure to asbestos: more than medical effects?. A.H. Lebovits, M. Byrne, J. Bernstein, et al. 1988;30(1):49-54. PubMed

Abstract

One hundred and twenty-nine workers chronically exposed to asbestos were interviewed regarding their perceived health status and concerns, their health behaviors, particularly their smoking behavior, and their psychologic well-being. In contrast to a non-exposed comparison group of postal workers, asbestos workers exhibited significantly elevated levels of somatic concern (P less than .03), and significantly lower levels of mental health functioning only when experiencing high levels of stress (P less than .01). Despite feeling significantly more susceptible to developing cancer (P less than .0001), 34% of asbestos workers were cigarette smokers (compared to 32% of the postal group) and long-term mask usage was minimal. Asbestos workers' increased sensitivity to stress and changes in health status along with the lack of adaptation of health-promotive behaviors indicate the need for interventions to attend to the psychologic effects of increased risk status.
Do pleural plaques produce symptoms? A brief report. B. Järvholm, S. Larsson. 1988;30(4):345-7. PubMed

Abstract

The occurrence of symptoms due to pleural plaques was studied by means of a questionnaire administered to asbestos-exposed workers participating in a health-screening program. One hundred thirty subjects who were found to have pleural plaques were compared with 1,103 control subjects who had no plaques and showed no changes on x-ray examination. No difference in occurrence of thoracic pain was found between the two groups. Dyspnea was more common among patients with pleural plaques, who also tended to have lower lung function values. There was a good correlation between reported dyspnea and lung function. The increased number of complaints of dyspnea among patients with pleural plaques could not be explained by differences in age or in smoking habits. It is suggested that dyspnea in patients with pleural plaques is caused by sub-roentgenologic fibrosis.
Exponential models for analyses of time-related factors, illustrated with asbestos textile worker mortality data. N. Pearce, H. Checkoway, J. Dement. 1988;30(6):517-22. PubMed

Abstract

In any study based on an occupational cohort, it is important to consider the variation in risk factors over time. Cumulative exposure is the most important time-related factor for exposure-response analyses, whereas other time-related factors such as age at risk, year at risk, and length of follow-up may be confounders and effect modifiers. This paper examines the family of exponential models which can be used for time-related analyses of studies based on an occupational cohort. Analyses using Poisson regression, the proportional hazards model, and the logistic model are presented, and their interrelationships explored. These models are illustrated with data from a cohort study of lung cancer mortality among asbestos textile plant workers. All three approaches yielded similar effect estimates. In particular, Poisson regression and the proportional hazards model yielded very similar findings, but Poisson regression has some conceptual and computational advantages.
Mortality of workers in two Minnesota taconite mining and milling operations. W.C. Cooper, O. Wong, R. Graebner. 1988;30(6):506-11. PubMed

Abstract

Mortality during the years 1947 to 1983 was studied in 3,444 men employed for at least 3 months in Minnesota taconite mining operations during the years 1947 to 1958. During 86,307 person-years of observation, there were 801 deaths for a standardized mortality ratio (SMR) of 88 (US white male rates) or 98 (Minnesota rates). The 41 deaths from respiratory cancer were fewer than expected, the SMR being 61 (P less than or equal to .01) (US rates) and 85 (Minnesota rates). There were 25 respiratory cancers 20 or more years after first taconite employment, for an SMR of 57 (P less than or equal to .01) (US rates). SMRs for colon cancer, kidney cancer, and lymphopoietic cancer were elevated, but below the level of statistical significance. There was one death from pleural mesothelioma, 11 years after first taconite employment, in a man with long prior employment as a locomotive operator. The pattern of deaths did not suggest asbestos-related disease in taconite miners and millers.
Pulmonary functional impairment by asbestos. A. Miller. 1988;30(4):285, 288. Letter PubMed
Spirometric abnormalities among asbestos insulation workers. Y. Lerman, H. Seidman, S. Gelb, et al. 1988;30(3):228-33. PubMed

Abstract

We studied the prevalence of spirometric changes among asbestos insulation workers to investigate when functional abnormalities appear during the course of asbestos employment and the influence of cigarette smoking. Of 1,249 eligible asbestos insulation workers in the New York-New Jersey metropolitan area, 1,117 (89.4%) were examined in the year 1963 to provide baseline pulmonary function status for long-term prospective observation. Forced vital capacity (FVC) was measured in all 1,117 workers and forced expiratory volume in 1 second (FEV1) in 613 workers (55%). Of 353 workers examined in the first 10 years after onset of exposure, 26 (7.4%) had FVC below 70% of predicted, a prevalence similar to that reported in nonexposed general populations. Prevalence increased with time from onset of exposure. Of the 117 workers examined 40 or more years after onset of exposure, 76 (55%) had FVC below 70% of predicted. A similar trend with time was shown for FEV1 and FEV1/FVC. Cigarette smoking had little influence on the prevalence of pure restrictive impairment. Cigarette smokers and non-cigarette smokers had much the same prevalence (28%) of moderate to severe reduction of FVC while the FEV1/FVC was normal. None of the non-cigarette smokers and five of the cigarette smokers had a predominantly obstructive pattern. One non-cigarette smoker and eight cigarette smokers showed reduction of both FVC and FEV1/FVC, consistent with a mixed ventilatory abnormality. The data demonstrate that asbestos alone without the additional effect of cigarette smoking has no measureable effect on the function of the large airways.
Use of oblique chest roentgenograms in detecting pleural disease in asbestos-exposed workers. C.B. Sherman, S. Barnhart, L. Rosenstock. 1988;30(9):681-3. PubMed

Abstract

Oblique chest roentgenograms have been recommended by some for use in screening programs of asbestos-exposed workers to increase detection of pleural fibrosis not evident on posteroanterior (PA) films. As a screening test, identification of pleural abnormalities with oblique films is especially important in subjects without evidence of other asbestos-induced abnormalities on PA films, namely, parenchymal fibrosis. To evaluate the incremental value of oblique films in the identification of pleural fibrosis, a comparison was made between PA films read alone and PA films read with both oblique views in a systematic evaluation of 489 male pipefitters examined in a screening program. Analysis of the subsets of pipefitters with and without parenchymal fibrosis showed that 2.5% of workers with normal PA films (n = 326) and 13.0% of subjects with isolated parenchymal fibrosis on PA films (n = 46) had pleural fibrosis detectable only on oblique films. In only eight (1.6%) did the oblique view represent the sole evidence of an asbestos-related roentgenographic abnormality. We conclude that oblique films should not be routinely used in screening workers for evidence of asbestos-induced disease.
Apportionment of risk among environmental exposures: application to asbestos exposure and cigarette smoking. R.C. Grimson. 1987;29(3):253-5. PubMed

Abstract

A new method for assessing the attribution of risk for each of two exposures is developed. In one instance it generalizes a method now used to evaluate compensation for smokers who have been exposed to asbestos and it extends the notion of attributable risk. This method of apportioning risk is applicable in occupational settings where risk assessment and/or compensation is required and an application is presented.
Asbestos and air flow limitation. P. Edelman. 1987;29(3):264-5. Letter PubMed
Comment on spirometry. P. Enright. 1987;29(10):842. Letter PubMed
Comparison of methods for determining occupational exposure in a case-control interview study of chronic lymphocytic leukemia. M.S. Linet, W.F. Stewart, M.L. Van Natta, et al. 1987;29(2):136-41. PubMed

Abstract

A comparison was made between two indirect methods for linking reported lifetime occupations and industries of employment with specific exposures and with directly reported exposure information, using data from a population-based case-control interview study of chronic lymphocytic leukemia (CLL). Exposures previously suspected of being associated with CLL were examined using a job-exposure matrix developed by Hoar et al and a linkage between observed occupational exposures and specific occupations, by industry, based on data collected in the National Occupational Hazard Survey (NOHS). In general, concordance on exposure for the two occupation-exposure linkage methods was fairly poor, although it was better for some of the exposures studied (butadiene and asbestos, for which most kappas were between 0.40 and 0.60) than for others (carbon tetrachloride and benzene with kappas ranging from 0.01 to 0.12). Higher proportions of cases and controls directly reported exposure to benzene and asbestos than was determined using the two more indirect methods, neither of which showed consistently greater agreement with direct reporting.
Estimates of the probability of job-related death in 347 occupations. J.P. Leigh. 1987;29(6):510-9. PubMed

Abstract

In 1976 the Bureau of Labor Statistics began collecting data from selected states' workers' compensation files. The data include information on fatalities within three-digit occupations. The fatality data were combined with information on employment within three-digit occupations to produce estimates of mortality within 347 occupations. Loggers and asbestos workers appear to have the most dangerous blue collar jobs and airplane pilots the most dangerous white collar jobs.
Estimating asbestos exposure: a comparison of methods. B. Järvholm, A. Sandén. 1987;29(4):361-3. PubMed

Abstract

The association between pleural plaques and asbestos exposure was investigated in a cross-sectional study of 951 male shipyard workers. Asbestos exposure was estimated by the men themselves and also by an expert panel whose judgment was based only on occupational title. The analysis was restricted to men who had had at least 20 years of exposure and who had not changed jobs during their period of employment in the shipyards. The results showed that there was a much closer correlation between the occurrence of pleural plaques and the men's own estimates of exposure than between the occurrence and the experts' estimates. Contrary to reports of other investigators, the authors found no association between smoking habits and the occurrence of pleural plaques (rate ratio = 1.0, chi 2 (1) = 0.3).
Pleural plaques and asbestos-associated malignancy. P. Harber, Z. Mohsenifar, A. Oren, et al. 1987;29(8):641-4. PubMed
Unusually aggressive transmission of tuberculosis in a factory. C.B. Mosher, V.J. Derebery, B.J. Young, et al. 1987;29(1):29-31. Case report PubMed

Abstract

A case of pulmonary tuberculosis in a factory worker was studied to identify infected contacts and to gauge the degree of transmission. Initial findings suggested far more extensive transmission than anticipated, and the study was expanded. Of all factory workers tested, 33% were infected with the tubercule bacillus in spite of massive air volume-to-contact ratio. Deliberate stagnation of the air to prevent occupational exposure to lead and asbestos was believed to be a contributing variable.
Asbestos and airflow limitation. Z. Mohsenifar, A.J. Jasper, T. Mahrer, et al. 1986;28(9):817-20. PubMed · Publisher

Abstract

To assess the effect of asbestos on the airways, researchers studied 45 shipyard workers who were lifelong nonsmokers and had asbestos-related abnormalities seen on their chest roentgenograms. Patients with interstitial lung disease, bronchial asthma prior to asbestos exposure, recurrent pneumonias, or significant cardiovascular disease were excluded from the study. In addition to chest films, they had spirometry performed before and after bronchodilator inhalation, lung volumes, diffusing capacity, and arterial blood gases. Forced vital capacity and forced expired volume in one second were normal in all patients. Maximum midexpiratory flow rates (MMFR) were abnormal (MMFR less than 75% of predicted) in 13 patients (29%). Therefore, 29% of lifetime nonsmokers with asbestos exposure exhibited evidence of small airways dysfunction. An abnormal MMFR in these workers may be due, in part, to asbestos exposure and could conceivably indicate a population at risk for pulmonary fibrosis and/or obstructive airways disease.
Heat stress associated with the use of vapor-barrier garments. W.S. Beckett, J.E. Davis, N. Vroman, et al. 1986;28(6):411-4. Case report PubMed · Publisher

Abstract

Use of personal protective devices in the workplace, while intended to diminish risk of injury, may in some cases increase personal risk from environmental hazards. A case of a juvenile diabetic with complaints of near syncope while working in a plastics laminating process is analyzed. Although his symptoms might be attributed to a variety of causes, they were traced to the effects of heat stress related to wearing vapor-barrier disposable coveralls in a warm environment (85 degrees F). A field study of asbestos workers involved in abatement of asbestos steam pipe insulation illustrates how clothing impermeable to sweat may result in elevation of core body temperature. When workers use vapor-barrier coveralls, work practices or wet bulb globe temperature limits may need to be revised to prevent heat-related injury.
Interaction between tobacco smoking and occupational exposures in the causation of lung cancer. K. Steenland, M. Thun. 1986;28(2):110-8. Review PubMed

Abstract

The nature of the interaction between smoking and occupational exposure is controversial, in part because of lack of agreement on the definition of interaction and in part because of the scarcity of adequate epidemiologic data. Occupational investigators have assessed interaction primarily as a departure from an additive rather than from a multiplicative model of relative risks (or rate ratios). To determine whether smoking modifies the effect of occupational lung carcinogens, the literature was reviewed for the only four established occupational lung carcinogens for which there are data on smoking: radon daughters, asbestos, arsenic, and chloromethyl ethers. Where possible, departure was assessed from both an additive (synergism) and a multiplicative model (effect modification). Only nine studies were considered to have sufficient sample size and to provide sufficient information on tobacco use and occupational exposure to evaluate interaction. The existing data were contradictory for three of the agents studied: asbestos, radon daughters, and arsenic. Inconclusive or contradictory findings may result from small sample size or lack of comparability of the level of occupational or tobacco exposure. It is noteworthy that, for these four agents, whenever smoking did modify the effect of occupational exposure, the lung cancer rate ratio was greater for nonsmokers (compared to nonexposed nonsmokers) than smokers (compared to nonexposed smokers). However, with the exception of chloromethyl ethers, absolute lung cancer rates were higher for smokers than nonsmokers, regardless of occupational exposure.
Interventions in high-risk occupational cohorts: a cross-sectional demonstration project. S. Tillett, K. Ringen, P. Schulte, et al. 1986;28(8):719-27. PubMed · Publisher

Abstract

In 1980, the Workers' Institute for Safety and Health began a demonstration project designed to develop a model program of community-based intervention in three cohorts with different workplace exposures and target cancer sites. Program components included identification, notification, medical surveillance, education, social support services (eg, psychosocial, legal, financial, etc), and evaluation. The three cohorts included the Augusta cohort, a group at risk for bladder cancer due to workplace exposure to beta-naphthylamine; the Port Allegany cohort, a group at high risk of cancer associated with a workplace exposure to asbestos; and the Pattern Makers cohort, a group shown to be at increased risk of colorectal cancer. Together, these three projects give a cross-sectional view of possible approaches to educational and medical intervention strategies in diverse situations.
Medical screening for lung cancer: perspective and strategy. K.H. Kilburn. 1986;28(8):714-8. PubMed · Publisher

Abstract

Strategies to prevent or reverse cancer promotion are described. One strategy, involving the screening and prompt treatment of small lung cancers, is proposed as a study to be tested in occupational groups with very high risk, specifically asbestos-exposed shipyard workers who smoke cigarettes. The relative risk can be assigned on the basis of (1) age, (2) years since first asbestos exposure, and (3) cigarette smoking amount, recency of cessation and age at onset. Proposed surveillance would be chest x-ray films at 4-month intervals and sputum cytology in current smokers and those within 10 years of cessation. Means of detection, such as monoclonal antibody tests for adenocarcinoma and other marker molecules, would be explored. Prompt conventional treatment would be assured. Other inquiries would be directed at new treatment, such as using targeted molecules directed at surface antigens.
Obstructive airway disease as a risk factor for asbestos-associated malignancy. P. Harber, A. Oren, Z. Mohsenifar, et al. 1986;28(2):82-6. PubMed

Abstract

A case-control study of a heavily asbestos-exposed group was performed to determine if obstructive airway disorder is an independent risk factor for developing asbestos-associated malignancies. From a group of 1,500 asbestos workers who had previously undergone careful evaluation, 18 case employees were identified. Each case employee was matched by smoking status, pack-years, age, and years of asbestos exposure to a single referent, a member of the same exposed population known to be free of malignancy. The spirometry results, obtained prior to the clinical manifestation of the cancer, were compared. The FEV1/FVC ratio and the FEV1/height3 ratio were lower (P less than .05, P less than .10, respectively) in the case employees. These results suggest that obstructive airway disease may be an independent risk factor for cancer.
Approach to asbestos worker compensation plan alleged to be flawed. K.T. Kelsey, D.C. Christiani. 1985;27(11):790-1. Letter PubMed · Publisher
Asbestos and tuberculosis in Trieste, Italy. A.M. Walker, G. Stanta, M. Delendi. 1985;27(11):831-4. PubMed · Publisher

Abstract

The distribution of counts of asbestos bodies in lung specimens from 25 persons dying of fibrocaseous tuberculosis was essentially identical to that in age- and sex-matched control subjects. Although tuberculosis mortality has been elevated in the past in cohorts of asbestos workers, asbestos exposure at environmental levels found in a region with a history of heavy asbestos use appears to be unassociated with risk of tuberculosis. Potentiation of the risk of death from tuberculosis may require both a high risk of tuberculosis in the general community and intense personal exposure to asbestos.
Asbestos-related disease in plumbers and pipefitters employed in building construction. N.L. Sprince, L.C. Oliver, T.C. McLoud. 1985;27(10):771-5. PubMed

Abstract

Asbestos-related disease in a group of 153 plumbers and pipefitters employed in building construction was assessed by means of a cross-sectional prevalence study. Study methods were medical questionnaire, spirometry, measurement of diffusing capacity, physical examination of the chest, and chest roentgenogram. The major finding was bilateral pleural thickening in 28 (18.3%) of the participants. Unilateral pleural thickening was found in 12 subjects (7.8%). Small irregular opacities of profusion 1/0 or greater were found in 12 subjects (7.8%). Bilateral pleural thickening was associated with both age and time since first asbestos exposure, while unilateral pleural thickening was associated only with age. Decreases in forced vital capacity (percent predicted) were associated with duration of exposure. The most prevalent abnormality found was bilateral pleural thickening, which is more specific for asbestos exposure than is unilateral pleural thickening.
Evaluation for compensation of asbestos-exposed individuals. I. Detection and quantification of asbestos-related nonmalignant impairment. R.S. Mitchell, G.R. Chase, P. Kotin. 1985;27(2):95-109. PubMed

Abstract

An objective method for measuring nonmalignant respiratory impairment caused by inhaled asbestos has been devised. Three standard physiologic tests (the forced vital capacity [FVC], the forced expiratory volume in 1 s [FEV1], the single-breath diffusing capacity for carbon monoxide [DCO]) and the posteroanterior chest roentgenogram are utilized. The age-, height-, and sex-specific normal ranges of the FVC%, the DCO%, and the FEV1/FVC% have been used in the method. The theory and rationale are described. The resulting algorithm can be presented using a nomogram. Data on 586 asbestos-exposed subjects were analyzed by the proposed method. Empirical evaluation showed the sensitivity to be greater than 90% in definitive diagnosis of asbestosis without airflow obstruction, and the specificity to be greater than 80% for those cases judged eligible for nomographic evaluation. Exceptions were found in 15 cases diagnosed clinically as asbestosis, none of whom had any evidence of pulmonary fibrosis. In addition, 50 cases diagnosed as "no asbestosis" did have evidence of pulmonary fibrosis and would have qualified for some compensation by the proposed method. In summary, this approach has been shown to yield a reliable final asbestos-related lung impairment index that, when taken together with individual societal data, can provide a reliable basis for determining compensation.
Evaluation for compensation of asbestos-exposed individuals. II. Apportionment of risk for lung cancer and mesothelioma. G.R. Chase, P. Kotin, K. Crump, et al. 1985;27(3):189-98. PubMed

Abstract

The incidence of lung cancer in the cigarette smoking population occupationally exposed to asbestos is inordinately high. A method for apportioning risk to these two agents has been developed. It utilizes degree of asbestos and smoking exposures; the time interval from onset and, where applicable, termination of both exposures; the time interval to diagnosis of lung cancer; and morphologic, physiologic, and radiological evidence of pulmonary fibrosis.
Fitting relationships between exposure and standardized mortality ratios. J. Hanley, D. Liddell. 1985;27(8):555-60. PubMed · Publisher

Abstract

Practical methods are described for formal fitting of simple (linear) relationships between exposures in several subgroups and standardized mortality (or morbidity) ratios (SMRs) for these groups, whether derived from a cohort study by the person-years method or otherwise. The observed events are assumed to have Poisson variation about the fitted relationships. Procedures are outlined for obtaining parameter estimates by iterative weighted least squares regression, which is not only equivalent to, but also the simplest form of maximum likelihood estimation. A test of fit is available in a chi 2 statistic for deviations of observed data from "fitted" values. A further test allows one to examine whether the SMR at zero exposure is different from unity. The concept of relative slopes is discussed, and methods are given for obtaining estimates and confidence intervals. Generalizations to more than one exposure, and to quadratic and other relationships, are explained. Steps for computing the basic fits are detailed, and instructions for adapting packaged computer programs given. Illustrations are provided from data of lung cancer SMRs in relation to exposure to asbestos and to smoking.
Respiratory illness in the construction trades. I. The significance of asbestos-associated pleural disease among sheet metal workers. E.L. Baker, T. Dagg, R.E. Greene. 1985;27(7):483-9. PubMed

Abstract

To assess the rate of roentgenographic and lung function abnormalities in asbestos-exposed construction workers, the authors studied 314 white male members of a local sheet metal workers union. Health outcomes were assessed by questionnaire, simple spirometry, and chest roentgenography; data were collected and interpreted following guidelines of the American Thoracic Society and the International Labor Office. Analyses of union records showed the tested population to be representative of all those eligible for testing. Pleural abnormalities were common, increasing to a prevalence of approximately 70% in workers with more than 30 years employment. Roentgenographic evidence of pleural disease was significantly correlated with decreased forced vital capacity (p = 0.027) after controlling for the potential confounding effects of age, height, cigarette consumption history, and employment duration. In contrast, forced expiratory volume in 1 s showed a stronger association with amount smoked (p = 0.022) than with pleural abnormality (p = 0.316). Logistic regression analyses showed that cigarettes act to increase the effect of asbestos in causing pleural disease among exposed workers. Cigarettes, in the absence of significant asbestos exposure, do not appear to cause pleural disease. The authors conclude that construction workers, such as those described herein, have a considerably increased rate of pleural disease, which has functional significance in view of the correlations noted with forced vital capacity measurements. Therefore, pleural disease in asbestos-exposed workers is not only an indicator of exposure but also an indicator of early impairment of pulmonary function.
Declining relative risks for lung cancer after cessation of asbestos exposure. A.M. Walker. 1984;26(6):422-6. PubMed · Publisher

Abstract

All studies that provide follow-up information for workers more than 35 years after initial exposure to asbestos show a declining ratio of observed to expected lung cancer deaths at the end of follow-up. The most parsimonious explanation of this finding is that relative risk for lung cancer begins to decline sometime after cessation of asbestos exposure.
Radiographic evidence of asbestos effects in American marine engineers. R.N. Jones, J.E. Diem, M.M. Ziskand, et al. 1984;26(4):281-4. PubMed

Abstract

Marine engineers undergoing routine annual chest roentgenography showed an unusual prevalence of pleural abnormalities including plaques suggestive of past asbestos exposure. A pilot survey, and a subsequent comprehensive study of the films of more than 5,000 men, showed an overall prevalence of 12% with pleural abnormality (typical calcification or plaque, or diffuse thickening). Prevalence of films classifiable for pneumoconiotic small opacities was negligible--1.2% in the pilot study. Prevalences of pleural abnormality were significantly higher among men with longer union membership, after controlling for age. Older merchant ships contain substantial amounts of asbestos-containing thermal insulation. Marine engineers often remove and reapply insulation, operations known to produce high airborne fiber concentrations. These roentgenographic survey results indicate significant past asbestos exposures of ships' engineering department personnel.
Behavioral, attitudinal, and physiologic characteristics of smoking and nonsmoking asbestos-exposed shipyard workers. V.C. Li, Y.J. Kim, P.B. Terry, et al. 1983;25(12):864-70. PubMed · Publisher

Abstract

The smoking characteristics of shipyard workers participating in an Asbestos Medical Surveillance Program (N = 3,991) were assessed. Sources of data were: (1) a self-assessment questionnaire on the smoking history and respiratory symptomatology of the 871 current smokers who participated in the smoking study, and (2) chest roentgenograms and pulmonary function test results and medical records for the entire population. The study population included 1,711 current smokers, 988 former smokers and 1,292 never smokers. The annual "quit rate" for former smokers had increased from less than 1% in 1961 to 4.2% in 1978. Of the 871 current smokers who participated in the smoking study, 19% had resumed smoking after having given up cigarettes for one year or longer. Men in the smoking study were reasonably well informed about the health consequences of smoking. While they perceived themselves to be susceptible to disease, and the disease to be serious, the benefits they saw in quitting were related more to economics and aesthetics than to health. When the results were age adjusted, no differences in rate of pulmonary function abnormalities and chest film abnormalities were found between current smokers who voluntarily participated in the smoking study and those who did not. All pulmonary function testing abnormality and chest film abnormality rates were significantly lower for former smokers and never smokers.
Feasibility of identifying high-risk occupations through tumor registries. M.D. Whorton, J. Schulman, S.R. Larson, et al. 1983;25(9):657-60. PubMed · Publisher

Abstract

The primary objective of this study was to assess the feasibility of using a population-based tumor registry to identify occupational groups at high risk of developing cancer. The study group comprised 6,424 union members residing in the San Francisco/Oakland Standard Metropolitan Statistical Area (SMSA) who represent six occupations: asbestos workers, bakers, painters, plasterers, plumbers and roofers. Computer linkage of union rosters to the California Tumor Registry (CTR) file identified incident cases of cancer. The CTR's age-sex-year-specific incidence rates were used to calculate the expected number of cancer cases, and estimated standardized incidence ratios (SIRs). The results demonstrate, as expected, increased cancer incidence (SIR = 498) for trachea, bronchus, lung and pleura among asbestos workers, a group widely recognized as having high risk for respiratory cancers, and among painters (SIR = 199). Strengths and weaknesses of such an approach are discussed.
Mesothelioma in Connecticut, 1955-1977. Occupational and geographic associations. M.J. Teta, H.C. Lewinsohn, J.W. Meigs, et al. 1983;25(10):749-56. PubMed

Abstract

All cases of malignant mesothelioma (201) and other primary malignant pleural tumors (19) reported to the Connecticut Tumor Registry from 1955 through 1977 were studied in an attempt to identify high-risk jobs, industries and geographic locations and to estimate the risk attributable to asbestos exposure in the workplace. Data were obtained from hospital records, death certificates and city directories for cases, case spouses and a random sample (604) of Connecticut decedents (1955-1975). Three cases involved histories of work in asbestos products manufacture, but there was no evidence of residential risk in that geographic area. Relative risk (RR) for carpenters and cabinetmakers was 2.25 (p less than .05); for plumbers and pipefitters, 3.87 (p less than .05); and for persons "ever employed" in the rubber industry, 5.08 (p less than .01). Occupational exposure was indicated in 85% of the cases; attributable risk (AR) was 36%. Risk increased with greater exposure and older age. AR was 81% in men aged 70 to 89 years at diagnosis. Reduction of unnecessary occupational asbestos exposure remains the highest public health priority.
Projections of asbestos-related disease 1980-2009. A.M. Walker, J.E. Loughlin, E.R. Friedlander, et al. 1983;25(5):409-25. PubMed

Abstract

Approximately 19,000 cases of mesothelioma and 55,000 cases of lung cancer will arise in U.S. men with histories of nontrivial occupational exposure to asbestos. There are approximately 65,000 U.S. men now alive with clinically diagnosable asbestosis. These estimates are based, in the case of the cancer, on estimates of the effective number of asbestos-exposed workers required to produce the current national incidence of mesothelioma. The asbestosis estimates are based on a number of rough measures relating the prevalence of asbestosis to the incidence of mesothelioma, the incidence of compensable asbestosis in other countries, the prevalence of and mortality from pneumoconioses generally, and the number of workers heavily exposed to asbestos.
The health of welders in naval dockyards. The risk of asbestos-related diseases occurring in welders. G.H. McMillan. 1983;25(10):727-30. PubMed · Publisher

Abstract

Welders employed in Her Majesty's Dockyards before the late 1960s are likely to have been exposed to asbestos dust at work. Several studies have been made to assess the risk of their developing asbestos-related pulmonary parenchymal fibrosis, pleural fibrosis and mesothelioma. Potential exposures and their possible effects are described.
Tobacco and asbestos: consistent treatment advocated. M. Silverstein, R. Pak, N. Maizlish. 1983;25(9):694-5. Editorial PubMed · Publisher
Missing records in occupational disease epidemiology. P.E. Enterline, G.M. Marsh. 1982;24(9):677-80. PubMed · Publisher
Respiratory morbidity among workers in an amosite asbestos insulation plant. W.M. Johnson, R.A. Lemen, G.A. Hurst, et al. 1982;24(12):994-9. PubMed
Role of exercise testing in assessing functional respiratory impairment due to asbestos exposure. J. Howard, Z. Mohsenifar, H.V. Brown, et al. 1982;24(9):685-9. PubMed · Publisher

Abstract

To evaluate the complaint of exertional dyspnea in asbestos-exposed shipyard workers, pulmonary function tests were performed at rest and during exercise on 90 subjects with pleural plaques. We divided the subjects into four groups based on resting pulmonary function studies. Group I subjects (eight) had a restrictive defect; group II subjects (30) had an obstructive defect; group III subjects (six) had an isolated reduction in diffusing capacity; and group IV subjects (46) had a normal study. Subjects with a restrictive defect demonstrated minor physiologic abnormalities during exercise. Subjects with an obstructive defect demonstrated abnormalities consistent with their obstructive defect. Subjects in groups III and IV demonstrated an abnormally elevated wasted ventilation fraction, which may be an early indicator of interstitial disease due to asbestos exposure. We believe exercise testing was a useful tool in excluding the presence of significant functional exercise limitation due to asbestos exposure in the majority of subjects and also in disclosing some physiologic abnormalities in some of the subjects in our study.
Smoking and duration of asbestos exposure in the production of functional and roentgenographic abnormalities in shipyard workers. J.L. Pearle. 1982;24(1):37-40. PubMed

Abstract

Functional and roentgenographic abnormalities in 131 asbestos-exposed shipyard workers were assessed in terms of duration of asbestos exposure and smoking history to determine the relative contributions of these factors. Both exposure and smoking contributed to the frequency of abnormalities in FEV1 and FVC. In contrast, airways obstruction (FEV1/FVC less than 70%) was unrelated to exposure but correlated closely with smoking. Abnormalities in DLCO were minimally associated with asbestos exposure, but were strongly related to smoking history, suggesting that diffusion impairment in these workers is more likely to be related to smoking and emphysema than to interstitial disease. Significant roentgenographic pleural abnormalities were associated with both duration of exposure and smoking. Interstitial disease did not correlate with exposure and was only mildly associated with smoking. Smoking contributes to many of the functional and roentgenographic abnormalities in asbestos-exposed workers.
Fiber toxicology. J.P. Leineweber. 1981;23(6):431-4. PubMed · Publisher
Pleural plaques and cigarette smoking in asbestos workers. W. Weiss, R. Levin, L. Goodman. 1981;23(6):427-30. PubMed · Publisher

Abstract

In a survey of 45 men aged 40 or over who had worked five years or more in an asbestos manufacturing plant, the prevalence of pleural plaques was studied with respect to age, duration of asbestos exposure, estimated cumulative asbestos dose, and smoking habit. Plaques were found in 38 to 53% of the men, depending on the interpretation of the chest film reader. Cigarette habit appeared to be the most important factor; the prevalence was lowest in non-smokers, intermediate in current smokers, and particularly high in exsmokers. There was some confounding of this relationship by estimated cumulative asbestos dose but such confounding did not seem to be sufficient to explain fully the relationship between the prevalence of plaques and smoking habit. Both factors must be considered in studies of the risk of pleural plaques in asbestos workers.
Use of asbestos-cement pipe. J.R. Millette. 1981;23(4):226. Letter PubMed
Asbestos disease in Finland. M.S. Huuskonen, K. Ahlman, T. Mattsson, et al. 1980;22(11):751-4. PubMed

Abstract

Finland was the world's main producer of anthophyllite asbestos between 1918 and 1975. The total amount of mined anthophyllite asbestos was 350,000 tons of which 230,000 tons were exported. Anthophyllite quarry workers who had worked at least five years between 1936 and 1972 showed the highest risk of asbestosis, in comparison with other groups of asbestos workers.
Gastrointestinal carcinoma and occurrence of pleural plaques on pulmonary X-ray. G. Hillerdal. 1980;22(12):806-9. PubMed · Publisher
Radiographic changes following asbestos exposure: experience with 7,500 workers. J.S. Felton, E.N. Sargent, J.S. Gordonson. 1980;22(1):15-20. PubMed
The clinical significance of ferruginous bodies in sputa. J.W. McLarty, S.D. Greenberg, G.A. Hurst, et al. 1980;22(2):92-6. PubMed · Publisher

Abstract

The clinical significance of ferruginous bodies in sputa was examined in a study of 674 former asbestos workers. Data from occupational histories and smoking behavior questionnaires, chest radiographs, spirometric measurements and counts of ferruginous bodies were obtained as part of a five-year surveillance program. Statistical analysis demonstrated that ferruginous bodies found in the sputa were significantly related to radiographic findings of interstitial pulmonary disease and pleural fibrosis and to spirometric findings of restrictive lung disease. Age and cigarette smoking were also found to be related to the presence of ferruginous bodies.

1970s

How the industrial physician can reduce mortality from asbestos-related diseases. R.J. Levine. 1978;20(7):464-8. Review PubMed · Publisher

Abstract

Risk indicators for asbestos-related diseases (cancers of the lung, larynx, and alimentary tract; mesothelioma; and asbestosis) and methods of early detection are reviewed and evaluated. The best medical means of reducing mortality from these diseases is to recognize particularly susceptible persons during a preemployment examination and to recommend that they not be hired for jobs involving asbestos exposure. Workers necessarily exposed to asbestos should be enrolled in a medical screening program and urged not to smoke.
Mesothelioma in the United States. Incidence in the 1970's. M.W. Hinds. 1978;20(7):469-71. PubMed · Publisher

Abstract

Mesothelioma is a rare neoplasm, the occurrence of which has been clearly related to asbestos exposure. Data recently collected by population based cancer registries in Washington, Hawaii, New Mexico, Connecticut, Michigan, Utah, Louisiana and Iowa were obtained for the determination of mesothelioma incidence rates. These registries represent a total population of over 16 million persons. Crude incidence rates were found to range from 3.0 to 7.1 per million per year. Age specific incidence rates showed a steady increase from the third through the eighth decade, with a more rapid increase for males than females. Sex specific incidence rates, age adjusted to the 1970 U.S. population, were found to range from 4.4 to 11.1 per million per year for males and from 1.2 to 3.8 per million per year for females. The highest rates for both males and females were found in the New Orleans area of Louisiana and the Puget Sound area of Washington state, both with significant shipbuilding activity.
Pleuropulmonary disease among asbestos workers in relation to smoking and type of exposure. W. Weiss, P.A. Theodos. 1978;20(5):341-5. PubMed

Abstract

The chest roentgenograms of employees aged 40 and over in two asbestos manufacturing plants were read by consensus without knowledge of the plant or smoking habits. Plant A used only chrysotile asbestos throughout its history and Plant B used amosite as well as chrysotile, the amosite being limited to the period 1950-64. The prevalence of pulmonary disease was 25% in Plant A and 33% in Plant B. The prevalence of pleural thickening was 18% in Plant A and 35% in Plant B. Neither age nor work duration were factors in these differences. In Plant A there was no obvious relationship between smoking and pleuropulmonary disease. In Plant B there was a definite relationship of smoking to pulmonary disease and perhaps to pleural thickening. Both type of asbestos and smoking habits appear to be determinants of pleuropulmonary disease in asbestos workers.
Asbestosis -- a diagnostic enigma: a personal view. H.C. Lewinsohn. 1977;19(9):607-10. PubMed

Abstract

Although the carcinogenic properties of asbestos are presently attracting a good deal of attention, asbestosis is still the earliest lung disease resulting from exposure to it and its incidence in an exposed population is the most useful indicator of the degree of dust control exercised over a period of time. The diagnosis of asbestosis depends upon: (1) An adequate occupational exposure history. (2) Physical signs of pulmonary fibrosis. (3) Progressive radiological changes. (4) Confirmatory measurements of altered lung function. Asbestosis is a clinical entity and is readily diagnosed when all the above-mentioned criteria are met. Problems in diagnosis are encountered when one or more of the diagnostic criteria listed above cannot be substantiated. At the present time every effort is made to diagnose the disease in its early stages in the hope that removal from further exposure will prevent the direct and indirect complications.
Geographical pathology as a method for detecting occupational cancer. J.R. Goldsmith. 1977;19(8):533-9. PubMed

Abstract

Geographical pathology points to environmental factors in cancer and helps estimate their potential magnitude. An occupational contribution was established by 1972 for cancer of the mouth, lung, bladder, and skin. Additionally partly based on geographical pathology, an occupational etiology is accepted for some cancer of nasopharynx, brain, liver, pleura, nasal sinus, bone and bone marrow, and possibly stomach. For identifying new occupational factors based on geographical comparisons, both an optimal size of work force to be followed-up and a sufficiently high proportion of work force in the geographical unit's population are necessary. Hypothetical variations based on 30-year follow-up of asbestos workers illustrate this. Cancer surveys and registries can greatly facilitate detection of occupational cancer. Evidence for occupational factors in the geographical pathology of lymphosarcoma is briefly summarized; but no conclusions are reached.
Mortality of a cohort exposed to chrysotile asbestos. W. Weiss. 1977;19(11):737-40. PubMed

Abstract

A 30-year historical cohort mortality study was made of 264 men hired during 1935-45 who worked in a chrysotile asbestos products factory for one year or more and were alive January 1, 1945. Follow-up was 94% complete. The overall standardized mortality ratio (SMR) was only 0.61 while the SMR for all cancers was 0.75, for lung cancer 0.93, and for gastrointestinal cancer 1.05. Two men died of asbestosis. The overall SMR was higher for men who worked five years or more than for men who worked one to four years but the 30-year mortality rates were the same after age adjustment. For asbestos-related diseases the differences in work duration had no effect on mortality. The data show a favorable mortality experience for men exposed to chrysotile alone.
Occupational differences in rates of lung cancer. H.R. Menck, B.E. Henderson. 1976;18(12):797-801. PubMed · Publisher

Abstract

Lung cancer rates in Los Angeles County were reviewed for different occupations and industries. Employment groups found to be at excess risk who have not been previously implicated included roofers, dental lab technicians, decorators, nonautomotive mechanics, photoengravers, clothing ironers, electricians, bar and restaurant managers, janitors: and workers in the radio-TV brooad-casting, dairy, leather, food and drink, bakery, and auto repair industries. Mo lung cancer in Los Angeles County had exposure to asbestos, polycyclic aromatic hydrocarbon compounds (PAH), or both.
Pitfalls in epidemiological research. An examination of the asbestos literature. P.E. Enterline. 1976;18(3):150-6. Review PubMed
Occupational health's future. E.J. Baier. 1975;17(3):171-2. PubMed
Editorials: After Armageddon--what?. R.B. O'Connor. 1974;16(12):810. PubMed
Implementation of the federal asbestos standard in Connecticut. J.B. Schoenberg, C.A. Mitchell. 1974;16(12):781-4. PubMed · Publisher
Letter: Occupational disease information. L.J. Ahern. 1974;16(3):146-7. PubMed
Medical criteria for work in respiratory hazards. I.R. Tabershaw. 1974;16(6):402-5. PubMed
Health standards and required medical examinations. P.J. Whitaker. 1973;15(9):740-1. PubMed
Recent developments in industrial carcinogens. R.E. Eckardt. 1973;15(11):904-7. Review PubMed
Asbestos: identification of fibrous particles in lungs. P. Gross, J.M. Davis, R.A. Harley, et al. 1972;14(10):757-9. PubMed
Evaluation of asbestos exposure in the working environment. Recommendation of subcommittee on asbestosis of the permanent commission and international association on occupational health. 1972;14(7):560-2. PubMed
Asbestos exposure to coke oven operators. I.J. Selikoff, E.C. Hammond. 1971;13(10):496-7. PubMed · Publisher

1960s

Asbestos as an environmental hazard. I.R. Tabershaw. 1968;10(1):32-7. PubMed
Measurement of asbestos exposure. J.R. Lynch, H.E. Ayer. 1968;10(1):21-4. PubMed
Research on health effects of asbestos. L.J. Cralley, W.C. Cooper, W.S. Lainhart, et al. 1968;10(1):38-41. PubMed
Mortality pattern in a cohort of asbestos workers. A study on employment experience. T.F. Mancuso, A.A. el-Attar. 1967;9(4):147-62. PubMed
Ann Arbor case reports. II. Mesothelioma in an accountant. T.N. Markham, V.N. Dodson. 1966;8(3):138-9. Case report PubMed · Publisher

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