Surveillance of high-risk groups exposed to asbestos in the United States

Our plain-English summary of Surveillance of high-risk groups exposed to asbestos in the United States, by H.C. Lewinsohn (Annals of the New York Academy of Sciences, 1979).

The study

• Author: H.C. Lewinsohn
• Journal: Annals of the New York Academy of Sciences
• Published: 1979;330:533-40
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 003987).

In plain English

This 1979 paper, by an author at Raybestos Manhattan, Inc., discussed surveillance of groups at high risk from asbestos in the United States. It was not a new study. The author defined asbestos and risk. The paper then reviewed some published studies from 1965 to 1978 on deaths from cancer and asbestosis among workers in asbestos mining and milling, the manufacture of asbestos products, and the installation of asbestos insulation. In the author's summary table drawn from those studies, cancer accounted for 16.9% of deaths in mining and milling, 25.7% in manufacturing and 45.0% in insulating. Lung cancer accounted for 4.5%, 11.7% and 21.9%, and asbestosis for 1.9%, 5.5% and 7.8%. The author wrote that this trend may indicate the worst health experience is in the insulation industry. The paper described the 1972 OSHA asbestos standard, which required medical examinations, and a 1975 proposed revision. It listed shortcomings, including no stated qualifications for examining physicians and no central record-keeping system. The author concluded that people exposed to asbestos need surveillance to determine the degree of risk.

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

What the study did and found

• Design: Discussion paper with a review of selected published mortality studies, summarized in tables
• Who was studied: Workers in previously published studies: chrysotile miners and millers in Quebec and Italy, anthophyllite miners in Finland, asbestos products manufacturing workers in the United States and England, and insulation workers in New York, Belfast, and the United States and Canada
• Exposure: Occupational asbestos exposure in mining and milling, the manufacture of asbestos products, and the installation of asbestos insulation. The paper describes chrysotile and the amphiboles amosite, crocidolite, anthophyllite, tremolite and actinolite.
• Main results:
  • In the author's summary of published reports, among mining and milling workers, cancer accounted for 16.9% of deaths, lung cancer for 4.5% and asbestosis for 1.9%
  • Among insulation workers, cancer accounted for 45.0% of deaths, lung cancer for 21.9% and asbestosis for 7.8%
  • Among asbestos products manufacturing workers, cancer accounted for 25.7% of deaths, lung cancer for 11.7% and asbestosis for 5.5%
  • The author wrote that the trend in the summary table may indicate the worst health experience is in the insulation industry
  • The 1972 OSHA asbestos standard required employers to provide preplacement, annual and termination medical examinations, including a chest X-ray, a respiratory symptom history and lung function tests
  • The author listed shortcomings of this approach: no qualifications set for examining physicians, no central record-keeping system, no provision for transferring affected persons to other jobs, and no definition of the exposure that triggers the requirement
• The authors' conclusion: The authors concluded that people exposed to asbestos need to be kept under surveillance to determine the degree of risk. They held that fiber type and industrial sector must be taken into account, and that surveillance should include workplace inspection, exposure measurement, counseling, education and training.
• Limitations the authors state:
  • The author stated that current knowledge was limited by inadequate information on exposure levels, fiber types used, baseline medical data and diagnostic criteria, and by unverified causes of death on death certificates
  • The author stated that no large-scale study had been designed to quantify risk across differently exposed groups of workers, and that the studied populations were usually those with the highest dust levels

Topics

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

Related studies

• Surveillance of high-risk groups--a survey of asbestos workers: the present position in the United Kingdom — W.J. Smither (1979)
• Occupational carcinogenesis. High-risk industrial groups: identification, education, and surveillance. Tyler Asbestos Workers Program — S.D. Greenberg, G.A. Hurst, et al. (1976)
• Mesothelioma trends in the United States: an update based on Surveillance, Epidemiology, and End Results Program data for 1973 through 2003 — B. Price, A. Ware (2004)
• Re: "Mesothelioma trends in the United States: an update based on surveillance, epidemiology, and end results program data for 1973 through 2003" — J.H. Lange (2004)
• Changes in B-readings over time in the United States Navy Asbestos Medical Surveillance Program — J.G. Muller, W.G. Rudolph, et al. (2007)
• Asbestos disease in United States shipyards — I.J. Selikoff, R. Lilis, et al. (1979)

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