The Third Wave of Asbestos Disease: Exposure to Asbestos in Place--Public Health Control. Conference. New York, New York, June 7-9, 1990

Our plain-English summary of The Third Wave of Asbestos Disease: Exposure to Asbestos in Place--Public Health Control. Conference. New York, New York, June 7-9, 1990 (Annals of the New York Academy of Sciences, 1991).

The study

• Journal: Annals of the New York Academy of Sciences
• Published: 1991;643:1-625
• Read it: PubMed

In plain English

The text is a February 1990 Asbestos Litigation Reporter reprint of a paper by Irving J. Selikoff, not the cited conference volume. The author described a third phase of disease, from asbestos already in place. Of 17,800 insulation union members in the United States and Canada, 4,951 died in 1967-1986. On best evidence there were 1,168 lung cancer deaths against 268.66 expected; the paper notes these are not strictly comparable. There were 173 pleural and 285 peritoneal mesothelioma deaths and 427 asbestosis deaths. Larynx, kidney, pancreas and some other cancers were increased; bladder, prostate, primary liver cancer, leukemia, lymphoma, melanoma and brain tumors were not shown to be. In 1972-1973 asbestos was removed, in many instances, from insulation these workers used, though some exposure continued. Crude mesothelioma and asbestosis rates rose afterward. Compared by years since starting work, lung cancer, peritoneal mesothelioma and asbestosis death rates fell, except at 40 or more years from onset. Pleural mesothelioma did not fall. Almost two-thirds of 1,331 sheet metal workers surveyed in 1986 had asbestos-related X-ray changes. The author warned this phase could prove as difficult as earlier ones.

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: Overview paper presenting data from a prospective mortality study of insulation workers (Mount Sinai School of Medicine and American Cancer Society), plus a radiological survey of sheet metal workers
• Who was studied: 17,800 men in the International Association of Heat and Frost Insulators and Asbestos Workers (United States and Canada), followed January 1, 1967 to December 31, 1986 (301,592.6 person-years); also 1,331 sheet metal workers examined in a 1986 survey in six cities
• Exposure: Asbestos in insulation materials used by insulation workers (fiber types not specified). In 1972-1973 asbestos was removed in many instances from the insulation materials these workers used, though some exposure continued during repair and rip-out work.
• Main results:
  • Lung cancer among the insulation workers: 1,168 deaths on best evidence and 1,008 on death certificates, against 268.66 expected. Expected deaths came from death-certificate rates, and the paper says ratios using best-evidence counts are not strictly comparable with them.
  • Mesothelioma among the insulation workers (confirmed by Mount Sinai histopathology review): 173 pleural (57.36 per 100,000 person-years) and 285 peritoneal (94.50 per 100,000 person-years); no U.S. expected rates were available
  • Asbestosis deaths among the insulation workers: 427 on best evidence (141.58 per 100,000 person-years)
  • Among the insulation workers, the author reported that a number of other cancers were increased, including cancer of the larynx, oro-pharynx and buccal cavity, kidney, pancreas, and gall bladder and bile ducts, though not to the magnitude of the four major causes
  • Pancreatic cancer among the insulation workers: 39.52 deaths were expected and death certificates listed 92, but best evidence found 54. The author stated this was still significantly increased.
  • An increased incidence was not demonstrated among the insulation workers for urinary bladder, prostate, leukemia, lymphoma, melanoma, brain tumors and primary liver cancer. Death certificates listed 31 liver cancer deaths against 11.06 expected, but 19 of these were not primary liver cancer.
  • Approximately two-thirds of the deaths from asbestos-associated disease occurred before age 65
  • Crude death rates (per 1,000 person-years) from mesothelioma and asbestosis among the insulation workers rose from 1967-1972 to 1973-1979 and 1980-1986. The author said these figures can mislead because the men had more years since onset of exposure in later periods.
  • When expected and observed deaths were calculated separately for each period and compared by years from onset, death rates from lung cancer, peritoneal mesothelioma and asbestosis decreased after exposure was reduced, even after 15 to 25 years of work exposure
  • No such decrease was seen among men already 40, 45 or 50 years from onset of work
  • Pleural mesothelioma death risk did not decrease with the reduction in work exposure
  • Among 1,331 sheet metal workers examined, radiologically evident asbestos-related changes were seen in almost two-thirds, particularly in those 35 or more years from onset of work
• The authors' conclusion: The author concluded that exposure to asbestos already in place (in buildings, ships, plants and railroads) may be a new phase of asbestos exposure that could prove as difficult as earlier phases. The author stated that people walking through buildings would not have a detectable increased cancer risk, but those doing maintenance and repair would have considerable risk unless fully protected.
• Limitations the authors state:
  • The author stated that projections for this third phase are insecure, partly because of limited information
  • Dust measurements before, during and after the 1972-1973 removal were fragmentary and infrequent
  • Ratios comparing best-evidence observed deaths with death-certificate-based expected deaths were calculated for information only, because the two are not strictly comparable

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