PubMed1998
A large cohort of men born between 1891 and 1920 and employed for at least a month in the chrysotile producing industry of Quebec has been under study since 1966. These men were followed from first employment (the earliest in 1904) to 1992, by which time over 8000 had died, 657 from lung cancer. The current study is of 488 cases of lung cancer formerly employed at three places, viz. a major complex, here called Company 3, in the region of Thetford Mines (243 cases), the mine and mill in the town of Asbestos (206) and a small asbestos-products factory in the same town (39). For each case, four referents were sought by random selection from among survivors to a greater age, after matching on place of employment, age of starting work, smoking habit and date of birth. This process was highly successful, although six cases had less than four referents. For each man (the 488 cases with 1941 referents) and for each calendar year of employment, we obtained the fraction of the year worked at various levels of intensity, assessed in 13 'dust categories' of mpcf (million particles per cubic foot). We then calculated how many years each man spent at these various levels; these years, adjusted for the length of the working week (66 h until 1937; 48 h 1938-1949; and 40 h 1950-1985), were accumulated up to ten years before the death of the case. The men were classified according as they were non- or ex-smokers, or smokers, of cigarettes. For each man at Company 3 and one referent for each, his years of work in a central area of five mines and in a peripheral area of ten mines were differentiated; contamination of the chrysotile by fibrous tremolite was known to be much greater in the central than in the peripheral area. Case-referent comparisons, within place of employment, were made by conditional logistic regression. As anticipated from earlier subject-years analyses, lung cancer risks were found to be negligible for years worked in dust categories 1 and 2 (averaging 0.5 and 2 mpcf), regardless of place; as the upper limit of category 1 is considerably higher than permitted nowadays, the lung cancer risk from exposure to chrysotile at permitted levels can be taken as extremely small. Patterns of exposure-response for higher categories were irregular. At Company 3, some risks appeared elevated for years spent in the higher dust categories: 3-4, 5-7, 8-10 and 11-13, with averages around 9, 20, 36 and 92 mpcf, respectively. For categories 3-4 and 8-10, the odds ratios were high for some or all work in the central area, but minimal for years spent in the peripheral area only. Odds ratios were fairly low for cigarette smokers who worked in categories 5-7 and also for years spent in the highest categories (11-13). At the mine and mill in Asbestos, all risks were low except for years worked by non- and ex-smokers in categories 7-13 (ca. 40 mpcf). There were no increased risks at the factory. It was known from the subject-years analyses that most of the excess had occurred at Company 3, but it is now clear that for all practical purposes it was confined to the central area there, probably due largely to fibrous tremolite and in dust conditions of at least dust category 3. The average of this category was 7 mpcf or very roughly 24 fibres/ml, about two orders of magnitude higher than today's hygiene standards.