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PubMed1997

Malignant mesothelioma in women.

About 8% of our cases of mesothelioma occur in women, with a median age of 59 years. Our percentage is lower than other series reported in the literature because of the large number of occupationally exposed men referred to our laboratory. Tumor arose in the pleura in 86% of the women in our study, and the majority were epithelial. Pleural plaques were found in half of the women for which this information was available, and asbestosis was found in only 16%. A history of exposure to asbestos was identified in three quarters of the women, more than half of whom were household contacts of asbestos workers. Occupational exposure to asbestos was identified in only 19% of patients. An elevated tissue asbestos burden was noted in 70% of women from whom lung tissue was available for analysis. The main fiber type identified was amosite, followed by tremolite and chrysotile. These findings and those from other countries suggest a need for reassessment of the background rate of mesothelioma in industrialized nations.

Adult↗
PubMed1998

Asbestos in the lungs of persons exposed in the USA.

Tissues obtained at autopsy or biopsy from 81 workers and 2 household persons, were chemically digested. The asbestos fibres recovered were characterized by analytical transmission electron microscopy. Among the 83 causes of death were 33 mesotheliomas, 35 lung cancers, 12 asbestosis and 3 from other cancers. Of the three major commercial asbestos fibre types, amosite was found to be the most prevalent fibre, occurring in approximately 76% of the cases, followed by chrysotile in approximately 60% and crocidolite in approximately 24%. Amosite and chrysotile were observed as the single commercial fibre in approximately 22 and approximately 17% of the cases respectively, whereas crocidolite and tremolite were found as the single fibre type in only approximately 2.5% of the cases. Among the fifteen cases where chrysotile and tremolite occurred together, the amount of chrysotile fibre always exceeded tremolite. However, tremolite was also found in ten additional cases where chrysotile was not detected. Amosite was present in four, amosite plus crocidolite in three, and crocidolite alone in one. Amosite was present in all of the insulation workers' lungs studied and was found in the highest concentration in this exposure category. The highest chrysotile concentration was found among workers in general trades. Although most prevalent in shipyard workers lungs, crocidolite concentration is not statistically different among the exposure groups studied. Although crocidolite was found in twenty cases, amosite accompanied it in eighteen of these. Eleven of the 20 cases were from shipyard workers. Of the 8 mesothelioma cases, 7 also contained amosite. Crocidolite alone only occurred in 1 of the 33 mesothelioma cases analysed. We concluded the following: crocidolite exposure occurred among USA insulators and a large percentage of other workers as well; insulation workers are primarily exposed to amosite; mixed fibre exposures are associated with more mesotheliomas than single fibre exposures; chrysotile only exposure is associated with approximately 12% of the mesothelioma cases studied; and if tremolite exposure is associated with chrysotile exposure, the chrysotile amount exceeds that for the associated tremolite.

Aged↗
PubMedDate not supplied

The carcinogenic effect of inhaled asbestos fibers.

Inhalation of asbestos fibers is associated with high incidence of lung cancers and pleural or peritoneal mesotheliomas in humans. All of these lesions were successfully reproduced in animal experiment, and it was shown that asbestos neoplasm may occur with or without accompanying asbestosis. Incidence of tumors from crocidolite was nearly three times as high as from chrysotile or amosite. It is possible that different carcinogenic entities are responsible for the causation of lung tumors and mesothelial tumors. Lung tumors seem to depend on the adsorptive capacity of asbestos fibers, allowing other carcinogens (heavy metals, polycyclic hydrocarbons, cigarette smoke) to attain a critical focal concentration. Mesothelial tumors, on the other hand, might arise in response to mechanical irritation by fibers which may become lodged during lymphatic spread. Tissues subject to constant respiratory movement (e.g., pleura or peritoneum) are specifically vulnerable to the latter action.

Asbestos↗
PubMed1998

[Asbestos: current knowledge and perspectives].

Diseases due to asbestos inhalation are not only a concern for occupational physicians, but also for general practicioners and pneumologists. The real or supposed risk has extended beyond the factories employing "primary asbestos workers" to thousands of people exposed to this material or simply working in buildings insulated with asbestos. The spectrum of asbestos-related diseases has changed: asbestosis (parenchymal fibrosis due to asbestos) tends to disappear, whereas the incidence of pleural lesions, which can be associated with lower cumulative exposures, increases. Patients with asbestos related diseases do not die any more from respiratory failure but from late neoplastic complications, such as mesothelioma and lung cancer. The lack of interest and of training in occupational medicine leads to an underrecognition and an underestimation of cancers due to asbestos by the physicians. Recent progresses in CT imaging and evaluations of exposure to fibers through mineralogical analysis of lung samples have led to improve the diagnostic approach of fiber-related diseases.

Asbestosis↗
PubMed1998

Expression of cyclooxygenase-2 in human lung carcinoma.

Epidemiological studies indicate that the use of aspirin decreases incidence of and mortality from gastrointestinal cancers. A major target of aspirin and other nonsteroid anti-inflammatory drugs is cyclooxygenase (Cox), the rate-limiting enzyme in the conversion of arachidonic acid to prostanoids. Two Cox genes have been cloned (Cox-1 and Cox-2), of which Cox-2 has recently been found to be expressed in several human carcinomas. We have now studied the expression of Cox-2 mRNA and protein in human lung adenocarcinoma, squamous cell carcinoma, and small cell lung cancer. Cox-2 mRNA steady-state levels were high in well-differentiated adenocarcinoma samples, but low in poorly differentiated adenocarcinoma, squamous cell carcinoma, and small cell lung cancer, as detected by Northern blot analysis. Immunohistochemistry showed Cox-2 staining in 19 of 21 adenocarcinomas. However, well-differentiated adenocarcinomas contained more Cox-2 staining than the poorly differentiated ones. Expression of the Cox-2 protein was also seen in all 11 squamous cell carcinomas studied, although the level of staining seemed to be less than that in the adenocarcinomas. Small cell lung cancer specimens (n = 4) stained with a relatively weak intensity. Interestingly, atypical alveolar epithelium, which associates with asbestosis and idiopathic fibrosing alveolitis and is considered to be a precursor lesion for lung cancer, expressed the Cox-2 protein. Our data, thus, suggest that Cox-2 is expressed in human lung carcinomas and in precursor lesions leading to this malignancy.

Adenocarcinoma↗
PubMed1998

[Pleural malignant mesothelioma with osseous cartilaginous and rhabdomyogenic differentiation].

A 63-year-old man, who was formerly an asbestos factory worker who had been followed due to asbestosis, and was admitted to our hospital with left chest pain and dyspnea on exertion. A chest X-ray and chest computed tomogram (CT) on admission revealed a large tumor in the left lung field. Percutaneous needle biopsy determined that the tumor was a sarcoma. No clinical response was obtained by systemic chemotherapy. The autopsy revealed diffuse malignant mesothelioma of sarcomatous type with osseous, cartilaginous and rhabdomyogenic differentiation. Osseous and cartilaginous differentiation in a malignant mesothelioma is rare, and the presence of a malignant rhabdomyogenic component is the first to be described in the Japanese literature.

Asbestosis↗
PubMed2001

Diagnosis of pulmonary alveolar proteinosis: usefulness of papanicolaou-stained smears of bronchoalveolar lavage fluid.

BACKGROUND: The globules (stained green, orange, or orange in the center coated with a green rim) seen in Papanicolaou-stained smears of bronchoalveolar lavage fluid are suggested to be characteristic of pulmonary alveolar proteinosis (PAP). OBJECTIVE: To evaluate the usefulness of Papanicolaou-stained smears of bronchoalveolar lavage fluid in aiding a diagnosis of PAP. METHODS: Papanicolaou-stained smears of bronchoalveolar lavage fluid obtained from 7 patients (5 idiopathic, 2 secondary) with PAP were evaluated. To serve as controls, the smears of 11 normal subjects and 128 patients with other pulmonary disorders were also examined. The findings on the presence and number of globules were recorded. To differentiate PAP from other pulmonary disorders, the highest globule value obtained from the control group was chosen as the cutoff point. RESULTS: The characteristic globules were not found in normal subjects and only found in 6 of 128 patients with other pulmonary disorders. Their clinical diagnoses were Sjögren syndrome in 2 cases; polymyositis, idiopathic pulmonary fibrosis, asbestosis, and hypersensitivity pneumonitis in 1 case each. The numbers of globules in these 6 patients were 1, 3, 17, 7, 3, and 2. In contrast, more than 100 globules were found in all patients with PAP. The number of globules was highly sensitive and specific in aiding a diagnosis of PAP when the cutoff value was set at 18. CONCLUSION: The globules seen in Papanicolaou-stained smears of bronchoalveolar lavage fluid may be valuable in aiding a diagnosis of PAP, especially when the number of globules is more than 18.

Adult↗
PubMed1996

Approaches for assessing the efficacy of occupational health and safety standards.

The regulation of hazards is one of the most dramatic forms of intervention in occupational safety and health (OSH). Despite their high degree of potential social and economic impact, relatively little research has been conducted to specifically evaluate the effectiveness of OSH standards with regard to preventing occupational diseases and injuries. This paper reviews the basic scientific approaches that may be used to evaluate the efficacy of OSH standards. These approaches encompass the following research areas: (1) exposure surveillance, (2) disease surveillance, and (3) prospective studies following the introduction of the standard. Research on asbestos and asbestosis, respirable crystalline silica (quartz) and silicosis, and respirable coal mine dust and coal workers' pneumoconiosis (CWP) are used to illustrate these approaches and the type of information that is currently available. The examples (quartz, coal dust, asbestos) reveal substantial limitations in the types of information currently available for evaluating the efficacy of these OSH standards. Ideally, plans for evaluating the efficacy of OSH standards should be developed for existing and future standards. These plans should include programs for the surveillance of exposures and adverse health effects and, when possible, for prospective studies designed to evaluate how the risk of disease (or injury) is modified by the introduction of the standard.

Forecasting↗
PubMed1997

Proportionate mortality among unionized construction ironworkers.

This report presents the results of proportionate mortality ratios (PMR) and proportionate cancer mortality ratios (PCMR) among 13,301 members of the International Union of Bridge, Structural, and Ornamental Ironworkers who had been members for a minimum of 1 year, were actively paying dues into the death beneficiary fund, and had died between 1984-1991. Using the United States proportionate mortality rates as the comparison population, statistically significant elevated risks, using 95% confidence intervals (CI), were observed for several types of injuries: falls (N = 259, PMR = 3.57, CI = 3.15-4.03), transportation injuries (N = 363, PMR = 1.22, CI = 1.10-1.35), and other types of injuries (N = 225, PMR = 1.63, CI = 1.43-1.86). The deaths due to falls were significantly elevated for each 10-year age group under age 60 (PMR > 7.00) and for those workers with < 20 years in the union (PMR > 6.00). Elevated mortality risks were also observed for all malignant neoplasms combined (N = 3,682, PMR = 1.09, CI = 1.06-1.13) as well as for site-specific malignant neoplasms of the lung (N = 1,523, PMR = 1.28, CI = 1.21-1.35), pleural mesothelioma (N = 7, PMR = 1.67, CI = 0.67-3.44) and "other and unspecified sites" (N = 307, PMR = 1.29, CI = 1.15-1.44). The category "pneumoconiosis and other respiratory diseases" was also significantly elevated (N = 690, PMR = 1.11, CI = 1.03-1.20); in this category, deaths due to asbestosis had the greatest elevated risk (N = 10, PMR = 3.56, CI = 1.70-6.54). No elevation in risk was found for kidney cancer or for chronic nephritis which were of interest because of Ironworkers' potential exposure to lead. The present study underscores the importance of fall protection and other injury prevention efforts in the construction industry, as well as the need to control airborne exposures to asbestos, welding fumes and other respirable disease hazards.

Accidents, Occupational↗
PubMed1997

Silicosis, mixed dust pneumoconiosis, and lung cancer.

A total of 764 autopsy cases with a pathological diagnosis of nonasbestos pneumoconiosis were investigated in a search for lung cancer: 146 patients bore 148 lung cancers (19.1%). The incidence of a lung cancer was associated positively with aging longer occupational exposures, and smoking habits. A reverse correlation was found between carcinogenesis and the severity of pneumoconiosis. A statistically significant increase in the incidence of certain types of lung cancer (squamous cell carcinoma + small cell carcinoma) was found in silicotic lungs with massive fibrosis as compared to lungs with mixed dust pneumoconiosis of comparable severity. Although there appears to be no dose-response relationship in general between silicosis and lung cancer, it is advisable to consider the possibility that a presumptive silica-induced carcinogenesis might be masked by the severe fibrosis of a silicotic type, which obliterates the lung tissue in a different way from asbestosis, which is associated with epithelial proliferation.

Aged↗
PubMed1998

Proportionate mortality among union members employed at three Texas refineries.

The cause-specific mortality (1940-1993) of 2,985 male workers employed in three oil refineries was examined using a proportionate mortality study design. Separate analyses were undertaken by race, refinery, employment status (active and retired), and time since entry into the Oil, Chemical, and Atomic Workers (OCAW) union. Proportionate cancer mortality ratio (PCMR) analyses also were conducted. Proportionate mortality ratios (PMR) were significantly increased (P < 0.05) for cancers of the lip (PMR = 384), stomach (PMR = 142), unspecified sites of the liver (PMR = 238), pancreas (PMR = 151), connective tissues (PMR = 243), prostate (PMR = 135), eye (PMR = 407), brain (PMR = 181), benign and unspecified neoplasms (PMR = 289), and leukemia (PMR = 175) for the entire cohort. Significantly decreased mortality was observed for respiratory tuberculosis (PMR = 29), esophageal cancer (PMR = 45), rectal cancer (PMR = 49), and cancers of the bladder and other urinary organs (PMR = 40). Skin cancer was observed to be significantly increased (PMR = 242) for workers with less than 20 years since union initiation. Significantly increased PCMRs were seen for cancers of unspecified sites of the liver (PCMR = 205), brain (PCMR = 147), benign and unspecified neoplasms (PCMR = 243), and leukemia (PCMR = 146). Among nonwhites, an increased risk of bone cancer was observed in the PCMR analysis (PCMR = 704), although based on only two deaths. Analyses of mortality patterns for white males by refinery revealed similar patterns in each refinery as was seen in the overall cohort of refinery workers. Mortality patterns for whites and nonwhites also were similar. Additional analyses of deaths between 1960 and 1993 demonstrated increased mortality due to asbestosis (PMR = 683) and multiple myeloma (PMR = 124), although the multiple myeloma excess was not statistically significant. Ten deaths due to mesotheliomas were observed among these refinery workers.

Adult↗
PubMed1998

Lung health among boilermakers in Edmonton, Alberta.

BACKGROUND: Construction boilermakers may be exposed to a variety of substances, including asbestos and welding fumes. Past studies of boilermakers have shown increases in mortality from lung cancer and asbestosis and radiographic changes consistent with asbestos exposure. METHODS: Respiratory symptoms, lung function, and radiographic changes were compared for 102 actively employed boilermakers with 20 or more years of union membership and 100 telephone workers. Posteroanterior chest radiographs were evaluated by two experienced chest physicians, with a third arbitrating disagreed films. Union members were further categorized as boilermakers (n = 50) or welders (n = 52), based on longest service. Lung health was also compared with employment in a number of work sectors for time, and time-weighted exposure to dust and fumes. RESULTS: Boilermakers had more respiratory symptoms than telephone workers, but lung function did not differ. Radiographic changes were more common among the boilermakers (20% with any change, 8% circumscribed, and 9% diffuse pleural thickening). None of the boilermakers had small radiographic opacities. Several symptoms suggestive of bronchial responsiveness were associated with fume exposures in the gas and oil industry. Workers whose longest service was as a boilermaker demonstrated more symptoms than did welders. FEV1, FEV1/FVC, FEF25-75, and FEF50 were significantly lower among boilermakers compared with welders. CONCLUSION: Health screening programs for these workers are warranted.

Adult↗
PubMed1999

Mortality patterns among electrical workers employed in the U.S. construction industry, 1982-1987.

BACKGROUND: Studies of electrical workers in the utility and manufacturing industries have reported excess site-specific cancer. No previous studies of electrical workers in the construction industry have been conducted. METHODS: Our study evaluated the mortality patterns of 31,068 U.S. members of the International Brotherhood of Electrical Workers who primarily worked in the construction industry and died 1982-1987. RESULTS: Comparison to the U.S. population by using the NIOSH life table showed significantly elevated proportionate mortality for many causes. Excess mortality for leukemia (proportionate mortality ratio (PMR)=115) and brain tumors (PMR=136) is similar to reports of electrical workers with occupational exposure to electric and magnetic fields in the electric utility or manufacturing industry. Excess deaths due to melanoma skin cancer (PMR=123) are consistent with findings of other PCB-exposed workers. A significantly elevated PMR was observed for the diseases caused by asbestos: lung cancer (PMR=117), asbestosis (PMR=247), and malignant mesothelioma (PMR=356) and from fatal injuries, particularly electrocutions (PMR=1180). The findings of statistically significant excess deaths for prostate cancer (PMR=107), musculoskeletal disease (PMR=130), suicide (PMR=113), and disorders of the blood-forming organs (PMR=141) were unexpected. CONCLUSIONS: Results suggest that more detailed investigations of occupational risk factors and evaluation of preventive practices are needed to prevent excess mortality in this hazardous occupation. Am. J. Ind. Med. 36:630-637, 1999. Published 1999 Wiley-Liss, Inc.

Adult↗
PubMed1976

Primary pleural mesothelioma.

In this series of nine patients with primary pleural mesothelioma, three patients, all women, had "localized benign" tumors located in the left chest, although one had a recurrence on the right. Five patients all male, had the "diffuse malignant" type, and one woman had "multiple discrete" pleural tumors. Classification on the basis of gross appearance is useful clinically and prognostically, as reflected by the relatively benign behavior of localized pleural mesothelioma in contrast to the relentless lethal nature of the diffuse type. Although seven patients had pleural effusion, cytologic studies were of little help in establishing the diagnosis and all underwent thoracotomy. None of these patients had hypoglycemia or evidence of asbestosis, although three patients had a history of previous asbestos exposure.

Aged↗
PubMed1988

Concentration of hyaluronan in the serum of untreated cancer patients with special reference to patients with mesothelioma.

The concentration of hyaluronan was measured in the serum from patients with tumors. The patients were divided into nine groups: two control groups, i.e., those with benign tumors and those having undergone radical surgery; and seven groups of patients with untreated malignant conditions, i.e., mesotheliomas, sarcomas, lymphomas, breast carcinomas, brain tumors, bronchial carcinomas, and a group of various malignancies. As an additional control group, subjects with benign pulmonary diseases were investigated. The control groups and all the groups with malignant tumors except the mesotheliomas had serum hyaluronan values equal to or only slightly higher than those of healthy volunteers of the same age. The patients with mesotheliomas had significantly elevated hyaluronan levels (287 +/- 282 [Standard deviation] micrograms/l; n = 35; P less than 0.001) compared with healthy volunteers (54 +/- 28 micrograms/l in the age group of 51 to 60 years). Patients with asbestosis do not exhibit increased serum hyaluronan. The analysis of serum hyaluronan should therefore be of value in the diagnosis of mesothelioma.

Adult↗
PubMed2001

Mortality among unionized construction plasterers and cement masons.

BACKGROUND: Plasterers perform a variety of duties including interior and exterior plastering of drywall, cement, stucco, and stone imitation; the preparation, installation, and repair of all interior and exterior insulation systems; and the fireproofing of steel beams and columns. Some of the current potential toxic exposures among plasterers include plaster of Paris, silica, fiberglass, talc, and 1,1,1-trichloroethylene; asbestos had been used by the plasterers in the past. Cement masons, on the other hand, are involved in concrete construction of buildings, bridges, curbs and gutters, sidewalks, highways, streets and roads, floors and pavements and the finishing of same, when necessary, by sandblasting or any other method. Exposures include cement dust, silica, asphalt, and various solvents. METHODS: Proportionate mortality ratios (PMRs) and proportionate cancer mortality ratios (PCMRs) were calculated for 99 causes of death among 12,873 members of the Operative Plasterers' and Cement Masons' International Association who died between 1972 and 1996 using United States age-, race-, and calender-specific death rates. Statistical significance (P value) of results was based upon the Poisson distribution. RESULTS: Among plasterers, statistically significant elevated mortality was observed for asbestosis, where the PMR reached 1,657 (P < 0.01) with eleven observed deaths and less than one death expected, for lung cancer (PCMR = 124, P < 0.01), and for benign neoplasms (PMR = 210, P < 0.05). Among cement masons, statistically significant elevated mortality was observed for cancer of the stomach (PCMR = 133, P < 0.01), benign neoplasms (PMR = 132, P < 0.01), and poisonings (PMR = 159, P < 0.05). Except for poisonings, which were not thought to be occupationally related, all of the statistically significant results occurred among those members who entered the union prior to 1950. However, the risk for lung cancer among plasterers was still elevated among those entering the union after 1970 as was the risk for stomach cancer among cement masons who entered the union after 1950. CONCLUSIONS: The present study suggests that plasterers and cement masons still have elevated risks for certain diseases, especially lung and stomach cancer. Therefore, union members currently living should be screened for asbestos-related diseases and educated about the future risks for these diseases.

Adult↗
PubMed2001

Malignant mesothelioma from neighborhood exposure to anthophyllite asbestos.

BACKGROUND: Anthophyllite asbestos has been reported to cause asbestosis, lung cancer, mesothelioma, and pleural plaques in occupationally exposed workers. Anthophyllite has also been associated with pleural plaques in Finland and Japan among those who live near mines and mills and have neighborhood or environmental exposure. METHODS: We evaluated a 38-year-old patient with pleural mesothelioma who lived, attended school, and delivered newspapers near a manufacturing facility that used exclusively anthophyllite asbestos fiber from ages 8-17 years. He had no work exposure to asbestos. RESULTS: The pleural mesothelioma was an epithelial type with tubulopapillary structures and was treated with an extrapleural pneumonectomy followed by radiation therapy. The malignant cells were positive by immunohistochemistry for cytokeratin but negative for carcinoembryonic antigen, S100, B72.3, and leu M1 antigen. Anthophyllite fibers were > 5 microm in length in lung tissue compared to 3 microm from a general population study. CONCLUSIONS: Anthophyllite asbestos has been associated with neighborhood environmental exposure and pleural plaques; we now report a neighborhood exposure and pleural mesothelioma.

Adult↗
PubMed2005

A proportionate mortality study of bricklayers and allied craftworkers.

BACKGROUND: Mortality among members of the International Union of Bricklayers and Allied Craftworkers (IUBAC) is examined. Bricklayers and allied craft workers may be exposed to cobalt, epoxy resins, pitch, lime, and to lung carcinogens such as asbestos, silica, and nickel. METHODS: Proportionate mortality ratios (PMRs) were computed using US age-, gender-, and race-specific mortality rates for members who died during 1986-1991. RESULTS: Statistically significant PMRs among white men were found for cancers of the esophagus (PMR=134), stomach (PMR=131), respiratory system, trachea, bronchus, and lung (PMR=144), other parts of the respiratory system (PMR=216), other and unspecified sites (PMR=125). Elevated PMRs were also found for other diseases of the blood and blood forming organs (PMR=201), emphysema (PMR=133) and for asbestosis (PMR=554), and other respiratory diseases (PMR=119). CONCLUSIONS: Results are consistent with those found in previous studies, and suggest the need for intervention activities directed at the prevention of these cancers, and other respiratory diseases.

Adult↗