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PubMed1999

A study of lung cancer mortality in asbestos workers: Doll, 1955.

Between 1935 and 1953, a series of publications appeared in England, Germany and America reporting cases of lung cancer amongst asbestos workers. As early as 1943, the German scientific consensus was that the evidence was strong enough to deem the association to be causal. On reviewing a more extensive bibliography, this view was shared by an American cancer expert. The results of industry sponsored experiments, in which lung tumors had been induced in mice by asbestos, were circulated in confidence to its scientists, but being unpublished were unknown to the general scientific community. There were also cancer mortality data recorded for populations of exposed asbestos workers, but these were confidential and remained to be analyzed. To deal with the persistent allegations of a lung cancer hazard, in 1953 Dr. Richard Doll was asked by Turner Brothers Asbestos ("the Company"), whose in-house analyses had been reassuring, to study the mortality data of a group of its workers. Despite the limitations of the data, Doll convincingly demonstrated so substantial an excess of lung-cancer in heavily exposed long-term asbestos workers as to overcome honest doubt. Despite determined attempts made to dissuade them, Doll and the editor of the journal to which he submitted his paper, courageously went ahead and published the paper. Industry overestimated the harm that publication of the paper would do to their immediate interests. It produced so profound a lack of sense of urgency, that legislation addressed to the control of lung cancer specifically had to wait 20 years, and asbestos workers contracting it were to wait 25 years, before they might be considered for compensation, and even then, only under extremely limiting conditions.

Animals↗
PubMed1999

Asbestos exposure in lung carcinoma: a necropsy-based study of 414 cases.

BACKGROUND: The prerequisites necessary for attributing lung carcinoma to asbestos, represent a controversial issue. METHODS: Three parameters (occupational history, pleural plaques, and lung asbestos bodies) were investigated in 414 consecutive cases of lung carcinoma, examined at necropsy at the Hospital of Monfalcone, Italy. Occupational data were obtained from the patients' relatives by personal or telephone interviews. Pleural plaques were classified into three classes (small, moderate, large). Routine lung sections were examined for asbestos bodies in all cases; isolation and counting were performed in 408 cases. RESULTS: The series included 353 men, and 61 women, aged between 38 and 97 years. The male patients had worked in industries in 74% of cases (60% in shipbuilding). Men showed pleural plaques in 82% of cases (moderate or large plaques in 58.7%). Asbestos bodies were observed in routine lung sections in 34.8%, and in 31% exceeded the value of 5,000 bodies per gram of dried tissue. Among women the principal features were: history or domestic exposure to asbestos in 36% of the cases, prevalence of pleural plaques 34% (moderate or large plaques 15%), asbestos bodies in routine lung sections in 3.3% and there was no case with an asbestos body burden over 5,000/g. The fraction of asbestos-related carcinomas among male patients varied between 24.7 and 61%, depending on the criteria used for attribution. CONCLUSIONS: Different criteria indicated about 60% of the present lung carcinomas among men as plausibly attributable to asbestos.

Adult↗
PubMed1999

High-resolution computed tomography abnormalities in ex-insulators annually exposed to asbestos dust.

BACKGROUND: characterize To the effects of high asbestos exposure during annual periods of insulation. METHOD: 170 ex-workers underwent clinical examination, spirometry, standard chest X-rays and high-resolution computed tomography (HRCT). Asbestos exposure was retrospectively assessed for latency, duration, and intensity. RESULTS: Sixty-six percent of these workers were annually exposed to high concentrations of asbestos dust. Respiratory symptoms were mild. One hundred and nineteen subjects had pleural or pulmonary changes on HRCT, compatible with asbestos exposure. Localized pleural thickening was found in 113 subjects (66.5%); pulmonary nodules or lines in 35 (20.6%). The presence of pleural plaques was linked to intensity of asbestos exposure (P <.01), and length of employment (P <.05). Parenchymal lesions were related to intensity (P <.05) and duration of exposure (P <.05). Lung function of subjects with X-ray changes was not significantly altered. CONCLUSIONS: Annual asbestos exposure led to a high prevalence of pleural plaques and to mild parenchymal anomalies.

Aged↗
PubMed2000

Medical examination for asbestos-related disease.

There are millions of workers whose exposure to asbestos dust prior to the implementation of asbestos regulation and improved control measures places them at risk of asbestos-related disease today. In addition, workers are still being exposed to significant amounts of asbestos, when asbestos materials in place are disturbed during renovation, repair, or demolition. Given the continued presence of asbestos-containing materials in industrial, commercial, and residential settings throughout the U.S., a sizeable population remains at risk of asbestos-related disease. This article reviews the health effects associated with exposure to asbestos and delineates the steps necessary for the comprehensive screening and clinical assessment for asbestos-related disease, in order to assist physicians in identifying and preventing illness associated with exposure to asbestos among their patients.

Asbestos↗
PubMed2000

Lung cancer risk of workers in shoe manufacture and repair.

BACKGROUND: The occupational lung cancer risk in manufacturing and repair of shoes was studied by pooling of two major case-control studies from Germany. METHODS: Some 4184 incident hospital-based cases of primary lung cancer and 4253 population controls, matched for sex, age, and region of residence were intensively interviewed with respect to their occupational and smoking history. Based on the occupational coding and a free text search, all individuals who had ever worked in shoe manufacturing or repair for at least half a year were identified. Shoemaker-years were calculated as the cumulated duration of working in shoe manufacturing or repair. Odds ratios (OR) and 95% confidence intervals (CI) were calculated via conditional logistic regression. Additional adjustment for smoking and occupational asbestos exposure was used. RESULTS: Seventy-six cases and 42 controls who had ever worked in shoe manufacture or repair (OR = 1.89, 95% CI: 1.29-2.78). After adjustment for smoking, this risk was lowered to 1.69 (95% CI: 1.09-2.62). Further adjustment for asbestos exposure only slightly changed the risk estimates upwards. The smoking adjusted OR in males was 1.50 (95% CI: 0.93-2.41) and 2.91 (95% CI: 0.90-9.44) in females. Logistic regression modeling showed a positive dose-effect relationship between duration of exposure in shoe manufacture and repair and lung cancer risk. The odds ratio for 30 years of exposure varied between 1.98 and 2.24 depending on the model specified. CONCLUSIONS: The study demonstrates an increased lung cancer risk for shoemakers and workers in shoe manufacturing. The risk seems to double after being 30 years in these occupations.

Adult↗
PubMed2000

Laryngeal and hypopharyngeal cancer and occupational exposure to asbestos and man-made vitreous fibers: results of a case-control study.

BACKGROUND: The data from a case-control study performed in France between 1989 and 1991 were used to test whether exposure to either asbestos or to man-made vitreous fibers (MMVF) is a risk factor for cancer of the larynx or the hypopharynx. METHODS: This study involved 315 incident cases of laryngeal cancer, 206 cases of hypopharyngeal cancer, and 305 hospital-based controls with other types of cancer, all recruited in 15 hospitals in six French cities. The subjects' past occupational exposure to asbestos and to four types of MMVF (mineral wool, refractory ceramic fibers, glass filaments, and microfibers) was evaluated based on their job history, with the aid of a job-exposure matrix. Odds ratios were calculated with unconditional logistic regression, with adjustment for smoking and drinking levels. RESULTS: Exposure to asbestos resulted in a significant increase in the risk of hypopharyngeal cancer (OR = 1.80, 95% CI: 1.08-2.99) and a nonsignificant increase in the risk of laryngeal cancer (OR = 1.24, 95% CI: 0.83-1.90). Risk was highest for the epilarynx (highest cumulative level of exposure: OR = 2.22, 95% CI: 1.05-4.71). Exposure to mineral wools was of borderline significance for the risk of hypopharyngeal cancer (OR = 1.55, 95% CI: 0.99-2.41), and nonsignificantly associated with the risk of laryngeal cancer (OR-1.33, 95% CI: 0.91-1.95). The risk was again highest for the epilarynx (OR = 1.85, 95% CI: 1.08-3.17). No significant results were observed for the other MMVF. CONCLUSIONS: These results suggest that asbestos exposure increases the risk of epilaryngeal and hypopharyngeal cancers. It is difficult to reach a conclusion about the effects of mineral wools, because nearly all the exposed subjects were also exposed to asbestos. The possible effects of other MMVF were difficult to assess in this study, because of the paucity of exposed subjects.

Adult↗
PubMed1977

Cancer following occupational exposure to asbestos and vinyl chloride.

A review is presented of the various factors important in the identification of carcinogenic disease from occupational and environmental exposure to asbestos and vinyl chloride. The long lapsed period, usually of 20 or more years from first exposure to these materials, is discussed, as well as the requirement for sufficiently long observation periods in prospective epidemiological studies. The multiple-factor etiology of lung cancer involving cigarette smoking and asbestos exposure is illustrated. The risks of asbestos-related cancers to other than those directly working with the material are discussed in a variety of circumstances, and finally the effectiveness of control procedures for vinyl chloride and asbestos are compared.

Asbestos↗
PubMed2001

Increased body mass index is related to apparent circumscribed pleural thickening on plain chest radiographs.

BACKGROUND: Diffuse pleural thickening and pleural plaques are the commonest radiological manifestations of asbestos exposure. Differentiation between subpleural fat and non-calcified pleural plaques is important clinically and medico-legally. This study aims to determine if apparent circumscribed pleural thickening on chest radiographs is related with obesity. METHODS: Surveillance chest x-rays of 693 former asbestos workers were read with the ILO classification. Subjects with costophrenic angle obliteration (n = 57) were analyzed separately. The remaining subjects were subdivided according to their body mass index (BMI): Group 1 < 26 kg/m(2); Group 2 26-30 kg/m(2); Group 3 > 30 kg/m(2). RESULTS: Baseline characteristics, asbestos exposure, and profusion scores were evenly distributed. BMI of > 30 kg/m(2) was associated with a higher prevalence of pleural thickening on CXR (Gp1 = 8.5%; Gp2 = 9.3%; Gp3 = 18.3%). This relationship was strongest in the subgroups with 25-50% of the lateral chest wall involved and pleural thickness of < 10 mm. CONCLUSIONS: Obesity (BMI > 30 kg/m(2)) is related to apparent circumscribed pleural thickening on CXR, especially thin (< 1 cm) shadows covering 25-50% of the lateral chest wall.

Adipose Tissue↗
PubMed2002

Study of smoking behavior in asbestos workers.

BACKGROUND: Asbestos exposure and concomitant cigarette smoking markedly increase the risk of lung cancer and contribute to the prevalence and severity of pulmonary interstitial fibrosis. METHODS: A cross-sectional survey of 214 asbestos workers was initiated to determine the prevalence of smoking and their readiness to quit smoking using the stage of change theory. RESULTS: The study was comprised of 61 never smokers (28.5%), 118 ex-smokers (55.1%), and 35 current smokers (16.4%). Reasons for smoking cessation in ex-smokers included perception of ill-health (51%) and knowledge of smoking-asbestos hazards (3.4%). Stage of change of current smokers revealed: precontemplation (26.5%), contemplation (35%), preparation (29%), and action (8.8%). Current smokers had the highest prevalence of small airway obstruction on spirometry. CONCLUSIONS: A detailed smoking history during medical surveillance activities will enable the occupational physician to identify asbestos workers who have difficulty quitting and to develop a system in which such individuals can be referred to comprehensive smoking cessation programs.

Adult↗
PubMed2003

Cape Asbestos, Barking, health and environment: 1928-1946.

BACKGROUND: The mining of chrysotile began in the province of Quebec in the late 1870s. Twenty years later, while annual exports were still measured in hundreds of tons, serious and lethal effects were being reported in England and shortly after in France. In 1913, after a number of years of operating in South Africa, Cape Asbestos Company established a factory in Britain in Barking, Essex. Some 15 years later, in 1929, the local Medical Officer of Health was seeing their asbestotic workers at his Chest Clinic, the local Chest Hospital was investigating them and publishing their findings, and the Coroner began what was to be a long series of inquests. METHODS: Documents from the Institute of Mining and Metallurgy, The Royal School of Mines, Central Library of Imperial College, The Porton and Barking Archives, and documents obtained by legal discovery were utilized in preparing this historical perspective. RESULTS: Despite complaints from the local authority, Parliament was assured that there was no special incidence of disease at Cape, Barking, and that its exhaust ventilation was quite up to the general standard and constantly being improved. Reports on the factory environment and information on the health of Cape's workforce that are available for the years 1928-1934, provide a less sanguine view of the situation, as was confirmed by subsequent health reports on its workforce. CONCLUSIONS: The case of asbestos is considered as a paradigm for the economic considerations that are considered to justify the perpetuation of unsafe and unhealthy occupations, decisions with which medical opinion can be found to concur.

Asbestos, Serpentine↗
PubMed2003

Quantitative analysis of asbestos burden in women with mesothelioma.

BACKGROUND: Lung tissue from 15 women who died from mesothelioma was evaluated for tissue burden of ferruginous bodies and uncoated asbestos fibers. The group contained individuals who had occupational exposure to asbestos and others had family members whose work history included vocations where contact with asbestos containing materials occurred. METHODS: Tissue samples from tumor free lung were digested and filtered and then investigated for ferruginous bodies by light microscopy and asbestos and non-asbestos fibers by analytical transmission electron microscopy (ATEM). Size and type of fibers were also analyzed. RESULTS: Asbestos bodies were found in 13 of the 15 samples and asbestos fibers were found in all cases. The most commonly found uncoated asbestos fiber in these individuals was amosite whereas tremolite was the second most commonly found form. The asbestos fiber burden in these females was often of mixed types. CONCLUSIONS: The asbestos body and fiber burden in these cases show variation in tissue burden. Some cases in this study had appreciable burden, which was attributed to secondhand exposure from occupationally exposed family members. Mesothelioma can occur also in individuals with comparatively low tissue burdens of asbestos.

Aged↗
PubMed2003

Surveillance of respiratory diseases among construction and trade workers at Department of Energy nuclear sites.

BACKGROUND: Medical screening programs were begun in 1996 and 1997 at three Department of Energy (DOE) nuclear weapons facilities (Hanford Nuclear Reservation, Oak Ridge, and the Savannah River Site) to evaluate whether current and former construction workers are at significant risk for occupational illnesses. The focus of this report is pneumoconiosis associated with exposures to asbestos and silica among workers enrolled in the screening programs through September 30, 2001. METHODS: Workers provided a detailed work and exposure history and underwent a respiratory examination, which included a respiratory history and symptom questionnaire, a posterior-anterior (P-A) chest radiograph, and spirometry. Both stratified and multivariate logistic regression analyses were used to explore the risk of disease by duration of DOE employment and frequency of exposure, while controlling for potential confounders such as age, race, sex, and other work in the construction and building trades. RESULTS: Of the 2602 workers, 25.2% showed one or more chest X-ray changes by ILO criteria and 42.7% demonstrated one or more pulmonary function defects. The overall prevalence of parenchymal changes by ILO criteria (profusion 1/0 or greater) was 5.4%. In the logistic regression models, the odds ratio for parenchymal disease was 2.6 (95% confidence interval (CI) = 1.0-6.6) for workers employed 6 to 20 years at Hanford or Savannah River and increased to 3.6 (95% CI = 1.1-11.6) for workers employed more than 35 years, with additional incremental risks for workers reporting routine exposures to asbestos or silica. CONCLUSIONS: Continued surveillance of workers is important given their increased risk of disease progression and their risk for asbestos related malignancies. Smoking cessation programs should also be high priority and continued abstinence for former smokers reinforced. Although the observed respiratory disease patterns are largely reflective of past exposures, these findings suggest that DOE needs to continue to review industrial hygiene control programs for work tasks involving maintenance, repair, renovation, and demolition.

Age Factors↗