Document 1ydxoGqKpo1qapQoeEzw73nBa

FILE NAME Household Contact HC DATE 2005 DOC HC031 DOCUMENT DESCRIPTION Journal Article - Mesothelioma in Household Members of Asbestos Workers 32 United States Cases Since 1990 AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 458 4622005 Brief Report Mesothelioma in Household Members of Asbestos Workers 32 United States Cases Since 1990 Albert Miller MD Background Mesothelioma is significant as an indicator of asbestos exposure as a continuing major cause ofdeath in those exposed and as a riskfollowing lesser exposures One such exposure is living in the household of an asbestos worker and coming into contact with fibers brought home on her body clothing etc. Methods Law firms throughout the US known for their pursuit of asbestos claims were polled for mesothelioma claims brought on behalf of family members of identifiable asbestos workers Cases with any occupational environmental or other possible exposure were not included Results This study reports 32 household mesothelioma cases diagnosed since 1990. Relationships were wife 15 daughter 11 son 3 sister law 1 niece 1 and boarder 1 Occupations of the workers included shipyard 13 insulator 7 and other 12 Of the 27 pleural cases 13 were epithelial 5fibrous 3 biphasic and 6 not specified ofthe 5 peritoneal cases 4 were epithelial and Ifibrous Latency was greater than 40 years in 27 cases 6 cases were 40-49 years of age and 17 were 60 or older Conclusions Records from law firms were a useful source of information Mesothelioma resulting from household exposure is a continuing problem It is more likely to present in the elderly after latencies of 40 years Am J. Ind Med 458-462 2005 '2005 Wiley Inc. KEY WORDS mesothelioma household exposure family members asbestosexposed workers INTRODUCTION The risk of mesothelioma in the United States from inhalation of asbestos fibers remains high even as new use of asbestos has largely ceased This is attributable to the long New York Medical College Valhalla New Yorankd Saint Vincent Catholic Medical Centeorf New Brookdyn Division New York Correspondence to Albert M^lerResearch Professor Center for the Biology of Natural Systems Queens College of the City University of New York 163-03 Horace Harding Expressway Flushing NY 11365. mail almiller@svcmcny.org Accepted 1 March 2005 DOI 10.1002 ajim.20167 Published online in Wiley InterScience www.interscience.wiley.com latency for this disease the wide presence of asbestos in place in buildings and equipment and the potential for this malignancy to be induced by relatively low levels of exposure One such exposure recognized since 1965 Newhouse and Thompson 1965 is asbestos brought home to family members on the hair clothing and personal effects of asbestos workers Review of the literature on this exposure is difficult Many of the descriptions are of single or of a few cases a report of the same four cases appeared in the literature a second time Joubert et al 1991 24 years after the first Anderson et al 1976 Family exposures are combined with building exposures asbestos present in offices or schools or environmental exposures as occupational exposures Konetzke et al 1990 Iscovich et al 1999 '2005 Wiley Inc. Mesothelioma in Household Members 459 Magnani et al 2000 Many cases described as family members had their own sometimes less recognized exposures Risberg et al 1980 Lynch et al 1985 Hammar et al 1989 Dawson et al 1992 Bianchi et al 1993 Ascoli et al 1998 Hiyama et al 1998 The concern of other reports of family cases was with a possible genetic cause looking at mesothelioma in occupationally exposed blood relatives Risberg et al 1980 Martensson et al 1984 Krousel et al 1986 who may have lived in the same household Hammar et al 1989 This report of 32 cases of mesothelioma since 1990 attributable only to asbestos brought home by another resident of the household demonstrates the continuing nature of the problem in the United States It utilizes an under appreciated data source the files of law firms throughout the United States which are active in the pursuit of asbestos claims METHODS Law firms throughout the United States known for their pursuit of asbestos claims were polled on three occasions over 5 years for mesothelioma claims brought on behalf of family members of identifiable exposed workers Of 25 firms 15 submitted demographic and exposure information and medical records on such clai- mants Cases with any occupational environmental e.g. wives living in the same community as their Manville NJ asbestos factory worker husbands building other than the dwelling shared with the exposed worker or other possible exposure e.g. smokers of Kent cigarettes whose filters contained crocidolite asbestos were not included Cases from nine firms met criteria including onset after 1990. The diagnosis of mesothelioma was based on the pathology report confirmed by immunohistochemical staining in 29 autopsy in 2 and surgery in the remaining case Exposure information from testimony depositions and employment records and medical data were reviewed Latency was estimated from year of first exposure until onset of symptoms or of diagnosis if the former was not available Differences in latency between wives and offspring were assessed by pooled and Saterthwaite Tests In the final analysis many of the firms had gone out of existence split and merged It was not possible to obtain a total member of mesothelioma cases from them let alone the outcomes RESULTS From the files of nine plaintiff law firms throughout the United States 32 cases of mesothelioma were analyzed who had no occupational environmental or other exposure to asbestos than as a household member of a worker with clear occupational exposure Information on demographics diag- nosis and exposure are provided in Table I. Patients are ordered by date of onset of symptoms or of diagnosis if the onset of symptoms is unclear Age at first exposure was 10 years in 13 10 1y9ears in 5,20-29 years in 9 30-39 years in 2 and unavailable in 3 Mean latency was 49.0 10.7 year Latency was skewed towards greater length consistent with the requirement that the disease be manifest no earlier than 1990 20 2y9ears in 2,30-39 2,30-39 years in 2 40-49 years in 12 5y0ears in 15 and unavailable in 1. Latency for offspring was slightly longer than for wives 52.9 versus 45.4 years a difference which approached significance 0.07 Mean age at presentation was 62.3 -11.7 year 17 cases were age 60 or greater All patients lived in the same household as the exposed worker In the three cases of dual relationship daughter and sister daughter and wife daughter and wife the earlier exposure is counted Relationships were wives 15 daughters 11 one stepdaughter sons 3 one stepson sister ) niece ) and boarder 1 this last being a woman who lived in a boarding house with several shipyard workers from age 20 to 28 Occupations of the worker who lived with the present cases were shipyard 13 insulator other than shipyard 7 railroad 2 manufacture of asbestos materials 2 boiler- maker 2 steel mill 2 refinery 1 pipe fitter 1 refractory bricklayer 1 and construction 1 Histologic classification of the 32 cases is typical of mesothelioma in general 27 pleural 13 epithelial 5 fibrous 3 biphasic and 6 not specified and 5 peritoneal 4 epithelial 1 fibrous Among the 29 female cases 24 were pleural and 5 peritoneal all 3 male cases were pleural Diagnosis was confirmed by immunohistochemical reactions in 29 and was based on multiple specimens reviewed by pathologists in different institutions in the remaining three Although information about other asbestos disease was incomplete pleural plaques were present in at least 10 household mesothelioma cases 4 of whom also had asbestosis DISCUSSION Inhalation of asbestos fibers is the predominant cause of mesothelioma The majority of cases result from occupational exposures of the patient not infrequently far removed in time and memory Mesothelioma resulting from household exposure to asbestos brought home on the hair clothing and effects of workers has been recognized since the report of Newhouse and Thompson 1965 which included seven wives and two sisters of asbestos workers among 83 cases of mesothelioma dating back to 1917. Anderson and coworkers reported four cases of mesothelioma attributable to household exposure in 1976 and reviewed the literature totaling 37 cases Anderson et al 1976 Most reports have been of single or a small number of cases Huncharek 1986 Maltoni TABLE Demographics Histology Chronology and Exposures of Household Member Mesothelioma Cases 1990 2004 Year of na Relationship birth Hist Age at Dx Year of Ox Year of death Period Sx to death Exposed family member Trade began Yr quit Age 1st exposure Latency yr 1 Wife 1938 Epith 52 1990 1992 29M INS 1956 1964 18 34 23 Wife 1929 Epith 60 1990 1991 15M INS 1947 1987 18 fifi 3 Daughter 1947 Epith 43 1990 1993 33M Steel mill 1947 1972 Birth 43 Sister Steel mill 1947 1972 456760 Daughter NA Epith NA 1992 1996 6Y INS 45670 Boarder 1922 NA 8 1992 1992 11M SY 456760 Wife 1912 Fib 80 1992 1993 3M SY 456760 Wife 1923 Epith 69 1992 1995 30M SY 456760 Daughter 1931 Epith 61 1994 1995 34M SY 456760 Wife 1918 NA 24 1993 1993 3W MF 10 daughter 1948 Epith 24 1993 NA NA INS 1915 NA NA NA NA 1942 1950 2888T 98 1942 1982 2888T 50 1943 1944 2888T % 1951 1957 2888T + 1935 1955 2888T 58 1954 1961 6 39 11 Wife 1921 Epith 71 1993 1995 20M SY 1941 1946 2252 2322 12 Wife 1920 NA 8 3928 792 1993 1994 5M Steel Mill 1950 1980 2252 2322 13 Daughter 1936 Epith 8 3928 792 1994 NA NA Refinery 1941 1955 2252 2322 14 Wife 1914 Epith 8 3928 792 1994 NA NA PF 1942 1975 2252 2322 15 Wife 1947 Epith 8 3928 792 1994 1995 12M Construction NA NA Assumed Assumed 25 16 Daughter 1945 Epith 8 3928 792 1995 NA NA BM 1945 1969 Birth 49 17 Wife 1930 PL 8 3928 792 1995 1996 12M Refr Bricklayer 1948 1990 18 46 18 Wife 1938 Epith 83928792 1996 NA NA INS 1955 1988 17 41 19 Wife 1949 Fib 8 3928 792 1996 1997 12M RR brakes NA NA Assumed 22 Assumed 25 22 Niece 1941 Fib 8 3928 792 1997 1997 18M SY 1955 1975 14 41 22 Daughter 1941 Epith 83928792 1998 1999 21M SY 1942 1963 1 56 Wife BM 1962 1980 2 Son 1940 Fib 58 1998 NA NA SY 1942 1945 2 23 Son 1939 Fib 58 1998 Alive 12M SY 1942 1945 3 24 Wife 1934 PL 64 1998 NA NA spray asbestos 1954 1977 20 gt 25 Wife 1915 Fib 82 clinical 1999 1Y SY 1935 1963 20 gt 2 Stepson 1934 Epith 64 1999 NA NA SY 1941 1944 7 57 2 Daughter 1946 Epith 53 2001 2002 32M SY 1941 1965 Birth 333 2 Daughter 1928 PL 72 2000 NA NA MF 1930 1949 2 333 8 Wife 1924 NA 75 2000 NA NA BM 1940 1959 20 333 8 law 1920 Epith 80 2001 2001 6M SY 1941 1947 21 333 31 Daughter 1957 Epith 46 2003 NA NA INS 1953 1976 Birth * 32 Daughter 1932 NA 72 2005 NA NA blacksmith 1932 NA Birth 3 Wife PF 1954 1992 BM boilermaker DOB date of birth Dx diagnosis Hist histologic diagnosis INS insulator MF manufacture product PE PF pipe fitter PL pleural Refr refractory RR railroad Sx symptoms SY shipyard Mesothelioma in Household Members 461 et al 1995 Schneider et al 1996 Two series report more than eight cases Leigh et al 2002 list 4,838 cases from the Australian Mesothelioma Register 1986-2000 of whom 42 lived washed clothes of an products worker and 29 lived in an asbestos containing dwelling no information on gender age relationship etc. is provided Roggli et al 1997 reported that 33 of 59 female mesothelioma cases with an available exposure history were family contact only Calendar years of exposure onset of symptoms or diagnosis were not provided so that the number of cases since 1990 cannot be determined These 59 cases were among 770 reviewed by the senior author an expert pathologist to whom histologic materials are sent for review by other pathologists and by attorneys The present series is similar to that of Roggli et al in that both comprise cases from throughout the United States many or all of which came to legal attention The 33 household exposure cases in the Roggli series were similar to the present series in the distribution of peritoneal versus pleural cases 4 vs. 29 age frequency of pleural plaques 9 distribution of family relationships 22 wives 6 daughters 2 mothers and 6 multiple and occupation of household contact 10 insulators 6 shipyard workers 4 pipe steam fitters 2 oil refinery 7 miscellaneous and 7 not available Family relationships and occupations of these household contacts total 36 since 3 cases had their own occupational exposures The identification of household exposure as the mechanism for family mesothelioma has been complicated by reporting family cases with their own occupational Bianchi et al 1993 Hiyama et al 1998 or other nonoccupational exposures such as neighborhood proximity to an industrial source asbestos present in buildings of employment or asbestos in cigarette filters Family cases resulting from household exposure have been confounded with possible genetic predisposition to mesothelioma reported in consanguineous family members who have been occupationally exposed Risberg et al 1980 Martensson al 1984 Lynch et al 1985 Krousel et al 1986 Hammar et al 1989 Similar to wives daughters and boarders household pets are at risk from asbestos brought home by exposed workers An asbestos related occupation of a household member was associated with mesothelioma in dogs diagnosed with mesothelioma at the Veterinary Hospital of the University of Pennsylvania Glickman et al 1983 Wives predominated in the present and in Roggli's series Anderson reported a far higher frequency of benign radiographic abnormalities in wives 48 compared with daughters 21 despite similar durations of exposure Anderson et al 1979 This is consistent with a greater burden of asbestos in wives Household exposure has been suggested as the source for mesothelioma presenting at an earlier age This was identified in 5 of 10 cases of mesothelioma presenting in patients /4y0ears of age at one medical center Kane et al 1990 None of our patients presented 40 years of age only 6 cases presented in the age decade 40-49 4 offspring 2 wives That more than half the cases were 60 years of age or greater demonstrates that household exposure should not be ruled out when mesothelioma is detected in an older patient Although household exposure is generally thought to be low level and is often classified with other low level exposures building neighborhood fiber content of lung tissue from such exposure was found to be similar to that of shipyard and most exposed trades other than insulators and far greater than that of building occupants Roggli and Longo 1991 In contrast to men in whom 90 of mesotheliomas are attributable to asbestos and 90 are pleural Spirtas et al 1986 only 20 of mesotheliomas in women are said to be attributable to asbestos and thirds are pleural Spirtas et al 1994 The higher proportion 83 of pleural to peritoneal mesotheliomas in the present series tends to confirm asbestos as the source The incidence of mesothelioma in the United States is likely declining since the early 1990s attributable to the decreased use of asbestos Weill et al 2004 Nevertheless that these 32 and undoubtedly other cases of mesothelioma caused by household contact with asbestos have come to legal attention since 1990 confirms the ongoing risk of this exposure This is consistent with the persistence of asbestos in the homes of contacts the greater intensity of this exposure than is generally recognized and the very long latency for mesothelioma The predominance of women in these house- hold contact cases suggests that such exposure may have taken place in the large percentage of women whose mesotheliomas have not been attributed to asbestos see above REFERENCES Anderson HA Lilis R Daum SM Fischbein AS Selikoff IJ 1976 Household contact asbestos neoplastic risk Ann NY Acad Sci 311 323 Anderson HA Lilis R Daum SM Selikoff IJ 1979. 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