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FILE NAME: Shipbuilders Council of America (SHIP) DATE: 1973 Mar DOC#: SHIP050 DOCUMENT DESCRIPTION: Journal Article - Biologic Response to Kind and Amount of Asbestos PLAINTIFF'S EXHIBIT Biologic Response to Kind C -> and Amount of Asbestos --i CD OT M orris KtetafcM , M .D . cn cn CO o, D tud ies of (he biologic response to different types of asbestos dusts in dicate that their inhalation m adequate c o ncentrations can produce pulmonary and pleural fibrosis and/or several types of malignancy, chiefly of the lung, pleura and peritoneum' Associations between and decreased pulmonary compliance. Asbestotic pulm onary fibrosis has been produced experimentally in various animal species However, dala on relative fibrogemcity of different asbestos dusts in animal w ork has not been con sistent* * Human data on relative smokers Age. sex an d duration o M . posure to asbestos d id not account for this differen ce T h e p revalen ce oi pulmonary fibrosis rose with increasing am ount and duration oi cig are'c smoking and with increasing exposure io asbestos. asbestos dust exposure and malignancy fibrogemcity of different asbestos dusts is 2. Bronchogenic Carcinom a Availab'e of the gastrointestinal tract have been reported* 14 However, a general con sensus with regard to this association has not been evolved' Most of the evidence of association between asbestos ex posure and human d.-ease Ha; been stiff inconclusive Murphy, Ferns and Burgess7 studied pipe coverers exposed mainly to chrysotile and amosite dust Asbestosis w as first observed after 13 years of exposure to the dust or about 60 million particles per cubic foot (mpef) data confirm a relationship between pasi occupational exposure to asbestos dasis and higher than expected incidence oi bronchogenic ca rcin o m a 10 -' 2 Some studies have demonstrated ditterences n degree of risk am ong dmerent oc acquired from oec'- c a : cmallx exposed years The prevalence w as 38% aller 20 CUpationaily exposed g-pups probah1. groups years of exposure In a recent un published study of talc workers exposed to a mixture of talc with tremolite a n d related to type an d concentration asbestos fiber, nature oi work n fo rm e d , a n d other factors such a- Effects o f E x p o su re to D iffe re n t anthrophyllite as the predom inant sm oking cigarettes1* and presence of Types of In h a le d A sb e sto s D u sts 1. Asbestotic Pneum oconiosis O f the diff?rent pathogenic effects associated with asbestos dust exposure, the first clearfy demonstrated adverse effect of asbestos in man was pulmonary fibrosis or asbestotic pneumoconiosis There is general agreement that all forms of asbestos in commercial use can produce fibrotic effects m the lungs' Asbestotic pneumoconiosis is c h a ra c te re d roent- fibrous components, Kletnfeld, Messite and Unger* found only one case of pneumoconiosis among a group of 39 workers whose mean expo-ure was 16 2 years with a range of 11 to 22 years. The mean dust concentration to w hich the workers had been exposed over a 20 year period w as 23 mppcf with an average minimum concentration of 6 and an average maximum oi 68 mppcf. In both studies' 8 consideration w as metals in the asbestos dust14 For exam pie, in a study of mortality in relation to occupational exposure in the asbestos in d u stry , Em erhne. DeCoutle ,-nd Hen d e r s o n 12 o b s e r v e d d ifte re n c e s ' respiratory c a n c e r mortality betwevm a in te n a n c e s e r v ic e w o rk e rs an production workers Tw o possible x< plantations w ere offered for the on ferences in respiratory cancer i c between these tw o groups, one rhai genographicatly by diftuse interstitial given onh to nme-we'ghted average ex intermittent asbesfos exposure ot mj fibrosis of variable degree sometimes associated with pleural fibrosis and calcification Clinical signs .nclude lung crepitations finger clubbing and dysp nea, physiological changes are con sistent with a restrictive lung d.sordrr manifested by decreased 'orced vital capacity d'mimshed dirtunon capacity posures Peak concentrations were not mentioned Lacking data on peak ex posures and since the operations ditrered significantly one cannot truly compare the relative patnogenicitv of the dusts reierred to m the two studies As m the case ot bronchogenic ca r cinoma the lactor ot smoking must be consip L'cd m r" lo'i. s j j'b e s lo - e x tenancy se rv ic e w orkers prouably a. very High level, produced excerespiralory ca n cer but n o grt'it excess > asbestosis: another exoianacon .v j based on types of asbestos to * f / these tw o groups of workers were posed Srxtv-tour perepnt of ;re ma tenance service w o r k e r with h gh posures had been exposed ro croculo 0'C ' >* i 1 *-- Vv posure and d e v c io n i'.c - nr pulm onary asbestos whereas 8C oi tS- pruduc. 1 Yo'o Nu*" 0* ,>afifnpf' of .abof 31 O ~ ^ *V^V Ws N> XM} uoj c " U ? ' r ' l-^ tiorosis In a -ti-cS iji i& ; a-r.x'-li.x texii'e vvbrkers with high exp,:-u-e- h jd b v<ror\,ne''Ul 's`t < * .y wo . ` w o r k e r s W e i' - 4 ' n ^ - d th at 'h o so exposed, rnckcatirii. Ju t c.,jO .: ji % C f If* - p m sal'n -o nr p ^ i i b t o s w wa- w as more ore,no g- jn jn i->. - rn. r, MU*" K '* *00 Of f' 1" " t ' ' " y t =s 40 j m -"i ;-.c-- }- 24 , in no" asbestos dcol' nam e1, c `i ' xf 11 ,, 296 'II8 9 9 9 0 1 S *noiite. to w hich these workers w ere reported 33 case* of mesolheiial tumors western Cape The greater penetration oposed. Cigarette smoking is an id - in a part of South Africa important for to the deeper alveoli adjacent to the ijHionil factor or importance, (n a study crocidolite mining, investigators <n other pleura by the smaller crocidolite fibers gi .nsulation workers, Selikoff, Ham- parts of the w o rld 1* 17 have examined the could account for differences m in mood and Churg11 reported a mortality distribution of mesotheliomas m the c id e n c e o f m e s o t h e lio m a a m o n g ,,sk 92 times greater among insulators general population and among o c workers m the two areas In addition to nho smoked cigarettes compared to cupationally exposed asbestos workers the biologic importance of fiber diameter men w ho neither smoked cigarettes nor The results indicate a fairly good and shape, other factors such as metallic worked in (he insulation industry More relationship between exposure to dif cations and enzym es present in asbestos rtcentfy. the role of trace metals has also ferent a s b e s to s d u sts, n a m e ly , dust remain to be evaluated, particularly been considered a m aior factor in car crocidolite, ehrysotife and amosue or m view of the fact that not all cinogenesis among asbestos insulators'* mixtures thereof, and the occurrence of mesotheliomas are related to asbestos Wagner. Gilson Berry et a l' co m mesotheliomas. W agner1* pointed out dust exposure mented that the risk of bronchogenic that amphibole fibers, w hich are straight, There have been a variety of animal carcinoma is dearly related to the in are more likely to reach (he periphery of studies m w hich experimentally induced tensity of past exposure and to the risk or rhe lung in contrast to chrysotile ribers. mesothelioma has been reported in dti- asbestos's When the environm ental which resemble stretched coils and are ferent animals.^1 " O f particular interest control is surf c ie n t to e lim in a te -eaduy intercepted by the bronchi, is the study of Roe. Carter. W alters et a l-' jvbestosis. tne excess risk of- bron- especially at bifurcations The lesser risk w ho produced pleural an d peritoneal ihngentc canoe' d mmishes Wagner 31 developing mesothelioma iro n ex mesothelioma in mice subcutaneously ind associates also -m cated that it s posure to chrysotile fibers mav be due to injected with crocidolite, amosite and not known whether me woe of asbestos -eir curly nature, w hich prevents most Chrysotile and thus have show n ev i inhaled influences me risk of bronchial o- uem from reaching tne p'eura dence ot migration o i fibers, a finding cancer in man Excenmenrs m animals 'Aagner has, therefore, emphasned that w h ic h h e lp s e x p la in p e n io n e .il suggested to them mat t should because Ojant.tative studies oi the distnojlion of mesothelioma in workers exposed to dil- thrysotile produces 'ess severe fibres.s o.-erent woes of liber within me lung terent asbestos dusts Kan does amosue or crocidolite in eaua. 'llowing nhalauon need !o be e*- O ne noteworthy feature about the o c iio-.es 'ended However not all a.-r.pnioole currence of asbestos mesotheliomas has The quest.on ot whether _the c a - ' oers show an increased prevalence tor been the long period, com m only over 50 onogeruc role o f asbestos is rela'ed m ~esotheltoma production De-oite a years between nrst exposure to asbi-tos ^ *te specific kind ot nber is more d i" c . -o-ouen searen uu inesuiiieiiOTas h a .e and app-ea-mce m m e s o t h e lio m a - 1 in answer than the question of do-r- oeen associated with ar.tn jiv llit e \\hitw ii and R uw clute-' observed 'Hot telated response For this purpose a-bestos production in Fm laro ' the interval from first exposure to ` Wnght* indicated that populations w.m f'.mbrell Griintns and P o cev - em- asbestos and appearance or m eso lung-term exposure to only one vanet. o h a sn ed the im p ortan ce ot lib er theliomas ranged trom 13 to 63 sears h< fiber are need ed . V irtu ally ah diameter in addition to liber shape in with a mean or 42 years They ex ubncatmg processes use more than one re la tio n to d e v e lo p m e n t of pressed the opinion that the incidence ol variety within the same premises at any m e s o th e lio m a They p ro v id e d a mesothelioma w ill continue to nse with one time or have used more than one plaus'bte explanation for difrerences in increasing use of asbestos until about 40 sanely at various times. Populations frequency of diffuse mesotheliomas in years after adequate protective measures restricted to m in in g a n d m illin g the Northwestern Cape of South Africa have been taken. Another important i operations m the production of asbestos where only crocidolite is mined com feature about mesothelioma m contrast 'iber lend themselves best to a study of pared to the Transvaal region where to bronchogenic carcin o m a is that He etrects of a single kind of asbestos both crocidolite and the closely related cigarette smoking does not appear to be 'her it is these populations w hich can amosite are mined The occurrence of an important factor related to its 11 P'Oxide the answer to the influence of a mesothelioma in the Transvaal is rare development onge variety ol asbestos fiber m terms The mean fiber diameters ot Transvaal 4 Pleural Calcification- Cato tied or carcinogenesis However, the role of crocidolite and amosite w ere ih-ee times pleural plaques have been reported hi'twent types of asbestos in raising the those of Northwestern Cape crocidolite am o ng w o r k e r s e x p o s e d to an - ,nc dence of bronchogenic cancer ap pears to be dose-related and may Timbrell et al postulated that differences m diameter w ould influence the ability thophyllile, chrysotile, amosite and tren.olite. or mixtures thereof-1* - 1* ( hr/vid upon the specific category of of fibers to penetrate to the periphery of Multiple or bilateral pleural plaques are i V ' especially m -egard to degree of ef- 'he lung and pleura where the tumors regarded by som e investigators as v ir V develop 8ecau se of their greater tually diagnostic of asbestos related 1 M esom ehal Tum ors Primary "a1 gnani tumors of the pleura and m* toneum, torme'ly regarded as ex -dingly rare bv most pathologists are ng reported more frequently, par aerodynamic sire, a higher proportion bv mass of Transvaal fibers w ill be deposited in the 'arger a.-wavs by gravitational settling and hr tee will reach the periphery ot the lj~a-. with disease; however, other cau>i> ot pleural calcification are w ell known Robinson" found pleural plaques m 2 7a of 1,82d autopsies per-onned chiefly upon adult male* No relation a ' - 1arIv among workers exposed :o .'i-os dust Smcp VVag-'C' ' 5 ' much less chic eocv than h* shorter and smaller diameter libers Ot North ship to ty p ic a l a sb e sto s b o d ies degenerative or neoplastic disease or d.-nal cf Occupational Medicme'Vat 15 No 3 March 1973 297 STOSUS75 k n o w n in fe c tio u s d ise a se w as d isco vered . Robinson in d icated that pleural plaques should not be con sidered proof of asbestosis not termed "benign fib ro tic m esotheliom a". W ith regard to those occupationally exposed, pleural calcificatio n rarely ap pears u ntil 20 yean after first exposure and does not necessanly correlate w ith pulm onary fib ro sis. Pleural calcificatio n also appears to d iffer in frequency m d if ferent occupatio nally exposed groups, but studies to date have not explained such differences. The finding of pleural calcificatio n o r pleural plaques has been reported as being com m on in Urge segments of populations not directly ex posed occupationally to asbestos but ivm g in or near regions w here asbestos ibers are being produced and used" 11 There is no evidence that presence of pleural plaques bears any relation to the d e ve lo p m e n t o f m e so th e lio m a. In Finland and Eastern Q uebec w here a greater frequency of pleural plaques has been reported, there has been no increased frequency of m esotheliom a' Furtherm ore, one cannot conclude that presence Of pleural calcification is an in dicator of previous asbestos exposure since other causes 'ead to th's condition, nor can it be assumed that absence or plaques excludes a history of exposure to asbestos. w ho had asbestosis w ith the charac teristics o l dirterent jobs in the w ork place nor w ith tim e spent on the job. Peak concentrations w ere not given. In a recent u np ub lished paper, W illia m s, Baier and Thom as** com piled data on exposure levels at various textile processing operations in tw o plants for 37 years and 20 years, respectively. Even though exposures w ere m ainly below 5 m ppcf and in m any instances below 2 m ppcf, 64 w orkers w ere repotted to have asbestosis. in an unpublished study, Ktdnfetd, M essite and U nger* found only one case of pneum oconiosis in a group of 39 w orkers exposed to com m ercial talc containing trem olite and anthrophyllite as the mat or fibrous com ponents, despite a mean exposure o f 16 2 years w ith a range of 11 to 22 years and a tim e-weighted average o f 23.0 m ppcf The mean fiber count, obtained only in 1970, w as 34 fibersfm l w ith a fiber length greater than 5 m icrons/m l The range varied from a low of 8 to a high of 160 fibers/m l In a com parative study of talc w orkers em ployed in tw o different p lan ts and exposed to the sam e m inerals, these authors* observed a Significantly increased prevalence ot pneum oconiosis based on chest roent genograms and clin ica l findings in the w orkers w ho had four times the mean fiber count than the com parative group even though mean age and average Effects Related to Quantity of Inhaled Asbestos Ousts 1. Correlation of Environmental Ex posure and Biologic Response Balaer and Cooper*4 reported asbestosis among insulation workers exposed to levels not exceeding the time-weighted average of 5 mppcf Chrysotile and amosue were the principal types ot asbestos m inerals lo w hich the group studied was e x posed Murphy, Ferns and Burgess et at' reported that asbestosis was first ob served in the group they studied after U years of exposure, or about 60 mppcfyears The highest average concentration was TOO mppcf and lowest 0 8 mppc* with an overall average of 5 2 mppcf Amosite and chryson'e were used but no crocido'ite w as present No asbe-tosw w as found m men exposed less than 60 m ppcf-years Twenty percent of those exposed lor '5 to ' 00 mppct years were considered to have asbt-tosis \ j a'- tempt was made <o correh'e w orse's duration of exposure and range w ere sim ilar fo r both groups, indicating a dose-rer ponse relationship. Enterfine. D eCaufle and H enderson* re c e n tly d em o n strated c o n v in c in g evid en ce for an exposure-response relationship between chrysotile asbestos, m easured in terms of m illio n parts per cubic loot years (m ppef-years), and risk of m a lig n a n t and n o n -m a lig n a m respiratory disease Sp ecifically, the nsk of respiratory cancer increased from 166 7 (Standardized Mortality Ratio) at m in im al ex p o su res to 555 6 at cumulative exposures in excess of 750 mppcf-year5 The percentage increase exceeded 300 With regard to non- malignant respiratory disease, the in creased risk w as not only to pneumocon owx and pulmonary nbrosis but to othe' diseases of the respiratory svstem as wel' McDonald Ross.ter. Eyssen et a l'7 reported on' 29 primary thoracic rito D a-n ' > j - ---- ^ 9 304 to'me- em ployee* in a ch ryso tile asbestos m ire and m ill. Five of the neoplasm s were m esotheliom a*. Although the autnory concluded that even heavy asbestos exposure earned only a m odest nsk of con tracting lung cancer and an even lesser risk o f co n tra c tin g m eso th elio m a. 5efikoff** in com m enting on M cD onald's "h e a v ily exposed" group stated that these w orkers dem onstrated five tim es as m uch lung o n c e r as the group af "lig h tly exposed" w orkers. W hereas b ranchial cancer is more d e a rly related to intensity of exposure, data on m esotheliom a are less certain w ith regard to the influ en ce ol quantity There are m any exam ples w here ex posure has been short, though not necessanly slight'. As mentioned by W agner, G ilso n , Berry et a l10, m esothelial tum ors apparently o ccu r more frequently in the peritoneum than in ihe pleura w hen the exposure has been extensive, but the route of entry of dusts into me abdom en is not kn o w n Epidemiological studies show that there is much clearer evidence Of nsk of m esotheliom a varying w ith type of asbestos than m the case of b ro n ch ial carcinom a The study ot K iv ilu o to and U p u m in 't P 'O vd e s evidence that exposure to anthophvil 'e very rarely causes mesothelioma The very long period that elapses tchveen first exp osure and development o( m esotheliom a has prevented an estimate of w hat proportion of an exposed group develops m esothelial tumors Wagner. G ilso n , Berry et a l10 believe that the proportion is like ly to be fairly >mali. m uch less than that follow ing exposure to bladder carcinogens for exam ple As true fo r pleural ca lcificatio n , not all pleural m esotheliom as are relatable to e xp o su re to a sb e sto s, there are presum ably other causative factors This makes interpretation o f the relationship between asbestos exposure at a low level and m esotheliom a d ifficu lt Thete is need for m ore prospective studies on the quantity as w e ll as type ot asbestos bur den in the lung and occurrence ol m esotheliom a. 2. Mortality Experience From Lung Cancer, Asbestosis an d Other Non,Malignant Respiratory Diseases Studies of the mortality of workers in d.iterent asbestos mdustnes and trades and d.'ferent asbestos dust exposures' " '' ,Q N *> indicate that past exposure to dir erer.t asbestos minerals has c o n rib u 'ec to an excess of mortality of cancer o' th. lu Biologic Response to Kind and Amount of Asbestos hlenfeld 298 ura and peritoneum and its comcX io n s. and non-m alignant 3,ratory disease over the general sulation In several studies an excess deaths from gastrointestinal lignancy1 '* Has been reported. itudies on mortality experience point the importance of elapsed time from lal exposure and duration and degree exposure as factors w hich increase the a precise anim al m odel from w hich to derive a dose-response relationship for extrapolating nsk factors m producing disease IS lackin g. U nfortunately, the am ount of asbestos dust required to produce pathologic effects rn anim als is unusually large in proportion to am ounts to w hich man is exposed Hence, anim al data w h ich have show n different respon ses to different types of asbestos* 4 can There is no generally accepted basis that permits assignment of relative risk factors to fibers m the electron m icroscope range compared to fibers in the light m icroscope range. Suzuki and Churg4' co n te n d that su b m icro sco p tc fib ers are responsible for most o f the biologic changes p ro d u ce d by asbestos. O th er in vestigators have also pointed out that the fine dust partides below 1 micron in <. of malignant and non-malignant not be used as a basis for draw ing Arm length may be just as dam aging as dust pitatory disease. In some instances c o n c lu s io n s a s to th e re la tiv e particles containing both large and sm all <e exposure w as of short duration pathogenicity of different types of fib e rs 41 C ro s s41 in fo rm ed us that degree w as relatively high, there w as asbestos in m an. O ne m aior im pedim ent in h a la tio n of th e su b m ic ro s c a p ic excess of observed deaths from can- in evaluating the relative pathogenicity asbestos fibers experim entally produced of the lung and pleura and cancer of in m an is the fact that m most instances only a phagocytic response; he does not set sites com pared to the number ex- industrial exposures are not solely to one believe that subm tcroscopic fibers are :ted Knox, Holmes Doll et al40 type of asbestos m ineral but rather to a responsible for the m ore exten sive ind, m a preliminary reoort. that after m ixture of several plus metals and oils biologic changes produced b y asbestos. st controls were introduced m a and possibly other m inerals It is possible that the relative risks ush asbestos textile o'ant during the There are only a few studies which associated with fibers of different sizes 50's. the incidence or respiratory can- 'elate malignancy in exposed groups to a are different for malignant and non- tell from a tenfold excess to a rate single type of asbestos'4 - 19 \to<t m a h g n a n t changes fu rth er studies mlar to that in ihe general population epidemiological studies that appear to bearing on this matter are necessary incuso and El-Attar " m meir study Of - z cate differences m pathogenicity K lein feld Mpssite a n d U n g e r * ro u n d that yestos workers obse'>e<3 '"at trie nsk pulmonary cancer .u 'e U with em3.merit duration n v o 1' nvfances as a - c - g b-oes of asbestos contain tlaws m f a - "' ey lack quantitative data on ; . --. a t v e exposures, nber charec- (he nature of the dust samples analyzed indicated that nber counts of aerosols did not provide a true picture of ex level ot e * n p i o v r t n e f eftce HPn mnriaitrv rj e ju luiuiM ^ f ;x and presence ot c o 'acto's '" "*r'T'Ore ll I5J OMHlUtl tv V'dfJtf u i>'?>*r`*>* posure to asbestiform minerals because i.ucv .ociiedcd `cic fibers but -ce'> increased v\11n 'egard to ope mi asbestos Kle n- ; =- a asb estos as to re at *e b i ' .ie n icitv with regard to eu ier m an y `malt d<bes to> Mbers and "aggregate fibers" w hich contained sub d ,s.iesM(e, An- m a n et a l 1 observed s or neoplasia stantial amounts of asbestitorm m inerjls excess of m r . r j Tom cancer of the _ ; e ? ,o date indicate that bo:n namely tremolite and anthophyllue GO -g and pleura ami me -ale workers ex- r - a :e and size or asbestos iib ers are In light of recent observations, one -ed to a mixture ot talc and tremolite - i~ ' cant tactors in determ inin g cannot exclude the influence or cota c significant increase in incidence ap- esc a.litv deposition, retention and tors on biologic enects as a m ajor deter J1 ared in the oldrvr age group, 60 to 79 c ea'a rce rrom tbe pulmonary fa ct and minant o f pathogenicitv Onton, Lowe, CD ars rather than m me middle age thus are important determinant? ot the Richards el a l14 postu/aied that asnestos Oh mp -10 to 59 iears Th's was at s re and nature of tissue response The fibers probably serve as vectors in CO nance with their nndings among importance of fiber diameter and length producing disease bv carrying toxic or -w j beios insulators exposed to chrysotile m explaining the disparity in the pre oncogenic substances to vulnerable erv b amosite whose du'ation ot exposure valence Ot mesothelioma in ihe n-nrtn- sites Relevant studies included analysis ax ,,miiar to 'hat ot the talc workers western Cape and that ot the Transvaal of various types or asbestos to determine noeg the a'besiox mvy'ators there was region of South Africa has been components present in each with special i mc*eased incidence ot .ung and eural cancers m both middle and streng'nened by the study oi T mbreil Grrriths and Poolev20 The cuny shape o' emphasis on metals and polycyclic hydrocarbons'4 '> The present con best age groups There was no excess the chrvsotile fiber oners an explanation sensus is that contaminants are present carcinoma ot the gastrointestinal tract 0 peritoneum in taic workers whereas asbestos w o rk e r gastrointestinal and - nneal malignancv was sigmficantlv c eased com pared to the general anJanon, as also obse'ved by Selikoff, ii* nond and Chu'g 14 'Scu5sion and Conclusion - .- a t studies have been usetjl m -,Jt -g ecru ii 'actors 'hat exp am ot its interception by the bronchi especially at bifurcations in contrast to amphibole fibers which are needle-hke and mav. therefore, reach more deeply into the .ung parenchyma and pleura Since one of the amphiboles, namelv anthophyllite has rarely been associated with mesothelioma production tactore other than shape and size must oe ce n sidered L n '.t recently, most w ork and ` peclanon involved onlv fibers d e te c t d h but that identification or a speem e pathogenetic role for them requires fur ther studv If subsequent investigations verify that trace metals and other trac tions of the various types of asbestos dust do in fact play a m aior role in producing asbestosis or neoplastic diseases customarily associated w ith ex posure to asbestiform mineral dusts, then existing standards governing ex posure to asbestiform minerals in the United States and G -eat Britain un _i ^ ; c acuon or aspt.xi0 , now ese - m e o p tica l or light m ic rO vC o ra doubted'v will be xjbiect to revision r n j l ; Occ-pat coal MTicine'Yol 15 Nt 3 March 1973 299 References 1 Asbevoi The neerS fo. in d feasibility of air pollution controls Panel on Asbestos Committee on Biologic Effects of Atmospheric Pollutants Washington, DC, Division of Medical Sciences, National Research Council 1971 I Selikoff t|. Hammond EC. Churg I vior- alny espenences of asbestos insulation workers, 1943-1968, p p 180-186 In H A Shapiro Ed. Pneumoconiosis Proceedings of .he International Conference, fohannesburg, '969 Cape Town Oxford University Press. 1970 3 klemfetd M. Messee f. Ktxsyman O, et al Mortality among talc mines and millers m New York State, Arch Environ H tilth 14 663- t*1 '%7 * Wight CW Asbestos and health in 1969, *m Rev Resp On 10# 467 470. i960 5 -` oh Pf Mills I, Young OK Experimental I'Oes'Osis m -ihe aumea-pig. I Pith gact n ' 85 195 1966 6 Morns 1C, Roberts VVH, Sitvenon RE. et al DC 2. 205 in C N Davies. Ed .nhaled Pit- ne'es and Vapours Pergammor Press, Lon don-Parts 1969 Murphy RIM. ferns BG. Burgess WA et al Ettects ot low concentrations of asbestos, New frig/ f Med 28S 1271 1278 '971 4 Meinfefd M, Messae I, langer AM A study of workers exposed to asbesmorm minerals m commercial rate maruiac'uie To be published 9 Weiss VV C ia '.'!? smoxing asbesios c"d ojlm cna- b-o* s -im a?., n.. 104 223-227 - s 10 Wagner C C on 'C Be-n C el al Epidem ology o' asoes'os ca"ce-s Snf \ted Soil 27 71-76 19" I I Braun D C eoidemmiogical -cs asbestos miners A';* ' - - a ' r O An 31 cancer .n -- 17 634.453 1958 12 Interline P DeCou'V P Henderson V MoitaKv in re-ai r n o occup,:.oral etDOSuie m ihe asbestos npusirv P-esenteO at me mp.,can Industrial Hygiene Conterence San 'me sco. 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