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Asbestos Disease in Family Contacts of Shipyard Workers Kavi II. Kiiiiiikn. Ml). Klim l.u is. Ml). Hi nky A. Anth kson. Ml). (". Thomas Btivt in, Ml). Hans I.. I-inmi in. Ml). Sui-.-J. S. Johnson. Ml), anii Kai'iiai i Wahsiiaw. IIA AMrart: K.m<h4<>);k' Mpis of pulnioaurv .isNsii's disease were run>l in 11 l per eenl of 274 wives -hips.Mil workers who were 7n i mine uars from initial fin lilt: in m shfpv.inls m I O'. Angeles t iHfiiiv Xslieslirsis was also IihiikI in 7 h per. enl nl 7*t sons .mil. I pri iriil ot 140 daughters til these workers. Ilte mus. suns, anil daughters were without occiipalioilaf exposure Comparabk- nuttiiprupliK signs weie not found m comparison groups It is probable that ashe'los cvp<''iiie in Hte household pliers these family mem hers al risk lor ineMilhelHinu .old hints eami'i. tAm J Puhtw Ht'dith I'lHX' 7' til' h!7 I ST0282685 Imnxlui Iloti tle.illli risks1 ' are associated with even brief proximity lo .mborne asbeslti.s libers' in tiwny tlifl'cri-nl work plaees. IV risk assoei.ilial with less direct exposure. iillltiHiiilt originally ilescriheil by Wagner in l%0` and laler bv NcwIhinse ami IlwHUpson in 1`ho.' lias received III lie allenlion. In otie study. f.tniilv contacts ot asbestos insulation produclion workers showed ;i h per cent overall pievalence of radiographic ahnot nudities eharaeteristie ot asbeslosjs ami resulting frofn sccundarv exposures in their homes" Shipyards have Vvn iIk* site of widespread eximstire lo asbestos for al least 1.5 nullum workers in v.uioos tiades. ami radiographically delectable ashcslosis has Ivcn reported hi several groups of such workers. ' In a recent slmlv of 2Hh rurient ami retired ship repair workers, most of whom were in' bystander" trades mil workingdirccllv with asbestos, Kb per rent li.nl aslvslosis. and lint|: cancer was delected in live.'" I he risks for asheslns disease have mil been assessed previously in family contacts of bystander winkers. Ibis report concerns N'2 stibieels ivlui were studied in I9NI. and mcliitlcs male ami female shipyard work sis and IVir wives, daughters. and sons. Ihe nhjeelivc was to tklcrminc the prevalence of asbeslosis. i.e.. dilfitse ptdmonarv lihrosis aml/or pletintl fibrosis including eak ilic.il n>n as seen by eliest radiographs, in household exposed wives ami chiklien of shipyard workers, and lo compare such pic'vak-nces lo those in popnlatiuns m*t so exposed. r fhlhixh The population studied CiHisisled id' 1.017 workers and IVir wives, sons, ami daughters recruited liom Ihe I imp Ikach. Wilminplon. ami San IVdro ateas of law Anpcles I'minly bv a public media cninpatpn. luich rcspomlcnl was screened briefly by a telephone interviewer lo ilelerniine if die worker was 20 years of nuire from uiilial shipyard employment. i.e.. lirsi exposure lo asbestos. Appointments wne made for examinations dtirtnp Mav I9KI. AJdrc'v rvp*it rcgm/sK In K.tvt' II KtlKim. Ml). |*infvte nf MtIi line. jmI Chkcf. IStlHhHiMy IVc.isc Scvtmii. I Vfvu intent <T Mtilmnc. 1'iuvcrMtv nf 4 Mnltnm-. I(.trk>w I ISC' Ikv u|M i*t*ul Uc4kh i VMtr, .'ll-' Amal A*cmk\ I *s An:rlrv I A **U0U An!lt*r> llovlrn. I tnslem. iohnwHi ,iml Watshdw ,m* ,4m the CM' (kittpatMvi.4 Uf.iltk Ci'nfi'i. |1v | iHn is iiti IIk' l nvmnirnlj| Ssik-mos 14hi3inry. Mi. Shmi Sthonl <T Mctlnmc. CUNY. New Yofl. Or AwWrs><n r% wKk the WiNoMVxm Sl4l fkt.Mil nf llrrifth. l-.ovinmmciU.il I pwk.mn4*fy. Out. paprr. Mihtnttu-tl in ifc- Journal April N. 1VK4. wan itvtsctl awd iHkrfMcYl lor pnt4nTUMn J.iihuiv V l*m> *' Amcncan Jimiwil *4 |*uWn. Health (I Mi After infotmed consent was otuained. I rained interview ers obtained infomialiim about oeeupalitmal esprvsure and workittp conditions ..pulmonary and etirditK' diseases, respi ratory symptoms, particularly shortness of hneath. emtph. sfiulimi. ami wltee/inp. ami knowli-dpc and attitudes ahottl asbestos disease'. I he occupational (|iieslionnairewas based on that used in a piior sltklv of family contacts of asbestos workers''and in the' studies for the ellccts of polybrominated biphenyls in Hie Male of Michigan." Ihe icspiralory disease i|iic'siio/.Maiie included Ihe Medical Kesemeh Council chron ic bronchitis <|iicsiions with additions concerning asthma and the degree of breathlessness as recommended in Ihe cpide- miolopv standardization prpic'c't.1' l-ioiu 1.017 subjects studied, 1.1 were exeltulcd as distant relatives who were imlside Ihe slmlv categories ami II subjects had incmupk-le data, usually having refused chest x-ravs. There were 7h subjects wluvw asbestos expo sure was at woik sites other than shipyards. Thirty-nine sons and daughters were excluded because their fathers were less than 2(1 years horn initial occupational exposure to asbestos. An additional 24 shipyard workers, both men and women, also wete less than 2(1 years from initial exposure to ashes- Ids. Ihe women analyzed were cither female shipyard workers, or wives or daughters of workers: 24 per cent were employed but mine of the wives or daughters had worked with asbestos ( Table 11. (`omparisons were made with two oilier groups of adult women" " (Table I) who had been stiklied using chest radiographs and questionnaires similar to those used in this study. Ilte 7`> sons id' shipyard workers were compared lo f.7.1 men (mean age 50 1 17) front the I oug llcacli census tract" ami 5**4 men (mean age 41 v 14) from the Michigan sample." TosteriwnlerMH' ami lateral chest radiograms (14 x 17 inch) were' tdstained in all subjects al standard six foot distance using conventional techniques. ChcM radiograms were screened bv a physician and repealed if they appeared tvchnicallv mivtiislaciory lor evaluation of pneumoconiosis bv ltd (Inlcrnuiion.d I alxMir (Irganizationl criteria Iherc.liter, thiee e\|vrieuced readers with at least ")i" re.nler qualifications for leading pneumoconiosis las established by Ihe American College of Kmliology) independently read (lie postcroanteriiw radiograms of all three groups for presence ami profusion of in egttlar opriciliex and presence and extent of pleural abnormalities (dillitse thickening, plaques, and ealcilication) They used the criteria of the 19110 revision of Ihe II.O classification for pneumoconiosis" which grades ihe profusion of opacities from absent (grade 0) lo few (grade It. to moderate (grade 21. ami numerous (grade 1). Alt study and control x-rays had idculiiicution covered and were intermixed. 'Ihe x-rays were graded from IV0 to 1/1 by AJPH June 1905. Vol. 75. No. 6 8-36 615 hJlBURN. rr Ml. TASLC 1 Cempectoona ol Three Oroupe * Vatontoer ww mnm vi Tim Study fletomaca Group r *nP`V---l-n--C---l Group 2" For Coni by Ago 16-64 35-9* S5* iqh trmmnQ Pw Com ay Rao* wide Black Oitar % Employed % Cipoeeil to aaOoatoe to wort % pomMv lo Mbmoi at homo (Nas) 22 32 45 t 86 13 1 24 0 100 (N74) 25 22 42 11 99 0 1 unknown 3 6 (N5C3) 43 35 21 1 93 1 54 5 16 tM net house Is hosts kray raciuawew. lang >isav CA. 1f7S-<t7S; 7(% af Stoss sitsasd wsts stsnsnsd <t3s. ISSIl) rsntora sstspls. isoussd Dy ptoos. Mcfvgen. l7S: 0% ol Stoss ntssd sra ssswst (H|. arithmetic consensus of the three gradings. To be considered positive, two readings had to indicate the presence of asbestosis grade 1.0, or definite pleural abnormalities. Read ings which differed by two or more grades of profusion, for example I/O to 1/2 or 2/1, were reviewed by the three readers as a panel until they reached a consensus. For the following analysis irregular opacities with a profusion of 1/0 or greater were considered as positive for asbestosis as recommended by ILO criteria. Similarly, pleural findings were counted as positive if any combination of pleural thickening, plaques, and calcification were consistent with asbestos disease. The term asbestosis. when used in this report, is synonymous with radiologic signs of this condition. TMLI 3 Piaratonca at AebMtoala ol Longa andtor Plsun tor Ship. yard Worhara and Pam9y Contorts and to Lang Beach and Oroupe Male Shipyard Workers rvnw unpyvo wonm Wives ol SWpywd Warkem Sone of Shipyard Workers Daugf*** of Sfrpyart Wortupv Gompartoon Population Long Beach Ceneua Tract Men Long Beach Ceneua Tract Woman Mkhigan Sample Mon Michigan Sample Women ft 269 71 274 79 140 73 <74 504 S83 Per Cent wth Aabeatoew 642 211 11.3 76 2.1 37 06 os 00 Decade of birth was used as an approximation of years from initial exposure to asbestos for creating four groups so that asbestosis prevalence could be compared in shipyard workers and their wives. This was done because exact dates of first asbestos contact were unknown or first contact was outside of shipyards. Results The prevalence of asbestosis in the shipyard workers and their wives and children is shown in Table 2; a detailed breakdown of diagnostic criteria appears in Table 3. The male workers had engaged in all skilled shipyard trades. Many had begun as laborers and no ufcde predominated. Their mean age was 61 ( 10.8); 81 per cent had a history of cigarette smoking, although at the time of the study, only 25 per cent continued to smoke. Asbestosis was present in 185 (64.2 per cent) of the male shipyard workers. TABLE S--Itadtotogle Signs ol AabaatoaJs In DtOnaol Group# ol IndlvMuato Oroupftisaasa PrahMlon ol kragtoar OpadSM (V0 (VI 10 in >1/1 Male Slapyard Workers (N - 288) IO only 99 72 53 so PT + PC PT + PC O 26 42 27 29 Negative 73 30 female Sl*>yvd Worken (N 71) IO only SO 14 4 1 PT PC PT PC IO 63 10 Negative 45 It Wives (N - 274) IO only 221 34 16 3 PT PC 57 PT+ PC+ O 0 21 Negative 216 27 Sons (N - 79) Corny 69 7 2 1 PT + PC 21 PT PC + O 20 Negative 27 6 Daughters (N - 140) CorSy 132 7 1 0 PT * PC 20 PT PC + C 00 Negative 130 7 14 10 2 1 0 0 0 0 0 0 NOTES. 0 * <r*gui*r apecnes n tog PT PC * ptevrai tocMnine artoor afeitcaam. UndfffcMd AurttMrf Mn coirtvd m cHH>ng pwianca. Total (%) 51 (17 7) <6 (23.6) 66 (22.9) 103 (356) 6 (7.0) 6(113) 2 (2 6) 56 (78.9) 16 (5.6) 12 (4.4) 3 (D) 243(68 7) 3 (3 6) 3 (3 6) 3 (2 5) 73 (92 4) 1 (07) 2 (1) 137 (97.9) C/) H CD ro ro err CO cr> 616 8-37 AJPH Juno 1905, Vol. 75. No. 6 ST0282687 ASBESTOS IN SHIPYARD WORKERS' FAMILIES All of Ihe women shipyard workers were wives of male shipyard workers: two had been insulators and one had been a welder: 32 were present or former cigarette smokers: 21.1 per cent had asbestosi'. Mean age of 274 wives was 38 (z 9.3); asbestosis was found in 11.3 per cent and was equally frequent in nonsmok ers, cx-smokers. and current smokers. Three wives who were cigarette smokers had lung masses detected by chest radiograph. Two of these were cancers and one was sarcoid osis. Six of 79 sons (mean age 29.3 8.3) had asbestosis. as compared to three of the 140 daughters (mean age 32.3 10.3). Analysis of workers by decade of birth showed a strong relationship between decade of birth and asbestosis preva lence in shipward workers: in the wives of workers, the relationship is less striking but remains suggestive (Table 4). As shown in Table 2. the prevalence of radiologic signs of asbestosis were far higher in the wives, sons, and daugh ters of shipyard workers than in the two comparison groups studied. All studies, particularly those involving human volun teers. may be biased. It is possible that Ihe shipyard workers and family members who volunteered for this study were more aware of the dangers of asbestos exposure and that a higher proportion had been previously diagnosed with asbes tosis than a random sample offamilies of present and former shipyard workers. However, we collected data during this study about health awareness and previously recognized respiratory diseases and symptoms. Analysis of these data (to be reported later) did not bear out this possibility. Although data on risks to family contacts of shipyard workers are still incomplete, five mesotheliomas have been recognized in family members of asbestos insulation manu facturing workers in Paterson.* We believe that, the feasibil ity and benefits of undertaking surveillance for cancer in the families of workers exposed to asbestos should be consid ered, particularly for individuals who continue to smoke cigarettes or who have smoked for many years in the past. Anderson HA Unpublished data. Discussion Most'of the shipyard workers studied did not work directly with asbestos, but were exposed to airborne asbes tos during application and ripout of insulation by pipe coverers and insulators. Finding asbestosis signs in 11.3 per cent of their wives is fresh evidence of the pervasiveness of asbestos as an occupational hazard carried home by work ers. Those wives bom in the decade 1900-10 had the highest proportion of asbestos signs, two-thirds as high as the 48 per cent in wives of Paterson, New Jersey insulation factory workers studied by Anderson, era/.*'' Sons without occupational exposure to asbestos had a 7.6 per cent prevalence which is in keeping with their youth. If exposure of the sons began in infancy, they may continue to develop asbestos signs throughout their lifetimes, and the prevalence will rise as they grow older. Only 2.1 per cent of daughters had asbestos signs. A similar sex difference was found at Paterson.14 Reasons for the difference are un known, but may reflect greater difficulty in recognizing irregular opacities through the breast shadows on chest radiographs. Although shipyard workers appear to have lower expo sures to asbestos compared to tnose making asbestos insula tion products,7'* the gradient of asbestos signs with earlier decades of birth suggests that the time lapsed from first exposure may be a more important determinant than is the average dose. TABU! 4--Comparison ot tb* Pravstene* of Aab*totl* In Woriwr* and WTv--, by Dacad* ot Birth Mato Shipyard Workera Wives' cad* ot Bum N % Pontrva N % Poriiv* 1900-10 1911-20 1921-30 1931-40 37 86 5 117 70 1 93 61 7 39 308 22 31 8 90 122 102 78 49 10 2 `Mudn omy Mom. ano rtf. mprirt 9W1 a not otwm< nporad to REFERENCES 1. Sclikoff IJ. Chura J <edv): Biological effect* of asbestos Ann NY Acad Sci 1965: 142:1-766. 2. Sclikoff IJ. Hammond EC feds): Multiple risk factors in environmental cancer, /*.- Fraumem JF Jr (edi: Persona at High Risk for Cancer. New York: Academic Press. 1978. 3. Sodman H. SeNkoff IJ. Hammond EC Short-term asbestos work expo sure and long-term observation. Ann NY Acad Set 1979; 3)0:61-69. 4. Wagner JC. Sfcggs CA. Marchand P: Diffuse pleural mesothelioma and asbestos exposure in the North Wester* Cape province. Br J Ind Med I960: 17.260-271. 5. Newhousc ML. Thompson H: Mesothelioma of pleura and peritoneum following exposure to asbestos in the London area. Br J Ind Med 1965: 22:261-269. 6. Anderson HA. Lilts R, Daum SM. Fischbrin AS. Sclikoff IJ: Household contact asbestos neoplastic risk. Ann NY Acad Sci 1976; 271:311-323. 7. Sclikoff IJ. Ulis R. Nicholson WJ: Asbestos disease in United States shipyards. Ann NY Acad Sci 1979. 3)0:295-311. 6. Polakoff PL. Horn BR. Scherer OR: Prevalence of radiographic abnor malities among northern California shipyard workers. Ann NY Acad Set 1979; 3JO:3JJ-JJ9. 9. Felton JS Radiographic search for asbevlos-reiated disease in a naval shipyard. Ann NY Acad Sci 1979; 330:341-332. 10. Selilioff IJ. Nicholson WJ. Lilis R: Radiological evidence of asbestos disease among ship repair workers. Am J Ind Med I960; 1:9-22. 11. Sclikoff U. Anderson HA: A survey of the general population of Michigan tor health effects of polybrominated biphenyl expoure. In; Report to the Michigan Department of Public Health. September 30. 1979. Environmen tal Science Laboratory. Mt. Sinai School of Medicine 12. Ferns BG Jr: Epidemiology standardization project. II. recommended respirator) disease questionnaires for use with adults and children in epidemiological research. Am Rev Respir Dix 1978; 116 tNo 6 Pan 2) 73? 13. Detels R. Savre JW. Coulson AH. Rokaw SN. Massey FJ Jr. Tashkin DP. Wu Mci-Miat?: The ICLA population studies of chrome obstructive respirators disease. [V. respiratory effect of long-term exposure to photochemical oxidants, nitrogen, and sulfates on current and never smokers. Am Rev Respir Dis 1961. 124:673-660. 14. international Labour Office International classification of radiographs pneumoconiosis I960. Occupational Safety and Health Senes 22. Geneva, ILO. 1980. 15. Anderson HA. Lilis R. Daum SM. Sclikoff IJ: Asbestosis among house hold contacts of asbestos factory workers. Ann NY Acad Sci 1979: 330- 367-399 ACKNOWLEDGMENTS This research supported by a grant from the American Lung Association of Los Angeles County Thix study was presented in part to the Amerwan Thoracic Society meeting. May 9. 1963 AJPH June 1965. VoL 75, No 6 8-38 617