Document 3Q1Zyb6LdLZrm92oqg9JOdwJ3

FILE NAME Talc TALC DATE 2002 DOC TALC023 DOCUMENT DESCRIPTION Journal Article - Mesothelioma among Workers in Asbestiform bearing Talc Mines in NY State Ann occup Hyg Vol 46 Supplement 1 pp 132-135,2002 132-135,2002 '2002 British Occupational Hygiene Society Published by Oxford University Press DOI 10.1093 annhyg mef651 Mesothelioma among Workers in Asbestiform Fiber- bearing Talc Mines in New York State MINDY J. HULL,,JERROLD L. ABRAHAM,,and BRUCE W. CASE State University of New York Upstate Medical University Pathology Syracuse NY 13210 USA 2School of Environment McGill University Montreal Canada Asbestos disease among talc miners and millers in a group of mines in two counties of northern New York State has been noted and disputed since the 1930s One of the two counties was identified as among the 10 in the USA with the highest mesothelioma mortality up to 1981 having for both men and women Eight tale miners had been identified in previous studies as mesothelioma In the current study we ) report five new cases of mesothelioma among tale workers ii present the results of and demonstrate the similarity between lung fiber burden analyses for selected cases and controls and iii update mesothelioma mortality in this district using demographic and cause of death cancer information from 1950 to 1997. Our results indicate that New York talc exposure is associated with mesothelioma and deserves further public health attention Keywords mesothelioma talc pathology epidemiology mortality scanning electron microscopy asbestos } BACKGROUND In 1878 talc mining introduced an economic boon to the rural agricultural counties of St Lawrence and Jefferson in northern New York State The hub of this industry was Gouverneur home of several talc mines at least one of which is still operational We believe that occupational exposure to dust from the talc mines and mills caused the mesothelioma excess in these counties We support this by examining the similarity between the lung fiber burden of talc miners with and without mesothelioma and determining the presence or absence of retained fibers indicative of commercial amphibole asbestos exposure There are at least eight histologically confirmed cases of mesothelioma among New York State talc miners and millers reported as of 1986 and increased pleural mesothelioma mortality in Jefferson County Here we report five new mesothelioma cases and epidemiological data to determine if this trend continues In the 1930s Merewether 1930 and others begin to describe asbestos exposure and its role in fibrotic lung disease Pathology related to talc exposure also was being investigated with a reported range of lung findings from nodular silicosis to diffuse * Author to whom correspondence should be addressed Department of Pathology SUNY Upstate Medical University 750 East Adams Street Syracuse NY 13210 USA asbestos patterns Porro et al 1942 By 1943 Siegal and workers were studying New York State talc miners and millers Siegal et al 1943 They described the mined talc of a fibrous variety with it is found tremolite similar appearing mineral occurring in a fibrous or asbestiform state which changes over to talc Midget impinger concentrations of particles ranged from 6 to 5000 million particles per cubic foot mpcf in mining and from 20 to 215 mpcf in milling They found evidence of marked pulmon- ary fibrosis on chest roentgenograms in 32 all of whom had a 10 yr exposure history out of a total of 221 talc workers This established a clear relationship between lung fibrosis and duration of talc exposure Fourteen of these workers also had pleural plaques providing the first documentation of talc plaques In 1967 Kleinfeld et al documented 9/220 talc workers with lung cancer this represented a fold excess In addition the first pleural fibrosarcoma and peri- toneal mesothelioma in talc miners were described in this cohort Vianna et al 1981 conducted an incidence study of all histologically confirmed mesos in New York State between 1973 and 1978. They found that Jefferson County had a mesothelioma rate twice that of the rest of the state A total of six cases of mesothelioma four male two female occurred in talc miners Enterline and Henderson 1987 also concluded a mesothelioma excess in Jefferson County after looking at national mesothelioma incidence by county from 1968 to 1981. They observed four cases in 132 Mesothelioma in asbestiform bearing talc mines 133 Table 1. Diagnosis and immunohistochemical results where applicable of three mesothelioma cases Case 1 Case 2 Case 3 Case 4 Case Description of pleural mesothelioma Biphasic diffuse Sarcomatous Epithelial with rare biphasic areas Diagnosis of mesothelioma made by New York State Worker's Compensation Board No tissue available Diagnosis of mesothelioma made by death certificate No tissue available Immunohistochemistry cytokeratin +++ calretinin +++ Cytokeratin +++ calretinin CEA - alcian blue + cellular mucicarmine + rare focal +++ strongly positive + weakly positive - negative Table 2. Pertinent data from New York talc miners diagnosed with malignant mesothelioma Case 1 2 Birth 1931 1937 Death 1989 1990 Smoking historya 10 0 Relevant occupation in the talc industry Mucker driller Hardinge operator Packed talc into trucks First year job 1952 = Job duration yr 22 1955 3 1912 1984 0 Mechanical engineer construct two talc mines Unknown 222 4 1923 1981 Unknown Unspecified employment at a single talc company 1953 222 5 1925 1994 Unknown Roustabout foreman packhouse worker 1949 25 In pack no of packs per day x no of yr smoking Includes all known dusty jobs talc or otherwise females 0.6 expected and seven cases in males 1.4 expected This gave Jefferson County the second and sixth highest mortality rates from mesothelioma for females and males respectively in the USA METHODS AND RESULTS Subjects The SUNY Upstate Medical University serves the catchment area of Jefferson and St Lawrence counties From 1984 to 1987 36 biopsy and autopsy samples were recovered from talc workers with lung disease Hospitalization employment and when applicable death information were collected From the 36 miners five mesothelioma cases were documented For three of these the diagnosis of mesothelioma was histologically and immunohistochemically confirmed using hematoxylin & eosin alcian blue mucicarmine calretinin carcinoembryonic antigen CEA and cytokeratin staining see Table 1 Case 1 is described in detail as a represent- ative clinical course of mesothelioma Table 2 contains demographic data for the five mesothelioma cases Observed and expected pleural mesothelioma mortality in mining counties Calculations of mortality were performed at the University of Pittsburgh using the same protocol as that described by Enterline and Henderson 1987 Observed and expected values were updated to include the most recent years available overall from 1968 to 1997 Figure 1a presents the mesothelioma mortality for males and females respectively a 2.5 2.0 | 1.5 ~ mist Lawrence | | Background + 1.0 0.5 = 0.0 4 1m 1965- 1970-1975- 1970-1975- 1980- 1985-1990-1995- 1985-1990-1995- 1985-1990-1995- b 2.5 1.5 1.0 - jBackground| 0.5 + 0.0 1965- 1970- 1975- 1980- 1985- 1990- 1995- Fig 1. Yearly mesothelioma mortality rate per 100000 a males and b females retained particulate and fiber analysis Lung parenchyma from two mesothelioma cases and eight mesothelioma cases was available for analysis The fibrous inorganic particulate lung 134 M. J. Hull J. L. Abraham and B. W. Case burden was measured using morphometric in situ analysis of tissue sections Abraham and Burnett 1983 For fiber analysis lung tissue was digested with sodium hypochlorite and the residue collected on polycarbonate filters for analysis of asbestos bodies by light microscopy or fibers by scanning electron microscopy dispersive ray spectroscopy Abraham et al 1991 The analytical results are displayed in Table 3. For fibers > ...mlength width and chemistry were recorded Log normalized lengths and widths of the fibers found in the meso- thelioma cases and the mesothelioma cases were compared using Student's test Analyze Software Ltd Significance was defined as P < 0.05 Finding no difference between dimensions of each fiber type would support similar dust exposure between miners with and without mesothelioma Case 1 illustrates a representative medical history This was a old 5'8 190 lb white hypertensive male with a 10 pack smoking history who presented in 1974 with hardness of breathing for 4-5 yr He reported nocturnal wheezing persistent anterior chest pressure chronic cough ( oz daily sputum occasional hemoptysis and difficulty walking -200 m He had a 22 yr talc dust exposure history working at times as a mucker driller and Hardinge operator at two New York talc mines He had optional access to a respirator that proved too cumbersome to work with Both his father now deceased and brother had been diagnosed with talc pneumoconiosis His physical examination showed a symmetrical chest wall with an increased anteroposterior dimension and diminished inspiratory expansion Auscultation revealed harsh inspiratory and expiratory bilateral diffuse rhonchi and fine scattered expiratory wheezing A chest ray showed bilateral prominence of mediastinal shadows and increased reticular pulmonary markings particularly over the lower lung zones He had markedly restricted ventilatory function on spirometry with FVC - 3.31 3.31 75 predicted FEV1 = 2.51 2.51 74 predicted and V - 60 min 39 predicted Like his brother and father he was diagnosed with talc pneumoconiosis His disease progressed and in < yr he was placed on permanent total disability He died at age 58 15 yr after presentation The mortem revealed a biphasic diffuse pleural mesothelioma encasing the left lung which had not been suspected during life It is noteworthy that congestive heart failure was the only listed cause of death was no mention of mesothelioma on the death certificate DISCUSSION AND CONCLUSIONS We have found a continued trend of increased mesothelioma mortality at 5-10 times the background rate in Jefferson County from 1982 to 1997 with five new male cases two expected and three new female cases 0.5 expected We also show that increasing talc exposure duration is associated with an increase in lung burden of both fibrous and non- fibrous talc Asbestos bodies were also seen in elevated concentration in most men with 10 yr exposure who had not been diagnosed with meso- thelioma The concentrations of each fiber type from mesothelioma and mesothelioma cases were similar except for a high tremolite concentration in case 2. There was no significant difference found between mesothelioma and mesothelioma miners with regard to length and width of the tremolite and talc fibers Tables 4 and 5 supporting our hypothesis that they were exposed to dust with similar Table 3. retained particulate analyses of mesothelioma and mesothelioma cases Age at death Years of talc mining Diagnosis Asbestos bodies Asbestos fibers Mesotheliomas 1 2 58 52 22 4 ATM 350 ATM 93 mesotheliomas A B C D E F G H 49 58 60 63 66 71 71 76 21 21 18 30 23 25 2 10 ATSC 200 ATS 10 ATP ATSP = ATPC ATP Pn 980 890 417 4850 1 10 Anthophyllite 5 Tremolite 256 Chrysotile 256 Talc fibrous 46 Talc fibrous 37 Silicad 7 d 1110 21 96 146 n 12 1 7 24 511 15 85 105 188 716 60 10 64 7 10 47 n a 4 17 21 157 139 68 14 31 9 195 a n d 0.04 0.4 43 0.07 0.9 19 0.18 2.6 233 0.1 3.1 51 1 1 d ] 1 a not available n not detected "NInormal Pn pneumonia A asbestosis T talcosis S silicosis P pleural plaques M mesothelioma C lung cancer b Thousands of bodies dry lung * Millions of fibers dry lung Millions of fibrous particles lung Mesothelioma in asbestiform bearing talc mines 135 Table 4. Dimensional analysis for lung fibers in two New York State talc miners with immunohistochemically diagnosed malignant mesothelioma Fiber type Actinolite Anthophyllite Chrysotile Tremolite Talc na Width ...m -- Min Max 1 0.20 - ~ 6 0.15 0.06 0.30 5 0.05 0.03 0.06 38 0.22 0.10 0.40 54 0.20 0.05 1.00 Length ...m x 4.6 Min - 10.6 3.9 4.1 1.9 4.5 1.7 5.3 1.4 Max - 30.2 6.1 10.6 53.0 ARb 23 90 93 26 43 Number of fibers measured Mean aspect ratio = length x width Geometric mean Table 5. Dimensional analysis for lung fibers in eight New York State talc miners with pulmonary disease other than mesothelioma Fiber type Actinolite Anthophyllite Chrysotile Tremolite Talc ---- 7 85 33 51 284 Width um X Min 0.18 0.12 0.24 0.05 0.08 0.04 0.34 0.33 0.04 0.06 Max 0.25 1.60 0.40 1.00 2.80 Length ...m X Min 3.4 2.5 7.7 1.6 7.4 2.1 5.3 1.5 6.4 1.3 Max 5.4 146.0 36.1 17.0 219.0 ARb 20 56 133 24 30 Number of fibers measured Mean aspect ratio = length x width Geometric mean % fiber dimensions Finally in all of the 10 cases analyzed only a single commercial amphibole fiber was found New York talc miners are exposed to a mixture of platy talc silica and fibrous minerals resulting in a disease process much more complex than pure talcosis The asbestiform fibers in the New York talc miners lungs are a mixture of talc tremolite and related mineral series Our results indicate that mesos continue to occur at high rates in counties where New York talc mining occurs Furthermore New York talc miners without evidence of commercial amphibole asbestos exposure develop mesos Talc miners with mesos have lung fiber burdens similar to those without indicating comparable exposures Increased public health attention to the risks of exposure to New York talc is indicated Acknowledgements was a Post Sophomore Fellow in Pathology during part of this work Supported by Department of Pathology SUNY Upstate Medical University REFERENCES Abraham JL Burnett BR 1983 Quantitative analysis of inorganic particulate burden in situ in tissue sections Scanning Electron Microsc Part 2 681 96 Abraham JL Burnett BR Hunt A. 1991 Development and use of a pneumoconiosis database of pulmonary inorganic particulate burden in over 400 lungs Scanning Microsc 5 95-104 Enterline P Henderson B. 1987 Geographic patterns for pleural mesothelioma deaths in the United States 1968-81 J Natl Cancer Inst 79 31-7 Kleinfeld M Messite J Kooyman O Zaki MH 1967 Mortality among talc miners and millers in New York State Arch Environ Health 14 666 7 Merewether ERA 1930 Occurrence of pulmonary fibrosis and other pulmonary affections in asbestos workers J Ind Hyg 12 198 Porro FW Patton JR Hobbs AA 1942 Pneumoconiosis in the talc industry Am J Roentgen 42 507 24 Siegal W Smith AR Greenburg L. 1943 The dust hazard in tremolite talc mining including roentgenological findings in talc workers AmJ Roentgen 49 11 29 Vianna NJ Maslowsky J Robert S Spellman G Patton B. 1981 Malignant mesothelioma epidemiologic patterns in New York State NY J State Med 81 735-8