Document 3eYY86wda32xgVnBr2V0j6jbJ

FILE NAME Household Contact HC DATE 1996 DOC HC022 DOCUMENT DESCRIPTION Journal Article - Pleural Mesothelioma and Household Asbestos Exposure REVIEWS ON ENVIRONMENTAL HEALTH MED MED 1116 VOLUME 11 NOS 1-2 1996 Pleural Mesothelioma Household Asbestos Exposure Joachim Schneider Kurt Straif and Joachim Woitowitz Institut und Poliklinikf^...rArbeits- und Sozialmedizin der Universit^/tGiessen Aulweg 129 35385 Giessen Deutschland SUMMARY This article discusses the development of induced malignant mesotheliomas after occupational environmental exposure to asbestos through contact with occupationally exposed household members In our policlinic we have seen six fatal pleural mesothelioma cases five wives and one son of asbestosindustry workers with ---- history of occupational asbestos exposure In five women a causal relation was established between the fa disease and inhalation of asbestos fibers whue cleaning the contaminated work and shoes of their husbands at home The son had also been exposed to asbestos throughout his childhood during daily visits with his father at the workplace INTRODUCTION Asbestos mesothelioma No. 4105 of he German Ordinance of Occupational Diseases BeKV is one of the most frequently compensated occupational cancers / Malignant mesothelioma is specifically regarded as a signal tumor of previous exposure to asbestos in the workplace 2 To our knowledge causes other than asbestos and The comparably persistent mineral Erionite have not been found 3,4 Mesothelioma is considered a marker for occupational asbestos exposure as well 5,6 Asbestos mesotheliomas have been described in the vicinity of asbestos mines in South Africa 7,8 Canada 9 Australia 10,11 and C 12 Industrial asbestos manufacture also presents a significant health risk to the environment In Saxony 13 and especially in the HamburgBergedorf area the incidence of mesothelioma Freund Publishing House Ltd. 1996 cases was significantly increased in areas that are close to industrial asbestos emitters 14-17 Many reports have emerged from Turkey 18-20 the northwestern part of Greece 21 and Corsica 22 23 about the endemic incidence of diffuse malignant mesotheliomas caused by environmental exposure to asbestos or Erionite through soil erosion In certain regions of central Anatolia mesothelioma incidence figures of up to 216 per 1,000,000 inhabitants have been recorded although the expected mesothelioma incidence in the general population was very low The estimate of an annual mesothelioma mortality rate of 1 to 8 per one million inhabitants 24-26 relates to about one mesothelioma death per 1000 to 10,000 deaths from all causes An article by Grossgarten and Woitowitz 6 presents an overview of asbestosinduced pleural mesotheliomas that are linked to indoor inhalation by household contacts PATIENTS AND EXPOSURE CRITERIA In our policlinic we have seen asbestos tumors in members of households where at least one worker had been occupationally exposed to asbestos Between 1986 and 1994 five women and one young man one patient's son with no occupational history of asbestos exposure died of - asbestos mesothelioma Their ages ranged from 42 to 68 years Table ) The diagnosis was always confirmed by histology on specimens autopsy Detailed job histories revealed that neither the women nor # the son had ever worked in an asbestos factory Asbestos exposure was exclusively through residential inhalation of asbestos from contaminated work clothes or shoes that were brought home from / the workplace by the husband Throughout his childhood the son had regularly delivered a hot 65 66 J. SCHNEIDER ET AL 7 it Table 1 Asbestos pleural mesothelioma in six wives and one son of asbestos workers Patient Patient Bom Died Died Length of household exposure Latency years Occupation Occupation of household contact G.J. E.L. 1923 1925 1986 1993 1950-59 1961-84 35 Insulation manufacturing 31 Turbine revision H.B. M.L. G.K. 1926 1931 1933 1994 1954-71 38 Roofer asbestos 1987 1969-76 17 Asbestos cardboards A 1992 1964-74 26 Insulator 19 H.J. 1946 1992 .1950-59 42 Insulation mats manufacturing fl Son of G.J. ee fl meal to his father at the workplace From 1950 to 1984 the husbands were employed in different companies that manufactured asbestos mats asbestos textiles and asbestos cardboard or in such occupations as insulators roofers or turbine- revision workers who process asbestos products Thus the asbestos exposure at such jobs is indisputable The husbands two patients G.K. and G.J. had already developed pulmonary m households fell between 50 and 2000 ng chrysotile 27 For comparison only 32 to 8S mchrysotile was measured in the homes Se 3 residents who were not employed in the mine Measurements were also taken from the area where the work clothes were cleaned in an American asbestos textile factory Between 10,000 lang 80,000 30,000 asbestos fibers of a lang median cloth L > ...mair were foundin the qs asbestosis The contaminated clothes were not removed in the factory for cleaning but rather were taken home where the wives brushed them area 28 Brushing asbestos contaminated yer> clothes results in asbestos concentration > few hundred crocidolite fibers per cm29 4537 almost daily and washed them once or twice a week Residential fiber measurements are unavailable The length of the household exposure was between 7 and 23 years see Table ) TheyThey latency period time between onset of the residential | th In 1989 Huncharek et al 30 reported shipyard machinist's wife who had washed contaminated work clothes at home ding of pleural mesothelioma The mortem lungs burden analysis yielded concentrations of chrysotile asbestos exposure and the development of the disease varied from 17 to 38 years amosite and crocidolite as well as tremolit~ . . actinolite and anthophyllite fibers per gram dry lung tissue of the same magnitude as that found in DISCUSSION For almost three decades the international specimens from patients with occupational asbestos f exposure 0 i Bianchi et al 131 found ferruginous bodies in na * q the mortem lung tissue specimens of 73 . scientific literature of environmental and occu- mesothelioma patients of whom 6 were asbesto:s: 9 pational medicine has published papers describing workers wives with only household exposure da et asbestos diseases in family members of Between 1,000 and 10,000 ferruginous bodies per lung |: crema workers who have been occupationally exposed to gram dry tissue were measured in half the| mma t gy co asbestos 5,6 In the United States the air wives as many as 10,000 to 100,000 were reportad acas sae concentration of chrysotile was measured in the in one wife Such concentrations are comparablet~ s 5 we en houses of 13 asbestos miners who usually did not those found in 56 former : shipyard weet remove work clothing after working in the factory employees Measurements showed between ki es. jet About 75 of the air measurements in such and 10,000 ferruginous bodies per gram dry lupe ee en, hen ASBESTOS MALIGNANT MESOTHELIOMA 67 ^"ssuein 20 shipyard workers between 10,000 and 100,000 in 23 workers and 100,000 in 10 workers Low concentrations 1,000 ferruginous bodies per gram dry lung tissue were measured only in three shipyard workers and two of their wives pleural The special risk for death from mesothelioma in wives of industry workers is well known from many international case reports 12,30-46 The risk of mesothelioma death in ousehold members has also been investigated in Gidemiological control and cohort studies In control study in England Newhouse and Sompson 47 reported that 9 of 76 malignant sothelioma patients did not have occupational bestos exposure Seven female patients had ashed the work clothes of their occupationally posedhusbands and siblings Two male patients re exposed at the respective ages of 9 and 13 Ars via their siblings who were working in an Destos mill The original publication did not quish between occupational and para- ional exposure however A secondary tosis tosis of household contacts gave a crude odds %~ OR= 16.75 with a 95 confidence interval of -%. . 136.78 12 a matched control study na and Polan 48 described pleural and oneal mesotheliomas in 52 New York females ight pairs only the patients seven wives and : daughter of occupationally exposed men were posed while washing contaminated work othes whereas in one pair only the control was us exposed A secondary analysis excluding ccupational mesotheliomas resulted in an odds tio OR = 8.0 with a 95 confidence interval of 0 to 64.0 The authors presented the occupation the male family members as the main risk factor r the disease A control study of McDonald 5 557 esothelioma cases revealed that in eight pairs nly the patients five during childhood had been posed to asbestos via household contacts By ntrast in two pairs only the controls had a story of domestic exposure to asbestos The dx x= 3.03 was not statistically significant - 6.08 cohort study of Anderson 49 revealed that m 1941 to 1945 only three mesotheliomas were diagnosed among 2218 household members of amosite workers The published data did not specify however the expected mesothelioma mortality rate which should have been close to zero Further occupational asbestos exposure after 1945 cannot be ruled out from the information provided in this study In a cohort study by Magnani et al 150 1740 female household members were monitored from 1965 to 1988. Overall 210 deaths occurred versus 229.1 expected deaths Four patients died of pleural tumors three were confirmed mesotheliomas which is significantly more than the expected rate of 0.5 SMR The 95 confidence interval of the SMR 215.9 to 2028.8 is statistically significant The studies reviewed here confirm that despite certain members methodological limitations household predominantly wives asbestos workers have an increased risk of dying from mesothelioma Other reports show that not only wives but also sons and daughters of asbestos workers have a high risk of dying from mesothelioma In the Anderson cohort study on amosite workers 49 for example the three adult patients a year son and two daughters aged 41 and 51 years 46 who died from mesothelioma had been exposed to asbestos at home during their childhood Glage 51 published one of the first reports from Germany on malignant mesothelioma with a demonstration of asbestos fibers and ferruginous bodies in the lung of an adult whose prolonged household exposure to asbestos had taken place during infancy The patient was between three and seven years old when she was exposed to the contaminated work clothes of her father who cleaned carding machines An occupational exposure of the daughter to asbestos was ruled out Kane et al 152 reported five adults under the age of 40 with pleural mesotheliomas Residential asbestos exposure happened during childhood exclusively through their fathers most of whom were working in the shipyard industry Household exposure can begin at a relatively early age 53 At least 5 of 668 mesotheliomas diagnosed in Canada between 1960 and 1975 and in the United States in 1972 can be linked to a household contact during infancy 19 Konetzke et al 54 reported that of seven eight cases of  68 J. SCHNEIDER ET AL 1 tt a SS Tits tTMAS ne Woe Ale te ot a asbestos diseases ensuing from asbestos exposure during childhood were attributed exclusively to occupational exposures The published data however were not sufficient to determine whether the asbestos diseases were mesotheliomas or merely radiologically diagnosed pleural plaques The contaminated work clothes of siblings also poses a risk Newhouse et al 47 mentioned three mesothelioma patients who at three years of age had been exposed to the clothing of sisters who were working in an asbestos mill Between 1965 and 1992 many reports of mesothelioma cases that had been linked to contact during infancy with the work clothes of either fathers or siblings or both were published in the United States 15 Canada ) England 5 Germany 2 Sweden 2 Italy 2 and Australia ) 19,32,36-37,42,44-47,51- 52,55-59 see 60,61 for overview Occupations of the siblings comprised working in an asbestos 47 an asbestos 1571 an asbestos 56 and with asbestos- products 46 insulators 132,37,38 carding- machine cleaner 51 pipe lagger 55 foundry worker 58 steam fitter 40 glass 52 and shipyard industry 45,52 workers and a railroad worker 44 Twenty patients had been exposed to fathers and eight to siblings Several reports have described a family clustering of asbestos malignant mesothelioma in patients with household exposure 62,63 A review by Dawson et al 164 covers 27 families comprising 64 40 male and 24 female mesothelioma patients only 30 patients had a history of occupational asbestos exposure The exposure of 11 patients was exclusively through household contact 6 others lived near an asbestos factory and 17 had no known asbestos exposure Otte et al 65 described three mesothelioma patients in a single family where family members had helped with packing an asbestos product that was manufactured in a very dusty atmosphere in their home In another report 58 a pair of siblings who died of mesothelioma had been exposed to asbestos solely through the workclothes of the father who worked in a foundry where asbestos textiles were used for heat protection Other articles describe mesotheliomas in multiple family members mainly wives and children with no occupational history of asbestos exposure Krousel et al 40 and Li et al 137 42 reported that wives and daughters of insulators died from meso- ; thelioma Like others the exposure was due to OF inhaling asbestos while washing the clothes of the husband During infancy one daughter had ame reportedly worn diapers that were made from nN cotton sacks that had been previously used for storing asbestos We can infer from the evidence presented in this case series not only that mesotheliomas caused exclusively by household asbestos exposure are a problem in Germany now but also that such tumors will continue to appear in the future During the period of reconstruction after World War II the annual consumption of asbestos in the Federal Republic of Germany increased until the 1970s In 1975 for example 164,000 tons of raw asbestos were turned into about 1.5 million tons of asbestos- containing products in various industries 66 Accurate estimates of how many workers were constantly or occasionally exposed to asbestos during the manufacture and use of asbestoscontaining products are not available but figures of 800,000 such individuals have been claimed 66 About 45,000 workers were employed in industries processing raw asbestos which is a plausible number A relatively high fluctuation in dusty jobs can be assumed 4 A valid estimate of household members at risk cannot be given In our policlinic the latency period for the malignancy ranged from 17 to 36 years which is typical for occupational pleural mesotheliomas 67,68 The duration of the household exposures7 to 23 agrees with the reported range of 2 to 41 years 47 In England shorter exposure periods preceding mesothelioma have been reported but it should be noted that in such cases the first year of exposure fell between 1912 and 1941 when occupational hygiene standards were rare The combination of short exposure periods and the long latency of asbestos diseases underscores the significance of taking a detailed exposure history of mesothelioma patients who claim to have had no occupational asbestos exposure Such patients should always trigger a suspicion of secondary asbestos exposure through household contact ASBESTOS MALIGNANT MESOTHELIOMA 69 REFERENCES Butz M. 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