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41be supplied free q{ vailaWe on tht pay. additional reprints e form sent with the c Editor will not be I British JournalofIndustrialMedicine 1588;45:5-13 Mortality in miners and millers ofcrocidolite in Western'Australia ' -* may be subject to *8. ubi , editorials jommatioaed. The regarding suitable in editorial. howdiscussion wth the BK ARMSTRONG.4 N H DE Ki-ERK,' A W MUSK,1 M ST HOBBS* from the NaiwmUiealth andMedkalResearch ComoilResearch f/nts to pamwlogyandRremulve Mtdicine,1ptpanmenl ofMedicine. UnberrityofWestern Australia. Perth, the Deportment ofRespiratory Uedi&i*?Sir CharierGaadntrUmpired.Media*is,mdU*#efCibsuolfyidetmohgpj Department of Medicine, (Mwrifty ofWestern Australia. Perth, Western AvareJia abstract H ia known that 6505 toot sad 411 woowa wen employed in the mining and mining of crocadoiUe si Wittmootn is tije Pilbara region of Western Australia between 1943 sod {546. EjnpJoymcBi was usually brief (median duration four months) and exposure intense (median estimated cumulative exposure fs&res/ccyears). The vitalstatus vf73% ofthemwand $8% ofthe women employed in the industry was known at 31 December 1980.providing95 204 person-years of follow up with 820 deaths in men and 49Mperson-years with 23deathsbt women. Tbestandardised mortality ratio (SMR) for ail causes ifrtnen was 1-53 (95% confidentf intern! 1-43 to 1-64). Statistkailysgnificaatcxcesdeath rateswereobservedismenforneoplasms,particularlymalignant mesothelioma (32deaths),neoplasmsofthetrachea,bronchus, andlung(SMR264), and neoplasms of the swfftsch (SMfUl-9% respiratory diseases, particularly pneumoconiosis (SMR 25 5); infections, particularly tuberculosis (SMR 4*09); mental disorders particularly alcoholism (SMR 447);digestive diseases, paflseulariy peptic ulceration (SMR 2*46) and orthosis of the liver (SMR 3*94); and injuries and poisonings, particularly non-transport accidents (SMR 236). The excess mortality frompneumoconiosis, malignant mesothelioma,and respiratory cancers, but not stomach neoplasms, was dependent on time since first exposure and cumulative exposure. There was ao increase is mortality from laryngeal cancer (SMR 109) or neoplasms other than those listed, The SMR forall causes in women was i*47 (95% confidence interval0*9S-2O sod for twoplssuss l 99; there was onedeathfrommalignant pleural mesothelioma. Numerous epidemiologicalstudies h*v* mmiftfrf the effectsofexposuretoasbestosofdifieremtypes*. Few, "however, 6a 4oak .(risk .expanar Ur ootidoUte akroe. they have included follow up studies of wartime gas mask workers la Nottingham" and Uyfead* is England, where West Australian eraadoSte was used, and Ottawa,* Canada, where the source of the croddohu was sot stated, the prcpotv tion of female workers is dues stsdies ranged from 43%' us MOT*.' AH nodiet showed high mortality from meaothehoma and tome showed increased mor tality fromovariancmas.uTheeffectsofexposureto South African crocgolite have ben examined through a case scrim* and a cross sectteaal survey,* both studies iadieadog probably high metorbetoam mortality rates. A raxnt nudy comparing mortality rases tncroctdofrtirfftroogdirtriew with otherdistricts m South Africa also showed high death rates from `is'bcsusm anWor mtsoibeUoma" as weU as excesses of deaths from fdeg eagecr.-st3aach.caacra. attd tuberculosis.* Crocidofitt was trdned at Wtteooom Gorge ar Western Australia from 1937 uatii 1966, From 1943 until 1966 thc'ptisapa} leases were mined by a single company, Australian Blue Asbestos (ABA), which employed orer6000 people. mostly for short periods. This population presides %e opportunity tostudy the effects of a short period of intense exposure to croctfotices&rteax fewemployees bad otherasbestos exposure to mming or manufacturing industries and most stayed m Western Australia so that H has been possible to determine their present vital status. Measurements ofdustcoocestratiofu in the industry WV-004280 6 therelation between fibreconcentration and mortality in this population. Previous follow upof thiscohort to the end of 1977 showed increased mortality from pneumoconiosis, malignant pleural mesothelioma, and bronchogenic carcinoma.' The increases were related to duration aodittcAUty ofwposuitiomwidoliteand time since ~ exposurebegw.Auhu timethere had beam nodeaths from malignant peritoneal mesothelioma recorded Itv ihis population and therewas noexcess ofdeathsfrom gastrointestinal cancer. In the current study we hare extendedfallow upto theendof1980and undertaken searches ofdeath registries in all states ofAustralia to provide rowaccurate d*on raonairty. Sheets Data 09 employees of ABA were obtained from emptoyrnem records ofthe company and supplemen ted by records of subscribers to t mioewocken benevotou fond (The Western Australian Mineworkem Relief Fuad). Name, data of btnb. age at first etnptoymceX. o&tloaslity, dates of employment, and occupation* at Wtttrtoom were recorded whenever possible. Additionaldatawtt obtained from records ofsubjects presentingthemselves forcompulsory chest radiographstaken by the PerthChestClinic. Acohort of6506 rsate and 411 tensis employed wa ~trrr bfed. M&o* 0ETEBMIRATION Of VITAL STATUS The nanus ofaO workers in the cohon were searched -- forin death registries mall states ofAustralis from i faunas* J5 to l\ December *980, *U state and Commonwealthelectoral rodscurrentin 198i orlater, all Australia telephonedirectories current-in 1912<w lataf. aad record* ofpermanent depanurc overseas in the period 1972-fi held by the Australian Department of hnxoigratioa.The names werealso searched forin ..aeeoRls-cf tbeTJneaeKxor&aa boards and cancer registries of Western Au*a*8a, Sew South Wales. Victoria, aad Saudi Australia, the principal public hospitals ra Western Australia, and the motor vehicle driven tensing aufoorite in Western Auarafia, Smith Australia, and New South Wales. Matches between aware ofpeople in thecohon and names in three records wereaccepted only after clerical inspec tion of *U identifying data ia poteatiaUy matched records. Use ofrecord* of hospital and cancer regia, tries for the deterretDation of vital status meant that subjectswhohadbceo ill weremorelikely to be traced than thosewho bad net , Anumoof, drKltii, Musk. Hffb> ESTIMATION Of CUMULATIVE EXTOSCBE TO CRoctQoutt tiaaes Measurements ofdust concentrations m trie airofri mine and mill at WUtenoom were made periodical between 1949 and 1958 by the Mutes Department c Western Australiaminfig total fou pastteSreperctfiwbenomStre (ppce) wereeountsdsni the uppermeasurement hreit of IflOO ppce was oftr> exceeded. Thesetnea&urenKMs wggestfore,timewv littlechangeta total dim concentration in this period at least untila newtniS wucoatisustoned to Septem ber 1957. AwcdotaJ inftonnatioa indicates that it* Mines Department inspectionswereoftenprecc&dby shavdown ofopmtiet#. The concentrations ofairborne rrephmbte fibrre of owidefce greater foao J vaktota a teagfo were measured in various workplace* in * survey under taken fortheMines Department In 1966.*Sampfe*for counting foe tusnher of foes wre tafc^a with a CreaSa long ruanisg thermal precipitator. The dure* tionoftnostsaavpleswasbesweenfourand fiveboon. ACasefia gravTtnetricdustaaD^erandaHeafolnwere used tocollectdust toestimatensasa. Fibre <Mecewra- ticas varied from 23 fibre percabieemiimOtr(f/ce> tocanals part* offoe tram to 100 floe in the bagging area of foe cafe. The ratio of fibres greater than S nticronl hi length w total pankks varied from i-3% . to4-0%iod*sae*a. ) Using foe judgement of an cx-superimesdem of [ operations at Watesoom (who bad a Agtaflei t fceowfedge of sO jobs on foe the throughout foe J production period)*U87jobcategorireta foevarious j wdfopteeaweregradedonafito 16scaleofestimated } fibre levels for both before and after September 1957 when a less duy sull started operating.Tte*grading was verified by the sKfcmrial hyguafot who was ? responsible for the 1966 surrey asd again by the ex* 1 superintendent. By equaljog the padre of the wort* \ places withfibre hrvtb knows from foe 1966 survey it | was possible to estimate, toy linear interpolation, foe fikdyfitettnceatrstioBsapplyingtootherjob/wwi* * place gomb!nations. Each, subject's <ustuilatise .eapawgfrwascbeotaicuiatcd aHwe yean per cubic centimetre (f/ecy) by adding over sll their different 1 jobkfoeprodumcdibreeoncntretionforthajtjobapd 1 the length oftimere thejob. f MdlTAtlTY . Especxed numbers of deaths to foe cohon we** * calculated by foenM-yeara method1' by use ofage, ^ period,cause,aadsc*spebfie death raws fre^Westren Auatsi^a. Tbese taaa were prepared for titis study from annual ufoidatioos of deaths prepared by the . Atatraiifla Bureau ofStatutes- Thecaknd&i perioda * adopted were detigsed to begin or end with yean of chaise from one rcvmos of foe ImematioaaJ Osa-  Klerk, Musk, Hobbi EXPOS UM TO tiions in tiw airofthe .tc made periodically fine* Department of ttt>Only totaldual <c>werecounted arcd 1000 ppcc was often .uggeat ibai therewas (ration in ibisperiod, missioned in Septemjp indicates that the ere often precededby te reparable fibres of row ia length were $ in a survey aadet:n 1966."Sampiesfor were taken with a ecipuaior. The duranfowandfive bows, eraada Heshtet were us Fibreeoncemr*' ubkrrentimeier<f/ec) JO f uhflbeggiflg fibre* greater than 5 fe* varied from i-3% cx*sapenntendetu of ho had a detailed site throughout the rgories m the various 10scaleofestimated ifter September 1957 erating. This grading hygienist who was *ttd'Bgore by sbeoagrades of the work ers the S966wrvey it ar interpolation, the ig to otherjob/work* ubject's cumulative fibre yean per eubte ail their different ation forthatjoband in the cohort were .hod11 by use of age, ith ratesfor Westers pared for this study ths prepared by the The calendar periods ore'-1 with yean of - In ition&i CJaw Mottahty In amen andmUUnofcrocidotiteat Wtsitm Australia sificstioBofDUeasedCD)to thetreat. Thefirstperiod TtWg t Pfnvuagt Astrtbviiataefjvbfttirurfnpkie was 1950-3 ddeathreteaforthisperiodwereused to 0^*etkrtiafeddiaraa*ratl& a Wiiwteom calculate expected numbers of deaths in all personyears accumulatedIVem 1943 to 1953. SMRs were tbeo calculated as the ratio of observed to expected CtMrmma M(*omt tXS) IVmm (m - 4lt) deaths. Because ofthehighproportionofsufejecutwho were nottracedtotheend fJ9&>, mostofwhomwere not traced beyond the esd oferejdoyment at Wittenooq (are 'below), and the substaiuiafiy corepkte ascertainmentofdealhj(at leastinAuonliakconvtndooal method?ofcalculation will probably giverise to as overestimate of mortality. To deraosnrate this forty btsi and to provide maximum and minimum estimatesofthe effectsofeoddotite exposure, capes* ted eumbera of dealba were calculated with two different censoring dates: 31 December 1980 for SM*1 and thedate last know* tobe alivefor SMR2. Theformeraasumes that alt subjects who were lost to foSow up were alive at this data. AH tabjeQa were censoredatage85 Ifthey werenotknowntohavedied bsfore thatage. To Sustme possible effects ofcumulative exposure to crocidoSte oo mortality, death rate* for different causes,directly standardised to the world population of DcQ,d < calculated within groupings of time sincefirstapostsc and total cumulativeexposure. Resafc* yew of ft* aupWymeat: IWV4i_. 1S5J-S7* 19H-*2 1MM7 UftMM Agem fim inijfcmimu: 10-44 2S*H >1$ tlnfcnwOTi NtUasahtr AuKRbu AwMaasarSniHfe OUot Ifcfcm WMfOiatUo:Hj Waeattlr MaudcSrdiect Mtaeasdto**B*t tfekam PtBvUoB ofe^tosmeBUS < i iBotus l- SaoMitf 44TBMUM I- SJWI 9fytm UefcBBWB DiiuninitnfriidiUiv pa taftejM CHAXACTEftlSTICS OF THE WOftSFOaCB (Man m ? a-e 90 W-6 art 25 1 12 225 20T 3H !S4 i ns 15-5 >j 12S M 193 u-s (H 2-T 04 creddoEte 5M 41 4 1>3 ns 294 321 OS 401 2U 262 102 114 1M 154 ISO OS OS OS 04 90S OS 101 :r? m as 10 24 sa-i 04 74 Staff were first enjoyed by ABA at Wltlenoom is 1943andthelastterminatedemployment therein 1967 (laWe Ik Most were employed after the new mill was started in 1957; the median year of first employment aOT*SBHWOTae*mM*SqKbw WT __ ^ tWJm4eWw^mrwwmt>aremsotfe^v<resdM4wai. tHMw 4WWVOT far mowOTW we*-vrt renod*TusSmw WwioB0'U. was 1959. Most subjects began work si Witienootn beforeage 30andworked there for lessthanoneyear. tndeetii9%-wcrired there-for-tea thaas>moeth,'C reflection, perhaps, of the poor working end living conditions." The median duration ofemployment was fourmonth*. MostoftheworkforcewasorAustralia or Britishorigin.Thecategory "Australianor British'1 (table 1)refer* to peoplewho gave theirnationality a* British." It wascommons* thetimeforthose bomin Australia of Bri&h origin to consider themselves ofteasafasgger. . p?rp^-^J<BiiMm.^gh.flhrpennermratioos to the ma.mostsubjecaacMmulatedkss thananestimated I00y of exposure ami only 5-5% of men eecsitiated more than 100 f/ecy. Theseobservation* aresubstantiallyexplained by thecomerslively ritort ereidoymot periods. The medka estimamd cumuliveexposuretofibreswaafrORccy in menand G-5 f/ccy in women. British and death certificates indicate that some 39% ofthosesoGasifiedonwork historyshewswere bom in Australia. Momenworked inthetmneormiUand sometimes both (table IX la total. 31% of those with a known worksite worked in the msU. the rite of heaviest croridclitt exposure, at sons time. Most women, akboogbemployed by ABA. did not work m themine orthe mill,orevenelsewhere on the siteofoperations, but in the town <80% of(hose with known workst*X Two women had worked to the mine as surveying twB.M? two in the mill, one as a oulihaad and fOCLOW ur Tbs vital status at 31 December 1980 was known for 73>2%ofraceand58-0% ofwomen(table 2>.Tolabof 135 513 person-yes&rs of follow up were recorded in men and 8718 person-years m women ifthose lost to foSow up were considered to be censured at 31 Decembet 198$. end 95 264 pmoe-yesn In men and 4914pencft-ytarsistwomen ifthey wereconsidered to becensored auhe daw last known to beahve. To indicate the possible effects ofloss to follow up on the resultsofthemortality analysestheparentages i. <f. ;JX t Table 2 Arnd/j efmetnt ofsubject* SI December 1986, {aw }l Drcw^mo Urn He K Dad Aka Pefcwatady wniarmtd ftgaAiitifU* (miaMMw No folio*upjnfomMioe Tnadafter tads* cwntopMot bat ton MWit Demebet tW 820 isu tM 12* 1*9 td i&9 2j-e US IS Wemr He % 2) J4 309 S09 IS S66 7 1? ofctrbysxr *t*2r toess fotkiw up beyond Jeraswiatka of employment are shown withincategories ofdemogr*. phieandwork relatedcharacteristic*intable3, Follow up wu fpoea&y stalest is those with complete identifying information and in those ofAustralian or Sritisk aeHotu&ty who were mptoyed recently and fee loag periods. Fallow up was cxpcQally poor in those employed at Wittenoom for fes* than a month and (hi de&dt is reflected ia the low proportion flowed up b the lowest category of estimated cs&mtetire exposure tecrocidotott- WOITALITY Table 4 shows the SMRs for all causes of death aad categories ofcause fdeath as defined by chapter* of dwICDfS^hfewion)according totberivocensoring methods. SMRS {censored at 3! December 1910} for all causes wu just undn 1-0 ia both sexes whereas SMR2 (censored at the date last knows to be aSve) suggested shout & 50% Increase in overall mortally. in nren, reganttesseftbe method ofestimation of the opened number of deaths, there was increased mortatUy free infectious and parasitic diseases, neo plasms. mental disorder*, respiratory diseases, dips** dvc'^fiseasos. and-symptom, asgnx. -and all defined foodjiioBg. For eareslfltwy dmawea, mortality was substantially tea titan expected under censoring method I CSMRt - 0-fiT) and near that expected under method 2 <SMR2 MO). For injury and poisoning SMRI was ms unity whereas SMR2 was jjgnifissBtfy increasedaboveunity. Thefewdeathsinwomen Limitsthe informativeness of cause apedfie mortality analysts. Mortality from neoplasm* wasincreasedmtiyundermethod2 (SMR2 1-99}. Oneofthe Ifldeaths fromneoplasms wwsdue tomalignanttraaothetiomaorthe pleura (MMPKtwo tooth respiratorycancer* (expectednumbersofH9 and O'TO under methods 1 and 2 respectively), two to cancer of the cervix, and one each to cancers of the brtan. ovary, skm. tongue, and colon. There was no suggsuon. on review of available records, that the cancers of the ovary and colon coidd have been Armstrong, de Klerk. Musk, Hobbs U&UiH< peritoneal mesotheliomas. The two deaths from n* ^ piratotydiseases (certifieda*due tochronic bronehius J*** f' and tapiratotyjafecuo^. wu^^nsi^t ------------- twofold increase in mortally from these condtuoAs. There wasalsoahighmortality fromdigestive diseases based on two deaths, one from intestinal obstruction without hernia aad one from cirrhosis of the liver. _ ....... There was no suggestion, or review of available wa records, that the death due to intestinal obsiraetioa could have beesduetoperitonea! mesothelioma, SCO chapters with oitiy one o* no female deaths were grouped together in the "*B other causes" category. There were three such deaths, one from a motor ____ vthtdc accident, one from senile dementia, and esc JJJSE from nephritis. Sowi"** To obtain sore specific mdicatiow of the &efy causesofincreasedmortality inmen, theICDcbapten , which contributed to excess mortality tinder both **** methods of calculation of expected number* were subdivided imo smaller categories ofcause of death. To avoid amfioaUy raised SMRs due to the poor {2m speeifidly of cause of death coding for mahgoant fcrradfm* pleural mesotheHore*,- subjects known from other ____ f*Wr3 wiiMfmtfeBo**9bryeed urmmatb* efempisymnu si coirgerin ofdrmcff4p* and gymgap work nbueddtsrmtetdiiettu Wiimottn OnwMd Him YouofSr* (BvotovBtnc 194M2 t3-97 I9SP42 ms- UsJuwiw Aceaifem tnMwK ie-M 29-M > UakWMB riHimitiljAatutSu AWft*awflntdA Otto Uakew* Womens M&mb MFseewr KoMiMhdns oor BUM N**kerat&aerw IMzewv DansiM e(erfltoyw**t < iBMlfe Sswna* M2 Mete 1- Sywm Sjem Vtkoow* finsauaesRMtsuw Msmun looroebottu: otifatnn >lOwiBn tiakWMa 71** 7*7 rt-7 7*i me* 7*1 740 }*| u ts*t ?*2 712 M 74* 7H *2d 7P9 W 4tr* 7M 7T1 *0-7 h\ 7** 7*'2 til U+ fTmmn ( 4111 m 5*2 4*% *H SH 7*0 721 5 s no SH 90S sem S>0 ! SH *>$ Hi 7H TJ'S 7H *6-7 s IU K1 ia :tefk, Musk, Hobbs MortalityIn minersandmillers oferotideHte in Western Australia 9 o deaths from res-' t i Mortalityfrom aOtmsa anduletitdchapterseftheInternesisoalClaatfieebenafBbtbm tnm&mfmSm*3wfie<mwt&3e?ifit > chronic bronchitis bewn oferoeMiie at Wtiienoom. Western Australia consistent with a 4 n these conditions, - Mm amm m digcstivc fliscaM3 tcyinal obstruction thesis of the fiver, eview of avaihthfe cstinii obstruction mesothelioma. ICD emak deaths were f causa' category, jne from a isoior dementia. and one sum sHMm^ KMO turn 44***** iwMWM*ad l*aEKS*t tions of (he likdy tt. theICDchapters ns&y under both icd sembcrV were . ofcause ofdeath, s due to the poo* ling for msfigum knows from ibex n> aLiBMPt jiudiiunw asumireiMHUBB suoauauiwul iAnttoomorn rruriWMKBBi xkwraMMi rcov tttop&f i Q V VI vn vm a X XVT 3CVB mrvs XT-XV Obmoel Motto | 14 20 tt MS a 4? 14 14 m 19... stt*r 04* (040*1431 >7) (145-24?) M3 (044-1301 2*10 (MS-346) 102 (6VMM) W (0S9-0W >44 (HW'li) 043 " J40 to* 404S-I22} 044 (IHS-i' Homor SMKX Hi (143-404) 247 (J-6JI> 143 (i-eo4-t 344 (2-36444) 143 (640-243) 110 2-30 (2<52->M 246 (ISS-3 77) 133 (P79-2M) U* <i'5*-M1) 147 (1*24^<73> 121 $72-2) Qtmrml 23 --i " -4 SMMl` OSS fOJVIJV) H7 43-211) -- SMMtf 147 (04S-2-2I) 14* (fOT-J-TO) -- 6 040 * 143 co-n-un (046-229} 2 1<72 249 RM3-689? {0-1S-i2fl) 2 2*17 >11 4M4D (04M32V --t " --t n 043 (036-243) 144 s> ten ivnt, .jmrttpbeymd <ma*mc*U u31 Decemberms, s tfdema$repfue tmd hMteettumudustua kooM (eheabvc fl&gm--torteamndadadmpten I. fli-V!,adX-XYTL Oil f 411/ SH 2 Wi 615 Sit *7M> m 9S s**> 34-3 1)4 Kt 4 300 300 ten 333 J snss< 7)5 350 467 JS J S3* 361 sources ofiafoimaiion to have died from this disease wereexcluded fromtheobservednumbersofdeathsm thecausa ofdeath towhichthey wereceded ondeads certificates. Of the 32 such deaths, 19 were ceded as ffeuftl neoplasm* (16malignant. 3 benign),cinewere coded as lung earner <8 malignant,! undemrsnoed nature), and twowerecodedasmultiplemalignancim without specification of site, ooe as lymphatic leak* sard* end ooe aschrome bucrstiual pscumoma. Table S shows the results of the oaoriahly analyses forthese smallersubdivfcdoo*ofcause ofdeath in was. Infectiousandparasiticdiseases--TheSMR fortuber* culosa was large under both censoring schema (2<? sod <61 respectively} and seamed to account lot the escew ofdeatiufrominfectiousandparasiticdiaasrs The other five deaths is this category were from unspecified viral disease* (2 deaths) aod septicaemia, Bemsgococcstl mating]tis, and actinomycosis (one each}. foeptem*--Apart from pleural mesothelioma only neoplasms of the stomach (SMRi - l<2,SMR2 I*9)andneoplasms ofthe trachea, brooefcua.andlung (SMFI - 16, SMR2 2-6) showed raised SMRa under`both censoring schema. Among other neo plasms for which exposure to asbestos has been cmpHcaied as posable cause, there was ooiy one death from peritoneal mesothelioma (0 expected under both schemes) and there were two deaths from laryngeal career (2 9 and 1*8 expected under the two censoring schema). There were halfas many deaths from other neoplasm as expected under censoring scheme I but near lo the number expected under scheme 2. Mental disorder*--All HI deaths from mental disor ders were due to alcohoists (19 coded to alcoholism and 1 to alcoholic psychosis) with 6*3 and 4*1 deaths expected underthe twoschaos. Respiretorydiseases--A targe proportion oftheexcess deaths from respiratory disease was certified to pneumocontosts <Mobservedand2>3or 1*3expected). Therewore22deaths-due to bronchitisoremphysema (26*5 or 14-9 expected) and 26 to other respiratory disease (28*0 or 16*9 expected). These 26 consisted of 1? front pneumonia, five from chrome obstructive airways disease, and four frominflusaa. (^sr^tf*e*c*--T1re werelargeincreases in moftalUyfrom bothcirrhosisofdie liver<25observed, 9-9 or 6*3 expected) and peptic ulceration (12 observed. 7-6 or 4*8 caponed). The 10 other deaths from digestive diVi*** tnriurfM two froot other liver dis ease, two from pancreatitis, and ooe eaeh from intestinal volvulus, gastroenteritis, oesophageal db* ease,intestinaldiseasenos,disease oftbestomaehnos, aaddiseaseofthe paecrea*nos. Symptoms, signs. and01definedeondiiteai*-Ofthe 14 deaths in this category. 12 were coded as cause 10 Armstrong,drKlerk, Musk, Hobbs,' Mon Tabic 3 Dttaded maiysis ofmortality f>m mfreiiovs and porosine diseases.digestive sysimdiseases,andmftoyendsessmungin nn . nenphtmu. wmfof disorders, respiratory \ Cm* efdeath la/acbom sad jgliamc 4njw: * TubnmtOiH OOof feoptani.* Natrium'e(v&crMKd9BUm uaat Naopttof alocccpteftn Tfnflimir n( nrnnaii Mteptunr at ituwwi tnd^ta| nciib HwWinMtfyuaw OtherJiciiwm needmal yfCOjiUHH < ||QW Nm)wvlnaalMsoMAiN jgs| Tilitinrn tnnrliftiinn rf Him |~lriri| lioopimmrai Uk pouaw LyspbOBU aM aoefcna Otto* MumliMifirfkii fjtobodsm OUter knpinitwj dttmMK SraadMo lad cmpferwvu Other ftpsamflumcE repoe tdnmooo CErrhaeacfcte (aw Other Oimnti Omit 9 s 5 J 11 14 t 2 3 91 5 t 23 a 0 M 23 a 1a 8 sun 2 72 0*2* 5 24) . 1*9 (0>v 2 411 01$ <039- 2*5) on re-24- 2 22) Hi t072- 117) Oa (0*1- HI) >1k (OUr- 1 39) 0*5 (Oil- M!) 044 (017- 2-74) 140 <t'3>- 1*7) 4S7 (0-24- |.J1> 04$ (024* 1*0) 051 (0W-077) y\b (24*- 449) SUM 3 B:y"acn...-h .*. 409 {21V 714) 144 (&4V 395) .............. l-JJ {050- 925) I II (0- 344) 190 (MS- 344) H4 94V {93} HI (OSO- M3> or! roivaas) 149 (02V0K> 244 (215--324} (<9 ^4*. MJ) 097 1044. 714k &S0 (03V )-2B) Ort (9 IV135) 1. g 1 1 li t 001 -2M1 OG (035- 1 ) 093 (04i- 137) ! 1090- 2 2 35 (t - J W) &r (04*- 1-6*) 25 5 (IS-2 -JS-T) 1*1 {097- 2-151 1*4 (14V 227) 2-4* (141- 4>37) 39* (244- $45} 1*0 (073- 24* 4fl 35 30 f 25 Il20 15 1C 5 OtheracofeMM SMddt Hamack** M 070 a-54- 099} ire (orv iw Si 142 M2) *36 (1 11* 549) 31 090 (04*- S-M> 139 (100- 1911 HI (052- 3-41) 196 fOH- ym tefoeKlaenstiacd eeeitfe. flip. tfflfBfc tfmat fwa, (lawerfntarta. other with. orepawym. mjwpljeryni. bffH**ryBX. oOm pfejgyta. anal guftka. Obc Cbm* dtec to ctehnaa stcwtbttMtwqfOepewonewn fOfifaeUhaeaeeeeoM nh(sui pbsnlmm&en*. rt> iawegahamaoe. bum teaeepiUBL ad ami poctum*. The* fcm feeea euAekd ftoaathe iailttr Uarea ttnetotimm the itbstace. jtac&to effeaaeof fl ecaflewta. +tK&*Us cteti*due iajery set luwwn *MNf Bfioflicad or bm. **BdaUltaapgTofBByiafliortuqttrT*cttM *2 S <e . unknown, one dyspnoea, sodoneas asphyxia. fnfitry and poisoning--Most of the ateas mortality from injury and poisoning tame from the $3 deaths due (o non*transportaccidents <327 or 225expected) spread overmanydifferent caqsre ufollows; acciden tal poisoning 0,fails iI,fires4,cataclysm {.drowning -% ending 3, duttuag i, machinery 4 (2 whSt employed at Whteooom). electridty ). firearms 2 (l while employed at Witteooora). exposure 1. undents NOS 8 <i while employed at Wittenoom),comphca* dost in noo'therapeutic proredwts X and lets effects ofa motor vehicle acekfent 4. There were 54 deaths from transport resident* <71*1 or 500 expected) including 49 involving motor vehicles (1 while at WHtenoomfc threw mvohisg railways <2 while employed st WitcesoomVaod two involvingatreraA. There were 37 uiksdes (38-7 or 26*7 expected). two while sliM employed at Wittenoom. three violent death* that were undetermined whether acctdemafiy orpurposefullycaused, and fourhomteidea (2-9 or20 expected), poss-sesponsb bilations The figure showa-the changes in age standardised death rates te (osb categories of time dace first exposure to craddolue for four major diseases of interest m three categories of cumulative exposure. The smaller estimates of penoa^ycare {censofmg schgne 2) were used T^ereis evidence ofan effect of exposure oa monafily from lung cues in both level ofexposure and time from fire! exposure. In contrast the graph for stomach earner shows oo consistent evidence of dependence of mortality on cnddoUte exposure. Threewere no deaths from daiscause in the highest exposure group and only the lowestexposure group showedany increaseo ratewith time fromfirst exposure. Te confirm that the raised death rate for stomach cancer was oot due to misdiagnosis of peritoneal t&ac&e&xna, a possibility suggested by Doll aad Pew,' the bases for the death certificate diagnosis of the 17 deaths from stomach cancer were cammed Apart from four deaths that owtamt before 1970, Ages itrtb Q-- A-- whe pail stor V ORh The tkm The evki a1 p de Klerk, Musi, Hobbs re/ dis&dt'i. ftapvasoty S#*l * <21V ?6> M4 (Otf- 34J) VM .**>23) MS (O-J*- > 1*9 (lit-)*} H4 fMV 142) J 21 <* 2-SS) -07? IMS- 24$) 37 244 <2 (-->24) | (04>. 241) 44? <04*- 216) 40 (0}>- ( ) *17 {) I*- MR 239 <182 -J37) 1 tf <481- 2 22) 1W U43-227) 241 <|4I-4 >7) 34* 343) 140 (fr?$- 240? tf98J- l* (Ml- 349) IJ9 <}- 141) 146 *74- 322) Mrjm. au4)**, y4rmine/*andmiiitn ofcrocuioitit m HVswre Australia Cancer of stomach ip -xgcmudftfdacd i of time since fast Jr major diseases of .umuiatire exposure. ;on-ycars (censoring ideoce of an effect of i carer *n both farwi :xpourc. lacontrast 'hows no eonsisuau -taftty on croddofite >om this oosp iathe the loweu exposure e wnh'tune fromfirs nh rue for stomach /no*rt of peritoneal sewed by Do0 and ntficatc diagnosis of *cer x examsod cur. .xfore 1970, Aframdardbeddeathromper WOC&}persP"yt<mforipec$*coxae*by Urn fcwftcfiMd r'tmdnjb* txpojwi tomdd&e- *xpo*d toeroei&Q*ffrdtffemu --------- Q`... O A------- A * ........... < iOfluy 10-WO fitly >IOO/Jtty gjf combined(ntefidtofvnbuwnexpom*). where the death certificate was the only data scarce, paihokjgrcaJ information confirmed the diagnosis of stomach carerin each case. This updated and detailed review of mortality in the Mortality ftem mcsoibdkwns was misted lo dose cohort ofcroedohie workersfrom WirceeoomGorje only star 29 or more years since exposure began, has shown a stnUar pattern of disease to that, there were, therefore, indications of a longer indue* previously observed.* There were exposure related lion period for mesotbehonsa than'for king cancer. increases in mortality from pneumoconiosis, malig The dose effect for pneumocontosia. howevci. was nant pleural mesothelioma, and lung carer. These erideni much sooner after firstexposureand therewas increases were present in ell exposure groups, includ a mock greater difference between the highest ingthelowest with < 10 f/edycumulativeexposure to exposure group sad the lowerones than for the other crocidolitc. There were also increases in mortahey diseases. attributed totuberculosis, malignant neoplasms ofthe otherexplanations art required. The best catenateofthe increase in overall or cause specific mortality in thiscohort probably iks between * to comparisoaSftth some'otteR-,`*tui lAtfi'ttOUd 1 thattaiggtttMby SMRl *MteatsuggestedbySMRl before.* Shipyard woriten exposed to croddoSte, Wee- U is most unlikely that all objects who have not been however, have also been noted seldom to develop , N&tic traced& still afeve as anplted by SMRl. Many orUm peritoneal tnaoteelioma." Although Browne end . Aas* WUle&oc workforce were itinerant and many were Smithm showed a longer latentperiod for peritonea! >( Hf migrants. newly arrived ia Western Australia, who than pleural metothefoma* others have shows no ' with) desired more rerminemuw and less unpleasant work* difference." Other factors dacrirmtaiing between > Mft tag ssdfiringcondttfor*''so (hat theydidnot sesyin Witnmoom long. This is reflected io the data on dunttioBofen&ynamtwid the relation between it sad the proportion successfully foUowed up. Their -------- ---------- >Aj> Uau.n Uiiwi/un flam m^v vlferulu mewthcfiornaaiiieetmealsodisceBEiod^sewhare^'biR ft JBb Bofinncoadosiom were reached. . i Ccdt Other studiohave noted dmitareioas numbers of ' Mrs. cases of oaSg&ant mosotbrfioraa and long cancer in rep' Vu, nt npolan !a tMi Mhivt tkatw t. _ . taown.A proportion probabty returnedearlyto their waaas excessof lung cancer of34 or51 cases amen. ! country of origin, were missed In our search of depending on die method used to calculate expected \ { ^ departurerecordsfovail&Weonly after 1971) and haw number*, compared with 32 mesotheliomas. The ,i since died. In addition anecdotal information ocm numbers are therefore similar for the two * * * J mdkatrn that several peepte worked at Wittettoom conditions although tbs high prevalence ofsmokingin \ > under assumed names and changed their name* on thecohort** would account for someoftheexcess of j leaving. Wh3e theefcaomlroUoftheCdfnmonwealte hingcaneer. fi of Australia is befieved to cover some 93% of the tW increases st mortality fVtnn tubcrcvlosii and 3 ** population ofAustrafc aged IS and older fofeaorei stomachcancerta durcohoftmaybrcjrpbMedbyifetf 4A rcpaintiea il compulsory and the roll is carefully high proportionofmigrants from continental Europe !| manuairwrf) it is ccoa=vab4c that the former workers a the cohort whoare known to havea high mortality j at WHteaoom are overrepresented ro the 2% not on m Australia fro thesediseases*0 indeed SMR2 for * * che rcii, if otsfy became of tbs high proportion of migrants for siomsch catmgr was 3*7 compare! with } * * signal*. some of whom may nevq have become 1*7 for Australian or British bom worker*. the high 'Australianritlftret. Wehaveoo data that wouldallow mortalityfrail aleoboSsm and alcohol related eoadi> tj us to estimate foe relative eoatributiens of these tiow fdnhosis of the liver and peptic uker) Is fc various factor* the incomplete follow up. It Is consistent with s known high level of alcohol con- r 7 7 difficuh. therefore, tocome to any firm conclusion aa suatpttoa is tecWttttcooa workforce.0 .6 to where, between SMRl and SMR2. foe truth lies. Patterns of mortality nraiUr to this cohort have | We believe foai a is probably nearer SMR2 than recently been noted among a much tma&r cohort of * SMRl. former venreeu&e mlnett exposed to (remote*,* j, f t Possibly more acogtta SMRs could have been anotherampfebofe fibre. There was, however, ahwer 3 derived by assigning estimated follow op tiroes (o proportional mortality for mesothelioma and one of \ those lost to follow op on foe basis of average follow fomefourdeaths wasperitowalioorigin butatiailsr , uptkDC9tofoosewifo6triilardtaractcristks9idiiad pnjpoi'Uen of 'mgBotheUooxa-deaths .has beasi area n '* tatm^f/lCaWor.prreonafconeetKrafontk^ anwagSritahjisbeMre wim easffejed before the method,however,tsroddleadto furtherconfusiondue s-`" -r<,**J-' 4"---* * to coafoundingofmonabty with wtuchevercharaeter- isaka woe dwsea, espcoally aa the major difference between traced aad tatrared workers waa in their duration ofgapfoymem. locbntrast^fothepreviousreponoothiscohort,* sueztfots have bees made here to relate mortality experiencetofibre level*measured iafoeindustry,the results indicate dore-respemse eflbcts. Probably, hoawer, cumulative dose was usderestsmated for most men because the measurement* were performed towards foe cad of foe working tee of foe industry when atf dsn mpprearion measures that had bees ' msdtuted were m operatic. Aa e reauU foe estimates responserelafionla terms ofcumulative doseanotaa % problematical** for this cohort as it might be for 1 others because of the relatively short durations of < employment cmnparaf wifo duration of fotfar up, * Further analysis of foe data will concentrate on the exposure response relation for the separate djyasw 4 u&mg whhin cohort comparisons with separation of ^ does Jerei end duration end pFcyereioas for future ^ ricidenceofasbestosrelated crease. 1 y. ds Xierfc. WfaJk. tfo&fcr bm ter cauriog &*sat effects ofparticular'dose tty stearate. oihelionum ihiscohort hen"" has been noted tposed to CTOOtkfite. led settees to develop XHhoogh Browne *nd nt periodforperitoneal tuber* have above no ^scrim*&ttag bervtea isousedeUewhe" but ied lilar wees*nujobenof trtt and lung cancer In in tins cohort there *34 or SI cases in men, 1 to calculate eipected mesoUwlleRws. T^e similar for the fo natynce of smoking a * some of thecxces* of *. m ttbertulosis tad iy f- plained b? the tic jenta) Europe have highmortalty oa Meed SMR2 for i 3-7 ed with n workers. The high fcohol related coadi* nd pepoc oter| Cl rvri of alcohol eon* fore*.0 u* this cohon have A smaller cohort of *ed to uttaoUto,* is, bowevetaJew . Setkwa* and one of origin butasimilar ihs ha* been seefl npfoyed before th* Regulations.0 mftonal standard* ton (he diagnosis ;pt with respect to Tftsskso of doio itivedoseisnwas * ft.migu be for ^on durations of ion of follow up. sneetsme o* tht separate diseases to separation of <.lions for future ifcriahry inminersendmittenejeroekbttudr H'eflent duitraiki . .--_. ... ^ PS. A teeem svody of men retiring from a United States asbctfdS*company end opawd primarily to chrysolite has, however, reported almost identical SMRs for bothstomach cancer andtuberculosa.* dmfiftt AtSbiSm wwBjruttiWlr rmifrtmm. SxAuf, tHto. Spsacr Jotof Cool BbtU. 11 f9SO --,r--; rj-nr `^-f-rrf-r^TT^riiT fftiff 12 OgB a.Coftetoliito hi I V*W| i|uutofc iQ.iatfdorttodleuate WegratrfoSyacVrtovdedge FinandaJ support flora the National KeaJih and Medial Frvtrrh Couaai of Aunra^, CSR Ltd. and the Sir Claries Geirdfler HaspU&T&eseasch Special Puracsa Fuad. Help ihtheestimation ofezporore levelswasprovided by Mr C Major and Mr 6 ARaa. The help of Mrs B BJuasdoa, Mr P AUansoo. Mr A Uhraac, Mr* 3 Eedes,MrSWoodward, DrJ Baker. MsE Biogle,and MnA-M Haynesincofaeting data andpreparingthis report is gratefullyafknowfadgeii ttMaotot, WPC.Crmmf. t***H!.*.Cm vtotev A d*t iMortowff. Vff IU, L)ar tamttoaJ attata to* itM*M eo Cnev. to7fcM*?. B t^nooL Wori pad wrtm'napwaooi WiTwatem iwa aA fn'BQ'iiy AWto 19*i9;l-lA Wksl Afiuitom BK. iMN m. Raffn 3M. Mol AW. Sb&to KC, Tafftoen*Bt7 ftwribuHcaui wcootototoees tf too (Sosb*. oaf profoeticA tad w<futowaAswttos. ar^>^jrlWtUlUJ-7. HfbomctoL.Bgiraftuaigoftnon&tf jaiit.-nimteary * wcetaffto | rode* 4 HtAaiSct l7 to . ktonaxM C, Mu H, MMUtovcWeMemcf lltoftor*oOAiintoto<UTs)Mtf&ffMMOoato. toOl7. A M7 AntoSri to KeftfcBM 1 Pag It Sag J.efitumhrsMt/rxfta^firadesmtlnrdim! HnYfeuaMKm&*aaa,HM50;tyU 2 pact JSP, Saatb BG> hoatoy Fp. r aL TV effwtojaatn of. up--oww*imMiftatte* mm p**aaA tadnrf. tw W*aw JC. al towtoisto <tfr*o <*f w**ff Arcs. tMoriiwnt Aenany tor Trmnirvn ms Cm*, ietfr&lMl. (UgCKifivWNa#.}------- I WfrMflBK.?w aoeouhSnu, dr * Ai*t gO.^OaaW.StyewOWXOiteeU.Mwe^yef ro ffeops of vanvui a>e WBtokwut m fre toiiwtoto ito wieriin itfbcMfara totyofWto*n P/lad 1 MclfrmtK *D, Mittoufe 1C UoaMom ahw aeadoAM apoRn dwtag fU ut HUBtoam fla>*a* As m&cfJeM. S W^w K. 9*p CA. IttM P DUfat jemt a-o- <tiii,tuni frt uhniiHO ettowui tte Htoft Vooqn C*w Pronecs. p JIodMtdHeftlT TTofcat W.Hmw WO. Wen K'Upm\.h wrveyet Mm* Miat*offcmet the Qipoffeotfotomaul Ifc ty 17 Bte W/. fmwtoeeiiF.CmrcswaftotoywewerUn.!has QhflgrjSwmBWBaywitoiu/ oay. tlhnhi? (open N J No* Veto; CeU SpnBe Korber UMets. UtS-AVAA IS BfWBB K. Wtoer W;, Athutiowhrtrt no xiihn flumi toon* StoiAitoMiWN borwea (tewto wto SoowooMl Kto p J lad IS SoSagU.KMiWif tC.fM^roiiiH.tawBcyat*fw<m fwrato oaeew aMUtfee orttor to the LWud Mo ja Crotfo cm lebbiAzttotoe. 20 CMkn wa* M NK. Mato AW. Anauaes BX, <3iMy il.HobbtMVt. T^n*r>k.<nofoSto*rtto'**togja to wOrieofte ctoocn *ad rnOkn Wliuenoa. Wfftos Ae* ms* to*aswaterteea7CAso-i. 21 ItotoJg. UrntmanfSHkimiet fm*ntttfv**ie*4 rmphnti^mt toBMtWo*Q(tojto<nw.Wlo ^gawoe winrw Panto Utowtoy of Wtaora AwueSa. ins. fPfeO ttoatol 22 Ohh Mto T6toOdaRi Btotow Bawd Mtowto. Wwoiu AsWtoto IMA 23 McUfctoW AA wa HoniMRM M. Tt. Ptotorw to jwntfBoJ fttoxr to Eoreto*******'*** ^anrrtV toe mlc aftow> totuee. Av A Cmorr iMftZl* 4JN? Aiaffy tot itaMflffCM*, iwftrrya. (iA*c*s *m No SO.) i eai^tmftuLauffrtaHgiiiioiiwuiiiirnioiiii 'nu* aaoce. ham cirwr and Mbuim *oaw>c wnMhifiwii> to eMto^cOuftooiaadtons* toSMto Afticto 4m/SpPmdi tSSfetOJMO. 9 Kefato MST. Wm4wu<J SZJ Mofphy A Mvto A. Btor/fi. Tbo WatoNa of .......... ..... sstMieloeO *d atoor roapOKor) ub to bob mjjteto to mtoa# *d oStoa erotoStoceto UtomAumlto. to: WmikciCetdwtocfft fltos T Mto^to Sto**. lyow btfmummd ajuiry for HeMnto ofiComb. IW>s(s.u. OAftCd eW>6 4 to MgorO.Aihrftoi ihmmp--w.ta: M^nrC.alAmrfiiief M MoOtowtoSC MAatoUfA2>,AflBBoesASebantoB F.Cetowi aJyaftoowtoraf^wmniiitr iniunri lopo--j tnvoomukA .IMMieKWBto 23 ItodtlwiST. baaRg.Mam% <faff--wi owiMi g feaMafl ad Wtoto iM|. to J MMtf tptfcOl&M* . 3 ftMadfloH. WtOtoto ipoflviiiMPuU vwg. Anwtoiwn*w to Ac mumimoTtaw. SOn** M?tltolSfrA 2? Me J. Smm pcobiuM la doto^iopeBa cuimfftoe to eowwr itoitoin'ml"U tevea* V%. BtttferOCNotfDO, ftotoa DA oda. SMmP/Pntlm**rtor<toerto toWr* to"*** eW a to.Rbltoo Nr* Veto; Wifcy cadSaco. IttA 2t Ciii*iffnjti H. Mtodvr 3. Mcnicnm V. AtoRHac owl euear a CotoMt toflaaul Bp A dm*, to/hdttmtIVf7>A>eS-40l.