Document 4vv5wn3qMv8v8G6kZ7b31gkLQ

ST0I999I5 1268 \jy / z- ) mission's 1976 data base to identify chemicals used in in dustry but did not consult NOHS data, NIOSH stated. Hie omitted substances in this case were 4-bipbenylamine; dianzo methane: hydrazine sulfate: thiourea: and certain estrogens. Substances in Category I which should be evaluated to determine if they satisfy the necessary criteria were hematite, nickel refinery dust, gamma isomers of hexachlorocydohexane, and testorone, NIOSH said. Another 50 classifications should be reexamined for this reason, the in stitute added. The NIOSH review found substances appearing in both Category II and Category III: 2-naphthylamine, 2-phenanthrecenecarboxylic acid. l-ethyl-l,2,3,4-tetrahydro-7-methoxy-2. In other instances, chemical abstracts numbers were incorrect or roisassigned, NIOSH said. NIOSH offered to explain the methodology of its review of the list and offered assistance to OSHA in the classification of carcinogens. Anson Keller, project officer for the proposed carcinogens policy at OSHA. confirmed the NIOSH recommendations had been received but said he could not comment immediately on them. Carcinopans ASBESTOS ASSOCIATION CALLS HEW REPORT ON OCCUPATIONAL CANCER 'UNSUPPORTABLE* In a letter to the Secretary of Health, Education, and Welfare, the asbestos industry charged that a federal report on occupational cancer was based on "scientifically unsupportable assumptions." The Asbestos Information Association/North America sent HEW Secretary Joseph A. Califano, Jr., comments December 13 on the federal report, "Estimates of the Frac tion of Cancer in the United States Related to Occupational Factors." The "Estimates" paper released by Califano in a speech in September said previous estimates of the contribution to cancer incidence in the United States of occupational ex posures were low and that the occupational factor probably was closer to 20 percent (Current Report, September 14, p. 459). The posthearing record on the OSHA cancer policy closed December 19 following extensions of more than two months for receipt of additional comments. Work to prepare the un usually large record for certification by the administrative law judge was proceeding smoothly and was expected to take another week, hearing officer Tom Hall said January 2. Overestimate Charged The asbestos industry group, summarizing its criticisms, said the population at risk ol dying from asbestos-caused cancer was "grossly overestimated" in the government report. The AIA accused the authors of ignoring "the likelihood that minimal, short-term exposures" to cancercausing substances would carry far less risk for workers than sustained, long-term heavy exposures. "The very important objective of protecting the health of employed persons will not be served either by un derestimating or exaggerating the risks to which they are exposed," AIA President T. A. Dougherty wrote to Califano. A copy of the letter also was sent to the Labor Department where the Occupational Safety and Health Administration has included the "Estimates" paper in the record of a OCCUPATIONAL SAFETY & HEALTH REPORTER proposed carcinogens regulatory policy (Current Report September 21, p. 517). Contributors to the asbestos association's comments were William Weiss, professor of medicine at Hanneman Medical College la Philadelphia: Philip E. Enteriine, professor of biostatistics at the University of Pittsburgh Graduate School of Public Health; and Hans Weill, professor of medicine at Tulane University School of Medicine. Comments also were included from Paul Kotin and Gerald R. Chase of the health, safety, and environment department of Jobns-Manville Cor poration. Hstvily Expo sad Groups According to Weill, the HEW estimates of relative risks for future cancer are based on workers who were heavily ex posed in the past in jobs as insulators. "These same relative risks are being applied to working populations who have recently been exposed to far lower levels of asbestos dust, a procedure which ignores the demonstrated and uniformly agreed upon dose-relatedness of environmental car cinogenesis." Weill said the experience of heavily exposed workers of the past was being projected onto a cohort of four million workers regarded as heavily exposed now but that this pro jection was not based on fact Weiss, of Hanneman, commented: "The `fallacy' of 'one effect -- one cause' explanations is developed by mis directed discussion." Weiss continued that the synergistic relationship of asbestos and smoking in causing lung cancer is well established. But lung cancer is rare In asbestoe workers who do not smoke, he claimed, and thus smoking is the primary factor and asbestos an enhancing factor, Weiss concluded. Weiss cited a study of Irish insulators presented at a re cent New York Academy of Sciences conference. According to Weiss, the study concluded that smoking is the "important factor." The "survival curve" for the insulators who did not smoke was similar to that of the general population, Weiss reported. Concerning the paper's estimates of car.cer f.om arsenic ex posure, Weiss declared that "the same sin is committed as in the estimate of asbestos risk." The high risk assigned part of a cohort of smelter workers who received 15 or more years' exposure to arsenic was applied to 1.5 million workers, he said. "Do all arsenic workers have the same risk as half the smelter workers? This question is not even considered by the authors," Weiss commented. Other Overestimates Alleged Enterline echoed the doubts of the other commenters over figures on workers who had received heavy asbestos ex posure. He said the "Estimates" paper apparently applies "heavy exposure" to the type of exposure experienced by 17,300 insulation workers studied by Irving J. Sellkoff at the Mount Sinai Medical Center in New York and referred to in the paper. Of the seven to 10 million workers alive today who are or were exposed to asbestos, four million were estimated in the paper to have received heavy exposure. "I question whether there are 4,000,000 workers in the U.S. who have had that type of exposure." Enterline wrote. The University of Pittsburgh scientist also said the paper ex aggerated the number of asbestos-related cancers. Enterline differed with the conclusions on the risk-factor for lung cancer of workers exposed to hexavalent chromium. He said the "Estimates" paper relied on a study of workers refining chromite ore who had "an extraordinary risk." Put assigning a five-fold lung cancer risk for 1.5 million workers from that evidence was in error, Enterline argued. 1-4-79 Cccupafionoi Safety & Health Reporter 0095-3237/79/SGO 50 DOW-1842 U.S. DEPARTMENT OP M April 25, 1978 ,AND WGLMRE CONTACT:' JOHN 3LAMPHIN 202/245-6343 ST0I999I6 STATEMENT OF SECRETARY JOSEPH A. CALIFANO, JR. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Scientific scudies have demonstrated that asbestos creates an especially high risk of lung cancer and other serious lung disease for workers who have been heavily exposed to this toxic substance. The total number of workers exposed to asbestos since the beginning of World War II is estimated at between S and 11 million. Of that total, approximately 1.5 to 2.5 million are presently employed, while the remainder -- between 6.5 and 8.5 million workers -- were formerly employed in environ ments with significant asbestos exposure, including 4.5 million who worked in shipyards during World War II. Of those exposed in the past, a certain number -- which we cannot estimate with accuracy today -- have already died, either from asbestos-related or other causes. Federal government responsibility for regulating current asbestos exposure is lodged in several agencies -- with the CHORE) T - ... . -2- ' : \1< \ i i: Occupational Safety and Health Admlr.lstratlcn bearing primary responsibility for regulating asbestos levels in the workplace and requiring employers to provide warnings to current employees. But, to data, there has been no systematic government effort to notify physicians, past workers and others at risk of the hazards associated with asbestos exposure. Such notification is of special importance because the serious diseases associated with asbestos take a long time to develop -from 15 to 35 or more years -- and because recent studies have underscored that workers exposed in the past, especially Chose from the war years, may just now be facing immediate, serious health threats. As part of my responsibility to promote and protect the public health, I 'am today announcing several steps to inform doctors, workers and others about the increased health risks of asbestos exposure. Dr. Julius Richmond, the Surgeon General of the United States, will immediately send an advisory letter to all 400,000 doctors in the nation. This Surgeon General's advisory will set out the nature of the health risk posed by asbestos, describe certain steps doctors nay wish to take when diagnosing or treating patients, and tell physicians where they can obtain additional information about " 1 1 6 6 6 1 UTS (MORE) i1 -3- asbestos-related diseases. /Soth che physician advisory and a more decailed National Cancer Institute question and answer paper are attached to this statementJ HEW will launch a public information campaign aimed at workers and others exposed to asbestos. Dr. Arthur C. Upton, director of the National Cancer Institute, and Dr. David P. Rail, director of the National Institute of Environmental Health Sciences, will co-chair an HEW team to develop a decailed public information proposal in consultation with ocher Executive Departments, unions, employers and ocher interested parties. To che extent possible, the campaign will be targeted on those at the greatest risk. I have spoken with Secretary of Defense Harold Brown, and he has directed che Department of Defense personnel to work with us in taking appropriate steps to inform former military and Federal civilian workers in Naval shipyards. The HEW team will consider other measures which the Department might cake to deal with che asbestos problem, in addition to preparing the public information campaign. Such measures include: improved surveillance, ocher means of informing (MORE) ST0I999I8 - 4- affected individuals such as outreach through unions and employers, development: of further information for physicians, and additional research. STO 199919 Asbestos is the tern used for a group of fibrous materials that do not bum and are excellent thermal insulators. In the past four decades, asbestos has been used for a great number of purposes -- more than 3,000 uses have been identi fied -- with two-thirds of all asbestos used in the construction industry. Ship construction has been an activity with especially high use of asbestos, since the substance is effective in insulating boilers, steampipes, hot water pipes and nuclear reactors. Unfortunately, numerous studies have indicated that exposure to asbestos in settings, like the workplace, where it is concentrated, significantly increases the risk of incurring four serious diseases: lung cancer, asbestos is (a progressively debilitating lung disease that impairs breathing and increases risk cf serious illness or death from respiratory infections like pneumonia), mesothelioma (a cancer of the chest and abdominal cavities) and certain gastro-intestinal cancers. Both the Surgeon General's advisory and public informacion campaign will suggest certain actions that individuals l i ii . i exposed to asbestos can cake to reduce or mitigate the health threat to the greatest extent possible. They will /'UAH tr \ j ! i STO199920 3cress that no single seen has a more important effect in reducing risks from two of the nest common diseases associated vich asbestos -- lung cancer and asbestosis -- chan stopping cigarette smoking. Our best estimates of the increased risks associated with asbestos exposure are based on HEW supported studies of workers heavily exposed to asbestos before the government began to regulate asbestos in the workplace in the lace 1960's and early 1970's. As a result of recent government regulation, current workers, without previous exposure, can be expected to* face smaller risks chan chose exposed in the past. The risks for past workers regularly exposed to asbestos are estimated to be as follows: Lung Cancer. A non-smoker who has been exposed to asbestos is three to four titles more likely to develop lung cancer than a non-smoker who has not been exposed. However, a smoker who has been exposed to asbestos is up to 90 times more likely to incur lung cancer chan a non-smoker who has not been exposed, and up to 30 times as likely to incur lung cancer chan a non-smoker who has been exposed. At present, it is estimated that 20-25 percent of workers, both smokers and non-smokers, exposed to asbestos before the era of government regulation die of lung cancer. (MORE) Asbescosis. -6Only individuals exposed co asbestos contract asbescosis which afflicts approximately 7 percent of the number of workers exposed in the past. Asbescosis is an irreversible and progressively disabling lung disease that impairs breathing, and individuals with the disease are much more likely co die of respiratory ailments, like pneumonia, Chan individuals who do not have asbestosis. The Surgeon General advises me chat clinical experience indicates a person who smokes and has been exposed to asbestos faces a greater risk of developing asbescosis and of dying from a respiratory ailment that an asbestos exposed individual who does not smoke. Mesothelioma. As with asbescosis, only chose individuals exposed to asbestos appear co contract this disease. Approxi mately / --10 percent of these exposed to asoestos cn the past die of this cancer. Gastro-intestinal cancer. Individuals exposed to asbestos in the past are estimated to be about twice as likely to die of gastro-intestinal cancers -- including cancers of the esophagus, stomach and colon -- as non- asbestos exposed individuals. Approximately 3 co 9 percent of asbestos-exposed individuals die of these types of cancer. In addition to the 4.5 million persons who worked in shipyards during World War II, it is estimated that 500.000 to 1.4 million persons have been employed in shipyards ST0I999ZI (MORE) 22666 0ISl * - 7- since Che War. Ocher occupations in which there has been significant exposure co asbestos include asbestos mining and processing; construction work involving insulation; building demolition; roofing; and automotive work in brake and clutch lining installation and repair. In addition to the Surgeon General's advisory, information will be available co physicians through other means: Ca-The Cancer Journal for Clinicians. a publication of the American Cancer Society, is publishing this week in its Mar oh-April issue an article by Dr. Irving Selikoff and Dr. Z. C. Hammond on the effect asbestos exposure has had on shipyard workers; the American Medical Association will be publishing a physician advisory in its Journal; and the attached question and answer background paper prepared by the National Cancer Institute will be made available to doctors through the American Cancer Society, the American Lung Association and all state nedical societies, as well as through the National Cancer Institute Itself. The actions I am announcing today with respect to asbestos are based on a number of factors, but two cf the most important are: the number of individuals affected who are unaware of the risk and the fact chat asbestos is one of the most dangerous and insidious substances ir. the workplace. (MORS) T a Given Che mashers of unaware individuals affecced and Che serious risks involved, it is imperative that HEW -- the Executive Department primarily charged with developing., health policy -- work closely with ocher Executive Departments and Agencies in devising all appropriate seeps co protect Che health of our citizens. If individuals have questions about what they should do in addition to stopping smoking, they should consult their personal physicians. ### STO199923 50*At zr THE :I^3LC ALTH SO'flCS DEPARTMENT OF HEALTH. EDUCATION. AND WELFARE wamimtsh. o.c. aaoi April 25, 1978 ST0199924 PHYSICIAN AQVISORY - HEALTH SFrcCTS OF ASBESTOS The results of recent studies of shipyard workers have increased concern about the health effects associated with previous occupational exposure to asbestos. This advisory notice will assist you in dealing with Inquiries from your patients and other members of the puolic. Asbestos refers^ to a group of widely used fibrous minerals- Significant exposure of men and women employed in shipyards is known to have occurred, even among those not directly working with asbestos, exposure to asbestos can also occur in many settings, such as, direct mining and manufacturing; construction; insulation; roofing; demolition; brake lining; ana the manufacture and installation of asbestos pice, sheets, panels, paper products, friction materials, textiles, floor tiles, paints, and gaskets. The risk has been .documented extensively for certain occuoational exposure: and there are reports that asbestos-associated disease also occurs in household contacts of asbestos workers. The primary effects of past asbestos exposure are asbestosis, a lung disease, and certain types of cancer, primarily lung cancer and oleural and peritoneal mesothelioma and, less frequently, gastro-intestinal and other cancers. It is now known that the health effects of asbestos appear after a long latent period (15, 25, 35 or more years) after the initial exposure. Exposures as short as a month may result in disease many years later, because the inhaled dust, being mineral, tends to remain in the tissues. It has been noted in studies of heavily exposed workers that approximately 20 to 25 of each 100 deaths among asbestos workers 20 or more years from onset of exposure are found to be from lung cancer, 7 to 10 from mesothelioma, 4 from cancer or the esophagus, stomach, col an/rectum, and some excess cancers of other sites (oropharynx, larynx, and kidney). In addition, in some grouos, as many as 7 oercent of workers die of a form of pneumonoconio$is, asoestosis. Cigarette smoking significantly increases the lung cancer risk of asbestos exoosure and aggravates asbestosis. T -2- In dealing with your patients or other individuals who worked in shipyards or believe that they were otherwise exposed to asbestos, you nay wish to consider the following issues: 1. Occupational or Exposure History -- A detailed, lifetime history must be ootainea. Inis is time consuming, but important because significant exposures may have been brief (one month) and may have occurred many years ago (i.e;, during World War II). 3ecause the World War II work force was comprised of many women as well as men, the potential for female patient involvement should not be overlooked. 2. Careful Management of Lung Disease -- A detailed history for symptoms sucn as snortness of oreath or exertional dyspnea, physical examination, chest x-ray, and pulmonary function tests may be helpful in diagnosing the pneumonoconioses associated with asbestos. Early x-ray changes are often subtle so x-rays must be reviewed carefully by experienced readers. Such readings should include a thorough search for pleural changes. Careful attention to and aggressive treatment of respiratory infections may be important in patients with asbestosis. The use of currently effective influenza and pneumococcal vaccines should be considered. 3. Emphasis on Smoking Cessation -- Discontinuation of smoking is an important step in tne control of the sequelae of asbestosis and will assist in the prevention of lung cancer. Individuals who smoke and who have been exposed to asbestos have 30 to 90 times the risk of getting lung cancer of individuals who neitner smoke nor have been exposed to asbestos and 7^= to 30 t*'~es the r's* of the non-smoking asbestos workers. Data are available which show that cessation of smoking will significantly diminish the risk of developing lung cancer among asbestos workers. 4. Cancer Surveillance -- The usefulness of screening asymptomatic, exposed individuals for lung, gastro-intestinal and other cancers is now under study in clinical trials. Individuals, however, should be carefully questioned regarding possible symptoms which could be related to cancer: chest pain, hoarseness, hemoptysis, weight loss, melena, etc. If such symptoms are present, an appro priate diagnostic workup should be undertaken. It is important to note that many people exposed to asbestos -- perhaps a majority -- suffer no apparent ill effects. It Is hoped that most of your patients will be in this category. Current use of asbestos is regulated, but attention must be given to proper ventilation and engineering controls and the use of resoiraters -all measures of primary prevention. In the past the cancars of asbestos exposure were not fully aooreciated; much exDOSure occurred in previous decades, particularly in shipyards, where individuals often womec :n confined quarters. STOI 99925 ;I -3- A discussion of asbestos and its health effects aooears in the March/April issue of Ca. pe Cancer Journal for Clinicians and is available through the American Cancer Society, 777 third Avenue, New York, New York 10017. A more detailed physician information alert will be distributed by the National Cancer Institute through a number of medical journals within the next two or three months including the Journal of the American Medical Association. Additional information including a more detailed series of questions and answers can be obtained by writing to Asbestos, National Cancer Institute, 9000 Rockville Pike, Sethesda, Maryland 20014. Sincerely, /Oulius B. Richmond,,M.D. Surgeon General Assistant Secretary for Health ST0I9992G