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26 ASBESTOS EXPOSURE-SELIKOFF ET AL JAMA, April C, 1904 growing number of reports of individual cases suggests that these tumors are perhaps becoming relatively frequent complications of asbestos ex posure. Our observations in this series are similarly sug gestive. In three of the 255 deaths among the men who had worked for 20 years or more, the exam ining pathologist considered the death due to dif fuse pleural mesothelioma, and in the two cases in which we have been able to review the histological material, the histological appearance was that of ten so categorized, and asbestos bodies were pres ent. This incidence of more than 1% of deaths from pleural mesothelioma is strikingly high for a tumor which is generally considered to be extreme ly rare. In one case in our series pathological ex amination suggested diffuse peritoneal mesotheli oma. This single experience is too fragmentary for evaluation. Gastrointestinal Carcinoma.--Isolated instances of gastrointestinal carcinoma in the presence of asbestosis have been known, but there have been no data to indicate that these were more than coinci*1 ntal findings. Among the asbestos workers studied here, cancer of the stomach, colon, and rectum was three times as frequent as expected. These data suggest that there may perhaps be an etiological relationship between industrial asbestos exposure and carcinoma of the gastrointestinal tract. Environmental Asbestos Exposure--The recent demonstration, by South African 0 and British * in vestigators of pleural and peritoneal neoplasms among individuals who had chance environmental exposure to asbestos many years before raises the very important question of possible widespread carcinogenic air pollution. The possibility of en vironmental exposure has long been known. Soon after the initial clarification of asbestosis as a clinic entity, Haddow 10 demonstrated asbestos bodies in a man not employed in the industry but living next door to an asbestos factory. This finding was later mirrored in the finding of chronic beryllium dis ease among residents of a community near a beryl lium factory.11 What is new, however, is an appre ciation of the potential extent of the problem. Thomson and associates 12 have reported the fre quent findings of asbestos bodies in the lungs of urban dwellers. Among 6,312 individuals x-rayed in an area about an asbestos mine in Finland, Kiviluoto 13 found 499 cases of pleural calcification of the type characteristically seen among asbestos workers, without obvious cause. In a comparable area without any asbestos mine, no cases were found among 7,101 persons x-rayed. It should be noted that these were not people who worked in the mine--none did--but, rather, were farmers, housewives, and others who lived in the general location. In one subject who came to autopsy, polarized-liglit microscopy demonstrated asbestos fibers in the lung. Similarly, the lung of a cow graz ing near the mine also showed the presence of asbestos. A particular variety of environmental exposure may be of even greater concern. Asbestos exposure in industry will not be limited to the particular craft that utilizes the material. The floating fibers do not respect job classifications. Thus, for ex ample, insulation workers undoubtedly share their exposure with their workmates in other trades; intimate contact with asbestos is possible for elec tricians, plumbers, sheet-metal workers, steamfitters, laborers, carpenters, boiler makers, and fore men; perhaps even the supervising architect should be included. 1 E 100th St, New York 10029 (Dr. Selikoff)., This study was supported by the Health Research Coun cil of the City of New York. Cooperating in this investigation were the executive of ficers of the International Association of Heat and Frost Insulators and Asbestos Workers, Washington, DC, and the officers and membership of the New York and Newark, NJ, locals of this Union. References 1. Lynch, K.M., and Smith, W.A.: Pulmonary Asbestosis: Carcinoma of Lung in Asbesto-Silicosis, Amer J Cancer 24:56-64 (May) 1935. 2. Annual Report of Chief Inspector of Factories for Year 1955, London: Her Majesty's Stationery Office, 1956, cmnd 8, p 206. 3. Doll, R.: Mortality From Lung Cancer in Asbestos Workers, Brit J Industr Med 12:81-86, 1955. 4. Bohlig, H., and Jacob, C.: Neue Gesichtspunkte fiber den Lungeakrebs der Asbestarbeiter, Deutsch Med Wschr 81:231-233 (Feb 17) 1956. 5. Braun, D.C., and Truan, T.D.: Epidemiological Study of Lung Cancer in Asbestos Miners, AMA Arch Industr Health 17:634-653 (June) 1958. 6. Wagner, J.C.; Sleggs, C.A.; and Marchand, P.: Diffuse Pleural Mesothelioma and Asbestos Exposure in North Western Cape Province, Brit J Industr Med 17:260-271, 1960. 7. Hammond, E.C., and Garfinkel, L.: Smoking Habits of Men and Women, J Nat Cancer Inst 27:419-442 (Aug) 1961. 8. Hammond, E.C., and Horn, D.: Smoking and Death Rates: Report on Forty-Four Months of Follow-up of 187,783 Men. I. Total Mortality; II. Death Rates by Cause, JAMA 166:1159-1172 (March 8); 1294-1308 (March 15) 1958. 9. McCaughey, W.T.E.; Wade, O.L.; and Elmes, P.C.: Exposure to Asbestos Dust and Diffuse Pleural Mesothelio mas, Brit Med ] 2:1397 (Nov 24) 1962. 10. Haddow, A.C., in Report of Annual Meeting of British Medical Association, Manchester, 1929, Lancet 2:230-231 (Aug 3) 1929. 11. Chesner, C.: Chronic Pulmonary Granulomatosis in Residents of Community Near Beryllium Plant: Three Autopjied Caseis, Ann Intern Med 32:1028-1048 (June) 1950. 12. Thomson, J.G.; Kaschula, R.O.C.; and MacDonald, R.R.: Asbestos as Modem Urban Hazard, S Afr Med J 37:77-81 0an 19) 1963. 13. Kiviluoto, R.: Pleural Calcification as Roentgenologic Sign of Non-Occupational Endemic Anthophyllite-Asbestosis, Acta Radiol Suppl 194, pp 1-67, 1960. 146