Document 5b1eDoY6BkmKwVw2oMpNXwyG8

FILE NAME: Talc (TALC) DATE: 1967 DOC#: TALC009 DOCUMENT DESCRIPTION: Article from Industrial Hygiene Review - Mortality Among Talc Miners & Millers in NY State DIVISION OF INDUSTRIAL HYGIENE DEPARTMENT OF LABOR STATE OF NEW Y ORK INDUSTRIAI HYGIENE REVIEV VOLUME 9 NUMBEF In T h is Is su e . . . . \\ M ortality Among Talc Miners and Millers in New York State, M. Kleinfeld, M.D.; J. Messite, M.D.; O. Kooyman, M.D.; end M. Zaki, M.D.................................................................... M ortality Experience in a Group of Asbestos Workers, M. ; Kleinfeld, M.D.; J. Messite, M.D.; and 0 . Kooyman, M .D .,. A Note on "Let-Go" Current, S. Moskowitz, Ph.D., P.E. DIVISION O F INDUSTRIAL HYGIEI* DEPARTMENT O F LABC STATE O F NEW YO i INDUSTRIAL HYGIENE REVIEW \KW >OKK S T \ T K DKP/VK'FMKAT OF LAHOR 80 O n l r c Street \ r w A oi k. ; \en U>rl\ 1001.) iNl.i,s o R o c K i ' F K U . i i i ! . Cover nor M. P. Cvi HHiW ooi). I ndust r i al Co mmi s s i o n e r IHrision of Industrial Hygiene MOKKI s KLKtA'FHI.n. M.D., J)ho!,,, L d i i o i uil <inmniiltou Ja* quHino M.P.. Assistant lhic<i<n |a<k Balifl, P.K.. Chicj. Engincauig Section Kfhwud Mein. Pli.D.. C.hicl. Labnraton SCition Moni s Klfinfold. M.D.. Chunnnm E Jitot: Kol>ort Katajai k M O R T A LIT Y AM O NG T A L C M IN E R S A N D M IL L E R S IN N EW Y O R K S T A T E MOKRIX K LEI N EKED, .MI); - L U ' Q l ' E L I X E AIKSSITE. AID; OL I VE KOOYMAX. AID; AND AIAIIFOEZ II ZAKI. AID Xiu cc .1940, tlir D ivisio n of i u d u s i n a l H y g i e n e lias c a r r ie d mil a. n u m b e r of' stu d ie s on tali- minors and m i ll e r s iu llto n o r t h e r n part of Now Y o r k state. 'The p rim e purpose of those stu d ie s was 1o ascertain the health hazards associated with the exposure to dust in tale mining- a n d milling-, In 1940, a chest \ - r u y s u rv e y of 991 tale, m in e rs and m ille rs employed in several p l a i n s in this region disclosed p u l m o n a r y fibrosis in 152 w o rk e rs , 19 o f whom had had no other occupation.'!I dust exposure. T h is survov clearly indicated 11ia 1 e xp o su re in these tale m ines and m ills w a s capable o f pro ducing- a fiImogenie type of pnenmoconiosis.1 In 1944, a follow-up study of flip 92 w orkers with pulmonary fibrosis disclosed that the pneumoconiosis was progressive and disabling but that die pro gression wo slow and the disability occurred p rim a rily in the o lder age g ro u p .- A report on the el ideal, r o e n tg e n o g ra p h ic . and pathological find ings in six patients a ho had an average exposure to ta lc dust o f 2(> y e a r s xvilh a ran ge of 20 1o 90 y e a r s w a s re ported in 19 3 The m a jo r clin ical features were c h ro n ic p ro d uctive cough, dyspnea, diminished breath sounds, lim ited chest expansion, diffuse rales, and clubbing The chest roentgenogram disclosed p u lm o n a ry in filtra tio n both basally and in the m id ln n g fields. In some instances obscuration of the card iac borders or costophreuic sinuses, or both, were present. The most freq uent pathological change was a diffuse fibrosis containing macrophages with absorbed dust particles. A pattern of endarteritis w ith uitim al hyperplasia was frequent ly noted. Distension of bronchi and bronchioles with formation of cystic spaces was common. R ath e r characteristic was (be presence of elongated, term inally clubbed bodies indistinguish able fro m asbestos bodies ns seen in ash. stnsi. T l . . . r.d dense fibrotie thickening. Cor pulmonale was the m a jo r complica tion in four of the six eases and was the m echanism of death in Kroni [hp Division uf industrial Hygiene. Xt\v York ( l)rs. Kloiuudd. Me1--Uo. and Koo\ main , and. the Ktnte Ynivei Miy of \ ony York, Donji^ia ic Medical (Ynloi. "Brooklyn. Y Y (Dr Xaki ) Reprinted from the Atehivcs of Dm ironmcnt al Health. (May 10(17. Ynhnn< 1-1. j;i ! dGE-EGT. ( `Mj.yii^ht 100?. Anici it'.ni Medical Association three. A comparative clinical, roentpenopraphic, and pin siolopic s l ii d y of w o rk e rs exposed 0> fibrous a n d T a m ila r 1alc diisl was made in IlK i- l.1 T h e iw o rou ps were s i m i l a r w ith reput'd 1o ape, sex, depreo of exposure, and smokinp habits. There were no sig nificant differences in Hie clinical and roenlpenopraphir find ups between the (w o rou p s. H o w e ve r, the num b er of ab norm al values I'or each p ara m e te r o f p u lm o n a r y fu n c iio n measured ( W , V C , , ,MI'>C, P Y . T I jC . P Y T L C and 1)1,,,,1 was a p p r e c ia b l y p rea te r in those exposed to fibrous Ilian to the prarm btr v a r ie ty of tale. In 1!Kib. p u lm o n a ry fim e tio n le s fs were p e r f o n I on V ! w o rk e rs rn 'aped in file m i l l i n ' ! of the fibrous variety of tale,'' T h e mean d u ra tio n and weighted averape of exposure was 111 ye a rs and (>2 2 million particles per eubie foot, respect i \ e l \ , An apju'eeiabb' iium 1s t of (be w o r k e r s bad ab n o rm al p u lm o n a r y fu nctio n m easure menls. This was p a rtic u la rly evident In the vilal capacity, tola I I n n capacity , and diffusinp: e a p a e iiy T h e r e were 1(1 who showed p u lm o nary in iiltra tio n on th e ir rlmst roentpeimpm ms as compared to 97 without such evidence Tho se xvi 111 positive radio loeie fim lin p s load a proport io n ately ren te r n u m b e r of r e s p i r a t o r y sym pto m s and sipns and abnormal pulm onary function values as compared lo those without In peneral. the correlation between the doice of pulmonary function impairment and the clinical and roentpenoTaphie tindiups was poor. T h e purpose of the present fo llow -up s tu d y was tw o fo ld : d i to obtain an cstmiato of the incidence of disease anion lids select prouji of tale w o rk e rs, and 1'2) 1o compare the observed m o rtality experience from specific diseases w ith the expected m o rtality amonp a sim ilar basic population. Materials and Methods A ll talc m in e rs a n d m ille rs employed in 1d 10 w ho bad I n or more years of exposure to tale dust as well as those who achieved a m inim um of lb y e a r s of such exposure between 1910 and UHio were included in this study. The prnnp tolalled 220 workers, and d is believed that the overall n um ber of 220 constituted the total work force in the eatepory under study Sourer of T>dla.-- T h e data wore obtained from a num ber of sources. P la in records were examined and ihe work h islo ry of each individual was detailed to include ebanpes of job and specific years of emplm moiii. Death eertifionlos were1 studied in all instances . In i, available T h e ret ords of the physe-ia iw a m -iid m the work- ciN p r i v a t e l y wore reviewed Nuhst ant hi I medical in iornuit ion on 1he tn n jo i'ily of the w o r k e r s w as a v a il;id le hi tlit* 1)i \ n i o i i ' s files and w as used as an a d d itio n a l source id' dnla llo s p H a l records imdudmp awtopsi reports and hisddopieal specimens were rxam in ed w h e re v e r a v a ila b le . A u t o p s y records were obtained in ob of tlie ill deaths Stalls! nil , 1mil in is. -- 'I'he toi al n u m b e r of deal its was dial rih u t ed in tlie folloubnp eat e y o r ie s : ma I ipnam bes, e a rd iae , piieutnoconiosis or coni pi eat ions 01 botli, aeeideitls or suicides, a n d all other causes T h e p r o p o rtio n s of m o r t a l i n Front c a n c e r id' the hmir and p leu ra a n d of Ibe y ;is lro ln te s t inal t r a d and peritoneum out of the total m o rta lity, w ere compared with the e x p e d e d m ortalities due to the above eauses in the various aye croups. The expected m o d u li! \ represents 1he p ro p o rtio n of deaths amom.*' w h ite men in tlie l ulled .States, dim to tlie specific causes in the y e a r 1bed . 'Fins p a r t i c u l a r y e a r w a s chosen as s ta n d a rd la cause it is die m ed ian \ e a r oF death iiiiiini!.: the P I deaths. Differences between observed and expected f rep Henries were irs le d fo r s ip n ifira n e r usina th normaJ (-urve w ith larpe n u m b e rs and tlie h h s h r r ' s exact p r o h a b ilit i test i'er sm all lYequrneios. hiudinii's Total Pailhs.- T h e re were !d deaths in the p m up of 220 l a i r workers. Tlie causes of death in the \arioiis ralepones are shown ju T ab le 1. A brea kd o w n of die deaths ae co rd ia e to ape ;>.ruup showed that Dvo w o rk e rs u n d e r 10 died. w orkers who w m e be tween 40 and ol) y e a rs died, -17 between bO and 70 s e a r s , and Four died who were 80 y e a rs and o ve r ( T a b l e 2 ) . T h e average ape a1 death ol` the id lab- w o r k e r s was 00.4 y e a rs w it h a rauue of :>8 to 84 vears. 11 n l i u i i t n i c h v.- ( ) f 1 he 01 d e a llis . 1lie observed and expected m i m her o.F deaths due to canee es of the lim p , p le u ra , past m i n t e d ina I tract, and peritoneum are shown in Table 2 O f die ten mudi" ...... : . i , i ,, i ... .,p . .p .Ite, linn Milt tfiim iuuiwix 111 l nr in a i; and one w as a fibrosarcoma of die p le u ra . OF the seven mal p lia n cies of the paetroiulesthml t r a d and peritoneum, two were cancers of die stomach, and one each of carcinoma of the colon, rectum , and pancreas. T h e re was one p r im a r y hepatoma of the liv e r, and Hie rein ainiiip case was a peritoneal mesothelioma. The m alipuaiieies 311x n iv in p otiu-r sdes n n l u d c d one com ol retro p e rito n ea l r e t ic u lu m . el I sa i coma and one of eh l oi d r !\ m pliat n !i ok. in in Tab le 3 .--C o m p arative Dust Counts m Talc M in es e n d M ills, N o rth e rn N ew Y o rk'1 Table 4 .--D eath s a n d E x p e c te d G a stro in testin a l Tract and M o rta lity From C a n cer o f th e Lung a n d P leu ra P e rito n eu m R e la te d to A g e in A s b e s to s W o rk e rs and Age G ro u p "otcil C c aths D eaths From M aO gnart Causes Lung and R ie u ra G !' and P e rito n e u m Le-e crd O bserved Proportioned M o rto i'ty Theo retical G an a Peritoneum O bserved Theo retical <40 0-5? 21 5 60 79 23 6 so - Q o 4 2 3 .S 3 26.1 0 0 C 7 .4 ' ]? 3 8- 13 0 5 6i5 Total 46 12 7 26.1 3 r 15 2 3 9' D ifte 'e n c e b e tw e e r o b serve d a n 3 ` h e cred cct -rolues is t c d s t'c c l' ) s ic ' c a r t P 'Statistical a n a ly s is io ` p e rfo rm e d b e ca u se of sm a ll nu m b er in g ro u p 1!) ol fiee s ilic a. In the absence of adequate sm okinp data one cannot assess 1he role played by s m o k h ip in tlie c an salion of the p u lm o n a r y carcinom as in belli series. In three of the ten talc workers where a sino kinp h is to r y was o btain able , tw o smoked at least one pack d a i l y fo r over 20 y e a r s and one smoked fen cip-ars d a i l y fo r do years. W illi repaid to carcinoma of the cast ro iiilrslin a] tra d and peri toneum aniony the ta le w o r k e r s , we did not find a n y M ynificant difference between the observed and expected values in the overaU and specific ape croups studied. How ever, in tlm asbestos p'roup (T a b le 1) a s ip n ilie a n i difference between flic observed and e x pected values was found in tlm overall eatepories. O ur findings in the asbestos w o r k e r s are s i m i l a r to what lias 1........ reported by SelikolV. Oburp, and I lam iiu aid.''1 I f a clear-cut et Ird<i<r'i <-;i 1 r e la t io n , ship is sahsi'ipiently establisla-d between exposure to asbeslos and carcinom a of the mast roi ntest i nal 1raet. limn one m ay a t trib u te the differences in incidence between Hie asbestos and tab' croups to die reasons pivou for carcinoma of the lim p and pleura. Deaths Dm 1o I'm Hinucoiiiusis a) ( `uinphcatioiu.: or Both .- - I ' i'e vions smdies have reported that eor pulmonale is a m ajor com plication of tale pneumoconiosis and is a m ajo r cause of death amnnp tale w o r k e r s ."' T h e fim liu p s in th is s tu d ) are consistent with the previous reports. B i p l i r Cirri'.---Annum the death, c r o u p of 01 eases, there were ten subjects w lm had a duodenal u lc e r , and in one ol' the ten die n ice r was the cause of death. In the 1.20 w o r k e r s who a re s till alive. 10 had a diagnosis of duodenal u lcer. 'Fids Is a total of 20. oi' l . ' k : ! ' , . A e e o rd ln p to the health s ta tis tic s of the ['. S. D e p a r t ment of T/enlth, balneation, and W e lfa r e , die prevalence of peptic u lc e r found between lO b? to 1!),'>!) for males of a ll apes is 0] I per thousand population, of 2 . H i 7 Despite tin fact d ia l the fipures obtained 1humph the National H ealth S u rv e y represent poinl if appears lliat the incidence of peptic ulcers amonsr tale w orkers is hipher Ilian ainonp the peneral population A sipnifieanl in crease in incidence of peptic ulcer v a r y in s between 20H to 2-/v has been found in patients w ith chrom e obsl met i ve p u lm o n a ry disease s Since the talc workers bate p rim a rih a restrictive ra ilin ' dam an n h s lru e liv e iu u p d is o rd e r, one ma\ speculate dun fn>1 h p i s m , t y be assoi at c d wi t h a n i n c r e a s e d i in o h m-c o (' p o p ; a- u l c e r C on i iahai of ( 'o/'ct iio/ixi of I . m m Wiilt A / / n Cm-aCton o] If > p/isiur or I 'ik mnoconiosis or Bolli. I John iup c a r e moina of 11u' limp w ith d u r a l ion ol' exp o sure , it m iplit bo relevaut that all Dm nd i victuals \vilh carcinoma of the limp or pleura had their initial e\ posare p r io r 1o Die i n s t it u t io n ol' v e t d ia li hip. T h u avorupe d u ra tio n of exposure p r i o r to flu- ini roduet ion of v e t d rilling ' Mas 14,(i y e a r s AIDiouph i l i i s was a period of h ea vy expo sure ( T a b le Mi 1lie re k no evidenee (o indiente Miai tlua'e w as a direct rela tio n s h ip between 1he d u ra tio n ol' e xpo sure p r i o r to the onset of wet d r illin g ' ain the o ccurrence of ])id n io u a ry c arcino m a T h e mean aire of tin cToiip of ten w o r k e r s who developed carein onia of Dm lim p m pleu ra was (iddi y e a r s w ith a raim v of T> io 7b \ ea rs. 'I' ll is is s l ip h t l y above Die mean ape of <10. ( y e a r s w ith a lampe of MS p S I years fo r Die overall p.roup of ID death cases isiucc Die l i b e.xpeetaucy oI w hite men horn in Die T i n t e d S ta te s in 1IW' i) is inveii as ID ,I years and since these w orkers were horn in 1T0 or e arlie r there does not Snelli to be a redimi ion in the life span from tin e xp o s u re .11 W ith renard to eai e i i ionia o f the lim p am i pim miioeonio sis. our data indicated Dun eipht of Die len persons with carcinoma of Dm lim p had e le a re m evidence of an associated pneum oconiosis \ 'o co nfirm ato ry evidence w as obtained in Dm romaininn two. om of whom bad a fibrosaivo m a of Dm p le u ra and Dm other a f i l a t e r a massive pleural effusion. Summary and Conclusions M o rlalitv data on ID Dale m in e rs and m ille rs in Xcvv Y o r k , stati who had I or more ye a rs of exposure to tale dust by 1!D() or hai achieved In vears between 1440 and lfHTi were reviewed. T in averape ape m tienili was GO 4 y e a rs w it h a r a n e e of Ms to 84 y e a r s Proportional m ortality from carcinoma of the limp and plour; amoiip tale w o rk e rs w as fo ur tim es th a t of Die coni ml population H o w e v e r , the sipnifieaiit increase hi incidence appeared in Die (it to 7!i y e a r ape p r im p r a t h e r th an in Die 40 1o oh y e a r p rim p . T l ii i was at varia n ce with our i'mdiups in asbestos w orkers who had ; v 1* ' `V " - * , * no u v m ^ K i pninil avIi -td ih. increase in observed incidence was present in both ape eatopories The earlier occurrence in Die asbestos workers was attributed b Dm p re m e r e av ein o p o n ch y an d possibly lo exposure to asbesto dust of prem er concent ration as compared to commercial tab C a rcin o m a of the past rointest inai tract and peritoneum showei n o s i p m i k . m l d i f f e i e m - e m tile lode a w 1 w i n h d p o p u l a t i o n s How " \ w . io Du' a s b e s t o s wo! lows posi eoi ni esi i mil a n d p e r i t o n e a l m a l i e lum en s were e l e i tied siym liieant ly. Death due to niiemiioeoiimsis or its roin pi ira i ions, or bolli, was recorded m -IS imi i \ d uals. 1!) ol' whom died from cor pulm onale Tlu> r a u s r of deal b in i l u 1 re maining' ni lie was 1ii lie re ulo,sis i d i or b ro n cho p n eu m o nia ( d , T he lapsed timo from (irsi tale exposure 10 death from pneinnoeoniosis or eoniplieat ions, or both, a vernavi! 2u.d y e a r s , x\ i 1h a ra n y v from Id to df) y e a rs . K x c t u d i n y eov pu lm o nale. there were 2b eardiae deaths. 1!) of wldeh were due lo coronare a r t e r y disease, three In iiypiM'toiisive heart disease, and three to rheum atic heart disease O f 11to !] death eases, data on en v irn iu n e iu a I exposure were a \ a il aide in sO, T h e mean d u ra tio n of expo sure f o r 1his y r o u p w as 24 d y ea rs w iib a ran ye of 1,d t o 47 y ea rs, I ' lVYious studies have iiulioato<! that eor pulmonale was a m ajor cause of death anione1tale miners and m illers. T h is was also found in the p r i s m i - f i n i i , Mom ever. what h as not been p re v io u sly b ro n ch i on 1 is the increase in observed incidence of carcino m a of the imi' a l u n n i ; ' these w o r k e r s as <b monsl rated in th is .study. Rvi'crewe- I s j('a .i !, W ; S m a l l . -\, It : am i (. n v n b u i ;. T n -iin d ile T a t i M ila n e , I m i inline I cent eeliclue i( ,il I in i r / h' m it i 'ii n |c : 1 I 21' ( . I n n i P i n t !,, T l i e D i n i l a / . o ' i l in l-'iiifbne- in P ili YPoil.ie , It, K [oh n VM . M . dies,-i ie. .1.. and 'I a lie r- lie w . 1. I t . 1, ri, h u h i x l r U m i l i V2 : MU. V i I tub . Pl.V,. "I'ali l 'ne im iei im i.i i' a K i e m le l il , M.. el a ]. T a le Pumi ini.n m n a e , \ R e p e l! el sy- P a tie m a W i l l i P o- tn n n n a n P i n d n r - . 1>vh 77 ,i rn e n I h a l l l i ; I (II ! 1 " i .111 y liHi-'i 4. K l e i n l e i i t , V P . el a t ' la m e t' d in n ii ni w 'Iddi Pill-inlneir s im h el W elker- Kspesed le PUiiens ( m 1. kfM e ufi l l m l l h <} : fell nii i Niw i k ' k l W'lnlwi-- \ le t u p n .u p e anil (nanna* Tali Dii-i-. .1. K l e i n l e i i t . VI . el a] Kll'oel el T a l e t i u - l I n i i a l a k e n en P u n y I nie ; n m, ! i rii U n i i n n i H va lil i ]0 : i 4 J-4M7 ( Ma r c h i 11Hi . (j. Sellimi)'. 1 .1. ("nui'e. J . and H.nninend. P, < A-lie-te- r.\|H i-ine ami X'eoplasia. / t M 1 IP/iiDAM; (A p r i ! (5 ! 1004. 7. " P o p l i n l leni a R e p e a le d in l l i l o i w i e w - . " i il I . S'. X n l i o n a l l / n i / l h S u i n i / , W a s h i n g t o n IP ( ' : 12. A. Dopai l i n e i l i el H e a l l l i I'. d u e a li o n . and M e J i a m , P u l i i le 'Tieniti. S e n n r 1000. S " i'h r e n ii ( )h-11 ilei i\e lOdjnenayi l)i-en-e ' in X a p e n . i l T u P e r i u l e - i - A s - e i l a l i e n 1OOP. p ( 1. If a l l i m i h n J' h J i m e/.i s, u. so n l n l l i a l A ' i i l n i t l n f I hc I i r U A yi<` i i i . t . S. P m e.m el l Ile Cen-ie-, 1Olid, d. - 7 , \\ a -K : up! . e . 11 1 MORTALITY EXPERIENCE IX A CROLP OF ASBESTOS WORKERS .MORRIS KEKIXEERR. AID; .) ACQ TRIM X E AIEXSITE. MI); A X D <>D1YE K O O Y A 1 A X . AID T h e te rm " a s b e sto s" is list'd 1o i d e n t i f y a u ro u p of fibrous sili f a i r s . P ro ln u p e d in ha la I mu of siyii itieant a m o iin ls of aslieslo s dus o\or an extended period of time ran produce in certain individual a re sp ira to r! disorder known as ashesTosis. it is characterize! p r im a r i D by couch. d\spjten, basal c re p ita tio n s, and ret iculonodii la r s h u d o w in p oi chest roenle'enoernms. ('Iubbm<r and ecan osi a r c u s u n lh seen in 11m m ere a d v a n c e d si aye of th is d is o rd e r ( T r o n i c broimh it is and e nipln soma are associated w it h th is disease 1lie e m p h y se m a Dei up* more of a lo ca lized than a diffuse o b s tr u c tiw D p i . D o r pulmonale is the m a jo r com phealion and usual cans of death fro m this disease, T h is is pai 1ieula r ly tru e in those w il l excessive dusi exposure There is an increased inrideiw e of hue carcinom a and mesothelioma of pleura and peritoneum associate! udtli s n s t a im d asbestos e \p n sure T h e most consistent jiatlioloyii-a iimline: is a dense fibrosis eoiitainino' m acropliaucs with absorbn 11ust p a n i c l e s w hich in m a n y are as o b lite rate s 1he p u i i n o n a n a n d ii l e d ore. A p a tte rn of i m d a r l e r h i s w ith i i m m a l l it p e r p b t s ia eon sistent w illi pulmonary liypei'ti-nsion and bruiieliioleidasia an assoeifited m a jo r fiudinjrs. R a t h e r sirik in o - is I he presence o f elon patcil, te rm in a lh clnhhed Indies, both seomented and nnseirmented in t in resp irato ry bronchioles or imbedded in the fibrous tissue or both T h e pleura often shows dense fihrotie thiekeninp. am not i n f r e i | U r n 1ly there are calcified p le u r a l p laip ies over the p le u r a s u r f a c e s T h e c lin ic a l and pal holoiriea] fe atu res are i n d ic a t i v e <> a. p r o n o u n c e d d y s fu n c t io n of the r e s p i r a t o r y m ec h an ism . T h i s ha been confirmed by studies of p u lm o n a ry function which have show i a tlist u rbam-e in both ven tilato r! fu n ctio n and diffusion ca p a c ii\ Tim main pin siolopie alteration is a reduced diffusion cap a city.1 T h e purpose of the present stu d y was to obtain m o rta lit y dal; III -I Ol'hllD ml' MS.')IOC1/\V tVn r k ,>Vl' Ml!/) -i/\ M/!1>, t\M . -tll/l /.) )X'>;*< '.(D' ta llly experienee from specific diseases with the expected iiiortalit\ antony a sim ilar basic population. K i ` m tl io 1)j\ it-;*)ii m: in d ii '- l r i a ) LlA jA c n c , X om ^ o i k ( D i w K l e i n i V l d , Me< "he and K o o yim n n j . R o n n m o d t i o m ilu* A r o l m c s ot K u r i l m im i ' n i ; i ! IkD tH li , A u g u s t 19 07. A'nium. !') |ij). 177-1 S(. ( 'o p y r i j i l i i 1007. k m d i c d i i A lo dio al A ^ o r i a t i o n Material and Method' The study group consisted of lod asbestos workers who had Id or more ye a rs of asbestos expo sure by ltM-u or had achieved Id years of exposure to asbestos dust between liMb and liKid Source of Data.--- Persona! data were obtained from union rec ords. and the occupational history obtained for each man included operations performed and dates and places of employment, F o r those who had died, records of the health and w elfare fund pro vided (bite and place of death. Copies of dealh certificates were examined in al I in sta nce s when a v ailab le , fifin' records of 1he p h y s i cians attending' the workers privately were rr\ ic w rd . Hospital records and h istological specim ens were exam in ed w h e n e v er .nail able. A u to psy records w ere obtained in IT of the 4(i deaths. SlaHstliciil A n t t h / s i s -- 'fa ta l num b er of deaths were d is trib u te d in the following categories: malignancies, cardiac, pneumoconiosis or complications or both, accidents, and all other causes fifiic ob served m ortality from cancer of the lung and pleura and of the gastrointestinal tract and peritoneum were compared with the expected m ortalities due to the above causes in the v a rio u s age groups. The expected m o rtality represents the proportion of dealhs among C S w hite males due 1o the specific causes in the y e a r Jttlb This p a r tic u la r y e a r teas chosen as sta n d a rd because it is die me dian y e a r of dead) am ong the 4(i dealhs. fifiic differences between die observed and the expected Frequencies were detailed for sie nificance, using the normal curve for large numbers and the F is h er's exact probability test for small frequencies T a b le 1.--C a u se s o f D e a lh in 46 A sb e s to s W o rk e rs fro m 1945 to 1965 C au se of Death M alignancies Lung and p leura G astro in te stin al and peritoneum A ll other m alignancic' C a rd ia c deaths (other than cor p ulm o nale) Asbestosis and com plications A is n l r A ll other causes Total No. 23 12 7 4 13 2 '1 6 46 on 50 28 .3 4 3 4 2 13.1 26.1 1 5 .2 8 .7 100 Find ings Tolol Dt ol hs- -fifiiere wore 4(1 deaths in the group of 1dfi asbestos insulators The causes of death in die various categories are shown in Table 1. A disl rib u t ion o f 1he deaths a c c o r d in g 1 ago g r o u p showeel 1lia1 (h e re was 1 less than +0 y e a r s , -1 between 40 and -AO y e a rs . 2.'! between b() and 7!) y e a rs , and 1 over 80 y e a r s { T a b l e 2 ) . T h e av e ra g e aye o f death of die 4b asbestos w o r k e r s was b().,`i y e a r s w it h a. range of T> to 83. T h e average age fo r th e o v e r a ll g ro u p of 3-72 asbestos w o r k e r s w as 7.'>.7 y e a rs w it li a ran g e of -i-'i to S3. i\frtii<lim rtrics.- <M` the 4(i deaths. tlu> observed and expeeted n u m ber of deaths due to cancer of the lung and pleura, gastrointestinal trac t and p e rilo n e im i are shown in T a b le 2. O f the 12 m a lig n a n c ie s of the lu n g and pleura, ten were carcinom as of the hmg. and two were pleu ral tum ors, one a mesothelioma and the other a fibro sarcoma O f the seven malignancies of the cast m in ie slin a l t r a d and peril oneiini. two were cancers of the stom ach; one. a lymphosaicoma of the small in te stin e ; one, a cancer of the colon; and three were pe rito n ea l tu m o rs . 1wo of w hich w e re m esotheliom as and one a mesemlric sarcoma. T h e m alig na ncies in v o lv in g other sites included one ease of chrome lym p h a tic leukem ia, and one retroperitoneal reticulum cell sarcoma and one metastatic c a r cinoma, p rim a ry site unknown. ('(inline D( ailis.-- O f the l.'J eardim deaths e x c lu d in g cor p u l monale. eight llatl coronary a ite r y disease, three had hypertensive heart disease, one rheum atic heatl disease and one s y p h ilitic head disease. Asix stusis ar ( at jilu at to i e m Boi h. -- O! the 4b deaths, tw o had asbeslosis com p lica te d by c o r p u lm o n a le . ,4/1 Ollu r ('aiisis.---O f the s i x in 1liis categ o ry, there w as one each of lire follow ing, cerebrovascular accident, p u lm o nary uibor cnlosis. acute peritonitis, chronic u rtlirilis, gangrenous appendicitis with peritonitis, and i-aeimoe cirrhosis, Tj'ii'i'iyfjnmvniui E . t w s n r i .- -The mean d u ra tio n of e xposure i'oi the 372 asbestos w o r k e r s w a s 2b y e a r s w it h a range of 17 to 7( VPfir Arflilr- fllhil l\>t -if! -.mwH.' n .os 'y.-m-c- V, i 1, 1,, f, I UJ1 -1 of 37 to 47 years. A lthough fiberglass w as introduced into tin i n d u s t r y d u r i n g the past ten y e a rs , it is fairly- c e rta in that all ol these asbestos insulators had a m inim um of five y e a rs' exposure to asbestos dust E v e n though fiberglass even tually became tin p r i m a r y component of the i n s u la t in g m a te r ia l, some asbestos van iievert he less i ne-or porat ed T a b le 2.-- D e a t h s a n d P r o p o r t i o n a l M o r t a l it y F ro m C a n c e r of th e L u n g a n d P le u r a a n d G a stro in te stin a l Tract a n d P erito n eu m R e la te d to A g e in A sb e s to s W o rk e rs Age G ro u p Tc ta f De iths D eath s From M alig n an t C auses Lung and P leu ra G P o-c PerPoneua: Prop ortional M o rtality Lung and P le u ra O h se'ved Expected G 1a n d P erito n e u m Obser/ed Expected 40 i ----- --------- 40-59 ; 1 60-79 :o 80 ' Total ^6 1 -- 5 6 0 12 0 1 -- 4 23 3 7.4 i 3 26.1 3 8, 0 0 7 26.1 3 V, 0 T9 5.6i 13 5; 0 15.2 3.9; ' G I indicates g astro in testin al tract 1 D ifference betw een observed an d expected valu es is sta tistica lly sig nificant (P - <C0 01) 3- 34 4 Z714 4 2 " 4 y T^l ?*" 4 X *: ^ 4 x y 4 4 x y. 7 4 c 4 - jT li 4 4 i-- ,. r2-^(4.; 44 --4 c 4 d y 41 E -- d- C 2 ___ .E" Sr --4 3 42 4 4 T 4 --r'l C* 4 4 3 2 i "3 T9 T. E- c xc 5- X- 4 s- 4 i=i 4 y r 5" 7 c 3 -- - 4l y. 2 ^ 3j /N . : --' 2 E. --43 4 1 4i 4- ds 4 T9 '2 ' ~L 0 9T r. 4 3 43 IC =*5 5 2* y T- y. ;4 2 . r E = 4 fo 4 y r 4 __ 4 *3 74 y _. C -4 Zd y4 44 , - ' 4. 4 4 4c 4 'l1 - "4 'Z /. -4 -4 2 ^ ~ X X 'T ~ 7 a' zd X > y n E IT y y 75 4 4 ^ 4 --o ^ 2. 44 U -- l --> -- h -- *" 31 3; __ --34 H. 1 C 4* c-4 4 y 1' 1- ~ 4. -- 4 4 ~ z-1 4 4. "" 3 4 14 E 1 c 0 ---r- y-- c 3 5 4_ :r 4" 4` y 4 --r hall 'C y 2 ~ -? 3" X x 10 vi y 0 3" " - y 4 y v: fl X 4> i-- -_ io TO c --^ 4h y K c_ y? V. ~ X O y y V - * TC 3" V. J iZ y X ~ X S Ts ~ IS iZ T9 ~ t: 5^ citimiia o! 1he g a s tro in t e s tin a l tr a c t. Hien one max a t t r ib u t e 111< difference in incidence between ( lie asbestos and l a i c c r o u p s to llic reasons given 1`or c a rc in o m a of 1lia lung and pleura Deaths Jhtr to A six stasis mu! Com pheat inn s-- Previous studios have reported that cor pulm onale is a m ajor complication of as bestosis am i a m ajo r cause of death among asbestos w orkers'' The findings in 1lns stu d y, however, are not consistent with the pro\ious reports, and this m at be e x p la in e d by a lower concent rat ion of asbestos dust exposure over a prolonged period of time, The moan duration of exposure of (hose who developed lung or pleural cancer was 28,2 y e a r s noth a range o f In to 40 y e a rs T h i s is consistent w it h 1he, o bservatio n of (b is o n '1 who r ec e n tly pointed out that a reduction in asbestos dust exposure is less likely to produce chronic lu n jf disease, but the risk' of neoplasia increases with sustained exposure to relativ e ly lower concentrations In 2(1 of the deaths w he re roentgonographie data were av a ila b le . 12 showed changes eonsistenl w ith asbestosis. In only two of the 12, death was related to the asbestosis, cor pulmonale being the p r im a r y cause in both, O f the 12 t lit died of m a lig n a n c y of th e lung or pleura, live had asbestosis. and three did not. and no in fo rm t ion w as a v a ila b le on 1lie re m a in in g four, Correlation of Carcinoma of L u n g or Pit lira 'With H/c. Dura Hon of Expos air. or Asia stasis. The mean age of the gruup of 2 workers who developed eareinoma of the king or pleu ra was b(i,b years w ith a range of 44 to hi years. T h is is slig h tly below the mean age of 60.4 y e a rs w it h a range of 44 to 81 y e a rs l o r the overall group of 46 deatli eases. Tin- mean duration of exposure of those that had cancer of the Jung and pleura was 28,2 yea rs w ith a range of 1b to 40 \ e a rs . T h e average y e a rs from onset of exposure to death in th is group was 2b.b years with a range of 1b to 40 ye a rs . T h e mean d u r a tio n of exposure fo r the o ve rall gro up of 46 deaths w a s 41.e y e a r s with a range of 1b to 47 y e a r s The differences in mean age and mean duration of (exposure for the 46 deaihs cases and the group that developed cancer of the lu n g or p leu ra are not s t a t is t ic a ll y sig nifican t. W i t h re g a rd to carcinoma of the lu n g and asbestosis, the data indicated that five of the 12 i n d i v i d u a l s w it h e arein om a of the lu n g had asbestosis, three, did not, and in four no in fo im alio n was available. The small n um be r of eases p lu s the absence of in formal ion in fo u r eases p re cludes the, m a k in g o f a n y c o rre la tio n . Smmnaiw .uul ( lout ludons .M ortality data on -Mi asbestos in s u la to rs in W \ v Y o r k s la te win lias l a or more \ oars of e xp o s u re 1o asbestos dust by 11)45 or luu achieved 15 y e a r s of e x p o s u re between 11)45 and 11)55 w ere re viewed T h e a t e r a y e aye n1 death w as (it).5 y e a rs \vi1h a r a n y e o .'b'i to 81 y e a rs . T h e r e w ere 1*2 deaths due to ma liu n a n e ie s o f lim< or pleu ra. T h e d ill'ereiiees in the mean aye and mean d u r a t i o n o exposure fo r ihe 4(> deaths and the g ro up th at developed c a n c e r o f lim y or phmra were not s t a t i s t i c a l l y significant I ' roport iona I m o rta lity from carcinom a of the lim y and pleuri am ong asbestos w o r k e r s s tu d ied w as n in e times that e x p e c te d ii l :S white males. The observed m ortality was significantly hiyhe in the JO- to oil- as w ell as in the (>() to 71) y e a r aye g ro u p s. T h i was al va ria n ce w ith a n ilin e s ' p rev io u s findings amony tale w o r k e r who had a s im ila r d u ra l ion of exposure eoveriny a s im i l a r perioi but where the o h sen ed incidence inereased sig nifican tly o n ly i the lid- 1o TD-xear aye e a te y o r y . 'Pile oeeurrenee of n i a l i y u a n e y o lun y and pleura in the \ o im y e r aye group of ashestos w o rk e rs ma. be a t trib u te d to the y real or ca r e in o y c n ie iD of asbestos or tli lonyer duration of exposure to ashestos dust or hotli as eom p arn to tale dust exposure. T h e mean d u ra tio n of exposure of the abeslos w o rk e rs w ith limy or pleural cancers was five years Ion ye in d u ra tio n than 1ha1 fo un d in the tale y ro n p w it h s i m i l a r m a liy nancies, fn ad flitio n , other components in the asbestos d u st ex 1insure such as Ihe presence of m e la llie cations m a y also be fa d o r 1o account fo r the diffe re n ce in incidence between the t w yronps. Carcinom a of the gastrointestinal tract and periloneun of wliieli there were seven eases, showed a sig n ifican tly yroate incidence in the obseiwed as compared to the expected in I'M whit males. Death due to enr pulm onale was observed in o n ly two ii di\ duals. The low tncidmiee of eor pulmonale as a cause of deaf as compared 10 the h.iyh in c id e n c e of p u lm o n a r y and y a s t r o ii te s iin a l c arc in o m a m a y be a s c rib e d to a lowin' level of asbestos dus exposure occiirriny over a lonyer period of time. M. H . X a k i . Ml). I V y a i t m e n t d K m n omne lital Medicine. S t a t e L ' n i w n s i ! ot' Vew Y o r k l>e\\ e s ta t e i l e d i c .i l C en ter, New V o l k , a ssisted in the s t a t i s t i c ; '.Ti )IV-sl- of il.i-f un ! ! KciVrrnci^ 1. K l e i n It'ld. M. : M o r s i le . . . a n d S l m p ii . .! r i m i r a i . l i a d i o l o i A r a i and Pl)YMolo<iical KjlidnyiiM m Va 1o^Toi-.i -., A r d i I n e r i i Mei! 1 1 7 : S j ; y ] <)<*(> 2. P>ador 1W. K . ; Hador, U. A . : and K H i k o d . I. .!. P i i i n u m a n Fin u-ti ou in Asbi^lu^is <>t Limo. Ahicr ./ lieti ;>() : 2-'!b, pie! SHikofV. I. J . ; ('liu rii. -I,: and 1I aminomi. K, ('. N e o p lasia. J \ M \ 18i: 22.' lHi4. WborAo** K \ po nine and 1. K l e i n t 'old. M.. et a l : M t> rlalit\ A n i o n e T a l e M i rii1r- and M i l i a r e ni New \ o r k S i a t e . \ r e h H m i r o u H e a l t h I 1; 1i<>: ;-1i<J7. ld<>7. a. H o a id , P. K . , and W i l l i a m s II . T a o PallioIutM of A A * e W o x K W t h Potei oih o lo Limo P un ctn m . Thoi'i.i 1 ; m;-j. lid i]. *d. ( l i l s o n , d, (dian^in^ l i a z ; u ( U n i LApo-mre lo \A)e>toN l ) i r 4 . proMunod al ( 'o n le r o iK r oli Pio]n_meal K i e c l s o! A nK'- 'x . Net\ V o i k A r a d e m v or Sei- o rn i- , New ^ ork. Oet. li) 21. PHi4. \ NOTE ON " LKT-GO" CORK HA M il E L M O H K O W IT Z . 1MI.1K V.K In an article entitled " S a fe ty in the (No of H a n d I l t s ia lic S p r a y Ooaiitiy E q u ip m e n t ." which 'Vas w ritto i a i i l l i o r and pulilisHod in 1he* -lime, 1060 issue o f 1l iis joen , statement w as made that 1lu> so-called " lei-"'o" level f o r a pound adult is a current o f 60 m illian ip cre s o f 00 cycle AC. v a s also stall'd that " This w ill cause dixeoordinalion of heart ac tion in app ro xim ately ihr most sensitive 1 '2 of .IK of ad ults sub jected to such current lliroiisrh the bod,\.' ' T w o rea d e rs of the a r tic le have objected to e a llim r a flow of as much as (if) m A of 60 m ele A C ' a "' l e i - y o " o u r r o n t sin c e th a t much tumid be h a r m f u l T h i s objection is w ell ta ken. R o b erts ( 1 ). rjnot imr A l e x a n d e r ( 2 d states that " W ith c o n tin u e d contact and How of a 60 cycle alle rn n I imr c u rre n t, c u rren ts o te r 26 m A m iyht lx harm ful, whereas currents of 70-00 mA could prove f a t a l .' " Thilziel i f l ) has pointed out th al -`10 m i ll i a n i p c r e s o f 60 c yc le A t ' is a " r e a sonable safe c u r r e n t " for a d u ra tio n m a y in d u c e a f r e e z i u y J);iz a r d . " He .also has pointed out that " C u r r e n t s of the lot-yo level i f th ey flow for an ap p re c ia b le lim e , are more th an sufficient t< produce deep burns, and both types teleeiric and th erm al) mat be produced s i m u l t a n e o u s l y ." It is hoped th at this note w il l bo used in co nnectio n w ith tin article on electrostatic paird sp rayin p References 1. K o lu - ii" , f-f .), N1jn*cnh'psy fo llo w in g i n j u r y b y ( 'j b c i r ir <!u r r e n t , A rc / E n r l r o u H e a l t h 33 :1 2 3 . 1P00, 2. A lo v a n c io r. L . : K l e r i r l c a l n ijn r u 'S in th e m i t r a l tiorv->n^ s y s te m . Mer (ll'a y o r ( h I mcr 22:0(18. liJoS. 2. Dal/Ud. C. V. . KlocinV Mioek. Tht- Kncvclopedm of KliTtronics. ed In ( `httrloH R u ^ k i n d . pp. 200-20S, lirinhold Tkiklisliiriii Co.. New Y o rk . 1002.