Document 6BMG4jVd5Oj80gpV1rZD78e2R

FILE NAME: Talc (TALC) DATE: 1967 May DOC#: TALC008 DOCUMENT DESCRIPTION: Medical Journal Article - Mortality Among Talc Miners and Millers in NY State 663 fT~- tures are a feed lian village pro- edieal servia* in control. Cases of deaths froto all fortnightly home lax! intake an* the Pan .c ; HiMlth Ofa-inis the National ins' > ami von, 4 T . j Sc: 245: lio : pjXUTnz ef Tintemahm InTh R-29T VJG4. o-nal 1'robit'tu.s ,: P:\nmnn, fd-du: in- 1 yndrom* l\,i: and It* rw'rriii')'* ,rml Studies No ''> 'rgani/ation of the a iVh'l ,'W iL V; ,, s Dt'\feIop<*a (/wn .`gioiil Behaviu m dl WHO iUre-N) ndifs o Dial ihn;,! Demographic DN,, ase in Two Run! Righiends. Ana-' -) ` Diauheui Disep-aEtiology of KmUnnatemiilafi Children. -400, 1002. teed Dxbea.se, Am<-r of Diarrheal Dtsironmentiil Factor of Acute Diarrheal ages. Am<'r J Trap arid hood Output a Agricultural Foortmeni of Agrl nS Foreign llegioor.l nsibiUiies is 3 licenses.-- ools, JAMA Mortality Among Talc Miners and Millers in New York State Me: ns Kh-nlcid MD Jacqumne JVf.--.stl-\ Mil Ohre Ko.-v-.rn, MO. and K` ' Mahid? 11 Xah, Mil .V,. Yod. S lN C K 1940, the Division of Industrial Hv'dene has carried out a number of studies on laic miuf'is and millers in the northern port of New York state The j-nmc- purp* of tlicse studies was to ascertain the healt-t h zards associated with the exinisure to uual in iale mining and milling. In TJ >, a chest r;iv bUrvt.y of 221 talc miners and millers employ1 in se\oral plaids in thn region disclosed pulmonary fibrosis in 32 workers. 18 of whom had had no other occupational dust exposure. This survey clearly indicated tha.t exposure in these talc mines and nulls vu callable of producing a fibiogcnic type o: ' 1 I0S-1. n fnlllW.im slucK- of the 32 workers with pulmonary fibrosis disclosed that the pneumoconiosis was progressive and disabling but that the progression was slow and the disability 0l~ curred primarily in the older age group.-' A report on the clinical, ruentgenographic, mid pathological findings in six patients who had an average exposure to talc dust of 26 yearn with a range of 20 to 33 years was reported in 1963 3 The major clinical feature were ' chronic productive cough, dyspnea, dimin ished breath sounds, limited chest expun * sion, diffuse rales, and clubbing. The chest *roentgenogram disclosed pulmonary infiltm- %_tlon S:>oth basalty and in the midlung fields, f jj n some instances obscuration of the car- 4. diac borders or costophrenic sinuses,, or both, talning macrophages with -ibsotk-d dust particles. A patu-m of endarteritis wdh mt>mal hypoplasia was frequently noted. Idfotcu-'ion of brondii and bionchwlcs with tur ination of cystic spaces was common. K.ither characteristic was the presence of elongated, lernunaliv dubbed bodies iiiriiatimunsb.ddfrom asbestos budits as *-eu; in asbestosis The pleura showed dense fibrotic thitkvning. Cor pulmonale was the major complica tion in four of the six cases and was the mechanism of death in three. A comparative clinical, ruentgenographic, and physiologic rtudy of workers exposed to fibrous ana i.'lY.nulwr talc dust was made in 1961* The two groups were similar wun rev,mu sex, degice of exposure, mid smoking habits. There were no significant dUl'ereitecs in the clinic.il and roenlgcnopaphic findings be tween the two groups. However, the mmibci^ of abnormal values for each parameter ot pulmonary function measured ',VC, M- >Ml>r, RV, TLC, RV/TLO and DL, 1 was appiv.cial.ily greater in those expo to fibrous than to the granular varietv of talc. In 1965, pulmonary function tests wi-ve per formed on 43 workers engaged in the milling of the fibrous variety of talc.6 The mean du ration and weighted average of exposure was 19 years and 62.3 million particles per cubic foot, respectively. An appreciable umber of the workers had abnormal pulmo nary function measurements. This was par T w ere present, The most frequent patho ticularly evident in the vital capacity,^ total l o g i c a l change was a diffuse fibrosis don lung capacity, and diffusing capacity. I here were 16 who showed pulmonary infiltration ' t Submitted for publication Vhx 21. W - .p u rt 1 *:7 Jan 10, 1907. N, $ From the Division of industrial Hygew. # York (Drs Klein fold, Messite, and Kooyinan), and the State Univ,>> of New York, rtowostate Mn?Ca! renter (Tin,. Klemfeld, Messite, and ZokU. on their chart roentgenograms as compared to 27 without such evidence. Those with pos itive radiologic findings had a proportion ately greater number of respiratory symp toms and signs and abnormal pulmonary * BrS p r in l S L s t e fo 80 Centre St, New York 10U13 function values as compared to those with- O r Klcinfeld). fWcS -M A- 664 MORTALITY AMONG TALC MIN EHS~ KLEINFELD ET AL out. In general, the correlation between the degree of pulmonary function impairment and the clinical and roentgenographie findings was poor. The purpose of the present follow-up Study was twofold: (1} to obtain an estimate of the incidence of disease among this select group of talc workers, and (.2) to coinpare the observed mortality experience from spe cific diseases with the expected mortaiily among a similar basic population. Materials and Methods Ail talc /moors and millets employed m 19-10 who had la or more years of exposure to tale dust as well as those who achieved a minimum of 15 years of such exposure hi tween 1940 and 1965 wei e included in this study. The group to talled 220 workers, and it is beliovtd that the oveiali number of 22u constituted the total work force in the categoiy under study. Source of Data.---The data were obtained from a number of sources. Plant records were examined and the work history of each individ ual was derailed to include-1changes id job and specific years of employment Death ceitificates were studied in all instances when available. The records of file physicians attending the workers privately were reviewed. Substantial mi riicai information on the majority of the workeis was available in the Division's files and was used as an additional source of data. Hos pital records including autopsy repoits and his tological specimens were examined wherever available. Autopsy records were obtained in 35 of tire 91 deaths. Statistical Analysis.---The total number of deaths was distributed m the foliowing catego ries: malignam-ies, cardiac, pneumoconiosis or complications or both, accidents or suicides, and all other causes. The proportions of mor taiity from cancer of the lung and pleura and of the gastrointestinal tract and peritoneum, out of the told mortality, were compared with the expected inortaiitki; due to the above causes in the various age groups. The expected mortality represents the proportion of deaths among white men in the United States, due to the specific causes in the year 1957. This par ticular year was chosen as standard because it is the midian year of death among the 9! deaths. Differences between observed ind ex pected frequencies were tested for significance using the normal curve with large numbers and the Fisher's exact probability test for small frequencies. ' Findings Total Deaths.--There were 91 deaths in the group of 220 talc workers. The causes m death in the various allegories ate shown m Table 1. A breakdown of the dentils accord ing to age group showed that two workers under 40 died, 38 workers who were between 10 and 59 years died, 47 between (50 and '<) years, and four died who \vc 80 years a: d over (Table 2 j. The average age at death if the 91 talc: workers was 60.4 years with a range of 38 to 84 years. Malignancies.---Of the 91 deaths, the oh .-erved and expected number of deaths ck.r lo cancers of the lung, pleuia, gastruime.suual tract, and peritoneum are shown in T i hie 2. Of the ten malignancies of the lurg and pleura, nine were carcinomas of tl c lung and one was a fibrosarcoma of the plea ru. Of l!ie seven malignancies of the gas trointestinal tract and peritoneum, two werecancers of the stomach, and one each of car cinoma of the colon, rectum, and pancreas. 'There was one primary hepatoma of the lr or, and the remaining cast: was a pt-mone: i mesothelioma. The malignancies invokm" other sites included one case of retroperito neal reticulum ceil sarcoma and one of chronic, lymphatic leukemia. Cardiac Deaths,--Of the 25 cardiac dead x excluding cor pulmonale, 19 subjects had coronary artery disease, three had hyperten sive heart disease, and three had rheumatic heart disease. Pneumoconiosis or Complications or Both.--Of the 91 deaths, 28 were due to pneumoconiosis or complications or both. Nineteen of the 28 were due to cor pulnHnule, five to advanced tuberculosis, and four Table 1.-- C auses ot Death in 9 1 Talc Workers During Period ot 1940 to 1965 Ceius o' M 'ii- natu lue t ung fnti pk'uia CrtStrointe'.tifi.i! and p.'itor,urn Ali ot?M.r maurojnc C-d-rUiiH. -' itO T (.Ot ii*.' c or (julu io n alc) Cnaotu-.H d 'u o p i p!I1o'YipIrc.'ii'ur^ A t.u cion K or sou-iJe* Act o tn e r cdur.er, Tci.ti '>,, io .v ' A rch E nviron H ealth-- Voi 14, M ay 19G7 to bronchi fust talc roniosis o 25.9 year' ll! this gi en talc in millers o' exposure engineer!! in the ta All fill Pus cate;: 1, i aceidc the reran bleeding m l hern peritoniti mesontw. Enviro death cn remnent nnulubk duration ! group w: , range of dust exp dominan with oth 1`serpenti carbon,! I : amount compare lythe tak ' prior lo i 19-16 .in. 'Table 8 Malie ton can tlji i r al MORTALITY AMONG TAW MINERS--KLEINEELD ET AL 665 Table 2 -- D eaths an d Expected Mortality From Cancer oi the Lung and Pleura and Gastrointestinal Tract and Peritoneum Related to Age in Talc Workers were 91 death in [h-w W s f r o m 'fopw'-ttofici! Mhrt.ility <ers. The cause of ones are shown in the deaths acconi- 9 `Clip To*-;! Death MullJ'nri.'.t (SiUSljA [ upkond Plcwrct r., a! G i rami Pn-;tu Oh- Tn that two workers who were between 40 00 36 b.bf jetv,e< u 60 and 79 4 l t.i 9; |i 4 3 were 8 0 years a n d r A f; , 3 t tf ge age at death of "iota! 60 4 years with ,j tfaf! ,, , , ,,,, , If D P te ff-n , h p.. ! . a - iP . ^ . r v r .! a n J 'o e n r-P -v -u vabn* j <`U< 'T a ti .>..it y ^ x D t vt (,r' u h v - . c-c' or. i ihoor-*; r?t! v {>t`jd> ..d...U...i.t..-.i...r.1.<.*f bignt*` u 91 deaths, the ob iter of deaths due .'ura, gastrointcsliaro shown in 'fameies of tire lung -areinornas of the .rconia of the pleu nicies of the gasitoneum, two were id one each of c ar om, and pancreas, patonia of the liv e was a peritonea! ur-indra involving use of retropcrilooma and one of ha. i 25 cardiac deaths 19 subjects had tree had hypertenree had rheumatic ,'omplications or , 28 were due to lications or both, due to cor pulinoerculosis, and four in 91 Talc Workers 40 to 1965 i 2 to htoiuhopneiunoma. The lapsed time from first talc exposure to dealh from pnenurtortmiosis or complications, or both, averaged 25.9 years, with a range from 15 to 39 years in this group there were 11 talc millers, sev en talc miners, and nine who had been lx>th millers and miners All 28 had their initial exposure before 1945 when more effective engineering controls, including wet drilling in the talc mines, were introduced. All Other Causes.--Of the H deaths in this category, four were due to cciehrovn*cuh.r accidents, two to lobar pneumonia, and the remaining five, to one of the following' bS<*edi'ng duodenal ulcer, .strangulated ingui nal hernia, perforated diverticulum with peritonitis, acute glomerulonephritis, and mesenteric arterial occlusion. Environmental Exposure.--Of the 91 and pleura shows an overall mortality from carcinoma of the lung and pleura to be ap proximately four times that expected. How ever, the significant increase appears to oc cur in the age group of 60 to 79 yearn rattier than in the 40 to 59 year age group. This is at variance to what we have observed among workers exposed to aslx-stos dust where the observed values in the 40 to 59 as well as 60 to 79 year age gioups were significantly different from the expected values (Table 4). The asbestos group consisted of 152 asbestos insulators who had 15 or more years of exfiosure in 1945 or achieved 15 years between the period of 1945 to 1965 The overall mortality was 46 or 30.3%. The reason for the earlier oc currence of an increased incidence of lung or pleural cancers in the asbestos workers com- death cases, data on envi ; ro amenta 1 exposure were available in 80. The mean ' duration of exposure for this Tabte 3.- -Comparative Dust Counts in Talc Mines and Mills, Northern Now York* 1946 |y group was 24.7 years with a ferange of 1-5 to 47 years. The Work Typr j dust exposure consisted pre p-domiuamlv of talc admixed |w ith other silicates such as p erpentine and tremolite, ^carfxwiatti., and a small famount of free silica. Tire Icomparative dust counts in Ithe talc mines and mills |prior to 19-15 and between *1946 and 1965 are shown, in Table 3. Comment Malignancies.--The data fon carcinoma of the lung Mirurb Dotting Murwjng Scrap, ng Mill? Cf ubhtng Sr romping Mili.ng S s 4 ) 3 2800 81 a -j 30 4 7o le v Ntl On At (.'0' u n t s Mad.' (UP to W 4 S ) 22 69 69o 180 A it 6 L 136 6 !' ,<7 7b 2/1 u? 0 3 10 3 9 b d id (,` 9 4 9 196b! i I n Vt 0 8 37 68 30 70 Garner? anti heptfratoi s Ui' 70 728 >:/ 8 21 60 P u ir e ' icers No Outvt C o u n ts Mane 5*5 28 M Ul ggii.7 7 b 1/9 520 Ibi 5 23 69 H ftcar nod truck loan Blow Roo1"! Open chines No Ou-.t Cc.unt? M-TC` *T ? f l 9 o 2 4 S 0 1 2> 21 83 440 12b 18 03 160 DiiOH ttinuet Disco-' mnuru C o n c e n t r a t io n in ' omTo p s . o f c/arftcieb pif c u b ic fo o t <kf o i f - A rch En viro n H e a lth ---Voi 14, M ay 19$7 'JV-, -'--!----1i 111- MPM Tfi P P InP t 666 MORTALITY AMONG TALC M IN E liS-K lE IN F JSL t) F/f AL T 8 r l w Df 3t,fe 7 r xf ected Mortality From Cancer of the Lung and P `ema and ___ G fesf" '3/ T ^ c t and Peritoneun, Related to Age in Asbestos Workers Deatt-s from M. t ' i Ca u s e s P'opoftiorio! Mortality Ac* Tcta; Group Deatrc.- 40 ........ " 1 ' 40 60 '' ? i 60-? 9 ~ " ?3 &0-+- " 1_ Total *-b tUllR AH', --- Pi*Uy.r,. 6 ~ b 0 ` Q i <mci f' niu( i-Li, _ 4~ 3 o Oh .L-fypd 0 6 1 I'la-j Xv\KOI <Ff G 1 3,,:i 06iefv>vi _G ' i 9 1 j 1bft'Ari HI nDbv>rV't`d ai ' SGitir-iic-.j! a,inly.-' , r.ot oe'6. rrt. valuer -i, st.ittsDc.A'y iipn.h ,-int t u iu oi in -.v, liuintipr hi roi'p ' ,it, t nporcrtN^i p .u e d to ill.t ta lc w o r k e rs tn, greater carcinogenicity of asbestos -)1 cases, there wore ten subjects who hail - duit or to an increased level of exposure to diKKlenal ulcer, and in one of the ten the ul asbestos dust or both, as compared to com cer was the (use of death. In the 129 work mercial talc which is a mixture of silicates ers who ate still alive, 19 had a diagnosis'of and carbonates with a small amount, of free duodenal ulcer. This is a total of 29, or sJica, in the absence of adequate smoking 13,2%.^ According to the health statistics oi data one cannot assess the role played bv the US Department of Health, Education, smoking in the causation of the pulmonary and Welfare, the prevalence of peptic ulcer caramon iu both series. In three of the ten found between 1957 to 1959 for males of rdl talc workers where a smoking bistory was mbs is 21,1 per thousand population. o` obtainable, two smoked at least one' pack b.1% < Despite the fact that the figures ob- Wok ik. -- . i! v.au alia one snioKed ten tamed {fiiQUyh Iflf Niltinrril Hnnlih cigars daily for 56 years. represent point prevalence in contrast to the With regard to carcinoma of the gastroin period prevalence figures of our study, it ap testinal tract and peritoneum among the talc pears that tiie incidence of peptic ulcers workers, we did not find any significant among talc workers is higher than among difference between the observed" and expect the general papulation. A significant in ed values in the overall and specific age crease m incidence of peptic ulcer v.irynw groups studied. However, in the asbestos between 20% to 2f.% has been found in pa" group (Table 4) a significant difference be tients with chronic obstructive pulmonary tween the observed and expected values was disease.*1 Since the talc workers have pri found m the overall categories. Our findings marily a restrictive rather than an obstruc in the asbestos workers are similar to what tive lung disorder, one may speculate that has been reported by Selikoff, Churg, and both types may be associated with an in Hammond." If a dear-cut etiological rela creased incidence of peptic ulcer. tionship is subsequently established between Correlation of Carcinoma of Lung With exposure to asbestos and carcinoma of the Age, Duration of Exposure or Pneumoconio gastrointestinal tract, then one may attrib sis or Both.--Relating carcinoma of the lung ute the differences m incidence between the with duration of exposure, it might be rele asbestos and talc groups to the reasons given vant that all the individuals with carcinoma for carcinoma of the lung and pleura. of the lung or pleura had their initial expo Deaths Due to Pneumoconiosis or Com sure prior to the institution of wet drilling. plications or Both.--Previous studies have he average duration of exposure prior to reported that cor pulmonale is a major com the introduction of wet drilling was 34.6 plication of talc pneumoconiosis and is a years. Although this was a period of heavy major cause of death among talc workers.-' exposure (Tabic 3) there is no evidence to dhe findings m this study are consistent indicate that there was a direct relationship with the previous reports. between the duration of exposure prior to Peptic Dicer.--Among the death group of the onset of wet drilling and the occurrence of pulmonary carcinoma. The mean age of A tch F n e iro n H cn lth -- Vol 14. M nv m ? the group o cinoma of t with a ran,'; ly above lirange of (2of 91 drat!, of white m 1920 is giv worker.- vo dues not -i span from carcinoma our data i; son with < evidrnu ' Mo conlirr the remain sarcoma o! oral niassj S Mortali eis in Men years of c- ,^L k..vJ 1 were rev it was 6U.4 years. Proper: the lung f four time However, dence ap group rut Tills was liestos wt of ex post the inapresent i occurreiw tributed possibly greater < merciol ; nal Iran nillcant papula ti ere gas! nancies due to i