Document 71E4L1nxvDrOBpX6M300OkGvg

FILE NAME Packings and Gaskets PAG DATE 1995 DOC PAG029 DOCUMENT DESCRIPTION Journal Article - Ignored Occupational Risks of Asbestos Mesotheliomas La medicina del lavoro Clinica del Lavoro L. Devoto Via San Barnaba & Milano Italy Med Lav 1995 86 5 484-489 IGNORED OCCUPATIONAL RISKS OF ASBESTOS MESOTHELIOMAS C. PINTO M. SOFFRITTI C. MALTONI Rischi professionali sconosciuti di mesoteliomi da amianto Vengono riportati 9 casi di mesoteliomi da amianto insorti in seguito ad esposizioni ignorate a questo minerale In questi casi l'esposizione ad amianto ^stata identificata in seguito ad un'approfondita indagine medica condotta nell'ospedale Un tale tipo di indagine dovrebbe ridurre il numero di mesoteliomi dovuti a cause sconosciute o considerati spontanei Viene sottolineato il ruolo degli ospedali come fonte primaria di informazione epidemiologica I Key words mesotheliomas asbestos ignored exposures i i. i INTRODUCTION Mesothelioma of the pleura peritoneum and pericardium is a rare tumour Several decades ago mesothelioma represented an exceptional finding but since then its frequency has been steadily increasing and nowadays although rare it cannot be anymore considered exceptional Asbestos is known to be the major cause of mesothelioma as has been demonstrated by numerous epidemiological and experimental data 1-2 The increase in the historical frequency of mesothe- lioma is correlated with the increase in the European Ramazzini Foundation of Oncology and Environmental Sciences and Institute of Onco- logy of Bologna Bologna Italy This investigation has been performed within the framework of the oncologic epidemiology programme of the Ramazzini Foundation of Oncology and Environmental Sciences and of the Bologna Institute of Oncology supported by the Bologna Section of the Italian League for the Fight against Cancer diffusion of asbestos fibres in the occupa- tional and general environment Since mesothelioma is rare and be- cause of the causal interrelationship between mesothelioma and asbestos this neoplasia has been considered a sentinel pathological event of asbestos exposure There is however a fraction of cases of observed mesotheliomas in which the ex- posure to the mineral is not evidenced for these cases there is the tendency by many to consider a spontaneous origin This is a mistake since an unproven unknown cause is not a synonym of spontaneous origin In fact existing causes may remain unknown if they are not systematically diligently and specifically resear- ched The spontaneous origin of mesothelioma cannot be ruled out experimen- tal research has shown that there is no tumour produced in animals by means of carcinogens which cannot be also observed in control animals spontaneously be PAR R os Bonde a ve cutest oat Geel Sepa 15 86 5 484-489 nner OF portati 9 casi di jesto minerale un'approfondita ebbe ridurre il anci Viene sot- iologica in the occupa- ent rare and be- elationship beasbestos this red a sentinel estos exposure on of cases of a which the exevidenced for tendency by taneous origin unproven un- nym of sponta- ing causes may e not systematicifically resear- n of mesothe- Out experimen- hat there is no als by means of ot be also ob- spontaneously IGNORED ASBESTOS EXPOSURES 485 arising although at a lower frequency and in old age in the tested animal colony The problem is another one it is that of defining which percent of mesotheliomas is due to environmental exogenous causes asbestos other natural fibres made mineral fibres etc. and which percent may be really spontaneous This type of information is not only scientifically important but provides a more adequate basis for a correct approach to problems of public health such as prevention and compensation The correlation between asbestos exposure and mesotheliomas may be theoreti- cally established by 4 different types of investigations herein listed in order of increasing precision crude population mortality data reviewed population mortality data retrospective mortality research in known exposed populations and oriented research on individual clinical cases diagnosed in general and specialized hospitals This last type of investigation unfortunately practised today so rarely within the hospitals can in fact dispose of the following favourable circumstances for a precise diagnosis not always easy for mesotheliomas and for establishing the asbestosmesothelioma correlation ) the collec- tion of all the available past clinical do- cumentation 2 the possibility of performing all exams needed for a precise diagnosis 3 the possibility of interdisciplinary collaboration to optimize the final diagnosis 4 the possibility of interviewing directly the patients the members of their families and their colleagues for pointing to possible asbestos exposure and 5 a better opportunity to collect information on the exposure scenario The interview with the patients members of the families and colleagues is of crucial importance for establishing the relationship between mesothelioma and exposure to asbestos or other materials Over the last 10 years such a type of approach has been applied for all patients with mesotheliomas diagnosed at the Bologna Institute of Oncology The series of cases of mesotheliomas at our Institute is particularly large for two major reasons ) the cytopathological unit of our institution being the largest in our country examines routinely or for consulting purposes a large amount of serous effusions of patients from our area and also nationwide 2 patients with mesothelioma are sent to our institution for best diagnosis characterization of the neoplasia and for therapy planning It must be underlined that the cytological examination of serous effusions in our series of mesotheliomas has provided the first diagnostic indication in 49.75 of our cases With this report we refer 9 paradigmatic examples of cases of mesotheliomas whose relationship with asbestos has been found after a thorough inquiry into the exposure history Without this inquiry the relationship with the causative agent would have been lost and these mesothe- lioma cases would have been classified epidemiologically by desk epidemiologists as due to unknown causes at the best or spontaneous at the worst THE CASE SERIES Case 1 Pleural mesothelioma in a bank clerk 64 years old at the time of the diagnosis of the tumour The patient worked for 31 years in a modern and apparently clean office figure ) in one of the most importaut banks of the Province of Bologna 486 PINTO ET AL The space between the ceiling and the underceiling the latter made of metallic staves figure ) with gaps between the single staves figure 2 3 was heavily insulated with asbestos igure 3 The asbestos fibres coming down between the staves were polluting the office environment where the patient and the other clerks were working The latency time of mesothelioma time elapsed from the start of the exposure to the early manifestations of the tumors was 35 years Figure 2 Figure 1 Figure 3 Case 2 Pleural mesothelioma in a barber 57 years old at the time of the diagnosis of the tumour The patient had worked for 34 years in a barber's shop located 300 metres from an asbestos cement factory The workers of this asbestos cement fac- tory were regular clients of the patient These workers usually went to the barber's shop directly from work before going home and having the opportunity to wash to comb their hair and to change their cloth been heavi asbestos c hair and th ticular clic mesothelio Case 3 Pleural 67 years c of the tum 25 years in the boat \ boat moto cement w temperatur crack and room who Moreover frequently more made spe with adapt cutt time ofthe Case 4 Pleural exotic fish the time ( Twenty ye tumour t years in bottom of with slates constructio were cut tained but of which w place The lioma was . a barber 57 e diagnosis of id worked for plocated plocated 300 ement factory s cement fac- of the patient it to the barwork before opportunity to and to change IGNORED ASBESTOS EXPOSURES 487 their clothes The patient had therefore been heavily exposed for 34 years to the asbestos contaminating the clothes the hair and the body of many of these particular clients The latency time of the mesothelioma was 34 years Case 3 Pleural mesothelioma in a fisherman 67 years old at the time of the diagnosis of the tumour The patient had worked for 25 years in a fishingboat His main job in the boat was as a motor engineer The boat motors were insulated with asbestos cement which in time as an effect of temperature and vibration tended to crack and crumble polluting the engine room where the patient was working Moreover during navigation the patient frequently had to repair the motor and more specifically to substitute gaskets made with asbestos which he used to adapt cutting them by hand The latency time of the mesothelioma was 41 years Case 4 Pleural mesothelioma in a trader of exotic fishes and aquaria 72 years old at the time of the diagnosis of the tumour Twenty years before the diagnosis of the tumour this trader had assisted for 2 years in the construction of aquaria the bottom of which was made at the time with slates of asbestos cement During the construction of the aquaria these slates were cut with a special saw which retained but not completely the dust part of which was therefore polluting the workplace The latency time of the mesothe lioma was 20 years Case 5 Pleural mesothelioma in a farmer 64 years old at the time of the diagnosis of the tumour This farmer many years be- fore the onset of the tumour had worked directly with a building team on the con- struction of a cow stable on his own land Slates of asbestos cement were used as building material These slates were cut and shaped with saws so generating heavy dust pollution Case 6 Pleural mesothelioma in a farmer and breeder 61 years old at the time of the di- agnosis of the tumour The patient 34 years before the diagnosis of the tumour had worked directly with a building team on the construction of a cow stable and five mink stables on his own land The construction of the six stables was per- formed over a period of three years and the building of each stable took three months For these stables construction slates of asbestos cement were used and cut with saws to the required dimension This procedure heavily polluted the workplace with asbestos dust The latency time of the mesothelioma was 34 years Case 7 Pleural mesothelioma in a car work- shop worker 40 years old at the time of the diagnosis of the tumour The patient had worked for 18 years in a car work- shop and his primary job was to fix the car brakes which were heavily contami- nated with asbestos dust In the course of this job the patient used to clean the 488 PINTO ET AL brakes with a jet of compressed air which diffused the asbestos in the workplace atmosphere The latency time of the meso- thelioma was 19 years Case 8 Pleural mesothelioma in a worker en- gaged in assembling cleaning ma- chines and irons 40 years old at the time of the diagnosis of the tumour The patient had worked on the assembling of steam irons whose reservoirs were in- sulated with glass fibres and for 14 years on the installation of cleaning machines insultated with glass fibres and whose gaskets made of asbestos he adapted cutting them by hand The latency time of the mesothelioma was 25 years Case 9 Pleural mesothelioma in a worker en- gaged in the assembly of printing machines 50 years old at the time of the diagnosis of the tumour The patient was engaged in this occupation for 15 years His activity included the assembling of asbestos slates used as thermal insulation on the sides of the machines The slates were provided shaped and holed to allow the passage of mechanical connections and electrical cables but the shapes and the holes were more precisely adapted during assembly with a file This procedure generated dust which was easily inhaled by the worker since the precision needed in this operation brought the worker himself within a short distance from the machine The latency time of the mesothelioma was 27 years COMMENTS For all the 9 referred cases of mesothe- lioma the relationship of the tumours with asbestos exposure has been traced after a thorough inquiry and particularly after diligent interviews with the patients and their relatives by a trained medical doctor involved in the study of asbestos carcinogenesis since several years There are good reasons to think that without such a type of inquiry these cases would have been considered epidemiologically independent from asbestos exposure These 9 cases are a sample of a large series of ours of asbestos mesotheliomas due to currently ignored occupational and also occupational asbestos ex- posure It is important in our view to focus more attention and to devote more inves- tigations toward a better identification of possible exposure to asbestos in all cases of proved mesotheliomas A more careful approach could in fact bring about - the discovery of yet unknown or not yet considered hazardous scenarios and consequently the identification of new populations at risk of asbestos mesothelioma and therefore the improvement of the epidemiological knowledge of asbestos diseases and also of preventive measures more realistic information on the relative incidence of mesotheliomas due to unknown causes or considered sponta- neous - a more precise risk assessment of the asbestos hazard in society at large more precise criteria for the compensation of mesothelioma as an occupa- tional disease The reported cases also point to the role of the hospital and the medical doctor in the epidemiology of occupational and environmental lar reference to tur need to better an the hospitals as p demiological infor pects this role can other public health SUMMARY Nine cases of following usually sure were reported bestos exposure ha cases of mesothethe tumours with en traced after a particularly after the patients and ed medical doctor of asbestos carciyears There are at without such a cases would have niologically inde- posure sample of a large os mesotheliomas ed occupational onal asbestos ex- ur view to focus evote more invesr identification of bestos in all cases s A more careful ring about t unknown or not us scenarios and ification of new asbestos mesothe- improvement of wledge of asbestos entive measures ormation on the sotheliomas due to onsidered sponta- : assessment of the y at large eria for the comma as an occupa- also point to the | the medical doc- y of occupational IGNORED ASBESTOS EXPOSURES 489 and environmental diseases with particular reference to tumours and highlight the need to better and more extensively use the hospitals as primary sources of epidemiological information For many aspects this role cannot be covered by any other public health structure a thorough medical inquiry within the hospital Such a type of inquiry would reduce the number of mesotheliomas due to un- known causes or considered spontaneous The role of the hospitals as a primary source of epidemiological information is stressed SUMMARY Nine cases of asbestos mesothelioma following usually ignored asbestos exposure were reported In these cases the asbestos exposure has been traced following REFERENCES 1. IARC Asbestos Lyon IARC Monographs on the evaluation of carcinogenic risk of chemicals to humans vol 14 1977 2. SELIKOFF IJ LEE DHK Asbestos and diseases New York Academic Press 1978