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FILE NAME Household Contact HC DATE 2007 DOC HC054 DOCUMENT DESCRIPTION Journal Article - Scientific Knowledge Concerning Neighborhood and Household Exposure to Asbestos and Disease 2007 Scientific Knowledge Concerning Neighborhood Exposure To Asbestos And Disease - 2007 and Household Richard A. Lemen Ph.D. Asbestos diseases can occur at virtually all levels of exposure Higher exposures result in higher risks and lower exposures result in lower risks of developing disease At the current OSHA standard the risk of death is 3.4 per 1,000 at 0.1 fibers over a working time Even at this new limit it can be clearly seen that the risk for dying from cancer is not zero The World Health Organization has stated that he human evidence has not demonstrated that there is a threshold exposure level for lung cancer or mesothelioma below which exposure to asbestos dust would not be free of hazard to health This continues to support what the industry representatives reported in 1965 at the New York Academy of Sciences Conference on the Biological Effects of Asbestos that the only safe level to prevent disease is zero.,, All commercial forms of asbestos including chrysotile amosite crocidolite tremolite and anthophyllite can cause asbestosis asbestos pleural diseases lung cancer and mesothelioma.2 By 1964 there were more than 700 articles in the worldwide medical literature dealing with health effects associated with asbestos exposure. By 1964 all of the major asbestos related diseases ' Commenting on the effectiveness of asbestos guidance concentrations S.A. Roach of the University of London stated that " . .5 million particles per cu Ft are simply standards although I hope I did not use the word safe These are standards which are actually used although they are not ever expressed as being safe standards Roach further went on to state that even if this was dropped to 2 million particles per cu ft that this would not necessarily be a perfectly safe level of dust Roach 1965 It is interesting to note that a worker would not be able to see this concentration of dust in the ambient air and would not see any dust until a concentration of between 20 to 40 mppcf was reached Hemcon 1955 Warren Cookin 1942 said This 5 mppcfis a very small concentration so small in fact that the condition may look good even to a critical eye and still present an exposure greater than this low limit Cook 1942 The 5 mppcf guidance concentration remained in effect until the 1960s DOL 1960 Cooper 1967 states the 5 mppcf recommendation for protection from asbestos exposure proposed by the ACGIH since 1946 rests on shakier evidence compared to other such recommendations 2 World Health Organization 2006. Elimination of asbestos diseases Geneva Institute of Medicine 2006. Asbestos Selected Cancers draft Committee on Asbestos Selected health Effects The National Academies Press Washington DC Dupre JS Mustard JF Uffen RJ 1984. Report of the Royal Commission on Maters of Health and Safety Arising from the Use of Asbestos in Ontario Ontario Ministry of the Attorney General Toronto ON Canada Queen's Printer for Ontario IARC 1976. IARC Monographs on the Evaluation of Carcinogenic Risk of Chemicals to Man- Asbestos Research Volume 14. International Agency for Lyon France on Cancer World Health Organization 3 Ozonoff D. Medicine In 1988. Failed Warnings Asbestos Disease and Industrial The Health and Safety of Workers - case studies in the Politics of Asbestos home Exposures Richard A. Lemen Ph.D. 2 including asbestosis lung cancer and established by the epidemiology literature mesothelioma had been Because asbestos diseases are response diseases each exposure to asbestos has the potential to increase the overall risk of developing an asbestos disease As reported by Brodkin and Rosenstock While it is likely that there is some exposure threshold none has been demonstrated convincingly such that individuals with low exposures or higher exposures of short duration e.g. for a period of days to weeks are not at risk This pattern is probably different from the relation between exposure and asbestos malignancies in which even level or brief exposures may confer at least some increased , risk There is also a marked enhancement of the risk of lung cancer in persons exposed to asbestos who also smoke However there is no evidence that smoking enhances the development of mesothelioma as it does with lung cancer.6 Professional Responsibility Oxford Ed Ronald Bayer Oxford University Press New York 4 Merewether E.R.A. and Price C.W. 1930. Report on the effects of asbestos dust on the lungs and dust suppression in the asbestos industry I. Occurrence of pulmonary fibrosis and other pulmonary affections in asbestos workers II Processes giving rise to dust and methods for its suppression London H.M. Stationery Office Merewether ERA 1930 The occurrence of pulmonary fibrosis and other pulmonary affections in asbestos workers J Indus Hyg Vol 12 No. 4 p Western 239 Merewether E.R.A. 1949. Annual Report of the Chief Inspector of Factories for the year 1947. London HMSO 1949. p 78 Doll R. 1955. Mortality from lung cancer in asbestos workers Br J. Ind Med Vol 12 p 81 Wagner J.C. Sleggs C.A. and Marchand P. 1960. Diffuse pleural mesothelioma and asbestos exposure in the North Cape Province Br J. Ind Med Vol 17 p 260 Mancuso T.F. and Coutler E.J. 1963. Methodology in industrial health studies The cohort approach with special reference to an asbestos company Arch Env Health Vol 6 p 210 & Selikoff I.J. Churg J. and Hammond E.C. 1964. Asbestos exposure and neoplasia JAMA Vol 188 p 22 5 Brodkin CA Rosenstock L 2005. Asbestosis and asbestos pleural disease 19.8 In Rosenstock L Cullen Mr Brodkin CA Redlich CA Textbook of Clinical Occupational and Environmental Medicine second edition Elsevier Saunders 364- 379 6 Smoking and Risk of lung cancer increases more than just additive but of a multiplicative nature Both asbestos and smoking are independently capable of increasing the risk of lung cancer One of the largest cohorts of asbestos workers to demonstrate this is that of the North American insulators studied by Dr. Selikoff His investigator Dr. E. Cyler Hammond of the American Cancer Society ACS reported among 12,051 insulation workers with more than 20 years of work experience when compared to a control population from the ACS of 73,763 men both of whose smoking history was known that the RR went up to 53.24 for smoking asbestos insulation workers compared to smoking asbestos workers with 5.17 and asbestos insulation workers as controls of 10.85 Hammond et al 1979 In addition another summary of smoking and asbestos exposure combined reported the RR for 3 additional studies to be 8.2 32.7 and 25.7 Blennerhassett et al 1995 Asbestosis patients had an Standard Mortality Ratio SMR of 15.47 95 CI 11.2-20.8 for lung cancer Morinaga et al 1993 An analysis of 23 studies on asbestos exposure and smoking shows that asbestos multiplies the risk of lung cancer smokers and smokers by Asbestos home Exposures Richard A. Lemen Ph.D. 3 home asbestos on workers clothes shoes or hair can cause household exposures as can proximate residential exposures to asbestos sources These types of exposures and their resultant disease manifestations are outline very effectively in the National Institute for Occupational Safety and Health Report to Congress on Workers Home Contamination Study which was conducted under The Workers Family Protection Act 29 U.S.C. 671a In this report NIOSH concludes that " families of asbestos workers have been at increased risk of pleural pericardial or peritoneal mesothelioma lung cancer cancer of the gastrointestinal tract and malignant pleural and parenchymal abnormalities as well as asbestosis It has been known for many years that the best method to control diseases associated with exposure to asbestos was to control the exposure to the dust containing the asbestos fibers.8 As early as 1897 Netolitzky a physician reporting on lung disease among textile workers also observed illness among their family members.9 1913 it was suggested that street clothes should not be worn in the work area and that work clothes should be removed prior to leaving the factory thus preventing industrial poisons from being carried away from the workplace and exposing workers to the industrial hazard.10 Kober and Hayhurst 1924 advised that street clothes should not be worn at work and that change rooms and washing facilities be furnished by the employer at the workplace.11 The International Labour Office in their Standard Code of Industrial Hygiene published in 1934 recommended that In dusty trades cloakrooms wishing accommodations and eventually douche separate from the workrooms should be provided for the workers The Code also stated that Such smoke a similar factor and that the combined relationship of exposure to asbestos and smoking can be best described by a multiplicative rather than an additive model Lee 2001 7 NIOSH 1995. Report to Congress on Workers Home Contamination Study Conducted Under The Workers Family Protection Act 29 U.S.C. 671a U.S. Department of Health and Human Services Public Health Service Centers For Disease Control And Prevention National Institute for Occupational Safety OH 45226 September See sections on Asbestos p tables 2-6 pp 145-159 8 See Chapter X in Drinker P. & Hatch T. 1936. and Health NIOSH Cincinnati 6-11 45-46 55 62-63 86-87 INDUSTRIAL DUST - Hygienic Significance Measurement and Control and London . McGraw Book Company Inc. New York 9 Netolitzky a 1897. Hygiene der Textilindustrie Handbuch der Hygiene Weyl T. ed Vol 8 Industrial Hygiene Jena G. Fischer Pub pp 1102-1103 10 See p 248-249 in Tolman W.H. & Kendall L.B. MCMXIII 1913 SAFETY Methods For Preventing Occupational And Other Accidents And Disease Harper & Brothers Publishers New York & London 11 Kober G.M. & Hayhurst E.R. 1924. Industrial Health P. Blackiston Son Philadelphia p 24 Asbestos home Exposures Richard A. Lemen Ph.D. 4 fumes and gas should be rendered harmless prior to being passed into the outside air In 1940 the German GUIDELINES FOR THE PREVENTION OF HEALTH HAZARDS FROM DUST IN ASBESTOS MANUFACTURING PLANTS specifically mentions that street garments must not be left in the working area and that the retained on intervals dust working clothes must be removed at regular 13 In 1943 the United States Public Health Service published in their MANUAL OF INDUSTRIAL HYGIENE AND MEDICAL SERVICE IN WAR INDUSTRIES the importance of cleanliness so that the worker did not carry the workplace exposures out of the workplace The Manual stated that It is highly necessary that workers have adequate washing facilities This implies enough wash stands or showers and a sufficient quantity of hot water as well as cold There should also be adequate time to enable thorough cleansing change of clothes and dressing between the end of work and the time when transportation facilities are available Many plants give too little time between the end of work and the bus home The report further states that The work clothes should be provided and laundered by the employer Also that he employer should without expense to the employees furnish proper boots or shoes for the use of the employees while at work in such places As can be seen from the above cited references concern for take home exposure and the release of toxic materials from the factory were a major concern Specifically by 1943 documentation of the effects of these home and environmental contamination concern's were appearing in the literature Good & Pensky 1943 reported a few cases in workers wives of eruptions resembling their husbands from halowax acne cable rash The authors suspected the cases in the wives to have been the result of contact with work clothes and from laundering shirts and underwear In 1965 two events documented asbestos home exposure and environmental exposure to asbestos with disease The first was the publication of Newhouse & Thompson reporting mesothelioma among persons with a history of living with asbestos workers and of cases in 12 ILO 1934. STANDARD CODE OF INDUSTRIAL HYGIENE International Labour Office Geneva R. S. King & Son Ltd. London 13 See GUIDELINES FOR THE PREVENTION OF HEALTH HAZARDS FROM DUST IN ASBESTOS MANUFACTURING PLANTS Effective as of 1 August 1940. See Bulletin for labor Practicesin the Reich No. 29/1940 III 263. 14 See Gafafer W. M. ed 1943 MANUAL OF INDUSTRIAL HYGIENE AND MEDICAL SERVICE IN WAR INDUSTRIES Division of Industrial Hygiene national Institute of Health United States Public Health Service W. B. Saunders Company Philadelphia and London p 168 350-351 15 Good C. K. & PenskyN. 1943. Halowax Acne Cable Rash Cutaneous eruption in marine electricians due to certain chlorinated naphthalenes and diphenys Arch Derm Syph September Vol 48 No. 3 American Medical Association 254 Asbestos home Exposures Richard A. Lemen Ph.D. , LO persons living in the neighborhood of asbestos factories Also at a meeting of the New York Academy of Sciences published in December 1965 discussion of the Newhouse & Thompson findings the Wagner findings of community disease in South Africa first published in 1960 and reported at the NYAS meeting and the Kiviluoto finding of bilateral pleural calcification in a 50 year old woman whose only known exposure to asbestos was living in the immediate vicinity of an asbestos mill and playing with asbestos as child Subsequent to the events of 1965 many studies have shown the effects of home asbestos exposure and of community environmental exposures Navratil & Trippe 1972 in Czechoslovakia found 9 out of 155 persons living in the neighborhood of an asbestos factory to have xray evidence of pleural calcification with or without other signs of asbestosis when only 0.53 would have been expected They also found 4 out of 114 persons older than 20 years who were relatives of factory workers when only 0.39 would have been expected Finally they found 28 of 8,127 persons over the age of 40 years that lived in the same district of the factory but not in the immediate neighborhood of the factory to have pleural calcification or about 0.34 Lieben & Pistawka 1967 of the Pennsylvania Department of Health reported several cases from both neighborhood and household asbestos exposures that resulted in mesothelioma.19 Anderson et al 1976 1979a 1979b & Anderson 1983 reported on familial exposure to asbestos and disease showing both malignant and malignant disease occurring in family members not otherwise exposed to asbestos.20 In 1991 Joubert et al followed 16 Newhouse M. L. & Thompson following exposure to asbestos in 261-269 H. the 1965. Mesothelioma of pleura and peritoneum London area Brit J industr Med Vol 22 pp 17 See papers by Thompson - Asbestos and the urban dweller pp 196-214 Kiviluoto Pleural plaques and asbestos Further observations on endemic and other nonoccupational asbestosis pp.235-245 Mancuso T. F. Discussion p 589 in BIOLOGICAL EFFECTS OF ASBESTOS 1965. Selikoff I. J. & Churg J. eds Annals of the New York Academy of Sciences Vol 132 Art 1 pages 1-766 See Wagner J. C. Sleggs C.A. & Marchand P. 1960. Diffuse pleural mesothelioma and asbestos , exposure in the North Western Cape Province Br J Ind Med Vol 17 p 260 18 Navratil M. & Trippe F. 1972. Prevalence of pleural calcification in persons exposed to asbestos dust and in the general population in the same district Environ Research Vol 5 pp 210-216 ; 19 Lieben J. & Pistawka H. 1967. Mesothelioma and asbestos exposure Environ Health Vol 14 April pp 559-568 Arch 20 Anderson H.A. Lilis R. R. Daum S.M. et al 1976. Household exposure to asbestos and risk of subsequent disease In Saffiotti U. & Wagoner J.K. eds Occupational Carcinogenesis Ann NY Acad Sci vol 271 pp 311-323 Anderson H.A. Lilis R. Daum S. et al 1979a Household exposure to asbestos and risk of subsequent disease In Lemen R. & Dement J. eds Dusts and Disease Chicago Pathotox Publishers Inc. pp 145-156 Anderson H.A. Lilis R. Daum S.M. & Selikoff I. J. 1979b Asbestosis among household contacts of asbestos factory Asbestos home Exposures Richard A. Lemen Ph.D. 6 household contacts from one amosite factory in New Jersey and found 28 died of lung cancer 23 died of gastrointestinal tract cancer and % died from mesothelioma The authors stated that this represented 2 times expected based on national estimates Magnani et al 1993 reported that among family members of Italian cement workers that 4 pleural tumors 1 mesothelioma were observed when only 0.5 were expected and that 6 lung cancers were observed when only 4 were expected This represented a significantly elevated SMR of 792.3 for cancer of the pleura among domestically exposed women The authors reported that the plant had no laundering facilities and therefore the work clothes were laundered at home.22 Miller 2005 reported on 32 cases of home asbestos resulting in mesothelioma Miller's unique approach surveyed law firms reporting such claims and from 15 firms received information to evaluate the claims relevance to home induced mesothelioma After excluding those with other potential exposures to asbestos found 32 cases with sufficient evidence to conclude home asbestos as their only source of exposure to asbestos All cases were diagnosed since 1990 which the author attributes to the ongoing risks of asbestos cancers Roggli and Longo 1991 found that household mesothelioma patients had similar exposures to shipyard workers and other asbestos trades and far greater than building occupants Many other community studies control studies and according workers Ann NY Acad Vol 330. Pp 387-399 Anderson H.A. 1983. Family contact exposure In Proceedings of world symposium on asbestos Montreal Canada Canadian Asbestos Information Center PP 349-362 21 Joubert L. Seidman H. & Selikoff I. J. 1991. Mortality experience of family contacts of asbestos factory workers Ann NY Acad Sci vol 643 pp 416-418 22 Magnani C. Terracini B. Ivaldi C. et al 1993. A cohort study on mortality among wives of workers in the asbestos cement industry in Casale Monferrato Italy Brj Brj Ind Med Vol 50 pp 779-784 23 Miller A 2005. Mesothelioma I household members of asbestos workers 32 United States cases since 1990. Am J Ind Med May 47 458-62 24 Roggli VL Longo WE 1991. Mineral fiber content of lung tissue in patients with environmental exposures Household contacts vs. building occupants Ann NY Acad Sci 643 511-518 25 Kilburn K.H. Lilis r anderson H.A. et al 1985. Asbestos disease in family contacts of shipyard workers Am J Pub Health Vol 75 No. 6 pp 615-617 26 Ashcroft T. & Heppleston A.G. 1970. Mesothelioma and asbestos on Tyneside pathological and social study In Shapiro H.A. ed Pneumoconios Proc Int Conf Johannesburg South Arrica Capetown South Africa Oxford University Press Pp 177-179 McDonald A.D. & McDonald J.C. 1980. Malignant mesothelioma in North America Cancer Vol 46 No. 7 pp 1650-1656 McEwen J. Finlayson A. Mair A. Gibson A.A.M. 1971. Asbestos and mesothelioma in Scotland An epidemiological study Int Arch Arbeitsmed Vol 28 pp 301-311 Rubino G. F. Scansetti G. Donna A. & Palestro G. 1972. Epidemiology of pleural mesothelioma in Western Italy Piedmont Brit J Ind Med Vol 29 pp 436-442 Vianna N.J. & Polan A.K. 1978 Asbestos home Exposures Richard A. Lemen Ph.D. , 7 to NIOSH some 17 case reports and 22 case series reports have also discussed both home asbestos exposure and subsequent disease development as well as neighborhood exposure to asbestos and disease Additionally one study observed 12 of 16 dogs with mesothelioma had a history of asbestos exposure Among these 75 of dogs had a history of exposure to asbestos 9 were living in a house with a member having an asbestos occupation or hobby 5 lived in households where additional insulation or home remolding had occurred and 5 others were living in residential proximity to industrial sources of asbestos It is interesting that when using a method to equate dog to human age that the mesothelioma were occurring at similar ages in dogs as in humans Laundering of Worker Clothing Contaminated with Asbestos Much of the exposures to asbestos among family members can come from the laundering of worker clothing Laundresses or those that wash clothing have been known for centuries to be at risk of a variety of diseases . . they inhale by the mouth and nose a mixture of harmful vapors of all sorts . . . This observation by Bernardio Ramazzini the father of modern occupational medicine in 1713.30 Family members of asbestos workers who laundry their clothes are also at risk of diseases as is the worker from exposures to asbestos Concentrations of asbestos were recorded in workers homes who brought their work clothes home of 50 to 2000 m when compared to homes of asbestos workers of 32 to 65 m.31Newhouse and Thompson reported 7 females among 76 mesothelioma patients who only had a history of washing the work clothes of their occupationally exposed occupational exposure to asbestos and malignant mesothelioma in woemen Lancet Vol 1 pp 1061-1063 Whitwell F. Scott J. & Grinshaw M. 1977 Relationship between occupations and asbestos fibre content of the lungs in patients with pleural mesothelioma lung cancer and other diseases Thoraz Vol 32 pp 377- 386 27 NIOSH Conducted 1995. Under Report to Congress on Workers Home The Workers Family Protection Act 29 Contamination U.S.C. 671a Study U.S. Department of Health and Human Services Public Health Service Centers for Disease Control and Prevention National Institute for Occupational Safety and Health , September Table 5 pp 151-153 28 See Reference 19 NIOSH 1995 Table 6 pp 154-159 29 Glickman L.T. Domanski L.M Maguire T.G. Dubielzig R.R. & Churg A. 1983 Mesothelioma in pet dogs associated with exposure of their owners to asbestos Environ Res vol 32 pp 305-313 30 Ramazzini B 1713. Diseases of Workers De Morbis Artificum of 1713 Translated by Wilmer Cave Wright Published under the auspices of the Library of the New York Academoyf Medicine Hafner Publishing Company New YorkLondon 1964 31 Nicholson WJ Tumour incidence after asbestos exposure in the USA Cancer risk of the occupational population Berichte Nr 475 D^...sseldorf161-177 Asbestos home Exposures Richard A. Lemen Ph.D. 8 husbands or family members In the Newhouse and Thompson study 9 of the mesotheliomas did not have occupational exposures and a secondary analysis found their 16.75 95 CI 2.0-136.78 Vianna and Polan doing a control study of mesothelioma found 7 wives and 1 daughter's only exposures were to washing asbestoscontaminated work clothes In the control study only one matched control had such a history Schneider et al calculated the 8.0 95 CI 1.0-64.0 Schneider et al mentions two other reports where the family members developing mesothelioma had only exposure during washing their other family members work clothes contaminated with asbestos.36 Roquin et al 1994 report two cases of family members with pleural mesothelioma The first a 33 year old man whose father worked with asbestos boards for 5 years and the work clothes were laundered at home The second was a 76 year old woman who had laundered her husbands work clothes as he worked 32 years in and asbestos factory and developed the disease 18 years later.37 32 Newhouse ML Thompson H 1965. Mesothelioma of Pleura and peritoneum following exposure to asbestos in the London area Br J Inudst Med 22 261-267 33 Schneider J Straif K Woitowitz H 1996. Pleural mesothelioma and household asbestos exposure Rev Environ Health 1-2 65-70 34 Vianna NJ Polan AK 1978. occupational exposure to asbestos and malignant mesotheliomian females Lancet 20 1061-1063 35 Schneider J Straif K Woitowitz H 1996. Pleural mesothelioma and household asbestos exposure Rev Environ Health 1-2 36 Schneider J Straif K Woitowitz H 1996. asbestos exposure Rev Environ Health 1-2 65-70 Pleural 65-70 mesothelioma and household 37 Roguin A Shahar M Dror G Cohen , Hazani E 1994. Malignant mesothelioma in families of asbestos workers Harefuah June 15 126 702-704 764