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FILE NAME Household Contact HC DATE 1976 DOC HC102 DOCUMENT DESCRIPTION Journal Article - Household Asbestos Neoplastic Risk H.A. Anderson HOUSEHOLD ASBESTOS NEOPLASTIC RISK * Henry A. Anderson Ruth Lilis Susan M. Daum Alf Fischbein and Irving J. Selikoff Mount Sinai School of Medicine The City University of New York New York New York 10029 =.The occupational risk associated with asbestos exposure has been well docu- mented parenchymal fibrosis described in the ILO UC_Pneu- moconiosis Classification -calcification -calcification as irregular opacities pleural fibrosis and pleural afflicted many occupational groups exposed to these mineral en Although optimistic forecasts had predicted a decline in the incidence induced disease recent experience proves that the risk is still involving large numbers of workers in various trades present have shown that such Epidemiologic studies risk of death due exposed individuals have a significantly increased to malignant mesothelioma lung and gastrointestinal cers and nonmalignant ( asbestosis diseases can- significant Asbestos pollution from industrial sources was not anticipated to pose any significant health hazard to the general public However Wagner's work in South Africa and Newhouse's studies in the United Kingdom suggested that the . risk had already spread beyond the factory mine or mill gate dal In 1960 Wagner reported mesothelioma in nonoccupationally exposed individuals In 1964 Newhouse et al. nine cases of mesothelioma in of of asbestos workers and eleven cases among fel family conindividuals whose only identi- living asbestos exposure wasassociatwietdh abestos factory These initial case reports within were not isolated mile of an occurrences peculiar to only one or two regions TABLE ) Additional reports from nine . countries have brought the total number of reported cases of household x thelioma to 37,1-18 Thus household asbestos contact has been meso- established as householdSuch case reports did . not assess the actual incidence or extent of risk to household members or the general public nor did they give any suggestion of prevalence of asbestos have associated radiologic changes in such populations We investigated such disease the problem in order to determine whether the potential hazard is common or rare since such evaluation would assist in messing measures needed for clinical surveillance and for preventive control METHODS We have undertaken a study to assess the risks of nonmalignant and ma- We disease associated with household exposure to derived asbestos \ MES 00928 2 This research supported by National Institute of Environmental Health Sciences 311 1976 NYAS mn: tee ee ere SOIEE 312 Annals New York Academy of Sciences TABLE 1 HOUSEHOLD Great Britain United States Canada Italy South Africa Australia East Germany Scotland West Germany ASBESTOS EXPOSURE MESOTHELIOMA CASE Newhouse & Thompson 1965 Rusby 1968 Ashcroft & Heppleston 1970 Champion 1971 Greenberg & Davies 1974 Lieben & Pistawka 1967 Heller et al 1970 Lillington et al 1974 Anderson 1975 McDonald et al 1970 McDonald & McDonald ( 1973 Rubino et al 1972 Wagner et al 1960 Milne 1969 Bittersohl & Ose 1971 McEwen et al 1971 Knappmann 1972 REPORTS et - 9 1 1 I 2 t t i 4 { 5 ] ! f t 1 1 dust We have investigated one factory in which serious documented asbestos disease has been recorded From 1941 to 1954 when the closed 1664 workers were factory time producing amosite employed asbestos in the factory for varying periods of with them at the time products Their household contacts living they worked in the plant are currently being traced and examined When this process is complete we will examine in detail the bidity and mortality experience of this cohort mor- Among those already traced two pleural mesothelioma deaths have been imdeesnottifhieeldioAmuatopsy tumor tissue has been reviewed and confirmed as pleural of The first the daughter of a man who had worked with asbestos than 13 years died at age 52. Her household more The second the daughter a man with feixvpeoyseuarres hoafdasbbeegsutnosiwnoerakrlyatcthhieldphloaond~- died at age 41. These women were first exposed as children and both had died from a mesothelioma meso- In addition two living cohort members have proven pleural theliomas and are currently under therapy One is a year woman sisterlaw of a worker and the other is a year son of another plant employes Clinical StuUDY Concurrent with the mortality study household contacts of the former asbestos workers were invited to participate in medical examinations to assess Anderson et al Household Asbestos 313 their current health status and the prevalence of early asbestos health effects such as the radiographic changes of parenchymal fibrosis pleural fibrosis and calcification Each individual provided a comprehensive occupational medical smoking and respiratory history 14 17 inch PA right and left oblique chest x rays were taken as were spirometric and volume screening pulmonary function tests Physical examination was done by a physician with emphasison the chest - sicians All the chest x rays were read blind by a panel of five experienced phy- ; sicians using the ILO Pneumoconiosis Classification The consensus read- ing was used for statistical analysis RESULTS <a We have so far examined 354 household contacts After careful questioning were found to have had prior personal occupational asbestos exposure 5 bad abnormal x rays Eleven did not live in the household at the time of the index worker's active employment at the asbestos factory all had normal chest Trays TABLE 2 represents the 326 household contacts who lived in the index had workers homes during their employment who themselves occupational asbestos exposure vot had prior * _ The actual intensity of t^mily household asbestos contamination and length of each contact's exposure to such fibers is unknown We do not know of course . how much asbestos each worker might have brought home on his clothes shoes md hair We do however know when the worker was first employed the total duration of his employment and in many cases the extent of his radio- ~ 2) The index workers length of employment ranged from one day to thirteen fears. Fifty percent of the household members examined came from households TABLE 2 WORKERS DISTRIBUTION OF 326 HOUSEHOLD MEMBERS OF AMOSITE ASBESTOS BY RELATIONSHIP TO WORKER . Relationship Wives Daughters Sons Sisters Brothers Mother Father Cousins etc. Number Examined 83 118 188 70 78 78 78 : 32 23 13 Percentage 25 58 10 % 314 Annals New York Academy of Sciences TABLE } DISTRIBUTION OF HOUSEHOLD CONTACTS BY THEIR INDEX WORKERS LENGTH OF EMPLOYMENT Number of cohort members Total 326 1 31 95 mo- YT 136 41.1 yr- 5 yr 115 321 5.1- 10 yr 29 89 10.1 yr 15 4.87 ) in which the index workers length of employment and thus active contamination of the home was less than one year Thirteen percent had employment periods over five years TABLE 3 RADIOLOGIC Findings All examined individuals considered themselves to be healthy Of the 326 114 35 had chest ray abnormalities ILO Classification irregular opacities 1/0 or more and calcification and thickening of the pleura TABLE 4 a There was a predominance of pleural changes fibrosis and calcification Pleural changes as the only abnormality were seen in 52 16 of those ex- ami^-ed parenchymal fibrosis was found alone of the ILO having parenchymal examined % Only two x rays were read as UC Classification group 1 0-1 parenchymal changes Table 6 were found in 27 fibrosis greater th^n FIGURES 1 a8re examples of the radiologic changes seen DISCUSSION household Of 326 otherwise healthy household contacts ofamosite asbestos workers examined 25-30 years after the onset of presumed contamination with amosite asbestos % had chest - abnormalities pleural_and pleural_and parenchymal characteristic of asbestos exposure We conclude that significant RAY - TABLE4 ABNORMALITIES AMONG 326 HOUSEHOLD OF AMOSITE ASBESTOS WORKERS MEMBERS Ray Finding Pleural thickening present Pleural calcification present Irregular opacities present One or more of above abnormalities ee _ s Number of Household Members 69 % 19 % 62 % 114 35 Anderson et al Household Asbestos TABLE 5 RAY ABNORMALITIES AMONG 326 HousEHOLD OF AMOSITE Asbestos WORKERS MEMBERS 315 Ray Findings Pleural thickening the only abnormality Pleural calcification the only abnormality Pleural thickening and pleural calcification Irregular opacities the only abnormality Irregular opacities pleural thickening and pleural calcification _ * .Total Number of Household Members 42 % 7 % 52 16 35 11 27 % 114 35 bousehold contamination with asbestos from industrial sources can and does commonly occur and may result in characteristic radiologic changes and less frequently in associated neoplastic disease Four pleural mesotheliomas have already occurred When tracing and follow of the entire cohort is complete we will analyze expected and observed deaths by cause to determine whether there n asbestos is a significant increase in cancer risk with household exposure - Pleural fibrosis and calcification without parenchymal fibrosis were seen more frequently than parenchymal fibrosis alone The ratio of individuals with parenchymal changes alone to individuals with pleural changes alone was 0.67 Interestingly this observation differs from the experience of the index amosite asbestos workers in whom pleural changes as the only abnormality was far less common The ratio of workers with only parenchymal changes to those with only pleural changes was 1.92 The explanation for this apparent differ- encien response to these fibers is uncertain Differences in the intensity and extent of exposure are likely + The possible relationship of pleural changes to tumor risk is incompletely known ^ n1974 Edge 1 reported on the prospective observation of 235 men former shipyard workers who had pleural fibrosis and calcification on their TABLE 6 ILO PNEUMOCONIOSIS CLASSIFICATION OF 62 ABNORMAL HOUSEHOLD COHORT RAYS ILO Classification Irregular opacities 1/0 23 37 ) ee vi 1/1 34 55 ) 1/2 3 4.8 ) 2/2 2 3.2 316 Annals New York Academy of Sciences Anderson et al Hou Colette oj FIGURE 1. Calcified diaphragmatic plaques and lateral pleural thickening in the year wife of an asbestos worker employed for 2 years 1945 48 Diaphragmatic $yFe IGUaREr2.wiDfeiaopfhragmatic plpaqluaeque and lateral a worker employe AndersonAndersonAndersonAnderson et al HouseholdHousehold Household HouseholdContactContact AsbestosAsbestosAsbestosAsbestos 317 thickening in 45-48 2. Diaphragmatic FIGUREDiaphragmaticDiaphragmatic plaqueplaque and lateral chest wall old wife of an asbestos worker pleural thickeningthickeningthickening in the employed for 3 weeks in 1950 1950 318 Annals New York Academy of Sciences FIGURE 3 left Lateral pleural thickening in a year son of a worker employed for 10 years 1942-52 FIGURE 4 right Lateral pleural thickening in a 31year son of an asbesots worker employed for 6 years 1948 54 Anderson et al Household Asbestos 319 aghPeast 5. Interstitial fibrosis pleural thickening and calcificationin a year FFiguiregLuofrean asbestos worker employed for 2 years 1941 2 320 Annals New York Academy of Sciences FIGURE 6. Oblique film on case shown in FIGURE 5 more clearly demonstrating the extensive lateral pleural thickening Anderson et al Household Asbestos 321 +. Frouxe 7 Pleural mesothelioma in a year daughter of who had beeinn the trade more than 25 years and in the study also died of a mesothelioma . an asbestos plant 1941 worker 54He 322 Annals New York Academy of Sciences FIGURE 8. Pleural mesothelioma in a year daughter of an asbestos worker employed for 5 years 1943 48 chest x rays in 1970. Of the 70 deaths recorded 1970 197317 % were from mesothelioma Further study is needed to investigate the association of pleural fibrosis and calcification and the occurrence of mesothelioma of the pleura The prospective study of this household cohort should help clarify this relationship and also the role of such disease response variables as the effect of age at first exposure possible sex differences in response the effect of intensity of exposure and the effect of interrupted versus continuous exposure These preliminary data available show significant prevalence of asbestos- Anderson et al Household Asbestos . 323 related radiographic changes Adequate industrial not only protect exposed workers hygiene procedures should - a well including household neighborhood and environmental pollution generalcommunity contamina- REFERENCES b WAGNER C. C. A. SLEGGS & P. - lioma and asbestos MarchaND 1960. 271 exposure in N.W. Cape Province Diffuse pleural mesotheBr J. Ind Med 17 260 NEWHOUSE M. L & peritoneum following Med 22 261 269 THOMPSON 1965. exposure to asbestos Mesothelioma of the in the London area pleura and Br J. Ind ; RUSBY N. L 1968. Pleural = in relation to malignant manifestations following the inhalation of asbestos vA ASHCROFT T. & A. G. change J. Royal Naval Med Serv LIV 142 148 Tyneside HEPPLESTON 1970. Mesothelioma and asbestos pathological and social study Conf Johannesburg So. In Pneumoconiosis on Proc Int - ford Univ Press CapetowAnfrSioc.aAf1r9i6c9a. H. A. Shapiro Ed : 177 179Ox- CHAMPION P. 1971. Two cases of - Am Rev. Resp Dis 103 malignant mesothelioma after exposure to 6. GREENBERG M. & T A. L. 821 825 J - . Ind Med 31 91 104 DAVIES 1974. Mesothelioma Register 1967 68 ; Epidemiology LIEBEN J. & H. PISTAWKA 1967. Mesothelioma Environ Health 14 559 563 and asbestos exposure Arch R. M. J. L. JANOWER & A. L WEBER festations of malignant pleural 1970. The radiological mani- mesothelioma G. A. W. Jamplis Am J. Roent 108 53 59 Editar Conjugal malignant R. DIFFERDING 1974. Letter to the mesothelioma New Engl J. Med 291 583 584 Y MCDONALD D. of A. HARPER O. A. EL ATTAR C. MCDONALD Poe 26914 919Octopbreirmary malignant mesothelial tumors in Canada Ca1n9c7e0r In McDonald A. D. & J. C. MCDONALD 1973. _ Rums^>enosothelioma in Canada Can Med Assoc I. 1E0pi9de3m5i9ologi3c62surveillance of Scansetti A. Donna & G. PaleSTRO 1972. Epidemiology of western Italy Piedmont Br J. Ind Med : Ke Pleuramesotheliomas | cases of pleural mesothelioma associated with BITTERSOHL G. & H. Os asbestos in Victoria Med J. Australia 2 669 1971. Zur Epidemiologie des occu- 673 Z. Gesante Hyg 17 861 864 11. 16 16 Furness Mesotheliom ae MCEWEN J. A. FINLAYSON A. Mair & A. and mesothelioma in Scotland Int M. M. GIBSON 1971. Asbestos KNAPPMANN J. 1972. Arch Arbeitsmed 28 301 311 ^finHamburg Beobachtungen an 251 1958-1968 Pneumonologie obuzierten SELIKOFF J. C. HAMMOND & J. 148 . Arch Environ Health 25CH1U8R3-G1816972 Carcinogenicity of amosite Asbestos related disease in Environ Res To