Document 93bJm9abJ92pgXVgqkXQg14dD

08/05/2003 TUE 15:32 FAX 312 996 1899 UIC LHS CHICAGO @002 lat exposure to i significant imtion or disease. i by Public Health 6-06 and NIH HD s of Health, id by Cecelia Kane, Imonary laboratory. `lid-expiratory Flow Rev Reap Dis 90: :.H,, Jr.: Pulmonary Embolization, Amer dethods, Iowa City: : Respiratory Func~ . B. Saunders Co., S.C.: Histochemical ith Other Cutaneous 146 (June) 1960. osis vs Sarcoidosis, <62. HH.; and Becker, jRev . Reap Dla ind Williams, M.H., i Patients With Bi t. Arch Intern Med arises directly to continuous pt themselves inditions have 1 effects often ed. Industrial arranging for <ork; (2) by of importance [uate sleeping h, Norwegian 4, pp 82-83. Malignancies in Asbestos Workers JAM LIEBEN. MD, HARRISBURG, FA 'Within recent years and months a con siderable amount of evidence has appeared in the literature which indicates that asbestosis is directly related to the incidence of malignant tumors and cancer.1"8 As early as ten years ago a Pennsylvania pathologist reported that he had seen at autopsies many cancer cases in persons who also suffered from asbestosis. The pathol ogist is on the staff of a hospital which re ceives most of the patients from a nearby town where a large asbestos producing plant is located. The findings of the pathologist have created concern in the asbestos industry and it was felt appropriate for the Pennsyl vania Health Department to review the prob lem. f' Exposures in the Plant The following information was obtained from the files of the health department which has studied environmental exposures of workers in this plant on several occasions in the past 30 years. During this timethere has been a tremendous iihprovement in dust conditions in all operations and dustiness has been held close to or below the present threshold limit. The textile department used chrysotile, primarily, for many years. It was not un common for the milled fiber received by the textile plants to contain 30% or more of fines. The fiber of today is very much cleaner than that received prior to 1950. The use of light oil in the blending department began around 1955. This was helpful in improving conditions and minimizing dust. Prior to 1950 amosite was processed in small quanti ties for making thermal blankets. Although the processing of amosite never exceeded one card and the operations were at times intermittent, this operation, was much dustier than from cards processing chrysotile. Crocidolite has never been handled in the textile department. In the friction products operations ex tensive changes in the formulations have Submitted for publication June 6, 1966>accepted July 1. . From Division of Occupational Health, Department of Health, Harrisburg, Pa. Reprint requests to Division of Occupational Health, Department of Health, P.O. Box 90, Harrisburg, Pa 17120. taken place over the past 30 years. Prior to 1945, coal tars and pitches were com monly used as impregnums in making brake linings, clutch facings, and packing materials: Since 1945, these have been essentially re placed by resins and other materials so that at present only a very small amount of tar and pitch is used in packing materials.' A small amount of crocidolite is still used in making some packings. The Study Since asbestosis is a disease which, once established, progresses even after exposure to dust ceases, it was decided not to ask plant management for cases known to them. Instead, the record rooms of six hospitals which draw their patients from the area of the asbestos plant were checked for cases of asbestosis. Admissions only for the period between 1956 and 1964 were included. Seventy-five hospital records coded as as bestosis were located. Asbestosis was diag nosed in these people on admission, by x-ray, or at autopsy, or asbestosis was men tioned in the differential diagnosis. After obtaining the 75 records, medical, occupational, and smoking histories were obtained for all these former patients. Many were deceased and their survivors had to be contacted. Other data were obtained from plant management. Seven either had not worked at the asbestos plant under study or the diagnosis had been changed. This left 68 asbestos workers who had worked at one time in the above-mentioned textile and friction materials plant. Further study of the records showed that 21 of these not only had evidence of asbestosis but also had suf fered from malignancy. By the time of the Table 1.--Number of Coses and Duration of Occupational Asbestos Exposure by Departments Exposure Duration Less than 10 years 10*20 years 20*30 years 30-f* years Department Textile Friction Textile Unknown and Friotion 1 Oil 3a 3 il 6i Arch Environ Health--Vol 13, Nov 1966 SCF-FA-5880 PA-262.20 lil i: i, i! f! rr 1 !i i.; 620 MALIGNANCIES--LIEBEN Table 2.--Summary of Cases Studied Cage Birth Death Type of Tumor Length of Employment in Aobentos Type of Employment Smoking Remarks 1 1911 1962 Bronchogenic carcinoma, 1986-1967 Yarn twisting 12-16 cigarettes histologic type 1964-1962 unspecified 2 1900 1969 Squamous cell broncho 1929-1969 Weaver 1929-1959 1 pack/day genic carcinoma S 1898 1968 Squamous cell broncho* genic carcinoma 1918-1928 Breakiine weaver 1018-1928 No cigarettes 30 yr foundry work 4 1907 1961 Oat cell bronchogenic carcinoma 6 1896 1961 Squamous cell broncho genic carcinoma G 1901 1966 Bronchogenic adenocarcinoma 7 1901 1957 Anaplastic broncho genic carcinoma 1927-1967 1947-1961 Only 6 mo 1919 8 mo only in 1928 Weaving and later loom fixer Laborer sweeper, picker bouse Weaver--later lath foundry worker Area unknown. later bote] operator No cigarettes 1 pock-f/day Cigars only No cigarettes Also cirrhosis of liver Probably not due to asbestos Probably not aebeetoa 1928-1967 Linotype operator 1921-1828 8 1896 1966 Bronchogenic carcinoma, 1926-1987 Carding room. histologic type gardening for unspecified 19 yr thereafter 9 1897 1968 Squamous ceD broncho 1982-1964 Weaver 1922-1954 genic carcinoma 10 1906 1961 Alveolar cell carcinoma of the lung 11 1896 1960 Carcinoma of the lung, origin and type 1960-1990 1926-1960 Friction materials, laborer on lathe Inside driver in weaving room unknown 12 1908 1966 Lung tumor, x-ray diagnosis 1019-1966 Loom fixer, machine shop foreman, toolmaker 1 pack/day Lees than 10 cigarettes/day Unknown No cigarettes 2-8 cigarettes/day Diagnosis from hospital record no autopsy IS 1907 1961 Anaplastic bronehogenic carcinoma 1928-1961 General foreman--* spinning before last job No 14 1901 1961 Intra-abdominal adenocarcinoma, origin unknown 1984-1948 Most of the time in friction products, spinning 1928-1987, later upholsterer 1 pack/day 16 1894 1966 Carcinoma of the colon 16 1884 1969 Lymphatic leukemia, chronidty unknown 1928-1866 6 mo only 1941 Weaver 8weeper aad laborer June 12,1941 Mechanics helper for 6-10 cigarettes/day No Probably net due to aateitas 46 years for trucking company 17 1901 1962 Malignant lymphoma 1926-1948 Carding room supervisor No cigarettes, little pipe . 18 1888 1964 Chronic lymphatic leukemia 1988-1947 Laborer--handtrucker Very few --supplied weavers cigaro only with spools; . 8 coronaries farmer till 1987, sexton at church till death 19 1877 1960 Aoute leukemia, 1922-1049 Shipping room only 5-10 cigarettes/day T aebestosis type unknown Carcinoma of throat. origin and type unknown 80 1896 1968 Multiple myeloma Carcinoma of prostate. metastatic 1935-1967 Weaver--loom fixer. textile foreman 1986-1947, packing mill Pipe only 1947-1967 21 1894 1967 Carcinoma of bladder 1917-1937 Supervisor friction mill 20 yean 1 pock *f/day 1917*1987, lee eream maker 20 years \ 1987*1957 * study all 21 had died. Ten of these cases paper which appeared in Cancer in August have also been reported by O'Donnell' in a 1966.4 Thirteen of these had lung cancer Arch Environ Health--Vol 13, Nov 1966 08/05/2003 TUG 15:33 FAX 312 996 1899 UIC LHS CHICAGO @004 Remarks 80 yr foundry work Also cirrhosis of liver Probably not due to asbeatoo Probably not asbestos . Diagnosis from hospital record no autopsy Probably not due to asbestos 1 coronaries * osbestosis in August ing cancer . MALIGNANCIES--LIEBEN 621 and eight had various other growths which included two abdominal cancers, one bladder cancer, two lymphatic leukemias, one acute leukemia, one lymphoblastoma, and one multiple myeloma. No cases of mesothelioma were in this group. There were four cases in former plant employees but these em ployees had been admitted to hospitals either prior to 1956 or after 1964 and because of that are not included in this study. The diagnosis of the condition of these 21 patients had been established in 13 by au topsy, in four by operation, in two by biopsy, and in two by x-ray only. The death certificates of all 21 were ob tained. The malignancy diagnosis was re ported on 15 death certificates. Six were signed out as follows: two as cardiac failure, one as coronary disease, and three as asbestosis. If death certificates alone had been utilized in this study, these six cases of malignancy would have been missed. The smoking history of the 13 lung cancer patients revealed that five had never smoked, seven smoked, and in one case no smoking history was obtainable. Of the eight pa tients with other malignancies, three were cigarette smokers, two never smoked, and three were cigar smokers only. Of the 21 patients with cancer, 13 had worked in the textile department of the plant only, for a sum total of 301 years. Four worked in the friction materials department for a total of 48 years. The department where one man had worked remains un known and three others worked at various jobs which included both textiles and friction materials (Table 1). Two of the 13 lung cancer and one of the lymphoblastoma patients had worked in the asbestos plant for a period of less than six months each, which is a rather short ex posure. One wonders if this short exposure could have contributed towards their dis<ease. Eighteen of these 21 patients had started work in the plant prior to 1940 and 12 had started work prior to 1920. Of the 21 patients with cancer 9 were between 50 and 60 and 12 were over 60 years of age (Table 2). Comments and Conclusions vr>. The incidence of malignancy in this se lected group of hospital admissions with asbestosis was very high--21 out of 68. This is eight times higher than in the general population 45 years of age and over, for the eight years of the study period. The incidence of 19% (or 16% if we do not consider exposures of less than one year) of lung cancer in this group ,/>f work ers with asbestosis is comparabl&^'o that reported by Isselbacher1 who summarized data of various authors and reported that of 603 persons with asbestosis, lung cancer was found in 83 (13.8%). It is also close to that reported in the literature review by Behrens who collected 44 cases of lung cancer (14%) in 309 patients with asbesto ses. Only three patients with these malig nancies had their first exposure after 1940, when dust conditions had been much im proved. A repeat study in the future may clarify whether this reduction of cancer occurrence in more recent employees is due to a latent period, to the age factor, or to the dust control measures instituted by the plant. The patients with lung cancer were gen erally younger than those with cancers of other organs. Eight of those in the lung cancer group were under 60 and all eight of those in the other group were over 60 (Table 2). Summary A study of 68 hospital admissions with asbestosis from an asbestos textile and fric tion materials plant included 21 malignancies --13 of these were carcinoma of the lung and eight carcinomas of other organs. Eigh teen of the patients had exposures to as bestos in their occupational environment for a period of 10 to 36 years. Only three pa tients had their first exposure after 1940. Extensive dust control measures have been instituted by the plant. REFERENCES Isselbacher, KJ.; Klaus, H.; and Hardy, H.L.: AW(Bstosis and Bronchogenic Carcinoma: Report of One Autopsied Case and Review of Available Litera ture, Amor 1 Med 15:721-722 (Nov) 1953. 2. Doll, R.: Mortality from Lung Cancer in Asbestos Workers, Brit J Industr Med 12:81-86 (April) 1955. 3. Hueper, W.C.: Environmental Causes of Cancer of the Lung Other Than Tobacco Smoke, Dis Chest 30:141-159 (Aug) 1956. 4. O'Donnell, W.M.: Mesothelioma Associated With Asbestosis: A Report of Three Cases, Cancer 19:521 (Aug) 1966. 5. Cancer Mortality and Morbidity, Harrisburg, Pa: Pennsylvania Department of Health, 1964. - 6. Behrens, W., lr.: The Clinical Picture and Pa thology of Asbestosis, Z Unfallmed, Berufskr 45:129, 1952. Arch Environ Health--Vol 13, Nov 1966 tI it. !. t ft) 1 ,! /