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FILE NAME Rogers Corporation ROG DATE 1977 DOC ROG064 DOCUMENT DESCRIPTION Journal Article - Asbestos and Mesothelioma Incidence in Connecticut Cover Photo The Davis Building Hartford Connecticut was explosively demolished on October 10 1974. The film strip from which this frame was taken was supplied by Ralph ; Eno WFSB Hartford Asbestos and Mesothelioma Incidence in Connecticut Leonard Bruckman and Robert A. Rubino State of Connecticut Department of Environmental Protection Barbara Christine State of Connecticut Department of Health The relationship between asbestos consumption and mesothelloma Incidence in Connecticut has been investigated Asbestos has many industrial applications however several of these result in the dissipation of this material e.g. vehicle brake and clutch lining erosion In Connecticut asbestos manufacturing operations contribute approximately 10 tons of airborne asbestos fibers each year while vehicle brake and clutch lining erosion add another 2 tons The demolition especially the explosive demolition of buildings which have been fireproofed and Insulated with asbescontaining materials may be the most significant future source of asbestos emissions unless adequate precautions are taken . Occupational asbestos fiber exposure has been known to cause asbestosis lung cancer and cancer of the lining of the stomach and lung mesothelioma for some time Recently the previously rare mesothellal malignancy has been linked to nonoccupational asbestos fiber exposure as well There were 133 Conn resie dent ts di iagc noseu d wt ith mesothelioma between 1935 and 1972. Although subject to diagnostic error available statistics suggest that the combined sex adjusted mesothelioma incidence rate AAR per 100,000 Connecticut pop- ulation has exhibited a possible fold increase since 1935 rising from 0.02 during 1940 to 1949 to 0.25 from 1960 to 1969. The trends for both men and women also showed sharp Increases over the same time period 1940 to 1970 The rapid rise in Connecticut's mesothelloma incidence rate closely follows the increase in the State's cumulative asbestos consumption and suggests a linearly increasing cause relationship February 1977 Volume 27 No. 2 Asbestos is the name commonly used to describe several fibrous naturally occurring silicate minerals consisting of approximately 40-60 silica combined with oxides of magnesium iron and other metals The minerals which differ in their chemical and physical properties e.g. fiber diameter flexibility tensile strength can be divided into two major _ categories serpentines chrysotile and amphiboles anthophyllite crocidolite tremolite amosite grunerite and actinolite Sources of Airborne Asbestos Fibers The mining and milling of asbestos materials the milling and beneficiation of metal ores that contain asbestos the manufacture of products containing asbestos there are currently over 3000 different commercial uses of asbestos the consumption of the many asbestos containing products e.g. the erosion of vehicle brake linings and clutch facings the demolition of asbestos containing structures the disposal of asbestos waste materials and the weathering of asbestos containing rock outcroppings are the major sources ofairborne asbestos fibers In Connecticut asbestos manufacturing op- erations assuming that reasonably efficient asbestos control equipment e.g. 95 removal efficiency or better is employed contribute approximately 10 tons of airborne asbestos fibers each year while the erosion of vehicle brake and clutch linings add another 2 tons annually.3 Notwithstanding EPA's current regulations covering the demolition of asbestos containing structures perhaps the largest potential future source of asbestos emissions might be the demolition of buildings which have been fireproofed and insulated with asbestos materials The authors feel 121 that the portion of EPA's regulations pertaining to the demolition of structures which contain any boiler pipe or supporting structural member that has been insulated or fireproofed with friable asbestos materials i.e. any material that contains more than % asbestos by weight and that can be crumbled pulverized or reduced to powder when dry by hand pressure has several shortcomings The subject regulation does not clearly state what requirements a demolition operator must meet in order to ascertain whether a structure to be demolished does or does not contain friable asbestos materials The inherent difficulty in determining whether a building to be demolished contains any asbestos materials and the associated costs involved in removing such materials if present lead the authors to believe that some type of formalized testing procedure is necessary Briefly this test might entail taking samples from the walls insulation covering supporting structural members and the floor and ceiling tile of at least one floor of the structure to be demolished and in addition the insulation covering the boiler and pipes A composite sample should then created and analyzed to determine its asbestos content This Asbestos Evaluation Test should be performed bya licensed independent engineer with access to laboratory facilities Furthermore although the asbestos fibers incorporated into wallboards floor and ceiling tiles are usually considered to be tightly bound and therefore unable to escape i.e. nonfriable asbestos materials the authors feel that these materials might be a significant source of asbestos emissions if the structure to be removed were explosively demolished The Judd Building located in Hartford Connecticut was recently demolished using the explosive demolition technique see Figure 1 This demolition procedure appears to be rapidly gaining popularity judging from recent events elsewhere Miami St. Louis etc. The amount of asbestos fiber dust that might be released by a structure that has been demolished in such a manner is unknown at this time but would appear to be potentially large and should be quantified as soon as possible Health Occupational and Nonoccupational Although occupational exposure to asbestos has been shown to cause asbestosis a debilitating scarring of the lungs lung cancer and cancer of the lining of the stomach and lung mesothelioma adverse health effects due to ambient concentrations have yet to be adequately demonstrated However recently the previously rare malignant condition known as mesothelioma has been linked to nonoccupational as well as occupational asbestos fiber exposure Asbestos enters the body primarily through inhalation but may also be introduced through the ingestion of asbestos contaminated food and water supplies Once in the body asbestos fibers are not readily removed and may remain dormant for many years However after 20 or 30 years malignancies especially mesothelioma induced by past asbestos fiber exposure may become clinically apparent This long time interval between one's first exposure to asbestos and the early signs of mesothelioma in addition to the rapid increase in United States asbestos consumption since the turn of the 20th century only emphasizes the potential problem created by asbestos for individuals who have been occupationally and , occupationally exposed Occupational Asbestos Air Quality Standard The U.S. Department of Labor has recently proposed a new standard to workers and their families from the adverse health effects resulting from excessive asbestos fiber exposure.9.15 The Labor Department's Occupational Safety and Health Administration indicated that the current standard of 5 fibers greater than 5 microns in length per cubic 122 Figure 1. Explosive demoliton of the Judd Building Hartford Connecticut Photos courtesy of the Hartford Times photographer Ellery Kington centimeter of air sampled 5 fibers would not prevent either asbestosis or asbestos cancers The Labor De- partment's newly proposed standard of 0.5 fibers would further reduce a lower standard i.e. 2 fibers scheduled to take effect sometime in 1976.15,16 Journal of the Air Pollution Control Association Ambient Asbestos Air Quality Standard Although the importance of asbestos in most portions of the economy cannobte denied numerical standards have been proposed in lieu of EPA's qualitative no visible emissions standard with the objective of protecting the general public from excessive airborne asbestos fiber concentrations.In Connecticut the criteria of mesothelioma was selected as the basis for developing an ambient asbestos air quality standard of either 30 m or its fiber equivalent of 30,000 fibers i.e. total asbestos fibers of all sizes based on 30 day average sample Mesothelioma incidence was chosen as the basis for developing Connecticut's proposed asbestos standard for the following reasons the thheigh frequency of lung cancer in the general population makes it difficult to relate a given case of bronchiogenic carcinoma to asbestos exposure with the high degree of probability that exists for mesothelioma and some investigators suggest that the smaller asbestos fibers - i.e. those fibers less than 5 in length most likely encountered in the ambient air may be incapable of producing lung cancer however it has not been demonstrated that these shorter asbestos fibers are incapable of inducing | mesothelioma Connecticut's proposed asbestos ambient air quality standard is based on a 30 day average sampling period instead of the usual 24 hr duration because a 1 month averaging time is more manageable from a monitoring standpoint and is not sensitive to short perturbations in air asbestos emissions but at the same time provides the public with a high degree of protection from the adverse health effects caused by excessive asbestos fiber concentrations Compliance with the proposed standard can be easily and accurately evaluated using Connecticut's newly developed low volume continuous 30 day particulate ambient air sampler vol Connecticut has recently conducted an ambient air asbestos survey of the State Total suspended particulate matter samples were col- lected using membrane collection filters 8 in x 10 in Gelman metricel GN 0.45...pore size nylon reinforced and the vol Subsequent asbestos determinations were made by the Memorial Institute using electron microscoTphye results of this survey will be reported at a later date The 0.5 fiber proposed occupational asbestos stan- dard is equivalent to a general public exposure of approximately 6000 m assuming that 20 asbestos fibers greater than 5 in length are approximately equivalent to 1 ng of asbestos and * occupational exposure concentrations which are based on an 8 hr day 5 day week can be related to exposure levels for the general public by dividing the occupational levels by 4.2 i.e. 24 hr hr ^ 7 days days = 4.2 Thus disregarding the fact that the aforementioned equiva- lent occupational standarids essentially for a 1 day exposure period and the proposed Connecticut ambient standard is 0.4 rate rate population population 83 population population incidence incidence population Connecticut f ---- ---- 4 ---- ---- ---- ---- P| ---- ---- mesothelioma 0.2 Connecticut 1 Sexes combined Sexes Sexes mesothelioma Conecticut Sexes Sexes a eo adjusted 10,00 oe Female Female 1 adjusted 100,000 adjusted O.1F per per o of a a ars i oy aoa eet? aa Age va o y* 5 oe Ln ead fey oa 1940-49 1950-59 Period 1960-69 ; Figure 2. Connecticut mesothelioma incidence by 10 year period based on a 30 day interval Connecticut's standard is approximately 1/200 of the occupational standard This difference does not seem unreasonable since ambient standards are de- signed to protect all segments of the general population which include many susceptible groups of people such as infants and the elderly who must voluntarily and continuously en- dure the ambient environment Consequently ambient air quality standards are usually well below corresponding occupational standards Furthermore it has not yet been adequately demonstrated that the newly proposed occupational asbestos standard is low enough to protect the worker exposed to asbestos fiber dust on the job from contracting mesotheli- oma Incidence of Mesothelioma in Connecticut All cases of mesothelioma diagnosed in residents of Connecticut from 1935 to 1972 were identified through the re- sources of the Connecticut Tumor Registry located in the Connecticut State Department of Health The Registry routinely received reports on all cancer patients admitted to a hospital within the state If a Connecticut resident is known to be admitted to a hospital outside the state the specific in- stitution involved is contacted for more information In addition all death certificates for Connecticut residents on which cancer is mentioned are sent to the Registry Detailed description of the operations of the Connecticut Tumor Registry have been published There were 133 Connecticut residents diagnosed with mesothelioma from 1935 through 1972. Eighty of these were men and 44 were women Table ) Table I. Mesothelioma number and percent of cases by primary site and sex Connecticut 1935 Period and sex Primary site No. by sex M F 1935-39 1940-44 1945-49 1950-54 1955-59 M F M M F M F M F 1960-64 M F 1972 1965-69 M F Pleura 57 27 I 2 1 2 7 5 11 3 25 10 Lung 11 3 5 1 1 5 1 1 Perit 15 7 1 1 2 5 4 1 1 Testis 2 2 Other 4 7 1 3 2 1 1 3 - Total 89 44 1 1 3 6 5 10 9 28 9 . 27 15 1970-72 M F 10 7 6 1 4 16 8 Total No. % 84 14 22 2 11 133 63.2 10.5 16.5 1.5 8.3 100.0 February 1977 Volume 27 No. 2 123 Table II Mesothelioma number and percent of cases by . occupational group and sex Connecticut 1935 1972 Total Occupation 1. Outside work e.g. carpentry gardening etc. . ) 2. Industry including shipbuilding and printing 8. Maintenance 4. Plumbing chemical etc ... 5. Public works 6. Office Professional 7. Armed services 8. Other 9. Unknown Total Male Female 10 No. 10 33 3 36 12 32 7 1 7 13 60 812+ 812+ 812+ 2 89 44 44 8 7 19 1 2 6 133 % 7.5 27.1 88.0 6.0 5.2 14.3 0.8 1.6 4.5 100.0 The fact that the age of almost all of the Connecticut resi- dents diagnosed with mesothelioma was at least 40 years appears to substantiate the reported extended lag period be- tween exposure to asbestos and mesothelioma induction Figure 3 The short elapsed time from the date of diagnosis to death almost always less than 3 years indicates the serious nature of this type of malignancy Figure 4 Relationship between Mesothelioma Incidence and Asbestos Consumption Cumulative United States asbestos consumption has increased rapidly since the beginning of the 20th century and is projected to exceed 60 million tons by 1980 Connecticut's asbestos consumption has been estimated by proportionally | allocating total U.S. consumption using the appropriate Connecticut to United States population ratio Table V Figure 5 A plot of both cumulative U.S. and Connecticut estimated asbestos consumption and Connecticut's com- mounted The trend in men through the 10 yr period cov- ering 1960 to 1969 from an age adjusted rate AAR obtained using the indirect method of 100,000 Connecticut population for the interval between 1940 and 1949 to 0.37 from 1960 1969. No mesotheliomas were diagnosed in Connect- icut women until the period 1950 to 1959 when 12 were re- ported yielding an AAR of 100,000 The trend for females increased slightly to 0.15 in 1960 to 1969 Figure 2 Table II The combined AAR rose from 100,000 during 1940 to 0.25 from 1960 to 1969 over a fold increase The increase in cases over the years may in part reflect an increased awareness of this type of tumor and an attempt by patholo- gists to classify all malignancies Though increases in both occupational and nonoccupational asbestos fiber exposure are expected to have occurred over the last 40 years only 4 people were reported with known exposure to asbestos Eight others were felt to have experienced some exposure Occupation at the time of diagnosis was obtained from hospital admission records and the usual occupation from death certificates It was found that 44 individuals 33.0 worked in the home or in like occupations Thirty 27.1 were reported to have worked in manufacturing industries Nineteen 14.3 worked in offices as professionals or clerical employees Table III Of the remaining individuals it is interesting to note that one person was listed as a toll collector Unfortunately complete occupational histories of each of those individuals afflicted with mesothelioma are not available at this time Approximately 58 of those afflicted with mesothelioma resided in urban areas 34 lived in suburban locations and % inhabited rural regions This represented a lower percentage of rural and suburban and a larger percentage of urban residents respectively than would have been ex- pected from the average population distribution within the State over the entire period under study Table IV Table III Mesothelioma number of cases and adjusted rate per 100,000 population by sex and period of diagnosis Connecticut 1940-1969 Sex Male Female Combined 1940-1949 No. 4 Rate 0.04 4 0.02 Period 1950-1959 No. 18 12 30 Rate 0.15 0.10 0.18 1960-1969 No. Rate 50 0.37 24 0.15 74 0.25 124 Table IV Mesothelioma number of cases and percent distribution by place of residence and average Connecticut population distribution 1935 1972 Place of Residence Rural Suburban Urban Unknown Total Male 5 26 58 89 Sex Female Combined Percent Average Connecticut population distribution in percent 4 9 6.8 21.5 19 45 33.8 41.0 20 78 58.6 87.5 1 1 0.8 44 133 100.0 100.0 bined mesothelioma 100,000 population as a function of time suggests that the sharp increase in mesothelioma incidence closely followed the rapid rise in the State's cumu- lative asbestos consumption for comparable intervals i.e. 1940 to 1970 Figure 6 Furthermore a plot of the meso- thelioma AAR between 1940 and 1970 as a function of Con- necticut's asbestos consumption over the same period suggests a linearly increasing effect relationship which warrants further investigation Cumulative asbestos con- sumption seems to relate to mesothelioma incidence This might be partially explained by the persistent nature of as- 100 q qT qT q v qT T qT T 4 80 ' cases 8 CONE of CUIVONE CCU Number 40 GUT eas 20 [ . 1 0 0 20 40 60 80 . 100 Age at diagnosis years Figure 3. Connecticut mesothelioma incidence by age at diagnosis Journal of the Air Pollution Control Association 100 T 5 persons 60 persons of FE Number aol Number Number Number 5 20 +a et rn 4. rt L 1 4 4 01 al. 0 2 4 6 8 10 Time from date of diagnosis to death years Figure 4. Time from date of mesothelioma diagnosis to death . ambient standards are designed to protect all segments of the general population including the most susceptible groups and are therefore normally well below occupational standards and the newly proposed occupational asbestos standard may not adequately protect the worker from contracting mesothe- lioma There were 133 Connecticut residents diagnosed with mesothelioma between 1935 and 1972. The combined mesothelioma incidence rate per 100,000 Connecticut population has exhibited a fold increase since 1935 rising from 0.02 during 1940 to 1949 to 0.25 from 1960 to 1969. The trends for both men and women also demonstrated sharp increases over the same period The rapid rise in Connecticut's mesothelioma incidence rate closely follows the increase in the State's cumulative asbestos consumption for comparable intervals i.e. 1940 to 1970 and suggests a linearly increasing effect relationship which warrants further investiga- tion bestos in the environment and expected associated increases in background asbestos levels in different environmental media such as air and water supplies with increasing asbestos usage Unfortunately the relationships among asbestos con- sumption environmental asbestos levels and asbestos disease cannot be completely quantified at this time due to an insufficient data base Therefore the authors strongly recommend that the rate of environmental sampling for as- bestos in different media especially the atmosphere be ini- tiated and continued so that future effect trends can be accurately determined Table V. Asbestos consumption.18 Period 1890-1899 1900-1909 1910-1919 1920-1929 1930-1939 1940-1949 1950-1959 1960-1969 Apparent Consumption short tons" United States Connecticut & 64,500 265,000 986,500 1,999,500 1,880,000 4,654,000 7,417,000 7,561,000 800 3,200 12,300 26,000 24,400 60,500 100,100 109,600 aA short ton is equivalent to 2000 lb. bEstimated by proportionally allocating total United States asbestos consumption using the appropriate Connecticut to United States population ratio Conclusions The most significant potential source of airborne asbestos fibers in the future may be the demolition especially the explosive demolition of large structures which have been fireproofed and insulated with containing materials The amount of asbestos fiber dust released by a building demolished in this manner should be quantified as soon as possible Connecticut's proposed asbestos air quality standard of 30 m or 30,000 total asbestos fibers of air sampled 30 day average is expected to reduce state asbestos fatalities to yr.This standard is approximately 1/200 of the newly proposed occupational standard fibers cc however this difference does not seem unreasonable since February 1977 Volume 27 No. 2 ' 10 , consumption consumption consumption consumption 10 consumption tons asbestos short asbestos 10 CCuummullaattiivvee Cumulative Cumulative 10 United States Connecticut Estimated _ 102 mesothelioma mesothelioma population 101 population population population population 105 1 Combined AAR Combined 10-1 10 190 -09 1910-19 1910-19 oe 1910-19 1920-29 1930.39 1900-09 1920-29 1930.39 Period 1940-49 1940-49 3 1960-69 1950-59 1950-59 1 Nn 10 10 Figure 5. Cumulative asbestos consumption and Connecticut mesothelioma incidence as a function of time 0.3 1 1 1960-69 mesothlima poulation0.20.2 T 1 1950-59 Combined AAR0.10.1 T 1940-49 1 L dt ) 1x105 2x105 3x105 4x105 Estimated cumulative Connecticut asbestos consumption short tons Figure 6. Connecticut mesothelioma incidence as a function of Connecticut's cumulative asbestos consumption 125 Acknowledgment The authors wish to acknowledge the assistance of Paul Norton and Mary Lakonski both of the staff of the Department of Environmental Protection Engineering Section Air Compliance Unit References 1. Asbestos as A Hazardous Contaminant II Report No. ARB- 01-75 Air Resources Branch Ministry of the Environment - Ontario Canada Jan. 1975 2. Asbestos in the Great Lakes Basin with Emphasis on Lake Su- perior A Report to the International Joint Commission from the Great Lakes Research Advisory Board Feb. 1975 3. L. Bruckman and R. A. Rubino Rationale behind a proposed asbestos air quality standard J. Air Poll Control Assoc 25 1207 1975 4. National emission standards for hazardous air pollutants as- bestos beryllium and mercury Federal Register 38 66 April 6 1973 5. Asbestos and mercury proposed amendments to national emission standards Federal Register 39 208 October 25 1974 6. Biological Effects of Asbestos Proceedings of a Working Conference held at the International Agency for Research on Cancer Lyon France Oct. 1972 7. M. L. Newhouse and H. Thompson Mesothelioma of pleura and peritoneum following exposure to asbestos in the London area Brit J. Ind Med 22 261 1965 8. I. J. Selikoff and E. C. Hammond Environmental epidemiology III Community effects of occupational environmental as- bestos exposure Amer J. Publ Health 59 1658 1968 9. J. Selikoff E. C. Hammond and H. Heimann Critical Evalu- ation of Disease Hazards Associated with Community Asbestos Air Pollution in H. M. Englund and W. T. Beery eds Pro- ceedings of the Second International Clean Air Congress Aca- demic Press New York 1971 10. I. J. Selikoff W. J. Nicholson and A. M. Langer Asbestos air pollution Arch Environ Health 25 1 1972 11. J. Lieben and H. Pistawka Mesothelioma and asbestos expo- sure Arch Environ Health 14 559 1967 12. M. Newhouse and H. of mesothelial tumors Thompson Epidemiology in the London area Ann N.Y. Acad Sci 132 579 13. J. C. Wagner C. A. Sleggs and P. Marchand Diffuse pleural mesothelioma and asbestos exposure in the north western Cape Province Brit J. Ind Med 17 260 1960 14. P. Champion Two cases of malignant mesothelioma after ex- posure to asbestos Am Rev. Resp Dis 103 821 1971 15. Occupational exposure to asbestos notice of proposed rule- making Federal Register 40 197 Oct. 9 1975 16. Criteria for a Recommended Standard for Occupational Exposure to Asbestos U.S. Department of Health Education and Welfare Public Health Service Health Services and Mental Health Administration National Institute for Occupational Safety and Health HSM 72-10267 Washington DC 1973 17. National primary and secondary ambient air quality standards Federal Register 36 84 April 1971 * .18 Health Effects and Recommendations for Atmospheric Lead Cadmium Mercury and Asbestos Illinois Institute for Envi- ronmental Quality Environmental Health Resources Center Report No. 73-2 Chicago IL 1973 19. P. Gross Is fibered asbestos dust a biological hazard Arch Environ Health 29 115 1974 20. P. Gross R. T. P. deTreville and M. N. Haller Asbestos versus nonasbestos fibers Arch Environ Health 20 571 1970 21. L. Bruckman E. Hyne and P. Norton A Low Volume Particulate Accuracy Ambient Air Sampler presented at the Specialty Con- ference Measurement Accuracy As it Relates to Regulation Compliance New Orleans LA Oct. 1975 E. eds 22. W. Fulkerson and H. Goeller Cadmium the Dissipated Element Oak Ridge National Laboratory ORNL Oak Ridge TN 1973 23. R. A. Greenberg The Connecticut tumor registry Connecticut Health Bulletin 73 35 1969 24. R. R. Connelly P. C. Campbell and H. Eisenberg Central registry of cancer cases in Connecticut Public Health Reports 83 386 1968 25. L. Fleiss Statistical Methods for Rates and Proportions John Wiley & Sons New York 1973 26. A. Clifton Asbestos Preprint from the 1972 Bureau of Mines Minerals Yearbook U.S. Department of the Interior Washington 1975 Mr. Bruckman is principal air pollution control engineer in Air Compliance Monitoring and Mr. Rubino is assistant director of Air Compliance Engineering State of Connecticut Department of Environmental Protection State Office Building Hartford CT 06115. Dr. Christine who was a consultant to the Cancer Programs State of Connecticut Health Department died in 1975 . 126 Journal of the Air Pollution Control Association