Document DvjMzQqg2vy9OeV9dYyraqR9N

FILE NAME Household Contact HC DATE 1992 DOC HC018 DOCUMENT DESCRIPTION Journal Article - Environmental Household Exposures to Asbestos and Occurrence of Pleural Mesothelioma ) 1992 American Journal of Industrial Medicine 681-687 ( ; 1105 1105 Environmental Household Exposures to Asbestos and Occurrence of Pleural Mesothelioma 1105 - Daniela Dodoli MD Maurizio Del Nevo MD Carla Fiumalbi MD Tonina Enza fala MD Alfonso Cristaudo MD Pietro Comba DSc Cecilia Viti MS and Giuseppe Battista MD MED period 1975-1988 which occurred in the F We reviewed the certificates of 39,650deaths 1958 1988 in Leghorn and of 45,900 in La Spezia Italy in the period mesothelioma The main occupational In total 262 cases have been recorded as pleural - exposures toasbestos 13 cases of mesothelioma were occupational Regarding the work clothes of their relatives at home we also who had i found in womewan shed asbestos which were rarely or never discussed previously ' found other domestic uses of in the literature six cases might be explained by the installation of fireproof or non- &1992conductive materials in the domestic environment until now These exposures probably more frequent than realized : Wiley Inc. We Ee A ar Key words asbestos household household exposures exposures pleural INTRODUCTION case reports Numerous investigations particularly and case series have studied of mesothelioma as a consequence of occupational asbestos ex- j the occurrence and exhaustive review has recently been presented by GardnSaeracrci posure An have addressed the health effects of asbestos exposure 1989 number of reports and factories Arul and Holt 1977 Green- : for those who live around asbestos mines berg and Lloyd Davies 1974 Lieben and Pistawka 1967 Newhouse and Thompson : 1965 Wagner et al 1960 due to asbestos carried into the house domestic Several reports look at exposure of fibers in _ the work clothes of subjects exposed in the workplace Concentration by* these situations may have been higher than that occurring for residential exposures Nicholson et al 1980 We who had a relative working Newhouse and Thompson 1965 found 9 patients Unit of Occupational Medicine Faculty of Medicine University of Pisa Pisa Italy D.D. M.D.N. C.F. T.E.I. A.C. G.B. Istituto Superiore di Sanit^ Rome Italy P.C. of Earth Sciences University of Siena Siena Italy C.V. Department Battista Cattedra di Medicina Preventiva dei Lavoratori Address reprint requests to Professor Giuseppe Universit^ degli Studi di Siena Via dei Tufi , 5100 Siena Italy 682 Dodoli et al with asbestos versus 1 control Three cases of mesothelioma who had a relative employed in the asbestos industry were described by Lieben and Pistawka 1967 Four cases of pleural mesothelioma were detected by Anderson et al 1976 among the relatives of workers active in a plant where amosite products were man- . ufactured one of the cases was the daughter of a worker who also died of mesothe- lioma Two cases of mesothelioma in the same family described by Li et al 1987 involved the wife and the daughter of an insulator who was affected by asbestosis and : oe died of lung cancer and examined occupational ore Vianna asbestos Polan19781978examined and and A environmental exposurteo in environmental 4m asbestosoffemalecasesofmesothelioma ddecasedeceased in NewYork Stateexcluding eee New York City between 1967 and 1977 and a matched sample of controls significantly me see * higher number of cases than controls had husbands and fathers active tm 5 in asbestos related occupations mainly insulation relative risk 95 confidence 3 eerie interval 1.42-37.40 gpres The role of household exposure to asbestos in the development of mesothelioma peathamne merce in young adults has been recently reassessed by Kane et al 1990 who suggested Te that mesothelioma in the first four decades of life might be more common than Te ordinarily believed According to the authors a detailed occupational and occu- STRAPTET pational interview may detect unsuspected modes of exposure As far as Italy is concerned a survey on hyaline pleural plaques occurrence coca examining 343 necropsies performed on females in the years 1979-1984 was con TMS _ ducted in Monfalcone northeastern Italy The prevalence of pleural plaques was 21.6 In most cases domestic exposure to asbestos was detected mostly linked to contaminated work clothes of relatives active in a shipyard Two of these women were affected by pleural mesothelioma Bianchi et al 1987 The present paper describes a cluster of cases of pleural mesothelioma attrib- utable to occupational exposure to asbestos in the towns of La Spezia and eae * Leghorn These towns located on the western coast of Italy have been selected because their mortality rates from pleural neoplasms are among the highestin Italy In 1980-1983 the province of La Spezia had a mortality rate of 7.13 x 10-5 in males and 1.59 x 10 in females Leghorn in the same years had rates of 4.92 ^ 10-5 4 and 1.96 ^ 10fl5respectively Bruno et al 1988 Both towns are important centers of the shipbuilding industry In contrast rates for the whole of Italy are 1.35 ^ 10-5 in males and 0.75 ^ 10fl5in females MATERIALS AND METHODS This workis concerned with occupational exposures to asbestos among 16 cases of mesothelioma that occurredin the towns of Leghorn 1975-1988 and La Spezia 1958-1988 In all the causes of death were examined for 39,650 subjects deceased in Leghorn and 45,650 in La Spezia There were 88 deaths 60 men 28 women in Leghorn and 174 146 men 28 women in La Spezia recorded pleural mesothelioma in the quoted periods for a total of 262 cases 206 men 56 women It was not possible to collect any information on 60 subjects 43 males 17 females that we considered lost cases Table ) We took under consideration the diagnosis of death of the mortality registries of general population Oe = - ma ee Household Exposures and Mesothelioma 683 TABLE 1. Asbestos Exposure of Subjects Deceased From Pleural Mesothelioma in Leghorn 1975 198a8nd La Spezia 1958 1988 Exposure Sure occupational Probable occupational Indirect occupational definite . : Total interviews Lost cases Men 114 24 3 22 163 43 Women 3 2 13 +3 18 39 . 17 Total 117 26 19 40 202 - 60 Total cases recorded on mortality registries 206 56 262 Domestic asbestos exposure very probably but not sure It was possible through direct or telephone interviews with close relatives of the deceased to obtain information on 202 persons 77 of total cases 163 men 79 and 39 women 70 Among 202 cases on whom we collected satisfactory information we can classify 143 subjects 138 males and 5 females as occupationally exposed surely or probably exposed The exposures of cases were classified by three hygienists with intimate knowledge of the industrial processes of the area People surely exposed were mainly shipyard and insulating workers For 16 cases as mentioned we found occupational exposures usually domestic to asbestos indirect exposure for 40 subjects we have not been able to assess any definite exposure to asbestos For these female cases in brackets in Table ) we considered domestic exposure to asbestos very probable but not sure Table I briefly summarizes there findings the most frequent occupational ex- posures occurred in shipyard industry The occupational exposures in our review are noteworthy because they have not been reported previously and awareness of new sources can contribute to Fl ' s prevention % Be Because of the long latency we were not able to achieve technically reliable at information about the insulating materials installed in the houses of the subjects ih deceased of mesothelioma Nevertheless we analyzed 5 panels and a cord still used as fireproofing in houses in Leghorn and La Spezia SEMb We collected these specimens in the dwellings of low social class individuals aS. and submitted them to inspection of a geologist and to scanning electron microscopy cry ede RESULTS 4 In Table II the cases of mesothelioma with occupational exposure to asbestos are described 13 women and 3 men by year of death and by occupa- tion The average age of death was 63 years range 60 6f5or men and 76 range 66 8f7or women Among the thirteen women ten Cases 1-10 lived with workers who were exposed to asbestos for occupational reasons 8 of them were the wives and one was  684 Dodoli et al oer _ TABLE II Cases of Mesothelioma With Occupational Exposure to Asbestos Leghorn 1975 198L8a Spezia 1958 1988 8 No. Year of death City Sex Age Occupation i et l 1967 SP F 73 Housewife 2 1979 33 F 70 Housewife en 3 1980 LI F 73 Housewife Ww te 4 1981 SP F 87 Housewife S 1982 33333 F 75 Housewife 6 1985 33333 F 74 Housewife we 7 1985 33333 F 66 Housewife es Pre c 8 1987 33333 F 79 Housewife 9 1988 33333 F 82 Housewife 10 1988 SP F 74 Housewife tl 1980 SP F 83 Housewife 12 1984 SP F 74 Housewife 13 1988 SP F 79 Housewife 14 1967 SP M 60 Musician wine dealerb 15 1970 : SP M. 88 Oyster cultivator 16 1988 SP M 65 Shipyard employeeb SP = La Spezia LI = Leghorn Both occupational and occupational exposure see text the sister of shipyard workers another was the wife of an oil refinery worker By interviewing relatives it was learned that the ten women used to wash the work clothes of their relatives at home Two of these cases also used asbestos boards for ironing clothes In the kitchen of the Case 11 the exposed insulation of hot water pipes was asbestos The last two women Cases 12 and 13 were exposed to asbestos panels that had been installed behind radiators to limit heat dispersion In a similar manner the three men Cases 14-16 lived in houses where asbestos panels were employed to limit heat dispersion However two of these males also experienced occupational exposures one Case 14 prepared filters to improve the quality of the wine he soldand another Case 16 worked as warehousemen at the military shipyard in La Spezia It is remarkable that the occupational exposures of these two cases occurred so near the date of death six and two years before respec- tively that a causal relation to occupational asbestos exposure cannot be estimated as sufficient It seems likely that there is sufficient latency with regard to the nonoccupational exposure to permit a causal relation All of the interviewees recalled the duration of domestic exposures to be a long not specified period the whole life many years etc. Table III summarizes the quoted form of occupational exposures to asbestos In addition to the series described there are also three female cases not The man who worked in the oil refinery was exposed to asbestos fibers while repairing insulated pipes and boilers there Filterswere made and periodically replaced by inserting asbestos powder in a suitable net placed along the wine passing Household Exposures and Mesothelioma TABLE III Occupational Exposure to Asbestos of 16 Subjects Deceased From Pleural Mesothelioma in Leghorn 1975 198a8nd La Spezia 1958 1988 Men Women x Work clothes wash 0 10 Domestic use of fireproof panels 3 2 Domestic insulation for hot water pipes 0 1 Both occupational and occupational exposure see,text see,text 685 ~ reported in the tables for whom exposure to asbestos has to be considered very probaOblnee bouftthneotwo sumreen could have inhaled asbestos fibers that were brought into the domestic environment by her son who was an employee in a firm that sold non- conductive material used as substitute for asbestos i.e. ceramic fibers As a consethis man worked daily in environments where asbestos was present and qwhueernecehe went to propose the alternative products We have no confidence about the of this case to asbestos and to ceramic fibers but it is clear that the son exposure also kept some samples of ceramic material in his house Two other women had been married to men occupationally exposed to asbestos a ship engineer and a locomotive engineer in the port but their interviewed relatives did not remember if the deceased women had washed their husbands work clothes at home No other supplementary information about asbestos fibers inhalation was available Table IV summarizes the results of the mineralogic examination of 5 fireproof and a cord still used in houses in the area of Leghorn and La Spezia panelsCrocidolite was found in none of the examined specimens we stress however that these results can be referred only in hypothetic terms to the aetiology of the cases of mesothelioma above reported DISCUSSION al Our findings are consistent with previous reports in the literature Gardner et 1989 and have also been described earlier by some of us Neri et al 1989 mesothelioma However the present series deals with more numerous findings Our study is based on death certificates which have the advantage of systematic coverage of the population even if it iswell known that pleural is mesothelioma Delendi underreported as a cause of death evi- It is well known that the diagnosis of mesothelioma requires pathologic dence and death certificates are affected by a margin of error Nelson and Fare- brothePrleu1r9al87mesothelioma nevertheless is included among the sentinel health events described by Rutstein et al 1983 and an example of surveillance of me- sothelioma by use of death certificates is provided by Schwartz 1986 Previous studies by us show that only about 70 of patients affected by pleural mesothelioma are correctly registered as malignant neoplasms of pleura at death Bruno et al 1990 A general discussion of the issue can be found in the paper by Dubrow et al 1987 matters For the cases we report a diagnostic bias for compensation payment 686 Dodoli et al 4 aTnAdBLLaESIpeVziMaineralogic Examination of Fireproof Materials Still Used in the Area of Leghorn SEM Macroscopic features investigation fiber types SEM investigation fiber average sizes fibrous particies A Flexible 4 mm thick panel Chrysotile Length = up Chrysotile ; Slightly breakable friability and mm diameter = { maximum fiber dispersion mostly 1-5 ... along rims and angles B Poorly flexible 2 mm thick panel Poorly breakable friability and maximum fiber dispersion mostly along rims and angles Chrysotile Length = up to 1.5 mm diameter = 1-5 Chrysotile f C Flexible 6 mm thick panel Glass fibers Length = up Quartz barite Highly breakable spread me chrysotile mm diameter = chrysotile friability and maximum fiber 5-15 o aneee / . dispersion along rims angles and flaking planes . * | D Stiff 1 cm thick panel Slightly breakable friability and maximum fiber dispersion mostly Chrysotile Length = up to 1.5 mm diameter = 1-10 ... Chrysotile along rims and angles E Poorly flexible 2 mm thick panel Poorly breakable friability and maximum fiber dispersion mostly along rims and angles Chrysotile Length = up to 1 mm diameter = 1-10 ... Chrysotile F Totally moldable 1 mm thick cioth cord Poorly breakable very low friability and fiber dispersion Chrysotile Length = up to 1.5 mm diameter = 1-5 Chrysotile H SEM = scanning electron microscopy fibrous phase cannot be suspected Furthermore items about exposure were collected without in- forming the interviewed persons about the aims of the study and information can therefore be deemed fairly reliable -- --,, Briefly in thirty women with a pleural mesothelioma diagnosis -- --t,,heir death certificate and for whom it has been possible to collect medical records and interview information thirteen were definitely exposed to asbestos in the domestic environment three more cases were probably exposed and 5 were exposed work exposure In addition the number of lost cases plus the cases without definite could obscure some additional cases with occupational exposure It is very dif- to constitute total important inhaled occupational exposure According Huncharek al 1989 total amount inhaled fibers ficult in fact through the interviews of the decedents relatives to identify domestic the fibers or time activities that occasion inhalation of asbestos Domestic washing of work clothes seems especially to et the of 5 # : | this operation may be comparable to that inhalebdy workers occupationally exposed to asbestos * . Although work clothes have been no longer washed at home in Italy many years we have observed that a questionable domestic use of asbestos still exists- aN Household Exposures and Mesothelioma 687 namely as conductive material to limit heat dispersion often without any regard to friability and fiber dispersion We found only chrysotile in the specimens exam- ined but in our opinion the unnecessary domestic use of all types of asbestos even my that overlooked in the past should now be banned Health education is also required 3 , i 4 REFERENCES fae : a Anderson HA Lilis R Daum SM Fischbein AS Selikoff IJ 1976 Household contact asbestos ~ neo- d. plastic risk Ann NY NY Acad Sci 311 323 Ge q Arul KJ Hott PF 1977 Mesothelioma possibly due to environmental exposure to asbestos in childhood 4 Int Arch Occup Environ Health 141 143 1 1 Bianchi C Brollo A Bittesini L Ramani L 1987 Hyalin pleural plaques and domestic exposure to i ie asbestos Med Lav 44-49 Bruno C Comba P De Santis M Malchiodi F 1988 Mortalit^ per tumore maligno della pleura in it {i Italia 1980 198R3oma Istituto Superiore di Rapporti Istisan 88/24 1 Bruno C Comba P Maiozzi P Vetrugno T 1990 Studio della mortalit^ di pazienti di mesotelioma pleurico Atti 5"Convegno Nazionale sugli Studi di Mortalit^ Firenze Comitato Italiano Studi autopsy 2 Mortalit^ CSPO Publ Firenze 1990 Delendi M Riboli E Peruzzo P Stanta G Cocchi A Gardiman D Sasco AJ Giarelli L 1991 oe ss * Comparison of diagnoses of cancers of the respiratory system on death certificates and at In Riboli E Delendi M eds Autopsy in Epidemiology and Medical Research Lyon IARC Sci Publ 112 pp 55 62 Se Dubrow R Sestito JP Lalich NR Burnett CA Salg JA 1987 Death certificate occupational fh, mortality surveillance in the United States Am J Ind Med 329 342 ; MJ Saracci fibres wens Gardner R. 1989 Effects on health of occupational exposure to airborne mineral ; Lyon Re: . 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Nicholson WJ Rohl AN Weisman I Selikoff IJ 1980 Environmental asbestos concentrations in the 7 , y United States In Wagner JC ed Biological Effects of Mineral Fibres Lyon IARC Sci Publ cor Srey dei i 823-827 Rutstein DD Mullan RJ Frazier TD Halperin WE Melius JM Sestito JP 1983 Sentinel health events occupational A basis for physician recognition and public health surveillance Am J Public Health 1054 1062 Schwartz E 1986 Use of death certificate for surveillance of related illnesses New Hampshire in . MMWR 537 540 Vianna NJ Po an AK 1978 occupational exposure to asbestos and malignant mesothelioma Sree * females Lancet 1061 1063 Wagner JC Sleggs CA Marchand P 1960 Diffuse pleural mesothelioma and asbestos exposure in the North Western Cape Province Br J Ind Med 260 271