Document G6mb93bR5rGg5abBnGx76B01r

pergamon 4~.*rv*Hrt. J* he iR.UMU. M* Cwrif^i . fm*KtliftOenwUMAiXrp"(Snn- frmvi^Cnx Unto*. AS**S*Tj*wa 0CG>-8?8<94)E9C32-U MESOTHELIOMA AMONG CAR MECHANICS?* H.-J. Worrowrrz sod K. ROdelspercex <Aeerte4 30 Nmmhar l3 tutd Infatalfam 15 Frkmarj 1994) Paper read at the Workshop on Health Risks Associated with Chrysolite Asbestos, held m Jersey, Channel Islands, 1<M7 November 1993. NoAffftC*. Ix 1991 and i992preBsunaryinformatkrfi was givenonan n-goingease-controlstudy of mesothelioma, which up to that time involved 175 cases, of whom 14 were car mechanics (Worrowrrz and R&delsfergex, 1991.1992). This study has now been finished (Worrowrrz<t of., 1994)and the final results relating to car mechanics can be reported. Of the original 14 cases four had to be rejected, since the pane] of pathologists finally classified them only as "possible mesothelioma*. Ultimately out of224 cases of mesothelioma Id were classified as motor vehicle mechanics (according to code 421 "KraRfehrzeug-Instandseiar''--"motor vehicle repair worker*--of the German Federal Statistical Office).They were compared with 16mechanicsamong215hospital controls and 12 mechanics among 182 population controls (see Table I). The hospital controls were patients who had undergone lung resection for reasons other than mesothelioma, in most instances because oHung cancer. Evaluation of the occupational histories ofcases and controls showed shat one of the mesothelioma eases and one of the hospital controls worked with locomotive enginesanda second case worked with trams. Athird mesothelioma patient workedin automobile production where he was exclusively involved in fitting windscreens. Among the population controls who had worked with cars one had only painted cars and another had produced ear spare pans. The motor mechanics began their employment in that capacity between 1925 and 1972. the median due being 1949 for both groups of patients and 1946 for the population controls, The duration of relevant employment was longer for controls than for cases, with median values of S, 5,5 and 4 years, respectively. Seven of the mesothelioma cases, nice ofthe hospitaI controls and three ofthe population controls said that they had dbne brake repair work. In all three groups there were some individuals who had substantial asbestos exposure in other types of employment {e^ in a power plant orin theshipbuilding industry). Only fourofthe mesothelioma mrs, two of the hospital controls and five of the population controls had no history of asbestos exposure. Three of these four mesothelioma cases, and also two of the five Supported by the German Federal Minify of Soeaec *ftd Technology. Project No. Q| HK 07$ M. 63J PLAINTIFFS exhibit HT-12486 PLAINTIFFS EXHIBIT US33.00 WV-12486 H.-J. Wottowiri and K. H ill does * o i s u n th il oth mwAiaJca n *w e d ite d In b o te sivis*, Mesotiidiomi amoe|ormcriunics? M2 hospital controls and two of the five population controls, stated that they had been engaged in brake repairs. Lung tissueanalysis was available for two ofthe mesothelioma eases and for one of the hospital controls (R5osls?erge* ei ai, 1993, see Table 2). For mesothelioma ?Aia 1 lWQ TBSVS aKALYUS OP WB&TKtLtOUA CJ48 AW HOSPITAL CCKTKKA. smuoss as motor vswcu hechawcs. Tms amaitocal saMsmvrrv a DEnsto as eWCNTRATtN PO PISKZ No, $t*iw Lusg 6ast Ifbn ecncrturttion 4*5 pa xtO'fl" (dry) Afi*lyiai Oihcr mtjjtMty ChryiMik Amphi&ofe minerals ] Cub 2 Cat 3 Control 22 i 25 0 0 00 282 0 0n patient No. 1 no fibres longer than 5 pm were found. Since 1972 he had worked for g years as a car mechanicand was engaged in brake repairwork during this time. There was so suggestion of any other asbestos exposure. For mesothelioma patient No. 2 characteristic araphiboie fibres longer than S tm were observed. Hehad worked as aearmechanicfor only 1 yearin 1940and hed beaa a Luftwaffe pilot from 1941 to 1945; he had no known asbestos exposure from other employment. Control patient No. 3 hadnumerous long chrysotile fibres but noamphibole fibres. He had worked as car mechanic from 1934 to 1939. From 1943 to 1950 he was a prisoner ofwar in Russia where he had to arc-weld steel structures and to install glass fibre insulation. Subsequently he is assumed to have had so further occupational exposure to asbestos. CONCLUSIONS From these results there is no evidence that car mechanics are exposed to an increased risk ofmesothelioma even if they do brake repairs, but asbestos exposure in other employment is an important confounding factor, so that if there is a mesothelioma risk for carmechanics but it were small is would not be detectable. The absena offibres in the lung tissue analysis for one of the mesothelioma cases--despite' his employment for$ years as a car mechanic, repairing brakes--does not exdude the possibility that, decades before, chrysotile fibres wereactive at the target cells. On the other hand, it is doubtful that (he amphibole and chrysotile fibres, ia the lung tissue of two other patients, can be related to their employment as car mechanics. [For the discussion of the issues raised in this and the other allied pawn see pp. 407-425.] RSFERENC6S UtoEiiKicu.K..WonowTTC.H..3,, BROcxeu B.. ARKCLCtx. R,, g(MX. w..Pcwuasue, H. and J6cxel. K,*H. ttWJ) f*tLKwtoii-StM<} an Meswhfltiemfaikftecn wm Gehsit *ngaftia4hef Faitm m $3S ri.-j, WQirowirx and K. fcaueojuxcm Untttub. Vonng aufdem KoUoquiuro P**rnrure Siiube: VonMoften. Wirtungen, Mewung Mtndemnfr Kommtuion fteinhaKong dcr Loft in VDj und DIN Pirid*. 7-9 S?temecr WJ. VDt* * Btriefta 1573, - 25>-i6?. VDJ.Verl*j. Ditsetxtoti. Wonown. K.-J. an* JWueupkj. K. flW!) Cbryioafie ubmot and m*o:\etiam. {Uvet to 0) EdUwO >"> bd. Mrd. I?. 55I-SS3. WOTOwjz. H.J.aad XOtSUPO&M. K, flWUChtfMtae ubaio*. ffhettama and pngstncetunia: RttfoMa to Df Wong, 4m. /, MJ. #tf. 3i. <33-455, wanmn,H.4, HtuiuMt. G..C*i>v*nma..BsghXusek, K. H,. Rdccurtttccx. K..JC**el. K.-H. tt el. (19M) Mulratmriiehr end mustidiaiplinirt Untenurtuogeo *>r Analy* von Ratt> und inflBfakloren da difeua non Mesothelioma. ScbrilienreiSie der BsftdesMUii f5 Arbeiiu* dtuu. WiiutiuAgvsrhig NW. Bnmctnaven. . TWO BY TWO TABLE CALCULATION Title: Mesothelioma in Garage Mechanics Woitowstz ond Rodelsperger (1994) Ann Oceup Hyg "Exposed" = motor vehicle mechanics Exposed Nonexposed Total Coses 16 J 30fi 324 Controls 28 489 497 0.8701299 Chi-square = 0.0750711 Lower limit c 0.3218605 Upper limit = 2.3538047 Totot 44 777 87.1 iTSt-2X2.*Ot} O fm> Pergarooo 4-. am*. VeL M. Ha., p#. UMa. J** Et*vir<&m<* Ltd Caftiufu '* &ioA Cwwr-HW HmwSowv rv>naaOw* timfafl. *B fytm ttEMIlW S7i0*fi 000>-4*78{94)ED032-y MESOTHELIOMA AMONG CAR MECHANICS?* H.-J, Wcrrowrrzand K. R6deupercfr IfcctJetJ30fhvmber 1993 W kf/ut/sm S5 TAtvorj I994j Paper read at the Workshop on Health Risks Associated with Chrysolite Asbestos, held in Jersey, Channel islands. 14--J ? November 1993. No Atfnet ix 1991 and 1992 preliminaryinformation was given on an ongoing case-eoMroi study of mesothelioma, which up to that time involved 175 esses, of whom 14 were car mechanics (Worrowrrz and RSdelsteroe*, 1991. 1992). This study has now been finished (Worrowru e: e!., 1994)and the final results relating to carmechanics can be reported. Of the original 14 cases four had to be rejected, since the panel of pathologists finally classified them only as "possible mesothelioma**. Ultimately out of324 cases of mesothelioma 16 were classified as motor vehicle mechanics (according to code 421 "Kraftfahrzeug-Jnstandretzcr**--"motor vehicle rtpait worker"--of the German FederalStatistical Office).Theywerecompared with 16 mechanics among 315 hospital controls and 12 mechanics among 182 population controls (seeTable 1), The hospital controls were patterns who had undergone lung resection for reasons other than mesothelioma, in most instances because oflung cancer. Evaluation of the occupational histories of cases and controls showed that one of the mesothelioma cases and one of the hospital controls worked with locomotive engines and asecond case worked with trams, A third mesothelioma patient worked sc automobile production where he was exclusively involved in fitting windscreens. Among the population controls who had wotted with cars one had only painted cars and another had produced car spare parts. The motor mechanics began thexr employment in that capacity between 1925 and 1972. the mediae date being 1949 for both groups of patterns and 1946 for the population controls. The duration of relevant employmem was longer for controls than for cases, with median values of 5, 5,5 and 4 years, respectively. Seven of the mesothelioma cases, nice of the hospital controls and three ofthe population controls said that they had done brake repair work. In all three groups there were some individuals who had substantial asbestos exposure in other types of employment (e.g. in a powerplant or in the ship-building indusiry). Only fourof the mesothelioma cases, two of the hospital controls 2nd five of the population controls had no history of asbestos exposure. Three of these four mesothelioma coses, and also two of the five Supposed by the German Federal MiniHry af Science and Technology.'Projest No. 0! HK 076 A6. 635 i 6}* H.-J. WOiW'*^Z*n K. Wl>ELSM*CW ( ii Mtsothefierna among ear mccMnet? 63? hospital controls and two of the five population controls, stated that they had been engaged in brake repairs. Lung tissue analysis was available for two ofthemesothelioma cases and for one of the hospital controls (R6delsferger et at., 1993* see Table 2). For mesothelioma Taku 2. Lw*a nstrs analysis or mesothowa cases an hospital cont*ou, Itt&AGED Ai KOTO* VEHICLE HCCH*NiC T ANAtmCAi SStfSrTJVTTy IS OEftNCOAS CWCSKTOATiOH Ft* fU No, Sujuj } Cut *1 Case 3 Conire) Lung Cub fibreconcentwion i&S im - JO**!*1 iiryi AwUytieal Otbtr nnutmiy ChrpDlile AmphJbdJc minerals 22 0 00 14 0 282 0 25 J.WC 0 76 patient No. \ no fibres longer than 5 sen were found. Since 1972 he had worked for 8 yearsas a car meehanicand was engaged in brake repair work duringthis time. There was no suggestion of any other asbestos exposure. For mesothelioma paiism No, 2 characteristic amphibole fibres longer than 5 jrrn were observed. He had worked as a car mechaniclor only 1 yearin 1940 and had been a Luftwaffe pilot from 2941 to 2945; he had no known asbestos exposure from other employment. Control patient No. 3 had numerouslong chrysotilc fibres but no amphibolc fibres. He had worked as car mechanic from 2934 to 1939, From 1945 to 2950 he was a prisoner ofwar is Russia where he had to arc*weld steel structures and to install glass fibre insulation. Subsequently he is assumed to have had no further occupational exposure to asbestos. CONCLUSIONS From these results there is no evidence that car mechanics are exposed to an increased risk ofmesothelioma even if theydo brake repairs, but asbestos exposure in other employment is an important confounding factor, so that if there is a mesothelioma risk for ear mechanics but it were small it would not be detectable. The absence offibres in the lung (issue analysis for one of the mesotheliomacases--'despite' his employment for 8 years as a car mechanic, repairing brakes--does not exclude the possibility that, decades before, chrysorile fibres were active at the target cells. On the other hand, ir is doubtful that the amphibole and ehrysofile fibres, in the lung tissue of two other patients, can be related to their employment as car mechanics. [For the discussion of the issues raised in this and the other allied papers set pp. 407-425.] REFERENCES ROoeumacek.X,. Wwtowjti. H,`}.,B*One?l, B.. Akkslsea, 8ROhu, W., Pohublln. H,ttdJOCKli.. K.-H. (1993) Fatl-KomreU-Stuflie an Meaoihelicmpaticnccn Cehali aiwjar.Uehcr FascfTi m 63K H.-J. Wonowsrt ind K. Rdu&LSrtxCU LufigauMab-Vonraiai^flcm KoNoQuiwsn Fwerforrmjc Stiube: Vonehiifwn, Wtfkns*n. Me&sung. Minderanj. K^mmaHOB RejntuSiung der Laf? in VDi und DIN Fulda. 7-9 September 1993, VT>!betie&t JC7& j*p. 2S>-2&. VDJ-Vewaj, DSaohlorf. Worrowm, H.-J. and R4a&sPtt*. K, (Mil OtryioUh asbestos *nd nwoihebema. [Utter to the Editor,} Ax. J. fU Mrd. 19, SSI-SS3. WomjietT*. H.*3.nd RAttUKiGtft. K. (l')OryaotiI atbcsaes.mesoihalioawand farage meehama: Response to Dr Wonfi. Am. J, M. Mei. 21.4i3--*55. WamwfTZ,W.J* Hsuswi. d C*i>vkocs>a^Beb*iusa. K-H- R6nos*watt.K..J&cml. K.-H, et 0f. 99*J MuMumrittht tmd muHidiapliiiStt Umeauehungas xur Analyse von ftaike- end EittatsS&ktorcn ds diffuMfl maiden MesoiWiOffis- &fcrffien/eftt der BundttanmH ft* Arbeit*chya. WifuefcaAswieg NW, Bremertu *on. TWO BY TWO TABLE CALCULATION Title; Mesothelioma in Garage Mechonics Woitowitz end Rodelsperger (1994) Ann Oecup Hyg "Exposed" motor vehide mechonics Exposed Nonexposed Total Coses 16 508 324 RR * 0.8701299 Chi-square c 0.0750711 Lower Limit =s 0.3216505 Upper Limit a 2.3538047 Controls 78 469 497 Total 44 777 871 (m.-2X2.W011 fmelo