Document GmJNBOemDJdXEB19Ynp2NjzBv

FILE NAME Talc TALC DATE 1967 May DOC TALC008 DOCUMENT DESCRIPTION Medical Journal Article - Mortality Among Talc Miners and Millers in NY State aed 663 turesare a feed alan village proedical service in control Cases of lleeaatthhss from all fortnightly home food intake are the Pan Ameurai Ameurai 1 Health Orgon the National inst , and Wyom B 2 Sc 245 1, Patterns of Famil Cuxternalan Ind's | 31-293 1964 onal Problems ot Panama Pediatry Pediatry 1 Syndrome Pott and Its Prevention nal Studies No Organization of the - Developed Coun ogical Behavior 3-20 m udies of Diantwal Demographic Rugal Highlands Amer Etiology Diarcheal Enden atemalaatemnalan Children 400 1962 real Disease Amer of Diarrheal Dis ironmental Factors of Acute Diarrheal ages Amer J Trop orld Food Output d Agricultural Ecortment of Agricul Foreign Regional nsibilities is e licensesl.icen-ses.- nols JAMIA Mortality Among Talc Miners and Millers in New York State Mens Kleinfeld MD Jacqueline Messite MesM sitDe MNeDw OYhoirrek Koovinen MD MD and Mahjour 1 Zaki SINCE SINCE SINCE 1940 the Division of Industrial Hygiene has carried out a number of studies tale miners and millers in the northern on of New York state The prime purpose part ascertain the health of these studies was to hazards associated with the exposure to dust in tale mining and milling In 1940 a chest ray survey of 221 tale miners and mullers employed in several plants in this region disclosed pulmonary fibrosis in 32 workers 18 of whom had had no other occupational dust exposure This survey clearly indicated in these tale mines and mills that exposure was capable of producing a fibrogenic type In 1051 a followum 0 pneumonial study of the 32 workers with pulmonary fibrosis disclosed that the pneumoconiosis was progressive and disabling but that the progression was slow and the disability oc curred primarily in the older age group A report on the clinical roentgenographic and pathological findings in six patients who had an average exposure to tale dust of 26 year- with a range of 20 to 33 years was reported in 1963. The major clinical features were chronic productive cough dyspnea dimin- ished breath sounds limited chest expan Bze sion diffuse rales and clubbing The chest roentgenogram disclosed pulmonary infiltra- 'tion both basally and in the midlung fields g 'In some instances obscuration of the car- diac borders or costophrenic sinuses or both ba The most frequent patho- were present logical change was a diffuse fibrosis con- Submitted for publication Dec 21 1966 accepted ie fe? Jan 10 1967 New From the Division of Industrial Hygiene Uy York Drs Kleinfeld Messite and Kooyman and Y of New York Downstate Medi- 8 the State University Kleinfeld Messite and Zaki cal Center Drs BeBrooklyn NY Reprint requests to 80 Centre St New York 10013 Dr Kleinfeld taining macrophages with absorbed dust particles A pattern of endarteritis with inti- Inal hypoplasia was frequently frequently noted Dis- tension of bronchi and bronchioles bronchioles with tormation of cystic spaces was common Rather characteristic was the presence of elongated terminally clubbed bodies indistinguishable indistinguishable indistinguishable from asbestos bodics us seen in asbestosis The pleura showed dense fibrotic thickening Cor pulmonale was the major complica- tion in four of the six cases and was the mechanism of death in three A comparative clinical roentgenographic and physiologic study of workers exposed to fibrous and granular tale dust was made in 1964. The two groups were similar with regard to age sex degree of exposure and sucking habits There were no significant differences in the clinical and roentgenographic roentgenographic findings be- tween the two groups However the number of abnormal values for each parameter of pulmonary function measured : VC VC MBC RV TLC TLC and DL > was appreciably greater in those exposed to fibrous than to the granular variety of tale In 1965 pulmonary function tests were per formed on 43 workers engaged in the milling of the fibrous variety of talc The mean du- ration and weighted average of exposure was 19 years and 62.3 million particles per cubic foot respectively An appreciable number of the workers had abnormal pulmo- nary function measurements This was particularly evident in the vital capacity total lung capacity and diffusing capacity There were 16 who showed pulnionary infiltration on their chest roentgenograms as compared to 27 without such evidence Those with pos- itive radiologic findings had a proportion- ately greater number of respiratory symp toms and signs and abnormal pulmonary function values as compared to those with- Arch Environ Health 14. May 1967 H +" a, | i :S hi ie re 8 be afl : i +E a wa: see 2 664 MORTALITY AMONG TALC MINERS KLEINFELD ET AL out In general the correlation between the degree of pulmonary function impairment and the clinical and roentgenographic findings was poor The purpose of the present follow study was twofold 1 to obtain an estimate of the incidence of disease among this select group of tale workers and 2 to compare the observed mortality experience from specific discases with the expected mortality among a similar basic population Materials and Methods All tale mmers and millers employed in 1940 who had 15 or more years of exposure to tale dust as well as those who achieved a minimum of 15 years of such exposure between 1940 and 1965 were included in this study The group totalled 220 workers and it is believed that the overall number of 220 constituted the total work force in the category under study Source of Data data were obtained from a number of sources Plant records were examined and the work history of each individual was detailed to include changes of job and specific years of employment Death certificates were studied in all instances when available The records of the physicians attending the workers privately were reviewed Substantial dical information on the majority of the workers was available in the Division's files and was used as an additional source of data Hos pital records including autopsy reports and histological specimens were examined wherever available Autopsy records were obtained in 35 of the 91 deaths Statistical Analysis total number of deaths was distributed in the following categories malignancies cardiac pneumoconiosis or complications or both accidents or suicides and all other causes The proportions of mor tality from cancer of the lung and pleura and of the gastrointestinal tract and peritoneum out of the total mortality were compared with the expected mortalitics due to the above causes in the various age groups The expected mortality represents the proportion of deaths among white men in the United States due to the specific causes in the year 1957. This par- ticular year was chosen as standard because it is the median year of death among the 91 deaths Differences between observed and ex- pected frequencies were tested for significance using the normal curve with large numbers and the Fisher's exact probability test for sinall frequencies Findings Total Deaths were 91 deaths in the group of 220 tale workers The causes of death in the various categories are shown in Table 1. A breakdown of the deaths accord- ing to age group showed that two workers under 40 died 38 workers who were between 40 and 59 years died 47 between 60 and 19 years and four died who were 80 years and over Table 2 The average age at death of the 91 tale workers was 60.4 years with a range of 38 to 84 years Malignancies the 91 deaths the ob served and expected number of deaths duc to cancers of the lung pleura gastrointesti nal tract and peritoneum are shown in Ti ble 2. Of the ten malignancies of the lurg and pleura nine were carcinomas of the lung and one was a fibrosarcoma of the pleu ra Of the seven malignancies of the gas trointestinal tract and peritoneum two were cancers of the stomach and one each of carcinoma of the colon rectum and pancreas There was one primary hepatoma of the Ir er and the remaining case was a peritone| mesothelioma The malignancies involving other sites included one case of retroperito- neal reticulum cell sarcoma and one chronic lymphatic leukemia Cardiac Deaths the 25 cardiac death > excluding cor pulmonale 19 subjects had coronary artery disease three had hypertensive heart disease and three had rheumate heart disease Pneumoconiosis of Complications er Both the 91 deaths 28 were due to pneumoconiosis or complications or both Nineteen of the 28 were due to cor pulmo nale five to advanced tuberculosis and four to bronch fust tale coniosis 15.9 years In this sa en tale m millors of exposure engineeri in the ta All of this cate I accid the rema bleeding t nal herr peritoniti mesenter Enviro death ca _ rcament available * ge * duration we. group w range of | dust exp i * dominan Table Causes of Death in 91 Talc Workers During Period of 1940 to 1965 Cause of Death No ARF with oth SY MF serpenti i carbonat amount Malignancies Lung and pleura Gastrointestinal and peritoneum All other mangunc 6. Cardiac de tres other than cor pulmonale) Pagunvoco Pagunvoco and complications Accidents Accidents or suicides A other causes Tcial 19 13 ; . S -" 8 11 91 PA il . y & 27 30 7 > 12 100 compara the tal prior to E 1946 an Table 3 Malig on carc Arch Environ Health 14 May 1967 Fat nc T eT hat eee TUU TUU BU eg JOOM Tr P^ GEP^ GE+2 +2 AL MORTALITY AMONG TALO KLEINFELD ET AL f Table Deaths and Expected Mortality From Cancer of the Lung and Pleura and and Peritoneum Related to Age in Talc Workers were 91 deaths in - - Deaths Deaths from Proportional Mortality cers The causes of ories are shown in the deaths accordthat two workers ? 3 q Age % Group Total Death 7 Malignant Causes - Lung and Pleura Gang Gang : PaaS Long Long and Mera sebse ie 4 . Date te al Clara For Pi who were between 35 ce 2 ay SERS between 60 and 79 Al & a Vv Set were 80 years and 4a i a ; . Rhy - Gacituintestinal DENTS:aitek ge age at death of / 11 aan with * signdieart ES 604 years a tract Difference Difference biotecen chiserved chiserved and theoretical theoretical values is not statistically statistically statistically signdieart . Dfercice Dfercice ben ben observed observed on theoretical theoretical values statistically man man , , wes 91 deaths the ob- ber of deaths duc to bronchopnetunoma The lapsed time from and pleura shows an overall mortality from ura gastrointest first tale exposure to death from pneumo- carcinoma of the lung and pleura to be ap- are shown in Ta- incies of the lung arcinomas of the coniosis or complications or both averaged 25.9 years with a range from 15 to 39 years In this group there were 11 tale millers ser proximately four times that expected However the significant increase appears to oc- cur in the age group of 60 to 79 years rcoma of the pleu incies of the gasitoneum two were id one each of car- en talc miners and nine who had been both millers and miners All 28 had their initial exposure before 1945 when more effective engineering controls including wet drilling rather than in group This is have observed to asbestos dust the 40 to 59 year age at variance to what we among workers exposed where the observed values um and pancreas Patoma of the liv e was a peritoneal mancies involving ase of retroperitooma and one of in the tale mines were introduced All Other Causes the 11 deaths in this category four were due to cerebrovascu Ir accidents two to lobar pneumonia and the remaining five to one of the following bleeding duodenal ulcer strangulated ingui- in the 40 to 59 as well as 60 to 70 year age groups were significantly different from the expected values Table 4 The asbestos group consisted of 152 asbestos insulators who had 15 or more years of exposure in 1945 or achieved 15 years between the period nia nal hernia perforated diverticulum with of 1945 to 1965 The overall mortality was 25 cardiac deaths 19 subjects had ree had hyperten- peritonitis acute glomerulonephritis and mesenteric arterial occlusion s Environmental Exposure the 91 46 or 30.3 The reason for the carlier occurrence of an increased incidence of lung or pleural cancers in the asbestos workers com- ree had rheumatic death cases data on envi . ronmental exposure were Table Comparative Dust Counts in Talc Mines and Complications or , 28 were due to available in 80. The mean P duration of exposure for this 2 20) Mills Northern New York Before 1946 1965 lications or both due to cor pulmoerculosis and four 91 Talc Workers 19 at 20 11 & 22 275 group was 24.7 years with a range of 15 to 47 years The @aH dust exposure consisted pre dominantly of talc admixed with other silicates such as serpentine and tremolite carbonates and a small amount of free silica The comparative dust counts in the tale mines and mills prior to 1945 and between 1946 and 1965 are shown in E Table 3 Work Type Mines = Drilling Mucking _ Scraping Mills - Milling Garners Separators Pursenz Pulverizers ' Me dim Hoof Aver spe ( up to 1948 22 69 699 180 61 136 75 271 58 70 728 278 No Dust Counts Made 129 151 teow Me 316.1 High Aver 21875 S 2 30.7 00 1 Comment Malignancies data No Dust Counts Mete 18 1190 83 2480 1227 440 125 69 169 fi a Son carcinoma of the lung Rede oo - THI GY 01 21PM 21PM TO PEGE PEGE 666 MORTALITY AMONG TAIC KLEINFELD ET AL Table Deaths and Expected Mortality From Cancer of the Lung and Pleura Gastrointestinal Tract and Peritoneum Related to Age in Asbestos Workers and Death's From Malignant Causes Proportional Mortality Lung and Gland Ponitor eut Lung and Pleura - Observed Observed Theoretical Theoretical Gland Perdoneu Perdoneu cate ee Observed Civaretion the group o cinoma of t with a rang ly above th range of 25 of 91 death 23 re " con nga 19 b 13 _ 26 31 observed between and theoretical theoretical values is statistically signif not performed because of smal number in group 152 ant 001 001 er) ot 39 of white m & 1920 is giv workers w does not d span from carcinoma our data in findings pared to the tale workers may be partly duc 91 cases there to the greater were ten subjects who had a dust to carcinogenicity of asbestos duodenal ulcer and in one of the ten the ul- or an increased level of exposure to asbestos dust or both as compared to com- cer was the cause of death In the 129 work- mercial talc which is ers who are still alive 19 had a diagnosis of a mixture of silicates and carbonates with a small amount of free duodenal ulcer This is a total of 29 of 13.2 According to the health silica In the absence of adequate smoking the US statistics of data one cannot assess the role Department of Health Education x played by and Welfare the prevalence of peptic ulcer smoking in the causation of the pulmonary carcinomas in both series In three of the ten found between 1957 to 1959 for mules of all ages is 21.4 tale workers where a per thousand population of smoking history was obtainable two smoked at least one pack 2.1 Despite the fact that the figures obtained through the National Houlth daily fox fox 28 years and one smoked ten Sowmy cigars daily for 55 years represent point prevalence in contrast to the With regard to carcinoma of the gastroin- period prevalence figures of our study it appears that the incidence of peptic ulcers testinal tract and peritoneum among the tale workers we did not find among tale workers is higher than among any significant the general population A difference between the observed and expect crease in incidence significant in- ed values in the overall and specific of peptic ulcer varying age groups studied However in the asbestos between 20 to 25 has been found in pa tients with chronic obstructive pulmonary group Table 4 a significant difference be tween the discase Since the tale workers have observed and expected values was primarily a restrictive rather than an obstruc- found in the overall categories Our in the asbestos tive lung disorder one may speculate that workers are similar to what has been reported by Selikoff Churg and both types may be associated with an increased Hammond If a clear incidence of peptic ulcer etiological rela- tionship is subsequently established Correlation of Carcinoma of Lung With between exposure to asbestos and carcinoma of the Age Duration of Exposure or Pneumoconiosis or Relating carcinoma of the lung gastrointestinal tract then one may attrib- with duration of ute the differences in incidence between the exposure it might be rele- asbestos and tale vant that all the individuals with carcinoma groups to the reasons given for carcinoma of the lung and pleura of the lung or pleura had their initial expo- Deaths Due to Pneumoconiosis or Com- sure prior to the institution of wet drilling The average duration of exposure prior to plications or Previous studies have the introduction of reported that cor pulmonale is a major com- wet drilling was 14.6 plication of tale years Although this was a period of heavy pneumoconiosis and is a exposure Table 3 there is major cause of death among tale workers The findings in this study are consistent no evidence to indicate that there was a direct relationship between the with the previous reports duration of exposure prior to Peptic Among the death group of the onset of wet drilling and the occurrence of pulmonary carcinoma The mean of age sons with evidence No confir the remain Sarcoma of eral massi Mortali ers in Nev years of e were revi was 60.4 years Proport the lung a four time However dence ap group rat This was bestos w of exposi the incr present i Occurrenc tributed possibly greater mercial : nal trac nificant populati ers gast nancies due to Arch Environ Health 14. May 1967 01:22 01:22 ID POZ POZEE aaa |