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FILE NAME Talc TALC DATE 1979 DOC TALC021 DOCUMENT DESCRIPTION Conference Presentation from Dusts & Disease Conference - Mortality Among Miners and Millers of Non- Asbestiform Talc 378 BOUNDY AL REFERENCES Brown C.E Talc In Brobst D.A. and Pratt W.P. (editors) U.S. 1973 pp 619-625 Mineral Mineral Washington Resources Washington D.C. J.W. Goldin Cares A.S. Lynch J.J. and Burgess W.A The Determination of Quartz in Airborne Granite by Infrared Spectrophotometry Am Ind Hyg Ass J. 34 298 1973. Respirable Dust Hildick G.Y The Biology of Talc Brit J. Ind Med 33 217 1976 Jacobs E.C Talc and the Talc Deposits of Vermont Ninth Report Vermont State Geologist 1914 pp Antique Deposits Jacobs E.C The Talc and VerdVeerde Antique Deposits of Vermont Report Vermont State Geologist Geologist 1918 232-281 232-281 Leidel Evaluating Leidel N.A. , Bayer SS. .GG.. and Zumwalde , R.RD.DUSPHS NIOSH Filter MembraneFiFliltterer Method for Evaluating press Airborne Asbestos Fibers in Weiss B. and Boettner E.A Commercial Talc and Talcosis Archives of Env Health 14 304 1967 MORTALITY PATTERNS AMONG MINERS AND MILLERS OF ASBESTIFORM TALC Preliminary Report Sherry G. Selevan and John M. Dement Industry Studies Branch Division of Surveillance Hazard Evaluation and Field Studies National Institute for Occupational Safety and Health Joseph K. Wagoner and John R. Froines Occupational Safety and Health Administration U.S. Department of Labor Washington D.C. 20210 INTRODUCTION Industrial and consumer applications of talc and associated minerals are widespread Talc is used in such industrial applications as fillers in asphalt paper rubber ceramics paints and plastics Also uses include various dusting applications to prevent adhesion and as a parting agent in molding operations Consumer a applications include its use as filler for pills tablets as a cosmetic talcum and in - some countries as a coating for polished rice Blejer and Arlon 1973 U.S. Dept. of Int Bur of Mines 1975 A dichotomy has been identified in the classification of talc asbestiform talc including anthophyllite tremolite and chrysotile and asbestiform talc Early studies do not recognize this dichotomy and the potential for differing health effects The first reported case of talc pneumoconiosis was described by Thorel 1896 Since then studies of asbestiform talcs have repeatedly shown their association with progressive pneumoconiosis both among miners and millers Dreesen and Della Valle 1935 Porro et al 1942 Siegal et al 1943 Kleinfeld et al 1955 An increased risk of respiratory tract cancer among miners and milters exposed to talc containing anthophyllite and tremolite has also been demonstrated Kleinfeld et al 1967 Kleinfeld et al 1974 Until only recently there has been a paucity of epidemiologic data about workers exposed to talc free of both asbestiform minerals and significant quantities of free crystalline silica Studies of industrial populations exposed to these talcs present conflicting results In Italy workers exposed to such talcs both during its extraction and industrial use demonstrated a pneumoconiosis diagnosed by roentgenographic evidence that was reported to affect neither respiratory function nor working capacity Maranzana et al 1963 Scansetti et al 1963a Scansetti et al 1963b Subsequently a mortality study by Rubino et al 1976 found that miners exposed to similar ores demonstrated an increased risk of pneumonconiosis mortality which the authors attributed to exposure to crystalline silica However Fine et al 1976 in a sectional study of rubber workers performing dusting operations with talc low in asbestos fiber and free silica content demonstrated progressive decrements in pulmonary function associated with increasing duration and magni- 380 SELEVAN AL Other authors had previously suggested such a possibility based on case reports only Millman 1947 Seeler et al 1959 As a result of unanswered questions concerning the toxicity of talc free of both asbestiform minerals and significant quantities of free silica the National Institute for Occupational Safety and Health undertook an industry study cohort mortality study industrial hygiene study and sectional medical examination of Ver- mont talcs meeting these criteria i.e. low free silica and no asbestiform minerals This report contains an assessment of mortality patterns among the cohort exposed to this talc MORTALITY STUDY Materials and Methods Selected for study were all male Caucasian talc workers who had been radiographed as part of the Vermont Health Department's annual surveys initiated in 1937 of workers in the dusty trades Out of this group workers who met the following criteria were included in the study cohort ) workers were included who were employed in the Vermont talc industry between January 1 1940 and December 31 1969 and 2 were employed a minimum of one year before December 31 1969. Five companies in three geographic areas were studied two of these companies ceased operations in 1952 and 1960. Follow of all study group members therefore was from the time of the initial radiographic examination as a talc worker the date when twelve months of employment was achieved or January 1 1940 whichever was later and was continued through December 31 1975 Occupational and demographic data were obtained from the survey records of the Health Department and companies to permit vital status follow Company records were only used to supplement Health Department work histories when the latter were found to be incomplete Vital status ascertainment of the members of the study cohort was determined through December 31 1975 by means of records maintained by federal state and local agencies This included sources such as the Social Security Administration state vital statistics offices and state motor vehicle registration files For individuals not located through these data sources other data sources such as city directories post office mailing correction services and other local records were used As a result of this follow program only 1.0 Table ) of the study cohort 4 of 392 workers was lost to observation Death certificates were obtained from state vital records offices for those known to be dead and causes of death were in- terpreted and classified by a qualified nosologist according to the Revision of the International Lists of Disease and Causes of Death in effect at the time of death These codes were subsequently converted to the 7th Revision For analysis the total study cohort was examined and later was classified into two work areas milling 225 workers and mining 163 workers The worker was required to have a minimum of one year exposure in the area to qualify for inclusion These two groups were not mutually exclusive seven workers 12 of the total population qualified for inclusion in both groups A modified life table technique was used to obtain person of observation by year calendar time periods year age groups year exposure groups and year latency groups Latency is the number of years since onset of initial emplov- MORTALITY PATTERNS AMONG MINERS AND MILLERS 381 381 TABLE 1. Vermont Talc Study Cohort Status as of December 31 1975 Known to be alive Known to be deceased Death Certificate obtained Death Certificate outstanding Not known to be deceased Study Cohort Members No. % 298 76.0 90 23.023.0 85 21.7 1.3 5 1.3 1.3 4 oe 1.0 1.0 392 100.0 basis cohort and the number expected on the basis ooff sex age race calendar time and mortality rates Since many occupational cohort mortality studies specific was have used U.S. rates for comparison this group used in this study However Vermont rates for the causes of death of interest in this study malignant expected respiratory disease and respiratory cancer deaths are greater than the U.S. Therefore comparisons were made for these causes of deaths with those expected Vermont using rates specific expected deaths aplying obtained tallies studypopulationcensus of obtained by applying death rates calculated from yearly tallies deaths observation of data to the person of observation the cohort cohort members The yearly deatdeahthss Statistics data from 1940 the from the U.S. to 1967 were obtained the yearly Vital Statistics of United States National Center for Health extrapolation linear using Statistics After 1967deathsdeath data through 1975 timated using a linear extrapolation for all causes of obtained obtained from all years from 1949 death Office from the Vermont Office ofof obtained Statistics . U.S. and Vermont population estimates Vital decenial were obtained fromthe decennial data of the Bureau of Census U.S. Department of . linear inter- using midpoints Department of the year calendar periods were estimated using linear inter-inter- determined 1958 polationpolation Statistical significance tailed was Expectation Poisson Variable " the Expectation of a Poisson Variable Pearson etal , Limits Confidence using Confidence Limits for ). examined In to the preceeding analyses other relevant data were addition examined The Department most recent radiograph taken for the Vermont Health annual surveys was obtained for workers dying of malignant disease and for read respiratoryconsultants pneumonoconiosis by a member of the panel of radiology of using the Cincinnati classification of radiographic of blindappearanwciteh 1/0of cause death pneumoconiosis These radiographs 14 by 17 were read that is knowledge of exposure to talc or the underlying of Readings of or higher were considered consistent with pneumonoconiosis Results As shown in Table 2 a total of 90 deaths occurred among all talc workers from January datermined 1940 through DecemberDecmber with December 31 1975 as contrasted 77.32 expected December statistics patterns The distribution of these TABLE 2. Number of Expected and Observed Deaths by Cause by Among Vermont Talc Workers 1940 Through 1975 Cause of Death ICD No. 7th Revision Heart Disease 400-443 All Malignant Neoplasms 140-199 Respiratory 160-164160-164 Total Malignant Respiratory Disease 470-527 Influenza and Pneumonia 480-493 Other Malignant Respiratory Disease 470-475 500-527 Other Known Causes Unknown All Deaths SMR Based on 7682.6 person 0.01 Observed 29 16 6 112 0 Expected US 32.92 12.79 3.69 3.67 1.89 112 25 25 90 1.79 27.94 77.32 116 cohort occurred in the malignant respiratory disease category This 11 observed versus 1.79 expected was specific for other malignant reexscpeirsastory disease excluding influenza and pneumonia ONMRD more detailed analysis of specific mortality by working groups is shown in Table 3,,The mortality patterns observed in this table show that the excess of total malignant respiratory disease mortality and more specifically ONMRD mortality occurs primarily among thosethose in the milling group ONMRD 7 observed versus 0.89 expected significant increase in respiratoryrespiratory cancer mortality was observed only among miners 5 observed versus 1.15 expectedexpected No difference of consequence was noted the other group respectively Vermont's death rates for malignantmalignant respiratory disease and cancer are greater than corresponding ratesrates for the entire U.S. Vermont dreesaptihradtaotray were only available back to 1949. ConsequentlyConsequently the person of observation from 1950 through 1975 calculated inthe life table analyses described above were applied to death rates of the United StatesStates and Vermont to obtain for the study population during that timetime period The patterns of stateixsptieccatlleydsidgenaiftihcs- ant excess mortality were maintainedmaintained in this comparison The expected numbers of deaths for Vermont and the U.S. for ONMRD in millers are 1.33 and 0.86 tively versus 7 deaths observed 0.01 for both The number of respec- deaths expected in the miners was 1.22 and 1.09 respiratory cancer and 0.01 versus 5 deaths observed 0.05 If the excess observed of malignant respiratory disease deaths in millers was a result of talc exposure some confirmation of this relationshiprelationship could obtained by examining chest radiographs of these workers relationship could be These data do not tally with those listed in TableTable 2 due to the and miller overlap caused by the definitions of miner MMoorree .67 .56 1.15 or Year Expectd US 1.24 4.18 1.23 9.93 26.58 128 One Miners Employed in Observd Employed Milers 12 34 1.96 and and .83 .89 Expectd 15.7 Miners 6.28 1.72 Miners Talc 13.8 37.15 118 Milers Vermont Among Observd 16 Among R 7+ 15 Cause by Deaths DDeeaatthhss Expected Expected Expected 1975 Revison and Death and 480-93 of 7th Respiratoy 140-9 Through Cause1940 No. Observed Respiratoy Pneumoia person Observdof Area ICD 160- 4 Number Neoplasm Respiratoy Malignt Malignt 40-43 470-527 470-5 Disea WorkNumber to 3. Acording Malignt TABLE Heart All Disea Disea years person and 50-27 Cause 4128.5 2865.4 Influeza Other Known Other Unkow SMR on on Deaths BasedBased 0.50.1 Total All The Vermont Health Department supplied NIOSH with the readable radiographs for 8 of the 11 men who died of malignant respiratory disease Of these eight with readable radiographs six 75 had radiographic readings of 2/1 or greater indicating pneumoconiosis All of these were small rounded opacities the type usually observed with a fibrous exposure and were generally distributed throughout the lungs Two of the 11 ONMRD had prior dust exposure When these two were excluded six readable radiographs remain Of these 83.3 5 were read as 2/1 or greater Note should be made that these radiographs were taken while the workers were relatively healthy that is healthy enough to be actively employed Furthermore this information was supplemented by qualitative radiograph readings recorded by the Vermont Health Department for each annual survey No discrepancies were found when these were compared to the readings discussed above The Health Department information included readings for the three deaths whom radiographs were either missing or unreadable For the two cases with unreadable radiograph earlier readings were available All three cases had radiographic evidence of pneumoconiosis according to the Health Department's physician at the time the radiograph was taken With this information incorporated into the tally a total of nine of the eleven had radiographic readings consistent with pneumoconiosis ASSESSMENT OF OCCUPATIONAL EXPOSURES Analyses of both airborne dust samples and talc bulk samples showed talcs from all locations in the mines and mills studied to be similar in composition No asbestos was detected in any of the samples analyzed by either ray diffraction or analytical electron microscopy Levels of free silica in talc bulk samples were below 0.25 for nearly all samples and only in occasional air samples was free silica detectable Talc shards and ribbons were seen in talc bulk and airborne dust samples In addition to the mineral talc other minerals present in these ores in significant quantities include magnesite chlorite and dolomite in addition to traces of calcite biotite ankerite and phlogopite To determine potential differences in the talcs mines and milled by the company in the third geographic location no longeirnoperation seven samples of talcs were obtained and analyzed by the same techniques mentioned above These samples were found to be free of asbestos contamination and to have a mineral composition within the range of samples from currently producing operations The one remaining company also no longer in operation was located in the same geographic area as two of the currently operating companies The historic data on the studied facilities obtained from the Vermont Health Department were not sufficient to calculate cumulative exposure histories for miners and millers However they are sufficient to demonstrate that it was not uncommon for past exposure levels to both miners and millers to far exceed the present Occupational Safety and Health Administration OSHA and the Mining Cincinnati ratings were not used Analyses presented in Boundy M Occupational Exposures to Asbestiform Talc in Vermont Presented at Conference on Occupational Exposures to Fibrous and Particulate Dust and Their Extension into the Environment December 6 1977 Washington D.C. Enforcement and Safety administration MESA standard of 20 mppcf for nonfibrous talc % free Sio NIOSH 1974 " The talc in one of the closed mines is reported to have had cobblestones of serpentine rock which were highly tremolitic In the mining of this talc these cob- blestones were avoided and discarded Therefore miners may have been exposed to tremolite but it is unlikely that the millers from this company were Radon daughter levels in Vermont talc mines have been determined by MESA Mean levels ranged from trace quantities to 0.12 working levels Single measure- ments as high as 1.0 working levels have been measured in these mines NIOSH is currently attempting to identify any possibly confounding workplace Vermont exposures that may have occurred prior to or after employment in the talc industry for those who died from malignant or malignant respiratory disease Prior exposures have been identified to some extent by Vermont Health Department Records DISCUSSION workers The finding of excessive respiratory disease deaths among talc re- quires an evaluation of selection bias resulting from application of the criteria for inclusion in the study population Bias may exist from selection into employment in this industry and subsequent radiographic examination as talc workers During the annually early years of the program radiographic examination was not done There was no survey of talc workers for six of the first twelve years During this time the likelihood of missing workers with brief exposure was greater especially in the period from 1944 through 1947 when no examinations were done The bias associated with radiographic examination appears small as the probability of examina- tion increased with increasing length of employment As the data were examined by analyses latency and exposure categories this bias was accounted for in the The Health Department in the mid 1960's did attempt to document those missing in their surveys Although the completeness of this documentation is unknown the follow- ing information resulted Of the 178 workers identified during this check approximately 27 worked more than one year but less than % worked more than five years This supports the theory that those missed by the surveys were for the most part short term workers To examine the effect of potential selection bias for persons with a predisposi- tion toward respiratory disease analyses of ONMRD mortality risk were made according to latency that is the time interval since onset of initial employment in the Vermont talc operations The mortality patterns in millers demonstrate an observ- able excess after 15 years of employment 2 observed versus 0.31 expected a observed 0.05 and statistically significant risk after 30 years 5 versus 0.41 to expected 0.01 This lack of an excess prior 15 years and an increasing excess beginning after 15 years suggests that there was no selection bias toward less healthy workers the data were consistent with other data comparing working populations with the general population This phenomenon is known as the healthy worker effect Bayliss et al 1976 McMichael et al 1975 Those who are employed have lower death rates are generally more healthy than the general worker population which includes invalid and institutionalized people This healthy effect is more prominent in the years immediately after the workers are hired Waxweiler 1976 : practice it unlikely Since employment health screeningscrening was not past practice is unlikely that thus job selective selective such placement mine mine versus mill occurred due to health status and not explain the different trends observed selection could The role of prior employment in other dusty industries can be reasonablyreasonably excluded reasonaiblny to in the etiology of this malignant respiratory disease death risk two who died from ONMRD had reported dust exposure prior working workers two cases are excluded from analyses the pattern of an exces ive industry excessive riskWhofenONMRDONMRD mortality in millers persistspersists 7 observed versus 0.89 expected 0.01 significant If there is truly an association of the statisticallystaistcaly significant excess of ONMRD would examina- deaths with talc exposure one expect a confirmation of this with an dust exposures paper Insufficient historic data are available to estimate cumulative life for members of this cohort however available data show past sinurtehse mines and mills to be higher than the present OSHA and MESA exposure standard of 20 mppcf It is probable that cumulative dust exposures for millers over their time are higher than those of miners as mine operations are more : workingin nature than are mill operations eg intermittent operations such as sporadicAlthough there may be other possible factors the relative differences noted drilling in expected malignant respiratory disease deaths in the observed versus + consistent with a talc exposure etiology At this and milling populations are mining scientific the mines are extremely limited too limited to make respiratory judgement datajudgement as theto the presencepresence or absenceabsence of an excess malmailiggnantnant respiratory a ' disease death risk A majority of those workers who died of malignant respiratory disease or respiratory cancer did smoke cigarettes at some time during their lives Unfortu- nately no data the smoking habits of the study population and precise data the populations are available However it seems unlikely due to the - comparisonof the difference that the observed excess of malignant respiratory magnitude millers limited disease deaths is associated only with unusual smoking patterns and then only talc It is equally unlikely that the excess risk of lung cancer found in among the is associated with unusual smoking patterns only in that group Because miners of smoking data no conclusions may be drawn from these mortality data the possible additive or synergistic effects of smoking and talc dust conceexpronsuirneg SUMMARY AND CONCLUSIONS present The study demonstrated excessive mortality due to malignant a asbestiform disease among talc millers exposed to talc free both of respiratory of free silica Selective bias and other causative minerals and significant quantities factors do not adequately explain the observed excesses although the possibility does exist of an interactive effect between cigarette smoking and talc exposure and Radiographic evidence further support the role of talc exposure free of asbestos Radiographic free silica in the etiology of the increased risk of malignant respiratory disease among these talc millers past levels associated with this excess is unknown The cumulative talc exposure of the mills and mines However the nature of early sampling not uncommon for past due to the sporadic samples are sufficient to demonstrate that it was Health Administ- levels to far exceed the present Occupational Safety and exposure and Safety Administration standard of 20 mppcf ration and the Mining Enforcement for fibrous talc % free Sio reflective of these early exposure levels No Mortality patterns observed are the effects of present day can be made from this study concerning judgement exposures in this industry was observed for miners and not The fact that excess lung cancer mortality that millers despite probable higher daulsotneexoproisnucroemsbiinnatmiilolnowpietrhattailocndsusstuagfgfeecsttmine additional etiologic agent either for this cancer mortality risk workers The possible role of radon daughter exposures cannot be eliminated ACKNOWLEDGMENTS studies for this report were conducted by Maryanne under The industrial hygiene Harvard University School of Public Health the Boundy and Karen Gold of the and microscopic petrographic direction of William A. Burgess ray diffraction Walter C. McCrone Associates studies of talc bulk samples were conducted by under NIOSH contract Felson M.D. of the Department of Radiol- Radiographs were read by Benjamin ogy Cincinnati General Hospital and the United Cement Lime and Gypsum The authors thank Don Spatz studied and the Mine Enforcement Workers International Union the companies and Safety Administration MESA for their assistance Clorinda Battaglia The authors also thank Debra McDonald Patricia Johnson and and the mortality group Mary Gabriel Edith Dodd and the follow group also Lina Heid of the National Institute for Occupational Safety and Health and Marian Health Vermont Health Department Bizzozero of the Division of Occupational Ohio Regional Computer Center Bruce Gehring Mary Quinn and the Southwestern Staff Cincinnati Ohio REFERENCES H. .. Mortality patterns among fibrous glass Bayliss D. L. Dement J. M. WagYoonrekrAcJ.adK.emayndofBlSecjieernces 271 324-335 1976 J. of Occup production workers Ann New and environmental carcinogen .: Talc a possible occupational Blejer H. P. and Arlon Med 92-97 1973 to talc in two Georgia talc mills Public Health Dreesen W. C. and Della Valle J. M Effects of exposure Service Reports 131-143 1935 388 SELEVAN AL Fine L. J. Peters J. M. Burgess W. A. and Diberdinis L. .: Studies of respiratory mortality in rubber workers Part IV Respiratory morbidity in talc workers Archives of Environmental Health July195-200 1976 Kleinfeld M. Messite J. Kooyman O. and Zaki M. H Mortality among talc miners and millers in New York State Archives of Environmental Health 663-667 May 1967 Kleinfeld M. Messite J. and Tabershaw I. R Talc Pneumoconiosis Archives of Industrial Health 66-72 July 1955 Kleinfeld M. Messite J. and Zaki M. H Mortality experience among talc workers A follow study J. of Occup Med 345-349 May 1974 Maranzana G. C. and Tronzano L. T Epidemiology of silicosis in talc mines Medicina del Lavoro 591-596 1963 McMichael A. J. Haynes S. G. and Tyroler H. A Special Communications Observations on the evaluation of occupational mortality data J. Occup Med 128-131 1975 Millman N Pneumoconiosis due to talc in the cosmetic industry J. of Occup Med 391-394 1947 Pearson E. S. Hartley H. O. Editors Biometrica Tables for Statisticians Volume , 1958 ' Porro F. W. Patton J. R. and Hobbs A. A Pneumoconiosis in the talc industry Am J. of Roentgenology and Radium Therapy 507-524 1942 Rubino G. F. Scansetti G. Piolatto G. and Romano C. A Mortality study of talc miners and millers J. of Occup Med 18 No. 186-193 1976 Scansetti P. G. and Rasetti L On pneumoconiosis of talc workers Medicina del Lavoro 680682 1963a Scansetti P. G. Rasetti L. and Ghemi L Clinical and radiological course of penumoconiosis in the talc extraction industry Medicina del Lavoro 746-749 1963b Seeler A. O. Gryboski J. S. and MacHahon H. E Talc pneumoconiosis A.M.A. Archives of Environmental Health 392-402 1959 Siegal W. Smith A. R. and Greenburg L Study of talc miners and millers in St. Lawrence County New = ; York State Ind Bull 22 December 1943 Thorel C Die Specksteinlunge Ein beitrag zur pathologischen anatomie der staublungen Beitr Path Anat 85-101 1896 U. S. Dept. of Heath Education and Welfare National Institute for Occupational Safety and Health Criteria for a Recommended Standard Occupational Exposure to Crystalline Silica HEW Publication . No. NIOSH 75-120 1974 - U. S. Dept. of Interior Bureau of Mines Minerals in the U.S. Economy Year Demand Profiles for Mineral and Fuel Commodities 1965-74 1975 Waxweiler R Quantification of risk from industrial carcinogens Presented at the Detection and Prevention of Cancer Conference New York City April 1976 AN ANIM J.C. Wa Medical pital pital Pe F.D. Po Po Dept. INTRODU In this pape given are given In a nary results of cosmetic talc us those of chrysot MATERIAI The main a shipment of t been produced reasons Firstly secondly beca obtained from This partic imported in a median particle mineral by weig also found in th Extensive year perio were over 30 y no change in th asbestos mine the many sar itself has show could not be tra procedures ad For compa which we have inoculation W exposed to nei