Document JNJdXy0qQVxrzg7pV2aQVZ5oa

al/3LfZaat) aZI by iLZ bauyizb U 1X HUUb UN bHH LIB Hwbt vZ/ab Scand J Work Environ Health 2005:3 T supoi2:27-30 Asbestos hazard in the Swedish construction industry--recent trends in by Goran Engholm, MSc,] Anders England, MDS Engholm G, Englund A. Asbestos hazard in the Swedish construction industry--recent trends in mesothslioma incidence. Scand J Work Environ Health 2004;31 suppl 2:27-30, Objectives The aim of this study was to analyze the incidence of pleural tumors among various categories of Swedish construction workers and l`J determine iu what extent its change ovei Lime differs from l1j.il uf ilic general male population. Methods 'I radilinna! methods have been used to study cancer incidence through 1 998 in a colion comprising 370 165 male workers examined in 1371-1392 by Bygghiilsan, an organization at the time providing nation wide occupational health service. Incidence was assessed by linkage to The national canter register, Results Swedish construction workers, particularly those heavily exposed to asbestos, had an excess incidence of pleural tumors in 1975-1398 [standardized incidence ratio (SIR) 3,16. 35% confidence interval (95% Cl) 2.55-3.881. The excess declined with subsequent follow-up periods and birth cohorts with the exception of the most recent period (SIR 3.83, 95% Cl 2.64-5.38) and those borne in the 193(ls. Conclusions A possible decline in pleural tumors among men following the cessation of asbestos use 2$ years earlier in the population at targe may nol be applicable to an end-user sector like construction work. In occupations charged with repairing and refurbishing work, there may even nave Been an increase lately. Key terms asbestos use: end-user; lung; pleura; third wave. Many studies describing the health effects ot exposure to asbestos have been published it) the past 50 yEars, Most of them have concerned asbestos mining and the manufacturing of asbestos-containing products, includ ing asbesLos cement, However, already in a study in the 1960s, SelikofF et al (1) first reported elevated mesothe lioma mortality among insulators in the United Status, they ascribed this phenomenon to the workers" expo sure to asbestos. Some of the studied insulators had been working ip the construction industry. In a more recent report from the United Kingdom, Peto ct al (2) pointed ou(. ihaL die construction trade is one of those in which an excess incidence of asbestos-related cancer--in particu lar mesothelioma of the pleura--can be expected in the future. In the United Kingdom, preventive steps were earlier directed primarily towards the more asbestosspecific riades and neglected the end users (2). The aim of this study was to analyze the incidence of pleural tumors among various categories uf Swed ish construction workers and to determine to what extent its change over time differs from that of the general male population.---------------------------------------------- Study population and methods National cancer registration Since 1958, new findings of tumors are reportable by law to the rational cancer registry. Most notifications to the registry contain data on tumor site and patholo gy. Almost all pleural tumors arc reported as mosothe liomas. The national incidence ot pleural tumors and lung cancer has been calculated as the age-standardized incidence, with the Swedish 1980 population taken as the standard. For the calculation of expected numbers, 5-year period incidence Mies fnr h-ycar age groups (<19, 2(1-24..........80-84, 585) have been used,-------------- Data on asbestos import_____________________________ Data on the import of asbestos have been obtained from Statistics Sweden. Cohort studies on Swedish construction workers--------In 1.96B the employers and trade unions in the gwedtsfrconsLruction industry agreed to establish a jointly run I Department of East European Studies. Uppsala University. Uppsala, Sweden. 3-------- Fonrieilv with the Swedish Work Environment. Authority, Snlna. Sweden,-----------------------------------------------------Reprint inquest* to; Dr Anders Englund. Trolly 20. 5b-133 34 Saltsjdbaden, Sweden. [E-mail: anderS.englundtSav.se] Scsntj J Work Environ Health 005, vo! 31, suppt 2 01/31/2006 02:53---------713-5003125 -preuna grid lung tumors m Swedlsn cronsiruei/un withers U TX HOUSTON 5PH LIB~ PAGE 03/05 CT.tinni.1 health service (Dygghalsim) available to dl ^fmcdoB estab_lishme--nts anjd ...aiit) C0^tlU^'on WOTK- Sfrt1grfllCU,J^ --------- nationwide. The preventive medical services corn-_ -prisHl. emonc cithers, a health examination program to "which all consiTucuun Yorkers were invited with an m- Tenral of 2-3 years. Although participation was volun tary the participation rats was higher than 80%. At the "health check-ups, nurses with special training intcr- yi^vftri the wnrkers concerning t-heir exposures and ne- cord*edicodes --o.ff ^ciuipr-rre*rntrt aannrdl nprrpe.vviifo'iuiiQs nocnc^uiitplfalttiinonn.. OOnllSe putpose was to establish a 'hea'lth~i stur.ve.illa.nc.e svys..t.e..m. --fo.r the whole industry (3). Altogether some 370 000 male ^workers were examined during the period 1971-1992, most Df them more than once. On the basis of the oceupa^tio__n_c*,o1de-~rencwoArod.Aed&fatthtehefirf'CirTstrVclhPe-crtk-l-iunp,ftteflxlTalminEinCeSesWwETeCre classified into 17 different major categories. The cohort of examinees has been followed for mor tality and cancer incidence by linkage to various nation al registers, the cancer register, the register of deceased ^people, and a register ot migrants. Less than 0.1% of the cohort was tost to follow-np. The incidence of pleu- ral tumors and lung cancer has been expressed forvari -CUE categories as ihp- standardized incidence ratio tSlRJ -with the 9?% mnfVWe interval 195% CIt- For the cal culations, reference rates have been taken as rates for ~5-ycar age groups and 4-yeat calendar periods. Results Asbestos use in Sweden- -Import is the only source of asbestos in Sweden. Cony -pared with that of many other European countries, the Import was modest during the years between the two world wars. Although the import rose sharply during the mid-1950s to a level of some 1U 000 tonnes annually -(^..flilgglu^riwe 1), it was still at a Tamer tow level cgmpaicd -------- -------------------------------- ;-------------------------------T----- ;-------------?____ fitime 20 000 tonnes annually. The peak import occurred in the early 1970s. although it was briefly interrupted; in 973. The sharp and rapid decline in 1926, on the other hand, became permanent, lUiiiiks in particular to the Immediate cessation of die use of asbestos containi.ng products in the construction industry a total ban of utibesl1?; '"V* was onfarced in I9H2, although it pctimtted continued use for brake lining. jackets and the like under special circumstances and subject to individual authorization until less hazardous materials were avail able for such special applications. Swedish national pleural tumor incident# Since the mid-1970s the annual number of pleural tumors has increased substantially, in particular among men (figure 1). The total number accumulated during the first TO veam of the registry, was of the same magnitude as the annual numbers in the late 1990s, and the number of cases among men was only twice the number of those among women. The annual number and the incidence rate leveled off during the 1990s, Actually, the annual inci dence Has consistently been lower after the peak, in 1992. Tumors of the lung and pleura in constructbn wofkers- Tn 1971-1998, the cohort of examined construction workers showed an excess incidence of pleural tumors (SIR 1.64, 95% CT 1.43-1 S7). hut only a slight excess cf lung cancer (SIR 1.03, 95% Cl I .Oi.M.07 ifubk 1). Th'- pleural tumor incidence was high in the six heavily exposed groups when taken together (SIR 3.181 95% a 2.57^3.90), but also in the remaining 16 groups. when taken together (SIR 1.20, 9591, CT 1.00-1.44)- With rICeUgaftrmd tiwo liumnigfi cvca*nnc^er there was a--n e_x_c_ess inci_de_ nce for the heavily exposed cnly (SIR 1.14. 95% CT 1.06-1.23) In thI e* co.hort nnf examinee_ s_ lin ,t1h__e_L.h^enailivliilyJITeHxMpUuMsIed occupations r-nmhinp.fi the high excess of pleural tumor ncidence in 1975-1998 c__o___uld he seen mainly during the 28 Scand J Work Environ Hsaim 200S. vO! 31, supd S Figure 1. Annual Impon ul H&lniblui in agr-standardited incidence of tumors of the pleura (Internationa Classification of Diseases, 7th revision =1B2.2) by gender, (fyrs = persun-years) (Page 4 of 5) Ol/Jl/2006 02:58 713-5BB9125 U TX HOUblUN SPH LIB PAGE 04/05 Entjhom & England Table 1. Cancer InoldBnco In 1971-1938 among ths Swedish construction workers examined by Bygghalaan. (SIR - standardigej inaiUtimjB raliu, 95% Cl = 95% confidence interval)----------------------------------------------------------------------------------------------------------------- CatagDry-------------------------------------- Plptiral tumor;---------------------------------------------------------- 1 imp r.anrer .... . Uthor professions bsefvnd bffjected YZ'd V3ZS SIR t^O gyn 1.00-1.44 observed Expected ------ SIR----grrci-- 23T2---------229?-2------ ---- fr-------D,97-1.05-- ' All axamlnaes 215 131,1 1.64 1/13-1.87 3005 2906.4 1 .D3 1.00-1,07 ---------------------------------------------------- during the subsequent follow-up periods (table 2). Dur--- --Tahle 1. Pleural tumor incidence by category and calendar ps------------------------- ing the most recent follow-up period, however, the rlod. (SIR - standardised incidence ratio, 95% Cl = 95 % confi- standardized incidence ratio was again high in heavily exposed groups, particularly so for dlumbers and caint- CateaDrv Observed Exnected SIR 95 % Cl ers. No similar pattern over the follow-up periods was Examines? not heavily axposed to asbestos (Nn247 466) exposed (table 2) or for lung cancer in the combination of the heavily exposed occupations {figure 2). For the heavily exposed occupations combined, the birth cohorts showed different pleural tumor excess in __________________________________ cidences (figure 3) with the highest incidence for those 1975-1979 3 5,34 0,56 0,19-1,64 19B0-1984 15 13.81 1.D9 0.61-1.79 19B5-19B9------------- 31---------93.36-------1:39------0.94-1.97--------------------------------- 1990-1994 iqos inD 37 31-14 1.19 0.84-1.64 i n nu 1 m 1975-1936 120 100,57 1.19 0.99-143 __________________________________ horn in 19110-1909. Furthermore, those born in the iy.?? mTin corLun naa a Jiigner incidence tivm Q105C liHjrTlc QUriTlg Cllii lWO prC-CtUln^ OCvuGCoi .otlTiOn,g the painters, the 1.930--19Hy birth cohort had an excess 1975-1979 1 Qf|r) 1995-1989 1990-1994 1995-199a 7 1.36 5.15 3.07-10.6 1A ,qpq H7Q 9(\?^R1U 17 6.22 2.73 1.59-4,33 20 33 235 1.36-3,43 33 6.61 3.33 2.64-5,33 pleural tumor incidence of the same level as the birth cohorts of the beginning of the eemtirv. For lung can- floorers (Nt-5443) T375=T993 Insulator* (N^Q2) G 1.34 4,47 1.04-9.75 male population ('figure 4), Discussion 1975-I gga Plumbers (N"!5 664) iH7S-i07n 1930-1984 1935-1909 199D-1994 5 4 9 5 6 061 735 2.44-17,7 n.3H 10.46 2.84-27.0 1.05 8-53 3.91-15,3 09 7M 0.90-5.53 2155 2)36 0.80-5.12 25 years ago, the annual number of pleural tumors among men Jr the late lyyus was still auhstareaiiy nigti-- er than the annual number of fatal work accidents in __________________________________ Sweden (4). This is a relevant comparison, as almost __________________________________ all of such tumors are fatal within a year and most likely c&useq by previous cjccupauo'na.i exposure ip a^ocstrs. As mere arc reason's to dlucyc mat inc iiumiwi ui ^ lung cancers attributable to asbestos exposure cati be esrimated to be of the same order of magnitude as rhe number of cases of oleural tumors, the total number of 1975-1993--------------36----------- 65------- 434----- S.Q4-b.rJ1--------------------------------- PdlllltilS (N=ZD 71!:]--------------------------------------------------------------------------------------- 1975--1979 mmS 4 Pift A 3 CT53 5^8 1.17-15.5 n 1 07 1 *7 niQ-RRC) innn-iqtM 1995-1093 1975-1998 3 2.7 1.11 0.23-3.25 7 2 33 aim 1.21-6.19 17 8.92 1.91 1.01-10.1 1Q75-19S8 9 CIliLlI Ikilfl'I-'l \ltl--UU UUUJ in7R-109R 19 2.48 3.64 1,36-0.69 7.23 2,63 1.50-4,11 Although there are indications that ths incidence of pleural tumors among iwedish men has slowly Mailed to decline, the incidence during the most recent. 4-year follow-up period among construction workers was pos- -:u,. ftTM ntvuiraic Tifriods In SOtne lob Cat- egorien, the incidence of pleural tumors may still bo in- cr&asing. rtie concerned job ch(b,uL i&s snare tnc Tcniure of havinu been cxDOsed during repairing or other tasks but prnhably even painters. Although the manufacturing Of floor and wall covering nialmal containing as bestos was prohibited already in 1976, the risks continue far beyond, in particular, the work with floors is m- terestirc 9S th* installation of the new carpet presented U 1 1 IUUj 1 UN brH L1d -----------------PAGE--05/05--------------------- _jLE_ -W - 1.2 1,0 o.e a os -h4- -Eh2- o.o 1U/0- 1975- 1990- 13B5- 1990- 1935 74 73 84 B3 94 96 -AH- Calendar period ' Flflura ?. Incidence ul lung cancer [Intsnatlonal Classification of Diseases, 7th rc/iSion-162.1) by calendar per ad among Swedish construction workers heavily exposed to asbestos. (SIR = standarO- bed incidence ratio, 95% Ul = BSKj confidence interval) 14 12 _ 10 -t>-----3? 6 1000- 1910- 1920- 1930' 1940- 195009 19 29 T9------SB- Blrtfi ttmfi -AH- figure 3. incidence cl pleural tumors (International gasificationi of ni-nim, T*h rnuitinn-l fiO VI h-j time (if hirfh 3010110 Swedish COfl- slructiun workers heavily Exposed to asbestos. (SIR = standardized Incidence ratio. 95% L!l = cdtHlUs+HM-interu^^ .... ______ _____ environment and had been glued to the floor, it. had to be scrapped sway, and p.itpnsiirc to asbestos was caused by the needed grinding. In earlier periods, asbestos had been used sii fillet's in paints, and also painters might have been exposed when grinding or old paint at the time of repainting. Tn contrast to the pleural tumor incidence, the incidenre. of lung cancer among the heavily exposed conKtruction workers showed a consistent decline with time of birth relative to that of Swedish men in general. The various antismoking activities by the occupational nurs es combined with continuous feedback from lung euneer incidence data on smokers and notismokers among their peers may explain the decrease in smoking rates among the workers in the whole industry.______________ During the medical examinations and interviews, questions were also asked about the handling of and possible exposure to asbestos-containing material. As the interviews concerning work and exposures took plane at. the medical chcck-upa long before their tumors were diagnosed, recall bias is unlikely. This is even more the case for those first examined before the midj970s before all discussions in society about asbestos hazards. Out of the first 85 of the workers diagnosed with a pleural ttlflior, only 13 reported past exposure to asbestos (5), Such a lack of knowledge about one's own exposure probablv explains why the proportion of pleu[a! mcsothp-H<,|ma* reported as occupational diseases is so lnw in StMiJt: countries. -------Tn conclusion, the findings suggest thai.nji.othcrwayL. _ufg-31Q^lzincUiCc nifl-V appeal' in Lnt Wum nounced end-user trades in the constnjtliun UldustTy due-------------------------------------------to the continued handling of old asbestos-containing build- __________________________ 2 J-- ------ . : * 1-6 ijni tf 1 _____ t _________________________ 1LS_ ... .. f -- I- -- - 0 |-------------- H------------------ 1--- -----1--------Tf-------- *- -1909 191U- 192019 as 39 I"49 S9 Birth ttlW TM flunr" 4 incidence Df lung cancer (International Classification of Dirases Tlh TMdsian=ia2.l) by time Of birth among Sweuisn corttmHdfln workers heavily expand to asbestos. (SIR = standardized Inti^rrs ratio. 95% Cl = 95% CDfllWence interval) n0 prnhlom. white, at the time of replacement some 20 years later, it became a major source of exposure. As rhe. backside-------------------------------------------------------------- of the carpet contained asbestos fibers for References-------------------------------------------------------------------------------------------------------------- I. Selikol'f U, Cliurp J, Hammond EC. Asbustns exposure and n-npijutifl. .T Am M&d A.'isOt; 1 l> 7 Peto J. HodEson JT, Matthews FE, Junes JR. Continuing in/Trjisf! in mesothelioma mortality in Britain, the Lanuu 1995:345:535-9. u ch,i.,TMi a Swfriish atmrcinches to industry-w,de studies: the TMciion i In Undrigan W. H. rdilor. The [|1jTrt mavp of ashestna disease: exposure lo asbestos in placepublic health control- Ann N V Acad Set 1991.6^-3 313--5~ iwwn. R F.nnlnntl A. Albin. M. PJeurai mcsothelimum in siuir-rten: an analysis of the incidence according to the use ot rvnur Environ Med 1999:56:1 lu-d, 3 Hnrholm G. England A, Fletcher AC, ITallin N. Respiratory cancer incidence in Swedish construction workers exposed to man-made mineral fibres and asbestos. Ann Occup Hyg 30--------- szand J Work Environ Health 290!% vo! 31, suppt 2