Document Lod0Egr1Jxzp8vvqzLx8Z9K4b
FILE NAME Brakes BRK
DATE 1975
DOC BRK226
DOCUMENT DESCRIPTION Published Conference Presentation by Dr. Selikoff - Epidemiologic Investigations of Asbestos Workers in
the US
96. Selikoff .: Diskussionsbemerkung 2. Schweizerische Uns
falltagung der Deutschen Gesellschaft f^...rUnfallheilkunde Unfallheilkunde e V. Sektion Berufskrank-
heiten Asbest und Asbestose vom 19. bis 23.11.1975 in Berlin
BESTELLUNG dokumenTUM
|0
000000172
Bestelldatum 2015-04-30 11:32:51
Benutzernummer Name
Stra^ e Postleitzahl
Ort Stadt
Adresse
04000000109
Bohm Berndt
Universitaetsbibliothek der TUM 80290 Muenchen
berndt.bohm@ub.tum.de berndt.bohm@ub.tum.de
Unter Anerkennung des Urheberrechtsgesetzes Urheberrechtsgesetzes wird bestellt
ISSN Zeitschrift Aufsatz Aufsatz
Band
Jahrgang
Seiten
3-540-07892-4
a
2. OEsterreichisch Unfalltagung in Berlin
Selikoff
Asbest und Asbestose Diskussionsbemerkung
2
1975
5
2-
att
Signatur 1102 314 126
Vermerk der Bibliothek
Jahrgang nicht vorhanden
verliehen
o 0 nicht am Standort beim Buchbinder vermi^ t Sonstiges
512
den da^ sie diese Tagung
nicht ganz ohne Gewinn f^...r ihre wieder verlassen werden
eigenen
Arbeiten
Wir haben diese Tagung sozusagen in zwei Abschnitte geteilt Der heutige Tag soll uns sagen was die verschiedenen Forschergruppen zu den verschiedenen Themen welche der Asbest aufwirft als gesicherte Erkenntnis in ihren L^/ndern ansehen
Der morgige Vormittag soll dann in einem Gespr^/chvorwiegend unter den Referenten versuchen das herauszustellen
was sich z Zt in den verschiedenen Arbeitsgruppen in der For-
schung z T. auch der Forschungsplanung befindet
Diese zwei Tage tivit^/t unserer
sollen Arbeit
somit vor allem dazu dienen die Effekanzuheben die Arbeiten auf internationa-
ler Ebene aufeinander abzustimmen und damit das Asbestproblem
ein wenig von seinem Problematischen zu befreien
Ich w^...rdemich sehr freuen wenn Sie sich an diesen Tagen hier in Berlin wohlf^...hlen Heute abend gibt es den Berliner Abend im Hilton Hotel den Sie nicht vers^/umen sollten Vielleicht reicht die Zeit f^...r den einen oder anderen manches in dieser vom Schick-
sal schwer gepr^...ftenStadt anzusehen
Ich hoffe da^ wir gute Arbeit leisten k^nnen und er^ffnediese
gemeinsame Sitzung der Sektion Berufskrankheiten .
I.J. I.J. Selikoff New York
Epidemiologic Investigations of Asbestos Workers
in the United States
Comparatively few studies were undertaken in the United States concerning associated disease until the 1930s Then stimulated by the brillant series of British reports 1927-1929 concerning asbestos a number of buctory surveys were undertaken 1930-1935 and showed a significant prevalence of asbestosis At this time LYNCH nad SMITH reportet that lung cancer might also
result from asbestos exposure
Thus by 1935 the main directions of the problem were known Chrysotile asbestos virtually the only fiber then used could produce widespread disease this disease could be fatal and
malignancy might be a result of exposure
With this background it is difficult to explain the curious
quiet of
few and
It is of
the next 25 years Little was done regulations were
goverment inspections and supervision were infrequent
interest to note that during these years when no atten-
tion was paid to this problem 1935-1960 the use of asbestos
513
grew approximately fivefold in a rapidly expanding industry making thousands of products and that approximately one million men and women in the United States began work for shroter or longer periods often largely unprotected Many of the cases of asbestos disease now being seen in the United States had their
origin in uncontrolled excessive exposures during this time
Towards the end of this silent era disquiet appeared regarding the question of asbestos cancer Asbestos disease in the United States began to attract much more attention A number of studies identified two major problems which we have not solved
and with which we are now concerned
First and perhaps more important it soon became evident that asbestosis was not the principal hazard of exposure to the fiber but that the chief difficulty was cancer both in the factory production of asbestos products and among workers using these ma-
terials
In our experience
insulation workers
approcimately 40 of deaths among asbestos in recent jears have been due to malignancy
We followed a cohort of 632 asbestos insulation workers in the
New York metropolitan area from January , 1943 - December 31
1974 they continue under observation Altogether 305 deaths
were expected
Four hundred and fifty occurred The excess
was lergely due to cancer Fifty deaths were expected 200
occurred Analysis of the cancer deaths by site indicated that
12 lung cancer deaths were likely to have occurred 89 were found
Some two or three times as many cancers of the esophagus sto-
mach colon and rectum occured than were expected And there were
35 deaths from mesothelioma 10 pleural and 25 peritoneal Of
course no deaths of this rare disease were expected Table )
Similar findings have been obtained in other groups studied In
one we have been following all members of the Insulation Wor-
kers Union in the United States and Canada On January 1 1967
there were 17,800 such men deaths had occurred Again
By the end
there were
of 1973 more
approximately
than 1500 three times
as many cancers as expected Table 2 And again lung cancer
mesothelioma and gastrointestinal cancer were the principal
categories of such the excessive neoplastic deaths Sixty
deaths from lung cancer were anticipated 321 occured There were 103 deaths of mesothelioma again with a preponderance of
peritoneal sites of origin and a modest increase of cancer of
the esophagus stomach colon and rectum
We have considered the possibility that the complex environment in which these insulation workers are employed industrial construction might in some way be associated with their increased cancer risk This has led us to investigate the work force of two factories making insulation materials exposed to asbestos
but not to many of the other materials found at construction
worksites The first was a plant which made amosite asbestos insulation materials From June 1941 to the end of 1945 953 men began work at the plant Some worked for as little as 1 day
others for 1 or more months and a number for somewhat over 13
years until the plant ceased operations in November 1954. We
514
Table 1. Expected
bestos insulation
and observed deaths workers January 1
among 632 N.Y.-N.J. as-
December 31 1974
Total deaths all causes Total cancer - all sites
Lung cancer
.
Pleural mesothelioma
Peritoneal mesothelioma
Cancer of stomach
Cancer of colon
esophagus
Asbestoses All other causes
Expected
305.20
52.02
12.20
b
.
b
6.46
7,64
b
253.18
Observed 451
200 89 10 25 20
23
37 214
asix hundred and thirty two members were on the union's rolls on January , 1943. Nine died before reaching 20 years from first employment All others entered these calculations upon reaching the year from onset of first exposure point Expected deaths are based upon white male specific death rate data of the
U.S. National Office of Vital Statistics from 1947-72 Rates were
extrapolated 1943-48 from rates for 1949-55 and for 1954 from
rates for 1969-1973
U.S. death rates not available but these are rare causes of death in the general population
Table 2. Expected and
insulation workers in Dezember 31 1973
observed U.S.
deaths among 17,800 and Canada January
asbestos 1 1967
Expected
deaths a
Observed deaths
Ratio
Total deaths
Total cancer - all sites
Lung cancer Pleural mesothelioma Peritoneal mesothelioma
Cancer of stomach
Cancer of colon rectum Cancer of esophagus
All other cancer
Asbestosis
All other causes
1131.11 209.27
1577
658
66,99
b b 9.82 24.55 4.60
321 36 67 16 39 14
103.31
165
b
119
921.84
800
1.39 3.14 4.79
---
1.63 1.59 3.04 1.60
0.87
Expected deaths are based upon specific white male death
rate data of the U.S. National Office of Vital Statistics from
1967-1973
b U.
S. death
rates
not
available
available
but these are rare causes of
death in the general population
515
Table 3. Deaths among 933
asbestos factory starting
to December 31 1974
workers employed in an amosite
5 years from onset of work 1941-1945
Cause of death
All causes
Cancer - all sites
Lung
G.I.
cancer cancer
Pleural mesothelioma
Peritoneal mesothelioma
Asbestos cancer
Other cancer
Asbestosis
All other causes
Deaths 1946-1974
Expected Observed
285.62
483
50.10 12.45 12.05
b b 24.50
157 83 24 5 5
117
25.60
40
b
28
235.52
298
Ratio 1.69 3.13 6.67 1.99
-~-
4.78 1.56
--
1.27
aExpected deaths are based upon white male specific death
rate data of the U.S. National Office of Vital Statistica 1949-1973 Rates were extrapolated for 1946-1948 from rates for 1949-1955 and for 1974 from rates for 1969-1973
One hundred and twenty workers were omitted from these calculations thirty had prior asbestos exposure thirtyeight died in the first 5 years after onset of employment Fortynine were not completely traced and eight had other asbestos employment after the 5 year from onset point
b U.S. death rates not available but these are rare causes of
death in the general population
have traced this group of workers to December 31 1974. Table 3 includes the mortality experience of these workers starting 5
years from onset of their work It should be noted that their
experience was very much like who used the products made in
that this
of the construction workers
factory Again there was a
threefold increase of cancer of all sites 50 anticipated
157 observed Lung cancer gastrointestinal cancer and meso-
thelioma were also the major categories where excessive neo-
plastic deaths occurred
In an epidemiologic investigation of workers in another asbestos factory the largest in the United States we are following the 611 male production employees in this factory who had begun work before January , 1939 and were still there January , 1959 By December 31 1973 213 were dead Again cancer proved to be
the major asbestos hazard Table 4
A second major difficulty now with us is derived from the appre-
ciation that it may take much less asbestos to cause cancer than
to result in asbestosis
thus concerned not only spread dissemination of
- sometimes very little indeed We are
with asbestos workers but with the wide-
asbestos from the primary work site ex-
posing both other workers nearby as well as individuals not
516
Table 4. asbestos
Expected and observed deaths factory employees January ,
among 611 New December
Jersey male 31 1973"
Number of men Person of
observation
Total deaths all causes
Total cancer all sites
,
Lung cancer Pleural mesothelioma Peritoneal mesothelioma Gastrointestinal Other cancer
Asbestosis
All other causes
611 7795
Expected
151.53
30.87
10.16 b b
6.25
14.46
.b 120.66
Observed Ratio
213
1.41
77
2.49
30 10
8 11 18
2.95
a
-~-
1.76 1.24
23 113
--
0.94
a All these men began employment before January ,
still employed January 1 1959
1939 and were
b U.S. rates not available but these are rare causes of death
in the general population
c Expected deaths are based upon white male specific death
rate data of the U.S. National Office of Vital Statistica
1959-1973
associated with the work at all Household contamination occurs
from dust brought home by workers and there ist asbestos air pollution from asbestos facilities contaminating surrounding neighborhoods and to a lesser extent the general environ-
.
ment
Current United States Approaches to Asbestos Disease
Perspectives which provide a background to approaches designed to
control or eliminate asbestos disease in the United States are
largely derived from epidemiologic experiences such as those
above
1. associated cancer of primary concern Control mea-
sures are now based on the realization that it is necessary to
prevent associated cancer as
general this implies that permissible need be significantly lower than those
well as asbestosis In asbestos concentrations calculated to minimize
the risk of asbestosis alone
2. Long period of clinical latency In evaluating efficacy of
measures designed to prevent cancer it is appreciated that the long period of clinical latency of asbestos cancer must be taken
into account Our studies and those of others have demonstrated
that cancers associated with asbestos exposure often do not become
clinically evident for 20 or more Frequently the elapsed period is
years after onset of exposure 30 40 or more years
517
3. Brief excessive exposure may produce later disease Even brief exposure - a day a week a month - if excessive can later result in disease The inhaled fibers remain in the lung Thus the men employed in the amosite asbestos products factory mentioned above 1941-1945 worked for varying periods of time Approximately third worked for 3 months or less third-
for 3 - 1 months and third for a year or more Even less than
3 months of work resulted during the next 30 or so years in significantly increased cancer risk Table 5 Nevertheless those with longer periods of work were at an even greater risk
4. response relationship There is little doubt that a
response relationship exists for several associated
diseases This is well demonstrated by the experience of the
amosite asbestos factory
were exposed to the same
workers referred to above Here
fiber during the same period of
workers time
making the
ever with
same products in the regard to their total
same city
exposure
they varied
how-
The Table 6a and b indicates that the risk of death of lung cancer for example increased steadily with increassed exposure taking into account equivalent lapsed periods from onset
of exposure
An unanswered question related to the problem of disease
response relationship is whetheorr not a safe exposure exists From a practical point of view one might consider that observations'
of a continous reduction in identifiable cancer risk with decrease
in levels levels at increased
of exposure suggest that it may be feasible to reach
which it will not be possible to statistically define
risk of cancer of those sites known to be associated
with a neoplastic effect of asbestos
5. Unresolved questions Epidemiologic studies are also being
undertaken in a number of areas in which data are still in-
adequate for evaluation of health effects These include
a Industry efforts to control exposures In recent years there has been a sharp increase in the scope and intensity of industry approaches to control exposures Evidence is being sought concerning the effectiveness of these efforts
b End product use Still unresolved is the control of exposures
encountered in the use of asbestos products This is not true construction industry shipyards and power plants in such uses as brake repair and brake maintenance
only
but
c Demolition waste disposal maintenance and repair As with
end product use waste disposal demolition of asbestos
taining structures and the necessity for repair of facilities
containing asbestos materials are thorny probleme So far
little research has been devoted to the question of health
effects associated with such work
d Other factors which may influence risk It may be that risk also varies with other factors such as intensity of exposure peak exposures type of fiber individual susceptibility etc.
518 Table 5. Expected and observed deaths subsequent to first year after onset of employment among
870 amosite asbestos factory workers first employed 1941-45 and observed to December 31 1973 Distribution of duration of employment
3 months work or less
Expected Observ Ratio
3-11 months work
Expected Observ Ratio
1 year + work
Expected Observ Ratio
Total deaths all causes 99.75
112
Cancer - all sites
16.92
28
Lung cancer
4.13
16
Pleural mesothelioma
n.a.a
0
Peritoneal mesothelioma n.a.
1
Cancer stomach
1.46
1
Cancer colon rectum
2.38
4
Asbestoses All other causes
n.a.
1
82.83
82
1.12 1.65
3.87
---
0.68 1.68
--
1.00
94.34 16.29
4.00
n.a. n.a.
1,47
2.27
n.a.
78.05
170
46
16 2137 2137 2137 2137
2
122
1.80 2.82 4.00
~-
2.04 3.08
--
1.56
110.55
18.99
4.64
--
n.a.
1.73
;
2.67
n.a.
91.56
216 81
49
n.a.
4 5 5
23
112
1.95 4.27 10.56
---
2.89 1.87
-_
1.22
Number of workers
Person of observation
249 5747
294 6305
327 7061
This table excluded 63 men Ten died during first year of employment 34 could not be traced after the first year and 19 had prior occupational exposure to asbestos Of the 870 men 18 were partially traced and 16 had subsequent asbestos work These remained in the calculations until lost to observation or until onset of subsequent asbestos work Expected deaths are based upon white male specific death rate data of the U.S. National Office of Vital Statistics 1949-71 Rates were extrapolated for 1941-48 from rates for 1949-55 and for 1972-73 from rates
for 1967-71
a U.S. death rates not available but these are rare causes of death in general population
519
Table 6a Deaths of
an amosite asbestos
lung cancer among factory starting
933 workers employed in
5 years from onset of work
1941-1945 to December 31 1974. Effect of duration of exposure
Duration of
employment
1 month
1 month
2 months
3-5 months
6-11 months
1 2 3-4 5
year years years years
Total
No.
62 92 79 145 129 105 77 51 65
805
Death of Lung Cancer 1946-1974
Expected Observed
Ratio
1.34
3
1.44
5
1.30
8
2.24
8
1.63
9
1.53
12
1.06
13
0.87
9
1.04
16
12.45
83
2.24 3.47 6.15 3.57 5.52 7.84 12.26 10.34 15.36
6.67
Expected deaths are based upon white male specific death
rate data of the U.S. National Office of Vital Statistics
1949-1973 Rates were extrapolated for 1946-1948 from rates
for 1949-1955 an for 1974 from rates for 1969-1973
One hundred and twenty workers were omitted from these
calculations thirty had prior asbestos exposure thirty
eight died Forty
in the first years
were not completely
after onset
traced and
of employment eigth had other
asbestos employment after the 5 year from onset point
Table 6b Deaths of lung cancer among 933 workers employed in an amosite factory starting 5 years from onset of work 1941-1945
to December 31 1974. Effect of duration from onset of esposure
Years onset
from of exposure
Number alive
Deaths of lung cancer 1946-1974
start of period Expect Observ Ratio
5-9 10 - 14 15 - 19 20 - 24 25 A 29 30 - 32
Total
805 754 680 579 469 361
805
1.24
2
1.79
12
2.12
20
2.90
18
3.14
23
1.25
8
12.45
83
1.61 6.70 9.40 6.21 7.32 6.40
6.67
a
Expected deaths are
rate data of the U.S.
based upon white male specific death
National Office of Vital Statistics 1949-
1973. Rates were extrapolated for 1946-1948 from rates for 1949-
1955 and for 1974 from rates for 1969-1973
One hundred and twenty workers were omitted from these calculations thirty had prior asbestos exposure thirtyeight died in the first 5 years after onset of employment Fortynine were not completely traced and eight had other asbestos
employment after the 5 year from onset point
520
Conclusion
Asbestos disease and associated deaths that have recently been seen in the United States are largely related to the inadequately controlled use of asbestos 1930-1940 when some 150,000 300,000 tons per year were used in the United States At present
approximately 850.000 tons per annum are used Table 7 It is
sobering to consider that to the extent that this use was inadequately controlled we will see deaths of asbestosis and cancer
in the year 2000
Table U.S. consumption of asbestos
Tons
1930 1940 1950 1960
1973
120,000 262,000 727,000 710,000
862,000a
a
Chrysotile 839,200 tons
amosite
4,273
tons
crocidolite
17,966 tons and anthophyllite 1,162 tons Source U.S.
Bureau of Mines
References
1. DRESSEN W. C. et al A study of asbestosis in the asbestos
textile industry Washington D.C Pub Health Bull 241
August 1938
|
2. MANCUSO T. F. COULTER E. .: Methodology in industrial
health studies The cohort approach with special reference
to an asbestos company Arch Envir Health 6 210-226 1963
3. SELIKOFF I. J. CHURG J. HAMMOND E. .: Asbestos exposure
and neoplaJ.sAima er Med Assoc 188 22-26 1964
4. SELIKOFF I. J. HAMMOND E.C. CHURG .: Asbestos exposure smoking and neoplasia J. Amer Med Assoc 204 2 106-112
1968
\
5. HAMMOND E. C. SELIKOFF I. .: Relation of cigarette smoking
to risk of death of associated disease among insu-
lation workers in the United States In Biological Effects
of Asbestos Publ No. 8.
Ed P. Bogoyski et France 1973
al pp
209-216
IARC Sc
6. WAGNER J. C. BERRY G. SKIDMORE J. W. TIMBRELL .:
The effects of the inhalation of asbestos in rats Brit J.
Cancer 29 252-269 1974