Document LzYe4QgdxMKjnEpwBGadMgk5

FILE NAME Household Contact HC DATE 1989 DOC HC025 DOCUMENT DESCRIPTION Journal Article - Domestic Asbestos Exposure Lung Fibre Burden and Pleural Mesothelioma in a Housewife British Journal of Industrial Medicine 354 355 Domestic asbestos exposure lung fibre burden and pleural mesothelioma in a housewife M HUNCHAREK JV CAPOTORTO J MUSCAT From the Boston University School of Medicine Boston Massachusetts Staten Island Hospital Staten Island New York and Memorial Kettering Cancer Center New York USA Although the risk of mesothelioma associated with serous fluid Biopsy showed a malignant neoplasm occupational exposure to asbestos is well documen- consistent with malignant mesothelioma of the ted the risk posed by environmental and domestic biphasic subtype " exposure is uncertain Epidemiological analyses of In March 1983 a chest tube was placed and tetra- this problem is complicated by the lack of reliable cycline was instilled which satisfactorily controlled the estimates of the mesothelioma dose response effusion She received no chemotherapy or any specific relation.We report here on a diffuse pleural meso- treatment for the disease One month before death thelioma in the wife of a shipyard machinist with June 1983 her clinical state deteriorated with gradual quantitative evidence of substantial lung asbestos fibre weight loss decreased appetite and increasing weak- burden from domestic contact Although previous ness The patient died from her malignant meso- reports have documented an increased risk of asbestos thelioma in early July 1983 related diseases among household contacts of asbestos Necropsy showed a malignant mesothelioma affect- industry workers to our knowledge this is the first to ing the right chest with extension to the mediastinum provide data on actual lung fibre burden This report pericardium and left chest No evidence of metastatic suggests that such household contamination can result disease or other primary tumour was found in bystander exposure levels similar to those found The occupational history showed no direct in the industrial setting occupational exposure to asbestos An extensive interview with the patient's husband established that Case report he was employed for 34 years 1935-69 as a machinist in a shipyard where he dismantled boilers and other A 76 year old woman smoker born in 1906 was well until the spring of 1982 when she developed right sided chest pain In late November 1982 she was shipyard machinery throughout his employment He stated that his workclothes became covered with dust and that his wife regularly laundered these admitted to another hospital with rapid heart beat and complained of episodes of severe epigastric pain radiating to her chest Physical examinatioant this time showeda right sided pleural effusion Cope needle biopsy of the right parietal pleura showed atypical mesothelial proliferation and pleural fibrosis Pleural cytology was benign She was discharged in early December 1982. She had had a cholecystectomy in clothes at home Before beginning employment as a machinist he had worked as a merchant marine 1931 - a2rigger's helper on bridge construction 1932-4 and on bridge , construction assembling cranes for a construction company No exposure to asbestos was known to : occur during this period 1931-4 He retired from his job as a shipyard machinist in 1969 and no other 1979 and a history of diverticulosis and congestive heart failure occupational history was given This patient married her husband in 1931 at the age In January 1983 she was admitted to hospital of 25 after which she never worked outside the home * complaining of pleuritic chest pain and shortness of breath Chest x ray examination showed pronounced accumulation of the pleural effusion The patient subsequently underwent needle biopsy of the right parietal pleura followed by removal of 1000 cc of Accepted 23 May 1988 Her occupational history before 1931 was not given Her only documented exposure to asbestos was by secondary exposure through laundering her husband's asbestos contaminated workclothes At necropsy the patient's left lung was removed for asbestos fibre analysis by an expert pathologist The report of this analysis was reviewed and the results are summarised : in the table 354 Fee ae} ym wan omestic asbestos exposure lung fibre burden and pleural mesothelioma in a housewife 355 ng asbestosfibre content re type Noof fibres wet lung tissue ysotile 172 10 osite and crocidolite 59 ^ 10 molite actinolite nd anthophyllite anthophyllite 10 No of fibresig dry lung tissue 2.5 10 0.8 ^ 10 2 10 scussion nce the initial report of family contact asbestos sociated mesothelioma by Newhouse and Thompn in 1965 additional evidence has accumulated licating that indirect exposure to asbestos in the me may be a serious health hazard In most stances asbestos fibres are carried home on worker's thing and liberated on removal and during preparan for laundering interestingly only one study has attempted to antify the actual exposure to asbestos fibres in the mes of asbestos workers Nicholson et al found that exposure in the home can be substantial as reflected by the lung fibre burden outlined in the table Such exposures should therefore not be assumed to be light exposures This case report therefore provides evidence that family members exposed to asbestos fibres brought industry home on the workclothes of asbestos industry workers may accumulate lung fibre burdens similar to those seen in the occupationally exposed individuals and this contamination may constitute a significarinstk of mesothelioma This case was obtained from the files of the Canadian Tumor Reference Center with which MH was previously affiliated We thank the Reference Center for help with this report Requests for reprints to Michael Huncharek MPH Box 487 Boston University School of Medicine 80 East Concord Street Boston Mass 02118 rysotile asbestos concentrations in the air of the mes of 13 asbestos mine and mill employees ranged m 50 to over 2000 mSamples from three ghing homes of miners ranged from 32 to AB Unfortunately few quantitative data are ilable regarding actual respired dose of asbestos res by household contacts in such settings As seen in the table the lung asbestos fibre content this woman was similar to that seen in cases of sothelioma associated with occupational exposure asbestos Since lung fibre concentrations exceeding villion fibres per gram of dried tissue are associated h an increased risk of malignant mesothelioma it bears that such household contact as described ove may represent a considerable risk of meso- lioma . Currently the nature of the dose response relation asbestos related mesothelioma is uncertain Part of 3 uncertainty arises from the lack of accurate posure data and information on fibre type The data vided here indicate that secondary asbestos References 1 Selikoff IJ Lee DH Asbestos and disease New York Academic . Press 1978 2 Huncharek M. The epidemiology of pleural mesothelioma current concepts and controversies Cuncer Invest in press 3 Peto J Seidman H Selikoff IJ Mesothelioma mortality in asbestos workers implication for models of carcinogenesis and risk assessment Br J Cancer 124 35 4 Newhouse ML Thompson H. Mesothelioma of pleura and peritoneum following exposure to asbestos in the London area Br J Ind Med 261 9 5 Li FP Lokich J Lapey J Neptune WB Wilkins E. Familial mesothelioma after intense asbestos exposure at home JAMA 1978 6 Vianna NJ Polan AK occupational exposure to asbestos and malignant mesothelioma in females Lancet 521 2 7 Anderson HA Lilis R Daum SM Fishbein AS Selikoff IJ Household contact asbestos neoplastic risk Ann NY Acad Sci 311 23 8 Nicholson WJ Rohl AN Weismann I Selikoff IJ Environmental asbestos concentrations in the United States ARC Sci Publ 823 7 9 Mowe G Glyseth B Hartveit F Skaug V. Fiber concentration in lung tissue of patients with malignant mesothelioma a case control study Cancer 1985 1089 93