Document MGwzwBXXkVaDR0ovxy533QNzx

K plaintiff's exhibit DOW-1843 jjjjsnas and non swots to assess* Aprtl 2. 1578 office JSSi ;oou ^ethesoa, >'aT7iai ST0I99921 QUESTIONS AND ANSWERS ABOUT EXPOSURE TO ASBESTOS S 7 6 6 6 1O iS - 1. Who may be at risk of developing asbestos-related diseases?------------page' 1 2. What diseases may be caused by asbestos?------------------------------------ 7--page 2 3. What is the role or cigarette smoking?------------------------ --------------------page 2 4. Are there other work-related exposures that may aggravate risk of disease in workers previously exposed to asbestos?-------------- --------- page 2 5. How does asbestos cause disease?---------------------------- --------------- page 3 6. How much asbestos exposure is hazardous?------------------------------------------page 3 f. What is asbestos?-- ---------- ------ ----------- ------------ -------------------------- page 3 3. How much is used?------------------------ *----------------------------------------------------- page 3 9. How is it used?--------------------------- -page 3 10. How has asbestos been used in shipyards?------------------------------------------- page 4 11. What are the signs and symptoms of asbestosis?------------------ page 4 12. Dose asbestosis lead to lung cancer?-----------------------------page 3 13. What are the symptoms of lung cancer?--------------------------------------------- page 3 14. How is lung cancer diagnosed?------------------------------------- ---------- ---------- page 5 15. What is mesothelioma?----------------- ----------------------------------------- --page 5 16. How is mesothelioma detected and diagnosed?--------------------------------------page 6 17. If a worker currently is exposed to asbestos, what can he do to protect himself?----- ------------ -------------------------------------------------------- page 6 13. What else can a worker who was exposed occupationally to asbestos do to protect his health*?------------------------------------- page 7 19. What can be done to treat diseases that may be associated with asbestos?------------------------------------------------------------------------------------page 7 20. What Federal agencies are concerned with the effects of asbestos exposure?------- ---------------------- --------------- -................................... page 3 21. In addition to research on developing better detection methods and treatments, what steps are Federal agencies taking about the asbestos creoles in shipyard Markers?------------------ ---------------- page 3 Z2. Where can a worker go for more information about cancer and other asbestos-related diseases?----------------------------- page 9 STO199929 u National Cancer Institute Office of Cancer Communications Bethesda, Maryland 20014 QUESTIONS AND ANSWERS ABOUT EXPOSURE TO .ASBESTOS 1. Who may be at risk of developing asbestos-related diseases? Workers in many occupations, particularly in asbestos mining and processing, shipyards, construction, and workers in automotive brake lining repair commonly are exposed to asbestos, and may inhale or perhaps swallow dusts contaminated with concentrations of this substance. Risks of disease due to asbestos exposures have not been defined clearly for all occupational groups known to have significant exposure. Firm scientific data are available only for heavily exposed insulation workers. Over the past several years, evidence has accumulated that asbestos insulation workers previously employed in shipyards 3rd elsewhere are experiencing asbestos is, a progressive and disabling lung disease, bid markedly increased rates of cancer. Workers who manufactured the asbestos insulation materials used in shipyards also have increased asbestos-related * disease. There is evidence that the problem may be more widespread than previously believed. Workers from a variety of trades who have been employed in shipyards, presumably in or near areas contaminated by asbestos dust, are new beginning to show signs of X-rav abnormalities in the lungs typical of asbestos exposure. These induce painters, electricians, carpenters, machinists, boilermakers, and welders who may not realized they were exposed. Large nunbeTS of persons worked around asbestos in shipyards during and since World War II. During the peak war years, 1940-44, an estimated 4.5 million .persons worked in shipyards in the United States, and even those not directly exposed to asbestos dust may have a higher risk of asbestos-related disease. In the last IS years, the number of shipyard workers has stabilized to an annual workforce of approximately 200,000. Because of the high turnover in jobs during the wax and afterward, no one really knows hew many many people experienced significant asbestos exposure in their work in the shipyards. . i The total number of workers exposed to asbestos since the beginning of World War II, including shipyard workers is estimated between 3 and 11 million. ST0I 99930 Asbestos - 2 2. What diseases may be caused by asbestos? Asbestos can cause asbestosis and certain fonts of -cancer. .Among sere groups of workers vhc wore heavily exposed to asbestos, as susi 20*25 percent of all deaths are due to lung cancer. This rate is much higher than would be expected from the effects of cigarette sacking alone. In the general adult population, about -1*5 percent of all deaths are due to lung cancer. In addition, asbestos workers are at increased risk of mesothelioma, an otherwise uncannon type of cancer not associated with smoking and rarely observed in the general population. Above-average rates of cancers of the digestive system (esophagus, stomach, colon, rectum) have been found in groups of asbestos workers. Cancers of a number of other body sites also are thought to be associated with occupational exposure to asbestos, but these are less common. 5. What is the role of cigarette smoking? Asbestos and cigarette smoking together produce more lung cancer than either factor acting alone. For example, investigators at the Mt. Sinai School of Medicine in New York City, together with epidemi ologists at the American Cancer Society, have found that asbestos workers who smoke have a risk of lung cancer 3 times the risk of smokers in the general population. 'Cigarette smoking also increases the risk of other types of' cancer and disabling lung diseases (snphysema, bronchitis). * ST0I9993I Seme information suggests that quitting smoking can reduce this extremely high risk in asbestos workers. Although nonsmoking asbestos workers have more lung cancer than nonsmokers in general, this is still a comparatively low risk. They do not experience the extremely high risk of lung cancer of asbestos workers who smoke. However, they still are at increased risk of other asbestos - induced disease, including asbestosis, mesothelioma and gastrointestinal cancers. 4. Are there other work-related exposures that may aggravate risk of disease in workers previously exposed to asbestos? Whether exposures from operations such as welding, and substances such as volatile solvents interact with asbestos to increase risk of diseases such as cancer is not known at this time. However, workers should be aware of health hazards in the workplace and protect themselves from unnecessary exposure. .I Asbestos - 3 5. How does asbestos cause disease? The answer is not known. Asbestos fibers too fine to be seen by the human eye become airborne during various industrial processes and are inhaled and subsequently may be swallowed. Scientists ceiisve the most harmful fibers are so fine that an electron microscope is needed to see them. 3ecause of their sine and shape, asbestos fibers can penetrate body tissues. Because of their durability, they remain in the body far many years after entry. 6. How much asbestos exposure is hazardous? The answer is not Imown. In the case of asbestosis and lung cancer, the risk increases with increasing amount of exposure. Asbestosinduced disease is not likely to appear until IS to 35 or more years after first exposure. The time between first exposure and the appearance of disease appears related both to the amount and duration of exposure: more intense exposure sometimes results in asbestos-related disease within IS years. However, one study of workers in an asbestos plant showed that sane workers who were exposed only a month or two have developed asbestos-related diseases many years later. Typically, the first 10 to 15 years after initial exposure are free of signs or symptoms. Early X-ray changes may appear in lung tissue after 10 to IS years, but may not be accompanied by other significant symptoms. Some investigators have reported evidence cf impaired lung function ir. workers with less than 10* years of exposure to" asbestos. 7. What is asbestos? Asbestos is the common name foT a group of natural minerals that occur as masses of compact or relatively long, silky fibers. Six fibrous minerals, members of a family called silicates, are recognised as asbestos: chrysotile (white asbestos) and actinolita; amosite (brown asbestos), anthophyllite, crocicoiite (blue asbestos) and tremolite. Camercially, chrysotile is the most important form of asbestos, with most chrysotile used in the United States being imported from Canada. All forms have a tendency to break into a dust of tiny fibers that can float in the air and be inhaled or swallowed. 8. How much is used? .Asbestos has been used in small amounts for thousands of years. Modern industrial use in the United States dates frcr. about 1330, when mining of the Quebec chrysotile deposits began. Gradual increase; in production and use occurred during the next 50 years, followed by accelerated use more recently. From 19T0-"3. the amount cf asbestos fiber used in the United States averaged some 300,000 tens annuall*--, according to the U.S. Bureau cf Mines. .Amosite from South .Africa has been `used in the U.S. in smaller quantities in industries such as shipbuilding. ST01 99932 Asbestos - 4 9. How is it used? STO199933 Asbestos has about 3,000 different uses, with about two-thirds being used in the construction industry in building products, insulation, friction materials and textiles. Manufactured products have included reinforced asbestos cement sheets and pipes, patching and taping compounds, floor and ceiling tiles, as well as paints, coatings and sealants containing asbestos as reinforcing fillers, pipe linings and fillers for various liquids. Friction products include clutch facings and brake linings for automobiles, railroad cars, airplanes, and industrial machinery. A variety of other uses are known, including theatre curtains, fireproof "blankets," filtration materials, and until recently, artificial ashes in false fireplaces and dry-wall patching compounds. Once incorporated into manufactured itens, the hazard resulting from asbestos is less serious, as long as the substance is not disrupted in any way. However, the fibers are nearly indestructible. A potential health risk arises whenever asbestos fibers afe set free, resulting in asbestos dust. 10. Khas asbestos been used in shipyards? * Asbestos has been used extensively in shipyards to cover pipes and surfaces in new construction, repair and refitting. Major sources of exposure to asbestos in shipyards* have been in fabrication cf asbestc materials (such as pipe-coverings), their installation, and their removal during repair and refitting work. Asbestos has been included in insulation materials such as boards, mattresses, and cloth for engines, hulls, and decks; covering of ventilation and water pipes; coatings for cables and electric wires; wall boards and tiles;*and putties, caulks, paints, joint fillers, and cement products. It may also be present in construction materials such as gaskets, rings, tape, tubing, twine, webbing, washers and coated electric wires. Asbestos exposure in shipbuilding probably is now far less than it was in the past, due largely to improvements in engineering and industrial hygiene methods and the introduction of other insulation materials into construction. 11. What aTe the signs and symptoms of asbestosis? Asbestosis is a chronic lung disease whose signs and symptoms result from permanent changes in lung tissue due to asbestos exposure. The earliest and most prominent sign is shortness of breath or. exertion ST019993U Asbestos - 5 It rarely becomes apparent until at least a decade after first exposure. The disease process usually has to be rather advanced to produce shortness of breath, however. A dry, crackling sound (rales), coming from the lings during inhalation, is the most characteristic physical sign cf asbestosis. Clubbing of the fingers is sometimes found, usually late in the disease. A bluish discoloration of the skin and the lining of the mouth and of the tongue also may occur in the later stages of the disease. A physical exam with X-rays will show diffuse scarring cf the lungs as asbestosis develops, and lung function tests will show impairment of the maximum volume of air a worker can inhale. 12. Does asbestosis lead to lung cancer? Scientists do not believe asbestosis necessarily leads to lung cancer, but the presence cf this disease does indicate that a worker % received considerable asbestos exposure and has a greater risk of developing asbestos-associated cancers than an unexscsed person. Both types of disease can be caused by the same environmental agent, and the development of each may be independent of the other. 13. What are the s%jnptoms of lung cancer? A cough, or a change in cough habit, is found in most lung cancer patients. Chest pain is the second most common symptom. It is usually felt as a persistent ache unrelated to cough and is commonly experienced on the side on which the tumor is located. Blood-streaked sputin, coughed up from the lungs, is the initial symptom of a small percent* of lung cancers. 14. How is lung canceT diagnosed? Initial diagnosis is by chest X-ray examination. Confirmation is by means of medical procedures such as sputioa otology, or biopsy by means of fiberoptic bronchoscopy, mediastinoscopy or by thoracotomy.* 13. What is mesothelioma? Mesothelioma is an extremely rare cancer in the general peculation, but is cannon among asbestos workers. It affects the pleura, a membrane lining the chest cavity, or the peritoneum, a similar membrane lining the abdominal cavity. A large proportion of mesothelioma cases can be traced to prior asbestos exposure.* *More information is available i:n a brochure, "Progress against Cancer of the Lungavailable from the Office of Cancer Ccnrunicaticrs, Naticna! Cancer Institute, 3ethesda, Mar/ land 100*4. Living weth Lunc Cancer, a book in paperback fem far rat it: at nominal cost from Schmidt Prir.ting, Inc, ?.0. 3ox aOCe, Rochester, Minnesota 53901. .i Asbestos - 6 Only 120 cases of mesothelioma of the pleura and peritoneum were reported in the National Cancer Institute's Third National Cancer Survey of 1969-71, compared to ''.049 cases of lung cancer. 7r.e nine areas surveyed represented approximately 10 percent ci the United States population. There is seme indication from recent scientific reports that mesothelioma is becoming a more canton diagnosis. 16. How is mesothelioma detected and diagnosed? The most common first symptom may be shortness of breath or pain in the wall of the chest which is aggravated by deep breathing, or abdominal pain, which may vary from vague discomfort to severe spasms, sometimes located in the upper right region of the abdomen. Occasionally, this pain is accompanied by a need to urinate or defecate. Although chest X-ray is of seme help in diagnosing mesothelioma when it occurs in the lining of the lung, precise diagnosis of this unusual cancer is difficult and requires an exploratory operation of the chest i or abdomen, depending on the patient's'symptoms, to provide tissue for microscopic examination. 17. If a worker currently is exposed to asbestos, what can he do to protect himself? He can take steps to make sure his employer is aware of and following the asbestos exposure and related industrial exposures regulations of the Occupational Safety and Health Administration (CSKA). First, he can request a copy of the Standard on Worker exposure to Asbestos from the Office cf Infcmaticn. CSKA. Washington, 3.C. 10210 of from regional offices in 3oston, New York, Philadelphia, Atlanta, Chicago, Kansas City (Mo.), Dallas, Denver, San Francisco and Seattle. After studying the standard, a worker nay wish to discuss apparent shortcomings with his employer or union representative to try to get them corrected. He also may initiate a complaint of workplace hazards with OSHA for investigation. A booklet. Good Practices Manual for Insulation Installers, also is available and may oe oraered zrem toe Clearinghouse :cr Occupational Safety and Health Information, National Institute for Occupational Safety and Health, 4676 Columbia Parkway, Cincinnati, Chic 45226. This publication describes recommended procedures for working with asbestos. Recamended practices tor demolition operations have been published by the EPA. "Sprayed Asbestos-Containing Materials in Buildings: A Guidance Document" is available iron the Standards Development Branchy L\S. Environmental Protection Agency, Research Triangle Park, N.C. Z 1 ST01 99935 QP 6 6 I 0 IS :J Asbestos - 7 IS. What else can a worker who was exposed occupationally to asbestos do to protect his health? First, if still working around asbestos, he should take isnediate steps to avoid additional exposure. Second, if he hasn't smoked cigarettes he should never start. If he has, he should quit. This will reduce the risk of lung cancer, no matter how many years he has smoked. He should also be alert to other potential health hazards in the workplace. Third, he should get regular health check-ups. His doctor should be made aware of his occupational history (for example, that he once worked in a shipyard), and provide a physical examination, that includes a chest X-ray, a lung function test, a rectal examination, and a sputum analysis. (Sputum c/tology, the examination of cells in deep cough sputum samples, is a procedure still under study as a diagnostic method for lung cancer and is not widely available. However, it has shown seme usefulness in studies of asbestos workers as an aid in identifying exposure.) Lung cancer, mesothelioma, asbestosis and other serious complications of asbestos exposure are late results of asbestos-induced disease. Early X-ray changes often precede these serious consequences. Absence of* X-ray change is no guarantee of future safety. Some workers have had enough asbestos exposure to cause mesothelioma without showing earlier X-ray changes. However, in general, absence of X-ray change many years after initial exposure provides evidence of limited exposure. 19. What can be done to treat diseases that may be associated with asbestos? Asbestosis: Most deaths from asbestosis are due to superimposed respiratory infections such as pneumonia and bronchitis, rather than to direct effects of the disease itseii. These infections usually can be treated, but it is important to get medical attention early. Lung and Esophageal Cancer: Treatment of these cancers depends on the type anc amount or tissue affected. Lung cancer may be treated by surgery, drugs, radiation, or combinations ox these treatments. Esophageal cancer is treated most often with radiation, .is with most cancers, the treatment must be tailored to the individual patient. Cancer of the Colon and Rectum: Surgery is curative in many cases and early diagnosis increases the likelihood of cure. Methods are available to improve the frequency of early diagnosis. Mesothelioma of the Pleura or Peritoneum: Effective treatment is not yet availaoie. Researcn is underway in the United States, Great 3ritain, and France to improve the treatment. .I Asbestos - 3 Cancer of the Sccmach: Detection has been improved by development of the tlexioie gascrasccpe and gastric camera. Treatment is usially by surgery. N'ew treatment regimens using drugs are improving the outlook for patients with this cancer. Cancers cf the Kidney, Throat, and Nasal Passages: Physician awareness of toe possibility of occurrence improves "chances for early diagnosis. These'cancers often can be treated effectively by surgeTy and/or radiation therapy. 20. What Federal agencies are concerned with the effects of asbestos exposure? The National Cancer Institute (NCI) and National Institute of Environmental healtn Sciences lnLcHS) are connecting or sponsoring researca on the nealtn hacarcs of asbestos. The National' Institute for Occupational Safety and Health (NIOSH) also is responsible tor researci on tie cocumentatzon or canards, and operates'an information service to answer workers' questions about occupatiohai safety.* $10199931 The Occupational Safety and Health Administration (OSHA) regulates worker exposures. This Agency is part of the U.S. Department of Labor. The Environmental Protection Agency -.crA.) is charged wish monitoring level of asbestos in air and water. The rood and Drug .Administration (FDA), a part of the U.S. Department of Health, Education and Welfare, is concerned with asbestos contamination of foods, drugs, and cosmetics, such as might occur during the manufacturing process. The Consumer Product Safety Cccmission (CPSC) recently has banned the use cf asbestos as artificial ash for ceramic logs in. gas-burning fireplaces, consumer clothing made of asbestos, and the manufacture of dry-wall patching compounds containing asbestos. 21. In addition to research on developing better detection methods and treatments, what steps are Federal agencies taking about the asbestos problem in shipyard workers? j An Asbestos Subcommittee of the Armed Forces Epidemiology Soard has been established and currently is reviewing programs which might be recommended to the Secretary of Defense concerning asbestos-related disease among civilian employees of the Armed Forces, as well as veterans and men and women currently in service. At the request of this Subccranittse, additiorial information is being gathered to assess the health risks of shipyard workers in various U.S. locations. .Address is in question #17. i ST0199938 :1 Asbestos * 9 Investigators of the Environmental Sciences Laboratory, Mount Sinai School of Medicine ox the City University of New YoTk and the American Cancer Society, are collaborating in a number of studies of shipyard workers, funded partly by the National Institute of Environmental Health Sciences, Research Triangle ?ars. Norm Carolina. NLhHS also is sponsoring a study in rodents cn ingestion of asbestos minerals with partial support from the SPA. The National Cancer Institute (N'CI) has planned an analysis of respiratory cancer in several smpbuilding areas along the east coast of the United States. Currently,*NCI is completing an interview analysis of lung cancer cases and controls along the southeastern Atlantic seacoast where elevated lung cancer death rates were found in a nationwide study of geographic cancsT patterns. An educational program for physicians and the public is being developed by CHEW in cooperation with the voluntary health agencies, concerned unions, and the asbestos industry. 22. Where can a worker go for more information about cancer 3nd other asbestos-related diseases? Sixteen Cancer Information Service (CIS) offices provide toll-free telephone sources of information. These offices can help with a variety of questions about cancer, including causes, prevention, detection, diagnosis, treatment, rehabilitation assistance, medical facilities available in a particular region, home-cars assistance programs, financial assistance for cancer care, emotional counseling services, and patient referrals. These offices also can provide information about local smoking cessation clinics. CIS offices do not diagnose cancer or recommend treatment for individual cases. They do provide facts, understanding and rapid access to the latest information on cancer and local resources. The locations of the CIS offices aTe indicated on the attached brochure. Workers may wish .to contact their international unions, or the Industrial Union or Metal Trades Departments of the AFL-CIC, 315-16th StTeer, N.W., Washington, D.C. 20006 for specific source of medical help, information on asbestos control, and insurance matters. Individuals who once worked in the Navy shipyards may wish to contact the Department of Defense, Public Correspondence, Directorate for Management, Washington, D.C. 10301. Inquiries concerning environmental exposures such as those occurring during building demolition, or other air and water concerns mav be answered by the Public Information Center, TV.-213, U.S. Environmental Protection Agency, 401 M Street, 5.W., Washington, D.C. 20io0. Asbestos - 10 The Consumer Product Safety Comaission fCPSO operates a ''hot-line*' for answering questions about potential hacards of coiunercial products: (300) 633-2666 except Maryland residents, who should call (300) 492-2957. For information on current Federal regulations concerning the workplace, workers may contact the Occupational Safety end Health Administration, Office of Information, Washington, D.C. 20210. The Office of Cancer Connmications, National Cancer Institute, Bethesda, Maryland 20014, will answer questions about health risks associated with asbestos exposures. For specific information on how to quit smoking, a worker may contact the Office on Smoking and Health, Room 622E Humphrey Building, 200 Independence Avenue, 3.W., Washington, D.C. 20201. Civilian employees of the Navy may direct specific inquiries concerning compensation to the Department of Labor, Office of Workers' Compensation Programs, Employment Standards Administration, 200 Constitution Avenue, N.W., Room S3524, 'Washington, D.C. 20210. Employees of private contractors in the shipyards should contact their unions for advice, or the office of workers' compensation programs of the State government. Other sources of information on how to quit smoking, lung diseases, and cancer are provided by local offices of the American Lung Association and the American Cancer Society. These organizations have local offices throughout the United States that say be identified from the telephone book. I> ST0199939