Document MJbG5NR5rwNekdKwR05B0agKz

22616 Federal Register / Vol. 51; No. 119 / Friday. June 20, 1986 / Rules and Regulations oncology. Only 9 percent of lung cancer asbestos exposure and may develop patients survive for 5 or more years after within 10-20 years after the initial diagnosis (American Cancer Society, Ex. exposure. Plaques are opaque patches 64rl8Q). Asbestos exposure acts visible on chest X rays that consist of synergistically with cigarette smoking to dense strands of collagen fconnective multiply the risk or developing lung tissue protein) lined by mesothelial cancer. cells. All commercially used types of Many studies have also shown - asbestos induce plaques. Plaques can conclusively that mesothelioma is occur without Fibrosis and do not seem associated with asbestos exposure. In to reflect the severity of pulmonary some asbestos-exposed occupational parenchymal disease. Pleural groups, 10-18.percent of deaths have calcification is also commonly found in been attributable to malignant mesotheliomas. Malignant persons who have been exposed to asbestos (Craighead et al.. Ex. 84-033). mesotheliomas of the pleura and The adverse effects of exposure to peritoneum are extremely rare in asbestos have been observed in workers persons not.exposed to asbestos. involved in the manufacture of asbestos Generally, a latency period of at least cement pipes and shingles (Enlerline et 25-30 years is required before al., Exs. 84-044, 84-122; Weill et al., Ex. mesotheliomas are observed in an 84-123, Finkelstein, Exs. 84-208, 84-240), occupational cohort, although some asbestos mining and milling (Wagner et victims of mesothelioma have had al., Ex. 2-21; Liddell et al., Ex. 84-059; latency periods exceeding 40 years McDonald et al., Ex. 84-085; Hobbs et (Craighead el al'., Ex. 84-033). This form al., Ex. 84-072; Nicholson et al. Ex. 84- of cancer is rarely curable and is usually 086; Rubino et al,, Ex. 84-086), asbestos fatal within a year after diagnosis. textile manufacturing (Doll, Ex. 84-040; Some epidemiologic studies of Peto et al., Ex. 84-189; Berry et al.. Ex. asbestos-exposed persons have shown 84-020; Dement et al.. Ex. 84-037), increases in esophageal, stomach, colo insulation work (Selikoff et al., Ex. 84- rectal, kidney, laryngeal, pharyngeal, 109). shipbuilding (Selikoff et al., Ex. 84- and buccal cavity cancers. Although the 091: Blot et al.. ex. 84-109; Tagnon et al., increased risk of incurring cancers at Ex. 84-182), talc mining and milling these sites is not as great as the (Brown et al., Ex. 84-29) and in a variety increased risk of lung cancer and of asbestos products manufacturing mesothelioma, the increase is of . industries (Jones et al., Ex. 84-138; considerable importance because.of the Henderson and Enterline, Ex. 84-048; high background rates, and therefore the McDonald and McDonald; Ex. 84-154; large number of victims, associated with Seidman et al.. Exs. 84-087; 261-A; some of these tumors in the general Robinson et al.. Ex. 84-082; Acheson et population. For example, a 50 percent al.. Ex. 84-103): increase in a common cancer such as The conclusions just expressed are colo-rccta! cancer results in many.more widely accepted both in the U.S. and deaths than a 50 percent increase in a abroad. The following agencies and rare cancer. organizations have reviewed the health Asbestosis is pulmonary fibrosis - data for asbestos: International Agency caused by the accumulation of asbestos . for Research on Cancer (IARC) (Ex. 84- fibers in the lungs. The adverse effects 321), Organization for Economic of asbestosis range from shortness of Cooperation and Development (OECD) . breath during exertion to cyanosis, (Ex. 84-337), NIOSH (Exs. 84-338 and effusions of serous fluid, respiratory 84-320), Advisory Committee of the failure, cardiac decompensotion. ond' Health and Safety Commission of the death. Asbestosis is often a progressive United kingdom (Ex. 84-216), the. disease, even Inthe absence of Chronic Hazard Advisory Panel on continued exposure. The symptoms of Asbestos (CHAP) (Ex. 84t258), and the the disease are shorlness.of breath, , U.S, Environmental Protection Agency cough, fa tigue, and vague feelings of (Ex. 84-180). All of these groups have, sickness: When the fibrosis worsens, concluded that there is a causal shortness of breath occurs even at rest. relationship between asbestos exposure One clinical feature of early asbestosis and the development of cancer and non- as well as other lung diseases is end- malignant respiratory disease. NIOSH inspiratory crackles (rales). Diagnosis of recommended reducing the permissible asbestosis is based on the presence of exposure limit (PEL) for asbestos to 0.1 characteristic'radiologic changes, fiber per cubic centimeter (0.1 f/cc) in symptoms, rales, other clinical features of Fibrosing lung disease, and a history 1976. In 1980, a joint NIOSH-OSHA Asbestos Work Group stated that there of exposure to asbestos. Asbestos exposure can cause pleurul ' and/or other pulmonary disease. Pleural plaques are one of the markers of was no level of exposure to asbestos . below which clinical effects did not occur and recommended a PEL of 0.1 fiber per cubic centimeter (0.1f/cc), based on the limitations of current technologies for measuring airborne concentrations of asbestos. The 1979 report of the Advisory Committee of the Health and Safety Commission of the United Kingdom (hereafter referred to as the U.K: Committee] led to the reduction of the British standard for asbestos to 1 f/cc for chrysotile, 0.5 f/cc for amcslte. and 0.2 f/cc for crocidolite. The following sections describe the record evidence that demonstrates the causal relationship between asbestos exposure and increased riskB of incurring lung cancer, mesothelioma, gastrointestinal cancer, and nonmalignant respiratory diseases such as asbestosis. In addition, evidence is presented pertaining to the relationship between exposure to various types and sizes of asbestos Fiber and the risks of asbestos-related disease; evidence concerning the synergistic effect of smoking and asbestos exposure on the risks of developing lung cancer is also presented. Most of the health effects evidence was previously presented in OSHA's November proposal (48 FR 51099-51122). The current publication summarizes the evidence contained in that Federal Register notice and presents in detail new evidence obtained during and after the public hearing. B. Epidemiologic Evidence of Risk of Lung Cancer and Mesothelioma Mortality 1. Epidemiologic Studies The epidemiologic studies of greatest interest are those that show a correlation between the intensity and duration of asbestos exposure and an observed excess in lung cancer and mesothelioma. In the November proposal, OSHA reviewed several studies that provided information on exposure level and incidence of lung cancer (Exs. 84-^21:84-38; 84-37; 84-48; 84-87; 84-90; 84-208: 84-240) and mesothelioma (Exs. 84-30; 84-87; 84-90; 84-208: 84-240); These studies; which provide the basis for OSHA's . Quantitative Risk Assessment are briefly reviewed here, along with a number of more recent investigations (Exs. 182-C; 163-E; 168-A; 188^B; 261-A) that were submitted to the record after publication of the November proposal. Seidman et al. (Ex. 84-087) studied cause specific mortality among 820 amosite insulation manufacturing workers employed sometime during 1941-1945 at the Patterson insulation facility, which was known to have a deficientventilation system. Estimates of asbestos exposure at this facility GLEASON-000864