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FILE NAME Talc TALC DATE 2019 Feb DOC TALC189 DOCUMENT DESCRIPTION Journal Article - Asbestos in Commercial Indian Talc Received 8 August 2018 | Revised 14 February 2019 DOI ajim.22969 Accepted 17 February 2019 BRIEF REPORT { Check for updates Asbestos in commercial indian talc Sean Fitzgerald BS PG,, | Elizabeth Harty MPH2 | Tushar Kant Joshi MBBS MS MSc | Arthur L. Frank MD PhD40 ,,ScientificAnalytical Institute Greensboro North Carolina 2HHC Environmental Lebanon Ohio Ministryof Environment Forests and Climate Change Government of India New Delhi India Drexel University Dornsife School of Public Health Philadelphia Pennsylvania Correspondence Arthur L. Frank MD PhD Drexel University Dornsife School of Public Health 3215 Market Street 7th Floor Philadelphia PA 19104 Email Alf13@drexel.edu Abstract Background Easily available commercial Indian talc products widely used in Southeast Asia were examined for the presence of asbestos Asbestos in talc products carry all risks of asbestos disease Methods Using polarizing light microscopy transmission electron microscopy TEM electron diffraction and ray analysis multiple counter Indian talc products were examined for the presence of asbestos Results Results In an initial group of five Indian talc products one was found to contain tremolite asbestos The second group of eight products was tested and six of eight contained tremolite asbestos as well No other regulated amphibole was found Conclusion Large quantities of body talc products containing asbestos are used throughout Southeast Asia and are likely to pose a public health risk for asbestosrelated diseases especially for the cancers related to asbestos exposure The country of origin in which the talc examined was sourced for production is unknown to the authors and further investigation to measure associated public health risk is needed KEYWORDS asbestos cancer implications consumer products Indian talc tremolite 1 | INTRODUCTION As the international effort to eliminate asbestos diseases continues public health concerns surrounding the presence of asbestos in consumer talc products persists This is not a recent development Rohl Langer and Selikoff raised the awareness of asbestos in talc and personal talc products over 25 years ago Talc is composed of the elements magnesium silicon and oxygen and is classified as a hydrous silicate mineral The asbestos minerals serpentine and amphibole form under similar geologic conditions as talc and are also hydrous silicate minerals containing magnesium silicon and oxygen It is this close mineralogic relation- ship that is responsible for the common comineralization of talc and asbestos not to be confused with a contaminant that was added after the mine Talc has been commercially used in personal hygiene and cosmetic products to aid in keeping skin dry and prevent rashes as this mineral can be finely ground provide absorbent anticaking properties and a promotes soft cool feel Since the late 19th century the intimate relationship between talc and asbestos formations has been observed by the geological and industrial communities The International Agency for Research on Cancer IARC recognizes this relationship and holds the position that any talc supply or products that contain asbestos should be treated as asbestos accordingly a GroupI carcinogen In fact the IARC Working Group decided to expand the name of the Group I carcinogen from talc containing asbestiform fibers to talc containing asbestos or other asbestiform fibers which should be understood to mean any mineral including talc when it grows in the asbestiform habit It is therefore relevant to consider what the medical implications and public health consequences are for This is an open access article under the terms of the Creative Commons NonCommercial License which permits use and distribution in any medium provided the original work is properly cited the use is commercial and no modifications or adaptations are made '2019 The Authors American Journal of Industrial Medicine Published by Wiley Periodicals Inc. Am J Ind Med 2019 wileyonlinelibrary.com/journal/ajim | 1 WILEY- populations which are exposed to these substances in domestic settings in addition to traditional workplace settings The medical implications of using talc products containing asbestos include the malignant and nonmalignant diseases associated with any asbestos exposure as well as those related to talc.5 IARC has established a causal association between all forms of asbestos exposure and cancer of the larynx lung ovaries peritoneal mesothelioma and pleural mesothelioma.5 Nonmalignant diseases associated with asbestos include asbestosis asbestos warts and pleural effusion pleural plaques and diffuse pleural fibrosis Other reports of disease among those exposed to asbestos include renal oropharyngeal and gastrointestinal cancers Talc without asbestos can itself produce talcosis A review of the literature that examines asbestiform materials not regulated as asbestos finds that either deposits with only true asbestos are being reported on with no admixed minerals When there is evidence of asbestiform materials as part of the talc deposit there is usually also evidence of regulated asbestos fibers therefore it is difficult to state what role just nonasbestos asbestiform materials on their own may be playing in the health of those populations studied The World Health Organization WHO reports that 125 million people are occupationally exposed to asbestos worldwide and that approximately half of all occupational cancer deaths are believed to be caused by asbestos The WHO further states that global asbestos exposure in the home is associated with several thousand deaths annually.1 There are no population estimates of those exposed to asbestos contaminants in personal care products therefore substantial data to measure the past and future asbestos burden of disease are not available This lack of adequate data is significant when considering the traditional underreporting of diseases such as mesothelioma.19 While Western countries such as the United States have the capability to engage in the surveillance of diseases such as mesothelioma many developing nations throughout Southeast Asia exercise minimal to no mesothelioma surveillance In addition to the minimal surveillance of asbestos diseases in Southeast Asia the majority of these countries continue to permit the commercial use of asbestos despite its health effects which is counter to the trends in global asbestos production and consumption The combination of these circumstances amplifies the challenge for public health Many of these nations such as India and other Southeast Asian countries face the risk of dermal heat disorders due to the hot and tropical climate One such disorder is miliaria a widely recognized induced dermatitis that presents as a rash and has been documented since the time of Hippocrates.26 In modern vernacular the condition is commonly referred to as prickly heat The risk of miliaria is significant for anyone exposed to a hot and humid climate Those of lower socioeconomic status who usually have more exposure to these conditions are at elevated risk.25 In India alone the population exceeds 1.33 billion representing a significant portion of the global population exposed to the risk of heat stress.27 FITZGERALD ET AL To combat the risk of induced dermatitis major manufacturers market talcum powders cosmetic talc to the Indian and greater Southeast Asian populations These powders are advertised to cool against the effects of prickly heat and some claim to have bacteriostatic effects These powders come in a variety of scents that would appeal to a wide range of consumers In light of the recent evidence of the asbestos contamination or more accurately asbestos comineralization and subsequent personal injury litigation related to personal hygiene and cosmetic talc products sold in the West the objective of this study was to determine if similar product contamination is observed in cosmetic talc sold in the East as it is known that commercial talc deposits exist in 2,3,10,28-30 2 | METHODS 2.1 | Analytical procedures Polarized Light Microscopy PLM and Transmission Electron Microscopy TEM analyses were conducted following the analytical procedures described in the U.S. Environmental Protection Agency Test Method EPA Method for the Determination of Asbestos in Bulk Building Materials PLM analyses were conducted on a Leica DM750P petrographic microscope with polarized filters wave retardation and dispersion staining techniques at magnifications up to 400x TEM analyses were conducted on a JEOL 2000FX TEM equipped with dispersive ray analysis EDXA and selected electron diffraction SAED at magnifications up to 50,000 at an accelerating voltage of 100KeV Since it has been repeatedly found that countable asbestos structures can occur in talc below the resolution of PLM7,31 TEM analysis was conducted on all samples when definitive results were not obtained through PLM alone Further it has been shown that as little as 0.001 of asbestos in loose clay soil can produce around 0.1 fiber of asbestos in the air with a respirable dust concentration of around 5 m.32 Data from Libby Montana and other sites in the US provide evidence that debris containing significantly less than % asbestos can release unacceptable air concentrations of all types of asbestos fibers ie serpentine chrysotile and amphibole tremolite The TEM analytical area of final preparations was therefore expanded to increase analytical sensitivity i.e. the area of the final filter analyzed was increased to facilitate detection of lower asbestos fiber concentrations Quantification of countable asbestos structures per gram weight talc str was facilitated in TEM final analyses based on the asbestos counting criteria for structures containing fibers greater than 0.5 micrometers in length with at least a 5 aspect ratio as described in the Asbestos Hazard Emergency Response Act AHERA and ASTM methods D6281 D5755 D5756 and D6480 as well as in ISO 10312 and 13794. These counting criteria are consistent with the procedure for the analysis of talc for asbestos as published by Millette.34 Also consistent with Millette analytical sensitivity varied based on total filter particle loading and area analyzed FITZGERALD ET AL 2.2 | Preparations The samples were prepared for PLM analysis by initial examination under a stereomicroscope at magnifications between 4 to 20 Grain mounts were representative of the homogeneous powder constructed using appropriate refractive index liquid for the determination of optical characteristics consistent with the asbestos minerals For electron microscopy analysis a portion of the sample was weighed and suspended in an alcohol deionized water mix Measured aliquots of the sample suspension were then filtered through a 0.2 um mixed cellulose ester filter MCE The final MCE filter was dried collapsed with acetone and coated with carbon in a vacuum evaporator The fibers and solids collected on the carboncoated filter replicate were transferred onto copper grids for TEM analysis 2.3 | Detection limits All TEM scans in this analysis were at a minimum of 200 grid openings for samples where no fibers are identified If there are abundant fibers that number can decline significantly when a smaller number of grid openings demonstrate sufficient concentration calculation The analytical sensitivity is therefore variable based on the overall loading of the filter the number of grid openings analyzed aliquot of the suspension size of the individual grid openings and weight of the original talc suspended Of course the actual size of fiber can vary greatly so concentrations calculated as asbestos structures per gram are not directly comparable to a weight percent or parts per million value Detection limits in this study therefore varied from sample to sample depending on the optimum suspension dilution required to achieve appropriate loading as well as relative ease or difficulty in finding the asbestos fibers on the final filtrations Generally the lowest detection limits calculated were for those samples where no fibers were detected in the 1 ^ 10 structures per gram range which would equate to 0.0001 by weight assuming average fibers of 5 ...mx 0.25 ...mand the specific gravity of those fibers based on the mineral tremolite the most common asbestos type determined in this study Each sample was prepared by suspending 20 to 80 mg of the talc product in 400 mL of alcohol mix followed by filtering 1 to mL of that suspension onto a mm filter which was then prepared for direct examination under TEM on copper grids The analysis is an initial scan of the preparations a minimum of two grids each containing 100 grid openings of variable size usually approximately mmare scanned at 1200 and individual fibrous structures evaluated at 25,000x chemistry by EDS crystal structure by diffraction and fiber morphology eg length and width 2.4 | Initial sample set In February 2015 five samples of commonly available over counter brands of cosmetic talcum powders were purchased in India WE -WILEY some products were manufactured by national corporations that originated in the United States The mining source and location of talc used in these products are unknown These purchases were made on the open market available to all Indian customers The products were marketed for personal application as beat the heat fragranced talcum powders to be applied to the skin of the consumer All samples were shipped to a testing laboratory for the purpose of evaluation The product samples were labeled as 1 1A Talc2 1B Talc 1C Talc 1D Talc and E Talc Testing of these talc products was conducted to assess the presence of asbestos and whether the asbestos present in these samples was aerosolizeable and quantifiable When testing is conducted for asbestos and talc in the lab setting the presence of fibrous talc and possible transitional structures are noted when observed The samples were tested to include examination by SAED and EDXA a.k.a. EDS or EDX 2.5 | Repeat testing of initial sample set To confirm the first test results these original five samples underwent a repeat analysis using the same test methods The presence of asbestos specifically asbestiform tremolite was confirmed in one of the products ID Talc As the presence of asbestos in this commonly available talc product was found to be substantial and repeatable it was decided that further testing of other available personal hygiene talcs from India was warranted The testing lab made online purchases of four additional varieties of talc products sold by the same manufacturer as the above product as well as four varieties of another talcum brand 1A Talc through an Indian retail outlet 2.6 | Second sample set This second set of samples were labeled as ID.1 Talc ID.2 Talc 1D.3 Talc 4 1D.4 Talc Talc 1A.2 1A.3 Talc and 1A.4 Talc The samples were tested in the same manner as the initial sample set for the presence of asbestos in those products using the same analytical methods 3 | RESULTS 3.1 | Initial sample set product analyses light microscopy In the initial sample set analysis of preparations revealed abundant mineral particulate including platy and fibrous talc in all products tested see Table 1 PLM analysis was able to determine that the products contained fibers with optical properties consistent with talc and some possible asbestiform amphiboles Overall the talc product was found to be fibrous by light microscopy Preparations of the sample were therefore made for the determination of potential asbestos content by TEM | WILEY- TABLE 1 Initial sample set analytical summary Product initial First qualitative assessment of | tremolite asbestos sample set Presence Yes or No IA Talc No Second qualitative assessment of tremolite asbestos Presence Yes or No No IB Talc No No IC Talc No No ID Talc Yes Yes IE Talc No No 3.2 | Initial sample set Asbestos analysis Subsequent analysis of the initial set by TEM analysis confirmed the PLM findings of abundant mineral fibers including fibrous talc in all of the initial Indian talc products tested Fibrous talc is noted when the mineral appears as fibrous or bundles both by light microscopy such as PLM and electron microscopy such as TEM The presence of asbestos specifically asbestiform tremolite was confirmed only in the 1D Talc product see Figure 1 the asbestiform structures were of a countable concentration above baseline background.34 This is classified as substantial asbestos that is asbestos fibrous structures were found meeting the counting criteria of all airborne asbestos containing methods FITZGERALD ET AL TABLE 2 Second sample set analytical summary Product second sample set IA.1 Talc IA.2 Talc PLM findings of abundant mineral fibers including fibrous talc Yes Yes TEM quantitative identification of tremolite asbestos Yes Yes IA.3 Talc Yes Yes IA.4 Talc Yes Yes ID.1 Talc Yes No ID.2 Talc Yes No ID.3 Talc Yes No ID.4 Talc Yes Yes 3.3 | Second sample set PLM and TEM analyses for fibrous talc and asbestos PLM findings of abundant mineral fibers including fibrous talc was evident in all of the second sample set of products TEM analysis was able to qualitatively identify tremolite asbestos present in ID.4 Talc and the A.1 Talc YA.2 Talc A.3 Talc 1A.4 Talc products see Table 2 and Figures 2-5 Asbestiform tremolite fiber str were also quantified for these same talc products Concentrations of tremolite asbestos in the products were calculated for structures less than 5 mand greater than 5 ...mthe sum of the structure totals less than ...mand greater than ...mare reported as all structures see Table 3 Among these Talc had the lowest total tremolite asbestos at a sum of 4.55 million str with higher levels A.1 Talc 10.5 million structures per gram 1A.2 14.4 million str YA.4 Talc 20.4 million str and D.4 Talc which contained a sum of 59.9 million str of tremolite asbestos TEM Magnification 4,000x 4,000x FIGURE 1 Tremolite asbestos fiber in ID Talc found in the first testing of this product TEM magnification 4000x Total fiber dimensions 61.5 ...mlong by 0.5 ...mwide equates aspect ratio 120 This figure shows the part of the fiber extending into the grid opening The majority of the structure length extends underneath the copper grid bar to the right of the structure extending into the adjacent grid opening As can be seen from the micron marker less than third of the entire length was captured in this image This image demonstrates well the amphibole details alongside sheets of talc TEM transmission electron microscopy Color figure can be viewed at wileyonlinelibrary.com 3.4 | Asbestiform talc structures detected in samples Abundant fibrous structures of the mineral talc were identified in the cosmetic talcum powders tested Two basic morphologies were common of the fibrous talc more parallel fibers or bundle of sticks talc structures were observed in addition to more lath ribbons of talc often exhibiting kinks beds or folds Although many of these structures would be countable as asbestos if they were the minerals regulated as such the use of the term asbestiform when describing talc is controversial As talc is a replacement mineral that does not crystallize from molten rock it is often pseudomorphic after the protolith that is forms the shape of the mother rock from which it was derived Although it is common to observe the mineral anthophyllite in association with talc that mineral was not observed in any of the samples in this study Fibrous talc was observed in all of the samples analyzed for this study occasionally in abundance but talc fibers or fiber structures were not quantified as there are no published methods or counting criteria for talc fibers or complex structures FITZGERALD ET AL 10/6/2015 HT 100KY TEM Magnification 3,00x 3,000x FIGURE 2 _ Tremolite asbestos fiber bundle in ID.4 Talc found in the second batch of testing this product.TEM magnification 3000x Bundle dimensions are 13.1 ...mlong by 0.74 ...mwide Bundle thickness comprises numerous individual fibers within the structure therefore length to width aspect ratios should be based on constituents rather than whole bundle widths As this structure comprises over a dozen individual fibers it is inappropriate to calculate aspect ratio as 0.74 = 17.7 as known individual fibers greatly exceed that aspect TEM transmission electron microscopy Color figure can be viewed at wileyonlinelibrary.com KV Exposure Magnificabon Magnificabon Time 9/2/2015 FIGURE 4 _ Selected electron diffraction SAED of tremolite structure found in the Indian talc product ID.4 Talc All asbestos structures used in the calculation of concentrations in this report were confirmed by morphology chemistry by dispersive ray analysis EDXA and crystalline structure as demonstrated here by diffraction SAED Notice the 5.3 repeat of streaking lines consistent with the amphibole structure and the arcing brighter bands demonstrating a nearby crystal zone axis Analysis and quantifications were therefore limited to the six minerals regulated as asbestos with established counting criteria WF el 10/15/2015 HT 100KV TEM Magnification 5000x 5000x FIGURE 3 Tremolite asbestos fiber bundle in IA.I2A.2 Talc found in the first testing of this product TEM magnification 5000x Constituent fibers 10 ...min length less than 0.1 ...min width demonstrate aspect ratios up to and exceeding 100 Note both platy and fibrous talc also observed.As a bundle is defined as three or more fibers or 2 by the International Organization for Standardization ISO parallel and not separated by more than the width of a fiber a bundle contains constituent fibers by definition The micron marker was placed on the image when at the scope This provided the ability to resolve the other end through the crystal from which it protrudes conservative analysis indicates aspect ratios exceeding 100 Color figure can be viewed at wileyonlinelibrary.com 4 | DISCUSSION This product study of various talcum powders marketed to combat prickly heat purchased from Indian retailers both counter and online demonstrates the ease of general population access to such products and the potential for significant exposure to asbestos The analytical results of this study confirm that asbestos exposure of the Indian and potentially greater Southeast Asian populations is not limited to traditional occupational settings Products sampled in this study are sold in containers with 150 grams of product or more For those products that tested positive for tremolite asbestos the total product contamination for their containers ranges between a low of 600 million asbestos structures to high of 8 billion asbestos structures These findings imply that the asbestos medical and public health implications to consider will need to extend to persons of both genders and all ages among this population group This study's confirmation of an underappreciated source of asbestos exposure through personal care products also highlights the risk that anyone within breathing range of these aerosolizeable contaminated talcum products incurs With products of this nature being readily available and appealing to both genders it is necessary to consider what the potential health risks and burdens of disease are for millions of exposed women of childbearing age and the children for whom they provide care IARC has confirmed the causal association of asbestos with ovarian cancer and other cancers.5 Shifts in perspective in epidemiologic surveillance are needed to jpe wnat FITZGERALD ET AL 1995 ~~ rs 7 ee +e _ ee TAY pee se exellent ou * Ms ra 9.99 teueey ee tee 7771777717 77717 7 717 77717 77717 77717 77717 77717 77717 77717 77717 77717 77717 77717 77717 7771777717 77717 77717 77717 77717 77717 77717 77717 77717 77717 77717 ] ] ] ] ] ] ] 17771 17771 17771 17771 17771 17771 17771 17771 17771 17771 17771 17771 17771 17771 17771 17771 17771 17771 17771 17771 1771777711 17771 17 7117771 17771 17771 y rey 145 FIGURE 5 __ dispersive ray spectrum EDX showing chemistry of amphibole structure pictured in Figure 3 tremolite bundle in IA.2 Talc Relative ratios of magnesium Mg silica Si calcium Ca and iron Fe are consistent with the recognized chemical formula for the mineral tremolite Mg5.0-0.5Fe0.0-0.5 Other peaks observed include oxygen O observable from the element detector used and copper Cu resulting from the copper grid sample substrate Color figure can be viewed at wileyonlinelibrary.com consider how to better collect analyze and disseminate data that apply to these consumer product exposures It may also help us better understand a previously underappreciated source of exposure for those with asbestos cancers when no history of exposure can be elicited from those individuals A necessary measure to promote public health is to mandate quality control standards that guarantee all talc intentionally added as an ingredient to consumer products is tested before production and repeated testing is applied during production Analyses conducted by the most rigorous and sensitive methods possible are required to assure the absence ie nondetectability of asbestos in products Further records of where the talc was mined and the specific records of testing must be maintained users and manufacturers of those talc or talcum powder products should be held accountable for this information and make it available to consumers India's Consumer Protection Bill 2018 proposed legislation that would provide a measure of increased consumer protection although it remains under pending status in parliament.40,41 If this or a similar bill eventually passes India will be taking needed steps toward a establishing a central consumer protection authority b subjecting manufacturers to imprisonment if they are found guilty of false or misleading advertising c subjecting manufacturers to imprisonment if they are found guilty of the sale storage distribution or importing of products that contain adulterants and d introducing product liability action and class action concepts as avenues for consumer compensation.4 While the passage of this bill is a start toward protecting public health in general until asbestos is also viewed as a hazard in India and banned there will still be considerable risk to health.S.21 The presence of amphibole asbestos tremolite among the products analyzed in this study confirms that asbestos exposure in India and potentially beyond is not limited to occupational origins This heightened awareness of tremolite exposure in consumer products in India should also raise public health concern for the country that utilizes roughly 350,000 tons of chrysotile asbestos in approximately TABLE 3 Tremolite asbestos structures count per gram str product Product IA.1 Talc IA.2 Talc IA.3 Talc IA.4 Talc ID.4 Talc Structures 5 ...m 6,280,000 str 7,210,000 str 3,030,000 str 15,300,000 str 20,000,000 str Structures 5...m 4,190,000 str 7,210,000 str 1,520,000 str 5,090,000 str 39,900,000 str All Structures 10.5 million str 14.4 million str 4.55 million str 20.4 million str 59.9 million str FITZGERALD ET AL 100 manufacturing producing products such as cement piping cement roofing friction materials textiles and insulationwith little regulatory oversight.42oversight.42 These 100 manufacturing plants employ nearly 300,000 employees.4 The products these asbestos using manufacturing plants produce are reaching millions within India alone The limitations of this study pertain to its design The study was designed to demonstrate the potential for health risks and did not endeavor to identify health outcomes It is not known to the authors where the manufacturers of these products marketed throughout India and Southeast Asia sourced their talc supply The only fibers analyzed for this study were the six regulated fibers collectively called asbestos 5 | CONCLUSION Some global talc deposits are free of asbestos while others are 5,7,8,10-13 Therefore significant policy updates are necessary to promote product safety and accountability that protects the interest of consumers.42 Without such measures millions of people will be at heightened risk for asbestos exposure due to personal care talc products that contain millions of countable asbestos structures in every teaspoon full equivalent and diseases caused by such structures It is confirmed that these product samples are among those marketed and sold counter and online in India and other Southeast Asian countries It is believed that this is the first report of such findings in India It carries public health implications for Southeast Asia in general and perhaps beyond This study confirms that asbestos exposure in India and potentially elsewhere is possible through nonoccupational avenues previously overlooked AUTHOR CONTRIBUTIONS TKJ conceived the idea for this work assisted with writing and participated in the final approval of the version to be published EH assisted with writing conducted bibliographic research and participated in the final approval of the version to be published SF assisted with writing conducted analyses of materials participated in the final approval of the version to be published and was engaged in geologic mineralogic and laboratory work regarding asbestos and has been retained by both plaintiffs and defendants in asbestos and related matters ALF participated in the design of the work provided bibliographic references assisted with writing participated in the final approval of the version to be published and has engaged in medical work regarding asbestos generally for plaintiffs ETHICS APPROVAL AND INFORMED CONSENT No reviews and approvals needed no human subjects WW.STRIAL WILEY DISCLOSURE AUTHORS Dr. A.L. Frank regularly engages in medical work regarding asbestos generally for plaintiffs S. Fitzgerald PG regularly engages in geologic mineralogic and laboratory work regarding asbestos and has been retained by both plaintiffs and defendants in asbestos and related matters DISCLOSURE BY AJIM EDITOR OF RECORD None DISCLAIMER None ORCID Arthur L. Frank D http://orcid.org/0000-0001-7040-9520 REFERENCES 1. Asbestos Elimination of Asbestos Diseases www.who.int http://www.who.int/news-room/fact-sheets/detail/asbestos-eliminationasbestos Updated February 15 2018. Accessed July 11 2018 2. Feeley J Cronin M. & faces high stakes trial over 22 women's talc claims Bloomberg Web site https://www.bloomberg.com/news/ 2018-06-06 cancer Published June 6 2018. Updated June 6 2018 Accessed July 11 2018 3. Gordon RE Fitzgerald S Millette J. Asbestos in commercial cosmetic talcum powder as a cause of mesothelioma in women Int J Occup Environ Health 318-332 https://doi.org/10 2049396714Y.0000000081 4. 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Asbestos in India www.ceh.org https://www.ceh.org.in/asbestos-inindia Published May 23 2017. Accessed July 20 2018 How to cite this article Fitzgerald S Harty E Joshi TK Frank AL Asbestos in commercial indian talc Am J Ind Med 2019 1-8 https://doi.org/10.1002/ajim.22969