Document VjNzXQpQJLXN0E8pJaz5e7xaj

HFM - 003520 TABLE 5 Deaths among 17,800 asbestos insulation workers in the United States and Canada, Jan. 1,1987-Jan. 1,1877: Analysis by duration from onset of employment Yn from onset of employment <10 10-14 10-20 20-24 26-29 30-34 36-39 40-44 45+ Total deaths 61 85 188 320 388 340 263 203 442 cancer 0 8.24 15.43 18.44 26.80 32.94 26.09 19.21 16.61 Parcant of aU deaths Mesothelioma Pleural Peritoneal 0 0 1.06 1.88 3.86 2.94 6.32 1.97 2.94 0 0 1.60 0.94 4.64 6.47 7.11 7.88 6.56 y d 'i Total h ^ ^i 0- 2-60* 2.82 8.40; 9.41 13.43 9.85r: 9.50/ Total 2270 21.37 2.90 4.80 7.70 boilermakers as for welders. Review of changes raises the question of increased work practices makes this quite under risk of asbestos-associated neoplasms-in standable, of course. The conditions of the future. Those tO be considered include shipyard work have been such that it is: cancer of the lung, pleural mesothelioma, likely that asbestos exposure would have peritoneal mesothelioma, andesophagejd* occurred among all individuals at a work stomach, colorectal, oropharyngeal, la site where the material was being installed,. ryngeal and renal cancer. The extent of repaired or removed. Data are less certain . this risk is nOt nowknown. ' for the less common crafts, where fewer workers were examined; Although evi CURRENT SITUATION dence of asbestotic changes was found among some of these men and women as In terms of public health, the overwhelm well, one can estimate a proportion only ing problem is the undoing, ameliorating with less assurance. or modifying of both current and antici Thus, exposure to asbestos under past pated results of past mistakes. The prob conditions, of an intensity sufficient to lems are straightforward and, simulta cause significant asbestotic X-ray change, neously, complex. To a considerable, de was common at the shipyard in Groton. gree, the complexity derives from the fhct As a result, a large number of workers that we have had little experience to guide now have pulmonary changes associated us in such matters, especially on the scale with such exposure. The prevalence of found in the present situation. such a high proportion of asbestotic X-ray The following recommendations -- HO 01 1*92^- CA-A CANCER JOURNAL FOR CLINICIANS necessarily incomplete and tentative--are offered: 1. Knowledge concerning asbestos expo sure: Dissemination of information: under standing the disease potential of asbes tos exposure (past and future) would be valuable for both worker and manage ment. ;T" : Avoidance of additional exposure: appropriate engineering and industrial hygiene methods are crucial; removal or repair of asbestos materials now in place presents a problem for the future. : 2. Medical surveillance programs: Asbestosis: awareness of the presence of this disease by both the patient and the treating physician would be im portant, since most deaths of asbestosis are due to interburrent respiratory in fections, rather than to progressive pul monary fibrosis. Pulmonary infections can be well treated, and experience has shown that many lives can be saved. a Lung cancer: early diagnosis: can in crease the likelihood of successful treat ment to some extent (by no means as much as we would like). It is not known whether more energetic surveiUance (as with frequent sj^uni cytology examin ation) will increase the percentage of those successfully treated. Studies are now in progress to investigate this pos sibility. Colorectal cancer: early diagnosis increases the likelihood of cure. : Ompharyngealj tajyngeal or renal ce/v cinoma: awareness of theincreased risk. of'these cancersTmproves chances for; early study and/diagnosis of the pres ence of these conditions, which can be cured in many cdses. ' Pleural and/or peritoneal- mesothelio ma: effective therapy is not now avail able and early diagnosis does not sig nificantly increase the likelihood of survival. However, research concerning therapy is now-underway in the United States, Great Attain and France, and it may be hoped that improved treatment methods will become available. Education programs: Smoking: lung?cancer risk is greatly .... ...;, TABLE S Percentagedistribution of trades in private shipyards, June 194$: . Trade Welders Shipffttere Machinists . Pipefitters . Electricians Carpenters ..Laborers, Burners Palmers Sheetmstal workers : Riggers -- . Chipper: and caulkers Boilermaker: Crane operators Pipecoverers . All other Pttrctntagji 15.3 11.0 8.1 7.2 ; 6.8 6.1 5.5 3.8 . 3.1 . 3.0 2.8 Z8 2.3 1.3 , 0.2 21.1 Source: Bureau of Labor StartJitlcv .. Bulletin 824 multiplied by asbestos exposure.19 It is urgent that this information become available to workers who have beep, ex-. posed.to asbestos, and that every assis tance be afforded them-to help in their efforts to control and eliminate sipok-:' ing, espedally cigarette smoking: S^me ' data are also'available suggesting ifhat cessation of smoking will, after aijymher of years, reduce the risk of lung cancer, even with a historyof prior cig arette smoking, Should these experi ences be confirmed, it will be even mOre urgent to identify and alert former ship yard workers, to acquaint them with the important risk of lung cancer should . they continue cigarette smoking. Cigar-. ette smoking also increases the risk of serious disability associated with pul monary fibroris, and of the develop- VOL 28, NO. 2 MARCH/APRIL 1978 BO01 0925