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FILE NAME: Household Contact (HC) DATE: 0000 DOC#: HC023 DOCUMENT DESCRIPTION: Medical Journal Article - Household-Contact Asbestos Neoplastic Risk  t ffi-c ^ /V /y C ontrols Neither E mployment tory Indicating i Asbestos Not .lmost Availertain able ' much aware lifferences arc striking in its e small, there s. mokers. This of cigarettes, :or oncogenic .t now include kers, managehether or not noma. Lancet rcinoma. Lan1 and laryngeal HOUSEHOLD-CONTACT ASBESTOS NEOPLASTIC RISK * Henry A. Anderson, Ruth Lilis, Susan M. Daum, Alf S. Fischbein, and Irving J. Selikoff ' Mount Sinai School of Medicine The City University of New York New York, New York 10029 monlid AClKPattIOnal nsk ass ciated with asbestos exposure has been well docuAsbestosis-- parenchymal fibrosis (described in the ILO /U C Pneu S c a t i o n has ,f f l'T n " lrreUlar p3Cities)' Pleura> fibrosis, and pleural affl.lcted many occupational groups exposed to these mineral S ? h in h w8h p`!mistlc forecasts had predicted a decline in the incidence ,oasbestos-induced disease, recent experience proves that the risk is still present involving large numbers of workers in various trades. Epidemiologic studies l a T t r f d E h d 1 SUtCh aS^eSt S`eXposed individua,s have a significantly increased S i L d nnnmUr "l3]'8" 301 (mesothelioma, lung, and gastrointestinal can cels) and nonmalignant (asbestosis) diseases. PT li n f^m industrial sources was not anticipated to pose any ,he i ` " .ral publ" - W a s n e r'/w o * to -S ?h'A A d New,h use s stud,es m the United Kingdom suggested that the S a U r i E r i 7 Sprefud ,bey0nd the factory, mine, or mill gate. In 1960, Wagner fa iq*4 PMrtel meSOthe^l,.TMa in nonoccupationally asbestos-exposed individuals, t o of SC ? aL rf P? rted nine cases of mesothelioma in family con- of asbestos workers and eleven cases among individuals whose only identi c i asbestos exposure was associated with living within one-half mile of an ^ 2 " factory. These initial case reports were not isolated occurrences, only one or regionS (TABLE f>- Additional reports from nine i the ` taI number f reported cases of household meso- ifavnni ri3u 1 T^US' household asbestos contact has been established as fag potentially hazardous. , U|,ChMCaSe r! p0rts did not assess the actual incidence or extent of risk to cusehold members or the general public, nor did they give any suggestion of prevalence of asbestos-associated radiologic changes in such populations. for aV,e Anvest,ated fo problem in order to determine whether the potential cn disease hazard is common or rare, since such evaluation would assist in J J measures needed for clinical surveillance and for preventive control M ethods j 3V undertaken a st.udy t0 assess the risks of nonmalignant and ma^v . . dlsease associated with household exposure to work-derived asbestos S t S o 0 9 2 a8Ch SUpP rted by National Institute of Environmental Health Sciences 311 .S r-. -- fi Y' ^f'-' ) ffiSP: B S S .^ - 312 Annals New York Academy of Sciences H ousehold A sbestos Table 1 Exposure Mesothelioma Case Reports Great Britain United States Canada Italy South Africa Australia East Germany Scotland West Germany Newhouse &Thompson (1965)2 Rusby (1968)3 ' t Ashcroft &Heppleston (1970)* I Champion ( 1971)3 I Greenberg &Davies (1974)8 I i Lieben &Pistawka (1967)7 Heller et al. (1970)" 1 Lillington et al. (1974)" I Anderson ( 1975) 1 4 McDonald et al. ( 1970)10 McDonald & McDonald (1973)11 3I Rubino et al. (1972)u 3 Wagner et al. (I960)1 Milne (1969)13 Bittersohl &Ose (1971)" McEwen et al. (1971 )13 Knappmann ( I972)10 37 SestoTdiseale Which serious' well-documcntcd dosedT S i l l reC rdtf From 1941 to 1954 (when the factory rim ' l 664 workers were employed in the factory for varying periods of S t l T a ^ r t asbes`os Products- Their household contacts, living Z t d When r y WOrked m the pIant' are currentIy being traced and bmaStty aannddmmo?rtSalritty expPerrieCneScSe o" f cth?ims PcIoeh`eo.rtwe will examine in detail the mor- identified1Ah?SC already traced' tW0 P'eural mesothelioma deaths have been mesothelioma PSy " SSUe haS been revieWed and confirmed as pleural 13 daUf ? eL f t man Wh had WOrked with asbestos more than TheysecnnH fha ? ge m ' Hf househoId exposure had begun in early childhood, d i d ? ? ! ' da"ghter of a man with five years of asbestos work at the plant. latencv nerinri ' I f * W men Wefe fifSt eXp0sed 35 ch`ldren, and both had 3fl voJrF x ? eXp" Ure t0 ciinical appearance of mesothelioma-- of over d^from a m ts X h L t ^ f exP0SUre had In addition, two living cohort members have biopsy-proven pleural meso- ,, and are currently under therapy. One is a 32-year-old woman, sister- in-law of a worker, and the other is a 40-year-old son of another plant employee. Concurrent with the mortality study, household contacts of the former a: bestos workers were invited to participate in medical examinations to asses " Anderson et al. : Ho eir current health status and the p dects such as the radiographic chang ad calcification. Each individual j atdical, smoking, and respiratory h Unique chest x rays were taken, as wt pulmonary function tests. Physical ex {flipbasis on the chest. All the chest x rays were read "bi tfeians, using the ILO /U C Pneumocc ingwas used for statistical analysis. Re We have so far examined 354 hous. 17 were found to have had prior per had abnormal x rays). Eleven did not index worker's active employment at tl trays). Table 2 represents the 326 h writers' homes during their employme occupational asbestos exposure. The actual intensity of household a: family contact's exposure to such fibers howmuch asbestos each worker might and/or hair. We do, however, know \ total duration of his employment, and. logic disease. v The index workers' length of emph years. Fifty percent of the household it Tab Distribution of 326 H ousehold Me: , by Relations! .' Children Siblings Others Total Relationship Wives Daughters Sons Sisters Brothers Mother Father Cousins, etc. ;es ,se Reports 5 r 9 1 r 1 1 2 3 1 1 4 1 3 )u 3 1 1 | 1 1 37 us, well-documented 4 (when the factory r varying periods of hold contacts, living ltly being traced and ae in detail the mor- na deaths have been confirmed as pleural h asbestos more than in in early childhood, tos work at the plant, ldren, and both had esothelioma-- of over os exposure had also proven pleural meso:ar-old woman, sisterother plant employee- cts of the former ascaminations to asses* - Anderson et al.: Household-Contact Asbestos 313 their current health status and the prevalence of early asbestos-related health effects such as the radiographic changes of parenchymal fibrosis, pleural fibrosis, and calcification. Each individual provided a comprehensive occupational, medical, smoking, and respiratory history; 14 X 17 inch PA, right and left oblique chest x rays were taken, as were spirometric and flow-volume screening pulmonary function tests. Physical examination was done by a physician, with emphasis on the chest. All the chest x rays were read "blind" by a panel of five experienced phy sicians, using the IL O /U C Pneumoconiosis Classification. The consensus read ingwas used for statistical analysis. -1' . Results - We have so far examined 354 household contacts. After careful questioning, 7-were found to have had prior personal occupational asbestos exposure (5 had abnormal x rays). Eleven did not live in the household at the time of the index worker's active employment at the asbestos factory (all had normal chest stays). Table 2 represents the 326 household contacts who lived in the index workers' homes during their employment and who themselves had not had prior occupational asbestos exposure. V The actual intensity of household asbestos contamination and length of each family contact's exposure to such fibers is unknown. We do not know, of course, howmuch asbestos each worker might have brought home on his clothes, shoes, and/or hair. We do, however, know when the worker was first employed, the total duration of his employment, and, in many cases, the extent of his radio logic disease. The index workers' length of employment ranged from one day to thirteen |ears. Fifty percent of the household members examined came from households Table 2 Distribution til ' . . c'y of 326 H ousehold Members of A mosite by Relationship to Worker Relationship Number Examined A sbestos Workers Percentage ] if. Children Wives Daughters Sons 83 25% 118 188 58% 70 Siblings Sisters Brothers 20 32 10% 12 .Others vK- . ,, ' 2L. r , Total Mother Father Cousins, etc. 7 3 23 7% 13 326 314 Annals New York Academy of Sciences T able 3 D istribution of H ousehold C ontacts by T heir Index Workers Length of Employment Number of cohort members Total 326 <1 mo 31 (9.5%) 1.1 mo1 yr 136 (41.1%) 1.1 yr5 yr 115 (32.2%) 5.1 10 yr 29 (8.9%) 10.1 + yr 15 " (4.8% ) in which the index workers' length of employment (and thus active contamina tion of the home) was less than one year. Thirteen percent had emplovmem periods over five years (Table 3). 3 Radiologic F indings Anderson et al. : Houser Table X-Ray A bnormalities among of A mosite A sbe X-Ray Findings Pleural thickening the only abnormality Pleural calcification the only abnormality Pleural thickening and /o r pleural calcification Irregular opacities the only abnormality irregular opacities, pleural thickening, and/ or pleural calcification Total All examined individuals considered themselves to be healthy. Of the 3">6 household contamination with asbestos fr 114 (3 5 % ) had chest x-ray abnormalities, (IL O /U C Classification irregular commonly occur, and may result in chara opacities 1/0 or more, and/or calcification and thickening of the pleura) (Table 4 ). frequently, in asbestos-associated neoplastic have already occurred. When tracing an> There was a predominance of pleural changes, fibrosis and/or calcification. complete, we will analyze expected and ob Pleural changes as the only abnormality were seen in 52 (16% ) of those ex amined; parenchymal fibrosis was found alone in 35 (11% ) of those examined whether there is a significant increase in c to asbestos. (Table 5). Combined pleural and parenchymal changes were found in 27 Pleural fibrosis and calcification withe (8 % ). Only two x rays were read as having parenchymal fibrosis greater than more frequently than parenchymal fibrosis the IL O /U C Classification group 1 (1 /0 --1/2) (Table 6). parenchymal changes alone to individuals \ F igures 1--8 are examples of the radiologic changes seen. Interestingly, this observation differs from asbestos workers, in whom pleural change less common. The ratio of workers with D iscussion with only pleural changes was 1.92. The < race in response to these fibers is uncertai i Of 326 otherwise healthy household contacts of amosite asbestos workers examined 25-30 years after the onset of presumed household contamination with amosite asbestos, 35% had chest x-ray abnormalities (pleural and/or extent of exposure are likely. The possible relationship of pleural chi known. In 1974, E dge1S reported on the p parenchymal) characteristic of asbestos exposure. We conclude that significant former shipyard workers, who had pleural . Table 4 X-Ray Abnormalities among 326 H ousehold M embers of A mosite A sbestos Workers X-Ray Findings Pleural thickening present Pleural calcification present Irregular opacities present One or more of above abnormalities Number of Household Members 69 (2 1 % ) 19 (6 % ) 62 (1 9 % ) 114 (3 5 % ) Table 6 ILO/UC Pneumoconiosi of 62 Abnormal H ouseho Total w/Parenchymal Abnormalities 62 -- ----- ---------- ILO/UC Classii Irregular opac 1/0 i 23 34 (37%) (55 r'V u: r mmm /ORKF.RS - 10 I /r (- vr 1 is >%) (4 X 't ve connimituJ employment . Of the 320. ition irregular f the pleura) r calcification ) of those ex hose examined : found in 27 is greater than bestos workers contamination aleural and of that significant BERS Number of iehold Member' 69 (21C&) 19 (6%) 62 (19 %) 114 (35% ) Anderson et al.: Household-Contact Asbestos 315 Table 5 X-Ray A bnormalities among 326 H ousehold Members of A mosite A sbestos Workers X-Ray Findings pleural thickening the only abnormality Pleural calcification the only abnormality Pleural thickening and/or pleural calcification Irregular opacities the only abnormality Irregular opacities, pleural thickening, and/ or pleural calcification -- Total Number of Household Members 42 (13%) 7 (2% ) 52 (16%) 35 (11%) 27 (8%) 114(35% ) household contamination with asbestos from industrial sources can and does commonly occur, and may result in characteristic radiologic changes and, less frequently, in asbestos-associated neoplastic disease. Four pleural mesotheliomas have already occurred. When tracing and follow-up of the entire cohort is complete, we will analyze expected and observed deaths by cause to determine whether there is a significant increase in cancer risk with household exposure to asbestos. Pleural fibrosis and calcification without parenchymal fibrosis were seen more frequently than parenchymal fibrosis alone. The ratio of individuals with parenchymal changes alone to individuals with pleural changes alone was 0.67. Interestingly, this observation differs from the experience of the index amosite asbestos workers, in whom pleural changes as the only abnormality was far less common. The ratio of workers with only parenchymal changes to those with only pleural changes was 1.92. The explanation for this apparent differ ence in response to these fibers is uncertain. Differences in the intensity and extent of exposure are likely. The possible relationship of pleural changes to tumor risk is incompletely known. In 1974, Edge 13 reported on the prospective observation of 235 men, former shipyard workers, who had pleural fibrosis and/or calcification on their . , . T able 6 ILO/UC Pneumoconiosis Classification of 62 Abnormal H ousehold Cohort X-Rays ` Total w/Parenchymal ^.Abnormalities , 62 ILO/UC Classification Irregular opacities 1/0 23 (37%) 1/1 3 4 (55%) 1/2 3 (4.8%) 2/2 2 (3.2%) V /' Annals New York Academy of Sciences Anderson et H;. s** *?.' m , '; ,- ' 'VJ.. i - . 'X--; Figure 6. Oblique film on case shown in Figure 5 more clearly demonstrating the extensive lateral-wall pleural thickening. Figure 7. Pleural mesothelic who had been in the trade mor ilso died of a mesothelioma. 322 Annals New York Academy of Sciences Anderson et t related radiographic changes, not only protect exposed wor as well, including household, r lion. F igure 8. Pleural mesothelioma in a 41-year-old daughter of an asbestos worker employed for 5 years, 1943-48. chest x rays in 1970. Of the 70 deaths recorded, 1970-1973, 17 (24% ) were from mesothelioma. Further study is needed to investigate the association of pleural fibrosis and calcification and the occurrence of mesothelioma of the pleura. The prospective study of this household-contact cohort should help clarify this relationship, and also the role of such dose-disease response variables as the effect of age at first exposure, possible sex differences in response, the effect of intensity of exposure, and the effect of interrupted versus continuous exposure. These preliminary data available show significant prevalence of asbestos- 1. Wagner, J. C , C. A. Sleg< lioma and asbestos exposu 271. , 1 Newhouse, M. L. & H. T peritoneum following exp ' Med. 22: 261-269. : , 3. Rusby, N. L. 1968. Pleural in relation to malignant c: 4, Ashcroft, T. & A. G. Hi ' Tyneside--a pathological ^ Conf. Johannesburg, So. *,` ford Univ. Press. Capetow Champion, P. 1971. Two . \ asbestos. Am. Rev. Resp. 1 A6- Greenberg, M. & T. A. L V- J. Ind. Med. 31: 91-104. X Lieben, J. & H. Pistawka. ' . Environ. Health. 14: 559- Heller, R. M., J. L. Janov, festations of malignant ph X Lillington, G. A., R. W. J Editor. Conjugal malignar Kk McDonald, A. D,, A. H ari . Epidemiology of primary 26:914-919. October. 11. McDonald, A. D. & J. c. mesothelioma in Canada. 12. Rubino, G. F., G. Scansetti, - pleural mesothelioma in b 29:436-442. ;3. Milne, J. 1969. Fifteen cas pational exposure to asbest 4. Bittersohl, G. & H. Ose. 1 Z. Gesante Hyg. 17: 861-86 J J . McE wen, J., A. F inlayson, ' and mesothelioma in Scotia I. Knappmann, J. 1972. Beob . in Hamburg (1958-1968). H. Selikoff, I. J,, E. C. Hammo .. asbestos. Arch. Environ. H 1. Edge, J. R. Asbestos related be published. ; Anderson et al.: Household-Contact Asbestos 323 . f a d r tf a , ho,,s.h o ld, ,, d ghbo,hood, hr M i,ro" d"res sh "id r> References ' ^ Wagner, F C., C. A. Sleggs & P. M archand 1qad r v ff 1 , v.- S r " d ' xp" ore N-w - . S : f t t r t an asbestos wotl-if 17 (24% ) were s association of thelioma of the ort should help sponse variable' in response, ihc :rsus continu."1' ice of asbesto'" i ^& T 35?& & & *?SSi / T . ford Univ. Press. Capetown So k d c a ShaP'r ' Ed' ! 177~ 179' k ? J S . S K S mesothelioma after *-- - ' L in d Mi:dM31:&91-'104' L' AVIES- 1974` Mesothelioma Register 1967-68. LS o ! ; . H S t h IS^ 5 IH t I * S ^ 5 jg r 11. McDonald, A. D. & J C .4 S s **""" " 7- -- ~ M cD onaid and asbestos exposure. Arch. ^ T cS 1077 r- . . . * 3 M " " f B-x (fS S X I*. BtTTERsoHL, G. & H 0sE .97 : Z. Gesante H yJ 17: 861-864 w r "'> " 7n % h i LAustralia 2: 669-673. Epidemiologie des Pleuramesotheliomas. ' Mfn WEN' J'l A' F inlayson- X. Mair & A. M M Gibson 1071 a u , '* ? B e lh t lDt- ^ l i t SELnnc?FaFm rjS F 9? H968)- ^ ^ " o b g ie ^ U f T ? " MeSOtheli0m' Fallen v En^ " .s J i 8r - * -- * 3 ,v* be pubfehei SbeSt0S related dlSeaSe ,n Barrow-in-Furness. Environ. Res. To ft-,.; , ? . . lllil