Document YDRX6oY5Bx9aq95YEqj1BpNYk

***#h*> * -- Mesothelioma among Employees with Likely Contact with in-Place Asbestos-Containing Building Materials0 HENRY A. ANDERSON, LAWRENCE P. HANRAHAN, JOSEPH SCHIRMER, DEE HIGGINS, AND PRISCILLA SAROW Wisconsin Division of Health P.O. Box 309 Madison, Wisconsin 53701 When construction workers completed their tasks, care of new buildings became the responsibility of maintenance employees. Sometimes obviously, and at other times insidiously, asbestos-containing building material (ACBM) deteriorated or was physically damaged, necessitating repair or replacement. Not identified as a public health priority, such maintenance was often deferred when it was not cosmetically necessary. Although the health hazard of asbestos exposure from thermal asbestos insula tion during building maintenance work was recognized as early as 1932,2 and concerns were raised about the potential health hazard of spray-applied ACBM in 19323 and 1953,4 quantitative industrial hygiene assessment of exposure circum stances was not begun until the 1970s.56 Health investigations have begun de scribing asbestos-associated diseases among workers exposed to ACBM during the course of their usual work.7-12 In 1984 the United States Environmental Protection Agency (EPA) conducted a national survey of buildings to estimate the extent of friable ACBM in existing structures. They concluded that approximately 31,000 schools and 733,000 public and commercial buildings were likely to contain such materials.13 Priority has been placed upon addressing the ACBM in schools. The Wisconsin Division of Health (WDOH) within the Wisconsin Department of Health and Social Services (WDHSS) has served as the lead agency for the U.S. Environmental Protection Agency's (EPA) School Asbestos Programs since 1979. Wisconsin has 429 public-school districts containing 1,923 schools with a total of 2,230 buildings. There are an additional 986 private-school districts containing 1.014 schools with 1,142 buildings, and 18 government-school districts (state, county) with 28 schools and 107 buildings. All these schools are regulated under the Asbestos Hazard Emergency Response Act (AHERA). Under AHERA regulations, all school districts were required to submit asbes tos management plans to WDOH for review by October 1988. The WDOH devel oped and maintains a computerized database program for storing data abstracted " This project was partly supported through cooperative agreements with the National Institute of Occupational Safety and Health (NIOSH) and the Agency for Toxic Substances and Disease Registry, No. U53-CCU500801 and No. U60-CCU502984, and the U.S. Envi ronmental Protection Agency, No. K005903. 550 ANDERSON et at.: DISKAS! during the management plat identified from the inspectio Significantly damaged fr 37% of the public-school dis tricts. Significantly damagei public- and 1% of private-s private-school districts repot and ceiling tile), only 2% of p damaged miscellaneous matt Wisconsin Occupa, No national occupation01 the United States. The fr; terize the impact of past a characterized first in 198 from the National Acadei table l. Asbestos-Contai 1989 AHERA Plan Reviews Thermal Friable Da; Public-school districts (n = 411) Privateschool districts ( = 872) 326 (79%) 424 (49%) 153 130 To begin to address occupat in Wisconsin, the WDHSS ente ment with the National Institu The intent was to evaluate exis tional disease and injury survei veillance. In 1987 the pilot surveillar. Sentinel Event Notification Sys to include sentinel physician re Surveilla, 1. Wisconsin Vital Statistics 1 The Vital Statistics Registry computer data base beginning i OF SCIENCES e to the same 25 years (177). >ng males. The ^9--1973) to 2.8 : rapidly. Over t has remained females, espe)thers.21 These e recent years investigation, iver the period lata underesti' males. Histoo establish the on of usual octmental health the Wisconsin further invesjght sc1 ~ol for was connrmed mesothelioma ,ad performed -s occur where ividual by the -f the contribuvVisconsin will ories on all the e occupational certificate are ificant propor. but will miss jlative risk of quires skills in vork. and pipe ases, the work t many of the / and that five identified as a :he cumulative ANDERSON et atDISEASE & CONTACT WITH ACBM 569 All of the maintenance workers were likely to have performed tasks around thermal asbestos materials. It was commonly reported that periodic maintenance of boilers and pipes was performed either by the individuals or in their vicinity. Mention of acoustical or surfacing material was less common. The patients reported in cases 7 and 10 in Table 5 were employed at the same university facility, which was known to have friable thermal and acoustical ACBM. A similar situation was described in the school district in which the patients in cases 2 and 4 in Table 5 had both worked. It is unlikely that these clusters are due to chance alone. An unexpected observation was that four (17%) of the patients had served 4-vear enlistments in the U.S. Navy. Two (one a boilerman and the other an engineer) spent time in the engine room and were probably exposed to asbestos aboard ship. The other two served aboard ship and may also have been indirectly exposed. A recent report of the mortality of United Kingdom military serviceman (those with more than 5 years of service) found an excess of mesothelioma among the Royal Navy servicemen (7 cases of mesothelioma).26 Asbestos diseases have also been reported among long-term merchant seamen.27-28 It is important to consider military service when investigating possible sources of asbestos expo sure when mesothelioma develops. School Teachers This is the first report that systematically investigates possible sources of asbestos exposure among school teachers with mesothelioma. In 9 of the 12 cases, the only potential source of asbestos exposure identified was in-place ACBM. It was unexpected to find two teachers who were sisters. The occurrence of more than one mesothelioma in a family is a very rare event. The world medical literature contains less than 10 reports of family clustering of mesothelioma.29-30 In each instance, exposure to asbestos (occupational and/or environmental) has been identified. The two sisters in our series fit the pattern described in these reports-- sharing a similar tumor site and histology. It was postulated by both Martensson29 and Lynch30 that a hereditary predisposing factor may exist which is especially sensitive to induction by asbestos. If such is the case, our sisters probably re ceived their induction dose of asbestos from ACBM within their schools. AHERA reports indicate that friable thermal and surfacing material were present in the school of one of the sisters. The school in which the other sister taught no longer exists and no information is currently available whether ACBM was in the school. Considering the rarity of mesothelioma and the more than 3,000 schools in the state, it was unexpected to find two school clusters of two cases among the 12 teachers investigated. In both instances significantly damaged thermal and surfac ing ACBM was present in 1988-89. The status of ACBM at the time the teachers were in the schools is unknown. CONCLUSION Our investigation of mesothelioma cases in Wisconsin with school, residential, commercial and factory maintenance and repair employment identified asbestos exposure in every instance. For most, the opportunities for asbestos exposure came from multiple jobs, including maintenance work. However, in 10(34%), the only identifiable likely source of asbestos exposure was to in-place ACBM, proba bly intermittently disturbed while maintenance activities were performed. We 570 ANNALS NEW YORK ACADEMY OF SCIENCES conclude that building maintenance workers are at increased risk to develop mesothelioma from exposure to in-place ACBM. We report 12 mesothelioma deaths among school teachers. For 9, the only likely source of asbestos exposure was to in-place ACBM. Two teachers, with similar peritoneal mesotheliomas, were sisters. All previous sibling clustering of mesothelioma reports have identified asbestos exposure to the siblings. This sug gests that our two teachers must have been exposed to asbestos, most likely during each of their 40+ years of teaching. Especially for the maintenance staff in the public school buildings, the high prevalence (36%) of significantly damaged friable thermal insulation described in our AHERA plan reviews represents a serious concern and underscores the need for strict operations and maintenance programs including repair and/or removal of such material. Rapid implementation of rigorous operations and maintenance programs is needed to prevent future asbestos exposure to the large existing maintenance work force and the even larger population of building residents whose health may be jeopardized by episodic environmental contamination by inadequate maintenance and operational precautions. SUMMARY The occurrence of mesothelioma is a sentinel event in occupational and envi ronmental disease.1 A mesothelioma surveillance system was established utilizing existing computerized Wisconsin vital statistics data maintained since 1959 and a Cancer Reporting System (CRS) established in 1978. Review of the death certificate listing of usual occupation and industry from 487 mesothelioma deaths in Wisconsin from 1959 to 1989 led to the investigation of 41 persons with likely exposure to inplace asbestos-containing building mate rials (ACBM): 12 school teachers, 10 school maintenance employees, 7 public building maintenance workers, 5 private building maintenance workers, and 7 commercial and factory workers performing maintenance activities. For 10 (34%) of the 29 maintenance workers the only source of asbestos exposure identified was their maintenance work. For five (17%) histories indi cated some prior employment in occupations and industries with probable asbes tos exposures. Opportunities for indirect occupational exposure were identified for ten who had been employed in the residential construction industry. One maintenance worker was exposed to asbestos in the household and another had neighborhood exposure. For 9 (75%) of the school teachers, the only identifiable potential source of asbestos exposure was derived from in-place ACBM in schools. One teacher had spent a season in the merchant marine aboard an iron ore-hauling ship and 2 had worked in the residential construction industry. Two of the teachers were sisters, and in two instances, two teachers had taught in the same school facility. We conclude that individuals occupationally exposed to in-place ACBM are at risk for the subsequent development of mesothelioma. ACKNOWLEDGMENT We wish to thank the Center for Health Statistics of the Wisconsin Division of Health for their assistance in providing access to data from the Wisconsin Cancer Reporting System and Wisconsin mortality vital statistics. t OF SCIENCES risk to develop For 9, the only > teachers, with ng clustering of 'lings. This sug:os, most likely ldings, the high ion described in scores the need ld/or removal of id maintenance e large existing ilding residents mtamination by tional and enviblished utilizing ince 1959 and a i indu_y from re investigation : building mateoyees, 7 public workers, and 7 es. ce of asbestos ' histories indi probable asbeswere identified industry. One nd another had mtial source of >ne teacher had ship and 2 had rs were sisters, facility. e ACBM are at sin Division of iconsin Cancer ANDERSON et al.: DISEASE S 571 REFERENCES 1. Rutstein, D. D., R. J. Mullan, T. M. Frazier. W. E. Halperin. J. M. Melius & J. P. Sestito. 1983. Sentinel health events (occupational): A basis for physician recognition and public health surveillance. Am. J. Publ. Health 73(9): 1054-1061. 2. Russell, A. E. 1933. Proceedings of a Conference concerning Effects of Dusts upon the Respiratory System, November 16-17, 1932. Industrial Commission of Wiscon sin. Madison, WI. 3. 1932. Annotations: Asbestos in London tube railways. Lancet i: 410. 4. McLaughlin. A. E. G. 1953. The prevention of the dust diseases. Lancet i:49-53. 5. Lumley. K. P. S., P. G. Harries & F. J. O'Kelly. 1971. Buildings insulated with sprayed asbestos: A potential hazard. Ann. Occup. Hyg. 14: 255-257. 6. Sawyer. R. N. & C. M. Spooner. 1978. Sprayed asbestos-containing materials in buildings: A guidance document. EPA450/2-78-014. National Technical Information Service (NTIS). Springfield. VA. 7. Milham, S., Jr. 1978. Mortality experience of the AFL-CIO United Brotherhood of Carpenters and Joiners of America 1969-1970 and 1972-1973. Department of Health, Education and Welfare (NIOSH) Publication No. 78-152. Cincinnati, Ohio. 8. Hilt, B., S. Langard, A. Andersen & J. Rosenberg. 1985. Asbestos exposure, smoking habits, and cancer incidence among production and maintenance workers in an electrochemical plant. Am. J. Ind. Med. 8: 565-577. 9. Lilis, R., S. Daum. H. Anderson, M. Sirota, G. 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Recent s a to asbesl s sure may i tion of f e containir concern ; tion of b; 1 sure to a t haul pha : searching t tors.3 We re * fire fighte s i- New o criteria tl it asbestos. T York City F least five e City with a: with a hig 11 and all a ti Medical < ei Evalu ti history, r ei symptom . radiograp , on all job: h on jobs li Ke employm nl Chest Kone NIOSH of Pneumi'Ci ences in me least 1/0 prt equal numbt normal were