Document evpV7gRezqYkeeyzVBvyeJ1LM

( V MEDICAL ASPECTS OF OCCUPATIONAL EXPOSURE TO ASBESTOS / Hilton C. Lewinsohn, MB., BCh., Corporate Medical Director Raybestos-Manhattan, Inc. 100 Oakview Drive Trumbull, Connecticut 06611 DIH. (Talk to Members of Friction Materials Standards Institute, Inc. Annual Meeting on June 22, 1977) 'J C-lJ ASBESTOS INFORMATION ASSOCIATION; N North Amarica ' 3835 K Street, H. W. Suite 402 Washington, D. C. 2000S ji / A i 787b .-caljcria > UCC 007845 t ) i noidoi/boxdnl .A zmeez 31 nedw neve "aodadas" nxd9b od syswIs dl noidsoxdaxrfqoa rid do ansod oa ob od \iBzzeoannn zl 31 3sd3 oixn9p b 21 ^'aodasdeA" .bezzeibbs pnied eonelbus ed3 do evsd doldw zlsienim sdsolllz badBib^d lo Ydsxxsv b xod nrxd bds:isq3 9d od Ydilxds grid ,Yl9flisn ,9rixrdx%dris nommoo 9no zl emen erid rfpi/orfdlA .3idxd xdllz tddoa Y-^vidsIax orini 9vsrf rfoirfw zei.3eli.BV 9aorfd rfdxw bsdsxooaas zlBienim 11b od Idsoxlqqs si 31 xeons3ioqmi oipolonrfosd nnodid39das`' mie3 eriT ,noidqixoa9b 9Vods rid did rioirfw .vidqixoasb daom aqsrfxsq ax "zlBienim 3 .? IsdaY22 xi9rfd noqxj pnibnsqsb zezzslo nlem owd 9ie 9isriT xsd/nsm 9X02 srfT .aslodirfqms bns nidnqxa %YXsnisn iSxnrioi/xda assixqmoo rioiriw so3zedzs lidoBY^rio ax aaslo enidneqiBs rid do flixodxdasdas vxd xs xsrfT .noidonboxq blxow do 2P Y-t'2"^ ,9dxaoms ,9djtIobiooxo ,YX9msn ,9lodxriqms do zei3eliBV .e311onl3DB bns 9diIoinxd ,9dxIlYriqorfdns Isolni9rio-o9i3Yriq 9rfd bns y^912 sxs aodasdas do sezu edT Isloiemmoo iled3 enlmiedeb as idsixsv dn9xddib 9rid do asidxsqoxq sxnaoqxs moxd pnidltrasx anoxdsoxlqmoo Isoib9m 9riT .sonsdxoqmx Isoimario bns IsoiaYriq 9rid od b9dsl9x oals eis aodasdas od .asiosqa Isiealm anoxdid axrfd do aidX9qoxq UCC 007846 4 2 B. The "Asbestos Diseases" and Other Conditions Associated with Asbestos Exposure___________________________________________________________________ 1. Benign, non--disabling conditions (a) Asbestos corns, warts or callosities Workers handling raw asbestos fiber as it arrives from the mines, often get splinters in their hands. These splinters may cause an inflammatory reaction which eventually subsides leaving a hard, thickened, raised area of skin with a central core of fibrous tissue. There is no information available to in dicate whether this mode of asbestos penetration can lead to subsequent malignant change in distant.' organs and skin cancer has not been recorded as a complication of asbestos warts. The skin continually renews itself and the corns eventually merely mark the spot where fibers once were. (b) Asbestos Bodies In Belfast about one in five of elderly men coming to autopsy had a sufficient number of asbestos bodies in his lungs for these to be detected by examining one or two microscopic sections.^ 2 Thomson , in 1964, reported on investigations which began in Cape Town, South Africa, in 1960. These investigations were intended to determine the extent to which the ordinary urban dweller is exposed by occupation or environment to the inhalation of asbestos. Over 2536 of the lungs of 500 consecutive A i 787 3 UCC 007847 bsworfa nsvo bns anssY 21 do ado9tdna no asxqodus bsdnsda noEjnoriT .bszu borfjsm odd y^ soi&od aodasdaB sXirfw IdQI ni ^BbinoX'J ^xjjibxM nx Y^da nfiXimia s svidiaoq IXsnsvo srfT .9n9rfd noaasdonq 9pnsrfox9 9qsD ni saodd od nsXijnia YXdstfnsmsn 9isw apnibnid 9isw asibod 9dd 99293 svidiaoq sdd do S28 ni .rrwoT aspnsdo YlsnomJ-t/tI ddiw bsdsiooaas don 919W tY-^11533 do noidsnimsdnoo do dXxrasn 9dd as bsbxBpsn 9X9W bns b9nmsx9 asXsm sdd XXs do S3 ni .9i9dqsonidB nfidnu erid do YXdBffluasaq 919W bn anonsmirn snsw asibod 9dd .nxpino Ifinoxdsqnooo nxnsd nsbrur asibod aodasdas b9idiaasIo 9vsd 2 * ni don sib Ydd 9EirB09d anoidibnoo pniXdsaib-non 9is asibod-aodasdaA .sassaib do svidsoibni a9vl9axri9rfd do svidsoibni bns dnsni YXdsdonq ansdid bsdsXnaqsons a'noamoriT do anoidsoiXqmi edT .9nnaoqx9 aoda9das .nsqsq aidd ni nsdsi b9aauoaxb 9d Iliw apnibnid iBsqqs don ob asibod aodasdas ^ vddo3[iX92 od pnibnoooA do noidsXuqoq XBi9n9p 9rfd pnoms b9dudindaib YXfliobnsn YlisnoxdBqnoDO ,dnsdxs dnsdnoqmi ns od vsns dud tfnoY W9W .bsdsXsn bsdnsvnoo bns bsdsoo XXs don sib ansdid aodB9daA Ynsm nod daiai9q ybi ansdid b9dsoonU .asibod odnx .292693 aodasdas od snuaoqx9 nsdds ans9Y nxBdnoo a9ibod aodasdas dsrid nssqqs bXnow dl srid 915 ansdid bsdsoonu srfd dsrid bns ansdid bsdBvidosni Isnsnim nsrfdO .noidsauso sassaib ddiw bsdsiooaas asno UCC 007848 .V fibers can form similar bodies and \ ome people prefer the term ferruginous bodies,"* Glas i fiber, silicon \ carbide, filamentous aluminum silicate and fibrous talc could be confused with coated asbestcl fibers. 6\ Pooley has fotind that asbestos Indies in mesotheliom cases from 4 different countries were sasociated with amphibole exposure and that asbestos bciies detected in these lungs were all derived from am.yibole fibers. The importance of this will become appaxltt later. o A A > (c) Pleural Plaques. Pleural Fibrosis and Plcaral Calcificatio The lungs are invested by a thin laye\- of connective tissue known as the pleura. This membrane covers the '\ outer surface of each lung and is then reflected on itself in the midline to cover the inner suJ.race of the chest wall. A potential space exists betwee1 the two layera. Inhalation of asbestos dust results in v.i y characteristic changes in the pleura which car', oe regarded as an index to exposure. Pleural chat as may also occur after infections such as pneumonia a. \d \ pleurisy, tuberculosis, injury to the chest wall \ind exposure to commercial talcs. \ \ Pleural plaques are well-defined areas of plet ral thickening which are found on the domes of the dia,-' rragm, along the rib margins and in the gutter which runs ^long the margin of the vertebral column - the paravertebi i 1 gutter. These may be recognized on X-rays but often UCC 007849  Yaqodx/s ds b9i9vooaxb s:ie ^hb n"a dbn 9XB amooad \sm pninadoidd XBinsXq 10 zaupslq Isiual^ Yd bsdiioaab need zed noidsoidioiso Ismail .bgxi.lolso od noidnadds vaib aelbuda sssriT ^.bnelniY ni odoniWlX sinsXq add do noidsoidioLso do 9on9asiq bs9;iqa9bxw Wd odox/XiviJi ,,danb zodaadas od b9aoqx9 zaXdlwmrsioo \ni V.pnonts noidsoxiioXso Xs:ii/9Xq 3o pnibnil add no badioq\i do ydiaioiv add ni pnxviX Ydlnx/mrnoo Xboxhc s ni olqog.v ' \ voMIixi/H .aartxm sodsadse adillxdqoddne daso naqo owd'| auoidid add dsdd badaappua xidnaoai BvoXifirfoxM bne an^idjB'adnsonoo nx dn9e9:tq ai rfoirfw ,9dXoxq9a Xsisniin rfdiw JSidBpIxxS 3:o ad"xsq nxBdi90 ni lioa 3o X2 ob qu 3o aldianoqaai ad drfpxjn ,noxbsoi3ioXso leiuaiq 3o aadsi ripirf axjoiiBV ni anoidsoiHioXso iBix/alq XBnoidBqnooo-non io:t 3o YPoXoxm9bxq9 9rfd b9ibxxda aBri addxO 8 . 39xdxisjOD -Ibo isn;9Xq dsdd bmiod bns noidBoxlxoIso lBxir9lq - 9maoqx9 od aub don ebw snanim oadauQ pnoms noxdBox2xo pnixub b9ox/boxq adanb od dud ^diaadi .alidoa-^ido od nirfdxw 29ESD 3o noibndiidaxb srlT .snoxdsisqo pninixn abairb od 9ix/aoqx9 dsdd bawoda yidaubni oadauQ add YlniBjn baiiuooo noidsoidiolBo Isiualq -xol 9ldxanoqa9X rfdiw badBiooaas aiodaiadd siaw bns esnxM bioidsrfT ni add ni soim bns oXbT .anoid.snno3: XsoxpoXosp XbooX adnaps Y^s^i! baom 9rid b9i9banoo 9X9w B9is bioidsrfT 09dsxxD ni noideoidiolso Isiualq iod aldianoqaai .aiartiow alldozYndo bluodz io npinad yIbid a9pn5rfo Isn/olq 9S9rfd 9xA UCC 007850 ) \ (T>1 Cb S' O -33 N 6 they be considered as precursors of malignant changes? This question cannot yet be answered adequately, but in Gibbs' study, persons with definite and suspected pleural calcification showed no overall excess mortality when compared with all persons employed in the Quebec asbestos mining and milling industry born between 1891 10 and 1920. Elmes found pleural plaques in 25% of cases of mesothelioma studied by him in Belfast. He stated that when the exposure was mixed, i.e. to more than one type of fiber, the presence of pleural plaques in a population seemed to indicate a level of exposure * capable of producing mesotheliomas. Edge"^ found that shipyard workers with pleural plaques who had mixed exposure to asbestos (without evidence of pulmonary fibrosis) had a 2.5 times increased risk of developing lung cancer when compared with the general population. 12 Leathart described the lung function results in 181 asbestos workers and concluded that asbestosis was usually, but not always, associated with lung function defects while pleural calcification alone had no effect on lung function. Becklake showed that, while pleural calcification alone appeared to have no adverse effect on lung function, diffuse pleural thickening was accompanied by a reduction in certain parameters of pulmonary function. Pleural changes have been known to be associated with asbestosis for a long time, but changing circumstance UCC 007851 9i:todo6d nil Enoxdsndnsonoo daub baonbsi averf xidaubni nx IsoxqYd srfT .9isriw93l9 9ii/aoqx9 dnsddijjrcsdnx bns nili 919V92 aasl bns nommoo azaL pnxmoosd zi aiaodaadas Ylwols \iav s y^ f>9osIq9'3 9moo9d asrf bns 9d od b92n dd *-9i II9W grid slirfw ,apniil add ni gassaxb 9Vxaa9:rpo:iq amsa 9rfd od pnxat/ooo Hilda sis 39pnsrfo Isitralq basingoo auoivdo 9iom" 9moo9d svsrf aspnsrfo Isnuslq 9S9riT ,dn9dX9 9^9riT .Isminlm ai aaeaalb pnnl pniY-^s^ni/ orfd 93i/so9d axfODO 39pnsrfo IsiuaLq, aiadw ssonsdani amoa ad IIsw y-shi .9SB93xb prn/I pniY-tis&otf do sonssds grid nx V 893695IQ 3Qd39daA r alaodaedaA (s) apm/I 9rid do pnxxssoa io axaondid s ax axeodesdsA sod39das 9ldsixq39i do noidslsrini grid mold pnidltresi bspnoloiq s nod yXIsjjsu ,anodsndn9onoo rfpxrf ni ansdxd badalooaas arid sbr/Ioni anoridns gnio3 .amid do boi9q .noxdxnxd9b airfd ni siualq^ Isiaaalv add do pnxn9riorfd 9is pm/I 9rid do adnsq (d9WoI) dn9bn9qsb 9riT aisax add as aaaaaigonq 329oonq arid bns dsild bsdo9dds do sxaonpsxb 9rfT .asas90 9ii/3oqx9 nsdds nova xy^ op ;no 3bn9q9b aiaodaadas aiuaoqxa do Y^o^irf (I) ds asl^osno Y^odsnxqanl-bng snxd do pnlbnxd () s rfdxw noidsdluoaus no aaasd pnnl 9rfd 9qooaorfd9da Isxdn92a9 ns don) sispnxd arid do pnxddi/Io () (npxa oidaonpsib aagasda \sn-X () UCC 007852 8 (5) lung function changes indicative of restriction of ventilation or impairment of gas exchange. The ILO U/C International Classification of Radiographs of Pneumoconiosis (1971) has been developed for epidemiologic purposes and is descriptive, not diagnostic. A diagnosis of asbestosis can only be made V by examining the worker, the X-ray, the lung function tests and the occupational history. Other respiratory diseases such as chronic bronchitis, emphysema, asthma and certain chronic lung diseases can be mistaken for asbestosis. . The severity and progression of'asbestosis appears to depend on the amount of asbestos retained in the lung. From the time symptoms are first noted most workers can continue to work for 10 to 15 years and may live another 5 to 10 years after finishing work, usually having had to reduce the work-load in gradual stages because of increasing shortness of breath. Asbestosis is unusual under the age of 50. Other conditions leading to the necessity for light work and early retirement may precede asbestosis in this age group. As mentioned earlier, improving industrial conditions over the past 20 years have resulted in a less severe form of asbestosis than C4 was seen in the 1930's, 1940's and 1950's. This disease process may not appreciably shorten life in present day circumstances. A i 7a83 UCC 007853 , 7 ti 8 e iQonsP aodasdBA (d) 3i63" dnods 2sw di *noeXiD od pnib:ioooA njsp9d 20rfE9rfas lo noidBdioXqxs XeiDiemmoD arid nsdl^ Yd bsauso sd od dripnorfd daxiil ssw ^aonso pnnX dsiid airid sioisd sissy n9d isrfdons duods *(eX) daub arid nsrfdnni b bns * (S4>ei) sXdsdoaq drfpuorfd Y-1^9-*911^ esw aodesdas srfd ni bsrf&xXdsdaa YXIsnii ssw di 92o2sd nsd . (aeex xxoa) Yidaubni 9lidX9rf as ess asodB9das io XOd-05 asdsoiXqnioo nsonso pnixl od OE nsrfd s-som anoidibnoo od sissoqxs moni pnidXnasa Bod4?dBS srfd 5o enoidosa smoa ni .YXanoivsdq bissy 0 i T no X'oidnoo daub ni adnsrnsvo-iqmi 5o dosi^s srfd ^ziznbni b sd od anssqqs nsonsn pnuX io YdiXsdnora aasoxs srfd ridiw Xsilsnsq nl noidsoilqjnoo airid io noidodbsn oidsmsib -rfinda dsom srfT .sonsbioni siaodasdas ^o noidonb9i srfd woX 9rfd nsswdsd ai noaiO od pribnooos daB2dnoo pni mod osdsnO ni ansXXjbn bns aisnirn sXidoaYttrfo ni rfaii -ni 9rfd ni rfaii rfpirf 9rfd bos *0ei bns 1Q81 nsswdsd s od n99d svsri asniraoqxs snsrfw aisiiow noidsix/a no t.A.S.U 9rfd ni sdiaoms bns sXidosYdrfs io stmdxira >J.U srfd ni sdilobioono bns owd sa9rfd od bns 6326 soeitma spnsX s svsrf ai9di5 aodasdaA pnnJ . aXsinsdsra xsrfdo 3:0 noidqnoebs woIXs YXibssn no bsdnoabs asonsdadna no bsmeid nssd svsrf ansonso CP y\ i srfome 9dd92po ^aXedsm sosxd as rfona nsdii srfd od sjloma 9ddS2BpiO . esomoa usrfdo moni anod-aeoo^bYrf bng bns asddsnspio 3o noidosasdni srfd bns dnsddoqrni ai UCC 007854 10 asbestos exposure has been well documented by Selikoff.1 Non-smoking asbestos workers rarely get lung cancer. The types of lung cancer in smoking asbestos workers do not differ in their effects from primary lung cancers in other people. The majority of affected individuals die within a year of diagnosis. Although lung cancer is usually associated with underlying asbestosis, some authorities believe that this is not always the case. The risk of premature death from malignant chest disease seems to be confined to those with high dust exposure. Asbestosis usually no longer kills because improved dust conditions have resulted in a "milder" form of disease. Less mortality from asbestosis occuring after longer periods of exposure has resulted in survival of workers through the long latent period of lung cancer. (c) Mesothelioma The association between exposure to asbestos and diffuse malignant mesothelioma first attracted wide attention through the publication of a series of South African cases by Wagner, Sleggs and Marchand (1960) . ^ Subsequent comparisons between cases of this patho logically controversial condition and control patients have confirmed a statistically significant association with asbestos. Wagner et al also showed that neighbor hood or community exposure could be associated with this malignant tumor. A ; 788b UCC 007855 II noidsnnb d9ind do sd y;sm ssD smoa ni eiusoqxS (Isvn.9dni dnadBl) boinsq bsaqsl pnol s ai snsrid bns airiT .ridssb no aieonpsib bns 9nnaoqx9 danid naawdad . 9nom -30 anssY 0 od OS mond sd ybhi boin9q b9aqsl ni noidsatrso adi bed Yidsdonq yb^^ bsaonpsib 92692x0 ax69Y 0-OS n99Wi9d bslisvsnq rfoiriw anoidibnoo pnirtnow / .nspnol no ,ops d'nasob ,YJ-wo^a swonp snn9lq arid ado9dds nomnd 9riT allxif di bns Y^od 9rfd do adnsq nsrfdo od Y-^ik"* bsaiqs asnndoi/nda Isdiv bns pntrl 9rfd pniaa9nqmoo Y-t^ois Y^ nonlmoo aa9l ax nomnd IS9nodin9<3 .di rfdxw bsdsiooaas f1T nnooo nso nomnd sriT . adosdds adi ni nsliraia e bns ob S02 nsrid snom dud abnswno 2 do sps add dirods mond asob pnx^Ioma sddsnspiD .03 sps i9dds lidnn qolsvsb don .nodosd svidsanso s sd od ms9a don do Ypoioijn^kiqs arid do wsiv9n s od pnibnoooA Yd bsdnsasnq sonsbioni do asdsmxdaa mold smoil9rfdoa9m Isnoxdsnnsdnl IIIVX 9rid ds blsnodoM dd9dno0 bns rioailA ,2701 ni ,nodrfpina nx dd!s9H IsnoidsqnooO no aasnpnoD ripxd Yisro9^dX9 si anomnd Isxl9ddoa9m do 9orr9bxoni 9dd oriw saodd pnoms ,anodsInani pnoms :anoidsndia 99nrfd ni 9aodd pnoms bns abnsYqxrfa ridiw seidio ni svil no ni jfnovr aoda9das 9pnsl ddiw eaidio nisdnso ni 9vil no ni jlnow orfw .adnslq smoxlsridoasm ridiw noidsiooaas sdinid9b daom 9dT arid mond ansdxd sdilobioono od snnaoqx9 pnxwollod ai raoxi bns soindA ridno2 nx IssvansnT bns 9onivona sqsD UCC 007856 O CP CP Z' 12 Western Australia. McDonald and McDonald concluded that there are indications in most types of exposure of a gradient in the mesothelioma inducing potential of asbestos fiber with crocidolite being the most hazardous, amosite less hazardous and chrysotile least 17 hazardous. McDonald has recently demonstrated that cases from the chrysotile mines in Quebec, Canada, were due to crocidolite. Crocidolite was used for the Canadian army respirators and this fiber was processed at the site of the major Canadian chrysotile mine. Crocidolite was similarly used in gas masks in Britain. The Canadian gas-mask workers experience exactly 1Q parallels that recently reported by Dr. J. S. P. Jones and colleagues of some 1,600 persons employed, 1939-45, on the same process using Australian crocidolite in Nottingham, England. McDonald calculates that the risk of mesothelioma after crocidolite exposure in the circumstances described would appear to be at least 50 times greater than that associated with chrysotile production. There is no evidence that the general public is at risk of developing mesotheliomas from the fibers measurable in the ambient air. Occupational histories are deficient in those studies which have attempted to correlate environmental measurements with mesothelioma incidence. The correlations between increasing A;7887 UCC 007857 1 II isW bIioW 9Dnxa bas galnub zodzadzs 5o nol^ssili^u io boorfxl9jtxI add pnidsalbnl ^aLdsilai 910m 9is .Max-3 ddLead oxlduq riErfd iBrfdsi Mali IsnoxdBqinjod 9MsJ5 Ms aeuaal grfT .0 J-n9a9iq add ds ad&da dB zauzzi. aotsm sgirfd 9<J od iB9qqB sigrfT :sxv x9mid Yl9isa bg-xadDBlunsm 9d adouboxq zodsadzs obO (I) toa jtl -soda9daB do aieax; od Maxi y**b siadd ax (1) %bn.B zdouboiq pnxnxsdnoo i 6 9dr/dxdanoo 9ii;aoqx9 3o al9V9l wol ob (xx) T TMaxx rfdlsorf oxlduq 7aoda9das io3 bauol sd zadudldaduz xibO (} 9rfd 9Mbjh bnfi Biswans 9rfd sbxvoiq od pnxop ax orfW (E) Tanoxaiosb ' adptfbo^q aodagdaA do pnx-30doB3irnBM .I aezu add do y^sM .bBi-3y"i 926 aoda9daB 5o zazu 9rfT azuBoad eunxdnoo bns Y^ss2909nrur Y-td^doiq zodzadzs do aldsdiuz y^ >soBlq9i 9d donnso dl .bisd 9xb enoxdxbB-xd .SB935 y^^ nx d9Y as eBdudxdadua BiudBiBdxI bliow add nl 9on9bv9 Y^odosisxdBa ax BioriT b9dsl9X 9anoqe93-9aob b zl axao;ta9daB dsrfd sdsoxbnx od b dsdd aonabiva adsupabe xanonnaddn.ud Xax siarfT .azsazib lo a9xd3sqo-3q oxnsponxoxBO add nod. adaxxs oalB 9anoqs3~9ao6 (axaoidxli pni/I aoubonq od Ydxlxds) oxnspoadxl erfT . eodaadze \^ ^ UCC 007858 14 effect and the carcinogenic (cancer producing) effect of asbestos appear to be similar for all varieties in commercial use. The scientific opinion with regard to the proposed gradation of effect attributed to crocidolite, amosite, chrysotile, tremolite and anthophyllite in the production of diffuse malignant mesothelioma of the pleura or peritoneum, is divided. Although most observers believe that crocidolite, particularly that from Australia and the N.W. Cape Province of South Africa, is the most dangerous fiber, that amosite holds an intermediary position and that chrysotile presents the least hazard, some authorities do not accept this tht esis. Having weighed the evidence presented by both schools of thought, I am of the opinion that crocidolite has greater mesothelioma producing potential than amosite or chrysotile and that its use should be strictly curtailed. In the United Kingdom the use of crocidolite has virtually disappeared and no raw fiber has been imported or handled in production since 1970. In reviewing the literature it is obvious that advances in the control of asbestos manufacture did not proceed at the same pace in the industrialized world. The Asbestos Industry Regulations, 1931, which came into effect in the United Kingdom in 1933, preceded the rest of the world by approximately 4Q years (or more). Although it is difficult, if not impossible, to make comparisons of working conditions in different countries for the same type of industry, there are indications that the health experiences are different UCC 007859 21 noidonbondni n99wdad pel amid arid od anb aaindnnoo rfona ni e ni ansrfnow do quonp anO .aannasam londnoo aldsnsqmoo do pr ,VdPl ni anilloD Yd badinoaab Y^odosd nsoindA rfduoS ax naqsq airiT .anoidibnoo ballondnoonn Y-tbsdod ni barfnow noidqinoaab arid dud ,aiaYlsns Xsoidaidsda nod 9ldBdiif2 don ns'' ailso arf dsrfw ni %anoidibnoo do aniXXoD Yd navip daub arfT" a9dsda^,aH .pniYdinnorf ai *'* Ydanidan aoda9das ad blnoo bns *pod senab s baidmaaan pnibliud arid nirfdiw .aonsndna arid rfpuonrfd anarfqaomds arid odni pniqsoaa naaa -noo arid ni adlnsd mold ms9da ariil bsqsoea daub do adaL ^bI daub bns ^aanoloY^ bns allim naawdad amadaYa noidoub f ".sosima pnidos^onq bns msad Ynava no rfoirfd aqsrfnaq sis aadsdcl b9dinU srfd do aisjiiow noidslnani srfT dnsasnq ni aquonp bsdoup Y^sk^w daom bns bsibnda dasd srfd adinasn do noidsoildnq oidilonq 9rfd od sub snudsnsdil Isoibam isniS dnuoM 3b dnsmdnsqaCI aaonsioS Isdnsmnonivna arid Yd ansllim bns ansnim aodasdas slidOEYnrfO .tfnoY wsW ni XsdiqaoH OS bisnoQoM Yd b9ibnda XXew Yusups n99d svsrf osdsuQ ni ro rfoirfw amsidonq srfd Y^osslo sdiup asdsndanomab noalorioiH noidsiuani nod asnnaoqxs daub snidsb od pnirfqmsrfds ni daixs slirfw ,pnirfosX 9ns adnsmsnuessm daub sdsup9bs snsrfw anarfnow Yd bsbivonq noidsmnodni ssilidu od aids naad asrf blsnoCIoM daua" Xudpninsam s avinab od Yndanbni pninim aodasdas srfd osdsuQ ni an9nim slidoaYnrfo nod "xabnl (aaXidx9d) an9rinov/ aodB9das do vbuda badnamuoob daad arfT do dsrfd ai sdsb dnam9nuassm-daub bns Isoibam od bnspsn rfdiw no 99ddimmoD-du2 a'YdsiooS anaipYH IsnoidsquooO riaidinH arid CO CO cc UCC 007860 16 Asbestos Standards which was published in 1968 and recommended a cumulative standard of 100 fiber/cc years for chrysotile 22 asbestos. In 1970 NIOSH reported that records of dust concentrations between 1930 and 1967 in one asbestos textile factory, and between 1948 and 1968 in another, were assembled in the Pennsylvania Department of Health. In a report presented at the Western Industrial Health Conference by Howard Ayer, it was disclosed that, using lung function as the most sensitive indicator of asbestos health effect, it appears that cumulative exposures below 50 fiber/cc years cause no reduction in FVC, and exposures greater than 200 fiber/cc years are usually associated with reduction in FVC. If this emulative exposure were spread over 30 years, this would mean that concentrations less than 1.5 to 2 fibers/cc would cause no reduction in FVC; and that concentrations greater than 7 fibers/cc would usually lead to a reduction in FVC as well as X-ray changes in loss or more of workers. The present standard in the U.S.A., and most of the world, is 2 fibers/cc and is based on the BOHS Standard for chrysotile. In the United Kingdom and certain other countries crocidolite is dealt with more stringently because of its association with mesothelioma. In October 1975 OSHA proposed a tightening of the standard to 0.5 fibers/cc and in December 1976 NIOSH recommended that it be 0.1 fiber/cc. The argument regarding the adequacy of the standard is dependent upon the "no safe threshold .for a carcinogen" theory. There is qualitative evidence that the 1931 Asbestos Industry A 1789 1 UCC 007861 gnlauba? yIbsjTxsm 3o dosing 9rfrf bed .X.U add ni anoidslL/p9fl 829DX9 9rfd pnionb9i Y^^-i^1*2 bns sisorfasdas lo 9on9bioni srfrf grid yd b9xbxjrfa Y^od^si asn&a srfrf ni i9DnBD pnul moil arfrfsab S airfd- nx naea pni9d Ilirfa ax rfoslls iBubxasx smoa .3H0a nx rfpirf Y-t9V^dBl9X Ilirfa 9isw alsvsl daub aausoad Y^dos5 srfrf rfsrfrf bnxjn ni pniis93 .Y-^dnsogi y^sv iidnx/ 36 9X5 Y^m aorfasdaA van rfsrfrf *8391 lirfnn bsrfei J"dxjq don asw bisbnsrfa SH03 9391 Ixdnn mobpnxX bsrfinU add ni 9bsm don 9isw anoxdsInp9H b9ilqqs Y-^-S-i^-^lo don sbw bisbnsda oo\ai9dil 9rid rfsrfrf bns as nBo anolaulonoo on rfsrfrf anoivdo a rfi *0V9I lirfnn atadd badosdds Hid a rtaxn do i.9V9l 9rid od bisp9i rfrfiw nwsib 9d d9Y .bxfibn^tfa airfd rfrfiw eonfiilqmoo Isrforf ni anoidibnoo ni pnirtiow od Tt,' pnibi6p9n a9naai nism 9rfd W9iv9x od b9rfqm9rfrfs pnivsH at b9aoq noirfasnp 9rfrf od nav/ans add ,9inrfolnnsni aodsadas aonabiva add dud ,9x1/2 nod wonrf don ob bw dsrfd Y-tajJo^vdo YisdBJJpgbB nsrfw ,dsrfd noianlonoo 9rfd abisworf pnidnioq ai 9d nso X93/1S9 pnul bns ataodaadas do rfaii add ballotdnoa srfd qn bammua -asrf rfosofl .id .Xin Y--SIJdniv od bsoubsi tawollod as noirfsurfia ai 9X9rid drid b9dsxo9xqqs ai di n9riw e98ins m9ldoxq A" lo 99x1 \leduloed 9d od biss sd nso rioirfw 9TtrEoqx9 on ni bl9ri sxuaoqx9 bloriEsxrid 9laniB on e! 9X9riT .sieix sirid ,Yldn9up9enoo ,Ei sxsriT ,snoYX9V9 yd nommoo 9riT .9xi/Eoqx9 od noidl9x ni jfsix gniEssxoni yllenbsxa MM ,0AM ns ,VJT d99m od loxdnoo deub lo noidsoilqqfi bns dinxl Iliw bxsbaEde snsigyri XfillinxE xerfdo no ,91/Isv .ones od di sonbsx od yieifilm/ zl dud >iaix slid londnoo yl9bxw yxev ex eodsodas drid b9xsdm9:n9x ad od asrf di .9gxsl ds ydinuniffloo srfd od adxl9n9d l9x egnind bn bsan lo daoo 9rfd dsrfd dnssnlxda 02 sbsm sd bluoo bxsbnsda A bn noidcmboxq arid dsrfd ,svxdxdxrfoxq ei loxdnoo daub bns noidouboxq ,oiaonoo9 sd od e9S90 EOdasdas lo seu 9xs adxl9n9d bsisiooEas arid bns b9unxdnooaxb ai seu lo >.'alx srfd gnioubsx yd bsnxsg Edxlen9d 9riT .daol CO CX ^ UCC 007862 18 asbestosis through reducing air contaminant exposure ! have to be weighed against the possible los3 of direct v and indirect benefits to the community from the use of the material." He goes on later to remark: "The air quality attained in industry in different countries does differ and, no doubt, will continue to differ. A wealthy country can afford to spend more money on air-contaminant control. AI30, a country very conscious of the slightest risks to which its workers may be exposed through their occupation may be expected to have different standards from one which is not, where other health risks may be so much the greater. The benefits to the community from the use of inexpensive asbestos products have in some measure to be weighed in the balance against the benefits to the health of the workers that would accrue by reducing asbestos du3t exposure." The further comments of Dr. Roach are of interest and I quote: "To derive hygiene standards for an air contaminant which provide a known degree of protection against a health hazard, it is necessary to have a body of data showing the amount of air contaminant to which people are exposed and the corresponding effects or lack of them in the people. It is also necessary to have a grasp of the consequences to industry and users of limiting and controlling emissions of the contaminant. Our present information is very imprecise, particularly in terms of the practical consequences of specific hygiene standards. In developing recommendations for a hygiene standard, the British Occupational Hygiene Society Sub-committee found that knowledge of the relationship between exposure and risk was not the greatest area of uncertainty. A much more difficult and contentious problem was to decide on what, in fact, was an acceptable level of dust control. More information is needed, for example, on the expense of dust control. V/here this is done by ventilation it is important to know what is the minimum amount and what kind of local exhaust ventilation and dilution ventilation is necessary to achieve a given degree of air cleanliness in a work place, since costs tend to climb as the cube of the air flow. Research is needed to determine the balance between local and general ventilation which produces a specified degree of control at minimum cost. By setting down the capital A:7893 UCC 007863 ex ,b4boo eonansdniam bna gninnun ,4boo noidBllsdeni ,deoo esonsupsenoo arid s^om qeBng od 9ldieEoq esmoosd di Jo bn1>! airiT .abnabnada 9n9igYri naluoldnaq gnidqobs do eodeades do blsid 9rid duoriguonrid b9b99n ei noidamnodni do edeoo 9rid qu rfgi9w od 9lds 9d od sa oe Xondnoo deob .EB9niXnB9lo nia rigid gnivsirios bnsbnade Y^iXsup 'I-2 115 do solorio erid 9oub9n don e90b eiriT bssn arid biovB di B9ob non ,noidBUp9 iBoidjsmsridsm s od .bnsbnade do 9oiorio arid ni dnsagbut, 9siw 9eion9X9 od bb9X 9XddiX b cooed nso dnsmgbut rid ,nsv9woH n.dn9e9nq da narfd Y'iS'tfidns ni ai -gnlbssd svoda arid isbmj b9aoq ncida9up 5noosa sriT . adouboiq pninisdnoo eorfa9das do aiaau od rfaii odd od bisp9-x ,YXdn939i Xirfnu bna duoripuo^rfd bsau ax aode9daA di ,w9d rfoorf aisau .Y^rf^kni pnirndoadunsm srfd do sbiarfno > on b9daX9i-9eob si aiaodasdaa aeusosH . anoirfusos'xq y*'1 andau ni 9auso airfd mold dns'nsqqs asw bisssri rfdXssrf srfsibsnimi 9rfd ni ai sXni airfd od noidqsoxa 9rfT .adDi/boaq aoda9das do b9?{najn smaosd asaao do spxuaqu 9rfd eisrfw Y'srfstfkni noidsiuani do dXuB9x a aa YXdadotiq *a'OdPX yXibo bns a`05PI srisl srfd ni pni'iub anoidibnoo nooq -39bnu 9psau aodB9daa ni sassxoni arid ai9b:iip odno aodasdas pniYSiqa do 2B9Doiq 9rfT .II ibW bXttoW do xoiisdni arid no aode9daa pniYsiqa ,apnibXiud saii-rfpirf do 9au 9vian9dx9 srfd bna noiriaXuani bni/oa bns ds9rf lod apnibXiud YXdsdonq asw amaiponq pnibXiud-qirfa Xsvsn ni 2290010 airfd do enoidsi9qo Xsoinsrfo9M .i9vs 3930 auobissarf daoni 9rfd do sno arfoubonq aodasdaa do pnibsnds -30 pniIXixb ,pniwsa arid as rfoua bnsrf narfd daub 9iom sdssio aXood 39Woq bns daub srissio XXiw srfd no bnsqab oaXs XXiw bsoubonq daub do \didnsup srfT .aXood nsrfrio do siurisn srfd bns douboiq srfd ni eodasdas do rinuoms bsaad-aodasdas 9nsrfw xa9aasoo3q noirfiXomsb daoM .2rinenoqmoD UCC 007864 ) d' O CP /I ! Tf 20 products are being removed, are likely to give off considerable amounts of dust. It has been shown that brief exposure to crocidolite asbestos can result in development of mesothelioma. Users of asbestos products are usually exposed intermittently and accumulate a smaller dose of dust in the same period of time as workers continuously exposed in manufacture of asbestos products. Mesothelioma may occur in the absence of asbestosis. Mesothelioma has occurred in plumbers, carpenters, electricians, etc., who were exposed in the vicinity of insulation workers or others using asbestos. It has also been reported in persons who have lived in close proximity to crocidolite mines and mills and factories or building sites at which crocidolite asbestos was used. From all the epidemiological surveys there are between 5-30 of cases of mesothelioma in which no evidence of exposure to asbestos can be found. It has been shown that nearly everyone who lives in an urban community has some amphibole asbestos fibers in their lungs. There has been a great deal of controversy as to whether asbestos brake-linings constitute a health risk in terms of exposure of brake service mechanics. The epidemiological surveys conducted on this population have been carried out very recently by the Selikoff group, and no other epidemiological evidence is available as yet. There appears to be some evidence of radiologic changes in brake-service mechanics in the group 25 studied by Selikoff but no evidence of frank disease. At the Annual American Industrial Hygiene Conference last A ; 789b UCC 007865 IS jf-xow nsqonq do 93U 9rfd dsrfd pnxworfa sdsb b9dn9a9aq HSOIW ,rfdnom 9Dvi3 8 9>CBid do snuaoqxs sod39das srfd 9oub9n binow BSoldoBaq do ridOS\I Y-CsdBmxxo-aqqA) -I9V9I wol Y-[9m9'i;JX9 nB ri aolnsrfoani evaal Y-tT-norfa II iw HBOIW (.Isvsl AHBO aldlaalmnaq Y^daaaaiq arid 9riT .a9Dxrioxq rinow 9lddq9oos pnxnxlduo nidsllud Isoxnrfo9d b -nl od lBoidn9bi daomls 9d IIxw 39DXdosiq rinow b9bn9mmoo9i noidoxnd IIs od nBddrfnM-aod39dYBfl y<* bsbivonq anoxdounda / -3XB9Y S\I-S dasg 9rid nod ansmodeuo Isxnndsin nxsdnso do 9au arid od bsrfosdds riaxn 9irioa Y-tsuivc{o sx BisriT bns daub on ddo 9vxp Y^sra dud varioubo:iq pnxnxsdnoo aodsadas \993 nxBps xsvsn ,.od9 1Y2BnirioB.-n nx bsdsnoqnoonx sono tan9rfdo jbrfd nl nsrisd sd sybwIb bluoria s-xbd dssnD . Y^b do drfpxl srfd al9V9l daub 9rid bns dx pnxnlfidnoo alsn9d/n bns aod39dss do 93u -non nBm srfT .b9nxup9d mumxnxm 9rfd wol9d 9d aYswIs bluorfa pnxblxud dlsaxuoY-dx-ob nx ax aoda9das do 9su Isxxdaubnx nxsdnoo rioxrfw adoubonq oxda9jnob sraoa oals 9iB anariT .alBinsdsm ax si9rfT .39onBxIqqs Isoxnd09X9 ejjioa as rfous ,EoJ29d2B sdoubonq oxd39mob jnond b9ax9qaxb pnxsd ax9dxd do Xsxn 9ldipxlp9n noxdxbnoo boop n 9ns Ysrfd- b9bivonq sau Isnoon nl aladsL pnxnnsw adoubonq aoda9das do sauaxm 9rid dn9V3nq oT bsaxvbs 39oido'xq rfnow bns b9Xdds sd eybwIb bluoria YBa od soxddua bluoria dx noxdasup bixrid 9rid od i9wan6 nl dnoqqua od sonsbxvs loxpoIoxm9bxq9 b9rfaxlduq on ax 9i9rid dsrfd .oxlduq Isnonsp 9rid od nspnsb 9ldxasoq s do axasridoqYri arid baJaalinem bybwIs svsrf aojaedas do adosdds Ifioxpoloxd sriT bsaoqxs aleublvlbni do aquoxp no al&ublvlbnl nx asvlsamsrfd nsrfd n9d69np 9budxnpsra do ai9bno xnsm anoxdsnrfnsonoo daub od CO ^ 1^ j UCC 007866 22 levels measurable in the general environment. One major area of concern is the ingestion of fibers from water carried in asbestos cement pipes or from the filtration of wines, beers, spirits, beverages, etc., through chrysotile asbestos filters. This concern arises mainly because of the demonstration of an excess incidence of gastro-intestinal cancer in certain heavily exposed asbestos insulation workers and heavily exposed textile workers. It is interesting that the textile workers studied by the BOHS do not exhibit a similar excess mortality from GI cancer. If the use of chrysotile asbestos filters is discontinued this would be a retrograde step. The ingestion of chrysotile asbestos t and other types of fibers in experimental animals has failed to produce mesotheliomas. From human evidence, only people with a severe exposure to asbestos dust have contracted peritoneal mesotheliomas and these tumors have not been found in any of the asbestos mining areas except those mining crocidolite, in spite of the very heavy dust exposure especially in those exposed to chrysotile. 2. Asbestos Substitutes The major health problem associated with asbestos exposure is mesothelioma. As has been stated earlier in this paper, asbestosis can be controlled and lung cancer appears amenable to similar controls, but because the latent period between first exposure and diagnosis of mesothelioma is long, and this malignant tumor's association with asbestos exposure is a recent discovery, sufficient time has not yet elapsed to determine the level of dust capable of producing this response. Some evidence A i 7897 UCC 007867 E .->x s/nid 9dom dx/d tb9dBl9i 930b ai Bcnoxiarfdossni dsrfd bsp'isnis asrf YXsuoxvs-jq dosdd9 3:0 noidsbsip srfT .saob sirfd 9nijiri9d9b od bab99fl srfT ,noxdn9v9:iq do dxsdnoo ad3 ni dnsdioqmxE9moo9d b9BU02xb Ysm bns sonBdioqmx do ens sdo9dds do noidBbBiip airfd dod snoassi eb 8lsxi9dem si/oddid dsrfdo pnian 3to Y^i-t-*^863^ 9f^ 9ninri9d9b ,EOd59das nod asdi/didadna 3S snoxdsbsdp srfd nxsXqx9 pso XXsddmiT Yd b9qol9V9b Y^osrf^ srfT eH . EodssdsB do B9qY^ zuoii&v 9rfd do Xsxdnadoq oipoXoxd n 9rfd nx b9dXsoq9b 916 aisdid pnoi dfirfd adasppx/a nxsXqx9 Y^m airfd dBrfd bns anoirfsomdid 3s B9Xoirfonoid YdOds:iiqB9d . YdOdBdiqasd ridiw rfBdid b9dsioosBB 9d od abnsd BxsoddXd y^w dsrfd sdasppi/B oeXb 9H .Bdsdxd pnoX rfdiw bns BsXoxrfonodd bsiBonioo Edsdxd 9XodxrfqmB do sqsrfs "3B9niXxdo9-3" oidBidarfosisrfo 9rfd swoXXs ,Bi9did sXXdoaYdrfo do Ypoiorf<Iifn "yXiuo" 9rfd od Xdn9ioxdd9 9dOm pnxrX 9rfd do Bddsq isqssb od sdsndansq od egXodXrfqnjs boaoqodq n99d Ei/rfd asrf Ydosrfd 9Xdsnoas9:i A .Bdsdxd siidosYdrfo nsrfd dl - asmoxXsrfdoasm do dnsniqoisvsb 9rfd aod noessi 9rfd nxsXqx9 od 9dsid9n9q od dsdid do E9qYd nisdioo do Y-^dXxds 9rid noqd b9asd b Ydxvso XsdusXq srfd rfoB9d od bns aisrfdo nsrfd pnnX srfd odni i9q99b .noxdBddsnoq dosixb y<X daoni lod rfpi/orfdXs dripxroa pnxsd 9is aodasdas iod esdndxdadna sisdsnim anoidid dsrfdO .d9Y as bnnod ns9d 9VBrf 9non esaoqdx/q .bXoow Isienlm bns axsdxd BBsXp m9rfd pnoms bsiid pnxsd sib 9XdsqBo 919W eisdxd rfons di dBrfd sdsoxbnx sdns/nidsqxs XsuiinA BoxdBXdsdOBiBrfo XsoiaYrfq s/tibb srfd bsrf .9.x .sxngXq srfd pnirfossd do . BBfnoxIsrfdossm 9onboiq bXxroo Y^rf^ ,Bd9dxd aodasdas 9lodxrfqxns bb 9rfd odni noxdsdnBlqmx 9rfd aoqu abneqeb soasbivs eldsLisvs erfT Jr- UCC 007868 : ^8 03 24 pleural cavity by open surgical techniques, of the various materials tested to date. Both in Europe and in the United States epidemiological studies have failed thus far to demonstrate any carcinogenic hazard to workers in the man-made mineral fiber industry. This is a field of very active research and should hopefully provide answers in the near future which would prevent a repetition of the asbestos tragedy. 3. Who is going to decide? (a) Scientific Opinion "As long as there is any airborne asbestos dust in the work environment, there cay be some snail risk to health. Never theless exposure up to certain limits can be tolerated for a lifetime without incurring undue risks." (Roach)214 "With this discouraging picture of inadequate knowledge of risk, ill-defined exposure information, and limited enforcement of existing levels before us, one may well ask of what value a TLV is for asbestos, or for any carcinogen. Should such materials be banned from use in all forms? Asbestos is extensively used in industry for insulation, for inclusion in plastics and other products, for reinforcing high-3tress materials. At present, nearly 1 million ton3 are used annually in the United States. For some uses, as in brake linings, it is difficult to find a replacement. A societal decision to ban the use of asbestos would create serious, if not insurmountable, difficulties. Moreover, we would still face control problems posed by the large quantities of asbestos in current use. Our only recourse at this time is to limit human exposures to asbestos and other similarly recognized carcinogens to the lowest possible levels, with existing technology. In the case of asbestos, a TLV can serve a purpose: Recognizing that it is, in fact, a Risk Limitation Value, however ill-defined that risk might be, it can serve to mandate implementation of available technology and rule out the small fraction of work processes in which available technology fails to keep up with the major portion of the industry. More, however, is required than the specification of a number. The specification of work practices and engineering controls offers an essential supplement to a numerical TLV if the latter is used at all. Application UCC 007869 A ; 789J ^S. ,.'%v B9nub90onq 9ldieB9l y-^99*^199^ ^nB ^IlB9linono99 yasm lo iBoinamun gnxdEXxs woX9d rionm el9vsl od anuEoqx9 aouban nso E9nub900nq rioua tn9VoanoM . badbnni 9d bloods SB9riT -89ulsv dn9ffl93S/ism-noIno-dn9mm9v03 dniot ridxw b9xlxoeqE 9d nso nsrid Ylxb9T anota doom b9nodxnom 9d nso bfis noxdfinsqooo EbiBbnBde aoxdofinq-oHow bns sVJT .enoxdBndnaonoo daub aso Snxv9ld9 od W9iv ridxw Y-t^B9up9al bawaiven 9d bluorfa noidsoilxoaqs 9riT . Eanuaoqxa i9jhow ni noidouban b9unidnoo dnaaqolavab add nol euXumida s es avnae hbo VJT b9Eoqonq lo Ifioisosai duo eXun od no Bboridam Xondnoo-gnineanxana wan lo sninaaniana wan eA .baXXondnoo 9d donnBO ddd E9ee90onq bnfibnsdE Ifiminxm s lo gnxnawoX grid ,avXova edns3qol9V9b lo/xiold0llio9qE arid ridxw gnoXs U9>Isdnebnu 9d n0 .E6Tub90onq alnow avidoadonq Xsnoidibbs eodE9dss 9rid ni sofilq na>ld esri Eirid ,dnadxa bsdxnxl & oT . (nosIorioxK) " . Y-sdeubni sdnanoqnoo 9rid lo owd ylno 9i asnoasan aeob bn bloriesTriX*' .noldlu39n bri Xondnoo Isdnamnonivna ni gnx^2!-noxEX99b ni dneE9nq Bdi lo 11s ridiw ,db oilxdnaiOE od noidibbB ni 9dioqnoonx daum YdxIxdxEnoqeen ridiBari oxldoq .Efioxdsdimll rioua eajiovnx siriT .dnaagbof, ni nodosl es ''aonabmq" YXdnaaan E ^'jJex'i'' bns "eoxdBn dxlanadNdaoo" eb e9ussi n deod d ,oidn dilanad\deoo 9riT .jIXbI Yd bawaxvan od dsoo" 9rid edssniXab y*'3"^9 deum ,dnamnsdd avieuXa noidudindnoo 9Viddxdnup aril ".moriw od dllanad" bns "inorfw monl b9vxnab Y-I^ldna 9d 'Yllfiodniv dsun noxdsupa Eirid od lo noidEinmus arid - "Jlsin" lo dq9onoo arfT .nan no sdsb ,noidXuqoq od baxlqqs nsriw - asnoqean 9sob bn bXorieanrid eb nsiEOri no bagsd Y-^vlEuXoxa don dud Y^d2neqEibni ex od noidudindnoo Y^ods^odfiJ .dBb iBdnaminaqxa no eb IIsw biorfeanrid lo dq9onoo aXdsnad Y-^^id'na arid EasesqEoana "^Ein" lo doatduE 9rid od bseesabbs n9riw 9Enoqe9n asob as Il9w es od sdnags Xfidnsamonivna lo EbnBssri 9rid :aonanalnoo arid ^s.(nido2) ".nsn snoxrriJ sbsnT (d) nissob arid Y-teS"39! naad EBri dnamsEassB jiEin ,deq arid ni" evBri oriw Edaidn9ios dneannavog bns ,Xindsubnx ,oxcabsoB lo noxdBmolnx niarid ansriB od aidiesoq eb gnoX es bsdxsw yllsueu nol bean arid no euool XXxw noxEEuaeib eiriT .En95>now ridxw owd dB no gnxog eeeoonq b ad od dnsssEasEs Jiexn .XsooX bns Isnab9l .eXavai ^ q ^ anidd9e-fcnbnds arid ni dn9n9viovnx Xsn9b9l nol b9sn 9riT riaxn oxn93oniono gnibuXonx EJiasd ridxw .euoxvdo ex Eeaoonq n9riw bns ,dn9m9onolna ,3nidd9e-bnbnsda ,lX9Edl dnsnseaess gnl9d don sns en9>inow lx enoxdBoxixboo T9ridnul ,Y^seE90sn Esri dnamsvlovni T9>Inow nol ba9n ariT .bsdo9donq Y-sdaupebs Xanabal axrid gnxnua .bssingooan need Yi^339""3 sion y-Cbo nx9rid no sna>Jnow lo dnasavlovnx srid eesoonq gnxdd9E-bnbndE !>- UCC 007870 representatives is critical to the design of an adequate standard, monitoring, and medical surveillance. Once set, workers must have an active and informed role at the local level in assuring that the standard is enforced." (Wolfe).2 "To reiterate, the most difficult decisions to be made by government will not be scientific in nature. Social and moral decisions will be made that can channel and shape the development of our control technology, which itself will become a major determinant of our future welfare. In this process, labor's contribution is unique. Alone among American publics, the worker is most exposed to environmental- insult both in the community and in the shop, while being most vulnerable to the economic consequences of control. He and his institutions are of necessity, therefore, In a position of forced objectivity. Thus his is a critical voice to be heeded. The participation of organized labor is not automatic. A positive effort must be made, an effort I call "positive public advocacy." This is an essential government responsibility, Involving the public in decision-making processes such as the assessment of environmental risk." (Samuels).-9 (c) Government and its Agencies "Because the Federal government has provided for a National Cancer Plan under the leadership of the Director of the National Cancer Institute, it must be this Federal agency that provides overall leadership for an effective integrated national program for prevention and control of occupational cancer. A splintering of responsibility for research and training can work only to the detriment of the worker. The NCI cannot retreat from its responsibility to provide regulatory agencies with information concerning risk of exposure to specific chemical, physical, and parasitic agents demonstrated to induce tumors." (Lassiter-OSHA).3 4:7901 UCC 007871 ) 253M3flgT5fl Eod29daA do noidudxadexCI srfT" :(836X) .3.q ,E9mX3 & .0 ,Xi93^ .esdssdsA eeb nspni/jInlW 9rfoaxpoXoxa ".pnnJ erfd nirfdxW 29iboa ,S-6S .qq ,n9bssaCI ,8301 snsasdnoX Xsnoxdsna9dnI S ",i9ll9wa nsdaU srid bns eod2Sd2A" : (2361) .D.L ,noamorfT ,1 . daA ,X .IoV .Esonsloa do y^^s^A ^"aoY wsW sifd do aXsnnA .fcX-36i -qq EodE9dEA" :(0V6X) nsXY^d -3 ,bnommsH bns .ti.I .ddoXiXaS^ ".9miT do aboxasa owT nx noxdsXi/qoq Y^dO JfaoY wsH 9rfd nx 29xboa ,pai/dE9nnsrfoI. ,9onsa9dno3 Xsnoxdsna9dnI .Exaoxnooomn9nq :nl .onxqsria -A -H Y<d bsdxba . 636X bmf' XsoxdqO srfT" : (Y6X) .D.A ,nodssIqq9H .bns -T ,ddonorfaA^ asdxa aodascfaA Y^snomIn,I do noidsnimasdsO oxqooaoaoxM noado9X3 ".noi^3B9fl IsoxpoXorfdsq nsiiuH srfd od noxdsXsa edx bns noldsadnsoncO . :_3 ,YpoIoridsq XsoxniX3 do Xsnnnot. r.O.M.t. ,2xvsd bns *, .b.J ,YsXXsa3 ;.3 ,9XXxvsaT ab -,q ,aaoaO^ .3-62 \28_ .rfdsq .rioaA ".asxboS Euonxpnmsa Y`x6nomduq":(8d6i) ".eauEoqxa od noxdsl98 ni smoXXsrfdoasM" :(Y6X) .0.3 ,Y9-ooq** 2noxdSDIdnq oldidnsioS DHAI . sodasdsA do adosdda XsoxpoXoxS .3 .L ,noaXX0 .3 .L ,XX9admxT .V ,x?(Eoopoa .q :aaodxb3 .8 .oH .2SS-SSS .qq .a9rrpsW r asrfdnira :EOd9d2A bns asupsXq XsaxrsXq" : (2361) .3 ,odoxrXxvx>i ". ajtaodasdaA Xsnoxdsqi/ooo-noW asrfdO bns oxraebnS no anoxdsvasadO . ..6ES-2EE .qq .1 daA ;SEX ,o2 .bsoA .Y.H nnA g dnsdno3 eodE9daA" :(0Y6X) ,J ,svoXxsrioxM bns T ,vo?(Xiaua . :. ,B9H ,axvn3 ". axaodE9daA Xsau9Xq oxmsbna bns XxoB srfd do p Xsan9iq do Y^Q-to-^s&xqa 9rfT" :(SYei) .W jnsrfsaD ,eddiO 9dsnbsaD do Y-dXuos3 srid od b9ddxmdxr2 axasrfT A ": noxdsoxdxoXsD Edn9m9axxjp9H arid do dnemXXxdXxra XsidasO ni rfoassasH bns asibulB. .Xs9adnoM ,YdxsasvxnU XXxDoM ,Yrfqo2oXirfq do aodooO do 99ap9d srfd aod do smoil9rfdOEsM do YxodaxH Xsai/dsW erfT" : (SY6X) .3.q ,E9mXa0J: bns EnsxoxsYri^ do 29p9iXo3 rfai.nl srfd do XsnnuoL ".snnaXq 9rfd VXX :X, .2no9pana -j O CO s\ UCC 007872 2 Edge, J.R. (1977): "Asbestos Related Lung Disease in a British Shipbuilding Population with Particular Regard to the Incidence of Bronchial Carcinoma in Men with Pleural Plaques. A Mortality Study." (Abstract). Amer. Rev. Resp. Dis. 115 (4) part 2, 212. 12 Leathart, G.L. (1968): 'Pulmonary Function Tests in Asbestos Workers." Trans. Soc. Occup. Med. 18: 49-55. 13 Becklake, M.R.; Fournier-Massey, G.G.; McDonald, J.C. and Rossiter, C.E. (1968): "Relationship of Functional to Radiographic Change in Quebec Asbestos Workers." Biologische Wirkungen des Asbestes. Internationale Konferenz 1968, Dresden, p. 207. 14 Gilson, J.C. (1973): "Asbestos Cancer: Past and Future Hazards (Abridged)." Proceedings of the Royal Society of Medicine, 66: 395-403. ^Selikoff, I.J.; Hammond, E. Cuyler and Churg, J. (1968): "Asbestos Exposure, Smoking and Neoolasia." J. Amer. Med. Ass. 204: 106-112. ^6Wagner, J.C.; Sleggs, C.A. and Marchand, P. (I960): "Diffuse Pleural Mesothelioma and Asbestos Exposure in the North-Western Cape Province." British Journal of Industrial Medicine, 17.: 260-271. 17 McDonald, A,D. and McDonald, J.C. (1977): "Mesothelioma and Asbestos-Fiber Type." Amer. Rev. Resp. Dis. 115 (4) part 2, 229 (Abstract). 18 Jones, J.S.P.; Pooley, F.D. and Smith, P.G. (1976); "Factory Populations Exposed to Crocidolite Asbestos - A Continuing Survey." Environmental Pollution and Carcinogenic Risks. IARC Scientific Publications No. 13. INSERM Symposia Series Vol. 52. ^Collins, T.F.B. (1967) : "Asbestos - The Lethal Dust." S.A. Med. J., (July 15) pp. 639-646. 20 McDonald, J.C. (1973): "Asbestosis m Chrysotrle Mines and Mills." Biological Effects of Asbestos. IARC Scientific Publications No. 8. Editors P. Bogovski et al. 21 Nicholson, William J. (1976): "Case Study 1: Asbestos - The TLV Approach." Ann. N.Y. Acad. Sci. 271: 152-169. 22 British Occupational Hygiene Society (1968): "Hygiene Standards for Chrysotile Asbestos Dust." Annals of Occupational Hygiene, 1]^: 47-69. UCC 007873 4 17903 e bns .H %XXod ns nx ansMnoW pnomA . (aa9iq arid nl) .bsM C xosnxX ;.3 ,5ttewoH ;.T, tod9q \bu3Z Y^iXs^oM A" : (VV3X) .D.H ,nrfoanxwaI .-xdaubnl .1. .xa " .Y^oiosa ao^asdaA rfaxXpna ". aoitasdaA io3 sbisbnslZ snaipY1*" : (0V8X) .A.3 Ariosofl^S . 2X-V .qq xX .IoV .pYH .qi/ooO .nnA ;d:x9dXA xTtaXIiM : (dV6X) .L pnxvnl . 8XS-V0S : 3S luridlA xXrfofl ;.V.W v^9mxioJ ,33o?{ii93 bns .L msxXiiVf vnoaXorfoxW ,9n9xbsM 3o Xsn-xuoL xsnx2 dni/oM sriT XsoxpoXoxda as eiodosl XsoiaYrfq" : (VCX) .V ,Xi9idmxT ox3xdn9xo3 DXAI-' .eodasdaA 3o ad09333 XsoxpoXoxH amaxnsrfosM .Xs ds x?favopoa . q y^ bsjjtbZ . 0-G .qq .8 .oW anoxdsoiXdxrq VS bXorfae-xriT bns qxrfBnoxdsXsfl 9Bnoqa9H-9aod" :(dVei) .q vnxdoX .8S-SS ; X VS .loZ .bsoA . Y.H .nnA ".sdqsonoD OQ j(axH nx dnsm9vXovnI nsJhtoW loi 9asD A" :(dV9I) .3 x93;XoW . 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