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PLAINTIFF'S EXHIBIT Ennranmental Health Pcr^fieetire> VoI. 53. pp. 91-98. 1983 Epidemiology Study of the Use of Asbestos-Cement Pipe for the Distribution of Drinking Water in Escambia County, Florida by James R. Millette,* Gunther F. Craun,* Judy A. Stober,* Dale F. Kraemer,** H. G. Tousignant,*** Ellen Hildago,* Robert L. Duboise* and Jeffrey Benedict* Cancer mortality for the population census tracts of Escambia County, FL, which use asbestos-cement (AC) pipe for public potable water distribution, was compared with cancer mortality data collected from census tracts in the same county where other types of piping materials are used. An analysis of covariance was run to test for differences in standard mortality ratios for seven cancer sites among three potential asbestos exposure groups based on AC pipe usage. Twelve variables representing nonexposure-related influences on disease rates were combined in four independent factors and used as covariates in these analyses. No evidence for an association between the use of AC pipe for carrying drinking water and deaths due to gastrointestinal and related cancers was found. The limitations on the sensitivity of the analysis are discussed. Introduction Concern over the presence of asbestos fibers in drinking water supplies began in 1973 after mil lions of mineral fibers per liter were reported in the drinking water in Duluth, MN (1, 2). The question of possible increased risk of disease re sulting from long-term ingestion of asbestos fi bers in drinking waters is important because the association between some occupationally exposed asbestos workers and increased risk of respira tory and digestive disease has been documented (3,4). In June 1974, electron microscopy confirmed that fibrous material recovered from a kitchen faucet strainer in Pensacola, FL, was asbestos. While the source of mineral fibers in the Duluth water supply was related to industrial discharge of mining wastes, the fibers in the Pensacola Tbideology and Microbiology Division, USEPA, 26 West St. Clair Street, Cincinnati, OH 45268. tPresent address: University of Iowa, Iowa City, IA 52242. tEscambia County Health Department, 2251 North Palafox Street, Pensacola, FL 32574. Retired. water appeared to be connected with the deterio ration of asbestos-cement (AC) distribution mains. Because AC pipe is used to carry drinking water throughout the United States, it was de cided that a study of people should be conducted, by census tracts, in an area where there was evidence of fibers coming from the pipe. Study Area Escambia County is located on the Gulf Coast in the upper panhandle of Florida. A little over 200,000 people live in the county, which is divided demographically into 40 census tracts. Some of the tracts have been receiving water through AC pipe for 30-40 yr, other tracts have been serviced by nothing but cast iron pipe, and still others receive water primarily from private wells with no AC pipe. Data on water quality from 25 wells showed unfinished waters in the county to be very similar, all with the chemical characteristics that make water corrosive to most types of common plumbing materials as well as to unprotected water mains. Comparison of water quality data from 1951 and 1957 and 1975 data showed that the well source waters had changed little in their CAPCO JEN 0002443 ENVIRONMENTAL HEALTH PERSPECTIVES Volume S3, November 1983 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service National Institutes of Health h P David P. Rail. Director, National Institute of Environmental Health Sciences EDITORS George W. Lucier Gary E. R. Hook BOARD OF EDITORS John R. Bend Colin F. Chignel! Robert L. Dixon Hans L. Falk Robert A. Goyer Larry G. Hart Joseph K. Haseman David G. Hoel James E. Huff Burke Judd Heinrich V. Mailing H. B. Matthews Ernest E. McConnell James D. McKinney Clifford L. Mitchell Warren T. Piver Conrad B. Richter Raymond W. Tennant EDITORIAL REVIEW BOARD Phillip W. Albro John Bachmann J. Carl Barrett Stephen C. Bondy Gary A. Boorman Arnold R. Brody Rajendra S. Chhabra Gary Clemons Terri Damstra Jack H. Dean Richard P. DiAugustine Robert T. Drew Thomas E. Eling Richard B. Everson Lawrence Fishbein Bruce A. Fowler Donald Gardner Joe W. Grisham Frank E. Guthrie James R. Hass Victor Hasselblad Ernest Hodgson Michael Hogan David J. Holbrook David G. Kaufman Carole A. Kimmel George M. Kingman Albert C. Kolbye, Jr. Kenneth S. Korach Martin R. Krigman Donald I. McRee Tom S. Miya Robert A. Neal William C. Nelson Richard M. Philpot Herbert S. Posner Robert M. Pratt Jerry M. Rice Walter J. Rogan Seamus A. Rooney Michael D. Shelby William Sheridan Robert E. Staples Velimir B. Vouk Michael D. Waters Hanspeter Witschi Errol Zeiger EDITORIAL STAFF Dorothy L. Ritter Assistant Managing Editor Ruth Krigman. Copy Editor Linda Hein, Editorial Assistant i CAPCO JEN 0002444 CONTENTS Summary Workshop on Ingested Asbestos J. R. Millette. Preface................................................................................................................1 L. W. Condie. Review of published studies of orally administered asbestos.......................3 E. E. McConnell, A. M. Shefner, J. H. Rust and J. A. Moore. Chronic effects of dietary exposure to amosite and chrysotile asbestos in Syrian golden hamsters........... 11 E. E. McConnell, H. A. Rutter, B. M. UUand and J. A. Moore. Chronic effects of dietary exposure to amosite asbestos and tremolite in F344 rats....................................27 J. R. Millette, P. J. Clark, J. Stober and M. Rosenthal. Asbestos in water supplies of the United States................................................................................................................ 45 G. M. Marsh. Critical review of epidemiologic studies related to ingested asbestos......................................................................................................................................49 L. Polissar, R. K. Severson and E. S. Boatman. Cancer risk from asbestos in drinking water: summary of a case-control study in western Washington..................... 57 E. E. Sigurdson. Observations of cancer incidence surveillance in Duluth, Min nesota......................................................................................................................................... 61 P. M. Conforti. Effect of population density on the results of the study of water supplies in five California counties.......................................................................................69 M. E. Tarter, R. C. Cooper and W. R. Freeman. A graphical analysis of the interrelationships among w'aterbome asbestos, digestive system cancer and population density..................................................................................................................... 79 J. R. Millette, G. F. Craun, J. A. Stober, D. F. Kraemer, H. G. Tousignant, E. Hildago, R, L. Duboise and J. Benedict Epidemiology study of the use of asbestos-cement pipe for the distribution of drinking water in Escambia County, Florida........................................................................................................................................91 L. S. Erdreich. Comparing epidemiologic studies of ingested asbestos for use in risk assessment................................................................................................................................ 99 M. S. Kanarek. The San Francisco Bay epidemiology studies on asbestos in drinking water and cancer incidence: relationship to studies in other locations and pointers for further research............................................................................................................... 105 J. W. Meigs. Assessment of studies on cancer risks from asbestos in Connecticut drinking water.,,,..................................................................................................................107 R. C. Cooper. Comments on the California studies.............................................................109 W. J. Nicholson. Human cancer risk from ingested asbestos: a problem of un certainty ..................................................................................................................................Ill J. N. Rowe. Relative source contributions of diet and air to ingested asbestos exposure....................................................................................................................................115 P. M. Cook. Review of published studies on gut penetration by ingested asbestos fibers......................................................................................................................................... 121 E. S. Boatman, T. Merrill, A. O'Neill, L. Polissar and J. R. Millette. Use of quantitative analysis of urine to assess exposure to asbestos fibers in drinking , wa.er in the Puget Sound region....................................... .131 K. Seshan. How are the physical and chemical properties of chrysotile asbestos altered by a 10-year residence in water and up to 5 days in simulated stomach acid?..........................................................................................................................................143 ( CAPCO JEN 0002445