Document mpm9XoBrZG6KpGJeYqeR96JvZ

Mesothelioma Among Machinists in Railroad and Other Industries Thomas F. Mancuso, md The first phase of the exploration of occupation-related cancer among machinists was a retrospective review of deaths among members of the International Association of Machinists and Aerospace Workers in 1973, in which mesotheliomas were identified in workers in railroad and other industries. The second phase of the study initiated in 1982 was the establishment of a cohort study of machinists, employed for railroad company A, who were alive in January 1954. The cohort consisted of 197 machinists who had been employed by the same railroad prior to 1935 and observed to 1982. Causes of death were identified for 132 of the cohort. There were 18 alive and 47 not traced. Among the 29 cancer deaths, there were nine mesotheliomas and one endothelioma of the pleura. Additional retrospective surveys of deaths among members of the railroad lodges of the international union, together with the cohort study, identified a total of 42 mesothe liomas, two endotheliomas of the pleura, and two cancers of the pleura among former railroad machinists. Among the machinists employed in other industries, 16 mesotheliomas and six cancers of the pleura were identified. For decades, machinists, by the nature of their craft, have had a high risk of occupation-related cancer due to asbestos exposure. Key words: cohort, epidemiological, mesotheliomas, machinists, railroad, asbestos, steam locomotive, crafts, industry , INTRODUCTION For decades prior to the New York Academy Symposium on Biological Effects of Asbestos in 1964, investigators had studied workers exposed to asbestos in diverse industries and occupational situations and had reported on asbestosis, cancer of the lung, cancer of the pleura, mesothelioma of the pleura and peritoneum, and other cancer and noncancer effects. During the course of these investigations, asbestos exposure from insulation and insulation-type work was identified and recognized as Department of Industrial Environmental Health Sciences, Graduate School of Public Health, University of Pittsburgh. This paper was presented in part at the Medical Conference of the Association of American Railroads' 62nd Annual Meeting, May 13, 1982, Pittsburgh, PA. Address reprint requests to Thomas F. Mancuso, MD, Department of Industrial Environmental Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261. Accepted for publication January 25. 1983. 1983 Alan R. Liss, Inc. 502 Mancuso an important occupation-related cancer risk-among these workers [Russell, 1932; Ellman, 1934, Kuhn, 1940; Holleb and Angrist, 1942; Fleischer et al, 1946; Kenna- way and Kennaway, 1947; Mallory et al, 1947; Franchini and Canepa, 1949; Frost, 1950, 1956; Stoll etal, 1951; Weiss, 1953; Breslow, 1955; Hampe, 1956; Ahlborg et al, 1956; Mofino and Zannini, 1956; Pendergrass, 1958; Van der Shoot, 1958; Hertz and Reinwein, 1959; Anderson and Campagna, 1960; Ahlmark et al, 1960; Keal, 1960; Wagner et al, 1960; Eisenstadt and Wilson, 1960; Heard and Williams, 1961; Frankel and De Jager, 1961; Sleggs et al, 1961; Eisenstadt, 1962; Cordova et al, 1962; McCaughey et al, 1962; Bogetti, 1963; Castleman and Knowles, 1963; Farina and Mazzanti, 1963; Leathart and Sanderson, 1963]. Selikoff, from 1964 on, provided in succeeding years the broadest continuous emphasis on insulators as a high-risk group for occupation-related cancer in a major series of investigations that demonstrated a wide range of cancer effects for asbestos- exposed workers [Selikoff, 1964, 1981; Selikoff et al, 1964, 1965a,b]. The purpose of the present paper is threefold: first, to emphasize machinists as another important occupational group exposed to asbestos in diverse industries with an increased risk of cancer effects; second, to present the findings of mesotheliomas observed among machinist railroad workers; and third, to provide descriptive back ground on occupational exposure to asbestos in the railroad industry as a point of reference for subsequent investigative reports. The findings provide striking evidence and continued confirmation of a basic fact that has been known for decades: Increased cancer risk occurs wherever the exposure to asbestos exists, regardless of the job title, job assignment, or location of the exposure. The present paper includes the first epidemiological cohort study of machinists who were exposed to asbestos in the railroad industry during the early years of the steam locomotive. MATERIALS AND METHODS The first phase of the epidemiological exploration of occupational cancer among machinists, conducted in 1973, was a retrospective review of the causes of death reported during 1966-1971 among members of the International Association of Ma chinists and Aerospace Workers, together with computer listings from the research department on industrial employment classifications. In this process there were eight mesotheliomas identified among machinists employed in the railroad and five among those who worked in other industries [Mancuso, 1975, 1976]. Death claims filed with the international union for death benefits served as the basis of information on causes of deaths. Information about working conditions was obtained from former railroad workers who had been members of the international union. Where possible, micro scopic slides of tissue specimens were obtained and sent to Dr Christopher Wagner for histological review in 1973. Six asbestos samples were obtained from old loco motives which had been sitting in railroad shops for 30 or more years. These samples of asbestos were subjected to electronic microscopy and microprobe analysis in 1975 by Dr E.D. Pooley. Two were identified as chrysotile only and four as amosite. Efforts to obtain additional samples were deferred. The second phase of the epidemiological study began in 1982 when a 1954 seniority list was found of railroad machinists employed by the same railroad. A Mesothelioma Among Machinists 505 o -- *co .. o 2 12 3a> xw: T5,.ep C/3 C *oOw2 |>o> op .oSc CC c 3 <J "o 't; w 2~ *t5o .`5 Ou X2 060 s _I V3 > -- co o'-mVc.. _^_ pOi 3 jS *j at) vc NO On OC o 3_ca=t. 3Ccc&e3Oo0 I |J Q, 2 C E g En O =P J3 aco , 11ff a 1 13Vo60 5r < o a"o8.; j.-s?>a> -23u3u O < V <5 2 S .32 ab S o o5 o -o= .22 JS CL ov. o - O aZ Z < IS t: <u <' i vO vO On 8>>. 3P .3 CO Q. 5 .2.= to o 2 8. 8. w >. w t/i ."2S .c !s 2 -5 7? aO'r; 2sV ao" O B1 o 2 6 o s S * rt CO -Q. ~ & o 2 oj g ..9 ou .22to? go o ~ 4> 4) *- 1 ^ S4) c o -So 8u o '5 ES 60 60 C O 4) 4) c i J,Ti c ^ i 73 - 73 75 " f ^ft pO C C c C o v- - c to 3 oo vi 3 3 Ofi 3 V C3 4) o s < ^ o, ^ 2 p ? Or or- or- r* r- r1 On Ov ON Mancuso TABLE VI. Mesothelioma Among Machinists by Age and Year of Death Total Railroad 44, Other Industries 16* Year of death Age 1946 1950 1953 1954 1957 1958 1959 1960 1962 1963 1965 1966 1967 1968 1969 1970 1971 1972 1974 1975 1976 1977 1978 1979 1980 1981 67" [47] [44] 50 : 62 . [68] 58 [44] 66, 61" 67 [60] 71 72 [55] 65 [56] 65 [66] [58] 68, 78, 75, 62 [69] [57] 72, 71, 71 64 80 [77] 65, 73, 84 74, 72, 75, 85, 70 74, 73. 78, 69 [76] [67] 79, 54, 75, 78, 65 [68] [63] 73, 76 57 65, 71, 70, 83 Other industries in brackets. "Endothelioma. DISCUSSION Other investigators have observed mesotheliomas among railroad workers, primarily installators. Wagner et al [1960] reported pleural mesothelioma in two workers that lagged locomotive boilers with asbestos in South Africa and demon strated that the cancer risk existed wherever the exposure to asbestos occurred. Cochrane and Webster [1978] continued the observation in South Africa and reported 12 mesotheliomas among workers who applied insulation to boilers in the locomotive workshop. Mostert [1979] reported further on asbestosis and mesotheliomas among * re were eight i to endothe- It is readily :ime and that : hired in the 11 size of the iliomas. heliomas for s review the mas, as was lieve that the hinists would be obtained. v of histolog- de ogical nulation. The and 1919 was iive was 147. of the pleura e population, iral mesothed at the same ame time and 5). yf the imporaation-related sts who were lember of the e and start of ca ' study the Canadian lung cancer, iting factor in ng cancer and, rajor patterns re to asbestos ayment in the j by asbestos ty of studying ty exists that ily. i and specific studies wherg the dilution / Mesothelioma Among Machinists 511 factor of total plant and industry studies. Finally, long periods of observation, far beyond what has usually been done in occupation-related cancer epidemiological studies is essential. The findings of this study add to the growing realization that the true nature and extent of the occupation-related cancer problem has not been ade quately recognized in the past and evidently has been underestimated. ACKNOWLEDGMENTS This study was made possible through the excellent cooperation and assistance of the officers, staff, and members of the International Association of Machinists and Aerospace Workers, Mr William W. Winpisinger, president. I wish to express my appreciation to Dr F.D. Pooley. Department of Mineral Exploitation, University College, Cardiff, England, for the analysis of asbestos samples and to Dr Christopher Wagner, formerly of Medical Research Council Pneumoconiosis Unit, Penarth, England, for the histological review of the tissues of the mesothelioma cases. Their professional assistance has been most helpful. REFERENCES Ahlborg G, Hanssen C (1956): Asbestosis and industrial diseases new for Sweden. Svenska Lakartednin- gen 53:1376-1383. Ahlmark A, Bruce T, Nystrom A (1960): "Silicosis and Other Pneumoconioses in Sweden." Stockholm: Svenska Bokforlaget, pp 353-357. Anderson J, Campagna F (1960): Asbestos and carcinoma of the lung. Arch Environ Health 1:27-32. Bogetti F (1963): XIV International Congress on Occupational Health, Madrid, Spain. Sept. 16, Amsterdam: Abstracts of Free Communications, Excerpta Medica Foundation, Vol 4, p E52. Boillat MA, Lob M (1973): Risk of asbestosis in workers employed in replacing automobile brake linings. Schweiz Med Wochenschr 103(39): 1354-1359. Breslow L (1955): Industrial aspects of bronchogenic neoplasms. Dis Chest 28:421-430. Castleman B, Knowles LH (1963): Case records of Massachusetts General Hospital. N Engl J Med 69( 14):747--753. Cochrane JC, Webster I (1978): Mesothelioma in relation to asbestos fibre exposure: A review of 70 serial cases. S Afr Med J 54:279-281. Cordova JF, Tesluk H, Kundtson KP (1962): Asbestos and carcinoma of the lung. Cancer 15:1181-1187. Eisenstadt H (1962): Pleural asbestosis. Am Prac 13:573-578. Eisenstadt H, Wilson F (1960): Primary malignant mesothelioma of the pleura. Lancet 80:511-514. Ellman P (1934): Pneumoconiosis: Part III. Pulmonary' asbestosis. Br J Radiol 7(NS):2S 1-295. Farina S, Mazzanti G (1963): Asbestosis and lung neoplasms: Further contributions to a clinical case. Lavoro Umano 15:276-281. Fleischer WE, Viles FJ, Gade RL. Drinker P (1946): A health survey of pipe covering operations in constructing Naval vessels. J Ind Hyg 28:9-16. ' Franchini A, Canepa G (1949): Contribution to a study of pathology of pulmonary asbestos. Med Lav 40:161-172. Frankel M, DeJager H (1961): Mesothelioma peritonei in asbestosis pulmonum. Jaarb Kankerond Kankerbestr Nederl 11:99-106.