Document oJ6dDL90MJXD32NrxQyOQb8X

Latest word on asbestos represents a whopping 17% of all cancers detected annually in the U.S. won't be the last The joint study's ligures on exposure for workers are taken from HEW estimates (the department believes that 1.5 to 2.5 million U.S. workers are Scientific evidence against asbestos continues to still being exposed to asbestos), while the fatality percentages are borrowed accumulate, and OSHA's much-delayed exposure standard directly from a World Health Organization (WHO) position paper issued in goes on bringing criticism from all concerned parties. early 1977. This link with the WHO Meanwhile, millions of workers remain exposed to document is confirmed by Joseph \Vagoner, special assistant for carcino- asbestos dust in plants throughout the world. genesis with the Occupational Safety and Health Administration (OSHA), who was a member of the group of health experts that authored the WHO 0 Bad news about asbestos continues study estim<'.tes that between 8 and 11 study. to make he;1dlines. In September, for million U.S. workers have been Meanwhile, a spokesman for instance, Joseph A. Califano, Secre- exposed to asbestos since the beginning NCI/NIEHS says that the joint report is tary of Health, Education, and Wel- of World War II. Of these, about 4 basically an update of epidemiological fare (HEW), drew attention to an million have been "heavily ex- data on asbestos, in the light of new alarming statistic in a new study by the posed," -i.e., worked directly with the information uncovered in the past National Cancer Institute (NCI) and material most of the time-and 4 to 7 year. the National Institute of Environmen- million have received "peripheral" Whatever its origin, the NCIINIEHS tal Health Sciences (NIEHS): An aston- exposure-e.g., of the sort that a work is attracting its share of criticism ishing 17% of all cancer deaths in the maintenance worker would get in a by way of an attack on Califano's U.S. over the next few decades will be plant where asbestos was being recent statement. Some claim that the linked to some previous exposure to installed. HEW secretary is unnecessarily alarm- asbestos. The, NCI/NIEHS report assumes that ing the public. Asbestos no longer Speaking at the AFL-CIO National 20 to 25% of those in the first group causes widespread sickness because Conference on Occupational Safety will die of lung cancer, 7 to 10% of working conditions have changed, they and Health, Califano sai.d that the pleural or peritoneal mesothelioma (a say. NCI/NIEHS report definitely rejects the particularly lethal cancer), and 8 to Dr. Irving J. Selikoff, a well-known conventional estimate that 1 to 5% of 9% of gastrointestinal cancer. Assum- authority on asbestos, and director of all U.S. cancer incidence is related to ing that the risk to the second group is Mt. Sinai Medical Center's Environ- occupational exposure to carcinogenic 25% that of the first one, the report mental Health Laboratory (New York agents. Estimates of 20% to as high as concludes that a total of 2.15 million City), notes that "Califano's remarks 38% are not unreasonable, he added. workers will die over the next 30 to 35 are projections based on limited data, EXPOSURE TIIAT KILL'i- The joint years, or about 67,000 per year. This and probably represent an upper limit." But he warns that even if Cali- fano's figures are off by a factor of two, the problem is enormous. However, a spokesman for the American Cancer Soc. (ACS), New York City, feels that the NCIINIEHS report does overstate the problem. INDUSTRY RESPONSE- The Asbestos Information Assn. (AlA), Arlington, Va., an organization of asbestos processors, says that the NCIINIEHS data are being analyzed by the group's scientific advisors, and that a statement will be issued when the study is complete. Meanwhile, an AlA press L ........ ,...,[ ~~d :1 .,. .-.~:q#{\l1 ....)./ i'"~r ,,.n~\i?"~~'iUJI f +t ~ '~cn~---~,~- ....J J.../'~ ~") .... ... .::a.i.r ./ . ~ J1.....J. /l .~;( ~J release calls the report "simply another extrapolation in statistical terms from the same data which have been available to the international scientific community for some time." Another AlA press release, issued in response to a Califano statement Fiberglass insulation, an alternative to asbestos, is considered safer (made in April) regarding a large 76 CHEMICAL ENGINH:RJNG NOVEMUI::R 6, 197P FMSI 05789 ------------ ag fitt an div qw the div SOil sta got ran fitt 1 :1 =\'l'kJ i!SiiJ:)fJiii!41 U.S. firms still use it, despite its checkered career R-h. time-weighted basis, with a 15- min rei ling ci 'i fibers/ cm1. :\ll limits The term "asbestos" comprises a group of impure magnesium silicate minerals-e.g., rhrysotile, amosite-that occur in fibrous form. Reports of the toxic properties of asbestos date back to the I ~l20s in the U.S. However, it wasn't until the war broke out, when millions of workers were employed in shipyards insulating warships, that m;1ss exposure to asbestos dust ocmrred in this country. The material enjoyed wide popularity as an insulator in plants anrl buildings until 1970, when, in response to mounting e\'idence of its toxic properties, manufacturers stopped producing insulation made of loosely bound asbestos fiber. The Asbestos Information Assn. says that the 3,000 asbestos products made today in the U.S. contain chemically and physically bound fibers that do not flake off. Current end-use breakdown: asbestos cement products (pipe, sheets). 22..1%; roofing products, 34.9%; asbestos paper, 4.3%; flooring products, 15.6%; packing and gaskets, 2.8%; the-rmal and electrical insulation, 1.2%; friction products (brake linings), 8.8%; coatings and compounds, 2. 7%; plastics, 3.0%; textiles, 1.0%; and miscellaneous, 3.3%. apph .onlv to fibers longer than 5 ~-tm. (:--;Iosll, which serves in an advisory rapacity, has recommended a limit of 0. 1 fiber I cm1.) _OSII.-\ is currently evaluating the economic impact of the proposed standard, which is bound to affect both processing and use of the material. Predictably, industry reponse to the idea has not been favorable. AlA calls the 0.5-fiberI cm3 limit "not technicaltv feasible," and recommends instead the adoption of 2 fibers/ cm3 as a permanent standard-one that can be realized at a reasonable cost for dust control. On the other side of the spectrum, Roy Steinfurth, the asbestos workers' spokesman, feels that the only accept- able level is no asbestos exposure at all. The union official says that, even if the outbreak of asbestos-related diseases leading maker of asbestos products): exposure level is reduced to 0.5 among World War II shipyard work- "Clinical evidence shows that lung fiber I cm3, a worker would breathe in ers, explains that such a heavy expo- cancer in asbestos workers is virtual!y 4 million fibers in an 8-h workday. He sure to asbestos existed before medical limited to those who smoke cigarettes, estimates that as many as 50% of the I information revealed the dangers in- and that for practical purposes, lung members of his organization will evenvolved. Since then, millions of dollars cancer as an asbestos-related disease tually die of asbestos-related diseases. i have been spent in dust-control equip- would not be a problem were it not for In Europe, there is also a move to I ment by miners, millers, processors cigarette smokers." cut down on the exposure level, which and manufacturers of asbestos. AlA is currently on a vigorous has been 2 fibers/ cm3 in the past few In addition, note .other asbestos- campaign to persuade industry work- years. Italy, which lacks asbestos industry spokesmen, the type of prod- ers to stop smoking. deposits, is attempting to phase out the ucts made in the past-e.g., asbestos "There is no doubt that exposure material completely. Sweden moved to thermal insulation-are no longer and cigarette smoking have a synergis- a 1-fiberI cm3 standard a year ago, produced. They were phased out in tic effect," says an ACS spokesman, and U.K. authorities are clamoring for the early 1970s, when the inherent "but since so many workers included a reduction of the present limit. hazards became apparent (see box). in past studies were smokers or ex- Critics who complain that the OSHA Nevertheless, asbestos is still used as smokers, it's difficult to assess the risk proposal does not go far enough in an insulator or fire retardant in more to non-smokers." protecting workers also question why than 3,000 products ranging from The synergism is acknowledged in the standard should apply only to water pipes to brake linings. And an the WHO document. "Both cigarette fibers longer than 5 ~-tm. Both Selikoff estimated 500 million tons of the mate- smoking and exposure to asbestos and \Vagoner, for example, believe rial are still around in plants and independent! y cause lung cancer. that the smaller fibers are even more buildings throughout the U.S., accord- However, when present together, they active in producing lung tumors. And, ,,I ing to Roy Steinfurth, administrator of act in a multiplicative fashion." The according to Selikoff, "For each fiber the insulation health-hazards pro- NCI!NIEHS study agrees, and admits longer than 5 ~-tm, there may be as grams for the International Assn. of that it would be an error to attempt to many as I 00 shorter ones." Heat and Frost Insulators and Asbes- blame each type of cancer mentioned OSHA's Health Standards Project tos Workers (Washington). Workers in the report on an exclusive cause. Officer William Warren says that the still exposed to asbestos are not A NEW STANDARD?- The current 5-~-tm length was the most practical adequately protected, charges Selikoff. flareup of the asbestos controversy is of alternative because detection equip- CIGARETI'E LINK- Industry spokes- more than marginal interest to OSHA, ment does not pick up anything small- men also point out that exposure to which has been trying to modify pres- er. Warren notes that available moni- asbestos alone may not be enough to ent rules governing exposure to the toring units detect only "from a few cause lung cancer-the disease most material (the agency is studying the percent to 50%" of the actual number commonly associated with the breath- NCI/NIEHS report). of fibers in a sample. ing of asbestos fibers-and that the For more than three years, OSHA INSULATION DANGER-Spot checks connection between exposure and ciga- has been pushing a proposal to reduce with a number of U.S. insulation rette smoking has not been stressed the permissible level of airborne fibers manufacturers turned up no one still enough. Says John A. McKinney, in the workplace from a present value making the asbestos-containing ver- president of Johns-Manville Corp. (a of 2 fibers/ cm3 to 0.5 fiber I cm3 on an sion. However, there are still tons of it 78 CIH::.t\IICAI. I:.Nla:qf.F.RING NOVF.MBER 6. 1978 FMSI 05790 installed in chemical plants all o\'er the world. Since the asbestos is loosely hound, the cutting, handling and tearing down of such insulation poses a health hazard. "If the insulation is intact, there's no problem," says an engineer with Britain's ICI, Ltd., "\Vhenever maintenance requires stripping down and removal, we replace with a substitute material." lfe adds that the firm does not specify asbestos for any new plants. "We stopped using asbestos for insulation about seven or eight years ago," claims the safety manager of a U.S. refinery. "Although it is cheaper and easier to apply, the health risks persuaded us to switch to fiberglass and calcium carbide." He further notes that although some asbestos is still used, it is of the bonded type, which does not present a potential dust hazard. The indirect risks of asbestos insula- tion were highlighted in a recent study of maintenance workers at American Cyanamid's facility in Bound Brook, N.J. The survey, commissioned by the International Chemical \Vorkcrs Union (ICWU), \Vashington, and c:trricd out by the l\lt. Sinai ~ledical Center, identifies the risks faced by maintenance workers (other than insulation installers) when working in the vicinity of an insulation job. According to Larry Ahern, director of health and safety for ICWU, the results show that 44% of all workers, regardless of job function, had some form of asbestos-related lung abnormality. One group of workers expost'd for less than one month experienced a significant increase in the incidence of lung disease. \Vorse, the researchers discovered that many of the workers' relatives, who had not been in direct contact with the material, were affected. "About 123 wives were sick," says Steinfurth. HOW ABOUT SUBSTITUTES?-Such popular asbestos replacements as fiberglass, mineral wool and calcium silicate may have health hazards of their own, but these have yet to be identified. In a criteria document issued m April 1977. :>;lOSII said: "Fibrous glass seems to be considerably less hazardous than asbestos ... and, until more information is a\~tilahle, the recommended standard can also be applied to other manmade mineral ftbers." The :>;IOSII paper suggests a standard of 3 fibers/rm 3 for fibers of less than :l..'i-/.1111 dia. Larger fibers are not thought to be respirable. Ralph Zumwalde, an industrial hygienist at NIOSH, points out that most of the exposure to fiberglass involves fibrrs with diameters greater than 3.5 /.lm, even though some special products contain thinner ones. "Fiberglass is an irritant, and can cause skin irritation or upper respira- tory irritation," says Dr. Donald J. Billmaier, assistant medical director of Owens-Corning Fiberglas Corp. (Toledo, Ohio, "but our studies show that there are no chronic adverse health effects from using the material." Calcium silicate is classified as a nuisance dust, not a fiber. The OSHA standard is 15 particles/ cm3 for the respirable fraction. Vincent Cavaseno ~ Gulf Coast buildup may ease olefm glut D A more hopeful outlook for ethyl- ene derivatives is triggering major expansions in the Gulf Coast area, and these may help alleviate, at least locally, tht' ethylene surplus that is predicted through the early 1980s (Chon. J:.'ng., Mar. 27, p. 80). Consider, for example, the current buildup at the Raporte, Tex., complex of the USI Div. of National Distillers and Chemical Corp. The company, which last year increased its highdensity polyethylene (HOPE) capacity to 500 million lb/yr, boosted its lowdensity polyethylene (LDPE) rapacity by 200 million lb/ yr this spring. Another ethylene-consuming addition is under way- USI will complete early next year a vinyl acetate monomer expansion.This will raise monomer capacity from 375 million lb/yr to 600 million lb/ yr. The three expan- sions will consume a total of just under 500 million lb/yr of ethylene. Shell has marked the tenth anniversary of its complex at Geismar, La., by inaugurating ethylene oxide and ethylene glycol trains, now about 60'7o completed. About a year ago, the company began work to increase oxide production from :100 to 700 million lb/yr, and glycol output from 150 to 350 million lb/yr. "This expansion will be ready for startup in early I979," says pbnt manager Fred Foster. The ethylene oxide boost will require :HO million lh/ yr of ethylene raw material. Shell will also ~tdd flexibility to the Gulf Coast ethylene distribution system with a new :.!51-rni ethylene pipeline that will run from t\lmtt Belvieu (just east of I louston) to Napoleonville, La., ncar Shell's petrochemical plant at Norco. The company is building a 1.5-billion-lb/yr ethylene plant there, which is expected to go onstream in 1981. Says A. R. Flora, Shell's olefins business manager, "The pipeline will help to eliminate spot shortages in Texas and Louisiana complexes, which are the heart of the petrochemical industry." USI executives now speak more optimistically about the future of downstream products, and predict a better supply I demand balance. According to George Kappas, vice-president of National Petrochemicals Corp. (jointly owned hy National Distillers and Owens-Illinois), fiUPE is currently moving away from oversupply. "At present," says Kappas, "there is a slight surplus of HOPE. However, producers are not building up yearend inventories, and demand is growing steadily. Consequently, in 1980 and I 981, supply and demand will be somewhat tighter than they are today." Kappas notes that domestic need for the resin has !!;rown at an average annual rate of more than 11% since 1971. LDPE will be in balance by 1980, according to USI estimates. U: H a1 tt 80 . CHEMICAL LNc;JNl. ... KINlf NOVEI\tUER ll, 1978 FMSI 05791 ---~------ ----------------------------------------- .... OCT 30 1978 .r/I -' DRAIT SUMMARY ESTIMATES OF THE FRACTION OF CANCER INCIDENCE IN THE UNITED STATES ATTRIBUTABLE TO OCCUPATIONAL FACTORS NATIONAL CANCER INSTITUTE AND NATIONAL INSTITUTE OF. ENVIRONMENTAL HEALTH SCIENCES Not for use before 3:30 c.m_ EDT S~ctember 11, 1978. FMSI 05792 This statement will address the ques.tion: "What fraction of th2 cancer incidence in the United States is attributable in whole or part to occupational exposu=e to carcinogens in the workplace?" The conventional estin:.ates have been that this fraction is quite small, and figures of between one percent and five percent are often quoted. However, as. we will show below, these estimates were admittedly speculative and were incomplete or deficient in several respects. If the full consequences of occupational exposures in the present and the :recent uast are taken into account, est~ates of at least 20 p~rcent appear much oore reasonable and may even be conservative. Basis of the Estimation that 20 Percent of Cancer Deaths will be Associated with Occunational Exuosure to Che~icals I. Asbestos as a Well-Studied Exrumule The consequences of occupational exposure to asbestos in the United States have only been fully recognized in the past year. According to estimates made by the U.S. Department of Health, Education, and Welfare, between eight and eleven million workers have been exposed to asbestos in the U.S. since the beginning of World War II. Of that total, approximately 1.5 to 2.5 million are presently employed, while the remainder -- between 6.5 and 8. 5 million workers -- were formerly employed in . environments with significant asbestos exposure, including 4.5 million who worked in shipyards during World War II. Of these workers, approximately four million are believed to have had heavy exposure to asbestos. Based on epidemiological studies of workers, it is estimated that 20-25 percent of heavily exposed workers die of lung cancer, 7-10 percent of pleural or peritoneal mesothelioma, and 8-9 percent of gastrointestinal cancers. These figures are probably underestimates of lifetime :risks, because relatively few workers have yet been followed to the end of their normal lifespan. The total fraction of heavily exposed workers likely to die of these cancers is probably between 35-44 percent. FMSI 05793 - 2- ; Of the four million heavily exposed workers, approximately 1. 6 million are thus expected to die of asbestosrelated cancers. Assuming that the excess risk to the 4-7 million less heavily exposed workers is one-quarter of that to the heavily exposed workers, the total number of cancers associated with asbestos in the less-heavily exposed group would be expected to be about 0.55 million, raising the total to about 2.15 million. Since most n these cancers will be manifested in the next 30-35 years, the expected average number of cancers attributable to asbestos per year in that period will average about 67,000. Such numbers would represent about 17 percent of all cancers detected annually in the United States. II. Other Less Well Studied Examples Arsenic Number of workers potentially exposed: about 1,500,000. Risk ratios*: 3-8 for lung cancer. Estimated number of excess cancers per year: 2,100- 7,300. Benzene Number of workers potentially exposed: about 2,000,000. Risk ratios: 2-3 to 7 for leukemia. Estimated number of excess cancers per year: 240 - 1,400. Coal Tar Pitch Volat;les and Coke Oven Emissions Number of workers potentially exposed: about 60,000. Risk ratios: 2-6 for cancer of the lung, larynx, skin, and scrotum. Estimated number of excess cancers per year: 160-800. L * Risk Ratio: The ratio of cancers to the number expected in a normal population. A risk ratio of two means a doubling of the risk. FMSI 05794 .. 3- 7L.. ~.~ v-~ber of workers potentially exposed: about 2,260,000. Risk ratios; 200,4 and 1..9 respectively for hemangiosarcoma, brain and lung cancer. Estimated number of excess cancers: 1,940. /-:3 A total of ta percent of the cancers occurring in a year will be associated with these four substances .. III. Substances for which excess cancer incidence has been recorded but for which estimates of the number of workers exposed may be less accurate. Chromium Number of workers potentially exposed: about 1,500,000. Risk ratios: 3-40 for nasal cavity and sinus, lung and larynx. Estimated number of excess cancers per year: 2,40046,000. Iron Oxide Number of workers potentially exposed: about 1,600,000. Risk ratios: 2-5 for lung and larynx. Estimated number of excess cancers per year: 1,300- 5,000. Nickel Number of workers potentially exposed: about 1,370,000. Risk ratio: 5-10 for lung. Estimated number of excess cancers per year: 3,800- 5,000. Petroleum Distillates Number of workers potentially exposed about 3,000,000. Risk ratios: 2-6 for lung and larynx. Estimated number of excess cancers per year: 2,400- 12,000. A total of 3-18 percent of the cancers occurring in a year will be associated with these four substances. r ---------- FMSI 05795 4- IV. Totals. Thus the total excess incidence would be from 21 to 38 percent. We choose to use the figure 20 percent in order to be conservative. Summary and Conclusions !. The oft-quoted estimatess that only 1 percent to 5 percent of total cancers in the United States are attributable to occupational factors have not been scientifically documented. 2. Most cancers have multiple causes: it is an error to attempt to assign each cancer to an exclusive single cause. 3. Because cancer incidence is strongly dependent.on age and upon duration of exposure, most cancers resulting from exposure to carcinogens will occur late in life: many epidemiological studies detect only a small fraction of early-developing cancers. 4. Past exposure to asbestos is expected to result in over 2 million premature cancer deaths in the next three decades: this corresponds to roughly 17 percent of the total cancer incidence expected in that period. 5. Reasonable projections of.the future consequences of past exposure to established carcinogens suggests that at least 8 other substances may contribute substantially to cancer incidence comparable in their total effect to asbestos. 6. The projections suggest that occupationally-related cancers may comprise 20 percent or more of tot.al cancer incidence in forth-coming decades. (This does not include cancers attributable to ionizing radiation.) 7. Although exposure to some of the more important occupational carcinogens has been reduced in recent years, there are still many unregulated carcinogens in the U.S. workplaces; a number of occupations are characterized by excess cancer risks which cannot yet be attributed to specific agents. 8. There is no sound reason to assume that the future consequences of present-day exposure to carcinogens in the workplace will be less than those of exposure in the recent past. 1 FMS' 05796 ... - 59. Patterns and trends in total cancer incidence (and mortality) in the U.S. are consistent w~th the hypothesis that occupationally-related cancers comprise a substantial and increasing fraction of total cancer incidence. FMSI 05797 FRIOTION MATERIALS STANDARDS INSTITUTE. INO. 't OSHA's AsiJestos Standanf-A Status Repttd OSHA's current standard on asbestos was promulgated on June 7, 1972. It defined "as~ bestos" as chrysotile, amosite, crocidolite, ~em olite, anthophyllite, and actinolite and included every product containing any of these minerals. For regulatory purposes, an asbestos fi.ber was defined as a particulate form of asbestos, longer than 5 microns, with a length-to-diameter ratio of at least 3-to-1 and a maximum diameter of 5 microns. The 1972 standard originally established a maximum 8-hour time-weighted-average (TWA) concentration of 5 asbestos fibers per cubic centimeter of air, and a ceiling exposure limit of 10 fibers per cubic centimeter. On July 1, 1976, a further provision of the standard took effect, lowering the permissible 8-hour TWA to two fibers per cubic centimeter of air. The twofiber limit remains in effect today. On October 9, 1975, OSHA proposed a new regulation for asbestos. Among other things, the proposal would lower the permissible 8-hour TWA exposure level to 0.5 fibers per cubic centimeter and would reduce the permissible ceiling exposure level to 5 fibers per cubic centimeter for any 15-minute period. This proposal would not apply to the construction industry, which would be required to follow a different standard to be proposed later. A separate asbestos standard for the construction industry has not yet been proposed, nor have hearings on the 1975 proposal been scheduled. An economic impact statement concerning the proposed revision is nearing completion. Meanwhile, on December 2, 1975, OSHA asked NIOSH to reevaluate available information on the health effects of occupational exposure to asbestos. Completed in December of 1976, the NIOSH reexamination was forwarded to OSHA in May. Finding no evidence of a "safe" level of asbestos exposure, NIOSH recommended treating asbestos like other carcinogens by allowing only the lowest exposure level detectable by available analytical techniques. NIOSH recommended a 0.1 fiber 1WA and a 0.5 fiber ceiling limit for occupational JOB SAFETY M{D REALTH September 1977 FMSI 05798 ------------~------------------------------------ Po"lycyclic Aromatic Hydrocarbons in Soils of a Mountain Valley: Correlation with Highway Traffic and Cancer Incidence Max Blumer1 Woods Hole Oceanographic Institution, Woods Hole, Mass. 02543 Walter Blumer Arzt fiir Allgemeine Medizin FMH, CH-8754 Netstal, Switzerland NOV 15 1977 Theodore Reich Statistical Department, Institute for Radiation Therapy and Nuclear Medicine, University of ZOrich, CH-8006 Zurich, Switzerland Analyses of soils in the vicinity of a Swiss mountain town show a correlation between the content of polycyclic aromatic hydrocarbons (PAH) and the proximity to a highway. PAH contents range from 300 mg/kg dry soil near the highway to 4-8 mg/kg in the surrounding higher alps. The P AH composition ranges from three- to eight-membered rings and to heavily alkyl-substituted derivatives. The PAH mixtures are far more complex than was assumed in the past and resemble that of automobile exhaust. The low values in town close to industry but remote from the highway, and high P AH values outside of town but near the highway suggest a correlation between automobile traffic and PAH content of soils. These results indirectly suggest also a correlation between the au~ tomobile traffic and the observed mortality from cancer in this area. An epidemological study of a Swiss mountain town has demonstrated a strong correlation between cancer incidence among the residents and the proximity of their residences to the highway (1 ). The town of 3000 inhabitants is located within the 1-km-wide base of a deep valley with predominant winds along its axis and with frequent thermal inversions. It is divided by a 40-m-tall alluvial cone into the older main section with residential housing immediately adjacent to the heavily traveled highway (4000-5000 vehicles per day) and a newer section, about 400 m from the highway and shaded from it by the alluvial cone. Until recently, this section of town was serviced only by a dead-end road. During the period of the original study (1958-1970), death from cancer was nine times as frequent for residents near the Ihighway. A total of 72 persons died in the old part of town of various forms of cancer, whereas only three cases occurred in the traffic-free area. Cancer mortality near the highway is higher for all groups of residents, without correlation with age, sex, occupation, and smoking habits. Thus, 32 women died; none of them had smoked. ! This suggested a link between cancer incidence and environmental carcinogens, associated with the highway traffic, among them petroleum- and coal tar-ba~ed road asphalt, tire II particles, lubricants, asbestos, and the components of auto- mobile exhaust (lead compounds, polycyclic hydrocarbons, and other reactive chemicals). We have now surveyed the soils of this valley and of the surrounding mountains for their content of polycyclic aromatic hydrocarbons (PAH), as a possible group of trafficlinked carcinogens. Samples were taken immediately below the grass within the uppermost humus layer; those representative of the soils near the highways were collected within 1 m from the edge of the road. A dust sample was gathered from a high windowsill in 1 Deceased. 1082 Environmental Science & Technology the town church, 50 m from the main highway, and a soot sample was taken from the exhaust pipe of a small car and from the chimney of a residence heated with fuel oil. Most samples were handcarried to the analytical laboratory; they were kept under refrigeration in clean glass containers until extraction. Isolation of the PAH fraction and its final analysis followed the procedure of Giger and Blumer (2), except for the more efficient distillation into the mass spectrometer source from a glass capillary with restricted opening (3). During each distillation 40 spectra were obtained at 12 eV and inspected on a Finnigan 3200 mass spectrometPr with a 6000 data system; the total spectrum for each sample was reconstructed by the summation of all spectra containing appreciable intensities (3, 4) of the P AH molecular ions. Table I presents the total weights of the purified P AH fractions. These values are reproducible (2), but they may include the weights of some non-PAH impurities that were not rejected during the separation. Lower values are obtained by UV analysis, since they neglect the presence of alkylated PAH series and of still unidentified PAH components that are evident from the mass spectra. In our interpretation we consider the 12-eV mass spectra, the UV spectra, chromatographic mobilities, and the relative volatilities as observed in the probe distillation. We believe that our structural assignments (Table II) are sound, since they rest on the correlation of these different and independent analytical parameters. The mass spectra of the P AH fraction demonstrate a nearly uniform composition in all of the soil samples. Unsubstituted hydrocarbons predominate and range from phenanthrene to seven- and eight-membered aromatic ring systems that have not been identified before in environmental samples. Each unsubstituted hydrocarbon is accompanied by alkyl-homologs in gradually decreasing concen- c5trations to and beyond, with nearly identical abundance patterns in every series. Many isomers, differing in ring arrangement and in position and structure of the side chains, may be present. Some well-known carcinogens (benzo[a]pyrene, benzanthracene) occur together with other carcinogens and cancer initiators, whose presence in environmental samples is rarely considered (methylchrysenes). In addition, vast numbers of aromatic hydrocarbons are present whose structures are not sufficiently well known to assess their biological effect. Among these there may be many still unknown carcinogens and mutagens. The compogition of natural PAH assemblages is influenced by the processes involved in their formation (4-6), and chemical analysis can therefore distinguish between contributions from different sources. For instance, the relative abundance of alkylated PAH derivatives is influenced by the formation temperatures of pyrolytic PAH mixtures. At high temperatures, ~uch as in the coking of coal, only the unsubstituted hydrocarbons are formed or survive, while at lower temperatures, for instance during petroleum formation, highly. alkylated p:oducts predominate. These compositional fea- FMSI 05799 J. rures survive the processing to road asphalt and pitch (7). The mass spectra of the soil hydrocarbons demonstrate an alkvlation pattern different from those of cn&l t;.r ur petroleum (4, 5). The predominance of the unsubstitut.ed hvdroearbons and the gradual decrease in concentration tow~rd the more alkylated members speak for a pyrolytic origin at intermediate temperatures and enable us to rule out a major contribution from petroleum- or coal tar-based road asphalt or from lubricants. In spite of the general compositionaluniformitv. we note some subtle differences between samples. The soot from the exhaust pipe of a car contains the same extended P AH series as the soils (a finding in disagreement with earlier analyses obtained with less highly resolving methods). The PAH mixture is depleted in the lowest boiling hydrocarbon series. Apparently, this series is not retained within the hot soot deposits in the exhaust system of the engine. Rather, these compounds pass into the atmosphere, which is consistent with the observation that the phenanthrene and pyrene series are considerably more abundant in the dust from the church, even if that sample has a similar overall composition in terms of ring systems and alkyl-derivatives. Correspondingly, the content of low boiling hydrocarbons in the soils near the highway is intermediate between the soot from the exhaust system of the car and the material collected ir. the church. The soot from the chimney of a residence heated with fuel oil has a very different PAH composition. There. alkylated members of lower molecular weight P AH series predominate, and the unsubstituted hydrocarbons are in the minority. Higher ring-number series are present at low concentration or altogether absent. Thus, this soot sample reflects the Table I. Total Polycyclic Aromatic Hydrocarbons in Soils and Sediments Within town PAH, mg/kg dr)'wt Center of town (470 m elev.), at highway North end of town, at highway South end of town, at highway South end of neighboring town, at highway Dust from church, center of town, 50 m from highway Outlying section of town, ligl:t traffic, 400 m from main highway Outlying section of town, dead-end road, 250 m from main highway, 100m from foundry Secondary road in village, at road 110 220 85 300 100 21 6 18 Open country At main highway, 750 m south of town 300 m from main highway in valley 700 m from main highway in valley 1000 m from main highway, alluvial plain 120 15 5 5 Alpine soils, side valleys Camp ground, 850 m elev., no through traffic Mountain pass. no road, 1200 m elev. Alpine meadow, 1600 m elev. 8 6 4 Soils. marshes, and sediments, USA Maine, forest. 115m from secondary road Cape Cod, forest. 750 m from highway, 400 m from secondary road Air base, Cape Cod, sandy soil, 2 m from highway Marsh, Cape Cod, 750 m from highway Buzzards Bay, Mass.. marine sediments. surface 7 13 2 19 4-5 compositional features that are characteristic for crude oil and its distillates, rather than for high-temperature pyrolysis products, as is the case for car exhaust. The aromatic hydrocarbon composition of these Swiss soils is very similar to that of recent marine sediments and soils from the U.S. northeast coast. We believe that two different processes, but. operating at similar temperatures, have produced a similar set of hydrocarbons. Those in the U.S. samples, and possibly also in the high Swiss Alps, originate in natural fires; they are transported through the troposphere on soot particles and enter the sediments with fallout {-1, 8). Extended air transport would result in depletion of the low boiling hydrocarbons. This is observed both in the U.S. samples and those from the high alps. These hydrocarbon assemblages at concentrations near 5 ppm may well represent a worldwide PAH background. The high PAH levt>ls at the bottom of the Swiss valley, on the other hand, cannot be attributed to the same source, especially since their concentration far exceeds the levels in the immediately surrounding alps. The association of such high PAH levels with the proximity to the highway (Table I) suggests that they are produced in internal combustion engines. A major contribution from other PAH sources linked to the town or the highway can be excluded. Industrial and domestic heating produces some PAH. However, the low levels in town close to industry but remote from the highway, and the high level at the highway outside the town, speak for the association of the PAH production with the traffic. Aromatic hydrocarbons are also associated with the carbon used as filler in automobile tires. A comparison between tire life and gasoline consumption of automobiles suggests that even a minor conversion of the fuel into carbon can produce soot much more rapidly than it would be released by tire wear. In combination, the geographic distribution of the hydrocarbons, the correlation between structure and processes of formation, and the chemical agreement in the PAH composition of soot in automobile exhaust with the soil hydrocarbons provide a powerful argument that car exhaust is responsible for the observed PAH accumulation in the Swiss Valley. This work has many consequences. Our new analytical data, Table II. Aromatic Hydrocarbon Series in Soils lniUal mass Extent or series Representative compounds a 178 ToC6 Phenanthrene (UV) 202 ToC6 Pyrene (UV), fluoranthene (UV) 228 ToC6 Benzanthracene (UV). chrysene (UV), triphenylene 252 ToC6 Benzo[a]pyrene (UV), benzo[e]pyrene (UV), perylene (UV) 276 ToC9 Anthanthrene (UV), benzo[ghi)perylene (UV) 278 ToC9 Picene, dibenzanthracene, dibenzophenanthrene 300 ToC1 Coronene (UV) 302 ToC1 Dibenzofluoranthene 326 ToC1 Heptacyclic PAH, e.g., dibenzoperylene 350 ToC1 Octacyclic PAH, e.g., benzocoronene 352 ToC6 Tribenzofluoranthene (MS. chrom., dist.) 376 ToGs Octacyclic PAH, e.g., lribenzoperylene Relative abundance of series. at bottom of valley: 202 > 178 ;;: 228 > 252 > 276 > 278 > 302 > 300; for other samples. see text Structural evidence was derived in all instances from mass spectra. from the chrornatog-aphic position. and the relative volatility; uv.. indicates further confirmation from ultraviolet spectra. Volume 11, Number 12, November 1977 1083 FMSI 05800 ~ ..oJ.Jtained with much improved resolution, demonstrate that automobile exhaust and environmental PAH mixtures are far more complex than was assumed in the past. Therefore, earlier analyses now appear much more limited in their power to correlate with, or to predict, public health effects. Numerous additional components of exhaust and of environmental samples must now be considered in their possible roles as carcinogens, tumor inducers or promoters, and mutagens. The demonstrated correlation between highway traffic and the production of carcinogens strengthens indirectly also the correlation between highway traffic and the observed mortality from cancer. The implications for public health, for city and highway planning, and for efforts to control engine exhaust are considerable. Literature Cited (1) Blumer, W., Jaumann, R., Reich, Th., Schweiz. Rundsch. Med. Prax., 61,514-18 (1972). (2) Giger, W., Blumer, M., Ana!. Chern., ~6, 1663-71 (1974). (3) Blumer, M., Finnigan Spectra, 5 (:~) (1975). (4) Youngblood, W. W., Blumer, M., Geochim. Cosmochim. Acta, 39, 1303-14 (1975). (5) Blumer, M., Sci. Am., 234, 34-45 (1976). (6) Blumer, M., Chern. Geo!., 16, 245-56 (1975). (7) Greinke, R. A., Lewis, I. C., Ana!. Chern., 41,2151-55 (1975). (8) Blumer, M., Youngblood, W. W., Science, 188,53-55 (1975). Received for review January 3, 1977. Accepted May 26, 1977. Work at Woods Hole supported by the Office of Nam! Research (N0014-66 Contract C0-241) and the National Science Foundation (Grant DES 74-22781). Determination of Elemental Sulfur by Gas Chromatography John J. Richard, Raymond D. Vick, and Gregor A. Junk Ames Laboratory-ERDA. Iowa State University, Ames, Iowa 50011 11 Elemental sulfur was determined by combining electron capture detection with cyclohexane extractions of coal, particulate, and soil samples and with resin sorption of water samples. The sensitivity for sulfur permitted its determination in environmental samples at sub parts per billion levels. The extraction procedures allowed for a minimum of cleanup prior to the rapid and selective gas chromatography. The usual procedures for the determination of elemental sulfur are reduction to the sulfide or oxidation to the sulfate. These techniques generally lack the selectivity and sensitivity of reported gas-liquid (l-7), thin-layer (8), and liquid chromatographic (9) procedures. These are apparently useful for sulfur determinations, but none has been applied to the quantitation of elemental sulfur in environmental samples. This paper describes the methodology for the determination of elemental sulfur in stack particulate, soil, coal, and water samples using gas-liquid chromatography for the separation from other components present in the sample and electron capture for the selective and sensitive detection. Experimental Apparatus. A Tracor Model 550 equipped with aNi 63 electron capture detector (ECD) and a Beckman Model GC-5 equipped with a helium discharge ECD were used for the gas chromatography. Glass columns, 2m X 4 mm i.d., were packed with the solid supports and liquid phases listed in Table I. These columns were silanized with four injections of 25 ,uL each Silyl8 (Pierce Chemical Co.) before use. A DuPont 21-490-1 gas chromatograph-mass spectrometer (GC-MS) was used for positive identifications of the elemental sulfur extracted from various environmental samples. Reagents. Cyclohexane (J. T. Baker Chemical Co.), 98% grade, was further purified by distillation. Sulfur standards used for quantitation were prepared by volumetric dilution of a solution having 10 mg of 99.999% sulfur in 50 mL of cyclohexane. The 60-100 mesh J<'lorisil (Floridin Co.) used to clean up the sample extracts was calcined at 540 C by the manufacturer and activated for 5 h at 130 C prior to use. Analytical Procedures Coal, Particulate, and Soil Extractions. One-gram samples of crushed coal which had passed a 60 mesh sieve were Soxhlet extracted for 24 h. Large 35 X 90 mm glass thimbles were used to prevent plugging of the Soxhlet device by the fines from the coal samples. The 90 mL of cyclohexane used for the extraction were then quantitatively transferred to volumetric flasks and diluted to 100 mL. Five-,uL aliquots of this cyclohexane solution were subjected to gas chromatog- raphy without further cleanup. Particulate samples were collected from 4-in. sampling ports located approximately half-way up the stack of a local power plant. Three types of samples were collected. Particulates # 1 were from the accumulation in the ports. Particulates #2 were collected by drawing the atmosphere from inside the, stack through a glass tube containing a glass wool plug. Particulates #3 represented that portion which settled onto horizontal trays placed inside the stack. Ten grams of particulates were extracted in a Soxhlet for 24 h in 25 X 85 mm glass thimbles using approximately 50 mL of cyclohexane. The cyclohexane was transferred to volumetric flasks and diluted to 50 mL with cyclohexane. Five-,uL aliquot& of this solution were gas chromatographed without further cleanup. Ten-gram amounts of local soils were Soxhlet extracted with cyclohexane as above. The extracts were concentrated Table I. Gas Chromatographic Data for Elemental Sulfur Liquid phase 5% OV-210" 4% SE-30/ 6% OV-210" 3% OV-1" 5% OV-1" 1.5% OV-11/ 1.95% OV-210C 10% DC-200C Solid support 8 c G c c G .G IR, min 2.3 5.2 1.7 1.8 2.5 3.6 Column temp, C 180 200 120 120 200 200 Flow, mllmln 75 75 75 75 160 160 Cis Chromosorb WHP, 80-100 mesh; G is Gas ChromO, 100-120 mesh. Tracor Model 550; detector, 340 c: injector, 220 c. c Beckman GC-5; detector, 310 c: Injector, 240 c. 1084 Environmental Science & Technology FMSI 05801 TO TG=BrE .. U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Center for Disease Control National Institute for Occupational Safety and Health / / 0 ~ kr ll $ ~~'-.:C.:. [5.. . .p FMS\ 05802 .. .~ A GUIDE TO THE WORK-RELATEDNESS OF DISEASE Marilyn K. Hutchison, M.D., Editor U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Center for Disease Control National Institute for Occupatjonal Safety and Health 1976 For air by thr Supt'rintendrnt or Oocumrnta, U.S. Govrrnment Prlntlne OCfi'-r, Waahinaton, D.C. 20402 FMS\ 05803 This Guide is based upon the report submitted in accordance with NIOSH Contract No. 210-75-0075 Project Officers~ Marilyn K. Hutchison, M.D. Stanley Kusnetz, M.S. DHEW (NIOSH) Publication No. 77-123- / / FMSI 05804 PREFACE The goal of the National Institute for Occupational Safety and Health (NIOSH) is to protect the health and safety of working men and women. Within the context of this program are NIOSH efforts that are directed toward the identification of those diseas~ conditions that are causally related to occupation, as necessary prerequisite to their prevention. This guide is presented primarily as an aid to State agencies and others concerned with occupational disease compensation. The Guide presents one method for assembling and evaluating evidence that may be relevant in determining the work-relatedness of a disease in an individual. Information on five disease-producing agents is presented to illustrate the decision-making process. It should be noted that such information may not be complete and does not necessarily reflect the most recent data regarding health standards and epidemiologic studies. NIOSH will welcome suggestions for improvement of the Guide based upon experience with its use. iii FMSI05805 ABSTRACT This Guide discusses various factors associated with establishing the relationship between disease and occupation. Prepared as an aid to State agencies, physicians, and others concerned with workers' compensation for occupational disease, the publication describes a method for collecting, organizing, and appraising medical, occupational, and other evidence with the aim of determining the probable work-relatedness of a given disease. Illustrative material on five disease-producing agents is included. The Guide also contains a list of occupations with potential exposure to selected agents, and other information that may be useful to those with decision-making responsibility in cases of occupational disease. iv . FMSI 05806 ., ASBESTOS i Introduction Asbestos is a mineral fiber, and is the name given to about thirty silicate compounds. Of these, only the follo\'ting 5 are of significance in industry: Chrysotile (white asbestos) Amosite Tremol ite Crocidolite (blue asbestos) Anthophyllite Chrysotile accounts for about 97 percent of all the asbestos used in this country. Asbestos is widespread in the environment because of its extensive use in industry and the home. Over 3,000 products contain asbestos. Because of this wide usage, it may be difficult at times to determine if a disease arising from asbestos is occupational in origin. For example, the air of some relatively ne\'t apartment buildings has been found to. contain more asbestos fibers than the maximum recommended levels in industry. The source of the fibers in the apartment buildings is the insulating materials used in the ventilating system. Exposure to asbestos can produce a lung fibrosis called asbestosis. The onset of asbestosis is usually gradual, developing over a period of 10 to 30 years of exposure to significant concentrations of asbestos. Occasionally, from very massive exposures, it may develop more quickly. Asbestos is also a cancer producing agent (bronchogenic carcinoma, mesothelioma) and can cause certain specific skin diseases (asbestotic subcutaneous granulomatosis and asbes toti c cutaneous verruc a). Heavy exposure to dust containing asbestos can cause skin irritation. Epidemiologic studies (experience loJith groups of people) and anin:a.l studies have shown that increased exposure to any of the types of asbestos increases the risk of lung cancer (bronchial carcinoma). This carcinoma appears to be related to the degree of exposure to asbestos, the type of asbestos and cigarette smoking. It is also significant that cigarette smoking in men and women greatly increase the risk of lunk cancer in those who are exposed to asbestos. Smoking is a factor that should be considered \'Jhen determining whether 1ung cancer is caused, wholly or in part, by an occupational exposure to asbestos. Mesothelioma, a rare malignant tumor of the membrane which lines the chest cavity and the abdominal cavity, is occurrinq with increasing frequency in workers with exposure to asbestos. The development of this tumor apparently is not related to the amount of asbestos inhaled ar.d it is four.d in persons not having asbestosis. Levels of exposure which are within accepted standards for protection against asbestosis, may not vi 23 FMS\ osso7 protect against mescthelicma. ~n increased incidence of malignancy of the stomach and colon has been reported among insulation workers using asbestos. Occupations with Potential Exposure to Asbestos Acoustical Product Makers Acoustical Product Installers Air filter makers Asbestos-cement products makers A3Lestos-cement products users Asbestos-coatings makers Asbestos-coatings users Asbestos-grout makers Asbestos-grout users Asbestos-millboard makers Asbestos-millboard users Asbestos-mortar makers Asbestos-mortar users Asbestos millers Asbestos miners Asbestos-paper makers A~bestos-paper users Asbestos-plaster makers Asbestos-plaster users Asbestos sprayers Asbestos workers Asphalt mixers Automobile repair garage workers Brake lining makers Cuilding demolition workers Carders (asbestos) Caulking compound makers Caulking compound users Clutch facing makers Cobbers (asbestos) Construction workers Crushers (Asbestos) Fiberizers (Asbestos) Fi reproofers Firemen Furnace filter makers Gasket makers Heal resistant clothing makers Insulation workers Inert filter media workers Ironing board cover makers Laboratory hood installers Laggers Paint rna kers Pipe insulators Plastics makers Pump packing makers Roofers Roofing materials makers Rubber compounders Shingle makers Ship builders Ship demolition workers Spinners ~Asbestos) Talc miners Talc workers Textile flameproofers Textile workers Undercoa ters Vinyl-asbestos tile makers Vinyl-asbestos tile installers Weavers (asbestos) Medical Evaluation (Also, See Decision-Making Process) In addition to the usual medical history, the following should be considered: 1. Any history of diseases of the heart or lung or abnormal tissue growth should be carefully evaluated to determine the relationship between the previous disease and the claimant's present condition. 24 . FMSI 05808 .. 2. A resriratory questionnaire, a sample of which is shown in Appendix, can be useful in evaluating the extent and importance of respiratory symptoms such as: - breathlessnessI phlegm (sputum) production - chest pain - cough - wheezing Asbestosis Shortness of breath upon exertion is usually the first symptom, frequently accompanied by a dry cough. This symptom develops after several years of progressive pulmonary fibrosis. As asbestosis progresses, the following signs and symptoms are observed: - cough with production of sputum - anorexia (loss of appetite) - secondary respiratory infections that are difficult to control - rapid breathing - repetitive end-inspiratory crackles (crackling sounds heard in the lower part of the lungs through stethoscope when employee completes each of a series of inhaled breaths) - orthopnea (breathing difficulty in a recumbent position) - cyanosis (change in skin color to bluish, grayish, slatelike or dark purple) decrease of chest expansion - digital clubbing (rounding of the ends, and swelling of the fingers and/or toes) - sequelae (other resultant diseases) including cor pulmonale (right heart failure), branch ogenic carcinoma (lung cancer), stomach or intestinal cancer, or pleural carcinoma (cancer of the membrane lining the chest) Fibrosis results in alveolo-capillary block (impaired ability of the lungs to transfer oxygen into the blood). This impairment is often more severe than is indicated by chest x-rays. 25 FMSI 05809 Mesothelioma In cases of mesothelioma, the rare malignancy noted above, there may be a long latent period, as much as 40 years, between initial exposure to asbestos and the development of the tumor. Mesothelioma of the peritoneum (membrane surrounding the abdominal organs) is usually accompanied by abdominal swelling and pain that is not concentrated in a particular area. Signs and symptoms of this type oftumor (which may be associated with asbestos exposure) include: - weight loss - obstruction of the bowel excessive accumulation of fluid in the abdominal cavity (ascites) is almost always present This malignant tumor of the peritoneum may spread to the chest cavity. With mesothelioma of the pleura, complaints include chest pain and breathlessness. Signs and symptoms of pleural mesothelioma include: - pleural effusion (accumulation of fluid in the space around the lungs) - the tumor may grow outward through the chest wall in the form of a lump beneath the skin (subcutaneous lump) - the tumor may spread to involve bone, lymph glands (nodes) mediastinum (area between the right and left lungs), and pericardium (t~e sac enclosing the heart). As a result, the supraclavicular nodes may become enlarged, ribs may develop tumors, and obstruction of the superior vena cava (major vein draining the upper portion of the body) may occur. - ;n addition, pericardial effusion (fluid in the heart cavity) may occur, causing tamponade. Laboratory (See Decision-Making Process) Additional tests which will assist in arriving at a correct diagnosis are: Chest X-rays Findings should be classified according to the ILO/UC 1971 Classification of the Radiographs of the Pneumoconioses. (Appendix B) Findings for asbestosis vary, but the usual picture shows a density in both lungs, with the lower one-third of the lungs involved. In the affected area there is a ~'ground glass" appearance. ! 26 .. FMSI 05810 .. As asbestosis progresses, more and more of the lung is involved, except the apices (tips of the lungs). The X-rays will show gradual obscuring of the bcrder between the lungs and the diaphragm. It may show shadows from the presence of nodules. X-ray findings usually will show the following as the asbestosis progresses: - reduced radiographic volume formation of cysts combined with increased size of the heart, dilation {enlargement) of the proximal pulmonary arteries (arteries which lead from the heart to the lungs) Lung Function Tests Reduced lung capacities and other lung changes do not differ from those resulting from other forms of lung fibrosis, both occupational and nonoccupational. Therefore, the results of lung function tests alone or chest X-ray findings alone do not lead to diagnosis of asbestosis. Asbestos bodies in lymph nodes indicate exposure, but no~ necessarily asbestosis. - Asbestosis causes a reduction in the vital capacity (VC) of the lungs and a reduction in total lung capacity (TLC). These capacities are further reduced as the disease progresses. -The residual volume (RV)of the lungs will be normal or slightly increased. -The lungs' diffusing capacity for carbon monoxide (DL) will be reduced. Other lung function test results which are found in asbestosis include: - Increased minute ventilation (amount of air breathed in one minute) - Reduced oxygenation of the arterial blood (arterial hypoxemia) - Increased static transpulmonary pressures - Decreased lung compliance An exercise test will result in an increased amount of air required during physical effort, decreased oxygen in the blood, leading to cyanosis. Sputum Examinqticn Asbestos fibers or bodies may be found in the sputum. These indicate asbestos exposure, but not necessarily asbestosis. Where cancer cells are present in the sputum, and chest X-ray findings are normal, bronchoscopy may be necessary to confirm and locate the lung tumor. 27 FMSI 05811 Skin Tests--The following tests should be performed by the ph_ysician to exclude possible infectious diseases: 1. PPD (tuberculin test) 2. blastomycin 3. histoplasmin 4. coccidioidin Epidemiological Data Various epidemiologic studies have demonstrated the relatic~s~ip between 3sbestos and lung disease, including mesothelioma, in su:~ :r!des ar~ cccupa~ians as mining, insulation installation, textiles, paint, ~lec~rical ind~stries, and many other occupations as a result of ~he ~idespread use of this substance. The available information indicates evidence of a dose-response relationship for asbestos exposure and the risk of asbestosis a~d/or tronchogenic carcinoma. However, much of this information is eoidemio1cgicai in nature and there is little correlatio:-~ bet1<1een epidemiolo.;~o:: data a~d erwir0:1mental exoosure data. Fer this reason and others, including t~e lcng ~atent perfod for the development of carcinomas, it is diffic~lt to deve1cp a s~eciftc dose-response relationship. This shoul~ be taken into considerati~n when referring to the follcwing material: 1 Ent::rline has reported c.n exposure-response rehtionshio between asbestos exposure (~valuated as millions of particles per c~bic foo~ years) and the risk of malignant and nonmalignant respiratory disease. Enter~ine's data indicates th:!t the risk of respiril.tory :ancer ircreas~d from 166.7 (standardized mortality ratio) at minimum exposure to 555.6 at cumulativ.~ expos:Jres exceeding 750 million pdrticles per cubic foot years. Enter1ine's data is summarized in a table by NIOSH2. Murpily3 reported that asbestosis was 11 times more ccmmon among pipe coverers in new ship construction than in a control group. The first asbes~osis was found after 13 years of 2xposure to an estimated cumulative dose of about 60 million particles per cubic foot years. After 20 years, asbestosis pre~ valence was 38%. '1urphy reported no asbestosis for men exposed to 60 mpocf years but 20% asbestosis in men exposed to 75-100 mppcf years. Murphv reports atmospheric dust concP.ntrations ranged from 0.8-10.0 moocf depending on the different operations evaluated. Asbestosis was considered present if the worker had at least three of the following: vascular rales in b1o or more sites, clubbing of the fingers, vital capacity of less than 80% predicted, roentgenog~aphy consistent with moderately advanced or advanced asbestosis, shortness of breath on climbing one flight of stairs. The Pennsylvania Oepartment of Health4 reported a study of asbestos dust concentrations in two plants (one studies from 1930-~967 and the oth~r from 1948-1968). 64 cases of asbestosis \vere reported. In the two plants, the study indicates that the air concentrations of particulates were generally less than five mppcf and in many cases less than two mppcf. Epidemiological evidence is also available relating the development of mesothelioma with exposure to asbestos. Selikoff5,6 reported 14 deaths 28 . FMSI 05812 ., from mesothelioma in 532 abestos insulation workers from 1943-1968. No deaths from mesothelioma would be expected from the same number of individuals in the general population. Evidence of Exposure Historically, there have been two air sampling and analysis methods to determine the quantity of asbestos in the workplace environment. The earlier light field impinger count method allowed only a measure of the overall dust level in the air rather than focusing on the amount of asbestos fibers in the air. The current fiber count method. satisfactorily determines the amount of asbestos fibers in the air. It is performed by collecting airborne materials on a membrane filter and then counting the fibers using a phase contrast microscope at a 400 to 450 times n1agnification ratio (400X450X). Asbestos fibers occur in varying lengths and diameters. As of the publication of the guide, the Occupational Safety and Health Act (OSHA) establishes maximum allowable limits for asbestos fibers greater than five micrometers (urn) in length. OSHA limits such asbestos fibers to no more than five fibers per cubic centimeter of air (based on an eight hour time-weighted average exposure). OSHA further requires that no workers be exposed to more than 10 ~sbestos fibers (greater than five urn in length) during any one 15 minute period of time. For samples collected by the field impinger count method, results may be compared to the pre-1970 limit (TLV) of five million particles per cubic foot of air. Occupational exposure to asbestros fibers five urn in length or greater, at quantities averaging more than five fibers per cubic centimeter of air or frequent exposures to more than 10 such fibers during a 15-minute period of time is evidence of a possible causal relationship between disease and occupation. Toxicological (See References 1-6, Appendix A) Conclusion The diagnosis of occupational asbestosis is based on meeting the following criteria: 1. Confirmed history of occupational exposure to asbestos. 2. X-ray finding;s compatible with those indicating asbestosis according to ILO/UC 1971 "Classification of Radiographs of the Pneumoconioses." 3. Pulmonary impairment, particularly a decrease in lung diffusing capacity and an increase in alveolar-arterial oxygen difference, 29 FMSI 05813 as demonstrated by lung function tests. The diagnosis of occupational mesothelioma is based on meeting the following criteria: 1. Confirmed history of occupational exposure to asbestos. 2. Pathological evidence of mesothelioma. / 30 . FMSI 05814 .. A-1. TOXICOLOGICAL REFERENCES Asbestos 1. Enterline, P.; et. nl. A Study of the Dose-Response Relationship Asbestos Dust and Luna Cancer. Unpublished manuscript. 2. NIOSH. 1972. r.riteria for a Recommended StandardOccupational Exoosure to Asbestos. ~incinnati: NIOSH 3. Murphy, R. L.lt.; et al. 1971. N. Eng. J. Med. 285:1271. 4. Pennsylvania Dept. of Public Health. 'lnpublished Conmunication. 5. Selikoff, I.cl.; et a1. 1968. JAI<~A. 204:106. 6. <ielikoff, I.J.: et al. 1964. JAMA. 188:22. Carbon ~onoxi de 7. NIOSH. 1972. Criteria for a Recommended StandardOccupational Exoosure to Carbon Monoxide. Cincinnati: ~nosH. 8. ~ayers, R. R.; ct. a1. 1929. USPHS Bull. 186. Washington: r,pn. Q '1cFarl and, P. II. 1944. J. Aviation Med. 15:381. 10. Halperin, 'tH. ; et al. 1959. J. Ph.z::siol. 146:583. 11. Horvath, S.M. 1972. '\rch. Env. Health. 23:343. 12. Schulte, J.H. 1963. '\rch. Env. Health. 7:524 13. Beard, R.R.; and l-Jertheim, S. 1967. Am. J. Pub. Health. 57:2012. 14. Beard, q,q,; and Grandstaff, N.H. 1970. Proc. Ann. Conf. Env. Toxic. 1:q3. 15. Trouton, D.; nnd Eysewck, H.J. 1~61. Handbook of Abnormal Psycholnqy. Ne\'1 York: Basic Books. 16. NIOSH. 1972. Criteria for a Recommended Standard - Occ!Jpationar Exoosure to Carbon ~1onoxide. Cincinnati: ~IIOSH. 65 FMSI 05815 Lead 17. Elkins, 1!.11. 1959. The Chemistry of Industrial Toxicoloqy 2nd ed. -.lew York: John \~il ey. 18. Lane, ~.E. 1949. Brit. 1. Ind. ~1ed. 6:125. 19. Hi1liams, ~~.K.; et al. 1969. Brit. ,1. Ind. Med. 26:202. 20. rl!OSH. 1972. Criteria for a Recommended Standard Occupational Exposure to Inoraanic Lead. Cincinnati: :nosH. 21. Hartogenesis, c.; and Zie1huis, R.L. 1962. Ann. Occ. Hyq. 5:27. 22. Dreeson, t.r.c.; et al. 1941. Public !!~:tlth Bulletin 262. Hashington: GPO 23. National Academy of Sciences, Division of Medical Sciences, Committee on Biological Effects of Atmospheric Pollutants. 1971. Airborne Lead in Perspective. ~loi se 24. :!IOSH. 1972. Criteria for a Recommended Standard Occupational Exposure to Noise. (incinnati: NIOSH. 25. Coles; and Knight. 1960. 1\nn. nee. H~g. 2:267. 26. Yaffe; and Jones. 1961. u.s. Pub1i c Health Service Publication 850. Washington: '1PO. 27. Schneider: et al. 1961. II.IHA J. 22:245. 28. Brohm; and Zlamal. 1962. Cas. Lek. Ces. 101 :300. Czech. 29. Mancini; and Stancari. 1962. Pass. Med. Ind. 31:239. Italian. 30. Chad\oJick. 1963. J. Larynqol. 77:467. 31. Filin. 1963. Gog. Tr. Prof. 7abol. 7:3. Russian. 32. Heston. 1963. ,J. 11.us. Inst. Agr. Sci. 29:15. 33. r.ohen; ct a1. 1970. Arch. Env. Health 20:614~ r 34. Burns; And Robinson. 1970. Hearing and ~oise in Industry. London: ller Majesty's Stationery Office. 35. Stone; et a1. 1971. 'IHA J. 32:123 66 FMSl 05816 .. Toluene Diisocyantr. 36. fUOSH. 1973. Criteria for a Recommended Standard 9ccupational Exposu;~e to Toluene Diisocyanate. Cincinnati: NIOSH. 37. Walwor.th, 1l.T.; and Virchow, 'LE. 1959. AIHA J. 20:205. 38. Elkins, f!.!:L; et al. 1962. AIHA J. 23.265. 39. Glass, r.r.; and Thorn, N.G. 1964. ~I.Z. r1ed ..J. 63:642. 40. Hilliamson, K.S. 1964. Trans. 1\ssoc. Ind. Med. ~"~ff. 14:81. 41. Maxon, F.C. 1964. 1\rch. Env. Health. 8:755. 42. Bruckner, H.C.; t:!t al. 1968. \rch Env. Health. 16:619 43. Peters, J.M.; et al. 1968. ll.rch Env. Health. 16:642. 67 FMSI 05817 A-2. BIBLIOGRAPHY Asbestos 1. Arena, J.M. 1970. Poisoning, Toxicology, Symptoms, Treatments. Springfield: Charles C. Thomas. 2. Council on Occupational Health. 1963. ~rch. Env. Health. 7: 130. 3. Hamilton, A.; and Hardy, H.L. 1974. Industrial Toxicology. 3rd eo. Acton: Publishing Sciences Group. 4. Morgan, W.K.C.; and Seaton, A. 1975. Occupational Lung Diseases. Philadelphia: lr.11. Saunders. 5. Advisory Committee on Asbestos Cancers. 1972. The Biolooical Effects of Asbestos. Delivered to !1oricf Health Organization, Lyon, Oct. 5-6. 6. NIOSH. 1972. Criteria for a Recommended Standard Occupational Exposure to Asbestos. Cincinnati: NIOSH 7. Yater, H.M.; ;:~nd Oliver, 'I. F. 1961. Symptom Diaqnosis. 5th ed. New York: Appleton Century Croft. Carbon Monoxide 1. ~IOSH. 1973. Criteria for a Recommended Standard'kcupational Exposure to Carbon Monoxide. Cincinnati: NIOSH. 2. Gafafer, W.M. 1966. nccupational Diseases-A Guide to their Recognition. Washington: ll.5. Government Printing Office. 3. Breaker, W.; and Mossman, A.L. 1970. Toxic Gases: First Aid and Medical Treatment. Rutherford: Matheson Gas Products. 4. Hunter, D. 1969. The Diseases of Occupations. 4th ed. Roston: Litt 1e , 8rown . 5. '\rena, .1.~ 1 .' 1970. Poisoning, Toxicolooy, Symptoms, Treatment. ~prinofield: Charles C. Thomas. 6. Plunkett, E.R. 1966. 'landbook of Industrial To xi co1ogy. Ne1v York: Chemical Publishing. 68 .. FMSI 05818 ., C. SAMPLE RESPI~\TOUY QUESTIONNAIRE Use the actual wording of each question. Put X in the appropriate space after each question. When in doubt, record 11N0. 11 PREAMBLE: I am going to ask you some questions mainly about your chest. I should like you to answer 'YES' or 'NO' whenever possible. YES NO 1. Do you usually cough first thing in the morning or on getting up? (Count a cough with first smoke or on firEt going out of doors. Exclude throat clearing or a single cough.) 2. Do ycu cough like this on most days for as m~ch as three months each year? 3. Do you cough at work? 4. Do yc.u tlf''l3lly bring up some phlegm from you; chest: first thing in the morning or on getting up? (Count phl.~gm with the first smoke or on-first going out of doors. Exclude phlegm from the nose. Count swallowed phlc~ru.) / / 91 FMSI 05819 5. Do you bring up phlegm like this on most days for as much as three months each year? 6. In the past three years, have you had a period of (increased) cough and phlegm lasting 3 weeks or more? 7. Have you had more than one such period? 8. Does your chest ever feel tight or your breathing become diffi~ult? 9. Do you get this apart from colds? (If YES: specify . (Interviewer to code) (a) \-lith Exercise (b) At Work (c) Any Other Time If disabled from walking by skeletal or other physical disability put 'X' here. 10. Are 'OU troubled by shortness of breath, when hurrying on the levels or walking up a slight hill? (If 'NO' omit questions 11 and 12) 11. Do you get short of breath walking with other people of your own age on level ground? (If 'NO' omit question 12) 92 _,.. . FMSI 05820 .. ca1t ~ ~ ~~ 101'1. l.evel ground? U.. ]J}o ~~<all-y ~v~ a stuffy nose or <Clltt~ ~l: 1t~ bla<ek of your nose in the ((ruf ":NO'' 1t<t!> lb:ot:b rquest:ions 13 and 14, ~ lt'-0 rqu~tt::ii.~:n 16) ].3).. 'Jl1m ~ ~ 1tihd.s on m~ost: days for as much TI.IDw lJ1Wn::ii;n;g 1tihe -;rast: 3 years have you had any ~ ~]]IDess whlcb has kept: you off work <mJr fEmmm y=r llliSilal activities for as much J177.. InliLrl JW.U lbr.fuog up n::nnre phlegm than usual :!hn a:roy <P.f tt:llaese illnesses? .D$.. &vte :o/tW.u l11.alll 1100re t:han one illness with ~ ~ tt:lli~ in the last 3 years? ~~~ ~~~~y~ut ~~il~ after each positive answer.) 93 FMS' 05821 21. Bronchitis? 22. Pneumonia? 23. Pleurisy? 24. Pulmonary Tuberculosis? 25. Bronchial Asthma? 26. Eczema? 27, Dermatitis? 28. Pneumoconiosis? 29. Byssinosis? 30. Other chest troubles? 31. Have you ever smoked? (Record 'NO' if subject has never smoked as much as one cigarette a day, or 1 oz. tobacco a month, for as long as one year) 94 .. FMSI 05822 ' 32. Age when stopped._ __...years. Was this in the last month? If 'YES' to 31 and 32, fill in figures below: Cigarettes/day (Average including weekends) AMOUNT SMOKED BEFORE NOW STOPPING Oz. tobacco/week (handrolled) Cigars/week (large) Cigars/week (small) OCCUPATION (1st Interview Only) (Record on lines the years in which subject has worked in any of these industries, e.g., 1960-1963) 33. Have you ever worked in a dusty job? YES NO 34. In a coal mine ----------------- 35. In any other mine? 36. In a quarry? 37. In a foundry? 38. In a pottery? 39. In a cotton, flax or hemp mill? 40. With asbestos? 95 FMSI 05823 . 41. In any other dusty job? If 'YES', specify --------- 42. Have you been exposed regularly to irritating gas or chemical fumes? If 'YES', give details of nature and duration ---------------------- OCCUPATION {Follow-Up only) 43. What is your present job? ---------------------------44. How long have you been doing it? 45. What was your previous job in the factory? --------------- Taken with minor changes from Operating and Medical Codes of Practice for Safe Working with Toulene Diisocyanate, Health Advisory Committee, British Rubber Manufacturers' Association Ltd. 96 . FMSI 05824 i i i l j