Document po1KGzewZgwJdQ9JymBYGZLE

ASBS5TCS RELATED DISEASES .X' b 0 Until the early 1950's asbestos was thought to ba an inart material which did not causa any problem; although asbestosis wa first described in 1906 in England and in 1930 in the C7.S. and an association between asbestos exposure and lung cancer was noted as early as 1935, the fact that asbestos exposure could result in serious health problems was not widely accepted until much later. It should be noted that large scale use of asbestos did not start until close to the end of the last century. This is important since in most cases diseases resulting from exposure to asbestos do not become evident until many years after the exposure begins, in some cases up to 40 years. There are three disease entities which'result from exposure to asbestos. 1. Asbestosis 2. Mesothelioma 3. Cancer of the lung and other sites 132 mraiiawiiiMiTi OOP 0907484 DU 028585 -2- Asbeatosis is a chronic long disease in which tha lungs become slowly scarred and inelastic and the pleura (the outer surface of the lung) becomes thickened and sometimes calcified. The exact mechanism of asbestosis is unknown, but we believe that asbestos fibers are inhaled, and become trapped in the small air sacs in the lungs. The movement of the lungs during breathing causes the fibers to work their way into the lining of the bronchial tubes where they create a chronic irritation. The body's defense mechanism deposits various materials r.round the fiber in an atttaij: to destroy it or remove it. This is not possible and leads instead to the formation of a so called asbestos body.. The chronic irritation continues and eventually, scarring develops around the "asbestos bodies". The ultimate condition of the lung is one of severe emphysema. The disease develops slowly over the years and often continues to increase in severity even long after the exposure to asbestos has stopped. The effect on the patient is a progressive restriction of his ability to move air in and out of his lungs, and the ability of gases to be exchanged in the lungs, so that the body tissues are provided little oxygen and are unable to adequately eliminate carbon dioxide. The patient becomes progressively short of breath, and ultimately sueeuabs to intercurrent pulmonery infection or as a result of -heart failure. There is no effective treatment other then to provide some relief by restricting activities and providing tamperary ralief with oxygen and other respiratory aids. 0907485 DU 028586 -3Mesothelioma is a fj.nor which involve* the lining of the cavities of the body, primarily the lining of the chest cavity, both the outer surface of the lung and the inner surface of the chest wall. It is also frequently found in the abdominal cavity, and in the cavities around the heart and the testicles. Mesotheliomas art not vary malignant tumors in that they ' to There are two distinct types of mesothelioma, localized and diffuse. Most of the localized mesotheliomas can be successfully resected and there is no tendency for then to recur. There has been no association demonstrated between exposure to asbestos and the localized type of mesothelioma. The diffuse type begins in multiple areas within a body cavity. These "seedlings* grow laterally and finally coalesce and completely line the body cavity. If the lung is involved, expansion of the lung is restricted. At the same time they slowly invade the chest wall and result in severe pain. There is no effsctive treatment and death usually rasults in ona year. An association batwaen diffuse -<esotheioma and asbestos exposure was first described in I960) since then several othar epidaaiological studiaa have confirmed this association. Sosm epideaiological works shows excesses of diffuse mesthelioma even among members of the family of exposed workers and in the neighborhood of industrial sourcaa of asbestos. DUP 0907486 DU 028587 ,,8B!iB!8!3illilliii!afMgBSS Ihe disease ha* baan induced in experimental animals both by inhalation and by injection of asbestos in the cheat cavity. The diseaaa haa also been induced in the chicken by a virus, suggesting that possibly asbestos acts by activating such a virus which then induces mesothelioma. This is still highly speculative. The interval between the onset of exposure and development of the disease is long and is dose related. The average is said to be 30 years but varies between less than one year to 50 years. There is no evidence of any association between cigarette smoking and mesothelioma. 0US 090^87 DU 028588 -5Cancar of tha Lung and other sift Cancar of tha lung and other sites, specifically tha gastro intestinal tract and the larynx is tha third type of disease associated with asbestos exposure. Tha suspicion of an association between asbestosis and lung cancer was first published in 1935, but convincing evidence of such an association did not appear until 1955. As late as 1960 a standard textbook on occupational medicine statedi "Some authorities believe that asbestos may induce bronchogenic carcinoma, \ but as yet there is no impressive body of evidence to support this assumption." In the middle sixties Selikoff investigated the mortality experience of insulation workers and concluded that the death rate from cancer of the bronchus and pleura was 6.3 tines as high as that for the general United States white male population and cancer of the stomach, colon, and rectua was three tines as common. Cases of mesotheliomas and asbestosis were also found in this group. The Lung cancer risk in this group wes dose related. Some increase in lung cancer was saen in workers with lsss than 3 months exposure. An increase in cancer incidence was seen as little as 10-14 years from the onset of work exposure, but the greatest increese occurred 30-45 years from the onset of the work exposure, when cigarette smoking was takan into account, it was also calculatsd that asbestos insulation workers with a history of regular cigarette smoking had eight times the risk of lung cancer deaths compared with cigarette smokers who did not do such work, and approximately 90 times the risk of men who neither worked with asbeetoa nor smoked cigarettes. Dup 0907488 Dll 028589 for non-srackers there was no clear indication that asbestos exposure resulted in an increase in tha risk of lung cancer. In the seventies there have been several other studies indicating an association between lung cancer and exposure to asbestos, practically all supporting a dose related response. A dose related response has also been observed in the case of digestive system cancer. Lung tumors have been induced in experimental animals by inhalation with exposures as short as one day. All types of asbestos have been demonstrated to be able to produce both asbestosis and tumors; some however are more potent in inducing one response than the other. *9 DUP 0907489 .'!! 1 S'!__LJ DU 028590 AS3ESTCS RELATED DISEASES j rc iS'ZA Until the early 1950's asbestos was thought to b an inert material which did not cause any problem; although asbestosis wa first described in 1906 in England and in 1930 in the U.S. and an association between asbestos exposure and lung cancer was noted as early as 1933/ the fact that asbestos exposure could result in serious health problems was not widely accepted until much later. Zft should be noted that large scale use of asbestos did not start until close to the end of the last century. This is important since in most cases diseases resulting from exposure to asbestos do e not become evident until many years after the exposure begins, in some cases up to 40 years. There are three disease entities which' result from exposure to asbestos. 1. Asbestosis 2. Mesothelioma 3. Cancer of the lung and other sites 932 DUP 0907490 DU 028591 Asbestosis is a chronic lung disease in which the lungs become slowly scarred and inelastic and the pleura (the outer surface of the lung) becomes thickened and sometimes calcified. The exact mechanism of asbestosis is unknown, but we believe that asbestos fibers are inhaled, and become trapped in the small air sacs in the lungs. The movement of the lungs during breathing causes the fibers to work their way into the lining of the bronchial tubes where they create e chronic irritation. The body's defense mechanism deposits various materials around the fiber in an atteAp to deetroy it or remove it. This is not possible and leads instead to the formation of a so called asbestos body.. The chronic irritation continues and eventually.scarring develops around the "asbestos bodies". The ultimate condition of the lung is one of severe emphysema. The disease develops slowly over the years and often continues to increase in severity even long after the exposure to asbestos has stopped. The effect on the patient is a progressive restriction of his ability to mevt air in and out of his lungs, and the ability of gases to be exchanged in the lungs, so that the body tissues are provided little oxygen and are unable to adequately eliminate carbon dioxide. The patient becomes progressively short of breath, and ultimately succumbs to intercurrant pulmonary infection or as a result of -heart failure. Thera is no effective treatment other then to provide some relief by restricting activities and providing tamporary relief with oxygen end other respiratory aids. DU 028592 -3 Mesothelioma is a tumor which involves the Lining of the cavities of the body, primarily the lining of th chest cavity, both th outer surfac of th lung and th inner surfac of th chest wall. It is also frequently found in th abdominal cavity, and in th cavities around th heart and the testicles. Maaothaliomas ara not vary malignant tumora in that they do not have a great tendency , surrounding tissues, spread to distant sitas/^<*-/`_--j ~~ to There ara two distinct typas of masothalioma, localizad and diffusa. Moat of the localized mesotheliomas can ba successfully resected and there is no tendency for thea to recur. There has been no association demonstrated between exposure to asbestos and th localized type of mesothelioma. The diffuse type begins in multiple areas within a body cavity. These seedlings" grow laterally and finally coalesce and completely line the body cavity. If the lung is involved, expansion oi the lung is restricted. At the same time they slowly invade the chest wall and result in severe pain. Thar is no effective treatment and death usually results in one year. An association betveen diffusa masothalioma and asbestos exposure was first described in 1960; since then several othar epidamiological atudias have confirmed this association. Some epidemiological works shows axeassas of diffusa mesthelloma aven among members of the family of exposed workers and in the neighborhood of industrial soureas of asbastos. DUP 0907492 DU 028593 -4The disease ha bean induced in experimental animal* both by inhalation and by injection of asbestos in the chest cavity. The disease has also been induced in the chicken by a virus, suggesting that possibly asbestos acts by activating such a virus which then induces mesothelioma. This is still highly speculative. The interval between the onset of exposure and development o the disease is long ar.i is dose related. The average is said to be 30 years but varies between less than one year to SO years. There is no evidence of any association between cigarette smoking and mesothelioma. Dt/p 0907493 DU 028594 ri- JiMaslfl,, ai^rlrii-r-l*"- Immui jliiil Miilifi I*1** a,lU^ iaSi dm -5Cancsr oi the Lung and Other Sites Cancer of the lung and other sites, specificaliy the gastro intestinal tract and the larynx is the third type of disease associated with asbestos exposure. The suspicion of an association between asbestosis and lung cancer was first published in 1935, but convincing evidence of such an association did not appear until 1955. As lata as 1960 a standard textbook on occupational medicine stated: "Some authorities believe that asbestos may induce bronchogenic carcinoma, but as yet there is no impressive body of evidence to support this assumption." In the middle sixties Selikoff investigated the mortality experience of insulation workers and concluded that the death rata from cancer o the bronchus and pleura was 6.3 times as high as that for the general United States white male population and cancer of the stomach, colon, and rectum was three times as common. Cases of mesotheliomas and asbestosis were also found in this group. The lung cancer risk in this group was dose related. Some increase in lung cancer was seen in workers with less than 3 months exposure. An increase in cancer incidence was seen as- little as 10-14 years from the onset of work exposure, but the greatest increase occurred 30-45 years from the onset of the work exposure. When cigarette smoking was taken into account, it was also calculated that asbestos insulation workers with a history of regular cigarette smoking had eight times the risk of lung cancer deaths compared with cigarette smokers who did not do such work, and approximately 90 times the risk of men who neither worked with asbestos nor smoked cigarettes. it DUP 0907494 DU 028595 -6ror non-smokers there was no clear indication that asbestos exposure resulted in an increase in the risk of lung cancer. In the seventies there have been several other studies indicating an association between lung cancer and exposure to asbestos, practically all supporting a dose related response. A dose related response has also been observed in the case of digestive system cancer. Lung tumors have been induced in experimental animals by inhalation with exposures as short as one day. All types of asbestos have been demonstrated to be able to produce both asbestosis and tumors; some however are more potent in inducing one response than the other. *9 0907495 DU 028596 I 'aur.e j . --. rliSiCy 3. ?.. 3cl:or. H. S. Trigg H. I. Baldwin A. 3. Culver C. -coney 3. Z. Fanson C.; Springs W. 1. 'iteager L. E. '.Vililacs Carroll Wiggs 3. ?.. "aughan X. X. Bailey R. '.V. Calhoun. D. L. Swats W. _ D. Whitlow 0. 2. Fitzgerald C-. E. Lang J.'R. Brown W. G. Roberts E. T. Ruehl L. R. Robertson A. V. Episccpo W. J. Montgomery J. Mooyman X. Ash J. 3. Wright C. A. Smith W. W. Dowdy L. 'R. Moss T. T. Hampton < "I-- - s-u. llecours Wile. Wayr.esooro Seaford Cacaen Cacden Cace Fear Cape Fear Kinston Kinston Kinston Waynesboro Seaford Maxtinsvilla Martinsville Martinsville Louvlars Old Hickory Old Hickory Waynesboro Old Hickory Chestnut Run Chestnut Run Maitland Klngston-Ontario Chattanooga Cooper River Chattanooga Spruance Spruance ciac Engineer Safety it Fire legal iicS 3145 icu"' Engineering Field Malm. 2SCG "'2S8 Safety/Heaidi 3CF Eng. Area Engr. Spec. 3461 2591 4463 Environ. Cent. Supvr. Environ. Corn. 4223 6562 Field Mair.t. Lnsui. Super. Insul. Supvr. 5544 5634 2731 S&F Prot. iCSEA 253 Area Maint. Safety 2302 2343 Safety Supvr. 2348 Materials Engg. 2435 Chief Supvr. 7612 Section Supvr. 3722 Safety, Health, Eav. Affairs 2139 Snv. Control 8160 Safety-OSEA 3512 Area Maint. Supvr. 3325 Maint. Forem. 406 Maint. Foreman 681 Area Maint. Supv. 1453 Area Maint. Supv. -Staple 9190 Eav. Cont. 7237 S. H. E. A. 21C4 Engr. Supv. - Field 2940 934 DUP 0907496 DU 028597 .~ -- X. C-. Fiasky B. Bciton - ^ '--7? H. Z. Baldwin A. 3. C`liver C. looney B. Z. Ransor. W. 1. Springs 7/. X. Stenger 1. Williams Carroll Wiggs 3. R. Vaughan 2. 2. Bailey W. Calhoun D. 1. Swats W. D. 'Vhitlow O. E. Fitzgerald G. Z. Lang X. R. Brown W. C-. Roberts E. T. Ruehl L. R. Robertson A. V. Episcopo W. X. Montgomery X. Mooyman K. Ash X. 2. Wright C. A. Smith w. tv. Dowdy L. R. Moss T. X. Hampton L.C ^2, '; r 'Tezicurs l.'emours V/ivTissccrc Seaioru Camoen Camden Cape Fear Cape Fear Kinston Kinston , Kinston Waynesboro Seaicrd Martinsville Martinsville Martinsville Louviers Old Hickory Old Hickory Waynesboro Old Hickory Chestnut Run Chestnut Run Maitland Hingston-C ntario Chattanooga Cooper River Chattanooga. Spruance Spruance A ssi .tt"-* = nc S'ad: Zr.r_n.ee r ^ccS Safety i Fire 2d43 legal 563'' Z r.cin.95 rir.t7 23CC Field Main:. "293 Safsty/Health 3461 BCF Zng. Area 2531 Zn.gr. Spec. 4488 Environ. Cone. Supvr. 4223 Environ. Cent. 5582 Field Main:. 6544 Ir_sui. Super. 3634 Insul. Supvr. 2781 5&F Prct. &CSEA 353 Area Maint. 2302 Safety 2348 Safety Supvr. 2348 Materials Engg. 3435 Chief Supvr. 7612 Section Supvr. 3722 Safety, nealth, Env. Affairs 2139 Env. Control 3160 Safety-CSHA 3512 Area Maint. Supvr. 3325 Malnt. Forem. 406 Maint. Foreman 331 Area Maint. Supv. 1453 Area Maint. Supv. -Staple 3 ISO Env. Corn. . 7237 S.H.S.A. 2104 Engr. Supv. - Fle^* 2940 934 DUP 0907497 DU 028598