Document qdr1oL9aRZ2j6G66j2EnLYnEk

FILE NAME Talc TALC DATE 1980 DOC TALC106 DOCUMENT DESCRIPTION NIOSH Report - Occupational Exposure to Talc Containing Asbestos * Me TECHNICAL REPORT gf aS 77 OCCUPATIONAL EXPOSURtEo TALC CONTAINING ASBESTOS U. S. DEPARTMENT OF HEALTH EDUCATION AND WELFARE - Public Health Service Center for Disease Control National Institute for Occupational Safety and Health CONTENTS ABSTRACT . 2.2 ee ee 2.2... a rr ACKNOWLEDGMENTS . 2. 2. 1 e. e ee. eee ran DEFINITIONS 2... we ee ee ee ee we ee ee we ew INTRODUCTION FACILITIES 21 7 wee ee DESCRIPTION OF FACILITIES STUDIED . ew ce ee ee re INDUSTRIAL HYGIENE STUDY . 2... Methods 2... ew ee ee ee Results .....280.. Comparison of Present and Past 2... ew we eee ee ew ee ew wee we cee ew Exposures ee . Comparison of Exposure Characterisitcs with Other Talc Mines and Mills in the Gouverneur New York Area . 2... 0 ewe Gouverneur Gouverneur ew ee REVIEW OF HEALTH EFFECTS FROM EXPOSURE TO TALCS CONTAINING ASBESTIFORM AND ASSOCIATION MINERALS ww ... Respiratory Morbidity Studies .......2.00004 Mortality Studies .. 1.0... 00 ewe eevee CROSS SECTIONAL MORBIDITY STUDY ee . Description of Work Force Materials and Methods a ee eae Results .. 2. ee we ee eee ee ee ew Discussion . ww ee eee COHORT MORTAeLIeTY RETROSPECTIVE COHORT STUDY OF tt te ew ee ew we ew ek ee Methods Results 828 ceae .........0.088 2). 6 we ee we te we we we ee oe ee ee we ee ee Discussion . ee ee a . CONCLUSIONS AND RECOMMENDATIONS a TABLES 2 6 we ee we te te tt FIGURES ......... eee eee REFERENCES ww wee tt APPENDIX 2... for NIOSH 1975 ttt tt tt kt ke re tt we te tw tt ee ee ee et eee Hygiene Study iii xi xiii 1 3 5 5 6 9 10 11 11 16 19 19 19 20 24 29 29 29 31 33 35 82 89 97 10 11 12 13 14 TABLES Results of ray diffraction and petrographic microscopic analysis of bulk talc samples collected during study ........ Results of trace metal analyses of bulk talc samples collected during study ......... 36 Results of major components analyses of product talc samples . 1. se ee eee wee wae 37 Summary of TWA exposures by job mining operations .......e-e-. rr 38 Summary of TWA exposures by job title ........ 39 Summary of TWA amphibole fiber exposures all fiber lengths determined by electron microscopy 40 Summary of airborne fiber types determined by analytical electron microscopy .......se-esee-8 41 Summary of airborne positive amphiboles fiber diameters for .........e6.26eee8c8e0- Summary of airborne fiber lengths for positive amphiboles ..........2...e.ee. Aspect ratios for positive amphiboles determined by electron microscopy Summary of historic impinger dust measurements in mine and mill operations ........ rar Summary of historic fiber exposure measurements in mine and mill operations ..........2.46. Comparison of airborne fiber character- istics in study of mine and mill operations with New York talc operations acknowledged as containing asbestiform minerals Summary of morbidity studies of workers exposed to tremolite and anthophyllite fibers 6 wwe ee we anthophylite tt tt tt tt et vi 15 smoking composition of morbidity study population who had no previous occupational exposure to talc te se e ee 15A smoking composition of total morbidity study population regardless of previous employment . 6. 6 ee eee we we we we ww ew ew 56 16 exposure composition of morbidity study population who had no previous occupational exposure to talc 2... 2 ee ee ee ew we 57 16A exposure composition of total morbidity study population regardless of previous employment 57 17 Prevalence A of symptoms and radiographic findings by smoking habits among morbidity study population who had no previous occupational exposure to talc a 58 17A Prevalence A of symptoms and radiographic findings by smoking habits among the total morbidity study population regardless of previous employment .. .. 59 18 Prevalence A of symptoms and radiographic findings by age among morbidity study popula- tion who had no previous occupational exposure to talc we ee ee ee tee tt we we ee ee 60 18A Prevalence A of symptoms and radiographic findings by age among the total morbidity study population regardless of previous employment 2... 6. 2 eee ee ew ee ee ee 61 19 Prevalence A of symptoms and radiographic findings among talc workers included in morbidity study with no previous occupational exposure to talc compared to coal and potash workers adjusted for age height and smoking habits 6 1 ee ew eee ee we ee ~ 2s. 62 19A Prevalence A of symptoms and radiographic findings among all talc workers included in morbidity study compared to coal and potash workers adjusted for age height and smoking habits 2... ww ee ee ee ee eee 63 vii 20 response relations among talc workers observed pulmonary function as compared to pulmonary function of coal and potash miners adjusted for age height smoking habits and years worked Standard error in parentheses .... 64 21 Comparison of talc workers included in morbidity study and having no previous talc exposure with and without pleural thickening PT by age exposure and smoking habits Standard error in parentheses 93 6 ee ee ee ee ee ees 67 21A Comparison of all talc workers in morbidity study with and without pleural thickening PT by age exposure and smoking habits Standard error in parentheses 121 . 2 eee ee ee ee eee es 68 22 Average number of years worked for each individual in morbidity study having no previous talc exposure with and without pleural thickening and the number of these individuals working in selected jobs over the total work history of those with +e greater than 15 years work when 0 5 and 10 of the most recent years are omitted s + ee-s 69 23 24 Symptom prevalence radiographic findings and pulmonary function of talc workers in morbidity study by pleural thickening PT and years employment . . 2. 2 6 + se ee we a er 70 70 Symptom prevalence A of talc workers in morbidity study compared to asbestos1,3 and synthetic textile workers by age and smoking habits . 71 25 Prevalence of radiographic findings of talc workers in morbidity study compared to asbestos workers1 over 35 years of age and after age adjustment . 2 6 ee ee ee ew ee we es 72 26 Summary of the prevalence of pleural thick- ening PT in workers exposed to asbestos ...... 73 27 Vital status of 398 talc workers included in mortality study who began employment between 1947-1960 began ee ee eee eee eee 75 viii 28 29 30 Study cohort of talc workers included in mortality study according to length of employment 2 ... 6. 6 ee eee ew ee ew ee ws Study cohort of talc workers mortality study according to initial employment 1... included in date of 2 ee ee we we ee ews Observed and expected deaths according to major cause among talc miners and millers included in mortality study 30A Observed and expected deaths according to specific cause among talc miners and millers included in mortality study 1... we ee ee we we we 31 Bronchogenic cancer among talc miners and millers included in mortality study according to interval since onset of employment latency 79 32 Case review of deaths among talc miners and millers included in mortality study according to cause of death and select demographic factors 80 FIGURES Electron diffraction patterns and ray spectra of tremolite fibers in bulk samples ..... Electron diffraction patterns and ray spectral of anthophyllite fibers in bulk samples Electron photomicrograph of airborne par- ticulates in mine and mill ee eee Electron photomicrograph of airborne par- ticulates in mine and mill . .. . . Electron photomicrograph of airborne par- ticulates in mine and mill 1. 1 0 ee ew wee Mean yearly impinger dust concentrations for mine operations ... 2... 2 eee eee wens Mean yealy impinger dust concentrations for mill operations 1 ... 6 ee ww ew eh we ww ix ACKNOWLEDGMENTS ACKNOWLEDGMENTS ACKNOWLEDGMACKENOWNLEDTGMESNTS The assistance of the following is acknowledged Mike Grannan and Eric Kus of NIOSH and Jim Salois of MESA in collection of the industrial hygiene samples Mike Grannan Robert Phillips and Kenneth M. Wallingford in the optical asbestos fiber analyses Terry Boyle and Dennis Roberts in reduction of the field and laboratory data Dr. D.R. Bowes of the University of Glasgow in analysis of major elements of talc bulk samples W.C. McCrone Associates and the Mt. Sinai School of Medicine of the City University of New York in analysis of talc bulk samples We wish to thank the staff of the Biometry Section for their help in assembling the necessary data for the mortality study and in preparing the manuscript The guidance of Richard Lemen was especially helpful The time and effort of the field teams that participated in the collection of data for the morbidity study was greatly appreciated xi COUGH DYSPNEA FEF25 FEF50 FEF75 FEV1 FEV percent FVC HEMOPTYSIS PHLEGM SMR TWA DEFINITIONS YES to the question Do you cough like this on most days for as much as three months each year YES to the question Do you short of breath walking with people your own age on level ground get other Forced Expiratory Flow second at 25 percent 50 percent and 75 percent of expired FVC Forced Expiratory Volume in one second liters FEV1 ^ 100 Forced Vital Capacity liters YES to the question coughed up blood Have you ever YES to the question Do you bring up phlegm like this on most days for as much as three months each year Observed Expected deaths x 100 Eight time weighted average xiii INTRODUCTION The term talc in the mineralogical sense denotes a specific rockforming mineral of the sheet silicate category however when talc is referenced in the industrial or commercial setting it may represent a varied mixture of minerals with physical properties similar to the mineral talc 1 Minerals commonly found associated with talc include calcite quartz diopside magnesite serpentines chrysotile antigorite and lizardite and fibrous and nonfibrous amphiboles tremolite anthophyllite actinolite 1 2 The United States produces about 30 percent of the world's talc with New York California Vermont Texas and Montana accounting for fourths of the U.S. production The work force for both talc mining and milling has been estimated to be about 1,200 in over sixty facilities 3 Largely due to the great variety of minerals commonly associated with talc few studies have been undertaken which adequately characterize the various minerals to which talc workers are exposed and simultaneously delineate the latent disease manifestations associated with those work environments Recognizing the need for additional research with regard to health hazards from industrial talc exposure the National Institute for Occupational Safety and Health NIOSH undertook an industrywide program to study talc mining and milling in two geographic areas New York and Vermont This program includes detailed industrial hygiene studies to characterize the various agents to which workers have been exposed sectional medical surveys to evaluate respiratory impairment and retrospective cohort studies to evaluate latent disease patterns among workers who have been exposed to talc in the work environment The present report restricts itself to that part of the industrywide study concerning an investigation of talcs containing fibrous amphibole minerals as mined and milled in the Gouverneur Talc District in upper New York This talc mining district located in St. Lawrence County represents a complex association of amphiboles anthophyllite tremolite etc. talc quartz and serpentines 2 4 Previous studies by Kleinfeld et al 5 6 of asbestiform talc miners and millers in this district have demonstrated significantly increased proportional mortality due to both malignant and nonmalignant respiratory diseases Morbidity studies also have indicated increased symptoms and ray and lung function changes consistent with pneumoconiosis 7 8 9 10 11 12 More th recently a talc mining company in this district maintained that these studies were not applicable to all talcs in the Gouverneur Talc District The company stated that talcs extracted from its original mine in the Gouverneur Talc District do not contain asbestiform minerals and that the talcs have been so certified 13 One study however at the same operations concluded that asbestiform minerals were contained in the talcs 11 To address this contradiction the present study restricts itself to that one mine and mill reported by the company to be producing nonasbestiform talc DESCRIPTION OF FACILITIES STUDIED The company under study began talc mining and milling operations in the Gouverneur Talc District of upper New York in 1947 Talcs extracted from this mine are used for a variety of applications including ceramics pottery artware electrical insulators ceramic tile glaze and flux paint fillers in putties and in spackling compounds MINING In the study mine underground hard rock mining methods are employed using jackleg drills to make holes for blasting the ore in open stopes The mine consists of one main shaft 1,250 feet in depth with three main working levels In 1975 ore was being mined from approximately 6 of the 26 active stopes Mining follows a typical cycle including 1 blasting which is done with gelatin dynamite and ammonium nitrate 2 dissipation of dusts and gases 3 removal of ore with some secondary blasting and 4 drilling of blasting holes for the next shift Ore muck from the stoping areas is loaded into ton rail cars using either gravity drawpoint or scraper slusher loading Ore from these cars is discharged into a central jaw crusher located at the 700 level although some crushing is also done on the 1,110 level The crushed ore is loaded into a skip and carried to the mine headframe where a gyratory crusher reduces the ore to approximately in screen size The ore is then transported by conveyor belt to one of the four wet ore storage bins in the mill Approximately 40,000 cubic feet per minute cfm of mining ventilation is provided The ore may be inherently moist and wet drilling is employed Water sprays are also used for dust suppression at the 700 level crusher According to company personnel wet drilling has been practiced since the beginning of these operations MILLING Mill operations include cone crushing first followed by moisture removal in rotary dryers The dry ore is further reduced in particle size using a gyratory disc crusher followed by vibratory screening and transportation to one of six dry ore silos Finely ground products are made from these ores using either Hardinge pebble mills in closed circuit with Raymond separators or impact crushers in closed circuit with fluid energy mills The finely ground products are stored in one of several concrete silos and are withdrawn by air slides and pumped to the packaging and shipping areas Talcs are either sold in bulk or packaged in 50 valve Kraft paper bags Bag filling is done using pneumatic packing machines In the mill most material transfer points are provided with local exhaust ventilation and bucket elevators and conveyors are maintained under negative pressure At the bagging machines local exhaust ventilation is provided at the filling spout and downdraft ventilation at the bag hopper For bulk car loading the telescopic loading spout is provided with a local exhaust ventilation collar INDUSTRIAL HYGIENE STUDY METHODS In order to evaluate occupational exposure characteristics and levels among workers in this mine and mill and to compare them with those of previous studies of New York talc operations a detailed environmental study was undertaken This study included determinations of weighted average TWA exposures to respirable dust free silica and asbestiform minerals in addition to mineralogical assays of talcs produced at the mine and mill under study Talc product samples were collected during the study samples - and additional product samples from the mine and mill being studied were submitted by the company samples 1-7 Analyses of collected bulk talc samples were performed by both NIOSH and independent research laboratories These analyses included ray diffraction optical petrographic microscopy and electron microscopy For ray diffraction studies step scanning of diagnostic reflections for the asbestiform minerals and quartz was used 1 Electron diffraction and microchemical analyses of individual fibers were performed by electron microscopy 14 15 Bulk talc samples were also analyzed for major oxide composition and trace metal contamination These analyses were performed using spectrophotometry atomic absorption and flame photometry 1 Personal air samples were collected from the breathing zone of miners and millers to determine TWA exposures to respirable dust free silica and mineral fibers Personal samples for respirable dust and free silica were collected at a flow rate of 1.7 liters per minute 1pm using mm diameter polyvinyl chloride filters preweighed preceded by mm nylon cyclone separators Samples for fiber analysis were collected on faced mm diameter Millipore Type AA filters 0.8 pore size at a flow rate of 1.7 1pm Respirable dust samples were collected for the full work shift periods while fiber samples were changed periodically during the work shift as needed to prevent overloading of filters Free silica concentrations were determined using ray diffraction as specified in the NIOSH Criteria Document 15 All fiber samples were analyzed using the NIOSH phase contrast counting technique 17 In addition a representative number of the individual fiber samples was randomly chosen and the samples were analyzed by electron microscopy using selected area electron diffraction and energy dispersive ray analysis for fiber identification Electron microscopy was also used to determine airborne fiber concentrations and size diameter and length distributions 14 Samples for electron microscopic analysis were prepared using methods previous described 15 In order to compare results of the present industrial hygiene study with historic data for the facility studied midget impinger samples were also collected for selected jobs in a manner similar to past sampling techniques Breathing zone impinger samples were collected in ethyl alcohol at a flow rate of 0.1 cubic feet per minute with sampling periods ranging from 15 to 30 minutes These samples were counted at the end of each work shift using Dunn counting cells and bright field optical microscopy 100x Two preparations were made for each sample and allowed to stand for 30 minutes prior to counting Particle counts were made by two experienced counters and new preparations were made and samples recounted if counts differed by more than 10 percent RESULTS Product Samples Results of the ray diffraction and petrochemical microscopic analyses of bulk talc product samples collected during the study are shown in Table 1. Talc product samples were found to contain 14 to 48 percent mineral talc 37 to 59 percent tremolite and 4.5 to 15 percent anthophyllite All samples were found to contain 10-15 percent serpentines lizardite and antigorite and less than 2.6 percent free silica Calcite and dolomite were also present in trace quantities Trace metal analyses of talc product samples are shown in Table 2 and major components analyses are shown in Table 3. All trace metals except iron and manganese were essentially absent Iron and manganese levels were also very low 0.02 percent As seen in Table 3 all talcs were found to have a high CaO content which correlates with the observed high tremolite content Except for traces of calcite other carbonates were absent or negligible in these talcs as demonstrated by low CO2 values 18 The Fe and Mn analyses in Table 3 are consistent with the results shown in Table 2 and all major element analyses are in basic agreement with results obtained by Ross et al 19 and by Dreessen 20 for talcs in the Gouverneur New York area Ross et al 19 also suggested that an additional manganese amphibole tirodite may be found in trace quantities in these deposits While the major element analyses shown in Tables 1 2 and 3 show 0.12 to 0.22 percent MnO no manganese amphiboles were detected by the electron microscopy analyses using selected area electron diffraction and microchemical analysis Typical electron micrographs of fibers observed in the bulk samples are shown in Figures 1 and 2. Examples of typical electron diffraction patterns and ray spectra for the tremolite and anthophyllite fibers observed in these products| are also shown in these figures These analyses have shown that most of the long thin fibers in these talcs are low iron anthophyllite while tremolite fibers tend to be shorter and have smaller aspect ratios length Air Samples Tabular summaries of TWA exposures by job category for the mine and mill under study are given in Tables 4 and 5 respectively and more detailed summary statistics concerning these data are given in Appendix I. As shown in Tables 4 and 5 free silica exposures were found to be very low The highest silica exposure observed was 0.040 0.040 hour TWA exposure value of 0.05 TWA free , which is below the recommended by NIOSH for this material 16 Respirable dust exposures ranged from 0.25 to 2.96 No respirable dust standard has been determined for the mineral talc or talc containing fibrous however tremolite or anthophyllite these concentrations are well below the OSHA limits for nuisance dusts 21 TWA breathing zone impinger concentrations ranged from 0.5 to 15.8 million particles per cubic foot of air mppcf mppcf with highest concentrations being observed in the mine The present OSHA and MSHA standard for talc containing less than 1 percent free silica and no asbestos fibers is 20 mppcf 21 Only one of the 32 impinger samples exceeded 20 mppcf However since this talc contains asbestiform material this standard is not relevant to these exposures TWA exposures to asbestos fibers greater than ...min length exceeded 5 fibers per cc for three of six job categories sampled in the mine and for 6 of 18 job categories sampled in the mill In addition 17 of the 24 job categories sampled had TWA exposures exceeding the current OSHA standard of 2.0 fibers less than um in length Exposures in excess of the MSHA and OSHA allowable ceiling value of 10 fibers less than ...min length were observed in 9 of 24 job categories sampled A summary of TWA airborne fiber concentrations as determined by analytical electron microscopy is given in Table 6. In the mine concentrations of positively identified fibrous amphiboles all lengths ranged from 9.5 to 17.5 fibers whereas concentrations in the mill were somewhat higher ranging from 9.9 ae hee dR ... aT } 3 to 70.6 fibers These concentrations represent minimum estimates of true amphibole fiber exposures since many true amphibole fibers may not give identifiable electron diffraction patterns The concentrations found using electron microscopy are far in excess of those obtained by the optical microscopy as fibers less than ...min length are included in the electron microscopy results but not in those from optical microscopy A summary of airborne fiber types as determined by electron microscopy is shown in Table 7. In the mine 38 percent of all airborne fibers were anthophyllite 19 percent were tremolite and 39 percent were unidentified In the mill 45 percent of all fibers were anthophyllite 12 percent were tremolite and 38 percent were unidentified Three percent of the fibers in the mine and 2 percent in the mill gave chrysotile electron diffraction patterns Approximately 65 percent of the airborne fibers longer than ...min length were identified as anthophyllite while only 7 percent were tremolite The presence of chrysotile in the air samples is consistent with the results of the NIOSH bulk sample analyses where trace quantities of chrysotile were noted in some samples All of the chrysotile fibers observed in the air samples were less than ...min length Nearly all of the serpentine minerals identified in the bulk samples are lizardite Results of airborne fiber size determinations diameter and length for tremolite and anthophyllite fibers are shown in Tables 8 and 9 with appropriate summary statistics As expected tremolite fibers tended to be larger in diameter and shorter in length than anthophyllite fibers The size distributions for these minerals were similar for the mine and mill Median fiber diameters of 0.19 and 0.13 were observed for tremolite and anthophyllite respectively In the mine median fiber lengths of 1.6 for tremolite and 1.5 for anthophyllite were observed Similar lengths were seen in the mill In the mine and mill only 3 percent of the tremolite fibers were longer than ...mwhereas 8-10 percent of the anthophyllite fibers were longer than this length Median aspect ratios length to width of 9.5 and 7.5 were observed for anthophyllite and tremolite respectively as shown in Table 10. Only 30 percent of the tremolite fibers had aspect ratios greater than 10 to 1 whereas 48 percent of the anthophyllite fibers had aspect ratios greater than this value These fiber size characteristics are similar to those observed in other industrial operations processing asbestos fibers 22 Typical electron photomicrographs of airborne particulates from the mine and mill are shown in Figures 3 4 and 5. The asbestiform nature of these fibers may be further demonstrated by observations of their fibril structures COMPARISON OF PAST AND PRESENT EXPOSURES The present studies demonstrate elevated exposures to asbestiform minerals in nearly all mine and mill process operations Comparisons between present dust mppcf and fiber fibers > ...min length exposures and historic exposure measurements are shown in Tables 11 and 12 respectively These data are gathered from a number of sources 11 23-33 Trends in dust concentrations as a function of calendar time are difficult to interpret for several reasons Of primary importance is the relative paucity of data on some operations prior to 1970. Secondly very few samples were taken in any given year therefore the representative of these samples is unknown To illustrate trends in dust concentrations average yearly values for mine and mill operations were calculated and are shown in Figures 6 and 7 respectively Figure 6 shows no consistent trends in dust concentrations when all mine operations are considered On the other hand the mine exposures for such operations as drilling dragline loading tramming and mucking show relatively consistent exposure levels over time with only slight deviations This might be expected since wet drilling has been a routine practice In addition ores being mined are relatively wet Primary crushing and hoist loading operations show a slightly decreasing trend Controls such as water sprays for dust suppresion at the primary crusher are the most probable explanation for this trend A greater trend of decreasing dust concentrations in mill operations is demonstrated in Figure 7 for all mill operations combined Figure 7 also shows a more pronounced decreasing trend in exposure when the uncontrolled operation of loading bagged talc into box cars is excluded form the calculated yearly averages Engineering controls for talc milling operations have improved with time As shown in Table 12 fiber exposure measurements have only been made since 1970. Results of the 1975 NIOSH survey tend to show a recent reduction in fiber exposure when contrasted with earlier data for most operations Radon daughter measurements have been made in the mine under study by the Mining Enforcement and Safety Administration MESA Measurements taken in 1973 and 1976 showed only nil to trace levels 34 35 COMPARISON OF EXPOSURE CHARACTERISTICS WITH OTHER TALC MINES AND MILLS IN THE GOUVERNEUR N.Y. AREA Throughout the years a number of different companies have operated talc mining and milling operations in the Gouverneur Talc District In addition past health effects studies of workers in these mills have generally considered exposure characteristics between the various operations in this area to be substantially the same The company under study however maintains that ores from various mines in the area are not the same with some containing asbestos while others do not The company further maintains that ores from another nearby operation do contain anthophyllite asbestos while ores from the mine and mill which is the subject of the present study do not contain asbestos fibers In order to compare airborne exposure characteristics between these two operations 10 airborne dust samples collected by MESA in the mine and mill acknowledged as containing asbestos were obtained These samples were analyzed for airborne fiber characteristics using analytical electron microscopy analytical methods previously described Results of these studies and comparisons with data from the mine and mill studied by NIOSH and maintained to be asbestos free by the company are shown in Table 13 The data shown in Table 13 demonstrate that exposure characteristics between the two operations are substantially the same In fact the airborne dust samples from the mine and mill studied by NIOSH and maintained by the company to be asbestos free were found to contain a higher proportion of positively identified asbestiform amphiboles largely due to a higher tremolite content All other fiber characteristics such a median length diameter aspect ratio and proportion < ...min length were not statistically different at the 0.05 level 36 10 REVIEW OF HEALTH EFFECTS FROM EXPOSURE TO TALCS CONTAINING ASBESTIFORM AND ASSOCIATED MINERALS What are the known health effects of talc Inhalation by children of large doses of talc have resulted in an inflammatory pulmonary response leading to death in some cases 37 38 The acute symptoms are initial slight respiratory distress increasing after four to six hours and accompanied by cough tachycardia and cyanosis Autopsy revealed bronchitis and acute bronchiolitis with pulmonary edema focal atelectasis and emphysema Alivisator reported the rapid development of talcosis in eight workers between 16 and 60 months after first exposure in an industrial setting 39 The rapid development and progression was attributed to the high concentration of talc particles less than 50 in size as well as the high silicate content Most of these anecdotal reports have included little characterization of the talcs involved RESPIRATORY MORBIDITY STUDIES Three patterns of infiltration on chest ray among those exposed to talc have been described 1 nodular -- discrete opacities 3-5 mm similar to silicosis and favoring the lung fields 2 diffuse -- interstitial fibrosis similar to asbestosis and favoring the lower lung zone 3 mixed -- both types present 40 This varied type of ray pattern has been attributed to the heterogenicity of talc 40 Although changes suggestive of silicosis were observed in some instances in general ray changes were similar to those seen in asbestosis 9 10 41 More than four decades have elapsed since the first epidemiological data were published demonstrating adverse health effects of tremolite talc exposure In 1933 Dreessen 20 published the results of a chest ray study of 57 workers engaged in the mining and milling of talcs containing up to 45 percent tremolite and little free silica This study showed that all workers with greater than 10 years exposure had increased lung markings ranging from increased fibrosis to what was termed second stage pneumoconiosis Among these 17 workers no cases of active tuberculosis were observed Dreessen stated that the observed pneumoconiosis had not led to disability The respiratory effects of exposure to talc containing 10 percent bladed tremolite in two Georgia talc mines and mills were reported by Dreessen and Dalla Valle in 1935 42 A total 11 of 66 workers were given physical examinations and chest rays of which 19 were exposed for more than 10 years with only 2 having 20 or more years of exposure Twenty of these workers demonstrated pneumoconiosis with varying severity Approximately half of the mill workers exposed to an average dust concentration of 300 mppcf were diagnosed as having pneumoconiosis with eight having frank symptoms such as dyspnea cough chest pain rales and finger clubbing Examination of nine former talc workers who had been separated from exposure more than 3 years demonstrated pneumoconiosis in all cases with four cases in advanced stages causing these authors to conclude that the lung changes were permanent Many of the health effects studies on individuals exposed to talc have been done in New York in the same areas as this study Table 14 The exposures were generally quite high These studies indicate that exposed talc workers report increased subjective complaints of dyspnea and cough Physical findings include diminished breath sounds rales rhonchi wheezing crepitations and clubbing Pulmonary function measures suggest a restrictive disease with reduced transfer capacity DI In addition to these findings radiographic changes in the chest have also been noted although the findings have not been reported in ILO nomenclature These include fibrosis and pneumoconiosis primarily reported as pulmonary infiltrates of grade 0 1 2 and 3. The grading of pulmonary infiltrates involvesa reticulated appearance in the lower lung fields grade 1 reticulonodular infiltration involving approximately 50 percenotf the total lung area grade 2 and a more diffuse reticulonodular infiltration involving more than 50 percent of the total lung grade 3 10 Case studies of New York tremolite talc workers were first reported by Porro et al 43 Fifteen pneumoconiosis deaths in talc workers were studied in addition to five autopsy studies Thirteen of these deaths were considered to be directly attributable to the pneumoconiosis thus confirming the disabling character of this exposure These authors concluded that the disabling tissue changes were due to tremolite talc exposure Some classifications were noted Siegal et al 44 45 reported a study of roentgenological findings among New York talc workers in addition to an assessment of their exposures These talcs were described as containing fibrous tremolite and anthophyllite and less than 1 percent free Si02 A total of 221 talc workers in three mines and five mills were given chest ray examinations Of the 221 12 men examined 32 showed marked fibrosis Those workers with 10 or more years employment demonstrated an incidence of fibrosis of 29.9 percent whereas those employed for more than 30 years had a fibrosis incidence of 74 percent This fibrosis was described as disabling and often accompanied by dyspnea cough and fatigue Talc plaques were identified in 6.3 percent of the workers examined These authors described the fibrosis observed as resembling that seen among asbestos workers The 32 cases of pneumoconiosis identified by Siegal et al 44 45 were followed prospectively by Kleinfeld et al 46 In the 14 year period after the Siegal study 19 of the 32 workers died with the ages of death ranging from 48 to 84 years Four of these 19 deaths were believed to be directly attributable to talc pneumoconiosis One death due to pleural mesothelioma was reported Medical examinations of the 13 living workers were performed including a physical examination chest ray EMG and peripheral blood studies Hgb RBC WBC diffferential count Dyspnea of such severity as to limit ordinary physical activity was found in all workers Moderate to severe progression of lung ray findings were seen in 10 of these workers and talc plaques were seen in all but one worker Six out of 11 demonstrated an abnormal electrocardiogram Peripheral blood findings were not considered to be of significance These authors also reported the presence of asbestos bodies histologically Similar findings were reported in a latter study of six pneumoconiosis cases with autopsy studies 41 A comparative clinical and environmental study of workers exposed to fibrous and nonfibrous talcs in New York was reported by Messite et al 7 Three talc operations in St. Lawrence County fibrous ore formations and one operation in Lewis County nonfibrous ore formations were selected for study and a total of 229 workers were given physical examinations and chest rays Among miners the incidence of pulmonary fibrosis was low for both the St. Lawrence and Lewis County cohorts however the mean duration of exposure was only 12.7 and 10.3 years respectively Among millers the incidence of fibrosis was 12.2 percent and 4.3 percent respectively for the St. Lawrence and Lewis cohorts Exposure levels in the plant were described as being similar with all talcs having a low free silica content These authors concluded that both types of talc were capable of producing pulmonary fibrosis although the tremolite fibrosis variety was more pathogenic In addition these investigators stated that no cases of fibrosis were found in millers of either talc variety whose average exposure was less than 20 mppcf or whose duration of exposure was less than 10 years 13 In a follow study Kleinfeld et al 8 made additional comparisons including lung function between the St. Lawrence and Lewis County New York cohorts described above Thirty workers exposed to fibrous talcs and 13 exposed to nonfibrous talcs were given chest ray and pulmonary function tests Dyspnea was present in 16 of 30 workers in the fibrous talc exposed group and in 6 of 13 in the nonfibrous talc exposed group Abnormal auscultatory findings rales rhonchi wheezing were found in 8 of the 30 workers and 6 of the 13 workers exposed to fibrous and nonfibrous talc respectively The incidence of pulmonary infiltration as seen in chest films was 13 of 30 for the fibrous group and 3 of 13 for the nonfibrous group Both groups showed pulmonary function changes with 4 of 13 workers in the group exposed to nonfibrous talc and 14 of 30 workers in the group exposed to fibrous talc showing significantly reduced vital capacity Exposures to both groups were reported to be considerably in excess of 20 mppcf Kleinfeld et al 12 studied the lung function of 16 tremolite talc workers who ranged from 39 to 69 years of age mean age 54.8 years All had been exposed to talc dust in milling operations for 10 or more years and had no previous occupational dust exposures Clinical examinations of the 16 workers showed 14 had dyspnea on exertion 10 rales or wheezing and 6 clubbing of the fingers Increased pulmonary infiltration was noted in 5 of the 16 workers The lung function studies showed 7 of the 16 to have reduced vital capacities and one worker was found to have a lung function consistent with restrictive lung disease The mean duration of exposure for the 16 workers was 20.4 years and the mean weighted average exposure was reported to be 68.9 mppcf Thirteen of the 16 workers studied gave a positive smoking history 30 cigarettes per day for a minimum of 5 years In a subsequent study Kleinfeld 10 performed similar studies as those described above among a group of 43 tremolite talc workers and 41 unexposed controls of similar age and smoking history In the talc cohort 29 had dyspnea versus only 2 in the control population Eleven talc workers gave a history of chronic cough and 8 talc workers showed finger clubbing whereas no clubbing or cough was noted among controls Sixteen of 43 talc workers had positive ray findings of pulmonary infiltration versus none in controls and reduced vital capacity was also found in 13 talc workers and one control These talc workers were reported to have a mean exposure duration of 19 years and weighted average exposure of 62.3 mppcf A study of chest ray findings and miners and millers at the talc mine clinical and mill symptoms among under study was 14 reported by Kleinfeld et al 11 Thirty workers with a mean exposure of 16.2 years range 11-22 years were examined in addition to 41 controls who lived in the same geographic area and who were of the same sex and mean age but had no occupational dust exposure Dyspnea was present in 23.1 percent of the talc workers versus 7.3 percent of the controls a finding similar to that seen in anthophyllite asbestos workers 47 One worker studied was said to have radiologic findings _ compatible with pneumoconiosis whereas no cases were found among controls The authors suggested that talc containing tremolite and anthophyllite may be less fibrogenic than chrysotile and amosite asbestos at similar exposure levels and exposure duration however these authors did not preclude the possible existence of pneumoconiosis among these workers since no lung function studies were conducted The importance of sublight microscopic asbestos fibers in asbestosis has recently been reported 48 49 50 and brings into question the concept that only fibers greater than 5 microns in length are pathogenic in talcosis 51 In a patient with talc pneumoconiosis Miller et al 48 were unable to detect talc by histological techniques using light microscopy The presence of talc was established by ray diffraction and electron microscopy Most particles were less than 0.5 micron in length and therefore below the limit of resolution of the light microscope The question of the site of early changes in the human lung after exposure to talc has not been very well investigated Seeler et al 52 claimed that the earliest change involving the lung parenchyma in two cases of talc pneumoconiosis was a fibrous thickening of the alveolar walls Kleinfeld et al 41 noted deposition of ferruginous bodies in the respiratory bronchioles The earlier studies of talc workers in the New York area variably reported the presence of pleural plaques and pleural densities 41 44 45 46 The pleura of men exposed to talc are often found on autopsy to have dense fibrosis thickening 41 48 52 53 Pericardial calcification has also been observed 54 Pleural thickening is associated with symptoms and a decreased pulmonary function pleural plaques are not 55 Pleural thickening may also have a poorer prognosis 56 Pleural thickening and calcifications are a very common radiographic finding in asbestosis and individuals exposed to asbestos and may be more common than fibrosis 56 57 58 59 60 61 The prevalence of pleural changes is higher where there is exposure to anthophyllite 55 62 Not all pleural changes however are necessarily related to asbestos exposure 63 15 MORTALITY STUDIES Although a number of the studies described above have demonstrated the presence of pneumoconiosis among tremolite talc miners in New York these study designs were insensitive to detection of carcinogenic risks However two retrospective proportional mortality studies have demonstrated an increased risk of mortality due to cancer of the lung and pleura among these workers 5 6 An initial study by Kleinfeld et al 6 included 220 talc miners and millers employed in 1940 who had 15 or more years exposure between 1940 and 1965. Among this cohort there were 91 deaths of which 10 11 percent were due to malignancies of the lung or pleura whereas only 2.9 3.2 percent were expected In addition 28 deaths were due to pneumoconiosis or its complications One of the respiratory cancers was a fibrosarcoma of the pleura In a subsequent follow study Kleinfeld et al 5 extended the period of observation of the previouslprevyiously studied cohort from 1965 to 1969. This updated cohort consisted of 260 workers among which there were 108 deaths Thirteen of these deaths percent were due to respiratory cancer whereas only 4 3.7 percent were expected Twenty deaths were due to pneumoconiosis or its complications These authors analyzed mortality patterns by 5 year intervals between 1940 and 1969 12 and concluded that the respiratory cancer risk approached expected values after the period 1960-1964 The validity of this conclusion must be questioned since an analysis of mortality in relation to cancer latency was not undertaken Indeed during the additional 9 years of observation 17 deaths were observed of which 2 12 percent were respiratory cancers observations similar to previous findings In addition the limitations of proportional mortality studies in the presence of an elevated pneumoconiosis risk are now well known An excess cancer risk has been demonstrated among workers exposed to anthophyllite asbestos 47 64 65 Nurminen 65 reported on the mortality experience of anthophyllite asbestos workers in Finland This study included 1,030 workers who had been employed for 3 months or more from 1936 to 1966 and followed until 1968. Expected cause specific deaths were calculated using Finland national rates for 1951-1964 There were 224 deaths in this cohort whereas 204 were expected The mean age at death for the cohort was 53.4 years Twenty deaths 12 percent had asbestosis as an underlying cause and there was also a highly significant excess risk of respiratory cancer 13 obs versus 6 exp 0.01 No mesotheliomas were 16 detected The mean latency to asbestosis was 19 years between first exposure and death due One of the most comprehensive studies of mortality and morbidity among anthophyllite asbestos workers was reported by Meurman et al 47 and Kaviluto et al 64 A cohort of 1,092 workers who had worked at least 3 months between January 1936 and June 1967 was obtained from two mining operations one of which produced mainly tremolite talc For calculation of expected age and cause specific deaths proportional rates for Finland were used for 1958 which was the median year of death for these workers In addition a control group matched for date of birth and sex was chosen from a local population registry Of the 1,092 employees 248 deaths to asbestosis were observed were observed for the cohort Thirteen deaths and none in the due controls Twenty lung cancers were observed in the worker cohort versus 13 in the control group The most significant cancer risk was observed in those with 10 or more years of exposure These authors adjusted lung cancer rates for smoking habits and concluded that a nonsmoking asbestos worker has a relative risk of 1.4 whereas the smoking asbestos worker had a relative risk of 17.0 No cases of mesothelioma were reported All of the above studies of workers exposed to talc containing fibrous tremolite fibrous anthophyllite or anthophyllite asbestos have demonstrated an excess risk of both pneumoconiosis and respiratory cancer Little evidence of an excessive risk of mesothelioma among such exposed workers has yet been demonstrated however an excessive incidence of pleural changes including pleural thickening and calcifications has been observed in chest films 17 SECTIONAL MORBIDITY STUDY A sectional morbidity study was initiated to examine all presently employed workers in this talc mine and mill The study was designed to answer the following questions regarding chronic effects of exposure 1 Is there an increased prevalence of abnormal health effects e.g. symptoms decreased pulmonary function in workers exposed to talc when compared to other industrial populations populations 2 If there are detrimental effects of exposure what are the response relations DESCRIPTION OF WORK FORCE The present work force consists of approximately 156 male millers and miners 35 of whom had worked at other talc mines One hundred and twenty 78 percent participated in the study The average for years of talc exposure is 10.2 years for the study population and 10.5 years for the nonparticipants The participation rate among the different work areas is similar MATERIALS AND METHODS A modified Medical Research Council respiratory questionnaire containing questions on total work and smoking history was administered by trained interviewers Standard PA and lateral chest rays were taken and read by three readers using ILO scheme Flow volume curves from a minimum of five forced respiratory maneuvers were obtained and recorded on magnetic tape using an Ohio 800 rolling seal spirometer The maximum maximum values from the curves were used for analysis Lung function the prevalence of symptoms and radiographic findings in this population were compared with those from 9,347 coal miners from the second round of the National Coal Study and 1,095 potash miners examined by NIOSH in the Study of the Effects of Diesel Exhaust in Coal Miners Individuals in each control population were grouped into similar age 10 year intervals height 10 cm intervals smoking nonsmoker smoker and smoker and years in mining 15 years 15 years categories The expected prevalence of symptoms and radiographic findings in coal and potash workers were calculated by using the rates in each category of the comparison populations and multiplying them by the number of individuals in the same categories of the talc population Predictive 19 equations reflecting the effects of age and height were calculated for each smoking worked category of coal and potash miners Each talc worker's lung function was then compared to predicted values obtained from the appropriate category in the comparison population All comparison of talc worker's lung function with expected lung function was summated and multiplied by 100 to give the mean percent predicted lung function For FEV1 percent the difference between observed and expected +100 was used Dose was calculated in three ways 1 Years of exposure is simply the number of years worked at the plant under study 2 Cumulative exposure was calculated by multiplying a present exposure in each job as determined by personal sampling fibers mtimes b the time spent in that job years and then by summing all the exposure scores The results for each individual are expressed as years for cumulative fiber exposure and years mfor respirable particulate exposures As past environmental exposures are not well defined and in some jobs exposures were greater in the past than at present especially in the mill these estimates of cumulative exposure are lower than actual exposures 3 The relation of average time spent in each job was examined in workers with and without pleural thickening over the total work , history omitting the most recent 10 years RESULTS The smoking distribution of the 93 talc workers whose talc exposure was only at the mine and mill being studied is shown in Table 15. Almost half are cigarette smokers with slightly more smokers than nonsmokers Almost 2/3 of the nonsmokers are less than 30 and over 3/4 of the smokers are 40 years of age or more Smokers are more evenly distributed in all age groups although the percentage of smokers is highest in the 30-39 year age group The distribution is very similar for all 121 workers Table 15A Table 16 shows the distribution of years worked in talc and cumulative particulate and fiber exposures by age Except for the group over 60 years old where there are only two individuals there is a consistent and approximately equal increase in all three exposure parameters with increasing age A similar relationship of exposure with age is observed for all 121 workers Table 16 Tables 17 and 17A summarize the distribution of symptoms and radiographic findings by smoking habits Smokers have a higher 20 prevalence of cough phlegm hemoptysis and shortness of breath with symptoms markedly lower among nonsmokers The differences are also statistically significant for cough and phlegm Cigarette smoking shows no apparent association with pleural thickening There are two cases of calcification and four of irregular opacities but the numbers are too small to analyze for response relations Tables 18 and 18A summarize the association of age with symptoms and radiographic findings Age and therefore term exposure shows no discernible association with symptoms The higher prevalence of cough and phlegm in the 30-39 year age group is probably a reflection of the high proportion of smokers in the category Likewise the slightly higher prevalence of dyspnea in the 30-39 and 50+ year age group is also probably due to the relative proportion of smokers and smokers in those ages Pleural thickening on the other hand is not found in the age groups less than 40 mean of 14 years exposure and is highest in the 50-59 mean of 20 years exposure and greater than 60 year mean of 28 years exposure age groups In Tables 19 and 19A the prevalence of symptoms and radiographic findings are compared with coal and potash for age height smoking habits and years talc workers employed only at the mine and workers controlling worked Among the mill under study for less than 15 years the reported symptom prevalences of cough and phlegm are not significantly higher than those of coal and potash workers In the group of workers with more than 15 years experience there is no statistically significant difference in the prevalence of a hemoptysis in talc workers compared to coal and potash workers b cough in talc workers compared to coal workers and c phlegm in talc workers compared to potash workers Coal miners with more than 15 years experience have higher prevalence of phlegm and dyspnea than do talc workers while cough and dyspnea is higher in these talc workers than in the potash workers These differences are not statistically different The prevalence of radiographic abnormalities is less than two | percent in are higher all groups with less than 15 years worked The rates in the greater than 15 year groups but there are no significant differences in the prevalence of regular opacities between the talc and comparison groups In the talc workers with no previous talc exposure pleural calcification is 0 21 in those with less than 15 years worked and 3.4 percent pinerctehnotse with more than 15 years worked one case while pleural thickening is 1.6 percteonta arnadte31f.o0r ppelrecureanlt thickening of respectively This compares in coal miners and 0.5 percent to 4.4 0.3 percent to 1.6 percent calcification in percent in potash miners There is no pleural is 0 the potash population while in coal miners the prevalence for those working less than 15 years and 0.1 percent for percent those working more than 15 years In those with more than 15 opacities is 3.4 years experience the prevalence of irregular and 0.7 percent in talc coal and potash percent 5.3 percent workers respectively Table 19 rates increase slightly when all 121 talc Reported symptom workers are considered Table 19A In the 82 talc workers with less than 15 years worked cough and phlegm are higher than and coal workers There is little difference in the potash prevalence of dyspnea In the 39 talc workers with more than 15 is still higher than in potash years experience reported cough but is essentially the same as in coal miners Phlegm workers however the 26 is about the same in talc and potash workers percent phlegm reported by these talc workers is significantly less than the 46 percent prevalence among coal workers Dyspnea in these talc workers is 23 percent which is significantly less than the 39 percent in coal workers and greater than the 13 percent in potash workers Among these talc workers there is no unusual prevalence of hemoptysis in either category of years worked There are no differences in the prevalence of radiographic abnormalities in the group who have worked less than 15 years In those with more than 15 years experience pleural thickening and pleural calcification are higher in the talc workers than in coal and potash workers the increased prevalence of pleural thickening is highly statistically significant Irregular opacities among talc workers are higher than those in coal and potash workers but the increase is statistically significant only when compared with that in potash workers The prevalence of rounded opacities is 3 and 2 percent in talc and potash workers respectively but 15 percent in coal workers Table 20 summarizes the relationship between cumulative exposure and pulmonary function among both groups of talc workers employed only at the mine and mill under study Using predicted values based on coal and potash workers mean predicted FEV and FVC ranged from 92-95 percent Predicted FEV percent is near 100 and peak flow is above predicted compared to coal workers but this is not true when 22 compared to potash workers Mean flow rates are significantly reduced compared to both coal and potash workers Exposure among these talc workers to particulates and to fibers shows a significant association with reduced FEV and FVC For example a talc worker in a job with 2 mexposure to respirable particulate will on the average experience about a 1 - 1.4 percentage point reduction in observed to predicted ratio for FEV1 and FVC For an average exposure of 5 fibers the reduction is about 0.5 - 0.7 percentage points per year FEV percent and flow rates are not significantly related to exposure although the percentage point reduction is large for flows at lower lung volumes The reductions are larger when the comparison group is potash miners Similar reductions occur if age or years of employment are substituted for fiber or particulate exposure because of their high correlations These talc workers empirically age faster experience a faster reduction in the FEV1 and FVC compared to coal and potash miners Table 21 and 21A compare age smoking habits and exposure history of talc workers with and without pleural thickening As previously noted smoking is not related to pleural thickening For example the 50-59 year group with pleural thickening has the lowest mean pack years and the 40-49 year old group with pleural thickening has fewer average pack years than the 40-49 year old group without pleural thickening Particulate exposure is slightly lower in the groups with pleural thickening the average fiber exposure on a yearly basis is the same in the groups with and without pleural thickening In the 50-59 year age group those with pleural thickening started working at an earlier age than those without pleural thickening In the 40-60 year age group those with pleural thickening have reduced lung function Past environmental exposures in each job are not necessarily reflected by present exposure estimates Exposure information is not available for all jobs and past environmental data were largely collected using impingers rather than filters For these reasons time worked in different jobs by workers with and without pleural thickening were compared These data on the 93 talc workers employed only at the mine and mill in this study are summarized in Table 22. There are 9 individuals with pleural thickening and 20 without pleural thickening among those with greater than 15 years employment Among those with pleural thickening about 71 percent of their years worked were spent in seven particular jobs compared to about 17 percent of these same jobs for those without pleural thickening 23 To assess the significance of pleural thickening on the health of the individual symptoms and pulmonary function of all those with pleural thickening in this study are summarized in Table 23 Controlling for years employment those with pleural thickening are slightly older than those without pleural thickening Those with Grade 2 pleural thickening have significantly elevated rates of cough and phlegm but those with Grade 1 pleural thickening have rates lower than the comparable age group without pleural thickening The prevalence of hemoptysis and dyspnea increases with increasing grade of pleural thickening but the increases are not large Mean ratios of observed to predicted FEV1 and FVC in Grade 1 pleural thickening is about 10 percentage points below the group without pleural thickening there is about a 4 percentage point difference between Grade 1 and Grade 2 pleural thickening Mean FEV percent is reduced only in Grade 2 pleural thickening Predicted peak flow and FEF25 are not related to pleural thickening Predicted FEF50 and FEF75 are reduced by about the same proportion as FEV1 and FVC for those with Grade 1 pleural thickening compared to those with Grade 2 DISCUSSION Any sectional epidemiologic study of chronic effects is beset by the problem of selective survival This study population consists only of workers presently employed Nonrespondents present a similar problem For example if all 35 of the workers who did not participate had had no cough or phlegm and had participated the prevalence of cough would have been reduced from 32 percent to 24 percent Similarly if all 35 had reported cough and phlegm the rate would have increased from 32 percent to 49 percent Several methodological issues are important in interpreting the data Even if there had been 100 percent participation instead of 78 percent the size of the population would still be relatively small to disentangle the effects of age years worked and particulate and fiber exposure In order to evaluate the significance of the health findings and to adjust for confounding variables of age height and smoking habits in estimating response relations comparison groups of coal miners and potash miners were selected Although coal mining is a known health hazard and potash mines using equipment may also present a hazard using these mine workers as comparison populations can be justified in several ways 24 The measurement of lung function is not a completely standardized procedure with respect to equipment training and proficiency of technicians number of trials and calculation of the lung measurement These potential measurement errors are reduced in this study as these procedures were virtually the same in the control and study populations Comparison with previously published predictive equations e.g. Kory Morris may be misleading For example the NIOSH measurement of coal worker lung function tends to be higher than Kory's measurement of healthy nonexposed populations and is at least equivalent to Morris's measurements of nonsmoking exposed populations -- two commonly used prediction equations In addition prediction equations for different smoking categories are either nonexistent or based on small numbers thereby making smoking adjustments impossible or of questionable validity Since one of our primary interests is the effects of exposure to talc on pulmonary function it is necessary to adjust for age and smoking habits This is because pulmonary function generally decreases more rapidly in smokers than in smokers and nonsmokers Comparing smokers with nonsmokers may produce an apparent association of exposure with age which in fact may be a smoking interaction 66 By comparing observed pulmonary function of smokers smokers nonsmokers the analysis of exposure effects is not confounded by the effects of smoking Talc coal and potash workers are from mining populations populations and are likely to be similar with respect to many potentially confounding variables e.g. physique economic characteristics education that could affect the conclusions but are not related to the effect of work exposure preferable company or Using these mining comparison groups is therefore to comparisons with salaried workers in the same even local nonmining populations for in the comparisons with salaried or other workers there are problems of major discrepancies in physique pay education nutrition and other factors that by themselves could result in differences in health status 3 Comparing effects of talc exposure with effects from exposure to other substances will not conclusively indicate the nature of the effects of the talc exposure but it will provide relative comparisons for example if the health of talc workers is worse than coal miners the differences indicate the toxicity of talc as compared to coal and pinpoint specific health hazards associated with talc Conversely effects of talc less toxic than coal do not 25 a necessarily mean there is no risk associated with talc exposure but only that talc workers are better off e.g. have fewer symptoms fewer radiographic abnormalities etc. than coal workers If talc workers are healthier than coal miners they may still be less healthy than if they were not exposed to talc at all Although less studied than coal a mortality study of potash miners suggest that exposure to potash does not increase respiratory disease 67 Thus the medical findings in these talc workers are compared with those in two mining comparison groups -- one that is thought to have little effects on the respiratory system and one that is known to have a detrimental effect on the respiratory system The reported respiratory symptoms in this study group seem high for any healthy population Most of those with symptoms are either smokers or smokers and many populations in the dusty trades also report similarily high symptom rates Specifically the prevalence of symptoms except for dyspnea when contrasted with coal workers is higher in talc workers if length of time worked is less than 15 years but lower if years worked is greater than 15 years When compared to potash workers however talc workers have higher symptom rates in both groups except for phlegm and hemoptysis in the greater than 15 years group Table 24 compares the prevalence of respiratory symptoms from the talc workers in this study with chrysotile asbestos workers in Canada Except for the nonsmoking category where asbestos workers report a higher prevalence of symptoms the results are remarkably similar When compared to synthetic textile workers both the asbestos and talc workers generally have a considerably higher prevalence of phlegm and shortness of breath Anthophyllite asbestos workers cannot be compared directly with talc workers in this study but are included in the table for completeness The greatest difference between the coal and potash miners and the talc workers is the highly significant increased prevalence of pleural thickening in the talc workers with greater than 15 years of exposure In this group nearly one out of every three talc worker has pleural thickening Since smoking is not associated with radiographic changes and the same criteria are used it is possible to compare the prevalence of irregular small opacities pleural thickening and pleural calcification in chrysotile asbestos workers and the talc workers Table 25 Grade 1 pneumoconiosis and pleural calcification show no striking dissimilarity between the asbestos and talc workers 26 Pleural thickening on the other hand is four times higher in the talc workers than in the asbestos workers Pleural thickening is a common finding in workers exposed to asbestos It should be regarded as a significant indicator of exposure and may occur in the presence or absence of fibrosis 57 58 Table 26 Pleural calcification occurs later as it probably develops from the uncalcified pleural plaque 57 60 In insulation workers it rarely occurred in less than 20 years -from onset of exposure 68 Calcification particularly if bilateral is very useful in the diagnosis of asbestosis 57 68 although there are other causes of pleural calcification e.g. pleurisy injury following hemothorax inflammatory conditions that produce pleural effusion and empyema . Pleural thickening is accompanied by a decrease in lung function measuring either with or without fibrosis This was true FEV1 FVC or flow rates as in this and other studies and for diffusing capacity total lung capacity residual volume in other studies 61 69 70 when and Except for peak flow and FEV percent mean percent predicted pulmonary function is significantly reduced in the talc workers when compared to both coal and potash miners This reduction is thought to be the result of occupational exposure since adjustments are made for years worked and the known effects of age height and smoking habits on pulmonary function Despite the association of reduced FEV1 FVC and flow rates with fiber and particulate exposure and years worked interpretation of these data are difficult The cumulative exposure is only an index not an actual measure of exposure There is a suggestion from past environmental measurements that exposures in certain jobs particularly in the mill have declined over the years Exposure in the mine appears to be more constant Analysis of time spent in different jobs by those with and without pleural thickening shows that for the jobs of mine foreman hoistman crusher operator packer packer serviceman quality control technician and shipping and inventory coordinator those with pleural thickening spent more time in these particular jobs than those without pleural thickening The time spent in these thickening is 2-5 times greater than all other jobs and contributes to a jobs by those with pleural the average time spent in majority of the time spent in all jobs There is however no way to adequately determine actual or relative past exposure levels in these jobs 27 RETROSPECTIVE COHORT STUDY OF MORTALITY METHODS A retrospective cohort study was initiated to determine whether workers who have been employed at this mine and mill have experienced any unusual mortality patterns This study cohort was defined as all white those cohort members where racial status was unknown were considered white for purpose of the study since the majority of this work force is known to be white males initially employed sometime between January 1 1947 and December 31 1959. This cutoff date was selected to allow for a sufficient latent period for any development of chronic disease An effort was made to determine the vital status of each individual in the cohort as of June 30 1975 and person at risk and duration of employment for the cohort were accumulated until this date Vital status was determined through records maintained by Federal and State agencies including the Social Security Administration state vital statistics offices and state motor vehicle registration For those individuals who could not be located through these sources U.S. Postal Mail Correction Services and other follow searches were used For all those who were known to be deceased death certificates were requested and causes of death were interpreted qualified nosologist according to the International Classification of Diseases ICD Codes in effect at death and then converted to the 7th Revision of the by a the time of ICD Codes A modified life table technique was used to obtain person at risk of dying by year calendar time periods by year age groups by duration of employment and by number of years since initial employment at the talc company Comparison was made between the observed number of deaths among the study cohort and the number expected for this population using age calendar time and cause specific mortality rates of the U.S. white male population The vital status of 96 percent of the cohort was confirmed Table 27 Those with an unknown vital status are assumed to be alive as of June 30 1975 so that the true risk of mortality associated with exposure to talc is not overestimated RESULTS A total of 398 workers meeting the study cohort definition generated 8,733 person at risk of dying Fifty percent of the workers were employed less than one year while less than 25 29 percent were employed for 10 years or more Tables 28 and 29 illustrate the distribution of the study population by duration OR of employment and by date of initial employment Tables 30 and 30A summarize the deaths observed from the study cohort and those expected based on death rates for the U.S. white male population Although the overall observed mortality is higher than expected this difference is not statistically significant 0.05 However several specific causes of death exhibit increased mortality The standardized mortality ratio SMR SMR = observed expected deaths x 100 is significantly elevated for the cause of death category all malignant neoplasms which is partly due to the statistically significant increase in bronchogenic cancer 9 obs vs. 3.3 exp 0.05 Other statistically significant increases for specific causes of death occurred in the categories nonmalignant respiratory disease other than influenza pneumonia bronchitis and acute upper respiratory infection 5 obs vs. 1.3 exp 0.05 and respiratory T.B. 3.0 obs vs. 0.49 exp 0.05 One death due to mesothelioma was observed Table 31 demonstrates the association between bronchogenic cancer and the time interval between the initial date of employment and the date of death latency As seen there is an increasing risk of bronchogenic cancer with increasing latency a trend consistent with an occupational etiology In addition the deaths due to bronchogenic cancer have an average latency of 20 years Table 32 a period previously observed for a population occupationally exposed to anthophyllite and other minerals 47 64 65 Three additional deaths due to bronchogenic cancer are known to have occurred among study members However these deaths occurred shortly after the cutoff date 6/30/75 for analysis and therefore were not included as observed deaths One individual worked for 17 continuous years at the talc company under study and died at the age of 50. The latency period was 24 years Another individual who worked for 2 months at the talc company died at the age of 54. The latency period was 27 years The third lung cancer death was that of a worker employed for 12 years at the company under study previously at another New York talc company He of 59 and had a latency period of 23 years and 12 years died at the age At least three cases of nonmalignant respiratory disease among study cohort members are known to have been reported to the New York State Workmen's Compensation Board These individuals filed workmen's compensation claims for 1 pneumoconiosis 30 chronic bronchitis 2 talcosis pulmonary emphysema chronic bronchitis and 3 talcosis pulmonary fibrosis These individuals worked at the talc company under study for 18 years 18 years and 25 years respectively DISCUSSION The results of the present study demonstrate an excessive risk of 273 percent due to lung cancer mortality and 385 percent due to nonmalignant respiratory disease among a cohort of talc workers occupationally exposed to both asbestiform tremolite and anthophyllite but to little free silica However several possible confounding factors must be taken into consideration before one can attribute this observed mortality pattern to occupational exposures received at this talc mine and mill One such factor that has been shown to be correlated with the causation of lung cancer is cigarette smoking The smoking patterns are largely unknown for this cohort as is the case with most retrospective studies However it has been estimated that in heavy smoking worker population smoking alone would increase the expected lung cancer mortality risk by no more than 49 percent 71 Thus cigarette smoking per se is unlikely to account for the increased bronchogenic cancer risk of 273 percent observed among these talc miners and millers Another factor to be considered is occupational exposure among cohort members resulting from prior employment Known prior employment among those in the study who died from malignant and nonmalignant respiratory disease are given in Table 32. Several of these individuals as well as other members of the study cohort worked at other New York State talc companies located in the Gouverneur Talc District Due to this consideration industrial hygiene analyses were carried out to compare the make of talcs in a neighboring mine acknowledged as having asbestiform talc These comparisons are presented in Table 13 The analysis of amphibole fiber characteristics between these talc operations showed them to be substantially the same Thus while exposure levels in other talc companies may have been higher all operations involved exposures to asbestiform amphiboles with similar airborne fiber characteristics 11 these operations have been shown to have fiber exposures far in excess of established OSHA asbestos standards Thus exposures to asbestiform tremolite and anthophyllite stand out as the prime suspected etiologic factors associated with the observed increase in bronchogenic cancer and nonmalignant respiratory disease among this study cohort 31 Of interest is the fact that four of nine deaths due to bronchogenic cancer in this cohort were workers employed less than 1 year in the operations under study and only one of these cases is known to have previous exposures to talcs containing asbestiform minerals Although this cohort is relatively small it appears plausible that even brief periods of exposure to elevated concentrations of asbestiform minerals may be associated with an increased bronchogenic cancer risk Such an observation has previously been reported 72 One death due to mesothelioma is known to have occurred in the study population This individual worked for 16 years in the talc operation and had 11 years previous employment in construction work Without full knowledge of this individual's exposure as a construction worker it is difficult to arrive at any conclusions regarding the etiologic role of talc exposure from this mine and mill for this case Although previous studies 5 6 47 64 65 have not shown an association between exposure to asbestiform anthophyllite or tremolite and subsequent development of mesothelioma a study in Turkey by Baris 73 has demonstrated an increased risk of developing mesothelioma among residents of a particular community exposed to asbestiform tremolite probably from their drinking water Therefore the possible association between exposure to asbestiform tremolite and the risk of developing mesothelioma should be further studied by continued follow of these talc workers 32 CONCLUSIONS AND RECOMMENDATIONS An industrial hygiene study a sectional morbidity study and a retrospective mortality study were conducted among miners and millers of industrial talcs in upper New York These talcs were shown to contain fibrous tremolite and anthophyllite as major contaminants In addition both present and past worker exposures to these fibers were shown to be far in excess of occupational exposure standards established by the Occupational Safety and Health Administration OSHA and the Mining Enforcement and Safety Administration MESA now called Mine Safety and Health Administration MSHA The most striking finding of the morbidity study was an increased prevalence of pleural thickening in talc workers with greater than 15 years of exposure occurring in nearly one out of every three talc workers Reduced FEV1 FVC and flow rates were also observed after adjusting for smoking habits The study of mortality among the workers who began employment between 1947 and 1960 demonstrated an increased number of deaths due to bronchogenic cancer The average latency period for bronchogenic cancer was 20 years A thorough review of the available literature demonstrated that findings of the present studies are in agreement with those of other studies of occupational groups exposed to the same or similar minerals or mineral mixtures This is especially true for occupational exposures to anthophyllite asbestos These findings make it imperative that workers from the mine and mill studied herein be routinely observed using medical surveillance criteria established in the OSHA and MSHA asbestos standard Furthermore all provisions of these standards should be followed during the production and subsequent use of these talcs 33 Table 1 Results of Ray Diffraction and Petrographic Microscopic Analyses of Bulk Talc Samples Collected During Study Mineral Component Talc Sample Analysis % By Weight Product A | Product B Product C Product D Product E | Product F 31-36 43-48 30-35 33-38 35-40 14 Tremolite 40 35 Anthophyllite 10 Quartz 2.6 37 049 43 4.5 5 08 0.25 0.25 0.7 38 59 10 15 0.8 1.1 Calcite 1 0.5 0 0 0.5 < Dolomite 1 0.5 0.5 0 0.5 0.5 Serpentines 10-15 10-15 10-15 10-15 10-15 10 * Includes lizardite and antigorite Table 2 Results of Trace Metal Analyses of Bulk Talc Samples Collected During Study Product Date Collected Trace Metal PPM Cr | Co Fe Mn | Ni Zn | cd A 11/4/75 3 1 1100 1700 7 20 < B 11/4/75 3 < 1000 840 5 19 < 36 36 C 11/4/75 2 2 880 1000 17 < D 11/4/75 3 2 970 1300 7 20 < E 11/3/75 2 3 1000 1700 50 23 < F 11/3/75 3 2 900 1400 50 22 < * Trace metals determined by atomic absorption spectroscopy ** Parts per million by weight tat 7 pe, Table 3 ieee Results of Major Components Analyses of Product Talc Samples Major Components SiO2 TiO2 A1203 Fe 203 FeO MnO MgO 37 CaO Na2O K20 P205 HO CO2 Total Sample Analyses % By Weight Talc 1 2 3 4 5 6 7 Stds 54.85 0.04 0.38 0.10 0.04 0.21 28.40 9.02 0.28 0.10 0.03 5.37 1.35 100.17 54.52 0. 0.32 0.13 0.03 0.20 28.78 8.53 0.44 0.17 0.03 5.07 1.15 99.52 56.11 | 0.07 56.14 0.03 0.13 0.13 0.08 0.11 0.05 0.03 0.22 0.15 29.40 29.56 7.50 7.40 0.18 0.25 0.10 0.10 0.03 0.03 5.00 5.56 1.03 0.96 99.90 100.45 52.81 0.08 .16 0.08 0.03 0.12 30.20 8.15 0.38 0.10 0.03 6.07 1.30 99.51 52.47 0.04 11 0.06 0.01 0.10 30.56 8.30 0.16 0.10 0.03 6.67 0.98 99.59 55.47 0.07 0.13 11 0.03 12 29.10 8.25 0.18 0.13 0.03 24 0.84 99.59 61.49 0.01 1.20 0.38 1.07 0.00 30.54 0.46 == -~- 5.00 5.00 * Samples submitted to NIOSH by Company Analyses performed by Dr. D.R. Bowes University of Glasgow ** From talc standard analyses in reference 1 er Table 4 Summary By Job of TWA Mining Exposures Operations Job Title fibers 5 ...m in length Optical Microscopy Resp mg Impinger mppcf Free SiO2 mg Crusher Operator Trammer Scrapper Man Underground Laborer Driller Mucker Cageman Repairman Repairman's Helper Blacksmith Maintenance Mechanic 9.8 ( 4 5.6 25 --- 3.0 ( 5 -- 9.5 ( 5 --- 2.6 ( 3 . 12 -~ 0.64 3 1.29 3 0.58 1 0.98 3 -- 0.23 1 1.14 1 0.86 1 -- 0.42 1 a 10.1 3 11.8 5 ~~ 0.7 1 15.8 1 2.0 1 ~- 3.6 1 -- 1.5 1 ~- 0.020 3 0.012 3 0.006 2 0.014 2 ---- 0.000 1 -- 0.000 1 ( ) = Number of samples used for calculation of TWA values for each job category Samples for respirable mass and free SiO2 were full shift samples -- indicates no samples 38 Table 5 Summary of TWA Exposures By Job Title Job Title 3 ES EF Mill Foreman 3 General Laborer 3 Crusher Operator 3 Hardinge Operator f Wheeler Operator PF Packer EF Packer Serviceman E Packhouse Foreman F Fork Lift F Car Liner Operator F Bulk Car Loader 4 Millwright g Instrument Repairman Machinist Millwright Helper Sheet Metal Worker Oiler Welder fibers Fibers um in length Optical Microscopy 5.3 9 5.6 5 5.1 16 7.9 14 8.4 14 5.1 48 3.6 11 1.5 5 4.0 15 3.4 4 2.0 3 1.9 3 2.8 6 1.8 3 4.0 2 1.7 3 4.0 4 1.9 3 Resp Mass m 0.58 2 1.14 1 0.85 2 1.09 2 1.56 2 0.59 9 0.42 2 0.25 2 0.35 3 0.31 1 0.25 1 2.37 2 0.59 2 0.40 1 2.96 1 0.50 1 0.72 1 0.75 1 Impinger mppcf Free SiO2 m 2.9 2 0.5 1 2.6 4 3.4 2 3.1 2 3.6 6 2. 1 -- 1.6 1 - 1 > = ---=> 0.013 2 0.014 1 0.020 2 0.012 1 0.012 1 0.010 7 0.007 2 0.014 2 0.000 1 0.000 1 0.016 1 0.040 2 0.000 1 0.016 1 0.000 1 0.013 1 0.016 1 ( ) = Number of samples used for calculation of TWA values for each job category Samples for respirable mass and free SiO2 were full shift samples 39 Table 6 Summary of TWA Amphibole Fiber All Fiber Lengths in Mining Operations As Determined by Analytical Exposures and Milling Electron Microscopy Job Title Mine Trammer Driller Cageman Mechanic Asbestos Fiber Conc fibers 17.5 4 9.5 1 17.5 1 16.7 1 Mill Mill Foreman 25.0 2 General Laborer Crusher Operator Hardinge Operator Wheeler Operator Packer Packer Serviceman Packhouse Foreman Fork Lift Operator Machinist Welder 23.6 2 12.0 2 70.6 2 22.9 2 36.0 2 11.1 2 14.6 2 36.0 1 24.9 1 9.9 1 Concentrations shown are only for those giving identifiable electron diffraction patterns and include tremolite and anthophyllite ( ) Number of samples analyzed by electron microscopy 40 Sg Table 7 Summary of Airborne Fiber Types Determined By Analytical Electron Microscopy OpOepreartaitoinon / All Fibers Mine Mill Fibers > Nn 5 ...m in ms Length nh a Mine & Rl he Mill Bi Percent of Airborne Fibers All Lengths Positive Positive Amphiboles Amphiboles Tremolite Anthophylite Tremolite Anthophyllite Positive Chrysotile NonAsbestos Not Identi- fied 19 38 12 45 3 1 39 2 2 38 7 65 0 3 25 * Airborne fibers were identified as positive amphiboles by selected area electron diffraction ** Amphiboles differentiated by energy dispersive microchemical analysis *** Electron however diffraction patterns are not suffficient for identification many had ray spectra identical to tremolite 41 Table 8 Summary of Airborne Fiber Diameters for Positive Amphiboles Operation Operation and Fiber Fiber Type Median Diameter Diameter Um Geo Std Deviation Deviation Deviation 95 Conf Interval For Median Median Diameter Diameter um 0. ... in a in Diameterfi Mine Tremolite 83 0.19 2.3 0.16-0.23 88 Anthophyllite 164 0.13 2.4 0.12-0 93 Mill Tremolite 160 0.19 2.4 0.17-0.22 87 Anthophyllite 687 0.13 2.9 0.12-0.14 90 * Results of all samples combined for distribution analysis N = Number of individual fibers identified and sized using electron micro scopy q Table 9 ; Summary of Airborne Fiber Lengths for Positive Amphiboles Operation and Operation Ty Typ pee 95 Conf Median Geo Std Interval For Diameter | Deviation | Median Diameter um Um Mine Tremolite 83 Anthophyllite 164 1.6 1.5 1.8 2.6 1.4-1.8 1.3-1.7 Mill Tremolite 160 Anthophyllite 687 1.5 1.4 1.9 2.9 1.4-1.7 1.3-1.5 % 0.5 um in Length 4g : 97 90-92 i E i 97 90 * Results of all samples combined for distribution analysis N = Number of individual fibers identified and sized by electron micro- scopy 42 Table 10 Aspect Ratios for Positive Amphiboles Determined by All Fiber Lengths Electron Microscopy Aspect Ratio Measurement Median Aspect Ratio Tremolite Mine Mill 7.5 7.5 Anthophyllite Mine Mill 9.5 9.5 Aspect Ratio < 5/1 < 10/1 < 20/1 < 50/1 23 70 96 99 24 70 96 99 17 52 85 99 15 52 88 99 * Data shown are for all fiber lengths 43 Table 11 Operation Job or Operation Summary of Historic Impinger Dust Measurements in Mine and Mill Operations 1954 Mean Dust Concentration mppcf 1 2 2 2 NIOSH 1958 | 1963 | 1964 | 1969 | 1970 | 1972 | 1973 | 1975 | 1975 Median Yearly Average Mine Drilling 5 5 13 7 4 50 3 12 5 Dragline & Mucking 7 10 8 3 5 12 8 Tramming & Mucking 29 11 10 3 5 10-15 10 Primary Crushing 2 26 23 18 13 48 11 5 18 18 Hoist Loading 70 140 14 18 10 15 2 14 Mill 44 44 Secondary Crushing 12 23 00 10 12 13 3 3 3 : 9 Wheeler Grinding 15 13 5 11 19 4 10 3 10 Hardinge Grinding 18 14 4 8 10 3 8 Bagging 25 15 5 9 4 8 8 9 8 Palletizing Bulk Loading Loading Bags 40 25 109 39 31 10 6 10 62 8 15 2 10 35 50 Other Millwright Maintenance 1 Values for 1954 - 1970 taken from reference 16 2 Calculated from MESA reports references 33-42 4 4 12 2 Table 12 Summary of Historic Fiber Exposure Measurements in Mine and Mill Operations Job or Operation Mean Fiber Concentration fiber > ...m 1 | 2 | 2 | 2 | 2 | NIOSH 2 1970 | 1972 | 1973 | 1974 | 1975 1975 | 1976 Mine Drilling 00 4 1 1 1 Dragline & Mucking 16 6 1 2 Tramming & Mucking 22 6 1 3 Primary Crushing 260 22 5 9 20 Hoist Loading 29 5 10 13 3 3 24 6 6 00 10 25 10 12 45 Mill Secondary Crushing 13 5 14 6 9 5 18 Wheeler Grinding 30 14 13 17 8 14 Hardinge Grinding 33 13 10 8 14 Bagging 30 11 15 6 5 14 Palletizing 27 8 15 4 Bulk Loading 00 2 Loading Bags 3 Other Millwright Maintenance 2 14 2-4 38 1 Taken from reference 16 2 Calculated from MESA reports references 33-43 vrerpg: & oP 7 **** **** **** phwuphwu ! lamng OnE ne ggaFEORAArYbT ANe D FAD PE ir Menara eR a NR Ryn de ORT COR i ey EN See NE, RST PE BN BE pe te see Table 13 de ten Comparison of Airborne Fiber Characteristics in whe Study of Mine and Mill Operations with New York Talc Operations Acknowledged as Containing Asbestiform Minerals Airborne Airborne Fiber Fiber Characteristic Characteristic Characteristic Proportion Positive Amphiboles Proportion Anthophyllite Proportion Tremolite Median Fiber Length Anthophyllite Tremolite Median Fiber Diameter Anthophyllite Tremolite Median Fiber Aspect Anthophyllite Tremolite Ratio % of Fiber 5 ...m in Anthophyllite Tremolite length Asbestiform Mine and Mill 0.50 0.47 0.03 1.61 * ...m 0.16 * ...m 9.9 * 92 * Study Mine and Mill 0.58 0.45 13 Statistical Significance P 0.05 NS p 0.001 45 1.55 ...m ...m ; 0.13 0.19 ...m ... NS -~ NS -- 9.5 7.5 NS -- 90-92 97 NS -- * Insufficient number of fibers observed for calculation of size distribution parameters NS - Not significantly different at 0.05 level 46 TABLE 14 Summary of morbidity studies of workers exposed to tremolite and anthophyllite fibers Reference Mineral Characteristics Sample Exposure Medical Findings 20 Talc containing 45 tremolite 57 talc miners & Miners mppcf Bronchitis and no free silica millers 93 sample Millers mppcf Dyspnea St. Lawrence CO New York of mine & mill one Normal ray Fibrosis Early pneumoconiosis 26 Pneumoconiosis II 42 47 47 Steatite talc 70 talc 10 tremolite no quartz Murray County Georgia 66 talc miners & millers 30 work- ing at time of survey 8/11 fe- working males working 33 millers mppcf 13 miners mppcf 20 workers mppcf Pneumoconiosis Grade 0 1 2 3 High High Exposure 52 24 15 % Medium Exposure 54 46 - - Low Exposure 100 - - - 44 Fibrous talc containing tremolite anthophyllite % free silica St. Lawrence County N.Y. 221 men at 3 talc mines and 5 talc mills crushing milling mppcf Mine drilling 1350 mppcf Stoping mppcf Mucking mppcf Fibrosis Total population 14.5 10 years exposure 29.9 30 years exposure 74. Visceral plaque6s.3 for those 35-75 years old 4-52 years exposure TABLE 14 continued Reference Mineral Characteristics Sample Exposure Medical Findings 41 49 Talc admixed with tremolite and anthophyllite and a small amount of free silica Case histories of six talc miners and millers with pneumoconiosis 24 years 20-23 talc exposure Exposure in early years estimated as150-470 mppcf in later years as 0-53 mppcf Major Findings Clinical Chronic productive cough dyspnea diminished breath sounds limited chest ex- pansion diffuse rales clubbing X ray Interstitial infiltration opaque plate densities in region of diaphram less frequent emphysema and obser- vation of left cardiac border Fibrous County talc St. New York Lawrence 30 talc mill- Mean duration ers 10 years exposure and no of exposure 19.5 years previous occupa- 13-26 Aver- tional dust ex- age exposure posure 59 63.1 mppcf 15 smoked 20 cig- exposed 20-60 arettes per day mppcf for 5 years 15 exposed 60- 100 mppcf Dyspnea Abnormal findings rales rhonchi wheezin26g.7 Pulmonary infiltration 43.3 4 is grade 1 7 grade 2 2 grade ) Mean % predicted 76.6 Mean FVC Mean % predicted 120.8 Mean * predicted 105.2 Mean % predicted 82.1 Mean DLCO = 23.7 mm min TABLE 14 continued Reference Mineral Characteristics Sample Exposure Medical Findings Predominantly talc admixed with tremolite anthophyllite serpentine and 5 free silica 16 Talc millers with 10 years talc exposure and no previous occupational dust exposure 81 smoked 30 cigarettes > 5 years 7 avg exp Cough Exertional 20-60 mppcf 7 avg exp 60-120 mppcf dyspnea at rest % Dyspnea Lung find- ings rales rhonchi wheezing = 63 Club- 2 avg exp 120 mppcf bing Pulmonary Infiltration ray Grade 1 ======== 25 Grade 2 = 63 Grade 3 ======= 12 No platelike densities % predicted FVC - 72.5 48-91 50 44 were 75 FEV 6 were 60 = 70 53-84 % predicted RV == 100 72-153 % were 133 % predicted TLV = 81 54-103 31 were 73 * predicted TLC 96-143 50 were 124 19.2 mm min 10-38 38 were 17.7 Reference Mineral Characteristics Sample Exposure Medical Findings 10 51 47 Talc admixed with tremolite anthophyllite serpentine and % free silica 43 talc millers with 10 years exposure and no previous occu- pational dust ; exposure 26 had cigaretes smoked cigarettes 30 day . % avg exp mppcf 49 avg exp 20-60 mppcf 42 avg exp 60-120 60-120 mppcf % avg exp Cough = 33 Dyspnea = 65 Lung Crepitations == 28 Clubbing ======= 19 Pulmonary Infiltration ray Grade 2 = 23 Grade 3 = % % predicted FVC = 80 30 75 of pred FEV == 70 12 had < .60 % predicted RV == 10 14 133 % predicted TLC === 84 16 73 % predicted TLC = 116 37 124 DLCO 24.2 cc min 19 17.7 Anthophyllite asbestos Anthophyllite 707 living asbes- tos workers in- cluding office & forestry workers with no occupa- tional exposure 110 of these 787 had been engaged in asbestos work Nonsmoker 15 cigs 15 cigs for more than 10 Total years Adjusted for Smoking Cough % Dyspnea Mod All Exp Hvy Exp 17 14 59 20 32 27 57 23 35 30 57 13 27 23 58 20 TABLE 14 continued Reference Mineral Characteristics Sample 64 Anthophyllite asbestos 252 living workers Finland who had worked be- tween 1936-1967 Exposure Medical Findings Respiratory disease - 44 Normal chest ray = 44 Changes in lung parenchyma ray = 39 Pleural pathology only ray F 17 Pulmonary and pleural pathology 58 Lung pathology excluding pleural lesions ray == Slight % Moderate 15 Severe % 75 53 11 Anthophyllite asbestos Finland 116 employed 103 men & 24 retired 18 men miners & millers TLV for asbestos fibers > 5 m in length 33 2 yrs exp 27 5-15 yrs exp 15-25 yrs exp % 25 yrs exp Asbestosis ray = 27 Mild 49 Moderate Marked 19 32 Talc with tremolite & anthophyllite as major fibrous components 39 talc workers exposed 10 years 49 has smoked 20 cigarettes day for 5 years Avg yrs exp 16.2 11-22 + Mine Drilling 6 Mucking 20 Mill Crushing 15 Milling 13 Bagging 16 ++ 8 22 13 31.5 30 Cough = 26 Dyspnea 23 Grade 1 = 67 Grade 2 11 Grade 4 == 22 Lung Crepitations = % Clubbing = 08 Radiographic findings compatible with pneumo- coniosis == % TABLE 14 continued Reference Mineral Characteristics Sample Exposure Medical Findings 11 + mean dust counts mppcf over 20 year period ++ fiber count 75 ml in 1970 only 54 Table 15 Smoking Composition of Morbidity Study Population No Previous Occupational Exposure to Talc Who Had Smoking Status Nonsmoker smoker Smoker 20-29 30-39 Age 40-49 50-59 n% n% n8 n% 12 41 | 2 11 3 11 | 2 12 3 10 3 17 |} 13 48 8 47 14 48 | 13 72 | 11 41 7 41 60+ Total n* n% 0 ( 0 | 19 20 1 50 | 28 30 1 50 | 46 49 Total | 29 31 18 19 | 27 29 | 17 18 2 ( 2 | 93 Cells are column percentages marginals are percentages of the total 55 Table 15A Smoking Composition of Total Morbidity Study Population Regardless of Previous Employment Smoking Status Nonsmoker smoker Smoker 20-29 30-39 Age 40-49 50-59 60+ Total n 8 n * n * n % n * n % 16 46 3 13 3 (9 3 13 16 46 | 18 75 4 11 16 46 15 43 3 13 0 ( 0 | 26 21 13 54 |} 2 67 | 37 31 8 33 1 33 | 58 48 Total 35 29 } 24 20 | 35 29 | 24 20 | 3 ( 2 121 Cells are column percentages marginals are percentages of the total ern tertche ten bn 56 Table 16 Exposure Composition of Morbidity Study Population Who Had No Previous Occupational Exposure to Talc 20-29 Exposure 29 Employment years Particulate Exposure years Fiber Exposure years 2.7 0.3 2.0 0.3 10.4 1.6 Standard Error in Parentheses 57 30-39 18 5.9 0.8 4.6 1.0 16.7 3.3 Age 40-49 27 13.9 1.4 8.6 1.3 52.7 7.6 50-59 17 19.5 2.0 11. 2.0 68.8 13.1 60+ n 28.0 0 13.7 11.7 47.4 41.4 Table 16A Exposure Composition of Total Morbidity Study Population Regardless of Previous Employment 20-29 Exposure 35 Employment years Particulate Exposure years Fiber Exposure years 3.0 0.3 . 0.3 12.5 1.6 Standard Error in Parentheses 30-39 24 5.8 0.7 4.3 0.8 18.3 2.8 Age 40-49 35 14.0 1.2 9.3 1.3 55.7 7.7 50-59 24 19.5 1.8 12.1 1.7 72.2 11.2 60+ n 28.3 0.3 18.0 8.0 47.2 23.9 Table 17 and Radiographic Radiographic Findings by Smoking Habits Among Prevalence % of Symptoms to Talc Previous Occupational Exposure Morbidity Study Population Who Had Had No 7 Symptoms Radiographic Findings Findings Radiographic Radiographic Findings | | Nonsmoker n 19 smoker n = 28 Smoker Total n 46 = = 93 p Value Cough Phlegm Hemoptysis Dyspnea Grade 2 0 10.5 0 0 21.4 14.3 3.6 14.3 52.2 50.0 13 19.6 32.3 0.0001 31.2 0.0005 7.5 12 14.0 0.12 58 58 Pleural Thickening 10.5 14.3 8.7 10.8 0.76 Grade ) Pleural Calcification 5.3 0 0 1.1 0.14 Irregular Opacities 0 0 2.2 1.1 0.60 the three smoking categories There is no difference in rates among Ho Table 17A and and Radiographic Findings By Smoking Habits Among Prevalence % of Symptoms of Previous Employment The Total Morbidity Study Population Population Regardless Symptoms / Radiographic Findings Nonsmoker n = 26 smoker n = 37 Smoker n 58 Total n = 121 p Value Cough Phlegm Hemoptysis Dyspnea Grade 2 3.9 19 0 7.7 24.3 16.2 8.1 18.9 53.5 51.7 13.8 19.0 33.9 33.9 9.1 16.5 .0001 .0004 .12 .40 Pleural Thickening 59 18.9 8.6 11.6 .24 59 Grade 1 7.7 2.7 0 1.7 .37 Pleural Calcification 3.9 Irregular Opacities 8.1 1.7 3.3 .13 Grade 1 There is no difference in rates among the three smoking smoking categories Ho Table 18 Prevalence Prevalence % of Symptoms and Radiographic Findings by Age Among Morbidity Study Population Population Who Had No Previous Occupational Exposure to Talc Age Symptoms Radiographic Findings . 20-29 n 29 30-39 n = 18 40-49 n = 27 50-59 n = 17 60+ n=2 p = 93 | Value Cough 17.2 55.6 22.2 41.2 100.0 32.3 0.009 60 Phlegm 20.7 44.4 29.6 29.4 100.0 31.2 0.11 Hemoptysis 6.9 11 11.1 0 0 7.5 0.66 Dyspnea > Grade 2 Pleural Thickening > Grade ) Pleural Calcification 10.3 0 0 16.7 0 0 11.1 7.4 0 17.7 41.2 5.9 50.0 50.0 0 14.0 0.56 10.8 0.0001 . 0.34 Irregular Opacities > Grade 1 0 0 0 5.9 0 1 0.34 L_ in rates among the five age groups Ho There is no difference commie Sunkist ie saccants sine inci east Table 18A Prevalence % of Symptoms and Radiographic Findings by Age Among the Total Morbidity Study Population Regardless of Previous Employment Symptoms Radiographic Findings Age 20-29 n 35 30-39 n ====== 24 40-49 n = 35 50-59 60+ n = 24 = 3 Total n = 121 Value Cough 17.1 58.3 25.7 37.5 100.0 33.9 .001 Phlegm 61 61 Hemoptysis 22.9 50.0 37.1 25.0 66.7 33.9 .13 5.7 12.5 11.4 4.2 33.3 9.1 .42 Dyspnea > Grade 2 Pleural Thickening > Grade ) 11.4 0 16.7 0 11.4 5.7 29.2 41.7 33.3 16.5 66.7 11.6 32 .0001 Pleural Calcification 0 0 0 8.3 0 1.7 .08 Irregular Opacities > Grade ) 0 0 2.9 12.5 0 3.3 .08 Ho There is no difference in rates among the 5 age groups ENE tn ZestSg, Table 19 BSP Prevalence % of Symptoms and Radiographic Findings Among Talc Workers Included in Morbidity Study With No Previous Occupational Exposure to Talc 4 Compared to Coal and Potash Workers Adjusted for Age Height and Smoking Habits Radiographic Findings | Years Worked | Talc | Coal | Potash Cough Phlegm Hemoptysis Dyspnea Pleural Grade Thickening 1 and 2 Pleural Calcification Irregular Opacities Grade > Regular Opacities Grade > A 15 years V 15 years < 15 years > 15 years < 15 years > 15 years < 15 years > 15 years < 15 years > 15 years < 15 year*s* > 15 year*s* < 15 years > 15 years < 15 years > 15 years 31.3 34.5 4 20.9 | 36.7 34.4 24.1 26.0 44.6 10 0.0 6.4 9.4 12.5 |) 13.3 17.2 37.9 1.6 31.0 0.3 1.6 0.0 3.4 0.0 0 0.0 3.4 0.5 5.3 0.0 1.0 3.4 | 13.7 23.2 25.6 27.2 23.7 6.4 6.7 5.3 11.3 0.5 4.4 0.0 .0 0 0.7 0.0 1 * < 0.05 Hypothesis being tested is that there is no difference in rates between the coal and talc populations or between the potash and talc populations ** Expected values not large enough for chi square test 62 Table 19A Prevalence % of Symptoms and Radiographic Findings Among All Talc Workers Included in Morbidity Study Compared with Coal and Potash Workers Adjusted for Age Heighat nd Smoking Habits Radiographic Findings | Years Worked | Talc Coal Potash Cough Phlegm Hemoptysis Dyspnea Pleural Thickening ; i Grade 1 and 2 Pleural Calcification Irregular Opacities Grade > Regular Opacities Grade > 15 15 15 15 15 15 15 15 15 15 15 ++ ++ ++ 15 ++ 15 32.9 21.1 | 23.3 35.9 | 37.5 26.7 37.8 | 26.0 | 27.4 25.6 | 45.7 | 23.7 11.0 6.5 6.2 5.1 10.4 6. 13.4 13.7 23.1 | 39.2 5.3 13.4 1.2 33.3 0.3 **** 0.5 3.7 **** 0 0 0 5.1 0 0 0 10.3 .6 5.6 0 0.4 **** **** 0 1.0 2.6 | 14.5 0 1.6 * ** *** **** 05 2222 = .02 2222 = .005 2222 = .0005 Ho There is no difference in rates between the coal and talc populations or between the potash and talc popula- tions tions + 37 for potash comparisons ++ Expected values not large enough for chi square test whe ee i re e4 wez r rat a 63 Table 20 Response Relations Among Talc Workers Observed Pulmonary Function As Compared to Pulmonary Function of Coal and Potash Miners Adjusted For Age Height Smoking Habits and Years Worked Standrard Error in Parenthesis A. Mean Percent Predicted and Pulmonary Function of Talc Workers Compared to Coal and Potash Workers Coal Potash FEV a b n ===== 93 n = 121 **** **** 94.0 93.8 1.3 1.3 94.5 94.5 ****1 1.4 1.3 FVC a b n = 93 n || 121 **** **** 92.4 91.9 1.2 1 94.7 94.7 94.0 94.0 1.3 1.2 FEV a b n = 93 n == 121 101.3 101.5 0.7 0.7 99.8 99.9 0.7 0.7 Peak Flow c a n = 89 n === 114 108.1 108 2.8 2.5 99.4 99.5 2.6 2.3 FEF 25 j^ n = j^ n 89 114 * 93.6 * 94.0 2.8 2.7 88.8 88.9 88.9 2.7 2.6 FEF50 FEF50 FEF75 FEF75 C. a n - 89 n = 114 c a n === n 89 114 **** **** 85.9 86.8 3.1 2.9 **** **** 79.5 79.9 3.1 2.9 85.385.3 3.2 85.6 85.6 2.9 83.783.7 83.6 3.3 3.0 Ho Mean predicted pulmonary function is not different from 100 FEF75 = + Percent predicted for FEV FVC Peak Flow FEF50 FEF75 100 x observed i predicted For FEV = 100 + predicted 64 Table 20 continued Change function per in percent predicted pulmonary Coal 100 years Potash FEV a b n= = n 93 121 ** - *** - 9.4 10.3 3.2 3.0 **** **** - 13.7 14.4 3.4 3.1 FVC a b n = 93 n = 121 ** - **** ~ 9.6 11.6 3.1 2.6 *** - 12.7 **** = 14.7 3.3 2.8 FEV a n 93 b n = 121 + 0.2 1.7 + 0.8 1.5 - 0.7 1.8 ~ 0.05 Peak Flow d n = 89 = 114 FEF 25 C. . n= 3 89 114 + 2.7 7.1 + 0.4 5.7 + 4.8 6.9 + 0 6.2 - 2.3 6.5 1 4.0 5.2 - 0.3 6.8 - 1.5 5.9 FEF 50 FEF75 C. . n = n 89 114 C. a n= n 89 114 - 2.5 - 5.0 7.7 6.7 - 9.7 12.0 7.7 6.6 - 7.6 7.9 ~ 9.7 6.6 - * ~ 13.8 15.9 8.3 6.9 function per 10 particulateChange in percent predicted pulmonary yrs FEV 1 a b = 93 n = 121 FEV a b n = 93 n = 121 FEV a b n = 93 n = 121 Peak Flow a n = 89 n = 114 FEF25 C. a n = 89 n === 114 FEF 50 C. n === 89 n - 114 FEF 75 c a n == n 89 114 * - 5.2 * - 3. 1.9 1.8 ** - 5.3 *** - 5.5 1.9 1.6 ++ 0 ++ 1.2 1.0 0.9 ++ 1.2 + 1.6 4.2 3.3 - 0.03 + 2.2 4.1 3.6 - +2 + 1.2 4.6 4.0 - 4.6 - 1.8 4.6 3.9 *** - ** 1 7.5 6.2 2.2 1.9 ** - **** - 6.7 7.1 2.1 1.8 - 0.6 1.1 + 0.6 0.9 + 0.08 1 0.2 3.1 -- 2.3 4.2 - 0.4 3.6 - 4. 4.9 - 2.7 4.0 - 7.9 5.1 - 5.1 4.2 Ho function is not different from 0 Change in pulmonary 65 * = p 0.05 ** Q = < 0.005 *** = p 0.001 **** p = < 0.0001 Table 20 continued a For potash comparison 91 for FEV FVC FEV b For potash comparison 119 for FEV FVC FEV C. For potash comparison 87 for Peak Flow FEF 25 FEF50 FEF75 a For potash comparison 112 for Peak Flow FEF FEF50 FEF75 FEF75 66 Table 21 Comparison Previous of Talc Workers Included in Morbidity Study and Having No Talc Exposure With and Without Pleural Thickening PT By Age Exposure and Smoking Habits Standard Error in Parentheses 93 40-49 Age 50-59 60+ N No PT 25 10 1 PT 2 7 1 Age No PT PT |] 44.4 46.5 ( 0.5 | 53 ( 0.5 51. ( 0.6 | 63.0 ( 0.6 51.9 Smoking pack years ' Years Worked No PT PT | 27.8 39.0 No PT PT 13.8 14.5 Particulate Exposure | No PT yrs PT Fiber Exposure ' fibers PT PT 8.7 7.9 52.5 55.9 ( 4.7 23.0 | 39.0 | 18.6 ( 1.4 | 16.5 ( 6.5 | 23.7 ( 1.4 ' 11 ( 3.9 ' 11.2 ( 7.9 41.0 59.5 82.0 ( 8.6 j 99.0 ( 5.2 | 44.0 ( 3.1 | 28.0 ( 0.9 | 28.0 ( 2.6 | 25.4 ( 3.4 2.0 16.7 41.0 | 88.8 6.0 % Predicted FEV Coal No PT 97.9 ( 2.6 | 90.6 ( 4.7 | 84.0 PT 80.8 ( 3.2 | 77.6 ( 5.3 | 87.3 : Potash No PT | 96.3 ( 2.8 | 89.4 5.0 ] -- 4 PT 77.7 ( 5.3 75.4 ( 5.4 86.7 a : % Predicted FVC Coal No PT 95.9 ( 2.4 | 86.7 ( 4.5 | 79.6 | | PT 72.9 7.1 77.6 ( 4.4 82 2. Potash No PT | 96.7 PT 72.5 ( 2.5 | 88.3 ( 8.7 77.1 ( 4.8 | -- ( 4.3 83.2 : ** Pleural thickening Grades 1 and 2 67 Table 21A Exposure Comparison of All Talc Workers in Morbidity Study With and Without Pleural Thickening PT By Age and Smoking Habits Standard Error in Parentheses 121 40-49 Age 50-59 60+ N No PT 33 14 12 PT 2 10 2 Age Smoking packing years Years Worked No PT PT 44.5 46.5 No PT PT | 26.8 39.0 No PT PT | 14.0 14.5 ( 0.4 53.3 ( 0.5 | 52.4 ( 4.0 23.0 | 30.4 | 24.6 ( 1.3 | 16.6 ( 6.5 23.5 ( 0.5 | 63.0 ---( 0.7 | 60.5 0.5 ( 7.2 | 99.0 ( 6.8 | 27.0 ---17.0 ( 2.6 | 28.0 ( 1.5 28.5 ---( 0.5 Particulate Exposure | No PT yrs PT 9.4 7.9 Fiber Exposure fiber No PT PT 55.6 55.9 % Predicted FEV Coal No PT PT | 95.5 80.8 Potash No PT PT | 94.2 77.7 % Predicted FVC Coal Potash No PT PT 94.5 72.9 No PT PT | 95.6 72.5 ( 1.3 | 11.1 ( 3.9 | 13.5 ( 8.0 41.0 57.8 | 92.4 ( 3.1 | 91.9 ( 3.2 | 77.8 ( 3.3 | 90.0 ( 5.3 | 75.4 ( 2.6 | 87.4 ( 7.1 77.6 ( 2.2 | 25.4 ( 2.7 | 14.3 12.8 18.9 88.0 | 26.4 ( 3.8 | 84.0 ( 5.8 102.9 ---12.4 ---20.4 ---15.6 ( 3.9 -- ( 6.0 | 98.2 11.5 ( 3.4 | 79.6 ( 4.7 89.0 ---( 6.2 ( 2.8 | 88.3 ( 3.6 -- ( 8.7 77.0 ( 4.8 | 88.0 ( 4.8 * Pleural Thickening Grades 1 and 2 68 Table 22 Average Number of Years Worked for Each Individual in Morbidity Study Having No Previous Talc Exposure With and Without Pleural Thickening and the Number of These Individuals Working in Selected Jobs Over the Total Work History Of Those With Greater Than 15 Years Work When 0 5 and 10 of the Most Recent Years Worked are Omitted Selected Jobs Are Those Where the Number of Thickening is Equal to or Than Average Years Worked for Years Worked Divided by the Number Greater Than One and Greater Those Without Pleural Thickening With Pleural Average Number of Years Individual - All Years PT No PT Number of Individuals Ever on this Job Omit Most Recent Five Years PT No PT Omit Most Recent Ten Years PT No PT 69 Mine Foreman 19 ( 1 7.7 ( 3 14.1 ( 1 7 (2 9 (1 2 (2 Hoistman 26 ( ) 1 (1 21 ( 1 1 (1 16 ( 1 1 (1 Crusher Operator 24 ( } Packer Packer Serviceman | 14 ( 2 10 ( 2 Quality Control Technician 16 ( 1 Shipping & Inventory Coord 13 ( 2 All Other Jobs 5.1 11 8 (2 14 ( 2 0 4 (2 0 8.1 43 20 ( 1 6.5 ( 2 9 2 | 12.5 ( 2 7.5 ( 2 0 16 ( 1 1.5 ( 2 16 ( 1 0 5 10 7 38 15 ( 1 4 (2 11 ( 1 | 8 ( 2 5 (2 0 12 ( 1 2 (1 11 ( 1 0 4.6 ( 9 5.4 35 All Jobs 10.2 21 8.0 53 9.0 19 6.9 47 7.4 17 5.2 43 Note All Numbers for All Jobs and Other Jobs will exceed number of individuals with 9 and with 20 pleural thickening since many have held more than one job Table 23 Symptom Function Prevalence Radiographic Findings and Pulmonary By Pleural Thickening PT and Years Employment PT = 15 Years Employment PT == 0 15 Years Employment PT = * 15 Years Employment PT = 2 15 Years Employment Age Average Symptom Prevalence n = 81 32. 1.1 n = 26 48.9 1.0 n8 50.9 1.1 95 Confidence Levels in Parentheses Cough Phlegm Hemoptysis Dyspnea ( > Grade 2 Pleural Calcification Irregular Opacities 32.1 37.0 9.9 13.6 0 0 22-44 | 34.6 26-49 | 23.1 4.5-19 0 ( 7-24 19.2 ( 0-5 0-5 0 ( 0-5 0-5 3.9 18-55 | 12.5 ( 9-43 12.5 ( 0-13 | 12.5 ( 7-39 25.0 ( 0-13 25.0 ( 0-20 25.0 ( 0-50 ( 0-50 ( 0-50 ( 3-65 ( 3-65 ( 3-65 Pulmonary Function Standard Error in Parentheses FEV % Pred FVC % Pred Coal Potash Coal Potash 95.5 97.5 1.3 1.5 94.4 97 1.2 3 95.0 91.5 3.4 3.5 91.4 90.4 3.1 3.1 83.8 80.9 3.2 3.5 80.1 79.5 3.6 3.7 FEV 78. 0.9 75 1.3 76.0 1.7 n= 6 55.2 2.0 83.3 40-100 66.7 25-95 33.3 33. ( 4-75 ( 4-75 0 ( 0-45 16.7 ( 0-60 79.1 76 11.5 11.1 76.4 75.8 ( 7.4 (7 70.2 ( 4.1 Peak Flow % Pred FEF 25 % Pred FEF50 % Pred FEF75 FEF75 % Pred Coal Potash Coal Potash Coal Potash Coal Potash 74 106.1 99.5 2.8 2.7 91.6 88.6 3.0 2.9 86.6 87.3 3.1 3.3 82.6 87.4 3.2 3.5 113.4 99.7 5.5 4.5 98.4 89.9 6.1 5.9 91 86.2 7.2 7.0 80 82 7.0 7.5 113.2 99.8 10.7 ( 9.9 102.6 92.9 10.1 ( 9.6 82.9 79.1 10.0 10.7 65 65.4 ( 6.3 ( 5.1 110.6 97.2 17.2 16.3 93.4 83.5 21.1 19.3 76.0 70.9 24.5 20.0 65.5 66.7 .3 19.9 * One individual has less than 15 years employment all others with PT > 1 have more than 15 Years employment ** 24 for the potash comparisons ETON: 70 ag Table 24 Symptom Prevalence % of Talc Workers Compared to Asbestos and Synthetic Textile Workers2 By Age and Smoking Habits Nonsmoker smoker Smokers Total Winter Cough 3 mos Ages Asbestos Workers 21-35 19 36-69 35 Talc Workers 20-39 0 40-65 0 Anthophyllite Asbestos heavily exposed greater than 10 years Phlegm in Winter Asbestos Workers 3 mos Ages 21-35 36-69 16.8 26 40 27 21 33 21 -- 27 30 49 65 48 60 32.0 35.6 43 51 42 56 24.4 38.3 26.6 38 47 Synthetic Textile 15-39 6 ---- 12 10 Workers 40-70 9 5 22 17 Es . Talc Workers 20-39 18 17 45 24 40-65 20 11 60 37 Breathlessness- Grade 2 or More 7 Ages Asbestos Workers 21-25 0 0 13 9 : 36-39 22 23 23 23 4 Synthetic Textile 15-39 6 57 6 6 Workers 40-70 4 57 9 7 | Talc Workers 20-39 6 17 14 9 _ 40-65 0 14 20 17 Anthophyllite Asbestos 19.8 -- 23.0 19.9 dyspnea at rest 13.3 1 From J.C. McDonald et Asbestos Mine and Mill al Respiratory Symptoms in Chrysotile Workers of Quebec Arch Env Health 358 1972 2 J. A. Merchant Epidemiological Studies Among Cotton Textile Workers 1970-73 from white men working in synthetic wool of Respiratory Disease Rates are calculated mills in North Carolina 1970-71 > ae 3 L.O. Meurman R. Kivilvoto and M. Hakama Mortality and Mor- Bie. bidity Among the Working Population of Anthophyllite Asbestos Miners in Finland Brit J. Ind Med 105 1974 71 Table 25 Prevalence of Radiographic Findings in Talc Workers Compared to Asbestos 4 Workers Over 35 Years of Age and After Age Adjustment Prevalence % of Radiographic Findings Pleural Thickening Pleural Calcification Irregular Opacities Talc Workers with no previous occupational exposure 52 Asbestos Workers Talc Workers regardless of previous employment 70 Asbestos Workers 1 25.0 .01 4.8 28.6 .01 4.9 3.8 2.9 N.S. 7. 3.0 N.S. 1.9 N.S. 5.6 5.7 N.S. 5.8 1 Data from C.E. Rossiter et.al. 1972 Radiographic Chrysotile Asbestos Mine and Mill Workers of Quebec Health 388 ref 76 Changes in Arch Env This study of asbestos workers used the 1968 UICC classifi- cation for pneumoconiosis There are no differences in the 1968 and 1976 classification for irregular opacities pleural thickening and pleural calcification 72 of the Prevalence of Pleural Thickening PT in Workers Exposed to Asbestos Table 26 -- Summary Reference 56 1968 62 1969 73 63 1972 61 1972 76 1972 Exposure Naval Dockyard all types of asbesots fibers n Extensive PT Limited Plaques of PT Continuous Exposure 42 % 24 Prevalence of PT Intermittent Exposure 688 % Varied or Insignifi- cant Expo- sure 684 % % of Cases with 15 Yrs Since Expo- sure 91 % % 88 Former anthophy- llite asbestos workers . n 410 Prevalence % Of Diffuse PT All 35 No Pulmonary Fibro- sis 9 Pulmonary Fibrosis 268 Grade Diffuse PT 2 3 No pulmonary changes 71 14 14 Grade 1 pulmonary changes 50 32 18 Grade 2 pulmonary changes Grade 3 pulmonary changes 21 58 21 % 26 63 Men & women 40 yrs attending chest clinic in Birmingham UK area 3868 % had noncalcified pleural lesions % had pleural calcification and of these also had noncalcified pleural lesions 10 sample of 3 naval dockyards 2442 Extensive noncalcified PT === 0.01 Limited noncalcified PT ==== 0.01 Pleural abnormalities were more frequent than parenchymal disease 2 Chrysotile Asbestos Mines and Mills 36-40 n 1449 PT Grade 1 1.4 PT Grade in Production Wkrs at Thetford Mine 2.8 Asbestos 0.7 PT by Age 41-45 46-50 1446 1066 51-55 867 2.7 5.8 7.28 4.2 1.7 7.1 4.1 8.0 3.6 56-60 656 7.8 7.9 4.6 61-65 641 .38 11 7.68 TOTAL 11207 3.8 6.4 3.2 C sn RBGude oR bem atlg ~ cubes ' va gm TES wnt eee be cee eet tet Table 26 -- Summary of the Prevalence of Pleural Thickening continued PT in Workers Exposed to Asbestos 36-40 41-45 46-50 51-55 56-60 61-65 TOTAL . In Factory Workers n == 87 76 66 44 61 64 967 ,, in PT 1.1 2.6 4.5 6.8 4.9 ---TT 1.4 % PT by Dust Index 10 10-99 100-199 dust Level x yrs worked 200-399 400-799 800+ Production Workers Thetford Mine 2.4 Asbestos 2.9 4.6 2 6.5 3.0 5.8 3.0 8.3 4.7 10.5 .8 77 1975 74 2 asbestos cement Average age === 45 21-79 manufacturing plants primarily chrysotile chrysotile but some exposure to Average dust exposure 17 yrs 1 month yrs csriolciicdaolittaelc ammi oc siate n ======== 233 * 50 50-100 _ 233 9 92 15 % PT by mppcf 100-200 200-400 400+ TOTAL 130 22 245 168 159 16 859 15 Sues bien cotbat Table 27 Vital Status Who of Talc Workers Included Began Employment Between in Mortality 1947-1960 Study Known to be alive Known to be deceased Unknown vital status Total . 308 74 16 398 Table 28 Study Cohort of Talc According Workers Included in Mortality to Length of Employment Study Duration of Employment < 1 month 1 month - 6 months 6 months - 12 months 1 year - 10 years > 10 years Total Number 74 97 31 90 106 398 r= at 75 aitad drcate het Table 29 Study Cohort of Talc Workers Included According to Date of Initial in Mortality Employment Study Date of Initial Employment 1947 - 1949 1950 - 1954 1955 - 1959 Total Number 174 156 68 398 76 Table 30 Observed Among Talc and Expected Deaths According to Major Causes Miners and Millers Included in Mortality Study Cause of Death Number Observed Expected SMR Respiratory T.B. Malignant Neoplasms Diseases of the Heart 001-008 140-205 400-443 All malignant Respiratory Disease Accidents 470-527 E800 Other Known Causes [| cert tTTrO Total 3.0 19.0 27.0 8.0 10.0 7.0 74.0 0.49 10.6 26.5 2.9 6.4 14.4 61.3 610 j 180 F 102 280 156 --- 120 * p < 0.05 77 Table 30A Observed and Expected Deaths According to Specific Cause Among Talc Miners and Millers Included in Mortality Study Cause of Death Number Observed Expected Malignant Neoplasms 140-205 Digestive System 150-159 Respiratory System 160-164 Bronchogenic 162-163 Lymphatic and Hematopoietic 200-205 78 Other Neoplasms RR ) All malignant Respiratory Disease 470-527 Influenza Pneumonia Bronchi- tis and Acute Upper Respira- tory Infection 470-502 Other malignant Respiratory Diseases 510-527 19.0 0 10.0 9.0 4.0 2.0 8.0 3.0 5.0 10.6 3.0 3.5 3.3 1.2 2.9 2.9 1.5 1.3 * p < 0.05 ** p < 0.01 SMR 180 100 290 270 330 69 280 200 380 Table 31 Bronchogenic Cancer Among Talc Miners and Millers Included in Mortality Study According to Interval Since Onset of Employment Latency Interval Since Onset of Employment years 10 10-19 20-28 Total ** p < 0.01 * p < 0.05 Observed 0 3 60 9 Expected 0.5 1.5 1.3 3.3 SMR oon ; 200 460 - _ _. i 270 BA 79 Table 32 Case Review of Deaths Among Talc Miners and Millers Included in Mortality Study According to Cause of Death and Select Demographic Factors Case D.O.B. Age at Death App Length of Emplymt Date of Initial Emplymt Latency Years Other previous Emplymt Length of Emplymt A. Cancer of Respiratory System 1 12/04/06 63 1 month 8/10/49 2 05/22/17 54 1 month 10/21/48 3 06/08/14 59 1 year 11/08/48 4 03/19/24 46 80 5 06/14/09 55 6 06/28/07 53 7 05/10/20 54 8 04/22/891 79 9 01/03/22 39 10 10/10/11 62 2 months 11/22/48 3 years 07/19/48 5 years 08/04/54 2.5 years 07/12/50 < month 12/13/48 2.5 years 07/13/49 17 years 01/25/56 21 Unknown 23 Coal Supply 7 months Diamond Drill Other N.Y. State Talc Co. 25 Repairman N.Y. State Talc Co. 5 months Shaftman Mine 14 months 21 Rock Quarries 2 years Aluminum Plant 4 years Iron Ore Mine 4 months 18 Road Building 5 years Mining 6 years 6 Foundry 10 years Other N.Y. State Talc Co. 5-6 years 24 Mining 7 years 22 Construction unknown length 12 Mucker Mine " ) 18 Unknown B. Mesothelioma of Lung 1 02/08/06 62 16 years 12/04/52 16 Construction 11 years A asthe tnt tanic, fmt icaset tee eee at ae werden Table 32 continued C. malignant Respiratory Disease Other Than Influenza and Pneumonia 1 08/07/885 75 2 01/07/16 59 3 09/08/13 58 4 03/07/26 49 5 06/20/10 58 10 years 11/01/48 < month 12/15/48 14 years 06/14/54 10 years 04/05/52 1 year 04/17/50 13 Unknown 27 Unknown 17 Mucker & Driller - Limestone 9 years 23 Other N.Y. State Talc Co. 5 years 18 Unknown D. Respiratory T.B. 1 12/06/21 49 81 2 02/11/09 53 < 3 10/30/29 42 4 years 06/25/49 5 months 07/11/49 6 years 09/11/54 21 Construction 4 months Miner Miner 3 month 12 Miner N.Y. State Talc Co. 16 years Miner Mine unknown length 17 Unknown Figure 1. Typical Spectra Electron Diffraction Patterns and ray of Tremolite Fibers in Bulk Samples Ray Spectrum 130931NT 130931NT EV Diffraction Patterns Electron Photomicrographs Magnification 10,000 X 1 Micron Magnification _ 1,700 X 10 Micron + 82 Figure 2. Typical Spectra Electron Diffraction Patterns and ray of Anthophyllite Fibers in Bulk Samples ray Spectrum Diffraction Pattern Electron Photomicrograph Magnification 10,000 X 1 Micron Magnification 5,000 X 1 Micron I 101 MICRON MICRON - MAGNIF C T O 3,0 84 x Figure 3. Electron Photomicrograph of Airborne Particulates in Mine and Mill ee eS Sen SEP, Me Whe Brame i ein rates A epee Sate OE eae x a ei MAGNIFICATION 3,000 X 1 MICRON 10 MICRON 85 Mil and Mine in Particules ns pay Airbone of Photmicrgaph Electron Mill Figure Fett at 86 ee of Airborne Particulates in Mine and Mill Figure 5. Electron Photomicrograph 65 55 MPCF 87 CONETRAI DUST MEAN Figure 6 Mean Yearly Impinger Dust Concentrations for Mine Operations All Operations eatin iaeieeeienetaninel Drilling Dragline Loading Tramming and Mucking YEAR OF measuREMENT Secor dpe ck ade ha Figure Mean Yearly Impinger Dust Concentrations for Mill Operations All Operations All Operations Except Bag Loading MPCF 88 CONETRAI AVERG 19 55 REFERENCES Rohl A.N. Langer A.M. Selikoff I.J. Tordini A. Klimentidis R. Bowes D.R. and Skinner D.L. 1976 Consumer Talcums and Powders Mineral and Chemical Characterization J. Toxical Environ Health 225-294 Stemple I.S. and Brindley G.W. 1960 A Structural Study of Talc and Tremolite Relations J. Ceramic Soc 43 No. 34-42 January U.S. Department of Interior Bureau of Circular IC8639 1974. Proceedings of Talc Washington D.C. May 8 1973 Mines Information the Symposium on Ross M. 1974. Geology Asbestos and Health Health Perspect 123 124 Environ Kleinfeld Messite J. and Zaki H. 1974. Mortality Experiences Among Talc Workers A Follow study J. Occup Med 16 No. 345-349 Kleinfeld M. Messite J. and Kooyman Mortality Among Talc Miners and Millers Arch Environ Health 663 667 0. 1967 in New York State 7. Messite J. Reddin G. and Kleinfeld M. 1959 Pulmonary Talcosis A Clinical and Environmental Study A.M.A. Arch Ind Health 408-413 Kleinfeld M.J. Messite J. Shapiro J. Kooyman 0. and Swencicki R. 1964. Lung Function in Talc Workers A Comparative Physiologic Study of Workers Exposed to Fibrous and Granular Talc Dusts Arch Environ Health 559 566 Kleinfeld M. Messite J. Swencicki R. and Sarfaly J. 1965. Lung function changes in Talc Pneumoconiosis J. Occup Med 12-17 10. Kleinfeld M. Messite J. Swencicki R. and 1965. Effect of Talc Dust Inhalation on Lung Arch Environ Health 431 Sarfaly J. Function 11. Kleinfeld M. Messite J. and Langer A.M. 1973. A Study of Workers Exposed to Asbestiform Minerals in Commercial Talc Manufacture Environ Res 132-143 89 12. Kleinfeld M. Messite J. Kooyman 0. and Shapiro J. een 1964. Pulmonary Ventilatory Function in Talcosis of Lung eaur Dis Chest 592-8 etibnes 13. Letter of the R.T. Vanderbilt Company Inc. January 2 1975 Certifying 19 Products Tienes Tee rea 14. Gillam J.D. Dement J.M. Lemen R.A. Wagoner J.K. and Ta Archer V.E. 1976. Mortality Patterns Among Hard Rock very Miners Exposed to an Asbestiform Mineral Ann N.Y. Acad wet ernt Sci 336-344 15. Zumwalde R.D. and Dement J.M. 1977. Review and as A Evaluation of Analytical Methods for Environmental Studies of Fibrous Particulate Exposures U.S. DHEW NIOSH Publication No. 77-204 ee 16. National Institute for Occupational Safety and Health 1974. Criteria for a Recommended Standard Occupational Exposure to Crystalline Silica U.S. DHEW CDC 17 National Institute for Occupational Safety and Health 1972. Criteria for a Recommended Standard Occupational Exposure to Asbestos U.S. DHEW CDC 18 Pask J.A. and Warner M.F. 1954 Talc I. Constitution of Talcs J. 118-128 March Fundamental Am Ceramic Studies Soc 37 of No. 19 Ross M. Smith W.L. and Ashton W.H. 1968. Triclinic Talc and Associated Amphiboles from the Gouverneur Mining District New York Amer Mineralogist 751-769 June 20. Dreessen W.C. 1933. Effects of Certain Silicate Dusts on the Lungs J. Ind Hyg 15 No. 66-78 March 21. U.S. Department of Labor Occupational Safety and Health Administration 1975. Occupational Safety and Health Standards Federal Register 39 No. 125 June 27 1974 as recoded May 28 22. Lynch J.R. Ayer H.E. and Johnson D.L. 1970. The relationships of Selected Asbestos Exposure Indices Amer Ind Hyg Assoc J. 31 Sept. 23 New York Department of Hyg 1972. Report of Co. Balmat Mine July Labor Field 23 and Industry Division of Investigation Gouverneur Ind Talc 90 24 New York Department of Labor and Industry Division of Ind Hyg 1972. Report of Field Investigation Gouverneur Talc o F a Co. Balmat Mine August 10 dn 25 New York Department of Labor and Industry Division of Ind iHgt Hyg 1972. Report of Field Investigation Gouverneur Talc ers Co. Balmat Mine July 11 26 New York Department of Labor and Industry Division of Ind Hyg 1973. Report of Field Investigation Gouverneur Talc Co. Balmat Mine June 20 27 New York Department of Labor and Industry Division of Ind Hyg 1973. Report of Field Investigation Gouverneur Talc Co. Balmat Mill November 20 28 U.S. Department of Interior Mining Enforcement and Safety Administration 1973. Dust Survey of the American Talc ge Mill Gouverneur Talc Co. Balmat New York Sept. 19-20 omen 29 New York Department of Labor and Industry Division of Ind were Hyg 1974. Report of Field Investigation Gouverneur Talc Co. Balmat Mill July 18 30 U.S. Department of Interior Mining Enforcement and Safety Administration 1974. Memorandum to Lewis Roberts Evaluation of Airborne Dust Samples Gouverneur Talc Co. St. Lawrence County N.Y. Oct. 22 31 New York Department of Labor and Industry Division of Ind Hyg 1974. Report of Field Investigations Gouverneur Talc Co. Balmat Mine July 18 32 U.S. Department of Interior Mining Enforcement and Safety Administration Memorandum dated September 23 1976 Gouverneur Talc Co. Inc. Samples Denver Technical Support Center File HLS 3-1-6h 33. U.S. Department of Interior Mining Enforcement and Safety Administration Memorandum dated February 10 1977 Fiber Counts for Gouverneur Talc No. 1 Mine 1 Mill Balmat New York Denver Technical Support Center File HLS 3-1-6 HLS 5 91 34 U.S. Department of Interior Bureau of Mines Health and Safety Activity 1973. Health and Safety Report Health and Safety Spot Inspection Radiation American Mine Gouverneur Talc Co. Inc. Balmat St. Lawrence County N.Y. February 28 35 U.S. Department of Interior Mining Enforcement and Safety Administration 1976. Health and Radiation Inspection Report Gouverneur Talc Co. Mine No. 1 and Mill Balmat N.Y. March 24 36 Snedecor G.W. and Cochran W.G. 1967. Statistical Methods The Iowa State University Press 6th Ed 37 Molnar J.J. Nathenson G. and Edberg S. 1962. Fatal Aspiration of Talcum Powder by a Child N. Engl J. Med 36-37 38. Hughes W.T. and Kalmer T. Massive Talc Aspiration 1966. Am J. Dis Child 653 39 Alivisator G.P. Pontikakis A.E. and Terzis B. 1955 Talcosis of Unusually Rapid Development Br J. Ind Med 43-49 40. Parkes W.R. Occupational Lung Disorders 1974 Butterworths London 41 Kleinfeld M. Geil C.P. Majeranowski J.F. and Messite J. 1963. Talc Pneumoconiosis A Report of Six Patients with Postmortem Findings Arch Environ Health 107-121 42 Dreessen W.C. and Dalla Valle J.M. 1935. The Effects of Exposure to Dust in Two Georgia Talc Mills and Mines Public Health Report 131 43 Porro F.W. Patton J.R. and Hobbs A.A. 1942 Pneumoconiosis in the Talc Industry Am J. Roentgenal ; 507-524 4 44. Siegal W. Smith A.R. and Greenburg L. 1942. The Dust Hazard in Tremolite Mining Including Roetgenological Findings in Talc Workers J. Roentgenol and Rad Ther 11-29 45. Siegal W. Smith A.R. and Greenburg L. 1943. Talc Miners and Millers Ind Bull 3 12 Study of 92 46. Kleinfeld M. Messite J. and Tabershaw I. 1955. Talc Pneumoconiosis A.M.A. Arch Ind Health 66-72 47. Meurman L.O. Kiviluoto R. and Kakama M. 1974 Mortality and Morbidity Among the Working Population of Anthophyllite Asbestos Mines in Finland Br J. Ind Med 105-112 48. Miller A. Teirstein A.S. Bader M.E. Bader R.A. and Selikoff I.J. 1971. Talc Pneumoconiosis Significance of Sublight Microscopic Mineral Particles Am J. Med 395-402 49. Suzuki Y. and Churg J. 1969. Structure and Development of the Asbestos Body Am J. Pathol 55:79 50. Holt Mills J. and Young D.K. 1965. Experimental Asbestosis with Four Types of Fibers Importance of Small Fibers Ann N.Y. Acad Sci 132 51. Morgan W.K.C. and Seaton A. 1975. Occupational Lung Disease W.V. Saunders Co. Philadelphia 52. Seeler A.O. Gryboski J.S. and MacMahon H.E. 1959 Talc Pneumoconiosis A.M.A. Arch Ind Health 392-402 53. 53. Hunt A.C. 1956. Massive Pulmonary Inhalation of Talc Thorax 287 Fibrosis From the 54. Kleinfeld M. and Geil C.P. 1956 Calcification of the Pericardium Caused by a Hitherto Unrecognized Etiological Factor Am Heart J. 899 904 55 Jones J.S.P. and Sheers G. 1973. Pleural Plaques in Biological Effects of Asbestos Page 243. Proc of a Working Conference held at Lyon France October 2-6 1972. Int Agency for Research in Cancer Lyon 56 Sheers G. and Templeton A.R. 1968. Effects of Asbestos in Dockyard Workers Br Med J. 574 57 Solomon A. 1970. Radiology of Asbestosis Env Res 320 58 Solomon A. and Webster I. 1976. The Visceral Pleura in Asbestosis Env Res 128 93 59. Soutar C.A. Simon G. and Warwick M. 1974 The Radiology of Asbestos Induced Diseases of the Lungs Br J. Dis Chest 235 60. Hourihane D.O.B. Lessof L. and Richardson P.C. 1966 Hyaline and Calcified Pleura Plaques as an Index of Exposure to Asbestos Br Med J. 1069 61. Harries P.G. MacKenzie F.A.F. Sheers G. Kemp J.H. Oliver T.P. and Wright D.S. 1972. radiological Survey of Men Exposed to Asbestos in Naval Dockyards Br J. Ind Med 274 62. Kiviluoto R. Asbestosis Aspects of its Radiological Features In Shapiro H.A. Ed Pneumoconiosis Proceedings of the International Conference Johannesburg 1969 Cape Town Oxford University Press p 253 63. BTTA and MRCPV 1972. A Survey of Pleural Thickening Its Relation to Asbestos Exposure and Previous Pleural Disease Env Res 142 64 Kiviluoto R. and Meurman L. 1969. Results of Asbestos Exposure in Finland In International Conference on Pneumoconiosis Johannesburg pp 107-108 tTheora.s rematr 65. Nurminen M. 1962. A Study of the Mortality of Workers in TE ie an Anthophyllite Asbestos Factory in Finland Work Env Health 112-118 ede atin APSHA 66 Rossiter C.E. and Weil H. 1974. Synergism Between Dust le twat Exposure and Smoking An Artifact in the Statistical Analysis of Lung Functions Bull Physiopathol Resp Ro 717 67 Waxweiler R.J. Wagoner J.K. and Archer V.E. 1973 Mortality of Potash Workers J. Occup Med 486 68. Selikoff I.J. 1965. The Occurrence of Pleural Calcification Among Asbestos Insulation Workers Acad Sci 351 Am N.Y. 69 Beck lake M.R. et al 1970. Lung Function in Relation to Chest Radiographic Changes in Quebec Asbestos Workers Bull Physiopathol Resp 637 94 70. Weill H. et al 1973. Radiographic and Physiologic 1 Patterns Among Workers Engaged in Manufacture of Asebestos Cement Products J. Occup Med 248 : : i 71. Lundin F.E. et al 1971. Radon Duaghter Exposure and F Respiratory Cancer Quantitative and Temporal Aspects Report from the Epidemiologic Study of U.S. Uranium Miners ie t U.S. DHEW PHS Monograph No. 1 is a ig 72. Seidman H. Lillis R. and Selikoff I.J. 1976 Short Asbestos Exposure and Delayed Cancer Risk Presented at the Third International Sympoisum on Detection and Prevention of Cancer New York May April 1 73 Baris Y.I. 1975. Pleural Mesothelioma and Asbestos Pleurisies Due to Environmental Asbestos Exposure in Turkey An Analysis of 120 cases Hcettepe O. Bull of Med./Surg 8 No. 165 185 74 Scepers G.W.H. and Inhaled Mining Health 182 Durkan Dust on T.M. 1955. The the Human Lung Effects of Arch Ind 75 Ahlman K. Partanen T.J. Rintala E. and Wiikeri J. 1972. Anthophyllite Mining and Milling as Cause 569 Asbestosis In Biological Effects of Asbestos * } Proceedings of a Working Conference held at Lyon France October 2-6 p 165 76 Rossiter C.E. et al 1972. Radiographic Changes in Chrysotile Asbestos Mine and Mill Workers of Quebec Arch Env Health 388 77. Weill H. Ziskind M.M. Wagenspack D. and Rossiter C.E. 1975. Lung Function Consequences of Dust Exposure in Asbestos Cement Manufacturing Plants Arch Env Health 30:88 95 Appendix Summary Tables Statistics for NIOSH A through 10 1975 Industrial Hygiene Study Table A Summary Operations as of Fiber Exposures in Determined by Optical Mine Microscopy Operation Operation or Job Fiber 5 ...m in Length per cc Range of Mean + SE Median of Time- Individual | of Samples | | Individual Samples Individual Samples Weighted Average Crusher Operator Trammer Driller 25 5 Cageman 5 Blacksmith 3 Mechanic 12 4 | 7.7 - 14.7 2.3 - 14.6 09-68 09-68 09-68 6.0-18.2 6.0-18.2 6.0-18.2 1.2 - 4.4 0.2-3.9 0.2-3.9 0.2-3.9 10.3 + 1.5 6.4 +0.7 +0.7 3.9 + 1.0 10.3 + 2.1 3.1 + . 1.9 + 0.3 9.3 .1 4.6 3.7 1.9 9.8 5.6 3.0 9.5 2.6 1.7 ( ) Number of samples SE - Standard error ' t 97 i bees TABLE A Summary of Fiber Exposures in Mill Operations as Determined by Optical Microscopy Operation or Job Mill Foreman 9 General Laborer 5 Crusher Operator 16 Hardinge Operator 14 Wheeler Operator 14 Packer 48 98 Packer Serviceman 11 Packhouse Foreman 5 Fork Lift Operator 15 Rail Car Liner 3 Bulk Car Loader 3 Millwright 3 Instrument Repairman 6 Machinist 3 Millwright Helper 2 Sheet Metal Worker 3 Oiler 4 Welder 3 ( ) Number of samples SE Standard error Range of Individual Samples 2.4 16.0 1.5 13.2 11.6 1.7 26.8 2.6 29.1 0. 21.0 1.6 8.3 1.9 1.0 1.1 1.3 8.3 5.6 1.6 2.4 0.9 2.6 1 4.0 3 3.6 0.7 8.9 1 2.2 . 4.5 0.8 3.1 Fiber 5 ...m in Length per CC Mean + SE of Individual Samples Median of Individual Samples 5.8 + 1.4 5.8 + 2. 5.5 1+ 0.9 8.7 + 1 9.9 1+ 2.1 6.9 + 0.6 4.9 + 0.7 1.5 + 0.2 4.5 + 5 3.8 + 1.0 9 1+ 1.9 1+ 5 2.8 1+ 0.4 1.5 1+ 4.8 1+ 4.1 1.8 + 3.6 1+ 7 1.8 + 0.7 4.7 5.5 4.7 6.4 6.5 6.1 .5 1.6 4.6 4.1 1.8 2.3 3.0 0.5 4.8 1.9 4.1 1.6 Time- Weighted Average 5.3 5.6 5.1 7.9 8.4 5.1 3.6 1.5 4.0 3.4 2.0 1.9 2.8 1.8 4.0 1.7 4.0 1.9 hh cy sa & a n mm ie * fu a= TABLE A Summary of Amphibole Fiber Exposures in Mine Operations as Determined by Analytical Electron Microscopy Fiber Concentrations fibers Amphibole Time- of Mean + SE Median of Range Individual Weighted Operation or Job ; Individual of Individual Average : Samples Samples Samples L 99 99 Trammer 4 Driller 1 Cageman ) Mechanic 1 8.9 - 22.6 1 9.5-9.5 9.5-9.5 9.5-9.5 | 17.5 - 17.5 | 16 - 16.7 16.2 + 3 = 9.5 - 777 17.5 - 007 16.7 - --- 16.7 9.5 17.5 16.7 17.5 9.5 17.5 16.7 identified asbestos fibers of all lengths Concentrations are for positively ( ) Number of samples analyzed SE Standard error wore Aare: Caoene e no TABLE 4 Summary of Amphibole Fiber Exposures in Mill Operations as Determined by Analytical Electron Microscopy Operation or Job Amphibole Fiber Concentrations fiber Range of Individual Samples Mean + SE of Individual Samples Median of Individual Samples Mill Foreman 2 18.4 - 33.7 General Laborer 2 9.0 - 36.6 Crusher Operator 2 Hardinge Operator 2 10 Wheeler Operator 2 Packer 2 9.0 - 15.6 33.6 - 102.7 18.2 - 25.5 31 - 41 Packer Serviceman 2 7.3 - 26.7 Packhouse Foreman 2 13.6 - 16.2 Fork Lift Operator 1 36.0 - 36.0 Machinist 1 24 - 24.9 Welder 1 Jo. 9.9 - 9.9 26.0 + 7.7 22.8 + 13.8 12.3 + 3.3 68 + 34 21.9 + 3.6 36.8 + 4.9 17.0 + 9.7 14.9 + 1.3 36.0 - ---24.9 - <---> 9.9 = s--- 26.0 22.8 12 68.1 21.9 36.8 17.0 14.9 36.0 24.9 9.9 Concentrations are for positively identified asbestos fibers of all lengths ( ) Number of samples analyzed . SE Standard error Time- Weighted Average 25.0 23.6 12 70.6 22.9 36.0 11.1 14.6 36.0 24.9 9.9 j ee _, TABLE A : ee * Summary of Respirable Dust Exposures in Mine Operations : Operation or Job Range of Individual Samples Respirable Dust Concentrations - mg Mean + SE of Individual Samples : Median of Individual Samples Time- Weighted Average Trammer 3 Scrapper Man 3 101 Laborer 1 Driller 3 Cageman 1 Repairman 1 Repairman Helper 1 Mechanic 1 0.13 - 0.95 0.58 - 1.72 0.58 - 0.58 0.54 - 1.42 0.23 - 23 1.14 - 14 0.86 - 0.86 0.42 - 0.42 0.64 + 0.26 1.29 + 0.36 0.58 + --0.99 + 0.26 0.23 1+ --1.14 + 1 0.86 + 1 0.42 + --~ 0.85 1.57 0.58 1.00 0.23 1.14 0.86 0.42 0.64 1.29 0.58 0.98 0.23 14 0.86 0.42 ( ) Number of full shift samples collected SE Standard Error TABLE A Summary of Respirable Dust Exposure in Mill Operations Operation or Job Mill Foreman 2 Respirable Dust Concentrations - m Individual Samples 0.52 - 0.64 of Individual Samples 0.58 -0.06 Individual Samples 0.58 Weighted Average 0.58 General Laborer 1 Crusher Operator 2 Hardinge Operator 2 Wheeler Operator 2 Packer 2 Packer Serviceman 2 14 - 1.14 0.60 - 1.13 0.65 - 1.56 0.45 - 2.73 0.39 - 0.95 0.40 - 0.44 1.14 + corn 0.87 + 0.27 11 0.46 + 1.59 +1.14 +1.14 0.59 + 0.07 0.42 0.02 + 14 0.87 11 1.59 0.50 0.42 1.14 0.85 1.09 1.56 0.59 42 Packhouse Foreman 2 0.22 - 0.28 Fork Lift Operator 3 | 0.23 - 0.44 Car Liner 1 0.31 - 0.31 0.25 + 0.03 0.35 + 0.06 0.31 + 777 0.25 0.37 31 0.25 0.35 0.31 Bulk Car Loader 1 0.25 - 0.25 0.25 + --" 0.25 0.25 Millwright 2 16 - 4.64 Instrument Repairman 0.58 - 0.59 Machinist 1 0.40 - 0.40 2.41 +2.24 0.59 + 0.01 0.40 + --- 2.40 0.59 0.40 2.37 0.59 0.40 Millwright Helper 1 2.95 - 2.95 Sheet Metal Worker 1 | 0.50 - 0.50 Oiler 1 0.72 - 0.72 Welder 1 0.75 GAME 0.75 2.95 t 777 0.50 + --- 0.72 + --- 0.75 + -"7 2.95 0.50 0.72 0.75 2.95 0.50 0.72 0.75 ( ) Number of samples all full shift samples SE Standard Error 102 card ox i | u, TABLE A Summary of Respirable Free Silica Exposures in Mine Operations Operation or Job Respirable Free Si02 Concentrations - mg Range of Individual Samples Mean + SE of Individual Samples Median of Individual Samples Time- Weighted Average Trammer | 3 Scrapper Man 3 Laborer 2 0.012 - 0.025 0.012 - 0.012 0.000 - 0.012 0.020 + 0.004 0.012 + 0.000 0.006 + 0.006 Driller 2 0.000 - 0.024 0.014 + 0.007 Repairman's Helper Mechanic 1 1| 0.000 - 0.000 0.000 - 0.000 0.000 - ----- 0.000 - -~---- | } ( ) Number of full shift samples collected SE Standard error 0.024 0.012 0.006 0.014 0.000 0.000 0.020 0.012 0.006 0.014 0.000 | 0.000 103 TABLE A Summary of Respirable Free Silica Exposures in Mill Operations Respirable Free SiO2 Concentrations - m Samples Samples Mill Foreman 2 0.013 -0.014 -0.014 0.014 - 0.000 General Laborer 1 0.014 - 0.014 0.014 - ----- Crusher Operator 2 Hardinge Operator 1 Wheeler Operator 1 0.012 - 0.028 | 0.020 + 0.008 0.012-0.012 0.012-0.012 0.012-0.012 | 0.012 - ----- 0.012-0.012 0.012-0.012 0.012-0.012 012 ~- ----- Packer 7 0.000 - 0.015 | 0.019 + 0.002 Packer Serviceman 2 0.000 - 0.013 | 0.007 + 0.006 Packhouse Foreman 2 0.013 - 0.016 | 0.015 + 0.001 Fork Lift Operator 1 | 0.000 -0.000 -0.000 0.000 - ----- Car Liner 1 0.000 0.000 0.000 - ----- Bulk Car Loader 0.016-0.016 0.016-0.016 0.016-0.016 | 0.016 - ----- Samples 0.014 0.014 0.020 0.012 012 0.013 0.007 0.015 0.000 0.000 0.016 ( ) Number of full shift samples collected SE Standard error Average 0.013 0.014 0.020 0.012 012 0.010 0.007 0.014 0.000 0.000 0.016 104 TABLE A Airborne Dust Concentrations Concentrations in Mine Operations as Determined Summary of by Midget Impinger Optical Microscopy Techniques Impinger Dust Concentrations mppcf Operation or Job Range of Individual Samples Mean -SE of Individual Samples Trammer 3 Scapper Man 5 Driller 1 Mucker 1 Cageman 1 Repairman Helper 1 Mechanic 6.0 - 12.7 3.8 - 24.5 11.7 - 11.7 15.8 - 15.8 2.0 - 2.0 3.6 - 3.6 1.5 - 1.5 10.4 + 2 14.04.2 14.04.2 14.04.2 11.7 - ---7 15. - ---7 2.0 - ---7 3.6 - oe-- 1.5 - 2077 Median of Individual Samples 12.4 18.4 11.7 15.8 2.0 3.6 1.5 Time- Weighted Average 10.1 11.8 11.7 15.8 2.0 3.6 1.5 ( ) Number of individual samples SE Standard error mppcf cubic foot of air Millions of particles per 105 DEPARTMENT OF HEALTH EDUCATION AND WELFARE PUBLIC HEALTH SERVICE CENTER FOR DISEASE CONTROL NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH ROBERT A. TAFT LABORATORIES 4676 COLUMBIA PARKWAY CINCINNATI OHIO 45226 OFFICIAL BUSINESS PENALTY FOR PRIVATE USE 300 THIRD CLASS POSTAGE AND FEES PAIE S. DEPARTMENT OF HE HEW 396 DHEW NIOSH Publication No. 80-115