Document vB2KB8vnd0b66KzdMgvgYQ9Zm

X-must apologize to you--ri-ght at the outset of thio-^frlk. Be-in-g - a -foraXgaer I have been involved -in -soffl^fehing called-FBEX - the Federal of Licensing Examinations Board -or- oemothing anti. I Jus t finished tho exams last'-veek. This ic the second time-I have taken it-trill eh indicates -tee- you how -mueh-d-know -about basic -soionGoo and bi rw^Htua-i-rl-ry flnri all t.he-t.hingq that >wv<a H-ppnanod nn -this Rf^enfi since I graduated. The time I have had to prepare this talk has not been very great and I apologize to yon because what I am going to 4" Seat " a paper that was published this year in the British Journal of Industrial Medicine of which I was a co-author. I was only a co-author by virtue of the fact that I was ablo ta bo in a factory in the United Kingdom which has preserved its personnel records /, fturn of the mmi the/last century owwa^ds and which has good medical records going late "Ineic back to the/l^O1 s-early 1950' saad wfciah had previously been studied by my predecessor, John Knox in association with Richard Doll who noi^ ficuS or.l is the. Professor of Medicine at Oxford University whom I am sure you* know of as a leading epidemiologist tn ttw-'fiold. It was^Richard Doll who^in 1955^based upon studies of the population I am about to describe to proved that there was Indeed an association between lung cancer and exposure to asbestos. b TiiiPi11 n mi 11 in 1 I think it ie. aiiwys worthwhile to gm thcngh deject it? tho old pat belling fflUL'lnw^wwig--af lilli.ug--y ue=g3C8gfr^y what asbestos Ov^ ^Ne. ^,<r' raWiai is w&M -not oxaotly but Just giving- you some idea of what we are talking about. Bnliteo tho-Chairman of Turner A Hawaii )--the company whiffh T ninnlrad . far iiihlah was tr-large company ifith JOyOQO oap3^6>yeg in'the United Kingdom -and many awboidiagioa .throughout thc-w<H>I-d inalnfline 'minis "iTf CdllgUa , _ , a. i i Vou< bacW^^d oUha w. U fce* he (*" ^at and Southom Rhoctesia and factories in ttaliy countries yy $he <Soh c>lr A00903 UCC 010193 o4 a/' h^> 1 cu*>^r'r cs^p... 2 Chairman Z'who went out to Rhodesia to see for himself where the asbestos came from and after breakfast said let's go and look at /" the plantation. If wo eonld j^uet have the- first olido and the1 lights aff then fr-eeuid i-linai-radc to you just brlof-ly 'dliat Asbestos is a &LG>e i fibrous mineral silicate and bfceit there are a number of vari^ies that are of commercial importance. I am not going to go into i8r the argument^ detailc about the differences in biological effects which exist between the various forms of asbestos. Chrysotile asbestos which comes from Canada, Southern Rhodesia, the Soviet Union, Stoa2.>l*'A $ be jg Cyprus, Couth Africa-, United States,/the type of fiber which composes about 95$ of the world's usage of this material. It is a hydrated 4i>w.x/ tS rry.ru. v , magnesium silicate. Crocidolite^ which is a blue -pallet fiber^ aomooi>\ fifwi South Africa at the present time fpoa the Northwest Cape Province and the Northeast jmd Transvaal. It Reused to be mined in Australia but that no longer takes place and there was a H\ mci'dewt disastrous experience there with regard to aaeeunts of mesothelioma W1 CL , among the miners. Amosite is not an acceptable mineralogical terms 'it oa jtoA ,, ^ ,,* because it merely etattdc for Asbestos mines of South Africa X4 VKr^ ani. that is unique in that it only comes from one part of the world i,e. and thr>A^^ry- the Northeast Transvaal. The amosite and crocidolite Cod; from the Northeast Transvaal often#d occur*#*- in the same seam in the goelc and therefore it is contaminated with ainwy# possible frc-a#y that amosite 3-6 roay be caJ wee crocidolite* That ic possible. There are deposits of amosite in India but I dorr y think they have been commercially exploited yet, but thero are1 seme there af tohafr type ef fiber. 3rfce-ao..ic beWij h> cu-AA-'/'j1WVe-(j,fuAe<de ***** the eummlnt-lrfte-fce -ggunafcle series and just to digress for a moment the importance of the CG series (or the fact that amosite is part of that series^became apparent when Reserve fining ^ompan found^ itself antet-t-tieri with EPA, the State of CV A00904 UCC 010194 3 tfr-" Minnesota and various otherspenpie regarding the dumping of^ tailings^ 4<suo<vV x--''--------------------- ''"'"'x ccr-iy from its mines in Silver Bay^into Lake Superior^<wd/Df-i Soliltaff A waltBd into-Minneoata and waltaed out again ad gcally uysul~"the whole -apricot thore--and that bdltle~~ls~~s'tr4-Hr going oh with Reserve "TR-C hbct .<-> fr t "Vo li'V -, Milling. I am sure you are familiar with that story. Shat- nc CG a.-4 H\ \z\c-c wbMfi is similar to commercially used amosite. Apart from the frrct A that a lot gf the fibers- initially disoovorad-wara .JDia4imatie sKeIUTT>nb (S' /4nthophyllite isn't very widely used in industry. It's one of kflou-vthe oldest ^jwed asbestos fiber* particularly^Finland where for thousands of years it's been incorporated in the building of Sja</x baths* ifyeu like to-g anlu "that sort'^f oitupatioa. Howo.v.ag, t-t isn't feenibly important. Biologically it is^very wary., interesting ClW because no cases of mesothelioma have as yet been described with tho Suie 1 association ,a. anthophyllite exposure, and--we tan forget about the t.- o yA'Ai'tW is remolite which is^often found in commercial talc or industrial talc. Juat -to give--yeu nomo idoa-of neally thr f9ct___that.u3hrysnt11a aiaoi4olite/Ao bhwi amosifrc is sort of. an In ai-p hnf>. i r-nti -nnnlfll niiiig, hn--l.InU i ; magnesium and-rarreua anihsphyllito which- i-o aioe-^n ____ _____________ _ Su?T 3 mine up--in Canada)ahauing-'What has happedned to the aeuntwy tdiNo cade. This is a composite slide andthia io what we did with asbestos TTTg ,`S cfV'hftV and grad<T.t in Rochdale in England. hat1 e a rock, it 'iiag agamod at the mine ^ MoyereJ to some extent, .it w4 further opened at the factory in the process if -ftftneJ into nf uhnt ww called fiberizing,ad carding it wao ueod ae a sliver and foe.* Kw ' -* J* spun into a yarn,and that io--tho praoooo and thonHEhe yarn would he- >5 cam woven or sold to customers. Cloth would be used for various purposes OS oiowJ $ec'i*tr I/a<t>.aoKo |a/ -tti iei.A. nuhof cVaw !< , Aamfcfaog thinfr I think you should appreciate if you w3?l -read in the P"P"~ 4 g ,r~,, < + -- + ~ ~~ndwii--tr~ the fact that in the United Kingdom, Regulations were made in 1931 which took affect UCC 010195 A 00 9Gb 4 in ]?33rwh- nwi ^rior to the making of those regulations^ which were called the Asbestos Industry Regulations^ and. which -therefore-only aprly *lhf* " '' HwHmtpy inrl that al^n is i mportant.cfram the n-r u-i ^f* uliat happens Sll^oquaritlv h-gujatra-p .t.hngo t-ognl44.ftin; jpacultod -aftag a study whiah was conducted by M^rywhothor and Price OM-d bcfOV^-C in 1929 and published in 1930 whleh is owe - of the nast famous rfeudy the history of the -tr. thi c f*i ^3^i- n w a in a milestone in/KHjtkain British asbestos industry. What they found was that in people who had been employed for 20 or more years, - 81$ had ptJTMonq<y fibrosis. We are talking about asbestosis^ and-lt1 b impegtant to romomfeer-that-aabootoeic w-t-iw a 20th Century disease. The first case of asbestosis was not described until the beginning of the Century in London by Hoctagug (VtKfaw . and-thepof ore this io-a OOlh Century occupational di'seasg.1- The first evidence that exposure to asbestos was going to cause a problem to the health of uthe workers was the finding of asbestosis and the regulations that were made in 1931 and that took affect in 1933 were designed to reduce the incidence of pulmonary fibrosis. Lung cancer was not associated with asbestos exposure apart from A speculative case histories that first began appearing in 1935- No epidemiological study was done to confirm this suspected xxxkh a association until the work of Richard Doll in 1955* Although the c-l * same Mornywhether in 19^7 had shown that 13$ of asbestosis cases diagnosed in the United Kingdom werpcdying of lung cancer or had died of lung cancer. That leads to' another speculation.ng^n whirh _ [tie frf L. don;4 Intend ta-^waii 1 wpan rind that _ls win*pc asbestosis a Car, prerequisite for the development of lung cancer or lung cancer accu< in an asbestos workers without asbestosisio nvopthl --wi n^ ""1y TM " J> v. gi+ c- especially in view of the known multiplicative effect which cigarette^ x smoking has on lung cancer in asbestos woj^ky^^ p, 0 UCC 010196 5 However-j--I- show--that"Simply lu pulirt oat -what the-eitua.t4.-on was fr> W -tja--iojn u^h T-ogar-rf tA^hfigt-nci g. Sricx Pulmonary fibrosis w* e{-. WoA-S-ti. egappling aad killing ppnple o*td 81$ of those^with more than 20 : years exposure weo cwffarlnp from thia aemiliticm. By comparison '2? in 1975 only 0-77 or 0.8$ of the group ww compared with 26.2$ were AA found to have asbestosis and the 20 year and over.^ke incidence were X-S A down to 5%,-wiTiTk obviously is still joi unacceptable but what hove--to romembcr is that) some of IV e I*,3! i'<\ ytyyoA cases were 'in fact exposed before regulations. They were still werudnc and this xxx s is a Aa table of prevalence not incidence they were there *re<f irvLud-c^ and equated. It does indicate quite dramatically that those regulations A had reduced the incidence of asbestosis. o ta the paper--know wa wl^i iiciu tkw* phis co-hort bkot we are describing fa* the has been the subject of f 3 previous reports and the last of these reports was published in 1968,the-oao prior to this and~~hey from dealt particulary with mortality ctg lung cancer and respiratory disease in workers exposed to the high dust levels which preceded the 1931 asbestos industry regulations. They attempted to examine the 1/ fi>si>esbJ dependence of lung cancer incidence on t)*^ age and duration of exposure. fr\c pape*' A 'Dkiip tn t mu J.n 1968 the cohort was divided into 6 groups,wt^fcj'tftb-Cg ,, ,K A 1^33 bu4T group 1 had more than 10 years of exposure xhjbk groups 1, 2, 3 and 4 kad total A all had more than 20 years .but group 1 had giealei ttmn 10 jr&ar-p A a-vp^gmo wnmo iQ}3 Group 2 had between 5 and 10 years exposure 3 before 1933 when the regulations took affect. Group iff, bad less than 5 years exposure and Group 4 had had no exposure before 1933* Group 5 was all males and had had more than 10 years exposure but less than 20 with no exposure prior to 1933 and group 6 was all females and they tax had all been exposed after 1933 for more than 10 years. ^ 15" cue' toew' a> Vfhnn prnn ill--1" "A cancer of the lung and pleura, you sae- A we** oh?pruod and the oxpocted-1.6^so there about ahlljtimes UCC 010197 A 00 . L. 7 excess incidence of lung cancer in fctewfe group which Jww had the longest exposure prior to the improvements which came with regulations. An you go down you see that that dimlniohoe. When yera got to thic-- bat- group hwe no exposure before 1933^ with mSl'e^han 20. years^the difference is not statistically significan^y* That was very gdhsfyira dosp/vanu.' ^ inte-rcsting but the authors were wise an* fehoy point* out that no fwTthBT firm conclusions could be drawn because little carcinogenic effect kx would be expected for 20 years after first exposure and some of the follow-up had not been for long enough. -If we jucfe--go iJn-rnugh t.wn mrvrfi glidp.q dpaUng yt t.ft thflt~ pnhnrt.^r T.ri fVi 1^ here WM'^xve the men and women all exposed a since 1933 a**d-you o can -ooo that cancer of the lung and pleura wacx there was no statistically significance difference and in the women there wa? this difference. and +v^-t~ r`"'Ly 2 cases ad it was not possible to state what the [)ec&uu &rr&J meaning of that was^ What we are dealing with here is men and women employed 10 years or longer since 1933- This is--the gaumpgreup with-lesj than 20 years or 10 to 19 years and yPii. see "no difference in--thu ub^ai'VidQ lu Lhe expected i'iieidciicg-"Off lung' eetneer. In men employed 20 years,, those who worked before 1933 as~we have \Uf$Ou><B<r' ifondj dfW'K.' f'SikLJ . satd--bftfrcra 11 to 0.8*',T'1,1 to 1) and.all neoplasms 15 to 3 /3 !WV'` ^ ' A ^ 1933 3crto 2.9 s4-s- therefore it appeard from this information AA ^ ' that people who had worked since 1933 were sew no longer at risk ouj WCAUf* if you accepted this that the dust levels ttwrb had been brought ' A - .... .. ______ dovm^had been achieved{>a^~disappearce of the Iuny~cance7l) Fur the r- more this was against a diminishing background of incidence of asbestosis a*d as in 1975 the prevalence of asbestosis tvs 1^2^. was only $.0.8% in the factory population studied^ The report published in 1977 is concernrfwith the a tA an the post-1932 + C population mainly^which^ae I oaid although exposeed dust levvels UCC 010198 A 00908 7 uor"' higher than the present iaaRXii permitted levels, ttwg prp"1 was employed during the time of improving dust controls and plant modernization. The study is based on 1,106 men and women s kcwf qnlyfwomen/ and the cohorts been roughly sub-divided in the same way except that you will see there are only 5 groups instead of b+awg^-H-imi Ilia yrgvlnu'A giuup 3 and <! been eaakimd. I~fc Ahinlc thafrJ-9 what happened. I dsn't want to go into It tnn i-Tirnful i-y. Afc^in we got years in asbestos areas 20 or more, 10 pj^-dnore before 1933 sbad than 20 or more less than 10 we haya^faken^out the less than 5 group frbs that and then we havegone on so that will be from _to 10 ins^&fe^d of just 10 and then we go on to 20 or more with no exposure afte^*3^33 and that's the group we are particularly hxk interested''!n 10 to l^&Qd then females with 10 or more. Well there^ay^be some zxs females whb-.^iave done 20 years. We get Ir^lb6 with a total of 16,000 person yearh- of observations. Re-examination of our personnel records since the a last report in 1968 showed that a further 23 workers were eligible for inclusion ^cu-' in cohorts 1 and 2 and in addition 205 workers who hJHfe completed 10 years employment since June & 1966l were added to cohort^ 3 j 4 and 5* So the study comprised- 822^menyknd 284 women and the followup was until the 31st of December 1974 using the factory panes personnel records and the National Health Service Central register. Only 2% of workers could not be traced and 13 nirt thmli'r.22) WfrPC recordtiin the National Health Service Central registery as having imigrated or were not currently registered with tte GP. As you know everyone in the UK is registered with a p-p, yo" ao-nn- *m- -u* } vmi- mnatl prnplfl nrr . WC. rrel . gop?ai.ny p. ..nt-n * ymi ntin rnn that a very gmall Percentage .1*~1n n '"->"1'-''ji n jin 1 I i rru nrrH-uliW The remaining 1,071 ^96.8^have been UCC 010199 A00903 8 followed-up to the end of 197*+ The number of deaths in each group which have been attributed to lung cance-r^and lung cancer includes deaths due to mesotheliom^araii ikutxa number af deaths -in e-erch group attribute ch'to hinp aam>0Ti other cancers, respiratory disease and other causes are shown in the next slide and although it looks complicated it isn't really. If you simply locjJr'at tteert column which 1c the mx cause of de a th, whi eh is^ hpng cancer and mesothelioma^ other cancers respiratory diseases andy^ther causes,and if you will ' SKolJ , 6-- lust look at the oneswhich statistically xxgxiffxKaxttyx significant, u,, A. ffi'Tr you will see that ih Group lrwhich wo lnow feefere prc^-f ~- \ S T 0*9 ^ \ & had the 3r9--e*^ks= observed to expected ratio/xsut in gxararp: the respiratory diseases again there is a 3*6 observed to expected ratio and all causes the ratio is about 2 to 1 so there is an excess mortality in this population which is largely attributable to lung cancei* but some of which is attributable to other respiratory dise^a^s which might reflect a xk&x residue of asbestosis in fckx this population. The expected numbers gqp thooo of you *hu are intrcreofecd were calculated from National death rates by 5 ye^r- periods and 5 year age groups. To insure that the expected member,#7 are not underestimated, imigrants and those lost to follow up were assumed to be alive on December 1, 197*+. Deaths before the 1st of January 1931 or after the jcbxx age of 85 are ignored and expected members are calculated accordingly. In Rochdale itself lung cancer mortality was lower than the national average amnng tho mn which is interesting, in tlimb*'This is the ixxfc largest asbestos textile factory in the world. WI ft Rochdale a population of about 80,000 people had a lower than average lung'cancer mortality. It doesn't prove anything but jwu. t'f taa Per bl'teai* nlm=Mq--asbestos is an environmental pollutant which is going to cause an excess incidence of lung cancer in the general population ir^this doesn't seem to make sense. The A0Q9 1 C UCC 010200 -Po. standardized mortality ratio ix in Rochdale is 87A and oimilar for women tOWlilmte* s (j-959 to 1963 Registewi general 1971 Workers i .e. first exposed before 1933 o*v / Of l 'f e 1J k cohorts 1 and 2. suffered %' from excess of lung cancer and respiratory disease, Raxxi A / tf ^Particularly those with 10 or more years exposure prior to 33 ` *crv' mmL jthere is also some excess mortality^lung cancer and mesothelioma ^36 observed and 19. ixpected^tke P th`a'0.0^) and respiratory disease^35 observedy25yexpectech P rx^wAff O.OJ^ in those who entered after the 1st of January 1933 tha^i' s{cohorts 3,kh 4 and 5 combine^). lEou eombia those O eehafts. This excess is very much less than in the first two cohorts. What "1't liidl'gaLes is1 llij.li km In those ponplp-wtl.lr-lmigpf iiri rtrm tVuif who were first exposed after 1933^the longer follow up indicates that there is still an excess mortality from lung cancer, mesothelioma and respiratory diseases, In the 1968 study there was a slight excess of circulatory disease in cohorts 3 and that hasn't increased {27 observed 20.6 were expected^ In cohorts 4 and 5 there was a matching deficit{50 observed,60.10 expectea. The i^i dance that this was probably a chance observation seemed confirmed. There were 16 deaths attributable to gastro intestinal cancer comapred with 15*7 expected. This cohort^ever since it has been formed and iM hae teajn followed,has not yielded an excess incidence of g deaths from gastrointestinal carcinoma. It is also interesting that in a paper published in the same issue of the British Journal of Industrial Medicine^Elmes in Belfast^following up his insulation workers finds the incidence of gastro-intestinal carcinoma is declining as the papal time goes by and thinks that this might be due to improvements in earlier years. that hg-is fallowing the perpulaUieft fwfchar hiutii: uhuad 1 irritaaiu. However this excess incidence of gastro-intestinal carcinomaj in /asbestos workers appears to be something that is related to th^ UCC 010201 hQjavily i9 10 exposed gtt groups*ami Although this group of textile workers A in the earlier years was probably as heavily exposed as any, it has an.' progressively been getting less and less exposure and this excess of gastro-intestinal carcinoma has is never been found in Do^h'dalc Jthink itn ymvmfri will omby find that gastro-intestinal carcinoma ooV is associated with i4 in'oomo way Mfcfrh very severe exposures. ^ Wo d-eves That is just my personal opinion. No excess^for any of thaso-that ia statistical gastro-intestinal carcinoma approached/significanfce in any cohorts and no peritonencde mesothelioma was reported. To distinguish exposure immediately after 1933 from that under present conditions cohorts 3, 4 and 5 were divided into those first entering or first being exposed from 1933 to 1950 and those starting later. The reason we took 1950 was because in we fregardgd as the start of the modern period in that factory,feccBufrc Jt was the year in which tfc* routine dust sampling was initiated. Although Morrywhethcr had, way back in the 1930's Iwd tried to give some indication as to what he considered to be an unacceptable dusty the instrumentation and the techniques were not available to assess dustiness it-numerically md ti? accurately. It was only in 1951 when the thermo! ptec<e,rc,\i>i percipito-ter came into use in that ren'hca/pnrtw+jy was followed by the long-runhing thermoi precipitator and then, in 1961^ by the membrane filter method^ that it was possible to attempt to measure wtat the exposure **p<h~of these people and to control the UVf'A measurable environment aooor^teng W/dust levels rather than aooejdlagife VlSt'Wt best achievable results,violb^y. Observed and expected deaths for A ___ those first exposed between 1933 and 1950 are shown in Table Ifil 4rtrt mOv' x-up gef. there T no we got thera-.,Mnw-wwd unman finst ^pncorl inu I I "^rniqTk.Tin nnr-a Al ^ fll'U*) LJLT't l?5l nr Intrr-limg nnnnntr 33 t~ 50 wf fihirmrrM ~~iiji I 1" 1 with u l r<5 1 I'ULIU. Here we find that the 1968 authors w4rd^ ^ ^ UCC 010202 11 wise to add a word of caution about the length of follow up. It had only been 20 years and 20 years may not be long enough because here * and we feacL emerging mw something they didn't find/that is a slight excess A itso by ik> meai>c the -oignifi-eant- Gjecgyw of 11 to I-that T.ro havp Ua/3 prmrl nn n 1 y .*..bn t -hViarn Ip rti-Tl a nmmmmm of lung cancer in those persons exposed between 1933 and 1950. What feal'evfo.ei t(+W about 1951? Woll we huuu lT'^gain. We a have a ratio of 1.9jb^ ta*-' CO^'eA That io -only 6 cases observed to 3-2 S expected. The numbers CUE aigh-t at this stage be. small and th^efore this has to be followed ^ up have to increase the numbers and iha isagih blA wo hswe to bvA-V |fv 4 7 lengthen the follow-up u wmi people who first entered since 1951 wp tn 1<?P*i vhielfr gives yu^24 years^still show this slight excess. Again the statistical significance is not as great as for the thcr half of the cohorts not hk eiraHsly the half other 0/3 gpp-rmHmn.fcniy nf.tinn ninwi<-c t but here we have evidence that the lung cancer has not been totally eliminated in this population. There have been very few deaths among those first exposed in 1951 jt or subsequently and if we look at table 4, one of the things that is going to crop a; up about those 6 cases after 1951 is whether they smoked or not. H'ii aa iaaj.tant f othoro but Wi4 don't have o*V' the information available in tfeer medical records but we do a for culjlj a certain period of time whea smoking histories were added. In fact, the lack of inforxfatifyn on cigarette smoking in the earlier studies was a serious onussi/n, but there were no it '----- ' records kept in the medical records <a K-eigaPotto. oaekiwg until I wairt ii> 1966 . T rr.-n ---Vtrg smoking habits. Peuiu that Ttrie could see that JjJ 1976 if you beeke the population into age groups smokers, ex-smokers and non- smokers i~ want g<- into hew thoee aio dafanofl joat ouffiee to 9 |3 ttefe-thab^y-fchc sray tihoy wars at tha firaa. ~4here were 22$ who were ma non-smokers, 13$ who had given up smoking and t&Kjc x there were UCC 010203 12 65% who still smoked htfse were comparable to the national fVxne <v figures,in a-woy. This population was no different ikx it in its A smoking habits from the general population. What du yair do about j5 / s-moking-?--1- dan11 know. Table f shows deaths - lung cancer' including me scothelioma\ in the men and (^in^men first exposed 1933 to 1950 and men and women first exposed 1951 or later. They are <ioS* of distributed according to tho ay by-day first and time since first A exposure. If you look at- that 10 to lk years -&4.nre first exposure Vy to 19) 0 years op aoae_^n the the 20 years or more TA the o'- : ' ration is 2 to 1. In .thoeo-two grorrps -it--probably is not 9ign-ifircant. |'n Men and women first exposed 1951 or-lator 20 yoaro or more if-you take mTrtfyysraxtxkjK that g-rrmn 1g to 19 b^canea gnir-ftf tham vac jnt 1Q yftars which is clogf finfl11^ i'n or> **~``n n i * 1 i'L'\uun- >\r 3 nnd ?- o* n / \ke pT* 5 observed^l.oexpected 2.7 ao you? ratio of observed to expected"^ The 6 employees who were first exposed after 1950 who died of lung cancer were all men and they were all smokers. 5 worked in areas where dust levels were high in 1951 and one of them may have been exposed to asbestos dust from 1925 to 1930 in a previous occupation. He was a welder in a shipyard. No case of----x mesothelioma has occurred in the population first exposed aftej* 195j^2 Ck but that may not be long enough for follow up^ Although in view of + iwf-e the long latenl period, sek; would yet be expected. Aft apprcusiTBatoly (V multiplicative effect of asbestos exposure and cigarette smoking s incidence on lung cancer/has been suggested. As you know, Selikoff has suggested that an asbestos worker who smokes has a 92 times greater chance of dying from lung cancer than a non-smokEUg non-asbestos worker# pivh. wnfi an asbestos worker has s & fw * an 8 times greater chance of dying from lung cancer than -- --1----- U- empire. But without detailed smoking histories which have been collected for the future, we can't quantify what the K ;10 9 '' ** effect of smoking were in this particular study. Asbestosis wffs~/ UCC 010204 13 oX m found by the Pneumoconiosis MedicS^ Board ah exQminatlaHg of it three of the six cases. They all came to post-morteyfen. All asbestos -fo ftv- ' workers in Rochdale x who di^ have their x deaths reported^either by their doctors, tci the ooronoor er the hospital ropoht tm the ctrtwf or by the xxxtxx regi.fiter of^marriges and deaths. This has been done since 1930- The post mortejifni rate when I once looked rva< 'y into it was ac?e*Ly 70% oif eun whlchNj.s pretty high#-ad \ I used to go to^every post mortejftm that tool/plac^. TKSjEXacxa There is a lot of interesting work which wilI"~come out of the e post mortham work which was done in Rochdale. The numbers are too small for the magnitude of excess of lung cancer in those first employed after 1950 to be estimated with any precision. The implementation of the asbestos industry regulations started a drive to improve dust levels and as I explained to you the pxmfeiKmjE process were fiberizing the fiber came from the mines,, ^ i rivoljeJ wax was opened^ mixed and there wore certain operations such as mixing3^. opening,bags-osXlXittL>itnilglg^mUelCc^lhicaLlnlXivc^ad Xl buaaggggXiUngg, Than they wot i 1-- ^ -folfoi^c^ * an iBit-phe carding pa process smt if you are familiar with the textile industry the carding is simply a matter of teasing out the fibeiy^layering them all in one direction and yau 'tta tliig by passing them through two rollers moving in opposite directions with aha#d needle( projecting from jieoi. tease_JJiem out, and yeu (\ is -foWei Kikrch s.uVii'f'if e/ ojd jp*rv (o< fujlr+J.; --p- ge |4 fine web and than you, take tlrnl inch dM yuu .spin it &4- there A _y^)nnr 'joyrr\ is tujtfc dot? are different grades of yarn^fiwhawhtAefrve er and than yowhonnlng (?) -u winding iy Hie ______ __ _______ _______________ and if you-evor--get ojinfu^Pri with WBaYlng--l*im n 1 nrlri4 IIt-tiIi P` Tn,1-,*ti~" ir1inT,r arc the whaft gnec from wheft white and tha. whai'y 'gmea wimp wd doTirn and you *-.oan't forget -4t that way and that1". TTPV"yuu. weave. RaiW o'- ' . Phahtirig is obviously used for packings. Yo-a do things with platti&g COm is ultJ * Xttre Imp 1 c'giiiiatirrgJaciXh gxaak grease or graphite and this ^t>4 xfctiKj \10' J Hi MA 3,\b ""n*rs ^Tirp|ri t nvr, 5]v6*T UCC 010205 14- I think the?* -levels--and in those are particles per cc and af-tcr 61 yotr >-t the membrane -filter technique) and--yeu-are --getting -down to '"fa Swtt operation, I'll show you in a moment, is totally closed. fli'yI **;/-, J' us~?., # 1 <3V fcpf course that is the way to deal with lie-anything you close it you got o. ^ .A no dust. Dut fehooo ggadully "^rcttb down 6 fibor An-^961 to 3 in* A Sass. This factory population was used and studied by the British Occupational Hygiene k Society in 1966 an and on the morbidity study which was done at that time not a w" TMTM-"+m-y jity ., the /,presen"t79standard for asbestos xiuof fiber was developed, and To he?pea? of the people who <+ A aN. developed it became widely accepted throughout the world and/is how the U.b s \ (~zA current standard nor threshold limit valuefjifi asbestos of t 2 fiber/cc. A yy Originally it was a cumulative standard of 190 fiber/ psx years/cc,s*>_if a man worked for 50 year in 2 fiber/cc he stood a 1% risk of i getting asbestosis. The standard was not designed for lung cancer. Although there I^ (\$ Vf<oV the- i*octe*t ii /e/u-nv- some indication ttTTt I have shown you, if yeu reduce asbestosis aloe -poduoo the incidence of lung cancer law yaw may have to reduce the A /V exposure levels further still below 2 fiber/cc if we are going to eliminate the lung cancer. However no population in the world has been followed for long enough which has been purely kxjusxxk exposed to 2 fiber/cc or less. e? ou4[A No population has been followed tt> sa^ that 2 fiber/cc is or is not a A no effect level for lung cancer, and ati you knaw~There is a lot of controversy about whether there is or isn't either a safe or no effect level for any carcinogen. As you can see, in certain operations dust QmJ levels came down dramatically by 1974- in the whole weaving operation _-ka --there were less than 1. rTM 1 ~ 'In' that weaving there has never been a case of lung cancer associated with T^ exposure that n* know of and asbestosis doesn't occur in that weaving shed. .anHv~/hr|f1 g why~}Ti" old timers^ people who were involved in reporting the data to the British Occupational Hygiene Society in 1966^and some of them \ USiVu/ If " had been at the factory for a long timej Wag their gut feeling f^li^ Q 1) "| 6 that 2 fibers/cc was a reasonabl>level because of the health experience UCC 010206 of that weaving shed. No single/population in the world has^followed-up \/ \yy) "t u.'^ / . for long enough at a 2 fiber/cc or--kx less level to -**5^ based upon human experience \riother this is/an adequate level or not. -feet4) look tabled the mean dusKta&ie arid the number of men exposed CVW Tk 1Uti^i - ^ dUW .-bt to them. Fromtq36 to obvioualy-I--told you we dlein^fc have dust counts . Jn I'pr ttiry lilrln't imrniir twtim ntirt hi-ri n gJrTrr t counts^until 51-that is- _______________________ Mix but "it is Based on calculations made by th committee of the British Occupational Hygiene Society(&ir& the etatws ^station involved was Geoffrey Berry of the Medical Research Council'^ Pneumonociosis tit in Penarth\s4 they arrived at a m&nac of oal-eulafcing lWJ c^--- levels what would be a reasonable estimate of exposure in those years when dust counts were not available. So youcan -soo ao the ypa-r.e by + dlV? + ,| - ' J" | * ' -- !--'* ............ "1 mgO 1952 * ftwnt*( um * jU the beginning of a modernization of the factory whl-eh wac completed in aboutl1^^, * Sk.'vki'o <v\aiiy H lot' work was done^a-lo4- of Jobs were changed^o- lcrt- of mjuuf & (( Va,0<1o/H JA proces^were and that resulted in a better environment. 1969 /s A A new Regulations were made. Those x new regulations were -eal-lad ihx no longer x the Asbestos Industry ^gulations but the Asbestos Regulations /. and they applied not only to the asbestos industry, but to anybody using asbestos where xxfc asbestos dust was ^ivi-ag off in -excess concentrations i*fv> as q*6 liable to be harmful to the health of the exposed person. As opposed to the American method of doing it, the British iaue have not put a figure _ * in the asbestos c,+'nv''3 (T In Uni regulation* there is no legally enforceable --TS--A figure. The way it has been done is-fey-publishing as an addendum to the standard ynw liln? guidelines for the benefit of those people ntfcg -to whom I (k-r )tXMjuAau>' "|Su the-otan4ard applies wh4oh indicate what the current thinking of the factory inspectorate is a tko pro-eont-tie with regard to the levels \r> !pe ^ vji _ they are, gnl ng to enfo>ee . That means -^hat J,f they want to ahaitoc thuee> level^t W amiiiyx tomagfaw^and they have already changed them once since \ 196<A all they have to do is p11-11 pi ppo" + 003 ! 7 ^ i 1 nulriiti nn .Mid publiTli dhubher. It i*arinr doesn't require an act of Parliament or any UCC 010207 * 16 . VtX-Tir (<jc; ^ :"t &41 i? (U-' k tvc sort--f aonoultated mechanisms to do this, although six obviously tfae-y would consult before^f It'realy makes. it very much simplner to operate the k b> P^V <h. 'ft g/ tv ' regulations when you h-aimnit- gnt. a numbr1- whi nb y--^ rvr^lTd f-r IVvS if y^'11 6^- 1 ^einw nr .] phr.ua-^hi oh is the difference ilix between the OSHA standard fiui and the British standard. Howovo^,--that--Kh juot shows jmi thr Inin -"`tvi* t-,1- r1nn~ You will see that tho numbei erf men A. gC~F on ^ c W T1+ r. nnA.nn.j-hU n- n f>.hni^<ro 1 y ioi-ng bepaM3"*ti !* *c apo-ging tn begin to tat. people--ont- of thC'-eohort O. nnw anrt there are obviously fewerA in 1972 who have been exposed forA long period of time than there were in I960 because we are losing them. As-you >^r, that Jr 1972 , 32$ e&e exposed at less than 2 fiber/cc. In !5?& 1936 100$ were exposed to gxMfcct greater than 5 fiber/cc and only 3$ now remain^ in ii 2 in 1972 who aita exposed nha xzs axjuaxKii to greater than 5 <J&MLf*'C+lJuh fiber/cc. What this is go airly showing "yon" is that with time the number of people JriMBtSig exposed to high concentrations is declining. It is jtwt interesting to present it that way. -a nwnbeg-ef ___________^ always Sfc-h ^ t-ypn nf *i.a--g. World Wan 4o<fe plaoe and during the |j)t-i the regulations were relaxed. Factory inspector's didn't care too much about what the levels were. The government wanted production asbestos QmJ pK&tuiJ, ^ ' was essential it had to be juwie.Overtime worked was women were brought A^ in to work instead of men and long hours blackout restrictions made f+y/CiitA it impossible to operate ventilatio'no and all oorte ef things. Ye^-have VK-'t fchin-period-inrWorld Way whioh I don't know what effect tlwtt is going h(UX> i* fo tfwt t to ^ on the follow up. lilt is difficult to interpret the relevance of ^ fl (?*!*' dY the results which I have reported to you to aodfiim conditions. What Wulf we are looking at is a hoto ohpeth of bad conditions in the past and a continued exposure of the same population to changing conditions. What we need is a long term follow up of people exposed eventually at thi-e fjlavol- -hors less than 2 fiber/cc for 20 or 30 years, Dust levels don't c ome down in a day. -] fl4 and that is It takes a long time to get down to less than 2 fib^M/fc p {*' pW AUUo I o a pl*4 a; nf In the way in which the levels in the factory UCC 010208 17 of have been coining down. Even people exposed after 1950 nre having substantially higher levels of exposure than are at the present time permitted by law. The thing to remember is that what we are interested in is diseases wither *i\ci'dcue o<" ^ excess mortality. Shat .yuui factory may be Irnil-d here..and start pr-oAu&ing - hoT-o +^ yr,t, You diH don't begin to A see any difference in mortality experience , yntt mny gram a plight 0 of feller p fopV diff<itr<iine after 20 years but you may have to ge' 30, 40 or 50 years ^ ereupaf'i"'-`l ear'c&f~ wH;h oooupatisnal ennoors before feht excess mortality becomes apparent. fo A This is why it is important that .ynn keep records of medical findings J ym keep personnel records which are accurate with regard to date of employment and types of employment and if possible the type of toe*** materials va to which people !He exposed,whioh are -hnaapdoug or which ma-u- hft rr-itlpi downri hria^mi^ in till? nln ^ wni flAai ntain a Strict control of your environmental monitoring and dust sampling and that you record these meti curiously varying in mind that some time they will have to be related to the health experience of a group of people. It is only if you are meticulous about all that^ that in the future we will clear up a lot of the arguments and lot of the mess which we are in at the present time^ simply because our pxKftjbex predecesors had no concept of this type of approach a to occupational medicine. Occupational medicine in %hc-"past for many^yeetns was the transfer of .general practice into the factory a captive population and you could treat.ttaw*. Wha*fe "Hi is Xi my opinion i* thatl^ part of it tehnfr a fringe benefit, what mi filore important to me +0 *'<' to is to establish a system of keeping records abstract from these records +o (WttiWi information analyze it statistically and obtain an idea as to how iWi A w-lfc bMW population compares with another population or the general population. ^ c&a alf Iki/ Vltd pAi out yu/tjniusfaj (s ^ J.f you ~~ you have an -Idaa whether sax in any way in inpedeing or iaparing the health of -Mae employed peroon a I promised WOu'<J at- Rock^Jtf that I show you that improvement had taken place -wsd-Jhat doesn't show vp ^ kboW <3 /i'i-. * very well, that's a man and those are his legs and what he he-6 is a pitchfork. UCC 010209 A00313 there is a hole in the gpound and he is standing on a big wooden drum . ~his is asbestos and he is xxh using his pitchfork to blend it on a open llt's blowing floor throwing it up in the air and letting it settle.snad kkiantia* ii about fcW.Vp the have all over the place. That was takes place in ft factory that I xatx just JEXBJOTxyaH talked about until 195^ and in some American factories that I fke* visited in 1970 I saw that **#1 taking place and in some American / factories that I visited in 1976 something very similar fas was still taking place. And therefore that is another Youx have got to be very careful when you read the world literature because working when conditions in different countries vary and wfcai some pis people atxs ritaxxxiiaixg xx describe the horror and the disease associated with asbestos^ "h'"1 ^theyx conditions under which those people worked have to be taken into account. I could show you lots of horror haze slides. I have been around the world and^ seen conditions and I^got slides to demonstrate the differences between the U.S. somewhere like Hem . -- South Africa, __ -___________ , Meabasa, India, Britain.and Jit depends upon the degree of sophistication of Regulation and of dust control as to what is going to happen to those people but authors of papers describing the effects seldom pay attention to that, and they warn will talk about asbestos or asbestos textiles or asbestos cement and never show the pictures of the factory or tell you what the conditions ax were like.swsd tdrrt mb inn,|i ini jn, f<u OSHA or NIOSH to say that the Rochdale population was always exposed to 2 fiber/cc and hence the 2 fiber/cc standard is no good because they are still getting lung cancer is a lot of well there / II N"S are ladies present/AT That's what happened to job-it was totally >' gf\ciot<J . W miKPi fib** enclosed. The drum is now in--thec ^*d jt revolves aed"There is a vbVofpbv ^ A fibev e -` bag opening procedure' the bagfare fed on a conveyor belt and gM# into a' A,eh the drum tips it into another bin down on the floor and thft-fc is a<So S Stag'd be all enclosed and there is. no dust. Irht-Ic thn wny Itnrm in Ifjffi1 When I walked into that factory in 1966 I was taken on a tour and 00 ^C UCC 010210 tA Anbe*? _J_ looked at -fctee uunl*f uuid where do you want to start. A at the beginning where the fiber comes in.i -J t*-1 said t-111 start If take* may oaaora and I took my camera and that's what I found. This of course is very good fiber,tfee-t is the best fiber in the world it comes A. from Rhodesia. Turner & Newall owned the mines in kRhodesia and since r>t UDI they have not had any of that fiber. They have had any of the profits A and they have been cut off from their mines because of Dfitloh sanctions I *an wasn't allowed to visit Rhodesia while I worked for Turner Hfnefirnv' & Newill. However in tat RftiirVftotffic1 factories there is plenty of this stuff. The United States hasn't bothered about sanctions. Anyway this was 1966 bu<Ui> these were yoll4 -up bags. Every now and then you could see holes in them. Shippers used to love this stuff because it was fegai beautiful bala-ecd. They could put a few bags in a corner here and a few bags -and wirt a--gin row in a hole there and they could trim their ships^*d that's the way it $**t used to arrive in loose bags. The dockers had no respect A | wu - for these bags,they had big hooks and the way they lifted that kit--4re to fte** V fr.-: plunge a hook into the bags'swinging over their sholders zka -ehurk 4-t over n __ h> vr;u(* fav.'.: the side to someone else.anQ have fk horrible mess and these things used to arrive at the factory a4 the chaps in the warehouse frhay did not have quite as big hooks so the little holes are there wri Hi?y A + ^ pul1 + V.OPQ nr-T nn il t .1. 4 J-- l> nwl -- * nlr lilrn +* --^E=*^n f you can't imagine the size of this warehousej+, huge warehous full f of i fiber stacked to the ceiling. It 18 months supply because OM they knew *1 was coming and so they brought ai as much as they could and as much as they could stuff into the warehouse. There were bags bursting, there was fiber all over the place, fiaxk that's what you foundJ[t was an impossible situation and it was very very bad. That's fHe o* poly* ffcyie^t whah yuu find today. The bags are now# polyppophylene er poly-thyno they are pressurefc-packed at the mines rru- ^ ~ L are Solid y all hard- they are like bricks, they are palletized and very often they are covered with an __ is 4 A >*- 6' ^ Q 0 r* 2 t additional plastic cover. Andrphat em&s from Cassiar up in Canada . UCC 010211 V- ' 20 > IW Y^.,r ii *hc 2 mines $ there is one in North British Columbia and one in TTnarva. O* CVfk, -j- ------------------ Territoty^f Clinton 3*oop adit's a nice part of the world to go to / /, o in January* //What we have is a story that is unfolding #ad phis is rather "dj*J A A old slide ara it tells you about asbestosis beginning at the beginning of the century. The incidence declinS^ in textile workers from 1930 onwards. I haven't mentioned insulation workers at all but the lung cancer incidence noted to be increasing in the late 50's early 60's i*Sulaf'V' Xj fo c Iav'^c Asbestosis and lung cancer ovorall increasing this in the U.K* J ^ Mesothelial tumors recognized in association with asbestos in the VJf'1 A*b^s(5 uie rr\A< Ice-Jh late 1950's-early I9601 sad"-work-pfrodwvfci an-taken aff lilta during c^rceit the War and a aaoalarnting afterwards so that asbestos became a ,j ly w4daly- used material. It was cheap, ax easy to find and not expensive to mine and it was used in just about everything you could think of. With regard to mesothelioma in case you think we haven't had any in that factory, we have*aa*4 I don't want to get into a long argument about it but that factory did also process crocidolite fiber and in my opinion crocidolite fiber is the most hazardous type of fiber and the one mostly associated with mesothelioma,s4 Mii le I was there I collected S 27 cases of mesothelioma,ad.I hadn't Seen any in anybody exposed after 1950. The average lapsed interval was long. At the present time Prof. Doll is *' A stttcJv Wc. T^iiv Just before I left we completedgoing through our personnel record cards 15 ,, (fcorfi of back to #18 and collected something like naftaly 30,000 people who had A ever been employed. The group in Oxford are now going to check through those. They will probably take a random sample to start with and them to see what they can find with regard to mesothelioma .whether kia ve */ y underestimated our experience.or whothav jugt to try and saa. whnt thoy aon-find, jwlThat is the next study which is going to emerge from this particular group ii4--fijeferd. I have taken up a lot of your time. I think it's over the hour and I must apologize. That is all I have to say. UCC 010212 A00 92^