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FILE NAME Brakes BRK DATE 2004 DOC BRK150 DOCUMENT DESCRIPTION Letter to the Editor American Journal of Industrial Medicine RE Asbestos in Brakes Exposure and Risk of Disease Included in 143 AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 312-314 2004 Letter to the Editor RE Asbestos in Brakes Exposure and Risk of Disease To the Editor In a recently published review article Dr. Lemen attempted to summarize the data on asbestos exposure from brake work and the risk of mesothelioma Lemen 2004 He concluded that the epidemiological evidence is equivocal My colleagues and I conducted a study in the early 1980s that Dr. Lemen cited as one of the studies that supported this opinion Teta et al 1983 We identified one case and five controls employed in the category automotive repair and related services 0.=60.5 65 95 CI 0.08-5.53 Ours is one of a large number of epidemiological studies that have examined mesothelioma risk among vehicle mechanics or those involved in brake repair McDonald and McDonald 1980 Petersen and Milham 1980 Spirtas et al 1985 Olsen and Jensen 1987 Woitowitz and R^delsperger 1994 Coggon et al 1995 Hodgson et al 1997 Teschke et al 1997 Agudo et al 2000 Milham and Ossiander 2001 NIOSH 2002 While individual studies such as ours may be imprecise as a result of small numbers of individuals with a history of vehicle repair the best estimates of risk from the available analytical studies are consistently below the null value for this occupation This does not justify a conclusion that the evidence is equivocal We acknowledged in our study the fact that our work histories were based on city directories and death certificates and may not be complete but we went to great lengths to show comparability of completeness between cases and controls We did not conclude that lack of detailed information regarding the residual cases could obscure the true number of occupationally exposed cases as stated by Dr Teta has served as an expert witness in friction brake litigation Her employer Expo- nent Inc, receives funding for her work in this area from Ford General Motors and Daimler Chrysler Correspondence to M Jane Teta Exponent Health Group 420 Lexington Avenue Suite 408 New York NY 10172 mail exponent com Accepted 26 May 2004 DOI 10 1002 20060 Published online in Wiley InterScience www.interscience www.interscience wiley com Dr. Lemen We did discuss however that we may have missed occupationally exposed cases and controls and the issue of random misclassification Bias toward the null OR = 1.0 ifit existed would imply an unlikely true OR of less than 0.65 that we reported for the auto repair category This is in contrast to categories with ORs greater than 1.0 such as plumbers and pipefitters in which the true OR may be greater than the 3.87 we reported if bias toward the null had been operating for this group It is reassuring that the large number of studies that came after our 1983 report were consistent with ours in reporting no increased risk for vehicle mechanics using an interview approach to ascertain work history Rather than relying on a evidence evaluation of the epidemiological data Dr. Lemen emphasized recognized challenges in conducting occupational case- control studies such as small numbers of cases and incomplete work histories in selected individual studies As epidemiologists we recognize the inherent limitations of human observational data and therefore require that conclusions be drawn from a body of evidence not from a single study Other relevant studies in addition to ours have been mischaracterized in Dr. Lemen's review He discussed the study by Woitowitz and Rodelsperger 1994 that also " showed no increased risk for motor vehicle mechanics e He attributed to them the conclusion that if there was a mesothelioma risk it could not be detected by their methodology e But what the authors really said was From these results there is no evidence that car mechanics are exposed to an increased risk of mesothelioma even if they do brake repairs but asbestos exposure in other employment is an important confounding factor so that if there is a mesothelioma risk or car mechanics but it were small it would not be detectable Woitowitz and R^delsperger 1994 This is a fair statement by the authors that their study alone could not rule out a small risk '2004 Wiley Inc. 4 Letter to the Editor 313 Another negative control study that took potential confounding exposures into account also reported no increased risk for vehicle mechanics and specifically those who were involved in brake installation and repair Teschke et al 1997 exposures are known to exist The presence of these cases is particularly relevant for those in common occupations Nicholson et al estimated that in 1984 there were five million people in the US who had been vehicle mechanics at some time in their careers Nicholson et al 1984 Whether case reports of mesothelioma in men who at some time e The authors clearly stated One a priori risk worked as vehicle mechanics are indicative of an occupa- occupation had a reduced risk estimate vehicle tional risk related to this occupation is best determined from mechanics and as in the previous analysis brake epidemiological studies that include comparison popula- installation and repair did not appear to be associated tions and ideally the ability to address confounding by with mesothelioma other asbestos occupations These studies have been e Dr. Lemen summarized this study with the state- conducted and the results are not consistent with the ment The authors ... acknowledge their findings are implications of this review article Reliance on case reports based on small numbers of cases and any judgments of mesothelioma among men who worked at some time as ve about any causal associations would be speculative a vehicle mechanic while ignoring or misrepresenting the he Teschke et al 1997 did make such a statement but available evidence from epidemiological studies cannot be ull in reference to some of their positive findings defended OR The statement was not referring to occupations not associated with mesothelioma in their study e.g. vehicle mechanics ay all Two other negative control studies were not he discussed both of which examined the risk of mesothelioma e ort in vehicle mechanics excluding men who also worked in or occupations known to pose a mesothelioma risk due to in e asbestos exposure McDonald and McDonald 1980 Agudo e et al 2000 The numerous studies based on surveillance REFERENCES M. Jane Teta DrPH MPH Exponent Health Group 420 Lexington Avenue Suite 408 New York New York 10172 databases all of which reported PMR less than 1.0 were also not included in his review Petersen and Milham 1980 Olsen and Jensen 1987 Coggon et al 1995 Hodgson et al 1997 Milham and Ossiander 2001 Agudo A Gonz^lez CA Bleda MJ Ramirez J Hern^ndez S. L^pezF Calleja A Panad^sR Turuguet D Escolar A Baltr^n M. Gonz^lezJE 2000 Occupation and risk of malignant pleural mesothelioma A control study in Spain Am J Ind Med 159- 168 NIOSH 2002 Dr. Lemen placed greater weight on case reports of Coggon D Inskip H Winter P Pannett B. 995 Differences in occupational mortality from pleural cancer peritoneal cancer and 7387 mesothelioma in vehicle mechanics including case counts asbestosis Occup Environ Med 52.775-777 Ta at least 165 from negative control studies of vehicle Hessel PA Teta MJ Goodman M 2004 Mesothelioma among brake mechanics and from friction products manufacturing and mechanics An expanded analysis of a control study Risk Analysis en en ks asserted that these cannot be due to chance or ambient air 547-552 he a ol exposures He apparently dismissed 1 some cases who also Hodgson JT Peto J Jones JR Matthews FE 1997. Mesothelioma SO seat worked in some classic asbestos occupations and mortality in Britain Patterns by birth cohort and occupation occupation Ann Occup thademn 2 the known occurrence of cases with no documented Hyg 129 133 cet asbestos exposure First in our 1983 investigation we Lemen RA 2004 Asbestos in brakes Exposure and risk of disease Am J Ind Med 229 237 re identified an average of over three jobs for study subjects by from city directories and death certificates Teta et al 1983 McDonald AD McDonald JC 1980 Malignant mesothelioma in North Dr. Lemen himself noted that an overwhelming majority America Cancer 1650-1656 1650-1656 se of those who did brake repair work in the Spirtas et al 1985 Milham S Ossiander E 2001. Occupational mortality in Washington re study had also worked as insulators and shipbuilders My SotfaHteea1l9t5h0-1999 Epidemiology Office Washington State Department if colleagues and I obtained the data from the Spirtas et al er 1985 study and examined this issue looking at brake work Nicholson WJ Daum SM Lorimer WV Velez H Lilis R Selikoff IJ Miller A Anderson HA Fischbein SA Holstein EC Rom WN SO both occupationally and occupationally while adjust- Rosenman K Todaro JD Cheng W Li V Tart DT 1984 Investigation of CS ing for other occupational exposures Hessel et al 2004 health hazards in brake lining repair and maintenance workers " in press The results were negative overall and showed occupationally exposed to asbestos National Institute for Occupational Safety and Health NIOSH prepared by Mt. Sinai School of Medicine ir no evidence of increased risk with increasing duration of CUNY New York August to ld brake work Second idiopathic mesotheliomas and those NIOSH 2002 Letter MJ Teta from JT Walker regarding inquiry about due to occupational or unrecognized occupational PMRS for auto mechanics with attached data sheets Department of 314 Teta Health and Human Services DHHS Public Health Service National Institute for Occupational Safety and Health Olsen JH Jensen OM 1987 Occupation and risk of cancer in Denmark An analysis of 93,810 cancer cases 1970-1979 Scand J Work Environ Health Suppl 1-91 Petersen GR Milham S 1980. Occupational mortality in the state of California 1959-1961 National Institute for Occupational Safety and Health Research Report 33353 Sputas R Keehn R Wright W Stark A Beebe G Dickson E. 1985 Mesothelioma risk related to occupational or other asbestos exposure Preliminary results from a control study Am J Epidemiol 518 Teschke K Morgan MS Checkoway H Franklin G Spinelli JJ van Belle G Weiss NS 1997 Mesothelioma surveillance to locate sources of exposure to asbestos Can J Public Health 163-168 Teta MJ Lewinshon HC Meigs JW Vidone RA Mowad LZ Flannery JT 1983. Mesothelioma in Connecticut 1957-1977 occupational and geographic associations J Occup Med 749 156 Woitowitz HJ R^delsperger K 1994. Mesothelioma among car mechanics Ann Occup Hyg 635 638