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Malignancies in Asbestos Workers JAN UEBEN. MD. HARRISBURG. PA 619 V ITHIN recent years and months a con siderable amount of evidence has appeared in the literature which indicates tliat asbes- tosis is directly related to the incidence of malignant tumors and cancer.*1''1 -- As early as ten years ago a Pennsylvania pathologist reported that he had seen=at autopsies many cancer cases in persons who also suffered from asbestosis. The pathol ogist is on the staff of a hospital which re ceives most of the patients from a nearby town where a large asbestos producing plant is located. The findings of the pathologist have created concern in the asbestos industry and it was felt appropriate for the Pennsyl vania Health Department to review the prob lem. Exposures in the Plant The following information was obrained from the files of the health department which has studied environmental exposures of workers in this plant on several occasions in the past 30 years. During this time there has been a tremendous improvement in dust conditions in all operations and dustiness been held close to or below the present n.. eshold limit. The textile department used chrysotile, primarily, for many years. It was not un common for the milled fiber received by the textile plants to contain 30% or more of fines. The fiber of today is very much cleaner than that received prior to 1950. The use of light oil in the blending department began around 1955. This was helpful in improving conditions and minimizing dust. Prior To 1950 amosite was processed in small quanti ties for making thermal blankets. Although the processing of amosite never exceeded one card and the operations were at times intermittent, this operation was much dustier than from cards processing chrysotile. Crocidolite has never been handled in the textile department. In the friction products opjerations ex tensive changes in the formulations have Submitted (or publication June 6, 1966; accepted July 1. From Division of Occupational Kealth, Department of Health, Harrisburg, Pa. Reprint requests to Division of Occupau'ona! Health, Department of Health, P.O- Box 90, Harrisburg, Pa 17120. taken place over the past 30 years. Prior to 1945, coal tars and pitches were com monly used as impregnums in making brake linings, clutch facings, and packing materials. Since 1945, these have been essentially re placed by resins and other materials so that at present only a very small amount of tar and pitch is used in packing materials. A small amount of crocidolite is still used in making some packings. The Study Since asbestosis is a disease which, once established, progresses even after exposure to dust ceases, it was decided not to ask plant management for cases known to them. Instead, the record rooms of six hospitals which draw their patients from the area of the asbestos plant were checked for cases of asbestosis. Admissions only for the pieriod between 1956 and 1964 were included. Seventy-five hospital records coded as as bestosis were located. Asbestosis was diag nosed in these people on admission, by x-ray, or at autopsy, or asbestosis was men tioned in the differential diagnosis. After obtaining the 75 records, medical, occupational, and smoking histories were obtained for all these former patients. Many were deceased and their survivors had to be contacted. Other data were obtained from plant management. Seven either had not worked at the asbestos plant under study or the diagnosis had been changed. This left 68 asbestos workers who had worked at one time in the above-mentioned textile and friction materials plant. Further study of the records showed that 21 of these not only had evidence of asbestosis but also had suf fered from malignancy. By the time of the Table 1.--Slumber of Coses and Duration of Occupational Asbestos Exposure by Departments Expoiurt Deration Laatfean 10 yean 10-20 yean *0-00 mn + yean Department Textile Friction Textile Unknown and Friction 10 It <1 . 11 1 1 Arch Environ Health--Vol 13, Srov 1966 620 MALIGNANCIES--LIEBEN Table 2.--Summary of Cases Studied Case Birth 1 1*11 2 1*06 2 22*8 4 2*07 5 18*5 4 2*01 7 1*01 t 18*5 * 18*7 1* 2*04 11 18*5 22 1*08 12 1907 24 1901 15 18*4 1* 1884 . 17 1901 11 1888 It 1877 26 28*5 21 18*4 Death 1*42 2*51 1*58 1961 mi 1*56 2157 1956 1*58 1*61 2960 1*56 1961 1961 1*56 1*69 1*62 1964 1960 1958 1957 Type of Tumor Length of Ea>mmpploioyymmenit in Asbestos Type of Employment Bronchogenie carcinoma, histologic type unspecified Squamous cell broncho genic carcinoma Squamous cell broncho genic carcinoma Oat cell bronchogenic carcinoma Squamous eaO bronchofeme eareinoma Bnneboftak adenocarcinoma Anaplastic bronebtv Sente carcinoma 2935-1957 2929-1959 1918*1928 2927-2157 1947-1961 Osly 6 mo 2919 8 mo only in 1923 Bronchogenic carcinoma, histologic type unspecified Squamous cell broneboItnie carcinoma Alveolar cell eareinoma of the lung Carcinoma of tbe lust, origin and type unknown Lung tumor, x-ray diagnosis 1925-1937 2922-1954 1956-1960 1926-1960 1919-1955 Anaplastie bronchoffenie eareinoma Intra-abdominal adenocarcinoma, origin unknown 1*28-1*61 2934-1*42 Carcinoma of the colon Lymphatic leukemia, ehronicity unknown 1922-2*56 6 mo only 2941 Malignant lymphoma Cbronie lymphatic leukemia 1926-1942 1*36-1947 Acute leukemia. type unknown Carcinoma of throat. origin and type unknown Multiple myeloma Carcinoma of prostate. mctajtatie 1922-1949 1935-1957 Carcinoma of bladder 1117-1937 Yarn twisting 1934-1962 Weaver 2929-1959 Breakline weaver 1918-1921 Weaving and later loom fixer Laborer sweeper, picker house Weaver--later lath foundry worker Arcs unknown. later hotel operator 1823-19$? Linotype operator 1*21-1*23 Carding room. gardening lor 1* yr thereafter Weaver 1922-1954 Friction materials. laborer on lathe Inside driver in weaving room Loom fixer, machine shop foreman, toolmaker General foreman-- spinning before last job Moat of the time in friction products, spinning 1922-1937, later upholsterer Weaver Sweeper and laborer June 12,1941 Mechanics helper for 46 years for trucking company Carding room supervisor Laborer--handtrucker --supplied weavers with spools; farmer till 1937, eexton at church till death Shipping room only Weaver--loom fixer. textile foreman 1936-1947. packing mill 1947-195? Supervisor trietion mill 20 yean 1*1?.1937. tee cream Mftkar 20 years 1*27-1*57 Smoking 12-15 cigarettes Remarks 1 paek/dsy No cigarettes No cigarettes 1 peek -$ /day Cigars only No cigarettes 86 yr foundry * work Also eirrnosis ai liver Pro6*6'* notdf 4s asbestos ProOabty not asbestos 1 paek/day Less than 10 cigamtm'dsy Unknown No cigarettes 2-3 eigarettes/day Diagnosis from bespits) recc.d ao autopsy No 1 pack/day 5-10 cigarettm/day No Fiahahlv not due isastcsios No eigsrcttee. little pipe Very few cigar* only 8 aaronsrisa 5-10 cigarettm/day 7 a^astosis Pipe only 1 paek4*/day study all 21 had died. Ten of these cases paper which appeared in Cancer in August have also been reported by O'Donnell in a 1966.4 Thirteen of these had lnng cancer Arch Environ Health--Vol IS. A'or 1966 OUP 1141927 MALIGNANCIES--LIE8EN 621 and eight had various other growths which included two abdominal cancers, one bladder cancer, two lymphatic leukemias, one acute leukemia, one lymphoblastoma, and one multiple myeloma. X'o cases of mesothelioma were in this group. There were four cases in former plant employees but these em ployees bad been admitted to hospitals either prior to 1956 or after 1964 and because of that are not included in this study. The diagnosis of the condition of these 21 patients had been established in 13 by au topsy. in four by operation, in two by biopsy, and in two by x-ray only. The death certificates of all 21 were ob tained. The malignancy diagnosis was re ported on 15 death certificates. Six were signed out as follows: nvo as cardiac failure, one as coronary disease, and three as as bestosis. If death certificates alone had been utilized in this study, these six cases of malignancy' would have been missed. The smoking history of the 13 lung cancer bents revealed that five had never smoked, en smoked, and in one case no smoking history was obtainable. Of the eight pa tients with other malignancies, three_were cigarette smokers, two never smoked, and three were cigar smokers only. Of the 21 patients with cancer, 13 had worked in the textile department of the plant only, for a sum total of 301 years. Four worked in the friction materials department for a total of 48 years. The department where one man had worked remains un known and three others worked at various jobs which included ljoth textiles and friction materials (Table 1). Two of the 13 lung cancer and one of the lymphoblastoma patients had worked in the asbestos plant for a period of less than six months each, which is a rather short ex posure. One wonders if this short exposure could have contributed towards their dis ease. Eighteen of these 21 patients had started work in the plant prior to 1940 and 12 had started work prior to 1920. Of the 21 patients with cancer 9 were between 50 and 60 and 12 were oxer 60 years of age l Table 21. Comments and Conclusions The incidence of malignancy in this se lected group of hospital admissions \Wth asbestosis was very high--21 out of 6S. This is eight times higher than in the general population 45 years of age and over, for the eight years of the study period.5 The incidence of 19% (or 169c if xve do not consider exposures of less than one year) of lung cancer in this group of work ers with asbestosis is comparable to that reported by Isselbacher 1 who summarized data of various authors and reported that of 603 persons with asbestosis, lung cancer was found in 83 (13.S%). It is also close to that reported in the literature review by Behrens * who collected 44 cases of lung cancer (14%) in 309 patients with asbesto sis. Only three patients with these malig nancies had their first exposure after 1940, when dust conditions had been much im proved. A repeat study in the future may clarify whether this reduction of cancer occurrence in more recent employees is due to a latent period, to the age factor, or to the dust control measures instituted by the plant. The patients with lung cancer were gen erally younger than those with cancers of other organs. Eight of those in the lung cancer group were under 60 and all eight of those in the other group were over 60 (Table 2). Summary A study of 68 hospital admissions xvith asbestosis from an asbestos textile and fric tion materials plant included 21 malignancies --13 of these were carcinoma of the lung and eight carcinomas of other organs. Eigh teen of the patients had exposures to as bestos in their occupational enx-ironment for a period of 10 to 36 years. Only three pa tients had their first exposure after 1940. Extensive dust control measures have been instituted by the plant. REFERENCES 1. Isselbacher, KJ.; Klaus. H.; and Hardy, HX.: Asbestosis and Bronchogenic Carcinoma; Report of One Autopsied Case and Review of Available Litera ture, Amer J Med 15 721-722 (Nov) 1953. 2. Doll. R.: Mortality from Lung Cancer m Asbestos Workers, Brit J indusrr Med 12:81-86 (April) 1955. 3. Hueper, W.C.; Emironmemal Causes of Cancer of the Lung Other Than Tobacco Smoke, Dis Chest 30:141-159 (Aug) 1956. 4. O'Donnell, W.M.: Mesothelioma Associated With Asbestosis: A Report of Three Cases, Cancer 19:521 fAug) 1966. 5. Cancer Mortality and Morbidity. Harrisburg. Pa: Pennsylvania Department of Health, 1964. 6. Behrens, W., Jr.: The Clinical Picture and Pa thology of Asbestosis, Z VnfaUmed, Berufskr 45:129, 1952, Arch Emiron Health--Vol 12, Sov 1966