Document ykv7vbz8j3r88EJVJnDEDEGK4

Cancer Risk of Insulation Workers in the United States Irving J. Selikoff, M.D., E. Cuyler Hammond, Sc.D. and Herbert Seidman, M.B.A. Mount Sinai School of Medicine of the City University of New York and the American Cancer Society, New York Presented at the meeting of the Working Group to Assess Biological Effects of Asbestos International Agency for Research on Cancer Lyon, France October 4, 1972 i O ENVIRONMENTAL CANCER RESEARCH PROJECT CHEVBB 0003186 Cancer Risk of Insulation Workers in. the United States* Irving J. Selikoff, M.D., E. Cuyler Hammond, Sc.D. and Herbert Seidman, M.B.A. In 1963, information became available indicating that asbestos insulation workers employed in the construction industry were subject to a significant cancer hazard associated with their work (Selikoff, Churg and Hammond, 1964). Studying the mortality experience of the 632 members on the rolls of the New York-New Jersey branches of the insulation workers union on January 1, 1943. for the 20 year period ending December 31, 1962, it was found that death of cancer was almost three times as frequent as expected. The death rate from cancer of the bronchus and pleura was 6.8 times as high as the general U.S. white male population, both age and date being taken into consideration, and cancer of stomach, colon and rectum three times as common. Attention was called to the occurrence of pleural and peritoneal mesotheliomas (Selikoff, Churg and Hammond, 1965a). These studies were subsequently extended, to investigate the interrelation ships between asbestos exposure and cigarette smoking in the production of lung cancer, the significance of mesothelioma (Selikoff, Hammond and Churg, 1970), and to obtain further evidence on the possible relationship between asbestos exposure and the occurrence of gastro-intestinal cancer. The data were insufficient, however, to resolve a number of questions impor tant for full evaluation of the problem and*to provide guidance for establish ment of needed administrative and industrial control measures. To obtain such required added information, we have continued and widened our investi gations. *From the Environmental Cancer Research Project of the American Cancer Society and the Mount Sinai School of Medicine of the City University of Hew York. Supported in part by U.S. Department of H.E.W. research grants OH 00320 and E3 00r.;.s, and research grant U 1272 of the Health Research Council of the City of New York, to the Mount Sinai School of Medicine. chevbb -2 - lurrent studies Using approaches and methods previously reported (Selikoff, Churg and Hammond. 1964; Selikoff, Churg and Hammond, 1965b), we have studied the experiences of three cohorts of workers exposed to asbestos insulation materials. A) Hew York-New Jersey Cohort -- We have continued our surveillance of the New York-New Jersey insulation workers. 262 had died by December 31, 1962 . 370 were still alive on January 1, 1963. Each has been followed through December 31, 1971. Two additional groups of workers have been investigated. B) In one study, we registered the entire membership of the insulation workers union in the United States and Canada* on January 1, 1967 (17,800; including members of the New York-New Jersey locals mentioned above), recording many character istics for each man including date of birth and onset of insulation work. Each man has since been observed through December 31, 1971. C) A third group consisted of the entire workforce (1941-1945) of a factory in an eastern U.S. city which manufactured amasite asbestos insulation materials (including insulating block and pipe covering, asbestos mattresses). These products were then used by insulation workers in the construction industry, especially in ship construction and repair. The plant opened its doors in June, 1941 and remained in business until November 1954. Very few of the pro duction workers studied by us had had any prior occupational exposure to asbestos. Starting in 1941, a total of 933 men were hired to the end of 1945, some working for as little as one day .and others to 1954, when the plant closed. Results of physiological studies of men in this plant have been reported (Bader, Bader and Selikoff, 1961). Now, for the evaluation of cancer risk among them, we have traced the entire group through December 31, 1971. 877 were fully traced (94) and the remainder partially traced for varying periods. We have analyzed their mortality experience in relation to the duration of employment, age at onset of employment and lapsed period fron onset of employment. ^International Association of Heat and Frost Insulators and Asbestos Workers, AFL-CIQ. CHEV BB -3 Findings in Insulation. Workers in the Construction Industry .The experiences of the two cohorts of insulation workers in the construction industry (New York-New Jersey and U.S.-Canada cohorts) amply confirm the cancer risk first identified in 1963. By December 31, 1971, 430 of the original 632 (New York-New Jersey cohort) had died, 421 after reaching 20 years from onset of employment. 189 (45% of the 421 total deaths) died of cancer whereas 47.2 such deaths had been expected (Table 1). Insulation workers throughout the United States and Canada (U.S.-Canada cohort) were a much younger group, with considerably less work experience (Hammond and Selikoff, 1972). The excess of cancer deaths, nevertheless, was very much the same, these deaths occurring among the older men, those with longer work experience. Relatively few deaths were found among the younger men, despite the large number in the cohort. 144.09 cancer deaths were expected and 459 occurred, 41% of the total of 1,092 deaths observed 1967-1971 (Table 2). Lung Cancer Bronchogenic carcinoma was a leading cause of death among asbestos insulation workers. It accounted for approximately 45% of fatal neoplasms. In these two series reported, it was responsible for 20% of all deaths and was almost three times as common as pleural and peritoneal mesothelioma. Recent histo logical studies of tumors from these patients showed distribution of cell types to be that of lung cancer in general (Kannerstein and Churg, 1972) and our clinical experience indicates that their prognosis was equally poor. These findings stress the urgency of preventive measures, such as dust con trol and avoidance of cigarette smoking (Selikoff, Hammond and Churg, 1968; Hammond and Selikoff, 1972). Gasto-intestinal cancer In our initial reports (Selikoff, Churg and Hammond, 1964; Hammond, Selikoff and Churg, 1965b) attention was called to the then unexpected finding of a moderate excess of gastro-intestinal cancer among New York insulation workers. -HEVBB )00318Q -4 ertheless, relatively few deaths were studied and firm conclusions were : considered warranted. We have now collected additional data, and these remain in the same direction, and very much at the same level of excess, two or three times expected deaths (Table 1 and 2). These findings were present for cancer of esophagus, stomach, and colon and rectum. A similar excess has been found among insulation workers in Belfast (Slmes In Simpson, 1971). Taken together, these experiences suggest that the increase is real. While not responsible for a major proportion of excess deaths (exceeded by lung cancer, mesothelioma and asbestosis) the influence is nevertheless sub stantial; in New York-New Jersey 13.0 deaths were expected and 41 occurred and in the U.S.-Canada Survey, 27.3 were expected and 55 occurred. Moreover, the finding may be of considerable theoretical importance, in view of the dearth of useful hypotheses on the etiology of gastro-intestinal cancer in general, and cancer of the colon and rectum in particular. Other neoplasms The knowledge that a number of tissues are subject to asbestos-induced cancer, coupled with the observation that fibers and fibrils may be found in many organs, admits the possibility that a neoplastic effect exists for sites other than those heretofore identified. Examination of this hypothesis is hampered by the infrequency of some such tumors in general and by the as yet inadequate number of observations available. We do not at present find it useful, therefore, to comment on this question, although we have been particularly interested in cancer of pancreas, brain, oro-pharynx, genito urinary cancer, and lymphoma and leukemia. Risk with factory exposure to.asbestos Insulation materials In 1964, K. W. Smith (1965) called attention to the multiplicity of materials to which insulation workers were exposed. It seemed justified to seek evidence on whether asbestos insulation materials per se were specifically related to the disease observed. If not, examination of other insulation materials would be required. We, therefore, investigated the workforce of the insulation materials factory noted above, which had been exposed in the factory only to CHEV BB -5- .sbestos insulation, but not to other insulation materials used in the construction industry (fibrous glass, calcined diatomaceous earth, rock wool, etc.). 484 deaths are known to have occurred among the 877 men fully traced to December 31, 1971. The distribution of deaths strongly resembled that seen among insulation workers installing such materials, despite the fact that observation of this cohort has only reached 2S-30 years from onset. Thus, lung cancer accounted for 73 deaths, although only 11.41 were expected; gastro-intestinal for 26, with 12.86 expected (including esophagus). Meso thelioma caused three deaths, and asbestosis 27 (Table 3). These data indicate that asbestos insulation materials are capable of causi ing the disease patterns seen among insulation workers and there is no need to invoke influence of other insulation materials. Epidemiological Variables Lapsed period from onset of exposure. It has long been inferred, from rather limited data, that asbestos cancer largely occurs more than twenty years from onset of exposure. Experiences in the cohorts studied indicate that lung cancer may occur in considerable excess even as early as 10-14 years from onset, with 0.65 ex pected deaths vs. 10 observed among those working in the amosite factory more than one year (Table 5b). Moreover, death rates for lung cancer were significantly increased in the U.S.-Canada insulation workers cohort 15-19 years from onset. [4.68 deaths were expected and 18 occurred (Table 4)J. On the other hand, in terms of numbers, most deaths of lung cancer occurred among the insulation workers during and after the 30-39 year from onset decade. Therefore, circumstances may exist in which it would be difficult to fully evaluate the effects of asbestos exposure if opportunity for obser vation were not available for at least 40 years from onset of work exposure. CHEVBB A| at onset A number of methodological difficulties are encountered when study of effect of age at onset on lung cancer rates is attempted. Not least, are the secu lar changes in cigarette smoking habits in the past SO years (Hammond, 1966) and concurrent, increases in lung cancer death rates in the general population, which must be taken into account. With these in mind, there seems to be no striking variation as a result of differences in age at which asbestos work exposure first began (Table 6). Duration of exposure In one cohort, it was possible to study the effect of differences in length of exposure. While all the insulation materials factory employees started work 1941-1945, approximately one-third worked for less than three months, another third 3-11 months, and the remaining third for a year or more (Table 5a). All worked in the same factory, with like exposure to the same asbestos, starting at the same point in time. The only significant variable wns duration of exposure. All were traced to the end of 1971. Our findings indicate that duration of exposure and, thus, presumably total dose, has an important influence on lung cancer rates. While even those th less than three months of work had definite increase in lung cancer risk (13 observed versus 3.55 expected), and those with 3-11 months much the same, workers employed for a year or over had much more substantial increase (45 observed, 4.09 expected). (Table 7.) Fiber type Crocidolite was not used for insulation work in the United States during the period covered by the experiences of insulation workers we have studied. Indeed, very little crocidolite for any use was imported into the United States until after the second world war (Selikoff, Hammond and Churg, 1970). Exposure to this fiber therefore cannot explain the cancer risk observed. CHEV BB -7- Both chrysotile and amosite have been used in U.S. insulation materials, the farmer since the turn of the century (Selikoff, Churg and Hammond, 1965b) and the latter since the mid-1930's (Selikoff, Hammond and Churg, 1972). Amosite has been used principally in ship insulation, chrysotile in general construction and industrial work, although it is also found in some shipyard materials. It is difficult to compare the relative disease potential of the two varieties of fibers in insulation work, since cohorts which differ in this respect may also differ in other respects as well, including type and intensity of expo sure, duration of exposure and lapsed period from onset of exposure. Never theless, two sets of observations are available which may be of interest. We have compared the mortality experience of insulation workers in the New York-New Jersey group according to their duration of shipyard employment (ship insulation having been fairly important in the New York harbor area, especially 1939-1945). Among the 370 men in the Union, January 1, 1963, survivors of the 1943 cohort, we were able to obtain history of shipyard employment by personal interview in 337. The results have been reported (Selikoff, Hammond and Seidman, 1971). They indicate that the mortality experience in men with shipyard employment, with its greater potential for amosite exposure, did not differ substantially from that of men in the same Union, in the same period of time, without such employment (Table 8). In the U.S.-Canada Survey, each Union member was recorded as being registered in a specific Union local. Several of these locals were engaged entirely in shipyard work. Others, in the central and midwestern parts of the country, had no such opportunity. This is not to say that individual members of these locals did not, in the past, do some shipyard work, but is is un likely to have been a major part of their work-history. Vcr'e have analyzed the mortality experience of men in the two groups of locals, 1967-1971. There does not seem to have been any significant difference between them (Table 9). At least as reflected in these two sets of data, construction industry insulation work, with its preponderance of chrysotile exposure, was not more, or less, hazardous than shipyard work, with its wider use of amosite materials. CHEV BB inniioi -8Discussion. A serious cancer risk has been demonstrated among-asbestos insulation workers in the United States. Approximately one death in five, an extra ordinary Incidence, has been the result o lung cancer. Castro-intestinal cancer waj more than doubled in incidence, and mesothelioma was responsible lor 7'. of nil deaths. Increased incidence of lung cancer was seen in as little as 10-14 years from onset of work exposure. We suspect th3t more intense exposure, as among factory workers, tends to be associated with earlier appearance of asbestos lung cancer. On the other hand, especially among the less intensely exposed insulation workers, although early lung cancer increase was seen, che greater increase occurred 30-45 years from onset. In such circumstances, it would be difficult to fully evaluate the effects of asbestos exposure without observation for at least 40 years from onset of exposure. Data have been presented indicating that these risks were associated with th-? ashesco? insulation materials per se. v/e were r.ot able to detect evidence suggesting that chrysotile was associated with greater risk than amoaite, in insulation work, or vice versa. ire have r.e knowledge of the comparative effect crocidolite might have; it was not used in U.3. insulation work. CHEVBB nnn^io/i Rtfcrcnccs - 9~ Ashcroft, T. & Hcpplrston, A.G. (1970) Mesothelioma end asbestos on Tyne side - a pathological and social study. In Pneumoconiosis - Proceedings of the International Conference, Johannesburg 196.9, Cape Town, Oxford University Press, .op 177-179 Bader, M.E., Bader, R.A. & Selikoff, I.J. (19S1) Pulwonary function in asbostosis of the lung. An alveolar-capillary block syndrome. Am. J. Mod., 30, 235-242 Elmes, P.C. & Simpson, Marion J.C. (1971) Insulation workers in Belfast 3. Mortality 1940-1966. Brit. J. Industr. Med., 28, 226-236 Hammond, E.C. (1966) Smoking in relation to the death rates of 1,000,000 men and women. In Epidemiological Study of Cancer and other Chronic Dis eases, Rethesda, Md., National Cancer Institute, Monograph 19, pp 127-204 Hammond, E.C. L Selikoff, I.J. (1972) Relation of cigarette smoking to risk of death of asbestos-associated disease among insulation workers ir. the United States. This Conference. Hammond, E.C., Selikoff, I.J. & Churg, J,, (1965) Neoplasia among insulation workers ir. the United States with special reference to intra-abdominal neo plasia. Ann. N.Y. Acad. Sc., 132, 519-525 Kannerstoia, K. & Churg, J. (1972) Pathology of carciaoma of the lung associated with asbestos exposure. Cancer, 30, 14-21 McEwen, J., Finlayson, A., Mair, A.. & Gibson, A.A.?!. (1970) Mesothelioma in Scotland. Brit, nmi. J., 4, 575-578 CHEV BB nnneioc - 10 - Nawhousu, Muriel L., Berry, G.f Wagner, J.C. Turok, Mary E. (1972) A study of the mortality of female asbestos workers. Brit. J. industr. Med., 29, 134-141 Xewhouse, Muriel L. S: V/agner, J.C. (1969) Validation of death certifi cates in asbestos workers. Brit. J. industr, Med., 26, 302-307 Selikoff, I.J., Churg, J. & Hammond, E.C. (1964) Asbestos exposure and neoplasia. J. Aa. med. Ass., IBS, 22-26 Selikoff, I.J., Churg, J. Sc Hammond, E.C. (1965a) Relation between ex posure to asbestos and mesothelioma. ?few Eng. J. ?.lcd., 272,560-563 Selikoff, I.J., Churg, J. & Hammond, E.C. (1965b) The occurrence of asbestosis among insulation workers in the United States. Ann. X.Y. Acad. Sc., 132, 139-155 Selikoff, I.J., Hammond, E.C. & Churg, J. (1968) Asbestos exposure, smok ing and neoplasia. J. Am. med. Ass., 204, 106-112 Selikoff, I.J., Hammond, E.C. L Churg, J. (1970) Mortality experiences ox asbestos insulation workers. In Pneumoconiosis - Proceedings of the International Conference, Johannesburg 1969, Cape Town, Oxford University Press, pp 180-186 Selikoff, I.J., Hammond, E.C. & Churg, J. (1972) Carcinogenicity of amosi:-a:;bestos. Arch. Env. Hlth. (In press) S '! ikoff, I.J., Hammond, E.C. & Seidman, H. (1971) Asbestos disease asso ciated with insulation work in shipyards in the U.S. Int. Symp. on Safety ar.d Health in Shipbuilding and Ship Repairing, Helsinki, August 1971 (fn press) CHEV BB 00031QA - 11 - 5*sith, K.W. (1965) Treads In the health of the asbestos worker. Ann. :;.Y. Acad. Sc., 132, 685-690 Wagner, J.C., SI eggs, C.A. it Marchand, P. (I960) Diffuse pleural meso thelioma and asbestos exposure in North Western Cape Province. Brit. J. industr. Med., 17, 260-271 whitwell, F. & Hawcliff, Rachel M. (1971) Diffuse malignant pleural mesothelioma and asbestos exposure. Thorax, 26, 6-22 wHEV BB )003197 Acknowledgment wo wish to express our indebtedness to the skillful assistance of our stails. Wo arc particularly grateful to .Mrs. Janet S. Kaffenburgh, Mrs Inn Annenberg. Mrs. Frances Perez, Mrs. Dorothy Perron, Mrs. Shirley Levine, Mrs. Rayla Margoles and Mr. Charles V. Nolan for the successful tracing of the subiects in these epidemiological studies, and to Mr. I-iwr- nee Garfinkel and Mrs. Doris Fleisher for their devoted help in many aspects of the work. CHEV BB E x p e c te d * and o b s e rv e d num ber o f d e a th s among 623 Now Y ork-N ew J e rs e y asbestos in s titu tio n w o rke rs, Jan. 1, 1913-Dec. 31, 1971, tw enty o r more years a fte r onseL o f f ir s t txposure to asbestos. b O u v> vi y a *o ms au o > n Og P\ o b 0O) v in 9 *OS4 I * a a b 60 a -s* y> JS i 05 o fa fa c yo o av CM uy eOes oa to j: 9 * +> b es es 0 60 z fa *V vCi A JZ O CO 5to T3 aV H b 19 e 0H 00 ca S Si i vi S z o nv a c o rrft -*I M oa faa *o 3 oVsI ^a Jm a fa 3 y a a fa a 3 *o +fCaO fa Q a s> N X *6 tn <H e .y3 a H a. fa tn T5 u y iv b oy 1 co 00 Ci <33 b *> a C al tn a C * e tn a $ .QQ ob 3* -i y V ^ i7--p. u <** CBi > u c o faa <0"954* ^fa cO s v y * a bC yyy fs U a*- *mfa <mEOfa +J fa > 3 fa bas Ho 0tn y n. n, 3E ny xy 3 4J C5 V --* OI *3 yE *a a Cxm +* Si5pO w Nbb nvv U# 05 -* a * to V| Vi * Sso2 ca os >S Ed fO *T" u E xpected* and observed d e a th s among 17,800 asbestos in s u la tio n w orkers in th e U nited S ta te s , January 1, 1967-December 31, 1971 * Expected deaths are based upon age s p e c ific death ra te d a ta o f the U.S. N a tio n a l O ffic e o f V ita l S ta tis tic s . Rates fo r 1968-1971 were e x tra p o la te d from ra te s fo r 1961-1967. **U.S. death ra te s not a v a ila b le , but these are rare causes o f death in the general p o p u la tio n (V u3 --* 01 o Qm tv CJ u 0 s o a>> u --4 90 90 90 O V p4 4T in CO Ci n co CM --4 o 01 CO p* o o V a 44 0 *s2 m ft o <9 8 0 a u <S 9 o * o a a 90 r * CO * * * n o c* to o c* A * * m4 A H0 Q & CM aS to 9S a H *4 CO e Nn CM CO m 00 o W 44 S 0 fN u 3 xs CD U C9 o >u --4 --4 n ca CM n ca IN a >4 o J3 CM a O *4 0) *4 tro in m* ce 0 **> *as* Mu CB SS m91 5 o eV 4J 01 u 00 a >H *4 n (eOs CO o * * * t*. w4 a) n CO CO o 0J o t4fO4 * * CO CO ca tn a o V >u V m oi 0) o-- 01 n CO CO CM M I--S4 18 es C4O4 ca H 00 * m in m 8 --4 CQ 44 0 6* a n aoV* <8 a Q0 01 o 4T tHr CM * * * * CM (--4 CO 10 ne ca CO o* <0 c* 0*4 co IN r* * in *4 A A 0) C* *4 CM 44 <0 an oj *4 n co r* AA of of >-i A OO oo n t-4 ACO ca e w vo<nn * Uo  60 nt n 05 a (U 05 H w o* cs a 44 a 0) 0 a 05 H X CM w CO pH * * 00 fF * * m * * pH o* Ifl pH o f n * vfF n CO 05 o 01 CO * CO CO fa IA 05 Ol V CM pH O) pH CO +> CO W au fa be vt -- pH co c O CO 0) fa a a 0 CO fa 44 A0 +> 5 o CB 0) >i > a v fa 0) -D 44 CO 0) A >a O fa M u? A0a 0 *- CA "3 O lA S 2 T- C3 CO a * 3 4J 4fa4 i-4 aO' WaX 3O>a). pH a s<u a a > fa o a* n pH cn CM t% O) 3 4 1 o o CO CB rr O) ** CM Ha a. CM fF V N 01 o o 00 t* H CO ei fF CO CM * * * * 05 * 01 *4 .. oa 05 fa 0* pH 00 fa * CO lA t* * o . * 01 O fa o s> s> CO fa V -4 FF 09 & *4 a 1 N iA V t 05 a CM + ou CO a. fF 5 o otr CO V 01 CM * * V r- r* * * 00 * 00 CO *4 pH CA a 01 pH pH (A fa * CO o * fa . * o01 O * pH fcir -jv ns > 01 fa 00 IA a a a CO pH o CO fa CM o CO O fa 0 er F 44 a pH a * IA a a a o* * O* a a pH S pH a' E 0 a fa CS N -F in CM o pH o to S 44 fa 0 fa pH a44 a - 3 aa fa pH a44 0 o E 4So4 3 fi O pH 434 0 aa o e a44 fa o Cm h 3) cO a u s pH H *4 fa VI fa o0 f. e fa 0 44 fa fa fa a44 o -3 oe e 3 fa fa o c c c pH pH fa 5 pH a o u 44 44 pH a< 00 HH CO * * * fa n 0 44 A < 05 X* FF fF CO 05 05 in 05 in w 05 00 o c* pH o a 3 fa A o pH pH < n cn *v* o eg 4-*> t 58 44 fa a V4 + w fa. $5 fa a fF 44 1 00 >s V4 pfa 0 fa a> 0 fa M *D oV4 S CB fa (A a IA c 05 0 fa 44fa 1 05 a z 05 fa 09 fa o => V4 %H CR 0 4-> a 44 fa A a s8 fa 44 <M S fa CO V z 05 44 fa a1 fa TP 05 fa 44 a pH ? be fa a 44 X 3 a0 3 fa o n A 44 a os fa Q t- 44 aa *-* fH fa 1 pH a *U TH H 44 a pH s pH a E o fa o (fa a O fE3a) a09 TcJ a *i TJ e 6 ua *F fa 44 o 3) >t o s pH F^ 0 fa X 44 35 fa e& o o ja fa o > ac si E a o p4 E IA o to 3J pH + pH 5q a pH cn e i oo s JC a 0 M o 0 44 44 sQ fa > 35 0 fa U 3) JZ -> a eo c 0 a Fi 3 44 FF eg *3 0 FF bo 4fa4 s -F aV A 3 fa fa H Ft g s *3 3 0s >t cn 0 r- c fa 0 a oo E 4f4a pH 3 fa 3 O fa f4a4 O 3 fa E 3a 44 CO fa CO 3 a c fa * * _ 0 *H 44 pH & o a F^ a If V c CB CO CB & B H p* 44 A fa 0 0) 3 s fa fa fa 44 3 A pOH a >3h- 3 > a 44 o 3 fa 3 44 fa A44 Q w 01 a * CHEV BB Table 4 Deaths of lung cancer and pleural mesothelioma among 17,800 asbestos insulation workers in the U.S. and Canada, Jan. 1, 1967-Dec. 31, 1971: relation to elapsed period from onset of work exposure. Years from onset < 10 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+ Total Expected deaths* 0.48 1.69 4.86 7.55 8.50 6.24 3.53 4.04 3.72 3.81 Lung cancer Observed deaths Ratio 0 -4 2.4 18 3.7 25 3.3 41 4.8 44 7.1 23 6.5 24 5.9 17 4.6 17 4.5 44.42 213 4.8 Pleural Mesothelioma Observed deaths 0 O 2 4 7 1 1 3 4 1 26 Expected deaths are based upon age specific death rate data cf the U.S. National Office of Vital Statistics. Rates for 19681971 were extrapolated from data for 1961-1967. CHEV BB E xpected* and observed d e a th s among 9 3 3 ** am ositu asbestos fa c to ry w orkers f ir s t em ployed 1941-19-15, and observed to Dec. 31, 1971 b u t th e s e a re ra re .--i i :hcs o f d e a th in th e g e n e ra l p o p u la tio n -o sp* p-I4 > 001 6 00 01 03 ? 03 03 01 n n i> n efa o 3 fa V ffaa * * * 00 w t0*3 L<- V n m cn 03 n a CM 00 fa in * * n 01 CM CM o cwi opa5* NI *o 8 fa a CMm fa a TT p. OJ CO V n fa * * S3 CfaO CM <0 * * * * N fa CM 03 m CO fa ^3* * ** CO U) h* * * a o foa m 03 8 fa4 I COCMl 3 fa CrM- Cl 00 & oP"* a 'T m CM CM pfa a *** 00 n ** 00 pfa O N Wo> H <0 tn pfafa ,, * CM Ofa mm 01 CM 8 asos m <h . o pj N O (S 03 x*0>>) y 00 & *pfa * * * TJ* * pfa pfa T?* h* CM o * fa pfa o O 5 i 0 si fa pfa n 4fa fa 3 So Q fa pfa 4fa fa 0 a CE g o3 a pfa M o <H * 0 06 0o uQ fa UV pfa o s %fa *H fa fa c o0 o 2 a pfa C h4fa O 0 fa c fa 44 o 3 -fa o c fa c c Pfa fa 3fa s# P 0* O a O Q fa +4 00 fa M O fa fa fa 0 pfa fa fa O< 0 fa fa H << 03 03 w0) -a nt* .2 P fa fa fa CO fa 4 S fa fap 00| >s *4 P* 0 fa *f0c*a M S O* -- tfi a tn c ei f0a **I +> C3*l y. o w & M 0 fa faa u 5 u fa r? j4=J 01 01 am *a * ph o :i> 2a. to ffac e l 3 fa *3 R ej R fa f* < h fa (0 fa Cl fa 1 fa mdCl ^3 Cl (0 fa Cl fa c a o fa * fa 0 w fa fa + ws fwa -sD 3 iS W U w *0 3 - K fc s s r: JS fa * > ac * -- E IT p* --fa Crl -- 5C rt .cO c 0 0c fa W foa * .fa Jr o to a ** -3 a ff-Waa5 S' n fa P4 fa * fa fa s -J -) *J S >3 O h. fa h* a an 2 3 0 fa fa 3 fa c o fa a* fa fa CR "i 3 O J5 fa h3 fa nr 01 fa >p -4- j R > fa c fa R 71 fa 3 JZ fa 09 * CHEV BB Table 4 Deaths of lung cancer and pleural mesothelioma among 17,800 asbestos Insulation workers in the U.S. and Canada, Jan. 1, 1967-Dec. 31, 1971: relation to elapsed period from onset of work exposure. Years from onset < 10 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+ Total Lung cancer Expected deaths* Observed deaths Ratio 0.48 1.69 4.86 7.55 8.50 6.24 3.53 4.04 3.72 3.81 0 4 18 25 41 44 23 24 17 17 -_ 2.4 3.7 3.3 4.8 7.1 6.5 5.9 4.6 4.5 44.42 213 4.8 Pleural Mesothelioma Observed deaths 0 0 2 4 7 4 1 3 4 1 26 *Expected deaths are based upon age specific death rate data of the U.S. National Office of Vital Statistics. Rates for 19681971 were extrapolated from data for 1961-1967. CHEV BB Table 5a Age at onset of employment, 1941.1945, of 933 workers in an aaosite asbestos insulation factory. Duration of employment Age at employment Total <3 months 3-11 months l + rears 15-19 94* 42 30 21 20-24 114 35 34 45 25-29 120 28 48 44 30-34 114 32 40 42 35-39 106 27 40 39 40-44 101 30 38 33 45-49 83 29 21 33 50-54 90 26 27 37 55-59 60-64 55 14 21 20 30 6 12 12 65-69 16 6 4 6 70-74 4l 3 - 75-79 l- - 1 ITnknown 5 2 3 - Total 933* 278 321 333 ' Includes 1 man with unknown length of employment CHEV BB 0003190 Lung cancer among 326 a m o s ite a sb e sto s w o rk e rs employed fo r 1 year o r more s ta r tin g 1941-1945, and observed to Dec. 31, 1 9 7 1 .* Expected and observed d e a th s .* * A Si si s 8o A O ee si *r SI 8op s A A eee * O 0 AaI s o ai N 04 A A 8 n n e M oQ 1 I A8 A n II*? OW On AH o A A A 8 8 Oo A6 T O uaa; An .Ae 8 8 Q 8 AA o o o o wo 8 .II AO AO e o no SI A V ml nx> II9- A tn A t* on ml o AO O vfai + av s& ao** o a 1e a *9u> v . AI oi AI AOI A A) a fa I t So 3 a ha aoo A i u foa +* a a fa s! * fa S >a A + foa e o H A+eamom* *a* 93 Q -0C m eo e9 ^ fa VI A e9H 9fa a a* s * fa faa 1 vl a fa XI 9 9 + O VI V>l 8--I Ol A 9A 9A fOa e1 O 4-> m o tn za 03 aI 9 ^a o +J *fo4a a *8 4* 0fa au a>as 0| -33 >* eo a a cl * 91 +9> t* a fmaa 3U-i au faa XI > f9a a ml c S. as 3 +X O 9 9a 9 9> *e a fa A9 rCx4 a * 9fa a fa 9 *-> A a *o aa n *o 49* A 9fa 9a t pA_9 AA A--AffsI a oi A9>9 9 A -O' A fi22 * CHEV BB normal Table Expected and observed deatbs of lung cancer saong 17,800 asbestos Insulation workers, January 1, 1967 - December 31, 1971; distribution by age at onset of exposure. Age at of exposure Deaths of lung cancer Expected* Obsorv <* Ratio * 25 25-34 35-44 45+ 18.19 102 5.61 15.20 66 4.34 8.7m 38 4.33 2.25 7 3.11 "Expected deaths are based upon age specific death rates of the U.S. National Office of Vital Statistics. Rates for 1968-1971 were extrapolated from rates for 1961-1967. CHEV BB 0003192 among 873 employed D is trib u tio n by d u ra tio n o f employment. 1941-1945, and observed to Dec. 31, 1971.* r iarnscte fc Expected and observed d e a th s o f lu n g aaosite asbestos fa c to ry workers, u Voa a ec * * .1 a| a! Q ftd *0* m >* > tcot td uu0a 0 a ts V ol 2o to to in to in m nm m CD m A O. OJ PS in A P4j *A*| to-1|I nA H A A V A aetl| A (* N N psI A + 4 J9t5 +CJ H0 ao a coa fa a PS i V PS m e a t4--1 B O o *m* i s RS S S. SoI s+ a s <*4 O 5as ^a I *4 O s* e o foa 44 fae. f9ao --aiI o J4S4 B 01 -4 a 2. a *4 fa 0 44 <* aX o 4fa> 44 44 aa T3 fa Ua Vs ft a 9* 7*. *" 44 m 5 A 484 fa f9a 0 44 aafa o > 44 ao (5i, 1 M 4fa44 4no4. fa a 44 44I so a H S 0 Sa1 '*8 *0 -4 a' A* ioi is CO 4u* a h M M> O a 44 -i 44 44 (a cii C wa44t 83. - a ** l9i4e4 na a4faH4 nvf>a O I -1O3 *^44* A< a o 10 a. A O a e a fa 0 44 9 fa O 9o 44 IS 9> 44 u X 9 A 4* Att fl A r 44 a o 00 9a 44 Aa ae^JD 44 a a 44 a oo 4* liaj u no aa xd A 0) k o a H n ago m ja fa 4-> CQ 4foa4 44 a was 9 44 44 fa > 44 o o 9 8t 44 yo IZ SO as S2 CHEV BB )003193 M o rta lity experience o f 337 asbestos in s u la tio n w orkers Jan. 1, 1963 - June 3 0 , 1971, analyzed by d u ra tio n o f s h ip y a rd employment c 0 f** 8 e0 a c; 0CD 01 0 0 a a a u C 41 bs Si +* m tt *"4 s 0 * > e Do fa jo 0 o a a 3a o M 09 *0* 0 O3 JS a fa f0a s sh V u a 3 to m a 2. CO 3 VA 3 tao 004 ae --A0 *0>-<% 3 0u) > 0 >" 00 > a CO X0I f0a -a co f0a 0 c0 0 + 0 CD * a 3 +> 0 00 TJ 0Ma ? C0MQ 0 rf O a M4-1 3 00 a + -> H *< * ae * 3c + CHEV BB AA<% ^ A 4 Table 9 " Expected* and observed deaths among asbestos insulation workers in shipyard and construction industry work, January 1, 1967-December 31, 1971. Workmen registered in Union locals in southwest, midwest and central states Workmen registered in shipyard locals Expected Observed Expected Obsorv Total deaths 316.28 446 ,39.56 34 Total cancer: all sites 56.34 172 7.21 16 Lung cancer *Pleural mesothelioma Peritoneal mesothelioma Cancer of esophagus Cancer of stomach Cancer of colon, rectum All other cancers Asbestosis 17.47 ** ** 1.26 2.56 6.75 28.30 * 79 2.67 10 mm 13 mm 6 0.20 6 0.36 12 0.98 46 3.70 26 mm 9 2 1 i 0 0 3 3 Ml other causes 259.94 248 31.65 15 Number of men Person-years of observation 7,299 35,310 462 2,244 Expected deaths are based upon age specific death rate data of the U.S. National Office of Vital Statistics. Rates'for: 1968-1971 were extrapolated from rates for lSSl-lS^T. death rates are not available, but these are rare causes of death in the general population. CHEV BB 0003195