Document zQKZkDygX50axBeXymwrXqmG3

FILE NAME: OWILL DATE: 1991 OWILL097 DOC#: OWILL097 DOCUMENT DESCRIPTION: Journal Article - The Discovery of the Association Between Blue Asbestos and Mesotheliomas sra. Amtr^ jaspn Xa. sftali. fiic .dmsuis aod jcicjc Add, hydrolvunc Btp/tx? He ta tlcetK rvd oxidsbv -69. a m on**. ** 1 Slmder J*4huilk: a ^oc* Katon. i n upuitc in 143-9. r*!ctoncf am. Ttuntl OMmtnme - iccvarmut J47-*0o, L Effaets o, .3jui\nlia a. ai-r ney were .ere there i wax and ,iad later it grew. t planks, .sending hop. *ry that I <ing to : y house, und to *Jtout any too had ich there ,-d what I :o believe vent on. oad bees a musket 'oint his **r storic# WALDRON E d ito r r\;iu-c.* u T ; ** BniUh Journal of industrial Mtdtam 1991;4SJ99-403 399 The discovery of the association between blue asbestos and mesotheliomas and the aftermath J C VTagner A bstract University of Witwatcrsrind B J P Becker. 'SFe first A s th is is th e 30th anniv*r*ry o f th e public* undertook a detailed study to exclude any primary tion o f o u r p a p e r "Diffuse p leu ral m eso from another site, and as we found none, he agreed th elio m as a n d asbestos exposure in th e n o rth that it was probably a diffuse malignam mttothelioma w est C ape P ro v in c e ,"1asid 1 D ecem ber 1990 is of the pleura; wc carried out a full histological and the first a n n iv e rsa ry o f John Gilson* death I histochemical study of the (issues, which confirmed th in k it is a p p ro p ria te to su b m it th is p a p e r. I t this diagnosis. covers th e b ac k g ro u n d o f th e discovery o f th e As t was preparing the case for dtanonsttauon at series o f m eso th elio m as in the n o rth w estern the local thoracic group meeting, my assistant region o f th e C ape Province, a n d th e sub* M r D Munday suggested that we should take sequent p u b lic a tio n , w hich has becom e th e sections from the underlying lung tissue, and we m ost cited p a p e r in In d u strial m edicine. It w as ware surprised to.find occasional clumps of asbestos John Gilson w ho d ire cted th e next p hase, w hich bodies in the air spaces of the lung, but there was no su b sta n tia te d this discovery. He clarified the evidence ofan interstitial reaction. Olaf Martini and 1 situ atio n in h is S u m m ary o f th e re p o rt to the presented the case with the clinical, radiological, and d ire c to r o f th e I n te rn a tio n a l' Agency fo r pathological features. At this meeting was M r Libro Research in C ancer in 1972.^ T his I have Faro, chairman of the thoracic surgery department. quoted in full a n d have had th e te m e rity to A week later, Fieri received a request to see a patient u p d ate to 1990.1a m su re th a t m any will w an t to in Kimberly, the town at the centre of the diamond elab o rate th ese views, an d 1hope th a t they will mining industry (see fig 2). While in Kimberly, subm it th eir opinions to this Journal. Mr Fatti was consulted by D r Kit Sieggs, who was the superiritendant of the West End Tuberculosis Th* first diffuse pleural mesothelioma of our series Hospital. (During the second world war the Royal came for necropsy examination in February 1956. Air Force had established an air training school at The clinical features of this case were described by Kimberly for Royal Air Force and Commonwealth .Mutiny in 1956.* At the time of his desth the case, a pilots, and had built a hospital that was presented to Bantu man, was thought to have h id tuberculous the South African Government after the war.) It was pleurisy. He had not responded to chemotherapy. He had developed a pleural effusion, and attempts at i aspiration were not successful because of the "sticky" nature o f the fluid- It *** thought that he had developed an empyema, which was considered to be the cause of death. On opening the thoracic cavity, I was amazed to find a huge gelatinous tumour (fig IX which filled the right thoncc cavity, and infiltrated into the parietal pericardium. T he mediastinum was displaced, with congestion of the left lung. On slicing into the mast a greatly contracted right lung was found. 1 had never seen a mesothelioma but had read brief descriptions of these tumours in die larger tomes on pathology. 1 was also aware that there was a controversy as to whether these tumours existed or whether they were ell secondary tumours from other primary sites and I consulted the professor a t pathology at die Late of Che MRC PatuttoconlM ll (left. Present address 59 Coombe Valley R4, Preston, Weymouth, Dorset DT3 fiNL JC Vagner Figurt / Th* original mmsotAtk'oma. 09/08/95 14:41 TX/RX NO.2400 P.005 mmmmm 400 VTafntr decided io use this hospital for the treatment of tuberculosis, with D r Sleggs in chars. The hospital received cases from an area larfcx than Holland, with Kimberly at the centre. As tuberculosis was endemic only the most severe eases could be admitted with many suffering from tuberculous pleurisy. Initially these eases were inevitably fool, but with the event of such drugs as streptomycin and IN H some of these cases recovered. D r Sleggs noticed that the patients who recovered came from those eases from the eastern side, whereas the deaths continued among those coming from the western side. He then referred the western side caaes for opinions to the larger centres in the country and was informed that some of them were suffering from secondary cancer o f the pleura and .not tuberculosis. As D r Sleggs said "No one suggested where the primary tumour was." He invited ratti to see six o f these strange eases. Ftttx examined them and also looked at x ray films of previous cases. He was amaaart to sea features identical with the case chat wo had presented in Johannesburg. He returned to Johannesburg and arranged for his partner, M r Paul Marchand, to cake open biopsies from the cases in hospital, any Anther cases still alive, and future cases with similar radiological features. Paul Matohand submitted a steady flow of these to that by the end of tha year we had 10 biopsy specimens, and two more necropsy specimens showing the features of mesotheliomas. Professor Paul Steiner of Chicago was visiting Johannesburg and he agreed that foes were mesothelioma. The question then arose, as to why we were diagnosing to many cases of an extremely rare tumour. I recalled that D r Sleggs had stated that these cases were from the west o f Kimberly, and also that we had seen asbestos bodies In the lung ofthe first case. Xtherefore suggested that wg should investigate the possibility that these rumours were associated with asbestos. Blue asbestos (crocidolite) was produced from a series of mines extending Ion# the range of the Asbestos Mountains, which are 400 T-. m: ex* be: ih. of. an. cm hethl WC wc eat age her tha bot not tha ast un cot tra. tavv StO: USU aps JUS? 1: .Mar asbi that look pteu obta our., chilmer.' and occu T: was vilJa; M ia ad Whic: child, work amor, schoc the occu? expo Twer these forthind* ncitfr. hiitor 09/08/95 14:41 TX/RX NO.2400 P.006 | The d u a v tr y o f the a six ia a m bcrattn hiue m b a to i and m etatht^am ai and ih* afterm ath 401 miles long, starting near the Orange river and In the cases from the asbestos Adds foe average extending to foe Maiopo river, with the main mine time between first exposure and development of the being 00 miles w e of Kimberly (fig 2). tumour was 44 years. The youngest patient Most of the biopsies taken by Marchand were from developed a mesofochoraa at the age of 20; he bad the parietal pleura, but a few.contained a email piece been exposed as a baby when his mother carried him o f lung tissue. All these specimens were re-examined on her back while she was cobbing asbestos fibre- and we found a few asbestos bodies in three more cases. My hypothesis could not be supported however, from the original histories obtained from Type ofubestos and mesothelioma these patients, all of whom denied that they bad The next problem was were these tumours associated / wwoerrekeadswdiitvheerssebascohs,oaunsde,w*iinvdeese, dd,othmeeirstoicccsuepravtainotnss, wapipthoienxtpeodsutroe tao ortehseeratrycphesfeolfloawsbsehsitpos?inI h1a9d54beetno caulebreedcrt, fanners, i water bailiff, an insurance establish whether all types of asbestos caused the agent, an accountant, and an international, goal same diseases. Southern Africa was the only ccunu-y keeper! It was only subsequently that we discover! in the world where foe three major typos of that working with asbestos carried a sodal stigma for asbestos--namely, crocidolite, amosite, and , both white and black people. The white patients did chiy sodle were mined. Each of these fib re had been not like to admit to such poor financial circumstances produced for at least 30 yean by a large labour force. i that they had had to drive donkey wagons containing Through the South African Pneumoconiosis Bureau asbestos fibre to the rail heads or had had to work as wc were able to examine the thoracic organs of most unskilled labourers. The black patients regarded of the asbestos miners and millers who had died in cobbing as women`s work. Also, we learned that South Africa. The bureau had the radiological and I trade in illicit diamond selling flourished in the cfcnical evidence of disease for all miners and for a taverns on the asbestos fields. The diamonds were significant number of men who had previously been stolen In Kimberly, but to avoid the police, trading employed in the industry. Also, we had visited the usually took place elsewhere. Therefore if you asked hospitals near the amosite and chryiodic mines, and a patient if he had visited the asbestos mines you were had contact with the medical services supervising the suspected of having police connections. mines in Southern Rhodesia (Zimbabwe) and It was not until the middle of 1958 that Paul Swaziland. We found carcinoma of the lung, l Marchand had a patient to examine who had both asbestosis, and pleural plaques amongst the amosite asbesioiit and mesothelioma. The patient also denied miners and occasional cases of asbestosis among the that he had worked with asbestos, but when Paul chrysodle miners. Mesotheliomas were only seen in looked at x ray film from the patient's brother, large cases from the Cape asbestos fields, in those who had pleura] plaques were evident so, at last a history was been exposed to blue asbestos dust either environ obtained. Their father had managed a small asbestos mentally or in industry. There were, and this fact j mine and both sons had played oh the dumps as becomes more and more important as the story ` children. We then started asking about cnvjron- develops, several cases of mesothelioma in whom it r.d i mental exposure of patients, from them or relatives, was not possible to establish any history of exposure kC oacncdupwaetioonbatlahinisetdorya incommopsltecteueesn. vironmental and to Basybe1s9t6o2s. it became obvious that these investiga itr .ir The most sinister of the environmental exposures tions should be continued in foe United Kingdom. . 1 was the mill and its associated tailings dumps. The In 1957 I had visited Great Britain on sabbatical ve villages had grown around the mills and these dumps. leave end had discussed foe early evidence of the 'IV Many of the patients recorded living in a blue haze association between exposure to blue asbestos and JU. and the schools were established near the dumps, mesotheliomas with the authorities on occupational .a# which proved a fatal attraction for many of the health and foe directors of the main British asbestos if children; according to the present epidemiological companies. work, there is still a high rate of mesotheliomas Richard Doll's paper in 1955 had confirmed rhe > .TC among the people who went to the village primary increased incidence of carcinoma of the hmg among I are schools. At the end of 1981 we had seen 67 cases from asbestos workers. Industry showed little enthusiasm ut the Capo asbestos fields; of these 30 had had for the investigation of another possible neoplasm/ lae occupational exposure and a forth eight had been among their workers. Support came from the medicalf rit exposed working with asbestos outside that industry. authorities, on occupational health, who thought lie Twenty nine had no occupational exposure, but o f that I should return to South Africa and obtain :cd these 22 had been born on the Cape asbestos fields. A further evidence ofthe association. Support in South 'a* further nine cases had had exposure to blue asbestos Africa was lukewarm. Industry was worried that my Jje industrially elsewhere in South Africa. For two cases investigation would have a detrimental effect on foe ;oo nheisittohreyr coaulpdobseitiovbetaiinneddu.strial nor environmental ecoxnpvoirntcoefdasthbaesttfoose, amndaimn yremseeadricchalpsruopbpleomrtewrsaswtehree 09/08/95 14:41 TX/RX NO.2400 P.007 09/08/95 14:41 TX/RX NO.2400 P.008 M 212 552.4272 (FR I)09.08'95 13:40 / MO, 3000000325 P. *'Jf*r 3C510I, -cneni pons 'cats c.-n Jmoit public IP* :ad? mgthcetivc aiions t>T ity . accia pc of whh y less there twain from tt of with a few :n the when ."here dthe mo at of tale, oon- i:*.4 atc i to d as 'pc*r st of been *k of ~V to the ebu .vi .cnee Tt S The discovery of ih t association batm en blue asbestos and mesotheliomas and the afterm ath 43 evidence of no excess risk of mesotheliomas from asbestos air pollution which has suited in the neighbourhood of chrysotile and amotite mints. There are reported differences on incidence of mesothelioma between urban and rural areas, the causes of which have not been staWished. There it no evidence of risk to the general public at present. A. 1990. There it no further evidence about the comparison between urban and rural areas. There is definitely no risk to the general public except when buildings containing crocidolilo arc being demolished- The wholesale removal of chrysotile from buildings is absurd. (5) Q. Since 1964 has rite evidence changed on the importance of other factors such as d garetta smoking, waxes, oils, and trace dementi as con tributory factors to the cancer risk? A. 1972. The evidence has accumulated indieating: ;a) The cigarette is an important factor enhancing the lung cancer risk in asbestos-exposed workers, in both men and women. Asbestos workers have especially strong grounds for giving up smoking to protect cheir health. No association has been demonstrated between d garerte smoking and mesotheliomas, (b) Animal experiments designed thus far to test the importance of waxes and oils as contributory Actor in the production of mesothelioma have shown these contaminants are unlikely to be relevant. .c) Prom animal experiments there art no good dues suggesting that trace elementi arc likely to be a major Actor in the production of asbestos cancan. A. 1990. (a) Cigarette Smoking is the major factor in enhancing the lung cancer risk in asbestos workers. <b and e) No further evidence has been obtained. (6) Q. What other types of cancer are related to exposure to asbestos? A. 1972. Prospective surveys of occupational groups exposed to asbestos have in general shown a small excess risk of some ocher types of cancer fin addition, to bronchial and meiotheliftl), specially those of the gastro-intestjntl tract. The excess of these rumour is relatively small Oompared with that for bronchial cancer. Evidence for an association with ovarian tumours has not been supported by th t first large mortality survey of women previously exposed to tsbmtos. A. 1990. Slight evidence exists showing that incidence of tumours of tha upper respiratory trace may be increased. There is little support for an increase of tumours of the gastrointestinal tract. Tha situation concerning Carcinoma Of the ovary tt dif- ficuh. The problem is where docs the surface of the ovary end and where does the peritoneal xnesothelhim begin? T he situation is further complicated fey acme groups in th t United States who now describe mesotheliomas of tha ovary. (7) Q. Is there evidence of an increased risk o f Cancerresulting from asbestos fibre* present in water, beverages, food, or it) fluids used for the administra tion of drugs? A. 1972. Suds evidence as there is does not indicate any risk. A. 1990, No. (8) Q. Is there any ri*k of hzngfibrosis from low levels of exposure to asbetcos such as have been encountered by the general population in urban areas? A. 1972. There is at present no evidence of lung damage by asbestos to the general public, the amount of asbestos in the lungs of the general pubbe is very small, compared with those occupationally exposed. It is greatest where asbestos is mined or worked and lowest in the rural areas. A. 1990. A risk exists to bystanders or domestic associates of asbestos workers, who do nor have a change of clothing and adequate wishing facilities at work, after working with asbestos, particularly croddolita. No risk exists to the public at large. (9) Q. Has tha relationship between asbestos exposure and the development of pleural plaques been established? A- 1972. Pleural plaques have been associated with past exposure to all commercial types of asbestos- But additional factors, other than asbestos itself, are involved. T ha plaques may remain fibrous or become calcified. Not aO pleural plaques are associated with asbestos. A. 1990. Pleural plaques that are symmetrical and bilateral, are associated with exposure to tmphibole fibres or chrysotile contaminated with an amphibole. 1 Wagner JC ri*sS* C, Merduad ?. Diia pleure! Atto. tfeeJiomat end u b a te expoew in tbr nord m en Cmc Province, brjlnd Med 1*64*17:240-71. 2 Report of die ndmorr enatmince tmlib ate.cncti] (o die ebreeur of the Intern, nonet Acato- fot Research on Cancer. In: iUewofilnr I, Giison JC. Thnneeii V, Wagner JC, odi. BMagiuri tffont of otbttm - Lyon; Imern tKnul Agency for fteawefc on Cancer, 1*75:342-3.ilARCpubi So S.) ) Rayon and recornmendaifonaof^ wortio* group oe asbestos and mtmr (twrred under the avpiceo of the geographical pathology commfae of die International Union again 4 BiCeloMfxmatiie.BffrecftisnodfaMtoamd \oM.SRZeZp.o\rMt o. ftbeadvisory euromicm anaabateMoutrantothedireeterefthe Ituenuiionai Agency for Research on Cancer, /i Or* Hit J*7J,|*.-*-!7. 5 Martiny O. Report rat a ease ofmootbcUorn. of tht riu n irIAfacfcWOficrrt AtatcMrim Accepted 10 December 1*90 XXX END O F DOCUM ENT XXX no /no /oc 1 a . a 1 mv /n t; xtr\