Document zoxYvMnXQK0BvEOOx0Kmp4pb7

, ,A_ J?civd 12/31/2002 11:01AH in 11:06 on tine [2] for 40ALSTON * Pg 12/28 12/31/02 TUE 11:00 FAX PENCO INFORMATION @012 i new Chinese roentgenodiaj of pneumoconioaa of Ip; Health Supplement 1903: ei-Sl $ Kokvama N, Yokohama K',*| f fibre content of lungs ivith'< in Osaka, Japan; a prefmtf.'j RC Set Pub, Lyon 1989; So*' ; kizawa Y, Muvo H, et al; and form of asbestos fibers 5 water contaminated from a ipe with asbestos-cement. Jap :831-8fi0 vai K, TtntAOOsni K: Fetruin the lungs of the general ring a 45-ytW period and xamlnailon. Jap J Thorac Di$ 480 imedkfeiadeltorero teiilliradtllxnM ". Dc*sn" Ufa An Barmin ft Milsne, Inly Med Liiv 1995; fift 5:461 -477 [MESOTHELIOMAS FOLLOWING EXPOSURE TO ASBESTOS USED IN RAILROADS: 13(0 ITALIAN CASES _____ , ____ s __________________ ________________ 'i C. MALTONLC. PINTO, R. CARNLCCIO.D. VALENTI, P.LOD1.E. AMADUCCI 1 tMcsotdiomi da esposirione utt'amlanio usgto nelle Amine: J30 casi italfanh. Ven- gono brevemente passati In rassegna: ie conosccnzc digpontbili sui rischi organici da amianto, i dati sugli usi di amianto nelle ferrovie, con partlcoJare riguardo allc Kerrovie delta State italiane (FS) ed i gnippi di jJavoratori a rischio in geguito ali'csposizione ad amianto usato nelie ferrovie. Vengono tjiassunfi anche i dati, della letteratura dtsponibiU sugli effetti patologid di tale esposfzione, a soprattutto suU'inSorgeiua di mcsotelioioii tra i metcanici e gii altri lavoratorl delta ferrovie. Sono qtiindi riportati 130 cost di mesotelioma (122 plcurici, 1 pericardUio, 0 peritoneal! ed 1 pleuro-peritonealc), dovuti all'esposlzione alFamianto usato nelk ferrovie, osservati in vnrta regioni italiane. Cin- quantatre di questi casi (tra cui 49 riportati nella Regione Emilia Romagna) sono stati sottopostl ad una anali&i dcttagliata pjsso I'Istituto di Oncologia di Bologna. Settanta- sette casi di mesotelioma sono insert! tra lavoratori delta FS espofiti professlonalmcnte (soprattutto meccanid): 45 casi sono insorti tra meccanici di rotabili e lavoratori impfe- gati nella ripararione e demolizione di linee ferroviaric, in offttfne non appartenenti aile FS; 3 casi sono insorti tra impiegati non appartenenti alta FS, viagglanti su rotabili', e inline 5 cast sono insorti ncijfam'iUari (l figlia, 3 mogli c 1 sorella} di lavora tori delta ferrovie. Questa serie di casji, insieme a ca$i aimlll riferltl ncllu ietteratura, prova cbe i'amianto usoto ne)la ferrovie costituisce un rischio importante per la salute, e sottolinea la gravity di tale rischio. ^ulla base del dad disponibili, sono considerate nccessarie le seguenti aztoni: la promozlone di studi cpidemlologici sistematici, l'ado- zione di misure di prevenrione, i'attuarione di una sorvegliaiua medica oncologica, ed il risardmento automatico per i ttunori insorti in. SCguito all'esposlzlonc alTamlanto usato nolle ferrovie, .- j Key hlords; mesothelioma; asbestos; railroads European Rimaznni Foundation of Oncology and Envircnmcnuil Sciences, and Bologna Institute of Oncology, Bologna, Italy Tins investientian has been' performed within fhe Erptnework of the oncologic epidemiology programme of the Ramazzbi) Foundation or Oncology and Enjrironmentul Sciences and of the Bologna fnaltluie of Oticalogy, supported by tho Bologna Section of the lli lien League tor the Fight against Cancer Received 12/31/2002 11:01AK in 11:06 on line [21 for 40ALSTON * Pg 13/2B 12/31/02 TUB 11;06 FAS PENCO INFORMATION @013 462 haltoni at al INTRODUCTION To present, 13(j cases of misothelioma among people exposed to asbekos used in the Italian State Railroads (Ferrovie delio Stato=FS) (mainly; workers jbecause of their job) have been ascertained. To our knowledge, this isj the largest single series of cases of mesothelioma doe to such ex posure, worldwide This repojt refers the main epidemiological, clinical and patho logical data dealing with these c ises. ' The oncogenic risks related to asbestos exposure asbestos produces, in laboratory rodents, tumours of the lung and mesotheliomas of the pleura and peritoneum (S, 17,72). The following population groups are at risk for diseases related to asbestos; wor kers occupationally exposed to this ma terial (because of their job, or because of the contamination in the workplace), fam ily members of these workers (who bring home traces of the mineral in their clothes, in their hair and on their bodies), and those citizens who live near places where asbestos is quarried and utilized, or in any other places where asbestos is pres ent for some reason. From the beginning of this century, tens Uses of asbestos in railroads, with particu of millions of tons: of asbestoi , in various lar regard to Italy mineral forms (mslinly chiysome, crocidol- ite and amosite) have been quarried and Asbestos has been employed in the rail utilized for an enormous radge of uses, roads of many countries for a variety of > which include: thej prbductionljof asbestos- uses: 1) for a long time (since the '30s) as s cement, of manufactured products for the material for insulating boilers and water I builing industry, drid of pipes the insula and steam mains; 2) subsequently, for the tion of buildings and means 6f transport insulation of locomotive driving cabins ! i ation by both lank and sea; the construc and carriages; and 3) in more or less re i tion of brakes, etc. It has been estimated cent times, for the production of asbestos* that there are about 3,000 uses of asbe cement ties, which substituted those made stos (8). j: . I of wood. ' Tim association between exposure to In Italy, since the '40s, asbestos has asbestos and malignant tumours was es been utilized, generally in the form of tablished for the jbrst time by Lynch and boards and bands, to insulate boilers and Smith (1935) (9),jwho described a case of mains. In the '60s asbestos was used to in lung carcinoma associated to asbestosis. sulate drivipg cabins pf a particular type Since then, asbestos has been shown to of locomotive. From the '50s to the '70s produce, in humans, carcinomas of the asbestos was widely used to insulate the lung and mesotheliomas of the pleura and newly-built carriages, and to replace in peritoneum, and ki increase Jn the carci flammable insulating materials (such as nomas of the up^ter respiratory tract, of cork) in older carriages. The quantify of the oesophagus, jstomach, intestine, and asbestos employed to insulate a carriage gall-bl&dder/bile ducts and of the kidney was high: up to 1,000 kg per carriage. The (8,72,73). I. I systematic substitution of wood ties with The carcinogenicity of asbestos has asbestos-cement ties has been carried out been confirmed by experimental data: since the 70s. Chrysotile was the type of ITT* \ Received 12/31/2002 11:OlAM in 11:06 on line [2] for 40ALST0H * Pg 14/28 12/31/02 TOE 11;07 FAX PENCO INFORMATION ASBESTOS AND MESOTHELIOMA IN RAILROAD WORKERS @014 i 463 i s, in laboratory rodents, ng and mesotheliomas of ifoneum(8,17,72). population groups are at related to asbestos: worlly exposed to this mathdr job, or because of in the workplace), ftunleee workers (who bring the mineral in their air and on their bodies), s who live near places quarried and utilized, or s where asbestos is presn. # railroads, with partial* :en employed in the railiiunties for a variety of time (since the '30s) as ating boilers and water 2) subsequently, for tilt imotive driving cabins 3.) in more or less reoduction of asbestos- substituted those made the 140s, asbestos has orally in the form of to insulate boilers anti isbestoe was used to in ns of a particular type m the *50s to the '70s ly used to insulate the es, and to replace lu ng materials (such as riages. The quantity of to insulate a carriage 00 kg per carnage. The tion of wood ties with s has been carried out ysotfie was the type of asbestos prevalently used in the Italian C. workers engaged in the cleaning of railroads. .= carriages; ! About 10-12 years ago, for health- D. workers who are engaged in repair reasons, the removal of. asbestos from ing, demolishing the rails and correlated carriages was started in a systematic way. Structures, and in manoeuvring the points, Such removal has been performed partly since both the rails and the points can be in the workshops of the FS, and partly contamined by the asbestos dropped Prom in private workshops, with no adequate- the rolling-stock; and protection conditions particularly In the E. engine-drivers who work in locomo private facilities. The pollution resulted, tives which contain structures insulated therefore, particularly, high in private with asbestos. workshops. Removal of asbestos in such conditions, may have caused additonal risks of asbestos diseases among a wide, although not defined,, working popula tion. Asbestos was and still is replaced in carriages with glass fibres, in the past used "freely", and at present wrapped in plastic containers; on the basis of scien tific information, this type; of substitution may represent a problem pf occupational and environmental health In the near fu ture. ; Rolling-stock machinists end workers en gaged in the repair and demolition of the rails, of workshops not belonging to the FS (occupational exposure): A. workers engaged in the construction, repair and demolition of rolling-stock, and the removal of asbestos from rolling-stock ("machinists"); B. workers engaged in checking, repair ing and demolishing the rails' and corre lated structures; and 1 Groups of populations at risk due to expo C. workers engaged in the. collection, sure to asbestos used in j the railroads, transportation and stockage of waste con - with particular regard to the. Italian situ taining asbestos. ation i ' ' The following population; groups are potentially exposed to the asbestos used in railroad rolling-stock: ; .F Workers of the FS, especially machinists (occupational exposure): ; A. workers engaged in the repair, de molition, technical control;and mainten ance of rolling-stock, and in the removal of asbestos from rolling-stack ('`machin ists"); j B. workers engaged in jthe collection, transportation and stockagej of waste con taining asbestos; |; Personnel working on rolling-stock, be longing and not belonging to the FS (work place pollution: environment l exposure): A. the travelling staff of the FS, due to the great quantities of asbestos used to in sulate certain types of rolling-stock; B. the staff of companies which run the restaurant and sleeping-cars; C. post-office employees who travel in postal carriages; D. railroad policemen; E. soldiers; F. porters, and G. others. u I Received 12/31/2002 11:01AH in 11:06 on line [2] for 40ALSTON * Pg 15/28 12/31/02 TUB 11:07 FAX FENCO INFORMATION ,, @015 464 M'tLTONI BT AL family members of exposed workers of the served in railroad machinist;:, the risks fS and, of workshops not belonging to the due to asbestos used for insulating the FS (family contact) rolling-stock reach the dimension of an extremely severe and ubiquitous public Commuters. .! f health problem. In Italy, railroad machinists work in the Major Repair Workshops (MRW), in Lo The available information on the on comotive Depots (Up), and in Elevation cogenic effects of asbestos used in the Squads (ES), and also in the stations and railroads at world level along the lines for checking and emer gency repairs. j Since 1950 (82), cases of asbestos!* It has been estimated that there are and tumours (particularly mesotheliomas) more than 15,000 Italian PS machinists correlated to exposure to asbestos used In presently at work, ofr which more than railroads have been reported in several 8,000 are employed in the MRWs, It has countries. The previously available data also been calculated that the total number are listed in table 1. of FS machinists, who! worked for periods The table includes the findings reported of various lengths oti the railroads from by Mancuso (40, 41), which greatly con 1950 to date (inclusive of those dismissed, tributed in drawing the attention of the in retired, deceased and j still working, which ternational scientific community to the means the entire cohort at risk), amount health risks due to exposure to asbestos to about 50,000 individuals (25,000 of among railroad machinists. The table also whom at work continuously or periodi includes the Italian series of mesothelio cally in the MRWs). - j . mas. I Moreover, it is estiinated that an equal number , of rolling-stock machinists, with various types of jobs,Sworked and are still THE ITALIAN CASES working in railroad (workshops not be longing to the FS; it dan therefore be esti At present, 130 cases of mesothelioma mated that in our country the railroad ma following exposure to asbestos used in chinists considered tej be at risk because railroads have been found in various Ita of exposure to the asbestos used in the lian regions. The series of the cases is not railroads, from 1950 j to date, amount to the result of a systematic epidemiological about 100,000. This estimate does not in investigation, but rather of clinical and pa clude the workers of private workshops thological observation and anecdotal, in recently engaged in the removal of asbe formation. stos: from carriages. | For the 53 cases directly diagnosed/stu Extrapolating fromI the Italian data the died at the Bologna Institute of Oncology, number of rolling-stock machinists at a a systematic collection of all the available European and world ijavel, considering the information and raw materials on the oc other groups, occupationally or not poten cupational history, on the diagnostic as tially exposed, and taking into account certainment, and on the treatment and the furthermore the- available information clinical evolution, was carried out In par nn the asbestos-correlated pathology ob ticular all the available cytological and m IMJ-l'. . ,H.L.P!)p|lJ||MII|l Received 12/31/2002 11:01AM in 11:06 on line [2] for 40ALSTON * Pg 16/28 12/31/02 TUE 11:0* FAX PENCO INFORMATION id machinists, the risks used for insulating the h the dimension of an and ubiquitous public ^formation on the onf asbestos used in the level i2), cases of asbestosis tfculariy mesotheliomas) jsure to asbestos used In een reported in several reviously available data L. dee the findings reported 41), which greatly con ig the attention of the in?tific community to the to exposure to asbestos lachinists. The table also an series of mcsothelio- ASBESTOS AND MESOTHELIOMA IN RAILROAD WORK HRS ,ES 0 cases of mesothelioma re to asbestos used in en found in various Itaseries of the cases is not stematic epidemiological rather of clinical and paation and anecdotal, in t i l 1 is directly dtegnosed/stuna Institute of Oncology, ction of all the available uw materials on the oc/, on the diagnostic as3D the treatment and the was carried out. In parvailable cytological and @016 465 1 2/3 1 /0 2 TUE 1 1 :0 8 FAX Received 12/31/2002 11:01AM in 11:06 on lin e [2] fo r 40ALSTON * Pg 17/28 . PENCO INFORMATION (CoMlitued mbte 1) I Reference Country Asbestosis Lung . carckioenas Pieuial (>) PathoJoEY (No. ofcases) Mesotheliomas Pericardial Peritoneal Other/ unspecified site * Total Others Ol O' 1 VonRuUrtcr(Sl), 1985 Switzerland 14 , .,, 1 lUpbserrerf . 12.7 ejected 1 Mahoni (14). 1986 (1) Italy ! 5faenfeer(70), 1986 USA [ Hjorstberg(7),1988 Sweden 7 4 Maltoni (24), 1989(f) uSA Italy 13' 31 14 7 16 20 ... j , 14 31 ldtpleuror---peritoneal carcinosis" 87 pleura! plaques K 3z Bignon(2), 1990 Mahoni [19), 1990(f) Malta (123,1990(6] Mahoni (31), 199L (f) Mahoni (23), 1994(f) France Italy Sweden Italy Italy 78 1 11 80 1 114 1 49(B) 49 4 83 8 19 4 85 6 1(h) 122 (a) Casts of lung carcinoma were reported in several publications; in this table however data are only listed when both observed and ex pected numbers were indicated (b) These 2 different reports seem to deal with the same South African cases (c) These 2 different reports seemto deal with the same US cases (d) 4^ mesotheliomas, 2 "endotheljoiiias" and 2 "cancers" of the pleura (e) These 3 {Efferent reports seem to deal with the same Swedish cases (f) These 5 differentreportsdeal with the same Italian cases (g) 33 cases with asbestos exposure exclusivelyinrailroad industries 16 cases with asbestos exposure and in outside railroad industries (h) Plettro-pcritoneal mesothelioma _ @ 017 __ u.s'vs* 12/31/02 ' ,n m^,3b&2SiSrT" *pg w28 !' @018 ASBESTOS AMO ME SOTH6UOMA IN RAtUOAD WORKERS 467 histological slides 1 vere examined an 1 the One hundred and twenty-six of the total mesotheliomas classified by histo ypes, 130 cases have been previously published following the rules|iof the Italian Na ional (13-16, 19-24, 26-39, 47-64, 67, 68, 74, Panel on Mesothelipmas, of the Italia a So 75,80), ciety for Tumour | Prevention, Diagnosis The distribution of the 130 observed and Therapy (46), These 53 cases art dis cases, by categories of exposed popula tributed as fellows; | ; tion, and by site of the mesotheliomas, is -- 49 cases in the Emllla-Romhgn i Re reported in table 2: the great majority of gion, of which 4 ill cases in Bologna (32 the cases (122 out of the total 130) were among workers of |the FS, 6 among roll located in the pleura. The distribution of ing-stock machinists and workers!engaged the 54 cases observed in the Emilia Ro in the repair and demolition of the rt Its in magna Region, by categories of exposed workshops not belonging to the FS,! nd 3 population and by site of the mesothe in family members pf FS workers); 2 ases lioma, is presented in table 3: 52 out of in Bimini (among IS workers); 6 ernes in the 54 cases were localized in the pleura. Reggio Emilia (among workers d>f v Work The distribution by Italian regions of shops not belongingTM the FS); the 122 cases of mesothelioma due to job -- 1 case in the Abruzzo Regio i, in asbestos exposure is presented in table 4. t Sulmona (in an FS wprker); . Fifty-one cases out of the 122 (41.8%) i -- I case in thfe Liguria Regioi i, in were found in. the Emilia Romagna Re f Genova (in an FS worker); gion. The Inhabitants of the Emilia Ro -- 1 case in the iLombardia Regio a, in magna Region account for the 6.9% of the Milano (In a non FS [worker); and : Italian population (about 4 out of 58 mil -- 1 case in the Veneto Regior; in lions). The foot that a high percentage of Vicenza (in an FS wc rker). our scries of cases of mesothelioma come Table 2 -130 Italian apses of meiothelipmt s due to asbestos used m railroads; distribution acconiina to the category afpopulation exposed and to ihe site ofthe neoplasia Category I Asbestos exposure due lojob assignments No. ofcases of mesotheliomas Pleural Pericardial Peritoneal PlCuroperitoneal Total - Workers ofthe PS (a) [especially machinist I 74 77 - Rolling-stock machiir Ms and workers engaged in the repair i jnd demolition of the 40 45 rails, ofworkshops nc t belonging to the-FS - (Total) ' (114) (1) (6) (1) (122) Asbestos exposure due in workplace poljutlt it - Personnel working on polling-stock, not employed by the FS 0 0 03 Asbestos exposure due fa family contact: - Family members ofexposed workers of the FS and of worfcsh* : not belongingito thcFS 12/31/02 Received 12/31/2002 11:01AM in 11:06 on line [21 for 40ALSTON * Pg 19/28 THE 11:09 FAX f PENCO INFORMATION @019 468 ALTONI ET AL Table 3 - 54 Emilia Ron lagna cases ofmesoih :iiomas due to asbestos used in railroads: distribution ac cording to the category o -population exposedi nd to the site ofthe neoplasia Category No. ofcases of mesotheliomas Pleural Pericardial Peritoneal Pleuraperitoneal Total Asbestos exposure due job assignments - Workers of thsFS (a), especially machinists 34 0 35 - Rolling-stock machinii its and workers ' 15 0 16 engaged in the repairss|nd demolition ofjthe rails, of workshops no belonging to thelFS (Total) (49) 0) (0) (1) (51) Asbestos exposure due i oworkplace pdlutio t - Personnel working on rolling-stock,not employed by the FS o 0 00 Asbestos exposure duo o family contact | - Family members of ex weed workers of. the FS and ofworkshc pis not belonging to theFS Total 52 (a) FSHFerrovie dello Stato (Italian Staie'Rallroads) 54 Tabic 4 - 322 Italian cases of mesotheliomas due to asbestos exposure bicause of the fob as$, Jrt- meats (77 workers of the FS and 45 workers not belonging to the FS): distribution by region Region Casesl FS Not FS T< lal Abrwzo Campania Emilia Romagna Friuli-Venezia Giulia Lazio Liguria Lombardia Marche Piemonte Puglia . Sicilia . Toscana Trentino Umbria Vcncto All regions 10 2 9 t. 35 16 5. 29 03 24 31 10 92 40 20 1 8 i; 10 10 70 77 45 ! 12: I from the Emilia Romagna Region may be explained by 2 factors: 1) for a long tune, large FS and non-FS railroad workshops have been located in this region, and 2) moreover the cases of mesothelioma are systematically diagnosed, described and registered with particular dlligency in this area of Italy, by our institutions. The job assignments and their fre quency among these 122 cases are re ported in table 5, The average latency period (the time elapsed between the start of the exposure and diagnosis) of these cases is 31,0 years. The years of diagnosis, the period of latency, the survival times (period elapsed between the Hist signs/symptoms and death) and the age at death of 46 out of the 52 cases of mesothelioma due to asbe stos exposure because of job assignments in the Emilia Romagna Region, are given in table 6. The average period of latency ji .i*i 12/31/02 Received 12/31/2002 11:01AM in 11:06 on line 12] for 40ALSTON * Pg 20/28 THE It:Oft FAI PENCO INFORMATION <> @020 ASBESTOS AND HESOTHEIJtcqi.A IN RAILROAD WORKERS 469 -l Table 5 -122 Italian eases ofmesotheliomas is 30.5 years (ranging from 12 to 49 to asbestos exposure beams of tfie Job task years); the average age at death is 61 meats (77 workers of the FS and 43 workers i belonging to the FS): fttquenty of job ttssi, meats ' years (ranging from 3$ to 77 years); the average survival time is 15,8 months 1 Decreasing 'S <> order offrequency . Jobassignrr (ranging form 3 to 53 months). The job and the year of diagnosis of the 3 mesotheliomas due to workplace pollu tion are given in table 7. s I> .s S' 11 'k t It 1 Insulators and pantars The kinship, job assignments of the ax- 2 Electricians and eleefro-m echan- posed workers belonging to the family and ics 3 Labourers 4 Mechanical repairers 5 Engine drivers . the year of diagnosis of the 5 cases of mesothelioma due to asbestos exposure by family contact are given in table 8. 6 Joiners The distribution by death quinquen 7 Pipefitters nium of 107 of the 130 observed Italian 8 Mechanical contrt>ilejrs cases is given in figure 1. In the 2 decades, Welders j between 1970 and 1989, there is a clear- a CO XI f ' I 9 ' Boiler repairers Pointsmen j ! Sheet metal workers Upholsterers cut trend toward an increase in mortality. The trend toward mortality increase is even sharper when one considers the cases of the Emilia Romagna Region, 10 ' Foremen which must be considered to more accur Insulating board markers ately reflect die natural situation (figure < \ , Mechanics 2). Over and above the 130. cases herein ' 1 2S3h4un5te6r7s 8 9 10 11 12 11 ' Brakesmen Engineers < Controllers ' Fitters reported, nine new cases of probable mesothelioma among machinists of FS and not FS workshops are now being stu died in our Institute. Millers Rail inspectors Riggers . CONCLUSIONS Superstructure mechanics Supplies and station workmen From the reported data, some conclu 12 Carriage strippers Compressor operators Drivers Finishers Insulation removers Lappcrs Messengers Polishers Railroad lines machinists Skilled workmen sions can be drawn. 1. The series of Italian cases of meso thelioma due to asbestos used in the rail roads definitively confirms the high carci nogenic risk of this exposure. 2. Cases of mesothelioma correlated to exposure to asbestos used in the railroads have been observed in 15 out of the 20 Italian regions; this means that in Italy the problem is ubiquitous. WWW m 1 11C5CJ UlUCIOH 1C|JUI 1&U W m o l U1CU U lfi r l | j .1 Received 12/31/2002 11:0tAM in 11:06 on Line C2J for 40ALSTON * Pg 21/28 12/31/02 TUB 11:09 FAX PENCO INFORMATION @021 470 MAL.TONI ET AL Table 6 - 46 fa) Emilia Romagna eta M of mesotheliomas due to asbestos exposure because ofjob as signments (34 workers, of the and, 3 workers not belonging to FSj: years Of diagnosis and period of latency (46 cases), anytime elapsed b rWn start ofexposure and death, time elapsed between (he finu signs and/orsymptoms and death, !,e, s ((vbtpl time and age at death (40 cases) Category UL . Yeas Period of Utency Timeelapsed between Survival tine Age at death 4 ,(KBB) siari ofexposure turd fmontlulfvearsl Total Dead SdD diagriisp Average Raeae___ deaili fveanl___ Average Range Average Range ! alive ____ Average Range _________ FS workers 34 |30 Not FS workers 12 ilO i Total 46 :40 4 1978 2 '19*5 31.1 16-49 28.6 12*39 6 1976 93 303 12-49 33.3 31,5 32.9 17-49 15.1 3-44 60.7 39-77 26-41 17.9 4*53 61.5 45-77 17-49 15.fi >53 61.0 39-77 {a) Out of the 51 Table 7-3 Italian cases ofmesotheli* >mi as due to asbestos exposure because vfwrkptta * pc,fiuiton (workers not belonging to the PS): tif year ofdiagnosis j. Cases Job| Year';*! diagnosis 1 Military radar[operator 2 Post office clerk ' 3 Sleeping-car attendant lW\ 196'lj 19S9i Fig. 1 - 107 Italian cases (out of 130 observed] ol mesotheliomas following emoeure to asbestos used in railroads: distribution by death quinquennium Table 8*3 Italian cases of mesothelii due to asbestos exposure by family contact: iURiIshlp, job assignments of the deposed workeri ivil 'itn the jarc Cases Kinship Job assignments of i f die imposed worker: dilgDOSIS 1 Daughter Pointsman (FS) 2 Wife 3 Wife Enginne driver (PS) Mac"iinist (FS) 4 Wife Mac uniat (not FS) .966 *989 1994 ibss 5 Sister MachiIntit (FS) p95 IMMM IIW-N WMI IH044 F.Z - 45 Emilia Romagna cases (out or 54 eases of mesotheliomas folk*whig esposure In asbesto* used in railroads: distribution by death quinquen nium (of 1 patient the date of death Is net knowr and 8 patients arc still alive) 12/31/02 Received 12/31/2002 11:01AM in 11:06 on tine [2] for 40ALSTON * P9 22/28 TOE 11:10 FAI FENCO INFORMATION asbestos and mbs mieuoHA in railroad workers @022 471 7s exposure because ofjab as'ars ofdiagnosis and period of time elapsed between the first ai Survival time Age at death t fnwjithrt___ (venal . Average Range Average Range 15.1 3-44 60.7 39-77 17.9 4-53 61.5 4J-7? ' 15.3 3-53 61.0 39-77 + -vse* (out of 130 observed) of vine esposure to asbestos used ' onby death quinquennium ! ji 4 ji i l 4 I 4 I I I * HTiagna easel (out of S4 cases) illowing esposure to asbestos stribution by death quinqupiie dale of death ii not known alive) i l .3. The majority of cases have beer ob and thoracic surgery), which facilitate both served in the Emilia Romagna Region. ' diagnosis and registration. This rinding may be Riel effect of a pecu 7. The average latency period of this liar local situation of risH which shonjd be neoplasia, following job exposure among better assessed, and/or of a more accj irate workers of the FS and among workers of registration of the casei. i workshops not belonging to the FS, Is 4. The great majority of reported t ases -31-0 years at the national Level (30.5 years of mesothelioma occurred ' after 1 )80, for the Emilia Romagna cases). This pe- with an historical trend {which indlcai es a riod is shorter than that reported by Mfui- sharp tendency to increase, bath at thi na ` cuso (40) (about 45 years) and by Schen- tional level and in tlie 'Emilia Rom igna ker (70) (about 39 years): these data sug Region (figure 1,2). [ : gest a possibly heavier exposure of the Ita 5. The reported mesotheliomas ot cur- lian workers. red, following occtipationkl exposure 8. The data on survival (table 6) further among machinists and ojdier FS wor! :ers, confirm the poor prognosis of mesothelio among machinists ofj rolling-stock vor- ma. In our experience the natural history kshops not belonging to [the FS, folio ring (clinical evolution) of mesotheliomas is environmental workplace expos urc, not objectively modified by any type of among workers non Employed in the FS, therapy: the difference in the time pro but whose job was carried out on rof ing- gression, and therefore in survival, obser stock, and among faniily members ol ex ved among different cases, on the basis of posed workers. These {observations: de 1 preliminary results of a study in which we monstrate the real carcinogenic risk w rich evaluated the correlation between the pa exists in the various categories potenl ally thological characteristic of mesothelioma exposed (listed above). [The probleii i of and the prognosis, mayi be due rather to travelling employees and of travdlei s in die biological features of the different ty general, mainly those!who spend seieral pes of mesothelioma, which should be bet hours daily on trains, wfll be further i lve- ter assessed. ' '" sligated by the European Ramaizlni 9. The reported cases demonstrate, but Foundation and by the Bologna Institute do not quantify, the risk due to exposure of Oncology, utilizing the! data of the jacal ` to asbestos used in the railroads. Our se cancer registry, : . ries of cases of mesothelioma is not the 6. The great majority of mesothelic mas result of a systematic epidemiological in is localized in the pfonja. However^ the vestigation, but, as already stated, of occa onset of some cases of jmesotheHom t of sional clinical observations and Informa the peritoneum and pericardium mua in tion. It is logical to think, therefore, that duce us to take into careful considers lion the number of the cases reported by us is these sites also. This Icaje must be iven inferior to the real one, so underestima- greater, because the diagnosis of peritone . ting foe actual risk situation. Furthermore, al and pericardial mesothelioma -tnaj. be it must be considered that, on the basis of more difficult per sej and also bed use available scientific knowledge (71) for there are not, for ttaesje rites, specific: de each case of mesothelioma, other cases of partments, as is the case: or pleural ref :$o- tumours of different site/type due to foe thdiomas (departments of pneumd ogy same exposure to asbestos can be expec- | T Received 12/31/2002 11:01AM in 11:06 on tine t2] for 40ALSTON * Pg 23/28 12/31/02 TOE 11:10 FAX PENCO INFORMATION 0023 472 MALTONI er AL led. In conclusion, only A systematic epi demiological investigation can provide us with correct information on the reil bur den of the risk brought about by the past use of asbestos in railrajads. i The data which have been presented and the information giyen in the literature call for a series of actions which, inj consi deration of the extent and gravity |6f the problem, should not bej procrastinated, iec L the promotion of systematic |epide miological investigatioiis on railroad'wor kers (particularly machinists). Mortality studies by cohort are easily feasible; in the cases of the Italian F$ workers, since the employing administration has kept isill the records of its employees. A mortality stu dy by cohort on the machinists of (he FS, who had worked and j are working jin (he FS Compartment of the Emilia Rpmagna Region, is now becnj performed by our Foundation and Institute; j 2. the promotion and achievement of measures of primary prevention, to lower or eliminate the exposure to asbestds; such as: removal (in controlled conditions) of asbestos, its substitution with othd batc- rials (which must, bbwever, be proven safe), and measuresofprotection in th^y/ork- place. The choice of alternative material; is a difficult problem. The use of glass fibres, which has been going On for many yi sirs, in conditions often not sufficiently controlled, has been a choice which deserves Ifiirther and prompt reconsideration. Hie experi mental data have shojvn that glad fibres produce mesotheliomas in exper&iental rodents (65, 77, 78). |An epidemiological investigation performed by the Internatio nal Agency for :Research on Cancer (IARC), with the collaboration of Europe an glass fibre manufacturers, has indicated an increased incidence: of lung carcmoififw among workers exposed to glass! [fibres i (76). Recently, we have described 2 cases of mesothelioma (1 pleural and 1 peritone al) in workers exposed to glass fibres, in whose occupational history there was no trace of asbestos exposure (18,25). 3. the alerting of all workers of the FS, and of the machinists of rolling-stock wor kshops not belonging to the FS, about the syncarcinogenic effect of asbestos and to bacco smoking, with 'respect to lung carci noma, and about the benefit of giving up smoking; 4. the provision of medical surveillance to all workers of the FS and to the machi nists of rolling-stock workshops not be longing to the FS, fbr the early detection of those tumours due to asbestos (such as carcinomas of the upper respiratory tract, carcinomas of the gastrointestinal tract, and carcinomas of the kidney), which, if diagnosed at an early stage, can benefit from therapy. The reported cases definitively demon strate the carcinogenic risk of the groups of workers exposed to asbestos used in railroads. This knowledge should bring about the recognition of the tumours known to be correlated to asbestos expo sure, observed m these groups (including people environmentally exposed in the workplace), as being occupational diseases and therefore eligible for compensation. The possibilities of compensation for me sotheliomas following familiary exposure deserve prompt consideration. SUMMARY The available knowledge on the onco genic risks of asbestos, the data on the uses of asbestos in railroads, with particu lar regard to the Italian State Railroads (Ferrovie dello Stato=FS), and the groups at risk due to the exposure to asbestos 12/31/02 Received 12/31/2002 11:0tAM in 11:D6 on line [2] for 40ALSTOH tt Pg 24/28 TUB 11: 10 FAX PENCO INFORMATION \ @024 we have described 2 cases i (1 pleura! and 1 peritoneexposed to glass fibres, in onal history there was no * exposure (18,25). g of all workers of the FS, unists of rolling-stock worngittg to the FS, about the effect of asbestos and rowith respect to lung carciut the benefit of giving up ion of medical surveillance d the FS and to the machi-stock workshops not beFS, for the early detection rs due to asbestos (such as be upper respiratory tract, the gastrointestinal tract, ; of the kidney), which, if n early stage, can benefit I cases definitively demonnogenic risk of tire groups used to asbestos used in knowledge should bring lition of the tumours .dated to asbestos expoin these groups (including mentally exposed In the jjoing occupational diseases eligible for compensation, s of compensation for me(owing familiary exposure consideration. t i I t I I i Y i t r i I + I ii * i knowledge on the oncoa$be$to$, the data on the s in railroads, with particuhe Italian State Railroads Stato--FS), and the groups the exposure to asbestos i i * iL * i vt'1 ASBESTOS aNS MESOTHELIOMA IN RAILROAD WORKERS 473 used in railroads were briefly reviewed. The available data on the pathological] ef-; feels of such exposure, And particular!^ on. the onset of mesotheliomas among maphi-: nists and other railroad porkers, were also! summarized. One hundred and thirty lea ses of mesothelioma (122 pleural, 1 fieri-: cardial, 6 peritoneal anjl 1 pleuro-perito-; neal), related to the exposure to asbestos! used in railroads, observed in various life-, Han regions, were reported. Fifty-three of: these cases (among whiph 49 repotted in the Emilia Romagna Region) were submit ted to a detailed study ^t the Bologna] In-, stitute of Oncology. Seventy-seven cases of mesothelioma occurred among occupa tionally exposed FS workers, in particular machinists; 45 cases occurred among rol-; ling-stock machinists anA workers engaged1 in the repair and demolition of the rails of! workshops not belonging to the F5; 3 ca-j $es occurred among travelling workers of! rolling-stock, not belonging to the FS; and 5 cases were found in family members (1 daughter. 3 wives and 1; sister) of railipad workers. This series of cases, together with similar data from the literature,.]tro ves the existence of 2n[ actual, heath, risk due to asbestos used in railroads, and in dicates its gravity. On the basis of the available data, the following steps are c onsidered necessary; the promotion of syste matic epidemiological investigations, the! adoption of preventive measures, the per formance of medical okcologicai survil-i lance, and the autotnktiti compensation fori tumours following the exposure to the! asbestos used in railroads. 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