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Appendix A ASBESTOS EXPOSURE AND NEIMAN DISEASE. HAILS OBSERVATIONS AND STUDIES F ROM 1898 TO 1979 Disease or Benchmark Contribution to the Field References - Bronchitis ""bestos fiber lohalation in the workplace Anterson, 1898 Phthisis injurious to the bronchial tubes and lungs.' (see Greenberg, Clinical latency mitigates against establishing 1982) a stronger association between work with asbestos fiber and disease, because sick workers leave industry. No mortality data. Pulmonary Death due to pulmonary fibrosis (in an asbestos Murray, 1907 fibrosis textile worker without tuberculosis). Autopsy (see Greenberg, showed fibrosed lungs and presence of "spicules 1982) of asbestos in pulmonary tissues. When the worker wan alive, this sputum contained what was thought to be asbestos spicules." Fibrosis wan believed to be induced by dust. Different work areas had a range of dust conditions. Asbestonis Complete histological and gross pathological Cooke, 1924 description of asbestos. Author originated term anbestosis and cited experimental pathology studies indicating that asbestos dust causes fibrosis in the lungs of guinea pigs. Asbestosis First major reviews of asbentosis. Detailed Cooke, 1927; clinical, radiological, and pathological McDonald, 1927; description. Cooke noted the presence of Oliver, 192? "curious bodies' in pulmonary tissues of asbestotics. Asbestoals attack rate high for testlle workers opining Canadian chrysotile. A~bestoals "Curious bodies" probably some form of coated Cooke, 1929 fiber. Author recommended the term "asbestosis body . " . . . Asbestosis Re~lew of asbestosis in Great Britain and other Merewether, 1930 parts of the world. Relationship between asbestosis and tuberculosis discussed. Latency also discussed. Author suggested different fores of fiber may have different biological acti~rl~les. 237 Hi .

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l 238 Appendix ~ (cont. ) Disease or 8ench-szk Contribution to the Field References l Asbestosis Authors suggested, on the ba8i8 of S7 cases they Wood and Glo~e, had seen, tat tuberculosis increases severity 1931 of scarring in asbestotico. Asbesto~is "Constitutional factored may be important in determining who among the work force is -susceptible to asbestosis." Asbestoals German government lasses dictum forbidding all those under the age of 18 from employment in the asbestos industry. Germans followed Brltlah Home Office. Asbestosis Pleural asbestosis Author dlacussed the different physical and chealcal propertlen of the various asbestos types used in co~erce (e.g., size, shape, "others-) and their poselble role in determining the occurrence of disease and the types and patterns of lesions obeer~red. Different kinds and intensities of exposures in industry also described. Geographic differences in occur- rence of disease may be related to fiber types and/or genetic factors. Role of mineral contao`~nants unknown. Gerbis, 1932 Gerbia, 1932 Glove, 1932 Asbe~tosi ~Mortality data suggested asbestos workers have Merewether, shortened life espectanciea. Greater attack 1933, 1934 rate in mills may be related to the "ability of the fiber to split longitudinally into fibrils creating respirable dust." Asbestosis Lang cancer Primary lung cancer found at autopsy in two Gloyne, 1935 female textile workers with asbe~tosis. Asbesto- Primary lung cancer in Den employed in textile Lynch and silicosis plants in South Carolina. Lungs fibrosed. Smith, 1935 Lung cancer Lung cancer Author found that the length of elapsed time and latency frog' the start of asbestos work until the "bestosis tine of death was 15 to 21 years in all als of the cases Anon to him. In fire of the sis cases, the tumors developed in the lower lobes of the lung, whereas in the general population lung cancer was most colon in the upper lobes. It was well recognized that the more extensive fibroals in asbestosis was also fount in the lower lobes of the lung. Nordma~, 1938 Asbestosis and Among 943 cases of fatal sillcosis in Great Wilson, 1939 1uJlg cancer Britain in 1938, 23 lung cancers occurred attack rate (2.41~. tong 103 cases of fatal asbestosis for all prior years, 12 lung cancers were found (11.61~. Attack rates appeared to be different, although true incidence was unknown.

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. ~ ;~ 239 PPBJDIX ~(cons . Disease or Benchmark Contributlon to the Field References Asbestosis Comparison of autopsy series in general popula- Wedler, 1943 Long cancer tlon with 92 asbestotics. Fourteen malignancies Mcsothe- in asbestotlcs (16Z), compared with approslmately lions (?)a 2: in the "unexposed" general population. Metas Other tases to pleura, peritoneum, and pericardium. cancers (?) Histology much like "sarcoman.- Asbestosis Prevalence of lung cancer aeon" asbestotlce Barrett, 1948 Lung cancer increases with age: 25-34, 4.83; 35-44, 5.63; 45-54, 18.9%; 55-64, 25.61; 65 and older, 23.51. Latency, dose, and aging not separated as factors in this pattern. Lung cancer Other cancers and other sites Paeumoconlosis Compared mortality experience in different 'dusty trades" in Great Britain. Age at death for seven silica-exposed groups ranges from 44 to 63 years (lowest in pottery industry). Asbestos trades averaged 36 years (39 for males, 34 for females. Approximately 14: of asbestotice died with lung cancer. Author noted "strikingly" different attack rates in males and females: 19.6: for males, 9.7: for females. Neoplasms at other sites twice as high in asbestotlcs as compared to other pneumoconlosis groups (about 6:, compared to 3%~. Gloyne, 1951 Lung cancer, This study provided evidence linking certain Brealow et al., occupation, occupations (including those involving asbestos 1954 and ciga- exposure) with lung cancer. The study also rette offered additional evidence associating smoking cigarette smoking with lung cancer. A~bestosis Lung cancer Mesothelioma 5 . i, Cohort study of testlle workers at a plant in Great Britain. Incidence data indicated a standardlsed mortality ratio (SMR) of almost 14; 11 observed, 0.8 expected for lung cancer in workers employed before Protective standards" of the Asbestos Regulations Act of 1931. Author cautioned that smaller risk in workers employed after 1931 may be an artifact; they may have not yet reached "risk" period because of their short elapsed lime after onset of exposure. ~ endothelioo`e was obeer~red in a worker. ~ l~ indicates the tlsease was not diagnosed by Dame. Doll, 1955

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240 APPENDIX ~ (cont.) Disease or Benchmark Contrlbution to the Field , . Iteferences Pleural peso- Thlrty-t~ree cases of pleural aesothelio~a Wagner et al., thello~a reported among alders and Fillers of crocido- 1960 Envirocaental lite in the Northwest Cape Pro~loce, South esothelio~a Africa. Along the cases were area residents with no known occupational exposure. Histo logical evidence of asbestosis was not present in all cases. Pleural plaques Pleural fibrosis and calcification--stigmata Ki~riluoto, Environmental Connally associated with fibrous dust insult-- 1960 stigmata were found in a population ll~lag in a region of Finland where anthophyllite asbestos was mined and milled. ambient asbestos pollution was implicated. Asbestosis Abdominal tumors found in asbestotics durlag Keal, 1960 Abdominal autopsy. Ovarian cancers in women and general tumors carcinomatosis (no primary) in men. Mesothelioma ~ ? ~ Asbestos bodies Asbestos bodies were found in pulmonary tissues Thomson et al., and exposure in 261 of 500 consecutive autopsies conducted in 1963 the general population of Capetown, South Africa. Use of asbestos by society was questioned in view of the known cancer hazard. Asbestosis Morbidity and mortality data for insulation Selikoff Lung cancer workers showed excess cancer and asbestoals et al., 1964 Mesothelioma accounting for most decreased life expectancy. (pleural and Mallgnancies included lung cancer and pleural peritoneal) eesothelio~a. Ihere was also peritoneal Gastrointesti- mesothelioma and an excess of gastrointestinal nal (GI) cancer. cancer Peritoneal Peritoneal aesothelio~a seen in crocidolite- Entiknap and mesothelioma esposed workers. Other intrsabdoo~inal tumors Smither, 1964 Other cancer may have been present as well. (GI) Mesothelio~a Records in an east-end London hospital showed that a large proportion of the aesotheliomas that occurred were in nonoccupationally esposed persons: residents living within a half mile of an asbestos plant ant families of workers. Mesothelio~ Bystander occupational exposure Newhouse and Thompson, 1965 Mesothelio~a observed in shipyard workers whose Harries, 1968 Jobs were not asbestos-related. Most aeso- thelio~as occurred in bystander populations. Importance of fugitive dust raised.

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i . 241 APPENDIX ~ (cont.) Disease or Benchmark Contributlon to the Field Lung cancer and cigarette smoking Pleura asbestosi~ Pu1mor~ ry asbestosis Household exposures Eat rapulmonary cancers Multiple cancer in single hos to Fiber dose, latency, rink References _ Stridence suggested that cigarette - Poking as"atos workers had a greatly increased risk of developing lung cancer as compared to nonsmoking worlmates. The risk appeared to be multiplicati~re--the product of both smoking and asbestos risks. Radiographic and clinical surrey of 678 individuals cohabiting with asbestos workers. Thirty-fire percent (239) of them had pleural or pulmonary asbestosis. Questions raised concerning dust on clothing as the vector of the fiber. (In a follows up study published in 1979, the authors stated that they were ascertaining causes of death among a larger population of house- hold members. Of 550 decedents traced, five deaths were due to pleural mesothelioma.) SMRs showed slight excesses of cancer of the larynx, buccal cavity, brain, skin, kidney, pancreas, and prostate among 2,271 deaths (168,000 man-years of observation) in a cohort of 17,800 insulation workers in the United States and Canada. Authors reported that 2.1: of the deaths involved multiple primary cancers and that occult malignancies were present at time of death. Short-term (l-month) intense exposure to amosite fiber increased lung cancer risk. Latency period inversely related to dose. Selikoff _ al., 1968 Anderson et al., 1976, 1979 Selikoff et al., 1979 Seidman_ al., 1979

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242 REFERENCES Anderson, A. M. IB98. Obeer~rations published in H.M. Chief Inspector of Factories and Workshops, Report for the year IB98. Anderson, H. A., R . Lilis , S . M. Daum , A. S . Fischbein., and ~ . J. Selikoff. 1976. Household contact asbestos neoplastic risk. Ann. N. Y. Acad. Sci . 271:311. Anderson, H. A., R. Lilis, S. M. Daum, and I. J. Selikoff. 1979. Asbestosis among household contacts of asbestos factory workers. Ann. N.Y. Acad. Scl. 330:387-400. Barnett, G. P. 1948. Annual Report of the Chief Inspector of Factories for the year 1946. CMD 7299, Her Majesty's Stationary Office, London. 132 pp. Brealow, L., L. Hoaglin, G. Rasmussen, and H. Abrams. 1954. Occupatione and cigarette smoking as factors in lung cancer. Am. J. Pub. Health 44 :171-181. Cooke, W. E. 1924. Fibrosis of the lungs due to the inhalation of asbestos dust . Br. Med. J. 2:147. Cooke, W. E. 1927. Pulmonary asbestosis. Br. Med. J. 2:1024-1025. Cooke, W. E. 1929. Asbestos dust and the curious bodies found in pulmonary asbestosis. Br. Med. J. 2: 578-580. Doll, R. 1955. Mortality from lung cancer in asbestos workers. Br. J. Ind . Med . 12: 81-86. Entiknap, J. B., and W. J. Smither. 1964. Peritoneal tumors in asbestosis. Br. J. Ah. Med. 21:20-31. Gerbis, U. 1932. Ueber asbestosis der Lungen. Dent. Med. Woch. 58: 285-287. GloyDe, S. R. 1932. The morbid anatomy and histology of asbestosis. Tubercle 14: 445-451 . GIoyne, S. R. 1935. Two cases of squamous carcinoma of the lung occurring in asbestosis. Tubercle 17:5-10. GloyDe, S. R. 1951. Pne~oconiosis. A histological survey of necropsy material in 1,205 cases. Lancet 1:~10-B14. Greenberg, M. 1983. Classical airdromes in occupational medicine: The Montague Murray Case. Am. J. Ted. Med. 3:351-356. Harris, P. G. 1968. Asbestos hazards in naval dockyards. Ann. Occup. Hyg. 11:136. Ki~riluoto, R. 1960. Pleural calcification as a roentgenologic sign of non-occupational endemic anthophyllite asbestos. Acta Radiologica (Supp.) 194:1-67. Keal, E. E. 1960. Asbestos and abdominal neoplasms. Lancet II: 1211-1216. Lynch, K. M., and W. A. Smith. 1935. Pulmonary asbestosis III. Carcinoma of the lung in asbesto~ilicosis. Am. J. Cancer 24:56-64. McDonald, S. 1927. Histology of pulmonary asbe~tosis: A review. Br. Med. J. 2 :1025-1026. Merewether, E. R. A. 1930. The occurrence of pulmonary fibrosis and other pulmonary affections in asbestos workers. J. Ind. Hyg. 12 :198-222, 239-257. Ilerewether, E. R. A. 1933, 1934. A memorandum on asbestosis. Tube role 15: 69-~l, 109-118.

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at. ; ;1 . 243 Murray, J. M. 1907. Report of the Committee on Compensation for Industrial Diseases. Minutes of Evidence. Newhouse, M. L., and H. Thompson. 1965. Mesothelloma of pleura and peritoneum following exposure to asbestos in the London area. Br. J. Ind. Med. 22:261. Nordmana, M. 1938. Der Berufakrebs der Asbesarbeiter. fur Xrebaforschung. Vol. 47. 288 pp. Oliver, T. 1927. Clinical aspects of pulmonary asbestosis. 2:1026-1027. Seidman, H., I. J. Selikoff, and E. C. Hammond. 1979. Short-term asbestos work exposure and long-term-observation. Aan. N.Y. Acad. Sci. 330:61-90. Selikoff, I. J., J. Churg, and E. C. Hammond. 1964. Zeitachrift Br. Med. J. ~ bestos exposure and neoplasia. J. Am. Med. Assoc. 188:22-26. Selikoff, I.J., E.C. Hammond, and J. Churg. 1968. Asbestos exposure, smoking and neoplasia. J. Am. Med. Assoc. 204: 104-~ O. Selikoff, I. J., E. C. Hammond, and H. Seidman. 1979. Mortality experience of insulation workers in the U.S. and Canada, 1943-1976. Ann. N.Y. Acad. Sci. 330:91-116. Thomson, J. G., R. O. Kaschula, and R. R. McDonald. 1963. Asbestos as a modern urban hazard. S. Afr. Med. J. 37: 77-~. Wagner, J. C., C. A. Sleggs, and P. Marchand. 1960. Diffuse pleural mesothelioma and asbestos exposure in the Northwestern Cape Province. Br. J. Ted. Med. 17:260-271. Wedler, H. W. 1943. Asbestose und Lunge~kreba. Deut. Med. Woch. 69:575-576. Wilson, D. R. 1939. Annual Report of the Chief Inspector of Factories for the year 1938. CMD. 6081. Her Majesty's Stationary Office, London. 133 pp. Wood, W. B., and S. R. Gloyne. by pulmonary tuberculosis. 1931. Pulmonary asbestosis complicated Lancet II:954-956.