Change in prevalence of asbestos-related disease among sheet metal workers 1986 to 2016.

BACKGROUND: A medical screening program began in 1986 for sheet metal workers exposed to asbestos, primarily while working alongside insulators applying spray-on asbestos materials, a practice banned in 1973. Exposure continues during maintenance, renovation, and repair. METHODS: Radiographic abnormalities among 26 397 sheet metal workers examined from 1986 to 2016 were analyzed by year of entry into the trade. Logistic regression was used to examine risk factors for parenchymal and pleural abnormalities among the overall study population and among the subcohort who entered the trade after 1973. RESULTS: Prevalence of parenchymal disease was 17.4% for those starting work before 1950 compared with 0.8% for those starting work after 1973 (adjusted prevalence odds ratio [pOR] = 26.65, 95% confidence interval [CI] = 18.46-38.46). For each calendar year after 1973, entering the trade 1 year later was associated with an estimated 12.7% decreased odds of acquiring asbestos-related disease (adjusted pOR = 0.873, 95% CI = 0.832-0.916). CONCLUSION: Sheet metal workers who began work after the US implemented environmental and occupational regulations develop asbestos-related disease at much reduced rates, consistent with regulatory projections made for nonmalignant asbestos-related disease by the Occupational Safety and Health Administration at the time. Cancer remains a concern among this cohort, and lung cancer screening recommendations should consider year of entry into the trade. This study highlights the importance of regulatory intervention and of continued surveillance.

Early detection of lung cancer in a population at high risk due to occupation and smoking.

OBJECTIVE: The US National Comprehensive Cancer Network (NCCN) recommends two pathways for eligibility for Early Lung Cancer Detection (ELCD) programmes. Option 2 includes individuals with occupational exposures to lung carcinogens, in combination with a lesser requirement on smoking. Our objective was to determine if this algorithm resulted in a similar prevalence of lung cancer as has been found using smoking risk alone, and if so to present an approach for lung cancer screening in high-risk worker populations. METHODS: We enrolled 1260 former workers meeting NCCN criteria, with modifications to account for occupational exposures in an ELCD programme. RESULTS: At baseline, 1.6% had a lung cancer diagnosed, a rate similar to the National Lung Cancer Screening Trial (NLST). Among NLST participants, 59% were current smokers at the time of baseline scan or had quit smoking fewer than 15 years prior to baseline; all had a minimum of 30 pack-years of smoking. Among our population, only 24.5% were current smokers and 40.1% of our participants had smoked fewer than 30 pack-years; only 43.5% would meet entry criteria for the NLST. The most likely explanation for the high prevalence of screen-detected lung cancers in the face of a reduced risk from smoking is the addition of occupational risk factors for lung cancer. CONCLUSION: Occupational exposures to lung carcinogens should be incorporated into criteria used for ELCD programmes, using the algorithm developed by NCCN or with an individualised risk assessment; current risk assessment tools can be modified to incorporate occupational risk.

Hearing loss among older construction workers: Updated analyses.

BACKGROUND: A prior study of this construction worker population found significant noise-associated hearing loss. This follow-up study included a much larger study population and consideration of additional risk factors. METHODS: Data included audiometry, clinical chemistry, personal history, and work history. Qualitative exposure metrics for noise and solvents were developed. Analyses compared construction workers to an internal reference group with lower exposures and an external worker population with low noise exposure. RESULTS: Among participants (n = 19 127) an overall prevalence of hearing loss of 58% was observed, with significantly increased prevalence across all construction trades. Construction workers had significantly increased risk of hearing loss compared to reference populations, with increasing risk by work duration. Noise exposure, solvent exposure, hypertension, and smoking were significant risk factors in multivariate models. CONCLUSIONS: Results support a causal relationship between construction trades work and hearing loss. Prevention should focus on reducing exposure to noise, solvents, and cigarette smoke.

Longitudinal decline in lung function among older construction workers.

BACKGROUND: Occupational exposures to vapours, gasses, dusts and fumes (VGDF) and chest X-ray abnormalities by the International Labour Office (ILO) classification system are associated with reduced lung function, with the majority of published studies being cross-sectional. We examined the effects of VGDF exposures, as well as ILO parenchymal changes, pleural plaque and diffuse pleural thickening (DPT) on reduction in lung function in a longitudinal study. METHODS: Chest radiographs and spirometry for 3150 ageing construction workers enrolled in a medical screening programme with a baseline and at least one follow-up examination were studied. Indices for VGDF exposure, parenchymal changes, pleural plaque and DPT severity were developed and used in longitudinal mixed models of lung function. RESULTS: Smoking and VGDF exposure were associated with decreased FEV1 and FVC at baseline as well as accelerated rates of annual decline. High VGDF exposure was associated with a yearly decline of -19.5 mL for FEV1 and -15.7 mL for FVC. Parenchymal abnormalities, pleural plaque and DPT were more strongly associated with reduced FVC. An increase of one unit in the pleural plaque severity index resulted in approximately -5.3 mL loss of FVC and -3.3 mL loss of FEV1, with a possible non-linear effect of plaque on FEV1. CONCLUSIONS: Increasing pleural plaque severity was associated with progressively greater loss of FVC and FEV1, supporting a causal association. VGDF exposures were associated with reduced FVC and FEV1 at baseline as well as accelerated annual loss of lung function.

Impact of Secondary Prevention in an Occupational High-Risk Group.

BACKGROUND: A study of medical outcomes among 6857 elderly construction workers who received an initial and at least one periodic follow-up examination as a result of participating in a medical screening program was undertaken. METHODS: We compared results from the initial examination to follow-up examinations delivered at least 3 years after the initial examination for the following outcomes: body mass index (BMI); total serum cholesterol; nonhigh-density lipoprotein (non-HDL) cholesterol; hemoglobin A1c, hypertension; current cigarette smoking; and 10-year cardiovascular disease (CVD) risk scores. RESULTS: Statistically significant improvements (P < 0.05) were observed for all measures except BMI. CONCLUSIONS: Participation in a periodic medical screening program for elderly construction workers is associated with a favorable impact on common health outcomes. When presented with a program designed for them, blue-collar workers are motivated to seek improvements in their health status.

Beryllium disease among construction trade workers at Department of Energy nuclear sites.

BACKGROUND: A medical surveillance program was developed to identify current and former construction workers at significant risk for beryllium related disease from work at the DOE nuclear weapons facilities, and to improve surveillance among beryllium exposed workers. METHODS: Medical examinations included a medical history and a beryllium blood lymphocyte proliferation test (BeLPT). Stratified and multivariate logistic regression analyses were used to explore the risk of disease by age, race, trade, and reported work in buildings where beryllium was used. After adjusting for covariates, the risk of BeS was significantly higher among boilermakers, roofers, and sheet metal workers, as suggested in the stratified analyses. Workers identified as sensitized to beryllium were interviewed to determine whether they had been subsequently diagnosed with chronic beryllium disease. RESULTS: Between 1998 and December 31, 2010 13,810 workers received a BeLPT through the BTMed program; 189 (1.4%) were sensitized to beryllium, and 28 reported that they had had a compensation claim accepted for CBD. CONCLUSIONS: These data on former construction workers gives us additional information about the predictive value of the blood BeLPT test for detection of CBD in populations with lower total lifetime exposures and more remote exposures than that experienced by current workers in beryllium machining operations. Through this surveillance program we have identified routes of exposures to beryllium and worked with DOE site personnel to identity and mitigate those exposures which still exist, as well as helping to focus attention on the risk for beryllium exposure among current demolition workers at these facilities.

The worldwide pandemic of asbestos-related diseases.

BACKGROUND: Asbestos-related diseases are still a major public health problem. The World Health Organization (WHO) has estimated that 107,000 people worldwide die each year from mesothelioma, lung cancer, and asbestosis. We review what is known about asbestos use, production, and exposure and asbestos-related diseases in the world today, and we offer predictions for the future. Although worldwide consumption of asbestos has decreased, consumption is increasing in many developing countries. The limited data available suggest that exposures may also be high in developing countries. Mesothelioma is still increasing in most European countries and in Japan but has peaked in the United States and Sweden. Although the epidemic of asbestos-related disease has plateaued or is expected to plateau in most of the developed world, little is known about the epidemic in developing countries. It is obvious that increased asbestos use by these countries will result in an increase in asbestos-related diseases in the future.

Developments in asbestos cancer risk assessment.

BACKGROUND: Efforts have been made for 25 years to develop asbestos risk assessments that provide valid information about workplace and community cancer risks. Mathematical models have been applied to a group of workplace epidemiology studies to describe the relationships between exposure and risk. EPA's most recent proposed method was presented at a public meeting in July 2008. METHODS: Risk assessments prepared by USEPA, OSHA, and NIOSH since 1972 were reviewed, along with related literature. RESULTS AND CONCLUSIONS: None of the efforts to use statistical models to characterize relative cancer potencies for asbestos fiber types and sizes have been able to overcome limitations of the exposure data. Resulting uncertainties have been so great that these estimates should not be used to drive occupational and environmental health policy. The EPA has now rejected and discontinued work on its proposed methods for estimating potency factors. Future efforts will require new methods and more precise and reliable exposure assessments. However, while there may be genuine need for such work, a more pressing priority with regard to the six regulated forms of asbestos and other asbestiform fibers is to ban their production and use.

Mortality of older construction and craft workers employed at Department of Energy (DOE) nuclear sites.

BACKGROUND: The U.S. Department of Energy (DOE) established medical screening programs at the Hanford Nuclear Reservation, Oak Ridge Reservation, the Savannah River Site, and the Amchitka site starting in 1996. Workers participating in these programs have been followed to determine their vital status and mortality experience through December 31, 2004. METHODS: A cohort of 8,976 former construction workers from Hanford, Savannah River, Oak Ridge, and Amchitka was followed using the National Death Index through December 31, 2004, to ascertain vital status and causes of death. Cause-specific standardized mortality ratios (SMRs) were calculated based on US death rates. RESULTS: Six hundred and seventy-four deaths occurred in this cohort and overall mortality was slightly less than expected (SMR = 0.93, 95% CI = 0.86-1.01), indicating a "healthy worker effect." However, significantly excess mortality was observed for all cancers (SMR = 1.28, 95% CI = 1.13-1.45), lung cancer (SMR = 1.54, 95% CI = 1.24-1.87), mesothelioma (SMR = 5.93, 95% CI = 2.56-11.68), and asbestosis (SMR = 33.89, 95% CI = 18.03-57.95). Non-Hodgkin's lymphoma was in excess at Oak Ridge and multiple myeloma was in excess at Hanford. Chronic obstructive pulmonary disease (COPD) was significantly elevated among workers at the Savannah River Site (SMR = 1.92, 95% CI = 1.02-3.29). CONCLUSIONS: DOE construction workers at these four sites were found to have significantly excess risk for combined cancer sites included in the Department of Labor' Energy Employees Occupational Illness Compensation Program (EEOCIPA). Asbestos-related cancers were significantly elevated.

Asbestos-related disease among sheet metal workers 1986-2004: radiographic changes over time.

BACKGROUND: In 1985, the Sheet Metal Workers International Association and the Sheet Metal and Air Conditioning National Association formed The Sheet Metal Occupational Health Institute Trust (SMOHIT) to examine the health hazards of the sheet metal industry. Between 1986 and 2004 18,211 individuals were examined. At the time of the first examination 9.6% of all participants (1,745) had findings consistent with parenchymal disease (ILO > 1/0), and 21% (3,827) had pleural scarring. METHODS: 2181-Two thousand hundred eighty-one who had no radiographic evidence of pneumoconiosis on baseline examination underwent a second examination. RESULTS: By the second examination, 5.3% had developed parenchymal disease on chest radiograph; an additional 12.4% had developed pleural scarring without parenchymal disease. Factors that predicted new cases of pneumoconiosis on radiograph were the calendar year the worker entered the sheet metal trade, smoking, and shipyard work. Forty-seven percent of those smoking at the time of initial exam reported having quit smoking by the second examination. CONCLUSIONS: Asbestosis is still occurring 50 years after first exposure. Exposed workers benefit from medical screening programs that incorporate smoking cessation.

Asbestos exposure causes mesothelioma, but not this asbestos exposure: an amicus brief to the Michigan Supreme Court.

Manufacturers of asbestos brakes, supported by many manufacturing and insurance industry amicus curie, requested the Michigan Supreme Court to dismiss testimony of an expert regarding the ability of asbestos dust from brakes to cause mesothelioma as "junk science". Scientists are concerned with the sweeping and unequivocal claims that any conclusion that asbestos from brakes caused a signature asbestos-related disease in a particular person must be "junk science". The manufacturers' sweeping pronouncements are what veer from accepted, reliable mainstream scientific methods and conclusions. This article outlines the evidence supporting the conclusion that asbestos from brakes can and does cause mesothelioma, and describes the defendants' attempts to fabricate doubt about this conclusion.

Change in prevalence of asbestos-related disease among sheet metal workers 1986 to 2004.

In 1985, the Sheet Metal Workers International Association and the Sheet Metal and Air Conditioning National Association formed The Sheet Metal Occupational Health Institute Trust to examine the health hazards of the sheet metal industry in the United States and Canada. Between 1986 and 2004, 18,211 individuals were examined. The mean age of this cohort was 57.9 years, and the participants had worked for a mean (+/- SD) duration of 32.9 +/- 6 years in the sheet metal trade. Twenty-three percent of participants were current smokers, 49% were former smokers, and 28% were never-smokers. A total of 9.6% of participants (1,745 participants) had findings that were consistent with parenchymal disease (International Labor Organization [ILO] score, >/= 1/0); 60% of those with an ILO score >/= 1/0 were classified as 1/0, 34% as 1/1 to 1/2, and 6% as >/= 2/1. A total of 21% of participants (3,827 participants) had pleural scarring. There was a lower prevalence of nonmalignant asbestos-related disease among those who began to work after 1970, when compared to workers who began to work before 1949; those who began to work between 1950 and 1969 had a prevalence between the other two groups. The strongest predictor of both parenchymal and pleural disease on a chest radiograph was the calendar year in which the worker began sheet metal work; work in a shipyard was also an important risk. The results of this study suggest that the efforts to reduce asbestos exposure in the 1980s through strengthened Occupational Safety and Health Administration regulation have had a positive public health impact.

Asbestos and peritoneal mesothelioma among college-educated men.

The proportion of peritoneal mesotheliomas among all mesotheliomas has been decreasing, leading some to suggest that peritoneal mesothelioma occurs only after high levels of exposure to asbestos. To investigate the relationship between asbestos exposure and the development of peritoneal mesothelioma, a case-control study examined 40 cases of primary peritoneal mesothelioma from a single institution. This series differed from previous reports in that 75% of the cases and controls had attended college. Results show an odds ratio of 6.6 for asbestos exposure among this group of primary peritoneal mesothelioma cases with relatively slight asbestos exposures.

A review of peritoneal mesothelioma at the Washington Cancer Institute.

This article reviews a single institution's experience with 68 patients (21 females, 47 males) prospectively treated over the last 2 decades with an aggressive local-regional approach, combining maximal cytoreductive surgery with heated intraoperative intraperitoneal chemotherapy and early postoperative intraperitoneal chemotherapy. This multimodality treatment has resulted in a median survival of 67 months. Female patients had a significantly better prognosis than males. The other significant predictive factors of survival were: age, diagnosis by incidental findings, tumor extent, pathology, and completeness of cytoreduction.

Clinical presentation of peritoneal mesothelioma.

AIM: To describe the clinical presentation of peritoneal mesothelioma and its impact on survival. METHODS: Data was collected from 51 patients with peritoneal mesothelioma treated at the Washington Cancer Institute. The demographic, clinical and pathologic information were analyzed. RESULTS: Pain was the most common symptom (recorded in 33% of patients); increased abdominal girth occurred in 31%, increased abdominal girth and pain in 5%, and a new onset hernia in 12%. In an additional 14% of patients, a variety of other clinical findings led to the diagnosis. There was a statistically significant difference in survival by gender, weight loss and volume of disease. CONCLUSIONS: Pain was the most common initial presenting symptom, with increased abdominal girth as a second. A more favorable prognosis occurred in women with a small disease volume.