An updated evaluation of reported no-observed adverse effect levels for chrysotile, amosite, and crocidolite asbestos for lung cancer and mesothelioma.

This analysis updates two previous analyses that evaluated the exposure-response relationships for lung cancer and mesothelioma in chrysotile-exposed cohorts. We reviewed recently published studies, as well as updated information from previous studies. Based on the 16 studies considered for chrysotile (<10% amphibole), we identified the "no-observed adverse effect level" (NOAEL) for lung cancer and/or mesothelioma; it should be noted that smoking or previous or concurrent occupational exposure to amphiboles (if it existed) was not controlled for. NOAEL values ranged from 2.3-<11.5 f/cc-years to 1600-3200 f/cc-years for lung cancer and from 100-<400 f/cc-years to 800-1599 f/cc-years for mesothelioma. The range of best-estimate NOAELs was estimated to be 97-175 f/cc-years for lung cancer and 250-379 f/cc-years for mesothelioma. None of the six cohorts of cement or friction product manufacturing workers exhibited an increased risk at any exposure level, while all but one of the six studies of textile workers reported an increased risk at one or more exposure levels. This is likely because friction and cement workers were exposed to much shorter chrysotile fibers. Only eight cases of peritoneal mesothelioma were reported in all studies on predominantly chrysotile-exposed cohorts combined. This analysis also proposed best-estimate amosite and crocidolite NOAELs for mesothelioma derived by the application of relative potency estimates to the best-estimate chrysotile NOAELs for mesothelioma and validated by epidemiology studies with exposure-response information. The best-estimate amosite and crocidolite NOAELs for mesothelioma were 2-5 f/cc-years and 0.6-1 f/cc-years, respectively. The rate of peritoneal mesothelioma in amosite- and crocidolite-exposed cohorts was between approximately 70- to 100-fold and several-hundred-fold higher than in chrysotile-exposed cohorts, respectively. These findings will help characterize potential worker and consumer health risks associated with historical and current chrysotile, amosite, and crocidolite exposures.

Exposure to Amosite-Containing Ceiling Boards in a Public School in Switzerland: A Case Study.

The measurement of an airborne concentration in Amosite fibers above 5035 F/m3 in a school prompted a retrospective quantitative health risk assessment. Dose estimates were built using air measurements, laboratory experiments, previous exposure data, and interviews. A dose response model was adapted for amosite-only exposure and adjusted for the life expectancy and lung cancer incidence in the Swiss population. The average yearly concentrations found were 52-320 F/m3. The high concentration previously observed was not representative of the average exposure in the building. Overall, the risk estimates for the different populations of the school were low and in the range of 2 × 10-6 to 3 × 10-5 for mesothelioma and 4 × 10-7 to 8 × 10-6 for lung cancer. The results evidenced however that children have to be considered at higher risk when exposed to asbestos, and that the current reference method and target values are of limited use for amphibole-only exposures. This study confirmed that quantitative health risk assessments and participatory approaches are powerful tools to support public decisions and build constructive communication between exposed people, experts, and policy-makers.

Airborne Asbestos Exposures from Warm Air Heating Systems in Schools.

The aim of this study was to investigate the concentrations of airborne asbestos that can be released into classrooms of schools that have amosite-containing asbestos insulation board (AIB) in the ceiling plenum or other spaces, particularly where there is forced recirculation of air as part of a warm air heating system. Air samples were collected in three or more classrooms at each of three schools, two of which were of CLASP (Consortium of Local Authorities Special Programme) system-built design, during periods when the schools were unoccupied. Two conditions were sampled: (i) the start-up and running of the heating systems with no disturbance (the background) and (ii) running of the heating systems during simulated disturbance. The simulated disturbance was designed to exceed the level of disturbance to the AIB that would routinely take place in an occupied classroom. A total of 60 or more direct impacts that vibrated and/or flexed the encapsulated or enclosed AIB materials were applied over the sampling period. The impacts were carried out at the start of the sampling and repeated at hourly intervals but did not break or damage the AIB. The target air volume for background samples was ~3000 l of air using a static sampler sited either below or ~1 m from the heater outlet. This would allow an analytical sensitivity (AS) of 0.0001 fibres per millilitre (f ml(-1)) to be achieved, which is 1000 times lower than the EU and UK workplace control limit of 0.1 f ml(-1). Samples with lower volumes of air were also collected in case of overloading and for the shorter disturbance sampling times used at one site. The sampler filters were analysed by phase contrast microscopy (PCM) to give a rapid determination of the overall concentration of visible fibres (all types) released and/or by analytical transmission electron microscopy (TEM) to determine the concentration of asbestos fibres. Due to the low number of fibres, results were reported in terms of both the calculated concentration and the statistically relevant limits of quantification (LOQ), which are routinely applied. The PCM fibre concentrations were all below the LOQ but analytical TEM showed that few of the fibres counted in the background samples were asbestos. The background TEM asbestos concentrations for the individual samples analysed from all three schools were at or below the AS, with a pooled average below the LOQ (<0.00005 f ml(-1)). At the two CLASP schools, there was no significant increase in the airborne amosite concentration in the classrooms during simulated disturbance conditions. At the third school, four of the five classrooms sampled gave measurable concentrations of amosite by TEM during simulated disturbance conditions. The highest concentration of amosite fibres countable by PCM was 0.0043 f ml(-1) with a pooled average of 0.0019 f ml(-1). The air sampling strategy was effective and worked well and the results provide further important evidence to inform the sampling and management of asbestos in schools.

Pleural mesothelioma and lung cancer risks in relation to occupational history and asbestos lung burden.

BACKGROUND: We have conducted a population-based study of pleural mesothelioma patients with occupational histories and measured asbestos lung burdens in occupationally exposed workers and in the general population. The relationship between lung burden and risk, particularly at environmental exposure levels, will enable future mesothelioma rates in people born after 1965 who never installed asbestos to be predicted from their asbestos lung burdens. METHODS: Following personal interview asbestos fibres longer than 5 µm were counted by transmission electron microscopy in lung samples obtained from 133 patients with mesothelioma and 262 patients with lung cancer. ORs for mesothelioma were converted to lifetime risks. RESULTS: Lifetime mesothelioma risk is approximately 0.02% per 1000 amphibole fibres per gram of dry lung tissue over a more than 100-fold range, from 1 to 4 in the most heavily exposed building workers to less than 1 in 500 in most of the population. The asbestos fibres counted were amosite (75%), crocidolite (18%), other amphiboles (5%) and chrysotile (2%). CONCLUSIONS: The approximate linearity of the dose-response together with lung burden measurements in younger people will provide reasonably reliable predictions of future mesothelioma rates in those born since 1965 whose risks cannot yet be seen in national rates. Burdens in those born more recently will indicate the continuing occupational and environmental hazards under current asbestos control regulations. Our results confirm the major contribution of amosite to UK mesothelioma incidence and the substantial contribution of non-occupational exposure, particularly in women.

[Estimation of the indoor diffusion of asbestos fibers with the diffusion model for the external environment of Pasquill and Gifford]. / Stima della diffusione indoor di fibre di amianto con il modello diffusionale di Pasquill e Gifford per l'ambiente esterno.

In absence of results of environmental monitoring to proceed with the assessment of occupational exposure, it was developed a model that retraces the one of Pasquill and Gifford, currently used for the estimation of concentrations of pollutants at certain distances from the source in outdoor environment. Purpose of the study is the quantitative estimate of the diffusion of airborne asbestos fibers in function of the distance from the source in an factory where railway carriages were produced during the period when asbestos was sprayed as insulator of the body. The treatment was carried out in a large shed without separation from other operations. The application of the model, given the characteristics of the emitting source, has allowed us to estimate the diffusion of particles inside the shed with an expected decrease in concentration inversely proportional to the distance from the source. By appropriate calculations the concentration by weight has been converted into number offibers by volume, the unit of measure currently used for the definition of asbestos pollution.

Evaluation of the dark-medium objective lens in counting asbestos fibers by phase-contrast microscopy.

A Japanese round-robin study revealed that analysts who used a dark-medium (DM) objective lens reported higher fiber counts from American Industrial Hygiene Association (AIHA) Proficiency Analytical Testing (PAT) chrysotile samples than those using a standard objective lens, but the cause of this difference was not investigated at that time. The purpose of this study is to determine any major source of this difference by performing two sets of round-robin studies. For the first round-robin study, 15 AIHA PAT samples (five each of chrysotile and amosite generated by water-suspended method, and five chrysotile generated by aerosolization method) were prepared with relocatable cover slips and examined by nine laboratories. A second round-robin study was then performed with six chrysotile field sample slides by six out of nine laboratories who participated in the first round-robin study. In addition, two phase-shift test slides to check analysts' visibility and an eight-form diatom test plate to compare resolution between the two objectives were examined. For the AIHA PAT chrysotile reference slides, use of the DM objective resulted in consistently higher fiber counts (1.45 times for all data) than the standard objective (P-value < 0.05), regardless of the filter generation (water-suspension or aerosol) method. For the AIHA PAT amosite reference and chrysotile field sample slides, the fiber counts between the two objectives were not significantly different. No statistically significant differences were observed in the visibility of blocks of the test slides between the two objectives. Also, the DM and standard objectives showed no pattern of differences in viewing the fine lines and/or dots of each species images on the eight-form diatom test plate. Among various potential factors that might affect the analysts' performance of fiber counts, this study supports the greater contrast caused by the different phase plate absorptions as the main cause of high counts for the AIHA PAT chrysotile slides using the DM objective. The comparison of fiber count ratios (DM/standard) between the AIHA PAT chrysotile samples and chrysotile field samples indicates that there is a fraction of fibers in the PAT samples approaching the theoretical limit of visibility of the phase-contrast microscope with 3-degree phase-shift. These fibers become more clearly visible through the greater contrast from the phase plate absorption of the DM objective. However, as such fibers are not present in field samples, no difference in counts between the two objectives was observed in this study. The DM objective, therefore, could be allowed for routine fiber counting as it will maintain continuity with risk assessments based on earlier phase-contrast microscopy fiber counts from field samples. Published standard methods would need to be modified to allow a higher aperture specification for the objective.

The analysis of asbestos count data with "nondetects": the example of asbestos fiber concentrations in the lungs of brake workers.

OBJECTIVES: In the analysis of tissue for asbestos fibers, some measurements may be below the analytical detection limit (nondetects). The use of maximum likelihood and survival analysis methods have been recommended to perform comparisons between subjects in the presence of nondetects. When the data consist of "counts" another method is useful. This method is discussed, and illustrated with an analysis of asbestos lung burden data among brake mechanics previously analyzed by other methods. METHODS: Statistical models for count data, namely Poisson and negative binomial regression, were used to compare the asbestos fiber concentrations in the lungs of brake mechanics with those of control subjects. The fit of the models was assessed with an analysis of residuals. RESULTS: The negative binomial regression models fit the data well. The concentrations of Quebec asbestos fibers in the lungs of the brake mechanics were significantly higher than in the control population. CONCLUSIONS: Helsel recommended the use of maximum likelihood and survival analysis methods to perform comparisons in the presence of nondetects. When analyzing asbestos fiber count data, or other count data arising in occupational or environmental health, the use of models such as the Poisson and negative binomial may be added to the analyst's toolbox. Benefits are that neither of these methods requires the substitution of arbitrary values for the nondetects and that programs for the computation of count data models are contained in popular statistical software packages.

[Asbestosis still exists ]. / L'asbestose existe encore

A diagnosis of asbestosis, lung fibrosis due to asbestos exposure, was proposed in 2003 in a 64-year-old woman on the basis of the history, computed tomography appearances, lung function studies, and biometric data. This diagnosis was confirmed by the pathological examination of a lung lobe resected surgically for bronchial carcinoma in 2010. The diagnosis of asbestosis is now rarely made as a result of a substantial decrease in dust exposure over the past decades and mainly because of the interdiction of asbestos use in western countries. Currently, the most frequent thoracic manifestations of asbestos exposure are benign pleural lesions and mesothelioma. It has also become exceptional to have pathological confirmation of the diagnosis, obtained in this woman thanks to the surgical treatment of another complication of her occupational exposure.

Asbestos exposure during uncontrolled removal of sprayed-on asbestos.

Asbestos-containing materials in place in buildings, especially sprayed-on asbestos, are still an important health threat. Clearance of these materials has to be operated by specifically trained workers wearing specific individual protection suits after containment of the contaminated area. Good work practices are, however, not always applied. We report the case of two workers hired for ∼1 week to remove sprayed-on amosite asbestos during the remodeling of a former industrial hall. Regulatory protective equipments were not used. A legal action was initiated after disclosure of the working conditions. Medical examinations were performed 18 and 22 months after exposure. Workers denied any other asbestos exposure. Lung function tests and chest computed tomography scans were normal. Very high levels of asbestos fibers and bodies were discovered on mineralogical analysis of bronchoalveolar lavage fluid (BALF) by phase contrast light microscopy and analytical electron microscopy. All fibers were amosite. An extrapolation considering duration of exposure, breathing pattern, and BALF fiber content suggests that the workers were exposed to airborne fiber concentrations in the range from several tens to about a hundred World Health Organization fibers per milliliter air. In conclusion, exposures to historical airborne fiber levels prevailing half a century ago may still occur today when the work regulations are not applied. In these conditions, even very short exposures may result in considerable lung fiber retention in case of amphibole exposure with the subsequent risk for developing asbestos-related diseases. Fiber analysis in BALF is useful to clarify such exposures.

Mesothelioma and analysis of tissue fiber content.

The strong relationship between mesothelioma and asbestos exposure is well established. The analysis of lung asbestos burden by light and electron microscopy assisted to understand the increased incidence of mesothelioma in asbestos mining and consuming nations.The data on the occupational exposure to asbestos are important information for the purpose of compensation of occupational disease No. 4105 (asbestos-associated mesothelioma) in Germany.However, in many cases the patients have forgotten conditions of asbestos exposure or had no knowledge about the used materials with components of asbestos. Mineral fiber analysis can provide valuable information for the research of asbestos-associated diseases and for the assessment of exposure. Because of the variability of asbestos exposure and long latency periods, the analysis of asbestos lung content is a relevant method for identification of asbestos-associated diseases. Also, sources of secondary exposure, so called "bystander exposition" or environmental exposure can be examined by mineral fiber analysis.Household contacts to asbestos are known for ten patients (1987-2009) in the German mesothelioma register; these patients lived together with family members working in the asbestos manufacturing industry.Analysis of lung tissue for asbestos burden offers information on the past exposure. The predominant fiber-type identified by electron microscopy in patients with mesothelioma is amphibole asbestos (crocidolite or amosite). Latency times (mean 42.5 years) and mean age at the time of diagnose in patients with mesothelioma are increasing (65.5 years). The decrease of median asbestos burden of the lung in mesothelioma patients results in disease manifestation at a higher age.Lung dust analyses are a relevant method for the determination of causation in mesothelioma. Analysis of asbestos burden of the lung and of fiber type provides insights into the pathogenesis of malignant mesothelioma. The most important causal factor for the development of mesothelioma is still asbestos exposure.

[Asbestos fibre lung burden and exposure indices in asbestos-cement workers]. / Carico polmonare di fibre di asbesto e indici di esposizione cumulativa in lavoratori del cementoamianto.

BACKGROUND: In many previous studies, the asbestos fibres retained in the lung were regarded as a good index of cumulative occupational asbestos exposure. Twelve workers suffering from asbestos-related diseases and had been employed in an asbestos-cement factory operating from 1961 to 1994 underwent post mortem investigations in the course of a criminal law suit. OBJECTIVES: Samples of lung tissues were collected for electron microscopy analysis to measure the asbestos fibre burden of the lungs in workers with high exposure, and assess the possible correlation between asbestos fibre lung burden and the estimated levels of cumulative exposure. METHODS: Samples of lung parenchyma obtained from a consecutive series of 12 post-mortem examinations that were performed between 1994 and 2007and included 5 cases of malignant pleural mesothelioma, 4 lung cancers, 1 case of asbestosis and2 ofpleuralplagues, were collected, stored and analysed by SEM electron microscopy, according to the methods suggested by the current scientific literature. For each worker, all males, a detailed occupational history was reconstructed by means ofpersonal interviews; both the measurements of airborne asbestos fibresperformed by the factory in the 1970's and the duration of each single job in the plant were taken into account to estimate an individual cumulative exposure index. RESULTS: A wide variation of total asbestos fibre concentrations in the lung (1,320-118 million) was observed; in all 12 workers, the lung amphibole fibre burden exceeded 1,000,000 fibres per g/dry tissue, The highest values were detected in the mesothelioma cases, in which the mean fibre concentrations differed statistically (t=2.29, p=0.045) from the mean calculated for the other asbestos-related diseases; in 9 subjects only amphibole fibres were detected. There was a good correlation between total asbestos fibre concentration and cumulative exposure index (r=0.91, p<0.0001). CONCLUSION: This study, which was numerically the biggest ever performed in Italy for this category of workers, confirms a wide range of total asbestos fibre burden in heavily occupationally exposed workers and showed that of the asbestos-related diseases, the highest lung concentrations of asbestos fibres were reached in cases of mesothelioma. It was also observed that almost the entire lung burden consists of only amphibole fibres, all exceeding 1 million per gramme of dry tissue. This study tested a synthetic cumulative occupational exposure index, which appears to be well correlated to the level of exposure established by biological analysis.

Continued participation in an asbestos fiber-counting proficiency test with relocatable grid slides.

The effect of using relocatable reference slides of chrysotile and amosite in asbestos fiber counting proficiency testing was examined for volunteer analysts from laboratories in the USA. Results of participation in one round have been published; two more rounds are reported here. In the first round, participants were asked to draw what they saw, allowing identification of error type by comparison to the reference. In later rounds only the number of fibers per field was reported since the number of errors per field has been shown to be a reasonable estimate of proficiency. The third round included a training exercise. The total number of participants stayed reasonably constant with some reduction over time. More restricted numbers participated from round to round. Those who dropped out had lower average scores than those that remained in the program; from 2006 to 2007 this difference was significant, but for 2007 to 2008 it was not. The overall results for amosite were generally good compared to an arbitrary proficiency score of 60, and continued to improve further over time. The results for chrysotile were better in rounds 1 and 3 than round 2, so that both attention to detail (drawing the fibers in round 1) and training (round 3) may improve performance, which is consistent with the major type of error being oversight of fine fibers. However, the results are still poor, even by round 3, and no analyst achieved a score of 60 in all three rounds. Further improvement is preferred since chrysotile is the most commonly encountered type of asbestos in the USA. Depending on the adopted score for proficiency many laboratories or analysts may be labeled as poor performers and this may be a deterrent to voluntary participation in this type of exercise, especially for those in most need of assistance. Participants have tested new relocatable reference asbestos proficiency counting slides in three rounds of chrysotile and three rounds of amosite. Performance for amosite was good. Poor performance for chrysotile appears to be improved by greater attention and training.

Crocidolite and mesothelioma.

This study reports changes in the frequency of detection of various asbestos fiber types between 1982 and 2005. Crocidolite is increasingly detected in U.S. mesothelioma patients. The percentage of crocidolite fibers detected in lung tissue has risen from 4 to 10%, and the percentage of cases in which crocidolite was detected increased from 19 to 37%. Meanwhile, the frequency of detection of amosite and chrysotile has decreased. The authors performed a detailed analysis of cases in which crocidolite was identified in the absence of amosite. Most of such cases were identified in recent years, a finding of concern since crocidolite is considered the most potent fiber type with respect to the pathogenesis of mesothelioma.

A technical comparison of evaluating asbestos concentration by phase-contrast microscopy (PCM), scanning electron microscopy (SEM), and analytical transmission electron microscopy (ATEM) as illustrated from data generated from a case report.

As reported in the literature, there are more than 30 different standard methods available for the analysis of asbestos in a variety of situations. The methods include those for determining asbestos concentration in air, water, bulk building materials, surface dust, soil, and lung tissue (Millette, 2006; Dodson, 2006). Knowledge of the various methodologies is essential in determining which methodology is appropriate for any given situation. To better understand the use of various techniques in evaluating asbestos, we use an example of an individual who was a machinist in an auto supply/parts business. His work activity during much of his professional career included grinding, arcing, and drilling brake components. Asbestos has been identified as an important component of friction products, particularly brakes, and exposure to asbestos brake dust is of concern, particularly in workers where grinding, arcing, sanding, and drilling of brake components are recognized as releasing appreciable dust. Various methods can be used to evaluate asbestos in tissue and air. The case reported herein was of an individual who died from a pleural mesothelioma. Paraffin-embedded lung tissue was examined by a laboratory using scanning electron microscopy (SEM) and was reported to contain elevated asbestos body concentrations and five fibers, of which two were asbestos (one chrysotile and one tremolite). Tissue from the same paraffin block was analyzed by the laboratory of one of us (RFD) using analytical transmission electron microscopy (ATEM). While one might think the number of asbestos bodies and fibers would be similar using SEM and ATEM, this was not the case. Slightly elevated numbers of ferruginous asbestos bodies were detected in the digestate by light microscopy. Large numbers of uncoated chrysotile fibers were found by ATEM, but not by SEM. The majority of the chrysotile structures were fibrils whose detection required resolution levels attainable only at higher magnification by ATEM. The findings in this case clearly indicate that analysis of lung tissue digestates by ATEM at a higher magnification (15,000x) identifies significant numbers of asbestos fibers that are not identified by SEM at 1000x. These results further indicate that if causation of an asbestos-induced disease such as mesothelioma is based on asbestos concentration of lung tissue, erroneous conclusions can be made by analyzing tissue only by SEM. Thus, the methodologies that are available to analyze asbestos in lung tissue are extensively discussed here with respect to the type of procedure that should be utilized in various situations.

The quality of fiber counts using improved slides with relocatable fields.

A parameter based on discrepancies between reported fibers and verified fibers of relocatable slides is shown to be effective in monitoring the quality of airborne fiber counts. Analysts report only the fibers in each field examined. The verified fibers were determined by two experienced analysts, and are here considered as a "true" value. Most of the verified fibers were confirmed by the reported fibers, and the disputed fibers or fiber counting errors were all located and accounted for. In this study, reference (REF) slides were manufactured from proficiency analytical test (PAT) filter samples from the American Industrial Hygiene Association containing chrysotile or amosite. The slides were made using coverglasses bearing a grid pattern to allow accurate re-examinations. These coverglasses are an improved version of those used in previous studies. Seventy-four out of 85 amosite results and 51 out of 60 chrysotile results of REF slides were within their PAT proficiency ranges. When all reported fibers were normalized against their respective verified fibers, the average fiber count was over-estimated for amosite by 38.3% and under-estimated for chrysotile by 30.4%. The error from counting short fibers (sizing-extra) was 82.6% of the extra fibers and accounted for the 38% over-estimation of amosite fibers. For chrysotile fibers, sizing-extra errors were 74.0% of the extra fibers, but by far the larger errors were oversight-missing errors, which were 96.7% of the missing fibers and accounted for the 30% under-estimation of the chrysotile fibers. The discrepancies were found to be linearly related to counting errors as had been noted in a previous study, giving further weight to a proposed score, calculated from the discrepancy parameter (SigmaD(+) + |SigmaD(-)|)/VF(total), for evaluating the proficiencies of analysts. If a proficiency score =60 is selected, 48 out of 85 amosite results and 17 out of 60 chrysotile results satisfied this criterion in this study. The number of fiber counting errors in this study was larger than could be expected by PAT proficiency criteria. It may be useful to complement existing proficiency test programs with these REF slides. At the end of each proficiency testing round, detailed reports of discrepancies can be provided to participants so that they can improve on their skills in searching and sizing fibers and minimize their counting errors. In addition, the internal quality control program of each laboratory could include counting REF slides regularly by all analysts with control charts of (SigmaD(+)/VF(total)), (SigmaD(-)/VF(total)), (SigmaD(+) + |SigmaD(-)|)/VF(total) and RF(total)/VF(total) maintained to monitor errors, proficiencies and intercounter variations. Ten percent of relocatable slides of routine samples could also be recounted to monitor intracounter variation.

Human health effects associated with the commercial use of grunerite asbestos (amosite): Paterson, NJ; Tyler, TX; Uxbridge, UK.

Grunerite asbestos (amosite) has been shown in epidemiological and experimental animal studies to cause lung cancer, mesothelioma and pulmonary fibrosis commonly referred to as asbestosis. An overview of the human and experimental animal studies describing the health hazards of grunerite asbestos (amosite) is presented. Of the many human studies describing the health hazards of asbestos, only three factories using mainly, if not exclusively, grunerite asbestos (amosite) have been studied. The first is a series of reports on a cohort of 820 workers from a plant located in Paterson, NJ. Among this cohort, 18.7% died of lung cancer and 17 mesotheliomas occurred. The Paterson factory closed in 1954 and moved to Tyler, Texas where it operated until 1972. Among the 1130 former workers in the Tyler plant 6 mesotheliomas were reported with 15.8% lung cancer mortality. The third grunerite asbestos (amosite) exposed cohort was an insulation board manufacturing facility in Uxbridge, United Kingdom. Here 17.1% of the workers died of lung cancer and 5 mesotheliomas occurred. The lung content from 48 Uxbridge workers was analyzed by analytical transmission electron microscopy for mineral fibers. The relationship between grunerite asbestos (amosite) concentrations in the lung correlated with grades of fibrosis and asbestos bodies and was lower than the concentration found in the cases with malignant tumors. The lung cancer cases contained more grunerite asbestos (amosite) than mesothelioma cases, and in the cases of non-malignant disease the concentrations were still lower. In both types of malignancies the concentration of grunerite asbestos (amosite) was very high-over a billion fibers per gram of dried lung tissue. Occupational exposure to airborne concentrations of between 14 and 100 fibers of grunerite asbestos (amosite) per milliliter after 20 year latency causes marked increases in lung cancer, mesothelioma and pulmonary fibrosis (asbestosis).

A new parameter to evaluate the quality of fiber count data of slides with relocatable fields.

Asbestos reference slides with relocatable fields are effective in determining the fiber counting errors and evaluating intercounter precision and accuracy. The process is time consuming and expensive as it requires (a) the analysts to record the number and the positions of the fibers and (b) an experienced microscopist to determine the errors. A new parameter based on the discrepancies between the reported fibers and the verified fibers is being investigated for monitoring the quality of fiber counts. The discrepancies are related to the fiber counting errors. The new process requires the analysts to report only the fibers in each field examined.

The role of analytical SEM in the determination of causation in malignant mesothelioma.

The causative relationship between asbestos exposure and mesothelioma is firmly established. Some information in this regard comes from analysis of the fiber content of lung tissue by means of analytical electron microscopy. The author has had the opportunity to study the lung asbestos content of 396 cases of mesothelioma, including 28 peritoneal cases, by means of analytical scanning electron microscopy. The highest fiber levels occurred in patients who also had asbestosis, which was found in 12% of pleural and 43% of peritoneal cases. Elevated tissue asbestos content was identified in 87% of pleural and 75% of peritoneal cases. Peritoneal cases that are asbestos related have on average a higher lung fiber burden than pleural cases. Mesotheliomas in women have elevated tissue asbestos content in about 60% of cases, and many of these had a history of exposure as a household contact of an asbestos worker. The main fiber type identified in our series was amphibole, predominantly amosite. These fibers have been demonstrated to reach the target tissue, the pleura.

Asbestos burden in cases of mesothelioma from individuals from various regions of the United States.

Mesothelioma is a rare tumor that is considered an asbestos marker disease. It occurs in individuals following a longer latency period from first exposure than other asbestos-related diseases. The tumor also occurs in individuals with a wide range of exposures, including individuals with lower level or secondary exposures. In the present study lung tissue from 54 individuals with a pathological diagnosis of mesothelioma was evaluated for ferruginous body and uncoated asbestos fiber content. The data were compared with an earlier study of mesothelioma cases from the northwestern United States. Tissue was prepared via a digestion procedure, with the collected digestate reviewed by light microscopy for quantification of asbestos bodies and analytical transmission electron microscopy for determination of uncoated fiber burden. Twenty-seven cases in the present study had over 1000 ferruginous bodies per gram of dry tissue. The data suggest that amosite provides a more likely stimulus for ferruginous coating than the other forms of asbestos. All individuals were found to have asbestos fibers in their lung tissue. Amosite was the most commonly found fiber, with anthophyllite being the second most commonly found type of asbestos. The finding of tremolite in the tissue most often was associated with the finding of anthophyllite. A limited number of asbestos fibers of each type would have been seen in the light microscope, with the least detected being chrysotile. The majority of all fiber types were found as short fibers (< 8 mum), although some longer fibers were represented in each type of asbestos. The majority of the individuals were found to have mixed types of asbestos in their lungs.

[Assessment of asbestos exposure, mortality study, and health intervention in workers formerly exposed to asbestos in a small factory making drying machines for textile finishing and the paper mill industry in Pistoia, Italy]. / Ricostruzione dell'esposizione, studio di mortalità della coorte di lavoratori e intervento sugli ex-esposti ad amianto di una azienda metalmeccanica.

BACKGROUND AND OBJECTIVES: Three malignant pleural mesotheliomas occurred among workers of a small factory that manufactured drying machines for the textile and paper mill industries using asbestos cement (crocidolite, amosite and chrysotile) as insulating panels. The Occupational Medicine Unit of the Local Health Unit of Pistoia, Italy, carried out an intervention programme in the plant in order to 1) assess past asbestos exposure via analysis of the fibre content of samples from drying machines, and of dust samples collected in the factory. Information on the characteristics of occupational exposure was also collected; 2) investigate cancer mortality by means of a mortality study of the employees and, 3) carry out a health intervention programme in workers formally exposed to asbestos in the past. METHODS: Samples from the drying machines and dust samples collected in the factory were analysed using X-ray diffractometric methods. Information on the characteristics of occupational exposure were collected by interviewing plant workers. Two-hundred and fifty employees who had worked in the factory between 1962 and 2000 were included in the mortality study. Follow-up was performed from 1962 to 2002. Health intervention in workers exposed to asbestos in the past involved general practitioners and occupational physicians (first level medical examinations); pneumologists and radiologists (second level medical examinations) of the local health unit. RESULTS: Asbestos fibres were found both in samples from drying machines and in dust samples collected in the factory. Interviews with workers showed that asbestos exposure varied considerably. The SMR for mesothelioma and lung cancer in 234 male workers were 37.0 (95%CI: 4.47-130.0), and 1.29 (95%CI: 0.26-3.78), respectively, based on mortality rates for Tuscany region. Sixty-two workers underwent first level medical examinations; 57 second level examinations. Chronic obstructive lung disease was found in 3 workers; restrictive lung disease was found in 3 employees, one of whom had pleural plaques. CONCLUSIONS: Further investigation is needed in order to identify unknown asbestos exposures in small metal engineering factories.