Preventing Occupational Respiratory Disease from Exposures Caused
Occupational and 9/11 Exposures and Cancer Risk | Mesothelioma Applied Research Foundation
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Transcript of Occupational and 9/11 Exposures and Cancer Risk | Mesothelioma Applied Research Foundation
Occupational and 9/11 Exposures: Risk for Disease
Jacqueline Moline, MD, MSc, FACOEM, FACP
Director, Queens World Trade Center Clinical Center of Excellence
Vice President and Chair, Department of Population Health
North Shore University Hospital and Long Island Jewish Medical Center
Cases of mesothelioma each year in the US: roughly 3300
Cases of mesothelioma each year in the US appears to have peaked around the year 2000 and is now declining, thanks to strict regulation
Worldwide, though, cases of mesothelioma is increasing
In industrial nations, number of cases will peak this decade
In poorer countries, much higher numbers are expected due to lack of regulation, widespread use of asbestos commercially and in homes.
Mesothelioma: Trends
Price B, Ware A. Critical Reviews in Toxicology.
Aug2009, Vol. 39 Issue 7, p576-588 *age-adjusted
Incidence* of mesothelioma (per 100,00) for 17 states
Moolgavkar SH, Meza R, Turim J. Pleural and peritoneal
mesotheliomas in SEER: age effects and temporal trends, 1973-
2005. Cancer Causes Control. 2009 Aug;20(6):935-44.
Incidence of mesothelioma (per 100,00)
*age-adjusted
Price B, Ware A. Critical Reviews in Toxicology.
Aug2009, Vol. 39 Issue 7, p576-588
Incidence* of mesothelioma (per 100,00) for NY state
Projected Total Mesothelioma Cases through 2054
Price B, Ware A. Critical Reviews in Toxicology.
Aug2009, Vol. 39 Issue 7, p576-588
Construction Asbestos product manufacturing
(insulation, roofing, building materials)
Automotive repair shops (especially those that involve repair of brakes, clutches)
Mining companies Nonmetallic mineral stone
products Offshore rust removal
businesses Oil refineries Power plants Maritime companies
Sources of Asbestos Exposure: Industry
Shipbuilders, ship lines, and ship yards, repairing
Chemicals and other manufacturing
Railroads and Railways Yarn, thread, and fabric mills Trucking Plastic and rubber
manufactures Manufacturers of sand or
abrasives Steel manufacturers Tile cutters
Glazers Grinders Hod carriers Insulators Iron workers Laborers Libby vermiculite workers Longshoremen Painters Plumbers Pipefitters Auto Mechanics Plasterers Steamfitters Maintenance workers Operating engineers Drywallers Electricians Insulation workers Textile workers
Demolition Workers
Floor covering workers
Millwrights
Carpenters
Bricklayers
Laborers
Boilermakers
Furnace Workers
Building Inspectors
Merchant Marines
Welders and cutters
Janitors
Roofers
Refinery workers
Sheet metal workers
Shipyard workers
Tile setters
U.S. Navy personnel
Miners and millers
Sources of Asbestos Exposure: Occupation
Duct and home insulation Fire protection panels Fireplace artificial logs or ashes fuse box liners Gypsum wallboard Hair dryers Toasters Heater register tape and insulation Joint compounds Patching and spackling compounds Pipe or boiler insulation Pot holders and ironing board pads Sheet vinyl or floor tiles Shingles Textured acoustical ceiling Textured paints Underlayment for flooring and carpets Cement Pipes Elevator Brake Shoes Cement Wallboard HVAC Duct Insulation Cement Siding
Boiler Insulation Asphalt Floor Tile Breaching Insulation Vinyl Floor Tile Ductwork Flexible Fabric Connection Vinyl Sheet Flooring Cooling Towers Flooring Backing Pipe Insulation (corrugated air-cell, block, etc.) Construction Mastics (floor tile, carpet, ceiling tile, etc.) Heating and Electrical Ducts Acoustical Plaster Electrical Panel Partitions Decorative Plaster Electrical Cloth Textured Paints/Coatings Electric Wiring Insulation Ceiling Tiles and Lay-in Panels Chalkboards Spray-Applied Insulation
Roofing Shingles Blown-in Insulation Roofing Felt Fireproofing Materials Base Flashing Taping Compounds (thermal) Thermal Paper Products Packing Materials (for wall/floor penetrations) Fire Doors High Temperature Gaskets Caulking/Putties Laboratory Hoods/Table Tops Adhesives Laboratory Gloves Fire Blankets Joint Compounds Fire Curtains Vinyl Wall Coverings Elevator Equipment Panels Spackling Compounds
Other Sources of Asbestos Exposure
Sources of Asbestos from the Environment
Asbestos Fiber in the Lung
Direct use
Indirect use for insulation and auxiliary tools
Construction sector
Accidental and unaware exposures
Exposures to Asbestos – Four Macrocategories
Marinaccio et al; Int. J. Cancer 2012;130:2146-2154
Shipbuilding and repair
Asbestos cement industry
Railroad carriages construction and maintenance
Asbestos mining
Port handling
Asbestos textile industry
Friction materials production
Gaskets and packing production
Direct Use
Metal and engineering
Metallurgic
Oil refineries
Metal, food and drink industries
Sugar refineries
Organic and inorganic chemical plants
Wood processing
Power plants
Heat and steam generation
Tobacco
Leather tanning
Non-asbestos textile finishing
Glass and ceramic
Paper
Jewelry
Gas production
Navy and military defense work
Indirect Use
Spray-on asbestos
Ceilings
Floor tiles
Wallboard
Plaster/cement
Joint compound
Electrical work
Fire doors
Boilers
Steam pipes
HVAC
Sheet metal work
Caulk
Elevator work
Construction Sector – The Whole Industry!
Car mechanics
Brake mechanics
Heavy machine operators
Jute sack recycling
Dentists
Service industry employees where asbestos was in place
Talcum powder use
Laboratory workers
Researchers
Accidental and Unaware Exposure
50 year old advertising executive
In excellent overall health
Professional career spent in offices
No home renovations
Case #1
Full occupational history revealed college employment of note
Worked in an automobile manufacturing plant for three summers as a parts picker while in college
Father and brother also worked in same automobile plant
Parts: friction materials that contained asbestos
Case #1
54 year old dentist
Worked as dentist entire career, no other employment
Case #2
Crowns were made in dental school using the lost wax technique with asbestos containing dental tape
Similar exposures seen in jewelry industry using the same lost wax technique
Case #2
72 year old physician
In excellent health
Noticed shortness of breath while exercising
Diagnosed with mesothelioma
Case #3
Worked in a laboratory for years
Exposures from laboratory equipment
– Asbestos gloves
– Asbestos mesh
– Asbestos pads
– Insulation used around crucibles
Case #3
The asbestos fiber becomes coated with iron and calcium, which is why it is often referred to as a "ferruginous body" as seen here with an iron stain. Ingestion of these fibers by macrophages sets off a fibrogenic response via release of growth factors that promote collagen deposition by fibroblasts.
During work with asbestos
During work in the same space as others working with asbestos
On worker’s skin, hair, and clothing
In areas surrounding a mining operation
In areas of the world where construction or other human activity (such as gardening) results in disturbance of natural outcrops of asbestos-bearing rock
In homes and buildings where renovations or demolitions disturb asbestos-containing building materials
Methods of Exposure
Australian mesothelioma registry data
Rates steadily rising over past two decades
Most MM cases in men, but this type of exposure is much higher as a proportion in women
Men: increase from 3% to 8% from 1990s to 2005-2008
Women: increase from 5% of cases to over 35% of cases in same time period.
Incidence of Mesothelioma Increasing after Home Maintenance and Renovation
Most important non-occupational exposure
Exposure might be from performing the home renovations
Exposure might be from being present while renovations took place
Most instances, exposure might have lasted only a few days
Home Renovation as a Source of Asbestos
Pleural and parenchymal changes are significantly more prevalent in exposed households of asbestos workers
– 35% demonstrate pleural changes
– 17% demonstrate parenchymal changes.
Population surveys have identified higher rates of pleural abnormalities in locations where asbestos occurs naturally ranging from 2% and 17% of individuals.
Non-Occupational Environmental Asbestos Exposures
Shifting Gears: A Unique Exposure
Fallout from the World Trade Center disaster
Dust cloud from the WTC collapse. Source: NYPD
Lioy, Environ Health Perspectives, 2002;110:703-14
WTC Dust: Particle Composition
WTC Dust: Particle Size Large particles >> Small (respirable)
Alkaline pH (lye)
Larger the size, the more alkaline the pH
1-4% by mass were respirable particles PM2.5
Even large particles reached lower airways
– High concentrations – Mouth breathing
Particle Size (MMAD μm) 2.5 10 53 pH ~8.1 >10.0
Chen et al; Lancet 2002;360:S37-8.
Gavett et al; Environ Health Perspect 2003;111:981-91
WTC Dust: Particles, Gases and Fumes
Gypsum, calcite and crystalline silica
Diesel particulates and carbon monoxide
Glass, cellulose and crystalline asbestos fibers
Mercury and heavy metals
Volatile organics (benzene)
Semi-volatiles: PAHs, PCBs, Dioxins and Furans
Landrigan, Environ Health Perspectives,
2004; 112:731-9
Source Air Pollution
Constituents
Health Effects
Structural Collapse
Cement, ceiling tiles, drywall Calcium carbonate / Gypsum /
Vitreous Fibers
Airway and
pulmonary
irritation Calcium sulfate
Windows Glass fibers, Silicates
Fire retardant Asbestos Cancer
Combustion
Incomplete combustion -
plastics
Organic hydrocarbons Cancer
Diesel-powered rescue
equipment
Diesel exhaust Airway irritation,
cancer
WTC Dust: Known Health Effects
38 year old firefighter at Ground Zero from 9/11 – 9/24/01
Admitted with Pa02 of 53 mmHg, progressive dyspnea and cough
CT showed patchy ground glass densities, thickened bronchial walls and bilateral pleural effusions
Rom, et al Am J Respir Crit Care Med 2002; 166:797-800.
Acute Eosinophilic Pneumonia In a Firefighter
Chest CT. One-millimeter-thick section at the lung bases depicts patchy areas of consolidation (arrows). There is bronchial wall thickening and small pleural effusions (asterisks).
70% eosinophilia
Mineralogical analysis of lavage fluid
– Uncoated asbestos (chrysotile and amosite)
– Chromium
– Degraded fibrous glass
– Fly ash
– Metal particles
– Various silicates
Bronchoscopy Lavage Findings
Lancet 9/3/2011
Note: After correction for potential surveillance bias, Too few cases to achieve statistical power for any individual cancer analysis.
Lancet 9/3/2011
Cancer – WTC Covered Condition 10/12/12