1 Health Effects of Asbestos Exposure Jill Dyken, PhD, PE John Wheeler, PhD, DABT Agency for Toxic Substances and Disease Registry Asbestos Science Seminar Folsom, California August 18-19, 2004
2 Agency for Toxic Substances and Disease Registry (ATSDR) Is an independent, advisory agency Was created in 1980 Was created to look at public health impacts of releases of hazardous substances to the environment Is associated with the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia Works closely with EPA on hazardous waste issues
3 Types of Asbestos* Fibers Serpentine Chrysotile Amphibole Actinolite Tremolite Anthophyllite Crocidolite Amosite * Note: OSHA definition does not include other toxic fibrous mineral types.
4 Asbestos Health Effects Result from inhaling asbestos fibers into the lungs Fibers become trapped in the lungs Chrysotile fibers are cleared from the lungs faster than amphibole fibers
5 Health Effects Associated With Asbestos Inhalation Noncancer Asbestosis Pleural changes Cancer Lung cancer Mesothelioma
6 What Is Asbestosis? Scarring of lungs caused by very high exposure to asbestos; decreased elasticity of the lungs Smoking decreases ability to clear asbestos fibers and may increase risk of asbestosis A disease that progresses slowly; it takes decades to develop signs and symptoms Treatment: prevent complications and treat symptoms; disease rarely gets better
7 What Are Pleural Changes? Thickening and hardening of the lining of the lungs (pleura) Usually, no early symptoms Potential for decreased lung function; potential higher risk of cancer Role of smoking not clear Treatment: prevent complications and maintain general health
8 What Is Lung Cancer? Cancer that invades and blocks the lung's air passages Smoking plus asbestos exposure greatly increases the likelihood of lung cancer (more than smoking or asbestos exposure alone) Treatment: remove diseased part of lung; chemotherapy; radiation; or combination
9 What Is Mesothelioma? A rare cancer - affects the lining of the lungs or the lining of the abdominal cavity Known asbestos exposure is primary cause; in some cases exposure history is not known Most cases are diagnosed many decades after known exposure Poor prognosis Treatment: surgery, chemotherapy, and radiation are options depending on stage of disease; no good treatment
10 How Common Are Lung Cancer and Mesothelioma? Cancer Type Breast Cancer Prostate Cancer Lung Cancer New cases in 2001 in US (out of 100,000 people) Mesothelioma 1 All races; age-adjusted adjusted Nine areas around country Source: SEER Incidence Rates for Individual Years seer.cancer.gov/faststats/ 61
11 We ve reviewed health effects from asbestos exposure. Most medical information was obtained from people who worked directly with asbestos materials. Have these health effects been seen in people who were exposed nonoccupationally?
12 Epidemiologic Studies Study of disease or death rates in human populations Attempt to link exposure with disease Several nonoccupational epidemiologic studies have been conducted in areas of asbestos outcrops or near mines.
13 Amphibole Asbestos Epidemiologic Studies Cyprus Chrysotile and tremolite in stucco materials Elevated mesothelioma rate (McConnochie et al. IARC Sci Publ. 1989; 90: ; McConnochie et al. Thorax 1987; 42(5): )
14 Amphibole Asbestos Epidemiologic Studies (continued) Corsica Chrysotile and tremolite surface deposits Roads paved with crushed serpentinite Pleural changes, increased rate of mesothelioma (Magee et al. Am J Ind Med 1986; 9: ; Viallat et al. Ann NY Acad Sci 1991; 643: ; Rey et al. Eur Respir J 1993; 6: ; Dumortier et al.; Occup Environ Med 2002; 59: )
15 Amphibole Asbestos Epidemiologic Studies (continued) Biancaville, Eastern Sicily Quarry materials containing tremolite used in local building industry Annual mesothelioma incidence rate about 7 per 100,000 (Paoletti, Batistia, Domenico, Caterina, Di Paola, Gianfagna, et al.; Arch Environ Health 2000; 55(6): )
16 Amphibole Asbestos Epidemiologic Studies (continued) Da-Yao County in SW China Crocidolite amphibole blue clay prevalent Lifetime exposures from road dust, stucco on houses, stove use Pleural changes, asbestosis, mesothelioma, and lung cancer significantly elevated Average annual mesothelioma incidence rates per 100,000 (Luo, Liu, Tsai, and Wen; Occup Environ Med 2003; 60:35-42.)
17 Amphibole Asbestos Epidemiologic Studies (continued) New Caledonia Tremolite whitewash used in villages High incidence of lung cancer, mesothelioma (mesothelioma incidence rate about 12.5 per 100,000) (Luce, Bugel, Goldberg, Goldberg, Salomon, Billon-Galland, et al.; Am J Epidemiol 2000; 151(3): )
18 Amphibole Asbestos Epidemiologic Studies (continued) Anatolia, Turkey White soil containing amphibole asbestos used as whitewash, baby powder, etc. Lifetime exposures in rural villages Average annual mesothelioma incidence rates per 100,000 Fiber levels measured outdoors up to 0.04 f/cc; indoors up to 0.28 f/cc (Metintas, Metintas, Ucgun, and Oner; Chest 2002; 122: )
19 What Happened in These Locations? Authorities provided public health education People stopped activities that resulted in exposure Investigators continued monitoring in the area These actions will result in reduced risk for future asbestos-related disease in these areas.
20 Potential for Exposure in California Local deposits of chrysotile and amphibole (actinolite, tremolite) asbestos Some activities could release airborne fibers Construction Sports activities (dirt-biking, organized sports) Gardening Other
21 Potential for Exposure in California (continued) Exposure here may be different from epidemiologic studies Exposure data in epidemiologic studies is limited Most people in studies used asbestos regularly in everyday life People in the studies populations rarely moved The best way to evaluate how people are exposed here is activity-based sampling
22 Summary Inhaling chrysotile or amphibole asbestos can result in asbestosis, pleural changes, mesothelioma, or lung cancer. Risk for cancer is probably higher for amphibole exposure, especially mesothelioma. Asbestos diseases can result from noncommercial uses - fibers are of concern regardless of the source. Comparisons between exposure in California and other locations described in the literature are difficult to make. Activity-based sampling will give a better estimate of actual exposure than other methods.
23 ATSDR Contact Info Atlanta Staff: ( ATSDR) Jill Dyken, PhD, PE John Wheeler, PhD, DABT Ketna Mistry, MD, FAAP Regional Staff in San Francisco: Commander Susan Muza Libby Levy
CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Asbestos Exposure: Questions
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