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ASBESTOS Risk Assessment, Epidemiology, and Health Effects Edited by Ronald F. Dodson, Ph.D. Samuel P. Hammar, M.D. Boca Raton London New York A CRC title, part of the Taylor & Francis imprint, a member of the Taylor & Francis Group, the academic division of T&F Informa plc. 2829_Discl.fm Page 1 Thursday, August 25, 2005 1:46 PM Published in 2006 by CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2006 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group No claim to original U.S. Government works Printed in the United States of America on acid-free paper 10 9 8 7 6 5 4 3 2 1 International Standard Book Number-10: 0-8493-2829-2 (Hardcover) International Standard Book Number-13: 978-0-8493-2829-9 (Hardcover) Library of Congress Card Number 2005048604 This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with permission, and sources are indicated. A wide variety of references are listed. Reasonable efforts have been made to publish reliable data and information, but the author and the publisher cannot assume responsibility for the validity of all materials or for the consequences of their use. No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC) 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data Asbestos : risk assessment, epidemiology, and health effects / edited by Ronald F. Dodson, Samuel P. Hammar. p. ; cm. Includes bibliographical references and index. ISBN 0-8493-2829-2 (alk. paper) 1. Asbestos--Toxicology. 2. Asbestosis. I. Dodson, Ronald F. II. Hammar, Samuel P. [DNLM: 1. Asbestos--adverse effects. 2. Asbestosis--epidemiology. 3. Risk Assessment. WA 754 A7988 2005] RA1231.A8A74 2005 363.17'91--dc22 2005048604 Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com Taylor & Francis Group and the CRC Press Web site at is the Academic Division of T&F Informa plc. http://www.crcpress.com Dedication This book is dedicated to Sandy and Judy Acknowledgment We acknowledge Dinah Fleming for editorial assistance during the preparation of thisbook. Preface Asbestos is a naturally occurring fibrous form of mineral. It has been used in numerous applications owing to its unique properties. With the more complex evolution of industrialized societies came an increasing demand for lightweight, thermally and chemically resistant materials, which in many applications also required components to provide high tensile strength. Various types of asbestos mettheserequirementsandwereusedinnumerousapplications.Theuseofasbestos inbuildingcomponentswasasmuchattributabletotheeasewithwhichthesemin- eralscouldbeformedortroweledintodesiredshapesastoothercharacteristics.The fire-retardantpropertiesofasbestoshaveoftenbeenanimportantfeaturejustifying itsuseinmanyapplications.Theproblemwiththewidespreaduseofasbestosisthat exposedindividualsareatriskfordevelopmentofasbestos-relateddiseases.These diseases usually occur following long latency periods from first exposure before theyareclinicallydetectable.Asbestosisalsouniqueamongdustsinthatitsinhala- tioncanresultinthedevelopmentofcancerofthelungandinextrapulmonarysites. There have been various books that looked at the issue of asbestos and human health through specialized emphasis on certain facets of the subject. However, the aimofthisbookistoprovidearesourceinwhichthereadercanfindcomprehensive, interdisciplinary, state-of-the-art information regarding the various aspects of the asbestos and human health. This information includes a historical view of the use of asbestos, sampling techniques, and instruments needed to define the levels of asbestos in air,bulk,orsurface samples. Tounderstandthemethodsnecessaryinassessinglevelsofexposure,itiscritical tounderstandthetechniquesused insampling forasbestosincludingthoseused in establishingthelevelsasdefinedinFederalandStateregulations.Thedifferencesin theinherentdetectionlevelsforthevarioustechniquesusedforasbestoswillbedis- cussedasapplicabletothevarioustypesofenvironmentalandhumansamples.This willincludecomparisonofrecommendedandrequiredsamplingschemesaswellas the parametersassociated withthe instruments used ineach method. Asbestos induces disease in man has been confirmed through clinical obser- vations, pathological assessments of tissue, and epidemiological data obtained from exposed cohorts. The focus of three chapters as presented by specialists in these respective fields will offer state-of-the-art data regarding asbestos exposure andtheresultantdevelopmentofdisease.Thescreening processneededforidenti- fyingasbestos-relateddiseaseandanoverviewofthepathologicalstatesassociated with these diseases will be addressed. The epidemiological overview will discuss findings from the world’s literature as applicable to specific types of asbestos exposureand the development ofresultant diseases. Therespiratorysystemistheprimaryportalofentryforasbestosintothehuman body.Thusitisrelevantthatthereaderisprovidedwithanoverviewofthenormal anatomyandfunctionsoftherespiratorysystemasabackgroundbeforediscussions focusonmechanismsbywhichasbestos(andotherinhaledparticulates)inducetem- poraryandpermanentchanges.Justasitisrelevanttounderstandtheapplicabilityof techniquesandselectedinstrumentationforanalysisofenvironmentalsamples,itis equallyimportantindeterminationofasbestoscontentfrombiologicalsamplesthat a recognition is established as to what was observed and what cannot be observed with the instrumentation and techniques used in a given study. Such a comparison and examples are illustrated in this chapter. Fiber length related to the potential for inducingpathologicalresponses isalso discussedin thischapter. Asbestosisrecognizedasbeingapathogenicallyactivedustbasedonitsfibrous morphology.However,thereareconstantlyevolvingfindingsaboutthecellular,bio- chemical, and molecular influences that asbestos has once inhaled into the lung. These mechanisms are presented as complementary stimuli which when coupled with the fibrous morphology of asbestos can result in irreversible cellular damage andinsomecasesthedevelopmentoftumors.Therefore,areviewofthesemechan- isms will beprovidedfrom a molecular biology perspective. Various countries have sought to deal with asbestos and public health through regulatory guidance documents. These will be discussed in a chapter focusing on theregulationsthatexistinmoreindustrializedcountries,andexamplesofgovern- mental regulations that attempt to impact on the levels of potential exposures in somedeveloping countries. Oneofthemostunder servedspecialties inmedicineisthatofoccupationalor environmentalmedicine.Thedataindicatethatmedicalschoolcurriculatodayoffer onlyafewhoursonthesubjectastrainingprovidedtophysicians.Itis,therefore,not a surprise that histories taken from patients are often incomplete about historical exposure to asbestos in the workplace or in environmental settings. Thus making thediagnosisofasbestos-relateddiseaseispotentiallyonlyaslikelyastheaccuracy of the establishment of such historical exposure links. It was, therefore, deemed appropriatetohaveanoverviewonthesubjectofclinicalorpostgraduateeducation onthesubjectofasbestos-relateddiseases,whichwouldhaveapplicabilitytoawide range ofhealthcare professionals. Thefactthatasbestosiscapableofinducingdiseasesincludingcancerinmanhas stimulated considerable interest of subjects. The issues associated with asbestos exposure or potential for exposure involve professionals including those from state andfederalagencieschargedwithprotectinghumanhealth,aswellasindustrialspecial- ists who must consider replacement materials and the suitability of these replace- mentsinapplicationspreviouslymetwithasbestos. Public health officials including physicians, nurses, allied health professionals, and related support professionals must make decisions regarding causation of potential diseases that can be induced by exposure to asbestos. Ultimately all members of society can be potentially exposedtoasbestosinplace eitherathomeorworkand ascomponentsofproducts madefrommineralswhichcontainsmallamountsofasbestos.Asbestosexposureand relatedliabilitieshavealsobecomemajorlegalissueswithinmanycountries. Thepurposeofthisbookistooffertheinterestedprofessionalinanyoftheafore- mentionedspecialtiesasingle“state-of-the-art”reference,whichprovidesdatathat bydesignisinterdisciplinaryinnature.Thecontentisstyledsothatthedepthissuf- ficient to be appreciated by the specialist in a given field as well as provide useful informationfromwhichindividualsinotherareasofspecializationmaydrawrefer- encethatwillbetterenablethemtodealwithasbestos-relatedproblems. The Editors RonaldF.DodsonPh.D.,receivedhisB.A.inbiologyandgeneralsciences(double major)fromEastTexasStateCollege,andM.A.inbiologyandchemistryfromEast TexasStateUniversity.HisdoctoratewasfromtheLifeSciencesDivisionofTexas A&MUniversitywithanemphasisinbiologicalelectronmicroscopy.After7years inthefacultyatBaylorCollegeofMedicineinHouston,hewasrecruitedtodevelop aresearchprogramattheUniversityofTexasHealthCenteratTyler.Hisworkfor thelast20yearshasconcentratedindefiningdustburdenintissue,bodyfluids,and environmental samples by light and analytical transmission electron microscopy. His laboratories have developed some of the techniques which enable quantitative studies of tissue burdento becarried out. Hehasauthoredorcoauthoredover90scientificarticlesonthesubjectofdust- relateddiseaseswithmostofthesefocusingonasbestos-relatedissues.Hehasalso authoredorcoauthoredtenchaptersinbooksandgivennumerouspresentationson thetopicofasbestosandhumanhealth.Thesepresentationsincludethoseatscien- tific meeting and to more selected audiences such as the National Conference of State Legislatures and the Defense Research Institute. His academic achievements have been recognized in that he holds the status a Fellow in the American Heart Associationand Fellow in the College ofChest Physicians. He has held various administrative titles during his academic career including Chief of Department, Chairman of Department, Associate Director for Research, VicePresidentforResearch,andco-DirectoroftheTexasInstituteforOccupational SafetyandHealth.Hehasservedonnumerousacademiccommitteesandaswellas a reviewer for numerous journals. He has directed an EPA/Texas Department of Health(ModelAccreditationgoverned)approvedtrainingdivisionandholdslicenses throughtheTexasDepartmentofHealthoftheStateofTexasasanInspector/Manager Planner and Supervisor/Contractor in the area of asbestos-related activities. Dr.DodsonandDr.Hammarhaveauthoredorcoauthoredthemajorityoftheworld’s literatureonasbestoscontentinextrapulmonarysitesaswellasdefinedtissueburden (includingshorterfibers)inuniquecohortssuchasindividualswithmesothelioma. Samuel P. Hammar, M.D., is a board-certified anatomic and clinical pathologist whospecializesinlungdisease,cancer,anddiagnostictechniquesusedtoinvestigate cancer.HeobtainedaB.A.degreeinchemistryin1965andattendedtheUniversity of Washington Medical School from 1965 to 1969 where he obtained an M.D. degree. He did his training in pathology at the University of Washington School ofMedicineincludingtimeinexperimentalpathologyandelectronmicroscopy. Forthelast15years,Dr.Hammarhasbeenprimarilyinterestedinasbestos-related lungdisease,especiallymesothelioma.HeisamemberoftheU.S.-Canadianmesothe- lioma panel and a member of the International Mesothelioma Pathology Group. In conjunctionwithDr.Dodson, Dr.Hammarhasdoneextensiveresearchonasbestos- related lung disease and sees asbestos-induced lung disease on a regular basis as a pathologistinBremerton,Washington,thehomeofPugetSoundNavalShipyard.