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ABSTRACT: Childhood brain tumors (CBT) are the leading cause of cancer death in children; their risk factors are still largely unknown. Since most CBTs are diagnosed before five years of age, prenatal exposure and early postnatal factors may be involved in their etiology. We investigated the association between CBT and parental occupational exposure to engine exhausts in an Australian population-based case-control study. Parents of 306 cases and 950 controls completed detailed occupational histories. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for both maternal and paternal exposure in key time periods. Increased risks were observed for maternal exposure to diesel exhaust any time before the child's birth (OR 2.03, 95% CI 1.09-3.81) and paternal exposure around the time of the child's conception (OR 1.62, 95% CI 1.12-2.34). No clear associations with other engine exhausts were found. Our results suggest that parental occupational exposure to diesel exhaust may increase the risk of CBT. © 2012 Wiley Periodicals, Inc.
International Journal of Cancer 11/2012; · 5.44 Impact Factor
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ABSTRACT: BACKGROUND: There are few data on the long-term health outcomes of exposure to asbestos in childhood. This study investigated cancer and mortality of adults exposed to blue asbestos as children. METHODS: Data linkage to relevant health registries was used to identify cancers and mortality in a cohort of adults (n = 2,460) that had lived in an asbestos mining town during their childhood (<15 years). RESULTS: There were 217 (93 female) incident cancers and 218 (70 female) deaths among the cohort. Compared with the Western Australian population females had elevated mesothelioma, ovarian and brain cancers, and increased "all cause" and "all cancer" mortality. Males had elevated mesothelioma, leukemia, prostate, brain, and colorectal cancers, and excess mortality from "all causes," "all cancers," circulatory disease, diseases of the nervous system, and accidents. CONCLUSION: Exposure to blue asbestos in childhood is associated with an increased risk of cancer and mortality in adults. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.
American Journal of Industrial Medicine 08/2012; · 1.63 Impact Factor
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ABSTRACT: Clustering of cases of malignant mesothelioma within families has often been observed, but disentangling genetic and exposure effects has not been done. Former workers and residents exposed to crocidolite at Wittenoom, Western Australia, where many families shared exposure to asbestos, have had high rates of mesothelioma. Our study aimed to estimate the additional risk of mesothelioma in relatives, after allowance for common exposure to crocidolite. More than 11,000 former asbestos workers and residents from Wittenoom have been followed up in cancer and death registries. Levels of exposure for all members of the Wittenoom cohorts have been estimated previously. Relationships between family members of all mesothelioma cases were established from questionnaires, birth and death certificates. Expected numbers of cases of mesothelioma were estimated by fitting a Weibull survival model to all data, based on time from first asbestos exposure, duration and intensity of exposure and age. For each family group, the earliest case was considered the index case. Predicted risk was estimated for each subject from the time of diagnosis of the index case. Familial risk ratios were estimated by dividing observed cases by the sum of risks of all same degree relatives of index cases. There were 369 family groups with at least one case of mesothelioma and a further 25 cases of mesothelioma among relatives in the same families, with 12.9 expected. The risk ratio for blood relatives was 1.9 (95% confidence interval [CI] = 1.3-2.9, p = 0.002). These findings suggest an important, but not large, genetic component in mesothelioma, similar to many other cancers.
International Journal of Cancer 08/2012; · 5.44 Impact Factor
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ABSTRACT: To develop a list of carcinogens to guide decisions on priorities for preventive action in Australian workplaces.
The following criteria provided the assessment framework to establish a list of priority carcinogens: evidence of carcinogenicity using International Agency for Research on Cancer (IARC) criteria; use in occupational circumstances; and use in Australia industry. Literature from national and international agencies relating to carcinogens and industrial practice informed the assessment.
The final priority list contained 38 established or probable carcinogenic agents that are present in Australian workplaces. Agents were grouped into the following categories: combustion products, inorganic dusts, organic dusts, metals, radiation, other industrial chemicals and non-chemical agents. The priorities are based primarily on the potential for occupational exposure and evidence of use in Australian industry because there is limited information on the prevalence and level of exposure to occupational carcinogens in Australia.
The priority list of agents can provide direction for future disease burden studies to establish the prevalence and levels of exposure to carcinogens amongst Australian workers. From a policy viewpoint, a priority list will allow regulators to focus on activities such as setting exposure standards and restricting importation and use.
Australian and New Zealand Journal of Public Health 04/2012; 36(2):111-5. · 1.20 Impact Factor
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The Medical journal of Australia 02/2012; 196(3):162-4. · 2.81 Impact Factor
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ABSTRACT: To determine trends in incidence of malignant mesothelioma (MM) caused by exposure to asbestos during home maintenance and renovation.
Using the Western Australian Mesothelioma Register, we reviewed all cases of MM diagnosed in WA from 1960 to the end of 2008, and determined the primary source of exposure to asbestos. Categories of exposure were collapsed into seven groups: asbestos miners and millers from Wittenoom; all other asbestos workers; residents from Wittenoom; home maintenance/renovators; other people exposed but not through their occupation; and people with unknown asbestos exposure; or no known asbestos exposure. Latency periods and age at diagnosis for each group were calculated and compared.
In WA, 1631 people (1408 men, 223 women) were diagnosed with MM between 1960 and 2008. Since 1981, there have been 87 cases (55 in men) of MM attributed to asbestos exposure during home maintenance and renovation, and an increasing trend in such cases, in both men and women. In the last 4 years of the study (2005-2008), home renovators accounted for 8.4% of all men and 35.7% of all women diagnosed with MM. After controlling for sex and both year and age at diagnosis, the latency period for people exposed to asbestos during home renovation was significantly shorter than that for all other exposure groups, but the shorter follow-up and difficulty recalling when exposure first occurred in this group may partly explain this.
MM after exposure to asbestos during home renovation is an increasing problem in WA, and these cases seem to have a shorter latency period than other types of exposure. MM cases related to renovation will probably continue to increase because of the many homes that have contained, and still contain, asbestos building products.
The Medical journal of Australia 09/2011; 195(5):271-4. · 2.81 Impact Factor
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ABSTRACT: It is unknown whether parental occupational exposure to chemicals before during and after pregnancy increases the risk of acute lymphoblastic leukemia (ALL) in the offspring. Few studies on this topic have assessed maternal exposures.
In an Australian case-control study of ALL in children aged <15 years, parents were asked about tasks they undertook in each job using a set of job-specific modules (JSMs). An expert reviewed the likelihood of exposure to exhausts, solvents, glues, and paints. Exposure was examined in each job 2 years, 1 year and anytime before birth of the child, and up to 1 year after birth of child.
Solvent exposure was similar for case and control mothers in all time periods. More case mothers had moderate/high exposure to exhausts than control mothers anytime before the birth of the child (p = 0.010). Exposure to moderate or substantial levels of exhausts by mothers (OR = 1.97 95% CI 0.99-3.90) or fathers (OR = 1.37 95% CI 1.01-1.86) before the birth increased the risk of ALL in their offspring. Exposure to paints, pigments, glues, and resins was similar in case and control parents.
We found little evidence that parental occupational exposure to solvents, glues, and paints was associated with childhood ALL. There was some evidence ALL was associated with exhaust exposure.
Cancer Causes and Control 08/2011; 22(11):1575-85. · 2.88 Impact Factor
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ABSTRACT: The asbestos and ovarian cancer relationship is not well understood because of small numbers of women exposed to asbestos, small numbers of cases, and misclassification of peritoneal mesothelioma as ovarian cancer on death certificates. The aim of this study was to conduct a meta-analysis to quantify the evidence that exposure to asbestos causes ovarian cancer.
Fourteen cohort and two case-control studies were identified in Medline searches from 1950 to 2008.
Statistically significant excess mortality was reported in four of the cohort studies, all of which determined their outcomes from the death certificate. Peritoneal mesotheliomas were reported in these studies, two of which reexamined pathology specimens and reported disease misclassification. Exposure-response relationships were inconsistent. When all studies were included in a meta-analysis, the effect size was 1.75 (95% CI, 1.45-2.10) attenuating to 1.29 (95% CI, 0.97-1.73) in studies with confirmed ovarian cancers.
Taken without further analysis, women thought to have ovarian cancer had an increased rate in the meta-analysis if reporting having been exposed to asbestos, compared with reference populations. This result may have occurred because of disease misclassification.
Cancer Epidemiology Biomarkers & Prevention 06/2011; 20(7):1287-95. · 4.12 Impact Factor
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ABSTRACT: Owing to the high rates of malignant mesothelioma in workers exposed to crocidolite earlier at Wittenoom and evidence of protection against cancer by vitamin A, a population-based cancer prevention programme providing retinol supplements (25 000 IU/day) was commenced in 1990. The former workers at Wittenoom known to be alive and living in Western Australia in June 1990 constitute the study population. The participants were classified into two groups: those who received supplemental retinol (intervention group) and those who received none (comparison group). The relative rate of mesothelioma for those receiving retinol was estimated using Cox regression, adjusting for cumulative asbestos exposure and age at first exposure to asbestos. Nine hundred and twenty-eight former Wittenoom workers received retinol at some stage of the programme, whereas 1471 workers never received retinol (comparison group). Those who received retinol were younger, had a greater exposure to asbestos and smoked less than the comparison group. There were 65 cases of mesothelioma in the retinol group and 88 in the comparison group. After adjustment, the hazard ratio was 0.99 (95% confidence interval=0.70-1.41). This result did not alter when the participants who received only retinol once or those who received beta-carotene earlier were excluded from the analysis. In conclusion, this study provides little support for possible preventive effects of retinol against mesothelioma in workers exposed to blue asbestos.
European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP) 09/2010; 19(5):355-9. · 2.21 Impact Factor
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ABSTRACT: Among 2,968 women and girls exposed to crocidolite (blue asbestos) at Wittenoom, three cases of choriocarcinoma and three cases of hydatidiform mole have been identified (crude incidence rate of 9.9 per 1000 women and 1.7 per 1000 deliveries for choriocarcinoma and hydatidiform mole, respectively). The women with choriocarcinoma were resident at Wittenoom at the time of disease development, whereas hydatidiform mole occurred much later in women who had first been exposed to asbestos as young girls. Four of the six cases were known to have lived with asbestos company workers who brought their dusty work-clothes home for washing. Asbestos fibers have been reported in the lung, the pleural and peritoneal mesothelium, and the human ovary. They have also been detected in placental digests of live and stillborn infants. This cluster of gestational trophoblastic diseases has some biological plausibility for asbestos causation. Taking an occupational and residential history and examining pathologic specimens for asbestos fibers or bodies may prove useful in patients with gestational trophoblastic disease.
Cancer Epidemiology Biomarkers & Prevention 11/2009; 18(11):2895-8. · 4.12 Impact Factor
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ABSTRACT: Animal studies have suggested an association between asbestos and ovarian cancer, and asbestos fibers have been detected in human ovaries. Sexual intercourse may introduce asbestos fibers into the vagina and to the cervix and ovaries. Occupational cohorts have reported excess mortality from reproductive cancers, but exposure-response relationships are inconsistent. We examine the incidence and exposure-response relationships of these cancers among 2,968 women and girls exposed to blue asbestos at Wittenoom, Western Australia.
2,552 women were residents of the town and 416 worked for the asbestos company (Australian Blue Asbestos). Standardized incidence ratios compared the Wittenoom women with the Western Australian population. A nested case-control design and conditional logistic regression examined exposure-response relationships.
Ovarian (standardized incidence ratio, 1.27), cervical (standardized incidence ratio, 1.44), and uterine cancer (standardized incidence ratio, 1.23) increased but not statistically significantly among the Wittenoom women compared with the Western Australian population. Among the Australian Blue Asbestos workers, cervical cancer was twice that of the Western Australian population (standardized incidence ratio, 2.38), but ovarian cancer was less (standardized incidence ratio, 0.65). Women who first arrived at Wittenoom aged >or=40 years had an odds ratio of 13.9 (95% confidence interval, 2.2-90.2) for cervical cancer compared with those aged <15 years at first arrival. Women who lived with or washed the clothes of an Australian Blue Asbestos worker did not have an increased risk for any of the gynecologic or breast cancers.
There is no consistent evidence of an increased risk for gynecologic and breast cancers among the women from Wittenoom. Ovarian cancers and peritoneal mesotheliomas were not misclassified in this cohort.
Cancer Epidemiology Biomarkers & Prevention 01/2009; 18(1):140-7. · 4.12 Impact Factor
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ABSTRACT: Nearly 3000 women and girls were documented to have lived at the blue asbestos mining and milling town of Wittenoom in Western Australia between 1943 and 1992. Eight per cent of deaths among these women to the end of 2004 have been from malignant mesothelioma of the pleura.
To predict future mortality from mesothelioma to 2030 in this cohort.
Mesothelioma mortality rates incorporating parameters for cumulative exposure, a power of time since first exposure and annual rates of fibre clearance from the lung were calculated from maximum likelihood estimates. These rates plus age specific mortality rates for Western Australian females incorporating an excess lung cancer risk were then applied to all Wittenoom cohort women surviving to the end of 2004, in yearly increments, to predict the future numbers of cases of mesothelioma to 2030.
There were 40 deaths from mesothelioma among the Wittenoom women to the end of 2004. Using a range of models that incorporate time since first exposure, competing risks from other diseases, latency periods and clearance of mesothelioma from the lungs we predict 66 (lowest estimate) to 87 (highest estimate) deaths from mesothelioma until 2030. This represents one and a half to two and a half times the number of deaths that have already occurred to the end of 2004.
The high toll from mesothelioma in this cohort of women and girls will continue well into the future.
Occupational and environmental medicine 10/2008; 66(3):169-74. · 3.64 Impact Factor
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ABSTRACT: The impact of crocidolite exposure on the health of former Wittenoom miners and millers (largely male) has been well documented. Less is known about the health outcomes of the 2,968 women and girls who lived (N = 2,552) and worked (N = 416) in the blue asbestos milling and mining town of Wittenoom between 1943 and 1992. Quantitative exposure measurements were derived from dust studies undertaken over the lifetime of the mine and mill and the township. Incident cancers were obtained from the Western Australian (WA) Cancer Registry and the National Cancer Clearing House. Standardized incidence ratios (SIRS) compared Wittenoom females with the WA female population. Exposure-response relationships were examined using a matched case-control study design. There were (47) mesothelioma and (55) lung cancer cases among the 437 cancers in the Wittenoom females over the period 1960-2005. When compared to the WA female population, Wittenoom women and girls had higher rates of mesothelioma and possibly lung cancer. Mesothelioma incidence rates are increasing with the incidence rate of 193 per 100,000 in the period 2000-2005 being more than double that for the period 1995-1999 at 84 per 100,000. A significant exposure-response relationship was present for mesothelioma, but not for lung cancer. Forty years after the asbestos mine and mill at Wittenoom were closed, there is a high toll from cancer among the former female residents of the town and company workers.
International Journal of Cancer 06/2008; 122(10):2337-44. · 5.44 Impact Factor
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ABSTRACT: Blue asbestos was mined and milled at Wittenoom in Western Australia between 1943 and 1966.
Nearly 7000 male workers who worked at the Wittenoom mine and mill have been followed up using death and cancer registries throughout Australia and Italy to the end of 2000. Person-years at risk were derived using two censoring dates in order to produce minimum and maximum estimates of asbestos effect. Standardised mortality ratios (SMRs) compare the mortality of the former Wittenoom workers with the Western Australian male population.
There have been 190 cases of pleural and 32 cases of peritoneal mesothelioma in this cohort of former workers at Wittenoom. Mortality from lung cancer (SMR = 1.52), pneumoconiosis (SMR = 15.5), respiratory diseases (SMR = 1.58), tuberculosis (SMR = 3.06), digestive diseases (SMR = 1.47), alcoholism (SMR = 2.24) and symptoms, signs and ill defined conditions (SMR = 2.00) were greater in this cohort compared to the Western Australian male population.
Asbestos related diseases, particularly malignant mesothelioma, lung cancer and pneumoconiosis, continue to be the main causes of excess mortality in the former blue asbestos miners and millers of Wittenoom.
Occupational and environmental medicine 12/2007; 65(8):541-3. · 3.64 Impact Factor
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ABSTRACT: Blue asbestos was mined and milled at Wittenoom, Western Australia, from 1943 until 1966. Various public records were used to establish a cohort of residents of the nearby township. Mine tailings were distributed throughout the town.
To report the incident number of malignant mesotheliomas that have occurred in residents of the town who did not work at the mine or mill; and to determine if female subjects are more susceptible to asbestos exposure than male subjects, and if children are more susceptible than adults.
A total of 4,768 residents of the town of Wittenoom have been followed up in cancer and death registries.
There were 67 cases of mesothelioma, and 64 deaths with mesothelioma to the end of 2002. The mortality rate with mesothelioma increased with increasing residence duration, time since first exposure, and estimated cumulative exposure. The mesothelioma mortality rate was consistently lower for female subjects when compared with male subjects, but the dose-response curve was steeper for female subjects. The rate was lower in those first exposed as children compared with those first exposed at > or = 15 years of age. The dose-response slope for asbestos exposure and mortality from mesothelioma was not different between those who were first exposed as children than those who were first exposed at > or = 15 years of age.
Former residents of a crocidolite mining town have a high rate of mesothelioma. The rate is higher in male subjects and those > or = 15 years of age at first exposure, but women have a steeper dose-response curve.
Chest 03/2007; 131(2):376-82. · 5.25 Impact Factor
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ABSTRACT: To describe the dissemination of asbestos fibres within the Western Australian community.
A case report.
A 60-year-old female was referred for investigation of calcified pleural plaques. On questioning, she recalled exposure to asbestos as a child on the family farm. She had shaken hessian bags prior to recycling to the fertiliser supplier. Her father survived to 90 years. Her mother died from malignant pleural mesothelioma. Four of five siblings had shaken the bags, two had radiographic evidence of pleural plaques while two others had not had recent chest x-rays.
It appears that the use of recycled hessian bags for the fertiliser industry was endemic in the State during the period 1943-66. It is possible that many farmers and their families have had similar exposure to asbestos.
The risk of developing an asbestos-related disease is not restricted to any specific social or employment groups within the Australian community.
Australian and New Zealand Journal of Public Health 09/2006; 30(4):312-3. · 1.20 Impact Factor
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ABSTRACT: To examine the characteristics of persons attending a skin cancer screening clinic in Western Australia and compare the effectiveness of screening in different socio-demographic subgroups.
Questionnaires were completed by 5,950 self-selected participants who voluntarily attended the Western Australian Lions Cancer Institute's targeted skin cancer screening clinics during the period 1996-2003. A risk assessment technique was used to identify individuals at high risk of developing melanoma. Provisional diagnoses of suspicious lesions were given at the screening by a medical specialist. Suspicious lesions were later matched with histopathologically confirmed malignant melanomas reported to the Western Australia Cancer Registry.
Fifty-seven per cent of attendees were female. The mean age of attendees was 53 years. The yield of suspicious malignant melanomas detected was 24.7 per 1,000 participants screened; the yield of confirmed malignant melanomas detected was 3.0 per 1,000 participants screened. Persons over 50 years of age were three times more likely to have a histopathologically confirmed malignant melanoma detected at the screening than those younger than 50 years (p = 0.049).
The yield of confirmed melanomas detected by the Lions Cancer Institute is among the highest reported by a skin cancer screening program. This may have been attributable to the risk assessment technique used by the program.
A free community skin cancer screening program that targets high-risk individuals can detect melanomas.
Australian and New Zealand Journal of Public Health 03/2006; 30(1):75-80. · 1.20 Impact Factor
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ABSTRACT: The objective of this article was to assess the association between the incidence and mortality from aerodigestive cancers and exposure to crocidolite (blue asbestos). Our study is a cohort study of former workers of the now-defunct crocidolite mining and milling operation at Wittenoom, Western Australia, who have been followed up since 1979 and on whom asbestos exposure and smoking information was known. Standardised mortality and incidence rates were used to compare former workers with the Western Australian male population. Cases were matched with up to 10 randomly assigned controls, and conditional logistic regression was used to examine the relationship between asbestos exposure, smoking status and cancer incidence. There were 129 incident cases from all cancers of interest and 57 deaths. Former workers had a significantly higher risk of mortality from upper aerodigestive cancers than the Western Australian male population. The incidence of upper and lower aerodigestive cancers was higher in the Wittenoom cohort but not significantly so. Cumulative exposure to asbestos did not appear to be associated with the incidence of stomach cancer, colorectal cancer or upper aerodigestive cancers. Smoking status was strongly associated with the incidence of upper aerodigestive cancers, with current smokers experiencing the greatest risk. Our study with longer and more complete follow-up, smoking information and a stronger study design does not show an association between cumulative asbestos exposure and stomach cancer or other gastrointestinal cancers. The excess mortality from upper aerodigestive cancers seen in this cohort of former asbestos workers compared to the Western Australian male population does not appear to be associated with exposure to crocidolite.
International Journal of Cancer 10/2004; 111(5):757-61. · 5.44 Impact Factor
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ABSTRACT: The objective of this study was to examine the impact of the knowledge of past asbestos exposure on psychosocial health.
Blue asbestos was mined and milled at Wittenoom in Western Australia between 1943 and 1966. In 2007, SF-12 and Locus of Control (LOC) questionnaires were sent to 5,101 surviving Wittenoom workers and residents. Wellbeing scores and LOC scores were then examined in relation to quantitative exposure measures using linear regression.
Wellbeing scores were lower among Wittenoom workers and residents compared with the Western Australian population, although an exposure-response relationship with cumulative asbestos exposure was not found. Those who arrived in Wittenoom as children had a more external sense of control than those who arrived there as adults. There was a 0·12 increase in LOC with a 2·7-fold increase in cumulative asbestos exposure (f/ml-years) (P<0·01).
The study concluded that asbestos operation at Wittenoom may have had a detrimental impact on former workers' and residents' sense of control over their lives.
International journal of occupational and environmental health 18(2):116-23. · 1.03 Impact Factor
