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Asbestotic Radiological Abnormalities among United States Merchant Marine Seamen

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Abstract

There has been limited information concerning the prevalence of radiologically evident parenchymal and pleural fibrosis consistent with prior exposure to asbestos among merchant marine seamen, despite the wide use of asbestos in ship construction until the late 1970s and subsequent exposure of seamen to the asbestos that had been installed. A total of 3324 chest radiographs (1985-7) of long term United States seamen were reviewed. One third (34.8%) had parenchymal or pleural abnormalities, or both (ILO classification); pleural changes were predominant. Abnormalities increased with longer duration from onset of shipboard exposure (as defined by first year at sea). The prevalence of asbestotic changes was greater among seamen who had served in the engine department (391/420; 42.5%) compared with seamen in other departments, including deck (301/820; 36.6%), steward (278/981; 28.4%), or with service in multiple departments (167/541; 30.9%). Since many vessels, particularly those built before 1978, contain asbestos materials, appropriate engineering controls (including complete removal, if possible) are required as well as appropriate medical surveillance for those who served aboard such ships.

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... While there are a relatively large number of studies that have assessed airborne asbestos exposure among shipyard workers involved in installing, repairing or removing asbestos insulation, our review of the published literature found no studies that have characterized the exposure of maritime or merchant seamen to airborne asbestos (Balzer and Cooper, 1968; Cooper and Balzer, 1968; Harries, 1968 Harries, , 1971a Ferris et al., 1971; Bell, 1976). A few studies, however, have reported an increased incidence of asbestosrelated disease among this seafaring population (Jones et al., 1984; Selikoff et al., 1990; Varouchakis et al., 1991; Pukkala and Saarni, 1996; Saarni et al., 2002; Rafnsson and Sulem, 2003 ). It has been postulated that the increased incidence of asbestos-related disease among this population was, in part, due to the release of fibers from asbestos insulation occurring as a result of the natural movement and vibrations of a ship. ...
... To a much lesser degree, there can be exposure during accidental ruptures of pipes, failure of flange systems or pin holes in steam lines, because the insulation can degrade and fall to the floor but because, at that point, it is wet, the airborne concentrations are rarely appreciable. Studies of merchant seamen have reported increased incidence and mortality rates due to lung cancer, mesothelioma , and other pleural abnormalities especially among deck and engine crew and officers (Jones et al., 1984; Rafnsson et al., 1988; Velonakis et al., 1989; Kelman and Kavaler, 1990; Selikoff et al., 1990; Greenberg, 1991; Rapiti et al., 1992; Brandt et al., 1994; Rafnsson and Gunnarsdottir, 1995; Pukkala and Saarni, 1996; Saarni et al., 2002; Karlev et al., 2005). Many of these studies suggest that such high cancer rates were possibly due to previous asbestos exposure and/or constant exposure to low levels of airborne asbestos fibers from damaged or deteriorated asbestos-containing insulation released due to the natural vibrations of the ship or from insulation repairs conducted during travel at sea, including ruptures, failures or blowouts on steam piping. ...
... While results of the current analysis are generally higher than those reported for other ambient environments, they nonetheless are a fraction of the concentrations which have been reported to increase the risk of asbestos-related diseases, such as mesothelioma, asbestosis or lung cancer (Churg, 1998; Wong, 2001; Paustenbach et al., 2004; Roggli et al., 2004; Pierce et al., 2007). Numerous studies have analyzed health data for seamen, from about 1950 until 1980, suggesting an elevated mortality and morbidity risk from lung cancer and mesothelioma (Jones et al., 1984; Rafnsson et al., 1988; Velonakis et al., 1989; Kelman and Kavaler, 1990; Moen et al., 1990; Selikoff et al., 1990; Varouchakis et al., 1991; Morabia et al., 1992; Rapiti et al., 1992; Brandt et al., 1994; Rafnsson and Gunnarsdottir, 1995; Pukkala and Saarni, 1996; Saarni et al., 2002; Rafnsson and Sulem, 2003; Karlev et al., 2005). Some of these studies have suggested that excess mortality and morbidity may be at least partly attributed to constant exposure to low levels of airborne asbestos generated from vibrations of the insulated shipboard equipment and the natural movements of the ship. ...
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The exposure of shipyard workers to asbestos has been frequently investigated during the installation, repair or removal of asbestos insulation. The same level of attention, however, has not been directed to asbestos exposure of maritime seamen or sailors. In this paper, we assemble and analyze historical industrial hygiene (IH) data quantifying airborne asbestos concentrations onboard maritime shipping vessels between 1978 and 1992. Air monitoring and bulk sampling data were compiled from 52 IH surveys conducted on 84 different vessels, including oil tankers and cargo vessels, that were docked and/or at sea, but these were not collected during times when there was interaction with asbestos-containing materials (ACMs). One thousand and eighteen area air samples, 20 personal air samples and 24 air samples of unknown origin were analyzed by phase contrast microscopy (PCM); 19 area samples and six samples of unknown origin were analyzed by transmission electron microscopy (TEM) and 13 area air samples were analyzed by scanning electron microscopy (SEM). In addition, 482 bulk samples were collected from suspected ACMs, including insulation, ceiling panels, floor tiles, valve packing and gaskets. Fifty-three percent of all PCM and 4% of all TEM samples were above their respective detection limits. The average airborne concentration for the PCM area samples (n = 1018) was 0.008 fibers per cubic centimeter (f cc(-1)) (95th percentile of 0.040 f cc(-1)). Air concentrations in the living and recreational areas of the vessels (e.g. crew quarters, common rooms) averaged 0.004 f cc(-1) (95th percentile of 0.014 f cc(-1)), while air concentrations in the engine rooms and machine shops averaged 0.010 f cc(-1) (95th percentile of 0.068 f cc(-1)). Airborne asbestos concentrations were also classified by vessel type (cargo, tanker or Great Lakes), transport status (docked or underway on active voyage) and confirmed presence of ACM. Approximately 1.3 and 0% of the 1018 area samples analyzed by PCM exceeded 0.1 and 1 f cc(-1), respectively. This data set indicates that historic airborne asbestos concentrations on these maritime shipping vessels, when insulation-handling activities were not actively being performed, were consistently below contemporaneous US occupational standards from 1978 until 1992, and nearly always below the current permissible exposure limit of 0.1 f cc(-1).
... These increased risks were of particular concern among marine engineers123 5]. The findings have been attributed to asbestos exposure123 5], which is supported by indication of asbestos-related non-malignant pleural changes found in engine-room crew678. Work practice studies have indicated that repair work of former machinists involved high exposure to airborne asbestos fibers [9]. ...
... Previous studies on engine officers and engine crew have found an excess of lung cancer123 5] and mesothelioma [1, 3] and these cancers were found in excess in the present study. Several previous observations on seamen, and particularly engine crews, have found non-malignant pleural changes attributable to asbestos exposure678. Previous asbestos exposure seems to have contributed to this mesothelioma risk; the cases were diagnosed in 1989–1997. ...
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Marine engineers are in their occupation exposed to different chemicals, organic solvents, exhaust gases, oils, and petroleum products, and were formerly exposed to asbestos. The aim was to study the cancer pattern, with particular attention to lung and bladder cancer, in an Icelandic cohort of marine engineers, indirectly controlling for their smoking habits. A cohort of 6603 male marine engineers was followed up from 1955 to 1998, a total of 167,715 person-years. The cohort was record linked by the engineers' personal identification numbers to population-based registers containing the vital and emigration status and cancer diagnosis. Standardized incidence ratios (SIRs) were calculated for all cancers and different cancer sites in relation to different lag time and year of graduation. Information on smoking habits was obtained by administering a questionnaire to a sample of the cohort (n = 1,501). In the total cohort 810 cancers were observed, whereas 794 were expected (SIR 1.0, 95% CI 1.0-1.1), and significantly increased risk of stomach cancer (SIR 1.3, 95% CI 1.0-1.5) and lung cancer (SIR 1.2, 95% CI 1.0-1.5) was found. Increased risk of all cancers (SIR 1.2, 95% CI 1.1-1.3), stomach cancer (SIR 1.5, 95% CI 1.1-1.9), lung cancer (SIR 1.4, 95% CI 1.2-1.8), pleural mesothelioma (SIR 4.8, 95% CI 1.3-12.3), and urinary bladder cancer (SIR 1.3, 95% CI 1.0-1.8) were observed when a 40-year lag time was applied. The engineers' smoking habits were similar to those in a sample of the general population. The predictive value for lung cancer was 1.03. The increased risk for mesothelioma is possibly attributable to the previous asbestos exposure. The excess of lung cancer could also be related to asbestos exposure. The high incidence of stomach cancer, lung cancer, and bladder cancer may be related to exposure to chemical risk factors, such as oils and petroleum products, as confounding due to smoking seems to be ruled out. In the light of the limited exposure information in the present study the importance of the different occupational exposures needs to be evaluated in further studies.
... The abnormalities increased with years worked. A third had parenchymal or pleural abnormalities with pleural changes being the most predominant [25]. The parenchymal changes (small opacities) were as follows: 0/0 = 67.9%; ...
... 1/0 = 9.3%; 1/1 = 5.7%; 1/2 = 0.8%; and 2/1 and higher = 0.9%. These 3324 readings were divided into 3 categories: (1) absence of pleural fibrosis, 2929 (88%); (2) circumscribed pleural fibrosis, 325 (10%); and (3) diffuse pleural fibrosis, 70 (2%) [25]. The abnormalities increased with the duration of shipboard exposures. ...
Article
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Sailors have long been known to experience high rates of injury, disease, and premature death. Many studies have shown asbestos-related diseases among shipyard workers, but few have examined the epidemiology of asbestos-related disease and death among asbestos-exposed sailors serving on ships at sea. Chrysotile and amphibole asbestos were used extensively in ship construction for insulation, joiner bulkhead systems, pipe coverings, boilers, machinery parts, bulkhead panels, and many other uses, and asbestos-containing ships are still in service. Sailors are at high risk of exposure to shipboard asbestos, because unlike shipyard workers and other occupationally exposed groups, sailors both work and live at their worksite, making asbestos standards and permissible exposure limits (PELs). based on an 8-hour workday inadequate to protect their health elevated risks of mesothelioma and other asbestos-related cancers have been observed among sailors through epidemiologic studies. We review these studies here.
... Various other industries where asbestos has been widely used for insulation have also shown significant numbers of mesotheliomas, or some other evidence of clinical effects, such as increased incidence of pleural plaques among school custodians (Oliver, 1991). Increased morbidity and/ or mortality rates attributed to asbestos exposure have been reported for oil refinery workers (Gennaro et al., 1994;Finkelstein, 1996;Tsai et al., 1996a,b), chemical industry workers ( Lilis et al., 1980), railway workers (Battista G et al., 1999), marine maintenance engineers ( Jones et al., 1984;Selikoff et al., 1990), workers in the electrical generation industry (Hilt et al., 1995, Crosignani et al., 1995 and building maintenance workers ( Anderson et al., 1991). There is also evidence from UK death certificates that construction workers who installed and maintained the ACMs were exposed to an increased risk ( Peto et al., 1995). ...
Article
Epidemiological data suggest that there has been and may continue to be a significant risk to maintenance workers, who through their work may disturb asbestos-containing materials (ACM). The sampling and assessment of maintenance workers' exposure is a particular problem because they may not know that they are working with ACM. A strategy to monitor their true exposure has been developed and applied to one group of workers. The asbestos exposure of industrial plumbers was measured using personal passive samplers developed at the Health and Safety Laboratory (HSL). The light-weight samplers, which collect particles by electrostatic attraction, are simple to use and do not require prior knowledge that asbestos is to be disturbed as does conventional sampling. The samplers were issued by post and analysed, after return, using transmission electron microscopy (TEM). The strategy was found to be a reasonably efficient and cost-effective way to obtain data on maintenance worker's exposure to asbestos. The results of the TEM analysis of the passive samplers showed that the percentage of workers exposed to >5 microm long asbestos fibres was 62% in Round 1 and 58% in Round 2. For phase contrast microscopy equivalent (PCME) asbestos fibres, the values were 46 and 29%, respectively. The three samples with the highest numbers of fibres were followed up and were associated with plumbers working in areas which had supposedly been stripped of asbestos just prior to their starting work, suggesting that poor removal, clean-up and clearance practice presents a significant part of the risk to plumbers. Although flow rates will vary with conditions and time, an approximate average sampling rate from previous comparisons was used to calculate the concentration. This gave an average exposure to regulated PCME fibres of 0.009 f ml-1 for amphibole asbestos and 0.049 f ml-1 for chrysotile. The calculate risk based on the PCME fibre types collected and their estimated concentrations, showed that the risk from airborne amphibole fibres was approximately 6 times greater than from chrysotile fibres. If representative, the estimated lifetime risk of death from an asbestos related cancer for an exposure from age 20 for 40 years would be 68 per 100,000, which equates to an annual risk of death of the order of 10 per million.
... Nonostante i dubbi sulla effettiva aerodispersione delle fibre di amianto negli ambienti di lavoro delle navi, il ruolo dell'asbesto nello sviluppo di mesoteliomi è dimostrato da Varouchakis [18] in un raffronto fra un marittimo con mansioni di macchina ed un altro con mansioni di coperta. Ulteriori conferme provengono da uno studio di Selikoff [19] fondato sulla revisione critica di 3324 radiografie del torace di marittimi Statunitensi nel periodo 1985-1987: un terzo presentava anormalità parenchimali o pleuriche, con una predominanza delle alterazioni pleuriche. Il riscontro di tali alterazioni risultava direttamente proporzionale alla durata dell'esposizione a bordo delle navi e la prevalenza di alterazioni asbesto-correlabili era maggiore tra i marittimi di macchina. ...
... Nearly all Navy personnel aboard ships had some asbestos exposure, even in berthing quarters and mess halls, particularly prior to 1980. Numerous studies have evaluated the health risks to seamen and those employed in shipyards (Bianchi et al., 2001;Greenberg, 1991;Kurumatani et al., 1999;Roggli et al., 2002;Selikoff & Hammond, 1978;Selikoff et al., 1990). With respect to mesothelioma specifically Roggli et al. (2002) noted that the numbers of mesothelioma cases were greatest in the shipbuilding and US. ...
Article
This literature review on refractory ceramic fibers (RCF) summarizes relevant information on manufacturing, processing, applications, occupational exposure, toxicology and epidemiology studies. Rodent toxicology studies conducted in the 1980s showed that RCF caused fibrosis, lung cancer and mesothelioma. Interpretation of these studies was difficult for various reasons (e.g. overload in chronic inhalation bioassays), but spurred the development of a comprehensive product stewardship program under EPA and later OSHA oversight. Epidemiology studies (both morbidity and mortality) were undertaken to learn more about possible health effects resulting from occupational exposure. No chronic animal bioassay studies on RCF have been conducted since the 1980s. The results of the ongoing epidemiology studies confirm that occupational exposure to RCF is associated with the development of pleural plaques and minor decrements in lung function, but no interstitial fibrosis or incremental lung cancer. Evidence supporting a finding that urinary tumors are associated with RCF exposure remains, but is weaker. One reported, but unconfirmed, mesothelioma was found in an individual with prior occupational asbestos exposure. An elevated SMR for leukemia was found, but was absent in the highly exposed group and has not been observed in studies of other mineral fibers. The industry will continue the product stewardship program including the mortality study.
... Selicoff, который с начала 1960 х годов на про тяжении последующих лет жизни, вплоть до 1992 г., был наиболее значительной фигурой в учении об асбестозах. В частности, им было доказана роль малых доз пылевого агента в развитии плевро пневмосклероза и онкологических заболеваний легких и плевры [7][8][9][10][11]. Подобная точка зрения впоследствии была подтверждена многочислен ными наблюдениями в других странах [12][13][14]. ...
... Pleural plaques and diffuse pleural thickening and pulmonary fibrosis are common manifestations of asbestos exposure [1,2]. Usually, the degree of asbestosis is evaluated using conventional chest radiographs [3,4]. Cumulative asbestos exposure over time increases the prevalence of pleural changes and parenchymal asbestos-related changes [5]. ...
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The purpose of the study was to evaluate the accuracy of magnetic resonance imaging (MRI) in detecting subclinical morphological changes caused by asbestos exposure. Conventional chest radiographs according to the International Labour Organisation (ILO) categories 0-11 and spirometric data were compared with MRI in 17 men with mean (+/-2SD) asbestos exposure time of 24.6+/-13.0 yrs. Mean age was 62.0+/-9.4 yrs. The inclusion criterion was an ILO score of 2 or more. Electrocardiographic registrations and antirespiratory movement artefact techniques were used in all MRI examinations to avoid movement artefacts. Mean ILO grading was found to be 7.7+/-3.8 on chest radiography and 9.8+/-2.0 with MRI (p=0.01). Five patients had a higher ILO stage as evaluated by MRI, but in nine patients the staging remained unchanged. MRI revealed mediastinal adenopathy in four patients. Forced expiratory volume in one second (expressed as a percentage of the predicted value) was negatively correlated with ILO score as assessed by MRI (r=-0.4, p=0.032). Magnetic resonance imaging seems to be more sensitive than conventional radiographs in detecting subclinical fibrosis as well as the extent of pleural asbestosis.
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We examined the development of knowledge concerning the risks posed by asbestos to seamen working aboard merchant ships at sea (i.e. commercial, rather than naval vessels). Seamen were potentially exposed to “in-place” asbestos on merchant ships by performing intermittent repair and maintenance tasks. We reviewed studies measuring airborne asbestos onboard merchant ships and health outcomes of merchant seamen, as well as studies, communications, and actions of U.S. organizations with roles in maritime health and safety. Up to the 1970s, most knowledge of the health risks of asbestos was derived from studies of workers in asbestos product manufacturing and asbestos mining and milling industries, and certain end-users of asbestos products (particularly insulators). We found that attention to the potential health risks of asbestos to merchant seamen began in the mid- to late 1970s and early 1980s. Findings of pleural abnormalities in U.S. seamen elicited some concern from governmental and industry/labor organizations, but airborne asbestos concentrations aboard merchant ships were found to be <1 f/cc for most short-term repair and maintenance tasks. Responses to this evolving information served to warn seamen and the merchant shipping industry and led to increased precautions regarding asbestos exposure. Starting in the 1990s, findings of modest increases in lung cancer and/or mesothelioma in some epidemiology studies of seamen led some authors to propose that a causal link between shipboard exposures and asbestos-related diseases existed. Limitations in these studies, however, together with mostly unremarkable measures of airborne asbestos on merchant ships, preclude definitive conclusions in this regard.
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The aim of the present historical cohort study was to enhance the understanding of the unusual mortality pattern seen among seafarers. The main object was to describe the mortality pattern of Danish seafarers in recent years with special reference to the influence of accidents in the maritime workplace and ashore and the influence of diseases related to lifestyle. A cohort of 24,132 male seafarers of all job categories employed on a Danish merchant ship between 1986 and 1993, was followed up. Mortality among those who left the occupation before the end of the follow-up period was analysed separately. The standardized mortality ratio was 1.43 (95% CI: 1.33-1.54) from all causes and 3.05 (95% CI: 2.62-3.52) from accidents. An excess mortality from natural causes was attributable mostly to an excess among deck and engine room crew and was mainly caused by diseases related to lifestyle. While active as seafarers, the SMR for accidents was 2.62 (95% CI: 2.12-3.20), accidents at the workplace explaining almost half the deaths. Among those who left shipping, the risk of fatal accidents increased. All categories of seafarers continued to have a high risk of fatal accidents into older age. Merchant seafarers were shown to have a higher mortality than the general population. Despite a very high risk of fatal accidents in the workplace, these accidents could only explain a proportion of the observed excess mortality. Accidents ashore and diseases related to lifestyle factors such as drinking and smoking made a major contribution to the observed excess mortality. The results indicate that people in occupations with a high risk of fatal accidents at the workplace also seem to have a high risk of accidents away from the workplace after leaving the occupation. The high risk lifestyle seems to be linked to lifestyle in general and hence the related diseases and high risk of death.
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The first patient known to have died from asbestosis (1900) began work in 1885, approximately 5 years after the industrial use of asbestos began in Britain. Mineral particles were found in his lungs. No special comment was made of their fibrous nature then nor when the first case was reported in 1924. The various neoplasms attributed to asbestos in the next decades posed an additional question: What influence did the fibrous shape of the particles have on carcinogenic potential? The cogency of the problem was amplified by the identification in humans of asbestos-like neoplasms with a fiber other than asbestos (erionite) and by the production of such neoplasms in experimental animals with a variety of man-made inorganic fibers, often used as substitutes for asbestos. The lessons learned about asbestos may help guide us in evaluating current fiber problems.
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A retrospective cohort study was performed to analyze the mortality patterns of Danish merchant seamen in the period 1970-1985. The population census in 1970 in Denmark was the source of information on individual occupation, age, and marital status. All men aged 20-64 years and economically active in 1970 were included. Computerized linkage with the Danish Mortality Register gave information about the deceased persons' date and cause of death. An increased overall mortality among all groups of seamen was found, being highest for deck and engine crew members. The overall mortality was strongly dependent on age and marital status. The highest mortality rate ratios (MRR) were found among young seamen and unmarried seamen. MRRs of 1.90 and 2.47 for cancer of the respiratory system were found among engine officers and crew. The MRRs for accidents and suicide were increased for all seamen, and were highest for crew members, among whom the MRR from accidents was stable within age groups but fell for suicide with increasing age. The same pattern was found with cirrhosis of the liver, although this was positively associated with increasing age. Excess mortality from ischemic heart disease was only found among engine crew (MRR = 1.43). This study confirms earlier findings of high mortality among seafarers. Negative selection into the occupation, occupational environmental factors, and lack of health and safety promotion programs and education could be causes of the high mortality.
Article
A cohort of 30,940 male and 11,529 female seafarers registered in the files of Seafarers' Pension Fund in Finland was followed up through the Finnish Cancer Registry for cancer in 1967-92. Among male seafarers, there were 1,199 cases of cancer, which corresponds to the average cancer incidence in Finnish men. There was a statistically significant excess of non-melanoma skin cancer (standardized incidence ratio [SIR] = 1.8, 95 percent confidence interval [CI] = 1.2-2.5) and mesothelioma (SIR = 2.9, CI = 1.2-5.6) in the follow-up category of 20 or more years since the first employment. Alcohol-related cancers were increased among seafarers (SIR for cancer of the mouth and pharynx = 1.5; esophagus = 1.4; and liver = 1.5; combined CI = 1.1-1.9). Deck crews had a significantly high risk of cancer of the pancreas (SIR = 2.0) and also prostate after 10 years since first employment (SIR = 1.6). Occupational asbestos exposure among seafarers is likely strong enough to cause excess cases of mesothelioma but not of lung cancer. Occupational exposures also may be associated with increased risk of cancers of the kidney, pancreas, prostate and old-age brain cancer in some of the main occupational categories. Cumulative ultraviolet radiation likely doubles the risk of nonmelanoma skin cancer among older men and repeated sunburns that of skin melanoma in ages below 30 (SIR among deck and engine crew = 4.6, CI = 3.1-6.5). Female ship personnel had a significantly elevated total cancer risk (observed number of cases = 732) which increased over follow-up time (SIR in the category ≥ 20 years since the first employment was 1.3, CI = 1.1-1.5). This excess was attributable primarily to lung cancer (SIR = 2.6, CI = 2.0-3.3). Also cancers of the cervix uteri, vulva, and vagina showed significant excess after 10 to 20 years since first employment aboard.
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The purpose of the study was to investigate to what extent marine engineers who are exposed to mineral oil mist in the engine rooms of ships have lung function disturbances and chest X-ray abnormalities. A previous study examined a cohort of 492 seamen from which we received 169 full-scale (40 x 40 cm) chest radiographs. Among these films were 68 from marine engineers and 101 from seamen who had never worked as engineers (controls). Spirometric data were obtained from 44 engineers and from 71 of the controls. The chest X-rays were classified independently by two certified B-readers, using the ILO classification. Only 7% of the seamen had parenchymal or pleural changes. The only statistically significant difference between the two groups for the chest X-ray findings was for all comments made by the ILO readers which were termed "any symbol" (9.3% for the engineers and 0.6% for the controls; RR = 14.6 (95% CI 1.1-75.5)) and the FEV% (FEV1/FVC x 100) for the spirometric values (82.8 (SD = 10.8) for the engineers and 86.6 (SD = 8.0) for the controls; P = 0.03). The results of the study indicate a slight lung function impairment and an increase in chest X-ray abnormalities, other than small opacities, among the marine engineers.
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The purpose of the study was to see if marine engineers have an increased prevalence of respiratory symptoms, and if so whether it can be related to occupational exposures. A self-administered questionnaire was sent to 700 male seamen from three Norwegian ferry companies. Of the 492 respondents, 169 were currently working as marine engineers and 295 had never worked as marine engineers. The outcomes of cough and wheezing, chronic bronchitis, severe dyspnea, any dyspnea, and mucous membrane irritation (MMI) were defined from the questionnaire. Age and smoking-adjusted prevalences of these respiratory conditions were compared between the groups. Logistic regression was used to further elucidate the explanatory variables. The exposure assessment indicated an exposure (TWAC) to oil mist for marine engineers in the range from 0.12 to 0.74 mg/m3 (mean 0.45 mg/m3) When comparing current marine engineers with those who had never worked as marine engineers, the prevalence ratios were 1.38 (95% CI 1.0-1.9) for MMI, 1.53 (95% CI 1.2-1.9) for any dyspnea, and 1.63 (95% CI 1.0-2.6) for severe dyspnea. The differences remained for some of the symptoms after controlling for self-reported former asbestos exposure in the regression analysis. The increased prevalence of respiratory symptoms found among marine engineers in this investigation may partly be explained be oil-mist exposure, or more probably by a combination of past asbestos exposure and past and present oil-mist exposure.
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This study describes the magnetic resonance findings of benign and malignant pleural diseases in asbestos-exposed subjects. Thirty patients with a history of asbestos exposure and pleural lesions in chest X-rays and computed tomography scans were examined with a 0.5- and a 1.5-T magnetic resonance unit. The examination protocol included cardiac-gated proton density and T2-weighted images, unenhanced and enhanced (Gd-DTPA; 0.1 mmol/ kg) T1-weighted images in the axial plane and sometimes in another orthogonal plane (sagittal or coronal or both). All the magnetic resonance images were reviewed by 3 experienced observers, who visually evaluated morphologic features, signal intensity, and contrast enhancement of pleural lesions. The diagnosis was established by means of percutaneous biopsy, thoracotomy, and combined clinical and radiological follow-up for at least 3 years. Eighteen patients affected with multiple pleural plaques showed low signal intensity on both unenhanced and enhanced T1-weighted and proton density and T2-weighted images. In 2 of these patients an acute pleural effusion was observed. All the malignant lesions (11 mesotheliomas) and a solitary benign pleural plaque revealed high signal intensity on the proton density and T2-weighted images and inhomogeneous contrast enhancement in the postcontrast T1-weighted images. The sensitivity, specificity, and diagnostic accuracy of the magnetic resonance imaging in classifying a lesion as suggestive of malignancy were 100%, 95% and 97%, respectively. The results point out 2 magnetic resonance signal intensity patterns for asbestos-related pleural lesions: (i) low-signal intensity on unenhanced and enhanced T1-weighted and proton density and T2-weighted images for benign plaques and (ii) nonhomogeneous hyperintensity in T2-weighted and enhanced T1-weighted images for malignant mesotheliomas.
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The occurrence of mesothelioma is a sentinel event in occupational and environmental disease. A mesothelioma surveillance system was established utilizing existing computerized Wisconsin vital statistics data maintained since 1959 and a Cancer Reporting System (CRS) established in 1978. Review of the death certificate listing of usual occupation and industry from 487 mesothelioma deaths in Wisconsin from 1959 to 1989 led to the investigation of 41 persons with likely exposure to inplace asbestos-containing building materials (ACBM): 12 school teachers, 10 school maintenance employees, 7 public building maintenance workers, 5 private building maintenance workers, and 7 commercial and factory workers performing maintenance activities. For 10 (34%) of the 29 maintenance workers the only source of asbestos exposure identified was their maintenance work. For five (17%) histories indicated some prior employment in occupations and industries with probable asbestos exposures. Opportunities for indirect occupational exposure were identified for ten who had been employed in the residential construction industry. One maintenance worker was exposed to asbestos in the household and another had neighborhood exposure. For 9 (75%) of the school teachers, the only identifiable potential source of asbestos exposure was derived from in-place ACBM in schools. One teacher had spent a season in the merchant marine aboard an iron ore-hauling ship and 2 had worked in the residential construction industry. Two of the teachers were sisters, and in two instances, two teachers had taught in the same school facility. We conclude that individuals occupationally exposed to in-place ACBM are at risk for the subsequent development of mesothelioma.
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The purpose of this study was to determine the concentrations of oil mist and hydrocarbon vapor to which marine engineers are currently exposed. Measurements were also taken of the sound level in the engine room and the control rooms. Area mist concentration measurements were performed in 21 ferries, 2 cargo ships, and 1 westamaran (an express ship with two keels). Measurements were also performed for four different tasks where exposures above area level were expected. The area level of oil mist in the engine rooms of the different ships varied from not detectable to 0.53 mg/m3 (mean 0.24 mg/m3). The levels of hydrocarbons in the different ships varied from 0.2 to 14.5 mg/m3. The sound level varied from 96 to 108 dB(A) in the engine rooms, and from 70 to 90 dB(A) in the control room. When compared to other studies, it is supposed that the exposure to noise and mineral oil mist in the engine rooms of ships may represent a risk of adverse health effects for workers on Norwegian ships. The sound level may cause neurogenic hearing loss when appropriate hearing protection is not used.
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To study the possible work related reasons for the increased incidence of many cancers among seafarers. A case-control study, nested in a cohort of all male seafarers (n = 30 940) who, according to the files of the Seamen's Pension Fund, had worked on board Finnish ships for any time during the period 1960-80. Cases of cancer of the lung, nervous system, kidney, and pancreas, leukaemia, lymphoma, and all cases histologically defined as mesotheliomas were identified from the Finnish Cancer Registry in 1967-92. The preceding numbers of years at sea in various occupational categories were collected according to the type of ship (dry cargo ship, tanker, passenger vessel, icebreaker, other vessel). The incidence for lung cancer among engine crew increased with the increase in employment time, the odds ratio (OR) after three years being 1.68 (95% CI 1.17 to 2.41). The OR of lung cancer for deck officers was 0.42 (95% CI 0.29 to 0.61). Deck personnel on icebreakers had a significantly increased risk of lung cancer > or =20 years after first employment (OR 3.41, 95% CI 1.23 to 9.49). The OR for mesothelioma among engine crew with a latency of 20 years was 9.75 (95% CI 1.88 to 50.6). The OR for renal cancer among deck officers after three years employment was 2.15 (95% CI 1.14 to 4.08), but there was no increase by employment time or by latency. A rise of OR for lymphoma was detected among deck personnel on tankers, if the employment had lasted over three years (OR 2.78, 95% CI 0.98 to 7.92). The risk pattern for leukaemia was similar to that of lymphoma, the OR among deck personnel on tankers varying from 2.26 (95% CI 1.01 to 5.06) to 6.86 (95% CI 1.62 to 28.8) depending on the length of employment. Results indicate that occupational exposures of deck crews on tankers add to their risk of renal cancer, leukaemia, and possibly lymphoma. Engine crews have an asbestos related risk of mesothelioma, and the engine room conditions also seem to increase risk of lung cancer.
Article
The aim of this study was to define the cancer pattern in an Icelandic cohort of deck officers while indirectly controlling for their smoking habits. A cohort of 3874 male deck officers was followed from 1966 to 1998. It was record-linked by the deck officers' personal identification numbers to population-based registers containing each person's vital and emigration status and cancer diagnosis. Standardized incidence ratios (SIR) were calculated for all cancers and different cancer sites in relation to different lag times and years of birth. Information on smoking habits was obtained by from a questionnaire administered to a sample of the cohort (N=728). In the total cohort 436 cancers were observed, equal to the expected 436 [SIR 1.0, 95% confidence interval (95% CI) 0.9-1.1], and a significantly increased risk of soft-tissue sarcoma (SIR 2.7, 95% CI 1.2-5.1) was found together with a decreased risk of testis cancer (SIR 0.0, 95% CI .. -0.7) and urinary bladder cancer (SIR 0.5, 95% CI 0.3-0.8). The deck officers' smoking habits were similar to those found in a sample of the general population. The predictive value was 1.11 for lung cancer An increased incidence of soft-tissue sarcoma was found among deck officers. This increase resembles that previously found for Swedish deck officers, and it warrants further study.
Article
A large amount of data indicates that seafarers are at risk for asbestos disease. Objectives: To trace the outlines of pleural mesothelioma among seafarers. Pleural mesotheliomas diagnosed among seamen in the Trieste-Monfalcone area, Italy, in the period 1973-2003, were reviewed. The series comprised 50 men aged between 53 and 91 years (mean age 75.7 years). The diagnosis of mesothelioma was confirmed by necropsy in 38 cases. The patients had served in the Italian Navy (24 persons), in the merchant navy (17 persons), or in both (9 persons). The trades were various including engine room as well as deck personnel. Asbestos bodies were detected on routine lung sections in 55% of the necropsy cases. Asbestos bodies isolated from the lungs in three cases ranged between 2100 and 7000 bodies per gram of dried tissue. Latency periods ranged between 33 and 72 years (mean 56.1 years). When compared with shipyard workers, the seamen with mesothelioma show signs of less intense exposure to asbestos, and longer latency periods. Mesothelioma in seamen should be considered as an occupational disease.
Article
Smoking is harmful for respiratory function. In young to middle-aged men the damage is insidious and difficult to demonstrate. The respiratory impairment could increase under specific stressful conditions in the professional environment. On the hypothesis that exhaled markers are useful for assessing airway susceptibility to inhaled irritants, we measured exhaled markers and lung function in smoking and non-smoking engine-driver military coastguards before and after a patrol at sea. Eighteen men, mean age 39 yrs (range 23-58 yrs), 8 smokers, underwent spirometry, exhaled and nasal nitric oxide (eNO, nNO), exhaled carbon monoxide (CO) and exhaled breath condensate (EBC) for measures of hydrogen peroxide (H2O2), leukotriene B4 (LTB4), proteins (Prots), 8-isoprostanes (8-IsoPs), nitrite (NO2-) and nitrosothiols (RS-NOs) at baseline and after an 8-hour patrol navigation on board small, high-speed diesel-powered ships. At baseline, the smokers showed higher middle flows and CO levels, lower eNO and nNO than non-smokers, but similar levels of EBC markers; geometric means (95% confidence interval), CO: 23.6 (14.5 to 38.3) vs. 3.5 (2.5 to 5.3) ppm; eNO: 7.9 (4.8 to 12.9) vs. 26.7 (15.7 to 45.5) ppb, p=0.000. After navigation, Prots, 8-IsoPs and RS-NOs (but not lung function variables or other markers) significantly increased only in smokers; baseline vs post-navigation RS-NOs: 0.27 (0.11 to 0.65) vs. 1.30 (0.58 to 2.89) micromol, p=0.012. The respiratory consequences of a stressing environment in engine-driver military coastguards who actively smoke are better assessed by measuring EBC markers than by eNO, nNO or lung function. By increasing airway inflammation from oxidative-stress, tobacco smoking appears to interact with other chemical or physical factors elicited during sea navigation. Precisely what these factors are deserves further investigation.
Article
Cancer mortality excess has been reported repeatedly over the past hundred years to occur in merchant seamen. More recently lung cancer has been found to account for some of this excess and the question of the contribution made by cigarette smoking raised. In the one study where there was some information on smoking habit, it did not appear that cigarettes would have accounted for all the excess cancer observed. In other mortality studies, where excess cancer mortality was observed, the other cigarette-linked causes of death were not prominent. In a preliminary mortality analysis of a small population of merchant seamen, two cases of malignant mesothelioma have so far been identified, and in a national mesothelioma register 28 cases have been reported in seamen: both instances constitute abnormal occurrences. The presence of substantial amounts of asbestos-containing materials in naval construction which are continuously subjected to vibration and intermittently disturbed during servicing, and the detection of radiological stigmata consistent with asbestos exposure, add plausibility to the hypothesis that occupational asbestos exposure contributes to the apparent excess cancer mortality in merchant seamen. Methodologic deficiencies in epidemiologic studies reported to date make for uncertainty. Properly designed studies will be needed to quantify disease excess and to identify potentially causal associations. Even in the absence of such data it would be prudent to contain the asbestos currently installed and to promote smoking cessation programs.
Article
Asbestos is a group of fibrous silicate minerals that includes two mineralogic groups: amphiboles and serpentines. While the carcinogenic role of amphiboles (eg, crocidolite and amosite) is well established, medical "experts" that tend to strongly advocate their views currently argue in medicolegal cases multiple specific issues regarding the carcinogenicity of asbestos fibers. For example, it is controversial whether chrysotile causes malignant mesothelioma (MM); what are the specific carcinogenic thresholds for amphiboles and chrysotile; what occupations are truly at risk to develop MM as a result of asbestos exposure; what is the role of chrysotile in the development of peritoneal MM; how to assign causation in individuals exposed to multiple industrial products containing variable concentrations of various asbestos fibers; and, what criteria should be used to accept causation in household exposure cases and others. The causation criteria currently acceptable in U.S. courts are surprisingly flexible and subject to variable interpretation by medical "experts." At a time where thousands of individuals are claiming causation of MM by asbestos exposure, there is a need to develop more specific causation guidelines based on scientific evidence. Evidence-based medicine has been proposed as a new approach to the study, teaching, and the practice of medicine and has been used as a process of systematically reviewing the relevant studies in the literature to assess their scientific validity and development of guidelines. This article summarizes some of the current controversies regarding the role of asbestos exposure in the causation of MM and suggests the need for future evidence-based medicine-type studies to develop causation guidelines that could be used consistently during litigation.
Article
Naval work (ship construction and repair, maritime and port activities) has been a major cause of mesothelioma. In Italy, the highest mortality rates for mesothelioma are observed in the Provinces with naval activities. Similar results have been reported from many other countries. In particular, the relationship between shipbuilding and asbestos-related mesothelioma is a basilar characteristic in the mesothelioma epidemiology. Mesothelioma may involve all people working in the shipyards, with a mean latency period of 50 years. Even longer incubation periods are seen among sailors. Dock workers, when involved in asbestos transport, may experience very heavy exposures. Given the high shipbuilding activity occurred in many countries (Japan and some European countries) during the period 1950-70, a further wave of mesotheliomas related to naval work has to be expected in the next decades.
Article
This chapter summarizes the current understanding of the health risks associated with employment in various industries where exposure is alleged to occur. Topics discussed include textile mill workers, shipbuilders and navy/merchant marine personnel, insulators, plumbers and pipe fitters, construction workers, building interior workmen, floor tile and linoleum installers and removers, asbestos-cement manufacturers and endproduct users, occupants of public and commercial buildings, electricians, automotive mechanics, railroad workers, and thermoelectric power and chemical plant workers.
Article
Full-text available
Anhand einer Literaturrecherche und drei eigener Erkrankungsfälle wird dargestellt, dass die Tätigkeit als Seemann mit dem Risiko asbestbedingter Berufskrankheiten verbunden ist. Abstract On basis of a literature search and three case reports we report on an increased risk of asbestos-related occupational diseases among seafarers.
Article
Seamen and marine engineers were formerly exposed to asbestos used in gasket, pipes, valves and machinery. Ship motion and vibration can release asbestos in the surrounding space. Asbestos fibres may also be inhaled by workers involved in maintenance operations of vessels built before 1992 in Italy. History of asbestos exposure has been reported by workers and confirmed by a higher prevalence of pleural abnormalities and a significant excess of mesothelioma with a Standardized Incidence Ratio (SIR) ranging between 1.83 and 4.8 as a function of years of exposure. SIR for lung cancer ranged between 1.10 and 1.62. Mesothelioma in seamen and marine engineers represents about 2.5% of the overall Italian mesothelioma cases with a very long latency period (47.6 +/- 9.6 years). There is no epidemiological evidence for an excess risk of mesothelioma in fishermen.
Article
Pleural plaques are the most common manifestation of exposure to asbestos. It is vital that they are properly defined radiologically; if this is done, the speci ficity for asbestos exposure is 80-90%. The ILO system is not very good for the diagnosis of plaques. In the general urban population, the incidence of plaques is 1-6.8% in Western countries among men aged 30 or more. Apart from occu pational exposure, pleural plaques have been reported from domestic expo sure and from environmental pollution in certain areas of the world where asbestos minerals occur locally. In some countries, exposure is mainly due to the local inhabitants using crushed asbestos-containing rocks for white-wash ing houses. In these areas, 40% or more of the population can show plaques on chest roentgenogram, and extremely high figures are seen on autopsy.
Article
On basis of a literature search and three case reports we report on an increased risk of asbestos-related occupational diseases among seafarers.
Article
The purpose of the article is to determine the best methods for Hong Kong in dealing with an expected spike to asbestos related claims in the near future. It evaluates a range of legal responses to issues of causation and compensation arising out of occupational malignant mesothelioma claims. A survey of the common law in the United Kingdom leads to an assessment of the law and policy settings which Hong Kong should adopt in relation to these issues. It is argued that Hong Kong is underprepared for the welter of asbestos-related litigation on the way to its shores and that the absence in Hong Kong of local common law on mesothelioma liability means that it will draw on English approaches which are, themselves, unsatisfactory and unsuitable to local conditions. In particular, is argued that (1) the high sympathy culture toward patients in Hong Kong’s healthcare system and (2) the high level of personal and corporate bankruptcy mean that stringent English compensation approaches to mesothelioma in cases of pre-cursor conditions and multiple employer apportionment of liability (respectively) are not a good fit for Hong Kong. It is concluded that the best method of funding health care costs and compensation claims for those injured by exposure to asbestos in Hong Kong is to establish a common fund to satisfy claims for applicants.
Article
The Monfalcone area, in northeastern Italy, is a small industrial territory (population about 60,000), with a large shipyard. Between October 1979 and April 1992, ninety-two malignant mesotheliomas were diagnosed at the Monfalcone Hospital. The series included 84 men and 8 women, aged 42 to 89 years (median age 68 years). There were 89 pleural and 3 peritoneal tumors. Seventy patients (69 men and 1 woman) had worked in the shipyards; six were seamen, and four insulators. Five men had been exposed to asbestos in various industries; six women had histories of domestic exposure, and one woman had a history of possible environmental exposure. The latency periods (intervals between first exposure to asbestos and diagnosis of the tumor) ranged from 20 to 65 years (median 52 years). Latency periods among insulators were significantly lower than among shipyard workers, as well as lower than among the other categories (p<0.01). Lung asbestos bodies were isolated after chemical digestion in 73 cases at necropsy, and in two cases at surgery. In necropsy cases, asbestos body burdens ranged between 100 and 10,000,000 bodies per gram of dried tissue (median 11,000). Pleural plaques were observed at necropsy in 62 out of 73 cases, and in two cases at surgery.In the time period we considered, the annual incidence rates for pleural mesothelioma were very high among male Monfalcone residents, being 189 per 100,000 among people aged 75 years or more.On the basis of occupational data and of objective signs (lung asbestos bodies, pleural plaques), all the cases of the present series but one (that with possible environmental exposure) were considered as asbestos-related. The role of co-factors in the development of asbestos-related mesothelioma is suggested. © 1993 Wiley-Liss, Inc.
Article
The cancer incidence was investigated among 27,884 fishermen and sailors from the merchant fleet who had been members of a pension fund for seamen during 1958-1986 in Iceland. The cancer incidence was followed through 1966-1988. Expected values were based on rates for the general male population in Iceland. In the whole cohort, 758 malignant neoplasms had occurred as compared to 688.43 expected, standardized incidence ratio (SIR) = 1.10, 95% confidence limit (CI) 1.03-1.18. There was an excess for cancer of the stomach, rectum, larynx, and lung and nonmelanoma skin cancer; the SIRs were 1.29, 1.44, 1.77, 1.61, and 1.51, respectively. When analyzing the cancer incidence according to length of employment, the SIRs for many of the cancer sites were high for those with a short employment and many SIRs decreased with increasing length of employment. The SIRs for lung cancer were high in all subgroups. Only for stomach cancer and leukemia was there a substantial increase in SIR with increasing length of employment. The SIR was 1.55 for stomach cancer (CI 1.01-2.27) in the group with longer than 10 years of employment, and 1.97 for leukemia (CI 0.85-3.87) in the same group. It is concluded that the risk of both stomach and lung cancer seems to be associated with the occupation of seamen.
Article
Two radiologists reviewed in masked fashion 144 standard chest radiographs, previously judged as normal by other readers, within a cohort of asymptomatic shipyard workers exposed to amosite. Among the 144 workers we selected subjects (n = 72) who fitted the following criteria: (1) documented occupational exposure to asbestos; (2) absence of any clinical symptomatology suggestive of asbestosis or of any other lung disease. Thirty-eight of them had standard chest radiogrphs that were confirmed as normal by both our radiologists, while 34 showed suspected pleural plaques or a very slight parenchymal involvement. These 72 subjects underwent high-resolution CT (HRCT): pleural plaques were shown in 33, parenchymal alterations in 7, and both pleural and parenchymal involvement in 13. HRCT findings were strictly correlated to the duration of amosite exposure and to the latency time since first exposure. Sensitivity, specificity and diagnostic accuracy values of standard chest radiographs were calculated with respect to HRCT and found to be, for pleural and parenchymal findings respectively: sensitivity 53% and 19%; specificity 72% and 94%; accuracy 60% and 72%. In conclusion, pleural and/or pulmonary involvement in asbestos-exposed workers can be shown by HRCT before the appearance of any symptomatology and abnormality on chest radiography. Furthermore the HRCT findings are correlated to the duration of exposure and latency time. time.
Article
This paper provides a review of the relevant literature on refractory ceramic fibers (RCFs), summarizing relevant data and information on the manufacture, processing, applications, potential occupational exposure, toxicology, epidemiology, risk analysis, and risk management. RCFs are amorphous fibers used for high-temperature insulation applications. RCFs are less durable/biopersistent than amphibole asbestos, but more durable/biopersistent than many other synthetic vitreous fibers (SVFs). Moreover, as produced/used, some RCFs are respirable. Toxicology studies with rodents using various exposure methods have shown that RCFs can cause fibrosis, lung cancer, and mesothelioma. Interpretation of these animal studies is difficult for various reasons (e.g., overload in chronic inhalation bioassays). Epidemiological studies of occupationally exposed cohorts in Europe and the United States have demonstrated measurable effects (e.g., mild respiratory symptoms and pleural plaques) but no disease (i.e., no interstitial fibrosis, no excess lung cancer, and no mesothelioma) to date. The RCF industry, working cooperatively with various government agencies in the United States, has developed a comprehensive product stewardship program (PSP) to identify and control risks associated with occupational exposure. One provision of the PSP is the adoption of a voluntary recommended exposure guideline (REG) of 0.5 fibers/milliliter (f/ml). Selected on the basis of prudence and demonstrated feasibility, compliance with the REG should reduce risks to levels between 0.073/1000 and 1.2/1000, based on extrapolations from chronic animal inhalation studies.
Article
Objectives While maritime safety generally has improved dramatically over the last century, modern seafarers are still faced with numerous occupational hazards potentially affecting their risk of chronic diseases such as cancer. The aim of this study is to offer updated information on the incidence of specific cancers among both male and female seafarers. Methods Using records from the Danish Seafarer Registry, all seafarers employed on Danish ships during 1986–1999 were identified, resulting in a cohort of 33 084 men and 11 209 women. Information on vital status and cancer was linked to each member of the cohort from the Danish Civil Registration System and the Danish Cancer Registry using the unique Danish personal identification number. SIRs were estimated for specific cancers using national rates. Results The overall incidence of cancer was increased for both male and female seafarers (SIR 1.19, 95% CI 1.15 to 1.23, and SIR 1.14, 95% CI 1.07 to 1.22) compared with the general population. This excess was primarily driven by increases in gastrointestinal, respiratory and genitourinary cancers. In addition, male seafarers working in areas with asbestos exposure showed significantly increased risk of mesothelioma. Finally, the male seafarers had an increased risk of lip cancer. Conclusions The majority of cancers among seafarers continue to be lifestyle-related. However, occupational exposure to asbestos and ultraviolet radiation seems to affect the cancer pattern among the male seafarers as well.
Article
A total of 2,208 male subjects, enrolled as merchant marine seamen at the Civitavecchia (Italy) harbor from 1936 to 1975 were followed up through 1989 in order to evaluate their mortality experience. Available information about the number of sailings made it possible to divide subjects into two subgroups: 948 workers with at least one sailing (cohort A) and 1,260 with no reported sailing (cohort B). Fewer than expected overall deaths were observed in both cohorts (cohort A: SMR = 0.83; cohort B: SMR = 0.81), mainly due to a lower mortality from circulatory, respiratory, and digestive diseases. Lung cancer deaths were significantly increased in cohort A (O = 30, SMR = 1.71, 95% CI = 1.15-2.44), whereas no excess was observed in cohort B (O = 6, SMR = 0.57, 95% CI = 0.21-1.26). Among subjects employed aboard ship, a trend in SMRs for lung cancer increasing with duration of employment was observed. Furthermore, three neoplasms of other parts of the respiratory system (including one mesothelioma) were detected in cohort A (SMR = 5.87), and one in cohort B. The study substantiates an increased risk of respiratory cancer among subjects with an occupational history of sailing; past exposure to asbestos and to other environmental carcinogens aboard could be implicated.
Article
One hundred and seventy malignant pleural mesotheliomas seen at necropsy at the Institute of Pathological Anatomy of the Trieste University during the period 1968-1987 were reviewed. The series included 153 men and 17 women, aged between 33 and 92 years (median 70 years). Lifetime work histories were obtained from the patients' relatives by personal or telephone interviews in 162 cases. A majority of the male subjects had been employed in "naval" work, 99 people having worked in the ship-building industry, 19 in the navy and merchant marine, and 7 in docks. A variety of trades appeared in the remaining histories. Work histories were indicative of occupational exposure to asbestos in 150 cases. A further 5 patients with negative or insufficient data showed asbestos bodies in routine lung sections and 5 women had a history of domestic exposure. A majority of the patients had had their first exposure before 1950. The intervals between first exposure and death ranged from 14 to 71 years (median 48 years).
Article
Clinical and morphologic observations are described of diaphragmatic and pleural plaques in six patients. The plaques were found by histologic (six patients) and ultrastructural examination (two patients) to consist of pure collagen. Although the exact cause of the plaques is unknown, the frequent finding by other investigators of asbestos bodies in the lungs of patients with these plaques suggests that the two are etiologically related.
Article
Psammoma bodies in serous body fluids suggest the diagnosis of adenocarcinoma. Their presence in the aspirated pleural fluid of our patient led to an intensive search for a primary site, which included multiple percutaneous pleural biopsies, whole lung tomography, mediastinoscopy, partial thyroidectomy, IVP, abdominal aortography and laparotomy, with the final diagnosis of mesothelioma as the primary tumor. This association of psammoma bodies with a mesothelioma is an exceedingly rare finding.
Article
The relationship between shipbuilding and related industries and risk of fatal lung cancer (1960-1975) is described for selected Louisiana parishes. Deaths from lung cancer were matched to deaths not caused by cancer. Shipbuilders had a significantly increased risk (greater than twofold) of dying of lung cancer as compared with other causes. The risk of dying of lung cancer in related occupations (seamen and longshoremen) was also increased. Information on laterality of lung cancer was not supportive of particulate substances contributing to causality due to the large number of unspecified cases. The preponderance of deaths appears to be occurring in men with a greater number of years of exposure to this industry and in those aged 20 to 34 years in 1940. These common occupations in Louisiana could contribute to the high rate of lung cancer.
Article
Two hundred and fifty men admitted to a thoracic surgical centre and matched controls were questioned in detail about their occupations after leaving school and their smoking habits. Of 201 men with confirmed bronchial carcinoma 58 gave a history of occupational exposure to asbestos, whereas only 29 out of 201 men matched for age and residential area who were admitted with other diseases gave such a history. This difference was statistically highly significant. The usual association of bronchial carcinoma with heavy smoking was observed, but asbestos exposure increased the risk of carcinoma whatever the level of smoking. These results are consistent with the hypothesis that asbestos exposure and the level of smoking act independently in causing bronchial carcinoma. The patients with carcinoma who had been exposed to asbestos presented on average three years earlier than those who had not been exposed. Asbestos regulations have eliminated the risk of exposure to workers in scheduled industries, so asbestos-induced diseases will probably be increasingly found among the many workers who have had incidental exposure to asbestos. It is therefore important to take a full occupational history.
Article
One hundred forty-one retired Greek mariners were examined radiologically for asbestos-related lung disease. Thirty-eight (27%) had small opacities classified as ILO category 1/0 or more; 37 (26%) had radiologic evidence of pleural lesions; 17 (12%) had both parenchymal and pleural lesions; and a total of 58 (41%) had one or more radiologic findings of asbestos-related lung disease. In discriminant analysis, duration of maritime employment was predictive of pleural lesions, but the association was not statistically significant (one-tail, p = 0.16). The prevalence of pleural lesions was also higher among sailors than among officers, and this association was statistically significant (one-tail, p = 0.05). In this group, none of the occupational variables studied (age, duration of maritime employment, and rank) was related to lung fibrosis. After controlling by multiple regression for mutual confounding effects, suggestive negative associations for the presence of pleural lesions were found with FVC (one-tail, p = 0.13) as well as with FEF25% (one-tail, p = 0.09) and FEF50% (one-tail, p = 0.07). By contrast, no association was found between pulmonary fibrosis and any of the respiratory volumes. The results of this study suggest that mariners may present evidence of asbestos-related disease after many years from onset of exposure on ships.
Article
A survey of the asbestos fibre concentrations associated with work involving asbestos insulating materials has been undertaken in Devonport Dockyard. The results show that application and removal of asbestos materials both create high dust concentrations, and measures to reduce the health hazards associated with such processes are described. The results of sampling after the introduction of preventive measures are briefly presented and these results indicate that the precautions are effective in reducing the asbestos dust concentrations in shipyard insulation processes.
Article
A brief description is given of the types of asbestos materials, and their uses in shipbuilding and ship repairing in Naval Dockyards. An outline of the problems to be faced and a description of preventive methods is followed by a series of questions intended to stimulate practical solutions to the problems of using asbestos materials safely in the industry.
Article
The relation between exposure to asbestos and the occurrence of neoplasia is reviewed and it is concluded that the increasing use of asbestos will result in an increasing incidence of tumours. It is known that inhalation of asbestos fibres results in the formation of asbestos bodies in the lungs. Typical asbestos initiated tumours—pleural and peritoneal mesothelioma—were found at an unusually high frequency in shipyard-workers. Only slight asbestos exposure had taken place in these cases. On the other hand the persons involved had been exposed to high concentrations of iron oxide (flame cutters and welders). Objects similar to asbestos bodies were found in their lungs. Originally it was thought that these were pseudo asbestos bodies, containing an iron oxide core, and it was suspected that pseudo asbestos bodies might play a part in the genesis of the tumours. Investigations carried out at TNO institutes showed that the kernel of the bodies contained asbestos of the amphibole type thus proving that they were not pseudo but normal asbestos bodies. The simultaneous exposure to low concentrations of asbestos and high concentrations of iron oxide raises the suspicion that iron oxide might be an important cofactor in the genesis of mesothelioma found in the shipyard-workers. Experiments with different types of asbestos and iron oxide, on animals, are considered to be highly desirable in order to verify or disprove this hypothesis.
Article
Unusual degree of folding of the lung is described in three cases. Diagnosis was made in the second and third patients before operation. The pathogenesis is discussed, and the possibility that these three cases were related to asbestos is suggested but unproved.
Article
There has been no report of malignant mesothelioma or asbestosis in Hong Kong despite the rapid growth of industry in the past few decades. Three patients with malignant pleural mesothelioma and one patient with asbestosis and small cell carcinoma of the lung are reported. All four patients were Chinese in Hong Kong and had a history of occupational exposure to asbestos. Although there is no mining of asbestos in Hong Kong, her rapid industrialization in the past few decades has led to a large population of asbestos-exposed workers in industry. The average annual consumption of crude asbestos (import minus re-export) has grown ten-fold in the past decade to 1.090 tonnes in 1978-79, and the number of workers handling asbestos products was estimated to be 20.000 in 1979. The problem of asbestos related diseases has however been little considered and further epidemiologic studies are warranted.
Article
The clinical and epidemiological features of 80 cases of malignant mesothelioma (as proved by examination of biopsy specimens) referred to the clinic at the National Centre for Occupational Health between January 1977 and June 1983 are reviewed. There was a positive history of asbestos exposure in 89% of cases. The mean survival time from diagnosis to death was 8,6 months and from the onset of symptoms to death 13,6 months. Survival time was unaffected by stage of the tumour, treatment, histological features, smoking status, presenting symptoms, presence or absence of effusion and asbestosis, side of the lesion, source of exposure and lag period from first exposure to diagnosis. The duration of survival was significantly affected by age at diagnosis, duration of asbestos exposure and the number, rather than the type, of treatment regimens used. Caution is advocated in interpreting these data since the number of cases was small and the study design was retrospective. A reference group of 546 cases notified over the same period was drawn from the records of the South African Asbestos Tumour Reference Panel. The incompleteness of national mesothelioma incidence data was noted, and an incidence figure of 7,2 per million per year was calculated from the best-available data for South Africa. This figure is an underestimate because not all diagnosed cases are reflected and, more important, significant numbers of cases are never diagnosed. The extent to which the compensation machinery functions is mentioned.
Article
Marine engineers undergoing routine annual chest roentgenography showed an unusual prevalence of pleural abnormalities including plaques suggestive of past asbestos exposure. A pilot survey, and a subsequent comprehensive study of the films of more than 5,000 men, showed an overall prevalence of 12% with pleural abnormality (typical calcification or plaque, or diffuse thickening). Prevalence of films classifiable for pneumoconiotic small opacities was negligible--1.2% in the pilot study. Prevalences of pleural abnormality were significantly higher among men with longer union membership, after controlling for age. Older merchant ships contain substantial amounts of asbestos-containing thermal insulation. Marine engineers often remove and reapply insulation, operations known to produce high airborne fiber concentrations. These roentgenographic survey results indicate significant past asbestos exposures of ships' engineering department personnel.
Article
In a prospective study of 336 consecutive patients with long-term pleural effusions, 32 cases of malignant mesothelioma were found. Microscopic examination of pleural tissue specimens, preferably selected at thoracoscopy, proved superior to pleural fluid analysis as an aid to correct diagnosis. The epithelial proved to be the most common type of malignant mesothelioma. As an example of the mesothelial cells' multipotent ability, malignant cells were seen transforming into fat-like cells with lipid-containing vacuoles. In the fibrous tumour type, cytological examination of pleural fluid revealed only normal cells. Cells with malignant features were seen in fluid samples from epithelial and biphasic tumour types. The malignant cells often formed tubuli-like aggregates which could be mistaken for adenocarcinoma. Hyaluronic acid was more frequently detected in tissue specimens than in the pleural fluid samples. The morphological type and the patient's age had an impact on the survival time, whereas sex and extensive surgical treatment seemed less important.
The American merchant marine and the asbestos environment
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Polland LD. The American merchant marine and the asbestos environment. Washington: Maritime Administration Office of Ship Construction, US Department-ofCommerce, 1979:12-4.
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Etude de 38 cas operes
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Disease prevention in asbestos insulation work. In: International symposium on safety and health in shipbuilding and ship repairing
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Selikoff IJ. Disease prevention in asbestos insulation work. In: International symposium on safety and health in shipbuilding and ship repairing, Helsinki, 1971. Geneva: International Labour Office, 1972. (Occupational safety and health series No 27.)
Etude clinique et professionelle de 54 mesotheliomes pleuraux diffus
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Lajartre M, Comet E, Corroler J, et al. Etude clinique et professionelle de 54 mesotheliomes pleuraux diffus. Rev Fr Mal Resp 1976;4:63-74.
Annual report of the Chief Inspector of Factories for the year 1956
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