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mesothelioma from asbestos Biogarphy

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In construction work, the principal activities leading to exposure involved the installation of asbestos-containing insulation, including spray-on insulation. Spray-on asbestos insulation was banned by the US Environmental Protection Agency (USEPA) for most uses in 1973 (38 Federal Register (FR) 8829), eliminating that potentially significant source of exposure. USEPA’s asbestos program also established asbestos management practices through guidance documents (USEPA, 1985; USEPA, 1990) and regulations addressing asbestos in schools in 1982 and 1987 (47 FR 23360; 52 FR 41826).OSHA regulations for construction work, including maintenance and repair (M/R) activities in buildings with ACM, were made explicit in 1986, and further refined in 1994 (29 CFR 1926.1101). Studies by Price (1992), Corn et al. (1994), and Mlynarek et al. (1996), which analyze exposure data for M/R workers, show that M/R exposures are very low relative to OSHA exposure limits. Combining air-sampling measurements (1,227 samples) and data on the frequency and duration of M/R activities, Price et al. (1992) projected annual average levels of exposure ranging from a median of 0.002 f/cm3 to 0.02 f/cm3 (90th percentile). Corn et al. (1994) published similar results to the Price et al. (1992) results, and Mlynarek et al. (1996) reported 8-hr time-weighted averages for M/R work no greater than 0.03 f/cm3 for 302 personal air samples covering nine M/R work categories.
Exposure to airborne asbestos experienced by office workers, school teachers, school children, and others who work or live in buildings with ACM was perceived by some in the late 1970s and early 1980s as a significant health risk. This perception, which may be characterized as a hysterical but misguided response to the experience of asbestos workers exposed to extremely high levels during the 1930s through the 1960s, subsequently was shown to be false (Wilson et al., 1994; Mossman et al., 1990; USEPA, 1992; 56 FR 13472). The exposure levels for this group of building occupants have been quantified at much less than 0.005 f/cm3, and typically 0.0005 f/cm3 and below (USEPA, 1988; HEI, 1991). The corresponding risk has been characterized as a "very slight risk, if any." (USEPA, 1990).
One partial gap exists in the US data, namely exposure data for workers who remove ACM from buildings. USEPA, through its NESHAP regulations in 1978 (43 FR 26372), specified various work-practices for the removal of ACM. By the mid-1980s, USEPA and OSHA had designed approaches for conducting asbestos removal that included wet methods, containment, negative air pressure, and respirators (USEPA, 1985; 49 FR 14116). Air-monitoring data collected during ACM removal activities show that when these work practices are employed, little if any asbestos escapes the contained work-area, and exposure inside the contained area is controlled by using wet removal methods and respirators (HEI, 1991). It is possible that there are some asbestos removals where none of the exposure control methods are used, although the full magnitude and extent of these removals and their associated exposures are unknown. Owing to long latency-periods for asbestos-related diseases, the consequences of these uncontrolled removal-induced exposures, if any, have not yet appeared in epidemiological data. We expect that by the 1980s, uncontrolled removals were infrequent. Recalling that the risk of asbestos-related disease is proportional to cumulative exposure to asbestos over a lifetime and accounting for likely frequency and duration of exposure associated with uncontrolled removals, it is unlikely that the exposures of asbestos-removal workers who would participate in but a limited number of uncontrolled removals would have significant consequences with respect to risk.
Peto et al. (1995) analyzed death rates from mesothelioma registries in England, Wales, and Scotland for 1968 through 1991. Hutchings et al. (1995) analyzed the same mesothelioma registry data as Peto and in addition reported on data collected in the Health and Safety Executive (HSE) mortality survey of British asbestos workers. The UK data were recently updated through 1995, but no analyses of trends incorporating these data have been reported.
For the 1968-1991 data, Peto reported a trend of increasing incidence of mesothelioma in the 1970s and 1980s, and a continuation of the trend for men now under the age of fifty, most of whom began work in the mid-1960s or later. The results of Peto et al. indicate that lifetime probability of dying from mesothelioma for males achieved its maximum of 1.3x10-3 for the 1943-1948 birth-cohort. Peto concluded that exposure in the UK was greater around 1970 than in any previous period, and that mesothelioma incidence rates will continue to increase as that
generation ages. Peto et al. stated that up to the year 2020, over "70% of all mesothelioma deaths will still be occurring in men born before 1948. After 2020, however, the prediction will be rapidly dominated by men born after 1958 for whom no data are yet available. If their risk is negligible, the epidemic will peak at about 2700 deaths per year and will disappear rapidly after 2020. If their lifetime risk is 50% of the 1943-1948 maximum, the annual total will peak at 3300 deaths around 2020 and then fall to about 2300 deaths per year. The risk is likely to lie somewhere between these limits."
Hutchings et al. (1995) summarized the same data as used by Peto et al. for his analysis in a variety of ways. The results are similar and consistent with Peto’s findings. One notable result in the analysis by Hutchings is the similarity of the female mesothelioma-incidence trend to the trend among males. The rates among females increase steadily until the 1940 and 1945 cohorts, and then fall. The decrease for females in the 1950 and 1955 cohorts from the 1940-45 maximum is similar to that for males (30% and 40%, respectively). Hutchings et al. noted that interpretations of the data for females are based on smaller numbers (than for males) and, therefore, are subject to greater statistical uncertainty.
A partial check on the model of Peto et al. for making projections, in addition to the statistical evaluation of the model fit to historical data (Peto et al., 1995), is to compare predicted values for future years with actual values for those years. Peto et al. based their analysis and predictions on data covering 1968 through 1991. These data now have been extended through 1995. Although data for making year-by-year comparisons for 1992 through 1995 are not available, it appears generally that the actual number of mesothelioma-induced deaths are running about 10% more than the projections of Peto et al. It also appears that the data Peto et al. relied on may have been revised. For 1990, Peto et al. reported approximately 700 mesothelioma deaths among males (Peto et al., 1995; Figure 2). The updated HSE data indicates 768 deaths. For 1995, the projection of Peto et al. is approximately 1000 deaths. The HSE data indicate 1140 deaths. The implications of this 10% increase in the ratio of actual versus projected mesothelioma–induced deaths are unclear. One possibility, however, is that the peak in mesothelioma deaths will be reached earlier than the date projected by Peto et al., 2020, and, therefore, the corresponding maximum exposures occurred earlier than 1970.
COMPARISONS BETWEEN US AND UK RATESackground Incidence: In the US, it is generally accepted that women were not commonly involved in occupations where they would experience exposure to asbestos. Therefore, the rate of mesothelioma incidence among females may be interpreted as a background rate. The SEER data show the lifetime probability of mesothelioma for women to be constant across birth cohorts and also indicate a constant annual incidence of about 500 cases. In the UK, Hutchings et al. (1995) reported that the mesothelioma pattern for females is very similar to that for males. The

female rates increase steadily until the 1940 and 1945 cohorts, and then fall. The results for females are based on smaller numbers than for males and, therefore, are subject to greater statistical uncertainty than the statistical uncertainty in the results for males. Nevertheless, this suggested trend for UK females is decidedly different than the trend for females in the US. An explanation for part of this difference in trend is that many women in the UK worked in factories where asbestos was used during the Second World War (Browne, pers. commun., 1997). This explanation does not fully account for the difference, which needs to be investigated further.Nicholson WJ (1982). Occupational Exposure to Asbestos: Population at Risk and Projected Mortality 1980-2030. American Journal of Industrial Medicine 1982; 3:259-311.
Peto J, Henderson BE, Pike MC (1981). Trends in Mesothelioma Incidence in the United States and the Forecast Epidemic Due to Asbestos Exposure During World War II. Brandbury Report 9, Quantification of Occupational Cancer, Richard Peto and Marvin Schneiderman eds., Cold Spring Harbor, 1981.
Peto J, Hodgson J, Matthews F, Jones J (1995). Continuing increase in mesothelioma mortality in Britain. The Lancet 1995; 345:535-539.Peto J, Decarli A, La Vecchia C, Levi F, Negri E (1999). The European mesothelioma epidemic. British Journal of Cancer 1999; 79(3/4): 666-672.

Price, B (1997). Analysis of Current Trends in Unites States Mesothelioma Incidence, American Journal of Epidemiology pages 211-218 Vol. 145, No 3, 1997.

Price B (1992). Airborne Asbestos Levels in Buildings: Maintenance Worker and occupant Exposures. Journal of Exposure Analysis and Environmental Epidemiology 1992; 2: 357-374.

Selikoff IJ, Hammond CE, Seidman H (1979). Mortality Experience of Insulation Workers in the United States and Canada, 1943-1976, Annals of the New York Academy of Sciences Volume 30, pages 91-116 December 1979.Spirtas R, Beebe G, Connelly R, Wright W, Peters J, Sherwin R, Henderson B, Stark A, Kovasznay B, Davies J, Vianna N, Keehn R, Ortega L, Hochholzer L, Wagner J (1986). Recent Trends in Mesothelioma in the United States. American Journal of Industrial Medicine 1986; 9:397-407.USEPA (1985). Guidance for Controlling Asbestos-Containing Materials in Buildings (The Purple Book), EPA 560-5-85-024 June, 1985.