Table Of ContentASBESTOS
Risk Assessment, Epidemiology,
and Health Effects
Edited by
Ronald F. Dodson, Ph.D.
Samuel P. Hammar, M.D.
Boca Raton London New York
A CRC title, part of the Taylor & Francis imprint, a member of the
Taylor & Francis Group, the academic division of T&F Informa plc.
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Library of Congress Cataloging-in-Publication Data
Asbestos : risk assessment, epidemiology, and health effects / edited by Ronald F. Dodson, Samuel
P. Hammar.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-8493-2829-2 (alk. paper)
1. Asbestos--Toxicology. 2. Asbestosis. I. Dodson, Ronald F. II. Hammar, Samuel P.
[DNLM: 1. Asbestos--adverse effects. 2. Asbestosis--epidemiology. 3. Risk Assessment. WA 754
A7988 2005]
RA1231.A8A74 2005
363.17'91--dc22 2005048604
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Dedication
This book is dedicated to Sandy and Judy
Acknowledgment
We acknowledge Dinah Fleming for editorial assistance during the preparation of
thisbook.
Preface
Asbestos is a naturally occurring fibrous form of mineral. It has been used in
numerous applications owing to its unique properties. With the more complex
evolution of industrialized societies came an increasing demand for lightweight,
thermally and chemically resistant materials, which in many applications also
required components to provide high tensile strength. Various types of asbestos
mettheserequirementsandwereusedinnumerousapplications.Theuseofasbestos
inbuildingcomponentswasasmuchattributabletotheeasewithwhichthesemin-
eralscouldbeformedortroweledintodesiredshapesastoothercharacteristics.The
fire-retardantpropertiesofasbestoshaveoftenbeenanimportantfeaturejustifying
itsuseinmanyapplications.Theproblemwiththewidespreaduseofasbestosisthat
exposedindividualsareatriskfordevelopmentofasbestos-relateddiseases.These
diseases usually occur following long latency periods from first exposure before
theyareclinicallydetectable.Asbestosisalsouniqueamongdustsinthatitsinhala-
tioncanresultinthedevelopmentofcancerofthelungandinextrapulmonarysites.
There have been various books that looked at the issue of asbestos and human
health through specialized emphasis on certain facets of the subject. However, the
aimofthisbookistoprovidearesourceinwhichthereadercanfindcomprehensive,
interdisciplinary, state-of-the-art information regarding the various aspects of the
asbestos and human health. This information includes a historical view of the use
of asbestos, sampling techniques, and instruments needed to define the levels of
asbestos in air,bulk,orsurface samples.
Tounderstandthemethodsnecessaryinassessinglevelsofexposure,itiscritical
tounderstandthetechniquesused insampling forasbestosincludingthoseused in
establishingthelevelsasdefinedinFederalandStateregulations.Thedifferencesin
theinherentdetectionlevelsforthevarioustechniquesusedforasbestoswillbedis-
cussedasapplicabletothevarioustypesofenvironmentalandhumansamples.This
willincludecomparisonofrecommendedandrequiredsamplingschemesaswellas
the parametersassociated withthe instruments used ineach method.
Asbestos induces disease in man has been confirmed through clinical obser-
vations, pathological assessments of tissue, and epidemiological data obtained
from exposed cohorts. The focus of three chapters as presented by specialists in
these respective fields will offer state-of-the-art data regarding asbestos exposure
andtheresultantdevelopmentofdisease.Thescreening processneededforidenti-
fyingasbestos-relateddiseaseandanoverviewofthepathologicalstatesassociated
with these diseases will be addressed. The epidemiological overview will discuss
findings from the world’s literature as applicable to specific types of asbestos
exposureand the development ofresultant diseases.
Therespiratorysystemistheprimaryportalofentryforasbestosintothehuman
body.Thusitisrelevantthatthereaderisprovidedwithanoverviewofthenormal
anatomyandfunctionsoftherespiratorysystemasabackgroundbeforediscussions
focusonmechanismsbywhichasbestos(andotherinhaledparticulates)inducetem-
poraryandpermanentchanges.Justasitisrelevanttounderstandtheapplicabilityof
techniquesandselectedinstrumentationforanalysisofenvironmentalsamples,itis
equallyimportantindeterminationofasbestoscontentfrombiologicalsamplesthat
a recognition is established as to what was observed and what cannot be observed
with the instrumentation and techniques used in a given study. Such a comparison
and examples are illustrated in this chapter. Fiber length related to the potential
for inducingpathologicalresponses isalso discussedin thischapter.
Asbestosisrecognizedasbeingapathogenicallyactivedustbasedonitsfibrous
morphology.However,thereareconstantlyevolvingfindingsaboutthecellular,bio-
chemical, and molecular influences that asbestos has once inhaled into the lung.
These mechanisms are presented as complementary stimuli which when coupled
with the fibrous morphology of asbestos can result in irreversible cellular damage
andinsomecasesthedevelopmentoftumors.Therefore,areviewofthesemechan-
isms will beprovidedfrom a molecular biology perspective.
Various countries have sought to deal with asbestos and public health through
regulatory guidance documents. These will be discussed in a chapter focusing on
theregulationsthatexistinmoreindustrializedcountries,andexamplesofgovern-
mental regulations that attempt to impact on the levels of potential exposures in
somedeveloping countries.
Oneofthemostunder servedspecialties inmedicineisthatofoccupationalor
environmentalmedicine.Thedataindicatethatmedicalschoolcurriculatodayoffer
onlyafewhoursonthesubjectastrainingprovidedtophysicians.Itis,therefore,not
a surprise that histories taken from patients are often incomplete about historical
exposure to asbestos in the workplace or in environmental settings. Thus making
thediagnosisofasbestos-relateddiseaseispotentiallyonlyaslikelyastheaccuracy
of the establishment of such historical exposure links. It was, therefore, deemed
appropriatetohaveanoverviewonthesubjectofclinicalorpostgraduateeducation
onthesubjectofasbestos-relateddiseases,whichwouldhaveapplicabilitytoawide
range ofhealthcare professionals.
Thefactthatasbestosiscapableofinducingdiseasesincludingcancerinmanhas
stimulated considerable interest of subjects. The issues associated with asbestos
exposure or potential for exposure involve professionals including those from state
andfederalagencieschargedwithprotectinghumanhealth,aswellasindustrialspecial-
ists who must consider replacement materials and the suitability of these replace-
mentsinapplicationspreviouslymetwithasbestos. Public health officials including
physicians, nurses, allied health professionals, and related support professionals
must make decisions regarding causation of potential diseases that can be induced
by exposure to asbestos. Ultimately all members of society can be potentially
exposedtoasbestosinplace eitherathomeorworkand ascomponentsofproducts
madefrommineralswhichcontainsmallamountsofasbestos.Asbestosexposureand
relatedliabilitieshavealsobecomemajorlegalissueswithinmanycountries.
Thepurposeofthisbookistooffertheinterestedprofessionalinanyoftheafore-
mentionedspecialtiesasingle“state-of-the-art”reference,whichprovidesdatathat
bydesignisinterdisciplinaryinnature.Thecontentisstyledsothatthedepthissuf-
ficient to be appreciated by the specialist in a given field as well as provide useful
informationfromwhichindividualsinotherareasofspecializationmaydrawrefer-
encethatwillbetterenablethemtodealwithasbestos-relatedproblems.
The Editors
RonaldF.DodsonPh.D.,receivedhisB.A.inbiologyandgeneralsciences(double
major)fromEastTexasStateCollege,andM.A.inbiologyandchemistryfromEast
TexasStateUniversity.HisdoctoratewasfromtheLifeSciencesDivisionofTexas
A&MUniversitywithanemphasisinbiologicalelectronmicroscopy.After7years
inthefacultyatBaylorCollegeofMedicineinHouston,hewasrecruitedtodevelop
aresearchprogramattheUniversityofTexasHealthCenteratTyler.Hisworkfor
thelast20yearshasconcentratedindefiningdustburdenintissue,bodyfluids,and
environmental samples by light and analytical transmission electron microscopy.
His laboratories have developed some of the techniques which enable quantitative
studies of tissue burdento becarried out.
Hehasauthoredorcoauthoredover90scientificarticlesonthesubjectofdust-
relateddiseaseswithmostofthesefocusingonasbestos-relatedissues.Hehasalso
authoredorcoauthoredtenchaptersinbooksandgivennumerouspresentationson
thetopicofasbestosandhumanhealth.Thesepresentationsincludethoseatscien-
tific meeting and to more selected audiences such as the National Conference of
State Legislatures and the Defense Research Institute. His academic achievements
have been recognized in that he holds the status a Fellow in the American Heart
Associationand Fellow in the College ofChest Physicians.
He has held various administrative titles during his academic career including
Chief of Department, Chairman of Department, Associate Director for Research,
VicePresidentforResearch,andco-DirectoroftheTexasInstituteforOccupational
SafetyandHealth.Hehasservedonnumerousacademiccommitteesandaswellas
a reviewer for numerous journals. He has directed an EPA/Texas Department of
Health(ModelAccreditationgoverned)approvedtrainingdivisionandholdslicenses
throughtheTexasDepartmentofHealthoftheStateofTexasasanInspector/Manager
Planner and Supervisor/Contractor in the area of asbestos-related activities.
Dr.DodsonandDr.Hammarhaveauthoredorcoauthoredthemajorityoftheworld’s
literatureonasbestoscontentinextrapulmonarysitesaswellasdefinedtissueburden
(includingshorterfibers)inuniquecohortssuchasindividualswithmesothelioma.
Samuel P. Hammar, M.D., is a board-certified anatomic and clinical pathologist
whospecializesinlungdisease,cancer,anddiagnostictechniquesusedtoinvestigate
cancer.HeobtainedaB.A.degreeinchemistryin1965andattendedtheUniversity
of Washington Medical School from 1965 to 1969 where he obtained an M.D.
degree. He did his training in pathology at the University of Washington School
ofMedicineincludingtimeinexperimentalpathologyandelectronmicroscopy.
Forthelast15years,Dr.Hammarhasbeenprimarilyinterestedinasbestos-related
lungdisease,especiallymesothelioma.HeisamemberoftheU.S.-Canadianmesothe-
lioma panel and a member of the International Mesothelioma Pathology Group. In
conjunctionwithDr.Dodson, Dr.Hammarhasdoneextensiveresearchonasbestos-
related lung disease and sees asbestos-induced lung disease on a regular basis as a
pathologistinBremerton,Washington,thehomeofPugetSoundNavalShipyard.
