Occupational and 9/11 Exposures
and Cancer Risk presented by Jacqueline Moline, MD, at the Mesothelioma Applied Research Foundation's conference in New York, NY on September 28, 2012. www.curemeso.org
Occupational and 9/11 Exposures and Cancer Risk | Mesothelioma Applied Research Foundation
1. Occupational and 9/11
Exposures: Risk for Disease
Jacqueline Moline, MD, MSc, FACOEM, FACP
Director, Queens World Trade Center Clinical Center of Excellence
Vice President and Chair, Department of Population Health
North Shore University Hospital and Long Island Jewish Medical Center
2. Mesothelioma: Trends
Cases of mesothelioma each year in the US: roughly 3300
Cases of mesothelioma each year in the US appears to
have peaked around the year 2000 and is now declining,
thanks to strict regulation
Worldwide, though, cases of mesothelioma is increasing
In industrial nations, number of cases will peak this
decade
In poorer countries, much higher numbers are expected
due to lack of regulation, widespread use of asbestos
commercially and in homes.
3. Incidence* of mesothelioma
(per 100,00) for 17 states
*age-adjusted Price B, Ware A. Critical Reviews in Toxicology.
Aug2009, Vol. 39 Issue 7, p576-588
4. Incidence of mesothelioma
(per 100,00)
Moolgavkar SH, Meza R, Turim J. Pleural and peritoneal
mesotheliomas in SEER: age effects and temporal trends, 1973-
2005. Cancer Causes Control. 2009 Aug;20(6):935-44.
5. Incidence* of mesothelioma
(per 100,00) for NY state
*age-adjusted
Price B, Ware A. Critical Reviews in Toxicology.
Aug2009, Vol. 39 Issue 7, p576-588
12. Exposures to Asbestos –
Four Macrocategories
Direct use
Indirect use for insulation and auxiliary tools
Construction sector
Accidental and unaware exposures
Marinaccio et al; Int. J. Cancer 2012;130:2146-2154
13. Direct Use
Shipbuilding and Port handling
repair Asbestos textile
Asbestos cement industry
industry Friction materials
Railroad carriages production
construction and Gaskets and packing
maintenance production
Asbestos mining
14. Indirect Use
Metal and engineering Tobacco
Metallurgic Leather tanning
Oil refineries Non-asbestos textile
Metal, food and drink finishing
industries Glass and ceramic
Sugar refineries Paper
Organic and inorganic Jewelry
chemical plants Gas production
Wood processing Navy and military defense
Power plants work
Heat and steam generation
15. Construction Sector – The Whole Industry!
Spray-on asbestos Fire doors
Ceilings Boilers
Floor tiles Steam pipes
Wallboard HVAC
Plaster/cement Sheet metal work
Joint compound Caulk
Electrical work Elevator work
16. Accidental and Unaware Exposure
Car mechanics Talcum powder use
Brake mechanics Laboratory workers
Heavy machine Researchers
operators
Jute sack recycling
Dentists
Service industry
employees where
asbestos was in place
17.
18. Case #1
50 year old
advertising executive
In excellent overall
health
Professional career
spent in offices
No home
renovations
19. Case #1
Full occupational Father and brother also
history revealed college worked in same
employment of note automobile plant
Worked in an Parts: friction materials
automobile that contained asbestos
manufacturing plant for
three summers as a
parts picker while in
college
20. Case #2
54 year old dentist
Worked as dentist
entire career, no
other employment
21. Case #2
Crowns were made in dental school using the
lost wax technique with asbestos containing
dental tape
Similar exposures seen in jewelry industry
using the same lost wax technique
22. Case #3
72 year old physician
In excellent health
Noticed shortness of breath while exercising
Diagnosed with mesothelioma
23. Case #3
Worked in a laboratory for years
Exposures from laboratory equipment
– Asbestos gloves
– Asbestos mesh
– Asbestos pads
– Insulation used around crucibles
24. The asbestos fiber becomes coated with iron and
calcium, which is why it is often referred to as a
"ferruginous body" as seen here with an iron
stain. Ingestion of these fibers by macrophages
sets off a fibrogenic response via release of
growth factors that promote collagen deposition
by fibroblasts.
25. Methods of Exposure
During work with asbestos
During work in the same space as others working with
asbestos
On worker’s skin, hair, and clothing
In areas surrounding a mining operation
In areas of the world where construction or other human
activity (such as gardening) results in disturbance of natural
outcrops of asbestos-bearing rock
In homes and buildings where renovations or demolitions
disturb asbestos-containing building materials
26. Incidence of Mesothelioma Increasing after
Home Maintenance and Renovation
Australian mesothelioma registry data
Rates steadily rising over past two decades
Most MM cases in men, but this type of exposure is
much higher as a proportion in women
Men: increase from 3% to 8% from 1990s to 2005-
2008
Women: increase from 5% of cases to over 35% of
cases in same time period.
27. Home Renovation as a
Source of Asbestos
Most important non-occupational exposure
Exposure might be from performing the home
renovations
Exposure might be from being present while
renovations took place
Most instances, exposure might have lasted
only a few days
28. Non-Occupational Environmental
Asbestos Exposures
Pleural and parenchymal changes are significantly
more prevalent in exposed households of asbestos
workers
– 35% demonstrate pleural changes
– 17% demonstrate parenchymal changes.
Population surveys have identified higher rates of
pleural abnormalities in locations where asbestos
occurs naturally ranging from 2% and 17% of
individuals.
29. Shifting Gears: A Unique Exposure
Fallout from the
World Trade Center disaster
46. WTC Dust: Particle Composition
Lioy, Environ Health Perspectives, 2002;110:703-14
47. WTC Dust: Particle Size
Large particles >> Small (respirable)
Alkaline pH (lye)
Larger the size, the more alkaline the pH
1-4% by mass were respirable particles PM2.5
Even large particles reached lower airways
– High concentrations
– Mouth breathing
Particle Size (MMAD μm) 2.5 10 53
pH ~8.1 >10.0
Chen et al; Lancet 2002;360:S37-8.
Gavett et al; Environ Health Perspect 2003;111:981-91
48. WTC Dust: Particles, Gases and Fumes
Gypsum, calcite and crystalline silica
Diesel particulates and carbon monoxide
Glass, cellulose and crystalline asbestos fibers
Mercury and heavy metals
Volatile organics (benzene)
Semi-volatiles: PAHs, PCBs, Dioxins and Furans
Landrigan, Environ Health Perspectives,
2004; 112:731-9
49. WTC Dust: Known Health Effects
Source Air Pollution Health Effects
Constituents
Structural Collapse
Calcium carbonate / Gypsum /
Cement, ceiling tiles, drywall
Vitreous Fibers Airway and
pulmonary
Calcium sulfate irritation
Windows Glass fibers, Silicates
Fire retardant Asbestos Cancer
Combustion
Incomplete combustion - Organic hydrocarbons Cancer
plastics
Diesel-powered rescue Diesel exhaust Airway irritation,
equipment cancer
50. Acute Eosinophilic Pneumonia
In a Firefighter
38 year old firefighter at Ground Zero from
9/11 – 9/24/01
Admitted with Pa02 of 53 mmHg, progressive
dyspnea and cough
CT showed patchy ground glass densities,
thickened bronchial walls and bilateral pleural
effusions
Rom, et al Am J Respir Crit Care Med 2002;
166:797-800.
51. Chest CT. One-millimeter-thick section at the lung bases depicts patchy
areas of consolidation (arrows). There is bronchial wall thickening and
small pleural effusions (asterisks).
52. Bronchoscopy Lavage Findings
70% eosinophilia
Mineralogical analysis of lavage fluid
– Uncoated asbestos (chrysotile and amosite)
– Chromium
– Degraded fibrous glass
– Fly ash
– Metal particles
– Various silicates
54. Lancet 9/3/2011
Note: After correction for potential surveillance bias, Too few cases to
achieve statistical power for any individual cancer analysis.