Lung cancer among glass fibre production workers: a case-control study

A cohort study among 4734 employees at an English glass fibre plant previously reported no excess of lung cancer mortality either overall or when examined in broad occupational groups. To investigate occupation in more detail, and to test the hypothesis that processes producing or using finer (respirable) fibres may be related to a higher risk of lung cancer, a nested case-control study has now been carried out. Included are 73 cases of lung cancer and 506 matched controls, for whom jobs held and processes worked on have been blindly recorded in more detail than for the cohort study. Workers known to have been employed on processes containing respirable fibres had a relative risk of lung cancer of 1.2 (95% confidence interval 0.7-2.0) compared with other workers. There was no evidence of a relationship of lung cancer to fibre diameter, duration of exposure, or time since first exposure. The results by broad occupational group were similar to those of the cohort study, and although some of the many detailed occupational categories examined had significantly raised relative risks, these did not appear to be related to exposure to respirable glass fibre. Although the study has not indicated a differential risk of lung cancer among workers exposed to finer diameter glass fibres, the exposure levels were low and the number of cases small.     

A case-control study of malignant and non-malignant respiratory disease among employees of a fiberglass manufacturing facility. II. Exposure assessment.

A case-control study of malignant and non-malignant respiratory disease among employees of the Owens-Corning Fiberglas Corporation's Newark, Ohio plant was undertaken. The aim was to determine the extent to which exposures to substances in the Newark plant environment, to non-workplace factors, or to a combination may play a part in the risk of mortality from respiratory disease among workers in this plant. A historical environmental reconstruction of the plant was undertaken to characterise the exposure profile for workers in this plant from its beginnings in 1934 to the end of 1987. The exposure profile provided estimates of cumulative exposure to respirable fibres, fine fibres, asbestos, talc, formaldehyde, silica, and asphalt fumes. Employment histories from Owens-Corning Fiberglas provided information on employment characteristics (duration of employment, year of hire, age at first hire) and an interview survey obtained information on demographic characteristics (birthdate, race, education, marital state, parent's ethnic background, and place of birth), lifetime residence, occupational and smoking histories, hobbies, and personal and family medical history. Matched, unadjusted odds ratios (ORs) were used to assess the association between lung cancer or non-malignant respiratory disease and the cumulative exposure history, demographic characteristics, and employment variables. Only the smoking variables and employment characteristics (year of hire and age at first hire) were statistically significant for lung cancer. For non-malignant respiratory disease, only the smoking variables were statistically significant in the univariate analysis. Of the variables entered into a conditional logistic regression model for lung cancer, only smoking (smoked for six months or more v never smoked: OR = 26.17, 95% confidence interval (95% CI) 3.316-206.5) and age at first hire (35 and over v less than 35: OR = 0.244, 95% CI 0.083-0.717) were statistically significant. There were, however, increased ORs for year of employment (first hired before 1945 v first hire after 1945: OR = 1.944, 95% CI 0.850-4.445), talc (cumulative exposure >1000 fibres/ml days v never exposed: OR = 1.355, 95% CI 0.407-5.515), and asphalt fumes (cumulative exposure >0.01 mg/m(3) days v never exposed: OR 1.131, 95% CI 0.468-2.730). For non-malignant respiratory disease, only the smoking variable was significant in the conditional logistic regression analysis (OR = 2.637, 95% CI 1.146-6.069). There were raised ORs for the higher cumulative exposure categories for respirable fibres, asbestos, silica, and asphalt fumes. For both silica and asphalt fumes, ORs were more than double the reference groups for all exposure categories. A limited number of subjects were exposed to fine fibres. The scarcity of cases and controls limits the extent to which analyses for fine fibre may be carried out. Within those limitations, among those who had worked with fine fibre, the unadjusted, unmatched OR for lung cancer was (1.0 (95% CI 0.229-4.373) and for non-malignant respiratory disease, the OR was 1.5 (95% CI 0.336-6.702). The unadjusted OR for lung cancer for exposure to fine fibre was consistent with that for all respirable fibre and does not suggest an association. For non-malignant respiratory disease, the unadjusted OR for fine fibre was opposite in direction from that for all respirable fibres. Within the limitations of the available data on fibre, there is o suggestion that exposure to fine fibre has resulted in an increase in risk of lung cancer. The increased OR for non-malignant respiratory disease is inconclusive. The results of this population, in this place and time, neither respirable fibres nor any of the substances investigated as part of the plant environment are statistically significant factors for lung cancer risk although there are increased ORs for exposure to talc and asphalt fumes. Smoking is the most important factors in risk for lung cancer in this population. The situation is less clear for non-malignant respiratory disease. Unlike lung cancer, non-malignant respiratory represents a constellation of outcomes and not a single well defined end point. Although smoking was the only statistically significant factor for non-malignant respiratory disease in this analysis, the ORs for respirable fibres, asbestos, silica, and asphalt fumes were greater than unity for the highest exposure categories. Although the raised ORs for these substances may represent the results of a random process, they may be suggestive of an increased risk and require further investigation.     

Occupational Exposure to Silica Dust in Slovenia is Grossly Underestimated

As a by-product or material used in various industries crystalline silica contaminates the air many occupational settings. If its fine particles are inhaled, they are deposited in the lungs and may cause the development of silicosis, chronic obstructive pulmonary disease, and lung cancer. The goal of this study was to estimate occupational exposure to respirable crystalline silica (RCS) in Slovenia and the associated health risks. To do that, we ran two cross-sectional studies, one to determine the number of workers at risk of occupational exposure to RCS in Slovene industries and the other to determine and classify changes in the lung radiographs of glass factory workers exposed to RCS, as a means to infer health risks for other RCS exposed workers in Slovenia. However, the first study shows that official public data on occupational exposure to silica in Slovenia are unreliable and incomplete and that company representatives strongly underestimate occupational exposure to silica. Measurements of total and silica dust are made by 8.3 % and 1.8 % of companies working with silica, respectively. The second study shows that about a third of the exposed workers had lung changes associated with silicosis. We have failed to achieve the goal of our study, as the obtained data are grossly underestimated and unreliable, but it has opened our eyes as to what needs to be improved. All companies need to systematically be informed about occupational health risks, field inspections need to be consistent, regular, and intensified, and health surveillance of all exposed workers implemented regularly.Key words: construction industry, glass industry, respirable dust, silicon dioxide, quartz     

Man-made Mineral Fibres

Insulation wools from glass fibres have been in production forover 40 years and similar products made from slag wool havebeen made since the 1880s. These products contain a significantproportion of fibres of respirable diameter. Continuous filamentsfor textile fibres have been made since the 1940s and containonly extremely small quantities of respirable fibres. The relativelyhigh falling speed of large diameter fibres means that highgravimetric estimations may be associated with very small quantitiesof airborne respirable fibres in production plants. Fibres above5 µm in diameter act as a primary irritant on the skinbut continued exposure leads to hardening and a cessation ofsymptoms, sensitization does not occur. Prevalence studies ofgroups of workers exposed for lengthy periods to glass fibresin several countries produced evidence of the absence of pulmonaryfibrosis, respiratory impairment and symptoms of bronchitis.Epidemiological studies have failed to show an excess risk oflung or other cancers. Reports of a small number of individualcases with respiratory disease and an exposure to glass fibreshave not demonstrated a causal effect. Postmortem studies ofworkers with long-term exposure to glass fibres have shown noevidence of lung damage. Animal inhalation studies, in general, show that man-made mineralfibres elicit a macrophage response and the reaction is typicalof a nuisance dust, significant fibrogenic reaction is not producedand carcinogenesis has not been demonstrated by inhalation.Injection of fibres into the pleura produces an incidence oftumours related to the number, diameter and length of fibres.The order of diameter of biological significance is believedto be between 0.5 and 1 µm in diameter. Such effects havenot been observed in man and are obtained with all durable fibres,asbestos being the only substance for which a similar effectis known to occur in humans. Cell culture work suggests themechanism of tumorigenesis differs from that of most carcinogensand may resemble the Oppenheimer effect. Requests for reprints should be addressed to: Dr J. W. Hill, Medical Centre, Pilkington Brothers Ltd., Prescot Road, St Helens WA10 3TT.     

Depletion of glutathione and ascorbate in lung lining fluid by respirable fibres

OBJECTIVE: The use of synthetic vitreous fibres has increased along with a decline in the utilisation of asbestos. There remains concern that these synthetic fibres pose a health risk to workers because of the generation of respirable fibres which can enter the lung and cause adverse health effects. An improved understanding of the mechanism of fibre pathogenicity should allow more rational short-term testing regimes for new fibres as they are developed. We hypothesised that carcinogenic fibres have greater free radical activity compared with non-carcinogenic fibres and that they contribute to disease by causing oxidative stress in the lung. We examined a panel of respirable fibres, designated as being carcinogenic or non-carcinogenic based on previous animal studies for ability to deplete antioxidants from lung lining fluid. METHODS: On the basis of inhalation studies, a panel of fibres was divided into three carcinogenic fibres-amosite asbestos, silicon carbide, and refractory ceramic fibre 1 (RCF1) and three non-carcinogenic fibres-man-made vitreous fibre 10 (a glass fibre MMVF10), Code 100/475 glass fibre, and refractory ceramic fibre 4 (RCF4). We measured the levels of glutathione (GSH) and ascorbate, two antioxidants present in lung lining fluid (LLF) after fibre treatment. All of the experiments were carried out at equal fibre number. RESULTS: Fibres had the ability to deplete both GSH and ascorbate from both LLF and pure solutions, an effect which was fibre number dependent. The greatest depletion of antioxidants was observed with the two non-carcinogenic glass fibres, and this effect was observed when A549 lung epithelial cells were treated with fibres. CONCLUSIONS: Our results show that antioxidant depletion in cell free solution and lung lining fluid solely is not a simple indicator of the ability of fibres to cause lung pathology and that other biological events in the lung are involved.     

Smoking imputation and lung cancer in railroad workers exposed to diesel exhaust

BACKGROUND: An association between diesel exhaust exposure and lung cancer mortality in a large retrospective cohort study of US railroad workers has previously been reported. However, specific information regarding cigarette smoking was unavailable. METHODS: Birth cohort, age, job, and cause of death specific smoking histories from a companion case-control study were used to impute smoking behavior for 39,388 railroad workers who died 1959-1996. Mortality analyses incorporated the effect of smoking on lung cancer risk. RESULTS: The smoking adjusted relative risk of lung cancer in railroad workers exposed to diesel exhaust compared to unexposed workers was 1.22 (95% CI = 1.12-1.32), and unadjusted for smoking the relative risk was 1.35 (95% CI = 1.24-1.46). CONCLUSIONS: These analyses illustrate the use of imputation in record-based occupational health studies to assess potential confounding due to smoking. In this cohort, small differences in smoking behavior between diesel exposed and unexposed workers did not explain the elevated lung cancer risk.     

Crystalline silica exposure and lung cancer mortality in diatomaceous earth industry workers: a quantitative risk assessment

OBJECTIVE—To use various exposure-response models to estimate the risk of mortality from lung cancer due to occupational exposure to respirable crystalline silica dust.
METHODS—Data from a cohort mortality study of 2342 white male California diatomaceous earth mining and processing workers exposed to crystalline silica dust (mainly cristobalite) were reanalyzed with Poisson regression and Cox's proportional hazards models. Internal and external adjustments were used to control for potential confounding from the effects of time since first observation, calendar time, age, and Hispanic ethnicity. Cubic smoothing spline models were used to assess the fit of the models. Exposures were lagged by 10 years. Evaluations of the fit of the models were performed by comparing their deviances. Lifetime risks of lung cancer were estimated up to age 85 with an actuarial approach that accounted for competing causes of death.
RESULTS—Exposure to respirable crystalline silica dust was a significant predictor (p<0.05) in nearly all of the models evaluated and the linear relative rate model with a 10 year exposure lag seemed to give the best fit in the Poisson regression analysis. For those who died of lung cancer the linear relative rate model predicted rate ratios for mortality from lung cancer of about 1.6 for the mean cumulative exposure to respirable silica compared with no exposure. The excess lifetime risk (to age 85) of mortality from lung cancer for white men exposed for 45 years and with a 10 year lag period at the current Occupational Safety and Health Administration (OSHA) standard of about 0.05 mg/m³ for respirable cristobalite dust is 19/1000 (95% confidence interval (95% CI) 5/1000 to 46/1000).
CONCLUSIONS—There was a significant risk of mortality from lung cancer that increased with cumulative exposure to respirable crystalline silica dust. The predicted number of deaths from lung cancer suggests that current occupational health standards may not be adequately protecting workers from the risk of lung cancer.


Keywords: crystalline silica; cristobalite; lung cancer     

Cancer risk among glass factory workers: an excess of lung cancer?

A total of 3749 workers employed for at least three months in two Finnish glass factories (cohorts A and B) were followed up for cancer in 1953-86 through the Finnish Cancer Registry. In cohort A (1353 men, 1261 women), 106 primary cancers were diagnosed among men, and their standardised incidence ratio (SIR) for all cancers was 99. Among women the risk was low (65 cases, SIR 64). In cohort B (450 men, 685 women), the relative risk of cancer was close to unity for both men (57 cases) and women (75 cases). The risk of cancer was analysed by primary site, type of work, years since first exposure, and age at diagnosis. The only significantly increased risks were those of lung cancer among men (SIR 130, 95% CI 100-167, cohorts A and B combined), and skin cancer among glass blowers (SIR 625, 95% CI 129-1827). An increased risk of lung, stomach, and colon cancer as well as of brain tumours has been reported in previous studies. It is postulated that the excess risk of lung cancer, detected in this study, can also be accounted for by lifestyle, and not only by possible occupational exposures, because a similar excess risk of lung cancer has been found previously for all industrial workers in Finland. Although the risk of stomach cancer in this study was increased among glass blowers, it was not high in the largest groups of plain glass workers. The risks of tumours of the central nervous system and colon were not increased either.     

Cancer risk among glass factory workers: an excess of lung cancer?

A total of 3749 workers employed for at least three months in two Finnish glass factories (cohorts A and B) were followed up for cancer in 1953-86 through the Finnish Cancer Registry. In cohort A (1353 men, 1261 women), 106 primary cancers were diagnosed among men, and their standardised incidence ratio (SIR) for all cancers was 99. Among women the risk was low (65 cases, SIR 64). In cohort B (450 men, 685 women), the relative risk of cancer was close to unity for both men (57 cases) and women (75 cases). The risk of cancer was analysed by primary site, type of work, years since first exposure, and age at diagnosis. The only significantly increased risks were those of lung cancer among men (SIR 130, 95% CI 100-167, cohorts A and B combined), and skin cancer among glass blowers (SIR 625, 95% CI 129-1827). An increased risk of lung, stomach, and colon cancer as well as of brain tumours has been reported in previous studies. It is postulated that the excess risk of lung cancer, detected in this study, can also be accounted for by lifestyle, and not only by possible occupational exposures, because a similar excess risk of lung cancer has been found previously for all industrial workers in Finland. Although the risk of stomach cancer in this study was increased among glass blowers, it was not high in the largest groups of plain glass workers. The risks of tumours of the central nervous system and colon were not increased either.     

Diesel motor exhaust and lung cancer mortality: reanalysis of a cohort study in potash miners

The aim of the reanalysis is to reassess lung cancer risk associated with occupational exposure to diesel motor exhaust in potash miners, while controlling for potential confounders such as smoking and previous occupational history. Our investigation is based on a cohort study of nearly 6,000 German potash miners, who were followed up from 1970 to 2001. The reanalysis also takes into account the employment periods before potash mining, in particular uranium mining. Different approaches (nested case–control study and Cox model) were used to adjust for confounding. The exposure estimates were recalculated, lagging the exposure by 5 years. Exposure groups were defined by tertiles of cumulative respirable elemental carbon (REC) exposure estimates and occupational categories, where exposure was estimated originally by representative measurements of total carbon for different occupations. The highest REC concentration was measured for production workers, about twice as much as for other occupations. The reanalysis revealed that while about 4 % of all study subjects had worked earlier in uranium mines, 10.3 % of later lung cancer cases did so. Although their absolute number was small, the corresponding relative risk estimator was significantly elevated. Our analysis did not show any notable association between cumulative REC exposure and lung cancer risk. Introducing cumulative REC exposure as a continuous variable into the conditional logistic regression model yielded an odds ratio of OR = 1.04 [0.70–1.53]_95 % adjusted for smoking and previous employment. The study results give no evidence for an association between REC exposure and lung cancer risk. Only for very high cumulative dose, corresponding to at least 20 years of exposure in the production area, some weak hints for a possible risk increase could be detected. The study underlines the importance of assessing the entire occupational history in occupational studies, especially if the supposed dose–response-relationship is weak.     

The quantitative risks of mesothelioma and lung cancer in relation to asbestos exposure

Mortality reports on asbestos exposed cohorts which gave information on exposure levels from which (as a minimum) a cohort average cumulative exposure could be estimated were reviewed. At exposure levels seen in occupational cohorts it is concluded that the exposure specific risk of mesothelioma from the three principal commercial asbestos types is broadly in the ratio 1:100:500 for chrysotile, amosite and crocidolite respectively. For lung cancer the conclusions are less clear cut. Cohorts exposed only to crocidolite or amosite record similar exposure specific risk levels (around 5% excess lung cancer per f/ml.yr); but chrysotile exposed cohorts show a less consistent picture, with a clear discrepancy between the mortality experience of a cohort of xhrysotile textile workers in Carolina and the Quebec miners cohort. Taking account of the excess risk recorded by cohorts with mixed fibre exposures (generally<1%), the Carolina experience looks uptypically high. It is suggested that a best estimate lung cancer risk for chrysotile alone would be 0.1%, with a highest reasonable estimate of 0.5%. The risk differential between chrysotile and the two amphibole fibres for lunc cancer is thus between 1:10 and 1:50.Examination of the inter-study dose response relationship for the amphibole fibres suggests a non-linear relationship for all three cancer endpoints (pleural and peritoneal mesotheliomas, and lung cancer). The peritoneal mesothelioma risk is proportional to the square of cumulative exposure, lung cancer risk lies between a linear and square relationship and pleural mesothelioma seems to rise less than linearly with cumulative dose. Although these non-linear relationships provide a best fit ot the data, statistical and other uncertainties mean that a linear relationship remains arguable for pleural and lung tumours (but not or peritoneal tumours).Based on these considerations, and a discussion fo the associated uncertainties, a series of quantified risk summary statements for different elvels of cumulative exposure are presented.     

Lung fibre burden in lung cancer cases employed in the rock and slag wool industry

OBJECTIVES: To evaluate the relationship between estimated exposure to man-made vitreous fibres (MMVF) and to asbestos fibres and their concentration in the lung tissue of lung cancer cases amongst MMVF production workers. METHODS: Retrospective retrieval of available lung tissue specimens was conducted following a case-control study that assessed estimated occupational exposures of MMVF workers. Fibre recovery and analysis by transmission electron microscopy (TEM) were conducted to determine fibre type, fibre dimension and numbers per gram of dry lung tissue. For cases with detailed exposure data, geometric mean (GM) concentrations were compared across the exposure categories, and regression models were used to investigate the relationship between the lung fibres and the variables of estimated exposure, with and without additional variables that may affect fibre retention. RESULTS: A total of 24 samples from 17 cases of lung cancer were available for analysis: MMVF were detected in all cases. Asbestos fibres were detected in 16. No difference or trend in GM MMVF concentration was observed across the estimated exposure categories. Odds ratio (OR) for MMVF g(-1) dry lung was 0.5 (95% confidence interval: 0.1-2.4) for the second, and 3.5 (0.6-18.9) for the third quartile of index of average exposure to MMVF in industry, compared with the first (lowest exposed) quartile (no cases in the highest quartile). CONCLUSIONS: No observable relationship existed between estimated exposure and directly-measured lung fibres among this sample of cases. Retrospective specimen collection, intra-individual variability in fibre concentration, effect of unknown factors on fibre retention and small sample size militated against this study providing evidence for or against a relationship between estimated exposure and lung fibre concentrations.     

Effects of work related confounders on the association between silica exposure and lung cancer: a nested case-control study among Chinese miners and pottery workers

Objective The role of silica in the causation of lung cancer is an ongoing debate. In order to explore whether observed association between silica exposure and lung cancer is confounded by exposure to other occupational carcinogens, we updated a previously nested case-control study among a cohort of male workers in 29 Chinese mines and factories on the basis of an extended follow-up. Methods Five hundred and eleven lung cancer cases and 1,879 matched controls were selected. Exposure to respirable silica as well as relevant occupational confounders were quantitatively assessed based on historical industrial hygiene data. The relationship between exposure to silica and lung cancer was analyzed by conditional logistic regression analysis adjusted for exposure to arsenic, polycyclic aromatic hydrocarbons (PAHs), radon, and smoking. Results In a crude analysis adjusted for smoking only, a significant trend of increasing risk of lung cancer with exposure to silica was found for tin, iron/copper miners, and pottery workers. But after adjustment for relevant occupational confounders, no relationship between silica and lung cancer can be observed. Instead, there is a significant association between lung cancer mortality and cumulative exposure to inorganic arsenic (OR = 1.86, 95% CI: 1.14, 3.04 for each mg/m³-year increase) and carcinogenic PAHs (OR = 1.35, 95% CI: 1.08, 1.69 for each 100 μg/m³-year increase). Conclusion This analysis does not provide any evidence to show that exposure to silica causes lung cancer in the absence of confounding factors.     

Airborne fibre concentrations and lung burden compared to the tumour response in rats and humans exposed to asbestos

The excess risk of tumours exposed to asbestos were previously compared with the results of rat inhalation experiments. It could be demonstrated that humans at the workplace suffer from a tumour risk at fibre concentrations which are 300 times lower than those needed in the rat inhalation model to produce the same risk. However, the estimation of human risk was based on the study of workers at a chrysotile textile factory, whereas animal experimental results were related to exposure to amphiboles. Since for this comparison the risk of cancer due to exposure to amosite or crocidolite fibres at the workplace is of interest, quantitative exposure-response relationships for lung cancer and mesothelioma for the white workforce of South African amosite and crocidolite mines were discussed. On comparing the risk of lung cancer in this study with the risk of lung cancer for chrysotile textile workers, it can be concluded, that the risk of lung cancer and mesothelioma from crocidolite and amosite was higher than in the chrysotile textile factory.It could be also demonstrated, on the basis of a study of the lung burden of mesothelioma cases and of controls, that a significantly increased odds ratio of about 5 was established at amphibole concentrations of between 0.1 and 0.2 f μg⁻¹ dry lung (WHO fibres longer than 5 μm from TEM analysis). On the other hand, carcinogenic response was observed at a fibre concentration 6000 times higher in animal inhalation experiments with crocidolite asbestos (SEM analysis of WHO fibres). As a result of these findings, it has been concluded that inhalation studies in rats are not sufficiently sensitive for the detection of hazards and risks to humans exposed to man-made fibres.     

Long-term effect of occupational dust exposure

In 1950-1960, a cohort of dust-exposed workers and a cohort of multiple matched unexposed subjects was set up from the files of preventive medical checkups performed in 1,089 Viennese plants. Male workers with a history of long-term exposure to nonfibrous particulates in different industries (metal, ceramics, brick, glass, stone etc.) aged greater than or equal to 40, and male workers without dust exposure (matched for residency, start of observation, age, and smoking) were followed up to 1980 or death (48,960 person yr). By life table methods, dust-exposed workers compared to unexposed workers showed a reduced survival of age 60 (p less than 0.0001), due to lung cancer (123 exposed, 87 controls, p = 0.001), stomach cancer (48/27, p = 0.003), silicosis (40/0), emphysema, bronchitis and asthma (41/23, p = 0.007). No difference in mortality from cardiovascular diseases was observed (p greater than 0.50). We concluded that heavy and long term exposure to respirable particulates is related to increased lung cancer mortality after age 60. A comparison of 2,212 deaths among Austrian silicotics, with deaths in the corresponding population showed a relation between lung cancer and silicosis (p less than 0.001), fairly independent of age and time-period. The estimated relative lung cancer risk of Austrian silicotics in the period 1955-79 averaged 1.41 (95% confidence 1.21-1.64).     

Changes in workplace concentrations of airborne respirable fibres in the European ceramic fibre industry 1987 1996

As part of a wider epidemiological research programme, an occupational hygiene study was carried out during 1995-1996 to assess workers' current exposures to airborne materials in six European refractory ceramic fibre (RCF) plants. These plants had also participated in a cross-sectional occupational hygiene survey in 1987. The sampling strategy focussed principally on personal shift-average exposures of workers, by occupation, to respirable fibres. Monitoring was undertaken in two integrated phases: a 1-week cross-sectional survey followed by a prospective, and ongoing, programme by the RCF industry. Statistical (analysis of variance) analyses to identify patterns of variability by plant, occupational group (OG) and occupations within group were based on 464 individual shift samples, the greatest amount of data being available for production occupations. Concentrations of respirable fibres showed marked differences between plants and between OGs. Average respirable fibre concentrations among Primary and Secondary Production and Ancillary workers ranged from <0.1 f ml(-1) to up to 0.4 f ml(-1), depending on OG and plant. Individual shift-average measurements were almost invariably <1 f ml(-1). Within Secondary Conversion and Finishing, plant-specific averages ranged from 0.3 f ml(-1) to 1.25 f ml(-1). Respirable fibre concentrations were, in some plants, less than half those found in 1987. In other plants, mainly those where concentrations had been relatively low in 1987, the dust exposure had remained essentially unchanged or increased slightly. An ongoing programme of sampling is being carried out by the participating companies, generating additional information that could assist research in the long term and in improving control.     

IARC multicenter study on neoplastic disease caused by man-made vitreous mineral fibers (MMVF)]

Man-made vitreous fibres (MMVF) showed carcinogenic potential in experimental animals. Epidemiological data suggested an increased mortality from lung cancer among production workers, but the interpretation is still a matter of controversy. A European study encompassing 13 plants in 7 countries pointed towards a moderate excess of lung cancer among workers employed longer than 1 year in the production of rock/slag wool (SMR = 1.34, 95% CI = 1.08-1.63) and glass wool (SMR = 1.27, 95% CI = 1.07-1.50); the latter increase was not confirmed after applying local rates to calculate expected deaths. The elevated risk among rock/slag wool producers was present even in comparison with local rates, and was associated with increasing time from first exposure, and duration of exposure. Glass wool results exhibited a less definite pattern. Smoking was excluded, although indirectly, as a sufficient alternative explanation of the increased lung cancer risk. In a few plants, exposure to asbestos had occurred in limited periods for some workers, and might have contributed to the findings. Case-control studies are under way to thoroughly investigate the relative and possibly combined role of the different exposures, either occupational or not. Cohort studies in the USA produced results closely consistent with those of the European study.     

Are the respiratory health effects found in manufacturers of ceramic fibres due to the dust rather than the exposure to fibres?

OBJECTIVES--To determine whether the respiratory symptoms and decrements in lung function found in manufacturers of ceramic fibres are related to exposure to the respirable fibre or inspirable mass constituents of the air in the working environment. METHODS--Cross sectional survey of all current European primary producers of ceramic fibre was carried out, with measurement of exposure to respiratory fibres by personal samplers that measured inspirable and total mass, together with a health survey with an expanded respiratory questionnaire and standardised measurement of lung function. Odds ratios were calculated for symptoms and current exposure by multiple logistic regression, and multiple linear regression coefficients for lung function related to cumulative exposures controlled for the effects of respirable fibre and inspirable mass separately and together. RESULTS--Significant effects of current exposure to both inspirable dust and respirable fibres were related to dry cough, stuffy nose, eye and skin irritation and breathlessness. The decrements found in smokers and to some extent in ex-smokers in forced expiratory volume in one second and forced expiratory flow from 25% to 75% of expiratory volume, seem to be related to the respirable fibres rather than the inspirable mass constituents of the environment. CONCLUSIONS--Current symptoms were related to both current exposure to inspirable dust and respirable fibre. The decrements in lung function were related to the fibre constituent of the exposure.     

Indirect validation of a retrospective method of exposure assessment used in a nested case-control study of lung cancer and silica exposure.

Validations of retrospective methods of assessment used in occupational epidemiological studies have rarely been published. This study is an indirect validation of a quantitative retrospective assessment of exposure to silica used in a nested case-control study of lung cancer among workers at 29 metal mines and pottery factories in China. Indices of cumulative total dust and cumulative respirable dust were calculated by merging work histories with the historical exposure profile for each subject. To validate indirectly the methods of exposure assessment used in the study of lung cancer, trends for exposure response relation between the two indices of exposure to silica and risk of silicosis were evaluated with 376 patients with silicosis from the study population as the cases, and 1262 controls without silicosis for comparison. Age adjusted odds ratios (ORs) as a measure of risk of silicosis showed striking trends with both indices of exposure to silica. For cumulative respirable dust, the OR (95% confidence interval) rose from 7.6 (5.1-11.4) for low exposure to 20.0 (13.2-30.6) for medium exposure, and to 51.7 (31.0-86.8) for high exposure. The strength of the association between exposure to silica and risk of silicosis suggests that the retrospective assessment of exposure used in the case-control study of lung cancer would accurately reflect an exposure response relation between silica and lung cancer, if it existed.     

Chemical and physical characteristics and toxicology of man-made mineral fibers]

The evidence for the adverse health effects following exposure to asbestos (i.e. fibrogenic and carcinogenic effect) has prompted widespread removal of asbestos-containing materials and led to banning of asbestos internationally (in Italy, DPR 257/1992), resulting in the increased use of substitutes composed of both naturally occurring and synthetic materials, including man made mineral fibres (MMMFs) and man made organic fibres (MMOF). MMMFs represent a family of synthetic, inorganic vitreous substances derived primarily from glass, rock, slag, or clay. MMMFs are further divided into two categories: 1) man made vitreous fibres (MMVFs), further divided as follows: a) fibrous glass, including mainly continuous filament, special purpose fibres; and microfibres. The materials are typically composed of oxides of silicon, calcium, sodium, potassium, aluminum, and boron. b) Mineral wool, including glass wool, rock wool (derived from magma rock) and slag wool (made from molten slag produced in metallurgical processes such as the production of iron, steel, or copper). The main components of rock wool and slag wool are oxides of silicon, calcium, magnesium, aluminum, and iron. 2) Refractory/ceramic fibres, amorphous or partially crystalline materials made from kaolin clay or oxides of aluminum, silicon or other metal oxides (i.e. oxides of zirconium and yttrium). Less commonly, refractory fibres are also made from non-oxide refractory materials such as silicon carbide, silicon nitride, or boron nitride. Industrial production of MMVFs began in the second half of the 19th century, while ceramic fibres production began more recently, in the early 1970s. Major uses of MMMFs include thermal, acoustic and aerospace insulation, fire proofing, reinforcing material in plastics, cement and textile, optic fibres, air and liquid filtration, friction products, refractory coatings. Serious questions have been raised about health implications of MMMFs. Suspicion about the possible occurrence of adverse effects following exposure to MMMFs arises mainly from some similarities of MMMFs with asbestos (fibrous aspects, inhalability, chemical composition, free radical formation). The fibre characteristics that have been identified as crucial in influencing the pathogenesis of fibre-related adverse respiratory effects can be mainly divided into two groups: fibre dimension, and chemical composition and structure. Fibre dimension plays a determining role in conditioning penetration in the lung. In a broad sense, the term "respirable" means "capable of being carried by breath into the respiratory system". For regulatory purposes, "respirable fibres" (i.e. RFP) are defined in most countries following WHO criteria: length > 5 microns, diameter < 3 microns, length/diameter > 3. MMMFs are generally produced as fibres of diameter higher than asbestos, and too large in diameter to be respirable. Moreover, due to the production process, they are structurally amorphous. Since MMMFs have no crystalline domains, they also have no clearly defined structural faults and they fracture transversely, and randomly. Fragments that are too large to be taken up by macrophages can be resolved in the lung by a leaching--or dissolution--process which leads to a progressive reduction of particle length. In contrast, when abraded, asbestos tends to split longitudinally into new, fine, straight fibres: these fibrils are of much smaller diameter, more respirable, and consequently more hazardous than parent fibres. Fibre chemical composition plays a determining role in conditioning the higher or lower biological activity, durability, biopersistence, and biodegradability. The term "biological activity" means reactivity or ability to interact (possibly due to formation of active oxygen species, identified as a crucial step in the mechanism of action) with biological structures and tissues. Fibre "durability" is strictly related to its solubility. It can be defined as the ability to resist