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- - United States Shipyards Irving J. Selikoff, M.O. and *// --*V^i , *.?T36|JJ5*%*0!` ^r-... ..v-.<ff>>YC*;<i-i<">'>*<ii,:'1 yw - >.--'> .ij^,:wmatA.v^in-snj* -n-.-'-j-^ir--t',--ii*!fr..-...^..t.n...i...i...i.n. v * *5 ~ - `.vvres^s-c^yr *' *&&#&&&$&& __ __ CLINICAL LATENCY OF ASBESTOS-ASSOCIATED CANCER ' During the- past 15 years the Important disease potential of.asbestos exposure has been clarified. The principal hazards have been demonstrated to be cancer of a num ber of sites, and asbestosis. Among asbes tos workers, approximately 20 percent of all deaths are due to lung cancer, six per cent or sevesr percent to pleural and/or . peritoneal mesothelioma, and there is an excess found in several other categories ' (e.g^ cancer of the esophagus, stomach, ' coion-restum, oropharynx, larynx, kid ney). Table 1 provides an analysis of causes - of death among* 17,800 asbestos insula - tios workers in the United States and Canada- followed prospectively from . January 1,1967 to January 1,1977. Risk of asbestos-assodated disease hasalso been observed in workers in other trades where asbestos exposure occurs-- Dr. Selikoff is ' Professor of Medicine, and Director. Environmental Sciences Laboratory, Mount Sinai School of Medidae, City UaivgdryofNew York, New York, New York. Dr. Hammond is Vice President, Epidemiology* and Statistics, Amoian Cancg Society, Inc^ New York, New York. This is a speriai report from the Environmental Cancer Research Project. Americas Cancer Soricty and- the- Environmental Sciences La^ oratory of the Mount Sinai School of Medicine of theCity University of New York. for ecample, where individuals simply working near "asbestos workers** are ex posed to the same dusts. Risk extends even to individuals not employed in an asbes tos-contaminated environment; mesothe lioma has been found among family con tacts of asbestos workers residing in the same households, as well as among people living within a quarter of a mile or so of asbestos plants or other fadlities-whieh have used asbestos-containing materials. Although-mesothelioma is not neces sarily the most common disease resulting from asbestos exposure, it provides a very useful index of such`problems, since it is only uncommonly sees as a result of ex posure to other agents or without iden tified cause. Large scale-investigations of series of cases of mesothelioma in France, Great Britain, the Netherlandslo and else where have demonstrated that the large majority of these cases can be traced to prior asbestos exposure* For these neoplasms, as for all can cers due to asbestos exposure (and, in deed, for extensive asbestosis as well), a rather uniform characteristic has been found: the disease usually does not be come clinically evident for 15, 25, 35 or more yean from onset of asbestos ex posure. The initial decades are periods of grace with no illness or disability. While some eariy X-ray changes may be seen after five to 15 yean, they are limited in extent and not usually accompanied by significant symptoms. They merely dem- ^as . TABLE1 ,. Deaths among 17,800 asbestos insulation worfcars in tha United States and Canada . January 1,19S7-January 1,1977 Number of men 17,800 Man-years of observation 166355- - -- Expected* Observed ^SWi^Sja J^-S04T*4il-vP*-<S< -*s$8wsa isre*:i& MKSune^ ****. .Total deetha, ail sum Total cancer, all sites Lung eanear Pleural mesothelioma Peritoneal mesothelioma . Cancer of esophagus. Carveer of stomach ' Cancer of colon-rectum Ail ether canoar Aibanowa . .. All ethv cause* 136036- 319.90 1053T ## 7.01 1433 37.86. 15433 ^^ * 1,351.06 2370 934 485 66.- .109 ...............18 i 22. 59 235 - 162 1,114 * Expected beam* are based upon white male age pacific morality data of the * U.S. National Center for Health Statistics for 1967-1975 and ewapoiatton to 1976. , . . Theee are rare causes of deem In the general population. * The mwnberWilp of the Intemetlonel Association of Heat and Frost tnxjleron and. Asbestos Worker*, A F L-C10, CLC, wee enrolled on January 1, 1967, and;haa been observed, since. onstrate that enough asbestos exposure has occurred to produce such changes. In this sense, they are harbingers of future risk of clinical disease. Tables 2-3 illustrate the characteristic latency of asbestos disease. In one group of 1,117 asbestos insulation workers in the New*York metropolitan area, most of 723 workers with less than 20 years from on set of exposure (Table 2) had normal Xrays. When changes were present, they were minimal in extent. On theother hand', after the 20-year point, most X-rays were found to be abnormal, frequently exten sively so.'Tables3-5 show that few meso theliomas and little excess cancer of the lung occurred less than 20 years from on set. Most occurred 30 or more years from onset of exposure. A young man may be gin work at the age of 18; his risk of as bestos-associated cancer does not become substantial until he is 40,30 or older. EARLY STUDIES: * MESOTHELIOMA IN SHIPYARDS* In 1968, the first warning that asbestos CJLA CANCER JOURNAL FOR CLINICIANS -<6p;*A3fc u.'2ajCV .. Onsite# lyrsJ 40430-3920-29' ... - 10-19 0-9 , . . TABLE 2 ; X-ray changes in asbestos insulation workers 1 Aabactosls (grd) .% % No. Normal ' Abnormal 1 2 -3 121 SJS 194 119 77 27.2 379 SSJ9 346 89.6 94.2 87.1 7Z8 44.1 114 35 - 51 102 49 35 17 156 9 36 0 28 18 4 0 a Total 1,117 51.5 46.5 366 126 50 disease might be a serious problem in shipyards was sounded by HarriesJin Great Britain and Stumphius * in the Neth erlands wjten they reported instances of mesothelioma, among shipyard workers. What was 'worrisome was that the men were not "asbestos workers'* but rather, individuals employed* in other trades. At the Devonport shipyard of the Royal Navy, for example, mesothelioma in a boilermaker, a fitter, a shipwright, a weld er and a laborer were described. This raised the important question of whether asbestos use in shipyards might result in the exposure of the workers em ployed in. many trades, to dust derived from the few "asbestos workers" in their midst. In 2943, in the United States, for example, approximately one in 500 ship yard workers was an insulator. The other 499 included welders, shipfitiers, machin ists, pipefitters, electricians, boilermakers and painters (Tabie 6). The significance of this question is made apparent by the fact that during World War II, approximately 4,500,000 men and women worked in our shipyards, many of them tinder conditions in which exposure to asbestos was possible. After World War II the total number of shipyard workers rapidly decreased from a high of 1,700,000 in the last months of 1943 to 200,000 or so. During the period of 1946-1976, total employment remained in this range, fluctuating with economic conditions and the country's shipbuilding program. The 200,000-250,000 figure characterized the total number in the yards at one time; however; there was much turnover, and the total number of different individuals was much larger. There are no accurate data readily avail able which could tell us how many differ ent people--carpenters, riggen, electri cians, draftsmen, welders, etc.--were so employed. Nevertheless, die early obser vations (soon augmented by later stud ies74) pointed to a potentially serious problem. Harries has recently published his fur ther observations at Devonport, through 1973.9 By the end of the year, he had ob served 55 cases of mesothelioma in that shipyard alone. Again, trades other than "asbestos workers" gave evidence of the hazard. Only two of the 55 worked directly with asbestos (lagger, sprayer). The other 53 included 14 shipwrights, nine boiler makers, eight fitters and eight electricians (Table 7). - John Edge of High Carley Hospital has published similar data from shipyards in Barrow (Tabie 8)10; his most recent observations are particularly disturbing.11 In Barrow, 429 individuals were seen, be- -------------- . . # TABLE 3 Deaths among 17,800 asbestos insulation workers in the United States and Canada January 1,1967-January 1,1977 : Analysis by . _ duration from onset of employment - - Total man Man-year* of observation ., " 12.683 89.486 Bafora 20 yarn - . from onset . 12.QS1 77,389 20 or more yeer* from onset -. -- Expectad* Observed Expected* Observed Total deaths, all causae- 283.33 324 1,377.01 1,946 ' ' Canear, all srtas - . ' * 1 , 425 83 277.25 911 Lung canear Pleural mesothelioma . Peritoneal mesothelioma Canear of esophagus ' Canear of stomaeh * - Cancer of eolorweetum Asbettosie # ' , 12.03 * 0.66 1.56 4.07 36 2 3 1 1 4 8 33.94 6.35 12.67 33.79 -- 449 64 106 17 21 55 154 ' "Expected deaths ere based upon white male age eeeiflc mortality data of the U.S. ' National Center for Health Statistics for 1967-1975 and exvaooiatlon to 1976 These are rare causes of death In the general population. -! - '. twees 1964 and 1971, with radiologically evident pleural plaques; these piaques were considered to signal prior shipyard employment. Controls were 429 men from a neighboring city (Carlisle), matched for ageasd date ofX-ray; they had no plaques on their roentgenograms. Both groups were observed through 1976, i.e., for a minimum of five years. Among the 429 mea with pleural plaques, there were 127 deaths; those with no piaques suffered 74 deaths. The excess was primarily in two categories, lung cancer and mesothelioma. These were 19 deaths from lung cancer and 23 from mesothelioma among the former shipyard workers. As for the con trols, four died of lung cancer and none died of mesothelioma. Findings of an extraordinary increase of mesothelioma were ai$o reported last year from the French shipyard area in Western Brittany. Lajartre el ai. analyzed cases of pleurai mesothelioma in Nantes. In the period 1957-63, there- were two eases; from 1964-1970 there were 12; and from 1971-1974 there were 24.u This was interpreted as consistent with the mark edly increased shipbuilding program dur ing and afta World War II, and with its attendant risk ofasbestos exposure. GA-A CANCER JOURNALFOR CLINICIANS *3* -*> . ,, w4nw.j^ja - 4 viw-w "(: ' *' . TABLE 4 ' . Deaths among 17,800 asbestos Insulation workers in the United States and Canada, Jan. 1,1967-Jan 1,1977: Analysis by duration from onset of employment' Duration Num* from bar eraat of. ' (yaare) man . Ptnofr' ` yaars ' of . obsarvation Lung eancar . Expactad? Obsarvad . fturai . maaothalioma NoVIOOO panon-yaara ParrtOfiaai masothaitoma NoJIOOO panorvyaars <10 5.552 ` 10-14 9,063 15-19 .9,948 20-24-' 8,837 ' .25-23 6,596 - .3034 3,547 . 3539* 2,019 40-44 1,108 '45* *1,030 26^33 29,003 . 34,069 . 31,267* 20,657 * 11398* 5,401* * 3,160 5306 0.69 2.77 - 837 17.03 .21.04 18.48 11.47 . 8.12 1732 0 7 2959 104112 ` 68 39 69 0 0* 0.06: 0.19 0.73. 036 23G. 137 2.45- 0. 0 0.09 CLIO 037 130 ` 333 . 5.06 S.47 *Expactad. tfaatha are ba*ad upon white mala age tpactfle mortality Oats oi tha U.S. Notional Canter for Health Ststlxtica for 1967-1975 and extrapolation to 1976: Smoictne-hsblta net taken Into account : ASBESTOS DISEASE IN U.S. SHIPYARDS There has been comparatively little writ ten concerning the potential for asbestosdiseasehazards in U.S. shipyards. In part, this may have been due to the fact that in the latter part of World War II a survey dircacd'to-this question failed to demon strate the prevalence -of significant asbes tos disease-'At thatlime, 1,074 insulation workers, employed in U.S. yards were examined and, with few exceptions, no evidence of disease was found.13 Unfortu nately, the significance of the fact that the very large majority of men-had begun working only a-short time before was not appreciated; neither was it understood that X-ray evidence of disease could not be expected to appear until one or two de cades later. During the 1960's, evidence accumu latedthat"asbestos workers'* (insulation) employed in shipyards had unhappy dis ease experience, with markedly increased death rates of cancer (lung cancer, pleural mesothelioma, peritoneal mesothelioma, gastrointestinal cancer) and asbestosis.* These observations, however, were con fined to insulation workers, and while they pointed to a possible- accompanying difficulty among other shipyard trades, especially in view of British experience, detailed observations concerning other workers were not available. The potential for asbestos disease in U.S. shipyards was further highlighted by accumulating knowledge that the workers who manufactured the asbestos insulation materials used in U.S. yards during and after World War II were themselves found to suffer serious asbestos disease. Invest}- . * gations of the.employees at one such pianr showed markedly increased risk of ne^* plastic and asbestosis, including' increased risk of death of cancer with as -little as one month of employment.u-* 91 -- - ZZ-. . - .. .. scriag lvi,`:,..,i.i^;'g-:,*l!'>-;*1*;: p.,i.-3r*:-i-a i.ril* jKrcTf *"S!^^S^aSSS@SSs -: .. - /I''iI>^nim*i; ^yi hJ^--ir<%w$ iii --|i --)! hi ,?-ieSiWi..i>P3Sw5uT4t| ' &*&?& .*-3 "; Rg. 1S.P. 4J.M. Extensive bi!aferaj-pleura> calcification in former shipyard workers. Asympto matic No partof.'pJeura is immunecostai: diaphragmatic, mediastinal. pericarfliaf. Bilateral calcifi- ' catlonof-thiesortrarefyseenexceptwithprioras&estos.exposore. :-. ' ". . Even wives and children of the employed"1 in the lung, or pleural) often precedethese workers showed evidence o.fasbestos dis-* .. serious consequences. While-such changes . ease, indicating that exposure; of lesser may occur to an extent- visibie by-X-ray . intensity might be seriously hazardous as without subsequent cancer or disabling. ' , welL" - ... . _ - asbestosis, their- -appearance among 'a,.- '.v group, of. workers'provides, eviidence'of ' ? RECENT SURVEY .. ` OriSHlPYARO-WORKERS, GROTON, CONNECTICUT ' .' ` prior significant asbestos exposure. Ab -' sence of such X-ray changes is ho guar- antee that important asbestos exposure has not occurred. Many workers may have had asbestos exposure sufficient to cause: Cases of- asbestos-associated disease -death from mesothelioma* for example, among-workers employed in a shipyard in without showing X-ray change. Neverthe Croton, in 1974-1975, were brought to our less, taken as a whole, absence of X-ray attention. Against the background ofwhat change in a group of workers suspected of - was already known concerning the poten having been ccposed to asbestos provides tial for asbestos disease in shipyards, it some evidence that the exposure was lim- appeared useful ..to obtain information .iited. On the other hand, .the presence of. - concerning whether there was the likeli . characteristic asbestoric X-ray abnormal- '' hood of a high incidence of such disease . ities-is-prima farie evidence-that; overall;. or whether.'the cases seen-were isolated; . there- was important asbestos., exposure . random exceptions., - j inthegroup. ' -.;3',... ' ... Lung cancer,- mesothelioma, extensive . -:Ih light of this/ wesoughtio^ascertain . asbestosis and other serious complications .' whether there was. agsuficanc prevalence - of asbestos exposure are late findings; of^asbestoric. X-ray.'abribnnaKties among T X-ray change (parenchymal, with- ' GrotdU'sMpyaid-.wbrkers. Exammations ; ;V.;-;c^CANCH-JOURNAVfiDCUNlClAMS  --v >>* . fig. 2 J.B. Both (ibrottc plagues and pleural calcification In x-ray of former shipyard worker. Asymptomatic. Their presence is merely evi dence of,prior asbestos exposure and not in dicative "that mesothelioma will necessarily follow. ............ Fig. 3 J.W. Age 49. 1975. Truck driver until 1960. when he became "pipe covered In a ship yard. X-ray, fifteen years later, shows reticular (irregular) opacities of moderate profusion (2/2 In the 110 U/C Classification). Some shortness of breath on exertion. Note: infiltrate in lower lung fields, upper lobes dear. This is common. were largely limited to those whose em ployment had begun 15 or more years be fore; all were volunteers. A caveat is in orders there is no way of knowing, under these circumstances, whether those who volunteered were necessarily represen tative o the entire work force, or even of their specific employment category. Al together; 1,000 men were examined,' in cluding 157 boilermakers, 121 pipefitters, 73 insulators, 82 painters, 69 carpenters, 117 welders, 104 electricians, 108 outside machinists, as well as laborers, molders, lead bonders, office workers, draftsmen, guards, and decontamination technicians. Films were categorized using the Inter national Gassification of Radiographs of Pneumoconioses (ILO U/C) (Appendix 1). Overall, approximately half of the workers examined showed X-ray evidence of pulmonary and pleural changes of the sort regularly seen following direct or in direct occupational oeposure to asbestos (pulmonary asbestosis, pieural asbotosis). The findings are outlined In Tables 9 and 10. One or another abnormality was present in 274 of 636 workers with less than 20 years from onset of exposure (43.1 percent) and among 185 of 364 shipyard workers 20 or more years from onset (50.8 percent). Parenchymal disease was seen in 29.6 percent of the former group and 36.8 percent of the latter. Pleural changes were found in 23.1 percent of the less experi enced workers and in 29.7 percent of the men with longer experience. The high prevalence of pieural changes was not un expected, having been found previously among shipyard workers in Britain and elsewhere. " " The importance of duration from on set of exposure is dearly seen in Table 10, where it is found that among 303 workers who began work only in 1961 or later, 115 (38.0 percent) had abnormalities onX-ray. In contrast, among 166 workers whose employment began in 1950 or before, 85 (51.2 percent) were abnormal. No trade was immune to changes, j Tables 11 and 12 indicate that this was as j true for painters as it was for electricians, j for carpenters as for machinists, and for * VOl.28, NO. 2 MARCH/APR1L1978 93F > ? .... ' * - ________ __ .* TABLE 5 % . Deaths among 17,800 asbestos insulation workers In < _ - i.; the United States and Canada, Jan. 1,1967-Jarul, 1977: - Analysis by duration from onset of employment . S* ' - . yew* ' onset employment <10 ; 10-14 15-20 . 20-24 2S-29 30-34 . 35-39 40-44 45- Percent of ell deaths' deaths * cancer Mesothelioma Pleural . Peritoneal 51 85" * 188 320 388 340 253' 203 442. o " &24 ' 15.43 18.44 28.80 3i94 26.09 19.21 16.61 %0 .0 . 1.06 1.88 ' 3.86 2.94 6.32 1.37 ZS+ * o. 0 1.60 0.94 4.64 6.47 7.11 . 7.88 ' 6.56 . . Total 0. o*'2.60 ZS2 3.40 9.41 13.43 9.85 90 Tgtal s. 2270 2137 Z90 4.80 7.70 -'bouermaien as for weiden. Review of ' work practices makes this quite under* standable, of course. The conditions of shipyard work have been such that it is likely that asbestos exposure would have . occurred among all individuals at a work site where the material was being installed, repaired or removed. Data are less certain for the less common crafts, where fewer workers were examined. Although evi dence of asbestotic changes was found among some of these men and women as well, one can estimate a proportion only with less assurance. Thus, exposure to asbestos under past conditions, of an intensity sufficient to cause significant asbestotic X-ray change, was common at the shipyard in Croton. As a result, a large number of workers now have pulmonary changes associated with such exposure. The prevalence of such a high proportion of asbestoticX-ray changes raises the question of increased risk of asbestos-associated neoplasms in the future. Those to be considered include cancer of the lung, pleural mesothelioma, peritoneal mesothelioma, and esophageal, stomach, colorectal, oropharyngeal, la ryngeal and renal cancer. The extent of this risk is not now known. CURRENT SITUATION In tenns of public health, the overwhelm ing problem is the undoing, ameliorating or modifying of both current and antici pated results of-past mistakes. The prob lems are straightforward and, simulta neously, complex. To a considerable de gree, the complexity derives from the fact that we have had little experience to guide us in such matters, especially on the scale found in the present situation. The- following recommendations -- 94 CA-A CANCER JOURNALFOR CUNIQANS A'iVv.V I . n K`. ^#3a*Ss* >>#: !'*fi/1----------w **---* . iA ? ~Z /& >-i---=^.f- %- ..''Tty-i-*r.'*'ii necessarily Incomplete and tentative--are offered: ... . -^.'-aX*&u)rrr ^ja| 1. Knowledge concerning asbestos exposore: Dissemination of information: under standing the disease potential of asbes* tos exposure (past and future) would be valuable for both worker and manage ment. a Avoidance of additional exposure: appropriate engineering and industrial , hygiene methods are crucial; removal , or repair of asbestos materials now in place presents a problem for the future. 2.Medical surveillance programs: Asbestosis: awareness of the presence of this disease by both the patient and the treating physician would be im portant; since most deaths of asbestosis are due to imercurTent respiratory in fections, rather than to progressive pul monary fibrosis. Pulmonary infections can be well treated, and experience has shown that many lives can be saved. a Lung cancer: edriy diagnosis can in crease the likelihood of successful treat . ment to some extent (by no means as much as we would like). It is not known -whether more energetic surveillance (as with frequent sputum cytology examin ation) will increase the percentage of those successfully treated. Studies are now in progress to investigate this pos sibility. a Colorectal cancer eariy diagnosis in creases the likelihood of cure, a Oropharyngeal, laryngeal or renal car cwome: awareness of the increased risk of these cancers improves chances for eariy study and diagnosis of the pres ence of these conditions, which can be cared in many cases. a Pleural and/or peritoneal mesothefio* ma: effective therapy is not now avail able and early diagnosis does not sig nificantly increase the likelihood of survival. However, research concerning therapy is now underway in the United States, Great Britain and France, and it may be hoped that improved treatment methods will become available. a Education programs: Smoking: lung cancer risk is greatly TABLE 6- . Percentage distribution of trades in privets shipyards, June 1943 Trade Percentage Welders 153' Shipflttar* 11.0' Machinists. 8.1 Pipefitters T3. Electricians' 6.6 Carpenters ' , 6.1 Laborers SJS Burners 3.3 Painters 3.1 Sheetmetsi workers 3.0 Riggers ZS Chippers and caulkers zs Boilermakers Z3 Crane operators 1.3 Pipe coveren 02 Alt other 21.1 Source: Bureau of Labor Statiftics, Bulletin 824 multiplied by asbestos exposure.19 It is urgent that this information become available to workers who have been ex posed to asbestos, and that every assis tance be afforded them to heip in their efforts to control and eliminate smok ing, especially cigarette smoking. Some data are also available suggesting that cessation of smoking will, after a num ber of yean, reduce the risk of lung cancer, even with a history of prior cig arette smoking. Should these experi ences be confirmed, it will be even more urgent to identify and alert former ship yard workers, to acquaint them with the important risk oflung cancer should they continue cigarette smoking. Cigar ette- smoking also increases the risk of serious disability associated with pul monary fibrosis, and of the develop- VOL 28. NO. 2 MARCHAPRIL 1978 ."J. I -- "V-a-.>.-- -.., vV . TABLE 7 Mesothelioma tumors in Devonport .. Dockyard, England, 1964-1973* - Agenesis *" (disability) No. % 16 36 is- 4' IS 11 6 S' 48 1S6 - * 103 23.1 9.6 OS 9.6 7.1 3.8. 3.2 t 30.8 . . Occupation Sprayers Laggers Shipwrights Boiiermekars Engine fitters Electricians' Caulksrs-Rivetars Welders . All others 'HwtIm, P.G., Envlr. Rm. 11:261-367, 1976. Mesothelioma (deaths) No. % 1. 1 U. 9 8 6 3 3 11 56 1.8 .1.3 25^ 16.4 14.5 9.1 5.5 5.5 20.0 . TABLE 9 ". X-ray abnormalities among workers employed m shipbuilding and ship repair *0 ABNORMALITY Las then 20 years from onset of shipyard am* pioymant (636) 20 or more years from onset of shipyard em ployment (364) Total Number % Number % Number % Arty abnormality 274 43.1 185 50.8 469 46.fi All parenchyma 188 29.6 134 36.8 322 3Z2 Parenchyma only 127 20.0 77 21.1 204 20.4 Parenchyma & pleura 61 9.6 57 15.7 118 11.8 AU pleura 147 23.1 108 29.7 255 2&5 Pleura only . 86 13.5 81 14.0 137 13.7 96 >*.; - ;,>r vy ., ~.-ii CA-A CANCER JOURNAL. FOR CLINICIANS ---------- *>' TABLE8 . '' Mortality experienca of 429 shipyard worker* in Barrow, England ' with pleural plaques on x*ray (1964-1971) compared . ____...... with control men in Carlisle, without pleural plaques . . . Tracing to December 31, 1976 _ Plaques " Alive.................... ' ' 299 * " Dead" Nortracad v:. ./ ; ' ' ; 127(30%) i 3 10,7%) . 429' . Cause* of deeds ' * PTequeS . Lung cancer - ... 19 Mesothelioma- . - 23 G. L eanear . . 7 All other cancer 13 Ischemic heart disease . 34 . Chronic bronchitis ' 9 All other causes 22 * '' ' ' Controls 347. 74 (17.2%) 8 ( 1.9%) 429 Controls! v. 4.-* .... 4: 7.. .29 9 21 ' ----------- - . TABLE 10 * X-Ray abnormalities among workers employed ------ ... in shipbuilding and ship repair: analysis by duration from onset of work ' .* Onset of work <-1950. 1951-1955 1956-1960 >1961 Total 166 198 333 303. 1000 NORMAL No, % 81 4&8 98 49,5 174 52L2 183 02.0 541 54.1 ABNORMAL No. % 85 100 169 f 115 ' 459 51.2 5IL5 47.8 33.0 4SJ9 VOL. ZB. NO. 2 MAROVAPfifL 1978 87 t l .............^ A <v<-.r_;wJS>T V .-vprwwwy****'*'. __ _ ..... ___ _ i --^ V.-^gfL/int -; *-*#*&**'* -vuiL TABLE 11 * X*Ray abnormalities among shipyard worker* j .. :* ' .. employed in shipbuilding and ship repair: * - - '` major crafts . ' CATEGORY ' All crafts .. . . . Painters Machinists (outside) Pipefitters Insulators . - Electricians * BoHermskert Welders Carpenters Years from onset of shipyard work All groups . 20 or more years Abnormal Abnormal Numbtr Number % Number % 1000 - * 82 108 121 73 104 157 117 69 -- 831 459 - 44 58 66 38 55 80 42 38 4S 53.7 53.7 54.5 52.0 SZ9 51.0 35^ 55.1 18S '- - 10/25 12/32 25/34 2/7' \ 23/34 41/84 25/48 12/33 - 50.8 40.0 37.5 73.6 28.6 67.8 48 52.1 36.4 Total 1000 ' 459 45.9 185/364 50.8 ment ofcancer of the esophagus. Again, educational programs would be ofvalue. information is required for proper clin ical surveillance. 3. Assessment of the potential for ship yard asbestos disease: Household contact asbestos disease: while families of asbestos workers are at risk, it is not known whether ship yard workers tended to contaminate their homes with appreciable amounts of asbestos in the past, and whether this has resulted in disease risk. Such Necessary additional data: appropriate studies of mortality experience, status of retired workers and effects of mini mal exposure are required for complete evaluation of the potential for future shipyard asbestos disease. Nevertheless, enough is now known to warrant rapid development of effective medical sur veillance programs. Further research can proceed apace. . CA-A CANCES JOURNALFOR CLINICIANS -- ri,?VT.:.^. . .TABLE 12 . `'j.'-.-'p *' . X-Ray abnormalities among workers employed . in shipbuilding and ship repair: lass common craft* ' . . * * V , .A '' ' _ -- No* Abnormal % Heavy equipment operators Laborers Inside machinists Mothers Lead bondga ' Decontamination technicians Guardi w/o previous job in yard Office workers -- Draftsmen ry w/o-pravioua job in yard'* ' . . 13 7 30 12 21 12 12 37* .- 8/13 1/7 1S/30 4/12 7/21 S/12 3/T2 16/37' - *. . 62 14 ' 50 33- 33 42... 26 43. References 1. Siena, M,; DiMenza^L.; Nebut^M., tad. Bignoo, J~,Regjjtre da maotheiiomomalias de la pieure et du peritoine. Premiere rtsul- tats. NouvellePresse Med. 6:3114,1977. 2. Greenberg, M., and Divies, T.A.L.: Meso thelioma Register 1967-63. Brit.J. Indusi_MeeL 31:91-104,1974. . 3. Zidhuis, R.U Vgsteeb; J.PJ., and-Plan- tejdt, HXt Pleural mesothelioma and exposure to asbestos. Int. Arch. Occup. Envir. Health 36:1-18.1975. ' 4. Selikoff, 1J.; Churg, J., and Hammond. E.Ct The occurrence of asbestoru among in sulation workers in the United Stato. Ann. N.Y. Acad. So. 132:139-155.1965. 5. Harries. P.Gu Asbestosis hazards in naval dockyards. Ann. Oecnp. Hyg. 11:135-145,1968. 6. Sxumphiut, J.; Epidemiology of mesothe lioma on Waicheren Island. Brit. J. Indusu Med. 28:59-66,1971. - 7. McEwes, J.; Finiaysoa; A.; Mair, A., and Gibson, Asbestos and mesothelioma in Scotland, 1st. Arch. Arbdtsmed. 28:301-311, 1971. 8. Fletghg, D.E.: A mortality study of ship yard workers with pleural piaques. Brit. J. Indus. Med. 29:142-145,1972. - : - 9. Hasrics, P.G.; Experience with asbestos disease and Its control in Great Britain's Naval dockyards. Envir. Res. 11^61-267,1976. 10. Edge. JJL; Asbstos^dated disease in Barrow-in-Furness. Envir. Res. 11:244-247; 1976. . >, * 11. Edge, J.R.: Personal communiatioa, December 16,1977. * 12: Lajartns, M., et aL: Mesothelioma pleu raux diffus et amiante. Ouest Med. 29:615-621, 1976. .... . . : 13. Fletcher, W.E.; Vfles, FJ., Jr.;- Cade, R.I_, and Drinks, P.: A health survey of pipe covering operations in constructing naval ves sels. J. End. Hyg. Toxicol. 28:9-16,1946. *' ' 14. SeiikofT, IJ^ Disease prevention in as bestos insulation, work- lnt. Symp. on Safety and Health in Shipbuilding and Ship Repairing^ Helsinki, Finland, 1971. Occupational Safety and Health Series #27,1LO, Geneva, 1972. - - 15. SeiikofT, U.; Hammond, B.C. and Churg. J.: Cardnogenidry of amositeaabestos. Arch. Env. Health 25:183-186,1972-. 16. Sodman, H.; UBs, R_ and SeiikofT, U.L Short-term asbestos exposure and cancer risk. Proc. Third inti. Symp. Detect. Prev. Caneg, 1977. 17. Anderson. RA., gaL: Household<ontact asbestos neoplastic risk. Ann. N.Y. Acad. Set. 271:311-323,1976. 18. Sheers, G., and Templeton, A.R.: Effeas of asbestos in dockyard workers. Brit. Med. J. 3:574-579,1968. 19. SeiikofT, I_JM* Hammond, E.C. and Churg. J.: Asbestos exposure, smoking and neoplasia. JAMA 204:106-112,1968. VOL. 28. NO. 2 MARCH/APRIL 1978 .99