Employing incidence data from the Quebec Tumor Registry, we examined the relative risks of cancer of all sites for the years 1969-73 in the asbestos-mining, rural, and metropolitan counties of Quebec Province, Canada. Generally, rates for males exceeded those for females, and the relative risks in the asbestos-mining counties for 7-10 different sites of cancer, all of low incidence, were from 1.50 to 8.08 times those of other rural counties of the Province for both sexes. Metropolitan counties exhibited equally high risk for many of these sites. We discovered higher risks among males in asbestos-mining counties for cancer of the pleura, peritoneum, lip, tongue, salivary gland, mouth, and small intestine and higher risks among females for cancer of the pleura, lip, kidney, salivary gland, and for melanoma. Because of the likelihood of a long latent period for asbestos-related cancers, the risks we observed were possibly the product of since-altered occupational and environmental conditions existing 20-30 years ago in the asbestos-mining areas. The similarities in risks for most cancers in asbestos-mining and urban areas were noteworthy.
There is a relationship between dust exposure, on the one hand, and serious disease and death, on the other, in chrysotile asbestos mine and mill workers of Quebec. Studies in current working populations indicate that prevalence of abnormality increases with increasing exposure. However, the relationship is weak and offers only a partial explanation of between-subject variability. In addition, there is no certain way to detect or predict change. Because of the relative nonspecificity of the health measurements examined and their poor relationship to exposure, control should be based on environmental monitoring, with biologic monitoring considered in a complementary role. This leaves the clinician with the dilemma of how best to advise the worker in whom questionable changes have been detected. At present, there appears little doubt that the decision must remain essentially clinical, based, on one hand, on all available information about the man, his job, and the plant or mine in which he works, from which an estimate of likely outcome must be made, and, on the other hand, on the social and human factors concerned, including the fact that removal from exposure does not necessarily prevent the appearance of abnormality.
We report a further follow-up of a birth cohort of 11 379 workers exposed to chrysotile. The cohort consisted of 10 939 men and 440 women, born 1891-1920, who had worked for at least a month in the mines and mills of Asbestos and Thetford Mines in Quebec. For all subjects, length of service and estimates of accumulated dust exposure were obtained, with a smoking history for the vast majority. Three methods of analysis, two based on the "man-years" methods, the other a "case-and-multiple-controls" approach, gave results consistent with one another and with previous analyses. By the end of 1975, 4463 men and 84 women had died. Among men, the overall excess mortality, 1926-75 was 2% at Asbestos and 10% at Thetford Mines, much the dustier region. The women, mostly employed at Asbestos, had a standardised mortality ratio (SMR) all causes, 1936-75) of 0.90. Analysis of deaths 20 years or more after first employment showed that in men with short service (less than five years) there was no discernible correlation with dust exposure. Among men employed at least 20 years, there were clear excesses in those exposed to the heaviest dust concentrations. Reanalysis in terms of exposure to age 45 showed definite and consistent trends for SMRs for total mortality, for lung cancer, and for pneumoconiosis to be higher the heavier the exposure. The response to increasing dose was effectively linear for lung cancer and for pneumoconiosis. Lung cancer deaths occurred in non-smokers, and showed a greater increase of incidence with increasing exposure than did lung cancer in smokers, but there was insufficient evidence to distinguish between multiplicative and additive risk models. There were no excess deaths from laryngeal cancer, but a clear association with smoking. Ten men and one woman died from pleural mesothelioma. If the only subjects studied had been the 1904 men with at least 20 years' employment in the lower dust concentrations, averaging 6.6 million particles per cubic foot (or about 20 fibres/cc), excess mortality would not have been considered statistically significant, except for pneumoconiosis. The inability of such a large epidemiological survey to detect increased risk at what, today, are considered unacceptable dust concentrations, and the consequent importance of exposure-response models are therefore emphasised.
Cites: Biometrics. 1969 Jun;25(2):339-555794104
Cites: Arch Environ Health. 1971 Jun;22(6):677-865574010
Cites: Arch Environ Health. 1972 Mar;24(3):189-975059627
Cites: Arch Environ Health. 1974 Feb;28(2):61-84809914
Cites: Arch Environ Health. 1974 Feb;28(2):69-714809915
Cites: Arch Environ Health. 1975 May;30(5):266-71130842
Mortality data from 9609 workers at two asbestos mining areas in Quebec were analyzed to assess the effects of the intensity and timing of exposure on lung cancer risk. Summary exposure measures based on differing assumption were computed for lung cancer cases and matched controls and were fitted to the data using conditional logistic regression. A non-linear relationship between intensity and risk fit both mining areas, but risk was greater at one area than the other. At the mine with lower risk, exposure occurring more than 30 years prior to death had little effect, while at the other mine risk did not vary with time since exposure and men starting employment before 1924 were at elevated risk. The results point to differences in dust composition at the two areas and illustrate the difficulties in estimating risk.
The epidemiological studies of ingested asbestos fibres conducted world-wide are reviewed and evaluated. Most of the studies have been done in the United States and Canada and have involved community exposures via natural contamination of drinking-water supplies. One or more studies found associations between asbestos fibres in drinking-water supplies and cancer incidence or mortality associated with many body sites, including oesophagus, stomach, small intestine, colon, rectum, gall-bladder, lungs, pancreas, peritoneum, pleura, prostate, kidneys, brain and thyroid. Each study has methodological limitations or weaknesses that limit the ability to assess risk from ingested asbestos. There is no agreement between the results of the various studies, but an association between ingested asbestos fibres and cancer of the stomach and pancreas has been found with some degree of consistency.
A review of 15,689 chest radiographs of Quebec chrysotile miners and millers, representing the latest film prior to November 1, 1966, for all such persons ever x-rayed, identified 206 men with pleural calcification. Of these, 198 had worked in the Thetford Mines area, 6 at Asbestos, and 2 at St. Remi de Tingwick; 2.5%, 0.08%, and 1% of the films from these areas, respectively. A series of case-control studies revealed that pleural calcification was concentrated in men employed at a small group of mines in Thetford Mines and occurred more often among miners and maintenance personnel than among millers. Calcification was not related to past history of illness or injury, place of residence, or employment in other industries. The distribution of pleural calcification in this Quebec industry suggests that it is related to some characteristic of airborne dust or mineral closely associated with the chrysotile that is encountered during mining in Thetford Mines but not in other mining areas. Possible minerals include mica, talc, and breunnerite.
Beginning in the 1930s, the Canadian asbestos industry created and advanced the idea that chrysotile asbestos is safer than asbestos of other fiber types.
We critically evaluate published and unpublished studies funded by the Quebec Asbestos Mining Association (QAMA) and performed by researchers at McGill University.
QAMA-funded researchers put forth several myths purporting that Quebec-mined chrysotile was harmless, and contended that the contamination of chrysotile with oils, tremolite, or crocidolite was the source of occupational health risk. In addition, QAMA-funded researchers manipulated data and used unsound sampling and analysis techniques to back up their contention that chrysotile was "essentially innocuous."
These studies were used to promote the marketing and sales of asbestos, and have had a substantial effect on policy and occupational health litigation. Asbestos manufacturing companies and the Canadian government continue to use them to promote the use of asbestos in Europe and in developing countries. Am. J. Ind. Med. 44:540-557, 2003.