Investigation of exposures to commercial asbestos in northeastern Minnesota iron miners who developed mesothelioma

Laying the Foundation for a Mesothelioma Patient Registry: Development of Data Collection Tools

Mesothelioma, a cancer of mesothelial cells that line the chest, lungs, heart, and abdomen, is a relatively rare disease. In the United States, approximately 3000 individuals are diagnosed with mesothelioma annually. The primary risk factor for mesothelioma is occupational asbestos exposure which can occur decades prior to disease development, though in approximately 20% of cases, known asbestos exposure is lacking. While several other countries have developed mesothelioma registries to collect key clinical and exposure data elements to allow better estimation of incidence, prevalence, and risk factors associated with disease development, no national mesothelioma registry exists in the U.S. Therefore, as part of a larger feasibility study, a patient exposure questionnaire and a clinical data collection tool were created using a series of key informant interviews. Findings suggest that risk factor and clinical data collection via an on-line questionnaire is feasible, but specific concerns related to confidentiality, in the context of employer responsibility for exposure in the unique U.S. legal environment, and timing of enrollment must be addressed. Lessons learned from piloting these tools will inform the design and implementation of a mesothelioma registry of national scope.

Integration of Evidence on Community Cancer Risks from Elongate Mineral Particles in Silver Bay, Minnesota

The potential for cancer-related risks to community members from ambient exposure to elongate mineral particles (EMPs) in taconite processing has not been formally evaluated. We evaluated 926 ambient air samples including 12,928 EMPs (particle structures with length-to-width ratio ≥3:1) collected over 26 years near a taconite processing facility in Silver Bay, Minnesota. Eighty-two percent of EMPs were ≤3 μm in length and 97% of EMPs had an average aspect ratio <20:1. A total of 935 (7.3%) EMPs had length >5 μm and AR ≥3:1. Average ambient concentration of NIOSH countable amphibole EMPs over all years was 0.000387 EMPs per cubic centimeter (EMP/cm³ ). Of 12,765 nonchrysotile EMPs, the number of amphiboles with length and width dimensions that correlate best with asbestos-related carcinogenicity ranged from four (0.03%) to 13 (0.1%) and the associated ambient amphibole air concentrations ranged from 0.000003 to 0.000007 EMP/cm³ . After 65 years of taconite processing in Silver Bay, evidence of an increased risk of mesothelioma and lung cancer in community members who did not work in the taconite industry is lacking. The absence of an increased risk of asbestos-related cancer in the Silver Bay community is coherent with supporting evidence from epidemiological and toxicological studies, as well as ambient exposure data and lake sediment data collected in Minnesota Iron Range communities. Collectively, the data provide consistent evidence that nonasbestiform amphibole minerals lack the carcinogenic potential exhibited by amphibole asbestos.

Oxidative potential (OP) and mineralogy of iron ore particulate matter at the Gol-E-Gohar Mining and Industrial Facility (Iran)

Concentrations of total suspended particulate matter, particulate matter with aerodynamic diameter <2.5 μm (PM_2.5), particulate matter <10 μm (PM₁₀), and fallout dust were measured at the Iranian Gol-E-Gohar Mining and Industrial Facility. Samples were characterized in terms of mineralogy, morphology, and oxidative potential. Results show that indoor samples exceeded the 24-h PM_2.5 and PM₁₀ mass concentration limits (35 and 150 µg m^-3, respectively) set by the US National Ambient Air Quality Standards. Calcite, magnetite, tremolite, pyrite, talc, and clay minerals such as kaolinite, vermiculite, and illite are the major phases of the iron ore PM. Accessory minerals are quartz, dolomite, hematite, actinolite, biotite, albite, nimite, laumontite, diopside, and muscovite. The scanning electron microscope structure of fibrous-elongated minerals revealed individual fibers in the range of 1.5 nm to 71.65 µm in length and 0.2 nm to 3.7 µm in diameter. The presence of minerals related to respiratory diseases, such as talc, crystalline silica, and needle-shaped minerals like amphibole asbestos (tremolite and actinolite), strongly suggests the need for detailed health-based studies in the region. The particulate samples show low to medium oxidative potential per unit of mass, in relation to an urban road side control, being more reactive with ascorbate than with glutathione or urate. However, the PM oxidative potential per volume of air is exceptionally high, confirming that the workers are exposed to a considerable oxidative environment. PM released by iron ore mining and processing activities should be considered a potential health risk to the mine workers and nearby employees, and strategies to combat the issue are suggested.

The epidemiologic evidence for elongate mineral particle (EMP)-related human cancer risk

Epidemiologic research on the role of fibers and other elongate mineral particles (EMP) and human diseases including cancers has generated a large body of literature over the last decades: nevertheless, there remain some questions for which the scientific community appears unable to reach consensus. Reasons for genuine differences in opinion include (i) ways in which exposures have been classified; (ii) methodological limitations of the available studies, (iii) criteria for the interpretation of study results, including potential underlying biological mechanisms, and (iv) methodology for integrating the evidence. Various approaches have been proposed in recent years to address these issues, which will be illustrated using examples from asbestos, talc, taconite, synthetic mineral fibers and silicon carbide, with emphasis on potential carcinogenic effects. Potential solutions include improved exposure and outcome assessment - including use of biomarkers and other molecular approaches, consideration of potential confounding and other sources of bias, implementation of guidelines for study quality assessment and evidence evaluation and integration.

A review of mortality associated with elongate mineral particle (EMP) exposure in occupational epidemiology studies of gold, talc, and taconite mining

BACKGROUND

Mining of gold, taconite, and talc may involve exposure to elongate mineral particles (EMP). The involved EMPs are typically non-asbestiform, include dimensions that regulatory definitions exclude, and have been less studied.

METHODS

A review of the literature was undertaken for this exposure and occupational epidemiological studies that occur in gold, talc, and taconite mining.

RESULTS

Quantitative EMP exposure information in these industries is incomplete. However, there are consistent findings of pneumoconiosis in each of these types of mining. A recent case-control study suggests a possible association between this exposure and mesothelioma. Lung cancer is inconsistently reported in these industries and is an unlikely outcome of non-asbestiform EMP exposure. There is evidence of cardiovascular mortality excess across all of these types of mining.

CONCLUSIONS

Non-malignant respiratory disease and cardiovascular mortality have been consistently increased in these industries. Further investigation, including additional insights for the role of non-asbestiform EMP, is warranted. Am. J. Ind. Med. 59:1047-1060, 2016. © 2016 Wiley Periodicals, Inc.

Exploring the usefulness of occupational exposure registries for surveillance: the case of the Ontario Asbestos Workers Registry (1986-2012)

Objective:

The ongoing presence of asbestos in products used across workplaces in Canada reinforces the importance of occupational exposure surveillance. This study evaluates the usefulness of the Ontario Asbestos Workers Registry.

Methods:

The study includes 30,829 workers aged 15 to 80 years. Researchers reported on the data quality and analyzed the proportions of workers exposed by industry, and standardized rates by geographic areas and over time.

Results:

The incidence of exposure started to decrease around 1990; but about 2000 workers were still exposed annually until 2006. Results showed large geographical disparities. Unexpectedly, workers from industries other than construction reported exposure.

Conclusions:

The Ontario Asbestos Workers Registry is a useful but challenging source of information for the surveillance of asbestos exposure in Ontario. The registry could benefit from well-defined surveillance objectives, a clear exposure definition, systematic enforcement, regular data analyses, and results dissemination.

State-of-the-science assessment of non-asbestos amphibole exposure: is there a cancer risk?

The distinction between amphibole asbestos fibers and non-asbestos amphibole particles has important implications for assessing potential cancer risks associated with exposure to amphibole asbestos or amphibole-containing products. Exposure to amphibole asbestos fibers can pose a cancer risk due to its ability to reside for long periods of time in the deep lung (i.e., biopersistence). In contrast, non-asbestos amphibole particles are usually cleared rapidly from the lung and do not pose similar respiratory risks even at high doses. Most regulatory and public health agencies, as well as scientific bodies, agree that non-asbestos amphiboles possess reduced biological (e.g., carcinogenic) activity. Although non-asbestos amphibole minerals have been excluded historically from Federal regulations, non-asbestos structures may be counted as asbestos fibers on the basis of dimensional criteria specified in analytical protocols. Given the potential to mischaracterize a non-asbestos structure as a "true" asbestos fiber, our objective was to assess whether exposure to non-asbestos amphiboles that may meet the dimensional criteria for counting as a fiber pose a cancer risk similar to amphibole asbestos. We reviewed analytical methods as well as the mineralogical, epidemiological, and toxicological literature for non-asbestos amphiboles. No evidence of demonstrable cancer effects from exposure to non-asbestos amphiboles that may be counted as fibers, under certain assessment protocols, was found. Data gaps (industrial hygiene data for amphibole-exposed cohorts), inconsistencies (analytical laboratory methods/protocols used to count fibers), and sources of potential bias from misclassification of exposure were identified.

A nonparametric approach for determining significance of county cancer rates compared to the overall state rate: illustrated with Minnesota data

Background

The study of the geographical distribution of disease has expanded greatly with GIS technology and its application to increasingly available public health data. The emergence of this technology has increased the challenges for public health practitioners to provide meaningful interpretations for county-based state cancer maps.

Methods

One of these challenges—spurious inferences about the significance of differences between county and overall state cancer rates—can be addressed through a nonparametric statistical method. The Wilcoxon’s signed rank test (WSRT) has a practical application for determining the significance of county cancer rates compared to the statewide rate. This extension of the WSRT, developed by John Tukey, forms the basis for constructing a single confidence interval for all differences in county and state directly age-adjusted cancer rates. Empirical evaluation of this WSRT application was conducted using Minnesota cancer incidence data.

Results

The WSRT procedure reduced the impact of statistical artifacts that are frequently encountered with standard normal significance testing of the difference between directly age-adjusted county and the overall state cancer rates.

Conclusion

Although further assessment of its performance is required, the WSRT procedure appears to be a useful complement for mapping directly age-adjusted state cancer rates by county.

Applying definitions of "asbestos" to environmental and "low-dose" exposure levels and health effects, particularly malignant mesothelioma

Although asbestos research has been ongoing for decades, this increased knowledge has not led to consensus in many areas of the field. Two such areas of controversy include the specific definitions of asbestos, and limitations in understanding exposure-response relationships for various asbestos types and exposure levels and disease. This document reviews the current regulatory and mineralogical definitions and how variability in these definitions has led to difficulties in the discussion and comparison of both experimental laboratory and human epidemiological studies for asbestos. This review also examines the issues of exposure measurement in both animal and human studies, and discusses the impact of these issues on determination of cause for asbestos-related diseases. Limitations include the lack of detailed characterization and limited quantification of the fibers in most studies. Associated data gaps and research needs are also enumerated in this review.

Mesothelioma and asbestos

The current state of knowledge concerning mesothelioma risk estimates is reviewed. Estimates of the risk of mesothelioma exist for the commercial asbestos fiber types chrysotile, amosite and crocidolite. Data also exist on which to assess risks for winchite (sodic tremolite) and anthophyllite asbestos. Uncertainty in estimates is primarily related to limitations in measurements of exposure. Differences in the dimensions of the various fiber types and of the same fiber types at different stages of processing add a further complication. Never-the-less, in practical terms, crocidolite presents the highest asbestos related mesothelioma risk. The risk associated with sodic tremolite (winchite) appears to be similar. In chrysotile miners and millers, the mesothelioma risk has been linked with exposure to asbestiform tremolite. Exposure to chrysotile in a pure form seems likely to present a very low if any risk of mesothelioma. While the majority of mesothelial tumors result from exposure to the asbestos minerals, there are other well established and suspected etiological agents. While a practical threshold seems to exist for exposure to chrysotile, it is unlikely to exist for the amphibole asbestos minerals, especially for crocidolite. To date there is no indication of an increased risk of mesothelioma resulting from non-commercial fiber exposure in the taconite industry.