Relation between lung asbestos fibre burden and exposure indices based on job history

Size characteristics of asbestiform fibers in lung tissue of animals that grazed in areas rich in ophiolitic outcrops in Central Calabria (Southern Italy)

In Calabria (Southern Italy) naturally occurring asbestos (NOA) mainly occurs in the ophiolitic sequences cropping in the Mount Reventino area. The most common type of asbestos detected was the amphibole tremolite; fibrous antigorite and minor chrysotile were also found. The development of asbestos-related diseases depends on, among other things, the morphological characteristics of fibers, length and width, affecting the durability of asbestos fibers in the lung. In this work fifteen lung samples of sheep, goats and wild boars, grazing around the Mount Reventino area were collected and asbestos fibers analysed. Observed fibers (357), of which 97 % were tremolite and 3 % antigorite fibers, were grouped according to species, grazing area and age of the animals. The aim of this work was to highlight any differences among the groupings and to compare our size results with data in literature related to exposed populations. Principal Component Analysis (PCA) highlighted a positive correlation between tremolite fiber length and width and revealed groupings in terms of animal age. The Kruskal-Wallis test showed statistically significant differences between fiber mean widths in young and old animals. 63 % observed asbestiform fibers were longer than 5 μm and 7 % of the fibers were longer than 20 μm (critical fiber length connected to the frustrated phagocytosis by the macrophage). Fibers conforming to the Stanton Hypothesis size (predictor of the carcinogenic potency of fibers) were 1 %. Our size parameters of fibers detected in the animal lungs were in fairly good agreement with literature data for human asbestos exposure to tremolite. These results confirmed that an animal-sentinel system could be used to monitor the natural background of the airborne breathable fibers exposure. In addition, the size correlation of animal-human breathed fibers could be useful to study their potential toxicity. Additional data are necessary for improving the agreement with human exposure data.

Fiber burden and asbestos-related diseases: an umbrella review

Objective:

What are the levels of asbestos exposure that cause each type of health effect? The objective of this study was to review the available scientific evidence on exposure levels for asbestos and their relationship to health effects.

Method:

An umbrella review of English-language reviews and meta-analyses, from 1980 to March 2021 was conducted. We included reviews involving quantified asbestos exposures and health outcomes. The review has been adapted to the indications of the PRISMA declaration. Methodological quality of the selected studies was assessed using the AMSTAR instrument.

Results:

We retrieved 196 references. After applying the search strategy and quality analysis, 10 reviews were selected for in-depth analysis. For lung cancer, the highest risk was observed with exposure to amphiboles. Longer, thinner fibers had the greatest capacity to cause lung cancer, especially those > 10 μm in length. For mesothelioma, longer and thinner fibers were also more pathogenic; amphiboles ≥ 5 μm are especially associated with increased mesothelioma risk. No studies observed an increased risk for lung cancer or mesothelioma at asbestos exposure levels < 0.1 f/ml. No reviews provided information on exposure concentrations for pulmonary fibrosis. Currently, there is limited evidence in humans to establish the causal relationship between gastrointestinal cancer and asbestos exposure.

Conclusions:

Banning all asbestos exposure remains the best measure to preventing its negative health effects. The highest quality reviews and meta-analyses support that there is little risk of lung cancer or mesothelioma at daily exposure levels below 0.1 f/ml.

Lung Asbestos Fibre Burden and Pleural Mesothelioma in Women with Non-occupational Exposure

BACKGROUND

Malignant pleural mesothelioma (MPM) due to environmental and familial (domestic) asbestos exposure is well recognized. However, information on cumulative asbestos dose in subjects affected by MPM is limited.

OBJECTIVES

To evaluate the residual lung asbestos fibre and asbestos body burden in women with MPM with past environmental and/or familial asbestos exposure.

METHODS

We collected lung samples from autopsies regarding 15 non-occupationally asbestos-exposed MPM cases, divided in three groups: (i) familial exposure from the Fincantieri shipyards in Monfalcone (No. 7), (ii) environmental and familial asbestos exposure from the asbestos-cement plant Fibronit in Broni (No. 6), and (iii) environmental exposure from the Fibronit plant (No. 2). Asbestos body (AB) and fibres (AF) per gram of dry lung tissue were counted by optical and scanning electron microscopy, respectively, and expressed as geometric means and standard deviations (GM, GSD).

RESULTS

GM/GSD of AB counts were 6123/9.6 (Group 1), 13 800/10.4 (Group 2), and 8400/1.1 (Group 3); GM/GSD of AF were 0.6/2.1 (Group 1), 7.9/2.1 (Group 2), and 6.0/2.3 (Group 3) million. Pleural plaques were observed in 12 cases.

CONCLUSIONS

Exclusive familial exposure to asbestos determined cumulative doses close to those observed in moderate occupational exposure circumstances. Our results also suggest that combined environmental and familial exposures may cause unexpectedly high cumulative fibre doses.

Relationship between pleural plaques and biomarkers of cumulative asbestos dose. A necropsy study

BACKGROUND

The relationship between pleural plaques and cumulative asbestos exposure is controversial.

OBJECTIVES

To evaluate the relationship between lung asbestos bodies (AB) and fibres (AF) and plaques presence and extension.

METHODS

In a necropsy series of shipyard workers with asbestos-related diseases, we measured counts (per g of dry lung tissue) of AB (thousands) and AF>1 µm (millions). Pleural plaques were classified into three extension grades. We fitted univariate and multivariable linear (dependent variables: AB and AF, log10 transformed) and multinomial (dependent variable: plaques grade) regression models.

RESULTS

We analysed 124 subjects, 13 without plaques 20 with grade 1, 69 with grade 2, and 22 with grade 3 plaques. Geometric means (GM) of AB were 10.6, 23.3, 126, and 140 in the four groups respectively (P=0.0001). GMs for AF (mostly amphiboles) were 1.2, 1.4, 7.3, and 12.9 (P=0.0001). AB and AF were strongly correlated (r=0.81). The likelihood of no plaques and grade 1 plaques decreased with increasing AB and AF doses, with a corresponding increase of grade 2 and 3 plaques. Plaque presence and extension was also associated with histologically verified asbestosis (P<0.001).

CONCLUSIONS

Our study showed a strong positive relationship between pleural plaque presence and extension and both lung asbestos burden and asbestosis.

Study on genotoxicity, oxidative stress biomarkers and clinical symptoms in workers of an asbestos-cement factory

The purpose of the present study was to investigate whether the markers of oxidative stress could be altered in workers exposed to asbestos. A comparative cross-sectional research was conducted in a group of 50 subjects exposed to asbestos and another group of 50 with the same age and sex unexposed to asbestos. Malondialdehyde (MDA), total thiol molecule (TTM), total antioxidant capacity (TAC), and DNA damage, were measured in the blood samples of workers and controls. Compared to the control group, the workers showed higher blood levels of DNA damage (P=0.0001) and MDA (P=0.0001). The workers showed lower TTM (P=0.02) as compared with the control group. There was no considerable difference on the level of TAC (P=0.1) between the groups. The workers indicated clinical symptoms such as breathlessness, phlegm, coughing and wheezing. There was a positive correlation between levels of 8-OHdG and MDA of asbestos workers and the smoking status suggesting the negative role of smoking.

Asbestos Lung Burden in Necroscopic Samples from the General Population of Milan, Italy

The present study analysed the asbestos lung burden in necroscopic samples from 55 subjects free from asbestos-related diseases, collected between 2009 and 2011 in Milan, Italy. Multiple lung samples were analysed by light microscopy (asbestos bodies, AB) and EDXA-scanning electron microscopy (asbestos fibres and other inorganic fibres). Asbestos fibres were detected in 35 (63.6%) subjects, with a higher frequency for amphiboles than for chrysotile. Commercial (CA) and non-commercial amphiboles (NCA) were found in roughly similar frequencies. The estimated median value was 0.11 million fibres per gram of dry lung tissue (mf g(-1)) for all asbestos, 0.09 mf g(-1) for amphiboles. In 44 (80.0%) subjects no chrysotile fibres were detected. A negative relationship between asbestos mass-weighted fibre count and year of birth (and a corresponding positive increase with age) was observed for amphiboles [-4.15%, 95% confidence interval (CI) = -5.89 to -2.37], talc (-2.12%, 95% CI = -3.94 to -0.28), and Ti-rich fibres (-3.10%, 95% CI = -5.54 to -0.60), but not for chrysotile (-2.84%, 95% CI = -7.69 to 2.27). Residential district, birthplace, and smoking habit did not affect the lung burden of asbestos or inorganic fibres. Females showed higher burden only for amphiboles (0.12 versus 0.03 mf g(-1) in males, P = 0.07) and talc fibres (0.14 versus 0 mf g(-1) in males, P = 0.03). Chrysotile fibres were shorter and thinner than amphibole fibres and NCA fibres were thicker than CA ones. The AB prevalence was 16.4% (nine subjects) with concentrations ranging from 10 to 110 AB g(-1) dry, well below the 1000 AB g(-1) threshold for establishing occupational exposure. No AB were found in subjects younger than 30 years. Our study demonstrated detectable levels of asbestos fibres in a sample taken from the general population. The significant increase with age confirmed that amphibole fibres are the most representative of cumulative exposure.

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.

Inter-rater agreement in the assessment of exposure to carcinogens in the offshore petroleum industry

OBJECTIVES

To evaluate the reliability of an expert team assessing exposure to carcinogens in the offshore petroleum industry and to study how the information provided influenced the agreement among raters.

METHODS

Eight experts individually assessed the likelihood of exposure for combinations of 17 carcinogens, 27 job categories and four time periods (1970-1979, 1980-1989, 1990-1999 and 2000-2005). Each rater assessed 1836 combinations based on summary documents on carcinogenic agents, which included descriptions of sources of exposure and products, descriptions of work processes carried out within the different job categories, and monitoring data. Inter-rater agreement was calculated using Cohen's kappa index and single and average score intraclass correlation coefficients (ICC) (ICC(2,1) and ICC(2,8), respectively). Differences in inter-rater agreement for time periods, raters, International Agency for Research on Cancer groups and the amount of information provided were consequently studied.

RESULTS

Overall, 18% of the combinations were denoted as possible exposure, and 14% scored probable exposure. Stratified by the 17 carcinogenic agents, the probable exposure prevalence ranged from 3.8% for refractory ceramic fibres to 30% for crude oil. Overall mean kappa was 0.42 (ICC(2,1) = 0.62 and ICC(2,8) = 0.93). Providing limited quantitative measurement data was associated with less agreement than for equally well described carcinogens without sampling data.

CONCLUSION

The overall kappa and single-score ICC indicate that the raters agree on exposure estimates well above the chance level. The levels of inter-rater agreement were higher than in other comparable studies. The average score ICC indicates reliable mean estimates and implies that sufficient raters were involved. The raters seemed to have enough documentation on which to base their estimates, but provision of limited monitoring data leads to more incongruence among raters. Having real exposure data, with the inherent variability of such data, apparently makes estimating exposure in a rigid semiquantitative manner more difficult.

Assessment of Environmental and Domestic Exposure to Tremolite in New Caledonia

In this study, the authors characterized exposure to asbestos in the population of New Caledonia, an area where a high mesothelioma incidence was found to be associated with the use of a tremolite-containing whitewash on dwellings. The authors collected airborne samples from various sources. Lung tissue samples or bronchoalveolar lavage fluids were available for 80 subjects, who were interviewed regarding their residential and occupational histories. The authors analyzed all samples by analytical transmission electron microscopy. Results indicated that the use of the tremolite-based whitewash may generate high airborne fiber levels and result in asbestos lung contents comparable with those observed in occupational settings. The highest airborne tremolite concentrations were reached during sweeping in whitewashed houses. Lung concentrations of tremolite fibers were significantly higher in subjects exposed to the whitewash than in unexposed subjects, and the concentrations increased with the duration of exposure.

Occupational exposure assessment in case-control studies: opportunities for improvement

Community based case-control studies are an efficient means to study disease aetiologies, and may be the only practical means to investigate rare diseases. However, exposure assessment remains problematic. We review the literature on the validity and reliability of common case-control exposure assessment methods: occupational histories, job-exposure matrices (JEMs), self reported exposures, and expert assessments. Given the variable quality of current exposure assessment techniques, we suggest methods to improve assessments, including the incorporation of hygiene measurements: using data from administrative exposure databases; using results of studies identifying determinants of exposure to develop questionnaires; and where reasonable given latency and biological half life considerations, directly measuring exposures of study subjects.

Lung mineral fibers of former miners and millers from Thetford-Mines and asbestos regions: a comparative study of fiber concentration and dimension

Fiber dimension and concentration may vary substantially between two necropsy populations of former chrysotile miners and millers of Thetford-Mines and Asbestos regions. This possibility could explain, at least in part, the higher incidence of respiratory diseases among workers from Thetford-Mines than among workers from the Asbestos region. The authors used a transmission electron microscope, equipped with an x-ray energy-dispersive spectrometer, to analyze lung mineral fibers of 86 subjects from the two mining regions and to classify fiber sizes into three categories. The most consistent difference was the higher concentration of tremolite in lung tissues of workers from Thetford-Mines, compared with workers from the Asbestos region. Amosite and crocidolite were also detected in lung tissues of several workers from the Asbestos region. No consistent and biologically important difference was found for fiber dimension; therefore, fiber dimension does not seem to be a factor that accounts for the difference in incidence of respiratory diseases between the two groups. The greater incidence of respiratory diseases among workers of Thetford-Mines can be explained by the fact that they had greater exposure to fibers than did workers at the Asbestos region. Among the mineral fibers studied, retention of tremolite fibers was most apparent.

Environmental epidemiology applied to urban atmospheric pollution: a contribution from the Experimental Air Pollution Laboratory (LPAE)

Systematic investigation on the effects of human exposure to environmental pollution using scientific methodology only began in the 20th century as a consequence of several environmental accidents followed by an unexpected mortality increase above expected mortality and as a result of observational epidemiological and toxicological studies conducted on animals in developed countries. This article reports the experience of the Experimental Air Pollution Laboratory at the School of Medicine, University of São Paulo, concerning the respiratory system and pathophysiological mechanisms involved in responses to exposure to pollution using toxicological and experimental procedures, complemented by observational epidemiological studies conducted in the city of São Paulo. It also describes these epidemiological studies, pointing out that air pollution is harmful to public health, not only among susceptible groups but also in the general population, even when the concentration of pollutants is below the limits set by environmental legislation. The study provides valuable information to support the political and economic decision-making processes aimed at preserving the environment and enhancing quality of life.

Mineral fibre analysis and routes of exposure to asbestos in the development of mesothelioma in an English region

OBJECTIVES

To compare the concentrations of inorganic fibres in the lungs in cases of mesothelioma and controls: to determine whether concentrations of retained asbestos fibres differ with the different exposures identified from interview; and to investigate the existence of a cut off point in concentrations of asbestos fibres that indicates occupational exposure.

METHODS

Case-control study; 147 confirmed cases of mesothelioma and 122 controls identified from deaths occurring in four districts of Yorkshire between 1979 and 1991. Surviving relatives were interviewed to determine lifetime exposure history to asbestos. Mineral fibre analysis was carried out on lung tissue from postmortem examinations.

RESULTS

Odds on high concentrations of retained asbestos fibres were greater in cases than controls. After excluding subjects with occupational and paraoccupational exposure, the odds on high concentrations were still greater in cases than controls, but only significantly so for amphiboles. There was only a weak relation between probability of occupational exposure to asbestos and concentrations of retained asbestos fibres, and no significant difference in fibre concentrations was found between subjects who had been exposed to asbestos through different routes: these comparisons were only based on small groups. There was considerable overlap in concentrations of retained asbestos fibres between cases and controls with and without histories of occupational exposure.

CONCLUSIONS

The study has confirmed previous results of higher concentrations of asbestos fibres in cases than controls, and has shown that this is still found in subjects with little evidence of occupational and para-occupational exposure. The overlap in concentrations of retained asbestos for different groups of subjects did not suggest a clear cut of value.

Relationship between Asbestos Exposures and 8-Hydroxydeoxyguanosine Levels in Leukocytic DNA of Workers at a Chinese Asbestos-material Plant

The objective of the study was to evaluate the level of 8-hydroxydeoxyguanosine (8-OHdG) in DNA of peripheral-blood leukocytes as a biological marker of asbestos exposure and/or its fibrotic effects in an occupational population exposed to asbestos. The setting was a large-scale asbestos plant in China producing brake linings, asbestos rubber, and textile using chrysotile. From a base population of active and retired workers with various levels of cumulative exposure to asbestos and grades of asbestosis, 39 study subjects were randomly selected to reflect incremental grades of asbestosis based on Chinese diagnostic standards. They consisted of 19 "normal" (control) and ten "suspected" and ten "definite" asbestosis-grade subjects, group-matched for age and sex. Leukocytic DNA was extracted from 5-mL samples of peripheral blood and 8-OHdG level measured by high-pressure liquid chromatography. A cumulative asbestos exposure index (CEI) was calculated for each subject as the summed product of duration and level of asbestos exposure per job, incorporating a job-exposure matrix. Geometric mean 8-OHdG levels showed a positive gradient in relation to increasing grades of asbestosis (control: 1.78, suspected: 2.21, definite: 2.58), with a significant difference between the control and definite-asbestosis subgroups (p < 0.05). The 8-OHdG level of the two subgroups combined as one "asbestosis" group was significantly higher than that of the control group (control: 1.78, asbestosis: 2.39, p = 0.01). Further, 8-OHdG levels were moderately correlated with CEIs for all subjects (r = 0.35, p < 0.05) and with grades of asbestosis for all (r = 0.47, p < 0.01) and for male subjects (r = 0.43, p < 0.05). In multiple regression analyses, grade of asbestosis explained 27% of the total variation in 8-OHdG and was a better predictor than CEI or duration of exposure. Thus, the 8-OHdG level in leukocytic DNA is related to grade of asbestosis and to individual cumulative exposure and may serve as a biologic marker reflecting the status of oxidative DNA damage by asbestos.