PAUL V. LANKFORD (State Bar No. 181506)
`PAUL LANNUS (State Bar No. 192551)
`LANKFORD & CRAWFORD LLP
`2 Theatre Square, Suite 240
`Orinda, CA 94563
`Telephone: 925.258.9091
`Facsimile: 925.258.9695
`
`Attorneys for Defendant
`FORD MOTOR COMPANY
`
`ELECTRONICALLY
`FILED
`Superior Court of California,
`County of San Francisco
`NOV 02 2009
`GORDON PARK-LI, Clerk
`BY: JUDITH NUNEZ
`Deputy Clerk
`
`SUPERIOR COURT OF THE STATE OF CALIFORNIA
`
`COUNTY OF SAN FRANCISCO
`
`HOYT GIBSONand
`BRENDA GIBSON,
`
`Plaintiff,
`
`Vv.
`
`ASBESTOS DEFENDANTS (BP),
`
`Defendants.
`
`ASBESTOS
`
`CASE No. 274587
`
`EXHIBIT A TO THE DECLARATION OF PAUL
`LANNUS IN SUPPORT OF MOTION IN LIMINE
`To EXCLUDE PLAINTIFF’S SCIENTIFIC
`CAUSATION EVIDENCE TO THE EXTENT IT
`Does NoT DEMONSTRATE RELATIVE RISK
`GREATER THAN 2.0
`IMIL #03]
`
`
`
`OOssDHthffGGhe
`
`10
`
`7 1
`
`2
`
`13
`
`14
`
`15
`
`16
`
`7 1
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`8
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`19
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`20
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`21
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`22
`
`23
`
`24
`
`25
`
`26
`
`27
`
`28
`LANKFORD &
`CRAWFORD LLP
`ATTORNEYS AT LAW
`
`
`EXHIBIT A TO THE DECLARATION OF PAUL LANNUS IN SUPPORT OF MOTION IN LIMINE TO EXCLUDE PLAINTIFF'S SCIENTIFIC CAUSATION
`EVIDENCE TO THE EXTENT IF DOES NOT DEMONSTRATE RELATIVE RISK GREATER THAN 2.0
`[MIL #03]
`
`

`

`EXHIBIT A
`
`EXHIBIT A
`
`

`

`.
`fo
`>
`-
`-
`Malignant Mesothelioma.in-North America
`:
`.
`ALISGN D. MCBRONALD,MO, FFCM,” AND J. CORBETT MODONALD, MD, FRCPy
`
`.
`
`T%
`
`‘ a
`I
`? i
`s
`3
`hy
`g
`2
`
`
`I
`{
`
`Na
`ecr
`or
`me
`cle
`3):
`thr
`inc
`cag
`
`4
`{
`}
`
`Asceriziament, through 7,400 pathologists, of all fatal malpnont mesothelial tumors in Canada (160-
`TS)and the UL 5. A. (L272) gare 2 totalof668 eases (272in 1973). inCanada, the anneal number of male
`cases tose from about 37 in 1966 10°25 in 1972 but the number of feniate eases remainedfairly
`Steady 21 2 much lower kevel. The annual lacidence ia NorthAmeria in E972 was estinvated at 2.8 per
`miftion males and 8.7 per million females aged 15 years and ever. Occupational histories were obtained
`bling" for480 ofthe 557casesthrough 1972,andthelrmatchedcontrols;relativetisks were asfollows:
`insulaiton work,46.0,asbestos production and manvfacture;§.1, beating trades fotherthan insulation)
`4.4, For nearly half the male cases and for about 5% of female sates, the furor could be attribated
`to occupationalexpostire lo asbestas. ofwhich = Sith werin shipyards. Neindicatlon masfound ofotber
`possibiecauses (includingmananade mineral Boers,fobacessmoking,orresidencenear zeolite deposits}.
`Four subjects were men who had been. eujployed In Quebec chrysotile mines and J were chifdren of
`emplorees, bul no othersubiect had ved in the niiningarea.The findings remaln constant wlth a mth
`gtealer mesothelioma-producing poitntial for crocidellic and amosite than for chrysotile; however,
`further studles af factory werkers exposed in chryshiile only art needed: ta’ confiren this. Mineral
`Biber analysis of lung thsue from patients and controls is in progress.
`Concer 46:3650-14656, 1980,
`,
`.
`N INTERVALS SINCE 1970, we have reported con-
`tinuing studies of malignant mesothelial i mars
`throughow Canada and mare recently in the United
`States,™""7 Cornplete ascertainment ofall fatal
`,
`ae
`‘
`c
`known to pathologists has been attempted, followed by
`.
`.
`detailed case-control enquiries. The need to moniter
`ae
`'
`.
`this disease and available methods ofcase finding have
`*
`"
`:
`asp been recently reviewed.” The purpose of this
`;
`,
`t
`:
`>
`report is to bringtogether the Information derived from
`:
`/
`.
`these surveys. published and unpublished, and to con-
`"
`ee nee
`:
`.
`:
`sider the epidemioiogic interpretation, with particular
`regard for the carcinogenicity of the various mineral
`types of asbestosfiber and the roles of ether possible
`tole se factors
`,
`Bt
`.
`
`From the “Deparincot of Epidemiology. Si. Mary"s Hosplis!
`Merlical School. London, and tYc Centenary lnathate ofOecupa.
`Honal: Health. Londow School of Ryriene aed Tropical Medicine,
`London, Bagand. -
`,
`.
`.
`;
`Supported in pati bya grant from the Ensiltute ef Occupational
`and Enviroumenta! Heskth of the Gucbed Asbestos Mining As
`sociation.
`“
`.
`Address for reprints: Dx. Alison BD. McDonald, Dxpariment af
`. Epigeminlogy. St. Mary's Hospital Medical School. Landen
`“Wr IPG, Encland.
`:
`* Tne authors thank pathologists throughout Nacth America.
`Stave and Provincial Health Departments and their field workers.
`the Canadian Tumour Reference Cenire. and the UICC Meso
`theboma Panel U.S. A.} for Heeit generous colighoradion, and
`Dr. David Oakes for performing the statistical analyses of matched
`, tase-controlpairs.
`Accepied for publication November 7. 1973,
`
`ple
`a
`oxy
`hac
`ana
`cod
`suk
`ass:
`ssi
`rest
`ther
`agrs
`gor
`‘por
`Cc
`hea
`mes
`B,:
`Materials and Methods
`ore
`At the end of 1967, wewrote to all members of the
`andl
`oes wee
`i
`-
`-
`iain pathologic societies in Canada enquiring about all
`resi
`
`fatal cases of primary malignant mesothelial tumors
`to 5
`di
`,
`Manic
`.
`iagnosed by means of autopsy or biopsy examination
`min.
`:
`;
`“
`-
`
`since 1959. These enquiries were continued. woGl a
`The
`:
`"
`:
`
`reply was received fromevery pathologist, ‘The pro-
`ave
`.
`.
`
`ceduréwas repeated at two to three year intervals and
`tert
`b
`:
`;
`«
`
`y this means, ali known cases were ascertained to
`of x
`:
`:
`7
`
`the end of 1975. In 1973, Jetters were writtento all
`T
`6,977
`pathologists listed by
`the United State
`ed
`cout
`
`174%
`Pathology
`y
`BEG
`§ Arm
`
`Forces Institute, of Pathology, Enquiring about any
`and
`fatal case in 1972.7 Responses were obtained from
`and
`
`ail but 394 pathologists, 311 of whom had workedala.
`are
`
`
`hospital from which ureply had been received, so we «
`fibew
`
`believe covernge inthe U.S. A. was also close to cor:
`ener
`
`plete. In each cast, a physician on ourstaff visited the .
`will
`
`hospltal, reviewed the records with the pathologist
`
`and selected, as acontrol, a case matched for sex.
`
`age and Year of death in which pulmonary metastaset
`were present from a nonpulmonary malignant tinor. ;
`
`Relatives were then visited, vsualiy by a public health g
`nurse who,’ without knowledge of the identity of
`
`cases and controls, completed a detailed four-pastg
`
`standard questionnaire covering foll occupational and
`residential history.and smoking habits, For each o¢*
`
`cupation reported,
`the respondents were system’.
`atically questioned about exposure to dust
`from
`
`S008-S43XARO1DG16H 50.85 & American Cancer Sociery
`
`1650
`
`
`
`
`
`
`
`

`

` No.3
`
`
`
` he
`
`all
`ners
`tion
`il a
`pro-
`and
`d to
`» all
`med
`any
`rom
`ata
`awe
`om:
`the
`gist .
`mex,
`Ses
`oF.
`‘alth
`of
`rage
`
`.
`
`MALIGNANT MESOTHELIOMA
`
`cement, wood, fiberglass, asbestos, rubber, copper,
`or nickel. Respondents were also asked. whether any
`memberof the houscheld bad brought home dusty
`clothing, and if sé, the nature of the work. In Canada,
`312 cases were registered during the period from 1960
`through 1972, and questionnaires completedfor 95%,
`including 281 case-contal pairs. In the U.S. A., 245
`cases were registered for 1972 and questionnaires com-
`pleted for 91%, including 269 case-control pairs.
`A jist of occupations associated with asbestos
`exposure was supplied by Professor L. J. Sclikoff. This
`had been used in Nest York and in the Netherlands™
`and included a series af Jobs with which our clerk
`coded the occupations, blind as to the identity of
`subjectsand controls. ‘The jobs listed were separately
`assessed at four centers experienced in asbestos
`research (Table 2, footnote*) as to the probability that
`they cntsiled exposure to asbestos. There was good
`agreemem over the “definite” and “unlikely” cate-
`gories but some diflerence tn separating ‘probable’ from
`“possible” (Table 2).
`Occupations were classified under seven main
`headings {A~G), five in which an association with
`mesothelioma has been recognised (A,
`insulation:
`Q, asbestos production and mansfacture: C, heating
`vades; D, shipyards; E, construction}, a sixth group, PF.
`ofotherlistedjobs though! to catail asbestos exposure,
`and a seventh group, G. of unlisted jobs. Place of
`residence was classified as arbanor rural and examined
`to see whether it waswithin 20 miles of an asbestes
`mine ard, in the U.S. A., of a known zeolite deposit.
`The latter was added because of the recent report of
`a very high incidehee of malignant mesotheliomas in
`certsin villages ia Turkey’ with a natural occurence
`of zeolites.?
`The eases in which a blopsy or autopsy specimen
`could be obtained are being reviewed by the Canadian
`and American mesothetioma panels of pathologists*
`and specimens of lang tissus from case-control pairs
`are being examined by De. FD. Pooley for mincrat
`fibers by means of. electron microscopy and way
`chery-dispersive analysis. The results of iis work
`will bereported Hater,
`
`Results
`
`Sex ond Age and Tumor Site
`
`Of 357 cases reported to the end of 1972, 395
`(7395) were male and 162 (9990) were female.
`In
`
`
`* Cinadlan Tumour Heference Centre, Nutlenal Cancer Asuch
`ation of Cenady at Valversity of Oinea. Graurle, HCC Mess
`thetioma Panel, 3: Barter Memoris! Hospital, Purerson. New
`Jersey,
`
`1654
`
`McDonald and McDonald
`meta
`BURR Stary
`
`
`
`oH ae Noo, tes
`Fic. 1, Annual numberaad sex of Catal cases of malignant mego-
`theloms reported by pathologisis in Cannda, (960-75 {three-year
`moving averages}.
`
`males, 307 (7896) were pleural (including three peri-
`cardial
`tumors) and. 88 (2266) were peritoneal
`in-
`cluding 14 also affecting whe pleura).
`In females,
`#9 {61%) were pleural
`(including ‘six pericardial
`tumors) and 63 (996) were peritoneal {including .
`seven also affecting the pleura), At the time of death .
`1856of mais subjects were under 45 years of age: 50%
`were 45.64 years old; and 3995, 65 years or alder. Only
`one subject, a mate, was under [5 years af age.
`incidence
`
`As malignant mesothelioma is usually fatal within
`18 months of first symptoms, deaths reflect incidence
`quite closely. The trend in Canada by dale of death
`is presented in Fig.
`4, using three-year moving
`averages. Ascertainment was begua in. f967 and same
`of the increase before then wag probably due to
`incomplete case finding for the carlier period. After
`1569, the trends separateas that for males continues
`io rise and for females, to fall back. Although the
`average annual
`incidence for
`the period between
`1966 and 73, based on the population for 1971, was
`considerably higher te. Quebes than in other parts of
`Canada, the incidence of accepted cases differed.lithe
`in the three regions (Table i), In tlie U.S. A., the rates
`for males were highest in the Paclfic and Mid-Atlantic
`tegions: review by the pathology panel reduced that in
`the Mid-Atlantic, Rates for females were aot related to
`those for males.
`
`Work Histariex
`
`Analysis of probability of occupational exposure
`io asbestos for patients and cantrols during the period
`up to 10 years before deathis presented in Table 2, Re-
`sults based on the four centers. gave similar nites for
`
`

`

`S
`
`
`1652
`
`Cancen Oriwher 1 1980
`
`Val, 46
`
`Na?
`
`YapLe 1, Antal tnchicace af Molignini Mesothellams per Millian Popokstion by Are. Sea, and Geographic Region
`and the Result af Review by Pathology Pane}
`
`.
`
`c:
`
`0 o.
`1”
`3
`13
`6
`0
`37
`
`]
`
`.
`Male
`Female
`4
`8 >
`
`Pathology panel
`inchicace iper midi
`Pathology pancl
`incidence tper mill}
`
`Tots
`rnin Tote =
`_ Ae
`43 yoors- Uyears
`aum- Num-
` Ac-
`43 gears
`1S years nam Num
`Ac
`
`
`
`
`ve hereof ‘berm cepied U-df9and1-44 and and aad berof berre. cemed .
`
`
`
`
`
`
`
`. averoocasesyeurs aver viewrd U3} years over aver cases viewed. (55) BL.
`
`
`
`
`
`
`
`
`
`Canada {8605 75):
`Provinces
`3
`Ontaria
`49
`Quebec
`i9
`Rest
`30
`Joya
`U.S. AL tFe:
`-
`Consus pegions
`New England and
`pe
`foo
`£9
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`BE
`o4
`7
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`South-Atlantic
`85
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`Northeast Cenical
`4.2
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`33
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`Sovibwest Centet
`74
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`-
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`ss
`a
`.
`were calculaced for both countries combined, by com
`definiteand unlikely exposure,and for the two inter.
`paring each group in turn with the twogroups F and G
`inedjate calegories taken together. Asbestos exposure
`taken together. Insulation carried by far the greater
`for both subjects and controls was considerably more
`isk (RR = 46.0}, followed by asbestos production
`frequently recordedin the U.S. A. than in Canada,
`and manufacture RR = 6.1), and the heating trades
`In Canada, 45.996"of subjects and 18.99 of contrels
` otber thanInsulation(RR = 4.4}.-Atier exclustos of
`had worked in occupation groups A-E and, in the
`men known to have worked in insulation or beating
`U. S.A, G4.89 of sublecis and 27.086 of controls
`trades, an elevated risk suit remained for thote wha
`(Table 3}. The five gfoups were ranked actording to
`worked in shipyards’ (RR 2.8) and construction
`the ratlo of subjects te controls and made mutually
`(RR = 2.6). In all, 49 cases involved men who had
`exclusive by entering each man enly once,
`in the
`worked in shipyards, including 29 who were insulators
`highest group for whick be qualified, Relative riskst
`Tapes 2. Dixirihustion (96) of 123 Canadian and 159 U, 5. Mate Case-Control Palen Accord?
`tg tO the Probability
`:
`
`of Cecupational Asbestos Expasure as Classified In Four Centers"
`as tne teymnnnennnn
`AsSestos expesare
`Caceeteigtral
`difference
`
`Unitkety
`Possithe
`Probable
`tor definite
`Definke
`
`Seems
`2
`and probable
`eaaeammneiemmmemanes
`.
`Cases Controls
`ehporarts.
`Cans.
` Controts
`Cases“Contrats
`Cases
`Controls
`Centes*
`Canady (1960-72)
`40.0
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`4
`* Centers:-{1) Envlronmentat Sciences Laboratory, Mount Sinai
`Health, McGill Unversity, Montreal, Canada; 4) TUC Cesitenary
`“School of Medicine, New York: (2) GesendshelteorpanisatieTNO.
`institute of Oecupational Health, London Schoot of Hygiené ind
`den Haag. the Nethertunds: 4} Department of Epidemiology and
` Tropient Medicine. London, England.
`~
`
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`Ae,
`cepted
`4%)
`
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`Pi
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`
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`
`on
`had
`tors
`
`Home Exposure
`Two mate and 6 female subjects but no matched
`coatrol had been exposed at home to the dusty
`clothing of an asbestos worker: 2 controls were so
`exposed and the paired. cases were. not 6? = 3.03,
`1 DE, P = 0.08). OF the 8 Subjects, 3 had been ex.
`
`.
`
`Taste 4, EmploymentinOther Lined Jobs afthe 146 Male Cases
`Who Had Not Worked in Occupational Groups AWE
`tad Thelr Marche Contrals®
`
`Conirols
`
`2I
`
`
`
`-OmeLior
`
`Ge
`tet
`be
`
`Occupation.
`
`Gorge
`Factocy making nabber products
`Maintenance man of buliding
`supetiniendans
`Of or chemieal refinery
`.
`Carpeniry
`Factory making plastic.products
`Paint fhetory
`Laihing
`Dry cleaning
`Sheet merai
`‘Franspor industry
`Paper factory
`Foran
`
`fe
`
`* See text for definition of prongs.
`
`Cates
`- ~
`
`Aesrrteoiike
`
`le
`ig
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
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`
`
`
`or pips or boiler fiuers. The remaining 20 men com-
`prised 7 electricians. 4 metal workers, 2 palaters, 2
`shipfitters, | carpenter, and 4 whose jobs were not
`Specified, For subjects briefly expasedto crocidolite
`asbestos, the interval berween first exposure and death
`from mesothelioma was 25-15 yearsv!™" feks were
`therefore recatculated for this peried. This slighily
`intreased the relative risk from 2.6 10 3.2 for heating
`Wades, and from 1.6 to 2.0 for work in shipyards.
`The distribution of occupations for
`156 cases
`and matched controls in group F. excluding those
`whe qualified for groups A~E (£88)
`is shown in
`Table 4.‘Phere weresmall excesses ofsome occupations
`but none in the larger groups-—notably garage. main-
`tenance, and transport-work. Amongotheroccupations
`luntisted-—-Group G), an excess wes ound only’ in
`horticulture {4 to 0} and railway werk (Fto 2),
`Work with asbestos was recorded for only 2 female
`subjects. One woman had sewed amosile blankets for
`naval
`insulation and the otlier packed gasmasks,
`Probably with crecidolite (a substantial quantity was
`foundin ‘lungtissue at autopsy}. However, 42 subjects
`and 26 controls had been.employed wuiside the home.
`20 through 40 years before deat, in work of an in.
`dusiriat nnture.
`
`sibel
`toe
`inlte
`bable
`sna!
`’
`3
`4
`5
`5
`;
`
`1
`=
`
`
`
`
`
`MALIGNANT MESOTHELIOMA - McDonaldand McDonald
`FABLE J. Employment in Occupational Geaups A-G* Ten or
`More Year: Before Death for 344 Male Cases
`and Their Matched Coninais (Canada,
`1
`18-72; U.S. AL, 19723
`Jobs
`
`iés3
`
`oo.
`Occupational group
`
`Meo
`l———— —_—_—_.
`Casen
`Controls
`Cases
`Controls
`cas
`"iy
`rz]
`i
`.
`5
`7
`4
`z
`iz
`2
`3
`z
`7
`i
`
`0
`
`dE
`45
`
`n
`
`a
`30
`
`il
`28
`a
`z
`B
`a
`ay
`Sy.
`3
`3
`i
`
`3
`3
`z
`i
`g
`g
`i
`&
`2
`3
`3
`
`Relative
`risk
`45.0
`bi
`
`4d
`
`LB
`26
`
`1
`
`“
`
`A, Tnsulsiien
`B. Asbestos productionaad sanufncturc
`Mining and milling tchroysotic}
`Maqufacture
`Asbestos coment products
`Factory using asbestos
`C, Heating trades (exci. insubuion)
`Job necessitating hezt-protective clothing
`installing or repeldng furnaces of boilers
`Steamfiter
`Holler maker
`Plumbing and heating
`Welder
`D. Shipyards
`E. Construction indusry
`Building trades
`Building demoiition
`Painting
`-
`Sheutrock spackling
`F. Otherfistedjobs fexcd, cen in groups A~E}
`a
`55
`.
`G, None of the above
`{16
`ist
`a
`a
`Toran
`|
`M4
`:
`%
`
`
`“ Med are fisted pove only tn thegroup ranked fighestt see text for definition ofgroups,
`
`

`

`
`
`
`
`
`
`
`
`29.1%,
`=
`24.195
`
`2.3%
`24%
`
`z |
`5
`16
`i
`5
`28
`t
`B
`9
`n
`D2
`42
`26
`o
`AGB
`x
`FRAG
`205°
`100%
`79
`BOO
`268
`-
`tumors ofbowh perloneem aad pleura.
`
`OR
`44
`
`Neighborhood Exposure
`
`Excluding those with occupational or domestic ex-
`posure, no subject, but 2 controls, had Hved within 20
`miles of a Canadian chrysatiie ming. In the UF S. AL,
`7 subject and 2 controls had fived within 20 miles af
`an chrysotile mine in California. The places of residence
`of women wert examined for the period 20 Ibrough 46
`years before death, OF96 case-conieilpairs in Canada,
`19 sabjects and 2) controls had lived onty in rural
`areas; of 50 case-control pairs in the U.S. A., 5 sub-
`jects and 10 controls had dows so. In Canada, 67 sub-
`jects and 66-controls, and in the U.S. A.. £5 subjects
`and {3 controls, had lived in urban areas only.
`
`Site of Tumor and Orcupation
`
`Of 265 male subjects with pleura! ternors, 55.196
`had worked in ons 6f the occupational Groups A to B,
`compared with 22.6% eftheir matched controls (Table
`5). The corresponding percentages of 79 males with
`peritoneal tumors and their matched controls were
`simfar, 53.295 and 22.8%, respectively. However,
`(29.1% of peritoneal cases and 10.9% of pleural
`tases, compared with 2.39 and 2.59% in the respec~
`live control groups, had worked as insulators er in.
`asbestos factories.
`
`.
`
`254.
`20.3%
`
`
`
`2 |
`0
`6
`2
`8
`iB
`al
`19
`
`
`
`
`
`
`1654
`
`Cancer Oetaber F 1980
`
`Vol. 46
`
`He. 7
`
`‘Taste §, Oecemplanul Group and Sie of Tumor in Malic Cescx and Controls
`
`
`
`
`Pleura’
`
`to all o
`— when
`:
`Peritoneumt
`.
`i
`,
`- ee differes
`.
`similar
`Controls
`Cases
`Controls
`Cases
`Occusulional group*
`tt .
`Byyee
`:
`bee
`
`Eg
`n Asbestos production and manufsciure
`has ber
`
`tt
`- Insulation
`the res
`6E
`C. Heating wades fexcl, Ad
`beei
`20
`D. Shipyards excl. A.C}
`Binnt
`38
`E. Consicuction teaci. A.C, DB
`1930s =
`
`
`SSA
`Had
`A-E
`tion im
`2.
`44.9%
`ig
`All other
`fiber fr
`iA. |
`
`100%
`26
`Fotar
`al 197
`10095
`
`ule sc
`
`* Ser texfor definnions.
`tumor
`
`+ Picura includes pericardial igmar and psrtoncum inchides
`-
`thelios
`
`but ne
`‘
`
`
`
`posed in childhood and the semaining 3 plus 2 controls9Osher Materials incrim
`as adulis, In3 cases and for f control, the clothing was
`Relative risksin
`mat
`+
`pai
`‘
`In ¢
`
`tha of a Quebsc chrysotile production workerand,in Tall 6 for,
`in Mate Casc-control pairs are shown
`proce;
`
`5 cases and for 1 control, an employee engaged in in-
`rable eG
`lor exposure to dust from fiberglass, cesient,
`perit
`
`sulation or factory work. In the U.S. A. survey, an
`™ oe eet nickel, and wood. Only for fiberglass
`insulic
`additional question was asked about exposure to
`the Ye ativeHs rene; after allowing for ex-
`like gy
`
`asbestos in work or hobbies in the home. Among the
`posureto2s ; ios,this fell to 18 (95% confidence
`posed
`
`156 men who had net worked in occupational Groups
`; +
`Sabo
`BR beet. respectively).
`| "conte:
`avenicen subjects and 12 controls had lived for 26 f+ illes:
`A~E, and their matched controls,affirmative answers
`
`through 40 years béfore death within 20 miles of re~ P
`:
`'
`been
`were piven for $ cascs and 2 controls.
`
`poned zeolite deposits™ in Western U.S. A, A paired
`betwe
`
`analysis gave a relative risk of 1.83, reduced to 1.60 }
`expo
`(7396 confidence Hmits, 0.58 and4.93, respectively)
`‘essin
`when allowance was made foroccupational exposure
`Of 4)
`
`BE 0.398
`ig asbestos.
`;
`
`» 6%
`Smoking
`Une
`
`Findings concerning Cigarette smoking habits were
`Whee
`
`similar to those previously reporied." No association
`
`with mesothelioma was fourid for Inale cases, Fe-
`
`mate subjects tended to be rather heavier smokers than
`
`controls, perhaps related to the higher proportion ent
`ployed. outside.the horace. Overall, it seems improbable |
`that tobacco smoking is an etiologic factor of any
`importance in this. disease,
`Diseussion
`
`The Hst of occupations provided by ihe Environ"
`mental Sclénces Laboratory, Mount Sinal Scheal of -
`
`Medicine, proved a satisfactory method of classifying
`
`occupations thought to emtail asbestos exposure. With
`
`minor modifications, the Hist could improve thd com J
`
`parabllity of case-control surveys in different regions
`
`and countries, Greater discrimination was achieved
`heaween cases and controls by selecting occupation’
`
`€
`

`

`1655
`
`
`
`
`
`
`Af
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`- Wert |
`dation
`Fee
`s than
`cil cm-
`» table
`f any
`
`MALIGNANT MESOTHELIOMA * McDonald and McDonald
`No.7
`to all occupations listed. It Is reassuring however that,
`Taries. Exposure wCertain Materials in Male Case-Control Pairs
`when the Iatter method was used.
`the order of
`.
`O40
`difference between “cases, and controls
`remained
`Relalive Confidence
`.
`Exposed Case Control
`similar.
`
`
`ior onlyooadiy=Bath Neither risk limits
`
`The very high relative risk in insulators bears out
`Fibes gless
`27
`R
`3
`302
`2.25
`if4, 444
`the cesults of earlier cohort studies.°! Chrysotile
`Cement
`ok
`%
`T
`256
`1.33
`O73, 175
`bas been used for insulation iq the U.S. A. since the
`Rubber
`fd
`a
`4
`300
`0.60
`O42, bd
`begining ef the century. Amosite, introduced in the
`Copper
`36
`a3
`6
`267
`£03
`G.65, 1.64
`Nickel
`#8
`i}
`i
`312
`1.38
`0,68, 1.40
`1930s and employed extensively for marie consteasc-
`Weed
`&
`§3
`19
`200
`0,98
`0.69, 1.40
`sion in the World War U2" became the predominant
`OE
`fiber for insulation in the 1950s.3 Insulators whe died
`in 1972 were thus exposed to amosite as well as chryso-
`lc sume 25-35 or more years before a mesothelial
`tumor developed. Since the observed risk of meso-
`thelioma has been high after work with amostite onky#
`but not with chrysotile only,* circumstances tead to
`incriminate the amosite component.
`-In subjects who had done inswlation and asbestos
`processing work, a high proportion of the tumors were
`petitoneal, This was also true of twa large series of
`insulators,”*! amosite factory workers2' crocida-
`lite gasmask workers,*!* and factory warkers cx-
`pused to crocidoliie, amosite, and chrysotile.!* This
`conimists wih the pattern ia chrysotile miners and
`miliers, among whemall cases‘so far observed have
`been pleural." However,
`the principal difference
`between chrysotile production workers and persons
`exposed to mixed mineral types of asbestos in proc.
`essing or application Hes in the absolute level of risk.
`Of 4,247 deaths among chrysotile miners and millers,
`0.396 were due ta mesotheliamal* compared with 8.
`16% in the other groups mentioned." It remains
`bacertain however whether the tisk continues to be low
`when chrysotile is processed. Two relatively small
`Studies of factory workers? Suggest
`that this may
`be so and, in the present Survey, ao increase In risk
`was found in garage workers, comainly exposed to
`chrysotile from brake linings.
`Borow ¢1 al, reponed 72 cases of mesothelioma,
`5? in, employses of a large asbestos factory in New
`Jersey.* Chrysotile only was manufactured from 1918
`uni! the mid-i930s when crocidolte was introduced
`for production of farge asbestos cement pipe and
`amosite for some otber products. The first case of
`mesothelioma occurred in 1951 and there were 3 more
`Cases before 1960, In the first half of the 1960s, the
`number of cases hadincreased by-a factor of 8 and in -
`Ihe second half, bya factor of 2. There was only 1.
`Stse.of mesothelioma in the large female woif' force
`employed in the 1extie department in which chrysotile.
`only was used. This contrasts with the £.9% death
`ratc“from mesothelioma reported by Newhouse for
`Workers in a textile factory ia which chrysoulle.
`Crodicotite. and amosite were used 2*
`
`
`‘The association of mescthelioma with exposure to
`asbestos-contaminated clothing in the home was again
`confirmed. Cases have not been found in the acighbor-
`hoed of the Guebec chrysotile mines and cnitls in cur
`studies or in those of Theriault and Grand-Bois,™ but,
`a& the number of cases among the workers. themselves
`was few, this is not surprising. The absence of micso-
`theloma in the seighborheod of the New Jersey
`amasile factory is more reassuring evidence.’
`In 1972, our inquiry from all North American
`pathologists yielded a total of 274 fatal cases of meso-
`ihelioma. From detailed analysis of data available for
`California, we concluded elsewhere! that our survey
`probably underestimated the true incidence by about
`30%. On the other hand, this is hatanced by an almost
`similar proportion of cases rejected by the pathology
`panels.
`It bes been argued’ that very intensive
`questioning is needed, preferably while the subject
`is SUH alive, in order to elicit a full history of asbestos
`exposure in cases of mesothetionia, While this may be
`inde, the same argument would apply, ofcourse, to the
`controls, but perhaps to a lesser degree.
`In case-
`control studies of the type described here, the propor-
`tion attributable to asbestos expostre may therefore
`bo somewhat underestimated. The upward tread in in
`cidence in the male population seen in Canada ts likely
`to be paralleled in the UW, 5. A. and, if due to the
`increased use of asbestos, will continue to rise for 20
`to 30 years at lenst, because-of the long latency period.
`The proportion of all cases ‘attributable to asbestos :
`must also therefore be expected to increase, Evén sa,
`the recent cstimate from the National Institutes. of
`Healthof a yearly average forthe next 30-35 years
`of 10,000 deaths from mesothelioma in the U. §. A.
`due to asbestes alone. is not supported by our findings.
`
`viron-
`ool of
`ifying
`. With
`conr
`
`rgions
`ie ved
`ations
`digma
`osure
`
`REFERENCES
`
`L. Baris U1, Anvinll M. Sahin AA. Environmenial mesathelioma
`in Turkey. Anu NYAcad Sc? (919: BOAT434,
`2. Borow M. Contin A. Livomese LL, Schalet N. Mesoihclioma
`following exposure ta asbestos: a roview of TE causes, Chea (97):
`So Add,
`
`3, Bridport K. Deeouffte P. Fraument JE, et ul, Estimates of the
`
`

`

`
`
`
`
`
`
`1656
`
`Cancer October 7 1980
`
`Vol, 48
`
`fraction of cancer in the Unhed States related io oceepations!
`faciers, Repon prepared by NUCL, BLLEHS, SLOSS.8. 97g.
`4. Cochrane JC, Webster f, Mesothelioms in relation to asbestos
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`
`5, Cooper WC, Balzer H-R. Evaluation oad canal of exbesios.
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`1568: Deviches Zeateatinstiut {Gr Arbeitzmedizixs Berlin DDR:
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`.
`6. Doll, R. Retrospective and prospective studics. in Medical
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`2. Elwood PC, Cochrane AL. A follow up of workers from an
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`8. Rammond EC, SclitollU, Garfinkel L, Nicholson WJ. Mertal-
`ity experience of residents in the nciphboushood of an asbestos fac~
`lory. dan WY Acod Sei HTS) SMA YT472,
`>. Jones FSP, Posicy FD, Smith PG, Factory populations exposed
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`Publications INSEAM 1916: 5 b- TA.
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`consequences of asbestas dist exposure in a wartime gas. mask
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`Fiores, Lyoo, Sept 25-27, 1979 (proceedings in press}.
`iL McDonald AD, Mesothelloma registrics in identifying as-
`bestos haiards, Ana NY Acad Sei 1979; 330441~444_
` MeDonakt AD, Harper A, E) Attar OA, McDonald 3C.
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`6. McDonald JC. Exposure relationships and malignant ine
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`from estimated incldente. Prev Med 1977: 6:416-446,
`18, Newhouse ML, Berry G. Predictions of mortalily from
`mesothelial umours in asbestos factory workers, Brd ind Med 197b:
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`15. Rohl AN, Langer AM. Wolf MS. Weisman J. Asbestos te
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`.
`48. Scllkol 1, Hammond EC, Churp J. Mortality cxpericaes
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`WHAET-AB,
`rae
`T, Shephard RA. Zeolites in sedimentary deposits of the United
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`Province of Quebec, 1969-72, Areh Environ Health 1978; 31th~04,
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`Freoith 1975; 3it— 1B,
`
`
`
`

`

`.
`ime
`
`UCLUBEK L, L980, vol. 46 n0. 7
`ISSN 0008-—543Xx
`CANCAR
`
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`
`et,
`
`x
`
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`

`

`"Ba
`
`
`
`
`
`Volume 46
`Os
`Number?
`October 1, 1980
`J
`rrAtARR
`
`CONTENTS (Cominuedi
`
`1377 Radiation Exposure as a Possible Eiolegic Factor in Hairy Celt Leukemia (Leukemic
`Reticulacndotheliosis)
`David J, Stewart and Michael J. Keating
`.
`‘1581 Pulmonary Mycobscteriosis and Malignancy: Presumed Activation by Irradiation
`Larry W. Rumons
`-
`
`1584 Prolactin-Secreting Pituitary Oncocytoma with Galactorrbea—Amenorrhea Syndrome;
`A Histologic, Ultrastructural, and immunocytochemicat Study
`Uma P,
`Kalyanaraman, N, 5. Halmi, and Patrick W. Elwood
`
`1590 Clonal Changes in Chronic Granulocyte Leukemia In Blastic Transformation and
`During Remission
`German Beltran and Maris Varela
`3594 Purification of Herpes Shaptex Virus Tumor Associated Antigen from Human Kidney
`Carcinema=Reberta Cocchiara, Giulio Tarre, Glovanni Flaminio, Mario Di
`Gioia, Riccardo Smeraglia, and Domenice Geraci
`.
`
`
`
`1002 in Vitro Evidence for an Unusual Progenitor Cell in Acute Momecylic Leukemia
`Raymond Tactle and Linda Iver
`1508 Yerhorrbagte Infarcis Caused by Mucin Eraboll Mimicking Brain Purpura
`Robitaille
`
`Y¥.
`
`1617) Ackerzaan’s Tumor (Verracous Carcinoma) of the Larynx: A Clinicopatiologié
`Study of T1 Cases
`Alfio Ferlito and Gianfranco Recher
`.
`
`1612 H