ASBESTOS

SELECTED CANCERS

Committee on Asbestos: Selected Health Effects

Board on Population Health and Public Health Practices

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

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ASBESTOS SELECTED CANCERS Committee on Asbestos: Selected Health Effects Board on Population Health and Public Health Practices

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropri- ate balance. This study was supported by Contract N01-OD-4-2139 between the National Acad- emy of Sciences and the National Institutes of Health. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number 0-309-10169-7 (Book) International Standard Book Number 0-309-65952-3 (PDF) Library of Congress Control Number: 2006928950 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www. nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2006 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engi- neers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Coun- cil is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON ASBESTOS: SELECTED HEALTH EFFECTS Jonathan M. Samet, M.D., M.S. (Chair), Professor and Chairman, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland Lonnie R. Bristow, M.D., Private Practice and Former President of American Medical Association, Walnut Creek, California Harvey Checkoway, Ph.D., M.P.H., Professor, Department of Environmental and Occupational Health Sciences, University of Washington, Seattle Paul Demers, Ph.D., M.Sc., Associate Professor, Department of Health Care and Epidemiology, University of British of Columbia, Vancouver Ellen A. Eisen, M.S., Sc.D., Adjunct Professor, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts George D. Guthrie, Jr., Ph.D., M.A., Geology and Chemistry Group, Los Alamos National Laboratory, Los Alamos, New Mexico Rogene F. Henderson, Ph.D., D.A.B.T., Senior Scientist, Lovelace Respiratory Research Institute, Albuquerque, New Mexico Joseph W. Hogan, Sc.D., Associate Professor, Biostatistics Section and Center for Statistical Sciences Department of Community Health, Brown University, Providence, Rhode Island Agnes B. Kane, M.D., Ph.D., Professor, Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island Fadlo R. Khuri, M.D., Professor, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia Roberta B. Ness, M.D., M.P.H., Chair and Professor, Department of Epidemiology, University of Pittsburgh, Pennsylvania Michael J. Thun, M.D., M.S., Vice President, Epidemiology and Surveillance Research, American Cancer Society, Atlanta, Georgia Assistants with Graphical Data Li Su, Graduate Research Assistant in Biostatistics, Department of Community Health, Brown University Yunxia Sui, Graduate Research Assistant in Biostatistics, Department of Community Health, Brown University Staff Mary Burr Paxton, Study Director Rose Marie Martinez, Director, Board on Population Health and Public Health Practice v

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Michael Schneider, Senior Program Associate Tia S. Carter, Senior Program Assistant Norman Grossblatt, Senior Editor vi

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Reviewers This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional stan- dards of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following for their review of this report: John C. Bailar, Professor Emeritus, University of Chicago, Illinois Peter R. Buseck, Professor, Department of Geological Sciences and Department of Chemistry and Biochemistry, Arizona State University, Phoenix Robert G. Coleman, Professor Emeritus, Stanford University, Atherton, California Arthur Frank, Professor and Chair, Department of Environmental and Occupational Health, School of Public Health, Drexel University, Philadelphia, Pennsylvania Robert F. Herrick, Lecturer, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts Karl T. Kelsey, Professor, Departments of Cancer Cell Biology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts vii

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viii REVIEWERS Alfred I. Neugut, Program Director, Cancer Epidemiology and Control, Division of Epidemiology, Mailman School of Public Health, Columbia University, New York H. Catherine Skinner, Research Affiliate and Lecturer, Department of Geology and Geophysics, Yale University, New Haven, Connecticut Mark Utell, Professor, Departments of Medicine and of Environmental Medicine and Critical Care Division, University of Rochester, New York Gerald van Belle, Professor, Department of Environmental and Occupational Health Sciences, University of Washington, Seattle David Wegman, Dean, Health and Environment, University of Massachusetts, Lowell Noel S. Weiss, Professor, Department of Epidemiology, University of Washington, Seattle Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Paul D. Stolley, Univer- sity of Maryland, School of Medicine, Baltimore, and by Edward B. Perrin, University of Washington, Seattle. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accor- dance with institutional procedures and that all review comments were care- fully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Contents SUMMARY 1 1 Introduction 13 Statement of Charge, 13 Current Legislation, 13 Overview of Patterns of Asbestos Use and Recognition of Its Health Consequences, 14 Committee’s Approach to Its Charge, 16 References, 17 2 Committee’s Approach to Its Charge and Methods Used in Evaluation 18 General Approach to Evidence Review, 18 Evidence Considered, 22 Criteria for Evidence Evaluation, 25 Methods Used for Quantitative Meta-Analysis, 36 Integration of Data, 43 References, 45 3 Background Information on Asbestos 49 Introduction, 49 “Fibrous” and “Asbestiform,” 50 Serpentine Asbestos (Chrysotile) Mineralogy, 52 Amphibole Asbestos Mineralogy, 55 Properties of Potentially Hazardous Fibrous Minerals, 57 References, 61 ix

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x CONTENTS 4 Exposure and Disposition 63 Exposure, 63 Dosimetry, 68 References, 77 5 Biological Aspects of Asbestos-Related Diseases 81 Asbestos-Related Pulmonary Diseases and Their Mechanisms, 81 Information from Animal Studies, 90 Biomarkers, 94 References, 96 6 Description of Epidemiologic Studies Included in Evidentiary Dataset 104 Cohort Studies, 104 Case-Control Studies, 140 Integration of Epidemiologic Evidence with Non-Epidemiologic Evidence, 144 References, 145 7 Pharyngeal Cancer and Asbestos 159 Nature of This Cancer Type, 159 Epidemiologic Evidence Considered, 161 Evidence Integration and Conclusion, 169 References, 170 8 Laryngeal Cancer and Asbestos 173 Nature of This Cancer Type, 173 Epidemiologic Evidence Considered, 175 Evidence Integration and Conclusion, 186 References, 188 9 Esophageal Cancer and Asbestos 193 Nature of This Cancer Type, 193 Epidemiologic Evidence Considered, 195 Evidence Integration and Conclusion, 198 References, 200 10 Stomach Cancer and Asbestos 203 Nature of This Cancer Type, 203 Epidemiologic Evidence Considered, 204 Evidence Integration and Conclusion, 211 References, 212

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xi CONTENTS 11 Colorectal Cancer and Asbestos 216 Nature of This Cancer Type, 216 Epidemiologic Evidence Considered, 217 Evidence Integration and Conclusion, 224 References, 226 12 Summary and Recommendations 230 Summary, 230 Recommendations, 232 APPENDIXES A Agendas of Public Meetings Held by the Committee on Asbestos: Selected Health Effects 233 B Lineage and Design Properties of Studies on Cohorts Informative for Selected Cancers 237 C Description of Case-Control Studies of All Selected Cancers as Related to Exposure to Asbestos 255 D Cohort Results Tables 271 E Case-Control Results Tables 297 F Initial Analyses of Available Data Concerning Cancers of the Colon and/or Rectum and Asbestos Exposure 309 G Committee on Asbestos: Selected Health Effects 323

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