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The National Cancer Institute's Fact Sheet on Asbestos Exposure Key Points There are two subgroups of asbestos: chrysotile, which has curly fibers and is in the serpentine family of minerals; and amphibole asbestos, which has straight, needle-like fibers and includes actinolite, tremolite, anthophyllite, crocidolite, and amosite asbestos. Chrysotile asbestos is the form that has been used predominantly in commercial applications worldwide (1, 2). How is asbestos used? In the late 1970s, the U.S. Consumer Product Safety Commission (CPSC) banned the use of asbestos in wallboard patching compounds and gas fireplaces because the asbestos fibers in these products could be released into the environment during use. Additionally, in 1979, manufacturers of electric hairdryers voluntarily stopped using asbestos in their products. In 1989, the U.S. Environmental Protection Agency (EPA) banned all new uses of asbestos; uses established prior to 1989 are still allowed. The EPA also established regulations that require school systems to inspect for damaged asbestos and to eliminate or reduce the exposure to occupants by removing the asbestos or encasing it (2). In June 2000, the CPSC concluded that the risk of children’s exposure to asbestos fibers in crayons was extremely low (1). However, the U.S. manufacturers of these crayons agreed to eliminate talc from their products. In August 2000, the EPA responded to reports it received about the adverse human health effects associated with exposure to asbestos-contaminated vermiculite by conducting a series of tests to evaluate the extent of the risk. The EPA investigation concluded that the potential exposure to asbestos from some vermiculite products poses only a minimal health risk to consumers. The EPA recommended that consumers reduce the low risk associated with the occasional use of vermiculite during gardening activities by limiting the amount of dust produced during use. Specifically, the EPA suggested that consumers use vermiculite outdoors or in a well-ventilated area; keep vermiculite damp while using it; avoid bringing dust from vermiculite use into the home on clothing; and use premixed potting soil, which is less likely to generate dust. The regulations described above and other actions, coupled with widespread public concern about the health hazards of asbestos, have resulted in a significant annual decline in U.S. use of asbestos. Domestic consumption of asbestos amounted to about 803,000 metric tons in 1973, but it had dropped to about 2,400 metric tons by 2005 (3, 5). What are the health hazards of exposure to asbestos? Asbestos has been classified as a known human carcinogen (a substance that causes cancer) by the U.S. Department of Health and Human Services, the EPA, and the International Agency for Research on Cancer (2, 3, 7, 8). Studies have shown that exposure to asbestos may increase the risk of lung cancer and mesothelioma (a relatively rare cancer of the thin membranes that line the chest and abdomen). Although rare, mesothelioma is the most common form of cancer associated with asbestos exposure. In addition to lung cancer and mesothelioma, some studies have suggested an association between asbestos exposure and gastrointestinal and colorectal cancers, as well as an elevated risk for cancers of the throat, kidney, esophagus, and gallbladder (3, 4). However, the evidence is inconclusive. Asbestos exposure may also increase the risk of asbestosis (a chronic lung disease that can cause shortness of breath, coughing, and permanent lung damage) and other nonmalignant lung and pleural disorders, including pleural plaques (changes in the membrane surrounding the lung), pleural thickening, and pleural effusions (abnormal collections of fluid between the thin layers of tissue lining the lung and the wall of the chest cavity). Although pleural plaques are not precursors to lung cancer, evidence suggests that people with pleural disease caused by asbestos exposure may be at increased risk for lung cancer (9). Who is at risk for an asbestos-related disease? Since the early 1940s, millions of American workers have been exposed to asbestos. Health hazards from asbestos fibers have been recognized in workers exposed in shipbuilding trades, asbestos mining and milling, manufacturing of asbestos textiles and other asbestos products, insulation work in the construction and building trades, and a variety of other trades. Demolition workers, drywall removers, asbestos removal workers, firefighters, and automobile workers also may be exposed to asbestos fibers. However, recent studies do not support an increased risk of lung cancer or mesothelioma among automobile mechanics exposed to asbestos through brake repair (10). As a result of Government regulations and improved work practices, today’s workers (those without previous exposure) are likely to face smaller risks than did those exposed in the past. Those involved in the rescue, recovery, and cleanup at the site of the September 11, 2001, attacks on the World Trade Center (WTC) in New York City are another group at risk of developing an asbestos-related disease. Because asbestos was used in the construction of the North Tower of the WTC, when the building was attacked, hundreds of tons of asbestos were released into the atmosphere. Those at greatest risk include firefighters, police officers, paramedics, construction workers, and volunteers who worked in the rubble at Ground Zero. Others at risk include residents in close proximity to the WTC towers and those who attended schools nearby. These populations will need to be followed to determine the long-term health consequences of their exposure (11). One study found that nearly 70 percent of WTC rescue and recovery workers suffered new or worsened respiratory symptoms while performing work at the WTC site. The study describes the results of the WTC Worker and Volunteer Medical Screening Program, which was established to identify and characterize possible WTC-related health effects in responders. The study found that about 28 percent of those tested had abnormal lung function tests, and 61 percent of those without previous health problems developed respiratory symptoms (12). However, it is important to note that these symptoms may be related to exposure to debris components other than asbestos. Although it is clear that health risks from asbestos exposure increase with heavier exposure and longer exposure time, investigators have found asbestos-related diseases in individuals with only brief exposures. Generally, those who develop asbestos-related diseases show no signs of illness for a long time after their first exposure. It can take from 10 to 40 years or more for symptoms of an asbestos-related condition to appear (2). There is some evidence that family members of workers heavily exposed to asbestos face an increased risk of developing mesothelioma. This risk is thought to result from exposure to asbestos fibers brought into the home on the shoes, clothing, skin, and hair of workers. To decrease these exposures, Federal law regulates work practices to limit the possibility of asbestos being brought home in this way. Some employees may be required to shower and change their clothes before they leave work, store their street clothes in a separate area of the workplace, or wash their work clothes at home separately from other clothes (2). Cases of mesothelioma have also been seen in individuals without occupational exposure, but who live close to asbestos mines or have been exposed to fibers carried home by family members working with asbestos (6). What factors affect the risk of developing an asbestos-related disease? Dose (how much asbestos an individual was exposed to). How does smoking affect risk? How are asbestos-related diseases detected? Shortness of breath, wheezing, or hoarseness.
Studies have shown that computed tomography (CT) (a series of detailed pictures of areas inside the body taken from different angles; the pictures are created by a computer linked to an x-ray machine) may be more effective than conventional chest x-rays at detecting asbestos-related lung abnormalities in individuals who have been exposed to asbestos (14). A lung biopsy, which detects microscopic asbestos fibers in pieces of lung tissue removed by surgery, is the most reliable test to confirm the presence of asbestos-related abnormalities. A bronchoscopy is a less invasive test than a biopsy and detects asbestos fibers in material that is rinsed out of the lungs. It is important to note that these tests cannot determine how much asbestos an individual may have been exposed to or whether disease will develop (14). Asbestos fibers can also be detected in urine, mucus, or feces, but these tests are not reliable for determining how much asbestos may be in an individual’s lungs (2). How can workers protect themselves from asbestos exposure? Workers who are concerned about asbestos exposure in the workplace should discuss the situation with other employees, their employee health and safety representative, and their employers. If necessary, OSHA can provide more information or make an inspection. Regional offices of OSHA are listed in the "United States Government" section of a telephone directory’s blue pages (under "Department of Labor"). Regional offices can also be found at http://www.osha.gov/html/RAmap.html on the Internet. More information about asbestos is available on the OSHA Asbestos Web page, which has links to information about asbestos in the workplace, including what OSHA standards apply, the hazards of asbestos, evaluating asbestos exposure, and controls used to protect workers. This page is available at http://www.osha.gov/SLTC/asbestos/index.html on the Internet. OSHA’s national office can be contacted at: Organization: Mine workers can contact MSHA at: Organization: The National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention, is another Federal agency that is concerned with asbestos exposure in the workplace. NIOSH conducts asbestos-related research, evaluates work sites for possible health hazards, and makes exposure control recommendations. In addition, NIOSH distributes publications on the health effects of asbestos exposure and can suggest additional sources of information. NIOSH can be contacted at: Organization:
People with occupational asbestos-related diseases also may qualify for financial help, including medical payments, under state workers’ compensation laws. Because eligibility requirements vary from state to state, workers employed by private companies or by state and local government agencies should contact their state workers’ compensation board. Contact information for state workers’ compensation officials may be found in the blue pages of a local telephone directory or at http://www.dol.gov/esa/regs/compliance/owcp/wc.htm on the Internet. If exposure occurred during employment with a Federal agency, medical expenses and other compensation may be covered by the Federal Employees’ Compensation Program, which is administered by the DOL, Employment Standards Administration’s Office of Workers’ Compensation Programs.  This program provides workers’ compensation benefits to Federal (civilian) employees for employment-related injuries and diseases. Benefits include wage replacement, payment for medical care, and, where necessary, medical and vocational rehabilitation assistance in returning to work. Benefits may also be provided to dependents if the injury or disease causes the employee’s death. The program has 12 district offices nationwide. In addition, the Longshore and Harbor Workers’ Compensation Program provides benefits to longshoremen, harbor workers, other maritime workers, and other classes of private industry workers who are injured during the course of employment or suffer from diseases caused or worsened by conditions of employment. Information about eligibility and how to file a claim for benefits under either of these programs is available from: Organization: Eligible veterans may receive health care at a Department of Veterans Affairs (VA) Medical Center for an asbestos-related disease. Veterans can receive treatment for service-connected and nonservice-connected medical conditions. Information about eligibility and benefits is available from the VA Health Benefits Service Center at 1–877–222–8387 (1–877–222–VETS) or on the VA Web site at http://www1.va.gov/health on the Internet. Is there legislation to help victims of asbestos-related health diseases? What other organizations offer information related to asbestos exposure? The Agency for Toxic Substances and Disease Registry (ATSDR) is the principal Federal agency responsible for evaluating the human health effects of exposure to hazardous substances. The agency works in close collaboration with local, state, and other Federal agencies, with tribal governments, and with communities and local health care providers to help prevent or reduce harmful human health effects from exposure to hazardous substances. The ATSDR provides information about asbestos and where to find occupational and environmental health clinics. The ATSDR can be contacted at: Organization: The U.S. Environmental Protection Agency (EPA) regulates the general public’s exposure to asbestos in buildings, drinking water, and the environment. The EPA offers a Toxic Substances Control Act (TSCA) Hotline and an Asbestos Ombudsman. The TSCA Hotline provides technical assistance and information about asbestos programs implemented under the TSCA, which include the Asbestos School Hazard Abatement Act and the Asbestos Hazard Emergency Response Act. The Asbestos Ombudsman focuses on asbestos in schools and handles questions and complaints. Both the TSCA Hotline and the Asbestos Ombudsman can provide publications on a number of topics, particularly on controlling asbestos exposure in schools and other buildings. The Ombudsman operates a toll-free hotline for small businesses, trade associations, and others seeking free, confidential help. The EPA Web site includes a list of EPA regional and state asbestos contacts at http://www.epa.gov/asbestos/pubs/regioncontact.html on the Internet. In addition, EPA’s Asbestos and Vermiculite home page provides information about asbestos and its health effects and links to asbestos resources, including suggestions for homeowners who suspect asbestos in their homes, and laws and regulations applicable to asbestos. This page can be found at http://www.epa.gov/asbestos/ on the Internet. Questions may be directed to: Organization: Another EPA resource that may be of interest is the brochure titled Current Best Practices for Preventing Asbestos Exposure Among Brake and Clutch Repair Workers. Released in April 2007, this brochure includes work practices for both automotive professionals and home mechanics that may be used to avoid asbestos exposure. It also summarizes existing OSHA regulatory requirements for professional auto mechanics. The brochure supersedes the EPA’s existing Guidance for Preventing Asbestos Disease Among Auto Mechanics, which is known as the "Gold Book." The brochure can be found at http://www.epa.gov/asbestos/pubs/brakesbrochure.html on the Internet. The U.S. Consumer Product Safety Commission (CPSC) is responsible for protecting the public from unreasonable risks of serious injury or death from more than 15,000 types of consumer products, including asbestos, under the agency’s jurisdiction. The CPSC maintains a toll-free 24-hour hotline where callers can obtain product safety and other agency information and report unsafe products. In addition, CPSC publications provide guidelines for repairing and removing asbestos, and general information about asbestos in the home. CPSC can be contacted at: Organization: Individuals can also contact their local or state health department with questions or concerns about asbestos. Information about cancer is available by calling the National Cancer Institute’s (NCI) Cancer Information Service (CIS) at 1–800–4–CANCER (1–800–422–6237) or by visiting the NCI’s Web site at http://www.cancer.gov on the Internet. The NCI is a component of the National Institutes of Health. Information about quitting smoking, including smoking cessation counseling, is available by calling the NCI’s Smoking Quitline toll-free at 1–800–44U–QUIT (1–800–448–7848) or visiting the NCI’s smoking cessation Web site at http://www.smokefree.gov on the Internet. Selected References 1.  Agency for Toxic Substances and Disease Registry (April 2006). What Is Asbestos? Retrieved August 30, 2006, from: http://www.atsdr.cdc.gov/asbestos/more_about_asbestos/what_is_asbestos.
Related Resources Publications (available at http://www.cancer.gov/publications) National Cancer Institute Fact Sheet 6.36, Mesothelioma: Questions and Answers National Cancer Institute (NCI) Resources Cancer Information Service (toll-free)
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