Biomedical subjects
Publications and source records attributed to H J Woitowitz.
We report five cases of pleural mesothelioma in housewives, that are attributed to inhalative household-contact with asbestos. An occupational history of asbestos exposure could not be revealed. A causal relationship between the fatal disease and the inhalative house-hold-contact with asbestos was established based on the cleaning of asbestos contaminated work-clothes of the husbands.
The case histories of a family are described where 3 out of 4 developed asbestos-related diseases. Only the husband had direct occupational exposure handling blue-asbestos materials while working in a producing insulating factory in 1950-59. He died of pulmonary asbestosis as an occupational disease. His wife and his son died of asbestos related mesothelioma. Detailed exposure history revealed exposure to asbestos by laundering her husband's contaminated working clothes. His son was exposed to asbestos during childhood by helping his mother laundering the father's working clothes and in addition by visiting his father's working place regularly. The significance of nonoccupational exposure to asbestos is emphasized as a causative factor in the development of malignant mesothelioma.
The excess risk of tumours exposed to asbestos were previously compared with the results of rat inhalation experiments. It could be demonstrated that humans at the workplace suffer from a tumour risk at fibre concentrations which are 300 times lower than those needed in the rat inhalation model to produce the same risk. However, the estimation of human risk was based on the study of workers at a chrysotile textile factory, whereas animal experimental results were related to exposure to amphiboles. Since for this comparison the risk of cancer due to exposure to amosite or crocidolite fibres at the workplace is of interest, quantitative exposure-response relationships for lung cancer and mesothelioma for the white workforce of South African amosite and crocidolite mines were discussed. On comparing the risk of lung cancer in this study with the risk of lung cancer for chrysotile textile workers, it can be concluded, that the risk of lung cancer and mesothelioma from crocidolite and amosite was higher than in the chrysotile textile factory. It could be also demonstrated, on the basis of a study of the lung burden of mesothelioma cases and of controls, that a significantly increased odds ratio of about 5 was established at amphibole concentrations of between 0.1 and 0.2 f micrograms-1 dry lung (WHO fibres longer than 5 microns from TEM analysis). On the other hand, carcinogenic response was observed at a fibre concentration 6000 times higher in animal inhalation experiments with crocidolite asbestos (SEM analysis of WHO fibres). As a result of these findings, it has been concluded that inhalation studies in rats are not sufficiently sensitive for the detection of hazards and risks to humans exposed to man-made fibres.
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A cohort study was conducted of 616 German female workers with a history of exposure to asbestos. Standardized proportionate mortality analysis was done except for mesothelioma, for which proportionate mortality was computed based on best evident cause of death. Mortality from lung cancer was increased three times over expected value. Death rates due to mesothelioma were 340 times higher than in the general population. Female mortality rates surpassed those observed in men twofold for lung cancer and fourfold for mesothelioma. In comparison with published data from international cohort studies, the observed mortality for mesothelioma in our female cohort appeared higher than that previously reported. German women with a history of asbestos exposure are considered a high-risk group for developing mesothelioma and lung cancer. They should be a target group for intervention strategies (eg, chemoprevention, smoking cessation, early cancer detection).
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In the course of the past few decades there has been a heavy world-wide increase in the incidence of mesotheliomas among the industrialised nations. A characteristic feature of this is an extremely great difference in respect of the expected incidence of the tumour between persons who had been in contact--even though a long time back--with asbestos fibre dust, or who worked or resided near sources of asbestos emission, or who had contact with asbestos fibres in their household, on the one hand, and with the rest of the population on the other. Hence, pleuromesothelioma is not only a tumour signalling the risk brought about by the presence of asbestos or of zeolites in the environment, it is also so to say the environmental tumour par excellence. Among the members of those artisan professions where products containing asbestos are being employed, pleuromesotheliomas have been a far more frequent source of professionally conditioned cancer than among the workers of the asbestos industry proper. Since the latency period is as a rule 30 years, the physician must go back scrupulously 20 to 60 years in the patient's previous history to find out whether there had been an exposure to asbestos at any time that would induce tumour formation, the more so since a mere couple of weeks' exposure can be enough to induce a tumour so many years later. On account of the pleurotropy of inhaled asbestos fibres, pointers to an asbestosis of the lungs and/or pleura should be followed up on-target. Further practical consequences are discussed.
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Working site related health risks, in particular cancer as a model of industrial latency diseases, belong to the extensively studied "environmental diseases". As much as 14 classes of chemical substances causing cancer at different localization are classified in the occupational disease compensation law of the Federal Republic of Germany. Within the recent decades the number of carcinogens identified by experimental cancer research has been enormously increasing, whereas new data in occupational oncology stagnate. In particular, the disagreement in the "social partnership" regarding the originator principle with the consequence of the liability of employers to compensate occupational diseases can be considered as the socio-political background of this stagnation. Especially investigations on cancer related to the working site often fail due to data privacy. With regard to this problem, some actual cases are listed. The mandate of medical science to gain new knowledge in the field of work related diseases for a legal assessment, as determined in the RVO section 551, chapter 1 and 2, should be refused until a new balance of protective measures in occupational medicine and data privacy will be established.
Tar bitumens are increasingly being used as a binder in road works. They consist of a standard product of about 70% bitumen and 25-30% tar. Tar bitumens are classifiable as the pyrolysis products of organic materials and are applied hot. Depending on the temperature used there are emissions of various intensities of polycyclic aromatic hydrocarbons (PAH), some of which are carcinogenic. A total of 250 one hour air samples was taken at breathing height on 20 days at 11 road works sites. The region of road paving operations in the immediate neighbourhood of the finishing machine operator and the screedmen were the chosen sampling points. A total of 19 unsubstituted chromatography/mass spectrometry. These included benzo[b]fluoranthene, benzo[a]pyrene, chrysene, dibenzo[a,h]anthracene, and indeno[1,2,3-cd]pyrene, all of which are carcinogenic. The median concentrations of chrysene and of benzo[b,j + k] fluoranthenes (determined en masse) were 9.3 and 2.8 micrograms/m3 respectively. The median concentrations of benzo[a]pyrene (BaP) and indeno[1,2,3,-cd]pyrene were 0.7 and 0.2 micrograms/m3 respectively. Dibenzo[a,h]anthracene had the lowest median concentration with about 0.03 micrograms/m3. Of the resulting shift means, the BaP concentration was over 1 microgram/m3 in about 50% of the cases, over 2 micrograms/m3 in 35%, and over 5 micrograms/m3 in about 15%. Even when the temperature of the paving mix was only between 120 degrees and 135 degrees C. 4.8% of the concentrations (identical to 3 samples) were greater than 2 micrograms BaP/m3, this value was exceeded in 34.9% of the determinations (identical to 30 samples) when the temperature of the tar bitumen was between 135 degrees and 150 degrees C. The highest concentration measured here was 17.8 micrograms BaP/m3. The recommended maximum paving temperature of the paving mix of 150 degrees C was exceeded in about 23% of all cases. The maximum concentration determined under any condition was 22 microgram/m(3). Thus the employment of tar bitumen as a binding material during road paving operations must be regarded as causing a considerable risk to health. The primary task is to ascertain whether tar bitumen can be replaced as a binder in paving for roads and what safety measures are practicable.