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Τρίτη 14 Φεβρουαρίου 2017

What programs are available to help individuals with asbestos-related diseases?

Mesothelioma lawsuits were created to give victims of asbestos-related diseases a way to get compensation for medical expenses, pain and suffering, lost wages, and in some instances, punitive damages.

Is there Federal legislation to help victims of asbestos-related diseases?
No Federal legislation has been enacted to compensate victims of asbestos-related diseases or to protect people from asbestos exposure. However, a bill called the Fairness in Asbestos Injury Resolution Act, or FAIR Act, has been introduced in Congress several times. This bill would create a national trust fund to compensate victims suffering from asbestos-related diseases. The proposed trust fund would be administered by the DOL, outside of the courts, through a claims process in which all individuals with certain medical symptoms and evidence of asbestos-related disease would be compensated. Funding for the trust would come from insurance companies and companies that mined, manufactured, and sold asbestos or asbestos products. Under the bill, individuals affected by asbestos exposure would no longer be able to pursue awards for damages in any Federal or state court.

What programs are available to help individuals with asbestos-related diseases?

Some people with asbestos-related illness may be eligible for Medicare coverage. Information about benefits is available from Medicare's Regional Offices, located in 10 major cities across the United States and serving specific geographic areas. The Regional Offices serve as the agency's initial point of contact for beneficiaries, health care providers, state and local governments, and the general public. General information about Medicare is available by calling toll-free 1–800–633–4227 (1–800–MEDICARE) or by visiting the Medicare website.

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 on the DOL website.

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:

Office of Workers' Compensation Programs
Employment Standards Administration
U.S. Department of Labor
Frances Perkins Building
200 Constitution Avenue, NW.
Washington, DC 20210
1–866–692–7487 (1–866–OWCPIVR)
202–693–0040 (Federal Employees' Compensation Program)
202–693–0038 (Longshore and Harbor Workers' Compensation Program)
OWCP-Public@dol.gov
http://www.dol.gov/owcp

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 website.


Asbestos-related diseases

From Wikipedia, the free encyclopedia
Asbestos-related disease
Asbestos effect.jpg
Figure A shows the location of the lungs, airways, pleura, and diaphragm in the body. Figure B shows lungs with asbestos-related diseases, including pleural plaque, lung cancer, asbestosis, plaque on the diaphragm, and mesothelioma.
Classification and external resources

Asbestos-related diseases are disorders of the lung and pleura caused by the inhalation of asbestos fibres. Asbestos-related diseases include non-malignant disorders such as asbestosis (pulmonary fibrosis due to asbestos), diffuse pleural thickening, pleural plaques, pleural effusion, rounded atelectasis and malignancies such as lung cancer and malignant mesothelioma.

People who worked in jobs with high asbestos dust exposure are at the highest risk of developing asbestos-related disease. However, exposure to asbestos may also occur in the worker's home due to dust that has accumulated on the worker's clothing (para-occupational exposure). Asbestos-related diseases can also occur as a result of non-occupational, environmental exposure. Asbestos was extensively used in many building materials, therefore large quantities of asbestos still remain in buildings that were built prior to the restriction of asbestos use that applies in many countries. The weathering and aging of such buildings may cause asbestos fragments to be released in the air and create a potential hazard. Anyone who disturbs the asbestos-containing material during home maintenance and renovation can be affected,[1] although the exact risks are difficult to quantify.

Pathophysiology

Inhaled asbestos fibres enter the upper and lower respiratory tracts when asbestos is released into the air. Some of the inhaled fibers are cleared by the mucociliary clearance mechanism but long thin asbestos fibers may reach the lower airways and alveoli, and can be retained in the lungs for many years. Amphibole fibers are not cleared as effectively as serpentines and therefore accumulate more readily in the distal lung parenchyma.[2] Asbestos fibres are recognised by the lungs as foreign bodies and cause the activation of the lung's local immune system leading to inflammation, cell and tissue damage. In the long term, this can lead to fibrosis, or rarely to malignancy. From the lungs, some asbestos fibres (mainly short fibres) can also migrate to pleural and peritoneal spaces.[3]

Non-malignant asbestos-related pleural diseases

Benign asbestos-related pleural abnormalities encompass four types of pleural changes:

  • Pleural plaques
  • Diffuse pleural thickening
  • Benign asbestos pleural effusions
  • Rounded atelectasis (folded lung)

The pleura appears to be more sensitive than the lung parenchyma to the effects of asbestos fibres.[4] Thus asbestos-related pleural diseases can result from much lower doses than the fibrotic changes in the lung.

Pleural plaques

Pleural plaques are the most common manifestation of asbestos exposure, affecting up to 58% of asbestos-exposed workers. The prevalence among the general population exposed environmentally ranges from 0.53 to 8%.[4] Pleural plaques are discrete circumscribed areas of hyaline fibrosis (patches of thickening) of the parietal pleura and rarely the visceral pleurathat develop 20 to 40 years after first exposure. Over time, usually more than 30 years, they often become partly calcified. They consist of mature collagen fibers arranged in an open basket-weave pattern and are covered by flattened or cuboidal mesothelial cells.[5] They have a white or pale yellow shaggy appearance and are typically distributed on the posterolateral chest wall, diaphragm, and mediastinal pleura.[6] The number and size varies. Pleural plaques are typically asymptomatic, however, there is still some controversy on this topic. An association between pleural plaques and chest pain has been reported,[7] but this has not been confirmed in more recent studies.[8] Similarly, an association between pleural plaques and a restrictive impairment with diminished diffusing capacity on pulmonary function testing has been described.[9] This has not been a consistent finding and it has been postulated that this might be related to undetected early fibrosis.[5] The pathogenesis of pleural plaques remains uncertain. The most likely explanation is that asbestos fibres reach the parietal pleura by passage through lymphatic channels where they excite an inflammatory reaction.[4] The chest X-ray is the usual tool for diagnosing pleural plaques but chest CT scan is more sensitive and specific in this regard. Pleural plaques are evidence of past asbestos exposure and indicate an increased risk for the future development of other asbestos-related diseases. Pleural plaques in themselves are not pre-malignant. Individuals with pleural plaques are usually not compensated in most compensation systems.

Diffuse pleural thickening

Diffuse pleural thickening (DPT) is non-circumscribed fibrous thickening of the visceral pleura with areas of adherence to the parietal pleura and obliteration of the pleural space.[10] It often extends over the area of an entire lobe or lung, with fibrotic areas involving costophrenic angles, apices, lung bases, and interlobar fissures. The thickness ranges from less than 1 mm up to 1 cm or more and may extend for a few millimeters into the lung parenchyma.[5] Fibrous strands ("crow's feet") extending from the thickened pleura into the lung parenchyma can be often detected on CT scan. Diffuse pleural thickening develops 20 to 40 years after first exposure.[11] All types of asbestos can cause diffuse pleural thickening and a dose-related relationship has been described.[6] It is thought that asbestos fibres that reach the pleura induce subpleural fibroblasts and mesothelial cells to produce scar tissue and collagen deposition, resulting in subpleural thickening.[6] Pleural plaques often coexist with DPT although the latter is rare compared with pleural plaques. According to the Australian Surveillance of Australian Workplace Based Respiratory Events (SABRE) scheme, DPT accounted for 22% of all asbestos-related diseases.[12] It usually begins with an inflammation of the pleura that is accompanied by a pleural effusion. Most patients complain of exertional breathlessness, however, chest pain has been also associated with this disorder.[10][11] DPT has a significant impact on pulmonary function, causing a decrease in forced vital capacity, reducing total lung capacity and diffusing capacity.[10][13] The restrictive impairment is a result of adhesions of the parietal with the visceral pleura as well as possible diaphragmatic involvement. Medical imaging is needed for diagnosis of diffuse pleural thickening. The appearance on a postero-anterior chest radiograph is of a continuous, irregular pleural shadowing. In accordance with the International Labor Organisation (2000) classification, diffuse pleural thickening is considered to be present if there is obliteration of the costophrenic angle in continuity with ≥3 mm pleural thickening.[14] CT scanning is more sensitive than chest radiography and can detect early pleural thickening (i.e. 1-2mm in thickness).[6] The most commonly used classification system defines diffuse pleural thickening as a continuous sheet of pleural thickening more than 5 cm wide, more than 8 cm in craniocaudal extent, and more than 3 mm thick.[15] Most patients are only mildly impaired by diffuse pleural thickening. Treatment options are limited but any new onset or severe pain should be investigated to exclude malignancy. In most compensation systems, patients are eligible for compensation which corresponds to the severity of disability.

Benign asbestos pleural effusion

Benign asbestos pleural effusion is an exudative pleural effusion (a buildup of fluid between the two pleural layers) following asbestos exposure. It is relatively uncommon and the earliest manifestation of disease following asbestos exposure, usually occurring within 10 years from exposure. Effusions may be asymptomatic but rarely, they can cause pain, fever, and breathlessness.[5] Effusions usually last for 3–4 months and then resolve completely. They can also progress to diffuse pleural thickening. Diagnosis relies on a compatible history of asbestos exposure and exclusion of other probable causes.

Rounded atelectasis

Rounded atelectasis (also known as Blesovsky's or folded lung syndrome) develops from infolding of thickened visceral pleura with collapse of the intervening lung parenchyma.[5] It presents radiographically as a mass and may be mistaken for a tumour. On a CT scan of the chest it appears as a rounded mass like opacity in the peripheral lung adjacent to thickened pleura and with curvilinear opacities which are the bronchi and vessels (comet tail).[16] Rounded atelectasis is the least common asbestos-related benign pleural disease. Exposure to asbestos is the most likely cause today but it can occur following other medical conditions. It is a chronic condition and usually asymptomatic.

Asbestosis

Asbestosis is a chronic lung disease caused by scarring of lung tissue, which results from prolonged exposure to asbestos. It is defined as diffuse interstitial pulmonary fibrosis secondary to asbestos exposure. It initially affects the lung bases and usually manifests after 15 or more years from initial exposure. It occurs after high intensity and/or long-term exposure to asbestos. Asbestos-related fibrosis is progressive because it continues to progress in the lung even if no further asbestos is inhaled. The scar tissue causes the alveolar walls to thicken, reducing the lung capacity which leads to the patient experiencing shortness of breath (dyspnea). Sufferers are at an increased risk for heart failure and certain malignancies.

Malignant asbestos-related diseases

Malignant mesothelioma

Malignant mesothelioma is an aggressive and incurable tumour caused by asbestos arising from mesothelial cells of the pleura, peritoneum (the lining of the abdominal cavity) and rarely elsewhere. Pleural mesothelioma is the most common type of mesothelioma, representing about 75 percent of cases. Peritoneal mesothelioma is the second most common type, consisting of about 10 to 20 percent of cases. Mesothelioma appears from 20 to 50 years after the initial exposure to asbestos. The symptoms include shortness of breath, chronic chest pain, cough, and weight loss. Diagnosing mesothelioma is often difficult and can include physical examination, chest X-ray and lung function tests, followed by CT scan and MRI. A biopsy is needed to confirm a diagnosis of malignant mesothelioma. Mesothelioma has a poor prognosis, with most patients dying within 1 year of diagnosis. The treatment strategies include surgery, radiotherapy, chemotherapy or multimodality treatment. Several tumour biomarkers (soluble mesothelin-related protein (SMRP),[17] osteopontin[18] and fibulin3[19]) have been evaluated for diagnostic purposes to allow early detection of this disease. Novel biomarkers such as volatile organic compounds measured in exhaled breath are also promising.[20]

Asbestos-related lung cancer

Asbestos can cause lung cancer that is identical to lung cancer from other causes. Exposure to asbestos is associated with all major histological types of lung carcinoma (adenocarcinoma, squamous cell carcinoma, large-cell carcinoma and small-cell carcinoma). The latency period between exposure and development of lung cancer is 20 to 30 years. It is estimated that 3%-8% of all lung cancers are related to asbestos.[21] The risk of developing lung cancer depends on the level, duration, and frequency of asbestos exposure (cumulative exposure). Smoking and individual susceptibility are other contributing factors towards lung cancer. Smokers who have been exposed to asbestos are at far greater risk of lung cancer. Smoking and asbestos exposure have a multiplicative (synergistic) effect on the risk of lung cancer. Symptoms include chronic cough, chest pain, breathlessness,haemoptysis (coughing up blood), wheezing or hoarseness of the voice, weight loss and fatigue. Treatment involves surgical removal of the cancer, chemotherapy, radiotherapy, or a combination of these (multimodality treatment). Prognosis is generally poor unless the cancer is detected in its early stages. Out of all patients diagnosed with lung cancer, only 15% survive for five years after diagnosis.

Asbestos disease medical articles

Thousands of scientific and medical articles have chronicled human understanding of the hazards of asbestos to human life.[22][23] This understanding paralleled the growth of theindustrial revolution, particularly in the textile factories and mines of Great Britain. This body of knowledge is frequently referred to in litigation as the state of the art or the benchmark for determining if a company acted within the bounds of negligent behavior. The following is a chronological list of some of the major pre-1950 scientific and medical articles relating to the knowledge of the medical and scientific communities regarding asbestos and disease in humans:

YearPublication
1898"Annual Report of the Chief Inspector of Factories and Workshops, Part II". H.M. Stationery Office. 1898: 171–172.
1912"Effect of Asbestos Dust on Workers Health in Asbestos Mines and Factories". The Labour Gazette: 761–762. 1912. External link in |journal= (help)
1918Hoffman, F.L. (1918). Mortality from Respiratory Diseases in Dusty Trades (Inorganic Dusts). U.S. Dept. of Labor, Bureau of Labor Statistics. pp. 35–47, 163–181.
1924Cooke, W.E. (July 26, 1924). "Fibrosis of the Lungs due to the Inhalation of Asbestos Dust". British Medical Journal. 2: 147–140. doi:10.1136/bmj.2.3317.147.PMC 2304688Freely accessible. PMID 20771679.
1928Editorial (1928). "Pulmonary Asbestosis". JAMA. 90 (2): 119–120. doi:10.1001/jama.1928.02690290049014.
1928Simpson, F.W. (1929). "Pulmonary Asbestosis in South Africa". British Medical Journal. 1: 885–887. doi:10.1136/bmj.1.3516.885.
1929Haddow, A.C. (August 3, 1929). "Asbestosis". The Lancet. 214: 231. doi:10.1016/s0140-6736(01)04102-2.
1929Wood, W.B. (May 10, 1929). Tubercle: 353–363. Missing or empty |title= (help)
1930Correspondence, Foreign Letters (June 28, 1930). "Compensation Act to be Extended to Asbestosis". JAMA. 94 (26): 2078. doi:10.1001/jama.1930.02710520044016.
1930Mills, R.G. (June 28, 1930). "Report of a Case". Minnesota Medicine: 495–499.
1930Editorial (1930). "Current Comment, Pulmonary Asbestosis". JAMA. 95 (19): 1431. doi:10.1001/jama.1930.02720190042014.
1930Merewether, E.R.A. (May 1930). "The Occurrence of Pulmonary Fibrosis and Other Pulmonary Afflictions in Asbestos Workers". J.Indus.Hyg. 5. 12: 198–257.
1930"Health and Industrial Hygiene - Pulmonary Asbestosis". Monthly Labor Review. 31: 74–76. 1930.
1930Encyclopedia of Hygiene, Pathology and Social Welfare: Occupation and Health, Vol. I, A-H. Geneva: International Labor Office. 1930. pp. 189–181.
1930Gardner, L.U. (1931). "Studies on Experimental Pneumonoconiosis: VI. Inhalation of Asbestos Dust, Its Effect Upon Primary Tuberculosis Infection". J.Indus.Hyg. 2. 13: 65–114.
1930Gordon, B (June 1931). "Pulmonary Asbestosis". Penn.Med.J. 35: 637–639.
1934Woods, W.B.; Gloyne, S.R. (1934). "PULMONARY ASBESTOSIS". Lancet. 2: 1383–1385. doi:10.1016/s0140-6736(00)43332-5.
1938Dreesen (August 1938). "A Study of Asbestos in the Asbestos Textile Industry". U.S. Treasury Dept., Public Health Bulletin: 1–126.
1941Dublin (1941). "Occupational Hazards and Diagnostic Signs, Bulletin". U.S. Dept. of Labor, Div. of Labor Standards. 41: II, IV, V and 25.
1942Holleb, H.B. (1942). "Bronchiogenic Carcinoma in Association with Pulmonary Asbestosis". American Journal of Pathology: 123–131.
1944Wedler, H.W. (1944). "Asbestosis and Pulmonmary Carcinoma". Bulletin of Hygiene. 19: 362.
1944Editorial (November 25, 1944). "Environmental Cancer". JAMA. 126 (13): 836. doi:10.1001/jama.1944.02850480036012.
1944Hutchinson (1944). "Dust as an Industrial Health Hazard". Heating and Ventilating. 41 (6): 57–61.
1946Fleischer, W.F. (1946). "Health Survey of Pipe Covering Operations in Constructing Naval Vessels". Journal of Industrial Hygiene and Toxicology. 1: 9–16.
1948Lynch, K.M. (1948). "Asbestosis IV: Analysis of Forty Necropsied Cases, Diseases of the Chest": 79–81.
1949Merewether (1949). "Annual Report of the Chief Inspector of Factories for 1947". London: H.M. Stationary Ofc.: 79–81.
1949Wyers (1949). "Asbestosis". Postgraduate Medical Journal: 631–638.

See also

References

  1. Olsen NJ, Franklin PJ, Reid A, et al. Increasing incidence of malignant mesothelioma after exposure to asbestos during home maintenance and renovation. Medical Journal of Australia 2011;195:271-274 [1]
  2. Kamp, D.W., Asbestos-induced lung diseases: an update. Translational Research, 2009. 153(4): p. 143-52.[2]
  3. Broaddus VC. Apoptosis and asbestos-induced disease: Is there a connection? The Journal of Laboratory and Clinical Medicine, 2001 May;137(5):314-5 [3]
  4. Peacock, C., S.J. Copley, and D.M. Hansell, Asbestos-related benign pleural disease. Clinical Radiology, 2000. 55(6): p. 422-32. [4]
  5. American Thoracic Society. Diagnosis and Initial Management of Nonmalignant Diseases Related to Asbestos. American Journal of Respiratory and Critical Care Medicine 2004;170:691-715 [5]
  6. Miles SE, Sandrini A, Johnson AR, Yates DH Clinical consequences of asbestos-related diffuse pleural thickening: A review. Journal of Occupational Medicine and Toxicology 2008;3:20 [6]
  7. Mukherjee S, de Klerk N, Palmer LJ, et al. Chest pain in asbestos-exposed individuals with benign pleural and parenchymal disease. American Journal of Respiratory and Critical Care Medicine 2000;162:1807-1811 [7]
  8. Park EK, Thomas PS, Wilson D, et al. Chest pain in asbestos and silica-exposed workers. Occupational Medicine 2011;61:178-183. [8]
  9. Oliver LC, Eisen EA, Greene R, Sprince NL. Asbestos-related pleural plaques and lung function. American Journal of Industrial Medicine 1988;14:649–656.
  10. Yates, D.H., et al., Asbestos-related bilateral diffuse pleural thickening: natural history of radiographic and lung function abnormalities. American Journal of Respiratory and Critical Care Medicine, 1996. 153(1): p. 301-6. [9]
  11. Jeebun V, Stenton SC. The presentation and natural history of asbestos-induced diffuse pleural thickening. Occupational Medicine 2012;62:266-268. [10]
  12. Hannaford-Turner K, Elder D, Sim MR, Abramson MJ, Johnson AR, Yates DH. Surveillance of Australian workplace Based Respiratory Events (SABRE) in New South Wales. Occupational Medicine. 2010 Aug;60(5):376-82. [11]
  13. Kee ST, Gamsu G, Blanc P. Causes of pulmonary impairment in asbestos- exposed individuals with diffuse pleural thickening. American Journal of Respiratory and Critical Care Medicine 1996;154:789–793 [12]
  14. International Labor Office International, Classification of Radiographs of Pneumoconioses. Geneva, Switzerland: International Labour Organization; 2011. [13]
  15. Lynch, DA; Gamsu, G; Aberle, DR (1989). "Conventional and high resolution computed tomography in the diagnosis of asbestos-related diseases". Radiographics. 9: 523–51.doi:10.1148/radiographics.9.3.2727359.
  16. Batra, P., et al., Rounded atelectasis. Journal of Thoracic Imaging, 1996. 11(3): p. 187-97. [14]
  17. Park EK, Sandrini A, Yates DH, et al Soluble mesothelin-related protein in an asbestos-exposed population: the dust diseases board cohort study. American Journal of Respiratory and Critical Care Medicine. 2008;178:832-837 [15]
  18. Park EK, Thomas PS, Johnson AR, Yates DH. Osteopontin levels in an asbestos-exposed population. Clinical Cancer Research 2009;15:1362-1366. [16]
  19. Pass HI, Levin SM, Harbut MR, et al. Fibulin-3 as a blood and effusion biomarker for pleural mesothelioma. The New England Journal of Medicine 2012;367:1417-1427 [17]
  20. Chapman EA, Thomas PS, Stone E, et al. A breath test for malignant mesothelioma using an electronic nose. The European Respiratory Journal 2012;40:448-54. [18]
  21. McCormack, V., et al., Estimating the asbestos-related lung cancer burden from mesothelioma mortality. British Journal of Cancer. 106(3):575-84.[19]
  22. Lemen, Richard; Dement, (Feb 1980). "Epidemiology of asbestos-related diseases". Environ. Health Perspectives. 34: 1–11. doi:10.1289/ehp.80341. PMC 1568524Freely accessible. PMID 6993197.
  23. Environmental Working Group, List of References regarding asbestos hazards
Retrieved from "https://en.wikipedia.org/w/index.php?title=Asbestos-related_diseases&oldid=758983396"

Asbestos Exposure and Cancer Risk

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What is asbestos?

Asbestos is the name given to a group of minerals that occur naturally in the environment as bundles of fibers that can be separated into thin, durable threads. These fibers are resistant to heat, fire, and chemicals and do not conduct electricity. For these reasons, asbestos has been used widely in many industries.

Chemically, asbestos minerals are silicate compounds, meaning they contain atoms of silicon and oxygen in their molecular structure.

Asbestos minerals are divided into two major groups: Serpentine asbestos and amphibole asbestos. Serpentine asbestos includes the mineral chrysotile, which has long, curly fibers that can be woven. Chrysotile asbestos is the form that has been used most widely in commercial applications. Amphibole asbestos includes the minerals actinolite, tremolite, anthophyllite, crocidolite, and amosite. Amphibole asbestos has straight, needle-like fibers that are more brittle than those of serpentine asbestos and are more limited in their ability to be fabricated (1, 2).

How is asbestos used?

Asbestos has been mined and used commercially in North America since the late 1800s. Its use increased greatly during World War II (3, 4). Since then, asbestos has been used in many industries. For example, the building and construction industries have used it for strengthening cement and plastics as well as for insulation, roofing, fireproofing, and sound absorption. The shipbuilding industry has used asbestos to insulate boilers, steam pipes, and hot water pipes. The automotive industry uses asbestos in vehicle brake shoes and clutch pads. Asbestos has also been used in ceiling and floor tiles; paints, coatings, and adhesives; and plastics. In addition, asbestos has been found in vermiculite-containing garden products and some talc-containing crayons.

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. In addition, manufacturers of electric hairdryers voluntarily stopped using asbestos in their products in 1979. In 1989, the U.S. Environmental Protection Agency (EPA) banned all new uses of asbestos; however, uses developed before 1989 are still allowed. The EPA also established regulations that require school systems to inspect buildings for the presence of damaged asbestos and to eliminate or reduce asbestos 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, U.S. manufacturers of these crayons agreed to eliminate talc from their products.

In August 2000, the EPA conducted a series of tests to evaluate the risk for consumers of adverse health effects associated with exposure to asbestos-contaminated vermiculite. The EPA concluded that exposure to asbestos from some vermiculite products poses only a minimal health risk. 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 vermiculite 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 into the home on clothing; and use premixed potting soil, which is less likely to generate dust (2).

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 the 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?

People may be exposed to asbestos in their workplace, their communities, or their homes. If products containing asbestos are disturbed, tiny asbestos fibers are released into the air. When asbestos fibers are breathed in, they may get trapped in the lungs and remain there for a long time. Over time, these fibers can accumulate and cause scarring andinflammation, which can affect breathing and lead to serious health problems (6).

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 (an inflammatory condition affecting the lungs that can cause shortness of breath, coughing, and permanent lung damage) and other nonmalignant lung and pleural disorders, including pleural plaques (changes in the membranes surrounding the lung), pleural thickening, and benign pleural effusions (abnormal collections of fluid between the thin layers of tissue lining the lungs 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 exposure to asbestos may be at increased risk for lung cancer (2, 9).

Who is at risk for an asbestos-related disease?

Everyone is exposed to asbestos at some time during their life. Low levels of asbestos are present in the air, water, and soil. However, most people do not become ill from their exposure. People who become ill from asbestos are usually those who are exposed to it on a regular basis, most often in a job where they work directly with the material or through substantial environmental contact.

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 the 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. Studies evaluating the cancer risk experienced by automobile mechanics exposed to asbestos through brake repair are limited, but the overall evidence suggests there is no safe level of asbestos exposure (3, 8). 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.

Individuals 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 individuals will need to be followed to determine the long-term health consequences of their exposure (10).

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 (11). 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 the 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 (6). 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 workplace 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 asbestos exposure who live close to asbestos mines (6).

What factors affect the risk of developing an asbestos-related disease?

Several factors can help to determine how asbestos exposure affects an individual, including (2, 6):

  • Dose (how much asbestos an individual was exposed to).
  • Duration (how long an individual was exposed).
  • Size, shape, and chemical makeup of the asbestos fibers.
  • Source of the exposure.
  • Individual risk factors, such as smoking and pre-existing lung disease.

Although all forms of asbestos are considered hazardous, different types of asbestos fibers may be associated with different health risks. For example, the results of several studies suggest that amphibole forms of asbestos may be more harmful than chrysotile, particularly for mesothelioma risk, because they tend to stay in the lungs for a longer period of time (1, 2).

How does smoking affect risk?

Many studies have shown that the combination of smoking and asbestos exposure is particularly hazardous. Smokers who are also exposed to asbestos have a risk of developing lung cancer that is greater than the individual risks from asbestos and smoking added together (3, 6). There is evidence that quitting smoking will reduce the risk of lung cancer among asbestos-exposed workers (4). Smoking combined with asbestos exposure does not appear to increase the risk of mesothelioma (9). However, people who were exposed to asbestos on the job at any time during their life or who suspect they may have been exposed should not smoke. 

How are asbestos-related diseases detected?

Individuals who have been exposed (or suspect they have been exposed) to asbestos fibers on the job, through the environment, or at home via a family contact should inform their doctor about their exposure history and whether or not they experience any symptoms. The symptoms of asbestos-related diseases may not become apparent for many decades after the exposure. It is particularly important to check with a doctor if any of the following symptoms develop (6):

  • Shortness of breath, wheezing, or hoarseness.
  • A persistent cough that gets worse over time.
  • Blood in the sputum (fluid) coughed up from the lungs.
  • Pain or tightening in the chest.
  • Difficulty swallowing.
  • Swelling of the neck or face.
  • Loss of appetite.
  • Weight loss.
  • Fatigue or anemia.

A thorough physical examination, including a chest x-ray and lung function tests, may be recommended. The chest x-ray is currently the most common tool used to detect asbestos-related diseases. However, it is important to note that chest x-rays cannot detect asbestos fibers in the lungs, but they can help identify any early signs of lung disease resulting from asbestos exposure (2).

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 (12).

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 (12). 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?

The Occupational Safety and Health Administration (OSHA) is a component of the U.S. Department of Labor (DOL) and is the Federal agency responsible for health and safety regulations in maritime, construction, manufacturing, and service workplaces. OSHA established regulations dealing with asbestos exposure on the job, specifically in construction work, shipyards, and general industry, that employers are required to follow. In addition, the Mine Safety and Health Administration (MSHA), another component of the DOL, enforces regulations related to mine safety. Workers should use all protective equipment provided by their employers and follow recommended workplace practices and safety procedures. For example, National Institute for Occupational Safety and Health (NIOSH)-approved respirators that fit properly should be worn by workers when required.

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"). Information about regional offices can also be found on OSHA's website.

More information about asbestos is available on OSHA's Asbestos 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. OSHA's national office can be contacted at:

Office of Public Affairs
Occupational Safety and Health Administration
U.S. Department of Labor
Room N–3649
200 Constitution Avenue, NW.
Washington, DC 20210
202–693–1999
1–800–321–6742 (1–800–321–OSHA)
1–877–889–5627 (TTY)
http://www.osha.gov/workers.html (workers' page)

Mine workers can contact MSHA at:

Office of Public Affairs
Mine Safety and Health Administration
U.S. Department of Labor
21st Floor
1100 Wilson Boulevard
Arlington, VA 22209
202–693–9400
1–800–746–1553
http://www.msha.gov
http://www.msha.gov/codeaphone/codeaphonenew.htm (National Hazard Reporting Page)

The National Institute for Occupational Safety and Health (NIOSH), which is part of the Centers for Disease Control and Prevention (CDC), 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:

Education and Information Division
Information Resources Branch
National Institute for Occupational Safety and Health
4676 Columbia Parkway
Cincinnati, OH 45226
1–800–CDC–INFO (1–800–232–7636)
cdcinfo@cdc.gov
http://www.cdc.gov/niosh
 

What programs are available to help individuals with asbestos-related diseases?

Some people with asbestos-related illness may be eligible for Medicare coverage. Information about benefits is available from Medicare's Regional Offices, located in 10 major cities across the United States and serving specific geographic areas. The Regional Offices serve as the agency's initial point of contact for beneficiaries, health care providers, state and local governments, and the general public. General information about Medicare is available by calling toll-free 1–800–633–4227 (1–800–MEDICARE) or by visiting the Medicare website.

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 on the DOL website.

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:

Office of Workers' Compensation Programs
Employment Standards Administration
U.S. Department of Labor
Frances Perkins Building
200 Constitution Avenue, NW.
Washington, DC 20210
1–866–692–7487 (1–866–OWCPIVR)
202–693–0040 (Federal Employees' Compensation Program)
202–693–0038 (Longshore and Harbor Workers' Compensation Program)
OWCP-Public@dol.gov
http://www.dol.gov/owcp

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 website.

Is there Federal legislation to help victims of asbestos-related diseases?

No Federal legislation has been enacted to compensate victims of asbestos-related diseases or to protect people from asbestos exposure. However, a bill called the Fairness in Asbestos Injury Resolution Act, or FAIR Act, has been introduced in Congress several times. This bill would create a national trust fund to compensate victims suffering from asbestos-related diseases. The proposed trust fund would be administered by the DOL, outside of the courts, through a claims process in which all individuals with certain medical symptoms and evidence of asbestos-related disease would be compensated. Funding for the trust would come from insurance companies and companies that mined, manufactured, and sold asbestos or asbestos products. Under the bill, individuals affected by asbestos exposure would no longer be able to pursue awards for damages in any Federal or state court.

What other organizations offer information related to asbestos exposure?

The organizations listed below can provide more information about 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. This 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:

Agency for Toxic Substances and Disease Registry
4770 Buford Highway, NE.
Atlanta, GA 30341
1–800–232–4636 (1–800–CDC–INFO)
1–888–232–6348 (TTY)
cdcinfo@cdc.gov
http://www.atsdr.cdc.gov

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 website includes a list of EPA state asbestos contacts. In addition, EPA's Asbestospage provides links to information about asbestos and its health effects, including suggestions for homeowners who suspect asbestos in their homes, and laws and regulations applicable to asbestos. Questions may be directed to:

U.S. Environmental Protection Agency
EPA West Building
National Program Chemicals Division
Mail Code 7404T
1200 Pennsylvania Avenue, NW.
Washington, DC 20460
202–554–1404 (TSCA Hotline)
202–554–0551 (TTY)
1–800–368–5888 (Asbestos Ombudsman)
tsca-hotline@epa.gov
http://www.epa.gov/asbestos

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 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:

Office of Information and Public Affairs
U.S. Consumer Product Safety Commission
4330 East West Highway
Bethesda, MD 20814
1–800–638–2772
1–800–638–8270 (TTY)
http://www.cpsc.gov

Individuals can also contact their local or state health department with questions or concerns about asbestos.


Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
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