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Mass Tort Update Asbestos Update
Asbestos and Your Health
Why is Asbestos dangerous?
When Asbestos is separated into very fine fibers, it becomes a serious health hazard. These fine fibers enter the body mainly through breathing. Fibers which cannot be coughed up or breathed out become trapped, causing cancers and irreparable scarring of the lungs. The killer qualities are associated with the length, diameter and strength of the fibers. The risk of disease is dose related. There is no safe level of exposure but increased exposure will increases the risk.
A typical fiber is approximately 2,000 times thinner than a human hair. It is believed that smaller, thinner, "respirable" fibers, measuring less than 0.3 microns (a millionth of a millimetre) in diameter and less than 5 microns in length are the ones which do the most damage. These fibers are invisible to the naked eye. Fibers up to 0.5 microns in width are not even visible under the optical microscope, the instrument used to analyze air samples.
Some of the small fibers remain in the lower parts of the lung for years. Some work their way through the lung lining. The fibers can induce cancers though it is not known how. There is speculation that macrophages, cells which are part of the body's defense mechanisms, try to engulf the fibers, but fail because of their shape. In the process they release powerful chemicals which may do the damage.
The main types of Asbestos diseases
Asbestosis
A disabling and ultimately fatal scarring of the lungs causing severe breathlessness and chest pains. The term was first used in 1924 by Cook in the British Medical Journal. The destructive effects of Asbestos cause the slow replacement of healthy lung tissue, responsible for the exchange of oxygen and carbon dioxide, by fibrous or scar tissue, which cannot "breathe". Lungs have a natural reserve capacity which means the disease will develop over many years without any symptoms showing. By then the damage is well and truly advanced. The victim will be short of breath, unable to walk very far, will have coughing, general weakness and chest pain. The damaged lungs strain the heart and can lead to congestive heart failure. X-Rays detect the damage at an early stage: a routine medical examination will not. Often a fine fibrosis is seen at the base of the lungs unlike the effects of other silicas.
This disease is most common among those who have had regular and high exposures to fibers: laggers, Asbestos textile workers, and those involved in the manufacture of Asbestos products. There are, however, documented cases where relatives of workers have died of Asbestosis and where people have worked for only short periods in the Asbestos industry. Because controls reducing fiber levels and bringing in respiratory protective equipment were introduced in these high risk areas many years ago Asbestosis should now become less frequent.
Lung cancer
A painful and nearly always fatal disease. The evidence that Asbestos could cause lung cancer was available in 1934. In the early 1940s there were reports in Germany. In 1949, the Chief Inspector of Factories reported finding lung cancer in 13.9% of UK Asbestosis cases. This increased risk of lung cancer was then confirmed epidemiologically in 1955 in Britain by Doll.
Asbestos and smoking
Lung cancer is generally associated with smoking. Recent figures by the Cancer Research campaign show that in the UK almost 40,000 people a year die from lung cancer, the most common cancer in men, and second most common in women. Smoking is assumed to be the main cause, but Peto's figures show that some 6,000 lung cancers a year may yet prove attributable to previous Asbestos exposure.
In 1966 a US study estimated that the risk of lung cancer in a non-smoker exposed to Asbestos is five times the expected rate. Smoking alone would increase the risk of lung cancer by a factor of 11. Asbestos and smoking together would increase the risk to 52 times that prevailing in the general population. The International Agency for Research on Cancer has quoted a study of Asbestos workers suggesting that Asbestos workers who smoke have eight times the risk of lung cancer as compared to all other smokers, and 92 times the risk of non-smokers not exposed to Asbestos.
There is an easily identifiable group with an enormous risk of developing lung cancer: smokers who have been exposed to Asbestos. A survey by the Liverpool Occupational Health Project involving 2,601 interviews in 1992 found that one in eight men had been exposed to Asbestos and of these one third were still smoking. Does this not call for urgent health education campaigns?
In Telemark County in Norway an intervention programme was set up to reduce Asbestos lung cancer by reinforcing stop smoking campaigns. It is still in progress so final results are not available. In a study of insulation workers who had stopped smoking before 1967 and who were observed from 1967 to 1976, the risk of dying from lung cancer was reduced to one third. An American stop-smoking programme targeted at Asbestos workers persuaded 34% of them to give up. It was important to tell them about the extra risk of lung cancer caused by Asbestos, and that the risk is reduced by stopping smoking.
Mesothelioma
A rapidly fatal and painful cancer of the lining of the lung (pleura), the abdomen (peritoneum), or heart (pericardium). Until the 1960s this form of cancer was unrecognised. More than 10 times as many deaths are due to pleural mesothelioma than to peritoneal mesothelioma. Some people develop both.
Pleural thickening
The lung walls thicken because of the scarring caused by Asbestos. This is seen on X-ray examination. Extensive thickening may cause severe shortness of breath. It can be described as on one side of the lungs, or both sides (bilateral) or it can be described as widespread (diffuse).
Pleural plaques
Also show up on X-rays. They are dense bands of scar tissue, different from pleural thickening. Plaques are usually seen on both sides of the lungs. People with pleural plaques may run an increased risk of developing lung cancer.The lung cancer rate in a group of shipyard workers with plaques was double that of shipyard workers without.
Other types of cancers
In 1982 the International Agency for Research on Cancer (IARC) said there is sufficient evidence of increased risk of gastrointestinal cancers and cancers of the larynx in workers exposed to the three main types of Asbestos.
In a 1985 review for the HSC Doll and Peto concluded Asbestos probably caused cancer of the larynx. They are more hesitant about agreeing with American research, mainly that of Irving Selikoff, about the increased risk of gastrointestinal cancer. They considered 16 studies which together showed the relative risk of gastrointestinal cancer was generally about 20% of the excess risk of lung cancer. They say, "These findings could arise because Asbestos is a cause of cancer in practically every organ..." but then conclude these excess gastrointestinal cancers might really be misdiagnosed cancers of the lungs and mesotheliomas of the pleura and peritoneum (except in the case of cancer of the oesophagus). They note that in the studies special efforts were made to make sure there was no misdiagnosis. In failing to agree with IARC that there is an increased risk of gastrointestinal cancer they appear to be placing a great deal of weight on animal experiments which have failed to reproduce these cancers. They noted in conclusion that three out of five studies found an increase of cancer of the ovary but that in these studies there could have been some misdiagnosis (which presumably also means there may not have been).
This report records the fact that a number of small studies have shown an increased risk of cancer of the kidney and large cell lymphoma of the oral cavity related to Asbestos exposure. The studies are too small to draw definite conclusions but add to the overall picture that Asbestos is lethal.
Asbestos and children
Certain factors mean extra care should be taken to protect children from Asbestos. First of all the younger you are when exposed, the younger you will be should disease start to show despite the long latency period. Secondly children might be particularly vulnerable to cancers. Young body tissue is growing and may be more susceptible to carcinogens.
The 1960 paper by Wagner, which first described mesothelioma in South Africa, refers to eleven cases where the disease resulted from exposure in childhood. The children lived in the vicinity of a blue Asbestos (crocidolite) mine. Several cases of children developing mesothelioma are described by Paul Holt in Inhaled Dust and Disease. One Asbestos factory near London seems particularly guilty of killing children in its neighbourhood, though this might only mean that other factories have not been studied so thoroughly. 12 cases of mesothelioma are known, all of people who lived near to the factory during their childhood; 11 of them were women.
Asbestos has been found in the lungs of very young children (three weeks-25 months) when examined after they had died.
A 1983 US Consumer Product Safety Commission expressed concern about the risk of exposure to levels of Asbestos fibers at or below the environmental action level of 0.01 fiber/ml. It is worrying that schools may be declared safe and uncontaminated at this level. The Commission added, "Because of the rapid increase of risk with time, the lifetime effect of exposure in childhood is likely to be much greater than if exposure begins in adulthood."
This US Commission attempted to quantify the risk to children's health. They estimated that three children in every 1,000 exposed to 0.01 fibers/ml (the "acceptable" environmental level) for 10 years would die of Asbestos-related cancer. This figure although frightening in itself, takes no account of the increased risk from "peak" exposures or the fact that many children, particularly the disadvantaged, live in homes containing so much Asbestos they can be described as Asbestos boxes.
Women and Asbestos
A recent New Statesman article by Sally Moore, a partner at solicitors Leigh, Day and Co., and Joanne Lenaghan, a former researcher for Clydeside Action on Asbestos, highlights the fact that many women die of Asbestos-related diseases, yet they are ignored by the system, especially for state benefits. They do not dispute that there is a much higher level of these diseases among men. They argue, however, that there tends to be a lack of adequate investigation into the possibility that Asbestos may have caused these illnesses in women. They point to "a combination of ignorance and prejudice in the medical, social and legal professions."
A lot of the problem is due to the mistaken belief that only a very large dose of Asbestos can cause cancer or Asbestosis. The way in which women tend to have been exposed in the past confirms that there is no level below which exposure to Asbestos can be considered "safe".
Women who have died recently include two teachers, Jeanette Sawyers from Glasgow and Shirley Gibson from London, a cleaner in a bus garage, and many women who worked in the manufacture of Asbestos containing products. 70 female former employees of Boots, producers of gas masks in the war, have died from mesothelioma. Hannah Meres worked to "do her bit" for the war effort at Boots in Nottingham. Because she was pregnant it was only for five weeks, yet 53 years later she died of mesothelioma. Liverpool Occupational Health Project has highlighted the deaths of women warehouse workers who recycled Asbestos sacks, a problem likely to be found in other warehouse workers.
Alice Grace Jefferson, the subject of Alice: a Fight for Life, worked with Asbestos at Cape industries, Hebden Bridge for only nine months when she was a young woman aged 17. She died aged 48, after being ill for eight years and in great pain for the last year of her life. Many other women who worked in this factory also suffered and died prematurely.
Alice: a Fight for Life was a Yorkshire TV documentary first shown in July 1982. It changed society's view on the hazards of Asbestos in a way no other programme has ever achieved. Alice's death was unnecessarily because the factory was covered by Regulations introduced in 1930. Yet a 1976 Ombudsman report showed the factory inspectorate were complacent to the 107 deaths that had taken place at that point.
Washing work clothes seems an innocent enough activity, but for many women it has led to their death. The SWORD scheme mentioned earlier, reports for 1993, 25 cases of mesothelioma, 16 of benign pleural disease and one of pneumoconiosis (Asbestosis), all these were from domestic exposure to Asbestos. Domestic exposure is rarely described further in the SWORD scheme, but it generally means cases which resulted from workers bringing home dust on their clothes, and the victims of such exposure are usually, but not exclusively, women.
The Liverpool women
Hundreds of Liverpool women may have been exposed to high levels of Asbestos while working in sack repair warehouses. Used cargo bags were sent up from the docks to be recycled. Some of the sacks contained a residue of dusts including nuts, grain, flour and Asbestos. To clean the bags of dust, women would place the bags under huge static blowers and blow the used bags inside out. Women have described the levels of dust as so great, they could not see further than a few paces in front of them. In 1928, Ellen Wilkinson MP raised questions in Parliament, "After a few hours at this work the women become choked with grain and mineral dust". Illness among such workers was reported in the 1960s and 1970s.,
The Liverpool and District Victims of Asbestos Support Group have been contacted by over 80 women who did such work. Most of the women have severe breathing problems. So far the project knows about 15 such sack repair warehouses in Liverpool. One warehouse operated up to the early 1970s. There are likely to have been similar warehouses elsewhere in the UK, whose ex-workers need help.
Cryptogenic Asbestos
Julia Campbell worked as a school cleaner in Glasgow for more than 30 years. As a non-smoker she never had any health problems until recently when she began to experience shortness of breath and pains in her chest. A chest consultant has diagnosed cryptogenic fibrosing alveolitis. This means Julia is suffering from a fibrosis of the lung tissue, exactly what occurs as a result of Asbestos exposure, except that cryptogenic means "of unknown cause". A post mortem is needed to distinguish between the conditions. Julia has been exposed to Asbestos. 15 years earlier she regularly cleaned a science lab with a damaged ceiling. Every day for six months she would clean up Asbestos dust that had fallen from insulation material. She also has pleural plaques, accepted as evidence of Asbestos exposure, yet the Department of Social Security has refused her claim for benefit. Her work history is said to be insufficient to cause Asbestosis.
Environmental exposures
According to Julian Peto, "Every single person in the UK has some Asbestos in their lungs. It is the level of exposure and the frequency that's important. All the established cases (of mesothelioma) so far have been due to high and regular exposure. What we don't know is if the lower levels due to environmental exposure cause mesothelioma. Since the risk to men is six times higher than the risk to women (who are seldom exposed to Asbestos at work), environmental exposure is clearly not as significant as occupational exposure."
There is a great deal of resistance to the idea that low level exposure to Asbestos is a risk to health. In actual fact people with evidence of lower levels of exposure to Asbestos are develop mesothelioma but they then have a harder time gaining compensation because experts go into court and say the environmental risk is negligible.
It is not natural to have Asbestos in your lungs. If it is truly the case that everyone now has some, then the prospects are terrifying given the long latency for the diseases. Environmental exposures have caused disease as the deaths of many women prove. Deaths caused by such exposures are likely to rise in the future because much Asbestos in buildings is totally uncontrolled. Asbestos has blighted the lives of whole communities in the industrial centers of the UK, not just in shipbuilding cities and towns.
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