In 1965 the polarization of expert opinion began between Irving Selikoff and his Mount Sinai co-investigators, and the British and largely European view on the role of chrysotile asbestos in causation of mesothelioma versus crocidolite asbestos. Selikoff et al (62) stated, American asbestos utilization differed to some extent from British and South African experience in at least one important respect. Crocidolite is a relative newcomer to the American asbestos-industry scheme. Thus American imports of crocidolite (none mined here) were less than 500 tons in 1935 and reached a level of only 20,000 tons even in 1962. In contrast, chrysotile, the type of asbestos fiber widely used in the American asbestos industry, was imported at a level of 165,000 tons in 1935 and 650,000 tons in 1962.
Later the authors stated, “If mesothelioma could be found with increased frequency in association with asbestos in this country, it would demonstrate that this tumor was another neoplastic hazard of asbestos exposure in general and not limited to one area or to one type
of asbestos.” How much of the incidence of mesothelioma in America was due to amosite was unclear.
mesothelioma
J.S. Harington (79) wrote a chapter on mesothelioma in the book The Prevention of Cancer, edited by Raven and Rowe in 1967. He stated, “The results of animal experimentation so far available suggests that croci-dolite and chrysotile may be more active in inducing mesotheliomas than amosite. If the present trend is confirmed, substitution in mining
and industry of amosite (for example, for the more dangerous types of asbestos where they cannot be safely used) may be a practical and important preventative measure.”
Later the authors stated, “If mesothelioma could be found with increased frequency in association with asbestos in this country, it would demonstrate that this tumor was another neoplastic hazard of asbestos exposure in general and not limited to one area or to one type
of asbestos.” How much of the incidence of mesothelioma in America was due to amosite was unclear.
mesothelioma
J.S. Harington (79) wrote a chapter on mesothelioma in the book The Prevention of Cancer, edited by Raven and Rowe in 1967. He stated, “The results of animal experimentation so far available suggests that croci-dolite and chrysotile may be more active in inducing mesotheliomas than amosite. If the present trend is confirmed, substitution in mining
and industry of amosite (for example, for the more dangerous types of asbestos where they cannot be safely used) may be a practical and important preventative measure.”
In an unsigned editorial in Lancet published on March 5, 1966, the author stated, “A possible important clue to prevention was just un-covered by Wagner in South Africa, where after showing association between mesothelial tumors and exposure to the crocidolite form of
asbestos, he and his colleagues were unable to find any tumors in those exposed only to the amosite or chrysotile-types of fiber. The position in South Africa remains the same, despite the continuing intensive search in the amosite and chrysotile mining areas.” He goes on to say,
“Mesothelioma tumors have been seen in a few individuals apparently exposed only to chrysotile in the United States and Canada, and other populations, either industrial or residential, exposed only to one type of fiber must now be investigated. This can be achieved only by inter-national cooperation, because such exposures are almost entirely limited to those engaged in mining and milling of the fiber, which is done in the countries where the different types of asbestos are found.” Selikoff et al (80) reviewed the results of a study of an asbestos insula-tion manufacturing plant in Paterson, New Jersey, and published their results in the Archives of Environmental Health in September 1972. In this paper the authors pointed out “few data exist concerning the compar-ative neoplastic potential in man of the several kinds of asbestos, and
particularly there has been no evidence concerning whether amosite variety is carcinogenic....Whether or not amosite is carcinogenic is of some practical importance. Because this variety of asbestos has not been reported to cause cancer, there has been a tendency in Great Britain, for example, to substitute it for other types of asbestos, especially crocidolite.” Selikoff and coworkers went on to report an increased incidence of lung cancer and mesothelioma in this plant, where it was thought to be just a pure exposure to amosite asbestos.
While it was generally accepted in the United States that pure amosite caused a high incidence of mesotheliomas and lung cancers, the paper by Selikoff and coworkers was not well accepted abroad. McCullagh (81) published a paper in the Journal of the Society of Occupational Med-
icine in 1980, “Amosite as a Cause of Lung Cancer and Mesothelioma in Humans.” He pointed out that many of the Paterson, New Jersey, cohorts studied by Selikoff had previous exposure to asbestos. He felt that rather than one fiftieth of the group, it seemed more likely that one third of the group or 300 members of the Paterson cohort had been occupationally exposed to asbestos before entering the cohort. This is of import since crocidolite was being used in large quantities in asbestos factories in the same area. Selikoff had felt that very little crocidolite had been used in the shipyards and in the United States, and therefore, if a mesothelioma developed, it was most likely related to amosite since there was very little crocidolite exposure. In fact the monthly trade journal Asbestos mentioned the use of crocidolite
and amosite asbestos in July 1919.
John Harington and Neil McGlashan (82) reviewed the destination of South African exports of crocidolite and amosite asbestos as well as chrysotile from 1959 until 1993, and the studies indicate that the United States received a considerable amount of crocidolite asbestos up until
1992. This study and others have suggested there was more crocidolite asbestos used in the United States than had been previously recog-nized, and that the use of crocidolite asbestos is a major reason why there was an increased risk of mesothelioma.
asbestos, he and his colleagues were unable to find any tumors in those exposed only to the amosite or chrysotile-types of fiber. The position in South Africa remains the same, despite the continuing intensive search in the amosite and chrysotile mining areas.” He goes on to say,
“Mesothelioma tumors have been seen in a few individuals apparently exposed only to chrysotile in the United States and Canada, and other populations, either industrial or residential, exposed only to one type of fiber must now be investigated. This can be achieved only by inter-national cooperation, because such exposures are almost entirely limited to those engaged in mining and milling of the fiber, which is done in the countries where the different types of asbestos are found.” Selikoff et al (80) reviewed the results of a study of an asbestos insula-tion manufacturing plant in Paterson, New Jersey, and published their results in the Archives of Environmental Health in September 1972. In this paper the authors pointed out “few data exist concerning the compar-ative neoplastic potential in man of the several kinds of asbestos, and
particularly there has been no evidence concerning whether amosite variety is carcinogenic....Whether or not amosite is carcinogenic is of some practical importance. Because this variety of asbestos has not been reported to cause cancer, there has been a tendency in Great Britain, for example, to substitute it for other types of asbestos, especially crocidolite.” Selikoff and coworkers went on to report an increased incidence of lung cancer and mesothelioma in this plant, where it was thought to be just a pure exposure to amosite asbestos.
While it was generally accepted in the United States that pure amosite caused a high incidence of mesotheliomas and lung cancers, the paper by Selikoff and coworkers was not well accepted abroad. McCullagh (81) published a paper in the Journal of the Society of Occupational Med-
icine in 1980, “Amosite as a Cause of Lung Cancer and Mesothelioma in Humans.” He pointed out that many of the Paterson, New Jersey, cohorts studied by Selikoff had previous exposure to asbestos. He felt that rather than one fiftieth of the group, it seemed more likely that one third of the group or 300 members of the Paterson cohort had been occupationally exposed to asbestos before entering the cohort. This is of import since crocidolite was being used in large quantities in asbestos factories in the same area. Selikoff had felt that very little crocidolite had been used in the shipyards and in the United States, and therefore, if a mesothelioma developed, it was most likely related to amosite since there was very little crocidolite exposure. In fact the monthly trade journal Asbestos mentioned the use of crocidolite
and amosite asbestos in July 1919.
John Harington and Neil McGlashan (82) reviewed the destination of South African exports of crocidolite and amosite asbestos as well as chrysotile from 1959 until 1993, and the studies indicate that the United States received a considerable amount of crocidolite asbestos up until
1992. This study and others have suggested there was more crocidolite asbestos used in the United States than had been previously recog-nized, and that the use of crocidolite asbestos is a major reason why there was an increased risk of mesothelioma.
J.C. Wagner recapitulated his overview of the association between blue asbestos and mesotheliomas in an article published in the British Journal of Industrial Medicine in 1991. He reviewed his story of the dis-covery of the association between asbestos and mesothelioma, and con-cluded that there was evidence that all types of commercial asbestos except anthophyllite may be responsible for a mesothelioma. He went on to state, “The risk is greatest with crocidolite, less with amosite, and apparently less with chrysotile. With amosite and chrysotile there appears to be a higher risk in the manufacturing than in mining and milling.... There is overwhelming evidence that crocidolite is a main fiber associated with mesotheliomas.” This has primarily been the British view, and Raymond Parkes (83), in his classic book Occupational Lung Disorders, 2nd edition, published in 1982, stated about mesothe-lioma causation, “On present evidence its occurrence appears to be closely, but not uniquely, related to crocidolite alone or a mixture of fiber types in the distant past” (p. 276).
The most recent article relating to the historical crocidolite exposure issue in the United States was by Langer and Nolan (84) entitled, “Asbestos in the Lungs of Persons Exposed in the USA” and published in Monaldi Archives of Chest Disease in 1998. In their appendix of croci-dolite consumption in the United States, they pointed out that blue asbestos for boiler and steam covering for locomotives was advertised in trade journals, such as Engine, as early as 1897. The data from the U.S. Department of Commerce reveals significant crocidolite importa-
tion in the 1920s and 1930s, and it included the spraying of crocidolite in the form of Limpet up until 1966. The paper goes on to mention that all three major fiber types were permanently used on ships, and croci-dolite was extensively applied in warships in the United Kingdom.
International investigators outside the United States have interpreted this to mean that crocidolite was also used aboard American ships, and if mesotheliomas occurred among American insulation workers who worked in military shipyards, this was indirect evidence of crocidolite exposure. The authors went on to state, “Still other investigators suggested that British ships were re-outfitted in U.S.A. ports during the war, and they have been the source of crocidolite exposure to American shipyard workers. This most certainly occurred and citations
in the literature support this.” It seems ironic that 100 years earlier in 1870 the distinct pathologic
entity of pleural mesothelioma was postulated by one Wagner, and then greatly advanced 100 years later by another physician named Wagner whose contributions have propelled science into the next millennium.
tion in the 1920s and 1930s, and it included the spraying of crocidolite in the form of Limpet up until 1966. The paper goes on to mention that all three major fiber types were permanently used on ships, and croci-dolite was extensively applied in warships in the United Kingdom.
International investigators outside the United States have interpreted this to mean that crocidolite was also used aboard American ships, and if mesotheliomas occurred among American insulation workers who worked in military shipyards, this was indirect evidence of crocidolite exposure. The authors went on to state, “Still other investigators suggested that British ships were re-outfitted in U.S.A. ports during the war, and they have been the source of crocidolite exposure to American shipyard workers. This most certainly occurred and citations
in the literature support this.” It seems ironic that 100 years earlier in 1870 the distinct pathologic
entity of pleural mesothelioma was postulated by one Wagner, and then greatly advanced 100 years later by another physician named Wagner whose contributions have propelled science into the next millennium.
Selikoff in hindsight also reviewed the literature on mesothelioma and stated, “During the 1950s there were several reports of deaths in asbestos workers caused by these diffuse tumors of the mesothelial sur-faces. These isolated cases would have received little notice had it not been for the fact that the tumor has always been considered extraordi-narily rare. It is no longer rare amongst asbestos workers. Indeed, it is so common a cause of death amongst them now. While still rare amongst individuals not known to be exposed to asbestos—it almost constituted tumor specific to asbestos exposure.” Furthermore, writing in 1988, Dr. Selikoff and coworkers (85) stated, “Nevertheless only in the past 25 years has malignant mesothelioma been widely accepted as an independent diagnostic entity.” These workers found 175 deaths from mesothelioma occurred among 2221 men who died between 1967 and 1976, and 181 more deaths in the next 8 years for a total of 356 deaths from mesothelioma out a total of 3500 deaths from all causes by 1984; 134 of these were pleural and 222 were peritoneal mesotheliomas.
The history of the early years of mesothelioma discovery are an example of how slowly the medical community accepts new discover-ies. Acceptance was in part slowed by the lack of specific mesothelial cell markers such as are available today to assure proper diagnosis;
experts disagreed among themselves as to the proper classification of these tumors. As the frequency of these tumors increased, pathologists made the diagnosis with more confidence and, as noted by Selikoff, there was general acceptance of not only the criteria for diagnosis but
also the clear association with asbestos exposure by 1973. The role of specific fiber types would have to await the results of further studies, particularly lung fiber analysis by electron microscopy over the next 30 years.
The history of the early years of mesothelioma discovery are an example of how slowly the medical community accepts new discover-ies. Acceptance was in part slowed by the lack of specific mesothelial cell markers such as are available today to assure proper diagnosis;
experts disagreed among themselves as to the proper classification of these tumors. As the frequency of these tumors increased, pathologists made the diagnosis with more confidence and, as noted by Selikoff, there was general acceptance of not only the criteria for diagnosis but
also the clear association with asbestos exposure by 1973. The role of specific fiber types would have to await the results of further studies, particularly lung fiber analysis by electron microscopy over the next 30 years.
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