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Our 1990 article reported on recent papers in the peer-reviewed literature and two international symposia, one at the International Agency for Research on Cancer (2) and the other at Harvard University (3), all concluding that chrysotile fibers are less active than amphibole types (crocidolite, amosite, tremolite) of asbestos in the causation of mesothelioma in man. In his summary of the IARC meeting, Sir Richard Doll, an eminent epidemiologist, concluded there is the difference between the effects of chrysotile and amphiboles, which is so great in relation to mesothelioma that it is possible to argue that chrysotile does not cause mesothelioma at all (2). This observation has been supported by numerous peer-reviewed papers and working groups subsequently (4-6).
Mesothelioma, a fatal cancer usually found on the lining of the lung, is specifically recognized in Ontario—as is asbestosis—as arising from exposure to asbestos. Mesothelioma is written into the Compensation Act as a Schedule 4 Disease.
In stating that a threshold of effect has never been found for asbestos, Rall stands behind the outdated one fiber can kill theory of carcinogenesis. However, Rall fails to mention data supporting a threshold for chrysotile in lung cancer (11, asbestosis (12), and mesothelioma (13) as well as a panel report from the Health Effects Institute-Asbestos Research (HEI-AR) detailing animal and in vitro dose-response studies exhibiting no-observed adverse effect levels (NOAELs) for asbestos (14). Our recent work documents a dose-dependent increase in asbestos-induced proto-oncogene activation in mesothelial cells with no induction at lowest concentrations of fibers tested and an enhanced potency of crocidolite asbestos in comparison to chrysotile (15).
The Monfalcone area, in northeastern Italy, is a small industrial territory (population about 60,000), with a large shipyard. Between October 1979 and April 1992, ninety-two malignant mesotheliomas were diagnosed at the Monfalcone Hospital. The series included 84 men and 8 women, aged 42 to 89 years (median age 68 years). There were 89 pleural and 3 peritoneal tumors. Seventy patients (69 men and 1 woman) had worked in the shipyards; six were seamen, and four insulators. Five men had been exposed to asbestos in various industries; six women had histories of domestic exposure, and one woman had a history of possible environmental exposure. The latency periods (intervals between first exposure to asbestos and diagnosis of the tumor) ranged from 20 to 65 years (median 52 years). Latency periods among insulators were significantly lower than among shipyard workers, as well as lower than among the other categories (.
A spatial cluster of pleural mesothelioma cases was detected in Broni, in the Province of Pavia (northwestern Italy). Eighteen deaths due to malignant pleural neoplasms were observed in the years 1980-87 (SMR: 556; 95% confidence interval: 329-878) and the incidence of pleural mesothelioma in 1980-89 was 9.1 cases per 100,000 person-years among men and 4.3 cases among women. These findings are discussed with reference to the presence in Broni of a plant manufacturing asbestos cement products. _____________________________________________________________
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