Biological effects: asbestos-cement manufacturing.

Fourteen cohorts of asbestos-cement workers have been studied. These studies have demonstrated exposure-response relationships for lung cancer, mesothelioma and asbestosis. For lung cancer, relatively consistent results have been observed, with risk two-fold or less in 13 of the 14 cohorts. Among New Orleans workers, excess risk was restricted to those with X-ray evidence of asbestosis. Workers employed at least 21 years but without X-ray abnormalities, experienced no elevated risk, while those with small opacities (1/0 or higher) had substantially elevated risk (SMR > 400). Exposures in these two groups had been similar. These results suggest that asbestosis may be a necessary precursor for asbestos-induced lung cancer; if so, then the no-threshold model for lung cancer risk is inappropriate since there is general agreement that very low exposures will not result in radiologically detectable lung fibrosis. Further data on this potential link are needed. As in other industries, mesothelioma risk was strongly related to amphibole exposure, especially to crocidolite in asbestos-cement pipe manufacture. A cluster of cases has recently been reported in a family amosite-cement business. Among New Orleans workers, risk of asbestosis was related to cumulative exposure but there was little evidence of risk below 30 f ml-1-years. Progression of asbestosis in these workers was slow, related to past cumulative exposure and not related to lung function decline. Asbestosis risk is therefore not likely to develop in workers under current controlled exposure conditions.