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Loewen G, Black B, McNew T, Miller A. Lung cancer screening in patients with Libby amphibole disease: High yield despite predominantly environmental and household exposure. Am J Ind Med 2019; 62:1112-1116. [PMID: 31535393 PMCID: PMC6899927 DOI: 10.1002/ajim.23042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 01/11/2019] [Accepted: 08/06/2019] [Indexed: 12/17/2022]
Abstract
Background Lung cancer screening with low‐dose computed tomography (CT) scanning (LDCT) is accepted as a screening tool, but its application to populations exposed to recognized occupational or environmental carcinogens is limited. We apply LDCT to a population with a predominantly nonoccupational exposure to a recognized human lung carcinogen, Libby amphibole asbestos (LA). Methods Patients in an asbestos disease clinic in Libby, Montana who were aged 50 to 84 years, greater than or equal to 20 pack‐year history of tobacco use (irrespective of quit date), and asbestos‐related pleuropulmonary disease on high‐resolution CT scan were offered free annual lung cancer screening over a 39‐month period. Results Of 2897 clinic patients, 1149 (39.7%) met eligibility criteria, and 567 (49%) were screened with 1014 low‐dose CT scans. Most screened patients had principally environmental (333 or 59%) or household exposure (145 or 25%) to LA. Seventeen primary lung cancers were identified, mostly in early stages: 10 at stage 1, two at stage 2, three at stages 3 to 4, and two at limited small‐cell cancers. The screening yield was 1.9 at baseline scan and 1.5% on the first annual scan. Conclusions Consistent with the guidelines of the National Comprehensive Cancer Network and American Association of Thoracic Surgery, LDCT for early lung cancer detection should be offered to people with significant exposure to occupational or environmental human lung carcinogens.
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Affiliation(s)
- Gregory Loewen
- Washington State University Spokane Washington
- Center for Asbestos‐Related Disease Libby Montana
| | - Brad Black
- Center for Asbestos‐Related Disease Libby Montana
| | - Tracy McNew
- Center for Asbestos‐Related Disease Libby Montana
| | - Albert Miller
- Barry Commoner Center for the Environment and Health, Queens CollegeCity University of New York Flushing New York
- Division of Pulmonary and Critical Care MedicineMount Sinai Beth Israel Medical Center New York New York
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Miller A, Szeinuk J, Noonan CW, Henschke CI, Pfau J, Black B, Yankelevitz DF, Liang M, Liu Y, Yip R, McNew T, Linker L, Flores R. Libby Amphibole Disease: Pulmonary Function and CT Abnormalities in Vermiculite Miners. J Occup Environ Med 2018; 60:167-73. [PMID: 29200190 DOI: 10.1097/JOM.0000000000001178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This article describes radiologic and pulmonary function findings among miners exposed to Libby amphibole. Computed tomography (CT) permits the detection of the characteristic thin, lamellar pleural thickening (LPT). METHODS Individuals who worked at the mine for a minimum of 6 months had chest CT and pulmonary function tests. RESULTS Pleural thickening was noted in 223 (87%) of the 256 miners, parenchymal abnormalities in 49 (19%). LPT, found in 151 (68%), was associated with low values of forced vital capacity and diffusion capacity and significantly lower values in all pulmonary function tests when associated with parenchymal abnormalities. CONCLUSION Eighty-seven percent of miners exposed to Libby Amphibole had pleural abnormalities on CT. LPT alone, and more so with parenchymal abnormalities, resulted in decreased pulmonary function. The importance of this easily missed LPT is demonstrated by its high frequency and significant functional effects.
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Gavett SH, Parkinson CU, Willson GA, Wood CE, Jarabek AM, Roberts KC, Kodavanti UP, Dodd DE. Persistent effects of Libby amphibole and amosite asbestos following subchronic inhalation in rats. Part Fibre Toxicol 2016; 13:17. [PMID: 27083413 PMCID: PMC4832450 DOI: 10.1186/s12989-016-0130-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/10/2016] [Indexed: 12/31/2022] Open
Abstract
Background Human exposure to Libby amphibole (LA) asbestos increases risk of lung cancer, mesothelioma, and non-malignant respiratory disease. This study evaluated potency and time-course effects of LA and positive control amosite (AM) asbestos fibers in male F344 rats following nose-only inhalation exposure. Methods Rats were exposed to air, LA (0.5, 3.5, or 25.0 mg/m3 targets), or AM (3.5 mg/m3 target) for 10 days and assessed for markers of lung inflammation, injury, and cell proliferation. Short-term results guided concentration levels for a stop-exposure study in which rats were exposed to air, LA (1.0, 3.3, or 10.0 mg/m3), or AM (3.3 mg/m3) 6 h/day, 5 days/week for 13 weeks, and assessed 1 day, 1, 3, and 18 months post-exposure. Fibers were relatively short; for 10 mg/m3 LA, mean length of all structures was 3.7 μm and 1 % were longer than 20 μm. Results Ten days exposure to 25.0 mg/m3 LA resulted in significantly increased lung inflammation, fibrosis, bronchiolar epithelial cell proliferation and hyperplasia, and inflammatory cytokine gene expression compared to air. Exposure to 3.5 mg/m3 LA resulted in modestly higher markers of acute lung injury and inflammation compared to AM. Following 13 weeks exposure, lung fiber burdens correlated with exposure mass concentrations, declining gradually over 18 months. LA (3.3 and 10.0 mg/m3) and AM produced significantly higher bronchoalveolar lavage markers of inflammation and lung tissue cytokines, Akt, and MAPK/ERK pathway components compared to air control from 1 day to 3 months post-exposure. Histopathology showed alveolar inflammation and interstitial fibrosis in all fiber-exposed groups up to 18 months post-exposure. Positive dose trends for incidence of alveolar epithelial hyperplasia and bronchiolar/alveolar adenoma or carcinoma were observed among LA groups. Conclusions Inhalation of relatively short LA fibers produced inflammatory, fibrogenic, and tumorigenic effects in rats which replicate essential attributes of asbestos-related disease in exposed humans. Fiber burden, inflammation, and activation of growth factor pathways may persist and contribute to lung tumorigenesis long after initial LA exposure. Fiber burden data are being used to develop a dosimetry model for LA fibers, which may provide insights on mode of action for hazard assessment. Electronic supplementary material The online version of this article (doi:10.1186/s12989-016-0130-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephen H Gavett
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, NC, 27711, USA.
| | - Carl U Parkinson
- The Hamner Institutes for Health Sciences, Research Triangle Park, NC, 27711, USA
| | - Gabrielle A Willson
- Experimental Pathology Laboratories, Inc. (EPL®), Research Triangle Park, NC, 27711, USA
| | - Charles E Wood
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, NC, 27711, USA
| | - Annie M Jarabek
- National Center for Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, NC, 27711, USA
| | - Kay C Roberts
- The Hamner Institutes for Health Sciences, Research Triangle Park, NC, 27711, USA
| | - Urmila P Kodavanti
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, NC, 27711, USA
| | - Darol E Dodd
- The Hamner Institutes for Health Sciences, Research Triangle Park, NC, 27711, USA
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Abstract
PURPOSE OF REVIEW The vermiculite ore formerly mined in Libby, Montana, contains asbestiform amphibole fibers of winchite, richterite, and tremolite asbestos. Because of the public health impact of widespread occupational and nonoccupational exposure to amphiboles in Libby vermiculite, numerous related studies have been published in recent years. Here we review current research related to this issue. RECENT FINDINGS Excess morbidity and mortality classically associated with asbestos exposure have been well documented among persons exposed to Libby vermiculite. Excess morbidity and mortality have likewise been documented among persons with only nonoccupational exposure. A strong exposure-response relationship exists for many malignant and nonmalignant outcomes and the most common outcome, pleural plaques, may occur at low lifetime cumulative exposures. SUMMARY The public health situation related to Libby, Montana, has led to huge investments in public health actions and research. The resulting studies have added much to the body of knowledge concerning health effects of exposures to Libby amphibole fibers specifically and asbestos exposure in general.
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Winters CA, Hill WG, Rowse K, Black B, Kuntz SW, Weinert C. Descriptive analysis of the respiratory health status of persons exposed to Libby amphibole asbestos. BMJ Open 2012; 2:bmjopen-2012-001552. [PMID: 23175736 PMCID: PMC3532993 DOI: 10.1136/bmjopen-2012-001552] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Describe respiratory health and quality of life in persons exposed to Libby amphibole asbestos (LAA) contaminated vermiculite. DESIGN Cross-sectional descriptive. SETTING Asbestos-related disease clinic in Libby, Montana USA. PARTICIPANTS 329 individuals exposed to LAA; mostly men, married, between 50 and 69 years; two-thirds lived in the surrounding county; one-third lived elsewhere in the state and USA. PRIMARY OUTCOME MEASURES Chest radiograph (CXR), pulmonary function data and the St George Respiratory Questionnaire (SGRQ). RESULTS Exposure categories included vermiculite workers=7.6%; family/household contact of vermiculite worker=32%; and environmental exposure only=60%. Of the participants, 55% had only pleural abnormalities; 5.4% had only interstitial abnormalities; nearly 21% had both abnormalities and 18% had no lung abnormality on chest x-ray. Mean forced vital capacity (FVC) 95.3% (SD=18.7); forced expiratory volume (FEV(1)) mean 87% (SD=20.2); ratio of FEV1(1)/FVC 95.5% (SD=12.0); and diffusing capacity (DLCO) of 83% (SD=21.7) of the percent predicted. The mean total SGRQ (38.5; SD=22.1) indicated a lower quality of life than healthy persons and persons with other chronic conditions. SGRQ subscale means were Symptoms 52.1 (SD=24.9), activity 49.4 (SD=26.9) and impacts 27.5 (SD=21.9). Participants with normal CXR differed significantly from those with both interstitial and pleural abnormalities on total, activity and impacts scores. For activity alone, subjects with normal CXR differed significantly from those with pleural disease; no differences were found for those with interstitial disease. Significant findings were found for smoking history across all pulmonary measures, and for exposure status, radiographic findings, age and gender for select pulmonary parameters. Subjects with any smoking history had significantly worse average total and subscale scores on the SGRQ. CONCLUSIONS Of 329 persons exposed to LAA, the majority (182) had pleural abnormalities identified on CXR. SGRQ scores for persons with abnormalities (pleural, interstitial or both) (269) differed significantly from those with a normal CXR.
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Affiliation(s)
| | - Wade G Hill
- Montana State University, College of Nursing, Bozeman, Montana, USA
| | - Kimberly Rowse
- Center for Asbestos Related Disease, Libby, Montana, USA
| | - Brad Black
- Center for Asbestos Related Disease, Libby, Montana, USA
| | - Sandra W Kuntz
- Montana State University, College of Nursing, Bozeman, Montana, USA
| | - Clarann Weinert
- Montana State University, College of Nursing, Bozeman, Montana, USA
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Weinert C, Hill WG, Winters CA, Kuntz SW, Rowse K, Hernandez T, Black B, Cudney S. Psychosocial health status of persons seeking treatment for exposure to libby amphibole asbestos. ISRN Nurs 2011; 2011:735936. [PMID: 22007326 PMCID: PMC3169324 DOI: 10.5402/2011/735936] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 03/30/2011] [Indexed: 11/23/2022]
Abstract
A cross-sectional exploratory study was conducted to describe the psychosocial health status of persons seeking health care for exposure to Libby amphibole asbestos (LAA). Health indicators including depression, stress, acceptance of illness, and satisfaction with access and financial aspects of care were obtained via electronic and paper-pencil survey. The exposure pathway and demographic data were gleaned from the health record. Of the 386 participants, more than one-third (34.5%) demonstrated significant levels of psychological distress. The oldest group of women had the lowest levels of depression and stress and the highest acceptance of illness. Gender, age, and satisfaction with financial resources were significantly related to depression, stress, and acceptance of illness. Satisfaction with access to care was significant only for stress. No differences in depression, stress, and acceptance of illness were found based on residence, exposure pathway, or insurance status.
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Affiliation(s)
- Clarann Weinert
- College of Nursing, Montana State University, P.O. Box 173560, Bozeman, MT 59717-3560, USA
| | - Wade G. Hill
- College of Nursing, Montana State University, P.O. Box 173560, Bozeman, MT 59717-3560, USA
| | - Charlene A. Winters
- College of Nursing, Montana State University, 32 Campus Drive no. 7416, Missoula, MT 59812, USA
| | - Sandra W. Kuntz
- Robert Wood Johnson Foundation Nurse Faculty Scholar and College of Nursing, Montana State University, 32 Campus Drive no. 7416, Missoula, MT 59812, USA
| | - Kimberly Rowse
- Center for Asbestos Related Disease, 214 E 3rd Street, Libby, MT 59923, USA
| | - Tanis Hernandez
- Center for Asbestos Related Disease, 214 E 3rd Street, Libby, MT 59923, USA
| | - Brad Black
- Center for Asbestos Related Disease, 214 E 3rd Street, Libby, MT 59923, USA
| | - Shirley Cudney
- College of Nursing, Montana State University, P.O. Box 173560, Bozeman, MT 59717-3560, USA
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Rohs AM, Lockey JE, Dunning KK, Shukla R, Fan H, Hilbert T, Borton E, Wiot J, Meyer C, Shipley RT, Lemasters GK, Kapil V. Low-level fiber-induced radiographic changes caused by Libby vermiculite: a 25-year follow-up study. Am J Respir Crit Care Med 2007; 177:630-7. [PMID: 18063841 DOI: 10.1164/rccm.200706-841oc] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
RATIONALE From 1921 to 1990, vermiculite ore from Libby, Montana, was shipped worldwide for commercial and residential use. A 1980 study of a manufacturing facility using Libby vermiculite was the first to demonstrate a small but significant prevalence of pleural chest radiographic changes associated with amphibole fibers contained in the ore. OBJECTIVES This follow-up study of the original cohort evaluated the extent of radiographic changes and cumulative fiber exposure (CFE) 25 years after cessation of exposure. METHODS From the original cohort of 513 workers, 431 (84%) were living and available for participation and exposure reconstruction. Of these, 280 (65%) completed both chest radiographs and interviews. Primary outcomes were pleural and/or interstitial changes. MEASUREMENTS AND MAIN RESULTS Pleural and interstitial changes were demonstrated in 80 (28.7%) and 8 (2.9%) participants, respectively. Of those participants with low lifetime CFE of less than 2.21 fiber/cc-years, 42 (20%) had pleural changes. A significant (P < 0.001) exposure-response relationship of pleural changes with CFE was demonstrated, ranging from 7.1 to 54.3% from the lowest to highest exposure quartile. Removal of individuals with commercial asbestos exposure did not alter this trend. CONCLUSIONS This study indicates that exposure within an industrial process to Libby vermiculite ore is associated with pleural thickening at low lifetime CFE levels. The propensity of the Libby amphibole fibers to dramatically increase the prevalence of pleural changes 25 years after cessation of exposure at low CFE levels is a concern in view of the wide national distribution of this ore for commercial and residential use.
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Affiliation(s)
- Amy M Rohs
- Department of Environmental Health, University of Cincinnati College of Medicine, 3223 Eden Avenue, ML 0056, Cincinnati, OH 45267, USA
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Abstract
An unusual case of pleuroparenchymal lung disease caused by the inhalation of vermiculite dust, presumably containing asbestos fibers is described. The uniqueness of the case lies in the very indirect nature of exposure -- the wife of a factory owner, rather than a worker exposed to asbestos, whose factory manufactured vermiculite. The present case illustrates the importance of taking careful occupational histories of all household members when presented with a patient whose chest radiograph exhibits features consistent with asbestos exposure.
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Affiliation(s)
| | - Victor Hoffstein
- Correspondence: Dr Victor Hoffstein, St Michael’s Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8. Telephone 416-864-5516, fax 416-864-5649, e-mail
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Affiliation(s)
- A R Gibbs
- Department of Pathology, Environmental Lung Disease Research Group, Llandough Hospital, Penarth
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