Help professional automotive technicians and home mechanics

Asbestos is a naturally occurring mineral fiber, once widely used in building materials and products for its thermal insulating properties and fire resistance. Intact, undisturbed asbestos-containing materials generally do not pose a health risk. These materials may become hazardous and pose increased risk if they are damaged, are disturbed in some manner, or deteriorate over time and release asbestos fibers into building air.

A number of building materials and products still in use today contain asbestos. Asbestos remains in use as an acoustic insulator, and in thermal insulation, fire proofing, roofing, flooring and other materials.

This information can help professional automotive technicians and home mechanics who repair and replace brakes and clutches. By law, most professional automotive shops must follow the Occupational Safety and Health Administration's (OSHA) regulations at 29 CFR 1910.1001 and specifically paragraph (f)(3) and Appendix F. These are mandatory measures that employers must implement for automotive brake and clutch inspection, disassembly, repair, and assembly operations. State and local governments with employees who perform brake and clutch work in states without OSHA-approved state plans must follow the identical regulations found under the EPA Asbestos Worker Protection Rule (PDF) (2 pp, 53K). While home mechanics are not required to follow the OSHA work practices (or the identical requirements under the EPA Asbestos Worker Protection Rule), by using these practices home mechanics can minimize potential exposure to asbestos if it is present and thereby reduce their risk of developing any asbestos-related diseases.

Because some, but not all, automotive brakes and clutches available or in use today may contain asbestos, professional automotive technicians and home mechanics who repair and replace brakes and clutches may be exposed to asbestos dust. Brake and clutch dust can be seen when a brake disk, drum, clutch cover, or the wheel is removed from a car, truck, or other equipment. There are also many small dust particles that cannot be seen with the eye. If the brakes contain asbestos, the dust may contain asbestos fibers, which could be inhaled.

Asbestos in Your Home

Asbestos is a mineral fiber. It can be positively identified only with a special type of microscope. There are several types of asbestos fibers. In the past, asbestos was added to a variety of products to strengthen them and to provide heat insulation and fire resistance. 

Most products made today do not contain asbestos. Those few products made which still contain asbestos that could be inhaled are required to be labeled as such. However, until the 1970s, many types of building products and insulation materials used in homes contained asbestos. Common products that might have contained asbestos in the past, and conditions which may release fibers, include:

Leukemia facts

1. Leukemia is a cancer of the blood cells.
2. While the exact cause(s) of leukemia is not known, risk factors have been identified.
3. Leukemias are grouped by how quickly the disease develops (acute or chronic) as well as by the type of blood cell that is affected (lymphocytes or myelocytes). The four main types of leukemia include acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myelocytic leukemia (AML), and chronic myelocytic leukemia (CML).
4. People with leukemia are at significantly increased risk for developing infections, anemia, and bleeding. Other symptoms and signs include easy bruising, weight loss, night sweats, and unexplained fevers.

Asbestos in Schools

Asbestos is a naturally occurring mineral fiber, once widely used in building materials for its thermal insulating properties and fire resistance. Although the removal of asbestos from school buildings is an option for schools, many schools and local education agencies have chosen to manage some sbestos-containing building material in place.

Intact, undisturbed asbestos-containing materials generally do not pose a health risk. These materials may become hazardous and pose increased risk if they are damaged, are disturbed in some manner, or deteriorate over time and release asbestos fibers into building air.

Asbestos

Asbestos refers to a set of six naturally occurring fibrous minerals. Asbestos has six primary sub-classifications. These are chrysotile, crocidolite, amosite, anthophyllite, tremolite, and actinolite. Among these, chrysotile and amosite asbestos are the most common.

Asbestos fibers are microscopic but extremely durable and resistant to fire and most chemical reaction and breakdown. For this reason, asbestos was used for many years in a number of different commercial and industrial capacities. Because of its strength and resistance to heat, asbestos was used in roofing shingles, floor tiles, ceiling materials, cement compounds, textile products, and automotive parts. Asbestos is now strictly regulated as asbestos exposure is now associated with a number of lung and respiratory health conditions.

Mesothelioma Clinical Trials

Clinical trials for mesothelioma patients primarily focus on pleural and peritoneal mesothelioma, the two most common forms of the cancer. Because a definitive cure has not been established, these clinical trials typically evaluate experimental treatment methods involving chemotherapy drugs, surgery techniques and other emergent procedures. Overall, mesothelioma clinical trials offer a way to test up-and-coming treatments and medications that have not yet been approved for safe and effective use. 

Mesothelioma patients often elect to participate in clinical trials to take advantage of cutting-edge treatments such as immunotherapy or gene therapy. Participating in clinical trials does come with some element of risk depending upon the structure of the trial. Discussing this option with your doctor is important to understand all the risks and potential benefits of participating in a clinical trial.

Clinical Trial Phases

Three primary phases help to classify the stages of clinical trials. These separate phases determine when a particular treatment is tested for safety, effectiveness and whether or not it is better than a current approach. 

Phase I

Recurring Mesothelioma

Mesothelioma recurrence is almost impossible to avoid, even after the most aggressive surgery, after a multimodality approach to treatment and after adjuvant follow-up therapy. The recurrence of mesothelioma cancer is likely because of the unique characteristics of this disease, which can spread through the lining of the lungs, heart and abdomen.

The location of tumors so close to organs makes it difficult for doctors to eliminate it completely, even with the most advanced medical technology. The key – and the hope – is to delay the eventual recurrence, keeping it under control for as long as possible.

What is cancer recurrence?

Mesothelioma Life Span

Although the disease of mesothelioma ultimately will cause the death of anyone diagnosed with this virulent form of cancer, there is no way to determine uniformly the life span of a mesothelioma patient.
The primary reason for this is simple: The process of mesothelioma begins when someone first inhales or ingests asbestos fibers, and it's not always clear when that exposure occurred. That exposure, when combined with repeated incidents, as happens during many on-the-job exposures, set the stage for a disease that doctors have yet figured out how to cure.

Determining Life Span

Mesothelioma Death Rate

Approximately 2,000 to 3,000 people are diagnosed with mesothelioma each year. Because the cancer is rare, many patients and their loved ones are not sure what the cancer is and what exactly a mesothelioma diagnosis entails. Questions about prognosis and the mesothelioma death rate often surface.

The disease's death rate and how a patient can increase life expectancy are among the many topics covered in the Mesothelioma Center's free informational packet. The comprehensive guide delivers a number of resources at your door about mesothelioma and how to battle the disease.

Mesothelioma Mortality Rate

Mesothelioma Life Expectancy

"How long do I have to live?" This is the first question doctors often hear when they deliver a diagnosis of mesothelioma, and it is also the hardest question to answer. Research scientists and doctors have been working to improve the life expectancy for mesothelioma patients for decades. While there is no definitive cure for mesothelioma, patients can  elect to undergo specialized treatment or participate in clinical trials that often help prolong their life expectancy and improve their overall quality of life.
In an effort to help patients understand and improve their life expectancy, The Mesothelioma Center offers a complimentary packet that contains treatment information tailored to your specific diagnosis. The packet also covers the nation's top mesothelioma doctors and cancer centers, as well as financial assistance options to help cover medical costs.

Life Expectancy Factors

Mesothelioma Symptoms

A patient with mesothelioma usually begins showing symptoms 15 to 50 years after their exposure to asbestos. The cancer may take decades to develop in the body and symptoms do not arise until after the cancer is present. Common early symptoms of mesothelioma include fatigue, coughing, shortness of breath and reduced respiratory function. Many patients are unaware they have developed mesothelioma or the severity of their condition as mesothelioma symptoms typically resemble symptoms of less serious illnesses and occur so long after the initial exposure.
If you have a history of asbestos exposure, the leading cause of mesothelioma, and believe you may be showing signs of mesothelioma, it is best to seek immediate medical advice. Informing your doctor of previous asbestos exposure can alert them to the possibility of an asbestos-related disease such as mesothelioma.
If you have already been diagnosed with mesothelioma, you should strive to gather as much information as possible about symptoms, doctors and the disease of mesothelioma. The Mesothelioma Center offers a free packet covering the nation's leading mesothelioma doctors and treatment centers, as well as financial assistance options to help cover medical costs.

What are the Symptoms of Pleural Mesothelioma ?

Patient Resources

The Mesothelioma Center offers a wide range of resources for patients and their families. Please browse through our Patient Resources section to discover how we can help answer questions concerning treatment options, doctor selection and anything else that may be on your mind.

Cancer patients have many forms of support available to them, but often don’t have the time or resources to find everything that’s available. The Mesothelioma Center aims to make this process simple and worry-free for patients by providing comprehensive resources through our website and our Patient Advocates who personally assist patients one-on-one. 

Free Asbestos & Mesothelioma Awareness Wristbands

Mesothelioma Research

After nearly a century of mesothelioma research, doctors have learned what causes this cancer, who is most at risk for contracting the disease, what symptoms indicate its presence and what tools are most effective at diagnosing and treating the cancer. These strides have significantly impacted how medical professionals diagnose and treat mesothelioma. Current efforts are working to develop more effective treatments and an eventual cure for this life-threatening disease.

Pharmaceutical Breakthroughs for Mesothelioma

Estimating the attributable fraction

Management and prognosis

Median survival of patients with MM treated with supportive care alone is approximately 7 months.

Surgery
The role of surgery is debated. The presence of different staging systems have so far not provided very accurate estimates of prognosis. However, in general, patients with stage I according to Butchart’s classification should be considered candidates for radical surgery; these patients have a tumor confined within the capsule of the parietal pleura, involving only the ipsilateral lung, pericardium and diaphragm. The preoperative staging procedures are, unfortunately, rather imprecise.
There are two main types of operation which have been employed in patients with malignant pleural mesothelioma: pleurectomy and extrapleural pneumonectomy. Pleurectomy consists of stripping the pleura from the apex of the lung to the diaphragm, along with the pericardium (if necessary). This operation generally requires a thoracotomy.

Operative mortality is only 1–2%, and complications include bronchopleural fistulas, hemorrhage and subcutaneous emphysema. The value of pleural decortication as a palliative measure in case of recurrent effusion has not been well established and might be taken into consideration if pleurodesis fails repeatedly.

Extrapleural pneumonectomy is en bloc removal of the parietal pleura, lung, pericardium and hemidiaphragm. Diaphragmatic resection is followed by reconstruction to prevent herniation. In the hands of experienced thoracic surgeons this complex procedure currently has an operative mortality of 5–9%, but serious complications are seen in 25% of patients, which include bronchopleural fistulas and empyema, vocal cord paralysis, chylothorax, arrhythmia and respiratory insufficiency. Extrapleural pneumonectomy is a complex operation, which should be performed by skilled surgeons and in select centers only.

Radiotherapy
The role of radiotherapy in the management of malignant pleural mesothelioma is unsettled, although radiotherapy alone probably has no major role to play in this disease. The most recent series do not indicate that irradiation improves survival when compared to best supportive care. The treatment volume is a crucial aspect of radiation of malignant pleural mesothelioma, and treatment of the entire pleura is indicated. 

This is extremely difficult to achieve without causing serious side effects in normal surrounding tissues, such as
the lung, heart and liver. Radical irradiation has delivered 40–50 Gy to the entire pleural space and the mediastinum, followed by boost irradiation up to 55–71 Gy to areas of gross disease; until now, however, no satisfactory technique has been developed which allows high-dose radiation without major risks for the adjacent normal tissues.

Radiotherapy is more often used for palliation of pain, or added to surgery in an attempt to improve local control. The results of the published literature are rather difficult to interpret, because radiotherapy was used as part of a multimodality treatment in locally advanced cases of pleural mesothelioma, the small number of patients reported in single studies and because of a lack of randomized trials. In a recent study 47 patients were given 40 Gy followed in some cases by doxorubicin/cyclophosphamide: there were only three responses, and median survival was only 7 months, with a high frequency of pneumonitis.

The only available randomized trial of radiotherapy has proven that radiotherapy to the thoracoscopy entry tract significantly reduces the incidence of local relapse: in this study 0/20 patients who received 21 Gy delivered in three fractions 10–15 days after thoracoscopy had local recurrence, whereas local recurrence developed in 8/20 (40%) patients who did not receive radiation.

Chemotherapy
A large number of chemotherapeutic agents have been investigated in MM. The level of activity of most agents is poor, and may vary greatly from study to study. Due to the rarity of the disease, phase II studies were usually performed in small numbers of patients especially in the past. Several patients with mesothelioma and sarcomatous histology have in the past been included in soft tissue sarcoma studies and these results are difficult to assess. Extensive reviews of chemotherapy in malignant mesothelioma have recently been published.

Combination chemotherapy does not, so far, appear to yield substantially higher response rates than single agents. The most common combinations contain doxorubicin and cisplatin. Although some of these combinations appear to give higher response rates than singe agents, responses are of short duration and complete responses are very rarely observed. In general, none of the published agents or com- binations appears to provide any advantage in survival compared with historical controls, although randomized trials against best supportive care have not been conducted.

At the 2002 American Society of Clinical Oncology meeting in Orlando an important randomized study was presented. This study is the largest study ever performed on this malignancy and included a total of 448 patients randomized between cisplatin alone and cisplatin plus pemetrexed (ALIMTA). This study confirmed modest activity of cisplatin alone and demonstrated superiority of the combination in terms of response rate, time to progression and overall survival. Pemetrexed alone has also been tested as a single agent and reported to have a response rate of 16%. Pemetrexed is a novel antimetabolite with multiple mechanisms of action.

Leukemia

Leukemia is a cancer of the bone marrow and blood. The two primary types of leukemia are lymphocytic leukemia, which involves an increase of white blood cells called lymphocytes; and myelogenous leukemia (also known as myeloid or myelocytic leukemia), which involves an increase in white blood cells called granulocytes. Leukemia can be acute or chronic. Acute forms of leukemia progress rapidly, whereas chronic forms of leukemia progress slowly, leading to different approaches to diagnosis and treatment.

Lung Cancer, the Number One Cancer Killer

Each year, about 200,000 people in the United States are told they have lung cancer and more than 150,000 people die from this disease. Deaths from lung cancer represent about one out of every six deaths from cancer in the U.S.

Risk Factors
Research has found several causes and risk factors for lung cancer. A risk factor is anything that changes the chance of getting a disease. Lung cancer risk factors include :

1. Smoking.

Estimation of exposure

To estimate the proportion of workers exposed to carcinogens for lung cancer and leukaemia, we use the exposed proportions  of workers in the industrial sectors or occupations who were exposed to the carcinogens (from CAREX, a European survey described below in Section 5.2).  This was  the approach recently used in a global estimate of the disease burden (Ezzati et al., 2002; WHO, 2002; Concha-Barrientos et al., 2004).  However, should exposure data be available for the national or local level, they should be used instead of the CAREX data.  For the CRA project (Concha-Barrientos et al., 2004), routine employment data were used to determine the proportion of people in each industrial sector.  The exposed populations were then divided into high and low exposure groups.  This information was then combined with the CAREX data to estimate the proportion of workers exposed at high or low levels to the carcinogens.

Ideally, the above information should come from data assessed in the country or study area, particularly the first three requirements, but since this is not always possible values based on the global analysis can be used (Concha-Barrientos et al., 2004).

Choice of health outcomes

Work-related malignant conditions can arise from a variety of exposures, but we consider only the three  main documented occupational cancers: lung cancer, leukaemia and malignant mesothelioma.  Although other cancers are known to have occupational causes, there are not enough data on exposure and risk, and the number of cases are too few, for the data to be  included in this guide.  These other cancers
(and their causative agents) include:

1. bladder cancer (aromatic amines, benzidine dyes and methylene-bis-ortho-chloroaniline);
2. liver cancer (vinyl chloride);
3. nasal cavity and middle ear cancer (hardwood dust, chromium VI compounds, nickel compounds);
4. bone and articular cartilage cancer (ionizing radiation);
5. skin cancer (arsenic, by-products of distillation, ionizing radiation);
6. lung cancer (from passive smoke in the workplace).

In the comparative risk assessment (CRA) study of Concha-Barrientos et al. (2004), the criteria used to assess causal connections between exposures and outcomes of interest were a consistent relationship between the risk factor and the outcome across different studies and settings; and the strength of the evidence of the relationship.
Data sources were evaluated to assess the strength of the evidence linking specific cancers with exposure to chemical or physical agents.

The burden of disease from occupational exposures

Nurminen & Karjalainen (2001) estimated  the proportion of fatalities related to occupational factors in Finland.  The average number of exposed workers in Finland was estimated from census data stratified by gender, age, occupation and industry, and from the FINJEM national job-exposure matrix.  Relative risks were obtained from review of epidemiological studies, focusing on risk estimates that were most valid for the Finnish exposure circumstances.  

The authors used AF methodology to determine the proportion of deaths in  the population attributable to occupational factors, and reported that 30% of these deaths in 1996 were caused by cancer.  Occupational lung cancer accounted for 0.9% of all deaths, and leukaemia, malignant mesothelioma and other cancers together accounted for another 0.2% of all deaths.The authors attributed 24% of bronchus and lung cancers (29% for men and 5.3% for women) to occupational exposures to combined risk factors. 

The AFs for urinary cancer were 10.3% overall, and 14.2% for men and 0.7%  for women.  Occupational risk factors also accounted for 10.9% (18.5% for males, 2.5% for females) of leukaemia deaths, the majority (17.8% for males and 2.3% for females) from electrical occupations.  In contrast, only 0.7% (males) and 0.2% (females) of leukaemia deaths were attributable to occupational exposure to benzene.  For malignant mesothelioma cases, an average of 71.3% (90% for males, 25% for females) was attributed to occupation.

Identification of the risk factors

The International Agency for Research  on Cancer (IARC, 2002) has classified 150 chemical or biological agents as known or probable human carcinogens, and exposures to many of these carcinogens (e.g. asbestos, cadmium and benzene) occur in occupational settings.  Occupational exposure is defined as any contact between the human body and a potentially harmful agent or environment in the workplace.
Specific exposures are related to the type  of work that people do (i.e. occupation), where they do it (e.g. the industrial sector − also called the economic sector) and the measures that are taken to limit exposures.  The probability that a worker will develop cancer is influenced by the total dose of carcinogen received, the potency of the carcinogen, the presence of other exposures (notably tobacco smoking), and individual susceptibility.  Excess exposure to carcinogens can lead to changes at the cellular level, resulting in  the uncontrolled growth of abnormal cells that invade and destroy normal tissues in the lung, blood system, etc.  

IARC has classified 87 agents, mixtures, or exposure circumstances as Group 1 Carcinogenic to Humans, including various chemical compounds, pharmaceuticals, and bacterial and viral infections.  An additional 63 agents, mixtures, or exposure  circumstances have been classified as Group 2A Probably Carcinogenic to Humans (IARC, 2001).  

With the exceptions described below, the analysis in this document includes IARC Group 1 and 2A carcinogens associated with cancers  of the lung, leukaemia, and malignant mesothelioma.
The most important lung carcinogens in occupational settings are asbestos, radon, arsenic, chromium, silica, beryllium, nickel, cadmium and diesel exhaust.  The most important agents for leukaemia are benzene, ionizing radiation and ethylene oxide.
Asbestos is a causal agent of asbestosis, lung cancer and malignant mesothelioma, and silica causes silicosis in addition to lung cancer (the role of asbestos in asbestosis and silica in silicosis is also considered in a forthcoming guide in the EBD series, on occupational airborne particulates). 

Magnitude, Rates , Sex, Race, Occupation

Magnitude and Trend

Number of U.S. residents aged 15 or older with malignant mesothelioma listed as an underlying or contributing cause on the death certificate by type of mesothelioma, 1999. Of the 2,485 malignant mesothelioma deaths in 1999, the highest proportion was classified as an unspecified type. In nearly 95% of all deaths, malignant mesothelioma was listed as the underlying cause. (Note: The total number of deaths by subtype exceeds the number for all sites because more than one subtype was listed for some decedents.)

Rates among States

Age-adjusted mortality rates for malignant mesothelioma in U.S. residents aged 15 or older by State, 1999. The highest malignant mesothelioma mortality rates occurred in Alaska and Maine in 1999. The rates for each of these States were more than twice the national rate of 11.7 per million. States in the next highest rate group were widely dispersed, with a concentration on the eastern seaboard and in the West. The rates in these States were nearly 1.5 to 2 times the U.S. rate.

Sex and Race

Distribution and number of malignant mesothelioma deaths in U.S. residents aged 15 and older by sex and race, 1999. More than 80% of malignant mesothelioma deaths occurred in men in 1999. White residents accounted for 94.8% of malignant mesothelioma deaths.

Occupation and Industry

PMRs and 95% confidence intervals for malignant mesothelioma in U.S. residents aged 15 or older by industry and occupation, 1999. Industrial and miscellaneous chemicals, electric light and power, and construction industries were associated with the highest significant malignant mesothelioma PMRs. Plumbers, pipefitters, steamfitters, and electricians (which are occupations associated with the construction industry) were highly associated with malignant mesothelioma mortality. Elementary school teachers also had a significant malignant mesothelioma PMR. (Note: This figure presents the highest significant PMRs based on 10 or more deaths.)

Mesothelioma from Asbestos

Mesothelioma is a rare and deadly form of cancer that manifests itself years after the inhalation of airborne asbestos fibers.
It is known the world over as the signature asbestos-caused cancer. Three thousand cases of mesothelioma are diagnosed in America every year, according to the National Cancer Institute.
Many public figures have died from the ravages of one of the most deadly, yet preventable, cancers on record. Screen actor Steve McQueen and songwriter Warren Zevon, both of whom worked in asbestos-related occupations prior to their public careers, died of mesothelioma within months of being diagnosed.
In layman’s terms, the tissues that line our internal organs, including the lungs, are called “mesothelium.” Mesothelioma is cancer of that tissue. Some patients have been known to live longer, though most succumb to the disease within four to 14 months after being diagnosed. There is no known cure for mesothelioma, and treatment for this disease has not advanced far since the 1980s.
American auto plants are also notorious for exposing factory workers to asbestos, an ingredient still utilized to this day in automobile brake shoe linings. Since mesothelioma can take decades to develop (up to 50 years in some cases), these workers are only now being diagnosed.
Mesothelioma is usually caused by workplace exposure to airborne asbestos fibers. It is a preventable disease that is frequently the result of an employer’s choice for greater profits over worker health safety.