Asbestos: Risk Assessment, Epidemiology, and Health

Effects, Second Edition

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SECOND EDITION

ASBESTOS
R ISK A SSESSMENT ,
E PIDEMIOLOGY ,
AND H EALTH E FFECTS

RONALD F. DODSON
SAMUEL P. HAMMAR

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Dr. Dodson dedicates the book to the memory of his parents, Benjamin
F. Dodson and Vera I. Dodson. Their inspiration and encouragement
were motivation for both the personal and professional facets of his
life. He also dedicates the book to his wife, Sandy, who has always
provided a loving, stabilizing, and encouraging presence.

Dr. Hammar dedicates the book to his beloved Mother, Ella Hammar,
who was the hardest working person he has ever known. He also
dedicates the book to his special friend, Lee Hewitt, who greatly
encouraged him during the process of developing the Second Edition.
 Contents
Preface...............................................................................................................................................ix
Acknowledgments .............................................................................................................................xi
Editors ............................................................................................................................................ xiii
Contributors ..................................................................................................................................... xv

Chapter 1
The History of Asbestos Utilization and Recognition of Asbestos-Induced Diseases...................... 1
Douglas W. Henderson and James Leigh

Chapter 2
Asbestos Analysis Methods ............................................................................................................. 23
James R. Millette

Chapter 3
Analysis and Relevance of Asbestos Burden in Tissue ................................................................... 49
Ronald F. Dodson

Chapter 4
The Molecular Pathogenesis of Asbestos-Related Disorders ........................................................ 109
Sonja Klebe and Douglas W. Henderson

Chapter 5
Epidemiology of Asbestos-Related Diseases and the Knowledge That Led to What Is
Known Today ................................................................................................................................. 131
Richard A. Lemen

Chapter 6
Asbestos and Carcinoma of the Lung ............................................................................................ 269
Douglas W. Henderson and James Leigh

Chapter 7
Asbestos and Mesothelioma ..........................................................................................................307
Samuel P. Hammar

Chapter 8
Asbestos and Other Cancers .......................................................................................................... 419
Samuel P. Hammar, Richard A. Lemen, Douglas W. Henderson, and James Leigh

vii
viii CONTENTS

Chapter 9
Asbestosis ...................................................................................................................................... 447
Samuel P. Hammar

Chapter 10
Asbestos-Induced Pleural Disease ................................................................................................. 481
Samuel P. Hammar

Chapter 11
Uncommon Nonmalignant Asbestos-Induced Conditions ............................................................ 501
Samuel P. Hammar

Chapter 12
Clinical Diagnosis and Management of Nonmalignant Asbestos-Related Diseases..................... 521
Gary K. Friedman

Chapter 13
Malignant Diseases Attributed to Asbestos Exposure .................................................................. 561
Gary K. Friedman

Chapter 14
Core Curriculum for Practicing Physicians Related to Asbestos .................................................. 593
Jeffrey L. Levin and Paul P. Rountree

Chapter 15
Asbestos Regulations and Their Applications ............................................................................... 617
Daniel T. Crane and Adele Cardenas Malott
 Preface
Asbestos is a generic term for the fibrous form of a group of silicate minerals. The term asbestos
is often limited to the six regulated forms defined in regulatory guidelines. These terms provide a
common basis for communication regarding the applicably defined fibrous forms of minerals that
are commonly found in commercial products. Asbestos is used in products because of its physi-
cal attributes, which, in the past, have given it the designation as “a magic mineral.” Asbestos is
lightweight and offers excellent insulation properties, fireproofing, and increased tensile strength as
a component of other products. Other important features of asbestos that have made it a material
of choice in many commercial applications is its relative inexpensiveness and ease of application.
From a health effect standpoint, inhalation of asbestos fibers can result in a variety of cancers and
other pathological responses, including fibrotic diseases. A unique feature of asbestos fibers as com-
pared with most other inhaled dusts is their carcinogenicity.
The physical properties of asbestos resulted in its widespread use in many products. Contrary
to popular opinion, the United States has not yet joined over 50 countries in the world where
­asbestos-containing products have been banned. Thus, imported products with asbestos compo-
nents are still being sold commercially. The remaining asbestos in place from previous applications
is an issue that society will be dealing with for decades. The other important issue when dealing
with potential asbestos exposure consists often of even knowing that a given material contains
asbestos.
Asbestos is a potential threat to health when it becomes friable or disturbed, thus creating aero-
solized and respirable fibrous dust. Asbestos and asbestos-like particulates are components of vari-
ous minerals mined for a wide array of products. These are not often considered to contain asbestos
because asbestos is not added for any commercial application and is often simply a component of
the mined vein. Thus, unsuspected exposures may occur from disturbance of these products.
The complexities resulting from asbestos exposure and the resultant understanding of health-
­related effects require a working understanding of a multidisciplinary nature. The first edition
of this book offered one of the first volumes that specifically brought specialists from different
disciplines together to provide the reader with a single resource for answering complex questions
regarding asbestos-related issues. The second edition expands the successful approach used in the
first edition by adding additional chapters and expanding the content of the previous chapters to
make this an all-inclusive thesis on the subject of asbestos and asbestos-related public health issues.
Internationally recognized authors were invited to contribute sections where their expertise was
brought together with that of other outstanding specialists into one cohesive document.
The historical overview of asbestos and the awareness that it constitutes a risk to human health
set the basis for understanding what we know and what we are still learning about asbestos and
human health. The evolving laboratory techniques that offer reproducible observations as to the
presence/quantitation of asbestos in various physical and aerosol samples provide the reader with
quick references as to the state-of-the-art use of instrumentation and procedures applicable to
answering specific questions.
The main point of entry for asbestos dust is via the respiratory system. It is critical the reader
has a basic understanding as to how and what dust reaches what levels of the respiratory system and
how our lungs are designed to protect against inhaled particulates when they are capable of doing
so without being overwhelmed.
Considerable information exists regarding tissue burden of asbestos, but to appreciate the appro-
priate interpretation of the data, one must appreciate the limitations of the techniques or count
schemes as applied. This fundamental understanding is critical if one is to fully appreciate what is
reported in a tissue sample by first being able to determine what was included in a count scheme
and what was “overlooked.” The concept that fiber length alone is a predictor of the potential for

ix
x PREFAcE

pathogenic responses attempts to foolishly oversimplify the various mechanisms by which an

inhaled fiber may induce a disease. Ignoring the fact that short fibers are the primary form of asbes-
tos reaching extrapulmonary sites creates a false aura that one can pick one’s favorite length of fiber
and then make the disease somehow fit that particulate dimension.
The fact that the physical features of asbestos alone do not explain all components of asbestos-
induced diseases is clearly appreciated by the reader once he or she has evaluated the chapter on
molecular mechanisms. The pathological complexities of asbestos-related disease have resulted in
the second edition containing specific chapters on asbestosis, pleural disease, lung cancer, can-
cers outside of the lung (excluding mesothelioma), and mesothelioma. The state-of-the-art over-
view regarding interpretation of diagnostic information in the clinical chapters provides a complete
reference for the healthcare specialist. The findings from studies of various groups of individuals
exposed to asbestos form the basis of the extensive detail provided to the reader in the chapter dis-
cussing asbestos-related epidemiology. The results of known exposures are discussed as applicable
to the development of specific diseases. As with all of the chapters, a basis is provided to the reader
from which various views are considered, based on the variations of the questions asked.
The significance of asbestos as a pathologically active dust necessitates that special emphasis
be given to clinical monitoring and resultant interpretations. These issues are addressed in prac-
tical terms for the practicing clinical professional as they pertain to diagnostic interpretations.
Furthermore, an additional chapter offers an overview as to what the clinical educator or postgrad-
uate clinical specialist should consider as part of the adaptation to good clinical practice regarding
asbestos-related issues.
All specialists involved with asbestos-related issues need to be aware of the regulatory guide-
lines and their intended applicability. Specialists from the two major regulatory agencies have pro-
vided the readers with a quick reference of the governing documents applicable to asbestos as well
as insight into the regulatory process governing asbestos-related issues.
Readers of the first edition of our book have commended the usefulness of the interdisciplin-
ary approach of the book. This second edition has taken those positive comments and provides the
reader with an updated and expanded state-of-the-art discussion concerning important interdisci-
plinary factors associated with asbestos-related issues in an easy to use reference document.
 Acknowledgments
Drs. Hammar and Dodson would like to make special recognition of Ms. Michaele Stoll for her
contribution in the development of the Second Edition of Asbestos: Risk Assessment, Epidemiology,
and Health Effects. Michaele provided editorial assistance both via continuing interactions with
each of the authors as well as intensive review of the drafts of each chapter. Her knowledge of ter-
minology regarding asbestos-related diseases enabled the editors to rely heavily on her attention to
detail in the critique of the submitted documents. Dr. Hammar also would like to acknowledge the
assistance of Ms. Nancy Bennett in his office for providing additional support needed during the
process of developing the Second Edition.

xi
 Editors
Ronald F. Dodson, PhD, received his BA in biology and general sciences (double major) from East
Texas State College and an MA in biology and chemistry from East Texas State University. His doc-
torate was from the Life Sciences Division of Texas A&M University with an emphasis in biological
electron microscopy. After a postdoctoral appointment in anatomy at the University of Texas Health
Science in San Antonio, he joined the faculty of Baylor College of Medicine in Houston where he
conducted ultrastructural research. Dr. Dodson was recruited to join the faculty of the University of
Texas Health Center where he was charged with beginning a research effort. His academic career
at the Health Center included serving in administrative positions, including chief of Department
of Cell Biology/Environmental Sciences, chairman of the same department, associate director for
research, vice president for research, and codirector of the Texas Institute for Occupational Safety
and Health. He was awarded the status of professor of biology with tenure at the University of
Texas at Tyler in the early 1980s. Dr. Dodson has also directed an EPA/Texas Department of Health
(Model Accreditation governed) training division and holds licenses through the Texas Department
of Human Health Services as an inspector/manager planner and supervisor/contractor (restricted)
as applicable in the areas of asbestos-related activities.
Dr. Dodson was invited to serve on the EPA, NIOSH, and IOM groups where he offered his per-
spective on asbestos-related issues. He has served on the advisory board for the Texas Department
of Health, which was charged with developing the first state regulation in Texas for governing
asbestos-related work activities in public buildings. His laboratory was one of only a few academic
laboratories in the country that also participated in the AHERA/NIST accreditation program in
analytical transmission electron microscopy. Dr. Dodson presently serves as a member of the advi-
sory board of the School of Rural Public Health of Texas A&M University School of Medicine.
Dr. Dodson has served as a peer reviewer for numerous scientific journals and granting agen-
cies. He has published over 100 scientific contributions on dust-related health issues with most of
those focusing on asbestos. He has presented numerous papers at scientific meetings and agency-
sponsored meetings as well as other professional societies where asbestos-related issues are of inter-
est. His laboratory has developed some of the preparative techniques that have permitted them to
evaluate tissue burden of asbestos in a number of types of samples. He has published much of the
world’s literature on asbestos content in extrapulmonary sites and has authored numerous articles
where total fiber burden in a sample (including short fibers) were quantified. He has authored some
of the limited number of research publications where lavage and sputum materials were evaluated
for ferruginous body content and uncoated asbestos fibers. Dr. Dodson holds the status of fellow
in the American Heart Association and fellow in the College of Chest Physicians. Dr. Dodson was
selected as the Eminent Scientist and Outstanding Scholar of the Year in 2001 and as the Millennium
Golden International Award Winner by the International Research Promotion Council (Asia-Pacific
Chapter) for his works as applicable to asbestos-related health issues in developing countries.
Dr. Dodson retired in 2005 from his two academic appointments and created his own consulting
company: Dodson Environmental Consulting, Inc. In this position, he continues to provide consul-
tative evaluation of tissue samples, write scientific documents, and conduct scientific research into
asbestos-related issues.

Samuel P. Hammar, MD, is a board-certified anatomic and clinical pathologist who specializes in
lung disease, cancer, and diagnostic techniques used to investigate cancer. He obtained a BA degree
in chemistry in 1965 and attended the University of Washington Medical School from 1965 to 1969
where he obtained his MD degree. He did his training in pathology at the University of Washington
School of Medicine, including time in experimental pathology and electron microscopy.
For the past 25 years, Dr. Hammar has been primarily interested in asbestos-related lung disease,
especially mesothelioma. He is a member of the U.S.–Canadian Mesothelioma Panel, a member of
xiii
xiv EDITORS

the International Mesothelioma Pathology Group, and a member of the International Mesothelioma
Interest Group. In conjunction with Dr. Dodson, Dr. Hammar has done extensive research into
asbestos-related disease and sees asbestos-induced lung disease on a regular basis as a practicing
pathologist in Bremerton, Washington, the home of the Puget Sound Naval Shipyard.
Dr. Hammar is particularly interested in all aspects of mesothelioma. In association with his
friend and colleague, Dr. Ronald Dodson, they have conducted extensive studies concerning the
concentration and type of asbestos in extrapulmonary sites. Dr. Hammar and Dr. Dodson are cur-
rently evaluating the concentration/type of asbestos in the “normal” visceral and parietal pleura and
in mesothelioma tumor tissue, hyaline plaque, and lung tissue.
Dr. Hammar and Dr. Dodson consider themselves extremely fortunate to study asbestos-induced
diseases and hope to contribute to the knowledge of such diseases. Dr. Hammar considers himself
fortunate to be able to provide information to patients and their families who are suffering from
asbestos-related diseases.
Dr. Hammar may be reached via e-mail at [email protected] or by telephone at 360-
479-7707 (work) or 360-434-7546 (cellular phone).
 Contributors

Daniel T. Crane James Leigh

Occupational Safety and Health Administration Sydney School of Public Health
U.S. Department of Labor University of Sydney
Sandy, Utah Sydney, Australia

Ronald F. Dodson Richard A. Lemen

Dodson Environmental Consulting, Inc. United States Public Health Service (Ret.)
ERI Consulting, Inc. Canton, Georgia
Tyler, Texas

Gary K. Friedman Jeffrey L. Levin

Pulmonary Division, Texas Lung Institute Department of Occupational Health Sciences
The University of Texas Health The University of Texas Health
Science Center Science Center
Houston, Texas Tyler, Texas

Samuel P. Hammar Adele Cardenas Malott

Diagnostic Specialties Laboratory U.S. Environmental Protection Agency
PAKC/DSL, Inc., P.S. Dallas, Texas
Bremerton, Washington
James R. Millette
Douglas W. Henderson
MVA Scientific Consultants
Department of Surgical Pathology
Duluth, Georgia
Flinders Medical Centre
Adelaide, South Australia
Paul P. Rountree
Sonja Klebe Department of Occupational Health Sciences
Department of Anatomical Pathology The University of Texas Health
Flinders Medical Centre Science Center
Adelaide, South Australia Tyler, Texas

xv
 CHapTeR 1

The History of Asbestos Utilization and

Recognition of Asbestos-Induced Diseases

Douglas W. Henderson and James Leigh

CONTENTS

1.1 What Is Asbestos?..................................................................................................................... 1

1.2 Preindustrial History of Asbestos ............................................................................................. 2
1.3 Asbestos from the Beginning of the Industrial Era ..................................................................3
1.4 Evolution of Knowledge Concerning Asbestos-Related Diseases............................................8
1.4.1 Asbestosis ..................................................................................................................... 8
1.4.2 Asbestos-Related Lung Cancer................................................................................... 10
1.5 Asbestos Exposure and Mesothelioma: Historical Knowledge .............................................. 12
1.6 Trade-Offs (Cost–Benefit Arguments): A Defense of Asbestos? ........................................... 14
1.7 The Global Burden of Asbestos-Related Diseases ................................................................. 17
1.8 Summary ................................................................................................................................ 18
References ....................................................................................................................................... 19

1.1 WHAT IS ASBESTOS?

“Asbestos”—derived from the Greek for inextinguishable or unquenchable—is a commercial

term applied to a variety of hydrated fibrous silicates that have (i) the capacity to add tensile strength
when added to other materials (such as cement to produce asbestos cement); (ii) resistance to fire;
(iii) poor thermal conductivity (insulating properties); and (iv) resistance to corrosion by acids and
alkalis (especially the amphibole varieties of asbestos). Because of these properties, it was once
regarded as a “magic mineral”1—used in approximately 3000–4000 different products—but it is now
regarded as a deadly threat to health (“killer dust”1) and has been banned in more than 50 nations,
although its use continues, most notably in the “developing world” and especially in Asia.
Asbestos is conventionally divided into two broad groups (Table 1.1)2: (i) the serpentine group
that contains only a single member, namely, chrysotile, the name of which is derived from the Greek
for gold (chrysos) and fiber (tilos); and (ii) the amphiboles, which include crocidolite, amosite, and
the (usually) noncommercial amphiboles, namely, tremolite, actinolite, and anthophyllite (the last of
these being mined at the Paakkila mine in Finland until it was closed and at a few other sites). The
serpentine chrysotile is characterized by curly fibers that tend to matt together, whereas the amphi-
boles are characterized by straight needle-like fibers with a capacity for longitudinal splitting.2–4
1
2 ASBESTOS

Table 1.1 Chemical Composition of Asbestos Fiber Types

Asbestos Type Chemical Formula
Serpentine
Chrysotile Mg3Si2O5(OH)4
Amphiboles: commercial
Crocidolite Na2(Fe32+)(Fe23+)Si8O22(OH)2
Amosite (Fe, Mg)7Si8O22(OH)2 Fe > 5
Amphiboles: noncommercial
Tremolite Ca2Mg5Si8O22(OH)2
Anthophyllite (Mg, Fe)7Si8O22(OH)2 Mg > 6
Actinolite Ca2(Mg, Fe)5Si8O22(OH)2

1.2 PREINDUSTRIAL HISTORY OF ASBESTOS

Accounts of past and continuing use of asbestos can be found in many standard texts and journal
articles.3–7 One of the best-documented and referenced accounts of its preindustrial usage can be
found in Rachel Maines’ book Asbestos and Fire: Technological Trade-offs and the Body at Risk,7
although her argument in later sections of the book is open to dispute (see later discussion).
The occasional and sometimes colorful use of asbestos has extended from Neolithic times until
the twenty-first century. In this setting, asbestos (anthophyllite) has been found in Neolithic pot-
tery in Finland from about 2500 BCE3—apparently added to confer tensile strength when added to
clay—and its use has also been recorded in other Neolithic sites, including Central Russia, Norway,
and Lappland.8 However, in the Western literature, the earliest known documented reference to what
might have been asbestos has been attributed by some to Theophrastus (ca. 372–287 BCE)—
a student of Aristotle and his successor at the Lyceum in Athens8—in his book De Lapidibus [On
Stones],9 compiled in about 300 BCE. In Chapter II.17, he wrote:
In the mines at Scapte Hyle a stone was once found which was like rotten wood in appearance. Whenever
oil was poured on it, it burnt, but when the oil had been used up, the stone stopped burning, as if it were
itself unaffected.
(Scapte Hyle was a mining district in Thrace opposite the island of Thasos in the Northern Aegean.9)
In commentary on this description, Theophrastus’ twentieth-century translators/editors Caley and
Richards9 set forth the following commentary:
Moore [in Ancient Mineralogy, p. 153] thought that Theophrastus was really referring to asbestos. The
color of the stone makes this unlikely, though its structure makes it less improbable, since some forms
of decayed wood do have a fibrous structure like asbestos. We know from statements of various early
authors that asbestos was known in antiquity, and that it was mainly used for the manufacture of incom-
bustible cloth, though evidently wicks for oil lamps were also made of it. Moreover, direct evidence of the
use of asbestos by the ancients has been obtained in modern times by the discovery of ancient garments
woven from this mineral. It is, however, unlikely that Theophrastus is alluding to asbestos, since the min-
eral does not occur in the locality mentioned. There were only two known sources of asbestos in Greece
and its vicinity in ancient times: Karystos at the southern extremity of the island of Euboea, and a place
to the southeast of Mt. Troodos on Cyprus, where the abandoned workings are still to be seen today.
It is much more probable that Theophrastus [was] referring to the well-known brown fibrous lignite,
which in appearance and in other respects very often closely resembles rotten wood. Lignite of various kinds
is known to occur in the region named by Theophrastus. . . . Lignite of the kind to which he apparently refers
often contains in its natural state as much as 20 per cent of water; thus it cannot readily be ignited . . .
Maines8 refers to Chinese, Singhalese, and Indian sources concerning the use of asbestos in antiq-
uity. She8 mentions Lih-tsze who wrote near the end of the fifth century BCE concerning a fireproof
HISTORY OF ASBESTOS UTILIZATION AND ASBESTOS-INDUCED DISEASES 3

cloth that was cleaned by fire. It is also claimed that Herodotus recorded the use of asbestos in a
cremation shroud.5,10,11
Gaius Plinius Secundus (23–79 CE), better known as Pliny the Elder, certainly refers to asbestos
in book XXXVI.xxi of his Natural History where he commented:12
Asbestos looks like alum and is completely fire-proof; it also resists all magic potions, especially those
concocted by the Magi.
Maines8 refers to book XIX.iv:
Chapter IV. Also a linen has now been invented that is incombustible. It is called “live” linen, and I have
seen napkins made of it glowing on the hearth at banquets and burnt more brilliantly clean by the fire
than they could be by being washed in water. This linen is used for making shrouds for Royalty, which
keep the ashes of the corpse separate from the rest of the pyre.
Having stated this, it appears that Pliny thought that asbestos was a plant that grew
. . . in the deserts and sun-scorched regions of India where no rain falls, the haunts of deadly snakes, and
it is habituated to living in burning heat; it is rarely found, and is difficult to weave into cloths because
of its shortness. . . . The Greek name for it is asbestinon, derived from its peculiar properties.
It is sometimes claimed that Pliny had warned of the dangers of asbestos and that slaves who
worked with the material wore masks to protect against the dust.6 However, Maines8 asserts that no
reference can be found to the wearing of masks by “slaves” who worked with this material—so that
the often-repeated claim on this issue appears to be in error. It seems more likely that the masks
were worn by artisans who worked with cinnabar, not asbestos, and Pliny apparently did not state
that the artisans were slaves (Book XXXIII.xli).8
It is said that Pausanias (ca. 175 CE) recorded a gold lamp made by Callimachus of Athens for
the goddess Minerva, which had a wick made of Carpasian linen—“the only linen which is not con­
sumed by fire.”10 Over a thousand years later, in The Travels, Marco Polo13 described cloths used by
Tartars in the Khanate Province of Ghinghintalas during the Yüan dynasty:
When the stuff found in this vein . . . has been dug out of the mountain and crumbled into bits, the parti-
cles cohere and form fibres like wool. . . . Then this wool-like fibre is carefully spun and made into cloths.
When the cloths are first made, they are far from white. But they are thrown into the fire and left there for
a while; and there they turn as white as snow. And whenever one of these cloths is soiled or discoloured,
it is thrown into the fire and left there for a while, and it comes out as white as snow. . . . One of these
cloths is now at Rome; it was sent to the Pope by the Great Khan as a valuable gift . . . . (pp. 89–90).
Marco Polo’s account clearly indicated that asbestos is a mineral in character as opposed to the hair
of a mythical fire-resistant salamander as widely supposed in Medieval superstition.
It has been claimed that the Emperor Charlemagne (ca. 742–814 CE) had a tablecloth made of
asbestos thrown into the fire after dinner to the amazement of his guests, but this story seems apoc-
ryphal.8 However, Maines8 refers to an account by Ibn al-Fatiq, who recorded that tenth-century
Christian pilgrims to Jerusalem were sold small pieces of what appears to have been asbestos,
claimed to have been fragments of the True Cross, the divine and magical properties of which were
proven by their incombustibility.
Much later, the chevalier Jean Albini (1762–1834)—nephew of Galvani and a professor of phys-
ics at the University of Bologna—used asbestos cloth to make a fire-resistant suit that he exhibited
in several European cities and at the Royal Institution in London in 1829.14

1.3 ASBESTOS FROM THE BEGINNING OF THE INDUSTRIAL ERA

A useful account of the modern history of asbestos has been set forth by Frank15 and by Hammar
and Dodson.3 By about 1850, chrysotile deposits had been found around Thetford in Canada and
4 ASBESTOS

at about that time the fire-resistant properties of asbestos were demonstrated by a forest fire in the
mid-1870s, where the rocky outcrops of asbestos deposits did not burn, unlike the trees.15 According
to Frank,15 approximately 50 tons of asbestos were mined in Quebec by 1876, and by the 1950s more
than 900,000 tons were mined each year.15 In the early nineteenth century, asbestos was noted in
South Africa, particularly in the North West area of Cape Province, and the name crocidolite was
assigned to the blue-gray stone (“wooly stone”).15 According to Frank’s15 account, serious produc-
tion of asbestos in South Africa did not get underway until the early twentieth century, with produc-
tion far less than in Canada, and less than approximately 10,000 tons each year until 1940. In the
Transvaal area, amosite (reportedly an acronym for Asbestos Mines of South Africa)3,15 was mined,
and approximately 80,000 tons of amosite were produced each year by 1970.
Other nations with significant production of asbestos include Russia, where chrysotile was
discovered in 1720 in the region of the Ural Mountains near the Tagyl River.16 The deposit was
soon mined, and an asbestos cloth produced therefrom was presented to Peter the Great in 1722.16
However, by 1735, production was discontinued “. . . due to lack of practical importance of the
deposit. . . .”16 In 1765, an anthophyllite deposit was discovered south of Ekaterinburg, in a hill sub-
sequently called Asbestoyaya.16 Still later, the Bazhenovskoye chrysotile deposit was found in late
1884, and mining began in 188617 (the Vosnessenskiy mine)16,17—where production of chrysotile
still continues around the monogorod town of Asbest.* Other chrysotile deposits were later found in
the middle and southern Urals.16
Major chrysotile asbestos production continues in Kazakhstan (chrysotile), Zimbabwe (initially
the Shabata deposits and then the Shabani mine from about 19503), Brazil, and, more recently,
China.15
Asbestos was also mined in Italy (e.g., chrysotile at the Balangero mine). In the United States,
small deposits of asbestos were mined in Vermont, Arizona, and California as well as even smaller
deposits of anthophyllite in North Carolina and Georgia.15 The use of asbestos in the United States18
is shown in Table 1.2 for the years 1920–2003.
In Australia, approximately 47 tonnes of amphiboles were mined at Jones’ Creek, near Gundagai,
New South Wales between 1880 and 1889, and approximately 35 tonnes of chrysotile were mined
at Anderson’s Creek, Tasmania between 1890 and 1899. South Australia was the first state to mine
crocidolite in a very small mine at Robertstown in 1916. During the twentieth century, there was a
gradual increase in asbestos production, with more chrysotile than amphiboles mined until 1939.
After commencement of mining at Wittenoom in Western Australia (WA)19 in 1937, crocidolite
dominated production until final closure in 1966. New South Wales, the first state to mine asbes-
tos, also produced the largest tonnages of chrysotile (until 1983) as well as smaller quantities of
amphiboles (until 1949). With the closure of the crocidolite mine at Wittenoom in 1966, Australian
asbestos production declined to a pre-1952 level. Exports declined from 1967. Imports of chrysotile
also began to decline. The earliest records of asbestos imports date from 1929: the main sources of
raw asbestos imports were Canada (chrysotile) and South Africa (crocidolite and amosite). About
twice as much chrysotile was imported as was mined, and half as much crocidolite was imported
than was mined. After Wittenoom was closed, a small amount (122 tonnes) of crocidolite was mined
in South Australia. In New South Wales, the chrysotile mine at Baryulgil continued production. In
1971, the chrysotile deposits at Woodsreef near Barraba, New South Wales, began to be exploited,
and exports of asbestos fiber expanded as production increased; this operation was opencast with
dry milling.
Australian production of asbestos decreased in 1981 because of the drop in world demand for
asbestos and the increased operating costs at the Woodsreef mine. This mine ceased production in

* A monogorod town is one based on and exists because of a single industry, such as Togliatti in the former Soviet Union,
which came into existence for the specific purpose of automobile production.
HISTORY OF ASBESTOS UTILIZATION AND ASBESTOS-INDUCED DISEASES 5

Table 1.2 Asbestos Production, Imports, and Consumption for

the United States, 1920–2003, by 10- and 5-Year
Intervals, with Data for 2003
Year Production Imports Exports Consumption
1920 1500 151,000 600 152,000
1930 4000 189,000 700 192,000
1940 17,000 224,000 4000 237,000
1950 38,000 640,000 17,000 660,000
1960 41,000 607,000 5000 643,000
1970 114,000 589,000 35,000 668,000
1975 89,000 489,000 33,000 545,000
1980 80,000 327,000 49,000 359,000
1985 57,000 142,000 46,000 154,000
1990 20,000 41,000 29,000 32,000
1995 9000 22,000 17,000 15,000
2000 5000 15,000 19,000 1000
2003 – 4500 3500 4600
Note: All data are in metric tons. Apparent consumption calculated as
­production + imports – exports, with no adjustment to account for
changes in government and industry stocks: negative values indi-
cate shipments from stocks. The values in the U.S. Geological
Survey are stated to be reasonably accurate to the first three dig-
its so that the numbers listed above have been rounded off to the
nearest 50 tonnes for values <1000 to 500 for values in the range
of 1000–10,000 and to the nearest 1000 tones for numbers
>10,000: this being so, some of the values do not add up exactly.
Source: Data are from U.S. Geological Survey (USGS). See, Virta, R.L.
Worldwide asbestos supply and consumption trends from 1900
through 2003: U.S. Geological Survey Circular 1298, 80 pages,
2006, available only online, accessible at http://www.usgs.gov/
pubprod and Larson, T., Melnikova, N., Davis, S.I., Jamison, P.
Int. J. Occup. Environ. Health, 13, 398–403, 2007.

1983 when the dry milling plant could not meet dust control regulations. Tables 1.3 and 1.4 set forth
data for the production, importation, and consumption of asbestos in Australia.20
In this context, it has been asserted by some authors such as Price and Ware21 and Kelsh et al.22
(with no cited supporting evidence) that “. . .  the Australian high rates of [malignant mesothelioma]
are not unexpected due to widespread environmental exposures to high levels of amphibole asbestos
including crocidolite.”21 In reality, in Australia most mesotheliomas are attributable to specifically
identifiable asbestos exposure, especially amphibole-containing exposures, whether occupational
(direct and bystander) or nonoccupational, and including low-dose exposures from identified point
sources of exposure.23 Studies on airborne asbestos fiber concentrations in the general urban envi-
ronment have not demonstrated environmental exposures significantly in excess of those recorded
for other nations. For example, a 1990 report from the Western Australian Advisory Committee on
Hazardous Substances24 found that among schools in WA—mainly schools in Perth, the capital city
of the Australian State where the Wittenoom Blue Asbestos Industry was located—the airborne
concentrations of asbestos fibers were less than 0.002 fiber per milliliter, perhaps even less than that
figure by one order of magnitude (i.e., below the working detection limit).* These fiber levels in the

* All but 1 of the 13 schools inspected had asbestos cement roofs; a visual inspection was carried out, and samples were
taken from each of the roofs and samples were also taken from gutters, downpipes, and soil. The condition of the roofs
was assessed and ranked on a scale of 1–5, the score of 1 indicating that the condition was virtually as good as new,
whereas 5 corresponded to extensive deterioration. The roofs ranged in size from small to very large, and they had been
in place for 10–34 years. Only one achieved a ranking of 1 (time of construction unknown); all others had scores of 2–5,
and the highest scores correlated with the longest times since construction. The percentage of asbestos content for the
6 ASBESTOS

Table 1.3 Production and Imports of Asbestos in Australia, 1930–1983

Chrysotile Crocidolite Amosite
Years Production Imports Production Imports Production Imports
1930–1939 1200 – 400 – 50 –
1940–1949 3000 – 5600 – 750 –
1950–1959 11,500 314,100 63,250 2800 1 107,500
1960–1969 8850 329,000 86,550 – – 81,450
1970–1979 394,350 388,000 – – – 87,900
1980–1983 160,400 64,650 – – – 8500
Note: Data have been rounded off to the nearest 50 tonnes.
Source: Based on data from the Bureau of Mineral Resources and modified from Leigh, J., Driscoll, T.
Int. J. Occup. Environ. Health, 9, 206–17, 2003.

Table 1.4 Production, Imports, Exports, and Apparent Consumption in

Tonnes of Asbestos (All Types) for Australia, 1930–1985
Apparent
Years Production Imports Exports Consumption
1930–1939 1600 51,550 1200 52,000
1940–1949 9350 140,000 2400 146,900
1950–1959 74,750 314,100 51,400 337,400
1960–1969 95,400 434,700 44,700 485,400
1970–1979 394,350 555,600 45,500 704,450
1980–1985 160,400 104,300 109,800 154,950
Total 740,300 1,602,800 450,000 1,888,000
Note: Values have been rounded off to the nearest 50 tonnes and therefore
may not add up exactly.
Source: Based on data from the Bureau of Mineral Resources and modified
from Leigh, J., Driscoll, T. Int. J. Occup. Environ. Health, 9, 206–17,
2003.

“general environment” are comparable with those recorded in other nations (e.g., see Health Effects
Institute–Asbestos Research25 and World Health Organization26).
Major producers of asbestos now include Canada (which exports most of its chrysotile asbes-
tos production), Russia, and China (most of which is used for domestic consumption in those two
nations).21 Russian production in 2000 was approximately 700,000 tonnes followed by 450,000
tonnes in China and 335,000 tonnes in Canada (see Table 1.5 for data for 1975). In 2000, the world-
wide production of asbestos was 2,130,000 tonnes, mostly chrysotile from Canada, Russia, and
China, with a sharp decline in production thereafter (see Table 1.6 for data for 2003). As men-
tioned in the first paragraph of this chapter, more than 50 nations (including the United Kingdom,

roof samples ranged from 0% to 40% in one sample, and most samples contained 10% to 20%. Crocidolite was detected
in 6 of 18 roof samples (only in roofs 30 years old or older), and amosite was identified in 14 of 18; all samples contained
chrysotile. High-volume air sampling (approximately 10 m3) was carried over 24 h out at three sites whenever possible at
each of seven schools—a classroom, a veranda, and a remote open site such as a sports field—using a vertical elutriar/37
mm cassette/vacuum pump and was studied by both phase-contrast light microscopy and scanning electron microscopy.
Despite more than 100 h of scanning, not a single fiber was found in 20 samples; a single amosite fiber attached to a
3.25-μm nonfibrous particle and assessed as nonrespirable was found at one school. Not one fiber was found on air sam-
pling either in central Perth or in a rural town some 100 km east of Perth (York). Air sampling carried out in 1989 in a
railways workshop in Perth—where there were more than “8 acres” of asbestos cement roofing more than 60 years old—
revealed a concentration of more than 0.01 fibers/mL in one sample from the “asbestos shed” used for asbestos removal
(as assessed by phase-contrast light microscopy: PCLM); two other samples with fiber concentrations of 0.05 and 0.02
fibers/mL (PCLM) from the same “shed” were then assessed by scanning electron microscopy: in one of these samples,
only 1 of 16 fibers was asbestos, and there were no asbestos fibers in the other.
HISTORY OF ASBESTOS UTILIZATION AND ASBESTOS-INDUCED DISEASES 7

Table 1.5 Ten Major Producers and/or Importers of Asbestos in 1975, Plus Data for
the United States
Country Production Imports Exports Consumption
Soviet Union (Russia + 1,900,000 – 613,000 1,287,000
Kazakhstan)
Canada 1,056,000 5000 1,086,000 –25,000
West Germany – 386,000 74,000 312,000
South Africa 355,000 29,000 368,000 15,000
Southern Rhodesia 262,000 – 260,000 2000
Japan 5000 253,000 2000 256,000
China 150,000 – – 150,000
Italy 147,000 66,000 81,000 132,000
France – 139,000 2000 137,000
United Kingdom – 139,000 2000 137,000
United States 90,000 489,000 33,000 545,000
World total 4,213,000 2,746,000 2,628,000 4,331,000
Note: Apparent consumption calculated as production + imports – exports, with no adjustment
to account for changes in government and industry stocks: negative values indicate
­shipments from stocks. The values listed above have been rounded off to the nearest
1000 tonnes: this being so, some of the values do not add up exactly. The values in bold
indicate whether the country was a major producer or importer of asbestos.
Source: Data are from U.S. Geological Survey (USGS). See citation in the source to Table 1.2.

Europe,27 Scandinavia, Australia, and apparently Japan) have now banned the use of all forms of
asbestos, apart from a few special applications for which no substitute is available.
It appears that on a per capita basis, the greatest production or importation of asbestos is in
Russia and the former Soviet Republics including Kazakhstan and in Thailand15 (Table 1.6). Apart
from those nations with asbestos bans in place, the countries with the lowest per capita consumption
include Canada and the United States15 (Table 1.6).
Japan has been an importer of asbestos as opposed to a significant producer. Little asbestos was
used in Japan during the Second World War because of the Allies’ blockade, but the use of asbestos
in Japan accelerated after 1945. One consequence is that the rise of asbestos-related diseases in
Japan appears to have taken place later than similar rises in western industrialized nations. In 1960,
77,000 tons of asbestos were imported into Japan, reaching a peak of 352,316 tons in 1974.28
The major uses of asbestos are as follows:15

• The use of asbestos (both chrysotile and the commercial amphiboles)—as an insulating and fire-
resistant material in a variety of circumstances that include commercial buildings, ships (naval ves-
sels including submarines,* merchant ships, and passenger liners), power stations, and locomotives
and as insulation around steam pipes and in boilers of all types and furnaces and ovens, and the list
goes on.
• The use of both chrysotile or crocidolite or amosite in differing proportions in asbestos cement
building materials, including asbestos cement walls; the use of thick asbestos blocks in wet areas of
houses and in the roofs of houses, for example, in the eaves; and as corrugated asbestos cement roof-
ing material itself. Such high-density asbestos products were based on the capacity of asbestos fibers
to add tensile strength to such materials, their lightness in terms of weight, and their fire resistance
and insulating properties.
• The use of chrysotile in particular for brake blocks/linings and gaskets.
• Asbestos textiles (chrysotile) for the production of asbestos blankets and fire-resistant and insulating
suits, for example, for firemen and workers in foundries as well as asbestos rope.

* The present authors’ files include cases of mesothelioma among workers involved in the dismantling of German U-boats
after the Second World War, in Barrow-in-Furness.29