Motion-Secondary: LOUIS CASTAGNA VS. ASBESTOS DEFENDANTS (B/P)AS REFLECTED ON EXHIBITS et al

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                                LANKFORD
CRAWFORD
MORENO LLP

ATTORNEYS ATLAW

PAUL V. LANKFORD (State Bar No. 181506)
PAUL LANNUS (State Bar No. 192551)
LANKFORD CRAWFORD MORENO LLP
1850 Mt. Diablo Blvd., Suite 600

Wainut Creek CA 94596

Telephone: 925.300.3520

Facsimile: 925,300,3386

Attorneys for Defendant
FORD MOTOR COMPANY

ELECTRONICALLY
FILED

Superior Court of California,
County of San Francisco

JAN 12 2011

Clerk of the Court
BY: ALISON AGBAY
Deputy Clerk

SUPERIOR COURT OF THE STATE OF CALIFORNIA

COUNTY OF SAN FRANCISCO

SAMUEL LEAL,
*Plaintiff,
Vv.
ASBESTOS DEFENDANTS (B#P},

Defendants.

LOUIS CASTAGNA,
Plaintiff,
Vv.

ASBESTOS DEFENDANTS (B#P),

ASBESTOS
BRAYTON GROUP 536

Case No. CGC-08-274807

CasE No. CGC-07-274230

Exmrerrs B To K To THE DECLARATION
OF PAUL LANNUS IN SUPPORT OF
DEFENDANT ForD MOTOR COMPANY’S
Motron In Limine To EXCLUDE

Defendants. PLAINTIFF’S SCIENTIFIC CAUSATION
EVIDENCE To THE EXTENT IT DorEs Nor
DEMONSTRATE RELATIVE RISK
GREATER THAN 2.0 [MIL #3]
+ The use of the term “plaintiff” as used herein refers to the plaintiff in a personal injury action and the

decedent in a wrongful death action; and the use of “plaintiff” shall refer to both plaintiff in the singular and plural, as

appropriate.

-1-

ALANKFORD
CRAWFORD
MORENO LLP

ATTORNEYS AT LAW

GARY COATES,
Plaintiff,
Vv.
ASBESTOS DEFENDANTS (BP),

Defendants.

CLEM FITZHUGH,
Plaintiff,
v.
ASBESTOS DEFENDANTS (BP),

Defendants.

Case No. CGC-08-274784

Case No, CGC-08-274645

Exuipits B To K TO THE DECLARATION OF PAUL LANNUS IN SUPPORT OF DEFENDANT
Forp Motor Company’s MOTION IN LiMINnE TO EXCLUDE PLAINTIFF’S SCIENTIFIC
CAUSATION EVIDENCE TO THE EXTENT It Does Nor DEMONSTRATE RELATIVE Risk

GREATER THAN 2.0 [MIL #3]

AEXHIBIT B

EXHIBIT B© Pergamon Const

ston orn Hyg YALA Hos

lth Ooxepst
ed ta Get By

elt, te
Seieaze Lud

0003-4878(94)E0032-U

MESOTHELIOMA AMONG CAR MECHANICS?

H-i, Worrowntz and K. RODELSPERGER

(Received 30 Nocember 1993 and in final form.i5 February 1994)

Papet ccad at the Workshop on Health Risks Associated with Chrysotile Asbestos,
held in Jersey, Channel Yslands, 14-17 November 1993. °

No Astract.

Fe 1991 and 1992 preliminary information was given onan on-going case-control study
‘of mesothelioma, which up to that time involved 175 casts, of whom 14 were car

qnechanics (Worrowrtz and RODELSPERGER, 1991.

1992), This study bas now been

finished (Wortownz.et al., 1994) and the final results relating to car mechanics can be

repotted.

‘Of the ofiginal 14 casts four had to be rejected, since the panel of pathologists
finally classified them only as “possible mesothelioma”. Ultimately out of 324 cases of
mesothelioma 16 were classified as motor vebicle mechanics (according to code 421
“Kraftfahrzeug-Instandsetzer”—“motor vehicle repair worker"—of the German

Federal Statistical Office). They were compared with

{6 mechanics among 315 hospital

controls and 12 mechanics among 182 population controls (see Table 1). The hospital
controls were patients who hed undergone lung resection for reasons other than
mesothelioma, in most instances because of tung cancer. .

Evaluation of the occupational histories of cases and conirols showed that ont of
the mesothelioma cases and one of the hospital controls worked ‘with locomotive
engines and asecond case worked with trams. A third mesothelioma, patient worked in

automobile production where he was exclusively

involved in fitting windscreens.

Among the population controls who had worked with cars one had only painted cars

_ and ‘another had-produced car space parts.

The motor mechanics began their employment in that capacity between 1925 aad
1972, thé median date being 1949 for both groups of patients and 1946 for the °
population conirols. The duration of relevant employment was longer for controls

than for cases, with median values of 5, 5.5 and4

years, respectively. Seven of the

mesothelioma cases, nine of the hospital controls and three of the population controls
said that they had done brake, fepair work. In all three groups there were some
individuals who had substantial asbestos exposure in other types of employment (e-g-
ina power plant orin the ship-building industry). Only four of the mesothelioma cases,

two of the-hospital controls and five of the"po)

lation ‘controls had no history of

asbtstos exposure. Three of these four mesatheliorna cases, and also two af the five

ee
“suppodted by the German Fédixl Ministey of Seitnee and

aS

Technology, Projeet No, OL HK 076 AS.H.-J. Worrowrr7, and K. RODELSPERCER

AM

“anyasas a33eaq ij pake¥us sou aiam so]tuyaoul s94y0 WYP BOW JOU F9OP “ELLs

(se-vol (asa!-oz61) .
cz s v1 t ss eG 9 tt zB
(toni-s@en)

os $ 6t ‘ Goi a ste Mosyston prydsoy
(wan) (zeat~ocor) . 5
vl +e er 9 ’ 4b61 oe ot vee. ‘ausped uuoyartosayy
% Nn % nN sSuuz piv anina uiypaut % wn ww dnasg °
‘sansouzo oA 99819 Uy [s3va4) Syouysaa —soquiny

Padma LOL,

ForsyiM syLo ON poBusLs APBANIUYSG — jUDWAG|AL> Jo
wo

ROWYNYOIN] “STOULNGD SHOLLYINdOd 73). NY F10¥LNCO TVUMFOH $1 'SBVD YINOMIHLOTIN pZC AMUNY SINT SIZINGA ROLOW *} sinwLMesothelioma smong ear mechanier? on

hospital controls and wo of the five population controls, stated that they had been
eugaged in brake repairs.

Lung tissuc analysis was available for two of the mesothelioma cases and for one of
the hospital controls (RGostsPeRGeR et al., 1993, see Table 2). For metothefioma

“Tase L LONG TISSUE ANALYSIS OF MESOTHELIOMA CASES AND HOSTAL CONTROLS,
ENGAGED AS MOTOR VEMICLE MECHASTCS. THE ANALYTICAL SENSTIVITY IS DEFINED AS
CONCENTRATION PER FLERE

Lung dust bre concentration L>S pm

x wr egr! (dry)
Analytid Other
No. Sats sensitivity Chrysotile = Amphibole minerals
1 Case 2 - oO o o >
z Case ta 0 282 a
3 Control 25 1.630 o. 1%

patient No. I no fibres longer than 5 pm’were found. Since 1972 he had worked for
8 years as a car mechanic and was engaged in brake tepair work during this time. There
was no suggestion.of any other asbestos exposure.

For mesothelioma patient No, 2 characteristic amphibole fibres longer than S yen
were observed. He had worked as a carmechanicforonly] yearin 1940 and had been a.
Luftwaffe pilot from 1941 ‘to 1945; he had no known asbestos exposure from other
employment.

Conirol patient No. Shad numerous long chrysotile fibres but no amphibole. fibres.
He had worked as car mechanic from 1934 to 1939. From 1945 to 1950 he was a
prisoner of war in Russia where he had to acc-weld steel structures and to install plass
fibre, insulation, Subsequently he is assumed 16 have had-no further occupational
exposure Ie asbestos,

CONCLUSIONS

From these results there is no evidence that car miechanics are exposed to an.
increased risk of mesothelioma even if they do brake tepairs, but asbestos exposure in
other eimployment is an important confoudding factor, so that if there is a
aniesothelioma risk for car inechaniics but it were small it would not be detectable, The
‘absence of | fibres in the‘lung tissué analysis lor onc of the mesothelioma cases—despite
his employment for 8 years as a car mechanic, repairing brakes—does not exclude the

. possibility that, decades before, chrysotile fibres were active at the target ceils. On the

other hand, itis doubtful that the amphibole and chrysotile fibres, in the lung tissue of
two other patients, can be related to their employment as car mechanics.”

(For the discussion of the issues raised in this and the other allied papers see,
pp. 407-425.)

REFERENCES

Rooersrencer, K., Worrowi7z,H-) .Balcnét,B., Aum cer R., ROMER. W., POHLAUELS. H. and JOcKen,
KH, (1993) Fall-Kontroll-Studie an Mesethcliompatienter num Gehalt anorganischer Fascen im68 Hod, Wortaorra and K. RAWELSHENGER

Lungenstaud, Vorirag auf dem Kolluquium Faserfrmige Siiube: Vorschrifien, Wirkuagea, Messung,

Mindereng, Kommision Reinhalwung der Lufi ia YDU und DIN Fulda, 7 9 September 1993. VDI.
Berichte 1025, Pp. 253-247, VDI-Veriag. Dilsseldad. oo

Woirawrrz. HJ. and Roprespencen, K. (1991) Chrysotile asbestos and mesothelioma, (Letter to the
Editor.) Am J. ind. Med. 19, $51 583. .

Woven, Hf. and RéveLsrexcta, K, (1992] Chiysotile asbestos, mesothaioma and garage mechanies:
Response to Dr Wong. dn. J. ind. Med. 24, 453-485,

Woirawrrz, H.-I, Hituennat, G., CaLavaezos, A. Bexcucusen.K, H.. RODELSeREGER, KJOCKEL. KH,
et ol, (1994) Multizentrische und muttidistipfinire Untersuchungen, zue Anslyse von Risike- und

EinfuBlaktoren des diffusen malignen Mevotbelioms. Schrifienrethe der Bundesansiah fir Atbciss-.
chutt, Wirschaheverlag NW. Breroerhaven,EXHIBIT C

EXHIBIT C9

eontremit
958 IC:
IC
juane

Mesothelioma Surveillance to Locate
Sources of Exposure to Asbestos

Kay Taschke, pop.! Michael S. Morgan, Sco? Harvey Checkoway, P80?
Gary Franklin, MD? Jobn j. Spinelli, pap,' Gerald van Belle, pap?

Cancets generally have long latency
periods, s0 sources of carcinogen exposure
may na longer exist when, a disgoosis ix
made. However, recent studies of
mesothelioma cases have led to the dis-
covery of previously untccognized cient
asbestor exposure sources. Paci er al!
found 2 large excess of mesothelioms
eases among textile workcts in Iraly. An
ndusecial hygiene investigation found
that rags in the reprocessed cextile indus-
were wrapped in bags char had con
ined asbestos? Jarvolin ct aP found an
elevated tisk of mesothelioma in Swedish
pulp and paper workers; 1 of 25 cates
‘wets found to have had cértain of proba-
ble asbestos exposure, most during main-
tenance work,
“These studies sugges that oven though
asbestos it one of the best known carcino-
genr of this century.” there may still be
value in mesothelioma surveillance to
locate previously unrecognized current
sources of eapasure, We compared the
occupational histories of mesothelioma
cases to those of population controls to
determine whedhee unrecognized eources of
exposure to asbestos existed in British
Colambis (BC). The sudy was part of a
larger investigation that included iasal and
bladder cancer cases.

ity of British Columbt
Canada .

f Public Health sad Coimmunicy.
Usirenity of Washington, Seattle,

Gorrespoodence and reprint requests: Kay
‘Teuchke, Department of Health Care and
Epidemiclogy, University of British Columbia,
Vancouver, BC VOT IZ3, Te: 604-822-2041, Fas
604.822.4994, Emad eache@uniagubec

This study was supported by the Beitish
Columbis Elcalth Reeatch Fouhdatioh.

Noel S. Weiss, mb, DpH?

MATERIALS AND METHODS
AND METHODS

{dentification of eases and controls

All persons with histologically conFcencd
primary malignant tumours of the pleural
mesochefium (international Clasiifiadion
of Diseases for Oncplogy. 1976, topo
graphy code 163 and histology code 905)

aged 19 ox more and registered by the

British Columbia Cancer Agency (BCCA)
from September 1, 1990, 10 August 31,
1992. were considered eligible for the
study. A BCCA pathologise (Dr. Aon
Milner}, not blinded co the initial diagno-

reviewed tissue samples far every case
inicially identified as eligible.

Control subjects were randomly selected
from Five-year age and sex strata of the
provincial vocers list and Frequency
matched to the agé' and tex disteibution of

e280 of all chtee types of cancer included
do the study.

Interviews

‘The subject contact methads were
approved by the University of British
Columbia Behavioural Scicnces-Screcning
Committee. All subjects living within
abour six hours’ surface teavel time of
‘Vancouver (ene way) weer interviewed
either in person or by telephione, ae their
convenience, Subjects living elsewhere in
BC were interviewed by tdeptione.

ha subject did not speak English well-or
had crouble recalling cvents in his o¢ her
fife,.a rolacive chosen by the subject was
asked co help wich the interview. If the
subject. was dead, the surviving nexeofkin
who had mest cecencly lived with the sub-
ject was concacted for interview. We
attempted to frequency match next-of-kin
interviews of eases and controls within age
secs.

MAY —JUNE 1997

CANADIAN JOURNAL OF PUBLIC HEALTH 163MESOTHELIOMA SURVEILLANCE,

Incerviews were conducted using 2 stan-
dardized questionnaice, which included
occupational, residential. smoking, and
medical histories, and an exposure history
aimed ac identifying caposures considered
by the Internacional Agency for Research
fon Cancer 20 be “known” er “probably”
carcinogenic.

All interviews were conducted by a regis~
cered nurse who was awate of the eazefcon-
trol scatus of the subjects. and were then
‘reviewed for compleceness by an industcal
hygienist (KT), who was nit.

Case-control analysis

All occupations and industries were
toded to the fourth digic of the Standard
Occupational and Industrial
Classificacions.¢? In cowl. 3,951 separate
jobs were Lsced by the interviewees, repre
senting over 300 occupational and. $00
industrial codes. For analysis, « study-spe-
cific occupational grouping scheme was
developed. which assigned all job listings
@ one of 37 occupational eroups.

‘Odds ratios (ORs) and 959% confidence”

Himits were calculared for evct employed
(for six or more months) versus never
employed in cach aceupatianal group.
Effecr estimates were also caleulated for
‘two categories of duration of employment:
6 months co less than 10 years, and 10
yeats oF tore, Latency analyser west con:
ducted for all occupational groups, with
the mast recent 20 yeacs of employment
temaved. AM OR estimaces were adjusted
for sex and age (in theee strata: «60 yean;
60.69 yeats: and 270 years),

Toitial analyses were conducted inchud=
ing all cases and controls. To detect new
eccupationdl groups with pocential expo-
sures to asbestos, rranalyses were donc after
excluding case and control subjects who
had held otcupations or worked in
Procestes known 4 prior! toshave consistent
Strong associations with mesothelioma and
confirmed in this study.

Exacr methods were used (0 summarize
ORs across all surara and calculate confi.
dence intervals (Egret, Statistics and
Epidemiclogy Research Corporation,
Scitde, WA, 1993). :

An occupational group was corisidered
for asbestos survelllince followup if 1) in
had an OR of a lean’3:0 in che reanalysis,

Resporise Characteristics of Me
. Descriptive Chia

helioma Case

site or histology

Total regiaered by BC Cancer Agency
“pele Be
Not histologically confirmed

Interview complete 0% of elgibte)
Male (%)

‘Meon age, in years landard exror
Range

Nest-obkin Interviews (9)

Pa
racteristics of interwa

Cigarette smating, mean pack-years (saredaed error)
Range

NYA» not applicable

‘or an OR greater than 1.2 if it was consid-
ered @ priori at risk based on a Viteracare
review and 2) ac least three cases in the
oceupstional group had a pacern af similar
Job duties or exposures.

RESULTS

Companbility of cases and controls

‘Table I lists the roral number of cases and
controls finally considered eligible for the
study and selected descriptive characteristics
OF the subjects. The proportion of dl
controls who participated was B19, 736
lower than among cases. The proporion af
male caset was 10% higher than among
controls, because of the higher proportion
of men with mesothelioma compared with
the other cancer sites (bladder and nasal) 0
which controls were aso matched, The
grester proportion of nex-of-kin intcrvicus
among castt Is partly arttibutable co the
shorter'suvival for mesothelioma than the
two other eancer sites, but in addition some
controls radomly selected 19 have next-ol-
Min interviews were reluctant to panicipae
if others Would be answering questions on
theie behalf

‘Occitpational associations, all ces and
eonuols

‘Table Il lists ORs and.confidence incer-
vals for aunciations beoween cach occupae

he

tonal group and mesothelioma, Three
occupational groups had ORs of $.0-n¢
Greater in the inicial analysis: sheer metal
workers, plumbers znd pipefinters, and
shipbuilding workers, not dlsewhere clatsi-
Mied. Ail these ORs were seatitically signifi-
sant and followed the expected wend of
increased celative risk with increasing dura-
1 of employment (OR 10+ years « infi-
ce, ali three groups),

Eight other occupational groups had
ORs of 3.0 o¢ higher: painters: welders;
gardeners; bricklayers, plasterers, and
sement workers; miners, drillers, and
blasters; machiniso; construction foremen;
and electricians and electrical equipment
insraflers, Several other occupational
groups that might be considered a prion’ at
risk had clevated ORs induszial mechan-
jes; stationary engineers and boitcrmakers;
‘construction labourers and transpore engi-
peers and firemen. One @ priori ateritk
‘occupation had & reduced risk ‘estimates
Ychicle mechanics,

Associations with asbestos posure and
specific processes, all cases and esntrals
Table III shows the ORs far associations
between mesothelioma and occupational
asbestos exposure or specific occupational
processes queried in the exposure histary
section of the questionnaire. Strongly ele-
vated ORs were found for asbestos

164 REVUE CANADIENNE DESANTE PUBLIQUE

VOLUME Wa. NO. 3MESOTHELIOMA SURVEILLANCE

TABLEN
Between Occupational Groups and Pleural M
Controls (n = 154) included .

Ever Employed

Ee
Most Recent 20 Yeirs Remade

Odds
cal cae
wile
Employed) “Int Controls
9.6 2.
2 Bz
“5.0, TA
Lf g
x a
“34 iT
32 YT
31 a
32 “eT
a Se zy
a AY 18
‘B 8
08 ‘820 08
O68 HAT as
as S76 os
04 ZZ Os
1.0 aio 1.2
og Ad oe
ia AS 1
10 we Ld
OF uw OB
o2 Ww 02
O4 56 as
Os a4 Ob
137 0.7 10/37 Oz
yy OG 8 Vo
m2 Oe wi 06
ws. 04 ws o
Ya 10 OK o
of woe .
#
ye yo ww
2 Os
2Y B21 10
19/43 i
ais * 23 23
g aa OR
B ony a
we 06-50 Mt
F 03-19 72s
C6105 WP
1528 08.3.9 3p
we? 0-18 -
a O34 .
Hos ge a
TAB Roa ).4 a
ao is 056.5, w

thelioma, All Cases (n= $4) and’

60.489, and 270 years)
al ne

MAY ~ JUNE 1997

CANADIAN JOURNAL OF PUALIC HEALTH 10MESOTHELIOMA SURVEILLANCE,

TABLE EE

~ , Odds Ratias Showing AssagtaUons Detween Specific Expasure Agents or Processes and Pleural Meso

desothelioma,
All Cases (n ='S1) and Controls (n = 154) Included :
; Ever Employed ost Recent 20 Years Removed
Nomber Odi Number Odds
cary BABE cy ES conta
confidence ° idence
- Conteols Employed — “terval Controls employed — Interat®
& Agents ”
Abetos een 3025 2 40-05 JOn3 10.8 4A-28.6
Processes .
+] hip Buldiog,repotr or demotion mar oat dai9z 1 38
Etc ¢ # ER ow x
Pi fecsir Aspalr 5. 1 .(
Freee beer nsec aw a5 Veto nant “3
Building demolition or renovation oe wy 24 0.9-6,1 rer 2
rake Hing Inslallaton or repair wr a3 od ae a3

‘Odds Ratios Showing Associations Between Selected O
Controls Removed if individual Ever Held Certain At-Risk O:
. . (Remaining Cases n = 19;

TABLE FV

ccupational Groups and Pleural Mesothelioma, Cases and

‘ccupations or Performed Certain At-Risk Processes
Remaining Controls n= 120)

ver Briployed ‘Most Reegat 20 Years Removed
Number Odds Number Ofide .
a Ratio 35% ot Ratio
Coed Ger Confidence Gases Ever Confidence
Convele Employed — taterent Convey Employed —“Satereat
Occupations) groups with OR > 3
Gardeners POMPE 2 ns mous o7.203
Malnees diilors, & blasters 3 38 3s 36 1833.0
Industral mechanics B 62 w 62 o56es
Palmers A 3s ma ozs
Bricklaye, plasterers & cement workers ae 54 1B 68 1.23986
Chemica! & pelroteum workaiy 28 53 04-550 ws 4 Osta
A prior suspect occupational gro
Einamactoh Isbourees at Bros Shs 22 07-106 D743
nae ie i Saat S152
Nad
Vehicle mechanics wis ox 32 032
Trans englocers& frei a 8 043 :
ea neers Bf :
Slationsry engineers, boliermakes* a2 Q :
Bening a elecirical oA 8 O53 :
Egulomeet Intalfors . .
«Biber repel akong were et meal oder plumbers and pipeinen, snd siphalding woikanj cxcladel soaaw i re mace or bolle ital
” Eibhsr Hy plane ipetieg Iuling rea ad spies ai we prpeenes Were Rama .
5 Mee gt and eats wes ; :
+ No eases, no furer analyses done .

exposure; shipbuilding. repair or demol
tion; installing insulation; plumbing, pi
fincing or heating repair; furnace or boiler
insallation or repair; and building demo-
Nrion or renovation, In most cases, point
estimates of risk were higher with
increased duiation of exposure and with
the 20-year latency period taken into
account. As with vehicle mechanics in the
occupational analysis, a history of brake
Tinting installation or repair had a risk esti-
mate below 3.0.

Occupational abd process associations
Prior’ at-risk groups removed

To. determine whether there were
asbestos-expaied occupation! groups that
were not detected:in the first analysis
because ofthe strong association between
mesothelioma and certain occupations, 2
reanalysis was conducted after dimainating
case and conuol subjects who had been in
eccupational groups or performed process
s considered a priori co be suonply at risk
and confirmed in che first.analysis.

Individuals ever employed a6 sheet metal
workeis, plumbers and pipelines oF zhip-
building workers were excluded, 24 were
those who performed related processes
(furnace ot boiler installation or repair;
plumbing, pipefitting or heating repair,
and shipbuilding, cepsis ot demolition).
Two of the occupational groups with
strongly clevated ORs in the firse analysis ~
welders, and electricians and electrical
equipment instalters — had no cases left
once the three occupational groups and the

466 REVUE CANADIENNE DE SANTE PUBLIQUE

VOLUME B8.NO, 3MESOTHELIOMA SURVEILLANCE

camparable processes were removed. The
ORs of ewo others were considerably
reduced: consteuction foremen and
machinists (Table ('V). This suggests chat
these jobs had clevated risks by viewe of
asbestos exposure in the processes that
were eliminated for this analysis.

Six occupational groups that had elevat-
ed ORs inv the initia! analysis were found
to have increased risk: estimate, indicating
potential for exposures independent of the
eliminated jobs or processes: gardeners;
mloers, drillers and blasters; industrial
anechanics; painters; bicklaye, plasterers
and cement workers; and chemical and
petroleum workers (Table TV). Among the
remaining ocaupasions considered at disk a
priori, the ORs for construction labourers
hhad increased to nearly 3.0, vehicle
mechanics continued to have a relative risk
‘estimate below 1.0, and no eases cemained
for trassport or stationary engineers.

Of the occupations of interest, only in
three—the miners, bricklayers, and can-
seruction Isbourers—were thete more than

three eases remaining in this analysis Some ~

of che case subjects in these jobs recalled
asbestos exposures. In che miners group,
none mined asbestor, However, one min~
cr's nextof-tin suggested that there may
brave been asbestos if the ore; a maine assay"
er remembered using asbestos cloth in the
Tab; and anochér miner said the pipes in
the mine were lagged with asbestos. In the
bricklayers group, 2 next-of-kin thought
she subject may lave used asbestos when
laying fireplace bricks. Two individuals
from this group were brickayers, the other
Svo wete concrete mixers, and all were
expored to cement aggregats (compared
‘with four controls). Although they did nae
recall exposure, three of the construction
Yabourers worked in jobs thas may'have
cnsalled asbestos expastuc: building demo-
Ticion, and sewer arid weatet main, construc-
tion (compared with no control): The
cases in these three occupational groups
‘overlapped: all of the bricklzycts group and
thrce of the conseruction Lnboucers were in
the mines: group.

A teanalysis was also done for asbestos
exposure and specific processes. Ne case
subjecs temained who bad installed insu-
lation at work, suggesting dat dhe irisula-

tion work a¢ risk was included in the

MAY -JUNE 1997

processes or occupations that had been
eliminated from this analysis,
Occupational building demolition e¢ reno-
vation had an increased risk (OR = 28,
95% confidence interval (Ci: 0.6-11.9)
compared with the fisst analysis; and. wich
the 20-year latency taken into accouns, the
cescimane was 4,6 (95% Cl: 0.9-22.1), Asia
the previous analysis, brake insrallation and.

repale did not appear to be astociaccd with
mesathelinma.

DISCUSSION.

Many of the jobs sssociazed wich
mesothelioma in chis study have been
identified previously in the scientific liter-
atdre shipbuilders!“" sheer meral worke
ers: insulation workers:!™ heating
tradespeople, including boiler and furnace
installation, and plumbing and heat
ii and construction workers,
including electricians, bricklayers,
painters, welders, and building demolition
workers." One painter in this snidy
had direct asbestor exposure through sand
ing of zsbenor-containing autobedy filler:
vehicle body workers have recently been,
shown elsewhere fo be a¢ tisk.!? Forty-four
(86%) of the case subjects had held jobs in
these categatics.

Nonc.of the care subjects in this scudy
was an asbestos logger, alchough some had
performed asbestos insulation work 9s part
of their jabs as pipefiteers or shcetmetal
workers. The burden of asbestos disease in
British Columbia may be shifting from the
insulators theroselves to ather cradespoople.

Several occupations that have never o¢
nirdy been sssodiared with mesothclioma
were detected in the reanalysis with bigh
sisk groups removed: gardeners, non-
asbestos miners, and chemiéal and pocrolc-
um workers. One previous study found
auiuciations with hordculrual work," and
an Onrario study recently fouind elevated
sks of mesothelionia among refinery
workers.” There do not appear ro bave
heee tepors of mesothelioma’in miners
other chan asbestos miners. Exexps for the

* mies, none of thize oécupations showed

common patterns of duties in three or
more workers, and for some of the eases,
alternative soucces of asbestos exposure
were reported in the interview, The jobs

held by che gardener cares in this seudy (a
horicultucis and a garden digper) did por
suggest commen activities or exposuce,
except possibly sail constinuents. The
chemical and petrolcum workers both
worked in che gas and oil industry, one a8 2
safety man, the other in an unknown oceu-
pation (next-of-kin intervicwe:).

‘The small size of chis scudy meant that
isk estimates were imprecise for some of
‘the occupational groups, In addition,
grouping of occupations was likely to
vault in non-diffecendal miscassifiction,
usually biasing, tisk estimates to the null
valuc. Despite these potzatial problems,
the major occupations at rik for mesothe-
Fioma: were easily detected in this arudy.
Acenaing cases over additioial ycars would
allow more specific occupatianal groups co
be separately analyzed, and would decer-
mine whether any les prevalent occupa-
Sons with elevated tists had been mised
by this eeudy.

About one-third of case interviews and
onc-seventh of control interviews were
with nexof-kin. Exposure data and dates
were less well known by these intervicwees.
Yn addition, on average, abour 195 Fewer
Jobs were cocalled by next-of Win Interview-
ces than by the subjects themsclyes, A
review of the ncxtolkin interviews sug
gests chat mising information tended to be
from carly in the life of he eubject.
Relative risk estimates for such jobs and
exposures: would be expectal to be bissed
downward whenever there was 2 «mailer
Proportion of next-of-kin interviews
among controls,

Biased recall of asbestos exposure war a
potential problem, because many’ physi-
cians knew the association between
asbesoos and mesothelioma, Two raesothe-
Tiara case subjects in thls study Indicated
tac theic physician had wld them asbestar
‘caused their disease, even though they File
theic exposure had beca uivial. A similar
bias may occur if physicians were more
Uleely vo diagnose mesothelioma in patients
reporting asbestos exposure.

Mesothelioma is 4 raze cancer with one
major ecologic exposure, therefore surveil-
lance using each case as a sentinel event
might seem more reasonable fer this dit-
ease than for cancer with muldfaccorial
causation. However, control comparisons

CANADIAN JOURNAL OF PUBLIC HEALTH 1673

MESOTHELIOMA SURVEILLANCE,

are still useful co-help distinguish which of
multiple occupations provide expotures
imporranc to the etiology of the case. In
addition. many individuals may nor recall
shears expasute;.compurisans with con-
trol groups are useful to help locate
sources of exposure. ‘Twenty-one meiathe~
Homa ease subjéas in dis study did not
recall occupational asbestos exposure; 14
of there had held jobs Identified in the
ase-control analyzes as having high rela-
ve risks, :

‘Most of the mesothelioma eases in this
study were explainable by sources of
asbestos exposure well kinewn in the liter-
ature: ship building, cepaiz, or demoli-
tion; insralling insulations plumbing, pip-
cfirting, or heating repair, and construc
ion work, including bricklaying, plascer-
ing, patnting, welding, and clectrical
work. These occupations are also recog
nited by local regulatory authorities a5
invalving acbestos exposure, Sevesal occu
gations and exposure scenatios were iden-
tified chac had nox previously been linked
to mesothelioma, All except non-asbestas
mining involved umall aurubers, chere-
fore judgements about whether chese
associations were cousal would be specu-
rive,

ACKNOWLEDGEMENTS

‘The authors would like to thank the fol-
lowing individuals for their assistance dur-
ing the design, implementation or analysis
of this study: Jody Slakov, Ruth Hershles,
Dr. Clyde Herman, Bob Hitthe, Dr.
Steve Marion, Dr. Anne Milner, and
Hind Sarginson, We are grateful to all the
case and controt subjects, and nexrof-kin
who gave their time co make pant in this

“suudy.

REFERENCES

1. Paci E, Dini 5, Buiaeei E ex al, Maligoane

Lows ia eon-asbesta: textile worker i
Floren. din J J Med 19871 12249-54,

2 Quinn MM, Kitlbel D, Buisni E, ct al, Ao
‘mbesies bated ia dee reuile indus
7. Arn | Ted Med VOBTAVI5S-66,

3. Jarvbolm B, Malker H, Mather By ex al, Pleural
‘mesodheFiomad and siberios esparire ia che pulp
and paper industri: A new tisk group Sdcauied,
by Unkage of official registers. Am Ind Aled
1990;13:361-67.

4. Imeruational Agency for Reiearch on Cancer.

Monogtaphs on the Evaluation of the
Crcinoreoe Risk of Chemica 19 Humans,
valuations of Carcinogenicity: An

Updating of LARC Monographt Volumes re
42, Supplement 7. Lyon: IARC Seientifie
Publications, 1987,

3. Teachke K, Morgan MS, Checkoway H, «¢ al
Nard sod iddt anstsoreilna wp loote
seorees of exporure (0 occupadonal esrcinogens.
Occup Environ Med In pres”

6 Statins Canada. Standard Occupatiosal
Chuifiesion. Onunrat Mintzer of Supply aad
Seees, 1940

7. Statistics, Camndi. Standard Ioduscsiat
Glautheatan: Oren: Minka of Supply and

A Brolow NE, Day NE. Suatiier Methods in
Concer. Reseerch. Lyoe: IARC Scicatific
Publications, 19803140.

3. Mchu CR. Patel NR, Gray. R. Computing an

eae conf

10. Lemen RA, Demenr JM, Boponcr JK.

‘exposure, and enalignant menchehion,

vs RT tr
. Peta J, Hodgson JI, Masthews FE, Joou JR.
Condtuel ens i pesodeton eee
Brin, Lancet 1995H5535-39,

4. Salkaff J. Hommend FC. Seidman &

onary experiences. an worker

Unied, Stace and Canada. 1543-1576. dies NY
Asal 5G 1979330: 0-116, ,

45. Tea J, Lewinsohn HC, Meigt JW, ec al,
Mesathelioma ix Connecticut, 1935-1977. J

Mra 903:25749-56,
16, Fladwe AC. Engholia G, Englund A. The dik
flung eanccs foe: asberras amang Sredisk cone

awuaion worker: Sdfvreponied Ciparure are

i ge mauriz eomparcd, Fat J Epidemiol
oilitwramag si) &

17. Fiakelinein Md. Merothelioma in il ecfaery

thers. Scand J Work Enviren Health

96:22:67,

Received: July 25, 1996
Acceperd: January 24, 1997

168 REVUE CANADIENNE DE SANTE PUBLIQUE

VOLUME 88, NO. 3EXHIBIT D

EXHIBIT DMesothelioma in Connecticut,

1955-1977

Occupational and Geographic Associations

Mary Jane Teta, M.P.H
Linda Z, Mowad, R.N.; and John T. Flannery, BA.

All cases of molignant mesothelioma (201) ond other
primary maltgiant pleurel tumors (19) reported to the
Connecticut Tumor Registry from 1955 through 1977 were
studied in an attempt ¢o identify high-risk jobs, industries
and geographic locations and to estimete the risk attribute-
ble t0 asbestos exposure in the workplace. Data were ob-
tained tram’ hospital records, decth certificates ond city
directories for cases, case spouses ond @ rondom sample
{604} of Connecticur decedents (1935-1975). Three case
“avolved histories of work ia asbestos Broducts monulace
ture, but there was no evidence of residential risk ia that
ptogrephic area, Relovve risk (RRJ for corpenters and
Cabinetmakers was 2.25 {p < .05}: for plumbers end pipe
fitters, 3.87 (p < .05); ond for persons “ever employed” in
the rubber industry, 5.08 (p <.01). Occupational expasure
was indicared in 85%. of the coses; atributoble rick (AR)
war 36M. Risk increased with greater exposure and older
gt. AR was 8158 in men aged 70 to 89 years at diagnosis.
Reduction of unnecessary occupational asbestos exposure
remoins the highest public health priority.

Jn 1980, Lewinsohn ex ab! described mesothelioma in
Connecticut from 1935 thraugh 1977, Problems of diagno-
sis and ascertalament made results for the years prior to.

From the Yale Schoot of Epidemistogy and-Public Health, New
Havin, Conn. (MS. Teta, Asoclat: In Research, Connecticuy Cancer
Ebidemitogy Unit, Dr. Meigt, Clinica! Profenior of Epitemiofory
and Public Health and M6. Mowad, Associa: In Research}; the
Union Carbida Corporation, Danbury, Conn. (Or. Lewiotohn,
Auictant Corporate Medieat Director): the Vile Univenity School
of Medicine (Dr, Vidone, Associate Clinical Professar of Pachology)
and the Connectleut Tumor Reystry, Connecdeut Spate Depa
ment of Health Services, Hanford (Mr. Flannery, Director], Ms. Teta,
i now alfifated with Union Carbide Corporation, Danbury, Conn.

Address correspondence to Unien Carbide Corparation, Health,
Silety.and Environmental Affair, Dept #2, 1 Ridgebury Rd,
‘Danbury, CT 06817 (Ma, Tera},

‘THY investigation was supportéd by pints NOI-CP-33235 and
NDCP-61NU2 awarded by the Navona Cancer Inftitute, US
Deparment of Heal aga Human Services, and by the Institute of
Occupational Medicine and Hygiene, Yale Uniyerity School of
Meateine, .

Journal of Gccupational Medicine/Vol, 25, No. 10/October 1983

ilton C, Lewinsohn, M.8., B.Ch.; J. Wister Meigs, M.O.

omeo A, Vidone, M.0,;

195S of uncertain value. From 19SS through 1977 the
ageadjusted rates among mates rose from about 0.19 to
0,60/100,000 and among. females from 0.13 to 0.19/
100,000.

Bruckman'et 2!2.claimed in 1977 that increases in the
disease are due to the increase In the “cumulative asbestos
consumption” and that_cmissions into the environment
fe.g., building construction, demolition, automobile brake
linings) are somehow involved as caumative factors The
substantial rise, however, in the male-feriate ratio ts more
consistent with occupational exposures of men at work,
Bruckmsn et al were unable to provide complete o¢cupa-
Tonal histories for the 133 diagnosed cases of mesotheli-
oma (1935-1972) drawn from the Connecticut Tumor
Registry (CTR) on which their report was based. Despite
this linitation, the Alr Compliance Unit of the Connecticut
Department of Environmental Protection has propssed an
ambient air standard of 30 ng/m3, measured overa 30-day
interval. This proposal was based. on estimated asbestas
concentrations at several selected sites in Connecticut.

Mesothelioma Is a rare disease with approximately 2.2
cas per million population expected annually. The
proportion of cas not astociated with same forn of
asbestos exposure bas been reported to be near 15H?
This disease may sheve as 2 marker for.unsuspected past
asbestos exposure. The present study was designed pri
enarily to examine the job categories and industry tues of
identified cases of malignant mesothelioma recanded in
‘he CTR in an attempt to (1) identify job categories,
duswies, specific employers, and Connecticut geographic
jocations that are associated with an excess risk formeso-
thelioma and that may‘also be asscclated with asbsitos
usage: and (2} determine the proportion of cases involving
possible exposure toasbestos inthe workplace. =.

The health implications of the proposed ambient air
standard make it desirable to estimate the kinds and num
bers of cases that may be due to dccupational asbestos
exposure, other as yer undetermined risk factors, or posse
ble asbestos exposure from the general environment.

‘There remain numerous unanswered questions concam-
ing the existence of a threshold sand the nature of the. as.

4gbestos-mesothelioma dose-response relationship.-* |The
data available allowed us to approach these problems
indirectly. In lieu of dust measurements, job and industry
tives, ascertained for study subjects for periods up wo 50
years, were used 2s Indicators of exposure,

Methodology

Since mesothelioma has aften been confused with other
matignant wmors, an anatomic pathology review of all
casas reported ‘to the CTR between 1955 and 1977 wis
undertaken. Histologic material, along eithzgrats autopsy
and clinical reports, was submitted to one of us {R.AM)
for review, No personal identifiers or occupational data
were included. Although the final results of this review will
he published separately, specific findings will be discussed
in the coatgxt of the present report.

The CTR registered 196 cases of primary malignant
mesothelioma during the years 1955 to 1977. inclusive.
With the exception of the Veterans Administration (va)
Hospitals in Connecticut, it fr mandatory for hospitals to
report diagnosed malignant neoplaims to the central
registry. A tevitw of all autopsy records from the larger of
the two VA hospitals in the stam from 1955 through 1977
yielded five additional cases of mesothetioma, bringing the
yotal number to 201, This included 137 cases with site
pleura, 29 with site peritoncum, and 35 of other or un-
known sites. Concems about diagnostic sensitivity prompt
‘ed the Inclusion of 19 cases reported as pleural tumors
other than mesothelioma during the same 23-year period.
These concerns were justified by the slide review tat
idendiied several cases of mesothelioma in this group. The
tout case study popuilalion size was 220 (Table #}.

Medical, demographic, and occupational dara have been
collected for these 220 cases, Similar information wes
gathered by Roush-et al?9 for a computer-generated sane
dom sample of 604 decedents (1955-1975} aged 20 to 98

Table 1 — Sex, Age aad Diagnostic Classification af 201 Cases of
Malignant Mesothefioms ang (8 Other Pleoral Temors Diagnostd
‘in Connecticut, 1955-1977

Diagnasi* Mates Femaes Toul bean Aget

Pleural wo 06? 8
mesothelioma:

Pleural tumor u a a 6
other than
mmesotheliora)

Peritontal Bw on @ 9
mesothelioma

Mesothelioma at ao ow 4
other sitet and .
atunknown sitet

Ton! 180 ww a &t

* Wold Health Orsanization (1926), 21 originally recorded by
cTh ae
T At dissnotir

750

years who provided 2 contro! group. Thete contials were
drawn without stratification of any kind from the dexth
certitficne Gles of the Division of Health Statistics of the
Connecticut State’ Department of Health Services (CSDHS).
Death certificates (DCs} provided demographic datz and
uswal occupation for study subjects at time of death, Gry
diceclorits (CDs) were searched for residential and employ-
ment histories 1, 10, 20, 25, 30, 40, and 50 years prior to
date of diagnosis or death, provided that the subject was at
least 20: years old at the time.*? The Price and Lee City
Directories, which are avatlable for about two thirds of
Connecticuc towns from 3890 to 1960, have a target
population of 92% of the adult mates in the state. A similar
occupational history 2nd eznter search was conducted for
all spouses (n = 193) of the 220 cases to explore the possi-
bilities for domestic. exposure that may have originated ini
the workplace.

‘The three-digit 1970 U.S, Census industrial and occupa.
onal codes!? were assigned to the employment informa.
tlao ascertained. Industrial coding was determined on the
basis of product descriptions for each employer which were
fousd in the manufacturing directories of Connecticut
published by the State Department of Labor and in the
Price and Lee directories Yor nonmanufacturing industries}?

The study population for occupational analysis was re-
suicted to males over 30 years of age at death or diagnosis.
A large proportion of females (465 cases, 31% controls)
had no known work history. Although nonoccupational
etiologies may be 2 possibility, the absence of reliable
occupational data for females prevented 2 formal analysis
of their occupational asbestos exposure, Since all cases were
bom after 1274, controls born prior to 1875 were ex-
duded, There remained 614 mate subjects for the occupa-
thonat analysis: 136 mesothelioma cates; 1 I_cases of pleura!
tumors, other this mesothelioma; and 464 centrals, The
case-control ratio was zpproximately 1:3. Seven cases
jaduded in the analysis were those of individuals who wart
ative at the time of the data collection period (1976).

Sudy subjects were fist compared on the bass of
whether they bad “ever worked” in selected jobs or indus-
ues with. known potential for occupational asbestos ¢x-
posure or for whith there were sufficient numbers to be
informative. Formal statistical comparisons were made for
seven job categories (engineers; brickmasons and stone-
masons; cabinetmakers and carpenters; electricians; fore~
men; painters, construction and maintenance workers;
and plumbers and pipefitiers) and for elght industry cate
geries (construction; miscellaneous nonmetailic. mineral
and stone products; electrical machinery equipment and
supplies; aircraft and: parts; ship and boat building; yam,
thread and fabric mills; rubber product; and aromobile
repair and, eelated service). The MaitelHaenszel odds
ratio was used to estimate gtlative risk (RR)

To increase Statistical power and provide a more direct
measure of causation, efforts were made lo classify study
stubjects in terms of the probability of occupational asbes-
Tos exposures A subset of jobs and another svbitc of ine
dustries were selected for which exposure to asbestos was
considered either “possible” or “likely” (Tables 2 and 3).
‘These subsets were developed by one of us {HCL} with-
out reference to Information about discass status. Compari-
sons of case-control praportions with occupational abestas

Mesothelioma in Connecticut/Teta ex al

etFasc ero a rote wept Capone Foe Gorey

Tote 2 Lei a a fbb ity ol aphouns Unser on reppin

1 Mesias et

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AL ary sacaneet chance cata test

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et micas

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ash winartan pt ertanetantoo
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: AS) ihe

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7 da ceeetin evi e tetror S49 w Aer Seoutid he hers mpm
Wey treed D ween st Som ta eens .
| Gangresn in with tan et me ce rg rent ho md
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raeetacy

fee erat rounds

of chiee sources of information — job wdle, industry
ey and Job wile and. industry due. For each of these
Comparisons, adjustment was made (nonsimultaneously) for
age (30 to 49 years, 50 to 69 years, 70 t0 89 years), year of

Journal of Occupational Medicine/Vol. 25, No, 10/October 1983

Yk Cm Earanent Fo 3, Coen Contre ey Ta
feria toner
o a fei
a iz ve
on
Gk tte oe mates oe Ider Fe
ML Gata hirme 10S alate wero ad mba TO Rranianave, ren wea
eyo MM Gauge ome
0 lances la myn : TA tree ee one
WM Kedorasie feces HL Sadat ord ott tice
te Gaete Sk Pesan rd Marrero oats 21 tone eany
ates Tati meatal wer 2a Meera na ad asere
BH Rstaedgcate: M2 Beha Aston, i pwvaure
TAL Pemonensgims “ME Coated ete Puctonl mpnctasture
“th eam aan Onieers tat ri,
“kes AD Yeaticane ‘cet a
tome Pinenaedabien heiow once
O15 Syeatiommand IE Manonaee spares Pkg Rikon et see mismo
2B Gare alta mmc ag Tetietwera
i Femanmemoe BE sito alr marae
eeemranet 3 Urumee Hema
cin Cecelia MA Ean neseranecet Mnee imine —aberate
cubemirmnet 1 Ebteuati Ayworimt mei ete
teu 43 tyne eatin
A cream ioe sone Bt secatinean macht
a oe
TES Danie gena ganna tte Bt pectacs
16 wens ploy mtg nese pear aah daa,
mentine on 1 tersenetaert
a1 foneaae Be Moteesnestenin
UY Tegra tevnvan, $5) estte id eecdry aes
Sk ufwancn went en AL Canepa whence
Si bat beet aad 42 Cement name sae
“SE Gonatereatn BL Sainatey tion
toaece

sure (possible and likely) wete analyzed separately for.

ie
AE Lact pebicatoring

Take © at ori an

birth (1870-1889, 1890-1509, 1910-1929, 1930-1949), and
zeographic location. The 1966 labor market area (LMA}
divisions of Connecticut were utlized for the geographic
‘isk analysis} Particular attention was given two the LMAs
surrounding Connecticut's five largest urban areas and two
rapldly expanding, previously rural cegioris.

A scaring procedure was developed to provide an indica-
tor of the durgtion.and severity of occupational asbestos
exposure for both eases and controls, For ezch job tile
in the “likely” category thar could be documented from
OCs, CDs of both for an Individual, a score of 2 was a
signed. A job te from the “possible” group was given
score of 1 and from. the “unlikely” subset, a score of 0.
‘These values were summed across all available time periods
for which employment information was available. Indi-
viduals lacking any employment history, which included
those never employed and those for whorn data were mit-
sing, were excluded, Each of the remaining study subjects
was assigned a final single job Index of expasure. This

TSchide measure provided an ordered exposure variable,
vhich was categorized into five. levels. Level O included 2
job index of 0, level 1 included a job index of 1, level 2.2
job index of 2; level 3, Job indexes. of 3 and 4: J level 4,
job indexes greater than 4. Each study subject with a job
index of exposure was assigned to one of the five groups
(Although the medical records of some cates noted past
occupational asbestos exposure, this information could not
be incorporared into the analysis since such data were fack-
Ing for controls and has nat been systematically colecud
for cases over time.)

Mantel-Haenszel standardized odds ratios were com-
puted, comparing cases and controls across each of the four
levels of “exposure” to "no exposure.” Finally, the Coch-
randMantel-Haenszel Test of Partial Association®® was
Applied i test the disease-exposure relationship for trend
while controling for the potential confounding of age,
which was stratified into 20-year intervals: 30 to 49 years;
50 to G9 years; 70 to 89 years. The 90+ stratum with too
few numbers to be inforinative (two cases, Seven controfs)
was excluded from the dose-response analysis. These result
are reported for an estimated exposure index based on job
only, The coding of industries into the broad categories of
the US. Census does not discriminate sadsfactorily among
Jobs with different exposures.

Controls tended to be older at death with a mean age of
68 yeas as opposed to 64 for cases (Table 4). They pre-
dominated in the earlier bith cohorts with B15 born prior
to 1910, Since age and year of birth are likely to be eclated
to occupational asbestos expasure, as well as to disease
status, they wert considered potentiat confounders and
controlled for in the analysis whenever sample slze per-
mitted. The confounding effect of these variables, however,
‘was not substantiat, The standardized odds ratios differed
minimally from the crude, and simultaneous adjustment
was not deemed necessary. :

The proportions of individuals with at least coe job Ude
from DCs, CDs or both were comparable for cases and con-
Yeats and virwally complete using all sources ~ 96% for
casts, 99% for controls {Table 5), The percentages with 14
and 5-8 job Utles were nearly identical. CDs provided fewer

+ job and industry titles than DCs but more names of specific

employers. One year prior to death ar diagnosis less ine
formation was obtained for contrals from CDs, mast likely

‘Tables ~ Demographic Characteritics of Crs and-Contrats™

Cems Controts
Mrxn ytarol dtxth ordiagnosis 1969 1865
Mean. spt 2 death os disgnoys a 68
‘Binh Cohort Distribution, %
1870 — 1885 8 Rr
1890 — 1903. 55 ag
1910 = 1323 a ve
1930 - 1949 2 1
100 tog

* Mates older than 30 yean at death or diagnesis, barn after
1874

752

attribuable to the larger proportion of retirees in the fatter
group. For all ocher time periods the percentages of cases
and controls with a jab or industry ue were siraar, Using
both CDs and DCs, at least one Industry title was available
for 89% of eases and 90% of conteols.

Results

We have described secular and time tends for mesathel-
joma in Connecticut from 1935 through 1977 in an earlier
report} In the presenticase-coniral occupational risk analy-
sis’ for the year; 195$ through 1977, based-on job title
alone; the more than twofold risk for cabinetmakers and
carpenters and the nearly fouriold risk for plumbers and
Plpefitrers were significant (> < 05) (Table 6), Excess risk
was obterved for tngineers, masons, elecwicians, foremen,
and palnters, but ia none of these categories did it reach
statistical significance at the .OS level. It should be noted
that for the Job- and industry-specific analyses the study
provided adequate power to detect only large associations
for the less common categories of employment. Fourteen
of the 15 ‘cases amorig the carpenters were diagnosed as
pleural mesothelioma and the single cast of periotonea!
mesothelioma occurred in the only: individual who had
worked in a boat yard. All seven plumbers and pipefiriers
were mepistered at the CTR with pleural mesothelioma,
and all death certificates reported them to be in this job
category, Although CD data were available for ently four of
these cists, it was in perfect agreement with DC data and
revealed first employment in this category to be at feast 30
years before diagnosis for each. >

A parallel comparison of cases and controls using indus
uy tide Hone’ revealed a significant association with the

rubber industry (relative risk [RR] = 5.08; p < 01) (Table
7), which was patticularly suiking when limited to subjects
70 to BO years of age at-death ar d