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NYSCEF DOC. NO. 283 RECEIVED NYSCEF: 03/17/2023
EXHIBIT 74
FILED: ERIE COUNTY CLERK 03/17/2023 08:48 PM INDEX NO. 815818/2020
NYSCEF DOC. NO. 283 RECEIVED NYSCEF: 03/17/2023
Ep~emlology BlostulisliG ond Pvb!lcllemlb· 2015, Volume 12, NuRJher 1 I
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Critical reappraisal of Balangero
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chrysotile and mesothelioma risk I I
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EDWARD B.ILGRENCil, fREDERICK 0. Poo~, YUMI MKUMIYAOJ AND )OliN A. HoSKJNs143
BAcKGROUND: Bahlllgero, 40 km northwest of Torino In the Pledmonte Raglan, was home to tha
largest and most active dnysotlte mine In Europa operatln~r from 1916 • 1990 and employed over
300 men at any one time. The cbrysotlle WllS thought to be pure. Despite this some claim It has been
responsible for causing numerous mesotheUomas, This report refutes this claim on the gruunds that
It Is not pure but potenttaUy contaminated by tremollte 11Sbestos. In addition there are numerous
alternate sources of naturally occurring and commercially available amphibole asbestos In the region,
METHODS: Geological studies Illustrate the presence of naturally otturr!ng tremollte and various
analyses have shown naturally occurring ami colllmerclally used amphibole by Its presencaln animal
and human tissue. The diagnostic criteria used to study pleural disease In the Balangero cohort were.
examlned.on a case by cue basis.
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RESULTS: Several authors have searched available registries for post-mortem Information and listed
possible mesothelioma c:ases. Cross matching these searches has been attemJ>ted and the strength
of the!r diagnoses examined.
CONCLUSIONS: There Is good evidence that croddollte, amoslte and tremoUte are responsible for
the aUe,ged mesothelioma cases at Balangero. Myriad sources of naturally occurrl~g and commerclal
amphibole ubestos exist In the region to account for tha aUeged cases. Regrettably, nece.ssary
Information Is fncomplete and Insufficient for the cohort which calts the diagnostic accuracy of the
CliS&S Into quesUon. The problem Is furtbercomponnded by confuslonsurroundlnB"Iob titles and raises
the question If any of the cases actually occurred In 'miners' per se. I
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Key words: chrysotJie, Balansero, Pledmonte, Casale Mon(erato, mesothelioma
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(1) llormm.)' l'acul!JI o[ BlologlcDl Sclencer, Oxford COIIRESl'Oli'DINGJl'C!rHOII:B4uJanf./J U,rrn,l'rmnrt{)l
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tmro,.sliJt ll>fonl, U1C l'IJCIIJt:/ of Bfologk.rl Sl:f•n-, Orford Unlu.,.~ Qrj'ord; I
(2) .l!u•Al"fuscr l'lltboUtp D•,ptzr,_t M•dlall
.Mlc:n>1<0.PJ1 sc~enco Lol>o,.,.lor,y, Cord/JJ' u~. ca..slff
liX MMil: 4rtdlltr'"CQoJ.,om
;I
Cl) .l'omt#fl' B'l'n Mawr Cblll&•,l'•IIIUJIII1anllt, tltll
(-() Consull>lnt~co/oght, Hasl#rnlre, Sumo', tiX
/)OJ: l~~7/t 0125 ...
A=p/111 onNoJ!Iml>or II. 2014
srHrOim Dr /lcron wrolllblt ,papu uJIItl> II Ccnsultanr II>
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INTRODUCTlOM Analytlt11l Evidence
Balangero Is ca.. 40 km northwest of Dl.ted: analysis of 'Balangero chtysotlle bas
Totino 1n !be Pledl!lonte Region of Italy. It W2S shown lhc presence of trcmolltc. For cnmplc;
hoxne to the largat and most active clllyt>otlle Bader [6] f'oond.trett10Ule In one of!bur Balangcro
mlnc ill Rurope ope:ra&g fi:om l911i • 1990 nmp1cs b.e studied using 'rEM- DD.
~d. eulplayed. over 300 men at ;my one A.ddltlonal studies of a1r and long show
lime. The cllty3oliie was !bought tD be pun:. tremolitc. Short and long term a1r sampling
DC$plle l!s presnmed purlLy, soxnc cWm it ln. the I.an%o and Susa Va.Ueys dcteeted
1-w been ~sponsiblc for causing n u = long tremolltc a.nd actlnoUte fibres using
roesothel!Oillali, '11lls report refutes the clalnls S'EM - BDS. Lung botdco. studlcs of cows
that Balangcro c:btysotllc ls able to prodnce grazing in both La.n:o and Susa valleys also
mesothelioma on tbe grounds that it ls not showed elevated concentrations of trcmol\te/
pure but potentially coo.t:wlnated by ttcmlo~ actlnollte asbC$toS ~.71. Sl.tollafly, hu!IUUl
asbestos; because !be dla&nos!s of most of lung 621Dples from those residing ellhct in
the allegedly atttlbutable cases has not been or near Babnger;o ln the ta.nw Vdley and
proven; also lllllllefous altcmate sou= of •others Uvlng iu the S\1$1 valley ncatby also
naturally oa:ua:lng a!ld oommetcially ava.ilablc c:ontalncd trexnolitc/actinolite asbestoa tlbtes
aJUpb!bole a.sbes1:05, and possibly olhct fibrous [2 17). Udne samples from flldivl.duals residing
slll.c:ates can explain !be allegcd!)r ~ubble fn Susa valley also cooa!ncd ttcxnolite {2,71.
mesothelloma CIJSCS, Mitabelli et a1. [6) cite Fomem's animal long
burden work to support the a.Ueged colo::
of ll:l.langcro cluysoti\e In prod.uc!llg an
QUESTIONS OF PURITY •.TREMOLITE: cnviroDJII~:nt:al· mesothcUoma. rlsk but fill
to mention l'ometO's finding of ~Utotal and
Geological Evidence commercial lllllJ?hibo1e asbestos In tiiJillY of
thcsalllJ?lcsb.ken.
The Balangcto c:hrysot!le mine fs situated Pooley [91 demons~ elevated ttemolltc
In 11 setpentinitc sate1111e body of the ta.n:w cot1cenl:ta.ttons In lung tissue from three
Muslf (Piedmollt, Italy), the largest ultralllati.c Balangeco wotlcetS 0.1% of l!bl:es > 5 pm !()l).g:
body of the West=& Alps {1). Various areas Table 4z In £9D and nloc comrol subJects crabk
wlthln tb.e Lamo massif are conducive to 1). 'l1l.e wotkcrs d{ed of asbestosis, lung cancer
the foonat!on of tremoUte asbestos as shown and mesothelioma; the controls from DOll-
lhrougb. d!rcct sampUng of rock, air and asbestos xelated causes.
lung dssue. l'orncro et al. [21 noted that Na.tllnlly occumng t.temollte is not
the region ls very :deb in sexpe11tlne rocks, surpdslng. The geology Is condnciYe to lts
many of t'!u:m oot=~pping, and some that formation. Why has its ptesct~c:e net been
have been exploited 1n the past dudng the noted before? Sampl!ng enor ls certainly one
quany!Dg of asbestos. "In areas such as
Piedmont, everyone ls exposed tD low doses
of llitbor:nc asbestos ...The asbestos species
commonly found moa.1unl SOUICC$ (Lc. rock$)
c:xplanadon u very few samples have beet\
analyz:ed, the sal!lple slz.cs luve genesally been
smal11 and the ~UW1ytical methods (.'!CB.D) may
not have been suffldcnt to detect lt. None,
j. l
ts asbestos ttemollte and asbestos a.cUnolite•
{3], Man:y have noted this and In consequence
parts of the SUA V:allcy IU:C contaminated with
trcrnollte, Many local tslc Dllnes [4l found neat
aside from 'Butler (6], ever tested samples
using add digest\on !Lnd Tl!M-XRD. The
considei:!Lble mining w:a and bcterogeneity,ln
the ore body created difficulties fll obtalnlng
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Balangcro are contaminated wlth ll:eiOOiite represent:ative samples ovet the t1.eady 75
asbestos. One, 'Btun.etlll' was thought to be yens of 1ts opcratlon.
the sow:cc of the tremoiJte asbestDs found by 'Relatively sm~U percel\t2.ges of tn:molllc
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Pooley in the lungs of a Balangcro wotkecwith Clln be biologlcall.y l!nportant representing
mesothelioma "'hc presence of tremolite In substantial ahbome fibre c;opc.cntl:ations [10).
soil in !he Suss. and Chlsone Valleys (Westem Thcrefote, the Vcrf blch dust lev~ produced
.Alps) Is a plaWllble Cltplanat!on for the mo$1: during rnlo!ag (11·131, 1112.y have conblned very l
westcm me5olhelloma. cluster$....• [51 high coo.oentmtlons of tremolitc.
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fiJldaminlogy Bioslni'Blics ond l'ubnc Heollh-2015, V®lmal2, Number 1
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BALANGERO CHRYSOTI\.E COHORT· lnstltull: for Plw:maco1ogical !Wcarch, 'Msrlo
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DIAGNOSTIC ISSUES; Negd', (MN) who lnvestig'a!l:d the health of the l
Piolatto et al. [14] reported the fust two
mesothcllolll8S 1n the ·Balanges:o cohort. The
6t&t case (1.975) wu di2gnosed cytologlClllly;
the other (19Tf) blstolog\e9.lly. Neither used
&langero worki!.CS based uponll!l2lyse& of dCidb.
ccrt:lflcates found through seatcblng company
records. Since the 10M had very limited ~$
to hosptt.l. recotds and palhology material &st
band diagnostic con.6.tmatlon wu genetdl.y
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immunoh!stochCmlstry (IH.C), C'Jllsti (121 not possible. l'Jra et al. L1Sl said: "'lbe osc of . I
teported II tbhd 111C$othc11osnt. ln. the Bala.ngero dca.th. ccdif1catl:s lllStelld of caru:et reglstdc:~ In
cohort whilst llt:ovnle (19.92. pw commun.)
said that as of 1~1 there wcte ~ most £our
OCOlpatloml cobotb lnvcstlga.lUig cancer r:lsk
Ju..s inherent Umlratlons due to the inadequacy
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mesothell.omas repotted at })alanges:o, •one In of available Information•. Apparently, on me
a llWlager, but they wete GUSpect &fven the occ::asiDDs Plra et at. {.151 could Identify cases
doubtful nattare of the occupational blsto~.
Mon:~tly,tb.eGtndlesofthe!ncidenceof
of mcsoth.et!osnt. u$1ng means other th3n death
c.~ll: sinee they sa.ld "One case of pleural
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mesothelloma In 'Balangero chty&otlle 'workers' mesothelioma waa l.dcn!llied In the cohort but i
(sec below) Ju..ve been conduclcd by two groups
in Torino, One, situated largely at the IllStltull:
for Occupat.l.onal Medl.clne (tOM) the other at
tung cancer as a cause of death was ~ortcd.
in the death certlflc.ate. Sloce the diagnosis
of mesothcUoma b 5till complex, 1h1s Is not
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the Unlvcxslly of TUrin In collaboration with the surpr:lsing". The methods used to Identify the j
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Epidemiology lllos1ulislics ond Puhlit llaolib· 2015, Volumel2, Number 1
me~>othello~~UL case were net dlscussec!. ~ported by Callstl ct a1 [12}
Another group, the Unit of Cancer Since histology with lHC Is the cunentl.y
Epldem.lology, (CPO) ~llcd principally upon tccognb:ed standatd for the diagnosis oi
the 'Regisb:y ofMalignantMesolhcllOTDAS (RMM) .mcsolhd!Oma, no more than two of the cases
l8,11,16). Thl6 o.Dly coveted lnfonnaticn from teported to ~tc have used the tl:ch.nlq)le aJ>.d
1980 on"iVVUd5 but cues among tolne employeea 10 uc potentblly coof!rmed. However, the
could be ldcntilicd in some ln.1!a.nces In the c:::actpanel. of me =kcts used, the adcqoacy
hospltlll records and othct Rcgfstty materlllls. of negative aud poslt.lve con!rols, md the
'Ihe snost recent update.~ of the Ba1angero sb!nlng pattems and lnteo.slties for those
ch:tysot!le wodws w= done by 1'ira. et Ill. [15) stains are not ~own and so confumatlon Is
at tb.c IOM-MN and by .Mlmbclll et Ill. {8] at not dc<:e.
the :RMM. l'lt7. et Ill (15) COIDpmd their results 'Ihea: Is the further question. that none of
'on pleural aud pcdtoneal cancer to lllOse the cases uc speclflcally caiied 'miners'. Pot
reported In ancthcc analysis coruluctet3 In the CDIIlple, MlrabeUI. et ,]. [8') cla!ms to Jl1tve
sall18 area, bas,cd on the Piedmont~: registry of found a 'cluster of 14 mesothelioma cases
malipnt mesolhe.llomas'. Pira. ct a1 (lSI 'found among warltcrs who were acll1111 fn tee rn1nll'
4 ·deaths from plewal and 1 from peritoneal ·but only list 9 such cases 1n Table 1 of their
cancer as CO!IIpm:d to 6 ~ from pleoral report and none a~:e cal1cd 'mfrws', Confusion
m.esothellonla durlng the same pcdod in the on the point also concerns the watkcn studied
rcgi.stry based study. 'Ihcy concluded thi.t bythelOMandMN.llublno eta!, (13] said 'the
'despite the 'd!fi'ea:nt sources of d:ala (death work force 1m; numbeted abollt 300 mea.. At
certlf!catc versus regtstry infutiiJ~tlonl the u:sutts present some 350 men a.s:e employed. in the
for p1eura1 cancer are Jn subst'an!W ~t'. mble md Its 1\&SOcb.ted m!lllng, a:usbing,
Despite the elfocts 1D compm: tbc fllldlngs of sa:eenlns 1Uld b:agging plant'. Their cohort
the IOM and the BMM, the lndl.vldoal cases have consisted of 952 male wotkeu with at least 30
oevct been matched. Pmf :r.,. Vccx:hfa, Pt Negd days employment between 1 Jan 1950 sw.d 31
and Dt l'cluccbl M.ve provided the available Dec 194S. Tbclr cohort da.tiL are POt broken.
Ullded.yhlgdetail on the six asencpoded byl'Jra down.ltlto those who worked at the mine ar~d/
et aL 115] to compue with the nine 'oa:upatlcwlr or the mill/plant u opposed to those who
cases repelled by Mltabclll ct al. [8). PuU. analysis only worked at the mi.= vetSUS those who
of the comph:x. aoss-malrhlog Is given in the only worked at the 'mlll/plant'. Bofglnatically,
supplemental dala to this paper. IWblno ct aL [131 $'aid "almost all workcts had
Sylveslrl. et a!. (11} also assessed the changed their job dru!ng t.he1c worldxlg life
incidence of mesothelioma fn the cohort. 'on lit the fadory•, 1\Jld Plolatto et Ill. [1.4J said
the buls of ~ se:a:c:h of the Ute.tatu.re !l.rui thelt study Is an 'update of c:ancec ·mortality
of the files of th.c Mesothelioma l!egistry of IIJII.ong cbxysotlle asbestos miners' but 'the
:•
Piedmo~ They said 'Three additlonlll cues cohort eomp:d&ed .men who had worked for
of malignant me:sothello.tU of lhe pleura we~:e at least one year at the factory between 1940
foutui 'With past exposure In the sn1ne, and and 1987'. What Is meant by 'W:toxy' Is not
no evldcnce of othct occupations entlliling CleplaJned. Slmiluly, l'lnl et a!. (15) said they
exposure to asbestos'• .Aho, 'Lifelong work- 'obtained employment d2!ll. ftoxu perBoJUlel
history was lcnown for two with.no evidence J:CCOrds at the factory and asecttalned v!W
of o'thet o~patlons ental.lln3 exposure to Glatu$ t.nd cw.sca of death t!uough populadon
asbestos, Case 1 was a technical clerk (the rcalstcts and copies of death cettlf!catcs from
stndy was limited to blue-¢ollar wolkets) xuunlclpa.l teglstta.tlon ofilces,' So lt looks
who dled lifter the end of follow-up. Case Z like the IOM - MN has been studying '&.etory
worked In the Bal11llgero .mine from 1936' to worlccrs' nther than 'miners', The term 'plant'
15144. O:Se 3 wu Included In the study by ensendctS furthct confusion. Specific: data for
l'iolatto et al. but died after the end of follow- millen ar:e also not provided. though s:eferencc
up.' Thaefore, case 1 can be dismissed. C2.:1e ls ii:equen!'ly made to work In the mill.
3 appeam to be one of the cases s:eported Therefore, ta1dng the slrlctest ~ of
by Plob.,tto shown in Table a (supplemelll:2l the dab. presented In the litctatuce to date by
data) • Case 2, on the basis of the dates of the IOM. and. th.e RMM, Including the recently
hire and sepantlon, m.ay be the same as thi.t obblned unpubllshcd clata Ctom MN1 no more
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"""""~ -m!Mitllol-2111> .... 1~ W . 1 -
:"::.:-.:-.... _._,._-z.';:i!.~":!.:·""-r:~· .......""::·.-.~-::;.~ .:~'1:""~.. ..t;;Z..-:-:..-:.. ..."t"'..-:;..:~~.:.,~.-;·. -:::-.::.:=.-:.:-.:.~n~~
than two CUe$ aUeged to be au:sothelloiJla Sourres In tlle mine. and the mill
would begin to 1!1CCt prC$ent ~y d/agllostf,c
standards. Bow~ neither case Cl.ll be aald to Pooley 191 ldcotlfu:d slgo.iflcanlly c1c9ated.
be, with a. hlgh degree of a:rt!Jnty,a Balangero conrentndOIIS of aotldo11te Jp. the lungs of lhtee
asbestos miner, wo.&:eu and four 011t of nine COil!rol sub)ecta
llving ln. the vlclnit.y of the .llllce (see :above)
(l'll.ble 1), In. addlt!on to the uemollle/act!nollte
BALANGERO CHRYSOTILE COHORT· "DOted above C1JV/ and bu.lllan lung I!B5Ue from. the
SOURCES OF ALTERNATE CAUSATION
General Consldetatlons
Lanza. vaUcy also ~ed amcsltt: wbll&t lho~
from SUR bad both !llllOsitc and aocidollte. AJr
sampling fuund long crocldoUte fibres ln. both I
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LinZa e.nd. SuA vallc;ys.
Piedmont Wll6 home to many a.sbcsto• 1lle~wun:esofcolll!tleldalamphlbole
Wiustdes {17). Tb.e ·legion around and I.a. asbestos~ In~ 11t0und 'Balangero CJ?!a!n.
Turlu and 'Balaogcro !Wtoriolly housed tbcluog bwden ~. Product!on had.foal:asc:d
I
e.n extensiv~:~ asbestw lndu$!ry wilh roa.ny. dudng lbe post-wa~: rccoostnJCI!Dil pedod. and
foauer a.sbe$tos factodes and p1anu. In tcd!nologlcal ~In rha mld·19SOs ~
c:onocquencc, !llllphiboles were tho 'common snaln1y I.a. mining methods and only 'lJIIIl'ginllly m
Utban env!roPU.IIlD!Dl pollut2nt ln 'l'Urln' [U}. dust control. PuUng th.e sixties p!:IXfudjoA fn the i
Amphiboles Brst anivcd fi:om South .Aiiica. at
the factory at Basse dl 'Dora ('Caplaml.anto') tn
Todno whkh .lll&de 'all klnds of Vlblt:e, blue,
1111d smosite asbestor.· articles and specblbed
JDlli lnal:aw11D between 100,000 and ISO,OOO
tonncs pet year. [16).
Sollie 'mtoc• wotkers Jlso worked ontslde
Bilangero wl!h.possible exposure to oth.er l:fPes
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in white and blue a.soestos te.xtites [181. Other of asbestos [17), In tallway coach consttuctfon,
fa.ctodes in the area also used South .llfr::lcan In e.n Iron fou.ndry :and ln. a 1n0tof vehicle
blue (croddolltc) 8$bestos and am.ositr: U9) • assembly plant. 2Urthet- a.ltr:lnllte exposures
.All crude asbestos fot Ibly WII.S initially In the mine may lulve come from the use
dcllvered to Genoa mel. some JllCil from the of crocldoUte asbestos cement &oi:A Ca.&ale.
Piedmont would conunute to work from Croc!.dollt.e WII.S also ~paxendy used. Jn the 1:
the Dllnca and plsnts to the port to work I.a.
shipyards a.nd steel IXIllls [18,l0}. Piedmont
Balangero mine fot 'short' pedods fn amall
a;nounts for IJlatetlal ~g :md. prepatlng
l
was home to the gcettcr part of the Italian mlx1ur:es {15)1 and ln dlffi:rep.t pad$ of tbe
a.&bestos industry (~1,221 Ba1angero m!ae and mill for 'loDFf' pc.dods
The e.xtepslve Wie of a.mphibole asbestos!$ fot varlous purposes. Ctocldollt4 was also at
xefiected ln. tb.e slgn!.!lomtiy elevated Incidence lfmcs added to tbc Ba.langero cbzysotilc Ol'Cj
of mc;sothclioma in Turln and the sunoundlng {25). Crocldolltc and am~ were mnsft.aed
provil\ce and has bee11 demogn;pb.tcaUy to the mine by Bilaogeco subcontractom f.ro111
de:m.onstnted fox this tcglo11 ~O,U] wllh dlffcttnt asbestos flnno. .Ampblbole asbc.stos
reopcc:t. to the location of the IJialn asbestos cement covcrlngs in the 'IICW part of the
lndustdca IU\d the re&ldcaces of mesothelloiJla 'Balanf:ero .lllill." [12) wete $alii to c:ontl.ln
cases. Cl\!Ster$ of pleural. c:aucc:u In cllifctent crocldollte fcom ~lc. CJocldolite and 2.111oestos,
of Totino aloo dem.ollStl:a.ted. large numbers
of mesotheliomas 1n tcb.tlon to the many
J.o.dustrlallldlVit!es found !n the lllell [24). 'lhe OCOJpaUons at Risk of Mesotllelloma In tile
spatial wotW!ty studies lllso found a clrculu Pledmon.te
duster lltllund Tudn that leached the l.~
Valley 'Whcte Balangero .15 situated llO). MaD.y Job titles lUld occupations have
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Epidemiology Bl~lits llnd Pubtit Hcoltb •2015, Vobne 1~ Number I
beea. reported to be at rlsk of ll!CIIatheltoma 1n ()r!b.belll et al, [17], their Table 2)]: AU ~
the Piedmonm [lO,lZ,24,27·29]. Most of lhese cases •of ltlllllgaaat mesothello111a. In wo.dtcr:ll
comport wen with the ·~ exp0$1!Ces' never emplayed at the Bal~ mining sil:c,
noted in most of M!mbelll ct tl's [171 cases but oo:upi.t!ona!ly exposed to cbty$otile fmrn
s:Ud to be attrlbubble to B;ibngez:o cbxyiotlle the ml.ne", lUll IZl2rla:d with an 'a.', Mrnbclll. et
exposure. Rubino et a1 ~l] ldentlfied 2Z mdes al [171 ni4 'ases 15 and 17 may also have been
at risk. ltopco ct a1. [24} iOent!licd semat exposed to fibrous trcnollte" at a ntlll outside
!ndusl:.des u well as trades at rlslc. Ncsti et ll the mlnlng sUe not owned by AmlanUfera
1.291 foUAd, on the basls of the ~glstty .asWysls. treating Bala.nF~Q ore. Case 16 likewise since
high risk ~tegodcs In include bdcldu:yea, he analysed ore ti:om the Balatlgexo %lllne IU1d
plumbeG, ~tpemets1 dectrk:12.os ~~:~d others. bullr/managed pilot plants foe ore explolti!Son.
Mirabelli et aL {28] also noted that 'Other These could have U5CCl ccocldollle fn. their
lndustdes pcodudng ubestos-co.ob.inlng consb;oction. All' cases had~ sources
matedals, &ac:b. u asbe51ns textiles, lining& tbr of altctnate exposu~
1:!12ltes :a.nd tlutchc8, and tllibtstoP =dhow
and pa.c:ldng, were ma!a1y loca~ed In l'll:dmont'. •eases of malignant mcsothcUOIIllL due
Mauhle et aL [201 found cases fn the tat!le to houschold/eSl:vfromncnbl c::xpostUe" (5
5ecto.r, cement and o. foundry) synthetic- cases) (Mirabelll et aL [17], fuel!: Table 3): Of I
I
fibre textile pl.aslls, and local m!lway autiage the live "cases of maUga;.nt mesothelioma due
constcuctlon. to bousehold or envlronmcntal exposure•, :four
I
of the ave merely lived in 'ptCDiiDity of the
mine aite'. However, naiDCtOUS othtt sources
case Specllk Altmnate Sources of Exposure of comtllCICbl1 amphibole ubesltls exposu,ce
outside the Mine and the Mill ~ present In the atea !muu:d!atcly uound
Balangero. (Detltils In the supplelncnta1 data.)
MJ.n.belli et al {8] beUeve Bal.n.ngero
cbrysotile also slgnl.tlcantly contributed to the "cases: of mallgnant mesothelioma I.
I
production of lliCIIOtheUoma found In 13 other among persons upo5ed to III.I:M tallinp 'U$ed I
1· people exposed. to Ba!angero clufsotile ootside ootsldc mine• (S Cues). (Mlnbelll et aL (17),
of the worldo~:C~:. They consldeted 17 cases
In four c:xporute c:ategodes, marked wllh a
ruperscrtpt 'a' On thdr table legends) to denote
'possible exposUte to othci: types of asbe&tos'.
"Cues of maligrumt mcsothcUoma
their Table ~~ Of the flvc 'cases of mal!gmnt
mesothelioma 2fiiOII&" persons exposed to mine
ta1llng$ used oU!ilde mine', three are mlllltcd
with an 'a.'. 1lslng asbesiD$ conll&mlJI~ted jute
bag& by Case 23 WtlB not d!sco\IM:d as t.
po11:n!W ~we In thelr series [17]. "Besides
I
I
among work~s employed. by sub-con'lraetol:$
at the Bala.ngero snio.ing rite• (S Cues)
chtysot!le ubestos of d!Iferent flbte length, the
mlll produced by-products of difiUent 5pcdllc:
I
(Mimbelll et at [171, !belt Table lB): Of the weight md aushed stone (gravel 6h!nglcs)
five •cases of mallgnant mesothelloma. among to be used tlB ballul" [111. Bx:pof>llfe ID mine
workea; employed by sub-conl'lactots at the talllngs used ss balb.st may h~ InVolved
'Balangl:l:o m!ning ·site•, one ls madtcd '1.' PS tr:emolltc c:xpow.te when it was llom oth=-
haYing possible exposun: to ot!w types of m!Dlng :uw outside Balan,gc!:o aod prores&ed
asbesto5. 'l'hn:c others wor:ked In fa.cllitie$ at the Bala!lgez:o Jnlll [17). In all, ~t least thtee
s:nd/or had job tl.tlcs at potent!al. high risk of the .live cases claluled to be due to Balangez:o
for mesothelioma. Case 10 was also probably clu:ysotilc had potencial 1.~h!bo~ CXJ?OS!lre$.
exposed to croc!dollte transported to and
used In the co.rutxuclion. of the asbe5tos m!ll.
Therefore, four of the five cases had s1go!.6~nt Conclusion
potentlaleoun:cs of alternate exposure.
Fowteen of lhc 17 mesothelioma ~es
•cues of tn.alignant mcsotbcl.lt>ma in reported by MitabclU et aL [171 attrlbuted to j
worke:ts never ejnployed a.t the Btiangero
· mining site, but occupation.Uy CJq>osed
to cluysotile from the ~e· a Cllses)
&langero c'Mysot!le worked l.n occupations
at high tWt for tOCSothelioma froll\ potential
aroph!bole ubesto$ exposure.
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FILED: ERIE COUNTY CLERK 03/17/2023 08:48 PM INDEX NO. 815818/2020 NYSCEF DOC. NO. 283 RECEIVED NYSCEF: 03/17/2023 EXHIBIT 74 FILED: ERIE COUNTY CLERK 03/17/2023 08:48 PM INDEX NO. 815818/2020 NYSCEF DOC. NO. 283 RECEIVED NYSCEF: 03/17/2023 Ep~emlology BlostulisliG ond Pvb!lcllemlb· 2015, Volume 12, NuRJher 1 I I Critical reappraisal of Balangero I I chrysotile and mesothelioma risk I I .I.i I EDWARD B.ILGRENCil, fREDERICK 0. Poo~, YUMI MKUMIYAOJ AND )OliN A. HoSKJNs143 BAcKGROUND: Bahlllgero, 40 km northwest of Torino In the Pledmonte Raglan, was home to tha largest and most active dnysotlte mine In Europa operatln~r from 1916 • 1990 and employed over 300 men at any one time. The cbrysotlle WllS thought to be pure. Despite this some claim It has been responsible for causing numerous mesotheUomas, This report refutes this claim on the gruunds that It Is not pure but potenttaUy contaminated by tremollte 11Sbestos. In addition there are numerous alternate sources of naturally occurring and commercially available amphibole asbestos In the region, METHODS: Geological studies Illustrate the presence of naturally otturr!ng tremollte and various analyses have shown naturally occurring ami colllmerclally used amphibole by Its presencaln animal and human tissue. The diagnostic criteria used to study pleural disease In the Balangero cohort were. examlned.on a case by cue basis. .. ' RESULTS: Several authors have searched available registries for post-mortem Information and listed possible mesothelioma c:ases. Cross matching these searches has been attemJ>ted and the strength of the!r diagnoses examined. CONCLUSIONS: There Is good evidence that croddollte, amoslte and tremoUte are responsible for the aUe,ged mesothelioma cases at Balangero. Myriad sources of naturally occurrl~g and commerclal amphibole ubestos exist In the region to account for tha aUeged cases. Regrettably, nece.ssary Information Is fncomplete and Insufficient for the cohort which calts the diagnostic accuracy of the CliS&S Into quesUon. The problem Is furtbercomponnded by confuslonsurroundlnB"Iob titles and raises the question If any of the cases actually occurred In 'miners' per se. I I i Key words: chrysotJie, Balansero, Pledmonte, Casale Mon(erato, mesothelioma I! I i (1) llormm.)' l'acul!JI o[ BlologlcDl Sclencer, Oxford COIIRESl'Oli'DINGJl'C!rHOII:B4uJanf./J U,rrn,l'rmnrt{)l I!,I tmro,.sliJt ll>fonl, U1C l'IJCIIJt:/ of Bfologk.rl Sl:f•n-, Orford Unlu.,.~ Qrj'ord; I (2) .l!u•Al"fuscr l'lltboUtp D•,ptzr,_t M•dlall .Mlc:n>1<0.PJ1 sc~enco Lol>o,.,.lor,y, Cord/JJ' u~. ca..slff liX MMil: 4rtdlltr'"CQoJ.,om ;I Cl) .l'omt#fl' B'l'n Mawr Cblll&•,l'•IIIUJIII1anllt, tltll (-() Consull>lnt~co/oght, Hasl#rnlre, Sumo', tiX /)OJ: l~~7/t 0125 ... A=p/111 onNoJ!Iml>or II. 2014 srHrOim Dr /lcron wrolllblt ,papu uJIItl> II Ccnsultanr II> ilb-!00>-1~·... , ~~""~' ·,·-;~=~~-~-· ~~~ . . . >=:• .~::.·_ T'·~~..:.r;:~::.~-r:-:;~ct...""';:;:"'~:.:-\;:..' \'"t:':r~-::;.:..."'t';. • .:fit INTRODUCTlOM Analytlt11l Evidence Balangero Is ca.. 40 km northwest of Dl.ted: analysis of 'Balangero chtysotlle bas Totino 1n !be Pledl!lonte Region of Italy. It W2S shown lhc presence of trcmolltc. For cnmplc; hoxne to the largat and most active clllyt>otlle Bader [6] f'oond.trett10Ule In one of!bur Balangcro mlnc ill Rurope ope:ra&g fi:om l911i • 1990 nmp1cs b.e studied using 'rEM- DD. ~d. eulplayed. over 300 men at ;my one A.ddltlonal studies of a1r and long show lime. The cllty3oliie was !bought tD be pun:. tremolitc. Short and long term a1r sampling DC$plle l!s presnmed purlLy, soxnc cWm it ln. the I.an%o and Susa Va.Ueys dcteeted 1-w been ~sponsiblc for causing n u = long tremolltc a.nd actlnoUte fibres using roesothel!Oillali, '11lls report refutes the clalnls S'EM - BDS. Lung botdco. studlcs of cows that Balangcro c:btysotllc ls able to prodnce grazing in both La.n:o and Susa valleys also mesothelioma on tbe grounds that it ls not showed elevated concentrations of trcmol\te/ pure but potentially coo.t:wlnated by ttcmlo~ actlnollte asbC$toS ~.71. Sl.tollafly, hu!IUUl asbestos; because !be dla&nos!s of most of lung 621Dples from those residing ellhct in the allegedly atttlbutable cases has not been or near Babnger;o ln the ta.nw Vdley and proven; also lllllllefous altcmate sou= of •others Uvlng iu the S\1$1 valley ncatby also naturally oa:ua:lng a!ld oommetcially ava.ilablc c:ontalncd trexnolitc/actinolite asbestoa tlbtes aJUpb!bole a.sbes1:05, and possibly olhct fibrous [2 17). Udne samples from flldivl.duals residing slll.c:ates can explain !be allegcd!)r ~ubble fn Susa valley also cooa!ncd ttcxnolite {2,71. mesothelloma CIJSCS, Mitabelli et a1. [6) cite Fomem's animal long burden work to support the a.Ueged colo:: of ll:l.langcro cluysoti\e In prod.uc!llg an QUESTIONS OF PURITY •.TREMOLITE: cnviroDJII~:nt:al· mesothcUoma. rlsk but fill to mention l'ometO's finding of ~Utotal and Geological Evidence commercial lllllJ?hibo1e asbestos In tiiJillY of thcsalllJ?lcsb.ken. The Balangcto c:hrysot!le mine fs situated Pooley [91 demons~ elevated ttemolltc In 11 setpentinitc sate1111e body of the ta.n:w cot1cenl:ta.ttons In lung tissue from three Muslf (Piedmollt, Italy), the largest ultralllati.c Balangeco wotlcetS 0.1% of l!bl:es > 5 pm !()l).g: body of the West=& Alps {1). Various areas Table 4z In £9D and nloc comrol subJects crabk wlthln tb.e Lamo massif are conducive to 1). 'l1l.e wotkcrs d{ed of asbestosis, lung cancer the foonat!on of tremoUte asbestos as shown and mesothelioma; the controls from DOll- lhrougb. d!rcct sampUng of rock, air and asbestos xelated causes. lung dssue. l'orncro et al. [21 noted that Na.tllnlly occumng t.temollte is not the region ls very :deb in sexpe11tlne rocks, surpdslng. The geology Is condnciYe to lts many of t'!u:m oot=~pping, and some that formation. Why has its ptesct~c:e net been have been exploited 1n the past dudng the noted before? Sampl!ng enor ls certainly one quany!Dg of asbestos. "In areas such as Piedmont, everyone ls exposed tD low doses of llitbor:nc asbestos ...The asbestos species commonly found moa.1unl SOUICC$ (Lc. rock$) c:xplanadon u very few samples have beet\ analyz:ed, the sal!lple slz.cs luve genesally been smal11 and the ~UW1ytical methods (.'!CB.D) may not have been suffldcnt to detect lt. None, j. l ts asbestos ttemollte and asbestos a.cUnolite• {3], Man:y have noted this and In consequence parts of the SUA V:allcy IU:C contaminated with trcrnollte, Many local tslc Dllnes [4l found neat aside from 'Butler (6], ever tested samples using add digest\on !Lnd Tl!M-XRD. The considei:!Lble mining w:a and bcterogeneity,ln the ore body created difficulties fll obtalnlng I !I Balangcro are contaminated wlth ll:eiOOiite represent:ative samples ovet the t1.eady 75 asbestos. One, 'Btun.etlll' was thought to be yens of 1ts opcratlon. the sow:cc of the tremoiJte asbestDs found by 'Relatively sm~U percel\t2.ges of tn:molllc I Pooley in the lungs of a Balangcro wotkecwith Clln be biologlcall.y l!nportant representing mesothelioma "'hc presence of tremolite In substantial ahbome fibre c;opc.cntl:ations [10). soil in !he Suss. and Chlsone Valleys (Westem Thcrefote, the Vcrf blch dust lev~ produced .Alps) Is a plaWllble Cltplanat!on for the mo$1: during rnlo!ag (11·131, 1112.y have conblned very l westcm me5olhelloma. cluster$....• [51 high coo.oentmtlons of tremolitc. 1 ·. FILED: ERIE COUNTY CLERK 03/17/2023 08:48 PM INDEX NO. 815818/2020 NYSCEF DOC. NO. 283 RECEIVED NYSCEF: 03/17/2023 • f • 4 fiJldaminlogy Bioslni'Blics ond l'ubnc Heollh-2015, V®lmal2, Number 1 I BALANGERO CHRYSOTI\.E COHORT· lnstltull: for Plw:maco1ogical !Wcarch, 'Msrlo lI ~ i 1I I DIAGNOSTIC ISSUES; Negd', (MN) who lnvestig'a!l:d the health of the l Piolatto et al. [14] reported the fust two mesothcllolll8S 1n the ·Balanges:o cohort. The 6t&t case (1.975) wu di2gnosed cytologlClllly; the other (19Tf) blstolog\e9.lly. Neither used &langero worki!.CS based uponll!l2lyse& of dCidb. ccrt:lflcates found through seatcblng company records. Since the 10M had very limited ~$ to hosptt.l. recotds and palhology material &st band diagnostic con.6.tmatlon wu genetdl.y 1 I I I ! I immunoh!stochCmlstry (IH.C), C'Jllsti (121 not possible. l'Jra et al. L1Sl said: "'lbe osc of . I teported II tbhd 111C$othc11osnt. ln. the Bala.ngero dca.th. ccdif1catl:s lllStelld of caru:et reglstdc:~ In cohort whilst llt:ovnle (19.92. pw commun.) said that as of 1~1 there wcte ~ most £our OCOlpatloml cobotb lnvcstlga.lUig cancer r:lsk Ju..s inherent Umlratlons due to the inadequacy ~ mesothell.omas repotted at })alanges:o, •one In of available Information•. Apparently, on me a llWlager, but they wete GUSpect &fven the occ::asiDDs Plra et at. {.151 could Identify cases doubtful nattare of the occupational blsto~. Mon:~tly,tb.eGtndlesofthe!ncidenceof of mcsoth.et!osnt. u$1ng means other th3n death c.~ll: sinee they sa.ld "One case of pleural I I mesothelloma In 'Balangero chty&otlle 'workers' mesothelioma waa l.dcn!llied In the cohort but i (sec below) Ju..ve been conduclcd by two groups in Torino, One, situated largely at the IllStltull: for Occupat.l.onal Medl.clne (tOM) the other at tung cancer as a cause of death was ~ortcd. in the death certlflc.ate. Sloce the diagnosis of mesothcUoma b 5till complex, 1h1s Is not l I the Unlvcxslly of TUrin In collaboration with the surpr:lsing". The methods used to Identify the j :.· '·· '· FILED: ERIE COUNTY CLERK 03/17/2023 08:48 PM INDEX NO. 815818/2020 NYSCEF DOC. NO. 283 RECEIVED NYSCEF: 03/17/2023 Epidemiology lllos1ulislics ond Puhlit llaolib· 2015, Volumel2, Number 1 me~>othello~~UL case were net dlscussec!. ~ported by Callstl ct a1 [12} Another group, the Unit of Cancer Since histology with lHC Is the cunentl.y Epldem.lology, (CPO) ~llcd principally upon tccognb:ed standatd for the diagnosis oi the 'Regisb:y ofMalignantMesolhcllOTDAS (RMM) .mcsolhd!Oma, no more than two of the cases l8,11,16). Thl6 o.Dly coveted lnfonnaticn from teported to ~tc have used the tl:ch.nlq)le aJ>.d 1980 on"iVVUd5 but cues among tolne employeea 10 uc potentblly coof!rmed. However, the could be ldcntilicd in some ln.1!a.nces In the c:::actpanel. of me =kcts used, the adcqoacy hospltlll records and othct Rcgfstty materlllls. of negative aud poslt.lve con!rols, md the 'Ihe snost recent update.~ of the Ba1angero sb!nlng pattems and lnteo.slties for those ch:tysot!le wodws w= done by 1'ira. et Ill. [15) stains are not ~own and so confumatlon Is at tb.c IOM-MN and by .Mlmbclll et Ill. {8] at not dc<:e. the :RMM. l'lt7. et Ill (15) COIDpmd their results 'Ihea: Is the further question. that none of 'on pleural aud pcdtoneal cancer to lllOse the cases uc speclflcally caiied 'miners'. Pot reported In ancthcc analysis coruluctet3 In the CDIIlple, MlrabeUI. et ,]. [8') cla!ms to Jl1tve sall18 area, bas,cd on the Piedmont~: registry of found a 'cluster of 14 mesothelioma cases malipnt mesolhe.llomas'. Pira. ct a1 (lSI 'found among warltcrs who were acll1111 fn tee rn1nll' 4 ·deaths from plewal and 1 from peritoneal ·but only list 9 such cases 1n Table 1 of their cancer as CO!IIpm:d to 6 ~ from pleoral report and none a~:e cal1cd 'mfrws', Confusion m.esothellonla durlng the same pcdod in the on the point also concerns the watkcn studied rcgi.stry based study. 'Ihcy concluded thi.t bythelOMandMN.llublno eta!, (13] said 'the 'despite the 'd!fi'ea:nt sources of d:ala (death work force 1m; numbeted abollt 300 mea.. At certlf!catc versus regtstry infutiiJ~tlonl the u:sutts present some 350 men a.s:e employed. in the for p1eura1 cancer are Jn subst'an!W ~t'. mble md Its 1\&SOcb.ted m!lllng, a:usbing, Despite the elfocts 1D compm: tbc fllldlngs of sa:eenlns 1Uld b:agging plant'. Their cohort the IOM and the BMM, the lndl.vldoal cases have consisted of 952 male wotkeu with at least 30 oevct been matched. Pmf :r.,. Vccx:hfa, Pt Negd days employment between 1 Jan 1950 sw.d 31 and Dt l'cluccbl M.ve provided the available Dec 194S. Tbclr cohort da.tiL are POt broken. Ullded.yhlgdetail on the six asencpoded byl'Jra down.ltlto those who worked at the mine ar~d/ et aL 115] to compue with the nine 'oa:upatlcwlr or the mill/plant u opposed to those who cases repelled by Mltabclll ct al. [8). PuU. analysis only worked at the mi.= vetSUS those who of the comph:x. aoss-malrhlog Is given in the only worked at the 'mlll/plant'. Bofglnatically, supplemental dala to this paper. IWblno ct aL [131 $'aid "almost all workcts had Sylveslrl. et a!. (11} also assessed the changed their job dru!ng t.he1c worldxlg life incidence of mesothelioma fn the cohort. 'on lit the fadory•, 1\Jld Plolatto et Ill. [1.4J said the buls of ~ se:a:c:h of the Ute.tatu.re !l.rui thelt study Is an 'update of c:ancec ·mortality of the files of th.c Mesothelioma l!egistry of IIJII.ong cbxysotlle asbestos miners' but 'the :• Piedmo~ They said 'Three additlonlll cues cohort eomp:d&ed .men who had worked for of malignant me:sothello.tU of lhe pleura we~:e at least one year at the factory between 1940 foutui 'With past exposure In the sn1ne, and and 1987'. What Is meant by 'W:toxy' Is not no evldcnce of othct occupations entlliling CleplaJned. Slmiluly, l'lnl et a!. (15) said they exposure to asbestos'• .Aho, 'Lifelong work- 'obtained employment d2!ll. ftoxu perBoJUlel history was lcnown for two with.no evidence J:CCOrds at the factory and asecttalned v!W of o'thet o~patlons ental.lln3 exposure to Glatu$ t.nd cw.sca of death t!uough populadon asbestos, Case 1 was a technical clerk (the rcalstcts and copies of death cettlf!catcs from stndy was limited to blue-¢ollar wolkets) xuunlclpa.l teglstta.tlon ofilces,' So lt looks who dled lifter the end of follow-up. Case Z like the IOM - MN has been studying '&.etory worked In the Bal11llgero .mine from 1936' to worlccrs' nther than 'miners', The term 'plant' 15144. O:Se 3 wu Included In the study by ensendctS furthct confusion. Specific: data for l'iolatto et al. but died after the end of follow- millen ar:e also not provided. though s:eferencc up.' Thaefore, case 1 can be dismissed. C2.:1e ls ii:equen!'ly made to work In the mill. 3 appeam to be one of the cases s:eported Therefore, ta1dng the slrlctest ~ of by Plob.,tto shown in Table a (supplemelll:2l the dab. presented In the litctatuce to date by data) • Case 2, on the basis of the dates of the IOM. and. th.e RMM, Including the recently hire and sepantlon, m.ay be the same as thi.t obblned unpubllshcd clata Ctom MN1 no more ·. FILED: ERIE COUNTY CLERK 03/17/2023 08:48 PM INDEX NO. 815818/2020 NYSCEF DOC. NO. 283 RECEIVED NYSCEF: 03/17/2023 """""~ -m!Mitllol-2111> .... 1~ W . 1 - :"::.:-.:-.... _._,._-z.';:i!.~":!.:·""-r:~· .......""::·.-.~-::;.~ .:~'1:""~.. ..t;;Z..-:-:..-:.. ..."t"'..-:;..:~~.:.,~.-;·. -:::-.::.:=.-:.:-.:.~n~~ than two CUe$ aUeged to be au:sothelloiJla Sourres In tlle mine. and the mill would begin to 1!1CCt prC$ent ~y d/agllostf,c standards. Bow~ neither case Cl.ll be aald to Pooley 191 ldcotlfu:d slgo.iflcanlly c1c9ated. be, with a. hlgh degree of a:rt!Jnty,a Balangero conrentndOIIS of aotldo11te Jp. the lungs of lhtee asbestos miner, wo.&:eu and four 011t of nine COil!rol sub)ecta llving ln. the vlclnit.y of the .llllce (see :above) (l'll.ble 1), In. addlt!on to the uemollle/act!nollte BALANGERO CHRYSOTILE COHORT· "DOted above C1JV/ and bu.lllan lung I!B5Ue from. the SOURCES OF ALTERNATE CAUSATION General Consldetatlons Lanza. vaUcy also ~ed amcsltt: wbll&t lho~ from SUR bad both !llllOsitc and aocidollte. AJr sampling fuund long crocldoUte fibres ln. both I I LinZa e.nd. SuA vallc;ys. Piedmont Wll6 home to many a.sbcsto• 1lle~wun:esofcolll!tleldalamphlbole Wiustdes {17). Tb.e ·legion around and I.a. asbestos~ In~ 11t0und 'Balangero CJ?!a!n. Turlu and 'Balaogcro !Wtoriolly housed tbcluog bwden ~. Product!on had.foal:asc:d I e.n extensiv~:~ asbestw lndu$!ry wilh roa.ny. dudng lbe post-wa~: rccoostnJCI!Dil pedod. and foauer a.sbe$tos factodes and p1anu. In tcd!nologlcal ~In rha mld·19SOs ~ c:onocquencc, !llllphiboles were tho 'common snaln1y I.a. mining methods and only 'lJIIIl'ginllly m Utban env!roPU.IIlD!Dl pollut2nt ln 'l'Urln' [U}. dust control. PuUng th.e sixties p!:IXfudjoA fn the i Amphiboles Brst anivcd fi:om South .Aiiica. at the factory at Basse dl 'Dora ('Caplaml.anto') tn Todno whkh .lll&de 'all klnds of Vlblt:e, blue, 1111d smosite asbestor.· articles and specblbed JDlli lnal:aw11D between 100,000 and ISO,OOO tonncs pet year. [16). Sollie 'mtoc• wotkers Jlso worked ontslde Bilangero wl!h.possible exposure to oth.er l:fPes l I in white and blue a.soestos te.xtites [181. Other of asbestos [17), In tallway coach consttuctfon, fa.ctodes in the area also used South .llfr::lcan In e.n Iron fou.ndry :and ln. a 1n0tof vehicle blue (croddolltc) 8$bestos and am.ositr: U9) • assembly plant. 2Urthet- a.ltr:lnllte exposures .All crude asbestos fot Ibly WII.S initially In the mine may lulve come from the use dcllvered to Genoa mel. some JllCil from the of crocldoUte asbestos cement &oi:A Ca.&ale. Piedmont would conunute to work from Croc!.dollt.e WII.S also ~paxendy used. Jn the 1: the Dllnca and plsnts to the port to work I.a. shipyards a.nd steel IXIllls [18,l0}. Piedmont Balangero mine fot 'short' pedods fn amall a;nounts for IJlatetlal ~g :md. prepatlng l was home to the gcettcr part of the Italian mlx1ur:es {15)1 and ln dlffi:rep.t pad$ of tbe a.&bestos industry (~1,221 Ba1angero m!ae and mill for 'loDFf' pc.dods The e.xtepslve Wie of a.mphibole asbestos!$ fot varlous purposes. Ctocldollt4 was also at xefiected ln. tb.e slgn!.!lomtiy elevated Incidence lfmcs added to tbc Ba.langero cbzysotilc Ol'Cj of mc;sothclioma in Turln and the sunoundlng {25). Crocldolltc and am~ were mnsft.aed provil\ce and has bee11 demogn;pb.tcaUy to the mine by Bilaogeco subcontractom f.ro111 de:m.onstnted fox this tcglo11 ~O,U] wllh dlffcttnt asbestos flnno. .Ampblbole asbc.stos reopcc:t. to the location of the IJialn asbestos cement covcrlngs in the 'IICW part of the lndustdca IU\d the re&ldcaces of mesothelloiJla 'Balanf:ero .lllill." [12) wete $alii to c:ontl.ln cases. Cl\!Ster$ of pleural. c:aucc:u In cllifctent crocldollte fcom ~lc. CJocldolite and 2.111o