International Journal of Occupational and Environmental Health Features Discovery of Asbestos-Related Pain Origin from Scientists at the Karmanos Cancer Institute in Detroit 

Scientists at the Barbara Ann Karmanos Cancer Institute’s National Center for Vermiculite and Asbestos-Related Cancers (NCVAC) have discovered a probable reason for the unrelenting chest pain experienced in certain patients with asbestos-related diseases and cancers. The findings, featured in the July 20, 2009 edition of the International Journal of Occupational and Environmental Health, were published in an academic peer-reviewed manuscript by principal author Michael Harbut, M.D., MPH, co-director of the NCVAC and chief of the Center for Occupational and Environmental Medicine, affiliated with Wayne State University.  

Harbut reported the findings after studying a patient who was exposed to taconite dust as a child.  

Using a new radiography approach developed by Carmen Endress, M.D., FACR, associate professor of Radiology, Wayne State University School of Medicine and radiologist at the NCVAC, there was a documented increase in pleural plaques, causing erosion on the interior wall of the ribs. 

“This action of the pleural plaque against the covering of the bone and the bone itself is a biologically plausible and an anatomically logical explanation of the unrelenting pain which some patients experience,” said Dr. Harbut.

This new imaging approach involves enhancing images obtained on the 64-slice high resolution CT scan using the Vitrea(R) imaging software program by Vital Images. By using this imaging approach, Dr. Harbut was able to demonstrate that: 

Evidence based on the CT findings, the physical examination, pulmonary function studies, epidemiology and history of the patient’s intractable pleural pain meets the criteria for diagnosis of asbestosis. Combined with the known science of taconite dust, a link between the mine where the patient’s father worked and the patient’s disease was established.  

Due to the clarity and definition of this new imaging approach, it is more likely to detect asbestos-related diseases and cancer at an earlier stage.  

Earlier detection will allow the possibility for additional treatment options to manage the pain caused by pleural plaque beyond the narcotics often prescribed for patients with advanced stages of asbestos disease. This includes exploring other forms of traditional and nontraditional methods to control pain.  

The patient, studied since 2004 and currently 55 years of age, was exposed as a child to taconite dust unknowingly by her father, a taconite miner from 1962 – 1969, who carried the taconite dust on his work clothes. Taconite is used in the production of steel and road-patching material. It has been mined in Michigan and Minnesota. 

The patient has experienced increasing pain on her right side for the past 31 years, a persistent cough and wheezing. As the pain increased so did her medication. Using the new imaging approach, Dr. Harbut was able to show the progression of the patient’s pleural plaque over a three year period, from 2005 – 2008. The patient’s pleuritic pain, as well as the findings of her pulmonary function, physical exam and symptomology are consistent with those diagnosed with asbestosis and pleural plaques, as established by the American Thoracic Society.  

These findings also support earlier human and animal reports that dusts produced by taconite mining can evoke the same biological responses as do other fibers already defined as asbestos or asbestiform materials. 

Harbut added, “Patients often require a lifetime of narcotics to allow functioning, but we are hopeful that with this new imaging technology, more selective pain management approaches with fewer side effects can be instituted resulting in a better quality of life.”

Finally, the report supports the identification of taconite, which has not yet been categorized as asbestos but causes a disease consistent with asbestosis, and recommends a reevaluation of the definition of asbestos. This is especially important within the context of legislative efforts to prohibit the use of asbestos. 

Karmanos scientists are continuing their series of patient studies and will submit similar findings for peer review later this summer.  

In addition to Dr. Harbut, co-authors of the report include Carmen Endress, M.D., FACR; John J. Graff, Ph.D., MS, assistant professor, Wayne State University School of Medicine, and chief, Cancer Surveillance Research at the Barbara Ann Karmanos Cancer Institute; Christopher Weis, Ph.D., National Enforcement Investigations Center, United States Environmental Protection Agency; and Harvey Pass, M.D., director, New York University’s Division of Thoracic Surgery.  

About the National Center for Vermiculite and Asbestos-Related Cancers (NCVAC at Karmanos)  

In response to the United States Environmental Protection Agency’s (EPA) identification of major sources of public asbestos exposure in Michigan, and to address the need for early diagnosis and aggressive treatment of asbestos-related diseases, the Barbara Ann Karmanos Cancer Institute and the Center for Occupational and Environmental Medicine (COEM) affiliated with Wayne State University established Karmanos’ National Center for Vermiculite and Asbestos-Related Cancers. The NCVAC is co-directed by Michael Harbut, M.D., MPH, Karmanos Cancer Institute and Chief of the Center for Occupational and Environmental Medicine; and John J. Graff, Ph.D. MS, chief of Cancer Surveillance Research, Karmanos Cancer Institute and assistant professor, Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine. 

Reference: Barbara Ann Karmanos Cancer Institute, International Journal of Occupational and Environmental Health Features Discovery of Asbestos-Related Pain Origin from Scientists at the Karmanos Cancer Institute in Detroit , US Newswire, DETROIT, July 20, 2009.

Racial disparities in pregnancy outcome in the United States are significant, persistent and costly, but the causes are poorly understood. We propose that disproportionate exposure of African-American women to environmental endocrine disrupting compounds (EDCs) may contribute to birth outcome disparities. Marked racial segregation, as well as health behaviors associated with poverty could result in differences in exposure to particular EDCs. One EDC that has aroused concern in recent years is bisphenol-A (BPA), a widely used industrial plasticizer with known estrogenic properties.

Published studies indicate that excessive BPA exposure is associated with reduced fetal survival, as well as reductions in maternal weight and fetal body weight. Related findings include adverse effects of BPA exposure on ovarian function, mammary gland development, earlier age of puberty onset and some metabolic parameters. However, these findings are largely limited to experimental animal studies, and need to be validated in human populations.

Our review supports the need to move beyond the currently dominant toxicological approach to examining the effects of BPA exposure, and rely more on observational human studies and epidemiological methods. Many of the risk factors for racial disparities in pregnancy outcome are global or difficult to modify, but exposure to BPA is a potentially malleable risk factor. If BPA contributes to racial disparities in pregnancy outcome, there are important implications for prevention. It is our hope that this review will stimulate further research in this important and neglected area.

Reference: Ranjit N, Siefert K, Padmanabhan V., Bisphenol-A and disparities in birth outcomes: a review and directions for future research, Journal of Perinatology advance online publication, 9 July 2009; doi:10.1038/jp.2009.90.

State Identifies Dangerous Chemicals

The Maine Department of Environmental Protection (DEP) and the Maine Center for Disease Control and Prevention (CDC) announce the publication of Maine’s List of Chemicals of High Concern. Publishing the list of about 1700 chemicals is the first step toward implementing Maine’s new Toxic Chemicals in Children’s Products law.

The law aims to make children’s products safer and less toxic. Maine DEP and CDC have taken the first step, which is to identify and list chemicals known to governments as causing cancer and other health concerns.

“Increasing public awareness of toxic chemicals and their presence in children’s products will promote the use of safer chemicals in Maine and move us toward our long term goal of protecting the public and the environment,” said DEP Commissioner David Littell. “We also hope this list will prove helpful to businesses, including manufacturers, as they work to improve the chemical safety of their products.”

The CHC list was compiled from existing government lists which identified chemicals that are known to pose specific health threats including those that cause cancer. Some of the commonly recognized chemicals on the list include: lead, mercury, formaldehyde, and bisphenol A.

“Far too often we are forced to confront the risks and benefits of chemicals in products only after we discover they are present in children’s bodies at levels of possible concern,” said Dr. Dora Anne Mills, State Health Officer and Director of the Maine Center for Disease Control and Prevention. “We need to be assured that children’s products are safe from toxic chemicals when they are put on the market. The Maine CHC list is an important first step toward that critical goal.”

In the past, Maine and other states have targeted specific chemicals or products. The CHC listing takes a more holistic approach – it sets up a process to, prioritize, access chemical information, and replace some of the harmful chemicals in children’s products. The law gives the state the authority to phase out the use of dangerous chemicals in children’s products when safer alternatives are effective and available at a comparable cost.

Next year, the DEP and CDC will begin to look more closely at these chemicals, the extent of their use, the level of exposure to children, and documented presence in the human body or environment. The law required the DEP to move at least two “priority chemicals” forward for further scrutiny and possible regulatory action.

Maine is one of several states to implement news laws to reduce toxic chemicals in consumer products. Maine is the first state to publish a List of Chemicals of High Concern.

• Maine’s List of Chemicals of High Concern
• Chemicals of High Concern, Complete List of about 1 700 Chemicals in pdf format

Reference:Department of Environmental Protection Maine, State Takes First Step in Protecting Children from Toxic Chemicals, Identifies Dangerous Chemicals, July 17, 2009

A group of chemists from the University of Santiago de Compostela (USC) has developed a method to quantify the fragrance allergens found in baby bathwater. The researchers have analysed real samples and detected up to 15 allergen compounds in cosmetics and personal hygiene products. 

A team of scientists from the Department of Analytical Chemistry, Nutrition and Bromatology at the USC has developed a method to detect and quantify the 15 most common fragrance allergens included in soap, gel, cologne and other personal hygiene products.   

“Applying the method to eight real samples obtained from the daily baths of a series of babies aged between six months and two years old, we discovered the presence of all the compounds under study in at least one of the samples,” co-author of the study published this month in Analytical and Bioanalytical Chemistry, María Llompart, explained to SINC. 

The scientists found at least six of the 15 compounds in all the samples. In some cases, concentrations were “extremely high”, exceeding 100ppm (parts per million = nanograms/millilitre). Some of the substances that appeared were benzyl salicylate, linalol, coumarin and hydroxycitronellal. 

“The presence and levels of these chemical agents in bathwater should be cause for concern,” Llompart said, “bearing in mind that babies spend up to 15 minutes or more a day playing in the bath and that they can absorb these and other chemicals not only through their skin, but also by inhalation and often ingestion, intentional or not.”

New Method to Detect Fragrances

Allergens were able to be detected due to the high level of sensitivity of the method, which for the first time applies the Solid-Phase Micro Extraction (SPME) technique to determining the ingredients of cosmetics and child hygiene products. This technique makes it possible to concentrate and isolate chemical components from a sample by absorbing them into fibres with a certain coating. 

The researchers have also employed gas chromatography to separate compounds and mass spectrometry to identify and measure the abundance of each of the fragrances. 

European regulations stipulate that the presence of such substances should be indicated on the label of the product when levels exceed a certain limit (0.1 or 0.01%, depending on the type of compound), but some associations believe these limits are excessively tolerant, particularly where child hygiene and baby and child care products are concerned. 

References: J. Pablo Lamas, Lucia Sánchez-Prado, Carmen Garcia-Jares y María Llompart. “Solid-phase microextraction gas chromatography-mass spectrometry determination of fragrance allergens in baby bathwater”. Analytical and Bioanalytical Chemistry 394 (5): 1399-1411, julio de 2009.

Today, WHO publishes its first guidelines on indoor air quality, addressing dampness and mould. (1) They are the result of a rigorous two-year review of the currently available science by 36 leading experts worldwide, coordinated by the WHO Regional Office for Europe. The authors conclude that occupants of damp or mouldy buildings, both private and public, have up to a 75% greater risk of respiratory symptoms and asthma. The guidelines recommend the prevention or remediation of dampness- and mould-related problems to significantly reduce harm to health.

“As people spend most of their daily lives in homes, offices, schools, health care facilities or other buildings, the quality of the air they breathe indoors is critical for their health and well-being,” says Dr Srdan Matic, Unit Head, Noncommunicable Diseases and Environment at the WHO Regional Office for Europe. “For the first time, these guidelines offer guidance to public health and other authorities on how to ensure safety and healthy conditions in buildings. We believe that this work will contribute to improving the health of people around the world.”

The book is the first in a series of WHO guidelines on indoor air quality. They are intended for worldwide use, to protect health under various environmental, social and economic conditions. Future publications addressing selected chemicals and combustion products are being prepared. Together, the guidelines will comprise the first-ever comprehensive evidence-based recommendations to tackle indoor air pollution, one of the major causes of death and disease worldwide.

Globally, about 1.5 million deaths each year, mostly among women and children in developing countries, are associated with the indoor combustion of solid fuels. In the European Union (EU) alone, combustion, chemicals from building materials and dampness cause an annual loss of over 2 million years of healthy life due to premature death or to chronic diseases, such as asthma and cardiovascular diseases.

In many EU countries, 20-30% of households have problems with dampness. Strong evidence indicates that this is a risk to health. In damp conditions, hundreds of species of bacteria and fungi grow indoors and emit spores, cell fragments and chemicals into the air. Exposure to these contaminants is associated with the incidence or worsening of respiratory symptoms, allergies, asthma and immunological reactions. Children are particularly susceptible. According to recent evidence, 13% of childhood asthma in developed countries in the WHO European Region could be attributable to damp housing.

Knowledge of indoor air pollutants is the key to enabling action to prevent related health effects and maintain clean air. Many of these actions are beyond the power of individual building users and occupants, and must be taken by public authorities. The guidelines recommend measures to ensure that buildings are well designed, constructed and maintained, and to make adequate housing and occupancy policies. Building owners are responsible for providing healthy workplaces or living environments, free of moisture and mould, by ensuring adequate insulation. Occupants are responsible for managing the use of water, heating and ventilation to avoid excess humidity.

“In the absence of clear evidence, building standards and regulations have not sufficiently targeted prevention and control of excess moisture. The new guidelines are essential, as they provide reference criteria for what constitutes healthy indoor air,” concludes Dr Michal Krzyzanowski, Regional Adviser, Noncommunicable Diseases and Environment at the WHO Regional Office for Europe, and the leader of the WHO project to draw up the guidelines. “More than 100 studies on the health effects of damp environments were reviewed in the preparation process. This body of evidence forms the basis of the guidelines and provides a solid foundation for action.”

Full Report: Indoor Air Quality Guidelines on Dampness and Mould

The Regional Office web site offers further information on air quality and health.

Reference: WHO guidelines on indoor air quality: dampness and mould. Copenhagen, WHO Regional Office for Europe, 2009, accessed 16 July 2009.