NYC Department of Health information sheet on asbestos in schools,

NYC 9/11 Public Portal Document THE NEW YORK CITY DEPARTMENT OF HEALTH January-February 1994 Vol. 13 No. 1 CITY HEALTH INFORMATION ASBESTOS Common Questions The presence of asbestos in New York Ciry schools has raised many questions about the health risks associated with exposure Last fall, Health Department physicians visited schools around the city to answer questions from parents, teachers, and administrators We continue to receive calls,including many from paysicians, about what exposure to asbestos means, Lhis issue is tor physicians whose patients may have been occupationally exposed, and for those whose patients (including parents of schoolchildren) are concerned about the dangers of asbestos in schools and other buildings. For more information, please see the back page. What Is It and How Was It Used? Asbestos is a term for several different mineral silicates that exist in fibrous form. It was used extensively between 1940 and the 1970's in more than 3,000 products, including thermal, acoustic, and electric insulation; in fire-proofing materials; in floor, tile, roof, and cement products, and in friction materials, such as automobile brakes. By the late 1970's, federal regulations had prohibited most asbestos use About 20% of the nation's buildings, and more than two-thirds of the buildings in New York City, contain some asbestos. Asbestos containing materials that are intact and undamaged are not considered hazardous. To pose a threat, the fibers have to become airborne and, therefore, respirable. Which Diseases Are Associated With Exposure? The latency period for asbestos-asso- ciated pulmonary diseases is usually 20 to 30 years or longer. ASBESTOSIS is a scarring dis- ease of the lung that causes shortness of breath. The disease is associated with high exposure and can progress in the absence of continued exposure. CANCERS OF THE LUNG are the most frequent associated with asbestos. Cigarette smoking greatly increases the risk of lung cancer in persons exposed to asbestos. For example, studies of as- bestos insulation workers have shown the risk of lung cancer for those who smoked to be 80 to 90 times higher than for the general population. (See Reter- PLEURAL SCARRING of the lin- ing of the lung or chest wall is generally associated with extensive exposures, but can also occur at levels lower than those required to produce asbestosis. It is associated with impairment of lung function, especially when extensive. MALIGNANT MESOTHELIOMA, both pleural and peritoneal, has oc- curred most often among persons with prolonged, high-dose exposure. It has also been diagnosed following brief high-dose, or prolonged low-dose ex- posure. Some cases have been reported among persons who lived near asbestos factories, and among household con- tacts of asbestos workers. Many experts believe that nearly all adult cases are associated with asbestos. Mesothelioma risk does not appear to be affected by Who Should Be Examined for Asbestos-Related Diseases? A lifetime occupational history should be obtained to assess your pa- tient's risk of disease. (See Reference 18.) Physical examinations, labo- ratory assessments, and ongoing medical surveillance are indi- cated for persons occupationally exposed to asbestos. The Occupa- tional Safety and Health Administra- tion (OSHA) specifies the legal obliga- tions of employers for medical surveillance of workers exposed to asbestos (29 CFR 11910.1001). The chance that low-level, intermit- tent exposures will result in clinically detectable markers for asbestos dis- ease is extremely small. Therefore, medical examinations and sur- veillance are not useful for eval- uating the risk of asbestos disease for schoolchildren, teachers, of- fice workers, and other occupants of buildings that contain asbes- tos. Neither are medical examinations warranted for persons exposed in a single accidental environmental re- lease of asbestos. Because any exposure to asbestos may increase lifetime risk of disease (by adding to the cumulative dose) all exposure events should nevertheless be documented in the permanent medical record to guide fúture care. For medical consultation and referral, please see page 2. What is the Risk of Disease From Asbestos in Buildings? Because exposures and risks are low, and latency periods long, there have been no direct measurements of disease risk for persons exposed to the extremely low evels of airborne asbestos normally found in buildings. Instead this risk has been estimated statistically, based on stud- ies of disease among persons occupa- tionally exposed to much higher doses. The lifetime risk of death from exposure to asbestos in buildings among non-occu- pationally exposed occupants (including schoolchildren and teachers) has been estimated to be comparable to the lifetime risk of dying from a lightning strike (1-3 per 100,000 persons). (See Reference 20.) Public health efforts focus on preven- tion measures to minimize or remove Regular monitoring is needed to assure the prompt identification and proper repair or removal ot damaged as estos-containing materials Given the high risk of lung cancer among smokers exposed to asbestos, physicians should continue providing the strongest possible anti-smoking messages to all patients. It is imperative that patients with asbestos-related disease, as well as asymptomatic patients known or suspected to have been occupationally ex- posed to asbestos, be advised not to smoke. Physicians can help patients concerned about the dangers of non-occupational ex- posure by putting the risk in perspective, and by providing information on smoking prevention and cessation. Acknowledgements—Susan Klitzman, Ph.D., Director of Environmental and Occupational Epidemiology; and Andrew Goodman, M.D.. M.P.H., Assistant Commissioner Bureau of Communiny and Occupational Health, New York City Department of Health; and Stephen Levin, M.D., Medical Director, Irving/ Selikoff Occupational Health Clinical Center, The Mount Sinai Medical Center: NYC-WTC_000142685