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time as less hazardous but equally effective and affordable substitutes can be found, the strictly controlled use of chrysotile need entail no detectable risk. Society must therefore determine whether its resources should be directed at attempts to further reduce risks conceivably associated with the use of asbestos, a difficult and costly task, rather than concentrate on the major threats to life, health and happiness, which are all too abundant. These decisions should be taken by well-informed local people in the light of national priorities; it is unlikely that they will be the same everywhere. 6- References 1. McDonald JC. Health implications of environmental exposure to asbestos. Environ Health Perspect, 1985;42:319-328. 2_ McDonald JC. Cancer risks due to asbestos and man-made fibres. In: Recent Results in Cancer Research, Vol 120, (ed Band P), Springer-Verlag Berlin Heidelberg 1990, pp 122-131. 3. Berry G, Newhouse ML, Antonis P. Combined effects of asbestos exposure and smoking on mortality from lung cancer and mesothelioma in factory workers. Br J Ind Med, 1985;42=12-18.

12 4. Liddell D. Epidemiological observations on mesothelioma and their implications for non-occupational exposure to asbestos_ In: Proceedings of Symposium on Health Effects of Exposure to Asbestos in Buildings, December 14-16, 1988, (eds Spengler JD, bzkaynak H, McCarthy JF, Lee H), Harvard University Energy and Environmental Policy Centre, Cambridge, MA, 1989. 5. McDonald JC, McDonald AD. Epidemiology of mesothelioma. In: Mineral Fibres and Health (eds Liddell FDK, Miller K), CRC Press, Bocca Raton FLA, 1991; pp 143-164. 6. Rogers AJ, Leigh J, Berry G, Fergusson DA, Mulder HB, Ackad M. Relationship between lung cancer fiber type and concentration and relative risk of inesothelioma. Cancer, 1991;67:1912-1920. 7. Enterline PE. Extrapolation from occupational studies: a substitute for environmental epidemiology. Environ Health Perspect, 1981;42:39-44. 8. Doll R, Peto J. Effects on health of exposure to asbestos. London, Health & Safety Commission, Her Majesty's Stationery Office, 1985. ' 9. Hughes JM, Weill H. Asbestos exposure-quantitative N assessment of risk. Amer Rev Resp Dis, 1986;133:5-13. V7 O N i A ~ ~ O1 0)

13 10. Vacek PM, McDonald JC. Effect of intensity in asbestos- cohort exposure-response analyses. In: Occupational Epidemiology (ed Sakurai H, et al), Elsevier Science Publishers, 1990, pp 189-193. 11. Vacek PM, McDonald JC. Risk assessment using exposure intensity: an application to vermiculite mining. Brit J Ind Med, 1991;48:543-547. 12. Health Effects Institute - Asbestos Research. Asbestos in public and commercial buildings, Cambridge MA, HE1.AR, 1991. 13. McDonald JC. An epidemiological view of asbestos in buildings. Toxicol Ind Health, 1991;7:187-193.

TABLES AND FIGURES Source Table 1 Exposure-response for lung cancer in McDonald (1) male cohorts where exposure estimates Table 3 were made for each subject individually Table 2 Lung cancer and smoking in asbestos Berry etal (3) workers Table 8 Table 3 Estimated lifetime risks per million McDonald (1) population from non-occupational Table 4 exposure to asbestos Table 4 Lifetime risk estimates for populations McDonald (13) exposed to chrysotile only Table 4 Figure 1 Standardized mortality ratio (SMR) by exposures to asbestos fibres. Exposure- response relationships from 11 studies Figure 2 Concentrations of chrysotile and amphibole fibres more than 8pm in length in lung tissue at autopsy from mesothelioma cases and controls Figure 3 Relationship of loge (odds ratio) to log,o (fibre concentration in lung) for total uncoated fibres by light microscopic analysis McDonald (2) Figure 2 . McDonald & McDonald.(5) Figure 3 Rogers e al 6) Figure 1

Number Luna can<er Re)etia slapc Stndy _ n Type of /ndustry Study Place Fihcr ttyr in eohon Tou1 death> empected case a per mlxbyr I Mlmnaand Mcl)onild(fll Quclwc Chrysa6lc 1U.939 3.291 1&l OIW 2 mulme Gcnera) Hendersanand U.$. ChryzaWc 1,075 78) 133 a3sa manufactwe En4rGne It5) CroudnOte Anwsite 3 Cement prvducu Weill Iss) New Orlearu Chry.ntJe CrocidoGt< 5,W5 501 49.2 U.658 e Teztilea Dement (ty) S. Carolina C~hysotile 'i60 191 ].5 6.896 Table 1 5 Tutilu MeDovld (W) & Cuoatu Ghrywtile 2,543 857 29.6 5.863 5 Mafnly tutiks M<UonaM (e9) Pennaylvavla CJ.ryaoti)e 4,137 1,392 50.5 5.101 Amoute 7 Frictien produtt. Berry and New. Enelud QocdoGte Chrpetile 9,113 1,610 139.5 'efteeGve)y urv' houx(f0) Crvddolite e Frietion produc4 M<DOrWd Ul) Cannectiat Chry.ntile 3,64) 1,26T e9.1 'e!(ectively ura' 9 Cemena Product-+ FSnaebaein 4)f1 Ontario Chrykot{k 536 138 5.J noe dculatM Gocdnlite Table 2 Pable 3 'able 4 Nommaken Rmaken• sway obv.c.e6 F~peta R fati euk ohserwd Ezyned Re3aiire riek (U rmuption rwkca 0 0.05 0 y 29t i.) New York and Nc.lcncy, 196}T1" (2) Insularora. USA an 4 0.9 5.> 2" 514 5.3 Unada, I%T-T6'a ' (3) !kmorim fattary 5 02 #.0 l5 9.6 4.7 worknn. 1961-T]'• (41 Fa.aory rock<ra I 0.1 5.0 14 19 24 (wamcn4 UK, 1%0-70' (SI Faqory.wkcra. 4 055 ] 3 75 31.02 24 UK,1911-90 A.Wt«capmrrc 16) Minen and mi)leas. Gnadti1951-75 .ntrot dau'• Yes Not Y¢ Not Lunpon¢r .l7 6 IS( 69 Cnmro)s 93 103 3.0 274 l"0 IJ CombinW nnaia Relativc aWntoa 95z eRCt wnRdenec (N55) liml¢ Lung cancer Mesothe5oma Enterline (!2) 2 100' Schneidennan (F5) 3-32 4-24 Nicholson (40) 12-18 6-24 NRC Committ.ee (46) Smokecs, male 64-320 Smokers, female 23-120 Nonsmokers, male 6-29 9-46 Nonsmokers, female 3-15 'This figure should probably have been about 50 (see tezt). N N 0 Wpulaticn(n) Cancertration (llration AttriOutable cases f/ml) (yr) Lug cancer Nesochelinte Total N ~ A AsbeStos ~t 0.5 20 26 5 31 ~ wcrkers(10,000) 40 51 6 57 i ~ Sd,ool chi ldrrn (1 millian) 0.001 6 0,6 0.9 1.5 . - 0.003 1.9 2.6 4.5 BaSed an tUgY¢s an4 Weill (1986)

Figure 1 Figure 2 Figure 3 Lung Cancer SMR 1 .- - - - - - - - - 700 200 Exposure WmIA F-1CC Fibre[)ub r lo rl G~.LGi, Z (~ilip Sw)d 30 )0 io So w )o t0 fs ( 1 1 1 1 1 1 ( fC ( 9.i Relative risk (odds ratio) (loge scale) a 10 54 1 300 [r.l.[i.. Z (ltob.bil(t) s[lle) 20 30 w so w 70 ao p rt 1e I 1 ( 1 ( r 1 1 ( ( • • 4-0 4•5 5•0 515 6•0