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Table 1.—Occupational exposure limits and biologic monitoring,medical screening,and morbidity and for asbestos mortality data. This analysis may provide information about the relatedness of adverse health effects and occupational ex- Exposure 3imits ex- mg/m"' posure that cannot be discerned from results in individual _OSHA PEL TWA 0.2 workers.Sensitivity,specificity,and predictive values of bio- Action level 0.1 logic monitoring and medical screening tests should be evalu- NIOSH REL TWA (Ca)t 0.1 ated on an industrywide basis prior to application in any given ACGIH TLV® TWA(Ala)§ worker group. Intrinsic to a surveillance program is the dis- Chrysotile 2.0 semination of summary data to those who need to know, in- Amosite 0.5 cluding employers, occupational health professionals, 0 2 potentially exposed workers,and regulatory and public health Crocidolite agencies. Other forms 2.0 • Preplacement medical evaluation * Fibers greater than 5 lAm in length. Prior to placing a worker in a job with a potential for exposure t(Ca):NIOSH recommends treating as a potential human car- to asbestos,the physician should evaluate and document the cinogen. worker's baseline health status with thorough medical,environ- §(Ala): Human carcinogen with an assigned TLV°. mental,and occupational histories,a physical examination,and HEALTH HAZARD INFORMATION physiologic and laboratory tests appropriate for the anticipat- ed occupational risks.These should concentrate on the func- • Routes of exposure tion and integrity of the respiratory system using the principles Asbestos may cause adverse health effects following exposure and methods recommended by NIOSH and the American via inhalation or ingestion. Thoracic Society (ATS). • Summary of toxicology 1.Effects on animals:Single intrapleural injections of asbestos A preplacement medical evaluation is recommended in order in rats,rabbits,and hamsters produced mesothelioma(cancer to detect and assess preexisting or concurrent conditions which of the chest or abdominal linings). In rats,chronic inhalation may be aggravated or result in increased risk when a worker or oral administration of asbestos produced cancers of the is exposed to asbestos at or below the NIOSH REL. The ex- lungs,stomach,kidneys,liver,or mammary glands.All forms amining physician should consider the probable frequency,in- of asbestos were found to be carcinogenic in treated animals. tensity, and duration of exposure, as well as the nature and 2.Effects on humans:Exposure to asbestos has been found to degree of the condition, in placing such a worker. Such con- significantly increase the risks of contracting asbestosis,lung ditions, which should not be regarded as absolute contraindi- -ancer, and mesothelioma. cations to job placement, include cigarette smoking, • Signs and symptoms of exposure preexisting asbestos-related disease,and significant breathing 1. Short-term (acute): Exposure to asbestos can cause short- impairment due to preexisting chronic lung diseases.In addi- ness of breath,chest or abdominal pain, and irritation of the tion to the medical interview and physical examination, the skin and mucous membranes. means to identify these conditions may include the methods 2. Long-term (chronic): Exposure to asbestos can cause recommended by NIOSH and ATS. reduced pulmonary function,breathing difficulty,dry cough, • Periodic medical screening and/or biologic monitoring broadening and thickening of the ends of the fingers,and bluish Occupational health interviews and physical examinations discoloration of the skin and mucous membranes. should be performed at regular intervals.Additional examina- RECOMMENDED MEDICAL PRACTICES tions may be necessary should a worker develop symptoms that may be attributed to exposure to asbestos.The interviews,ex- Medical surveillance program aminations,and appropriate medical screening and/or biologic Workers with potential exposures to chemical hazards should monitoring tests should be directed at identifying an excessive be monitored in a systematic program of medical surveillance decrease or adverse trend in the physiologic function of the intended to prevent or control occupational injury and disease. respiratory system as compared to the baseline status of the in- The program should include education of employers and work- dividual worker or to the expected values for a suitable refer- ers about work-related hazards,placement of workers in jobs ence population. The following tests should be used and that do not jeopardize their safety and health,earliest possi- interpreted according to standardized procedures and evalua- ble detection of adverse health effects,and referral of workers tion criteria recommended by NIOSH and ATS:standardized for diagnostic confirmation and treatment.The occurrence of questionnaires, tests of lung function, and chest X-rays. disease(a"sentinel health event,"SHE)or other work-related • Medical practices recommended at the time of job trans- adverse health effects should prompt immediate evaluation of fer or termination primary preventive measures(e.g_,industrial hygiene monitor- The medical,environmental,and occupational history inter- ing,engineering controls,and personal protective equipment). views,the physical examination,and selected physiologic and A medical surveillance program is intended to supplement,not laboratory tests which were conducted at the time of placement replace, such measures. should be repeated at the time of job transfer or termination. A medical surveillance program should include systematic col- Any changes in the worker's health status should be compared lection and epidemiologic analysis of relevant environmental to those expected for a suitable reference population. Because 2 Asbestos 1988