Archive for the 'Chrysotile toxicity' Category

Ford Motor Company appeals record asbestos judgment in Australia

Ford Australia has lodged an appeal against a landmark decision to award a former mechanic $840,000 compensation for exposure to asbestos when he worked at Ford car dealerships. Antonino Lo Presti, 58, was the first motor mechanic in Australia to win a successful negligence verdict against a car company for exposure to asbestos, last month in the West Australian Supreme Court. Mr Lo Presti used compressed air to blow out the brake drums and handled asbestos brake linings when brakes were serviced or changed between 1970 and 1971 at two Ford dealerships he worked at.

Complete story here.

Information about mesothelioma medical and legal options provided by the Law Office of Roger G. Worthington, P.C., www.mesothel.com.

Mesothelioma science news update

Chrysotile asbestos increases risk of lung cancer

PubMed

This study investigated the relationship between simple exposure to chrysotile and lung cancer.

The nested case-control study method was used. All of lung cancer cases collected from a male fixed prospective cohort with follow-up of 30 years served as cases and a 1:4 matched proportion was used to select non-cancer case as controls. Controls matched for sex age (+/-5 years old), work time (+/-5 years) and smoking were collected in the same cohort. RESULTS: Forty cases died of lung cancer in the study cohort, and the incidence was higher than the average incidence (SMR =1.77). The top four work types of death density were raw material (741.5), combing and spinning (424.3), weaving (365.0), and repairing (285.5), which was consistent with exposed level. According to the exposed level of chrysotile, the research objects were divided into the high level group and the low level group. The result demonstrated that lung cancer incidence of the high exposed level group of chrysotile was higher (OR = 3.7 95% CI 2.30 approximately 8.16), compared with the low exposed level group.

Simple exposure to chrysotile can increase the risk of lung cancer for workers who are exposed to chrysotile.

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi, 2007, Zhou DL, Lan YJ, Wang ZM, Wang MZ, West China School of Public Health, Sichuan University, Chengdu 610041, China.

Mesothelioma and U. S. shipyard workers

From PubMed

The risks for four cancers, leukemia, lymphopoietic cancers (LHC), lung cancer and mesothelioma, were studied in workers from shipyards involved in nuclear powered ship overhauls. The population represented a sample of all workers based on radiation dose at study termination. The final sample included 28,000 workers with >/= 5.0 mSv, 10,462 workers with < 5.0 mSv and 33,353 non-nuclear workers. Nuclear workers had lower mortality rates for leukemia and LHC than US white males but higher rates of lung cancer and a significant five-fold excess of mesothelioma. Dose-dependent analyses of risks in the high exposure group indicated that for each cancer the risk increased at exposures above 10.0 mSv. An internal comparison of workers with 50.0 mSv exposures to workers with exposures of 5.0-9.9 mSv indicated relative risks for leukemia of 2.41 (95% CI: 0.5, 23.8), for LHC, 2.94 (95% CI: 1.0,12.0), for lung cancer, 1.26 (95% CI: 0.9, 1.9) and for mesothelioma, 1.61 (95% CI: 0.4, 9.7) for the higher exposure group. Except for LHC, these risks are not significant. However, the increasing risk with increasing exposure for these cancers, some of which are known to be related to radiation, suggests that low-level protracted exposures to gamma rays may be associated with these cancers. Other agents such as asbestos, which are common to shipyard work, may play a role especially in the risk of mesothelioma. Future follow up of the population would identify bounds on radiation risks for this population for comparison with similar risks estimated from other populations.

J Radiat Res (Tokyo). 2007 Aug 10; Cancer Risks and Low-Level Radiation in U. S. Shipyard Workers; Matanoski GM, Tonascia JA, Correa-Villaseñor A, Yates KC, Fink N, Elliott E, Sanders B, Lantry D.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health.

Information about mesothelioma medical and legal options provided by the Law Office of Roger G. Worthington, P.C., www.mesothel.com.

Baryulgil mesothelioma deaths prove chrysotile toxicity

Despite claims by the asbestos industry that chrysotile asbestos is a benign, non-carcinogenic mineral, recent reports of mesothelioma and other asbestos related diseases in Bayulgil, Australia, conclusively show that exposure to chrysotile is linked to mesothelioma, asbestos, and other illnesses. The Bayulgil operation, run by a subsidiary of James Hardie, mined white chrysotile. Residents are now suffering from extraordinary levels of mesothelioma and other asbestos related diseases. The catastrophe rivals the massive public health disaster caused by W.R. Grace in Libby, Montana. The Australian reported the details.

OMB Watch piles on against chrysotile apologist Paustenbach

EPA Asbestos Panel Should Stay Insulated from Industry

EPA is considering appointing Dennis C. Paustenbach to the asbestos panel of its Science Advisory Board. According to the Environmental Working Group (EWG), Paustenbach has made a career out of defending corporations in asbestos exposure suits.

Agency panels and committees, such as EPA’s Science Advisory Board, are important tools for regulatory decision-makers. Panels are supposed to consist of impartial experts who can provide valuable scientific and technical advice.

EPA created the asbestos panel to aid the agency in maintaining risk assessments and exposure standards consistent with the most up-to-date scientific data and technological feasibility. Unfortunately, it appears Paustenbach’s expertise is in downplaying the risks of asbestos exposure and advocating for less protective federal standards.

EWG has sent a letter to EPA further detailing their opinion as to why Paustenbach is a bad choice. To read the letter, click here.

Posted by Matt Madia

EWG protests mesothelioma apologist’s inclusion on NIOSH short list

May 16, 2007

Ms. Vivian Turner
Designated Federal Officer
Environmental Protection Agency
Via email: turner.vivian@epa.gov
RE: OBJECTION TO ASBESTOS PANEL CANDIDATE
DENNIS C. PAUSTENBACH

Dear Ms. Turner:

Environmental Working Group is disturbed to learn that Dennis C. Paustenbach is on the “Short List” of potential appointees to the Asbestos Panel of the EPA Science Advisory Board. EPA’s Invitation for Comments, dated April 19, 2007, specifies that appointees to the Panel should display “absence of financial conflicts of interest” and “absence of an appearance of a lack of impartiality.” Based on evidence of his work for defendant corporations in lawsuits over asbestos exposure, his studies that consistently aim to refute or minimize the scientifically established risks of asbestos exposure, and other evidence detailed below of a lack of adherence to scientific and professional ethics, it is clear that Dr. Paustenbach is unfit to serve on the Panel.

Dr. Paustenbach has spent virtually his entire career as a paid expert for polluting corporations arguing for weaker health protections for workers and the public from some of the most notorious toxic substances ever known. To our knowledge, Dr. Paustenbach has never argued for greater health protections from any toxic material, regardless of the science base. To the contrary, Dr. Paustenbach has engineered the fabrication of science to absolve a client of major financial liability, in the case of chromium, a fact that contributed to an article produced by Paustenbach’s company being retracted from the Journal of Occupational and Environmental Medicine (JOEM). Paustenbach is legendary in New Jersey where his science, which is now largely discredited, led the state to weaken soil contamination standards for chromium more than a thousand-fold. Now Paustenbach is defending the asbestos industry, leading a science-for-hire campaign to roll back protections from chrysotile asbestos. As we argue below, asbestos is nothing more than a profit center for Paustenbach. It is absurd to think that he will bring any sort of objectivity to the scientific review process on chrysotile carcinogenicity. He has an overwhelming financial interest in only one outcome of this chrysotile review, that which will benefit his clients in the asbestos industry, and is without question unfit to serve on the Panel.

1. CONFLICTS OF INTEREST

Dr. Paustenbach is founder and president of ChemRisk, Inc. As head of this firm, and in previous positions, he has a long history of work for corporations who were defendants in lawsuits over asbestos exposure. His resume on ChemRisk’s web site[1] does not disclose the names of his clients. Last year, in an investigation of auto industry lobbying against federal rules on asbestos brakes, the Baltimore Sun cited documents showing that Chemrisk and Paustenbach’s previous firm, Exponent, were paid more than $23 million since 2001 by Ford, General Motors and Daimler-Chrysler to help fight asbestos lawsuits brought against them by former workers.[2]

In addition, research by the independent Center for Science in the Public Interest[3] has documented the following list of other Paustenbach clients who are or have been defendants in asbestos litigation, or who are associated with such defendants:

Alcoa
Allied Signal
Amoco
ARCO
Beazer Corporation
Chemical Manufacturers Association
Chevron Chemical Company
Dow Chemical
Exxon
FMC
GATX
General Dynamics
General Electric
Gould Industries
Hercules
ICI Americas
Industrial Health Foundation
Koppers
Maxus Energy Corporation
McKesson
Mobil Oil Corporation
Monsanto
Montrose
Rhône Poulenc
Shell
Stauffer Chemicals
Union Carbide
Vulcan Chemicals
Zeneca

2. LACK OF IMPARTIALITY

According to his resume, in 2005 and again in 2006 Dr. Paustenbach was a featured speaker at conferences organized by the Chrysotile Institute and the International Chrysotile Association, formerly the Asbestos Institute and the International Asbestos Association. These are front groups for the asbestos industry. Numerous articles on the Institute’s website make clear that these organizations have a strong bias against the objective evaluation of chrysotile’s health hazards:

“If people preaching the banishment [of chrysotile] were really well informed and were using their contacts with the media, in particular, to make public the good and true news about chrysotile, people would not panic any more. On the contrary, they would be reassured of knowing that many cities of the planet were built, irrigated and supplied out of drinking water thanks to chrysotile products, and this, in full safety. Unfortunately, the poor combat they carry out only propagates quite inaccurate information serving only their economic or ideological interests.[4]“

At the 2006 International Conference on Chryosotile in Montreal, Dr. Paustenbach delivered a presentation entitled “The Roles of Dose Reconstruction and Simulation Studies in Understanding Historical Exposure to Asbestos.” The 30-minute presentation, available in a video file on the Chrysotile Institute’s website,[5] is a thinly veiled pitch for asbestos litigants to hire ChemRisk to conduct simulation studies for their defense. Dr. Paustenbach advises his audience that asbestos juries expect to see such studies, and that the studies asbestos defendants relied on just a few years ago are outdated. Also telling is Dr. Paustenbach’s use of the pronoun “we” to refer to the U.S. asbestos industry’s response to Congress’ proposed creation of a trust fund to cover claims:

“It’s a complex subject, and it takes a lot of work and a lot of money to do them [studies]. But I can assure you it’s worth the effort. To the best of my knowledge in litigation that was traditionally lost in the United States, I’m not aware of a single case that has been lost when a high quality simulation study was done and exposures were considered de minimus.
. . .

“It’s a shame to have to have spent, let’s say, $250,000 to do this study when it’s really intuitive that there wouldn’t be much exposure. But when it costs $4 million in the United States to work up and take a case to trial — that’s just the expenses, that’s not the outcome — a $250,000 or $500,000 study is a drop in the bucket. So when you heard yesterday — remember we turned down a settlement of $150 billion, that’s with a B, to settle the litigation crisis in the United States — these kinds of $250,000, $500,000 investments go a long way. If you’ve got 100 cases and it takes $4 million for the lawyers and consultants to get ready for the case and to take it to trial, you can see it’s a drop in the bucket. So when I hear people say, ÔWe can’t afford it,’ I don’t understand.”

3. LACK OF ADHERENCE TO ETHICAL STANDARDS

In July 2006, the prestigious Journal of Occupational and Environmental Medicine (JOEM) retracted a 1997 study that had appeared to be written solely by two Chinese scientists, JianDong Zhang and ShuKun Li. In reality, the paper was largely written by Dr. Paustenbach’s firm, ChemRisk, while under contract with Pacific Gas & Electric (PG&E). The retraction was specifically for hiding PG&E’s financial sponsorship of the paper as well as ChemRisk’s intellectual input, but there is compelling evidence of wider fraud.

Dr. Paustenbach was CEO of ChemRisk when PG&E hired the company to help defend against a major lawsuit brought by the small town of Hinkley, California. Local residents had sued PG&E, claiming that the utility was responsible for contaminating the town’s drinking water with hexavalent chromium which, in turn, had caused many serious health problems in the community, including cancer.

Zhang and Li’s original paper, published in 1987 by JOEM, had found a strong association between consumption of chromium-6 laced water and stomach, and PG&E wanted to cast doubt on that finding. In 1986, under Dr. Paustenbach’s direction, ChemRisk scientists obtained Zhang and Li’s original data, manipulated it to obscure the connection between chromium-6 in drinking water and cancer and rewrote their paper. Then they submitted it under Zhang’s byline to JOEM, where it was published. JOEM knew nothing of the paper’s real author and funding source until Environmental Working Group exposed the deception last year.

Not long after publication of the 1997 paper, PG&E paid damages of $333 million to settle the Hinkley case, which became the basis for the film Erin Brockovich. But the fraudulent study had a much wider impact, influencing a federal Agency for Toxic Substances & Disease Control guidance document and forcing California regulators to re-evaluate a risk assessment for chromium-6 in drinking water, causing several years’ delay in setting safety standards.

The details of this fraud are well documented in a front-page article in The Wall Street Journal[6] and in our own investigation[7], which includes links to the original documents making the case against Dr. Paustenbach and ChemRisk. They show convincingly that in the chromium-6 case, Dr. Paustenbach violated the code of ethics of the Society of Toxicology, his professional association, by failing to conduct himself with integrity, failing to be honest and truthful in reporting and communicating his research, hiding clear material conflicts of interest, and failing to avoid situations that imply a conflict of interest.

The task before the Asbestos Panel — to provide technical advice on EPA’s proposed methodology to estimate potential cancer risk from inhalation exposure to asbestos — is crucial. EPA’s determination will affect the future health and safety of every American who is exposed to asbestos in the workplace and in consumer products. To ensure that this decision relies on the best objective science, without influence of corporations with a financial stake in the outcome, the Asbestos Panel must be free of all conflict of interest or bias, and consist of scientists who adhere to the highest ethical standards. We believe that Dennis C. Paustenbach does not meet those tests.

Thank you. If you need any more information, please let me know.

Sincerely,

Richard Wiles
Executive Director

[1] http://www.chemrisk.com/team/paustenbach.htm
[2] Andrew Schneider, “Pressure at OSHA to Alter Warning,” The Sun (Baltimore, Md.), Nov. 20, 2006.
[3] http://www.cspinet.org/integrity/index.html
[4] http://www.chrysotile.com/en/chrysotile/controversy/default.aspx
[5] http://www.chrysotile.com/en/conferences/speakers/Dennis_Paustenbach.aspx
[6] Peter Waldman, “Study Tied Pollutant to Cancer, Then Consultants Got Hold of It.” The Wall Street Journal, Dec. 23, 2005.
[7] http://www.ewg.org/reports/chromium

www.ewg.org is the website for both Environmental Working Group and EWG Action Fund
Copyright 2006, EWG Action Fund. All Rights Reserved.
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Protest to EPA re: stacked advisory panel, bias against mesothelioma victims and chrysotile causation

Ms. Vivian Turner
Designated Federal Officer
Science Advisory Board (1400F)
U.S. Environmental Protection Agency
1200 Pennsylvania Avenue, NW
Washington, DC 20460

Anthony F. Maciorowski
Associate Director for Science
Science Advisory Board (1400F)
U.S. Environmental Protection Agency
1200 Pennsylvania Avenue, NW
Washington, DC 20460

Re: Nominations of Bruce W. Case, Dennis Paustenbach, and Art Langer to EPA Task Panel

Dear Ms. Turner and Mr. Maciorowski,

I oppose the inclusion of Dr. Case, Dr. Paustenbach, and Dr. Langer on EPA’s scientific advisory board regarding asbestos toxicity.

The advisory board is charged with reaching conclusions about asbestos toxicity that are scientific and non-partisan. Members of the board are obligated to demonstrate through their professional backgrounds and conflict of interest disclosures that they can serve on the board with scientific objectivity and nonpartisanship.

Scientific Objectivity

Dr. Case served as a consultant to a 2003 EPA peer panel on asbestos risks. He was given all relevant studies and charged with providing an unbiased evaluation of all the data. In his analysis, Dr. Case made a mockery of his scientific duties when he chose to use only those studies that supported the asbestos industry, ignoring his own research which showed that fiber dimension did not affect toxicity.[1] A 2003 report to the Office of the Inspector General documents Dr. Case’s public statements that chrysotile asbestos does not cause cancer, and his claim that the scientific community agrees with him.[2] The International Agency for Research on Cancer,[3] the European Union,[4] as well as experimental and epidemiologic studies have all affirmed the carcinogenicity of chrysotile. One member of the scientific community that supposedly “agrees” with Dr. Case publicly rebuked him in the New England Journal of Medicine[5] for his outlandish claims. Dr. Case clearly lacks the scientific objectivity to evaluate asbestos toxicity.

Dr. Paustenbach conceived, drafted, edited, and submitted to a peer-reviewed medical journal a redacted Chinese study on chromium-6 under the names JianDong Zhang and ShuKun Li that suppressed key cancer data despite a letter of objection from the scientist who led the original study.[6] The Journal of Occupational and Environmental Medicine took the rare step of retracting the article when it learned that the real author was Paustenbach’s industrial consulting firm, ChemRisk, and that the cancer data had been intentionally ignored.[7] This scandal was written up in the Wall Street Journal.[8] Dr. Paustenbach also devised a “scientific” probabilistic risk assessment methodology for a DOW Chemical flood plain soil study that was explicitly rejected by the EPA as inadequate and not accepted by the scientific community.[9] Paustenbach’s methodological flaw was labeled a critical deficiency to the study.[10] Dr. Paustenbach lacks the capacity to serve on any panel requiring scientific objectivity or personal integrity.

Dr. Langer has a distinguished record as a scientific investigator, and published pioneering work on asbestos toxicity in the 1970’s. Although I believe his early career demonstrates unimpeachable scientific research, he should be barred from this panel for the reasons set out below.

Nonpartisanship

Dr. Case is listed on the EPA’s short list as a consultant to attorneys representing “plaintiffs and/or defendants in asbestos litigation.”[11] We challenge Dr. Case to prove a single consulting job for a plaintiff in asbestos litigation, ever. To the contrary, he is an established consultant for asbestos companies, having worked on behalf of AC&S, U.S. Gypsum, Garlock, Mobil, and Georgia-Pacific, to name only a few.[12] Dr. Case has denied that any his research was ever funded by the asbestos industry, when the Archives of Environmental Health explicitly acknowledges that his research funding was partially obtained from JM Asbestos Corporation.[13] Dr. Case has also admitted in legal testimony that a 1989 study in which he participated was sponsored by the Quebec Mining Companies.[14] In addition to open partisanship for asbestos manufacturers, Dr. Case has attacked the honesty and integrity of scientists who disagree with him, including researchers Dodson, Egilman, Suzuki, and Landrigan.[15] In 1998, in response to a short story about a young woman who contracted mesothelioma by playing with a chrysotile rock from a Canadian mine posted on my website, he warned me to take them down “for my own protection,” a threat he later confessed was “silly” under penalty of perjury.[16] Dr. Case is unqualified to pursue the scientific question of asbestos toxicity due to his extreme partisanship.

Dr. Paustenbach is not simply partisan—he is for hire.[17] His industrial research as corporate vice-president for Exponent, and his position as CEO of ChemRisk have put him consistently on the side of asbestos manufacturers and corporations. He cannot be expected to fairly pursue research objectives for asbestos toxicity unless the research conclusions are favorable to the asbestos industry for which his corporation works.

Dr. Langer’s work as a consultant for defendant asbestos companies has led him to repudiate his earlier, sound research that demonstrated the toxicity of joint compound and brake linings. Dr. Langer, like Drs. Case and Paustenbach, can hardly be expected to pursue or endorse toxicity findings at loggerheads with his consulting clients.

Conclusion

I believe that EPA’s short list has numerous other candidates whose scientific background and personal history ensure that they will follow the tenets of objective investigation and analysis, as well as behave with honesty and integrity.

Sincerely,

Roger G. Worthington, Esq.

RGW/cr

CC: Sen. Barbara Boxer
Sen. Diane Feinstein


 [1] EPA internal memorandum, April 16, 2004, by Case Jenkins, Ph.D., “Bruce Case, MD, EPA consultant for asbestos: conflict of interest misrepresentations and slander against other scientists.”
[2] Id.
[3] International Agency for Research on Cancer (IARC) - Summaries & Evaluations, 1987, http://www.inchem.org/documents/iarc/suppl7/asbestos.html
[4] News story, http://ban.org/ban_news/wto_will.html
[5] Letters 006-009, New England Journal of Medicine, October 1, 1998, Vol. 339 #14, pp. 999-1002
[6] Environmental Working Group report, April 2006, http://www.ewg.org/reports/chromium/part1.php
[7] Letter to editorial board members, Journal of Occupational and Environmental Medicine, May 31, 2006, NOTICE OF RETRACTION: It has been brought to our attention that an article published in JOEM in the April, 1997 issue by Zhang and Li1 failed to meet the journal’s published editorial policy in effect at that time. Specifically, financial and intellectual input to the paper by outside parties was not disclosed. Although it is impossible to know what the impact of such disclosure would have been, it is possible that full knowledge of the circumstances may have altered the review process or the subsequent interpretation of the study by readers. Therefore, after thorough investigation, consultation with outside experts and consideration by the Editorial Board, I have decided that retraction is necessary. It should be understood that there is no evidence to suggest the existence of scientific fraud in this work and that the factual content of the article has not been re-evaluated. This decision is based solely on the violation of the journal’s policy regarding disclosure. The corresponding author of this article (Dr. Zhang) has since died. However, the co-author (Dr. Li) has been informed of this decision and has agreed to the retraction of the article. We will also make appropriate notification to the National Library of Medicine regarding future citation of this paper. Paul Brandt-Rauf, M.D., Sc.D., Ph.D., Editor, 1 Zhang J, Li S. Cancer mortality in a Chinese population exposed to hexavalent chromium in water. JOEM 1997;39:315-319.
[8] Wall Street Journal, Dec. 23, 2006
[9] EPA Region 5 Critical Deficiency Comments on the Tittabawassee River Floodplain Remedial Investigation Work Plan and Midland Area Soils Remedial Investigation Work Plan Midland, Michigan, Feb. 10, 2006
[10] Id.
[11] Invitation for Comments on the Short List Candidates for the Asbestos Panel of the EPA Science Advisory Board, April 19, 2007, http://www.epa.gov/sab/pdf/asbestos_panel_shortlist_biosketches.pdf
[12] EPA internal memorandum, supra
[13] Id.
[14] Id.
[15] Id.
[16] http://www.mesothel.com/pages/case.htm
[17] www.ChemRisk.com

The scientific basis for a total asbestos ban

La Medicina del lavoro, 2006 Mar-Apr; 97(2):383-92

Numerous countries have already enacted total bans on asbestos, while others continue to use it as if the documented dangers over the last century never existed. This disparity, with developed countries tending to ban asbestos and poorer countries serving as dumping grounds for asbestos makers, led the University of Turin’s Center for the Study of Asbestos to conduct a review of the scientific basis for a total asbestos ban.

The review concluded that in order to ensure adequate protection for workers, their families, and people involved in everyday activities, there is no alternative to a total ban. The review concluded that the evidence for carcinogenicity of chrysotile is as good as for the amphibole type fibers, and it noted that while the carcinogenic potency of chrysotile is lower than that of the amphiboles, risk estimates must be based on the fact that chrysotile represents 95% of asbestos used worldwide. The review insisted that the role of asbestos as the cause of mesothelioma does not warrant reconsideration.

The review also rejected calls for “controlled use,” pointing out that the safety of the controlled use theory has not been tested scientifically and that it is impractical in the countries that are currently the major consumers of asbestos.

 Citation

All types of asbestos related to high incidence of mesothelioma in Australia

American Journal of Industrial Medicine, 2002 Mar; 41(3):188-201

Rebutting the misrepresentation that chrysotile asbestos does not cause mesothelioma, a 2002 article published by the Center for Occupational and Environmental Health, Department of Public Health and Community Medicine in Sydney, Australia reviewed mesothelioma in that country between 1945-2000.

The review, based on a national malignant mesothelioma case registry begun in 1980, noted a marked increase in the incidence of mesothelioma in the last twenty years. The article concluded that Australia’s high incidence of mesothelioma is related to high past asbestos use of all fiber types across a wide spectrum of occupational and environmental settings. This conclusion directly rebuts the claim of defense lawyers and asbestos manufacturers that mesothelioma is caused by some fiber types and not by others.

The article chronicled the scope of the asbestos epidemic in Australia, and predicted that the number of cases is expected to reach 18,000 by 2020, with about 11,000 yet to appear. Currently 450-600 cases are notified annually in a population of 20 million. The review used registry data to calculate time trends in mesothelioma incidence. The article analyzes incidence by age, sex, anatomical site, and state of notification, and describes the association of occupational and environmental asbestos exposure histories. Australia has the highest number of reported mesothelioma cases in the world.

Citation