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Asbestos exposure among hairdressers

   The Lombardy Mesothelioma Registry (Registro                ers can determine asbestos fibres emissions in the environ-
Mesoteliomi Lombardia, in Italian: RML) includes Malig-        ment; as a consequence, the exposure of their users can be
nant Mesothelioma (MM) cases whose exposure to as-             considered moderate but most likely sufficient to determine
bestos remains uncertain and therefore classifies them as      a risk for the onset of mesothelioma. Fixing and mainte-
having an “unknown exposure” (7). However the RML              nance operations undoubtedly increase the level of expo-
staff observed that some of these cases did the same job       sure, even if such operations are not essential to classify a
(hairdressers) and therefore tried to figure out whether       subject as exposed; in fact, using the hairdryers can be con-
there were possible exposure sources in this specific occu-    sidered a source of risk by itself.
pation.                                                            Following such considerations, the RML staff reevaluat-
   The last report by the National Mesothelioma Registry       ed the criteria used to classify asbestos exposure in hair-
(Registro Nazionale dei Mesoteliomi, in Italian: ReNaM)        dressers and defined:
(6) had already indicated asbestos as a potential component        - occupational exposure as certain if the MM cases re-
of some everyday household appliances: for instance, both            ported that their personal hairdryers contained as-
hand-held and hood-type hairdryers may have contained                bestos;
asbestos as insulation for the overheating of the electrical       - occupational exposure as possible if the MM cases re-
resistance.                                                          ported the use of hairdryers without giving informa-
   During the period 1979-1981 both the scientific com-              tion about their characteristics, for at least one year be-
munity and the US Governmental Agencies investigated as-             fore asbestos was banned;
bestos exposure – and its potential effects on human health        - exposure as unknown if the MM cases reported that
– in workers using hand-held and hood-type hairdryers. In            they worked exclusively as “head-washer” and for a
particular, in 1979 the Consumer Product Safety Commis-              brief time-window (e.g. less than 1 year).
sion (CPSC) – a US Governmental Agency in charge of                Out of a total of 2,989 incident MM cases in Lombardy
protecting the public from unreasonable risks of injury or     (time-window: 2000-2009), RML selected 18 (0.6%) hair-
death from consumer products – accepted a corrective ac-       dressers with unknown exposure, and reclassified them as
tion proposed by the major hairdryer manufacturers, provid-    having certain (4 cases) or possible (13 cases) occupational
ing for either repair, replacement or refund for hand-held     exposure; only one case who had worked exclusively as a
hairdryers containing asbestos (90% of all domestic hairdry-   “head-washer” for a few months remained with unknown
er sales annually) (1). In the same year the National Insti-   exposure (7). RML excluded from the present reclassifica-
tute for Occupational Safety and Health (NIOSH) con-           tion the case of one hairdresser – previously reported on
ducted an investigation on 30 asbestos-containing hairdry-     this Journal (8) – who had been considered as occupation-
ers, and observed airborne asbestos concentrations generat-    ally exposed because his usual customers worked in an as-
ed by these dryers ranging from 0 to 0.11 structures/cm3 (a    bestos cement factory.
unit of measurement accounting both for fibre count and            We found 12 more MM cases who worked as hair-
for sample volume), corresponding to a mass concentration      dressers but had already reported other asbestos exposure
of 7652 ng/m3 (3). Some epidemiological studies, after ex-     sources: 9 occupational, two environmental, and one during
trapolating low exposure levels of asbestos from studies on    leisure time. According to the new criteria, all these cases
subjects with high occupational exposure, obtained mortali-    were reclassified as having a possible occupational exposure
ty estimates (for lung or respiratory cancers) that were not   to asbestos as hairdressers.
consistent (2, 4). More recently (2006) the Health Safety          Reconsidering the questionnaires allowed us to high-
Laboratory (HSL) – a UK healthcare regulatory agency –         light information that had been previously underestimated,
conducted an investigation on two asbestos-containing          such as the presence of usually more than one hairdryer in
hood-type hairdryers, and observed airborne asbestos con-      the workplace, operating nearly continuously for the entire
centrations lower than the declared detection limit of 0.01    working day. Subjects who performed maintenance of the
fibres/ml (5). The list of the major US and European manu-     hairdryers declared they manually removed the old and
facturers of asbestos-containing hairdryers can be found in    crumbly asbestos protections.
the CPSC and HSL documents, respectively.                          Four cases only were aware their hairdryers contained
   The RML staff could therefore affirm with reasonable        asbestos; most of the subjects did not know or had not de-
certainty that using either hand-held or hood-type hairdry-    clared it when interviewed. This suggests it is important
                                                  LETTERE IN REDAZIONE                                                   71

and valuable to extend and detail the information that can
be obtained with the questionnaire.                              html
   In conclusion, RML identified a total of 30 hairdressers   2. ENTERLINE PE: Extrapolation from occupational stud-
(14 males and 16 females); the availability of a wide MM         ies: a substitute for environmental epidemiology. Environ
case record, together with detailed information about occu-      Health Perspect 1981; 42: 39-44
pational activities and lifestyle, allowed the RML staff to   3. GERACI CL, BARON PA, CARTER JW, SMITH DL: Test-
hypothesize and then to confirm the existence of an occu-        ing of Hair Dryers for Asbestos Emissions: Division of
pational asbestos exposure risk, at least in the past. Such      Physical Sciences and Engineering, NIOSH, U.S. De-
exposures, though likely to be absent nowadays in the Ital-      partment of Health, Education, and Welfare, Cincinnati,
ian occupational context, can still represent a real public      Ohio; 1979. Report No.: PB89165237
health problem, both due to the potential household use of    4. HALLENBECK WH: Consumer product safety: Risk as-
old hairdryers, and to the importing of household appli-         sessment of exposure to asbestos emissions from hand-
ances from countries where asbestos is still normally used.      held hair dryers. Environmental Management 1981; 5:
                                            M. Carugno        5. LOMAS-FLETCHER D: Asbestos Emission Tests in Salon
        Post-Graduate School of Occupational Medicine,           Hood-Style Hairdryers: Health & Safety Laboratory;
  Department of Occupational and Environmental Health,           2006. Report No.: HSL/2006/114. http://www.hse.
            Università degli Studi di Milano, Milan, Italy
                            E-mail:        6. MARINACCIO A, BINAZZI A, DI MARZIO D, et al: Il
                                                                 Registro Nazionale dei Mesoteliomi. Terzo Rapporto. Ro-
                       Carolina Mensi, Claudia Sieno,            ma: ISPESL, 2010
                              D. Consonni, L. Riboldi         7. NESTI M, ADAMOLI S, AMMIRABILE F, et al. Linee guida
        Department of Preventive Medicine, Fondazione            per la rilevazione e la definizione dei casi di mesotelioma
     IRCCS Ca’ Granda - Ospedale Maggiore Policlinico,           maligno e la trasmissione delle informazioni all’ISPESL da
                                           Milan, Italy          parte dei centri operativi regionali. Roma: ISPESL; 2003.
REFERENCES                                                    8. RIBOLDI L, MENSI C, CANTI Z, et al: Mesotelioma ma-
                                                                 ligno della pleura in barbiere: caso di esposizione profes-
1. CPSC: CPSC Accepts Corrective Actions From Major              sionale atipica ed indiretta ad amianto. Med Lav 2005;
   Hair Dryer Companies: U.S. Consumer Product Safety            96: 177-178
   Commission; 1979. Report No.: Release # 79-022.

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