Lung Cancer Background and Developments regarding the Role of Asbestos as a Cause of Lung Cancer

Lung Cancer: Medical Aspects of Causation Aneuploidy Unlimited cell reproduction and failure of cell death Animal Studies Basic Toxicology

New Data on Causation New Studies New Statistics – Number of cases – Years since cessation New Research on DNA and toxicology

Lung Cancer Causation Smoking as a Cause Other agents – Radon – Silica – Industrial Plant Exposure Refinery Other types of plants

Lung Cancer Causation: Asbestos as a Cause Lung cancer has historically (early 20 th Century) been associated with certain exposures to asbestos; Selikoff studies of Insulators; Usefulness of Historical data for lung cancer in 2014

Plaintiff Arguments on Lung Cancer Causation

Do not need Asbestosis to Attribute Lung Cancer to Asbestos

The Role of Animal Studies Dr. Brody and Photomicrographs

The Role of Epidemiology Case Reports and Animal Studies can be included Are some studies better than others? – If so, which ones and Why?

At What Level of Asbestos Exposure can one attribute Lung Cancer to Asbestos? Reasoning and Authority Increased Risk – Does Doubling of Risk Bear on Causation?

The Role of Synergy Old v. New Studies Levels of Exposure

The Role of Governmental Regulatory Agency Papers What is the science? When can they Inform on Causation?

Defendants’ Arguments on Lung Cancer Causation

Asbestosis is needed to attribute Lung Cancer to Asbestos Weight of Science

What is Asbestosis? Pathology – Roggli Standard Radiology – CT and HRCT scans PFT/Other clinical data Confounding data – UIP – Smoking related Interstitial fibrosis – CHF

If Asbestosis is not Found, one needs to find Significant Exposure to Asbestos 25 f/cc-years of exposure or more – Hammar – Helsinki – Others

Is Synergy Important? Selikoff Markowitz Others: Additive v. multiplicative

Use of Industrial Hygiene Data to Prove Exposure Usefulness of Retrospective Studies What is a fiber/cc-year and how does this fit with causation?

Treatment of Low Dose Asbestos Exposure Medical v. Legal Cause Differences between states Increased risk v. doubling of risk Effect of smoking on asbestos causation Does fiber type matter? Ambient Air levels

Lung Cancer is not Mesothelioma Chrysotile issue Amphibole: as little as.1 f/cc-year may cause mesothelioma For Lung Cancer, mixed exposure, 25 f/cc-year exposure or more? Helsinki

The Role of Cigarette Warnings Post 1962 Post 1985 Complete Defense in warnings cases?

Venue for Lung Cancer Madison County Others – California, New York, Pennsylvania, Delaware Forum Non conveniens

Other Cancers 2006 National Academy of Science Data Laryngeal and Ovarian Cancer - epidemiology Other cancers