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There is no safe level of asbestos exposure. While much exposure to asbestos occurs as an occupational hazard, those living with asbestos workers are also at risk. The mineral can be brought home on workers’ hair, skin and clothing, exposing loved ones and leading to mesothelioma diagnoses.

01. Overview

What is Secondary Exposure?

Secondary asbestos exposure is a form of non-occupational exposure to asbestos fibers. Secondary exposure can also be called secondhand exposure, non-occupational, take-home exposure or para-occupational exposure. This exposure can occur when living with an asbestos worker who, after direct contact with asbestos products, brings home asbestos dust or fibers on their person. In some cases, environmental exposure, or exposure from being around natural asbestos or asbestos dust lingering in the air, can also cause fibers to be brought home and lead to secondary exposure. These forms of exposure typically occur at lower concentrations than the primary exposure experienced by occupationally exposed individuals. Additionally, secondary exposure may start at an earlier age if someone in the household is an asbestos worker.

Repeated secondary asbestos exposure can cause asbestos-related diseases, such as mesothelioma, asbestos lung cancer and asbestosis. Asbestos fibers may be brought home by workers if proper decontamination practices haven’t been followed, which leads to asbestos contamination in the car and home. These types of exposures account for about 20% of mesothelioma cases.

02. At-Risk Populations

Most At-Risk Populations

Individuals who live with asbestos workers and experience secondary asbestos exposure are twice as likely to develop asbestos-related diseases than the general public. Studies have shown that prolonged asbestos exposure and elevated concentration of exposure increase the risk of mesothelioma.

Among the most prevalent examples of secondary exposure occurred in Libby, Montana, where W.R. Grace and Company employed hundreds of workers at an asbestos mine. Researchers studying asbestos exposure caused by the mines established that living with a W.R. Grace employee was one of four strongest indicators of asbestos-related disease. According to their findings, there were cases of both pleural mesothelioma and peritoneal mesothelioma in individuals living with the miners. Only two out of more than 200 female participants in the study had been previously employed by W.R. Grace. According to death certificate analysis, there were 115 non-malignant respiratory diseases and 80 malignancies of respiratory organs among the women. The researchers surmise that secondary asbestos exposure contributed to the women’s deaths.

Living with an asbestos worker was the cause of mesothelioma survivor Heather Von St. James’ asbestos exposure. As a child, Heather would frequently wear her father’s work coat when doing her chores, which, unknown to her and her family, was coated with asbestos dust. Heather was diagnosed with pleural mesothelioma when she was 36 years old and given 15 months to live. After completing aggressive treatment, Heather is now cancer-free and advocates for mesothelioma patients and the ban of asbestos.

In addition to living with an asbestos worker, research has shown that women are often the most impacted by secondary asbestos exposure. In a 2017 study, researchers found 64% of the female mesothelioma patients analyzed had experienced secondary exposure. Comparatively, only 12% of male participants were exposed secondhand. According to their findings, the researchers believe the main cause of malignant mesothelioma in women is secondary exposure.

For example, a study conducted in Italy analyzing more than 1,000 mesothelioma patients found 35 cases of pleural mesothelioma caused solely from living with asbestos workers. The majority of the workers in the study were exposed in shipyards. Again, 33 of the 35 cases caused by secondary exposure occurred among women. The women included wives, daughters and mothers of asbestos workers. The two men exposed to asbestos secondhand were sons of occupationally exposed individuals.

03. Sources of Secondhand Exposure

Common Sources of Secondhand Asbestos Exposure

Asbestos particles are friable, or easily crumbled, and can become airborne. This breakable nature, coupled with their abrasive texture, allows fibers to attach to fabrics, hair and other materials. Secondhand exposure begins when a worker fails to properly decontaminate themselves before heading home to their families, though most don’t even realize they were exposed to asbestos themselves. Anything the asbestos worker comes into direct contact with while still carrying asbestos fibers on their person becomes a potential source of secondary asbestos exposure.

Sources of Secondary Asbestos Exposure
Source Associated Risk
Cars If asbestos-contaminated items or people enter a vehicle, the car may then contain the fibers. Family members can experience exposure when riding in the vehicle.
Clothing Counterintuitively, the act of washing clothing can cause domestic exposure. Asbestos fibers may transfer from one or two contaminated articles to an entire load, exposing not only the person washing the clothes but also those wearing the now contaminated items.
Furniture Beds, couches, chairs and other pieces of furniture could all be contaminated with asbestos fibers and lead to household exposure. If the asbestos worker sits on them in contaminated clothing, or their dirty work clothes are placed on the items, it may lead to toxin transfer.
Personal Contact If decontamination practices haven’t taken place, a simple hug or loving embrace can facilitate transfer of the toxic dust from a workers clothing onto their family members.

One of the most common cases of secondary exposure occurs from washing or handling contaminated clothing. Workers and their families should not attempt to wash any asbestos-contaminated clothing themselves to mitigate risk of spreading the particles. One recent study found women exposed through laundering asbestos-contaminated clothing had lung asbestos concentrations similar to men working in construction, an industry with high risk for exposure. Anything that has come into contact with asbestos should be either disposed of or laundered in special facilities.

04. Impact on Mesothelioma

How Secondary Exposure Impacts a Mesothelioma Diagnosis

Secondary exposure can impact mesothelioma patients in a number of ways. The mesothelioma diagnostic process for patients exposed to asbestos secondhand is often more complex than for those with direct exposure, as it can be much more difficult to recognize past contact with the toxin. Additionally, researchers believe that gender bias plays a role in the diagnosis of mesothelioma patients with secondary asbestos exposure. Many patients who experience this exposure are wives of asbestos workers, and historically mesothelioma is more commonly diagnosed in men.

The development of mesothelioma is also different in patients who faced secondhand exposure. These patients are most often diagnosed with pleural mesothelioma, which occurs in the lining of the lungs. Pleural mesothelioma is the most common form of the disease and has a more favorable prognosis than pericardial mesothelioma, but a less favorable prognosis than peritoneal mesothelioma. The average life expectancy for pleural mesothelioma patients is approximately 18 months.

In addition to mesothelioma, household asbestos exposure can also result in pleural plaques and asbestosis. One study, found 32 cases of mesothelioma attributed to household asbestos exposure. Among those with mesothelioma, 10 patients also experienced pleural plaques, while four patients were also diagnosed with asbestosis. Of the 32 cases, 27 were pleural mesothelioma and five were diagnosed with peritoneal mesothelioma, supporting the belief that secondary exposure most often results in the development of mesothelioma within the lungs.

Since secondary exposure also often occurs at a younger age, patients may see an impact on latency period. According to some studies, exposure that begins at birth, like exposure experienced by children who live with an asbestos worker, does not impact mesothelioma latency period. However, there have been reports of longer latency periods in patients exposed early in life. It’s unclear if that is due to the lower concentration of asbestos exposure commonly experienced by those exposed secondhand. In general, the latency period for mesothelioma is between 10 – 50 years.

Once symptomatic, it may still take time to receive a proper diagnosis due to the common nature of associated symptoms. Common mesothelioma symptoms include breathing difficulty, cough and fever, which may be mistaken for other more common conditions. After diagnosis, prognosis for mesothelioma is generally poor, though if diagnosed in the early stages, patients have improved survival rates due to more viable treatment options.

05. Treatment

Treatment Options For Mesothelioma Patients with Secondary Exposure

Mesothelioma patients who experience secondary exposure have the same treatment options available to them as those who’ve experienced primary exposures. Treatment for mesothelioma is commonly a multimodal approach, including a combination of chemotherapy, surgery and radiation. Similar to patients who experience occupational or environmental exposures, mesothelioma patients exposed secondhand who are able to receive treatment early tend to have better outcomes than those with late-stage diagnoses. When administered in the earlier stages of disease, patients have more viable curative treatment options.

In some cases, patients with secondhand exposure may have a better response to treatment. Many patients diagnosed with mesothelioma due to secondhand asbestos exposure are women, and studies have shown that women have more favorable results following mesothelioma treatment. One study found women had longer survival than men regardless of treatment type. Of the mesothelioma cases analyzed, 5-year survival was just 4.5% in male patients, while 13.4% of female patients experienced 5-year survival.

When treatments are unsuccessful, or if the cancer is not caught early enough, patients may receive palliative treatment to manage symptoms and improve quality of life.

06. Preventative Regulations

Preventive Workplace Regulations

Asbestos use in the United States is now highly regulated by both the Environmental Protection Agency (EPA) and the Occupational Safety and Health Administration (OSHA). Some industries known to have elevated risk of occupational asbestos exposure have specific guidelines for employers in order to protect both employees and their families. The construction industry, general industry and shipyards are all given industry-specific guides to mitigate the high-risk of asbestos-related disease.

In general, employers are required to provide workers with personal protective equipment, which when used properly would eliminate risk of workers bringing asbestos particles home on their clothing. Lockers should be available for employee use, preventing contamination of street clothing from contact with personal protection equipment. Showers should also be provided at the worksite for employee use at the completion of their shift. This practice helps to alleviate the risk of any asbestos fibers being brought home on an employee’s hair and skin.

Even with various guidelines in place, secondary and direct asbestos exposure still occur regularly today. Individuals who are living with, or who previously lived with, an asbestos worker should be vigilant about their health and risk of asbestos-related diseases.

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