Document 2qkQM67nYkbXbNeX0ZwD7NRz5

FILE NAME Brakes BRK DATE 2014 DOC BRK246 DOCUMENT DESCRIPTION Journal Article - Asbestos is Still a Health Problem Maanedsskrift for almen praksis 2014 1030-1038 Asbestos is still a health problem Rolf Petersen M.D. Ph.D Sigurd Mikkelsen M.D. M.D. Dr.MedSc Department of Occupational Medicine Slagelse Hospital Denmark Department of Occupational and Environmental Medicine Bispebjerg Hospital Denmark This year it is 50 years since a scientific consensus was achieved that asbestos can asbestosis lung cancer and mesothelioma It cause international conference in New York happened at a big and later very famous Yet two decades went by before effective Denmark a ban prevention was adopted in the western world In against the use of asbestos was first introduced in 1986. But million people daily continue to be globally about 150 exposed to asbestos in their work workers die every year from asbestos diseases Approximately 107,000 In Denmark about 250 people each year get lung cancer or mesothelioma as a result of previous work with asbestos Deaths from asbestos diseases are 4-5 times higher than the number of those who die in accidents in the work place and despite the ban on the use of The incidence of asbestos cancer is turns Asbestos is expected to rise until around 2025 before the curve removed or encapsulated but exposure may still occur Asbestos still significant quantities in buildings ships trains etc. exists in Denmark The history of asbestos both internationally and in is a working environment scandal Economic interests have ruled the prevention of serious and fatal diseases It is important lesson of history that the research and an environment assessment of risks in the working must be publicly available transparent and independent of applies to the decisions of the authorities industry The same What is asbestos The main asbestos related diseases are asbestos lung asbestosis lung cancer and mesothelioma but can also cause laryngeal cancer exudative pleuritainsd pleural plaques WHO estimates that and that approximately 150 million people are daily exposed to asbestos in their about 107,000 workers die each year from work asbestos diseases 2 Asbestos production and world consumption is still increasing in Russia China Brazil and other third countries This means that the incidence of increase in the years ahead asbestos diseases will continue to Asbestos is now banned in 55 countries and therefore allowed in the other 135 countries in the world Asbestos is used especially in many developing countries WHO asbestos should stop and recommends that all use of Ramazzini the many occupational medicine societies including the Collegium International Joint Policy Committee of Societies of Federation of Public Health Associations are advocating for a worldEwpiiddeembiaonlogy and the World Lobbyists from the asbestos industry are trying to avoid a ban In particular they are active in the developing countries Independent researchers doctors and public health warned against these lobby activities 3 experts have recently The history of asbestos During World War 2 it was suspected that asbestos in population studies from can cause lung cancer and this was confirmed mid 1950s 4 In 1960 studies also showed mesothelioma among those an increased incidence of exposed to asbestos 5 But even if the results scientific journals and doctors and other were published in did not reach the public and experts warned against the harmful effects the warnings were concealed from the workers so as not to create unrest and to avoid adverse economic effects on the unnecessary asbestos industry This policy of silence ceased only gradually after 1964 when the held the first International New York Academy of Sciences Congress on the biological effects of asbestos 6 This breakthrough for broad recognition that congress was the and fatal lung disease working with asbestos involved a high risk of disabling A particularly glaring <xamplies the particularly particularly glaring activities were were carried by The Chrysotile example activities activities supported Chrysotile Institute the Canadian associated associated with University University Canada supported Canadian government was was the world's largest asbestos exporter exporter asbestos chrysotile strategy strategy to blame the white asbestos amosite the it adverse effects on other types of asbestos amosite white asbestos asbestos claim claim crocidolite safe of chrysotile chrysotile asbestos Institute Institute Asbestos history history Denmark In Asbestos history the asbestos story story as dramatic as the international one. In Denmark consumption consumption peaked Subsequently Subsequently imports tons tons tons asbestos see see Fig Subsequently imports deimpcortsrdeeacrseeasdedta o ann insignificant insignificant level 1986 insignificant level in 1986, Asbestos mesothelioma Approximately 90 of all cases of malignant mesothelioma of the pleura is believed to be caused by asbestos exposure The number of new cases continues to rise Fig 3 and 4 Because of greater exposure to asbestos men have a much higher incidence of mesothelioma than women and subjects with known asbestos exposure have a higher risk than subjects without exposure For example the incidence of mesothelioma in the period 1961-2005 was 22 times higher for plumbers than for farmers Other building workers sailors and mechanics also had a higher risk Table 1 12 Following a change in workers compensation law in 2007 all cases of mesothelioma recorded in the National Board of Health are passed over to the Industrial Injury Board to be examined for workers compensation In 2011 106 men and 17 women were diagnosed with cancer in the pleura Of these cases 83 67 were recognized for compensation as an occupational disease A short exposure to low concentrations of asbestos fibers in the air is enough to increase the risk of mesothelioma The latency period is about 30 years or more Asbestos lung cancer In a reference document on asbestos exposure and lung cancer it was estimated that 4-8 of new lung cancer cases are caused by asbestos exposure 13 ie 100-150 new cases annually Each year about 75 cases of asbestos lung cancer are reported to the Industrial Injury Board and just below half of those are recognized to be compensated as an occupational disease Unlike mesothelioma which can occur after even low exposure to asbestos the exposure to asbestos needed to cause lung cancer is bigger response relationship at low exposures is uncertain Internationally it is generally accepted that asbestos exposure equivalent to approximately 25 fibers x year per ml doubles the risk of lung cancer 14 In a study from Sweden a doubling of risk of lung cancer was found in persons exposed to 4 fibers x year per ml 15 The latency is about 10 to 30 years Asbestos exposure increases the risk of lung cancer equally in smokers and smokers Lung cancer in asbestos smokers should be recognized in the same way as in smokers i.e. without prejudice for smoking It is unfortunately not the case today but will hopefully be changed in connection with a pending lawsuit 16 The significance of the remaining asbestos The use of asbestos was banned in Denmark in 1986. At the same time the safety rules were reinforced for workers dealing with the remaining asbestos The remaining asbestos is found in Eternit asbestos cement insulation and brake linings Whether release of asbestos fibers takes place depends on the condition of the material Damaged , materials will release the most asbestos fibers The highest incidence is found in buildings but how big it exactly is is not known A total of 73 of the buildings in Denmark were built before 1980 and therefore potentially contain asbestos 17 In these buildings asbestos can be found as insulation around pipes in floor coverings in sheets for walls and ceilings in glues in paints and as fire insulation in e.g. stairwells Outside of buildings asbestos can be found in the roof and facade panels Eternit e.g. on farms It is particularly buildings constructed between 1920 and 1990 which contain asbestos Exposure to asbestos fibers can occur during renovation or demolition of buildings containing asbestos materials if workers are not aware of it or if the rules deliberately are bypassed to save time and money The Labour Inspection authorities unfortunately have experience of the latter from time to time 18 What can we learn from the history of asbestos The history of asbestos is the story of how companies physicians regulators and politicians let things happen year after year regardless of scientifically based knowledge about asbestos hazard Economic interests were given precedence over the workers health The human victims have been - and will remain - considerable in number and suffering Not undeservedly the asbestos story today both in Denmark and internationally is called the largest safety scandal ever But we can learn from history First of all there should be openness and transparency in all matters relating to the investigation and assessment of risks associated with the working environment You cannot count on data if it is the industry itself that is responsible for investigations and risk assessment It is therefore important that the public sector ensure a good framework for independent research and risk assessment To the extent that industry contributes to public research through research funding from the date of authorization there should be a clear separation between any influence from the grant donor and the recipient conducting the research task and data should then be publicly available Transparency and the requirement to operate at arm's length is generally a good protection against misuse of power It is worth remembering this at a time when there is much talk of cooperation between public research institutions and private industry Authorities and other decision makers must in the same way secede from corporate interests and implement the measures necessary to prevent workers from becoming ill from their work Economic conflicts of interest none declared Figure 1. Electron microscope image of macrophage in alveoli trying to phagocyte an asbestos fiber Foto Lennart Nilsson tons 15 15 } 1000 10 10 1 1943-47 1948-52 1953-57 1958-62 1963-67 1968-72 1973-77 1978-82 1983-87 1988-92 1993-97 Figure 2. Annual asbestos imports in Denmark 1943-2003 7 19982003 wade Pleura ome Peritoneum -e Pericardium - Total 2 1.8 mam 1.6 f 1.4 JZ, , 0.80.6 | 0.4 0.2 1943-1947 1948-1952 1953-1957 1958-1962 1958-1962 1963-1967 1968-1972 1973-1977 1943-1947 1948-1952 1953-1957 1963-1967 1968-1972 1973-1977 111994349-319-44179847-1915948-21952 19531-915139-9515395-771957 1958-1962 1958-1962 196139-611399-616397-617967 1968-1972 1973-197 1973-1977 1953-1957 1958-1962 1973-1977 1943-1947 1948-1952 1953-1957 1958-1962 1963-1967 1968-1972 1973-1977 1978-1982 1983-1987 1988-1992 1978-1982 1988-1992 198 -19 2 1993-1997 1998-2002 2003-2007 20 8-20 9 1993-1997 1998-2002 20 3-20 7 2008-2009 1998-2002 1978-1982 1983-1987 1983-1919883-71987 199819-3-1927 002 2003-2007 208-209 203-207 1978-1982 1988-1992 1978-1982 1983-1987 1988-1992 1993-1997 1998-2002 2003-2007 1993-1997 1998-2002 2003-2007 2008-2009 Year Figure 3. adjusted annual incidence of mesothelioma per 100,000 men in Denmark 19432009 9 The figure was previously published in the Danish Medical Journal and placed with the authors permission Incidence per 100,000 person years 2 1.8 1.6 4 1.4 1.2 1 0.8 0.6 - 0.4 0.2 0 _ z >} ' x ! fi 1943-1947 1948-1952 1953-1957 1958-1962 1968-1972 1973-197 1983-1987 198-192 193-197 198-20 Year Year Year wie Pleura =e Peritoneum * Pericardium www Total Figure 4. adjusted annual incidence of mesothelioma per 100,000 women in Denmark 19432009 9 The figure was previously published in the Danish Medical Journal and placed with the authors permission 10 Figure 5. Number of mesothelioma cases among men in Denmark and standardized incidence ratio SIR for the period 1961-2005 in selected trades with a statistically significant SIR 12 Trade isco 1958 Technical skills Teachers Farmers Sailers Welders Mechanics Plummers Electricians Wood workers Machine operators Obs 136 14 32 26 101 187 27 31 109 34 SIR 1.53 0.36 0.18 2.53 3.53 2.46 3.92 1.69 2.13 1.78 11 Figure 6. There are still many thousands of square meters of asbestos cement sheets on roofs in Denmark as a potential source of exposure to asbestos fibers Private photo Jonathan Aavang Petersen Literature 1. IARC Monograph 100C http://monographsiarc.fr/ENG/Monographs/vol100C/mono100C.pdf htp:/mongraphsiarc.fr/ENG/Mongraphs/vol10C/mon10C.pdf http://monographsiarc.fr/ENG/Monographs/vol100C/mohtnp:/moongrap1hsirc.0f/ENG0MongraCphs/vo.l10C/mpon10Cd.pff p 219-309 2. WHO http://www.who.int/mediacentre/factsheets/fs343/en/ http://www.who.int/mediacentre/factsheets/fs343/en/ 3. Statement in response to asbestos industry efforts to prevent a ban on asbestos in Pakistan Chrysotile asbestos use is not safe and must be banned Arch Environ Occup Health 2013 68 243-9 4. Doll R. Mortality from lung cancer in asbestos workers 1955. Br J Ind Med 1955 5. Wagner JC Sleggs CA Marchand P.Diffuse pleural mesotelioma and asbestos exposure in North Western Cape Province Br J Ind Med 1960 17 260-271 6. Selikoff IJ Churg J. Biological effects of asbestos Annals of the New York Academy of Science 1-766 7. Brauer C Baandrup U P Jacobsen et al Screening for asbestbetingede sygdomme Ugeskr L^ger 2009 171 433-36 12 8. Ruff K. Asbestos a continuing failure of ethics by McGill University Int J Occup Environ Health 2014 3 9. Skammeritz E Omland ^ Hansen J Johansen JP Regional differences in incidence of malignant mesothelioma in Denmark Dan Med J 2013 10. B^...lowHans Under anklage - En beretning om asbesten og dens ofre..K^,benhavnTiderne Skifter 1989 11. Jacobsen Kurt Asbest magisk mineral og dr^berst^,Kv^,benhavnInformations Forlag 2012 12. Pukkala E Martinsen JI Lynge E et al Occupation and - cancer follow of 15 million people in five Nordic countries Acta Oncologica 646-790 13. Sherson D et al Occupational asbestos exposure and lung cancer Odense Odense University Hospital 2013. htp:/ww.ask.dk/~/media/ASK/pdf/Raporter/ http://www.ask.dk/~/media/ASK/pdf/Rapporter/ Udredningsrapport 20cancer 202013pdf.ashx 14. Tossavainen A. Asbestos asbestosis and cancer the Helsinki criteria for diagnosis and attribution Scand J Work Environ Health 311-316 15. Gustavsson P Nyberg F Pershagen G et al Dose Exposure to Asbestos and Lung Cancer Dose- Response Relations and Interaction with Smoking in a Population Referent Study in Stockholm Sweden Am J Epidemiol 2002 155 1016-22 . 16. Frost P Petersen R Thomsen JF Mikkelsen S. Problematisk afg^,relse| Ankestyrelsen i sag om erstatning til asbestudsatte rygere med lungekr^ftUgeskr L^ger1070-71 17. Rasmussen TV Asbest i Bygninger Statens Byggeforskningsinstitut Aalborg Universitet 2010 18. Mortensen H. Tilsynschef Danish Labour Inspection personal information 13