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FILE NAME Brakes BRK DATE 2001 DOC BRK124 DOCUMENT DESCRIPTION Journal Article - Malignant Mesothelioma in Australia 1945 to 2000 - Journal of Occupational Health & Safety & Australia has maintained a total national malignant mesothelioma case register since 1980. There has been a marked increase in the incidence of mesothelioma in the last 20 years Currently 450 to 600 cases are notified annually in a population of 19 million While the history of the Wittenoom Western Australia crocidolite mine and its aftermath are well known Wittenoom cases comprise only % of the total Australian cases This article describes the incidence of mesothelioma in Australia as a whole from 1945 to 2000 Australia's high incidence of mesothelioma is related to high past asbestos use of all fibre types in a wide variety of occupational and environmental settings The number of cases in total is expected to be about 18,000 by 2020 with about 11,000 yet to appear These predictions are consistent on a population and asbestos use adjusted basis with those made for Europe Scandinavia the US and Japan are those of the reflectreflect those of the Safety Commission MALIGNANT MESOTHELIOMA INCIDENCE ASBESTOS EXPOSURE FUTURE PREDICTIONS ) Occup Health Sofety Aust NZ 2001 17 453-470 453 a ee ce ee aes OT et JctoTEC JctoTEC 2 TOL NO TAUNC HO13 WON mesothelioma inAustr 194a5 l to i 20a 00 Method Australian Mesothelioma Surveillance Program The Australian Mesothelioma Surveillance Program the Program began on 1 January 1980 after preliminary work from 1977 Formal voluntary notification of cases was actively sought from a network of respiratory physicians pathologists general and thoracic surgeons adminstraors medical superintendents medical records administrators State and Territory departments of occupational health cancer registries compensation authorities and any other source Notifications from other than the diagnosing physician were confirmed with him After gaining the appropriate consents a full occupational and environmental history was obtained for each case either from the patient or next The history taking was directive but included specific questions on asbestos exposure at the end These histories were coded by two occupational hygienists who naturally could not be blinded to case status They also discussed cases together and were thus not independent The diagnosing pathologist was requested to provide slides and tissue specimens These were circulated among a pathology panel for confirmation of diagnosis mortem examination was actively sought in every case in order to confirm diagnosis and to obtain lung tissue free of tumour for lung fibre content analysis Australian Mesothelioma Register From 1 January 1986. a less detailed notification system has operated Although the system includes a short questionnaire on occupational and environmental exposure history is followed up very assiduously up to four letters per case there is no pathology panel diagnosis and only sporadic lung fibre counts In the case of NSW and WA 60 of all Australian notifications histories are obtained from direct detailed questioning by compensation authorities or cancer registries Only histologically confirmed cases are accepted and full reconciliation with all State cancer registries and compensation authorities is carried out This system is a continuation of the Program but it is now known as the Australian Mesothelioma Register the Register A copy of the current Register notification form is shown as Figure 2 Incidence rates are periodically calculated on cases notified to the Register and an annual report series is produced Age standardised rates are based on the World Standard Population greater than 20 years Incidence rates have been calculated to the end of 1997 only because of the up to year delay in notification that is experienced while awaiting confirmed diagnosis and reconciliation with the State cancer registries Rates to the end of 1998 are available in the Australian Mesothelioma Register Report 2001. Results The incidence of mesothelioma in Australia From 1 January 1980 to 31 December 2000 a total of 5,671 notifications had been received by the Program and Register Between 1945 and 1979 there were 658 cases 535 male 123 female in Australia Thus the total number of mesotheliomas in Australia from 1945 to 2000 inclusive is 6,329 A further 600 cases have been notified in the period 1 January 2001 to 30 September 2001 some being incident in earlier years Notifications show a continuing upward trend in both males and females Figure 3 The notifications prior to 1982 were probably the result of bedding in the new Program and are artificially low 1980 1981 although a smooth curve of increasing incidence starting from the early 1960s has since been demonstrated by a retrospective search Figure 4 The Australian population has increased from 14.5 million in 1980 to 19 million in 2000. Mesothelioma incidence rates standardised to the World Population greater than 20 years have increased from 11.8 per million per year in 1982 to 29.8 per million per year in 1997 males and females combined or 50.6 per 456 J Occup Health Safety Aust NZ 2001 17 453-470 SA WHI : T II 2007 AI Ler chatt-- 7 19+ ON NOHA LiotTa 4 s - FIGURE 2 Australian Mesothelioma Register Notification Form pan NATIONAL OCCUPATIONAL HEALTH AND SAFETY COMMISSION AUSTRALIAN MESOTHELIOMA REGISTER NOTIFICATION Pleme direct all correspondence to The Registrat National Occupational Health and Safety Commission GPO Box 58 Sydney NSW 2001 Telephone 02 9577 9304 Patient details - please supply ALL avaliable information SURNAME ADDRESS FIRST NAMES STATE oo. ccenaeermen ~ POSTCODE .... .~ GENDER M DATE OF BIRTH i ; IF DECEASED DATE OF DEATH i f PLACE OP DEATH DATE OF INITIAL DIAGNOSIS Month .............. a Year ........ 2 HISTOLOGICAL YES HOSPITAL DIAGNOSED PRIMARY SITE- CLINICIAN'S NAME { entries NAME OF LOCAL GP ADDRESS ADDRESS ...... Please describe briefly main occupation of patient's worklife OCCUPATION . INDUSTRY I Z. ua 2 3 rn ae KNOWN ASBESTOS EXPOSURE YES If YES please cirumstances and duration YEAR td 19 19 - 19 - 19 1 \ Details of person completing this form NAME SIGNATURE ADDRESS see sac ante cne cece sanenneseratat eta sau seavessce coveaeennredteaItI NPT eoastarinees arson DATE MERINO ties teen Please cingle the appropriate category = CLINICIAN PATHOLOGIST CANCER REGISTRY DUST DISEASES OTHER ADICAL RECORDS ADMIN Office Use Only Date Revivali REGISTRATION NO || | J Occup Health Safety - Aust NZ 2001 17 453-470 A WHC II 2007 SI UPC CHATHA Z 10+ = ON NOUJ LAO LONI mesothelioma Austral1i94a5 FIGURE3 Australian Mesothelioma Register notifications 1979 to 2000 by sex 500 450 a 350 - Maler a - 300 Notifications Notifications 200 Notifications Notifications 150 he . Ae aoe ee a aol . a ry a mee a 100 - a e Famalas * ae 50 .5* ' , errr She Tee * crc a eeaeeeer rat .* Peer ale wee Pers ee er ae | 0 baa 1979 1981 1983 1985 1987 1989 1991 1903 1995 1097 1909 2001 Year of Notification million per year males and 9.0 per million per year females Corresponding crude rates for 1997 were 59.8 per million per year males and 10.9 per million per year females Figures 5 and 6 show crude and standardised rates by time and sex If the 1981 figure is accepted it can be claimed that mesothelioma incidence rates have increased four to fold in 19 years in Australia Both male and female rates have increased but the male rate over five times the female rate These are the highest reported incidence rates in the world They are equal to the Australian NSW incidence rate of liver cancer and in mortality terms equal to the mortality rates of kidney cancer in males and uterine cancer in females Mesothelioma is no longer a rare disease Figure 7 shows specific incidence rates for males and females over 20 years of age for 1997. Incidence increases with age up to 80 years and then falls consistent with a cohort effect in that the oldest persons may have missed the heaviest exposure era from 1950 to 1970. The occurrence of cases in the under year age groups indicates that exposure can occur in children Figures 8 and 9 show specific incidence trends over time for males and females Generally the time trend of increasing incidence is restricted to age groups over 50 years from 1986 onwards suggesting that occupational exposure controls introduced from the 1970s have been effective Figure 10 shows time trends in World Population > 20 years standardised mesothelioma incidence by State for recent years Table 1 shows notifications by State up to 31 December 2000 Western Australia has the highest incidence 1997 crude rates total 52.8 male 96.2 female 9.4 but contributes only 15 of the total cases Wittenoom contributes only % of the Australian cases yet is 458 J Occup Health Safety P Aust NZ 2001 17 453-470 SA WHCHWHCH II 2007 ST UPC JJ CHOTHE CHOTHE 7 TOL OK KOU1 Fi oe ee er ee ee 750 4 700 4 FIGURE 4 Incident cases of mesothelioma in Australia 1945 to 1997 Cases Ly of 400 400 Na Number 1945 1950 He 1955 1960 Pe = ci kel 1965 1970 1975 1980 Year of Diagnosis 1985 1990 1995 2000 FIGURE 5 Time trend of crude annual incidence rate per million population mesothelioma in Australia by sex 1982 to 1997 20 years of 70 50 4 Rate 88 4 a Incidenc 304 Crude 20 Males Persons Females a4 1982 1983 pete 1984 1985 1986 1987 1988 1989 1990 1991 Diaogf nDioagsnoisiss 1992 1993 1994 1995 1996 1997 J Occup Health Safety A~ ust NZ 2001 17 453-470 459 9d WH97 2002 81 ver S^ I^ Z^19+ = ON ENOHJ UDI " LIONU FIGURE 6 Time trend of age standardised annual incidence rate per million population 20 years of mesothelioma in Australia by sex 1982 to 1997 standardised to World Population 60 30 Rote Incidence Incidence Incidence Standardised H/ Standardised Standardised Standardised StandardisedStandardised 20 4 Males Persons Females 10 oe ee t - 0 . os - r 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1003 1994 1995 1996 Year of Diagnosis FIGURE 7 specific incidence rates of mesothelioma in Australia 1997 male and female 1000 Incidence per Million 100 . 10 460 1 t. i 4 L i 4 4 i 4 a 6 20-24 25-29 30-34 35-39 10-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age in Years ae Males + Females " J Occup Health Safety - Aust NZ 2001 17 453-470 Por a LOLITT LOLITT 7007 OT - ... ...' ' 1260tbc 7 TO OKU<NAUJ OKU<NAUJ 40137 40137 40137 40137 ee WONY WONY FIGURE 8 specific incidence of mesothelioma in Australia 1986 to 1997 male 350+ Males milion per Incidenc 1986 1987 1988 1989 1950 1991 1992 1993 Year of Diagnosis 1994 1995 1996 1997 FIGURE 9 specific incidence of mesothelioma in Australia 1986 to 1997 female 40 35 4 a 30 5 uo. = 25 2 a Age 65-79 ^'/ Age 80+ & 20 a . 15 f= a $e 10 3 50-64 Age / 5 " Age 35-49 0 1986 1987 1988 1989 1990 : 1991 1992 _ 1993 1994 1995 - Age 20-34 1996 1997 Year of Diagnosis J Occup Health Safety - Aust NZ 2001 17 5 453-470 461 8d WU9IIT 2002 81 ver LIS^ OIDELIS^ OIDE 7 19+ : ON ENOHA - M LIONI LIONI LIONI FIGURE 10 Time trend of age standardised annual incidence rate per million population 20 years of mesothelioma in Australia by State 1982 to 1997 standardised to World Population Rate Vic | Incidenc #Qld SA Standrised 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 Year of Diagnosis certainly the most publicised and best known internationally Most of the cases come from the two most populous and industrialised States that is NSW and Victoria In 93.2 of all Program cases the mesothelioma was pleural in site 6.5 of cases were peritoneal and only 0.3 were in other sites Among men 94.3 were pleural 5.3 peritoneal among women 86.3 were pleural 13.7 peritoneal These proportions have been generally maintained Register cases although the female peritoneal proportion has dropped to 10.4 Of the cases that underwent pathology panel review 96 were confirmed as mesothelioma 73 definite 17 probable and % possible The most common occupational exposures were repair and maintenance of asbestos materials 18 shipbuilding 11 asbestos cement production % asbestos cement use % railways crocidolite milling % % Wittenoom insulation manufacture % wharf labouring % power stations % boilermaking % and para occupational hobby and environmental 15 When the earlier cases classed as no history of exposure were reviewed it was found that 57 of the 203 so classified actually had a history of some exposure recorded Thus only 19 had no known history Moreover of this no known history group 81 had transmission electron microscopy fibre counts > 200.000 fibres dry lung detected in the lungs 30 with more than 10 fibres > 2 micron including long > 10 micron fibres suggesting that nearly all cases had been exposed Past exposure is not always recognised as such and this is more likely to be the case in females Indeed even absence of fibres in the lungs does not negate exposure as fibres may have initiated mesothelioma and then been cleared before death The shortest duration of exposure was 16 hours a waterside worker loading crocidolite fibre Three per cent of cases had exposure of less than three months According to history assessment by the two hygienists of the first exposure of 530 cases most cases J Occup Health Safety - Aust NZ 2001 17 453-470 6D WULP IT 2002 81 vef 22S^ 9T62 19+ : ON ENOKA 10137 10137 O ) TABLE 1 Mesothelioma notifications in Australia 1980 to 2000 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 All / NSW 15 51 90 53 76 71 46 54 57 124 111 105 117 99 151 124 87 107 160 252 168 Vic 1 3 20 23 38 39 34 40 28 25 82 44 45 34 41 89 157 32 84 113 106 2,118 37.3 1,078 19.0 Qld fe) 18 9 26 20 27 38 26 45 35 43 46 40 42 7A 49 53 64 65 73 99 892 15.7 WA ce) 22 0 46 26 30 32 28 23 44 26 66 37 47 32 33 127 82 66 79 47 893 15.7 SA 0 S 20 19 14 19 18 32 36 22 25 55 39 25 30 43 30 24 21 20 60 557 9.8 Tos NT (+) Oo 5 fe) 2 (o) & fa) I 1 1 fe) 2 1 0 Q 1 G 3 o 1 Oo 10 3) 3 1 5 re) 8 fs] 11 ] 4 1 5 fe) 8 fa) 7 0 7 0 90 5 1.6 0.1 ACT 6 9) 1 0 2 2 I 2 2 1 1 2 1 0 1 3 4 4 1 7 3 38 0.7 Totals 16 104 142 173 178 189 172 182 192 254 289 328 283 252 337 353 463 318 405 551 490 5,671 100 55 had mixed amphibole exposure % amphibole only % amphibole plus possible chrysotile % chrysotile with possible amphibole and % chrysotile only with 15 unknown fibre type Mean latency from first exposure to presumptive diagnosis was 37.4 years The range of latencies was 4 to 75 years In the cases reported since 1 January 1986 when less detail of history of exposure was sought 89.9 of males responding to questionnaires and 61.2 of females gave a history of asbestos exposure overall 86.4 response 22 males 30 females The - pattern of exposure history is changing and more product domestic environmental and = para occupational exposure is apparent compared with the older traditional industries Table 2 shows the circumstances of exposure in cases from 1986 to 2000 This is a combination of occupation and industry or domestic or environmental circumstance Exposure occurred in a wide range of occupations and industries and occupational settings Some common exposure histories were repair and maintenance of asbestos materials 13 shipbuilding % asbestos cement production % railways % power stations % boilermaking % Wittenoom % wharf labour % para occupational hobby and environmental % carpenter % builder % navy % plumber % brake linings % and multiple 12 ] Occup Health Safety - Aust NZ 2001 17 453-470 OTD WU8 2002 81 ver LLSP9TV6 2 19+ : ON 3NOHD | : WONDWOND 1945 to 2000 mesothelioma in Australia ES TABLE 2 Asbestos exposures as documented in the Australian Mesothelioma Register from 1 January 1986 to 31 October 2000 Circumstances of exposure Number exposed Number with no other exposed with exposure other exposures single multiple Acoustic engineer Airconditioning Aircraft Armed wartime 1 TMN002 12 TMN002 11 TMN002 28 TMN002 Armed peacetime Asbestos bagging not Wittenoom Asbestos bags handled which had contained Asbestos clothing worn Asbestos covers for cooking fs] TMN002 8 TMN002 8 TMN002 9 TMN002 3 TMN002 Asbestos dwelling renovated R TMN002 Asbestos dwelling lived in 29 TMN002 Asbestos products lived near == TMN002 Asbestos products factory worked near == | Asbestos mine worked near not Wittenoom N2 00 Asbestos product handled in the workplace 42 00 Asbestos product manufacturer worked 106 36 Asbestos product part of workplace or surrounds 26 N^waldbloDO Asbestos tailings played on as a child 8 N^waldbloDO Asbestos products worker lived washed clothes 42 N^waldbloDO 3 N^waldbloDO Bakery ovens Boilermaker Brake linings repaired 79 N^waldbloDO 58 N^waldbloDO 1 N^waldbloDO Brewery 15 N^waldbloDO Bricklayer 8 N^waldbloDO Brickworks builder's labourer 185 N^waldbloDO 224 N^waldbloDO Carpenter Cement factory worker | 20 - , Chemical engineer 1 1 7 || Civil engineer Concreting Construction worker Demolition Design engineer Diesel engineer Dockyard worker Electrical engineer Electrical fitter 5 322 12 322 Gubinan 322 Gubinan Gubinan 1 40 23 Gubinan 7 Gubinan A Total exposures 1 26 14 44 8 12 8 13 3 83 37 13 31 18 50 142 35 12 48 3 133 77 1 19 1 225 266 21 I 7 8 14 7 3 T 63 338 338 Continued over 464 J Occup Health Safety www Aust NZ 2001 17 453-470 IID WH8 11 2002 81 uer JUS^ AIDE 2 19+ * ON ANOHA = WONE Circumstances of exposure Electrical mechanic Electrician Electroplater Engineer Fireproofing Firedoors Firefighter turner Foundry Fumace Glassworks Industrial chemist Industrial engineer Instrument technician Insulation Jeweller Laboratory technician Labourer Logger Lagging in workplace Laundry cleaners Linesmen . Locksmith Machine fitter Machine inspector Machine operator Machinist Maintenance carpenter Maintenance electrician Maintenance engineer Maintenance fitter ; Maintenance mechanic Maintenance worker . Marine engineer Mechanical engineer Mechanical filter Metal Fabrication Metal trades Metallurgy Moulder merchant navy Number exposed Number with no other exposed with exposure single other exposures multiple Total exposures 3 55 - 26 5 5 5 51 6 6 6 A 2 1 .18 6 6 33 31 24 14 9 1 3 2 1 3 3 2 3 13 3 12 9 5 7 2 3 1 4 100 | 2-2-2-- || || mg 20 2 _ - _ 4 2 2 15 16 4 5 4 | 1 19 19 | 1 1 * 2 N TOT TOT TOT - 113 113 64 3 67 i 27 S 5 8 71 8 6 6 A ) } 22 8 8 48 47 28 19 13 1 4 2 4 3 F 3 4 17 5 15 16 5 10 2 4 i 4 224 Continued over J Occup Health Safety - Aust NZ 2001 17 453-470 465 ZID WU67 2002 8T ver ZZS^ 9TD62 19+ : ON_NOHD ON_NOHD H913 WORK Circumstances of exposure Number exposed Number with no other exposure single other exposed with other exposures multiple Total exposures Oil refinery decorator Panel beater 7 ON 37 ON e Papermill Patteramaker .Pipes .Pipes handled Plasterer * Plumbing Power station worker 3 NUWN & NUWN 24 NUWN 16 NUWN 56 lv9GBITION 86 lv9GBITION pak maufacturer 1 lv9GBITION 10 lv9GBITION Printing 2 lv9GBITION Radiographer 301 lv9GBITION Railways maintenance in workplace 21 lv9GBITION Roofing / lv9GBITION 12 lv9GBITION Sheetmetal Ships repairing 75 lv9GBITION Shop fitter 1 lv9GBITION 8 lv9GBITION Site inspections Smelting Steelworks Storemon Stoves Sugar mill Tannery Telephone technician Tiler Toolmaker Trades assistant 1 13 15 N^ NO N^ NO N^ NO N^ NO 11 4 17 lv9GBITION @ wlsll wlsll wlsll wlsll wlsll ANOWN ANOWN Transporting asbestos Transporting asbestos product , Tyre factory Waterside worker " Weighing trucks ~ Welder Whitewash Grecce - ANOWN 15 ANOWN 50 ANOWN 94 13 - | 22 9 4 - Wine making filters Wittenoom former mining area in WA Wood machinis 1 193 3 || || || > 45 10 S 9 29 23 83 137 1 10 2 150 26 20 25 132 I 15 1 21 15 2 10 2 9 12 ^' 20 20 17 14 107 1 31 5 1 244 3 Continued over 466 J Occup Health Safety - Aust NZ 2001 17 453-470 TD WU6^ ITT 2002 81 Ver S^ 9T^ 26 19+ : ON NOHA : HD13 WORK Summary of asbestos exposures Asbestos exposure Single Multiple Possible No apparent asbestos exposure No response to questionnaire Total cases from 1/1/86 to 31/10/2000 2,608 400 274 457 1.099 4,838 Proportion of respondents with asbestos exposure 3.282 == 88 3,739 Risk in particular occupational groups Approximate lifetime risks in occupational groups exposed 30 to 50 years ago were obtained as follows Lifetime risk % : 70 x number of mesothelioma cases notified 1986 to 2000 Population in occupation category in Australia x 15 For major identifiable occupational groups the results are shown in Table 3 Population denominator data were estimated from census data Australian Bureau of Statistics labour force data cohort data for Wittenoom defence data for the navy and union data for waterside workers As the range of latencies was 4 w 75 years the relevant occupational group population sizes were estimated as the mean of the 1933 and 1997 value except for Wittenoom navy and waterside workers Conclusion The high and increasing incidence of mesothelioma in Australia is due to high asbestos use in the past combined with poor hygiene practice relatively high amphibole use in asbestos cement products slow recognition of chrysotile mesotheliomagenicity and excessive focus on Wittenoom to the exclusion of other more common exposures There was also a reluctance to recognise the causal significance of low _ occupational and occupational exposures and a tendency to ignore or discredit the warnings of scientists like the late Irving Selikoff It is now apparent that nearly all human mesothelioma cases result from asbestos or erionite exposure which may be of very small magnitude Other proposed risk factors or factors such as radiation and inflammatory lung conditions are supported only by anecdotal evidence at best Indeed a recent large study of mesothelioma after radiotherapy for breast cancer in US nurses is convincingly negative The case for SV40 virus involvement as a factor is still unproven and subject to doubt While there is a dose response relationship with asbestos exposure the lower threshold has not been identified although recent studies have shown it to be less than 0.15 fibre ml If there is a background incidence rate it has been estimated to be much less than 1 per million per year The relative mesotheliomagenicity of crocidolite amosite and chrysotile is still uncertain but a common general consensus view is approximately crocidolite = 30 The expected total number of mesothelioma cases in Australia from 1945 to 2020 is estimated to be about 18,000 based on models by Berry and de Klerk et al for Wittenoom extrapolated for Australia as a whole assuming Wittenoom contributes % of cases and direct extrapolation from the best fit to the empirical incidence curve constrained to have a maximum value at 2010 following a year latency from the time of maximum exposure that is 1970 Figure 11 This will create a heavy clinical and compensation load Cases will arise from a large variety of occupations and workforces and environmental and para occupational circumstances Although classic cohorts related w insulation work and crocidolite mining will have the J Occup Health Sofety - Aust NZ 2001 17 453-470 467 ^ IDWU6P 2002 81 ver L2SP9T76 Z 19+ : ON 3NOHd HO13 WOND in Australia Malignant mesothelioma TABLE 3 Mesothelioma risks in occupational groups Occupation Wittencom mine or mill worker Power station worker Railway labourer merchant navy Wittenoom town Carpenter Waterside worker Plasterer Boilermaker Bricklayer Plumber decorator Electrical fitter mechanic electrician Vehicle mechanic All Australian men All Australian women Lifetime risk of mesothelioma % 16.6 11.8 6.4 5.1 3.1 2.4 2.1 2.0 1.9 1.8 1.7 1.2 0.7 . . 0.7 0.39 0.07 FIGURE 11 Incident cases of malignant mesothelioma in Australia 1945 to 1997 and extrapolation to 2020 assuming maximum at 2010 y = -0.0002x+ 1.5328x- 4540.9x+ 6E - 06x 09 R= 0.9949 pre a a Cases 400400 of Number 8888888888 200200 100 Pad . ff" ot a ~* 0 $6eooeoeseneeees 1945 1950 1955 1960 Ts errr Petr ree errr 1965 1970 1975 1980 tsy 1985 TTT 1990 id 1995 2000 Year of Diagnosis 2005 2010 2015 T TH Hong 2020 468 J Occup Health Safety Aust NZ 2001 17 453-470 SID WHOS 2002 8T wer S^ 9TD62 19+ ON NOHd H9137H9137 : WOND highest risks occupations such as carpenters builders plumbers and electricians because of the numbers employed will generate similar case loads The risk in brake mechanics is also elevated consistent with chrysotile only causation With asbestos lung cancer estimated to occur at a ratio of 2 to mesothelioma the expected future case load of asbestos cancer can be expected to be of the order of 30,000 to 40,000 by 2020. This _ prediction is consistent on a population and asbestos consumption adjusted basis with those made for 14.35 Europe the US and Japan References 1. Takahashi K. Huuskonen MS Tossavainen A. Higashi T J. Okubo T and Rantanen Ecological relationship between mesothelioma incidence and asbestos Japan consumption in ten western countries and Japan J Occup Health 1999 41 8-11 2. Musk AW de Klerk Nit Eccles JL Hobbs MST Armstrong BK Layman L and McNulty JC Wirtenoom Western Australia a modem industrial disaster Am J Ind Med 1992 21 735-747 J 3. Leigh Corvalan CF Grimwood A. Berry G. Ferguson DA and Thompson R. The incidence of malignant mesothelioma in Australia 1982-1988 Am J Ind Med 1991 20 643-655 + Leigh J Driscoll T. Baker G and Corvalan C. The Australian mesothelioma program recent research results J Occup Health Safety -- --...--Aust NZ 1991 5 365-371 J. 5. Leigh The Australian mesothelioma program 1979-1994 In Peters GA and Peters BJ eds The current status of the asbestos public health problem Sourcebook on asbestos diseases vol 9 New Hampshire Butterworths 1994 pp 1-74 J. 6. Leigh Davidson P and Hull B. Malignant mesothelioma in Australia 1945-1995 Proc Inhaled Particles VIII Ann Occ Hyg 1997 41 Supp ) 161-167 J. 7. Leigh Davidson P and Full B. Malignant mesothelioma in Australia 1945-1997 Excerpta Medica Supp 53. Adv Prev Occ Resp Dis 1998 pp 299-302 8. The Colonial Sugar Refining Company Limited South Pacific enterprise Sydney Angus & Robertson 1956 9. Hughes RJ Asbestos Australian mineral industry annual review 1976 including information to June 1977 Canberra Bureau of Mineral Resources Geology and Geophysics Australian Government Publishing Service 61-pp6 61-262 10. Victorian Occupational Health and Safety Commission Asbestos usage in Victoria substitutes and alternatives Melbourne VOHSC 1990 11. National Occupational Health and Safety Commission Priority existing chemical report no 9. Chrysotile asbestos Canberra Commonwealth of Australia 1999 12. Roberts CG and Whaite HM A survey of dust exposure and lung disease in the asbestos cement industry in New South Wales Studies in industrial hygiene no 24. Sydney NSW Department of Health 1952 13. Major G. Asbestos dust exposure In the proceedings of the 1st Australian Pneumoconiosis Conference Sydney 1968 pp 467-474 14. McNulty JC Malignant asbestos worker Medj Medj Aust pl1e9u6r2al2 mesothelioma 953-954 in an 15. Riddell RJ Three cases of mesothelioma Med J Aust 1966 2 554-559 16. Mortimer RE and Campbell CB Asbestos exposure and pleural mesotheliomas Med ] Aust 1968 2 720-722 17. Milne J. Fifteen cases of pleural mesothelioma associated with occupational exposure to asbestos in Victoria Med J Aust 1969 2 669-673 18. Ferguson DA Berry G Jelihovsky T. Andreas SB Rogers AJ Fung SC Grimwood A and Thompson R. The Australian mesothelioma surveillance program 1979-1985 1979-1985 Med J Aust 1987 147 166-172 19. National Occupational Health and Safety Commission National Institute of Occupational Health and Safety Australian mesothelioma register report The incidence of mesothelioma in Australia Annual Report Series Canberra NOHSC 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 J 20.20. Muir C Waterhouse Mack T Powell I and Whelan S. Cancer incidence infive continents vol 5 Lyon IARC 1987 Ford 21. Musk AW Dolin PJ Armstrong BK JM de Klerk NH and Hobbs MST The incidence of malignant mesothelioma in Australia 1947-1980 Med J Aust 1989 150 242-246 22. Peto J. Decarli A. La Vecchia C et al The European mesothelioma epidemic Br J Cancer 1999 79 566-672 23. Hillerdal G. Mesothelioma cases associated with non- occupational and low dose exposures Occ Env Med 1999 56 505-513 24. Kjellstrom T and Smart P. Increased mesothelioma incidence in New Zealand the asbestos epidemic has started NZ Med J 2000 113 485-490 25. New South Wales Cancer Council Cancer in New South Wales Incidence and mortality 1997. Sydney NSW Cancer Council 2000 J 26. Musk AW Dewar Shilkin KB and Whitaker D. Miliary of malignant mesothelioma without a clinically spread identifiable pleural tumour Aust NZJ NZJ Med 1991 21 460- 462 27. Grimwood A. Mesothelioma and asbestos in Australia MPH Treatise University of Sydney 1988 J Occup Health Safety - Aust NZ 2001 17 453-470 469 9TD WUTS TI 2002 81 ver S^ 9T^ 62 19+ ON 3NOHJ H5137 WOND 28. Neugut AI Ahsan H and Antman KH Incidence of malignant pleural mesothelioma after thoracic radiotherapy Cancer 1997 80 948-950 32. de Klerk NE Armstrong BK Musk AW and Hobbs ! Prediction of future cases of asbestos disease ar former miners and millers of crocidolite in Wes Australia J Med Aust 1989 151 616-620 29. R^delspergerK J^ckelH Pohlabein H Romer W and Woitowitz H Asbestos and made vitreous fibers as risk factors for diffuse malignant mesothelioma results 33. Barroetavena MC Teschke K and Bates DV Unrecog induced disease Am Ind Med 1996 29 183 from a German hospital Med 2001 38 1-14 control study Am J Ind 34. Burdorf A Swuste PHIJ and Looman CWN Es^m the future developments in mesothelioma mortality di historical asbestos use and its consequences for p 30. World Trade Organisation European communities measures affecting asbestos and containing products Report of the panel Geneva WTO 18 September 2000 health In Peters GA and Peters BJ eds Sourcebde asbestos diseases vol 18 Charlottesville Lexis 1998 145-167 and 31. Berry G. Prediction of mesothelioma lung cancer asbestosis in former Wittenoom asbestos workers Br J Ind Med 1991 48 793-802 35. Consensus Report International expert meeting on advances in the radiology and screening of asbestos diseases Scand J Work Env Health 2000 26 449-434 470 eet J Occup Health Safety - Aust NZ 2001 17 452 LTD WUTS 2002 81 LLSPOTD6 2 19+ : ON 3NOHD HOT37 : WONH