Document ppVwgD8rOjbK8w1vg63kdRGzE
FILE NAME Brakes BRK
DATE 2002
DOC BRK125
DOCUMENT DESCRIPTION Journal Article - Malignant Mesothelioma in
Australia 1945 to 2000 - American Journal of Industrial Medicine
AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 188-201 2002
Malignant Mesothelioma in Australia 1945-2000
James Leigh MB BS MA MSc MD PhD* Patricia Davidson,
Leigh Hendrie BA MPH and Dale Berry
Background 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 450-600 cases are notified annually in a population of 20 million While the history of the Wittenoom Western Australia crocidolite mine and its aftermath is well known these cases comprise only % of the total This study describes the incidence of mesothelioma in Australia from 1945 to 2000 Methods Using register data time trends in mesothelioma incidence were calculated Analyses of incidence are reported by age sex anatomical site and state of notification Associations with occupational and environmental asbestos exposure histories are described Lung fiber content measurements were made on a subset of cases Results Australia has had 6,329 cases of mesothelioma from 1 January 1945 to 31 December 2000. A further 620 cases were notified in the period from 1 January 2001 to 31 October 2001. Annual incidence rates for Australia per million population 20 years 1997 were male 59.8 female 10.9 total 35.4 Incidence rates have been continually increasing and are the highest reported national rates in the world While Western Australia has the highest rate 1997 total rate 52.8 most cases arise from the two most populous eastern states New South Wales and Victoria In 88 male 90 female 61 of cases a history of asbestos exposure was obtained Exposures occurred in a wide variety of occupational and environmental circumstances In 80 of cases with no history of exposure TEM lung asbestos fiber counts > 200,000 fibers > 2 mlength per gm dry lung were obtained suggesting unrecognized exposure Conclusions Australia's high incidence of mesothelioma is related to high past asbestos use of all fiber 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 Am J. Ind Med 188-201 2002. '2002 Wiley Inc.
KEY WORDS malignant mesothelioma incidence Australia asbestos exposure future predictions
Abbreviations used NSW New South Wales VIC Victoria QLD Queensland TAS Tasmania SA South Australia WA Western Australia ACT Australian Capital Territory NT
Northern Territory
Center for Occupational and Environmental Health Department of Public Health and Community Medicine University of Sydney Sydney NSW Australia
National Occupational Health and Safety Commission Sydney NSW Australia The views expressed in this article are those of the authors and do not necessarily
reflect those of the National Occupational Health and Safety Commission Dr. James Leigh works as a Director Correspondence to Dr. James Leigh Center for Occupational and Environmental Health
Department of Thoracic Medicine Concord Hospital 2139 NSW Australia mail jleigh@bigpond.com jleigh@bigpond.com jleigh@bigpond.com
Accepted 30 November 2001
'2002 Wiley Inc. DOI 10.1002 ajim.10047
INTRODUCTION
Asbestos was mined in Australia for over 100 years
and Australia was the world's highest user per capita of asbestos in the 1950's Given the ecological relationship between per capita asbestos consumption and mesothelioma incidence Takahashi et al 1999 is no surprise that in the
last twenty years of the 20th century Australia has had the world's highest reported incidence of malignant mesothelioma Australia has one of the world's most complete national surveillance systems for mesothelioma and this has
Malignant Mesothelioma in Australia
189
been in operation since 1980. We will describe the history of
asbestos use and the incidence of mesothelioma in Australia
as a whole rather than concentrating on the known Wittenoom crocidolite mining operation and township in Western Australia Musk et al 1992 This study updates and enhances previous reports Leigh et al 1991b 1997 1998 Leigh 1994
History of Asbestos Production
and Use in Australia
Between 1880 and 1889 approximately 47 tonnes of amphiboles were mined at Jones Creek near Gundagai New South Wales and between 1890 and 1899 about 35 tonnes of chrysotile was mined at Anderson's Creek
Tasmania South Australia was the first State to mine croci-
dolite at Robertstown in 1916
Over the 20th century there was a gradual increase in asbestos production with more chrysotile than amphiboles mined until 1939. With the commencement of mining at Wittenoom Western Australia in 1937 crocidolite dominated production until final closure in 1966. New South Wales the first State to mine asbestos also produced the largest tonnages of chrysotile until 1983 as well as smaller quantities of amphiboles until 1949
With the closing of the crocidolite mine at Wittenoom in 1966 Australian asbestos production declined to a 1952 level Exports declined from 1967. Imports of chrysotile also started to decline The earliest records of asbestos imports date from 1929. The main sources of raw asbestos imports were Canada chrysotile and South Africa crocidolite and amosite About twice as much chrysotile was imported as was mined and half as much crocidolite was imported as was mined After Wittenoom was closed a small amount 122 tonnes of crocidolite was mined in South Australia In New South Wales the chrysotile mine at Baryulgil continued production In 1971 the chrysotile deposits at Woodsreef near Barraba New South Wales began to be exploited and exports of asbestos fiber expanded as production increased This operation was open with dry milling
Australian production of asbestos fiber decreased in 1981 because of the drop in world demand for asbestos and the increased operating costs at the Woodsreef mine This mine ceased production in 1983 when the dry milling plant could not meet dust control regulations
Details of Australian asbestos production and imports are shown in Tables I and II Australian asbestos crocidolite and chrysotile was exported to the USA Japan UK and Europe In particular Wittenoom crocidolite was exported to the USA and Europe The Colonial Sugar Refining Company Limited 1956
In addition to imports of asbestos fiber Australia also imported many manufactured asbestos goods including
TABLE . Asbestos Production in Australia 1880-1983
Years 10
1880-1889 1890-1899 1900-1909 1910-1919 1920-1929 1930-1939 1940-1949 1950-1959 1960-1969 1970-1979 1980-1983
Crocidolite tonnes
Chrysotile
tonnes
_ _
_
22 18 422 5,619 63,227 86,566
_
_
20 61 580 3,577
1,151
2,967 11,511 8,855 394,361 160,408
Amosite
tonnes
2
|
2225 2225 2225 2225 750
1
_ _
Total
tonnes
26 20 80 625 3,649 1,624 9,338 74,739 95,421 394,361 160,408
Total
155,874
583,491
926
740,291
Based on figures supplied by Bureau of Mineral Resources Hughes 1978
asbestos cement products asbestos yarn cord and fabric joint and millboard friction materials and gaskets The main sources of supply were the United Kingdom USA Federal Republic of Germany and Japan Apparent consumption of asbestos the difference between production and imports and export is shown in Table III and Figure 1. This gives a
crude estimate of overall exposure However the export process itself bagging transport and wharf labor caused
much exposure In Australia over 60 of all production and 90 of all consumption of asbestos fiber was by the asbestos cement manufacturing industry Hughes 1978 From about 1940 to the late 1960's all three types of asbestos were used in this industry crocidolite then being phased out Amosite use in this industry continued until about 1983. Chrysotile was used until about 1987. Much of this industry output remains in service today in the form of
TABLE II Asbestos Imports Prior to 1930 Until 1983 in Australia in tonnes
Year
Chrysotile Amosite Crocidolite
1930 1930-1940 1940-1949 1950-1959 1960-1969 1970-1979 1980-1983
_ _
_
_
--
186,855 329,129 388,003
64,672
107,509 81,432 87,901 8,338
_ _ _
2,778
_ _
_
Other
_
_
_
16,938 24,112 79,683
4,188
Total
2,568 51,554 139,987 314,080 434,673 555,587 77,198
Total
968,659
285,180
2,778
124,921 1,575,647
Based on figures supplied by Bureau of Mineral Resources Hughes 1978
190
Leigh et al
TABLE III Asbestos Consumption in Australia
Year
1880-1889 1890-1899 1900-1909 1900-1909 1910-1919 1920-1929 1930-1939 1940-1949 1950-1959 1960-1969 1970-1979 1980-1985
Production
tonnes
26 20 82 625 3,649 1,624
9,338 74,739 95,421 394,361 160,408
Imports
tonnes
_
_
_
2,568 51,554 139,987 314,080 434,674 555,587 104,324
Exports
tonnes
_ _
_
_
1,196 2,410 51,413 44,703 45,523 9,786
Apparent consumption
tonnes
26 20 82 625
6,217 51,982 146,915 337,406 485,392 704,425 154,946
Total
740,293
1,602,774
455,031
1,888,036
Based on figures provided by Bureau of Mineral Resources Hughes 1978
fibro houses and water and sewerage piping By 1954 Australia was fourth in the world in gross consumption of asbestos cement products after the USA UK and France and was clearly first on a per capita basis After World War II to 1954 70,000 asbestos cement houses were built in the State of New South Wales alone 52 of all houses built
In Australia as a whole until the 1960's 25 of all new
housing was clad in asbestos cement
Australia still imports about 1,500 tonnes a year of chrysotile fiber and about A13.5 m worth of asbestos products a year over half as friction material but also fabricated yarn fabric jointing gaskets millboard and asbestos cement products Victorian Occupational Health and Safety Commission 1990 NOHSC 1999 However a phase out of new chrysotile asbestos use by 2003 is in place Handling of asbestos in place and removal operations are subject to a strict National Code of Practice A series of regulations adopted in the late 1970's and early 1980's by the Australian states and territories now impose exposure limits of 0.1 fiber for crocidolite amosite and mixtures
all states and territories and 0.1 ACT 0.5 NSW VIC or
1.0 fiber SA WA NT QLD TAS for chrysotile TWA 8 hr membrane filter method light microscopy WHO fibers The chrysotile limit is currently under review
Exposures in the past were very high in some industries and jobs For example up to 25 million particles per cubic foot were documented in asbestos pulverizors and disintegrators in the asbestos cement industry Roberts and Whaite 1952 High concentrations of fibers in mining occupations were also recorded up to 600 fibers in baggers at Wittenoom Major 1968
With this background it was almost certain that Australia would suffer a mesothelioma epidemic of a severe
nature
The first reported case from Wittenoom was in 1962 McNulty 1962 Three more cases were reported from Victoria in 1966 Riddell 1966 two from Queensland in 1968 Mortimer and Campbell 1968 and an additional nine from Victoria in 1969 Milne 1969
Tonnes
800000
600000 +
400000 +
200000 +
0
7
r
1900-1909 1910-1919 1920-1929 1930-1939 1940-1949 1950-1959 1960-1969 1970-1979 1980-1985
Year
FIGURE Asbestos consumption in Australia 1900-198190-51985 1900-1985
Malignant Mesothelioma in Australia
191
METHODS
Australian Mesothelioma
Surveillance Program
The Australian Mesothelioma Surveillance Program the Program as it finally became known endeavored to
correct most of the weaknesses identified in the 1960's and
70's in other such surveillance schemes throughout the world viz reporting of cases uncertain diagnosis poor elucidation of the role of occupational and environmental asbestos exposure and less than comprehensive coverage Ferguson et al 1987
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 medical superintendants medical records administrators State and Territory departments of occupational health cancer registries compensation authorities or any other source Notifications from other than the diagnosing physician were confirmed with him After gaining the appropriate consents a complete occupational and environmental history was obtained for each case either from the patient or next by a specially trained interviewer The history taking was directive but included specific questions on asbestos exposure 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 or tissue specimens These were circulated among a pathology panel for confirmation of diagnosis mortem examination was actively sought for in every case in order to confirm diagnosis and to obtain lung tissue free of tumor for lung fiber content analysis
Occupational and environmental exposure was classified as definite probable and possible based on the subjective opinions of the two hygienists Further grading of intensity of exposure was also very subjective in many cases and duration depended on historical recollection
Year of presumptive diagnosis was the year in which mesothelioma was first suspected clinically Year of definitive diagnosis was the year when pathology panel diagnosis was finalized The panel of five members of the Royal College of Pathologists of Australasia reported individually on the diagnosis as definite probable possible and not mesothelioma The level of consensus was good with exact agreement or disagreement of only one category in 94 of cases A scoring system of 1 definite 0.75 probable 0.5 possible 0 not mesothelioma was used
and the definitive score taken as the score nearest the mean
of five Panel members also classified mesothelioma cell
type as epithelial sarcomatous mixed or not agreed
Lung fiber content was assessed by a local modification of a sodium hypochlorite digestion and filter method Both light and transmission electron microscopy TEM with energy dispersive ray analysis were used Fibers were counted by asbestos type and length but not diameter All fiber lengths were recorded but because of uncertainties about filter contaminants by < ...mfibers only fibers > m TEM or > ...m LM were considered in analyses These methods gave a sensitivity corresponding to one fiber counted of 15,000 fibers dry lung LM and 200,000 fibers dry lung TEM Assuming a Poisson distribution of fibers in the counting units the upper limit of the 95 confidence interval for the population mean given
a zero count obtained is 3.69 Thus the TEM detection
limit is about 740,000 fibers Rogers 1984 Reports on lung fiber content levels were sometimes used for medicolegal purposes in a fallacious way in that counts were reported as being within the normal range as if this excluded an occupational asbestos exposure and liability The normal range was in fact taken from urban hospital patients without mesothelioma and where fibers were counted exposure obviously had been received and not always environmental only as judged by fiber length
distribution It must have sometimes been from occupational sources but no work histories were available It was
not realized until later that these patients should be treated as cases referents in a referent study
Detailed analyses of Program data relating lung fiber content cell type tumor site and survival Leigh et al 1991a lung fiber type and content to risk Rogers et al 1991 1994 and clinical studies Driscoll et al 1993 have been previously reported
Australian Mesothelioma Register
From 1 January 1986 a less detailed notification system has operated with a short questionnaire occupational and environmental exposure history followed up assiduously with up to four letters per case no pathology panel diagnosis and only sporadic lung fiber 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 is now known as the Australian Meso-
thelioma Register but is a continuation of the Program Incidence rates are periodically calculated on cases
notified to the Register An annual report series is produced
NOHSC 1989-2001 Cases accepted by the pathology panel in the Program as definite probable or possible are included In this report incidence rates have been calculated up to the end of 1997 only due to a possible year delay in notification experienced while awaiting confirmed
192
Leigh et al
diagnosis and reconciliation with the state cancer registries
Incidence rates for 1998 are available in the Australian
Mesothelioma Report for 2001 NOHSC 2001
RESULTS
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 Musk et al 1989
Thus the total number of mesotheliomas in Australia from
1945-2000 inclusive is 6,329 An additional 620 notifications have been received in the period 1 January 2001 to 31 October 2001. Notifications show a continuing upward trend in both males and females Fig 2 The notifications prior to 1982 were probably the result of initial slow acceptance of a new Program and are artificially low 1980 1981 although a smooth curve of increasing incidence starting from the early 1960's has since been demonstrated by retrospective search Fig 3 The Australian population has increased from 14.5 million in 1980 to 20 million in 2001. Mesothelioma incidence
rates in persons over 20 years of age have increased from 11.8 per million per year in 1982 to 35.4 per million
per year in 1997 males and females combined 59.8 per
million per year males and 10.9 per million per year female Figure 4 shows incidence rates by time and sex If the 1981 figure is accepted it can be claimed that
mesothelioma incidence rates have increased four- to five-
fold in 19 years in Australia Both male and female rates have increased but the male rate is over five times the
female rate These are the highest reported incidence rates in the world Hillerdal 1999 Peto et al 1999 Takahashi et al 1999 Kjellstrom and Smartt 2000 and equal to the Australian NSW incidence rates of liver cancer and in mortality terms equal to the mortality rates of kidney cancer
in males and uterine cancer in females New South Wales Cancer Council 2000 Mesothelioma is no longer a rare disease
Figure 5 shows specific incidence for males and females > 20 years for the year 1997. Incidence increases
with age up to 80 year and then falls consistent with a cohort effect in that the oldest persons may have missed the heaviest exposure era from 1950-1970 The occurrence of cases in the 40 year age groups indicates that exposure can occur in children Figures 6 and 7 show specific incidence trends over time for males and females Generally
the time trend of increasing incidence is restricted to age groups over 50 from 1986 onwards suggesting that occupational exposure controls introduced from the 1970's have been effective Table IV shows notifications by state up
to 31 December 2000
500 450 + 400 4 350 4 300 -
Notifcans 250 4 200 200 200 il 150 +
a ever
q
0 --
1979
1981
T
1
t
T
T
T
1983
1985
1987
T
1989
1991
1993
Year of Notification
1995
FIGURE 2. Australian Mesothelioma Register Notifications 1979-197-20 219079-020000 by sex
1997
1999
2001
Malignant Mesothelioma in Australia
193
Cases
of
350 350 350 1
Number
0
=
1945
S aamenns
1950
1955
+
1960
+
1965
1970
T
1975
T
1980
Year of Diagnosis
T
1985
FIGURE 3. Incident cases of mesothelioma in Australia 1945-1997
T
1990
T
1995
1
2000
Western Australia has the highest incidence 1997 rates total 52.8 per million male 96.2 female 9.4 but contributes only 15 of the total cases Wittenoom contributes only % of the Australian cases yet is certainly the most publicized and best known internationally Most of the cases come from the two most populous and industrialized states New South Wales and Victoria Table IV
In 93.2 of all Program cases the mesothelioma was pleural in site with 6.5 peritoneal and 0.3 in other sites Among males 94.3 were pleural 5.3 peritoneal among
women 86.3 pleural 13.7 peritoneal These proportions have been generally maintained in 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 % Wittenoom crocidolite milling % insulation manufacture
70
60 +
50 +
Rate
Rate
Incidence 40 +
Incidence Incidence
Incidence
Incidence
Incidence 30
Crude
Crude
Crude 20 4
Males Persons
Females
10
aa
ee
Q
T
T
T
T
li
T
T
T
T
T
T
T
li
T
T
1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
Year of Diagnosis
FIGURE 4. Time trend of annual incidence rate per million population > 20 years of mesothelioma in Australia by sex 1982-1997
194
Leigh et al
1000 Incidence per Million
100
*
*
a
aa
|
a
-
eS
==
et
L
Yr
}
7
x
t
Vi
ma
[
M4
20-24
PY
25-29
l
30-34
\
35-39
{
40-44
I
45-49
i
50-54
rt
55-59
|
60-64
1
65-69
1
70-74
4 75-79
1 80-84
1 85+
Age in Years
M ae les
+ Females
FIGURE 5. specific incidence rates of mesothelioma in Australia 1997 male and female
installation % wharf laboring % power stations % boilermaking % 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 history of some exposure recorded Thus only % had no known history Moreover of this no known history group % had fiber counts > 200,000
fibers dry lung detected in the lungs 30 with more
than 106 fibers > 2 ...mincluding long > 10 ) ...m fibers
suggesting that nearly all cases have been exposed Past exposure is not always recognized as such and this is more likely to be the case in females Indeed even absence of fibers in the lungs does not negate exposure as fibers may
have initiated mesothelioma and then been cleared before
350 5
300
Males 250
milion 200
per 150
Incidenc 100
504
0 1986
1987
Age 50-64
_
1988
7
1989
1990
1991
1992
qu'e .
Age 35-49
Sd
Quvcnnenniesah
dienes
wy
Age
20-34
1993
1994
1995
1996
1997
Year of Diagnosis
FIGURE 6. specific incidence of mesothelioma in Australia 1986-1997 1986-1997 1986-1997 male
Malignant Mesothelioma in Australia
195
40
]
35 -
? Age 65-79
Females 30 25 -
Age 80+
milion 20
2 Age 50-64
per
15
7
No
4
\-
Incidenc 10
5 cat Mecsscecstenseas pence eo FLSoe
o
eT ge tenet fen
I ew
wn
oe
ne
0
T
T
T
T
T
T
T
T
1986
1987
1988
1989
1990
1991
1992
1993
1994
Age 2
eae
ere
Serta
Age
v
y
i
1995
1996
1997
35-49 20-34
Year of Diagnosis
FIGURE 7. specific incidence of mesothelioma in Australia 1986-1986-197 119986-919797 female
TABLE IV Mesothelioma Notifications in Australia 1980-2000
NSW
VIC
QLD
WA
SA
TAS
NT
ACT
Total
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 ALL %
1
0
0
0
0
51
3
18
22
5
--
0
g
20
9
0
20
2
0
$$
23
26
46
19
6
0
$$
38
22
26
14
1
1
71
39
22
30
19
1
0
$
34
38
32
18
2
1
54
40
26
28
32
0
0
/
28
45
23
36
1
0
124
25
35
44
22
3
0
111
82
43
26
25
1
0
105
44
46
66
55
10
0
117
45
40
37
39
3
1
99
34
42
47
25
5
0
151
41
74
32
30
8
0
124
89
49
33
43
11
1
87
157
53
127
30
4
1
107
32
64
82
24
5
0
160
84
65
66
21
8
0
252
113
73
79
20
7
0
168
106
99
47
60
7
0
2,118
1,078
892
893
557
90
5
37.3
19.0
15.7
15.7
9.8
1.6
0.1
0
16
0
104
1
142
0
173
2
178
2
189
1
172
2
182
2
192
1
254
1
289
2
328
1
283
0
252
1
337
3
353
4
463
4
318
1
405
7
551
3
490
38
5,671
0.7
100
NSW New South Wales VIC Victoria QLD Queensland WA Western Australia SA South Australia TAS Tasmania NT Northern Territory ACT Australian Capital Territory
Exposed with no other
exposure single
Exposed with other exposures multiple
Total exposures
1
-
1
12
14
26
wartime forces
ed peacetime Asbestos bagging not Wittenoom Asbestos handled which had contained asbestos Asbestos clothing
Asbestos covers for cooking Asbestos renovated Asbestos dwelling in Asbestos products near Asbestos products worked near Asbestos worked near not Wittenoom Asbestos product handled in the workplace Asbestos product manufacturer Asbestos product of workplace or surroundings Asbestos tailings on as a child Asbestos products worker washed clothes Bakery ovens
Boilermaker
Brake repaired
Brewery
Bricklayer
Brickworks
Builder's laborer
Carpenter
Cement factory worker Chemical engineer Civil engineer
Concreting
Construction worker
Demolition
Design engineer Diesel engineer Dockyard worker
Electrical engineer
Electrical fitter
Electrical mechanic
!
Electrician
Electroplater
Engineer
Fireproofing
Firedoors
Firefighter
turner
11
28 6 8 8 9 3
70 29 11 11 12 42 106 26
8 42
3 79 58
1 15
8 185 224
20 1 7 5
12 5 2
40 5
15 3
55
26 5 5 5
51
3 16
1
4
13 8 2
_
6 8 36 9 4 6
_
54 19
4 3 40 42 1
3 2 2 1 1 23 7 4
12 1 1
_ _
322 322
14 44
8 12
8 13
3 83 37 13 11 18 50 142 35 12 48
3 133
77 1
19 11 225 266 21
1 7 8 14 7 3 1 63 2 1 3 67 1 27 5 5 8 71
Foundry
Furnace
6
322
8
6
6
Glassworks
6
_
6
TABLE V. Continued
Circumstances of exposure
Industrial chemist Industrial engineer Instrument technician Insulation Jeweller
Laboratory technician
Laborer
Lagger Lagging in workplace Laundry cleaners
Linesman 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 fitter Metal fabrication Metal trades
Metallurgy
Moulder
merchant navy Oil refinery
decorator Panel beater Papermill Patternmaker handled Plasterer
Plumbing
Power station worker Pressure pack manufacturer
Printing Radiographer Railways maintenance in workplace Roofing
Sheetmetal
repairing Shop fitter Site inspections
Malignant Mesothelioma in Australia
197
Exposed with no other exposure single
4 2 1 18 6 6 33 31 24 14 14 9 1 3 2
3 23
3323
Exposed with other exposures multiple
| |
15
3
3
Pl
64
2
8
1
23571F62357251125F67
101 21
14 75
Total exposures +2 +2 1
22 00 8
48 47 28 19 13 13
4
2
3 3
4
17
17
5616565
10
224
45 10
29 23 83 137
10
150 26 20 25 132
198
Leigh et al
TABLE V. Continued
Circumstances of exposure
Smelting
Steelworks Storeman Stoves
Sugar mill Tannery Telephone technician
Tiler Toolmaker Trades assistant
Transporting asbestos Transporting asbestos product Tire factory
Waterside worker
Weighing trucks
Welder Whitewash
Wine making filters Wittenoom former mining area in Western Australia
Wood machinist
Asbestos exposure
Single Multiple Possible
No apparent asbestos exposure No response to questionnaire Total cases from 1/1/86 to 31/10/2000 Proportion of respondents with asbestos exposure
Exposed with no other exposure single
1 13 15
2 6 2 6 11 4 17 14 15 10 94 1 22 4 1 193 3
Exposed with other exposures multiple
-
30-5 30-5
30-5
Summary of asbestos exposures
2,608
400 274 457 1,099 4,838
3,282 = 88
Total exposures 1
107 31 244
death Becklake and Case 1994 The shortest duration of
exposure was 16 hr waterside worker loading crocidolite
fiber Musk et al 1991 Three percent of cases had
exposure of less than 3 months According to history assess-
ment of exposure of the first 530 cases by the two hygienists
most cases 55 had mixed chrysotile expo-
sure 13 amphibole only % amphibole plus possible
chrysotile % chrysotile with possible amphibole and %
chrysotile only with 15 unknown fiber type Grimwood
1988 Mean latency from first exposure to presumptive
diagnosis was 37.4 years Ferguson et al 1987 The range
of latencies was 4
7y5ears
In the cases reported since 1 January 1986 when less
detail of history of exposure was sought 89.9 of males
responding to questionnaire 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 occupational exposure is apparent compared to
the older traditional industries Table V shows the circumstances of exposure in cases from 1986-2000 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 % powerstations % boilermaking % Wittenoom % wharf labor % occupational hobby environmental % carpenter % builder % navy % plumber % brake linings % and multiple 12
CONCLUSIONS
The high and increasing incidence of mesothelioma in Australia is due to high asbestos use in the past combined
700 -
600 +
500 +
Cases 400 ~
of
300 5
Number 200 +
Malignant Mesothelioma in Australia
199
y = -0.0002x+ 1.5328x-1.5328x- 4540.9x+ 06x - 3E R= 0.9949
1945
1950
1955
1960
1965
1970
1975
1980
1985
1990
Year of Diagnosis
1995
2000
2005
2010
2015
FIGURE 8. Incident of malignant mesothelioma Australia 1945-1997 1945-1997 1945-1997 and extrapolation to 2020 assuming maximum at 2010
2020
with poor hygiene practice relatively high amphibole use in asbestos cement products carcinogenic potency of chryso-
tile and excessive focus on Wittenoom to the exclusion of other more common exposures There was also a reluctance
to recognize the causal significance of low occupational and occupational exposures and a tendency to ignore or discredit the warnings of scientists the late Irving J. Selikoff
among others
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 very large study of mesothelioma after radiotherapy for breast cancer in US nurses is convincingly negative Neugut et al 1997 The case for SV40 virus
involvement as a factor is still unproven While there
is a response relationship with asbestos exposure a threshold has not been identified although recent studies have shown it to be less than 0.15 fiber year R^delsperger et al 2001 If there is a background
incidence rate it has been estimated to be much less than 1 per million per year Hillerdal 1999
The studies relating lung fiber content and type to
mesothelioma risk showed that for Australia as a whole
the greatest risk of mesothelioma was associated with
exposure to crocidolite > 10 min length It was difficult to assess the risks associated with chrysotile alone due to almost universal assessed mixed exposure to amphibole and chrysotile and the possibility of differential clearance effects However in a subset of cases and referents with
only chrysotile found in the lungs a significant dose-
response trend was found
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 1991 and de Klerk et al 1989 for Wittenoom extrapolated for Australia as 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 40 year latency from the time of maximum exposure 1970 Fig 8 This will create a heavy clinical and compensation load Cases will arise from a large variety of occupations and workforces and environmental and occupational circumstances Although classic cohorts related to insulation work and crocidolite mining will have the highest risks occupations such as carpenters builders plumbers and electricians because of numbers employed will generate similar case loads The risk in brake mechanics is also elevated WTO 2000 consistent with chrysotile only causation
With asbestos related lung cancer estimated to occur at a ratio of 2 to mesothelioma Barroetavena et al 1996 the expected future case load of asbestos related cancer can be expected to be of the order of 30,000-40,000 by 2020 This prediction is consistent on a population and asbestos consumption adjusted basis with those made for Europe Burdorf et al 1998 Peto et al 1999 USA and Japan
Consensus Report 2000 The various Australian state territory and federal
government preventive clinical and compensatory authorities are now developing a national strategy for dealing
200
Leigh et al
with this problem The elements of this strategy are the phasing out of all new use of asbestos in Australia by the
end of 2003 strict control of demolition and removal
operations involving asbestos containing materials screening programs for high risk asbestos exposed groups using spiral CT support programs for victims of asbestos disease research into better clinical treatments prophy-
laxis programs where indicated and uniform compensation standards based on the principles of the Helsinki criteria
Leigh J Davidson P Hull B. 1997. Malignant mesothelioma in Australia 1945-1995 Proc Inhaled Particles VIII Ann Occ Hyg 41
Suppl 161
167
Leigh J Davidson P Hull B. 1998. Malignant mesothelioma in Australia 1945-1997 Excerpta Medica Suppl 53. Adv Prev Occ
Resp Dis 299-302
Major G. 1968. Asbestos dust exposure In Proc 1st Aust Pneu-
moconiosis Conf Sydney 467
474
McNulty JC 1962. Malignant pleural mesothelioma in an asbestos
worker Med J Aust 953-954
Consensus Report 2000
Milne J. 1969. Fifteen cases of pleural mesothelioma associated with occupational exposure to asbestos in Victoria Med J Aust 669-673
REFERENCES
Mortimer RH Campbell CB 1968. Asbestos exposure and pleural
mesotheliomas Med J Aust 720-722
Barroetavena MC Teschke K Bates DV 1996. Unrecognized
induced disease Am J Ind Med 183-185
Becklake MR Case BW 1994. Fiber burden and asbestos lung disease determinants of response relationships editorial Am J Resp Crit Care Med 1488-1492
Berry G. 1991. Prediction of mesothelioma lung cancer and asbestosis
in former Wittenoom asbestos workers Br J Ind Med 793-802
Burdorf A Swuste PHJJ Looman CWN 1998. Estimating the future developments in mesothelioma mortality due to historical asbestos use and its consequences for public health In Peters BA Peters BJ editors Sourcebook on Asbestos Diseases Vol 18. Charlottesville Lexis p 145-167
Consensus Report 2000. International expert meeting on new advances in the radiology and screening of asbestos diseases
Scand J Work Environ Health 449-454
Musk AW Dolin PJ Armstrong BK Ford JM de Klerk NH Hobbs MST 1989. The incidence of malignant mesothelioma in Australia 1947-1980 Med J Aust 242-246
Musk AW Dewar J Shilkin KB Whitaker D. 1991. Miliary spread
of malignant mesothelioma without a clinically identifiable pleural
tumour Aust NZ J Med 460-462
Musk AW de Klerk NH Eccles JL Hobbs MST Armstrong BK Layman L McNulty JC 1992. Wittenoom Western Australia a modern industrial disaster Am J Ind Med 735-747
National Occupational Health and Safety Commission National Institute of Occupational Health and Safety 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Australian Mesothelioma Register Report The Incidence of Mesothelioma in Australia Annual Report Series Canberra Commonwealth
of Australia
de Klerk NH Armstrong BK Musk AW Hobbs MST 1989. Prediction
of future cases of asbestos disease among former miners and
National Occupational Health and Safety Commission 1999. Priority Existing Chemical Report No. 9. Chrysotile Asbestos Canberra
millers of crocidolite in Western Australia Med J Aust 616
620Commonwealth of Australia
Driscoll T Baker G Daniel S Thompson R Lee J Ferguson DA Leigh J. 1993. Clinical features of malignant mesothelioma in
Australia Aust NZ J Med 19-25
Neugut pleural
950
Al Ahsan H Antman KH mesothelioma after thoracic
1997. Incidence of malignant radiotherapy Cancer 948-
Ferguson DA Berry G Jelihovsky T Andreas SB Rogers AJ Fung
SC Grimwood A Thompson R. 1987. The Australian Mesothelioma
Surveillance Program 1979-1985 Med J Aust 166-172
Grimwood A. 1988. Mesothelioma and asbestos in Australia MPH
Treatise University of Sydney
Hillerdal G. 1999. Mesothelioma cases associated with occupa-
tional and low dose exposures Occup Environ Med 505
513
Hughes RJ 1978. Asbestos Australian Mineral Industry Annual Review 1976 including information to June 1977 Bureau of Mineral Resources Geology and Geophysics Canberra Australian Govern-
ment Publishing Service p 61-62
Kjellstrom T Smartt P. 2000. Increased mesothelioma incidence in New Zealand the asbestos epidemic has started NZ Med J
485-490
Leigh J. 1994. The Australian Mesothelioma Program 1979-1994 In
Peters GA Peters BJ editors The Current Status of the Asbestos Public Health Problem Vol 9 Sourcebook on Asbestos Diseases NH Butterworth p 1-74
Leigh J Rogers AJ Ferguson DA Mulder HB Ackad M Thompson R. 1991a Lung asbestos fiber content and mesothelioma cell type site and survival Cancer 135-141
Leigh J Corvalan CF Grimwood A Berry G Ferguson DA Thompson R. 1991b The incidence of malignant mesothelioma in Australia
1982-1988 Am J Ind Med 643-655
New South Wales Cancer Council 2000. Cancer in New South Wales
Incidence and Mortality 1997. Sydney NSW Cancer Council
Peto J Decarli A La Vecchia C Levi F Negri E. 1999. The European mesothelioma epidemic Br J Cancer 566-672
Riddell RJ 1966. Three cases of mesothelioma Med J Aust 554559
Roberts CG Whaite HM 1952. A survey of dust exposure and lung disease in the asbestos cement industry in New South Wales Studies in Industrial Hygiene No. 24 NSW Dept. of Health
Rogers AJ 1984. Determination of mineral light microscopy and transmission electron Hyg 1-12
fibre in human tissue by microscopy Ann Occup
Rogers AJ Leigh J Berry G Ferguson DA Mulder HB Ackad M. 1991. Relationship between lung asbestos fiber type and concentration and relative risk of mesothelioma control study Cancer
1912-1920
Rogers A Leigh J Berry G Ferguson D Mulder H Ackad M. Morgan
GG 1994. response relationship between airborne and lung
asbestos fibre type length and concentration and the relative risk of
mesothelioma Ann Occ Hyg 38 Suppl 631
638
R^delspergerK J^ckelH Pohlabein H Romer W Woitowitz H
2001. Asbestos and made vitreous fibers as risk factors for diffuse
malignant mesothelioma results from a German hospital casecontrol study Am J Ind Med 1-14
Malignant Mesothelioma in Australia
201
Takahashi K Huuskonen MS Tossavainen A Higashi T Okubo T Rantanen J. 1999. Ecological relationship between mesothelioma incidence and asbestos consumption in ten western countries and Japan J Occup Health 8-11
The Colonial Sugar Refining Company Limited 1956. South Pacific Enterprise Sydney Angus and Robertson
Victorian Occupational Health and Safety Commission 1990 Asbestos Usage in Victoria Substitutes and Alternatives Melbourne
VOHSC
World Trade Organization 2000. European Communities affecting asbestos and containing products Report of the panel DS135 18 September 2000. Geneva WTO