Asbestos in Europe

Domyung PaekSeoul National University

World Health Organization

Table 1. Early developments of the asbestos industry.[Information from Stover Publishing Co., 1953, p. 4–6; Selikoff and Lee, 1978, p. 17–18]1857–1880.... First packings and flat seals using asbestos.1866................. First bonded and molded asbestos product for heat insulation.1866–1876.... Start of systematic asbestos textile processing in Italy.

1868–1869..... First U.S. use of asbestos in roofing felt and cement.1878................. Asbestos paper first made in the United States.1882................. Concept of asbestos-containing magnesia insulation developed.1890................. Asbestos textile processing began in Canada.1893................. First spinning of crocidolite in Republic of South Africa.

1896................. First asbestos-containing woven brake bands made in England.1899................. Wet machine process of making asbestos cement developed.1900................. Method for manufacturing asbestos-cement panels developed.1904................. Flat asbestos-cement board manufactured in the United States.1906................. Asbestos first used as brake lining.1918................. Asbestos-containing molded clutch facing developed.1929................. Asbestos-cement pipe industry began in the United States.

1931................. Technique for spraying asbestos developed in England.

1940s............... Asbestos-cement pipe introduced into England.1944................. Spraying asbestos on deckheads and bulkheads began in British naval ships.

Asbestos Production & Export

Russia 700 000China 450 000Canada 335,000Kazakhstan 180,000Brazil 170,000Zimbabwe 130,000Greece 35,000Swaziland 25,000India 23,000South Africa 20,000Japan 18,000Colombia 10,000United States 7,000Bulgaria 7,000Other countries 20,000TOTAL 2,130,000 (Year 2000)

Recognition & Control of Asbestos Hazards

• 1924 – Asbestosis report by William Cook in BMJ (UK)• 1931 – Asbestos Industry Regulation (UK)• 1936 – Asbestosis Comp (Germany)• 1940 – Controlling dust in Asbestos processing factories

(Germany)• 1942 – Lung cancer (w. asbestosis) Comp (Germany)• 1955 – Lung cancer w/o asbestosis by Richard Doll who believed

the risk was eliminated in 30’s and gone• 1959 – Mesothelioma case report from SA• 1969 – Asbestos regulation in UK (MAC)• 1972 – Central registry for asbestos exposed workers (Germany)• 1973 – Protection against health impairing mineral dust (Germany)• 1977 – Mesothelioma Comp (Germany)• 1979 – Ban on the processing of sprayed asbestos (Germany)• 1993 – General Ban of Asbestos use (Germany)• 1997 – Laryngeal Cancer Comp (Germany)• 1999 – General Ban of Asbestos use (UK)

Asbestosis Comp• History

– Work– Smoking, alcohol– Complaint (hoarseness)

• Exam• Lung Function• Chest x-ray• Additional Exam• Schedule 12-36/60 months

– 15 years after first exposure or when 45 years old• ILO 1/1 profusion compensable w/o functional

impairment since 1993 in Germany• Respiratory Rehabilitation in outpatient clinics

Lung Cancer Comp

• Same with asbestosis screening• Compensable in most countries via two

different pathways– either in connection with asbestosis

(bridging symptom)– or with intense exposure (Helsinki criteria

or threshold of 25 fiber/ml*year)• At least 1 year in major exposure• 5-10 years in moderate exposure• Exposure calculated as at least 25 fiber/cc*year

• About of 10% of lung cancer in general population

Mesothelioma Comp

• Same with asbestosis screening• Long latency period and registration needs

– Without sign of disease– With occupational disease such as asbestosis or

pleural lesions• Hard to diagnose because of pathologic

variety, and some countries have mesothelioma panels

• Almost exclusively due to asbestos, and in all the Europe, even modest exposure (a few weeks) to asbestos dust is sufficient for recognition

Ecological association between asbestos-related diseasesand historical asbestos consumption: an international

analysisRo-Ting Lin, Ken Takahashi, Antti Karjalainen, Tsutomu Hoshuyama, Donald Wilson, Takashi

Kameda, Chang-Chuan Chan, Chi-Pang Wen, Sugio Furuya, Toshiaki Higashi, Lung-Chang Chien, Megu Ohtaki

Lancet 2007; 369: 844–49

Laryngeal Cancer Comp

• 1997, Germany based on increased risk even after controlling other factors

• Not yet universal

CORRESPONDENCE

Does Asbestos cause laryngeal cancer?Dr Maher El AlamiQueens Medical Centre, Nottingham, UKClin. Otolaryngol. 2004, 29, 285

Year of Ban

CountryMesothelioma

Incidence1981 Norway 13.8 1986 Denmark 17.1 1986 Sweden1989 Switzerland 8.8 1990 Austria1991 Netherlands1992 Finland 5.2 1992 Italy 4.0 1993 Germany 7.9 1996 France 4.6 1998 Belgium 6.1 1999 UK2000 Ireland2002 Spain 0.1 2005 Greece

Post-hoc comments• 30’-60’: asbestos risk believed to be controllable

– Technical professionals’ approach (medical inspectors and hygienist)

– Most dangerous risks including cancer was thought to be eliminated in 30’s by regulation, only appear due to the long latency

– Still setting TLV based on asbestosis risk not cancer risk

• 60’-70’: hazards beyond the heavily exposed during production– First extended to the end-users– Then community risks reported and media attention

brought– Calling for ban and industry propaganda

Asbestos and Mesothelioma in Europe

• Mesothelioma incidence ↑ → Asbestosis detection rate ↑↑

• EU15+ countries tend to have more asbestosis cases detected while with lower incidences of mesothelioma than EU+12 countries

Analysis of National H&S Program

• Focus on Input-Output-Outcome linkage

→→ Exp Assmnt, Dis Assmnt, and H&S Solution

Exp Monitoring

ExpReduction

DiseaseReduction

Exp Monitoring

DiseaseIncrease

ExpReduction

versus

Discussions (1)• The H&S problem solving cycle is

not Exp Ass → Exp Reduction → Dis Reduction, but Exp Ass → Dis Detection → Exp Reduction.

• Here the core ideas of problem solving strategy should lie with how to link exposure assessment with disease detection, and also how to link disease detection to source control.

• Many countries still show high exposure assessment coverage with no or minimal disease detections, and high disease detection rate with no source controls.

Discussions (2)• Differences in H&S among Euro member

countries could be identified as expected from membership history.

• Problems of H&S usually drive the program as in the case of high mesothelioma incidence that leads to even higher detection of asbestosis, but country differences could be identified.

• Comparatively higher problems should be stressed and concerns be raised for each country until the lowest possible examples can be obtained. We need collective and comparative social issue making.

Discussions (3)• Scope of the H&S program is important in that

the coverage determines the detection rate of NIHL and pneumoconiosis, and for accidents, it determines the over-all accident rates of the society.

• Target priority may be important, but general universal acknowledgement of H&S values by the society is more fundamental to the effectiveness of the program.

• Risk population is at risk, not because of high risk works, but because of acceptance of high risks for that particular working population.

• Minority populations including non-standard workers and illegal migrant workers should be given particular considerations in this issue of the H&S program scopes.