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Asbestos in Europe

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

Asbestos Import in Europe (1920-2000)
450000 400000 350000 Asbestos (metric Ton) 300000 250000 200000 150000 GDR GFR Austria Belgium&Luxemburg Denmark Spain Finland France Greece Italy Ireland Netherlands Norway UK Sweden 0 1920 1930 1940 1950 1960 1970 1980 1990 1995 2000 Switzerland

100000
50000

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

Compensated Asbestosis in Europe
2500 GFR 2000 GFR GFR 500 450 GFR

GFR
GFR GFR GFR 400 GFR 350 300

GFR 1500 GFR 1000

250 200 150

GFR
500 GFR GFR 0 1980 1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 GFR 50 0 GFR 100

GDR
Ireland Sweden Denmark

GFR
Netherlands Switzerland Spain

Finland
Norway Austria France

Greece
UK Belgium&Luxemburg Italy

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

Compensated Lung Cancer in Europe
1200 200 180 1000 160 140 120 600 100 80 400

800

60
40

200

20
0 1980 1985 1990 GDR Greece Sweden Spain 1991 1992 1993 GFR Ireland Switzerland Finland 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 0

Austria Netherlands Belgium&Luxemburg Italy

France UK Denmark Norway

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

Compensated Mesothelioma in Europe
900 800 700 600 500 50 400 40 300 200 100 0 1980 1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 30 20 10 0 100 90 80 70 60

GDR
Greece UK Spain

GFR
Italy Sweden Finland

Austria
Ireland Belgium&Luxemburg Norway

France
Netherlands Denmark Switzerland

Ecological association between asbestos-related diseases and historical asbestos consumption: an international analysis
Ro-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 Alami Queens Medical Centre, Nottingham, UK Clin. Otolaryngol. 2004, 29, 285

Year of Ban 1981 1986 1986 1989 1990 1991 1992 1992 1993 1996 1998 1999 2000 2002 2005

Country Norway Denmark Sweden Switzerland Austria Netherlands Finland Italy Germany France Belgium UK Ireland Spain Greece

Mesothelioma Incidence 13.8 17.1

8.8

5.2 4.0 7.9 4.6 6.1

0.1

Mesothelioma Incidence (2000) and Year of Asbestos Ban in Europe
18

Denmark (1986)

Mesothelioma Incidence (/Million)

16

14

Norway (1981)

12

10

8

Switzerland (1989) Germany (1993) Belgium (1998) Finland (1992) France (1996) Italy (1992)

6

4

2

0 1975 1980 1985 1990 1995 2000

Spain (2002)
2005 2010

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

versus
Exp Disease ReductionMonitoring

Exp Exp Reduction Monitoring

Exp Reduction

Disease Increase

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.


								
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