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					Journal of Occupational Safety and Health 18: 232-243 (2010)




                                  Asbestos Is Still with Us:
                               Repeat Call for a Universal Ban
                                                    Collegium Ramazzini
                   Collegium Ramazzini International Headquarters Castello dei Pio 41012 Carpi/Modena Italy


                                                               Abstract

               All forms of asbestos are proven human carcinogens. All forms of asbestos cause malignant
        mesothelioma, lung, laryngeal, and ovarian cancers, and may cause gastrointestinal and other
        cancers. No exposure to asbestos is without risk. Asbestos cancer victims die painful lingering
        deaths. These deaths are almost entirely preventable.
               When evidence of the carcinogenicity of asbestos became incontrovertible, concerned
        parties, including the Collegium Ramazzini, called for a universal ban on the mining,
        manufacture and use of asbestos in all countries around the world [1]. Asbestos is now banned in
        52 countries [2], and safer products have replaced many materials that once were made with
        asbestos. Nonetheless, a large number of countries still use, import, and export asbestos and
        asbestos-containing products. And in many countries that have banned other forms of asbestos,
        the so-called “controlled use” of chrysotile asbestos is exempted from the ban, an exemption that
        has no basis in medical science but rather reflects the political and economic influence of the
        asbestos mining and manufacturing industry.
               All countries of the world have an obligation to their citizens to join in the international
        endeavor to ban all forms of asbestos. An international ban on asbestos is urgently needed.


        Keywords: Asbestos, Universal ban, Cancers, Occupational disease, Legislation




* footnote: The Collegium Ramazzini, an international academic society that examines critical issues in occupational
  and environmental medicine, is dedicated to the prevention of disease and the promotion of health. The Collegium
  derives its name from Bernardino Ramazzini, the father of occupational medicine, a professor of medicine of the
  Universities of Modena and Padua in the early 1700s. Currently, 180 renowned clinicians and scientists from around
  the world, each of whom has been elected to membership, comprise the Collegium. It is independent of commercial
  interests.

Correspondence to: General Secretariat, Castello di Bentivoglio, 40010 Bentivoglio, Bologna Italy,
                   39 051 6640650, E-mail: collegium@ramazzini.it


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                                                                 Asbestos Is Still with Us: Repeat Call for a Universal Ban




              Introduction                                Program (NTP) more than 20 years ago [4-6].
                                                          The scientific community is in overwhel-
       Asbestos is a term applied to six na-              ming agreement that there is no safe level
turally occurring fibrous minerals. These                 of exposure to asbestos [7]. Moreover, there
minerals occur in two configurations: ser-                is no evidence of a threshold level below
pentine and amphibole. The only type of                   which there is no risk of mesothelioma [8].
asbestos derived from serpentine minerals,
chrysotile, also known as white asbestos,
accounts for 95 percent of the asbestos ever              The asbestos cancer pandemic
used around the world, and it is the only type              occupational exposures to
of asbestos in commercial use today. Amph-                           asbestos
ibole minerals include five asbestos species:
amosite, crocidolite, tremolite, anthophy-                      Many millions of workers have already
llite, and actinolite. The two forms of amph-             been exposed to asbestos. About 20-40
ibole asbestos that previously were most                  percent of adult men report past occupations
commercially important--amosite, or brown                 that may have entailed asbestos exposures [9].
asbestos, and crocidolite, or blue asbestos               In the most highly affected age groups,
--are no longer in use.                                   mesothelioma may account for over 1% of all
       Asbestos fibers can withstand fire, heat           deaths [10-11]. In addition to mesothelioma,
and acid. They have great tensile strength.               5-7 percent of all lung cancers are potentially
They provide thermal insulation and acoustic              attributable to occupational exposures to
insulation. For these reasons, asbestos came              asbestos [12].
into wide commercial use and gave rise to a                  Worldwide, the yearly number of asbestos-
burgeoning industry many years before its                 related cancer deaths in workers is estimated
detrimental health effects, which often take              to be 100,000-140,000. In Western Europe,
years to appear, became known.                            North America, Japan, and Australia 20,000
       All forms of asbestos cause asbestosis, a          new cases of lung cancer and 10,000 cases of
progressive, debilitating fibrotic disease of the         mesothelioma result every year from expos
lungs. All forms of asbestos also cause                   ures to asbestos [13]. The British mesoth-
malignant mesothelioma, lung, laryngeal, and              elioma death-rate is now the highest in the
ovarian cancers, and may cause gastrointes-               world, with 1,740 deaths in men (1 in 40 of
tinal and other cancers [3]. Asbestos was                 all male cancer deaths below age 80) and
declared a proven human carcinogen by                     316 in women in 2006. About 1 in 170 of all
the US Environmental Protection Agency                    British men born in the 1940s will die of
(EPA), the International Agency for Re-                   mesothelioma [11]. Australia's high incidence
search on Cancer (IARC) of the World Health               of mesothelioma is expected to reach 18,000
Organization, and the National Toxicology                 by 2020, with 11,000 cases yet to appear [14].

                                                    233
Journal of Occupational Safety and Health 18: 232-243 (2010)




      The US National Institute for Occup-                           despite repeated warnings that the use of
ational Safety and Health (NIOSH) estimates                          asbestos in these products is highly dangerous
that current occupational exposures to asbe-                         because of the large numbers of people ex-
stos even at OSHA’s permissible exposure                             posed to the airborne dust and the extreme
limit will cause 5 deaths from lung cancer and                       difficulty of controlling exposures once these
2 deaths from asbestosis in every 1,000 work-                        materials have been disseminated into comm-
ers exposed for a working lifetime [15]. This                        unities where people of all ages, including
mortality reflects the fact that an exposure                         young children, are at risk of exposure [16].
to 0.1 fibers of asbestos per cc of inspired air,                          Both community-based and industrial
over the course of a day, amounts to daily in-                       exposures to asbestos and asbestiform fibers
halation of more than one million asbestos                           increase risks for mesothelioma [17]. Thus a
fibers.                                                              study of women residing in Canadian asbestos
                                                                     mining communities found a sevenfold
      Environmental exposures                                        increase in the mortality rate from pleural
             to asbestos                                             cancer [18]. The risk of developing asbestos-
                                                                     related cancer following in-home exposures in
      Non-occupational, environmental                                communities near Canadian mines over a 30-
exposure to asbestos from the use of asbestos                        year period is estimated to be 1 in 10,000 [19].
in construction materials is also a serious and                      Likewise, environmental exposures to asb-
often neglected problem in countries                                 estos waste on the surfaces of roads and yards
throughout the world. In developed countries                         in a contaminated community of 130,000
large quantities of asbestos remain as a legacy                      residents in The Netherlands result each year
of past construction practices in many                               in several cases of malignant mesothelioma
thousands of schools, homes, and commercial                          [20]. And in a third example, the currently
buildings. And in developing countries, where                        observed increase in female cases of mesoth-
asbestos is used today in large quantities in                        elioma in the United Kingdom, many with no
construction, asbestos-contaminated dust is                          occupational exposure to asbestos, suggests
now accumulating in thousands of communi-                            widespread environmental contamination [11].
ties.
      More than 90 percent of the asbestos
used worldwide today is used in the manu-
facture of asbestos-cement sheets and pipes.                               The position of industry
Use of asbestos in these materials continues
                                                                          In efforts to sustain markets in the face
   footnote: The average adult at rest inhales 7 to 8
liters of air per minute. That totals approximately                  of a steadily growing body of scientific
11,000 liters of air in a day. An exposure standard of               evidence that irrefutably links asbestos to
0.1 f/cc would then result in 11,000,000 cc x 0.1 f/cc
   = 1.1 million fibers/day.                                         asbestosis and human cancer, the asbestos



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                                                                 Asbestos Is Still with Us: Repeat Call for a Universal Ban




industry has attempted to obfuscate the links            great that these estimates should not be used
between asbestos and disease by provoking                to determine occupational and environmental
spurious scientific debate over the roles of,            health policy. The EPA has rejected and
viruses, fiber types and genetics in the                 discontinued work on its proposed methods
development of lung cancer and malignant                 for quantifying potency factors for partitioned
mesothelioma. These tactics closely resemble             asbestos fiber types and sizes [23].
those used by the tobacco industry.                             A third activity of the asbestos industry
       Early on the asbestos industry blamed             is to commission the publication of articles,
malignant mesothelioma occurrence on                     primarily in toxicology journals, termed
poliovirus vaccines used during the 1950s and            "product defense" articles. These articles are
1960s that were contaminated with simian                 frequently sponsored by asbestos interests
virus 40 (SV40), a monkey virus tumorigenic              such as the defendants in personal injury
in rodents. However, age-specific trends in              asbestos litigation. They are distinguished
pleural mesothelioma incidence rates are not             from other science papers in that they are
consistent with an effect of exposure to SV40-           written by scientific consultants and
contamined poliovirus vaccine [21].                      consulting firms, who are paid substantial
       The industry continues to generate                sums for their work. Their goal is to defeat
endless debate on the relative hazards of                liability claims [24-27]. Editors of scientific
asbestos of different fiber type and dimension.          journals must be very stringent about the
In these debates industry spokespersons argue            details and wording of authors’ statements on
that some forms of asbestos are less harmful             conflicts of interest, and carefully select
than others. However, epidemiological and                unbiased peer reviewers of articles regarding
statistical efforts to characterize relative             asbestos in accordance with the International
cancer potencies for different asbestos fiber            Committee of Medical Journal Editors
types and for fibers of different sizes have not         guidelines [28].
been able to overcome limitations of the                        Despite their lack of scientific found-
exposure data. Nor can these analyses account            ation, these continuing controversies and
for the fact that in the real world exposure is          ploys generated by the asbestos industry have
almost always to mixtures of asbestos fibers             helped to make the disease experiences and
of different types and sizes.                            early deaths of asbestos-exposed workers and
       Epidemiologic, experimental, and                  people in asbestos-contaminated communities
molecular evidence suggests that the                     invisible and uncompensated, allowing the
arguments for the role of fiber size relative to         asbestos industry to escape accountability
dose, dose–response effect, and genetic                  [29].
susceptibility are fraught with enormous
uncertainties [22]. Indeed NIOSH scientists
contend that the uncertainties have been so                        Chrysotile asbestos


                                                   235
Journal of Occupational Safety and Health 18: 232-243 (2010)




      Chrysotile represents 95 percent of all                        leading health experts oppose the export of
the asbestos ever used worldwide. It is the                          asbestos to developing countries. The
only variety in international trade in the 21st                      National Public Health Institute of Quebec
century. There is general agreement among                            (INSPQ) has published fifteen reports, all of
scientists and physicians, and widespread                            them showing a failure to achieve “controlled
support from numerous national health                                use” of asbestos in Quebec itself. Pat Martin,
agencies in countries around the world,                              a member of Canada’s parliament and former
United Nations agencies, and the World Trade                         asbestos miner asks, “If we in the developed
Organization, that chrysotile causes various                         world haven't found a way to handle chryso-
cancers, including mesothelioma and lung                             tile safely, how can we expect them to do so
cancer [30-39].                                                      in developing nations? [54]
      Early suggestions that chrysotile might                               The reality of the current use of
be less dangerous than other forms of asbestos                       Canadian asbestos in India was broadcast by
have not been substantiated. And although                            the Canadian Broadcasting Corporation in a
chrysotile accounts for almost all the asbestos                      2009 documentary [55]. This stunning piece
ever used, the asbestos industry continues to                        of investigative journalism exposed the
claim that asbestos-related cancers are the                          fallacy underpinning the asbestos industry's
result of the amphibole varieties [40-41].                           commercial propaganda; showing there is no
Consultant experts of the Canadian chrysotile                        such thing as the safe use of asbestos. The
asbestos industry contend that “Exposure to                          World Trade Organization has accepted this
chrysotile in a pure form seems likely to                            conclusion [56].
present a very low if any risk of mesothelio-
ma” [42].                                                                     Current production
      The Chrysotile Institute, a registered                                  and use of asbestos
lobby group for the Quebec asbestos mining
industry, takes the position that chrysotile can                           Despite all that is known about the
be handled safely [43]. Numerous epidem-                             health effects of asbestos, annual world
iologic studies, case reports, controlled animal                     production remains at over 2 million tons.
experiments, and toxicological studies refute                        This level of production has remained steady
the assertion that chrysotile is safe [13,44-49].                    following a 50% decline in the 1990s. Russia
These studies demonstrate that the socalled                          is now the leading producer of asbestos
"controlled use" of asbestos is a fallacy [50].                      worldwide, followed by China, Kazakhstan,
Workers exposed to chrysotile fiber alone                            Brazil, Canada, Zimbabwe, and Colombia.
have excessive risks of lung cancer and mes-                         These six countries accounted for 96% of the
othelioma [51-53].                                                   world production of asbestos in 2007 [57].
      The Canadian Medical Association, the                          Russia has mines rich enough in asbestos
Canadian Cancer Society, and Canada’s                                deposits to last for more than 100 years at



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                                                                Asbestos Is Still with Us: Repeat Call for a Universal Ban




current levels of production. The majority of            is by far the largest consumer of asbestos in
the 925,000 tons of asbestos extracted annu-             the world today, followed by India, Russia,
ally in Russia is exported.                              Kazakhstan, Thailand , Ukraine, and Uzbe-
       Asbestos is now banned in 52 countries,           kistan.
including all EU member countries, and safer
products have replaced many that were once
made with asbestos. Virtually all of the                     Position of United Nations
polymeric and cellulose fibers used instead of                 agencies on asbestos
asbestos in fiber-cement sheets are greater
than 10 microns in diameter and hence are                      International organizations have con-
non-respirable. Nonetheless, these 52 coun-              demned the continuing use of chrysotile
tries make up less than a third of WHO mem-              asbestos [58]. In 2006, WHO called for the
ber countries.                                           elimination of diseases associated with
       A muc h l a r g e r n u mb e r o f WH O           asbestos [38]. WHO supports individual
member countries still use, import, and export           countries in developing national plans to ban
asbestos and asbestos-containing products                asbestos and eliminate asbestos disease. The
[38]. Over 70 percent of the world production            ILO has expressed concern about an evolving
of asbestos is used in Asia and Eastern                  epidemic of asbestos-related diseases, and has
Europe, in countries desperate for industrial            drafted a resolution to promote a worldwide
growth and often naïve to the health effects of          asbestos ban [32].
occupational and environmental exposures to                    The Rotterdam Convention is an inter-
asbestos. Most of the world’s people still live          national treaty intended to regulate global
in countries where asbestos use continues                trade in dangerous chemicals-chemicals that
with little or no provision for prevention or            have been banned or severely restricted
compensation. And in many countries that                 because of their hazards to human health or
have banned other forms of asbestos, the                 the environment. It was enacted in 2004, and
"controlled use" of chrysotile asbestos is still         131 nations are currently parties to the
exempted from the ban because of the size of             Convention. The goal is to protect the world’s
the asbestos industry, its pervasive influence,          most vulnerable countries-developing coun-
and the importance of asbestos mining and                tries and countries with economies in trans-
manufacture to the economy. The toll in most             ition-against importation without their prior
countries still using large amounts of asbestos          knowledge or consent of hazardous pestic-
may never be fully recorded.                             ides and other regulated chemicals.
       In developing countries, where too                      Prior Informed Consent (PIC) is the
often there exists little or no protection of            core principle of the Rotterdam Convention.
workers and communities, the asbestos cancer             This legally binding procedure requires that
pandemic may be the most devastating. China              governments in all countries be provided full



                                                   237
Journal of Occupational Safety and Health 18: 232-243 (2010)




information prior to importation about the                           For roofing, lightweight concrete tiles can be
risks to health and the environment of each of                       made and used in the most remote locations,
the hazardous materials regulated by the                             using locally available plant fibers including
Convention. Annex III of the Rotterdam                               jute, hemp, sisal, palm nut, coconut coir, and
Convention contains a list of the chemicals-                         wood pulp. Galvanized iron roofing and clay
37 in number-currently regulated by the                              tiles are among the other alternative materials
Convention.                                                          [60].
       Repeated efforts to include chrysotile                               If global use of asbestos were to cease
asbestos under the Rotterdam Convention                              today, a decrease in the incidence of asbestos-
have failed, because of the Convention’s                             related diseases would become evident only
requirement for unanimity and the determined                         two or more decades from now [38]. The
opposition of asbestos mining and manu-                              asbestos cancer pandemic may take as many
                                                                     as 10 million lives before asbestos is banned
facturing countries [59]. At the 2008 con-
                                                                     worldwide and all exposure is brought to an
ference of parties on the Convention, opp
                                                                     end [58,61]. In this conservative estimate, it
osition to chrysotile asbestos was led by
                                                                     is assumed that asbestos exposures are going
Canada, Russia, and India. Kazakhstan and a
                                                                     to cease and that the epidemic will run itself
few asbestos importing countries thwarted the
                                                                     out, but currently the world’s production of
will of over 100 other countries.
                                                                     asbestos continues at an alarming rate, and
                                                                     therefore these figures may be underestimates
     Conclusion - the need for a                                     of the true reality of this pandemic.
     universal ban on asbestos                                              An international ban on the mining and
                                                                     use of asbestos is urgently needed. The risks
      The profound tragedy of the asbestos                           of exposure to asbestos cannot be controlled
pandemic is that virtually all illnesses and                         by technology or by regulation of work
deaths related to asbestos are preventable.                          practices. Scientists and responsible authori-
Safer substitutes for asbestos exist, and they                       ties in countries allowing the use of asb-
have been introduced successfully in many                            estos should have no illusion that "controlled
nations. Asbestos-cement (A-C) pipes, sheets,                        use" of chrysotile asbestos is an effective
and water storage tanks account for 90                               alternative to a ban on all use of asbestos
percent of asbestos used in the world today.                         [62-64]. Even the best workplace controls
Substitutes for A-C water pipe include ductile                       cannot prevent occupational and environ
iron pipe, high-density polyethylene pipe, and                       mental exposures to products in use or to
metal-wire-reinforced concrete pipe. Many                            waste.
substitutes exist for roofing, interior building                            All countries of the world have an
walls and ceilings, including fiber-cement flat                      obligation to their citizens to join the
and corrugated sheet products, made with                             international endeavor to ban all forms of
polyvinyl alcohol fibers and cellulose fibers.                       asbestos.



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                                                              Asbestos Is Still with Us: Repeat Call for a Universal Ban




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