A baseline profile of asbestos in the US-affiliated Pacific Islands

Our plain-English summary of A baseline profile of asbestos in the US-affiliated Pacific Islands, by A.M. David, H. Ogawa, K. Takahashi (International Journal of Occupational and Environmental Health, 2012).

The study

• Authors: A.M. David, H. Ogawa, K. Takahashi
• Journal: International Journal of Occupational and Environmental Health
• Published: 2012;18(1):22-8
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Asbestos is a recognized occupational and environmental hazard in the Asia-Pacific region, yet information regarding asbestos consumption, exposure, and asbestos-related diseases in the US-affiliated Pacific Islands (USAPIs) is scarce, and the situation regarding asbestos in these islands, particularly with regard to disease burden, surveillance, and health care capacity, is not well understood. Searching through scientific and "gray" literature and interviews with local cancer registry personnel and health professionals yielded no published data, only sufficient, indirect evidence of past and ongoing asbestos exposure, documented cases of mesothelioma and asbestosis, and minimal capacity for preventing and recognizing asbestos-related illnesses. Capacity and resource limitations within the USAPIs can impede regional progress in asbestos prevention and highlight the need for an integrated regional approach to address these data and capacity gaps. A regional mechanism to share expertise and resources and facilitate technical assistance to the USAPIs is urgently needed.

In plain English

This World Health Organization-commissioned article was a preliminary review building a baseline profile of asbestos in six US-affiliated Pacific Islands: American Samoa, the Northern Mariana Islands, the Federated States of Micronesia, Guam, the Marshall Islands and Palau. The authors searched databases, websites and news reports and contacted cancer registry staff, health professionals and local regulators. The peer-reviewed literature search found nothing. No asbestos production or consumption data were found. US federal asbestos legislation covered the US territories, but only Guam had a local law specifically on asbestos removal, abatement and disposal. Four local companies reported asbestos work in three of the six jurisdictions. Guam's cancer registry held three mesothelioma cases since 1998. The only civilian pulmonologist in the islands, based on Guam, reported five to seven asbestosis and 12 to 15 pleural plaque cases over seven years. American Samoa had two anecdotal mesothelioma reports. Outside the military health system, Guam had one known trained 'A' chest X-ray reader and no known certified 'B' readers. The authors concluded that past and current exposures are likely, that data probably underestimate disease, and that regional support is urgently needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Preliminary review of available data (scientific and 'gray' literature, websites, news reports) plus phone and email contacts with local sources, used to build a descriptive baseline profile; commissioned by WHO
• Who was studied: The six US-affiliated Pacific Islands: American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Federated States of Micronesia (FSM), Guam, Republic of the Marshall Islands (RMI) and Republic of Palau. Information came from published and online sources and from cancer registry personnel, health professionals, and local OSHA and EPA representatives.
• Exposure: Asbestos in general; no specific fiber types were studied. Potential sources discussed were past shipbuilding on Guam and CNMI, asbestos-containing building materials and their removal or demolition, possibly unlabeled imported construction materials, typhoon or earthquake damage to buildings, and decaying military equipment and buildings.
• Main results:
  • A systematic search of peer-reviewed medical, public health and environmental health databases found no documents on asbestos in the USAPIs.
  • The expanded online search identified 49 relevant sites. Close to half (45%) were private businesses offering asbestos-related services: remediation or removal companies (27%) and asbestos litigation lawyers (18%).
  • No data on asbestos consumption in the USAPIs were found, and no evidence of asbestos production or mining.
  • US federal asbestos-related legislation covers the US territories, and the Freely Associated States aim to align with US standards.
  • Among local laws, only Guam had one addressing removal, abatement and disposal of asbestos-containing materials.
  • None of the USAPIs was a Party to ILO Convention 162 on safety in the use of asbestos.
  • Websites of four local environmental service providers showed completed and ongoing asbestos work in three of the six USAPIs.
  • Guam: three mesothelioma cases in the Guam Cancer Registry since 1998.
  • Guam: one mesothelioma case diagnosed by Guam's clinical pathologist.
  • Guam: five to seven cases of asbestosis and 12 to 15 cases of pleural plaques diagnosed in the past seven years by the only civilian pulmonologist in the USAPIs, who is Guam-based.
  • Guam: 10 to 12 cases diagnosed in the past 15 years by Guam's senior radiologist. The flattened table layout makes it unclear which disease category these cases fall under.
  • Mesothelioma was documented in Guam and possibly in American Samoa, where there were two cases from anecdotal reports. CNMI, FSM and RMI had no data.
  • Outside the military health care system, there was only one known 'A' (trained) reader of chest radiographs on Guam and no known 'B' (certified) readers. No such readers were known in the other USAPIs.
  • The authors judged that enough evidence existed to confirm asbestos is present in the islands, and that past and current exposures are likely.
• The authors' conclusion: The authors concluded that significant data gaps exist, that past and current asbestos exposures are likely, and that a regional mechanism to share expertise and resources and to facilitate technical assistance is urgently needed.
• Limitations the authors state:
  • No established registries capture asbestos-related diagnoses.
  • The health professionals interviewed believed existing data likely underestimate the actual prevalence of disease. The authors stated registry data are likely severely underestimated.
  • The absence of consumption data may not mean no asbestos is used, because the USGS database may be less complete for small populations.
  • Because military personnel serve in many places, it may be hard to establish whether their exposure actually occurred on Guam.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Cancer Registry, Asbestos Exposure, Mesothelioma.

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