An Approach to Overcome the Limitations of Surveillance of Asbestos Related Diseases in Low- and Middle-Income Countries: What We Learned from the Sibaté Study in Colombia

Our plain-English summary of An Approach to Overcome the Limitations of Surveillance of Asbestos Related Diseases in Low- and Middle-Income Countries: What We Learned from the Sibaté Study in Colombia, by J.P. Ramos-Bonilla, M. Giraldo, D. Marsili, et al (Annals of Global Health, 2023).

The study

• Authors: J.P. Ramos-Bonilla, M. Giraldo, D. Marsili, R. Pasetto, B. Terracini, A. Mazzeo, C. Magnani, P. Comba, B. Lysaniuk, M.F. Cely-García, V. Ascoli
• Journal: Annals of Global Health
• Published: 2023;89(1):64
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: The asbestos industry began its operations in Colombia in 1942 with the establishment of an asbestos-cement facility in Sibaté, located in the Department of Cundinamarca. Despite extensive asbestos use and production in Colombia, the country lacks a reliable epidemiological surveillance system to monitor the health effects of asbestos exposure. The Colombian health information system, known as SISPRO, did not report mesothelioma cases diagnosed in the municipality, posing a significant challenge in understanding the health impacts of asbestos exposure on the population of Sibaté.

Methods: To address this issue, an active surveillance strategy was implemented in Sibaté. This strategy involved conducting door-to-door health and socioeconomic structured interviews to identify Asbestos-Related Diseases (ARDs). Validation strategies included a thorough review of medical records by a panel of physicians, and the findings were communicated to local, regional, and national authorities, as well as the general population.

Results: The active surveillance strategy successfully identified a mesothelioma cluster in Sibaté, revealing the inadequacy of the existing health information system in monitoring asbestos-related diseases. The discovery of this cluster underscores the critical importance of implementing active surveillance strategies in Colombia, where governmental institutions and resources are often limited.

Conclusion: The findings of this study emphasize the urgent need for Colombia to establish a reliable epidemiological surveillance system for asbestos-related diseases (ARDs). Active surveillance strategies can play a crucial role in identifying mesothelioma clusters and enhancing our understanding of the health effects of asbestos exposure in low- and middle-income countries.

Copyright: © 2023 The Author(s).

In plain English

This article described a step-by-step method for finding asbestos-related diseases where official health records are unreliable. It drew on the Sibaté study in Colombia, a town where an asbestos-cement facility opened in 1942, and many of the results it recounts come from the group's earlier publication. Colombia's official health database, SISPRO, showed no cases for Sibaté, so researchers carried out door-to-door structured interviews and completed 355. In four neighborhoods, 270 interviews were obtained out of 1164 dwellings (23%). Residents reported 29 mesothelioma cases, among other diseases. Medical records were obtained for 17 of these. A panel of physicians classified 15 as certain, one as probable and one as not mesothelioma. Based on 9 cases diagnosed while living in Sibaté, the age-adjusted mesothelioma incidence rate was 3.1 per one hundred thousand person-years in males and 1.6 in females. From this, the study concluded that a cluster existed. Of 13 certain cases studied in detail, only one had worked at the facility. The authors noted that non-responses were not recorded, that the figures likely underestimate the true number of cases, and that the method is resource-intensive.

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: Methods and protocol paper describing the approach used in the Sibaté study (door-to-door structured interviews, validation of cases by a physician panel, estimation of age-adjusted incidence rates, exposure classification and communication of findings). Most results are cited from the group's earlier publication.
• Who was studied: Residents of Sibaté, Colombia: 355 structured interviews, 270 of them from all dwellings in four neighborhoods (San Martín, El Carmen, San Rafael, El Progreso) and 85 from other areas. Most interviews were done between August 2015 and June 2016.
• Exposure: Living in a town with an asbestos-cement facility and landfilled zones with an underground layer of friable asbestos. Cases' exposures were classified using Italian Mesothelioma National Register categories: occupational, household, non-professional and environmental.
• Main results:
  • SISPRO, the official database, showed no reported cases for the municipality of Sibaté when searched by year of diagnosis.
  • In the four neighborhoods, the estimated response rate was 23% (270 interviews out of 1164 dwellings).
  • Interviews identified self-reported cases: 29 mesothelioma, 26 lung cancer, 1 larynx cancer, 3 ovarian cancer and 7 asbestosis.
  • Medical records were obtained for 17 of the 29 self-reported mesothelioma cases. The panel classified 15 as certain, one as probable and one as not mesothelioma.
  • Among 13 mesothelioma cases diagnosed in 2007–2017, one was diagnosed in their 30s, seven in their 40s and five in their 50s. The study took this early age at diagnosis to suggest that many may have been exposed during childhood.
  • Based on 9 cases (6 males, 3 females) diagnosed while living in Sibaté, the age-adjusted mesothelioma incidence rate was 3.1 per one hundred thousand person-years for males and 1.6 per one hundred thousand person-years for females. The article prints the denominator as "100.000". Compared with IARC data, these rates were described as notably high, with the female rate among the highest in the world.
  • Of the 13 certain mesothelioma cases whose exposures were analyzed, only one had worked in the asbestos-cement facility.
• The authors' conclusion: The authors concluded that the method can help where surveillance systems are missing, but that it does not replace surveillance programs and reliable health databases. They also concluded that it requires collaboration among many disciplines.
• Limitations the authors state:
  • The number of non-responses was not tracked during interviewing.
  • Because the interviews were not exhaustive, the case figures likely underestimate the actual number of cases.
  • The strategy is resource- and time-intensive and may not be suitable for large populations.
  • Few workers of the asbestos-cement facility took part, and the workers' union did not actively participate. Mesothelioma or other diseases among workers therefore cannot be ruled out.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos-Cement, Asbestos Exposure, Mesothelioma, Active Surveillance, Mesothelioma Cluster, Discovery.

Related studies

• Where are the landfilled zones? Use of historical geographic information and local spatial knowledge to determine the location of underground asbestos contamination in Sibaté (Colombia) — B. Lysaniuk, M.F. Cely-García, et al. (2020)
• Prevention of Asbestos-Related Disease in Countries Currently Using Asbestos — D. Marsili, B. Terracini, et al. (2016)
• Occupational burden of asbestos-related cancer in Argentina, Brazil, Colombia, and Mexico — R. Pasetto, B. Terracini, et al. (2014)
• The Italian Experience in the Development of Mesothelioma Registries: A Pathway for Other Countries to Address the Negative Legacy of Asbestos — C. Magnani, C. Mensi, et al. (2023)
• Using GIS to Estimate Population at Risk Because of Residence Proximity to Asbestos Processing Facilities in Colombia — B. Lysaniuk, M.F. Cely-García, et al. (2021)
• Asbestos related diseases in Italy: an integrated approach to identify unexpected professional or environmental exposure risks at municipal level — A. Marinaccio, A. Scarselli, et al. (2008)

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