Asbestos in High-Risk Communities: Public Health Implications

Our plain-English summary of Asbestos in High-Risk Communities: Public Health Implications, by E.A. Emmett (International Journal of Environmental Research and Public Health, 2021).

The study

• Author: E.A. Emmett
• Journal: International Journal of Environmental Research and Public Health
• Published: 2021;18(4)
• Type of article: Review
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Asbestos-related diseases (ARDs)-mesothelioma, lung cancer, and asbestosis-are well known as occupational diseases. As industrial asbestos use is eliminated, ARDs within the general community from para-occupational, environmental, and natural exposures are more prominent. ARD clusters have been studied in communities including Broni, Italy; Libby, Montana; Wittenoom, Western Australia; Karain, Turkey; Ambler, Pennsylvania; and elsewhere. Community ARDs pose specific public health issues and challenges. Community exposure results in higher proportions of mesothelioma in women and a younger age distribution than occupational exposures. Exposure amount, age at exposure, fiber type, and genetic predisposition influence ARD expression; vulnerable groups include those with social and behavioral risk, exposure to extreme events, and genetic predispositions. To address community exposure, regulations should address all carcinogenic elongated mineral fibers. Banning asbestos mining, use, and importation will not reduce risks from asbestos already in place. Residents of high-risk communities are characteristically exposed through several pathways differing among communities. Administrative responsibility for controlling environmental exposures is more diffuse than for workplaces, complicated by diverse community attitudes to risk and prevention and legal complexity. The National Mesothelioma Registries help track the identification of communities at risk. High-risk communities need enhanced services for screening, diagnosis, treatment, and social and psychological support, including for retired asbestos workers. Legal settlements could help fund community programs. A focus on prevention, public health programs, particularization to specific community needs, and participation is recommended.

In plain English

This article is a review by a single author of published research on communities at high risk of asbestos-related diseases from non-occupational exposure. It described five well-studied communities: Wittenoom, Western Australia (crocidolite mining); Broni, Italy (an asbestos cement factory); Libby, Montana (vermiculite contaminated with Libby Amphibole Asbestos); Karain, Turkey (houses built of rock containing erionite); and Ambler, Pennsylvania (asbestos-cement manufacturing). Citing other studies, the review stated that mesothelioma from community exposure involves a higher proportion of women and a younger age distribution than occupational exposure. The author argued that banning asbestos will not remove asbestos already in place, that regulations should cover all fibers capable of causing mesothelioma, including erionite, and that responsibility for controlling community exposures is spread across many parties. The author concluded that responses must be tailored to each community, suggesting a 'Four Ps' focus on prevention, programs, particularization and participation, and that legal settlements might help fund community programs. The author noted that published evidence on socioeconomic factors is sparse.

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: Narrative review by a single author. It reports no new data and draws on published studies of high-risk communities to discuss public health issues.
• Who was studied: Geographic communities at high risk of asbestos-related disease, mainly five well-studied ones: Wittenoom (Western Australia), Broni (Italy), Libby (Montana), Karain (Turkey) and Ambler (Pennsylvania). Others are mentioned, such as Biancavilla (Italy) and areas identified by registries in Italy and Poland.
• Exposure: The review covers several kinds of exposure:
• Para-occupational exposure (living with an asbestos worker).
• Environmental exposure from industrial operations.
• Naturally occurring fibers.

The fiber types differ by community:

• Wittenoom: crocidolite.
• Broni: chrysotile, crocidolite and lesser amounts of amosite.
• Libby: Libby Amphibole Asbestos, predominantly winchite and richterite, with lesser amounts of tremolite.
• Karain: erionite.
• Biancavilla: fluoro-edenite.
• Main results:
  • Citing other studies, the review stated that mesothelioma from non-occupational community exposure involves a higher proportion of females and a tendency toward a younger age distribution than occupational exposure.
  • Citing a published study of Broni, Italy: 147 mesothelioma cases were diagnosed from 2000 to 2011 in Broni and surrounding towns. Of these, 38 were attributed to occupational, 37 to para-occupational and 72 to environmental exposures.
  • Citing earlier studies of Karain and Tuzkoy, Turkey: mesothelioma of the pleura and peritoneum together accounted for more than 50% of all deaths in these communities.
  • Citing a pooled analysis by other researchers, the review stated that pleural mesothelioma predominates at lower non-occupational exposures. The highest, predominantly occupational, exposures are associated with excess lung cancer and asbestosis and a higher proportion of peritoneal mesothelioma.
  • Citing a study by De Klerk and colleagues of Wittenoom family groupings, the risk ratio for mesothelioma in blood relatives compared with non-blood relatives was 1.9 (95% CI 1.3 to 2.9, p = 0.002).
  • The author stated that banning the import, export and use of asbestos will not by itself eliminate hazards from asbestos already in place in contaminated communities or from natural sources.
  • The author argued that regulation should cover all fibers capable of producing mesothelioma and other asbestos-related disease. If revising the definition proves insurmountable, coverage should at least be extended to erionite, fibrous-edenite, winchite and richterite.
  • The author stated that, for many environmental and lifestyle-related exposures, the chain of responsibility for control is very complex, unlike workplaces. The Bo-Rit Asbestos Superfund site near Ambler was given as an example.
  • Citing Leigh and Driscoll: 19% of subjects with mesothelioma in the Australian Mesothelioma Registry gave no history of asbestos exposure. When lung tissue was examined, 81% of this group had fiber counts above 200,000 fibers per gram of dry lung.
  • Citing the French National Registry: a panel of pathologists could confirm only about 2/3 of submitted mesothelioma diagnoses.
  • The Libby Center for Asbestos Related Diseases (CARD) community program has operated since 2000, and the population it follows regularly now exceeds 5000.
• The authors' conclusion: The author concluded the following:
• High-risk communities are a growing public health concern requiring action at both the policy level and the local community level.
• Responses must be tailored to individual communities.
• A 'Four Ps' focus (prevention, programs, particularization, participation) is suggested.
• Where feasible, legal settlements might fund community programs.
• Limitations the authors state:
  • The review covers only geographic high-risk communities. It does not attempt to address all potential environmental sources of asbestos to the general population.
  • The author noted a lack of published literature on socioeconomic determinants of asbestos-related disease within communities.
  • The author noted that data are sparse on whether groups such as pregnant women, the seriously ill, the aged, or any ethnic group have increased predisposition given equivalent exposures.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Lung Cancer, Occupational Disease, Wittenoom, Karain, Occupational Exposure, Carcinogenic, Mineral Fiber.

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• Public health risks from asbestos cement roofing — M. Kottek, M.L. Yuen (2022)
• Asbestos in the air of public buildings: a public health risk? — J. Whysner, V.T. Covello, et al. (1994)
• Public Health and Independent Risk Assessment — P. Vineis (2019)
• Rural public health policy models to address an evolving environmental asbestos disaster — S.W. Kuntz, C.A. Winters, et al. (2009)

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