Asbestos-related cancers: the 'Hidden Killer' remains a global threat

Our plain-English summary of Asbestos-related cancers: the 'Hidden Killer' remains a global threat, by N. van Zandwijk, G. Reid, A.L. Frank (Expert Review of Anticancer Therapy, 2020).

The study

• Authors: N. van Zandwijk, G. Reid, A.L. Frank
• Journal: Expert Review of Anticancer Therapy
• Published: 2020;20(4):271-278
• Type of article: Review
• Cited by: 25 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Asbestos, the most frequent cause of occupational cancer, continues to be consumed on a massive scale, with millions of people exposed on a daily basis. This review explains why we have failed in curtailing the silent epidemic of asbestos-related disease and why the numbers of asbestos victims are likely to remain high. Emerging and developed countries have to be reminded that asbestos exposure has yet to become a problem of the past. The worldwide spread of asbestos, followed by the surge of asbestos-related cancers, resembles the lung cancer epidemic caused by smoking and stimulated by manufacturers.Areas covered: Underreporting of malignant mesothelioma and asbestos-induced lung cancer, frequently-used arguments in the amphibole/chrysotile debate and the conclusion from bona-fide research organizations, that all forms of asbestos are carcinogenic, are reviewed. Special attention is paid to the consequences of ubiquitous environmental asbestos and the 'changing face' of malignant mesothelioma in countries with heavy asbestos use in the past.Expert opinion: Experts in oncology, respiratory medicine, occupational and public health, and basic researchers must take responsibility and acknowledge the ongoing silent epidemic of asbestos-related diseases. The call for a world-wide asbestos ban is more urgent than ever.

In plain English

This article is a narrative review, not a new study. The authors summarized published research and data on asbestos and cancer. They argued that asbestos-related disease remains a worldwide problem, especially where asbestos is still used without restriction, mainly in Asia. They covered all asbestos types: chrysotile and the amphiboles (amosite, crocidolite, tremolite, anthophyllite and actinolite). They wrote that unexpectedly low reported mesothelioma numbers in some countries reflect a lack of local pathology expertise rather than a lack of cancer-causing potency of asbestos. Among the work they cited were three sources. In Australian registry data, more than 20% of new male and more than 90% of new female mesothelioma cases reported asbestos exposure only outside work. In a Danish study of more than 12,000 former pupils, attending primary school near an asbestos cement plant was followed by a highly significant increase in mesothelioma later in life. In a follow-up of Italian chrysotile miners, mesothelioma risk rose with cumulative exposure. The authors stated that conclusive data linking environmental asbestos to lung cancer are not yet available. They concluded that a worldwide asbestos ban is more urgent than ever.

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 of published research and data. No new data were collected.
• Who was studied: No study population of its own. The review discusses published studies, registry data and asbestos use worldwide, with emphasis on emerging countries, especially in Asia.
• Exposure: All forms of asbestos: chrysotile (serpentine) and the amphiboles amosite, crocidolite, tremolite, anthophyllite and actinolite. The review covers occupational, para-occupational (household) and environmental exposure.
• Main results:
  • Citing Australian Mesothelioma Registry data, the review reports that in 2017 mesothelioma incidence in Australia was not yet declining. More than 20% of newly registered male cases and more than 90% of female cases reported asbestos exposure in non-occupational-only settings.
  • Citing a Danish register-based cohort study of more than 12,000 former school pupils followed for more than 60 years, the review reports that attending primary school near an asbestos cement plant led to a highly significant increase in mesothelioma incidence in later life.
  • Citing a follow-up study of Italian chrysotile miners, the review reports that pleural and peritoneal cancer mortality and mesothelioma incidence rose with increasing cumulative exposure, duration and latency. Similar trends were seen for lung cancer.
  • Citing an earlier study of a factory making crocidolite-containing cigarette filters, the review reports the following for the 33 people who had worked there: 15 died from cancer (8 lung cancer cases and 5 mesotheliomas) and 5 died from asbestosis. The review prints a relative risk of 8.2 (95% confidence interval 4.6 to 13.4) next to the cancer deaths.
  • The authors stated that unexpectedly low numbers of mesothelioma cases reported in emerging countries reflect a lack of local pathology expertise, not a lack of carcinogenic potency of asbestos.
  • Citing other work, the review reports that India consumes more than 300,000 metric tons of asbestos each year and that 1.25 million asbestos-related cancer patients are expected there.
• The authors' conclusion: The authors concluded that experts must acknowledge an ongoing silent epidemic of asbestos-related disease, and that the call for a worldwide asbestos ban is more urgent than ever.
• Limitations the authors state:
  • The authors stated that conclusive data on the association between environmental asbestos and lung cancer incidence are not yet available.
  • The authors stated that the links between asbestos and cancers of the ovary, larynx and GI tract rest largely on epidemiological studies. Many of those studies do not account for co-factors such as smoking and alcohol, and more research is needed.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Lung Cancer, Malignant Mesothelioma, Amphibole Group, Chrysotile, Carcinogenic.

Related studies

• Asbestos still poses a threat to global health: now is the time for action — P.D. Sly, R. Chase, et al. (2010)
• The global health dimensions of asbestos and asbestos-related diseases — C. Ramazzini (2016)
• The JPC-SE position statement on asbestos: a long-overdue appeal by epidemiologists to ban asbestos worldwide and end related global environmental injustice — W.K. Al-Delaimy (2013)
• Asbestos fibres inhibit the in vitro activity of lymphokine-activated killer (LAK) cells from healthy individuals and patients with malignant mesothelioma — L.S. Manning, M.R. Davis, et al. (1991)
• Effects of in vitro asbestos exposure on natural killer and antibody-dependent cellular cytotoxicity — R.G. Barbers, J. Oishi (1987)
• Exposing Hidden Targets: Combining epigenetic and immunotherapy to overcome cancer resistance — K. Olino, T. Park, et al. (2020)

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