Elimination of asbestos use and asbestos-related diseases: an unfinished story

Our plain-English summary of Elimination of asbestos use and asbestos-related diseases: an unfinished story, by E.K. Park, K. Takahashi, Y. Jiang, et al (Cancer Science, 2012).

The study

• Authors: E.K. Park, K. Takahashi, Y. Jiang, M. Movahed, T. Kameda
• Journal: Cancer Science
• Published: 2012;103(10):1751-5
• Type of article: Review
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Asbestos is a proven human carcinogen. Asbestos-related diseases (ARDs) typically comprise lung cancer, malignant mesothelioma, asbestosis, pleural plaques, thickening and effusion. International organizations, notably the World Health Organization and the International Labour Organization, have repeatedly declared the need to eliminate ARDs, and have called on countries to stop using asbestos. However, the relevant national-level indicators (e.g., incidence/mortality rates and per capita asbestos use, as well as their interrelationships) indicate that ARDs are increasing and asbestos use is continuing in the world. Lessons learned by industrialized countries in terms of policy and science have led to a growing number of countries adopting bans. In contrast, industrializing countries are faced with a myriad of forces prompting them to continue using asbestos. Full-scale international cooperation will thus be needed, with industrialized countries sharing their experiences and technologies to enable industrializing countries to make smooth transitions to banned states and achieve the goal of eliminating ARDs.

© 2012 Japanese Cancer Association.

In plain English

This was a review article by researchers in Korea and Japan on worldwide asbestos use and asbestos-related diseases. Part of it summarized the authors' earlier studies of national data, alongside WHO and IARC assessments and other researchers' work. The review noted that global asbestos use stayed at about 2.1 million metric tons per year during 2003–2007. An earlier WHO database analysis found 92 253 mesothelioma deaths reported by 83 countries in 1994–2008, with crude and age-adjusted rates of 6.2 and 4.9 per million. An international comparison found that each 1 kg per capita of past asbestos use corresponded to a 2.4-fold increase in mesothelioma. A further study estimated 39 000 unreported mesothelioma cases in 33 countries over the 15-year period 1994–2008, led by Russia. The review also traced Japan's move to a total ban in 2006, with the last exemptions removed in March 2012. The authors concluded that stopping all asbestos use is the key to preventing future disease and called for worldwide cooperation. They acknowledged that national-level comparisons cannot show cause in individuals, but noted wide consensus that the evidence of causation is sufficient.

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: Review article (narrative review of published studies, national indicators and policy history)
• Who was studied: No study population of its own. The review covered published data on asbestos use and asbestos-related disease worldwide, including the authors' earlier national-level studies, WHO and IARC assessments and other researchers' work. It included a section on Japan's policy history and one on industrializing countries.
• Exposure: Asbestos in general, including all commercial types (chrysotile, crocidolite, amosite, anthophyllite, tremolite and actinolite). The review noted that chrysotile made up 95% of asbestos used worldwide since 1900.
• Main results:
  • The review reported, citing published supply data, that global asbestos use remained fairly stable at 2.1 million metric tons per year during 2003–2007.
  • An earlier analysis by the authors' group of the WHO mortality database (83 countries, 92 253 mesothelioma deaths, 1994–2008) found crude and age-adjusted mortality rates of 6.2 and 4.9 per million. The age-adjusted rate increased by 5.4% per year.
  • An earlier international ecological study found that historical asbestos use explained 74% of the variation in mesothelioma and 79% of that for asbestosis. An increment of 1 kg per capita asbestos use corresponded to a 2.4-fold increase in mesothelioma and a 2.7-fold increase in asbestosis.
  • An earlier study found that adopting an asbestos ban doubled the pace of reduction in asbestos use. It also found that changes in asbestos use during 1970–1985 correlated with changes in age-adjusted pleural mesothelioma mortality during 1996–2005 (R2 = 0.47, P less than 0.0001).
  • An earlier study estimated 39 000 unreported mesothelioma cases in 33 countries over the 15-year period 1994–2008. Russia led with 21 308 estimated missing cases, followed by Kazakhstan (6500), China (5107), India (2158) and Thailand (545).
  • Asia accounts for 64% of the world's current asbestos use but only 13% of recent asbestos-related deaths in the WHO mortality data.
  • Japan adopted a total asbestos ban on 1 September 2006, with a list of exempted items. The exemptions were completely eliminated on 1 March 2012.
• The authors' conclusion: The authors concluded that the key to countering the future burden of asbestos-related disease is to stop the use of all asbestos. They called on the international community to promote worldwide cooperation among asbestos-dependent, banned and in-transition countries.
• Limitations the authors state:
  • The authors acknowledged that ecological (national-level) analyses are often criticized for the 'ecological fallacy', the error of drawing individual-level causal inferences from aggregate data. They added that, for asbestos-related diseases, there is wide consensus that the evidence for causality is sufficient.
  • For their earlier study of asbestos bans, the authors noted that the observation period for disease rates probably did not extend far enough to capture the full effects of the bans.

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Malignant Mesothelioma, Pleural Plaques.

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