International Journal of Environmental Research and Public Health

About the journal

Publisher: MDPI
Published: 2004 to the present, Switzerland
Language: English
ISSN: 1660-4601 (electronic), 1661-7827 (print)
Its record in the NLM Catalog

2020s

Economic Impact of Asbestos in Colombia: Estimation of the Direct and Societal Costs of Lung Cancer and Mesothelioma in 2022. G. Villamizar, T. Driscoll, S. McArdle, et al. 2026;23(8). PubMed · Publisher · Free full text

Abstract

Asbestos exposure remains an important cause of lung cancer and mesothelioma worldwide, and the long latency of asbestos-related diseases means that health and economic consequences persist even after asbestos bans. In Colombia, the economic burden attributable to historical asbestos exposure has not been comprehensively quantified. This study estimated the economic burden attributable to asbestos exposure in Colombia in 2022 using a prevalence-based cost-of-illness framework from a societal perspective. Direct medical costs were derived from a national lung cancer cost study and updated to 2022 values. Epidemiological inputs were obtained from the Global Burden of Disease (GBD) database. Mesothelioma was considered predominantly attributable to asbestos exposure, while lung cancer was adjusted using population-attributable fractions and an alternative 1:3 mesothelioma-to-lung-cancer ratio scenario. Indirect costs were estimated using the human capital approach, and disability-adjusted life year (DALY) losses were monetized using alternative willingness-to-pay thresholds. Colombia was estimated to have 150 prevalent mesothelioma cases and between 389 and 450 asbestos-attributable lung cancer cases in 2022. Direct costs ranged from USD 6.5 to 10.7 million annually, increasing to USD 16.7-23.1 million when productivity losses were included. Expanded societal valuation scenarios ranged from USD 71 million to more than USD 180 million annually. Asbestos-related malignancies continue to impose a substantial economic burden in Colombia and support the need for strengthened surveillance, long-term management of installed asbestos, and policies aimed at reducing future asbestos-related disease burden.
Health, Work, Invisibilities and Collective Resistance in an Asbestos-Exposed Territory in the Pedro Leopoldo Region, (MG), Brazil. E.G. Felix, A.C. Guimaraes. 2026;23(3). PubMed · Publisher · Free full text

Abstract

Asbestos, a group 1 carcinogen, has generated a serious health and environmental liability in Pedro Leopoldo/MG, Brazil, even after its national ban in 2017. This study aims to analyze the silent epidemic of asbestos-related diseases (ARDs) through the lens of social injustice. We used a qualitative, socio-historical, and clinical approach within the framework of an Expanded Research Community (ERC), based on ergology, with content analysis of interviews with workers and institutional documents. The evidence reveals a pattern of institutional silencing and omission, marked by corporate fraud, denial of risk, and medical underreporting, perpetuating occupational, domestic, and environmental exposure. In response, the Brazilian Association of Asbestos-Exposed Individuals of Minas Gerais (ABREA/MG) emerged as a central actor in the struggle for recognition and justice. It is concluded that overcoming this injustice requires structured public policies of recognition, integrated surveillance, historical reparation, and strengthening of the SUS (Unified Health System), with collective resistance being fundamental to transforming suffering into memory and social demands.
Persistence of Asbestos-Containing Friction Materials in the Hungarian Waste Stream Twenty Years After the European Union Ban. Á. Szandi, Z. Balog, K.S. Zaka, et al. 2026;23(6). PubMed · Publisher · Free full text

Abstract

Although asbestos has been banned in the European Union since 2005, asbestos-containing materials, such as brake pads and clutch linings, may still occur in waste streams due to the long service life of vehicles, legacy equipment, and international trade in spare parts. The persistence of these materials raises environmental and occupational health concerns, particularly in waste management systems. This study aims to assess the presence, temporal trends, and sectoral distribution of asbestos-containing friction materials in the Hungarian waste management system two decades after the EU ban, and to evaluate the associated regulatory and occupational risk implications. The analysis is based on national hazardous waste datasets classified under EWC code 16 01 11* (asbestos-containing brake pads), with a specific focus on this waste category rather than on the full range of asbestos-related waste streams recorded in the national database. The results indicate that asbestos-containing friction materials are still present in the waste stream, with measurable quantities recorded annually. Despite regulatory control, identification challenges and potential misclassification may contribute to underreporting. The continued occurrence of asbestos-containing materials highlights the persistence of legacy hazardous materials within circular economy systems. Strengthened monitoring, improved identification protocols, and enhanced occupational safety measures are necessary to mitigate residual exposure risks. The findings underline that asbestos is not merely a historical issue but remains a contemporary environmental and public health challenge.
A Community-Based Assessment of Attitudes, Health Impacts and Protective Actions During the 24-Day Hangar Fire in Tustin, California. S. Masri, A.M.W. LeBrón, A. Zhang, et al. 2025;22(7). PubMed · Publisher · Free full text

Abstract

Fire events can impact physical and mental health through smoke exposure, evacuation, property loss, and/or other environmental stressors. In this study, we developed community-driven, cross-sectional online surveys to assess public attitudes, health impacts, and protective actions of residents affected by the Tustin hangar fire that burned for 24 days in southern California. Results showed the most frequently reported fire-related exposure concerns (93%) to be asbestos and general air pollution and the most commonly reported mental health impacts to be anxiety (41%), physical fatigue (37%), headaches (33%), and stress (26%). Nose/sinus irritation was the most commonly reported (26.0%) respiratory symptom, while skin- and eye-related conditions were reported by 63.0% and 72.2% of the survey population, respectively. The most commonly reported health-protective actions taken by residents included staying indoors and/or closing doors and windows (67%), followed by wearing face masks (37%) and the indoor use of air purifiers (35%). A higher proportion of low-income residents had to spend money on remediation or other health-protective actions compared to high-income residents. Participants overwhelmingly reported disapproval of their city's and/or government's response to the fire disaster. Findings from this study underscore the potential impacts of major pollution events on neighboring communities and offer critical insights to better position government agencies to respond during future disasters while effectively communicating with the public and addressing community needs.
Epidemiological Trends in Mesothelioma Mortality in Colombia (1997-2022): A Retrospective National Study. L.F. Moyano-Ariza, G. Villamizar, G. Henríquez-Mendoza, et al. 2025;22(5). PubMed · Publisher · Free full text

Abstract

Background: Mesothelioma is a rare and aggressive cancer primarily caused by asbestos exposure. In Colombia, asbestos use began in 1942, but mortality surveillance remains limited. Long latency periods and poor documentation hinder public health action.

Materials And Methods: A retrospective descriptive study was conducted using mortality data from 1997 to 2022 obtained from the National Administrative Department of Statistics (DANE), including all mesothelioma cases recorded under the five ICD-10 diagnostic categories (C45.0 to C45.9), covering all anatomical sites of first occurrence. Variables analyzed included sex, age, occupation, and place of residence. Mortality rates and trends were estimated using R, Excel, JoinPoint, and Minitab.

Results: A total of 1539 mesothelioma deaths were recorded. Most occurred in men (65.1%) and in individuals over 60 years old (62.6%). Urban areas accounted for 92% of deaths. The most frequent diagnosis was unspecified mesothelioma (61.3%). Cities with the highest adjusted mortality rates per 100,000 inhabitants were Sibaté (38.36), Soacha (8.41), and Bogotá (1.89), aligning with historical exposure zones.

Conclusions: Mesothelioma is still a preventable public health issue in Colombia, with sustained mortality affecting even working-age populations. The high rate of unspecified diagnoses and weak linkage between morbidity and mortality data underscore the need to strengthen diagnostic capacity, improve surveillance, and implement a national asbestos-related disease elimination strategy.
Examining the Environmental Ramifications of Asbestos Fiber Movement Through the Water-Soil Continuum: A Review. G.Z. Macher, A. Torma, D. Beke. 2025;22(4). Systematic review PubMed · Publisher · Free full text

Abstract

The environmental pollution potential of asbestos products is a worldwide health issue, but their dissemination through the water-soil continuum is often an overlooked aspect. Similarly, the behavior of asbestos fibers released from the products is still not fully understood, although our knowledge is based on studies concerning their mineralogical characteristics, health effects, and waste disposal. It has been claimed and contradicted that asbestos harm is only found in air and humans. Asbestos fibers are found not only in industrial settings but also through the industrial use of asbestos cement products, which has contributed to asbestos emissions and its movement in water and soil. Asbestos fibers are diverse in their physicochemical properties, and this diversity has a significant influence on their behavior in the environment. Recent research has confirmed that asbestos can be transported by water and spread to other parts of the environment. However, the mechanisms underlying this, such as the settling of fibers, their attachment to soil particles, or their movement in groundwater, as well as the environmental and health implications, require further investigation. This paper examines the process and impact of asbestos contamination in the interconnected water, soil, and plant environmental sectors, providing a systematic review of the latest literature.
Marble Waste Dump Yard in Rajasthan, India Revealed as a Potential Asbestos Exposure Hazard. R. Singh, S. Fitzgerald, R. Dada, et al. 2025;22(2). PubMed · Publisher · Free full text

Abstract

Asbestos is a fibrous variety of certain minerals, some of which occur naturally as an accessory to a wide variety of mineral resources. Although asbestos itself has been historically mined for various useful properties, the negative health effects of asbestos dust have greatly diminished it as a useful earth material, as many countries have banned the use of these fibrous minerals based on those health concerns. Resulting regulations of asbestos have focused primarily on intentionally mined material used in product manufacturing, such as building materials made with beneficiated asbestos and their derivative exposures, e.g., airborne asbestos in schools with asbestos-containing materials. The hazards of asbestos as unintended byproducts have not been as extensively considered, although this "contamination" has been repeatedly observed in common earth materials including talc, vermiculite, sand, and gravel. This study reveals such contamination of ornamental and dimension stone commonly referred to as "marble". Asbestos types that can be associated with certain Indian marble reserves include asbestiform tremolite, actinolite, anthophyllite, and chrysotile asbestos. This case reveals such contamination in a marble reserve in Rajsamand, Rajasthan. At this location, marble dust in slurry is disposed at waste collection points, unfortunately including a location now open to the public that has become a tourist destination. Using Transmission Electron Microscopy (TEM) in this study, dust from this location revealed abundant tremolite asbestos fibres in the disaggregated dust. This poses potential health risks to the workers, bystanders, and tourists that may be exposed to this recognized carcinogen, a known cause of mesothelioma, lung cancer, and other asbestos-related diseases.
Measurement and Evaluation of Dust Concentrations in the Air After the Kahramanmaraş Earthquake in Turkey. T. Oral, M. Ensari Özay, R. Uçan, et al. 2025;22(4). PubMed · Publisher · Free full text

Abstract

The 6 February 2023 earthquake in Kahramanmaraş, Turkey, caused significant debris accumulation, raising concerns about air quality and public health. This study assessed dust concentrations during debris removal and emergency response efforts over a five-day period. Post-disaster respirable and total dust concentrations were measured using dust monitoring devices and the MDHS-14/3 gravimetric method. Scanning electron microscopy (SEM) and energy-dispersive X-ray (EDX) analyses identified fibrous structures and elements associated with asbestos, suggesting potential long-term health risks such as asbestosis and lung cancer. The average respirable dust concentration was 30.84 mg/m3, and the total dust concentration was 33.66 mg/m3. The findings emphasize the urgent need for protective measures to mitigate exposure risks for affected populations and emergency responders. Integrating health risk assessments into disaster management strategies are crucial to reducing long-term public health impacts.
Mosses in Urban Environments as Passive Biofilters and Organisms Impacted by Asbestos-Contaminated Habitats. G.Z. Macher, D. Beke. 2025;22(6). Review PubMed · Publisher · Free full text

Abstract

Asbestos cement materials represent a persistent source of environmental contamination, particularly in urban areas where weathering facilitates the release of hazardous chrysotile fibres. Despite extensive research on the human health impacts of asbestos, ecological interactions remain poorly understood. This paper explores the dual role of bryophytes colonising asbestos cement roofing as passive filters that trap airborne fibres and as vulnerable organisms subjected to asbestos-induced stress. Using a synthesis of recent findings, we assess the capacity of mosses to immobilise chrysotile fibres through their dense, mat-like structures, potentially reducing local dispersion. Simultaneously, we examine physiological and biochemical responses to prolonged fibre exposure, including reduced photosynthetic activity and signs of oxidative stress. The findings highlight a paradoxical function of bryophytes: while they contribute to pollution mitigation, they also accumulate contaminants and suffer from sublethal damage. These interactions may have broader implications for contaminant redistribution, particularly through decomposition and trophic transfer. Understanding these dynamics is essential for advancing ecological risk assessments and developing sustainable remediation strategies in asbestos-contaminated habitats.
A Comparative Analysis of Lung Cancer Incidence and Tobacco Consumption in Canada, Norway and Sweden: A Population-Based Study. J. Chen. 2023;20(20). PubMed · Publisher · Free full text

Abstract

Risk factors for developing lung cancer include tobacco smoking, exposure to second-hand smoke, radon gas, asbestos and other carcinogens, as well as air pollution and aging. Canada, Norway and Sweden are three Arctic countries that are very similar in socioeconomic status, similar in the social determinants of health and many environmental factors, including current smoking rates. However, lung cancer incidence rates differ significantly among the three countries. Since tobacco smoking is the principal risk factor for developing lung cancer, and there is a long lag time between tobacco consumption and lung cancer incidence at the population average level, a comparative analysis is conducted with historical data available publicly in the three countries to demonstrate how tobacco consumption in the past impacts lung cancer incidence decades late. The analysis shows that lung cancer incidence rates increase proportionally with the increasing tobacco consumption rates with a lag time of 20-30 years. On average, one more cigarette smoked per person per day can increase lung cancer cases by 2 to 5 per 100,000 population.
After a Century of Research into Environmental Mutagens and Carcinogens, Where Do We Stand?. J.D. Vitorino, P.M. Costa. 2023;20(2). Review PubMed · Publisher · Free full text

Abstract

Cancer is one of the longest-known human diseases, yet only in recent times have we begun to perceive that the percentage of neoplasms caused by environmental factors, lifestyle and chemicals, is likely underestimated. The first medical reports associating cancer with pollutants like tars appeared by the early 20th century, but despite initial evidence relating oncogenesis and chromosomal alterations, only after the structure of DNA had been elucidated in the 1950s have genetic disorders been fully perceived as cause. This led to a growing interest in genotoxic and mutagenic pollutants. Even though we are now familiar with a range of environmental carcinogens spanning between aromatic hydrocarbons and asbestos to radionuclides and forms of carbon nanomaterials, establishing causal networks between pollutants and cancer remains cumbersome. In most part, this is due to the complexity of toxicant matrices, unknown modes-of-action of chemicals or their mixtures, the widening array of novel pollutants plus difficulties in subtracting background effects from true aetiology of disease. Recent advances in analytical chemistry, high-throughput toxicology, next-generation sequencing, computational biology and databases that allocate whole normal and cancer genomes, all indicate that we are on the verge of a new age of research into mechanistic 'oncotoxicology', but how can it impact risk assessment and prevention?
Laying the Foundation for a Mesothelioma Patient Registry: Development of Data Collection Tools. J.M. Gaitens, M. Culligan, J.S. Friedberg, et al. 2023;20(6). PubMed · Publisher · Free full text

Abstract

Mesothelioma, a cancer of mesothelial cells that line the chest, lungs, heart, and abdomen, is a relatively rare disease. In the United States, approximately 3000 individuals are diagnosed with mesothelioma annually. The primary risk factor for mesothelioma is occupational asbestos exposure which can occur decades prior to disease development, though in approximately 20% of cases, known asbestos exposure is lacking. While several other countries have developed mesothelioma registries to collect key clinical and exposure data elements to allow better estimation of incidence, prevalence, and risk factors associated with disease development, no national mesothelioma registry exists in the U.S. Therefore, as part of a larger feasibility study, a patient exposure questionnaire and a clinical data collection tool were created using a series of key informant interviews. Findings suggest that risk factor and clinical data collection via an on-line questionnaire is feasible, but specific concerns related to confidentiality, in the context of employer responsibility for exposure in the unique U.S. legal environment, and timing of enrollment must be addressed. Lessons learned from piloting these tools will inform the design and implementation of a mesothelioma registry of national scope.
Mesothelioma Due to Workplace Exposure: A Comprehensive Bibliometric Analysis of Current Situation and Future Trends. H. Lai, C. Hu, M. Qu, et al. 2023;20(4). Review PubMed · Publisher · Free full text

Abstract

Background: This article provides an overview of the current status and research progress of mesothelioma. Methods: A total of 2638 documents published from 1 January 2004 to 30 November 2022 were retrieved from the Web of Science Core Collection and analyzed via Microsoft Office Excel 2019, VOSviewer 1.6.18, and Tableau 2022.2. Results: There was an obvious increase in the number of publications regarding mesothelioma in the last 18 years, with the United States dominating the research field with 715 publications and 23,882 citations, while the University of Turin contributed the most (118). Occupational & Environmental Medicine was the most popular journal (80), with Corrado Magnani being the most prolific author (52) and Michele Carbone obtaining the most citations (4472). "Oncology" and "Health Science of Environment & Occupation" were the two main subjects, while the keywords "asbestos", "lung cancer", "gene expression", "apoptosis", "survival", and "cisplatin" were the most popular. Conclusions: The containment of mesothelioma calls for more participation from low- and middle-income countries, and further attention needs to be paid to clinical research.
The Brazilian System for Monitoring Workers and General Population Exposed to Asbestos: Development, Challenges, and Opportunities for Workers' Health Surveillance. R.J. Buralli, R.D.C. Pinheiro, L.L. Susviela, et al. 2023;20(5). PubMed · Publisher · Free full text

Abstract

Unlabelled: The lack of safe levels of asbestos exposure and the long latency of asbestos-related disease (ARD) makes workers' health surveillance challenging, especially in lower-income countries. This paper aims to present the recently developed Brazilian system for monitoring workers and general population exposed to asbestos (Datamianto), and to discuss the main challenges and opportunities for workers' health surveillance.

Methods: a descriptive study of the Datamianto development process, examining all the stages of system planning, development, improvement, validation, availability, and training of health services for its use, in addition to presenting the main challenges and opportunities for its implementation.

Results: The system was developed by a group of software developers, workers' health specialists, and practitioners, and it was recently incorporated by the Ministry of Health to be used for workers' health surveillance. It can facilitate the monitoring of exposed individuals, epidemiological data analysis, promote cooperation between health services, and ensure periodical medical screening guaranteed to workers by labor legislation. Moreover, the system has a Business Intelligence (BI) platform to analyze epidemiologic data and produce near real-time reports.

Conclusions: Datamianto can support and qualify the healthcare and surveillance of asbestos-exposed workers and ARD, promoting a better quality of life for workers and improving companies' compliance with legislation. Even so, the system's significance, applicability, and longevity will depend on the efforts aimed at its implementation and improvement.
The Epidemiological Surveillance of Mesothelioma Mortality in Italy as a Tool for the Prevention of Asbestos Exposure. L. Fazzo, G. Minelli, M. De Santis, et al. 2023;20(11). PubMed · Publisher · Free full text

Abstract

As part of a surveillance plan active since the early 1990s, this study evaluates malignant mesothelioma (MM) mortality for the time-window 2010-2019 in Italy, a country that banned asbestos in 1992. National and regional mortality rates for MM, and municipal standardized mortality ratios (all mesotheliomas, pleural (MPM) and peritoneal (MPeM)), by gender and age group were calculated. A municipal clustering analysis was also performed. There were 15,446 deaths from MM (11,161 males, 3.8 × 100,000; 4285 females, 1.1 × 100,000), of which 12,496 were MPM and 661 were MPeM. In the study period, 266 people ≤50 years died from MM. A slightly decreasing rate among males since 2014 was observed. The areas at major risk hosted asbestos-cement plants, asbestos mines (chrysotile in Balangero), shipyards, petrochemical and chemical plants, and refineries. Female mortality excesses particularly were found in municipalities with a fluoro-edenite-contaminated mine (Biancavilla) and textile facilities. Excesses were also found in a region with the presence of natural asbestos fibres and in males living in two small islands. The Italian National Prevention Plan stated recommendations to eliminate asbestos exposures and to implement health surveillance and healthcare for people exposed to asbestos.
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, A. Binazzi, et al. 2023;20(2). PubMed · Publisher · Free full text

Abstract

Asbestos (all forms, including chrysotile, crocidolite, amosite, tremolite, actinolite, and anthophyllite) is carcinogenic to humans and causally associated with mesothelioma and cancer of the lung, larynx, and ovary. It is one of the carcinogens most diffuse in the world, in workplaces, but also in the environment and is responsible for a very high global cancer burden. A large number of countries, mostly with high-income economies, has banned the use of asbestos which, however, is still widespread in low- and middle-income countries. It remains, thus, one of the most common occupational and environmental carcinogens worldwide. Italy issued an asbestos ban in 1992, following the dramatic observation of a large increase in mortality from mesothelioma and other asbestos-related diseases in exposed workers and also in subjects with non-occupational exposure. A mesothelioma registry was also organized and still monitors the occurrence of mesothelioma cases, conducting a case-by-case evaluation of asbestos exposure. In this report, we describe two Italian communities, Casale Monferrato and Broni, that faced an epidemic of mesothelioma resulting from the production of asbestos cement and the diffuse environmental exposure; we present the activity and results of the Italian mesothelioma registry (ReNaM), describe the risk-communication activities at the local and national level with a focus on international cooperation and also describe the interaction between mesothelioma registration and medical services specialized in mesothelioma diagnosis and treatment in an area at high risk of mesothelioma. Finally, we assess the potential application of the solutions and methods already developed in Italy in a city in Colombia with high mesothelioma incidence associated with the production of asbestos-cement materials and the presence of diffuse environmental asbestos pollution.
A Cohort Study on Cancer Incidence among Women Exposed to Environmental Asbestos in Childhood with a Focus on Female Cancers, including Breast Cancer. S.B. Dalsgaard, E.T. Würtz, J. Hansen, et al. 2022;19(4). PubMed · Publisher · Free full text

Abstract

Objectives: To examine the risk of cancer in former school children exposed to environmental asbestos in childhood with a focus on female cancers, including breast cancer.

Methods: We retrieved a cohort of females (n = 6024) attending four schools located in the neighborhood of a large asbestos cement plant in Denmark. A reference cohort was frequency-matched 1:9 (n = 54,200) in sex and five-year age intervals. Using Danish registries, we linked information on historical employments, relatives' employments, cancer, and vital status. We calculated standardized incidence rates (SIRs) for all and specific cancers, comparing these rates with the reference cohort. Hazard ratios were calculated for selected cancers adjusted for occupational and familial asbestos exposure.

Results: For cancer of the corpus uteri (SIR 1.29, 95% CI 1.01-1.66) and malignant mesothelioma (SIR 7.26, 95% CI 3.26-16.15), we observed significantly increased incidences. Occupationally, asbestos exposure had a significantly increased hazard ratio for cancer in the cervix, however, a significantly lower risk of ovarian cancer. The overall cancer incidence was similar to that of the reference cohort (SIR 1.02, 95% CI 0.96-1.07). The risk of cancer of the lung was increased for those exposed to occupational asbestos, those with family members occupationally exposed to asbestos and for tobacco smokers.

Conclusions: In our study, environmental asbestos exposure in childhood is associated with an increased risk of cancer of the corpus uteri and malignant mesothelioma in women.
Application of Pattern Mining Methods to Assess Exposures to Multiple Airborne Chemical Agents in Two Large Occupational Exposure Databases from France. J.F. Sauvé, A. Emili, G. Mater. 2022;19(3). PubMed · Publisher · Free full text

Abstract

Surveys of the French working population estimate that approximately 15% of all workers may be exposed to at least three different chemical agents, but the most prevalent coexposure situations and their associated health risks remain relatively understudied. To characterize occupational coexposure situations in France, we extracted personal measurement data from COLCHIC and SCOLA, two large administrative occupation exposure databases. We selected 118 chemical agents that had ≥100 measurements with detected concentrations over the period 2010-2019, including 31 carcinogens (IARC groups 1, 2A, and 2B). We grouped measurements by work situations (WS, combination of sector, occupation, task, and year). We characterized the mixtures across WS using frequent itemset mining and association rules mining. The 275,213 measurements extracted came from 32,670 WS and encompassing 4692 unique mixtures. Workers in 32% of all WS were exposed to ≥2 agents (median 3 agents/WS) and 13% of all WS contained ≥2 carcinogens (median 2 carcinogens/WS). The most frequent coexposures were ethylbenzene-xylene (1550 WS), quartz-cristobalite (1417 WS), and toluene-xylene (1305 WS). Prevalent combinations of carcinogens also included hexavalent chromium-lead (368 WS) and benzene-ethylbenzene (314 WS). Wood dust (6% of WS exposed to at least one other agent) and asbestos (8%) had the least amount of WS coexposed with other agents. Tasks with the highest proportions of coexposure to carcinogens include electric arc welding (37% of WS with coexposure), polymerization and distillation (34%), and construction drilling and excavating (34%). Overall, the coexposure to multiple chemical agents, including carcinogens, was highly prevalent in the databases, and should be taken into account when assessing exposure risks in the workplace.
Asbestos and Other Hazardous Fibrous Minerals: Potential Exposure Pathways and Associated Health Risks. T.A. Berry, E. Belluso, R. Vigliaturo, et al. 2022;19(7). Review PubMed · Publisher · Free full text

Abstract

There are six elongate mineral particles (EMPs) corresponding to specific dimensional and morphological criteria, known as asbestos. Responsible for health issues including asbestosis, and malignant mesothelioma, asbestos has been well researched. Despite this, significant exposure continues to occur throughout the world, potentially affecting 125 million people in the workplace and causing thousands of deaths annually from exposure in homes. However, there are other EMPS, such as fibrous/asbestiform erionite, that are classified as carcinogens and have been linked to cancers in areas where it has been incorporated into local building materials or released into the environment through earthmoving activities. Erionite is a more potent carcinogen than asbestos but as it is seldom used for commercial purposes, exposure pathways have been less well studied. Despite the apparent similarities between asbestos and fibrous erionite, their health risks and exposure pathways are quite different. This article examines the hazards presented by EMPs with a particular focus on fibrous erionite. It includes a discussion of the global locations of erionite and similar hazardous minerals, a comparison of the multiple exposure pathways for asbestos and fibrous erionite, a brief discussion of the confusing nomenclature associated with EMPs, and considerations of increasing global mesothelioma cases.
Asbestos Exposure and Severity of COVID-19. G. Granados, M. Sáez-López, C. Aljama, et al. 2022;19(23). PubMed · Publisher · Free full text

Abstract

Background: The aim of this study was to analyse the relationship between occupational exposure to asbestos and the severity of SARS-CoV-2 infection.

Methods: We evaluated patients who survived admission in our centre for COVID-19 pneumonia. Demographic, analytical, and clinical variables were collected during admission. After discharge, a previously validated occupational exposure to asbestos questionnaire was administered. Spirometry, CO diffusion test, the 6-min walk test, and high-resolution chest CT were performed. Patients who required respiratory support (oxygen, CPAP, or NIV) were considered severe.

Results: In total, 293 patients (mean age 54 + 13 years) were included. Occupational exposure to asbestos was detected in 67 (24%). Patients with occupational exposure to asbestos had a higher frequency of COVID-19 pneumonia requiring respiratory support (n = 52, 77.6%) than their unexposed peers (n = 139, 61.5%) (p = 0.015). Asbestos exposure was associated with COVID-19 severity in the univariate but not in the multivariate analysis. No differences were found regarding follow-up variables including spirometry and the DLCO diffusion, the 6-min walk test, and CT alterations.

Conclusions: In hospitalised patients with COVID-19 pneumonia, those with occupational exposure to asbestos more frequently needed respiratory support. However, an independent association between asbestos exposure and COVID-19 severity could not be confirmed.
Asbestos Exposure in Patients with Malignant Pleural Mesothelioma included in the PRIMATE Study, Lombardy, Italy. A. Spinazzè, D. Consonni, F. Borghi, et al. 2022;19(6). PubMed · Publisher · Free full text

Abstract

The PRIMATE study is an Italian translational research project, which aims to identify personalized biomarkers associated with clinical characteristics of malignant pleural mesothelioma (MPM). For this purpose, characteristics of MPM patients with different degrees of asbestos exposure will be compared to identify somatic mutations, germline polymorphism, and blood inflammatory biomarkers. In this framework, we assessed exposure to asbestos for 562 cases of MPM extracted from the Lombardy region Mesothelioma Registry (RML), for which a complete interview based on a standardized national questionnaire and histopathological specimens were available. Exposure assessment was performed: (1) through experts' evaluation (considered as the gold standard for the purpose of this study), according to the guidelines of the Italian National Mesothelioma Registry (ReNaM) and (2) using a job-exposure matrix (SYN-JEM) to obtain qualitative (ever/never) and quantitative estimates of occupational asbestos exposure (cumulative exposure expressed in fibers per mL (f/mL)). The performance of SYN-JEM was evaluated against the experts' evaluation. According to experts' evaluation, occupational asbestos exposure was recognized in 73.6% of men and 23.6% of women; furthermore, 29 men (7.8%) and 70 women (36.9%) had non-occupational exposure to asbestos. When applying SYN-JEM, 225 men (60.5%) and 25 women (13.2%) were classified as occupationally exposed, with a median cumulative exposure higher for men (1.7 f/mL-years) than for women (1.2 f/mL-years). The concordance between the two methods (Cohen's kappa) for occupational exposure assessment was 0.46 overall (0.41 in men, and 0.07 in women). Sensitivity was higher in men (0.73) than in women (0.18), while specificity was higher in women (0.88) than in men (0.74). Overall, both methods can be used to reconstruct past occupational exposure to asbestos, each with its own advantages and limitations.
Correction: Saito et al. Sex-Specific Mortality from Asbestos-Related Diseases, Lung and Ovarian Cancer in Municipalities with High Asbestos Consumption, Brazil, 2000-2017. Int. J. Environ. Res. Public Health 2022, 19, 3656. C.A. Saito, M.A. Bussacos, L. Salvi, et al. 2022;19(11). PubMed · Publisher · Free full text

Abstract

In the original publication [...].
Deep Learning for the Automatic Quantification of Pleural Plaques in Asbestos-Exposed Subjects. I. Benlala, B.D. De Senneville, G. Dournes, et al. 2022;19(3). PubMed · Publisher · Free full text

Abstract

Objective: This study aimed to develop and validate an automated artificial intelligence (AI)-driven quantification of pleural plaques in a population of retired workers previously occupationally exposed to asbestos.

Methods: CT scans of former workers previously occupationally exposed to asbestos who participated in the multicenter APEXS (Asbestos PostExposure Survey) study were collected retrospectively between 2010 and 2017 during the second and the third rounds of the survey. A hundred and forty-one participants with pleural plaques identified by expert radiologists at the 2nd and the 3rd CT screenings were included. Maximum Intensity Projection (MIP) with 5 mm thickness was used to reduce the number of CT slices for manual delineation. A Deep Learning AI algorithm using 2D-convolutional neural networks was trained with 8280 images from 138 CT scans of 69 participants for the semantic labeling of Pleural Plaques (PP). In all, 2160 CT images from 36 CT scans of 18 participants were used for AI testing versus ground-truth labels (GT). The clinical validity of the method was evaluated longitudinally in 54 participants with pleural plaques.

Results: The concordance correlation coefficient (CCC) between AI-driven and GT was almost perfect (>0.98) for the volume extent of both PP and calcified PP. The 2D pixel similarity overlap of AI versus GT was good (DICE = 0.63) for PP, whether they were calcified or not, and very good (DICE = 0.82) for calcified PP. A longitudinal comparison of the volumetric extent of PP showed a significant increase in PP volumes (p < 0.001) between the 2nd and the 3rd CT screenings with an average delay of 5 years.

Conclusions: AI allows a fully automated volumetric quantification of pleural plaques showing volumetric progression of PP over a five-year period. The reproducible PP volume evaluation may enable further investigations for the comprehension of the unclear relationships between pleural plaques and both respiratory function and occurrence of thoracic malignancy.
Disease Latency according to Asbestos Exposure Characteristics among Malignant Mesothelioma and Asbestos-Related Lung Cancer Cases in South Korea. D.A. Huh, W.R. Chae, Y.H. Choi, et al. 2022;19(23). PubMed · Publisher · Free full text

Abstract

Korea was one of the major consumers of asbestos in the late 1900s, and asbestos-related disease patients have been reported continuously to date, owing to long disease latency. Several studies have been conducted to predict the future incidence of malignant mesothelioma and lung cancer in Korea, but little is understood about the latency time. Therefore, the aim of this study is to estimate the latency period of malignant mesothelioma and asbestos-related lung cancer in Korea and its determinants. We obtained information from the Environmental Health Centers for Asbestos in Korea on the history of asbestos exposure and demographic characteristics of 1933 patients with malignant mesothelioma and asbestos-related lung cancer. In our study, the latency periods for malignant mesothelioma and lung cancer were 33.7 and 40.1 years, respectively. Regardless of the disease type, those with a history of exposure related to the production of asbestos-containing products or asbestos factories had the shortest latency period. In addition, we observed that those who worked in or lived near asbestos mines tended to have a relatively long disease latency. Smoking was associated with shorter latency, but no linear relationship between the lifetime smoking amount (expressed in pack years) and latent time was observed. In addition, the age of initial exposure showed a negative linear association with the latency period for mesothelioma and lung cancer.
Frequency of Asbestos Exposure and Histological Subtype of Ovarian Carcinoma. P. Vidican, O. Perol, J. Fevotte, et al. 2022;19(9). PubMed · Publisher · Free full text

Abstract

The International Agency for Research on Cancer established a causal link between asbestos exposure and ovarian cancer. However, the exposure frequency and histological characteristics of asbestos-associated ovarian cancers remain to be investigated in detail. This multicenter case-case study assessed the asbestos exposure in ovarian carcinoma (OC) patients, alongside its association with histological subtype. Women were recruited in four hospitals in Lyon, France. Histological reports were reviewed by a pathologist. Patient and family members' data were collected by phone-based questionnaires. Asbestos exposure was defined as direct (occupational and environmental) and indirect (via parents, partners, and children). An industrial hygienist assessed the probability and level of exposure. The 254 enrolled patients (mean age 60 years) reported having an average of 2.3 different jobs (mean working duration 29 years). The prevalence of direct and indirect asbestos exposure was 13% (mean exposure duration 11 years) and 46%, respectively. High-grade serous carcinoma accounted for 73% of all OCs and 82% of histological subtypes in women with direct exposure. After adjustment on a familial history of OC, no significant associations between asbestos exposure (direct and/or indirect) and high-grade serous carcinoma were found. Women with OC had a high prevalence of asbestos exposure. Establishing risk profiles, as reported here, is important in facilitating compensation for asbestos-related OCs and for the surveillance of women at risk.
Heavy Metals in Harvested Rainwater Used for Domestic Purposes in Rural Areas: Yatta Area, Palestine as a Case Study. F. Anabtawi, N. Mahmoud, I.A. Al-Khatib, et al. 2022;19(5). PubMed · Publisher · Free full text

Abstract

Rainwater harvesting is considered one of the most important water resources in the Palestinian countryside. In this research, the study area chosen for the study was Yatta town in Hebron city. 75 water samples were collected from 74 cisterns in a number of neighborhoods in Yatta, and a structured household survey was conducted with the same households where the water samples were collected. Statistical analysis was made using the SPSS software. An analysis for the samples was made using ICP-MS to test the existence of a number of heavy metals, namely Pb, Cr, Mn, Co, Ni, Cu, Zn and Cd. The results were compared with the WHO and Palestinian limits for drinking water quality. Considering the metals Mn, Co, Cu and Cd, neither of the samples exceeded any of the two limits. For the metals, Pb, Cr, and Ni, two samples exceeded both limits. For the metal, Zn, one sample exceeded the WHO limit only. Sources of pollution by heavy metals of the harvested rainwater were identified by means of a questionnaire distributed to the households. The results showed that except for nickel and the water collection surface of the cistern factor, there is no direct relationship between the factors and activities that may contribute to contaminate harvested rainwater with heavy metals and the existence of heavy metals beyond local and international limits. Based on the questionnaire and literature: Possible sources of lead and zinc are the roof, storage tanks, distribution systems and plumbing; possible sources of chromium are road dust, asbestos brakes and anthropogenic activities occurring around the house; possible source of nickel is leaching from metals in contact with harvested rainwater such as pipes and fittings which are used to collect the harvested rainwater. In addition, an assessment of the potential health risks due to contamination of the harvested rainwater by heavy metals was made for all the samples that exceeded either WHO limit or the Palestinian limit or both. The Chronic Daily Intake (CDI) and the Health Risk Index (HRI) were calculated. The assessment was made for both adults and children. The results showed that all the samples are considered safe (HRI < 1), which means that there are no potential health risks for consumers.
Historical Asbestos Measurements in Denmark-A National Database. A.S. Fonseca, A.K. Jørgensen, B.X. Larsen, et al. 2022;19(2). PubMed · Publisher · Free full text

Abstract

Objectives: Due to the long lag-time for health outcomes, historical asbestos exposure measurements are valuable to support assessments of associated occupational health effects, and also to assess time trends and effects of preventive measures.

Methods: Different sources of stored data were collated, assessed and refined to create a harmonized database on historical asbestos fibre concentrations measured in specific work tasks and different industries. The final database contains 9236 asbestos measurements from Danish workplaces collected from 1971 to 1997.

Results: The geometric mean of asbestos concentrations in different occupations and tasks ranged from 0.003 to 35 fibres cm-3. Highest concentrations were registered during handling of asbestos products in the construction services during the period 1981-1997. Although all the measured asbestos exposures without the use of respiratory equipment by the worker in the period of 1971-1997 exceeded the current 8-h time-weighted average exposure limit of 0.1 fibres cm-3, the majority of samples collected in the earlier period of 1971 to 1980 did not exceed the exposure limit of 2 fibres cm-3, which was in place at the time. All exposure data obtained from 1980 and onwards were found to be one seventh of the mean fibre concentrations in the previous measurement period. The impact of time shows a clear exponentially decreasing trend-line.

Conclusions: Despite limitations in coverage of different occupations and tasks associated with the inventoried historical asbestos measurements, the data are helpful to identify specific work scenarios within an industry, where relatively high asbestos exposure levels may still occur or have occurred from 1971 to 1997.
Immune Status of Workers with Professional Risk of Being Affected by Chrysotile Asbestos in Kazakhstan. S. Koigeldinova, A. Alexeyev, Z. Zharylkassyn, et al. 2022;19(21). PubMed · Publisher · Free full text

Abstract

The purpose of this research was to study the particularities of the immune status of workers in the field of chrysotile asbestos production, depending on their work experience and professional risk of being affected by chrysotile dust. The research covered 125 men, who were workers at the only enterprise dealing with the extraction and beneficiation of chrysotile ores in Kazakhstan. Indicants of cell immunity were detected by flow cytometry; IgA, IgM, and IgG were detected by a multiplex immunological assay. It was found that, among workers impacted by chrysotile asbestos for more than 15 years, compared with individuals who were not impacted by asbestos dust, the level of CD3+ T-cells was decreased (t = -8.76, p < 0.001), as well as the number of CD4+ T-cells (U = 1246.0, p < 0.001). Moreover, CD8+ T-cells increased (t = 5.308, p = 0.001), and neutrophil phagocytic activity also increased, by 1.2 times (U = 305.5, p < 0.001). It was found that working under the condition of professional contact with chrysotile asbestos dust modifies the indicants of humoral immunity, IgA, IgM, and IgG, to a lesser extent than those of cellular immunity.
Impact of Naturally Occurring Asbestos on Asbestos Ban: Regulations and Experience of the Republic of Korea. J. Kwon. 2022;19(2). Review PubMed · Publisher · Free full text

Abstract

This review examined the main issues debated in Korea regarding the production and use of materials containing naturally occurring asbestos (NOA) as impurities, and investigated the impacts of these debates on the asbestos ban, as well as the future implications. In Korea, incidents associated with the production and use of NOA-contaminated talc powders, construction rocks, serpentinites, and dolomite rocks raised public concern and led to accelerating the ban on asbestos. The main controversies concern policies on appropriate asbestos content limits, whether materials containing a trace amount of NOA should be banned, and the control of materials with high human exposure risk. To address recurring controversies, the implementation of preventive measures to manage elongated mineral particles and the use of transmission electron microscopy for more sensitive analysis need to be discussed, along with reaching social agreement on the controversial policies. To minimize the potential exposure to asbestos that may occur during the production and use of industrial minerals in the future, it is necessary to apply occupational exposure control measures and monitor the health effects of the relevant population groups. These national policies on NOA should be prepared based on close collaboration and discussion with policymakers, industry stakeholders, and related academic experts.
Job Exposure Matrix for Chrysotile Asbestos Fibre in the Asbestos Cement Manufacturing (ACM) Industry in Zimbabwe. B. Mutetwa, D. Moyo, D. Brouwer. 2022;19(5). PubMed · Publisher · Free full text

Abstract

Occupational chrysotile asbestos exposure data in Zimbabwe is limited. The aim of this study was therefore to develop a job exposure matrix (JEM) specific to the chrysotile asbestos cement manufacturing industry using the available personal exposure concentration data. Quantitative personal exposure chrysotile fibre concentration data collected by the two factories from 1996 to 2020 were used to construct the JEM. Exposure groups from which data was extracted were classified based on the Zimbabwe Standard Classification of Occupations (ZSCO), 2009-2019. Analysis of amphiboles in raw chrysotile was done by scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS). Descriptive statistics, namely mean, standard deviation and range were computed for the main variable, job/occupation. All jobs/occupations in both factories had annual mean personal exposure concentrations exceeding the OEL of 0.1 f/mL, except for the period from 2009 to 2016 in the Harare factory and the period from 2009 to 2020 in the Bulawayo factory. Despite the Harare factory having no AC manufacturing activity since 2017, personal exposure concentrations showed elevated levels for the period 2018-2020. Amphiboles were detected in almost all bulk samples of chrysotile asbestos analysed. The established JEM, which has been generated from actual local quantitative exposure measurements, can be used in evaluating historical exposure to chrysotile asbestos fibre, to better understand and predict occurrence of ARDs in future.
Lung Cancer Screening in Asbestos-Exposed Populations. S.B. Markowitz. 2022;19(5). Review PubMed · Publisher · Free full text

Abstract

Asbestos exposure is the most important cause of occupational lung cancer mortality. Two large randomized clinical trials in the U.S. and Europe conclusively demonstrate that annual low-dose chest CT (LDCT) scan screening reduces lung cancer mortality. Age and smoking are the chief risk factors tested in LDCT studies, but numerous risk prediction models that incorporate additional lung cancer risk factors have shown excellent performance. The studies of LDCT in asbestos-exposed populations shows favorable results but are variable in design and limited in size and generalizability. Outstanding questions include how to: (1) identify workers appropriate for screening, (2) organize screening programs, (3) inform and motivate people to screen, and (4) incorporate asbestos exposure into LDCT decision-making in clinical practice. Conclusion: Screening workers aged ≥50 years with a history of ≥5 years asbestos exposure (or fewer years given intense exposure) in combination with either (a) a history of smoking at least 10 pack-years with no limit on time since quitting, or (b) a history of asbestos-related fibrosis, chronic lung disease, family history of lung cancer, personal history of cancer, or exposure to multiple workplace lung carcinogens is a reasonable approach to LDCT eligibility, given current knowledge. The promotion of LDCT-based screening among asbestos-exposed workers is an urgent priority.
Near Missed Case of Occupational Pleural Malignant Mesothelioma, a Case Report and Latest Therapeutic Options. C.M. Handra, M. Chirila, R.A. Smarandescu, et al. 2022;19(22). Case report PubMed · Publisher · Free full text

Abstract

Asbestos use started to be gradually banned in Europe from 1991 onwards, and there are currently strict occupational exposure limits for asbestos. However, malignant mesothelioma has a long latency time (in some cases up to 50-60 years), so the risks related to asbestos exposure should not be forgotten. Considering the increased risk of lung cancer following the inhalation of asbestos fibers, lifetime health monitoring should be considered in people occupationally exposed to asbestos, with an emphasis on the respiratory system. An assessment of their occupational history should be performed rigorously, especially in the areas with a history of asbestos production/use, as this is a key element for an early diagnosis and appropriate treatment. This case report presents a near-missed case of occupational pleural malignant mesothelioma. The latency time between the first asbestos exposure and the diagnosis of occupational pleural malignant mesothelioma was 49 years. The accurate diagnosis was made two years after the first symptoms appeared.
Occupational Exposures and Esophageal Cancer: Prog Study. A. Gressier, G. Gourier, J.P. Metges, et al. 2022;19(16). PubMed · Publisher · Free full text

Abstract

Esophageal cancer is the sixth most common cause of cancer death worldwide. In France, Brittany is one of the regions most seriously affected. This increased incidence is usually linked to high rates of alcohol overconsumption and smoking, established risk factors for esophageal cancer, but the region has special occupational exposures. We aim to describe the occupational exposures of patients with esophageal cancer. Between June and October 2020, we conducted a monocentric descriptive study in a French Teaching Hospital and identified 37 eligible patients. We gathered data through a systematic individual interview for each participant and by an analysis of their medical file. We were able to include 36 patients; most were men (n = 27, 75.0%) and smokers (n = 25, 69.4%), 21 (58.3%) presented an adenocarcinoma esophageal cancer, 13 (36.1%) a squamous cell cancer, and 2 other types. On occupational exposure, patients declared respectively high exposure by manipulating asbestos materials for 11 (30.6%) patients, regularly in contact with benzene by handling fuel in 7 cases (19.4%), chlorinated solvents in 4 cases (11.1%), pesticides in 4 cases, and ionizing radiation exposure in 3 patients (8.3%). Our findings support the creation of a large-scale study to explore the impact of occupational exposures, particularly exposure to asbestos and hydrocarbons.
Occupational Mortality Matrix: A Tool for Epidemiological Assessment of Work-Related Risk Based on Current Data Sources. S. Massari, V.C. Malpassuti, A. Binazzi, et al. 2022;19(9). PubMed · Publisher · Free full text

Abstract

Mortality from occupational diseases significantly afflicts society, in terms of both economic costs and human suffering. The International Labour Organization (ILO) estimated that 2.4 million workers die from work-related diseases every year. In Europe, around 80,000 workers die from cancer attributed to occupational exposure to carcinogens. This study developed the Occupational Mortality Matrix (OMM) aimed to identify significant associations between causes of death and occupational sectors through an individual record linkage between mortality data and the administrative archive of occupational histories. The study population consisted of 6,433,492 deceased subjects in Italy (in the period 2005-2015), of which 2,723,152 records of work histories were retrieved (42%). The proportional mortality ratio (PMR) was estimated to investigate the excess of mortality for specific causes associated with occupational sectors. Higher PMRs were reported for traditionally risky occupations such as shipbuilding for mesothelioma cases (PMR: 8.15; 95% CI: 7.28-9.13) and leather production for sino-nasal cancer (PMR: 5.04; 95% CI: 3.54-7.19), as well as for unexpected risks such as male breast cancer in the pharmaceutical industry (PMR: 2.56; 95% CI: 1.33-4.93) and brain cancer in railways (PMR: 1.43; 95% CI: 1.24-1.66). The OMM proved to be a valid tool for research studies to generate hypotheses about the occupational etiology of diseases, and to monitor and support priority actions for risk reduction in workplaces.
Pathogenic Potential of Respirable Spodumene Cleavage Fragments following Application of Regulatory Counting Criteria for Asbestiform Fibres. M. Gardner, M. Cross, S. Reed, et al. 2022;19(24). PubMed · Publisher · Free full text

Abstract

Health risks from exposure to lithium-bearing spodumene cleavage fragments are unknown. While asbestiform fibres can lead to fibrosis, mesothelioma and lung cancer, controversy remains whether non-asbestiform cleavage fragments, having equivalent dimensions, elicit similar pathologic responses. The mineralogy of respirable particles from two alpha (α)-spodumene concentrate grades (chemical and technical) were characterised using semi-quantitative X-ray diffraction (XRD). Particles were measured using scanning electron microscopy (SEM) and the dimensions (length [L], diameter [D], aspect ratio [AR]) applied to regulatory counting criteria for asbestiform fibres. Application of the current World Health Organization (WHO) and National Occupational Health and Safety Commission (NOHSC) counting criteria, L ˃ 5 µm, D ˂ 3 µm, AR ˃ 3:1, to 10 SEM images of each grade identified 47 countable particles in the chemical and 37 in the technical concentrate test samples. Of these particles, 17 and 16 in the chemical and technical test samples, respectively, satisfied the more rigorous, previously used Mines Safety and Inspection Regulations 1995 (Western Australia [WA]) criteria, L ˃ 5 µm and D ≤ 1 µm. The majority of the countable particles were consistent with α-spodumene cleavage fragments. These results suggest elongated α-spodumene particles may pose a health risk. It is recommended the precautionary principle be applied to respirable α-spodumene particles and the identification and control of dust hazards in spodumene extraction, handling and processing industries be implemented.
Prediction of Asbestos-Related Diseases (ARDs) and Chrysotile Asbestos Exposure Concentrations in Asbestos-Cement (AC) Manufacturing Factories in Zimbabwe. B. Mutetwa, D. Moyo, D. Brouwer. 2022;20(1). PubMed · Publisher · Free full text

Abstract

The use of historical asbestos measurement data in occupational exposure assessment is essential as it allows more quantitative analysis of possible exposure response relationships in asbestos-related disease (ARD) occurrence. The aim of this study was to predict possible ARDs, namely lung cancer, mesothelioma, gastrointestinal cancer, and asbestosis, in two chrysotile asbestos cement (AC) manufacturing factories. Prediction of ARDs was done using a specific designed job-exposure matrix for airborne chrysotile asbestos fibre concentrations obtained from the Harare and Bulawayo AC factories and through application of OSHA's linear dose effect model in which ARDs were estimated through extrapolation at 1, 10, 20, and 25 years of exposure. The results show that more cancer and asbestosis cases are likely to be experienced among those exposed before 2008 as exposure levels and subsequently cumulative exposure were generally much higher than those experienced after 2008. After a possible exposure period of 25 years, overall cancer cases predicted in the Harare factory were 325 cases per 100,000 workers, while for the Bulawayo factory, 347 cancer cases per 100,000 workers exposed may be experienced. Possible high numbers of ARDs are likely to be associated with specific tasks/job titles, e.g., saw cutting, kollergang, fettling table, ground hard waste, and possibly pipe-making operations, as cumulative exposures, though lower than reported in other studies, may present higher risk of health impairment. The study gives insights into possible ARDs, namely lung cancer, mesothelioma, gastrointestinal cancer, and asbestosis, that may be anticipated at various cumulative exposures over 1, 10, 20, and 25 years of exposure in AC manufacturing factories in Zimbabwe. Additionally, results from the study can also form a basis for more in-depth assessment of asbestos cancer morbidity studies in the AC manufacturing industries.
Prevention of Occupational Hazards Due to Asbestos Exposure in Dentistry. A Proposal from a Panel of Experts. C. Anaya-Aguilar, M. Bravo, A. Magan-Fernandez, et al. 2022;19(6). PubMed · Publisher · Free full text

Abstract

Asbestos in all its forms is a Group 1 material agent with proven carcinogenic effects in the human being since 1977. Exposure to asbestos can be considered unsafe. The use of asbestos in the field of dentistry had a common use in the manufacture of dental prostheses in the 1960s and 1970s. Taking into account the long induction period of this agent and the plausibility for being a risk factor in dentistry, the objective of this study is to propose a plan for the prevention of occupational risks due to asbestos exposure in dentistry by means of the contribution of a panel of experts. An Expert Panel (EP) approach was used in which a group of nine experts identified and documented the use of asbestos in the dental profession. EP was created and followed the protocol in accordance with the EuropeAid Assessment Guidelines. As a result of this study, EP documented the common use and sources of asbestos in dentistry in prosthetic materials, dental dressings, and in the coating of casting cylinders. EP also created a consensus document on the priority measures for the Plan for the Prevention of Risks from Asbestos in Dentistry, based on previous reports from the European Commission Senior Labour Inspectors' Committee. The document concluded that obtainment of information, receiving specific training on the subject and performing epidemiological studies, and the proper risk assessments were the priority measures to adopt.
Screening and Optimization of Conditions for the Adsorption of Cd2+ in Serpentine by Using Response Surface Methodology. X. Zhang, L. Du, W. Jin. 2022;19(24). PubMed · Publisher · Free full text

Abstract

In order to explore the optimal conditions for the adsorption of Cd2+ in serpentine, this paper studied the adsorption of simulated cadmium solutions with serpentine as an adsorbent. On the basis of a single factor experiment, four factors including the amount of serpentine, initial pH, the initial concentration of solutions, and adsorption time were selected as the influencing factors, and the adsorption quantity and adsorption rate of serpentine to Cd2+ were double response values using the Box-Behnken design. Response surface analyses were used to study the effects of four factors on the adsorption quantity and adsorption rate of serpentine on cadmium, and the interaction between various factors. The results showed that the optimum adsorption conditions were as follows: the amount of serpentine was 1%, the initial pH was 5.5, the initial solution concentration was 40.83 mg·L-1, and the adsorption time was 26.78 h. Under these conditions, the theoretical adsorption quantity and adsorption rate of serpentine to Cd2+ were 3.99 mg·g-1 and 95.24%, respectively. At the same time, after three repeated experiments, the actual adsorption quantity and adsorption rate of serpentine to Cd2+ were 3.91 mg·g-1 and 94.68%, respectively, and the theoretical value was similar to the actual value. Therefore, it was proved that the experimental design of the regression model is reliable, and it is feasible to use the response surface method to optimize the adsorption conditions of serpentine on Cd2+.
Sex-Specific Mortality from Asbestos-Related Diseases, Lung and Ovarian Cancer in Municipalities with High Asbestos Consumption, Brazil, 2000-2017. C.A. Saito, M.A. Bussacos, L. Salvi, et al. 2022;19(6). PubMed · Publisher · Free full text

Abstract

The aim of this study is to compare the mortality rates for typical asbestos-related diseases (ARD-T: mesothelioma, asbestosis, and pleural plaques) and for lung and ovarian cancer in Brazilian municipalities where asbestos mines and asbestos-cement plants had been operating (areas with high asbestos consumption, H-ASB) compared with in other municipalities. The death records for adults aged 30+ years were retrieved from multiple health information systems. In the 2000-2017 time period, age-standardized mortality rates (standard: Brazil 2010) and standardized rate ratios (SRR; H-ASB vs. others) were estimated. The SRRs for ARD-T were 2.56 for men (257 deaths in H-ASB municipalities) and 1.19 for women (136 deaths). For lung cancer, the SRRs were 1.33 for men (32,604 deaths) and 1.19 for women (20,735 deaths). The SRR for ovarian cancer was 1.34 (8446 deaths). Except for ARD-T and lung cancer in women, the SRRs were higher in municipalities that began using asbestos before 1970 than in municipalities that began utilizing asbestos from 1970 onwards. In conclusion, the mortality rates for ARD-T, and lung and ovarian cancer in municipalities with a history of asbestos mining and asbestos-cement production exceed those of the whole country. Caution is needed when interpreting the results of this ecological study. Analytical studies are necessary to document the impact of asbestos exposure on health, particularly in the future given the long latency of asbestos-related cancers.
Spatial Analysis of Shared Risk Factors between Pleural and Ovarian Cancer Mortality in Lombardy (Italy). G. Stoppa, C. Mensi, L. Fazzo, et al. 2022;19(6). PubMed · Publisher · Free full text

Abstract

Background: Asbestos exposure is a recognized risk factor for ovarian cancer and malignant mesothelioma. There are reports in the literature of geographical ecological associations between the occurrence of these two diseases. Our aim was to further explore this association by applying advanced Bayesian techniques to a large population (10 million people).

Methods: We specified a series of Bayesian hierarchical shared models to the bivariate spatial distribution of ovarian and pleural cancer mortality by municipality in the Lombardy Region (Italy) in 2000-2018.

Results: Pleural cancer showed a strongly clustered spatial distribution, while ovarian cancer showed a less structured spatial pattern. The most supported Bayesian models by predictive accuracy (widely applicable or Watanabe-Akaike information criterion, WAIC) provided evidence of a shared component between the two diseases. Among five municipalities with significant high standardized mortality ratios of ovarian cancer, three also had high pleural cancer rates. Wide uncertainty was present when addressing the risk of ovarian cancer associated with pleural cancer in areas at low background risk of ovarian cancer.

Conclusions: We found evidence of a shared risk factor between ovarian and pleural cancer at the small geographical level. The impact of the shared risk factor can be relevant and can go unnoticed when the prevalence of other risk factors for ovarian cancer is low. Bayesian modelling provides useful information to tailor epidemiological surveillance.
The Association between the Histological Subtypes of Mesothelioma and Asbestos Exposure Characteristics. T. Vorster, J. Mthombeni, J. teWaterNaude, et al. 2022;19(21). PubMed · Publisher · Free full text

Abstract

Asbestos mining operations have left South Africa with a legacy of asbestos contamination and asbestos-related diseases continue to be a problem. The large-scale mining of three types of asbestos presents a unique opportunity to study malignant mesothelioma of the pleura (mesothelioma) in South Africa. This study aimed to describe the demographics of deceased individuals diagnosed with mesothelioma and explore any associations between the histological morphology of mesothelioma and asbestos characteristics. We reviewed the records of all deceased miners and ex-miners from the Pathology Automation System (PATHAUT) database of the National Institute of Occupational Health (NIOH) that were histologically diagnosed with mesothelioma in the period from January 2006-December 2016 (11 years). The study population does not include all cases of mesothelioma in South Africa but rather those that reached the compensation system. Crocidolite asbestos fibres were identified in the majority of mesothelioma cases (n = 140; 53.4%). The epithelioid subtype was most commonly present in both occupational and environmental cases. Cases with the sarcomatous subtype were older at death and fewer female cases were diagnosed with this subtype. No relationship between mesothelioma subtype and asbestos type or asbestos burden or fibre size was established.
The Impact of Ambient Environmental and Occupational Pollution on Respiratory Diseases. C. Nishida, K. Yatera. 2022;19(5). Review PubMed · Publisher · Free full text

Abstract

Ambient pollutants and occupational pollutants may cause and exacerbate various lung and respiratory diseases. This review describes lung and respiratory diseases in relation to ambient pollutants, particularly particulate matter (PM2.5), and occupational air pollutants, excluding communicable diseases and indoor pollutants, including tobacco smoke exposure. PM2.5 produced by combustion is an important ambient pollutant. PM2.5 can cause asthma attacks and exacerbations of chronic obstructive pulmonary disease in the short term. Further, it not only carries a risk of lung cancer and death, but also hinders the development of lung function in children in the long term. It has recently been suggested that air pollution, such as PM2.5, is a risk factor for severe coronavirus disease (COVID-19). Asbestos, which causes asbestosis, lung cancer, and malignant mesothelioma, and crystalline silica, which cause silicosis, are well-known traditional occupational pollutants leading to pneumoconiosis. While work-related asthma (WRA) is the most common occupational lung disease in recent years, many different agents cause WRA, including natural and synthetic chemicals and irritant gases. Primary preventive interventions that increase awareness of pollutants and reduce the development and exacerbation of diseases caused by air pollutants are paramount to addressing ambient and occupational pollution.
In plain English

This was a review article. The authors searched the PubMed database for English-language reviews, meta-analyses, trials, and books published between 1 January 2017 and 1 December 2021. Of 275 records found, 8 studies were included. The review covered lung diseases linked to outdoor air pollution, especially fine particles (PM2.5), and to workplace pollutants: asbestos, crystalline silica, agents that cause work-related asthma, and agents that cause hypersensitivity pneumonitis. On asbestos, the review described two fiber groups, serpentine (chrysotile) and amphibole (crocidolite, amosite, tremolite and others), and said both are related to lung cancer and malignant mesothelioma. Citing earlier studies, it stated that:
- an estimated 5 to 10% of lung cancer cases worldwide are due to workplace carcinogens;
- occupational asbestos exposure is associated with a five-fold increase in lung cancer risk;
- asbestos exposure caused 23,000 cases of malignant mesothelioma in 2015;
- the risk of asbestosis is higher after amphibole exposure than after serpentine exposure;
- asbestos-related diseases can appear several decades after exposure.
The authors concluded that these respiratory diseases can be avoided and that avoiding exposure to all harmful materials is crucial to preventing and controlling them.

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.
Activity-Based Exposure Levels and Cancer Risk Assessment Due to Naturally Occurring Asbestos for the Residents Near Abandoned Asbestos Mines in South Korea. S. Lee, D. Kang, Y. Kim, et al. 2021;18(10). PubMed · Publisher · Free full text

Abstract

This study aims to evaluate the overall asbestos exposure intensity and assess the health risk to residents due to naturally occurring asbestos (NOA) near abandoned asbestos mines in South Korea. Of 38 mines, we found 19 with measured concentrations of NOA. We evaluated the average of airborne NOA concentrations according to the environmental exposure category. When evaluated regionally by dividing into two clusters, the mean concentrations in activity-based sampling (ABS) scenarios exceeded the Korean exposure limit (0.01 f/cc) in both clusters. Moreover, airborne NOA concentrations in agricultural activity (5.49 × 10-2 f/cc) and daily activity (6.95 × 10-2 f/cc) had the highest values for clusters A and B, respectively. The excess lifetime cancer risk of one region (cluster A) by the ABS scenarios did not exceed the Korean Ministry of the Environment's criteria for soil purification (1 × 10-4). However, one of the ABS scenarios-the daily life activity of clusters centered on Chungcheongbuk-do (cluster B)-showed an exposure of 1.08 × 10-4, greater than the limit (1 × 10-4). This indicates non negligible health damage to residents living near the abandoned asbestos mines, and it is necessary to continuously monitor and clean up the asbestos contamination.
Asbestos Exposure and Malignant Mesothelioma in Construction Workers-Epidemiological Remarks by the Italian National Mesothelioma Registry (ReNaM). A. Binazzi, D. Di Marzio, M. Verardo, et al. 2021;19(1). PubMed · Publisher · Free full text

Abstract

Notwithstanding the ban in 1992, asbestos exposure for workers in the construction sector in Italy remains a concern. The purpose of this study is to describe the characteristics of malignant mesothelioma (MM) cases recorded by the Italian registry (ReNaM) among construction workers. Incident mesothelioma cases with a definite asbestos exposure have been analyzed. Characteristics of cases and territorial clusters of crude rates of MM in construction workers have been described, as well as the relation between asbestos use before the ban and the historical trend of workforce in the construction sector in Italy. ReNaM has collected 31,572 incident MM cases in the period from 1993 to 2018 and asbestos exposure has been assessed for 24,864 (78.2%) cases. An occupational exposure has been reported for 17,191 MM cases (69.1% of subjects with a definite asbestos exposure). Among them, 3574 had worked in the construction sector, with an increasing trend from 15.8% in the 1993-98 period to 23.9% in 2014-2018 and a ubiquitous territorial distribution. The large use of asbestos in construction sector before the ban makes probability of exposure for workers a real concern still today, particularly for those working in maintenance and removal of old buildings. There is a clear need to assess, inform, and prevent asbestos exposure in this sector.
Asbestos Exposure Level and the Carcinogenic Risk Due to Corrugated Asbestos-Cement Slate Roofs in Korea. E.S. Lee, Y.K. Kim. 2021;18(13). PubMed · Publisher · Free full text

Abstract

Asbestos-cement slate roofs are one of the most common environmental causes of asbestos exposure. However, few studies have examined residential asbestos-cement slate-related exposure and its effects on human health. This study was performed to evaluate cumulative asbestos exposure levels and to calculate the Excess Lifetime Cancer Risk (ELCR) of residents of asbestos-cement slate-roofed houses. We reviewed previous Korean literature to estimate the concentration of airborne asbestos from asbestos-cement slate roofed buildings. Finally, eight studies were selected, and a pooled analysis was performed. The results derived from the pooled analysis were combined with the data from a health impact survey conducted from 2009 to 2016 at the Environmental Health Center for Asbestos (EHCA) of the Yangsan Pusan National University Hospital, and a carcinogenic risk assessment was performed. As a result, the representative value of the indoor exposure concentration related to asbestos-cement slate was found to be 0.0032 f/cc on average, and the representative value of the exposure related to occupational asbestos-cement slate dismantling and demolition was found to be 0.0034 f/cc. In addition, the ELCR of asbestos-cement slate related indoor exposure and occupational dismantling and demolition was found to be of medium risk, and the ELCR of residential dismantling and demolition of asbestos-cement slate was less than 10-6, indicating that the risk was low. Since there is no threshold for carcinogenicity related to asbestos, this should not be ignored even if the risk appears low, and it would be reasonable to calculate the carcinogenic risk based on total lifetime exposure. More studies on asbestos exposure scenarios and the scope of similar exposure groups through additional data collection and further analysis of risk are needed.
Asbestos in High-Risk Communities: Public Health Implications. E.A. Emmett. 2021;18(4). Review 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.
Ascertainment Bias in a Historic Cohort Study of Residents in an Asbestos Manufacturing Community. J.D. Wortzel, D.J. Wiebe, S. Elahi, et al. 2021;18(5). PubMed · Publisher · Free full text

Abstract

This paper describes follow-up for a cohort of 4530 residents living in the asbestos manufacturing community of Ambler, PA, U.S. in 1930. Using re-identified census data, cause and date of death data obtained from the genealogic website Ancestry.com, along with geospatial analysis, we explored relationships among demographic characteristics, occupational, paraoccupational and environmental asbestos exposures. We identified death data for 2430/4530 individuals. Exposure differed significantly according to race, gender, age, and recency of immigration to the U.S. Notably, there was a significant difference in the availability of year of death information for non-white vs. white individuals (odds ratio (OR) = 0.62 p-value < 0.001), females (OR = 0.53, p-value < 0.001), first-generation immigrants (OR = 0.67, p-value = 0.001), second-generation immigrants (OR = 0.31, p-value < 0.001) vs. non-immigrants, individuals aged less than 20 (OR = 0.31 p-value < 0.001) and individuals aged 20 to 59 (OR = 0.63, p-value < 0.001) vs. older individuals. Similarly, the cause of death was less often available for non-white individuals (OR = 0.42, p-value <0.001), first-generation immigrants and (OR = 0.71, p-value = 0.009), second-generation immigrants (OR = 0.49, p-value < 0.001), individuals aged less than 20 (OR = 0.028 p-value < 0.001), and individuals aged 20 to 59 (OR = 0.26, p-value < 0.001). These results identified ascertainment bias that is important to consider in analyses that investigate occupational, para-occupational and environmental asbestos exposure as risk factors for mortality in this historic cohort. While this study attempts to describe methods for assessing itemized asbestos exposure profiles for a community in 1930 using Ancestry.com and other publicly accessible databases, it also highlights how historic cohort studies likely underestimate the impact of asbestos exposure on vulnerable populations. Future work will aim to assess mortality patterns in this cohort.
Burden of Mortality from Asbestos-Related Diseases in Italy. L. Fazzo, A. Binazzi, D. Ferrante, et al. 2021;18(19). PubMed · Publisher · Free full text

Abstract

Asbestos is one of the major worldwide occupational carcinogens. The global burden of asbestos-related diseases (ARDs) was estimated around 231,000 cases/year. Italy was one of the main European asbestos producers until the 1992 ban. The WHO recommended national programs, including epidemiological surveillance, to eliminate ARDs. The present paper shows the estimate of the burden of mortality from ARDs in Italy, established for the first time. National standardized rates of mortality from mesothelioma and asbestosis and their temporal trends, based on the National Institute of Statistics database, were computed. Deaths from lung cancer attributable to asbestos exposure were estimated using population-based case-control studies. Asbestos-related lung and ovarian cancer deaths attributable to occupational exposure were estimated, considering the Italian occupational cohort studies. In the 2010-2016 period, 4400 deaths/year attributable to asbestos were estimated: 1515 from mesothelioma, 58 from asbestosis, 2830 from lung and 16 from ovarian cancers. The estimates based on occupational cohorts showed that each year 271 deaths from mesothelioma, 302 from lung cancer and 16 from ovarian cancer were attributable to occupational asbestos exposure in industrial sectors with high asbestos levels. The important health impact of asbestos in Italy, 10-25 years after the ban, was highlighted. These results suggest the need for appropriate interventions in terms of prevention, health care and social security at the local level and could contribute to the global estimate of ARDs.
Cancer Incidence and Mortality among Firefighters: An Overview of Epidemiologic Systematic Reviews. E. Laroche, S. L'Espérance. 2021;18(5). Systematic review PubMed · Publisher · Free full text

Abstract

Firefighters are exposed to carcinogens that may increase their risk of developing many types of occupational cancer. Many systematic reviews (SRs) have been produced with sometimes conflicting conclusions. In this overview of reviews, we aim to assess the conclusion consistency across the available systematic reviews on the cancer risk in firefighters. Literature searches were conducted in several indexed databases and grey literature to retrieve systematic reviews aiming to evaluate cancer incidence or cancer mortality in firefighters. Results from included SRs were analyzed according to the tumour site. Out of 1054 records identified by the search in the databases, a total of 11 SRs were ultimately included. The original studies (n = 104) analyzed in the SRs were published between 1959 and 2018. The results consistently reported a significant increase in the incidence of rectal, prostate, bladder and testicular cancers as well as mesothelioma and malignant melanoma in firefighters compared to the general population. The SRs also indicate that death rates from rectal cancer and non-Hodgkin's lymphoma are higher among firefighters. Consistent SR results suggest that several types of cancer may be more frequent in firefighters than in the general population.
Cancer Incidence and Mortality among Petroleum Industry Workers and Residents Living in Oil Producing Communities: A Systematic Review and Meta-Analysis. F.M. Onyije, B. Hosseini, K. Togawa, et al. 2021;18(8). Meta-analysis · Systematic review PubMed · Publisher · Free full text

Abstract

Petroleum extraction and refining are major sources of various occupational exposures and of air pollution and may therefore contribute to the global cancer burden. This systematic review and meta-analysis is aimed at evaluating the cancer risk in petroleum-exposed workers and in residents living near petroleum facilities. Relevant studies were identified and retrieved through PubMed and Web of Science databases. Summary effect size (ES) and 95% confidence intervals (CI) were analysed using random effect models, and heterogeneity across studies was assessed (I2). Overall, petroleum industry work was associated with an increased risk of mesothelioma (ES = 2.09, CI: 1.58-2.76), skin melanoma (ES = 1.34, CI: 1.06-1.70 multiple myeloma (ES =1.81, CI: 1.28-2.55), and cancers of the prostate (ES = 1.13, Cl: 1.05-1.22) and urinary bladder (ES = 1.25, CI: 1.09-1.43) and a decreased risk of cancers of the esophagus, stomach, colon, rectum, and pancreas. Offshore petroleum work was associated with an increased risk of lung cancer (ES = 1.20; 95% CI: 1.03-1.39) and leukemia (ES = 1.47; 95% CI: 1.12-1.92) in stratified analysis. Residential proximity to petroleum facilities was associated with childhood leukemia (ES = 1.90, CI: 1.34-2.70). Very few studies examined specific exposures among petroleum industry workers or residents living in oil producing communities. The present review warrants further studies on specific exposure levels and pathways among petroleum-exposed workers and residents living near petroleum facilities.
Cancer Incidence and Risk of Multiple Cancers after Environmental Asbestos Exposure in Childhood-A Long-Term Register-Based Cohort Study. S.B. Dalsgaard, E.T. Würtz, J. Hansen, et al. 2021;19(1). PubMed · Publisher · Free full text

Abstract

Objectives: To examine the asbestos-associated cancer incidence and the risk of multiple cancers in former school children exposed to environmental asbestos in childhood.

Methods: A cohort of 12,111 former school children, born 1940-1970, was established using 7th grade school records from four schools located at a distance of 100-750 m in the prevailing wind direction from a large asbestos-cement plant that operated from 1928 to 1984 in Aalborg, Denmark. Using the unique Danish personal identification number, we linked information on employments, relatives' employments, date of cancer diagnosis, and type of cancer and vital status to data on cohortees extracted from the Supplementary Pension Fund Register (employment history), the Danish Cancer Registry, and the Danish Civil Registration System. We calculated standardized incidence rates (SIRs) for asbestos-associated cancers, all cancers, and multiple cancers using rates for a gender and five-year frequency-matched reference cohort.

Results: The overall incidence of cancer was modestly increased for the school cohort (SIR 1.07, 95% confidence interval (CI) 1.02-1.12) compared with the reference cohort. This excess was driven primarily by a significantly increased SIR for malignant mesothelioma (SIR 8.77, 95% CI 6.38-12.05). Former school children who had combined childhood environmental and subsequent occupational exposure to asbestos had a significantly increased risk of lung cancer. Within this group, those with additional household exposure by a relative had a significantly increased SIR for cancer of the pharynx (SIR 4.24, 95% CI 1.59-11.29). We found no significant difference in the number of subjects diagnosed with multiple cancers between the two cohorts.

Conclusions: Our study confirms the strong association between environmental asbestos exposure and malignant mesothelioma and suggests that environmental asbestos exposure in childhood may increase the overall cancer risk later in life.
Comparison of Asbestos Victim Relief Available Outside of Conventional Occupational Compensation Schemes. K.M. Lee, L. Godderis, S. Furuya, et al. 2021;18(10). PubMed · Publisher · Free full text

Abstract

The asbestos victim relief schemes were introduced to resolve the issue of victims of asbestos-related diseases not receiving compensation through conventional legal orders. This article seeks to derive the differences and commonalities of various asbestos victim relief schemes available outside of the conventional occupational compensation system along with a systematic understanding and to propose plans for improvement through a comparative study. After the degree of asbestos exposure, the population, and the period of implementation were corrected, the recognized claims of the total of conventional occupational compensation schemes and the asbestos victim relief schemes could be ranked in the order of South Korea (KOR) (1867, total), France (FRA) (1571), Japan (JPN) (966), KOR (847, asbestosis grade 2,3 excluded), the United Kingdom (GBR) (670), and the Netherlands (NLD) (95). The average amount of compensation per person, in the case of mesothelioma, was higher in the order of FRA (4.60 times), KOR (1.46 times), GBR (1.03 times), and NLD (0.73 times) of the median income per year. The differences between countries were largely caused by the purpose of institutional design and influenced by the level of qualification, the existence of an expiration date, type of disease, type of benefit, level of judgment criteria, the existence of a procedure for appeals, and recognition rate (GBR: 102%, FRA: 84%, NLD: 81%, JPN: 76%, KOR: 73%, and BEL: 54%). Based on this analysis, suggestions could be made regarding the expansion of disease types, benefit types, and the overall review of judgment criteria.
Correction: Lemen, R.A.; Landrigan, P.J. Sailors and the Risk of Asbestos-Related Cancer. Int. J. Environ. Res. Public Health 2021, 18, 8417. R.A. Lemen, P.J. Landrigan. 2021;18(21). PubMed · Publisher · Free full text

Abstract

There was an error in the original article [...].
Development of Nationwide Excess Lifetime Cancer Risk Evaluation Methods with Comprehensive Past Asbestos Exposure Reconstruction. D. Kang, S.H. Lee, Y.J. Kim, et al. 2021;18(6). PubMed · Publisher · Free full text

Abstract

Although exposure to asbestos via various routes has been acknowledged, comprehensive exposure and risk assessment methods have not been developed at the national level. We conducted a study to reconstruct comprehensive past asbestos exposure estimations and to suggest a method to calculate the Excess Lifetime Cancer Risk (ELCR) of Koreans. The past occupational exposure reconstruction was conducted by rebuilding the previous general population job-exposure matrix (JEM). The para-occupational and household exposure estimation was based on the pooled analysis of data from other countries as well as Korea. The neighborhood exposure from occupational sources by distance was estimated by the exponential decay model. As a result, 141 JEM exposure groups across four periods including ~79, the 80s, 90s, 2000s with a ratio of 2.0:1.0:0.5:0.05 were reconstructed. The para-occupational and household exposures were 11% and 1% of the JEM respectively. The environmental exposure source concentration from outside occupational exposure was 2.5% of the inside concentration. The ratio of the concentration of environmental exposure source (C0) to distance d (Cd) was exp-kd with a decay constant k of 6.834. The mean concentrations (f/cc) were 2.28 × 10-3 for outdoor, 4.65 × 10-5 for indoor, 1.95 × 10-2 for transportation activity, 4.44 × 10-2 for agricultural activity, and 4.68 × 10-2 for daily life activity in naturally occurring asbestos areas. Indoor and outdoor asbestos concentrations from living in a slate roof house were 1.73 × 10-6 and 2.70 × 10-8, respectively. For improved generalizability, validity, and applicability of the proposed method, further studies on each route with real assessments and experiments are required.
Development of the "National Asbestos Profile" to Eliminate Asbestos-Related Diseases in 195 Countries. D. Arachi, S. Furuya, A. David, et al. 2021;18(4). PubMed · Publisher · Free full text

Abstract

Worldwide, 230,000+ people die annually from asbestos-related diseases (ARDs). The World Health Organization (WHO) recommends that countries develop a National Asbestos Profile (NAP) to eliminate ARDs. For 195 countries, we assessed the global status of NAPs (A: bona fide NAP, B: proxy NAP, C: relevant published information, D: no relevant information) by national income (HI: high, UMI: upper-middle, LMI: lower-middle, LI: low), asbestos bans (banned, no-ban) and public data availability. Fourteen (7% of 195) countries were category A (having a bona fide NAP), while 98, 51 and 32 countries were categories B, C and D, respectively. Of the 14 category-A countries, 8, 3 and 3 were LMI, UMI and HI, respectively. Development of a bona fide NAP showed no gradient by national income. The proportions of countries having a bona fide NAP were similar between asbestos-banned and no-ban countries. Public databases useful for developing NAPs contained data for most countries. Irrespective of the status of national income or asbestos ban, most countries have not developed a NAP despite having the potential. The global status of NAP is suboptimal. Country-level data on asbestos and ARDs in public databases can be better utilized to develop NAPs for globally eliminating ARDs.
Epidemiological Research on Occupational and Environmental Carcinogens. C. Ledda. 2021;18(5). Editorial PubMed · Publisher · Free full text

Abstract

The cancer risk associated with exposure to environmental and occupational carcinogens such as asbestos, benzene, radiation, or lifestyle carcinogens such as cigarette smoking depends on the entire history of exposure to the carcinogen, including the age of exposure and the time-varying intensity of exposure [...].
Future Incidence of Malignant Mesothelioma in South Korea: Updated Projection to 2038. K. Kwak, S.I. Cho, D. Paek. 2021;18(12). PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma (MM) is a cancer that is largely caused by exposure to asbestos. Although asbestos is no longer used in South Korea, the incidence of MM continues to increase due to its long latent period. We aimed to update the previous prediction of MM incidence until 2038. We predicted the incidence of MM over the next 20 years (2019-2038) in South Korea using Møller's age-period-cohort (APC) model and a Poisson regression model based on asbestos consumption. The APC model predicted that the crude incidence rate would increase sharply in men and slowly in women. Despite the sex discrepancy in the rate of increase, the incidence rate for both sexes is expected to continue increasing until 2038. In the Poisson model, the crude incidence rate was predicted to increase continuously until 2038, and far more cases of MM were predicted to occur compared with the results of the APC model. When compared with actual incidence data, the APC model was deemed more suitable than the Poisson model. The APC model predicted a continuous increase over the next 20 years with no peak, suggesting that the incidence of MM will continue to rise far into the future.
Immunohistochemical Expression of Serine and Arginine-Rich Splicing Factor 1 (SRSF1) in Fluoro-Edenite-Induced Malignant Mesothelioma: A Preliminary Study. G. Broggi, G. Angelico, V. Filetti, et al. 2021;18(12). PubMed · Publisher · Free full text

Abstract

Unlabelled: The Serine and Arginine-Rich Splicing Factor 1 (SRSF1) has a proto-oncogenic function, being associated with angiogenesis and frequently overexpressed in many human malignant neoplasms. Its immunohistochemical expression has never been investigated in malignant pleural mesothelioma (MPM). We evaluated SRSF1 immunoexpression and its possible relation to angiogenesis in a selected cohort of 10 fluoro-edenite(FE)-induced MPM cases.

Methods: Immunohistochemical analyses with an anti-SRSF1 antibody were performed. We interpreted the cases as positive if tumor cell nuclei were stained; a semi-quantitative analysis of the cases was performed by evaluating the intensity of staining and the percentage of tumor positive cells. A microvessel density (MVD) count was also performed.

Results: High and low immunoexpressions of SRSF1 were seen in six and four MPMs, respectively. A trend of shorter overall survival was found in FE-induced MPM patients with SRSF1 overexpression. In addition, a significant association between high-MVD and high SRSF1 immunoexpression (p = 0.0476) was found.

Conclusions: SRSF1 appears to be involved in MPM pathogenesis and its immunoexpression may represent a prognostic biomarker capable of identifying subgroups of patients with different prognosis. However, given the preliminary nature of the present study, further investigations on larger series, and additional in vitro studies, are required to validate our findings.
Incidence of Cancer and Asbestos-Related Diseases among Residents Living near Abandoned Asbestos Mines in South Korea: A Retrospective Cohort Study Using National Health Insurance Database. K. Kwak, K.E. Zoh, D. Paek. 2021;18(3). PubMed · Publisher · Free full text

Abstract

The use of asbestos has been banned since 2009 in South Korea. However, there is still a risk of exposure to environmental asbestos originating from abandoned asbestos mines. We constructed a retrospective dynamic cohort using the National Health Insurance Database of South Korea. We determined the risk of developing asbestos-related diseases (ARDs) among residents living near asbestos mines compared with those living in the control area and the general population. The risks of asbestosis (adjusted hazards ratio [HR] 65.40, 95% CI = 35.02-122.12) and pleural plaques (adjusted HR 3.55, 95% CI = 1.96-6.41) were significantly increased among residents living near the asbestos mines compared with the control area. The risk of malignant mesothelioma was increased near asbestos mines compared with the control area; however, it was not significant (adjusted HR 1.83, 95% CI = 0.61-5.47). When a separate analysis according to sex was conducted, the risk of mesothelioma among male residents was statistically significant (adjusted HR 8.30, 95% CI = 1.04-66.63), and the standardized incidence ratio (SIR) was significantly increased (SIR 3.48, 95% CI = 1.50-6.85). The risk of ARDs was increased due to environmental asbestos exposure near abandoned asbestos mines in South Korea.
Increased Risk of Gastric Cancer in Asbestos-Exposed Workers: A Retrospective Cohort Study Based on Taiwan Cancer Registry 1980-2015. Y.J. Fang, H.Y. Chuang, C.H. Pan, et al. 2021;18(14). PubMed · Publisher · Free full text

Abstract

Asbestos has been recognized as a human carcinogen associated with malignant mesothelioma, cancers of lung, larynx, and ovary. However, a putative association between gastric cancer and asbestos exposure remains controversial. In this study, we aimed to explore gastric cancer risk of workers potentially exposed to asbestos in Taiwan. The asbestos occupational cohort was established from 1950 to 2015 based on the Taiwan Labor Insurance Database, and Taiwan Environmental Protection Agency regulatory datasets, followed by the Taiwan Cancer Registry for the period 1980-2015. Standardized incidence ratios (SIRs) for cancer were computed for the whole cohort using reference rates of the general population, and also reference labor population. Compared with the general population, SIR of the asbestos occupational cohort for the gastric cancer increased both in males (1.05, 95% confidence interval (CI): 1.02-1.09) and females (1.10, 95% CI: 1.01-1.18). A total of 123 worksites were identified to have cases of malignant mesothelioma, where increased risk for gastric cancer was found with a relative risk of 1.76 (95% CI: 1.63-1.90). This 35-year retrospective cohort study of asbestos-exposed workers in Taiwan may provide support for an association between occupational exposure to asbestos and gastric cancer.
Inorganic Fiber Lung Burden in Subjects with Occupational and/or Anthropogenic Environmental Asbestos Exposure in Broni (Pavia, Northern Italy): An SEM-EDS Study on Autoptic Samples. S.D. Visonà, S. Capella, S. Bodini, et al. 2021;18(4). PubMed · Publisher · Free full text

Abstract

Increased mortality due to malignant mesothelioma has been demonstrated by several epidemiologic studies in the area around Broni (a small town in Lombardy, northern Italy), where a factory producing asbestos cement was active between 1932 and 1993. Until now, the inorganic fiber burden in lungs has not been investigated in this population. The aim of this study is to assess the lung fiber burden in 72 individuals with previous occupational and/or anthropogenic environmental exposure to asbestos during the activity of an important asbestos cement factory. Inorganic fiber lung burden was assessed in autoptic samples taken from individuals deceased from asbestos-related diseases using a scanning electron microscope equipped with an energy-dispersive spectrometer. Significant differences in the detected amount of asbestos were pointed out among the three types of exposure. In most lung samples taken from patients who died of mesothelioma, very little asbestos (or, in some cases, no fibers) was found. Such subjects showed a significantly lower median amount of asbestos as compared to asbestosis. Almost no chrysotile was detected in the examined samples. Overall, crocidolite was the most represented asbestos, followed by amosite, tremolite/actinolite asbestos, and anthophyllite asbestos. There were significant differences in the amount of crocidolite and amosite fibers according to the kind of exposure. Overall, these findings provide novel insights into the link between asbestos exposure and mesothelioma, as well as the different impacts of the various types of asbestos on human health in relation to their different biopersistences in the lung microenvironment.
Is Mesothelioma Unrelated to the Lung Asbestos Burden? Comment on Visonà et al. Inorganic Fiber Lung Burden in Subjects with Occupational and/or Anthropogenic Environmental Asbestos Exposure in Broni (Pavia, Northern Italy): An SEM-EDS Study on Autoptic Samples. Int. J. Environ. Res. Public Health 2021, 18, 2053. D. Mirabelli, A. Angelini, P.G. Barbieri, et al. 2021;18(13). Comment PubMed · Publisher · Free full text

Abstract

We read with interest the report by Visonà and coworkers on the lung asbestos fiber burden in an autopsy series of decedents from mesothelioma (MM: 59 cases) and individuals who "suffered from asbestosis and died of its complications" (13 cases) [...].
Mesothelioma in Agriculture in Lombardy, Italy: An Unrecognized Risk. C. Mensi, B. Dallari, M. Polonioli, et al. 2021;18(1). PubMed · Publisher · Free full text

Abstract

Cohort studies showed consistently low risks for malignant mesothelioma (MM) among agricultural workers, however the investigated exposures did not include asbestos. Our aim is to describe sources of asbestos exposure of MM in agriculture. Twenty-six MM cases in agricultural or seed trades workers were identified through the MM registry of the Lombardy region, Italy in 2000-2016. Asbestos exposures were investigated through a standardized questionnaire. The most frequent exposure circumstances were recycled jute bags previously containing asbestos (11 cases) and maintenance and repair of asbestos roofs (12 subjects). Three subjects performed maintenance and repair of tractor asbestos brakes and two used asbestos filters for wine production. Our data suggest asbestos exposure opportunities in the agricultural setting, underlining the need to look for this exposure in subjects affected with mesothelioma.
Meta-Analysis of the Association between Asbestos Exposure and Esophageal Cancer. C.W. Wu, H.Y. Chuang, D.L. Tsai, et al. 2021;18(21). Meta-analysis PubMed · Publisher · Free full text

Abstract

Background: We conducted a meta-analysis to quantitatively assess the association between asbestos exposure and esophageal cancer.

Methods: We systematically collected articles from three electronic databases and calculated the pooled standardized mortality rate (SMR) from the meta-analysis. Subgroup analysis according to the type of asbestos exposure, follow-up years, sample size, industry classification, sex, and high-dose exposure was conducted.

Results: From 242 studies, 34 cohort studies were included in our meta-analysis. Pooled SMR was positively associated with asbestos exposure and esophageal cancer (pooled SMR = 1.28; 95% confidence interval (CI) 1.19-1.38, p < 0.00001). In the subgroup analysis, (1) chrysolite, (2) four groups with follow-up over ten years, (3) the textile industry and shipyard, (4) both male and female, and (5) eight studies on highest asbestos exposure, all the subgroups showed significantly increased pooled SMRs.

Conclusion: Asbestos exposure was significantly and positively associated with esophageal cancer, especially chrysolite. Considering the long latency period, we suggest that patients should be followed up for cancer, including esophageal cancer, for over ten years.
Predictors of Lung Cancer Risk: An Ecological Study Using Mortality and Environmental Data by Municipalities in Italy. C. Gariazzo, A. Binazzi, M. Alfò, et al. 2021;18(4). PubMed · Publisher · Free full text

Abstract

Lung cancer (LC) mortality remains a consistent part of the total deaths occurring worldwide. Its etiology is complex as it involves multifactorial components. This work aims in providing an epidemiological assessment on occupational and environmental factors associated to LC risk by means of an ecological study involving the 8092 Italian municipalities for the period 2006-2015. We consider mortality data from mesothelioma as proxy of asbestos exposure, as well as PM2.5 and radon levels as a proxy of environmental origin. The compensated cases for occupational respiratory diseases, urbanization and deprivation were included as predictors. We used a negative binomial distribution for the response, with analysis stratified by gender. We estimated that asbestos is responsible for about 1.1% (95% CI: 0.8, 1.4) and 0.5% (95% CI: 0.2, 0.8) of LC mortality in males and females, respectively. The corresponding figures are 14.0% (95% CI: 12.5, 15.7) and 16.3% (95% CI: 16.2, 16.3) for PM2.5 exposure, and 3.9% (95% CI: 3.5, 4.2) and 1.6% (95% CI: 1.4, 1.7) for radon exposure. The assessment of determinants contribution to observed LC deaths is crucial for improving awareness of its origin, leading to increase the equity of the welfare system.
Reply to Mirabelli et al. Is Mesothelioma Unrelated to the Lung Asbestos Burden? Comment on "Visonà et al. Inorganic Fiber Lung Burden in Subjects with Occupational and/or Anthropogenic Environmental Asbestos Exposure in Broni (Pavia, Northern Italy): An SEM-EDS Study on Autoptic Samples. Int. J. Environ. Res. Public Health 2021, 18, 2053". S.D. Visonà, S. Capella, S. Bodini, et al. 2021;18(13). Comment PubMed · Publisher · Free full text

Abstract

We appreciate very much the interest of Mirabelli et al. [...].
Sailors and the Risk of Asbestos-Related Cancer. R.A. Lemen, P.J. Landrigan. 2021;18(16). Review PubMed · Publisher · Free full text

Abstract

Sailors have long been known to experience high rates of injury, disease, and premature death. Many studies have shown asbestos-related diseases among shipyard workers, but few have examined the epidemiology of asbestos-related disease and death among asbestos-exposed sailors serving on ships at sea. Chrysotile and amphibole asbestos were used extensively in ship construction for insulation, joiner bulkhead systems, pipe coverings, boilers, machinery parts, bulkhead panels, and many other uses, and asbestos-containing ships are still in service. Sailors are at high risk of exposure to shipboard asbestos, because unlike shipyard workers and other occupationally exposed groups, sailors both work and live at their worksite, making asbestos standards and permissible exposure limits (PELs). based on an 8-h workday inadequate to protect their health elevated risks of mesothelioma and other asbestos-related cancers have been observed among sailors through epidemiologic studies. We review these studies here.
Standardized Incidence Ratio and Standardized Mortality Ratio of Malignant Mesothelioma in a Worker Cohort Using Employment Insurance Database in Korea. E.A. Kim. 2021;18(20). PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is one of the appropriate indicators for assessing the carcinogenic effects of asbestos. This study compared the risk ratio of mesothelioma according to the industry in the worker cohort. A cohort was constructed using the Korean employment insurance system during 1995-2017, enrolling 13,285,895 men and 10,452,705 women. The standardized mortality ratio (SMR) and standardized incidence ratio (SIR) were calculated using the indirect standardization method. There were 641 malignant mesotheliomas that occurred; the SIR was significantly higher than the general population (men 1.36, 95% confidence interval (CI) 1.24-1.48, women 1.44, 95% CI: 1.23-1.7). More than half (52.8%) of malignant mesothelioma cases occurred in the manufacturing (n = 240, 38.6%, SIR: men, 1.72, 95% CI: 1.37-2.15, women, 3.31, 95% CI: 1.71-5.79) and construction industries (n = 88, 14.2%, SIR: men, 1.54 95% CI: 1.33-1.78, women, 1.62 95% CI: 1.25-2.11). The accommodation and food service (men, 2.56 95% CI: 1.28-4.58, women 1.35, 95% CI: 0.65-2.48) and real estate (men 1.34, 95% CI: 0.98-1.83, women 1.95, 95% CI: 0.78-4.02) also showed a high SIR, indicating the risk of asbestos-containing materials in old buildings. The incidence of malignant mesothelioma is likely to increase in the future, given the long latency of this disease. Moreover, long-term follow-up studies will be needed.
The Epidemiologic Characteristics of Malignant Mesothelioma Cases in Korea: Findings of the Asbestos Injury Relief System from 2011-2015. S.C. Kwon, S.S. Lee, M.S. Kang, et al. 2021;18(19). PubMed · Publisher · Free full text

Abstract

(1) Background: The purpose of this study was to investigate the epidemiological characteristics of malignant mesothelioma in Korea by investigating cases compensated under the asbestos injury relief system. (2) Methods: A total of 407 compensated cases between 2011 and 2015 were reviewed using medical records and resident registrations in order to investigate the dates of diagnosis and death. Asbestos exposure and patients' general characteristics were investigated through face-to-face interviews. The standardized incidence ratio was calculated as the number of observations from 2005 to 2014 per exposure region in Korea, using the mid-annual population of each region in 2009 as the standard population. (3) Results: Among the 407 cases, 65.1% were male. The pleura and peritoneum were affected in 76.9% and 23.1% of cases, respectively. For peritoneal mesothelioma, the median survival duration was longer (p = 0.005), and the proportion of affected women was higher than that in pleural mesothelioma. The standardized incidence ratio (95% CI) by province of primary exposure was Chungnam 3.33 (2.51-4.35), Ulsan 1.85 (0.97-3.21), and Seoul 1.32 (1.06-1.63). (4) Conclusions: Although the representativeness of the data is limited, it is sufficient to assume the epidemiologic characteristics of malignant mesothelioma, help improve the compensation system, and contribute to future policies.
The Significance of Short Latency in Mesothelioma for Attribution of Causation: Report of a Case with Predisposing Germline Mutations and Review of the Literature. S. Klebe, A.J. Hocking, M. Soeberg, et al. 2021;18(24). Case report · Review PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is a tumour of the serosal membranes, related to asbestos exposure. Median latency is in the order of 40 years in various registries, but small numbers of cases with shorter latencies have long been reported and often dismissed as unrelated to asbestos exposure. However, emerging data regarding the significance of inherited mutations leading to a predisposition to mesothelioma suggest that the causative effect of asbestos may be associated with shorter latencies in a subset of patients. Here, we describe a male patient with germline mutations in RAD51 and p53 who developed peritoneal mesothelioma 8.5 years after well-documented asbestos exposure and discuss the current literature on the subject. Mesothelioma in situ is now a WHO-accepted diagnosis, but preliminary data reveal a potential lead time of 5 or more years to invasive disease, and this is also a factor which may affect the recording of latency (and potentially survival) in the future.
Trends in Airborne Chrysotile Asbestos Fibre Concentrations in Asbestos Cement Manufacturing Factories in Zimbabwe from 1996 to 2016. B. Mutetwa, D. Moyo, D. Brouwer. 2021;18(20). PubMed · Publisher · Free full text

Abstract

Zimbabwe has two major factories that have been manufacturing chrysotile asbestos cement products since the 1940s. Exposure monitoring of airborne fibres has been ongoing since the early 1990s. This study examines trends in personal exposure chrysotile asbestos fibre concentrations for the period 1996-2016. Close to 3000 historical personal exposure measurements extracted from paper records in the two factories were analysed for trends in exposure. Exposure over time was characterised according to three time periods and calendar years. Mean personal exposure chrysotile asbestos fibre concentrations generally showed a downward trend over the years in both factories. Exposure data showed that over the observed period 57% and 50% of mean personal exposure chrysotile asbestos fibre concentrations in the Harare and Bulawayo factories, respectively, were above the OEL, with overexposure being exhibited before 2008. Overall, personal exposure asbestos fibre concentrations in the factories dropped from 0.15 f/mL in 1996 to 0.05-0.06 f/mL in 2016-a decrease of 60-67%. These results can be used in future epidemiological studies, and in predicting the occurrence of asbestos-related diseases in Zimbabwe.
Using GIS to Estimate Population at Risk Because of Residence Proximity to Asbestos Processing Facilities in Colombia. B. Lysaniuk, M.F. Cely-García, M. Giraldo, et al. 2021;18(24). PubMed · Publisher · Free full text

Abstract

The recent enactment of the law banning asbestos in Colombia raises a significant number of challenges. The largest factories that have historically processed asbestos include five asbestos-cement facilities located in the cities of Sibaté (Cundinamarca), Cali (Valle del Cauca), and Barranquilla (Atlántico), and Manizales (Caldas), which has two, as well as a friction products facility in Bogotá D.C. An asbestos chrysotile mine has also operated in Colombia since 1980 in Campamento (Antioquia). In the framework of developing the National Asbestos Profile for Colombia, in this study, we estimated the population residing in the vicinity of asbestos processing plants or the mine and, therefore, potentially at risk of disease. Using a geographic information system, demographic data obtained from the last two general population censuses were processed to determine the number of people living within the concentric circles surrounding the asbestos facilities and the mine. In previous studies conducted in different countries of the world, an increased risk of asbestos-related diseases has been reported for people living at different distance bands from asbestos processing facilities. Based on these studies, circles of 500, 1000, 2000, 5000, and 10,000 m radii, centered on the asbestos processing facilities and the mine that operated in Colombia, were combined with the census data to estimate the number of people living within these radii. Large numbers of people were identified. It is estimated that in 2005, at the country level, 10,489 people lived within 500 m of an asbestos processing facility or mine. In 2018, and within a distance of 10,000 m, the number of people was 6,724,677. This information can aid public health surveillance strategies.
Vinyl-Asbestos Floor Risk Exposure in Three Different Simulations. L. Zichella, F. Baudana, G. Zanetti, et al. 2021;18(4). PubMed · Publisher · Free full text

Abstract

Vinyl floors are widely used in public areas for their low cost and easy cleaning. From 1960 to 1980, asbestos was often added to improve vinyl floor performances. The Italian Ministerial Decree (M.D.) 06/09/94 indicates asbestos vinyl tiles as non-friable materials and, therefore, few dangerous to human health. This work aims to check through three different experimental tests if asbestos floor tiles, after decades of use, maintain their characteristics of compactness and non-friability. The effect of a small stone fragment stuck in the sole of rubber shoes was reproduced by striking the vinyl floor with a crampon. A vinyl tile was broken into smaller pieces with the aid of pliers to simulate what normally happens when workers replace the floors or sample it to verify the presence of asbestos. The third test reproduced the abrasion of the tile surface due to the dragging of furniture or heavy materials or sand grains that remain attached to the soles of shoes. The tests were carried out in safe conditions, working under an extractor hood with a glove box. Airborne sampling in the hood obtained the concentration of asbestos fibers produced in each test. The simulation tests performed confirms the possible release of fibers if the vinyl tiles are cut, abraded or perforated, as indicated by the Italian M.D.
Asbestos Air Pollution: Description of a Mesothelioma Cluster Due to Residential Exposure from an Asbestos Cement Factory. L. Vimercati, D. Cavone, M.C. Delfino, et al. 2020;17(8). PubMed · Publisher · Free full text

Abstract

The study describes a cluster of 71 malignant mesothelioma cases among Bari residents without asbestos exposure other than residential exposure. This small cohort, as expected, was composed of a majority of females (56.34%) with a M/F ratio of 0.8, ages ≤ 65 years old (52.11%) and the epithelioid morphological type (78.87%). Sixty-four subjects (90.14%) lived between 10 m and 1000 m from the asbestos cement factory (Fibronit), and the latency length was longer than 55 years for 25 subjects (35.21%). The adjusted risk (adjusted OR) of observing the epithelial form of mesothelioma among subjects living at small distances from Fibronit was high (OR = 1.870 (0.353-9.905)) for people living 550-1000 m from the site and for those living less than 550 m from the site (OR = 1.470 (0.262-8.248)). Additionally, the subjects with a high length of exposure showed a relevant risk of epithelioid mesothelioma both for 21-40 years of exposure (OR = 2.027 (0.521-7.890)) and more than 40 years of exposure (OR = 2.879 (0.651-12.736)). All of the estimates were high but not significant because this transitional study has a typically low power. The adjustment for latency showed the same trend. Using detailed information collected by the regional mesothelioma registry, this study provided evidence of a continuing health impact of the Fibronit asbestos cement factory in Bari on the resident population.
Asbestos-Related Lung Cancer: A Hospital-Based Case-Control Study in Indonesia. A. Suraya, D. Nowak, A.W. Sulistomo, et al. 2020;17(2). PubMed · Publisher · Free full text

Abstract

Indonesia has limited data on asbestos-related diseases despite abundant use. This study investigated the risk of occupational asbestos exposure for lung cancer development, utilizing a hospital-based case-control study. Subjects were patients who received a thoracic CT scan at Persahabatan Hospital, Jakarta. The cases had primary lung cancer confirmed by histology, the controls were negative for lung cancer. The cumulative occupational asbestos exposure was calculated by multiplying the exposure intensity by the years of exposure. The exposure intensity was obtained by adopting the weighted arithmetic mean value of asbestos exposure from a job-exposure matrix developed in Korea. The primary data analysis was based on logistic regression. The study included 696 subjects, with 336 cases and 360 controls. The chance of lung cancer for subjects exposed to asbestos was doubled (OR = 2.04, 95% CI = 1.21-3.42) compared with unexposed, and subjects with a cumulative asbestos exposure of 10 fiber-years or more even showed an OR of 3.08 (95% CI = 1.01-9.46). The OR of the combined effect between smoking and asbestos was 8.7 (95% CI = 1.71-44.39); the interaction was consistent with an additive and multiplicative risk model. Asbestos exposure is associated with a higher chance of lung cancer. Improved policies are needed to protect the population from asbestos hazards.
Burden of Mesothelioma Deaths by National Income Category: Current Status and Future Implications. O. Chimed-Ochir, D. Arachi, T. Driscoll, et al. 2020;17(18). PubMed · Publisher · Free full text

Abstract

Background: This study compares estimates of the global-level mesothelioma burden with a focus on how existing national mortality data were utilized and further assesses the interrelationship of country-level mesothelioma burden and asbestos use with national income status. Methods: Country-level mesothelioma deaths in the WHO Mortality Database as of December 2019 were analyzed by national income category of countries in terms of data availability and reliability. Numbers of mesothelioma deaths from the study of Odgerel et al. were reanalyzed to assess country-level mesothelioma death burdens by national income status. Results: Among 80 high-income countries, 54 (68%) reported mesothelioma to the WHO and 26 (32%) did not, and among 60 upper middle-income countries, the respective numbers (proportions) were 39 (65%) countries and 21 (35%) countries, respectively. In contrast, among 78 low- and lower middle-income countries, only 11 (14%) reported mesothelioma deaths while 67 (86%) did not. Of the mesothelioma deaths, 29,854 (78%) were attributed to high- and upper middle-income countries, and 8534 (22%) were attributed to low- and lower middle- income countries. Conclusions: The global mesothelioma burden, based on reported numbers, is currently shouldered predominantly by high-income countries; however, mesothelioma burdens will likely manifest soon in upper middle-income and eventually in low and lower middle-income countries.
Characteristics of Cancer Patients in the World Trade Center Environmental Health Center. N. Durmus, Y. Shao, A.A. Arslan, et al. 2020;17(19). PubMed · Publisher · Free full text

Abstract

The destruction of the World Trade Center (WTC) towers on 11 September 2001 released many tons of aerosolized dust and smoke with potential for carcinogenic exposures to community members as well as responders. The WTC Environmental Health Center (WTC EHC) is a surveillance and treatment program for a diverse population of community members ("Survivors"), including local residents and workers, present in the NYC disaster area on 9/11 or in the days or weeks following. We report a case series of cancers identified in the WTC EHC as of 31 December 2019. Descriptive characteristics are presented for 2561 cancer patients (excluding non-melanoma skin cancer) and 5377 non-cancer WTC-EHC participants who signed informed consent. We identified a total of 2999 cancer diagnoses in 2561 patients: 2534 solid tumors (84.5%) and 465 lymphoid and hematopoietic tissue cancers (15.5%) with forty-one different cancer types. We describe the distribution, frequency, median age of cancer diagnosis and median latency from 9/11 by cancer site. In addition to common cancer types, rare cancers, including male breast cancers and mesotheliomas have been identified. The current study is the first report on cancer characteristics of enrollees at WTC EHC, a federally designated treatment and surveillance program for local community members affected by the 9/11 terrorist attack on the WTC.
Comment on Małgorzata Krówczyńska and Ewa Wilk. Environmental and Occupational Exposure to Asbestos as a Result of Consumption and Use in Poland. Int. J. Environ. Res. Public Health 2019, 16, 2611. B. Świątkowska, W. Hanke. 2020;17(5). Comment PubMed · Publisher · Free full text

Abstract

Krówczyńska M [...].
Estimation of Occupational Exposure to Asbestos in Italy by the Linkage of Mesothelioma Registry (ReNaM) and National Insurance Archives. Methodology and Results. C. Airoldi, D. Ferrante, L. Miligi, et al. 2020;17(3). PubMed · Publisher · Free full text

Abstract

The identification and monitoring of occupational cancer is an important aspect of occupational health protection. The Italian law on the protection of workers (D. Leg. 81/2008) includes different cancer monitoring systems for high and low etiologic fraction tumors. Record linkage between cancer registries and administrative data is a convenient procedure for occupational cancer monitoring. We aim to: (i) Create a list of industries with asbestos exposure and (ii) identify cancer cases who worked in these industries. The Italian National Mesothelioma Registry (ReNaM) includes information on occupational asbestos exposure of malignant mesothelioma (MM) cases. We developed using data from seven Italian regions a methodology for listing the industries with potential exposure to asbestos linking ReNaM to Italian National Social Security Institute (INPS) data. The methodology is iterative and adjusts for imprecision and inaccuracy in reporting firm names at interview. The list of asbestos exposing firms was applied to the list of cancer cases (all types associated or possibly associated with asbestos according to International Agency for Research on Cancer (IARC) monograph 100C) in two Italian regions for the indication of possible asbestos exposure. Eighteen percent of the cancer cases showed at least one work period in firms potentially exposing to asbestos, 48% of which in regions different from where the cases lived at diagnosis. The methodology offers support for the preliminary screening of asbestos exposing firms in the occupational history of cancer cases.
Evaluation of Nonresponse Bias in a Case-Control Study of Pleural Mesothelioma. C. Airoldi, D. Ferrante, D. Mirabelli, et al. 2020;17(17). PubMed · Publisher · Free full text

Abstract

Nonparticipation limits the power of epidemiological studies, and can cause bias. In a case-control study on pleural malignant mesothelioma (MM), we found low participation in interviews (63%) among controls. Our goal was to characterize nonresponder controls and assess nonresponse bias in our study. We selected all nonresponder controls (204) and a random sample of responder controls (174). Data were obtained linking hospital admissions and town registrars, and concordance between sources was assessed. Nonresponse bias was evaluated using a logistic regression model applying the inverse probability weighting approach. The odds ratio (OR) for the status of the respondents was 0.61 (95% confidence interval (CI): 0.33-1.16) for controls aged 61-70, 0.37 (CI: 0.20-0.66) for those aged 71-80, and 0.40 (CI: 0.20-0.80) for those aged above 80 (reference group: ≤60 years). Controls with low education level had lower OR (0.47; CI: 0.26-0.84). After adjustment, the ORs for MM by categories of cumulative exposure to asbestos were similar to the unadjusted results, ranging from 4.6 (CI: 1.8-11.7) for cumulative exposures between 0.1 and 1 f/mL-y to 57.5 (CI: 20.2-163.9) above 10 f/mL-y. Responder controls were younger and had higher education level. Nevertheless, there was little evidence of bias from nonresponse in the risk estimates of MM.
Exhaled Breath Analysis in Diagnosis of Malignant Pleural Mesothelioma: Systematic Review. Z.N. Töreyin, M. Ghosh, Ö. Göksel, et al. 2020;17(3). Systematic review PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is mainly related to previous asbestos exposure. There is still dearth of information on non-invasive biomarkers to detect MPM at early stages. Human studies on exhaled breath biomarkers of cancer and asbestos-related diseases show encouraging results. The aim of this systematic review was to provide an overview on the current knowledge about exhaled breath analysis in MPM diagnosis. A systematic review was conducted on MEDLINE (PubMed), EMBASE and Web of Science databases to identify relevant studies. Quality assessment was done by the Newcastle-Ottawa Scale. Six studies were identified, all of which showed fair quality and explored volatile organic compounds (VOC) based breath profile using Gas Chromatography Coupled to Mass Spectrometry (GC-MS), Ion Mobility Spectrometry Coupled to Multi-capillary Columns (IMS-MCC) or pattern-recognition technologies. Sample sizes varied between 39 and 330. Some compounds (i.e, cyclohexane, P3, P5, P50, P71, diethyl ether, limonene, nonanal, VOC IK 1287) that can be indicative of MPM development in asbestos exposed population were identified with high diagnostic accuracy rates. E-nose studies reported breathprints being able to distinguish MPM from asbestos exposed individuals with high sensitivity and a negative predictive value. Small sample sizes and methodological diversities among studies limit the translation of results into clinical practice. More prospective studies with standardized methodologies should be conducted on larger populations.
Forecast of Malignant Peritoneal Mesothelioma Mortality in Italy up to 2040. E. Oddone, J. Bollon, C.R. Nava, et al. 2020;18(1). PubMed · Publisher · Free full text

Abstract

Despite their differences, pleural and peritoneal mesothelioma are frequently lumped together to describe epidemic curves and to forecast future mesothelioma trends. This study aims to describe the malignant peritoneal mesothelioma (MPeM) epidemic in Italy (1996-2016) and to forecast future trends up to 2040 in order to contribute to the assessment of MPeM future burden. All MPeM deaths in Italy from 1996-2016 were collected (as provided by the Italian National Statistical Institute (ISTAT)) in order to estimate MPeM mortality rates for each 3-year period from 1996 to 2016. Poisson age-period-cohort (APC) models were then used to forecast MPeM future trends. Between 2017 and 2040, 1333 MPeM deaths are expected. The number of MPeM deaths, as well as mortality rates, are expected to constantly decrease throughout the considered period. Based on considering the information from this study, it can be concluded that the MPeM epidemic has probably already reached its peak in Italy.
Non-Malignant Respiratory Illnesses in Association with Occupational Exposure to Asbestos and Other Insulating Materials: Findings from the Alberta Insulator Cohort. S. Moitra, A. Farshchi Tabrizi, K. Idrissi Machichi, et al. 2020;17(19). PubMed · Publisher · Free full text

Abstract

Many insulating materials are used in construction, although few have been reported to cause non-malignant respiratory illnesses. We aimed to investigate associations between exposures to insulating materials and non-malignant respiratory illnesses in insulators. In this cross-sectional study, 990 insulators (45 ± 14 years) were screened from 2011-2017 in Alberta. All participants underwent pulmonary function tests and chest radiography. Demographics, work history, and history of chest infections were obtained through questionnaires. Chronic obstructive pulmonary disease (COPD) was diagnosed according to established guidelines. Associations between exposures and respiratory illnesses were assessed by modified Poisson regression. Of those screened, 875 (88%) were males. 457 (46%) participants reported having ≥ 1 chest infection in the past 3 years, while 156 (16%) were diagnosed with COPD. In multivariate models, all materials (asbestos, calcium silicate, carbon fibers, fiberglass, and refractory ceramic fibers) except aerogels and mineral fibers were associated with recurrent chest infections (prevalence ratio [PR] range: 1.18-1.42). Only asbestos was associated with COPD (PR: 1.44; 95% confidence interval [CI]: 1.01, 2.05). Therefore, occupational exposure to insulating materials was associated with non-malignant respiratory illnesses, specifically, recurrent chest infections and COPD. Longitudinal studies are urgently needed to assess the risk of exposure to these newly implemented insulation materials.
Predictions of Mortality from Pleural Mesothelioma in Italy After the Ban of Asbestos Use. E. Oddone, J. Bollon, C.R. Nava, et al. 2020;17(2). PubMed · Publisher · Free full text

Abstract

Even if the epidemic of malignant pleural mesothelioma (MPM) is still far from being over worldwide, the health effects of regulations banning asbestos can be evaluated in the countries that implemented them early. Estimates of MPM future burden can be useful to inform and support the implementation of anti-asbestos health policies all around the world. With this aim we described the trends of MPM deaths in Italy (1970-2014) and predicted the future number of cases in both sexes (2015-2039), with consideration of the national asbestos ban that was issued in 1992. The Italian National Statistical Institute (ISTAT) provided MPM mortality figures. Cases ranging from 25 to 89 years of age were included in the analysis. For each five-year period from 1970 to 2014, mortality rates were calculated and age-period-cohort Poisson models were used to predict future burden of MPM cases until 2039. During the period 1970-2014 a total number of 28,907 MPM deaths were observed. MPM deaths increased constantly over the study period, ranging from 1356 cases in 1970-1974 to 5844 cases in 2010-2014. The peak of MPM cases is expected to be reached in the period 2020-2024 (about 7000 cases). The decrease will be slow: about 26,000 MPM cases are expected to occur in Italy during the next 20 years (2020-2039). The MPM epidemic in Italy is far from being concluded despite the national ban implemented in 1992, and the peak is expected in 2020-2024, in both sexes. Our results are consistent with international literature.
Psychological Distress after a Diagnosis of Malignant Mesothelioma in a Group of Patients and Caregivers at the National Priority Contaminated Site of Casale Monferrato. M. Bonafede, A. Granieri, A. Binazzi, et al. 2020;17(12). PubMed · Publisher · Free full text

Abstract

Background: Patients of malignant mesothelioma (MM) and their caregivers face significant physical and psychological challenges. The purpose of the present study is to examine the emotional impact after the diagnosis of MM in a group of patients and familial caregivers in a National Priority Contaminated Site (NPCS).

Methods: A sample of 108 patients and 94 caregivers received a sociodemographic/clinical questionnaire, the Beck Depression Inventory II, the Davidson Trauma Scale, the Coping Orientation to the Problems Experienced-New Italian Version, and the Defense style questionnaire. The risk of depressive and post-traumatic stress disorder (PTSD) symptoms in relation to the strategies of coping and defense mechanisms was estimated in patients and caregivers separately by logistic regression models.

Results: For patients, a high risk of depression was associated with high usage of Defense Style Questionnaire (DSQ) Isolation (OR: 53.33; 95% CI: 3.22-882.30; p = 0.01) and DSQ Somatization (OR: 16.97; 95% CI: 1.04-275.90; p = 0.05). Other significant risks emerged for some coping strategies and some defenses regarding both depression and trauma in patients and caregivers.

Conclusions: This research suggests that for both patients and caregivers unconscious adaptive processes have a central role in dealing with overwhelming feelings related to the disease.
Reply to Comment on Małgorzata Krówczyńska and Ewa Wilk. Environmental and Occupational Exposure to Asbestos as a Result of Consumption and Use in Poland. Int. J. Environ. Res. Public Health 2019, 16, 2611. M. Krówczyńska, E. Wilk. 2020;17(6). Comment PubMed · Publisher · Free full text

Abstract

Thank you for the possibility of enabling us to provide a response to the comment on our paper "Environmental and Occupational Exposure to Asbestos as a Result of Consumption and Use in Poland" [...].
Retrospective Exposure Assessment Methods Used in Occupational Human Health Risk Assessment: A Systematic Review. F. Borghi, L.A. Mazzucchelli, D. Campagnolo, et al. 2020;17(17). Systematic review PubMed · Publisher · Free full text

Abstract

As part of the assessment and management of chemical risk and occupational hygiene, retrospective exposure assessment (REA) to chemical agents can be defined as the estimate of exposure associated with a person's work history. The fundamental problem underlying the reconstruction of the exposure is that of transforming this type of information in quantitative terms to obtain an accurate estimate. REA can follow various approaches, some of which are technically complicated and both time and resource consuming. The aim of this systematic review is to present the techniques mainly used for occupational REA. In order to carry out this evaluation, a systematic review of the scientific literature was conducted. Forty-four studies were identified (published from 2010 to date) and analyzed. In exposure reconstruction studies, quantitative approaches should be preferable, especially when estimates will be used in the context of health impact assessment or epidemiology, although it is important to stress how, ideally, the experimental data available for the considered scenario should be used whenever possible as the main starting information base for further processing. To date, there is no single approach capable of providing an accurate estimate of exposure for each reasonably foreseeable condition and situation and the best approach generally depends on the level of information available for the specific case. The use of a combination of different reconstruction techniques can, therefore, represent a powerful tool for weighting and integrating data obtained through qualitative and quantitative approaches, in order to obtain the best possible estimate.
Validation of an Asbestos Exposure Questionnaire (QEAS-7) for Clinical Practice. J. Ferrer, G. Granados, S. Hernández, et al. 2020;17(24). PubMed · Publisher · Free full text

Abstract

Introduction: The seven-item QEAS-7 questionnaire (exposure to asbestos questionnaire) has been designed as a useful and simple tool to establish the probability of exposure to asbestos. The objective of the present study is to validate the QEAS-7 following the recommended methodology.

Methods: The QEAS-7 was prospectively administered to 90 subjects with and without asbestos-related disease (ARD), on two consecutive occasions by two independent researchers. Logical and content validity was evaluated by a committee of experts and construct validity through hypothesis testing. Intra- and interobserver reliability was assessed by calculating Cohen's Kappa index (κ), which was estimated as weak if below 0.40, moderate if between 0.41 and 0.60 and good/very good if above 0.60. The comparison between proportions was examined using Pearson's Chi-square test.

Results: The majority of participants (88.9%) were male. Mean age was 70.8 years (SD = 8.4) and most of the sample had completed primary education but had not progressed further (62.2%). Forty-three had ARD. The logical, content and construct validity of the QEAS-7 was considered adequate both by a committee of experts and by the users interviewed. The mean administration time was 9 min and 25 s (SD = 3 min and 49 s). The verification of the five hypotheses confirmed the construct validity and the intra- and interobserver reliability to be κ = 0.93 and κ = 0.50 respectively. The concordance in the estimation of asbestos exposure was κ = 0.65.

Conclusions: The QEAS-7 is a simple, valid and reliable tool for estimating the probability of exposure to asbestos. Its application in clinical practice appears justified. What is already known about this subject? No studies have been published to date on the validation of specific questionnaires designed to determine asbestos exposure for routine use by healthcare staff in the clinical setting. What are the new findings? This questionnaire can be considered a comprehensible, viable, valid and reliable instrument for identifying exposure to asbestos. Its brevity and simplicity of administration make it ideally suited for use in daily clinical practice. How might this impact on policy or clinical practice in the foreseeable future? This questionnaire can be of help for physicians attending to patients with suspected asbestos-related diseases both in the hospital and in the primary care setting.

2010s

Asbestos, Smoking and Lung Cancer: An Update. S. Klebe, J. Leigh, D.W. Henderson, et al. 2019;17(1). Review PubMed · Publisher · Free full text

Abstract

This review updates the scientific literature concerning asbestos and lung cancer, emphasizing cumulative exposure and synergism between asbestos exposure and tobacco smoke, and proposes an evidence-based and equitable approach to compensation for asbestos-related lung cancer cases. This update is based on several earlier reviews written by the second and third authors on asbestos and lung cancer since 1995. We reevaluated the peer-reviewed epidemiologic studies. In addition, selected in vivo and in vitro animal studies and molecular and cellular studies in humans were included. We conclude that the mechanism of lung cancer causation induced by the interdependent coaction of asbestos fibers and tobacco smoke at a biological level is a multistage stochastic process with both agents acting conjointly at all times. The new knowledge gained through this review provides the evidence for synergism between asbestos exposure and tobacco smoke in lung cancer causation at a biological level. The evaluated statistical data conform best to a multiplicative model for the interaction effects of asbestos and smoking on the lung cancer risk, with no requirement for asbestosis. Any asbestos exposure, even in a heavy smoker, contributes to causation. Based on this information, we propose criteria for the attribution of lung cancer to asbestos in smokers and non-smokers.
Environmental and Occupational Exposure to Asbestos as a Result of Consumption and Use in Poland. M. Krówczyńska, E. Wilk. 2019;16(14). PubMed · Publisher · Free full text

Abstract

Unlabelled: Asbestos is harmful to human health; exposure to asbestos causes a wide range of asbestos-related diseases.

Aim: Malignant mesothelioma (MM) is unique to occupational and environmental asbestos exposure.

Methods: Environmental asbestos exposure was examined in relation to asbestos use and manufacturing, the quantity of the asbestos-containing products still in use, the concentrations of asbestos fibres in the air and the number of MM cases diagnosed each year per county.

Results: The correlation coefficient of the measurements of the asbestos fibre concentrations in the air and the quantity of asbestos-cement products in use is high and amounts to 0.68. Meanwhile, the correlation coefficient of the measurements of asbestos fibre concentrations in air and MM morbidity rate resulting from environmental exposure calculated for particular counties in provinces is low and amounts to 0.37. The highest MM morbidity rate was observed for Małopolskie and Śląskie, a typical industrial area of Poland.

Conclusions: There are MM cases which are still attributable to occupational asbestos exposure, although MM cases resulting from environmental exposure to asbestos have an increased MM risk. Poland is among those countries with a low MM incidence rate, which seems to be an underestimation of environmental asbestos exposure. As long as asbestos-cement products are used in the environment, actions should be undertaken to protect public health.
Exposure to Amosite-Containing Ceiling Boards in a Public School in Switzerland: A Case Study. D. Vernez, O. Duperrex, H. Herrera, et al. 2019;16(24). PubMed · Publisher · Free full text

Abstract

The measurement of an airborne concentration in Amosite fibers above 5035 F/m3 in a school prompted a retrospective quantitative health risk assessment. Dose estimates were built using air measurements, laboratory experiments, previous exposure data, and interviews. A dose response model was adapted for amosite-only exposure and adjusted for the life expectancy and lung cancer incidence in the Swiss population. The average yearly concentrations found were 52-320 F/m3. The high concentration previously observed was not representative of the average exposure in the building. Overall, the risk estimates for the different populations of the school were low and in the range of 2 × 10-6 to 3 × 10-5 for mesothelioma and 4 × 10-7 to 8 × 10-6 for lung cancer. The results evidenced however that children have to be considered at higher risk when exposed to asbestos, and that the current reference method and target values are of limited use for amphibole-only exposures. This study confirmed that quantitative health risk assessments and participatory approaches are powerful tools to support public decisions and build constructive communication between exposed people, experts, and policy-makers.
Lung Cancer Mortality Trends in a Brazilian City with a Long History of Asbestos Consumption. G.A. Fernandes, E. Algranti, G.M.S. Conceição, et al. 2019;16(14). PubMed · Publisher · Free full text

Abstract

There are scarce epidemiological studies on lung cancer mortality in areas exposed to asbestos in developing countries. We compared the rates and trends in mortality from lung cancer between 1980 and 2016 in a municipality that made extensive use of asbestos, Osasco, with rates from a referent municipality with lower asbestos exposure and with the rates for the State of São Paulo. We retrieved death records for cases of lung cancer (ICD-9 C162) (ICD-10 C33 C34) from 1980 to 2016 in adults aged 60 years and older. The join point regression and age-period-cohort models were fitted to the data. Among men, there was an increasing trend in lung cancer mortality in Osasco of 0.7% (CI: 0.1; 1.3) in contrast to a mean annual decrease for Sorocaba of -1.5% (CI: -2.4; -0.6) and a stable average trend for São Paulo of -0.1 (IC: -0.3; 0.1). Similar increasing trends were seen in women. The age-period-cohort model showed an increase in the risk of death from 1996 in Osasco and a reduction for Sorocaba and São Paulo State during the same period. Our results point to a need for a special monitoring regarding lung cancer incidence and mortality in areas with higher asbestos exposure.
Pulmonary Function and CT Scan Imaging at Low-Level Occupational Exposureto Asbestos. G. Satta, T. Serra, F. Meloni, et al. 2019;17(1). PubMed · Publisher · Free full text

Abstract

Background: In spite of the reduced exposure level, and its ban in numerous countries, compensation claims for asbestos-related diseases are far from decreasing. Methods: We used retrospective exposure assessment techniques to explore respiratory function and a computerized tomography (CT) scan in relation to past asbestos exposure in 115 male workers retired from an acrylic and polyester fiber plant. Based, on detailed information on exposure circumstances, we reconstructed a cumulative exposure estimate for each patient. Results: Time-weighted average exposure in our study population was 0.24 fibers/ml (95% confidence inteval (CI) 0.19-0.29), and the average cumulative exposure was 4.51 fibers/mL-years (95% CI 3.95-5.07). Exposure was elevated among maintenance workers, compared to other jobs (p = 0.00001). Respiratory function parameters did not vary in relation to the exposure estimates, nor to CT scan results. Risk of interstitial fibrosis showed a significant upward trend (Wald test for trend = 2.62, p = 0.009) with cumulative exposure to asbestos; risk associated with 5.26 fibers/mL-years or more, was 8-fold (95% CI 1.18-54.5). Conclusions: Our results suggest that a CT scan can detect pleuro-parenchymal lung alterations at asbestos exposure levels lower than previously thought, in absence of respiratory impairment. Further studies are required to validate our techniques of retrospective assessment of asbestos exposure.
Stomach Cancer and Exposure to Talc Powder without Asbestos via Chinese Herbal Medicine: A Population-Based Cohort Study. C.J. Chang, Y.H. Yang, P.C. Chen, et al. 2019;16(5). PubMed · Publisher · Free full text

Abstract

The present investigation was designed to explore the risk of stomach cancer by oral intake of talc powder without asbestos. We conducted a population-based cohort study on a randomly sampled cohort from Taiwan's health insurance database, with population of 1,000,000. The study participants were followed up through 2013. The outcome event of interest was the diagnosis of stomach cancer. The exposure of interest was the prescription of talc powder. Cox regression analyses were performed respectively. There were 584,077 persons without talc exposure and 21,575 talc users, 1849 diagnosed with stomach cancer. Persons with exposure of talc had a higher hazard ratio of stomach cancer (adjusted hazard ratio, 2.13; 95% confidence interval (CI), 1.54⁻2.94; p < 0.001). Classification by cumulative exposure of talc yielded adjusted hazard ratios of stomach cancer of 1.58 (95% CI, 0.79⁻3.17; p = 0.19) and 2.30 (95% CI, 1.48⁻3.57; p < 0.001) among persons with high (>21 g) and medium (6⁻21 g) exposure of talc, as compared to the low-exposure counterparts. Our data demonstrated positive association between increased risk of stomach cancer and oral intake of talc without asbestos. Despite the absence of dose-response effect, there might be a link between stomach cancer and talc.
Using a Mobile Phone App to Identify and Assess Remaining Stocks of In Situ Asbestos in Australian Residential Settings. M. Govorko, L. Fritschi, A. Reid. 2019;16(24). PubMed · Publisher · Free full text

Abstract

Asbestos-containing materials (ACMs) were used extensively throughout much of the 20th century and can still be found in many Australian homes. Therefore, we developed a mobile application ("app"), called ACM Check, which guides users through a home inspection to identify and assess certain types of in situ ACM. A cross-sectional study was conducted using the app to collect data on the type and condition of in situ asbestos in Australian residential settings. Since being released in June 2017, we have received data for 702 home inspections. Of these, 578 (82.3%) houses contained a total of 1895 in situ materials categorised as positive for asbestos by the app. The most prevalent ACMs were used for the backing board to electrical meter boxes (50% of homes), eaves and soffit linings (44.2% of homes), and fencing (28.1% of homes). While the majority of ACMs were categorised as 'very low' or 'low' priority for removal or remediation, 6.6% of all ACMs were considered to be of 'high' priority. Mobile apps offer a platform to help increase people's awareness of possible health hazards found in the residential environment, such as asbestos, while also being used to collect data for public and environmental health research.
Asbestos Consumption in Mongolia: 1996-2014. N. Damiran, A. Frank. 2018;15(1). PubMed · Publisher · Free full text

Abstract

Asbestos is still used in Mongolia in the energy and construction sectors, among others. However, limited data is available on asbestos consumption and asbestos-related disease in Mongolia. The purpose of this paper is to present the available information on the importation of asbestos into Mongolia. We used data on annual asbestos imports between 1996 and 2014 from Mongolian Customs Statistics and the National Council on Toxic and Hazardous Substances Affairs. The uses of this material are also presented with respect to chrysotile alone. Most asbestos is used for construction. Mongolia started using asbestos in the energy and construction industries as thermal insulation in 1961. Asbestos is still allowed for use in Mongolia under the Law on Toxic and Hazards Substances. There are no asbestos mines in Mongolia, and the manufacture of asbestos-containing materials does not take place there. Thus, asbestos is mainly imported from China and Russia. Mongolia used 44,422 metric tons of asbestos-containing materials between 1996 and 2014. In Mongolia, with the current use of asbestos, there will be a continuing risk of developing asbestos-related diseases from past use, and proper oversight of asbestos-involving activities and the safe removal and disposal of asbestos must be considered.
Asbestos Exposure and the Mesothelioma Incidence in Poland. M. Krówczyńska, E. Wilk. 2018;15(8). PubMed · Publisher · Free full text

Abstract

Unlabelled: Asbestos is carcinogenic to humans; the exposure to asbestos causes a wide range of diseases.

Aim: Malignant mesothelioma (MM) is unique for asbestos exposure.

Methods: Based on the physical inventory of asbestos-cement roofing, the social-economic situation of communes, the proximity of asbestos manufacturing plants, the land use data referring to the surface of the built-up area, and the historical data on the annexations, the amount of asbestos-containing products in use was estimated by computing best Random Forest models. Per capita asbestos use is an indicator to compare the state of asbestos use among countries. MM cases in the local administrative units (provinces) were tested by the application of Moran's I and Getis and Ord statistic.

Results: The total amount of asbestos roofing in Poland was estimated at 738,068,000 m² (8.2 million tons). In total there were 28 plants in Poland located in 11 provinces throughout the country. The amount of asbestos-cement roofing in use is correlated primarily with the measurements of asbestos concentration fibers (rs = 0.597). MM raw morbidity rate was calculated, stratified by province, and classified into five groups with respect to incidence. Hotspots of MM cases are in the southern part of Poland.

Conclusions: MM cases are concentrated in the same geographical areas, which may indicate an increasing impact of environmental exposure. The results of the local and global autocorrelation clearly indicate a statistically significant relationship between incidences of MM in provinces. Poland and other Eastern European countries are among countries with low MM incidence rate. Detailed investigation is desirable since the current MM morbidity rate in Poland seems to be underestimated.
Asbestos-Related Disorders in Germany: Background, Politics, Incidence, Diagnostics and Compensation. X. Baur. 2018;15(1). Review PubMed · Publisher · Free full text

Abstract

There was some limited use of asbestos at end of the 19th century in industrialized countries including Germany, but its consumption dramatically increased after World War II. The increase in use and exposure was followed by the discovery of high numbers of asbestos-related diseases with a mean latency period of about 38 years in Germany. The strong socio-political pressure from the asbestos industry, its affiliated scientists and physicians has successfully hindered regulatory measures and an asbestos ban for many years; a restrictive stance that is still being unravelled in compensation litigation. This national experience is compared with the situation in other industrialized countries and against the backdrop of the constant efforts of the WHO to eliminate asbestos-related diseases worldwide.
Australia's Ongoing Legacy of Asbestos: Significant Challenges Remain Even after the Complete Banning of Asbestos Almost Fifteen Years Ago. M. Soeberg, D.A. Vallance, V. Keena, et al. 2018;15(2). PubMed · Publisher · Free full text

Abstract

The most effective way of reducing the global burden of asbestos-related diseases is through the implementation of asbestos bans and minimising occupational and non-occupational exposure to respirable asbestos fibres. Australia's asbestos consumption peaked in the 1970s with Australia widely thought to have had among the highest per-capita asbestos consumption level of any country. Australia's discontinuation of all forms of asbestos and asbestos-containing products and materials did not occur at a single point of time. Crocidolite consumption ceased in the late 1960s, followed by amosite consumption stopping in the mid 1980s. Despite significant government reports being published in 1990 and 1999, it was not until the end of 2003 that a complete ban on all forms of asbestos (crocidolite, amosite, and chrysotile) was introduced in Australia. The sustained efforts of trade unions and non-governmental organisations were essential in forcing the Australian government to finally implement the 2003 asbestos ban. Trade unions and non-government organisations continue to play a key role today in monitoring the government's response to Australian asbestos-related disease epidemic. There are significant challenges that remain in Australia, despite a complete asbestos ban being implemented almost fifteen years ago. The Australian epidemic of asbestos-related disease has only now reached its peak. A total of 16,679 people were newly diagnosed with malignant mesothelioma between 1982 and 2016, with 84% of cases occurring in men. There has been a stabilisation of the age-standardised malignant mesothelioma incidence rate in the last 10 years. In 2016, the incidence rate per 100,000 was 2.5 using the Australian standard population and 1.3 using the Segi world standard population. Despite Australia's complete asbestos ban being in place since 2003, public health efforts must continue to focus on preventing the devastating effects of avoidable asbestos-related diseases, including occupational and non-occupational groups who are potentially at risk from exposure to respirable asbestos fibres.
Global Asbestos Disaster. S. Furuya, O. Chimed-Ochir, K. Takahashi, et al. 2018;15(5). Review PubMed · Publisher · Free full text

Abstract

Introduction: Asbestos has been used for thousands of years but only at a large industrial scale for about 100⁻150 years. The first identified disease was asbestosis, a type of incurable pneumoconiosis caused by asbestos dust and fibres. The latest estimate of global number of asbestosis deaths from the Global Burden of Disease estimate 2016 is 3495. Asbestos-caused cancer was identified in the late 1930's but despite today's overwhelming evidence of the strong carcinogenicity of all asbestos types, including chrysotile, it is still widely used globally. Various estimates have been made over time including those of World Health Organization and International Labour Organization: 107,000⁻112,000 deaths. Present estimates are much higher. Objective: This article summarizes the special edition of this Journal related to asbestos and key aspects of the past and present of the asbestos problem globally. The objective is to collect and provide the latest evidence of the magnitude of asbestos-related diseases and to provide the present best data for revitalizing the International Labor Organization/World Health Organization Joint Program on Asbestos-related Diseases. Methods: Documentation on asbestos-related diseases, their recognition, reporting, compensation and prevention efforts were examined, in particular from the regulatory and prevention point of view. Estimated global numbers of incidence and mortality of asbestos-related diseases were examined. Results: Asbestos causes an estimated 255,000 deaths (243,223⁻260,029) annually according to latest knowledge, of which work-related exposures are responsible for 233,000 deaths (222,322⁻242,802). In the European Union, United States of America and in other high income economies (World Health Organization regional classification) the direct costs for sickness, early retirement and death, including production losses, have been estimated to be very high; in the Western European countries and European Union, and equivalent of 0.70% of the Gross Domestic Product or 114 × 10⁸ United States Dollars. Intangible costs could be much higher. When applying the Value of Statistical Life of 4 million EUR per cancer death used by the European Commission, we arrived at 410 × 10⁸ United States Dollars loss related to occupational cancer and 340 × 10⁸ related to asbestos exposure at work, while the human suffering and loss of life is impossible to quantify. The numbers and costs are increasing practically in every country and region in the world. Asbestos has been banned in 55 countries but is used widely today; some 2,030,000 tons consumed annually according to the latest available consumption data. Every 20 tons of asbestos produced and consumed kills a person somewhere in the world. Buying 1 kg of asbestos powder, e.g., in Asia, costs 0.38 United States Dollars, and 20 tons would cost in such retail market 7600 United States Dollars. Conclusions: Present efforts to eliminate this man-made problem, in fact an epidemiological disaster, and preventing exposures leading to it are insufficient in most countries in the world. Applying programs and policies, such as those for the elimination of all kind of asbestos use-that is banning of new asbestos use and tight control and management of existing structures containing asbestos-need revision and resources. The International Labor Organization/World Health Organization Joint Program for the Elimination of Asbestos-Related Diseases needs to be revitalized. Exposure limits do not protect properly against cancer but for asbestos removal and equivalent exposure elimination work, we propose a limit value of 1000 fibres/m³.
Monitoring and Simulating Environmental Asbestos Dispersion from a Textile Factory. D. Kang, Y. Hwang, Y. Choi, et al. 2018;15(7). PubMed · Publisher · Free full text

Abstract

Although workplace asbestos concentrations (AC) have been reported several times, the past environmental AC are relatively poorly studied. Due to the harmful effects of the asbestos industry, production has moved from early industrialized countries (Japan), to late industrialized countries (Korea), and finally to industrializing countries (Indonesia). The purpose of this study was to determine current occupational exposure levels and evaluate neighborhood environmental exposure levels in an Indonesian asbestos textile factory through collaboration among three generation of industrialized countries. Asbestos concentrations were measured inside and outside of the factory and compared with simulated data. ACs in the factory were similar to those of 1980s and 1990s levels in the Korean factory that transferred the machines. Environmental ACs were dispersed according to wind direction. There were no significant differences between monitored and simulated data, and correlation coefficients between downwind, upwind, and middle wind directions were high, with some statistical significance. This study can be used to estimate past environmental ACs to understand the causality of asbestos related diseases. Because of the small sample size and specific weather conditions, a large-scale study of various asbestos exposure sources, including asbestos cement factories, shipyards, and mines, and various atmospheric conditions is required.
Relationships of Lower Lung Fibrosis, Pleural Disease, and Lung Mass with Occupational, Household, Neighborhood, and Slate Roof-Dense Area Residential Asbestos Exposure. D. Kang, Y.Y. Kim, M. Shin, et al. 2018;15(8). PubMed · Publisher · Free full text

Abstract

This study aimed to evaluate the relationship between various asbestos exposure routes and asbestos-related disorders (ARDs). The study population comprised 11,186 residents of a metropolitan city who lived near asbestos factories, shipyards, or in slate roof-dense areas. ARDs were determined from chest X-rays indicating lower lung fibrosis (LFF), pleural disease (PD), and lung masses (LMs). Of the subjects, 11.2%, 10.4%, 67.2% and 8.3% were exposed to asbestos via occupational, household, neighborhood, and slate roof routes, respectively. The odds ratio (OR) of PD from household exposure (i.e., living with asbestos-producing workers) was 1.9 (95% confidence interval: 0.9⁻4.2), and those of LLF and PD from neighborhood exposure, or residing near asbestos factories) for <19 or >20 years, or near a mine, were 4.1 (2.8⁻5.8) and 4.8 (3.4⁻6.7), 8.3 (5.5⁻12.3) and 8.0 (5.5⁻11.6), and 4.8 (2.7⁻8.5) and 9.0 (5.6⁻14.4), respectively. The ORs of LLF, PD, and LM among those residing in slate-dense areas were 5.5 (3.3⁻9.0), 8.8 (5.6⁻13.8), and 20.5 (10.4⁻40.4), respectively. Substantial proportions of citizens residing in industrialized cities have potentially been exposed to asbestos, and various exposure routes are associated with the development of ARDs. Given the limitations of this study, including potential confounders such as socioeconomic status, further research is needed.
The Asbestos Ban in Korea from a Grassroots Perspective: Why Did It Occur?. Y.R. Yoon, K.M. Kwak, Y. Choi, et al. 2018;15(2). Historical article PubMed · Publisher · Free full text

Abstract

In 2009, asbestos was finally banned in Korea, about 70 years after the first opening of asbestos mines under Japanese control. After having presented the history of asbestos industry, together with its regulations and health effects over time, we constructed narrative analyses of how the asbestos issue under the prevailing risk system was managed by whom and for what purpose, to provide context for the change. We could identify five different phases: laissez-faire, politico-technical, economic-managerial, health-oriented cultural, and human rights-based post-cultural risk systems. The changes leading to the asbestos ban evolved over different phases, and each phase change was necessary to reach the final ban, in that, without resolving the previous issues by examining different categories of potential alternatives, either the final ban was not possible or, even if instituted, could not be sustained. An asbestos ban could be introduced when all the alternatives to these issues, including legitimate political windows, economic rationalizations, health risk protections, and human rights sensitivities, were available. We think the alternatives that we had were not in perfect shape, but in more or less loosely connected forms, and hence we had to know how to build solidarities between different stakeholders to compensate for the imperfections.
The Secretory Response of Rat Peritoneal Mast Cells on Exposure to Mineral Fibers. V. Borelli, E. Trevisan, V. Francesca, et al. 2018;15(1). PubMed · Publisher · Free full text

Abstract

Background: Exposure to mineral fibers is of substantial relevance to human health. A key event in exposure is the interaction with inflammatory cells and the subsequent generation of pro-inflammatory factors. Mast cells (MCs) have been shown to interact with titanium oxide (TiO₂) and asbestos fibers. In this study, we compared the response of rat peritoneal MCs challenged with the asbestos crocidolite and nanowires of TiO₂ to that induced by wollastonite employed as a control fiber.

Methods: Rat peritoneal MCs (RPMCs), isolated from peritoneal lavage, were incubated in the presence of mineral fibers. The quantities of secreted enzymes were evaluated together with the activity of fiber-associated enzymes. The ultrastructural morphology of fiber-interacting RPMCs was analyzed with electron microscopy.

Results: Asbestos and TiO₂ stimulate MC secretion. Secreted enzymes bind to fibers and exhibit higher activity. TiO₂ and wollastonite bind and improve enzyme activity, but to a lesser degree than crocidolite.

Conclusions: (1) Mineral fibers are able to stimulate the mast cell secretory process by both active (during membrane interaction) and/or passive (during membrane penetration) interaction; (2) fibers can be found to be associated with secreted enzymes-this process appears to create long-lasting pro-inflammatory environments and may represent the active contribution of MCs in maintaining the inflammatory process; (3) MCs and their enzymes should be considered as a therapeutic target in the pathogenesis of asbestos-induced lung inflammation; and (4) MCs can contribute to the inflammatory effect associated with selected engineered nanomaterials, such as TiO₂ nanoparticles.
Trends and the Economic Effect of Asbestos Bans and Decline in Asbestos Consumption and Production Worldwide. L.P. Allen, J. Baez, M.E.C. Stern, et al. 2018;15(3). PubMed · Publisher · Free full text

Abstract

Although some countries have reduced asbestos consumption and instituted bans, other countries continue to produce and consume asbestos even as asbestos-related deaths mount and the associated societal costs are high. Asbestos production and consumption has declined globally; the number of bans has increased; and the speed at which countries have tapered off consumption has increased. Using country-level data, we study the economic impact of historical changes in the production and use of asbestos. We compare changes in gross domestic product (GDP) following the enactment of asbestos bans. We do not find any significant effect on GDP following an asbestos ban. In a regional case study, we compare changes in GDP and employment with changes in asbestos production. Regional-level data revealed a temporary employment decline at the local level that was then reversed.
Asbestos Ban in Italy: A Major Milestone, Not the Final Cut. D. Marsili, A. Angelini, C. Bruno, et al. 2017;14(11). PubMed · Publisher · Free full text

Abstract

Background and history: Italy was the main asbestos producer and one of the greatest consumers in 20th century Europe until the asbestos ban was introduced in 1992. Asbestos exposure affected the population in a wide range of working environments, namely mining and marketing of asbestos, asbestos cement production, shipyards and textile industries. This also determined a widespread environmental asbestos exposure affecting the surrounding communities. Methods: To investigate the drivers and difficulties of the process leading to the asbestos ban and its subsequent implementation, we focused on stakeholder involvement, environmental health policies, capacity building and communication. Results: In the past three decades, stakeholder involvement has been instrumental in advancing the industrial asbestos replacement process, prevention and remediation interventions. Furthermore, involvement also contributed to the integration of environmental and health policies at national, regional and local levels, including capacity building and communication. In a global public health perspective, international scientific cooperation has been established with countries using and producing asbestos. Discussion and Conclusions: Key factors and lessons learnt in Italy from both successful and ineffective asbestos policies are described to support the relevant stakeholders in countries still using asbestos contributing to the termination of its use.
Banning Asbestos in New Zealand, 1936-2016, an 80-Year Long Saga. W.I. Glass, R. Armstrong, G. Chen. 2017;14(12). Historical article PubMed · Publisher · Free full text

Abstract

The banning by the New Zealand Government of the import and export of asbestos-containing products resulted from the interplay of a number of factors. At a personal level, there were the actions of the asbestos sufferers, their families and support groups. At the political level, there were the activities of progressive trade union groups representing the hazardous trades, such as labourers, construction workers and demolition workers, and at a Government level, there was a positive response to these public health pressures. The Prohibition Order 2016 concerning Imports and Exports (asbestos-containing products) was the outcome of this 80-year long saga.
Barriers and Facilitators to the Elimination of Asbestos Related Diseases-Stakeholders' Perspectives. J. Vincenten, F. George, M. Martuzzi, et al. 2017;14(10). PubMed · Publisher · Free full text

Abstract

Despite sound scientific knowledge and evidence that any exposure to asbestos fibers in all of its forms, are carcinogenic to humans, its presence, use and trade is still substantial, including in the World Health Organization (WHO) European Region. Banning the production and use of all forms of asbestos, as recommended by the International Labour Organization (ILO) and WHO, has been proven as the most efficient evidence-based strategy to eliminate Asbestos Related Diseases (ARDs). To effectively move elimination of ARDs forward, attaining a greater understanding of key stakeholders perspectives was identified as an important action. The WHO Regional Office for Europe, the European Centre for Environment and Health, undertook semi-structured interviews, and follow-up discussions with diverse representatives dealing professionally with asbestos. The interview questionnaire was developed based on the current ARDs WHO Report, the Evidence Implementation Model for Public Health and categories of the theory of diffusion. Data were attained on three main questions within the interview questionnaire: (1) Identifying barriers to implementation of WHO evidence-based asbestos recommendations; (2) Describing roles of key stakeholders; and, (3) Proposing possible solutions. The results demonstrated use of sound and convincing scientific evidence along with economic evidence and facilitators can be used to achieve evidence-based policy development, and comprehensive diverse actions.
Experience of Japan in Achieving a Total Ban on Asbestos. S. Furuya, K. Takahashi. 2017;14(10). PubMed · Publisher · Free full text

Abstract

This paper aims to examine the process through which a total ban on asbestos was achieved in Japan. We reconstructed the process, analyzed the roles of involved parties/events, and drew lessons from the Japanese experience of achieving the ban. In Japan, a bill to phase out asbestos was proposed in 1992 but rejected without deliberation. Wide support for such a ban subsequently grew, however, largely due to the actions of trade unions and civil societies in establishing a coalition, raising awareness, organizing asbestos victims and their families, and propagating information on international developments. A governmental decision towards a ban was made in 2002 based on several national and international factors. A huge asbestos scandal in 2005 preponed the achievement of a total ban and led to the establishment of comprehensive measures to tackle asbestos issues. However, challenges remain for the elimination of asbestos-related diseases.
History of Asbestos Ban in Hong Kong. C.K. Wong, S.H. Wan, I.T. Yu. 2017;14(11). Historical article PubMed · Publisher · Free full text

Abstract

As millions of immigrants moved to Hong Kong (HK) from China in the recent decades, large amount of residential housings were built in the early years and a substantial proportion of those buildings used asbestos-containing materials (ACMs). Since the number of new cases of ARDs diagnosed has increased year by year since 1990's, the remarkable increase of incidences had drawn the attention of the public and most importantly the HK government. It became one of the trigger points leading to asbestos ban in HK history. Comparatively, non-governmental organizations (NGOs), labor unions and patients' self-help organizations demonstrated a more aggressive and proactive attitude than the HK government and have played a key role in the development of asbestos banning policy in HK. After numerous petitions and meetings with the government representatives by those parties in the past decade, the HK government eventually changed its attitude and started to consider terminating the endless threat from asbestos by amending the policy, and the new clause of legislation for banning of all forms of asbestos was enacted on 4 April 2014. Other than the restriction of asbestos use, the compensation system about ARDs has also made some great moves by the effort of those parties as well. Based on the experience we learnt through the years, efforts from different stakeholders including patients' self-help organizations, NGOs, legislative councilors, and media power are absolutely essential to the success of progression and development in today's asbestos banning in HK.
How Canada Changed from Exporting Asbestos to Banning Asbestos: The Challenges That Had to Be Overcome. K. Ruff. 2017;14(10). PubMed · Publisher · Free full text

Abstract

Less than ten years ago, the asbestos industry enjoyed the support of every Quebec and Canadian political party. The Chrysotile Institute and the International Chrysotile Association, both located in Quebec, aggressively marketed asbestos around the world, claiming scientific evidence showed that chrysotile asbestos could be safely used. The industry created a climate of intimidation. Consequently, no groups advocating for victims of asbestos or campaigning for its outright ban existed in Quebec to challenge the industry. A campaign was launched to mobilize the scientific community to speak out. Working with scientists, activists, and asbestos victims around the world, a small group of Quebec scientists exposed the false arguments of the asbestos industry. They publicly and repeatedly challenged the unscientific and unethical asbestos policy of the government. By appealing to Quebec values and holding those in power accountable, the campaign won public support and succeeded against all odds in defeating the asbestos industry.
The Tale of Asbestos in Sweden 1972-1986-The Pathway to a Near-Total Ban. P. Westerholm, B. Remaéus, M. Svartengren. 2017;14(11). PubMed · Publisher · Free full text

Abstract

This paper provides a narrative of the national intervention strategy in Sweden aimed to restrict the industrial use of asbestos. For many years, asbestos was imported for widespread industrial use, resulting in large amounts throughout Swedish society. In 1972, the whistle was blown in a Communist Party parliamentary motion describing asbestos as a health hazard and requesting action to prohibit its use. Although the motion was rejected, it initiated the extensive charting of asbestos sources on a tripartite basis, involving government agencies, and employer and trade-union organizations. Restrictive asbestos management practices were enforced from July 1982. The year 1985 saw the Government Asbestos Commission review, covering use-determining factors, international regulations, and assessments of cancer risks. The relative risks of chrysotile and amphibole were considered internationally (by the IARC), since chrysotile (a Canadian export) was regarded as unharmful in Canada at that time. Prohibiting asbestos use resulted in its virtual disappearance as an import to Sweden from the early 1980s. However, asbestos has undergone a transition from an occupational to a public-health hazard (although some work-related hazards, such as handling and disposal, remain). The transition reflects the public's exposure to existing stocks, in homes, workplaces, etc. Mesothelioma incidence has come to be regarded as an indicator of prevention effectiveness.
Toward an Asbestos Ban in the United States. R.A. Lemen, P.J. Landrigan. 2017;14(11). Historical article · Review PubMed · Publisher · Free full text

Abstract

Many developed countries have banned the use of asbestos, but not the United States. There have, however, been multiple efforts in the US to establish strict exposure standards, to limit asbestos use, and to seek compensation through the courts for asbestos-injured workers' In consequence of these efforts, asbestos use has declined dramatically, despite the absence of a legally mandated ban. This manuscript presents a historical review of these efforts.
Transnational Dynamics Amid Poor Regulations: Taiwan's Asbestos Ban Actions and Experiences. H.Y. Wu, R.T. Lin, J.D. Wang, et al. 2017;14(10). Historical article PubMed · Publisher · Free full text

Abstract

This article describes the history of the asbestos use regulation process in Taiwan and the associated factors leading to its total ban in 2018. Despite the long history of asbestos mining and manufacturing since the Japanese colonial period, attempts to understand the impact of asbestos on the health of the population and to control its use did not emerge until the early 1980s. We attempted to investigate the driving forces and obstructions involved in asbestos regulations by reviewing available public sources and scientific journal articles and conducting interviews with key propagators of the asbestos regulation and ban. Correlation between asbestos exposure and asbestos-related diseases has already been established; however, authorities have been unable to effectively regulate the extensive application of asbestos in various light industries that support economic growth since the 1960s. More stringent regulations on asbestos use in industries and an eventual ban were caused indirectly by appeals made by visionary scholars and healthcare professionals but also due to the subsidence of asbestos-related industries. With the elucidation of factors that affect asbestos regulation and ban, a thorough long-term healthcare plan for the neglected victims of asbestos-related diseases and upstream measures for policy change must be developed.
Turkey National Mesothelioma Surveillance and Environmental Asbestos Exposure Control Program. S. Metintaş, H.F. Batırel, H. Bayram, et al. 2017;14(11). PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma (MM) is an important health problem due to ongoing asbestos exposure. Environmental asbestos exposure leads to a high risk of MM in Turkey. The Turkish Mesothelioma Working Group and the Turkish Public Health Institute designed and performed the Turkey National Mesothelioma Surveillance and Environmental Asbestos Exposure Control Program (TUNMES-EAECP). The aim of this study was to analyze the results of the TUNMES-EAECP. Patients diagnosed with MM (code C45.0-C45.9) between 2008 and 2012 were identified. The "from case to the field" method was used to determine the villages with current or previous asbestos exposure. Special public health teams took soil samples from these villages, which were then examined using an X-ray diffractometer. Direct Standardized Average Annual Mesothelioma Incidence Rate (AMIR) and relative risk (RR) of MM were calculated. Finally, a projection on the incidence of MM between 2013 and 2033 was made. The number of confirmed MM cases was 5617 with a male to female ratio of 1.36. Mean age was 61.7 ± 13.4 (20-96) years. The median survival was eight (95% CI 7.6-8.4) months. Asbestos exposure continues in 379 villages, with 158,068 people still living in high risk areas. The standardized AMIR was 2.33/100,000 per year. The risk of MM was higher in males, in both sexes over the age of 40, in asbestos-containing provinces, and in those where the TUNMES was organized. Among the population with continuing asbestos exposure in rural areas, the number of MM cases between 2013 and 2033 was estimated as 2511. As such, the incidence of MM in Turkey is as high as in industrialized countries. Asbestos exposure in rural areas continues to be a serious problem in Turkey, which obviates the necessity for effective preventive measures.
Estimating the Additional Greenhouse Gas Emissions in Korea: Focused on Demolition of Asbestos Containing Materials in Building. Y.C. Kim, W.H. Hong, Y.L. Zhang, et al. 2016;13(9). PubMed · Publisher · Free full text

Abstract

When asbestos containing materials (ACM) must be removed from the building before demolition, additional greenhouse gas (GHG) emissions are generated. However, precedent studies have not considered the removal of ACM from the building. The present study aimed to develop a model for estimating GHG emissions created by the ACM removal processes, specifically the removal of asbestos cement slates (ACS). The second objective was to use the new model to predict the total GHG emission produced by ACM removal in the entire country of Korea. First, an input-equipment inventory was established for each step of the ACS removal process. Second, an energy consumption database for each equipment type was established. Third, the total GHG emission contributed by each step of the process was calculated. The GHG emissions generated from the 1,142,688 ACS-containing buildings in Korea was estimated to total 23,778 tonCO₂eq to 132,141 tonCO₂eq. This study was meaningful in that the emissions generated by ACS removal have not been studied before. Furthermore, the study deals with additional problems that can be triggered by the presence of asbestos in building materials. The method provided in this study is expected to contribute greatly to the calculation of GHG emissions caused by ACM worldwide.
Prevention of Asbestos-Related Disease in Countries Currently Using Asbestos. D. Marsili, B. Terracini, V.S. Santana, et al. 2016;13(5). Review PubMed · Publisher · Free full text

Abstract

More than 40 years of evaluation have consistently confirmed the carcinogenicity of asbestos in all of its forms. This notwithstanding, according to recent figures, the annual world production of asbestos is approximatively 2,000,000 tons. Currently, about 90% of world asbestos comes from four countries: Russia, China, Brazil and Kazakhstan; and the wide use of asbestos worldwide represents a global threat. The purpose of this paper is to present a review of the asbestos health impact and to discuss the role of epidemiological investigations in countries where asbestos is still used. In these contexts, new, "local" studies can stimulate awareness of the size of the problem by public opinion and other stakeholders and provide important information on the circumstances of exposure, as well as local asbestos-related health impacts. This paper suggests an agenda for an international cooperation framework dedicated to foster a public health response to asbestos, including: new epidemiological studies for assessing the health impact of asbestos in specific contexts; socio-cultural and economic analyses for contributing to identifying stakeholders and to address both the local and global implications of asbestos diffusion; public awareness on the health and socio-economic impact of asbestos use and banning.
Students' Perceived Heat-Health Symptoms Increased with Warmer Classroom Temperatures. S. Bidassey-Manilal, C.Y. Wright, J.C. Engelbrecht, et al. 2016;13(6). PubMed · Publisher · Free full text

Abstract

Temperatures in Africa are expected to increase by the end of the century. Heat-related health impacts and perceived health symptoms are potentially a problem, especially in public schools with limited resources. Students (n = 252) aged ~14-18 years from eight high schools completed an hourly heat-health symptom log over 5 days. Data loggers measured indoor classroom temperatures. A high proportion of students felt tired (97.2%), had low concentration (96.8%) and felt sleepy (94.1%) during at least one hour on any day. There were statistically significant correlations, when controlling for school cluster effect and time of day, between indoor temperatures ≥32 °C and students who felt tired and found it hard to breathe. Consistently higher indoor classroom temperatures were observed in classrooms constructed of prefabricated asbestos sheeting with corrugated iron roof and converted shipping container compared to brick classrooms. Longitudinal studies in multiple seasons and different classroom building types are needed.
Domestic asbestos exposure: a review of epidemiologic and exposure data. E. Goswami, V. Craven, D.L. Dahlstrom, et al. 2013;10(11):5629-70. Meta-analysis · Review PubMed · Publisher · Free full text

Abstract

Inhalation of asbestos resulting from living with and handling the clothing of workers directly exposed to asbestos has been established as a possible contributor to disease. This review evaluates epidemiologic studies of asbestos-related disease or conditions (mesothelioma, lung cancer, and pleural and interstitial abnormalities) among domestically exposed individuals and exposure studies that provide either direct exposure measurements or surrogate measures of asbestos exposure. A meta-analysis of studies providing relative risk estimates (n = 12) of mesothelioma was performed, resulting in a summary relative risk estimate (SRRE) of 5.02 (95% confidence interval [CI]: 2.48-10.13). This SRRE pertains to persons domestically exposed via workers involved in occupations with a traditionally high risk of disease from exposure to asbestos (i.e., asbestos product manufacturing workers, insulators, shipyard workers, and asbestos miners). The epidemiologic studies also show an elevated risk of interstitial, but more likely pleural, abnormalities (n = 6), though only half accounted for confounding exposures. The studies are limited with regard to lung cancer (n = 2). Several exposure-related studies describe results from airborne samples collected within the home (n = 3), during laundering of contaminated clothing (n = 1) or in controlled exposure simulations (n = 5) of domestic exposures, the latter of which were generally associated with low-level chrysotile-exposed workers. Lung burden studies (n = 6) were also evaluated as a surrogate of exposure. In general, available results for domestic exposures are lower than the workers' exposures. Recent simulations of low-level chrysotile-exposed workers indicate asbestos levels commensurate with background concentrations in those exposed domestically.
Pulmonary oxidative stress, inflammation and cancer: respirable particulate matter, fibrous dusts and ozone as major causes of lung carcinogenesis through reactive oxygen species mechanisms. A. Valavanidis, T. Vlachogianni, K. Fiotakis, et al. 2013;10(9):3886-907. Review PubMed · Publisher · Free full text

Abstract

Reactive oxygen or nitrogen species (ROS, RNS) and oxidative stress in the respiratory system increase the production of mediators of pulmonary inflammation and initiate or promote mechanisms of carcinogenesis. The lungs are exposed daily to oxidants generated either endogenously or exogenously (air pollutants, cigarette smoke, etc.). Cells in aerobic organisms are protected against oxidative damage by enzymatic and non-enzymatic antioxidant systems. Recent epidemiologic investigations have shown associations between increased incidence of respiratory diseases and lung cancer from exposure to low levels of various forms of respirable fibers and particulate matter (PM), at occupational or urban air polluting environments. Lung cancer increases substantially for tobacco smokers due to the synergistic effects in the generation of ROS, leading to oxidative stress and inflammation with high DNA damage potential. Physical and chemical characteristics of particles (size, transition metal content, speciation, stable free radicals, etc.) play an important role in oxidative stress. In turn, oxidative stress initiates the synthesis of mediators of pulmonary inflammation in lung epithelial cells and initiation of carcinogenic mechanisms. Inhalable quartz, metal powders, mineral asbestos fibers, ozone, soot from gasoline and diesel engines, tobacco smoke and PM from ambient air pollution (PM₁₀ and PM₂.₅) are involved in various oxidative stress mechanisms. Pulmonary cancer initiation and promotion has been linked to a series of biochemical pathways of oxidative stress, DNA oxidative damage, macrophage stimulation, telomere shortening, modulation of gene expression and activation of transcription factors with important role in carcinogenesis. In this review we are presenting the role of ROS and oxidative stress in the production of mediators of pulmonary inflammation and mechanisms of carcinogenesis.
Cancer incidence of 2,4-D production workers. C. Burns, K. Bodner, G. Swaen, et al. 2011;8(9):3579-90. PubMed · Publisher · Free full text

Abstract

Despite showing no evidence of carcinogenicity in laboratory animals, the herbicide 2,4-dichlorophenoxyacetic acid (2,4-D) has been associated with non-Hodgkin lymphoma (NHL) in some human epidemiology studies, albeit inconsistently. We matched an existing cohort of 2,4-D manufacturing employees with cancer registries in three US states resulting in 244 cancers compared to 276 expected cases. The Standardized Incidence Ratio (SIR) for the 14 NHL cases was 1.36 (95% Confidence Interval (CI) 0.74-2.29). Risk estimates were higher in the upper cumulative exposure and duration subgroups, yet not statistically significant. There were no clear patterns of NHL risk with period of hire and histology subtypes. Statistically significant results were observed for prostate cancer (SIR = 0.74, 95% CI 0.57-0.94), and "other respiratory" cancers (SIR = 3.79, 95% CI 1.22-8.84; 4 of 5 cases were mesotheliomas). Overall, we observed fewer cancer cases than expected, and a non statistically significant increase in the number of NHL cases.
Clinical, radiological, and pathological investigation of asbestosis. T. Kishimoto, K. Kato, H. Arakawa, et al. 2011;8(3):899-912. Case report PubMed · Publisher · Free full text

Abstract

By the radiological examination, differential diagnosis of asbestosis from chronic interstitial pneumonia such as IPF/UIP is difficult. The pathological features of asbestosis show the peribronchiolar fibrosis which suggest that asbestos fibers cause the inflammation of bronchioli. Therefore, the criteria for pathological diagnosis of asbestosis in 2010, contain the finding of peribronchiolar fibrosis again. Chest CT scanning including HRCT for total of 38 cases clinically diagnosed asbestosis were reviewed by 3 radiologists and one pulmonologist. On the other hand, the histology of lung tissues obtained by surgery or autopsy were examined by 4 pulmonological pathologists. Furthermore, the content of asbestos bodies in the lung was counted by phase-contrast microscopy. Thirteen cases were definitely diagnosed of asbestosis in the image including HRCT and 17 cases were diagnosed by the histopathological examination showing lung fibrosis with peribronchiolar fibrosis. Only 10 cases were indicated asbestosis by both the radiological and histopathological examinations. The mean value of asbestos bodies for these cases, was 2,133,255 per gram of dry lung tissue.
Identification of occupational cancer risks in British Columbia, Canada: a population-based case-control study of 1,155 cases of colon cancer. R. Fang, N. Le, P. Band. 2011;8(10):3821-43. PubMed · Publisher · Free full text

Abstract

Objective: Cancer has been recognized to have environmental origin, but occupational cancer risk studies have not been fully documented. The objective of this paper was to identify occupations and industries with elevated colon cancer risk based on lifetime occupational histories collected from 15,463 incident cancer cases.

Method: A group matched case-control design was used. All cases were diagnosed with histologically proven colon cancers, with cancer controls being all other cancer sites, excluding rectum, lung and unknown primary, diagnosed at the same period of time from the British Columbia Cancer Registry. Data analyses were done on all 597 Canadian standard occupation titles and 1,104 standard industry titles using conditional logistic regression for matched data sets and the likelihood ratio test.

Results: Excess colon cancer risks was observed in a number of occupations and industries, particularly those with low physical activity and those involving exposure to asbestos, wood dusts, engine exhaust and diesel engine emissions, and ammonia.

Discussion: The results of our study are in line with those from the literature and further suggest that exposure to wood dusts and to ammonia may carry an increased occupational risk of colon cancer.
Three potential sources of microfungi in a treated municipal water supply system in sub-tropical Australia. N.B. Sammon, K.M. Harrower, L.D. Fabbro, et al. 2011;8(3):713-32. PubMed · Publisher · Free full text

Abstract

Some microfungi are known to be opportunistic human pathogens, and there is a body of scientific opinion that one of their routes of infection may be water aerosols. Others have been implicated as causative agents of odours and off-tastes in drinking water. This study was undertaken to investigate three potential sources of microfungi in a treated, oligotrophic municipal water supply system in sub-tropical Australia. Formation of the microfungal component of developing biofilm on hard surfaces in water storage reservoirs was also assessed. Inside and outside air samples were collected from two reservoirs using two types of Burkard air samplers. Biofilm and soft sediment samples were collected from the inner surfaces of asbestos cement water pipes and from pipe dead ends respectively. These were analysed for microfungal growth and sporulation using Calcofluor White stain and epifluorescent microscopy. Artificial coupons of glass, PVC and concrete were immersed in two reservoirs to assess microfungal biofilm formation. This was analysed periodically using Calcofluor White stain and epifluorescent microscopy, cultures of coupon swabs and scanning electron microscopy. Fungal spores were recovered from all air samples. The number of colonies and the genera were similar for both inside and outside air. Microfungal filaments and sporulating structures were recovered from most of the pipe inner surface biofilm and dead end sediment samples, but were sparser in the biofilm than in the sediment samples. No recognisable, vegetative filamentous fungi were found in the slowly developing biofilm on coupons. This study indicates that airborne spores are an important potential source of microfungi found in water storage reservoirs. It has also demonstrated conclusively that filamentous microfungi grow and sporulate on water pipe inner surfaces and in soft sediments within the water distribution system.

2000s

Tobacco smoke: involvement of reactive oxygen species and stable free radicals in mechanisms of oxidative damage, carcinogenesis and synergistic effects with other respirable particles. A. Valavanidis, T. Vlachogianni, K. Fiotakis. 2009;6(2):445-62. PubMed · Publisher · Free full text

Abstract

Tobacco smoke contains many toxic, carcinogenic and mutagenic chemicals, as well as stable and unstable free radicals and reactive oxygen species (ROS) in the particulate and the gas phase with the potential for biological oxidative damage. Epidemiological evidence established that smoking is one of the most important extrinsic factor of premature morbidity and mortality. The objective of this study was to investigate oxidative and carcinogenic mechanisms of tobacco and synergistic action with other respirable particles in the respiratory system of smokers. Electron Paramagnetic Resonance (EPR) and spin-trapping techniques were used to study stable free radicals in the cigarette tar, and unstable superoxide anion (O2 (*-)) and hydroxyl (HO(*)) radicals in the smoke Results showed that the semiquinone radical system has the potential for redox recycling and oxidative action. Further, results proved that aqueous cigarette tar (ACT) solutions can generate adducts with DNA nucleobases, particularly the mutagenic 8-hydroxy-2'-deoxyguanosine (a biomarker for carcinogenesis). Also, we observed synergistic effects in the generation of HO(*), through the Fenton reaction, with environmental respirable particles (asbestos fibres, coal dust, etc.) and ambient particulate matter (PM), such as PM(10), PM(2.5) and diesel exhaust particles (DEP). The highest synergistic effects was observed with the asbestos fibres (freshly grounded), PM(2.5) and DEP. Finally, we discuss results from our previous study of conventional cellulose acetate filters and "bio-filters" with hemoglobin impregnated activated carbon, which showed that these filters do not substantially alter the free radical content of smoke in the particulate and in the gaseous phase.
Cytotoxic responses and potential respiratory health effects of carbon and carbonaceous nanoparticulates in the Paso del Norte airshed environment. K.F. Soto, L.E. Murr, K.M. Garza. 2008;5(1):12-25. PubMed · Publisher · Free full text

Abstract

We have utilized a range of manufactured or commercial nanoparticulate materials, including surrogate carbon nano-PM along with combustion-generated carbonaceous (soot) nano-PM characteristic of environmental nano- PM (both indoor and outdoor) to investigate and compare their cytotoxic response in vitro with an immortalized human epithelial (lung model) cell line (A549). These have included nano-Ag, Al2O3, TiO2, Fe2O3, ZrO2, Si3N4, chrysotile asbestos, BC, 2 types of MWCNT-aggregate PM (MWCNT-R and MWCNT-N), and high-volume glass fiber collected soots: candle, wood, diesel (truck), tire, and 3-types of natural gas kitchen burner-generated soots: yellow (fuel-rich) flame, low-flow blue flame, and normal flow blue flame soot PM. These carbonaceous nano-PM species can be found in either the indoor and outdoor environments or microenvironments. Two-day and two-week in-vitro cultures of A549 showed cell death (or decreased cell viability) for all nanoparticulate materials, but especially significant for all but the TiO2 and candle, wood, and diesel PM. The natural gas kitchen burner combustion PM cell death response was characteristic of BC and MWCNT PM. There was no correlation with total PAH content of the soot PM. Cytokine release (IL-6, IL-8) was detected for the Ag, Fe2 O3, asbestos, BC and the MWCNT PM. Reactive oxygen species (ROS) production was also detected for Ag, Fe2 O3, ZrO2, asbestos, BC, and the MWCNT aggregate PM, as well as the natural gas kitchen burner combustion PM. TEM, FESEM, and optical microscopy examination of these nanomaterials illustrate the wide range in PM morphologies and crystallinities as well as cell morphologies. Taken together, these results illustrate proinflammatory and related respiratory health issues in relation to environmental nanoparticulates.
Microstructures and nanostructures for environmental carbon nanotubes and nanoparticulate soots. L.E. Murr. 2008;5(5):321-36. PubMed · Publisher · Free full text

Abstract

This paper examines the microstructures and nanostructures for natural (mined) chrysotile asbestos nanotubes (Mg3 Si2O5 (OH)4) in comparison with commercial multiwall carbon nanotubes (MWCNTs), utilizing scanning and transmission electron microscopy (SEM and TEM). Black carbon (BC) and a variety of specific soot particulate (aggregate) microstructures and nanostructures are also examined comparatively by SEM and TEM. A range of MWCNTs collected in the environment (both indoor and outdoor) are also examined and shown to be similar to some commercial MWCNTs but to exhibit a diversity of microstructures and nanostructures, including aggregation with other multiconcentric fullerenic nanoparticles. MWCNTs formed in the environment nucleate from special hemispherical graphene "caps" and there is evidence for preferential or energetically favorable chiralities, tube growth, and closing. The multiconcentric graphene tubes ( approximately 5 to 50 nm diameter) differentiate themselves from multiconcentric fullerenic nanoparticles and especially turbostratic BC and carbonaceous soot nanospherules ( approximately 8 to 80 nm diameter) because the latter are composed of curved graphene fragments intermixed or intercalated with polycyclic aromatic hydrocarbon (PAH) isomers of varying molecular weights and mass concentrations; depending upon combustion conditions and sources. The functionalizing of these nanostructures and photoxidation and related photothermal phenomena, as these may influence the cytotoxicities of these nanoparticulate aggregates, will also be discussed in the context of nanostructures and nanostructure phenomena, and implications for respiratory health.
Fluoro-edenite fibers induce expression of Hsp70 and inflammatory response. V. Cardile, L. Lombardo, E. Belluso, et al. 2007;4(3):195-202. PubMed · Publisher · Free full text

Abstract

Many asbestos-like mineral fibers have been detected in the air of mountainous and volcanic areas of Italy and other parts of the world. These fibers have been suspected to be the cause of increased incidences of lung cancer and other lung diseases in these areas. However, the mechanisms of the cellular response and defense following exposure to these microscopic fibers have not been characterized. We continue to study these mechanisms to be able to propose preventive strategies in large populations. The objective of the present study was to determine comparatively biological responses of mesothelial Met-5A and monocyte-macrophage J774 cells following exposure to two types of fluoro-edenite fibers having low and high iron content (labeled 19 and 27, respectively) obtained from Biancavilla (Sicily, Italy). The reference fiber was a non-iron fibrous tremolite from Val di Susa (Piemonte, Italy). The cells were treated with 5, 50, and 100 mug of fibrous matter per 1 ml for 72 hr. We identified several key mechanisms by which cells responded and counteracted the injury induced by these fibers. The fibers caused induction of the heat shock protein 70 (Hsp70), stimulated formation of reactive oxygen species (detected by using DCFH-DA as a fluorescent probe) and NO* (measured as nitrite). Exposure of cells to the fibers induced lactate dehydrogenase activity and decreased viability. The fluoro-endenite type 27 was the most potent fiber tested, which indicated that iron and possibly manganese contribute significantly to this fiber toxicity. The J774 cells were more sensitive to fluoro-edenite than Met-5A cells suggesting that the primary site of the fiber-induced inflammatory response could be the macrophage rather than the pulmonary epithelium. Fluoro-edenite produces more biological alterations with respect to non-iron tremolite. Hsp70 and free radicals could be important factors in the context of mineral fiber-induced acute lung injury leading possibly to mutagenic effects. We anticipate that pharmacological blockade of the fiber-dependent cellular responses could in long term offer preventive approach to combat lung diseases induced by these fibers.
Toxicity and carcinogenicity mechanisms of fibrous antigorite. V. Cardile, L. Lombardo, E. Belluso, et al. 2007;4(1):1-9. PubMed · Publisher · Free full text

Abstract

We studied the effects of fibrous antigorite on mesothelial MeT-5A and monocyte-macrophage J774 cell lines to further understand cellular mechanisms induced by asbestos fibers leading to lung damage and cancer. Antigorite is a mineral with asbestiform properties, which tends to associate with chrysotile or tremolite, and frequently occurs as the predominant mineral in the veins of several serpentinite rocks found abundantly in the Western Alps. Particles containing antigorite are more abundant in the breathing air of this region than those typically found in urban ambient air. Exposure of MeT-5A and J774 cells to fibrous antigorite at concentrations of 5-100 microg/ml for 72 hr induced dose-dependent cytotoxicity. Antigorite also stimulated the ROS production, induced the generation of nitrite and PGE2. MeT-5A cells were more sensitive to antigorite than J774 cells. The results of this study revealed that the fibrous antigorite stimulates cyclooxygenase and formation of hydroxyl and nitric oxide radicals. These changes represent early cellular responses to antigorite fibers, which lead to a host of pathological and neoplastic conditions because free radicals and PGE2 play important roles as mediators of tumor pathogenesis. Understanding the mechanisms of the cellular responses to antigorite and other asbestos particles should be helpful in designing rational prevention and treatment approaches.
Combustion-generated nanoparticulates in the El Paso, TX, USA / Juarez, Mexico Metroplex: their comparative characterization and potential for adverse health effects. L.E. Murr, K.F. Soto, K.M. Garza, et al. 2006;3(1):48-66. PubMed · Publisher · Free full text

Abstract

In this paper we report on the collection of fine (PM1) and ultrafine (PM0.1), or nanoparticulate, carbonaceous materials using thermophoretic precipitation onto silicon monoxide/formvar-coated 3 mm grids which were examined in the transmission electron microscope (TEM). We characterize and compare diesel particulate matter (DPM), tire particulate matter (TPM), wood burning particulate matter, and other soot (or black carbons (BC)) along with carbon nanotube and related fullerene nanoparticle aggregates in the outdoor air, as well as carbon nanotube aggregates in the indoor air; and with reference to specific gas combustion sources. These TEM investigations include detailed microstructural and microdiffraction observations and comparisons as they relate to the aggregate morphologies as well as their component (primary) nanoparticles. We have also conducted both clinical surveys regarding asthma incidence and the use of gas cooking stoves as well as random surveys by zip code throughout the city of El Paso. In addition, we report on short term (2 day) and longer term (2 week) in vitro assays for black carbon and a commercial multiwall carbon nanotube aggregate sample using a murine macrophage cell line, which demonstrate significant cytotoxicity; comparable to a chrysotile asbestos nanoparticulate reference. The multi-wall carbon nanotube aggregate material is identical to those collected in the indoor and outdoor air, and may serve as a surrogate. Taken together with the plethora of toxic responses reported for DPM, these findings prompt concerns for airborne carbonaceous nanoparticulates in general. The implications of these preliminary findings and their potential health effects, as well as directions for related studies addressing these complex issues, will also be examined.
Cytotoxicity assessment of some carbon nanotubes and related carbon nanoparticle aggregates and the implications for anthropogenic carbon nanotube aggregates in the environment. L.E. Murr, K.M. Garza, K.F. Soto, et al. 2005;2(1):31-42. PubMed · Publisher · Free full text

Abstract

Nanotechnology and nanomaterials have become the new frontier world-wide over the past few years and prospects for the production and novel uses of large quantities of carbon nanotubes in particular are becoming an increasing reality. Correspondingly, the potential health risks for these and other nanoparticulate materials have been of considerable concern. Toxicological studies, while sparse, have been concerned with virtually uncharacterized, single wall carbon nanotubes, and the conclusions have been conflicting and uncertain. In this research we performed viability assays on a murine lung macrophage cell line to assess the comparative cytotoxicity of commercial, single wall carbon nanotubes (ropes) and two different multiwall carbon nanotube samples; utilizing chrysotile asbestos nanotubes and black carbon nanoaggregates as toxicity standards. These nanotube materials were completely characterized by transmission electron microscopy and observed to be aggregates ranging from 1 to 2 microm in mean diameter, with closed ends. The cytotoxicity data indicated a strong concentration relationship and toxicity for all the carbon nanotube materials relative to the asbestos nanotubes and black carbon. A commercial multiwall carbon nanotube aggregate exhibiting this significant cell response was observed to be identical in structure to multiwall carbon nanotube aggregates demonstrated to be ubiquitous in the environment, and especially in indoor environments, where natural gas or propane cooking stoves exist. Correspondingly, preliminary epidemiological data, although sparse, indicate a correlation between asthma incidence or classification, and exposure to gas stoves. These results suggest a number of novel epidemiological and etiological avenues for asthma triggers and related respiratory or other environmental health effects, especially since indoor number concentrations for multiwall carbon nanotube aggregates is at least 10 times the outdoor concentration, and virtually all gas combustion processes are variously effective sources. These results also raise concerns for manufactured carbon nanotube aggregates, and related fullerene nanoparticles.

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