Long-term epidemiological observation of asbestos-related diseases in Poland, 1970-2015

Our plain-English summary of Long-term epidemiological observation of asbestos-related diseases in Poland, 1970-2015, by B. Swiatkowska, N. Szeszenia-Dabrowska (Occupational Medicine, 2017).

The study

• Authors: B. Swiatkowska, N. Szeszenia-Dabrowska
• Journal: Occupational Medicine
• Published: 2017;67(3):182-187
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Occupational exposure to asbestos constitutes a major public health concern. Despite this in many countries, data and registration systems for occupational asbestos-related diseases are non-existent or poorly developed.

Aims: To analyse the incidence of occupational asbestos-related diseases in Poland between the years 1970 and 2015, with particular emphasis on the periods after introduction of a ban on asbestos and following introduction of a surveillance programme.

Methods: Analysis based on all medically recognized cases, certified as occupational diseases and reported obligatorily from all over the country to the Central Register of Occupational Diseases.

Results: During the period 1970-2015, 4983 cases were reported as asbestos-related diseases. The most prevalent were asbestosis, lung cancer, diseases of pleura or pericardium and mesothelioma. A considerable increase in the number of such cases from the beginning of their registration until 2004 occurred after introduction of the Amiantus programme, a nationwide programme of periodic medical examinations for former asbestos workers.

Conclusions: Introduction of a medical surveillance programme improved case recognition and allowed a more reliable estimate of the number of reported asbestos-related diseases.

© The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected]

In plain English

This study analysed all occupational asbestos-related disease cases reported by law from across Poland to the national Register of Occupational Diseases, 1970 to 2015. The register held 4983 cases, 3193 of them recorded after the 1997 asbestos ban. There were 3110 cases of asbestosis (62% of all cases), 653 of asbestos-related lung cancer and 398 of mesothelioma (390 pleural, 8 peritoneal). Case numbers rose from the start of the study period until 2004. The authors attributed this rise to the diseases' long latency and to Amiantus, a nationwide programme of periodic medical examinations for former asbestos workers begun in 2001. For asbestosis, lung cancer and mesothelioma, patients diagnosed in 2013 to 2015 were on average older than those diagnosed in 1998 to 2000. Their mean latency periods were also longer, at 41.6, 41.6 and 41.1 years respectively. The authors concluded that the surveillance programme improved case recognition and allowed a more reliable estimate of the number of reported asbestos-related diseases. They noted that the register holds only cases accepted as occupational diseases and that some asbestos-related diseases go undiagnosed and unrecorded.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Descriptive analysis of a national, legally mandatory register of certified occupational diseases (absolute numbers, percentages, means and trends)
• Who was studied: All cases of occupational asbestos-related disease reported from all over Poland to the Register of Occupational Diseases at the Nofer Institute of Occupational Medicine in Łódź, 1970 to 2015
• Exposure: Occupational asbestos exposure. The authors estimate that about 2 million tons of asbestos were imported to Poland after World War II, 90% of it chrysotile. Most cases were in former workers of asbestos-processing plants, and some came from construction work such as mounting eternit boards.
• Main results:
  • 4983 cases of occupational asbestos-related disease were reported between 1970 and 2015
  • 3193 of the 4983 cases were recorded after the 1997 asbestos ban
  • The number of asbestos-related diseases rose from the beginning of the study period until 2004
  • The authors attributed the increase through 2004 to two factors: the long latency of the diseases and the introduction of the Amiantus programme
  • Former workers of the 28 asbestos-processing plants gained the right to free periodic medical examinations under Amiantus in 2001
  • There were 3110 asbestosis cases, 62% of all diagnosed asbestos-related disease
  • 68% of asbestosis cases were in males
  • In the last 15 years of observation, 52% of cases were asbestosis, 21% pleural or pericardial disease, 15% lung cancer and 11% pleural mesothelioma
  • From 2001 to 2015, reported asbestosis cases decreased by an average of 8.5 cases a year
  • There were 653 cases of asbestos-related lung cancer from 1978 to 2015. In Poland, any lung cancer with documented asbestos exposure counts as occupational, regardless of smoking.
  • Asbestos-related cases made up about 41% of all occupational lung cancer cases over the whole period, and 52% in 2001 to 2015
  • 398 mesothelioma cases were reported up to 2015: 390 pleural and 8 peritoneal
  • 78% of mesothelioma cases were in men
  • From 2003 to 2015 there were 612 cases of asbestos-related pleural changes. 93% were extensive pleural thickening and 7% were extensive pleural plaques or pericarditis.
  • Of cases reported in 2001 to 2015, more than 72% were in former employees of closed asbestos-processing plants who were included in the Amiantus programme
  • Mean age at diagnosis was higher in 2013 to 2015 than in 1998 to 2000 for asbestosis (65.3 vs 56.0 years), lung cancer (66.5 vs 61.5) and mesothelioma (64.6 vs 59.9), with P less than 0.05
  • Mean latency was longer in 2013 to 2015 than in 1998 to 2000 for asbestosis (41.6 vs 26.3 years), lung cancer (41.6 vs 33.9) and mesothelioma (41.1 vs 31.6), with P less than 0.05. Mean exposure duration was shorter in 2013 to 2015 for lung cancer (14.7 vs 20.8 years) and mesothelioma (15.2 vs 22.7), also with P less than 0.05.
  • 6% of cases came from the construction industry, most of them mesothelioma, with latency periods of up to 55 years
• The authors' conclusion: The authors concluded that introducing a medical surveillance programme improved case recognition and allowed a more reliable estimate of the number of reported asbestos-related diseases
• Limitations the authors state:
  • The register contains only registered cases accepted as occupational diseases
  • Because of the long time between exposure and symptoms, some asbestos-related diseases are neither diagnosed nor recorded
  • The low proportion of mesothelioma recognised as occupational may reflect missing detailed occupational histories
  • The shorter exposure durations in recent cases were influenced by who attended the Amiantus programme, where people with less than 20 years of exposure dominated

Topics

Medical terms in this study, explained in our Lexicon: Occupational Exposure, Occupational Disease, Lung Cancer, Pleura, Pericardium, Mesothelioma.

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