Occupational burden of asbestos-related cancer in Argentina, Brazil, Colombia, and Mexico

Our plain-English summary of Occupational burden of asbestos-related cancer in Argentina, Brazil, Colombia, and Mexico, by R. Pasetto, B. Terracini, D. Marsili, et al (Annals of Global Health, 2014).

The study

• Authors: R. Pasetto, B. Terracini, D. Marsili, P. Comba
• Journal: Annals of Global Health
• Published: 2014;80(4):263-8
• Cited by: 37 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: An estimate at the national level of the occupational cancer burden brought about by the industrial use of asbestos requires detailed routine information on such uses as well as on vital statistics of good quality. A causal association with asbestos exposure has been established for mesothelioma and cancers of the lung, larynx, and ovary.

Objectives: The aim of this study was to provide estimates of the occupational burden of asbestos-related cancer for the Latin American countries that are or have been the highest asbestos consumers in the region: Argentina, Brazil, Colombia, and Mexico.

Methods: The burden of multifactorial cancers has been estimated through the approach suggested for the World Health Organization using the population attributable fraction. The following data were used: Proportion of workforce employed in each economic sector. Proportion of workers exposed to asbestos in each sector. Occupational turnover. Levels of exposure. Proportion of the population in the workforce. Relative risk for each considered disease for 1 or more levels of exposure. Data on the proportion of workers exposed to asbestos in each sector are not available for Latin American countries; therefore, data from the European CAREX database (carcinogen exposure database) were used.

Findings: Using mortality data of the World Health Organization Health Statistics database for the year 2009 and applying the estimated values for population attributable fractions, the number of estimated deaths in 5 years for mesothelioma and for lung, larynx, and ovary cancers attributable to occupational asbestos exposures, were respectively 735, 233, 29, and 14 for Argentina; 340, 611, 68, and 43 for Brazil; 255, 97, 14, and 9 for Colombia, and 1075, 219, 18, and 22 for Mexico.

Conclusions: The limitations in compiling the estimates highlight the need for improvement in the quality of asbestos-related environmental and health data. Nevertheless, the figures are already usable to promote a ban on asbestos use.

Copyright © 2014 Icahn School of Medicine at Mount Sinai. Published by Elsevier Inc. All rights reserved.

In plain English

This study aimed to estimate the burden of cancer from workplace asbestos exposure in Argentina, Brazil, Colombia, and Mexico. It did not examine individual workers. Instead, it combined existing national statistics using a method suggested for the World Health Organization. Estimates of how many workers in each economic sector were exposed to asbestos were not available for the countries studied, so the authors used European Union figures from 1990 to 1993. For mesothelioma, the authors reported all recorded deaths, not a workplace-only figure. Based on 2009 WHO data, estimated mesothelioma deaths in 5 years were 735 in Argentina, 340 in Brazil, 255 in Colombia, and 1075 in Mexico. Estimated lung cancer deaths attributable to occupational asbestos were 233, 611, 97, and 219 respectively, with smaller numbers for larynx and ovary cancers. A second lung cancer method gave higher figures than the first in every country except Brazil. The authors concluded that a few to several hundred occupational asbestos-related cancers occur per 5 years in each country, and that these numbers are almost certainly underestimated. They also said the estimates are exploratory and rest on assumptions open to debate and on limited data.

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: National burden-of-disease estimate (modelling exercise) using population attributable fractions, following an approach suggested for the World Health Organization; for lung cancer, also a mesothelioma-to-lung cancer ratio method
• Who was studied: The populations and workforces of Argentina, Brazil, Colombia, and Mexico. Workforce data by economic sector came from the International Labour Organization (2006), and cancer death counts came from the WHO health statistics database for 2009.
• Exposure: Occupational asbestos exposure, with no fiber type specified for the model. The share of workers exposed in each economic sector was taken from the European CAREX database (EU countries, 1990-1993), because no such estimates were available for the countries studied. The model assumed two exposure levels (50% high, 50% low) and applied a turnover factor of 4.
• Main results:
  • Argentina, estimated deaths in 5 years: mesothelioma 735, lung 233, larynx 29, ovary 14. The mesothelioma figure was the total of recorded mesothelioma deaths from official WHO mortality data. The lung, larynx, and ovary figures were modelled as attributable to occupational asbestos exposure.
  • The same estimates were 340, 611, 68, and 43 in Brazil; 255, 97, 14, and 9 in Colombia; and 1075, 219, 18, and 22 in Mexico.
  • For lung cancer in Mexico, the mesothelioma-to-lung cancer ratio method (1:1 and 1:2) gave 717 and 1433 attributable cases in 5 years. The population attributable fraction method gave 219.
  • The ratio method gave higher lung cancer estimates than the population attributable fraction method in Argentina, Colombia, and Mexico (up to 5-fold in Mexico). The reverse occurred in Brazil. The authors said the differences were difficult to interpret and suggested Brazil's pattern might reflect limited amphibole use there.
• The authors' conclusion: The authors concluded that a sizable number of occupational asbestos-related cancers (a few to several hundred per 5 years) occur in each country, and that these numbers are almost certainly underestimated. They called for remediation of asbestos contamination, a national asbestos ban in Brazil, Colombia, and Mexico, and better asbestos-related environmental and health data. They described the estimates as exploratory.
• Limitations the authors state:
  • The estimates rely on a number of assumptions open to debate.
  • The databases needed are limited or nonexistent in Latin American countries and have not been adequately checked for quality and completeness.
  • The European CAREX exposure proportions may differ from those in Latin American countries because of differences in industrial cycles and asbestos products.
  • The quality of mesothelioma mortality statistics in Latin America is a major problem, because the diagnosis may be difficult.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Mesothelioma, Population Attributable Fraction (PAF), Relative Risk.

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