Prevention of Asbestos Exposure in Latin America within a Global Public Health Perspective

Our plain-English summary of Prevention of Asbestos Exposure in Latin America within a Global Public Health Perspective, by E. Algranti, J.P. Ramos-Bonilla, B. Terracini, et al (Annals of Global Health, 2019).

The study

• Authors: E. Algranti, J.P. Ramos-Bonilla, B. Terracini, V.S. Santana, P. Comba, R. Pasetto, A. Mazzeo, F. Cavariani, A. Trotta, D. Marsili
• Journal: Annals of Global Health
• Published: 2019;85(1)
• Type of article: Review
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Asbestos consumption in Latin America (LA) amounts to 10% of yearly global production. Little is known about the impact of asbestos exposure in the region.

Objective: To discuss scientific and socio-economic issues and conflicts of interest and to summarize epidemiological data of asbestos health effects in LA.

Discussion: Recent data on chrysotile strengthened the evidence of its carcinogenicity and showed an excessive risk of lung cancer at cumulative exposure levels as low as 1.5 fibre-years/ml. Technology for substitution is available for all asbestos-containing products and ceasing asbestos production and manufacturing will not result in unemployment and loss of income, except for the mining industry. The flawed arguments used by the industry to maintain its market, both to the public and in courtrooms, strongly relies on the lack of local evidence of the ill effects and on the invisibility of asbestos-related diseases in LA, due to the limited number of studies and the exposed workers' difficulty accessing health services. The few epidemiological studies available show clear evidence of clusters of mesothelioma in municipalities with a history of asbestos consumption and a forecasted rise in its incidence in Argentina and Brazil for the next decade. In Brazil, non-governmental organizations of asbestos workers were pivotal to counterbalance misinformation and inequities, ending recently in a Supreme Court decision backing an asbestos ban. In parallel, continuous efforts should be made to stimulate the growth of competent and ethical researchers to convey adequate information to the scientific community and to the general public.

© 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.

In plain English

This article was a review and perspective piece, not a new study. The authors discussed scientific, economic and epidemiological evidence on asbestos in Latin America, with a focus on chrysotile. Citing earlier work, they noted that a study of chrysotile textile workers found excess lung cancer risk at cumulative exposures below 1.5 f-years/ml. Earlier studies they reviewed found mesothelioma cases clustered in Brazilian municipalities that had housed asbestos-cement plants. Among people aged 15 or older in Argentina, age-adjusted mesothelioma mortality rose from 3.04 to 5.62 per million between 1980 and 2013. Mortality was forecast to keep rising until 2026 in Brazil and 2020 in Argentina. Mesothelioma diagnoses on death certificates agreed poorly with other records in Brazil and Mexico. The authors argued that low recorded mesothelioma numbers in the region likely reflect underreporting. They described a 2017 Brazilian Supreme Court decision against chrysotile use, which awaited judgment on appeals filed by the asbestos industry. The authors concluded that a ban is necessary but not sufficient. They also concluded that surveillance and diagnostic gaps should not be used to delay regulation.

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

What the study did and found

• Design: Review and perspective article discussing published studies and data; no new study was conducted
• Who was studied: Published literature and national data on asbestos use and asbestos-related disease in Latin American countries, especially Brazil, Argentina, Colombia and Mexico
• Exposure: Asbestos used in Latin America, discussed with a focus on chrysotile. The article also reports imports of crocidolite and/or amosite into some countries and notes that in Brazil nearly all raw asbestos went to the asbestos-cement industry. Occupational, household and environmental exposures are discussed.
• Main results:
  • From a cited study (Hein) of chrysotile textile workers: there was an excess lung cancer risk for workers whose cumulative exposure was less than 1.5 f-years/ml
  • From an earlier Brazilian mortality study (2000 to 2012): clusters of mesothelioma cases were found in Brazilian municipalities that had formerly housed asbestos-cement industries
  • From an earlier Argentine study using national mortality data, limited to people aged 15 or older: age-adjusted mesothelioma mortality was 3.04 per 1,000,000 in 1980 and 5.62 per 1,000,000 in 2013
  • From earlier forecasting studies: mesothelioma mortality was projected to keep increasing until 2026 in Brazil and until 2020 in Argentina
  • From an earlier study of pleural mesothelioma in Mexico (119 cases and 353 controls): odds ratios increased with increasing levels of exposure. Attributable risks to asbestos were estimated at 83.2% for the exposed population and 44% for the general population.
  • From an earlier Rio de Janeiro study of 217 mesothelioma cases on death certificates (1979 to 1994), of which 31 could be paired with other databases: diagnosis on death certificates agreed with histopathology in 35.5% and with medical records in 59.3%. A Mexican study found 29.0% agreement between immunohistopathology and death certificate codes.
  • From Colombian studies of brake repair workers: 25% of 103 full-shift personal asbestos measurements in 18 brake repair shops exceeded the occupational limit of 0.1 f/cc
  • From a cited Brazilian economic study (University of Campinas): job losses from a ban would occur only in asbestos extraction. This contradicted an industry federation document that predicted job losses and higher housing costs.
  • In 2017 the Brazilian Supreme Court upheld state laws prohibiting asbestos and declared unconstitutional the federal law permitting chrysotile use. The article states that the decision was awaiting judgment of appeals already filed by the asbestos industry.
• The authors' conclusion: The authors concluded that countries still using asbestos should aim for a total ban, which they called necessary but not sufficient because of asbestos remaining in buildings. They also concluded that the apparently low number of mesothelioma cases in Latin America likely reflects underreporting, and that surveillance and diagnostic problems should not be used to delay regulation.
• Limitations the authors state:
  • Regular reporting of exposure and asbestos-related diseases is poorly implemented in Latin America, which limits the precision of morbidity and mortality estimates
  • The cited Latin American occupational studies with exposure assessment were limited to selected sectors of the population and could not give an overall estimate of exposure in the region
  • The cited burden estimates for Argentina, Brazil, Colombia and Mexico rested on assumptions that could not be checked and on the reliability of national vital statistics

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Chrysotile, Lung Cancer, Cumulative Exposure, Mesothelioma.

Related studies

• International scientific cooperation on asbestos-related disease prevention in Latin America — D. Marsili, P. Comba, et al. (2014)
• Children's health in Latin America: the influence of environmental exposures — A. Laborde, F. Tomasina, et al. (2015)
• Prevention of Asbestos-Related Disease in Countries Currently Using Asbestos — D. Marsili, B. Terracini, et al. (2016)
• Characteristics and long-term outcomes of advanced pleural mesothelioma in Latin America (MeSO-CLICaP) — L. Rojas, A.F. Cardona, et al. (2019)
• Status of the ban on asbestos use in Spain and Latin America — R.A. Accinelli Tanaka, L.M. López Oropeza (2015)
• The art of perpetuating a public health hazard — M. Greenberg (2005)

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