Asbestos as an environmental and a health problem


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Asbestos as an environmental and a health problem

  2. 2. AGENDA Asbestos overview Asbestos- an environmental problem Asbestos-a health problem Role of Egyptian press media in Asbestos banning Role of Egyptian Government in Asbestos banning Take home message
  3. 3. Asbestos overview
  4. 4. Asbestos Definition The word asbestos derives from a Greek word meaning “inextinguishable”
  5. 5. What is Asbestos •Naturally occuring fibrous minerals . •All types of asbestos tend to break into very tiny fibers. •These individual fibers are so small they must be identified using a microscope. •Some fibers may be up to 700 times smaller than a human hair.
  6. 6. What is Asbestos? Because asbestos fibers are so small, once released into the air, they may stay suspended there for hours or even days.
  7. 7. Asbestos: Types Serpentine Amphibole (93% of commercial use) (7% of commercial use) Chrysotile Actinolite, Amosite, Anthophyllite, Crocidolite, Richterite, Tremolite
  8. 8. Common Types Of Asbestos Note: The general use of asbestos is now banned. Blue and Brown Asbestos banned UW-Eau Claire Facilities Planning & Management in 1985, white in 1999.
  9. 9. Properties of Asbestos • Good tensile strength • Flexible • Heat resistant Asbestos ore • Electrical resistance • Good insulation Asbestos fibers • Chemical resistant Because of these unique properties, asbestos was used extensively in variety of products.
  10. 10. Uses of Asbestos Asbestos has been used for centuries, but greatly increased during and after World War II in ship insulation and the following: • Pipe insulation • Surfacing insulating materials Asbestos insulated pipe • Reinforcement of materials • Fireproofing • Acoustic and decorative plaster • Textiles Use has greatly declined since the late 1970’s Asbestos insulated boiler
  11. 11. Uses of Asbestos Sheet vinyl containing asbestos Sprayed-on fireproofing material These products may be found in homes and buildings constructed before 1981. Vinyl asbestos flooring
  12. 12. Asbestos cement pressure pipes Used for water supply
  13. 13. Value of Asbestos Imports (2003) Country US $ Iran 26,019,000 United Arab Emirates 10,787,000 Egypt 1,996,000 Pakistan 1,357,000 Lebanon 1,123,000 Oman 590,000 Iraq 194,000 Saudi Arabia 161,000 Syrian Arab Republic 6,000
  14. 14. Chrysotile Asbestos Imports for EM Region (tonnes) Country 1960 1970 1975 1980 Iran 1246 11,197 24,814 23,392 United Arab ----2000 4631 Emirates Egypt 6583 6609 5477 4387 Pakistan ----7000 10,679 Iraq 450 2000 1482 --Saudi Arabia ----10,405 52,225 Syrian Arab ----3391 4076 Republic Morocco 2676 3551 7160 6770 Lebanon 2258 6418 ----Total 13,213 29,775 61,729 106,160 The data in the table come from statistics compiled by the United States Geological Survey.
  15. 15. Asbestos-an environmental problem
  16. 16. Asbestos environmental exposures Natural sources (erosion of asbestos containing rocks) Residence in the viciniy of mines or plants manufacturing asbestos products Release of fibers from public, residential and commercial buildings containing friable asbestos Contamination of homes by work clothes
  17. 17. The World Health Organization estimates that 60% of the 125 million people exposed to asbestos in their homes or workplace . Broken bags of asbestos cement lie in open storage
  18. 18. Airborne asbestos fibre counts at various locations surrounding Sigwart El Maasara (Zakaria et al., 1989) f/cc Location North North west Range 0.21 00 South east 0.42-8.3 (Autostrade road) South west 0.17-0.25 East 3.8 - 5.4 Zakaria, Y., El Zahabi, M., Hussein, M., El‐Karim, A., 1989. Neighborhood risks of asbestos exposure and malignant mesothelioma. Egyptian Journal of Chest Diseases and Tuberculosis 36, 71‐80 mean 0.21 00 4.6 00 3.45
  19. 19. Airborne asbestos fibre counts in the residential areas surrounding the Sigwart El Maasara f/cc Location Eldin et al. (2005) Mean El‐Maadi (~5 km ) 0.002 Hadayk Helwan 0.02 El Maasara 0.062 El‐ Maasara (the main gate) 0.057 Autostrade 3.02 East, 25 m of the factory wall Eldin, N., 2008. Airborne asbestos fibers around Sigwart Al Maasara and ORA‐Egypt. Technical Report, National Cancer Institute, Cairo University, Egypt. Eldin, N., Gaafar, M.R., Abdel Hameed, A.A., Abdelrahman, M.A., Aboulkassem, F., 2005. Mesothelioma in Egypt. Egyptian Journal of Community Medicine 23, 41‐45 Eldin (2008) mean 0.0044 0.069 0.0887 0.358 0.1407 0.058
  20. 20. OSHA Permissible Asbestos Exposure Limits The Occupational Safety and Health Commission (OSHA) has set a permissible asbestos exposure limit (“PEL”) of 0.1 fiber per cubic centimeter (f/cc) for work in all industries. Despite Limits, No Safe Level of Asbestos Exposure Asbestos Standard For General Industry - OSHA
  21. 21. Asbestos is an Inhalation Hazard Airborne asbestos fibers inhaled deep into the lung can cause damage. • Tiny breathable asbestos fibers are deposited in the alveoli, the ending small air sacs in the lungs. Pleura • The body’s defense mechanisms cannot break down the fibers. • Asbestos fibers cause damage to the lungs. • The fibers may also travel to the pleura, the membrane lining the outside of the lungs. Alveoli
  22. 22. Asbestos-a health problem
  23. 23. Asbestos-related diseases The potential for asbestos related disease depends on: • Amount of fibers inhaled • Length of exposure • Whether exposed worker smokes • Age – because of delayed effects Don’t smoke! An asbestos worker is at much greater risk of developing lung cancer if he/she smokes.
  24. 24. Asbestos and smoking – the multiplicative effect • 20 pack years of smoking gives 10-fold increased risk of lung cancer over lifelong non-smoker • 40 pack years gives 40-fold increased risk • Asbestos exposure increases these figures by 1.4 with light exposure (plaques only); and 8 times with heavy exposure (asbestosis)
  25. 25. Kouki Inai, M.D., Ph.D. Hiroshima University, Japan
  26. 26. Asbestos related diseases • Pulmonary •Pleural –Asbestos related pleural plaques –Benign pleural effusions –Pleural thickening –Mesothelioma –Asbestosis –Lung cancer
  27. 27. Pleural plaque •Usually first identified > 20 years after initial exposure •Occur in 50% persons exposed to asbestos •Parietal pleura adjacent to ribs, particularly along 6th-9th ribs and along diaphragm •Calcifications on CXR in 20% and on chest CT in 50% •Plaques alone are not associated with malignancy
  28. 28. Photograph (original magnification, approximately ×0.5) shows multiple raised pearly plaques that arise from the parietal pleura. Roach H D et al. Radiographics 2002;22:S167-S184 ©2002 by Radiological Society of North America
  29. 29. Pleural Plaques
  30. 30. Diffuse Pleural Thickening • Diffuse thickening of parietal pleura Involves diaphragmatic pleura, extends up lateral chest wall • Commonly obliterates costophrenic angles • Spares apices of lungs • Associated with rounded atelectasis.
  31. 31. Diffuse Pleural Thickening
  32. 32. Benign asbestos pleural effusion • Most common pleuropulmonary manifestation within the first 20 years of exposure… but can present <1 post-exposure to >50 years after first exposure • Typical presentation: acute pleuritic CP, fever, other systemic sx but can be insidious • Can resolve spontaneously • Pleural fluid analysis: exudative, serosanguinous, predominance of eosinophils, cytology with atypical macs, occasionally positive for RF • Rounded atelectasis and/or diffuse pleural thickening may be sequelae
  33. 33. Axial CT scan of an asbestos-exposed person shows a left-sided pleural effusion (arrow). Roach H D et al. Radiographics 2002;22:S167-S184 ©2002 by Radiological Society of North America
  34. 34. Asbestos – A Carcinogen Asbestos is 1 of over 130 occupational carcinogens listed by the U.S. Government Source: HAWKINS PARNELL THACKSTON&YOUNGLLP
  35. 35. What is asbestos-related lung cancer? Asbestos-related lung cancer functions like most lung cancers. It is made up of a tumor (or multiple tumors) in the lungs. Lung cancer can be broken into two specific categories; Small Cell Cancer A fast-growing type of lung cancer, small cell lung cancer can be broken down into three categories; •Mixed small cell/large cell carcinoma •Combined small cell carcinoma •Small cell carcinoma (also known as oat cell cancer) this is the most common variety of small cell lung cancer. Small cell makes up approximately 15% of all lung cancers. The cancer cells are small in the very early stages, but then grow rapidly to form large tumors .These tumors then spread (or metastasize) affecting other areas of the body. The cancer can quickly become life-threatening once the tumors have spread to the surrounding vital organs such as the heart, brain, bones, or liver.
  36. 36. Non-Small Cell Non-small cell lung cancer (or NSCLC) is the most common type of lung cancer, and grows slower than small cell lung cancer. NSCLC can be broken down into three varieties: •Squamous cell carcinoma – the cancer cells are typically found in the center of the lung near the bronchus (airway passage that conducts air into the lungs) •Adenocarcinoma –the cancer cells develop in the outer area of the lung •Large cell carcinomas –a fast spreading lung cancer type that can develop anywhere in the lungs
  37. 37. Small Cell Carcinoma
  38. 38. Large Cell Carcinoma
  39. 39. Adenocarcinoma
  40. 40. Squamous Cell Carcinoma
  41. 41. Asbestosis • Symptoms may include dyspnea and cough • Bilateral crackles . • Pulmonary function tests may reveal: – Reduced diffusing capacity – Restrictive pattern on PFTs Histopathologic view of asbestosis
  42. 42. Epidemic features of mesothelioma in Egypt during the periods Years Epidemic features of mesothelioma 1989‐1999 ‐ 148 cases of MPM were diagnosed and treated at NCI, Cairo Univ., Egypt. ‐ Median age was 48 (17‐85) years ‐ Young adults < 40 years represented 29.7%. ‐ Male/female 1.7 ‐ Residential asbestos exposure was 81.1% ‐ Occupational 13.5%. ‐ Median duration of exposure was 32 years ‐ Median overall survival was 7 months. 1989‐2003 (Eldin et al., 2005)
  43. 43. Epidemic Features of Mesothelioma In Egypt(cont) 2000‐2003 • - 635 cases of MPM were diagnosed at NCI and Abbasia Hospital Cairo,Egypt. • ‐ Median age was 53 (19‐90) years. • ‐ Young adults < 40 years represented 19.1%. • ‐ Females represented 39.2% • ‐ Residential exposure was evidenced in 64.7% of cases(Shoubra El‐kheima 35.6%, El Maasara 23.6%, and El Zytoon 5.2%). • ‐ 25% came from other Cairo areas and 9.8% from other governorates. Eldin, N., Gaafar, M.R., Abdel Hameed, A.A., Abdelrahman, M.A.,Aboulkassem, F., 2005. Mesothelioma in Egypt. Egyptian Journal of Community Medicine 23, 41‐45
  44. 44. Number of MPM cases diagnosed at Abbassia Chest Hospital in the period from 1998 to 2008 No. of Cases Year 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Total 42 46 79 80 89 122 96 135 140 126 128 1083
  45. 45. Mesothelioma In Egypt Map of Greater Cairo Malignant pleural mesothelioma is an increasing disaster in Egypt which is under estimated and neglected. Mesothelioma in Egypt is mainly attributed to an environmental origin i.e. exposure to asbestos, with a high incidence in women and young adults. Ismail HM et al (2006):. Journal of the Egyptian Nat. Cancer Instit, vol. 18, No. 4: 303-3120. Industrial areas highly polluted with asbestos
  46. 46. Data obtained from the information network of the General Organization for Industrialization in Egypt, showed that 14 asbestos factories were present in Egypt in the year 2004. These factories affect an area of approximately 5-7 km in radius, which explains the high incidence of mesothelioma in the neighborhood of these factories. workers employed since 1948 by the Egyptian asbestos company Sigwart at the mills in greater Cairo (El-Maasara and Shubra El-Khemia) had an increased risk of mesothelioma. Kazan Allen L (2006): Asbestos: the environmental hazard. In: Proceedings of the International Conference Asbestos Risk Reduction and Measurement of Asbestos Fibre concentration, Cracow, ploand, September 28-29: Krakow, Faculty of Materials Science and Ceramics, AGH University of Science and technology ( pdf, accessed 11 August 2008).
  47. 47. %
  48. 48. Aim of the Work This study aimed to: 1. Evaluate the prevalence of MPM due to occupational and environmental (nonoccupational) exposure to asbestos among persons who had worked in asbestos manufacturing plant and in persons living in an area nearby the plant with potentially significant population exposure. 2. Estimate exposure-response relationships between environmental exposure to asbestos and mesothelioma.
  49. 49. Subjects and Methods Sampling areas: 1) Asbestos plant (SigwartStore) 2) El-Wehda El-Arabia(100m) 3) Manshiyt El-Horriya (1Km) 4) Ezbet Rostom (2.5 Km) 5) Ezbet Osman (1 Km) 6) El-Manshiya El- Gadida (800m) 7) Manshiyet Abd Elmoneim Riyad (2 Km) Map of Shubra El-Kheima city with superimposed direction and speed of wind. Direction and speed of wind
  50. 50. Results The mean age of malignant pleural mesothelioma cases Sex No. of cases Percent Mean age (y) SD Range Male 34 38.6% 54.1 8.45 39 – 70 Female 54 61.4% 49.5 7.39 35 – 60 Both male & female 88 100% 51.3 8.08 35 – 70 T test = 2.6 P = 0.009 HS = Highly significant Age Distribution in 88 cases of malignant pleural mesothelioma Age No. (%) 20 – 24 0 0 25 – 29 0 0 30 – 34 0 0 35 – 39 10 11.4 40 – 44 6 6.8 45 – 49 15 17 50 – 54 16 18.2 55 – 60 33 37.5 > 60 8 9.1
  51. 51. Results Risk of mesothelioma among exposed and non exposed groups. Mesothelioma cases +ve -ve Exposed group No= 3400 No 87 3313 Relative risk (RR)= 26 % 2.6 97.4 Non Exposed group No= 979 No % 1 0.1 978 99.9
  52. 52. Results Airborne asbestos fiber concentration in the surrounding areas outside the asbestos plant and number of MPM cases. Area No of MPM Fiber concentration (f/ml) cases Mean SD El-Wehda El-Arabia (100m) 39 2.16* 0.16 El Manshiya El Gadida (800m) 17 0.04 0.01 Manshiyet El Horriya (1km) 8 0.021 0.0005 Ezbet Osman (1km) 9 0.021 0.002 Manshiyet Abd El Moneem Riyad (2km) 6 0.025 0.004 Ezbet Rostom (2.5km) 4 0.021 0.003 Total 83 0.38 0.87 0.0021 0.013 Control F = 47.01 * = P<0.01
  53. 53. Malignant Pleural Mesothelioma
  54. 54. Malignant Pleural Mesothelioma
  55. 55. Interview by Mahmoud Bakr and Sherine Nasr Al-Ahram Weekly 3 - 9 June 1999 Issue No. 432  What are you doing about the manufacturing of asbestos, and the trade in this substance, which has been proven to cause cancer?  The decision to halt the importing of asbestos -- a bold and important step -was taken by the Minister of Supplies and Trade Dr Ahmed Guweili. As for the Sigwart Asbestos Factory at Al-Ma'assara, the plant is under continuous inspection, and will remain so until it has complied with the law by installing a fully-enclosed system that will prevent waste escaping into the surrounding area.
  56. 56. PREPCOM 3 for the Further Development of a Strategic Approach to International Chemicals Management (SAICM) Vienna | Tarek Eid El Ruby, Egypt, asked to retain reference to asbestos. Austria Center Vienna, site of SAICM PrepCom-3.
  57. 57. Egyptian Pollution Abatement Project Hazardous Waste Management Manual For Industries Final Draft Prepared by Environics Management of Environmental Systems July 2002
  59. 59. Secretariat for the Rotterdam Convention on the Prior Informed Consent Procedure for Certain Hazardous Chemicals and Pesticides in International Trade Proceedings Near East Consultation on the Rotterdam Convention on the Prior Informed Consent Procedure for Certain Hazardous Chemicals and Pesticides in International Trade Cairo, Egypt 29 May – 1 June 2005
  60. 60. Take home message
  61. 61. TAKE HOME MESSAGES • The major route of exposure to asbestos is inhalation • There is no known “safe” level of exposure •Asbestos becomes a health hazard when fibres become airborne. •Asbestos is extremely hazardous. •All types of Asbestos are carcinogenic to human •Though, the importation of raw Asbestos into Egypt was banned on November 2004 ,the threat of developing Asbestos related diseases will remain for a considerable period of time due to latency period.
  62. 62. • • • • • clinicians in both primary and secondary care should have high index of suspicion in persons with environmental exposure to asbestos. Periodic monitoring of the environment for permissible exposure limits (PEL). Increasing awareness for the public regarding the risk of asbestos exposure. periodical medical checks for population at risk living in Shubra El Kheima and Helwan with its surrounding areas Attention should be directed to small informal workshops which use asbestos with high risk of significant environmental exposure