AND A HEALTH PROBLEM
Dr. Hussein Fatehy Mahmoud
Abbassia Chest Hospital
Asbestos- an environmental problem
Asbestos-a health problem
Role of Egyptian press media in
Role of Egyptian Government in
Take home message
The word asbestos derives from a
Greek word meaning
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.
What is Asbestos?
fibers are so small,
once released into
the air, they may
there for hours or
(93% of commercial use)
(7% of commercial use)
Actinolite, Amosite, Anthophyllite,
Crocidolite, Richterite, Tremolite
Common Types Of Asbestos
Note: The general use of asbestos is now banned. Blue and Brown
Facilities Planning &
in 1985, white in 1999.
Properties of Asbestos
• Good tensile strength
• Heat resistant
• Electrical resistance
• Good insulation
• Chemical resistant
Because of these unique properties,
asbestos was used extensively in variety of products.
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
• Acoustic and decorative plaster
Use has greatly declined since the late 1970’s
Asbestos insulated boiler
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
Asbestos cement pressure pipes
Used for water supply
Value of Asbestos Imports (2003)
United Arab Emirates
Syrian Arab Republic
Chrysotile Asbestos Imports for EM Region (tonnes)
11,197 24,814 23,392
29,775 61,729 106,160
The data in the table come from statistics compiled by the
United States Geological Survey.
Natural sources (erosion of asbestos
Residence in the viciniy of mines or plants
manufacturing asbestos products
Release of fibers from public, residential and
commercial buildings containing friable
Contamination of homes by work clothes
The World Health
60% of the 125
asbestos in their
Broken bags of asbestos cement lie in open storage
Airborne asbestos fibre counts at various locations
Sigwart El Maasara (Zakaria et al., 1989)
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
Airborne asbestos fibre counts in the residential areas
surrounding the Sigwart El Maasara
Eldin et al. (2005)
El‐Maadi (~5 km )
El‐ Maasara (the main gate)
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
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
OSHA Permissible Asbestos
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 Standard For General Industry - OSHA
Asbestos is an Inhalation Hazard
Airborne asbestos fibers inhaled deep into the lung can cause
• Tiny breathable asbestos fibers are
deposited in the alveoli, the ending
small air sacs in the lungs.
• The body’s defense mechanisms
cannot break down the fibers.
• Asbestos fibers cause damage to the
• The fibers may also travel to the
pleura, the membrane lining the
outside of the lungs.
The potential for asbestos related
disease depends on:
• Amount of fibers inhaled
• Length of exposure
• Whether exposed worker
• Age – because of delayed
Don’t smoke! An asbestos worker is at much greater risk of
developing lung cancer if he/she smokes.
Asbestos and smoking – the
• 20 pack years of smoking gives 10-fold
increased risk of lung cancer over
• 40 pack years gives 40-fold increased
• Asbestos exposure increases these
figures by 1.4 with light exposure
(plaques only); and 8 times with heavy
Kouki Inai, M.D., Ph.D. Hiroshima University, Japan
Asbestos related diseases
•Usually first identified > 20 years after initial
•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
•Plaques alone are not associated with
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
• 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
Asbestos – A Carcinogen
Asbestos is 1 of
listed by the U.S.
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
•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.
Non-small cell lung cancer (or NSCLC) is the most common
type of lung cancer, and grows slower than small cell lung
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)
–the cancer cells develop in the outer area of the lung
•Large cell carcinomas
fast spreading lung cancer type that can
develop anywhere in the lungs
• Symptoms may include
dyspnea and cough
• Bilateral crackles .
• Pulmonary function
tests may reveal:
– Reduced diffusing
– Restrictive pattern on
Histopathologic view of asbestosis
Epidemic features of mesothelioma in Egypt during
Epidemic features of mesothelioma
‐ 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)
Epidemic Features of Mesothelioma In
• - 635 cases of MPM were diagnosed at NCI and Abbasia
• ‐ 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
Eldin, N., Gaafar, M.R., Abdel Hameed, A.A., Abdelrahman, M.A.,Aboulkassem,
F., 2005. Mesothelioma in Egypt. Egyptian Journal of Community Medicine
Number of MPM cases diagnosed at Abbassia Chest
Hospital in the period from 1998 to 2008
No. of Cases
Mesothelioma In Egypt
Map of Greater Cairo
mesothelioma is an
increasing disaster in Egypt
which is under estimated
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
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
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 (www.Ceramika.agh.edu.pl/azbesto612. pdf, accessed 11 August 2008).
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
Subjects and Methods
1) Asbestos plant
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
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
The mean age of malignant pleural mesothelioma cases
No. of cases
Mean age (y)
39 – 70
35 – 60
Both male & female
35 – 70
T test = 2.6
P = 0.009
HS = Highly significant
Age Distribution in 88 cases of malignant pleural mesothelioma
20 – 24
25 – 29
30 – 34
35 – 39
40 – 44
45 – 49
50 – 54
55 – 60
Risk of mesothelioma among exposed
and non exposed groups.
Relative risk (RR)= 26
Airborne asbestos fiber concentration in the
surrounding areas outside the asbestos plant and
number of MPM cases.
No of MPM Fiber concentration (f/ml)
El-Wehda El-Arabia (100m)
El Manshiya El Gadida (800m)
Manshiyet El Horriya (1km)
Ezbet Osman (1km)
Manshiyet Abd El Moneem
Ezbet Rostom (2.5km)
F = 47.01
* = P<0.01
Interview by Mahmoud Bakr and Sherine Nasr
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.
PREPCOM 3 for the Further Development of a Strategic
Approach to International Chemicals Management (SAICM)
Tarek Eid El Ruby, Egypt, asked to retain reference to
Austria Center Vienna, site of SAICM PrepCom-3.
Egyptian Pollution Abatement
Manual For Industries
Management of Environmental Systems
REGIONAL WORKSHOP ON
THE IMPLEMENTATION OF
AND SYNERGIES WITH
OTHER CHEMICAL RELATED
CAIRO – EGYPT (21-24 February 2005)
Secretariat for the Rotterdam Convention on the
Prior Informed Consent Procedure for Certain Hazardous
Chemicals and Pesticides in International Trade
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
TAKE HOME MESSAGES
• The major route of exposure to asbestos is
• 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
•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.
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
periodical medical checks for population at risk living in
Shubra El Kheima and Helwan with its surrounding
Attention should be directed to small informal
workshops which use asbestos with high risk of
significant environmental exposure