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Asbestos:
a time-bomb with a long fuse
Professor Nico van Zandwijk
Asbestos Diseases Research Institute
University of Sydn...
Introduction:
the ticking time-bomb of Asbestos
“…..the prolonged latency period
from exposure to diagnosis, and
the ongoi...
Focus of this presentation
• Global patterns in Asbestos consumption
• Scientific certainty on the Asbestos-Cancer
associa...
Global patterns of
Asbestos consumption
Changes over time in
global Asbestos consumption
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
1920 1930 1940 1950 1...
Changes over time in
global Asbestos consumption
-1,000,000
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
1920
1930
...
Changes over time in
global Asbestos consumption
-20%
0%
20%
40%
60%
80%
100%
1920
1930
1940
1950
1960
1970
1980
1990
2000...
Changes over time in
global Asbestos consumption
0%
20%
40%
60%
80%
100%
1920 1930 1940 1950 1960 1970 1980 1990 2000 2010...
Changes over time in
Asbestos use in the Asian region
1920-1970 1971-2000 2001-2007
Kilogram per capita per
year
Source: L...
International Ban Asbestos Secretariat
Compilation 2015
International Asbestos Ban Secretariat
Scientific certainty for the
Asbestos-Cancer association
Non-Malignant and Malignant
Asbestos-related Diseases (ARDs)
Disease Latency period Level of
asbestos
exposure
Fatal Benig...
IARC carcinogen classification system
Group Description Number of
agents
1 Carcinogenic to humans 113
2a Probably carcinog...
Group Description Number of
agents
1 Carcinogenic to humans 113
2a Probably carcinogenic to
humans
66
2b Possibly carcinog...
Asbestos/Chrysotile Cancer Risks
• Low chrysotile exposures dangerous
van der Bij, Cancer Causes Control (2013) 24:1-12
• ...
Global disease burden from
occupational exposure to
Asbestos
Burden of disease measured as
Disability-Adjusted Life Years (DALYs)
The sum of years of potential life lost due to
premat...
Global estimates of death attributable to
occupational exposure to Asbestos, 1990 and
2010
Source: Lim et al. 2013. A comp...
Global estimates (1000s) of DALYs attributable to
occupational exposure to Asbestos, 1900 and 2010
Source: Lim et al. 2013...
Patterns of
Mesothelioma incidence
Exposure-Outcome Lag Time:
The Mesothelioma Epidemic Curve only appears at least two
decades after Asbestos Consumption
0
...
Median age-standardised Malignant
Mesothelioma incidence rates per 100,000 by
geographic region and calendar period (males...
Malignant Pleural Mesothelioma:
incidence rate trends in Europe, 1986-1995
Overall trend
Incidence rates still increasing ...
Financial burden of Asbestos-
related diseases
Financial burden of
Asbestos-related diseases
Medical costs
+
Compensation costs
+
Environmental costs
+
Research costs
Cost of hospital care for patients with
Malignant Mesothelioma, Scotland, 2000
• The total estimated cost of
hospital care...
Estimated medical costs of care for
Mesothelioma patients in the European
region
Source: WHO Regional Office for Europe. (...
Cumulative compensation payments for
Mesothelioma and Asbestosis, Australia
Source: Australian National Data Set for Compe...
Company producing Asbestos-containing
materials pays compensation to 42-year
old male diseased by Asbestos waste
• AUD $2 ...
Asbestos insulation in Canberra homes
(June 2014)
• More than 1,000
homes in the
Australian Capital
Territory contain
loos...
Replacement of Australian Asbestos shed
roofs (April 2014)
• Sugar mill factory
spent AUD$10 million
on a project to repla...
Cost of remediation of Asbestos (mainly
chrysotile) sites in Italy
Site(s) Cost (Euro)
Ferrandina 500,000
Broni 500,000
Ca...
Research investment in Asbestos-
related Disease, 2000-2010 (Australia)
01234
FundingAUD$million
2000 2001 2002 2003 2004 ...
Summary:
the ticking time-bomb of Asbestos
Source: International Ban Asbestos Secretariat, http://ibasecretariat.org/graph...
Summary:
the ticking time-bomb of Asbestos
“The clear dangers of Asbestos usage
in all occupational and non-
occupational ...
Funding and acknowledgements
Cancer Institute NSW Translational Program Grant awarded to Professor Nico van
Zandwijk and c...
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Professor Nico van Zandwijk: Karachi Ticking Time Bomb

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Professor Nico van Zandwijk
Asbestos: A Time-Bomb With A Long Fuse
World Asbestos Congress 2015
Karachi, Sindh, Pakistan
January 31, 2015

Published in: Government & Nonprofit
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Professor Nico van Zandwijk: Karachi Ticking Time Bomb

  1. 1. Asbestos: a time-bomb with a long fuse Professor Nico van Zandwijk Asbestos Diseases Research Institute University of Sydney World Asbestos Congress 2015 Karachi, Sindh, Pakistan 31st January 2015
  2. 2. Introduction: the ticking time-bomb of Asbestos “…..the prolonged latency period from exposure to diagnosis, and the ongoing presence and use of these dangerous fibres, have led to the increasing prevalence of malignant mesothelioma worldwide.”Linton et al. 2012. The ticking time-bomb of asbestos: Its insidious role in the development of malignant mesothelioma. Critical Reviews of Oncology/Hemotology. 84; 200-2012. Image source: http://nancyknowlton.com/
  3. 3. Focus of this presentation • Global patterns in Asbestos consumption • Scientific certainty on the Asbestos-Cancer association • Global disease burden of occupational exposure to Asbestos • Global patterns of Malignant Mesothelioma incidence • Financial burden associated with Asbestos- related diseases
  4. 4. Global patterns of Asbestos consumption
  5. 5. Changes over time in global Asbestos consumption 0 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 Metric tonnes Calendar year Global Asbestos consumption (metric tonnes), by calendar year Source: Analysis performed by the Asbestos Diseases Research Institute based on data provided on global asbestos consumption by the U.S. Geological Survey.
  6. 6. Changes over time in global Asbestos consumption -1,000,000 0 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 Metric tonnes Calendar year Global Asbestos consumption (metric tonnes), by region and calendar year Unknown South America Oceania Europe Central and North America Asia Africa Source: Analysis performed by the Asbestos Diseases Research Institute based on data provided on global asbestos consumption by the U.S. Geological Survey.
  7. 7. Changes over time in global Asbestos consumption -20% 0% 20% 40% 60% 80% 100% 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 Proportion of total asbestos consumption Calendar year Proportion of Asbestos consumption (%), by region and calendar year Unknown South America Oceania Europe Central and North America Asia Africa Source: Analysis performed by the Asbestos Diseases Research Institute based on data provided on global asbestos consumption by the U.S. Geological Survey.
  8. 8. Changes over time in global Asbestos consumption 0% 20% 40% 60% 80% 100% 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 Calendar year Asbestos consumption in the Asian region as a proportion of total global consumption Source: Analysis performed by the Asbestos Diseases Research Institute based on data provided on global asbestos consumption by the U.S. Geological Survey.
  9. 9. Changes over time in Asbestos use in the Asian region 1920-1970 1971-2000 2001-2007 Kilogram per capita per year Source: Le at al., 2011. Asbestos use and asbestos-related diseases in Asia: Past, present and future. Respirology, 16, 767-775.
  10. 10. International Ban Asbestos Secretariat Compilation 2015
  11. 11. International Asbestos Ban Secretariat
  12. 12. Scientific certainty for the Asbestos-Cancer association
  13. 13. Non-Malignant and Malignant Asbestos-related Diseases (ARDs) Disease Latency period Level of asbestos exposure Fatal Benign/ Malignant Pleural plaques Around 20 years Low No Benign Diffuse pleural thickening Around 20 years Low No Benign Asbestosis Around 20 years High Eventually Benign Lung Cancer 20-30 years Relatively low exposures increase risk Yes Malignant Mesothelioma 30-50 years No safe level of exposure Yes Malignant Sources: Hadley and Rennell (2013), “Asbestos: the future risk”, Iskaboo Publishing, p. 22 Offermans et al, JOEM (2014) 56:6-19
  14. 14. IARC carcinogen classification system Group Description Number of agents 1 Carcinogenic to humans 113 2a Probably carcinogenic to humans 66 2b Possibly carcinogenic to humans 285 3 Not classifiable as to its carcinogenicity to humans 505 4 Probably not carcinogenic to humans 1
  15. 15. Group Description Number of agents 1 Carcinogenic to humans 113 2a Probably carcinogenic to humans 66 2b Possibly carcinogenic to humans 285 3 Not classifiable as to its carcinogenicity to humans 505 4 Probably not carcinogenic to humans 1 Asbestos All forms of Asbestos are included as a Group 1 human carcinogenic agent as defined by the International Agency for Research on Cancer, 1977, 1987 and 2012 IARC carcinogen classification system
  16. 16. Asbestos/Chrysotile Cancer Risks • Low chrysotile exposures dangerous van der Bij, Cancer Causes Control (2013) 24:1-12 • A 37-year observation mortality in Chinese chrysotile asbestos workers Wang et al, Thorax Online, October 2011 • Mesothelioma from Chrysotile, review (a world-wide ban is warranted) Kanarek, Annals Epidemiol (2011) 21:688-697 • Asbestos levels encountered at the lower end of exposure distribution associated with increased risk of pleural mesothelioma, lung cancer and laryngeal cancer Offermans, JOEM (2014) 56:6-19 Hillerdal, Occup Environ Med (1999) 56: 505-513 • Chrysotile asbestos use is not safe and must be banned (in Response to Chrysotile Institute/Bernstein’s lobby) Archives of Environmental & Occupational Health (2013) 68: 243-249
  17. 17. Global disease burden from occupational exposure to Asbestos
  18. 18. Burden of disease measured as Disability-Adjusted Life Years (DALYs) The sum of years of potential life lost due to premature mortality and the years of productive life lost due to disability.
  19. 19. Global estimates of death attributable to occupational exposure to Asbestos, 1990 and 2010 Source: Lim et al. 2013. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analyses for the Global Burden of Disease study 2010. The Lancet. 380, 2224-2260. 0 5,000 10,00015,00020,00025,000 1990 2010 By gender Males Females
  20. 20. Global estimates (1000s) of DALYs attributable to occupational exposure to Asbestos, 1900 and 2010 Source: Lim et al. 2013. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analyses for the Global Burden of Disease study 2010. The Lancet. 380, 2224-2260. 0 100200300400500 1990 2010 By gender Males Females
  21. 21. Patterns of Mesothelioma incidence
  22. 22. Exposure-Outcome Lag Time: The Mesothelioma Epidemic Curve only appears at least two decades after Asbestos Consumption 0 0.5 1 1.5 2 2.5 3 0 25 50 75 100 125 150 Decade1 Decade1 Decade2 Decade3 Decade4 Decade5 Decade6 Decade7 Decade8 Decade9 Decade10 Mesothelioma incidence or mortality rate Measurement of asbestos exposure Calendar period Malignant mesothelioma incidence and mortality is a function of asbestos exposure Asbestos consumption Mesothelioma incidence rate Asbestos ban
  23. 23. Median age-standardised Malignant Mesothelioma incidence rates per 100,000 by geographic region and calendar period (males) 0123456 Rateper100,000 Africa Asia C&SAmerica Europe NAmerica Oceania 1993-1997 0123456 Rateper100,000 Africa Asia C&SAmerica Europe NAmerica Oceania 2003-2007 Source: Analysis performed by the Dr Matthew Soeberg (Asbestos Diseases Research Institute) using data published in: Forman D et al. eds (2013) Cancer Incidence in Five Continents, Vol. X Lyon, IARC. http://ci5.iarc.fr ; Curado MP, et al. 2007. Cancer Incidence in Five Continents, Vol. IX. Lyon, IARC. and Parkin DM, Whelan SL, Ferlay J, Teppo L, and Thomas DB. 2002. Cancer Incidence in Five Continents, Vol. VIII. Lyon, IARC.
  24. 24. Malignant Pleural Mesothelioma: incidence rate trends in Europe, 1986-1995 Overall trend Incidence rates still increasing but evidence for deceleration in some countries. Differences by age group Increase over time in incidence rate greater for people aged 65-74 years than for people aged 40-64 years. Source: Montanaro et al. 2003. Pleural mesothelioma incidence in Europe: evidence of some deceleration in the increasing trends. Cancer Causes and Control. 14, 791-803.
  25. 25. Financial burden of Asbestos- related diseases
  26. 26. Financial burden of Asbestos-related diseases Medical costs + Compensation costs + Environmental costs + Research costs
  27. 27. Cost of hospital care for patients with Malignant Mesothelioma, Scotland, 2000 • The total estimated cost of hospital care for 100 people who died from Mesothelioma in Scotland, 2000, was £942,038. Number of days of treatment Cost Day cases 103 £35,073 Inpatients 3,285 £906,965 Total 3,388 £942,038 Source: A Watterson, T Gorman, C Malcolm, M Robinson & M Beck. (2006) The economic costs of health service treatments for asbestos-related mesothelioma deaths. Ann. N.Y.Acad.Sci. 1076: 871-881.
  28. 28. Estimated medical costs of care for Mesothelioma patients in the European region Source: WHO Regional Office for Europe. (2012) The Human and Financial Burden of Asbestos in the WHO European Region Meeting Report, 5-6 November 2012, Bonn, Germany. 0 5,000,000 10,000,000 15,000,000 20,000,000 25,000,000 30,000,000 35,000,000 Austria Belgium Denmark Finland France Germany Italy Netherlands Norway Poland Portugal Romania Spain Sweden United Kingdom Medical costs (€) Medical, surgical and palliative care treatment costs, Europe (2012), for people diagnosed with Malignant Mesothelioma
  29. 29. Cumulative compensation payments for Mesothelioma and Asbestosis, Australia Source: Australian National Data Set for Compensation-based Statistics (NDS). 0 50 100 150 200 250 AUD$million 2000/2001 2001/2002 2002/2003 2003/2004 2004/2005 2005/2006 2006/2007 2007/2008 2008/2009 2009/2010 2010/2011 2011/2012 Australia, 2000-2001 to 2011-2012 Cumulative total payments (AUD$ million) for workers expsosed to asbestos Mesothelioma Asbestosis
  30. 30. Company producing Asbestos-containing materials pays compensation to 42-year old male diseased by Asbestos waste • AUD $2 million in damages awarded to man who was exposed as a child to Asbestos waste
  31. 31. Asbestos insulation in Canberra homes (June 2014) • More than 1,000 homes in the Australian Capital Territory contain loose-fill Asbestos • Demands for AUD$ 5 million emergency assistance fund for families in affected houses
  32. 32. Replacement of Australian Asbestos shed roofs (April 2014) • Sugar mill factory spent AUD$10 million on a project to replace Asbestos-containing roof products
  33. 33. Cost of remediation of Asbestos (mainly chrysotile) sites in Italy Site(s) Cost (Euro) Ferrandina 500,000 Broni 500,000 Canolo 1,000,000 Vita, Gibellina, Partanna, Montevago, S.Margh. de Belice, Menfi 1,000,000 Messina 1,000,000 Tuscany 500,000 Source: F. Paglietti, S. Malinconico, V. di Molfetta & M. Giangrasso (2012) Guidelines for Asbestos Remediation at Italian Superfund Sites, Journal of Environmental Science and Health, Part C: Environmental Carcinogenesis and Ecotoxicology Reviews, 30:3, 253-286, DOI: 10.1080/10590501.2012.705161.
  34. 34. Research investment in Asbestos- related Disease, 2000-2010 (Australia) 01234 FundingAUD$million 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year Funding for ARD by the National Health and Medical Research Council Investment in national asbestos-diseases related research, Australia, 2000-2010 • More than $14.5 million invested by the National Health and Medical Research Council (NHMRC)
  35. 35. Summary: the ticking time-bomb of Asbestos Source: International Ban Asbestos Secretariat, http://ibasecretariat.org/graphics_page.php, accessed January 2015.
  36. 36. Summary: the ticking time-bomb of Asbestos “The clear dangers of Asbestos usage in all occupational and non- occupational settings….reinforce the ongoing need for a universal ban of Asbestos and a renewed focus on the protection of workers in developing nations.” Linton et al. 2012. The ticking time-bomb of asbestos: Its insidious role in the development of malignant mesothelioma. Critical Reviews of Oncology/Hemotology. 84; 200-2012. Image source: http://nancyknowlton.com/
  37. 37. Funding and acknowledgements Cancer Institute NSW Translational Program Grant awarded to Professor Nico van Zandwijk and colleagues at the Asbestos Diseases Research Institute (Dr Matthew Soeberg) Cancer Institute NSW Academic Chair and Scientific Director Role (Professor Jane Young) in cancer epidemiology and health services research awarded to The University of Sydney Professor Ken Takahashi and colleagues at the University of Occupational and Environmental Health, Japan, who have provided integral advice on asbestos-related diseases and occupational and environmental health

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