STF - Audiência Pública do Amianto - 31/08/2012 - Supremo Tribunal Federal


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Dr. EVGENY KOVALESKY, médico PhD em Saúde Ocupacional, Pesquisador Líder do Instituto de Pesquisas em Saúde Ocupacional da Academia Russa de Ciências Médicas.

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STF - Audiência Pública do Amianto - 31/08/2012 - Supremo Tribunal Federal

  1. 1. Development of National Program forElimination of Asbestos-RelatedDiseases in the Russian Federation. E. Kovalevskiy Institute of Occupational Health, Russian Academy of Medical Sciences, Moscow, Russia
  2. 2. “ ”
  3. 3. Being thoroughly examined the text of“Outline…” seems to consist of two different parts getting capriciously mixed up. It could be divided into:perfectly formulatedplan of real consequentmeasures on prepare of collection of politicalnational preventive appeals for chrysotileprograms aimed on banningelimination of asbestosrelated diseases
  4. 4. The Russian Federation do not acceptthe political part of the document whereasits technical part including data collection,preparation of the national profile andother issues, is in sphere of it’s interest.
  5. 5. Russia is largest asbestos producer andconsumer in the world. from 1886 to 2009
  6. 6. In Russia only chrysotile is produced and usedin civil industry.
  7. 7. Simeon Bogoslovskiy was the first Russianhygienist and medical statistician who paidattention to asbestos hazards. At the 10thN.Pirogov’s Congress of Russian physiciansthat was held in Moscow in 1907, Dr.S.Bogoslovskiy made a report “To theClassification of Jobs” where he mentionedthe main harmful factors of asbestos depositswhich workers had to undergo at that time. Healso wrote a monograph entitled “System ofOccupational Classification” published in1913 containing data on health effects due toexposure to asbestos.
  8. 8. During last decades dustiness levels wereconsiderably reduced due to many reasons:-strengthening of regulations concerning environmentprotection and implement of severe economicmeasures;-implement of sufficient financial compensation, whichindustrial authorities must pay for every case ofasbestos-related occupational disease;-development and implementation of different hygienicand technological measures for reduction of dustcontamination of environment and working zone air.
  9. 9. 10000 Maximum production of asbestos - 1974,7 thousand tons 3 1000 290,0 mg/m 100 29,3% 3 Dust level, mg/m 10 1 1936 1950 1955 1960 1965 1970 0,1 1975 1980Asbestosis morbidity, % 1985 1990 1995 2000 Asbestosis less 1% 0,01 С областями
  10. 10. 180 8 alignant 164,1 esothelioma 7,1160 7 orbidity of m140 5,9 6 pleural m * 5,1120 5 M100 Dust level, mg/m3 4 80 Morbidity of malignant pleural mesothelioma 3 g/m3 60 1,7 1,7 ust level, m 2 40 25,8 15,2 1 20 9,8 5,1 4,6 3,5 4 5,3 4,2 4 0 D 0 0 1951- 1956- 1961- 1966- 1971- 1976- 1981- 1986- 1991- 1996- 2001- 55 60 65 70 75 80 85 90 95 00 04
  11. 11. Our data were confirmed by results of Russian-Finnish-American research project “Health and exposuresurveillance of Siberian asbestos miners”.This project was realized in 1995-97 at worlds largestchrysotile asbestos mining and milling complex “Uralasbest”(Asbest, Russia) - is working out since 1889 and producesnow about 25% of total world chrysotile production; atdifferent periods more than 10 000 workers were employed.
  12. 12. Age, smoking habit and work years of chrysotile miners and millers (mean, range) Men Women Total n=1130 n=510 n=1640Age, years 46.4 49.7 47.4 (28-75) (27-78) (27-78)Smoking years 18.3 0.7 12.8 (0-58) (0-30) (0-58)Years of 22.8 21.5 22.4employment (3-49) (1-47) (1-49)Years since first 24.5 27.5 25.4exposure (5-57) (1-59) (1-59)
  13. 13. Men WomenX-ray Malignant neoplasms of Malignant neoplasms ofparenchymal respiratory system respiratory systemchanges Mortality Mortalityin 1996 Yes No Yes No rate rateNo 11 1061 0.010 1 482 0.002Yes 3 39 0.071 0 15 0.000
  14. 14. Men WomenX-ray pleural Malignant neoplasms of Malignant neoplasms ofchanges in respiratory system respiratory system1996 Mortality Mortality Yes No Yes No rate rateNo 11 1040 0.010 1 477 0.002Yes 3 60 0.048 0 20 0.000
  15. 15. X-ray Men Womenparenchymal Malignant neoplasms of Malignant neoplasms ofand pleural respiratory system respiratory systemchanges in Mortality Mortality Yes No Yes No1996 rate rateNo 9 1009 0.009 1 466 0.002Yes 5 91 0.052 0 31 0.000
  16. 16. All causes All malignant neoplasms Age Smokers Non-smokers Smokers Non-smokers 30-39 0.0±79.3 0.0±100.0 0.0±79.3 0.0±100.0 40-49 15.7±2.7 5.1±2.9* 2.2±1.1 1.7±1.7 50-59 12.3±1.6 4.6±2.0* 2.3±0.7 3.7±1.8 60-69 20.0±2.9 22.9±5.1 6.2±1.7 1.4±1.4* 70-79 21.9±5.2 18.2±6.8 4.7±2.7 6.1±4.280 and more 50.0±50.0 0.0±100.0 50.0±50.0 0.0±100.0 Total 15.6±1.3 11.1±1.9* 3.5±0.6 3.0±1.0
  17. 17. Including malignant Malignant neoplasms of Malignant neoplasms neoplasms of trachea, respiratory system of digestive system Age bronchi and lungs Non- Non- Non- Smokers Smokers Smokers smokers smokers smokers30-39 0.0±79.3 0.0±100.0 0.0±79.3 0.0±100.0 0.0±79.3 0.0±100.040-49 1.1±0.8 0.0±6.1 1.1±0.8 0.0±6.1 1.1±0.8 1.7±1.750-59 0.8±0.4 0.0±3.4 0.8±0.4 0.0±3.4 0.5±0.4 2.8±1.660-69 3.6±1.3 0.0±5.2 3.1±1.2 0.0±5.2 1.5±0.9 1.4±1.470-79 0.0±5.7 3.1±3.1 0.0±5.7 6.1±4.2 3.1±2.2 0.0±10.480 and more 0.0±65.8 0.0±100.0 0.0±65.8 0.0±65.8 50.0±50.0 0.0±100.0Total 1.4±0.4 0.2±0.3* 1.3±0.4 0.7±0.5 1.2±0.4 1.8±0.8
  18. 18. In 2009 basic legislative documents andregulations for safety in use of asbestos hasbeen revised and completed according tonational and international experienceconcerning harmful effects of different types ofindustrial fibres.Existing threshold levels and control methodsfor dusts containing asbestos and othermineral fibres measurement in the air andwastes have been reevaluated and improvedtoo.
  19. 19. Chrysotile containing materials allowed foruse in the Russian Federation according to:-2.1.2/–00 State Standard”List of asbestos-cement productsrecommended for use”;-Letter no. 1100/3232-1-110 of ChiefHygienist of the Russian Federation from9.11.2001“Asbestos products recommended forproduction and use at transport,equipment, industrial and common lifecommodities”.
  20. 20. Basic positions of legislative documents in RussianFederation are:•use of amphiboles is banned;•chrysotile can be used, but in controlled conditions;•spraying of chrysotile-contained insulation isbanned;•works with friable chrysotile containing materials andworks on removing (demolishing) of old materialscontaining synthetic fibres can be provided only bylicensed contractors under control of independentlaboratory;
  21. 21. •works with other types of asbestos containingmaterials should be provided under control andaccompanied by safety measures (dust emissionprevention);•owners of industrial and nonindustrial objects wherefriable insulation products containing asbestos andother industrial mineral fibres exist should get allinformation about amount and localization of productsor construction elements and are responsible forsafety measures organization;
  22. 22. •free of charge obligatory special medicalexaminations for workers before, during (and after ifnecessary) occupational contact with asbestoscontaining dust;•asbestos related diseases (asbestosis, chronicalbronchitis, upper airways cancers, lung cancer,malignant mesothelioma) are in official list ofoccupational diseases and compensatedautomatically if occupational contact with chrysotilecontaining dust is proved;
  23. 23. •thresholds for working zone air according to GN2.2.5.1313-03 are established in total dust indices(mg/m3) separately for 8 hours shift and for 30minutes maximum (values are depended onrespirable chrysotile fibres concentrations);•threshold for ambient air according to GN2.1.6.1338-03 established in respirable fibers (f/ml)measured by optical microscopy and is 0,06 f/ml.
  24. 24. To provide detailed planning andsuccessful realization of practicalmeasures we offer first of all to conductwork for informational resourcesmobilization – the development ofnational asbestos profile.
  25. 25. In 2009 preparation of National AsbestosProfile as a base for further successfulplanning and realization of practicalmeasures has begun.First of all evaluation of main sources ofexposure should be completed (includingoccupational and environmentalexposure).
  26. 26. Sufficient work should be done on estimation of:- total number of persons exposed from occupational, nonoccupational and environmental sources;- preparation of formal register of industries where exposureexists and industries with largest numbers of workers potentiallyexposed;- register of industries with high risk of exposure and estimatedtotal number of workers at high risk.Another important task is mapping of:- existing and closed at present enterprises produced and extensively used asbestos containing materials;- deposits of all types of asbestos (ever operated and never operated);- deposits of erionite, vermiculite, talc and other natural fibrous minerals.
  27. 27. Situation at different enterprises could be different:to inappropriate
  28. 28. The content of these registers must includeinformation on exposure levels typical forevery professional and nonprofessionalgroup and industry brunch in order to avoidas under-, as overrate the asbestos relateddiseases risks.We’ve got a lot of information for manyindustries, but for some of them (ship buildingand maintenance, chemical industry,metallurgy, several areas in constructionindustry, etc.) we or have not enough.
  29. 29. Series of studies were performed to estimatethe concentrations of respirable fibres inindoor and outdoor air at buildings whereasbestos and other fibres containingconstruction materials were used.The aim of this studies was to evaluate apotential sources of exposure to asbestos andother fibrous particles.
  30. 30. One of the surveys included twenty buildings in Moscow:1. Fourteen residential houses - three 5-storey panel buildings from the 1960s, - four 12-storey panel buildings from the 1970s, - three 16-storey panel buildings from the 1980s, - three high-rise brick buildings from the 1950s - and one 9-storey panel building from the 1970s2. Six public buildings - hospital, - covered stadium, - theatre - and three office buildings
  31. 31. All the buildings contained asbestos materials, most oftenasbestos cement panels and pipes in dwelling areas or thermalinsulations usually contained asbestos and synthetic vitreousfibres in heating rooms at the basement.
  32. 32. fibre concentrations in hospital building air 0,025 0,022 0,02 0,02 0,015Concentration f/ml 0,011 0,01 0,005 <0,001 < 0,001 <0,001 0 Corridor Elevator hall Street near entrance of building All fibers longer 5 mkm (optical microscopy) Chrysotile fibers longer 5 mkm (electron microscopy)
  33. 33. Fiber concentrations in living buildingsConcentration (f/ml) 0,09 0,08 0,07 0,06 0,05 0,04 0,03 0,02 0,01 0 5-storeys block 16-storeys panel 9-stores panel building buildings buildings (renov ation of water supply sistem) All fibers longer 5 mkm (PCOM) Organic fibers longer 5 mkm (SEM) Chrysotile asbestos fibers longer 5 mkm (SEM) Other inorganic fibers longer 5 mkm (SEM)
  34. 34. Fibre concentrations were measured also at fivelocations near Moscow motorways (North, East,South, West and Center).A series of measurements were made near a thermalpower plant where large quantities of asbestos andMMMF insulations were removed, repaired andinstalled.
  35. 35. fibres concentrations in the air of Moscow motorways 0,009 0,008 0,007 0,006 0,005 Concentration (f/ml) 0,004 0,003 0,002 0,001 0 North East South West Center Center (near thermal power station) Phase-contrast optical microscopy (all fibers longer 5 mkm) Electron microscopy (chrysotile fibers longer 1 mkm) Electron microscopy (chrysotile fibers longer 5 mkm) Electron microscopy (chrysotile fibers < 5 mkm)In summertime samples, low concentrations of all fibres (> 5µm)and chrysotile (>1 µm) were found at five locations near Moscowmotorways. The mean concentrations were 0,002 f/ml and below0,001 f/ml, respectively.
  36. 36. In general, the results of this study in Moscow are consistentwith measurements of nonoccupational exposure to fibrousparticles in other urban areas in Russia.General conclusions were:- asbestos cement materials and other asbestos containingconstruction materials when used with ordinary precautionswithout intensive destruction can not be recognized as sufficientsource of ambient air contamination by asbestos fibres;- uncontrolled demolition and repair of friable asbestos andMMMF materials can be an important source of occupationaland nonoccupational exposure to mineral fibres.
  37. 37. Crocidolite Rodusite Anthophyllite Actinolite
  38. 38. Despite the fact that amphiboles never havebeen used in Russia in civil industry, certainamounts of crocidolite and anthophylite wasmined and used for special non-civil purposes.
  39. 39. Exposure to amphiboles is possible due to:- erosion of soils in areas, surrounded theirdeposits (even never being processed),- in shipbuilding industry during maintenanceworks at old ships built in countries, whereamosite and crocidolite were widely used ininsulation products.This is the one of fields for priority actions.
  40. 40. Insulation materials contained chrysotile and amosite removed during ship renovation
  41. 41. Former crocidolite mine:
  42. 42. Former anthophyllite mine:
  43. 43. Especially should be stressed necessity ofseries of epidemiological studies to definerisk of carcinogenic effects due tooccupational and non-occupationalexposure to chrysotile asbestos in modernconditions.
  44. 44. «…The risk estimates used in thecalculations … were derived frompast exposures to relatively highlevels of chrysotile. Current levelsof exposure are much lower …and as such risk extrapolationsmay be an overestimate. Thereare several other reasons whythere is a great deal of uncertaintyregarding these risk estimates…»
  45. 45. Further work and selection of priority directionsof actions will be possible only after realizationof fundamental for further activities phase –preparatory phase according to ILO/WHO“Outline for the Development of NationalProgrammes for Elimination of AsbestosRelated Diseases”.
  46. 46. The issue of banning chrysotile or restricting it in internationaltrade has been repeatedly raised by both national andinternational organisations although scientific evidence ofimpossibility of its safe and responsible use has never beenprovided.Moreover, the question about banning chrysotile is usuallyraised by the countries where pure chrysotile free of morehazardous and justly prohibited amphibole asbestos fibres hasnever been used.So evaluation of existing scientific data published ininternational sources were made.
  47. 47. Chrysotile versus amphiboles (why it is impossible to use most ofEuropean and US epidemiological studies toaccess risks related to chrysotile exposure)
  48. 48. Oldershaw P., 2004
  49. 49. less
  50. 50. … Most chrysotile fibresdisappear from the lung withina year, and a limited period ofchrysotile exposure causes veryfew mesotheliomas in workerswith no other exposure.… observations suggest thatchrysotile exposure couldincrease the lifelongmesothelioma risk in thosewhose lungs containpersistent amosite orcrocidolite, just as it causes amuch larger increase in the lungcancer risk in lifelong smokersthan in non-smokers (Hammondet al., 1979b) …
  51. 51. … The effect onmesothelioma risk ofstopping asbestos exposureis much less marked thanthat of stopping smoking onlung cancer risk (Peto et al.,2000), perhaps becauseamphibole fibres persist inthe lung for many decadesafter exposure hasceased, so even briefexposure produces alifelong carcinogenicstimulus ...
  52. 52. «...Cohort studies of populations of workersusing only or predominantly chrysotile-containing products in applications such asconstruction have not been identified.Some relevant information is available,however, from population-based analysesof primarily mesothelioma in applicationworkers exposed generally to mixed fibretypes…” Environmental Health Criteria 203 − Chrysotile Asbestos (IPCS-1998)
  53. 53. “…It should be recognized that although theepidemiological studies of chrysotile-exposed workers have been primarilylimited to the mining and milling, andmanufacturing sector, there is evidence,based on the historical pattern of diseaseassociated with exposure to mixed fibretypes in western countries, that risks arelikely to be greater among workers inconstruction and possibly other userindustries…” Environmental Health Criteria 203 − Chrysotile Asbestos (IPCS-1998)
  54. 54. 4. …substitutes may be used in a varietyof applications with different exposurepotential, either alone or in combinationwith other substances, the workshop didnot embark on risk assessment, butrather, limited its work to assessing thehazard...
  55. 55. 7. …A completely inert fibre that couldbe used as a negative control in the …assays has not been identified…