2. ASBESTOS
AN ENVIRONMENTAL
AND A HEALTH PROBLEM
BY
Dr. Hussein Fatehy Mahmoud
PhD-FCCP -MCTS
CONSULTANT PULMONOLOGIST
Abbassia Chest Hospital
Cairo-Egypt

3. 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

4. Asbestos overview

5. Asbestos Definition
The word asbestos derives from a
Greek word meaning
“inextinguishable”

6. 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.

7. What is Asbestos?
Because asbestos
fibers are so small,
once released into
the air, they may
stay suspended
there for hours or
even days.

8. Asbestos: Types
Serpentine
Amphibole
(93% of commercial use)
(7% of commercial use)
Chrysotile
Actinolite, Amosite, Anthophyllite,
Crocidolite, Richterite, Tremolite

9. 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.

10. 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.

11. 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

12. 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

13. Asbestos cement pressure pipes
Used for water supply

15. 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
http://www.nrcan.gc.ca./mms/cmy/content/2003/20.pdf
6,000

16. 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.

17. Asbestos-an environmental
problem

18. 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

19. 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

20. 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

21. 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

22. 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
www.osha.gov/Publications/osha3095.pdf

23. 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

25. Asbestos-a health
problem

26. 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.

27. 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)

28. Kouki Inai, M.D., Ph.D. Hiroshima University, Japan

29. Asbestos related diseases
• Pulmonary
•Pleural
–Asbestos related
pleural plaques
–Benign pleural
effusions
–Pleural
thickening
–Mesothelioma
–Asbestosis
–Lung cancer

30. 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

32. 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

33. Pleural Plaques

34. 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.

35. Diffuse Pleural Thickening

36. 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

37. 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

38. Asbestos – A Carcinogen
Asbestos is 1 of
over 130
occupational
carcinogens
listed by the U.S.
Government
Source: www.cdc.gov
HAWKINS PARNELL
THACKSTON&YOUNGLLP

39. 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.

40. 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

41. Small Cell Carcinoma

42. Large Cell Carcinoma

43. Adenocarcinoma

44. Squamous Cell Carcinoma

45. 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

48. 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)

49. 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

50. 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

52. 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

53. 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 (www.Ceramika.agh.edu.pl/azbesto612. pdf, accessed 11 August 2008).

54. %

55. 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.

56. 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

57. 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

58. 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

59. 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

60. Malignant Pleural Mesothelioma

61. Malignant Pleural Mesothelioma

65. 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.

73. 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.

74. Egyptian Pollution Abatement
Project
Hazardous Waste
Management
Manual For Industries
Final Draft
Prepared by
Environics
Management of Environmental Systems
July 2002

80. REGIONAL WORKSHOP ON
THE IMPLEMENTATION OF
STOCKHOLM CONVENTION
AND SYNERGIES WITH
OTHER CHEMICAL RELATED
AGREEMENTS
CAIRO – EGYPT (21-24 February 2005)

81. 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

82. Take home message

83. 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.

84. •
•
•
•
•
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