Asbestos: A Public Health Crisis of 'Unprecedented Scale'

Kristin Jenkins

May 23, 2019

Rapidly developing nations such as Brazil, Russia, India, and China "face an impending public health crisis of an unprecedented scale" because they continue to produce and use asbestos, warn experts.

In 2016, these four countries accounted for almost 80% of the estimated 1.37 million metric tons of asbestos consumed globally, say Tianhui Chen, MD, PhD, of Zhejiang Academy of Medical Sciences, in Hangzhou, China, and colleagues.

The incidence of asbestos-related diseases may have peaked in the majority of countries in which asbestos has been banned, the authors say in an article published online May 23 in JAMA Oncology.

For a handful of developing countries, however, they predict that the incidence of malignant pleural mesothelioma, a rare but highly aggressive cancer associated with long-term asbestos exposure, will increase for decades.

"Because the latency period can be 20 to 50 years, the incidence of mesothelioma dramatically increases after asbestos exposure, even if the usage is completely prohibited," Chen and colleagues write.

"It is high time to completely ban asbestos use in developing countries," the authors comment.

[I]t is high time to completely ban asbestos use in developing countries. Dr Tianhui Chen and colleagues

The authors note that global efforts to ban asbestos began about 15 years ago. Many organizations have been involved, including the World Health Organization (WHO), the World Health Assembly, the American Public Health Association, the World Federation of Public Health Organizations, the International Commission on Occupational Health, and the International Trade Union Confederation.

In 2013, the WHO proposed a 7-year global plan to help nearly 200 member states reduce the incidence of asbestos-related diseases, especially mesothelioma.

Asbestos Still Being Used

Despite these efforts, asbestos is still widely used around the world.

The WHO estimates that 125 million people worldwide are exposed to asbestos at work. The International Labour Organization says more than 107,000 workers die each year from an asbestos-related disease.

In addition, asbestos exposure in the home is responsible for thousands of deaths each year, according to the WHO.

In addition to mesothelioma, asbestos exposure is associated with cancer of the lung, larynx, and ovaries and diseases such as asbestosis and the occurrence of plaques, thickening, and effusion of the pleura.

Asbestos exposure is particularly deadly for those who smoke, exponentially increasing the risk for lung cancer.

The naturally occurring fibrous minerals in asbestos give it high tensile strength. It conducts heat poorly and is resistant to chemicals. These qualities have made asbestos a key ingredient in many products, including roofing shingles and water supply lines. It is also used in cars and can be found in transmission clutches, brake linings and pads, and engine gaskets.

The largest producer of asbestos worldwide is Russia. In 2016, it produced 54% of the estimated 1.28 million metric tons of asbestos produced globally. One of its best customers is China, which is currently the second largest consumer and producer of chrysotile asbestos worldwide, after India.

In China, workers at major construction or reconstruction sites and shipyards are exposed to asbestos, as are those working in close proximity to boilers and insulation pipes, the authors point out.

Workers' families who are exposed to asbestos-contaminated clothing are equally susceptible, the authors note. Epidemiologic data are lacking because of the use of short-term contractors and temporary workers, they write.

"Despite the understanding of the health risks posed by asbestos use, historical records indicate that many companies that used asbestos in their facilities ignored that such materials are dangerous and continued to use asbestos-containing materials," Chen and colleagues say.

"Over time, as the experiences of sick employees became known, the Chinese government began to consider implementing laws to regulate the use of asbestos. In the future, China could face a public health crisis triggered by asbestos use," they write.

Chen has received grants from the National Bureau of Foreign Experts Affairs, the Key Research-Development Program of Zhejiang Province, and Startup Funds for Advanced Talents at Zhejiang Academy of Medical Sciences. The other authors have disclosed no relevant financial relationships.

JAMA Oncol. Published online on May 23, 2019. Abstract

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