professor nico van zandwijk: karachi ticking time bomb

Asbestos:

a time-bomb with a long fuse

Professor Nico van ZandwijkAsbestos Diseases Research Institute

University of Sydney

World Asbestos Congress 2015Karachi, Sindh, Pakistan

31st January 2015

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/

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

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 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.



-1,000,000

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

19

20

19

30

19

40

19

50

19

60

19

70

19

80

19

90

20

00

20

10

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





-20%

0%

20%

40%

60%

80%

100%

19

20

19

30

19

40

19

50

19

60

19

70

19

80

19

90

20

00

20

10

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





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




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.

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 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

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

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

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

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

premature

mortality and the years of productive life lost due to

disability.

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

5,0

00

10,0

00

15,0

00

20,0

00

25,0

00

Num

ber

of

att

ributa

ble

death

s

1990 2010

By gender

Males Females

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

100

200

300

400

500

Dis

abili

ty-a

dju

ste

d life y

ears

(100

0s)

1990 2010

By gender

Males Females

Patterns of

Mesothelioma incidence

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

De

ca

de 1

De

ca

de 1

De

ca

de 2

De

ca

de 3

De

ca

de 4

De

ca

de 5

De

ca

de 6

De

ca

de 7

De

ca

de 8

De

ca

de 9

De

ca

de 1

0

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

Median age-standardised Malignant

Mesothelioma incidence rates per 100,000 by

geographic region and calendar period (males)

01

23

45

6

Rate

per

100,0

00

Afr

ica

Asia

C &

S A

merica

Euro

pe

N A

merica

Oceania

1993-1997

01

23

45

6

Rate

per

100,0

00

Afr

ica

Asia

C &

S A

merica

Euro

pe

N A

merica

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.

http://ci5.iarc.fr

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.

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 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.

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 caretreatment costs, Europe (2012), for people diagnosed with Malignant

Mesothelioma

Cumulative compensation payments for

Mesothelioma and Asbestosis, Australia

Source: Australian National Data Set for Compensation-based Statistics

(NDS).

0

50

100

150

200

250

AU

D$ m

illio

n

2000/2

001

2001/2

002

2002/2

003

2003/2

004

2004/2

005

2005/2

006

2006/2

007

2007/2

008

2008/2

009

2009/2

010

2010/2

011

2011/2

012

Australia, 2000-2001 to 2011-2012

Cumulative total payments (AUD$ million) for workers expsosed to asbestos

Mesothelioma Asbestosis

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

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

Replacement of Australian Asbestos shed

roofs (April 2014)

• Sugar mill factory

spent AUD$10 million

on a project to replace

Asbestos-containing

roof products

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.

Research investment in Asbestos-

related Disease, 2000-2010 (Australia)

01

23

4

Fundin

g A

UD

$ m

illio

n

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)

Summary:


Source: International Ban Asbestos Secretariat, http://ibasecretariat.org/graphics_page.php, accessed

January 2015.

http://ibasecretariat.org/graphics_page.php

Summary:


“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/

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

professor nico van zandwijk: karachi ticking time bomb

Government & Nonprofit