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Asbestos-related Occupational Cancers Compensated under the Industrial Accident Compensation Insurance in Korea
Abstract
Compensation for asbestos-related cancers occurring in occupationally-exposed workers is a global issue; this is also an issue in Korea. To provide basic information regarding compensation for workers exposed to asbestos, 60 cases of asbestos-related occupational lung cancer and mesothelioma that were compensated during 15 yr; from 1993 (the year the first case was compensated) to 2007 by the Korea Labor Welfare Corporation (KLWC) are described. The characteristics of the cases were analyzed using the KLWC electronic data and the epidemiologic investigation data conducted by the Occupational Safety and Health Research Institute (OSHRI) of the Korea Occupational Safety and Health Agency (KOSHA). The KLWC approved compensation for 41 cases of lung cancer and 19 cases of mesothelioma. Males accounted for 91.7% (55 cases) of the approved cases. The most common age group was 50-59 yr (45.0%). The mean duration of asbestos exposure for lung cancer and mesothelioma cases was 19.2 and 16.0 yr, respectively. The mean latency period for lung cancer and mesothelioma cases was 22.1 and 22.6 yr, respectively. The major industries associated with mesothelioma cases were shipbuilding and maintenance (4 cases) and manufacture of asbestos textiles (3 cases). The major industries associated with lung cancer cases were shipbuilding and maintenance (7 cases), construction (6 cases), and manufacture of basic metals (4 cases). The statistics pertaining to asbestos-related occupational cancers in Korea differ from other developed countries in that more cases of mesothelioma were compensated than lung cancer cases. Also, the mean latency period for disease onset was shorter than reported by existing epidemiologic studies; this discrepancy may be related to the short history of occupational asbestos use in Korea. Considering the current Korean use of asbestos, the number of compensated cases in Korea is expected to increase in the future but not as much as developed countries.
... According to Ahn et al. (2009), compensation for occupational malignant mesothelioma and lung cancer associated with asbestos exposure, in accordance with the Industrial Accident Compensation Insurance Act, was made for the first time in 1993 in respect of malignant mesothelioma, and in 1998 for lung cancer. Subsequently, a total 19 cases of malignant mesothelioma and 41 cases of lung cancer were recognized as asbestos-related occupational cancers by 2007 [2]. ...
... According to Ahn et al. (2009), compensation for occupational malignant mesothelioma and lung cancer associated with asbestos exposure, in accordance with the Industrial Accident Compensation Insurance Act, was made for the first time in 1993 in respect of malignant mesothelioma, and in 1998 for lung cancer. Subsequently, a total 19 cases of malignant mesothelioma and 41 cases of lung cancer were recognized as asbestos-related occupational cancers by 2007 [2]. Moreover, between 1994 and 2011, the percentage of claims involving asbestos exposure among 179 workers who received worker's compensation for occupational lung cancer was 48.6% (n = 87) [3]. ...
... This study attempted to analyze asbestos-related diseases that had been listed as occupational disease claims to KCOMWEL between 2011 and 2015. With the findings, the study aimed to improve understanding of the epidemiologic characteristics of these diseases, and to provide useful information to help inform policies for asbestos-exposure prevention and compensation for exposed workers [2]. ...
Background
This study aimed to enhance understanding of the epidemiologic characteristics of asbestos-related diseases, and to provide information that could inform policy-making aimed at prevention and compensation for occupational asbestos exposure, through analyzing asbestos-related occupational disease claims to Korea Workers’ Compensation and Welfare Service from 2011 to 2015.
Methods
We analyzed 113 workers who filed medical care claims or survivor benefits for asbestos exposure and occupational-related disease from 2011 to 2015. Among these claims, we selected approved workers’ compensation claims relating to malignant mesothelioma and lung cancer, and analyzed the general characteristics, exposure characteristics, pathological characteristics, and occupation and industry distribution.
Results
Malignant mesothelioma and lung cancer occurred predominantly in males at 89.7 and 94%, respectively. The mean age at the time of diagnosis for malignant mesothelioma and lung cancer was 59.5 and 59.7 years, respectively, while the latency period for malignant mesothelioma and lung cancer was 34.1 and 33.1 years, respectively. The companies involving exposed workers were most commonly situated within the Busan-Ulsan-Gyeongnam region. Histology results for lung cancer indicated adenocarcinoma as the most common form, accounting for approximately one half of all claims, followed by squamous cell carcinoma, and small cell lung cancer. The most common occupation type was construction in respect of malignant mesothelioma, and shipbuilding in respect of lung cancer.
Conclusions
Considering the long latency period of asbestos and that the peak period of asbestos use in Korea was throughout the mid-1990s, damage due to asbestos-related diseases is expected to show a continued long-term increase. Few studies providing an epidemiologic analysis of asbestos-related diseases are available; therefore, this study may provide baseline data to assist in predicting and preparing for future harm due to asbestos exposure.
Trial registration
DUIH 2018–02–004-001. Registered 28 Februrary 2018.
... Among them were 17 cases of cancer, and 11 of these were lung cancer. Six cases of lung cancer were compensated because they were recognized as complications of pneumoconiosis (9). In a similar study of another period using the COMWEL database, Ahn et al. (19) analyzed 4,240 cases of compensated occupational disease that occurred from 2001 to 2003. ...
... Also, the number of cases detected by a nationwide malignant mesothelioma surveillance system has also increased by nearly three-fold. Thus, Korean society is concerned that a surge of malignant mesothelioma occurrence may begin soon (9, 10). The aim of this review is to overview occupational respiratory cancer including malignant mesothelioma in Korea. ...
Malignant mesothelioma and lung cancer are representative examples of occupational cancer. Lung cancer is the leading cause of cancer death, and the incidence of malignant mesothelioma is expected to increase sharply in the near future. Although information about lung carcinogen exposure is limited, it is estimated that the number of workers exposed to carcinogens has declined. The first official case of occupational cancer was malignant mesothelioma caused by asbestos exposure in the asbestos textile industry in 1992. Since then, compensation for occupational respiratory cancer has increased. The majority of compensated lung cancer was due to underlying pneumoconiosis. Other main causative agents of occupational lung cancer included asbestos, hexavalent chromium, and crystalline silica. Related jobs included welders, foundry workers, platers, plumbers, and vehicle maintenance workers. Compensated malignant mesotheliomas were associated with asbestos exposure. Epidemiologic studies conducted in Korea have indicated an elevated risk of lung cancer in pneumoconiosis patients, foundry workers, and asbestos textile workers. Occupational respiratory cancer has increased during the last 10 to 20 yr though carcinogen-exposed population has declined in the same period. More efforts to advance the systems for the investigation, prevention and management of occupational respiratory cancer are needed.
... mesothelioma, is insidious because the time from asbestos exposure to the incidence of malignancy can span several decades. (2,3) A Japanese study reported that the period from the first exposure to the appearance of asbestos-related lung cancer (ARLC) ranged from 5 to 71 years, with a median of 47 years.(4) A Swedish cohort study reported a mean latency period of >44 years. ...
Background: An accurate estimate of the nationwide prevalence of asbestos-related lung cancer (ARLC) is necessary to adequately operate a compensation subsidy program for patients with ARLC.
Our study aimed to estimate the proportion of patients with ARLC among patients with primary lung cancer, and describe the characteristics and distribution of ARLC.
Methods: All facilities that treated patients diagnosed with lung cancer in 2016 were requested to submit computed tomography images of 10 patients randomly selected from the national databases of hospital-based cancer registries. ARLC was defined as pleural plaques (PPs) extending over one-quarter of the inner lateral chest wall or existing PPs accompanied by obvious lung fibrosis. We estimated the proportion and distribution of ARLC among primary lung cancer cases and compared the characteristics of ARLC with those of primary lung cancer.
Results: Of 772 facilities that treated at least one patient with lung cancer, 370 provided 3,565 sets of CT images. Of these, 216 (6.1%) had PPs, and 86 (2.4%) met the compensation criteria. After sample weighting, 2.0% of all primary lung cancers were classified as ARLC in Japan. A higher percentage of patients with ARLC were male (94.2% vs. 68.6%; P < .01) and had more advanced-stage disease (stage III: 22.1% vs. 16.0%; stage IV: 44.2% vs. 39.8%; P =.05) than other primary lung cancers. A majority (53.5%) of patients with ARLC were diagnosed at designated cancer hospitals. The proportion of squamous cell carcinoma was higher in ARLC than in those with primary lung cancer (25.6% vs. 18.6%; P < .01).
COnCLUSION: The estimated number of patients with ARLC was larger than expected from the number of applicants in the compensation system for asbestos-related health damages (AHDRS). Consequently, countermeasures are required to accurately identify eligible compensation recipients.
... Therefore, it can be said that the number of people receiving asbestos injury relief is much higher than the number of recognized occupational accidents caused by occupational asbestos exposure. However, in Korea, studies to investigate the scale of malignant mesothelioma caused by asbestos are still insufficient [6]. If asbestos injury relief data continue to be gathered, it is expected that greater clarity with respect to the specific epidemiologic characteristics of patients with malignant mesothelioma will be obtained. ...
Background: The purpose of this study was to identify the epidemiologic characteristics and prognostic factors for malignant pleural mesothelioma in Korea, which are currently insufficient. The data were derived from malignant mesothelioma patients who registered under the Asbestos Injury Relief Act; Methods: A total of 728 patients received compensation from the Asbestos Injury Relief Act due to malignant mesothelioma between 2011 and 2015. Of these, 313 patients (43.0%) with malignant pleural mesothelioma were included in the study. The study variables were sex (male, female), age at diagnosis (<59, 60–69, ≥70), smoking history (yes, no), surgery (yes, no), chemotherapy (yes, no), occupational exposure to asbestos (yes, no), and histological subtype (epithelioid, nonepithelioid); Results: Median survival of mesothelioma was 8.0 months (95% confidence interval: 6.2 to 9.8). The 1-year, 2-year, and 5-year survival rates (%) were 43.5%, 23.6%, and 12.5%, respectively. In multivariate analysis of Cox’s proportional hazards model; sex, age, smoking history, occupational asbestos exposure, and histological subtype were not significant prognostic factors, but surgery and chemotherapy combined was a significant predictor; Conclusions: Although the representativeness of these data is limited, our study estimates the epidemiologic characteristics of malignant pleural mesothelioma. Non-occupational exposure had a similar prognosis to occupational asbestos exposure, and there was no sex difference. In addition, it was found that receiving a combination of surgery and chemotherapy affects the survival rate, but there is a limitation in that factors such as performance status, comorbidities, and stage that contribute to survival are not considered.
... Latency also tended to decrease with age at first exposure [57], with one case report of a 27-year-old female with mesothelioma 8.5 years after first asbestos exposure [5], or an 18-yearold female with a latency period of only two years [60]. Korea, with a short history of occupational asbestos use, similar to Peru also reported mesotheliomas with a latency period shorter than 10 years in a series of 19 cases [61]. ...
... In the United States, Henley et al. 8 demonstrated that the female lung cancer incidence rate in 2015 increased with age, with the highest rate in those aged 75-79 years. Secondhand smoke, radon gas, air pollution, cooking oil fume, occupational exposure, and female sex hormones were regarded as risk factors of lung cancer [9][10][11][12][13][14][15] . ...
... Also, changes in cigarette composition, such as an increase in the dose of potent tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), may have contributed to the rising incidence in adenocarcinoma 12,13 . However, in the present study, a substantial proportion of adenocarcinoma cases (58.5%) occurred in patients who had never smoked, and occupational risk, air pollution, and genetic susceptibility could, therefore, be risk factors in these patients [14][15][16] . ...
Background:
Lung cancer is a leading cause of morbidity and mortality worldwide, and the incidence continues to rise. Although many prognostic factors have been identified, the clinical characteristics and outcomes in Korean lung cancer patients are not well defined.
Methods:
Of the 23,254 new lung cancer cases registered at the Korea Central Cancer Registry in 2013, total 489 patients from 19 hospitals were abstracted by the Korean Central Cancer Registry. The clinical data retrospectively analyzed, patients were followed up until December 2015.
Results:
The median age was 69 years (interquartile range, 60-74 years); 65.4% were male and 62.1% were ever-smokers. Cough was the most common initial symptom (33.5%); 13.1% of patients were asymptomatic. While squamous cell carcinoma was the most common subtype in male patients (37.2%), adenocarcinoma was the most frequent histological type in all patients (48.7%) and females (76.3%). The majority of patients received treatment (76.5%), which included surgery, radiation therapy, and chemotherapy. Older age (hazard ratio [HR], 1.037), lower body mass index (HR, 0.904), ever-smoker (HR, 2.003), small cell lung cancer (HR, 1.627), and distant metastasis (HR, 3.990) were independent predictors of mortality. Patients without symptoms (HR, 0.387) and without treatment (HR, 0.364) were associated with a favorable outcome in multivariate Cox analysis.
Conclusion:
Lung cancer in Korea occurs predominantly in elderly patients, with adenocarcinoma being the most frequent subtype. The prognosis was poorer in ever-smokers and older, malnourished, and untreated patients with advanced lung cancer.
... Cases of asbestosis and asbestos-related lung cancer were reported over the ensuing years [7][8][9]. However, it took another eight years to have the second compensation officially accepted in 2002, and still the number of cases compensated for asbestos-related occupational diseases remains fewer than 20 per year [10] (Figure 3). When compared to European countries [11], the number (fewer than 10 cases/year) and proportion (less than 50%) of recognized lung cancer from asbestos exposure remains relatively small [12]. ...
In 2009, asbestos was finally banned in Korea, about 70 years after the first opening of asbestos mines under Japanese control. After having presented the history of asbestos industry, together with its regulations and health effects over time, we constructed narrative analyses of how the asbestos issue under the prevailing risk system was managed by whom and for what purpose, to provide context for the change. We could identify five different phases: laissez-faire, politico-technical, economic–managerial, health-oriented cultural, and human rights-based post-cultural risk systems. The changes leading to the asbestos ban evolved over different phases, and each phase change was necessary to reach the final ban, in that, without resolving the previous issues by examining different categories of potential alternatives, either the final ban was not possible or, even if instituted, could not be sustained. An asbestos ban could be introduced when all the alternatives to these issues, including legitimate political windows, economic rationalizations, health risk protections, and human rights sensitivities, were available. We think the alternatives that we had were not in perfect shape, but in more or less loosely connected forms, and hence we had to know how to build solidarities between different stakeholders to compensate for the imperfections.
... To the best of our knowledge, this is the first comprehensive study conducted in France on occupational asbestos exposure and lung carcinoma pathological features. The link between lung cancer and asbestos exposure is sometimes difficult to attest (16). Two criteria for this recognition are used in many countries (Germany, Austria, Belgium, Finland, Norway, Sweden and Switzerland): proved intense exposure (Helsinki criteria or threshold of 25 fibers/ml/year) and/or asbestos-related conditions (asbestosis and/or extensive modification of the pleura) (17). ...
Exposure to asbestos results in serious risks of developing mesothelioma and lung cancer. The link between asbestos exposure and lung carcinoma is well established. Nevertheless, precise histopathological data are poorly considered when investigating the asbestos-cancer link in a compensatory approach. In the present study, we aim to describe the features of individuals with compensated lung cancer who were referred to an occupational disease center, regarding occupational exposure to asbestos, smoking history and pathological data. We led a retrospective study of compensated ARLC cases seen in our occupational disease center between 2003 and 2013. A total of 146 men were included (mean age at diagnosis, 63.2 years) of whom approximately 90% were heavy current or former smokers (mean value, 30.4 packs/year). The major industries associated with the lung cancer cases were shipbuilding (69.9%), and building construction (7.5%) in this harbor region. The results of the present study showed that lung upper lobe was most prevalent (61.6%) and an excess of adenocarcinoma was found (45.9%), followed by squamous cell carcinoma (38.4%) as well as thoracic sarcomas (2.1%). Neoplasm was not histologically proven in 6.8% of the cases. Subsequent pathology examinations also reclassified 2 tumors as metastases from esophageal and laryngeal origins. In conclusion, smoking prevention should be encouraged in asbestos-exposed workers as reflected by the number of smokers with asbestos-related lung cancer. Thus, histological data should be considered further to evaluate the potent relationship between asbestos exposure and lung malignancy, especially in a compensatory approach.
... (ii) This case presented a very short latency period of 7.5 years which has been rarely reported (Bitchatchi et al., 2010) when in most of the cases this period is much longer (Marinaccio et al., 2007;Ahn et al., 2009). ...
A pleural mesothelioma arose in an employee of a wine farm whose work history shows an unusual occupational exposure to asbestos. The information, gathered directly from the case and from a work colleague, clarifies some aspects of the use of asbestos in the process of winemaking which has not been previously reported in such details. The man had worked as a winemaker from 1960 to 1988 in a farm, which in those years produced around 2500 hectoliters of wine per year, mostly white. The wine was filtered to remove impurities; the filter was created by dispersing in the wine asbestos fibers followed by diatomite while the wine was circulating several times and clogging a prefilter made of a dense stainless steel net. Chrysotile asbestos was the sole asbestos mineralogical variety used in these filters and exposure could occur during the phase of mixing dry fibers in the wine and during the filter replacement. A daily and annual time weighted average level of exposure and cumulative dose have been estimated in the absence of airborne asbestos fiber monitoring performed in that workplace. Since 1993, the Italian National Mesothelioma Register, an epidemiological surveillance system, has recorded eight cases with at least one work period spent as winemaker. Four of them never used asbestos filters and presented exposures during other work periods, the other four used asbestos filters but had also other exposures in other industrial divisions. For the information hitherto available, this is the first mesothelioma case with exclusive exposure in the job of winemaking.
... The major industries associated with lung cancer cases were shipbuilding and maintenance, construction, and manufacture of basic metals. Considering the current Korean use of asbestos, the number of compensated cases in Korea is expected to increase in the future but not as much as developed countires (Ahn et al., 2009 ). The magnitude of asbestosrelated health problems in Korea has been underestimated due to under-diagnosis, incomplete reports, and shorter duration of exposure. ...
The usage and types of chemicals being developed, with diversified new exposure of workers, are of natural concern to occupational disease. In Korea, with industrialization, application of many chemicals has increased. A large proportion of mortality and disease is due to cancer, and the causal hazardous agents include chemical agents, like heavy metals and so on. Due to the long latency period with malignancies and the fact they are usually found after workers' retirement, it is suggested that management policies must be established to prevent occupational cancers occurring among workers in Korea. To give a general description about the efforts to prevent the occupational cancer with exposure to chemicals, articles on the trends of occupational cancers were reviewed and summarized with related research and efforts for prevention in Korea. It is important to improve the understanding of occupational cancer and help to maintain sustainable and appropriate measures to guarantee workers safety and health.
... The statistics pertaining to asbestosrelated occupational cancers in Korea differ from those in other developed countries in that more cases of mesothelioma were compensated than lung cancer cases. Also, the mean latency period for disease onset was shorter than reported by existing epidemiologic studies; this discrepancy may be related to the short history of occupational asbestos use in Korea [28]. Our study revealed the possibility of severe under-estimation in recognizing occupational lung cancer and a consequent undercompensation in South Korea. ...
The lung cancer mortality in Korea has increased remarkably during the last 20 years, and has been the first leading cause of cancer-related deaths since 2000. The aim of the current study was to examine the time trends of occupational lung cancer and carcinogens exposure during the period 2006-2009 in South Korea, by assessing the proportion of occupational burden.
We defined occupational lung cancer for surveillance, and developed a reporting protocol and reporting website for the surveillance of occupational lung cancer. The study patients were chosen from 9 participating university hospitals in the following 7 areas: Seoul, Incheon, Wonju, Daejeon, Daegu, Busan, and Gwangju.
The combined proportion of definite and probable occupational lung cancer among all lung cancers investigated in this study was 10.0%, 8.6%, 10.7%, and 15.8% in the years 2006 to 2009, respectively, with an average of 11.7% over the four-year study period. The main carcinogens were asbestos, crystalline silica, radon, polyaromatic hydrocarbons (PAHs), diesel exhaust particles, chromium, and nickel.
We estimated that about 11.7% of the incident lung cancer was preventable. This reveals the potential to considerably reduce lung cancer by intervention in occupational fields.
... These investigations were requested by the Korea Workers' Compensation and Welfare Service (KOMWEL) for clarification of compensation issues. These investigations showed that various kinds of occupational cancers, such as mesothelioma, lung cancer, leukemia, non- Hodgkin's lymphoma, and bladder cancer, have appeared since 19926789. However, only one attempt has been made to estimate the occupational burden of cancer in Korean workers [10]. ...
The extent of the occupational cancer burden has rarely been estimated in Korea. The aim of this study is to provide an estimation of the population attributable fraction (PAF) of occupational cancer in Korea.
Nine kinds of Group 1 carcinogens addressed by the International Agency for Research on Cancer (IARC) and 7 kinds of cancer were selected for the target carcinogens and diseases, respectively. The prevalence of carcinogen-exposed workers was estimated and correction factors were applied so that the value would be representative of the total population. Data on relative risk (RR) were taken from IARC reports and were compared with the RRs from the studies on Korean workers. The PAF was estimated according to Levin's formula.
The proportion of the general Korean population exposed to carcinogens was 9.7%. The PAF of total cancer was 1.1% for incident cancer cases and 1.7% for cancer deaths. The PAFs of lung cancer and leukemia were 7.0% and 4.%, respectively. With the RRs reported from Korean studies, the PAF for lung cancer and leukemia were 3.7% and 3.4%, respectively.
The PAF in this study (1.1%) was lower than that reported in previous studies (2-4%) from developed countries. Considering that only 9 of the 29 kinds of Group 1 carcinogens were included in this study, the PAF might be underestimated. However, because the process of industrialization in Korea differs from that which occurred in other developed countries, 1.1% of the PAF might be appropriate for Korea.
... In 1993, the first case of mesothelioma in Korea was reported in an asbestos textile worker [Paek et al., 1995]. From that year to 2007, the Korea Labor Welfare Corporation approved compensation for 41 cases of asbestos-related occupational lung cancer and 19 cases of mesothelioma [Ahn and Kang, 2009]. Among the 60 cases of asbestos-related cancers, 7 cases of lung cancer and 4 of mesothelioma were shipyard workers. ...
Cancer is a major concern in shipbuilding. Since 1970s, shipbuilding and repair has been a strategic industry in Korea, which has become currently the world's largest shipbuilding country. The aim of this study is to investigate the cancer incidence in shipyard workers in Korea.
The cohort comprised 30,288 male employees (20,647 production workers and 9,641 office workers) ever employed between 1992 and 2005 in a shipyard in Korea. The authors compared the cancer incidence between the groups using the participants' hospital medical records and data received from Korea National Cancer Incidence Database and Korean National Statistical Office.
The total number of cancers was 135 among office workers and 519 among production workers in the shipyard. The age-standardized cancer rates among office and production workers were 136.2 and 179.7 per 100,000 person-years, respectively. The standardized rate ratios for stomach cancer, liver cancer, and lung cancer in production workers compared with office workers were 1.67 (95% CI: 1.12-2.49), 2.13 (95% CI: 1.37-3.36), and 3.71 (95% CI: 1.68-8.19), respectively.
The observed increase in stomach, liver, and lung cancers among production workers suggests that some occupational factors in the shipyard might have contributed to the increased cancer risk. Further study is needed to clarify the risk of those cancers and to identify the specific factors involved. Am. J. Ind. Med. 54:719-725, 2011. © 2011 Wiley-Liss, Inc.
... However, the information on the influence of chromium exposure on the age of disease onset is missing in the literature. Studies on the issue point to genetic predispositions and conclude that genetic constitution can play a role [32][33][34][35][36][37] in that the appearance of lung cancer in first-degree relatives can increase the risk of the early onset of lung cancer 5-fold [38,39]. ...
Workers chronically exposed to hexavalent chromium have elevated risk of lung cancer. Our study investigates the incidence of lung cancer types, age at onset of the disease, and survival time among chromium exposed workers with respect to the expression of anti-apoptotic p53 and pro-apoptotic survivin proteins.
67 chromium exposed workers and 104 male controls diagnosed with lung cancer were analyzed. The mean exposure time among workers was 16.7 ±10.0(SD) years (range 1- 41 years). To investigate the possible regulation of survivin by p53 we examined the expression of both proteins using immohistochemical visualization.
Chromium exposure significantly decreases the age of onset of the disease by 3.5 years (62.2 ±9.1 in the exposed group vs. 65.7 ±10.5 years in controls; P=0.018). Small cell lung carcinoma (SCLC) amounted for 25.4% of all cases in chromium exposed workers and for 16.3% in non-exposed individuals. The mean survival time in the exposed group was 9.0 ±12.7 vs. 12.1 ±21.9 months in controls, but this difference was not significant. Survivin was predominantly expressed in both cell nucleus and cytoplasm, whereas p53 was expressed in the nucleus. There was a negative correlation between survivin and p53 expression. A decreased intensity of expression and fewer cells positive for survivin was detected in SCLC compared with other types of lung cancer. p53 was expressed in 94.1% and survivin in 79.6% of the samples analyzed.
The study calls attention to decreased expression of survivin, as opposed to p53, in small cell lung carcinoma.
In this paper, we present a standardized approach for using cancer incidence and survival data to account for the timing between a reduction in carcinogen exposure and the subsequent reduction in cancer risk and fatality. While the estimates for this timing between a reduction in carcinogen exposure and reduced cancer risk would ideally come from high-quality studies specifically examining this question, very few such studies are available. Thus, we designed an approach to account for this timing when sufficient data are not available elsewhere. Our approach can be used in estimating monetized values for achieving small reductions in the risks for many common specific types of cancer in benefit–cost analyses of regulatory and non-regulatory policies in the United States that achieve cancer risk reductions by reducing carcinogen exposures. We provide estimated values for 108 different cancer sites and for all cancer sites combined. We accompany this paper with a spreadsheet-based tool that presents our results separately for non-fatal and fatal risks so that results can easily be calculated using different combinations of discount rates, latency between carcinogen exposure and cancer diagnosis, values for the willingness-to-pay to avoid fatal and non-fatal cancer risks, and potentially affected populations.
Background
Asbestos refers to a group of naturally occurring silicate minerals which have been traditionally used in building materials and household products. Inhalation of asbestos fibers, however, has been associated with adverse health outcomes, with the disease manifestations principally affecting the thorax. The aim of our study is to detect and evaluate the different radiological patterns of asbestos-related lung and pleural disease and its complications
Results
MDCT examination was able to assess and distinguish asbestosis as well as asbestos-related lung and pleural disease besides detection of any associated complications.
Conclusion
This study demonstrates that while reporting of malignant asbestos-related pleural disease is adequate, there is room for improvement in the reporting of more benign disease.
Objectives: The lack of reliable information on environmental pollution and health impacts related to asbestos contamination from abandoned mines has drawn attention to the need for a community health study. This study was performed to evaluate asbestos-related health symptoms among residents near abandoned asbestos mines located in the Chungcheong Provinces. In addition, exposure assessment for asbestos is needed although the exposure to asbestos was in the past. Methods: Past exposure to asbestos among inhabitants near abandoned asbestos mines was estimated by using surface sampling of deposited dust in indoor and outdoor residences. A total of 54 participants were divided into two groups with (34 cases) and without (20 controls) diseases related to asbestos. Surface sampling of deposited dust was carried out in indoor and outdoor residences by collecting 105 samples. Deposited dust for sampling was analyzed by polarization microscope (PLM) and scanning electron microscope?energy dispersive x-ray spectrometer (SEM-EDX) to detect asbestos. Subsequently, the elements of the deposited dust with asbestos were analyzed by SEM-EDX to assess the contribution of sources such as abandoned mines, slate and soil. Results: Among the 105 samples, asbestos was detected by PLM in 29 (27.6%) sampling points, and detected by SEM in 56 (48.6%) sampling points. Asbestos in indoor residences was detected by PLM in four sampling points, and by SEM in 12 sampling points. Asbestos detection in indoor residences may be due to ventilation between indoors and outdoors, and indicates long-term exposure. The asbestos detection rate for outdoor residences in the case group was higher than that in the control group. This can be explained as the case group having had higher exposure to asbestos, and there has been continuous exposure to asbestos in the control group as well as the case group. Conclusion: Past residential asbestos exposure may be associated with asbestosis among local residents near abandoned asbestos mines. Odds ratios were calculated for asbestos detection in outdoor residence by logistic regression analysis. Odds ratio between asbestos detection and asbestosis pulmonum was 3.36 (95% CI 0.90-12.53) (p=0.072), adjusting for age, sex, smoking status and work history with multi-variable logistic regression by PLM analysis method.
This study was performed to evaluate the asbestos exposure levels and to calculate excess lifetime cacer risks(ELCRs) in asbestos-containing buildings for maintenance and management. The range of airborne asbestos concentration of 33 buildings was 0.0018 ~ 0.0126 f/cc and one site exceeded indoor air-quality recommended limit 0.01 f/cc. And ELCRs based on US EPA IRIS(Integrated risk information system) model are 1.5E-06 ~ 3.9E-05 levels, and there was no site showed 1.0E-04 (one person per million) level or more, and 11 sites showed 1.0E-05 (one person per 100,000 people) level or more. To prevent the release of asbestos fibers, it needs operation and maintenance of asbestos-containing building materials, and there are some methods such as removal, repairment, enclosure and encapsulation. In conclusion, a risk-based air action level for asbestos in air is an appropriate metric for asbestos-containing building management.
Crocidolite quality control (QC) sampling created by the wet generation method has been validated by validation tests such as the accuracy, precision, and storage tests. For this study we designed and developed a manufacturing apparatus and standard operating procedure for making these QC samples. The most important step in the procedure of making QC samples was the stage eliminating static electricity in asbestos fibers. This static electricity hampers the fibers clog functioning. In accuracy and precision tests by phase contrast microscopy analysis, the difference between the reference values and the studied values was at maximum 17.8%. This satisfies the AIHA proficiency analytical test criteria for asbestos. We could confirm the nearly even distribution of crocidolite fibers on the membrane filter. Also, there was no loss of fibers in the storage test after the one month.
The asbestos textile industry is characterized by the highest asbestos ambient air concentration of those workers who have suffered from high incidence of lung cancer, malignant mesothelioma, and other asbestos related diseases (ARDs). Also, asbestos dust occurred in a factory can be disseminated into the environmental air around the factory, which can cause ARDs among residents of the factory. High lung cancer and malignant mesothelioma mortality rates among asbestos textile workers were established, and increase of ARDs among residents around the factory has been reported. A large number of environmentally exposed residents as well as severity of health problems among asbestos textile workers would cause huge social problems. The high exposure group needs to be monitored for early detection and management. In addition, a nationwide mandatory malignant mesothelioma registration system to identify exposure sources and high risk groups might help to predict and manage ARDs.
This article brings a brief review of asbestos exposure and asbestos-related diseases in Croatia in view of the asbestos ban. The fi rst cases of asbestosis were diagnosed in workers from an asbestos-cement factory in 1961. Between 1990 and 2007, 403 cases of asbestosis had been registered as occupational disease: 300 with parenchymal fi brosis and the rest with parenchymal and pleural changes, or pleural plaques. As a rule, asbestos-related changes were diagnosed at an early stage thanks to regular checkups of the exposed workers. Pleural plaques, considered to be the consequence of asbestos exposure, were also occasionally found in subjects who lived in areas with asbestos processing plants, but were not occupationally exposed. Early epidemiological studies on respiratory and gastrointestinal tract tumours in areas with an asbestos processing plant (1994) and an asbestos-cement plant (1995, 1996) focused on the occurrence of malignant tumours in persons exposed to asbestos at work or in the environment. More recently, the focus has shifted to the malignant pleural mesotelioma (MPM). An epidemiological study published in 2002 showed that the MPM incidence was signifi cantly higher in the coastal area than in the rest of the country. About two thirds of patients with the tumour were occupationally exposed to asbestos. This uneven distribution of the tumour incidence is obviously related to shipbuilding and other industrial sources of asbestos exposure located in the coastal Croatia. Sources of environmental exposure to asbestos also have to be taken into account. The second part of this article ventures into the issues ahead of us, after asbestos has been banned in the country. The long latency period of cancers, and particularly of asbestos-related mesothelioma, implies that the incidence of this tumour will not drop over the next few decades. In Croatia, the average annual rate of MPM between 1991 and 2006 was 40, and ranged between 20 in 1991 to 61 in 1999. In 2006 it was 58. Age-standardised incidence of this tumour between 1991 and 1997 was 0.74 per 100,000 (1.34 per 100,000 for men and 0.27 per 100,000 for women). Sadly, the diagnosis of mesothelioma is seldom timely, and treatment is usually unsuccessful.
To evaluate a case-control study of malignant mesothelioma through patterns of exposure to asbestos based upon information from telephone interviews with next of kin.
Potential cases, identified from medical files and death certificates, included all people diagnosed with malignant mesothelioma and registered during 1975-1980 by the Los Angeles County Cancer Surveillance Program, the New York State Cancer Registry (excluding New York City), and 39 large Veterans Administration hospitals. Cases whose diagnosis was confirmed in a special pathology review as definite or probable mesothelioma (n = 208) were included in the analysis. Controls (n = 533) had died of other causes, excluding cancer, respiratory disease, suicide, or violence. Direct exposure to asbestos was determined from responses to three types of questions: specific queries as to any exposure to asbestos; occupational or non-vocational participation in any of nine specific activities thought to entail exposure to asbestos; and analysis of life-time work histories. Indirect exposures were assessed through residential histories and reported contact with family members exposed to asbestos.
Among men with pleural mesothelioma the attributable risk (AR) for exposure to asbestos was 88% (95% confidence interval (95% CI) 76-95%). For men, the AR of peritoneal cancer was 58% (95% CI 20-89%). For women (both sites combined), the AR was 23% (95% CI 3-72%). The large differences in AR by sex are compatible with the explanations: a lower background incidence rate in women, lower exposure to asbestos, and greater misclassification among women.
Most of the pleural and peritoneal mesotheliomas in the men studied were attributable to exposure to asbestos. The situation in women was less definitive.
Inhalation of asbestos fibers increases the risk of bronchial carcinoma. It has been claimed that asbestosis is a necessary prerequisite for the malignancy, but epidemiologic studies usually do not have enough statistical strength to prove that asbestos-exposed patients without asbestosis are without risk. Several recent studies do actually indicate that there is a risk for such patients. In addition, case-referent studies of patients with lung cancer show an attributable risk for asbestos of 6% to 23%, which is much higher than the actual occurrence of asbestosis among these patients. Thus there is an increasing body of evidence that, at low exposure levels, asbestos produces a slight increase in the relative risk of lung cancer even in the absence of asbestosis. Consequently, all exposure to asbestos must be minimized.
This review assesses the contribution of occupational asbestos exposure to the occurrence of mesothelioma and lung cancer in Europe. Available information on national asbestos consumption, proportions of the population exposed, and exposure levels is summarized. Population-based studies from various European regions on occupational asbestos exposure, mesothelioma, and lung cancer are reviewed. Asbestos consumption in 1994 ranged, per capita, between 0. 004 kg in northern Europe and 2.4 kg in the former Soviet Union. Population surveys from northern Europe indicate that 15 to 30% of the male (and a few percent of the female) population has ever had occupational exposure to asbestos, mainly in construction (75% in Finland) or in shipyards. Studies on mesothelioma combining occupational history with biologic exposure indices indicate occupational asbestos exposure in 62 to 85% of the cases. Population attributable risks for lung cancer among males range between 2 and 50% for definite asbestos exposure. After exclusion of the most extreme values because of methodologic aspects, most of the remaining estimates are within the range of 10 to 20%. Estimates of women are lower. Extrapolation of the results to national figures would decrease the estimates. Norwegian estimates indicate that one-third of expected asbestos-related lung cancers might be avoided if former asbestos workers quit smoking. The combination of a current high asbestos consumption per capita, high exposure levels, and high underlying lung cancer rates in Central Europe and the former Soviet Union suggests that the lung cancers will arise from the smoking-asbestos interaction should be a major concern.
To review evidence about the joint relation of exposure to asbestos and smoking on the risk of lung cancer to answer three questions: (1) does asbestos increase risk in non-smokers; (2) are the data consistent with an additive model; and (3) are the data consistent with a multiplicative model?
Analysis of 23 studies reporting epidemiological evidence on the joint relation. Comparison of risk of lung cancer in subjects unexposed to asbestos or smoking, exposed to asbestos only, to smoking only, or to both. Estimation of the relative risk associated with asbestos exposure in non-smokers and of statistics testing for additivity and multiplicativity of risk.
Eight of the 23 studies provided insufficient data on the risk of lung cancer in non-smokers to test for possible effects of asbestos. Asbestos exposure was associated with a significantly (p<0.05) increased risk in non-smokers in six of the remaining studies and with a moderately increased, but not significant, increase in a further six. In two of the three studies that found no increase, asbestos exposure was insufficient to increase risks in smokers. In 30 of 31 data sets analysed, risk in the combined exposure group was greater than predicted by the additive model. There was no overall departure from the multiplicative model, the proportional increase in risk of lung cancer with exposure to asbestos being estimated as 0.90 (95% confidence interval (95% CI) 0.67 to 1.20) times higher in smokers than non-smokers. For two studies significant (p<0.05) departures from a multiplicative relation were found in some, but not all, analyses. Reasons are presented why these may not indicate true model discrepancies.
Asbestos exposure multiplies risk of lung cancer by a similar factor in non-smokers and smokers. The extent to which it multiplies risk varies between studies, no doubt depending on the type of asbestos involved, and the nature, extent, and duration of exposure.
A series of 557 malignant mesotheliomas of the pleura diagnosed in the Trieste-Monfalcone area, Italy, in the period 1968-2000 were reviewed. The series included 492 men and 65 women, aged between 32 and 93 years (median age 69 years). Necropsy findings were available in 456 cases (82%). Occupational histories were obtained from the patients themselves or from their relatives by personal or telephone interviews. Routine lung sections were examined for asbestos bodies in 442 cases. In 109 cases isolation and counting of asbestos bodies were performed. A majority of people had histories of working in the shipyards. Asbestos bodies were observed in lung sections in 67% of the cases. Lung asbestos body burdens after isolation ranged between 20 bodies and about 10 millions of bodies/g dried tissue. Latency periods (time intervals between first exposure to asbestos and death) ranged between 14 and 75 years (mean 48.8 years, median 51.0). Latency periods among insulators and dock workers were shorter than among the other categories. High asbestos consumption occurred in many countries in the 1960s and in the 1970s. The data on latency periods obtained in the present study suggest that a world mesothelioma epidemic has to be expected in the coming decades.
The update of predictions of mortality from pleural mesothelioma in the Netherlands1 provides welcome news that the peak number and the total during 2000–28 are now predicted to be only a little more than half of the figures predicted only four years earlier.2 This marked change in prediction has occurred because the known decrease in asbestos use after 1984 and a ban in 1993 were taken into account in the modelling, and there were five extra years of data (1994–98).
Since most mesotheliomas are caused by asbestos the pattern of use during different periods of time has a marked influence on …
To summarize the geographical and temporal variations in incidence of pleural mesothelioma in Europe, using the extensive data available from European general cancer registries, and consider these in light of recent trends in asbestos extraction, use and import in European countries.
The data were extracted from the European Cancer Incidence and Mortality database (EUROCIM). The inclusion criteria was acceptance in Volume VII of Cancer Incidence in Five Continents. Truncated age-standardized rates per 100,000 for the ages 40-74 were used to summarise recent geographical variations. Standardized rate ratios and 95% confidence intervals for the periods 1986-1990 and 1991-1995 were compared to assess geographical variations in risk. To investigate changes in the magnitude of most recent trends, regression models fitted to the latest available 10-year period (1988-1997) were compared with trends in the previous decade. Fitted rates in younger (40-64) and older adults (65-74) in the most recent period were also compared.
There was a great deal of geographical variation in the risk of mesothelioma, annual rates ranging from around 8 per 100,000 in Scotland, England and The Netherlands, to lower than 1 per 100,000 in Spain (0.96), Estonia (0.85), Poland (0.85) and Yugoslavia, Vojvodina (0.56) among men. The rank of the rates for women was similar to that observed for men, although rates were considerably lower. Between 1978 and 1987, rates in men significantly increased in all countries (excepting Denmark). In the following 10 years, there was a deceleration in trend, and a significant increase was detectable only in England and France. In addition, the magnitude of recent trends in younger men was generally lower than those estimated for older men, in both national and regional cancer registry settings.
While mesothelioma incidence rates are still rising in Europe, a deceleration has started in some countries. A decrease may begin in the next few years in certain European populations considering the deceleration of observed trends in mesothelioma and asbestos exposure, as well as the recent ban on its use.
Aims: To report the temporal pattern and change in trend of mesothelioma incidence in the United States since 1973.
Methods: The Surveillance, Epidemiology, and End Results (SEER) programme of the National Cancer Institute has since 1973 provided annual age adjusted incidence for mesothelioma in representative cancer registries dispersed throughout the USA. SEER data are analysed to describe the trend of male mesothelioma incidence in the USA.
Results: The US male mesothelioma incidence data indicate that after two decades of increasing incidence, a likely decline has been observed since the early 1990s, when a highly significant change in the upward course occurred.
Conclusions: Increasing male mesothelioma incidence for many years was undoubtedly the result of exposure to asbestos. The high mesothelioma risk was prominently influenced by exposure to amphibole asbestos (crocidolite and amosite), which reached its peak usage in the 1960s and thereafter declined. A differing pattern in some other countries (continuing rise in incidence) may be related to their greater and later amphibole use, particularly crocidolite. The known latency period for the development of this tumour provides biological plausibility for the recent decline in mesothelioma incidence in the USA. This favourable finding is contrary to a widespread fear that asbestos related health effects will show an inevitable increase in coming years, or even decades.
Comprehensive and updated throughout, this new edition makes it easy to detect, diagnose, and treat the full spectrum of problems caused by occupational or environmental factors, including physical, chemical, and biologic agents. An international cast of experts offers in-depth, authoritative guidance on clinical problems as well as the legal and regulatory issues impacting the practice of occupational and environmental medicine today. Section 1 is on principles and practice. Section 2 on work sectors and special populations includes a chapter on mining. Section 3 on occupational diseases and injuries includes several chapters of relevance to the coal mining industry, including diseases of the lung and pleura covering silicosis, respiratory diseases of coal miners, and malignancies of the respiratory tract and pleura. Section 4 on hazards in the workplace and the environment includes a chapter on mineral dusts. Section 5 covers policy, regulation and control.
In recent years, controversy has developed about whether pre-existing asbestosis is a prerequisite for the diagnosis of asbestos-related lung cancer. This paper presents the results of a prospective study, in a cohort of Ontario asbestos–cement workers, of lung cancer in relation to radiographs obtained 20 and 25 years from first exposure to asbestos. Radiographs were interpreted by a single NIOSH-certified “B” reader, and asbestosis was defined to mean an ILO code of 1/0 or greater. There were 143 subjects (123 without asbestosis, 20 with asbestosis), with a radiograph available for interpretation at 20 years from first exposure or later. The lung cancer standardized mortality ratio (SMR) among men without asbestosis at 20 years latency was 5.53 (95%CI: 2.9–9.7). There were 128 subjects (114 without asbestosis, 14 with asbestosis) with a radiograph available for interpretation at 25 years from first exposure or later. The lung cancer SMR among men without asbestosis at 25 years latency was 5.81 (95%CI 2.7–11). The results of this study are consistent with those of epidemiologic studies of asbestos-exposed populations in a variety of exposure situations. These studies have demonstrated that lung cancer risk is elevated in the presence of radiographic asbestosis, but they have also shown that lung cancer risk may be elevated in the absence of radiographic asbestosis. Am. J. Ind. Med. 32:341–348, 1997. © 1997 Wiley-Liss, Inc.
The early diagnosis of mesothelioma in a patient has resulted in a unique opportunity to observe aspects of its natural history.
This study was designed to test the hypothesis that the risk of lung cancer from asbestos exposure is confined to persons with radiographic evidence of pulmonary fibrosis. Occupational and smoking histories were obtained from 271 patients with a confirmed diagnosis of primary lung cancer and 678 referents (279 with other respiratory disease and 399 with cardiac disease). Histories were reviewed blind to assess the timing, duration, and probability of exposure to asbestos. To allow for a lag between asbestos exposure and the development of lung cancer, subjects were classified by the time they had spent in an occupation entailing definite or probable exposure more than 15 years before diagnosis. The presence and extent of fibrosis was assessed blindly from chest radiographs by three readers and scored for small opacities with the ILO 1989 International Classification of Radiographs of the Pneumoconioses. 93 (34.3%) cases had worked in an occupation with definite or probable asbestos exposure compared with 176 (25.8%) referents (crude odds ratio for lung cancer 1.49, 95% CI 1.09-2.04). After adjustment for age, sex, smoking history, and area of referral, the odds ratio (95% CI) was 2.03 (1.00-4.13) in the subgroup of 211 with a median ILO score for small parenchymal opacities of 1/0 or more, and 1.56 (1.02-2.39) in the 738 with a score of 0/1 or less (ie, those without radiological evidence of pulmonary fibrosis). These results suggest that asbestos is associated with lung cancer even in the absence of radiologically apparent pulmonary fibrosis.
To find the numbers of mesotheliomas in Calderdale over the period 1966-94 and determine their relation to asbestos exposure, pathology, and mineral fibre burden within the lungs of affected subjects.
Cases were entered into the study if the subject has been diagnosed with mesothelioma after postmortem and histopathological examinations. Occupational data were obtained mainly from the case records of the Cape Asbestos medical officer, hospital, and medical practitioner and from death certificates. Analyses of the mineral fibres were performed with transmission electron microscopy and energy dispersive x ray spectrometry.
73 mesotheliomas were diagnosed from 1966 to 1994. Forty four were associated with exposure at the Acre Mill factory, which manufactured asbestos products. Concentrations of amphibole asbestos fibres were found to be raised above controls in 31 out of 32 cases associated with Acre Mill exposure, in 10 out of 12 other cases exposed to asbestos and eight out of 17 cases not exposed to asbestos.
There was a high number of mesotheliomas in Calderdale. More than half of the cases were associated with occupation at the Acre Mill factory and were associated with exposure to amphibole asbestos, predominantly crocidolite. No cases associated with neighbourhood exposure to asbestos were identified.
In recent years, controversy has developed about whether pre-existing asbestosis is a prerequisite for the diagnosis of asbestos-related lung cancer. This paper presents the results of a prospective study, in a cohort of Ontario asbestos-cement workers, of lung cancer in relation to radiographs obtained 20 and 25 years from first exposure to asbestos. Radiographs were interpreted by a single NIOSH-certified "B" reader, and asbestosis was defined to mean an ILO code of 1/0 or greater. There were 143 subjects (123 without asbestosis, 20 with asbestosis), with a radiograph available for interpretation at 20 years from first exposure or later. The lung cancer standardized mortality ratio (SMR) among men without asbestosis at 20 years latency was 5.53 (95% CI: 2.9-9.7). There were 128 subjects (114 without asbestosis, 14 with asbestosis) with a radiograph available for interpretation at 25 years from first exposure or later. The lung cancer SMR among men without asbestosis at 25 years latency was 5.81 (95% CI 2.7-11). The results of this study are consistent with those of epidemiologic studies of asbestos-exposed populations in a variety of exposure situations. These studies have demonstrated that lung cancer risk is elevated in the presence of radiographic asbestosis, but they have also shown that lung cancer risk may be elevated in the absence of radiographic asbestosis.
This review examines the hypothesis that excess lung cancer risk in worker cohorts exposed to asbestos occurs only among those with asbestosis. The adequately designed studies in the literature support this hypothesis. The summary relative risk for lung cancer was 1.00 in seven cohorts with no deaths from asbestosis. In addition, there is a high correlation between asbestosis rates and lung cancer rates in 38 cohorts in contrast to a poor correlation between cumulative exposure data and lung cancer relative risks in eight cohorts with adequate data. The evidence indicates that asbestosis is a much better predictor of excess lung cancer risk than measures of exposure and serves as a marker for attributable cases.
Recently, a worker with lung carcinoma and a metastatic brain tumor was diagnosed as having a work-related disease. He had been employed in a non-asbestos textile company for 25 years. Consequently, to identify and explore possible causative agents for lung cancer in a non-asbestos textile manufacturing company and establish a causal relationship between exposure and lung cancer, an epidemiological investigative study was conducted and the work processes the worker was engaged in were examined. Air samples were taken from the workplace and during the drilling processes, and a suspected causative material was analyzed. The study revealed that the subject had been employed in the non-asbestos textile manufacturing company for 25 years from 1973 and his responsibilities included repairing spinning machines. In particular, the subject was involved in drilling B-bushings that were used to protect against gear abrasion in the spinning machines. An analysis of the B-bushings using a transmission electron microscope equipped with an energy dispersive X-ray analyzer indicated that they contained crocidolite asbestos fibers. Air samples obtained when drilling the B-bushings clearly indicated that the subject had most likely been exposed to crocidolite fibers when installing the B-bushings in the spinning machines. The frequency and duration of the work suggested that there would be a sufficient degree of exposure to crocidolite fibers to cause lung cancer. Except for smoking and asbestos exposure, no other chemical exposure was suspected for developing lung cancer in the workplace. Smoking appeared to be more of a potentiating risk factor in conjunction with the asbestos exposure. Accordingly, this case may provide significant evidence in identifying the cause of the mesothelioma or lung carcinoma found among workers in non-asbestos textile manufacturing companies elsewhere.
We analyzed the characteristics of 120 patients of primary lung cancer supposed to be induced by exposure to asbestos. Most of 120 patients were male and the age ranged from 47 to 87 years with a median of 70 years. No particular tendency was observed in the histological types of the lung cancer in 120 patients. Forty of the 120 patients were heavy smokers. When the occupational history was analyzed, most of the patients had been exposed to asbestos in former Japanese naval shipyard, commercial shipyards, construction industry and ironworks. The term of asbestos exposure was 2 to 60 years with a median 27 years. Lung cancers appeared after 15 to 69 years with a median 43 years from the initial exposure to asbestos. Lung cancer was accompanied by asbestosis in 35 patients and by pleural plaques in 77. Twenty-two patients had both asbestosis and pleural plaques. The number of asbestos bodies per 5 g wet lung tissue for 72 patients whose lung tissues obtained from autopsy or surgery was more than 150 bodies which meant the number of occupational asbestos exposure. As for the kinds of asbestos fibers of 32 patients, 14 patients exposed to crocidolite, 10 patients to amosite and 8 patients to chrysotile.
To report the temporal pattern and change in trend of mesothelioma incidence in the United States since 1973.
The Surveillance, Epidemiology, and End Results (SEER) programme of the National Cancer Institute has since 1973 provided annual age adjusted incidence for mesothelioma in representative cancer registries dispersed throughout the USA. SEER data are analysed to describe the trend of male mesothelioma incidence in the USA.
The US male mesothelioma incidence data indicate that after two decades of increasing incidence, a likely decline has been observed since the early 1990s, when a highly significant change in the upward course occurred.
Increasing male mesothelioma incidence for many years was undoubtedly the result of exposure to asbestos. The high mesothelioma risk was prominently influenced by exposure to amphibole asbestos (crocidolite and amosite), which reached its peak usage in the 1960s and thereafter declined. A differing pattern in some other countries (continuing rise in incidence) may be related to their greater and later amphibole use, particularly crocidolite. The known latency period for the development of this tumour provides biological plausibility for the recent decline in mesothelioma incidence in the USA. This favourable finding is contrary to a widespread fear that asbestos related health effects will show an inevitable increase in coming years, or even decades.
Due to environmental asbestos exposure, asbestos related lung diseases are common in Eskisehir district of Anatolia. In this study we aimed both to determine the epidemiological findings of the patients diagnosed as bronchial carcinoma and to discuss the features, which were probably related to asbestos exposure, presented by the patients. From May 1997 to December 2000, 301 cases were included in the study. Of the patients, 97 (32.2%) had epidermoid cell type, 84 (27.9%) had small cell, 39 (13%) had adenocarcinoma, 4 (1.3%) had large cell. Adenocarcinomas were more frequent in women. There were not significant differences among the cell types from the point of view of the age distributions. Adenocarcinomas were more frequently located in lower lobes of the lungs (36.9%) and more frequently showed peripheral locations (45.9%) than other cell types (20.6% for epidermoid and 14.6% for small cell). Pleural effusion was more detected in adenocarcinomas (48.7% to 17.3% in epidermoid, 18.3% in small cell). The duration of smoking was shortest in adenocarcinomas, mean 32.4 years; the same duration was 56.2 years for epidermoid carcinomas. Of the patients, 54% had asbestos exposure. Adenocarcinomas were more frequently detected in the patients who exposed to asbestos but did not smoke. Our findings support that asbestos exposure may increase adenocancer frequency. The epidemiological and clinical features of adenocancer cases exposed to asbestos environmentally were not different than those of adenocancer cases exposed to asbestos occupationally.
Aims: To report the temporal pattern and change in trend of mesothelioma incidence in the United States since 1973. Methods: The Surveillance, Epidemiology, and End Results ( SEER) programme of the National Cancer Institute has since 1973 provided annual age adjusted incidence for mesothelioma in representative cancer registries dispersed throughout the USA. SEER data are analysed to describe the trend of male mesothelioma incidence in the USA. Results: The US male mesothelioma incidence data indicate that after two decades of increasing incidence, a likely decline has been observed since the early 1990s, when a highly significant change in the upward course occurred. Conclusions: Increasing male mesothelioma incidence for many years was undoubtedly the result of exposure to asbestos. The high mesothelioma risk was prominently influenced by exposure to amphibole asbestos (crocidolite and amosite), which reached its peak usage in the 1960s and thereafter declined. A differing pattern in some other countries ( continuing rise in incidence) may be related to their greater and later amphibole use, particularly crocidolite. The known latency period for the development of this tumour provides biological plausibility for the recent decline in mesothelioma incidence in the USA. This favourable finding is contrary to a widespread fear that asbestos related health effects will show an inevitable increase in coming years, or even decades.
Firm scientific evidence supports the causal association between malignant mesothelioma (MM) and occupational exposure to asbestos. Risk attributable to occupation varies from 30 to 80% across different populations. The existence of a threshold level below which there is no risk of MM is still debated. A prompt and thorough assessment of exposure is essential to evaluate and manage MM cases, from diagnostic and epidemiological points of view.
To highlight the multiple areas of intervention by Occupational Physicians (OP) in MM evaluation and management, to describe an experience of OP in the province of Brescia.
The main areas of interest of the OP are exposure assessment, diagnosis (clinical, etiological), medico-legal issues, social consequences, preventive strategies, risk communication, scientific dispute/uncertainties. By means of an active search, the Brescia MM registry, managed by OP belonging to the local health authority observed 309 MM from 1977 to 2003; the local Institute of Occupational Health, hosted in a hospital of national relevance, evaluated about 200 MM in the last decade. The main outcomes of OP activity are the high percentage of direct interviews, individual case management, expert exposure assessment, etiological diagnosis, counselling, medico-legal assistance, better knowledge of occupational risks, enhanced cooperation among health professionals (oncologists, pathologists, surgeons, pneumologists, general practitioners and OP), important contribution to Registries and to epidemiology (estimates of attributable risks, incidence, survival rates), with positive social and scientific consequences (insurance agencies, trade union organizations, public events, teaching opportunities).
This experience highlights the multifaceted role of OP in active research and evaluation of MM cases, in the context of a multidisciplinary approach.
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