Abstract
Asbestos-related diseases (ARDs)—mesothelioma, lung cancer, and asbestosis—are well known as occupational diseases. As industrial asbestos use is eliminated, ARDs within the general community from para-occupational, environmental, and natural exposures are more prominent. ARD clusters have been studied in communities including Broni, Italy; Libby, Montana; Wittenoom, Western Australia; Karain, Turkey; Ambler, Pennsylvania; and elsewhere. Community ARDs pose specific public health issues and challenges. Community exposure results in higher proportions of mesothelioma in women and a younger age distribution than occupational exposures. Exposure amount, age at exposure, fiber type, and genetic predisposition influence ARD expression; vulnerable groups include those with social and behavioral risk, exposure to extreme events, and genetic predispositions. To address community exposure, regulations should address all carcinogenic elongated mineral fibers. Banning asbestos mining, use, and importation will not reduce risks from asbestos already in place. Residents of high-risk communities are characteristically exposed through several pathways differing among communities. Administrative responsibility for controlling environmental exposures is more diffuse than for workplaces, complicated by diverse community attitudes to risk and prevention and legal complexity. The National Mesothelioma Registries help track the identification of communities at risk. High-risk communities need enhanced services for screening, diagnosis, treatment, and social and psychological support, including for retired asbestos workers. Legal settlements could help fund community programs. A focus on prevention, public health programs, particularization to specific community needs, and participation is recommended.
Highlights
As the industrial use of asbestos is phased out or eliminated, asbestos is becoming a more prominent potential cause of environmental rather than occupational disease [1,2,3].The overall goal of this review is to address current asbestos issues with a view to the public health of communities at high risk of asbestos-related diseases (ARDs)
Much of our understanding of ARDs in high-risk communities derives from a small number of intensively studied locations, including Wittenoom, Western Australia; Broni, Italy; Libby, Montana; Karain, Turkey; and Ambler, Pennsylvania, whose risks resulted from a variety of industrial, community, environmental, and natural exposures [21]
The small town of Libby together with neighboring Troy, Montana, was the site of the first official US Public Health Emergency declared in 2009 [29] following the discovery of very high rates of ARDs associated with mining, milling, and transporting vermiculite ore from adjacent mountains [29,30]
Summary
As the industrial use of asbestos is phased out or eliminated, asbestos is becoming a more prominent potential cause of environmental rather than occupational disease [1,2,3]. The overall goal of this review is to address current asbestos issues with a view to the public health of communities at high risk of asbestos-related diseases (ARDs). The appreciation of public health needs should encourage research in areas that will benefit community efforts and should encourage the translation of knowledge in helpful ways This may help avoid the “asbestos neglect” which has characterized past efforts to address the health impacts of asbestos and related elongated mineral particles (EMPs) in a broad manner [4]. An excess of pleural and peritoneal mesothelioma is an indisputable indicator of past asbestos exposure. 45 years after first exposure, when it started to plateau, with no one surviving long enough for the excess risk to disappear, while the rate of peritoneal mesothelioma continued to increase for the entire 50 years of study. While new use is increasingly absent, we are better recognizing the potential health implications of the asbestos in place from the past use of asbestos products in building construction, from the disposal or distribution of asbestos or asbestos-containing materials (ACMs), and from disturbing natural sources of asbestos
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