Epidemics of asbestos-related diseases--something old, something new.

Abstract

At the beginning of the 21st century, the world is still confronted with some well-recognized major occupational and environmental health hazards, such as the continuing use of asbestos fibers in various industrial products and processes. This in spite of authoritative statements from UN bodies (the World Health Organization, the International Labor Organization, and the UN Environment Program) and various NGO (1). These organizations have called on countries throughout the world to eliminate asbestos-related diseases. They point to the great potential for prevention through banning new applications of asbestos and availing of effective hygienic tools for diminishing exposures where asbestos is already in use. Although the use of asbestos has been banned or strongly restricted in Western and North Europe, North America, and Australia, the annual production and global use of asbestos has remained at a high level of over two million metric tons. The largest producers currently are Russia, China, Kazakhstan, and Brazil.Recent decisions to ban asbestos use in most of Europe and North America have shifted manufacturing and its attendant hazards to emerging economies where millions of workers can be exposed to serious risks (2, 3). In India, for example, the use of asbestos has more than doubled in the last decade to more than 300,000 tons a year In an Industry which now employs more than 100,000 workers (4). While there is a broad consensus among health researchers that all types of asbestos are both fibrogenic and carcinogenic in humans, powerful lobbies (who have an Interest In the continuing use of asbestos) often argue that chrysotile is safe if it Is used safely. However, epidemiological studies have unequivocally Indicated that chrysotile exposure does increase the rate of pulmonary cancer In humans, and it Is the recommendation of International health agencies that only a total ban - covering all asbestos types - would represent a sustainable preventive policy for the future (5). The challenge is to have bans introduced in all parts of the world, and this means an obligation to continue the fight against lobbyists with commercial Interests in upsetting the consensus that all forms of asbestos are carcinogenic.According to WHO estimates, more than 107,000 people die each year from asbestos-related lung cancer, malignant mesothelioma, and asbestosis due to occupational exposure. This figure is most likely an underestimate as the increased use in the newly Industrialized countries has not yet been fully taken into account. The asbestos epidemic continues, and it Is even Increasing In strength In many emerging parts of the world. At present, Europe carries the majority of the global asbestos-related disease burden as a result of heavy asbestos use in earlier decades (6). Based on the past use of asbestos, it Is to be expected that the peak of asbestos-related diseases will occur In 2015-2030 in Industrialized countries. For countries, which have banned asbestos use early on, the future burden will most likely decrease. With the current data, we can estimate that the total toll of the asbestos epidemic globally may well be over ten million lives before asbestos is banned worldwide and exposures brought to an end, as LaDou (3) predicted already ten years ago.The epidemic of asbestos-related diseases is not over. The disease burden numbers attributed to asbestos use are large in comparison with any other occupational hazard. In many Industrialized countries, asbestos remains the most Important occupational lung carcinogen, where 5-7% of all lung cancers can be attributed to occupational exposures to asbestos. In exposed groups, mesothelioma (pleural or peritoneal) may account for up to 9% of the total deaths (7).In recent years, there has been several epidemic outbreaks of communicable diseases (such as cholera, Ebola, and the plague) where pathogens have posed a threat to public health In nations and even globally. …