The Burden of Asbestos-Related Diseases

Transcription

1 XI IOMU, Jakarta, Sep 2017 The Burden of Asbestos-Related Diseases Ken Takahashi, MD, PhD, MPH Director and Professor, Asbestos Diseases Research Institute (ADRI)

2 Background: WHO Position on Asbestos From WHO Website (accessed 11 Sep 2017) The most efficient way to eliminate ARDs is to stop the use of all types of asbestos Replace with safer substitutes; develop economic and technological mechanisms for replacement Prevent exposure to asbestos in place Improve diagnosis, treatment and medical rehabilitation of ARDs and establish registries 2

3 Industrial Applications Insulation to heat/cold & noise Resistance to wear, friction, chemical Construction material (>70%) Roofs (Asbestos Cement Roofs, often corrugated, but not always) Siding and flooring Asbestos Cement Pipes Friction material Car brake shoes/clutch lining Insulation for ducts, pipes, tanks Gaskets Vibration joint cloth (ductwork) Adhesive and sealant materials Fire hoses, heat resistant gloves Electrical wire cover, etc. Abundant, Cheap, Workable Binding & adhesive quality

4 Asbestos-Related Diseases Variable National Situations 4 Mesothelioma Lung Cancer Benign Pleural Effusion Diffuse Pleural Thickening Asbestosis (Pleural Plaques) Mesothelioma Asbestosis Singapore Japan Mesothelioma Lung Cancer Laryngeal Cancer Ovarian Cancer Asbestosis Pleural Plaques Mesothelioma Lung Cancer Asbestosis Diffuse Pleural Thickening Pleural Plaque and Adhesion Finland Cancer Caused by Asbestos Asbestosis (ILO R194 List of OD) Mesothelioma Lung Cancer Ovarian Cancer Asbestosis Australia (Deemed Diseases)

5 How does our body react to the presence of asbestos fibers? Nose Filters out fibers >100µ long Cilia Clears mucus (and fibers) from lung Lung Ca Mesothelioma Asbestosis Free Alveolar Macrophages (FAMs): Phagocytize fibers within lung Dr. RA Lemen

6 Where Does Mesothelioma Occur Mesothelioma develops in the two layers of the pleura Pleural Mesothelioma Remaining Lung Tumor then spreads to covers the lung in a thick sack that squeezes and suffocates as it grows Dr. R.A. Lemen

7 Where Does Mesothelioma Occur Peritoneal Mesothelioma

8 Exposure Level Important Characteristics of ARDs asbestosis lung cancer plaque/thickening mesothelioma years Latency Time

9 Practical Guide to Suspect Asbestos-Relatedness Attributable Fraction for Asbestos-Related Diseases & Credible References Type of Asbestos-Related Diseases Attributable Fraction Mesothelioma Pathology with Immuno-histochemical Staining Asbestosis (& Pleural Plaques) ILO International Classification of Radiographs of Pneumoconiosis 80% to 90% or higher 100% (100% except for Tb) Asbestos-Related Lung Cancer Around 10% (?) Helsinki Criteria Update 2014 (for Diagnosis and Attribution) Asbestos-Related Tracheal Cancer Asbestos-Related Ovarian Cancer Relatively Low Relatively Low 9

10 Ecological relations: Current mortality rates of asbestos-related diseases vs historical asbestos consumption (weighted by size of sex-specific national populations) Lin R-T, Takahashi K, et al. Lancet 2007, 369, (A) All mesothelioma (B) Pleural mesothelioma (C) Peritoneal mesothelioma (D) Asbestosis

11 Estimating the Burden of Disease for Mesothelioma Global Situation Based on National Situations Occup Environ Med in press 11

12 Basic Methodology Mortality Rates (MR) Countries with Data 1 Crude MR Judge Data Quality 2 Age-adjusted MR Assess Trend; Choose Best Model from Most Recent 1/2/3 yr of Reported Data 3 Gender and Age-Specific MR Extrapolate Rates from Countries to Reference to Countries to Estimate Extrapolation Countries with No Data or Poor-Quality Data 1 Cumulative Asbestos Use for groups ( no use low middle and high ) 2 Continent: 5 groups (Oceania, Africa, Asia, Europe and Americas) 3 Employment in Industrial Sector: 4 groups ( low middle high no data ) 12

13 Criteria for Poor Quality of Reported Data Method Crude MR 0.5 deaths per million Reported Number of Years 2 Total Reported Number of Deaths of 104 Countries Reporting Data Judged to have Poor Quality 13

14 National Data Reported to WHO Extracted Region Country Oceania Africa FJI AUS NZL EGY MAR MUS REU TUN ZAF Data reported; Data not reported 14

15 Breakdown of National Data Extracted Data not reported; Data reported but poor quality; Data reported with quality; Data reported with quality and referenced 15

16 The Case for Indonesia

17 Year Asbestos consumption (metric tons) Year Asbestos consumption (metric tons) Country USGS Database 2014 Asbestos use (metric tons) China 507,000 Russia 478,000 India 379,000 Brazil 181,000 Indonesia 109,000 Uzbekistan 76,400 Vietnam 52,900 Sri Lanka 42,100 Thailand 41,900 Kazakhstan 39, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,000.00

18 Per Capita Use Grouping Method of Asbestos Use For Estimations Based on Asbestos Use Cumulative Use High Middle Low High HH HM HL Middle MH MM ML Low LH LM LL 18 A total of 162 countries that reported asbestos use were grouped into 3 groups: high, medium and low. All countries were first grouped into 3 categories, high, medium and low based on cumulative use and per capita use (from 1925 to 1985), each of which were divided into three equal- sized sub-groups designated as high, medium or low. If either cumulative use or per capita use was high, then the country category was high. If both cumulative use and per capita use were low, then the country category was low. All others were categorized as medium. The fourth category none was composed of either countries that reported asbestos use as zero or countries that did not report asbestos use according to the USGS.

19 Calculations of Mesothelioma Deaths (Indonesia) For Estimations Based on Asbestos Use Sex M 12,326,000 11,961,333 12,106,667 11,411,000 10,301,333 10,265,000 10,586,000 9,809, W 11,742,333 11,269,667 11,426,333 10,903,667 10,179,667 10,407,667 10,564,667 9,640, Total 9,051,667 7,826,667 6,514,667 5,178,333 3,571,000 2,350,333 1,671,667 1,663, ,594, ,844,000 7,742,000 6,475,333 4,940,667 3,481,000 2,650,000 1,995,333 2,396, ,658, Mesothelioma in Indonesia Estimated by Asbestos Use 412 (M) (W) = 548

20 Estimated Mesothelioma Burden in Indonesia Based on Three Estimation Methods We estimated that Indonesia sustains about 548 (range 184 to 700) mesothelioma cases per year Estimation Method Estimated Number of Mesothelioma 1Asbestos Use 548 2Continent 700 3Employment in Industrial Sector

21 Estimated ARD Burden in Indonesia For Every Mesothelioma Case, a Country Should Expect 2 to 6 cases of Asbestos-Related Lung Cancer (ARLC) Inferred from McCormack et al, BJC 2012 endorsed by WHO 548 x (2 to 6) = 1,096 to 3,288 ARLC cases Add Asbestosis Type of Pneumoconiosis With Clinically Distinctive Features (job history is key!) Suspect Asbestos-Related Tracheal and Ovarian Cancers Endorsed by WHO More Difficult to Establish Causality (vs Mesothelioma, Asbestosis & ARLC) 21

22 What Should Indonesia Do? Hidden and Additional Burden of ARDs

23 Status of National Status Bans According to Cumulative Volume of Asbestos Use Countries banned asbestos Countries not banned asbestos * Countries produced (mined) any amount of asbestos during the same period that the asbestos volume is calculated for 23

24 Since 2014, WHO Emphasizes Chrysotile Stop using all types of asbestos Asbestos, Including Chrysotile, Causes Cancer of Lung, Larynx and Ovary, Mesothelioma and Asbestosis 107,000 Deaths Worldwide Every Year For Chrysotile Exposure, Mesothelioma : ARLC = 1 : 6 24

25 Int J Environ Res Pub Health Guest Editors: Ken Takahashi, Jukka Takala and Annete David Special Issue Global Panorama of National Experiences in Public Health Actions to Ban Asbestos Showcase national experiences and key lessons learned in the context of leadership, know-how and capacity ( soft technology), which are transferrable to the many countries still using asbestos, but with a vision to ban asbestos. WHO Position: The most efficient way to eliminate ARDs is to stop the use of all types of asbestos

26 Conclusion My Advices for Indonesia Significant (but Hidden) Burden of ARDs Already Exists Caused by Past Asbestos Use Destined to Surface After Long Latency Period Country Should Import Preventive, Medical and Legal Technologies for Detection Additional Burden Can be Prevented But Only by Stopping Asbestos Use Caused by On-going Asbestos Use 26

27 XI IOMU, Jakarta, Sep 2017 The Burden of Asbestos-Related Diseases Ken Takahashi, MD, PhD, MPH Director and Professor, Asbestos Diseases Research Institute (ADRI)

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29 CMR (per Million) Crude MR vs Number of Reporting Years 0.5 Number of Reporting Years 2 :Countries used for reference rates :Countries with poor quality data with <10 and >10 deaths

30 CMR (per Million) Crude MR vs Total Number of Deaths 0.5 Total Number of Deaths 10 :Countries used for reference rates :Countries with poor quality data with <3 and >3 reporting years

31 Breakdown of National Data Countries to Reference Rates (N=59) 230 Countries High Quality Data 59 Poor Quality Data 45 No Data 126 Countries to Estimate Rates (N=171) 31

32 Number of deaths Estimated Number of Global Meso Deaths 100,000 Reported Estimated 10,000 14,466 20,776 1,839 3,354 3,586 13,883 1,893 8,630 2,794 10,403 4,413 4,599 16,964 1, , High Medium Low No use Africa America Asia Europe Oceania High Medium Low No use 35/ /12 0 7/16 0 5/ /590 14/ / /21 0 2/ / /30 0 3/58 0 0/49 0 Level of asbestos use Asbestos Continent Employment 15,011/23,377 15,011/21,247 15,011/22,444 38,388 36,258 37,455

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34 ISEE 17, Sydney, Sep 2017 The Global Burden of and Public Health Action for Asbestos- Related Diseases Ken Takahashi, MD, PhD, MPH Director and Professor, Asbestos Diseases Research Institute (ADRI)

35 Global Estimates for Mesothelioma Driscoll (AJIM, 2005) 43,000 Annual Deaths Our Current Study (OEM, in press) 38,400 Annual Deaths GBD Collaborators (Lancet, 2015; 2016) 33,700 (2015) & 32,400 (2016) Annual Deaths Overemphasis on Detailed Numbers: Unproductive! Our Findings Easily Reproducible Commonly accessible data + Straightforward algorithm Amenable to Verification and Update

36 Discussion & Conclusion Odgerel C-O et al. Estimation of the global burden of mesothelioma deaths from incomplete national mortality data. Occup Environ Med, in press Strengths Accounted for Gender and Age structure of ALL countries Unconstrained by Number of Deaths due to Other Causes Limitations Arbitrary Criteria for Quality Possible Underestimation (developed countries) and Overestimation (developing countries) Conclusion Mesothelioma Mortality Data Variable for Availability and Quality Global Mesothelioma Burden Estimated at 38,400 Annual Deaths

37 Annual Number of Reported Mesothelioma Deaths in World (Average for ) Men Women 37

38 Age-Adjusted MR of Reported Mesothelioma in World (Average for ) Men Women 38

39 Annual Number of Reported Asbestosis Deaths in World (Average for ) Men Women 39

40 Age-Adjusted MR of Reported Asbestosis in World (Average for ) Men Women 40

41 Status of National Status Bans According to Per Capita Volume of Asbestos Use Countries banned asbestos Countries not banned asbestos * Countries produced (mined) any amount of asbestos during the same period that the asbestos volume is calculated for 41

42 Acknowledgments Dr. Chimed-Ochir Odgerel (Research Associate, Department of Environmental Epidemiology, IIES, University of Occupational and Environmental Health, Japan) Dr. Jukka Takala (Senior Consultant, Ministry of Manpower, Singapore) Professor Thomas Sorahan (University of Birmingham, U.K.) Professor Tim Driscoll (School of Public Health, University of Sydney) Dr. Matthew Soeberg (Asbestos Diseases Research Institute, University of Sydney) 42

43 Basic Facts: Asbestos Fibrous form of mineral silicates belonging to rockforming minerals of serpentine group, i.e., chrysotile (white) amphibole group, i.e., crocidolite (blue), amosite (brown), tremolite, actinolite, anthopyllite Or any mixture containing one or more of these > 95% 1 % 2-3 %

44 Human Hair w: 100 µm Asbestos l: µm w: µm (10-30 nm) Carbon nanotubes length: several mm width: ~1.3 nm

45 Basic Facts: Asbestos-Related Diseases (ARDs) asbestos fibers \ asbestosis pleural thickening pleural plaques liver bowels lung cancer pleural mesothelioma peritoneal mesothelioma