Pathology of Malignant Mesothelioma, Tallinn, Estonia,
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1 Pathology of Malignant Mesothelioma, Tallinn, Estonia, Global incidence of malignant mesothelioma Antti Tossavainen, Resident Twinning Adviser,Finnish Institute of Occupational Health Antti Tossavainen/Twinning/atoka44.ppt
2 Worldwide Production of Asbestos in 2005 Russia Kazakhstan Colombia Canada Brazil India Zimbabwe China Other Countries tons TOTAL tons AT/FIOH Antti Tossavainen/Twinning/atoka44.ppt
3 Asbestos consumption in 2003 tons kg/capita/ tons kg/capita/ year year China Japan Russia Belorussia India Mexico Ukraine Turkey Thailand Malaysia Brazil Colombia Iran Romania Uzbekistan Algeria Vietnam Azerbaijan Indonesia Cuba Kazakhstan Zimbabwe South Korea Canada Kyrgyzstan Other countries WORLD Antti Tossavainen/atoka039.ppt/rm
4 Mesothelioma incidence and use of asbestos. Country Mesothelioma incidence Use of asbestos Cases/year Cases/ Tons/year Kg/capita/ Tons/ million/year year mesothelioma Australia 678 (2001) (1970) Finland 75 (2002) (1970) France 870 (2000) (1970) Germany 1094 (2001) (1975) Great Britain1862 (2002) (1970) Italy 1050 (2000) (1975) Netherlands 389 (2000) (1976) New Zealand 60 (2000) (1970) Norway 57 (2000) (1970) Sweden 149 (2003) (1970) United States2800 (2000) (1975) TOTAL Antti Tossavainen/atoka039.ppt/rm
5 ASBESTOS CONSUMPTION AND MESOTHELIOMA INCIDENCE IN INDUSTRIALIZED COUNTRIES Mesothelioma incidence cases/million/year Finland ( 70, 99) Norway ( 70, 95) Sweden ( 70, 96) U.K. ( 70, 99) Italy ( 75, 95) U.S. ( 75, 00) Germany ( 75, 97) Netherland s ( 76, 97) New Zealand ( 70,96) France ( 70, 96) Australia ( 70, 00) Asbestos consumption kg/capita/year Antti Tossavainen/atoka039.ppt/rm
6 MESOTHELIOMA INCIDENCE IN CENTRAL AND EASTERN EUROPE (Bianchi et al. 2000) Country Cases/year Cases/million/year Croatia Hungary 78 8 Romania Slovakia 20 4 Estonia 5 3 Lithuania 12 3 Latvia 8 3 Poland Slovenia 5 3 Antti Tossavainen/atoka039.ppt/rm
7 Use of asbestos, thousand tons/year FINLAND Mesothelioma cases
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9 Germany Antti Tossavainen/atoka041.ppt/rm
10 Great Britain Antti Tossavainen/atoka041.ppt/rm
11 Asbestos-induced diseases in (cases of years are not available) Number of cases Pleural adhesions and calcifications Asbestosis Cancers Others FINNISH INSTITUTE OF OCCUPATIONAL HEALTH/Finnish Register of Occupational Diseases/Lea Palo
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17 WORK HISTORY Definite exposure: Probable exposure: Possible exposure: Unlikely exposure: Manufacture of asbestos products, asbestos spraying, insulation, demolition of old buildings Construction, shipbuilding, heating trades, pipefitting, sheet metal work Transport, railways, ship engine crew, firefighting, mining and quarrying, oil refining, chemical, paper and metal industries, car repair, general maintenance jobs Office work, agriculture and forestry, health care and education, telecommunication, textile industry Antti Tossavainen/atoka041.ppt/rm
18 HELSINKI CRITERIA (1) Radiological findings of small opacities (ILO grade 1/0) are regarded as early stage of asbestosis. Asbestosis is generally associated with high exposure levels at workplace. Low exposures from work-related, household and natural sources (below 0.01 f/cm 3 ) may induce pleural changes (up to 2 % in the adult population) and mesothelioma (up to 1-2 cases/million people/year). Smoking has no influence on the risk of mesothelioma. About 80 % of all mesothelioma cases are caused by asbestos exposure. Antti Tossavainen/atoka041.ppt/rm
19 HELSINKI CRITERIA (2) All major histological types of lung cancer can be related to asbestos. Clinical signs and symptoms are of no significant value in deciding whether or not an individual case is attributable to asbestos. One year of heavy exposure (manufacture as asbestos products, asbestos spraying, insulation work, demolition of old buildings) or 5-10 years of moderate exposure (construction, shipbuilding) may increase the lung cancer risk two-fold or more. Antti Tossavainen/atoka041.ppt/rm
20 HELSINKI CRITERIA (3) A cumulative exposure of 25 fibre-years can be applied to attribute a two-fold risk of lung cancer to asbestos exposure. A two-fold risk is related to the retained fibre level of 5 million asbestos fibres (>1µm)/gram dry lung tissue. Asbestosis is not prerequisite of lung cancer. Asbestos exposure multiplies the risk of lung cancer similarly in smokers, ex-smokers and nonsmokers. Accordingly, smoking habits have no influence on the attribution of an individual case to asbestos exposure. In industrialized countries, about 5 % of all lung cancer cases are caused by asbestos exposure equalling about two-fold the number of mesotheliomas. Antti Tossavainen/atoka041.ppt/rm
21 HELSINKI CRITERIA (4) For clinical purposes, the following levels identify those persons who highly probably have been exposed to asbestos at work: or or over 1 million amphibole fibres/g dry tissue over 1000 asbestos bodies/g dry tissue (100 asbestos bodies/g wet tissue) over 1 asbestos body/ml in brochoalveolar lavage fluid An increased risk of mesothelioma and pleural plaques may occur below or at these concentrations. A two-fold risk of lung cancer is related to the retained fibre level of 5 million asbestos fibres/g dry tissue. Antti Tossavainen/atoka041.ppt/rm
22 Asbestos in lung tissue samples from autopsies or surgical operations, million fibres/g dry tissue. Country and area Population Age, years mean (range) Chrysotile mean (range) Amphiboles mean (range) Over l million asbestos fibres/g dry tissue Finland, Helsinki Male autopsy series (N=300) 52 (33-69) < (< ) ant, cro, amo, tre 54/300 Finland, Helsinki Male lung cancer patients (N=113) 62 (35-81) < (< ) ant, cro, amo, tre 39/113 Finland, Tampere Lung cancer patients (N=25) 61 (43-78) < (< ) ant, amo 7/25 Estonia, Tallinn Lung cancer patients (N=20) 61 (39-72) 0.2 (< ) 0.1 (< ) tre 2/20 Russia, Karelian Republic, Petrozavodsk Lung cancer patients (N=20) 54 (43-70) 0.3 (< ) 0.1 (< ) tre 1/20 Hungary, Budapest Lung cancer patients (N=25) 58 (35-78) 1.0 (<0.1-11) 0.1 (< ) cro, tre 4/25 Antti Tossavainen/atoka041.ppt/rm
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28 ASBESTOS BANS Marketing and use of all products containing asbestos fibres added intentionally are prohibited (EU countries before , Estonia Worldwide over 40 countries have banned the use of asbestos Antti Tossavainen/Twinning/atoka44.ppt
29 JHS/2006 Antti Tossavainen/Twinning/atoka44.ppt
30 Asbestos policy documents World Health Organization, - Elimination of asbestos-related diseases (2006), International Labour Organization, -Asbestos Convention and Recommendation(1986) -Resolution concerning asbestos (2006) World Trade Organization, -European Communities-Measures affecting asbestos and asbestos-containing products (2001) United Nations Rotterdam Convention, -Prior Informed Consent (PIC) Procedure for chrysotile (2006) Antti Tossavainen/Twinning/atoka44.ppt
31 Ratifications of ILO Asbestos Convention 162 Belgium 1996 Bolivia 1990 Bosnia-Herzegovina 1993 Brazil 1990 Cameroon 1989 Canada 1988 Chile 1994 Colombia 2001 Croatia 1991 Cypros 1992 Ecuador 1990 Finland 1988 Germany 1993 Guatemala 1989 Japan 2005 Macedonia 1991 Netherlands 1999 Norway 1992 Portugal 1999 Russia 2000 Serbia 2000 Slovenia 1992 Spain 1990 Sweden 1987 Switzerland 1992 Uganda 1990 Uruguay 1995 Zimbabwe 2003 Antti Tossavainen/Twinning/atoka44.ppt
32 EU ASBESTOS DIRECTIVES 2003/18/EC on the protection of workers from the risks related to exposure to asbestos at work 1999/77/EC on the marketing and use of asbestos products 1987/217/EEC on the prevention and reduction of environmental pollution by asbestos Antti Tossavainen/Twinning/atoka44.ppt
33 Estonian asbestos regulations Asbestitööle esitatavad töötervishoiu ja tööohutuse nõuded,vabariigi Valitsuse määrus nr 32, ja nr 224, Elanikkonnale ja loodusele ohtlike kemikaalide käitlemise piirangud,sotsiaalministri määrus nr 36, Asbesti sisaldavate jäätmetekäitlus nõuded,keskkonnaministri määrus nr 22, Antti Tossavainen/Twinning/atoka44.ppt
34 OTHER REGULATIONS Tööõnnetuste ja kutsehaigestumise registreerimise,teatamise ning uurimise kord, Vabariigi Valitsuse määrus nr 146, Töötajate tervisekontrolli kord, Sotsiaalministri määrus nr 74, Kutsehaiguste loetelu, Sotsiaalministri määrus nr 66, Töötervishoiu ja tööohutuse seadus, ja Töötervishoiu ja tööohutuse nouded ehituses, Vabariigi määrus nr 377 Antti Tossavainen/Twinning/atoka44.ppt
35 Kutsehaiguste loetelu 2005 Sotsiaaliministri määrus nr Respiratorised kutsehaigused ja -kasvajad: asbestoos mesotelioom, mis on põhjustatud asbestitolmu sissehingamisest pneumokonioos, mis on põhjustatud silikaattolmu sissehingamisest asbestoosi tüsistusena tekkinut kopsukasvaja asbestist põhjustatud pleura fibroossed haigusest kopsukasvaja, mis on põhjustatud asbestitolmu sissehingamisest respiratoorised haigused, mida põhjustavad kvartsitolm, asbestitolm või tsemenditolm Antti Tossavainen/Twinning/atoka44.ppt
36 MANAGING OCCUPATIONAL RISKS RELATED TO ASBESTOS, EST-FIN Twinning Project Component 1. Survey of asbestos containing materials, work practices and regulations Component 2. Training of medical personnel Component 3. Screening study Component 4. Awareness raising and information Component 5. Kick-off and concluding meetings Antti Tossavainen/Twinning/atoka44.ppt
37 NECESSARY ACTIONS 1. Implementation of asbestos directive 2003/18/EC - notification and inspection of demolition works - training of employers and workers - health examinations of exposed people 2. Ratification of ILO Asbestos Convention - tripartite preparation of policies and regulations - licencing of competent demolition companies 3. Total revision of diagnosis, registration and compensation practices of occupational diseases - mandatory insurance for work accidents and occupational diseases (TõKS) - revival of the Occupational Health Center for research, service and information activities Antti Tossavainen/Twinning/atoka44.ppt
38 Four - dog defense of asbestos 1. Nothing has happened. ( Asbestos diseases don't occur here) 2. We don't own a dog, another dog bit him. (Old companies don't exist anymore, diseases were caused by smoking) 3. The dog bit him but didn't hurt. (Diseases are benign and signs of exposure only) 4. He knew that the dog was dangerous. (Workers should have worn respirators and paid their own accident insurance) Antti Tossavainen/Twinning/atoka44.ppt
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