RAMAZZINI DAYS 2014 Scientific Session II:"Breakthroughs and best practices in regional and global scientific collaboration" An ItalianItalian-Latin America scientific network to collaborate on asbestos asbestos--disease prevention Pietro Comba (Italy (Italy)) and Benedetto Terracini (Italy Italy)) 24 26 October 2014 Carpi, Italy
SCIENTIFIC COOPERATION Dissemination, training and researchon preventionof asbestos-relateddiseasein countries where the use of asbestos is still legal, or hasbeenrecentlybanned, with special reference to Latin America
SCIENTIFIC COOPERATION NETWORK ISS - Istituto Superiore di Sanità > Unit of Environmental Epidemiology, Department of Environment and Primary Prevention > Publishing Unit (Dissemination and Cooperation) INAIL Research Sector, Department of Occupational Medicine CRA Lazio Latium Region Asbestos Centre, Local Health Unit Viterbo DEP Lazio Department of Epidemiology of Latium Region Health Service Prof. Benedetto Terracini - University of Turin Ministry of Health, Universities and NGOs of Latin American Countries
COLOMBIA ConferenciaInternacionalde Salud ambiental y ocupacional BOGOTÀ, 19-20 February 2014 Proyecto«Arte, Enfermedades, Política» BOGOTÀ, 5-7 November 2014 COOPERATION NETWORK UniversidadNacional, Dep.to de Salud Pública Instituto de Salud Pública Universidadde losandes, Dep.to de Ingeňeria Ambiental
ECUADOR Environment and Health Prevention of Asbestos- Related Disease Quito, March 2006 [C.R.] Quito y Guayaquil, November 2008 Quito, November 2011 Quito, February 2014 COOPERATION NETWORK Corporación IFA, Quito (desde 2003)-[C.R.] -Corporaciónpara eldesarrollode la producción y del medioambiente laboral- Ministeriode SaludPública, Dirección Nacional de Salud y Ambiente Facultad Latino Americana de Ciencias Sociales(FLACSO),Maestría en Estudios Socioambientales Univ. Tecnológica Equinoccial Quito
BOLIVIA SEMINAR: SALUD OCUPACIONAL y AMBIENTAL ISSUES: asbestos; silica; contaminated sites; air pollution LA PAZ, 10-12 November 2014 COOPERATION NETWORK Embajada del Estado Plurinacional de Bolivia en Italia Ministerio de Salud Pública Relaciones Internacionales Dirección General de Promoción de la Salud Unidad de Promoción de la Salud, Área Salud Ambiental Instituto Nacional de Salud Ocupacional
Annals of Global Health, in press
PREMISE Notwithstanding the overwhelming scientific evidence of asbestos carcinogenicity, this agent is still largely used in the world. The Italian experience shows that in the process that lead to prohibition of asbestos use, a major role was played by studies documenting the health impact of asbestos in Italy Neoplasms causally associated with asbestos: mesothelioma of pleura, peritoneum, pericardium, and tunica vaginalis testis and cancer of the lung, larynx, and ovary. The number of mesothelioma cases within a population can be estimated: -directly from: mortality data, if reliable, or from pathology registries, where available - indirectly: from data on asbestos consumption Contrary to mesothelioma, the etiology of pulmonary, laryngeal, and ovarian cancers is multifactorial Population Attributable Fraction (PAF): the proportion of cases which would be prevented if exposure to asbestos was eliminated Limited to lung cancer, PAF can also be estimated using a reasonable ratio between mesothelioma and occupational lung cancer cases.
PAF PAF= ((Pi*RRi)-1)/ Pi*RRi) Piis the proportion of the exposed population in the exposure category i RRiis the risk for the disease in the exposure category irelative to the risk in the reference exposure category (i.e. the population not exposed) Driscoll et al. Occupational carcinogens: assessing the environmental burden of disease at regional and local levels. Geneva, WHO 2004 (Environmental Burden of Disease Series, N 6)
INFORMATION NEEDED TO COMPUTE PAFs a) proportion of the workforce employed in each sector b) proportion of workers exposed to asbestos in each sector c) occupational turnover d) levels of exposure e) proportion of the population in the workforce f) relative risk for each considered disease for different levels of exposure (when available)
Relative risk for asbestos related cancers other than mesothelioma site High exposures Low exposures Whatever exposure RR LCI * UCI** RR UCI* UCI* * lung 1.48 1.44 1.52 1.18 1.13 1.23 RR UCI* UCI* * larynx 1.44 1.19 1.64 ovary 1.77 1.37 2.28 Goodman et al 1999 18 IOM 2006 19 Camargo et al 2011 20 *Confidence interval lower limit **Confidence interval - upper limit
DISCUSSION & CONCLUDING REMARKS Inter-country differences in the reliability of the background statistics. The peculiarity of the estimates in Brazil might reflect the limited use of amphiboles Two conclusions : - Urgent need for remediation of asbestos contamination and a national asbestos ban - Improvement in the quality of asbestos-related environmental and health data The estimates are exploratory. They intend to stimulate the construction of local databases regarding the extent to which asbestos is or has been present in the occupational environment In each economic sector, prevalence of exposure may be specific in Latin American countries andmay have been different form the ones in Western European countries in the Nineties Estimates of the PAFs need more precise data on the proportion of workers exposed to asbestos in each productive sector, on the occupational turnover, and on levels of exposure
Scientific papers in English and Spanish open access publications for training and dissemination activities Asbestos case and its current implications for global health. Annali dell'istitutosuperioredi Sanità2013;49(3):249-251. MarsiliD, CombaP. Italy-Latin America cooperation: a contribution to training on prevention of asbestos-related diseases /Cooperación Italia-América Latina: una contribución a la formación en la prevención de las enfermedades relacionadas con el asbesto. Roma: IstitutoSuperioredi Sanità; 2013. (RapportiISTISAN13/31). MarsiliD. (Ed). International scientific cooperation on asbestos-related disease prevention in Latin America. Annals of Global Health. 2014 in press. Marsili D, Comba P, Pasetto R, Terracini B. Estimates of asbestos burden of occupational cancer in Argentina, Brazil, Colombia, and Mexico.Annals of Global Health. 2014 in press. Pasetto R, Terracini B, Marsili D, Comba P.