1 DOSH, Malaysia July 2, 2010 Epidemiology of Mesothelioma & Asbestos Diseases, A Global Perspective Ken Takahashi Professor of Environmental Epidemiology Acting Director of WHO-CC for Occup Health University of Occup & Environ Health, Japan
2 Core Points 1. Basic Facts 2. The Japanese Experience 3. Context of Global Health 4. Implications for Malaysia
3 Basic Facts
4 Malaysia Cumulative use of raw asbestos = 821,672 metric tonnes 94,540 (-1970; #30) + 727,132 ( ; #36) [USGS] Ranks # 27 among all countries in total asbestos use No report of mesothelioma deaths to WHO
5 Asbestos, definition asbestos means the fibrous form of mineral silicates belonging to rock-forming minerals of the serpentine group, i.e. chrysotile (white asbestos), and of the amphibole group, i.e. actinolite, amosite (brown asbestos, cummingtonite-grunerite), anthophyllite, crocidolite (blue asbestos), tremolite, or any mixture containing one or more of these (ILO C.162) chrysotile >95%; amosite 2-3%; crocidolite 1%
6 Asbestos chrysotile ( nm) vs. human hair 100
7 Commercial Values > Wide Applications Thermal insulation values (wide temperature ranges) Acoustical insulation qualities Resistance to corrosive chemicals Electrical insulation values (satisfactory) Wear/friction resistance Binding/adhesive qualities Workability Abundance and low cost Construction material (>70%) Roofing Siding Flooring Asbestos Cement Pipes Friction material Vibration joint cloth (ductwork) Mechanical gasketing Brake shoes/clutch lining Duct insulation, adhesive and sealant materials Tank insulation Fire hoses Heat resistant gloves Electrical wire cover Etc.
8 Asbestos Diseases/ ADs asbestos fibers 1. Lung Cancer 3. Asbestosis 4. Pleural Thickening 2. Mesothelioma (M) Pleural M Peritoneal M
9 ARDs: Exposure Level & Latency Time Exposure Level asbestosis lung cancer plaque calcification mesothelioma Latency Time (adapted from Bohlig 1975)
10 The Japanese Experience
11 Non-Accidental Occupational Diseases Recognized by WACIL
12 Kubota Shock of 2005 Japanese Asbestos Scandal Mainichi Newspaper
14 Chronology of related laws and reguls ISHL=Industrial Safety & Health Law; its enforcement order (EO); its ordinance Ordinance*=on Prevention of Hazards Due to Specified Chemical Substances 1971 (S46) 1975 (S50) 1995 (H07) Ordinance* enforced: regulated as Group 2 Substance (prevention of leakage; appointment of Operations Chief; implementation of Work Environment Measurement) Ordinance* amended: asbestos spraying is prohibited; implementation of Specific Medical Examination for asbestos-handling workers (on placement and every 6 mo.) EO (ISHL) amended: prohibition of crocidolite and amosite Ordinance amended: PPE mandated for designated jobs; reinforcement of regulatory procedures for removal of sprayed asbestos 1996 (H08) 2004 (H16) 2005 (H17) Health Administration Diary distributed and Medical Examination provided to retired workers who handled asbestos under a particular condition EO(ISHL) amended: chrysotile prohibited in principle (construction material, abrasive material, etc.) Ordinance on Prevention of Asbestos Hazards separated from Ordinance*
15 Total Ban of Asbestos Effective Sep Prohibition of manufacture, import, sales, provision, use for products containing 0.1%+ weight of asbestos
16 5 Top Occup Ca. in Japan Cumulative Number, Cumulative Number of Compensated Cases 1 Mesothelioma & Lung Cancer (Asbestos) 3,362 2 Urinary Tract Cancer (Benzidine, - naphtylamine) 3 Lung and Upper Resp Tract Ca. 4 (Chromium) Skin Cancer (Soot, Mineral Oil, Tar, Coal tar, Pitches, Asphalt, Parafyn) Lung or Skin Cancer (Arsenic) 77 Lung Cancer (Coke Oven Emissions) 76
17 5 Top Occup Ca. in Japan Recent Trends, Recent Trends of Compensated Cases (annual 1 Mesothelioma & Lung number) Cancer (Asbestos) Urinary Tract Cancer (Benzidine, - naphtylamine) 3 Lung and Upper Resp Tract Ca. 4 (Chromium) Skin Cancer (Soot, Mineral Oil, Tar, Coal tar, Pitches, Asphalt, Parafyn) 5 to 10 3 to 5 0 to 1 5 Lung or Skin Cancer (Arsenic) 0 Lung Cancer (Coke Oven Emissions) 3 to 12 Lung cancer among pneumoconiotics 30 ( ) to 100+ ( )
18 Unique Spread of Asbestos Exposure Direct Occupational Exposure: Workers, including self-employed Indirect Occupational Exposure: Workers, including self-employed Domestic Exposure: Families/Relatives of exposed workers Neighborhood Exposure: Residents lived near asbestos plant, mine, etc: residential exposure Environmental Exposure: the Public, from building, car, etc. Exposure which origin cannot be traced
19 Estimated future deaths from male pleural mesothelioma in Japan Murayama T, Takahashi K et al. Am J Ind Med, 2006
21 Context of Global Health
22 International Trends Declaration on Elimination of ARD (WHO, 2006) 108,000 annual deaths from ARDs (125 M exposed) International tools by ILO ILO C. 162 (1986) Resolution concerning asbestos of 2006 Rotterdam Convention All asbestos (excepting chrysotile) included in PIC List Inclusion of chrysotile advanced by RC
23 Ecological Relationship MORtality ( ) regressed on ASBestos ( ), weighted by POPulation All meso, male Pleural meso, male All mesothelioma, male: Log10 (MOR)=0.382 ASB Peritoneal meso, male Asbestosis, male All mesothelioma, female: Log10 (MOR)=0.208 ASB Lin RT, Takahashi K, et al. Lancet 2007; 369:
24 In numbers Historical consumption explains 74% of variation for mesothelioma and 79% of asbestosis (both p<.0001) Increment of 1 kg per capita corresponds to 2.4-fold increase in mesothelioma, 2.7-fold in asbestosis
25 Pleural Mesothelioma, males Period Mortality Rate ( ) : pmr (deaths/million/yr) DNK 12.9 UK 31.1 NLD 30.0 JPN 4.8 pmr (deaths/million/yr) AUS 25.5 NZL 20.5
26 Pleural Mesothelioma, males Annual Percent Change ( ): APC (%/year) ISL -1.4 NOR -2.7 FIN -0.3 AUT -5.9 FRA -1.0 HUN 11.0 DEU 3.3 HRV 11.0 JPN 3.9 BRA 9.0 APC (%/yr) 5 over 1 to 5 0 to 1-1 to 0-5 to -1-5 less AUS 4.6 ARG 8.9 Nishikawa, Takahashi et al. Environ Health Perspect, 2008
27 Change in Use vs. Change in during Mortality during Adjusted R [Linear Regression Analyses x 21 combinations] (p<0.0001) (p<0.0001) (p<0.0001) Environ Health Perspect, 2008
28 Motion Chart by Google
29 Asbestos use vs. economic development in WORLD 10 Environmental Kuznets Curve GDP per capita --x-- High Income --x-- Middle Income --x-- Low Income --x-- Others ,000 10,000 15,000 20,000 25,000 30,000 GDP per capita (1990 GK dollars) Le GV, Takahashi K et al. Environ Health Perspect, 2010
30 Asian concern for the present and future Data scanty Only 4 Asian countries reported 17.8% of all mesotheliomas in WHO-DB ( ) True? Short lag-time? Inadequate surveillance systems? Poor political commitment 2 Asian countries ratified ILO C.162 among 32 6 Asian countries banned asbestos among 44 Asian takeover of global asbestos share From 19% (840/3,500) in 1985 to 47% (950/2,040) in 2000 Takahashi K. Occup Med (Oxford) 2008.
31 Interim summary Burden of Disease correlates with national use of asbestos, lagged Developing countries at cross-road to benefit from primary prevention Lag in national phases provides opportunities for technology share and transfer Amenable to primary prevention; concern by international organizations: WHO, ILO, UNEP, UNU Gaining place on Global Health agenda
32 Implications for Malaysia
33 Cumulative Asbestos Use vs. Estimated 15-yr Cumulative Incidence of Mesothelioma Based on the strong correlation between the above, Malaysia s missed # of mesothelioma cases can be estimated.
34 Imported Volume of Raw Asbestos Upper: Total Volume (metric tons) Lower: Per Capita Volume (kilograms) Malaysia 2,868 14,321 19,932 32,242 19,064 22,000 28,200 17,711 per capita Japan 92, , , , , , ,800 98,595 per capita Thailand 6,433 21,272 42,521 58,756 71, , , ,563 per capita
35 <Male All Mesothelioma>
36 <Male All Mesothelioma>??? Now +10yr +20yr
37 Underlying Principles of AAI Focus on all Three Levels of Prevention with emphasis on primary prevention Recognize Societal Transitions may take some time with need to recognize unique national situations and variable-term goals Co-ordinate among academia, administration and NGO in close line with International Organizations Give ARDs a higher place on the Global Health Agenda!
38 Primarily, Who are WE? Academia, Researchers and Practitioners Administration (national and regional) Recognition by International Organizations WHO (HQ & regional) ILO (HQ & regional) UNEP UNU TRADITIONAL NEW Potential to cooperate with NGOs UNIQUE
39 What are our STRENGTHS? OBJECTIVITY EXPERTISE Quality information ( mandate to produce, compile and disseminate) RECOGNITION Enhance connectivity Power to influence (people and political will) We are the KEY PLAYERS!
40 Asian Asbestos Initiative (AAI) AAI1 in Kitakyushu 2008/10 AAI2 in BKK, Thailand 2009/12
41 Conclusion Asbestos has been used ubiquitously in and around Malaysia Recent current burden of ARDs is a consequence of use during Because Malaysia has peaked asbestos use around 1980, its effect should surface around Joining international effort (incl., adopting ban) is strongly recommended
42 DOSH, Malaysia July 2, 2010 Epidemiology of Mesothelioma & Asbestos Diseases, A Global Perspective Ken Takahashi Professor of Environmental Epidemiology Acting Director of WHO-CC for Occup Health University of Occup & Environ Health, Japan
43 References 1. Le GV, Takahashi K* et al. National use of asbestos in relation to economic development. Environ Health Perspect 2010, 118(1): Takahashi K. Asbestos-related diseases: time for technology sharing (editorial). Occup Med (Oxford) 2008, 58: Nishikawa K, Takahashi K* et al. Recent mortality from pleural mesothelioma, historical patterns of asbestos use, and adoption of bans: a global assessment. Environ Health Perspect 2008, 116: Lin R-T, Takahashi K* et al. Ecological association between asbestosrelated diseases and historical asbestos consumption: an international analysis. Lancet 2007, 369: Murayama T, Takahashi K et al. Estimation of future mortality from pleural malignant mesothelioma in Japan based on an age-cohort model. Am J Ind Med 2006, 49(1):1-7. *corresponding author