General problems related to asbestos exposure in Poland Problemi generali relativi all esposizione ad amianto in Polonia

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1 General problems related to asbestos exposure in Poland Problemi generali relativi all esposizione ad amianto in Polonia Neonila Szeszenia-Dabrowska, Urszula Wilczynska Department of Occupational and Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland Summary Aim. The aim of this paper is to discuss the problems associated with the production and use of asbestos-containing materials in Poland. Materials and methods. The data obtained from the National Register of Occupational Diseases on cases related to asbestos exposure are presented. Legal regulations regarding the production, use, storage, and disposal of asbestos-containing products are specified. The ongoing projects, dealing with medical examinations of former workers at asbestos-processing plants and personnel involved in the elimination of asbestos and asbestos products, are also outlined. Results. The total quantity of asbestos-containing products in Poland is estimated to be 15.5 million tonnes, including 14.9 million tonnes of asbestos-cement sheets. The manufacture and sale of asbestos-containing materials has been prohibited in Poland since 1997, but the problems of delayed health effects attributable to past occupational exposure still need to be resolved. Up to and including the year 2002, the National Register of Occupational Diseases reported 1883 cases of asbestosis, 294 of lung cancer, and 114 of pleural mesothelioma, as resulting from exposure to asbestos dust in the workplace. Environmental pollution in the vicinity of asbestos-processing plants also poses a serious problem. An assessment of the number and magnitude of asbestos waste landfills is one of the major objectives of the project on the elimination of asbestos and asbestos products. The legal regulations in force and the ongoing programme of medical examinations of workers exposed, in the past, to asbestos dust are focussed on reducing the adverse health effects of asbestos exposure. Key words: asbestos, asbestosis, lung cancer, mesothelioma, legislation Riassunto Obiettivo. La relazione ha per oggetto la presentazione dei problemi relativi alla produzione e all uso dei prodotti che contengono amianto in Polonia. Materiali e metodi. Sono presentati i dati del Registro Nazionale delle Malattie Professionali relativi Address/Indirizzo: Dr. Neonila Szeszenia-Dabrowska, Nofer Institute of Occupational Medicine, Department of Occupational and Environmental Epidemiology, 8, Sw.Teresy St., Lodz, Poland Tel/fax: 0048/42/

2 Eur. J. Oncol. Library, vol. 3 alle malattie causate dall esposizione ad amianto. Sono riportate le norme giuridiche relative alla produzione, all uso, allo stoccaggio e all eliminazione dei prodotti contenenti amianto. Sono stati inoltre presentati i programmi in corso relativi agli esami medici eseguiti tra gli ex dipendenti degli stabilimenti della lavorazione di amianto e tra il personale impiegato nell eliminazione dell amianto e dei prodotti che lo contengono. Risultati. Si valuta che in Polonia siano presenti 15,5 milioni di tonnellate di materiali contenenti amianto, tra cui 14,9 milioni di tonnellate di pannelli di cemento-amianto. Dal 1997 in Polonia è vietata la produzione e la vendita dei materiali contenenti amianto, ma devono essere ancora risolti i problemi legati alle conseguenze per la salute, a distanza di tempo, dovute alla passata esposizione professionale. Fino all anno 2002 nel Registro Nazionale delle Malattie Professionali sono stati registrati casi di asbestosi, 294 casi di tumore polmonare e 114 casi di mesotelioma pleurico causati dall esposizione alla polvere d amianto nei luoghi di lavoro. Un problema grave è costituito anche dall inquinamento ambientale nelle vicinanze degli stabilimenti di lavorazione dell amianto. Uno degli obiettivi principali del programma d eliminazione dell amianto e dei prodotti che lo contengono è la valutazione del numero e dimensioni delle discariche dei residui di amianto. Le norme giuridiche vigenti e gli attuali programmi di controlli medici dei lavoratori esposti in passato a polvere d amianto hanno come finalità la diminuzione degli effetti negativi per la salute causati da tale esposizione. Parole chiave: amianto, asbestosi, tumore polmonare, mesotelioma, norme giuridiche Introduction Poland has no asbestos deposits. In the 1970s, Poland s annual demand for asbestos amounted to about 100,000 tonnes. About 90% of that volume was covered by chrysotile imported mainly from the former Soviet Union, and 10% by crocidolite from the Republic of South Africa. In the next decade, the annual demand for asbestos decreased to about 60,000 tonnes, falling to 30,000 tonnes by The 1.7 kg per capita consumption of asbestos in the mid 1980s ranked Poland as the 16 th major asbestos consumer, preceded, among others, by the former East Germany (3.3 kg per capita), Czechoslovakia (2.8 kg), Japan (2.6 kg), Austria (2.0 kg), and Belgium and Luxembourg (1.9 kg) 1. At that time, about 65% of the total asbestos volume was used in the manufacture of asbestoscement products. In Poland, a large-scale commercial application of asbestos in the construction industry began in the 1960s, when four big asbestos-cement plants started operating. Chrysotile asbestos was the main raw material used in the plants, but until the mid 1980s, also crocidolite and small amounts of amosite were used, to manufacture pressure pipes. In the manufacture of asbestos-cement products, the total consumption of asbestos, since the time when the production had started to 1993, is estimated to be about 1.4 million tonnes, including about 8,500 tonnes of amosite and about 86,000 tonnes of crocidolite. About 72% of the total volume of crocidolite asbestos (i.e. about 60,000 tonnes), that was used for the manufacture of construction materials in Poland in , was consumed by one single plant, manufacturing large-diameter pressure pipes. Since 1985, crocidolite asbestos is no longer used in Poland. 34

3 N. Szeszenia-Dabrowska, U. Wilczynska: Asbestos-related problems in Poland According to the Parliamentary Act of 1997, the manufacture and sale of asbestos-containing materials is prohibited 2. Thus, the assessment of exposure to asbestos dust and the monitoring of health conditions of workers at asbestos-processing plants have become irrelevant. However, the delayed health effects attributable to past occupational exposure remain cause for concern. Environmental pollution from asbestos waste landfills in the vicinity of asbestos-processing plants, where considerable concentrations of asbestos fibres in ambient air are recorded, will also continue to be a serious problem. At present, two projects aimed at minimising the adverse effects of asbestos on population health and the environment are under way. These include the project on Elimination of asbestos and asbestos products used in Poland and a programme of prophylactic examinations of former workers exposed to asbestos dust. The latter is known as the Amiantus Project. The project on Elimination of asbestos and asbestos products used in Poland deals with workers contracted to perform demolition work and install protective coverage at asbestos waste landfills. This will be the exposed group who will need prophylactic health care. Hygienic standards and asbestos dust concentrations The earliest available information on the concentrations of asbestos dust in the workplace atmosphere at a plant manufacturing asbestos yarns and fabrics dates back to With the maximum admissible number of asbestos particles, set at that time at 180 million particles per 1 m 3 of air, the measurements in that plant had revealed from 2 to 24 times higher values. In 1954, the maximum admissible concentration (MAC) of asbestos dust in workplace atmosphere was set at 2 mg/m 3 (Table 1). In the 1950s, the actual asbestos dust concentration at some workplaces was over 50 times as high as the 2 mg/m 3 standard. The workers employed in asbestos plants where the production started shortly after World War II reported that asbestos dust in the production rooms resembled a snowfall. Dust concentration in production departments was significantly reduced, due to the application of machine casing and closed air circulation systems. Nevertheless, in the 1970s, asbestos dust concentrations in some departments (spinning) were still four times as high as the adopted MAC value. At many workposts, asbestos fibre concentration ranged from 1 to 2.5 mg/m 3. The average maximum concentrations of asbestos dust recorded in the 1980s at plants manufacturing asbestos yarns and fabrics varied from 7 to 8.3 fibre/m 3. Table 1 - Maximum admissible concentration (MAC) values for dusts containing mineral fibres in Poland (time-weighted average for 8-h working shift) Year Dusts containing chrysotile and other Dusts containing fibrous asbestos types (except amphiboles) crocidolite and antigorite Total dust Fibres, Total dust Fibres, diameter <3 μm, diameter <3 μm, length >5 μm length >5 μm mg/m 3-2 mg/m mg/m 3 2 f/cm 3 2 mg/m 3 1 f/cm mg/m f/cm mg/m f/cm a 1 mg/m f/cm mg/m f/cm 3 a Since June

4 Eur. J. Oncol. Library, vol. 3 Routine measurements of respirable fibre concentrations in 1 cm 3 of workplace air were initiated as late as the 1990s, when the hygienic standard that covered this specific parameter came into force. Standard methods that involve passing the air through membrane filters are employed to determine the gravimetric and numerical data on fibre content. Asbestos fibres deposited on the surface of a μm membrane filter are counted using an optical microscope. Only the fibres longer than 5 μm, with diameter less than 3 μm and with length/diameter ratio higher than 3:1 are counted. Since 1990, the Nofer Institute of Occupational Medicine, Lodz, Poland, has been running an interlaboratory quality assurance programme which permits the standardisation of the whole analytical procedure. A FM Mineral Fibre Laser Monitor has been used to determine asbestos fibre concentration in the workplace. In some asbestos-cement plants that started operating as early as the 1960s and 1970s, high asbestos dust concentrations were recorded until late 1980s, but the relevant values were, unfortunately, determined only in terms of mg/m 3. It may be assumed that during the period when dry processing techniques were used, the fibre concentration could be higher than a dozen, or even several dozen fibres in 1 cm 3 air. The introduction of wet processing methods has considerably reduced workplace dust concentrations. However, even as recently as in 1990, asbestos dust concentrations of 8 f/cm 3 could be recorded at workplaces of asbestos milling and delivery unit operators. The transportation of asbestos as the raw material and the initial stage of its processing (defibering), that are associated with high fibre concentrations in ambient air, posed a major problem of workplace hygiene. Asbestos, obtained mainly from the former Soviet Union, was frequently supplied in damaged packages, which brought about an additional environmental pollution. The implementation of an automatic system of asbestos supply ensured that workplace concentrations of chrysotile asbestos did not exceed the MAC value of 0.5 f/cm 3, and this was binding up to June The use of amphibole asbestos was discontinued in the mid 1980s. Size of population exposed Before the Amiantus Project was launched, no register of workers occupationally exposed to asbestos dust had been established in Poland. Based on the data collected from regional divisions of the State Sanitary Inspectorate, the number of workers at asbestos processing plants has been estimated to be about 20,000. Considering other sectors of the national economy (insulation work, building industry, car repair shops, shipbuilding industry, etc.), the number of workers exposed to asbestos dust from the use of asbestos-containing products is estimated to have reached 35,000, and 45% of this population was exposed in the past to concentrations higher than the relevant MAC values. Health effects of occupational exposure to asbestos dust The major health effects of workers exposure to asbestos dust include asbestosis, lung cancer and pleural mesothelioma, diseases belonging also to the category of occupational diseases. Over the period in Poland, 1,883 cases of asbestosis, 114 of pleural mesothelioma, and 294 of lung cancer were recorded as deriving from occupational exposure to asbestos dust (Table 2). 36

5 N. Szeszenia-Dabrowska, U. Wilczynska: Asbestos-related problems in Poland Table 2 - Asbestos-related occupational diseases recorded in Poland: Year Asbestosis Lung cancer Pleural mesothelioma Total Asbestosis, or interstitial pulmonary fibrosis, constitutes the main occupational disease of workers exposed to asbestos dust. The remarkable increase in the number of asbestosis cases recorded in is associated with an increased detection of new cases through the clinical examinations of workers employed in selected asbestos-processing plants: these examinations were initiated within the framework of a research project carried out by the Nofer Institute. The considerable increase in the number of cases that were diagnosed in 2001 may be associated with the implementation of the Amiantus Project 3. According to official statistics, pleural mesothelioma is a rather rare type of cancer in Poland. With the rate of about 4 cases per 1 million people, Poland is classified among the countries with a very low incidence of this disease in the general population 5. However, since 1980, a slight increase in the incidence of pleural mesothelioma has been observed both among males and females (Table 3). Over the period , a total of 114 cases of pleural mesothelioma were classified as an occupational disease (Table 2). As shown in Table 3, the cases from the period (i.e. when pleural mesothelioma was considered in the national statistics) accounted for as little as 2.4% of the total number of cases of pleural mesothelioma diagnosed at that time in the general population (3.2% in males, 1.5% in females). These data suggest that the knowledge of asbestos as a causal agent of mesothelioma is inadequate among the clinicians and that they do not collect the work history data properly. A number of factors need to be taken into account when one considers the relatively low total number of mesotheliomas in the general population, as well as of the occupational mesotheliomas. These include: difficulties in diagnosing this rare cancer; long period of latency (30-40 years) for mesothelioma, so pleural mesotheliomas usually develop in elderly people, above years of age; large industrial plants, processing considerable quantities of blue asbestos, started operating in the 1960s-1970s; therefore, the increased number of deaths from that cancer that are presently recorded may be associated with this long latency; low cumulative dose of asbestos dust due to short periods of employment: a high proportion of asbestos workers were employed for a short period of time; 37

6 Eur. J. Oncol. Library, vol. 3 Table 3 - Number of deaths due to malignant pleural mesothelioma in the general population and cases of pleural mesothelioma registered as an occupational disease in Poland: Year a Males Females Number Occupational Number Occupational of deaths 4 disease of deaths 4 disease Total Age (years ± SD) 61.7± ± ± ±8.0 a Before 1980 and since 1997 there are no separate statistical data available on deaths due to malignant pleural mesothelioma in the general population small number of workers employed at workplaces with high asbestos dust concentrations; predominant use of chrysotile asbestos. Lung cancer. Some of the hypothetical causes of the relatively low number of pleural mesotheliomas in Poland, including those of occupational aetiology, refer also to asbestosrelated lung cancers 6. In spite of the low number of diagnosed cases of occupational asbestos-related lung cancer, they accounted for as many as 31% of the total cases of lung cancer as an occupational disease recorded in (fig. 1). It should be noted that, in the instance of occupational exposure to asbestos dust, every case of lung cancer is com- Fig. 1. Registered cases of occupational lung cancer (total cases) and asbestos-related lung cancer in Poland:

7 N. Szeszenia-Dabrowska, U. Wilczynska: Asbestos-related problems in Poland pensated in Poland as an occupational disease, no matter whether asbestosis had been diagnosed prior to lung cancer detection and whether the patient had reported a smoking habit. Legal regulations The Polish legal regulations regarding the protection of human health against adverse effects of asbestos dust, as well as the management of asbestos wastes, are in compliance with the international standards and European Union (EU) legislation (EU Convention No 162 and Recommendation No 172, and EU Directives 83/477, 91/382, 98/24, 91/689, 94/31). However, they are scattered over regulations of different type and rank. The most important provisions are included in the Act of 19 June 1997, on the prohibition of the use of asbestoscontained materials 2 and on regulations based thereon. By virtue of Article 1 of this Act, the manufacture of asbestos-containing products was banned and so was the introduction and trading of asbestos and asbestos-containing materials over the territory of Poland. The revoking of this prohibition is possible only in strictly defined and exceptional circumstances when, for technological reasons, the non-asbestos-containing materials cannot be used. Presently, the main problem in Poland is the safe use of already existing asbestos products and their gradual elimination. The executive regulations to the Act specified above determine the ways and conditions for safe use and elimination of asbestos products 7,as well as the principles of work safety and hygiene regarding the management and disposal of asbestos wastes and a training programme in this respect 8. Of relevance to human safety and health protection against asbestos hazards are the provisions of the Labour Code, and the executive regulations thereto 9. The latter determine the procedure and frequency of measurements of asbestos dust concentration in workplace atmosphere, the procedure for recording and storage of their results and making them accessible to the workers, and the maximum admissible concentrations of asbestos dust in workplace atmosphere It should be stressed that the Polish legal regulations provide for special health care for current and former workers exposed to asbestos dust, that covers prophylactic examinations, free medication in asbestos-related diseases, and treatment in health resorts 2, 9, An issue essential for the protection of human life and health against asbestos dust hazards is the proper management of asbestos wastes that is provided for in the Environmental Protection Law and the Act on Waste Management 15 and executive regulations thereto. The Amiantus Project Since 2001, the programme of medical examinations of workers occupationally exposed to asbestos dust, referred to as the Amiantus Project, has been implemented. The medical examinations of former asbestos workers are performed by virtue of the Act of 19 June 1997 on the prohibition of use of asbestos-containing products 16. Periodical examinations enable detection of pathological changes at the pre-symptomatic or earlysymptomatic stage. The main objectives are as follows: 1) to ensure good quality of periodical examinations for workers through standardising the methods for medical examinations and detection of pathologies resulting from exposure to asbestos dust, based on international criteria for diagnosing asbestos-related diseases (the Helsinki criteria, 1997) 17 ; 39

8 Eur. J. Oncol. Library, vol. 3 2) to monitor respiratory health effects in workers occupationally exposed to asbestos dust; 3) to run a database on workers subjected to periodical examinations all over the country and on results of these examinations. The Amiantus Project includes the strategy of mass screening that covers development of documentation (questionnaires on clinical, radiological and spirometric examinations) and instructions for persons to conduct these examinations. Each centre involved in project implementation has been provided with criteria based on international standards 17 for clinical, radiological, spirometric and histological examinations to detect asbestos-related diseases: asbestosis, pleural mesothelioma and lung cancer. The data obtained will enable assessment of the morbidity and incidence of asbestosrelated diseases among workers with a history of exposure to asbestos dust in asbestos-processing plants. Elimination of asbestos and asbestos products used in Poland In 2002 the Government of Poland approved the project on Elimination of asbestos and asbestos products used in Poland, the aim of which is to minimise the adverse effects of asbestos on the health of the population. This is a long-term project, to be implemented from 2003 up to 2032, and comprises the following activities: elimination of environmental asbestos as well as removal of asbestos products; limitation of environmental impact of asbestos for ultimate compliance with legislation regarding environmental protection. The total quantity of asbestos-containing products is estimated to be 15.5 million tonnes, including 14.9 million tonnes of asbestos-cement sheets (1,351.5 million m 2 ), 600,000 tonnes of piping and other asbestos-cement goods. In terms of spatial distribution, the highest volume of asbestos products (about 3 million tonnes) can be found in eastern Poland. The elimination of asbestos on this scale is expected to be a costly process this will make a considerable burden on the state budget over the 30 years period envisaged as the project s implementation time. The project covers: assessment of the total quantity of asbestos products and their spatial distribution in Poland; estimation of the number and magnitude of asbestos waste landfills, including the costs of investment and exploitation; regulatory proposals regarding asbestos use. References 1. Swedish Working Environment Association. Asbestos in Working Environment. Working Environment 1992, Stockholm. 2. Act of 19 June 1997, on the prohibition of use of asbestos-containing products. Law Gazette, 1997, 101, 628, later amended; 1998, 156, 1018; 2000, 88, 986; 2001, 100, 1085; 2003, 7, 78; 2003, 65, Wilczynska U, Szeszenia-Dabrowska N. The incidence of asbestosis in Poland. Med Pracy 2002; 53 (5): Cancer in Poland (annual reports). The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warszawa,

9 N. Szeszenia-Dabrowska, U. Wilczynska: Asbestos-related problems in Poland 5. Szeszenia-Dabrowska N, Szymczak W, Wilczynska U. Prevalence of malignant pleural mesothelioma in Poland in Przeg Epid 1996; 50 (4): (in Polish). 6. Szeszenia-Dabrowska N, Strzelecka A, Wilczynska U, et al. Occupational malignant neoplasms in Poland in the years Med Pracy 1997; 1: 1-13 (in Polish). 7. Regulation of the Minister of Economy of 14 August 1998, Law Gazette 1998, 138, Regulation of the Minister of Labour and Social Policy of 2 April 1998, Law Gazette. 1998, 45, Labour Code, Law Gazette 1998, 21, Regulation of the Minister of Health and Social Welfare of 9 July 1996, Law Gazette 1996, 86, Regulation of the Minister of Labour and Social Policy of 29 November 2002, Law Gazette 2002, 217, Regulation of the Minister of Health of 9 July 1996, Law Gazette 2001, 88, Regulation of the Minister of Health of 7 August 2001, Law Gazette 2001, 62, Environmental Protection Law of 27 April 2001, Law Gazette 2001, 62, Act on Waste Management of 27 April Law Gazette 2001, 62, Szeszenia-Dabrowska N, Szubert Z. Prophylactic examinations of former workers at asbestos processing plants: The Amiantus Project. Med Pracy 2002; 53 (6): (in Polish). 17. Asbestos, asbestosis, and cancer: the Helsinki criteria for diagnosis and attribution. Scand J Work Environ Health 1997; 23:

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