Asbestos risks, safety and its role in lung disease

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1 Asbestos risks, safety and its role in lung disease Fraser Brims Respiratory Physician, SCGH Head of Occupa9onal and Respiratory Health Unit, Ins9tute for Lung Health, WA Lung Founda9on Australia Educa9on Mee9ng Thus 14 May 2015

2 Asbestos What is it? Where is it? Introduc9on Should we worry about it? The legacy of asbestos in WA Asbestos related lung disease Can anything be done for people exposed to asbestos?

3

4 Mined from the ground Asbestos Crystaline-hydrated silicate mineral fibre Wide range of commercial uses Serpentine Chrysotile (white) long, curly, pliable Amphibole Crocidolite (blue), amosite (brown) short, straight, stiff

5 Asbestos and the lung Benign effects Pleural plaques Rolled atelectasis Diffuse pleural thickening Benign asbestos related pleural effusion Asbestosis Malignant Malignant mesothelioma Lung cancer

6 Trades Carpenters, joiners, builder Plumber Boilermakers FiTers, turners, machinists Telecommunica9ons Mechanic, fiter, panel beaters Marine engineers Shipwrights, Waterside workers Armed services

7 The legacy of Asbestos in WA WiTenoom

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10 The legacy of Asbestos in WA WiTenoom Buildings, houses If it is intact it is low risk - leave it Tradies Home renova9ons

11 Asbestos and the lung There is no known safe level of exposure But all the diseases are dose dependent Different fibres have different effects But there is no such thing as safe asbestos It takes decades to develop most diseases

12 Asbestos related lung diseases Pleural plaques Scaring on the inside of the chest wall Incidental finding on x- rays or CT scans They do nothing They become nothing Dose dependent No compensa9on

13 Asbestos related lung diseases Asbestosis Scarring within the lung 9ssue Does cause breathlessness Some9mes gradually worsens, some9mes not No treatment / cure Dose dependent Compensa9on

14 Asbestos related lung diseases Mesothelioma Cancer around the lining of the chest wall Up to more than 50 years since first exposure Dose dependent risk Symptoms No cure Survival is very variable Compensa9on

15 Asbestos related lung diseases Lung Cancer Cancer within the lung 9ssue Smoking is the biggest risk factor Asbestos + smoking increases the risk more

16 What can be done about this? SCGH / UWA Highly experienced clinicians World class researchers Research Clinical Understanding the effect of exposure Understanding the biological effects

17 Western Australia Mesothelioma Register 1971-

18 Mesothelioma in WA Olsen, MJA 2011

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20 Asbestos Review Program (ARP) 1990 surviving members of Wittenoom workers cohort invited to take part in cancer prevention program Regular annual surveillance 2007 analysis demonstrated no benefit

21 Asbestos Review Program (ARP) Non-Wittenoom cohort also developed 3 months full time equivalent of occupational exposure to asbestos Pleural plaques We are still on the look out for more people!!

22 ARP Smoking, alcohol, dietary ques9onnaires Blood (biomarkers, DNA) Lung func9on tests Annual CXR now a low dose CT scan Research has shown that LDCT screening programs for lung cancer can save lives

23 Lung cancer - Australian Sta9s9cs 5- year survival Lung 8.7% 14% Breast 72% 89% Colorectal 48% 66% Prostate 57% 85% Most lung cancer cases ~80% inoperable at diagnosis Cancer Australia

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26 Summary Asbestos causes benign and malignant condi9ons The more you are exposed to the more chance of developing an illness Early detec9on of lung cancer is only way to improve outcomes at the moment

27 LungScreen WA CT scans for high risk smokers New risk- models to find people at high risk

28 LungScreen WA CT scans for high risk smokers New risk- models to find people at high risk q Aged Phone: q Current or ex- smoker q No current / <5 yrs other malignacy q No previous lung cancer

29 Occupational and Respiratory Health Unit, Sir Charles Gairdner Hospital, Perth, Australia LungScreen ARP

30 IS YOUR PATIENT AT RISK OF LUNG CANCER? Aged Current or former smoker No known malignancy within 5 years No previous lung cancer LungScreen WA Project is recruiting participants for a study into lung cancer screening with low dose CT chest Please call

31 Why low dose CT? Background (Perth) 2-3 msv CXR PA & Lat 0.1 msv Standard CT Chest 5-8 msv PET- CT >10-15 msv LDCT <5 msv Ultra LDCT <1 msv 0.1 to 0.15mSv at PMH and Envision 7 Hour flight 0.02 msv

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