MESOTELIOMA and CHRYSOTILE

MESOTELIOMA and CHRYSOTILE in RUSSIA Kashansky S.V., Grinberg L.M., Kuzmin S.V., Berdnikov R.B., Berzin S.A. Ekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers Ural State Medical Academy Sverdlovsk Regional Pulmonological Center Ural Scientific-Research Institute of Phthisiopulmonology Ekaterinburg Russia

Mesothelioma incidence in 1990s (cases per million a year) [Bianchi C., 2004; Indulski J. et al, 1997; Takahashi K. et al, 1999; Tossavainen A., 2004] Ukraine Tunisia Morocco Slovenia Israel Lithuania Latvia Estonia Slovakia Poland Japan Romania Hungary Greece Croatia Denmark USA Norway Sweden Germany France Finland NewZealan Italy Belgium Netherlands Great Australian 0,2 0,6 0,7 2,6 3 3,2 3,2 3,4 3,7 4 5 5,9 7,7 9,6 10 13 14 14 15 15 17 18 18 19 29 30 33 35 0 5 10 15 20 25 30 35

MESOTHELIOMA in RUSSIA True incidence rates of mesothelioma in Russia are UNKNOWN [Bianchi C. et al,, 2000].

MESOTHELIOMA in RUSSIA An extensive use of asbestos in Russia presupposes high mesothelioma incidence and mortality rates [LaDou The author believes that low rates of mesothelioma incidence and prevalence in Russia and many other countries of the world can be explained only by concealment of factual data. LaDou J., 2004].

MESOTHELIOMA in RUSSIA?. Tossavainen (Finland) explains this by saying that only chrysotile asbestos has been used in Russia, and the life expectancy of the population is not long enough for mesothelioma to develop [Tossavainen?., 2005].

RESEARCH TEAM Kashansky S.V.,., Kuzmin S.V. Ekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers Grinberg L.M. Ural State Medical Academy, Sverdlovsk Regional Pulmonological Center Berzin S.A. Ural State Medical Academy Berdnikov R.B. Ural Scientific-Research Institute of Phthisiopulmonology

MAIN DIRECTIOMS of RESEARCH Studying state-of of-the-art issue of Mesothelioma in Russia ; Determining clinical and epidemiologic characteristics of mesothelioma in the Sverdlovsk Region.

STUDYING MESOTHELIOMA in RUSSIA Primary data: In Russian statistical forms mesothelioma of the pleura and other sites are NOT ALLOCATED to a separate group. There is NOT A SINGLE official mesothelioma register in Russia.

STUDYING MESOTHELIOMA in RUSSIA By 2005 Russian-speaking speaking scientists have published 806 works containing information about 3,259 mesothelioma cases diagnosed in Russia for the period of 133 years (1871-2004).

TOTAL NUMBER of MESOTHELIOMA CASES in Russia Sex Pleura Perito neum Perica rdium Testis Other N.A. Total M 1,033 117 75 12 3-1,240 F 798 184 60-1 - 1,043 N.A. Total 897 2,728 57 358 21 156-12 - 4 1 1 976 3,259 N.A. - data not available

Mesotheliomas in different areas of the Russian Empire,, USSR and Russia

Ukraine 0,2 Byelorussia 0,6 Kuybishev Region 1,8 Perm Region 1,9 Lithuania 3,2 Latvia 3,2 Estonia 3,4 Republic of Karelia 3,8 0 0,5 1 1,5 2 2,5 3 3,5 4 Mesothelioma epidemiology in regions of the USSR and Russia (cases per million a year)

10000 140 1000 100 10 1 Asbestos prodused, thousand tons Asbestos prodused, thousand tons Absolute number of cases Absolute number of cases 120 100 80 60 0,1 40 0,01 20 0,001 0 Year 1880 1890 1900 19101920 1930 1940 1950 1960 1970 1980 1990 2000 Asbestos produced and number of mesotheliomas in the Russia (1871-2005)

LOCAL in TOWNS Asbest Ekaterinburg Asbest [Kogan F.M. et al, 1986], Ekaterinburg [Kashansky S.V. et al, 2003]. REGIONAL Republic of Karelia Sverdlovsk Region (pilot 1996]. Karelia[Romanchuk I.Yu., 1999], pilot) [Fedosenko N.E.,

Sverdlovsk Region on the map of Russia

Main asbestos deposits and asbestos enterprises in the Sverdlovsk Region

CONVENTIONAL SINGNS

Main asbestos deposits and asbestos enterprises in the Sverdlovsk Region

URALASBEST Enterprise Opened Closed Productivity, thousand tons Mine 1885 operating 34,000, of ore Oktyabrskaya mill 1896 1956 20 Mill # 1 1924 1955 70 Mill # 2 1930 1980 260 Mill # 3 1936 1977 320 Mill # 4 1956 operating 260 Mill # 5 1955 1994 325 Mill # 6 1969 operating 550

REASONS for EXCLUDING from the ANALYSIS PATIENTS with the INITIAL DIAGNOSIS of MESOTHELIOMA Reasons for exclusion Cancer of other sites Nonneoplastic pleurisy Tuberculous pleurisy Chronic pancreatitis Neither life-time nor postmortem morphologic verification has been done Medical records and initial morphologic assays have been lost Residents of other regions Total Abs. 43 11 1 1 14 28 3 101

TUMORS REASONS for EXCLUDING from the ANALYSIS PATIENTS with the INITIAL DIAGNOSIS of MESOTHELIOMA Reasons Lung cancer(of different sites,, histologic types, invasion and metastasis in the pleura) Metastasis of uterus cancer Metastasis of brain cancer Metastasis of liver cancer Metastasis of ovarian carcinoma Metastasis of prostate adenoma Pleural angiofibroma Metastasis of unspecified primary source Total Abs. 24 6 4 1 1 1 1 5 43 % 55.8 14.0 9.3 2.3 2.3 2.3 2.3 11.7 100

AGE and SEX DISTRIBUTION of MESOTHELIOMA CASES 20 19,2 16 Men Women 16 15,2 12 10,4 10,4 10,4 8 7,2 4 3,2 3,2 3,2 1,6 0 0 < 29 30-39 40-49 50-59 60-69 > 70

SOME GENERAL MESOTHELIOMA INCIDENCE RATES in the SVERDLOVSK REGION Indices 1986-90 1981-85 1991-95 1996-00 2001-04 Total Absolute 20 39 25 21 20 125 Incidence rate per million a year 0.88 1.67 1.04 0.97 1.11 1.11 Percent of mesothelioma cases in the general structure of cancer incidence,, % 0.036 0.063 0.039 0.032 0.036 0.041 Percent of pleural mesothelioma cases in the structure of regional incidence of respiratory cancer,, % 0.19 0.31 0.21 0.19 0.25 0.23

Mesothelioma incidence in the Sverdlovsk Region, cases per million a year

DYNAMICS of MESOTHELIOMA INCIDENCE in the SVERDLOVSK REGION 1,8 1,5 1,2 0,9 0,6 1981-85 1986-90 1991-95 1996-00 2001-04

WORKPLACES of PATIENTS with OCCUPATIONAL ASBESTOS EXPOSURE Enterprises Uralasbest JSC,, including: miners millers UralATI JSC Anatolyevsky mine and mill Motor transport Shabrovsky talc plant Total Abs. 734 1 3 3 1 15 % 46.6 20.0 26.6 6.7 20.0 20.0 6.7 100.0

Indices for occupationally exposed malignant mesothelioma cases by asbestos type, mean (range) Index, years Mean age, diagnosis Mean age, first contact Mean length of service Latency period Total dust load, gram Chrysotile 63.0±2.5 (55-75) 22.3±1.4 (18-27) 25.8±4.5 (10.5-45) 36.6±5.2 (13-57) 609.0±114.2 (292.7-1062.6) Amphibole 48.3±3.7 3.7 (41-53) 19.3±0.3 (19-20) 10.2±4.0 (5-18) 26.7±4.2 (22-35) 205.4±87.1 (72.6-369.4) Statistically significant differences?< 0.01 0.05 0.01-0.01

Asbestos enterprises and mesothelioma incidence in the Sverdlovsk Region

Asbestos enterprises and mesothelioma incidence in the Sverdlovsk Region

10000 8 9000 8000 7000 6000 5000 4000 3000 2000 Production of chrysotile asbestos, thousand tons 2032,5 4359,7 6937,5 7891,7 9376,1 7,1 8286,7 5,9 * 6921,8 5,1 6776,1 3388,8 Morbidity of malignant pleural mesothelioma 7 6 5 4 3 3329,1 1,7 1,7 2 2144,1 1000 0 1951-55 Production of chrysotile asbestos Morbidity of malignant pleural mesothelioma 1956-60 1961-65 1966-70 1971-75 1976-80 1981-85 1986-90 1991-95 1996-00 Production of chrysotile and the incidence of malignant pleural mesothelioma in Asbest (* - according to F.M. Kogan, 1986) 0 2001-04 1 0

180 160 140 120 100 80 60 40 20 0 164,1 Dust level, mg/m3 1951-55 25,8 1956-60 Dust level, mg/m3 15,2 1961-65 9,8 1966-70 5,9 5,1 4,6 3,5 4 5,3 4,2 4 0 1971-75 1976-80 Dust level at Uralasbest and incidence rates of malignant pleural mesothelioma in Asbest (* - according to F.M. Kogan, 1986) 7,1 Morbidity of malignant pleural mesothelioma * 1981-85 5,1 1986-90 1,7 1,7 1991-95 1996-00 Morbidity of malignant pleural mesothelioma 2001-04 8 7 6 5 4 3 2 1 0

Results of assessing risk of environmental exposure to asbestos Areas Added personal risk Relative personal risk Added population risk Added share of population risk Asbest (except( industrial workers) 0.33 1.30 0.37 0.33 Nevyansk 0.33 1.30 0.37 0.33 Alapayevsk 2.09 2.32 2.32 2.09 Asbest (general) 3.20 3.88 3.55 3.20 Sysertsky district 5.98 6.39 6.64 5.98

CONCLUSIONS During 24 years of conducting the first Russian systematic study of mesothelioma epidemiology in the largest industrial region of the country we revealed 125 cases of morphologically verified mesotheliomas.

CONCLUSIONS The average long-term mesothelioma incidence rate in regional towns varied from 0.2 to 27.1 cases per million a year during the study period, the mean being 1.1.

CONCLUSIONS In 50% of regional towns and the regional average incidence rate was comparable to background rates in other countries of the world - 1-2 cases per million a year.

CONCLUSIONS A statistically significant association between asbestos exposure and mesothelioma was established in 12.0% of cases. All of them had experienced occupational exposure to high asbestos concentrations in 1950-60s.

CONCLUSIONS Assessing risk of environmental exposure to chrysotile asbestos were similar to regional averages when excluding cases of occupational disease.

CONCLUSIONS The role of chrysotile asbestos in etiology of mesothelioma remains disputed. It is obvious that chrysotile is not an obligatory and, moreover, the only mesothelioma-inducing inducing factor.

Thank you for your attention!