Worldwide mesothelioma mortality trends Harvard Symposium 24 th July 2009 Julian Peto London School of Hygiene and Tropical Medicine and Institute of Cancer Research
Asbestos-related diseases Asbestosis (non-malignant lung fibrosis) is caused by prolonged heavy exposure to any type of asbestos. Lung cancer is caused by all types of asbestos, but the risk is much lower in nonsmokers. Mesothelioma is caused mainly by blue and brown asbestos. The risk is much lower with white asbestos.
Asbestos epidemiology the past and the future Mesothelioma projections Better methodology Actuarial issues future liability Developing countries
Asbestos epidemiology the past and the future The role of amosite Fibre type length, diameter, surface properties, persistence, dose-response Managing asbestos in buildings and waste sites Nanofibres Continuing use in developing countries Differences between mesothelioma and lung cancer
Chrysotile and mesothelioma At present day levels of exposure to commercial chrysotile, whether or not contaminated with tremolite, the risk must be vanishingly small JC & AD McDonald 1997 Exposure to chrysotile probably remains the leading cause of mesothelioma in the world in view of the far wider use of this material than of other types of asbestos...the proposition of putting more asbestos into the environment...is foolhardy MR Cullen 1998
Chrysotile mesothelioma and lung cancer The quantitative risks of mesothelioma and lung cancer in relation to asbestos exposure Hodgson & Darnton (2000) Ann. Occup. Hyg. 44:565-601 The exposure specific risk of mesothelioma.is broadly in the ratio 1:100:500 for chrysotile, amosite and crocidolite respectively. The risk differential between chrysotile and the two amphibole fibres for lung cancer is between 1:10 and 1:50.
Exaggeration of the hazards of chrysotile diverted attention from amosite The hazards of chrysotile asbestos: a critical review. Landrigan, Nicholson, Suzuki, Ladou Ind Health. 1999 Jul;37(3):271-80 Comparative analyses have established that chrysotile is 2 to 4 times less potent than crocidolite asbestos in its ability to cause malignant mesothelioma, but of equal potency of causation of lung cancer.
Asbestos use in Britain After 1970 crocidolite was not used, and asbestos exposure was < 2 fibre/ml in most British factories. Uncontrolled use continued in construction into the 1980s, including amosite (brown) asbestos cement board. Environmental exposure was very low, but after 1980 public concern led to extensive removal from schools and public
Average ambient air concentrations of asbestos fibres >5um long before, during and after an asbestos removal programme from a sixstorey teaching block (Burdett et al 1989) 0.1 0.065 TEM concentration of asbestos (f/ml). 0.01 0.001 <0.0002 0.0058 0.008 0.0004 <0.0003 0.0001 before removal 2 weeks (no activity) 9 weeks (refurbishment) 26 weeks (refurbishment) 35 weeks (normal occupation) ambient (outside building)
1995 recognition of the mesothelioma epidemic in Britain
Rate per 10 million (log scale) 10000 1000 100 10 1 0.1 The HSE Mesothelioma Register: British mesothelioma deathrates by birth cohort, 1968-91 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age 1891 1896 1901 1906 1911 1916 1921 1926 1931 1936 1941 1946 1951 1956 1961 1966
UK asbestos imports, and observed (1970-91) and predicted (1992-2040) mesothelioma deaths in men Peto et al 1995: Lancet 345: 535-39 Annual UK asbestos imports (1000 tons). 200 180 160 140 120 100 80 60 40 20 0 Chrysotile Amosite Crocidolite Predicted deaths 1900 1920 1940 1960 1980 2000 2020 2040 Year 3000 2500 2000 1500 1000 500 0 Annual male mesothelioma deaths.
UK Health and Safety Executive Asbestos Workers Mortality Survey Deaths 1971-91 in 50,000 workers covered by the 1969 Asbestos Regulations (Hutchings, Jones and Hodgson: Decennial Supplement, OPCS 1995) Industry Lung Cancer Obs Exp O-E Meso Asbestosis Textile manufacture 58 44.6 13.4 11 5 Asbestos cement manufacture 95 87.7 7.3 19 15 Asbestos/rubber/bitumen manufacture 156 110.1 45.9 20 5 Asbestos board/paper manufacture 35 23.4 11.6 4 2 Garment manufacture 3 2.5 6.5 0 2 Insulation/plaster manufacture 7 3.5 3.5 0 1 Maintenance in manufacture 69 66.2 2.8 18 4 Asbestos removal 14 15.8-1.8 12 1 Shipbuilding 50 47.3 2.7 17 6 Construction 12 8.9 3.1 6 6 Insulation 169 64.0 105.0 67 47 Total 668 474.0 194.0 170 88
British male mesothelioma deaths since 1970 1200 1000 Deaths per year age 65+ 800 600 400 age 55-64 200 age 45-54 0 age<45 1970-74 1975-79 1980-84 1985-89 1990-94 1995-99 2000-04
British male mesothelioma deaths below age 50 since 1970 45 40 Deaths per year 35 age 45-49 30 25 20 15 10 5 age 35-39 age 40-44 0 1970-74 1975-79 1980-84 1985-89 1990-94 1995-99 2000-04
The worldwide mesothelioma epidemic The tenth revision of ICD death coding, introduced in different countries between 1995 and 2003, includes mesothelioma as a specific cause of death, so worldwide data are now available for the first time
Mesothelioma mortality data 2000-2004 (WHO database all countries with 10 or more mesothelioma deaths per year and at least 90% death registration) Country Population (millions) Mesothelioma deaths per year Male Female Australia 20 410 79 New Zealand 4 58 10 UK 60 1548 272 W Europe (other) 333 2324 642 E Europe 106 217 123 USA 291 1971 462 Canada 31 264 53 Japan 128 620 205 Israel 6 19 7 Argentina 38 62 34 Chile 16 25 14 Mexico 102 93 49
Male mesothelioma mortality 2000-2004 and asbestos consumption 1960-69 Lin et al 2007 Lancet 369: 844-849 Death rate (log scale) 0 2 4 6 Annual asbestos consumption (kg per head 1960-69)
45 Male mesothelioma death-rates in 2000-04 in developed countries 40 35 30 25 20 Australia UK Netherlands France USA Japan 15 10 5 0 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age group
Male mesothelioma death-rates in 2000-04 in Central and South America 5 Rate per 100,000 4 3 2 Argentina Chile Mexico 1 0 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age group
British male mesothelioma mortality rates by age and birth cohort 1968-2001 1000 1938-42 and 1943-47 100 Rate per milion 10 1 1958-62 1953-57 1948-52 0.1 0.01 20 30 40 50 60 70 80 90 Age
10.00 Comparison of British birth cohort trends in male mesothelioma death-rates before and after 1990 Relative rate (log scale) 1.00 0.10 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 <1990 1990 0.01 Age group
Rate per 10 million (log scale) 10000 1000 100 10 1 0.1 The HSE Mesothelioma Register: British mesothelioma deathrates by birth cohort, 1968-91 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age 1891 1896 1901 1906 1911 1916 1921 1926 1931 1936 1941 1946 1951 1956 1961 1966
Modelling assumption After asbestos exposure has largely stopped, the mesothelioma rate in each birth cohort follows the same age-distribution in all countries. In other words, the simple age and birth cohort model is correct. International mesothelioma trends can therefore be modelled from the 1995-1999 and 2000-2004 death-rates
Proportional increase in mesothelioma death-rates from each agegroup to the next (Based on male rates in 1995-1999 and 2000-2004) 100.00 10.00 Relative rate (log scale) 1.00 0.10 0.01 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Australasia W Europe N America Asia E Europe C&S America GB cohort 1990 Age group
Cumulative mesothelioma death-rates up to age 85 in men and women (rates per 100,000 in 2000-04) 120 Australia 100 UK Slovenia Female 80 60 40 20 Austria Chile Czech Spain Lith Hungary Israel Rom Japan SloArgentina Serb Mexico Portugal Poland Finland France Denmark Germany Sweden USA Canada Norway Croatia New Zealand Netherlands Australasia W Europe USA Japan E Europe C&S America Background 0 0 100 200 300 400 500 600 700 800 Male
100 Male and female mesothelioma death-rates in 2000-04 in countries with high rates (i.e. cumulative male rate by age 90 over100 per 100,000) and low rates Death rate per 100,000 (log scale) 10 1 0.1 HIGH: male LOW: male HIGH: female LOW: female 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ 0.01 Age group
Background and work-related mesothelioma rates Background rate (unrelated to occupation, and the same in men and women) ١. Spontaneous the same worldwide ٢. Environmental related to asbestos consumption Work-related rate Predominantly in men Modelling assumption on work-related plus environmental rate: Male rate = 10 x female rate
Male mesothelioma death-rates in 2000-2004 Age: 35-39 40-44 45-49 rate (no.) rate (no.) rate (no.) UK 0.05 (5) 0.19 (16) 0.87 (66) USA 0.07 (41) 0.12 (66) 0.26 (139) Background 0.03 (19) 0.09 (53) 0.13 (69) (USA women) Predicted excess rates 40 years later in 2040-2044 Age: 75-79 80-84 85-89 UK 1.7 10.3 38.1 USA 3.2 3.5 7.1 Background 9.8 11.0 9.5
Projection of annual numbers of male mesothelioma deaths in the UK, assuming no asbestos exposure in men born after 1970 (red line) or after 1960 (blue line) 2500 2000 <1960 <1970 Background Deaths per year 1500 1000 500 0 2000-04 2005-09 2010-14 2015-19 2020-24 2025-29 2030-34 2035-39 2040-44 2045-49 Year
Projection of annual numbers of male mesothelioma deaths in Australasia, assuming no asbestos exposure in men born after 1970 (red line) or after 1960 (blue line) 900 800 700 <1970 <1960 Background 600 Deaths per year 500 400 300 200 100 0 2000-04 2005-09 2010-14 2015-19 2020-24 2025-29 2030-34 2035-39 2040-44 2045-49 Year
Projection of annual numbers of male mesothelioma deaths in USA, assuming no asbestos exposure in men born after 1970 (red line) or after 1960 (blue line) 2500 <1970 <1960 Background 2000 Deaths per year 1500 1000 500 0 2000-04 2005-09 2010-14 2015-19 2020-24 2025-29 2030-34 2035-39 2040-44 2045-49 Year
Projection of annual numbers of male mesothelioma deaths in Japan, assuming no asbestos exposure in men born after 1970 (red line) or after 1960 (blue line) 1400 1200 <1970 <1960 Background 1000 Deaths per year 800 600 400 200 0 2000-04 2005-09 2010-14 2015-19 2020-24 2025-29 2030-34 2035-39 2040-44 2045-49 Year
Projection of annual numbers of male mesothelioma deaths in Central and S America, assuming no asbestos exposure in men born after 1970 (red line) or after 1960 (blue line) 800 700 600 <1970 <1960 Background 500 Deaths per year 400 300 200 100 0 2000-04 2005-09 2010-14 2015-19 2020-24 2025-29 2030-34 2035-39 2040-44 2045-49 Year
Deaths per year Projection of annual numbers of male mesothelioma deaths 2000-2050, assuming no asbestos exposure in men born after 1970 5000 4500 4000 3500 3000 2500 2000 1500 W Europe & Canada USA UK Japan Australasia E Europe C & S America 1000 500 0 2000-04 2005-09 2010-14 2015-19 2020-24 2025-29 2030-34 2035-39 2040-44 2045-49 Year
Predicted male mesothelioma deaths 2000-49 Australia 27,000 New Zealand 4,000 UK 78,000 W Europe (except UK and Italy)154,000 USA 90,000 Japan 47,000 E Europe 22,000 Argentina 7,000 Chile 4,000 Mexico 14,000
Why are male mesothelioma death-rates in 2000-2004 almost five times higher in Britain than in the USA? Age: 35-39 40-44 45-49 50-54 Born: 1965 1960 1955 1950 rate (no.) rate (no.) rate (no.) rate (no.) UK 0.05 (5) 0.19 (16) 0.87 (66) 3.14 (242) USA 0.07 (41) 0.12 (66) 0.26 (139) 0.68 (314)
900,000 Asbestos imports into the US (includes small percentage of US mined chrysotile) 800,000 Tonnes of fibre 700,000 600,000 500,000 400,000 300,000 200,000 Chrysotile Amosite Crocidolite 100,000 0 1950 1960 1970 1980 1990 2000 Year
Asbestos imports into the UK 180000 Tonnes of fibre 160000 140000 120000 100000 80000 60000 Chrysotile Amosite Crocidolite 40000 20000 0 1940 1950 1960 1970 1980 1990 2000 Year
Australian asbestos production + imports 90000 80000 70000 Chrysotile Amosite Crocidolite 60000 Tonnes of fibre 50000 40000 30000 20000 10000 0 1950 1960 1970 1980 1990 2000 Year
Amphibole imports into UK and US 30000 25000 UK Amosite US Amosite US Crocidolite UK Crocidolite 20000 Tonnes of fibre 15000 10000 5000 0 1940 1950 1960 1970 1980 1990 Year
Amosite imports 30000 25000 UK USA Australia Tonnes of fibre 20000 15000 10000 5000 0 1940 1950 1960 1970 1980 1990 Year
US insulation workers were exposed to amosite (brown) but much less crocidolite (blue) Asbestos in the lungs of persons exposed in the USA Langer and Nolan Monaldi Arch Chest Dis 1998 53:168-80 Among the 83 causes of death were 33 mesotheliomas, 35 lung cancers, 12 asbestosis and 3 from other cancers. Of the three major commercial asbestos fibre types, amosite was found to be the most prevalent fibre Amosite was present in all of the insulation workers' lungs studied and was found in the highest concentration in this exposure category
Why should amphiboles (brown and blue asbestos) be so much more dangerous than chrysotile (white asbestos)? They persist in the lung.
Lung cancer mortality is almost constant in exsmokers. Halpern et al (1993) JNCI 85, 457 Death rate per 1000 7 6 5 4 3 2 1 0 Age stopped 60-64 55-59 50-54 40-49 40 45 50 55 60 65 70 75 Age
Epidemiology of lung cancer and smoking Lung cancer in cigarette smokers: Incidence rate α (years of smoking) 4 Lung cancer in non-smokers: Incidence rate α (age) 4
Lung cancer incidence in non-smokers is proportional to the fourth power of age. In smokers it is proportional to the fourth power of duration of smoking, independent of age. (Doll 1978: Cancer Research 38: 3573-83)
Epidemiology of mesothelioma and asbestos Mesothelioma in asbestos workers: Incidence rate α (years since first asbestos exposure) 3 Mesothelioma in the unexposed population: Incidence rate α (age) 3
Mesothelioma mortality in North American insulation workers is independent of age (Peto et al 1982: Br J Cancer 45: 124-135) 20 20 Cumulative Mesothelioma Risk (%) 10 Cumulative mesothelioma risk (%) 10 Age at first exposure (years) ---- 15-24 ---- 25-34 ---- 35+ 0 30 45 55 65 75 Age (years) 0 10 25 35 45 55 Years since beginning exposure
Mesothelioma incidence is proportional to the third power of time since first asbestos exposure, independent of age. In unexposed people it is proportional to the third power of age. (Peto et al 1981: Banbury Report 9, Cold Spring Harbor Laboratory Peto et al 1982: Br J Cancer 45: 124-135)
UK national case-control study of 622 mesotheliomas (512 men, 110 women) and 1420 controls interviewed 2001-2005 65% aged < 65 years at diagnosis Rake et al (2009) Br J Cancer 100: 1175-83
Male mesotheliomas: Duration of asbestos exposure before and after age 30. Odds ratios are relative to 38 cases and 413 controls with no asbestos exposure at work (reference group) Duration after age 30 Duration before age 30 Cases/ controls none <10 years 10 years OR (95% CI) Cases/ OR (95% CI) Cases/ OR (95% CI) controls controls None 38/413 1.0 (ref) 5/21 2.4 (0.9, 6.9) 3/28 1.1 (0.3, 3.7) <10 yrs 59/163 3.9 (2.5, 6.1) 27/76 3.9 (2.2, 6.7) 47/104 4.6 (2.8, 7.5) 10 yrs 19/31 6.5 (3.3, 12.8) 54/53 10.7 (6.4, 17.9) 260/223 12.7 (8.6, 18.6)
Case control study: 512 male mesotheliomas and 1112 male controls. Odds ratios by duration in job category before age 30 compared to 38 cases and 413 controls who only worked in low risk jobs (lifetime risk 0.12%) Nonconstruction high risk Carpenters Plumbers, electricians & painters Other construction Medium risk industrial None 2.6 3.0 5.4 3.0 1.5 <5 years 9.4 8.1 4.0 3.3 2.1 5-9 years 17.6 24.1 12.1 4.3 1.2 10 years 15.1 49.3 16.5 6.7 5.0 Lifetime risk for 10 yrs in category 1.8% 5.9% 2.0% 0.8% 0.6%
Lifetime exposure histories of 512 male mesothelioma cases diagnosed 2000-2004 and 1,112 male controls Highest exposure category Cases Caused by this exposure Controls Yes No* Total OR (95% CI) Occupational exposure Non-construction high risk jobs 144.1 8.9 153 138 17.2(10.1,29.3) Carpenters 86.4 2.6 89 42 33.9(18.5,62.1) Plumbers, electricians & painters 104.8 7.2 112 114 15.6 (9.1,27.0) Other construction 43.0 9.0 52 142 5.8 (3.3, 10.4) Medium risk industrial 51.4 16.6 68 263 4.1 (2.4, 7.1) Other substantial exposure 5.3 1.7 7 27 4.1 (1.6, 10.6) Non-occupational exposure Father exposed 6.8 6.2 13 98 2.1 (1.0, 4.5) None of the above (ref group) - 18.0 18 288 1.0 Total * Number population of cases not caused by exposure 441.8 = Total/OR 70.2* *70.2 512 environmental 1112 cases
Lifetime exposure histories of 110 female mesothelioma cases diagnosed 2000-2004 and 308 female controls Highest exposure category Cases Caused by this exposure Controls Yes No* Total OR (95% CI) Occupational exposure Non-construction high risk 4.0 1.0 5 5 5.1 (1.4, 19.2) Carpenters - - 0 0 - Plumbers, electricians & painters - - 0 2 - Other construction - - 0 1 - Medium risk industrial 18.7 13.3 32 63 2.4 (1.4, 4.4) Other substantial exposure 1.8 0.2 2 1 8.8(0.7,103.0) Non-occupational exposure Father or husband exposed 17.5 19.5 37 86 1.9 (1.1, 3.3) None of the above (ref group) - 34.0 34 150 1.0 Total * Number population of cases not caused by exposure 42.0 = Total/OR 67.8* 110 *67.8 environmental 308 cases
Asbestos lung burdens (fibres > 5µ) in patients with mesothelioma, lung cancer and pneumothorax Million fibres per gram (TEM) Mesothelioma patients Lung cancer patients Pneumothorax patients Born <1970 Born 1970 n (%) n (%) n (%) n (%) <0.025 12 (29.3%) 28 (65.1%) 21 (70.0%) 20 (95.2%) 0.025-0.200 13 (31.7%) 13 (30.2%) 9 (30.0%) 1 (4.8%) 0.200 16 (39.0%) 2 (4.7%) 0 0 Total 41 43 30 21
Why have female rates increased about five-fold in the UK since 1970? Could environmental exposure (~ 0.0001 fibre/ ml) account for the background mesothelioma risk in unexposed men and women, whose lifetime risk is about 0.1%? 1. Exposure from birth or age 20: Risk x 5 2. Continuous exposure (168 hours/week) or at work (10 20 hours/week): Risk >10 times greater
HSE case-control study: Lung cancer risk by duration in high-risk jobs (mainly construction) identified from mesothelioma analysis Duration worked before age 35 Carpenters only 0 yrs <10 yrs 10+ yrs All high-risk jobs 0 yrs <10 yrs 10+ yrs Lung cancers N (%) 273 (92.9%) 13 (4.4%) 8 (2.7%) 125 (42.5%) 84 (28.6%) 85 (28.9%) Controls N (%) 800 (96.6%) 15 (1.8%) 13 (1.6%) 508 (61.4%) 172 (20.8%) 148 (17.8%) Relative Risk 1.0 1.7 3.0 1.0 1.6 2.0 (95% CI) (0.7 4.2) (1.0 9.4) (1.1 2.4) (1.3 2.9) Total 294 (100%) 828 (100%) - - OR adjusted for year of birth, SES and smoking Attributable fraction for all high-risk jobs = 23%. Are one in 4 of all lung cancers in British men caused by asbestos?
World asbestos production 1975 5 million tons 1991 4 million tons 2003 2 million tons
What will future death rates be 1. For mesothelioma? 2. For lung cancer?
Who knew what was happening? Why did amosite use continue in Britain and Australia for about 15 years after crocidolite had been abandoned? S.F. McCullagh, Principal Occupational Physician, James Hardie Industries, Australia J Soc Occup Med`1980 30: 153-6 The Advisory Committee on Asbestos has lately recommended that the hygiene standard for amosite should be 0.5 f/ml, half the limit recommended for chrysotile. The evidence.does not suffice to justify different limits.
Lancet editorial Dec 6 th 2008 Asbestos is a combination of naturally occurring minerals with two primary varieties: chrysotile and crocidolite All forms of asbestos are carcinogenic. Mesothelioma, the most common asbestos-related disease, is caused by inhalation of asbestos fibres In the UK alone, 2,000 people annually die from asbestos exposure. A similar epidemic is likely to arise in developing countries where asbestos is still widely used Despite [Canada s] claims that chrysotile poses a lower health risk than other types of asbestos, it acknowledges that chrysotile is a carcinogen The only way to eliminate asbestos-related disease is to stop the use of all types of asbestos
Christine Rake and Clare Gilham (Institute of Cancer Research) John Hodgson and Andrew Darnton (Health and Safety Executive)
Asbestos regulation and consumption in Asia Takahashi and Karjalainen IJOEH (2003) Imports ($M) Ban Trend blue brown white China 1,275 yes no no up Indonesia 211?? no up Korea 42 yes yes no down Malaysia 23 yes no no flat Philippines 76 yes yes no up Taiwan 22 yes yes no down Thailand 62 yes yes no up Vietnam 78 no no no up
Lung cancer mortality in British men born 1891-1970 British lung cancer death-rates by birth cohort 9000 8000 Rate per million 7000 6000 5000 4000 3000 Born 1896-1900 80% smoked from 1914 (age 16) Born 1891-95 80% smoked from 1914 (age 21) 1891 1896 1901 1906 1911 1916 1921 1926 1931 1936 1941 1946 2000 1951 1956 1000 1961 1966 0 Born 1946-50 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age
British female mesothelioma deaths Number of female deaths in a 3 year period 500 450 400 350 300 250 200 150 100 50 0 65+ 55-64 45-54 0-44 1976-78 1979-81 1982-84 1985-87 1988-90 1991-93 1994-96 1997-99 Year
Lifetime mesothelioma risks in British men PMR Percent of all deaths in 2005 at age 40-79 All British men: 100 0.9% Construction: Plumbers 413 3.7% Carpenters 388 3.4% Electricians 279 2.5% Manufacture: Metal plate workers 503 4.5% Vehicle body makers 526 4.7% Low risk: Farmers 26 0.2% Doctors 28 0.2% Motor mechanics 48 0.4%
UK national case-control study of mesotheliomas (512 men, 110 women) interviewed 2001-2005 Year of birth Unexposed cases Asbestos-exposed cases Male Female Male Female 1965 1 2 1 0 1960-64 0 1 4 0 1955-59 2 7 11 1 1950-54 2 5 42 2 1945-49 14 11 105 6 1940-44 10 21 145 13 1935-39 7 17 82 8 1930-34 1 7 48 5 1925-30 1 2 36 2 Total 38 73 474 37
Chrysotile production + imports 900000 800000 Tonnes of fibre 700000 600000 500000 400000 300000 USA UK Australia 200000 100000 0 1950 1960 1970 1980 1990 2000 Year
Average asbestos consumption (1,000 tonnes p.a.) consumption=production+imports exports (% shown in table) 1950s 1960s 1970s 1980s Australia Blue 6 8 0 0 Brown 9 7 8 <1 White 17 31 74 12 % exported 14% 9% 5% 47% USA Blue 17 14 10 4 Brown 13 17 5 <1 White 626 655 646 182 % exported <1% 3% 6% 24% UK Blue 7 7 0 0 Brown 14 21 ~15 ~1 White 107 131 136 43
Average asbestos consumption (1,000 tonnes p.a.) 1950s 1960s 1970s 1980s Australia Blue 6 8 0 0 Brown 9 7 8 <1 White 17 31 74 12 USA Blue 17 14 10 4 Brown 13 17 5 <1 White 626 655 646 182 UK Blue 7 7 0 0 Brown 14 21 ~15 ~1 White 107 131 136 43
Amphibole imports into UK and US 30000 25000 UK Amosite US Amosite US Crocidolite UK Crocidolite 20000 Tonnes of fibre 15000 10000 5000 0 1940 1950 1960 1970 1980 1990 Year
Mesothelioma deaths in Britain and predicted numbers based on new HSE model 2000 Hodgson et al (2005) Br J Cancer 92: 587-93 Annual deaths. 1500 1000 500 Observed Predicted 0 1960 1980 2000 2020 2040 2060 Year
Projected British male mesothelioma deaths all deaths (red) and deaths below age 80 (purple) Hodgson et al (2005) Br J Cancer 92: 587-93 2000 Exposure index Deaths 200 Mesothelioma deaths 1500 1000 500 150 100 50 Exposure index 0 1940 1960 1980 2000 2020 2040 0 Fitted/projected deaths Observed deaths Exposure index (fitted/projected) Deaths at ages<80
Most Western countries Most or all asbestos products are now banned. Mesothelioma rates are still rising in old age, but are level or falling at younger ages in countries that have stopped using asbestos products. Rest of the world Asbestos use is continuing and in some cases increasing. Leading consumers include Russia, India and most other Asian countries except Japan.
Crocidolite imports + production 25000 20000 USA UK Australia Tonnes of fibre 15000 10000 5000 0 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 Year