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The landmark paper by Wagner et al1 published in this journal in 1960, which linked work with crocidolite asbestos and mesothelioma in South Africa, has been instrumental in the dramatic reduction in asbestos mining and other measures to reduce asbestos exposure, most successfully in developed countries. This contrasts sharply with the lack of progress in newly industrialising countries, in particular large countries such as Brazil, China and India, which continue to produce, import and use large amounts of chrysotile asbestos.
There have been several recent developments in the state of the science relating to asbestos-related cancers which have strengthened the call for more intensive action to cease asbestos mining, the manufacturing of asbestos products and to reduce exposure from existing asbestos-containing materials. In the UK, the spectrum of workers at high risk of developing mesothelioma has been changing, with a decline in those involved in mining and manufacturing and the rise in risk in carpenters, plumbers and other tradespeople, which highlights the flow-on health effects on downstream workers.2 Such findings are likely to increase the timeframe of the peak of the epidemic curve for mesothelioma, currently estimated to be within the next 10 years in Australia, where bans were first introduced more than 30 years ago.3 In addition, a recent paper in this journal has identified that fibre length is an important factor in increasing the risk of lung cancer among those who are exposed to chrysotile.4 There is also increasing evidence of non-occupational (domestic and environmental) asbestos exposure increasing in proportion as a cause of mesothelioma and other asbestos-related disease, which again demonstrates the ripple effect of health risks to those in proximity to asbestos workers.5 ,6
As a result of this increasing scientific evidence base, the International Agency for Research on Cancer, as part of its recent re-evaluation of all Group 1 carcinogens in Volume 100 of its Monograph series, concluded there is sufficient evidence in humans for the carcinogenicity of all forms of asbestos (chrysotile, crocidolite, amosite, tremolite, actinolite, and anthophyllite).7 Further, it concluded that asbestos causes cancer at several sites in the body, with the strongest evidence being for mesothelioma and cancer of the lung and larynx. While there is some continuing scientific debate about the different degrees of potency for the various forms and sizes of asbestos, this should not be used to hinder efforts to further reduce asbestos mining and manufacture, where the state of the science is clear enough to prompt action.8
In 2012 two influential international professional bodies have urged the need for further action in the elimination of asbestos and the reduction of asbestos related diseases. The International Commission on Occupational Health (ICOH) has called for a total ban on the production and use of asbestos and for ICOH members and member organisations to introduce greater efforts aimed at primary, secondary and tertiary prevention of asbestos-related diseases.9 This is particularly important for those working with asbestos products which are already in existence in the community, which require other protective measures, as bans on asbestos production and export are already too late.
The Joint Policy Committee of the Societies of Epidemiology, after its own review of the scientific evidence of asbestos and cancer, released a Position Statement in 2012 calling for similar action (ban on the mining, use and export of asbestos) and has highlighted the looming epidemic in industrialising countries of asbestos related disease, which are yet to peak even in developed countries despite bans on asbestos use being in place for some decades.10 This Position Statement highlights the need for greater information about the risks from asbestos to be given to the public and to oppose efforts by asbestos lobby groups to intimidate scientists who work in this field of research.
Such international efforts appear to be making some headway. Canada, after considerable international pressure and many years of intransigence regarding its continued mining and export of chrysotile asbestos, announced in September 2012 that it would drop its efforts to prevent the listing of chrysotile as a dangerous substance under the Rotterdam Convention. This followed the decision by the newly elected Quebec government to cancel a $58 million loan to keep the last chrysotile mine in Canada operational. In parallel the Chrysotile Institute, an asbestos mining lobby group based in Montreal and which has been a strong promoter of the continued mining and use of chrysotile, closed its offices.
One of the main arguments which had been used by this lobby group and similar groups in other countries is that because asbestos has been around for many decades and has been the subject of considerable research about its cancer risks, the methods to control its use are well known and so it can be safely used. The inadequacy of this argument is readily apparent to anyone with any knowledge of the poorly developed regulatory approach to asbestos and other workplace hazards in many newly industrialising countries. The Asian Asbestos Initiative has been expanding its influence in Asia, which is the geographical area where the largest problem exists. Pressure for a total asbestos ban is building in countries such as Thailand and South Korea, although progress in the two largest countries in Asia, China and India, remains a challenge. This is also the topic of high level debate In other parts of the world, such as Brazil.
As a major publisher of many of the key scientific papers which have documented the health risks from asbestos exposure, Occupational and Environmental Medicine lends its weight to these international efforts to eliminate the mining of asbestos and the manufacture of asbestos containing products and to take steps to reduce exposure to existing asbestos materials, both in the workplace and the general community. Despite some recent progress, much remains to be done if we are to have any hope of consigning asbestos-related disease to the scientific archive by the centenary of Wagner's paper in 2060.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.
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