Friday, April 1, 2011

Asbestos and Risk of Cancer

Asbestos (from Greek σβεστος or asbestinon, meaning "unquenchable" or "inextinguishable") is a set of six naturally occurring silicate minerals exploited commercially for their desirable physical properties. They all have in common their asbestiform habit, long, thin fibrous crystals. The inhalation of asbestos fibers can cause serious illnesses, including malignant lung cancer, mesothelioma (a type of cancer strongly associated with exposure to amphibole asbestos), and asbestosis (a type of pneumoconiosis). Long exposure to high concentrations of asbestos fibers is more likely to cause health problems, as asbestos exists in the ambient air at low levels, which itself does not cause health problems. The European Union has banned all use of asbestos and extraction, manufacture and processing of asbestos products.

Asbestos became increasingly popular among manufacturers and builders in the late 19th century because of its sound absorption, average tensile strength, and its resistance to heat, electrical and chemical damage. When asbestos is used for its resistance to fire or heat, the fibers are often mixed with cement or woven into fabric or mats. Asbestos was used in some products for its heat resistance, and in the past was used on electric oven and hotplate wiring for its electrical insulation at elevated temperature, and in buildings for its flame-retardant and insulating properties, tensile strength, flexibility, and resistance to chemicals.
Worldwide, at least 90 000 people die every year from illnesses resulting from occupational exposure to asbestos. However, this number only takes into account workers and ex-workers who have been identified with asbestos-related lung cancer, mesothelioma, and asbestosis. But asbestos has also been linked to laryngeal and ovarian cancer. Factor in asbestos-related illness among individuals whose work history has not been recorded, the family members of those who work with asbestos, and people living near asbestos factories and mines, and the death toll is much higher.

The lengthy latency period of asbestos-related malignant diseases—in some cases more than 40 years—means that even in countries that no longer use the material, the disease burden continues to rise. The UK, for example, banned all forms of asbestos in 1999 but at least 3500 people die from asbestos-related illnesses every year, and this figure is expected to increase to about 5000 in the coming years.
All of which has prompted more than 40 countries—including all member states of the European Union—to ban chrysotile. The World Bank has determined not to use it in any new development projects; and WHO has noted that “the most efficient way to eliminate asbestos-related disease is to stop using all types of asbestos”.

Nevertheless, about 125 million people across the globe are exposed to Asbestos in their working environment. Worldwide production remains at roughly the same level as in 1960: nearly 2·2 million metric tonnes per year. Vast development projects in Asia are largely responsible for maintaining the market. In particular, India’s asbestos industry is burgeoning. Only in first decade of 21st century, the demand of asbestos in India has doubled from roughly 125 000 metric tonnes to about 300 000. Nearly all of India’s asbestos is mixed with cement to form roofing sheets. The health consequences especially rise in lung diseases in India are already well known, but for various political reasons, the cause behind this meteoric rise in lung diseases has never been attributed to the extensive use of asbestos or at least there has been no campaigns by government agencies to make people aware about the consequences of using this disastrous material. Though mesothelioma has never been documented as a major cancer in India, however we can not ignore the fact that current health system which is primarily under control of government of India, does not have sufficient resources to record death and diseases and most of the deaths due to any disease especially in rural areas go unnoticed and without proper diagnoses due to poor infrastructure in medical health.  Besides, there is nihilistic attitude prevailing among people as well health care providers towards cancer in India as it primarily victimizes older people.  Therefore I believe that there is a need for a real assessment of asbestos related diseases especially mesothelioma in order to achieve real statistics.

Also, it is important to notice that out of India’s 300 or so medical schools, few have a training program in occupational health. Out of several thousands of physicians in India, only few of them have had training in occupational health. Consequently, asbestosis is frequently misdiagnosed as tuberculosis or bronchitis. The latest cancer registry data have no information on mesothelioma. The health and safety legislation does not cover 93% of workers in the unorganized sector where asbestos exposures are extremely high. Workers remain uninformed and untrained in dealing with asbestos exposure. Enforcement agencies are not fully conscious of the risks of asbestos exposure. Industrial hygiene assessment is seldom carried out and pathologists do not receive training in identifying mesothelioma histopathologically. The lack of political will and powerful influence of the asbestos industry are pushing India toward a disaster of unimaginable proportion. Rapidly industrializing India is described by the International Monetary Fund as a young, disciplined, and vibrant economy with an average GDP of 8.6% for last 4 years. But now it is time to introspect and question: are Indians going to pay a heavy price in the terms of health for this rapidly growing economy???

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