Monday, March 8, 2010

Is Asbestos-related Disease a Pandemic?

Last week I attended a conference on Asbestos Surveillance and Compensation. On presentation by Dr. Leslie Stayner (Professor and Director of the Division of Epidemiology and Biostatistics at the School of Public Health, University of Illinois at Chicago) asked the provocative question, “Is there really a pandemic of Asbestos diseases?”

I suppose one way to answer this questions is to ask if Asbestos is causing the same sort of damage as other pandemics. Pandemic H1N1 influenza is a current and convenient comparator. The World Health Organization recently stated, “As of 28 February 2010, worldwide more than 213 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 16,455 deaths.” By comparison, Stayner pointed out that WHO estimates from 2006 placed the occupationally-related deaths from asbestos disease at approximately 90,000 per year:
  • 43,000 Mesothelioma
  • 39,000 Lung Cancer
  • 7,000 Asbestosis
He points out that this estimate does not include other cancers such as Laryngeal and ovarian cancers that may be asbestos related.

The next way to evaluate his claim that asbestos disease is a pandemic is to see if it really is represented worldwide. Quoting from various research sources, professor Stayner showed the distribution of mesothelioma alone was covered much of the planet with the highest rates of disease in countries with the highest consumption of asbestos. While Australia had the greatest number of cases mesothelioma deaths per million per year, other countries such as Canada, the US and Great Britain were in similar territory. Countries from Asia, South America and Europe were also widely represented. Africa does not register highly in this analysis (but that may be changing).

So, on the face comparison with pandemic H1N1, asbestos-related disease has almost the same spread and actually a greater number of deaths.

Stayner’s point is that we need to think about asbestos-related disease as being an active disease of the present and not of the past. He notes that asbestos disease is on the rise in most of the world and that production and consumption of asbestos has remained relatively flat (although down in developed countries, increasing in the developing nations). He adds that we can expect the epidemic in the developed world to start to gradually decrease in 10 to 20 years; based on consumption, he expects to see increases in developing nations.

It is important to note that asbestos persists in our environment. The installed base of products with asbestos are going to be with us for a very long time.

As we saw with pandemic H1N1 influenza, once you attach the pandemic label, funds and resources as well as public attention may be brought to bear on prevention, treatment and control. Elimination of disease is the ultimate objective.

Stayner concluded his presentation with the following quote from the WHO 2006 Report on the Elimination of Asbestos-related diseases:

“The most efficient way to eliminate asbestos-related disease is to stop the use
of all types of asbestos.”

Perhaps he is right. Perhaps we should start thinking about asbestos-disease as a pandemic and bringing resources, education, and prevention efforts to eliminate asbestos-related disease.

1 comment:

Zanuck said...

A somewhat tangential comment:

I have reservations about the use of the term "pandemic" in this context. It strikes me as using a currently "hot" term to gain attention at the cost of blurring or diluting the meaning of the term.

Currently, a "pandemic" requires three conditions:
1) a source of illness against which humans have no or little immunity;
2) the source must make humans ill;
3) the source must be efficiently transmissable from human to human.

I don't think asbestos-related disease qualifies under point 3.

My reservations stem from the concern and confusion engendered during the recent "Pandemic H1N1" event. In the lead up to the pandemic, the word pandemic was used to conjure images of mass deaths and societal disruption on a scale of the 1918 Spanish Flu or the Black Death of the middle ages. In effect, "pandemic" was conflated with "high mortality".

In retrospect, I think this sloppy use of the term pandemic hampered us in our contingency planning and also cost us credibility when the actual pandemic infection turned out to be a relatively mild illness.

In a nutshell, my preference would be to use another term but I realise this is probably being pedantic. Ideally, I think we need a new definition or terminology which includes a measure of the severity of the consequences of the illness.