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Medical aspects of asbestos exposure

Medical aspects of asbestos exposure. Sjaak Burgers respiratory physician Netherlands Cancer Institute, Amsterdam. s.burgers@nki.nl. Medical consequences. mesothelioma asbestosis lung cancer benign pleural plaques. Today. Medical introduction Asbestos mesothelioma lung cancer

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Medical aspects of asbestos exposure

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  1. Medical aspects of asbestos exposure Sjaak Burgers respiratory physician Netherlands Cancer Institute, Amsterdam s.burgers@nki.nl

  2. Medical consequences • mesothelioma • asbestosis • lung cancer • benign pleural plaques

  3. Today • Medical introduction • Asbestos • mesothelioma • lung cancer • (Problems in) risk assessment

  4. Mesothelioma captures the lung

  5. Mesothelioma captures your breath

  6. Mesothelioma: local growth

  7. Mesothelioma: high mortality survival with the BEST available treatment Cisplatin vs cisplatin-pemetrexed. Vogelzang, JCO 2003

  8. Lung cancer • 15% cure rate • 50% 1-year mortality • 90% smoking-related • asbestos • increases the risk for lung cancer • more than adds to the smoking-induced risk 40-y old women. Lung cancer recently diagnosed.

  9. Risk assessment • Whatever the risk is, • the consequences are life threatening.

  10. Difference between exposure to • asbestos and • sigarette smoke

  11. Mesothelioma mortality in North American insulation workers is independent of age Age at first exposure (years) ---- 15-24 ---- 25-34 ---- 35+ Peto et al 1982: Br J Cancer 45: 124-135

  12. Lung cancer mortality is almost constant in ex-smokers Age stopped 60-64 55-59 50-54 40-49 Halpern et al 1993: JNCI 85, 457

  13. Evidence • individual data • “All my colleagues died of this disease”. • local data • national data • global data

  14. Environmental exposure: Cape blue asbestos • 33 cases • median age 49y (31-68y) • exposed to asbestos no other cases in South Africa Wagner et al Br J Industr Med 1960

  15. Environmental exposure:Dutch example mesothelioma incidence in the Netherlands, females

  16. Environmental exposure • roads paved by Eternit remnants • mean exposure 0,11 fiber years • expected 4 cases, observed 26 cases

  17. 2 national examples

  18. Projected British male mesothelioma deaths Hodgson et al (2005) Br J Cancer 92: 587 Deaths Exposure index 2000 200 1500 150 Exposure index Mesothelioma deaths 1000 100 500 50 0 0 1940 1960 1980 2000 2020 2040 Fitted/projected deaths Exposure index (fitted/projected) Observed deaths

  19. Banning asbestos helps 1977 1993 1982

  20. Global data:asbestos consumption /meso deaths Lin, Lancet 2007 Nawrot, Lancet 2007

  21. Translation to risk assessment • still no answer to the question • “What is the risk that a particular person gets cancer due to a particular asbestos exposure?”

  22. Complicated exposure-response relation for mesothelioma • I=incidence; t= time since exposure; f=fiber count; d=duration of exposure; KM= fiber dependent EPA, 1986

  23. Is there a safe exposure level? Theoretically there is; Netherlands Health Counsil: Risk level: likelyhood of dying of cancer as a result of exposure current Dutch safety level 0.02 fibres/ml = 1/10 of EU standard

  24. Thus, • abundant evidence relating asbestos to mesothelioma and lung cancer • exact risk levels hard to calculate

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