Asbestos as an environmental and a health problem

ASBESTOS AN ENVIRONMENTAL AND

A HEALTH PROBLEMBY

Dr. Hussein Fatehy Mahmoud

PhD-FCCP -MCTSCONSULTANT PULMONOLOGIST

Abbassia Chest Hospital Cairo-Egypt

AGENDA Asbestos overviewAsbestos- an environmental problem Asbestos-a health problem Role of Egyptian press media in Asbestos banning Role of Egyptian Government in Asbestos banningTake home message

Asbestos overview

Asbestos Definition

The word asbestos derives from a Greek word meaning “inextinguishable”

What is Asbestos•Naturally occuring fibrous minerals .•All types of asbestos tendto break into very tiny fibers.•These individual fibers are so small they must beidentified using a microscope.•Some fibers may be up to700 times smaller thana human hair.

What is Asbestos?Because asbestos fibers are so small, once released into the air, they may stay suspended there for hours or even days.

Asbestos: Types Asbestos: Types

Serpentine(93% of commercial use)

Amphibole(7% of commercial use)

ChrysotileActinolite, Amosite, Anthophyllite, Crocidolite, Richterite, Tremolite

UW-Eau ClaireFacilities Planning & Management

Common Types Of Asbestos

Note: The general use of asbestos is now banned. Blue and BrownAsbestos banned in 1985, white in 1999.

Properties of Asbestos

Asbestos ore

• Good tensile strength

• Flexible

• Heat resistant

• Electrical resistance

• Good insulation

• Chemical resistantAsbestos fibers

Because of these unique properties, asbestos was used extensively in variety of products.

Uses of Asbestos

• Pipe insulation

• Surfacing insulating materials

• Reinforcement of materials

• Fireproofing

• Acoustic and decorative plaster

• Textiles

Asbestos insulated pipe

Asbestos insulated boiler

Asbestos has been used for centuries, but greatly increased during and after World War II in ship insulation and the following:

Use has greatly declined since the late 1970’s

Uses of Asbestos

Vinyl asbestos flooring

Sprayed-on fireproofing material

Sheet vinyl containing asbestos

These products may be found in homes and buildings constructed before 1981.

Asbestos cement pressure pipesUsed for water supply

Country                      US $

Iran 26,019,000

United Arab Emirates 10,787,000

Egypt 1,996,000

Pakistan 1,357,000

Lebanon 1,123,000

Oman 590,000

Iraq 194,000

Saudi Arabia 161,000

Syrian Arab Republic 6,000

Value of Asbestos Imports (2003)

http://www.nrcan.gc.ca./mms/cmy/content/2003/20.pdf

Chrysotile Asbestos Imports for EM Region (tonnes) Country 1960 1970 1975 1980 Iran 1246 11,197 24,814 23,392 United Arab --- --- 2000 4631 EmiratesEgypt 6583 6609 5477 4387 Pakistan --- --- 7000 10,679 Iraq 450 2000 1482 --- Saudi Arabia --- --- 10,405 52,225 Syrian Arab --- --- 3391 4076 RepublicMorocco 2676 3551 7160 6770 Lebanon 2258 6418 --- --- Total 13,213 29,775 61,729 106,160 The data in the table come from statistics compiled by the United States Geological Survey.

Asbestos-an environmental problem

Natural sources (erosion of asbestos containing rocks)Residence in the viciniy of mines or plants manufacturing asbestos productsRelease of fibers from public, residential and commercial buildings containing friable asbestosContamination of homes by work clothes

Asbestos environmentalexposures

The World Health Organization estimates that 60% of the 125 million people exposed to asbestos in their homes or workplace .

Broken bags of asbestos cement lie in open storage

Airborne asbestos fibre counts at various locations surrounding

Sigwart El Maasara (Zakaria et al., 1989)

f/cc Location Range meanNorth 0.21 0.21North west 00 00 South east 0.42-8.3 4.6(Autostrade road)South west 0.17-0.25 00East 3.8 - 5.4 3.45 Zakaria, Y., El Zahabi, M., Hussein, M., El Karim, A., 1989. Neighborhood‐

risks of asbestos exposure and malignant mesothelioma. EgyptianJournal of Chest Diseases and Tuberculosis 36, 71 80‐

Airborne asbestos fibre counts in the residential areas surrounding the Sigwart El Maasara

f/cc Location Eldin et al. (2005) Eldin (2008) Mean meanEl Maadi (~5 km ) 0.002 0.0044‐Hadayk Helwan 0.02 0.069 El Maasara 0.062 0.0887El Maasara (the main gate) 0.057 0.358‐Autostrade 3.02 0.1407East, 25 m of the factory wall 0.058

Eldin, N., 2008. Airborne asbestos fibers around Sigwart Al Maasara andORA Egypt. Technical Report, National Cancer Institute, Cairo‐University, Egypt.Eldin, N., Gaafar, M.R., Abdel Hameed, A.A., Abdelrahman, M.A.,Aboulkassem, F., 2005. Mesothelioma in Egypt. Egyptian Journal ofCommunity Medicine 23, 41 45‐

OSHA Permissible Asbestos Exposure Limits

The Occupational Safety and Health Commission (OSHA) has set a

permissible asbestos exposure limit (“PEL”) of 0.1 fiber per cubic centimeter (f/cc) for work in all industries.

Despite Limits, No Safe Level of Asbestos ExposureAsbestos Standard For General Industry - OSHAwww.osha.gov/Publications/osha3095.pdf

Asbestos is an Inhalation Hazard

• Tiny breathable asbestos fibers are deposited in the alveoli, the ending small air sacs in the lungs.

• The body’s defense mechanisms cannot break down the fibers.

• Asbestos fibers cause damage to the lungs.

• The fibers may also travel to the pleura, the membrane lining the outside of the lungs.

Airborne asbestos fibers inhaled deep into the lung can cause damage.

Alveoli

Pleura

Asbestos-a health problem

Asbestos-related diseases

• Amount of fibers inhaled• Length of exposure• Whether exposed worker

smokes• Age – because of delayed

effects

The potential for asbestos related disease depends on:

Don’t smoke! An asbestos worker is at much greater risk of developing lung cancer if he/she smokes.

Asbestos and smoking – the multiplicative effect

• 20 pack years of smoking gives 10-fold increased risk of lung cancer over lifelong non-smoker

• 40 pack years gives 40-fold increased risk

• Asbestos exposure increases these figures by 1.4 with light exposure (plaques only); and 8 times with heavy exposure (asbestosis)

Kouki Inai, M.D., Ph.D. Hiroshima University, Japan

Asbestos related diseases

•Pleural –Asbestos related pleural plaques–Benign pleural effusions–Pleural thickening–Mesothelioma

• Pulmonary–Asbestosis–Lung cancer

Pleural plaque•Usually first identified > 20 years after initial exposure•Occur in 50% persons exposed to asbestos•Parietal pleura adjacent to ribs, particularly along 6th-9th ribs and along diaphragm•Calcifications on CXR in 20% and on chest CT in 50%•Plaques alone are not associated with malignancy

Photograph (original magnification, approximately ×0.5) shows multiple raised pearly plaques that arise from the

parietal pleura.

Roach H D et al. Radiographics 2002;22:S167-S184

©2002 by Radiological Society of North America

Pleural Plaques

Diffuse Pleural Thickening • Diffuse thickening of parietal pleura Involves diaphragmatic pleura,

extends up lateral chest wall• Commonly obliterates costophrenic

angles• Spares apices of lungs • Associated with rounded atelectasis.

Diffuse Pleural Thickening

Benign asbestos pleural effusion• Most common pleuropulmonary manifestation

within the first 20 years of exposure… but can present <1 post-exposure to >50 years after first exposure

• Typical presentation: acute pleuritic CP, fever, other systemic sx but can be insidious

• Can resolve spontaneously• Pleural fluid analysis: exudative, serosanguinous,

predominance of eosinophils, cytology with atypical macs, occasionally positive for RF

• Rounded atelectasis and/or diffuse pleural thickening may be sequelae

Axial CT scan of an asbestos-exposed person shows a left-sided pleural effusion (arrow).

Roach H D et al. Radiographics 2002;22:S167-S184

©2002 by Radiological Society of North America

Asbestos – A Carcinogen

Asbestos is 1 of over 130 occupational carcinogens listed by the U.S. Government

HAWKINS PARNELL

THACKSTON&YOUNGLLPSource: www.cdc.gov

What is asbestos-related lung cancer?Asbestos-related lung cancer functions like most lung cancers. It is made up of a tumor (or multiple tumors) in the lungs. Lung cancer can be broken into two specific categories;

Small Cell CancerA fast-growing type of lung cancer, small cell lung cancer can be broken down into three categories;

•Mixed small cell/large cell carcinoma

•Combined small cell carcinoma

•Small cell carcinoma (also known as oat cell cancer) this is the most common variety of small cell lung cancer.Small cell makes up approximately 15% of all lung cancers. The cancer cells are small in the very early stages, but then grow rapidly to form large tumors .These tumors then spread (or metastasize) affecting other areas of the body. The cancer can quickly become life-threatening once the tumors have spread to the surrounding vital organs such as the heart, brain, bones, or liver.

Non-Small CellNon-small cell lung cancer (or NSCLC) is the most common

type of lung cancer, and grows slower than small cell lung cancer.

NSCLC can be broken down into three varieties:

•Squamous cell carcinoma – the cancer cells are typically found

in the center of the lung near the bronchus (airway passage that

conducts air into the lungs)

•Adenocarcinoma –the cancer cells develop in the outer area of the lung

•Large cell carcinomas – a fast spreading lung cancer type that can

develop anywhere in the lungs

Small Cell Carcinoma

Large Cell Carcinoma

Adenocarcinoma

Squamous Cell Carcinoma

Asbestosis • Symptoms may include

dyspnea and cough• Bilateral crackles .• Pulmonary function

tests may reveal:– Reduced diffusing

capacity– Restrictive pattern on

PFTs

Histopathologic view of asbestosis

Mesothelioma

in Egypt

Epidemic features of mesothelioma in Egypt during the periods

Years Epidemic features of mesothelioma1989 1999‐ ‐ 148 cases of MPM were diagnosed and treated at NCI,

Cairo Univ., Egypt. ‐ Median age was 48 (17 85) years‐ ‐ Young adults < 40 years represented 29.7%. ‐ Male/female 1.7 ‐ Residential asbestos exposure was 81.1% ‐ Occupational 13.5%. ‐ Median duration of exposure was 32 years ‐ Median overall survival was 7 months.

1989 2003 (Eldin et al., 2005)‐

Epidemic Features of Mesothelioma In Egypt(cont)

2000 2003‐• - 635 cases of MPM were diagnosed at NCI and Abbasia

Hospital Cairo,Egypt.• ‐ Median age was 53 (19 90) years.‐• ‐ Young adults < 40 years represented 19.1%.• ‐ Females represented 39.2%• ‐ Residential exposure was evidenced in 64.7% of cases(Shoubra El‐

kheima 35.6%, El Maasara 23.6%, and El Zytoon 5.2%).• ‐ 25% came from other Cairo areas and 9.8% from other

governorates.

Eldin, N., Gaafar, M.R., Abdel Hameed, A.A., Abdelrahman, M.A.,Aboulkassem, F., 2005. Mesothelioma in Egypt. Egyptian Journal of Community Medicine 23, 41 45‐

Number of MPM cases diagnosed at Abbassia Chest Hospital in the period from 1998 to 2008

Year No. of Cases1998 421999 462000 792001 802002 892003 1222004 962005 1352006 1402007 1262008 128

Total 1083

Mesothelioma In Egypt

Malignant pleural mesothelioma is an increasing disaster in Egypt which is under estimated and neglected. Mesothelioma in Egypt is mainly attributed to an environmental origin i.e. exposure to asbestos, with a high incidence in women and young adults.

Ismail HM et al (2006):. Journal of the Egyptian Nat. Cancer Instit, vol. 18, No. 4: 303-3120.

Map of Greater Cairo

Industrial areas highly polluted with asbestos

Data obtained from the information network of the General Organization for Industrialization in Egypt, showed that 14 asbestos factories were present in Egypt in the year 2004.

These factories affect an area of approximately 5-7 km in radius, which explains the high incidence of mesothelioma in the neighborhood of these factories.

workers employed since 1948 by the Egyptian asbestos company Sigwart at the mills in greater Cairo (El-Maasara and Shubra El-Khemia) had an increased risk of mesothelioma.

Kazan Allen L (2006): Asbestos: the environmental hazard. In: Proceedings of the International Conference Asbestos Risk Reduction and Measurement of Asbestos Fibre concentration, Cracow, ploand, September 28-29: Krakow, Faculty of Materials Science and Ceramics, AGH University of Science and technology (www.Ceramika.agh.edu.pl/azbesto612. pdf, accessed 11 August 2008).

%

This study aimed to: 1. Evaluate the prevalence of MPM due to

occupational and environmental (non-occupational) exposure to asbestos among persons who had worked in asbestos manufacturing plant and in persons living in an area nearby the plant with potentially significant population exposure.

2. Estimate exposure-response relationships between environmental exposure to asbestos and mesothelioma.

This study aimed to: 1. Evaluate the prevalence of MPM due to

occupational and environmental (non-occupational) exposure to asbestos among persons who had worked in asbestos manufacturing plant and in persons living in an area nearby the plant with potentially significant population exposure.

2. Estimate exposure-response relationships between environmental exposure to asbestos and mesothelioma.

Aim of the Work

Sampling areas: 1) Asbestos plant (SigwartStore) 2) El-Wehda El-Arabia(100m) 3) Manshiyt El-Horriya (1Km) 4) Ezbet Rostom (2.5 Km) 5) Ezbet Osman (1 Km) 6) El-Manshiya El- Gadida (800m)7) Manshiyet Abd El-moneim Riyad (2 Km)

Map of Shubra El-Kheima city with superimposed direction and

speed of wind.

Sampling areas: 1) Asbestos plant (SigwartStore) 2) El-Wehda El-Arabia(100m) 3) Manshiyt El-Horriya (1Km) 4) Ezbet Rostom (2.5 Km) 5) Ezbet Osman (1 Km) 6) El-Manshiya El- Gadida (800m)7) Manshiyet Abd El-moneim Riyad (2 Km)

Map of Shubra El-Kheima city with superimposed direction and

speed of wind.

Subjects and Methods

Direction and speed of wind

The mean age of malignant pleural mesothelioma casesThe mean age of malignant pleural mesothelioma cases

Results

Sex No. of cases Percent Mean age (y) SD Range

Male 34 38.6% 54.1 8.45 39 – 70

Female 54 61.4% 49.5 7.39 35 – 60

Both male & female 88 100% 51.3 8.08 35 – 70

Age Distribution in 88 cases of malignant pleural mesothelioma Age Distribution in 88 cases of malignant pleural mesothelioma

Age No. ( % )

20 – 24 0 0

25 – 29 0 0

30 – 34 0 0

35 – 39 10 11.4

40 – 44 6 6.8

45 – 49 15 17

50 – 54 16 18.2

55 – 60 33 37.5

> 60 8 9.1

T test = 2.6 P = 0.009 HS = Highly significantT test = 2.6 P = 0.009 HS = Highly significant

Risk of mesothelioma among exposed

and non exposed groups.

Risk of mesothelioma among exposed

and non exposed groups.

Results

Mesothelioma cases

Exposed groupNo= 3400

Non Exposed group

No= 979

No % No %

+ve 87 2.6 1 0.1

-ve 3313 97.4 978 99.9

Relative risk (RR)= 26Relative risk (RR)= 26

Airborne asbestos fiber concentration in the surrounding areas outside the asbestos plant and

number of MPM cases.

Airborne asbestos fiber concentration in the surrounding areas outside the asbestos plant and

number of MPM cases.

Results

Area No of MPM cases

Fiber concentration (f/ml)

Mean SD

El-Wehda El-Arabia (100m) 39 2.16* 0.16

El Manshiya El Gadida (800m) 17 0.04 0.01

Manshiyet El Horriya (1km) 8 0.021 0.0005

Ezbet Osman (1km) 9 0.021 0.002

Manshiyet Abd El Moneem Riyad (2km) 6 0.025 0.004

Ezbet Rostom (2.5km) 4 0.021 0.003

Total 83 0.38 0.87

Control 0.0021 0.013F = 47.01 * = P<0.01 F = 47.01 * = P<0.01

Malignant Pleural Mesothelioma

Malignant Pleural Mesothelioma

Role of Egyptian press media in Asbestos banning

Al-Ahram Weekly3 - 9 June 1999Issue No. 432

What are you doing about the manufacturing of asbestos, and the trade in this substance, which has been proven to cause cancer?

The decision to halt the importing of asbestos -- a bold and important step -- was taken by the Minister of Supplies and Trade Dr Ahmed Guweili. As for the Sigwart Asbestos Factory at Al-Ma'assara, the plant is under continuous inspection, and will remain so until it has complied with the law by installing a fully-enclosed system that will prevent waste escaping into the surrounding area.

Interview by Mahmoud Bakr and Sherine Nasr

: العدد أكتوبر ( 1471مجلة الثاني ) كانون يناير 2005السبت

Role of Egyptia

n Government

in

Asbesto

s banning

األهرام 2004أكتوبر 6جريدة

PREPCOM 3 for the Further Development of a Strategic Approach to International Chemicals Management (SAICM)

Tarek Eid El Ruby, Egypt, asked to retain reference to asbestos. Austria Center Vienna, site of SAICM PrepCom-3.

Vienna |

Egyptian Pollution Abatement ProjectHazardous Waste Management Manual For Industries Final Draft

Prepared by

EnvironicsManagement of Environmental Systems

July 2002

رقم األسبوعى العدد الوفد في 1087جريدة الصادر23/12/2004

REGIONAL WORKSHOP ON THE IMPLEMENTATION OF STOCKHOLM CONVENTION AND SYNERGIES WITH OTHER CHEMICAL RELATED AGREEMENTS

CAIRO – EGYPT (21-24 February 2005)

Proceedings Near East Consultation on the Rotterdam

Convention on the Prior Informed Consent Procedure for Certain Hazardous Chemicals and Pesticides in International Trade

Cairo, Egypt 29 May – 1 June 2005

Secretariat for the Rotterdam Convention on the

Prior Informed Consent Procedure for Certain HazardousChemicals and Pesticides in International Trade

Take home message

TAKE HOME MESSAGES • The major route of exposure to asbestos is inhalation

• There is no known “safe” level of exposure

•Asbestos becomes a health hazard when fibres become airborne.

•Asbestos is extremely hazardous.

•All types of Asbestos are carcinogenic to human

•Though, the importation of raw Asbestos into Egypt was banned on November 2004 ,the threat of developing Asbestos related diseases will remain for a considerable period of time due to latency period.

• clinicians in both primary and secondary care should have high index of suspicion in persons with environmental exposure to asbestos.

• Periodic monitoring of the environment for permissible exposure limits (PEL).

• Increasing awareness for the public regarding the risk of asbestos exposure. • periodical medical checks for population at risk living in

Shubra El Kheima and Helwan with its surrounding areas

• Attention should be directed to small informal workshops which use asbestos with high risk of significant environmental exposure

• clinicians in both primary and secondary care should have high index of suspicion in persons with environmental exposure to asbestos.

• Periodic monitoring of the environment for permissible exposure limits (PEL).

• Increasing awareness for the public regarding the risk of asbestos exposure. • periodical medical checks for population at risk living in

Shubra El Kheima and Helwan with its surrounding areas

• Attention should be directed to small informal workshops which use asbestos with high risk of significant environmental exposure