Asbestos fibres have potent cancerogenic and fibrogenic properties and may lead to development of cancer and fibrosis in the lung parenchyma and pleura. The Danish Ministry of Employment has established rules which should prevent development of disease when working with asbestos in future but, on account of the very long latent period between exposure and development of asbestos-related disease, these conditions will still occur during the next 30-40 years. Primarily, the more benign pleural plaques will be concerned but serious disease such as bronchial carcinoma and pleural mesothelioma will occur in the future. When patients are encountered who present symptoms or objective/paraclinical findings which are compatible with disease produced by asbestos, it is important to remember that exposure to asbestos may be many decades ago and, particularly where the malignant conditions are concerned, exposure need not have been particularly massive or prolonged. All cases where asbestos-related disease is suspected should be notified to the insurance administration.
This paper discusses the different explanatory models and the contested perceptions of cancer etiology among residents of two Anatolian villages and migrants from these villages in Turkey, Sweden, and Germany. These communities suffer from an endemic, deadly cancer called mesothelioma, the cause of which is associated with exposure to an environmental carcinogenic substance, erionite, which is present in large deposits in the ground, in the stones, and white stucco that the villagers used to build their homes, and in the air in the form of dust. However, an examination of patients' disease trends, experiences, and local explanations has led to new investigations of possible familial risk cofactors. This paper selectively focuses on different aspects of cancer risk and its manifested metaphors, aesthetics, and perceptions. The different categories of cancer risk freely interact, derive an important part of their meaning from the context of the doctor-cancer patient relationship, and are created and navigated by the cancer narrative.
Several countries have banned the use of asbestos. The future health impacts of previous use have been modeled but there are to our knowledge no convincing studies showing a decreased occurrence of asbestos-related diseases due to a ban. The aim of our study was to estimate the effects of the ban and other measures to decrease the use of asbestos in Sweden.
The effect was measured through comparing the incidence of pleural malignant mesothelioma in birth cohorts who started to work before and after the decrease in the use of asbestos, i.e. in mid-1970s. Cases were identified through the Swedish Cancer Registry and the analysis was restricted to persons born in Sweden.
Men and women born 1955-79 had a decreased risk of malignant pleural mesothelioma compared to men and women born 1940-49 (RR 0.16, 95% CI 0.11-0.25; and RR 0.47, 95% CI 0.23-0.97 respectively). The decreased use of asbestos prevented each year about 10 cases in men and two cases in women below the age of 57 years in 2012.
The ban and decreased use of asbestos in Sweden can be measured today in birth cohorts that started their working career after the decrease.
Cites: Br J Cancer. 2012 Jan 31;106(3):575-8422233924
Cites: Int J Cancer. 2005 Jan 10;113(2):298-30115386418
Cites: Am J Ind Med. 2014 Jan;57(1):49-5524108505
Cites: Environ Health Perspect. 2010 Jul;118(7):897-90120601329
Cites: Br J Cancer. 1982 Jan;45(1):124-357059455
Cites: Bull World Health Organ. 2011 Oct 1;89(10):716-24, 724A-724C22084509
Cites: Bull World Health Organ. 2014 Nov 1;92(11):790-725378740
Cites: Environ Health Perspect. 2013 May;121(5):a144-523635993
Cites: Ann Occup Hyg. 2006 Jan;50(1):29-3816126764
Cites: Lancet. 2007 Mar 10;369(9564):844-917350453
Cites: Environ Health Perspect. 2008 Dec;116(12):1675-8019079719
Cites: Occup Environ Med. 1999 Feb;56(2):110-310448315
The number of fatal malignant mesotheliomas was ascertained for the period 1960-70 by contacting all pathologists in Canada. The annual incidence was steady between 1966 and 1970 at 1.4 per million population. Of 71 cases registered in 1968-70 and not previously reported, 66% were pleural, 24% peritoneal and the remainder in both sites; 45% of tumours were in women. The diagnosis of mesothelioma was approved by the Canadian Mesothelioma Panel in 59%. Sixty-nine cases were successfully investigated epidemiologically. A history of definite or probable occupational asbestos exposure was found in 30% of male cases compared with 11% of controls, but in none of the female cases or controls. However, among cases, four women and one man had had domestic exposure to dusty clothing of an asbestos worker. Most of the excess occupational exposure was in the manufacture of asbestos products or insulation and little in mining or milling. No case other than those occupationally or domestically exposed had lived within 20 miles of asbestos mines or mills.
Cites: N Engl J Med. 1972 Sep 14;287(11):570-15050439
This paper describes an investigation of 85 notifications of either probable or possible mesothelioma to the Finnish Cancer Registry from 1953 through 1969. The investigation covers characteristic epidemiologic features and the possibility of the mesothelioma being connected with occupational or other exposure to asbestos. The incidence rate of pleural mesothelioma was estimated at 1.1 per million per year. The male/female ratio was 1.3:1, which greatly differed fsrom that for malignant neoplasms of the bronchus or lung in Finland in 1960. The mean age at dealth from mesothelioma was over 7 years lower than that for bronchial carcinoma. The ratio of the crude incidence rates for the urban and rural populations was 4.2; the corresponding ratio for cases of carcinoma oopulations was 4.2; the corresponding ratio for cases of carcinoma of the bronchus or lung was 1.2 in Finland in 1960. THE LAST OCCUPATIONS OF THE 82 DECEASED PERSONS, OBTAINED FROM THE DEATH CERTIFICATES, WERE DIVIDIED INTO THREE CATEGORIES ACCORDING TO POSSIBLE ASBESTOS EXPOSURE. Exposure was present or probable in 9 (11.0) cases, 28 (34.2 %) had a possible exposure, and in 33 (40.2 %) cases exposure was absent or unlikely. The occupation of 12 (14.6) persons was unknown. Additional information of possible exposure history was obtained by interviewing the relatives of 10 mesothelioma patients. For half of the persons a definite, although in some cases trivial, exposure to asbestos could be ascertained. For the other five persons no exposure, either occupational, neighborhood or domestic, to asbestos could be traced. The residental distribution of the 85 persons with mesothelioma revealed no clustering of cases.
This paper is based on fieldwork done from 1996-1999 in different locations among village communities from Central Anatolia afflicted with the deadly malignancy of mesothelioma. Medical research has long established the relationship between mesothelioma and the environment; yet in earlier work correlations deduced through my genealogies provide evidence of a possible genetic cofactor causing these cancer deaths. This paper illustrates how medical research becomes an arena for local and global political interests and how the disruption of the doctor-cancer patient relationship impedes medical research. Methods include illness and clinical narratives, kinship charts and pedigrees, and observation of involved doctors and patients in multiple sites and geographical locations. Under focus are the anthropologist's involvement in global biomedical research and her interconnectedness with its political events.
OBJECTIVES: The cancer incidence among 2957 boiler welders was investigated. The subjects were registered electrical welders from 1942 to 1981. A subcohort of 606 stainless steel welders was studied separately. METHODS: The investigation was a historical prospective cohort study based on a national registry. The loss of follow up was 4.9%. RESULTS: There were 625 deaths (659 expected). There were 269 cancer cases (264 expected). An excess of lung cancer was found; 50 cases v 37.5 expected. There were three cases of pleural mesotheliomas v 1.1 expected. The subcohort of stainless steel welders had six cases of lung cancer v 5.8 expected, and one case of pleural mesothelioma v 0.2 expected. CONCLUSIONS: The welders in the study were assumed to represent a qualified work force. These welders had a small excess risk of lung cancer. The excess risk did not seem to be associated with stainless steel welding. Smoking and asbestos exposure were potential confounders.
The incidence of malignant mesothelioma is extremely high in some Turkish villages where there is a low-level environmental exposure to erionite, a fibrous zeolite. The best known example is the village of Karain. However, since epidemiological studies are difficult to perform in Turkey, the incidence and the dose-response curve have not been thoroughly examined. A small cohort of immigrants from Karain who have lived in Sweden for many years were studied. Exposure data, i.e. the time residing in Karain, and hospital records including pathological diagnosis, were recorded. The cohort consisted of 162 people. During the observation time, 18 deaths occurred, 14 (78%) of which were due to malignant pleural mesothelioma. In addition, there were five patients with mesothelioma who were still alive, one of whom had a peritoneal mesothelioma. Thus, the risk of mesothelioma is 135-times and 1,336-times greater in males and females, respectively, than for the same sex and age groups in Sweden. The risk increased with duration of residence.