Lung cancer and mesothelioma risk assessment for a population environmentally exposed to asbestos

Measurement and removal of asbestos in residential dwellings to be demolished-urban transformation experience in Izmir, Turkey

Asbestos has been used extensively in the construction industry for its superior insulation properties before its health hazards were discovered and its use eventually banned. It is likely that many residential buildings built before the 2000s in Turkey contain asbestos. Therefore, it is important to raise awareness of the potential danger of asbestos exposure during demolition work and to identify asbestos-containing materials and ensure their safe removal and disposal. This study is executed to determine the residential dwellings containing asbestos in Izmir, Turkey. The research included field studies to determine asbestos presence in the buildings that were damaged during the 2020 earthquake. Air measurements and bulk samples were taken from 50 buildings that would go through the demolition process. Eleven buildings were found to contain asbestos which corresponds to 22%. The detected asbestos type was 60% chrysotile (white asbestos). Results could be helpful for future demolition work, which are conducted in the same region that includes buildings with similar properties. Also, it is expected that the database created for this study could be useful in other studies in Turkey, where accurate statistical data related with asbestos measurements is essentially non-existent.

Mesothelin methylation, soluble mesothelin related protein levels and inflammation profiling in workers chronically exposed to naturally occurring asbestos fibers

Exposure to asbestiform fibers, including chrysotile and amphibole, is carcinogenic, causing malignant pleural mesothelioma (MPM) when inhaled. Some populations globally face Naturally Occurring Asbestos (NOA) exposure, leading to MPM cases like in Biancavilla, Italy, from Fluoro-edenite (FE) contamination. Studies show NOA exposure causes epigenetic changes, focusing on mesothelin methylation, an MPM marker, and altered inflammation, emphasizing the health risks of FE and asbestos. This research, conducted from February 2022 to October 2022, studied 125 construction workers from Biancavilla and 125 controls from 40 km away without Biancavilla work history. With at least ten years in construction and no respiratory conditions, participants underwent medical assessments and gave blood samples for analysis, including inflammation markers, mesothelin methylation, and soluble mesothelin-related protein levels. The results showed similar demographics but differing inflammation and methylation levels in exposed workers, suggesting long-term cellular changes. Pearson correlation showed intricate biomarker relationships. Significant inflammatory differences were found between FE exposed and non-exposed workers, indicating potential health impacts from FE. This raises concerns for communities like Biancavilla, emphasizing the importance of extensive epigenetic research for public health.

An overview on multimodal imaging for the diagnostic workup of pleural mesothelioma

Pleural mesothelioma (PM) is an aggressive disease that has a strong causal relationship with asbestos exposure and represents a major challenge from both a diagnostic and therapeutic viewpoint. Despite recent improvements in patient care, PM typically carries a poor outcome, especially in advanced stages. Therefore, a timely and effective diagnosis taking advantage of currently available imaging techniques is essential to perform an accurate staging and dictate the most appropriate treatment strategy. Our aim is to provide a brief, but exhaustive and up-to-date overview of the role of multimodal medical imaging in the management of PM.

A critical review of asbestos concentrations in water and air, according to exposure sources

Asbestos, a group of minerals with unique physical and chemical properties, has been widely used in various industries. However, extensive exposure to asbestos fibers, present in the environment, has been linked to several types of cancer, mesothelioma, and asbestosis. Despite worldwide regulations prohibiting or regulating the use of this material, the uncertainty surrounding the concentrations of asbestos fibers in the environment (air and water) from different sources of exposure persists. The objective of this review paper is to identify the levels of asbestos in air and water reported in the literature based on the source of exposure in diverse contexts to assess conformity with the reference limits for this mineral. Initially, the review delineates various forms of exposure and the origin of fiber generation in the environment, whether direct or indirect. Regarding the presence of asbestos in the environment, high concentrations were identified in natural water bodies known as Naturally Occurring Asbestos (NOA), and there is a risk in the process of distributing drinking water due to the presence of asbestos-cement pipes. In the air, studies to determine asbestos concentrations vary based on the sources of exposure in each region or city studied. The presence of asbestos mines around the city and the intensity of vehicular traffic are some of the most relevant sources found to be related to high concentrations of asbestos fibers in the air. The present review paper features a critical review section in each chapter to highlight critical points found in the literature and suggest new methodologies/ideas to standardize future research. It emphasizes the necessity to standardize methods for measuring asbestos concentrations in air and water arising from diverse sources of exposure to enable comparisons between different regions and countries.

Lung Cancer and Pleural Mesothelioma Risk Assessment for the General Population Exposed to Asbestos in Different Regions of Tehran, Iran

BACKGROUND

Asbestos is a natural fiber leading to health risks like chronic lung diseases. The current study aimed to estimate pleural mesothelioma and lung cancer risk for population exposure to asbestos in Tehran, Iran.

STUDY DESIGN

A cross-sectional study.

METHODS

According to the annual report of Air Quality Control Company (AQCC), from 2011-2020, carcinogenic risk and mesothelioma were assessed based on the Environmental Protection Agency (EPA) method using the Monte Carlo simulation (MCS). The relative risk (RR) of mortality cancer was calculated based on Camus and colleagues' model. Moreover, mesothelioma risk was estimated by Bourgault and colleagues' model.

RESULTS

The mean concentration and health risk of asbestos in ambient air generally reduced from 2011 to 2020. The highest mortality risk for lung cancer was 8.4 per 100000 persons in 2011 and reduced to 1.8 in 2017. For mesothelioma, the corresponding values were 8.96 per 100000 persons in 2011 and reduced to 1.92 in 2017.

CONCLUSION

The findings of this study could be helpful to health policymakers in the management of asbestos risk.

Air pollution: A culprit of lung cancer

Air pollution is a global health problem, especially in the context of rapid economic development and the expansion of urbanization. Herein, we discuss the harmful effects of outdoor and indoor pollution on the lungs. Ambient particulate matters (PMs) from industrial and vehicle exhausts is associated with lung cancer. Workers exposed to asbestos, polycyclic aromatic hydrocarbons (PAHs), and toxic metals are also likely to develop lung cancer. Indoors, cooking fumes, second-hand smoke, and radioactive products from house decoration materials play roles in the development of lung cancer. Bacteria and viruses can also be detrimental to health and are important risk factors in lung inflammation and cancer. Specific effects of lung cancer caused by air pollution are discussed in detail, including inflammation, DNA damage, and epigenetic regulation. In addition, advanced materials for personal protection, as well as the current government policies to prevent air pollution, are summarized. This review provides a basis for future research on the relationship between lung cancer and air pollution.

An Innovative Filtering System for the Handling of Asbestos-Based Products: Improvement of Safety and Quality of Work in Analysis Laboratories

Although being banned or restricted in many countries since the early 1990s, large quantities of asbestos are still used or present in building materials all over the world and its removal or handling requires specific systems that limit exposure to airborne fibers The exposure to asbestos causes chronic diseases such as asbestosis and lung cancer with an incubation period of 20 to 50 years. Among the operators most exposed to contamination are those who handle and analyze the materials in laboratories. For this reason, our work focused on an innovative method for removing a filter unit from a laboratory extraction hood, in order to improve the safety conditions for the operators and the surrounding environment. The hood has a particular construction technology with a mechanism that allows the spraying of a special encapsulating liquid on the ULPA filters below the work-bench, which is capable of forming a film and blocking the fibers on the surface of the same filter. The fibers are irreversibly bounded and can no longer be released into the surrounding environment. The monitoring of activity highlighted the absence of asbestos fibers in the air after installation of the filter and workers feel safer performing their activities. The introduction of an innovative filtering system enhanced the safety of work activities involving asbestos exposure, moreover, the time spent on the hood’s maintenance and the risk perception of workers were improved.

Asbestos and Other Hazardous Fibrous Minerals: Potential Exposure Pathways and Associated Health Risks

There are six elongate mineral particles (EMPs) corresponding to specific dimensional and morphological criteria, known as asbestos. Responsible for health issues including asbestosis, and malignant mesothelioma, asbestos has been well researched. Despite this, significant exposure continues to occur throughout the world, potentially affecting 125 million people in the workplace and causing thousands of deaths annually from exposure in homes. However, there are other EMPS, such as fibrous/asbestiform erionite, that are classified as carcinogens and have been linked to cancers in areas where it has been incorporated into local building materials or released into the environment through earthmoving activities. Erionite is a more potent carcinogen than asbestos but as it is seldom used for commercial purposes, exposure pathways have been less well studied. Despite the apparent similarities between asbestos and fibrous erionite, their health risks and exposure pathways are quite different. This article examines the hazards presented by EMPs with a particular focus on fibrous erionite. It includes a discussion of the global locations of erionite and similar hazardous minerals, a comparison of the multiple exposure pathways for asbestos and fibrous erionite, a brief discussion of the confusing nomenclature associated with EMPs, and considerations of increasing global mesothelioma cases.

ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural mesothelioma

The European Respiratory Society (ERS)/European Society of Thoracic Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery (EACTS)/European Society for Radiotherapy and Oncology (ESTRO) task force brought together experts to update previous 2009 ERS/ESTS guidelines on management of malignant pleural mesothelioma (MPM), a rare cancer with globally poor outcome, after a systematic review of the 2009-2018 literature. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. The evidence syntheses were discussed and recommendations formulated by this multidisciplinary group of experts. Diagnosis: pleural biopsies remain the gold standard to confirm the diagnosis, usually obtained by thoracoscopy but occasionally via image-guided percutaneous needle biopsy in cases of pleural symphysis or poor performance status. Pathology: standard staining procedures are insufficient in ∼10% of cases, justifying the use of specific markers, including BAP-1 and CDKN2A (p16) for the separation of atypical mesothelial proliferation from MPM. Staging: in the absence of a uniform, robust and validated staging system, we advise using the most recent 2016 8th TNM (tumour, node, metastasis) classification, with an algorithm for pretherapeutic assessment. Monitoring: patient's performance status, histological subtype and tumour volume are the main prognostic factors of clinical importance in routine MPM management. Other potential parameters should be recorded at baseline and reported in clinical trials. Treatment: (chemo)therapy has limited efficacy in MPM patients and only selected patients are candidates for radical surgery. New promising targeted therapies, immunotherapies and strategies have been reviewed. Because of limited data on the best combination treatment, we emphasize that patients who are considered candidates for a multimodal approach, including radical surgery, should be treated as part of clinical trials in MPM-dedicated centres.

Activity-Based Exposure Levels and Cancer Risk Assessment Due to Naturally Occurring Asbestos for the Residents Near Abandoned Asbestos Mines in South Korea

This study aims to evaluate the overall asbestos exposure intensity and assess the health risk to residents due to naturally occurring asbestos (NOA) near abandoned asbestos mines in South Korea. Of 38 mines, we found 19 with measured concentrations of NOA. We evaluated the average of airborne NOA concentrations according to the environmental exposure category. When evaluated regionally by dividing into two clusters, the mean concentrations in activity-based sampling (ABS) scenarios exceeded the Korean exposure limit (0.01 f/cc) in both clusters. Moreover, airborne NOA concentrations in agricultural activity (5.49 × 10^-2 f/cc) and daily activity (6.95 × 10^-2 f/cc) had the highest values for clusters A and B, respectively. The excess lifetime cancer risk of one region (cluster A) by the ABS scenarios did not exceed the Korean Ministry of the Environment's criteria for soil purification (1 × 10^-4). However, one of the ABS scenarios-the daily life activity of clusters centered on Chungcheongbuk-do (cluster B)-showed an exposure of 1.08 × 10^-4, greater than the limit (1 × 10^-4). This indicates non negligible health damage to residents living near the abandoned asbestos mines, and it is necessary to continuously monitor and clean up the asbestos contamination.

Monitoring of airborne asbestos fibers in an urban ambient air of Mashhad City, Iran: levels, spatial distribution and seasonal variations

Asbestos, as with other pollutants in the air, has adverse effects on the health of human beings and animals. Today, the relationship between presence of asbestos fibers in the air breathed by humans and developing serious diseases such as lung cancer (asbestosis) and mesothelioma has been proven. The objectives of this study were to monitor the levels of asbestos fibers in ambient air of Mashhad, Iran during 2018, and to draw its Geographic Information System (GIS) distribution map for the city. In this descriptive study, 13 sampling points in Mashhad city were chosen. Sampling of asbestos was carried out for 3 hour during summer and winter at 2018. Sampling of asbestos was performed using MCE (Mixed Cellulose Ester) membrane filters (pour size 0.45 µm; diameter: 25 mm) and cassette holder and peripheral pump. The samples were the analyzed by the phase contrast microscopy (PCM) method (NIOSH7400). Also, to investigate the type of asbestos and for more accurate counting of fibers, Scanning Electron Microscopy (SEM) analysis was utilized. Meteorological parameter were recorded through portable devices. To draw the graphs, Excel, R and Arc GIS software were used. Results showed that the mean asbestos fiber concentrations were equal to 11.40 ± 2.14 and 14.38 ± 2.52 f/L in summer and winter, respectively. The maximum level of asbestos fiber was detected in the station of Baitolmoghaddas square by 26.64 ± 2.14 and 19.3 SEM f/L in winter and summer, respectively. High concentration of asbestos fiber observed in this study can be attributed to the heavy traffic, the presence of prominent industries in the vicinity of the study area, and topographic features. The results from this research recommends that suitable controlling policies should be regulated to reduce both ambient air asbestos and its adverse health endpoints in Mashhad.

ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural mesothelioma

The European Respiratory Society (ERS)/European Society of Thoracic Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery (EACTS)/European Society for Radiotherapy and Oncology (ESTRO) task force brought together experts to update previous 2009 ERS/ESTS guidelines on management of malignant pleural mesothelioma (MPM), a rare cancer with globally poor outcome, after a systematic review of the 2009-2018 literature. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. The evidence syntheses were discussed and recommendations formulated by this multidisciplinary group of experts. Diagnosis: pleural biopsies remain the gold standard to confirm the diagnosis, usually obtained by thoracoscopy but occasionally via image-guided percutaneous needle biopsy in cases of pleural symphysis or poor performance status. Pathology: standard staining procedures are insufficient in ∼10% of cases, justifying the use of specific markers, including BAP-1 and CDKN2A (p16) for the separation of atypical mesothelial proliferation from MPM. Staging: in the absence of a uniform, robust and validated staging system, we advise using the most recent 2016 8th TNM (tumour, node, metastasis) classification, with an algorithm for pre-therapeutic assessment. Monitoring: patient's performance status, histological subtype and tumour volume are the main prognostic factors of clinical importance in routine MPM management. Other potential parameters should be recorded at baseline and reported in clinical trials. Treatment: (chemo)therapy has limited efficacy in MPM patients and only selected patients are candidates for radical surgery. New promising targeted therapies, immunotherapies and strategies have been reviewed. Because of limited data on the best combination treatment, we emphasise that patients who are considered candidates for a multimodal approach, including radical surgery, should be treated as part of clinical trials in MPM-dedicated centres.

Optimal management program for asbestos containing building materials to be available in the event of a disaster

The safe management and disposal of asbestos is a matter of considerable importance. A large number of studies have been undertaken to quantify the issue of waste management following a disaster. Nevertheless, there have been few (if any) studies concerning asbestos waste, covering the amount generated, the cost of disposal, and the degree of hazard incurred. Thus, the current study focuses on developing a program for the management of Asbestos Containing Building Materials (ACBMs), which form the source of asbestos waste in the event of a disaster. The study will also discuss a case study undertaken in a specific region in Korea in terms of: (1) the location of ACBM-containing buildings; (2) types and quantities of ACBMs; (3) the cost of ACBM disposal; (4) the amount of asbestos fiber present during normal times and during post-disaster periods; (5) the required order in which ACBM-containing buildings should be dismantled; and (6) additional greenhouse gases generated during ACBM removal. The case study will focus on a specific building, with an area of 35.34m², and will analyze information concerning the abovementioned points. In addition, the case study will focus on a selected area (108 buildings) and the administrative district (21,063 buildings). The significance of the program can be established by the fact that it visibly transmits information concerning ACBM management. It is a highly promising program, with a widespread application for the safe management and optimal disposal of asbestos in terms of technology, policy, and methodology.

Estimating the Additional Greenhouse Gas Emissions in Korea: Focused on Demolition of Asbestos Containing Materials in Building

When asbestos containing materials (ACM) must be removed from the building before demolition, additional greenhouse gas (GHG) emissions are generated. However, precedent studies have not considered the removal of ACM from the building. The present study aimed to develop a model for estimating GHG emissions created by the ACM removal processes, specifically the removal of asbestos cement slates (ACS). The second objective was to use the new model to predict the total GHG emission produced by ACM removal in the entire country of Korea. First, an input-equipment inventory was established for each step of the ACS removal process. Second, an energy consumption database for each equipment type was established. Third, the total GHG emission contributed by each step of the process was calculated. The GHG emissions generated from the 1,142,688 ACS-containing buildings in Korea was estimated to total 23,778 tonCO₂eq to 132,141 tonCO₂eq. This study was meaningful in that the emissions generated by ACS removal have not been studied before. Furthermore, the study deals with additional problems that can be triggered by the presence of asbestos in building materials. The method provided in this study is expected to contribute greatly to the calculation of GHG emissions caused by ACM worldwide.