The Asbestos Ban in Korea from a Grassroots Perspective: Why Did It Occur?

Assessing trends and burden of occupational exposure to asbestos in the United States: a comprehensive analysis from 1990 to 2019

BACKGROUND

This study aimed to analyze the trends and burden of occupational exposure to asbestos in the United States (U.S.) from 1990 to 2019, focusing on mortality rates, geographic distribution, age and sex patterns, and causes of death.

METHODS

Data on the number of deaths attributable to occupational exposure to asbestos were collected from 1990 to 2019 in the U.S. Joinpoint analysis was conducted to assess trends over time, and regression models were applied to calculate annual percentage changes (APC) and annual average percentage changes (AAPC). Geographic distribution was examined using mapping techniques. Age and sex patterns were analyzed, and causes of death were identified based on available data.

RESULTS

From 1990 to 2019, the overall number of deaths due to occupational exposure to asbestos in the U.S. increased by 20.2%. However, age-standardized mortality rates (ASMR) and age-standardized disability-adjusted life years (DALYs) rates (ASDR) exhibited a decline over the same period. Geographic analysis revealed differences in the number of deaths across states in 2019, with California reporting the highest number of fatalities. Age-specific mortality and DALYs showed an increase with age, peaking in older age groups. Tracheal, bronchus, and lung cancer were the leading causes of death attributed to asbestos exposure, with increasing trends observed over the past five years.

CONCLUSION

The study highlights significant trends and burden in occupational exposure to asbestos in the U.S., including overall increases in mortality rates, declining ASMR and ASDR, geographic disparities, age and sex patterns, and shifts in causes of death. These findings underscore the importance of continued monitoring and preventive measures to mitigate the burden of asbestos-related diseases.

An urgent call to action: The absolute necessity to ban asbestos production and sales

The issue with asbestos highlights the shortcomings in the global management of health policies for dangerous substances. The perils of asbestos dust were identified about a century ago. A significant number of individuals succumb to asbestos-related diseases worldwide annually. A considerable portion of occupational cancer fatalities are believed to be due to asbestos. A large population across the globe is exposed to asbestos in their workplaces. To address issues like asbestos, it is crucial for policymakers to prioritize public interest, and third parties should actively participate in scrutinizing the actions of these policymakers.

There is plenty of asbestos at the bottom. The case of magnesite raw material contaminated with asbestos fibres

Although all six asbestos minerals (the layer silicate chrysotile and five chain silicate species actinolite asbestos, amosite, anthophyllite asbestos, crocidolite and tremolite asbestos) are classified as carcinogenic, chrysotile is still mined and used in many countries worldwide. Other countries, like Italy, impose zero tolerance for all asbestos species, but conflicting views repress the development of globally uniform treaties controlling international trade of asbestos-containing materials. Hence, countries with more severe legislations against the use of these hazardous materials lack of an international safety net against importation of non-compliant products. This research reports the first discovery of commercial magnesite raw materials contaminated with white asbestos (chrysotile). X-ray powder diffraction and thermogravimetric/thermodifferential measurements showed the presence of serpentine group minerals in both the semi-processed (powder) and quarried material. The univocal identification of chrysotile in the powders was confirmed by its peculiar Raman bands of the OH stretching vibrations between 3500 and 3800 cm-1, with an intense peak at ∼3695 cm-1 and a weak contribution at ∼3647 cm-1. Transmission electron microscope showed that chrysotile forms fibres up to a few microns long and up to 80 nm thick with a nanotube structure characterized by inner channels as large as 30-40 nm. Fibres size analysis obtained by scanning electron microscopy indicates mean length and diameter of 5.95 and 0.109 μm with medians of 2.62 and 0.096 μm, respectively; some among the fibres analysed exhibit the so-called "Stanton size" (i.e., asbestos fibres longer than 8 μm and thinner than 0.25 μm that are strongly carcinogenic). Quantitative analysis showed a chrysotile content around 0.01 wt% not allowed by current regulations in Italy and many other countries. More generally, our findings demonstrate that without shared policies aimed at regulating asbestos circulation on the global market, "asbestos-free" national policies will inevitably fail.

Global, regional, and national trends in mesothelioma burden from 1990 to 2019 and the predictions for the next two decades

Objectives

We aimed to analyze the secular trends in mesothelioma burden, the effect of age, period, and birth cohort, and project the global burden over time.

Material and methods

Based on the mesothelioma incidence, mortality, and Disability-Adjusted Life Years (DALYs) data from 1990 to 2019 in Global Burden of Diseases (GBD) database, the annual percentage change (APC) and average annual percent change (AAPC), calculated from joinpoint regression model, was used to describe the burden trends. An age-period-cohort model was utilized to disentangle age, period, and birth cohort effects on mesothelioma incidence and mortality trends. The mesothelioma burden was projected by the Bayesian age-period-cohort (BAPC) model.

Results

Globally, there were the significant declines in age-standardized incidence rate (ASIR) (AAPC = -0.4, 95%CI: -0.6,-0.3, P < 0.001), age-standardized mortality rate (ASMR) (AAPC = -0.3, 95%CI: -0.4,-0.2, P < 0.001), and age-standardized DALY rate (ASDR) (AAPC = -0.5, 95%CI: -0.6,-0.4, P < 0.001) of mesothelioma overall 30 years. For regions, Central Europe presented the most distinct increases and the most substantial decrease was observed in Andean Latin America on all ASRs (age-standardized rates) from 1990 to 2019. At national level, the largest annualized growth for full-range trends of incidence, mortality, and DALYs was in Georgia. Conversely, the fastest descent of all ASRs was observed in Peru. The ASIR, ASMR, and ASDR in 2039 predicted 0.33, 0.27, and 6.90 per 100,000, respectively.

Conclusions

The global burden of mesothelioma declined over the past 30 years, with variability across regions and countries/territories, and this trend will continue in the future.

Asbestos awareness among the residents of St. Kitts and Nevis: a cross-sectional study

Background

High levels of public awareness regarding the hazards of asbestos, rights to health, and benefits of an asbestos-free country can increase advocacy and political commitment to a total ban on asbestos. We aimed to investigate asbestos awareness and associated sociodemographic characteristics among the adult population of St. Kitts and Nevis.

Methods

In this cross-sectional study, 1009 participants completed an online questionnaire with questions about sociodemographic data and asbestos awareness. We applied multiple regression models to estimate associations between sociodemographic factors, levels of asbestos knowledge, and attitudes toward asbestos management.

Results

We found that 70% of residents of St. Kitts and Nevis considered asbestos exposure to be a general public concern and believed the government should prevent it. Of all participants, 54% were in favor of completely banning the use and importation of all asbestos products and materials; those with higher levels of asbestos knowledge were more likely to favor a total ban. Higher proportions and odds of favoring a total asbestos ban were also observed in participants aged ≥ 30 years, women, those with higher education, and those living in St. Kitts (vs. Nevis).

Conclusions

These findings support implementing policies to regulate and outright ban the use of asbestos products and materials in St. Kitts and Nevis. This data can be used to develop tailored campaigns to improve asbestos knowledge among sociodemographic groups with lower asbestos awareness, such as in the wider Caribbean and other under-resourced countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12992-022-00874-w.

Impact of Naturally Occurring Asbestos on Asbestos Ban: Regulations and Experience of the Republic of Korea

This review examined the main issues debated in Korea regarding the production and use of materials containing naturally occurring asbestos (NOA) as impurities, and investigated the impacts of these debates on the asbestos ban, as well as the future implications. In Korea, incidents associated with the production and use of NOA-contaminated talc powders, construction rocks, serpentinites, and dolomite rocks raised public concern and led to accelerating the ban on asbestos. The main controversies concern policies on appropriate asbestos content limits, whether materials containing a trace amount of NOA should be banned, and the control of materials with high human exposure risk. To address recurring controversies, the implementation of preventive measures to manage elongated mineral particles and the use of transmission electron microscopy for more sensitive analysis need to be discussed, along with reaching social agreement on the controversial policies. To minimize the potential exposure to asbestos that may occur during the production and use of industrial minerals in the future, it is necessary to apply occupational exposure control measures and monitor the health effects of the relevant population groups. These national policies on NOA should be prepared based on close collaboration and discussion with policymakers, industry stakeholders, and related academic experts.

Asbestosis diagnosis algorithm combining the lung segmentation method and deep learning model in computed tomography image

BACKGROUND

Early detection of asbestosis is important; hence, quick and accurate diagnostic tools are essential. This study aimed to develop an algorithm that combines lung segmentation and deep learning models that can be utilized as a clinical decision support system (CDSS) for diagnosing patients with asbestosis in segmented computed tomography (CT) images.

METHODS

We accurately segmented the lungs in CT images of patients examined at Seoul St. Mary's Hospital using a threshold-based method. Lungs with asbestosis and normal lungs were classified by applying the segmented image to the long-term recurrent convolutional network deep learning model. Performance was evaluated using the area under the receiver operating characteristic curve (AUROC) and F1 score from the test data.

RESULTS

The algorithm developed using the DenseNet201pre-trained model showed excellent performance, with a sensitivity of 0.962, specificity of 0.975, accuracy of 0.970, AUROC of 0.968, and F1 score of 0.961.

CONCLUSIONS

We developed an algorithm with significantly better diagnostic accuracy than a radiologist (0.970 vs. 0.73-0.79). Our developed algorithm is expected to be an excellent support tool if used as a CDSS to diagnose asbestosis using CT images.

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.

Asbestos-related cancers: the 'Hidden Killer' remains a global threat

Introduction: Asbestos, the most frequent cause of occupational cancer, continues to be consumed on a massive scale, with millions of people exposed on a daily basis. This review explains why we have failed in curtailing the silent epidemic of asbestos-related disease and why the numbers of asbestos victims are likely to remain high. Emerging and developed countries have to be reminded that asbestos exposure has yet to become a problem of the past. The worldwide spread of asbestos, followed by the surge of asbestos-related cancers, resembles the lung cancer epidemic caused by smoking and stimulated by manufacturers.Areas covered: Underreporting of malignant mesothelioma and asbestos-induced lung cancer, frequently-used arguments in the amphibole/chrysotile debate and the conclusion from bona-fide research organizations, that all forms of asbestos are carcinogenic, are reviewed. Special attention is paid to the consequences of ubiquitous environmental asbestos and the 'changing face' of malignant mesothelioma in countries with heavy asbestos use in the past.Expert opinion: Experts in oncology, respiratory medicine, occupational and public health, and basic researchers must take responsibility and acknowledge the ongoing silent epidemic of asbestos-related diseases. The call for a world-wide asbestos ban is more urgent than ever.

Changes of 30 years in the recognized occupational diseases of Korea: Lessons from the system change perspective

Thirty years ago, in 1988 of Korea, street demonstrations for the recognition of a 15-year-old boy's death as occupational mercury poisoning had shattered the taboo against occupational disease, and since then, the volume and contents of recognized diseases had changed a lot. Here we tried to ascertain and explain the changes from the system viewpoint. The system of risk management at work was analyzed in narrative terms of what, how, who, and why of the occupational disease managements, then and now, and we conclude the system of last 30 years was to manage the benevolent benefit to the victims for politico-economic purposes. Despite a big shift in outer appearance, the changes in the inner operation were small, and we propose to adopt newer approaches of more health and safety oriented together with human rights.