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Vorster T, Mthombeni J, teWaterNaude J, Phillips JI. The Association between the Histological Subtypes of Mesothelioma and Asbestos Exposure Characteristics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14520. [PMID: 36361401 PMCID: PMC9654086 DOI: 10.3390/ijerph192114520] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
Asbestos mining operations have left South Africa with a legacy of asbestos contamination and asbestos-related diseases continue to be a problem. The large-scale mining of three types of asbestos presents a unique opportunity to study malignant mesothelioma of the pleura (mesothelioma) in South Africa. This study aimed to describe the demographics of deceased individuals diagnosed with mesothelioma and explore any associations between the histological morphology of mesothelioma and asbestos characteristics. We reviewed the records of all deceased miners and ex-miners from the Pathology Automation System (PATHAUT) database of the National Institute of Occupational Health (NIOH) that were histologically diagnosed with mesothelioma in the period from January 2006-December 2016 (11 years). The study population does not include all cases of mesothelioma in South Africa but rather those that reached the compensation system. Crocidolite asbestos fibres were identified in the majority of mesothelioma cases (n = 140; 53.4%). The epithelioid subtype was most commonly present in both occupational and environmental cases. Cases with the sarcomatous subtype were older at death and fewer female cases were diagnosed with this subtype. No relationship between mesothelioma subtype and asbestos type or asbestos burden or fibre size was established.
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Affiliation(s)
- Trudie Vorster
- Faculty of Health Sciences, Department of Biomedical Sciences, University of Johannesburg, Johannesburg 2028, South Africa
- Pathology Division, National Institute for Occupational Health, National Health Laboratory Service, Johannesburg 2000, South Africa
| | - Julian Mthombeni
- Faculty of Health Sciences, Department of Biomedical Sciences, University of Johannesburg, Johannesburg 2028, South Africa
| | | | - James Ian Phillips
- Faculty of Health Sciences, Department of Biomedical Sciences, University of Johannesburg, Johannesburg 2028, South Africa
- Pathology Division, National Institute for Occupational Health, National Health Laboratory Service, Johannesburg 2000, South Africa
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Emmett EA. Asbestos in High-Risk Communities: Public Health Implications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1579. [PMID: 33562413 PMCID: PMC7915393 DOI: 10.3390/ijerph18041579] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/19/2021] [Accepted: 01/31/2021] [Indexed: 02/07/2023]
Abstract
Asbestos-related diseases (ARDs)-mesothelioma, lung cancer, and asbestosis-are well known as occupational diseases. As industrial asbestos use is eliminated, ARDs within the general community from para-occupational, environmental, and natural exposures are more prominent. ARD clusters have been studied in communities including Broni, Italy; Libby, Montana; Wittenoom, Western Australia; Karain, Turkey; Ambler, Pennsylvania; and elsewhere. Community ARDs pose specific public health issues and challenges. Community exposure results in higher proportions of mesothelioma in women and a younger age distribution than occupational exposures. Exposure amount, age at exposure, fiber type, and genetic predisposition influence ARD expression; vulnerable groups include those with social and behavioral risk, exposure to extreme events, and genetic predispositions. To address community exposure, regulations should address all carcinogenic elongated mineral fibers. Banning asbestos mining, use, and importation will not reduce risks from asbestos already in place. Residents of high-risk communities are characteristically exposed through several pathways differing among communities. Administrative responsibility for controlling environmental exposures is more diffuse than for workplaces, complicated by diverse community attitudes to risk and prevention and legal complexity. The National Mesothelioma Registries help track the identification of communities at risk. High-risk communities need enhanced services for screening, diagnosis, treatment, and social and psychological support, including for retired asbestos workers. Legal settlements could help fund community programs. A focus on prevention, public health programs, particularization to specific community needs, and participation is recommended.
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Affiliation(s)
- Edward A Emmett
- Occupational and Environmental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Gerwen M, Alpert N, Flores R, Taioli E. An overview of existing mesothelioma registries worldwide, and the need for a US Registry. Am J Ind Med 2020; 63:115-120. [PMID: 31701555 DOI: 10.1002/ajim.23069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/24/2019] [Accepted: 10/29/2019] [Indexed: 12/11/2022]
Abstract
The association between asbestos exposure, mainly in occupational settings, and malignant mesothelioma has been well established; this has prompted several countries to establish mesothelioma epidemiologic surveillance programs often at the request of national agencies. This review compares currently existing mesothelioma registries worldwide to develop a concept model for a US real-time case capture mesothelioma registry. Five countries were identified with a mesothelioma specific registry, including Italy, France, UK, Australia, and South Korea. All, except the UK, used interviews to collect exposure data. Linkage with the national death index was available or was in future plans for all registries. The registries have limited information on treatment, quality of life, and other patient-centered outcomes such as symptoms and pain management. To thoroughly collect exposure data, "real-time" enrollment is preferable; to maximize the capture of mesothelioma cases, optimal coverage, and a simplified consent process are needed.
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Affiliation(s)
- Maaike Gerwen
- Department of Population Health Science and Policy, Institute for Translational EpidemiologyIcahn School of Medicine at Mount SinaiNew York City New York
| | - Naomi Alpert
- Department of Population Health Science and Policy, Institute for Translational EpidemiologyIcahn School of Medicine at Mount SinaiNew York City New York
| | - Raja Flores
- Department of Thoracic SurgeryIcahn School of Medicine at Mount SinaiNew York City New York
| | - Emanuela Taioli
- Department of Population Health Science and Policy, Institute for Translational EpidemiologyIcahn School of Medicine at Mount SinaiNew York City New York
- Department of Thoracic SurgeryIcahn School of Medicine at Mount SinaiNew York City New York
- Tisch Cancer InstituteIcahn School of Medicine at Mount SinaiNew York City New York
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Alaazi DA, Aganah GAM. Understanding the slum-health conundrum in sub-Saharan Africa: a proposal for a rights-based approach to health promotion in slums. Glob Health Promot 2019; 27:65-72. [PMID: 31375057 DOI: 10.1177/1757975919856273] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sub-Saharan Africa is the world's least urbanized region but is ironically also the region with the largest proportion of urban slum dwellers. However, there exists limited understanding of the impact of slums on health in the region. To address this knowledge gap, we conducted a systematic search in PubMed, Google, and Google Scholar to identify and review studies examining the slum-health relationship in sub-Saharan African cities. Subsequently, we performed thematic analysis of 40 studies to identify themes that explain the health impact of slums in the region. The majority of studies characterize slums as health-damaging settings, where poverty and unfavorable environmental conditions pose threats to public health and safety. Only a handful of studies suggest a beneficial relationship between slums and health, in such areas as affordable housing provision, employment generation, and community cohesion. We argue that the literature's overwhelming emphasis on the environmental risks of slums feeds into a neoliberal urban agenda that seeks to clear slums at the expense of their beneficial contributions to health. Accordingly, we advocate a shift in policy discourse, from static characterization of slums as health risks to a health-promotion agenda that emphasizes the housing and service rights of slum populations.
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Affiliation(s)
- Dominic A Alaazi
- School of Public Health, University of Alberta, Edmonton, Canada
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Metintas S, Ak G, Metintas M. A review of the cohorts with environmental and occupational mineral fiber exposure. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2018; 74:76-84. [PMID: 29677456 DOI: 10.1080/19338244.2018.1467873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/28/2018] [Accepted: 04/17/2018] [Indexed: 06/08/2023]
Abstract
The aim of the study was to examine factors associated with Malignant Mesothelioma (MM) incidence rate of the groups with occupational asbestos and environmental asbestos or erionite exposure in rural area. In this ecological study, a total of 21 cohort datasets (8 environmental and 13 occupational) were evaluated. Data were analyzed using a multiple linear regression analysis model. In environmental cohorts, the risk of MM incidence was higher in women and people exposed to erionite. In this cohort, the incidence rate of MM increased as the median exposure time increased, while the incidence decreased as the median cumulative exposure dose increased. In occupational cohorts, the incidence rate of MM was positively correlated with the median cumulative exposure dose. The risk of mesothelioma was lower in those exposed to tremolite than others. Environmental asbestos exposure is as important as occupational exposure to develop MM, and it has its own unique exposure features on the risk of MM.
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Affiliation(s)
- Selma Metintas
- a Lung and Pleural Cancers Research and Clinical Center , Eskisehir Osmangazi University , Eskisehir , Turkey
- b Medical Faculty, Department of Public Health , Eskisehir Osmangazi University , Eskisehir , Turkey
| | - Guntulu Ak
- a Lung and Pleural Cancers Research and Clinical Center , Eskisehir Osmangazi University , Eskisehir , Turkey
- c Medical Faculty, Department of Chest Diseases , Eskisehir Osmangazi University , Eskisehir , Turkey
| | - Muzaffer Metintas
- a Lung and Pleural Cancers Research and Clinical Center , Eskisehir Osmangazi University , Eskisehir , Turkey
- c Medical Faculty, Department of Chest Diseases , Eskisehir Osmangazi University , Eskisehir , Turkey
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Ndlovu N, Rees D, Murray J, Vorajee N, Richards G, teWaterNaude J. Asbestos-related diseases in mineworkers: a clinicopathological study. ERJ Open Res 2017; 3:00022-2017. [PMID: 28852644 PMCID: PMC5572945 DOI: 10.1183/23120541.00022-2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/03/2017] [Indexed: 11/21/2022] Open
Abstract
The accurate diagnosis of asbestos-related diseases is important because of past and current asbestos exposures. This study evaluated the reliability of clinical diagnoses of asbestos-related diseases in former mineworkers using autopsies as the reference standard. Sensitivity, specificity, positive predictive value and negative predictive value were calculated. The 149 cases identified had clinical examinations 0.3–7.4 years before death. More asbestos-related diseases were diagnosed at autopsy rather than clinically: 77 versus 52 for asbestosis, 27 versus 14 for mesothelioma and 22 versus 3 for lung cancer. Sensitivity and specificity values for clinical diagnoses were 50.6% and 81.9% for asbestosis, 40.7% and 97.5% for mesothelioma, and 13.6% and 100.0% for lung cancer. False-negative diagnoses of asbestosis were more likely using radiographs of acceptable (versus good) quality and in cases with pulmonary tuberculosis at autopsy. The low sensitivity values are indicative of the high proportion of false-negative diagnoses. It is unlikely that these were the result of disease manifestation between the last clinical assessment and autopsy. Where clinical features suggest asbestos-related diseases but the chest radiograph is negative, more sophisticated imaging techniques or immunohistochemistry for asbestos-related cancers should be used. Autopsies are useful for the detection of previously undiagnosed and misdiagnosed asbestos-related diseases, and for monitoring clinical practice and delivery of compensation. Asbestos-related diseases are difficult to diagnose; 58% diagnosed at autopsy had been missed clinicallyhttp://ow.ly/L9u230dr0bv
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Affiliation(s)
- Ntombizodwa Ndlovu
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David Rees
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
| | - Jill Murray
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
| | - Naseema Vorajee
- National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Guy Richards
- Division of Critical Care, Charlotte Maxeke Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Jim teWaterNaude
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Liu B, van Gerwen M, Bonassi S, Taioli E. Epidemiology of Environmental Exposure and Malignant Mesothelioma. J Thorac Oncol 2017; 12:1031-1045. [DOI: 10.1016/j.jtho.2017.04.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 03/21/2017] [Accepted: 04/01/2017] [Indexed: 01/11/2023]
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Ehrlich R, Rees D. Reforming Miners' Lung Disease Compensation in South Africa--Long Overdue but What Are the Options? New Solut 2016; 25:451-468. [PMID: 26463260 DOI: 10.1177/1048291115610434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A number of countries have workers' compensation systems which reserve specific arrangements for workers in certain sectors, notably mining. This article describes the current impetus to reform of the century-old South African mining compensation system. It is intended as a case study of the implications of harmonization of two disparate compensation systems for occupational lung disease, specifically in relation to equity in financial benefits, equity in coverage, linkage of compensation to disease prevention, and efficient administration. After decades of neglect, it is clear that while inferior financial benefits for miners are no longer tenable, the costs of equalization are not supportable by the current actuarial status of the miners' Compensation Fund. There is also an argument for two miner-specific entitlements to be retained--free medical examinations for ex-miners and autopsy-based posthumous compensation. A new dispensation to support the casualties of a declining industry will require sustained political will.
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Affiliation(s)
- Rodney Ehrlich
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - David Rees
- National Institute for Occupational Health, Johannesburg, South Africa School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Ahn YC, Chae YG, Hwang SS, Chun BK, Jung MH, Nam SJ, Lee HY, Chung JM, Oak C, Park EK. In vivo Optical Coherence Tomography Imaging of the Mesothelium Using Developed Window Models. JOURNAL OF THE OPTICAL SOCIETY OF KOREA 2015; 19:69-73. [DOI: 10.3807/josk.2015.19.1.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Ndlovu N, Naude JT, Murray J. Compensation for environmental asbestos-related diseases in South Africa: a neglected issue. Glob Health Action 2013; 6:19410. [PMID: 23364080 PMCID: PMC3556709 DOI: 10.3402/gha.v6i0.19410] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/22/2012] [Accepted: 10/22/2012] [Indexed: 11/14/2022] Open
Abstract
Background Environmentally acquired asbestos-related diseases (ARDs) are of concern globally. In South Africa, there is widespread contamination of the environment due to historical asbestos mining operations that were poorly regulated. Although the law makes provision for the compensation of occupationally acquired ARDs, compensation for environmentally acquired ARDs is only available through the Asbestos Relief Trust (ART) and Kgalagadi Relief Trust, both of which are administered by the ART. This study assessed ARDs and compensation outcomes of environmental claims submitted to the Trusts. Methods The personal details, medical diagnoses, and exposure information of all environmental claims considered by the Trusts from their inception in 2003 to April 2010 were used to calculate the numbers and proportions of ARDs and compensation awards. Results There were 146 environmental claimants of whom 35 (23.9%) had fibrotic pleural disease, 1 (0.7%) had lung cancer, and 77 (52.7%) had malignant mesothelioma. 53 (36.3%) claimants were compensated: 20 with fibrotic pleural disease and 33 with mesothelioma. Of the 93 (63.7%) claimants who were not compensated, 33 had no ARDs, 18 had fibrotic pleural disease, 1 had lung cancer, and 44 had mesothelioma. In addition to having ARDs, those that were compensated had qualifying domestic (33; 62.2%) or neighbourhood (20; 37.8%) exposures to asbestos. Most of the claimants who were not compensated had ARDs but their exposures did not meet the Trusts’ exposure criteria. Conclusions This study demonstrates the environmental impact of asbestos mining on the burden of ARDs. Mesothelioma was the most common disease diagnosed, but most cases were not compensated. This highlights that there is little redress for individuals with environmentally acquired ARDs in South Africa. To stop this ARD epidemic, there is a need for the rehabilitation of abandoned asbestos mines and the environment. These issues may not be unique to South Africa as many countries continue to mine and use asbestos.
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Affiliation(s)
- Ntombizodwa Ndlovu
- National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa.
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