Professor Nico van Zandwijk Asbestos: A Time-Bomb With A Long Fuse World Asbestos Congress 2015 Karachi, Sindh, Pakistan January 31, 2015

1. Asbestos:
a time-bomb with a long fuse
Professor Nico van Zandwijk
Asbestos Diseases Research Institute
University of Sydney
World Asbestos Congress 2015
Karachi, Sindh, Pakistan
31st January 2015

2. Introduction:
the ticking time-bomb of Asbestos
“…..the prolonged latency period
from exposure to diagnosis, and
the ongoing presence and use of
these dangerous fibres, have led
to the increasing prevalence of
malignant mesothelioma
worldwide.”Linton et al. 2012. The ticking time-bomb of asbestos: Its insidious role in the development of malignant mesothelioma. Critical Reviews of
Oncology/Hemotology. 84; 200-2012.
Image source: http://nancyknowlton.com/

3. Focus of this presentation
• Global patterns in Asbestos consumption
• Scientific certainty on the Asbestos-Cancer
association
• Global disease burden of occupational
exposure to Asbestos
• Global patterns of Malignant Mesothelioma
incidence
• Financial burden associated with Asbestos-
related diseases

4. Global patterns of
Asbestos consumption

5. Changes over time in
global Asbestos consumption
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
1920 1930 1940 1950 1960 1970 1980 1990 2000 2010
Metric tonnes
Calendar year
Global Asbestos consumption (metric tonnes), by calendar year
Source: Analysis performed by the Asbestos Diseases Research Institute based on data provided on
global asbestos consumption by the U.S. Geological Survey.

6. Changes over time in
global Asbestos consumption
-1,000,000
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
1920
1930
1940
1950
1960
1970
1980
1990
2000
2010
Metric tonnes
Calendar year
Global Asbestos consumption (metric tonnes),
by region and calendar year
Unknown
South America
Oceania
Europe
Central and North America
Asia
Africa
Source: Analysis performed by the Asbestos Diseases Research Institute based on data provided on
global asbestos consumption by the U.S. Geological Survey.

7. Changes over time in
global Asbestos consumption
-20%
0%
20%
40%
60%
80%
100%
1920
1930
1940
1950
1960
1970
1980
1990
2000
2010
Proportion of total
asbestos
consumption
Calendar year
Proportion of Asbestos consumption (%),
by region and calendar year
Unknown
South America
Oceania
Europe
Central and North America
Asia
Africa
Source: Analysis performed by the Asbestos Diseases Research Institute based on data provided on
global asbestos consumption by the U.S. Geological Survey.

8. Changes over time in
global Asbestos consumption
0%
20%
40%
60%
80%
100%
1920 1930 1940 1950 1960 1970 1980 1990 2000 2010
Calendar year
Asbestos consumption in the Asian region
as a proportion of total global consumption
Source: Analysis performed by the Asbestos Diseases Research Institute based on data provided on
global asbestos consumption by the U.S. Geological Survey.

9. Changes over time in
Asbestos use in the Asian region
1920-1970 1971-2000 2001-2007
Kilogram per capita per
year
Source: Le at al., 2011. Asbestos use and asbestos-related diseases in Asia: Past, present and future.
Respirology, 16, 767-775.

10. International Ban Asbestos Secretariat
Compilation 2015

11. International Asbestos Ban Secretariat

12. Scientific certainty for the
Asbestos-Cancer association

13. Non-Malignant and Malignant
Asbestos-related Diseases (ARDs)
Disease Latency period Level of
asbestos
exposure
Fatal Benign/
Malignant
Pleural plaques Around 20 years Low No Benign
Diffuse pleural
thickening
Around 20 years Low No Benign
Asbestosis Around 20 years High Eventually Benign
Lung Cancer 20-30 years Relatively low
exposures
increase risk
Yes Malignant
Mesothelioma 30-50 years No safe level of
exposure
Yes Malignant
Sources: Hadley and Rennell (2013), “Asbestos: the future risk”, Iskaboo Publishing, p. 22
Offermans et al, JOEM (2014) 56:6-19

14. IARC carcinogen classification system
Group Description Number of
agents
1 Carcinogenic to humans 113
2a Probably carcinogenic to
humans
66
2b Possibly carcinogenic to
humans
285
3 Not classifiable as to its
carcinogenicity to humans
505
4 Probably not carcinogenic to
humans
1

15. Group Description Number of
agents
1 Carcinogenic to humans 113
2a Probably carcinogenic to
humans
66
2b Possibly carcinogenic to
humans
285
3 Not classifiable as to its
carcinogenicity to humans
505
4 Probably not carcinogenic to
humans
1
Asbestos
All forms of Asbestos
are included as a Group
1 human carcinogenic
agent as defined by the
International Agency for
Research on Cancer,
1977, 1987 and 2012
IARC carcinogen classification system

16. Asbestos/Chrysotile Cancer Risks
• Low chrysotile exposures dangerous
van der Bij, Cancer Causes Control (2013) 24:1-12
• A 37-year observation mortality in Chinese chrysotile asbestos workers
Wang et al, Thorax Online, October 2011
• Mesothelioma from Chrysotile, review (a world-wide ban is warranted)
Kanarek, Annals Epidemiol (2011) 21:688-697
• Asbestos levels encountered at the lower end of exposure distribution associated with
increased risk of pleural mesothelioma, lung cancer and laryngeal cancer
Offermans, JOEM (2014) 56:6-19
Hillerdal, Occup Environ Med (1999) 56: 505-513
• Chrysotile asbestos use is not safe and must be banned (in Response to Chrysotile
Institute/Bernstein’s lobby)
Archives of Environmental & Occupational Health (2013) 68: 243-249

17. Global disease burden from
occupational exposure to
Asbestos

18. Burden of disease measured as
Disability-Adjusted Life Years (DALYs)
The sum of years of potential life lost due to
premature
mortality and the years of productive life lost due to
disability.

19. Global estimates of death attributable to
occupational exposure to Asbestos, 1990 and
2010
Source: Lim et al. 2013. A comparative risk assessment of burden of disease and injury attributable
to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analyses for the
Global Burden of Disease study 2010. The Lancet. 380, 2224-2260.
0
5,000
10,00015,00020,00025,000
1990 2010
By gender
Males Females

20. Global estimates (1000s) of DALYs attributable to
occupational exposure to Asbestos, 1900 and 2010
Source: Lim et al. 2013. A comparative risk assessment of burden of disease and injury attributable
to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analyses for the
Global Burden of Disease study 2010. The Lancet. 380, 2224-2260.
0
100200300400500
1990 2010
By gender
Males Females

21. Patterns of
Mesothelioma incidence

22. Exposure-Outcome Lag Time:
The Mesothelioma Epidemic Curve only appears at least two
decades after Asbestos Consumption
0
0.5
1
1.5
2
2.5
3
0
25
50
75
100
125
150
Decade1
Decade1
Decade2
Decade3
Decade4
Decade5
Decade6
Decade7
Decade8
Decade9
Decade10
Mesothelioma
incidence or
mortality rate
Measurement
of asbestos
exposure
Calendar period
Malignant mesothelioma incidence and mortality is a function of
asbestos exposure
Asbestos consumption Mesothelioma incidence rate
Asbestos ban

23. Median age-standardised Malignant
Mesothelioma incidence rates per 100,000 by
geographic region and calendar period (males)
0123456
Rateper100,000
Africa
Asia
C&SAmerica
Europe
NAmerica
Oceania
1993-1997
0123456
Rateper100,000
Africa
Asia
C&SAmerica
Europe
NAmerica
Oceania
2003-2007
Source: Analysis performed by the Dr Matthew Soeberg (Asbestos Diseases Research Institute) using data published
in: Forman D et al. eds (2013) Cancer Incidence in Five Continents, Vol. X Lyon, IARC. http://ci5.iarc.fr ; Curado MP,
et al. 2007. Cancer Incidence in Five Continents, Vol. IX. Lyon, IARC. and Parkin DM, Whelan SL, Ferlay J, Teppo L,
and Thomas DB. 2002. Cancer Incidence in Five Continents, Vol. VIII. Lyon, IARC.

24. Malignant Pleural Mesothelioma:
incidence rate trends in Europe, 1986-1995
Overall trend
Incidence rates still increasing but
evidence for deceleration in some
countries.
Differences by age group
Increase over time in incidence rate
greater for people aged 65-74 years
than for people aged 40-64 years.
Source: Montanaro et al. 2003. Pleural mesothelioma incidence in Europe: evidence of some
deceleration in the increasing trends. Cancer Causes and Control. 14, 791-803.

25. Financial burden of Asbestos-
related diseases

26. Financial burden of
Asbestos-related diseases
Medical costs
+
Compensation costs
+
Environmental costs
+
Research costs

27. Cost of hospital care for patients with
Malignant Mesothelioma, Scotland, 2000
• The total estimated cost of
hospital care for 100 people
who died from Mesothelioma
in Scotland, 2000, was
£942,038.
Number of
days of
treatment
Cost
Day cases 103 £35,073
Inpatients 3,285 £906,965
Total 3,388 £942,038
Source: A Watterson, T Gorman, C Malcolm, M Robinson & M Beck. (2006) The
economic costs of health service treatments for asbestos-related mesothelioma
deaths. Ann. N.Y.Acad.Sci. 1076: 871-881.

28. Estimated medical costs of care for
Mesothelioma patients in the European
region
Source: WHO Regional Office for Europe. (2012) The Human and Financial Burden of Asbestos in the WHO European Region Meeting Report, 5-6
November 2012, Bonn, Germany.
0 5,000,000 10,000,000 15,000,000 20,000,000 25,000,000 30,000,000 35,000,000
Austria
Belgium
Denmark
Finland
France
Germany
Italy
Netherlands
Norway
Poland
Portugal
Romania
Spain
Sweden
United Kingdom
Medical costs (€)
Medical, surgical and palliative care
treatment costs, Europe (2012), for people diagnosed with Malignant
Mesothelioma

29. Cumulative compensation payments for
Mesothelioma and Asbestosis, Australia
Source: Australian National Data Set for Compensation-based Statistics
(NDS).
0
50
100
150
200
250
AUD$million
2000/2001
2001/2002
2002/2003
2003/2004
2004/2005
2005/2006
2006/2007
2007/2008
2008/2009
2009/2010
2010/2011
2011/2012
Australia, 2000-2001 to 2011-2012
Cumulative total payments (AUD$ million) for workers expsosed to asbestos
Mesothelioma Asbestosis

30. Company producing Asbestos-containing
materials pays compensation to 42-year
old male diseased by Asbestos waste
• AUD $2 million in
damages awarded to
man who was exposed
as a child to Asbestos
waste

31. Asbestos insulation in Canberra homes
(June 2014)
• More than 1,000
homes in the
Australian Capital
Territory contain
loose-fill Asbestos
• Demands for AUD$ 5
million emergency
assistance fund for
families in affected
houses

32. Replacement of Australian Asbestos shed
roofs (April 2014)
• Sugar mill factory
spent AUD$10 million
on a project to replace
Asbestos-containing
roof products

33. Cost of remediation of Asbestos (mainly
chrysotile) sites in Italy
Site(s) Cost (Euro)
Ferrandina 500,000
Broni 500,000
Canolo 1,000,000
Vita, Gibellina, Partanna,
Montevago, S.Margh. de
Belice, Menfi
1,000,000
Messina 1,000,000
Tuscany 500,000
Source: F. Paglietti, S. Malinconico, V. di Molfetta & M. Giangrasso (2012)
Guidelines for Asbestos Remediation at Italian Superfund Sites, Journal of
Environmental Science and Health, Part C: Environmental Carcinogenesis and
Ecotoxicology Reviews, 30:3, 253-286, DOI: 10.1080/10590501.2012.705161.

34. Research investment in Asbestos-
related Disease, 2000-2010 (Australia)
01234
FundingAUD$million
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year
Funding for ARD by the National Health and Medical Research Council
Investment in national asbestos-diseases related research, Australia, 2000-2010
• More than $14.5
million invested by
the National Health
and Medical
Research Council
(NHMRC)

35. Summary:
the ticking time-bomb of Asbestos
Source: International Ban Asbestos Secretariat, http://ibasecretariat.org/graphics_page.php, accessed
January 2015.

36. Summary:
the ticking time-bomb of Asbestos
“The clear dangers of Asbestos usage
in all occupational and non-
occupational settings….reinforce the
ongoing need for a universal ban of
Asbestos and a renewed focus on the
protection of workers in developing
nations.”
Linton et al. 2012. The ticking time-bomb of asbestos: Its insidious role in the development of malignant mesothelioma. Critical Reviews of
Oncology/Hemotology. 84; 200-2012.
Image source: http://nancyknowlton.com/

37. Funding and acknowledgements
Cancer Institute NSW Translational Program Grant awarded to Professor Nico van
Zandwijk and colleagues at the Asbestos Diseases Research Institute (Dr Matthew
Soeberg)
Cancer Institute NSW Academic Chair and Scientific Director Role (Professor Jane Young)
in cancer epidemiology and health services research awarded to The University of Sydney
Professor Ken Takahashi and colleagues at the University of Occupational and
Environmental Health, Japan, who have provided integral advice on asbestos-related
diseases and occupational and environmental health