1 / 24

Medical aspects of asbestos exposure

Medical aspects of asbestos exposure. Sjaak Burgers respiratory physician Netherlands Cancer Institute, Amsterdam. s.burgers@nki.nl. Medical consequences. mesothelioma asbestosis lung cancer benign pleural plaques. Today. Medical introduction Asbestos mesothelioma lung cancer

amma
Download Presentation

Medical aspects of asbestos exposure

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Medical aspects of asbestos exposure Sjaak Burgers respiratory physician Netherlands Cancer Institute, Amsterdam s.burgers@nki.nl

  2. Medical consequences • mesothelioma • asbestosis • lung cancer • benign pleural plaques

  3. Today • Medical introduction • Asbestos • mesothelioma • lung cancer • (Problems in) risk assessment

  4. Mesothelioma captures the lung

  5. Mesothelioma captures your breath

  6. Mesothelioma: local growth

  7. Mesothelioma: high mortality survival with the BEST available treatment Cisplatin vs cisplatin-pemetrexed. Vogelzang, JCO 2003

  8. Lung cancer • 15% cure rate • 50% 1-year mortality • 90% smoking-related • asbestos • increases the risk for lung cancer • more than adds to the smoking-induced risk 40-y old women. Lung cancer recently diagnosed.

  9. Risk assessment • Whatever the risk is, • the consequences are life threatening.

  10. Difference between exposure to • asbestos and • sigarette smoke

  11. Mesothelioma mortality in North American insulation workers is independent of age Age at first exposure (years) ---- 15-24 ---- 25-34 ---- 35+ Peto et al 1982: Br J Cancer 45: 124-135

  12. Lung cancer mortality is almost constant in ex-smokers Age stopped 60-64 55-59 50-54 40-49 Halpern et al 1993: JNCI 85, 457

  13. Evidence • individual data • “All my colleagues died of this disease”. • local data • national data • global data

  14. Environmental exposure: Cape blue asbestos • 33 cases • median age 49y (31-68y) • exposed to asbestos no other cases in South Africa Wagner et al Br J Industr Med 1960

  15. Environmental exposure:Dutch example mesothelioma incidence in the Netherlands, females

  16. Environmental exposure • roads paved by Eternit remnants • mean exposure 0,11 fiber years • expected 4 cases, observed 26 cases

  17. 2 national examples

  18. Projected British male mesothelioma deaths Hodgson et al (2005) Br J Cancer 92: 587 Deaths Exposure index 2000 200 1500 150 Exposure index Mesothelioma deaths 1000 100 500 50 0 0 1940 1960 1980 2000 2020 2040 Fitted/projected deaths Exposure index (fitted/projected) Observed deaths

  19. Banning asbestos helps 1977 1993 1982

  20. Global data:asbestos consumption /meso deaths Lin, Lancet 2007 Nawrot, Lancet 2007

  21. Translation to risk assessment • still no answer to the question • “What is the risk that a particular person gets cancer due to a particular asbestos exposure?”

  22. Complicated exposure-response relation for mesothelioma • I=incidence; t= time since exposure; f=fiber count; d=duration of exposure; KM= fiber dependent EPA, 1986

  23. Is there a safe exposure level? Theoretically there is; Netherlands Health Counsil: Risk level: likelyhood of dying of cancer as a result of exposure current Dutch safety level 0.02 fibres/ml = 1/10 of EU standard

  24. Thus, • abundant evidence relating asbestos to mesothelioma and lung cancer • exact risk levels hard to calculate

More Related