- Collegium Ramazzini

RAMAZZINI DAYS 2014
Scientific Session II:"Breakthroughs and best practices
in regional and global scientific collaboration"
An ItalianItalian-Latin America scientific network
to collaborate on asbestos
asbestos--disease prevention
Pietro Comba (Italy
(Italy))
and Benedetto Terracini (Italy
Italy))
24 – 26 October 2014
Carpi, Italy
SCIENTIFIC COOPERATION
Dissemination, training and research on
prevention of asbestos-related disease in
countries where the use of asbestos is still
legal, or has been recently banned, with
special reference to Latin America
SCIENTIFIC COOPERATION NETWORK
ISS - Istituto Superiore di Sanità
> Unit of Environmental Epidemiology,
Department of Environment and Primary Prevention
> Publishing Unit (Dissemination and Cooperation)
INAIL – Research Sector, Department
of Occupational Medicine
CRA Lazio – Latium Region Asbestos Centre,
Local Health Unit Viterbo
DEP Lazio – Department of Epidemiology
of Latium Region Health Service
Prof. Benedetto Terracini - University of Turin
Ministry of Health, Universities and NGOs
of Latin American Countries
COLOMBIA
COOPERATION NETWORK
Conferencia Internacional de
Salud ambiental y ocupacional
BOGOTÀ, 19-20 February 2014
Proyecto «Arte, Enfermedades, Política»
BOGOTÀ, 5-7 November 2014
Universidad Nacional,
Dep.to de Salud Pública
Instituto de Salud Pública
Universidad de los Andes,
Dep.to de Ingeňeria
Ambiental
ECUADOR
COOPERATION NETWORK
Environment and Health
Prevention of AsbestosRelated Disease
Quito, March 2006 [C.R.]
Quito y Guayaquil, November 2008
Quito, November 2011
Quito, February 2014
Corporación IFA , Quito (desde 2003)- [C.R.]
- Corporación para el desarrollo de la
producción y del medioambiente laboral Ministerio de Salud Pública,
Dirección Nacional de Salud y Ambiente
Facultad Latino Americana de Ciencias
Sociales (FLACSO), Maestría
en Estudios Socioambientales
Univ. Tecnológica Equinoccial Quito
BOLIVIA
SEMINAR:
SALUD OCUPACIONAL y
AMBIENTAL
ISSUES:
asbestos; silica; contaminated
sites; air pollution
LA PAZ, 10-12 November 2014
COOPERATION NETWORK
Embajada del Estado
Plurinacional de Bolivia en Italia
Ministerio de Salud Pública
Relaciones Internacionales
Dirección General de
Promoción de la Salud
Unidad de Promoción de la
Salud, Área Salud Ambiental
Instituto Nacional de Salud
Ocupacional
Annals of Global Health, in press
PREMISE
Notwithstanding the overwhelming scientific evidence of asbestos carcinogenicity,
this agent is still largely used in the world. The Italian experience shows that in
the process that lead to prohibition of asbestos use, a major role was played
by studies documenting the health impact of asbestos in Italy
• Neoplasms causally associated with asbestos:
mesothelioma of pleura,
peritoneum, pericardium, and tunica vaginalis testis
and cancer of the lung, larynx, and ovary.
• The number of mesothelioma cases within
a population can be estimated:
- directly from: mortality data, if reliable,
or from pathology registries, where available
- indirectly: from data on asbestos consumption
• Contrary to mesothelioma, the etiology of pulmonary,
laryngeal, and ovarian cancers is multifactorial
• Population Attributable Fraction (PAF):
the proportion of cases which would be prevented
if exposure to asbestos was eliminated
• Limited to lung cancer, PAF can also be estimated
using a reasonable ratio between mesothelioma
and occupational lung cancer cases.
PAF
PAF=∑((Pi*RRi)-1)/ ∑Pi*RRi)
Pi is the proportion of the exposed population in the exposure
category i
RRi is the risk for the disease in the exposure category i relative
to the risk in the reference exposure category (i.e. the
population not exposed)
Driscoll et al. Occupational carcinogens: assessing the environmental burden
of disease at regional and local levels.
Geneva, WHO 2004 (Environmental Burden of Disease Series, N° 6)
INFORMATION NEEDED TO COMPUTE PAFs
a) proportion of the workforce employed in each sector
b) proportion of workers exposed to asbestos in each
sector
c) occupational turnover
d) levels of exposure
e) proportion of the population in the workforce
f) relative risk for each considered disease for different
levels of exposure (when available)
Relative risk for asbestos related cancers other than mesothelioma
site
High exposures
Low exposures
Whatever exposure
RR
lung
LCI UCI** RR UCI* UCI* RR
*
*
1.48 1.44 1.52
1.18 1.13 1.23
larynx
ovary
1.44
1.77 1.37 2.28
*Confidence interval – lower limit
**Confidence interval - upper limit
UCI* UCI*
*
1.19
1.64
Goodman et al 199918
IOM 200619
Camargo et al 201120
DISCUSSION & CONCLUDING REMARKS
Inter-country differences in the reliability of the background statistics. The peculiarity of
the estimates in Brazil might reflect the limited use of amphiboles
Two conclusions :
- Urgent need for remediation of asbestos contamination and a national asbestos ban
- Improvement in the quality of asbestos-related environmental and health data
The estimates are exploratory. They intend to stimulate the construction of “local”
databases regarding the extent to which asbestos is or has been present in the
occupational environment
In each economic sector, prevalence of exposure may be specific in Latin American
countries and may have been different form the ones in Western European countries
in the Nineties
Estimates of the PAFs need more precise data on the proportion of workers exposed to
asbestos in each productive sector, on the occupational turnover, and on levels of
exposure
Scientific papers in English and Spanish
open–access publications
for training and dissemination activities
Asbestos case and its current implications for global health. Annali
dell'Istituto Superiore di Sanità 2013;49(3):249-251. Marsili D, Comba P.
Italy-Latin America cooperation: a contribution to training on
prevention of asbestos-related diseases / Cooperación Italia-América
Latina: una contribución a la formación en la prevención de las
enfermedades relacionadas con el asbesto. Roma: Istituto Superiore di
Sanità; 2013. (Rapporti ISTISAN 13/31). Marsili D. (Ed).
International scientific cooperation on asbestos-related disease prevention
in Latin America. Annals of Global Health. 2014 in press. Marsili D, Comba P,
Pasetto R, Terracini B.
Estimates of asbestos burden of occupational cancer in Argentina, Brazil,
Colombia, and Mexico. Annals of Global Health. 2014 in press. Pasetto R,
Terracini B, Marsili D, Comba P.