Effect of Asbestos Consumption on Malignant Pleural Mesothelioma in Italy: Forecasts of Mortality up to 2040

Statistical models used to forecast malignant pleural mesothelioma (MPM) trends often do not take into account historical asbestos consumption, possibly resulting in less accurate predictions of the future MPM death toll. We used the distributed lag non-linear model (DLNM) approach to predict future MPM cases in Italy until 2040, based on past asbestos consumption figures. Analyses were conducted using data on male MPM deaths (1970–2014) and annual asbestos consumption using data on domestic production, importation, and exportation. According to our model, the peak of MPM deaths is expected to occur in 2021 (1122 expected cases), with a subsequent decrease in mortality (344 MPM deaths in 2039). The exposure–response curve shows that relative risk (RR) of MPM increased almost linearly for lower levels of exposure but flattened at higher levels. The lag-specific RR grew until 30 years since exposure and decreased thereafter, suggesting that the most relevant contributions to the risk come from exposures which occurred 20–40 years before death. Our results show that the Italian MPM epidemic is approaching its peak and underline that the association between temporal trends of MPM and time since exposure to asbestos is not monotonic, suggesting a lesser role of remote exposures in the development of MPM than previously assumed.

Future Incidence of Malignant Mesothelioma in South Korea: Updated Projection to 2038

Malignant mesothelioma (MM) is a cancer that is largely caused by exposure to asbestos. Although asbestos is no longer used in South Korea, the incidence of MM continues to increase due to its long latent period. We aimed to update the previous prediction of MM incidence until 2038. We predicted the incidence of MM over the next 20 years (2019–2038) in South Korea using Møller’s age–period–cohort (APC) model and a Poisson regression model based on asbestos consumption. The APC model predicted that the crude incidence rate would increase sharply in men and slowly in women. Despite the sex discrepancy in the rate of increase, the incidence rate for both sexes is expected to continue increasing until 2038. In the Poisson model, the crude incidence rate was predicted to increase continuously until 2038, and far more cases of MM were predicted to occur compared with the results of the APC model. When compared with actual incidence data, the APC model was deemed more suitable than the Poisson model. The APC model predicted a continuous increase over the next 20 years with no peak, suggesting that the incidence of MM will continue to rise far into the future.

P.1.23 Gaps between international conventions and national asbestos ban policies: a global perspective

IntroductionThere is an international consensus that the most efficient way to eliminate asbestos-related diseases is to stop using asbestos. However, 80% of the global population lives in countries that lack any national policy that achieves a total ban on asbestos. We investigated whether national policies were in line with international conventions and identified countries that lag behind the global trend toward a total asbestos ban.MethodsWe obtained data on the year that each country implemented policies that ban chrysotile, crocidolite, and amosite. We also obtained the list of countries that have ratified the C162 Asbestos Convention and the Basel Convention, and their date of ratification. Data retrieved from the search databases were compiled for statistical analysis. We calculated the numbers and proportions of countries enforcing total bans, partial bans, and no bans.ResultsAs of 2018, there were 62 countries implemented the total asbestos ban policy. Countries that ratified both conventions and countries that ratified either one or unratified any convention, we found the former group had a higher proportion of implementing total ban compared to the latter group (65% vs. 41%, p-value<0.05). However, some countries, such as Russia and Kazakhstan, are still among the biggest producers of asbestos, despite they have ratified C162. Asbestos may have been consumed longer in countries not ratifying conventions than those ratifying conventions.ConclusionsHistorical asbestos consumption and loose regulations have introduced challenges to eliminate asbestos-related diseases. Although several countries have reoriented the national policy in line with the global trend of banning all types and forms of asbestos, the gap between adopting interventional conventions and developing national policies remain, warranting efforts to analyze driving forces behind successful political processes to ratify the international conventions, establish asbestos control limits, and eventually create a national policy for a total asbestos ban.

Asbestos exposure and mesothelioma incidence and mortality in Bulgaria

Bulgaria totally banned the import, production and use of asbestos in 2005, but produced and used asbestos products during the last 3–4 decades of the 20th century. The aim of this study was to follow the incidence and mortality of mesothelioma in Bulgaria in relation to past occupational exposures. A literature search between 1960 and 2014 was conducted to obtain information on asbestos consumption, occupational exposure and asbestos-related diseases (ARDs). Data on registered mesotheliomas were provided by the National Cancer Register and data for recognized occupational ARDs were provided by the National Social Security Institute. An increase in the incidence of mesothelioma from 5 to 58 from 1993 to 2013, with 666 cases in the 21-year period, was registered. Incidence, mortality rates, deaths and male-to-female ratios and were lower in comparison to industrialized countries. The increase in mesothelioma incidence is considered as a consequence of more recent production and use of asbestos and asbestos products and the high occupational exposure between 1977 and 1989, while the lower rate of mesothelioma deaths and male-to-female ratio need to be investigated further.