Asbestos Vigilance Still Needed
Written by Jan Hallam
Wednesday, 24 August 2016
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The discovery of asbestos in imported building materials on the construction site of the Perth Children’s Hospital last month was a sobering reminder that despite the material being banned in WA since 2003 and the myriad agencies established to control it, the continued risk of asbestos exposure is real.

It’s timely to look at the broader picture of how the use of the material is being monitored and how effective the asbestos-related disease surveillance has become.

201609-Brims-Fraser-Dr-Dec14A/Prof Fraser BrimsLast year, A/Prof Fraser Brims wrote in Medical Forum about the Asbestos Review Program (ARP) based at SCGH and funded by WA Health. Its objectives are to monitor the health of people who have had a minimum of three months continuous exposure to asbestos and provide health and clinical advice with the aim of early detection of cancers.

WA’s unique perspective

The program is unique to WA, which perhaps reflects the unique relationship the state has had with asbestos mining and the resulting rise of asbestos-related diseases over the decades. More than 5000 people since 1990 have visited the program at least once. Most attend annually (about 1200 people currently) and cancers in about two patients a year are diagnosed.

“Collaboration with the University of WA over the years has meant that observations in this cohort have translated into world-renowned research and the SCGH respiratory clinic has unparalleled experience in managing mesothelioma and other asbestos-related diseases,” Fraser said.

The ARP has been offering low dose CT scans and identifying treatable early stage lung cancer for four years and Fraser is hopeful that WA Health’s commitment to the program will continue. He added that a grant from the NSW Dust Diseases Board is facilitating research to establish who is at raised risk of lung cancer following asbestos exposure.

“We are trying to look at the combination of other risk factors along with asbestos to help us understand who we should be concentrating on.”

Sobering stats

According to the latest Australian Mesothelioma Registry (AMR) figures (2014), 641 people nationally were diagnosed with the disease that year. It was the lowest figure in the four years of the registry. In 2011 there were 692 cases diagnosed, 2012, 713; and 2013, 676. In WA 94 new cases were diagnosed in 2014 (77 men and 17 women) giving the state the highest rate of 3.6 people per 100,000 population, with Queensland next with 3.1.

Of the 641 cases of mesothelioma, 597 (93.1%) were tumours of the pleura (a combined term used here to represent pericardium, pleura and mediastinum) and 38 (5.9%) of the peritoneum.

“The elderly workforce offers a natural decline in that respect but we are also recruiting new people into ARP every week,” Fraser said. “The asbestos issue at the Perth Children’s Hospital site is an opportunity to flag to the community that this program exists and people who have had an exposure to asbestos for more than three months are entitled to be part of it. It is all bulk billed.”

“Text books and the internet give the impression nothing can be done but in WA we have a unique service so there is something doctors can do. You can refer people to the ARP where we will review them annually and treat lung cancer early. It makes a big difference to these people.”

WorkSafe on Asbestos

WorkSafe was one of several government agencies (Comcare, the WA Building Commission and the Department of Environment Regulation were others) called in to the Perth Children’s Hospital. We spoke to Ms Sally North, the Principal Scientific Officer of WorkSafe’s Occupational Hygiene and Noise Control Team.201609-Workers-asbestos-removal

While she was not able to comment on the details of the hospital audit, which is being led by WA Building Commissioner Peter Gow, she said that awareness of the use of asbestos in WA needed to improve.

“There are still buildings, plant and equipment where asbestos is present. Workplaces must be able to manage it. If asbestos is maintained in good condition and people know where it is and don’t inadvertently disturb it when renovating or demolishing, it can be properly managed,” she said.

“While workplaces are heavily scrutinised and regulated, I think we tend to forget just how many asbestos products were used domestically in Australia. WorkSafe does not control unpaid DIY work, so people who embark on these projects need to consider the possibility of asbestos being present.”

Global perpsective

When building panels supplied to the hospital’s builder John Holland by the Chinese company Yuanda were found to contain asbestos, it highlighted a problem that extended outside of Australia.

The Minister for Immigration, Peter Dutton, told The Australian newspaper it was “ridiculous” to suggest Australian Border Force could inspect all 2.4m containers entering Australia, while John Holland said Yuanda had provided certificates stating the 150 roof panels did not contain asbestos.

It reveals the dichotomy of views on the safety/efficacy of asbestos as a building material around the globe. While frantic alarm bells ring in countries such as Australia, the US and the UK when asbestos is detected, other countries continue to comfortably mine and manufacture Chrysotile (white asbestos).

“Many countries have banned asbestos industries but Russia and some Asian countries continue to mine and manufacture; it is perceived as a standard, cost-effective building material. Canada only stopped mining white asbestos in 2012,” Sally said.

It leaves regulation, awareness and education as the main weapons in the local fight being waged by a number of organisations in WA and Australia whose job it is to create systems to keep the community safe and informed.

“If the systems are poor, the risks are greater. Isolated incidences in themselves may not be a big issue, depending on the circumstances. But where people work in an industry where they may have a number of exposures, the more that happens the more the risks are increased. Mesothelioma is a unique cancer – it is easy to count. We are still waiting for those numbers to turn around and decline.”