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Summary

Asbestos has been recognised as an important risk factor for lung cancer for many years. However, there are a number of other agents that can cause the disease - most importantly, tobacco smoke - and lung cancers resulting from asbestos exposure are clinically indistinguishable from those caused by these other agents. This means that the total number of asbestos related lung cancers has to be derived from statistical estimates based on evidence from epidemiological studies rather than direct counting of individual cases.

  • It is likely that there are around as many asbestos related lung cancer deaths in Great Britain annually as there are mesothelioma deaths. There were 2156 mesothelioma deaths in 2007.
  • There were 240 recorded new cases of disablement in 2008 due to asbestos-related lung cancer and 79 reports of lung cancer in the THOR scheme, not all of which were asbestos-related. These numbers are substantially lower than the likely annual total number of deaths inferred from the number of mesotheliomas.

Summary

Mesothelioma is a formerly rare form of cancer which affects the pleura (the lining of the lungs) and the peritoneum (the lining surrounding the lower digestive tract). In the majority of cases mesothelioma is rapidly fatal following diagnosis so mesothelioma death statistics give a clear indication of the disease incidence. Mesothelioma is closely related to asbestos and many cases, particularly among men, are a result of exposures in occupational settings. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. The long delay between initial exposure to asbestos and death from mesothelioma is typically between 30 and 40 years. This means that deaths occurring now and most of those expected to occur in the future reflect industrial conditions of the past rather than current work practices.

  • The total number of mesothelioma deaths has increased from 153 in 1968 to 2156 in 2007.
  • The most frequently recorded occupations on death certificates of men now dying from mesothelioma include carpenters and joiners; plumbers, heating and ventilating engineers; and electricians and electrical fitters.
  • The expected number of deaths amongst males is predicted to increase to a peak of 2038 (90% prediction interval: 1929 to 2156) around the year 2016.

Summary

  • Based on Death certificates where asbestosis is described as being the underlying cause there were 96 deaths due to the disease in 2007.
  • There were 380 deaths in total in 2007 where the death certificate mentioned the term "asbestosis", and 66 of these are also included on the mesothelioma register because the death certificate also mentioned the term "mesothelioma".
  • Disablement benefit cases for asbestosis have risen erratically since the early 1980s, with the trend increasing strongly from the late 1990s through to the middle of the new millennium. The number of cases for 2008 is 795.

Introduction

Asbestosis is defined as lung fibrosis caused by the inhalation of asbestos fibres. Diagnosis is made on the basis of clinical features, X-ray appearances and a history of heavy asbestos exposure. It is generally recognised that heavy asbestos exposures are required in order to produce clinically significant asbestosis within the lifetime of an individual. Current trends therefore still largely reflect the results of heavy exposures in the past.

Overall scale of disease including trends

The Health and Safety Executive maintains a register of all deaths where death certificates mention asbestosis. These deaths include those where the underlying cause is specifically identified as asbestosis, but also those with other underlying causes but where asbestosis was nevertheless mentioned in the textual description of the cause of death. (The underlying cause of death is defined as the disease or injury that initiated the train of morbid events leading directly to death.) Thus the total number of deaths on the asbestosis register gives an indication of the number of individuals who were suffering from asbestosis when they died. In 2007 there were 380 deaths where the death certificate mentioned asbestosis and of these 96 had asbestos recorded as the underlying cause of death.

Interpretation of these figures is complicated by two issues:

Cases of asbestosis may sometimes not be recorded as such because they may be mistaken for other types of lung fibrosis or may go undiagnosed.

The word "asbestosis" is often mentioned on death certificates along with other asbestos-related diseases - i.e. mesothelioma and/or lung cancer. On some death certificates the wording of the cause of death description suggests that the term has been used incorrectly to indicate the role of asbestos in causing mesothelioma and/or lung cancer, rather than the presence of asbestos-induced lung fibrosis per se. This is particularly the case for mesothelioma, where the phrase "industrial disease of asbestosis" is often used when mesothelioma is given as a cause of death

There are four main diseases associated with inhalation of asbestos fibres. These are asbestosis (a scarring of the lung tissue caused by asbestos), two kinds of cancer (mesothelioma and asbestos related lung cancer), and diffuse pleural thickening (a non-malignant disease affecting the lung lining). The latest available statistics for each of these diseases are reported and discussed in the following sections:

  • Asbestosis
  • Mesothelioma
  • Asbestos-related lung cancer
  • Diffuse pleural thickening

Current evidence suggests that asbestos can also cause laryngeal cancer and may be implicated in causing pharyngeal, stomach and colorectal cancers.

Asbestos fibres are present in the environment in Great Britain so people are exposed to very low levels of fibres. However, a key factor in the risk of developing an asbestos-related disease is the total number of fibres breathed in. Working on or near damaged asbestos-containing materials or breathing in high levels of asbestos fibres, which may be many hundreds of times that of environmental levels could increase your chances of getting an asbestos-related disease.

When these fibres are inhaled they can cause serious diseases which are responsible for around 4000 deaths a year. There are four main diseases caused by asbestos: mesothelioma (which is always fatal), lung cancer (almost always fatal), asbestosis (not always fatal, but it can be very debilitating) and diffuse pleural thickening (not fatal).

Remember, these diseases will not affect you immediately but later on in life, so there is a need for you to protect yourself now to prevent you contracting an asbestos-related disease in the future. It is also important to remember that people who smoke and are also exposed to asbestos fibres are at a much greater risk of developing lung cancer.

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