Once An Industry Wonder, Now A Silent Killer

Asbestos has long been woven into human history, but we are only just beginning to feel its devastating impact on our health here in Asia.

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AsianScientist (Aug. 28, 2015) – BaoChoo had found her dream house in Kuala Lumpur. A marriage of red brick walls and grey louvre windows, the house looked every bit as charming as it did 60 years ago. It was perfect—except for the killers hiding in the ceiling.

BaoChoo recognized the snow-white ceiling boards. She grew up playing under similar ones, but now she feared. Those boards might contain asbestos—a fibrous mineral used in many building materials, it also causes cancer and lung diseases. Still, killer housemates were not so bad, BaoChoo reasoned, as long as they never crossed paths.

But when roof renovators fell through the ceiling, BaoChoo had to face her fears. She wore a mask, slipped on gloves, held her breath and picked up a piece of the broken board. She sealed it in a plastic bag and sent it to a laboratory.

Two months later, BaoChoo received the report. The bold capitalized letters screamed “ASBESTOS—POSITIVE.” BaoChoo slowed her breathing. She would stop breathing if she could. Asbestos fibers however, might have settled in her lungs weeks before she read the report.

Asbestos refers to six commercial silicate minerals classified into two groups: serpentine (chrysotile) and amphibole (crocidolite, amosite, actinolite, amosite, and anthophyllite). Asbestos fibers are flexible with high tensile strength. They do not burn, conduct little electricity, resist chemical corrosion, and tolerate temperatures of 500 Celsius and more.

We have been weaving asbestos into our lives for millennia. Northern Europeans mixed asbestos into pots 6,000 years ago. The sight of asbestos glowing bright white in a fire pit only to emerge clean and untarnished so fascinated our forefathers that they named it ‘indestructible’ in Latin. Pliny the Elder (23 – 79 A.D.) wrote that asbestos protected against all poisons and “attains the value of the most precious pearls.” Devotees prayed to lanterns and candles with asbestos wicks in Greek temples and Christian baptisteries.

Modern industries, yearning for an easy protection against heat and chemicals, replaced mythical worship of asbestos with pragmatic admiration. Asbestos was propelled to the top pedestal of industry. Miners pulled bundles of asbestos fibers from rocks and factory workers wove the fibers into more than 3,000 products, including asbestos-cement, brake pad linings, electrical wire covers and gaskets. TV advertisements sold asbestos tablecloths that did not burn. BaoChoo’s ceiling board was only a patch of asbestos’ rich tapestry.

Booming industries spurred asbestos production. Between 1900 to 1960, crude oil production increased 50-fold but asbestos mining jumped 70-fold. The cheap, versatile and protective asbestos was much prized. In a 1965 conference, asbestos was crowned the “mineral of the 20th century.”

The mineral of the 20th century is now recognized as a silent mass-killer of the 21st. The World Health Organization (WHO) estimated in 2006 that asbestos kills 107,000 people every year. That mortality count is a gross understatement, according to Dr. Ken Takahashi, Professor of Environmental Epidemiology at the University of Occupational and Environmental Health, Japan. Many health experts and international bodies like the WHO, the International Agency for Research on Cancer (IARC), the International Labor Organization, and Collegium Ramazzini support a global asbestos ban.

At BaoChoo’s house, the renovators disposed of the broken pieces of asbestos ceiling boards—she did not ask how—and patched the ceiling. The new ceiling board looked like the one before.

“What can I do? I’m not going to leave just because of the ceiling,” said BaoChoo. “Asbestos could be anywhere. Perhaps even in my office.”

Millions of tonnes of asbestos have accumulated in our cities and landfills, but we need not panic.

“As long as the asbestos fibers are contained in the products, we won’t breathe them in,” explains Dr. Krishna Rampal, Professor of Occupational Safety and Health at Perdana University, Malaysia.

But if asbestos products break, the fibers are released. Asbestos fibers, thinner than a human hair split 20-times and as long as the diameter of one, penetrate the deep ends of our lungs.

Scientists are still examining how asbestos fibers damage our cells. Animals and lab culture studies prompt scientists to hypothesize that asbestos fibers initiate a complex cascade of immune system processes that trigger tissue damage and cancers instead of removing the fibers.

In our lungs, sentries intercept the fibers. Macrophages—a type of white blood cell—reach out to swallow the fibers, but they struggle to engulf the longer ones. Just as indestructible in our bodies as they are in fire, asbestos fibers lodge in our lung tissue and continue to irritate. The frustrated macrophages enter overdrive and kick off a chain of inflammation which turns chronic. Excessive reactive oxygen and nitrogen species are released, and with free radicals generated by the fibers, wreak havoc on the cells and DNA. Cells refuse natural death but continue to multiply as cancer-related genes come on board. These processes cause asbestos-related diseases.

The three most prevalent asbestos-related diseases are asbestosis, lung cancer and mesothelioma—cancer of the pleura, the thin membrane that wraps our lungs. These diseases progress as mountains erode—surely but so slowly that nobody notices. Most victims do not suffer shortness of breath until two decades after first asbestos exposure. Asbestosis kills more than twenty years after initial asbestos exposure, and lung cancer and mesothelioma both after thirty. Although long in hiding, the diseases strike fast when they show. Mesothelioma victims often die within 18 months from diagnosis.

“Asbestos diseases kill you very badly, especially mesothelioma,” says Sanjiv Pandita, who leads the Asian Resource Monitor Center, which supports the labor movement in Asia. “Your lungs are clogged. You suffocate and die a very painful death.”

Since the 1970s, developed nations have realised the potency of asbestos and banned its use. Asbestos use peaked in 1980, then more than halved to two million tonnes in 2012. Almost all asbestos is now mined in Russia, China, Brazil and Kazakhstan. Yet developing nations are picking up the pace.

Asia consumed almost 1.5 million tonnes of asbestos in 2012, 60-fold more than in 1950. Half of all asbestos mined goes to China and India, and one-fifth goes to Indonesia, Vietnam, Thailand and Sri Lanka. Among these, India, Indonesia, and Sri Lanka are demanding ever more asbestos.

As more asbestos pours into Asia, the related diseases follow. Using data from mostly developed nations, researchers plotted current mesothelioma cases against asbestos consumption 40 years ago and found both numbers to fall closely along a positive straight line—the more asbestos was used 40 years ago, the more mesothelioma cases would develop today. Asia is expected to suffer similar patterns.

Although most scientists expect an asbestos-related disease epidemic in Asia, they cannot pinpoint its magnitude. The lack of asbestos-related disease data from major players like China, India, Thailand, Russia and Kazakhstan reduces scientific models into guessing games.

“In Asia very few states publish data on asbestos exposure or deaths,” says Pandita. If you looked, “you will find a huge black hole.”

Without actual data, one can only gauge Asian mesothelioma deaths with the best available data. Using patterns observed in mostly Western nations, Takahashi calculated global mesothelioma deaths in 1994-2008 to be 213,200. Of these, almost 8,000 went unreported in China, India and Thailand.

Based on the asbestos experience of developed nations, the generally poorer occupational safety standards in Asia, and “alarmingly high asbestos use rates,” Takahashi expects that “developing nations will face a much more serious epidemic of asbestos-related diseases in twenty years.”

The asbestos industry uses the absence of reported mesothelioma deaths in major consumer countries (e.g, China, India, Russia) to argue that chrysotile asbestos is safer than crocidolite asbestos, that which has already been largely banned worldwide. Although there is compelling evidence that the shorter and curlier chrysotile fibers are less carcinogenic, most scientists agree that even a single fiber of any asbestos can cause cancer.

BaoChoo worried for her roof renovators. They had ignored her warnings about asbestos and refused her masks. Such negligence did not surprise Pandita. “Asbestos looks so innocent,” says Pandita. Workers treat the white asbestos like cement. Day after day, asbestos follows workers home on their clothes. The workers now live with killer housemates.

But even if the exposed victims suffer chest pains decades later and check with a doctor, their asbestos-related diseases may likely be misdiagnosed for as other respiratory diseases. Physicians often “do not suspect asbestos and fails to check for asbestos history,” says Takahashi. Misdiagnosis is further confounded by the lack of expertise and facilities to diagnose asbestos-related diseases. For example, mesothelioma can be differentiated from lung cancer only with sophisticated antibody staining. Many countries lack such expertise.

A global asbestos ban is needed, but it would not stop the impending Asian epidemic of asbestos-related diseases. Scientists and labour action groups are working to raise awareness of asbestos and to improve diagnosis and treatment of these diseases. Takahashi hopes developing countries will escape the asbestos-dusty paths of developing countries.

BaoChoo plans to eventually rid her house of asbestos. For now, she avoids any renovation sites in her neighbourhood. Perhaps that may keep her safe from asbestos. She will know twenty years later.

This article won first place in the 2015 Asian Scientist Writing Prize.

Click here to read an interview with the top three winners. See the photos or watch the video highlights of the prize presentation ceremony held on July 27, 2015.
Also, look out for the other winning entries to be published in The Best of Science Writing from Asia 2015 coming out later this year.


Copyright: Asian Scientist Magazine; Photo: Shutterstock.
Disclaimer: This article does not necessarily reflect the views of AsianScientist or its staff.

Yao Hua writes on ecology and health sciences. He surveyed ants and dissected caterpillar salivary glands in McGill University, then studied cannibalism among bugs at University of California, Davis. He believes that the world is a great place, but only because it has insects and durians in it.

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