16 May 2018

The ongoing health challenge of asbestos

Chronic Disease Clinical Respiratory

Of all the items in Anita Aiezzo’s collection of asbestos horrors, the deadly-poison prize probably goes to the cigarettes tipped with blue-asbestos filters. 

Ironically, the cotton and asbestos-paper filters, used in Kent cigarettes produced by US manufacturer Lorillard Tobacco, were introduced in 1952 in response to early jitters about the links between tobacco smoking and lung cancer.   

In the marketing, the brand made much of its “scientific Micronite” filter technology, claiming it trapped tars and nicotine and had been used in hospitals to rid the air of microscopic impurities.

The filters were withdrawn in 1956, after the company became increasingly nervous about what it called a “whispering campaign” regarding the emerging health impacts of respirable asbestos fibres.  

Decades later, Lorillard and the filter supplier are still fighting legal claims from former Kent smokers and factory workers stricken with cancer, including mesothelioma, which they blame on asbestos exposure. 

Ms Aiezzo, a Melbourne-based asbestos management consultant and former WorkSafe Victoria regulator, has amassed hundreds of asbestos products demonstrating how widely the “magic mineral” permeated domestic life.

Parents actually bought asbestos “snow” to sprinkle on the family Christmas tree. Art teachers taught pupils how to make asbestos jewellery, guided by a 1960s book with photographs detailing each step in the process.

 “There’s a little girl called Mary-Lou, and she is spooning loose asbestos fibres from a paper bag, mixing it with resin and rolling it into beads,” Ms Aiezzo said.  “The material the students were handling was pure asbestos fibre in a brown paper bag.”

She uses the collection to grab the attention of trainees in asbestos management workshops with a message that asbestos was everywhere – in pipes, ashtrays, oven gloves, iron stands, kitchen paper, toasters, hairdryers, even blackboards.

Despite Australia’s 2003 ban on production and imports of asbestos, an estimated one-third of Australian homes still contain asbestos in some form, commonly in roofing, downpipes, floor tiles, walls, fireplaces and flues.

It was also widely used in public buildings, including schools and hospitals. “The [Sydney] Opera House is riddled with it,” Peter Tighe, CEO of the Asbestos Safety and Eradication Agency, told The Medical Republic.

Meanwhile, imported products containing asbestos – ranging from children’s crayons and magic tricks to building products and railway locomotives – keep appearing.

“Complacency is our biggest problem,” Mr Tighe said.  “It’s a wonderful product, asbestos. If it didn’t kill you, you’d say how good is this?  It has a strong tensile strength, can be woven into material, it’s a good electrical insulator, and it’s a good heat insulator and retardant,” he said.

Since its inception in 2013, ASEA has been gathering evidence about Australia’s asbestos legacy.  The agency is now about to embark on a second four-year phase focusing on high-risk removal led by government.

More than 4000 Australians die each year from asbestos-related diseases, including some 700 from the universally fatal cancer mesothelioma.   

Anyone who worked in the building industry up through the 1990s is likely to have been exposed to asbestos.  Avid use of the material during post-WWII building boom made Australia the world’s top per-capita consumer.

Now, electricians and plumbers are considered to be most at risk from disturbing “legacy” asbestos.  However, a growing trend is emerging in deaths with no direct occupational link. 

“The dynamic now is we are moving from occupational exposure to non-occupational exposure,” Mr Tighe said.

“What we are finding is, people are either getting secondary exposure through their partner – from washing their overalls, for example – or they have worked in an area where they have been exposed but we can’t tie down exactly where that occurred.”

Incidental exposure has been implicated in the deaths from asbestos-related disease of teachers and hospital workers.  Mr Tighe noted the case of a clerk employed at Sydney’s Westmead Hospital.

“His job was to deliver clerical documents, and he used to use the service tunnels under Westmead where there was asbestos lagging on the pipes. What that tells us is that there was a high fibre count in the air he was walking through.”

A reminder of the risk came in mid-March when a bushfire tore into the NSW town of Tathra, destroying 68 houses.  The discovery of asbestos at 30 of the razed properties led authorities to throw a cordon around the area, stabilise the ash with a gluey mixture of polyvinyl acetate and water, and deny access to homeowners for days.  

An estimated 6000 tonnes of fire-damaged asbestos waste had to be contained and transported to deep landfill, requiring a ban on public access to the regional waste depot for four months.  The NSW government allocated $10 million for the clean-up. 

While the local council characterised the risk to residents and tourists as negligible, Mr Tighe would prefer more open disclosure.“You don’t want to worry people. But my view is, tell them the truth, let them know. Don’t be hysterical, but don’t come up with statements which are, quite frankly, the sorts of things used to hose down the public.”

Fire victims should understand why they can’t poke around in the ashes for heirlooms, for instance. “When asbestos is exposed to fire is, it spalls. The moisture in the material explodes like a cracker, which releases fibres.  

Quite often those fibres are lifted in the updraft and distributed over the local community.  But often they will fall in the ashes residue.” 

The theory of time-weighted exposure and the likelihood of developing disease did not necessarily apply to asbestos, Mr Tighe said.

“Unfortunately, with asbestos fibres … it doesn’t take much exposure.  We’ve got situations in country areas where a cocky has come over to help his mate build a shed. That’s the only time he’s been there, that one day when fibres were generated, and he has come down with disease. There is more and more anecdotal evidence of that sort of thing happening.”

Once the agency’s asbestos audit is complete, it plans to be more proactive in removal and lifting public awareness. 

“If (a house) is painted with a plastic paint and it’s in good condition, there is no personal or clinical threat.  But if there is going to be renovations or extensions, or if there is a demolition or a fire, all these factors have an impact,” Mr Tighe said.  

In a new initiative, ASEA has started holding seminars to educate the building industry and importers about asbestos risk.

Despite stepped-up surveillance by customs in recent years, asbestos products from unregulated countries, including China, continue to test the rules.

“We want everyone in the supply chain to be involved, from people in design to architecture, builders and customs agents,” Mr Tighe said.

 “You can’t rely on a lot of certification from overseas.  We have been encouraging shippers to send product samples for checking in Australia. It requires constant vigilance. “

Ms Aiezzo, who is now adding new asbestos items to her collection, believes the published inventory of some 3000 products known to contain asbestos is far from complete.

“I think people have no idea of the extent of it,” she said.