America's asbestos epidemic
Asbestos: Think Again: America's asbestos epidemic
Deaths from Asbestos-related diseases
The highly politicized controversy in Washington over asbestos litigation has overshadowed a quiet and directly related crisis in public health: an epidemic of asbestos-caused diseases in the United States that claims the life of one out of every 125 American men who die over the age of 50.
Ten thousand Americans die each year -- a rate approaching 30 deaths per day -- from diseases caused by asbestos, according to a detailed analysis of government mortality records and epidemiological studies by the EWG Action Fund. Asbestos kills thousands more people than skin cancer each year, and nearly the number that are slain in assaults with firearms. The suite of diseases linked to asbestos exposure overwhelmingly affects older men.
Even more disturbing, deaths from asbestos in the United States appear to be increasing. Mesothelioma and asbestosis mortality rose steadily from 1979 through 1998. Asbestosis mortality, however, rose at more than three times the rate of mesothelioma, at 7.8 percent per year, compared to 2.3 percent annually for mesothelioma over the 24-year period 1979-2001.
As in the United Kingdom (Treasure 2004) and Australia (Leigh 2003), there are many reasons to believe that the peak of the U.S. asbestos disease epidemic may not be reached for a decade or more.
Asbestos use and exposure crested in the United States in the mid 1970s when a number of factors converged: more than 3,000 consumer and industrial products on the market at that time contained asbestos; asbestos product factories were polluting nearby neighborhoods; asbestos workers were heavily exposed on the job and were bringing home substantial amounts of asbestos dust to their wives and children; and asbestos was commonly used in public buildings and workplaces for soundproofing, fireproofing, and insulation. Meaningful workplace safeguards were not in place until at least 1980, and for many industries, such as construction, levels in excess of the pre-1980 standard persist even today (NIOSH 2002).
Asbestos diseases have a 20 to 50 year latency period, meaning that a substantial portion of individuals exposed in the 1960s and 1970s are just now showing up as disease or mortality statistics. Better tracking accounts for the dramatic increase in mesothelioma mortality reported in 1999, but lung cancer deaths from asbestos are not reported at all, and asbestosis is still dramatically underreported even in worker populations where asbestos exposure is well established (Markowitz 1997). And asbestos has not been banned. It remains heavily used in brake shoes and other products, directly exposing auto mechanics and others who work with the materials, and indirectly exposing consumers and workers' families. In addition, millions of people are exposed at home or in their workplace by the monumental quantities of asbestos that remain in the built environment -- the attic insulation in 30 million American homes, for instance -- following decades of heavy use.
EWG Action Fund projects that over the next decade, four asbestos-related diseases — mesothelioma, asbestosis, lung cancer and gastrointestinal cancer — will claim the lives of over 100,000 Americans. The epidemic is national in scope, affecting every state. And for every life that asbestos claims, many more will be compromised by an array of serious, if nonfatal, asbestos-caused illnesses.
The EWG Action Fund's projections, while specific to the United States, are consistent with the assessments of other experts who assert the industrialized world is in an epidemic of asbestos-induced cancer that has yet to reach its peak. In January, 2004, an article in the British Medical Journal characterized one form of asbestos-induced cancer, mesothelioma, as an epidemic that is not expected to peak in Britain until 2015 to 2020, when it will claim an estimated 2000 lives per year (Treasure 2004). The authors assert that 100,000 people alive now in the developed world will die of mesothelioma alone. Scientists in Australia expect mesothelioma deaths on that continent to peak in about 2010 and to claim 18,000 lives by 2020 (Leigh 2003). In the United States, mesothelioma accounts for about one quarter of all asbestos fatalities.
The analysis on this site presents the most detailed national and state-level estimates ever presented on the disturbingly -- and surprisingly -- high death toll from just two causes of asbestos fatalities, mesothelioma and asbestosis. The magnitude of this public health crisis raises profound questions about the wisdom and fairness of doing anything to cut off any avenue that might provide assistance or protection to the tens of thousands of Americans who become sick and die from asbestos exposure.
Mounting mesothelioma and asbestosis mortality
To develop our projections, EWG Action Fund researchers began by examining 25 years-worth of U.S. government data on asbestos mortality derived from death certificates. We found that deaths have been increasing steadily for the past 20 years and are still on the rise for the two asbestos diseases where data are available (see figure 2). Between 1979 and 2001, at least 43,000 Americans died from the signature asbestos cancer, mesothelioma, and an often-fatal non-cancer disease of the lungs called asbestosis. The actual number of deaths from these two diseases could easily be twice as high due to chronic misdiagnoses of both diseases (Markowitz 1997) and the absence of federal tracking for mesothelioma for nearly all of the time period analyzed.
In 2001, almost 1,500 people died with asbestosis listed as the primary or contributing cause of death, a 50 percent increase since 1990 and 340 percent increase since 1980 (NCHS, 2003). Between 1990 and 1999, the National Institute for Occupational Safety and Health estimates that a total of 114,506 years of potential life lost was due to asbestosis (NIOSH, 2002). The estimated number of discharges from non-federal hospitals for asbestosis has also increased dramatically, about four-fold, since 1990 and numbered 20,000 in 1999 (NIOSH 2002).
Mesothelioma was not tracked as a cause of death by federal health officials until 1999. Prior to that time, the National Center for Health Statistics (NCHS) and National Institute for Occupational Safety and Health (NIOSH) tried to estimate the number of deaths due to malignant mesothelioma by using "malignant neoplasm of pleura" (NIOSH) or "malignant neoplasms of the pleura or peritoneum" (NCHS) as surrogate measures because other studies show that a high percentage of these tumors are mesotheliomas. Scientists now know that estimates of mesothelioma based on these surrogate indicators dramatically underestimated the number of deaths due to mesothelioma. The first year that federal officials began tracking mesothelioma as a distinct cause of death, official mortality more than doubled. In 1998, the last year surrogate indicators were used, the estimated number of mesothelioma deaths was 935. One year later, when malignant mesothelioma was specifically coded as a cause of death, the number of deaths was 2,343.
More than 100,000 asbestos deaths in the next decade
To estimate future mortality we considered two scenarios. The first scenario assumes that mortality rates for mesothelioma and asbestosis will increase at the average rate observed in the 1990s (1990-1998) — a 4.4 percent annual increase for asbestosis and a 3.5 percent annual rate for mesothelioma. The second assumes half the rate of increase during that time.
Asbestos cancers and the fatal forms of asbestosis have a 20 to 50 year latency period, with the majority occurring at least 30 years after initial exposure. Exposure to asbestos peaked in about 1975 or 1980. Extrapolating out from this peak exposure period, one would expect asbestos mortality to crest sometime in the next 20 years.
If the increase in mortality that occurred in the 1990s continues for the next ten years there will be 3,776 deaths from mesothelioma and 2,536 deaths from asbestosis reported to the federal government in 2014. This rate of increase would produce 6,312 deaths annually for the two diseases one decade from now, up from 3,864 reported by the government in 2001. Overall, a mortality increase at this rate over the next decade would yield 22,000 deaths from asbestosis and 35,000 deaths from mesothelioma.
The second scenario [see graph below] assumes a growth rate in asbestosis and mesothelioma mortality of half the 1990-1998 rate. Projecting this growth rate over the next ten years we estimate 44,600 deaths from asbestosis and mesothelioma from 2004 through 2013, with 1,922 asbestosis deaths and 3,025 mesothelioma fatalities in 2014.
Mortality projections for these two diseases are fraught with complexities, and above all are creatures of the underlying assumptions. But the available data on asbestos mortality and use do not indicate that we have reached the peak incidence. The widely varying latency periods for disease onset, sometimes more than 50 years after exposure, make it impossible to know when the cohorts of people—mostly working men—who were exposed in the 1960's, 70s and 80s might develop mesothelioma or asbestosis. Also, because so many exposures continue in unregulated, unmonitored settings, either on the job or in homes, schools or workplaces, no one can be sure when asbestos contamination will taper off, reducing death rates in succeeding decades.
The fact that these two signature asbestos-caused diseases could easily kill 60,000 Americans, 80 percent of them men, over the coming decade is ample cause for strong public health measures, including medical and financial assistance for those stricken and their families. The threat from other deadly asbestos-caused cancers only raises the stakes.
Asbestos and other forms of cancer
Though there is no debate about whether asbestos causes lung cancer, other confounding causes of the disease make it impossible to identify the exact number of asbestos-caused lung cancer illnesses and deaths. The best estimates for asbestos-caused lung cancer deaths over the past two decades range from 5,000 to 10,000 per year (AIA 1980, Nicholson 1982), accounting for between 100,000 and 200,000 fatalities during that time.
Asbestos has been determined to cause gastro-intestinal cancer by the Occupational Safety and Health Administration (OSHA 1994), and the World Health Organization International Agency for Research on Cancer (WHO 1989). According to the OSHA medical surveillance guidelines for asbestos exposure: "These studies have shown a definite association between exposure to asbestos and an increased incidence of lung cancer, pleural and peritoneal mesothelioma, gastrointestinal cancer, and asbestosis" (OSHA 1994). Estimates vary for the number of asbestos-caused GI cancers annually. The best national estimates average about 1,200 asbestos-caused gastro-intestinal cancers per year (Nicholson 1982, Lilienfeld 1988).
When deaths from these four diseases are combined, EWG Action Fund estimates that asbestos is killing at least 10,000 Americans a year, and will cause the deaths of at least 100,000 Americans over the next decade. At least that number will die during subsequent decades, even if remaining uses of asbestos were banned immediately. And a greater number than that will be disabled by asbestos as asbestosis slowly progresses through their lungs, scarring more and more tissue, making it increasingly impossible for them to breathe.
Experts testifying before the United States Senate in the summer of 2003 predicted between 43,000 to 70,000 mesothelioma deaths over the 27 year life of the proposed federal asbestos trust fund, as well as up to 240,000 total cancer cases, and up to 1.6 million compensated non-cancer claims (Peterson, 2003). By any measure the magnitude of future asbestos death and injury is enormous.
Unsafe exposures persist today
The ongoing increase in asbestos mortality is due largely to the fact that asbestos-caused cancers and other diseases take at least twenty years and often fifty years or more after initial exposure to appear. Massive asbestos exposures from the 1960s through the 1980s are just beginning to show up as mortality statistics today. Asbestos will continue to cause diseases and death as long as it is used.
Even in workplaces where asbestos is regulated, hazardous conditions persist. In 1994, OSHA adopted tighter workplace exposure limits for asbestos (0.1 fibers/cc or 0.1 fibers/ml), fourteen years after they were recommended by NIOSH (NIOSH 2002). The mere existence of this standard, however, has not translated into safe working conditions for men and women in trades with significant asbestos exposure, such as construction, manufacturing, and mining.
In 1999, asbestos air levels exceeded the far weaker pre-1980 "permissible exposure limit" at 13 percent of construction and 5.6 percent of manufacturing sites monitored (NIOSH 2002). This pre-1980 limit, which was established by the Mine Safety and Health Administration (MSHA) and still applies to mining, is 20 times less protective than the 1994 OSHA standard (0.1f/cc vs. 2 f/cc). Between 19 and 91 percent of all mining sites sampled between 1982 and 1991 exceeded the 1994 OSHA standard. In 1991, 32.4 percent of mining sites sampled exceeded this level.
Even full compliance with the OSHA standard does not mean that workers will not die from asbestos caused cancer and other diseases. The preamble to the OSHA standard itself estimates that one in every 300 workers will develop lung cancer from exposure at the legal limit (OSHA 1986). A more recent assessment concludes that one in every 200 workers will develop lung cancer if they are exposed to a career's worth of asbestos at the OSHA "safe" level. One in 500 will develop asbestosis under a similar exposure scenario (Stayner 1997). The federal government estimates that 1.3 million Americans currently are exposed to asbestos on the job (OSHA 2004).
Asbestos mortality by state
California, Florida, New York, Pennsylvania, and Texas totaled the most asbestosis and mesothelioma fatalities from 1979 through 2001, at between 3,800 and 5,900 deaths each. In nine of the top ten states, the number of combined mesothelioma and asbestosis fatalities is increasing every year. Seventeen states had more than 1,000 asbestos fatalities from these two diseases during these years, and no states reported zero deaths. Only two states, Wyoming and Alaska, had less that 100 deaths from asbestosis and mesothelioma during the 23 year period where data are available.
Asbestos mortality by county
The top counties for reported asbestos mortality from mesothelioma and asbestosis are Los Angeles County, California; Cook County, Illinois; Philadelphia County, Pennsylvania; King County, Washington; and Harris County, Texas. These counties had from 400 to 1,200 deaths from these two diseases during the time period analyzed.
Several counties stand out with a high number of asbestos-related fatalities, while their states ranked lower overall. Massachusetts, Michigan, Maryland, and Arizona were not in the top ten states for asbestos mortality, but four counties within these states (Wayne County, Michigan; Middlesex County, Massachusetts; Baltimore County, Maryland; and Maricopa County, Arizona), ranked in the top 20 out of more than 2,000 counties reporting asbestos mortalities.
- American Insurance Association (1980). "Estimates of potential liability from asbestos and DES related injury (draft preliminary report)." Presented to the task force on tort liability for cumulative trauma and latent injury.
- Elmes, P. C. (1966). "The epidemiology and clinical features of asbestosis and related diseases." Postgrad Med J 42(492): 623-35.
- Greenberg, M. and T. A. Davies (1974). "Mesothelioma register 1967-68." Br J Ind Med 31(2): 91-104.
- Leigh, J. and T. Driscoll (2003). "Malignant mesothelioma in Australia, 1945-2002." Int J Occup Environ Health 9(3): 206-17.
- Lieben, J. and H. Pistawka (1967). "Mesothelioma and asbestos exposure." Arch Environ Health 14(4): 559-63.
- Lilienfeld, D. E., J. S. Mandel, et al. (1988). "Projection of asbestos related diseases in the United States, 1985-2009. I. Cancer." Br J Ind Med 45(5): 283-91.
- Lilienfeld, D. E. (1991). "Asbestos-associated pleural mesothelioma in school teachers: a discussion of four cases." Ann N Y Acad Sci 643: 454-86.
- Markowitz, S. B., A. Morabia, et al. (1997). "Clinical predictors of mortality from asbestosis in the North American Insulator Cohort, 1981 to 1991." Am J Respir Crit Care Med 156(1): 101-8.
- National Center for Health Statistics (NCHS) (2003). "Multiple Cause of Death files, 1985-1999."
- National Institute for Occupational Safety and Health (NIOSH) (2002). "Work-related lung disease surveillance report." Division of Respiratory Disease Studies.
- Nicholson, W. J., E. J. Swoszowski, Jr., et al. (1979). "Asbestos contamination in United States schools from use of asbestos surfacing materials." Ann N Y Acad Sci 330: 587-96.
- Nicholson, W. J., G. Perkel, et al. (1982). "Occupational exposure to asbestos: population at risk and projected mortality--1980-2030." Am J Ind Med 3(3): 259-311.
- Occupational Safety and Health Administration (OSHA). (1986). "Final Rule: Asbestos." 51 FR 22612. Department of Labor, Occupational Safety and Health Administration. June 20, Federal Register.
Occupational Safety and Health Administration (OSHA). (1994). "Medical surveillance guidelines for Asbestos - Non-Mandatory" 29 CFR 1915.1001 App I. http://www.osha.gov/pls/oshaweb/
- Occupational Safety and Health Administration (2004). "Safety and Health Topics: Asbestos." Viewable on the web at: http://www.osha.gov/SLTC/asbestos/index.html.
- Peterson, M. A. (2003). "Forecasting the Costs of S.1125 As Amended on July 10, 2003." Prepared for Caplin and Drysdale, September 8, 2003.
- Stayner, L., R. Smith, et al. (1997). "Exposure-response analysis of risk of respiratory disease associated with occupational exposure to chrysotile asbestos." Occup Environ Med 54(9): 646-52.
- Stein, R. C., J. Y. Kitajewska, et al. (1989). "Pleural mesothelioma resulting from exposure to amosite asbestos in a building." Respiratory Medicine 83: 237-39. Respiratory.pdf
- Treasure, T., D. Waller, et al. (2004). "Radical Surgery for Mesothelioma: The epidemic is still to peak and we need more research to manage it." British Medical Journal 328: 237-8.
- Wagner, J. C., G. Berry, et al. (1974). "The effects of the inhalation of asbestos in rats." Br J Cancer 29(3): 252-69.
- World Health Organization (WHO). (1989). Occupational Exposure Limit for Asbestos. WHO/OCH/89.1, Office of Occupational Health, World Health Organization, Geneva.
Notes from Table
1 Mesothelioma reported as the cause or contributor to death on death certificates, average 1999 through 2001. Assumes 100 percent of mesothelioma deaths are accurately identified and reported. Centers for Disease Control, National Center for Health Statistics, Multiple Cause of Death Files, 1999-2001.
2 Asbestosis reported as a cause or contributor to death on death certificates, average 1999-2001. Some experts estimate that 50 percent of asbestosis mortality is misdiagnosed and not reported (Markowitz 1997). Centers for Disease Control, National Center for Health Statistics, Multiple Cause of Death Files, 1999-2001.
3 Lung Cancer (Nicholson 1982). Assumes zero non-occupational lung cancer deaths from asbestos exposure in the home or environment.
4 Gastro-intestinal cancer (OSHA 1994), (WHO 1989), (Lilienfeld 1988), (Nicholson 1982).