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In the UK the use of asbestos peaked first in 1965, when 180,000 tonnes were imported and then again in 1973, with over 195,000 tonnes. It fell to 40,000 tonnes in 1984, and 25,000 tonnes in 1989. The UK has imported approximately 6 million tonnes of all types of asbestos, mostly from Canada and South Africa, since the turn of the century.

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At the time of its initial use, asbestos was largely chosen for financial reasons. While much has been made by the asbestos industry of the fire proofing or enhanced safety properties of the mineral (and the 1970 Fire Precautions Act encouraged heavy use of asbestos insulation board) the main use has been for its high tensile strength reinforcing asbestos cement in construction:

• cement mixed with about 15% asbestos fibre is capable of making a rigid sheet less than five millimetres thick;
• if iron was used instead, the sheet would have to be three centimetres thick in order to have the same strength.
• without asbestos, rigid cement pipes need to be three centimetres thick and only one metre long to avoid breaking;
• with asbestos, pipes can be produced at a thickness of only one centimetre.

For construction companies, asbestos saves on the amount of cement used and on transport costs. Its lightness make it easier to handle - always providing that the health risks are discounted.

Yet despite being recognised as a hazard for nearly a hundred years, people still die as a direct result of exposure to asbestos. UK deaths from lung cancer, mesothelioma and asbestosis directly attributable to asbestos will number between 150,000 and 250,000 people over the next thirty years.

Because of a combination of a long latency period which can be up to sixty years and past complacency on the part of government and corporations regarding asbestos use for much of the twentieth century, deaths from the incurable asbestos-related cancer, mesothelioma, are actually increasing. There were 1874 deaths in 2003 compared with 153 in 1968 and projections suggest that the annual number of mesothelioma deaths in Great Britain will not peak until some time between 2011 and 2015 when deaths could reach 2450 a year. Deaths from lung cancer directly attributable to asbestos are more difficult to quantify as the disease can also result from smoking but complex medical models suggest that while in 1985, the Health and Safety Commission accepted evidence that deaths from asbestos would have fallen to "only" one worker a year, by the turn of the century, it is now widely accepted that the combined deathtoll of cancers directly attributable to asbestos (mesothelioma and lung cancer) will result in the deaths of around ten people a day (around 3600-3800 annually) until at least 2020. Many more are blighted for life by progressive non-malignant conditions which considerably diminish the quality of life of the sufferer and their families.

• Based on death certificates were asbestosis is described as being the underlying cause of death there were 113 deaths due to the disease in 2003. In 2004 there were 750 disablement benefit cases.
• The annual number of new cases of asbestosis according to the Department of Work and Pensions (DWP) Industrial Injuries Scheme (IIS) (which compensates workers for prescribed occupational diseases) has risen erratically, but rather strongly since the early 1980s, reaching the current level of 750 in 2004. This is likely to be an underestimate of the total number of cases.
• There were 415 new cases of disablement benefit for diffuse pleural thickening in 2004.
• The trend in diffuse pleural thickening has increased over recent years, although this may be partly or wholly explained by the acceptance of claims under the IIS scheme for unilateral (affecting only one lung) cases and other changes in data collection methods

Asbestos use

Asbestos is used to describe a number of naturally occurring minerals that have crystallised to form long thin fibres and fibre bundles. The fibres have a resistance to heat and electrical current and a high tensile strength which made the mineral particularly appealing for insulation purposes and as a building material. While always a hazard, asbestos poses few risks of sealed in a block but when the materials become airborne and are inhaled - either in the exctraction or manufacturing process or when drilled or chipped. Separated into very fine fibres, asbestos becomes a serious health hazard. These fibres enter the body mainly through breathing and become trapped, causing cancers and irreparable scarring of the lungs. The killer qualities are associated with the length, diameter and strength of the fibres. The risk of disease is dose related. There is no safe level of exposure but increased exposure will increases the risk.

All the asbestos-related diseases - lung cancer, mesothelioma (a cancer of the lining of the lungs or lower digestive tract) and asbestosis (a chronic fibrosis of the lungs) relate to inhalation and the largest number of asbestos related injury cases are unsurprisingly found amongst people who have worked in the construction industry. Because asbestos was installed in so many buildings people still have the potential to be exposed – and there is a continuing risk particularly to building and maintenance workersand The Control of Asbestos at Work Regulations introduced in May 2004 imposes a new duty on those responsible for non-domestic premises to manage the asbestos contained in them.

Types of asbestos

Asbestos comes in six types divided into two groups. Most common is the serpentine group, which includes chrysotile (white asbestos) and which has been the most frequently mined. A second asbestos group known as the amphiboles includes crocidolite (blue asbestos) and amosite (brown asbestos), anthophyllite, tremolite (which can occur with talc and white asbestos) and actinolite. Only chrysotile (white), crocidolite (blue), amosite (brown) and anthophyllite have been in common industrial use. The colours are obvious when freshly mined, but ageing and heat turns all asbestos a similar colour and only by scientific tests can asbestos be identified and classified by type. By the end of the 1970s, 95% of all asbestos mined was chrysotile and it is the only type still being exploited.

Though chrysotile (white asbestos) has been used most widely, the greater potency of amphibole (blue and brown) asbestos is generally recognised with blue asbestos having a risk about 500 times that of white asbestos for mesothelioma and 10-50 times as high for lung cancer. The equivalent risk ratio for brown asbestos is 100 for mesothelioma and the same as blue (10-50) for lung cancer. However any asbestos material that would crumble easily if handled, or that has been sawed, scraped, or sanded into a powder, is a health hazard. If disturbed, asbestos material may release asbestos fibres which can be inhaled into the lungs. The fibres can remain there for a long time as they are not easily destroyed or degraded. Asbestos related diseases generally takes many years – often several decades – to develop after exposure and conditions experienced long ago can have set the charge for a slowly ticking time bomb.

Asbestos related diseases

Diseases occur as a result of particles becoming lodged in the lung and asbestos is particlarly associated with two kinds of cancer:

• Mesothelioma is a cancer of the lining of the lung (pleura), abdomen (peritoneum) or heart (pericardium). More than 10 times as many deaths are due to pleural mesothelioma than to peritoneal mesothelioma. Some people develop both. The only known cause of mesothelioma is previous exposure to asbestos. Of all the diseases caused by asbestos mesothelioma requires the least exposure to the product. A typical symptom of pleural mesothelioma is breathlessness caused by the build up of fluid around the lungs. In some cases this can be eased by way of drainage of the fluid but unfortunately there is no known cure for mesothelioma and by the time it is diagnosed, it is almost always fatal. Mesothelioma has a long latency period (time between exposure and onset of disease) of at least 15 years and sometimes as long as 60 years.
• Lung Cancer (Carcinoma of the Bronchus) is a malignant tumour of the bronchi covering which almost always results in death. The condition is often caused by smoking, but can be caused by exposure to asbestos alone. It is generally accepted that cigarette smoking combined with exposure to asbestos, greatly increases the chances of contracting the disease than either exposure alone. The tumour grows through surrounding tissue, invading and often obstructing air passages. Withou the presence of other asbestos related diseases, such as asbestosis, pleural plaques and pleural thickening it can be difficult to prove that lung cancer is caused by asbestos exposure, especially if a person has previously been a heavy smoker. Damages are certainly likely to be reduced in circumstances where the claimant is a heavy smoker (for reasons of contributory negligence) although some such cases have succeeded in the past. Again, the disease has a long latency period – typically at least 20 years.

Two non-malignant lung diseases are also associated with asbestos:

• Asbestosis is a scarring of the lung tissue which impairs the elasticity of the lung and hampers its ability to exchange gases leading to inadequate oxygen intake to the blood. Asbestosis restricts breathing leading to decreased lung volume and increased resistance in the airways. It causes severe breathlessness and chest pains and is a slowly progressive disease with a latency period of 15 to 30 years. In extreme cases the disease can be fatal. The damaged lungs strain the heart and can lead to congestive heart failure. X-Rays can detect the damage at an early stage but a routine medical examination will not. Unlike with other silica related effects, a fine fibrosis is seen at the base of the lungs. The disease is particularly common among those who have had regular and high exposures to fibres such as laggers, asbestos textile workers, and those involved in the manufacture of asbestos products. There are, however, documented cases where relatives of workers have died of asbestosis and where people have worked for only short periods in the asbestos industry. The disability tends to worsen gradually over time, even after asbestos exposure has ceased. Because controls reducing fibre levels and bringing in respiratory protective equipment were introduced in these high risk areas many years ago asbestosis is less frequent an occurance than it once was.
• Diffuse pleural thickening is a non-malignant disease in which the lining of the lung (the pleura) becomes scarred. Pleural fluid, only a few millimetres thick, lubricates the movement of the lungs, but when the pleura is irritated by asbestos fibres, extra fluid collects (known as pleural effusion). When the liquid is reabsobed into the pleura, the lung walls thicken. In some cases the condition can be sufficiently acute as to restrict the lungs' ability to expand and contract. Eextensive thickening may thus cause severe shortness of breath. Pleural thickening can be detected by X-ray examination. It can be described as on one side of the lungs, or both sides (bilateral) or it can be described as widespread (diffuse). Relatively small areas of pleural thickening are known as pleural plaques. Pleural plaques are dense bands of scar tissue which differ from pleural thickening and are usually found on both sides of the lungs. Pleural plaques indicate an increased risk of the chances of the sufferer developing lung cancer. (A surver found that the incidence of lung cancer in a group of shipyard workers with plaques was double that of shipyard workers without). Pleural plaques are a strong indication that the sufferer has been exposed to asbestos and in the past, sufferers have been advised to seek an award for provisional damages which allow them to return to court should they develop a more serious asbestos-related disease at a future date. It normally takes at least 10 years after the first exposure to develop asbestos-related pleural disease. The disease is a chronic condition with no cure.

"Safe" levels of exposure

Mesothelioma

There is a lack of scientific consensus as to whether there exists a threshold of exposure to asbestos below which a person is at zero risk of developing mesothelioma. However, there is evidence from epidemiological studies of asbestos exposed groups that any threshold for mesothelioma must be at a very low level – and it is fairly widely agreed that if a threshold does exists then it cannot currently be quantified. For practical purposes HSE does not assume that such a threshold exists.

Asbestosis and lung cancer

The situation for lung cancer and asbestosis is uncertain. Arguments for a threshold for lung cancer are based on the notion of the carcinogenic process being an extension of the chronic inflammatory processes producing fibrosis. It is generally recognised that heavy doses of white asbestos are required to produce clinically significant lung fibrosis. However, the situation for blue and brown asbestos is more uncertain and fibrosis has been observed at much lower exposures. This also suggests that if a threshold for lung cancer does exist for blue and brown asbestos it must be at a very low level indeed.

It is widely accepted that tobacco smoke interacts with asbestos in the causation of lung cancer. This means that the risk of lung cancer for a smoker exposed to asbestos is greater than the sum of the individual effects due to smoking and due to asbestos.

Occupations most at risk

Based on the deaths from 1980 – 2000 the ten occupations found to have the highest risk of mesothelioma for males were Metal Plate Workers, Vehicle Body Builders, Plumbers and Gas Fitters, Carpenters, Electricians, Sheet Metal Workers, Electrical Plant Operators, Production Fitters, Construction Workers, and Electrical Engineers. Because of the long latency period of mesothelioma (between 15 and 60 years) these results generally relate to exposures before the 1980s. These and other high-risk occupations can generally be associated with three broad areas of past asbestos use: shipbuilding, railway carriage and locomotive building, and the installation of lagging or other insulation materials in buildings or industrial plant. However, over 25% of those dying from mesothelioma had worked in the building or maintenance industry, an area of exposure which may not have been fully eliminated.

• See Mesothelioma occupation statistics: male and female deaths aged 16-74 in Great Britain [591kb]

The use, supply and importation of asbestos and asbestos products has been banned for all but a few exceptions by the Asbestos (Prohibition) Regulations. Work with asbestos generally requires a licence and the use of strict control measures, including personal protective equipment such as respirators. The fact that a wide range of people now have the potential to be exposed to asbestos – particularly workers involved in building maintenance – led to the latest revision of the Control of Asbestos at Work Regulations which introduced a duty on those responsible for commercial premises to manage the asbestos contained in them.

Some areas of the country appear to shower a higher prevelence of mesothelioma than others. High-risk areas tend to be those containing, or near to, industrial sites where asbestos was used extensively in the past – for example, shipyards, asbestos manufacturing factories and railway engineering works. This will usually mean that the area has a higher proportion of people who have worked in these industries than the average for the country, and excess mesotheliomas are likely to occur in people who have worked in them. In some cases there may have been a general environmental risk in places close to these sites in the past. Individual risk has more to do with occupation rather than geographical location of residence. Nowadays, those working in building maintenance trades are most llikely to be at highest risk.

Asbestos and children

Certain factors mean extra care should be taken to protect children from asbestos. First of all the younger you are when exposed, the younger you will be should disease start to show despite the long latency period. Secondly children might be particularly vulnerable to cancers. Young body tissue is growing and may be more susceptible to carcinogens.

Asbestos has been found in the lungs of very young children (three weeks-25 months) when examined after they had died.

A 1983 US Consumer Product Safety Commission expressed concern about the risk of exposure to levels of asbestos fibres at or below the environmental action level of 0.01 fibre/ml. It is worrying that schools may be declared safe and uncontaminated at this level. The Commission added, "Because of the rapid increase of risk with time, the lifetime effect of exposure in childhood is likely to be much greater than if exposure begins in adulthood." The USCPSC attempted to quantify the risk to children's health. They estimated that three children in every 1,000 exposed to 0.01 fibres/ml (the "acceptable" environmental level) for 10 years would die of asbestos-related cancer.

Women and asbestos

Sally Moore, a partner at Leigh, Day and Co., and Joanne Lenaghan, a former researcher for Clydeside Action on Asbestos, highlight the fact that many women die of asbestos-related diseases, yet they are ignored by the system, especially for state benefits.

Moore and Lenaghan do not dispute that there is a much higher level of these diseases among men. They argue, however, that there tends to be a lack of adequate investigation into the possibility that asbestos may have caused these illnesses in women. They point to "a combination of ignorance and prejudice in the medical, social and legal professions."

A lot of the problem is due to the mistaken belief that only a very large dose of asbestos can cause cancer or asbestosis.

The way in which women tend to have been exposed in the past confirms that there is no level below which exposure to asbestos can be considered "safe". Women who have died recently include two teachers, Jeanette Sawyers from Glasgow and Shirley Gibson from London, a cleaner in a bus garage, and many women who worked in the manufacture of asbestos containing products.

Documented cases

70 female former employees of Boots, producers of gas masks in the war, have died from mesothelioma. Hannah Meres worked to "do her bit" for the war effort at Boots in Nottingham. Because she was pregnant it was only for five weeks, yet 53 years later she died of mesothelioma.

Liverpool Occupational Health Project has highlighted the deaths of women warehouse workers who recycled asbestos sacks, a problem likely to be found in other warehouse workers.

Alice: a Fight for Life was a Yorkshire TV documentary first shown in July 1982. It changed society's view on the hazards of asbestos in a way no other programme has ever achieved. Alice Grace Jefferson, the subject of Alice: a Fight for Life, worked with asbestos at Cape Industries, Hebden Bridge for only nine months when she was a young woman aged 17. She died aged 48, after being ill for eight years and in great pain for the last year of her life. The factory was operated under regulations introduced in 1930 and yet a 1976 Ombudsman report showed the factory inspectorate had been complacent about the 107 deaths that had taken place at that point. Aside from Alice, many other women who had worked at the factory had also suffered and died prematurely.

Washing work clothes seems an innocent enough activity, but for many women it has led to their death. The Surveillance and Work-Related Occupational Disease. (SWORD) scheme reports for 1993, indicate 25 cases of mesothelioma, 16 of benign pleural disease and one of pneumoconiosis (asbestosis), which it stated derived from domestic exposure to asbestos most of which derived from workers bringing home dust on their clothes, and the victims of such exposure are usually, but not exclusively, women.

Survey1: The Liverpool survey

Hundreds of Liverpool women may have been exposed to high levels of asbestos while working in sack repair warehouses. Used cargo bags were sent up from the docks to be recycled. Some of the sacks contained a residue of dusts including nuts, grain, flour and asbestos. To clean the bags of dust, women would place the bags under huge static blowers and blow the used bags inside out. Women have described the levels of dust as so great, they could not see further than a few paces in front of them. In 1928, Ellen Wilkinson MP raised questions in Parliament, "After a few hours at this work the women become choked with grain and mineral dust". Illness among such workers was reported in the 1960s and 1970s.

The Liverpool and District Victims of Asbestos Support Group have been contacted by over 80 women who did such work. Most of the women have severe breathing problems. So far the project knows about 15 such sack repair warehouses in Liverpool. One warehouse operated up to the early 1970s. There are likely to have been similar warehouses elsewhere in the UK, whose ex-workers need help.

Cryptogenic asbestos

Julia Campbell worked as a school cleaner in Glasgow for more than 30 years. As a non-smoker she never had any health problems until recently when she began to experience shortness of breath and pains in her chest. A chest consultant has diagnosed cryptogenic fibrosing alveolitis. This means Julia is suffering from a fibrosis of the lung tissue, exactly what occurs as a result of asbestos exposure, except that cryptogenic means "of unknown cause". A post mortem is needed to distinguish between the conditions.

Julia has been exposed to asbestos. 15 years earlier she regularly cleaned a science lab with a damaged ceiling. Every day for six months she would clean up asbestos dust that had fallen from insulation material. She also has pleural plaques, accepted as evidence of asbestos exposure, yet the Department of Social Security has refused her claim for benefit. Her work history is said to be insufficient to cause asbestosis.

Environmental exposures

According to Julian Peto, "Every single person in the UK has some asbestos in their lungs. It is the level of exposure and the frequency that's important. All the established cases (of mesothelioma) so far have been due to high and regular exposure. What we don't know is if the lower levels due to environmental exposure cause mesothelioma. Since the risk to men is six times higher than the risk to women (who are seldom exposed to asbestos at work), environmental exposure is clearly not as significant as occupational exposure."

There is a great deal of resistance to the idea that low level exposure to asbestos is a risk to health. In actual fact people with evidence of lower levels of exposure to asbestos are develop mesothelioma but they then have a harder time gaining compensation because experts go into court and say the environmental risk is negligible.

It is not natural to have asbestos in your lungs. If it is truly the case that everyone now has some, then the prospects are terrifying given the long latency for the diseases.

Environmental exposures have caused disease as the deaths of many women prove. Deaths caused by such exposures are likely to rise in the future because much asbestos in buildings is totally uncontrolled. Asbestos has blighted the lives of whole communities in the industrial centres of the UK, not just in shipbuilding cities and towns.

Survey 2: J.W. Roberts factory, Leeds

In 1990 doctors in Leeds published a study of 180 Leeds mesothelioma deaths among workers, plus those of 30 people born in the city. Nearly one-quarter of the sample worked at the former J.W.Roberts factory, or a relative or another close contact had done so. 87 had worked in other jobs where there was a probable contact with asbestos. Nearly a quarter had been in occupations with no currently recognised asbestos exposure such as the non-asbestos textile industry in Leeds. Detailed family occupational histories were not taken so conclusions cannot be drawn from this about this industry.

For 23 deaths the occupation was unknown, or described as housewife. For 19 cases described by the coroner or the media as due to "environmental" exposure, links with the factory were found, mainly because someone close worked there. These people might have had problems obtaining compensation because of the environmental tag. Two others had high risk jobs for asbestos, engineer and electrical engineer. 15 people seemed not to have occupational exposure to asbestos. The authors conducted personal interviews with next-of-kin for eight of this group and found no evidence of occupational exposure. Seven of the eight, however, lived within 250 yards of the factory.

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