Comments on the 2014 Helsinki Consensus Report on Asbestos

Background: The Finnish Institute of Occupational Health (FIOH) convened an Expert Committee in 2014 to update the 1997 and 2000 Helsinki criteria on asbestos, asbestosis, and cancer. Methods: The Collegium Ramazzini reviewed the criteria for pathological diagnosis of the diseases caused by asbestos presented in the 2014 Helsinki Consensus Report and compared them with the widely used diagnostic criteria developed in 1982 by the College of American Pathologists and the National Institutes of Occupational Safety and Health (CAP-NIOSH). Findings: The sections of the Helsinki Consensus Report dealing with pathological diagnosis are based on a biased and selective reading of the scientific literature. They are heavily influenced by the outdated and incorrect concept that analysis of lung tissue for asbestos bodies and asbestos fibers can provide accurate information on past exposure to asbestos. Five specific problems are :1.Over-reliance on the detection of “asbestos bodies” as indicators of past exposure to asbestos.2.Over-reliance on asbestos fiber counts in lung tissue as an indicator of past exposure to asbestos.3.Use of the scanning electron microscope (SEM) at low magnification as a tool for evaluation of asbestos-related disease.4.Failure to recognize that chrysotile is the predominant type of asbestos fiber found in pleural mesothelioma tissue.5.Postulating the existence of a threshold for development of an asbestos-related lung cancer.. Conclusion: Accurate diagnosis of the diseases caused by asbestos must be based on a carefully obtained history of occupational exposure. An accurate exposure history is a far more sensitive and specific indicator of asbestos exposure than asbestos body counting or lung fiber burden analysis. Ethical note: The sections of the 2014 Helsinki Consensus Report on asbestos, asbestosis, and cancer dealing with pathologic diagnosis of the diseases caused by asbestos appear to have been influenced by members of the Expert Committee with undisclosed financial conflicts of interest

Comments on the Causation of Malignant Mesothelioma: Rebutting the False Concept That Recent Exposures to Asbestos Do Not Contribute to Causation of Mesothelioma

Background: European asbestos manufacturers and their expert witnesses have advanced the claim that recent exposures to asbestos are not of significance in the causation of malignant mesothelioma. They argue that in cases of prolonged exposure to asbestos only the earliest exposures contribute to mesothelioma induction. Methods: The Collegium Ramazzini examined this claim and compared it with the findings of the Epidemiology and Public Health Working Group of the Second Italian Consensus Conference on Pleural Mesothelioma. This independent Working Group noted that earlier exposures are more effective in inducing mesothelioma, but that subsequent exposures also contribute and cannot be excluded. They found convincing evidence to support the conclusion that mesothelioma incidence is proportional to cumulative asbestos exposure. Conclusion: The Collegium Ramazzini concludes that risk of malignant mesothelioma is proportional to cumulative exposure to asbestos in which all exposures - early as well as late - contribute to the totality of risk. The Collegium Ramazzini rejects as false and scientifically unfounded the notion that only the earliest exposures to asbestos contribute to mesothelioma induction

The Global Health Dimensions of Asbestos and Asbestos-Related Diseases

The Collegium Ramazzini (CR) reaffirms its long-standing position that responsible public health action is to ban all extraction and use of asbestos, including chrysotile. This current statement updates earlier statements by the CR with a focus on global health dimensions of asbestos and asbestos-related diseases (ARDs). The ARD epidemic will likely not peak for at least a decade in most industrialized countries and for several decades in industrializing countries. Asbestos and ARDs will continue to present challenges in the arena of occupational medicine and public health, as well as in clinical research and practice, and have thus emerged as a global health issue. Industrialized countries that have already gone through the transition to an asbestos ban have learned lessons and acquired know-how and capacity that could be of great value if deployed in industrializing countries embarking on the transition. The accumulated wealth of experience and technologies in industrialized countries should thus be shared internationally through global campaigns to eliminate ARDs

Asbestos is Still with Us: Repeat Call for a Universal Ban

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