[Update 4/22/2011: see CDC's NIOSH corrects asbestos statement]
It was almost too much to believe. Here I was attending the Asbestos Disease Awareness Organization’s (ADAO) annual meeting, mingling and learning from patients and researchers about asbestos-related disease, and I hear that the Center for Disease Control and Prevention’s (CDC) National Institute for Occupational Safety and Health (NIOSH) has just issued its treatise on asbestos. That document, called a “current intelligence bulletin” is supposed to convey the most up-to-date scientific information on a hazard and risk of harm from exposure to it. The NIOSH subtitle actually says it’s a “state-of-the-science” report.
We depend on our public health agencies to provide an independent assessment of the best available information about hazards and health risks. When it comes to asbestos (and other contaminants,too) this is especially important because the scientific literature is loaded with studies paid for by corporations and organizations that have an economic interest in downplaying the risk (here, here, here, here.) We’ve known since at least the 1940’s that worker exposed to asbestos were at increased risk of developing lung cancer, and in 1971, the WHO’s International Agency for Research on Cancer (IARC) designated chrysotile asbestos, amosite asbestos, tremolite asbestos, anthophyllite asbestos, and crocidolite asbestos as carcinogenic to humans. In 2009, IARC reconfirmed this designation for cancers of various sites. In the U.S., our National Toxicology Program designated asbestos as a known human carcinogen in 1980, and has reconfirmed that classification in each of its ten subsequent Report on Carcinogens. Finally, and most recently, the President’s Cancer Panel report, issued in 2010, devotes an entire section on asbestos-related cancers from both workplace and environmental exposures. There’s no question that exposure to any commercial form of asbestos is associated with increased risk of cancer.
Imagine the disbelief—like a bad April Fool’s joke—when we learn that in the year 2011, NIOSH labels asbestos: “a potential occupational carcinogen.” A potential carcinogen? That’s like saying tobacco smoke or solar radiation might be carcinogens.
The link between asbestos and cancer of several types is unequivocal. In fact, if one of my public health students wrote in an assignment or exam that asbestos is a “potential occupational carcinogen,” I’d insist on meeting with them to discuss their answer. The whole public health community knows that asbestos is a known human carcinogen. Except for NIOSH.
I won’t have any trouble explaining to students or reporters why NIOSH has it wrong. But, what about others who read NIOSH’s statement and accept it. It comes afterall from the CDC. I cringe at the thought of individuals and firms who get rich defending asbestos users holding up this document in court. They now have a brand-spanking new document from the CDC saying asbestos is only potentially a carcinogen.
I’ve no doubt NIOSH officials have an explanation for their “potential occupational carcinogen” phrase. It probably sounds reasonable and rational to their ears. To my ear drums, it’s worse than fingernails on a blackboard.
NIOSH says they used the “potential occupational carcinogen” phrase because it appears in a 1980 policy on carcinogens issued by OSHA at the end of Jimmy Carter Administration. (It was published on day three of the Reagan Administration, and has never been used by OSHA.) The history of that 1980 policy tells us that OSHA was trying to devise a system to set regulatory priorities for toxic materials. OSHA proposed criteria for classifying contaminants that were suspect carcinogens; it was not for compounds that were already well-established by the scientific community as carcinogenic to humans. In fact, the very first health standard OSHA issued was on asbestos, in 1977, because the evidence was clear the deadly fibers caused cancer.
I’m also troubled by NIOSH’s qualifier: occupational, as if non-occupational exposure to asbestos aren’t also associated with cancer. I’m sure NIOSH thinks it makes sense for them to restrict their assessment to “occupational” exposures because their authority comes from the OSH Act, not some broader environmental statute. That kind of narrow thinking—–as if the work environment does not affect the communities outside the fence line—-does not advance public health. In fact, it is exactly because of exposures at work, that individuals with no known occupational exposure, are developing asbestos-related cancers. Julie Gundlach was only 35 years old when she was diagnosed with peritoneal mesothelioma. Her father was an IBEW-member electrician and likely brought the deadly fibers home on his work clothes. Heather Von St James was only 36 years old when she was diagnosed with pleural mesothelioma. Her dad also worked around asbestos as a fireman and construction laborer. (I met both of these courageous women at the ADAO conference this weekend, and they want you to know that asbestos is not banned in the U.S.) There is no magic barrier that separates hazards at work (the work environment) from becoming hazards in a community.
NIOSH’s Current Intelligence Bulletin 62 includes more than this carcinogen classification. But it lost even more credibility with me when NIOSH gives “equal time” to studies (funded by asbestos interests) that raise doubt about adverse health effects of asbestos exposure. NIOSH also provides a venue for others who manufacture uncertainty about the risk of exposure to other long, thin durable mineral fibers. How disappointing.
This week (April 1-7) people around the globe are marking Global Asbestos Awareness Week. The WHO estimates an annual global toll from asbestos-related lung cancer, mesothelioma and asbestosis from occupational exposures alone is 107,000 deaths and 1,523,000 disability-adjusted life years. Senator Max Baucus (D-MT) and his colleagues joined earlier this month in passing Senate Res. 63 to designates this week National Asbestos Awareness Week. Individuals whose lives have been changed forever because of an asbestos-related disease have set aside time this week to participate in events to raise awareness about the deadly toll of the malevolent mineral. Little did we think that CDC’s NIOSH would need the lesson.