Dr. EVGENY KOVALESKY, médico PhD em Saúde Ocupacional, Pesquisador Líder do Instituto de Pesquisas em Saúde Ocupacional da Academia Russa de Ciências Médicas.

1. Development of National Program for
Elimination of Asbestos-Related
Diseases in the Russian Federation.
E. Kovalevskiy
Institute of Occupational Health,
Russian Academy of Medical Sciences,
Moscow, Russia

4. “
”

5. Being thoroughly examined the text of
“Outline…” seems to consist of two different
parts getting capriciously mixed up.
It could be divided into:
perfectly formulated
plan of real consequent
measures on prepare of collection of political
national preventive appeals for chrysotile
programs aimed on banning
elimination of asbestos
related diseases

6. The Russian Federation do not accept
the political part of the document whereas
its technical part including data collection,
preparation of the national profile and
other issues, is in sphere of it’s interest.

7. Russia is largest asbestos producer and
consumer in the world.
from 1886
to 2009

8. In Russia only chrysotile is produced and used
in civil industry.

12. Simeon Bogoslovskiy was the first Russian
hygienist and medical statistician who paid
attention to asbestos hazards. At the 10th
N.Pirogov’s Congress of Russian physicians
that was held in Moscow in 1907, Dr.
S.Bogoslovskiy made a report “To the
Classification of Jobs” where he mentioned
the main harmful factors of asbestos deposits
which workers had to undergo at that time. He
also wrote a monograph entitled “System of
Occupational Classification” published in
1913 containing data on health effects due to
exposure to asbestos.

14. During last decades dustiness levels were
considerably reduced due to many reasons:
-strengthening of regulations concerning environment
protection and implement of severe economic
measures;
-implement of sufficient financial compensation, which
industrial authorities must pay for every case of
asbestos-related occupational disease;
-development and implementation of different hygienic
and technological measures for reduction of dust
contamination of environment and working zone air.

15. 10000 Maximum production of asbestos - 1974,7
thousand tons
3
1000 290,0 mg/m
100
29,3%
3
Dust level, mg/m
10
1
1936 1950 1955 1960 1965 1970
0,1 1975 1980
Asbestosis morbidity, % 1985 1990 1995 2000
Asbestosis less 1%
0,01
С областями

16. 180 8
alignant
164,1
esothelioma
7,1
160 7
orbidity of m
140 5,9
6
pleural m
*
5,1
120
5
M
100
Dust level, mg/m3
4
80 Morbidity of malignant pleural mesothelioma
3
g/m3
60
1,7 1,7
ust level, m
2
40
25,8
15,2 1
20 9,8
5,1 4,6 3,5 4 5,3 4,2 4
0
D
0 0
1951- 1956- 1961- 1966- 1971- 1976- 1981- 1986- 1991- 1996- 2001-
55 60 65 70 75 80 85 90 95 00 04

17. Our data were confirmed by results of Russian-Finnish-
American research project “Health and exposure
surveillance of Siberian asbestos miners”.
This project was realized in 1995-97 at world's largest
chrysotile asbestos mining and milling complex “Uralasbest”
(Asbest, Russia) - is working out since 1889 and produces
now about 25% of total world chrysotile production; at
different periods more than 10 000 workers were employed.

20. Age, smoking habit and work years of chrysotile
miners and millers (mean, range)
Men Women Total
n=1130 n=510 n=1640
Age, years 46.4 49.7 47.4
(28-75) (27-78) (27-78)
Smoking years 18.3 0.7 12.8
(0-58) (0-30) (0-58)
Years of 22.8 21.5 22.4
employment (3-49) (1-47) (1-49)
Years since first 24.5 27.5 25.4
exposure (5-57) (1-59) (1-59)

25. Men Women
X-ray
Malignant neoplasms of Malignant neoplasms of
parenchymal
respiratory system respiratory system
changes
Mortality Mortality
in 1996 Yes No Yes No
rate rate
No 11 1061 0.010 1 482 0.002
Yes 3 39 0.071 0 15 0.000

26. Men Women
X-ray pleural Malignant neoplasms of Malignant neoplasms of
changes in respiratory system respiratory system
1996 Mortality Mortality
Yes No Yes No
rate rate
No 11 1040 0.010 1 477 0.002
Yes 3 60 0.048 0 20 0.000

27. X-ray Men Women
parenchymal Malignant neoplasms of Malignant neoplasms of
and pleural respiratory system respiratory system
changes in Mortality Mortality
Yes No Yes No
1996 rate rate
No 9 1009 0.009 1 466 0.002
Yes 5 91 0.052 0 31 0.000

28. All causes All malignant neoplasms
Age
Smokers Non-smokers Smokers Non-smokers
30-39 0.0±79.3 0.0±100.0 0.0±79.3 0.0±100.0
40-49 15.7±2.7 5.1±2.9* 2.2±1.1 1.7±1.7
50-59 12.3±1.6 4.6±2.0* 2.3±0.7 3.7±1.8
60-69 20.0±2.9 22.9±5.1 6.2±1.7 1.4±1.4*
70-79 21.9±5.2 18.2±6.8 4.7±2.7 6.1±4.2
80 and more 50.0±50.0 0.0±100.0 50.0±50.0 0.0±100.0
Total 15.6±1.3 11.1±1.9* 3.5±0.6 3.0±1.0

29. Including malignant
Malignant neoplasms of Malignant neoplasms
neoplasms of trachea,
respiratory system of digestive system
Age bronchi and lungs
Non- Non- Non-
Smokers Smokers Smokers
smokers smokers smokers
30-39 0.0±79.3 0.0±100.0 0.0±79.3 0.0±100.0 0.0±79.3 0.0±100.0
40-49 1.1±0.8 0.0±6.1 1.1±0.8 0.0±6.1 1.1±0.8 1.7±1.7
50-59 0.8±0.4 0.0±3.4 0.8±0.4 0.0±3.4 0.5±0.4 2.8±1.6
60-69 3.6±1.3 0.0±5.2 3.1±1.2 0.0±5.2 1.5±0.9 1.4±1.4
70-79 0.0±5.7 3.1±3.1 0.0±5.7 6.1±4.2 3.1±2.2 0.0±10.4
80 and
more 0.0±65.8 0.0±100.0 0.0±65.8 0.0±65.8 50.0±50.0 0.0±100.0
Total 1.4±0.4 0.2±0.3* 1.3±0.4 0.7±0.5 1.2±0.4 1.8±0.8

30. In 2009 basic legislative documents and
regulations for safety in use of asbestos has
been revised and completed according to
national and international experience
concerning harmful effects of different types of
industrial fibres.
Existing threshold levels and control methods
for dusts containing asbestos and other
mineral fibres measurement in the air and
wastes have been reevaluated and improved
too.

31. Chrysotile containing materials allowed for
use in the Russian Federation according to:
-2.1.2/2.2.1.1009–00 State Standard
”List of asbestos-cement products
recommended for use”;
-Letter no. 1100/3232-1-110 of Chief
Hygienist of the Russian Federation from
9.11.2001
“Asbestos products recommended for
production and use at transport,
equipment, industrial and common life
commodities”.

33. Basic positions of legislative documents in Russian
Federation are:
•use of amphiboles is banned;
•chrysotile can be used, but in controlled conditions;
•spraying of chrysotile-contained insulation is
banned;
•works with friable chrysotile containing materials and
works on removing (demolishing) of old materials
containing synthetic fibres can be provided only by
licensed contractors under control of independent
laboratory;

34. •works with other types of asbestos containing
materials should be provided under control and
accompanied by safety measures (dust emission
prevention);
•owners of industrial and nonindustrial objects where
friable insulation products containing asbestos and
other industrial mineral fibres exist should get all
information about amount and localization of products
or construction elements and are responsible for
safety measures organization;

35. •free of charge obligatory special medical
examinations for workers before, during (and after if
necessary) occupational contact with asbestos
containing dust;
•asbestos related diseases (asbestosis, chronical
bronchitis, upper airways cancers, lung cancer,
malignant mesothelioma) are in official list of
occupational diseases and compensated
automatically if occupational contact with chrysotile
containing dust is proved;

36. •thresholds for working zone air according to GN
2.2.5.1313-03 are established in total dust indices
(mg/m3) separately for 8 hours shift and for 30
minutes maximum (values are depended on
respirable chrysotile fibres concentrations);
•threshold for ambient air according to GN
2.1.6.1338-03 established in respirable fibers (f/ml)
measured by optical microscopy and is 0,06 f/ml.

37. To provide detailed planning and
successful realization of practical
measures we offer first of all to conduct
work for informational resources
mobilization – the development of
national asbestos profile.

38. In 2009 preparation of National Asbestos
Profile as a base for further successful
planning and realization of practical
measures has begun.
First of all evaluation of main sources of
exposure should be completed (including
occupational and environmental
exposure).

39. Sufficient work should be done on estimation of:
- total number of persons exposed from occupational, non
occupational and environmental sources;
- preparation of formal register of industries where exposure
exists and industries with largest numbers of workers potentially
exposed;
- register of industries with high risk of exposure and estimated
total number of workers at high risk.
Another important task is mapping of:
- existing and closed at present enterprises produced and
extensively used asbestos containing materials;
- deposits of all types of asbestos (ever operated and never
operated);
- deposits of erionite, vermiculite, talc and other natural fibrous
minerals.

40. Situation at different enterprises could be different:
to inappropriate

41. The content of these registers must include
information on exposure levels typical for
every professional and nonprofessional
group and industry brunch in order to avoid
as under-, as overrate the asbestos related
diseases risks.
We’ve got a lot of information for many
industries, but for some of them (ship building
and maintenance, chemical industry,
metallurgy, several areas in construction
industry, etc.) we or have not enough.

42. Series of studies were performed to estimate
the concentrations of respirable fibres in
indoor and outdoor air at buildings where
asbestos and other fibres containing
construction materials were used.
The aim of this studies was to evaluate a
potential sources of exposure to asbestos and
other fibrous particles.

43. One of the surveys included twenty buildings in Moscow:
1. Fourteen residential houses
- three 5-storey panel buildings from the 1960's,
- four 12-storey panel buildings from the 1970's,
- three 16-storey panel buildings from the 1980's,
- three high-rise brick buildings from the 1950's
- and one 9-storey panel building from the 1970's
2. Six public buildings
- hospital,
- covered stadium,
- theatre
- and three office buildings

44. All the buildings contained asbestos materials, most often
asbestos cement panels and pipes in dwelling areas or thermal
insulations usually contained asbestos and synthetic vitreous
fibres in heating rooms at the basement.

45. fibre concentrations in hospital building air
0,025
0,022
0,02
0,02
0,015
Concentration f/ml 0,011
0,01
0,005
<0,001 < 0,001 <0,001
0
Corridor Elevator hall Street near entrance of
building
All fibers longer 5 mkm (optical microscopy)
Chrysotile fibers longer 5 mkm (electron microscopy)

46. Fiber concentrations in living
buildings
Concentration (f/ml)
0,09
0,08
0,07
0,06
0,05
0,04
0,03
0,02
0,01
0
5-storeys block 16-storeys panel 9-stores panel building
buildings buildings (renov ation of water
supply sistem)
All fibers longer 5 mkm (PCOM)
Organic fibers longer 5 mkm (SEM)
Chrysotile asbestos fibers longer 5 mkm (SEM)
Other inorganic fibers longer 5 mkm (SEM)

47. Fibre concentrations were measured also at five
locations near Moscow motorways (North, East,
South, West and Center).
A series of measurements were made near a thermal
power plant where large quantities of asbestos and
MMMF insulations were removed, repaired and
installed.

48. fibres concentrations in the air of Moscow motorways
0,009
0,008
0,007
0,006
0,005
Concentration (f/ml)
0,004
0,003
0,002
0,001
0
North East South West Center Center (near
thermal
power
station)
Phase-contrast optical microscopy (all fibers longer 5 mkm)
Electron microscopy (chrysotile fibers longer 1 mkm)
Electron microscopy (chrysotile fibers longer 5 mkm)
Electron microscopy (chrysotile fibers < 5 mkm)
In summertime samples, low concentrations of all fibres (> 5µm)
and chrysotile (>1 µm) were found at five locations near Moscow
motorways. The mean concentrations were 0,002 f/ml and below
0,001 f/ml, respectively.

49. In general, the results of this study in Moscow are consistent
with measurements of nonoccupational exposure to fibrous
particles in other urban areas in Russia.
General conclusions were:
- asbestos cement materials and other asbestos containing
construction materials when used with ordinary precautions
without intensive destruction can not be recognized as sufficient
source of ambient air contamination by asbestos fibres;
- uncontrolled demolition and repair of friable asbestos and
MMMF materials can be an important source of occupational
and nonoccupational exposure to mineral fibres.

50. Crocidolite Rodusite
Anthophyllite
Actinolite

51. Despite the fact that amphiboles never have
been used in Russia in civil industry, certain
amounts of crocidolite and anthophylite was
mined and used for special non-civil purposes.

52. Exposure to amphiboles is possible due to:
- erosion of soils in areas, surrounded their
deposits (even never being processed),
- in shipbuilding industry during maintenance
works at old ships built in countries, where
amosite and crocidolite were widely used in
insulation products.
This is the one of fields for priority actions.

53. Insulation materials contained chrysotile and amosite
removed during ship renovation

54. Former crocidolite mine:

55. Former anthophyllite mine:

57. Especially should be stressed necessity of
series of epidemiological studies to define
risk of carcinogenic effects due to
occupational and non-occupational
exposure to chrysotile asbestos in modern
conditions.

58. «…The risk estimates used in the
calculations … were derived from
past exposures to relatively high
levels of chrysotile. Current levels
of exposure are much lower …
and as such risk extrapolations
may be an overestimate. There
are several other reasons why
there is a great deal of uncertainty
regarding these risk estimates…»

59. Further work and selection of priority directions
of actions will be possible only after realization
of fundamental for further activities phase –
preparatory phase according to ILO/WHO
“Outline for the Development of National
Programmes for Elimination of Asbestos
Related Diseases”.

61. The issue of banning chrysotile or restricting it in international
trade has been repeatedly raised by both national and
international organisations although scientific evidence of
impossibility of its safe and responsible use has never been
provided.
Moreover, the question about banning chrysotile is usually
raised by the countries where pure chrysotile free of more
hazardous and justly prohibited amphibole asbestos fibres has
never been used.
So evaluation of existing scientific data published in
international sources were made.

62. Chrysotile versus amphiboles
(why it is impossible to use most of
European and US epidemiological studies to
access risks related to chrysotile exposure)

69. Oldershaw P., 2004

70. less

71. … Most chrysotile fibres
disappear from the lung within
a year, and a limited period of
chrysotile exposure causes very
few mesotheliomas in workers
with no other exposure.
… observations suggest that
chrysotile exposure could
increase the lifelong
mesothelioma risk in those
whose lungs contain
persistent amosite or
crocidolite, just as it causes a
much larger increase in the lung
cancer risk in lifelong smokers
than in non-smokers (Hammond
et al., 1979b) …

72. … The effect on
mesothelioma risk of
stopping asbestos exposure
is much less marked than
that of stopping smoking on
lung cancer risk (Peto et al.,
2000), perhaps because
amphibole fibres persist in
the lung for many decades
after exposure has
ceased, so even brief
exposure produces a
lifelong carcinogenic
stimulus ...

79. «...Cohort studies of populations of workers
using only or predominantly chrysotile-
containing products in applications such as
construction have not been identified.
Some relevant information is available,
however, from population-based analyses
of primarily mesothelioma in application
workers exposed generally to mixed fibre
types…”
Environmental Health Criteria 203 − Chrysotile Asbestos (IPCS-1998)

80. “…It should be recognized that although the
epidemiological studies of chrysotile-
exposed workers have been primarily
limited to the mining and milling, and
manufacturing sector, there is evidence,
based on the historical pattern of disease
associated with exposure to mixed fibre
types in western countries, that risks are
likely to be greater among workers in
construction and possibly other user
industries…”
Environmental Health Criteria 203 − Chrysotile Asbestos (IPCS-1998)

83. 4. …substitutes may be used in a variety
of applications with different exposure
potential, either alone or in combination
with other substances, the workshop did
not embark on risk assessment, but
rather, limited its work to assessing the
hazard...

84. 7. …A completely inert fibre that could
be used as a negative control in the …
assays has not been identified…