The Slovakian Asbestos Experience: Use, Health Effects and Preventive Measures
Use of asbestos in Slovakia
Asbestos imported from Canada, Soviet Union and South Africa has been used in the past time in Slovakia in the building material industry, in asphalt insulation material production, as a filtrate material in chemical, pharmaceutical and food industries, as an insulating material in shipbuilding and piping, as a fire retardant construction, and in brakeline materials. Approximately 75-80 % of asbestos has been used in asbestos-cement products.
There was one serpentine mine in Slovakia with total production about 80 000 tons a year , the production has been step by step lowered and in 1999 the mine was closed.
The asbestos cement products has been produced by 2 enterprices, but according to the Slovak legislation the use of asbestos as so as production of a-c products has been year by year lowered and in 1999 [the first], resp. in 2000 [the second one] was stopped.
Exposure to asbestos
A. Professional exposure has been controlled by the State Institutes of Public Health [SIPH] – Departments of Occupational Health since 1985. Information about occupational exposure in producer and user enterprises have been collected. SIPH also carried out their own measurements. The gravimetric and numeric methods are authorised by the Ministry of Health. There were 231proffesionally asbestos - exposed workers registered in the central register at the State Institute of Public Health of SR based on the data from District Institutes of Public Health in 1996, in 1998 the number of exposed workers was 173 and in 2000 - 92. In 1989 only in western Slovakia the number of asbestos-exposed workers was 948. There exists uncontrolled professional exposure to asbestos of electricians and building trade workers, especially at reconstruction and demolition work.
B. Environmental exposure is practically uncontrolled. The indoor contamination comes from pipe insulation, fireproof walls, doors, paints, some building materials, insulation materials used in wooden buildings, a-c pipes [water-supply, sewerage, chimney], the outdoor one from a-c roofs, wall face, waste dumps, use of asbestos containing waste for pavements, roods, uncontrolled manipulation and transportation of asbestos containing waste.
The evidence of asbestos-related diseases is well-known, especially for asbestosis, pleural disorders [asbestos- related thickening and fibrosis of parietal or visceral pleura with or without calcification], malignant mesothelioma and lung cancer. Asbestos-related occupational diseases registered in Slovakia are as follows: Asbestosis, Lung cancer combined with asbestosis and Malignant mesothelioma diagnosed according to Helsinki criteria.
A. Occupational asbestos-related diseases
The number of 42 registered occupational diseases, 16 of them were lung carcinoma, in Slovakia during the time period 1980-2000, as shown in Fig.1. The working population has been about 2 200 000 people. One can conclude, that the recognition and registration of professionally influenced diseases do not reflect the real situation in occupational exposure to asbestos.
A special cohort study of 737 workers exposed to asbestos more than 10 years and more than 20 years since the first exposure in an asbestos-cement factory has been performed during the time period 1983-2000. We have diagnosed 29 cases of asbestosis, including 8 cases combined with lung carcinoma, and 5 cases wit malignant mesothelioma. Relative risk of lung cancer increases 2,2-9,4 % for each fibre year of exposure. We also have observed three times higher risk of lung cancer in smokers exposed to asbestos than asbestos-exposed non smokers.
B. Asbestos-related diseases – malignant mesothelioma in the Slovak population
Number of histologically approved cases of malignant mesothelioma [MM] registered in the National Cancer Register is shown in Fig.2. The total number of MM during the time period 1987-1997 was 285. The number of cases per year varies from 4  to 32 , but both the number and incident cases per 100 000 inhabitants [Fig.3] show increasing tendency from 0,08 in 1978 to 0,59 in 1997. The age analysis of MM patients gives an information [Fig.4], that most frequent has been the age group 60-69 [86 cases], the second one is the age group 70 –79 [63 cases], the third is age group 50-59 [60 cases]. One MM patient was 15 years old boy, whose father had been working in an a-c factory and brought his contaminated working clothes home.
The number of registered MM in 1997 is about 60 % higher than expected, so we also can expect the asbestos-related diseases epidemy.
As the Primary prevention is most effective the main emphasis of health administration has been oriented to the health protection legislation and control and asbestos risk management.
The National Assembly of SR has adopted the Law No. 272 / 1994 on the Protection of Human Health and the Law No. 330 / 1996 on the Occupational Health and Safety.
The Ministry of Health has published Regulation No. 4 / 1985 Bull. of the Ministry of Health on Health Principles to be kept in Handling and Work with Chemical Carcinogens, Regulation No. 8 / 1990 Bull. of the Ministry of Health on control of Asbestos and PCBs.
The main principles of the Regulations (1985, 1990):
The use of asbestos is prohibited at all cases, where there exists a less hazardous substances
Products and materials containing asbestos can only be used when other suitable non-hazardous alternatives are not available
Work with materials containing asbestos must be performed under strict health and safety regulations determined by health protection authorities
All employees must be informed about asbestos health risks, including increased risk of smoking and they should take adequate protective measures
Production and import of asbestos and materials and products containing asbestos must be approved by the Ministry of Health only for a short time not exceeding 31.12.1988
Ministry of Health SR is authorised to set asbestos exposure limit values
Special requirements for destruction of buildings where materials containing asbestos have been used must be defined and kept
The use of personal protective equipment is obvious
Preferred are collective preventive measures: automatisation, ventilation, time and space isolation of work operations with asbestos.
The preparation of the new legislation implementing the EU Directives is going on [Law on Healthy Living and Working Conditions (proposal), Governmental Order on Workers Protection against Risk at Work caused by Asbestos ].
Control and risk management expertise is performing by health inspectors and experts of State Institutes of Public Health, District and Regional Public Health Officers and Director Public Health Officer at the Ministry of Health.
Secondary prevention is provided by health personnel [factory physicians, occupational medicine units, institutes of public health] in co-operation with employers and employees , the measures of it are as follows:
All workers exposed to asbestos should obligatory undergo regular medical examinations during their working period and also after leaving for another type of job, or retirement
Restriction of tobacco smoking
Minimalisation and registration of occupational exposure to asbestos
Early detection, adequate therapy and rehabilitation of asbestos-related changes
The mining and production of asbestos cement products were finished in the Slovak Republic in 1999
The import of asbestos and asbestos containing materials into SR is not allowed
The number of under control asbestos - exposed workers has been rapidly reducing
There are some problems in preventive health care services for workers exposed to asbestos due to the transition of the health care system in SR
The unknown number of workers are uncontrolled exposed to asbestos – the adequate measures have been introduced
The population of SR is uncontrolled exposed to asbestos from existing outdoor and indoor sources
The number of patient with malignant mesothelioma with unregistered – probably environmental - exposure to asbestos is growing
The Governmental Order on Asbestos (based on EU Directives)will be implemented in 2002
June 8, 2001