Current Asbestos Issues in Romania
Asbestos is still used in modern society. The exposure of the workers to asbestos fibers in Romania has extended to various industrial branches in the last decades: asbestos mining in the Banat County (with its processing and transportation to the users), which has decreased in intensity in the last years, the manufacturing of asbestos cement products, friction materials, asbestos textiles, asphalt mixtures, etc. Romania imported asbestos from the former Soviet Union, Yugoslavia, Canada. Unfortunately, in addition to chrysotile, crocidolite was also imported for some technological needs or due to low costs. All stages in the use and handling of asbestos products (e.g. brake lining, asbestos cement pipes) may release asbestos fibers that pose a threat either to the workers or to the general population, through the general environment and consumer products. After 1973 the use of asbestos in Romania has become more and more popular, even though the exposure was known to cause asbestosis, lung cancer, cancer of pleura and of the peritoneum (mesothelioma) and pleural diseases.
Growing attention was paid to the evaluation and prevention of health hazards caused by asbestos in the late 1970s, 1980s and till our days. Therefore the Institute of Public Health Bucharest set the following goals:
1. Monitoring occupational exposure to asbestos.
2. Determining the number of people exposed to asbestos and identifying the individuals exposed.
3. Assessment of the health risk caused by exposure to asbestos.
4. Development of diagnostic for asbestos related diseases in Romania.
5. Development of scientific research projects.
Monitoring occupational exposure to asbestos
The adopted technique for measuring the concentration of air-borne asbestos fibers in occupational atmospheres wasperformed by membrane filter method using phase optical microscopy. The Council of the European Community and the International Labor Office adopted this method in the early 1980s.
In Romania the exposure limit for work place air should be lowered from 1fibre/cm³(Occupational Medicine Regulations, 1996)(1).
In order to identify or to differentiate the various types of asbestos the scanning electron microscope was used.
The level of exposure in some technological processes using asbestos in the 1980s was:
Sewing of asbestos suits: 2.3-3 fibres/cm³ of air
Asbestos cement production: 3.5-5 fibres/cm³
Manufacturing and insulating operations with asbestos cord: 4.5-20 fibres/cm³
In 1991, specialists from The Asbestos Institute, in Canada performed some measurements at the Brake and Sealing Elements Plant from Ramnicu Sarat. Some results are given below:
Cold press friction elements, 5-6 fibres/cm³
Mixture for friction elements, 7.1 fibres/cm³
Weaving 9.4 fibres/cm³
Defibrillation of friction materials, 17.6 fibres/cm³
Recent investigations made by our specialists revealed a decrease of those levels, owed mainly to the reduction of the economical activity of the plant.
Defibrillation mills, 1.6-3.1 fibres/cm³
Asbestos weaving, 5 fibers /cm³
Plate brake press, 0.32 fibres/cm³
This plant took an important measure during the last two years in finding substitutes for asbestos.
In 1996 The Institute for Work Safety Research Bucharest elaborated Specific Regulations for the Safe Use and Handling of Asbestos. These regulations comply with and are edited according to E.U. Framework Directives 83/477/EEC and 91/382/EEC (2).This regulations stresse the fact that the asbestos-related diseases prevention can be achived through control of worker exposure by application of engineering principles.Control technologies can be suplemented by administrative strategies and the use of personal protective equpement.
The Occupational Medicine Departments from the Institute of Public Health in Bucharest and Cluj have only few specialists trained to perform analysis using optical and electron microscopes.
The Occupational Lung Disease Laboratory from the Institute of Public Health in Bucharest has carried out measurements needed for the technical assessment of asbestos work at dozens of work places especially in the big enterprises. In contrast, no measurements have been carried out to estimate the exposure of individual workers (e.g. plumbers, insulators) employed with small size enterprises.
No surveys of buildings have been conducted in the last years, to determine their asbestos content.
2. Identifying people occupationally exposed to asbestos
According to official statistics during the last decade, we observed a decrease in the number of people exposed to asbestos. However, in 2000, the number increased again.
We consider that the real number of workers exposed is higher. We dont know exactly how many workers are involved when buildings are demolished and ships dissembled, cars are repaired and various maintenance and service operations are carried out.
We have not official data regarding the exposure to asbestos of the general population.
3. Health effects caused by exposure to asbestos among the workers exposed
The diseases caused by exposure to asbestos fibres include asbestosis ,pleural fibrosis(with discrete of diffuse pleural thickening),benign pleural effusion, chronic bronchitis,chronic airflow limitation, malignant mesothelioma,respiratory track cancer and gastro-intestinal cancer.In Romania the list of declared occupational diseases comp0rises only asbestosis, mesothelioma and lung cancer.
Identification of people exposed to asbestos and the search for asbestos-induced diseases had focused on groups with significant exposure levels. For groups with lower levels of exposure, the identification was rather poor.
No cases of lung cancer or mesothelioma due to asbestos were officially declared. We consider that the morbidity data presented earlier does not show the real situation, especially because the percentage of the exposed people periodically checked up is still reduced (aprox. 60%).
4.Development of diagnostic techniques for asbestos related diseases in Romania
Most asbestos-induced occupational diseases are still not recognized as such. To increase the effectiveness of diagnostics, attention should be paid to systematic determination of the work history and exposure to asbestos wherever it is suspected that a disease might be caused by asbestos. A system where only specialized radiologists and occupational health physicians interpret conventional radiographs was established in Romania. In every county there is a special commission for pneumoconiosis which includes a specially trained radiologist and two occupational health physicians. ILO system for radiological diagnosis and categorization of lung and pleural abnormalities is used. Clinical and radiological examinations are completed with ventilatory tests. The frequency of the periodical check-up is established in official occupational medicine regulations dating from 1982(4).
Today in Occupational Medicine Clinics advanced tomography methods are more and more used to improve the diagnosis of asbestosis. Another method applied is the broncho-alveolar lavage, but this is only occasionally performed.
As a screening method we used the sputum cytology to detect the pretoumoral cells alteration. This method is applied especially when the workers were exposed for more than ten years to asbestos. Unfortunately sputum cytology has not been demonstrated to add value to screening on a mass basis.
It should be stressed that, although the legislative measures and official regulations to prevent exposure to asbestos demand it, the medical survey of the workers exposed is not done constantly. The same situation is for the pleural mesothelioma. This is the consequence of the lack of:
suitable personnel to administer screening tests and interpret results
staff and facilities to perform, interpret and follow-up tests.
Basically it is the task of the authorities to monitor the implementation of the above given measures.
Regarding lung cancer in Romania, about 10,000 new cases are detected annually (4). Unfortunately we dont know how many of them are caused by asbestos.
5. Development of scientific research projects
The topics of studies performed by Romanian experts included the role of asbestos as an etiological factor in lung cancer, methods in the diagnosis of asbestos-induced diseases, occurrence of radiological changes caused by exposure to asbestos among various population groups.
Since 1998 the laboratory of lung diseases from the Institute of Public Health in Bucharest is involved in a multi-center lung cancer case-control study, coordinated by the International Agency of Research on Cancer (IARC)(5). One of the methods for retrospective exposure assessment in hospital based case-control studies, is the case by case experts assessment. The list of exposures of interest also contains asbestos in general and chrystotile and crocidolite.
Assessment of cancer, due to asbestos risk, includes an analysis of duration and concentration of exposure, estimation of latent period and probability of exposure. Further analysis will estimate the contribution of both occupational and non-occupational risk factors to the disease burden. This study is due on the 31st of December 2001. Our team has begun to process some data and till now, we have observed that from two hundred cases of lung cancer, five subjects were exposed only to asbestos during their working life.
Important and original studies were performed in our laboratory e.g.: determination of urinary asbestos by scanning electron microscopy in the urine of a group of workers exposed to chrysotile in a factory of insulation elements and in asbestos cement industry (6). The number of fibres\ml of urine varies depending on asbestos absorption either by inhalation or ingestion (1044 33346 no. Fibres\ml of urine all dimensions). The results of the study demonstrated that the inhaled or ingested fibers pass through bronchial epithelium or the pulmonary blood vessels or the intestinal epithelium and migrate within various organs and tissues. Another aspect stressed by the study related to the presence of asbestos in the urine is the degradation (dissolution) of the fibers in the organism.
Other important Romanian studies referred to the surface properties of harmful fibers.Using NMR and FTIR spectrometry, chemist Stănescu R. Ph.D. studied the presence of active sites on the surface of asbestos and the physical and chemical interaction between asbestos and a series of biological compounds: proteins, aluminum, hemoglobin, DNA (7). The same group of researchers showed (using NMR-10MHz) low creatinine asbestos interaction and strong chemical γ -globulin asbestos interaction (8). They also observed that asbestos interaction capacity with hemoglobin was not influenced by pre-treatment of asbestos at 400˚C, but the interaction capacity was diminished by the thermal pre-treatment of asbestos at 600˚C.(9) "In vitro" studies were performed in order to analyse the interaction capacity of asbestos with DNA.(10).
Experimental and clinical studies were also carried out in big plants using asbestos in their technological process e.g.: asbestos-cement plants, brake lining and sealing elements (11). During the next two years well work on a project regarding the heath effects of natural and man-made fibres in Bucharest area.Asbestos fibres were found to vary substantially in their fibrogenic and carcinogenic properties, but as a whole they constitue a global occupational problem that calls preventive actions.The evidence on severe health hazards from the use of man-made mineral fibres in present practice was found to be less conclusive.
In conclusion, not only did we observed, but we can say with scientific evidence, that we have known the dangers of asbestos for many years, but we had many difficulties promoting primary prevention in order to stop this continuing tragedy of asbestos-related diseases.
Further actions and recommendations
1. The exposure limit for work-place air should be lowered from 1 fibre/cm³ to 0.2 fibres/cm³ of air.
2. The work safety of asbestos should be improved by developing equipment and work methods and by augmenting the supervision carried out by the authorities. Labor protection and environmental aspects should be taken into account in management of wastes to eliminate asbestos hazards.
3. Asbestos inspections should be made especially in public buildings as well as in industrial and residential buildings. An asbestos inspection must always be carried out before any renovation work begins.
4. The special analytics required by material and dust samples must be maintained at the Institutes of Public Health and the achieved standard must be ensured by steady quality control. In particular, resources (equipment and technologies) must be ensured permanently for determining asbestos in the work environment .
5. Further monitoring of the work environment of workers exposed to asbestos in small enterprises, in house building, car maintenance workshops, shipyard sectors etc.must be done constantly.
6. In Romania we started using substitute materials but these materials have in their composition mineral man made fibers!
7. Registration of people exposed to asbestos must be entered in a computerized register for further examination and for medical monitoring.
8. Monitoring people exposed to asbestos. People engaged in asbestos must undergo a medical examination at the beginning of their activity a periodically one afterwards, in accordance with the Romanian regulations (especially standard radiographs which must be carried out periodically).
All people who have been exposed to asbestos in the past and who are still working should be monitored through the occupational health services. The family doctors should be responsible for the health monitoring of retired and self-employed workers who have been exposed to asbestos.
9. We propose that patients with asbestosis and pleural diseases should be surveyed periodically by occupational health physicians and pneumologists
The new Law regarding the insurance for work injuries and occupational diseases will enclose to compensations for the occupational diseases. The Commission of Occupational Medicine from the Ministry of Health proposed to update the list of occupational diseases with new asbestos related diseases eg.chronical bronchitis, larynx cancer (according to the WHO list).
10. The most important targets for early diagnosis of asbestosis will be the use new of radiographic methods, advanced tomography methods, and epidemiological studies.
11. The activities of the expert groups on pneumoconiosis should be harmonized by holding meetings at regular intervals. Meanwhile the general practitioners and pneumologists must be trained and informed about asbestos- induced diseases.
This is a very important problem for Romania because we have only 250 specialists in occupational medicine.
12. Research should continue in particular to improve the early diagnosis of asbestos cancer and to evaluate the individual Susceptibility to disease. This kind of research must be performed in cooperation with international organizations (WHO, ILO, IARC), because we need financial support is required to continue work in this field.
13. Training and information is important because exposure to asbestos and asbestos-induced diseases will continue to occur in the following decades.
The risk must be communicated to the workers exposed, employers and general public.
14. Regulations must also be adopted for the general environment.
We stress that the legislative measures and official regulations for preventing exposure to asbestos must be implemented and that action based upon these regulations have to be taken in order to solve the asbestos problem which still lies ahead. Basically, it is the task of the specialists and of the authorities (Ministry of Health, Ministry of Work and of Social Solidarity, Public Health Directions from every county) to monitor the implementation of the above mentioned measures.
Many thanks to my colleagues of the Pneumology and Oncology Department, Institute of Public Health, Bucharest
Rodica Stanescu chemist, Ph.D. specialist in work environment monitoring using FTIR spectrometry and EM and structure research studies in biological compounds-asbestos interactions
Dana Mates MD principal investigator in studies on environmental/occupational risk factors and cancer, coordinated by IARC and NCI
Vali Constantinescu biologist specialist in cytological screening of sputum in workers exposed to asbestos and in phagocytes reactivity measured by chemiluminescence for individual susceptibility to develop cancer
Bogdan Georgescu diplomat engineering, specialist in work environment monitoring
Felicia Stroe biostatistician
Doina Matase statistician
Ilinca Murgulescu nurse
Gabriela Manescu nurse
June 8, 2001