Asbestos ingestion and gastrointestinal cancer: a possible underestimated hazard

Leaching and geochemical modeling of asbestos-cement waste and mine asbestos

Asbestos-Containing Materials (ACMs) were widely used in the construction sector but, due to their harmful health effects, many countries have banned their use. ACMs are classified as hazardous and, in contact with water, produce potentially harmful leachates. The objective of this work was to determine the leaching behavior of 20 elements from two asbestos-cement materials and mine asbestos samples across the entire pH range and varying liquid-to-solid ratios (column tests). The pH-dependence tests showed consistent leaching patterns across the three materials. Geochemical speciation model (LeachXS) predictions were successful in most cases of the batch experiments and were improved by adjusting iron oxides concentration for some elements. Model predictions were successful for fewer elements in the column experiments. Depending on the pH, element release was controlled by respective solid phase dissolution, sorption onto iron oxides and substitution in ettringite. Some leaching concentrations exceeded the EU limits for granular non-hazardous waste landfills. Considering the strongly alkaline nature of monolithic asbestos-cement waste undergoing carbonation, we propose all three materials to be disposed of in non-hazardous waste landfills, according to EU legislation. A case study concluded that geochemical modeling of ACMs leaching is a useful tool in estimating element release under various environmental conditions.

Review of epidemiological and toxicological studies on health effects from ingestion of asbestos in drinking water

Asbestos is a group of naturally occurring fibrous minerals that were commonly used in the construction of cement pipes for drinking water distribution systems. These pipes deteriorate and can release asbestos fibers into drinking water, raising concerns about potential risk to human health. The objective of this work was to synthesize human, animal, and in vitro evidence on potential health risks due to ingested asbestos in drinking water and evaluate the weight of evidence (WoE) of human health risk. A systematic review of epidemiological evidence was conducted, along with critical review of animal and in vitro evidence, followed by WoE evaluation that integrated human, animal, and in vitro evidence. The systematic review included 17 human studies with health outcomes mostly related to various cancer sites, with the majority focusing on the gastrointestinal system. The WoE evaluation resulted in very low levels of confidence or insufficient evidence of a health effect for cancers in 15 organ systems and for three non-cancer endpoints. While eight studies reported possible associations with stomach cancer in males, few high-quality studies were available to verify a causal relationship. Based on high-quality animal studies, an increased risk for cancer or non-cancer endpoints was not supported, aligning with findings from human studies. Overall, the currently available body of evidence is insufficient to establish a clear link between asbestos contamination in drinking water and adverse health effects. Due to the lack of both high-quality epidemiological studies and a validated kinetic model for ingested asbestos, additional research on this association is warranted.

Environmental health and clinicians: time to promote more action

Climate change and ambient air pollution are threats to human health, with dramatic short- and long-term effects on mortality and morbidity. Pollution generates fears among citizens who rarely receive adequate information for risk mitigation. A large burden of evidence is describing since decades the health effects of pollution, linking environmental exposure to pathophysiological mechanisms (mainly, low-grade chronic inflammation) that lead to an array of chronic non-communicable diseases. Epidemiologists are deeply involved to depict environment-related diseases, identify risk factors as well as to offer suggestions for prevention policies. However, their warnings are frequently disregarded by clinicians and policymakers. In clinical practice, diagnostic evidence is the basis for therapeutic interventions. Conversely, epidemiological evidence in the field of environmental health rarely generates appropriate preventive and clinical actions. Despite the great interest and concerns of citizens and epidemiologists, the perception of pollution as a major hazard to health is often scarce among clinicians, as witnessed by the poor presence of environmental health in the majority of clinical guidelines, meetings of scientific societies, and medical curricula. As a consequence, inaction is not uncommon among clinicians, who often fail to routinely engage in counseling their patients on how to reduce their health risks from living in an unsafe environment nor to act as advocates in order to enact changes in the community. This gap should be urgently bridged by creating opportunities for health professionals to be adequately informed and trained to play an active role in tackling environmental risks.

Mobility of crocidolite asbestos in sandy porous media mimicking aquifer systems

Asbestos is widely recognized as being a carcinogen when dispersed in air, but very little is known about its exposure pathways in water and its subsequent effects on human health. Several studies have proved asbestos presence in groundwater but failed to assess its mobility in aquifer systems. This paper aims to fill this gap by studying the transport of crocidolite, an amphibole asbestos, through sandy porous media mimicking different aquifer systems. To this purpose, two sets of column test were performed varying the crocidolite suspension concentration, the quartz sand grain size distribution, and the physicochemical water parameters (i.e., pH). The results proved that crocidolite is mobile in quartz sand due to the repulsive interactions between fibres and porous media. The concentration of fibres at the outlet of the column were found to decrease when decreasing the grain size distribution of the porous medium, with a bigger impact on highly concentrated suspensions. In particular, 5-to-10-µm-long fibres were able to flow through all the tested sands while fibres longer than 10 µm were mobile only through the coarser medium. These results confirm that groundwater migration should be considered a potential exposure pathway while implementing human health risk assessment.

Chrysotile asbestos migration in air from contaminated water: An experimental simulation

In Naturally Occurring Asbestos (NOA) rich areas, water flows through asbestos bearing rocks and soils and generates waterborne fibres that may migrate in air and become a risk for humans. Research on the migration and dispersion after water vaporisation has been so far only marginally evaluated. This study investigates the migration in air of asbestos from a set of suspensions contaminated by chrysotile from Balangero (Italy), under controlled laboratory conditions. We evaluated i) the morphological modifications that might occur to chrysotile during migration from water to air, and ii) the amount of airborne chrysotile mobilised from standardised suspensions. Morphological alteration of asbestos fibres occurred during water-air migration and impacted on the analytical response of electron microscopy. Waterborne asbestos concentration higher than 40 ∙ 10⁶ f/L generates in air concentration higher than 1 fibre per litre [f/L], the alarm threshold limit set by World Health Organization for airborne asbestos. A possible correlation between the waterborne fibre concentration as mass or number of fibres per volume unit [μg/L or f/L] was observed.

Contributing factors common to COVID‑19 and gastrointestinal cancer

The devastating complications of coronavirus disease 2019 (COVID-19) result from the dysfunctional immune response of an individual following the initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Multiple toxic stressors and behaviors contribute to underlying immune system dysfunction. SARS-CoV-2 exploits the dysfunctional immune system to trigger a chain of events, ultimately leading to COVID-19. The authors have previously identified a number of contributing factors (CFs) common to myriad chronic diseases. Based on these observations, it was hypothesized that there may be a significant overlap between CFs associated with COVID-19 and gastrointestinal cancer (GIC). Thus, in the present study, a streamlined dot-product approach was used initially to identify potential CFs that affect COVID-19 and GIC directly (i.e., the simultaneous occurrence of CFs and disease in the same article). The nascent character of the COVID-19 core literature (~1-year-old) did not allow sufficient time for the direct effects of numerous CFs on COVID-19 to emerge from laboratory experiments and epidemiological studies. Therefore, a literature-related discovery approach was used to augment the COVID-19 core literature-based ‘direct impact’ CFs with discovery-based ‘indirect impact’ CFs [CFs were identified in the non-COVID-19 biomedical literature that had the same biomarker impact pattern (e.g., hyperinflammation, hypercoagulation, hypoxia, etc.) as was shown in the COVID-19 literature]. Approximately 2,250 candidate direct impact CFs in common between GIC and COVID-19 were identified, albeit some being variants of the same concept. As commonality proof of concept, 75 potential CFs that appeared promising were selected, and 63 overlapping COVID-19/GIC potential/candidate CFs were validated with biological plausibility. In total, 42 of the 63 were overlapping direct impact COVID-19/GIC CFs, and the remaining 21 were candidate GIC CFs that overlapped with indirect impact COVID-19 CFs. On the whole, the present study demonstrates that COVID-19 and GIC share a number of common risk/CFs, including behaviors and toxic exposures, that impair immune function. A key component of immune system health is the removal of those factors that contribute to immune system dysfunction in the first place. This requires a paradigm shift from traditional Western medicine, which often focuses on treatment, rather than prevention.

Management of Asbestos Containing Materials: A Detailed LCA Comparison of Different Scenarios Comprising First Time Asbestos Characterization Factor Proposal

This work addresses the complex issue of asbestos containing materials (ACMs) management, by focusing on the scenario of six municipalities comprised in the Reggio Emilia province of Emilia Romagna Italian region. Particularly, the life cycle assessment (LCA) methodology was applied in order to assess in a quantitative and reliable manner the human toxicity as well as the ecotoxicity impacts associated with all of the different phases of ACMs management. The latter comprises mapping of ACMs, creation of a risk map for defining priority of intervention, encapsulation and removal of ACMs, as well as the as obtained asbestos containing waste (ACW) end of life. Particularly, a thermal inertisation treatment performed in a continuous industrial furnace was considered as the innovative end of life scenario to be compared with what actually was provided by the legislation of many countries worldwide, that is, the disposal of ACW in a controlled landfill for hazardous wastes. A characterization factor for asbestos fibers released both in outdoor air and in occupational setting was proposed for the first time and included in the USEtox 2.0 impact assessment method. This allowed us to reliably and quantitatively highlight that inertisation treatments should be the preferred solutions to be adopted by local and national authorities, especially if the obtained inert material finds application as secondary raw materials, thus contributing to a decrease in the environmental damage (limited to its toxicological contributions) to be associated with asbestos management.

Risk of gastric cancer in the environs of industrial facilities in the MCC-Spain study

BACKGROUND

Gastric cancer is the fifth most frequent tumor worldwide. In Spain, it presents a large geographic variability in incidence, suggesting a possible role of environmental factors in its etiology. Therefore, epidemiologic research focused on environmental exposures is necessary.

OBJECTIVES

To assess the association between risk of gastric cancer (by histological type and tumor site) and residential proximity to industrial installations, according to categories of industrial groups and specific pollutants released, in the context of a population-based multicase-control study of incident cancer conducted in Spain (MCC-Spain).

METHODS

In this study, 2664 controls and 137 gastric cancer cases from 9 provinces, frequency matched by province of residence, age, and sex were included. Distances from the individuals' residences to the 106 industries located in the study areas were computed. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95%CIs) for categories of distance (from 1 km to 3 km) to industries, adjusting for matching variables and potential confounders.

RESULTS

Overall, no excess risk of gastric cancer was observed in people living close to the industrial installations, with ORs ranging from 0.73 (at ≤2.5 km) to 0.93 (at ≤1.5 km). However, by industrial sector, excess risks (OR; 95%CI) were found near organic chemical industry (3.51; 1.42-8.69 at ≤2 km), inorganic chemical industry (3.33; 1.12-9.85 at ≤2 km), food/beverage sector (2.48; 1.12-5.50 at ≤2 km), and surface treatment using organic solvents (3.59; 1.40-9.22 at ≤3 km). By specific pollutant, a statistically significant excess risk (OR; 95%CI) was found near (≤3 km) industries releasing nonylphenol (6.43; 2.30-17.97) and antimony (4.82; 1.94-12.01).

CONCLUSIONS

The results suggest no association between risk of gastric cancer and living in the proximity to the industrial facilities as a whole. However, a few associations were detected near some industrial sectors and installations releasing specific pollutants.

Evaluation of potential gastrointestinal carcinogenicity associated with the ingestion of asbestos

The inhalation of asbestos, depending on the fiber type and dose, may be associated with the development of mesothelioma and other asbestos-related diseases. However, little is known about the potential adverse effects associated with the ingestion of asbestos. Evidence of asbestos fibers released from asbestos-cement pipes used in water distribution systems has led to concerns of potentially contaminated drinking water. The purpose of this study is to determine whether ingestion of asbestos fibers may lead to cancerous effects on the gastrointestinal (GI) tract. Data from animal and human studies were analyzed using a weight-of-evidence approach to evaluate the potential risk of GI cancers associated with asbestos ingestion. Seventeen human and 23 animal studies were identified and evaluated in this study. Animal studies were conducted in multiple species with inconsistent dosing protocols. Overall, animal studies reported that the asbestos fibers, irrespective of fiber type and dose, failed to produce any definitive GI carcinogenic effect. The 17 identified human epidemiological studies reported the ingestion of asbestos-contaminated water with concentrations from 1 to 71,350 million fibers per liter (MFL). A majority of the epidemiology studies reported statistically significant increases in multiple GI-specific cancers. However, these findings are confounded due to several critical study limitations including flawed study design, small sample size, selection bias, lack of individual exposure history, lack of adequate latency, and the inability to account for confounders including occupational history, diet, and smoking history. Based on our weight-of-evidence assessment, there is insufficient evidence of causality between the ingestion of asbestos and an increased incidence of GI cancers.

Incidence of Cancer and Asbestos-Related Diseases among Residents Living near Abandoned Asbestos Mines in South Korea: A Retrospective Cohort Study Using National Health Insurance Database

The use of asbestos has been banned since 2009 in South Korea. However, there is still a risk of exposure to environmental asbestos originating from abandoned asbestos mines. We constructed a retrospective dynamic cohort using the National Health Insurance Database of South Korea. We determined the risk of developing asbestos-related diseases (ARDs) among residents living near asbestos mines compared with those living in the control area and the general population. The risks of asbestosis (adjusted hazards ratio [HR] 65.40, 95% CI = 35.02-122.12) and pleural plaques (adjusted HR 3.55, 95% CI = 1.96-6.41) were significantly increased among residents living near the asbestos mines compared with the control area. The risk of malignant mesothelioma was increased near asbestos mines compared with the control area; however, it was not significant (adjusted HR 1.83, 95% CI = 0.61-5.47). When a separate analysis according to sex was conducted, the risk of mesothelioma among male residents was statistically significant (adjusted HR 8.30, 95% CI = 1.04-66.63), and the standardized incidence ratio (SIR) was significantly increased (SIR 3.48, 95% CI = 1.50-6.85). The risk of ARDs was increased due to environmental asbestos exposure near abandoned asbestos mines in South Korea.

Positive correlation between human exposure to organophosphate esters and gastrointestinal cancer in patients from Wuhan, China

As kinds of endocrine disruptors, organophosphate esters (OPEs) pollution in the environment had received increasing attention recently. Food and water intake were two important exposure pathways for OPEs. However, the studies about the potential association between OPEs and gastrointestinal cancer were limited. This study investigated the possible association between OPEs and gastrointestinal cancer. All cancer patients were diagnosed with gastrointestinal cancer from a Grade 3 A hospital in Wuhan, China, while the control group was non-cancer healthy persons. The results showed that 6 OPEs were found in the control samples, while 8 in the samples from patients with gastrointestinal cancer. The detection frequencies of OPEs in gastrointestinal cancer patients were significantly higher than those in the control group (p < 0.05 or p < 0.01), except for triethyl phosphate (TEP) and tris (methylphenyl) phosphate (TMPP) in the gastric cancer group. The concentrations of OPEs in the control group were significantly lower than those in the gastric cancer group and colorectal cancer group (p < 0.01). In the control group and gastrointestinal cancer group, TEP was the dominant pollutant. Correlation analysis found that concentrations of TEP, tris(2-chloroisopropyl) phosphate (TCIPP), triphenyl phosphate (TPHP), TMPP, tris(2-ethylhexyl) phosphate (TEHP), and 2-ethylhexyl diphenyl phosphate (EHDPP) were associated with gastric cancer (p < 0.01), and concentrations of TEP, TCIPP, TPHP, TMPP and TEHP were associated with colorectal cancer (p < 0.01). A cluster analysis divided the 34 patients with gastric cancer and 40 patients with colorectal cancer in four groups. The results showed that the elderly male patients with gastric cancer were more sensitive to the exposure of EHDPP, while the TEP exposure was more sensitive to the relatively young gastrointestinal cancer patients. These findings indicated that OPEs might play a role in developing gastrointestinal cancer.

Exposure to asbestos and the risk of colorectal cancer mortality: a systematic review and meta-analysis

Asbestos exposure is associated with mesothelioma and cancer of the lung, larynx and ovary. However, the association between asbestos exposure and colorectal cancer is controversial despite several systematic reviews of the literature, including a number of meta-analyses. We performed a systematic review and meta-analysis to evaluate quantitatively the association between exposure to asbestos and colorectal cancer. We searched for articles on occupational asbestos exposure and colorectal cancer in PubMed, EMBASE and Web of Science published before April 2018. In total, 44 articles were selected and 46 cohort studies were analysed. The overall pooled risk estimates and corresponding 95% CIs of the association between occupational asbestos exposure and colorectal cancer were calculated using a random-effects model. Subgroup analyses and sensitivity tests were also performed. There was a significantly increased risk of colorectal cancer mortality among workers exposed to asbestos occupationally, with an overall pooled SMR of 1.16 (95% CI: 1.05 to 1.29). The pooled SMR for colorectal cancer was elevated in studies in which the asbestos-associated risk of lung cancer was also elevated (1.43; 95% CI: 1.30 to 1.56). This implies that the risk of colorectal cancer mortality increases as the level of asbestos exposure rises. A sensitivity analysis showed robust results and there was no publication bias. Although the effect size was small and the heterogeneity among studies was large, our findings indicate that occupational exposure to asbestos is a risk factor for colorectal cancer.

Micro-Raman Spectroscopy, a Powerful Technique Allowing Sure Identification and Complete Characterization of Asbestiform Minerals

Micro-Raman spectroscopy has been applied to fibrous minerals regulated as “asbestos”—anthophyllite, actinolite, amosite, crocidolite, tremolite, and chrysotile—responsible of severe diseases affecting mainly, but not only, the respiratory system. The technique proved to be powerful in the identification of the mineral phase and in the recognition of particles of carbonaceous materials (CMs) lying on the “asbestos” fibers surface. Also, erionite, a zeolite mineral, from different outcrops has been analyzed. To erionite has been ascribed the peak of mesothelioma noticed in Cappadocia (Turkey) during the 1970s. On the fibers, micro-Raman spectroscopy allowed to recognize many grains, micrometric in size, of iron oxy-hydroxides or potassium iron sulphate, in erionite from Oregon, or particles of CMs, in erionite from North Dakota, lying on the crystal surface. Raman spectroscopy appears therefore to be the technique allowing, without preparation of the sample, a complete characterization of the minerals and of the associated phases.

Asbestos fiber identification in liver from cholangiocarcinoma patients living in an asbestos polluted area: a preliminary study

PURPOSE

To assess whether asbestos fibers may be observed in liver tissue of patients with cholangiocarcinoma (CC) with environmental or working asbestos exposure.

METHODS

Detection of fibers was performed directly on histologic sections of liver from 7 patients with CC using optical microscope and variable pressure scanning electron microscopy equipped with energy-dispersive spectroscopy (VP-SEM/EDS). All patients were from Casale Monferrato, Italy, a highly asbestos-polluted town. Due to ethical constraints, observers were blinded to patients' clinical features.

RESULTS

Fibers/bundles of fibers of chrysotile were detected in 5 out of 7 patients (71%). The boundary between healthy and neoplastic tissue or the fibrocollagen tissue produced by the neoplasia were identified as areas of fiber incorporation.

CONCLUSIONS

This study is the first report about the detection of chrysotile asbestos fibers in the liver of patients with CC. Further studies on larger cohorts are needed to corroborate our preliminary findings.

Mineralogical Characterization and Dissolution Experiments in Gamble's Solution of Tremolitic Amphibole from Passo di Caldenno (Sondrio, Italy)

In nature, asbestos is often associated with minerals and other non-asbestiform morphologies thought to be harmless, but not much is known about the potential toxic effects of these phases. Therefore, the characterization of natural assemblages should not be limited to asbestos fibers only. This paper combines a multi-analytical characterization of asbestos from Valmalenco (Italy) with data from dissolution experiments conducted in a simulated interstitial lung fluid (Gamble's solution), and a detailed dimensional study that compares the particle population before and after this interaction. The sample is identified as a tremolitic amphibole, exhibiting a predominance of fiber and prismatic habits at lower magnification, but a bladed habit at higher magnification. The results show that at different magnification, the dimensional and habit distributions are notably different. After the dissolution experiments, the sample showed rounded edges and pyramid-shaped dissolution pits. Chemical analyses suggested that a nearly stoichiometric logarithmic loss of Si and Mg occurred associated with a relatively intense release of Ca in the first 24 h, whereas Fe was probably redeposited on the fiber surfaces. A rearrangement of the more frequent habits and dimensions was recorded after the dissolution experiment, with a peculiar increase of the proportion of elongated mineral particles.

Indoor release of asbestiform fibers from naturally contaminated water and related health risk

This study investigates the occurrence of airborne asbestiform fibers released in indoor ambient due to the use of asbestos naturally contaminated water. Some experiments employed a laboratory physical model using an ultrasonic humidifier charged with contaminated groundwater. Other experiments were carried out at full scale to assess the release of asbestiform fibers during showering. Obtained results show that the concentration of the airborne asbestiform fibers released in the bathroom during showering is higher than the limit value set by the European and Italian Regulations, while the concentration of fibers released by the humidifier is much lower. However, it is noteworthy that the use of the humidifier at high exposure time results in similar health risk. Strong correlations were found between the concentration of the airborne asbestiform fibers and a novel surrogate parameter (i.e. the exposure-specific-water-consumption). These correlations can be used to monitor the asbestiform fibers concentration at varying operating conditions and therefore, to control the resulting health risk.

Occupational exposure to asbestos and risk of cholangiocarcinoma: a population-based case-control study in four Nordic countries

OBJECTIVES

To assess the association between occupational exposure to asbestos and the risk of cholangiocarcinoma (CC).

METHODS

We conducted a case-control study nested in the Nordic Occupational Cancer (NOCCA) cohort. We studied 1458 intrahepatic CC (ICC) and 3972 extrahepatic CC (ECC) cases occurring among subjects born in 1920 or later in Finland, Iceland, Norway and Sweden. Each case was individually matched by birth year, gender and country to five population controls. The cumulative exposure to asbestos (measured in fibres (f)/ml × years) was assessed by applying the NOCCA job-exposure matrix to data on occupations collected during national population censuses (conducted in 1960, 1970, 1980/81 and 1990). Odds ratios (OR) and 95% CI were estimated using conditional logistic regression models adjusted by printing industry work.

RESULTS

We observed an increasing risk of ICC with cumulative exposure to asbestos: never exposed, OR 1.0 (reference category); 0.1-4.9 f/mL × years, OR 1.1 (95% CI 0.9 to 1.3); 5.0-9.9 f/mL × years, OR 1.3 (95% CI 0.9 to 2.1); 10.0-14.9 f/mL × years, OR 1.6 (95% CI 1.0 to 2.5); ≥15.0 f/mL × years, OR 1.7 (95% CI 1.1 to 2.6). We did not observe an association between cumulative asbestos exposure and ECC.

CONCLUSIONS

Our study provides evidence that exposure to asbestos might be a risk factor for ICC. Our findings also suggest that the association between ECC and asbestos is null or weaker than that observed for ICC. Further studies based on large industrial cohorts of asbestos workers and possibly accounting for personal characteristics and clinical history are needed.

Asbestos fibre burden in gallbladder: A case study

The methods conventionally used to determine the burden of asbestos fibres inhaled/incorporated in lung require chemical digestion of the biological matrix before counting/characterising the inorganic fibrous phases under scanning electron microscopy and energy dispersive spectroscopy (SEM/EDS). Asbestos fibres can also be present in extra-pulmonary organs, and we set out to quantify the fibres in gallbladder. Although the standardised procedure requires approximately 5 × 10^-1 g of wet tissue, this amount of tissue is not always available. We applied the procedure on about 9 × 10^-4 g of gallbladder from a patient with known environmental and workplace exposure to asbestos. The patient died of malignant pleural mesothelioma and was also affected by severe bile-tract problems. The traditional procedure of digesting tissue samples in NaClO and filtering the resulting suspension was carried out. The filter was then examined under SEM/EDS using two methods 1. following the standardised procedure to assess the fibre burden in lung by investigating only 2 mm² of the filter (660 microscopic fields), and 2. analysing all the microscopic fields in one-quarter of the filter (about 82 mm²). In parallel, histological sections (prepared in the usual way for medical diagnosis) were analysed without digestion or manipulation of the sample using variable pressure SEM/EDS. The fibre counts obtained using the two methods were of the same order of magnitude, i.e., ∼10⁵ fibres/g of wet tissue. We showed that the counting of fibres in human tissue may be successfully carried out even when a limited amount of tissue is available. We also found that, when exposure to asbestos is considerable, the number of asbestos fibres accumulating in the gallbladder may be significant.