Slide 1 – title slide
Asbestos-Related Cancer - Research and Prevention
Professor Nico van Zandwijk Asbestos Diseases Research Institute University of Sydney
International Conference on Asbestos Awareness and Management - 18 November 2014
Slide 2 - Content
 Global and local data on Asbestos-related disease
 High-quality population-based cancer registry data (Australian Mesothelioma Registry) and its role in preventing
Asbestos-related cancer
 Other ways of preventing Asbestos-related disease
 Research at the Asbestos Diseases Research Institute (ADRI)
Slide 3 – Malignant Mesothelioma in the global
context
Slide 4 – Global asbestos consumption
Global Asbestos consumption (metric tonnes)
5,000,000
4,000,000
3,000,000
Metric tonnes
2,000,000
1,000,000
0
1920
1930
1940
1950
1960
1970
1980
1990
2000
2010
Calendar year
Source: Analysis performed by the Dr Matthew Soeberg (Asbestos Diseases Research Institute) based on data provided on global
asbestos consumption by the U.S. Geological Survey.
Slide 5 – Exposure-outcome lag time: the
mesothelioma epidemic curve only appears at least
two decades after asbestos consumption
Malignant mesothelioma incidence and mortality is a
function of asbestos exposure
Measurement
of asbestos
exposure
150
3
125
2.5
100
2
75
1.5
50
1
25
0.5
0
Mesothelioma
incidence or
mortality rate
0
Decade 10
Decade 9
Decade 8
Decade 7
Decade 6
Decade 5
Decade 4
Decade 3
Decade 2
Decade 1
Decade 1
Calendar period
Asbestos consumption
Mesothelioma incidence rate
Slide 6 - Median age-standardised Malignant
Mesothelioma incidence rates per 100,000 by
geographic region and calendar period (males)
4
3
2
Oceania
N America
Europe
C & S America
Asia
Africa
Oceania
N America
Europe
C &S America
Asia
Africa
0
0
1
1
2
3
Rate per 100,000
4
5
5
6
2003-2007
6
1993-1997
Source: Analysis performed by the Dr Matthew Soeberg (Asbestos Diseases Research Institute) using data published in: Forman D et al. eds
(2013) Cancer Incidence in Five Continents, Vol. X Lyon, IARC. http://ci5.iarc.fr ; Curado MP, et al. 2007. Cancer Incidence in Five Continents,
Vol. IX. Lyon, IARC. and Parkin DM, Whelan SL, Ferlay J, Teppo L, and Thomas DB. 2002. Cancer Incidence in Five Continents, Vol. VIII. Lyon,
IARC.
Slide 7 – Malignant Pleural Mesothelioma:
incidence rate trends in Europe, 1986-95
Overall trend
Incidence rates still increasing but evidence for deceleration in some countries.
Differences by age group
Increase over time in incidence rate greater for people aged 65-74 years than for people aged 40-64 years.
Source: Montanaro et al. 2003. Pleural mesothelioma incidence in Europe: evidence of some deceleration in the increasing trends. Cancer
Causes and Control. 14, 791-803
Slide 8 – The epidemic curve of Malignant
Mesothelioma in Australia
Slide 9 – Asbestos consumption: Australia, 19202013
Australia’s asbestos consumption peaked in the 1970s.
Asbestos import/export data, 1988-2013, are currently being analysed by the Asbestos Diseases Research Institute.
800000
700000
600000
500000
Metric tonnes 400000
300000
200000
100000
1980-1985
1970-1979
1960-1969
1950-1959
1940-1949
1930-1939
1920-1929
1910-1919
1900-1909
0
Calendar period
Source: Leigh and Driscoll. 2003. Malignant Mesothelioma in Australia, 1945-2002. International Journal of Occupational and Environmental
Health. 9(3), 206-217.
Slide 10 – Australian Mesothelioma Registry

Monitors all new cases of Malignant Mesothelioma in Australia from 1 July 2010.

Includes fast-tracked incidence and mortality data.

Collects information from consenting patients in order to monitor patterns and levels of occupational and
environmental asbestos exposure.

Allows people diagnosed with Mesothelioma to self-notify to the Australia Mesothelioma Registry.

Aims to prevent Mesothelioma in the future by informing government policy and providing a resource to
researchers.

Funded by Safe Work Australia and Comcare and overseen by a consortium of key organisations.
Slide 11 – Malignant Mesothelioma: Numbewr of
incident cases, Australia, 1982-2013
Between 1982 and 2013, 14,225 people were newly diagnosed with Malignant Mesothelioma.
Interpretation:
Recent data should be interpreted with care due to delays in notification of recent incident cases.
1000
100
Number of
incident cases
(Log-scale)
10
1
1980
1985
1990
1995
2000
2005
2010
2015
Calendar period of diagnosis
Males (AIHW)
Females (AIHW)
Persons (AIHW)
Males (AMR)
Females (AMR)
Persons (AMR)
Source: Data from the Australian Institute of Health and Welfare (1982-2010) and the Australian Mesothelioma Registry (2011-2013) graphed
by the ADRI
Slide 12 – Classification scheme for probability of
asbestos exposure
Category
Description
Unlikely
Low likelihood of asbestos exposure
Possible
Asbestos exposure may have occurred
Probable
Convincing information on asbestos exposure
Slide 13 – Australian Mesothelioma Registry
Exposure assessment at 30 April 2014
Slide 14 – Non-occupational exposure assessment
summary at 30 April 2014
Slide 15 – Job-specific interview modules assigned
to Mesothelioma patients diagnosed in 2010–2014
Job category
Trades
Type of jobs
Construction worker, Electrician, Plumber, Boilermaker,
Welder etc
Land transport
Driver, Mechanic/Fitter/Panel beater etc.
Water transport
Marine engineer/Mechanic,
Other seagoing jobs (including military navy)
Shipwright/boat builder etc.
Asbestos users/other
Laundry worker & many other jobs
*Allocated job questions at least once
No. participants*
203
56
43
35
Slide 16 - Asbestos exposure, 2010–2014
Sources of non-occupational asbestos exposure among participants without occupational
exposure
Non Occupational module section
Lived in house made mainly of fibro
Lived near asbestos mine or asbestos products factory
Did major home renovations (asbestos products)
Lived in house during major renovations
Ever serviced car brakes/clutch
Lived with someone with asbestos-exposed job
Visited Wittenoom in Western Australia
Visited another Australian asbestos mining town
Other credible evidence
Probability of exposure
unlikely
possible
probable
73
130
86
68
115
114
125
137
125
64
5
51
69
22
14
12
12
2
9
Slide 17 – Prevention of Cancer
 Primary prevention = avoid exposure to carcinogens (smoking, asbestos etc.)
 Secondary prevention = preventing, delaying the occurrence of cancer in people with
elevated risk (exposed to carcinogens)
Slide 18 – Primary Prevention

Lag time!

Carefully review all dangerous exposures

Make sure that occupational circumstances in Australia are safe

Make sure that the Australian environment is safe

Help developing countries in increasing their awareness (show them what we have learned)
Slide 19 – Secondary Prevention

Aspirin tested in Mouse Mesothelioma Model (WA, Perth) & checked in Human cohort (negative)

Statins: no effect in Mouse Mesothelioma Model (WA, Perth) and Human cohort (negative)

Animal studies at UTS (Sydney)

Negative effect of vitamins (beta-carotene)
Slide 20 – Research at the Asbestos Diseases
Research Institute

Systematic Review of the World’s literature on diagnosis and treatment of Malignant Pleural Mesothelioma

Epidemiology & Prevention: Carefully studying the epidemiological data NSW, assist AMR, increase
awareness in South East Asia (+APHEDA)

Prognostic Markers for patient selection

Study the biology of Tumour Suppressors in Malignant Mesothelioma (cell cultures, animal models)

MesomiR-1 study, new treatment concept based on supplementing missing microRNAs for Malignant
Mesothelioma and Lung Cancer (Phase I)

Psychosocial research: emotional burden of (diagnosis of) Malignant Mesothelioma in patients and carers
Slide 21 – Novel solution for microDNAdelivery:
Minicells or EngeneIC Delivery Vesicles (EDVs)
Slide 22 – Conclusions

Prevention of Asbestos-related diseases based on registration/exposure data (vital role
for AMR)

Better diagnostic pathways, better (treatment) selection of patients and new treatment avenues for Asbestosrelated cancer are only identified by continued (collaborative) disease-oriented research

We must show the world how Australia is dealing with its Asbestos Legacy and increase the awareness of the
dangers of Asbestos in developing countries
Slide 23 – Funding and acknowledgements

Cancer Institute NSW Translational Program Grant awarded to Professor Nico van Zandwijk and colleagues at
the Asbestos Diseases Research Institute.

Cancer Institute NSW Academic Chair and Scientific Director Role (Professor Jane Young) in cancer epidemiology
and health services research awarded to The University of Sydney.

Dr Matthew Soeberg, epidemiologist at ADRI and Sydney University/Cancer Institute NSW Dr Paula Laws and
colleagues at the Australian Mesothelioma Registry.
Slide 24 – Acknowledgements AMR
 Funding:
o Safe work Australia
o Comcare
 Registry management/operations:
o Cancer Institute NSW
o Centre for Occupational and Environmental Health, Monash University
o Asbestos Diseases Research Institute
o Hunter Research Foundation
o The University of Sydney
 State and territory cancer registries:
o ACT Health
o Northern Territory Government
o Queensland Government, Cancer Council Queensland
o University of Tasmania
o Western Australia Department of Health
o Cancer Council Victoria
o South Australia Health
 Death data linkage:
o Australian Institute of Health and Welfare