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Review

Asbestos: Communicating the Health Issues Derived from Fibrous Minerals to Society

by
Monica Hernández
1,
Dolores Pereira
1,* and
Andrea Bloise
2,3
1
Research Group CHARROCK, Department of Geology, University of Salamanca, 37008 Salamanca, Spain
2
Department of Biology, Ecology and Earth Sciences, University of Calabria, I-87036 Rende, Italy
3
University Museum System—SiMU, Mineralogy and Petrography Section, University of Calabria, I-87036 Rende, Italy
*
Author to whom correspondence should be addressed.
Appl. Sci. 2024, 14(19), 8980; https://doi.org/10.3390/app14198980
Submission received: 31 July 2024 / Revised: 4 September 2024 / Accepted: 1 October 2024 / Published: 5 October 2024
(This article belongs to the Special Issue Environmental Contamination and Human Health)
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Abstract

:
Asbestos, also known by its commercial name “amianthus”, has been widely used in various industries due to its unique properties. However, the extensive use of asbestos has had serious consequences for human health, most notably asbestosis, an irreversible chronic lung disease. Asbestosis increases the risk of lung cancer and malignant mesothelioma, both of which are fatal. Applied sciences such as microscopy (optical and scanning electron microscopy) and geochemistry have been fundamental in characterizing the mineral fibers of asbestos to understand its role in human health. We previously used these techniques to characterize these fibers; in this study, we explored the issues associated with asbestos and asbestosis, as well as the challenges facing science communication strategies in effectively informing society and workers about these risks. The lack of scientific culture, in general, has led to a lack of public awareness of the risks of asbestos. As such, effective communication and outreach plans and strategies, including the visualization of the fibers to demonstrate why problems arise if inhaled, must be implemented to address these challenges. Educational campaigns, guidelines, and plans that are informative and actionable, teaching workers, communities, and the public about the risks of asbestos are crucial. A general knowledge of mineralogy and geochemistry is needed, and providing and disseminating proper scientific communication may help to close the knowledge gap. We use examples and experience from Spain and Italy to illustrate this matter, as we have been working on the characterization of ultramafic complexes in these countries for more than ten years. Additionally, because these countries have strict laws for asbestos-containing materials, they are currently involved in retiring and demolishing buildings and infrastructure that contain asbestos.

1. Introduction

Asbestosis, which is caused by the inhalation of asbestos, is a serious health issue and a research field that is subject to debate. Asbestosis produces alterations in living beings’ health and can affect the environment in regions where asbestos has been extracted. Asbestosis is a chronic illness affecting the lungs that is provoked by the inhalation or ingestion of fibrous minerals. Asbestosis needs to be explained in detail to society using communication tools that reach both workers and the public so that, with this information, prevention measures can be easily implemented. Asbestosis can evolve into lung cancer and malignant mesothelioma, both of which are fatal diseases. The aim of asbestos education is to communicate its risks without causing alarm while helping to implement prevention measures.
Asbestos, well known for its carcinogenic consequences, has historically been predominantly assessed in air; however, its possible presence in water resources has been neglected. Recently, growing attention has been paid to asbestos fibers in groundwater, recognizing that this environmental matrix is an unconventional source of exposure to asbestos fibers. The use of asbestos-polluted water for household, agricultural, and industrial purposes poses the risk of fiber migration from water to air and into domestic, public, and working spaces. Through evaporation or mobilization processes, asbestos-polluted water can lead to airborne fiber concentrations surpassing legal limits [1]. Water acts as a carrier of asbestos fibers, facilitating their transport and accumulation in distant areas. Thus, hydro-dispersed asbestos represents an emerging pollutant, as its presence has not been systematically assessed. Furthermore, the risk of ingesting asbestos fibers via drinking water has rarely been discussed, and conclusive evidence of this risk is still lacking. The correlation between consuming water contaminated with asbestos and the development of gastrointestinal diseases emphasizes the importance of considering the water matrix when studying asbestos pollution. Some epidemiological studies conducted in the USA and Canada have suggested an increased incidence of stomach cancer in populations exposed to asbestos-contaminated water [2], although evidence of the danger of this route of exposure is inconclusive.
Notably, asbestos is not only dangerous due to its fiber shape but also to its heavy metal content [3]. The presence of potentially toxic elements (PTEs), such as Fe, Mn, Co, Ni, Cr, Ba, Pb, and V, as major, minor, and trace elements within the structure of asbestos fibers, along with other parameters related to shape, is an additional concern regarding asbestos toxicity. The release of PTEs in asbestos fibers can increase the risk of lung diseases. For this reason, asbestos can be considered a carrier of PTEs [3,4,5,6,7]. When inhaled, asbestos fibers can dissolve within the lungs, releasing their toxic contents and potentially causing cellular disorders. Toxic elements, even in low concentrations in humans and animals, induce substantial oxidative stress within cells [8]. This results in an increase in the levels of reactive oxygen species (ROS) and, in some cases, leads to the disruptions of DNA, to which these elements can bind [9,10].
All the applied sciences involved in this field (e.g., geochemistry, mineralogy, and medical sciences) should be developed into the appropriate language, images, and tools to reach society, so prevention measures can be implemented with the involvement of both the public and workers.
Asbestos has become a serious environmental and health issue [11,12] as well as an economic issue because the extraction of asbestos is an important economic activity in several regions globally [13]. Asbestos was a much-used resource for construction during the last century. However, the use of asbestos-built materials was soon found to cause health problems in workers and their families in the form of lung illnesses. Asbestos hazards have traditionally been linked to occupational exposure; however, nonoccupational exposure has also been described. The impacts of nonoccupational exposure differ by sex as the occurrence of pleural mesothelioma in women can be explained by occupational exposure in only 40% of the cases [14]. The rest of these cases would thus be nonoccupational. Asbestos in its natural state, when not extracted for commercial purposes, is commonly referred to as naturally occurring asbestos (NOA) and may be found in mafic and ultramafic rocks and soils as a result of natural geological processes [15]. NOA drew worldwide attention when investigations revealed increased incidences of malignant mesothelioma in populations living near NOA sites [16,17]. NOA fibers may mobilize into the air due to both natural weathering and human ground-disturbing activities, representing a serious hazard to workers and the general population [18]. As such, plans for construction activity have been enacted to control asbestos exposure in some states in the USA, such as Maryland, Pennsylvania, California, and Virginia [19].
Nonoccupational asbestos exposure has been recognized for many years, but, in our opinion, the dissemination of information that could have diminished the impact of asbestos on human health has been insufficient. Nonoccupational exposure can occur from the environment or at home. The latter can also occur from different sources: traditionally, people working with asbestos or asbestos-containing material take their workplace clothes home to be washed. In this manner, those in the home will be exposed to asbestos [20]. Manipulating talc products contaminated with asbestos is another source of exposure, both occupational, and nonoccupational if resulting from the contamination of cosmetics with fibers.
The true exposure of consumers to asbestos is poorly understood and has likely been underestimated. The asbestos content of talc-based cosmetics may have been overlooked, and characterizing the source of asbestos exposure is difficult [21], including in baby powder, as we discuss below. In this paper, we emphasize the need for public communication regarding asbestos hazards. This is not only a scientific issue but also a public issue that can be reduced via early and frequent communication, awareness, the use of the “rule of threes” in media communication, the open acknowledgment of uncertainty, prioritizing the response to community concerns, dispersing myths, and supporting community action [22].

2. Materials and Methods

We reviewed the literature on asbestos, both scientific and law reviews, to determine the current state of the field and to reflect on what is needed in a risky society to avoid health issues related to asbestos while avoiding the creation of panic and alarm. Spain and Italy are the countries chosen for the evaluation. Both countries are very concerned about the health issues related to asbestos and can represent Europe in a legal frame. Also, they are the working areas of the authors of this paper, where the complete scientific characterization of ultramafic complexes has been performed and data have been published during, at least, the last ten years. To illustrate the example cases, showing clear details of the mineralogy, we used a Leica DM2500P petrographic microscope (PM) under transmitted light to describe the mineralogy and textures of asbestos-containing rocks.

3. Asbestos and Asbestosis

3.1. The Minerals

The National Institute for Occupational Safety and Health (NIOSH) defines asbestos as any elongated particle, including fibrous minerals such as serpentine (mainly chrysotile) and fibrous amphiboles (e.g., actinolite and tremolite) [23]. In the European Union, asbestos is defined as fibers with a length of more than five micrometers, a width of less than three micrometers, and a length/width ratio greater than 3:1 (Directive 2003/18/EU) [24]. All the mentioned minerals are chemically inert and heat-resistant, which led to the past use of asbestos for a wide variety of important industrial applications. However, these minerals are notably different. Amphiboles normally appear as prismatic phases, whereas serpentine (mainly chrysotile) appears as fibers (Figure 1a,b).
Asbestos is a fibrous mineral commonly found in metamorphic ultramafic rocks and is most frequently hosted by serpentinites. Serpentinites form through the metamorphism of ultramafic igneous rocks, involving fluids of different origins (Ref. [25] and the references therein). These rocks are characterized by a very low silica content and high quantities of Fe and Mg minerals (e.g., olivine and pyroxene), giving the rock a dark color. The original minerals in igneous rocks, mainly olivine and pyroxene, transform into amphiboles and serpentine (antigorite, lizardite, and chrysotile) during metamorphism, which is highly influenced by the temperature and composition of the transforming fluids.
In some countries, “amianthus” is used to refer to asbestos, although this term is used more in industrial contexts. Additionally, amianthus is a silky variety of asbestos that can be knitted to produce textiles that have the useful thermal properties of asbestos [26]. However, “asbestos” refers to a whole mineral family, all of which are fibrous minerals, and the differences in the shapes of the minerals in this family should be clarified when explaining the societal problems derived from asbestos. Scientific experts should communicate these differences, as they are able to reply to any questions that arise.
The problems that arise from the use and manipulation of these minerals are owing to the lack of knowledge of their nature. The danger is not only related to the shape of the mineral [27] but also to the chemical composition, as the real formula (e.g., for serpentine, Mg3[Si2O5](OH)4) often deviates from the theoretical formula, so these minerals may include potentially toxic elements, including various minor and trace elements (heavy metals, e.g., Cr, Mn, Co, Ni, Cu, Zn, Be, Ad, Rb, Sb, Ba, Pb, and Sr) [3]. Asbestos can be a main phase in rocks and be released when disturbed, (e.g., quarry extraction, the production of construction materials, and the restoration of monuments through laser cleaning [28]). Asbestos was frequently used in different industry sectors from the 19th to most of the 20th century (Table 1).

3.2. Sources of Asbestos Contamination

From the 1970s, the use of asbestos diminished until being banned in many countries. However, asbestos can contaminate the atmosphere through natural processes. The erosion and weathering of asbestos-containing rocks may disperse these fibers into the atmosphere, causing health issues in people living in the surrounding areas. By knowing the different scenarios, prevention measures can be implemented to reduce the health problems and mortality linked to asbestos inhalation. Some studies in this context have been conducted in Spain and in Italy involving the mapping and characterizing of rocks (e.g., Cabo Ortegal ultramafic complex in Galicia, Spain [25,28,30]; the Ronda mountains in the south of Spain [31]; and Calabria in the south of Italy [3,12]). The remobilization of these particles may produce increases in the levels of natural contamination, so asbestos can enter human and animal bodies through the respiratory system [32]. The risk depends on the dimension and shape of the particles, the persistence in the environment, the chemical composition of the particles, and their capacity to react with oxygen, generating multiple reactive molecules (ROS) [33]. The evolution of asbestos fibers in the lungs after inhalation has largely been documented; however, the potential toxicity derived from the heavy metal content of these minerals is less understood [3]. Several studies describe the generation of tumors leading to lung cancer, mesothelioma, and/or bronchogenic cancer due to asbestos toxicity [9,34,35,36].
Currently, anthropogenic asbestos contamination is mainly linked to work in quarries via the extraction of asbestos-containing rocks (e.g., serpentinites), mainly for construction. These rocks have been used for centuries for stone buildings in many countries (e.g., Spain, Italy, India, Pakistan, and the USA). Asbestos was also extracted to produce amianthus products, but these activities were banned in many countries as soon as research showed the direct link between asbestos and respiratory diseases. Many countries developed specific laws to forbid the extraction of these materials to protect workers (e.g., Germany, Austria, Bulgaria, Belgium, Croatia, Cyprus, Denmark, Slovakia, Spain, Estonia, Finland, France, Italy, Portugal, Norway, Holland, the United Kingdom, Japan, and the USA), but some places have more relaxed labor safety laws that still permit the extraction and use of asbestos (e.g., China, India, and Russia) [37]. The powder generated in these quarries affects the workers and those living in nearby areas. The most common pathologies derived from asbestos exposure are asbestosis, lung cancer, and mesothelioma (Figure 2) [7,34,38,39].

3.3. Clinical Features

Asbestosis arises through the alteration in lung tissue that occurs when asbestos is inhaled, and fibers are in direct contact with the lung cells. The fibers are stored in lung tissue, where they transform into rigid matter, reducing in size. The pleural area is also affected [32]. Symptoms are not immediate (requiring up to 10–20 years of exposure before symptoms appear), posing a serious challenge because treatment may be delayed until the damage is irreversible. The symptoms of asbestosis include sustained respiratory difficulties, dry coughing, and pain and pressure on the thorax in advanced illness. In acute cases, the fibrosis of lung tissues may develop into heart disease, affecting the right part of the thorax, derived from lung hypertension. This may progress into cyanosis and jugular engorgement [41]. Sudden changes in physical parameters, such as the loss of weight and/or appetite, should be cause for alarm.
The first symptoms of the disease may progress into other complications such as respiratory insufficiency, cor pulmonale [42], and cancer. Maldonado De Sasia [43] noticed that the risk of the latter is higher in individuals who are also exposed to tobacco smoke.
Experiments with animals have demonstrated that when asbestos is in contact with the internal parts of the lung (e.g., the bronchia and alveolus), inflammation occurs, which reduces respiratory capacity. Figures explaining how the lungs are affected by inflammation and body defenses in asbestosis can be found in Burgos Díez [44] and López [45].

3.4. Asbestosis Incidence in the Population

Up to 1 million deaths owing to the consequences of asbestos inhalation had been registered as of 2020. Data from the WHO (World Health Organization) indicate that 107.000 workers who have been exposed to asbestos die each year [46,47]. Those most affected are employed in the construction sector and mineral exploration. In Spain, this number was estimated at 2.300 per year [48].
The exposure to asbestos, and thus the risk of asbestosis, can arise through different paths: (1) direct exposure to the mineral (e.g., shipyards, nonmetallic mineral industry, fiber cement industry, and the production of certain vehicles parts), which accounts for 98% of those affected; (2) employment in sectors such as electricity, construction, and painting; (3) exposure through contact in specific environments such as during highway construction, or at or near dumps and waste lands [49].
In 1963, the first case of asbestosis was diagnosed in Spain. In 2001, asbestos was banned in Spain, but the number of cases increased until 2020 due to the disease’s latency [50], mainly in Galicia, Cataluña, Madrid, and Valencia, which are the industrial areas in Spain (Figure 3) [43,51]. The Spanish government reports approximately 700 cases of mesothelioma per year, but the national health security only reported 20 cases as derived from occupational safety in 2018 [52]. This is probably due to the overlapping of asbestosis- and tobacco use-related illnesses. Washington University estimated that in Spain alone, 96.804 deaths were due to occupational exposure to asbestos fibers between 2001 and 2019, indicating that this number is probably increasing because of the latency of the related illnesses [53] (http://www.ibasecretariat.org/da-lka-global-asbestos-mortality-data.php, last visited 22 August 2024). Figure 3 shows the correlation between the areas in Spain where asbestos was used for different economic activities (e.g., construction, transport, and naval) with the asbestosis incidence in terms of occupational safety. Lope et al. [54] studied the distribution of ovarian cancer in Spain and the map they plotted agrees with that in Figure 3. However, the source of risk may not be related to the same activities. Textile and leather industries, prior to mechanization, were a woman-dominated sector in the 20th century; asbestos (chrysotile) was used as a raw material and for the maintenance of machinery [54]. The asbestosis trend from 1990 to 2021 is displayed on the Global Burden of Disease (GBD) website; this organization assesses the mortality and disability owing to hundreds of diseases, injuries, and risk factors worldwide [55].
The National Institute for Occupational Security (INSHT) proved that asbestos may have a lifespan of 30 to 50 years. After that time, the mineral starts to decompose into thinner fibers and powder that continue to contaminate different ecosystems [56]. The banning of asbestos in Europe was triggered in 1978 when the European parliament learned that mineral fibers were affecting human health and declared asbestos as carcinogenic [48]. In 1999, asbestos was banned in European directive 1999/777UE, and the European Union forbade the use and marketing of asbestos in 2005 [57]. The Spanish Decree of the 31st of March 396/2006 [58] established the minimum safe and healthy working conditions for workers who had been exposed to asbestos, stating they should be periodically checked after finishing their employment contract or even after retirement [59] and that national health insurance should cover related expenses. Additionally, a guide for the evaluation and prevention of risks related to asbestos was published [56], but little scientific evidence was included, hindering the evaluation of the evolution of the illnesses related to asbestos. After banning asbestos use, the elimination of the remaining asbestos in, for example, infrastructure and buildings, was promoted to fully and safely remove asbestos in the European Union (2015/C 251/03) [60]. This directive indicated the obligation to develop programs and actions, starting with public buildings and, at a local level, protecting workers [61,62]. A crucial step was implementing professional programs for technicians to inform workers regarding the risk of asbestos exposure and the importance of periodic supervision. In Spain, the complete removal of asbestos is scheduled for 2028, although this deadline appears unreasonable due to the large amount that remains in the infrastructure in the country. Many public institutions such as schools, hospitals, and government buildings used asbestos in their construction for insulation purposes, which now must be demolished.

3.5. Prevention Measures

As with any risk, the most important step is prevention. If illness has already occurred, then the space and the affected individuals must be treated. As such, we must determine the level of asbestos exposure of the population, quantitatively and qualitatively analyze the asbestos fibers dispersed in the air, isolate the area, provide and maintain personal protection equipment (PPE), dispose of materials using only special and specific transportation, and clean the area with checks afterward to verify that asbestos is no longer present.
Measures for treating the affected individuals must also be implemented. Technology has not yet established specific measures that should be used for individuals. Again, prevention is the most important step in reducing the harm caused by asbestos to the population. Here, early detection is important in cases of respiratory difficulty, so oxygen supplements can be made available and vaccinations provided against illnesses that could worsen the diseases (e.g., influenza). Once diagnosed, specific therapies should be implemented: drugs (corticoids, steroids, and antibiotics), oxygenation, surgery, and lung transplant.

Communication and Education as the Best Prevention Methods

The national and regional Spanish governments designed a health vigilance program for workers who had been exposed to asbestos. The first step involved creating a database of those workers with the help of companies that were registered as at risk of asbestos (Spanish Registro de Empresas con Riesgo de Amianto (RERA)) [63]. Protocols were established by the Ministry of Health and are now within the Specific Sanitary Watching Protocols (in Spanish). They are available to the public in general, so information is available on all matters related to handling asbestos and to reducing individual risks. However, these protocols are not scientific documents. The protocols include procedures for post-asbestos-exposure medical checks. This step is essential because legal recognition arises through these checks when occupational illnesses are identified, assigning economic resources to the program and the workers. Cataluña created an association for asbestos victims (Asociación de Víctimas Afectadas por el Amianto (AVAAC)) and, in 2017, published an informative guide for the public in general, with indications and information about the mineral, related risks, health complications, and control and prevention measures to reduce the harm caused by asbestos [56]. The information includes the mean lifespan of asbestos effect after manipulation; sites where asbestos may reside in the workplace, infrastructure, and domestic artifacts (e.g., roofs, water deposits, and fume conduits); and economic activities that may have involved the use of asbestos (Table 1). These guides are supposed to help workers and the public in general, but other effective communication actions can be used, such as pictures and videos, to more effectively gain the attention of people.
Asbestos is not only a health problem, it is also an environmental problem if waste is abandoned in an uncontrolled site [56]. The AVAAC proposed several urgent measures to decrease these problems in the future: (1) cataloging all the asbestos installed, prioritizing schools and hospitals; (2) defining schedules for applying measures for the complete elimination of asbestos, covered by public funding and taxes. These measures will help with locating specific asbestos sites and sources, including domestic uses. The AVAAC is concerned regarding the set date for finalizing the removal and cleaning work as Cataluña has many buildings, including public buildings (e.g., schools) that used asbestos in their construction in the last century.
Risk analysis should start with prevention measures, and communication is the most affordable tool. Specific guides should be available for the public in general, but accompanying measures such as round tables and seminars, led by experts, may help with improving the understanding of the danger of asbestos fibers. Workers should be the main target, but other collectives may be included, asking questions to experts who will ensure that the real problem, derived from the scientific characterization of asbestos (e.g., fiber shape and heavy metals), is understood and an unwanted alarm is avoided. A general guide should provide information on concepts and good practices (e.g., asbestosis definition, symptoms, diagnosis, treatment, prevention, social impact, and recommendations). However, the exchanges of information with the public and workers, describing the physical reasons why asbestos is dangerous (e.g., the texture of the different minerals, and the chemical composition of the fibers) may help with explaining the importance of wearing prevention equipment. This is a direct application of science, providing scientific information to the public using appropriate language and communication tools. Posters with clear information and catching images should be visible for workers and people who may be exposed to asbestos; they should be displayed in all the affected areas and surroundings (Figure 4 and Figure 5). A replacement for asbestos should also be considered, and research should also focus on alternatives such as fiberglass, polyethylene plates, steel, and PVC plates. The replacement of asbestos with these alternatives can be considered a preventive measure as well.
Education is another method of managing the risk of asbestosis as other occupational illnesses related to natural resources (e.g., silicosis related to the extraction and manufacturing of ornamental stones or the natural radioactivity of construction materials). The seriousness of these health problems increases when linked to smoking, and the dangers associated with earth materials and living habits should be discussed at schools and universities. Specific seminars, such as webinars on mineralogy and geochemistry related to human health (i.e., medical geology), should be included as mandatory, at the grade school level and above. Graduates working in the stone sector may transfer their knowledge to peers, related companies, and society. Asbestos contains a specific group of minerals that is not always covered in mineralogy courses, either because of the lack of time during the academic year or because of the lack of experts among the university staff. Universities should ensure that subjects as socially important as asbestos are covered in their programs and that the content is academically supplied. Dissemination and science communication should be included in crucial aspects of university curricula, and the methodology applied should be scientific, starting with literature reviews that are available and then contributing new findings. Science should be disseminated through social media and the media in general to demonstrate that scientists are concerned about health. The nature of the materials used in industry and any economic activity should be public knowledge so that people are aware of any potential dangers. A related practice with students could involve searching the available databases (e.g., PubMed, Scopus, and Web of Science) for terms and keywords such as “asbestos”, “asbestosis”, “amianthus”, “dissemination”, “risk communication”, “public health”, “prevention”, and “education”. Another activity could involve separating the available literature on the subject into prior to and after 1980 to show that the interest in the subject had increased once scientists and medical doctors learned about the health problems related to asbestos. Preparing graphics and diagrams will help with visualizing the findings, and specific tasks and presentations could be prepared not only at the academic level but also for the public. This material should be adapted and made available as open access for sharing with countries that may not have all the information easily available.

4. Discussion and Conclusions

In the United States, strict regulations have been implemented on the use of asbestos due to its relationship with serious health hazards. However, the regulated use of asbestos is still permitted under federal law, with some exceptions. Every year, approximately 3000 new cases of mesothelioma and 2500 related deaths are recorded in the UDA [66].
Factories often being the only employment opportunity for those who had to emigrate, leaving their families behind, explains the evolution of the use of asbestos in the lives of the population and its effects on health.
Italy was Europe’s largest producer of and one of the largest consumers of asbestos until the 1992 asbestos ban. Between 2003 and 2014, 16,086 deaths were related to malignant mesothelioma in Italy, leading to an average of 1340 deaths per year [67]. For example, workers in the port of Genoa (Italy) are at a higher risk of dying from the tumors of the pleura, lungs, larynx, and bladder, and have a higher incidence of respiratory diseases. This is due to the use of asbestos as insulation in compartments, air conditioning systems, and as a component of steam and hot water pipes [68]. Specific exposure to asbestos resulted in a rise in the mortality rates for pleural (+475%), lung (+54%), and laryngeal (+83%) cancers, as well as an increase in respiratory (+27%), asbestosis (+2177%), and gastrointestinal tract diseases (+15%) [68]. In Casale Monferrato, in the province of Alessandria (Italy), the hazardous effects of asbestos dust exposure were recognized early on. In the early 1900s, the main economic activity in the Casale Monferrato region was linked to the Eternit factory, the first producer of artificial stone. The company was founded between 1907 and 1912 and continued to operate until 1986. Only in the 1980s did the University of Turin’s Cancer Epidemiological Unit and the Piedmontese Cancer Register conduct official studies on the health effects of asbestos exposure with the aim of determining the incidence of pleural cancer among the inhabitants of Casale Monferrato. The first cohort study of Eternit workers was published in January 1987, which reported a significant number of excess deaths from asbestos-related diseases, mainly pleural and peritoneal cancer, lung cancer, and asbestosis. A total of 107 deaths were caused by lung tumors, 57 by tumors in the pleural or peritoneal cavity, and 89 by asbestosis-related illness [69]. The Casal Monferrato region had a high prevalence of mesothelioma, even among people without occupational exposure to asbestos [70]. On 12 March 1992, Italy passed law number 257 prohibiting the extraction, importation, exportation, and production of manufactured goods containing asbestos. However, even today, past exposure and residual asbestos remain public health problems. Between 1934 and 1989, an asbestos cement pipe plant operated in Bari (Italy) utilizing an asbestos blend comprising 15% crocidolite, 5% amosite, and 80% chrysotile fibers. In 1974, a case–control study was conducted considering 48 mesothelioma deaths and 273 control subjects who were not occupationally exposed residents, finding an increased odds ratio for mesothelioma in people who lived within a 500 m radius of the factory [71].
A problem related to asbestos has arisen regarding talc powder and ovarian cancer in women and other cancers in persons who have used this product. Recently, Johnson & Johnson had to retire a baby powder product because clients had sued the company for the lack of information on its potential asbestos content. Uterus and ovary cancers were reported from various women, and the baby powder was suggested as a potential cause, although final conclusions on this subject have not yet been reached [72]. Talc is a mineral produced from the metamorphism of ultramafic rocks (Figure 6). The reaction to generate talc is as follows:
2Mg3Si2O5(OH)4 (serpentine) + 3CO2 = Mg3Si4O10(OH)2 (talc) + 3MgCO3 (magnesite) + 3H2O.
In this transformation, some serpentine (e.g., chrysotile) may remain as an accessory mineral.
Although these asbestos inclusions may not cause any health issues, and although no reports derived from the investigations have been conclusive, clients and users should know the actual composition of products to be able to decide whether to use that product. Johnson & Johnson supposedly did not appropriately communicate the complete composition of their baby powder. This is a case of poor communication practices because implementing a transparent communication strategy would have been less damaging for the company both in terms of reputation and budget. Research on the effects of baby powder on the human body started in the USA and Canada after several demands [73], which continues today.
The knowledge of the nature of asbestos derives from the application of science. Mineralogy and geochemistry are the most important scientific fields that can provide complete information on this mineral group and on the differences among species. This knowledge should be transparently transferred to society. Asbestos has been an important natural resource in developing some economies, but once we found asbestos could be the cause of serious illnesses, its extraction and use were banned in many countries. As prior actions are not easily reversible, the large amounts of asbestos in infrastructure should be removed. The removal of this asbestos could be harmful if not performed by experts. These experts should know where the danger lies and how asbestos can affect their health if precaution is not taken. The best method of prevention is to provide appropriate information to society while avoiding alarm.
We suggest a protocol for public communication that includes occupational and nonoccupational asbestos risk analysis (Figure 7). Involving the general public should be the goal of any outreach activity, and our work with samples from Cabo Ortegal, Spain, could provide suitable data for spreading scientific information on the local geology, as Cabo Ortegal was nominated as UNESCO Global Geopark in 2023, providing the opportunity to communicate the science and risks related to stones as asbestos, as an aspect of medical geology.
Communication is an important part of the transfer of scientific knowledge. Geochemistry and mineralogy are the most important scientific areas for characterizing asbestos and asbestos-bearing rocks, but the scientific language does not properly translate to the general public if appropriate communication tools are not used. We proposed steps and protocols to communicate the danger associated with asbestos, both for workers and for those living near ultramafic massifs. Many cases of nonoccupational asbestos illness, mainly linked to women, could have been avoided if clear information had been shared. Unaware workers used to take their clothes home, and their homes could have contained high asbestos. The contaminated clothing should have been left in the workplace. Employees and workers should have been educated on the occupational risks and hazards, thus minimizing the risk of developing diseases, especially diseases that can be prevented [20]. Natural contamination could be as harmful as anthropogenic contamination. As such, having the necessary information can save lives and industry [74].
We conclude that a matter as serious as asbestos hazard should be a priority for research and politics. Discussions on the occupational and nonoccupational asbestos risks should continue [75].

Author Contributions

Conceptualization, D.P. and A.B.; methodology, D.P. and M.H., formal analysis, D.P. and A.B.; investigation, D.P., M.H. and A.B; resources, D.P.; writing—original draft preparation, D.P. and A.B.; writing—review and editing, D.P., M.H. and A.B.; funding acquisition, D.P. All the authors have read and agreed to the published version of the manuscript. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

The mineralogy and geochemistry data used to conduct this review can be found in the literature, which are included as references, and are available upon request from the corresponding author.

Acknowledgments

The authors are grateful to the anonymous reviewers for their constructive comments and notes.

Conflicts of Interest

The authors declare no conflicts of interest.

References

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Figure 1. Microscopic view of a serpentinized ultramafic rock from Cabo Ortegal (Galicia, Spain), where the original minerals are being transformed into serpentine and carbonate. The rigid amphiboles can be distinguished from the flexible fibers of serpentine: (a) cross Nichols; (b) parallel Nichols.
Figure 1. Microscopic view of a serpentinized ultramafic rock from Cabo Ortegal (Galicia, Spain), where the original minerals are being transformed into serpentine and carbonate. The rigid amphiboles can be distinguished from the flexible fibers of serpentine: (a) cross Nichols; (b) parallel Nichols.
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Figure 2. The movement of asbestos fibers from inhalation to affecting the lungs (modified from [35]). Asbestos fibers pass from the alveoli to the rest of the body via paracellular and translocation processes [40].
Figure 2. The movement of asbestos fibers from inhalation to affecting the lungs (modified from [35]). Asbestos fibers pass from the alveoli to the rest of the body via paracellular and translocation processes [40].
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Figure 3. (a) Distribution of Spanish workers exposed to asbestos between 1968 and 2013 (modified from [35]). (b) The distribution of the Spanish incidence of asbestosis between 1990 and 2010 [43]. The legend shows the number of cases.
Figure 3. (a) Distribution of Spanish workers exposed to asbestos between 1968 and 2013 (modified from [35]). (b) The distribution of the Spanish incidence of asbestosis between 1990 and 2010 [43]. The legend shows the number of cases.
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Figure 4. Example of warning signs used in asbestos-risk environments, modified from [64].
Figure 4. Example of warning signs used in asbestos-risk environments, modified from [64].
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Figure 5. Images of individual safety measures, including masks and filters, modified from [65].
Figure 5. Images of individual safety measures, including masks and filters, modified from [65].
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Figure 6. Transformation of ultramafic rock into talcocite. Most rock converted into talc. However, the remnants of serpentine fibers were found, both in vein-like positions and in rock voids. The sample was obtained from the ultramafic complex of Cabo Ortegal (Spain). Cross Nichols.
Figure 6. Transformation of ultramafic rock into talcocite. Most rock converted into talc. However, the remnants of serpentine fibers were found, both in vein-like positions and in rock voids. The sample was obtained from the ultramafic complex of Cabo Ortegal (Spain). Cross Nichols.
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Figure 7. Diagram of communication and dissemination protocol.
Figure 7. Diagram of communication and dissemination protocol.
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Table 1. Activities and economic sectors related to asbestos exposure (modified from [29]).
Table 1. Activities and economic sectors related to asbestos exposure (modified from [29]).
ActivityEconomic Sector
Brickwork Shipyards and ship-breaking yards
FirefightersBoiler making
Loading and unloading of asbestosCarpentry
Installation of insulationConstruction
Excavation of oil wells Oil and gas extraction and refining
Asbestos extraction, preparation, and transportAsbestos miners and millers
Manufacture of asbestos paperManufacture of paints and plastics
Manufacturing of fiber cement boardsManufacturing of posts and uprights
Manufacturing and repair of brake shoes Manufacturing of asbestos shingles and cardboard
Railway workersAsbestos fragmentation
FireproofingAsbestos insulation industries
Asbestos-free cardboard and paper industriesFiber cement product industries
Asbestos textile industriesTransport and treatment of waste
Chemical rubber industryAcoustic product installers
Installation of pipes and ovensManufacturing of asbestos products
Turbine manufacturingCar mechanics
Asphalt mixersIron gangue miners
Talc minersConstruction demolition operations
Factory workersPlastic chemicals (aeronautical)
Machinery manufacturesChemicals
Asbestos coating of boilersClutch and brake repair
Fiber cement canyon liningAir filtration systems
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Hernández, M.; Pereira, D.; Bloise, A. Asbestos: Communicating the Health Issues Derived from Fibrous Minerals to Society. Appl. Sci. 2024, 14, 8980. https://doi.org/10.3390/app14198980

AMA Style

Hernández M, Pereira D, Bloise A. Asbestos: Communicating the Health Issues Derived from Fibrous Minerals to Society. Applied Sciences. 2024; 14(19):8980. https://doi.org/10.3390/app14198980

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Hernández, Monica, Dolores Pereira, and Andrea Bloise. 2024. "Asbestos: Communicating the Health Issues Derived from Fibrous Minerals to Society" Applied Sciences 14, no. 19: 8980. https://doi.org/10.3390/app14198980

APA Style

Hernández, M., Pereira, D., & Bloise, A. (2024). Asbestos: Communicating the Health Issues Derived from Fibrous Minerals to Society. Applied Sciences, 14(19), 8980. https://doi.org/10.3390/app14198980

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