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 June 27, 2016
Asbestos-related cancer costs Canadians billions

 A first-ever estimate of the toll of asbestos-related cancers on society pegs the cost of new cases at $1.7-billion per year in Canada, and notes that is likely an under-estimate.

The economic burden of lung cancer and mesothelioma from work-related asbestos exposure in Canada amounts to an average of $818,000 per case, according to a team led by health economist and senior scientist Dr. Emile Tompa at the Institute for Work & Health, a research organization, whose calculation includes costs related to health care and lost productivity and quality of life.

This is the first time a tally of these costs has been made public. Asbestos remains the top cause of occupational deaths in Canada: Workers' compensation boards have accepted more than 5,700 claims since 1996. About 150,000 Canadian workers are exposed to asbestos in their workplaces, the research project Carex Canada estimates, among them construction workers and contractors, mechanics, shipbuilders and engineers. This country continues to allow exports and imports of asbestos, which rose to a six-year high last year. Dozens of other countries, including Australia and Britain, have banned it.

Prime Minister Justin Trudeau said last month the federal government is "moving forward on a ban." It is the first time since taking office that he has publicly talked about a potential ban, although he gave no timeline and it was not an official announcement.

"We are moving to ban asbestos," he told a conference of building trades unions on May 10. "Its impact on workers far outweighs any benefits that it might provide."

The economic burden numbers are based on newly diagnosed cases in 2011 that were attributable to occupational exposure. The calculation is based on the number of new cases of mesothelioma, a cancer associated almost exclusively with asbestos exposure, for that year, along with estimates on the numbers of new lung cancer cases caused by workplace asbestos. These totalled 2,099 in 2011.

The study noted that new cases are likely to grow in the near future due to long latency periods of these diseases and continued exposure. The key question the analysis sought to answer is what the savings to society would be if no cases of cancer attributable to occupational asbestos exposures occurred in a particular year.

The study looked at direct and indirect costs. Direct health-care costs are a just a fraction of the estimate. Health-care costs for mesothelioma are pegged at $46,000 per case, and for lung cancer at $28,000. "Often times, the health-care costs are very low because the fatality rates are extremely high following diagnosis. Most of these people don't survive a year," Dr. Tompa said.

Health-related quality of life, which includes morbidity (loss of function due to poor health), lost years of life and human suffering, is the biggest component, comprising 80 per cent of the costs. This is calculated by using a measure called quality adjusted life years. It compares morbidities and life expectancies of people with asbestos-related cancer to Canadian age- and gender-specific averages.

The $1.7-billion total is a conservative estimate. "It's quite an underestimate and might not give people the full sense, even though the number's quite big," he said, because it focuses only on newly diagnosed cases, not previously existing cases, in one single year. Nor does it include other types of diseases linked to asbestos exposure, such as cancer of the larynx or asbestosis. The numbers also do not encompass para-occupational exposure, such as when a family member breathes in dust from a worker's clothing or gear.

The costs are also to society at large, Dr. Tompa noted. "We all play different roles in society. Even if you're retired, you might have community roles, domestic roles, you might take care of your grandchildren."

The study, conducted with the Occupational Cancer Research Centre, was funded by the Canadian Cancer Society. The sponsor was not involved in designing the study, collecting and analyzing the data or writing the report. The funding application, which detailed the planned analysis, was peer reviewed, although the economic burden tally has not yet been reviewed. It is due to be submitted to the American Journal of Public Health for peer review.

Dr. Tompa is working on another estimate that will also include the cost of para-occupational exposures in Canada. "I think we're cutting new ground in terms of putting that economic measure to it, and just some methods development too, because there's not a lot of precedents about how to frame these issues in the economic lens."

For now, given that asbestos has not been banned, and that, "in the construction sector, they're still using products that are made with asbestos, we're adding to the problem in the future."

In an e-mail, the Prime Minister's Office said the federal government is "reviewing its strategy on asbestos, including a potential ban."

The cancer society, many health groups, and unions including the Canadian Labour Congress, are urging the federal government to announce a comprehensive ban on asbestos, something the Liberal Party had pledged to do last year if elected.

Urgent action is needed, said Fred Clare, Eastern Canadian vice-president at the International Association of Heat and Frost Insulators and Allied Workers. He was a journeyman insulator for three decades, and has watched more than a dozen co-workers and family members die of asbestos-related diseases. "People are getting mesothelioma -- and they're gone before you even know about it."

Pressure is growing on the local level too. Mike Bradley, mayor of Sarnia, Ont., a city hard hit with the legacy of asbestos exposure, wrote to the Prime Minister in March, calling on the federal government to end asbestos use in Canada. The PM's recent comments were "most welcome, and we now can start to see the victory finish line to ban asbestos in Canada," the mayor said, adding that "sadly there are many Canadians who will not see the victory line having died too soon."

Health Canada referred questions on asbestos policy to Innovation, Science and Economic Development Canada. ISED said in an e-mail that it is "not in a position to provide further commentary on this issue at the moment, adding that it hopes to have more to say "in a matter of time," but did not elaborate.

CLC president Hassan Yussuff said a comprehensive strategy is needed, and he hopes to see a plan proposed in the coming months. This should include a full ban on asbestos imports and exports, and an online inventory of federal buildings and workplaces that contain asbestos. He would also like to see a registry of workers who have asbestos-related diseases, licences required for abatement and remediation companies, and stronger rules and enforcement on disposal of the materials.

"Nobody goes to work to die," he said in an interview. "The unfortunate part about this substance is that's what ends up happening to people without them having some ability to protect themselves."

David Boyd, adjunct professor at Simon Fraser University, said it is "fantastic" news that Mr. Trudeau said Canada is moving to ban asbestos. "This will be a life-saving, health improving move, not just for Canadians, but for people in other nations. I hope that a comprehensive ban on imports, exports, and all products containing asbestos is put in place as rapidly as possible."