[Expectations after ban on asbestos].
This article brings a brief review of asbestos exposure and asbestos-related diseases in Croatia in view of the asbestos ban. The first cases of asbestosis were diagnosed in workers from an asbestos-cement factory in 1961. Between 1990 and 2007, 403 cases of asbestosis had been registered as occupational disease: 300 with parenchymal fibrosis and the rest with parenchymal and pleural changes, or pleural plaques. As a rule, asbestos-related changes were diagnosed at an early stage thanks to regular checkups of the exposed workers. Pleural plaques, considered to be the consequence of asbestos exposure, were also occasionally found in subjects who lived in areas with asbestos processing plants, but were not occupationally exposed. Early epidemiological studies on respiratory and gastrointestinal tract tumours in areas with an asbestos processing plant (1994) and an asbestos-cement plant (1995, 1996) focused on the occurrence of malignant tumours in persons exposed to asbestos at work or in the environment. More recently, the focus has shifted to the malignant pleural mesotelioma (MPM). An epidemiological study published in 2002 showed that the MPM incidence was significantly higher in the coastal area than in the rest of the country. About two thirds of patients with the tumour were occupationally exposed to asbestos. This uneven distribution of the tumour incidence is obviously related to shipbuilding and other industrial sources of asbestos exposure located in the coastal Croatia. Sources of environmental exposure to asbestos also have to be taken into account. The second part of this article ventures into the issues ahead of us, after asbestos has been banned in the country. The long latency period of cancers, and particularly of asbestos-related mesothelioma, implies that the incidence of this tumour will not drop over the next few decades. In Croatia, the average annual rate of MPM between 1991 and 2006 was 40, and ranged between 20 in 1991 to 61 in 1999. In 2006 it was 58. Age-standardised incidence of this tumour between 1991 and 1997 was 0.74 per 100,000 (1.34 per 100,000 for men and 0.27 per 100,000 for women). Sadly, the diagnosis of mesothelioma is seldom timely, and treatment is usually unsuccessful.
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