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The lack of safe levels of asbestos exposure and the long latency of asbestos-related disease (ARD) makes workers’ health surveillance challenging, especially in lower-income countries. This paper aims to present the recently developed Brazilian system for monitoring workers and general population exposed to asbestos (Datamianto), and to discuss the main challenges and opportunities for workers’ health surveillance. Methods: a descriptive study of the Datamianto development process, examining all the stages of system planning, development, improvement, validation, availability, and training of health services for its use, in addition to presenting the main challenges and opportunities for its implementation. Results: The system was developed by a group of software developers, workers’ health specialists, and practitioners, and it was recently incorporated by the Ministry of Health to be used for workers’ health surveillance. It can facilitate the monitoring of exposed individuals, epidemiological data analysis, promote cooperation between health services, and ensure periodical medical screening guaranteed to workers by labor legislation. Moreover, the system has a Business Intelligence (BI) platform to analyze epidemiologic data and produce near real-time reports. Conclusions: Datamianto can support and qualify the healthcare and surveillance of asbestos-exposed workers and ARD, promoting a better quality of life for workers and improving companies’ compliance with legislation. Even so, the system’s significance, applicability, and longevity will depend on the efforts aimed at its implementation and improvement.

Background Silicosis is the most prevalent pneumoconiosis in Brazil. We aimed to estimate mortality rates and temporal trends for silicosis, and to identify areas of highest mortality. Methods Records of silicosis as the underlying (1980-2017) or contributory (2000-2017) cause of death in adults aged 20 years and older were retrieved from the Brazilian Mortality Database. Age-standardized mortality rates (ASMR) were calculated. The annual trend in ASMR was analyzed by joinpoint regression. Mortality rates per 100,000 person-years were calculated for each municipality. We analyzed temporal trends in municipalities where similar activities with exposure to silica were performed. Results There were 3164 death records (96.6% men) distributed over 14% of the municipalities. Mean age of death was 59.2 (SD 15.1) and mean ASMR was 0.085/100,000 (confidence interval 0.080-0.091). Joinpoint regression showed a significant increase in ASMR from 1980 to 2006 and a significant decrease after 2006 driven by a decline in deaths of individuals younger than 70 years. The highest mortality rate was 21.83/100,000 person-years, in a municipality with small mining operations for gems. Gold mining municipalities showed the highest composite death rate, 4.0/100,000 person-years. Tuberculosis was the main cause of death when silicosis was a contributing cause. Conclusions In contrast with developed countries, silicosis mortality in Brazil increased to 2006 and subsequently started to drop, mostly from a plateau or decrease in deaths occurring in municipalities which regulated economic activities. However, this decrease did not occur in the older age group nor in the unregulated sector, the latter being the main challenge for exposure control and surveillance.

The aim of this study is to compare the mortality rates for typical asbestos-related diseases (ARD-T: mesothelioma, asbestosis, and pleural plaques) and for lung and ovarian cancer in Brazilian municipalities where asbestos mines and asbestos-cement plants had been operating (areas with high asbestos consumption, H-ASB) compared with in other municipalities. The death records for adults aged 30+ years were retrieved from multiple health information systems. In the 2000–2017 time period, age-standardized mortality rates (standard: Brazil 2010) and standardized rate ratios (SRR; H-ASB vs. others) were estimated. The SRRs for ARD-T were 2.56 for men (257 deaths in H-ASB municipalities) and 1.19 for women (136 deaths). For lung cancer, the SRRs were 1.33 for men (32,604 deaths) and 1.19 for women (20,735 deaths). The SRR for ovarian cancer was 1.34 (8446 deaths). Except for ARD-T and lung cancer in women, the SRRs were higher in municipalities that began using asbestos before 1970 than in municipalities that began utilizing asbestos from 1970 onwards. In conclusion, the mortality rates for ARD-T, and lung and ovarian cancer in municipalities with a history of asbestos mining and asbestos-cement production exceed those of the whole country. Caution is needed when interpreting the results of this ecological study. Analytical studies are necessary to document the impact of asbestos exposure on health, particularly in the future given the long latency of asbestos-related cancers.

Background Identification of biomarkers associated with the diagnosis and prognosis of silicosis would be highly advantageous in the clinical setting. The aim of this study is to evaluate inflammatory and oxidative stress biomarkers in subjects exposed to silica. Methods A cross-sectional study of crystal craftsmen currently (n = 34) or formerly (n = 35) exposed and a group of nonexposed subjects (n = 12) was performed. Personal respirable dust samples were collected. Plasma inflammatory mediators (bone morphogenetic protein- BMP2 and chemokines CXCL16, and CCL5), oxidative stress enzymes (thiobarbituric acid reactive substances [TBARs] and superoxide dismutase [SOD]), and nitrite (NO2 - ) were analyzed in parallel with nitric oxide in exhaled breath (FeNO). Results Being currently or formerly exposed to silica was related to increased levels of CXCL16 and TBARs. Currently, exposed subjects showed decreased levels of SOD. Thirty-seven craftsmen with silicosis (26 formerly and 11 currently exposed) showed higher levels of CXCL16, which was positively associated with the radiological severity of silicosis. Compared with the nonexposed, subjects with silicosis had higher levels of TBARs and those with complicated silicosis had lower levels of SOD. In multivariate analysis, higher levels of CXCL16 were associated with exposure status and radiological severity of silicosis. Smoking was not a confounder. FeNO did not distinguish between the exposure status and the presence of silicosis. Conclusion CXCL16 emerged as a potential biomarker that could distinguish both silica exposure and silicosis. TBARs were elevated in exposed individuals. However, their clinical applications demand further investigation in follow-up studies of representative samples.

This study examined inter-observer agreement and diagnostic accuracy in classifying radiographs for pneumoconiosis among Asian physicians taking the AIR Pneumo examination. We compared agreement and diagnostic accuracy for parenchymal and pleural lesions across residing countries, specialty training, and work experience using data on 93 physicians. Physicians demonstrated fair to good agreement with kappa values 0.30 (95% CI: 0.20-0.40), 0.29 (95% CI: 0.23-0.36), 0.59 (95% CI: 0.52-0.67), and 0.65 (95% CI: 0.55-0.74) in classifying pleural plaques, small opacity shapes, small opacity profusion, and large opacities, respectively. Kappa values among Asian countries ranging from 0.25 to 0.55 (pleural plaques), 0.47 to 0.73 (small opacity profusion), and 0.55 to 0.69 (large opacity size). The median Youden's J index (interquartile range) for classifying pleural plaque, small opacity, and large opacity was 61.1 (25.5), 76.8 (29.3), and 88.9 (23.3), respectively. Radiologists and recent graduates showed superior performance than other groups regarding agreement and accuracy in classifying all types of lesions. In conclusion, Asian physicians taking the AIR Pneumo examination were better at classifying parenchymal lesions than pleural plaques using the ILO classification. The degree of agreement and accuracy was different among countries and was associated with background specialty training.

RESUMO: Objetivo: Estimar o grau de concordância e validade dos diagnósticos de neoplasias malignas relacionadas à exposição ao asbesto registrados no Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS), em comparação aos Registros Hospitalares de Câncer do Estado de São Paulo (RHC/SP). Métodos: Óbitos com registros de neoplasias malignas associadas ao asbesto foram identificados e extraídos do SIH/SUS entre 2007 e 2014. Óbitos nos casos de câncer registrados na base do RHC/SP foram extraídos para o mesmo período. Essas bases foram unidas pelos mesmos indivíduos empregando-se o software Link Plus. Um único diagnóstico codificado pela CID-O3 ou CID-10 selecionado de cada sistema foi analisado. A proporção de concordância e a sensibilidade, especificidade e valores preditivos foram estimados. Resultados: Encontraram-se 19.458 pares com registros nas duas bases. A proporção de concordância foi elevada, variando de 92,4% para a localização primária desconhecida a 99,7% para o câncer de pleura. O índice Kappa variou de 0,05 (IC95% 0,04 - 0,07) para o câncer de pleura a 0,85 (IC95% 0,84 - 0,87) para o câncer de pulmão. A menor sensibilidade foi de 0,08 (IC95% 0,01 - 0,25), para o câncer de pleura, e a maior de 0,90 (IC95% 0,90 - 0,91), para o câncer de pulmão. Conclusão: Diagnósticos de neoplasias malignas associadas ao asbesto alcançaram maiores níveis de concordância e validade quando comuns. Os diagnósticos mais raros apresentaram baixa acurácia no SIH/SUS. ABSTRACT: Objective: To estimate the degree of agreement and validity of diagnoses of asbestos-related malignant neoplasms registered in the Hospital Information System of the Brazilian Unified Health System (SIH/SUS), in comparison to the Hospital Cancer Registries of the State of São Paulo (HCR/SP). Methods: Deaths with records of malignant neoplasms associated with asbestos were identified and extracted from SIH/SUS between 2007 and 2014. Deaths in cases registered in the HCR/SP were extracted for the same period. The databases were linked using software Link Plus. A single ICD-10-coded diagnosis selected from each system was analyzed. The proportion of agreement, and the sensitivity, specificity and predictive values were estimated. Results: 19,458 pairs were found with records in both bases. The proportion of agreement was high, ranging from 92.4% for the unknown primary site, to 99.7% for cancer of the pleura. The Kappa Index ranged from 0.05 (95%CI 0.04 - 0.07) for cancer of the pleura to 0.85 (95%CI 0.84 - 0.87) for lung cancer. Sensitivity varied from 0.08 (95%CI 0.01 - 0.25) for cancer of the pleura, to 0.90 (95%CI 0.90 - 0.91) for lung cancer. Conclusion: Diagnosis of asbestos-related malignancies reached higher levels of agreement and validity when common. Rare diagnoses showed low accuracy in SIH/SUS.

ObjectiveTo evaluate silicosis diagnosed through CT, with integration of clinical-occupational data, in silica-exposed workers presenting chest X-rays within International Labor Organization (ILO) category 0.MethodsCross-sectional study with 339 former gold miners, with comparable exposures and X-rays classified as ILO subcategory 0/0 (n=285) and 0/1 (n=54) were submitted to volume-based CT. The findings were classified according to the International Classification of HRCT CT for Occupational and Environmental Respiratory Diseases.ResultsA profusion degree of round opacities (RO)>1 was found in 22.4% (76/339) of the CT exams. After integrating the CT findings with clinical and occupational data, silicosis was diagnosed as follows: 43/285 (15.1%) and 14/54 (25.9%) in workers whose X-rays had been classified as 0/0 and 0/1, respectively. There was an upward trend towards longer exposures, reaching 38.9% when working more than 10 years underground and classified as 0/1 (p=0019). Those with presence of RO whose final diagnosis was not silicosis were mainly cases of tuberculosis or ‘indeterminate nodules’. Emphysema was found in 65/339 (19.1%), only 5 being detected in the X-ray.ConclusionVolume-based CT proved to be useful in the investigation of silicosis among individuals with a relevant exposure to silica, capturing diagnoses that had not been identified on X-rays. A response gradient of silicosis was showed by CT even in this population with ILO category 0 radiographs. It can be indicated based on quantitative and/or qualitative criteria of occupational exposure, especially considering the possibilities of low CT dosage.

Background In low- and middle-income countries, such as Brazil, studies on the causes of death in asbestos-exposed workers are scarce. Methods A cohort study was performed involving 988 males who had worked in the asbestos-cement industry in the state of Sao Paulo, with a total of 12,217 person-years of observation between 1995 and 2016. The standardized mortality ratio (SMR) stratified by age was calculated as the ratio between the observed rate and the expected rate in the state of Sao Paulo. Results Increased SMRs were observed for overall mortality (SMR 1.1, 95% confidence interval [CI], 0.98-1.23) and mortality due to pleural malignant neoplasms (MN) (SMR, 69.4; 95% CI, 22.55-162.1), asbestosis (SMR, 975.7; 95% CI, 396.4-2031), peritoneal MN (SMR, 5.0; 95% CI, 0.13-27.78), laryngeal MN (SMR, 1.4; 95% CI, 0.30-4.20), and pulmonary MN (SMR, 1.5; 95% CI, 0.82-2.64). Conclusion The present study highlights the damage caused by asbestos exposure and reinforces the existing evidence of a causal association between exposure and increased mortality due to pleural MN, pulmonary MN, and asbestosis.

OBJECTIVE To evaluate the frequency and severity of pleuropulmonary alterations in anthophyllite-exposed former workers in Itapira, Sao Paulo, Brazil. The amphibole anthophyllite, a magnesium-iron silicate, had its mining, marketing, and use forbidden in Brazil in 1995. METHODS Former workers were followed from 1999 to 2011. All completed chest X-ray interpreted using the International Labour Office (ILO) classification. High-resolution computed tomography was used at the final evaluation. Spirometry assessed forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV1/FVC throughout the follow-up period. Samples from the mined ore were analyzed by X-ray diffraction (XRD) and scanning electron microscopy coupled to energy dispersive spectroscopy (SEM-EDS). RESULTS XRD and SEM-EDS confirmed the presence in ore of anthophyllite at a concentration of 75%, in addition to tremolite and other amphiboles in lower concentrations. Twenty-eight subjects were evaluated. Median time of exposure was 3 years (minimum = 1; maximum = 18; interquartile interval = 1-4). Twenty cases of pleural abnormalities were diagnosed in 26 evaluated (77%). The average latency time was 25.6 ± 7.4 years. Two individuals (7.7%) showed progressive worsening of diffuse pleural thickening (DPT) and exhibited an annual FVC decrease of 85 mL and 150 mL, respectively. CONCLUSION This small sample showed a very high index of nonmalignant pleural abnormalities in anthophyllite-exposed workers compared with workers exposed to other kinds of fibers. Rapidly progressive DPT, defined by the severity of pleural compromise, was possibly secondary to the presence of other amphibole types in the inhaled dust. No significant loss of FVC was found in the studied group as a whole. No cases of asbestosis, lung carcinoma, and mesothelioma were diagnosed in this cohort.

To estimate the degree of agreement and validity of diagnoses of asbestos-related malignant neoplasms registered in the Hospital Information System of the Brazilian Unified Health System (SIH/SUS), in comparison to the Hospital Cancer Registries of the State of São Paulo (HCR/SP).Deaths with records of malignant neoplasms associated with asbestos were identified and extracted from SIH/SUS between 2007 and 2014. Deaths in cases registered in the HCR/SP were extracted for the same period. The databases were linked using software Link Plus. A single ICD-10-coded diagnosis selected from each system was analyzed. The proportion of agreement, and the sensitivity, specificity and predictive values were estimated.19,458 pairs were found with records in both bases. The proportion of agreement was high, ranging from 92.4% for the unknown primary site, to 99.7% for cancer of the pleura. The Kappa Index ranged from 0.05 (95%CI 0.04 - 0.07) for cancer of the pleura to 0.85 (95%CI 0.84 - 0.87) for lung cancer. Sensitivity varied from 0.08 (95%CI 0.01 - 0.25) for cancer of the pleura, to 0.90 (95%CI 0.90 - 0.91) for lung cancer.Diagnosis of asbestos-related malignancies reached higher levels of agreement and validity when common. Rare diagnoses showed low accuracy in SIH/SUS.Estimar o grau de concordância e validade dos diagnósticos de neoplasias malignas relacionadas à exposição ao asbesto registrados no Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS), em comparação aos Registros Hospitalares de Câncer do Estado de São Paulo (RHC/SP).Óbitos com registros de neoplasias malignas associadas ao asbesto foram identificados e extraídos do SIH/SUS entre 2007 e 2014. Óbitos nos casos de câncer registrados na base do RHC/SP foram extraídos para o mesmo período. Essas bases foram unidas pelos mesmos indivíduos empregando-se o software Link Plus. Um único diagnóstico codificado pela CID-O3 ou CID-10 selecionado de cada sistema foi analisado. A proporção de concordância e a sensibilidade, especificidade e valores preditivos foram estimados.Encontraram-se 19.458 pares com registros nas duas bases. A proporção de concordância foi elevada, variando de 92,4% para a localização primária desconhecida a 99,7% para o câncer de pleura. O índice Kappa variou de 0,05 (IC95% 0,04 - 0,07) para o câncer de pleura a 0,85 (IC95% 0,84 - 0,87) para o câncer de pulmão. A menor sensibilidade foi de 0,08 (IC95% 0,01 - 0,25), para o câncer de pleura, e a maior de 0,90 (IC95% 0,90 - 0,91), para o câncer de pulmão.Diagnósticos de neoplasias malignas associadas ao asbesto alcançaram maiores níveis de concordância e validade quando comuns. Os diagnósticos mais raros apresentaram baixa acurácia no SIH/SUS.

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Objective: To develop a linkage algorithm to match anonymous death records of cancer of the larynx (ICD-10 C32X), retrieved from the Mortality Information System (SIM) and the Hospital Information System of the Brazilian Unified National Health System (SIH-SUS) in Brazil. Methodology: Death records containing ICD-10 C32X codes were retrieved from SIM and SIH-SUS, limited to individuals aged 30 years and over, between 2002 and 2012, in the state of São Paulo. The databases were linked using a unique key identifier developed with sociodemographic data shared by both systems. Linkage performance was ascertained by applying the same procedure to similar non-anonymous databases. True pairs were those having the same identification variables. Results: A total of 14,311 eligible death records were found. Most records, 10,674 (74.6%), were exclusive to SIM. Only 1,853 (12.9%) deaths were registered in both systems, representing true pairs. A total of 1,784 (12.5%) cases of laryngeal cancer in the SIH-SUS database were tracked in SIM with different causes of death. The linkage failed to match 167 (9.4%) records due to inconsistencies in the key identifier. Conclusion: The authors found that linking anonymous data from mortality and hospital records is a feasible measure to track missing records and may improve cancer statistics. RESUMO: Objetivo: Desenvolver um algoritmo de vinculação de registros para parear registros de óbito por câncer de laringe (CID-10 C32X), recuperados do Sistema de Informação de Mortalidade (SIM) e do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS) do Brasil. Métodos: Foram filtrados registros de óbitos contendo códigos CID-10 C32X do SIM e do SIH-SUS, de indivíduos de mais de 30 anos, entre 2002 e 2012, no Estado de São Paulo. As bases de dados foram vinculadas por meio de um identificador único e de variáveis sociodemográficas comuns a ambos os sistemas. O desempenho da vinculação de dados foi aferido aplicando-se o mesmo procedimento em bancos de dados nominais. Os pares verdadeiros apresentavam os mesmos valores nas variáveis de identificação. Resultados: Ao todo, 14.311 registros elegíveis de óbito foram encontrados. A maioria dos registros, 10.674 (74.6%), era exclusiva do SIM. Apenas 1.853 (12.9%) óbitos foram registrados em ambos os sistemas, representando pares verdadeiros. Um total de 1.784 (12.5%) casos de câncer de laringe presentes no SIH-SUS constavam com diferentes causas de óbito no SIM. Houve falha na vinculação em 167 (9.4%) registros, devido a inconsistências na chave de identificação. Conclusão: Constatou-se que a vinculação de dados anônimos de registros hospitalares e registros de óbito é viável e pode auxiliar na melhoria de estatísticas de câncer.

Two hundred and thirty-three individuals read chest x-ray images (CXR) in the Asian Intensive Reader of Pneumoconiosis (AIR Pneumo) workshop. Their proficiency in reading CXR for pneumoconiosis was calculated using eight indices (X1–X8), as follows: sensitivity (X1) and specificity (X2) for pneumoconiosis; sensitivity (X3) and specificity (X4) for large opacities; sensitivity (X5) and specificity (X6) for pleural plaques; profusion increment consistency (X7); and consistency for shape differentiation (X8). For these eight indices, one-way analysis of variance (ANOVA) and Scheffe’s multiple comparison were conducted on six groups, based on the participants’ specialty: radiology, respiratory medicine, industrial medicine, public health, general internal medicine, and miscellaneous physicians. Our analysis revealed that radiologists had a significant difference in the mean scores of X3, X5, and X8, compared with those of all groups, excluding radiologists. In the factor analysis, X1, X3, X5, X7, and X8 constituted Factor 1, and X2, X4, and X6 constituted Factor 2. With regard to the factor scores of the six participant groups, the mean scores of Factor 1 of the radiologists were significantly higher than those of all groups, excluding radiologists. The two factors and the eight indices may be used to appropriately assess specialists’ proficiency in reading CXR.

Background Brazil is an exporter of precious stones and craftsmen often work in poor conditions. We assessed silica-related diseases among crystal craftsmen and the complexity of its control. Methods Case-series including 118 subjects evaluated from 2006 to 2015, based on medical interviews, chest X-rays, spirometry, and respirable silica samples. Results Median age and length of exposure were 32 and 13 years, respectively. Silicosis, with 1/0 as a threshold, was diagnosed radiologically in 57 individuals (48.3%). Respirable silica concentrations were 0.9–29.3 times greater than the Brazilian occupational exposure limit. A Receiver Operating Characteristic (ROC) curve with the same diagnosis threshold showed best discrimination at a cut point of 12.5 years of exposure, corresponding to 4.85 mg-y/m3 of cumulative silica exposure. There was a significant decline in FEV1 across radiological and cumulative silica exposure categories. Eleven individuals (9.3%) had mycobacterial diseases at baseline or follow-up. Conclusion Crystal craftsmen continue to suffer from silicosis, lung function impairment, comorbidity, and death due to silicosis. To date collective protection in some work sheds has not diminished silica levels. Long-term follow-up is needed to evaluate further improvements in preventive measures. Am. J. Ind. Med. 60:239–247, 2017. © 2017 Wiley Periodicals, Inc.

Exposure to environmental and occupational particulate matter (PM) induces health effects on the cardio-pulmonary system. In addition, associations between exposure to PM and metabolic syndromes like diabetes mellitus or obesity are now emerging in the literature. Collection of exhaled breath condensate (EBC) is an appealing non-invasive technique to sample pulmonary fluids. This hypothesis-generating study aims to (1) validate an ion chromatography method allowing the robust determination of different metabolism-related molecules (lactate, formate, acetate, propionate, butyrate, pyruvate, nitrite, nitrate) in EBC; (2) apply this method to EBC samples collected from workers exposed to quartz (a known inflammatory particle), to soapstone (a less inflammatory particle than quartz), as well as to controls. A multi-compound standard solution was used to determine the linearity range, detection limit, repeatability and bias from spiked EBC. The biological samples were injected without further treatment into an ion chromatograph with a conductivity detector. RTube® were used for field collection of EBC from 11 controls, 55 workers exposed to soapstone and 12 volunteers exposed to quartz dust. The analytical method used proved to be adequate for quantifying eight anions in EBC samples. Its sub-micromolar detection limits and repeatability, combined with a very simple sample preparation, allowed an easy and fast quantification of different glycolysis or nitrosative stress metabolites. Using multivariate discriminant analysis to maximize differences between groups, we observed a different pattern of anions with a higher formate/acetate ratio in the EBC samples for quartz exposed workers compared to the two other groups. We hypothesize that a modification of the metabolic signature could be induced by exposure to inflammatory particles like quartz and might be observed in the EBC via a change in the formate/acetate ratio.

WRA accounts for 15-20% of asthma in adults. The aim is to assess socioeconomic and quality of life (QoL) impact of WRA in a middle-income country. Methods: 201 patients from a referral hospital were evaluated, 101 asthma patients with no relation to work (NWRA) and 100 WRA cases. All subjects had occupational histories taken, socioeconomic status determined and responded to asthma control questionnaires (ACQ6 and ACT), Hospital Anxiety and Depression Scale (HADS) and Juniper Asthma Quality of Life Questionnaire (AQLQ). Results: The most prevalent occupations in the NWRA group was in the administrative services sector, while WRA patients worked mostly in cleaning services. NWRA group had more women (p=0.04), more asthma family history (p=0.04) and more rhinitis (p=0.036) while WRA group was older (p Indviduals with WRA had a decrease in wage and family income (p Conclusion: Individuals with WRA showed negative socioeconomic impact since diagnosis, and when compared to NWRA group they had worst asthma control, QoL and psychological outcomes.

There are scarce epidemiological studies on lung cancer mortality in areas exposed to asbestos in developing countries. We compared the rates and trends in mortality from lung cancer between 1980 and 2016 in a municipality that made extensive use of asbestos, Osasco, with rates from a referent municipality with lower asbestos exposure and with the rates for the State of S&atilde, o Paulo. We retrieved death records for cases of lung cancer (ICD-9 C162) (ICD-10 C33 C34) from 1980 to 2016 in adults aged 60 years and older. The join point regression and age-period-cohort models were fitted to the data. Among men, there was an increasing trend in lung cancer mortality in Osasco of 0.7% (CI: 0.1, 1.3) in contrast to a mean annual decrease for Sorocaba of -1.5% (CI: &minus, 2.4, &minus, 0.6) and a stable average trend for S&atilde, o Paulo of -0.1 (IC: &minus, 0.3, 0.1). Similar increasing trends were seen in women. The age-period-cohort model showed an increase in the risk of death from 1996 in Osasco and a reduction for Sorocaba and S&atilde, o Paulo State during the same period. Our results point to a need for a special monitoring regarding lung cancer incidence and mortality in areas with higher asbestos exposure.

Background: Asbestos consumption in Latin America (LA) amounts to 10% of yearly global production. Little is known about the impact of asbestos exposure in the region. Objective: To discuss scientific and socio-economic issues and conflicts of interest and to summarize epidemiological data of asbestos health effects in LA. Discussion: Recent data on chrysotile strengthened the evidence of its carcinogenicity and showed an excessive risk of lung cancer at cumulative exposure levels as low as 1.5 fibre-years/ml. Technology for substitution is available for all asbestos-containing products and ceasing asbestos production and manufacturing will not result in unemployment and loss of income, except for the mining industry. The flawed arguments used by the industry to maintain its market, both to the public and in courtrooms, strongly relies on the lack of local evidence of the ill effects and on the invisibility of asbestos-related diseases in LA, due to the limited number of studies and the exposed workers’ difficulty accessing health services. The few epidemiological studies available show clear evidence of clusters of mesothelioma in municipalities with a history of asbestos consumption and a forecasted rise in its incidence in Argentina and Brazil for the next decade. In Brazil, non-governmental organizations of asbestos workers were pivotal to counterbalance misinformation and inequities, ending recently in a Supreme Court decision backing an asbestos ban. In parallel, continuous efforts should be made to stimulate the growth of competent and ethical researchers to convey adequate information to the scientific community and to the general public.