Professor Marcus Kennedy, a consultant respiratory physician at Cork University Hospital, has diagnosed many asbestos-related cancers.
Working in the US, he came across such illness in American Navy veterans.
“Merchant navy and military ships were lined with asbestos as a fire repellent in the past,” he says. “The health dangers of it weren’t realised then. Asbestos-related illnesses have been common in Northern Ireland too because of the shipbuilding industry there.
“Here in Cork, we’d see it in particular in people who worked in the UK in construction, maybe 30 years ago.
“A lot of farmers would have worked there when they were young or double jobbed in construction too. We’ve seen it in ex-Ford workers also because asbestos was used in car brake linings.”
Brakes and clutches were often made from chrysotile (white) asbestos due to its heat resistance and strength qualities.
ESB employees and electricians have also been affected but it can be seen in many different types of occupations, the professor says.
“For farmers, the risk nowadays is in old machinery, older buildings and sheds and farmhouses, as well as old lagged pipes. It can take a long time, sometimes as much as 30 or 40 years, for the symptoms to start.”
It is inhaling the asbestos fibres when asbestos is worked with, cut or disturbed that does the damage, he says.
“It gets into the lungs, particularly into the lining of the lungs and can cause a number of chest illnesses – asbestiosis, lung cancer and mesothelioma [an incurable lung lining cancer specific to asbestos]. About 50 people are diagnosed with mesothelioma [a notifiable disease] each year in Ireland.”
Asbestosis is a scarring of the lungs.
“It is caused by inhaling asbestos dust over long periods. It’s a type of what we call lung fibrosis which is where lung tissue gets gradually damaged and scarred. It’s not a malignancy [a cancer] but it makes you very breathless and it can get worse over time.”
Asbestos exposure also causes pleural plaques, he adds. “The lining of the lung thickens and you get fluid around the lungs which can also cause breathlessness.”
Asbestos exposure is also a risk factor in what may be called standard lung cancer, particularly if you smoke.
“We see a lot of lung cancers and asbestos is the cause of around 14% of them. If you smoke as well, your risk of developing it is much, much greater.”
With the most serious cancer – mesothelioma – it progresses around the lining of the lungs over time.
Singer Christie Hennessy died of mesothelioma in December 2007, at the age of 62. The singer-songwriter, who was originally from Kerry, spent many years working on building sites in Britain in his 20s, which is where, it is believed, he came in contact with asbestos, which later led to him developing cancer. He highlighted the disease before his death. “People get breathless and get chest wall pain also. They may lose weight too. It’s a nasty tumour and isn’t curable unfortunately,” Hennessy said.
In all three illnesses mentioned above, a chest x-ray is the initial test used when the patient reports symptoms (including persistent and progressive shortness of breath, cough, weight loss, fatigue and chest wall pain). A referral to a respiratory physician will follow.
“For all these illnesses, maintaining good lung health, including stopping smoking, good diet, exercise and avoidance of infection including through recommended vaccinations is very important,” says Professor Kennedy.
Because there are lots of causes of lung fibrosis (including ‘farmer’s lung’), a CT scan is done and possibly a lung biopsy to show the asbestos fibres in the lung.
“We now have specific anti-fibrotic drugs that won’t cure it but they will slow its progression,” Professor Kennedy says. “The person may eventually need oxygen due to progression, however.”
Doctors who diagnose such illnesses will always ask patients about their current risk.
“It may be that the person is still being exposed, maybe working in a shed regularly where there is asbestos in the cement [as a strengthener] or in the lining or the lagging of the roof [for fireproofing]. We’d always ask what’s going on now but typically the exposure happened maybe 30 years before.”
“In the elderly it’s often advanced, unfortunately, and not curable but treatments are getting better.
“These include better and safer radiation therapy and chemotherapy, personalised targeted treatments based on patients’ individual tumours and medication that enhance your immunity towards cancer. However, if it is identified early it is curable with surgery and radiation.”
The prognosis for this is generally poor with people who are diagnosed with mesothelioma usually dying within a year or less.
“Only rarely can the tumour be removed, and radiation or chemotherapy doesn’t tend to work,” he says. “While new drugs have come out, they are still only at trial stage.”
Financial compensation should be available to those who suffer workplace asbestos-related illness and Professor Kennedy and his colleagues do inform patients of that.
“It is easier in the UK. There is a national compensation scheme there but none here.
“Here you have to seek compensation from the company that employed you and, of course, a lot of those are gone — but we would support patients or their families in seeking compensation by providing the necessary medical reports.”
He points out that family members can also develop mesothelioma if they have been living with someone who has worked with asbestos.
“The classic scenario in a traditional family is where the wife would have been washing the clothes, and she may have inhaled the fibres from that,” he says.
Asbestos can also affect the lining of the abdomen and may be a risk factor for stomach, head and neck cancer as well.
Threat of exposure
Darren Arkins of the Health & Safety Authority says: “The HSA receives nearly 400 notifications each year from asbestos removal companies to remove high-risk asbestos materials.
“If asbestos materials are correctly managed, they can remain in place. However, removal of asbestos should only be carried out by trained contractors under strictly controlled conditions.
“Although the tragic fatalities today are caused by asbestos exposure in the past, there still remains a threat of exposure to this deadly material. It is important to remain vigilant and take the necessary precautions as required by law when disturbing the fabric of older buildings to ensure workers’ health is not put at risk.”
• Why was it used?
Because the fibrous mineral was resistant to heat, fire, chemical and biological degradation and was mechanically strong. This made it ideal for use in insulation material for buildings, walls, flooring, roofs, heating systems and equipment.
• Where was it used?
Asbestos can be found in any industrial, commercial, public or residential building built or refurbished before the year 2000.
• Most dangerous types?
Blue (crocidolite) and brown (amosite) which were often used for lagging hot water pipes up to the 1960s. It is very dangerous as pipe lagging because it can break easily and release powder-like fibres into the air.
• Where else could farmers encounter it?
Older farm buildings including farmhouses, pens and sheds, roofs, wall partitions and gutters. Asbestos cement pipes were commonly used as field drains on farmland. Repair and maintenance of equipment, machinery and farm structures could expose farmers to asbestos.
• When was its use banned?
In 1999. It is now prohibited to use, re-use, sell or supply asbestos or asbestos-containing materials or products. However, products or materials containing asbestos which were already installed or in service prior to the prohibition may remain in place until they are disposed of or reach the end of their service life. As a result, there is still potential for exposure to asbestos in a variety of workplaces.
• What is the law now?
The Health and Safety Authority must be notified well in advance of disturbing asbestos. Handling asbestos materials is a specialist task for specialist contractors requiring appropriate training and equipment, including PPE.
• Who needs to be particularly aware?
Plumbers, electricians, facilities managers, designers, architects and engineers, farmers and builders.
• How many cases of mesothelioma are diagnosed each year?
Some 56 cases, the Irish Cancer Society said in 2020 — up from 34 cases in 2014.
• How is asbestos disposed of?
The Environmental Protection Agency (EPA) deals with the licensing of storage of hazardous waste, including asbestos. Any company or local authority that stores asbestos waste must be licensed. Asbestos waste is hazardous and must be disposed of properly.
Licensed hazardous waste transfer stations can accept asbestos waste and then arrange to have it disposed of at an appropriate facility here or abroad.
Some 371 asbestos notifications were processed by the Health & Safety Authority in 2021, according to its 2022 Annual Report.
HSE hse.ie/mental-health 1800 111 888
The Samaritans 116 123, firstname.lastname@example.org.