Why some patients with ovarian or laryngeal cancer are "forgotten victims"

2023-04-26 06:47:36

Asbestos was at the heart of a vast health scandal, particularly in the 1990s, when people became aware of the risk for the health who were associated with it. Classified as a carcinogen since 1977, it has been banned in France since 1997.

We now know for sure that exposure to asbestos fibers is the cause of lung cancer (bronchopulmonary cancer) and cancer of the pleura (mesothelioma), the double membrane that envelops the lungs and lines the inside of the chest cavity.

But this substance is also at the origin of laryngeal and ovarian cancers. However, if this link is known, scientists, neither doctors specializing in these pathologies, nor the general public are really informed on this subject.

This lack of knowledge has largely contributed to the underreporting of these two types of cancer in the context of the recognition of occupational diseases. Another consequence: the medical monitoring of workers exposed to asbestos is incomplete.

This situation is all the more problematic since the sectors best known for exposure to asbestos, and which are therefore the most studied, employ a majority of men. With regard to the risks to the ovaries, what about the exposure of women in other sectors at risk? What is the impact on their health?

In a recent report, the National Agency for Food, Environmental and Occupational Health and Safety (Anses) update on this question.

What is asbestos?

Banned in France since 1997, asbestos had been used since the end of the 19th century in many sectors of activity. “Asbestos” is a generic term that designates six natural mineralsof the fibrous hydrated silicate type (magnesium and iron silicates), divided into two groups which are distinguished by their physical and chemical properties: serpentines (with long, flexible and curved fibres) and amphiboles (with straight, stiff and usually brittle).

It is the inhalation of asbestos fibers (here serpentine) that causes cancer (laboratory analysis, TEM view) – Pvince73 / Shutterstock

Its commercial value is conferred on it by various special properties, including low electrical and thermal conductivity, good chemical stability, durability, high tensile strength, flexibility, etc. But if its physical assets were quickly understood and exploited, its effects on health have long been underestimated.

Even today, doctors and patients are insufficiently informed, which leads to under-declaration and under-recognition of cancers – in particular of the ovary and larynx as occupational diseases.

The larynx and the ovary: two unknown targets of asbestos

In his report published in September 2022ANSES recommends better information for doctors and better social, medical and administrative support for workers exposed to asbestos and suffering from cancer of the larynx or ovary (as well as their dependents), to help them in their process of declaration and recognition of occupational diseases.

The hearing of doctors specializing in ovarian cancer within the framework of this expert appraisal made it possible to inform about the limits of the dissemination of scientific knowledge, even among specialist doctors.

It appeared that ovarian cancer was today very little known as being able to be associated with occupational risk factors. Laryngeal cancer, on the other hand, is better known for its link with factors such as tobacco or alcohol consumption, thus masking the possible role of asbestos.

Doctors are not the only ones to misunderstand these relationships: the same is true of the population. Consequently, the patients themselves do not make the connection between their work and their disease.

Of course, other factors, not specific to ovarian and laryngeal cancers such as asbestos (complexity of administrative procedures, lack of occupational medicine resources, difficulty in tracing occupational exposure, etc.) also contribute to this under-declaration and this under-recognition in occupational disease.

Risks of exposure that still exist

Despite the ban in 1997 in France, exhibitions remain possible because asbestos is still present in many products and materials in our environment (old buildings, walls, floors with vinyl-asbestos tiles). Professionals in contact with such old materials are, in fact, exposed to asbestos.

Despite the large amount of data, the evaluation of occupational exposure to asbestos is only partially studied, on the one hand in terms of sectors of activity, on the other in terms of gender.

The recent report pointed to the sectors exposing or having exposed to asbestos. The most documented are now clearly identified: these include construction, metallurgy and car manufacturing.

But many other sectors are also impacted and are much less known: administration, maintenance, education, health, but also textiles… Moreover, these sectors are little studied in the scientific literature. . However, one of their specificities is that they mainly employ women: which limits the assessment of asbestos exposure among the latter and the risks incurred.

Many sites are still contaminated with asbestos, and can affect audiences very different from those usually considered to be at risk. Administration, health or education are thus underestimated, and these are often sectors where women are in the majority. — Many sites are still contaminated with asbestos, and can affect audiences very different from those usually considered to be at risk. Administration, health or education are thus underestimated, and these are often sectors where women are in the majority – Leitenberger Photography / Shutterstock

A dangerous lack of data for women

Indeed, since women are less represented than men in sectors of activity known to be exposed to asbestos, it is more difficult to have data to document their exposure.

This is why the work carried out by ANSES led to the formulation of recommendations for better identification and characterization of women’s exposure to asbestos. It is indeed necessary to have more data on the sectors, professions and work exposing them to this risk as well as quantitative data to better characterize their exposure.

ANSES also recommends improving the information intended for women regarding the possibility of the occurrence of ovarian cancer linked to occupational exposure to asbestos.

More generally, it is necessary to encourage the production of scientific data allowing to enrich the knowledge on the differences in working conditions between men and women and their impact on their health.

Create a new table of occupational diseases

The Agency’s expert appraisal work confirmed, on the basis of the IARC Monograph 100Cbut also meta-analyses and articles published subsequently, the existence of a proven causal link between exposure to asbestos and the occurrence of larynx and ovarian cancer.

All of these scientific elements plead in favor of the creation of tables of occupational diseases to facilitate the recognition of these cancers as occupational diseases and thus, the compensation of patients or beneficiaries.

The creation of these tables would make it possible to facilitate the process of recognition of occupational diseases, but also to inform doctors and workers exposed to asbestos of the risks they run.