Asbestos is a fibrous mineral that was widely used in Australia in the 20th Century for many industrial and domestic applications. Inhalation of asbestos fibres has been shown to lead to a number of serious health risks, including asbestosis and the cancer mesothelioma. As these can take a number of decades to develop, it is likely that the effects on the Australian community of exposure to asbestos will continue to increase into the 21st Century.
What is asbestos?
Asbestos is a group of naturally-occurring silicate minerals that are made up of fine, fibrous crystals. Three of these are crocidolite (blue asbestos), amosite (brown or grey asbestos) and chrysotile (white asbestos).
Asbestos fibres have many useful qualities: they are strong and flexible, resistant to fire and chemical attack, and have good insulating properties. They can even be spun and woven into cloth.
Asbestos is also relatively cheap to mine and process. Historically, asbestos was seen as a desirable raw material in a range of products such as insulation, construction materials, concrete, an additive in paints and sealants, vehicle brake pads and clutches, and even outdoor furniture.
Why is asbestos a health risk?
Asbestos becomes a hazard when microscopic fibre fragments become airborne and are inhaled. Due to their size and shape they can remain airborne for some time, and enter even the smallest air passages in the lungs where they embed in lung tissue. The fibres are highly resistant to removal by the lungs’ natural cleaning processes. 
Asbestos related diseases
Embedded asbestos fibres irritate the lung tissue around them, causing a number of diseases:
Inflammation and irritation of the outer lining of the lung, the pleura. The pleura stiffens and thickens widely (diffuse thickening) or in patches (plaques), and can fill with fluid. This thickening can restrict breathing.
This is scarring of the lungs: the airways become so inflamed and scarred that oxygen is no longer able to pass from the lungs into the blood. The lungs become stiff and inelastic, making breathing progressively difficult. Symptoms include tightness in the chest, dry cough, and in the later stages, a bluish tinge to the skin caused by lack of oxygen. Asbestosis is usually seen in former asbestos miners, asbestos manufacturing workers and insulation workers, and usually takes a decade or more to develop.
Exposure to asbestos fibres greatly increases a person’s risk of developing lung cancer, particularly if they are also a smoker.
Mesothelioma is a cancer of the pleura. It typically grows quickly and spreads widely before symptoms appear, making its early diagnosis and effective treatment very difficult. The average survival time after diagnosis is only 6-18 months. A very small exposure to asbestos can be enough to trigger the cancer, however only a small percentage of people exposed to asbestos develop mesothelioma. There may be a lag of 20 to 40 years after asbestos exposure before mesothelioma results.   
Other risk factors
Two further factors that increase the health risks from asbestos are:
- The typical lag of 20 to 40 years between exposure and the onset of symptoms of disease. This can make detection, prevention and risk management for asbestos related health risk very difficult. It is estimated that the peak of the epidemic of asbestos-related disease in Australia will not occur until the 2020s.  
- The extremely widespread use of asbestos in construction in Australia last century means that exposure to it is also widespread. The weathering and ageing of asbestos-containing materials and renovation of buildings containing asbestos products may continue to release asbestos fragments for many years. 
Who is at risk of asbestos-induced cancers?
Those who are particularly at risk of asbestos-induced cancers, as noted by the Asbestos Diseases Society of Australia Inc,are people exposed to the loose fibres of asbestos in mining, manufacturing, building and construction or at work, school or in the home; as well as those exposed through asbestos removal, and the consequences of uncontrolled, unsafe removal.
Mortality from asbestos related diseases
Australia and the UK have the highest rates of asbestos-related death in the world.  This is understood to be because of the amount of asbestos used in these countries, and the relatively high proportion used of the most dangerous types, blue and brown. It is estimated there have already been at least 4,700 deaths from mesothelioma in Australia since records began in the early 1980s , and more than 25,000 Australians will die from it over the next 40 years. 
Currently, each year 500 men and 100 women develop mesothelioma in Australia, and this is expected to rise to 900 new cases a year by 2020. 
Asbestos in Australia
Between 1945 and 1980, asbestos was used extensively in construction and industry in Australia. Most public buildings and about one third of private dwellings built in this era contained asbestos in the forms of concrete, asbestos cement sheeting (AC sheeting or fibro), vinyl floor coverings, lagging of pipes and boilers, and insulation (laid or sprayed). Removing this asbestos, and dealing with asbestos that remains in situ, have required careful management.  
Asbestos was phased out in Australia after 1980. It was finally banned from building products in 1989, though it remained in gaskets and brake linings until recently. Asbestos was prohibited completely after 31 December 2003, and can not be imported, used or recycled.  
The mining of asbestos ended in Australia in 1983. Before that, blue asbestos was mined primarily at Wittenoom in WA, with earlier and smaller mines in SA, Tasmania and NSW. White asbestos was mined in NSW and Tasmania. Asbestos was also imported from South Africa and Canada. 
Blue asbestos (which is considered to be the most dangerous form of asbestos) was mined near Wittenoom in Western Australia between 1943 and 1966 — at a large scale after 1943. Precautions taken against asbestos contamination were non-existent, so many workers were exposed to intense levels of airborne asbestos fibre.  Asbestos containing dust from the mine was also allowed to contaminate the nearby township and surrounding country. 
An NHMRC-funded follow-up study of former miners and residents from Wittenoom has shown that they are prone to dying from mesothelioma, other cancers, asbestosis and tuberculosis, among a range of causes, at rates significantly in excess of comparable populations. 
Court cases in Australia
Although the health risks associated with asbestos had been long observed and were confirmed scientifically early in the Twentieth Century, it was not until the 1970s that the Australian community was made aware of the problem. At this time the first compensation cases by injured workers against asbestos manufacturers were made and widely reported in the media.  As former workers in environments contaminated by asbestos began to fall sick and die in ever increasing numbers, a series of cases put before Australian courts after 1980 established a precedent for civil damages to be awarded to sufferers of asbestos related diseases by their former employers: asbestos producers, manufacturers, transporters, and users of asbestos materials. 
In 2001, the building materials manufacturer James Hardie Industries set up the Medical Research and Compensation Foundation (MRCF) to fund compensation for people injured by its asbestos-containing products, as a '...means of separating the asbestos liabilities from those of the [James Hardie] Group . Investigating concerns about MCRF from former James Hardie employees and others, in 2004 a NSW commission of inquiry (‘the Jackson Inquiry’) issued a finding highly critical of James Hardie Industries’ setup and management of the MRCF. 
In his summary Commissioner David Jackson QC wrote:
"The notion that the holding company would make the cheapest provision thought ‘marketable’ in respect of those liabilities so that it could go off to pursue other more lucrative interests insulated from those liabilities is singularly unattractive. Why should the victims and the public bear the cost not provided for?" 
One of the leading negotiators for the former employees of James Hardie was Bernie Banton, a former employee himself, who had contracted asbestosis and pleural disease.  For his service to the community, particularly as a tireless advocate for people affected by asbestos-related illnesses, Bernie Banton was made a Member of the Order of Australia in 2005.
Bernie Banton later developed peritoneal mesothelioma and died in November 2007 at age 61.
Centre of Clinical Research Excellence into Asbestos-Related Disease
In January 2009, the Australian Government announced that from 2010, $4.5 million would be directed to support world-class research into Asbestos Related Diseases
In July 2010, the National Centre for Asbestos-Related Diseases was awarded $4.5 million over five years to further the centre’s research focusing on improving diagnosis, early intervention strategies and improving treatment of asbestos-related diseases.
Existing research centres who work on asbestos related diseases will be able to apply for this funding. This funding will be part of NHMRC's Centres of Research Excellence scheme.
Bernie Banton Research Fellowship
Within the NHMRC Research Fellowships Scheme, there is recognition of health and medical researchers who work in the field of mesothelioma and asbestosis through the award of an NHMRC Bernie Banton Fellowship. This NHMRC Fellowship is awarded to the most highly ranked NHMRC Research Fellowship applicant for this award in the funding cycle for that year. This award has been established to commemorate the life of Bernie Banton through recognising this important area of research. It does not provide any additional funding to the NHMRC Research Fellowship package.
NHMRC funding for research into asbestos related diseases
NHMRC has invested more than $14.5 million from 2000 to 2010 for research related to asbestos related diseases.
A number of high quality research projects are funded with grants through the Project Grant Scheme. These projects range from epidemiological studies of at-risk asbestos exposed populations and discovery of new blood markers of mesothelioma, through to testing novel clinical treatment studies. More information on NHMRC funding for asbestos related disease research (including mesothelioma)
National Centre for Asbestos-Related Diseases (NCARD)
The National Centre for Asbestos Related Diseases (NCARD) is a collaboration of researchers across Australia, with a national and strategic focus into asbestos related diseases and cancers. NCARD provides a platform to build on Australia’s existing research expertise and encourages strong organisational linkages to ensure our research is systematic and complementary to existing research efforts in the area of asbestos related diseases.
Through NHMRC, $6.2 million was provided to set up the NCARD collaboration, with $5.8 million of this allocated in a competitive grants process to 11 research centres across Australia, including the University of Western Australia, Peter MacCallum Centre in Victoria, James Cook University in Queensland, and The Prince Charles Hospital in Queensland. The remaining $0.4 million has been used to support NCARD at the University of Western Australia to administer and coordinate the research network.
NCARD’s research projects include:
- A study of epidemiology and community consequences of asbestos exposure.
- The development of sensitive serum markers for improved diagnosis, monitoring and screening for early detection of mesothelioma.
- An investigation of the importance of specific genes in asbestos-related disorders and their relationship to environmental factors.
- The development of a national resource for mouse models, to help understand the disease in humans and provide essential data for clinical trials.
- An investigation of mechanisms to inhibit the body’s collagen production to slow growth in malignant mesothelioma tumours.
- A combination of conventional therapies with immuno/gene therapies that encourage the body’s own anti-cancer immune responses.
- An investigation of ways to improve the ability to measure patient responses to chemotherapy treatment.
- An examination of chromosomal changes in cancer cells to help improve the early detection of mesothelioma.
- The development of a sustainable community-based response to asbestos-related disease in Aboriginal communities.
- A study of people with chronic obstructive pulmonary disease who were formerly exposed to asbestos and cigarette smoke.
A number of states have contributed to asbestos research, often in partnership with other funding agencies.
The NSW Government has contributed over $3 million of research over the last 8 years into asbestos- and other dust-related diseases through the Dust Diseases Board.
The Western Australian Government has funded a Vitamin A prevention trial plus a clinical trials program, with the aim of developing and trialling novel therapies for asbestos cancers.
In December 2007 NHMRC entered into an agreement with the New South Wales Government to accept funds for research into asbestos-related disease, as a result of the NSW Supreme Court ruling against James Hardie Industries. Under the agreement, James Hardie will fund $500,000 per year for ten years (total of $5 million).
NHMRC has used these funds to support research, such as NHMRC Project Grants, into asbestos-related disease, and may use future amounts to provide some of the funding for the new Centre of Research Excellence into asbestos-related diseases.
James Hardie has no influence on the selection of individual research projects and NHMRC must approve any release of information by James Hardie in relation to the agreement with NHMRC.
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Criminal investigation follows report on asbestos compensation fund
BMJ 2004;329:762 (2 October), doi:10.1136/bmj.329.7469.762-b
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