The Spectre Haunting Danish Schoolchildren
The issue of asbestos contamination of schools has been the subject of media reports all over the world, with current examples focusing on the ongoing health hazard posed by asbestos in schools in Philadelphia (US),1 Birmingham (UK),2 Villeneuve-le-Roi (France)3 Murcia (Spain),4 Melbourne (Australia)5 and Soweto (South Africa).6 In most cases, the long-term health of children and staff was endangered by exposures to asbestos-containing products incorporated within buildings. According to a 2019 paper entitled Environmental asbestos exposure in childhood and risk of mesothelioma later in life: a long-term follow-up register-based cohort study,7 in Aalborg, Denmark the situation was, however, different as the danger was external: from toxic dust liberated by the operations of the countrys only asbestos-cement plant.
The Dansk Eternit factory, 1971 (photographer: Clausens; photo: Nordjyllands Historiske Museum).
Between 1928 and 1984, 620,000 tons of asbestos (89% of which was chrysotile) were consumed by operations at the Dansk Eternit Fabrik (Danish Eternit Factory),8 located in a densely populated area of the city between 100 and 750 meters (<1 kilometre) from the Allé, Sønderbro, Vejgaard Vestre and Østermarken schools.
Compulsory school records for 12,111 former seventh grade pupils who attended the schools between 1940 and 1970 were used to identify names, birthplaces and Danish personal identification numbers. The researchers obtained data from Danish national registries including: the Civil Registration System (CRS) (operational since 1968),9 the Danish Cancer Registry (DCR) (operational since 1943),10 and the Danish Supplementary Pension Fund Register (ATP). The availability of data going back decades was crucial because of the long latency of malignant mesothelioma (MM) the signature cancer associated with asbestos exposure. The control group was a random Danish cohort that was matched (1:9) for birth year and gender.
The discovery that children who had attended the schools had a 7-fold increase in the risk of mesothelioma set off alarm bells throughout the country and generated extensive media coverage in newspapers, on television and via online portals.11 In a press interview, Professor Øyvind Omland, one of the papers five authors, expressed his surprise at the deadly repercussions of the environmental exposures saying he had doubted that substantial differences in the mesothelioma incidence between the school and comparison cohorts would be found. The findings of this paper were, however, in line with those from an observational study entitled: Non-occupational exposure to asbestos is the main cause of malignant mesothelioma in women in North Jutland which found that the highest relative risk for mesothelioma up to 10.5 times higher than in the rest of Denmark was for women living in the closest proximity to the asbestos factory: Non-occupational asbestos exposure is the main cause of MM and may account for up to 66% of MM cases among women in North Jutland, Denmark.12
Concluding the 2019 school paper, the authors highlighted the public health import and social policy ramifications of their findings:
environmental asbestos exposure by school attendance near an asbestos cement factory significantly increases the risk of MM. Even though occupational asbestos exposure is a powerful determinant of MM risk, our results suggest that childhood environmental asbestos exposure is also an important risk factor. In light of our results, we suggest considerations towards altering the Danish compensation regulations to apply for all mesothelioma cases regardless of type of asbestos exposure.13
The researchers call for government support for all mesothelioma sufferers, not just those whose exposures to asbestos were occupational or para-occupational (i.e. to asbestos dust brought home on the work clothes of family members), was echoed by the Danish Cancer Society which said: Regardless of how you have been exposed to carcinogenic asbestos dust, you must be offered a reimbursement if you get the life-threatening and rare [cancer] mesothelioma.14 The Societys Managing Director Jesper Fisker, who called the asbestos case a national disaster, stated that compensation was an acknowledgement that Denmark, having permitted asbestos to be used, had a responsibility to the injured; it has been estimated that extending the government compensation scheme to include all of the countrys mesothelioma sufferers would cost a further six million Danish krone (US$ 907,000). Currently, sufferers who were occupationally exposed to asbestos can obtain compensation from the Labor Market Business Insurance Scheme with their partners and children eligible for a special allowance (DKK 170,000/ US$25,700) under the Act on Compensation for Second Hand Exposed Asbestos Victims. Other mesothelioma victims such as the former schoolchildren exposed environmentally are currently ineligible for government compensation.15
Looking outside of Denmarks borders, Oluf Dimitri Røe, Associate Professor and Senior Consultant Oncologist at the Cancer Department, Aalborg University Hospital, principal investigator of the observational study and one of the co-authors of the school paper, commented:
Our findings underscore the serious public health hazard posed by environmental exposures to asbestos, and a continuous increase in cancer cases 33 years after the final ban of asbestos in Denmark. Still, the commercial exploitation of asbestos continues in many parts of the world including Brazil, Russia, China, India, Indonesia and Thailand where mining and factories are often sited in densely populated areas. It is appalling to think that in forty years time, other researchers will be reporting on elevated asbestos cancer incidences to current generations of schoolchildren in those countries.
March 25, 2019
1 Despite recent cleanups, Philadelphia schools still expose kids and teachers to asbestos. December 17, 2018.
2 Eight out of ten schools in Birmingham could contain asbestos. February 28, 2019.
3 Amiante: au lycée Brassens de Villeneuve-le-Roi, gare au peril [Asbestos: at Brassens high school in Villeneuve-le-Roi, beware of danger]. March 19, 2019.
4 Las zonas de Espaa más contaminadas por la presencia de Amianto [The areas of Spain most contaminated by the presence of asbestos]. March 13, 2019.
5 Asbestos discovered at Essendon North Primary School. March 5, 2019.
6 Soweto primary school falling apart roofs collapsing, toilets broken. March 29, 2018.
7 Dalsgaard SB, Wurtz ET, et al. Environmental asbestos exposure in childhood and risk of mesothelioma later in life: a long-term follow-up register-based cohort study. March 17, 2019.
8 Although, asbestos was gradually banned in Denmark from 1972, the Dansk Eternit factory was granted an exemption to use asbestos for the manufacture of roofing panels in the 1980s.
9 The CRS was the source for information on place of birth, civil status, emigration, disappearance, death and identity of parents, siblings, spouses and children.
10 Malignant mesothelioma cases registered between April 1968 until the end of 2015, including tumor characteristics, were identified from the DCR.
11 Ny forskning: Større risiko for sjælden kræftform for naboer til eternitfabrik i Aalborg. [New research: Greater risk of rare cancer for neighbors of eternit factory in Aalborg.] March 14, 2019.
Kræftens bekæmpelse: Alle, der har fået sjælden kræft af asbest, bør kompenseres [Cancer Control: Anyone who has had rare cancer of asbestos should be compensated]. March 14, 2019.
Partileder og Kræftens Bekæmpelse:Eternitbørn bør få erstatning. [Party leader and the Danish Cancer Society: Eternit children should receive compensation.] March 15, 2019.
12 Panou V, Omland Ø, Røe OD et al. Non-occupational exposure to asbestos is the main cause of malignant mesothelioma in women in North Jutland, Denmark. 2019.
13 Dalsgaard SB, Wurtz ET, et al. Environmental asbestos exposure in childhood and risk of mesothelioma later in life: a long-term follow-up register-based cohort study. March 17, 2019.
14 Kræftens bekæmpelse: Alle, der har fået sjælden kræft af asbest, bør kompenseres. [Cancer Control: Anyone who has had rare cancer of asbestos should be compensated.] March 14, 2019.
15 Gik i skole nær eternitfabrikken: Børn fik ’asbestkræft [Went to school near the eternit factory: Children got asbestos cancer]. March 14, 2019.