Comments on the 2014 helsinki consensus report on asbestos

The Collegium Ramazzini recognizes the work of the 2014 expert committee convened by the Finnish Institute of Occupational Health (FIOH) to update the 1997 and 2000 Helsinki criteria on Asbestos, Asbestosis and Cancer in light of new advances in research. The published consensus report of the Helsinki Committee and its more extensive on-line version (Helsinki Criteria Update 2014 Asbestos, Asbestosis, and Cancer) provide a valuable synthesis of many aspects of current knowledge of the hazards of asbestos. The Collegium Ramazzini is, however, very concerned about the sections of the 2014 Helsinki consensus report that discuss criteria for pathological diagnosis of the diseases caused by asbestos. The sections of the Helsinki report dealing with pathology diagnosis are based on a selective reading of the medical literature. They rely overly much on certain published articles while omitting reference to other important and highly relevant information. They are heavily influenced by the outdated and incorrect concept that analysis of lung tissue for asbestos fibers and asbestos bodies can provide data to contradict exposures that are documented in a reliable occupational history. Further, without any explanation the most accepted CAP-NIOSH 1982 asbestos definition which underwent extensive review and endorsement by NIOSH is now replaced in the 2014 Helsinki criteria by the more restrictive CAP/PPS modification which differs especially in the early histological stages of asbestosis and in the higher numbers of asbestos bodies needed to make the pathological diagnosis of asbestosis. These sections of the Helsinki report appear to have been influenced by members of the Helsinki committee with undisclosed financial conflicts of interest. Applying the 2014 Helsinki report recommendations on pathology diagnosis will lead to: ・Missed diagnoses of cases of disease caused by asbestos, ・Failure of workers’ compensation systems to properly compensate workers who have been exposed to asbestos, and ・Lost opportunities for public health authorities to recognize asbestos hazards and to prevent asbestosrelated disease. For these reasons, relying on lung tissue analysis for the diagnosis and compensation of asbestos-related disease while ignoring the history of occupational exposure is unacceptable. Application of these recommendations will cause harm to the health of workers and their families in countries around the world. The Collegium Ramazzini has identified four specific problems with the pathology sections of the 2014 Helsinki consensus report: