1. Ovarian cancer due to asbestos as a new occupational disease in germany
Dennis Nowak, Tobias Weinmann, Katja Radon, Matthias Möhner*
*Federal Institute for Occupational Safety and Health

2. Occupational Asbestos Cancer in Germany:
History (1)
1884 Occupational Accidents Statutory Insurance
1925 Occupational Diseases Statutory Insurance
1943 „Lung cancer with asbestosis“
1976 „Asbestos-induced mesothelioma“
1988* „Lung cancer with asbestosis or asbestos-induced pleural disease“
1992* „…or with cumulative exposure to 25 fiber-years“
1997* „Laryngeal cancer or lung cancer…“
*CR fellow H-J Woitowitz

3. Occupational Asbestos Cancer in Germany:
History (2)
1993 Asbestos prohibition in Germany (CR fellow Woitowitz)
2005 Asbestos prohibition in EU

4. IARC 2009: Monography 100 C: Sufficient evidence
Summary: Straif K, Benbrahim-Tallaa L, Baan R, Grosse Y, Secretan B, El Ghissassi F, et al A review of human carcinogens—part C: metals, arsenic, dusts, and fibres. Lancet Oncology 10:453–454.

5. Environ Health Perspect 119 (2011) 1211-1217

6. Environ Health Perspect 119 (2011) 1211-1217

7. Meta-analysis Ovarian cancer due to Asbestos
Camargo MC et al, Environ Health Perspect 119 (2011)

8. Meta-analysis Ovarian cancer due to Asbestos
Camargo MC et al, Environ Health Perspect 119 (2011)

9. Minor differences between reviews
IARC included environmental exposures
IARC mentioned one additional case control study
Reid et al (2011)* found lower effect estimate when including Rosenblatt‘s (1992) case control study with 90 % asbestos exposure in cases and controls
Bounin et al (2014)** included more case control studies
Two more papers , one more update
* Reid A et al, Cancer Epidemiol Biomarkers Prev 20 (2011)
**Bounin A et al, Bull Cancer 101 (2014)

10. Möhner M, Nowak D, Meta analysis for German Ministry of Work and Social Affairs (2017)

11. Meta-Analysis Ovarian cancer due to Asbestos
Studies without histological verification:
Pooled effect estimate 1.89 (95 % CI )
Studies with histological verification:
Pooled effect estimate 1.98 (95 CI )

12. Occupational Asbestos Cancer in Germany:
History (3)
„Lung cancer or laryngeal cancer or ovarian cancer - with asbestosis - or with asbestos-induced pleural disease - or with cumulative exposure to 25 fiber-years“
8 yrs gap between IARC and German legislation
Hopefully, we are not too late with compensation
No evidence based screening yet available
One more argument for world-wide ban of asbestos

13. Retrospective cohort study about to start
formerly asbestos-exposed females are listed in a
statutory accident insurance surveillance system
These women are at risk for ovarian cancer
Feasability study was funded with 5 % (800 of )
females
5 (2-11) ovarian cancers expected
Participation rate? X rays / CT scans available?
Histology available?
Starting 10/2017 (Dr. Weinmann, LMU Munich)

14. Thank you