Commentary The Case for a Global Ban on Asbestos Joseph LaDou,1 Barry Castleman,2 Arthur Frank,3 Michael Gochfeld,4 Morris Greenberg,5 James Huff,6 Tushar Kant Joshi,7 Philip J. Landrigan,8 Richard Lemen,9 Jonny Myers,10 Morando Soffritti,11 Colin L. Soskolne,12 Ken Takahashi,13 Daniel Teitelbaum,14 Benedetto Terracini,15 and Andrew Watterson16 1Division of Occupational and Environmental Medicine, University of California–San Francisco, San Francisco, California, USA; 2Environmental Consultant, Garrett Park, Maryland, USA; 3Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA; 4Department of Environmental and Occupational Medicine, Robert Wood Johnson Medical School, Piscataway/New Brunswick, New Jersey, USA; 5Former HM Inspector of Factories, London, United Kingdom; 6Chemical Carcinogenesis, Office of the Director, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA; 7Center for Occupational and Environmental Health, New Delhi, India; 8Global Health Program, Mount Sinai School of Medicine, New York, New York, USA; 9National Institute for Occupational Safety and Health (retired), Canton, Georgia, USA; 10Center for Occupational and Environmental Health Research, University of Cape Town, Cape Town, South Africa; 11European Foundation for Oncology and Environmental Sciences, Bologna, Italy; 12School of Public Health, University of Alberta, Edmonton, Alberta, Canada; 13Department of Epidemiology, University of Occupational and Environmental Health, Kitakyushu, Japan; 14School of Public Health, University of Colorado, Denver, Colorado, USA; 15Center for Cancer Prevention, University of Torino, Torino, Italy; 16Occupational and Environmental Health Research Group, University of Stirling, Stirling, Scotland Background : All forms of asbestos are now banned in 52 countries. Safer products have replaced many materials that once were made with it. Nonetheless, many countries still use, import, and export asbestos and asbestos-containing products, and in those that have banned other forms of asbestos, the so-called “controlled use” of chrysotile asbestos is often exempted from the ban. In fact, chrysotile has accounted for > 95% of all the asbestos used globally. o Bjectiv : We examined and evaluated the literature used to support the exemption of chrysotile asbestos from the ban and how its exemption reflects the political and economic influence of the asbestos mining and manufacturing industry. d iscuon : All forms of asbestos, including chrysotile, are proven human carcinogens. All forms cause malignant mesothelioma and lung and laryngeal cancers, and may cause ovarian, gastro- intestinal, and other cancers. No exposure to asbestos is without risk. Illnesses and deaths from asbestos exposure are entirely preventable. c onclusi : All countries of the world have an obligation to their citizens to join in the inter- national endeavor to ban the mining, manufacture, and use of all forms of asbestos. An inter- national ban is urgently needed. hTere is no medical or scientific basis to exempt chrysotile from the worldwide ban of asbestos. k ey words : asbestos, asbestos cancer pandemic, asbestos-related diseases, ban, cancer, chrysotile, controlled use, disinformation, mesothelioma, product defense. Environ Health Perspect 118:897–901 (2010). doi:10.1289/ehp.1002285 [Online 1 July 2010] The Collegium Ramazzini first called for a universal ban on the mining, manufacture, and use of asbestos more than a decade ago (Collegium Ramazzini 1999). All forms of asbestos are now banned in 52 countries, and safer products have replaced many materials that once were made with it. Nonetheless, a large number of countries still use, import, and export asbestos and asbestos-containing products. In many countries that have banned other forms of asbestos, the so-called controlled use of chrysotile asbestos is exempted from the ban, an exemption that reflects the political and economic influence of the asbestos mining and manufacturing industry lobbies. All forms of asbestos cause asbestosis, a progressive, debilitating fibrotic disease of the lungs. All forms of asbestos also cause malignant mesothelioma and lung and laryn- geal cancers, and may cause ovarian, gastro- intestinal, and other cancers (Straif et al. 2009). More than 20 years ago, asbestos was declared a proven human carcinogen by the U.S. Environmental Protection Agency (U.S. EPA 1986), the International Agency for Research on Cancer (1977) of the World Health Organization (WHO), and the U.S. National Toxicology Program (NTP 1980). The scientific community is in overwhelming agreement that there is no safe level of expo- sure to asbestos (Welch 2007; Welch et al. 2009). Moreover, there is no evidence of a threshold level below which there is no risk of mesothelioma (Hillerdal 1999). The Asbestos Cancer Pandemic Occupational exposures to asbestos. About 125 million people around the world are exposed to asbestos in their work environments (WHO 2006), and many millions more work- ers have been exposed to asbestos in years past. As noted by Stayner et al. (1997), the U.S. National Institute for Occupational Safety and Health (NIOSH) has estimated that cur- rent occupational exposures to asbestos, even at the U.S. Occupational Safety and Health Administration (OSHA) permissible exposure limit, will cause five deaths from lung cancer and two deaths from asbestosis in every 1,000 workers exposed for a working lifetime. In 2000, an estimated 43,000 deaths world- wide resulted from malignant mesothelioma, Environmental Health Perspectives • volume 118 | number 7 | July 2010 and a much larger number of lung cancer deaths were due to occupational exposures to asbestos (Driscoll et al. 2005). Population-attributable risk for lung cancer among males exposed to asbestos ranges between 10% and 20% (Albin et al. 1999). An estimated 20,000 asbestos- related lung cancers and 10,000 cases of mesothelioma occur annually across the popu- lation of Western Europe, Scandinavia, North America, Japan, and Australia (Tossavainen 2000). The national incidence rates for meso- thelioma in Australia are the highest in the world (Leigh and Driscoll 2003). In the United Kingdom, at least 3,500 people die from asbestos-related illnesses each year, and this number is expected to increase to 5,000 in future years. Asbestos accounts for more than half of the work-related cancer deaths in Great Britain (Rushton et al. 2008). The British mesothelioma death rate is now the highest in the world, with 1,749 deaths in men (1 in 40 of all cancer deaths in men < 80 years of age) and 288 in women in 2005 (Rake et al. 2009). The projected lifetime risk of fatal mesothelioma in all British men born in the 1940s is 0.59%, or about 1 in 170 of all deaths. By 2050, there will have been approxi- mately 90,000 deaths from mesothelioma in Address correspondence to J. LaDou, Division of Occupational and Environmental Medicine, University of California School of Medicine, San Francisco, CA 94143-0924 USA. Telephone: (415) 476-4951. Fax: (415) 476-6426. E-mail: joeladou@aol.com The Collegium Ramazzini is an international aca- demic society that examines and evaluates critical public health issues in occupational and environ- mental health. The Collegium derives its name from Bernardino Ramazzini, the father of occupational medicine, a professor of medicine of the universities of Modena and Padua in the early 1700s. One hun- dred eighty clinicians and scientists from around the world are elected to membership. The Collegium is independent of commercial interests. B.C., A.F., R.L., and D.T. have served as expert witnesses in asbestos-related litigation cases. The remaining authors declare they have no actual or potential competing financial interests. Received 12 April 2010; accepted 8 June 2010. 897