Global Asbestos Congress 2000

Reducing Asbestos-related Lung Cancer on Wirral

Julie Hotchkiss and Chris Harwood

Wirral Health Authority, St Catherine's Hospital, Church Road, Tranmere, Birkenhead, Wirral, CH41 0LQ
Telephone: + 44 151 651 3917
FAX : + 44 151 652 2668 e-mail:
juliehotchkis@mersinet.co.uk

Background

The Wirral peninsula in the North West of England is located just across the river Mersey from the city of Liverpool. It is an area with a few medium sized towns which are heavily industrialised, interspersed with rural and quite affluent residential areas. The population of Wirral (327,000) may be expected to have had a relatively high historic exposure to asbestos, due to its shipbuilding industry. Current data for lung cancer mortality shows that three municipal wards on the Mersey side of the peninsula experience the highest death rates. These are also the most economically deprived wards.

A review of surveillance and intervention studies on respiratory cancers in asbestosexposed workers was published in 1997 (Merler et al). A cross-sectional cohort study in Telemark, Norway, where 21,319 men were followed up over 8 years, found that those asbestos exposed men who abstained from tobacco for greater than 12 years reduced their lung cancer risk by two thirds (Waage et al, 1993). This has encouraged us to attempt to reduce lung cancer in the Wirral, by targeting those most at risk with assistance to quit smoking. A smoking cessation service has just been established, so any people who want support can now access it, either by referral from their doctor, or by ringing up themselves. As a first stage of this prevention programme, we are attempting to quantify the problem, by undertaking a prevalence study in two practice populations (8032 adults).

Objectives:

  1. To establish the prevalence of current smoking and previous asbestos exposure in two practice populations, one in a supposed high-exposure area and one in a low exposure area.
  2. To test the validity of the questionnaire developed.
  3. To assess the impact of the survey and heightened awareness of the issues, on patients and staff at the practices.

Methods

Prevalence study

We are working collaboratively with two general practices, one in a supposed high exposure area (Tranmere) and one in a low exposure area (Heswall). They have adult populations of 4396 and 3636 respectively.

In order to determine prevalence of both smoking and asbestos exposure, we will survey all adults (aged 18 and over) in the two practices. No existing tool was quite fit to purpose, so a new one has had to be devised (Available on request). It has been designed to be as brief and simple to complete as possible, with smoking questions on one side, and occupational history on the reverse. A cover letter from the practices encourages all patients to complete the questionnaire, and offers entry in a free prize draw as an inducement.

A briefing for staff (GPs and practice nurses) has been written to cover medical, legal and benefit support issues of asbestos related disease, with local contacts for further support if necessary (Available on request)

The questionnaires will be being sent out in September 2000.

We are considering conducting about 200 in-depth occupational histories with willing respondents, assessing existing chest X-rays from local hospital or using biochemical markers (none suitable yet identified) to test how well our questionnaire truly assesses exposure to asbestos.
We welcome correspondence from any parties who have relevant experience to share with us.