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Commentary on Notification and Recordkeeping of Occupational Mesothelioma in India
1Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA.
Abstract:
In India, some occupational diseases are notifiable under the Mines Act, 1952, and the Factories Act, 1948. Mesothelioma, primarily attributable to asbestos exposure, has been listed specifically as one of the notifiable diseases under the Mines Act, 1952, and is notifiable under the category of occupational cancer in the Factories Act, 1948. The total number of cases of mesothelioma notified to the Directorate General of Mines Safety under the mining safety law was zero from 2004 to 2024. Similarly, under the factory safety law, only one case of occupational cancer was notified in one state, in a country of 28 states and 8 union territories (mesothelioma being listed under occupational cancer and not a separate entry under the factories law). This is in sharp contrast to the medical literature, where a large number of cases have been published by researchers and doctors from Indian hospitals. The absence of notified disease may not automatically mean the absence of disease. Further, a parallel National Cancer Registry Program, which is not only for occupational cancers, but which may overlap with occupational cases, covers only 16% of the country's population. With clear lack of notification of cases and underreporting of occupational mesothelioma, and cancer not being declared as universally notifiable at the national level, disease surveillance in India may need to be invigorated so that easily preventable disease is reduced, load on the already strained healthcare infrastructure is decreased, and overall national medical costs are reduced in the future.
Insights
Occupational mesothelioma, linked to asbestos, is underreported in India. Zero cases were officially notified under mining law and only one under factory law, despite published medical literature indicating a higher incidence. Disease surveillance requires strengthening.
Area of Science:
- Occupational Health
- Public Health Surveillance
- Cancer Epidemiology
Background:
- Mesothelioma is a serious occupational cancer primarily caused by asbestos exposure.
- India has specific laws (Mines Act, 1952; Factories Act, 1948) for notifiable occupational diseases, including mesothelioma.
- Published medical literature indicates a significant burden of mesothelioma in India, contrasting with official notification data.
Purpose of the Study:
- To investigate the discrepancy between reported and actual incidence of occupational mesothelioma in India.
- To evaluate the effectiveness of current disease notification systems for occupational cancers.
- To highlight the need for improved disease surveillance and reporting in India.
Main Methods:
- Analysis of official notification data for mesothelioma and occupational cancer under the Mines Act, 1952, and Factories Act, 1948, from 2004 to 2024.
- Comparison of official data with published medical literature on mesothelioma cases in Indian hospitals.
- Assessment of the coverage and scope of the National Cancer Registry Program in relation to occupational cancers.
Main Results:
- Zero cases of mesothelioma were notified under the Mines Act, 1952, between 2004 and 2024.
- Only one case of occupational cancer (mesothelioma category) was notified under the Factories Act, 1948, across India's states and union territories.
- Existing cancer registries cover only 16% of the population, potentially missing occupational cases.
Conclusions:
- Significant underreporting and lack of notification of occupational mesothelioma exist in India.
- Current disease surveillance systems are inadequate for accurately tracking occupational cancers like mesothelioma.
- Vigorous enhancement of national disease surveillance is crucial to reduce preventable diseases, healthcare burdens, and future medical costs.
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