How great is the health risk posed by asbestos exposure? A public debate was reignited by a recent fire starting on the 26th floor of the Marco Polo high-rise condominiums. The Honolulu Fire Department fought the seven-alarm fire for more than four hours. Given that the building was constructed in the mid-1970s, there was concern regarding asbestos exposure from the fire for residents, firefighters, their families and bystanders.

Allegedly, before leaving the scene, the protective equipment worn by the firefighters was not decontaminated or bagged, and they rode back to the stations in full gear. The Hawaii Fire Fighters Association is concerned by the lack of decontamination procedures and the potential for asbestos fibers being spread to the stations, cars and homes of firefighters. A month after the fire, it was announced that HFD was removing contaminated gear from service.

Dr. Michele Carbone of the University of Hawaii Cancer Center, an acclaimed expert in the field, wrote a letter to the editor of the Honolulu Star-Advertiser on Aug. 16 arguing that the risks posed by this level of exposure are minimal. However, HFFA has received reports that when firefighters raise concerns to their superiors, Carbone’s letter is being cited in response. HFFA is concerned that this letter underestimates potential hazards related to asbestos exposure.

I recall my own concerns regarding asbestos exposure during the late ’70s and early ’80s as I worked my way through the building trades, eventually becoming a licensed general contractor before studying medicine. During several large demolition jobs, I questioned whether proper precautions had been neglected. Later, during medical school and while earning a master’s degree in public health with a focus on occupational and environmental health, I took a particular interest in the risks associated with asbestos exposure.

Carbone correctly points out in his editorial that the chances of developing mesothelioma, a rare form of lung cancer uniquely associated with asbestos, are quite small, especially from a single exposure. However, asbestos exposure is also associated with an increased frequency of other, more common forms of lung cancer such as bronchogenic carcinoma, as well as a noncancerous lung condition called asbestosis. There are a host of additional factors that affect the risk of asbestos-related diseases including the specific type of asbestos fibers, human genetics and cigarette smoking. To be sure, higher intensity and repeated exposure increase risks.

As such, there is no replacement for following medical recommendations and regulatory requirements for asbestos detection and abatement. Having said that, safety is also an “industry,” meaning there is always an opportunity for profit. A popcorn ceiling built in the ’70s may just be torn out and replaced at one price. It also first may be checked for asbestos; if found to be positive, a “certified team” must come out that follows abatement protocol with protective gear. It’s not cheap.

I recall in 2001 when my family moved from a house we had been renting into a home we purchased. Both structures had identical popcorn ceilings and were built in 1970. We tested the one we had been renting, and it was negative. We then asked the seller to test his ceiling. He called back in a lather saying that we could test it, knowing we would not buy it otherwise. He also made us sign a document making us promise not to tell him the result. He should have been ashamed or worse. He wasn’t. It was about money.

Carbone was right to point out the very low risk of mesothelioma. Still, we have to remember that if our chances are 1 in 100,000 that we will have an adverse health event, if it happens to us, it happens 100 percent to us. Mesothelioma is a very serious cancer. The HFFA is also right in asking questions and expressing its concerns to ensure that proper protocols are followed and that the men and women who risk their lives every day to ensure the safety of the people of Hawaii are appropriately protected.

Ira “Kawika” Zunin, M.D., M.P.H., M.B.A., is a practicing physician. He is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. His column appears the first Saturday of every month. Please submit your questions to info@manakaiomalama.com.