Major sources of environmental asbestos exposure are asbestos mines, asbestos textile factories, and the shipbuilding industry. The majority of asbestos mines were concentrated in Chungnam, and most asbestos textile factories were concentrated in Busan. Also, shipbuilding and repair industries are mainly located in Ulsan, Busan, and Gyeongnam . These environmental exposure sources are major target areas for EHCAs’ HISs. PNUYH EHCA is in charge of the southern and eastern halves of Korea, whereas SCHUCH manages the northern and western halves of Korea. Hence, PNUYH concentrates on asbestos textile factories and shipbuilding companies, while SCHUCH focuses on asbestos mines and factories around the area of the capital. For SCHUCH, the main focus is Gwangcheon mine and Hongseong mine. PNUYH focuses on Jeil Chemical, which is an asbestos textile factory with many occupational victims located in residential areas in Busan . As the main environmental asbestos sources for the patients of the two EHCAs differ, this means that their HIS results differ. Because of the long latency of ARDs it is difficult for people to realize that their diseases are consequences of previous asbestos exposure. As asbestos mines were located in rural areas with fixed residents, gathering and finding victims of mines could be relatively easier than in urban areas. As Korea experienced rapid economic growth, the urban population changed residential areas more frequently than residents of rural areas. This might explain the large differences between participants of HISs in the two EHCAs.
Based on the fact that the major ARDs worldwide are mesothelioma, lung cancer, and asbestosis , the afflictions of AVMP holders differ. Whereas asbestosis is predominant in AVMP holders, lung cancer is very rare. The rarity of lung cancer as an ARD might be explained by the strict criteria in place for recognizing lung cancer as an environmental as well as an occupational ARD . On the basis of the current AIRA, an asbestosis or a pleural abnormality is essential for lung cancer to be recognized . Although quantitative and qualitative exposure assessment and estimation should be a major means of recognizing environmental ARDs, it is a minimum requirement for relief. Exposure information is not a criterion for deciding whether lung cancer or asbestosis is related to environmental exposure. Hence, quantification of asbestos exposure without additional radiological findings only requires a single condition for lung cancer to be recognized.
As the number of asbestos victims recognized through HISs is small, the efficiency of HISs appears low. The HIS is based on voluntary participation. Considering persons with severe ARDs may have died or were unable to travel to the examination location, this voluntary HIS has limitations. There are high-risk groups or a vulnerable population who have experienced high exposure. Asbestos exposure during young age may have a higher potential to cause ARDs in the future . The implementation of active surveillance that focuses on high-risk groups has been blocked by the personal information protection act. This barrier needs to be removed by clarifying the necessity for providing relief for asbestos victims through AIRA.