Asbestos and cancer: the international lag

Our plain-English summary of Asbestos and cancer: the international lag, by P.E. Enterline (The American Review of Respiratory Disease, 1978).

The study

• Author: P.E. Enterline
• Journal: The American Review of Respiratory Disease
• Published: 1978;118(6):975-8
• Type of article: Historical article
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002119).

In plain English

This editorial was a historical review of why acceptance that asbestos causes lung cancer came about 20 years later in the United States than in Germany. It reported no new data. The author traced early autopsy reports, beginning with 2 cases of lung carcinoma among 43 cases of asbestosis reported in England in 1934. German investigators accepted a link early, and in 1950 West Germany classified lung cancer associated with asbestosis as an occupational disease. In the United States, the author wrote, several things prolonged the debate. These were concern about how autopsy cases were selected, a lack of experimental evidence, an unanswered argument about differences in fiber type, and demands for epidemiologic evidence. The first two North American epidemiologic studies, in 1958 and 1960, did not show a significant increase in lung cancer. The author credited the end of the debate to positive U.S. epidemiologic studies in 1963 and 1964, a 1960 study linking asbestos to malignant mesothelioma, and experimental evidence in 1962 and 1964. The author concluded that the matter involved a question of what counts as acceptable and conclusive evidence.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Editorial; a historical review of published reports, with no new data
• Who was studied: Not a study population. The author reviewed published case reports, animal experiments and epidemiologic studies from England, Germany, the United States and elsewhere, from 1934 to a 1964 conference
• Exposure: Asbestos in general. No specific fiber types are named. The author describes an argument that the type of fiber used in England and Germany differed from that used in the United States
• Main results:
  • In 1934 in England, 2 cases of lung carcinoma were reported at autopsy among 43 cases of asbestosis
  • Gloyne was concerned about selection of cases for autopsy. Necropsy records at the London Chest Hospital showed 21.3 per cent primary lung cancer, compared with 2.4 per cent of deaths from malignant disease of the lung in the general population aged 15 and over
  • German investigators quickly accepted Nordmann's view of a cause-effect relationship. In 1950 West Germany classified lung cancer associated with asbestosis (of any degree) as an occupational disease
  • In the United States the question of asbestos and lung cancer was debated for another 20 years. One concern was the lack of experimental evidence: other animal experiments were negative, and only Nordmann and Sorge claimed to have produced cancer with asbestos
  • The author wrote that a 1955 English epidemiologic study showing excess lung cancer in asbestos workers probably set back acceptance in the United States by another decade, because epidemiologists then demanded epidemiologic evidence
  • The first 2 epidemiologic studies of asbestos-exposed workers in North America, in 1958 and 1960, did not show a significant increase in lung cancer
  • According to the author, the U.S. debate probably ended because of 3 things: positive U.S. epidemiologic studies in 1963 and 1964, a 1960 study associating asbestos with malignant mesothelioma, and experimental evidence in 1962 and 1964
  • At a 1964 conference in New York City, none of 20 papers in which an opinion was expressed dissented from the view that asbestos is a cause of cancer
• The authors' conclusion: The author concluded that the matter involved a question of what is acceptable and conclusive evidence. The author suggested that special rules may be needed where another biologic response, such as asbestosis, can serve as evidence of significant exposure

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Lung cancer.

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