Asbestos fibre dust and gastro-intestinal malignancies. Review of literature with regard to a cause/effect relationship

Our plain-English summary of Asbestos fibre dust and gastro-intestinal malignancies. Review of literature with regard to a cause/effect relationship, by A.B. Miller (Journal of Chronic Diseases, 1978).

The study

• Author: A.B. Miller
• Journal: Journal of Chronic Diseases
• Published: 1978;31(1):23-33
• Type of article: Review
• Cited by: 60 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. 001091).

In plain English

This was a single-author literature review based on a report prepared for the Workman's Compensation Board of Ontario. It covered only population-based epidemiological or statistical studies of asbestos fibre dust and later gastro-intestinal cancers. The studies covered Quebec chrysotile miners and millers, amosite factory workers, Finnish anthophyllite miners, textile workers and insulation workers. Some studies, including the Finnish one, showed no excess; the author suggested these may have been too small or followed too briefly. In studies by Selikoff and colleagues, 632 insulation workers had 18 stomach cancers against 5.1 expected. Among 17,800 insulation workers, gastro-intestinal cancers excluding peritoneal mesotheliomas, up to the end of 1972, numbered 56 against 33.2 expected in the period 20 years or more from onset of exposure. The author called the association weak, with observed-to-expected ratios rarely above three. The author concluded that, absent an explanation to the contrary, the exposure must be regarded as causal. In the author's view, there is a latent period, and the increased risk of gastro-intestinal cancer in asbestos workers 20 years or more after first exposure approximates 3-fold.

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: Review of published literature (population-based epidemiological and statistical studies), based on a report prepared for the Workman's Compensation Board of Ontario, assessed using Bradford Hill's criteria for causation
• Who was studied: Published population-based epidemiological or statistical studies of asbestos-exposed workers. They included Belfast insulation workers, an English asbestos textile factory, Quebec chrysotile miners and millers, Finnish anthophyllite miners, amosite factory workers, and US and Canadian insulation workers.
• Exposure: Asbestos fibre dust. The reviewed studies involved chrysotile (Quebec mines and mills), amosite (a single factory), anthophyllite (Finnish mines), textile factory work, and insulation work.
• Main results:
  • Reported from Selikoff and colleagues, cohort of 632 insulation workers: 18 stomach cancers observed against 5.1 expected, and 22 colon and rectum cancers against 7.5 expected
  • Reported from Selikoff and colleagues, cohort of 933 amosite factory workers: 10 stomach cancers observed against 4.89 expected, and 16 colon and rectum cancers against 7.65 expected
  • Reported from Selikoff and colleagues, cohort of 17,800 insulation workers with results up to the end of 1972, all gastro-intestinal cancers excluding peritoneal mesotheliomas considered together. In the observation period less than 20 years from onset of exposure, 5 were observed against 4.6 expected. In the period 20 years or more from onset of exposure, 56 were observed against 33.2 expected.
  • Reported from McDonald and colleagues, Quebec chrysotile mines and mills: intestinal or rectal cancer mortality rose with the dust index, with a ratio of 3.5 between the highest and lowest categories
  • Reported from the Finnish anthophyllite mine study: 7 digestive organ cancers in the asbestos workers and 9 in the control cohort, against 14.9 expected from national rates. The author regarded this as a negative study but suggested that follow-up may have been too short and that the expected numbers may have been overestimated.
  • The author judged the association across studies to be weak, with observed-to-expected ratios rarely above three and often around two
• The authors' conclusion: The author concluded that exposure to asbestos is associated with gastro-intestinal malignancies and, in the absence of an explanation to the contrary, must be regarded as causal. In the author's view there is a latent period, all sites of the gastro-intestinal tract appear to be affected, and the increased risk of gastro-intestinal cancer in asbestos workers 20 years or more after first exposure approximates 3-fold.
• Limitations the authors state:
  • In studies that did not specify diagnosis by site, a substantial proportion of the reported cases may have been peritoneal mesotheliomas
  • Much of the literature consists of repeated reports describing the same series of individuals
  • The literature lacks data on the exact anatomical sites of the cancers
  • In the Selikoff cohorts, expected numbers came from national rates and no outside control group was used
  • Few studies allowed a dose-response relationship to be assessed

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