Asbestos-Related Disease: An Epidemiological Review

Our plain-English summary of Asbestos-Related Disease: An Epidemiological Review, by J.C. Mcdonald (1980).

The study

• Author: J.C. Mcdonald
• Published: Biological Effects Of Mineral Fibres (J.C. Wagner, Editor), Lyon: Iarc Scientific Publications, Volume 30, Pp. 587-601 (1980)
• Type of article: Conference paper
• Our copy: from Johns-Manville's own medical library, J-M no. 000835. The article is still under copyright, so we describe it here rather than post it.

In plain English

This article reviewed epidemiological evidence on asbestos-related disease, including papers submitted to the same IARC conference and the author's own Quebec work. For lung cancer, the standardized mortality ratio was 2.47 in Western Australian crocidolite miners and 1.28 in Quebec chrysotile miners. The author noted that this comparison ignored fibre concentrations and work conditions. In two smoking data sets, North American insulation workers fitted a multiplicative model, while Quebec chrysotile miners and millers were more than additive but less than multiplicative. Lung tissue studies found much more amosite in mesothelioma cases than in controls, but no difference in chrysotile. Only 37 of 100 North American matched pairs had results so far, and the UK controls were acknowledged as unsatisfactory. The author concluded that all kinds of asbestos cause lung cancer and that amphiboles appear to carry a higher lung cancer risk than chrysotile, though comparable exposure-response data across fibre types were still lacking. The author also concluded that mesothelioma risk after chrysotile appears small, with most asbestos-related cases probably due to crocidolite or amosite. Links with gastrointestinal and laryngeal cancer were less consistent.

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 epidemiological evidence (other authors' studies, conference papers, and the author's own earlier work)
• Who was studied: Published studies and papers submitted to the IARC conference on asbestos workers and other groups, including Quebec chrysotile miners and millers, Western Australian and South African crocidolite miners, gas-mask workers, insulation workers, naval dockyard workers and textile workers
• Exposure: Chrysotile, crocidolite, amosite and anthophyllite asbestos, alone or in mixtures, in mining, milling and manufacturing; tobacco smoking as a co-factor
• Main results:
  • Lung cancer standardized mortality ratio was 1.28 in Quebec chrysotile miners and 2.47 in Western Australian crocidolite miners
  • In North American insulation workers (Hammond et al., 1979), relative risks fitted a multiplicative model. Compared with 1 for never-smokers never exposed to asbestos, the relative risk was 5.17 for exposed never-smokers, 10.85 for unexposed ever-smokers and 53.24 for exposed ever-smokers
  • In Quebec chrysotile miners and millers, the smoking-asbestos interaction appeared more than additive but less than multiplicative
  • In Australian crocidolite miners (Hobbs et al.), 30 cases of mesothelioma were identified, 17 (3.3%) among 519 ascertained deaths
  • In Nottingham gas-mask workers, 17 of 166 deaths to the end of 1978 were ascribed to mesothelioma
  • In naval dockyard workers (cohort of 6292), there were 1042 deaths: 28 from mesothelioma and 13 from all other asbestos-related diseases. The author suggested that the use of crocidolite in the British Navy could explain this pattern
  • In lung tissue studies from North America (37 case-control pairs so far) and the United Kingdom (108 cases, 56 controls), chrysotile did not differ between mesothelioma cases and controls
  • In the same lung tissue studies, amosite was present in much larger quantities in cases than in controls
  • In a London case-control study of laryngeal cancer (Newhouse et al.), patients smoked more heavily than controls but had not been more frequently exposed to asbestos
  • In Quebec chrysotile miners and millers, cancer at other sites showed 304 deaths observed versus 285.8 expected (SMR 1.06)
• The authors' conclusion: The author concluded that lung cancer is caused by all kinds of asbestos without need for any other factor, and that amphiboles appear to carry a higher lung cancer risk than chrysotile, though there are still no comparable exposure-response data with different fibre types. The author also concluded that mesothelioma risk after chrysotile appears small, with most asbestos-related cases probably due to crocidolite or amosite, and that the association with other cancers is less consistent
• Limitations the authors state:
  • Very few epidemiological surveys had any data on dust or fibre concentrations, so only substantial differences in risk between fibre types have much meaning
  • The Quebec versus Western Australia lung cancer comparison took no account of environmental conditions, fibre concentrations, or type and duration of work
  • The UK lung tissue study's controls were acknowledged as unsatisfactory and possibly not wholly comparable with the cases
  • In the North American lung tissue study, results were so far available for only 37 of 100 matched case-control pairs
  • There are still no comparable data on exposure-response relationships for different fibre types or in various industrial circumstances

Topics

Medical terms in this study, explained in our Lexicon: IARC, Lung Cancer, standardized mortality ratio (SMR), Crocidolite, Quebec Chrysotile, Insulator, Amosite, Mesothelioma.

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