Asbestos-Related Disease: Difficulties In Diagnosing Occupationally Related Illness

Our plain-English summary of Asbestos-Related Disease: Difficulties In Diagnosing Occupationally Related Illness, by R. Murphy (1980).

The study

• Author: R. Murphy
• Published: Comprehensive Therapy 6(5):6-13, May (1980)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library, J-M no. 000845. The article is still under copyright, so we describe it here rather than post it.

In plain English

This narrative review of asbestos-related disease diagnosis reported no new study data. The author stated that about 10% to 20% of asbestos workers die of lung cancer. Citing McDonald and McDonald, the author reported that among mesothelioma patients in whom asbestos was considered a possible cause, two-thirds had a definite or probable exposure history. Where the exposure history was known and mesothelioma was found at autopsy, the average time since first exposure was over 30 years. The author called the risk from small, urban exposures unknown. The author cited Wallace and Langlands, who found crackling lung sounds (rales) in 18% of exposed and 2% of control subjects. Becklake's review of 375 published cases, most with unequivocal lung changes on X-ray, found airway obstruction in 11%, a restrictive defect in 39%, and both in 18%. Citing Gilson, the author regarded pleural thickening as nonspecific. Pleural plaques or calcification were called better evidence of exposure, but calcification was described as a late finding. The author concluded that combinations of abnormalities were more reliable, and that occupational lung disease is preventable.

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: Narrative review / clinical overview; no original data collected
• Who was studied: No study population of its own; the article discusses published studies of asbestos workers, patients with mesothelioma and asbestosis, and control groups
• Exposure: Asbestos in general. The author names chrysotile, anthophyllite, a third type whose name is damaged in the scan, and amosite as the most common industrial forms, and treats their health effects as similar for practical purposes.
• Main results:
  • The author stated that about 10% to 20% of asbestos workers die of lung cancer.
  • Citing a review by McDonald and McDonald: among mesothelioma patients in whom asbestos was considered a possible cause, two-thirds had a definite or probable history of asbestos exposure.
  • Where the exposure history was known and mesothelioma was found at autopsy, the average time since first exposure was over 30 years.
  • Citing Wallace and Langlands: rales were found in 18% of exposed subjects and 2% of control subjects. Citing Kleinfeld: 14.3% vs. 0%.
  • Citing Becklake's review of 375 published cases, most with unequivocal parenchymal changes on the chest X-ray: airway obstruction was present in 11%, a restrictive defect in 39%, and both problems in 18%.
  • Citing Selikoff: pleural calcification was found in only 1.1% of 727 insulation workers with less than 20 years from onset of exposure. Selikoff also found pleural fibrosis in 65% of persons 40 years after first exposure, and severe pleural thickening in only 2.5% of asbestos workers studied.
  • Citing Gilson: pleural thickening was found on 187 of 3860 routine chest X-rays in Great Britain. Comparing 113 of these subjects with 113 age- and sex-matched controls showed only a slight excess of asbestos exposure histories among the cases.
  • In the author's opinion, combinations of abnormalities (rales, vital capacity, diffusing capacity and chest X-ray) are more reliable than any single test.
• The authors' conclusion: The author concluded that if asbestosis can be diagnosed early, control measures can be instituted, and that occupational lung disease is preventable.
• Limitations the authors state:
  • The author stated that no studies had followed an entire exposed population over working careers with properly matched unexposed comparisons.
  • The author stated that the true risk from exposure to small quantities of asbestos, as in an urban, industrialized population, was unknown.

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Mesothelioma, Exposure History, Autopsy, Pleural Thickening, Pleural Plaques, Occupational Lung Disease.

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