Asbestosis And Abdominal Neoplasms

Our plain-English summary of Asbestosis And Abdominal Neoplasms, by E.E. Keal (1960).

The study

• Author: E.E. Keal
• Published: Lancet 2:1210-1216, December 3 (1960)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library, J-M no. 001599. The article is still under copyright, so we describe it here rather than post it.

In plain English

This 1960 report by E. E. Keal searched the records of The London Hospital for patients admitted with asbestosis and described 23 women and 19 men. The patients had worked in asbestos jobs such as spinning, weaving, grinding and factory work. The article does not name fiber types. Of 15 deaths among the women, 9 were associated with ovarian or peritoneal cancer, an incidence of 60%. Only 1 of these women had a definite ovarian tumour without peritoneal involvement. In the others there was diffuse peritoneal growth. One man (case 24) showed a similar picture of diffuse peritoneal cancer. Lung cancer was found in 10 of 15 deaths among the men (67%). The author largely explained this by selection, because 6 of those 10 men had been referred with a diagnosis of lung cancer. Four women died with lung cancer (26% of the women's deaths), and all 4 were nonsmokers. The author concluded that the link with peritoneal cancer appeared to be more than chance, but that no single satisfactory explanation could be drawn. The author also said the series was too small for statistical analysis.

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: Retrospective case series drawn from hospital records, with individual case descriptions
• Who was studied: Patients with asbestosis found in the records of The London Hospital, London: 23 women and 19 men. Asbestosis patients seen only as outpatients were not included.
• Exposure: Occupational asbestos exposure in jobs such as asbestos spinning, weaving, grinding, carding, mattress and slab-making departments, lagging and other factory work. Durations ranged from about one month to many years. No fiber types are named.
• Main results:
  • Among the women, 9 of 15 deaths were associated with ovarian or peritoneal cancer, an incidence of 60%.
  • Of the 9 women with ovarian or peritoneal cancer, only 1 (case 1) had a definite ovarian tumour without peritoneal involvement. In every other case there was diffuse peritoneal growth.
  • One man (case 24) had a similar picture of diffuse peritoneal cancer.
  • Among the men, lung cancer was found in 67% of deaths (10 of 15). The author attributed this largely to selection, because 6 of the 10 men were referred directly to thoracic units with a diagnosis of lung cancer.
  • Among the women, lung cancer accounted for 26% of deaths associated with asbestosis (4 women). All 4 were nonsmokers.
  • For the 4 women with lung cancer, the average duration of exposure was only about nine and three-quarters years. The average time from first exposure to death was twenty-five years.
• The authors' conclusion: The author concluded that the association of ovarian or peritoneal cancer with asbestosis appeared to be more than a chance association, and that spread from undiagnosed lung cancer seemed unlikely. The author added that no single satisfactory explanation for these cases could be drawn from the available material.
• Limitations the authors state:
  • The series was too small for statistical analysis.
  • Many asbestosis patients were seen only as outpatients and were not in the diagnostic index, so their total number is not known.
  • The peritoneal cancers might be secondary spread from undetected lung (bronchial) cancers. In cases 9 and 24 a missed bronchial primary was harder to rule out.
  • Doubt was cast on the ovarian diagnosis, because in 3 cases where the ovaries were identified they did not appear to be the primary site.

Topics

Medical terms in this study, explained in our Lexicon: Neoplasm, Lung Cancer.

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