Projections of asbestos-related disease 1980-2009

Our plain-English summary of Projections of asbestos-related disease 1980-2009, by A.M. Walker, J.E. Loughlin, E.R. Friedlander, et al (Journal of Occupational Medicine., 1983).

The study

• Authors: A.M. Walker, J.E. Loughlin, E.R. Friedlander, K.J. Rothman, N.A. Dreyer
• Journal: Journal of Occupational Medicine.
• Published: 1983;25(5):409-25
• Cited by: 106 articles, as counted by NIH iCite
• Read it: PubMed
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000650).

Abstract

Approximately 19,000 cases of mesothelioma and 55,000 cases of lung cancer will arise in U.S. men with histories of nontrivial occupational exposure to asbestos. There are approximately 65,000 U.S. men now alive with clinically diagnosable asbestosis. These estimates are based, in the case of the cancer, on estimates of the effective number of asbestos-exposed workers required to produce the current national incidence of mesothelioma. The asbestosis estimates are based on a number of rough measures relating the prevalence of asbestosis to the incidence of mesothelioma, the incidence of compensable asbestosis in other countries, the prevalence of and mortality from pneumoconioses generally, and the number of workers heavily exposed to asbestos.

In plain English

This report, submitted to attorneys for the Manville Corporation, projected new mesothelioma and lung cancer cases for 1980 to 2009 in U.S. men with nontrivial occupational asbestos exposure, and how many such men would live with diagnosable asbestosis. It counted all disease in exposed men, not only asbestos-caused disease. From regional cancer surveillance data, they estimated about 974 mesothelioma cases in U.S. men in 1977. Their best estimate was that 54% of U.S. male mesothelioma cases had a definite or probable asbestos exposure history. Working backward to the size of the exposed workforce and then forward, they projected about 19,000 mesothelioma and 55,000 lung cancer cases. They estimated about 65,000 men alive in the early 1980s with clinically diagnosable asbestosis. Counting minimal X-ray changes would roughly triple that figure. They projected about 45,000 lawsuits from 1982 on, between a lower bound of 30,000 and an indefinite upper bound near 120,000. They noted the asbestosis estimates rested on very little directly relevant data. They said uncertainties in several inputs could shift absolute mesothelioma numbers by as much as 30% either way.

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: Projection (mathematical modeling) report estimating future asbestos-related disease, submitted to attorneys for the Manville Corporation
• Who was studied: U.S. men with nontrivial occupational exposure to asbestos; projections for 1980-2009 counting all disease in exposed persons, not only asbestos-attributable disease
• Exposure: Nontrivial occupational exposure to asbestos (no single fiber type analyzed), modeled in terms of 'insulation-worker equivalents' and split into heavy and light exposure
• Main results:
  • Best estimate of about 974 mesothelioma cases in U.S. men in 1977, after adjusting regional SEER surveillance data for time trend, nonrepresentativeness and underdiagnosis
  • Best estimate, from averaging classifications by several research centers, that 54% of U.S. male mesothelioma cases had a definite or probable history of asbestos exposure
  • Projected about 19,000 new mesothelioma cases in exposed U.S. men
  • Projected about 55,000 new lung cancer cases in exposed U.S. men
  • About 55,000 men living with diagnosable asbestosis in the late 1970s (first estimation method; a prevalence figure, not new cases)
  • About 65,000 U.S. men alive with clinically diagnosable asbestosis at the time of the report (Table 16 gives 65,800 for 1980-1984), assuming new asbestosis occurred only through 1984
  • Central projection of about 45,000 lawsuits from all diseases from 1982 on
• The authors' conclusion: The authors concluded that a reasonable central projection of lawsuits from all diseases from 1982 on is about 45,000, with a reasonably firm lower bound of 30,000 and a very indefinite upper bound on the order of 120,000
• Limitations the authors state:
  • The asbestosis projections depend on a scientific judgment made with very little directly relevant data
  • The net effect of uncertainties in several inputs (trend, registry representativeness, underdiagnosis, fraction exposed) on absolute mesothelioma incidence may be as much as 30% either way; the authors say this has no final effect on lawsuit projections
  • The asbestosis estimates would have to be roughly tripled if minimal (grade 1) X-ray asbestosis were included
  • Data on women were too scanty for direct estimation of disease in women
  • There is no a priori reason to expect the assumed decline in lung cancer risk multipliers, and modeling of other, smaller data sets does not suggest one

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Lung Cancer, Occupational Exposure.

Related studies

• Projection of asbestos related diseases in the United States, 1985-2009. I. Cancer — D.E. Lilienfeld, J.S. Mandel, et al. (1988)
• Asbestos-related disease among sheet-metal workers. Preliminary results of the National Sheet Metal Worker Asbestos Disease Screening Program — L.S. Welch, D. Michaels, et al. (1991)
• Critical review of epidemiologic studies related to ingested asbestos — G.M. Marsh (1983)
• Asbestos and other fiber-related diseases of the lungs and pleura. Distribution and determinants in exposed populations — M.R. Becklake (1991)
• Asbestos-related disease — A.B. Morrison (1979)
• Comparison of the ultra-low-dose Veo algorithm with the gold standard filtered back projection for detecting pulmonary asbestos-related conditions: a clinical observational study — M. Tekath, F. Dutheil, et al. (2014)

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