Symposium Awkward medicolegal problems in asbestos-induced disease

Our plain-English summary of Symposium Awkward medicolegal problems in asbestos-induced disease, by P.C. Elmes (1978).

The study

• Author: P.C. Elmes
• Published: Journal of the Royal Society of Medicine, Volume 71. December 1978
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library. The article is still under copyright, so we describe it here rather than post it.

In plain English

This short paper was one of several read at a 1977 meeting of the Section of Occupational Medicine. It reported no new study data. The author grouped asbestos-exposed people by exposure level and discussed each group's medicolegal questions. For workers with asbestosis after controlled (moderate) exposure, the author stated that a non-smoker's lung cancer risk was raised about four-fold above that of non-smokers in the general population, so four cases out of five could be attributed to occupation. A heavy smoker had a ten- to twenty-fold increased risk compared with members of the public with the same smoking habit. The author wrote that mesothelioma risk ranged from very high in insulation workers to very low in factory workers with exclusively chrysotile exposure. Because mesothelioma without a known cause is so rare, the author considered all cases with a history of occupational exposure attributable to that exposure. Smoking was called unimportant for mesothelioma. Past short periods of exposure were described as always relevant for mesothelioma. Discussing low continuous or occasional high exposure, the author wrote that mesothelioma presented the main medicolegal problem in the individual case.

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: Expert opinion paper presented at a symposium (narrative discussion with a short bibliography; no original study data)
• Who was studied: No study population. The author discussed asbestos-exposed workers in general, grouped as high-level exposure, controlled (moderate) exposure, and low continuous or occasional high exposure, with reference to industry in Britain.
• Exposure: Asbestos exposure at different levels: very dusty factory conditions before the 1933 regulations, relatively high levels in places such as shipyards, controlled factory levels falling after about 1960 to the then-current standard of 2 fibres per cc, and low continuous or occasional high exposure. Fiber types mentioned were chrysotile and mixed exposure. Insulation workers and factory workers were named.
• Main results:
  • The author stated that for a non-smoker with asbestosis in the moderately exposed group, lung cancer risk was raised about four-fold above that of non-smokers in the general population. Legally this meant four cases out of five were attributable to occupation (80% of full compensation).
  • The author stated that a heavy smoker in the same group had a ten- to twenty-fold increased risk compared with members of the general public with the same smoking habit. Legally this corresponded to 90 to 95% of full compensation.
  • For a worker diagnosed with asbestosis at age 50 or 55, the author stated that a heavy smoker's lung cancer risk was between 70 and a figure the scanned text prints as '1007', apparently 100% with the per-cent sign misread. In that instance, all lung cancers could be considered occupational.
  • The author stated that mesothelioma risk in the moderately exposed group ranged from very high in insulation workers to very low in factory workers with exclusively chrysotile exposure. In insulation workers it reached 50% of the lung cancer rate in the same group.
  • Because mesothelioma without a known cause is so rare, the author considered all cases with a history of occupational exposure attributable to it. The scanned text prints the degree as '1007,', apparently 100% with the per-cent sign misread. Exposure was usually not enough to cause asbestosis in pleural cases, but usually was enough in peritoneal mesothelioma.
  • The author stated that smoking is unimportant for mesothelioma.
  • The author's working rule was to regard the last 10 years of exposure as irrelevant for lung cancer and mesothelioma. Past short periods of exposure were always relevant for mesothelioma.
  • In the low exposure group, the author considered lung cancer probably not a significant risk. The author added that attributability would be difficult to deny if a pathologist found numerous asbestos bodies or fibres and interstitial fibrosis.
• The authors' conclusion: In the section on low continuous or occasional high exposure, the author concluded that mesothelioma presented the main medicolegal problem in the individual case. The reasons given were that it often arises without asbestosis or pleural plaques, and the exposure may be long forgotten. The author considered identifying sources of exposure leading to mesothelioma urgent, both for individual cases and to prevent future cases.

Topics

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

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