A comprehensive multidisciplinary approach for identifying asbestos exposure among underground workers

Our plain-English summary of A comprehensive multidisciplinary approach for identifying asbestos exposure among underground workers, by A. Salvado, L. Capone, P. Zamorano, et al (Revista Brasileira de Medicina Do Trabalho, 2024).

The study

• Authors: A. Salvado, L. Capone, P. Zamorano, M. Samudio, M.T. Garcia-de-Dávila, G. Ernst
• Journal: Revista Brasileira de Medicina Do Trabalho
• Published: 2024;22(4):e20241271
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Inhalation of asbestos fibers can lead to a range of diseases, including asbestosis, pleural plaques, lung cancer, and malignant mesothelioma. Despite regulatory efforts, asbestos-related diseases remain a significant public health issue.

Objectives: This study aimed to assess the characteristics and prevalence of asbestos-related diseases among exposed workers.

Methods: We conducted a descriptive cohort study with underground workers in Buenos Aires, Argentina, from March 2018 to March 2023. A comprehensive screening and surveillance program, including medical examinations, was implemented to identify exposure-related signs and symptoms. Histological sections from paraffin-embedded tissue blocks were analyzed using light and polarization microscopy for lung cancer cases.

Results: A total of 2,690 participants were included, of whom 2.8% (n = 77) had asbestos-related diseases and 0.22% (n = 6) had lung cancer. Occupational exposure exceeding 20 years was significantly associated with an elevated risk of asbestos-related diseases (odd ratio: 3.02; 95%CI 1.7-5.3).

Conclusions: The prevalence of occupational diseases among underground workers was consistent with findings from other surveillance programs for asbestos-exposed workers. Occupational exposure exceeding 20 years emerged as a significant risk factor, markedly increasing the likelihood of asbestos-related diseases.

In plain English

This descriptive cohort study followed underground workers in Buenos Aires, Argentina, enrolled in an asbestos surveillance program, from March 2018 to March 2023. The article does not say which asbestos fiber types these workers were exposed to. Screening included a questionnaire, examination, chest X-rays, spirometry and, when needed, CT scans. Of 2,709 workers, 19 were excluded, leaving 2,690. Of these, 2.8% (77) were diagnosed with an occupational disease, including six cancers (0.22%), all in men. Diagnoses for the other 71 were not broken down. The six were four adenocarcinomas, one squamous cell carcinoma and one malignant epithelioid mesothelioma; five of the six patients were current or former smokers. In the multivariate analysis, working more than 20 years was associated with occupational disease (odds ratio 3.02, 95% CI 1.72 to 5.31). The more-than-10-years result (1.28, 0.58 to 2.83) was not statistically significant. The authors left smoking out of the multivariate analysis because its recording may have been biased, although their methods section says it was included. The authors wrote that their findings emphasize the need for regular follow-up of exposed workers.

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: Descriptive cohort study based on a workplace surveillance program; the authors also refer to its retrospective nature
• Who was studied: Underground employees in the city of Buenos Aires, Argentina, followed March 2018 to March 2023 and grouped as drivers, workshop workers or other employees. 2,709 were initially included and 19 were excluded for loss to follow-up, leaving 2,690. 90.1% were male (n = 2,440) and 9.9% female (n = 250). Mean age was 48.1 years.
• Exposure: Workplace asbestos exposure among workers listed in the Risk Agents Register, analyzed by years worked (under 10, 10 to 20, over 20 years). The background names serpentine, amphibole and chrysotile asbestos, but the article does not say which fiber types or products these workers were exposed to.
• Main results:
  • Of 2,690 workers, 2.8% (n = 77) were diagnosed with an occupational disease, including six cases of cancer (0.22%). Of the 77, 73 were men and 4 were women.
  • Working over 20 years: 63.6% (49 of 77) of workers with occupational disease, compared with 35.9% (940) of workers without it.
  • Smoking habits did not differ significantly between workers with and without occupational disease. Current smokers were 35.0% (27) versus 23.5% (614), p 0.4. Ex-smokers were 29.8% (23) versus 22.4% (585), p 0.1.
  • Six male patients developed malignant neoplasms. Four had been exposed for more than 20 years and one for less than 10 years. Five were current or former smokers.
  • Table 2 lists the six diagnoses as four adenocarcinomas, one squamous cell carcinoma, and one malignant epithelioid mesothelioma. The mesothelioma was in a 55-year-old who never smoked, with 7 years of exposure.
  • Iron staining (Perls' technique) of tissue from the cancer cases did not show the typical drumstick-shaped iron bodies. Iron deposits and anthracotic (carbon) pigment were found.
  • Multivariate analysis results: working more than 20 years, odds ratio 3.02 (95% CI 1.72 to 5.31). Working more than 10 years, odds ratio 1.28 (95% CI 0.58 to 2.83 in Table 3; 0.5832 to 2.83 in the text).
  • Increasing age was associated with a slightly higher risk of occupational disease (odds ratio 1.04, 95% CI 1.02 to 1.05). The authors hypothesized this may reflect years of exposure.
• The authors' conclusion: The authors stated that their findings emphasize the need for regular, structured follow-up for all workers with direct or indirect asbestos exposure, along with smoking cessation counseling and a multidisciplinary approach.
• Limitations the authors state:
  • Because the study was retrospective, smoking history may have been documented with bias. For that reason smoking was not included in the multivariate analysis.

Topics

Medical terms in this study, explained in our Lexicon: Multidisciplinary Team, Asbestos Exposure, Pleural Plaques, Lung Cancer, Malignant Mesothelioma, Cohort Study, Paraffin Block, Occupational Exposure.

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