A history of awareness of asbestos disease and the control of occupational asbestos exposures in The Netherlands

Our plain-English summary of A history of awareness of asbestos disease and the control of occupational asbestos exposures in The Netherlands, by L. Burdorf, P.H. Swuste, D. Heederik (American Journal of Industrial Medicine, 1991).

The study

• Authors: L. Burdorf, P.H. Swuste, D. Heederik
• Journal: American Journal of Industrial Medicine
• Published: 1991;20(4):547-55
• Type of article: Historical article
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 004854).

Summary of the article

This historical article traced how awareness of asbestos-related disease developed in the Netherlands, how it was reflected in occupational disease registration, and how it shaped Dutch regulation of occupational asbestos exposure. The authors compared the first suggestion and first case description of each disease in the international and Dutch literature, and reviewed national registers and legislation. Asbestosis was first mentioned in Dutch literature in 1930, and the Labour Inspectorate described the first Dutch case in 1931. The first Dutch case of asbestos-associated lung cancer was reported in 1956, and mesothelioma was linked to asbestos in 1958. Consensus on mesothelioma followed the 1968 Dresden conference and a 1969 study in which 22 of 25 mesothelioma patients on Walcheren had worked at the same shipyard. Of 324 asbestosis cases registered in 1931-1988, 79% came from Labour Inspectorate investigations. Only 17 mesotheliomas were reported to the Occupational Disease Register between 1965 and 1988, which the authors judged a gross underestimate compared with death certificate data. Regulation progressed from a non-enforced 1971 guidance note, to 1978 regulations banning crocidolite and asbestos spraying with a 2 fibers/ml standard, to 1988 regulations and a proposed total ban from 1991. The authors concluded that the national register played no role in the debate, that mesothelioma was recognized rapidly owing to the academic interest of Dutch pathologists and clinicians, and that public opinion helped bring about the 1978 regulations.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was a historical review of how awareness of asbestos disease grew in the Netherlands, how such diseases were registered, and how Dutch workplace asbestos rules developed. Drawing on Dutch medical literature and official reports, the authors noted that the first diagnosed Dutch asbestosis case was published in 1931 and the first Dutch case of lung cancer with asbestosis in 1956. The national Occupational Disease Register recorded 324 asbestosis cases from 1931 to 1988, 79% contributed by the Labour Inspectorate, and only 17 mesothelioma cases from 1965 to 1988. Comparing the register with death certificates for malignant neoplasm of the pleura, the authors stated that the register grossly underestimated true pleural mesothelioma mortality. Rules moved from a non-binding 1971 guidance note to 1978 regulations banning crocidolite and asbestos spraying with a standard of 2 fibers/ml, then 1988 regulations, and a proposed complete ban. The authors concluded that the register played no role in the Dutch discussion of asbestos health effects, and they raised serious doubts about the validity of its asbestosis figures.

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: Historical review of Dutch medical literature, official occupational disease and death registers, and legislation
• Who was studied: The Netherlands: Dutch scientific publications, cases reported to the Occupational Disease Register of the Labour Inspectorate from 1931 to 1988, and National Death Register deaths from 1969 to 1987
• Exposure: Occupational asbestos exposure in the Netherlands, mainly sprayed asbestos in shipbuilding and asbestos cement products; regulations also concerned crocidolite (blue asbestos) and chrysotile
• Main results:
  • The first diagnosed case of asbestosis in the Netherlands was described by the Labour Inspectorate's Medical Advisor in 1931; the first Dutch case of asbestosis together with lung cancer was reported in 1956
  • The first Dutch case of mesothelioma without asbestosis was described in the Labour Inspectorate's annual report for 1968
  • 324 asbestosis cases were reported to the register from 1931 to 1988; 79% came from Medical Inspectors of the Labour Inspectorate
  • The other 21% came from general practitioners and occupational physicians, no more than 1 to 2 cases a year, and none from 1974 to 1988
  • Only 17 mesothelioma cases were reported to the register from 1965 to 1988; compared with death certificates coded malignant neoplasm of the pleura, the register grossly underestimated true pleural mesothelioma mortality
  • Peritoneal mesotheliomas were not reported to the register; deaths coded malignant neoplasm of the peritoneum showed no trend over time, between 35 and 70 per year
  • Reviewing two earlier Dutch studies, the authors reported that 22 of 25 mesothelioma patients diagnosed on Walcheren had worked at the same shipyard (Stumphius 1969), and that asbestos exposure was definite or probable in 72% of mesothelioma cases (Zielhuis et al. 1975). On this basis it was estimated that 80% of mesothelioma cases were likely due to asbestos
  • The 1971 guidance note P-116 was not legally enforced; it judged above 12 fibers/ml unacceptable and required protection at 2 to 12 fibers/ml
  • The 1978 Asbestos Regulations prohibited crocidolite and asbestos spraying and set a workplace standard of 2 fibers/ml; a ban on asbestos cement products was not enforced because of pressure from manufacturers
  • The 1988 regulations, initiated by a European directive, set a level of 1 fiber/ml requiring protection and an action level of 0.25 fiber/ml; a 1990 proposed revision called for a complete ban on asbestos use
• The authors' conclusion: The authors concluded that recognition of asbestosis was slow in the Netherlands, that mesothelioma was recognized quickly (which they attributed to the academic interest of Dutch pathologists and clinicians), and that the national occupational disease register played no role in the discussion of asbestos health effects
• Limitations the authors state:
  • The authors stated serious doubts about the validity of the registered asbestosis figures because so few cases were reported independently of the Labour Inspectorate
  • Neither Dutch mesothelioma study had reliable lifetime exposure data, so the remaining 20% of cases could not be considered truly unexposed
  • The authors noted that in individual cases it had not been possible to distinguish asbestos-related lung cancer from other lung cancer, which may explain the lack of reported lung cancer cases

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Occupational Disease, Lung Cancer, Mesothelioma, Death Certificate, Crocidolite.

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• Occupational lung disease survey of respiratory physicians in Northern Ireland — T.F. McKeagney, K. Addley, et al. (2015)
• Medical screening for occupational disease risk is not a control measure — S.M. Kennedy (1991)
• Classical syndromes in occupational medicine: the Montague Murray case — M. Greenberg (1982)
• From Awareness to Action: The Community of Sarnia Mobilizes to Protect its Workers from Occupational Disease — D. Kramer, K. McMillan, et al. (2015)

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