A study of lung cancer mortality in asbestos workers: Doll, 1955

Our plain-English summary of A study of lung cancer mortality in asbestos workers: Doll, 1955, by M. Greenberg (American Journal of Industrial Medicine, 1999).

The study

• Author: M. Greenberg
• Journal: American Journal of Industrial Medicine
• Published: 1999;36(3):331-47
• Type of article: Historical article
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Between 1935 and 1953, a series of publications appeared in England, Germany and America reporting cases of lung cancer amongst asbestos workers. As early as 1943, the German scientific consensus was that the evidence was strong enough to deem the association to be causal. On reviewing a more extensive bibliography, this view was shared by an American cancer expert. The results of industry sponsored experiments, in which lung tumors had been induced in mice by asbestos, were circulated in confidence to its scientists, but being unpublished were unknown to the general scientific community. There were also cancer mortality data recorded for populations of exposed asbestos workers, but these were confidential and remained to be analyzed. To deal with the persistent allegations of a lung cancer hazard, in 1953 Dr. Richard Doll was asked by Turner Brothers Asbestos ("the Company"), whose in-house analyses had been reassuring, to study the mortality data of a group of its workers. Despite the limitations of the data, Doll convincingly demonstrated so substantial an excess of lung-cancer in heavily exposed long-term asbestos workers as to overcome honest doubt. Despite determined attempts made to dissuade them, Doll and the editor of the journal to which he submitted his paper, courageously went ahead and published the paper. Industry overestimated the harm that publication of the paper would do to their immediate interests. It produced so profound a lack of sense of urgency, that legislation addressed to the control of lung cancer specifically had to wait 20 years, and asbestos workers contracting it were to wait 25 years, before they might be considered for compensation, and even then, only under extremely limiting conditions.

In plain English

This article was a historical review, not a new study. The author examined Richard Doll's 1955 paper on lung cancer deaths among workers at the Turner Brothers Asbestos factory in Rochdale, England. The author read it alongside the published literature and company archive papers obtained through legal discovery. As this article describes it, Doll found that 15 of 75 autopsied employees with asbestosis had lung cancer, compared with three of 30 without asbestosis. Doll concluded that men employed 20 or more years in 'scheduled areas' had a lung cancer risk some 10 times that of the age-matched general population of England and Wales. The author reported that company records were incomplete and inconsistent. For 1935 to 1950, the company medical adviser J.F. Knox counted 10 lung cancer deaths while Doll listed 13. The author also described unpublished industry-sponsored mouse experiments, the company's opposition to publication, and delays in regulation and compensation. The author concluded that Doll added further support to an existing belief in a causal association between respiratory cancer and asbestos exposure. The author noted that surviving documents were patchy.

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 Doll's 1955 paper and the circumstances of its writing and publication, based on published literature and company archival documents
• Who was studied: The reviewed paper (Doll 1955) studied employees of Turner Brothers Asbestos's Rochdale factory: 105 employees (male and female) autopsied by coroners from 1935 to 1952, and 113 men employed 20 or more years in 'scheduled areas'. The author drew on company papers obtained by legal discovery and on Doll's files.
• Exposure: Asbestos work at the Rochdale factory, specifically employment in 'scheduled areas' (areas designated hazardous under the Asbestos Industry Regulations 1931); fiber type not specified for the workers
• Main results:
  • As reported in Doll's 1955 paper (described here): among autopsied employees, 15 of 75 with asbestosis had lung cancer, compared with 3 of 30 without asbestosis
  • Doll concluded that workers employed 20 or more years in scheduled areas had a lung cancer risk some 10 times higher than the age-matched general population of England and Wales
  • In an earlier unpublished company analysis, Knox found 10 lung cancers among 100 post-mortem records (10%), compared with 7.5% calculated from national statistics; Knox described the difference as hardly statistically significant
  • Company records were inconsistent: for 1935 to 1950, Knox counted 10 lung cancer deaths while Doll listed 13 (12 men and 1 woman)
  • Gardner reported to industry sponsors in 1943 an excess of lung cancers in asbestos-exposed mice; according to the author, these findings were never published by Saranac Laboratory
  • The company strongly opposed publication of Doll's paper
  • A UK review of the health aspects of asbestos did not begin until 1966, and the article states that 30 years passed after Doll's report before asbestos workers with lung cancer became entitled to compensation, with strict limitations
• The authors' conclusion: The author concluded that Doll, analyzing data not evaluated for accuracy and completeness, added further support to the existing belief in a causal association between an excess of respiratory malignancy and asbestos exposure
• Limitations the authors state:
  • The surviving archival documents are incomplete
  • Some original company reports could not be found
  • Higher autopsy rates and closer pathological scrutiny of company workers may have increased lung cancer detection, though the author judged this unlikely to discount Doll's excess

Topics

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

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

Related studies

• Re: Doll's 1955 study on cancer from asbestos — B.I. Castleman (2001)
• Analysis of mortality patterns and workers' compensation awards among asbestos insulation workers in Ontario — M.M. Finkelstein (1989)
• Mortality from lung cancer in asbestos workers 1955 — R. Doll (1993)
• Loyalty of the asbestos worker: a brief historical note — M. Greenberg (2004)
• Mortality from lung cancer in asbestos workers — R. Doll (1955)
• Mortality experience of insulation workers in the United States and Canada, 1943--1976 — I.J. Selikoff, E.C. Hammond, et al. (1979)

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