Asbestos and non-Hodgkin's lymphoma

Our plain-English summary of Asbestos and non-Hodgkin's lymphoma (Lancet, 1983).

The study

• Journal: Lancet
• Published: 1983;1(8317):189-90
• Type of article: Case report, Letter
• Cited by: 4 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. 001737).

In plain English

This item is two letters to The Lancet, both responding to a paper by Ross and colleagues on asbestos and non-Hodgkin's lymphoma (NHL). Neither letter is a new formal study. In the first, authors from the U.S. National Institute for Occupational Safety and Health pointed to earlier published data. They cited a cohort study of 2722 male workers at an asbestos textile, friction and packaging products plant in Pennsylvania. That study recorded 7 deaths from NHL, against 3.28 expected. About 99% of the asbestos used at the plant was chrysotile. Among women at the plant, no lymphoma deaths were seen, but fewer than 1 was expected. These authors proposed that the investigators of thirty-three asbestos-worker cohorts count NHL deaths and send tissue from them to a central panel of pathologists. In the second letter, authors from Ferrara, Italy, described two men with long workplace asbestos exposure and lung fibrosis. One, a plumber, developed IgG multiple myeloma. The other, a building-industry worker, was diagnosed with B chronic lymphocytic leukaemia. These authors suggested that the effects of asbestos on immune control may be more relevant than local irritation. They also said that the immune status of asbestos workers generally should be monitored.

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: Two letters to the editor responding to Ross et al. The first cites earlier published disability, mortality and cohort data. The second reports two cases.
• Who was studied: Letter 1 cites a cohort of 2722 male workers at an asbestos textile, friction and packaging products plant in Pennsylvania (from a 1979 cohort study of mortality from 1940 to 1975), plus U.S. disability claimants (1959-62) and U.S. male deaths in 1950. Letter 2 describes two men in Italy, aged 55 and 50, with prolonged occupational asbestos exposure.
• Exposure: Pennsylvania plant: about 99% of the asbestos used was chrysotile. Case 1: a plumber who worked for 30 years grinding and installing asbestos-containing pipes. Case 2: a man who worked 25 years in the building industry, continually exposed to asbestos powders.
• Main results:
  • Among the 2722 male workers at the Pennsylvania plant (cited cohort study), there were 7 deaths due to NHL (7th revision I.C.D. 200 only) versus 3.28 expected.
  • On the death certificates of the 7 male cases, 3 were recorded as malignant lymphomas and 4 as lymphosarcomas.
  • The 7 male NHL cases had an average age at death of 44 years (range 25 to 56) and an average plant employment of 14 years (range 1 to 35).
  • Among female workers at the same plant, no lymphoma deaths were observed, but fewer than 1 such death would have been expected.
  • An earlier study of 68 cases of asbestosis from the same plant identified 5 additional haematopoietic and lymphatic malignancies.
  • Cited national data: in U.S. deaths in 1950, stationary engineers had a significantly raised standardised mortality ratio of 1.6 for lymphopoietic and haematopoietic malignancies excluding leukaemia. Among 1959-62 social security disability claimants, stationary engineers had a significantly raised proportionate morbidity ratio of 1.4 for lymphoma and leukaemia.
  • The first letter states that none of six other published cohort studies of workers exposed solely to chrysotile asbestos had reported data for NHL.
  • Case 1, the plumber, had asbestos-induced lung fibrosis and was later diagnosed with IgG multiple myeloma. He died after 1 year of heart failure and pneumonia.
  • Case 2, the building-industry worker, had diffuse interstitial lung fibrosis. Tests showed a marked leucocytosis (46 000/μl) with 90% mature lymphocytes, and B chronic lymphocytic leukaemia was confirmed. His blood T-lymphocyte percentage was much reduced: only 15% were positive on the E-rosette test and 18% reacted to mitogen stimulation.
• The authors' conclusion: The first letter's authors wrote that an asbestos cause for NHL is plausible. They proposed that investigators of thirty-three asbestos-worker cohorts determine observed and expected NHL deaths and submit pathology material to a central panel of pathologists for review. The second letter's authors suggested that asbestos effects on immunological control, T-lymphocyte numbers and cell-mediated immunity may be more relevant than local irritation of the gut. They also said that the immunological status of asbestos workers should be monitored to detect early signs of immunological alterations.
• Limitations the authors state:
  • The first letter's authors noted that any single cohort has few NHL deaths, and that the criteria for classifying NHL subtypes keep changing.
  • The first letter's authors noted that few cohort studies of asbestos workers have reported observed and expected deaths from NHL.

Topics

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

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