Asbestos, asbestosis and mesothelioma of the pleura

Our plain-English summary of Asbestos, asbestosis and mesothelioma of the pleura, by W.J. Smither (Proceedings of the Royal Society of Medicine, 1966).

The study

• Author: W.J. Smither
• Journal: Proceedings of the Royal Society of Medicine
• Published: 1966;59(1):57-9
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001512).

In plain English

This abridged meeting paper is by an author from the Cape Asbestos Company. It compares asbestosis cases from one East End London factory with earlier published series drawn wholly or partly from that factory. The author examined 26 cases certified since 1960. Their average exposure before certification was 17.5 years, against 7, 10.4 and 14.5 years in earlier series. Disability at certification was only 10% in 21 of them, and 18 had breathlessness. Of 71 post-mortems from 1957 to 1964, 26 (36.6%) showed lung carcinoma, 2 (2.8%) a primary pleural malignancy and 13 (18.3%) a primary peritoneal tumour. An earlier series of 115 post-mortems recorded 17 (14.8%), 1 (0.8%) and none. The author thought some of its other abdominal cancers might have been peritoneal tumours, but even all of them would fall well below 13. Before 1960, certification required definite clinical and X-ray findings; many recent cases were certified earlier, on lung function. The author concluded that improved working conditions had more than doubled average exposure before certifiable disability, and that asbestos may also affect the pleura or peritoneum.

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 report comparing a new series of certified asbestosis cases and a post-mortem series from one factory with earlier published series (abridged meeting paper)
• Who was studied: 26 new cases of asbestosis certified since 1960 (1960 to 1964) at one factory, plus 71 post-mortem examinations reported to the author since 1957 (1957 to 1964), 51 of them personally attended
• Exposure: Work at one asbestos factory in the East End of London. The article does not state which asbestos fiber types the cases were exposed to.
• Main results:
  • The present series of 26 certified cases had an average exposure of 17.5 years before certification. Earlier series had averages of 7 years (1930s), 10.4 years (1940s) and 14.5 years (1950s).
  • In 21 of the 26 present cases, disability at certification was only 10%.
  • Only 18 of the 26 present cases had dyspnoea (breathlessness) at certification.
  • Permanent dry rales were found in all but one of the later cases.
  • In the 71 post-mortems (1957 to 1964), 26 (36.6%) showed lung carcinoma, compared with 17 (14.8%) of 115 in the earlier Wyers series (1931 to 1949).
  • In the 71 post-mortems, 2 (2.8%) showed a primary pleural malignancy, compared with 1 (0.8%) in the Wyers series.
  • In the 71 post-mortems, 13 (18.3%) showed a primary peritoneal tumour. The Wyers series recorded none, although the author thought some of its other abdominal cancers might be reclassified as primary peritoneal tumours. Even if all were included, the total would be well below 13.
  • 4 of the 71 post-mortem cases showed tuberculosis, all only old healed lesions; the earlier series had 36 cases (31.3%).
  • 7 of the 71 post-mortem cases had cancer of other abdominal organs, including bladder, colon, rectum and stomach. Histological examination excluded mesothelioma in these.
• The authors' conclusion: The author concluded that improved working conditions had more than doubled the mean exposure before certifiable disability develops, and that as well as causing interstitial pulmonary fibrosis, asbestos may also affect the pleura or the peritoneum.
• Limitations the authors state:
  • Cases certified before 1960 required definite clinical and radiological findings, while many in the present series were certified earlier on lung function evidence, so the series are not directly comparable.
  • The author attributed the lower rate of finger clubbing and the smaller reduction in diffusion capacity in the present series to earlier diagnosis.
  • Some of the abdominal cancers in the earlier Wyers series might, on critical analysis, have been primary peritoneal tumours.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleura.

Related studies

• Asbestosis and abdominal neoplasms — E.E. Keal (1960)
• Peritoneal tumours in asbestosis — J.B. Enticknap, W.J. Smither (1964)
• The discriminant value of pulmonary function tests in asbestosis — M.L. Thomson, A.M. Pelzer, et al. (1965)
• Secular changes in asbestosis in an asbestos factory — W.J. Smither (1965)
• Asbestos and asbestosis — W.J. Smither (1970)
• Asbestos, carbon nanotubes and the pleural mesothelium: a review of the hypothesis regarding the role of long fibre retention in the parietal pleura, inflammation and mesothelioma — K. Donaldson, F.A. Murphy, et al. (2010)

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