Asbestos disease screening by non-specialists: results of an evaluation

Our plain-English summary of Asbestos disease screening by non-specialists: results of an evaluation, by S. Zoloth, D. Michaels, M. Lacher, et al (American Journal of Public Health, 1986).

The study

• Authors: S. Zoloth, D. Michaels, M. Lacher, D. Nagin, E. Drucker
• Journal: American Journal of Public Health
• Published: 1986;76(12):1392-5
• Cited by: 16 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. 000455).

Abstract

We performed a medical audit of an asbestos disease screening program offered to New York City sheet metal workers by a corporate medical service. The screening program purported to evaluate the health status of workers exposed to asbestos in the past and present during construction and renovation of commercial buildings. Using current Occupational Safety and Health Administration (OSHA) regulations as a benchmark, medical records for more than 800 workers who took the examination between 1982-83 were reviewed; x-ray interpretations of the staff radiologist were compared with the interpretations of specialists in occupational lung diseases. The audit found inadequate record-keeping procedures, a lack of a comprehensive occupational history, poor notification and absence of any form of health education. Further, there was an extreme lack of concordance between the staff radiologist and the specialist readers in the interpretation of x-rays (kappa = .14 for pleural disease and .26 for asbestosis). To an increasing extent, occupational clinical services are being provided by corporate medical groups; such groups may not be familiar with occupational health problems.

In plain English

This study audited a corporate medical group's asbestos disease screening program for New York City sheet metal workers. These workers had been exposed to asbestos in commercial building construction and renovation. The authors reviewed records of 800 union members examined between May 1982 and May 1983, using OSHA rules as a minimal benchmark. About 16 per cent of participants had one or more asbestos-related lung abnormalities. Using specialist x-ray readings, among those aged 45-64, 19 per cent had pleural disease and 21 per cent asbestosis. Agreement between staff radiologists and occupational lung specialists was poor (kappa .14 for pleural disease, .26 for asbestosis). No occupational history was taken, and specialists' readings were often missing from charts. Specialists' findings were routinely reported three to eight months late, and the authors concluded such notification may have ceased in 1983 and 1984. Workers received no education about asbestos hazards. The authors suggested the x-ray disagreement may reflect unfamiliarity with occupational lung diseases. They concluded the results support training and certification standards for occupational health providers. They noted that self-selected participation could bias the prevalence estimates.

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: Medical audit (evaluation) of an occupational asbestos screening program, including comparison of chest x-ray readings by staff radiologists and occupational lung disease specialists
• Who was studied: Medical records of 800 members of Local 28 of the Sheet Metal Workers International Association in New York City who were examined between May 1982 and May 1983; both sets of x-ray readings were located for 775 individuals
• Exposure: Asbestos exposure (fiber type not specified) among sheet metal workers during construction of commercial buildings and renovation of office buildings
• Main results:
  • About 16 per cent of the sheet metal workers screened had one or more asbestos-related lung abnormalities
  • Among workers aged 45-64, based on specialist x-ray readings: 19 per cent had pleural disease, 21 per cent had asbestosis, and 34 per cent had one or both
  • Staff radiologists identified 61 people with x-ray signs of asbestosis. Specialists agreed on only 22 of them (36 per cent), and they read as abnormal 54 people whom the staff radiologists had read as normal
  • Agreement between staff radiologists and specialists was poor: kappa .14 for pleural disease and .26 for asbestosis (values below .4 suggest poor agreement)
  • Using published data from a separate study of 1,771 taconite workers, the authors calculated a kappa of .38 between a B reader and an experienced radiologist. They suggested the lower agreement in this study may be due to unfamiliarity with occupational lung diseases
  • The medical examination included no occupational history, not even a simple list of jobs
  • No provision was made for preplacement or termination examinations
  • Normal specialist x-ray readings were never filed in patients' records. During the audit the authors located and filed over 500 missing x-ray interpretations
  • Abnormal findings by the staff radiologist were often reported within two weeks, but reports of specialists' x-ray findings were routinely delayed three to eight months
  • During 1983 and 1984 the records were so incomplete that the authors concluded notification based on the specialists' findings may have ceased
  • Some attention was paid to lifestyle risks, but workers received no education about the hazards of asbestos exposure
  • The authors judged the quality of the physical examination to be high
• The authors' conclusion: The authors concluded that the results support standards for the training and certification of providers of occupational health services. They also stated that executive-oriented health programs may not be aware of blue-collar workers' occupational health needs.
• Limitations the authors state:
  • Workers chose whether to take part, which could bias the prevalence estimates, although participants' age distribution resembled the union membership
  • The OSHA regulations used as the benchmark are minimal; many screening programs offer substantially more

Topics

Medical terms in this study, explained in our Lexicon: OSHA, Occupational Lung Disease, Occupational History.

Related studies

• Participatory mapping of occupational hazards and disease among asbestos-exposed workers from a foundry and insulation complex in Canada — M.M. Keith, J.T. Brophy (2004)
• An Evaluation Into the Robustness of Grading of Pleural Mesothelioma Outside of Specialist Centres — S. Prabhakaran, A.J. Hocking, et al. (2025)
• Evaluation of the K2 asbestos screening test kit — W. Sahle (1987)
• Asbestos-related disease among sheet-metal workers. Preliminary results of the National Sheet Metal Worker Asbestos Disease Screening Program — L.S. Welch, D. Michaels, et al. (1991)
• Exposure of sheet-metal workers to asbestos during the construction and renovation of commercial buildings in New York City. A case study in social medicine — E. Drucker, D. Nagin, et al. (1987)
• 18-FDG positron emission tomography in the evaluation of malignant pleural diseases - a pilot study — A. Carretta, C. Landoni, et al. (2000)

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