Asbestos exposure and lymphomas of the gastrointestinal tract and oral cavity

Our plain-English summary of Asbestos exposure and lymphomas of the gastrointestinal tract and oral cavity, by R. Ross, R. Dworsky, P. Nichols, et al (Lancet, 1982).

The study

• Authors: R. Ross, R. Dworsky, P. Nichols, A. Paganini-Hill, W. Wright, M. Koss, R. Lukes, B. Henderson
• Journal: Lancet
• Published: 1982;2(8308):1118-20
• Cited by: 46 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. 001784).

Abstract

An epidemiological case-control study of non-Hodgkin's lymphomas revealed an excess of male patients with large-cell lymphomas primary to the gastrointestinal tract and oral cavity who had evidence of substantial exposure to asbestos. Between 1977 and 1981, 28 men with large-cell lymphomas primary to these sites were interviewed about previous environmental exposure. Pathology slides from 26 of these cases were reviewed by haematopathologists, who confirmed each to be non-Hodgkin's lymphoma of large-cell type. Neighbourhood controls were matched to patients for age, race, and sex. 13 matched pairs were discordant for asbestos exposure, and in 12 of these the exposed individual was a lymphoma patient. 10 patients and 1 control also reported a history of malaria.

In plain English

This was a matched case-control study in Los Angeles County of men with large-cell lymphomas (histiocytic lymphoma or immunoblastic sarcoma) that began in the gastrointestinal tract or the oral cavity and were diagnosed between January 1977 and June 1981. Of 56 eligible men, 28 were interviewed at home. Each was matched to a neighbourhood control of similar birth date and the same race and sex. Asbestos exposure was judged in three ways: usual occupation, shipyard work, and personal reports. Using usual occupation or shipyard work, 9 pairs differed in exposure, and in 8 of them the exposed man was the patient (relative risk 8, p equal to 0.01). Using all three measures, 13 pairs differed, 12 with the patient exposed (relative risk 12, p equal to 0.002). For the 17 patients with evidence of substantial exposure, the median time from first exposure to disease was 34 years. Ten patients and 1 control reported past malaria. The authors thought this link was most likely fortuitous, because several men had both exposures during naval duty in the 1939-45 war. The authors reported an association between occupational asbestos exposure and these lymphomas.

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: Matched-pairs case-control study with neighbourhood controls
• Who was studied: 28 men aged 19 to 75 with newly diagnosed histiocytic lymphoma or immunoblastic sarcoma primary to the gastrointestinal tract (stomach, large and small intestines, mesentery) or oral cavity (tonsil, tongue, pharynx). They were identified by the Los Angeles County Cancer Surveillance Program between Jan. 1, 1977, and June 30, 1981, and interviewed out of 56 contacted. They were matched to 28 neighbourhood controls by date of birth, race and sex. Patients' ages ranged from 24 to 75 (mean 58). Primary sites were stomach 11, colon 4, small intestine 5, oral cavity 8.
• Exposure: Asbestos exposure, assessed three ways: usual occupation rated blind for likelihood of asbestos exposure (for example insulation work, heating trades, shipyard work, construction, brake repair), any shipyard employment, and personal reports of workplace asbestos exposure. Fiber types were not specified. A history of malaria was also examined.
• Main results:
  • By usual occupation, 6 patients and 2 controls were judged to have a high likelihood of asbestos exposure.
  • By usual occupation or shipyard work, 9 matched pairs were discordant for asbestos exposure. In 8 of these the exposed person was the patient (relative risk 8, p equal to 0.01).
  • By any of the three criteria, 13 pairs were discordant for asbestos exposure: 12 patients and 1 control were the exposed member (relative risk 12, p equal to 0.002).
  • Among the 17 patients with some evidence of substantial asbestos exposure, the median interval from first exposure to disease was 34 years (range 22-47 years), and the median duration of exposure was 19 years.
  • A history of malaria was reported by 10 patients and 1 control. Of the 8 patients with malaria who had been exposed to asbestos, 6 had worked in shipyards.
  • Two experienced haematopathologists, without knowledge of asbestos exposure, confirmed the diagnosis of non-Hodgkin's lymphoma for 26 of the 28 cases.
• The authors' conclusion: The authors reported that their case-control study showed an association between occupational asbestos exposure and large-cell lymphomas of the gastrointestinal tract and oral cavity. They suggested the malaria association was most likely fortuitous, because several patients had both asbestos exposure and malaria during naval duty in the 1939-45 war.
• Limitations the authors state:
  • The authors were concerned about the uniformity of diagnoses made by many pathologists across Los Angeles, particularly for the asbestos-exposed patients. They addressed this by blinded pathology review.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Case-Control Study, Environmental Exposure, Pathology.

Related studies

• Occupational exposures to asbestos, polycyclic aromatic hydrocarbons and solvents, and cancers of the oral cavity and pharynx: a quantitative literature review — S. Paget-Bailly, D. Cyr, et al. (2012)
• Occupational exposures and squamous cell carcinoma of the oral cavity, pharynx, larynx, and oesophagus: a case-control study in Sweden — P. Gustavsson, R. Jakobsson, et al. (1998)
• Assessing Tumor-Infiltrating Lymphocytes in Solid Tumors: A Practical Review for Pathologists and Proposal for a Standardized Method from the International Immuno-Oncology Biomarkers Working Group: Part 2: TILs in Melanoma, Gastrointestinal Tract Carcinomas, Non-Small Cell Lung Carcinoma and Mesothelioma, Endometrial and Ovarian Carcinomas, Squamous Cell Carcinoma of the Head and Neck, Genitourinary Carcinomas, and Primary Brain Tumors — S. Hendry, R. Salgado, et al. (2017)
• Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomised controlled trial — C. Baldwin, A. Spiro, et al. (2011)
• In vitro approaches for determining mechanisms of toxicity and carcinogenicity by asbestos in the gastrointestinal and respiratory tracts — B.T. Mossman (1983)
• Cancer of the gastrointestinal tract and exposure to asbestos in drinking water among lighthouse keepers (Norway) — K. Kjaerheim, B. Ulvestad, et al. (2005)

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