Asbestos exposure and multiple primary tumors

Our plain-English summary of Asbestos exposure and multiple primary tumors, by V.A. Dohner, R.G. Beegle, W.T. Miller (The American Review of Respiratory Disease, 1975).

The study

• Authors: V.A. Dohner, R.G. Beegle, W.T. Miller
• Journal: The American Review of Respiratory Disease
• Published: 1975;112(2):181-99
• Cited by: 23 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. 001125).

Abstract

Recently we observed 5 patients with multiple primary tumors who also had a history of occupational asbestos exposure. Two patients had a lung carcinoma and a colon carcinoma and 3 others had 2 distinct pulmonary carcinomas. Most of the attending physicians were unaware of the patient's occupational risk for asbestos exposure and the resultant health hazards. Therefore, we review the uses of asbestos and occupations at risk for asbestos exposure.

In plain English

This 1975 article described five men seen in Seattle who had worked with or around asbestos and who each had two definite or probable separate (primary) cancers. Their jobs included shipyard and ship work (scaler and painter, rigger and ship's fireman, electrician), longshore work handling bags of asbestos, and pipe fitting with asbestos-containing pipe covering. The case reports did not name the fiber types involved. Three men had two lung cancers. Two had a colon tumor (in one, adenocarcinoma in situ) followed by lung cancer. In one man the authors could not rule out that the second lung tumor was a spread of the first. Asbestos bodies were found in lung tissue in two cases, and all five men were heavy smokers. In three cases the referring physicians had not known about the asbestos exposure, so the authors also tabulated uses of asbestos and occupations at risk, adapted from earlier sources. The authors concluded that multiple primary tumors after asbestos exposure are not common. They also wrote that a solitary lung nodule after removal of a lung or gastrointestinal carcinoma does not necessarily mean spread.

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: Case series (five case reports), with tables listing asbestos uses and occupations at risk taken from earlier publications
• Who was studied: Five men aged 47 to 66, seen in Seattle (Firland Sanatorium, the U.S. Public Health Service Hospital and others) between 1960 and 1971, each with two definite or probable primary malignant tumors
• Exposure: Occupational asbestos exposure; the case reports do not state the fiber type. Jobs were shipyard scaler and painter; shipyard rigger and Merchant Marine fireman; longshoreman handling bags of asbestos between 1950 and 1970; pipe fitter exposed to asbestos-containing pipe covering materials for at least 40 years; shipyard and ship's electrician. Three men recalled periods of heavy exposure in confined spaces.
• Main results:
  • Cases 1, 4 and 5 each had two malignant lung tumors. Cases 2 and 3 had a colon tumor and a lung carcinoma.
  • Case 4 (pipe fitter) had a squamous cell carcinoma in the left lower lobe and an adenocarcinoma in the left upper lobe. Pleural plaques and frequent asbestos bodies were also found.
  • Case 5 had a well-differentiated adenocarcinoma removed from the right lower lobe in 1965. At autopsy in 1971 a squamous cell carcinoma was found that differed in appearance from the 1965 tumor, with no microscopic evidence of mesothelioma.
  • Case 1 had two squamous cell lung carcinomas, removed or biopsied in 1966 and 1969, with asbestos bodies in lung and tumor tissue. The authors could not exclude that the second was a metastasis of the first.
  • Case 3 (longshoreman) had a villous adenoma of the colon with areas interpreted as adenocarcinoma in situ. A squamous cell lung carcinoma followed later in 1970.
  • All five patients were heavy smokers.
  • In cases 2, 3 and 5 the physicians requesting pulmonary consultation were not aware of the patients' occupational asbestos exposure.
• The authors' conclusion: The authors wrote that multiple primary tumors after asbestos exposure are not common. Among the points they stressed was that a solitary lung nodule after previous resection of a lung or gastrointestinal carcinoma does not necessarily signify a metastasis.
• Limitations the authors state:
  • In case 1, the authors said whether the second lung tumor was a separate primary tumor is open to conjecture.
  • No post-mortem examination was permitted in case 1.
  • In case 5, a distinct site of origin within the lung could not be identified at autopsy.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Carcinoma, Treating Physician.

Related studies

• Sudden death of an elderly man with multiple malignant neoplasms — L.R. Boglioli, M.L. Taff, et al. (1991)
• Multiple primary malignancies — R.S. Hoffman, A.H. Rossof, et al. (1984)
• Comparative genetic analysis of a rare synchronous collision tumor composed of malignant pleural mesothelioma and primary pulmonary adenocarcinoma — T. Naka, Y. Hatanaka, et al. (2016)
• Quantitative x ray microanalysis of pulmonary mineral particles in a patient with pneumoconiosis and two primary lung tumours — S. Anttila, S. Sutinen, et al. (1984)
• Minute localized malignant pleural mesothelioma coexisting with multiple adenocarcinomas — R. Maeda, N. Isowa, et al. (2010)
• Localized mesothelioma tumour arising synchronously with a primary contralateral lung cancer — W. Andrews, S. Paul, et al. (2013)

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