Asbestos Exposure and Ovarian Cancer - a Gynaecological Occupational Disease. Background, Mandatory Notification, Practical Approach

Our plain-English summary of Asbestos Exposure and Ovarian Cancer - a Gynaecological Occupational Disease. Background, Mandatory Notification, Practical Approach, by D. Nowak, B. Schmalfeldt, A. Tannapfel, et al (Geburtshilfe und Frauenheilkunde, 2021).

The study

• Authors: D. Nowak, B. Schmalfeldt, A. Tannapfel, S. Mahner
• Journal: Geburtshilfe und Frauenheilkunde
• Published: 2021;81(5):555-561
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

In 2017, ovarian cancer due to asbestos exposure was designated a new, and thereby the first, gynaecological occupational disease in Germany. Asbestos is a naturally occurring mineral fibre with an annual usage in Germany of 160 000 - 180 000 metric tonnes in the 1960s and 1970s. The carcinogenicity of asbestos for the target organs lungs, larynx, pleura including pericardium, and peritoneum including tunica vaginalis testis has been clearly established for many years. Recent meta-analyses of data from cohort studies have demonstrated that the risk of ovarian cancer roughly doubles in women with occupational exposure to asbestos. Since the group of people with double the risk of developing lung cancer due to work-related asbestos exposure has a 2.25-fold increased risk of mortality from ovarian cancer on average, work-related ovarian cancer has been assigned the same recognition requirements as in occupational lung (and laryngeal) cancer. Thus, gynaecologists must obtain a thorough history of occupational exposure to asbestos, even if it may have taken place long in the past. The law mandates that suspected such cases must be reported to the Statutory Accident Insurance carrier or the State Occupational Safety and Health Agency.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).

In plain English

This article was a review, written for gynaecologists, explaining why Germany added ovarian cancer caused by asbestos in 2017 to occupational disease no. 4104. That category already covered asbestos-related lung and laryngeal cancer. The authors did not collect new data. They reported a meta-analysis carried out by the Medical Expert Advisory Board on Occupational Diseases at the Federal Ministry of Labour and Social Affairs, covering studies up to September 2016. Across all studies, women occupationally exposed to asbestos had a standardised mortality ratio (SMR) for ovarian cancer of 1.88 (95% CI 1.47–2.39). In study subgroups whose lung cancer SMR was above 2.0, the ovarian cancer SMR was 2.25 (95% CI 1.64–3.07). In the highest-exposure groups it was 2.78 (95% CI 1.36–5.66). On this basis, ovarian cancer was given the same recognition criteria as lung cancer: asbestosis, asbestos-related pleural disease, or at least 25 fibre years of exposure. The authors noted that the underlying studies often had poor histological validation or small patient numbers. They concluded that gynaecologists must take a work history covering decades and are legally required to report suspected cases.

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: Review: the authors set out the scientific background and the German legal and practical procedure. They did not report new data of their own, but summarised a meta-analysis by a German government advisory board and a separately published pilot study.
• Who was studied: Published cohort studies of women occupationally exposed to asbestos, pooled in a meta-analysis by the Medical Expert Advisory Board on Occupational Diseases at Germany's Federal Ministry of Labour and Social Affairs (BMAS), with literature up to September 2016. The article also described a pilot study: 1,000 women were randomly drawn from 16,000 asbestos-exposed insured female workers registered with the GVS at BG ETEM.
• Exposure: Occupational asbestos exposure. The article named chrysotile and crocidolite, and tremolite and actinolite as contaminants of minerals such as talc. Industries listed included asbestos cement, friction linings (brake and clutch), asbestos textiles, rubber-asbestos, paper and gaskets, sprayed insulation, and demolition and repair work. The legal dose threshold is 25 fibre years.
• Main results:
  • In the advisory board's random-effects meta-analysis of all studies, the overall SMR for ovarian cancer in women occupationally exposed to asbestos was 1.88 (95% CI 1.47–2.39).
  • The pooled estimate was 1.89 (95% CI 1.40–2.55) for studies without histological verification of ovarian cancer and 1.98 (95% CI 1.32–2.97) for studies with histological confirmation. The difference was described as negligible (p greater than 0.8).
  • In subgroups with a lung cancer SMR greater than 2.0, the ovarian cancer SMR was 2.25 (95% CI 1.64–3.07). This figure was the basis for applying the lung cancer recognition criteria to ovarian cancer.
  • In the groups with the highest exposure, the ovarian cancer SMR was 2.78 (95% CI 1.36–5.66).
  • In participants in European studies, the ovarian cancer SMR was 1.95 (95% CI 1.51–2.51).
  • Since 2017, German occupational disease no. 4104 covers lung, laryngeal or ovarian cancer in any of three cases: with asbestosis, with asbestos-related pleural disease, or with a cumulative workplace dose of at least 25 fibre years.
  • In the separately published pilot study the authors described, 17% of invited women agreed to participate, against a target of 60%. There were six suspected ovarian cancer cases, two of them confirmed by medical documentation. Only the expected-number-of-cases feasibility criterion was met.
• The authors' conclusion: The authors concluded that women with a history of occupational asbestos exposure have about double the risk of dying from ovarian cancer compared with women without such exposure. They stated that gynaecologists must take an occupational history covering decades and are legally required to report suspected cases.
• Limitations the authors state:
  • The authors stated that the studies on which the new occupational disease was based often had poor histological validation or small patient numbers.
  • The authors stated that the available studies did not allow a precise calculation of the cumulative asbestos dose at which ovarian cancer risk doubles.
  • The authors stated that there are no data on how many patients with pleural mesothelioma develop ovarian cancer.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Ovarian Cancer, Occupational Disease, Pleura, Pericardium, Peritoneum, Tunica Vaginalis, Occupational Exposure.

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