Asbestos exposure and related neoplasia. The 28 year experience of a major urban hospital

Our plain-English summary of Asbestos exposure and related neoplasia. The 28 year experience of a major urban hospital, by F.M. Hasan, G. Nash, H. Kazemi (The American Journal of Medicine, 1978).

The study

• Authors: F.M. Hasan, G. Nash, H. Kazemi
• Journal: The American Journal of Medicine
• Published: 1978;65(4):649-54
• Cited by: 27 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. 002123).

Abstract

In a retrospective study of 49 cases of asbestosis, a steady increase in the frequency of diagnosis of asbestosis and asbestos-related neoplasia is documented from a major urban hospital since 1960. Although in the majority of cases the subjects were exposed to asbestos in a neighboring shipyard, in 20 per cent of the cases, asbestos exposure was in industries not related to shipbuilding, reflecting its widespread use. This selective population of patients with asbestosis more often than not had an associated neoplasm. The most likely accompanying tumor was pleural mesothelioma, and among cell types of lung cancer, adenocarcinoma was notably frequent.

In plain English

This was a retrospective review of hospital records for all 49 patients diagnosed with asbestosis at Massachusetts General Hospital in Boston from 1945 through 1972. Asbestosis was confirmed by tissue examination in 36 patients and diagnosed from clinical, occupational and X-ray findings in 13. Thirty-eight patients (78 per cent) had worked in naval shipyards, mostly covering pipes with asbestos insulation. Others worked in brake lining manufacture, an asbestos factory, floor tile installation, a textile mill or cigarette filter making, and one had no known exposure. Only four cases were diagnosed before 1960. Thirty patients (61 per cent) also had a tumor: 17 mesotheliomas (eight of them tentative without autopsy), 12 lung cancers (six adenocarcinomas) and one prostate cancer. The mean time from first exposure to diagnosis of a tumor was 26.3 years. Initial occupational histories taken by doctors and students averaged 0.73 on a 0 to 3 scale. The authors concluded that diagnoses rose steadily after 1960 and that the most likely accompanying tumor was pleural mesothelioma. They noted that the small number of cases limits interpretation.

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: retrospective review of hospital records (case series) of all patients with an asbestosis diagnosis at one hospital
• Who was studied: All 49 patients with asbestosis seen at Massachusetts General Hospital, Boston, from 1945 through 1972. 45 were male, and ages ranged from 35 to 67 years (mean 57.7). The 49 included 17 mesothelioma cases the authors had reported before. Nineteen mesothelioma patients with no history of asbestos exposure and no asbestosis on histology were excluded.
• Exposure: Occupational asbestos exposure, with fiber type not specified. 38 of 49 patients (78 per cent) worked in naval shipyards, mostly covering pipes with asbestos insulation sheets. The others were in auto brake lining manufacturing (3), an asbestos factory (3), floor tile installation (2), a textile mill (1) and cigarette filter making (1). One patient had no known exposure. 27 patients (55 per cent) were exposed for more than 15 years.
• Main results:
  • Only four of the 49 asbestosis cases (8 per cent) were diagnosed before 1960. Diagnoses became more frequent after that.
  • 30 of the 49 patients (61 per cent, per Table II) had an associated tumor. 17 were mesotheliomas, 12 were lung cancers and one was a prostate cancer.
  • Among the 12 lung cancers, adenocarcinoma was the most common cell type (6 cases). There were also 4 squamous cell and 2 oat cell carcinomas.
  • Mesothelioma was confirmed at autopsy in nine patients. In one of these nine, a positive PAS-D stain cast doubt on the diagnosis. In eight other patients the mesothelioma diagnosis was tentative because there was no postmortem examination.
  • Most patients with brief asbestos exposure had an associated tumor. 12 of the 13 patients exposed for less than 5 years had a tumor.
  • Among patients with an asbestos-related tumor, the mean time from first exposure to diagnosis was 26.3 years.
  • Smoking history was found in 93.3 per cent of patients with a related tumor and 89.5 per cent of patients with asbestosis alone. Only four of the 49 patients were known nonsmokers.
  • Initial occupational histories were rated poor. They averaged 0.73 on a 0 to 3 scale, and the rating did not improve over time.
  • Pleural plaques were the most common chest X-ray finding, seen in 43 of 49 patients (88 per cent).
  • In the 20 autopsied patients, the chest X-ray seemed to underestimate disease. Nine showed pleural plaques on film, but 14 of 20 had pleural thickening at autopsy. Seven showed interstitial fibrosis on X-ray, but all 20 had it under the microscope.
• The authors' conclusion: The authors concluded that diagnoses of asbestosis and asbestos-related tumors rose steadily after 1960. They found that patients with asbestosis in this selected group more often than not had an associated tumor, most likely pleural mesothelioma, and that adenocarcinoma was notably frequent among the lung cancers. They also concluded that when strict clinical criteria were met, lung tissue was not needed to confirm asbestosis.
• Limitations the authors state:
  • The small number of cases limits how far the findings can be interpreted.
  • The study population was highly selective.
  • Part of the increase may reflect wider recognition of the link between asbestosis and tumors, not only more disease.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Neoplasm, Pleural Mesothelioma, Lung Cancer, Adenocarcinoma.

Related studies

• The significance of asbestos exposure in the diagnosis of mesothelioma: a 28-year experience from a major urban hospital — F.M. Hasan, G. Nash, et al. (1977)
• Diffuse malignant pleural mesothelioma in an urban hospital: clinical spectrum and trend in incidence over time — K.E. Shepherd, L.C. Oliver, et al. (1989)
• Outcomes of cytoreduction with hyperthermic intraperitoneal chemotherapy: our experience at a midwest community hospital — B. Goslin, S. Sevak, et al. (2012)
• Variation in number of general practitioner consultations before hospital referral for cancer: findings from the 2010 National Cancer Patient Experience Survey in England — G. Lyratzopoulos, R.D. Neal, et al. (2012)
• Malignant mesothelioma: prognostic variables in a registry of 180 patients, the Dana-Farber Cancer Institute and Brigham and Women's Hospital experience over two decades, 1965-1985 — K. Antman, R. Shemin, et al. (1988)
• Induction chemotherapy, extrapleural pneumonectomy, and adjuvant radiotherapy for malignant pleural mesothelioma: experience of Guy's and St Thomas' hospitals — A. Bille, E. Belcher, et al. (2012)

Browse more research in The American Journal of Medicine, or return to medical research.