Asbestos exposure in lung carcinoma: a necropsy-based study of 414 cases

Our plain-English summary of Asbestos exposure in lung carcinoma: a necropsy-based study of 414 cases, by C. Bianchi, A. Brollo, L. Ramani, et al (American Journal of Industrial Medicine, 1999).

The study

• Authors: C. Bianchi, A. Brollo, L. Ramani, C. Zuch
• Journal: American Journal of Industrial Medicine
• Published: 1999;36(3):360-4
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The prerequisites necessary for attributing lung carcinoma to asbestos, represent a controversial issue.

Methods: Three parameters (occupational history, pleural plaques, and lung asbestos bodies) were investigated in 414 consecutive cases of lung carcinoma, examined at necropsy at the Hospital of Monfalcone, Italy. Occupational data were obtained from the patients' relatives by personal or telephone interviews. Pleural plaques were classified into three classes (small, moderate, large). Routine lung sections were examined for asbestos bodies in all cases; isolation and counting were performed in 408 cases.

Results: The series included 353 men, and 61 women, aged between 38 and 97 years. The male patients had worked in industries in 74% of cases (60% in shipbuilding). Men showed pleural plaques in 82% of cases (moderate or large plaques in 58.7%). Asbestos bodies were observed in routine lung sections in 34.8%, and in 31% exceeded the value of 5,000 bodies per gram of dried tissue. Among women the principal features were: history or domestic exposure to asbestos in 36% of the cases, prevalence of pleural plaques 34% (moderate or large plaques 15%), asbestos bodies in routine lung sections in 3.3% and there was no case with an asbestos body burden over 5,000/g. The fraction of asbestos-related carcinomas among male patients varied between 24.7 and 61%, depending on the criteria used for attribution.

Conclusions: Different criteria indicated about 60% of the present lung carcinomas among men as plausibly attributable to asbestos.

In plain English

This autopsy-based study from the Hospital of Monfalcone, a shipbuilding area in north-eastern Italy, examined 414 consecutive people with lung carcinoma: 353 men and 61 women. Relatives were interviewed about work and smoking. Pathologists graded pleural plaques by size and looked for asbestos bodies in lung tissue, counting them in 408 cases. Nearly all the men had smoked. Most of the men had worked in industry, mainly shipbuilding. Among the men, 82% had pleural plaques. Asbestos body counts were above 10,000 per gram of dried lung tissue in 24.7% and above 5,000 in 31%, and 109 men (30.8%) were diagnosed with asbestosis. Larger plaques went with higher asbestos body counts. Under the 1997 "Helsinki criteria," lung carcinoma was attributable to asbestos in 216 men (61%) and 3 women (4.9%). Other criteria gave figures for men between 24.7% and 61%. The authors concluded that different criteria indicated about 60% of these men's lung carcinomas as plausibly attributable to asbestos. They noted that the high share of former shipyard workers in this population may account for the high proportion.

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: Necropsy (autopsy)-based case series of consecutive lung carcinoma cases, assessing occupational history, pleural plaques and lung asbestos bodies
• Who was studied: 414 consecutive lung carcinoma cases (353 men aged 38 to 93, 61 women aged 44 to 97) among 3,431 necropsies at the Hospital of Monfalcone, Italy, October 1979 to June 1997
• Exposure: Asbestos exposure, mainly in shipbuilding for men; at least 17 women had domestic exposure from cleaning relatives' work clothes. Fiber types were not specified.
• Main results:
  • Nearly all men were smokers or ex-smokers; among women there was a large prevalence of non-smokers
  • 74% of men had worked in industries. The abstract gives 60% in shipbuilding; Table IV lists 201 men (58.1%) in shipbuilding.
  • Pleural plaques were found in 82% of men
  • Large or moderate plaques were seen in 58.7% of men and 15% of women; overall plaque prevalence in women was 34% (Table V: 40 of 61 women had no plaques)
  • Asbestos bodies were seen in routine lung sections in 34.8% of men and 3.3% of women
  • Asbestos body burdens exceeded 10,000 per gram of dried tissue in 24.7% of men and 5,000 per gram in 31% of men; no woman exceeded 5,000 per gram
  • Pulmonary asbestosis was diagnosed in 109 men (30.8%) and in no women
  • Log10 mean asbestos body burdens rose with plaque size: 2.110 with no plaques, 2.399 in class 1, 2.945 in class 2 and 4.058 in class 3; differences highly significant (P less than 0.000001)
  • By the Helsinki criteria, lung carcinoma was attributable to asbestos in 216 men (61%) and 3 women (4.9%)
  • Assuming 2 asbestos-related lung carcinomas per asbestos-related mesothelioma gave about 36% attributable; a ratio of 3 gave 54%
  • Across criteria, the asbestos-related fraction among men ranged from 24.7% to 61%; attribution by pleural plaque size gave the same proportion as the Helsinki criteria
• The authors' conclusion: The authors concluded that different criteria indicated about 60% of the lung carcinomas among men in this series as plausibly attributable to asbestos (they wrote that this 'suggests' the fraction is close to 60%), and that in some occupational categories the proportion may reach 50 to 70%
• Limitations the authors state:
  • The different sources of exposure information (occupational data, asbestos bodies, plaques) may have very different degrees of reliability, and some work histories are difficult or impossible to interpret
  • It is problematic to set a cut-off value for lung asbestos body burdens
  • Because chrysotile fibers clear quickly from the lung, asbestos body or fiber analysis may not reflect exposure decades earlier
  • The autopsy population had a high percentage of former shipyard workers, which may account for the high proportion of asbestos-related cases

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Carcinoma, Autopsy, Occupational History, Pleural Plaques, Asbestos Bodies, Asbestos Body Formation, Attribution.

Related studies

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• Pulmonary endpoints (lung carcinomas and asbestosis) following inhalation exposure to asbestos — B.T. Mossman, M. Lippmann, et al. (2011)
• Environmental associations and histopathologic patterns of carcinoma of the lung: the challenge and dilemma in epidemiologic studies — J.C. Ives, P.A. Buffler, et al. (1983)
• The distribution of amosite asbestos fibers in the lungs of workers with mesothelioma or carcinoma — A. Churg, B. Wiggs (1989)
• PAX8 Expression in a Subset of Malignant Peritoneal Mesotheliomas and Benign Mesothelium has Diagnostic Implications in the Differential Diagnosis of Ovarian Serous Carcinoma — D.B. Chapel, A.N. Husain, et al. (2017)
• Pseudomesotheliomatous carcinoma of the pleura: an autopsy case of metastasis from a G-CSF-producing anaplastic carcinoma of the pancreas — Y. Hattori, K. Sentani, et al. (2018)

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