Asbestos link to lymphoid neoplasms still just a hypothesis

Our plain-English summary of Asbestos link to lymphoid neoplasms still just a hypothesis, by P. Silcocks (American Journal of Clinical Pathology, 1984).

The study

• Author: P. Silcocks
• Journal: American Journal of Clinical Pathology
• Published: 1984;81(3):410
• Type of article: Letter
• Cited by: 1 article, 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. 001636).

In plain English

This letter to the editor reported no new data. The author challenged a 1983 article by Kagan and Jacobson supporting an association between lymphoplasmacytic neoplasms and asbestos exposure. The author argued that most of that article's cases were chosen because they already had asbestos-associated disease, making an exposure history unsurprising. The author added that numbers were small and there was no control group. Among other studies cited in support, those by Lieben and by Gerber were faulted for selection bias and for possibly reflecting asbestosis rather than asbestos fiber itself. Robinson's study found only a non-significantly raised standardized mortality ratio for malignant lymphoma deaths (213; 95% confidence limits 82 to 405). Milham's proportional mortality analysis found a significant elevation for lymphoid neoplasms only in 1951-60, not in later periods up to 1980. The author wrote that Dworsky's work may be criticized for possible survivorship bias, a high nonresponse rate and possible confounding by malaria exposure. The author noted that other asbestos-exposed groups had shown no excess of lymphoid neoplasms. The author concluded that much remained to be done before the idea that asbestos exposure causes lymphoid neoplasms could be accepted.

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: Letter to the editor commenting on published studies; no original data
• Who was studied: No study population; the letter discusses previously published studies (Kagan and Jacobson; Lieben; Gerber; Robinson; Milham; Dworsky and others)
• Exposure: Asbestos exposure and its proposed association with lymphoid and lymphoplasmacytic neoplasms
• Main results:
  • The author argued that in the Kagan and Jacobson article most cases were selected because they already had asbestos-associated disease. The author added that the study was small and had no control group.
  • The author argued that Lieben's study suffered from selection bias, because it compared cancer mortality in a heterogeneously selected group of asbestosis cases with the general population.
  • The author suggested that both Lieben's and Gerber's studies may have detected an effect of asbestosis rather than of asbestos fiber itself.
  • According to the author, Robinson's study found only a non-significantly raised standardized mortality ratio (SMR) for malignant lymphoma (SMR 213, 95% confidence limits 82 to 405).
  • According to the author, Milham's proportional mortality analysis found a significantly elevated proportional mortality ratio (PMR) for lymphoid neoplasms only for 1951-60, and not for any subsequent interval up to 1980.
  • The author wrote that Dworsky's work may be criticized on three grounds. First, possible survivorship bias, because 18 of the 56 cases deemed suitable had died. Second, nonresponse by 10 of the 38 living cases. Third, possible confounding from malaria exposure.
  • The author noted that other asbestos-exposed occupational cohorts and shipyard workers had shown no excess of lymphoid neoplasms. The author also noted that an atlas of cancer mortality showed little congruence between areas of high mesothelioma mortality and areas of high lymphoid neoplasm mortality.
• The authors' conclusion: The author concluded that much remains to be done before the idea that asbestos exposure causes lymphoid neoplasms can be accepted.

Topics

Medical terms in this study, explained in our Lexicon: Neoplasm.

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