Asbestos-related cancer in naval personnel: findings from participants in the British nuclear tests 1952-1967

Our plain-English summary of Asbestos-related cancer in naval personnel: findings from participants in the British nuclear tests 1952-1967, by R.T. Gun, G.M. Kendall (Scientific Reports, 2023).

The study

• Authors: R.T. Gun, G.M. Kendall
• Journal: Scientific Reports
• Published: 2023;13(1):18842
• Read it: PubMed · Publisher · Free full text

Abstract

Asbestos-containing materials (ACM) were present in British and Australian naval vessels throughout the twentieth century. The aim of this study was to identify and quantify the incidence of cancer in naval personnel from onboard asbestos exposure. Subjects were four cohorts of subjects who had served in the armed forces of the United Kingdom and Australia in the 1950s and 1960s. All cohorts had previously been studied, three of them in relation to radiation exposures from British nuclear testing. Comparisons of SIRs between services were made to identify cancers attributable to asbestos exposure. Excess mesotheliomas were found in naval personnel in all cohorts. In all but one cohort the lung cancer incidence was highest in navy personnel. Comparison of other smoking-related conditions indicated that the excess in navy personnel was not smoking-related. The relatively high SIRs for mesothelioma and the occurrence of deaths from asbestosis were indicative of high levels of asbestos exposure, with an expectation of cases of asbestos-related lung cancer. The findings are consistent with the occurrence of significant excesses of mesotheliomas. In addition, notwithstanding some inconsistencies in the results between the cohorts, we estimated that approximately 27% of lung cancers in Australian seamen and 12% in British seamen were related to onboard asbestos exposure.

© 2023. The Author(s).

In plain English

This study reanalysed published data on four groups of British and Australian service personnel from the 1950s and 1960s: British nuclear test participants, British controls, Australian test participants and Australian Korean War veterans. The authors compared cancer rates in navy, army and air force veterans, using standardised incidence ratios (SIRs) against national male rates. Navy veterans had raised mesothelioma SIRs in all four groups, ranging from 1.75 to 2.79. These were statistically significant except among the Korean War veterans. Lung cancer SIRs were higher in the navy than the army except among Korean War veterans, where the army was higher. In the combined British groups, death rates from COPD and heart disease and rates of bladder cancer, all linked to smoking, were similar in navy and army veterans. In the British groups, 12 navy veterans died of asbestosis, compared with 2 army veterans. The authors estimated that about 27% of lung cancers in Australian seamen and 12% in British seamen were related to onboard asbestos exposure, calling the uncertainty substantial. They had no individual data on smoking or asbestos exposure.

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: Secondary analysis of previously published cohort studies. Cancer incidence and mortality ratios, standardised against national male populations, were compared between navy, army and air force veterans.
• Who was studied: Four cohorts of United Kingdom and Australian service personnel from the 1950s and 1960s, with civilians excluded. UK test participants: 6305 navy, 5794 army, 8443 air force. UK control cohort: 7343 navy, 5462 army, 8702 air force. Australian test participants: 2613 navy, 1037 army, 2459 air force. Australian Korean War veterans: 5102 navy, 8934 army.
• Exposure: Onboard exposure to asbestos-containing materials on British and Australian naval vessels. There were no exposure measurements, so navy service, compared with army and air force service, was used as the proxy. In the discussion, the authors suggested the British naval exposure may have been mainly crocidolite and the Australian exposure mainly other asbestos types.
• Main results:
  • Mesothelioma SIRs in navy veterans were 2.79 (1.59–4.52) in Australian test participants, 1.75 (0.83–2.67) in Australian Korean War veterans, 2.62 (2.04–3.31) in UK test participants and 2.57 (2.04–3.20) in UK controls. All were statistically significant except for the Korean War veterans.
  • Among Australian test participants, the lung cancer SIR was 1.50 (1.26–1.77) in the navy and 1.09 (0.78–1.49) in the army.
  • In the combined British cohorts, the lung cancer SIR was 1.15 (1.08–1.23) in the navy and 1.01 (0.94–1.09) in the army. The authors described this difference as close to statistical significance.
  • Among Australian Korean War veterans, the lung cancer SIR was higher in the army (1.59) than in the navy (1.25).
  • In the combined British cohorts, COPD, ischaemic heart disease and bladder cancer were similar in navy and army veterans. Navy versus army figures were: COPD SMR 0.93 vs 0.97, heart disease SMR 0.92 vs 0.91, and bladder cancer SIR 1.00 vs 1.05. Laryngeal cancer was higher in the navy (SIR 1.64 vs 0.91), which the authors suggested may be alcohol-related.
  • Among Australian Korean War veterans, rates of smoking-related conditions were very high in army veterans. Navy versus army figures were: COPD SMR 1.30 vs 1.69, and heart disease SMR 1.04 vs 1.18. Bladder cancer was the exception, with SIR 1.31 in the navy vs 1.03 in the army.
  • Asbestosis deaths in the combined British cohorts were 12 in the navy (SMR 2.51), 2 in the army (SMR 0.51) and 4 in the air force (SMR 0.67).
  • Navy mesothelioma SIRs were comparable to the highest-risk occupations in a British study and a Connecticut study. Only four occupational categories in the British study and two in the Connecticut study had higher figures.
  • The authors estimated about 50 asbestos-related lung cancers in British test participants, against 70 mesotheliomas, and 60 in British controls, against 81 mesotheliomas. This gave a ratio of 0.74 lung cancers per mesothelioma in both British cohorts. The ratio in Australian test participants was 2.4.
  • The authors equated these estimates to about 27% of lung cancers in Australian seamen and 12% in British seamen being related to onboard asbestos exposure.
• The authors' conclusion: The authors concluded that naval veterans had elevated mesothelioma rates, not seen in the other services, attributable to onboard asbestos exposure. They also concluded that naval veterans had excess lung cancer not fully explained by differences in smoking. Despite inconsistencies between cohorts, they judged the findings consistent with a substantial number of asbestos-related lung cancers.
• Limitations the authors state:
  • There were no data on smoking or asbestos exposure. For the Australian cohort, there were also no mortality data on asbestosis or on smoking-related conditions other than cancer.
  • The lung cancer estimates carry substantial uncertainty. They assume that absolute differences in observed cancers exactly equal the number of asbestos-related lung cancers.
  • In the Korean War veterans cohort, the authors could not identify any asbestos contribution to navy lung cancer.
  • The Korean War veterans cohort was not fully independent of the Australian test participant cohort.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos-Containing Material (ACM), Asbestos Exposure, Mesothelioma, Lung Cancer.

Related studies

• Mortality and cancer incidence of Australian participants in the British nuclear tests in Australia — R.T. Gun, J. Parsons, et al. (2008)
• Mortality among U.S. military participants at eight aboveground nuclear weapons test series — J.D. Boice, S.S. Cohen, et al. (2022)
• Noninvasive detection of early asbestos-related disease of the thorax: algorithmic analysis of radiographic, nuclear, and serologic tests — S.D. Rockoff, A.M. Schwartz (1991)
• The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999 — A.K. Hilliard, J.K. Lovett, et al. (2003)
• Lung cancer risk test trial: study design, participant baseline characteristics, bronchoscopy safety, and establishment of a biospecimen repository — E.L. Crawford, A. Levin, et al. (2016)
• Asbestos-related abnormalities in school maintenance personnel — L.C. Oliver, N.L. Sprince, et al. (1991)

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