Asbestos-related chest disease in joiners

Our plain-English summary of Asbestos-related chest disease in joiners, by D.E. Fletcher (Proceedings of the Royal Society of Medicine, 1971).

The study

• Author: D.E. Fletcher
• Journal: Proceedings of the Royal Society of Medicine
• Published: 1971;64(8):837-8
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002441).

Summary of the article

This report examined pleural plaques and other chest changes in joiners at Barrow-in-Furness. Routine PA chest films held by the Vickers Shipbuilding and Engineering Works Clinic were reviewed, excluding females and men under 25: 4,223 sets of films. Overall, 5.5% of workmen had evidence of pleural plaques. Prevalence was highest among joiners (33% of 81), nearly double that in laggers (17.5% of 45). Through shop stewards of the Amalgamated Society of Woodworkers, detailed examinations were offered to 185 shipyard joiners and 90 joiners working for building contractors in the town. Of these, 177 men attended and had PA and oblique films. Plaques were found in 62 men (35%): 50 (28.2%) with soft tissue density only and 12 (6.8%) with calcification. Prevalence rose with age, to 64% at 45-54 years, then fell to 56% at 55-64 years. There were occasional cases of diffuse pleural thickening and 5 joiners with probable pulmonary fibrosis. The author considered an asbestos insulation board containing 30% amosite, often hand-sawn in confined spaces, the most likely cause, though unproven. Death certificates for the last ten years showed no deviation from average figures for any cause of death. Of 14 successive deaths of joiners with plaques, 6 were bronchial carcinomas and 1 a mesothelioma; this was not statistically significant. Of 39 men who had never worked in a shipyard, 7 had plaques. Two joiners aged 24 had shadows suggesting early plaques. The author suggested that a latent period of less than 8 years might be enough for plaques to develop.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This short report from Barrow in Furness described chest X-ray findings in joiners. The author first reviewed 4,223 sets of routine chest films of men aged 25 and over held by the Vickers Shipbuilding and Engineering Works clinic. Of all workmen, 5.5% showed pleural plaques. Among the 81 joiners the figure was 33%, nearly double the percentage found in the 45 laggers. Detailed examinations were then offered to 185 shipyard joiners and 90 building-contractor joiners, and 177 attended. Of these, 62 (35%) had pleural plaques, mostly uncalcified, and 5 had probable pulmonary fibrosis. Of 39 men who had never worked in a shipyard, 7 had plaques. Death certificates over ten years showed no deviation from average for any cause of death among Barrow joiners, though the author warned it may be too early for an effect. Fourteen deaths of joiners with plaques included 6 bronchial carcinomas and 1 mesothelioma, which the author said had no statistical significance. The author stated there was no proof of the cause but considered an asbestos insulation board containing 30% amosite the most likely.

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: Radiographic (chest X-ray) survey: a review of routine chest films of shipyard and engineering workers, followed by chest X-ray examinations of joiners
• Who was studied: First part: 4,223 sets of routine chest films of Vickers Shipbuilding and Engineering Works employees, excluding females and men under 25. Second part: 185 shipyard joiners and 90 joiners working for building contractors in Barrow in Furness were offered examinations, and 177 attended. Survey dates are not given.
• Exposure: Work as a joiner, mainly in a shipyard. Joiners handled many materials, including asbestos, and might work near laggers on board ship. The author considered a proprietary asbestos insulation board containing 30% amosite the most likely cause. It was sometimes cut with a handsaw in cabins and other confined spaces.
• Main results:
  • In the review of 4,223 sets of routine chest films, 5.5% of all workmen had evidence of pleural plaques.
  • In the routine films, 33% of 81 joiners had pleural plaques, nearly double the percentage found in the 45 laggers. The OCR does not render the laggers' exact percentage reliably.
  • In the survey of 177 joiners, 62 (35%) had pleural plaques. Of these, 50 (28.2%) had soft tissue density only (uncalcified) and 12 (6.8%) had calcification.
  • Plaques rose with age: none of 17 joiners aged 15 to 24 had plaques, compared with 25 of 39 (64%) aged 45 to 54. The figure fell to 14 of 25 (56%) in those aged 55 to 64, which the author suggested may reflect less exposure in the past.
  • Apart from plaques, occasional cases of diffuse pleural thickening were seen among the surveyed joiners, and 5 joiners had probable pulmonary fibrosis.
  • Of 39 surveyed men who had never been in a shipyard, 7 had uncalcified plaques. The author estimated that, if this small group is representative, about 18% of joiners in building work have plaques.
  • Death certificates for the last ten years showed no deviation from average figures for any cause of death among Barrow joiners. The author noted it may be too early for an effect to be observed.
  • There were 14 successive deaths of joiners with plaques in recent years, including 6 bronchial carcinomas and 1 mesothelioma. The author said these numbers had no statistical significance but may be the beginning of a trend.
• The authors' conclusion: The author stated that there was no proof of the cause of these changes, but considered a proprietary asbestos insulation board containing 30% amosite the most likely cause.
• Limitations the authors state:
  • The author stated there was no proof of the cause of the changes seen.
  • The author noted it may be too early for an effect to show in death certificates.
  • The number of deaths was too small for statistical significance.
  • The estimate for building-work joiners rests on a small group of 39 men who may not be representative.
  • Possible early plaques in two joiners aged 24 need a few years of follow-up to be certain.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Plaques, Posteroanterior (PA) View, Insulator, Diffuse Pleural Thickening, Pulmonary Fibrosis, Amosite, Death Certificate, Carcinoma.

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• Asbestos-related chest diseases: plain radiographic findings — W.T. Miller, W.B. Gefter, et al. (1992)
• Chest radiographs in subjects with asbestos-related abnormalities: comparison between ILO categorizations and clinical reading — B. Hilt, A. Borgerson, et al. (1992)
• Nonmalignant respiratory disease mortality among woodworkers participating in the American Cancer Society Cancer Prevention Study-II (CPS-II) — P.A. Demers, S.D. Stellman, et al. (1998)
• Chest pain in asbestos-exposed individuals with benign pleural and parenchymal disease — S. Mukherjee, N. de Klerk, et al. (2000)

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