Asbestos related disease in Barrow-in-Furness

Our plain-English summary of Asbestos related disease in Barrow-in-Furness, by J.R. Edge (Environmental Research, 1976).

The study

• Author: J.R. Edge
• Journal: Environmental Research
• Published: 1976;11(2):244-7
• Cited by: 40 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. 002269).

Summary of the article

The author described asbestos-related disease in Barrow-in-Furness, a British shipbuilding town where asbestos use peaked before and during World War II and captured German ships were stripped and refitted after the war. A 1968 radiographic survey of every tenth shipyard workman found pleural plaques in about 6% and pulmonary fibrosis in under 0.5%. Among 100 consecutive autopsies in 1970, 35 of 72 men had plaques. Since 1966, 28 histologically confirmed pleural mesotheliomas had arisen. The average time since first exposure was 35 (20-45) years, and the average survival after diagnosis was 18 (5-35) months. In a prospective study, 235 men with plaques were followed for 4 years or more. Of these, 70 died: 17 from mesothelioma and 13 from bronchial carcinoma, against 5.4 bronchial carcinoma deaths expected (2.4 times; P = 0.001). The author also compared 156 men with plaques with 156 age-matched men with normal radiographs taken in 1962-1969. The plaque group had 48 versus 28 deaths, 8 versus 3 bronchial carcinoma deaths, and 13 versus 2 mesothelioma deaths. Autoantibody levels in 160 men with plaques did not differ significantly from those in the general British population. The author concluded that shipyard workers with plaques, without fibrosis, had a 2.5 times increased risk of bronchial carcinoma, and that these serological tests were unlikely to be useful for screening.

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 report described asbestos-related disease among shipyard workers in Barrow-in-Furness, Great Britain. A 1968 X-ray survey of every tenth shipyard worker found pleural plaques in about 6% and pulmonary fibrosis in less than half of 1%. In 100 consecutive autopsies, 35 of 72 men had pleural plaques. Since 1966, 28 confirmed cases of pleural mesothelioma had arisen, on average 35 years after first exposure, with average survival of 18 months after diagnosis. Of 235 men with plaques followed 4 years or more, 70 died, 13 from bronchial carcinoma against 5.4 expected, a 2.4-fold risk. A second comparison set 156 men with plaques against 156 age-matched men with normal X-rays: deaths were 48 versus 28, bronchial carcinoma 8 versus 3, and mesothelioma 13 versus 2. The author noted that these controls had also been exposed to asbestos. The author concluded that these workers with plaques, without evidence of pulmonary fibrosis, had a 2.5 times increased risk of bronchial carcinoma compared with matched controls. Autoantibody levels in 160 men with plaques did not differ significantly from those of Britain's general population.

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: Short report combining a one-in-ten radiographic survey, an autopsy series, a case series of pleural mesothelioma, a prospective follow-up of men with pleural plaques (with a matched control comparison), and a study of circulating autoantibodies
• Who was studied: Shipyard workers and men of Barrow-in-Furness, Great Britain. The parts were: a 1968 survey of every tenth workman on the shipyard payroll; 100 consecutive autopsies (72 men) in 1970; 28 pleural mesothelioma cases since 1966; 235 men with plaques first X-rayed 1955 to 1969; 156 men with plaques first X-rayed 1962 to 1969 compared with 156 matched controls; and 160 workmen with plaques in the autoantibody study
• Exposure: Asbestos exposure in shipbuilding. Use was greatest before and during World War II, with heavier exposure when captured German ships were stripped out and refitted after the war. No fiber type is named.
• Main results:
  • In the 1968 one-in-ten radiographic survey of shipyard workers, about 6% of men had pleural plaques and less than half of 1% had pulmonary fibrosis
  • In 100 consecutive unselected autopsies (subjects over 20) in 1970, 35 of the 72 men had pleural plaques. The author suggested the true prevalence is substantially higher than the 6% seen on radiographs.
  • The autopsy series included five mesotheliomas
  • About 400 men with plaques were expected in the works from the survey prevalence, but 579 men with X-ray changes due to plaques came to notice
  • Since 1966, 28 histologically confirmed cases of pleural mesothelioma had arisen, with eight further suspected cases being evaluated
  • Of the 28 pleural mesothelioma patients, 22 had pleural effusions at some stage and six had metastases
  • In the mesothelioma patients, average time since first exposure was 35 years (range 20 to 45), and average survival from diagnosis to death was 18 months (range 5 to 35)
  • Among the 28 mesothelioma patients, pleural plaques were present on radiographs in 20 and at autopsy in two more. Plaques were definitely absent in three, and five were awaiting evaluation.
  • Of 235 men with plaques followed for 4 years or more, 70 died
  • Among the 235 men with plaques, 13 deaths from bronchial carcinoma were observed against 5.4 expected (from Registrar General's returns), an increased risk of 2.4 times (chi-square 10.7, P = 0.001), described as statistically highly significant
  • Over a 4-year follow-up, 156 men with plaques first X-rayed 1962 to 1969 had 48 deaths, compared with 28 among 156 age-matched men with normal radiographs. Deaths from bronchial carcinoma were 8 versus 3, and from mesothelioma 13 versus 2.
  • The excess of bronchial carcinoma in the plaque group versus matched controls was statistically significant (O/E = 2.6, chi-square 8.3, p = 0.004)
  • Circulating autoantibody levels (rheumatoid factor and antinuclear factor) in 160 workmen with pleural plaques did not differ significantly from those of the general population of Britain
• The authors' conclusion: The author concluded that this group of shipyard workers with pleural plaques (without evidence of pulmonary fibrosis) had a 2.5 times increased risk of bronchial carcinoma compared with matched controls without plaques. The author also concluded that the serological tests are unlikely to be a useful screening test for susceptibility to pleural changes after asbestos exposure.
• Limitations the authors state:
  • No control radiographs from before 1962 could be obtained because chest films are routinely destroyed after 10 years
  • The control group had also been exposed to asbestos: there were two mesothelioma deaths among them, and most had worked in the shipyard
  • The follow-up was ongoing, and an unexposed control group from a neighboring town was still being sought

Topics

Medical terms in this study, explained in our Lexicon: Pleural Plaques, Pulmonary Fibrosis, Pleural Mesothelioma, Mesothelioma, Carcinoma, Fibrosis.

Related studies

• Malignant mesothelioma of the pleura in Barrow-in-Furness — J.R. Edge, S.L. Choudhury (1978)
• Epidemiology of asbestos-related diseases — R.A. Lemen, J.M. Dement, et al. (1980)
• Experience with asbestos disease and its control in Great Britain's naval dockyards — P.G. Harries (1976)
• Work-related respiratory disease in the United Kingdom, 1989-1992: report on the SWORD project — S.K. Meredith, J.C. McDonald (1994)
• Occupational and work-related respiratory disease attributed to cleaning products — M. Carder, M.J. Seed, et al. (2019)
• SWORD '93. Surveillance of work-related and occupational respiratory disease in the UK — B.A. Sallie, D.J. Ross, et al. (1994)

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