Asbestos-related diseases of the lung and other organs: their epidemiology and implications for clinical practice

Our plain-English summary of Asbestos-related diseases of the lung and other organs: their epidemiology and implications for clinical practice, by M.R. Becklake (The American Review of Respiratory Disease, 1976).

The study

• Author: M.R. Becklake
• Journal: The American Review of Respiratory Disease
• Published: 1976;114(1):187-227
• Type of article: Review
• Cited by: 454 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. 002259).

In plain English

This article was a review, not an original study. The author reviewed published research, much of it from international conference proceedings, on diseases linked to asbestos, including chrysotile, crocidolite, amosite and anthophyllite. The aim was to weigh epidemiologic findings for their meaning in clinical practice. The review covered pleural plaques, benign pleural effusion, asbestosis, pleural and peritoneal mesothelioma, lung cancer and other cancers, and exposure at work, at home and in the neighborhood. The author reported that the reviewed studies consistently found a relationship between estimated dose and response, although dose estimates were crude. Mesothelioma risk was described as greatest with crocidolite, less with amosite and apparently even less with chrysotile. Mesothelioma had also been documented after apparently low, brief neighborhood or household exposure. In people exposed to both asbestos and smoking, the combined lung cancer risk was described as considerably more than additive, probably multiplicative. Relative risks of lung cancer differed considerably between studies, many of which had small numbers of deaths. The author concluded that effective health protection lies in environmental control.

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: Narrative review ("State of the Art" article) of published epidemiologic, clinical, pathologic and experimental literature
• Who was studied: No new study population. The author drew on published studies of asbestos-exposed workers, people with household or neighborhood exposure, and autopsy series, relying heavily on proceedings of international asbestos conferences (New York 1964, Dresden 1968, Lyon 1972, Johannesburg 1959 and 1969).
• Exposure: Asbestos of all commercial fiber types (chrysotile, crocidolite, amosite, anthophyllite, tremolite, actinolite). The review covered occupational exposure in mining, milling, manufacturing and secondary uses such as construction, shipbuilding and automotive repair, as well as domestic, neighborhood and environmental exposure.
• Main results:
  • Across the reviewed studies, a relationship between estimated dose and biologic response (lung fibrosis and lung cancer) was a consistent finding, in mining, manufacturing and secondary use.
  • Mesothelioma risk was described as differing by fiber: greatest with crocidolite, less with amosite, apparently even less with chrysotile. This followed the conclusions of the Advisory Committee at the Lyon meeting.
  • Mesothelioma had a documented association with apparently low levels of exposure for brief periods in the remote past from neighborhood or domestic sources.
  • Lung cancer appeared to develop only very rarely in exposed nonsmokers. The risk from exposure to both asbestos and cigarettes was considerably more than additive, and probably multiplicative.
  • Relative risks of lung cancer in mortality studies of male asbestos workers were consistently raised but differed considerably between studies in degree.
• The authors' conclusion: The author concluded that no medical measures can protect an exposed person's health, because effective protection lies in environmental control. Good work practices and quitting or not smoking were described as the best "medical measures" for the individual worker.
• Limitations the authors state:
  • In epidemiologic studies, dose estimates were crude, based on years of service, years since first exposure, or estimated job dustiness, often with scanty or no past dust measurements.
  • Most lung cancer mortality studies involved relatively small numbers of deaths, so risk estimates could be influenced by the addition or loss of one case.

Topics

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

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

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