Asbestos-related lung cancers: A retrospective clinical and pathological study

Our plain-English summary of Asbestos-related lung cancers: A retrospective clinical and pathological study, by M. Uguen, J.D. Dewitte, P. Marcorelles, et al (Molecular and Clinical Oncology, 2017).

The study

• Authors: M. Uguen, J.D. Dewitte, P. Marcorelles, B. Loddé, R. Pougnet, P. Saliou, M. De Braekeleer, A. Uguen
• Journal: Molecular and Clinical Oncology
• Published: 2017;7(1):135-139
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Exposure to asbestos results in serious risks of developing mesothelioma and lung cancer. The link between asbestos exposure and lung carcinoma is well established. Nevertheless, precise histopathological data are poorly considered when investigating the asbestos-cancer link in a compensatory approach. In the present study, we aim to describe the features of individuals with compensated lung cancer who were referred to an occupational disease center, regarding occupational exposure to asbestos, smoking history and pathological data. We led a retrospective study of compensated ARLC cases seen in our occupational disease center between 2003 and 2013. A total of 146 men were included (mean age at diagnosis, 63.2 years) of whom approximately 90% were heavy current or former smokers (mean value, 30.4 packs/year). The major industries associated with the lung cancer cases were shipbuilding (69.9%), and building construction (7.5%) in this harbor region. The results of the present study showed that lung upper lobe was most prevalent (61.6%) and an excess of adenocarcinoma was found (45.9%), followed by squamous cell carcinoma (38.4%) as well as thoracic sarcomas (2.1%). Neoplasm was not histologically proven in 6.8% of the cases. Subsequent pathology examinations also reclassified 2 tumors as metastases from esophageal and laryngeal origins. In conclusion, smoking prevention should be encouraged in asbestos-exposed workers as reflected by the number of smokers with asbestos-related lung cancer. Thus, histological data should be considered further to evaluate the potent relationship between asbestos exposure and lung malignancy, especially in a compensatory approach.

In plain English

This retrospective study from an occupational disease center in Brest, France, described 146 men whose lung cancer had been financially compensated as asbestos-related between 2003 and 2013. Their mean age at diagnosis was 63.2 years. Most had smoked: 79.5% (116/146) were ex-smokers and 10.3% (15/146) current smokers, while 5.5% (8/146) had never smoked. Ship building and repair was the main industry (69.9%, 102/146), followed by building construction (7.5%, 11/146). Asbestos exposure lasted 28.3 years on average. Tumors were most often in the upper lobe (61.6%, 90/146). Adenocarcinoma was the most frequent type (45.9%, 67/146), followed by squamous cell carcinoma (38.4%, 56/146). Three tumors were sarcomas. Two tumors were later reclassified as spread from esophageal and laryngeal cancers. In 6.8% (10/146) cancer was never confirmed by tissue examination. Almost half (49.3%) had pleural plaques, and one man had asbestosis. The authors concluded that the cases argued strongly for smoking cessation in asbestos-exposed workers. They also concluded that tissue findings should be considered when judging whether a lung tumor is asbestos-related.

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: Retrospective descriptive case series of compensated asbestos-related lung cancers, with no comparison group
• Who was studied: 146 men with lung cancer compensated as asbestos-related, seen at the occupational disease center of Brest University Hospital, France, between 2003 and 2013. Mean age at diagnosis was 63.2 years (plus or minus 9.9; range 37 to 85).
• Exposure: Occupational asbestos exposure, mainly in ship building and repair (69.9%, 102/146), building construction (7.5%, 11/146) and electricity (4.8%, 7/146). The materials quoted most often were thermal insulation (64 times), asbestos dust on equipment (58), seal coating (41), thermal protection workstation (33) and asbestos cement (25). Mean exposure duration was 28.3 years (plus or minus 10.1). Fiber types were not reported.
• Main results:
  • Smoking among the 146 men: 79.5% (116/146) ex-smokers, 10.3% (15/146) current smokers, 5.5% (8/146) never smokers, no data for 4.8% (7/146). Mean consumption among ex-smokers and smokers was printed as 30.4 packs/year (plus or minus 16.9).
  • Tumor location: upper lobe 61.6% (90/146), lower lobe 21.2% (31/146), middle lobe 3.4% (5/146), lower and middle lobe 2.1% (3/146), no data 11.6% (17/146).
  • Tumor type: adenocarcinoma 45.9% (67/146), squamous cell carcinoma 38.4% (56/146), small cell lung carcinoma 4.8% (7/146), and undifferentiated/sarcomatoid carcinoma 2.1% (3/146).
  • Three tumors were sarcomas: two without further specification (1.4%, 2/146) and one dedifferentiated liposarcoma (0.7%, 1/146).
  • Further pathology review reclassified two tumors as lung metastases: one of an esophageal adenocarcinoma and one of a primary laryngeal squamous cell carcinoma.
  • In 6.8% (10/146) of cases there was no histological (tissue) proof of cancer. Diagnosis rested only on radiological data.
  • Under the French occupational disease tables, 52.1% (76/146) were compensated under Table 30 and 46.6% (68/146) under Table 30 bis, with no data for 2 patients.
  • Other findings among the 146 men: pleural plaques in 49.3% (72/146), pleural thickening in 13% (19/146) and asbestosis in 0.7% (1/146).
• The authors' conclusion: The authors concluded that their results were broadly in line with other studies and that the cases strongly argued for the importance of smoking cessation in asbestos-exposed workers. They said histological data have to be considered when evaluating the link between asbestos and a lung malignancy, because the link is insufficiently proven for non-carcinoma tumors and cancers originating outside the lung, except mesothelioma.

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Mesothelioma, Asbestos Exposure, Carcinoma, Occupational Disease, Occupational Exposure, Adenocarcinoma, Squamous Cell Carcinoma.

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