Asbestos-related malignancy

Our plain-English summary of Asbestos-related malignancy, by K.H. Antman (Critical Reviews in Oncology/hematology, 1986).

The study

• Author: K.H. Antman
• Journal: Critical Reviews in Oncology/hematology
• Published: 1986;6(3):287-309
• Type of article: Review
• Cited by: 4 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. 000370).

Abstract

Due to the known association with asbestos exposure, malignant mesothelioma has assumed an importance out of proportion to its incidence in the American population (2.2 per million). Patients present with chest pain, shortness of breath, or both. The initial chest X-ray generally reveals a large unilateral pleural effusion. A large piece of tissue obtained via open biopsy is usually required for histologic diagnosis. Investigational approaches include multiple needle biopsies obtained for electron microscopy, as well as for immunoperoxidase staining for keratin and CEA. The tumor characteristically remains localized until late in its course. The treatment of mesothelioma remains unsatisfactory. However, anecdotes report long-term disease-free survival after intensive treatment. Palliation with a response rate of up to 30% to various chemotherapeutic regimens has been reported by a number of investigators.

In plain English

This article was a review by the author of published work on asbestos-related malignancy: lung, laryngeal and gastrointestinal cancer, lymphoproliferative disorders and mesothelioma. It also covered mesothelioma pathology, diagnosis and treatment. The review stated that the lifetime risk of lung (bronchogenic) cancer in asbestos workers, approximately one in four, exceeded that of mesothelioma, one in ten. It stated that smoking asbestos workers had up to a 60- to 90-fold risk compared with nonsmoking nonexposed workers. It described laryngeal and gastrointestinal cancer relative risks as small, some studies finding no excess, and lymphoproliferative disorder data as inconclusive. Asbestos contact was documented in perhaps one half to two thirds of malignant pleural mesothelioma patients; incidence peaked 35 to 45 years after first exposure. Large cancer centers reported 30 to 40% response rates for doxorubicin- or cisplatin-containing regimens in relatively small numbers of patients, against 0 to 10% in large multicenter studies; the review cited patient selection, treatment intensity and small numbers as possible explanations. The author described intensive combined treatment protocols as investigational until longer survival is documented.

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: Review of published literature on asbestos-related cancers and on the pathology, diagnosis and treatment of mesothelioma
• Who was studied: Published studies of asbestos-exposed people (primary asbestos workers, people working with or around asbestos products, household contacts of asbestos workers, residents near mines and mills) and of patients with mesothelioma. It also summarized a previously reported series from the author's group of 13 patients with peritoneal mesothelioma presenting since 1982.
• Exposure: Asbestos exposure in general (occupational, household and residential). The review discussed chrysotile and the amphiboles, stating that chrysotile appears less carcinogenic than the needle-like amphiboles. It also covered mesotheliomas linked to radiation and to zeolite.
• Main results:
  • Asbestos workers: lifetime risk of bronchogenic (lung) carcinoma approximately one in four, compared with one in ten for mesothelioma, as cited in the review
  • Asbestos workers: nonsmokers may have a lung cancer risk of 1 to 5 times that expected; smokers have up to a 60- to 90-fold risk compared with nonsmoking nonexposed workers, as cited in the review
  • Household members of asbestos workers: the risk of mesothelioma approaches 1% per person, and the total risk to an asbestos worker's family may be as high as 4%. The risk to the asbestos worker is stated as 8 to 13%.
  • Patients with malignant pleural mesothelioma: asbestos contact was documented in perhaps one half to two thirds
  • Mesothelioma: peak incidence occurs 35 to 45 years after first exposure, though cases have occasionally developed 20 years or less after first exposure
  • Laryngeal cancer in large cohorts of workers: relative risks appear small (one to three times), and some reports found no detectable excess risk
  • Gastrointestinal cancer in asbestos workers: relative risks have been small (less than 3), and at least three studies found no significant excess risk
  • Lymphoproliferative disorders in asbestos workers: the data were described as inconclusive regarding more than an incidental association
  • Mesothelioma chemotherapy at large cancer centers: response rates of 30 to 40% for doxorubicin- or cisplatin-containing regimens, in relatively small numbers of patients
  • Mesothelioma chemotherapy in large multicenter studies: response rates of 0 to 10%
  • The review gave several possible explanations for the difference between large centers and multicenter studies: patient selection, more intensive therapy at large centers, and statistical factors from small numbers
  • Pleural mesothelioma, radiotherapy at the Dana Farber Cancer Institute: relief of symptoms was complete or substantial in only 5 of 29 courses
  • The author's group's peritoneal mesothelioma series: none of the 7 patients with inoperable tumor had objective responses; all 6 patients with limited disease responded when evaluated by second laparotomy. Median survival of the limited-disease patients was at least 24 months.
• The authors' conclusion: The author concluded that intensive combined treatment protocols for mesothelioma remain investigational until prolonged survival in treated patients is documented. The author also stated that standard radiotherapy seems to offer little in survival or palliation for pleural mesothelioma.
• Limitations the authors state:
  • Many of the laryngeal cancer studies reviewed did not control for tobacco or alcohol use
  • In the gastrointestinal cancer studies, cause of death came from death certificates, so peritoneal mesotheliomas may have been mistakenly identified as gastrointestinal carcinomas
  • Differences in chemotherapy response rates between series may partly reflect small patient numbers
  • Selection bias in nonrandomized comparisons makes the effect of surgery on survival difficult to evaluate

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Malignant Mesothelioma, Chest X-Ray, Pleural Effusion, Biopsy, Mesothelioma, Disease-Free Survival.

Related studies

• Asbestos-related malignancy — J.A. Talcott, K.H. Antman (1988)
• Should uncertainty concerning the risk of malignancy be included in diagnostic (nongynecologic) cytopathology reports? — D.N. Poller, F. Schmitt (2021)
• How the industrial physician can reduce mortality from asbestos-related diseases — R.J. Levine (1978)
• Asbestos-related diseases of the lung and other organs: their epidemiology and implications for clinical practice — M.R. Becklake (1976)
• Use of antisera to epithelial membrane antigen for the cytodiagnosis of malignancy in serous effusions — A. To, D.V. Coleman, et al. (1981)
• The association of asbestos and malignancy — J.G. Gillis (1965)

Browse more research in Critical Reviews in Oncology/hematology, or return to medical research.