Asbestosis And Bronchogenic Carcinoma: Report Of One Autopsied Case And Review Of The Available Literature

Our plain-English summary of Asbestosis And Bronchogenic Carcinoma: Report Of One Autopsied Case And Review Of The Available Literature, by K.J. Isselbacher, H. Klaus, H.L. Hardy (1953).

The study

• Authors: K.J. Isselbacher, H. Klaus, H.L. Hardy
• Published: American Journal Of Medicine 15(5):721-732, November (1953)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library, J-M no. 001897. The article is still under copyright, so we describe it here rather than post it.

In plain English

This 1953 article reported one autopsied case and reviewed published literature on asbestos exposure and lung cancer. The patient was a 41-year-old asbestos mill worker admitted to Massachusetts General Hospital in April 1951. He had worked about twelve years in a mill, including five years in a carding room where authorities had found fiber levels considerably above the accepted safe level. He also smoked one to two packs of cigarettes daily. A ten-day trial of ACTH, a hormone treatment, produced no objective change. Lung tests showed an oxygen diffusion defect. At autopsy he had diffuse lung fibrosis and asbestosis bodies in all sections. He also had an adenocarcinoma arising in the lingula of the left upper lobe that had spread to the heart and a lumbar vertebra. In five published series the authors tabulated, 83 of 603 deaths with asbestosis (13.8 per cent) involved lung cancer. Reported rates in routine autopsies were 0.8 to 2.4 per cent. The authors concluded that asbestos may act as a carcinogen through chronic mechanical irritation, and they raised smoking as a possible second cause.

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: Case report of one autopsied patient, plus a review of the published literature on asbestosis and lung cancer
• Who was studied: One 41-year-old male asbestos mill worker (E. R.) admitted to Massachusetts General Hospital, Boston, in April 1951; the review also tabulated published series and 19 previously recorded autopsied cases of asbestosis with lung cancer
• Exposure: About twelve years in an asbestos mill: one year in the 'picker room' (crushing, grinding and sorting of long asbestos fibers) and five years in the carding room, where authorities had found the fiber concentration considerably above the safe level (stated as five million particles per cubic foot of air). Fiber type is not specified. He also smoked one to two packs of cigarettes daily for many years and used snuff.
• Main results:
  • At autopsy, the patient had an adenocarcinoma originating in the inferior lingual segment of the left upper lobe bronchus. It had spread through both lungs, extended into the pericardium and myocardium, and metastasized to the fourth lumbar vertebra.
  • In this patient, asbestosis bodies were present in all lung sections, with diffuse fibrosis throughout the lungs.
  • In this patient, widespread squamous metaplasia of the bronchial epithelium was found.
  • X-ray diffraction of a lung tissue sample from this patient indicated that the residue was mostly asbestos.
  • Lung testing in this patient showed an alveolar-arterial oxygen gradient of 27 mm Hg, which the authors interpreted as a defect in oxygen diffusion. Cardiac catheterization showed pulmonary hypertension that increased with exercise.
  • ACTH, 100 mg daily by injection for ten days, produced no objective changes in this patient's clinical course; the only effect noted was euphoria.
  • In the literature review, the five published series in the authors' Table III together recorded 83 lung cancers among 603 deaths with asbestosis, an average of 13.8 per cent. The largest of these, Merewether's series, had 31 among 235 cases (13.2 per cent).
  • The authors compared the asbestosis series with routine autopsies from other sources, where lung cancer ranged from 0.8 to 2.4 per cent over a comparable period (1935 to 1948).
  • Among the 20 autopsied cases of asbestosis with lung cancer listed in Table IV (19 previously reported plus this one), the tumor began in the lower lobes in about four-fifths of the cases where the primary site was given.
  • Twelve of the nineteen previously recorded cases in Table IV were of the squamous cell type.
  • The authors noted that the patient was both exposed to asbestos dust and a chain smoker, which raised the possible role of two causes.
• The authors' conclusion: The authors concluded that the association of lung cancer with asbestosis is more than coincidence. They proposed that the asbestos particle may serve as a carcinogen because of the chronic mechanical irritation it produces. They also wrote that a higher incidence of lung cancer should be expected among the roughly 10,000 workers in potentially hazardous asbestos operations in the United States.
• Limitations the authors state:
  • The authors cautioned that no conclusions should be drawn from the small number of cases in Table IV.
  • The authors noted that few reported cases of lung cancer linked to industrial asbestos exposure give data on the character and quantity of dust exposure, which they called a serious gap for studying causes.

Topics

Medical terms in this study, explained in our Lexicon: Bronchogenic Carcinoma, Asbestos Exposure, Lung Cancer, Carding, Autopsy, Fibrosis, Adenocarcinoma.

Browse return to medical research.