Asbestosis and primary intrathoracic neoplasms

Our plain-English summary of Asbestosis and primary intrathoracic neoplasms, by W.D. Buchanan (Annals of the New York Academy of Sciences, 1965).

The study

• Author: W.D. Buchanan
• Journal: Annals of the New York Academy of Sciences
• Published: 1965;132(1):507-18
• Cited by: 53 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. 002498).

Abstract

The findings of a continuing study by the Medical Branch of H.M. Factory Inspectorate, Ministry of Labour, of information recorded on death certificates of persons dying with asbestosis are presented. Arrangements are in force whereby copies of all such certificates are received routinely by the Medical Branch. It is considered, for reasons outlined, including the high proportion of such cases coming to autopsy, that this method is a reasonably accurate one of assessing both the incidence of all recognized cases as asbestosis and of complications ensuing.

A review of the literature indicates that the possibility of carcinoma of the lungs or bronchi as a complication had been expressed prior to 1947. Nevertheless, it is believed that the first series in which the incidence of lung carcinoma had been related to a sizeable group of asbestosis deaths was that published in the 1947 Annual Report of the Chief Inspector of Factories. Similar reports followed in 1954 and 1955.

Up to the end of 1963, 584 death certificates recording the presence of asbestosis have been obtained and the annual totals of such certificates are currently increasing. The proportion recording a thoracic tumor is also in both sexes continuing to increase disproportionately to the total number, so that currently over 50 per cent of males dying with asbestosis present have also a neoplasm. Data on the mean age at death over various periods of time of male and female asbestosis cases indicate an improving prognosis where the asbestosis is uncomplicated but no significant improvement where complicated by cancer. Suggestions to account for this and also the yearly increasing total of recorded cases of asbestosis are put forward.

The conclusion of the study is that even when viewed against the steadily rising incidence of lung cancer in the population as a whole, there seems little doubt that there is a special risk of an intrathoracic tumor if asbestosis is also present in the lungs.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This paper from Britain's Factory Inspectorate analyzed death certificates recording asbestosis. Registrars General for England and Wales and for Scotland supplied the certificates routinely. It also briefly reviewed early reports linking asbestosis with lung cancer. By the end of 1963 there were 584 deaths: 392 males and 192 females. Overall, 30.9 per cent of males and 13 per cent of females had a lung tumor. In 1961-1963, 42 of 77 male certificates (54.5 per cent) and 4 of 18 female certificates (22.2 per cent) recorded a cancer or mesothelioma. In the general population in 1962, primary lung or bronchial cancer caused 7.5 per cent of deaths in males aged 20 and over and 1.4 per cent in females. Average age at death rose in both sexes for uncomplicated asbestosis, but improved very little in the large male cancer group. The author noted that the population at risk was unknown, and that smoking and greater recognition of minor asbestosis may play a part. The author concluded there seemed little doubt of a special risk of intrathoracic tumor when asbestosis is present.

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: Descriptive analysis of death certificates recording asbestosis, collected over many years by the Medical Branch of H.M. Factory Inspectorate. It includes a brief historical review of earlier reports and has no population-at-risk denominator.
• Who was studied: 584 deaths in Great Britain (England and Wales, and Scotland) in which asbestosis was recorded on the death certificate: 392 males and 192 females. The tables cover 1924 to 1963.
• Exposure: Asbestosis recorded on the death certificate, diagnosed during life or found at autopsy. Fiber types, products and doses were not analyzed, and occupational histories were not followed up after the mid-1950s.
• Main results:
  • In the complete series, a lung tumor was recorded in 30.9 per cent of males and 13 per cent of females who died with asbestosis.
  • In 1961-1963, a cancer or mesothelioma was also recorded on 42 of 77 male asbestosis death certificates (54.5 per cent) and on 4 of 18 female certificates (22.2 per cent).
  • For comparison, in the general population in 1962, primary lung or bronchial cancer caused 7.5 per cent of deaths in males aged 20 and upwards and 1.4 per cent of deaths in females.
  • The ratio of the male to female percentage dying with a lung tumor was 2.4 to 1 among asbestosis deaths, compared with 5.4 to 1 in the general population in 1962.
  • Four cases were recorded as mesothelioma of pleura, two as cancer of the pleura and one as sarcoma of the pleura. If all seven were assumed to be mesotheliomas, they made up 1.2 per cent of asbestosis deaths, or 1.5 per cent in males only.
  • Eight cases were recorded as cancer of the ovary, abdominal cancer or malignant peritonitis. The author suspected some may have been mesothelioma of the peritoneum.
  • An earlier Inspectorate analysis (1947 Annual Report) found lung cancer in 13.2 per cent of 235 asbestosis deaths (both sexes), compared with 1.32 per cent of 6,884 deaths certified as silicosis.
  • Average age at death lengthened in both sexes for uncomplicated asbestosis.
  • In the large male group with cancer, average age at death improved very little. The small female group with cancer varied considerably.
• The authors' conclusion: The author concluded that, even against the rising incidence of lung cancer in the general population, there seemed little doubt of a special risk of an intrathoracic tumor when asbestosis is present in the lungs.
• Limitations the authors state:
  • Without knowing the size of the population at risk, death certificate data cannot give attack rates.
  • Greater awareness and compensation policies may lead to a lung cancer being linked on the certificate to minor asbestosis that was not causal. Recent totals may include people dying 'with' rather than 'from' asbestosis.
  • Lung cancer was increasing in the population as a whole, and other influences such as cigarette smoking also operate in people with asbestosis.
  • Apart from the early years, the data rest only on what was recorded on death certificates, without follow-up of occupational histories.
  • The totals probably understate the number of people dying with asbestosis.
  • The complete age-at-death data were inconclusive on whether the earlier age difference still held.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Lung cancer.

Medical terms in this study, explained in our Lexicon: Intrathoracic, Neoplasm, Death Certificate, Autopsy, Carcinoma, Bronchus, Prognosis, Lung Cancer.

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