Asbestosis and small cell lung cancer in a clutch refabricator

Our plain-English summary of Asbestosis and small cell lung cancer in a clutch refabricator, by J.L. Levin, M.F. O'Sullivan, C.J. Corn, et al (Occupational and Environmental Medicine, 1999).

The study

• Authors: J.L. Levin, M.F. O'Sullivan, C.J. Corn, M.G. Williams, R.F. Dodson
• Journal: Occupational and Environmental Medicine
• Published: 1999;56(9):602-5
• Type of article: Case report
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: To present a case of asbestosis and small cell lung cancer caused by asbestos in a clutch refabricator.

Methods: Exposed surfaces of used clutches similar to those refabricated in the worker's workplace were rinsed, and the filtrate analysed by analytical transmission electron microscopy. Tissue samples were also analysed by this technique.

Results: Numerous chrysotile fibres of respirable dimensions and sufficient length to form ferruginous bodies (FBs) were detected from rinsed filtrates of the clutch. Bronchoalveolar lavage fluid contained many FBs, characteristic of asbestos bodies. Necropsy lung tissue showed grade 4 asbestosis and a small cell carcinoma in the right pulmonary hilum. Tissue analysis by light and analytical electron microscopy showed tissue burdens of coated and uncoated asbestos fibres greatly exceeding reported environmental concentrations (3810 FBs/g dry weight and 2,080,000 structures > or = 0.5 micron/g dry weight respectively). 72% Of the cores were identified as chrysotile.

Conclusions: Clutch refabrication may lead to exposure to asbestos of sufficient magnitude to cause asbestosis and lung cancer.

In plain English

This case report described a 59-year-old man who worked as a clutch rebuilder and sorter from 1966 to 1990, drilling rivets to remove used clutch facings. He had smoked one to one and a half packs of cigarettes a day for 35 to 40 years. Bronchoscopy washings contained many ferruginous bodies consistent with asbestos bodies. A biopsy of a right hilar mass showed small cell carcinoma, and he died of respiratory failure. Necropsy showed grade 4 asbestosis and small cell carcinoma at the right lung hilum. Rinsings from six used clutch pads like those refabricated at the workplace contained numerous respirable chrysotile fibres. The lung tissue held 3810 ferruginous bodies per gram dry weight. More than 72% of the analysed cores were chrysotile, 9% amosite and 9% tremolite. At 20 000 times magnification, uncoated fibres longer than 0.5 µm numbered 2 080 000 structures per gram dry weight. The only uncoated asbestos type in the scanned area was chrysotile. The authors concluded that clutch refabrication may cause asbestos exposure sufficient to cause asbestosis and lung cancer. They noted that no air sampling existed.

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 (one worker), with electron microscopy analysis of lung tissue and of material rinsed from used clutches
• Who was studied: one 59-year-old man who had worked as a clutch rebuilder and sorter from 1966 to 1990 and had smoked one to one and a half packs of cigarettes a day for 35 to 40 years; he lived in the East Texas region (Tyler, Texas institution)
• Exposure: chrysotile asbestos from used clutches during refabrication; the worker drilled rivets from clutches to remove used facings from the plates; no airborne measurements were available
• Main results:
  • Rinsings from six used clutch pads similar to those refabricated in the workplace contained numerous bundles and separated fibres of chrysotile asbestos, many of respirable size
  • Bronchoscopy washings from the worker contained many ferruginous bodies consistent with asbestos bodies
  • Necropsy showed severe bilateral interstitial fibrosis graded as grade 4 asbestosis, and small cell carcinoma at the right lung hilum with metastasis
  • The worker died of respiratory failure after chemotherapy was started
  • Light microscopy counted 3810 ferruginous bodies per gram dry weight of lung tissue, which the authors said clearly exceeds levels in people with environmental exposures
  • Of the analysed ferruginous body cores, more than 72% were chrysotile, 9% amosite and 9% tremolite. The rest were totally coated and could not be analysed
  • Uncoated fibres in lung tissue numbered 1 216 000 structures per gram dry weight at the lower magnification scan. At 20 000 times magnification they numbered 2 080 000 structures per gram dry weight, because that count included shorter fibres longer than 0.5 µm
  • The only uncoated asbestos fibre type found in the scanned area was chrysotile, with fibres up to 44 µm long
• The authors' conclusion: The authors concluded that clutch refabrication may lead to exposure to asbestos of sufficient magnitude to cause asbestosis and lung cancer
• Limitations the authors state:
  • No air sampling was done, so airborne exposures in the workplace could not be measured
  • The small percentage of amphibole fibres could have come from other, unidentified exposures

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: Small Cell Lung Cancer, Analytical Transmission Electron Microscopy (ATEM), Chrysotile, Ferruginous Bodies, Bronchoalveolar Lavage (BAL), Asbestos Bodies, Autopsy, Carcinoma.

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