Cellular and molecular basis of the asbestos-related diseases

Our plain-English summary of Cellular and molecular basis of the asbestos-related diseases, by A. Cosentino, M.L. Warnock (The American Review of Respiratory Disease, 1992).

The study

• Authors: A. Cosentino, M.L. Warnock
• Journal: The American Review of Respiratory Disease
• Published: 1992;145(1):238-9
• Type of article: Comment, Letter
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 004125).

In plain English

This letter to the editor answered a 1991 review by Rom and colleagues. The review stated that asbestos-related lung cancer occurs on a background of alveolitis (lung inflammation) and probably cannot be separated from inflammation and fibrosis in workers exposed over 20 years. The letter's authors disagreed and examined the review's four cited human studies. Doll's cases, they argued, were chosen for having asbestosis, so could not show whether asbestos causes lung cancer without it. The second study appeared only as an abstract. The third was not designed for the question, lacked asbestos bodies in eight to 12 cases, and checked no unexposed lung cancer cases for fibrosis. The fourth, by Warnock and Isenberg, found no fibrosis in 10 of 60 lung cancer cases with moderate to high fiber concentrations. The authors concluded that the evidence linking inflammation and fibrosis to lung cancer was inconclusive. From the fourth study, they hypothesized that the lung fiber burden associated with asbestosis can cause lung cancer without asbestosis, given sufficient latency. Such cases, they said, must be evaluated individually using exposure history and lung fiber burdens.

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: Letter to the editor commenting on a published review (Rom and colleagues, 1991); no new data
• Who was studied: No study population of its own; the letter discussed four human studies cited in the review
• Exposure: Asbestos exposure in general (no fiber type named); the question was whether asbestos causes lung cancer without asbestosis
• Main results:
  • The review, as quoted by the letter, stated that asbestos-related lung cancer occurs on a background of alveolitis
  • The review, as quoted, also stated that lung carcinogenesis probably cannot be separated from inflammation and fibrosis in asbestos workers with more than 20 years of exposure
  • In Doll's study, cited by the review, the cases were selected because they had asbestosis, so in the letter authors' view it cannot show whether asbestos causes lung cancer without asbestosis
  • The second cited study (Hughes and Weill) was based on data presented only in abstract form
  • In the third cited study, of insulation workers who died of lung cancer, asbestos bodies were lacking in eight to 12 cases, depending on the series
  • The third cited study examined no lung cancer cases without asbestos exposure for fibrosis, so fibrosis related to the tumor itself was not controlled for
  • The fourth cited study (Warnock and Isenberg, 1986) found no gross or microscopic fibrosis in 10 of 60 lung cancer cases with moderate to high asbestos fiber concentrations
  • In that fourth study, degree of fibrosis did not differ significantly between persons with and without moderate to high asbestos fiber burdens
  • Based on the fourth study, the letter's authors hypothesized that the same lung burden of asbestos fibers associated with asbestosis can cause lung cancer without asbestosis, given a sufficient latency period
  • The letter's authors stated that such cases must be evaluated individually using exposure history supported by lung asbestos fiber burdens
• The authors' conclusion: The authors concluded that the evidence linking alveolar inflammation and fibrosis to lung cancer is inconclusive. They believe that, because people respond differently to asbestos, some will have an asbestos-related cancer without asbestosis, and that such cases should be evaluated individually using exposure history supported by lung fiber burdens.

Topics

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

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