Collegium Ramazzini: Comments on the 2014 Helsinki consensus report on asbestos

Our plain-English summary of Collegium Ramazzini: Comments on the 2014 Helsinki consensus report on asbestos, by X. Baur, A.L. Frank, L.T. Budnik, et al (American Journal of Industrial Medicine, 2016).

The study

• Authors: X. Baur, A.L. Frank, L.T. Budnik, H.J. Woitowitz, L.C. Oliver, L.S. Welch, P. Landrigan, R. Lemen, Collegium Ramazzini
• Journal: American Journal of Industrial Medicine
• Published: 2016;59(7):591-4
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This is a commentary, not a research study. It was written on behalf of the Collegium Ramazzini, an international society of occupational and environmental medicine. It criticizes the pathology sections of the 2014 Helsinki consensus report on asbestos, asbestosis and cancer. The authors argued that chrysotile, the main asbestos in use today, rarely forms asbestos bodies and stays only briefly in lung tissue. Because of this, they said, failing to find asbestos bodies or fibers in the lung cannot contradict a reliable occupational history. They objected to the report's guideline of over 1000 asbestos bodies per gram of dry tissue, to its use of low-magnification scanning electron microscopy, and to its silence on short fibers. They also objected to its more restrictive pathology definition of asbestosis. On lung cancer, they criticized the report's use of a 4% risk increase per fiber-year, the upper end of an earlier 0.5 to 4.0% range. The authors concluded that a carefully obtained occupational history is the cornerstone of diagnosis. They also concluded that lung biopsy is never ethically justified solely for legal or compensation purposes.

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: Commentary (expert opinion critiquing a consensus report); no new data were collected
• Who was studied: No study population. The subject is the pathology diagnosis sections of the 2014 Helsinki consensus report on asbestos, asbestosis and cancer.
• Exposure: Asbestos in general, with particular focus on chrysotile and on how past exposure is judged from lung tissue analysis versus occupational history
• Main results:
  • The authors objected to the Helsinki report's guideline that over 1000 asbestos bodies per gram of dry tissue (100 per gram of wet tissue), or over 1 per milliliter of lavage fluid, identifies a high probability of exposure. They said there is no reliable basis for such thresholds.
  • The authors argued that lung fiber counts are a highly insensitive measure of past chrysotile exposure because chrysotile fibers stay only a short time in lung tissue.
  • The authors noted that the Helsinki report does not discuss short asbestos fibers, those less than 5 microns long.
  • The authors said low-magnification scanning electron microscopy misses most chrysotile fibers. They recommended analytical transmission electron microscopy (ATEM) for fiber analysis instead.
  • The authors stated that chrysotile is the predominant fiber type found in pleural mesothelioma tissue, though it is relatively scarce in lung tissue, and that the Helsinki report does not recognize this.
  • The authors criticized the 2014 report for replacing the CAP-NIOSH 1982 asbestosis definition with the more restrictive CAP/Pulmonary Pathology Society (PPS) modification, without explanation.
  • The 1997 Helsinki report estimated that lung cancer relative risk rises 0.5 to 4.0% per fiber-year. The 2014 report used 4%, so that 25 fiber-years doubles risk. The authors said this chose the upper end of the range without explanation and implied a threshold, whereas they cited studies supporting a linear dose-response with no threshold.
  • The authors recommended against requiring lung biopsy, lung histopathology or lung fiber counts to diagnose pulmonary fibrosis, including asbestosis, in medico-legal or compensation cases.
• The authors' conclusion: The authors concluded that a carefully obtained occupational exposure history, taken by an experienced clinician and supplemented as needed by an industrial hygienist's assessment, is the cornerstone of accurate diagnosis of asbestos-caused disease.

Topics

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

Medical terms in this study, explained in our Lexicon: Collegium Ramazzini.

Related studies

• Comments on the 2014 Helsinki Consensus Report on Asbestos — P.J. Landrigan, Collegium Ramazzini (2016)
• Comments on the 2014 helsinki consensus report on asbestos — C. Ramazzini (2016)
• Comments on the 2014 Helsinki consensus report on asbestos — (2016)
• Dr. T.K. Joshi and asbestos in India: a message from the Collegium Ramazzini — P. Landrigan (2004)
• Collegium Ramazzini call for an international ban on asbestos — P.J. Landrigan, M. Soffritti (2005)
• Collegium Ramazzini statement on the Tokyo Declaration banning asbestos — P.J. Landrigan, M. Soffritti (2005)

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