Commentary regarding the article by Fischer et al.: Fibre years, pulmonary asbestos burden and asbestosis. Int. J. Hyg. Environ. Health 205, 245-248 (2002)

Our plain-English summary of Commentary regarding the article by Fischer et al.: Fibre years, pulmonary asbestos burden and asbestosis. Int. J. Hyg. Environ. Health 205, 245-248 (2002), by K. Rödelsperger, H.J. Woitowitz (International Journal of Hygiene and Environmental Health, 2003).

The study

• Authors: K. Rödelsperger, H.J. Woitowitz
• Journal: International Journal of Hygiene and Environmental Health
• Published: 2003;206(3):245-7; author reply 251-2
• Type of article: Comment, Letter
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This letter to the editor responded to a 2002 paper by Fischer et al., which concluded that 25 fibre-years of estimated cumulative exposure, introduced in 1992 into German lung cancer compensation, was insufficient on its own to judge asbestosis. The letter's authors re-analysed Fischer's figures. Among 64 patients with at least minimal asbestosis and over 700 asbestos bodies per cm3 of lung, 37 (58%) had estimates of 25 fibre-years or more. Among 193 patients without elevated asbestos body counts, 38 (20%) did. The authors called this difference statistically significant (chi-square test). They put the sensitivity at 58% and the specificity at 80%. In their own mesothelioma case-control data, they tested the 25 fibre-year cutoff against 1500 asbestos bodies per gram of wet lung, a Helsinki Criteria marker of doubled lung cancer risk: sensitivity was 25% for 147 controls and 60% for 66 cases, and specificity 97% and 79%. The authors concluded that fibre-year estimates should stay in use for compensation decisions. They noted that estimates below 25 fibre-years can occur even when asbestos body and amphibole fibre levels are clearly raised.

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 (commentary) re-analysing data published by Fischer et al. (2002) and comparing them with the authors' own earlier mesothelioma case-control data
• Who was studied: Fischer et al.'s patients: a total group of 366, including a group of 193 patients without elevated lung asbestos burden and a group of 64 patients with at least minimal asbestosis and more than 700 asbestos bodies per cm3. Also the authors' own German case-control study: 66 mesothelioma cases and 147 controls.
• Exposure: Estimated cumulative occupational asbestos exposure in fibre-years (the 25 fibre-year criterion), compared with asbestos burden in lung tissue measured as asbestos bodies (per cm3 in Fischer et al.; per gram wet lung in the authors' data)
• Main results:
  • In Fischer et al.'s group of 64 patients with at least minimal asbestosis, 27 (42%) were classed as false negatives because their exposure estimates were below 25 fibre-years
  • The authors compared 37 of 64 patients (58%) with at least minimal asbestosis against 38 of 193 patients (20%) without elevated asbestos burden, all with 25 fibre-years or more. By chi-square test with Yates correction, they reported the difference at the 0.001 level (the comparison sign is lost in the text).
  • Calculated from Fischer et al.'s data: sensitivity 58% (about 700 or more asbestos bodies per cm3 relative to the 25 fibre-year estimate) and specificity 80%
  • In the authors' own case-control data, they examined how well the 25 fibre-year estimate identified lung burden relative to a boundary of 1500 asbestos bodies per gram wet lung. These boundaries point to a 2-fold risk of lung cancer under the Helsinki Criteria. Sensitivity was 25% for the 147 controls and 60% for the 66 mesothelioma cases. These are not measures of diagnosing mesothelioma.
  • In the same comparison against the 1500 asbestos bodies per gram wet lung boundary, specificity was 97% for the controls and 79% for the mesothelioma cases
  • From the authors' earlier publication (Rödelsperger et al. 1999): odds ratios for mesothelioma calculated from lung burden data showed a steep, almost linear dose-response, rising up to an odds ratio of about 100, for amphibole asbestos only and not for chrysotile
• The authors' conclusion: The authors supported continued use of fibre-year estimates for industrial disease adjudication, which they described as essentially a stochastic exercise. They said their data did not conflict with Fischer et al.'s. They also said that, following the Helsinki Criteria, lung tissue asbestos body or fibre analysis should supplement the occupational history when fibre-year estimates are below 25.
• Limitations the authors state:
  • The authors noted that the sensitivity of fibre-year estimates may be too low: estimates below 25 fibre-years can be obtained even when asbestos body and amphibole fibre concentrations are unequivocally increased
  • The authors stated that the 25 fibre-year and 1500 asbestos bodies per gram boundaries, which relate to a 2-fold lung cancer risk under the Helsinki Criteria, are not appropriate for deciding whether a mesothelioma is asbestos-related

Topics

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

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