Comments on the 2014 Helsinki consensus report on asbestos

Our plain-English summary of Comments on the 2014 Helsinki consensus report on asbestos (Industrial Health, 2016).

The study

• Journal: Industrial Health
• Published: 2016;54(1):94-7
• Read it: PubMed · Publisher · Free full text

Abstract

The Collegium Ramazzini is an international scientific society that examines critical issues in occupational and environmental medicine with a view towards action to prevent disease and promote health. The Collegium derives its name from Bernardino Ramazzini, the father of occupational medicine, a professor of medicine of the Universities of Modena and Padua in the late 1600s and the early 1700s. The Collegium is comprised of 180 physicians and scientists from 35 countries, each of whom is elected to membership. The Collegium is independent of commercial interests.

In plain English

This is not a research study but a position statement by the Collegium Ramazzini, an international society of physicians and scientists, on the 2014 Helsinki consensus report on asbestos, asbestosis and cancer. It presented no new data. The Collegium said it was very concerned about the report's pathology sections. It argued that chrysotile asbestos rarely forms asbestos bodies and has a short residence time in lung tissue. In its view, failing to find asbestos bodies or fibers cannot contradict a reliable occupational history of exposure. It said there was no reliable basis for the report's threshold of over 1,000 asbestos bodies per gram of dry tissue. It also said low-magnification scanning electron microscopy cannot detect most chrysotile fibers. It criticized the report for using a 4% rise in lung cancer risk per fibre-year, the top of an earlier 0.5 to 4.0% range, without explanation. It said those sections appeared influenced by committee members with undisclosed financial conflicts of interest. The authors concluded that a carefully obtained occupational history is the cornerstone of diagnosis, and that lung biopsy solely for compensation purposes is never ethically justified.

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 / position statement by a scientific society criticizing a consensus report; no original study or data
• Who was studied: No people were studied. The subject is the 2014 Helsinki consensus report convened by the Finnish Institute of Occupational Health. The statement comes from the Collegium Ramazzini, a society of 180 physicians and scientists from 35 countries.
• Exposure: Asbestos in general, with particular focus on chrysotile asbestos, and on how lung tissue analysis (asbestos bodies, fiber counts) is used to judge past exposure
• Main results:
  • The authors argued that because chrysotile rarely forms asbestos bodies, failing to find asbestos bodies cannot be used to exclude chrysotile exposure.
  • The authors criticized the Helsinki report's guideline of over 1,000 asbestos bodies per gram of dry tissue (or over 1 per milliliter of bronchoalveolar lavage fluid). They said there is no reliable basis for such thresholds.
  • The authors stated that chrysotile fibers stay only a short time in lung tissue, so lung fiber counts cannot measure cumulative past exposure.
  • The authors noted that the Helsinki report did not discuss short asbestos fibers (less than 5 microns long).
  • The authors said low-magnification scanning electron microscopy (SEM) should not be used to attribute disease to asbestos. They recommended analytical transmission electron microscopy (ATEM) instead.
  • The authors cited multiple other studies as showing that chrysotile is the predominant asbestos fiber found in pleural mesothelioma tissue. They said the Helsinki report did not recognize this.
  • On lung cancer, the 1997 Helsinki report gave a 0.5 to 4.0% risk increase per fiber-year. The authors said the 2014 report used 4% (a 2-fold risk at 25 fibre-years) without explanation. They also said it implied a threshold, while published studies support a linear dose-response without a threshold.
  • The authors stated that the pathology sections appeared to have been influenced by committee members with undisclosed financial conflicts of interest.
  • The authors recommended against requiring lung biopsy or lung tissue analysis to diagnose pulmonary fibrosis, including asbestosis, in medico-legal or compensation cases.
• The authors' conclusion: The authors concluded that a carefully obtained occupational history is the cornerstone of accurate diagnosis of asbestos-caused disease. In their view, such a history is more sensitive and specific for lung cancer risk from chrysotile than asbestos body counting or lung fiber burden analysis.

Topics

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)
• Collegium Ramazzini: Comments on the 2014 Helsinki consensus report on asbestos — X. Baur, A.L. Frank, et al. (2016)
• Canada, chrysotile and cancer: Health Canada's Asbestos International Expert Panel report — L.T. Stayner (2008)
• After Helsinki: a multidisciplinary review of the relationship between asbestos exposure and lung cancer, with emphasis on studies published during 1997-2004 — D.W. Henderson, K. Rödelsperger, et al. (2004)
• Asbestos, asbestosis, and cancer: The Helsinki criteria for diagnosis and attribution. Critical need for revision of the 2014 update — X. Baur, H.J. Woitowitz, et al. (2017)

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