Comments on the 2014 helsinki consensus report on asbestos

Our plain-English summary of Comments on the 2014 helsinki consensus report on asbestos, by C. Ramazzini (Journal of Occupational Health, 2016).

The study

• Author: C. Ramazzini
• Journal: Journal of Occupational Health
• Published: 2016;58(2):224-7
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This is a letter to the editor, not a research study, from the Collegium Ramazzini, an international scientific society. It criticized the pathology diagnosis sections of the 2014 Helsinki consensus report on asbestos, asbestosis and cancer. The authors argued that chrysotile asbestos rarely forms asbestos bodies and stays only briefly in lung tissue. In their view, failing to find asbestos bodies or fibers in the lung cannot contradict exposure shown by a reliable work history. They said the report's asbestos-body thresholds had no reliable basis and that low-magnification scanning electron microscopy cannot detect most chrysotile fibers. They recommended analytical transmission electron microscopy instead. They also faulted the report for choosing the upper end (4%) of an earlier estimate that lung cancer risk rises 0.5-4.0% per fiber-year, without explanation. The letter stated that these sections appear to have been influenced by committee members with undisclosed financial conflicts of interest. The authors concluded that a careful occupational history is the cornerstone of diagnosis. They recommended against requiring lung biopsy or lung tissue analysis to diagnose pulmonary fibrosis, including asbestosis, in medico-legal or compensation cases.

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 by a scientific society on a published consensus report; no new data)
• Who was studied: No people were studied. The letter comments on the 2014 Helsinki consensus report, prepared by an expert committee convened by the Finnish Institute of Occupational Health.
• Exposure: Asbestos in general, with emphasis on chrysotile asbestos
• Main results:
  • The authors argued that chrysotile rarely forms asbestos bodies. They said there is no reliable basis for the Helsinki report's proposed asbestos-body thresholds, such as over 1000 asbestos bodies per gram of dry tissue.
  • The authors argued that failing to find asbestos bodies cannot be used to contradict a reliable occupational history of exposure, particularly to chrysotile
  • The authors argued that asbestos fiber counts in lung tissue are a highly insensitive measure of past chrysotile exposure, because chrysotile fibers have only a short residence time in lung tissue
  • The authors noted that short asbestos fibers, less than 5 microns long, are not discussed in the Helsinki report
  • The authors stated that low-magnification scanning electron microscopy cannot detect most chrysotile fibers. They recommended analytical transmission electron microscopy (ATEM) instead.
  • The authors said multiple studies show chrysotile is the predominant asbestos fiber type found in pleural mesothelioma tissue, which the Helsinki report did not recognize
  • The 1997 Helsinki report had estimated that lung cancer relative risk rises 0.5-4.0% per fiber-year. The authors said the 2014 report used the upper end (4%, with 25 fibre-years doubling the risk) without explanation. They also said it ignored studies supporting a linear dose-response without a threshold.
  • The authors stated that the pathology sections appear to have been influenced by Helsinki committee members with undisclosed financial conflicts of interest
  • The authors recommended against requiring lung biopsy, lung tissue histopathology or lung fiber counts to diagnose pulmonary fibrosis, including asbestosis, in medico-legal or compensation cases
  • In the authors' opinion, such invasive diagnostic procedures are never ethically justified solely for medico-legal or compensation purposes
• The authors' conclusion: The authors concluded that a carefully obtained occupational history is the cornerstone of accurate diagnosis of asbestos-related diseases

Related studies

• Comments on the 2014 Helsinki Consensus Report on Asbestos — P.J. Landrigan, Collegium Ramazzini (2016)
• Collegium Ramazzini: Comments on the 2014 Helsinki consensus report on asbestos — X. Baur, A.L. Frank, et al. (2016)
• Comments on the 2014 Helsinki consensus report on asbestos — (2016)
• 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)
• A Critique of Helsinki Criteria for Using Lung Fiber Levels to Determine Causation in Mesothelioma Cases — T. Tran, D. Egilman, et al. (2021)

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