Comments on the 2014 Helsinki Consensus Report on Asbestos

Our plain-English summary of Comments on the 2014 Helsinki Consensus Report on Asbestos, by P.J. Landrigan, Collegium Ramazzini (Annals of Global Health, 2016).

The study

• Authors: P.J. Landrigan, Collegium Ramazzini
• Journal: Annals of Global Health
• Published: 2016;82(1):217-20
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The Finnish Institute of Occupational Health (FIOH) convened an Expert Committee in 2014 to update the 1997 and 2000 Helsinki criteria on asbestos, asbestosis, and cancer.

Methods: The Collegium Ramazzini reviewed the criteria for pathological diagnosis of the diseases caused by asbestos presented in the 2014 Helsinki Consensus Report and compared them with the widely used diagnostic criteria developed in 1982 by the College of American Pathologists and the National Institutes of Occupational Safety and Health (CAP-NIOSH).

Findings: The sections of the Helsinki Consensus Report dealing with pathological diagnosis are based on a biased and selective reading of the scientific literature. They are heavily influenced by the outdated and incorrect concept that analysis of lung tissue for asbestos bodies and asbestos fibers can provide accurate information on past exposure to asbestos. Five specific problems are :

Conclusion: Accurate diagnosis of the diseases caused by asbestos must be based on a carefully obtained history of occupational exposure. An accurate exposure history is a far more sensitive and specific indicator of asbestos exposure than asbestos body counting or lung fiber burden analysis.

Ethical Note: The sections of the 2014 Helsinki Consensus Report on asbestos, asbestosis, and cancer dealing with pathologic diagnosis of the diseases caused by asbestos appear to have been influenced by members of the Expert Committee with undisclosed financial conflicts of interest.

Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

In plain English

This commentary is not a research study. The author wrote it on behalf of the Collegium Ramazzini. It reviewed the sections of the 2014 Helsinki Consensus Report on asbestos, asbestosis, and cancer that deal with pathological diagnosis. The authors argued that these sections rest on a selective reading of the literature, and they named five problems. First, the report relied too much on asbestos bodies, which chrysotile rarely forms. Second, it relied too much on lung fiber counts, which the authors called highly insensitive for chrysotile. Third, it used low-magnification scanning electron microscopy, which they said cannot detect most chrysotile fibers. Fourth, it did not recognize that chrysotile is the predominant fiber in pleural mesothelioma tissue. Fifth, it postulated a threshold for asbestos-related lung cancer, although published studies, they wrote, support a linear dose-response without a threshold. They stated that these sections appear to have been influenced by committee members with undisclosed financial conflicts of interest. The authors concluded that accurate diagnosis must be based on a carefully obtained occupational exposure history. They said lung biopsy and lung tissue examination to diagnose pulmonary fibrosis, including asbestosis, are never ethically justified solely for medicolegal 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 (critique of a consensus report); no original data
• Who was studied: No people were studied; the subject is the pathology-diagnosis sections of the 2014 Helsinki Consensus Report, compared with the 1982 CAP-NIOSH diagnostic criteria
• Exposure: Asbestos, with particular attention to chrysotile; methods of assessing exposure (asbestos bodies, lung fiber counts, electron microscopy, occupational history)
• Main results:
  • The authors argued that the pathology sections of the Helsinki report are based on a selective reading of the literature
  • The authors criticized the report's suggested guideline of over 1000 asbestos bodies per gram of dry tissue (100 per gram of wet tissue), or over 1 per milliliter of bronchoalveolar lavage fluid, for identifying persons with a high probability of asbestos exposure
  • The authors stated that lung fiber counts are a highly insensitive measure of past chrysotile exposure
  • The authors stated that low-magnification scanning electron microscopy cannot detect most chrysotile fibers
  • The authors stated, citing other studies, that chrysotile is the predominant asbestos fiber in pleural mesothelioma tissue, and criticized the report for not recognizing this
  • The authors objected to the report implying a threshold for asbestos-related lung cancer, stating that published studies support a linear dose-response relationship without a threshold
  • The authors noted that the 1997 report estimated a 0.5-4.0% increase in relative lung cancer risk per fiber-year, while the 2014 report used 4%; they said it chose the upper end of the range without explanation
  • The authors stated that the pathology sections appear to have been influenced by committee members with undisclosed financial conflicts of interest
  • The authors recommended against requiring lung biopsy, lung tissue histopathological examination, or lung tissue fiber counts to diagnose pulmonary fibrosis, including asbestosis, in medicolegal or compensation cases, and stated that such invasive diagnostic procedures are never ethically justified solely for those purposes
• The authors' conclusion: The authors concluded that accurate diagnosis of asbestos-caused diseases must be based on a carefully obtained occupational exposure history, which they considered more sensitive and specific than asbestos body counting or lung fiber burden analysis

Topics

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

Medical terms in this study, explained in our Lexicon: Helsinki Criteria, Collegium Ramazzini, NIOSH, Asbestos Bodies, Occupational Exposure, Exposure History, Asbestos Exposure, Asbestos Body Formation.

Related studies

• 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 — C. Ramazzini (2016)
• Comments on the 2014 Helsinki consensus report on asbestos — (2016)
• 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)
• Comments on the Causation of Malignant Mesothelioma: Rebutting the False Concept That Recent Exposures to Asbestos Do Not Contribute to Causation of Mesothelioma — P.J. Landrigan, Collegium Ramazzini (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)

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