Correlation between fibre content of lung and disease in east London asbestos factory workers

Our plain-English summary of Correlation between fibre content of lung and disease in east London asbestos factory workers, by R.M. Rudd (British Journal of Industrial Medicine, 1989).

The study

• Author: R.M. Rudd
• Journal: British Journal of Industrial Medicine
• Published: 1989;46(5):358-9
• Type of article: Comment, Letter
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000151).

In plain English

This item is a letter to the editor, not a research study. The author commented on a 1988 paper by Wagner and colleagues that reported asbestos fibre counts in the lungs of asbestos workers with various diseases and in control subjects. The author criticised that paper for giving only group averages, with no statistical analysis or measure of variation. The author questioned whether the controls (east London lung cancer surgery patients said to have no occupational asbestos exposure) were truly unexposed if this was judged from hospital records rather than detailed work histories. The author also argued that between 1976 and 1984, lung cancer cases in asbestos workers in whom clinical asbestosis had not been diagnosed were usually not reported to coroners. The author argued that, as a result, the paper's lung cancer cases were likely selected for having asbestosis. The author concluded that the data did not justify conclusions about how often and how severely asbestosis occurs in lung cancer compared with mesothelioma. The supplied text also includes a reply by Wagner and colleagues, who disputed some of the author's points.

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 (correspondence) criticising a previously published study; it reports no new data of its own
• Who was studied: The letter discusses the subjects of Wagner et al's 1988 study. These were asbestos factory workers whose cases went to the pneumoconiosis medical panel after coroners' postmortems between 1976 and 1984, and control subjects who were lung cancer surgery patients living mainly in east London.
• Exposure: Asbestos fibre content of lung tissue in workers from an east London asbestos factory where, according to the author, chrysotile was used extensively
• Main results:
  • The author criticised the Wagner et al paper for having no statistical analysis and for giving only mean values for the groups compared, without any measure of variation.
  • The author calculated a mean asbestos fibre count of 11.2 million per gram of dry lung in the control group (31.3% of 35.8 million). The author argued this was higher than in the control group of an earlier study by Wagner and colleagues, where the median appeared to be much less than 10 million.
  • The author argued that if the controls' lack of asbestos exposure was taken from hospital records rather than detailed work histories, the information was unreliable, because many east Londoners had held jobs with some asbestos exposure.
  • The author argued that between 1976 and 1984, cases of lung cancer in asbestos workers in whom clinical asbestosis had not been diagnosed were usually not reported to the coroner, whereas mesothelioma cases were more commonly reported whether or not asbestosis was present.
  • The author argued that during 1976 to 1984 lung cancer could be compensated by the Pneumoconiosis Medical Panel only if asbestosis was also present. The author therefore considered the original authors' view that selection bias was unlikely to be almost certainly incorrect.
  • As support for selection bias, the author pointed to the absence of any lung cancer cases with the lowest grade of asbestosis, and of any lung cancer cases without asbestosis.
  • In their reply, Wagner et al said the author's calculation wrongly equated percentage of average with average of percentages. They also confirmed that the controls' occupational histories came from routine hospital records.
  • In their reply, Wagner et al stated that 42 of the 56 controls had crocidolite and amosite fibre counts of less than 1 million per gram of lung tissue, while all but two of the asbestos workers exceeded 10 million.
• The authors' conclusion: The author concluded that the data presented by Wagner et al did not justify conclusions about the frequency and severity of asbestosis in patients with lung cancer and mesothelioma.

Related studies

• Correlation between fibre content of the lung and disease in east London asbestos factory workers — J.C. Wagner, M.L. Newhouse, et al. (1988)
• Correlation between fibre content of the lungs and disease in naval dockyard workers — J.C. Wagner, C.B. Moncrieff, et al. (1986)
• Mortality of factory workers in east London 1933-80 — M.L. Newhouse, G. Berry, et al. (1985)
• Mortality from all cancers of asbestos factory workers in east London 1933-80 — G. Berry, M.L. Newhouse, et al. (2000)
• Pulmonary asbestos and dust content in East Anglia — P.G. Stovin, P. Partridge (1982)
• Long term radiological effects of short term exposure to amosite asbestos among factory workers — R. Ehrlich, R. Lilis, et al. (1992)

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