Criteria for attributing lung cancer to asbestos exposure

Our plain-English summary of Criteria for attributing lung cancer to asbestos exposure, by P.T. Cagle (American Journal of Clinical Pathology, 2002).

The study

• Author: P.T. Cagle
• Journal: American Journal of Clinical Pathology
• Published: 2002;117(1):9-15
• Type of article: Comment, Editorial
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This editorial commented on a study by Mollo and coworkers of 924 consecutive lobectomies and pneumonectomies for lung cancer in northwest Italy. That study attributed 6% of the cancers to asbestos because of a histologic diagnosis of asbestosis. It raised the possibility that another 0.5% were asbestos-related: cases with interstitial fibrosis, no asbestos bodies on histologic section, but an elevated asbestos body concentration on digestion study. The author discussed criteria for attributing an individual lung cancer to asbestos. He stated that tobacco smoking causes about 90% of lung cancers and that asbestos is estimated to account for 2% to 5%, or about 3,400 to 8,500 new US cases each year. He argued that one or a few asbestos bodies on tissue sections, or pleural plaques, are not reliable criteria by themselves because they can occur below the exposure needed for lung cancer risk. He cited a series of 234 cases by Roggli and Sanders in which all patients with more than 50,000 amphibole fibers per gram of wet lung had asbestosis except 10 patients. He noted that occult asbestosis, if it exists, is extremely rare, and that the fibrosis in the Mollo cases might have other causes, including the cancer itself and smoking. He reported that no unique molecular marker for asbestos-related lung cancer has been identified. He concluded that asbestosis is currently the only consistently reliable marker, especially in smokers.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article is an editorial, not an original study. The author commented on a separate study by Mollo and coworkers in the same issue. That study reviewed 924 consecutive lung cancer operations in northwest Italy and raised the possibility that another 0.5% of cases, with fibrosis and a raised asbestos body count on digestion study but none on tissue sections, were asbestos-related. The author discussed whether sufficient asbestos tissue burden alone, or with asbestosis, should be the criterion for attributing lung cancer to asbestos. The author called tobacco smoke a powerful confounding factor. The author argued that one or a few asbestos bodies on tissue sections, depending on circumstances, and pleural plaques are not reliable criteria alone. Citing a separate study by Roggli and Sanders, the author reported that 10 of 155 patients without asbestosis (6.5%) had amphibole burdens above 50,000 fibers per gram of wet lung. The author stated that occult asbestosis, if it exists, is extremely rare and that no unique molecular marker has been found. The author concluded that asbestosis is the only consistently reliable marker of asbestos-related lung cancer.

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: Editorial (an opinion and commentary piece discussing other published studies; no new data)
• Who was studied: The author studied no patients. The editorial discussed a separate study by Mollo and coworkers of 924 consecutive lung cancer resections in northwest Italy, along with other published literature.
• Exposure: Asbestos exposure in general, measured as dose or lung tissue burden (amphibole fibers in the Roggli and Sanders data the author discussed). Tobacco smoke was discussed as a confounding cause of lung cancer.
• Main results:
  • According to the editorial, Mollo and coworkers found that another 0.5% of their cases had interstitial fibrosis without asbestos bodies on histologic section but with an elevated asbestos body concentration on digestion study.
  • The author argued that one asbestos body on tissue sections, or even a few depending on circumstances, and pleural plaques are not reliable criteria by themselves for causally linking a lung cancer to asbestos exposure on the basis of tissue burden.
  • The author drew on Table 6 of a separate study by Roggli and Sanders (234 lung cancer cases). In that study, all patients with burdens above 50,000 amphibole fibers per gram of wet lung tissue, measured by scanning electron microscopy, had asbestosis except 10 patients. Those 10 were 6.5% of the 155 patients without asbestosis.
  • The author stated that the literature indicates occult asbestosis, if it exists, is much rarer than the 0.5% of cases Mollo and coworkers raised.
  • The author noted that the asbestos body cutoff Mollo and coworkers used for a level sufficient to produce asbestosis is lower than what others have reported.
  • The author stated that no unique molecular marker for asbestos-related lung cancer has been identified.
• The authors' conclusion: The author concluded that, unless and until a better marker is found, asbestosis is the only consistently reliable marker of an asbestos-related lung cancer, especially in asbestos workers who also smoke.
• Limitations the authors state:
  • The author acknowledged that the published data cannot show whether the patients in the Roggli and Sanders series who had high asbestos burdens but no asbestosis had asbestos-related lung cancers.
  • The author noted that laboratories measure and report asbestos tissue burden by different methods, which makes studies hard to compare.

Topics

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

Medical terms in this study, explained in our Lexicon: Lung Cancer, Asbestos Exposure, Interstitial Fibrosis, Asbestos Bodies, Asbestos Body Formation, Pleural Plaques, Amphibole Group, Fibers Per Gram.

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• A comparison of asbestos fiber potency and elongate mineral particle (EMP) potency for mesothelioma in humans — D.H. Garabrant, S.T. Pastula (2018)
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• Mechanistic in vitro studies: What they have told us about carcinogenic properties of elongated mineral particles (EMPs) — B.T. Mossman (2018)

Browse more research in American Journal of Clinical Pathology, or return to medical research.