Criteria for the diagnosis of asbestosis and considerations in the attribution of lung cancer and mesothelioma to asbestos exposure. Prepared by the Medical Advisory Panel to the Asbestos International Association

Our plain-English summary of Criteria for the diagnosis of asbestosis and considerations in the attribution of lung cancer and mesothelioma to asbestos exposure. Prepared by the Medical Advisory Panel to the Asbestos International Association (International Archives of Occupational and Environmental Health, 1982).

The study

• Journal: International Archives of Occupational and Environmental Health
• Published: 1982;49(3-4):357-61
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000689).

Summary of the article

The Medical Advisory Panel to the Asbestos International Association, whose 15 listed members came from several countries, set out criteria for diagnosing asbestosis and considerations for attributing mesothelioma and lung cancer to asbestos exposure. The panel defined asbestosis as diffuse, irreversible fibrosis of the lung parenchyma caused by respirable airborne asbestos fibres. Its criteria were evidence of substantial occupational or para-occupational exposure, persistent basal inspiratory crackles, radiographic basal diffuse interstitial fibrosis recorded using the ILO classification, and a restrictive pattern of lung function. It stated that breathlessness, clubbing and asbestos bodies in sputum were not diagnostic on their own, that biopsy was seldom justified, and that the term "pleural asbestosis" was undesirable. For mesothelioma, the panel stated that most cases were related to asbestos and that latency was usually 20 to 40 years or longer. In industrial populations no relationship with asbestos could be established in 10% to over 30% of cases. Smoking played no part, and opinion was divided on whether risk differed by fibre type. It stated that recent work did not support the idea that any slight, casual or brief exposure may lead to mesothelioma. For lung cancer, it stated that cigarette smoking was the primary cause and that risk was greater at higher asbestos exposure. It also stated that no pathological feature allowed a case to be attributed solely to asbestos, and that lower levels of past exposure did not pose a detectable excess risk. Evidence on cancers of other sites was described as equivocal.

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 1982 consensus document reported no new research data. It set out diagnostic criteria from the Asbestos International Association's Medical Advisory Panel, with members from ten countries. For asbestosis, a diffuse fibrosis of the lung, the panel called for evidence of substantial occupational or para-occupational exposure. It said biopsy was very seldom justified and called the term "pleural asbestosis" undesirable, since pleural changes can occur without lung fibrosis. When mesothelioma was attributable to asbestos, it gave a usual latency from initial exposure to disease onset of 20 to 40 years or longer. In industrial populations, it said, no asbestos link could be established in 10% to over 30% of mesothelioma cases. It said many believed risk was greatest with crocidolite, less with amosite and apparently less with chrysotile, a view lacking unanimous support. On lung cancer, it said no pathological features allow an individual case to be attributed solely to asbestos. It cited epidemiological evidence that lower past exposure levels posed no detectable excess risk of bronchogenic (lung) cancer. It called the evidence on cancer at other sites equivocal.

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: Consensus document of diagnostic criteria and attribution considerations prepared by an expert panel; not an original study and no new data
• Who was studied: No study population. The document was written by a 15-member panel from Australia, Italy, the UK, Denmark, Belgium, Canada, the USA, Lebanon, France and South Africa, and addresses asbestos-exposed workers in general
• Exposure: Respirable airborne asbestos fibres in general. The mesothelioma section discusses crocidolite, amosite, chrysotile and anthophyllite
• Main results:
  • The panel stated that diagnosing asbestosis requires evidence of substantial occupational (or substantial para-occupational) exposure to asbestos fibres
  • The panel stated that biopsy is very seldom justified for diagnosing asbestosis
  • Because pleural changes can occur without parenchymal fibrosis, the panel considered the term "pleural asbestosis" undesirable
  • The panel stated that when mesothelioma is attributable to asbestos, the latent period between initial asbestos exposure and onset of the disease is usually 20 to 40 years or longer
  • The panel stated that in industrial populations no relationship with asbestos can be established in a proportion of mesothelioma cases varying from 10% to over 30%
  • The panel reported that many believe mesothelioma risk is greatest with crocidolite, less with amosite and apparently less with chrysotile, but that this opinion does not have unanimous support
  • The panel stated that recent work does not support the idea that any slight, casual or brief asbestos exposure may lead to mesothelioma
  • The panel stated that, as far as could then be determined, smoking plays no part in causing mesothelioma
  • The panel stated that no specific pathological features allow an individual lung cancer to be attributed solely to asbestos exposure
  • The panel cited epidemiological evidence that lower levels of past asbestos exposure do not pose a detectable excess risk of bronchogenic cancer
  • The panel considered the evidence linking asbestos to cancer of other sites equivocal
• The authors' conclusion: The authors concluded that diagnosis is a matter of weighing probabilities and the total evidence, requiring expert judgement in interpreting the criteria
• Limitations the authors state:
  • The panel noted that the long latency of mesothelioma makes a dose-response relationship difficult to establish, so the effects of dust control will only be known in the future
  • The panel noted that the ILO radiograph classification was designed for epidemiological purposes, not for evaluating an individual

Topics

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

Medical terms in this study, explained in our Lexicon: Attribution, Lung Cancer, Mesothelioma, Asbestos Exposure, Fibrosis, Parenchyma, Take-home Exposure, Interstitial Fibrosis.

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• Report of the Advisory Committee on Asbestos Cancers to the Director of the International Agency for Research on Cancer — (1973)
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• Clinical and radiological criteria for the differential diagnosis between asbestosis and idiopathic pulmonary fibrosis: Application in two cases — A. Stufano, A. Scardapane, et al. (2021)

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