Differences in occupational mortality from pleural cancer, peritoneal cancer, and asbestosis

Our plain-English summary of Differences in occupational mortality from pleural cancer, peritoneal cancer, and asbestosis, by D. Coggon, H. Inskip, P. Winter, et al (Occupational and Environmental Medicine, 1995).

The study

• Authors: D. Coggon, H. Inskip, P. Winter, B. Pannett
• Journal: Occupational and Environmental Medicine
• Published: 1995;52(11):775-7
• Cited by: 47 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: To assess whether the increased risk of disease related to asbestos in occupations from the construction and engineering industries applies equally to pleural cancer, peritoneal cancer, and asbestosis.

Methods: Analysis was based on deaths among men aged 20-74 in England and Wales during 1979-80 and 1982-90. (n = 1,656,096). Information about cause of death and the last full time occupation of decedents was derived from death certificates. Proportional mortality ratios (PMRs) by occupation were calculated for each of pleural cancer, peritoneal cancer, and asbestosis.

Results: Altogether, 2848 deaths were attributed to cancer of the pleura, 362 to cancer of the peritoneum, and 281 to asbestosis. When occupations were ranked according to PMRs from these diseases, striking differences were found. The category of construction workers which included laggers had the highest mortality from peritoneal cancer (PMR 990, 64 deaths), but a PMR of only 160 (77 deaths) for pleural cancer. In contrast, several occupations with much higher mortality from pleural tumours had no excess of peritoneal cancer. PMRs for asbestosis related more closely to those for peritoneal than pleural cancer.

Conclusions: These findings suggest that the exposure-response relations for diseases related to asbestos are not all linear, and that risks of pleural mesothelioma may be underestimated by simple extrapolation from observations in cohorts with heavy exposure.

In plain English

The authors analysed death certificates for men aged 20 to 74 who died in England and Wales in 1979-80 and 1982-90. Each man's most recent full-time job was sorted into one of 194 job groups. For each group the authors calculated proportional mortality ratios (PMRs) for cancer of the pleura, cancer of the peritoneum and asbestosis, using all occupations combined as the comparison. Of 1,656,096 deaths, 2848 were from pleural cancer, 362 from peritoneal cancer and 281 from asbestosis. Construction workers not elsewhere classified, a group that includes laggers, had the highest PMRs for peritoneal cancer (990, 64 deaths) and asbestosis (1592, 71 deaths). Their PMR for pleural cancer was only 160 (77 deaths). Metal plate workers, upholsterers, carpenters and electricians had high pleural cancer PMRs but no excess of peritoneal cancer. Motor mechanics showed no significant excess of any of the three diseases. The authors concluded that pleural mesothelioma risks may be underestimated if a linear exposure-response is assumed. They noted that death certificates can be inaccurate and that only each man's last full-time job was known.

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: Proportional mortality analysis of national death certificate data by occupation
• Who was studied: All deaths among men aged 20-74 in England and Wales in 1979-80 and 1982-90 (1981 was excluded as unreliable). There were 1,656,096 deaths in men with adequately described occupations, grouped into 194 job groups.
• Exposure: Occupation, taken from the most recent full-time job recorded on the death certificate and aggregated into 194 job groups. Asbestos exposure and fiber type were not measured.
• Main results:
  • Across all men studied, 2848 deaths were from cancer of the pleura, 362 from cancer of the peritoneum and 281 from asbestosis.
  • Construction workers not elsewhere classified, which includes laggers, had the highest PMR for peritoneal cancer (PMR 990, 64 deaths, 95% CI 762-1265). Their PMR for pleural cancer was 160 (77 deaths, 95% CI 126-200).
  • Several occupations with the highest pleural cancer mortality had no excess of peritoneal cancer: metal plate workers (PMR 709, 73 deaths), upholsterers (PMR 366, 16 deaths), carpenters (PMR 362, 167 deaths) and electricians (PMR 349, 127 deaths).
  • Asbestosis mortality was highest in construction workers not elsewhere classified (PMR 1592, 71 deaths).
  • Across the 24 job groups in the table, the Spearman rank correlation was 0.43 between asbestosis and peritoneal cancer, and 0.15 between asbestosis and pleural cancer.
  • Motor mechanics had no significant excess risk: PMR 46 (12 deaths) for pleural cancer, PMR 88 (three deaths) for peritoneal cancer and PMR 80 (two deaths) for asbestosis. The authors wrote that brake-lining exposure seemed to have no important effect on mortality from mesothelioma or asbestosis, perhaps because the fibres are modified by heat.
• The authors' conclusion: The authors proposed that exposure-response relations for mesothelioma and asbestosis are non-linear. They called for caution when extrapolating low-exposure mesothelioma risks for crocidolite and amosite from heavily exposed cohorts, and concluded that pleural mesothelioma risks may be underestimated if a linear exposure-response is assumed.
• Limitations the authors state:
  • Death certificates are inaccurate. Not all deaths coded as pleural or peritoneal cancer are mesotheliomas, and some mesotheliomas are coded to other or unspecified sites.
  • Some deaths may have been wrongly attributed to asbestosis on the basis of pleural thickening or plaques when no fibrosis was present.
  • Only the most recent full-time job was known, so asbestos exposure in earlier jobs was missed.
  • The study used proportional mortality rather than true death rates.

Topics

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

Medical terms in this study, explained in our Lexicon: Death Certificate, Proportional mortality, Pleura, Peritoneum, Insulator, Pleural Mesothelioma.

Related studies

• Trends in mortality from occupational hazards among men in England and Wales during 1979-2010 — E.C. Harris, K.T. Palmer, et al. (2016)
• Asbestos exposure and differences in occurrence of peritoneal mesothelioma between men and women across countries — A. Burdorf, B. Järvholm, et al. (2007)
• Differences between peritoneal and pleural mesothelioma in Lombardy, Italy — C. Mensi, M. Mendola, et al. (2017)
• DNA fingerprint analysis reveals differences in mutational patterns in experimentally induced rat peritoneal tumors, depending on the type of environmental mutagen — N. Kociok, K. Unfried, et al. (1999)
• Peritoneal tumours in asbestosis — J.B. Enticknap, W.J. Smither (1964)
• Asbestosis, laryngeal carcinoma, and malignant peritoneal mesothelioma in an insulation worker — A. Fischbein, J.C. Luo, et al. (1991)

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