Diffuse mesothelioma of the pleura and asbestos

Our plain-English summary of Diffuse mesothelioma of the pleura and asbestos, by P.C. Elmes, W.T. McCaughey, O.L. Wade (British Medical Journal, 1965).

The study

• Authors: P.C. Elmes, W.T. McCaughey, O.L. Wade
• Journal: British Medical Journal
• Published: 1965;1(5431):350-3
• Cited by: 93 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001523).

In plain English

This 1965 article reported three Belfast investigations. First, the authors compared the work histories of 42 patients with pleural mesothelioma and 42 matched controls. Asbestos exposure was found for 32 patients (8 heavy, 24 light) and 9 controls (2 heavy), a difference the authors called highly significant. In exposed patients, first exposure came 22 to 73 years before diagnosis. Second, asbestos bodies were found in the lungs of 21 of 24 mesothelioma patients at necropsy and 6 of 24 matched controls. Among men without lung cancer or mesothelioma, they were found in 14 of 100 dying aged 50-59 and 27 of 100 dying aged 60-69. Third, among necropsy patients with neither lung carcinoma nor pleural mesothelioma, an exposure history was found for 14 of 20 with asbestos bodies and 5 of 20 matched controls without them. Local asbestos included crocidolite, chrysotile and amosite, but individual fiber types were not identified. The authors noted that histories taken from relatives may be inaccurate. They concluded that asbestos exposure, even transient and many years earlier, is an important factor in pleural mesothelioma.

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: Three investigations: a matched case-control study of occupational histories; a necropsy study of asbestos bodies in lung tissue in several patient groups, some with matched controls; and a comparison of exposure histories in people with and without asbestos bodies, with exposure graded blind to the lung findings
• Who was studied: Belfast patients: 42 with pleural mesothelioma and 42 matched controls of the same sex and within 1 year of age (only two women among the patients); 200 men dying aged 50-69 without mesothelioma or bronchial carcinoma; 100 men dying with carcinoma of the bronchus (50 of them with matched controls); 24 mesothelioma patients with necropsy material and 24 matched controls; and 20 patients without lung carcinoma or pleural mesothelioma who had asbestos bodies at necropsy, plus 20 matched controls without them
• Exposure: Occupational asbestos exposure, mainly in insulating, boiler and steam pipe work and in the shipyards (pipe-coverers, boiler repairers, electricians, plumbers, joiners). Belfast asbestos contained crocidolite, chrysotile and amosite, but the type each person was exposed to was not identified. Exposure was graded arbitrarily: heavy meant at least one year full-time; light meant less than one year full-time, or intermittent exposure over many years.
• Main results:
  • Mesothelioma patients: 32 of 42 had a history of asbestos exposure (8 heavy, 24 light).
  • Matched controls: 9 of 42 had a history of exposure, 2 of them heavy. The authors described the difference from the mesothelioma patients as highly significant.
  • In exposed mesothelioma patients, the interval from first exposure to diagnosis ranged from 22 to 73 years (mean 43.4 years). Duration of exposure ranged from 3 to 56 years.
  • Men at necropsy without mesothelioma or bronchial carcinoma: asbestos bodies were found in 14 of 100 aged 50-59 and in 27 of 100 aged 60-69. The difference was reported as significant.
  • Men who died with carcinoma of the bronchus: asbestos bodies were found in 20 of 100. Among the 50 most recent deaths, they were found in 9, compared with 13 of 50 matched controls; this difference was not significant.
  • Mesothelioma patients with necropsy material: asbestos bodies were found in 21 of 24 (numerous in four, small numbers in the rest). They were found in 6 of 24 matched controls. The difference was reported as highly significant.
  • Selected necropsy patients without lung carcinoma or pleural mesothelioma: 14 of the 20 with asbestos bodies had a history of heavy or light exposure (2 heavy). Among the 20 matched controls without asbestos bodies, 5 had such a history (1 heavy). The difference was reported as significant.
• The authors' conclusion: The authors concluded that there is evidence that asbestos exposure, even if transient and many years earlier, is an important factor in the cause of pleural mesothelioma. They said this gives cause for anxiety because commercial use of asbestos is increasing.
• Limitations the authors state:
  • Occupational histories obtained from relatives or neighbours, often about work done 30 or 40 years earlier, are likely to be less accurate.
  • For about a third of patients with asbestos bodies in their lungs, no exposure history could be obtained from relatives, friends or neighbours.
  • Examining only two to six lung sections may miss asbestos bodies in people who were exposed. The authors said these errors would tend to underestimate the role of asbestos.
  • Exposure was graded arbitrarily from industrial histories.
  • The true number of mesothelioma cases may be higher, because diagnosis is difficult without biopsy or necropsy.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleura.

Related studies

• Exposure to asbestos and mesothelioma of the pleura — P.B. Fowler, J.C. Sloper, et al. (1964)
• The pathology of mesotheliomata and an analysis of their association with asbestos exposure — D.O. Hourihane (1964)
• Diffuse mesothelioma and exposure to asbestos dust in the Merseyside area — W.G. Owen (1964)
• Pleural mesothelioma in patient with pulmonary tuberculosis: report of a case — U.J. Martinis, V.R. Radovic (1965)
• Fibre distribution in the lungs and pleura of subjects with asbestos related diffuse pleural fibrosis — A.R. Gibbs, M. Stephens, et al. (1991)
• Localized mesotheliomas of the pleura. The pathologic evaluation of 18 cases — E.A. Foster, L.V. Ackerman (1960)

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