Environmental associations and histopathologic patterns of carcinoma of the lung: the challenge and dilemma in epidemiologic studies

Our plain-English summary of Environmental associations and histopathologic patterns of carcinoma of the lung: the challenge and dilemma in epidemiologic studies, by J.C. Ives, P.A. Buffler, S.D. Greenberg (The American Review of Respiratory Disease, 1983).

The study

• Authors: J.C. Ives, P.A. Buffler, S.D. Greenberg
• Journal: The American Review of Respiratory Disease
• Published: 1983;128(1):195-209
• Type of article: Review
• Cited by: 89 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. 000615).

Abstract

An update of histopathologic classification schemes is provided for carcinoma of the lung and factors that influence proportional distributions of cell types, i.e., sources and preparations of tissue specimens, observer variability, and use of secondary sources of information. Consideration is given to the natural history and to current knowledge of the demographic characteristics of cell types of carcinoma of the lung. A review of studies reporting histopathologic associations with environmental exposures suggests that no single type of carcinoma of the lung is specifically associated with exposure to tobacco smoke, arsenic, or beryllium. Furthermore, studies concerned with exposure to asbestos, chloroethers, chromates, nickel, vinyl chloride, and radioactivity lack sufficient information to conclude definitively that only one specific lung cancer cell type is associated with these exposures. In conclusion, an exclusive association of a single cell type of carcinoma of the lung with exposure to the physical or chemical agents reviewed has not been demonstrated.

In plain English

This article was a review, published as a clinical commentary. It described how lung cancer is classified into cell types, such as squamous cell, small cell, adenocarcinoma and large cell carcinoma. It then reviewed published studies linking particular cell types to tobacco smoke, asbestos, arsenic, beryllium, chromate, nickel, bis(chloromethyl) ether, vinyl chloride, radon in uranium mines, and atomic bomb radiation. The authors reported that the mix of cell types in studies depended on where the tissue came from: autopsy, surgery, or biopsy and cytology. The article did not name asbestos fiber types. For asbestos, 3 of 4 studies of lung cancer in exposed men reported adenocarcinoma as the predominant cell type, but 2 of those relied on autopsy material. In unpublished data from coastal Georgia, adenocarcinoma made up 5 of 95 lung cancers (5%) in people with shipbuilding employment and 31 of 362 (9%) in those never employed there. The authors judged that a link between asbestos and a single cell type was likely chiefly artifactual. They concluded that, to date, no study had unequivocally shown that a specific lung cancer cell type in humans was uniquely associated with a specific exposure.

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: Review (clinical commentary) of published studies on lung cancer cell types and environmental exposures
• Who was studied: Published studies of lung cancer cell types in groups exposed to tobacco smoke, asbestos, arsenic, beryllium, chloroethers, chromates, nickel, vinyl chloride and radioactivity (uranium and fluorspar miners, atomic bomb survivors)
• Exposure: Several agents. For asbestos: asbestos workers and shipyard workers, with no fiber types named and no doses given
• Main results:
  • The authors' review of reported studies indicated that the relative frequencies of lung cancer cell types were affected by the source of tissue specimens (autopsy, surgical, or biopsy and cytology series).
  • In 3 of the 4 studies specific to lung cancer in males exposed to asbestos, adenocarcinoma was reported as the predominant cell type.
  • In the Whitwell autopsy study of asbestos workers, adenocarcinoma made up 25% of lung cancers among 28 workers with mild asbestosis and 38% among 48 workers with moderate to severe asbestosis. The difference was not significant.
  • In a general hospital series of shipyard workers (coastal Georgia), there was no difference in the proportion of cell types between asbestos-exposed and non-exposed workers. Adenocarcinoma was 9% in the never-employed (unexposed) group (31 of 362) versus 5% in the exposed group (5 of 95).
  • The authors judged that an association of a single lung cancer cell type with asbestos exposure is likely chiefly artifactual.
  • Cigarette smoking was associated with an increase in all major cell types, with no significant excess of a single cell type.
  • In one study of 111 US underground uranium workers, small cell carcinoma made up 67% of cell types in the autopsy series and 43% in the biopsy series.
• The authors' conclusion: The authors concluded that, to date, no study had unequivocally shown that a specific lung cancer cell type in humans is uniquely associated with a specific physical or chemical exposure. They also said it is possible that one or more cell types may be associated with specific exposures.
• Limitations the authors state:
  • The authors stated that limitations in the reviewed evidence prevent definitive conclusions.
  • In two of the asbestos studies, the use of autopsy specimens may have influenced the relative frequency of cell types.
  • Two of the asbestos studies had small samples (n=17 and n=12), so their findings do not resolve the issue.

Topics

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

Medical terms in this study, explained in our Lexicon: Carcinoma, Environmental Exposure, Lung Cancer.

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