Exposure to asbestos and mesothelioma of the pleura

Our plain-English summary of Exposure to asbestos and mesothelioma of the pleura, by P.B. Fowler, J.C. Sloper, E.C. Warner (British Medical Journal, 1964).

The study

• Authors: P.B. Fowler, J.C. Sloper, E.C. Warner
• Journal: British Medical Journal
• Published: 1964;2(5403):211-3
• Cited by: 27 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. 001556).

Abstract

Two cases of mesothelioma of the pleura are reported. Despite the absence of severe pulmonary fibrosis, the lungs in both contained "asbestos bodies"; in both, too, there was an occupational history of exposure to asbestos, although in the second this was obtained with difficulty and after death. The association between mesothelioma of the pleura and exposure to asbestos is unlikely to be fortuitous ; but to establish this point all cases of mesothelioma, whatever their occupational history, should be studied with this possibility in mind; for evidence is now accumulating that this disease is an industrial hazard.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This 1964 article reported two cases of mesothelioma of the pleura in men. At the coroners' inquests into both deaths, it was not accepted that the tumour was attributable to inhaling asbestos fibre. The first man, born in 1902, had cleaned bags in an asbestos factory from 1926 to 1929 and stayed with the same firm, partly as a cleaner and partly as a canteen attendant, until 1942. The second man, born in 1889, worked for a laundry company. His duties included lagging pipes with asbestos and occasionally reinserting asbestos sheets in laundry presses, a history found only after his death. His tumour involved the pleura and the peritoneum. The fiber type was not stated for either man. Neither had severe lung fibrosis, but asbestos bodies were found in lung smears from both. The authors calculated that, even if one in ten people in Great Britain had asbestos bodies in their lungs, finding them in both cases could scarcely be chance (P= 0.01). The authors concluded that the association was unlikely to be fortuitous and that asbestos bodies should be sought in all patients with 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: Case report of two patients
• Who was studied: Two men with pleural mesothelioma. Case 1 was born in 1902 and was investigated at Charing Cross Hospital in 1957, then fell ill in 1961. Case 2 was born in 1889, was first seen in March 1961, and died on 2 October 1962. Both deaths were the subject of coroners' inquests.
• Exposure: Case 1 cleaned bags in an asbestos factory from 1926 to 1929, then worked for the same firm partly as a cleaner and partly as a canteen attendant until 1942, with no exposure for the next 20 years. Case 2 worked for a laundry company from 1918, as a general hand from 1938, lagging pipes with asbestos and occasionally reinserting sheets of asbestos in laundry presses. Fiber type was not stated for either case.
• Main results:
  • At the coroners' inquests, it was not accepted in either case that the tumour was attributable to inhalation of asbestos fibre.
  • Case 1: smears from the lung showed asbestos bodies. The tumour itself contained none, but a hilar gland that contained growth also contained asbestos bodies.
  • Case 1: there was no growth in the left lung or anywhere else in the body.
  • Case 2: the mesothelioma involved the pleura, and nodules and plaques were spread throughout the peritoneal cavity.
  • Case 2: smears from the right lung showed asbestos bodies. Autoradiographs of these bodies, exposed for 42 days, showed no local radioactivity.
  • In both cases there was no severe pulmonary fibrosis, yet the lungs contained asbestos bodies. In the second case the occupational history was obtained with difficulty and after death.
  • Asbestos bodies were found only with great difficulty in thin paraffin sections, but were readily seen in thick frozen sections.
  • The authors calculated that even if one in ten of the population of Great Britain had asbestos bodies in their lungs, their presence in both cases could scarcely be chance (P= 0.01).
• The authors' conclusion: The authors concluded that the association between mesothelioma of the pleura and asbestos exposure is unlikely to be fortuitous. They stated that asbestos bodies should be sought in the lungs of all patients with mesothelioma, even without an occupational history or severe fibrosis.
• Limitations the authors state:
  • A primary bronchial carcinoma could have been missed, as in all such cases.
  • The cytochemical (staining) observations are of limited value because the material was fixed in formol-saline.
  • Little is known about the risk of inhaling asbestos fibres in Great Britain, and comparable incidence figures for the country are lacking.

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: Mesothelioma, Pleura, Pulmonary Fibrosis, Asbestos Bodies, Occupational History.

Related studies

• Diffuse mesothelioma and exposure to asbestos dust in the Merseyside area — W.G. Owen (1964)
• The pathology of mesotheliomata and an analysis of their association with asbestos exposure — D.O. Hourihane (1964)
• Pulmonary ventilatory function in talcosis of lung — M. Kleinfeld, J. Messite, et al. (1964)
• Talc pneumoconiosis: a report of six patients with postmortem findings — M. Kleinfeld, C.P. Giel, et al. (1963)
• Peritoneal tumours in asbestosis — J.B. Enticknap, W.J. Smither (1964)
• Diffuse mesothelioma of the pleura and asbestos — P.C. Elmes, W.T. McCaughey, et al. (1965)

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