Exposure to asbestos and the risk of gastrointestinal cancer

Our plain-English summary of Exposure to asbestos and the risk of gastrointestinal cancer (British Journal of Industrial Medicine, 1988).

The study

• Journal: British Journal of Industrial Medicine
• Published: 1988;45(8):573-6
• Type of article: Letter
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M nos. 000191, 000271).

In plain English

These 1988 letters to the editor, not a research study, discuss a review by Edelman that concluded asbestos workers were not at increased risk of gastrointestinal cancer. R M Rudd argued that many studies were too small to detect a risk. Rudd cited other researchers who found that 13 of 21 studies showed an excess of gastrointestinal cancer, statistically significant in five. Edelman replied by looking at 11 studies that gave mortality ratios for gastrointestinal cancer as a combined group (ICD codes 150 to 159). Two of these showed significantly lower risk and two significantly higher risk. The other seven had at least 80% statistical power to detect a doubled risk. J Berlin and H Frumkin argued that two data sets were wrongly reported and that results should have been statistically combined. Edelman answered that the Puntoni shipyard data were not incorrectly transcribed. The newer Seidman paper had reached Edelman's library one month before the review was accepted. Edelman called combining results tempting but said the available techniques did not take into account differences among cohorts. Edelman kept the conclusion of no evidence of a cause-and-effect relation between asbestos and any gastrointestinal cancer.

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: Correspondence (letters to the editor) debating a published review of asbestos exposure and gastrointestinal cancer by Edelman, with the review author's replies; not an original study
• Who was studied: No new population was studied. The letters discuss previously published studies of asbestos-exposed worker cohorts, including 21 studies cited by Rudd from Davis et al and 11 studies in Edelman's reply table
• Exposure: Occupational asbestos exposure in the cohorts discussed, including Genoa dockyard (shipyard) workers studied by Puntoni et al and amosite asbestos factory workers studied by Selikoff and Seidman
• Main results:
  • Rudd, citing Davis et al: of 21 studies, 13 showed an excess risk of gastrointestinal cancer, statistically significant in five. Only six of the studies without a significant excess had more than 80% power to detect a relative risk of 1.5
  • Rudd argued that many of the negative studies should be given less weight than the positive studies
  • Edelman's reply: of the 11 studies giving SMRs for ICD 150-159, two SMRs were significantly below 1 and two were significantly above 1
  • Edelman's reply: the remaining seven of those 11 studies had at least 80% power to detect a twofold increased risk
  • Edelman's reply: four of those seven studies had at least 80% power to detect a 1.5-fold increased risk
  • Berlin and Frumkin stated that Puntoni's data were incorrectly transcribed in the review, and that this error introduced bias in the negative direction
  • Berlin and Frumkin argued that the review could have statistically combined results to increase statistical power
  • Berlin and Frumkin argued that confounding was unlikely to explain gastrointestinal cancer mortality ratios of around 2
  • Edelman replied that the Puntoni figures used expected deaths based on the general male population of Genoa, so they were not incorrectly transcribed
  • Edelman replied that the updated Seidman et al paper was received by Edelman's library one month before the review was accepted
  • Edelman reported that in the updated Seidman et al amosite cohort, all gastrointestinal SMRs were lower than in the prior report
  • Edelman called combining the results tempting, but said none of the analytical techniques took into account the many differences among the cohorts
  • Edelman argued that dose-response data could not reasonably be combined because exposure units differed between studies
• The authors' conclusion: Edelman concluded that the additional data did not change the review's conclusion: there was no evidence to support a cause-and-effect relation between asbestos exposure and cancer of any gastrointestinal site. Berlin and Frumkin, by contrast, concluded that the review gave little basis for inferring no increased risk.

Related studies

• Exposure to asbestos and the risk of gastrointestinal cancer: a reassessment — D.A. Edelman (1988)
• Risk of gastrointestinal cancers from inhalation and ingestion of asbestos — J. Gamble (2008)
• Gastrointestinal cancer mortality of workers in occupations with high asbestos exposures — S.K. Kang, C.A. Burnett, et al. (1997)
• Asbestos ingestion and gastrointestinal cancer: a possible underestimated hazard — A. Di Ciaula (2017)
• Assessing Tumor-Infiltrating Lymphocytes in Solid Tumors: A Practical Review for Pathologists and Proposal for a Standardized Method from the International Immuno-Oncology Biomarkers Working Group: Part 2: TILs in Melanoma, Gastrointestinal Tract Carcinomas, Non-Small Cell Lung Carcinoma and Mesothelioma, Endometrial and Ovarian Carcinomas, Squamous Cell Carcinoma of the Head and Neck, Genitourinary Carcinomas, and Primary Brain Tumors — S. Hendry, R. Salgado, et al. (2017)
• Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomised controlled trial — C. Baldwin, A. Spiro, et al. (2011)

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