Gastric and rectal cancers in workers exposed to asbestos: a case series

Our plain-English summary of Gastric and rectal cancers in workers exposed to asbestos: a case series, by B.J. Choi, S. Lee, I.J. Lee, et al (Annals of Occupational and Environmental Medicine, 2020).

The study

• Authors: B.J. Choi, S. Lee, I.J. Lee, S.W. Park, S. Lee
• Journal: Annals of Occupational and Environmental Medicine
• Published: 2020;32:e4
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: The Occupational Safety and Health Research Institute (OSHRI) of the Korea had not recognized gastrointestinal cancer as work-related disease during their evaluation. However, in 2018 OSHRI recognized gastric and rectal cancers as work-related disease in asbestos-exposed workers. We present 2 such cases along supportive evidence of causation.

Case Presentation: Patient A: A 57-year-old man had worked for about 40 years since 1978 as an oxygen cutter at workplaces that dismantle ships, buildings, boilers, and thermal power plants. In November 2016, endoscopy and biopsy confirmed the diagnosis of advanced gastric cancer, for which he underwent subtotal gastrectomy and chemotherapy; however, he later died of the cancer. Patient B: A 71-year-old man had worked in shipbuilding and repair workplaces for approximately 49 years, being employed in pipe laying, asbestos insulation installation, grinding, and other ship repair work. In 2003, he was diagnosed of rectal cancer by abdominal computed tomography. He accordingly underwent surgical removal of the cancer. Based on the occupational history of the 2 patients and our review of the relevant literature addressing the occupational environment, we concluded that both patients had continuous exposure to high levels of asbestos while performing their jobs for 40 and 49 years, respectively.

Conclusion: Both patients had a history of smoking and drinking (non-occupational personal risk factors). However, the possibility of an increased risk of gastric and rectal cancers from asbestos exposure cannot be excluded. Therefore, we considered that occupational exposure to asbestos had contributed to the cancer diagnosis in these cases. Workers exposed to asbestos should be made aware of the possibility of gastric or rectal cancer, and should undergo monitoring and medical examinations. Appropriate compensation for gastric and rectal cancers that occur in workers exposed to asbestos are anticipated in future.

Copyright © 2020 Korean Society of Occupational & Environmental Medicine.

In plain English

This case series from Korea's Occupational Safety and Health Research Institute (OSHRI) described two men whose cancers OSHRI recognized in 2018 as work-related to asbestos exposure. The authors reported these were the first gastrointestinal cancer cases OSHRI had recognized as work-related. Patient A, aged 57, had worked about 40 years from 1978 as an oxygen cutter dismantling ships, buildings, boilers and thermal power plants. He was diagnosed with stage IIIB gastric cancer in 2016 and died of it in January 2018. He had a 1 to 10 pack-year smoking history, did not drink, and was never tested for H. pylori infection. Patient B, aged 71, had worked about 49 years in shipbuilding and ship repair, including installing asbestos insulation, and had rectal cancer removed in 2003. He smoked and drank. The authors estimated both men's exposure from published workplace studies. They speculated it very likely exceeded 25 f/cc-years, but said they could not quantify it. The authors concluded that asbestos exposure had contributed to both cancers. The report describes two individuals and does not measure how often such cancers occur.

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 series (two cases) evaluated for work-relatedness, with exposure estimated from published literature
• Who was studied: Two Korean male day laborers evaluated by OSHRI: Patient A, 57, with gastric cancer diagnosed in 2016; Patient B, 71, with rectal cancer diagnosed in 2003
• Exposure: Occupational asbestos (fiber type not specified for the patients). Patient A worked about 40 years as an oxygen cutter in ship, building, boiler and thermal power plant dismantling. Patient B worked about 49 years in shipbuilding and ship repair, including asbestos insulation installation. Exposure levels were estimated from other published studies, not measured for these men.
• Main results:
  • Patient A was diagnosed with stage IIIB gastric cancer (T4N2M0) and died of gastric cancer on January 9, 2018, despite surgery and chemotherapy
  • Patient A had a 1 to 10 pack-year smoking history, did not drink, and had no relevant family medical history
  • Patient B's final diagnosis was rectal tubular adenocarcinoma, Borrmann type II, removed surgically in August 2003
  • Patient B's work included installing asbestos insulation on pipes and on the outer walls of frozen storage vessels
  • Patient B's smoking history could only be estimated at 2.5 to 25 pack-years. He drank 2 to 3 times per week until 2000 and was diagnosed with pneumoconiosis in 2004.
  • The authors speculated that both patients' cumulative asbestos exposure very likely exceeded 25 f/cc-years
  • Of 437 OSHRI cancer-related evaluations from 2010 to 2018, 51 concerned gastrointestinal cancer, and only these 2 cases (2018) were recognized as work-related
  • In OSHRI's review of 60 gastrointestinal cancer evaluations not recognized as work-related, the workers in 49 of the 60 had no job exposure to known gastrointestinal cancer risk factors
• The authors' conclusion: The authors concluded that the patients' occupational asbestos exposure contributed to their gastric and rectal cancers, despite non-occupational risk factors
• Limitations the authors state:
  • Total cumulative asbestos exposure could not be quantified
  • Exposure levels from foreign studies may not apply to Korean workplaces
  • Korean ship repair exposure data are recent and may not apply to Patient B's whole working period
  • Patient A's H. pylori infection status could not be determined
  • Patient A's official job history could not be established because he was a day laborer

Topics

Medical terms in this study, explained in our Lexicon: Causation, Endoscopy, Biopsy, Stomach Cancer, Chemotherapy, Occupational History, Asbestos Exposure, Occupational Exposure.

Related studies

• Occupational exposures and risk of esophageal and gastric cardia cancers among male Swedish construction workers — C. Jansson, A.L. Johansson, et al. (2005)
• Increased Risk of Gastric Cancer in Asbestos-Exposed Workers: A Retrospective Cohort Study Based on Taiwan Cancer Registry 1980-2015 — Y.J. Fang, H.Y. Chuang, et al. (2021)
• Variant Enrichment Analysis to Explore Pathways Disruption in a Necropsy Series of Asbestos-Exposed Shipyard Workers — S. Crovella, R.R. Moura, et al. (2022)
• Occupational Asbestos Exposure and Incidence of Colon and Rectal Cancers in French Men: The Asbestos-Related Diseases Cohort (ARDCo-Nut) — C. Paris, I. Thaon, et al. (2017)
• Simultaneous occurrence of a rectal carcinoma and a diffuse well differentiated papillary mesothelioma of the peritoneum — G.R. Jatzko, J. Jester (1997)
• Localized biphasic malignant peritoneal mesothelioma presenting as a rectal tumor — K. Saisho, S. Fujiwara, et al. (2020)

Browse more research in Annals of Occupational and Environmental Medicine, or return to medical research.