Government laboratory worker with lung cancer: comparing risks from beryllium, asbestos, and tobacco smoke

Our plain-English summary of Government laboratory worker with lung cancer: comparing risks from beryllium, asbestos, and tobacco smoke, by C. Steinmaus, J.R. Balmes (Environmental Health Perspectives, 2000).

The study

• Authors: C. Steinmaus, J.R. Balmes
• Journal: Environmental Health Perspectives
• Published: 2000;108(10):1003-6
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Occupational medicine physicians are frequently asked to establish cancer causation in patients with both workplace and non-workplace exposures. This is especially difficult in cases involving beryllium for which the data on human carcinogenicity are limited and controversial. In this report we present the case of a 73-year-old former technician at a government research facility who was recently diagnosed with lung cancer. The patient is a former smoker who has worked with both beryllium and asbestos. He was referred to the University of California, San Francisco, Occupational and Environmental Medicine Clinic at San Francisco General Hospital for an evaluation of whether past workplace exposures may have contributed to his current disease. The goal of this paper is to provide an example of the use of data-based risk estimates to determine causation in patients with multiple exposures. To do this, we review the current knowledge of lung cancer risks in former smokers and asbestos workers, and evaluate the controversies surrounding the epidemiologic data linking beryllium and cancer. Based on this information, we estimated that the patient's risk of lung cancer from asbestos was less than his risk from tobacco smoke, whereas his risk from beryllium was approximately equal to his risk from smoking. Based on these estimates, the patient's workplace was considered a probable contributing factor to his development of lung cancer.

In plain English

This case report described a 73-year-old former technician at a government weapons research facility who developed lung cancer. A biopsy of a left pleural density showed a tumor most consistent with poorly differentiated adenocarcinoma. He worked with beryllium almost daily from 1962 to 1964 and a few weeks a year until 1975, and he tested positive for beryllium sensitization. In the same period he removed, cut and replaced asbestos furnace insulation for about 1 or 2 hours a week; the article does not name the fiber type. He smoked a pack a day from age 15 to 37. Lacking personal exposure measurements, the authors estimated his risks from published studies. They estimated about 4–6 fiber-years of asbestos exposure, giving a lung cancer relative risk near 1.1. They put his beryllium relative risk close to 1.5 and his smoking risk between 1.07 and 2.10. The authors concluded that his workplace exposure, specifically beryllium, contributed to his cancer. They concluded that asbestos may also have contributed, with a lower estimated risk than beryllium or tobacco smoke. They called the estimates inexact.

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 (Grand Rounds clinical case) with literature-based estimates of the patient's lung cancer risk from each exposure
• Who was studied: One 73-year-old man who spent most of his working life, starting in 1959, at a single US government research facility specializing in weapons development; he was evaluated at the UCSF Occupational and Environmental Medicine Clinic at San Francisco General Hospital
• Exposure: Asbestos: removing, cutting and replacing asbestos insulation in furnaces about 1 or 2 hours per week, with visible dust until strict controls in the early 1970s (fiber type not stated). Beryllium: almost daily work from 1962 to 1964, then a few weeks per year until 1975. Tobacco: one pack of cigarettes per day from age 15 to 37 (22 pack-years), quit 36 years before evaluation.
• Main results:
  • In the patient, a biopsy of a left pleural density showed marked pleural fibrosis with a malignant tumor most consistent with poorly differentiated adenocarcinoma. A lymphocyte proliferation test was positive for beryllium sensitization.
  • The authors estimated the patient's cumulative asbestos exposure at about 4–6 fiber-years (10–15 fibers/cm3 × 10 years × 4% of working time).
  • The authors estimated the patient's lung cancer relative risk from asbestos at about 1.1, probably less than his risk from beryllium or smoking.
  • The authors estimated the patient's lung cancer relative risk from beryllium at close to 1.5. They based this on the figure Ward et al. reported for beryllium workers with more than 30 years since first employment.
  • Published risks for ex-smokers whose history resembled the patient's ranged from 1.07 to 2.10. The authors placed the patient's smoking-related risk somewhere in this range.
• The authors' conclusion: The authors concluded that the patient's workplace experience, specifically his beryllium exposure, was an important contributing factor to his lung cancer. They concluded that asbestos may also have contributed, but its estimated risk appeared below that of beryllium and tobacco smoke.
• Limitations the authors state:
  • The authors state that, given the limited data, their risk estimates are inexact.
  • No personal air sampling was done for the patient's beryllium exposure.
  • The asbestos exposure estimate was borrowed from data on asbestos insulators and is likely at the high end.
  • The published literature offers very little dose–response data for beryllium with which to assess the patient's risk.

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: Lung Cancer, Causation.

Related studies

• Risk of lung cancer associated with quantitative beryllium exposure metrics within an occupational cohort — M.K. Schubauer-Berigan, J.A. Deddens, et al. (2011)
• A primary mesothelioma involving the rectovaginal septum and associated with beryllium — C. Gold (1967)
• Effects of asbestos and beryllium on release of alveolar macrophage enzymes — K.Y. Kang, D. Bice, et al. (1979)
• Beryllium detection in human lung tissue using electron probe X-ray microanalysis — K.J. Butnor, T.A. Sporn, et al. (2003)
• Arsenic, tobacco smoke, and occupation: associations of multiple agents with lung and bladder cancer — C. Ferreccio, Y. Yuan, et al. (2013)
• Occupational exposures, environmental tobacco smoke, and lung cancer — F. Veglia, P. Vineis, et al. (2007)

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