Historical developments and perspectives in inorganic fiber toxicity in man

Our plain-English summary of Historical developments and perspectives in inorganic fiber toxicity in man, by I.J. Selikoff (Environmental Health Perspectives, 1990).

The study

• Author: I.J. Selikoff
• Journal: Environmental Health Perspectives
• Published: 1990;88:269-76
• Type of article: Historical article, Review
• Cited by: 28 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. 003846).

Abstract

The first patient known to have died from asbestosis (1900) began work in 1885, approximately 5 years after the industrial use of asbestos began in Britain. Mineral particles were found in his lungs. No special comment was made of their fibrous nature then nor when the first case was reported in 1924. The various neoplasms attributed to asbestos in the next decades posed an additional question: What influence did the fibrous shape of the particles have on carcinogenic potential? The cogency of the problem was amplified by the identification in humans of asbestos-like neoplasms with a fiber other than asbestos (erionite) and by the production of such neoplasms in experimental animals with a variety of man-made inorganic fibers, often used as substitutes for asbestos. The lessons learned about asbestos may help guide us in evaluating current fiber problems.

In plain English

This article was a historical review and perspective by the author. It traced how understanding of disease from inorganic fibers developed, from early asbestosis cases around 1900 to the idea that fiber shape and size affect cancer risk, and considered what this might mean for judging asbestos substitutes. It also presented mortality data for 17,800 asbestos insulation workers in the United States and Canada followed from 1967 to 1986. In this group, 4951 deaths occurred where 3450.5 were expected (the table prints 3453.50). After review of all available medical evidence, there were 1168 lung cancer deaths against 268.66 expected, 458 mesotheliomas where none were expected, and 427 asbestosis deaths. Several other cancers, including larynx and kidney, were increased. Lymphoma, leukemia, bladder and prostate cancer were not. Virtually no increases appeared in the first 15 years after exposure began. Lower exposure after the early 1970s was followed by lower death rates for asbestosis, lung cancer and peritoneal mesothelioma in the mid-period from onset, but not for pleural mesothelioma. The author concluded that reducing exposure can be important for some people already exposed.

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: Historical review and perspective article, including mortality data from a prospective cohort of asbestos insulation workers
• Who was studied: 17,800 asbestos insulation workers, the total membership of the International Association of Heat and Frost Insulators and Asbestos Workers in the United States and Canada, followed January 1, 1967 to December 31, 1986; expected deaths were based on U.S. white male death rates
• Exposure: Asbestos exposure in insulation work (fiber types for the cohort not specified); exposure was reported to decrease after 1964 and further after asbestos was removed from new insulation materials in 1972 and 1973
• Main results:
  • All causes in the insulation worker cohort: 4951 deaths observed versus 3450.5 expected in the text (3453.50 in Table 1; SMR 143, p less than 0.001)
  • All cancer in the cohort: 761.41 expected; 2127 on death certificates and 2295 on best evidence (SMR 301 on best evidence)
  • Lung cancer in the cohort: 268.66 expected, 1168 observed on best evidence (SMR 435); 1008 on death certificates (SMR 375)
  • Mesothelioma in the cohort: 458 deaths on best evidence (173 pleural, 285 peritoneal), with none expected
  • Asbestosis in the cohort: 427 deaths on best evidence (201 on death certificates)
  • Other cancers increased in the cohort included larynx (18 versus 10.57 expected, best evidence), oropharynx and buccal cavity, kidney, pancreas, and gall bladder and bile ducts
  • Lymphoma, leukemia, and cancer of the ureter, urinary bladder and prostate were not observed in excess in the cohort
  • In the cohort, virtually no increases in death rates were seen in the first 15 years after onset of exposure, and comparatively little until 25 or 30 years had passed
  • About one-third of mesothelioma deaths in the cohort occurred after age 65
  • Comparing 1967-1972, 1973-1979 and 1980-1986, reduced exposure was followed by lower death rates for asbestosis, bronchogenic carcinoma and peritoneal mesothelioma, at least in the mid-period from onset (analysis cited to a forthcoming paper)
  • After 40 years from onset, reduced exposure did not seem to make a difference, and pleural mesothelioma death rates did not fall even in the mid-period
• The authors' conclusion: The author concluded that reduction of exposure can be important in reducing risks for some individuals already exposed, and that lessons from asbestos may help in evaluating possible substitute fibers
• Limitations the authors state:
  • Ratios in Tables 2 and 3 were calculated for information only, because they compare best-evidence diagnoses with expected deaths based on death certificates, which are not strictly comparable
  • No expected rates were available for mesothelioma and asbestosis because they are rare causes of death in the general population
  • The control measures introduced after 1964 were not always rigorous

Topics

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

Medical terms in this study, explained in our Lexicon: Neoplasm, Carcinogenic, erionite.

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• Historical perspective on asbestos: policies and protective measures in World War II shipbuilding — J.K. Corn, J. Starr (1987)
• Asbestos: historical perspective — L. Garfinkel (1984)
• An update on pleuro-pulmonary cytopathology: Part i: Cytological diagnosis of mesothelioma and molecular cytology of lung cancer with an historical perspective — C.W. Bedrossian (2015)
• Diseases related to asbestos exposure: historical perspective — H.P. Pendergrass, J.D. Snell, et al. (1987)

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