How conflicted authors undermine the World Health Organization (WHO) campaign to stop all use of asbestos: spotlight on studies showing that chrysotile is carcinogenic and facilitates other non-cancer asbestos-related diseases

Our plain-English summary of How conflicted authors undermine the World Health Organization (WHO) campaign to stop all use of asbestos: spotlight on studies showing that chrysotile is carcinogenic and facilitates other non-cancer asbestos-related diseases, by X. Baur, C.L. Soskolne, R.A. Lemen, et al (International Journal of Occupational and Environmental Health, 2015).

The study

• Authors: X. Baur, C.L. Soskolne, R.A. Lemen, J. Schneider, H.J. Woitowitz, L.T. Budnik
• Journal: International Journal of Occupational and Environmental Health
• Published: 2015;21(2):176-9
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The silicate mineral asbestos is categorized into two main groups based on fiber structure: serpentine asbestos (chrysotile) and amphibole asbestos (crocidolite, amosite, anthophyllite, tremolite, and actinolite). Chrysotile is used in more than 2 000 applications and is especially prevalent in the construction industry. Although its use is banned or restricted in more than 52 countries, an estimated 107 000 workers die from asbestos exposure each year, and approximately 125 million workers continue to be exposed. Furthermore, ambient exposures persist to which the public is exposed, globally. Today, the primary controversies regarding the use of asbestos are the potencies of different types of asbestos, as opposed whether or not asbestos causes morbidity and mortality. The asbestos industry has promoted and funded research based on selected literature, ignoring both clinical and scientific knowledge. In this piece, we highlight a prominent example of a conflicted publication that sought to undermine the World Health Organization (WHO) campaign to stop the use of all forms of asbestos, including chrysotile asbestos. Independent and rigorous scientific data provide sufficient evidence that chrysotile asbestos, like other forms of asbestos, is a cause of asbestos-related morbidity and premature mortality.

In plain English

This was a short perspective article, not an original study, and it reported no new data. The authors criticized a 2014 paper by Bernstein on the health risk of chrysotile (white asbestos), saying that it used selected literature and relied mainly on the author's own animal studies, often with follow-up of 90 to 360 days. They noted that the International Agency for Research on Cancer has classified chrysotile as a group 1 carcinogen. They listed studies they said the Bernstein paper left out. These included a North Carolina textile cohort that reported a lung cancer standardized mortality ratio of 2.0 (95% CI 1.7 to 2.2) and a mesothelioma ratio of 11.1 (95% CI 3.0 to 28.4). They also cited mesothelioma cases linked to the Balangero chrysotile mine in Italy, Chinese chrysotile cohorts, and animal studies by other groups. The authors concluded that the Bernstein paper undermines the World Health Organization campaign to stop all asbestos use, and that chrysotile, like other forms of asbestos, causes disease and early death.

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: Critical assessment/perspective (commentary critiquing a published review); no original data
• Who was studied: No study population. The article examines a 2014 paper by Bernstein on the health risks of chrysotile asbestos and the studies the authors say it left out.
• Exposure: Chrysotile (white) asbestos, discussed in contrast to amphibole asbestos
• Main results:
  • The authors stated that the Bernstein paper drew its conclusions mainly from that author's own animal studies, often with limited follow-up of 90 to 360 days.
  • The authors noted that IARC has classified chrysotile as a group 1 carcinogen.
  • The authors cited a meta-analysis by Lenters et al. which found that differences in lung cancer effects between chrysotile and amphibole asbestos shrink when only high-quality studies are considered.
  • As an example of a study excluded by Bernstein, the authors cited a cohort of about 6 000 workers from four North Carolina textile plants, followed from 1950 to 2003. That cohort reported a lung cancer SMR of 2.0 (95% CI 1.7 to 2.2) and a mesothelioma SMR of 11.1 (95% CI 3.0 to 28.4).
  • The authors cited Italian data on tremolite-free chrysotile from Balangero: 14 mesothelioma cases among mine workers and 13 among others exposed to Balangero chrysotile.
  • The authors cited 37-year follow-up studies of Chinese chrysotile miners and textile workers. In those studies, lung cancer increased 3.5-fold with 10 employment years at entry and 5.3-fold with 20 years.
  • The authors stated that the Bernstein paper ignored large animal studies by other research groups (1974 to 2014) that found carcinogenic effects of chrysotile.
  • The authors disputed the Bernstein paper's statement that chrysotile fibers are absent from the pleura, saying animal studies have shown chrysotile fibers predominate there.
• The authors' conclusion: The authors concluded that the Bernstein paper is based on selected literature and undermines the WHO campaign to stop use of all asbestos types, including chrysotile. They further concluded that independent findings show chrysotile, like other forms of asbestos, causes asbestos-related disease and premature death.

Topics

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

Medical terms in this study, explained in our Lexicon: Chrysotile, Carcinogenic, Silicate, Serpentine Group, Amphibole Asbestos, Crocidolite, Amosite, Anthophyllite.

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