How the industrial physician can reduce mortality from asbestos-related diseases

Our plain-English summary of How the industrial physician can reduce mortality from asbestos-related diseases, by R.J. Levine (Journal of Occupational Medicine., 1978).

The study

• Author: R.J. Levine
• Journal: Journal of Occupational Medicine.
• Published: 1978;20(7):464-8
• Type of article: Review
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Risk indicators for asbestos-related diseases (cancers of the lung, larynx, and alimentary tract; mesothelioma; and asbestosis) and methods of early detection are reviewed and evaluated. The best medical means of reducing mortality from these diseases is to recognize particularly susceptible persons during a preemployment examination and to recommend that they not be hired for jobs involving asbestos exposure. Workers necessarily exposed to asbestos should be enrolled in a medical screening program and urged not to smoke.

In plain English

This 1978 article was a review, not a new study. It drew on material prepared for a National Cancer Institute monograph on asbestos. The author reviewed and evaluated risk indicators and early-detection methods for asbestos-related diseases: cancers of the lung, larynx and alimentary tract, mesothelioma, and asbestosis. The author described lung cancer as the most frequent asbestos-related cancer, causing the most deaths. The author recommended that people with lung cancer risk factors, or with sputum cell changes of moderate atypical squamous cell metaplasia or worse, not be hired for asbestos jobs. Citing earlier studies, the review said that screening by chest x-rays and questionnaires every six months had not improved lung cancer survival. It described mesotheliomas as uniformly fatal at that time and said risk factors for asbestosis had not been established. It proposed an experimental examination schedule for asbestos-exposed workers. The author concluded that the best medical way to reduce deaths was to identify especially susceptible people before hiring, and that exposed workers should be screened and urged not to smoke. The author noted that the evidence was incomplete and that the schedule's real benefits, if any, were unknown.

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: Narrative review with recommendations for industrial physicians, based on material from a National Cancer Institute monograph; no new data were collected
• Who was studied: No study population. The article is addressed to industrial physicians and draws on published studies of asbestos workers, the general population and laboratory animals.
• Exposure: Occupational asbestos exposure in general. Chrysotile miners and millers are mentioned specifically in connection with a magnetic technique, still under development, for estimating asbestos remaining in the lungs.
• Main results:
  • The author described lung cancer as the most frequent asbestos-related cancer and the one causing the heaviest mortality of any asbestos-related disease.
  • The author recommended that people with any lung cancer risk factor, or with sputum cytopathology equal to or worse than moderate atypical squamous cell metaplasia, not be hired for jobs involving asbestos exposure.
  • The author stated that no evidence existed that lung cancer risk falls among smoking asbestos workers who stop smoking, but considered it reasonable to assume so, and recommended encouraging them to stop.
  • Citing earlier studies, the review stated that screening programs using chest x-rays and symptom questionnaires every six months had been notably unsuccessful in improving lung cancer survival.
  • The review stated that cancers of the alimentary tract occur about twice as often among heavily exposed asbestos workers as in the general population.
  • The author described mesotheliomas as uniformly fatal at that time and stated that screening for mesothelioma beyond what is done for lung cancer was of no clinical value.
  • The author stated that risk factors for asbestosis had not been established.
  • The author stated that pleural thickening or plaques in an asbestos worker must always be suspected as a biological effect of inhaled asbestos. The author recommended that people with early asbestosis or pleural thickening be removed from exposure.
  • The article presented an experimental schedule of preemployment and follow-up examinations for asbestos-exposed workers. The schedule varies by smoking, sputum findings, age and years since first exposure, and was modified from a Mt. Sinai program.
• The authors' conclusion: The author concluded that the best medical means of reducing deaths from asbestos-related diseases is to recognize especially susceptible people at the preemployment examination and recommend that they not be hired for asbestos jobs. The author added that exposed workers should be enrolled in medical screening and urged not to smoke, and that screening should not be abandoned despite its limitations.
• Limitations the authors state:
  • The author stated that the evidence for the recommendations is incomplete.
  • The author stated that the real benefits of the proposed examination schedule, if any, were unknown.
  • The author noted that the judgment about alimentary tract cancer risk factors rests only on studies from Europe and North America.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Asbestos Exposure.

Related studies

• Cumulative asbestos exposure and mortality from asbestos related diseases in a pooled analysis of 21 asbestos cement cohorts in Italy — F. Luberto, D. Ferrante, et al. (2019)
• Asbestos-related diseases of the lung and other organs: their epidemiology and implications for clinical practice — M.R. Becklake (1976)
• Chest physician-reported, work-related, long-latency respiratory disease in Great Britain — M. Carder, A. Darnton, et al. (2017)
• Occupational lung disease survey of respiratory physicians in Northern Ireland — T.F. McKeagney, K. Addley, et al. (2015)
• Asbestos-related malignancy — K.H. Antman (1986)
• Inequities in reporting asbestos-related lung cancer: influence of smoking stigma and physician's specialty, workload and role perception — P. Verger, S. Arnaud, et al. (2008)

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