BMJ

Our medical research library holds 31 studies published in BMJ (1990–2024). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 5 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it. For 5 studies PubMed has no abstract for, we give the abstract printed in the article or, where there is none, a summary we wrote from it, each labeled as such.

About the journal

• Publisher: British Medical Association
• Published: 1988 to the present, England
• Language: English
• ISSN: 0959-8138 (print), 1756-1833 (electronic)
• Continues: British Medical Journal (Clinical Research Ed.)
• Its record in the NLM Catalog

2020s

• 25 year trends in cancer incidence and mortality among adults aged 35-69 years in the UK, 1993-2018: retrospective secondary analysis. J. Shelton, E. Zotow, L. Smith, et al. 2024;384:e076962. PubMed · Publisher · Free full text

  Abstract

  Objective: To examine and interpret trends in UK cancer incidence and mortality for all cancers combined and for the most common cancer sites in adults aged 35-69 years.

  Design: Retrospective secondary data analysis.

  Data Sources: Cancer registration data, cancer mortality and national population data from the Office for National Statistics, Public Health Wales, Public Health Scotland, Northern Ireland Cancer Registry, NHS England, and the General Register Office for Northern Ireland.

  Setting: 23 cancer sites were included in the analysis in the UK.

  Participants: Men and women aged 35-69 years diagnosed with or who died from cancer between 1993 to 2018.

  Main Outcome Measures: Change in cancer incidence and mortality age standardised rates over time.

  Results: The number of cancer cases in this age range rose by 57% for men (from 55 014 cases registered in 1993 to 86 297 in 2018) and by 48% for women (60 187 to 88 970) with age standardised rates showing average annual increases of 0.8% in both sexes. The increase in incidence was predominantly driven by increases in prostate (male) and breast (female) cancers. Without these two sites, all cancer trends in age standardised incidence rates were relatively stable. Trends for a small number of less common cancers showed concerning increases in incidence rates, for example, in melanoma skin, liver, oral, and kidney cancers. The number of cancer deaths decreased over the 25 year period, by 20% in men (from 32 878 to 26 322) and 17% in women (28 516 to 23 719); age standardised mortality rates reduced for all cancers combined by 37% in men (-2.0% per year) and 33% in women (-1.6% per year). The largest decreases in mortality were noted for stomach, mesothelioma, and bladder cancers in men and stomach and cervical cancers and non-Hodgkin lymphoma in women. Most incidence and mortality changes were statistically significant even when the size of change was relatively small.

  Conclusions: Cancer mortality had a substantial reduction during the past 25 years in both men and women aged 35-69 years. This decline is likely a reflection of the successes in cancer prevention (eg, smoking prevention policies and cessation programmes), earlier detection (eg, screening programmes) and improved diagnostic tests, and more effective treatment. By contrast, increased prevalence of non-smoking risk factors are the likely cause of the observed increased incidence for a small number of specific cancers. This analysis also provides a benchmark for the following decade, which will include the impact of covid-19 on cancer incidence and outcomes.

  © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

• Johnson & Johnson pays $700m to 42 US states to settle Baby Powder asbestos claims. O. Dyer. 2024;385:q1425. News PubMed · Publisher

• Cancer mortality after low dose exposure to ionising radiation in workers in France, the United Kingdom, and the United States (INWORKS): cohort study. D.B. Richardson, K. Leuraud, D. Laurier, et al. 2023;382:e074520. PubMed · Publisher · Free full text

  Abstract

  Objective: To evaluate the effect of protracted low dose, low dose rate exposure to ionising radiation on the risk of cancer.

  Design: Multinational cohort study.

  Setting: Cohorts of workers in the nuclear industry in France, the UK, and the US included in a major update to the International Nuclear Workers Study (INWORKS).

  Participants: 309 932 workers with individual monitoring data for external exposure to ionising radiation and a total follow-up of 10.7 million person years.

  Main Outcome Measures: Estimates of excess relative rate per gray (Gy) of radiation dose for mortality from cancer.

  Results: The study included 103 553 deaths, of which 28 089 were due to solid cancers. The estimated rate of mortality due to solid cancer increased with cumulative dose by 52% (90% confidence interval 27% to 77%) per Gy, lagged by 10 years. Restricting the analysis to the low cumulative dose range (0-100 mGy) approximately doubled the estimate of association (and increased the width of its confidence interval), as did restricting the analysis to workers hired in the more recent years of operations when estimates of occupational external penetrating radiation dose were recorded more accurately. Exclusion of deaths from lung cancer and pleural cancer had a modest effect on the estimated magnitude of association, providing indirect evidence that the association was not substantially confounded by smoking or occupational exposure to asbestos.

  Conclusions: This major update to INWORKS provides a direct estimate of the association between protracted low dose exposure to ionising radiation and solid cancer mortality based on some of the world's most informative cohorts of radiation workers. The summary estimate of excess relative rate solid cancer mortality per Gy is larger than estimates currently informing radiation protection, and some evidence suggests a steeper slope for the dose-response association in the low dose range than over the full dose range. These results can help to strengthen radiation protection, especially for low dose exposures that are of primary interest in contemporary medical, occupational, and environmental settings.

  © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

• Johnson & Johnson "regrets" 1971 study that injected asbestos into US prisoners. O. Dyer. 2022;376:o681. PubMed · Publisher

• Doctor with mesothelioma wins settlement for asbestos exposure in late 1990s. C. Dyer. 2020;369:m1783. PubMed · Publisher

2010s

• Asbestos disease expert wins right to obtain information held on him by lobbyist. C. Dyer. 2019;365:l1783. PubMed · Publisher

• Idiopathic pulmonary fibrosis and asbestos use. C.M. Barber, D. Fishwick. 2019;364:l1041. Letter · Comment PubMed · Publisher

  Summary

  In this letter, two occupational lung disease specialists responded to a study by Salciccioli and colleagues that noted high mortality from interstitial lung disease in the United Kingdom. They summarised their own earlier work. A UK study had found a significant association between mortality from idiopathic pulmonary fibrosis, the commonest form of interstitial lung disease, and mesothelioma, most deaths from which can be explained by asbestos exposure. Mortality from both conditions had risen steadily since the 1960s, in parallel with asbestos imports. A second study of 31 European countries had found a significant association between mesothelioma and idiopathic pulmonary fibrosis mortality, but not two other common forms of interstitial lung disease. Although limited by the available data, it also found a significant association between asbestos use and idiopathic pulmonary fibrosis mortality for each country. The authors argued that a link between asbestos and idiopathic pulmonary fibrosis was a biologically plausible hypothesis. Their reasons included that asbestos exposure, based on job title, was very common in the UK; that asbestos causes pulmonary fibrosis in humans and animal models; that recent research does not support a threshold of exposure for asbestosis; that diagnosing idiopathic pulmonary fibrosis requires excluding known causes, including asbestosis, which looks similar radiologically; and that diagnosing asbestosis relies on patients' recall of past exposure and a clinician's subjective judgement of a "sufficiently high" lifetime dose. Their final point was that idiopathic pulmonary fibrosis is likely to be diagnosed in people who have worked with asbestos if they are judged not to meet the criteria for asbestosis.

  PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

• Johnson & Johnson recalls its Baby Powder after FDA finds asbestos in sample. O. Dyer. 2019;367:l6118. PubMed · Publisher

• Johnson and Johnson under criminal investigation in US over asbestos in talcum powder. O. Dyer. 2019;366:l4747. PubMed · Publisher

• Johnson & Johnson knew for decades talcum powder contained asbestos, reports allege. O. Dyer. 2018;363:k5430. PubMed · Publisher

  Summary

  This BMJ news report, published on 28 December 2018, summarised investigations by Reuters and the New York Times alleging that Johnson & Johnson knew its talcum Baby Powder had sometimes contained asbestos. Reuters said it had examined thousands of pages of internal company documents provided to plaintiffs' lawyers in talcum powder litigation. Many of these had not been used in court or were confidential by court order. Reuters reported that from at least 1971 to the early 2000s the company's raw talc and finished powders sometimes tested positive for small amounts of asbestos. It said executives, scientists, doctors and lawyers discussed the problem without disclosing it to regulators or the public, and that the company sought to influence US regulators' plans to limit asbestos in cosmetic talc. The Food and Drug Administration (FDA) had regulated asbestos in drugs but not in cosmetics, and its commissioner announced a public forum for early 2019. Johnson & Johnson called the Reuters report "one-sided, false, and inflammatory" and said independent tests, including FDA tests in the 1970s and 2008-09, found no asbestos. The report noted that about 12 000 plaintiffs were seeking damages for mesothelioma or ovarian cancer. It also described a New Jersey judge's finding of "misrepresentation by omission" and a $4.7bn Missouri award to 22 women with ovarian cancer, which a judge upheld on 19 December. Health Canada had warned that talc may harm the lungs and increase ovarian cancer risk.

  PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

• Risk of cancer from occupational exposure to ionising radiation: retrospective cohort study of workers in France, the United Kingdom, and the United States (INWORKS). D.B. Richardson, E. Cardis, R.D. Daniels, et al. 2015;351:h5359. PubMed · Publisher · Free full text

  Abstract

  Study Question: Is protracted exposure to low doses of ionising radiation associated with an increased risk of solid cancer?

  Methods: In this cohort study, 308,297 workers in the nuclear industry from France, the United Kingdom, and the United States with detailed monitoring data for external exposure to ionising radiation were linked to death registries. Excess relative rate per Gy of radiation dose for mortality from cancer was estimated. Follow-up encompassed 8.2 million person years. Of 66,632 known deaths by the end of follow-up, 17,957 were due to solid cancers.

  Study Answer And Limitations: Results suggest a linear increase in the rate of cancer with increasing radiation exposure. The average cumulative colon dose estimated among exposed workers was 20.9 mGy (median 4.1 mGy). The estimated rate of mortality from all cancers excluding leukaemia increased with cumulative dose by 48% per Gy (90% confidence interval 20% to 79%), lagged by 10 years. Similar associations were seen for mortality from all solid cancers (47% (18% to 79%)), and within each country. The estimated association over the dose range of 0-100 mGy was similar in magnitude to that obtained over the entire dose range but less precise. Smoking and occupational asbestos exposure are potential confounders; however, exclusion of deaths from lung cancer and pleural cancer did not affect the estimated association. Despite substantial efforts to characterise the performance of the radiation dosimeters used, the possibility of measurement error remains.

  What This Study Adds: The study provides a direct estimate of the association between protracted low dose exposure to ionising radiation and solid cancer mortality. Although high dose rate exposures are thought to be more dangerous than low dose rate exposures, the risk per unit of radiation dose for cancer among radiation workers was similar to estimates derived from studies of Japanese atomic bomb survivors. Quantifying the cancer risks associated with protracted radiation exposures can help strengthen the foundation for radiation protection standards.

  Funding, Competing Interests, Data Sharing: Support from the US Centers for Disease Control and Prevention; Ministry of Health, Labour and Welfare of Japan; Institut de Radioprotection et de Sûreté Nucléaire; AREVA; Electricité de France; US National Institute for Occupational Safety and Health; US Department of Energy; and Public Health England. Data are maintained and kept at the International Agency for Research on Cancer.

  © Richardson et al 2015.

• Scientists protest about Quebec's "hypocrisy" over export of asbestos. D. Spurgeon. 2010;340:c639. News PubMed · Publisher

2000s

• An overview of how asbestos exposure affects the lung. G.P. Currie, S.J. Watt, N.A. Maskell. 2009;339:b3209. Review PubMed · Publisher

  Abstract

  Summary points
  The risk of asbestos related lung disease is dose related and depends on fibre type
  Joiners, plumbers, electricians, painters, shipyard workers, builders, engineers, and asbestos miners are at greatest risk
  Asbestos exposure can cause benign disease (pleural plaques, pleural thickening, benign pleural effusions), malignant disease (mesothelioma, lung cancer), and interstitial lung disease (asbestosis)
  Mesothelioma will peak in incidence between 2011 and 2015; it should be considered in all patients with a pleural effusion, chest pain, and history of asbestos exposure
  Treatment options in asbestosis are limited
  Some patients are entitled to compensation and should seek advice from the Department of Work and Pensions or dedicated charity organisations

  PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

• Asbestos and the lung. Diffuse pleural thickening has new definition for claims. J.L. Hoyle, J.K. Walker. 2009;339:b3953. Letter PubMed · Publisher

• Canadian academics call for asbestos report to be published. D. Spurgeon. 2008;336(7656):1269. News PubMed · Publisher · Free full text

• Asbestos company is forced to fund compensation shortfall. B. Burton. 2005;330(7482):62. News PubMed · Publisher · Free full text

• Cigarette tar yields in relation to mortality from lung cancer in the cancer prevention study II prospective cohort, 1982-8. J.E. Harris, M.J. Thun, A.M. Mondul, et al. 2004;328(7431):72. PubMed · Publisher · Free full text

  Abstract

  Objective: To assess the risk of lung cancer in smokers of medium tar filter cigarettes compared with smokers of low tar and very low tar filter cigarettes.

  Design: Analysis of the association between the tar rating of the brand of cigarette smoked in 1982 and mortality from lung cancer over the next six years. Multivariate proportional hazards analyses used to assess hazard ratios, with adjustment for age at enrollment, race, educational level, marital status, blue collar employment, occupational exposure to asbestos, intake of vegetables, citrus fruits, and vitamins, and, in analyses of current and former smokers, for age when they started to smoke and number of cigarettes smoked per day.

  Setting: Cancer prevention study II (CPS-II).

  Participants: 364 239 men and 576 535 women, aged > or = 30 years, who had either never smoked, were former smokers, or were currently smoking a specific brand of cigarette when they were enrolled in the cancer prevention study.

  Main Outcome Measure: Death from primary cancer of the lung among participants who had never smoked, former smokers, smokers of very low tar (< or = 7 mg tar/cigarette) filter, low tar (8-14 mg) filter, high tar (> or = 22 mg) non-filter brands and medium tar conventional filter brands (15-21 mg).

  Results: Irrespective of the tar level of their current brand, all current smokers had a far greater risk of lung cancer than people who had stopped smoking or had never smoked. Compared with smokers of medium tar (15-21 mg) filter cigarettes, risk was higher among men and women who smoked high tar (> or = 22 mg) non-filter brands (hazard ratio 1.44, 95% confidence interval 1.20 to 1.73, and 1.64, 1.26 to 2.15, respectively). There was no difference in risk among men who smoked brands rated as very low tar (1.17, 0.95 to 1.45) or low tar (1.02, 0.90 to 1.16) compared with those who smoked medium tar brands. The same was seen for women (0.98, 0.80 to 1.21, and 0.95, 0.82 to 1.11, respectively).

  Conclusion: The increase in lung cancer risk is similar in people who smoke medium tar cigarettes (15-21 mg), low tar cigarettes (8-14 mg), or very low tar cigarettes (< or = 7 mg). Men and women who smoke non-filtered cigarettes with tar ratings > or = 22 mg have an even higher risk of lung cancer.

• Criminal investigation follows report on asbestos compensation fund. B. Burton. 2004;329(7469):762. News PubMed · Publisher · Free full text

• Fund for patients with asbestos induced diseases may run out. B. Burton. 2004;328(7442):728. News PubMed · Publisher · Free full text

• Radical surgery for mesothelioma. T. Treasure, D. Waller, S. Swift, et al. 2004;328(7434):237-8. Editorial PubMed · Publisher · Free full text

  Summary

  This editorial discussed the growing epidemic of malignant pleural mesothelioma and the place of radical surgery in managing it. The authors stated that one in every hundred men born in the 1940s would die of the disease, which is almost exclusively a consequence of asbestos exposure, with a lag time rarely under 25 years and often over 50 years. Britain had over 1800 deaths per year. Because UK exposure continued until 1980, the peak was expected in 2015 to 2020 at about 2000 deaths per year. About 25% of deaths were expected in men who had worked in the building industry, with carpenters and joiners most commonly affected, and about 90% were attributed to exposure in unmonitored settings. The authors described the difficulty of diagnosis and noted that median survival from diagnosis was usually under a year. Extrapleural pneumonectomy, usually given as part of trimodality treatment, had been associated with five-year survival of up to 48% in highly selected patients with epithelioid histology and no lymph node metastases. Only about 20 patients per year had received radical surgery in the UK. A pilot feasibility study, the MARS trial, was under way, and a full trial would need 670 patients over three years with five years' follow-up. The authors recommended early diagnosis, thoracoscopic talc pleurodesis combined with surgical biopsy, staging, and treatment within studies.

  PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

• Asbestos poisoning was covered up by doctors, claims health team. G. Mudur. 2003;327(7409):248. News PubMed · Publisher · Free full text

• Surgeon dies from hospital exposure to asbestos. C. Dyer. 2000;320(7246):1358A. PubMed · Free full text

1990s

• French minister promises action to clean up asbestos. A. Dorozynski. 1995;311(7010):898. News PubMed · Publisher

• Asbestos and lung cancer in Glasgow and the west of Scotland. H. De Vos Irvine, D.W. Lamont, D.J. Hole, et al. 1993;306(6891):1503-6. PubMed · Publisher · Free full text

  Abstract

  Objective: To quantify the relation between lung cancer and exposure to asbestos in men in west Scotland and to estimate the proportion of lung cancer which may be attributed to exposure to asbestos.

  Design: An ecological correlation study of the incidence of lung cancer in men and past asbestos exposure. The unit of analysis was the postcode sector. Correction was made for past cigarette smoking, air pollution, and deprivation.

  Setting: The region covered by the west of Scotland cancer registry, containing 2.72 million people and including Glasgow and the lower reaches of the River Clyde, where shipbuilding was once a major industry.

  Subjects: All men diagnosed with lung cancer between 1975 and 1984 whose residence at the time of registration was within the west of Scotland.

  Main Outcome Measure: The population attributable risk for asbestos related lung cancer.

  Results: An estimated 5.7% (95% confidence interval 2.3 to 9.1%) of all lung cancers in men registered in the west of Scotland during the period 1975-84 were asbestos related, amounting to 1081 cases.

  Conclusions: A considerable proportion of cases of lung cancer in men in Glasgow and the west of Scotland from 1975 to 1984 were asbestos related. Most of these may not have been considered for compensation by the Department of Social Security. Given the very small annual number of recorded cases of asbestosis this condition is probably not a prerequisite for the development of asbestos related lung cancer. A heightened awareness of the increasing incidence of asbestos related neoplasms and their more thorough investigation are recommended.

• The hazards of asbestos. Access to vital data is denied. M. Greenberg. 1993;307(6898):259. Comment · Letter PubMed · Publisher · Free full text

• The hazards of asbestos. Detailed occupational history is vital. A. Seaton. 1993;307(6898):258. Comment · Letter PubMed · Publisher · Free full text

• The hazards of asbestos. Inaccurate diagnoses distort results. F.G. Mayall. 1993;307(6898):258-9. Comment · Letter PubMed · Publisher · Free full text

• Mesothelioma and exposure to asbestos. W.K. Morgan. 1991;302(6785):1153. Letter PubMed · Publisher · Free full text

• Asbestos diseases and compensation. D.H. Yates. 1990;301(6752):609. Letter · Comment PubMed · Publisher · Free full text

• Asbestos diseases and compensation. L. Arblaster, P. Hatton, M.S. Schweiger, et al. 1990;301(6760):1101. Letter · Comment PubMed · Publisher · Free full text

• Asbestos diseases and compensation. A. Seaton. 1990;301(6750):453-4. Editorial PubMed · Publisher · Free full text

  Summary

  This editorial discussed the compensation available to people with asbestos related disease and how doctors should advise them. The author described two routes: industrial injuries benefit from the Department of Social Security, and damages through civil litigation for employer negligence. Four diseases were recognised as industrial diseases in people occupationally exposed to asbestos: asbestosis, mesothelioma, bilateral diffuse pleural thickening, and lung cancer with asbestosis or diffuse pleural thickening. Each year about 500 people were awarded benefits for mesothelioma, 200 for asbestosis, 100 for diffuse fibrosis and 60 for lung cancer in the presence of other asbestos related disease. Pleural plaques alone were not prescribed diseases. The author noted scope for diagnostic disagreement, and in about a third of cases the medical boards' verdict differed from that of the diagnosing doctor. Litigation could bring substantial awards but often failed because negligence could not be shown in the light of knowledge at the time. The author advised doctors to ensure the diagnosis was reasonably secure and to encourage eligible patients to claim benefit. Patients considering legal action should be referred to a trade union or solicitor rather than told to sue. Patients with pleural plaques should be reassured. After death, doctors should encourage necropsy and preservation of the lungs for analysis of asbestos content.

  PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

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