Journal of Occupational Medicine and Toxicology

Our medical research library holds 25 studies published in Journal of Occupational Medicine and Toxicology (2008–2026). 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. 25 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: BioMed Central
• Published: 2006 to the present, England
• Language: English
• ISSN: 1745-6673 (electronic)
• Its record in the NLM Catalog

2020s

• Welding and brazing fumes and lung cancer risk: a systematic review and meta-analysis. Y. Kim, E.M. Kim, I. Kim. 2026;21(1). Review PubMed · Publisher · Free full text

  Abstract

  Background: Previous systematic reviews have adopted binary exposure classifications without characterizing the heterogeneity of welding fume exposures. We aimed to estimate lung cancer risk from welding fumes with systematic exposure characterization by process type, base material, and metal fume component, and to examine evidence for related high-temperature processes.

  Methods: We searched PubMed, Embase, and Web of Science through July 2025 for cohort, case-control and other epidemiological studies. Exposure information was systematically extracted from full-text descriptions and classified by welding process, base material, and metal fume component. Separate random-effects meta-analyses were performed for comparative risk and standardized ratio estimates.

  Results: Of 86 studies meeting inclusion criteria, 58 were included in quantitative synthesis after excluding 12 overlapping cohorts and 16 high-risk-of-bias studies; 39 comparative risk and 22 standardized ratio studies were analyzed. The pooled relative risk was 1.51 (95% CI: 1.36-1.67; I2 = 39.4%) and standardized ratio was 1.32 (95% CI: 1.24-1.40; I2 = 76.6%). The association was robust across subgroup analyses: studies adjusting for smoking (RR = 1.55; n = 31) and asbestos (RR = 1.53; n = 12) yielded estimates consistent with the overall finding. A significant dose-response gradient was observed for both comparative risk (p = 0.03) and standardized ratio studies (p = 0.013). Gas metal arc welding (GMAW) and gas tungsten arc welding (GTAW) showed elevated point estimates, with stainless steel welding showing suggestive evidence of increased risk; however, secondary analyses were based on few studies with wide confidence intervals. Evidence of publication bias was detected but adjusted estimates remained significant. Evidence certainty was moderate for comparative risk and low for standardized ratio estimates.

  Conclusions: Welding fume exposure is associated with approximately 50% increased lung cancer risk, with consistent sensitivity analyses. Process-specific analyses suggest elevated risks for GMAW and stainless steel welding, though based on limited data, warranting further investigation alongside prioritized prevention efforts. Data on brazing, soldering, and flame cutting were limited, representing evidence gaps for future research.

  Trial Registration: PROSPERO CRD420251238410.

  © 2026. The Author(s).

• Cause-specific mortality among workers in asbestos mining and enrichment factories (Asbest Chrysotile Cohort Study) compared with the general population of Sverdlovsk Oblast, Russian Federation. A. Olsson, J. Schüz, I. Bukhtiyarov, et al. 2025;20(1):37. PubMed · Publisher · Free full text

  Abstract

  OBJECTIVES: Complementing the previously published cohort-internal comparison we hereby compare the cause-specific mortality in workers of the Asbest Chrysotile Cohort study (ACC) with the general population of Sverdlovsk Oblast where the mine and factories are located. METHODS: The ACC cohort database and the regional Federal State Statistic Service for the Sverdlovsk Oblast population were used. We calculated sex-specific standardized mortality ratios (SMRs) and 95% confidence intervals (CI) for the main ICD-10 disease groups and for selected cancer sites for the populations ≥ 15 years from 1980 to 2015. In relation to exposure, we applied the Sverdlovsk rates to the person-years in each exposure category to obtain expected numbers of lung cancer deaths. For comparing types of ACC workers (mine, enrichment factories, both), we calculated lung cancer SMRs in men by duration of employment (< 5 years, 5–14 years, and ≥ 15 years) and start of employment (before or after 1975) with miners as reference in each stratum. RESULTS: Overall mortality of men in the ACC was reduced by 14%, mainly because of the most common cause of death, circulatory disease; this effect was much weaker in women. Elevated mortality was observed for both sexes from diseases of the digestive system (10–30%) and blood and blood forming organs (121–181%). Lung cancer mortality in men was increased from the 3rd quartile of chrysotile containing dust and in the highest quartile with SMR 1.30, 95% CI 1.07–1.57, while the increase in high exposed women was not reaching statistical significance (SMR 1.69, 95% CI 0.87–2.96). No increased SMRs were seen for laryngeal, stomach or ovarian cancers. Male factory workers first employed before 1975 had higher lung cancer mortality compared to miners, but not when employed after 1974. CONCLUSIONS: The observed excess in lung cancer confirms previous observations in the ACC. Risk management measures in the enrichment factories may have reduced the lung cancer risk to the level of the miners in recent decades.

• Preparation methodology evaluation of rat pulmonary tissues containing mineral fibers following inhalation exposure to Libby amphibole asbestos. J.S. Richey, J.R. Shaw, A. Gupta, et al. 2025;20(1):35. PubMed · Publisher · Free full text

  Abstract

  Background: Inhaled mineral fibers including asbestos are associated with lung cancer and pleural disease. In this study, we evaluated methodologies for mineral fiber isolation with subsequent physical and chemical characterization from pulmonary tissues of rats exposed to Libby amphibole asbestos 2007 (LA 2007) fibers via repeated nose-only inhalation. At the completion of the exposures, lungs were collected either as is or instilled with liquid agarose to produce a pulmonary cast. To extract fibers, lung tissue with and without pulmonary casts were further processed by either high temperature ashing or chemical digestion. The use of liquid agarose to produce pulmonary casts was discontinued after the first study assessment as no fibers were present in the pleural cavity for evaluation. Fibers isolated from the lungs were analyzed by transmission electron microscopy (TEM) coupled with selected area electron diffraction (SAED) and energy dispersive X-ray spectroscopy (EDS) for physical and chemical characterization. The bulk LA 2007 test material was also analyzed to provide comparison of fiber dimensions and chemical composition of the fibers introduced during exposure. Particular interest was focused on the comparison between high temperature ashing and chemical digestion extraction methodologies.

  Results: Chemical digestion of lung tissue with and without pulmonary casts resulted in fiber dimensions and chemical profiles similar to the bulk LA 2007 test chemical and exposure atmosphere. Conversely, high temperature ashing resulted in degraded fibers with chemically altered profiles.

  Conclusions: Based on the findings in this study, chemical digestion of lung tissue is the preferred preparation method for the isolation of inhaled mineral fibers for lung burden analysis.

  © 2025. The Author(s).

• Pathological characterization of lung fibrosis in Sprague-Dawley rats treated with fluoro-edenite fibres by intrapleural injection. E. Tibaldi, F. Gnudi, D. Mandrioli, et al. 2024;19(1):45. PubMed · Publisher · Free full text

  Abstract

  Background: An increased incidence of pleural mesotheliomas in Biancavilla (Italy) was attributed to the environmental exposure to fluoro-edenite (FE). Results from the Ramazzini Institute (RI) in vivo long-term study confirmed the evidence that exposure to FE fibres is correlated with an increase of malignant pleural mesotheliomas in Sprague-Dawley rats. Recently asbestosis-like features were substantiated in Biancavilla residents without known occupational exposures. Aim of this work was to establish whether FE induce lung fibrosis with a pathogenetic mechanism similar to other asbestiform fibres.

  Methods: Original slides from the RI study were systematically re-examined to characterize the FE-induced lesions. Quantitative analysis of lung fibrosis was assessed following the Ashcroft method. Immunohistochemical analysis of protein involved in fibrotic responses and histochemical staining for FE-fibres identification were performed.

  Results: Like asbestos, FE caused fibrotic lesions, pleural plaques or nodules and mesotheliomas. A significant increase of lung fibrosis (p < 0.001) was observed in the FE-treated groups compared to untreated controls. In the fibrotic responses to FE, vimentin was the most expressed protein, followed by collagen-I and alpha-SMA. Finally, ferruginous bodies, characterized by iron deposits and ferritin expression, were observed in FE-induced lesions.

  Conclusions: This study confirmed that FE exposure promotes the onset of fibrotic lesions at pleural level, as fibrous plaques or nodules and fibrosis, through a mechanism similar to other form of asbestos. These results combined with epidemiological study reported in Biancavilla residents, corroborate the need to promote health and epidemiological surveillance plans of respiratory diseases in population living in FE contaminated sites.

  © 2024. The Author(s).

• Clinical outcomes and survival following lung transplantation for work-related lung disease: a single-center retrospective cohort study. C. Ju, Y. Yang, Q. Lian, et al. 2023;18(1):2. PubMed · Publisher · Free full text

  Abstract

  Background: Patients with work-related lung disease (WRLD) are at increased risk of death caused by severe lung tissue damage and fibrosis. This study aimed to assess the clinical outcomes of lung transplantation (LTx) for WRLD and compare the results of LTx between WRLD and idiopathic pulmonary fibrosis (IPF).

  Methods: This single-center retrospective cohort study reviewed the clinical data of patients who underwent LTx for WRLD or IPF at our hospital between January 2015 and December 2021. Cumulative survival rates after LTx were estimated using the Kaplan-Meier method.

  Results: The final analysis included 33 cases of WRLD and 91 cases of IPF. The 33 WRLD patients consisted of 19 (57.6%) cases of silicosis, 8 (24.2%) cases of coal workers' pneumoconiosis, 3 (9.09%) cases of asbestosis, and 3 (9.09%) cases of other WRLD. Pneumothorax as an indication for LTx was significantly more common in the WRLD group than in the IPF group (51.5% vs. 2.2%, P < 0.001). There was no significant difference in the 5-year cumulative survival rate between the WRLD patients and the IPF patients (66.6% vs. 56.7%, P = 0.67). There was no significant difference in the best performance of exercise capacity and lung function between the two groups at 1 year post-transplant.

  Conclusions: LTx had similar survival outcomes and lung function for WRLD and IPF patients. Pneumothorax was the primary indication for lung transplantation in WRLD.

  © 2023. The Author(s).

• Exposure to cosmetic talc and mesothelioma. J. Moline, K. Patel, A.L. Frank. 2023;18(1):1. PubMed · Publisher · Free full text

  Abstract

  Aim: Mesothelioma is associated with asbestos exposure. In this case series, we present 166 cases of individuals who had substantial asbestos exposure to cosmetic talc products as well as some who had potential or documented additional exposures to other asbestos-containing products and who subsequently developed mesothelioma.

  Methods: Data were gathered for all subjects referred to an occupational and environmental medicine specialist as part of medicolegal review. Years of total cosmetic talcum powder usage was noted as well as the latency from the onset of talcum powder use to the mesothelioma diagnosis. Alternate asbestos exposure in addition to the exposure from cosmetic talc was categorized as none, possible, likely, and definite.

  Results: In 122 cases, the only known exposure to asbestos was from cosmetic talc. For 44 cases, potential or documented alternate exposures in addition to the cosmetic talc were described.

  Conclusion: Cumulative exposure to asbestos leads to mesothelioma; for individuals with mixed exposures to asbestos, all exposures should be considered. Use of cosmetic talc is often overlooked as a source of asbestos exposure. All individuals with mesothelioma should have a comprehensive history of asbestos exposure, including cosmetic talc exposure.

  © 2023. The Author(s).

• Quantitative assessment of asbestos fibers in some normal and pathological extra-abdominal tissues-a scoping review. F. Graziosi, P. Caffaro, M. Bonetti, et al. 2023;18(1):24. PubMed · Publisher · Free full text

  Abstract

  Background: Asbestos is a mineral present in nature and it has been used for years in numerous settings. Asbestos enters the bloodstream and lymphatic system mainly through breathing.

  Objectives: Studies with asbestos fiber's quantification in human tissues are scarce except for the lung. This article summarizes asbestos studies in some extra-abdominal tissues.

  Methods: A scoping review of articles that quantified asbestos fibers in extra-abdominal tissues (lymph nodes, pharynx, larynx, trachea, heart) by electron microscopy (Scanning-SEM or Transmission-TEM) was performed.

  Results: The 10 studies selected comprised 52 cases, out of whom 108 samples were analyzed. Mostly samples were lymph node tissues (102), followed by larynx (3) and myocardium (3). No studies were found that determined the presence of asbestos in the pharynx or trachea. The concentration of asbestos fibers detected in the lymph nodes was from 0.003 million fibers per gram of dry tissue (mfgdt) up to 7400 mfgdt, in the larynx the range was from 0.5 mfgdt up to 3.6 mfgdt, in myocardium no asbestos fibers were detected.

  Discussion: The studies included were heterogeneous in terms of case and sample characteristics and analytical techniques. As subjects exposed to asbestos are often positive for fibers in thoracic lymph nodes, we suggest that whenever a human tissue sample is analyzed for asbestos presence, the relevant draining lymph node should be concomitantly studied.

  © 2023. The Author(s).

• Ongoing downplaying of the carcinogenicity of chrysotile asbestos by vested interests. X. Baur, A.L. Frank. 2021;16(1):6. Letter PubMed · Publisher · Free full text

  Abstract

  Industries that mine, manufacture and sell asbestos or asbestos-containing products have a long tradition of promoting the use of asbestos, while placing the burden of economic and health costs on workers and society. This has been successfully done in recent years and decades in spite of the overwhelming evidence that all asbestos types are carcinogenic and cause asbestosis. In doing so, the asbestos industry has undermined the WHO campaign to reach a worldwide ban of asbestos and to eliminate asbestos-related diseases. Even worse, in recent years they succeeded in continuing asbestos mining and consuming in the range of about 1.3 million tons annually. Nowadays, production takes place predominantly in Russia, Kazakhstan and China. Chrysotile is the only asbestos type still sold and represents 95% of asbestos traded over the last century.The asbestos industry, especially its PR agency, the International Chrysotile Association, ICA, financed by asbestos mining companies in Russia, Kazakhstan and Zimbabwe and asbestos industrialists in India and Mexico, continues to be extremely active by using slogans such as chrysotile can be used safely.Another approach of the asbestos industry and of some of its insurance agencies is to broadly defeat liability claims of asbestos victims.In doing so they systematically use inappropriate science produced by their own and/or by industry-affiliated researchers. Some of the latter were also engaged in producing defense material for other industries including the tobacco industry. Frequent examples of distributing such disinformation include questioning or denying established scientific knowledge about adverse health effects of asbestos. False evidence continues to be published in scientific journals and books.The persisting strong influence of vested asbestos-related interests in workers and public health issues including regulations and compensation necessitate ongoing alertness, corrections and appropriate reactions in scientific as well as public media and policy advisory bodies.

• Global use of asbestos - legitimate and illegitimate issues. A.L. Frank. 2020;15:16. Review PubMed · Publisher · Free full text

  Abstract

  Background: Exposure to asbestos causes non-malignant and malignant diseases including asbestosis, lung cancer, and mesothelioma. The modern history of such diseases goes back more than a century.

  Main Text: While much is known about the ability of asbestos to cause disease, the carcinogenic mechanism is not yet understood. Continuing legitimate scientific questions include such issues as potential differential toxicity and carcinogenicity of different fiber types. Illegitimate issues include the supposed "safe" use of asbestos, and the chrysotile hypothesis.

  Conclusion: Asbestos disease issues are highly politicized and vested economic interests perpetuate false issues regarding the hazards of asbestos.

  © The Author(s) 2020.

• Relations between vital capacity, CO diffusion capacity and computed tomographic findings of former asbestos-exposed patients: a cross-sectional study. A.M. Preisser, K. Schlemmer, R. Herold, et al. 2020;15:21. PubMed · Publisher · Free full text

  Abstract

  Background: Asbestos-related lung diseases are one of the leading diagnoses of the recognized occupational diseases in Germany, both in terms of their number and their socio-economic costs. The aim of this study was to determine whether pulmonary function testing (spirometry and CO diffusion measurement (DLCO)) and computed tomography of the thorax (TCT) are relevant for the early detection of asbestos-related pleural and pulmonary fibrosis and the assessment of the functional deficiency.

  Methods: The records of 111 formerly asbestos-exposed workers who had been examined at the Institute for Occupational and Maritime Medicine, Hamburg, Germany, with data on spirometry, DLCO and TCT were reviewed. Workers with substantial comorbidities (cardiac, malignant, silicosis) and/or pulmonary emphysema (pulmonary hyperinflation and/or TCT findings), which, like asbestosis, can lead to a diffusion disorder were excluded. The remaining data of 41 male workers (mean 69.8 years ±6.9) were evaluated. The TCT changes were coded according to the International Classification of High-resolution Computed Tomography for Occupational and Environmental Respiratory Diseases (ICOERD) by radiologists and ICOERD-scores for pleural and pulmonary changes were determined. Correlations (ρ), Cohens κ and accuracy were calculated.

  Results: In all 41 males the vital capacity (VC in % of the predicted value (% pred.)) showed only minor limitations (mean 96.5 ± 18.0%). The DLCO (in % pred.) was slightly reduced (mean 76.4 ± 16.6%; median 80.1%); the alveolar volume related value (DLCO/VA) was within reference value (mean 102 ± 22%). In the TCT of 27 workers pleural asbestos-related findings were diagnosed whereof 24 were classified as pulmonary fibrosis (only one case with honey-combing). Statistical analysis provided low correlations of VC (ρ = - 0.12) and moderate correlations of DLCO (- 0.25) with pleural plaque extension. The ICOERD-score for pulmonary fibrosis correlated low with VC (0.10) and moderate with DLCO (- 0.23); DLCO had the highest accuracy with 73.2% and Cohens κ with 0.45. DLCO/VA showed no correlations to the ICOERD-score. The newly developed score, which takes into account the diffuse pleural thickening, shows a moderate correlation with the DLCO (ρ = - 0.35, p < 0.05).

  Conclusions: In formerly asbestos-exposed workers, lung function alterations and TCT findings correlated moderate, but significant using DLCO and ICOERD-score considering parenchymal ligaments, subpleural curvilinear lines, round atelectases and pleural effusion in addition to pleural plaque extension. DLCO also showed highest accuracy in regard to pulmonary findings. However, VC showed only weaker correlations although being well established for early detection. Besides TCT the determination of both lung function parameters (VC and DLCO) is mandatory for the early detection and assessment of functional deficiencies in workers formerly exposed to asbestos.

  © The Author(s) 2020.

2010s

• Migrating pleural plaque in a patient with asbestos induced pleural disease: a case report. C. Eisenhawer, M.K. Felten, T. Hager, et al. 2017;12:25. Case report PubMed · Publisher · Free full text

  Abstract

  Background: Health surveillance of formerly asbestos exposed individuals focus on early detection of asbestos related diseases, such as lung fibrosis (asbestosis), pleural plaques, mesothelioma and lung cancer in particular. One main concern is the early and clear identification of lesions with a high risk of malignant changes and their undelayed clinical work-up. False positive results may lead to unnecessary and often painful diagnostic interventions, which create high costs when applied to a large cohort and also may discredit the whole program. We describe an unusual presentation of a common lesion among asbestos exposed individuals, which has to our knowledge never been described before. Being aware of this pathological pathway may prevent inadequate clinical decisions with disadvantages for the patient. Underlying implications regarding health surveillance and the reading of CT-scans of the thorax are important for the management of formerly asbestos exposed individuals.

  Case Presentation: During follow-up of an asbestos exposed 72 year old former power plant worker with known pleural changes, a nodule located next to the left costophrenic angle was newly discovered on CT-scan. As the previous scan 1 year before did not show any changes in that area, a fast growing tumour was suspected and an immediate biopsy performed. The tissue showed the characteristics of a pleural plaque with no signs of malignancy. After carefully reviewing all previous radiographs a rounded opacity attached to the mediastinal pleura close to the oesophagus and slightly cranial to the position of the removed nodule could be discerned. That nodule had increased in size over several years and was no longer visible on the latest scan. It appeared that the originally slow growing plaque had migrated to the costophrenic angle some time before it was discovered in the latest scan thus imposing as a fast growing tumour.

  Conclusions: We concluded that asbestos related pleural plaques can under special circumstances get separated from the pleura and migrate to another position in the pleural cavity. The case provides new insights in the development and properties of pleural lesions and may offer new options for the management of formerly asbestos exposed patients.

• Malignant mesothelioma incidence by nation-wide cancer registry: a population-based study. K. Tomasson, G. Gudmundsson, H. Briem, et al. 2016;11:37. PubMed · Publisher · Free full text

  Abstract

  Background: Malignant mesothelioma caused by asbestos exposure has a long latency period. A ban on asbestos use may not be apparent in decreased incidence in the population until after several decades. The aim was to evaluate changes in the incidence of malignant mesothelioma, and the possible impact of the asbestos ban implemented in Iceland in 1983.

  Methods: This is a population study on aggregate level; the source of data was the Icelandic Cancer Registry, the National Cause-of-Death Registry, and the National Register. Volume of asbestos import was obtained from Customs Tariff. The import figures reflect fairly accurately the amount used, as there are no mines in the country.

  Results: Asbestos import peaked in 1980 at 15.0 kg/capita/year, diminishing to 0.3 kg/capita/year ten years after the ban in 1983, and to zero in the most recent years. Seventy-nine per cent of the cases of malignant mesothelioma were men, and 72 % were of pleural origin. Mesothelioma incidence increased steadily from 1965 to 2014, when it reached 21.4 per million among men, and 5.6 among women. Mortality in 2014 was 22.2 per million among men, and 4.8 among women.

  Conclusion: Malignant mesothelioma incidence and mortality increased in the population during the period, despite the ban on asbestos use from 1983. This is in agreement with the long latency time for malignant mesothelioma. In line with the previously high per capita volume of asbestos import, many buildings, equipment, and structures contain asbestos, so there is an on-going risk of asbestos exposure during maintenance, renovations and replacements. It is thus difficult to predict when the incidence of malignant mesothelioma will decrease in the future. During the last ten-year period, the incidence in Iceland was higher than the recently reported incidence in neighbouring countries.

• Is it useful to combine sputum cytology and low-dose spiral computed tomography for early detection of lung cancer in formerly asbestos-exposed power industry workers?. M.K. Felten, L. Knoll, C. Schikowsky, et al. 2014;9:14. PubMed · Publisher · Free full text

  Abstract

  Background: Low-dose spiral computed tomography (LDSCT) in comparison to conventional chest X-ray proved to be a highly sensitive method of diagnosing early stage lung cancer. However, centrally located early stage lung tumours remain a diagnostic challenge. We determined the practicability and efficacy of early detection of lung cancer when combining LDSCT and sputum cytology.

  Methods: Of a cohort of 4446 formerly asbestos exposed power industry workers, we examined a subgroup of 187 (4.2%) high risk participants for lung cancer at least once with both LDSCT and sputum cytology. After the examination period the participants were followed-up for more than three years.

  Results: The examinations resulted in the diagnosis of lung cancer in 12 participants (6.4%). Six were in clinical stage I. We found 10 non-small cell lung carcinomas and one small cell lung carcinoma. Sputum specimens showed suspicious pathological findings in seven cases and in 11 cases the results of LDSCT indicated malignancies. The overall sensitivity and specificity of sputum cytology was 58.0% and 98% with positive (PPV) and negative (NPV) predictive values of 70% and 97%. For LDSCT we calculated the sensitivity and specificity of 92% and 97%. The PPV and NPV were 65% and 99% respectively.

  Conclusions: Our results confirmed that in surveillance programmes a combination of sputum cytology and LDSCT is well feasible and accepted by the participants. Sputum examination alone is not effective enough for the detection of lung cancer, especially at early stage. Even in well- defined risk groups highly exposed to asbestos, we cannot recommend the use of combined LDSCT and sputum cytology examinations as long as no survival benefit has been proved for the combination of both methods. For ensuring low rates of false-positive and false-negative results, programme planners must closely cooperate with experienced medical practitioners and pathologists in a well-functioning interdisciplinary network.

• Pulmonary fibrosis following household exposure to asbestos dust?. J. Schneider, B. Brückel, L. Fink, et al. 2014;9(1):39. PubMed · Publisher · Free full text

  Abstract

  An 81-year-old woman was dying from histologically confirmed pulmonary fibrosis without having had any asbestos exposure in the workplace. The lung dust fibre analysis showed significantly increased "asbestos bodies" (AB) (2,640 AB per gram of wet lung tissue) and asbestos fibre concentrations (8,600,000 amphibole fibres of all lengths and 540,000 amphibole fibres with a length ≥5 μm per gram of dry lung tissue). Asbestos exposure was revealed to have occurred during household contact after 27 years of washing her husband's industrial clothing that had been contaminated by asbestos at his workplace in an asbestos textile factory. Household asbestos dust exposure as a risk or co-factor in the aetiology of the fatal pulmonary fibrosis is discussed.

• Radiological surveillance of formerly asbestos-exposed power industry workers: rates and risk factors of benign changes on chest X-ray and MDCT. C. Eisenhawer, M.K. Felten, M. Tamm, et al. 2014;9:18. PubMed · Publisher · Free full text

  Abstract

  Background: To determine the prevalence of asbestos-related changes on chest X-ray (CXR) and low-dose multidetector-row CT (MDCT) of the thorax in a cohort of formerly asbestos-exposed power industry workers and to assess the importance of common risk factors associated with specific radiological changes.

  Methods: To assess the influence of selected risk factors (age, time since first exposure, exposure duration, cumulative exposure and pack years) on typical asbestos-related radiographic changes, we employed multiple logistic regression and receiver operating characteristic (ROC) analysis.

  Results: On CXR, pleural changes and asbestosis were strongly associated with age, years since first exposure and exposure duration. The MDCT results showed an association between asbestosis and age and between plaques and exposure duration, years since first exposure and cumulative exposure. Parenchymal changes on CXR and MDCT, and diffuse pleural thickening on CXR were both associated with smoking. Using a cut-off of 55 years for age, 17 years for exposure duration and 28 years for latency, benign radiological changes in the cohort with CXR could be predicted with a sensitivity of 82.0% for all of the three variables and a specificity of 47.4%, 39.0% and 40.6%, respectively.

  Conclusions: Participants aged 55 years and older and those with an asbestos exposure of at least 17 years or 28 years since first exposure should be seen as having an increased risk of abnormal radiological findings. For implementing a more focused approach the routine use of low-dose MDCT rather than CXR at least for initial examinations would be justified.

• Novel method using hybrid markers: development of an approach for pulmonary measurement of multi-walled carbon nanotubes. M. Ohnishi, H. Yajima, T. Kasai, et al. 2013;8(1):30. PubMed · Publisher · Free full text

  Abstract

  Background: Multi-walled carbon nanotubes (MWCNT)s are suspected to induce pulmonary and pleural cancers due to their asbestos-like configurations. Therefore, accurate measurement of inhaled nanotubes in target organs is crucial for assessing cancer risk. Conventionally, nanotubes are measured after combustion at high temperature for conversion into CO2; however, the sensitivity is poor and the method lacks versatility. We have therefore developed a novel approach using hybrid markers for nanotube analysis, featuring high sensitivity and the capacity to conduct repeated analyses. The method involves adsorption of markers to nanotubes, followed by their desorption and assessment by means of high performance liquid chromatography (HPLC).

  Methods: Recovery of MWCNT from rat lungs was conducted, and pulmonary MWCNT amounts were determined using rats intratracheally-exposed to MWCNT aerosol at 5 mg/m3 for 6 hours/day.

  Results: The correlation coefficient for the calibration curve of MWCNT weight and the HPLC area was 0.9991. Consequently, the lower quantitation limit yielded was 0.2 μg. The recovery was 92-98% at approximately 0.4-2.0 μg demonstrating that MWCNTs in the lung could be measured accurately and precisely.

  Conclusions: We have developed a novel method using a hybrid marker approach for nanotube analysis, featuring very high sensitivity and the capacity to conduct repeated analyses. We further confirmed correlations between the amounts of nanotubes and markers and pulmonary nanotube measurement demonstrated that trace amounts could be detected with values closely relating to the administered dose, verifying that the method is sensitive and precise.

• Comparative analysis of induced sputum and bronchoalveolar lavage fluid (BALF) profile in asbestos exposed workers. E.C. Alexopoulos, D. Bouros, M. Dimadi, et al. 2011;6:23. PubMed · Publisher · Free full text

  Abstract

  Background: Biological monitoring of healthy workers exposed to hazardous dusts lack validated screening tools. Induced sputum (IS) cellular profile was compared with bronchoalveolar lavage fluid (BALF) profile in asbestos exposed workers in order to assess its usefulness in monitoring workers exposed to asbestos for a long period of time.

  Methods: IS and BALF analysis was performed in 39 workers of a car brakes and clutches factory that uses chrysotile asbestos. Selection criteria were an employment history of > 15 years and the absence of a diagnosis of pneumonoconiosis. The type of cells, the existence of dust cells, of iron laden macrophages and of asbestos bodies were assessed and compared between IS and BALF samples.

  Results: 35 IS samples (90%) had dust cells, 34 (87%) iron laden macrophages and in 8 samples (21%) asbestos bodies were found. In most samples neutrophils were dominated. Samples with asbestos bodies (ABs) had significantly higher lymphocytes and lower neutrophils count compared with the samples without ABs. Macrophages and neutrophils in IS and BALF exhibited significant inter-relations (Spearman's rho: 0.26-0.29, p < 0.05) while IS lymphocytes count showed an inverse relation with BALF neutrophils (Spearman's rho: -0.36). Neutrophils and dust cells were highly correlated between the samples (Spearman's rho: 0.35, p < 0.05) while IS dust cells and lymphocytes were inversely related (Spearman's rho: -0.36, p < 0.05). More years of employment in the company was related with more neutrophils (Spearman's rho: 0.26) and less lymphocytes (Spearman's rho: -0.33) count. In multivariate analysis the presence of AB in IS samples was strongly related to the presence of asbestos bodies and lymphocytes count in BALF samples.

  Conclusions: IS and BALF analysis showed a similar cellular profile indicating that IS sampling in exposed workers to asbestos as a less invasive and expensive method may be useful in providing an insight both for inhalation of dusts and inflammatory processes in the lung.

• Lung function in asbestos-exposed workers, a systematic review and meta-analysis. D. Wilken, M. Velasco Garrido, U. Manuwald, et al. 2011;6:21. PubMed · Publisher · Free full text

  Abstract

  Background: A continuing controversy exists about whether, asbestos exposure is associated with significant lung function impairments when major radiological abnormalities are lacking. We conducted a systematic review and meta-analysis in order to assess whether asbestos exposure is related to impairment of lung function parameters independently of the radiological findings.

  Methods: MEDLINE was searched from its inception up to April 2010. We included studies that assessed lung function parameters in asbestos exposed workers and stratified subjects according to radiological findings. Estimates of VC, FEV1 and FEV1/VC with their dispersion measures were extracted and pooled.

  Results: Our meta-analysis with data from 9,921 workers exposed to asbestos demonstrates a statistically significant reduction in VC, FEV1 and FEV1/VC, even in those workers without radiological changes. Less severe lung function impairments are detected if the diagnoses are based on (high resolution) computed tomography rather than the less sensitive X-ray images. The degree of lung function impairment was partly related to the proportion of smokers included in the studies.

  Conclusions: Asbestos exposure is related to restrictive and obstructive lung function impairment. Even in the absence of radiological evidence of parenchymal or pleural diseases there is a trend for functional impairment.

• Evidence of carcinogenicity in humans of water-soluble nickel salts. T.K. Grimsrud, A. Andersen. 2010;5:7. Editorial PubMed · Publisher · Free full text

  Abstract

  Background: Increased risks of nasal cancer and lung cancer in nickel refiners have been investigated scientifically and discussed since they were detected in the 1930s. Nickel compounds are considered to be the main cause of the cancer excess. Parts of the nickel producing industry and their consultants oppose the classification of water-soluble nickel salts as human carcinogens, and argue that the risk in exposed workers should be ascribed to other occupational exposures and smoking.

  Discussion: Respiratory cancer risks in Welsh, Finnish, and Norwegian nickel refiners add to the evidence of carcinogenicity of water-soluble nickel. In Norwegian refiners, the first epidemiological study in 1973 identified high risks of lung cancer and nasal cancer among long-term electrolysis workers. Risk analyses based on exposure estimates developed in the 1980s supported the view that water-soluble nickel compounds were central in the development of cancer. Recently, new exposure estimates were worked out for the same cohort based on personal monitoring of total nickel and chemical determination of four forms of nickel. Additional data have been collected on life-time smoking habits, and on exposure to arsenic, asbestos, sulphuric acid mists, cobalt, and occupational lung carcinogens outside the refinery. After adjustment for these potential confounding exposures in case-control analyses, the risk pattern added to the evidence of an important role of water-soluble nickel compounds as causes of lung cancer. These Norwegian cancer studies rely on national Cancer Registry data, considered close to complete from 1953 onwards; and on National Population Register data continuously updated with mortality and emigration. Canadian mortality studies--perceived to offer the strongest support to the industry position not to recognise carcinogenicity of water-soluble nickel--appear to suffer from limitations in follow-up time, loss to follow-up, absence of risk analysis with individual exposure estimates, no confounder control, and a likely underestimation of cancer mortality.

  Conclusions: Rejection to recognise water-soluble nickel as a human carcinogen seems to contradict material epidemiological evidence that demonstrates a strong association between water-soluble nickel compounds and risks of lung cancer and nasal cancer. Independent international scientific bodies have classified nickel compounds as carcinogenic to humans, inclusive of water-soluble nickel.

• Patterns of pulmonary dysfunction in asbestos workers: a cross-sectional study. B.A. Abejie, X. Wang, S.N. Kales, et al. 2010;5:12. PubMed · Publisher · Free full text

  Abstract

  Background: Restrictive patterns of pulmonary function abnormalities associated with asbestos exposure are well described. Studies are less consistent, however, regarding the association of asbestos inhalation with airway dysfunction and obstructive impairment.

  Methods: We compared pulmonary function test results between 277 chrysotile exposed workers (22% non-smokers) and 177 unexposed controls (50.3% non-smokers). Information on exposure and smoking were collected using a standardized questionnaire. Standardized spirometric and DCLO Measurement methods were utilized. CXRs were read based on ILO pneumoconiosis guidelines.

  Results: Asbestos exposed subjects had significantly reduced FVC, FEV1, FEV1/FVC and DLCO. Restricting the analysis to non-smokers, asbestos workers still had about 3% lower FEV1/FVC ratio than controls, but this difference did not reach statistical significance. Among exposed workers, the presence of radiographic evidence of asbestosis further lowered FVC and DLCO but not FEV1/FVC compared to asbestos exposure without radiographic asbestosis. Additionally, smoking asbestos workers had significantly lower DLCO compared to non-smoking workers.

  Conclusion: Asbestos exposure, especially when radiographic evidence of interstitial fibrosis from asbestosis is present, leads to significant decreases in FVC, FEV1 and the DLCO. However, asbestos exposure alone is not significantly associated with a reduction of the FEV1/FVC. Smoking-asbestos workers had significantly lower DLCO than their non-smoking counterparts. Whether asbestos interacts with smoking additively or synergistically on DLCO needs further investigation. Similarly, further studies are needed to assess the progression and clinical significance of asbestos induced airway dysfunction.

• Retrospective exposure assessment to airborne asbestos among power industry workers. M.K. Felten, L. Knoll, C. Eisenhawer, et al. 2010;5:15. PubMed · Publisher · Free full text

  Abstract

  Background: A method of individually assessing former exposure to asbestos fibres is a precondition of risk-differentiated health surveillance. The main aims of our study were to assess former levels of airborne asbestos exposure in the power industry in Germany and to propose a basic strategy for health surveillance and the early detection of asbestos related diseases.

  Methods: Between March 2002 and the end of 2006, we conducted a retrospective questionnaire based survey of occupational tasks and exposures with airborne asbestos fibres in a cohort of 8632 formerly asbestos exposed power industry workers. The data on exposure and occupation were entered into a specially designed computer programme, based on ambient monitoring of airborne asbestos fibre concentrations. The cumulative asbestos exposure was expressed as the product of the eight-hour time weighted average and the total duration of exposure in fibre years (fibres/cubic centimetre-years).

  Results: Data of 7775 (90% of the total) participants working in installations for power generation, power distribution or gas supply could be evaluated. The power generation group (n = 5284) had a mean age of 56 years, were exposed for 20 years and had an average cumulative asbestos exposure of 42 fibre years. The occupational group of "metalworkers" (n = 1600) had the highest mean value of 79 fibre years. The corresponding results for the power distribution group (n = 2491) were a mean age of 45 years, a mean exposure duration of 12 years and an average cumulative asbestos exposure of only 2.5 fibre years. The gas supply workers (n = 512) had a mean age of 54 years and a mean duration of exposure of 15 years.

  Conclusions: While the surveyed cohort as a whole was heavily exposed to asbestos dust, the power distribution group had a mean cumulative exposure of only 6% of that found in the power generation group. Based on the presented data, risk-differentiated disease surveillance focusing on metalworkers and electricians from the power generating industry seems justified. That combined with a sensitive examination technique would allow detecting asbestos related diseases early and efficiently.

2000s

• Antemortem diagnosis of asbestosis by screening chest radiograph correlated with postmortem histologic features of asbestosis: a study of 273 cases. K.N. Mizell, C.G. Morris, J.E. Carter. 2009;4:14. PubMed · Publisher · Free full text

  Abstract

  Background: Accuracy in the clinical diagnosis of asbestosis has significant implications for the future health of affected patients as well as serious medicolegal implications for both patients and asbestos-associated industries. The radiographic gold-standard for diagnosis of asbestosis has been the plain chest radiograph, and in many asbestosis-screening clinics, chest radiograph abnormalities in conjunction with a history of asbestos exposure have been the mainstay of diagnosis. No studies have yet compared the antemortem chest radiographic diagnosis of asbestosis with the subsequent presence of pulmonary fibrosis and lung tissue ferruginous bodies at autopsy.

  Methods: Records were reviewed from 273 autopsies performed to investigate asbestosis over an 11-year period. Accrued data included age and gender as well as the presence or absence of the following: occupational exposure to asbestos, antemortem clinical diagnosis of asbestosis by chest radiograph, fibrous pleural plaques, peribronchiolar or interstitial pulmonary fibrosis, ferruginous bodies in histologic sections of lung tissue, and ferruginous bodies in digested lung tissue.

  Results: 242 cases with the antemortem radiographic diagnosis of asbestosis (study group) were identified. 31 additional autopsies had been requested based on history of asbestos exposure without radiographic documentation of asbestosis (control group). Comparison of the two groups showed a statistically significant increase in the association of chest radiograph-diagnosed asbestosis and the presence at autopsy of pleural plaques (p = 0.0109), peribronchiolar or interstitial pulmonary fibrosis (p = 0.0472), and histologically-diagnostic asbestosis (p = 0.0021). At autopsy, histologically-diagnostic asbestosis was confirmed in only 90 of the 243 study group cases. Comparison of individual parameters within the 242 study group cases showed a statistically significant correlation between the presence of fibrous pleural plaques and histologically-proven pulmonary fibrosis (p = 0.0025) as well as the subsequent histologic diagnosis of asbestosis (p < 0.0001).

  Conclusion: Clinical diagnosis of asbestosis by screening chest radiograph is more predictive of the postmortem presence of fibrous pleural plaques, pulmonary fibrosis, and histologically-proven asbestosis than is occupational exposure history alone. However, chest radiograph-based diagnosis of asbestosis significantly overpredicts the subsequent histologic diagnosis of asbestosis.

• Effects of rock wool on the lungs evaluated by magnetometry and biopersistence test. Y. Kudo, M. Kotani, M. Tomita, et al. 2009;4:5. PubMed · Publisher · Free full text

  Abstract

  Background: Asbestos has been reported to cause pulmonary fibrosis, and its use has been banned all over the world. The related industries are facing an urgent need to develop a safer fibrous substance. Rock wool (RW), a kind of asbestos substitute, is widely used in the construction industry. In order to evaluate the safety of RW, we performed a nose-only inhalation exposure study in rats. After one-month observation period, the potential of RW fibers to cause pulmonary toxicity was evaluated based on lung magnetometry findings, pulmonary biopersistence, and pneumopathology.

  Methods: Using the nose-only inhalation exposure system, 6 male Fischer 344 rats (6 to 10 weeks old) were exposed to RW fibers at a target fiber concentration of 100 fibers/cm3 (length [L] > 20 mum) for 6 hours daily, for 5 consecutive days. As a magnetometric indicator, 3 mg of triiron tetraoxide suspended in 0.2 mL of physiological saline was intratracheally administered after RW exposure to these rats and 6 unexposed rats (controls). During one second magnetization in 50 mT external magnetic field, all magnetic particles were aligned, and immediately afterwards the strength of their remanent magnetic field in the rat lungs was measured in both groups. Magnetization and measurement of the decay (relaxation) of this remanent magnetic field was performed over 40 minutes on 1, 3, 14, and 28 days after RW exposure, and reflected cytoskeleton dependent intracellular transport within macrophages in the lung. Similarly, 24 and 12 male Fisher 344-rats were used for biopersistence test and pathologic evaluation, respectively.

  Results: In the lung magnetometric evaluation, biopersistence test and pathological evaluation, the arithmetic mean value of the total fiber concentration was 650.2, 344.7 and 390.7 fibers/cm3, respectively, and 156.6, 93.1 and 95.0 fibers/cm3 for fibers with L > 20 mum, respectively. The lung magnetometric evaluation revealed that impaired relaxation indicating cytoskeletal toxicity did not occur in the RW exposure group. In addition, clearance of the magnetic tracer particles was not significantly affected by the RW exposure. No effects on lung pathology were noted after RW exposure.

  Conclusion: These findings indicate that RW exposure is unlikely to cause pulmonary toxicity within four weeks period. Lung magnetometry studies involving long-term exposure and observation will be necessary to ensure the safety of RW.

• Clinical consequences of asbestos-related diffuse pleural thickening: A review. S.E. Miles, A. Sandrini, A.R. Johnson, et al. 2008;3:20. PubMed · Publisher · Free full text

  Abstract

  Asbestos-related diffuse pleural thickening (DPT), or extensive fibrosis of the visceral pleura secondary to asbestos exposure, is increasingly common due to the large number of workers previously exposed to asbestos. It may coexist with asbestos related pleural plaques but has a distinctly different pathology. The pathogenesis of this condition as distinct from pleural plaques is gradually becoming understood. Generation of reactive oxygen and nitrogen species, profibrotic cytokines and growth factors in response to asbestos is likely to play a role in the formation of a fibrinous intrapleural matrix. Benign asbestos related pleural effusions commonly antedate the development of diffuse pleural thickening. Environmental as well as occupational exposure to asbestos may also result in pleural fibrosis, particularly in geographic areas with naturally occurring asbestiform soil minerals. Pleural disorders may also occur after household exposure. High resolution computed tomography (CT) is more sensitive and specific than chest radiography for the diagnosis of diffuse pleural thickening, and several classification systems for asbestos-related disorders have been devised. Magnetic resonance imaging and fluorodeoxyglucose positron emission tomography (PET) scanning may be useful in distinguishing between DPT and malignant mesothelioma. DPT may be associated with symptoms such as dyspnoea and chest pain. It causes a restrictive defect on lung function and may rarely result in respiratory failure and death. Treatment is primarily supportive.

• Gemcitabine combined with oxaliplatin in pretreated patients with malignant pleural mesothelioma: an observational study. A. Xanthopoulos, T.T. Bauer, T.G. Blum, et al. 2008;3:34. PubMed · Publisher · Free full text

  Abstract

  Background: The aim of this study was to investigate the efficacy and safety of oxaliplatin +/- gemcitabine in patients with diffuse malignant pleural mesothelioma (MPM) pretreated with pemetrexed.

  Methods: The study enrolled consecutive patients with relapsed MPM, all of them pretreated with a platin-pemetrexed-based chemotherapy. Oxaliplatin 80 mg/m2 was administered as monotherapy or in combination with gemcitabine 1000 mg/m2 given on day 1 and 8. Cycles were repeated every 21 days. The primary endpoints were response rate and disease control rate. Secondary endpoints included overall survival (OS), time to tumour progression (TTP), progression-free survival (PFS), time to treatment failure (TTF), and toxicity.

  Results: Between February 2005 and September 2007 29 patients (median age: 65.0 years, World Health Organisation (WHO) performance status: 0-3) were enrolled. The follow-up period encompassed 5.4 to 97.4 weeks (median: 24.3 weeks). Out of these 29 patients, 15 were treated in second, 10 in third, 3 in fourth and 1 in fifth line, respectively. The majority of the patients received the combination oxaliplatin and gemcitabine (n = 25 vs. 4; 86.2 vs. 13.8%).The median overall survival (OS) was 71.7 weeks (30.6-243.3 weeks), whereas survival from the start of oxaliplatin/gemcitabine-treatment was 24.3 weeks (5.4-97.3 weeks). Median time to tumour progression (TTP) was 9.3 weeks (3.0-67.6 weeks).Partial response (PR) was observed in 2 patients (6.9%), stable disease (SD) for at least three courses of treatment in 11 patients (37.9%). Thus, disease control rate was 44.8%, whereas 16 of 29 patients exhibited progressive disease (55.2%).The toxicity profile was favourable, with no WHO grade 4-toxicities, only few dose-reductions were performed due to non-symptomatic haematotoxicities (neutropenia, thrombopenia). Mild WHO grade 2 neurotoxicity was seen in 6 patients.

  Conclusion: Pemetrexed-pretreated patients with progressive MPM may benefit from a consecutive chemotherapy with oxaliplatin and gemcitabine without significant toxicity.

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