Occupational Medicine

Our medical research library holds 49 studies published in Occupational Medicine (1994–2024). 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. 41 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it. For 2 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: Oxford University Press
• Published: 1992 to the present, England
• Language: English
• ISSN: 0962-7480 (print), 1471-8405 (electronic)
• Continues: Journal of the Society of Occupational Medicine
• Its record in the NLM Catalog

2020s

• Bauxite mine and alumina refinery workers: mortality and cancer risk. N. Kinsman, A. Del Monaco, C. Dimitriadis, et al. 2024;74(7):508-513. PubMed · Publisher · Free full text

  Abstract

  Background: Aluminium industry workers are at risk of long-term health consequences.

  Aims: To investigate mortality and cancer incidence in bauxite mine and alumina refinery workers.

  Methods: A pre-existing cohort of workers was re-linked with the Australian National Death Index, and the Australian Cancer Database to provide additional death (7 years) and cancer (9 years) data. Standardized mortality ratios (SMRs) and standardized incidence rates (SIRs) were estimated by job category, duration of employment and time since first employment.

  Results: Linkage was performed for 6935 (6207 male) workers. Compared with the general population, there was a reduced or similar risk of death for mine/refinery workers for all causes except mesothelioma which was increased amongst male production workers [SMR 2.42, 95% CI 1.11-4.60]. Mesothelioma incidence was also increased amongst males [SIR 2.50, 95% CI 1.60-3.71]. Male office workers had a greater incidence of prostate cancer [SIR 1.30, 95% CI 1.06-1.57] and thyroid cancer [SIR 3.47, 95% CI 1.66-6.38]. Melanoma incidence was increased in female office workers [SIR 2.27, 95% CI 1.36-3.54]. Lip cancer incidence was increased in male maintenance/production workers [SIR 2.04, 95% CI 1.02-3.65]. Overall cancer incidence was otherwise similar to the general Australian population.

  Conclusions: Overall risk of death and incidence of cancer for bauxite mine and alumina refinery workers was similar to the general population. Incidence and risk of death from mesothelioma were higher, likely due to historic asbestos exposure in this and other industries. The increased risk of melanoma, lip, prostate and thyroid cancers requires further investigation.

  © The Author(s) 2024. Published by Oxford University Press on behalf of the Society of Occupational Medicine.

• Occupational asbestos exposure and ovarian cancer: updated systematic review. F. Turati, M. Rossi, A. Spinazzè, et al. 2023;73(9):532-540. Systematic review PubMed · Publisher

  Abstract

  Background: The association between asbestos exposure and ovarian cancer has been questioned given the possible misdiagnosis of peritoneal mesothelioma as ovarian cancer.

  Aims: To update a systematic review on ovarian cancer risk in women occupationally exposed to asbestos, exploring the association with the time since first exposure and the duration of exposure.

  Methods: We searched PubMed from 2008 onwards, screened previous systematic reviews, combined standardized mortality ratios (SMR) using random effect models and quantified heterogeneity using the I2 statistic. To assess tumour misclassification, we compared the distribution of observed excess ovarian cancers (OEOC) to that expected (EEOC) from the distribution of peritoneal cancers in strata of latency and exposure duration.

  Results: Eighteen publications (20 populations), including a pooled analysis of 21 cohorts, were included. The pooled SMR was 1.79 (95% confidence interval 1.38-2.31), with moderate heterogeneity between studies (I2 = 42%), based on 144 ovarian cancer deaths/cases. The risk was increased for women with indirect indicators of higher exposure, longer duration and latency, and lower for chrysotile than for crocidolite exposure. The effect of duration and latency could not be completely disentangled, since no multivariate analysis was available for time-related variables. The dissimilarity index between OEOC and EEOC for the time since first exposure was small suggesting a similar pattern of risk.

  Conclusions: While some misclassification between ovarian and peritoneal cancers cannot be excluded, the observed excess risk of ovarian cancer should be added to the overall disease burden of asbestos.

  © The Author(s) 2023. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected].

• Reconstructing historical exposure to asbestos: the validation of 'educated guesses'. S.D. Visonà, E. Crespi, E. Belluso, et al. 2022;72(8):534-540. PubMed · Publisher

  Abstract

  Background: In both the epidemiological and legal context, the causal attribution of asbestos-related lung diseases requires retrospective exposure assessment (REA).

  Aims: To assess the correlation between the retrospective assessment of occupational and anthropogenic environmental exposure to asbestos and its content in the lung tissue.

  Methods: Based on the available exposure information, a team of occupational physicians retrospectively assessed cumulative exposure to asbestos in 24 subjects who died of asbestos-related diseases. The asbestos lung content was analysed using analytical scanning electron microscope (SEM-EDS). The Log10 asbestos fibre count in the autoptic samples was predicted as a function of the Log10 estimated cumulative exposure using univariate regression analysis.

  Results: The median count of asbestos fibres by grams of dry weight (ff/gdw) in the lung tissue was 81 339 (range 0-2 135 849.06); it was 287 144 (range 0-2 135 849.06) among the occupationally exposed, and 29 671 (range 0-116 891) among the subjects who only had anthropogenic environmental and/or household exposure. Amphiboles, and particularly amosite (52%) and crocidolite (43%), were detected in all the study subjects. Chrysotile was not detected in any of the samples. Overall, the retrospective estimate of lifetime cumulative exposure to asbestos showed a moderate correlation with the total asbestos fibre count in the autoptic lung, with the regression model explaining 38-55% of the total variance.

  Conclusions: Detailed information on occupational, environmental and household exposure circumstances would be indispensable for experienced industrial hygienists and/or occupational physicians to reliably assess past exposure to amphiboles or mixed types of asbestos.

  © The Author(s) 2022. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected].

• Proportionate mortality study of unionized maintenance of way railroad workers. D.F. Goldsmith, G. Barlet. 2021;71(1):41-47. PubMed · Publisher

  Abstract

  Background: Railroad maintenance of way (MOW) workers are exposed to many workplace hazards, including diesel fuel and exhaust, ballast (silica) dust, asbestos, solvents, herbicides, welding fumes, heavy rolling equipment, vibration and extreme weather.

  Aims: Due to the number of excess deaths we found in a companion standardized mortality ratio (SMR) study for union members <65 years, we hypothesized that these workers may have elevated mortality risks among all ages for many chronic conditions.

  Methods: Proportionate mortality ratios (PMRs) were calculated for 37 661 male MOW workers ages 20 and older who were members of the Brotherhood of Maintenance of Way Employes Division (BMWED). A data set was submitted to the National Death Index (NDI) to identify decedents and to determine cause of death for workers who died between 1979 and 2014. The CDC WONDER database was used to determine expected mortality for US males.

  Results: For certain diseases and cancers the SMR and PMR findings have parallel mortality excesses. Examples include septicaemia and anaemia; diabetes; chronic obstructive pulmonary disease (COPD); nephritis; and transportation accidents. Among cancers, we found excess oesophageal, stomach, colorectal, lung, prostate, kidney and in situ cancers. Two excess SMR findings were not replicated in the PMR assessment-Alzheimer's and Parkinson's disease.

  Conclusions: The PMR findings suggest that some of the mortality excesses from the SMR study are elevated, which adds support to their being consistently raised among BMWED members. The shared excess causes of death in the PMR and SMR studies should be focused on for future prevention and surveillance activities.

  © The Author(s) 2021. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected].

• Underreporting of mesothelioma, asbestosis and pleural plaques in Brazil. V.S. Santana, L. Salvi, F. Cavalcante, et al. 2021;71(4-5):223-230. PubMed · Publisher

  Abstract

  Background: Brazil has a long history of heavy asbestos consumption. However, the number of asbestos-related diseases (ARDs) falls far below the one expected compared with other asbestos consumer countries.

  Aims: To examine underreporting of ARDs, that is mesothelioma, asbestosis and pleural plaques, in Brazil's Mortality Information System (SIM).

  Methods: Health information systems (HIS) were mapped, datasets retrieved and records of ARD deaths extracted. Records were pair-matched using anonymous linkage to create a single database. ARD-reported cases missing in SIM were considered unreported. The study's period ranged from 2008 to 2014, when every HIS contributed to the ARD records pool.

  Results: A total of 1298 registered ARD deaths were found, 996 cases of mesothelioma (77%) and 302 (23%) of asbestosis and pleural plaques. SIM was the major single data source of ARD but 335 mesothelioma deaths were missing, an average underreporting of 33%, with no clear time trend. For asbestosis and pleural plaques, underreporting of ARD oscillated from 55% in 2010 to 25% in 2014, a declining trend. ARD underreporting was not associated with sex or age.

  Conclusions: One-third of underreported ARD deaths in the universal SIM is unacceptably high and, apparently, it has not been improving substantially over time. After recoveries from multiple databases, the number of cases is still below, which could be expected based on asbestos consumption. Interoperability of multiple information systems could enhance case detection and improve the precision of mortality estimates, which are crucial for surveillance and for evaluation of remedial policies.

  © The Author(s) 2021. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected].

2010s

• Cancer incidence in UK electricity generation and transmission workers, 1973-2015. T.M. Sorahan. 2019;69(5):342-351. PubMed · Publisher · Free full text

  Abstract

  Background: Long-term health outcomes in cohorts of workers from the electricity supply industry have been studied.

  Aims: The aim of the study was to examine updated cancer incidence findings among a cohort of UK electricity generation and transmission workers.

  Methods: Cancer morbidity experienced by 81 616 employees of the former Central Electricity Generating Board of England and Wales was investigated for the period 1973-2015. All employees had worked for at least 6 months with some employment between 1973 and 1982. Standardized registration ratios (SRRs) were calculated based on national rates.

  Results: Overall cancer morbidity was slightly below expectation in males. Significant excesses were found in male workers for mesothelioma (observed [Obs] 763, SRR 326), skin cancer (non-melanoma) (Obs 5616, SRR 106), and prostate cancer (Obs 4298, SRR 106), and in female workers for cancer of the small intestine (Obs 13, SRR 220), nasal cancer (Obs 11, SRR 407), and breast cancer (Obs 758, SRR 110). More detailed analyses showed important contrasts, particularly for mesothelioma, lung cancer, skin cancer, prostate cancer and breast cancer.

  Conclusions: A clear occupational excess of mesothelioma was not matched by a corresponding excess of asbestos-induced lung cancer. Confident interpretation of the excesses of cancers of the nasal cavities and small intestine is not possible, although occupational exposures received in this industry may well not be involved. An excess of skin cancer in transmission workers may be associated with outdoor working.

  © The Author(s) 2019. Published by Oxford University Press on behalf of the Society of Occupational Medicine.

• Long-term epidemiological observation of asbestos-related diseases in Poland, 1970-2015. B. Swiatkowska, N. Szeszenia-Dabrowska. 2017;67(3):182-187. PubMed · Publisher

  Abstract

  Background: Occupational exposure to asbestos constitutes a major public health concern. Despite this in many countries, data and registration systems for occupational asbestos-related diseases are non-existent or poorly developed.

  Aims: To analyse the incidence of occupational asbestos-related diseases in Poland between the years 1970 and 2015, with particular emphasis on the periods after introduction of a ban on asbestos and following introduction of a surveillance programme.

  Methods: Analysis based on all medically recognized cases, certified as occupational diseases and reported obligatorily from all over the country to the Central Register of Occupational Diseases.

  Results: During the period 1970-2015, 4983 cases were reported as asbestos-related diseases. The most prevalent were asbestosis, lung cancer, diseases of pleura or pericardium and mesothelioma. A considerable increase in the number of such cases from the beginning of their registration until 2004 occurred after introduction of the Amiantus programme, a nationwide programme of periodic medical examinations for former asbestos workers.

  Conclusions: Introduction of a medical surveillance programme improved case recognition and allowed a more reliable estimate of the number of reported asbestos-related diseases.

  © The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected]

• Asbestos exposure and the risk of sinonasal cancer. M. Andersson, F. Selin, B. Järvholm. 2016;66(4):326-31. PubMed · Publisher

  Abstract

  Background: While the increased risk of lung cancer and mesothelioma is well established, the relationship between exposure to asbestos dust and sinonasal cancer is less clear.

  Aims: To study the risk of sinonasal cancer in relation to asbestos dust exposure.

  Methods: A retrospective cohort study of construction workers, linked to the Swedish Cancer Registry. Participants were classified into four exposure groups; heavy, medium, low or very low exposure to asbestos, according to the incidence of pleural mesothelioma in their occupational group. Standardized incidence ratios (SIRs) and relative risks (RRs) were analysed, adjusted for age and smoking habits. The risks of adenocarcinoma and squamous cell carcinoma were investigated separately.

  Results: Among the 280222 subjects, there was no increased risk of sinonasal cancer compared to the general population [SIR 0.85, 95% confidence interval (CI) 0.68-1.03], or any dose-response relationship with exposure to asbestos. The highest RR was found in the low exposure group (RR 1.25, 95% CI 0.69-2.28) and the lowest RR was found in the group with the highest exposure to asbestos (RR 0.71, 95% CI 0.33-1.53). No significantly increased risk or dose-response association could be found for adenocarcinoma or squamous cell carcinoma when analysed separately.

  Conclusions: This study did not find an increased risk of developing sinonasal cancer after asbestos exposure.

  © The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected].

• Mortality risk among workers with exposure to dioxins. J.J. Collins, K.M. Bodner, L.L. Aylward, et al. 2016;66(9):706-712. PubMed · Publisher

  Abstract

  Background: In several studies, dioxin exposure has been associated with increased risk from several causes of death.

  Aims: To compare the mortality experience of workers exposed to dioxins during trichlorophenol (TCP) and pentachlorophenol (PCP) production to that of the general population and to examine mortality risk by estimated exposure levels.

  Methods: A retrospective cohort study which followed up workers' vital status from 1940 to 2011, with serum surveys to support estimation of historical dioxin exposure levels.

  Results: Among the 2192 study subjects, there were nine deaths in TCP workers from acute non-lymphatic leukaemia [standardized mortality ratio (SMR) = 2.88, 95% confidence interval (CI) 1.32-5.47], four mesothelioma deaths (SMR = 5.12, 95% CI 1.39-13.10) and four soft tissue sarcoma (STS) deaths (SMR = 3.08, 95% CI 0.84-7.87). In PCP workers, there were eight deaths from non-Hodgkin's lymphoma (SMR = 1.92, 95% CI 0.83-3.79), 150 from ischaemic heart disease (SMR = 1.20, 95% CI 1.01-7.89) and five from stomach ulcers (SMR = 3.38, 95% CI 1.10-7.89). There were no trends of increased mortality with increased dioxin exposure except for STS and 2,3,7,8-tetrachlorodibenzo-p-dioxin levels. This finding for STS should be interpreted with caution due to the small number of deaths and the uncertainty in diagnosis and nosology.

  Conclusions: While some causes of death were greater than expected, this study provides little evidence of increased risk when dioxin exposures are considered.

  © The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected].

• UK asbestos imports and mortality due to idiopathic pulmonary fibrosis. C.M. Barber, R.E. Wiggans, C. Young, et al. 2016;66(2):106-11. PubMed · Publisher · Free full text

  Abstract

  Background: Previous studies have demonstrated that the rising mortality due to mesothelioma and asbestosis can be predicted from historic asbestos usage. Mortality due to idiopathic pulmonary fibrosis (IPF) is also rising, without any apparent explanation.

  Aims: To compare mortality due to these conditions and examine the relationship between mortality and national asbestos imports.

  Methods: Mortality data for IPF and asbestosis in England and Wales were available from the Office for National Statistics. Data for mesothelioma deaths in England and Wales and historic UK asbestos import data were available from the Health & Safety Executive. The numbers of annual deaths due to each condition were plotted separately by gender, against UK asbestos imports 48 years earlier. Linear regression models were constructed.

  Results: For mesothelioma and IPF, there was a significant linear relationship between the number of male and female deaths each year and historic UK asbestos imports. For asbestosis mortality, a similar relationship was found for male but not female deaths. The annual numbers of deaths due to asbestosis in both sexes were lower than for IPF and mesothelioma.

  Conclusions: The strength of the association between IPF mortality and historic asbestos imports was similar to that seen in an established asbestos-related disease, i.e. mesothelioma. This finding could in part be explained by diagnostic difficulties in separating asbestosis from IPF and highlights the need for a more accurate method of assessing lifetime occupational asbestos exposure.

  © Crown copyright 2015.

• Occupational lung disease survey of respiratory physicians in Northern Ireland. T.F. McKeagney, K. Addley, K. Asanati. 2015;65(9):719-21. PubMed · Publisher

  Abstract

  Background: Respiratory physicians are likely to encounter occupational lung disease (OLD) in their daily practice.

  Aims: To assess the profile of cases being encountered by general respiratory physicians in Northern Ireland (NI) and determine satisfaction with training, confidence in diagnosis and management of OLD.

  Methods: An online survey of all consultant respiratory physicians currently practising in NI. Questions assessed the numbers of new cases seen over the preceding year, case type, satisfaction with specialist registrar training in OLD and degree of confidence in the diagnosis and management of these conditions.

  Results: Of the 40 consultants identified, the response rate was 80% (n = 32) with 94% of respondents (n = 30) indicating they had dealt with patients suspected of having occupation-related respiratory symptoms. The most commonly encountered OLDs were pleural plaques (91% of respondents), occupational asthma (88%), asbestosis (84%), non-asbestosis pulmonary fibrosis (76%), hypersensitivity pneumonitis (67%) and mesothelioma (66%). Just over one third of consultants (36%, n = 10) indicated a lack of confidence in diagnosis and management of OLD with almost half (48%) dissatisfied with OLD training as a registrar and a further 78% (n = 25) indicating they would value additional training in OLD as a consultant.

  Conclusions: The majority of respiratory consultants in NI encountered OLD in their day to day practice and half were dissatisfied with their specialist registrar training in OLD and express a lack of confidence in the diagnosis and management of these conditions. This highlights the need for additional training at both registrar and consultant level.

  © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected].

• Work-related ill-health: Republic of Ireland, Northern Ireland, Great Britain 2005-2012. A. Money, M. Carder, P. Noone, et al. 2015;65(1):15-21. PubMed · Publisher

  Abstract

  Background: Data on work-related ill-health (WRIH) in the Republic of Ireland is inconsistent.

  Aims: To compare the incidence of WRIH in the Republic of Ireland (ROI), Northern Ireland (NI) and Great Britain (GB) reported by clinical specialists in skin and respiratory medicine and by specialist occupational physicians (OPs).

  Methods: Analysis of data reported to three surveillance schemes in The Health and Occupation Research (THOR) network in ROI and corresponding UK schemes.

  Results: Contact dermatitis was the most frequently reported skin disease in the three areas. Asthma was the most frequently-reported respiratory disease in the ROI, while asbestos-related cases predominate in GB and NI. Mental health disorders, followed by musculoskeletal disorders were reported most frequently by OPs. Annual average incidence rates for skin disease were 2 per 100000 employed (95% confidence interval [CI] 1.9-2.8) in the ROI and 7 per 100000 for GB (95% CI 4.8-9.4). Unadjusted incidence rates for respiratory disease were 1 (95% CI 0.3-1) and 8 (95% CI 6.1-10.7) per 100000 in the ROI and GB, respectively; adjusted for reporter non-response, these figures increased to 15 (95% CI 11.3-19.6) and 32 (95% CI 28.4-35.6) per 100000 respectively.

  Conclusions: This is the first paper to include THOR data on WRIH from the ROI, NI and GB. Consistent and dedicated data collection in the ROI via the THOR schemes is viable and important in the light of a deficit of occupational ill-health data. Sustained efforts to improve participation are underway.

  © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected].

• Working with asbestos and the possible health risks. D. Sen. 2015;65(1):6-14. PubMed · Publisher

  Abstract

  Background: The generic term asbestos refers to a group of crystalline mineral silicates that occur naturally in various forms. Because of their properties of strength, heat and electrical resistance and their ability to withstand corrosion by acids and sea water, asbestos was used extensively both in the UK and worldwide.

  Aims: To provide a historical perspective of this ubiquitous occupational hazard, consider the key changes in UK legislation aimed at improving the management of this occupational health risk and describe the evidence from the scientific literature concerning asbestos and disease.

  Methods: Original articles, reviews (including reference textbooks) and scientific literature in PubMed and other principal medical science databases, 1960-2014, were searched. Publications by regulatory agencies and by governmental organizations were also considered and included where relevant.

  Results: Asbestos remains the biggest cause of cancer deaths worldwide. For malignant mesothelioma deaths alone, it is estimated that in the UK, between 2015 and 2020, the number of cases will peak at 2500 cases annually. It is not clear whether there is a safe level of asbestos fibres in air. Evidence for the efficacy of health surveillance is lacking.

  Conclusions: Although the use of asbestos was banned in the UK in 1985 (amosite and crocidolite) and 1999 (chrysotile), it remains a significant occupational risk factor for work-related morbidity and mortality, causing both benign and malignant diseases, often with long latency. Further research is needed regarding exposure levels and health surveillance.

  © Crown copyright 2015.

• Lest we forget. J. Hobson. 2014;64(1):30. PubMed · Publisher

• Cancer incidence in UK electricity generation and transmission workers, 1973-2008. T. Sorahan. 2012;62(7):496-505. PubMed · Publisher

  Abstract

  Background: The effects of magnetic field exposure on cancer risks remains unclear.

  Aims: To examine cancer incidence among a cohort of UK electricity generation and transmission workers.

  Methods: Cancer morbidity experienced by a cohort of 81 842 employees of the former Central Electricity Generating Board of England and Wales was investigated for the period 1973-2008. All employees had worked for at least 6 months with some employment between 1973 and 1982. Standardized registration ratios (SRRs) were calculated on the basis of national rates.

  Results: Overall cancer morbidity was slightly below expectation in males and females. Significant excesses were found in male workers for mesothelioma (Observed [Obs] 504, SRR 331), skin cancer (non-melanoma) (Obs 3187, SRR 107) and prostate cancer (Obs 2684, SRR 107) and in female workers for cancer of the small intestine (Obs 10, SRR 306) and nasal cancer (Obs 9, SRR 474). Brain cancers were close to expectation in males and below expectation in females. Leukaemia incidence (all types) was slightly below expectation in males and females. More detailed analyses showed import ant contrasts for mesothelioma and leukaemia.

  Conclusions: The clear occupational excess of mesothelioma was not matched by a corresponding excess of lung cancer, and the level of asbestos-induced lung cancer in this industry must be low. Leukaemia risks declined with period from hire; confident interpretation of this finding is not possible. The excesses of cancers of the nasal cavities and small intestine are probably not occupational, though the excess of skin cancer may be due to outdoor work.

• Chronic disease prevention, asbestos exposure in diamond miners. P. Noone. 2012;62(1):76. PubMed · Publisher

• Giovanni Antonio Canale (Canaletto): The Arsenal The Water Entrance 1732. M. McKiernan. 2012;62(2):86-7. Historical article PubMed · Publisher

• Mortality from asbestosis and mesothelioma in Britain by birth cohort. A. Darnton, J. Hodgson, P. Benson, et al. 2012;62(7):549-52. PubMed · Publisher · Free full text

  Abstract

  Background: Analysis of occupational mortality in England and Wales during 1991-2000 showed no decline in work-attributable deaths from asbestosis.

  Aims: To explore why there was no decline in mortality from asbestosis despite stricter controls on asbestos exposure over recent decades.

  Methods: Using data from registers of all deaths in Great Britain with mention of mesothelioma or asbestosis on the death certificate, we plotted death rates by 5 year age group within 5 year birth cohorts for(a) mesothelioma and (b) asbestosis without mention of mesothelioma.

  Results: Analysis was based on a total of 33,751 deaths from mesothelioma and 5396 deaths from asbestosis. For both diseases, mortality showed a clear cohort effect; within birth cohorts, death rates increased progressively with age through to 85 years and older. However, highest mortality from mesothelioma was in men born during 1939-43, whereas, mortality from asbestosis peaked in men born during 1924-38.

  Conclusions: Our findings suggest that mortality, in Britain, from asbestosis has been determined mainly by cumulative exposure to asbestos before 45 years of age and that the effect of such exposure continues through to old age. That mortality from asbestosis peaked in earlier birth cohorts than mortality from mesothelioma may reflect a difference in exposure-response relationships for the two diseases. The discrepancy could be explained if risk of asbestosis increased more steeply than that of mesothelioma at higher levels of exposure to asbestos and if the highest prevalence of heavy exposure occurred in earlier birth cohorts than the highest prevalence of less intense exposures.

• Occupational and environmental cancer incidence and mortality in China. P. Li, S.S. Deng, J.B. Wang, et al. 2012;62(4):281-7. PubMed · Publisher

  Abstract

  Background: Most cancers are due to environmental, occupational or other non-genetic factors and are potentially preventable.

  Aims: To provide an evidence-based assessment of the burden of occupational and environmental-related cancers in China in 2005.

  Methods: The population attributable fraction (PAF) was calculated based on the assumption of no occupational agent exposure. Relative risk estimates for specific cancers of interest and prevalence of exposure were mainly derived from large-scale studies. Data on cancer incidence and mortality was obtained from the Third National Death Cause Survey and cancer registries in China.

  Results: We estimated that a total of 48,511 deaths of cancer were attributable to occupational agents in China in 2005, with 34,975 among men (3.1% of all cancer deaths) and 13,536 among women (2.1%). A total of 59,410 incident cases of cancer were attributable to occupational agents in China in 2005, with 42,724 among men (2.8% of all cancer incident cases) and 16,686 among women (1.6%). The highest PAF was observed for mesothelioma with asbestos, followed by leukaemia, bladder and lung cancers. Indoor radon was responsible for 0.2% of lung cancer-related deaths among men and women.

  Conclusions: Occupational agents represent an important cause of cancer, but indoor radon plays a relatively limited role in cancer causes in China. Our report provides strong evidence of the need for policy makers to develop strategies to reduce the risk of occupational cancers.

• The presentation and natural history of asbestos-induced diffuse pleural thickening. V. Jeebun, S.C. Stenton. 2012;62(4):266-8. PubMed · Publisher

  Abstract

  Background: Three forms of asbestos-related benign pleural disease are recognized: discrete pleural plaques, pleural effusions and diffuse pleural fibrosis. Of these, diffuse pleural fibrosis is the most significant on account of its chronicity and associated morbidity.

  Aims: The objectives of this study were to determine the latency of asbestos-induced diffuse pleural fibrosis, its presenting features and its clinical course once established.

  Methods: We conducted a retrospective review of 75 patients with asbestos-induced diffuse pleural fibrosis referred for assessment at our institution from 1992 to 2007. Diffuse pleural fibrosis was considered to be present if there was obliteration of the costophrenic angle in continuity with at least 3-mm pleural thickening, in accordance with the International Labour Organization 2000 Classification.

  Results: The median latency for development of diffuse pleural fibrosis from first asbestos exposure was 34 years. Seventy-three per cent of patients had unilateral disease at presentation and 24% of these were observed to develop contralateral disease after a median of 2 years. Unilateral pleural disease was commonest on the right. Forty per cent of patients presented with pleural effusions preceding the development of diffuse pleural thickening. The median latency for development of pleural effusions from onset of exposures was 38 years. Eighty per cent of the pleural effusions were unilateral. Once established, pleural thickening was reported to have remained stable in 91% on the ipsilateral side.

  Conclusions: The findings of this study may help in providing further insight into the natural history of diffuse pleural fibrosis to guide the clinician in the management of this condition.

• The RMS Titanic. K. Addley, P. McKeagney. 2012;62(3):165-6. Historical article PubMed · Publisher

• Chest pain in asbestos and silica-exposed workers. E.K. Park, P.S. Thomas, D. Wilson, et al. 2011;61(3):178-83. PubMed · Publisher

  Abstract

  Background: Chest pain may be the first symptom of developing respiratory malignancy, particularly in subjects with asbestos exposure, yet little information exists on this topic.

  Aims: To investigate chest pain in a cohort of subjects exposed to asbestos and silica dust applying for compensation.

  Methods: Cross-sectional study using a standardized questionnaire. Data collection included: smoking history, Medical Research Council scales of exercise capacity and respiratory symptoms.

  Results: We studied 621 subjects. Six disease groups were categorized: asbestosis (n = 27), diffuse pleural thickening (DPT) (132), asbestosis and DPT (14), silicosis (26), pleural plaques only (160) and healthy subjects with a history of dust exposure (256). Crude prevalence rates of chest pain were high, with chest pain approximately twice as common in subjects with asbestos-related disorders and silicosis as in healthy subjects, with an overall frequency of ~40%. However, when other variables were taken into account in a multivariate analysis the differences between groups disappeared. The factor most significantly related to chest pain was age.

  Conclusions: Chest pain is apparently common in subjects with asbestos-related disorders and silicosis, but after adjustment for other variables, no increased prevalence was apparent in subjects with pleural disorders. More sophisticated questionnaires and dedicated imaging are required to elucidate this further.

• Occupation and work-related ill-health in UK construction workers. S.J. Stocks, S. Turner, R. McNamee, et al. 2011;61(6):407-15. PubMed · Publisher

  Abstract

  Background: Construction workers are at increased risk of work-related ill-health (WRI) worldwide.

  Aims: To compare the incidence of medically reported WRI in occupations within the UK construction industry according to job title.

  Methods: We calculated standardized incidence rate ratios (SRRs) using WRI cases for individual job titles returned to The Health and Occupation Reporting network by clinical specialists and UK population denominators. We counted frequencies of reported causal exposures or tasks reported by clinical specialists, occupational physicians and general practitioners.

  Results: We found significantly increased incidence of WRI compared with other workers in the same major Standard Occupational Classification, i.e. workers with similar levels of qualifications, training, skills and experience, for skin neoplasia in roofers (SRR 6.3; 95% CI: 3.1-13.1), painters and decorators (2.1; 95% CI: 1.2-3.6) and labourers in building and woodworking trades (labourers, 6.6; 95% CI: 3.2-13.2); contact dermatitis in metal workers (1.4; 95% CI: 1.1-1.7) and labourers (1.6; 95% CI: 1.1-2.3); asthma in welders (3.8; 95% CI: 2.8-5.0); musculoskeletal disorders in welders (1.7; 95% CI: 1.1-2.8), road construction operatives (6.1; 95% CI: 3.8-9.6) and labourers (2.5; 95% CI: 1.7-3.7); long latency respiratory disease (mesothelioma, pneumoconiosis, lung cancer, non-malignant pleural disease) in pipe fitters (4.5; 95% CI: 3.2-6.2), electrical workers (2.7; 95% CI: 2.4-3.2), plumbing and heating engineers (2.3; 95% CI: 1.9-2.7), carpenters and joiners (2.7; 95% CI: 2.3-3.1), scaffolders (12; 95% CI: 8-18) and labourers (3.3; 95% CI: 2.6-4.1).

  Conclusions: UK construction industry workers have significantly increased risk of WRI. These data in individual construction occupations can be used to inform appropriate targeting of occupational health resources.

• Asbestos is still with us: repeat call for a universal ban. Collegium Ramazzini. 2010;60(8):584-5. Editorial PubMed · Publisher

  Summary

  In this editorial, the Collegium Ramazzini, an international academic society in occupational and environmental health, repeated its call for a universal ban on all forms of asbestos. It stated that all forms of asbestos cause asbestosis, malignant mesothelioma, and lung and laryngeal cancers, and may cause other cancers. It also stated that there is no safe level of exposure. Citing published sources, it reported that about 125 million people worldwide are exposed to asbestos at work, that 5–7% of lung cancers are potentially attributable to occupational asbestos exposure, and that asbestos-related cancer deaths in workers are estimated at 100 000–140 000 a year. In the UK, at least 3500 people die from asbestos-related illnesses each year, and 1740 men and 316 women died of mesothelioma in 2006. All forms of asbestos were banned in 52 countries, fewer than a third of WHO member countries. Most of the world's people live in countries where asbestos use continues, mainly in Asia, Eastern Europe, Latin America and Africa, with China the largest consumer. The editorial also described non-occupational exposure from asbestos in construction materials and cited an estimate that the pandemic may take as many as 10 million lives. It concluded that 'controlled use' of chrysotile is not an effective alternative, that safer substitutes are available, and that an international ban on asbestos mining and use is urgently needed.

  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.

• Medically reported work-related ill-health in the UK agricultural sector. S.J. Stocks, S. Turner, M. Carder, et al. 2010;60(5):340-7. PubMed · Publisher

  Abstract

  Background: Self-reported work-related ill-health (WRI) statistics suggest that agricultural workers in the UK are at an increased risk of musculoskeletal disorders (MSD), skin and respiratory disease. However, there is little comprehensive medically reported information on WRI in the UK agricultural sector.

  Methods: Cases of WRI within the UK from 2002 to 2008, as reported to The Health and Occupation Reporting (THOR) network by occupational physicians, clinical specialists and general practitioners, were analysed. Directly standardized incidence rate ratios (SRRs) for the agricultural sector versus all other sectors were calculated for dermatological, musculoskeletal, respiratory and psychological illness, using as the standard population the UK working population as estimated from the Labour Force Survey.

  Results: During 2002-08, 471 cases within the agricultural sector were reported to THOR (2% of all cases). Based on reports by clinical specialists, male agricultural workers aged <65 years had significantly raised SRRs for MSD (2.3, 95% CI 1.6-3.3), allergic alveolitis (32, 95% CI 19-51), asthma (1.9, 95% CI 1.2-3.0) and skin neoplasia (7.9, 95% CI 5.8-10.9) and a significantly reduced SRR for asbestos-related respiratory disease (0.4, 95% CI 0.2-0.7). Reports of mental ill-health in agricultural workers were low.

  Conclusions: These medically reported incidence data provide information on WRI in the UK agricultural sector. Consistent with other sources, there are increased risks for asthma, allergic alveolitis and MSD and a reduced risk for mental ill-health. The raised incidence of skin cancer requires confirmation and further comparison with reliable estimates of the incidence in the UK workforce.

• Surveillance of Australian workplace Based Respiratory Events (SABRE) in New South Wales. K. Hannaford-Turner, D. Elder, M.R. Sim, et al. 2010;60(5):376-82. PubMed · Publisher

  Abstract

  Background: The Surveillance of Australian workplace Based Respiratory Events (SABRE) New South Wales (NSW) scheme is a voluntary notification scheme established to determine the incidence of occupational lung diseases in NSW Australia.

  Aims: Data presented in this paper summarize the last 7 years of reporting to SABRE (June 2001 to December 2008).

  Methods: Every 2 months, participating occupational physicians, respiratory physicians and general practitioners (accredited by the NSW WorkCover Authority) reported new cases of occupational lung disease seen in their practices. Data collected include gender, age, causal agent and the occupations and industries believed responsible. Estimated incidence was calculated for each disease.

  Results: Three thousand six hundred and fifty-four cases were notified to the scheme, consisting of 3856 diagnoses. Most of the cases were males (76%). Pleural plaques [1218 (28%)] were the most frequently reported condition, followed by mesothelioma [919 (24%)]. Silicosis [90 (2%)] and occupational asthma [OA; 89 (2%)] were the most frequently reported non-asbestos-related diseases. Estimated rates for mesothelioma, diffuse pleural thickening (DPT) and OA were 83, 83 and 5 cases per million employed males per year, respectively. Trades such as carpenters and electricians associated with the building industry, electricity supply and asbestos product manufacture were the most common occupations and industries reported.

  Conclusions: Asbestos-related diseases are the most frequently reported conditions to SABRE NSW. The very low incidence of OA for NSW most likely reflects under-diagnosis as well as under-reporting. Occupational lung disease is still occurring in NSW despite current preventative strategies. The SABRE scheme currently provides the only available information in this area.

2000s

• Asbestos-related diseases: time for technology sharing. K. Takahashi, Asian Asbestos Initiative. 2008;58(6):384-5. Editorial PubMed · Publisher · Free full text

  Summary

  In this editorial, written on behalf of the Asian Asbestos Initiative (AAI), the author argued that countries experienced with asbestos-related diseases (ARDs) should share preventive technologies with Asian countries that still use asbestos. Using the Virta database, the author calculated that Asia's share of global raw asbestos use rose from 19% (840 of 4350 thousand metric tons) in 1985 to 47% (950 of 2040 thousand metric tons) in 2000, making Asia the world's centre for asbestos consumption. According to the WHO mortality database, mesothelioma accounted for 46 476 deaths in 62 countries between 1994 and 2004, of which 8258 (17.8%) occurred in four Asian countries. The author attributed the relatively low Asian burden to insufficient latency time and inadequate recognition of ARDs. He also noted continuing second-hand handling of asbestos in machinery repair, maintenance, demolition and shipwrecking. Japan, described as being in the midst of an ARD epidemic, was presented together with Singapore and Korea as able to lead technology sharing with asbestos-dependent countries such as Vietnam, China and Thailand. The AAI aimed to build an academic platform for sharing technologies across primary, secondary and tertiary prevention, ranging from substitution and exposure measurement to diagnosis, treatment and compensation. The author concluded that discontinuing asbestos use was the most effective means of prevention and that the time was ripe for technology sharing.

  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.

• Feasibility of a screening programme for lung cancer in former asbestos workers. G. Mastrangelo, M.N. Ballarin, E. Bellini, et al. 2008;58(3):175-80. PubMed · Publisher

  Abstract

  Background: Low-dose computed tomography (CT) has been found to detect more Stage IA lung cancer than chest x-ray.

  Aims: To investigate whether lung cancer screening with CT was effective and acceptable in former asbestos workers.

  Methods: CT scanning was carried out following the protocol previously described in the literature. A questionnaire was used to assess cumulative asbestos exposure. An economic analysis was also performed. Informed consent was obtained from all patients.

  Results: A total of 1119 male asbestos workers (58% of invited) were examined, of whom 65% were smokers or ex-smokers. Mean age was 57.1 years with mean cumulative exposure to asbestos of 123 fibres/ml x years. Pleural plaques were found in 375 workers (32%), while 338 workers (29%) were included in the radiological follow-up, which led to 25 biopsies (13 of lung, 9 of pleura, 3 of both) and five screen-detected lung cancers (0.4%), one in Stage I. Incidence rate was 149 per 10(5), equal to that in the male general population of similar age. The expenses for diagnosis were 1014 and 244962 Euro per screened subject and screen-detected lung cancer case, respectively.

  Conclusions: Screening adherence and frequency of detection were low, while costs and radiation dose were high. In spite of a high cumulative asbestos exposure, lung cancer risk was not increased relative to the general population. The screening programme was not felt to be cost-effective from the perspective of the government as a third-party funding agency.

• Mesothelioma in vehicle mechanics: is the risk different for Australians?. M.A. Kelsh, V.A. Craven, M.J. Teta, et al. 2007;57(8):581-9. Review PubMed · Publisher

  Abstract

  Background: The question of whether vehicle mechanics have an increased risk of mesothelioma has important public health implications. Calculations of relative risk using case reports from the Australian Mesothelioma Registry (AMR) indicate increased risks; however, this contrasts with the results of 19 epidemiologic studies that have found no association.

  Aim: To evaluate potential explanations for the discrepancy of findings from epidemiologic studies and AMR reports.

  Methods: We evaluated three hypotheses as possible explanations for the inconsistency between the AMR-based calculations and the findings from published epidemiologic studies: (i) differences in exposure characteristics of Australian vehicle mechanics versus vehicle mechanics in North America and Europe, (ii) limitations of the AMR data and (iii) errors in the risk calculations based on AMR data. We reviewed available exposure information specific to Australian vehicle mechanics and AMR data, obtained from the Australian National Occupational Health and Safety Commission, for this evaluation.

  Results: We did not identify differences in workplace exposures, processes or fibre type among Australian vehicle mechanics compared to vehicle mechanics in other countries. Our analysis of primary AMR data identified several errors in exposure classification and in the assumptions used to calculate relative risk.

  Conclusions: Discrepancies between epidemiologic studies and AMR-based calculations cannot be explained by differences in exposure. These discrepancies are most likely attributable to inadequate occupational information and classification in the AMR from 1986 forward and to erroneous assumptions used to derive relative risk estimates for mesothelioma among Australian vehicle mechanics.

• Effectiveness of smoking cessation advice for asbestos workers. A. Johnson, P. Farrow, R. Jenkins. 2006;56(1):59-60. PubMed · Publisher

  Abstract

  Aim: To assess effectiveness of smoking cessation advice to asbestos workers at statutory medical examinations.

  Methods: Workers are required to be examined every 2 years while continuing potential exposure to asbestos, including cessation advice if smokers. Records of 170 workers seen between 1986 and 2004 in Kent and Canterbury Hospital were reviewed. Respiratory symptoms, signs, lung function, radiological findings and smoking status were analysed.

  Results: At initial visit 109 (64%) were smokers. Thirty-four of these attended twice. Despite verbal advice, including emphasis on respiratory abnormalities detected in 62%, only three (9%) had ceased smoking by self-reporting at the second visit.

  Conclusion: Despite appropriate counselling regarding the potential risks of asbestos exposure and smoking, the cessation rate among asbestos workers was disappointingly low. Further measures to encourage asbestos workers to enter smoking cessation programmes should be considered.

• Estimates of work-related cancers in workers exposed to carcinogens. F. Deschamps, M. Barouh, G. Deslee, et al. 2006;56(3):204-9. PubMed · Publisher

  Abstract

  Aim: To evaluate the proportion of work-related cancers.

  Methods: A descriptive study of incident cases of cancer during 3 years in a French county. All people with cancer having a current or past working history were included in the studied population which was recruited from local hospitals. A working history was obtained from each subject by interview. The different organ cancers were linked using well-defined criteria, to specific occupational carcinogenic exposures. The results obtained were compared to international data on work-related cancer incidences.

  Results: A total of 2009 cases were included and 3.18% (64) met the criteria for work-related cancer as defined. Asbestos and polycyclic hydrocarbons were the main occupational carcinogens identified. Construction and fabricated metal products sectors were linked to almost two-thirds of work-related cancers. The percentage of the studied population with attributable risk for occupational cancer was relatively close to international data (mean 4%) and organ cancer distribution percentages did not vary significantly from international published validated data.

  Conclusion: Work-related cancers tend to be concentrated in relatively small groups of people among whom the risk of developing the disease may be quite large. The detection of occupational hazards should therefore have a higher priority in any programme of cancer prevention. Well-defined criteria to identify specifically cancers with an occupational origin should be specified by the scientific international community.

• Smoking rates in asbestos workers. J.H. Lange, J.A. Hoskins, G. Mastrangelo. 2006;56(8):581. Comment · Letter PubMed · Publisher

• A cancer incidence and mortality study of Dow Chemical Canada Inc. manufacturing sites. C. Burns, K. Harrison, B. Jammer, et al. 2005;55(8):618-24. PubMed · Publisher

  Abstract

  Background: Previously, the mortality was reported in a cohort of male workers at an Ontario chemical plant.

  Aims: To expand the cohort and to investigate the mortality and cancer incidence risk among chemical manufacturing sites.

  Methods: We followed 5277 men and 1301 women from 1950 to 1999.

  Results: Employees experienced lower mortality and cancer incidence rates than the general population for several major causes of death, including heart disease, respiratory cancer and many other cancers. There were no cases of angiosarcoma of the liver. We observed a lower mortality rate of prostate cancer [standardized mortality ratio = 0.79, 95% confidence interval (CI) 0.43-1.32], but a higher incidence rate of prostate cancer [standardized incidence ratio (SIR) = 1.22, 95% CI 1.00-1.48]. Among the Sarnia employees, the incidence of pleural neoplasms was increased (5 observed versus 1.48 expected, SIR = 3.37, 95% CI 1.09-7.86). These cancers were included in the 12 deaths with malignant mesothelioma at Sarnia.

  Conclusion: Consistent with the earlier report, lower mortality rates were observed for the major classifications of disease and malignant neoplasms. The higher incidence rates of prostate cancer are not readily explainable but may reflect increased screening among current employees and recent retirees. Past asbestos exposure prior to 1980 is probably a contributor to the deaths due to malignant mesothelioma but is not reflected in lung cancer mortality. We find little indication of any other increased rates of mortality or cancer within the overall workforce of these chemical plants.

• Mesothelioma mortality in Great Britain from 1968 to 2001. D.M. McElvenny, A.J. Darnton, M.J. Price, et al. 2005;55(2):79-87. PubMed · Publisher

  Abstract

  Background: The British mesothelioma register contains all deaths from 1968 to 2001 where mesothelioma was mentioned on the death certificate.

  Aims: To present summary statistics of the British mesothelioma epidemic including summaries by occupation and geographical area.

  Methods: Standardized mortality ratios (SMRs) were calculated for local authorities, unitary authorities and counties. Temporal trends in SMRs were also examined. Proportional mortality ratios (PMRs) were calculated using the Southampton (based on the 1980 standard occupational classification) coding scheme. Temporal trends in PMRs were also examined.

  Results: The annual number of mesothelioma deaths has increased from 153 in 1968 to 1848 in 2001. Current deaths in males account for about 85% of the cases. The areas of West Dunbartonshire (SMR 637), Barrow-in-Furness (593), Plymouth (396) and Portsmouth (388) have the highest SMRs over the period 1981-2000. The occupations with the highest PMRs are metal plate workers (PMR 503), vehicle body builders (526), plumbers and gas fitters (413) and carpenters (388).

  Conclusions: These data reinforce earlier findings that geographical areas and occupations associated with high exposure to asbestos in the past continue to drive the mesothelioma epidemic in Great Britain. However, the trends over time suggest a change in the balance of risk away from traditional asbestos exposure industries to industries where one could describe the exposure as secondary, such as plumbers and gas fitters, carpenters, and electricians.

• Mortality of UK electricity generation and transmission workers, 1973-2002. L. Nichols, T. Sorahan. 2005;55(7):541-8. PubMed · Publisher

  Abstract

  Objective: To examine mortality from cancer and non-malignant causes among a large cohort of UK electricity generation and transmission workers.

  Methods: The mortality experienced by a cohort of 83,923 employees of the former Central Electricity Generating Board of England and Wales was investigated for the period 1973-2002. All employees had worked for at least 6 months with some employment between 1973 and 1982. Standardized mortality ratios (SMRs) were used to assess mortality in the total cohort and in three sub-cohorts: power station workers, substation and transmission workers and workers at non-operational locations. These classifications were based on the place of work of the first known job.

  Results: Overall mortality was significantly below that expected, based on national rates [males: observed (Obs) 18,773, expected (Exp) 22,497.9, SMR 83; females: Obs 1122, Exp 1424.9, SMR 79]. Statistically significant deficits of deaths were also found for most of the major disease groupings. However, significant excesses of deaths were found in male power station workers for cancer of the pleura (Obs 129, Exp 30.3, SMR 426) and in male workers from non-operational locations for cancer of the brain (Obs 55, Exp 36.0, SMR 153). There was also a non-significant excess of deaths from cancer of the breast in male power station workers (Obs 10, Exp 5.3, SMR 190).

  Conclusions: Mortality was exceptionally low for most causes of death but late health effects from earlier asbestos exposure were still in evidence.

• Monitor. Mesothelioma deaths in Great Britain. M. Kinoulty. 2004;54(6):436. PubMed · Publisher

• Occupational respiratory disease in mining. M.H. Ross, J. Murray. 2004;54(5):304-10. Review PubMed · Publisher

  Abstract

  This review is based on research-based literature on occupational lung disease in the mining and related industries, focusing on conditions of public health importance arising from asbestos, coal and silica exposure. Both 'traditional' and 'new' concerns about occupational respiratory disease in miners are addressed, with the inclusion of practical evidence-based findings relevant to practitioners working in developed and developing countries. Mining is not a homogeneous industry since current miners work in formal and informal operations with numerous, and often multiple, air-borne exposures. A further occupational health challenge facing primary care practitioners are ex-miners presenting with disease only after long latency. The sequelae of silica exposure remain an occupational health priority, particularly for practitioners who serve populations with concomitant HIV and tuberculosis infection and even when exposure is apparently below the statutory occupational exposure level. Coal workers' pneumoconiosis, asbestos related diseases, lung cancer and other occupational respiratory diseases remain of considerable importance even after mining operations cease. While mining exposures contribute significantly to lung disease, smoking is a major factor in the development of lung cancer and chronic obstructive airways disease necessitating a comprehensive approach for prevention and control of mining-related occupational lung disease.

• Rounded atelectasis in an asbestos exposed worker. A. Thompson, M. Wills, R. House. 2004;54(7):494-6. Case report PubMed · Publisher

  Abstract

  The case history is presented of a 51-year-old electrical power worker with a history of asbestos exposure presenting with rounded atelectasis. No other radiological markers of asbestos exposure were present. A documented history of asbestos exposure and exclusion of other causes of rounded atelectasis led to the diagnosis of asbestos related rounded atelectasis. It is important to understand that rounded atelectasis can be an isolated finding due to asbestos exposure. This facilitates investigation of lung masses of unknown etiology and initiation of appropriate follow up of patients at risk for future development of more debilitating asbestos related pathology.

• Surveillance of Australian workplace Based Respiratory Events (SABRE): notifications for the first 3.5 years and validation of occupational asthma cases. D. Elder, M. Abramson, D. Fish, et al. 2004;54(6):395-9. PubMed · Publisher

  Abstract

  Aims: In Australia, the SABRE programme, a notification scheme, has been established to collect incidence data on occupational lung disease. This paper reports the first 3.5 years of this scheme and the results of an occupational asthma validation study.

  Methods: A notification form is mailed regularly to thoracic physicians and occupational physicians in the Australian states of Victoria and Tasmania, who use this to report new cases of occupational lung disease. The validation study was performed by a blinded panel of two doctors, who reviewed information extracted from the medical files of a sample of reported cases of occupational asthma.

  Results: A total of 520 diagnoses were reported. The mean (+/- SD) age of the 448 patients notified was 55.7 +/- 16.2 years. There were 394 (88%) males and 54 females. The most common single condition was asthma for which the most common causative agent was wood dust. However, the most commonly reported agent overall was asbestos. The validation study of occupational asthma found only fair agreement (kappa = 0.4) between the panel and notifying doctors. However, agreement was better (kappa = 0.5) when the analysis was restricted to those cases where the reporting doctor considered the likelihood of the diagnosis was high.

  Conclusions: Occupational asthma is the most common occupational respiratory condition reported, which suggests increasing importance for this disease over more traditional forms of occupational lung disease. The validation study suggests that such schemes should restrict notifications only to those cases where the likelihood of the diagnosis is considered high.

• The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999. A.K. Hilliard, J.K. Lovett, C.R. McGavin. 2003;53(3):209-12. PubMed · Publisher

  Abstract

  Background: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers.

  Methods: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records.

  Results: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test).

  Conclusion: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.

• Occupational and environmental medicine: moving the factory fence or hedging our bets?. P.G. Lewis. 2000;50(4):217-20. Review PubMed · Publisher

  Abstract

  Occupational and environmental medicine evolved out of concern for the effect of work hazards on health. The experienced gained in considering such hazards has been extended to understanding general risks in the environment. As we look toward the future, classical occupational and environmental hazards such as over exposure to lead, asbestos and mercury are waning and being replaced by concerns around sustainable development, toxicology testing and exposure information for high production volume chemicals, development of better approaches for setting workplace and community exposure limits, environmental justice and many others. The opportunities for the future exist in overcoming these new challenges.

• Occupational ceramic fibres dermatitis in Poland. M. Kieć-Swierczyńska, J. Wojtczak. 2000;50(5):337-42. PubMed · Publisher

  Abstract

  Recently, the use of asbestos has been considerably limited in Poland, with the simultaneous increase in the manufacture, processing and application of man-made mineral fibres, which includes ceramic fibres. The aims of this study were (1) to assess the type and frequency of dermal changes caused by the irritant activity of ceramic fibres among workers at the plants that manufacture packing and insulation products; and (2) to compare the irritant activity of Polish-made L-2 and L-3 ceramic fibres with that of the Thermowool ceramic fibres made in England. Workers (n = 226) who were exposed to ceramic fibres underwent dermatological examination. Patch tests with the standard allergen set, together with samples of the fibres L-2, L-3, and Thermowool fibres, were applied to all the workers. It has been shown that the Polish-made L-2 and L-3 fibres differed from Thermowool fibres in that the L-2 and L-3 fibres contained zirconium and were coarser. The proportion of filaments with diameters above 3 microns was 11.1% in the L-3 fibre and 6.3% in the L-2 fibre samples. The Thermowool fibre did not contain filaments thicker than 3 microns. Evident dermal changes, resulting from strong irritant activity of the fibres, were detected in 109 (48.2%) of the workers examined. Irritant contact dermatitis acuta (maculae, sometimes papulae and small crusts on the upper extremities, trunk, and lower extremities), disappearing after 2-3 days, was found in 50 (22.1%) workers. Irritant contact dermatitis chronica (diffuse permanent erythema with numerous telangiectasiae on the lateral portions of the face and neck, on the trunk, behind the auricles) was detected in 40 (17.7%) workers. The remaining 19 (8.4%) workers had both types of dermal change. All examined workers complained of very strong itching. The results of the patch tests confirmed the irritant activity of the ceramic fibres. Erythema without oedema, persisting for up to 96 h, appeared at the places where the fibres had been applied to the skin in 44 (19.5%) workers. In addition, the irritant activity of the fibres has been shown to be correlated with their thickness. The Thermowool fibre was the weakest irritant, because it did not contain filaments above 3 microns in diameter; the L-2 fibre containing 6.3% filaments above 3 microns caused somewhat stronger skin irritation; while the L-3 fibre, which contained 11.1% filaments thicker than 3 microns, was the strongest irritant. A few cases of allergy to nickel, chromium and colophony (rosin) were also detected.

• The Medical Research Council Pneumoconiosis Research Unit, 1945-1985: a short history and tribute. J.E. Cotes. 2000;50(6):440-9. Historical article PubMed · Publisher

  Abstract

  The Pneumoconiosis Research Unit (PRU) was set up to obtain the information needed to eliminate pneumoconiosis of coal workers. To this end, instruments and procedures were developed for dust sampling, delivering dust to animals, testing lung function, reading chest radiographs, conducting respiratory surveys and extracting the relevant information. A provisional estimate of safe working conditions was made using data from four pits. The National Coal Board extended the research to an additional 20 pits, refined the estimate and applied it nationally. Meanwhile at PRU aspects of treatment were explored, immunological techniques were added to the repertoire of skills, other occupational disorders were highlighted and new information obtained on biological variation in lung function and blood pressure. The work laid the foundations for medical epidemiology and evidence-based medicine. Starting in 1959, the Unit took the lead in a world campaign to control lung diseases due to asbestos. This account indicates how these successes were achieved, what were the failures, some tensions which developed and what might have been if some events had been handled differently. If there is a message, it is that for success in research the problem under consideration should be the prime focus of attention and resources.

1990s

• Mortality due to asbestos-related causes among railway carriage construction and repair workers. G. Battista, S. Belli, P. Comba, et al. 1999;49(8):536-9. PubMed · Publisher

  Abstract

  The objective of this study was to further clarify the cancer risk associated with asbestos exposure in railway carriage construction and repair. The cohort included 734 subjects employed between 1 January 1945 and 31 December 1969. Vital status was ascertained at 31 December 1997. Mortality was investigated in the time span 1970-97. Forty-two subjects (6%) were lost to follow-up and eight causes of death (4%) could not be ascertained. The overall mortality was not above the expected value. Among neoplastic diseases, excesses were observed for lung ştandardized mortality ratio (SMR) = 124; 90% confidence interval (CI) = 87-172; 26 obs), pleura (SMR = 1,327; CI = 523-2,790; 5 obs), larynx (SMR = 240; CI = 95-505; 5 obs), liver (SMR = 241; CI = 126-420; 9 obs), pancreas (SMR = 224; CI = 98-443; 6 obs) and multiple myeloma (SMR = 429; CI = 117-1,109; 3 obs). The observed excess of lung and pleural neoplasms can be causally related to asbestos exposure in the manufacture of railway carriages. A causal role of asbestos exposure in the raised SMRs from laryngeal and pancreatic neoplasms and multiple myeloma cannot be conclusively proven.

• Occupational lung diseases and global occupational health on the Net. K. Takahashi, A. Sekikawa, R.E. LaPorte, et al. 1998;48(1):3-6. PubMed · Publisher

  Abstract

  Occupational lung disease is a major area of concern in occupational health, exhibiting a diverse panorama across countries. While pneumoconiosis is deemed to be the most common occupational disease in many developing countries, emphasis is shifting towards asbestos-related lung diseases and occupational asthma in industrialized countries. Following the Occupational Health for All strategies set forth by the World Health Organization, we propose that a model system based upon the Global Health Network can serve as an effective vehicle towards the prevention of occupational lung diseases on a global scale. It has the potential to: (1) enhance transmission of data and collaboration with the primary health care system in disease surveillance; (2) strengthen research and information transfer and (3) promote education and training at all levels of prevention, with a possible application to the interpretation of chest radiograms.

• SWORD '97: surveillance of work-related and occupational respiratory disease in the UK. D.J. Ross, H.L. Keynes, J.C. McDonald. 1998;48(8):481-5. Review PubMed · Publisher

  Abstract

  SWORD is one of seven clinically based reporting schemes which together now provide almost comprehensive coverage of occupational diseases across the UK. Although SWORD is now in its tenth year, participation rates remain high. Of an estimated 3,903 new cases seen this year, 1,031 (26%) were of occupational asthma, 978 (25%) of mesothelioma, 794 (20%) of non-malignant pleural disease, 336 (9%) of pneumoconiosis and 233 (6%) of inhalation accidents. Incidence rates of occupational asthma were generally highest among workers in the manufacture of wood products, textiles and food (particularly grain products and crustaceans) and additionally, in the production of precious and non-ferrous metals, rubber goods, detergents and perfumes, and in mining. Health care workers were noted to have a surprisingly high incidence of inhalation accidents. Occupational asthma attributed to latex has increased dramatically; the highest rates are among laboratory technicians, shoe workers and health care workers.

• SWORD '94: surveillance of work-related and occupational respiratory disease in the UK. D.J. Ross, B.A. Sallie, J.C. McDonald. 1995;45(4):175-8. PubMed · Publisher

  Abstract

  Chest and occupational physicians participating in SWORD are estimated to have seen some 3300 cases of work-related respiratory disease in 1994, similar to the totals for 1992-1993. Occupational asthma was the single most frequent diagnosis (941 cases), but asbestos exposure was considered the cause in 1529 cases of diseases of long latency. Large-scale follow-up studies showed (i) that most patients with occupational asthma failed to recover and that half had left their employer, and (ii) that many patients had long-term respiratory illness including asthma following inhalation accidents. Over the six years of the scheme there have been slight changes in attributed agents for occupational asthma and in the frequency of various diagnoses; for example, there has been a gradual reduction in reports of pneumoconiosis. A decline with birth cohort in the proportion of mesotheliomas in men employed in shipyards is shown, with some evidence of a compensatory trend in construction trades.

• SWORD '93. Surveillance of work-related and occupational respiratory disease in the UK. B.A. Sallie, D.J. Ross, S.K. Meredith, et al. 1994;44(4):177-82. PubMed · Publisher

  Abstract

  Some 3500 new cases of occupational respiratory disease are estimated to have been seen annually by SWORD participants in 1992 and 1993 with little important difference between the two years. As the number of new cases recognized and reported by chest physicians is close to complete, the estimated incidence is essentially correct. The pattern of disease which clearly emerges shows that at least half is attributable to asbestos exposure, despite the fact that lung cancer from this cause may be under-reported. Benign pleural disease comprises a large proportion of the cases, the long-term implications of which are unknown. Almost 40% of the cases reported are of occupational asthma or inhalation accidents, both due to a very large number of different agents and affecting many and varied occupations. These cases are preventable providing their occupational aetiology is recognized and appropriate measures of control are intensified.

• Work-related respiratory disease in the United Kingdom, 1989-1992: report on the SWORD project. S.K. Meredith, J.C. McDonald. 1994;44(4):183-9. PubMed · Publisher

  Abstract

  The objective of this project is the creation of a reliable and cost-effective national system of surveillance for work-related respiratory disease as a basis for control and simple epidemiological research. With the voluntary participation of almost 800 chest and occupational physicians from throughout the UK, newly diagnosed cases of respiratory illness thought to be due to occupational factors have been reported regularly since January 1989. Since January 1992, reports from chest physicians have been submitted monthly by a core group with special interest in occupational lung disease (n = 32) and rotating random samples of the remainder. Between 1989 and 1991, 5576 new cases were reported, of which half were diseases of long latency mainly due to asbestos, 28% were occupational asthma, and the rest were divided between inhalation accidents (10%) and a variety of other acute diseases (14%). Disease incidence rates, with denominators from the Labour Force Survey, showed a very high risk of asthma among paint sprayers, chemical and food processors, laboratory staff, plastics and metal treatment workers, and in welding and electronic assembly. Some of the same groups also experienced high rates of inhalation accidents and bronchitis. The risk of diseases of long latency, using denominators from the 1961 census, was highest in shipyard and dock workers, miners and construction workers. The SWORD scheme has provided estimates of disease incidence not previously available, has encouraged awareness of occupational factors among chest physicians, has assisted those responsible for prevention and control, and has demonstrated the feasibility of this approach to surveillance.

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