Letter to the editor re: "Mesothelioma and asbestos"

Our plain-English summary of Letter to the editor re: "Mesothelioma and asbestos", by M.E. Wagner, L.B. Travis (Regulatory Toxicology and Pharmacology, 2008).

The study

• Authors: M.E. Wagner, L.B. Travis
• Journal: Regulatory Toxicology and Pharmacology
• Published: 2008;52(3):353-4; author reply 355
• Type of article: Comment, Letter
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This was a letter to the editor, not an original study. The authors responded to a 2008 review by Gibbs and Berry on mesothelioma and asbestos. They summarized studies reporting more mesothelioma after high-dose radiation therapy among survivors of testicular cancer, breast cancer, Hodgkin lymphoma or non-Hodgkin lymphoma. Tward et al. (2006) found a standardized incidence ratio of 2.3 (9 cases) among 21,111 irradiated non-Hodgkin lymphoma survivors. The risk was not elevated (0.9, 9 cases) among over 55,000 who did not initially receive radiotherapy. Deutsch et al. (2007) found a relative risk of 3.7 (3 cases) for pleural mesothelioma among 9432 breast cancer patients given radiotherapy, and no cases among 12,798 who were not. An earlier study (Neugut et al., 1997) found a non-significant excess of pleural mesothelioma among irradiated breast cancer survivors. Most of these studies, the authors noted, used cancer registries, which record only initial treatment and collect no asbestos exposure information. The authors concluded that confounding by asbestos was unlikely to explain the associations, because radiotherapy decisions are unrelated to asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Letter to the editor commenting on a review (Gibbs and Berry, 2008), summarizing other published epidemiologic studies; not an original study
• Who was studied: Published studies by other investigators of survivors of testicular cancer, breast cancer, Hodgkin lymphoma and non-Hodgkin lymphoma, mostly from population-based cancer registries in the US (SEER) and Europe
• Exposure: Therapeutic (high-dose) radiation for a prior cancer; asbestos is discussed only as a possible confounder
• Main results:
  • As cited in the letter, Neugut et al. (1997) was a SEER study of 62,453 irradiated breast cancer survivors. It reported a non-significant excess of pleural mesothelioma (RR = 1.8, 2 cases). It reported no excess among breast cancer survivors who did not receive radiation (RR = 0.9, 4 cases).
  • As cited in the letter, Travis et al. (2005) reported a significantly elevated fourfold relative risk of pleural mesothelioma among nearly 13,000 testicular cancer patients initially treated with radiotherapy alone.
  • As cited in the letter, Tward et al. (2006) reported a significantly elevated risk of mesothelioma (SIR = 2.3, 9 cases) among 21,111 irradiated non-Hodgkin lymphoma survivors. The risk was not elevated (SIR = 0.9, 9 cases) among over 55,000 patients who did not initially receive radiotherapy.
  • As cited in the letter, Teta et al. (2007) reported a significant excess of mesothelioma among male Hodgkin lymphoma patients whose initial treatment included radiotherapy (SIR = 6.6, 4 cases). There was no excess among male patients whose initial treatment did not include radiotherapy (SIR = 1.3, 1 case).
  • As cited in the letter, Hodgson et al. (2007) found a significantly increased 20-fold risk of pleural mesothelioma among over 18,000 five-year Hodgkin lymphoma survivors. Treatment type was not specifically addressed.
  • As cited in the letter, Brown et al. (2007) found a significantly elevated risk of pleural mesothelioma (SIR = 1.4, 40 cases) among 376,825 one-year breast cancer survivors in Sweden, Denmark, Finland and Norway. In a subgroup with treatment data (Brown et al., 2006), the SIR was 1.8 (15 cases) for women initially given radiotherapy. It was 0.95 (7 cases) for those who did not receive radiotherapy.
  • As cited in the letter, Deutsch et al. (2007) reported a significantly increased risk of pleural mesothelioma (RR = 3.7, 3 cases) among 9432 breast cancer patients given radiotherapy in clinical trials. There were no cases (1.1 expected) among 12,798 patients who did not receive radiation.
• The authors' conclusion: The authors concluded that, because radiotherapy decisions are unrelated to asbestos exposure, confounding by asbestos exposure is unlikely to account for the reported associations between radiotherapy and mesothelioma.
• Limitations the authors state:
  • Nearly all the cited studies used population-based cancer registries, which record only initial treatment and do not collect asbestos exposure information.
  • The authors stated that any misclassification of radiation exposure in the registry studies would likely tend to minimize the observed associations.
  • The Neugut et al. (1997) study was limited by a relatively short follow-up period.

Topics

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

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

Related studies

• Letter to the editor: "Comparing milled fiber, Quebec ore, and textile factory dust: has another piece of the asbestos puzzle fallen into place?" by D. Wayne Berman — J.M. Dement, L.T. Stayner (2010)
• Letter to the Editor regarding the Donovan et al. (2011) article — D. Egilman, J.H. Schilling (2012)
• Letter to the editor on commentary: malignant mesothelioma incidence among talc miners and millers in New York state by M M Finkelstein — R.P. Nolan, J.F. Gamble, et al. (2013)
• Response to a letter to the editor by Dr. Murray M. Finkelstein regarding the article by Finley et al. (2012) — B.L. Finley, J.S. Pierce, et al. (2013)
• Letter to the Editor re Bernstein et al: Health risk of chrysotile revisited. Crit Rev Toxicol, 2013; 43(2): 154-183 — M.M. Finkelstein (2013)
• Response to Murray M. Finkelstein, letter to the editor re Bernstein et al: Health risk of chrysotile revisited. Crit Rev Toxicol, 2013; 43(2): 154-183 — D. Bernstein, J. Dunnigan, et al. (2013)

Browse more research in Regulatory Toxicology and Pharmacology, or return to medical research.