Malignant asbestos-related disease in a population exposed to asbestos

Our plain-English summary of Malignant asbestos-related disease in a population exposed to asbestos, by R. Orriols, J. Tarrés, C. Albertí-Casas, et al (American Journal of Industrial Medicine, 2020).

The study

• Authors: R. Orriols, J. Tarrés, C. Albertí-Casas, M. Rosell-Murphy, R. Abós-Herràndiz, J. Canela-Soler
• Journal: American Journal of Industrial Medicine
• Published: 2020;63(9):796-802
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objectives: The first asbestos fiber cement plant in Spain operated in Cerdanyola, in the Barcelona metropolitan area, between 1907 and 1997. We describe clinical and epidemiological characteristics of patients diagnosed with the malignant asbestos-related disease (ARD) in the area of the plant between 2007 and 2016.

Methods: A prospective, descriptive study was undertaken in the 12 municipalities of the county of Barcelona most proximate to the plant. We describe malignant ARD cases by time of diagnosis, source of exposure, periods of exposure and latency, and distribution by sex. Cumulative incidence and age-standardized incidence rates (ASIR) are calculated.

Results: Of 477 patients diagnosed with ARD between 2007 and 2016, 128 (26%) presented with asbestos-associated malignancy. Pleural mesothelioma was noted in 105 patients (82.0%) with a linear trend Z-score of -0.2 (NS) in men and 2.7 (P < .01) in women. The highest ASIRs for malignant ARD (6.1/100 000 residents/year; 95% confidence interval [CI], 2.2-13.3) and pleural mesothelioma (4.8/100 000 residents/year; 95% CI, 1.5-11.6) occurred in municipalities closest to the focal point of contamination. The origin of malignant ARD was nonoccupational in 32.2% of men and 81.6% of women (P < .001).

Conclusions: More than 20 years after the closure of the fiber cement plant, the grave consequences of exposure to asbestos remain. The detection of cases of pleural mesothelioma in men seems to have plateaued whereas in women an ascending trend continues, which principally has its origin in nonoccupational exposures.

© 2020 Wiley Periodicals LLC.

In plain English

This study counted asbestos-related disease diagnosed from 2007 to 2016 in the 12 municipalities closest to Spain's first asbestos fiber cement plant, in Cerdanyola near Barcelona, which operated from 1907 to 1997. Of 477 patients with asbestos-related disease, 128 had a malignant form. Of these, 105 (70 men, 35 women) had pleural mesothelioma. New pleural mesothelioma cases among men showed no statistically significant trend over the period, while among women they rose significantly. The age-standardized pleural mesothelioma rate was 4.8 per 100,000 residents per year (95% confidence interval 1.5 to 11.6) in Cerdanyola-Ripollet, nearest the plant, versus 1.1 (0.0 to 5.9) in the other municipalities. Of the 105 pleural mesothelioma cases, 54 had nonoccupational exposure, either through sharing a home with an asbestos worker or through living near the plant. These 54 included 30 of the 35 women. The average time from first exposure to diagnosis of pleural mesothelioma was 50.8 years. The authors suggested that cases in men may have plateaued while still rising in women. They said more studies are needed because case numbers were small.

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: Prospective, descriptive study of incident cases with calculation of cumulative incidence and age-standardized incidence rates
• Who was studied: Patients diagnosed with asbestos-related disease between 2007 and 2016 in primary care centers and the reference hospital (Parc Taulí Hospital, Sabadell). The patients lived in the 12 municipalities closest to the fiber cement plant, which had 449,767 inhabitants in the 2011 census, including 95,595 in Cerdanyola and Ripollet. There were 477 patients with asbestos-related disease, 128 of them with malignant disease.
• Exposure: Asbestos from a fiber cement plant that processed 227,365 tonnes of asbestos from several countries over 90 years. Patients were grouped by source of exposure: occupational, shared accommodation with an exposed worker, or environmental (living in the plant area). The article does not specify fiber types.
• Main results:
  • Of 477 patients with asbestos-related disease, 128 (26.8%) had malignant asbestos-related disease: 90 men and 38 women. Their mean age at diagnosis was 70.9 years.
  • 105 patients had pleural mesothelioma: 70 men and 35 women.
  • Among men, the time trend in pleural mesothelioma cases over 2007 to 2016 was not statistically significant (Z for linear trend = -0.21; p = .84).
  • Among women, pleural mesothelioma cases showed a significant progressive increase over the period (Z = 2.68; P less than .01).
  • The age-standardized incidence rate of pleural mesothelioma was 4.8 per 100,000 residents per year (95% CI 1.5 to 11.6) in the Cerdanyola-Ripollet area, closest to the plant. It was 1.1 (95% CI 0.0 to 5.9) in the remaining municipalities.
  • The age-standardized incidence rate of all malignant asbestos-related disease in the Cerdanyola-Ripollet area (men and women together) was 6.1 per 100,000 per year (95% CI 2.2 to 13.3).
  • Of the 128 malignant cases, 68 (53.1%) had occupational exposure: 61 men and 7 women. Of these 68, 31 had worked in the fiber cement plant.
  • Of the 105 pleural mesothelioma cases, 54 (51.4%) had nonoccupational exposure: 24 men and 30 women.
  • The female/male ratio of pleural mesothelioma cases was 0.66 in the Cerdanyola-Ripollet area and 0.35 in the other municipalities.
  • Of the 38 malignant cases with environmental exposure, 28 (74%) had lived mainly within 2000 m of the plant.
  • Mean latency from start of exposure to diagnosis was 50.2 years for malignant asbestos-related disease and 50.8 years for pleural mesothelioma. Latency did not differ significantly between exposure types.
• The authors' conclusion: The authors suggested that pleural mesothelioma cases in men may have reached a plateau after a prior increase, while cases in women were still rising. They linked the rise in women mainly to nonoccupational exposure.
• Limitations the authors state:
  • The number of cases was relatively small, so the authors said other studies are needed to confirm the trend results.
  • The low lung cancer to pleural mesothelioma ratio could reflect underdiagnosis or underreporting. Some lung cancers may have been attributed to smoking, because asbestos exposure was determined by interview or existing documentation.

Topics

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

Medical terms in this study, explained in our Lexicon: Latency, Incidence, Pleural Mesothelioma, confidence interval.

Related studies

• Risk Factors of Mortality from All Asbestos-Related Diseases: A Competing Risk Analysis — R. Abós-Herràndiz, T. Rodriguez-Blanco, et al. (2017)
• Prospective study of asbestos-related diseases incidence cases in primary health care in an area of Barcelona province — M. Rosell-Murphy, R. Abós-Herràndiz, et al. (2010)
• Pleural mesothelioma in relation to meteorological conditions and residential distance from an industrial source of asbestos — J. Tarrés, C. Albertí, et al. (2013)
• Risk factors associated with asbestos-related diseases: a community-based case-control study — M.I. Rosell-Murphy, R. Abós-Herràndiz, et al. (2013)
• Ecological association between asbestos-related diseases and historical asbestos consumption: an international analysis — R.T. Lin, K. Takahashi, et al. (2007)
• Soluble mesothelin-related protein in an asbestos-exposed population: the dust diseases board cohort study — E.K. Park, A. Sandrini, et al. (2008)

Browse more research in American Journal of Industrial Medicine, or return to medical research.