Malignant pleural mesothelioma in western Glasgow 1980-6

Our plain-English summary of Malignant pleural mesothelioma in western Glasgow 1980-6, by G. Hulks, J.S. Thomas, E. Waclawski (Thorax, 1989).

The study

• Authors: G. Hulks, J.S. Thomas, E. Waclawski
• Journal: Thorax
• Published: 1989;44(6):496-500
• Cited by: 49 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000097).

Abstract

This study reviews all histologically proved cases of malignant pleural mesothelioma seen in the western district of Glasgow during 1980-6. Sixty eight cases were identified (three female) with an age range at presentation of 48-85 (mean 68.9) years. Asbestos exposure was identified in 54 (80%) of the patients, most of whom had been shipyard workers. Pain and dyspnoea were the most common presenting symptoms. Pleural effusion was found in 57 (84%) of the patients, in a ratio of 2.6 right:left. The median survival was only 30 weeks from the time of presentation. Prognosis was significantly better for those presenting with dyspnoea than for those with pain (median survival 44 v 22 weeks). Postmortem examination was performed in 40 cases and metastatic disease found in more than three quarters. There was no significant difference between the incidence of the various tumour cell types or any relation between cell type and survival or the incidence of metastatic disease. A substantial increase in cases of malignant pleural mesothelioma has been found in an area of already high incidence. The use of rigorous histological criteria to determine histological cell type has shown that this previously valued variable is of no discriminatory value with regard to disease activity or survival.

In plain English

This study reviewed every histologically proved case of malignant pleural mesothelioma found in pleural biopsy and postmortem reports at the Western Infirmary, Glasgow, during 1980-6. The hospital served an area of about 250 000 people. There were 68 cases (three female), aged 48 to 85. Asbestos exposure was identified in 54 (80%), most of them shipyard workers; the other exposed patients were joiners, plumbers or insulation workers. The article did not report fiber types. Median survival was 30 weeks from presentation. Patients presenting mainly with pain had a median survival of 22 weeks, compared with 44 weeks for those presenting with breathlessness (dyspnoea). The authors reported this difference as significant. Postmortems were done in 40 cases, and asbestos bodies were found in 28 of them. Tumour cell type (sarcomatous, epithelial or mixed), judged from several necropsy samples, showed no significant relation to survival or to spread of the cancer. The authors found an incidence almost three times that reported for the same population in 1981. They concluded that greater awareness of asbestos could not be the sole explanation and that there seemed to have been a genuine increase.

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: Retrospective review (case series) of all histologically proved cases of malignant pleural mesothelioma identified from one hospital's pleural biopsy and postmortem reports, with clinical data taken from case notes
• Who was studied: 68 patients (three female), aged 48 to 85 at presentation, with malignant pleural mesothelioma seen at the Western Infirmary, Glasgow, 1980-6; catchment population around 250 000
• Exposure: Asbestos exposure identified from case notes in 54 of 68 patients (80%), mostly shipyard workers; the rest of those occupationally exposed were joiners, plumbers or insulation workers. Fiber types were not reported.
• Main results:
  • Median survival of all patients was 30 weeks from presentation (range 2 to 247 weeks)
  • Patients presenting predominantly with pain had a median survival of 22 weeks (one-year survival 4%); those presenting with dyspnoea had a median survival of 44 weeks (one-year survival 41%). The authors reported that mode of presentation significantly influenced prognosis.
  • Pleural effusion was found in 57 of the 68 patients, in a ratio of 2.6 right to left
  • Pleural plaques were seen on chest films in 13 of the 68 cases
  • Postmortems were done in 40 of the 68 cases; asbestos bodies were found in 28 (70%) of these
  • Among the 40 necropsy cases (13 sarcomatous, 14 epithelial, 13 mixed), there was no significant difference in the incidence of the cell types and no correlation between cell type and metastatic disease. The table shows secondary disease in 10 (77%) sarcomatous, 12 (85%) epithelial and 10 (77%) mixed tumours.
  • There was no significant difference in survival between tumour subtypes (figure gives p=0.8)
  • Significant desmoplastic reactions were found in six necropsy cases (three mixed, two sarcomatous, one epithelial)
  • Numerous asbestos bodies were seen at necropsy in five of the eight necropsy cases in the group with no recorded asbestos exposure
  • The incidence of malignant pleural mesothelioma was almost three times that reported in the same population in 1981 (given as 39.5 per million population a year)
• The authors' conclusion: The authors concluded that increased awareness of asbestos could not be the only explanation for the rise in cases and that there seemed to have been a genuine increase in incidence
• Limitations the authors state:
  • Some of the increase in cases may reflect greater awareness of asbestos among the medical and legal professions and trade unions
  • Occupational histories in case notes are usually recorded by junior staff and may not be updated, so asbestos exposure may be under-recorded
  • Histological subtyping was done by subjective assessment without formal measurements
  • Biopsy material was considered inadequate for subtyping, so cell type was assessed only in the 40 necropsy cases
  • Pleural fluid may have masked pleural thickening on radiographs before aspiration
  • Some differences from earlier studies remain unexplained

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Asbestos Exposure, Pleural Effusion, Median Survival, Prognosis.

Related studies

• Clinical features and epidemiology of malignant pleural mesothelioma in west Glasgow 1987-1992 — A.N. McLean, K.R. Patel (1997)
• Asbestos and lung cancer in Glasgow and the west of Scotland — H. De Vos Irvine, D.W. Lamont, et al. (1993)
• Vitamin A and cancer prevention I: observations in workers previously exposed to asbestos at Wittenoom, Western Australia — A.W. Musk, N.H. de Klerk, et al. (1998)
• Cancer incidence among women and girls environmentally and occupationally exposed to blue asbestos at Wittenoom, Western Australia — A. Reid, J. Heyworth, et al. (2008)
• Ultra-low-dose chest computer tomography screening of an asbestos-exposed population in Western Australia — F.J. Brims, C.P. Murray, et al. (2015)
• Erionite in road gravel associated with interstitial and pleural changes--an occupational hazard in western United States — P.H. Ryan, M. Dihle, et al. (2011)

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