Medical examination for asbestos-related disease

Our plain-English summary of Medical examination for asbestos-related disease, by S.M. Levin, P.E. Kann, M.B. Lax (American Journal of Industrial Medicine, 2000).

The study

• Authors: S.M. Levin, P.E. Kann, M.B. Lax
• Journal: American Journal of Industrial Medicine
• Published: 2000;37(1):6-22
• Type of article: Review
• Cited by: 22 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

There are millions of workers whose exposure to asbestos dust prior to the implementation of asbestos regulation and improved control measures places them at risk of asbestos-related disease today. In addition, workers are still being exposed to significant amounts of asbestos, when asbestos materials in place are disturbed during renovation, repair, or demolition. Given the continued presence of asbestos-containing materials in industrial, commercial, and residential settings throughout the U.S., a sizeable population remains at risk of asbestos-related disease. This article reviews the health effects associated with exposure to asbestos and delineates the steps necessary for the comprehensive screening and clinical assessment for asbestos-related disease, in order to assist physicians in identifying and preventing illness associated with exposure to asbestos among their patients.

Copyright 2000 Wiley-Liss, Inc.

In plain English

This article was a review, not a new study. The authors summarized published research on the health effects of asbestos and set out the steps they considered necessary to screen and clinically assess people for asbestos-related disease, mainly the non-cancer diseases. They described asbestos exposure as a cause of lung cancer and of mesothelioma of the pleura and peritoneum. Citing earlier studies, they reported that pleural thickening is the most common consequence of occupational exposure and that over 9% of deaths among asbestos insulators were from mesothelioma. They also cited a 1979 study by Hammond and colleagues of heavily exposed insulators. Compared with non-smoking blue-collar workers not exposed to asbestos, the lung cancer mortality ratio was 5 for non-smoking insulators and 53 for smoking insulators. The authors wrote that there is compelling evidence that chrysotile can cause both lung cancer and mesothelioma. Their minimum criteria for diagnosing asbestosis included exposure beginning 15 or more years earlier. The authors concluded that a sizeable population remains at risk. They noted that an effect of low-dose CT screening on survival had not yet been shown.

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: Narrative review with clinical guidance on medical examination for asbestos-related disease; no new data collected
• Who was studied: No study population; the review addresses U.S. workers exposed to asbestos before regulation and workers still exposed during renovation, repair or demolition
• Exposure: Asbestos in general, including the commercially used amphiboles amosite, anthophyllite and crocidolite, the serpentine chrysotile, and tremolite and actinolite as contaminants; the review lists many occupations with significant exposure
• Main results:
  • The review states that asbestos exposure causes lung cancer and diffuse malignant mesothelioma of the pleura and peritoneum.
  • Citing earlier work, the review describes pleural thickening (plaques or diffuse fibrosis) as the most common consequence of occupational asbestos exposure.
  • Citing Hammond et al. (1979), heavily exposed asbestos insulators had a lung cancer standardized mortality ratio of 5 if non-smokers and 53 if smokers. The comparison group was non-smoking blue-collar workers in an American Cancer Society cohort who were not exposed to asbestos.
  • Citing Hammond et al. (1979), blue-collar cigarette smokers not exposed to asbestos had a lung cancer standardized mortality ratio of 11, against the same comparison group.
  • Citing Selikoff and Seidman (1991), over 9% of all deaths among asbestos insulators were due to malignant mesothelioma.
  • The authors noted a debate about chrysotile and mesothelioma. They wrote that there is compelling evidence chrysotile can cause both lung cancer and mesothelioma.
  • The authors' minimum criteria for diagnosing asbestosis were a reliable exposure history with onset 15 or more years earlier, plus either a chest x-ray read as abnormal (profusion 1/0 or greater under ILO-1980 guidelines) or a high-resolution CT scan showing diffuse fibrosis at the lung bases.
  • Citing a 1997 consensus report, the review states that asbestosis does not need to be shown on x-ray or in tissue to attribute a causal role to asbestos in lung cancer.
• The authors' conclusion: The authors concluded that, because asbestos-containing products are everywhere, a sizeable population remains at risk of asbestos-related disease.
• Limitations the authors state:
  • The article focuses on screening and assessment for the non-cancer asbestos diseases. Apart from mesothelioma, it does not cover diagnosis of asbestos-related cancers.
  • Results on low-dose spiral CT screening were preliminary, and an effect on survival had not been demonstrated.
  • No government estimate of the number of U.S. workers occupationally exposed to asbestos was available more recent than the 1978 NIH estimate.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos-Containing Material (ACM).

Related studies

• Clinical study of asbestos-related lung cancer diagnosed by asbestos medical examination — T. Yotsumoto, A. Sano, et al. (2018)
• Development of a medical examination program for former workers at a Department of Energy national laboratory — P.N. Breysse, V. Weaver, et al. (2002)
• Mortality among British asbestos workers undergoing regular medical examinations (1971-2005) — A.H. Harding, A. Darnton, et al. (2009)
• Comparison of U.S. Occupational Safety and Health Administration standards and German Berufsgenossenschaften Guidelines for Preventive Occupational Health Examinations — K. Straif, M. Silverstein (1997)
• Surveillance of respiratory diseases among construction and trade workers at Department of Energy nuclear sites — J.M. Dement, L. Welch, et al. (2003)
• Recommendations for the Diagnosis and Management of Asbestos-Related Pleural and Pulmonary Disease — C. Diego Roza, M.J. Cruz Carmona, et al. (2017)

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