Mesothelioma following exposure to asbestos: a review of 72 cases

Our plain-English summary of Mesothelioma following exposure to asbestos: a review of 72 cases, by M. Borow, A. Conston, L. Livornese, et al (Chest, 1973).

The study

• Authors: M. Borow, A. Conston, L. Livornese, N. Schalet
• Journal: Chest
• Published: 1973;64(5):641-6
• Cited by: 110 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001295).

In plain English

This article from Somerset Hospital in New Jersey described a series of 72 patients with mesothelioma: 53 treated by the authors' group and 19 found in the records of neighboring hospitals. Fifty-one had pleural and 21 had peritoneal mesothelioma, and 64 were men. The authors stated that a nearby asbestos mill was the source of all their cases. The mill mainly used chrysolite (the article's spelling), with crocidolite in some processes. Patients were exposed 20 or more years before the tumor appeared. Of about 35 patients with known exposure periods, most had worked 15 to 35 years, but five had less than four years. Only 3 of 70 patients were nonsmokers. The authors counted four cases from 1951 to 1959 and up to eight or nine a year in the second half of the 1960s. Median survival was 15-16 months, and treatment did not prolong life. Separately, 45 of 90 workers from this mill who had died and been seen at the authors' hospital had developed malignancies. The authors concluded that asbestos together with one or more cofactors should be considered direct causal agents of mesothelioma.

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: Case series: a review of hospital and autopsy records of 72 mesothelioma patients. It is not a review of the literature, although the journal section heading is 'Critical Review'. The article also gives hospital data on 90 deceased workers from the same mill.
• Who was studied: 72 patients with mesothelioma: 53 treated by the authors' group at Somerset Hospital, New Jersey (17 reported in 1967 plus 36 more) and 19 from neighboring hospitals' records. There were 51 pleural and 21 peritoneal cases; 64 (89 percent) were men and 8 were women. Separately, 90 workers who had been admitted to the authors' institution, drawn from approximately 600 employees who had worked at least 20 years in the mill up to 1959, about 200 of whom had died.
• Exposure: Work at a nearby asbestos mill that had operated for half a century. The authors stated that chrysolite (their spelling) was the main fiber, with crocidolite also present in some processes, and that chrysolite was the only fiber used in the textile division. Exposure periods were known for about 35 patients: most worked 15 to 35 years (average 25 years). Five had less than four years, including two stock boys employed 10 months and 18 months. All patients except two paraoccupational cases had an industrial history.
• Main results:
  • Of the 72 patients, 51 had pleural mesothelioma (71 percent) and 21 had peritoneal mesothelioma (29 percent).
  • Of the 72 patients, 68 had died and been autopsied; four were still living with disease.
  • The patients were exposed to asbestos 20 or more years before the mesothelioma appeared.
  • Among the roughly 35 patients with a known exposure period, most worked 15 to 35 years, with an average of 25 years.
  • Five patients had less than four years' exposure. Two of them, aged 41 and 45, had worked as stock boys.
  • None of the patients who worked fewer than five years showed radiographic evidence of pulmonary asbestosis. About one quarter of the mesothelioma patients had completely normal chest x-ray findings.
  • The authors' series had a total of four cases from 1951 to 1959, one to four per year in the first half of the 1960s, and up to eight or nine per year in the second half.
  • A review of all autopsy records from 1948 to 1963 found only two cases the authors now considered to be mesothelioma.
  • Only 3 of 70 mesothelioma patients did not smoke. The article also states that most smoked two or more packs of cigarettes per day.
  • Median survival in the series was 15-16 months. No patient survived over 19 months, except one.
  • Radiotherapy combined with chemotherapeutic agents did not prolong survival; the only benefit seen was occasional relief from pleuritic pain.
  • Only two cases had proved paraoccupational exposure; the rest had an industrial history. Only one woman with mesothelioma had worked in the mill's textile division, despite women working there for almost half a century.
  • Among 90 workers from the mill admitted to the authors' institution, 45 (50 percent) had developed malignancies: 26 of 48 autopsied and 19 of 42 who had surgical procedures. An additional seven died of pulmonary-cardiovascular complications of asbestosis.
  • The average age of the patient with mesothelioma was 54 years; the average age of the patient with bronchogenic carcinoma was approximately 10 years older.
• The authors' conclusion: The authors concluded that discrepancies in their series and elsewhere suggest some element in addition to asbestos is involved, and that asbestos fiber with one or more cofactors must be considered direct causal agents of mesothelioma. They also expected mesothelioma cases to keep increasing for the next 20 to 30 years.
• Limitations the authors state:
  • Occupational exposure history was not available for nine patients.
  • The period of asbestos exposure was known for only approximately 35 of the patients.

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: Mesothelioma.

Related studies

• Asbestosis following brief exposure in cigarette filter manufacture — A.M. Goff, E.A. Gaensler (1972)
• Abdominal Wall Morbidity Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy — F. Struller, I. Koenigsrainer, et al. (2017)
• Malignant mesothelioma following radiation exposure — K.H. Antman, J.M. Corson, et al. (1983)
• Malignant peritoneal mesothelioma following radiotherapy for seminoma of the testis — R.J. Stock, Y.S. Fu, et al. (1979)
• Recurrent pneumothorax following abdominal paracentesis — P.J. Stafford (1990)
• Asbestosis in South African asbestos miners — G.K. Sluis-Cremer (1970)

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