Mesothelioma in a brake repair worker

Our plain-English summary of Mesothelioma in a brake repair worker, by A.M. Langer, W.T. McCaughey (Lancet, 1982).

The study

• Authors: A.M. Langer, W.T. McCaughey
• Journal: Lancet
• Published: 1982;2(8307):1101-3
• Type of article: Case report, Letter
• Cited by: 37 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. 001785).

Summary of the article

This letter described a case of diffuse pleural mesothelioma in a man whose only known asbestos exposure was to chrysotile during brake maintenance and repair. A 55-year-old man was admitted to hospital in October 1980 with right-sided chest pain. Chest X-ray showed a right-sided pleural effusion, and a cytological diagnosis of mesothelioma was confirmed by biopsy and examination of resected tumour. He died in September 1981. Since age 19 he had serviced automobiles, including replacing brake linings, and had worked in used car, tyre and car repair businesses. He had no history of construction, shipyard or other occupational asbestos contact and had never lived near an asbestos-fabricating plant. Necropsy showed an epithelial type diffuse malignant mesothelioma, with slight interstitial fibrosis and anthracosis of the lung. No typical asbestos bodies were seen in tissue, and only one was found after ashing. Lung tissue (6310 mg) was digested and the residue examined by electron microscopy. Electron diffraction confirmed chrysotile fibrils, including fibrils longer than 5 µm. No amphibole fibres were found. The authors noted that brake repair work, particularly bevelling, refurbishing and refitting brake pads, can release unaltered chrysotile fibre. They stated that analytical electron microscopy may be essential for diagnosis in chrysotile-exposed people. They also stated that, given the large number of workers involved, more cases may be seen in the future.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This 1982 letter to The Lancet was a case report about one man. Aged 55, he was admitted to hospital in October 1980 with right-sided chest pain. A chest X-ray showed fluid on the right side of the chest, and a diagnosis of mesothelioma was confirmed by biopsy. He died in September 1981. From age 19 he had serviced cars, including replacing brake linings. He had no construction, shipyard or other work contact with asbestos, and had never lived near an asbestos plant. At autopsy the tumour was an epithelial type diffuse malignant mesothelioma of the right pleura that had spread to other organs. The lungs showed slight scarring, and only one typical asbestos body was found after ashing. Electron microscopy of lung residue found chrysotile fibrils, confirmed by electron diffraction, and no amphibole fibres. The authors stated that his sole asbestos exposure was to chrysotile during brake work. They concluded that analytical electron microscopy may be essential in such cases, and that more cases may be seen.

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 report (letter to the editor)
• Who was studied: One 55-year-old man, admitted to hospital in October 1980, who died in September 1981. Tissue samples came from the University of Tennessee.
• Exposure: Servicing automobiles, including replacing brake linings, from age 19. No construction, shipyard or other occupational contact with asbestos, and no residence near an asbestos-fabricating plant. The authors describe the exposure as being to chrysotile only.
• Main results:
  • Chest X-ray showed a right-sided pleural effusion. A cytological diagnosis of mesothelioma was confirmed by biopsy and by examination of the resected tumour.
  • At necropsy the tumour had nearly obliterated the right pleural space, extended through the diaphragm, and spread to mediastinal lymph nodes, liver and left lung. Its histology was consistent with an epithelial type diffuse malignant mesothelioma.
  • The lung showed slight interstitial fibrosis and anthracosis. No typical asbestos bodies were seen in tissue, and after ashing only one typical asbestos body was found.
  • A 6310 mg tissue mass was digested, and 0.02% of it was recovered as inorganic debris.
  • Electron microscopy showed chrysotile fibrils among mostly non-fibrous particles. Electron diffraction confirmed the chrysotile structure.
  • No amphibole fibres were found, which the authors said was consistent with the occupational history.
• The authors' conclusion: The authors concluded that diagnosing asbestos-related disease after chrysotile exposure is complicated because asbestos bodies do not form readily, and that, as in this case, analytical electron microscopy may be essential. They said the risk of malignant asbestos disease among brake workers seems low, but mortality data have yet to be thoroughly evaluated, and that with the large numbers at risk more cases may be seen.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Auto mechanics and brake work, Chrysotile, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Mesothelioma, Asbestos Exposure, Chrysotile, Chest X-Ray, Pleural Effusion, Biopsy, Brake Lining.

Related studies

• Asbestos Fiber Concentrations in the Lungs of Brake Repair Workers: An Updated Analysis Using Several Regression Methods to Handle Nondetectable Measurements — Y. Liu, G.M. Marsh, et al. (2018)
• Asbestos exposure during brake lining maintenance and repair — A.N. Rohl, A.M. Langer, et al. (1976)
• Asbestos dust exposure during brake repair — K. Rödelsperger, H. Jahn, et al. (1986)
• Evaluation of asbestos exposure during brake repair and replacement — H. Kakooei, M. Hormozy, et al. (2011)
• Cumulative asbestos exposure for US automobile mechanics involved in brake repair (circa 1950s-2000) — B.L. Finley, R.O. Richter, et al. (2007)
• Asbestos fiber concentrations in the lungs of brake repair workers: commercial amphiboles levels are predictive of chrysotile levels — G.M. Marsh, A.O. Youk, et al. (2011)

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