Mesothelioma in a community in the north of England

Our plain-English summary of Mesothelioma in a community in the north of England, by A.T. Edward, D. Whitaker, K. Browne, et al (Occupational and Environmental Medicine, 1996).

The study

• Authors: A.T. Edward, D. Whitaker, K. Browne, F.D. Pooley, A.R. Gibbs
• Journal: Occupational and Environmental Medicine
• Published: 1996;53(8):547-52
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: To find the numbers of mesotheliomas in Calderdale over the period 1966-94 and determine their relation to asbestos exposure, pathology, and mineral fibre burden within the lungs of affected subjects.

Methods: Cases were entered into the study if the subject has been diagnosed with mesothelioma after postmortem and histopathological examinations. Occupational data were obtained mainly from the case records of the Cape Asbestos medical officer, hospital, and medical practitioner and from death certificates. Analyses of the mineral fibres were performed with transmission electron microscopy and energy dispersive x ray spectrometry.

Results: 73 mesotheliomas were diagnosed from 1966 to 1994. Forty four were associated with exposure at the Acre Mill factory, which manufactured asbestos products. Concentrations of amphibole asbestos fibres were found to be raised above controls in 31 out of 32 cases associated with Acre Mill exposure, in 10 out of 12 other cases exposed to asbestos and eight out of 17 cases not exposed to asbestos.

Conclusions: There was a high number of mesotheliomas in Calderdale. More than half of the cases were associated with occupation at the Acre Mill factory and were associated with exposure to amphibole asbestos, predominantly crocidolite. No cases associated with neighbourhood exposure to asbestos were identified.

In plain English

This study counted mesotheliomas diagnosed at postmortem in Calderdale, a semi-rural community of 192 000 people in the north of England, from 1966 to 1994, and measured asbestos fibres in lung tissue from 61 cases. The area included Acre Mill, a factory that used all the main commercial forms of asbestos (chrysotile, amosite and crocidolite) until it closed in 1970. The authors found 73 mesotheliomas, 56 in men and 17 in women. Of these, 44 were linked to Acre Mill, 12 had other asbestos exposure and 17 had no history of significant exposure. Sixty-two were pleural and 11 peritoneal, all peritoneal cases being in the Acre Mill group. Amphibole fibres were above the background cut-off in 31 of 32 Acre Mill cases, 10 of 12 other exposed cases and 8 of 17 unexposed cases. Chrysotile was raised in only three cases, all also with raised amphiboles. No cases due to living near the mill were verified. The authors concluded this supports amphiboles having much greater potential than chrysotile to cause mesothelioma. They noted that case finding may have been incomplete and that they had no local control lung samples.

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 of all mesothelioma cases the authors could identify in one community over about 28 years, with review of pathology and electron microscopic analysis of lung fibre burden
• Who was studied: 73 people diagnosed with mesothelioma in Calderdale, a semi-rural community of 192 000 in the north of England, 1966 to 1994 (56 men, 17 women). The cases included a few former Acre Mill employees who died outside the area. Lung fibre analysis was done on 61 cases.
• Exposure: Work at the Acre Mill asbestos factory, which used chrysotile (1942 to 1970), amosite (1949 to 1970) and crocidolite throughout its life, to make gas mask filters, textiles, pipe lagging and insulation. Other cases had different asbestos exposures (other asbestos factories, boiler making or lagging, joinery, plumbing, laboratory work), and two women were exposed through their fathers' dusty clothes.
• Main results:
  • Of the 73 cases, 44 were associated with Acre Mill, 12 had a history of other asbestos exposure, and 17 had no history of significant asbestos exposure and did not live within two miles of the factory.
  • 56 cases were in men and 17 in women. Of the 17 women, 13 were associated with Acre Mill.
  • 62 of the 73 mesotheliomas were pleural (36 right, 23 left, 3 bilateral). The 11 peritoneal mesotheliomas all occurred in the Acre Mill group.
  • Amphibole asbestos concentrations were considered raised (above 1 million crocidolite or amosite fibres per gram of dry lung) in 31 of 32 Acre Mill cases analysed. Crocidolite was above 1 million in 29 of these and amosite in 24.
  • Amphibole concentrations were raised in 10 of 12 cases with other asbestos exposure. They were also raised in 8 of 17 cases with no history of exposure; the remaining 9 unexposed cases had normal fibre concentrations.
  • Chrysotile was considered increased in only three cases, all from Acre Mill, and in each case raised crocidolite or amosite was also present.
  • In the Acre Mill group, length of time worked at the mill was positively correlated with amphibole asbestos in the lungs (R 0.49, P = 0.005). The authors described the correlation with chrysotile fibre burden as negligible (R 0.34, P = 0.06).
  • Two Acre Mill cases had worked only two months, both in the textile department. Both had substantial crocidolite in the lungs (33.3 and 25.6 million fibres per gram of dried lung).
  • Two women, aged 47 and 61, were exposed through their fathers' dusty clothes from Acre Mill. One had an amosite level (0.2 million fibres) not considered above background; the other had raised crocidolite (4.3 million) and amosite (1 million).
  • No mesothelioma cases caused by living near Acre Mill (neighbourhood exposure) were verified.
• The authors' conclusion: The authors concluded that more than half the cases were associated with work at Acre Mill and with amphibole exposure, mainly crocidolite. They said their findings support previous studies showing amphiboles have much greater potential than chrysotile to cause mesothelioma, and expected Acre Mill-related mesotheliomas to continue for at least two more decades.
• Limitations the authors state:
  • Identification of cases was probably incomplete.
  • The authors had no local control lung samples from Calderdale. Background cut-offs were taken from control studies done elsewhere.
  • Employment details for the wartime period were unsatisfactory.
  • Reliable data on length of exposure were available only for the Acre Mill group.
  • Airborne fibre counts inside the factory were incomplete and uncertain.

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, Asbestos Exposure, Pathology, Cape Asbestos, Death Certificate, Transmission Electron Microscopy (TEM), Amphibole Asbestos, Crocidolite.

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