Mesothelioma on the coast of Brittany, France

Our plain-English summary of Mesothelioma on the coast of Brittany, France, by M. de Lajartre, A.Y. de Lajartre (Annals of the New York Academy of Sciences, 1979).

The study

• Authors: M. de Lajartre, A.Y. de Lajartre
• Journal: Annals of the New York Academy of Sciences
• Published: 1979;330:323-32
• Cited by: 5 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. 004020).

Summary of the article

The authors described 70 cases of diffuse pleural mesothelioma seen between 1956 and April 1978 in the Nantes–St. Nazaire region of Brittany, France, where asbestos was widely used in shipyards. Diagnosis rested on clinical course and histology, mostly from surgical biopsy. Fifty-four patients had thoracotomy, nine were autopsied and 10 had pleural needle biopsy. The number of cases rose from four in 1956–1964 to 14 in 1964–1970 and 51 in 1970–1978. Mean age at diagnosis was 57 years (range 22–83), and 67 patients were men. The usual presentation was recurring pleural effusion (90% of cases). Hyaluronic acid was found in the pleural fluid in 13 of 15 tests. Fifty-five tumours were epithelial and 15 were mixed. Mean duration of illness was 15 months, and eight patients were still alive. Metastases were found in 14 of 62 deceased subjects. Occupational asbestos exposure was certain in 51 cases, including 44 shipyard workers, probable in six and undetermined in 13. Asbestos fibres were found in tissue from 32 of 34 subjects examined, and crocidolite was present in three. Among 40 shipyard workers, exposure usually lasted more than 25 years, and latency exceeded 25 years in all but six. The shortest latency, 11 years, was in a lagger's son exposed as a child. The authors feared that mesothelioma frequency would remain high in the years to come.

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 article described 70 patients with diffuse pleural mesothelioma (67 men and three women) seen between 1956 and April 1978 in the Nantes-St. Nazaire region of France. The authors reported that cases rose over time: four from 1956 to 1964, 14 from 1964 to 1970 and 51 from 1970 to 1978. They judged work exposure to asbestos certain in 51 patients, 44 of them shipyard workers. It was probable in six and undetermined in 13. Asbestos fibers were found in tissue from 32 of 34 patients tested. These were usually chrysotile and amphibole, with crocidolite in three cases. Among 40 shipyard workers, first exposure came more than 25 years before the first symptom in all but six. The illness lasted on average 15 months from first symptom to death. Metastases (spread beyond the original site, for example to lymph nodes, the opposite pleura or the liver) were seen in 14 of 62 patients who had died. The authors said it was hard to pin down each worker's level of exposure. They wrote that it was feared diffuse pleural mesothelioma would remain frequent in the years to come.

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 clinical and occupational study of diffuse pleural mesothelioma cases seen at a hospital in Nantes
• Who was studied: 70 patients with diffuse pleural mesothelioma (67 men, three women) seen from 1956 to April 1978 in the Nantes-St. Nazaire region of Brittany, France; average age at diagnosis 57 (range 22 to 83)
• Exposure: Occupational asbestos exposure, mainly in the shipyards of Nantes-St. Nazaire. Other jobs were mechanics, metallurgy, a cardboard factory that used asbestos, and lagging. Exposure was assumed for anyone who handled asbestos or worked in air polluted by it. Tissue fiber analysis found chrysotile, amphibole and, in three cases, crocidolite.
• Main results:
  • The number of cases rose over time: four from 1956 to 1964, 14 from 1964 to 1970, and 51 from 1970 to 1978. That is an average of five or six a year since 1970, compared with one or two a year before.
  • Of the 70 patients, occupational asbestos exposure was certain in 51, probable in six and undetermined in 13.
  • Asbestos fibers were found in 32 of 34 patients whose tissue was examined by optical and electron microscopy. Exposure was certain for 26 of these, probable for four and undetermined for two.
  • The fibers were usually chrysotile and amphibole, often found together. Crocidolite was present in three cases. Fiber numbers were moderate except in nine cases.
  • Among 40 shipyard workers, the time from first exposure to first symptom was more than 25 years in all but six cases, and more than 45 years for 10.
  • The shortest latency period, 11 years, was in a patient first exposed as a child. His father was a lagger in the shipyards and quite likely brought home asbestos dust on his clothes.
  • Across the 70 patients, the average length of illness from first symptom to death was 15 months. Eight patients were still alive.
  • Metastases (tumor spread beyond where it began) were observed in 14 of 62 deceased patients. The listed sites included hilar (mediastinal) lymph nodes, the opposite pleura, the peritoneum and the liver, among others.
  • Of the 47 patients whose smoking habits were known, 33 were smokers.
  • X-rays showed calcifications due to asbestos in seven patients. Fibrohyaline pleural plaques were found in nine patients at thoracotomy or autopsy.
  • Only one peritoneal mesothelioma was observed in the series; it later spread to the pleura.
  • Duration of exposure and age at death were compared in two groups of shipyard workers. The 25 St. Nazaire workers had an average age at death of 57 and an average exposure of 30 years. The 14 Nantes workers had an average age at death of 63 and an average exposure of 18 years. The authors said the small number of cases did not allow a conclusion.
• The authors' conclusion: The authors gave three reasons for concern: shipyard conditions, the long delay before mesothelioma appears, and the only recent end of asbestos use in shipbuilding. Because of these, they wrote, it was feared that diffuse pleural mesothelioma would remain frequent in the years to come.
• Limitations the authors state:
  • The authors found it difficult to specify the extent of asbestos exposure for each shipyard worker.
  • The authors said the limited number of cases did not allow a conclusion about exposure duration and age at death.
  • The authors noted that only a small number of autopsies (nine) were performed.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Shipyards and maritime work.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Mesothelioma, Histology, Biopsy, Thoracotomy, Needle Biopsy, Pleural Effusion, Hyaluronic Acid.

Related studies

• Mortality among shipyard Coast Guard workers: a retrospective cohort study — S. Krstev, P. Stewart, et al. (2007)
• Case-control study of lung cancer in civilian employees at the Portsmouth Naval Shipyard, Kittery, Maine — R.A. Rinsky, J.M. Melius, et al. (1988)
• Radiographic search for asbestos-related disease in a naval shipyard — J.S. Felton (1979)
• Asbestos disease in United States shipyards — I.J. Selikoff, R. Lilis, et al. (1979)
• Mortality among shipyard workers in Genoa, Italy — R. Puntoni, M. Vercelli, et al. (1979)
• Incidence of bronchial carcinoma in shipyard workers with pleural plaques — J.R. Edge (1979)

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