Mesothelioma registries in identifying asbestos hazards

Our plain-English summary of Mesothelioma registries in identifying asbestos hazards, by A.D. McDonald (Annals of the New York Academy of Sciences, 1979).

The study

• Author: A.D. McDonald
• Journal: Annals of the New York Academy of Sciences
• Published: 1979;330:441-54
• Cited by: 15 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. 003994).

Summary of the article

The author examined methods of finding and registering cases of malignant mesothelioma, a rare tumour, as a way of monitoring asbestos hazards and detecting other possible causes. The paper reviewed experience with such surveys and made recommendations. The methods considered were published case series, statutory notification, cancer registries, workmen's compensation and pneumoconiosis panels, the Third National Cancer Survey (United States, 1969-71), registration through pathologists (four rounds in Canada and one in the United States in 1972) and death certificates. The Third National Cancer Survey gave an incidence per million people aged 45 and over of 11.20 in males and 3.53 in females. These rates were higher than those found in the pathologist surveys, except in Quebec. In California, only 31 of 60 deaths certified as mesothelioma were confirmed by pathologists. The author concluded that registration through pathologists gave the most complete and unbiased ascertainment, with death certificates the next best approach. Registration in Canada led to the discovery of crocidolite exposure in gas mask manufacture. Among 199 exposed workers, there were nine mesothelioma cases, 16% of 56 deaths. A rising trend was seen in Canadian males but not in females. In the case-control analyses, insulation work carried by far the greatest risk. In 344 case-control pairs, eight cases and two controls had domestic exposure. The author recommended continuing ascertainment through pathologists, followed by case-control studies with standardized diagnosis and methods.

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 1979 paper reviewed methods for registering malignant mesothelioma cases and what registries had shown. It drew largely on the author's own pathologist surveys in Canada and the United States. A Canadian pathology panel approved 49% of Quebec diagnoses, versus 80% in Ontario and 70% in the rest of Canada. In California, only 31 of 60 deaths certified as pleural or peritoneal mesothelioma were confirmed by hospital pathologists. Case-control comparisons indicated insulation work carried by far the greatest hazard. In 344 case-control pairs, eight cases and two controls had household exposure to asbestos workers' clothing. One registered case led to a wartime gas mask plant using crocidolite filter pads. In a cohort of 199 exposed workers, nine of 56 deaths (16%) were mesothelioma. The author concluded that, apart from the Third National Cancer Survey methods, which were not generally practicable because of cost and confidentiality, registration through pathologists appeared to give the most complete and unbiased case finding, with death certificates next best. The author noted that US case finding was less complete and the pathology review unfinished.

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: Review of methods for mesothelioma registration and their uses, including the author's own pathologist-based surveys and case-control studies in Canada and the United States
• Who was studied: Mesothelioma cases reported by pathologists in Canada (from 1960, four survey rounds; Canadian table data cover 1966-75) and the United States (one round, 1972), with matched controls (185 Canadian and 159 US case-control pairs in the occupational analysis); also published registries and surveys from other countries
• Exposure: Occupational asbestos exposure by job group (insulation, asbestos production and manufacture, heating trades, shipyards, construction), domestic exposure to asbestos workers' clothing, residence near chrysotile mines, and crocidolite in gas mask filter pads
• Main results:
  • In the Canadian panel review, 49% of Quebec diagnoses were approved by a majority of panel members, compared with 80% in Ontario and 70% in the rest of Canada
  • In the Third National Cancer Survey, incidence per million population aged 45 and over was 11.20 for males and 3.53 for females, higher than in the pathologist surveys. US ascertainment through pathologists in 1972 may have been deficient by about 33%
  • In California, of 60 deaths certified as pleural or peritoneal mesothelioma, only 31 were confirmed by hospital pathologists
  • Among men in the Canadian and US case-control analysis, insulation work carried by far the greatest hazard of the occupational groups
  • In 344 case-control pairs, six female and two male cases had a history of domestic exposure, compared with one female and one male control
  • No case who had lived within 20 miles of a chrysotile mine lacked occupational or domestic exposure
  • Eight (5%) of 146 women with mesothelioma had occupational or domestic exposure to asbestos
  • Tracing a cohort of 199 workers exposed to crocidolite in gas mask filter pad manufacture added five cases, for a total of nine (16%) of 56 deaths
  • Experts in four centers agreed substantially on which jobs involved definite or unlikely asbestos exposure, but differed over probable or possible exposure
  • A rising trend in fatal cases in Canadian males had recently become evident, with no similar change in females
• The authors' conclusion: The author concluded that, apart from the Third National Cancer Survey methods, which were not generally practicable because of cost and confidentiality of records, registration through pathologists appeared to provide the most complete and unbiased ascertainment of mesothelioma. Death certificates were the next best approach.
• Limitations the authors state:
  • Only one US survey had been made, and ascertainment there was less complete
  • There may be regional differences in diagnostic practice in Canada
  • The pathology panel review was not yet complete in Canada or the USA
  • Canadian ascertainment began in 1967 and was probably incomplete before 1966
  • In later rounds, relatives had often already been asked about asbestos exposure, which could bias the blind interviews
  • The secondary lung cancer controls often had terminal illnesses dissimilar to those of the cases

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Malignant Mesothelioma, Pneumoconiosis, Death Certificate, Discovery, Crocidolite.

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