Mortality from lung cancer in asbestos workers 1955

Our plain-English summary of Mortality from lung cancer in asbestos workers 1955, by R. Doll (British Journal of Industrial Medicine, 1993).

The study

• Author: R. Doll
• Journal: British Journal of Industrial Medicine
• Published: 1993;50(6):485-90
• Type of article: Historical article
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The cause of death, as determined at necropsy, is reported for 105 persons who had been employed at one asbestos works. Lung cancer was found in 18 instances, 15 times in association with asbestosis. All the subjects in whom both conditions were found had started employment in the industry before 1923 and had worked in the industry at least nine years before the regulations for the control of dust had become effective. One hundred and thirteen men who had worked for at least 20 years in places where they were liable to be exposed to asbestos dust were followed up and the mortality among them compared with that which would have been expected on the basis of the mortality experience of the whole male population. Thirty-nine deaths occurred in the group whereas 15.4 were expected. The excess was entirely due to excess deaths from lung cancer (11 against 0.8 expected) and from other respiratory and cardiovascular diseases (22 against 7.6 expected). All the cases of lung cancer were confirmed histologically and all were associated with the presence of asbestosis. From the data it can be concluded that lung cancer was a specific industrial hazard of certain asbestos workers and that the average risk among men employed for 20 or more years has been of the order of 10 times that experienced by the general population. The risk has become progressively less as the duration of employment under the old dusty conditions has decreased.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This 1955 study, reprinted in 1993, examined lung cancer at one asbestos works. The author first reviewed 105 coroners' necropsies on people known to have worked there. Lung cancer was found in 18, 15 times with asbestosis, and all with both had started work before 1923. The author then followed 113 men with at least 20 years in dusty areas, comparing their deaths with rates for all men in England and Wales. There were 39 deaths against 15.4 expected. Lung cancer accounted for 11, against 0.8 expected. All were confirmed by tissue examination and occurred with asbestosis. Other respiratory and cardiovascular deaths also exceeded expected. The article's table lists 14 with asbestosis and 6 without, against 7.6 expected, but the article's summary gives 22. Other deaths were close to expected. Asbestosis, and lung cancer with asbestosis, were rarer among men who had worked fewer years before 1933, when dust controls took effect. The author concluded that lung cancer was a specific industrial hazard of certain asbestos workers. Among men employed 20 or more years, the average risk was of the order of 10 times the general population's. The author noted the records might be incomplete.

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: Retrospective mortality study of a cohort of long-serving male workers, compared with national death rates, together with a series of necropsy (autopsy) records from the same works
• Who was studied: 113 men who had worked at least 20 years in the 'scheduled' (dusty) areas of one large asbestos works, followed from 1922 to 1953. Also 105 consecutive coroners' necropsies on persons known to have been employed at the same works.
• Exposure: Asbestos dust in the 'scheduled areas', the processes defined as dusty under the Asbestos Industry Regulations of 1931. Fiber type is not stated. Jobs listed for the lung cancer cases include weaver, fiberizer, spinner, disintegrater, bag carrier and maintenance man. The author compared men by how long they had worked before January 1, 1933, under the dustier conditions that existed before the regulations took effect.
• Main results:
  • Necropsy series (105 persons known to have been employed at the works): lung cancer was found in 18, of which 15 were in association with asbestosis.
  • Necropsy series: all subjects with both lung cancer and asbestosis had started work in the industry before 1923.
  • Cohort of 113 men: 39 deaths from all causes, against 15.4 expected from England and Wales rates.
  • Cohort: 11 lung cancer deaths, against 0.8 expected.
  • Cohort: all lung cancer cases were confirmed by tissue examination, and all were associated with asbestosis.
  • Cohort: deaths from other respiratory diseases (including pulmonary tuberculosis) and cardiovascular diseases exceeded the 7.6 expected. Table 4 as scanned lists 14 such deaths with mention of asbestosis and 6 without. The article's summary gives 22.
  • Cohort: mortality from diseases other than lung cancer, other respiratory diseases and cardiovascular diseases was close to that expected.
  • Men with under 10, 10 to 14, and 15 or more years of pre-1933 employment had observed cases of asbestosis with lung cancer of 1, 3 and 7. The expected numbers were 5.5, 2.4 and 3.1. The author described both asbestosis and lung cancer with asbestosis as becoming progressively less common as pre-1933 exposure years decreased.
  • The author estimated the lung cancer risk before 1933 as perhaps 20 times the general risk.
• The authors' conclusion: The author concluded that lung cancer was a specific industrial hazard of certain asbestos workers. For men employed 20 or more years, the average risk was of the order of 10 times that of the general population. The risk became progressively less as the duration of employment under the old dusty conditions decreased.
• Limitations the authors state:
  • The firm's personnel records may not have been complete.
  • Expected deaths were based on England and Wales rates rather than rates for the town where the men lived. The author notes the town's death rate from all causes was higher.
  • Part of the excess may reflect underestimated expected deaths, because lung cancer diagnosis improved over the period.
  • Too few men had been exposed only under the post-1933 conditions to say whether the risk had been eliminated.
  • The expected numbers of lung cancer cases in the trend analysis were small.

Topics

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

Medical terms in this study, explained in our Lexicon: Lung Cancer, Autopsy.

Related studies

• Follow-up study of chrysotile asbestos textile workers: cohort mortality and case-control analyses — J.M. Dement, D.P. Brown, et al. (1994)
• Mortality from all cancers of asbestos factory workers in east London 1933-80 — G. Berry, M.L. Newhouse, et al. (2000)
• Mortality and cancer morbidity in a cohort of Canadian petroleum workers — R.J. Lewis, A.R. Schnatter, et al. (2003)
• An updated study of mortality among workers at a petroleum manufacturing plant — Y. Honda, E. Delzell, et al. (1995)
• A cohort study on mortality among wives of workers in the asbestos cement industry in Casale Monferrato, Italy — C. Magnani, B. Terracini, et al. (1993)
• Morbidity and mortality in talc-exposed workers — E. Wergeland, A. Andersen, et al. (1990)

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