Occupational and environmental thoracic malignancies

Our plain-English summary of Occupational and environmental thoracic malignancies, by E.B. Gottschall (Journal of Thoracic Imaging, 2002).

The study

• Author: E.B. Gottschall
• Journal: Journal of Thoracic Imaging
• Published: 2002;17(3):189-97
• Type of article: Review
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Lung cancer is the most common thoracic malignancy caused by exposures at work and in the environment. The most unique thoracic malignancy is mesothelioma, because it is relatively rare and one of only a few neoplasms for which one specific inciting agent-asbestos-has been identified. Based on epidemiologic studies, approximately 15% of lung cancers in men and 5% of lung cancers in women are caused by occupational exposures. The International Agency for Research on Cancer has devised a rating system by which, based on animal and human data, they assign an agent, mixture, or exposure circumstance to one of five categories, ranging from group 1 (agent is carcinogenic to humans) to group 4 (agent is probably not carcinogenic to humans). Group 1 pulmonary carcinogens reviewed in this article include arsenic, asbestos, beryllium, bis (chloromethyl) ether, cadmium, chromium (IV), mustard gas, nickel, radon, and silica. The clinical presentation and pathology of lung cancers and mesothelioma caused by such exposures do not differ from those of cancers caused by other factors. The key to the recognition of a thoracic malignancy caused by workplace or environmental exposures is clinical suspicion and consideration of all causes for the disease present. Recognition of an exposure-related case of lung cancer or mesothelioma can aid in the identification of excess risk for a whole workforce or community and can lead to actions to reduce exposure, thus preventing future cases. In addition, such recognition allows the individuals struck by devastating illness to exercise their legal rights to compensation if so desired.

In plain English

This article is a narrative review, not an original study. The author reviewed published research on lung cancer and mesothelioma caused by workplace and environmental exposures. It covered asbestos and other agents that the International Agency for Research on Cancer classes as cancer-causing in humans. Citing Doll and Peto, the review stated that about 15% of male and 5% of female lung cancers in the United States result from occupational exposures. On asbestos, it stated that all fiber types can cause lung cancer and that lung cancer rates were low in mining and high in textile work. It also stated that asbestosis is generally accepted as not required to attribute lung cancer to asbestos, and that asbestos-exposed smokers have a 60-fold greater lung cancer risk than never-smokers who have not worked with asbestos. For mesothelioma, it stated that crocidolite is associated with the highest rates but any asbestos type may cause it. It added that smoking does not raise mesothelioma risk and that 30 to 50 years typically pass between first exposure and disease. The author concluded that recognizing these cancers depends on clinical suspicion and considering all possible causes.

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: narrative review of published literature on occupational and environmental lung cancer and mesothelioma
• Who was studied: No study population of its own; the article reviews previously published studies
• Exposure: Agents rated IARC Group 1 lung carcinogens, including asbestos (serpentine chrysotile and the amphiboles actinolite, amosite, anthophyllite, crocidolite, tremolite), arsenic, beryllium, bis (chloromethyl) ether, cadmium, chromium, mustard gas, nickel, radon and crystalline silica
• Main results:
  • Citing Doll and Peto, the review stated that 15% of male and 5% of female lung cancer cases in the United States result from occupational exposures
  • The review stated that lung cancer rates differ by asbestos industry, low in mining and high in the textile industry
  • The review stated that asbestosis is generally accepted as not required to attribute lung cancer to asbestos exposure
  • The review stated that asbestos-exposed smokers have a 60-fold greater lung cancer risk than never-smokers who have not worked with asbestos
  • The review stated that latency for asbestos-induced cancer ranges from 20 to 40 years
  • The review stated that crocidolite exposure is associated with the highest mesothelioma rates, but mesothelioma may occur after exposure to any type of asbestos
  • The review stated that cigarette smoking does not increase mesothelioma risk
  • The review stated that typically 30 to 50 years pass between first asbestos exposure and mesothelioma
• The authors' conclusion: The author concluded that recognizing a thoracic cancer caused by workplace or environmental exposure depends on clinical suspicion and considering all possible causes

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: Lung Cancer, Mesothelioma, Neoplasm, Occupational Exposure, Carcinogenic, Pathology, Environmental Exposure.

Related studies

• Imaging of thoracic occupational and environmental malignancies — K. Garg, D.A. Lynch (2002)
• Occupational exposure and thoracic malignancies, is there a relationship? — S. Baser, O. Duzce, et al. (2013)
• Epidemiological Research on Occupational and Environmental Carcinogens — C. Ledda (2021)
• COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study — M.C. Garassino, J.G. Whisenant, et al. (2020)
• Thirty-day mortality underestimates the risk of early death after major resections for thoracic malignancies — R.R. McMillan, A. Berger, et al. (2014)
• Chimeric Antigen Receptor (CAR) T-Cell Therapy for Thoracic Malignancies — S. Kiesgen, L. Chicaybam, et al. (2018)

Browse more research in Journal of Thoracic Imaging, or return to medical research.